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Reduced amounts of mature piRNAs are seen in germ cells deficient in PNLDC1, coupled with an accumulation of untrimmed pre-piRNA intermediates that retain 3 extensions that are typically eliminated during trimming [447,448,449]

Other clinical scenarios requiring vitamin K injection include: Malabsorption syndromes : Conditions such as coeliac disease, cystic fibrosis, or biliary obstruction impair fat-soluble vitamin absorption, potentially causing vitamin K deficiency and coagulopathy Antibiotic-associated deficiency : Prolonged broad-spectrum antibiotic therapy may disrupt gut flora responsible for vitamin K2 synthesis Hepatic dysfunction : Whilst vitamin K cannot correct coagulopathy caused by severe liver failure (where synthetic capacity is lost), it may help in cases where deficiency coexists with liver disease Nutritional deficiency : Rare in developed countries but may occur with severe dietary restriction or total parenteral nutrition without adequate supplementation Importantly, vitamin K injection does not reverse the anticoagulant effects of direct oral anticoagulants (DOACs) such as apixaban, rivaroxaban, or dabigatran

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