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There were males and females with an age range of to. At study entry patients completed a medical history and received a physical examination with emphasis on cognition and the nervous system.Repeat medical histories were taken every six months.Physical examination was repeated in all patients at the end of the study and if the serum vitamin B level fell into the lower of the reference range or new neurological symptoms developed.Patients received a loading dose of intramuscular g hydroxocobalamin at study entry and then followed the patient pathway as outlined. Thus all patients started the oral stage of the study with a similar baseline, receiving the oral study tablet medication of g of cyanocobalamin daily.Two patients whose serum B level did not fall sufciently to reach the lower quartile did not enter the oral phase of the study.Five patients were withdrawn from the oral stage of the study: death. Forty patients were then analysed from the oral treatment group.Patients were recruited to the study at a rate of eight to per month and the study ended on a xed date over two years later.Thus, patients took the treatments for variable periods of time.Cyanocobalamin was effective in of the patients in all the diagnostic groupsthat is, no patients had to restart vitamin B injections.There was a plateau in serum vitamin B levels at three months on oral treatment with a median value of pgml. This compared with a median at the start of oral   <a href="http://www.targetmol.com/compound/Sodium-Nitroprusside"></a> therapy of pgml or mean corpuscular volume over time.Physical examinations undertaken when the serum level of vitamin B entered the lower of the reference range and at the end of the study showed that the treatment did not result in any new neurological complications.Homocysteine levels monitored after the start of oral therapy showed no rise. This also provides further evidence that at months of oral treatment there is no indication of impending vitamin B deciency.Most patients preferred the tablet to the injection of vitamin B, found the tablets highly acceptable treatment, and said the tablets were acceptable.General practitioners can be condent that this alternative treatment is both safe and effective in the long termongoing monitoring of our patients has substantiated that belief. An oral treatment can produce substantial savings by removing the necessity for nurse involvement either at home or at the surgery for injection therapy.Patients much prefer oral medication and given the opportunity to choose between an injection and a tablet of vitamin B, clearly demonstrated this preference.Vitamin B replacement therapy is ideally suited to a standard monitoring protocol and this should become a regular part of our care.Patients with the very rare condition of tobacco amblyopia should remain on hydroxocobalamin as there is a theoretical possibility of cyanocobalamin increasing the risks of this condition.There is now an oral alternative to a parenteral treatment and oral vitamin B is now a therapy option.All the authors contributed to the design and the clinical work.BC and SD ran the study and PN undertook statistical analysis.The pain was greatly aggravated by sitting.

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