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If the Alfredson protocol and activity modification have not produced ASES score improvement of at least 15 points, peptide adjunct therapy is a reasonable next step before considering PRP or surgical consultation
Two types of vitamin B12 injections are usually given hydroxocobalamin and cyanocobalamin
Patients with pre-existing conditions including cardiovascular disease, liver disease, thyroid disorders, kidney disease, or gallbladder disease face particular uncertainty
Patients with pernicious anaemia, malabsorption disorders (such as Crohn's disease or coeliac disease), or following gastric surgery require regular B12 supplementation to prevent serious complications including megaloblastic anaemia and neurological damage
This confirms the well-documented role of cobalamin in lowering homocysteine levels in deficient or at-risk individuals
All nine patients serum vitamin B12 levels improved (mean increase, 117.4 pg/mL
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