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2,4 Diagnoses can be delayed due to low clinical awareness, highlighting the need for vigilance, especially among clinicians treating patients returning from surgery abroad

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Reduced folates act as coenzymes, which serve as one-carbon (1-C) donor or acceptor units in a variety of biochemical reactions, such as ( i ) methionine synthesis, ( ii ) histidine catabolism, ( iii ) purine ring synthesis, ( iv ) serine-glycine interconversion, and ( v ) thymidylate synthesis (a key reaction in pyrimidine synthesis)