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These may include: ( 4 ) Fatigue or lack of energy Brain fog or trouble concentrating Irritability or mood swings Pale skin or shortness of breath Tingling in the hands and feet Difficulty walking or staggering Anemia Swollen or inflamed tongue A B12 deficiency in men may also contribute to low testosterone, weight gain, and poor exercise recoverymaking it a hidden factor in many mens health concerns

Design A prospective, randomized, parallel, open label, controlled clinical trial Setting The outpatient Endocrinology clinic, Department of Endocrinology, Faculty of Medicine, Ain Shams University, Cairo, Egypt

et al.: Surfactant therapy: past, present and future