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Huang H, Chen M, Ding P, Xia X, Dai Q, Feng L, Xu L, Shu J, Li L. Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories? Spinal Cord 2024:10.1038/s41393-024-01040-2. [PMID: 39379498 DOI: 10.1038/s41393-024-01040-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 09/15/2024] [Accepted: 09/25/2024] [Indexed: 10/10/2024]
Abstract
STUDY DESIGN Observational cohort study. OBJECTIVE To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory. SETTING Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). METHODS All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study. RESULTS Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. CONCLUSION These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.
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Affiliation(s)
- Hui Huang
- Department of Nursing, The Second Hospital of Nanjing, Nanjing, China
- School of Nursing, Anhui Medical University, Hefei, China
| | - Mengmeng Chen
- School of Nursing, Anhui Medical University, Hefei, China
| | - Peipei Ding
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xiaoxiao Xia
- School of Nursing, Anhui Medical University, Hefei, China
| | - Qing Dai
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Linsheng Feng
- The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Li Xu
- Department of Nursing, The Second Hospital of Nanjing, Nanjing, China.
| | - Junmei Shu
- Department of Nursing, The Second Hospital of Nanjing, Nanjing, China.
| | - Lunlan Li
- School of Nursing, Anhui Medical University, Hefei, China.
- The First Affiliated Hospital of Anhui Medical University, Hefei, China.
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Aghili SH, Manavi MA, Panji M, Farhang Ranjbar M, Abrishami R, Dehpour AR. Mirtazapine Improves Locomotor Activity and Attenuates Neuropathic Pain Following Spinal Cord Injury in Rats via Neuroinflammation Modulation. Neurochem Res 2024:10.1007/s11064-024-04240-7. [PMID: 39271550 DOI: 10.1007/s11064-024-04240-7] [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: 04/01/2024] [Revised: 05/16/2024] [Accepted: 09/03/2024] [Indexed: 09/15/2024]
Abstract
Neuroinflammation-related locomotor deficits and neuropathic pain are expected outcomes of spinal cord injury (SCI). The atypical antidepressant mirtazapine has exhibited potential neuroprotective and anti-inflammatory effects. This research aims to investigate the impacts of mirtazapine on post-SCI neuropathic pain and locomotor recovery, with a particular focus on neuroinflammation. The study utilized 30 male Wistar rats divided into five groups: Sham, SCI with vehicle treatment, and SCI administered with mirtazapine (3, 10, and 30 mg/kg/day, ip, for one week). Locomotor activity was assessed using the Basso, Beattie, and Bresnahan (BBB) scale. Mechanical, thermal, and cold allodynia were assessed using von-Frey filaments, tail flick latency, and the acetone test, respectively. ELISA was utilized to measure cytokines, while Western blotting was used to determine TRPV1 channel, 5-HT2A receptor, NLRP3, and iNOS expression. Histopathological analyses were also examined, including hematoxylin and eosin (H&E) and Luxol fast blue (LFB) staining. Mirtazapine (10 and 30 mg/kg/day) significantly improved locomotor recovery according to BBB score. It attenuated mechanical, thermal, and cold allodynia post-SCI. Moreover, it decreased pro-inflammatory cytokines TNF-α, IL-1β, IL-6, and IL-18, while increasing anti-inflammatory cytokine IL-4 and IL-10. Furthermore, it downregulated iNOS, NLRP3, and TRPV1 expression and upregulated the 5-HT2A receptor. H&E and LFB staining further revealed attenuated tissue damage and decreased demyelination. Our findings suggest that mirtazapine can alleviate neuropathic pain and reinforce locomotor recovery post-SCI by modulating neuroinflammatory responses, NLRP3, iNOS, TRPV1 channel, and 5-HT2A receptor expression.
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Affiliation(s)
- Seyed Hadi Aghili
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran
- Neurosurgery Department, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Valiasr Hospital, Tehran, Iran
| | - Mohammad Amin Manavi
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran
| | - Mohammad Panji
- Research Center for Life, Health Sciences & Biotechnology of the Police, Directorate of Health, Rescue & Treatment, Police Headquarters, Tehran, Iran
| | - Mehri Farhang Ranjbar
- Department of Support and Services Management, Institute of Management and Organizational Resources, Policing Sciences and Social Studies Research Institute, Tehran, Iran
| | - Ramin Abrishami
- Research Center for Trauma in Police Operations, Directorate of Health, Rescue & Treatment, Police Headquarter, Tehran, Iran.
- Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran.
| | - Ahmad Reza Dehpour
- Experimental Medicine Research Center, Tehran University of Medical Sciences, P.O. Box 13145-784, Tehran, Iran.
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
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Parajuli B, Acharya K, Grooves CC, Dhakal R, Shrestha J, Shrestha R, Manandhar M. Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study. Spinal Cord Ser Cases 2023; 9:13. [PMID: 37024460 PMCID: PMC10079656 DOI: 10.1038/s41394-023-00566-6] [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: 07/17/2022] [Revised: 03/04/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
STUDY DESIGN Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. SETTING Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. METHODS Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. RESULTS Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. CONCLUSIONS PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.
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Affiliation(s)
- Bikash Parajuli
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal.
| | - Khagendra Acharya
- Department of Management Informatics and Communication, School of Management, Kathmandu University, Dhulikhel, Nepal
| | - Christine C Grooves
- Spinal Injury Rehabilitation Centre, Sanga, Nepal
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Raju Dhakal
- Spinal Injury Rehabilitation Centre, Sanga, Nepal
| | | | - Rahul Shrestha
- Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Nepal
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Zwecker M, Heled E, Bondi M, Zeilig G, Bluvstein V, Catz A, Dudkiewicz I. Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling. Arch Phys Med Rehabil 2022; 103:2375-2382. [PMID: 35810821 DOI: 10.1016/j.apmr.2022.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI). DESIGN Survey, cross-sectional study, and model testing using structural equation modeling. SETTING Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel. PARTICIPANTS Convenience sample of 156 individuals with SCI (N=156). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES QoL assessed by the World Health Organization Quality of Life Assessment-BREF. Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury. The Spinal Cord Independence Measure to assess SCI-related task performance. ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model. RESULTS Level of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL. CONCLUSIONS In order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients.
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Affiliation(s)
- Manuel Zwecker
- Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer; Sackler School of Medicine, Tel Aviv University, Tel Aviv.
| | - Eyal Heled
- Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer; Department of Behavioral Sciences, Ariel University, Ariel
| | - Moshe Bondi
- Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer; Sackler School of Medicine, Tel Aviv University, Tel Aviv
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer; Sackler School of Medicine, Tel Aviv University, Tel Aviv; School of Health Professions, Ono Academic College, Kiryat Ono
| | - Vadim Bluvstein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv; Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana
| | - Amiram Catz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv; Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana
| | - Israel Dudkiewicz
- Sackler School of Medicine, Tel Aviv University, Tel Aviv; Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel
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Trehalose-Carnosine Prevents the Effects of Spinal Cord Injury Through Regulating Acute Inflammation and Zinc(II) Ion Homeostasis. Cell Mol Neurobiol 2022; 43:1637-1659. [PMID: 36121569 PMCID: PMC10079760 DOI: 10.1007/s10571-022-01273-w] [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: 12/22/2021] [Accepted: 08/11/2022] [Indexed: 11/03/2022]
Abstract
Spinal cord injury (SCI) leads to long-term and permanent motor dysfunctions, and nervous system abnormalities. Injury to the spinal cord triggers a signaling cascade that results in activation of the inflammatory cascade, apoptosis, and Zn(II) ion homeostasis. Trehalose (Tre), a nonreducing disaccharide, and L-carnosine (Car), (β-alanyl-L-histidine), one of the endogenous histidine dipeptides have been recognized to suppress early inflammatory effects, oxidative stress and to possess neuroprotective effects. We report on the effects of the conjugation of Tre with Car (Tre-car) in reducing inflammation in in vitro and in vivo models. The in vitro study was performed using rat pheochromocytoma cells (PC12 cell line). After 24 h, Tre-car, Car, Tre, and Tre + Car mixture treatments, cells were collected and used to investigate Zn2+ homeostasis. The in vivo model of SCI was induced by extradural compression of the spinal cord at the T6-T8 levels. After treatments with Tre, Car and Tre-Car conjugate 1 and 6 h after SCI, spinal cord tissue was collected for analysis. In vitro results demonstrated the ionophore effect and chelating features of L-carnosine and its conjugate. In vivo, the Tre-car conjugate treatment counteracted the activation of the early inflammatory cascade, oxidative stress and apoptosis after SCI. The Tre-car conjugate stimulated neurotrophic factors release, and influenced Zn2+ homeostasis. We demonstrated that Tre-car, Tre and Car treatments improved tissue recovery after SCI. Tre-car decreased proinflammatory, oxidative stress mediators release, upregulated neurotrophic factors and restored Zn2+ homeostasis, suggesting that Tre-car may represent a promising therapeutic agent for counteracting the consequences of SCI.
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Prevalence of Posttraumatic Stress Disorder Symptoms Following Traumatic Spinal Cord Injury: A Systematic Review and Meta-analysis. Harv Rev Psychiatry 2022; 30:271-282. [PMID: 36103682 DOI: 10.1097/hrp.0000000000000340] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Limited evidence is currently available on the prevalence of posttraumatic stress disorder (PTSD) following traumatic spinal cord injury (SCI). This systematic review and meta-analysis aims to assess the prevalence and geographic distribution of PTSD symptoms after SCI. METHODS After a search in the MEDLINE, Embase, Scopus, and Web of Science databases, two reviewers independently summarized relevant studies published through 20 October 2021. Observational studies were included. The studies were eligible if they assessed PTSD symptoms using standard self-report or clinician-based instruments. Data and results were reported using the overall prevalence and the odds ratio (OR), with 95% confidence intervals (CIs). RESULTS 24 articles (5646 patients) met the inclusion criteria. The prevalence of PTSD symptoms ranged from 6.33% (95% CI, 2.73-13.97) to 61.76% (95% CI, 52.07-70.61). Pooled analysis demonstrated that the overall prevalence of PTSD symptoms in SCI patients was significantly higher in developing countries (41.64%; 95% CI, 31.11-52.55) than in developed countries (19.35%; 95% CI, 14.66-24.51) (OR = 1.24; 95% CI, 1.08-1.42; p = .003). The highest prevalence of PTSD symptoms was reported in South Africa (56.25%; 95% CI, 47.01-65.08), followed by Sri Lanka (45.71%; 95% CI, 30.47-61.81), and Greece (43.55%; 95% CI, 31.94-55.91). By contrast, Norway (6.33%; 95% CI, 2.73-13.97), Switzerland/Germany (8.65%; 95% CI, 4.8-13.42), and Denmark (10.71%; 95% CI, 6.89-16.30) were found to have the lowest prevalence of PTSD symptoms after SCI. CONCLUSION Many traumatic SCI patients suffer from PTSD symptoms, and their prevalence seems to be higher in developing countries than in developed countries. These findings underscore the need to consider the psychological aspects of traumatic SCI.
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Pang X, Li F, Zhang Y. The Role of Mental Adjustment in Mediating Post-Traumatic Stress Disorder Symptoms and Social Support in Chinese Ovarian Cancer Patients: A Cross-Sectional Study. Psychol Res Behav Manag 2022; 15:2183-2191. [PMID: 35983022 PMCID: PMC9380830 DOI: 10.2147/prbm.s372660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Accepted: 07/26/2022] [Indexed: 11/30/2022] Open
Abstract
Background Post-traumatic stress disorder (PTSD) can manifest in individuals following a traumatic event. There is a paucity of studies focusing on PTSD symptoms in ovarian cancer (OC) patients. This study aimed to investigate the association of social support, mental adjustment and PTSD symptoms in Chinese OC patients with a view to exploring whether mental adjustment could mediate the relationship. Methods A cross-sectional study was conducted from January 2015 to December 2016. A total of 171 OC subjects were recruited and the effective response rate was 81.3%. The PTSD Checklist-Civilian Version (PCL-C), Mini-Mental Adjustment to Cancer scale (Mini-MAC) and Duke-UNC Functional Social Support Questionnaire were disseminated to the patients. The Chinese Mini-MAC was used in this study focusing on three components, namely negative emotion, positive attitude, and cognitive avoidance. Hierarchical linear regression analyses were employed to investigate the association of social support and PTSD symptoms, and the role of mental adjustment in their mediation. Results The prevalence of PTSD symptoms was 17.3% in OC patients. PTSD symptoms were negatively related with both social support and positive attitude, and positively associated with negative emotion and cognitive avoidance. Social support was negatively associated with negative emotion and cognitive avoidance, and positively related with positive attitude. In addition, negative emotion and positive attitude mediated the association between social support and PTSD symptoms. Conclusion PTSD symptoms in OC patients should be paid attention to. Social support and mental adjustment were positive resources associated with PTSD symptoms. Moreover, mental adjustment could mediate the relation between social support and PTSD symptoms in OC patients. Therefore, intervention management that focusing on improving perceived social support as well as strengthening mental adjustment, especially negative emotion and positive attitude, may be useful for reducing PTSD symptoms in this context.
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Affiliation(s)
- Xiaoyan Pang
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Fangmei Li
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
| | - Yi Zhang
- Department of Gynecology, the First Hospital of China Medical University, Shenyang, Liaoning, 110001, People's Republic of China
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Khan A, Ullah F, Abid O, Awan KH. "Efficacy of Cognitive Behavioral Therapy in Post-traumatic Stress Disorder
Among Spinal Cord Injury Patients: A Randomized Controlled Pilot Study". JOURNAL OF EVIDENCE-BASED PSYCHOTHERAPIES 2021. [DOI: 10.24193/jebp.2021.2.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
"Post-Traumatic Stress Disorder (PTSD) develops after exposure to or
witnessing traumatic events. PTSD is very common among the Spinal Cord
Injury (SCI) patients. PTSD can be successfully treated with the Cognitive
Behavioral Therapy (CBT). However, CBT is mostly used in the western
countries, so its efficacy in the eastern culture is still not fully known.
Keeping this in view, the current study has determined the efficacy of CBT
in the treatment of PTSD among the SCI patients in Pakistan. Using a
Randomized Controlled Pilot Study design, data were collected through the
Clinician-Administered PTSD Scale for DSM-5 from thirty patients
admitted to the Paraplegic Center. Trauma-focused CBT(TF-CBT) protocol
was applied through fourteen sessions. Data were analyzed by descriptive
and multivariate statistics. Findings show that the level of PTSD symptoms
gradually decreased from high at baseline (CAPS-5 Mean Scores μ= 3.6) to
low during follow-up stage (CAPS-5 Mean Scores μ= 0.89). Results obtained
from the present study on the efficacy of CBT are in concurrence with the
research findings in other countries. This study supports the efficiency CBT
intervention among Pakistani patients who had developed PTSD symptoms
after suffering from SCI. Therefore, CBT can be widely used in the
management of PTSD in Pakistan."
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Affiliation(s)
- Anwar Khan
- Department of Psychology and Management Sciences, Khushal Khan Khattak University, Karak, Khyber Pakhtunkhwa, Pakistan
| | - Faseeh Ullah
- Paraplegic Centre Peshawar, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - Omer Abid
- Category-D Government Hospital, Badaber, Peshawar District, Khyber Pakhtunkhwa, Pakistan
| | - Khizra Hafeez Awan
- The Indus Hospital, University Town, Peshawar, Khyber Pakhtunkhwa, Pakistan
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