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EPS, particularly kefiran, modulate apoptotic pathways by downregulating B-cell lymphoma 2 (Bcl-2) and upregulating Bcl2-associated X protein (Bax), cytochrome c, and caspases 3, 8, and 9 (Rajoka et al., 2019)

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In children, the hyperactive-impulsive type is often easier to spot, but in adolescents and adults the signs are often more subtle (more on this below)