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Robinson ML, Johnson J, Naik S, Patil S, Kulkarni R, Kinikar A, Dohe V, Mudshingkar S, Kagal A, Smith RM, Westercamp M, Randive B, Kadam A, Babiker A, Kulkarni V, Karyakarte R, Mave V, Gupta A, Milstone AM, Manabe YC. Maternal Colonization Versus Nosocomial Transmission as the Source of Drug-Resistant Bloodstream Infection in an Indian Neonatal Intensive Care Unit: A Prospective Cohort Study. Clin Infect Dis 2023; 77:S38-S45. [PMID: 37406039 PMCID: PMC10321698 DOI: 10.1093/cid/ciad282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023] [Imported: 09/13/2023] Open
Abstract
BACKGROUND Drug-resistant gram-negative (GN) pathogens are a common cause of neonatal sepsis in low- and middle-income countries. Identifying GN transmission patterns is vital to inform preventive efforts. METHODS We conducted a prospective cohort study, 12 October 2018 to 31 October 2019 to describe the association of maternal and environmental GN colonization with bloodstream infection (BSI) among neonates admitted to a neonatal intensive care unit (NICU) in Western India. We assessed rectal and vaginal colonization in pregnant women presenting for delivery and colonization in neonates and the environment using culture-based methods. We also collected data on BSI for all NICU patients, including neonates born to unenrolled mothers. Organism identification, antibiotic susceptibility testing, and next-generation sequencing (NGS) were performed to compare BSI and related colonization isolates. RESULTS Among 952 enrolled women who delivered, 257 neonates required NICU admission, and 24 (9.3%) developed BSI. Among mothers of neonates with GN BSI (n = 21), 10 (47.7%) had rectal, 5 (23.8%) had vaginal, and 10 (47.7%) had no colonization with resistant GN organisms. No maternal isolates matched the species and resistance pattern of associated neonatal BSI isolates. Thirty GN BSI were observed among neonates born to unenrolled mothers. Among 37 of 51 BSI with available NGS data, 21 (57%) showed a single nucleotide polymorphism distance of ≤5 to another BSI isolate. CONCLUSIONS Prospective assessment of maternal GN colonization did not demonstrate linkage to neonatal BSI. Organism-relatedness among neonates with BSI suggests nosocomial spread, highlighting the importance of NICU infection prevention and control practices to reduce GN BSI.
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Kulkarni R, Rameshbabu B. Premature Atherosclerosis in Children With Transfusion-Dependent Thalassemia. Indian Pediatr 2023. [PMID: 36916365 DOI: 10.1007/s13312-023-2845-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/31/2023] [Imported: 09/13/2023]
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Kulkarni R. COVID-19 in Children With Tuberculosis: Methodological Issues. Indian Pediatr 2022. [PMID: 36511216 PMCID: PMC9798933 DOI: 10.1007/s13312-022-2678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] [Imported: 08/29/2023]
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Sonkawade ND, Kinikar AA, Kulkarni RK, Dawre RM, Valvi CT, Kamath PA. Screening of Extended Family Members of Thalassemia Major Children as a Thalassemia Preventive Strategy. Ethiop J Health Sci 2022; 32:1203-1210. [PMID: 36475260 PMCID: PMC9692158 DOI: 10.4314/ejhs.v32i6.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Accepted: 08/23/2022] [Indexed: 12/13/2022] [Imported: 09/13/2023] Open
Abstract
Background Thalassemia is considered as the most common single gene disorder worldwide. Preventive measures include identification of thalassemia carriers (traits) through screening, genetic counselling and prenatal diagnosis to reduce the incidence. This study aims at estimating the prevalence of carrier status detection among the extended family members of children having thalassemia major so as to use it as a screening prevention strategy with appropriate counselling. Methods This cross-sectional study was conducted in thalassemia unit of Pediatric Department of a tertiary care teaching hospital over a period of 18 months. Blood samples were collected from 117 extended family members (EFM) of 23 children with thalassemia major to carry out investigations such as Complete Blood Counts (CBC), Naked Eye Single Tube Red Cell Osmotic Fragility Test (NESTROFT), Reticulocyte count, High Performance Liquid Chromatography(HPLC) and serum ferritin. Reports were analysed to find out the prevalence of carriers. Results Among 117 EFM, 62 (52.9%) were males while 55(47.1%) were females. Mean age distribution in this study was 16.49 years (8.5). Prevalence of thalassemia trait (carrier) was 35%. NESTROFT test was positive in 57(48.7%) participants. The binary logistic regression found only positive NESTROFT test as a predictor (adjusted OR=0.022, P=0.001) of having raised HbA2 (HbA2≥3.5 %). Conclusion Screening of thalassemia carrier by targeting extended family members of thalassemia major children could yield more carrier cases and targeted counselling could help effectively in decreasing the number of children born with thalassemia major. This strategy could be included in future plan of national prevention programme for thalassemia.
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Bhardwaj S, Choudhary ML, Jadhav S, Vipat V, Ghuge R, Salvi S, Kulkarni R, Kinikar A, Padbidri V, Bafna S, Bavdekare A, D'costa P, Gujar N, Potdar V. A retrospective analysis of respiratory virus transmission before and during the COVID-19 pandemic in Pune the western region of India. Front Public Health 2022; 10:936634. [PMID: 36159243 PMCID: PMC9494283 DOI: 10.3389/fpubh.2022.936634] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] [Imported: 09/13/2023] Open
Abstract
Background SARS-CoV-2 was first reported in China in December 2019 and quickly spread across the world. Non-pharmaceutical interventions (NPIs) are the key to control the transmission of respiratory viruses. To stop the spread, NPI is widely recommended and is still followed by most countries. Methods At the National Influenza Center of the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), the surveillance of severe acute respiratory illness and acute respiratory illness cases for influenza and other respiratory viruses is in place. In this study, we analyzed surveillance data on respiratory viruses and/or SARS-CoV-2 testing from January 2017 to December 2021. Multiplex real-time PCR was used to detect the respiratory viruses. Results Our findings indicate that during the pandemic, the positivity for influenza A and B, metapneumovirus, parainfluenza virus, respiratory syncytial virus, and human coronavirus declined significantly. Conclusion The annual distinct seasonal outbreaks of influenza, RSV, and other respiratory viruses as observed during the pre-COVID-19 period were not observed during the COVID-19 pandemic in years 2020 and 21. Social distancing, lock-downs, and non-pharmaceutical interventions may play an important role in the reduction of respiratory viruses. Understanding the seasonal respiratory virus decline could help public health experts prepare for future respiratory virus pandemics.
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Kulkarni R, Kinikar A. Use of mobile app for curbing COVID-19 pandemic in India. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_324_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Kulkarni R, Kinikar A. Medical education in India during the COVID-19 pandemic. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_234_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Jannawar S, Ambike D, Ahmed S, Kulkarni RK, Ambike D. Generalised Epidermolysis Bullosa with Severe Anaemia in an Adolescent: A Case Report. JOURNAL OF NEPAL PAEDIATRIC SOCIETY 2021; 41:290-293. [DOI: 10.3126/jnps.v41i2.35059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
EBS is a rare genodermatosis usually inherited in an autosomal dominant fashion, although rare autosomal recessive cases have been reported. In severe generalised EBS, infants exhibit severe symptoms at the onset which tend to improve with time. We report an adolescent with severe generalised epidermolysis bullosa simplex (EBS), the most severe form of EBS, with severe iron deficiency anaemia
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Kulkarni R, Rajput U, Dawre R, Sonkawade N, Pawar S, Sonteke S, Varvatte B, Aathira KC, Gadekar K, Varma S, Nakate L, Kagal A, Kinikar A. Severe Malnutrition and Anemia Are Associated with Severe COVID in Infants. J Trop Pediatr 2021; 67:fmaa084. [PMID: 33313926 PMCID: PMC7798483 DOI: 10.1093/tropej/fmaa084] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] [Imported: 09/13/2023]
Abstract
BACKGROUND COVID-19 is uncommon and less severe in children than adults. It is thought that infants may be at higher risk for severe disease than older children. There is a paucity of literature on infants with COVID, particularly those with severe disease. OBJECTIVE We describe demographic, epidemiologic, clinical, radiological, laboratory features and outcomes of infants with confirmed SARS-CoV-2 infection admitted to a tertiary care teaching hospital in Pune, India. METHODOLOGY Infants who tested positive for SARS-CoV-2 and were admitted between 1 April 2020 and 7 August 2020 were included in the study. RESULTS A total of 13 infants were admitted during the study period. The median age was 8 months (IQR 6) and nine were male. Common presenting features were fever (n = 8, 62%), poor feeding, irritability, and runny nose (n = 3, 23%). Comorbidities noted were severe acute malnutrition (SAM) in three cases (23%) and nutritional megaloblastic anemia, iron deficiency anemia, sickle thalassemia and renal calculi in one case (8%) each. There was a history of low birth weight in two cases (15%). Pallor was noted in three cases (23%), SAM in three cases (23%) and tachypnea and respiratory distress in four cases (30%). Severe anemia, thrombocytopenia, elevated ferritin, abnormal procalcitonin, abnormal C Reactive Protein and deranged D-dimer was noted in three cases (23%) each. Neutrophil-lymphocyte ratio was normal in all cases. Three infants (43%) had evidence of pneumonia on the chest radiograph, of which one had adult respiratory distress syndrome (ARDS) like pattern, one infant had cardiomegaly and perihilar infiltrates. Hydroxychloroquine and azithromycin were given to five patients (38%), Intravenous Immunoglobulin and methylprednisolone were administered to one patient (8%). One infant died of ARDS with multi-organ dysfunction with refractory shock and hemophagocytic lymphohistiocytosis. CONCLUSION SAM and anemia may be associated with severe COVID in infants.
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Kulkarni R, Naresh DS, Aarti AK, Valvi C, Rajput U, Dawre R, Pawar S, Jadhav T, Chandanwale A, Tambe M, Venkatesham K, Suryavanshi N. Knowledge, attitude, and practices among police force toward covid-19 pandemic during Lockdown in Pune, India - An Online cross-sectional survey. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2021. [DOI: 10.4103/mjdrdypu.mjdrdypu_303_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Kulkarni RK, Kinikar AA. Ethics and the COVID-19 pandemic; A clinician’s perspective. JOURNAL OF NEPAL PAEDIATRIC SOCIETY 2020; 40:146-147. [DOI: 10.3126/jnps.v40i2.29409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] [Imported: 09/13/2023] Open
Abstract
The COVID-19 pandemic has raised exigent medical, ethical and organizational challenges. While some excellent articles have been published about the ethical aspects of pandemics from a bioethicist’s perspective , there is meager published literature on clinician’s perspective. The issues important from a clinician’s point of view are duty to treat, personal safety, safety of family, safety of colleagues, resource allocation, care for non COVID-19 patients and research.
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Kulkarni RK, Kinikar AA, Jadhav T. Fatal Covid-19 in a Malnourished Child with Megaloblastic Anemia. Indian J Pediatr 2020; 87:757-758. [PMID: 32548735 PMCID: PMC7297666 DOI: 10.1007/s12098-020-03408-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 06/10/2020] [Indexed: 12/15/2022] [Imported: 08/29/2023]
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Kulkarni R, Rajput U, Dawre R, Valvi C, Nagpal R, Magdum N, Vankar H, Sonkawade N, Das A, Vartak S, Joshi S, Varma S, Karyakarte R, Bhosale R, Kinikar A. Early-onset symptomatic neonatal COVID-19 infection with high probability of vertical transmission. Infection 2020; 49:339-343. [PMID: 32743723 PMCID: PMC7395939 DOI: 10.1007/s15010-020-01493-6] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 07/26/2020] [Indexed: 12/20/2022] [Imported: 09/13/2023]
Abstract
BACKGROUND There are few reports of COVID-19 in neonates and most are suspected to be due to postnatal transmission. Vertical transmission has been proven in only a couple of cases so far. METHODS We describe early-onset, severe COVID-19 disease in a neonate with very strong evidence of vertical transmission of SARS-CoV-2. RESULTS A COVID-19 suspected mother, who tested negative by RT-PCR for COVID, but tested positive for SARS-CoV-2 by serology, delivered a term baby. The neonate was kept in strict isolation. Molecular tests for SARS-CoV-2 on umbilical stump, placenta, and nasopharyngeal aspirate of the neonate, collected at birth were positive. On day 2, the neonate developed clinical features of COVID in the form of fever, poor feeding, and hyperbilirubenemia along with elevated inflammatory markers. Antibiotics were started empirically pending cultures. Blood, CSF, and urine cultures were sterile. Baby tested RT-PCR positive for SARS-CoV-2 on two more occasions before testing positive for antibodies and was discharged on day 21 of life. CONCLUSION This report highlights a very strong possibility of vertical transmission of COVID-19 from a mildly symptomatic, RT-PCR negative but antibody-positive mother with significant symptomatic, early-onset neonatal infection.
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COVID-19: Important Issues for Pediatricians. Indian Pediatr 2020. [PMID: 32393678 PMCID: PMC7387252 DOI: 10.1007/s13312-020-1903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] [Imported: 09/13/2023]
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Valvi C, Chandanwale A, Khadse S, Kulkarni R, Kadam D, Kinikar A, Joshi S, Lokhande R, Pardeshi G, Garg P, Gupte N, Jain D, Suryavanshi N, Golub JE, Shankar A, Gupta A, Dhumal G, Deluca A, Bollinger RC. Delays and barriers to early treatment initiation for childhood tuberculosis in India. Int J Tuberc Lung Dis 2020; 23:1090-1099. [PMID: 31627774 DOI: 10.5588/ijtld.18.0439] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] [Imported: 09/13/2023] Open
Abstract
BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.
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Kulkarni R, Kinikar A. Protocol Driven Extubation in Neonates- A Quality Improvement Initiative. Indian Pediatr 2020; 57:183. [PMID: 32060252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] [Imported: 08/29/2023]
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Protocol Driven Extubation in Neonates- A Quality Improvement Initiative. Indian Pediatr 2020. [PMID: 32060253 DOI: 10.1007/s13312-020-1744-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] [Imported: 09/13/2023]
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Kulkarni R, Kinikar A, Jadhav T. Adverse drug reaction profile of prophylactic hydroxychloroquine for COVID-19 among doctors. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2020. [DOI: 10.4103/mjdrdypu.mjdrdypu_220_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Kulkarni RK, Kinikar A, Valvi C, Khadse S. Tremors Following Blood Transfusion in Children with Megaloblastic Anemia. Indian J Pediatr 2016; 83:738-9. [PMID: 26558920 DOI: 10.1007/s12098-015-1933-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 10/21/2015] [Indexed: 11/24/2022] [Imported: 08/29/2023]
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Kulkarni R, Kedari V, Valvi C, Kinikar A, Khadse S. D-transallethrin: An unusual agent for accidental poisoning. MEDICAL JOURNAL OF DR. D.Y. PATIL UNIVERSITY 2016. [DOI: 10.4103/0975-2870.168008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Kinikar A, Valvi C, Doshi P, Kulkarni R. Hemorrhagic cystitis in two cases of novel influenza A (H1N1) infection. J PEDIAT INF DIS-GER 2015. [DOI: 10.3233/jpi-2011-0296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] [Imported: 09/13/2023]
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Kumbhojkar A, Kulkarni R, Chheda A, Gambhir P, Kinikar A, Khadse S. Acute megakaryoblastic leukemia M7 presenting with extreme myelofibrosis. INDIAN J PATHOL MICR 2014; 57:512-4. [PMID: 25118770 DOI: 10.4103/0377-4929.138812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] [Imported: 09/13/2023] Open
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Indigenous bubble CPAP and swine flu pandemic. Indian J Pediatr 2012; 79:822; author repy 822. [PMID: 22194241 DOI: 10.1007/s12098-011-0660-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Accepted: 12/12/2011] [Indexed: 10/14/2022] [Imported: 09/13/2023]
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