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Symptoms of the disease include weakness, tiredness or even exhaustion and dyspnoea a sensation of running out of the air and of not being able to breathe fast enough or deeply enough

[10] Long-term use of proton pump inhibitors (PPIs) and H2-receptor antagonists reduces gastric acid, potentially impairing the release of B12 from dietary proteins

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Moreover, examination of other tissues where HSL is expressed, for instance adrenal, testis, ovary, and heart, showed the almost complete absence of neutral cholesteryl ester hydrolase activity [2, 4]