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Niscola P, Gianfelici V, Giovannini M, Piccioni D, Mazzone C, de Fabritiis P. Quality of life considerations in myelodysplastic syndrome: not only fatigue. Expert Rev Hematol 2024. [PMID: 38970288 DOI: 10.1080/17474086.2024.2378035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 07/05/2024] [Indexed: 07/08/2024]
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Bazdar S, Bloemsma LD, Baalbaki N, Blankestijn JM, Cornelissen MEB, Beijers RJHCG, Sondermeijer BM, van Wijck Y, Downward GS, Maitland-van der Zee AH. Hemoglobin and Its Relationship with Fatigue in Long-COVID Patients Three to Six Months after SARS-CoV-2 Infection. Biomedicines 2024; 12:1234. [PMID: 38927441 PMCID: PMC11201257 DOI: 10.3390/biomedicines12061234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/28/2024] Open
Abstract
Background: While some long-term effects of COVID-19 are respiratory in nature, a non-respiratory effect gaining attention has been a decline in hemoglobin, potentially mediated by inflammatory processes. In this study, we examined the correlations between hemoglobin levels and inflammatory biomarkers and evaluated the association between hemoglobin and fatigue in a cohort of Long-COVID patients. Methods: This prospective cohort study in the Netherlands evaluated 95 (mostly hospitalized) patients, aged 40-65 years, 3-6 months post SARS-CoV-2 infection, examining their venous hemoglobin concentration, anemia (hemoglobin < 7.5 mmol/L in women and <8.5 mmol/L in men), inflammatory blood biomarkers, average FSS (Fatigue Severity Score), demographics, and clinical features. Follow-up hemoglobin was compared against hemoglobin during acute infection. Spearman correlation was used for assessing the relationship between hemoglobin concentrations and inflammatory biomarkers, and the association between hemoglobin and fatigue was examined using logistic regression. Results: In total, 11 (16.4%) participants were suffering from anemia 3-6 months after SARS-CoV-2 infection. The mean hemoglobin value increased by 0.3 mmol/L 3-6 months after infection compared to the hemoglobin during the acute phase (p-value = 0.003). Whilst logistic regression showed that a 1 mmol/L greater increase in hemoglobin is related to a decrease in experiencing fatigue in Long-COVID patients (adjusted OR 0.38 [95%CI 0.13-1.09]), we observed no correlations between hemoglobin and any of the inflammatory biomarkers examined. Conclusion: Our results indicate that hemoglobin impairment might play a role in developing Long-COVID fatigue. Further investigation is necessary to identify the precise mechanism causing hemoglobin alteration in these patients.
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Affiliation(s)
- Somayeh Bazdar
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Lizan D. Bloemsma
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Nadia Baalbaki
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Jelle M. Blankestijn
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Merel E. B. Cornelissen
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - Rosanne J. H. C. G. Beijers
- Department of Respiratory Medicine, Nutrim Institute of Nutrition and Translational Research in Metabolism, Faculty of Health, Medicine and Life Sciences, Maastricht University, 6202 AZ Maastricht, The Netherlands;
| | | | - Yolanda van Wijck
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
| | - George S. Downward
- Department of Environmental Epidemiology, Institute for Risk Assessment Sciences (IRAS), Utrecht University, 3584 CL Utrecht, The Netherlands;
- Department of Global Public Health & Bioethics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Anke H. Maitland-van der Zee
- Department of Pulmonary Medicine, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (S.B.); (L.D.B.); (J.M.B.); (M.E.B.C.)
- Amsterdam Institute for Infection and Immunity, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam UMC, 1105 AZ Amsterdam, The Netherlands
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Efficace F, Buckstein R, Abel GA, Giesinger JM, Fenaux P, Bewersdorf JP, Brunner AM, Bejar R, Borate U, DeZern AE, Greenberg P, Roboz GJ, Savona MR, Sparano F, Boultwood J, Komrokji R, Sallman DA, Xie Z, Sanz G, Carraway HE, Taylor J, Nimer SD, Della Porta MG, Santini V, Stahl M, Platzbecker U, Sekeres MA, Zeidan AM. Toward a more patient-centered drug development process in clinical trials for patients with myelodysplastic syndromes/neoplasms (MDS): Practical considerations from the International Consortium for MDS (icMDS). Hemasphere 2024; 8:e69. [PMID: 38774655 PMCID: PMC11106800 DOI: 10.1002/hem3.69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 03/04/2024] [Accepted: 04/01/2024] [Indexed: 05/24/2024] Open
Abstract
Notable treatment advances have been made in recent years for patients with myelodysplastic syndromes/neoplasms (MDS), and several new drugs are under development. For example, the emerging availability of oral MDS therapies holds the promise of improving patients' health-related quality of life (HRQoL). Within this rapidly evolving landscape, the inclusion of HRQoL and other patient-reported outcomes (PROs) is critical to inform the benefit/risk assessment of new therapies or to assess whether patients live longer and better, for what will likely remain a largely incurable disease. We provide practical considerations to support investigators in generating high-quality PRO data in future MDS trials. We first describe several challenges that are to be thoughtfully considered when designing an MDS-focused clinical trial with a PRO endpoint. We then discuss aspects related to the design of the study, including PRO assessment strategies. We also discuss statistical approaches illustrating the potential value of time-to-event analyses and their implications within the estimand framework. Finally, based on a literature review of MDS randomized controlled trials with a PRO endpoint, we note the PRO items that deserve special attention when reporting future MDS trial results. We hope these practical considerations will facilitate the generation of rigorous PRO data that can robustly inform MDS patient care and support treatment decision-making for this patient population.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Rena Buckstein
- Department of Medical Oncology/HematologySunnybrook Health Sciences CentreTorontoOntarioCanada
| | - Gregory A. Abel
- Divisions of Population Sciences and Hematologic MalignanciesDana‐Farber Cancer InstituteBostonMassachusettsUSA
| | | | - Pierre Fenaux
- Hôpital Saint LouisAssistance Publique Hôpitaux de Paris and Paris Cité UniversityParisFrance
| | - Jan Philipp Bewersdorf
- Leukemia Service, Department of MedicineMemorial Sloan Kettering Cancer CenterNew YorkNew YorkUSA
| | - Andrew M. Brunner
- Leukemia Program, Harvard Medical SchoolMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Rafael Bejar
- Division of Hematology and Oncology, Moores Cancer CenterUC San DiegoLa JollaCaliforniaUSA
| | - Uma Borate
- Ohio State University Comprehensive Cancer Center/James Cancer HospitalOhio State UniversityColumbusOhioUSA
| | - Amy E. DeZern
- Sidney Kimmel Comprehensive Cancer CenterJohns Hopkins HospitalBaltimoreMarylandUSA
| | - Peter Greenberg
- Department of Medicine, Division of Hematology, Cancer InstituteStanford University School of MedicineStanfordCaliforniaUSA
| | - Gail J. Roboz
- Weill Cornell Medical College and New York Presbyterian HospitalNew YorkNew YorkUSA
| | - Michael R. Savona
- Department of Medicine, Division of Hematology/OncologyVanderbilt University Medical CenterNashvilleTennesseeUSA
| | - Francesco Sparano
- Italian Group for Adult Hematologic Diseases (GIMEMA), Health Outcomes Research UnitGIMEMA Data CenterRomeItaly
| | - Jacqueline Boultwood
- Blood Cancer UK Molecular Haematology Unit, Radcliffe Department of MedicineNuffield Division of Clinical Laboratory SciencesUniversity of OxfordOxfordUK
| | - Rami Komrokji
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - David A. Sallman
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Zhuoer Xie
- Department of Malignant HematologyH. Lee Moffitt Cancer CenterTampaFloridaUSA
| | - Guillermo Sanz
- Health Research Institute La Fe, Valencia, SpainHospital Universitario y Politécnico La FeValenciaSpain
| | - Hetty E. Carraway
- Leukemia Program, Hematology and Medical OncologyTaussig Cancer Institute, Cleveland ClinicClevelandOhioUSA
| | - Justin Taylor
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Stephen D. Nimer
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Matteo Giovanni Della Porta
- Department of Biomedical SciencesIRCCS Humanitas Clinical and Research Center & Humanitas UniversityMilanItaly
| | - Valeria Santini
- Myelodysplastic Syndromes Unit, Department of Experimental and Clinical Medicine, Hematology, Azienda Ospedaliero Universitaria CareggiUniversity of FlorenceFlorenceItaly
| | - Maximilian Stahl
- Department of Medical OncologyDana‐Farber Cancer Institute and Harvard Medical SchoolBostonMassachusettsUSA
| | - Uwe Platzbecker
- Department of Hematology and Cellular TherapyUniversity Hospital LeipzigLeipzigGermany
| | - Mikkael A. Sekeres
- Sylvester Comprehensive Cancer CenterUniversity of Miami Miller School of MedicineMiamiFloridaUSA
| | - Amer M. Zeidan
- Section of Hematology, Department of Internal MedicineYale University School of Medicine and Yale Cancer CenterNew HavenConnecticutUSA
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Efficace F, Koinig K, Cottone F, Bowen D, Mittelman M, Sommer K, Langemeijer S, Culligan D, Filanovsky K, Storck M, Smith A, van Marrewijk C, Dugas M, Stojkov I, Siebert U, de Witte T, Stauder R. Raising the standards of patient‐centered outcomes research in myelodysplastic syndromes: Clinical utility and validation of the subscales of the QUALMS from the MDS‐RIGHT project. Cancer Med 2022; 12:7529-7539. [PMID: 36533415 PMCID: PMC10067097 DOI: 10.1002/cam4.5487] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 09/30/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Clinical decision-making for patients with myelodysplastic syndromes (MDS) is challenging, and both disease and treatment effects heavily impact health-related quality of life (HRQoL) of these patients. Therefore, disease-specific HRQoL measures can be critical to harness the patient voice in MDS research. METHODS We report a prospective international validation study of the Quality of Life in Myelodysplasia Scale (QUALMS) with a main focus on providing information on the psychometric characteristics of its three subscales: physical burden (QUALMS-P), emotional burden (QUALMS-E), and benefit finding (QUALMS-BF). The analysis is based on patients enrolled from three European countries and Israel, participating to the MDS-RIGHT Project. The scale structure and psychometric properties of the QUALMS were assessed. RESULTS Overall, 270 patients with a median age of 74 years were analyzed and the majority of them (60.3%) had a low MDS-Comorbidity Index score. Results of the confirmatory factor analysis supported the underlying scale structure of the QUALMS, which, in addition to a total score, includes three subscales: QUALMS-P, QUALMS-E, and the QUALMS-BF. The QUALMS-P exhibited the highest Cronbach's alpha coefficients. Discriminant validity analysis indicated good results with the QUALMS-P and QUALMS-E distinguishing between patients with different performance status, comorbidity, anemia, and transfusion dependency status. No floor and ceiling effects were observed. Responsiveness to change analysis supported the validity of the measure. Patients with a hemoglobin (Hb) level of <11 g/dL at study entry, who subsequently showed an improvement in their Hb levels, also reported a mean score change of 9 and 8 points (scales ranging between 0 and 100) in the expected direction of the QUALMS-E and QUALMS-P, respectively. CONCLUSIONS Our study provides additional validation data on the QUALMS from the international MDS-RIGHT Project. The use of this disease-specific HRQoL measure may contribute to raise quality standards of patient-centered outcomes research in MDS.
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Affiliation(s)
- Fabio Efficace
- Italian Group for Adult Hematologic Diseases (GIMEMA)Data Center and Health Outcomes Research UnitRomeItaly
| | - Karin Koinig
- Department of Internal Medicine V (Hematology and Oncology)Medical University InnsbruckInnsbruckAustria
| | - Francesco Cottone
- Italian Group for Adult Hematologic Diseases (GIMEMA)Data Center and Health Outcomes Research UnitRomeItaly
| | - David Bowen
- St. James's Institute of Oncology, Leeds Teaching HospitalsLeedsUK
| | - Moshe Mittelman
- Department of HematologyTel Aviv Sourasky (Ichilov) Medical Center, Sackler Faculty of Medicine, Tel Aviv UniversityTel Aviv‐YafoIsrael
| | - Kathrin Sommer
- Italian Group for Adult Hematologic Diseases (GIMEMA)Data Center and Health Outcomes Research UnitRomeItaly
| | - Saskia Langemeijer
- Department of HematologyRadboud University Medical CenterNijmegenThe Netherlands
| | | | | | - Michael Storck
- Institute of Medical Informatics, University of MünsterMünsterGermany
| | - Alexandra Smith
- Epidemiology and Cancer Statistics Group, Department of Health SciencesUniversity of YorkYorkUK
| | - Corine van Marrewijk
- Department of HematologyRadboud University Medical CenterNijmegenThe Netherlands
| | - Martin Dugas
- Institute of Medical Informatics, Heidelberg University HospitalHeidelbergGermany
| | - Igor Stojkov
- Department of Public Health, Health Services Research and Health Technology AssessmentInstitute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT ‐ University for Health Sciences, Medical Informatics and TechnologyHall in TirolAustria
| | - Uwe Siebert
- Department of Public Health, Health Services Research and Health Technology AssessmentInstitute of Public Health, Medical Decision Making and Health Technology Assessment, UMIT ‐ University for Health Sciences, Medical Informatics and TechnologyHall in TirolAustria
- Departments of Epidemiology and Health Policy & ManagementCenter for Health Decision Science, Harvard Chan School of Public HealthBostonMassachusettsUSA
- Institute for Technology Assessment and Department of RadiologyMassachusetts General Hospital, Harvard Medical SchoolBostonMassachusettsUSA
| | - Theo de Witte
- Department of Tumor ImmunologyNijmegen Center for Molecular Life Sciences, Radboud University Medical CenterNijmegenThe Netherlands
| | - Reinhard Stauder
- Department of Internal Medicine V (Hematology and Oncology)Medical University InnsbruckInnsbruckAustria
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Zeidan AM, Tsai JH, Karimi M, Schmier J, Jayade S, Zormpas E, Hassan A, Ruiters D, Anthony C, Hill K, Wert T, Botteman M. Patient Preferences for Benefits, Risks, and Administration Route of Hypomethylating Agents in Myelodysplastic Syndromes. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2022; 22:e853-e866. [PMID: 35729009 DOI: 10.1016/j.clml.2022.04.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 04/18/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION/BACKGROUND Therapy with infused or injected hypomethylating agents (HMAs) may lead to higher treatment administration burden (ie, local reaction, visit frequency and duration) vs. oral HMAs. OBJECTIVES: To reveal preferences of US and Canadian patients with myelodysplastic syndromes (MDS) for HMAs' benefits, risks, and administration burden through an online discrete-choice experiment (DCE). MATERIALS AND METHODS Choice of DCE attributes and survey development were informed by literature review and interviews with clinicians, MDS patients, and caregivers serving as patient proxies, and patient advocacy groups (PAGs) representatives, including from AAMAC, AAMDS, and MDSF. DCE choice tasks were analyzed using random parameter logit models. Survey patients were recruited by the PAGs via their networks. To understand key preference drivers and how much patients were willing to trade between attributes, we calculated each attribute's relative attribute importance (RAI) and marginal rates of substitution. RESULTS One hundred eighty-four respondents (including 158 patients; mean age, 67.2 years; male, 50.5%; White, 50.5%; US residents, 88%) completed the survey. MDS risk was low (34.8%), high (30.9%), or unknown (34.2%). RAI (in decreasing order) was as follows: risk of AML (40%), fatigue level (33%), number of visits (12%), mode of administration (6%), visit duration (5%), and administration frequency (4%). Assuming the same risk of AML transformation or level of fatigue, most respondents (76.6%) were predicted to switch to an oral pill if it were available to them. CONCLUSION Given equivalent effectiveness across HMAs, patients' preferences for HMA administration method should be considered in treatment decision-making to minimize burden and facilitate adherence.
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Affiliation(s)
- Amer M Zeidan
- Section of Hematology, Department of Medicine, Yale School of Medicine, and Yale Cancer Center, New Haven, CT.
| | | | | | | | | | | | - Audrey Hassan
- The Myelodysplastic Syndromes (MDS) Foundation, Yardville, NJ
| | - Desiree Ruiters
- Aplastic Anemia and MDS International Foundation, Bethesda, MD
| | - Cindy Anthony
- Aplastic Anemia and Myelodysplasia Association of Canada (AAMAC), King City, Ontario, Canada
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Giesinger JM, La Nasa G, Sparano F, Angermeyer M, Morelli E, Mulas O, Efficace F, Caocci G. Health-Related Quality of Life Assessment in Patients with Myelodysplastic Syndromes: Evidence from Randomized Clinical Trials. Clin Pract Epidemiol Ment Health 2021; 17:307-314. [PMID: 35444708 PMCID: PMC8985474 DOI: 10.2174/1745017902117010307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 11/22/2022]
Abstract
Myelodysplastic syndromes (MDS) are characterized by ineffective hematopoiesis and blood cytopenia with a variable risk of progression to acute myeloid leukemia. The main goal of therapy for the large majority of patients is to improve health-related quality of life (HRQoL). Its rigorous assessment is now recommended in international MDS guidelines. Our review provides an overview of HRQoL results from randomized controlled trials (RCTs) in MDS patients. The literature search undertaken in PubMed identified 10 RCTs with HRQoL endpoints (all secondary) published between August 2008 and September 2020. These RCTs have helped to better understand the impact of therapies from the patient perspective and have generated valuable information that can be used to further support clinical decisions. However, the number of RCTs in MDS patients, including HRQoL endpoints, is still low. Given the importance of symptom relief and HRQoL improvement in the treatment of MDS patients, the assessment of the patient perspective in future RCTs is highly recommended to keep expanding the knowledge of the impact of new MDS therapies.
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Peric SZ, Cornblath DR. Fatigue in chronic inflammatory demyelinating polyradiculoneuropathy. Muscle Nerve 2020; 62:649-651. [DOI: 10.1002/mus.27076] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 09/11/2020] [Accepted: 09/19/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Stojan Z. Peric
- Neurology Clinic, Clinical Center of Serbia, Faculty of Medicine University of Belgrade Belgrade Serbia
| | - David R. Cornblath
- Department of Neurology John Hopkins University School of Medicine Baltimore Maryland USA
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