1
|
Hazan I, Ziv O, Marom T, Zloczower E, Pitaro J, Warman M. Has COVID-19 Changed Pediatric Acute Rhinosinusitis Epidemiology During the First 2 Pandemic Years? Pediatr Infect Dis J 2023; 42:412-417. [PMID: 36795587 PMCID: PMC10097472 DOI: 10.1097/inf.0000000000003856] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/07/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE To study national pediatric acute rhinosinusitis (ARS) burden fluctuations before and during the first 2 coronavirus-19 (COVID) years, characterized by alternating lockdown and relaxation periods, the introduction of COVID vaccines, and the emergence of nonalpha COVID variants. METHODS This was a cross-sectional, population-based study covering the 3 pre-COVID years and the first 2 COVID years from a big database of the largest Israeli Health Maintenance Organization. For comparison purposes, we explored ARS burden trends with those of urinary tract infection (UTI), which is unrelated to viral diseases. We identified children <15 years presenting with ARS and UTI episodes and categorized them according to their age and presentation date. The average ARS and UTI episodes of the 3 pre-COVID years were used to calculate the incidence rate ratios (IRRs) of the 2 COVID years, analyzed separately. Seasonal variations were explored. RESULTS We identified 44,483 ARS and 121,263 UTI episodes. There was a substantial reduction in ARS episodes during the COVID years (IRR 0.36, 95% CI: 0.24-0.56, P < 0.001). Although UTI episode rates also decreased during COVID (IRR 0.79, 95% CI: 0.72-0.86, P < 0.001), the reduction in ARS burden was 3-fold higher. The dominant pediatric ARS age group was between 5 and 15 years. The largest decrease in ARS burden was during the first COVID year. ARS episode distribution showed a seasonal fluctuation, with a peak during the summer months during the COVID years. CONCLUSIONS Pediatric ARS burden decreased during the first 2 COVID years. Episode distribution was noted to be year-round.
Collapse
Affiliation(s)
- Itai Hazan
- From the Joyce and Irvin Goldman Medical School, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
| | - Oren Ziv
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Clalit Health Services, Tel Aviv, Israel
| | - Tal Marom
- Division of Otorhinolaryngology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheba, Israel
- Clalit Health Services, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ashdod, Israel
| | - Elchanan Zloczower
- Clalit Health Services, Tel Aviv, Israel
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Jacob Pitaro
- Clalit Health Services, Tel Aviv, Israel
- Department of Otolaryngology-Head and Neck Surgery, Shamir Medical Center (formerly Assaf Harofeh), Zerifin, Israel, affiliated to the Sackler School Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Meir Warman
- Clalit Health Services, Tel Aviv, Israel
- Department of Otorhinolaryngology, Head and Neck Surgery, Kaplan Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| |
Collapse
|
2
|
Izurieta P, Scherbakov M, Nieto Guevara J, Vetter V, Soumahoro L. Systematic review of the efficacy, effectiveness and impact of high-valency pneumococcal conjugate vaccines on otitis media. Hum Vaccin Immunother 2022; 18:2013693. [PMID: 35020530 PMCID: PMC8973322 DOI: 10.1080/21645515.2021.2013693] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Otitis media (OM) is a common disease of childhood and available pneumococcal conjugate vaccines (PCVs), with different compositions, could have different impact on OM reduction. This systematic literature review evaluated available data describing the efficacy, effectiveness, and impact of 10-valent pneumococcal Haemophilus influenzae protein D conjugate vaccine (PHiD-CV) and 13-valent PCV (PCV13) on OM outcomes. Statistically significant reductions in all-cause and complicated OM, tympanostomy tube placement and OM-related hospitalizations were consistently observed after the introduction of PHiD-CV and PCV13. Impact studies with data in children <2 years of age using PCV13 report 47–51% and PHiD-CV 34–43% reduction of all-cause OM (primary care, outpatient, ambulatory, emergency department visits) compared to periods before PCV introduction. When the impact of both vaccines is assessed in comparable settings, some studies suggest PHiD-CV may offer better protection against some OM outcomes. Well-designed, head-to-head comparisons are needed to better understand the differences and guide vaccination policies.
What is the context?
Pneumococcal vaccines are highly effective in preventing pneumonia and meningitis in children. The two main pneumococcal vaccines are PHiD-CV (Synflorix, GSK) and PCV13 (Prevenar 13, Pfizer). Both vaccines have been shown to provide protection against otitis media despite differing in their composition. However, it is currently unknown if both vaccines confer similar level of protection against otitis media.
What is new?
We conducted a literature review to evaluate the effects of PHiD-CV and PCV13 on otitis media. From 33 articles, we found that:‡Both vaccines were effective in reducing doctor visits for otitis media as well as the number of severe cases and cases requiring hospitalization. ‡Four studies suggested a higher level of protection provided by PHiD-CV compared to PCV13, although more data is needed to confirm this finding.
What is the impact?
Available information shows that PHiD-CV and PCV13 are effective in preventing a proportion of otitis media during childhood. Given the remaining substantial burden associated with the disease and the related significant usage of antibiotics, the development of improved vaccines with higher impact on otitis media would be welcome.
Collapse
|
3
|
Sapir A, Ziv O, Leibovitz E, Kordeluk S, Rinott E, El-Saied S, Greenberg D, Kaplan DM. Impact of the 13-valent pneumococcal conjugate vaccine (PCV13) on acute mastoiditis in children in southern Israel: A 12-year retrospective comparative study (2005-2016). Int J Pediatr Otorhinolaryngol 2021; 140:110485. [PMID: 33168224 DOI: 10.1016/j.ijporl.2020.110485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 10/31/2020] [Accepted: 11/01/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To define the trends in acute mastoiditis (AM) incidence, microbiology, complications and management in children, before and after the 13-valent pneumococcal conjugate vaccine (PVC13) introduction. METHODS Medical records of all AM patients <15 years of age diagnosed during 2005-2016 were reviewed. The study years were divided into three periods: pre-vaccination (2005-2008), interim (2009-2011) and post-PCV13 vaccination (2012-2016). RESULTS 238 patients (53.4% males) were enrolled, 81, 56 and 101 in the 3 time periods, respectively. Overall, 177/238 (75.2%) of children were <5 years of age. Mean AM incidence in the whole population was 10.32/100,000, with no changes during the study years. Ninety-three (45.6%) of 204 evaluable patients had positive middle ear fluid/mastoid cultures; S. pneumoniae (SP) was isolated in 47/93 (50.5%) cases. Mean incidence of SP-AM during the study years was 2.49 cases/100,000. A trend for decrease in mean incidence of SP-AM was recorded between the pre and the post-vaccination periods (3.05/100,000 vs. 1.82/100,000, P = 0.069). Among patients <5 years, SP-AM rates decreased from pre to post-vaccination period (19/50, 38% vs. 15/73, 20.6%, P = 0.034). No changes were reported in percentages of culture negative-AM and of AM complications in the post-PCV13 period compared with the pre-vaccine period. A significant decrease in distribution of PCV13 serotypes was recorded (17/19, 89.5% vs. 8/12, 66.6% and vs. 7/16, 43.75% during the 3 study periods, P = 0.015) accompanied by a complementary increase in non-vaccine serotypes. CONCLUSIONS The introduction of PCV13 was accompanied by a significant decrease in SP-AM cases among children <5 years of age. PCV13 serotypes decreased significantly as etiologic agents of SP-AM while non-vaccine serotypes and culture negative-AM became more common in the postvaccination period.
Collapse
Affiliation(s)
- Aviad Sapir
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Oren Ziv
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Eugene Leibovitz
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel.
| | - Sophia Kordeluk
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Ehud Rinott
- Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Sabri El-Saied
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - David Greenberg
- Pediatric Infectious Disease Unit, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| | - Daniel M Kaplan
- Department of Otolaryngology-Head and Neck Surgery, Beer-Sheva, Israel; Soroka University Medical Center, Beer-Sheva, Israel; Faculty of Health Sciences, Beer-Sheva, Israel; Ben-Gurion University, Beer-Sheva, Israel
| |
Collapse
|
4
|
Marom T, Shemesh S, Habashi N, Gluck O, Tamir SO. Adult Otogenic Meningitis in the Pneumococcal Conjugated Vaccines Era. Int Arch Otorhinolaryngol 2020; 24:e175-e181. [PMID: 32256838 PMCID: PMC6986945 DOI: 10.1055/s-0039-1697995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 08/11/2019] [Indexed: 10/31/2022] Open
Abstract
Introduction Streptococcus pneumoniae is a major pathogen of otogenic meningitis (OgM), the most commonly reported intra-cranial complication of otitis media (OM). Objectives To study the changes in adult OgM patients in the pneumococcal conjugated vaccines (PCVs) era. Methods Retrospective cohort of adults presenting with concurrent OM and meningitis in a secondary medical care center between 2005 and 2015. Data collected included demographics, OM-related symptoms, cerebrospinal fluid (CSF) and ear culture results, pre- and during hospitalization antibiotic treatment, imaging findings, and complications. We compared the pre-PCV years (2005-2009) with the post-PCV years (2010-2015). Outcomes were 1) incidence of all-cause adult OgM from the total meningitis cases; 2) impact of PCVs on the clinical presentation of OgM and bacteriology. Results Otogenic meningitis was diagnosed in 26 out of 45 (58%) cases of all-cause meningitis admissions. Of those, 10 (38%) were male, with a mean age of 62.4 years old. Ear-related signs and symptoms were documented in 70% of the patients, and OgM was diagnosed following imaging studies in 6 out of 26 (23%) patients. All of the patients received intravenous antibiotic therapy, and 7 (27%) patients required surgical interventions: 6 required myringotomy and 1 required mastoidectomy. There were 12 (46%) patients in the pre-PCV years and 14 (56%) in the post-PCV years. The positive pneumococcal CSF and ear culture rates remained high and unchanged (∼ 75%). There were no significant changes in the clinical presentation or mortality rates. Conclusion Micro-otoscopy should be included in the routine work-up of any suspected adult meningitis, because OgM is underdiagnosed. Unlike their impact on pediatric otitis media, PCVs did not change the epidemiology and bacteriology of OgM.
Collapse
Affiliation(s)
- Tal Marom
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | - Shay Shemesh
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | - Nadeem Habashi
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | - Ofer Gluck
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| | - Sharon Ovnat Tamir
- Department of Otolaryngology-Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben-Gurion University of the Negev Faculty of Health Sciences, Ashdod, Israel
| |
Collapse
|
5
|
Updated Guidelines for the Management of Acute Otitis Media in Children by the Italian Society of Pediatrics: Prevention. Pediatr Infect Dis J 2019; 38:S22-S36. [PMID: 31876602 DOI: 10.1097/inf.0000000000002430] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND In recent years, new information has been acquired regarding the diagnosis, treatment and prevention of acute otitis media (AOM). The Italian Pediatric Society, therefore, decided to issue an update to the Italian Pediatric Society guidelines published in 2010. METHODS The search was conducted on Pubmed, and only those studies regarding the pediatric age alone, in English or Italian, published between January 1, 2010 and December 31, 2018, were included. Each study included in the review was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) methodology. The quality of the systematic reviews was evaluated using the A MeaSurement Tool to Assess systematic Reviews (AMSTAR) 2 appraisal tool. The guidelines were formulated using the GRADE methodology by a multidisciplinary panel of experts. RESULTS The importance of eliminating risk factors (passive smoking, environmental pollution, use of pacifier, obesity, limitation of day-care center attendance) and the promotion of breastfeeding and hygiene practices (nasal lavages) was confirmed. The importance of pneumococcal vaccination in the prevention of AOM was reiterated with regard to the prevention of both the first episode of AOM and recurrences. Grommets can be inserted in selected cases of recurrent AOM that did not respond to all other prevention strategies. Antibiotic prophylaxis is not recommended for the prevention of recurrent AOM, except in certain carefully selected cases. The use of complementary therapies, probiotics, xylitol and vitamin D is not recommended. CONCLUSIONS The prevention of episodes of AOM requires the elimination of risk factors and pneumococcal and influenza vaccination. The use of other products such as probiotics and vitamin D is not supported by adequate evidence.
Collapse
|
6
|
Talathi S, Gupta N, Sethuram S, Khanna S, Sitnitskaya Y. Otitis Media in Fully Vaccinated Preschool Children in the Pneumococcal Conjugate Vaccine Era. Glob Pediatr Health 2018; 4:2333794X17749668. [PMID: 29308427 PMCID: PMC5751904 DOI: 10.1177/2333794x17749668] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/08/2017] [Indexed: 11/17/2022] Open
Abstract
Objectives. To evaluate the effect of pneumococcal conjugate vaccine (PCV13) on the burden of acute otitis media (AOM) and to evaluate the characteristics of AOM versus otitis media with effusion (OME) in the 2 PCV periods. Methods. A cohort of fully vaccinated children aged 18 to 60 months diagnosed with AOM from 2006 to 2015 was identified. Patients with otorrhea/bulging tympanic membrane were considered as true AOM, while those without bulging/otorrhea were considered to have OME. Burden of true AOM in the PCV7 and PCV13 periods and clinical features of true AOM versus OME were compared. Results. Of 393 episodes in our cohort, 50.8% occurred in PCV7 period. Burden of true AOM in the 2 PCV groups was similar: 26% in PCV7 versus 26.4% in PCV13 (odds ratio [OR] = 1.02, 95% confidence interval [CI] = 0.65-1.60). Factors significantly associated with OME were cold season (OR = 1.54, 95% CI = 1.04-2.4), fever (OR = 2.05, 95% CI = 1.29-3.3), and recurrence (OR = 2.24, 95% CI = 1.22-4.09). No complications of AOM were identified. Majority episodes were treated with antibiotics. Conclusion. Unlike the role of PCV13 in reducing invasive pneumococcal disease, its effect on reducing the burden of AOM is minimal as compared with PCV7. With regard to characteristics of AOM versus OME, findings of tympanic membrane should be used to suggest a diagnosis of AOM, instead of occurrence of fever or recurrence of AOM episodes. Using this approach would help in guiding the use of antibiotics appropriately.
Collapse
|
7
|
Cavel O, Tauman R, Simsolo E, Yafit D, Reindorf-Kfir E, Wasserzug O, Unger O, Handzel O, Fishman G, Oestreicher-Kedem Y, DeRowe A. Changes in the epidemiology and clinical features of acute mastoiditis following the introduction of the pneumococcal conjugate vaccine. Int J Pediatr Otorhinolaryngol 2018; 104:54-57. [PMID: 29287882 DOI: 10.1016/j.ijporl.2017.10.025] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/13/2017] [Accepted: 10/13/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Seven years after the introduction of the pneumococcal conjugate vaccines (PCV) in Israel, its effect on the incidence and severity of episodes of acute mastoiditis (AM) remains unclear. The primary objective of this study was to determine the incidence of AM and describe its clinical features in children during the years that followed the introduction of the PCV13 in comparison with the pre-PCV period. METHODS Included in this retrospective comparative case series were all pediatric patients diagnosed with AM between Jan. 2007 and Dec. 2015 in one tertiary medical center. The patients were divided into 3 groups: pre-PCV, post-PCV7 (July 2009 through Dec. 2010) and post-PCV13 (Jan. 2011 through Dec. 2015). The patients' medical records were reviewed, and data on age at presentation, gender, presenting signs, bacterial ear cultures, hospitalization course, complications, surgical interventions, inflammatory response and outcome were retrieved and compared between the groups. Comparison was made between the pre-PCV and the post-PCV13 groups. RESULTS 216 children were identified for analysis, 80 children in the pre-PCV period, 31 in the post-PCV7 period and 105 in the post-PCV13 period. Their mean age was 2.6 years. The number of AM cases per 1000 visits at the emergency room decreased by 46% in the post-PCV13 period compared to the pre-PCV period. There was no difference in the rate of AM between the post-PCV7 and post-PCV13 periods. No differences were found in age, gender, hospitalization length, C-reactive protein level, white blood cell count, rate of surgical interventions (mastoidectomy and incision and drainage) and rate of complications between the 3 groups. CONCLUSION The incidence of AM was lower in the post-PCV13 period compared to the pre-PCV period. The rate of AM complications, however, has not changed, nor has the number of mastoidectomies.
Collapse
Affiliation(s)
- Oren Cavel
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Riva Tauman
- Department of Pediatric Pulmonology, Critical Care and Sleep Medicine, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eli Simsolo
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Danny Yafit
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Reindorf-Kfir
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Oshri Wasserzug
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Omer Unger
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ophir Handzel
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Gadi Fishman
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Oestreicher-Kedem
- Department of Otolaryngology, Head & Neck and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ari DeRowe
- Pediatric ENT Unit, Dana-Dwek Children's Hospital, Tel Aviv Sourasky Medical Center, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
8
|
Decrease in Pneumococcal Otitis Media Cultures With Concomitant Increased Antibiotic Susceptibility in the Pneumococcal Conjugate Vaccines Era. Otol Neurotol 2017; 38:853-859. [DOI: 10.1097/mao.0000000000001419] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
|