B12 is naturally present in food that comes from animals, including fish, meat, poultry, eggs and dairy products. We are here to help, Community Partnerships Profile: NAMI San Diego. The latter reaction is accompanied by the conversion of methyltetrahydrofolate to tetrahydrofolate, a precursor for purine and pyrimidine synthesis. Axillary and pubic hairs was intact. Learn about what's happening at Tri-City and how we're working to advance the health and wellness of the community we serve. 3a,b) with a few lymphocytes and plasmacytes around them were observed in the dermis, as well as free melanin granules. What it does: B9 works like an antioxidant to promote cell turnover and fight free radical damage. 2013, Article ID 680459, 5 pages, 2013. https://doi.org/10.1155/2013/680459, 1Department of Internal Medicine, Howard University, Washington, DC 20060, USA, 2Department of Family Medicine, York Hospital, York, PA 17403, USA. Reversible skin hyperpigmentation is a well-known clinical finding in vitamin B12 deficiency. The anti-intrinsic factor antibodies, anti-parietal cell antibodies, anti-microsomal thyroid and anti-thyrospherine antibodies, anti-gliadin and anti-tissue transglutaminase antibodies, anti-dsDNA, anti-ENA, RNP, anti-SM, SSA(Ro), SSB(Lo), antiJO1 and Ra-test were negative. The patient was started on 1,000g injections intramuscularly daily for 7 days followed by once a week and once a month for one year thereafter. She regained consciousness within a few minutes.
Orthostatic hypotension is considered a neurological manifestation of vitamin B12 deficiency and clearly relates to the underlying autonomic neuropathy [12]. Conversely, people who have dull skin are often not eating the right types of food and may be suffering with a number of vitamin deficiencies. The effects of vitamin B12 deficiency on the hematologic, nervous, and gastrointestinal systems are well studied. It also helps with mucus secretion in the skin, thus preventing the dryness that leads to oil production (and therefore acne) andimproves zinc absorption, another important mineral for skin health. You can unsubscribe at any time. 6. Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India. Vitamin B12 level was repeated at 4 and 8 months with values of 269pg/mL and 412pg/mL, respectively. Vitamin B12 is an essential nutrient that keeps the body functioning properly - but when you're running low on the vitamin, a number of unusual changes may occur.
Typically, these involve hyperpigmentation, mostly localized in the dorsum of the hands, fingers and feet and sometimes in skin folds and mucosal surfaces. The human body can't create vitamin B12, so you need to get this nutrient from your diet. Article of the Year Award: Outstanding research contributions of 2021, as selected by our Chief Editors.
Perls technique for haemosiderin was negative. If you are having dull and dry skin and wondering for acne treatment, you can try skin whitening treatment, offered at Four Fountains De-Stress Spa.
News18 Lifestyle is one-stop destination for everything you need to know aRead More.
Eight Vitamins, One B-Complex: Your Recipe for Glowing Skin, B Vitamins offer a myriad of skin health benefits, but two of the most significant are cell renewal and stress relief (and who doesnt need help, Because theyre water-soluble rather than fat-soluble, B vitamins are most effective when taken orally as a. Deficiency of vitamin B-9 (folic acid) and B-12 (cobalamin) can cause pigmentation problems leading to patchy skin. Hyperpigmentation associated with vitamin B12 deficiency is completely reversible with treatment. Br J Haematol 2001; 113: 415421. In a study of 63 patients by Aaron et al. No related content is available yet for this article. In the majority of Caucasian cases, the pigment changes are spotty or reticulated, usually involving different parts of the body rather than being generalized (13). All rights reserved. Her medical history included primary growth hormone deficiency, for which she had been treated with subcutaneous injections of growth hormone.
Theyre also essential for cell growth, development, and overall functioning. Peripheral blood film showed oval macrocytes, marked anisocytosis and poikilocytosis.
We describe here a case of a 21-year-old Greek woman in whom hyperpigmentation (reddish-brown colour) was confined to the lateral surfaces of the legs. , causing acne, rashes, dry and flaky skin, cracked lips, and wrinkles. Almonds, sweet potato, eggs, onions, whole grains, tomatoes, sardines, broccoli.
Over the last couple of months, she had multiple episodes of fall but no loss of consciousness. The cutaneous manifestations described in the literature include but are not limited to skin hyperpigmentation, hyperpigmentation of surgical scars [15], and mucus membrane of the vulva [16], vitiligo, recurrent angular stomatitis, and hair changes. Our patient (case 2) had classical presentation of subacute combined degeneration of the cord as indicated by the positive Babinski and Romberg sign. Historically, Thomas Addison described pernicious anemia and Addisons disease.
Kyriaki Aroni, Konstantina Anagnostopoulou*, Eugenia Tsagroni and Eleftherios Ioannidis, Department of Dermatopathology, University of Athens, 50 Nikiforou Lytra Street, GR-11474 Athens, Greece. It has been implicated as a cause of orthostatic hypotension [8], mood disorders [9], dementia, psychosis, depression, myocardial infarction, stroke [10], and retinal hemorrhages [11]. Acne is one of the most distressing skin conditions. (A) Multiple clusters of vessels and a few lymphocytes and plasmacytes around them in the dermis (haematoxylin-eosin (H&E) 200). Its deficiency is a major health issue and a major diagnostic challenge; its presentation varies from being asymptomatic to affecting multiple organ systems. It helps to convert glucose into energy, aids in wound healing, and is essential for proper nerve functions. People who have a shiny, healthy and glowing skin tend to have a good impression on others. Although iron is necessary for many important physiological functions, too much iron accumulation can affect organs such as liver and skin. Where to find it: Tuna, turkey, beef, chicken, potatoes, sunflower seeds, spinach, bananas. What it does: Another major stress-buster, B6 helps to regulate mood and sleep by aiding the body in producing serotonin (the happy hormone), melatonin (the sleep hormone), and norepinephrine (a stress hormone), among others. Laboratory investigation showed hemoglobin of 66g/l, mean corpuscular volume 109 fl, total leucocyte count 3.6 109/l and platelet count of 78 109/l. Example: Yes, I would like to receive emails from Tri-City Medical Center. Early diagnosis can limit morbidity and inappropriate workups. She was admitted to the hospital for further investigation and workup. 3. (b) Decreased hyperpigmentation 3 months after treatment. B7 also fights inflammation and protects against acne, fungal infections, and rashes. Coronavirus (COVID-19): Important Information From Tri-City Medical Center Learn more. Multiple clusters of vessels CD34-positive (Fig. The skin hyperpigmentation may be associated with finger-nail pigment changes and premature grey hair, both reversible after treating the anaemia (13). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Vitamin B12 deficiency becomes important in high-risk populations such as the elderly, patients with either malabsorption diseases as in gastric and ileal resection or gastric mucosal disease resulting from either an autoimmune process or from gastric atrophy, pancreatic insufficiency, coeliac disease, Crohns disease, ileitis, vegetarians and long-term use of proton pump inhibitors [4], histamine (H2) receptor antagonists [5], or biguanides [6, 7]. The hyperpigmentation seen in Addison disease has been linked to increased melanocyte-stimulating hormones (alpha and beta MSH) and adrenocorticotrophin (ACTH). 2. Crivellato E, Beltrami CA, Mallardi F, Ribatti D. The mast cell: an active participant or an innocent bystander? It is observed in patients with megaloblastic, non-pernicious anaemia, mainly in those with dark-coloured skin (13).
Only found in animal products, though vegetarians can opt for fortified foods. Ht = 37.5%, Hb = 12.5 g/dl, MCV = 96 fl (normal = 7895 fl), PLT = 250000, PT = 13.5 s, INR = 1, APTT = 35.6 s. Serum folate, Zn, ferritin, TIBC, T3, T4, TSH, DHEA, DHEA-S and ACTH were all within normal limits. Sometimes called the anti-stress vitamin, it bolsters the immune system and soothes the nervous system, helping prevent stress-related breakouts. Whole grains and fortified cereals/grains, wheat germ, legumes, sunflower seeds, mussels, pork, B2 aids cell turnover and collagen maintenance, which protects the structural integrity of your skin, reduces inflammation, and speeds wound healing. A level <200ng/l suggests deficiency, however clinical features usually occur below level of 100ng/l. Lee SH, Lee WS, Whang KC, Lee SJ, Chung JB. Published by Oxford University Press on behalf of the Association of Physicians.
We use your sign-up to provide content in ways you've consented to and to improve our understanding of you. The boy was offered a vitamin B12 treatment which involved weekly injections for a month. However, a lot of times, when we wake up from sleep, we notice freckles on our faces. Sources include eggs, dairy, fish, and meat. For example, milk, curd, cheese and green vegetables etc.
Fig. Patient responded appropriately with serum cortisol of 7.1g/dL at baseline, 22.9g/dL at 30 minutes, and 27.3g/dL 60 minutes after cosyntropin administration. Skin is the largest organ in the body that plays a vital role of protecting the internal organs from external environment. Microvessel overexpression of aquaporin 1 parallels bone marrow angiogenesis in patients with active multiple myeloma. In pernicious anemia, the gastric parietal cells are targeted by the autoimmune process.
The endoscopic findings were further reinforced by high serum levels of antibodies to intrinsic factor and gastric parietal cells confirming malabsorption of vitamin B12 due to lack of intrinsic factor.
Copyright 2022 Association of Physicians of Great Britain and Ireland. The patient was treated with intramuscular B12 (1 mg daily for 7 days, 1 mg/week for 3 weeks and 1 mg/month for 3 months, for maintenance). Perhaps its time to rethink that approach. Contact one of Tri-City Medical Centers registered dietitians today!
For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Nutritional quantity, supplements, contamination. Physical examination showed a well-developed woman in no distress. Those who follow vegetarian or vegan diets can get the nutrient from fortified nutritional yeasts. The primary source of vitamin B12 is derived from animal products such as dairy products, meat, eggs, fish, and shellfish. raise inflammation in the body, reduce cell regeneration, and contribute to dryness all factors that lead to breakouts and premature aging. It is sometimes used to treat conditions like psoriasis and eczema. However, weve got a relatively small storage tank for B vitamins, which means we need to keep refilling it each day.
Routine investigations were within normal limits, with no changes in chronic B12 deficiency, except a low serum B12 concentration of 100 pg/ml (normal 160900 pg/ml) and mild macrocytosis. Histol Histopathol 2004; 19: 259270. Thiamine was the first B Vitamin ever discovered.
Z Rheumatol 1993; 52: 191200. There was an increased number of mast cells around the vessels. Characteristically, hyperpigmentation is observed in the oral mucosa and over the dorsum of hands and feet, with accentuation over the interphalangeal joints and terminal phalanges [17], occasionally in the creases of palms and soles, rarely on lower extremities. *E-mail: nantin75@yahoo.com. 9. The acne marks are actually a type of post-inflammation pigmentation. Plain film radiological studies of her hands were normal, as was electromyography. Haematologica 2003; 88: 176185. The dark spots worsen when you try to break or squeeze the acne.
Neurological examination showed decreased sensation to light touch in a stocking and glove distribution. They help turn food into energy and affect the health of our nervous system, metabolism, organs, muscles, skin, and hair. Vitamin B12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases.
Vascular endothelial growth factor (VEGF) was weakly expressed by some endothelial and plasma cells. (You can unsubscribe anytime), 2020 Tri-City Medical Center | Privacy Policy |Notice of Non-Discrimination | Sitemap, Tri-City Medical Center is administered by Tri-City Healthcare District (A California Hospital District). It is also important to remember that, although uncommon, both diseases can coexist in the same patient in the context of polyglandular autoimmune syndromes.. 1. Her blood pressure was 113/88 sitting, 105/76 standing, temperature of 37 Celsius, pulse of 92 (sitting), 112 beats/minute (standing), and respiratory rate of 16 breaths/minute. Hoffman CF, Palmer DM, Papadopoulos D. Vitamin B12 deficiency: a case report of ongoing cutaneous hyperpigmentation. To our knowledge, co-existence of growth hormone deficiency and skin hyperpigmentation has not been reported previously.
Mast cells have been shown to accompany angiogenesis (7). It helps to convert glucose into energy, aids in wound healing, and is essential for proper nerve functions.
4. Premature graying of scalp hair has also been described [19]. and protects cells from damage and water loss, helping to keep your skin moist and plump. Report of three cases,, S. Aaron, S. Kumar, J. Vijayan, J. Jacob, M. Alexander, and C. Gnanamuthu, Clinical and laboratory features and response to treatment in patients presenting with vitamin B, K. Aroni, K. Anagnostopoulou, E. Tsagroni, and E. Ioannidis, Skin hyperpigmentation and increased angiogenesis secondary to vitamin B, R. Kannan and M. J. M. Ng, Cutaneous lesions and vitamin B, S. Niiyama and H. Mukai, Reversible cutaneous hyperpigmentation and nails with white hair due to vitamin B, A. Tefferi and R. K. Pruthi, The biochemical basis of cobalamin deficiency,, W. S. Beck, Neuropsychiatric consequences of cobalamin deficiency,.
Orthostatic hypotension is considered a neurological manifestation of vitamin B12 deficiency and clearly relates to the underlying autonomic neuropathy [12]. Conversely, people who have dull skin are often not eating the right types of food and may be suffering with a number of vitamin deficiencies. The effects of vitamin B12 deficiency on the hematologic, nervous, and gastrointestinal systems are well studied. It also helps with mucus secretion in the skin, thus preventing the dryness that leads to oil production (and therefore acne) andimproves zinc absorption, another important mineral for skin health. You can unsubscribe at any time. 6. Department of Medicine, Sardar Patel Medical College, Bikaner, Rajasthan, India. Vitamin B12 level was repeated at 4 and 8 months with values of 269pg/mL and 412pg/mL, respectively. Vitamin B12 is an essential nutrient that keeps the body functioning properly - but when you're running low on the vitamin, a number of unusual changes may occur.
Typically, these involve hyperpigmentation, mostly localized in the dorsum of the hands, fingers and feet and sometimes in skin folds and mucosal surfaces. The human body can't create vitamin B12, so you need to get this nutrient from your diet. Article of the Year Award: Outstanding research contributions of 2021, as selected by our Chief Editors.
Perls technique for haemosiderin was negative. If you are having dull and dry skin and wondering for acne treatment, you can try skin whitening treatment, offered at Four Fountains De-Stress Spa.
News18 Lifestyle is one-stop destination for everything you need to know aRead More.
Eight Vitamins, One B-Complex: Your Recipe for Glowing Skin, B Vitamins offer a myriad of skin health benefits, but two of the most significant are cell renewal and stress relief (and who doesnt need help, Because theyre water-soluble rather than fat-soluble, B vitamins are most effective when taken orally as a. Deficiency of vitamin B-9 (folic acid) and B-12 (cobalamin) can cause pigmentation problems leading to patchy skin. Hyperpigmentation associated with vitamin B12 deficiency is completely reversible with treatment. Br J Haematol 2001; 113: 415421. In a study of 63 patients by Aaron et al. No related content is available yet for this article. In the majority of Caucasian cases, the pigment changes are spotty or reticulated, usually involving different parts of the body rather than being generalized (13). All rights reserved. Her medical history included primary growth hormone deficiency, for which she had been treated with subcutaneous injections of growth hormone.
Theyre also essential for cell growth, development, and overall functioning. Peripheral blood film showed oval macrocytes, marked anisocytosis and poikilocytosis.
We describe here a case of a 21-year-old Greek woman in whom hyperpigmentation (reddish-brown colour) was confined to the lateral surfaces of the legs. , causing acne, rashes, dry and flaky skin, cracked lips, and wrinkles. Almonds, sweet potato, eggs, onions, whole grains, tomatoes, sardines, broccoli.
Over the last couple of months, she had multiple episodes of fall but no loss of consciousness. The cutaneous manifestations described in the literature include but are not limited to skin hyperpigmentation, hyperpigmentation of surgical scars [15], and mucus membrane of the vulva [16], vitiligo, recurrent angular stomatitis, and hair changes. Our patient (case 2) had classical presentation of subacute combined degeneration of the cord as indicated by the positive Babinski and Romberg sign. Historically, Thomas Addison described pernicious anemia and Addisons disease.
Kyriaki Aroni, Konstantina Anagnostopoulou*, Eugenia Tsagroni and Eleftherios Ioannidis, Department of Dermatopathology, University of Athens, 50 Nikiforou Lytra Street, GR-11474 Athens, Greece. It has been implicated as a cause of orthostatic hypotension [8], mood disorders [9], dementia, psychosis, depression, myocardial infarction, stroke [10], and retinal hemorrhages [11]. Acne is one of the most distressing skin conditions. (A) Multiple clusters of vessels and a few lymphocytes and plasmacytes around them in the dermis (haematoxylin-eosin (H&E) 200). Its deficiency is a major health issue and a major diagnostic challenge; its presentation varies from being asymptomatic to affecting multiple organ systems. It helps to convert glucose into energy, aids in wound healing, and is essential for proper nerve functions. People who have a shiny, healthy and glowing skin tend to have a good impression on others. Although iron is necessary for many important physiological functions, too much iron accumulation can affect organs such as liver and skin. Where to find it: Tuna, turkey, beef, chicken, potatoes, sunflower seeds, spinach, bananas. What it does: Another major stress-buster, B6 helps to regulate mood and sleep by aiding the body in producing serotonin (the happy hormone), melatonin (the sleep hormone), and norepinephrine (a stress hormone), among others. Laboratory investigation showed hemoglobin of 66g/l, mean corpuscular volume 109 fl, total leucocyte count 3.6 109/l and platelet count of 78 109/l. Example: Yes, I would like to receive emails from Tri-City Medical Center. Early diagnosis can limit morbidity and inappropriate workups. She was admitted to the hospital for further investigation and workup. 3. (b) Decreased hyperpigmentation 3 months after treatment. B7 also fights inflammation and protects against acne, fungal infections, and rashes. Coronavirus (COVID-19): Important Information From Tri-City Medical Center Learn more. Multiple clusters of vessels CD34-positive (Fig. The skin hyperpigmentation may be associated with finger-nail pigment changes and premature grey hair, both reversible after treating the anaemia (13). It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. Vitamin B12 deficiency becomes important in high-risk populations such as the elderly, patients with either malabsorption diseases as in gastric and ileal resection or gastric mucosal disease resulting from either an autoimmune process or from gastric atrophy, pancreatic insufficiency, coeliac disease, Crohns disease, ileitis, vegetarians and long-term use of proton pump inhibitors [4], histamine (H2) receptor antagonists [5], or biguanides [6, 7]. The hyperpigmentation seen in Addison disease has been linked to increased melanocyte-stimulating hormones (alpha and beta MSH) and adrenocorticotrophin (ACTH). 2. Crivellato E, Beltrami CA, Mallardi F, Ribatti D. The mast cell: an active participant or an innocent bystander? It is observed in patients with megaloblastic, non-pernicious anaemia, mainly in those with dark-coloured skin (13).
Only found in animal products, though vegetarians can opt for fortified foods. Ht = 37.5%, Hb = 12.5 g/dl, MCV = 96 fl (normal = 7895 fl), PLT = 250000, PT = 13.5 s, INR = 1, APTT = 35.6 s. Serum folate, Zn, ferritin, TIBC, T3, T4, TSH, DHEA, DHEA-S and ACTH were all within normal limits. Sometimes called the anti-stress vitamin, it bolsters the immune system and soothes the nervous system, helping prevent stress-related breakouts. Whole grains and fortified cereals/grains, wheat germ, legumes, sunflower seeds, mussels, pork, B2 aids cell turnover and collagen maintenance, which protects the structural integrity of your skin, reduces inflammation, and speeds wound healing. A level <200ng/l suggests deficiency, however clinical features usually occur below level of 100ng/l. Lee SH, Lee WS, Whang KC, Lee SJ, Chung JB. Published by Oxford University Press on behalf of the Association of Physicians.
We use your sign-up to provide content in ways you've consented to and to improve our understanding of you. The boy was offered a vitamin B12 treatment which involved weekly injections for a month. However, a lot of times, when we wake up from sleep, we notice freckles on our faces. Sources include eggs, dairy, fish, and meat. For example, milk, curd, cheese and green vegetables etc.
Fig. Patient responded appropriately with serum cortisol of 7.1g/dL at baseline, 22.9g/dL at 30 minutes, and 27.3g/dL 60 minutes after cosyntropin administration. Skin is the largest organ in the body that plays a vital role of protecting the internal organs from external environment. Microvessel overexpression of aquaporin 1 parallels bone marrow angiogenesis in patients with active multiple myeloma. In pernicious anemia, the gastric parietal cells are targeted by the autoimmune process.
The endoscopic findings were further reinforced by high serum levels of antibodies to intrinsic factor and gastric parietal cells confirming malabsorption of vitamin B12 due to lack of intrinsic factor.
Copyright 2022 Association of Physicians of Great Britain and Ireland. The patient was treated with intramuscular B12 (1 mg daily for 7 days, 1 mg/week for 3 weeks and 1 mg/month for 3 months, for maintenance). Perhaps its time to rethink that approach. Contact one of Tri-City Medical Centers registered dietitians today!
For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Nutritional quantity, supplements, contamination. Physical examination showed a well-developed woman in no distress. Those who follow vegetarian or vegan diets can get the nutrient from fortified nutritional yeasts. The primary source of vitamin B12 is derived from animal products such as dairy products, meat, eggs, fish, and shellfish. raise inflammation in the body, reduce cell regeneration, and contribute to dryness all factors that lead to breakouts and premature aging. It is sometimes used to treat conditions like psoriasis and eczema. However, weve got a relatively small storage tank for B vitamins, which means we need to keep refilling it each day.
Routine investigations were within normal limits, with no changes in chronic B12 deficiency, except a low serum B12 concentration of 100 pg/ml (normal 160900 pg/ml) and mild macrocytosis. Histol Histopathol 2004; 19: 259270. Thiamine was the first B Vitamin ever discovered.
Z Rheumatol 1993; 52: 191200. There was an increased number of mast cells around the vessels. Characteristically, hyperpigmentation is observed in the oral mucosa and over the dorsum of hands and feet, with accentuation over the interphalangeal joints and terminal phalanges [17], occasionally in the creases of palms and soles, rarely on lower extremities. *E-mail: nantin75@yahoo.com. 9. The acne marks are actually a type of post-inflammation pigmentation. Plain film radiological studies of her hands were normal, as was electromyography. Haematologica 2003; 88: 176185. The dark spots worsen when you try to break or squeeze the acne.
Neurological examination showed decreased sensation to light touch in a stocking and glove distribution. They help turn food into energy and affect the health of our nervous system, metabolism, organs, muscles, skin, and hair. Vitamin B12 deficiency should be considered in patients presenting with skin lesions especially with other coexisting autoimmune diseases.
Vascular endothelial growth factor (VEGF) was weakly expressed by some endothelial and plasma cells. (You can unsubscribe anytime), 2020 Tri-City Medical Center | Privacy Policy |Notice of Non-Discrimination | Sitemap, Tri-City Medical Center is administered by Tri-City Healthcare District (A California Hospital District). It is also important to remember that, although uncommon, both diseases can coexist in the same patient in the context of polyglandular autoimmune syndromes.. 1. Her blood pressure was 113/88 sitting, 105/76 standing, temperature of 37 Celsius, pulse of 92 (sitting), 112 beats/minute (standing), and respiratory rate of 16 breaths/minute. Hoffman CF, Palmer DM, Papadopoulos D. Vitamin B12 deficiency: a case report of ongoing cutaneous hyperpigmentation. To our knowledge, co-existence of growth hormone deficiency and skin hyperpigmentation has not been reported previously.
Mast cells have been shown to accompany angiogenesis (7). It helps to convert glucose into energy, aids in wound healing, and is essential for proper nerve functions.
4. Premature graying of scalp hair has also been described [19]. and protects cells from damage and water loss, helping to keep your skin moist and plump. Report of three cases,, S. Aaron, S. Kumar, J. Vijayan, J. Jacob, M. Alexander, and C. Gnanamuthu, Clinical and laboratory features and response to treatment in patients presenting with vitamin B, K. Aroni, K. Anagnostopoulou, E. Tsagroni, and E. Ioannidis, Skin hyperpigmentation and increased angiogenesis secondary to vitamin B, R. Kannan and M. J. M. Ng, Cutaneous lesions and vitamin B, S. Niiyama and H. Mukai, Reversible cutaneous hyperpigmentation and nails with white hair due to vitamin B, A. Tefferi and R. K. Pruthi, The biochemical basis of cobalamin deficiency,, W. S. Beck, Neuropsychiatric consequences of cobalamin deficiency,.