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Participants received one oral tablet containing 1000 µg of cyanocobalamin (HealthAid, Co, UK) or a placebo (Barij Essence Co, Kashan, Iran) daily for 12 weeks

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Neurological manifestations are particularly concerning and may include peripheral neuropathy with paresthesias (tingling and numbness in hands and feet), ataxia, impaired proprioception and vibratory sense, cognitive impairment, memory loss, and in severe cases, subacute combined degeneration of the spinal cord

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