Isolated thrombocytopenia in adults is a common clinical problem, often caused by various hematological disorders. However, vitamin B12 deficiency as a rare cause of isolated thrombocytopenia has been rarely reported in the medical literature. This case report aims to highlight the diagnostic challenges associated with atypical presentations of thrombocytopenia and emphasizes the importance of considering nutritional deficiencies, such as vitamin B12 deficiency, in the diagnostic workup. We report the case of a 38-year-old male who presented with generalized weakness, fatigue, and a history of bruises without trauma. Physical examination and laboratory investigations revealed thrombocytopenia (42 K/µL) with normal red blood cell morphology and no apparent abnormalities in other hematological parameters. Serum vitamin B12 levels were significantly diminished (128 pg/ml). The patient was treated with subcutaneous mecobalamin 1000 mcg supplementation, resulting in improvements in serum vitamin B12 levels (772 pg/ml) and platelet count (154 × 109/L) values. This case highlights the importance of considering vitamin B12 deficiency as a potential cause of isolated thrombocytopenia in adults. The lack of hypersegmented neutrophils and characteristic signs of macrocytic anemia in the context of vitamin B12 deficiency emphasizes the necessity for a thorough investigation to rule out other possible causes. Hematological problems associated with thrombocytopenia caused by vitamin B12 deficiency can be treated early to resolve them and avoid complications.
The school students are of particular importance in the HIV/AIDS awareness policies at both local and international level. This study was conducted to assess the level of knowledge of the modes of HIV transmission among urban and rural public secondary school students in Malaysia. In this cross-sectional study, post local ethics approval, 600self-administered questionnaires were randomly disseminated to students in 6 different secondary schools and areas (i.e. 3 urban schools and 3 rural schools). Data were descriptively and inferentially analyzed using Statistical Package of Social Sciences (SPSS®), version 17. The Pearson Chi-Square test was applied where applicable. Most respondents had heard about HIV (overall response rate: 96.2%). However, 8.9% of rural respondents (27/302) never heard about HIV and were excluded. Therefore, 275 urban students (Kuala Lumpur, Selangor, and Pahang) and 275 rural students (Terengganu) who successfully completed and returned the questionnaires were included in data analysis. Many respondents were female and within the age range of 15-16 years old. Most respondents in both areas knew that sharing needles can transmit HIV (93.5% urban; 97.1% rural). Out of 15 items concerning transmission modes of HIV, eight items showed significant values (p < 0.05) of rural vs. urban: saliva, urine, tears, using same swimming pool, blood transfusion, mosquito bites, sharing foods and donating blood to HIV patients. About 90.2% and 79.6% of respondents in urban and rural areas used television and newspapers as main source of knowledge on HIV, respectively. The implementation of incessant HIV and AIDS education programme could be useful in order to enhance and sustain awareness concerning HIV/AIDS among secondary school students.
Alzheimer's disease (AD) is the most conspicuous chronic neurodegenerative syndrome, which has become a significant challenge for the global healthcare system. Multiple studies have corroborated a clear association of neurotoxicants with AD pathogenicity, such as Amyloid beta (Aβ) proteins and neurofibrillary tangles (NFTs), signalling pathway modifications, cellular stress, cognitive dysfunctions, neuronal apoptosis, neuroinflammation, epigenetic modification, and so on. This review, therefore, aimed to address several essential mechanisms and signalling cascades, including Wnt (wingless and int.) signalling pathway, autophagy, mammalian target of rapamycin (mTOR), protein kinase C (PKC) signalling cascades, cellular redox status, energy metabolism, glutamatergic neurotransmissions, immune cell stimulations (e.g. microglia, astrocytes) as well as an amyloid precursor protein (APP), presenilin-1 (PSEN1), presenilin-2 (PSEN2) and other AD-related gene expressions that have been pretentious and modulated by the various neurotoxicants. This review concluded that neurotoxicants play a momentous role in developing AD through modulating various signalling cascades. Nevertheless, comprehension of this risk agent-induced neurotoxicity is far too little. More in-depth epidemiological and systematic investigations are needed to understand the potential mechanisms better to address these neurotoxicants and improve approaches to their risk exposure that aid in AD pathogenesis.Key messagesInevitable cascade mechanisms of how Alzheimer's Disease-related (AD-related) gene expressions are modulated by neurotoxicants have been discussed.Involvement of the neurotoxicants-induced pathways caused an extended risk of AD is explicited.Integration of cell culture, animals and population-based analysis on the clinical severity of AD is addressed.