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Neurological manifestations are among the most concerning signs: Paraesthesia (pins and needles) in hands and feet Numbness or altered sensation in extremities Difficulty with balance or coordination Memory problems or difficulty concentrating Mood changes, including depression or irritability Visual disturbances in rare cases These symptoms may be particularly difficult to distinguish from diabetic neuropathy, making objective assessment through blood testing essential rather than relying solely on clinical presentation

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Three authors (MM, AN, and JV) independently screened titles and abstracts following de-duplication