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Abbas I, Hildreth MB. Trichostrongyle infections in domestic ruminants from Egypt: A systematic review and meta-analysis. Vet Parasitol Reg Stud Reports 2022; 34:100761. [PMID: 36041796 DOI: 10.1016/j.vprsr.2022.100761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 07/01/2022] [Accepted: 07/10/2022] [Indexed: 06/15/2023]
Abstract
Trichostrongylid nematodes can cause serious loss in the livestock economy; nevertheless, infections with these ubiquitous nematodes in animals from developing countries are largely neglected. The present paper provides a systematic review and meta-analysis to evaluate the status of trichostrongyle infections in domestic ruminants from Egypt. Out of 626 collected publications, 118 were defined suitable for inclusion in this review and represented trichostrongyle infections in 5 ruminant species (sheep, goats, cattle, buffaloes and camels) from Egypt. Published surveys have mostly focused on sheep, which had the highest (44.8%) pooled prevalence of trichostrongyle infections based on 95% confidence interval (35.9-53.6%) with no significant variations among sheep in different Egyptian regions. Goats had lower infection prevalence (31.2%, 21.5-40.8%) in comparison to sheep, and no significant regional differences were also found. The management and marketing practices likely account for the wide distribution of infection among small ruminants across Egypt. Variable trichostrongyle infection rates were estimated for camels (38.8%, 28.9-48.7%), cattle (27.4%, 14.4-40.3%) and buffaloes (12.2%, 8.0-16.4%). The prevalence of infection was significantly high during winter (52.1%, 32.2-72.1%), which provide favorable conditions for development and survival of larvae on pastures. The most common trichostrongyle identified in infected animals was Haemonchus contortus. The parasite was detected in 38.8% (29.9-47.6%) of infected sheep, 35.3% (24.8-45.7%) of infected goats and in 40.6% (18.6-62.5%) of infected camels. Clinical infections have been reported in a limited number of studies. Analysis of fecal egg counts (FECs) revealed that more than half (52.7%, 30.4-75.0%) of the tested sheep had low counts (<500 eggs per gram EPG), whereas only a few sheep (6.1%, 3.5-8.7%) had high counts >2000 EPG, implying that subclinical infections are common; however, the clinical infections cannot be completely ruled out. Anthelmintic resistance does not appear to be serious in trichostrongyle populations infecting ruminants from Egypt; nonetheless there have been a few cases of albendazole resistance in trichostrongyles infecting sheep. This paper contributes to a better understanding of the epidemiology and economic implications of trichostrongyle infections in ruminants from Egypt, which is crucial for establishing effective control strategies against these ubiquitous nematodes.
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Affiliation(s)
- Ibrahim Abbas
- Parasitology Department, Faculty of Veterinary Medicine, Mansoura University, Mansoura 35516, Egypt.
| | - Michael B Hildreth
- Department of Biology and Microbiology, South Dakota State University, Brookings 57007, SD, USA
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Abdel‑Fatah OR, Arafa WM, Wahba AA, El‑Dakhly KM. Tegumental alterations and resistance of Fasciola gigantica adult worms exposed to flukicides in Egypt. BENI-SUEF UNIVERSITY JOURNAL OF BASIC AND APPLIED SCIENCES 2022. [DOI: 10.1186/s43088-022-00287-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The current study was designed to investigate the in vitro effect of commercially available fasciolicides; albendazole (40 and 400 µg/ml), triclabendazole, rafoxanide and nitroxynil (50 and 100 µg/ml, each) against Fasciola gigantica adult worms. For all, worms were incubated for 3 h. Worm's motility was macroscopically and microscopically detected. Reduction of egg deposition was estimated. Alterations of worm's cuticle post-treatments were recorded using scanning electron microscopy (SEM).
Results
Nitroxynil had the most flukicidal effect with mild movement quickly disappeared within 15 min post-treatment. It showed the highest egg reduction (88.3% and 95% at concentrations of 50 and 100 µg/ml, respectively). Findings of SEM showed severe furrowing and destruction of spines. In rafoxanide-treated group, the motility disappeared 75 min post-treatment, and the egg deposition was significantly (P ≤ 0.05) reduced to 70% and 85% at the same concentrations. Teguments showed thickening, moderate furrowing and destruction of the spines. Albendazole showed the lowest effect: the motility of the worms was observed till 160 min post-treatment and the egg reduction was 43% and 75% at the same concentrations. Interestingly, in albendazole-treated flukes, the tegument had severe furrowing and spines were completely sloughed. Similarly, in triclabendazole-treated flukes, worms motility was observed till 160 min post-treatment and the egg reduction was 76.6% and 88.3%. The tegument showed swelling and mild furrowing with moderately damaged spines.
Conclusions
Nitroxynil was the most potent flukicide inducing evidential cuticular changes. Although albendazole induced the most potent cuticular damage, it showed the lowest flukicidal effect. Further in vivo study to investigate resistance/susceptibility of Fasciola species in cattle and buffaloes will be carried out.
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Aboelhadid SM, Arafa WM, El-Ashram S, Noaman AF, Shokier KA, Darwish AB, Mahmoud MM, Gadelhaq SM. Haemonchus contortus Susceptibility and Resistance to Anthelmintics in Naturally Infected Egyptian Sheep. Acta Parasitol 2021; 66:329-335. [PMID: 32979177 DOI: 10.1007/s11686-020-00284-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 09/15/2020] [Indexed: 01/20/2023]
Abstract
PURPOSE Susceptibility and resistance of Haemonchus contortus to anthelmintic drugs, including ivermectin, levamisole, and albendazole in naturally infected sheep were investigated. METHODS Three sets of assays were conducted to detect drug efficacy. Firstly, in vivo estimation of drug resistance to H. contortus was explored in 80 sheep naturally infected with H. contortus. Sheep were divided into four equal groups (20 sheep for each group): the first group was treated with albendazole (5.00 mg/kg BW), the second with levamisole (7.50 mg/kg BW), the third with ivermectin (0.20 mg/kg BW), and the fourth group served as the untreated control. Fecal egg reduction test (FERT) was done at days 7 and 14 after treatment. Secondly, for in vitro egg hatching assay (EHA), H. contortus eggs from naturally infected sheep were collected and treated with 0.0002, 0.002, 0.02, 0.2, and 2.0 µg/mL albendazole. Thirdly, molecular detection of the albendazole resistance gene in adult male H. contortus worms and larvae from infected sheep was carried out using allele-specific PCR. RESULTS The FECRT results showed that the drug efficacy was 86.84% for albendazole and 100% for both levamisole and ivermectin. The result of EHA showed that eggs did not hatch at 2.0 µg/mL albendazole concentration. Molecular findings showed two forms, including H. contortus homozygous susceptible (SS) and heterozygous (RS) of "β-tubulin" gene at 200 sites, which were recorded in both single male worms and larvae. CONCLUSION H. contortus, which was susceptible to levamisole and ivermectin, had developed resistance to albendazole.
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Affiliation(s)
- Shawky M Aboelhadid
- Parasitology Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt.
| | - Waleed M Arafa
- Parasitology Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Saeed El-Ashram
- College of Life Science and Engineering, Foshan University, 18 Jiangwan Street, Foshan, 528231, Guangdong Province, China
| | - Asmaa Fathy Noaman
- Parasitology Department, Animal Health Research Institute, Beni Suef, Egypt
| | - Khalid A Shokier
- Parasitology Department, Animal Health Research Institute, Beni Suef, Egypt
| | - Ahmed B Darwish
- Department of Zoology, Faculty of Science, Suez University, Suez, Egypt
| | - Morad M Mahmoud
- Internal Medicine Department, Faculty of Veterinary Medicine, Beni-Suef University, Beni Suef, Egypt
| | - Sahar M Gadelhaq
- Department of Parasitology, Faculty of Veterinary Medicine, Minia University, El-Minia, Egypt
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Pitaksakulrat O, Chaiyasaeng M, Artchayasawat A, Eamudomkarn C, Thongsahuan S, Boonmars T. The first molecular identification of benzimidazole resistance in Haemonchus contortus from goats in Thailand. Vet World 2021; 14:764-768. [PMID: 33935425 PMCID: PMC8076480 DOI: 10.14202/vetworld.2021.764-768] [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] [Received: 09/23/2020] [Accepted: 02/05/2021] [Indexed: 11/16/2022] Open
Abstract
Background and Aim Haemonchus contortus is one of the major trichostrongyloid nematodes affecting small ruminant production worldwide, especially in tropical and subtropical regions. Adult H. contortus suck the blood from the host abomasum leading to anemia and often death in heavily infected animals. The mainstay of parasitic control is an anthelmintic drug, but long-term drug use may cause drug resistance. The aim of this study was to examine benzimidazole resistance in H. contortus of goats from different regions in Thailand by detecting the frequency of the F200Y polymorphism in the β-tubulin isotype 1 gene. Materials and Methods A total of 121 H. contortus adults were obtained from 31 naturally infected out of 37 slaughtered goats from city abattoirs in five regions of Thailand. The frequency of the F200Y polymorphism in the β-tubulin isotype 1 gene was detected following the allele-specific polymerase chain reaction protocol. Results The overall genotype frequencies in Thailand were homozygous resistant (RR: 24%), heterozygous (SR: 44.6%), and homozygous susceptible (SS: 31.4%). The allele frequencies were resistant allele (R: 46%) and susceptible allele (S: 54%). The R allele frequency and the RR genotype varied from 30% to 65% and 0% to 43.9%, respectively. The frequency of R alleles was significantly higher in the southern region (0.65) as compared to northern (0.30, p=0.001), western (0.38, p=0.04), and central regions (0.30, p=0.03). The RR genotype was also significantly higher in the southern region (43.9%) versus the northern (0 %, p=0.001), western (11.8%, p=0.012), and central regions (17.4%, p=0.001). Conclusion This is the first study of the detection of single-nucleotide polymorphisms in codon 200 of the β-tubulin isotype 1 gene of H. contortus from goats in Thailand. These findings are essential and imply that an integrated approach is needed for issues such as drug treatment, farm management, prevention, and control strategies. This is of interest to farmers, veterinarians, and the department of livestock.
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Affiliation(s)
- Opal Pitaksakulrat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Liver Fluke and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Monticha Chaiyasaeng
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Liver Fluke and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Atchara Artchayasawat
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Liver Fluke and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Chatanun Eamudomkarn
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Liver Fluke and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand
| | - Sorawat Thongsahuan
- Faculty of Veterinary Science, Prince of Songkla University, Songkhla 90110, Thailand
| | - Thidarut Boonmars
- Department of Parasitology, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Liver Fluke and Cholangiocarcinoma Research Institute, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.,Neglected, Zoonosis and Vector-Borne Disease Research Group, Khon Kaen University, Khon Kaen 40002, Thailand
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Mohammedsalih KM, Krücken J, Khalafalla A, Bashar A, Juma FR, Abakar A, Abdalmalaik AAH, Coles G, von Samson-Himmelstjerna G. New codon 198 β-tubulin polymorphisms in highly benzimidazole resistant Haemonchus contortus from goats in three different states in Sudan. Parasit Vectors 2020; 13:114. [PMID: 32122383 PMCID: PMC7053126 DOI: 10.1186/s13071-020-3978-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 02/17/2020] [Indexed: 01/12/2023] Open
Abstract
Background Benzimidazole (BZ) resistance in gastrointestinal nematodes is a worldwide problem for livestock production, particularly in small ruminants. Assignment of the emergence of resistance using sensitive and reliable methods is required to adopt the correct strategies for control. In Sudan, BZ resistant Haemonchus contortus populations were recently reported in goats in South Darfur. This study aimed to provide additional data regarding albendazole efficacy and to describe the prevailing molecular BZ resistance mechanisms. Methods Faecal egg count reduction and egg hatch tests (EHT) were used to evaluate albendazole efficacy in three different areas of South Darfur using naturally (Rehed Al-Birdi and Tulus) and experimentally infected (Tulus and Um Dafuq) goats. Using samples from Central, East and South Darfur, pyro- and Sanger sequencing were used to detect the polymorphisms F167Y, E198A and F200Y in H. contortus isotype 1 β-tubulin in DNA extracted from pooled third-stage larval (L3) samples (n = 36) on days 0 and 10 during trials, and from pooled adult male H. contortus (treated goats, n = 14; abattoirs, n = 83) including samples from populations previously found to be resistant in South Darfur. Results Albendazole efficacies at 5, 7.5 and 10 mg/kg doses were 73.5–90.2% on day 14 in natural and experimental infections while 12.5 mg/kg showed > 96.6% efficacy. EC50 in the EHT were 0.8 and 0.11 µg/ml thiabendazole in natural and experimental infection trials, respectively. PCRs detected Haemonchus, Trichostrongylus and Cooperia in L3 samples from albendazole-treated goats. Haemonchus contortus allele frequencies in codons 167 and 200 using pyrosequencing assays were ≤ 7.4% while codon 198 assays failed. Sanger sequencing revealed five novel polymorphisms at codon 198. Noteworthy, an E198L substitution was present in 82% of the samples (L3 and adults) including all post-treatment samples. Moreover, E198V, E198K and potentially E198I, and E198Stop were identified in a few samples. Conclusions To our knowledge, this is the first report of E198L in BZ resistant H. contortus and the second where this is the predominant genotype associated with resistance in any strongyle species. Since this variant cannot be quantified using pyrosequencing, the results highlight important limitations in the general applicability of pyrosequencing to quantify BZ resistance genotypes.![]()
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Affiliation(s)
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163, Berlin, Germany
| | - Amna Khalafalla
- Faculty of Veterinary Medicine, University of Khartoum, PO Box 32, Khartoum North, Sudan
| | - Ahmed Bashar
- Faculty of Veterinary Science, University of Nyala, Nyala, Sudan
| | | | - Adam Abakar
- Faculty of Medical Laboratory Sciences, University of Gezira, PO Box 20, Wad Medani, Sudan
| | | | - Gerald Coles
- Ubley Biologics, PO Box 170, Ubley, Bristol, BS40 6JA, UK
| | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163, Berlin, Germany
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Mohammedsalih KM, Khalafalla A, Bashar A, Abakar A, Hessain A, Juma FR, Coles G, Krücken J, von Samson-Himmelstjerna G. Epidemiology of strongyle nematode infections and first report of benzimidazole resistance in Haemonchus contortus in goats in South Darfur State, Sudan. BMC Vet Res 2019; 15:184. [PMID: 31164118 PMCID: PMC6549335 DOI: 10.1186/s12917-019-1937-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 05/29/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Since pastoralists in South Darfur, Sudan, had complained about lack of albendazole (ABZ) efficacy to control nematodes in goats, the frequency of infection with gastrointestinal helminths was studied before in vivo faecal egg count reduction tests (FECRT) were conducted using ABZ orally either at the dose recommended for sheep, 5 mg/kg body weight (bw) or at 10 mg/kg bw. Experiments included goats naturally infected with gastrointestinal nematodes or experimentally infected with local Haemonchus contortus isolates. Three study areas (Nyala, Beleil and Kass) were visited in autumn or winter. RESULTS Out of 478 screened goats, 82.4% were infected with gastrointestinal helminths and 82% were shedding eggs of strongyle nematodes with 90% of the strongyle larvae representing Haemonchus spp. A FECRT using naturally infected goats (n = 225: 71 untreated, 104 and 50 treated with 5 and 10 mg ABZ/kg bw, respectively) detected reduced ABZ efficacy in Nyala and Kass. Paired and unpaired FECRT calculations detected reductions of 72-92% with samples taken at 8 days post treatment with 5 mg ABZ/kg bw and of 85-94% with 10 mg ABZ/kg bw. The FECRT based on day 14 post treatment samples showed reductions of 69-77% with 5 mg/kg and of 75-87% with 10 mg ABZ/kg bw. In Beleil, ABZ efficacy was 95%. In the egg hatch test EC50 values for Nyala and Kass ranged from 0.12-0.24 μg thiabendazole/ml, corresponding to benzimidazole resistant phenotypes. Only Haemonchus spp. larvae were present after treatments in coprocultures. When the efficacy was evaluated experimentally using isolates of H. contortus from Nyala and Kass, the 5 mg ABZ/kg dose revealed reductions of 76-78% on day 8 and of 62-70% on day 14 with the unpaired method. Using 10 mg ABZ/kg, the FECR was still only 77-82%. CONCLUSIONS Both, in vivo and in vitro methods detected resistant H. contortus populations in goats from South Darfur State. The time point 14 days post treatment was more sensitive for detection of ABZ resistance than 8 days post treatment. This is the first report on the occurrence of anthelmintic resistance in Sudan confirming that anthelmintic resistance selection is occurring in African subsistence farming systems.
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Affiliation(s)
- Khalid M Mohammedsalih
- Faculty of Veterinary Science, University of Nyala, P.O. Box 155, Nyala, Sudan.,Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Amna Khalafalla
- Faculty of Veterinary Medicine, University of Khartoum, P.O. Box 32, Khartoum North, Sudan
| | - Ahmed Bashar
- Faculty of Veterinary Science, University of Nyala, P.O. Box 155, Nyala, Sudan
| | - Adam Abakar
- Faculty of Medical Laboratory Sciences, University of Gezira, P.O. Box 20, Wadmedani, Sudan
| | - Abdelhakaim Hessain
- Faculty of Veterinary Science, University of Nyala, P.O. Box 155, Nyala, Sudan
| | - Fathel-Rahman Juma
- Faculty of Veterinary Science, University of Nyala, P.O. Box 155, Nyala, Sudan
| | - Gerald Coles
- Ubley Biologics, P.O. Box 170, Bristol, Ubley, BS40 6JA, UK
| | - Jürgen Krücken
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163, Berlin, Germany.
| | - Georg von Samson-Himmelstjerna
- Institute for Parasitology and Tropical Veterinary Medicine, Freie Universität Berlin, Robert-von-Ostertag-Str. 7-13, 14163, Berlin, Germany
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Munguía B, Teixeira R, Veroli MV, Marín M, Domínguez L. Molecular analysis of benzimidazole-resistance associated SNPs in Haemonchus contortus populations of Uruguay. VETERINARY PARASITOLOGY- REGIONAL STUDIES AND REPORTS 2018; 13:110-114. [PMID: 31014856 DOI: 10.1016/j.vprsr.2018.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/25/2018] [Accepted: 05/11/2018] [Indexed: 11/26/2022]
Abstract
Haemonchus contortus is one of the most important parasite nematodes of small ruminants around the world and causes great economic losses in livestock production. Control of gastrointestinal nematode infections, like haemonchosis, relies mainly on anthelmintic drugs, but its excessive and inappropriate use has caused serious drug resistance issues in many countries, including Uruguay, where sheep production occupies an important place in the country's economy. Benzimidazole (BZ) anthelmintics have been used for decades to treat sheep against H. contortus infection and resistance to this anthelmintic group has been widely described. Molecularly, BZ resistance in H. contortus has been correlated with single nucleotide polymorphisms (SNPs) of the β-tubulin isotype 1 gene at codon 200 and 167 (both TTC to TAC, F167Y and F200Y) and at codon 198 (GAA to GCA, E198A).The aim of this work was to explore the presence of these tubulin SNPs in H. contortus adult worms recovered from sheep abomasa from a slaughterhouse in Uruguay. The mean resistant allelic frequencies at positions F167Y and F200Y were 20.25 and 47.45%, respectively, for worms recovered from naturally infected sheep slaughtered in 2013, while those that were slaughtered in 2014 presented only F200Y SNP with a frequency of 86.89%. Also H. contortus Kirby adult worms (anthelmintic- susceptible McMaster isolate), recovered from artificially infected sheep, were analyzed as reference for comparative purposes This analysis showed susceptible genotype at 167 and 198 position, and a low level of the resistance allele at the 200 position (3.66%). This is the first study for the presence of SNPs in the isotype-1 β-tubulin gene of H. contortus populations in Uruguay, which is consistent with the previous epidemiological studies carried out through the method of fecal egg count reduction test (FECRT), thus confirming the serious resistance levels to BZ anthelmintics also in this country.
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Affiliation(s)
- Beatriz Munguía
- Área de Farmacología, Depto. CIENFAR, Facultad de Química, Universidad de la República (Udelar), General Flores 2124, 11800 Montevideo, Uruguay.
| | - Ramiro Teixeira
- Área de Farmacología, Depto. CIENFAR, Facultad de Química, Universidad de la República (Udelar), General Flores 2124, 11800 Montevideo, Uruguay
| | - Maria Victoria Veroli
- Sección Bioquímica y Biología Molecular, Facultad de Ciencias, Udelar, Iguá 4225, 11400 Montevideo, Uruguay
| | - Mónica Marín
- Sección Bioquímica y Biología Molecular, Facultad de Ciencias, Udelar, Iguá 4225, 11400 Montevideo, Uruguay
| | - Laura Domínguez
- Área de Farmacología, Depto. CIENFAR, Facultad de Química, Universidad de la República (Udelar), General Flores 2124, 11800 Montevideo, Uruguay
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A novel controlled release microsponges containing Albendazole against Haemonchus contortus in experimentally infected goats. J Drug Deliv Sci Technol 2018. [DOI: 10.1016/j.jddst.2017.10.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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