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Jafri L, Khan AH, Ilyas M, Nisar I, Khalid J, Majid H, Hotwani A, Jehan F. Metabolomics of a neonatal cohort from the Alliance for Maternal and Newborn Health Improvement biorepository: Effect of preanalytical variables on reference intervals. PLoS One 2023; 18:e0279931. [PMID: 36607993 PMCID: PMC9821480 DOI: 10.1371/journal.pone.0279931] [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: 07/06/2022] [Accepted: 12/18/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND The study was conducted to determine reference interval (RI) and evaluate the effect of preanalytical variables on Dried blood spot (DBS)-amino acids, acylcarnitines and succinylacetone of neonates. METHODOLOGY DBS samples were collected within 48-72 hours of life. Samples were analyzed for biochemical markers on tandem mass spectrometer at the University of Iowa. Comparison of RI across various categorical variables were performed. RESULTS A total of 610 reference samples were selected based on exclusion criteria; 53.2% being females. Mean gestational age (GA) of mothers at the time of delivery was 38.7±1.6 weeks; 24.5% neonates were of low birth weight and 14.3% were preterm. Out of the total 610 neonates, 23.1% were small for GA. Reference intervals were generated for eleven amino acids, thirty-two acylcarnitines and succinylacetone concentrations. Markers were evaluated with respect to the influence of gender, GA, weight and time of sampling and statistically significant minimal differences were observed for some biomarkers. CONCLUSION RI for amino acids, succinylacetone and acylcarnitine on DBS has been established for healthy neonates, which could be of use in the clinical practice. Clinically significant effect of GA, weight, gender and time of sampling on these markers were not identified.
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Affiliation(s)
- Lena Jafri
- Department of Pathology and Laboratory Medicine, Chemical Pathology, Aga Khan University, Karachi, Pakistan
- * E-mail: (LJ); (FJ)
| | - Aysha Habib Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammad Ilyas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Javairia Khalid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Hafsa Majid
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Aneeta Hotwani
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Fyezah Jehan
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
- * E-mail: (LJ); (FJ)
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Ahmed S, Jafri H, Rashid Y, Ehsan Y, Bashir S, Ahmed M. Cascade screening for beta-thalassemia in Pakistan: development, feasibility and acceptability of a decision support intervention for relatives. Eur J Hum Genet 2021; 30:73-80. [PMID: 34121090 PMCID: PMC8200315 DOI: 10.1038/s41431-021-00918-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/20/2021] [Accepted: 05/25/2021] [Indexed: 11/11/2022] Open
Abstract
The government-funded ‘Punjab Thalassaemia Prevention Project’ (PTPP) in Pakistan includes cascade screening for biological relatives of children with beta-Thalassaemia Major (β-TM). However, there is low uptake of cascade screening. This paper presents the (i) development of a paper-based ‘decision support intervention for relatives’ (DeSIRe) to enable PTPP Field Officers to facilitate informed decision making about carrier testing, and (ii) assessment of the feasibility and acceptability of the DeSIRe. The intervention was developed using the International Patient Decision Aids Standards quality criteria and Ottawa Decision Support Framework. Twelve focus groups were conducted (September and October 2020) to explore the views of healthcare professionals (HCPs) and relatives of children with β-TM, in six cities. The focus groups were attended by 117 participants (60 HCPs and 57 relatives). Thematic analysis showed that the DeSIRe was considered acceptable for supporting relatives to make informed decisions about cascade screening, and potentially feasible for use in clinical practice. Suggestions for changing some words, the structure and adding information about how carrier testing relates to consanguineous marriages will enable further development of the DeSIRe. Participants generally welcomed the DeSIRe; however, they highlighted the perceived need to use more directive language, hence showed a cultural preference for directive genetic counselling. The findings highlight challenges for researchers using western theories, frameworks, policies and clinical guidelines to develop decision support interventions for implementation more globally. Future research is needed to evaluate the use of the DeSIRe in routine practice and whether it enables relatives to make informed decisions.
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Affiliation(s)
- Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK.
| | | | | | | | - Shabnam Bashir
- Punjab Thalassaemia Prevention Project, Lahore, Pakistan
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Alshammary AF, Khan IA. Screening of Obese Offspring of First-Cousin Consanguineous Subjects for the Angiotensin-Converting Enzyme Gene with a 287-bp Alu Sequence. J Obes Metab Syndr 2021; 30:63-71. [PMID: 33653971 PMCID: PMC8017326 DOI: 10.7570/jomes20086] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/19/2020] [Accepted: 01/26/2021] [Indexed: 12/22/2022] Open
Abstract
Background Consanguinity, defined as a blood relation between couples, is associated with genetic diseases in their offspring. In Saudi Arabia, obesity is considered a major health problem associated with increased risks of cardiovascular disease, insulin resistance, and type 2 diabetes mellitus. Angiotensin-converting enzyme (ACE) with insertion (I) and deletion (D) polymorphisms of an Alu-287 bp sequence has been implicated in multiple metabolic disorders, including obesity. To date, no studies have been conducted in the Saudi population regarding the ACE gene in consanguineous offspring with obesity. Therefore, the present study aimed to investigate genetic associations in offspring of first cousins, and specifically the relationship between obesity and ACE (Alu-287 bp) was evaluated in the Saudi population. Methods In total, 91 cases of obesity in the offspring of first-cousin couples and 100 control subjects without obesity but with a family history of consanguinity were included. Using genomic DNA, ACE ID polymorphisms between the cases and controls were evaluated by polymerase chain reaction. Results There were strong differences in the height, weight, and body mass index between the cases and controls (P<0.001). A genotype analysis confirmed the strong association with allele frequencies (P<0.001; odds ratio, 4.902; 95% confidence interval, 2.867–8.379) when compared between the cases and controls. One-way analysis of variance showed a positive correlation with height and logistic regression (covariance) that could not be strongly correlated (P>0.05). Conclusion In conclusion, the ACE gene polymorphism was found, through allele frequencies, to be associated with obesity in the offspring of consanguineous first cousins in the Saudi population.
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Affiliation(s)
- Amal F Alshammary
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Imran Ali Khan
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Cupp MA, Adams M, Heys M, Lakhanpaul M, Alexander EC, Milner Y, Huq T, Peachey M, Shah L, Mirza IS, Manikam L. Exploring perceptions of consanguineous unions with women from an East London community: analysis of discussion groups. J Community Genet 2020; 11:225-234. [PMID: 31313096 PMCID: PMC7062959 DOI: 10.1007/s12687-019-00429-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 06/26/2019] [Indexed: 12/29/2022] Open
Abstract
Consanguineous unions are relationships between blood relatives. This study explores the perceptions of consanguineous unions and risk of childhood disability and illness through the reported views and experiences of women in an ethnically diverse London community. This qualitative study utilised group discussions to elicit women's views and experiences. Field notes were recorded by independent note-takers in four group discussions. Field notes were coded manually and independently by two researchers who identified common themes for thematic analysis. Thirty-six women attended, of whom 20 identified as Asian Pakistani. Identified themes included variation in participants' views of consanguineous unions and associated health risks, the value of informed decisions and preferences for information distribution. Although participants had diverse opinions and experiences, they considered risk awareness to be vital for encouraging informed decisions in younger generations. This study highlights the importance of involving the community in efforts to increase awareness around consanguineous unions and genetic risk, emphasising the need for enabling educated choices and the value of co-developing educational efforts with the community.
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Affiliation(s)
- Meghan A. Cupp
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1DP UK
- Aceso Global Health Consultants Limited, 3 Abbey Terrace, London, SE2 9EY UK
| | - Mary Adams
- King’s College London, Division of Women and Children’s Health, Faculty of Life Science and Medicine, St Thomas’ Hospital, London, SE1 7HE UK
| | - Michelle Heys
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1DP UK
- East London NHS Foundation Trust, Trust Headquarters, 9 Alie Street, London, E1 8DE UK
| | - Monica Lakhanpaul
- UCL Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1DP UK
- Whittington NHS Trust, Magdala Avenue, London, N19 5NF UK
| | - Emma C. Alexander
- King’s College London School of Medical Education, Hodgkin Bldg, Newcomen St, London, SE1 1UL UK
| | - Yasmin Milner
- UCL Institute of Epidemiology & Health, 1-19 Torrington Place, London, WC1E 7HB UK
| | - Tausif Huq
- King’s College London School of Medical Education, Hodgkin Bldg, Newcomen St, London, SE1 1UL UK
| | - Meradin Peachey
- Newham University Hospital, Barts NHS Trust, 30 Guilford Street, London, E13 8SL UK
| | - Lakmini Shah
- Newham University Hospital, Barts NHS Trust, 30 Guilford Street, London, E13 8SL UK
| | - Iram Shazia Mirza
- Newham University Hospital, Barts NHS Trust, 30 Guilford Street, London, E13 8SL UK
| | - Logan Manikam
- Aceso Global Health Consultants Limited, 3 Abbey Terrace, London, SE2 9EY UK
- London Borough of Newham, Newham Dockside, 1000 Dockside Road, London, E16 2QU UK
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Riaz M, Tiller J, Ajmal M, Azam M, Qamar R, Lacaze P. Implementation of public health genomics in Pakistan. Eur J Hum Genet 2019; 27:1485-1492. [PMID: 31101884 PMCID: PMC6777461 DOI: 10.1038/s41431-019-0428-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/10/2019] [Accepted: 04/30/2019] [Indexed: 02/06/2023] Open
Abstract
There has been considerable recent progress in the implementation of public health genomics policy throughout the developed world. However, in the developing world, genetic services still remain limited, or unavailable to most. Here, we discuss challenges and opportunities related to the implementation of public health genomics in developing countries. We focus on Pakistan, a country with one of the world's highest rates of inter-family marriages and prevalence of inherited genetic conditions. Pakistan still lacks a national newborn screening programme, clinical genetic testing services, or public health genomics framework. The medical infrastructure in Pakistan, characterized by limited publicly-funded health services and a significant burden of infectious disease, may contribute to de-prioritization of genetic health services. In addition, there are a number of societal, cultural and religious factors to consider. Recently a number of large research studies have been conducted in populations of Pakistani descent, mostly in collaboration with major US, UK and European institutions. Some of these have yielded high-impact scientific findings, but have yet to translate into public health outcomes in Pakistan. Before the benefits of genomics can be realized in developing countries, the first initial steps towards strategic prioritization, resourcing, and long-term goal setting are required. We propose some practical recommendations and possible first steps forward.
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Affiliation(s)
- Moeen Riaz
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jane Tiller
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Muhammad Ajmal
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Maleeha Azam
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
| | - Raheel Qamar
- Translational Genomics Laboratory, Department of Biosciences, COMSATS University Islamabad, Islamabad, Pakistan
- Pakistan Academy of Sciences, Islamabad, Pakistan
| | - Paul Lacaze
- Public Health Genomics, Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
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Salway S, Yazici E, Khan N, Ali P, Elmslie F, Thompson J, Qureshi N. How should health policy and practice respond to the increased genetic risk associated with close relative marriage? results of a UK Delphi consensus building exercise. BMJ Open 2019; 9:e028928. [PMID: 31289086 PMCID: PMC6615806 DOI: 10.1136/bmjopen-2019-028928] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES (1) To explore professional and lay stakeholder views on the design and delivery of services in the area of consanguinity and genetic risk. (2) To identify principles on which there is sufficient consensus to warrant inclusion in a national guidance document. (3) To highlight differences of opinion that necessitate dialogue. (4) To identify areas where further research or development work is needed to inform practical service approaches. DESIGN Delphi exercise. Three rounds and one consensus conference. SETTING UK, national, web-based and face-to-face. PARTICIPANTS Recruitment via email distribution lists and professional networks. 42 participants with varied professional and demographic backgrounds contributed to at least one round of the exercise. 29 people participated in statement ranking across both rounds 2 and 3. RESULTS Over 700 individual statements were generated in round 1 and consolidated into 193 unique statements for ranking in round 2, with 60% achieving 80% or higher agreement. In round 3, 74% of statements achieved 80% or higher agreement. Consensus conference discussions resulted in a final set of 148 agreed statements, providing direction for both policy-makers and healthcare professionals. 13 general principles were agreed, with over 90% agreement on 12 of these. Remaining statements were organised into nine themes: national level leadership and coordination, local level leadership and coordination, training and competencies for healthcare and other professionals, genetic services, genetic literacy, primary care, referrals and coordination, monitoring and evaluation and research. Next steps and working groups were also identified. CONCLUSIONS There is high agreement among UK stakeholders on the general principles that should shape policy and practice responses in this area: equity of access, cultural competence, coordinated inter-agency working, co-design and empowerment and embedded evaluation. The need for strong national leadership to ensure more efficient sharing of knowledge and promotion of more equitable and consistent responses across the country is emphasised.
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Affiliation(s)
- Sarah Salway
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Edanur Yazici
- Department of Sociological Studies, University of Sheffield, Sheffield, UK
| | - Nasaim Khan
- Manchester Centre for Genomic Medicine, St Mary’s Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Parveen Ali
- School of Nursing and Midwifery, University of Sheffield, Sheffield, UK
| | - Frances Elmslie
- South West Thames Regional Genetics Service, St George’s University Hospitals, London, UK
| | - Julia Thompson
- Children and Young People’s Public Health Team, Sheffield City Council, Sheffield, UK
| | - Nadeem Qureshi
- Division of Primary Care, University of Nottingham, Nottingham, UK
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Maguire A, Tseliou F, O’Reilly D. Consanguineous Marriage and the Psychopathology of Progeny: A Population-wide Data Linkage Study. JAMA Psychiatry 2018; 75:438-446. [PMID: 29617531 PMCID: PMC6145769 DOI: 10.1001/jamapsychiatry.2018.0133] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
IMPORTANCE Approximately 1 in 10 children worldwide are born to consanguineous parents. The literature on consanguinity and mental health of progeny is scarce despite the fact that many of the factors associated with consanguineous unions are also associated with mental health. OBJECTIVE To investigate if children of consanguineous parents are at increased risk of common mood disorders or psychoses. DESIGN, SETTING, AND PARTICIPANTS This investigation was a retrospective population-wide cohort study of all individuals born in Northern Ireland between January 1, 1971, and December 31, 1986, derived from the Child Health System data set and linked to nationwide administrative data sources on prescription medication and death records. Data from the Child Health System data set identified all 447 452 births delivered to mothers residing in Northern Ireland between 1971 and 1986. The final data set comprised 363 960 individuals, alive and residing in Northern Ireland in 2014, with full data on all variables. The dates of analysis were June 1 to October 31, 2017. MAIN OUTCOMES AND MEASURES Degree of parental consanguinity was assessed from questions asked of the parents during routine health visitor house calls within 2 weeks of the child's birth. Potential mental ill health was estimated by receipt of psychotropic medication in 2010 to 2014. Ever or never use was used for the main analysis, with sensitivity analyses using a cutoff of at least 3 months' prescriptions. Receipt of antidepressant or anxiolytic medications was used as a proxy for common mood disorders, whereas receipt of antipsychotic medications was used as a proxy indicator of psychoses. RESULTS Of the 363 960 individuals (52.5% [191 102] male), 609 (0.2%) were born to consanguineous parents. After full adjustment for factors known to be associated with poor mental health, multilevel logistic regression models found that children of first-cousin consanguineous parents were more than 3 times as likely to be in receipt of antidepressant or anxiolytic medications (odds ratio, 3.01; 95% CI, 1.24-7.31) and more than twice as likely to be in receipt of antipsychotic medication (odds ratio, 2.13; 95% CI, 1.29-3.51) compared with children of nonrelated parents. CONCLUSIONS AND RELEVANCE A child of consanguineous parents is at increased risk of common mood disorders and psychoses.
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Affiliation(s)
- Aideen Maguire
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
| | - Foteini Tseliou
- Administrative Data Research Centre–Northern Ireland, Queen’s University Belfast, Institute of Clinical Sciences B Royal Hospitals Site, Belfast, United Kingdom
| | - Dermot O’Reilly
- Centre for Public Health, Queen’s University Belfast, Belfast, United Kingdom
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Hosseinpour M, Deris F, Solati-Dehkordi K, Heidari-Soreshjani S, Karimi N, Teimori H. The Effect of Consanguineous Marriage on Mental Health among the Students of the Shahrekord University of Medical Sciences. J Clin Diagn Res 2016; 10:GC01-GC04. [PMID: 28050399 DOI: 10.7860/jcdr/2016/21389.8794] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 08/18/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION In Iran, after unintentional accidents, mental health problems are the second leading burden of disease. Consanguineous marriage is very common in Iran and the association between parental consanguinity and mental health is an important issue that has not yet been studied sufficiently in Iran. AIM To investigate the effect of consanguinity and the degree of relationship on different levels of mental health. MATERIALS AND METHODS In this cross-sectional study, conducted in the Shahrekord University of Medical Sciences, two groups of students were enrolled. The first group consisted of 156 students that had consanguineous parent (case group) and the second group was 156 students whose parents had non-blood relationship (control group). The students were evaluated using General Health Questionnaire (GHQ-28). Statistical analysis was conducted by Pearson's correlation coefficient, independent t-test and the one-way analysis of variance. Odd ratio was used to estimate the relative risk. RESULTS Over 30% of the individuals were suffering from mental health problems. The most and least common mental health problems in both groups were social dysfunction (54.5% in the case group and the control group 50%) and depression (15.4% in the case group and 17.3% in the control group), respectively. No statistically significant difference was observed in the frequency of overall mental health and its subscales between student with non-consanguineous parent (control group) and the students that had consanguineous parent (case group) (p>0.05) and the status of mental health was not significantly different among student with different degree of kinship (p>0.05). CONCLUSION The study revealed that social dysfunction was very common among the study students and also there were no relationship between parental consanguineous marriage and mental health. Parental consanguinity and genetic factors may not be the major causes of high prevalence of mental health problems in Iran and the effects of the environmental factors on these problems may be greater than those of the inherited ones.
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Affiliation(s)
- Maryam Hosseinpour
- Student, Department of Genetics, Faculty of Science, University of Shahrekord , Shahrekord, Iran
| | - Fatemeh Deris
- Instructor, Department of Epidemiology and Biostatistics, School of Health, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Kamal Solati-Dehkordi
- Associate Professor, Department of Psychology, Faculty of Medicine, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Sheida Heidari-Soreshjani
- Student, Department of Laboratory Sciences, School of Paramedicine, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Negar Karimi
- Student, Department of Laboratory Sciences, School of Paramedicine, Shahrekord University of Medical Sciences , Shahrekord, Iran
| | - Hossein Teimori
- Associate Professor, Department of Genetics and Biotechnology, Cellular and Molecular Research Center, Shahrekord University of Medical Sciences , Shahrekord, Iran
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Affiliation(s)
- Erik Landfeldt
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.,Mapi Group, Stockholm, Sweden
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Abstract
Consanguineous marriage is a controversial topic in many Western societies, with attention mainly focused on the health of immigrant communities from Asia and Africa. In the UK consanguinity is especially prevalent in the Pakistani community, which now numbers over 1.1 million. Less attention has been paid to the influence of hereditary population stratification within Pakistani communities, in particular biraderi (literally brotherhood) membership, which denotes male lineages that largely govern marriage partner choice and hence the transmission of disease genes. The various roles played by biraderi and their relationship to other socio-occupational and kinship terms, such as caste, quom and zat, are often overlooked in health-based studies. The interchangeable use of these different kinship terms without rigorous definition can create identity uncertainty and hinders inter-study comparisons. Where feasible, standardization of terminology would be both desirable and beneficial, with biraderi the preferred default term to identify specific social and genetic relationships within the Pakistani diaspora.
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A review of consanguinity in Ireland—estimation of frequency and approaches to mitigate risks. Ir J Med Sci 2015; 185:17-28. [DOI: 10.1007/s11845-015-1370-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/07/2015] [Indexed: 11/26/2022]
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