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Abstract Background Pernicious anemia, an autoimmune disease, presents with gradual, nonspecific symptoms, often leading to delayed diagnosis owing to its overlap with other conditions and variability in laboratory findings, such as neurological symptoms without anemia or macrocytosis

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In addition to genetics, certain environmental exposures may increase the risk of developing ALS

Are we aiming for a holistic, systemic effect, or are we trying to isolate and influence a single, precise biological process

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