1
|
Ramos-Martínez E, Almeida-Aguirre EKP, Ramos-Martínez I, Torres-García VM, Pérez-Torres A, Roldán-Roldán G, Valencia-Ortega J, Moreno-Eutimio MA, Pastelin-Palacios R, Cerbón M. Neuroprotection mediated by prolactin against streptozotocin injury in brain rat areas. Brain Res 2024; 1842:149104. [PMID: 38945469 DOI: 10.1016/j.brainres.2024.149104] [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: 05/07/2024] [Revised: 06/25/2024] [Accepted: 06/27/2024] [Indexed: 07/02/2024]
Abstract
Prolactin has been recognized as neuroprotective hormone against various types of neuronal damage. This study was aimed to determine if prolactin protects against streptozotocin injury. A series of experiments were performed to determine neuronal survival by counting total neurons in medial hippocampus cortex and cerebellum. Astrogliosis was determined by immunofluorescence assays using GFAP, and behavioral improvement by prolactin after neuronal damage was determined by open-field and light-dark box tests. Results demonstrated that prolactin induced significant neuronal survival in both the hippocampus and cortex, but not in the cerebellum. No increase in astrogliosis was identified, but a significant reduction in anxiety levels was observed. Overall data indicate that prolactin may protect against a complex form of cell damage including oxidant stress and metabolic disruption by streptozotocin. Prolactin may be helpful strategy in the treatment of neuronal damage in neurological diseases.
Collapse
Affiliation(s)
- Edgar Ramos-Martínez
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico; Escuela de Ciencias, Universidad Autónoma Benito Juárez de Oaxaca, Oaxaca 68150, Mexico
| | | | - Iván Ramos-Martínez
- Departamento de Medicina y Zootecnia de Cerdos, Facultad de Medicina Veterinaria y Zootecnia,Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico
| | - Víctor Manuel Torres-García
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Armando Pérez-Torres
- Departamento de Biología Celular y Tisular, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Gabriel Roldán-Roldán
- Departamento de Fisiología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Jorge Valencia-Ortega
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico
| | - Mario Adán Moreno-Eutimio
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico
| | - Rodolfo Pastelin-Palacios
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico.
| | - Marco Cerbón
- Departamento de Biología, Facultad de Química, Universidad Nacional Autónoma de México, Coyoacán 04510, Mexico.
| |
Collapse
|
2
|
Nexha A, Caropreso L, de Azevedo Cardoso T, Suh JS, Tonon AC, Frey BN. Biological rhythms in premenstrual syndrome and premenstrual dysphoric disorder: a systematic review. BMC Womens Health 2024; 24:551. [PMID: 39375682 PMCID: PMC11457342 DOI: 10.1186/s12905-024-03395-3] [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: 12/12/2023] [Accepted: 09/29/2024] [Indexed: 10/09/2024] Open
Abstract
BACKGROUND Women with premenstrual syndrome (PMS) and premenstrual dysphoric disorder (PMDD) typically experience a range of psychological and physiological symptoms that negatively affect their quality of life. Disruption in biological rhythms, including alterations of the sleep-wake cycle, have been implicated in PMS/PMDD, though literature is still growing to substantiate these findings. The objective of this study is to systematically review the available literature on biological rhythms disruption in PMS/PMDD. METHODS A literature search was conducted on four databases (Pubmed, Embase, Medline, and Web of Science) on December 3rd, 2021. This search yielded a total of 575 articles that assessed the relationship between biological rhythms and PMS/PMDD/premenstrual symptoms. RESULTS After the exclusion of irrelevant articles and hand-searching references, 25 articles were included in this systematic review. Some studies showed that women with PMS/PMDD present lower melatonin levels, elevated nighttime core body temperature, and worse subjective perception of sleep quality when compared to women without PMS/PMDD. Other biological rhythms parameters showed either no differences between groups (wrist actimetry) or conflicting results (objective sleep parameters, cortisol, prolactin, and thyroid stimulating hormone). CONCLUSION Current research demonstrates that women with PMS/PMDD experience lower melatonin levels, higher body temperature, and worse subjective perception of sleep quality. This review outlines some possible mechanisms behind these findings and proposes recommendations for future research. This systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42020149921.
Collapse
Affiliation(s)
- Adile Nexha
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5 Street, Hamilton, ON, L8N 3K7, Canada.
| | - Luisa Caropreso
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5 Street, Hamilton, ON, L8N 3K7, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Taiane de Azevedo Cardoso
- Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Geelong, Australia
| | - Jee Su Suh
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5 Street, Hamilton, ON, L8N 3K7, Canada
| | - André C Tonon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5 Street, Hamilton, ON, L8N 3K7, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Benicio N Frey
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, 100 West 5 Street, Hamilton, ON, L8N 3K7, Canada
- Women's Health Concerns Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
- Mood Disorders Treatment and Research Centre, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| |
Collapse
|
3
|
Sun S, Jin W, Hou T, Tong S, Zhou S, Hong L, Yao K, Zhao K, Zheng T. Psychotic symptoms in Chinese adolescent patients with major depressive disorder: prevalence and related endocrine clinical factors. BMC Psychiatry 2024; 24:598. [PMID: 39237962 PMCID: PMC11376036 DOI: 10.1186/s12888-024-06023-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 08/16/2024] [Indexed: 09/07/2024] Open
Abstract
OBJECTIVE Major depressive disorder (MDD) is often accompanied by psychotic symptoms. However, few studies have examined the relationship between psychotic symptoms and endocrine factors in adolescent patients with MDD. Therefore, this study aimed to investigate the prevalence and related endocrine clinical factors of psychotic symptoms in Chinese adolescent patients with MDD. METHODS In total, 601 patients (aged 12-18) with MDD were recruited. The Patient Health Questionnaire - 9 items (PHQ - 9) was utilized for assessing depressive symptoms. Psychotic symptoms were assessed through clinical interviews. Prolactin (PRL), thyroid-stimulating hormone (TSH), triiodothyronine (T3), free triiodothyronine (FT3), thyroxine (T4), and free thyroxine (FT4) were also measured. RESULTS The incidence of psychotic symptoms in adolescent patients with MDD was 22.6%. The findings demonstrated that age, self-harming behavior, PHQ-9 score, FT4, and normalized PRL were independently associated with psychotic symptoms in patients with MDD (All p < 0.05). CONCLUSIONS PRL and FT4 levels are more likely to be abnormally elevated in major depressive adolescents with psychotic symptoms. Prolactin and thyroid hormones in patients with MDD should be paid more attention.
Collapse
Affiliation(s)
- Shiyu Sun
- Department of Mental Health, Affiliated Jinhua Hospital, Zhejiang University School of Medicine, Jinhua, China
| | - Wei Jin
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Tianle Hou
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
| | - Siyu Tong
- Lishui Second People's Hospital, Wenzhou Medical University, Lishui, China
| | | | - Lan Hong
- School of Mental Health, Wenzhou Medical University, Wenzhou, China
- The Third Hospital of Quzhou, Quzhou, China
| | - Keqing Yao
- Shenzhen Mental Health Center, Shenzhen, Guangdong, China.
- Shenzhen Kangning Hospital, 77 Zhenbi Road, Pingshan District, Shenzhen, Guangdong, China.
| | - Ke Zhao
- Lishui Second People's Hospital, Wenzhou Medical University, Lishui, China.
| | - Tiansheng Zheng
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, China.
| |
Collapse
|
4
|
Szukiewicz D. Current Insights in Prolactin Signaling and Ovulatory Function. Int J Mol Sci 2024; 25:1976. [PMID: 38396659 PMCID: PMC10889014 DOI: 10.3390/ijms25041976] [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: 01/10/2024] [Revised: 01/31/2024] [Accepted: 02/03/2024] [Indexed: 02/25/2024] Open
Abstract
Prolactin (PRL) is a pleiotropic hormone released from lactotrophic cells of the anterior pituitary gland that also originates from extrapituitary sources and plays an important role in regulating lactation in mammals, as well as other actions. Acting in an endocrine and paracrine/autocrine manner, PRL regulates the hypothalamic-pituitary-ovarian axis, thus influencing the maturation of ovarian follicles and ovulation. This review provides a detailed discussion of the current knowledge on the role of PRL in the context of ovulation and ovulatory disorders, particularly with regard to hyperprolactinemia, which is one of the most common causes of infertility in women. Much attention has been given to the PRL structure and the PRL receptor (PRLR), as well as the diverse functions of PRLR signaling under normal and pathological conditions. The hormonal regulation of the menstrual cycle in connection with folliculogenesis and ovulation, as well as the current classifications of ovulation disorders, are also described. Finally, the state of knowledge regarding the importance of TIDA (tuberoinfundibular dopamine), KNDγ (kisspeptin/neurokinin B/dynorphin), and GnRH (gonadotropin-releasing hormone) neurons in PRL- and kisspeptin (KP)-dependent regulation of the hypothalamic-pituitary-gonadal (HPG) axis in women is reviewed. Based on this review, a rationale for influencing PRL signaling pathways in therapeutic activities accompanying ovulation disorders is presented.
Collapse
Affiliation(s)
- Dariusz Szukiewicz
- Department of Biophysics, Physiology & Pathophysiology, Faculty of Health Sciences, Medical University of Warsaw, 02-004 Warsaw, Poland
| |
Collapse
|
5
|
Viudez-Martínez A, Torregrosa AB, Navarrete F, García-Gutiérrez MS. Understanding the Biological Relationship between Migraine and Depression. Biomolecules 2024; 14:163. [PMID: 38397400 PMCID: PMC10886628 DOI: 10.3390/biom14020163] [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: 12/27/2023] [Revised: 01/08/2024] [Accepted: 01/09/2024] [Indexed: 02/25/2024] Open
Abstract
Migraine is a highly prevalent neurological disorder. Among the risk factors identified, psychiatric comorbidities, such as depression, seem to play an important role in its onset and clinical course. Patients with migraine are 2.5 times more likely to develop a depressive disorder; this risk becomes even higher in patients suffering from chronic migraine or migraine with aura. This relationship is bidirectional, since depression also predicts an earlier/worse onset of migraine, increasing the risk of migraine chronicity and, consequently, requiring a higher healthcare expenditure compared to migraine alone. All these data suggest that migraine and depression may share overlapping biological mechanisms. Herein, this review explores this topic in further detail: firstly, by introducing the common epidemiological and risk factors for this comorbidity; secondly, by focusing on providing the cumulative evidence of common biological aspects, with a particular emphasis on the serotoninergic system, neuropeptides such as calcitonin-gene-related peptide (CGRP), pituitary adenylate cyclase-activating polypeptide (PACAP), substance P, neuropeptide Y and orexins, sexual hormones, and the immune system; lastly, by remarking on the future challenges required to elucidate the etiopathological mechanisms of migraine and depression and providing updated information regarding new key targets for the pharmacological treatment of these clinical entities.
Collapse
Affiliation(s)
- Adrián Viudez-Martínez
- Hospital Pharmacy Service, Hospital General Dr. Balmis de Alicante, 03010 Alicante, Spain;
| | - Abraham B. Torregrosa
- Instituto de Neurociencias, Universidad Miguel Hernández, 03550 San Juan de Alicante, Spain; (A.B.T.); (F.N.)
- Research Network on Primary Addictions, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - Francisco Navarrete
- Instituto de Neurociencias, Universidad Miguel Hernández, 03550 San Juan de Alicante, Spain; (A.B.T.); (F.N.)
- Research Network on Primary Addictions, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| | - María Salud García-Gutiérrez
- Instituto de Neurociencias, Universidad Miguel Hernández, 03550 San Juan de Alicante, Spain; (A.B.T.); (F.N.)
- Research Network on Primary Addictions, Instituto de Salud Carlos III, MICINN and FEDER, 28029 Madrid, Spain
- Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), 03010 Alicante, Spain
| |
Collapse
|
6
|
Jentsch M, der Strate BV, Meddens M, Meddens M, Schoevers R. Assessment of biomarker stability and assay performance parameters for medical diagnosis: a case study of diagnosis of major depressive disorder. Biomark Med 2024; 18:59-68. [PMID: 38305225 DOI: 10.2217/bmm-2023-0416] [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: 02/03/2024] Open
Abstract
Aim: Assessing the stability profiles and assay performance of 24 biomarker assays in 32 biomarker/body fluid combinations identified as relevant for prediction of major depressive disorder. Materials & methods: Combinations were tested for stability and assay performance with ELISA at different storage and freeze-thaw conditions in pooled samples of 40 patients. Results: Stability and assay performance issues were found in almost all cases except three biomarkers in urine and three in serum. Conclusion: This study shows that, to produce reliable measurement data, assessments of stability and assay performance are essential. In development, other quality assurance parameters might be implemented to increase the level of measurement reliability by increasing assay performance control.
Collapse
Affiliation(s)
- Mike Jentsch
- Brainscan BV, Zutphenseweg 55 7418 AH Deventer, Netherlands
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1 9700 RB Groningen, Netherlands
| | - Barry van der Strate
- University Medical Center Groningen, Research Office, Hanzeplein 1 9700 RB Groningen, Netherlands
| | - Marjolein Meddens
- Department of Radiology & Nuclear Medicine, University Medical Center Utrecht, Heidelberglaan 100 3584 CX Utrecht, Netherlands
| | - Marcus Meddens
- Brainscan BV, Zutphenseweg 55 7418 AH Deventer, Netherlands
| | - Robert Schoevers
- University of Groningen, University Medical Center Groningen, Department of Psychiatry, Hanzeplein 1 9700 RB Groningen, Netherlands
- Research School of Behavioral & Cognitive Neurosciences, University of Groningen, Ant. Deusinglaan 1, 9713 AV Groningen, Netherlands
| |
Collapse
|
7
|
Nayyar S, Archibong A, Nayyar T. Testosterone and Prolactin Perturbations Possibly Associated with Reduced Levels of β-Arrestin1 in Mononuclear Leukocytes of Women with Premenstrual Dysphoric Disorder. Int J Mol Sci 2023; 24:15449. [PMID: 37895130 PMCID: PMC10607656 DOI: 10.3390/ijms242015449] [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] [Received: 09/15/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Previously, we reported that a reduction in β-Arrestin1 protein levels in peripheral blood mononuclear leukocytes (PBMC) significantly correlated with the severity of depression symptoms in women with premenstrual dysphoric disorder (PMDD). This study aimed to determine whether the reduced premenstrual β-Arrestin1 protein levels were associated with changes in the regulator for late luteal phase progesterone secretion. The study participants (n = 25) were non-pregnant women between 18 and 42 years of age not taking any antidepressants or receiving therapy and experiencing the luteal phase of menstruation. ELISA determined the β-Arrestin1 protein in PBMC; testosterone and prolactin levels from the plasma were determined by radioimmunoassay. Reduced levels of β-Arrestin1 protein in women with Hamilton Rating Scale for Depression (HAM-D) scores above 19 were observed alongside significantly higher plasma testosterone and prolactin concentrations. Understanding the mechanism underlying the initiation of PMDD will allow for identification of a key perturbed metabolic enzyme that can serve as a target for drug development to ensure the alleviation of PMDD, which has been suggested earlier as a risk factor for developing major depressive disorders.
Collapse
Affiliation(s)
| | | | - Tultul Nayyar
- Meharry Medical College, 1005 Dr. D. B. Todd Jr. Blvd, Nashville, TN 37208, USA; (S.N.); (A.A.)
| |
Collapse
|
8
|
Faron-Górecka A, Latocha K, Pabian P, Kolasa M, Sobczyk-Krupiarz I, Dziedzicka-Wasylewska M. The Involvement of Prolactin in Stress-Related Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3257. [PMID: 36833950 PMCID: PMC9959798 DOI: 10.3390/ijerph20043257] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/07/2023] [Indexed: 06/18/2023]
Abstract
The most important and widely studied role of prolactin (PRL) is its modulation of stress responses during pregnancy and lactation. PRL acts as a neuropeptide to support physiological reproductive responses. The effects of PRL on the nervous system contribute to a wide range of changes in the female brain during pregnancy and the inhibition of the hypothalamic-pituitary axis. All these changes contribute to the behavioral and physiological adaptations of a young mother to enable reproductive success. PRL-driven brain adaptations are also crucial for regulating maternal emotionality and well-being. Hyperprolactinemia (elevated PRL levels) is a natural and beneficial phenomenon during pregnancy and lactation. However, in other situations, it is often associated with serious endocrine disorders, such as ovulation suppression, which results in a lack of offspring. This introductory example shows how complex this hormone is. In this review, we focus on the different roles of PRL in the body and emphasize the results obtained from animal models of neuropsychiatric disorders.
Collapse
Affiliation(s)
- Agata Faron-Górecka
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Katarzyna Latocha
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Paulina Pabian
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Magdalena Kolasa
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| | - Iwona Sobczyk-Krupiarz
- Department of Infectious and Tropical Diseases, Jagiellonian University Medical College, 30-688 Kraków, Poland
| | - Marta Dziedzicka-Wasylewska
- Department of Pharmacology, Maj Institute of Pharmacology, Polish Academy of Sciences, 31-343 Kraków, Poland
| |
Collapse
|
9
|
Nanjappa V, Raveesh H, Kuldeep A, K. S S, C. N M. Study of Acute Coronary Syndrome in Premenopausal Women in Correlation with Sex Hormones. INDIAN JOURNAL OF CARDIOVASCULAR DISEASE IN WOMEN 2022. [DOI: 10.25259/mm_ijcdw_485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objectives:
Higher testosterone and lower Estrogen levels are associated with cardiovascular disease in women. However, studies on endogenous sex hormones and acute coronary syndrome (ACS) in pre-menopausal women are sparse.
Material and Methods:
We studied 50 pre-menopausal women presenting with ACS and age-matched controls who consented to the study with Testosterone, Estradiol, and Sex hormone-binding globulin (SHBG) levels at baseline. They were clinically followed up for 6 months duration.
Results:
The mean age was 37.42 ± 5.7 years. 48% patients were obese. The mean body mass index was 27.53 ± 5.41 kg/m2. Hypertension followed by Diabetes was the most common risk factor. 14% had family history of coronary artery disease (CAD). 24% had atypical chest pain at presentation. Anterior wall ST elevation myocardial infarction was the most common presentation. Single-vessel disease was seen in 38%; 24% had Non-Obstructive CAD. Ratios of Bioavailable Testosterone: Estradiol, Estradiol: Low-density Lipoprotein (LDL), Estradiol: High-density Lipoprotein, SHBG: LDL, and SHBG: HbA1c were analyzed in cases and controls and were not found to be significantly associated.
Conclusion:
Endogenous sex hormones were not found to be significantly associated with ACS in premenopausal women.
Collapse
Affiliation(s)
- Veena Nanjappa
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India,
| | - Hema Raveesh
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India,
| | - Ashwini Kuldeep
- Department of Microbiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India,
| | - Sadanand K. S
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India,
| | - Manjunath C. N
- Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences and Research, Mysuru, Karnataka, India,
| |
Collapse
|