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The average 7-12 year delay from symptom onset to diagnosis reflects systemic failures in medical education, clinical assessment, and healthcare system organization rather than inherent limitations of medical knowledge or technology

However, only 22% of the variation in MMA levels was explained by vitamin B12, estimated glomerular filtration rate, age, sex, and socioeconomic status, suggesting that other underlying disease was likely the reason for elevated MMA levels

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Experimental dermatology