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Serebral Palsili Çocuklarda B12 Vitamini Düzeyleri Neden Yüksek ?

Yıl 2023, Cilt: 3 Sayı: 2, 1 - 8, 21.08.2023
https://doi.org/10.58961/hmj.1230922

Öz

Amaç: Bu çalışmanın amacı serebral palsi tanısı ile izlenen olguların sağlıklı kontrollere göre vitamin B12 düzeylerinin değerlendirilmesi hedeflenmiştir.
Metod: Çalışmaya Adıyaman Üniversitesi Eğitim ve Araştırma Hastanesi çocuk nöroloji polikliniğine başvuran ve serebral palsi tanısı konulan 53 olgu retrospektif olarak dahil edildi. Kontrol grubuna aynı dönemde çocuk sağlığı ve hastalıkları polikliniğine başvuran, sağlıklı çocuk muayenesi girilen ve yaş ve kilo açısından benzer 63 olgu alındı. Hasta dosyalarından demografik veriler, laboratuvar sonuçları [hemoglobin (Hb), hematokrit (Hct), ortalama korpüsküler hacim (MCV), platelet (plt), folat, ferritin, vitamin B12, 25 OH D vitamini], kranial görüntülemeleri ve elektroensefalografi (EEG) bulguları kayıt altına alındı.
Bulgular: Çalışma ve kontrol grubunda hemogram parametreleri [Hb (p=0.004), Hct (p=0.000), MCV (p=0.000), plt (p=0.001)], vitamin B12 (p=0.031) ve vitamin D (p=0.002) düzeyleri arasında istatiksel olarak anlamlı düşük saptandı.
Sonuç: Çalışmamızda literaturde belirtilen çalışmaların aksine SP’li hastalarda sağlıklı kontrollere göre vitamin B12 düzeyinin daha yüksek olduğu saptanmıştır. Bu durumun altta yatan pato-fizyolojik mekanizması tam olarak bilinmemesini konunun literatürde sınırlı olarak çalışılmasından kaynaklandığı ortadadır.

Kaynakça

  • Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007 Feb;109:8-14.
  • Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013 Jun;55(6):509-19.
  • Rempel GR, Colwell SO, Nelson RP. Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 1988 Dec;82(6):857-62. PMID: 3186375.
  • Papadopoulos A, Ntaios G, Kaiafa G, Girtovitis F, Saouli Z, Kontoninas Z et al. Increased incidence of iron deficiency anemia secondary to inadequate iron intake in institutionalized, young patients with cerebral palsy. Int J Hematol 2008;88:495-497.
  • Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC et al. Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc 2002;102:361-73.
  • Dahl M, Thommessen M, Rasmussen M, Selberg T. Feeding and nutritional characteristics in children with moderate or severe cerebral palsy. Acta Paediatr 1996;85:697–701.
  • Sullivan PB, Juszczak E, Lambert BR, Rose M, Ford-Adams ME, Johnson A. Impact of feeding problems on nutritional intake and growth: Oxford feeding study II. Dev Med Child Neurol 2002;44:461–467.
  • Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford feeding study. Dev Med Child Neurol 2000;42:674– 680.
  • Prelack K, Sheridan RL. Micronutrient supplementation in the critically ill patient: strategies for clinical practice. J Trauma 2001;51:601–620.
  • Kalra S, Aggarwal A, Chillar N, Faridi MM. Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls. Indian J Pediatr 2015;82:140-4.
  • Sánchez-Lastres J, Eirís-Puñal J, Otero-Cepeda JL, Pavón-Belinchón P, Castro-Gago M. Nutritional status of mentally retarded children in northwest spain: II. Biochemical indicators. Acta Paediatr 2003;92:928-34.
  • Romano C, van Wynckel M, Hulst J, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 2017;65:242-64.
  • Hillesund E, Skranes J, Trygg KU, Bøhmer T et al. Micronutrient status in children with cerebral palsy. Acta Paediatr 2007;96:1195–1198.
  • Kuperminc MN, Stevenson RD. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev 2008;14(2):137-46. doi: 10.1002/ddrr.14. PMID: 18646022; PMCID: PMC2830751.
  • Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571–6.
  • Thommessen M, Kase BF, Riis G, Heiberg A. The impact of feeding problems on growth and energy intake in children with cerebral palsy. Eur J Clin Nutr 1991;45:479–87.
  • Rosenbaum P. The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years. Dev Med Child Neurol 2007;49:724.
  • Lopes PA, Amancio OM, Araújo RF, Vitalle MS, Braga JA. Food pattern and nutritional status of children with cerebral palsy. Rev Paul Pediatr 2013;31(3):344-349.
  • Rogozinski BM, Davids JR, Davis RB, Christopher LM, Anderson JP, Jameson GG et al. Prevalence of obesity in ambulatory children with cerebral palsy. J Bone Joint Surg Am 2007;89(11):2421-2426.
  • Ceylan H. "Serebral palsili çocuklarda beslenme durumunun değerlendirilmesi." Pamukkale University, 2020.
  • Almuneef AR, Almajwal A, Alam I, Abulmeaty M, Bader BA, Badr MF et al. Malnutrition is common in children with cerebral palsy in Saudi Arabia – a cross-sectional clinical observational study. BMC Neurology 2019;19(1).
  • Corkins KG. Nutrition-focused physical examination in pediatric patients. Nutr Clin Pract 2015;30(2):203–209.
  • Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(7):1911–1930.
  • Xu Y, Zhang N, Xu S, Xu H, Chen S, Xia Z. Effects of phenytoin on serum levels of homocysteine, vitamin B12, folate in patients with epilepsy: A systematic review and meta-analysis Medicine 2019;98(12):e14844.
  • Duncan B, Barton LL, Lloyd J, Marks-Katz M. Dietary considerations in osteopenia intubefed no ambulatory children with cerebral palsy. Clin Pediatr 1999;38(3):133–7.
  • İspiroğlu E, Güler E, Dilber C, Dalkiran T, Olgar Ş, Davutoglu M et al. Anemia, vitamin B12, folic acid and iron deficiency in children who can not feed themselves due to neurological disease. Turkish Archives of Pediatrics 2012;47(3):199-203.
  • Hals J, Ek J, Svalastog AG, Nilsen H. Studies on nutrition in severely neurologically disabled children in an institution. Acta Paediatr 1996;85(12):1469–75.
  • Ayata A. Serebral palsili çocuklarda hemoglobin düzeyleri. SDÜ Tıp Fak Derg 1996;3:15-16.
  • Hong L, Tong G, Zhang M, Zhao M, Wu J, Hong LI. Analysis of anemia state of 229 children with cerebral palsy. Anhui Medical and Pharmaceutical Journal 2007;12:24-30.
  • Henderson R, Kaıralla J, Barrington J, Abbas A, Stevenson R. Longutudinal changes in bone density in children and adolsecents with moderate to severe cerebral palsy. J Pediatr 2005;146(6):769–75.
  • Huang HL, Zhou H, Wang N, Yu CY. Effects of antiepileptic drugs on the serum folate and vitamin B12 in various epileptic patients. Biomed Rep 2016 Oct;5(4):413-416.
  • Chiche L, Jean R, Romain F, Roux F, Thomas G, Canavese S et al. Implications cliniques de la de ́couverte d’une hypervi- tamine ́mie B12 en me ́decine interne. Rev Med Interne 2008;29:187–94.
  • Deneuville T, Mario N, Tiev KP, et al. Concentration plasmatique e ́leve ́e de la vitamine B12: un indicateur des maladies he ́patiques ou tumorales? Rev Med Interne 2009;30(Suppl. 2):73.
  • Chiche L, Mancini J, Arlet JB. investigateurs. de l’e ́tude BDOSE. Hypervitamine ́mies B12 en me ́decine in- terne: re ́sultats de l’e ́tude BDOSE. Rev Med Interne 2009;30(Suppl. 4):377.
  • Molad Y, Rachmilewitz B, Sidi Y, Pinkhas J, Weinberger A. Serum transcobalamin and transcobalamin levels in systemic lupus erythematosus. Am J Med 1989;88:141–4.
  • Grindulis KA, Calverley M, Cox C. Rheumatoid arthritis: is serum vitamin B12 high in active disease? J Rheumatol 1984;11:211–2.
  • Kalyoncu U, Buyukasik Y, Akdogan A, et al. Increased serum vitamin B12 levels are associated with adult-onset Still’s disease with reactive macrophage activation syndrome. Joint Bone Spine 2010;77:131–4.
  • Hintikka J, Tolmunen T, Tanskanen A, Viinamäki H. High vitamin B12 level and good treatment outcome may be associated in major depressive disorder. BMC Psychiatry 2003 Dec 2;3:17. doi: 10.1186/1471-244X-3-17. PMID: 14641930; PMCID: PMC317314.
  • Salles N, Herrmann F, Sakbani K, Rapin CH, Sieber C. High vitamin B12 level: a strong predictor of mortality in elderly inpatients. J Am Geriatr Soc. 2005 May;53(5):917-8. doi: 10.1111/j.1532-5415.2005.53278_7.x. PMID: 15877584.
  • Keenan N, Sadlier LG, Wiltshire E. Vascular function and risk factors in children with epilepsy: associations with sodium valproate and carbamazepine. Epilepsy Res 2014;108(6):1087-1094.
  • Stenberg R, Dahle C, Magnuson A, Hellberg D, Tysk C. Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy. J Pediatr Gastroenterol Nutr 2013;56(2):233-238.
  • Stenberg R, Böttiger A, Nilsson TK. High levels of vitamin B12 are fairly common in children with cerebral palsy. Acta Paediatr 2020 Jul;109(7):1493-1494. doi: 10.1111/apa.15195. Epub 2020 Feb 13. PMID: 32056285.
  • Hinkel J, Schmitt J, Wurm M, et al. Elevated Plasma Vitamin B12 in Patients with Hepatic Glycogen Storage Diseases. J Clin Med 2020 Jul 22;9(8):2326. doi: 10.3390/jcm9082326. PMID: 32707782; PMCID: PMC7463656.
  • Betul Ergul A, Turanoglu C, Karakukcu C, Guler Kazanci E, Altuner Torun Y. Increased vitamin B12 levels in children with zinc deficiency. Int J Vitam Nutr Res 2017 Sep;87(5-6):247-252. doi: 10.1024/0300-9831/a000444. Epub 2018 Aug 10. PMID: 30095365.
  • Butala S, Tersczuk M, Malay S, et al. Should we worry about elevated B12 levels in children? Clin Res 2021;7:1-5.
  • Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013;106:505-515.
  • Briani C, Dalla Torre C, Citton V, Manara R, Pompanin S, Binotto G et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients 2013;15:4521-4539.
  • Hope S, Naerland T, Høiland AL, Torske T, Malt E, Abrahamsen T et al. Higher vitamin B12 levels in neurodevelopmental disorders than in healthy controls and schizophrenia: a comparison among participants between 2 and 53 years. The FASEB Journal 2020;34(6):8114-8124

Why Vitamin B12 Levels Are High In Children With Cerebral Palsy ?

Yıl 2023, Cilt: 3 Sayı: 2, 1 - 8, 21.08.2023
https://doi.org/10.58961/hmj.1230922

Öz

Background: The purpose of the present study was therefore to evaluate vitamin B12 levels in cases under follow-up with diagnoses of cerebral palsy (CP) compared to healthy controls.
Methods: Fifty-three cases presenting to the Adiyaman University Education and Research Hospital pediatric neurology clinic diagnosed with CP were included retrospectively in this study. Sixty-three cases of similar age and weight presenting to the child health and diseases clinic in the control group. Demographic data, laboratory results [hemoglobin (Hb), hematocrit (Hct), mean corpuscular volume (MCV), platelet (plt), folate, ferritin, vitamin B12, and vitamin 25 OH D] findings were recorded from the patient files.
Results: Complete blood count parameters [Hb (p=0.004), hct (p=0.000), mcv (p=0.000), and plt (p=0.001)], vitamin B12 (p=0.031) and vitamin D levels (p=0.002) were significantly lower in the study group than in the control group.
Conclusions: In contrast to previous studies in the literature, vitamin B12 levels were higher in patients with CP than in the healthy controls. The fact that the underlying pathophysiological mechanism is not fully understood clearly derives from the limited investigation of the subject in the literature to date.

Kaynakça

  • Rosenbaum P, Paneth N, Leviton A, Goldstein M, Bax M, Damiano D et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl 2007 Feb;109:8-14.
  • Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol 2013 Jun;55(6):509-19.
  • Rempel GR, Colwell SO, Nelson RP. Growth in children with cerebral palsy fed via gastrostomy. Pediatrics 1988 Dec;82(6):857-62. PMID: 3186375.
  • Papadopoulos A, Ntaios G, Kaiafa G, Girtovitis F, Saouli Z, Kontoninas Z et al. Increased incidence of iron deficiency anemia secondary to inadequate iron intake in institutionalized, young patients with cerebral palsy. Int J Hematol 2008;88:495-497.
  • Fung EB, Samson-Fang L, Stallings VA, Conaway M, Liptak G, Henderson RC et al. Feeding dysfunction is associated with poor growth and health status in children with cerebral palsy. J Am Diet Assoc 2002;102:361-73.
  • Dahl M, Thommessen M, Rasmussen M, Selberg T. Feeding and nutritional characteristics in children with moderate or severe cerebral palsy. Acta Paediatr 1996;85:697–701.
  • Sullivan PB, Juszczak E, Lambert BR, Rose M, Ford-Adams ME, Johnson A. Impact of feeding problems on nutritional intake and growth: Oxford feeding study II. Dev Med Child Neurol 2002;44:461–467.
  • Sullivan PB, Lambert B, Rose M, Ford-Adams M, Johnson A, Griffiths P. Prevalence and severity of feeding and nutritional problems in children with neurological impairment: Oxford feeding study. Dev Med Child Neurol 2000;42:674– 680.
  • Prelack K, Sheridan RL. Micronutrient supplementation in the critically ill patient: strategies for clinical practice. J Trauma 2001;51:601–620.
  • Kalra S, Aggarwal A, Chillar N, Faridi MM. Comparison of micronutrient levels in children with cerebral palsy and neurologically normal controls. Indian J Pediatr 2015;82:140-4.
  • Sánchez-Lastres J, Eirís-Puñal J, Otero-Cepeda JL, Pavón-Belinchón P, Castro-Gago M. Nutritional status of mentally retarded children in northwest spain: II. Biochemical indicators. Acta Paediatr 2003;92:928-34.
  • Romano C, van Wynckel M, Hulst J, et al. European Society for Paediatric Gastroenterology, Hepatology and Nutrition guidelines for the evaluation and treatment of gastrointestinal and nutritional complications in children with neurological impairment. J Pediatr Gastroenterol Nutr 2017;65:242-64.
  • Hillesund E, Skranes J, Trygg KU, Bøhmer T et al. Micronutrient status in children with cerebral palsy. Acta Paediatr 2007;96:1195–1198.
  • Kuperminc MN, Stevenson RD. Growth and nutrition disorders in children with cerebral palsy. Dev Disabil Res Rev 2008;14(2):137-46. doi: 10.1002/ddrr.14. PMID: 18646022; PMCID: PMC2830751.
  • Bax M, Goldstein M, Rosenbaum P, Leviton A, Paneth N. Proposed definition and classification of cerebral palsy. Dev Med Child Neurol 2005;47(8):571–6.
  • Thommessen M, Kase BF, Riis G, Heiberg A. The impact of feeding problems on growth and energy intake in children with cerebral palsy. Eur J Clin Nutr 1991;45:479–87.
  • Rosenbaum P. The natural history of gross motor development in children with cerebral palsy aged 1 to 15 years. Dev Med Child Neurol 2007;49:724.
  • Lopes PA, Amancio OM, Araújo RF, Vitalle MS, Braga JA. Food pattern and nutritional status of children with cerebral palsy. Rev Paul Pediatr 2013;31(3):344-349.
  • Rogozinski BM, Davids JR, Davis RB, Christopher LM, Anderson JP, Jameson GG et al. Prevalence of obesity in ambulatory children with cerebral palsy. J Bone Joint Surg Am 2007;89(11):2421-2426.
  • Ceylan H. "Serebral palsili çocuklarda beslenme durumunun değerlendirilmesi." Pamukkale University, 2020.
  • Almuneef AR, Almajwal A, Alam I, Abulmeaty M, Bader BA, Badr MF et al. Malnutrition is common in children with cerebral palsy in Saudi Arabia – a cross-sectional clinical observational study. BMC Neurology 2019;19(1).
  • Corkins KG. Nutrition-focused physical examination in pediatric patients. Nutr Clin Pract 2015;30(2):203–209.
  • Holick MF, Binkley NC, Bischoff-Ferrari HA, Gordon CM, Hanley DA, Heaney RP et al. Endocrine Society. Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab 2011;96(7):1911–1930.
  • Xu Y, Zhang N, Xu S, Xu H, Chen S, Xia Z. Effects of phenytoin on serum levels of homocysteine, vitamin B12, folate in patients with epilepsy: A systematic review and meta-analysis Medicine 2019;98(12):e14844.
  • Duncan B, Barton LL, Lloyd J, Marks-Katz M. Dietary considerations in osteopenia intubefed no ambulatory children with cerebral palsy. Clin Pediatr 1999;38(3):133–7.
  • İspiroğlu E, Güler E, Dilber C, Dalkiran T, Olgar Ş, Davutoglu M et al. Anemia, vitamin B12, folic acid and iron deficiency in children who can not feed themselves due to neurological disease. Turkish Archives of Pediatrics 2012;47(3):199-203.
  • Hals J, Ek J, Svalastog AG, Nilsen H. Studies on nutrition in severely neurologically disabled children in an institution. Acta Paediatr 1996;85(12):1469–75.
  • Ayata A. Serebral palsili çocuklarda hemoglobin düzeyleri. SDÜ Tıp Fak Derg 1996;3:15-16.
  • Hong L, Tong G, Zhang M, Zhao M, Wu J, Hong LI. Analysis of anemia state of 229 children with cerebral palsy. Anhui Medical and Pharmaceutical Journal 2007;12:24-30.
  • Henderson R, Kaıralla J, Barrington J, Abbas A, Stevenson R. Longutudinal changes in bone density in children and adolsecents with moderate to severe cerebral palsy. J Pediatr 2005;146(6):769–75.
  • Huang HL, Zhou H, Wang N, Yu CY. Effects of antiepileptic drugs on the serum folate and vitamin B12 in various epileptic patients. Biomed Rep 2016 Oct;5(4):413-416.
  • Chiche L, Jean R, Romain F, Roux F, Thomas G, Canavese S et al. Implications cliniques de la de ́couverte d’une hypervi- tamine ́mie B12 en me ́decine interne. Rev Med Interne 2008;29:187–94.
  • Deneuville T, Mario N, Tiev KP, et al. Concentration plasmatique e ́leve ́e de la vitamine B12: un indicateur des maladies he ́patiques ou tumorales? Rev Med Interne 2009;30(Suppl. 2):73.
  • Chiche L, Mancini J, Arlet JB. investigateurs. de l’e ́tude BDOSE. Hypervitamine ́mies B12 en me ́decine in- terne: re ́sultats de l’e ́tude BDOSE. Rev Med Interne 2009;30(Suppl. 4):377.
  • Molad Y, Rachmilewitz B, Sidi Y, Pinkhas J, Weinberger A. Serum transcobalamin and transcobalamin levels in systemic lupus erythematosus. Am J Med 1989;88:141–4.
  • Grindulis KA, Calverley M, Cox C. Rheumatoid arthritis: is serum vitamin B12 high in active disease? J Rheumatol 1984;11:211–2.
  • Kalyoncu U, Buyukasik Y, Akdogan A, et al. Increased serum vitamin B12 levels are associated with adult-onset Still’s disease with reactive macrophage activation syndrome. Joint Bone Spine 2010;77:131–4.
  • Hintikka J, Tolmunen T, Tanskanen A, Viinamäki H. High vitamin B12 level and good treatment outcome may be associated in major depressive disorder. BMC Psychiatry 2003 Dec 2;3:17. doi: 10.1186/1471-244X-3-17. PMID: 14641930; PMCID: PMC317314.
  • Salles N, Herrmann F, Sakbani K, Rapin CH, Sieber C. High vitamin B12 level: a strong predictor of mortality in elderly inpatients. J Am Geriatr Soc. 2005 May;53(5):917-8. doi: 10.1111/j.1532-5415.2005.53278_7.x. PMID: 15877584.
  • Keenan N, Sadlier LG, Wiltshire E. Vascular function and risk factors in children with epilepsy: associations with sodium valproate and carbamazepine. Epilepsy Res 2014;108(6):1087-1094.
  • Stenberg R, Dahle C, Magnuson A, Hellberg D, Tysk C. Increased prevalence of antibodies against dietary proteins in children and young adults with cerebral palsy. J Pediatr Gastroenterol Nutr 2013;56(2):233-238.
  • Stenberg R, Böttiger A, Nilsson TK. High levels of vitamin B12 are fairly common in children with cerebral palsy. Acta Paediatr 2020 Jul;109(7):1493-1494. doi: 10.1111/apa.15195. Epub 2020 Feb 13. PMID: 32056285.
  • Hinkel J, Schmitt J, Wurm M, et al. Elevated Plasma Vitamin B12 in Patients with Hepatic Glycogen Storage Diseases. J Clin Med 2020 Jul 22;9(8):2326. doi: 10.3390/jcm9082326. PMID: 32707782; PMCID: PMC7463656.
  • Betul Ergul A, Turanoglu C, Karakukcu C, Guler Kazanci E, Altuner Torun Y. Increased vitamin B12 levels in children with zinc deficiency. Int J Vitam Nutr Res 2017 Sep;87(5-6):247-252. doi: 10.1024/0300-9831/a000444. Epub 2018 Aug 10. PMID: 30095365.
  • Butala S, Tersczuk M, Malay S, et al. Should we worry about elevated B12 levels in children? Clin Res 2021;7:1-5.
  • Andres E, Serraj K, Zhu J, Vermorken AJ. The pathophysiology of elevated vitamin B12 in clinical practice. QJM 2013;106:505-515.
  • Briani C, Dalla Torre C, Citton V, Manara R, Pompanin S, Binotto G et al. Cobalamin deficiency: clinical picture and radiological findings. Nutrients 2013;15:4521-4539.
  • Hope S, Naerland T, Høiland AL, Torske T, Malt E, Abrahamsen T et al. Higher vitamin B12 levels in neurodevelopmental disorders than in healthy controls and schizophrenia: a comparison among participants between 2 and 53 years. The FASEB Journal 2020;34(6):8114-8124
Toplam 48 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Konular Çocuk Sağlığı ve Hastalıkları
Bölüm Araştırma Makaleleri
Yazarlar

Hilal Aydın 0000-0002-2448-1270

İbrahim Bucak 0000-0002-3074-6327

Sevda Taştan 0000-0001-6481-4968

Yayımlanma Tarihi 21 Ağustos 2023
Gönderilme Tarihi 7 Ocak 2023
Yayımlandığı Sayı Yıl 2023 Cilt: 3 Sayı: 2

Kaynak Göster

Vancouver Aydın H, Bucak İ, Taştan S. Serebral Palsili Çocuklarda B12 Vitamini Düzeyleri Neden Yüksek ?. HTD / HMJ. 2023;3(2):1-8.

e-ISSN: 2791-9935