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ELZahrany Y, Alamry A, AlGeer A, AlKhalifah H, AlGhamdi A, AlYateem I, Alateah S, Asghar N, AlBarrak A. COVID-19 vaccine breakthrough infection among health care workers at MODHS hospitals in Saudi Arabia: A multicenter study. J Infect Public Health 2024; 17:1117-1124. [PMID: 38723321 DOI: 10.1016/j.jiph.2024.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 04/11/2024] [Accepted: 04/23/2024] [Indexed: 06/04/2024] Open
Abstract
BACKGROUND We investigated the clinical manifestation and severity of COVID-19 infection represented as a composite outcome (hospital or ICU admission, or in-hospital death) among infected fully vaccinated HCWs, the RT-PCR test Ct value (Cycle Threshold) of positive fully vaccinated HCWs, and we measure the interval from the second vaccine to acquiring the infection. METHODS A multicenter retrospective cohort study was conducted in different regions at (16) Ministry of Defense Health Services (MODHS) hospitals. Data were restricted to fully vaccinated (minimum of 2 doses) HCWs who had a confirmed positive PCR test and employed in MODHS hospitals from August 2021 to March 2022. RESULTS A total of 45862 HCWs were vaccinated as of Aug 2021. Of these 1253 participants met the selection criteria and were included in the study. The average age of infected HCWs was 35.27 years (SD = ± 8.10) of which 57% were females. The HCWs were employed as doctors (24%), nurses (33%), and other (43%). The most administered vaccine type was mRNA (44%) followed by Adenovirus Viral Vector (39%) and mixed vaccine (17%). The incidence of COVID-19 vaccine breakthrough (BT) infection among HCWs was observed at 2.73% (m-RNA 3.19%, Viral Vector 2.83% and mixed 1.87%). CONCLUSION the overall COVID-19 (BT) infection incidence proportion was (2.73%), with the Mixed vaccine group showing the lowest (BT) incidence proportion (1.87%). The most commonly reported symptoms among (BT) infections were cough (51%), sore throat (51%), fever (47%), headache (31%), and runny nose (23%), with overall (6%) asymptomatic (BT) infections. We had (1%) hospital admissions, Zero ICU admission, and Zero deaths. our finding may indicate that infection affecting fully vaccinated patients were less severe and mostly affected the upper respiratory tract.
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Affiliation(s)
- Yazeed ELZahrany
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia.
| | - Ahmed Alamry
- Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Abdulrahman AlGeer
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Hamzah AlKhalifah
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Department of Family and Community medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Alaa AlGhamdi
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Iyad AlYateem
- Center of Infection Prevention & Control (CIPC), Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Souad Alateah
- Department of Microbiology, Virology, and molecular virology, Central Laboratory& Blood Bank, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
| | - Nassirah Asghar
- Research Center, Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia
| | - Ali AlBarrak
- Ministry of Defense Health Services General Directorate (MODHS), Riyadh, Kingdom of Saudi Arabia; Infectious Diseases Division, Department of Internal medicine, Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia
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Nour D, Ismail MB, Osman M, Rafei R, Kasir D, Dabboussi F, Colson P, Hamze M. Evaluation of SARS-CoV-2 anti-Spike antibody levels and breakthrough infection risk among vaccinated adults in North Lebanon. PLoS One 2024; 19:e0302579. [PMID: 38722969 PMCID: PMC11081361 DOI: 10.1371/journal.pone.0302579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Accepted: 04/04/2024] [Indexed: 05/13/2024] Open
Abstract
Since March 2020, the COVID-19 pandemic has swiftly propagated, triggering a competitive race among medical firms to forge vaccines that thwart the infection. Lebanon initiated its vaccination campaign on February 14, 2021. Despite numerous studies conducted to elucidate the characteristics of immune responses elicited by vaccination, the topic remains unclear. Here, we aimed to track the progression of anti-spike SARS-CoV-2 antibody titers at two-time points (T1: shortly after the second vaccination dose, T2: six months later) within a cohort of 201 adults who received Pfizer-BioNTech (BNT162b2), AstraZeneca, or Sputnik V vaccines in North Lebanon. Blood specimens were obtained from participants, and antibody titers against SARS-CoV-2 were quantified through the Elecsys-Anti-SARS-CoV-2 S assay (Roche Diagnostics, Switzerland). We used univariate analysis and multivariable logistic regression models to predict determinants influencing the decline in immune response and the occurrence of breakthrough infections among vaccinated patients. Among the 201 participants, 141 exhibited unchanging levels of antibody titers between the two sample collections, 55 displayed waning antibody titers, and only five participants demonstrated heightened antibody levels. Notably, age emerged as the sole variable significantly linked to the waning immune response. Moreover, the BNT162b2 vaccine exhibited significantly higher efficacy concerning the occurrence of breakthrough infections when compared with the AstraZeneca vaccine. Overall, our study reflected the immune status of a sample of vaccinated adults in North Lebanon. Further studies on a larger scale are needed at the national level to follow the immune response after vaccination, especially after the addition of the third vaccination dose.
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Affiliation(s)
- Dalal Nour
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- Aix-Marseille Univ., Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Marseille, France
| | - Mohamad Bachar Ismail
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
- Faculty of Sciences, Lebanese University, Tripoli, Lebanon
| | - Marwan Osman
- Department of Neurosurgery, Yale University School of Medicine, New Haven, CT, United States of America
| | - Rayane Rafei
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Dalal Kasir
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Fouad Dabboussi
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
| | - Philippe Colson
- Aix-Marseille Univ., Institut de Recherche pour le Développement (IRD), Microbes Evolution Phylogeny and Infections (MEPHI), Marseille, France
- IHU Méditerranée Infection, Marseille, France
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Marseille, France
| | - Monzer Hamze
- Laboratoire Microbiologie Santé et Environnement (LMSE), Doctoral School of Science & Technology, Faculty of Public Health, Lebanese University, Tripoli, Lebanon
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Mohammed RA, Baqais O, Basalib SG, Owaidah AA, Mirza A, Alharizi RM, Sultan I. Post-COVID-19 Vaccination Infection Among Adults in Saudi Arabia: A Cross-Sectional Study. Cureus 2023; 15:e47552. [PMID: 38021606 PMCID: PMC10665761 DOI: 10.7759/cureus.47552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND While vaccines were one of the most effective tools to combat the COVID-19 pandemic, breakthrough infections have been reported. AIM OF THE WORK We aim to evaluate the effectiveness of Pfizer and AstraZeneca vaccines in preventing breakthrough infection, as well as to determine the possible risk factors and outcomes of post-vaccination infection. METHODS This is a cross-sectional study using self-reported data of adult Saudi residents, including Saudi and non-Saudi people who received at least two doses of either Pfizer or AstraZeneca vaccines. Based on the presence of COVID-19 symptoms that were confirmed by PCR, the participants were classified into three groups: (1) those with evidence of infection before vaccination, (2) those who had infection after vaccination, and (3) those who had infection before and after vaccination. For further evaluation, we compared the severity and outcomes in the participants who were infected before and after vaccination. RESULTS The study included 694 participants: 69.1% received three doses of the vaccine, and 71.1% of them were vaccinated with the Pfizer vaccine. COVID-19 infection was reported in 48.3% of the total subjects, with a higher infection rate (17.8%) after vaccination compared to 12.5% before vaccination. Additionally, 18.32% of participants experienced infection both before and after vaccination. Out of the total 694 participants, 137 (19.7%) had breakthrough infections. Pfizer vaccine was more prevalent among the non-infected group (74.25% vs. 65.5%), while AstraZeneca vaccine was more prevalent among the infected group (6.4% vs. 5.9% (p<0.039). Diabetes was significantly higher among the infected group (16.9% vs. 8.1%, p=0.001, OR=2.29, 95% CI=1.42-3.68). Among those who were infected before and after vaccination, 71.9% reported less severe symptoms after vaccination. CONCLUSION Breakthrough infections may occur after vaccination; however, vaccines are overall effective in preventing severe symptoms. Pfizer vaccine appeared to be more effective in preventing COVID-19 infection. The presence of comorbidities, including diabetes, may increase the risk of infection.
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Affiliation(s)
- Rehab A Mohammed
- Department of Internal Medicine, Faculty of Medicine for Girls, Al-Azhar University, Cairo, EGY
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Omar Baqais
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Samaher G Basalib
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Abdulaziz A Owaidah
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Abdulrahman Mirza
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
| | - Randa M Alharizi
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
- Department of Internal Medicine, Faculty of Medicine, Cairo University, Cairo, EGY
| | - Intessar Sultan
- Department of Medicine, Ibn Sina National College for Medical Studies, Jeddah, SAU
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Meister T, Kolde A, Fischer K, Pisarev H, Kolde R, Kalda R, Suija K, Tisler A, Uusküla A. A retrospective cohort study of incidence and risk factors for severe SARS-CoV-2 breakthrough infection among fully vaccinated people. Sci Rep 2023; 13:8531. [PMID: 37237050 DOI: 10.1038/s41598-023-35591-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/20/2023] [Indexed: 05/28/2023] Open
Abstract
SARS-CoV-2 vaccination is currently the mainstay in combating the COVID-19 pandemic. However, there are still people among vaccinated individuals suffering from severe forms of the disease. We conducted a retrospective cohort study based on data from nationwide e-health databases. The study included 184,132 individuals who were SARS-CoV-2 infection-naive and had received at least a primary series of COVID-19 vaccination. The incidence of BTI (breakthrough infection) was 8.03 (95% CI [confidence interval] 7.95⎼8.13/10,000 person-days), and for severe COVID-19 it was 0.093 (95% CI 0.084⎼ 0.104/10,000 person-days). The protective effect of vaccination against severe COVID-19 remained constant for up to six months, and the booster dose offered an additional pronounced benefit (hospitalization aHR 0.32, 95% CI 0.19⎼0.54). The risk of severe COVID-19 was higher among those ≥ 50 years of age (aHR [adjusted hazard ratio] 2.06, 95% CI 1.25⎼3.42) and increased constantly with every decade of life. Male sex (aHR 1.32, 95% CI 1.16⎼1.45), CCI (The Charlson Comorbidity Index) score ≥ 1 (aHR 2.09, 95% CI 1.54⎼2.83), and a range of comorbidities were associated with an increased risk of COVID-19 hospitalization. There are identifiable subgroups of COVID-19-vaccinated individuals at high risk of hospitalization due to SARS-CoV-2 infection. This information is crucial to driving vaccination programs and planning treatment strategies.
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Affiliation(s)
- Tatjana Meister
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia.
| | - Anastassia Kolde
- Institute of Mathematics and Statistics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Krista Fischer
- Institute of Mathematics and Statistics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
- Institute of Genomics, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Heti Pisarev
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Raivo Kolde
- Institute of Computer Science, Faculty of Science and Technology, University of Tartu, Tartu, Estonia
| | - Ruth Kalda
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Kadri Suija
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anna Tisler
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | - Anneli Uusküla
- Institute of Family Medicine and Public Health, Faculty of Medicine, University of Tartu, Tartu, Estonia
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Taus E, Hofmann C, Ibarrondo FJ, Gong LS, Hausner MA, Fulcher JA, Krogstad P, Kitchen SG, Ferbas KG, Tobin NH, Rimoin AW, Aldrovandi GM, Yang OO. Persistent memory despite rapid contraction of circulating T Cell responses to SARS-CoV-2 mRNA vaccination. Front Immunol 2023; 14:1100594. [PMID: 36860850 PMCID: PMC9968837 DOI: 10.3389/fimmu.2023.1100594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/24/2023] [Indexed: 02/17/2023] Open
Abstract
Introduction While antibodies raised by SARS-CoV-2 mRNA vaccines have had compromised efficacy to prevent breakthrough infections due to both limited durability and spike sequence variation, the vaccines have remained highly protective against severe illness. This protection is mediated through cellular immunity, particularly CD8+ T cells, and lasts at least a few months. Although several studies have documented rapidly waning levels of vaccine-elicited antibodies, the kinetics of T cell responses have not been well defined. Methods Interferon (IFN)-γ enzyme-linked immunosorbent spot (ELISpot) assay and intracellular cytokine staining (ICS) were utilized to assess cellular immune responses (in isolated CD8+ T cells or whole peripheral blood mononuclear cells, PBMCs) to pooled peptides spanning spike. ELISA was performed to quantitate serum antibodies against the spike receptor binding domain (RBD). Results In two persons receiving primary vaccination, tightly serially evaluated frequencies of anti-spike CD8+ T cells using ELISpot assays revealed strikingly short-lived responses, peaking after about 10 days and becoming undetectable by about 20 days after each dose. This pattern was also observed in cross-sectional analyses of persons after the first and second doses during primary vaccination with mRNA vaccines. In contrast, cross-sectional analysis of COVID-19-recovered persons using the same assay showed persisting responses in most persons through 45 days after symptom onset. Cross-sectional analysis using IFN-γ ICS of PBMCs from persons 13 to 235 days after mRNA vaccination also demonstrated undetectable CD8+ T cells against spike soon after vaccination, and extended the observation to include CD4+ T cells. However, ICS analyses of the same PBMCs after culturing with the mRNA-1273 vaccine in vitro showed CD4+ and CD8+ T cell responses that were readily detectable in most persons out to 235 days after vaccination. Discussion Overall, we find that detection of spike-targeted responses from mRNA vaccines using typical IFN-γ assays is remarkably transient, which may be a function of the mRNA vaccine platform and an intrinsic property of the spike protein as an immune target. However, robust memory, as demonstrated by capacity for rapid expansion of T cells responding to spike, is maintained at least several months after vaccination. This is consistent with the clinical observation of vaccine protection from severe illness lasting months. The level of such memory responsiveness required for clinical protection remains to be defined.
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Affiliation(s)
- Ellie Taus
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States
| | - Christian Hofmann
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - F Javier Ibarrondo
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Laura S Gong
- Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Mary Ann Hausner
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Jennifer A Fulcher
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Paul Krogstad
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States.,Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Scott G Kitchen
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Kathie G Ferbas
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Nicole H Tobin
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Anne W Rimoin
- Fielding School of Public Health, University of California Los Angeles, Los Angeles, CA, United States
| | - Grace M Aldrovandi
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Otto O Yang
- Department of Medicine, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States.,Department of Microbiology, Immunology, and Molecular Genetics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, United States
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Almufty HB, Mamani MMA, Ali AH, Merza MA. COVID-19 vaccine breakthrough infection among fully vaccinated healthcare workers in Duhok governorate, Iraqi Kurdistan: A retrospective cohort study. J Med Virol 2022; 94:5244-5250. [PMID: 35811398 PMCID: PMC9350230 DOI: 10.1002/jmv.27985] [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: 05/09/2022] [Revised: 06/15/2022] [Accepted: 07/02/2022] [Indexed: 12/15/2022]
Abstract
The aims of this study were: to determine the incidence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among vaccinated healthcare workers (HCWs), assess risk factors associated with the vaccine breakthrough (BT), and compare the effectiveness of vaccine manufacturers against SARS-CoV-2 variant of concern among HCWs in Duhok governorate. It is a multicenter retrospective cohort study, which enrolled 944 HCWs through March 2022. COVID-19 vaccinated HCWs aging 18 and above were included. A random sampling process was performed by asking the participants to fill out a standardized questionnaire by means of interviews or participant-completed surveys. Fully vaccinated HCWs with positive polymerase chain reaction tests were considered to have vaccine BT infection. Two hundred and eighty-four (30.1%) out of 944 vaccinated HCWs had SARS-CoV-2 infection postvaccination, of whom 241 (84.9%) were fully vaccinated, concluding that the incidence of BT infection is 25.5%. There were 422 (44.7%) males and 522 (55.3%) females. Most vaccine BT infections had developed in SARS-CoV-2 Omicron variant (53.5%). The majority of BT infections were mild to moderate (95.5%). Occupation, namely dentist was a significant risk factor, with a p value of 0.001. HCWs with a history of SARS-CoV-2 infection prevaccination were more prone to a vaccine BT infection (p value =0.002). Pfizer vaccine manufacturers revealed the highest effectiveness against BT infection (p value =0.0001). Paramedics showed a significant association with the disease severity (p value =0.02). The three available vaccine manufacturers in the Duhok governorate are effective against COVID-19 BT infections. Dentists and paramedics were significantly associated with poor COVID-19 outcomes.
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Affiliation(s)
- Hind B. Almufty
- Department of Clinical Pharmacy, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
| | - Masoud M. Ameen Mamani
- Department of Pharmaceutics, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
| | - Ali H. Ali
- Duhok Directorate of HealthDuhokIraqi KurdistanIraq
| | - Muayad A. Merza
- Department of Internal Medicine, Azadi Teaching Hospital, College of PharmacyUniversity of DuhokDuhokIraqi KurdistanIraq
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