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If there is a lack of cobalamin in the body, methylmalonyl CoA accumulates, which presumably leads to the neurological manifestations of B12 deficiency.[4][7][9][12] The replenishment with parenteral cyanocobalamin causes a rapid and complete improvement of megaloblastic anemia and gastrointestinal symptoms caused by vitamin B12 deficiency

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In contrast, -lactams exert their effect by irreversibly binding to PBPs, thereby inhibiting the final cross-linking/transpeptidation steps