Likewise, we would like to re-emphasize that, the patients workup involved a detailed history, laboratory and other essential studies which have been summarized in the paper. During admission the patient did not have any abnormal neurological findings. His intubation was due to development of severe acute respiratory distress syndrome. His medical history included only chronic obstructive pulmonary disease and ischemic heart disease, for which he had been hospitalized several times. He did not

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... ave diabetes, renal insufficiency nor any malignancies diagnosed during these hospitalizations. His serum vitamin B12 and serum 25OH vitamin D levels were within normal levels.