1
|
Ndoye NA, Welle IB, Lamega B, Diawara A, Zeng FTA, Ngom G. Ileal perforation peritonitis secondary to ingestion of magnetic beads in the older child: A case report. Int J Surg Case Rep 2024; 121:109915. [PMID: 38909390 PMCID: PMC11245974 DOI: 10.1016/j.ijscr.2024.109915] [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: 10/23/2023] [Revised: 06/10/2024] [Accepted: 06/15/2024] [Indexed: 06/25/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Foreign body ingestion is frequent in younger children, with generally good outcome on conservative management. However, magnetic beads ingestion is an exceptional cause of intestinal perforation in the older children. CASE PRESENTATION An 8-year-old boy presented with clinical signs of generalized acute peritonitis. Abdominal plain X-ray confirmed the foreign object in the digestive tract and oriented the etiology by highlighting several air-fluid levels, distended small bowel loops, pneumoperitoneum and the presence of a bilobed foreign body projected adjacent to the 5th lumbar vertebra. Open surgical exploration was performed and revealed a peritoneal fluid, 2 perforations in the small bowel and 2 adhered pieces of magnets. A 20 cm ileal resection, including the segment with the 2 perforations, was performed followed by a terminal ileostomy. The restoration of gastrointestinal continuity was performed 16 days later. After a follow-up of 2 years and 8 months, the patient was free of any symptom. CLINICAL DISCUSSION In cases of acute peritonitis due to perforation, the general condition deteriorates progressively. Fever may be absent, as was the case with our patient. Abdominal pain is the predominant symptom, it is often accompanied by vomiting that can be alimentary, bilious, or even fecaloid and/or by cessation of bowel movements and/or gas. Abdominal rigidity is a major physical sign, sometimes replaced by generalized guarding. CONCLUSION Ingestion of gastrointestinal foreign bodies is rare in older children, the presence of more than one magnet can lead to peritonitis due to intestinal perforation.
Collapse
Affiliation(s)
- Ndèye Aby Ndoye
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal.
| | - Ibrahima Bocar Welle
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Dakar, Senegal
| | - Bembo Lamega
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Dakar, Senegal
| | - Amadou Diawara
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Dakar, Senegal
| | - Florent Tshibwid A Zeng
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Dakar, Senegal
| | - Gabriel Ngom
- Department of Pediatric Surgery, Albert Royer National Children's Hospital Center, Université Cheikh Anta Diop, Dakar, Senegal
| |
Collapse
|
2
|
Quitadamo P, Gragnaniello P, Isoldi S, Bucci C, Esposito F, Russo S, Grella MG, Caldore M. Magnetic foreign body ingestion in pediatric age. Dig Liver Dis 2024; 56:1002-1006. [PMID: 37985250 DOI: 10.1016/j.dld.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 11/06/2023] [Accepted: 11/08/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVES To assess the clinical complications reported after the ingestion of magnetic foreign bodies (FBs) in pediatric age, along with their incidence among all FB ingestions and clinical presentation. STUDY DESIGN We've consecutively recruited all children aged 0-14 years who were admitted for single or multiple magnet ingestion from May 2015 to December 2022. Patient demographics, admission sources and discharge status were accurately recorded, along with their clinical management and outcomes. RESULTS Sixty-one children were enrolled, of whom 49/61 (80.3%) had ingested a single magnet and 12/61 (19.7%) multiple magnets. Only 1/49 children with single magnet required endoscopic removal due to esophageal retention. Among children having ingested multiple magnets, 5/12 (41.7%) undergo endoscopic removal since magnets were amenable to endoscopic retrieval whereas in 7/12 (58.3%) magnets could not be promptly removed. Among these, 4/12 (33.3%) later developed intestinal ischemia/necrosis or perforation and required FB surgical intervention whereas 3/12 (25%) uneventfully evacuated magnets. CONCLUSIONS Our data confirm that multiple magnet ingestion, unlike single magnet ingestion, pose a serious health hazard. Parents and caregivers should remove them from the reach of children. Medical providers should maintain a high index of suspicion of their ingestion since prompt evaluation and likely removal may be lifesaving and intestine saving.
Collapse
Affiliation(s)
- Paolo Quitadamo
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy.
| | - Piergiorgio Gragnaniello
- Department of Translational Medical Science, Section of Pediatrics, University "Federico II", Naples, Italy
| | - Sara Isoldi
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Cristina Bucci
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Francesco Esposito
- Department of Emergency Radiology, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | - Silvana Russo
- Pediatric Surgery Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| | | | - Mariano Caldore
- Pediatric Gastroenterology and Epatology Unit, Santobono-Pausilipon Children's Hospital, Naples, Italy
| |
Collapse
|
3
|
Alansari AN, Baykuziyev T, Soyer T, Akıncı SM, Al Ali KK, Aljneibi A, Alyasi NH, Afzal M, Ksia A. Magnet ingestion in growing children: a multi-center observational study on single and multiple magnet incidents. Sci Rep 2024; 14:4575. [PMID: 38403623 PMCID: PMC10894856 DOI: 10.1038/s41598-024-55127-0] [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: 12/13/2023] [Accepted: 02/20/2024] [Indexed: 02/27/2024] Open
Abstract
Over the past 15 years, there has been a noticeable uptick in incidents involving children ingesting multiple magnetic foreign bodies which can cause injuries and gastrointestinal complications including death. The current study aimed to identify the prevalence, clinical presentation, and management of single or multiple magnet ingestions. A retrospective multi-central cross-sectional study was conducted to include all pediatric patients < 18 years presented to the emergency department with ingestion of single or multiple magnets and admitted across hospitals in Qatar, UAE, KSA, Tunisia, and Turkey between January 2011 and December 2021. Demographics, symptoms, management, and outcomes were analyzed. There were 189 magnet ingestions, of which 88 (46.6%) were multiple magnet ingestions. Most patients (55.6%) were male, and the median age was 3.9 (IQR 2-7) years. An abdominal X-ray was obtained in all cases. 119 (62%) patients were conservatively treated, 53 (28%) required surgical intervention and 17 (8.9%) underwent gastroscopy. None of the patients with single magnet ingestions experienced morbidity or severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations, perforations (44.3%), severe intestinal necrosis (19.3%), peritonitis (13.6%), severe abdominal infection (10.2%), and septic shock (4.5%). The rate of surgical intervention (59.1% vs. 1.0%) and gastroscopy (15.9% vs. 3.0%) was significantly higher in the multiple ingestion group compared to the single magnet ingestion group. No deaths were identified. A high risk of serious complications, including the need for surgery to remove the magnets and substantial morbidity may result from swallowing more than one magnet. Magnet safety requirements, public education, and improved legislation are urgently required.
Collapse
Affiliation(s)
- Amani N Alansari
- Department of Pediatric Surgery, Hamad General Hospital, Doha, Qatar.
| | - Temur Baykuziyev
- Department of Anesthesiology, ICU and Perioperative Medicine, Hamad General Hospital, Doha, Qatar
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Servet Melike Akıncı
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Khalid Khalfan Al Ali
- Department of Pediatric Surgery, Al Qassimi Women and Children's Hospital, Sharjah, United Arab Emirates
| | - Adel Aljneibi
- Department of Pediatric Surgery, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Nafea Hussain Alyasi
- Department of Pediatric Gastroenterology, Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates
| | - Muhammad Afzal
- Department of Pediatric Surgery, Maternity and Children Hospital, Dammam, Kingdom of Saudi Arabia
| | - Amine Ksia
- Department of Pediatric Surgery, Faculty of Medicine, Fattouma Bourguiba Hospital, Monastir, Tunisia
| |
Collapse
|
4
|
Alareefy A, Barnawi E, Alrashed R, Alamri A, Aleidan AM, Alghofaily M, Alkhelaif M, Kanfar S. Pediatric Magnet Ingestion with Delayed Presentation: Case Series from Tertiary Center in Saudi Arabia. Pediatric Health Med Ther 2023; 14:231-236. [PMID: 37521122 PMCID: PMC10378458 DOI: 10.2147/phmt.s411079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/18/2023] [Indexed: 08/01/2023] Open
Abstract
Swallowing foreign bodies is common in young kids, especially those aged 6 months to 6 years. Magnet ingestion is a hazardous health issue that extremely jeopardizes the most vulnerable group, children, to risks of intestinal obstruction and worse, perforation. We, hereby, report 3 cases of magnet ingestion in the pediatric age group who had multiple beaded magnets stuck inside their GI tract over a variable period of 1 to 10 months before their presentation to the Emergency Department, King Fahad Medical City Riyadh, Saudi Arabia.
Collapse
Affiliation(s)
- Abdulaziz Alareefy
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Esam Barnawi
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Rawan Alrashed
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Abdulelah Alamri
- Pediatric Emergency Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Ahmed M Aleidan
- Pediatric Pulmonology Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Mazen Alghofaily
- General Pediatric Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Mayada Alkhelaif
- General Pediatric Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| | - Sara Kanfar
- Pediatric Surgery Department, King Fahad Medical City, Riyadh Second Health Cluster, Riyadh, Saudi Arabia
| |
Collapse
|
5
|
Abstract
OBJECTIVES To review the clinical management and outcomes of magnet ingestions at a large tertiary children's hospital. To determine the association of frequency of high-powered magnet ingestion with the regulation of these magnets. METHODS Children <18 years who presented to the emergency room and were admitted to the Children's Hospital of Philadelphia for ingestion of single or multiple magnets from January 2008 to December 2020 were included. Demographics, symptoms, management, and outcomes were analyzed. The frequency of magnet ingestion was compared over 3 eras: (1) pre-ban (2008-2012), (2) intra-ban (2013-2016), and (3) post-ban (2017-2020). RESULTS There were 167 magnet ingestions, including 99 with multiple magnets. Most patients (59%) were male and median age was 6 (interquartile range, 3-9) years. Most single magnet ingestions (86%) were discharged with outpatient monitoring, and none experienced severe outcomes. Multiple magnet ingestions led to significant morbidity including hospitalizations (68%), endoscopic procedures (48%), surgical procedures (14%), and severe outcomes (12%). Most patients (75%) were asymptomatic, however, there was a higher risk of surgery and severe complications based on the presence of symptoms ( P = 0.003). The rate of surgical intervention was higher with ≥3 magnets (31.7%) compared to 2 magnets (2.4%) ( P < 0.003). Additionally, we found an 160% increase in children with magnet ingestions in the post-ban period ( P = 0.021). CONCLUSIONS Multiple magnet ingestion is associated with high morbidity and rate of severe outcomes. There is a relationship between public policy of magnet sale and frequency of magnet ingestion.
Collapse
|
6
|
Ding G, Liu H, Zhou P, Niu Q, Wang W, Feng Z, Zhang S, Zhang Z, Geng L, Bu Z, Fu T. Pediatric Multiple High-Powered Magnetic Buckyballs Ingestion—Experience From Six Tertiary Medical Centers. Front Public Health 2022; 10:892756. [PMID: 35784204 PMCID: PMC9240617 DOI: 10.3389/fpubh.2022.892756] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/16/2022] [Indexed: 11/18/2022] Open
Abstract
Multiple high-powered magnetic Buckyball ingestions may lead to a high risk of severe complications. Great concerns have been raised by public health workers, and it remains challenging for clinicians to solve this troublesome problem. We report a large case series of children with Buckyball ingestion from six tertiary medical centers. The clinical data, including demographics, medical history, diagnosis tools, management options, intraoperative or endoscopic findings, and outcomes, were retrospectively analyzed. Seventy-one children aged 1–13 years ingested 2–41 Buckyballs. Among them, Buckyballs passed spontaneously on 2–10 days post-ingestion in seven cases; gastroscopic removal was performed in 14 cases; laparoscopic removal in 13 cases; laparoscopic-assisted surgical removal in 6 cases; and open surgical removal in 31 cases. Surgical indications included small bowel obstruction, perforation, peritonitis, acute abdominal pain, or along with ingestion of other metallic foreign bodies. Among those who underwent a surgical procedure, primary intestinal repair was performed in 44 cases, enterectomy with primary anastomosis in 6 cases. The postoperative hospital stay ranged from 5 to 28 days. No major complications occurred. In unwitnessed cases, a vague medical history and nonspecific symptoms usually make the diagnosis difficult. The treatment options should include the watch-and-wait approach, endoscopic, laparoscopic-assisted, or open surgical removal of Buckyballs, with primary intestinal repair or anastomosis. Preventive measures, including children's not having access to Buckyballs, are essential to protect children from this kind of unintentional injury.
Collapse
Affiliation(s)
- Guojian Ding
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
| | - Hongzhen Liu
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Peng Zhou
- Department of Pediatric Surgery, Zibo Maternal and Child Health Care Hospital, Zibo, China
| | - Qiong Niu
- Department of Gastroenterology, Binzhou Medical University Hospital, Binzhou, China
| | - Wei Wang
- Department of Pediatric Surgery, Maternity and Child Health Care of Zaozhuang, Zaozhuang, China
| | - Zhiqiang Feng
- Department of Pediatric Surgery, Taian Maternity and Child Health Hospital, Taian, China
| | - Shisong Zhang
- Department of Pediatric Surgery, Children's Hospital Affiliated to Shandong University, Jinan, China
| | - Zhengmao Zhang
- Department of Pediatric Surgery, Zibo Maternal and Child Health Care Hospital, Zibo, China
| | - Lei Geng
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- *Correspondence: Lei Geng
| | - Zhaoyun Bu
- Department of Pediatric Surgery, People's Hospital of Rizhao, Rizhao, China
- Zhaoyun Bu
| | - Tingliang Fu
- Department of Pediatric Surgery, Binzhou Medical University Hospital, Binzhou, China
- Tingliang Fu
| |
Collapse
|
7
|
Rashed Y, Khalfan K. Button Batteries and High-Powered Neodymium Magnet Ingestion in Children. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Foreign body ingestions in pediatrics are present highly variably. For each case, it is important to consider the size of the child, the age of the child, the size of the object, and the inherently different risk of different objects ingested. It is important to note that regardless of the type of object, any foreign body should be removed from the esophagus. Over the past decade, the medical literature has particularly identified the potential for morbidity and mortality in cases of button battery and magnet ingestions.
AIM: This study aims to describe the complications and how to avoid them in addition to studying the role of early endoscopic intervention in cases of button batteries (BB) and multiple magnets ingestion in children.
METHODS: There were 151 children enrolled in the study, classified into two groups. The first group constitutes ninety children with BB, the other group sixty children with multiple magnets ingestion. In addition to one patient with both multiple magnets and battery ingestion, which are extracted endoscopically from the stomach without complication. BB detected in the upper gastrointestinal tract (GIT) in the esophagus, stomach, and duodenum in 70 patients were extracted endoscopically. Other 20 patients where the batteries were detected distal to duodenum were observed till the discharge of batteries was confirmed. In patients with multiple magnets, the magnets were in the upper GIT in 46 patients while found distal to the duodenum in 14 patients.
RESULTS: There were 151 children enrolled in the study, classified into two groups. The first group constitutes ninety children with BB, the other group sixty children with multiple magnets ingestion. In addition to one patient with both multiple magnets and battery ingestion, which are extracted endoscopically from the stomach without complication. BB detected in the upper GIT in the esophagus, stomach, and duodenum in 70 patients were extracted endoscopically. Other 20 patients where the batteries were detected distal to duodenum were observed until the discharge of batteries was confirmed. In patients with multiple magnets, the magnets were in the upper GIT in 46 patients while found distal to the duodenum in 14 patients.
CONCLUSION: This study put alarm that multiple magnets ingestion carries a high risk of gastrointestinal perforation compared to battery ingestion. Invitation to ban on the sale of products with high-powered neodymium magnets, such as Buckyballs and Buckycubes, and to keep BB difficult reachable by children. In addition to encouraging urgent endoscopic management of suspected BB or multiple magnets ingestion.
Collapse
|
8
|
Taniguchi M, Hatachi T, Takeuchi M. Gastric perforation in the lesser curvature caused by multiple neodymium magnets. Pediatr Int 2022; 64:e15361. [PMID: 36564345 DOI: 10.1111/ped.15361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 07/10/2022] [Accepted: 09/20/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Masashi Taniguchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Takeshi Hatachi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| | - Muneyuki Takeuchi
- Department of Intensive Care Medicine, Osaka Women's and Children's Hospital, Osaka, Japan
| |
Collapse
|
9
|
Xin Y, Jia LQ, Dong YW, Wang Y, Hu YX, Wang XM. Application of high-frequency ultrasound in the diagnosis of gastrointestinal magnet ingestion in children. Front Pediatr 2022; 10:988596. [PMID: 36714638 PMCID: PMC9880474 DOI: 10.3389/fped.2022.988596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/28/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The incidence of magnet ingestion by children has recently increased in China. Magnet ingestion is associated with an extremely high risk of gastrointestinal damage because loops of bowel can become trapped and squeezed between multiple magnets in different locations. However, the lack of imaging sensitivity makes clinical decision-making difficult. OBJECTIVE This study was conducted to investigate the performance of ultrasound in diagnosing gastrointestinal magnet ingestion in children. METHODS From April 2017 to February 2021, all children with a history of magnet ingestion or a diagnosis of gastrointestinal magnet as shown by x-ray or ultrasound in our hospital were included as study candidates. Patients who were lost to follow-up or had known malformations of the gastrointestinal tract were excluded. Eligible patients were those with surgical or endoscopic confirmation of gastrointestinal magnet, those who passed the magnet out of the alimentary tract without assistance, and those with confirmed absence of the magnet on abdominal x-ray examination after 1 month of conservative treatment. All eligible patients' ultrasound and x-ray examination data were evaluated. The sensitivity, specificity, and area under the curve (AUC) of ultrasound was calculated for diagnosing magnet ingestion, locating the magnet (stomach, small intestine, or colon), and confirming the phenomenon of wall entrapment. RESULTS Of 112 patients, 107 had a magnetic foreign body and 5 did not. Magnets were correctly detected by ultrasound in 97 patients, with an observed sensitivity of 90.65% and specificity of 100%. Satisfactory sensitivity was obtained for ultrasound localization of gastric magnets (96.30%) and small intestinal magnets (100.00%), but sensitivity for ultrasound localization of colonic magnets was relatively poor (73.33%). The discrimination of wall entrapment by ultrasound was good (AUC = 0.93), with an observed sensitivity and specificity of 92.00% and 93.62%, respectively. CONCLUSIONS Ultrasound can be used to locate gastrointestinal magnets (in the stomach, small intestine, or colon) with good clinical efficacy in identifying wall entrapment.
Collapse
Affiliation(s)
- Yue Xin
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Li Qun Jia
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Ya Wei Dong
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yu Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Yan Xiu Hu
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| | - Xiao Man Wang
- Department of Ultrasound, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
10
|
Miyamoto R, Okumura A. Response to a letter to the editor by Dong et al. Acta Paediatr 2021; 110:1968. [PMID: 33626188 DOI: 10.1111/apa.15817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/23/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Ryosuke Miyamoto
- Department of Pediatrics Aichi Medical University School of Medicine Nagakute Aichi Japan
| | - Akihisa Okumura
- Department of Pediatrics Aichi Medical University School of Medicine Nagakute Aichi Japan
| |
Collapse
|