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B12 injections can lower elevated homocysteine levels, thereby reducing the risk of heart disease

Dihydrofolate reductase is a key enzyme in folate metabolism in vivo, responsible for the reduction of dihydrofolate to tetrahydrofolate, which is involved in the methyl shuttle required for the ab initio synthesis of thymidylate and certain amino acids

Therefore, clinicians must be aware of the possibility of psychiatric symptoms such as those seen in the present case in patients who have undergone total gastrectomy

25 Repeat Testing : Repeat testing of B 12 may be warranted after a trial of therapy or as an assessment of adherence