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Inflammation grading was carried out independently by 3 researchers according to established protocols (77) and to the following scale: 0= No inflammation, 1= small pockets of cellular infiltrations, 2= small pockets of infiltrations less than 3 cells deep surrounding more than one airway or blood vessel, 3= infiltrations more than 3 cells deep found surrounding more than one but less than 50% of the total airways, 4=most airways surrounded by significant immune cell infiltrations, 5= the majority of airways are surrounded by significant immune cell infiltrations which also are seen present in alveolar beds

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In addition, as this study was observational, prospective studies with standardized neuropsychiatric assessments are needed to confirm these associations

Repeated injections into the same spot cause scar tissue and lipohypertrophy, both of which reduce B12 absorption over time