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Cohen HS, Plankey MW, Ware D. A Retrospective Study of the Relationship Between Hypertension and Vestibular Disorders in Middle-Aged Women With and Without HIV. Cureus 2023; 15:e34988. [PMID: 36938264 PMCID: PMC10019901 DOI: 10.7759/cureus.34988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2023] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Patients often conflate the problem of lightheadedness from hypertension (HTN) and vertigo from a vestibular impairment, describing both problems as dizziness. The goal of the study was to learn if there is a relationship between measures of vestibular function and blood pressure. METHODS This retrospective study consisted of women who participated in a longitudinal study of the human immunodeficiency virus (HIV) and a control cohort of age-matched women without HIV. We used data from the point in time when participants were tested for vestibular functions with bi-thermal caloric tests and cervical vestibular evoked myogenic potentials; the data also included the blood pressure of the participants. RESULTS High odds ratios (1.48 to 2.05) suggest a relationship between HTN and vestibular impairment, although the sample size was too small to reach statistical significance. CONCLUSION The data suggest that high blood pressure may be related to vestibular impairments. Clinicians whose patients complain of vertigo and balance disorders consistent with vestibular impairments should consider blood pressure as a related problem during the initial visit.
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Affiliation(s)
- Helen S Cohen
- Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, USA
| | | | - Deanna Ware
- Medicine, Georgetown University Medical Center, Washington DC, USA
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Longino ES, Lindquist NR, Cass ND, Brignola E, Thompson RC, Haynes DS. Labyrinthitis With Negative MRI As a Precursor to Rapidly Developing Primary CNS Lymphoma of the Cerebellopontine Angle. OTOLOGY & NEUROTOLOGY OPEN 2022; 2:e020. [PMID: 38516576 PMCID: PMC10950143 DOI: 10.1097/ono.0000000000000020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Accepted: 07/21/2022] [Indexed: 03/23/2024]
Abstract
Background Few case reports have described primary central nervous system lymphoma (PCNSL) presenting as a cerebellopontine angle (CPA) lesion in HIV-positive patients. We describe a rare presentation of rapidly progressing PCNSL of the CPA/internal auditory canal (IAC) as labyrinthitis with initial negative MRI in an HIV-positive patient. Case A 58-year-old male with well-controlled HIV presented with sudden left sensorineural hearing loss, tinnitus, and imbalance. Vestibular testing suggested an uncompensated left peripheral vestibular weakness. MRI demonstrated facial and cochleovestibular nerve enhancement within the CPA and IAC. The presumptive diagnosis of labyrinthitis was made. Two months later, he presented to his infectious disease provider with left facial weakness and disequilibrium and was treated for presumed Bell's palsy. One month later, he presented with left corneal reflex dysfunction, decreased visual acuity, diplopia, and worsening ataxia. Repeat MRI demonstrated a new 3.6 cm lesion of the left CPA/IAC with vasogenic edema. Despite location, the mass lacked the brainstem compression characteristic of other extra-axial CPA masses such as vestibular schwannoma. Flow cytometry and cytology from cerebrospinal fluid was consistent with primary central nervous system large B-cell lymphoma. Conclusions We present a unique case of rapidly progressing PCNSL of the CPA/IAC in an HIV-positive patient, presenting initially as labyrinthitis with negative MRI followed by development of multiple cranial neuropathies and 3-month repeat MRI demonstrating a large CPA mass. In HIV-positive patients with a similar initial presentation, PCNSL should considered early in the diagnostic evaluation with close clinical monitoring and a low threshold for repeat imaging.
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Affiliation(s)
- Elizabeth S. Longino
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Nathan R. Lindquist
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Nathan D. Cass
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Emily Brignola
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Reid C. Thompson
- Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, TN
| | - David S. Haynes
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN
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Charumbira MY, Berner K, Louw QA. Functioning Problems Associated with Health Conditions with Greatest Disease Burden in South Africa: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192315636. [PMID: 36497710 PMCID: PMC9735592 DOI: 10.3390/ijerph192315636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 05/05/2023]
Abstract
A notable rise in health-related disability for which evidence-based rehabilitation is beneficial is evident in low-to-middle income countries. This scoping review aimed to systematically identify and map the most common functioning problems associated with health conditions that contribute most to disability in South Africa using the International Classification of Functioning, Disability and Health (ICF) framework. Peer-reviewed evidence published from January 2006 to December 2021 was systematically searched from five databases. Some 268 studies reporting on functioning problems (impairments, activity limitations, and participation restrictions) in South African adults (>18 years) related to 10 health conditions were included. A total of 130 different functioning problems were mapped to the ICF. The most prevalent problems (top 20) were related to mobility, pain, and mental health but spanned across several ICF domains and were mostly in patients at primary care. The high prevalence and wide range of functioning problems may be particularly burdensome on an already strained primary health care (PHC) system. This points towards targeted planning of innovative strategies towards strengthening rehabilitation service delivery at primary care to address these complexities where there is an inadequate rehabilitation workforce.
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Cohen HS, Plankey MW, Sangi-Haghpeykar H. Vestibular Impairments on Objective Diagnostic Tests in HIV+ Women and Control Men and Women. Laryngoscope 2021; 131:E2318-E2322. [PMID: 33645629 DOI: 10.1002/lary.29466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/29/2021] [Accepted: 02/05/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To describe the value of two vestibular test batteries across ages in healthy men and women for detecting vestibular disorders and to compare the occurrence of vestibular disorders in the healthy adult population and women with human immunodeficiency virus (HIV) disease. STUDY DESIGN Two groups were tested on the battery of objective diagnostic tests of the vestibular system. SETTING Two tertiary care centers. SUBJECTS Healthy controls (284 women and 105 men) and women (63) with HIV/AIDS (HIV+) who are being followed up in a longitudinal study of HIV. They were tested on objective diagnostic tests of the vestibular system. RESULTS In all age decades, healthy controls had evidence of vestibular impairment, significantly more in older adults. HIV+ subjects, all females, did not differ from healthy control females. CONCLUSION These data suggest that at all ages, people do have decreased vestibular function, even young, asymptomatic, and apparently healthy adults. HIV disease, itself, does not cause an increased prevalence of peripheral vestibular disorders when HIV is controlled on antiretroviral medication. LEVEL OF EVIDENCE 2 Laryngoscope, 131:E2318-E2322, 2021.
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Affiliation(s)
- Helen S Cohen
- Bobby R Alford Department of Otolaryngology-Head and Neck Surgery, Baylor College of Medicine, Houston, Texas, U.S.A
| | - Michael W Plankey
- Division of General Internal Medicine, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, U.S.A
| | - Haleh Sangi-Haghpeykar
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, U.S.A
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De Necker A, Biagio-de Jager L, Stoltz AC. Auditory Brainstem Response Test at Different Stimulus Rates in Normal-Hearing Adults Living With HIV. Am J Audiol 2020; 29:873-886. [PMID: 33030027 DOI: 10.1044/2020_aja-19-00125] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose The study investigated whether the auditory brainstem response (ABR) at a baseline and at higher repetition rates can detect if neurodegeneration has occurred in adults living with HIV who present with normal behavioral pure-tone thresholds. Method An exploratory research design was used. Forty adults with HIV (80 ears, 57.5% female; M age = 26.3 years, SD = 3.68) and 20 adults without HIV participated. Phase 1 compared ABR absolute and interwave latencies at a baseline rate. Phase 2 examined the effect of HIV status and category of immunodeficiency on ABR absolute Wave V latency and Wave V latency shift at increased stimulus rates. Analysis included a two-way analysis of variance of the interaction between stimulus rate and HIV status and between CD4+ category and rate, and multiple regression analysis. Results In adults living with HIV, the baseline ABR yielded prolonged Wave III and V absolute latencies and interpeak prolongations in 22.5%. Interaural Wave V latency differences were present in 15% of participants. An additional 15% of ears presented with abnormal Wave V at increased rates. No significant interaction between HIV status and rate in either ear or between CD4+ category and rate was found in either ear (p > .05). Although rate and gender contributed significantly to the prediction of Wave V latency of the rate study (left and right, p < .001), HIV status did not (left and right, p > .05). Conclusions Although the interaction of HIV status and CD4+ with rate was not significant, more ears were identified with abnormal results at increased stimulus rates than with the baseline ABR alone. The ABR at increased rates may therefore be a valuable addition for the identification of individuals living with HIV with auditory neural deficiencies.
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Affiliation(s)
- Adriana De Necker
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Leigh Biagio-de Jager
- Department of Speech-Language Pathology and Audiology, University of Pretoria, South Africa
| | - Anton Carel Stoltz
- Division of Infectious Diseases, Steve Biko Academic Hospital, Pretoria, South Africa
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Millar A, Joubert K, Naude A. Prevalence of Peripheral Vestibular Impairment in Adults with Human Immunodeficiency Virus. J Audiol Otol 2020; 25:36-42. [PMID: 32829624 PMCID: PMC7835440 DOI: 10.7874/jao.2020.00164] [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] [Received: 04/14/2020] [Accepted: 06/21/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, the human immunodeficiency virus (HIV) is responsible for one of the most serious pandemics to date. The vulnerability of the vestibular system in individuals with HIV has been confirmed, and central vestibular impairments have been frequently reported. However, there are disagreements on the impact of HIV on peripheral vestibular function. Thus, the current study aimed to determine the prevalence of peripheral vestibular impairment, specifically related to the semi-circular canals (SCCs), in HIV-positive individuals receiving antiretroviral (ARV) treatment. SUBJECTS AND METHODS A total of 92 adults between the ages of 18 and 50 years (divided into two groups) participated in the study. The first group comprised HIV-positive individuals receiving ARV treatment (n1=60), and the second group comprised HIV-negative participants (n2=32). The video head impulse test was used to conduct the head impulse paradigm (HIMP). RESULTS Bilateral normal HIMP results were obtained in 95% of the HIV-positive participants and all HIV-negative participants. The gain of the left posterior SCCs was significantly lower in the HIV-positive group, while the gains of all other canals between the two groups were comparable. CONCLUSIONS The prevalence of peripheral vestibular impairment in the HIV-positive group was not significantly different from that of the HIV-negative group. The reduced prevalence in the current study may be attributed to participant characteristics, the test battery employed, and the central compensation of the vestibular dysfunctions at the later stages of infection.
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Affiliation(s)
| | - Karin Joubert
- Department of Audiology, Faculty of Humanities, University of the Witwatersrand, Johannesburg, South Africa.,Ndlovu Wits Audiology Clinic, Groblersdal, South Africa
| | - Alida Naude
- Centre for Augmentative and Alternative Communication, Faculty of Humanities, University of Pretoria, Hatfield, South Africa
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Pichert MD, Plankey MW, Springer G, Cox C, Hoffman HJ, Cohen HS. Vestibular and oculomotor abnormalities among HIV-infected and HIV-uninfected men and women: A pilot study. J Vestib Res 2020; 30:329-334. [PMID: 32741798 PMCID: PMC11058317 DOI: 10.3233/ves-200707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To determine if middle-aged and aging men and women with HIV disease (HIV+) should be screened for vestibular and oculomotor dysfunction. METHODS Age- and sociodemographically matched HIV+ and HIV- men and women were tested on vestibular evoked myogenic potential (VEMP), bi-thermic caloric testing, Dix-Hallpike maneuvers and saccades. RESULTS HIV+ men had more caloric weakness than HIV- men. HIV+ subjects had more saccade abnormalities than HIV- subjects. A saccade abnormality was positively associated with being HIV+. Among the HIV+ sample, abnormalities were associated with increasing age, being male, ever taking monotherapy, and having an undetectable viral load. Only being male and having an undetectable viral load were statistically significant. Unilateral caloric weakness had a decreased prevalence with age per 10 years, and being HIV+ showed an increased prevalence. In HIV+ subjects only, these abnormalities decreased with age and being male but increased with undetectable viral load and ever taking antiretroviral monotherapy. No statistically significant differences were found. CONCLUSION Women are at greater risk of vestibular and oculomotor abnormalities than men. HIV+ adults are at greater risk than HIV- adults. Physicians who care for HIV+ men and women should monitor the symptoms of vestibular and oculomotor impairment.
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Affiliation(s)
| | | | - Gayle Springer
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Christopher Cox
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD
| | - Howard J. Hoffman
- National Institute on Deafness and Other Communication Disorders, National Instiutes of Health, Bethesda, MD
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Mahomed W, Heinze BM, Vinck BH, Stoltz A. Auditory, video head impulse test and vestibular evoked myogenic potentials findings in adults with human immunodeficiency virus. Auris Nasus Larynx 2019; 47:367-376. [PMID: 31862282 DOI: 10.1016/j.anl.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 11/12/2019] [Accepted: 11/29/2019] [Indexed: 01/10/2023]
Abstract
OBJECTIVES Even though there is an association between hearing loss and human immunodeficiency virus (HIV), particularly in low- and middle-income countries, further research is needed to investigate the nature of such hearing loss. Likewise, despite documented vestibular alterations in people with HIV, the true occurrence, presentation, and nature of these manifestations are yet to be established. Advances in technology for vestibular testing has allowed for objective site-of-lesion tests such as the video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMPs) and ocular vestibular evoked myogenic potential (oVEMPs). The current study aimed to compare and describe auditory, vHIT, cVEMPs and oVEMPs findings in adults with and without HIV. METHODS The current study included an HIV positive group (n = 30) and an HIV negative group (n = 30) who underwent an auditory assessment (tympanometry and pure tone audiometry) and objective vestibular assessments. RESULTS The occurrence of hearing loss was 53.3% in the HIV positive group compared to 33.3% in the HIV negative group. A higher occurrence of vestibular involvement was documented in the HIV positive group (73.3%) compared to 13.3% in the HIV negative group. CONCLUSION Auditory assessment and objective measures of vestibular end-organ function (vHIT and VEMPs) can be useful to detect sub-clinical alterations. The equipment is mobile and can be performed in any health care setting such as infectious disease clinics for surveillance and monitoring purposes.
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Affiliation(s)
- Waseema Mahomed
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Private bag X20, Hatfield 0028, Pretoria, South Africa
| | - Barbara M Heinze
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Private bag X20, Hatfield 0028, Pretoria, South Africa.
| | - Bart Hme Vinck
- Department of Speech and Hearing Sciences, Ghent University, University Hospital Ghent, 10 Corneel Heymanslaan, 9000 Gent, Belgium
| | - Anton Stoltz
- Department of Internal Medicine, Steve Biko Academic Hospital, Private bag X20, Hatfield 0028, Pretoria, South Africa
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Papathanasiou E, Straumann D. Why and when to refer patients for vestibular evoked myogenic potentials: A critical review. Clin Neurophysiol 2019; 130:1539-1556. [DOI: 10.1016/j.clinph.2019.04.719] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 04/08/2019] [Accepted: 04/22/2019] [Indexed: 12/13/2022]
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Khoza-Shangase K. VESTIBULAR FUNCTION IN A GROUP OF ADULTS WITH HIV/AIDS ON HAART. Afr J Infect Dis 2017; 12:7-14. [PMID: 29302644 PMCID: PMC5733256 DOI: 10.21010/ajid.v12i1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background: The high prevalence of HIV/AIDS and the established otological manifestations of the disease have important implications for research into vestibular function in this population. Materials and Methods: The main aim of the current study was to investigate and monitor the vestibular status in a group of adult patients with AIDS receiving Highly Active Antiretroviral Therapy (HAART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. The study was exploratory and observational in nature, with repeated measures in the form of pre- and post-treatment survey; and a control group. The measures were taken before commencement of antiretroviral therapy (ARVs), three months after initiation of treatment and six months into therapy. A comparison of results of the control group and treatment group was done for all objectives. A total of 150 (104 in the treatment group and 46 in the control group) participants who were recruited through a nonprobability convenience sampling technique were included in the study. All participants were at stage three of HIV/AIDS according to their CD4+ T-cell counts at baseline. Data were analysed through descriptive statistics. Results: Findings from the current study revealed occurrence of acute vertigo which spontaneously resolved in adults with AIDS on HAART over a monitoring period of six months; with this occurrence being higher in participants on HAART than in the control group. The symptoms occurred after diagnosis with HIV and mostly after HAART initiation; and participants who experienced vertigo did not report this to their attending doctor. Furthermore, there was a lack of a relationship between the increasing occurrences of hearing loss in the group to the presentation of vertigo over the six months of monitoring. Conclusion: Findings from the present study which revealed occurrence of possible acute vertigo that spontaneously resolves in adults with AIDS on HAART, over a monitoring period of six months, add to the existing literature on vestibular function in this population. These findings raise important research as well as clinical assessment and management implications in this population.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Khoza-Shangase K, Jade Van Rie K. Pathological vestibular symptoms presenting in a group of adults with HIV/AIDS in Johannesburg, South Africa. S Afr J Infect Dis 2017. [DOI: 10.1080/23120053.2016.1216816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Kayla Jade Van Rie
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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Park HJ, Cho CS, Kim NM, Yun SA, Yoon HJ. The First Case of Vestibulocochlear Neuritis in a Patient with Acquired Immunodeficiency Syndrome in Korea. Infect Chemother 2016; 48:132-5. [PMID: 27433384 PMCID: PMC4945723 DOI: 10.3947/ic.2016.48.2.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 11/18/2014] [Accepted: 11/19/2014] [Indexed: 11/24/2022] Open
Abstract
The incidence of human immunodeficiency virus (HIV) infections continue to increase throughout the world. Although neurologic complications are frequent in individuals with HIV infection or acquired immunodeficiency syndrome (AIDS), vestibulocochlear neuritis is still a relatively rare manifestation. We report the first case of vestibulocochlear neuritis occurring in an AIDS patient in Korea.
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Affiliation(s)
- Hyun Joo Park
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Chin Saeng Cho
- Department of Otorhinolaryngology, Eulji University Hospital, Daejeon, Korea
| | - Nak Min Kim
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Su A Yun
- Division of Infectious Diseases, Department of Internal Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hee Jung Yoon
- Division of Infectious Diseases, Seoul Metropolitan Government Seobuk Hospital, Seoul, Korea
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