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Gebran A, Dorken-Gallastegi A, Kaafarani HM. A Surgical Perspective of Gastrointestinal Manifestations and Complications of COVID-19 Infection. Gastroenterol Clin North Am 2023; 52:49-58. [PMID: 36813430 PMCID: PMC9537287 DOI: 10.1016/j.gtc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2, has quickly spread over the world since December 2019. COVID-19 is a systemic disease that can affect various organs throughout the body. Gastrointestinal (GI) symptoms have been reported in 16% to 33% of all patients with COVID-19 and in 75% of critically ill patients. This chapter reviews the GI manifestations of COVID-19 as well as their diagnostic and treatment modalities.
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Affiliation(s)
| | | | - Haytham M.A. Kaafarani
- Corresponding author. Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, 165 Cambridge Street, Suite 810, Boston, MA 02114
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Alnatour D, Nassar RI, Salhi Y, Thiab S, Alsayed AR. Perception and attitudes toward COVID- 19 vaccines in Jordan: lessons for future pandemics. Pharm Pract (Granada) 2023; 21:2781. [PMID: 37090450 PMCID: PMC10117358 DOI: 10.18549/pharmpract.2023.1.2781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/25/2023] Open
Abstract
Objective This study aimed to assess Jordanians' perception and attitudes toward COVID-19 vaccines authorized for use in Jordan. Another objective was to evaluate the population's confidence in vaccine efficacy, their fears of the vaccines, and their perceptions and attitudes after vaccination. Methods This cross-sectional study was conducted over four months (August 2021- December 2021) and included the general Jordanian population above 18 years old. Results A total of 398 participants were included in the study, with the majority (around 81.0%) received at least one dose of any of COVID-19 vaccines approved for use in Jordan. Most non-vaccinated participants (67.4%) were either unwilling to receive the COVID-19 vaccine or unsure. The main reasons for receiving the vaccine were: family protection, self-protection, global efforts to fight the virus and local restrictions, with some variability between vaccinated and non-vaccinated. The major reasons for fear of COVID-19 vaccines were limited research, vaccine effectiveness, and vaccine side effects. Pfizer-BioNTech vaccine was the most trusted vaccine by vaccinated and non-vaccinated participants (47.8% and 57.9%, respectively), and Oxford-AstraZeneca was the most feared by them (42.2% and 57.9%, respectively). Internet websites (>85.0%), social media platforms (>70.0%), relatives and friends (>69.0%), and news applications (>60.0%) were the major sources of information about the COVID-19 vaccines among participants. Conclusion Our results revealed that hesitation in receiving the vaccine remains a challenge in Jordan, as in other countries. The findings also show that participants, regardless of their vaccination status, had many concerns about the four types of vaccines approved for use in Jordan during the study conduction period. Moreover, the participants' perceptions and attitudes towards the vaccines were variable between vaccinated and non-vaccinated participants and were variable for the four types of vaccines.
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Affiliation(s)
- Dalal Alnatour
- PharmD. Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Razan I Nassar
- MSc. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | | | - Samar Thiab
- PhD. Assistant Professor in Pharmaceutical Analysis, Department of Pharmaceutical Chemistry and Pharmacognosy, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Ahmad R Alsayed
- PhD. Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman 11931-166, Jordan.
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Daboul SM, Abusamak M, Mohammad BA, Alsayed AR, Habash M, Mosleh I, Al-Shakhshir S, Issa R, Abu-Samak M. The effect of omega-3 supplements on the serum levels of ACE/ACE2 ratio as a potential key in cardiovascular disease: A randomized clinical trial in participants with vitamin D deficiency. Pharm Pract (Granada) 2023; 21:2761. [PMID: 37090459 PMCID: PMC10117361 DOI: 10.18549/pharmpract.2023.1.2761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 11/03/2022] [Indexed: 04/25/2023] Open
Abstract
Objective The aim of this randomized controlled clinical trial was to determine the effect of the omega-3 fatty acid supplementations 300 mg per day for 8 weeks on the serum levels of ACE/ACE2 ratio in Jordanian participants with vitamin D deficiency (VDD). Methods The physical and clinical characteristic of individuals in both intervention and control randomized controlled clinical trial were measured and analyzed. The comparisons between the two groups and the changes in each group before and after taking omega-3 doses were studied through independent t test and paired t test, respectively. Possible factors that have a role in the changes were determined by multivariate stepwise regression. Follow-up period lasted 10 weeks. Results The sample consisted of 82 participants with VDD and a mean age of 37.85 ± 9.85 years. Omega-3 Supplements resulted in a significant decrease in serum ACE levels, ACE/ACE2 ratio and serum 25-hydroxy vitamin D (25OHD). While the change in serum ACE2 levels and serum triglycerides levels were insignificant. Also, a significant increase in serum LDL levels were observed. Conclusion It is possible that taking high doses of omega-3 fatty acid supplementations have positive effects on the heart and circulatory system and could protect from COVID-19 or decrease disease severity, in connection with a decrease in the ACE/ACE 2 ratio. On the other hand, omega-3 supplement may have negative effect on cardiovascular system due to the significant increase in serum LDL levels.
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Affiliation(s)
- Sara M Daboul
- MSc. Department of Clinical Pharmacy and Therapeutics, Applied Science Private University, Jordan.
| | - Mohammad Abusamak
- MD. Assistant Professor, Department of Surgery, School of Medicine, Al-Balqa Applied University, As-Salt, Jordan, Amman Eye Clinic, Amman, Jordan.
| | - Beisan A Mohammad
- PhD. Assistant Professor, Department of Pharmaceutical Sciences, Fakeeh College for Medical Sciences, Jeddah, Saudi
| | - Ahmad R Alsayed
- PhD. Associate Professor, Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
| | - Maha Habash
- PhD. Assistant Professor, Michael Sayegh, Faculty of Pharmacy, Aqaba University of Technology, Aqaba, Jordan.
| | - Ibrahim Mosleh
- PhD. Professor, Departments of Clinical Laboratories, Jordan University, Amman, Jordan.
| | - Sami Al-Shakhshir
- PhD. Assistant Professor, Michael Sayegh, Faculty of Pharmacy, Aqaba University of Technology, Aqaba, Jordan.
| | - Reem Issa
- PhD. Associate Professor, Department of Pharmaceutical Sciences, Pharmacological and Diagnostic Research Center (PDRC), Faculty of Pharmacy, Al-Ahliyya Amman University, Amman 19328, Jordan.
| | - Mahmoud Abu-Samak
- PhD. Professor, Department of Clinical Pharmacy and Therapeutics, Faculty of Pharmacy, Applied Science Private University, Amman, Jordan.
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Xu X, Xia J, Zhao S, Wang Q, Ge G, Xu F, Liu X, Zhang W, Yang Y. Qing-Fei-Pai-Du decoction and wogonoside exert anti-inflammatory action through down-regulating USP14 to promote the degradation of activating transcription factor 2. FASEB J 2021; 35:e21870. [PMID: 34436790 DOI: 10.1096/fj.202100370rr] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 07/30/2021] [Accepted: 08/09/2021] [Indexed: 12/27/2022]
Abstract
COVID-19 is often characterized by dysregulated inflammatory and immune responses. It has been shown that the Traditional Chinese Medicine formulation Qing-Fei-Pai-Du decoction (QFPDD) is effective in the treatment of the disease, especially for patients in the early stage. Our network pharmacology analyses indicated that many inflammation and immune-related molecules were the targets of the active components of QFPDD, which propelled us to examine the effects of the decoction on inflammation. We found in the present study that QFPDD effectively alleviated dextran sulfate sodium-induced intestinal inflammation in mice. It inhibited the production of pro-inflammatory cytokines IL-6 and TNFα, and promoted the expression of anti-inflammatory cytokine IL-10 by macrophagic cells. Further investigations found that QFPDD and one of its active components wogonoside markedly reduced LPS-stimulated phosphorylation of transcription factor ATF2, an important regulator of multiple cytokines expression. Our data revealed that both QFPDD and wogonoside decreased the half-life of ATF2 and promoted its proteasomal degradation. Of note, QFPDD and wogonoside down-regulated deubiquitinating enzyme USP14 along with inducing ATF2 degradation. Inhibition of USP14 with the small molecular inhibitor IU1 also led to the decrease of ATF2 in the cells, indicating that QFPDD and wogonoside may act through regulating USP14 to promote ATF2 degradation. To further assess the importance of ubiquitination in regulating ATF2, we generated mice that were intestinal-specific KLHL5 deficiency, a CUL3-interacting protein participating in substrate recognition of E3s. In these mice, QFPDD mitigated inflammatory reaction in the spleen, but not intestinal inflammation, suggesting CUL3-KLHL5 may function as an E3 for ATF2 degradation.
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Affiliation(s)
- Xin Xu
- Suzhou Institute of Systems Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Suzhou, China
| | - Jun Xia
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Shiyi Zhao
- Suzhou Institute of Systems Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Suzhou, China
| | - Qun Wang
- Suzhou Institute of Systems Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Suzhou, China
| | - Guangbo Ge
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Feng Xu
- Department of Emergency Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xia Liu
- Department of Clinical Pharmacy, School of Pharmacy, Second Military Medical University, Shanghai, China
| | - Weidong Zhang
- Institute of Interdisciplinary Integrative Medicine Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yili Yang
- Suzhou Institute of Systems Medicine, Chinese Academy of Medical Science and Peking Union Medical College, Suzhou, China.,China Regional Research Center, International Centre for Genetic Engineering and Biotechnology, Taizhou, China
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Costa LB, Perez LG, Palmeira VA, Macedo e Cordeiro T, Ribeiro VT, Lanza K, Simões e Silva AC. Insights on SARS-CoV-2 Molecular Interactions With the Renin-Angiotensin System. Front Cell Dev Biol 2020; 8:559841. [PMID: 33042994 PMCID: PMC7525006 DOI: 10.3389/fcell.2020.559841] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 08/25/2020] [Indexed: 12/15/2022] Open
Abstract
The emergence of SARS-CoV-2/human/Wuhan/X1/2019, a virus belonging to the species Severe acute respiratory syndrome-related coronavirus, and the recognition of Coronavirus Disease 2019 (COVID-19) as a pandemic have highly increased the scientific research regarding the pathogenesis of COVID-19. The Renin Angiotensin System (RAS) seems to be involved in COVID-19 natural course, since studies suggest the membrane-bound Angiotensin-converting enzyme 2 (ACE2) works as SARS-CoV-2 cellular receptor. Besides the efforts of the scientific community to understand the virus' molecular interactions with human cells, few studies summarize what has been so far discovered about SARS-CoV-2 signaling mechanisms and its interactions with RAS molecules. This review aims to discuss possible SARS-CoV-2 intracellular signaling pathways, cell entry mechanism and the possible consequences of the interaction with RAS components, including Angiotensin II (Ang II), Angiotensin-(1-7) [Ang-(1-7)], Angiotensin-converting enzyme (ACE), ACE2, Angiotensin II receptor type-1 (AT1), and Mas Receptor. We also discuss ongoing clinical trials and treatment based on RAS cascade intervention. Data were obtained independently by the two authors who carried out a search in the PubMed, Embase, LILACS, Cochrane, Scopus, SciELO and the National Institute of Health databases using Medical Subject Heading terms as "SARS-CoV-2," "COVID-19," "Renin Angiotensin System," "ACE2," "Angiotensin II," "Angiotensin-(1-7)," and "AT1 receptor." Similarly to other members of Coronaviridae family, the molecular interactions between the pathogen and the membrane-bound ACE2 are based on the cleavage of the spike glycoprotein (S) in two subunits. Following the binding of the S1 receptor-binding domain (RBD) to ACE2, transmembrane protease/serine subfamily 2 (TMPRSS2) cleaves the S2 domain to facilitate membrane fusion. It is very likely that SARS-CoV-2 cell entry results in downregulation of membrane-bound ACE2, an enzyme that converts Ang II into Ang-(1-7). This mechanism can result in lung injury and vasoconstriction. In addition, Ang II activates pro-inflammatory cascades when binding to the AT1 Receptor. On the other hand, Ang-(1-7) promotes anti-inflammatory effects through its interactions with the Mas Receptor. These molecules might be possible therapeutic targets for treating COVID-19. Thus, the understanding of SARS-CoV-2 intracellular pathways and interactions with the RAS may clarify COVID-19 physiopathology and open perspectives for new treatments and strategies.
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Sales-Peres SHDC, de Azevedo-Silva LJ, Bonato RCS, Sales-Peres MDC, Pinto ACDS, Santiago Junior JF. Coronavirus (SARS-CoV-2) and the risk of obesity for critically illness and ICU admitted: Meta-analysis of the epidemiological evidence. Obes Res Clin Pract 2020; 14:389-397. [PMID: 32773297 PMCID: PMC7396969 DOI: 10.1016/j.orcp.2020.07.007] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 07/14/2020] [Accepted: 07/24/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To investigate the relationship between coronavirus disease 2019 (COVID-19) and obesity in critically ill patients admitted to the intensive care unit (ICU). METHODS We systematically searched PubMed, SCOPUS, Embase, LILACS, and Web of Science for studies published up to April 27, 2020. The outcome of interest was composite poor outcome, comprising mortality and severe COVID-19. We used a standardized data extraction form to collect information from published reports of eligible studies. Heterogeneity and publication bias were assessed using I2 statistic and funnel plots, respectively. RESULTS Nine studies including 6577 patients were selected for evaluation. The COVID-19 patients were 59.80% male and had comorbidities such as hypertension (51.51%), diabetes (30.3%), cardiovascular disease (16.66%), lung disease (15.99%), renal disease (7.49%), cancer (5.07%), and immunosuppression (1.8%). For patients with severe complications, the overall pooled event rates were 56.2% (random; 95% CI: 35.3-75.1; p = 0.015; I2 = 71.461) for obesity, 23.6% (random; 95% CI: 17.9-30.5; p = 0.000; I2 = 87.705) for type 2 diabetes, 45.9% (random; 95% CI: 38.0-53.9; p = 0.000; I2 = 90.152) for hypertension, 20.0% (random; 95% CI: 7.9-42.0; p = 0.000; I2 = 94.577) for smoking, 21.6% (random; 95% CI: 14.1-31.4%; p = 0.000, I2 = 92.983) for lung diseases, and 20.6% (random; 95% CI: 15.2-27.5; p = 0.000, I2 = 85.735) for cardiovascular diseases. DISCUSSION This systematic review indicated the relationship between obesity, ICU admission, severe COVID-19, and disease progression in patients with COVID-19. Obese patients with hypertension, type 2 diabetes, smoking habit, lung disease, and/or cardiovascular disease should be cared for with increased attention.
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Affiliation(s)
- Silvia Helena de Carvalho Sales-Peres
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, Brazil.
| | - Lucas José de Azevedo-Silva
- Department of Prosthodontics and Periodontology, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, Brazil
| | - Rafaela Carolina Soares Bonato
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, Brazil
| | | | - Ana Carolina da Silvia Pinto
- Department of Pediatric Dentistry, Orthodontics and Public Health, Bauru School of Dentistry, University of São Paulo, Al. Octávio Pinheiro Brisolla, 9-75, Vila Universitária, Bauru, Brazil
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Phipps MM, Barraza LH, LaSota ED, Sobieszczyk ME, Pereira MR, Zheng EX, Fox AN, Zucker J, Verna EC. Acute Liver Injury in COVID-19: Prevalence and Association with Clinical Outcomes in a Large U.S. Cohort. Hepatology 2020; 72:807-817. [PMID: 32473607 PMCID: PMC7300739 DOI: 10.1002/hep.31404] [Citation(s) in RCA: 248] [Impact Index Per Article: 62.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/24/2020] [Accepted: 05/28/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND AND AIMS Coronavirus disease 2019 (COVID-19) has been associated with acute liver injury (ALI) manifested by increased liver enzymes in reports worldwide. Prevalence of liver injury and associated clinical characteristics are not well defined. We aim to identify the prevalence of and risk factors for development of COVID-19-associated ALI in a large cohort in the United States. APPROACH AND RESULTS In this retrospective cohort study, all patients who underwent SARS-CoV-2 testing at three hospitals in the NewYork-Presbyterian network were assessed. Of 3,381 patients, 2,273 tested positive and had higher initial and peak alanine aminotransferase (ALT) than those who tested negative. ALI was categorized as mild if ALT was greater than the upper limit of normal (ULN) but <2 times ULN, moderate if ALT was between 2 and 5 times the ULN, and severe if ALT was >5 times the ULN. Among patients who tested positive, 45% had mild, 21% moderate, and 6.4% severe liver injury (SLI). In multivariable analysis, severe ALI was significantly associated with elevated inflammatory markers, including ferritin (odds ratio [OR], 2.40; P < 0.001) and interleukin-6 (OR, 1.45; P = 0.009). Patients with SLI had a more severe clinical course, including higher rates of intensive care unit admission (69%), intubation (65%), renal replacement therapy (RRT; 33%), and mortality (42%). In multivariable analysis, peak ALT was significantly associated with death or discharge to hospice (OR, 1.14; P = 0.044), controlling for age, body mass index, diabetes, hypertension, intubation, and RRT. CONCLUSIONS ALI is common in patients who test positive for SARS-CoV-2, but is most often mild. However, among the 6.4% of patients with SLI, a severe disease course should be anticipated.
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Affiliation(s)
- Meaghan M. Phipps
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Luis H. Barraza
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Elijah D. LaSota
- Division of Infectious DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Magdalena E. Sobieszczyk
- Division of Infectious DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Marcus R. Pereira
- Division of Infectious DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Elizabeth X. Zheng
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY,Center for Liver Disease and TransplantationColumbia University Irving Medical CenterNew YorkNY
| | - Alyson N. Fox
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY,Center for Liver Disease and TransplantationColumbia University Irving Medical CenterNew YorkNY
| | - Jason Zucker
- Division of Infectious DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY
| | - Elizabeth C. Verna
- Division of Digestive and Liver DiseasesDepartment of MedicineColumbia University Irving Medical CenterNew YorkNY,Center for Liver Disease and TransplantationColumbia University Irving Medical CenterNew YorkNY
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Palacios R, Mathias A. Learning from combination HIV prevention programmes to face COVID-19 emerging pandemic. Colomb Med (Cali) 2020; 51:e4276. [PMID: 33012888 PMCID: PMC7518725 DOI: 10.25100/cm.v51i2.4276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Before a vaccine against SARS-CoV-2 became available, several measures to control COVID-19 pandemic are necessary. Analogously, in the absence of an available vaccine, Combination HIV Prevention Programmes have consolidated a large experience of biomedical, behavioral and structural interventions suitable for several epidemiological settings. Adaptation of such experiences can organize mid-term and long-term responses to face COVID-19.
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Affiliation(s)
- Ricardo Palacios
- Instituto Butantan, Clinical Trials and Pharmacovigilance Center, São Paulo, Brazil
| | - Augusto Mathias
- Universidade de São Paulo, School of Medicine, Department of Preventive Medicine, São Paulo, Brazil
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