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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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33 This article updates previous articles on this topic by Langan and Zawistoski, 4 and by Oh and Brown

however, once opened, the contents should be discarded within 28 days to preserve sterility and effectiveness