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[26] A complication of severe chronic PA is subacute combined degeneration of spinal cord, which leads to distal sensory loss (posterior column), absent ankle reflex, increased knee reflex response, and extensor plantar reflex response

Therefore, the use of inorganic antimicrobial agents and antibiotics needs to follow more rigorous protocols, as improper use can lead to the emergence of superbugs and compromise the action of various antibiotic therapy strategies (Yonathan et al., 2022)