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It typically presents as macrocytic megaloblastic anemia and neurological impairments, including sensory and motor disfunctions, predominantly in the lower extremities, ataxia, and in more advanced stages cognitive decline progressing to dementia, as well as psychiatric disturbances (Sanjay et al., 2022

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Both treatment regimens resulted in tinnitus improvement compared with no treatment, but melatonin plus sulodexide was found to be more effective than melatonin alone