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The neurological aspects of the disease are thought to arise from the accumulation of methylmalonyl- CoA due to the requirement of B 12 as a cofactor to the enzyme methylmalonyl-CoA mutase

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This is the most frequent effect and is the body's normal response to a small puncture

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Once the peptides are reconstituted (mixed with bacteriostatic water) , they must be stored in the refrigerator to maintain their stability