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Abstract
Chlamydiae are a singular group of bacteria, with a vital cycle that is intracellular in part. These microorganisms adhere to epithelia, where they may provoke infection. There are three pathogenic species for humans: Chlamydia trachomatis, which produce infections mainly in the genital and urinary tracts, and C. psittaci and C. pneumoniae, which mostly produce respiratory infections. The last two microorganisms are now classified in a different genus, known as Chlamydophila.
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Roca B, Bahamonde D, Pesudo JV, González-Darder JM. [Hemoptysis and dorsalgya]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 2007; 24:103-4. [PMID: 17595740 DOI: 10.4321/s0212-71992007000200016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
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Roca B, Bahamonde D. Tuberculous meningitis presenting with unusually severe hyponatremia. THE MOUNT SINAI JOURNAL OF MEDICINE, NEW YORK 2006; 73:1029-30. [PMID: 17195892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
We report a patient with tuberculous meningitis who presented with unusually severe hyponatremia, an electrolyte disorder that may cause symptoms similar to those of tuberculous meningitis. The hyponatremia was probably due to the syndrome of inappropriate antidiuretic hormone secretion, and resolved after instituting water restriction and antituberculous medication.
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Galindo Puerto MJ, von Wichmann de Miguel MÁ, Roca B, Téllez MJ, Blázquez R. La comorbilidad como factor limitante del TARGA. Enferm Infecc Microbiol Clin 2006. [DOI: 10.1157/13096044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Lyme borreliosis is a zoonotic disease transmitted by ticks and caused by the spirochete Borrelia burgdorferi. There are cases of the infection reported at least since the beginning of last century, although a complete description of the disease is available only since 1982. Clinical presentation consists generally of a characteristic skin rash, known as erythema migrans, and a variety of systemic manifestations, which evolve in stages, along months to years. Diagnosis is usually made with serology tests, and the infection responds well to several antibiotics, especially if given in the early stages of the disease.
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Casado JM, Visus E, Recio JP, Sánchez-Ledesma M, Chimeno M, Roca B, Conthe P. [Neurohormonal blockade in patients with heart failure at discharge from hospital]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 2006; 23:478-82. [PMID: 17134310 DOI: 10.4321/s0212-71992006001000005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
With the objective to value the degree of fulfillment of the pharmacological processing in patients with heart failure was designed the study of therapeutic adherence in heart failure (ATICA). During the period of inclusion educational, social, demographic data have been obtained, personal antecedents, analytic and physical exploration of the patients. These data mentioned are the ones that are reflected in the present pilot study. The total of patients included is 554, the majority of which are women, the middle ages is advanced and they present a fraction of eyección conserved in more than the half. In the therapeutic plan only was collected information of groups with neurohormonal action and of great recognition in the processing of the heart failure. The most utilized pharmacological group are the IECA, nevertheless medicines as the espirolactona or the betablocker continue showing a worrying degree of infrautilización, although they present a greater prescription that in other series.
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Abstract
Mycoplasmas are prokaryote microorganisms without cellular wall, that usually colonize the respiratory and urogenital mucosae. The pathogenic species for mankind are Mycoplasma pneumoniae, that produce respiratory infections, among them pneumonia, and M. genitalium, M. hominis and Ureaplasma urealyticum, that produce urinary and genital infections. The diagnosis of these infections is fundamentally based on serology, since the culture of these germs is very laborious. In a near future, the antigen or DNA detection molecular techniques will probably permit a much faster and reliable diagnosis. The tetracyclines and fluorquinolones have excellent activity against these microorganisms.
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Roca B, Pesudo JV, Gonzalez-Darder JM. Meningitis caused by Enterococcus gallinarum after lumbar drainage of cerebrospinal fluid. Eur J Intern Med 2006; 17:298-9. [PMID: 16762785 DOI: 10.1016/j.ejim.2005.11.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2005] [Accepted: 11/10/2005] [Indexed: 10/24/2022]
Abstract
We report a rare case of meningitis caused by Enterococcus gallinarum, a bacterium characterized by its ability to express low-level resistance to vancomycin. As in the three other previously reported cases, this one occurred in a patient with a cerebrospinal fluid drainage catheter and properly responded to antimicrobial therapy and removal of the drain.
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Roca B, Marco JM. Presentation and outcome of infective endocarditis in Spain: a retrospective study. Int J Infect Dis 2006; 11:198-203. [PMID: 16797198 DOI: 10.1016/j.ijid.2006.04.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2005] [Revised: 02/27/2006] [Accepted: 04/20/2006] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To analyze cases of infective endocarditis in patients who attended the Hospital General de Castellón, Spain, between 1999 and 2004. METHODS This was a retrospective study. Demographic and clinical characteristics were assessed, variation in presentation over time was analyzed, and factors influencing outcome were determined. RESULTS A total of 54 cases in 48 patients were included; 33 (61%) were in men. The median patient age was 62 years. Infective endocarditis occurred on a native valve in 36 cases (67%), a mechanical prosthetic valve in 12 (22%), and a pacemaker in six (11%). The mitral valve was the most commonly affected site. Transthoracic and/or transesophageal echocardiography showed a vegetation in 45 (83%) cases, moderate or severe valvular regurgitation in 27 (50%), and intracardiac destructive lesions in five (9%). The outcome in 15 (28%) cases was death, and multivariate analysis disclosed significantly increased risk of death associated with older age, lower serum albumin, and higher white blood cell count. CONCLUSIONS This study confirmed the protean nature of infective endocarditis, and identified several factors predictive of mortality including advanced age, low serum albumin, and high white blood cell count.
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Roca B. Interleukin 2 treatment in HIV-1 infection. Lancet 2006; 367:1054. [PMID: 16581400 DOI: 10.1016/s0140-6736(06)68466-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Roca B. [Leptospirosis]. REVISTA DE MEDICINA DE LA UNIVERSIDAD DE NAVARRA 2006; 50:3-6. [PMID: 16999233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Leptospirosis is the most common zoonosis worldwide, although most cases occur in tropical countries. Leptospira interrogans, a spirochete, is the causative agent. Rats are the main reservoir. Most patients present a mild clinical form of the disease, which consists of a self-limited febrile process, without jaundice. Nevertheless, about 10% of patients suffer severe infections, with intense jaundice. Typically the disease manifests in two phases: acute or leptospiremic and immune or leptospiuric, although in many patients the two phases are indistinguishable, and in mild cases the second one is frequently absent. Diagnosis is carried out by serology or culture of the microorganism. Treatment consists of antibiotics such as penicillin G, ceftriaxone, doxycycline or amoxicillin.
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Roca B, Suárez C, Ceballos A, Varela JM, Nonell F, Montes J, Sobrino J, de la Peña A. Control of hypertension in patients at high risk of cardiovascular disease. QJM 2005; 98:581-8. [PMID: 15983023 DOI: 10.1093/qjmed/hci091] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hypertension is a major cardiovascular risk factor, but knowledge about the real magnitude of the problem and its determinants is lacking. AIM To assess control of hypertension and evaluate medical resource use, in patients at high risk of cardiovascular disease. DESIGN Multicentric cross-sectional study. METHODS We collected data for 2205 adult patients from 36 centres, representative of all regions of Spain. Patients had attended out-patient clinics from July 2002 to August 2003, had an absolute cardiovascular risk > or =20% at 10 years (according to the Framingham guidelines), and had a diagnosis of hypertension. Pregnant and terminally ill patients were excluded. RESULTS Hypertension was inadequately controlled in 1384 patients (62.8%). LDL cholesterol was higher in patients with uncontrolled hypertension (median 130.2 vs. 120.0 mg/dl, p < 0.001). Haemoglobin A(1c) in diabetic patients was also greater in those with uncontrolled hypertension (median 7.10% vs. 6.90%, p = 0.010). Uncontrolled hypertension was associated with the following variables, in descending strength of association: higher LDL cholesterol, taking antihypertensive medication, living in non-metropolitan areas, and higher body mass index. DISCUSSION Hypertension is poorly controlled in most patients with a high risk of cardiovascular disease. Uncontrolled hypertension is frequently associated with poor control of other risk factors.
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Roca B, Ferrer D, Pérez AP. [Liver abscess caused by Klebsiella oxytoca]. ANALES DE MEDICINA INTERNA (MADRID, SPAIN : 1984) 2005; 22:355. [PMID: 16302310 DOI: 10.4321/s0212-71992005000700017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
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Roca B. Intradural extramedullary tuberculoma of the spinal cord: a review of reported cases. J Infect 2005; 50:425-31. [PMID: 15907551 DOI: 10.1016/j.jinf.2004.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2004] [Accepted: 07/19/2004] [Indexed: 10/26/2022]
Abstract
Intradural extramedullary tuberculoma of the spinal cord (IETSC) is a rare modality of tuberculosis, with only a few cases described so far. Here we review 22 reports of the disease found in the literature of the last 25 years. IETSC is closely associated with tuberculous meningitis (TM). Both conditions may occur simultaneously, but more frequently IETSC is preceded by TM. IETSC has been described in a predominantly young population of both genders. The pathogenesis is unknown, although a paradoxical reaction to antituberculous medication is a reasonable possibility. The disease presents insidiously with paraparesis, hypoesthesia with a sensory level, and bladder dysfunction, due to cord involvement or compression by the inflammatory process. Permanent paraparesis is a common sequela. MRI is the diagnostic technique of choice in IETSC. Prompt surgical excision of the tuberculoma is the cornerstone of therapy. Antituberculous treatment is also indicated; unless resistance is present, conventional chemotherapy is probably enough. Corticosteroids are also generally recommended. In conclusion, IETSC is a rare complication of TM, which presents insidiously, despite adequate antituberculous treatment. To avoid the permanent disability that this condition may provoke, an early diagnosis and prompt treatment is critical.
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Roca B, Lapuebla C, Vidal-Tegedor B. HAART with didanosine once versus twice daily: adherence and efficacy. Int J Infect Dis 2005; 9:195-200. [PMID: 15964537 DOI: 10.1016/j.ijid.2004.07.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 06/17/2004] [Accepted: 07/19/2004] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Highly active antiretroviral therapy (HAART) containing didanosine taken twice daily was compared with HAART containing didanosine taken once daily in terms of adherence and efficacy. METHOD This was a self-controlled prospective cohort study, carried out in a tertiary level hospital. A total of 49 HIV-infected patients were included. They were prescribed HAART according to guidelines. After six months taking HAART containing didanosine twice daily, patients continued with the same regimen of HAART although once daily. Thereafter they were followed up for a further nine months. Adherence and virological efficacy were assessed at three-month intervals, for a total of six times, in every patient. RESULTS Overall, adherence was poor, with only 19 patients (39%) showing adequate adherence for all six visits. Adequate adherence was observed in 29 patients (59%) three months before didanosine switching, and in 37 patients (75%) three months after didanosine switching (P=0.034). Pooled HIV RNA results of the first three visits were higher than the same results of the last three visits (P=0.05). CONCLUSIONS Non-adherence is common among patients who take HAART. Simplification of regimens is useful to improve adherence and efficacy.
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Abstract
A rare case of primary large B-cell non-Hodgkin lymphoma of the larynx is reported. The patient was an 80-year-old female who presented with pharyngeal discomfort and dysphagia. Radiotherapy was instituted with complete remission of the tumor. Nine months afterward, she presented with aspiration pneumonia and dysphagia. Indirect laryngoscopy disclosed laryngeal and esophageal edema, which was probably related to radiotherapy. No signs of tumor recurrence were observed. Three months later, she was entirely asymptomatic. Although cases of aggressive course and poor response to therapy exist, primary large B-cell non-Hodgkin lymphoma of the larynx is generally considered a relatively benign and radiosensitive tumor.
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Teira R, Suárez-Lozano I, Muñoz P, Viciana P, Lozano F, Galindo MJ, Terrón A, Vergara A, Geijo P, Arribas JR, Cosín J, Domingo P, Ribera E, Roca B, García-Alcalde ML, Sánchez T, Muñoz-Sanz A. Patrón epidemiológico de la infección por el VIH en 15 hospitales españoles: casos de nuevo diagnóstico incluidos en la cohorte VACH en 2001 y 2002. Enferm Infecc Microbiol Clin 2005; 23:213-7. [PMID: 15826546 DOI: 10.1157/13073147] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Studying the changing trends of HIV epidemics is a useful means of evaluating the results of current preventive plans as well as of defining future needs and objectives. METHODS We performed a cross-sectional study of the newly-diagnosed cases of HIV infection included in the Spanish VACH cohort. New HIV cases were defined as those diagnosed between January 2001 and December 2002. Their epidemiologic characteristics were compared with those of patients included in the same cohort who had been diagnosed between January 1998 and December 2000. RESULTS We studied 603 new cases (27% women). In 146 (24.4%) HIV infection had been acquired by sharing material for intravenous drug use (IVDU), 171 (28,6%) were men who had had sex with other men (MSM) and 247 (41.3%) acknowledged some risk for heterosexual HIV transmission. The median age was 36 years (range: 18-80). Only 1.5% of the patients were younger than 20 years while 32.1% were older than 40 years. This percentage was significantly higher than that corresponding to 1998-2000 (27.5%; p < 0,05). HIV infection was diagnosed simultaneously with an AIDS-defining condition in 13.3% of patients and an AIDS-defining disease was diagnosed in the first month after HIV-diagnosis in another 40 patients (6.6%). CONCLUSIONS We confirm the trends observed in previous studies: a growing proportion of newly diagnosed cases among women, a decreasing proportion of IVDU, a growth of MSM, and a trend toward diagnosis at a later age.
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Abstract
The fibrosing disorders represent a diverse group of uncommon chronic diseases that include systemic sclerosis, eosinophilic fasciitis, eosinophilia-myalgia syndrome, toxic oil syndrome, and localized forms of fibrosis. A rare case of eosinophilic fasciitis is reported. The patient was a 61-year-old female who presented with generalized massive edema and eosinophilia. Signs of common edema-producing diseases, such as heart failure, were absent. Corticosteroids were initiated with slow improvement in edema. Over the ensuing months, miliary tuberculosis and tenosynovitis of her left hand and left foot developed, which responded to appropriate treatment. Moreover, prominent induration, hyperpigmentation, and coarse puckering of the skin gradually took place. Other conditions, especially neoplasms and infections, have been described in association with eosinophilic fasciitis, but this is the first reported case of miliary tuberculosis associated with the disease.
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Roca B, Martin JA. HIV infection presenting with duodenal tuberculosis. Neth J Med 2004; 62:459-61. [PMID: 15685899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Extrapulmonary tuberculosis is a protean and often difficult to recognise infection. Gastrointestinal tuberculosis is a rare condition that mainly occurs in immunodeficient people. We report a case of duodenal tuberculosis, which presented with gastrointestinal symptoms, anaemia and hyponatraemia, in a patient with previously undiagnosed HIV infection.
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Roca B, Mir A, Ibañez M. Air apple-core-like narrowing of the dilated transverse colon. JBR-BTR : ORGANE DE LA SOCIETE ROYALE BELGE DE RADIOLOGIE (SRBR) = ORGAAN VAN DE KONINKLIJKE BELGISCHE VERENIGING VOOR RADIOLOGIE (KBVR) 2004; 87:318. [PMID: 15679035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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Roca B, Gonzalez-Darder JM, Lucas A, Borras JM, Pesudo JV. Spinal cord compression from intradural extramedullary tuberculoma. Am J Med 2004; 117:620-1. [PMID: 15465517 DOI: 10.1016/j.amjmed.2004.06.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Roca B, Casado O, Borras JM, Gonzalez-Darder JM. Frontal brain abscess due to Streptococcus pneumoniae associated with an osteoma. Int J Infect Dis 2004; 8:193. [PMID: 15109597 DOI: 10.1016/j.ijid.2003.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2003] [Indexed: 10/26/2022] Open
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Reus S, Portilla J, Gimeno A, Sánchez-Payá J, García-Henarejos JA, Martínez-Madrid O, Usó J, Roca B, Galindo MJ, López-Aldeguer J. [Predictors of progression and death in patients with advanced HIV infection in the era of highly active antiretroviral therapy]. Enferm Infecc Microbiol Clin 2004; 22:142-9. [PMID: 14987534 DOI: 10.1016/s0213-005x(04)73054-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
INTRODUCTION To assess the factors associated with progression of infection and death in HIV-positive patients with severe immunodepression in the era of highly active antiretroviral therapy (HAART). METHODS We studied 146 HIV-infected patients with < 100 x 10(6)/L CD4+ lymphocytes and positive cytomegalovirus (CMV) serology enrolled between December 1997 and October 1998 and prospectively followed a median of 12.1 months. The main outcome measures were progression of HIV infection, defined as the appearance of a new AIDS-defining disease (CDC category C) or death. HIV viral load, lymphocyte count (CD4+ and CD8+), HAART administration and other clinical variables were evaluated at baseline. CMV viremia (determined by PCR) and HAART efficacy were recorded during follow-up. RESULTS Progression was observed in 40% of patients and 17% died. Factors associated with progression or death were CD4+ lymphocyte count less than 50 x 10(6)/L, CD8+ lymphocyte count less than 500 x 10(6)/L, HIV viral load more than 300,000 copies RNA/mL, CMV viremia, and absence or inefficacy of HAART. In the multivariate model, absence of HAART and low CD4+ and CD8+ counts remained statistically associated with progression, but the only variable associated with death was CMV viremia. CONCLUSIONS In patients with advanced HIV infection, CD4+ and CD8+ cell count and HAART were the most important factors related to progression, and CMV viremia was the strongest predictor of death.
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Roca B. [Liver transplant in patients co-infected with hepatitis C virus and human immunodeficiency virus]. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS : ORGANO OFICIAL DE LA SOCIEDAD ESPANOLA DE PATOLOGIA DIGESTIVA 2004; 96:517-8. [PMID: 15283636 DOI: 10.4321/s1130-01082004000700012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
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