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Case presentation Patient background: Age/gender: 33-year-old woman Symptoms: Right medial elbow pain persisting for one year following a minor trauma Previous treatment: Physical therapy and NSAIDs, with no significant improvement The patient reported ongoing pain in the medial aspect of her right elbow, which significantly affected her daily activities

Since multiple species of Propionibacterium produce no exotoxins or endotoxins and have been granted GRAS status (generally regarded as safe) by the United States Food and Drug Administration, they are the preferred bacterial fermentation organisms for vitamin B 12 production

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