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Many patients have successfully learnt to self-administer B 12 by intramuscular injection, which reduces both healthcare costs and burden on GP practices, and allows people who are B 12 deficient to optimise their treatment regimen.6566 Case example A man in his 70s presents with a nine month history of difficulty walking and climbing stairs, numbness and pain in his lower limbs, and paraesthesia in his hands

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Migrasome, a migration-dependent organelle

Then, apply traction and gently flex the middle phalanx until it slides smoothly into its natural anatomic position (Figure 109-1)

4.2. Vitamin E