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Papatheodoridis GV, Goulis J, Sypsa V, Lionis C, Manolakopoulos S, Elefsiniotis I, Anagnostou O, Tsoulas C, Hatzakis A, Dalekos GN. Aiming towards hepatitis C virus elimination in Greece. Ann Gastroenterol 2019; 32:321-329. [PMID: 31263353 PMCID: PMC6595935 DOI: 10.20524/aog.2019.0375] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Accepted: 03/12/2019] [Indexed: 02/06/2023] Open
Abstract
There are estimated to be 74,000-134,000 patients living with chronic hepatitis C in Greece, but only 20-30% of them are aware of their disease status. In July 2017, the Hellenic National Plan for Hepatitis C was announced in alignment with the World Health Organization goals for the eradication of hepatitis C virus (HCV) by the year 2030. This article discusses the epidemiology and current treatment of chronic hepatitis C in Greece. Additionally the authors propose actions on how to bring back to care diagnosed patients lost to follow up, optimize access to care for HCV-infected people who inject drugs, and increase HCV screening in the general population. The medical community in Greece can play a pivotal role in the implementation of the HCV National Plan and in the efforts to reach the goal of HCV elimination.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Medical School of National and Kapodistrian University of Athens, Laiko General Hospital (George V. Papatheodoridis)
| | - John Goulis
- 4 Department of Internal Medicine, Αristotle University of Thessaloniki Medical School (John Goulis)
| | - Vana Sypsa
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - Christos Lionis
- Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion-Crete (Christos Lionis)
| | - Spilios Manolakopoulos
- 2 Department of Internal Medicine, Medical School of National and Kapodistrian University of Athens, Hippokratio General Hospital of Athens (Spilios Manolakopoulos)
| | - Ioannis Elefsiniotis
- Academic Department of Internal Medicine-Hepatogastroenterology, "Agioi Anargyroi" General and Oncology Hospital, Athens (Ioannis Elefsiniotis)
| | - Olga Anagnostou
- Greek Organisation Against Drugs (OKANA), Athens (Olga Anagnostou)
| | - Christos Tsoulas
- Medical Department, Gilead Sciences Hellas, Athens (Christos Tsoulas)
| | - Angelos Hatzakis
- Department of Hygiene, Medical School of National and Kapodistrian, University of Athens, Epidemiology and Medical Statistics, Athens (Vana Sypsa, Angelos Hatzakis)
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, University of Thessaly Medical School, Larissa (George N. Dalekos), Greece
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Allyn PR, O'Malley SM, Ferguson J, Tseng CH, Chew KW, Bhattacharya D. Attitudes and potential barriers towards hepatitis C treatment in patients with and without HIV coinfection. Int J STD AIDS 2018; 29:334-340. [PMID: 28820346 PMCID: PMC5670019 DOI: 10.1177/0956462417725462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to assess attitudes and potential barriers towards treatment in patients with hepatitis C virus (HCV) infection, comparing those with and without HIV coinfection. A cross-sectional survey of 82 HCV-infected adults with and without HIV was conducted in greater Los Angeles between November 2013 and July 2015. Overall, there were 53 (64.6%) with HIV coinfection, 20 (25.0%) with self-reported cirrhosis, and 22 (26.8%) with a history of prior HCV treatment. Of all, 93.2% wanted HCV treatment, but 45.9% were unwilling/unable to spend anything out of pocket, 29.4% were waiting for new therapies, and 23.5% were recommended to defer HCV treatment. HIV/HCV-coinfected patients were more likely to want treatment within one year (90.2% versus 68.2%, p = 0.02), more willing to join a clinical trial (74.5% versus 8.0%, p < 0.01), more willing to take medications twice daily (86.3% versus 61.5%, p = 0.01), and more likely to prefer hepatitis C treatment by an infectious diseases/HIV physician (36.7% versus 4.0%, p < 0.01). Of all, 77.1% of coinfected patients were willing to change antiretroviral therapy if necessary to treat HCV, but only 48.0% of patients were willing to take a medication if it had not been studied in HIV-positive patients. Treatment preferences differ between HIV/HCV-coinfected and HCV-monoinfected patients. Despite a strong willingness among the study cohort to start HCV treatment, other factors such as cost, access to medications, and provider reluctance may be delaying treatment initiation.
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Affiliation(s)
- P R Allyn
- 1 Division of Infectious Diseases, Department of Medicine, 12222 University of California Los Angeles , Los Angeles, CA, USA
| | - S M O'Malley
- 2 UCLA Center for Clinical AIDS Research and Education (CARE), Los Angeles, CA, USA
| | - J Ferguson
- 3 Department of Medicine, Stanford University Medical Center, Palo Alto, CA, USA
| | - C H Tseng
- 4 Department of Medicine Statistics Core, 12222 University of California Los Angeles , Los Angeles, CA, USA
| | - K W Chew
- 1 Division of Infectious Diseases, Department of Medicine, 12222 University of California Los Angeles , Los Angeles, CA, USA
- 2 UCLA Center for Clinical AIDS Research and Education (CARE), Los Angeles, CA, USA
| | - D Bhattacharya
- 1 Division of Infectious Diseases, Department of Medicine, 12222 University of California Los Angeles , Los Angeles, CA, USA
- 2 UCLA Center for Clinical AIDS Research and Education (CARE), Los Angeles, CA, USA
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Heffernan A, Barber E, Cook NA, Gomaa AI, Harley YX, Jones CR, Lim AG, Mohamed Z, Nayagam S, Ndow G, Shah R, Sonderup MW, Spearman CW, Waked I, Wilkinson RJ, Taylor-Robinson SD. Aiming at the Global Elimination of Viral Hepatitis: Challenges Along the Care Continuum. Open Forum Infect Dis 2017; 5:ofx252. [PMID: 29354656 PMCID: PMC5767952 DOI: 10.1093/ofid/ofx252] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A recent international workshop, organized by the authors, analyzed the obstacles facing the ambitious goal of eliminating viral hepatitis globally. We identified several policy areas critical to reaching elimination targets. These include providing hepatitis B birth-dose vaccination to all infants within 24 hours of birth, preventing the transmission of blood-borne viruses through the expansion of national hemovigilance schemes, implementing the lessons learned from the HIV epidemic regarding safe medical practices to eliminate iatrogenic infection, adopting point-of-care testing to improve coverage of diagnosis, and providing free or affordable hepatitis C treatment to all. We introduce Egypt as a case study for rapid testing and treatment scale-up: this country offers valuable insights to policy makers internationally, not only regarding how hepatitis C interventions can be expeditiously scaled-up, but also as a guide for how to tackle the problems encountered with such ambitious testing and treatment programs.
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Affiliation(s)
- Alastair Heffernan
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK
| | - Ella Barber
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Médecins Sans Frontières, London, UK
| | - Nicola A Cook
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Asmaa I Gomaa
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Yolande X Harley
- Research Office, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Christopher R Jones
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK
| | - Aaron G Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Zameer Mohamed
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Liver and Antiviral Unit, Imperial College Healthcare NHS Trust, St. Mary's Hospital, London, UK
| | - Shevanthi Nayagam
- Department of Infectious Disease Epidemiology, Faculty of Medicine, Imperial College London, London, UK.,Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK
| | - Gibril Ndow
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK.,Hepatitis Unit, Disease Control and Elimination, MRC Unit, Banjul, The Gambia
| | - Rajiv Shah
- Infectious Diseases Department, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Mark W Sonderup
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - C Wendy Spearman
- Division of Hepatology, Department of Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Imam Waked
- Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom, Egypt
| | - Robert J Wilkinson
- Division of Infectious Diseases, Faculty of Medicine, Imperial College London, London, UK.,Institute of Infectious Disease and Molecular Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.,Tuberculosis Laboratory, The Francis Crick Institute, London, UK
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Mendes LC, Ralla SM, Vigani AG. Loss to follow-up in anti-HCV-positive patients in a Brazilian regional outpatient clinic. ACTA ACUST UNITED AC 2016; 49:e5455. [PMID: 27580006 PMCID: PMC5007075 DOI: 10.1590/1414-431x20165455] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 06/07/2016] [Indexed: 02/06/2023]
Abstract
Loss to follow-up (LF), which refers to patients who started care but voluntary stopped it, is a problem for patients with chronic disease. We aimed to estimate the rate of LF among patients seropositive for hepatitis C virus (HCV) and identify possible demographic and lifestyle risk factors associated with LF. From January 2009 through December 2012, 1010 anti-HCV-positive patients were included in the study. Among participants, 223 (22.1%) met the case definition for LF (more than 1-year elapsed since the last clinical appointment). Among 787 patients who remained in follow-up, 372 (47.2%) were discharged after undetectable HCV RNA, 88 (11.1%) were transferred (and remained on regular follow-up at the destination), and 25 (3.1%) died. According to univariate analysis, male gender, absence of a life partner, black race, psychiatric illness, previous alcohol abuse, previous or current recreational drug use, and previous or current smoking were significantly associated with LF. In multivariate analysis, absence of a life partner (adjusted odds ratio (AOR)=1.44; 95% confidence interval (95%CI)=1.03–2.02), black race (AOR=1.81, 95%CI=1.12–2.89), psychiatric illness (AOR=1.77, 95%CI=1.14–2.73), and the presence of at least one lifestyle risk factor (pertaining to substance abuse) (AOR=1.95, 95%CI=1.29–2.94) were independently associated with LF. Our study provides an estimate of the incidence of LF among anti-HCV-positive patients and identifies risk factors associated with this outcome. In addition, these results can help clinicians recognize patients at risk for LF, who require additional support for the continuity of care.
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Affiliation(s)
- L C Mendes
- Universidade Estadual de Campinas, Campinas, SP, Brasil.,Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
| | - S M Ralla
- Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
| | - A G Vigani
- Universidade Estadual de Campinas, Campinas, SP, Brasil.,Ambulatório Municipal de Hepatites Virais, Campinas, SP, Brasil
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Lee SS, Jeong SH, Jang ES, Kim YS, Lee YJ, Jung EU, Kim IH, Bae SH, Lee HC. Treatment rate and factors related to interferon-based treatment initiation for chronic hepatitis C in South Korea. J Med Virol 2015. [PMID: 26211752 DOI: 10.1002/jmv.24335] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Under-recognition and under-treatment of chronic hepatitis C virus (HCV) infection is an important determinant of the disease outcome. The aim of this study was to investigate the treatment rate and factor of initiation of interferon-based antiviral treatment for chronic hepatitis C patients in a prospective, multicenter Korean HCV cohort. Treatment-naïve 759 patients with chronic HCV infection were prospectively followed from January 2007-2013 at six university hospitals during a median (interquartile range) follow-up of 769 (76-1,427) days. The subjects consisted of patients with chronic hepatitis C (n = 553, 72.9%), liver cirrhosis (n = 127, 16.7%), and hepatocellular carcinoma (n = 79, 10.4%), and were treated usually using pegylated interferon alpha and ribavirin. Treatment initiation rate and its related factors were analysed. The initiation rate of antiviral treatment was 37.3% (n = 273), and the cumulative probability of treatment initiation over 5 years was 39.4%. Multivariate analysis showed that age <58 years (hazard ratio [HR] = 1.588, 95% CI = 1.151-2.193), job employment (HR = 1.737, 95% CI = 1.279-2.363), absence of HCC (chronic hepatitis, HR = 2.534, 95% CI = 1.003-6.400; liver cirrhosis, HR = 2.873, 95% CI = 1.101-7.494), alanine transaminase (ALT) >40 IU/L (HR = 1.682, 95% CI = 1.228-2.303), and genotype 2 (HR = 1.364, 95% CI = 1.034-1.798) were independent factors related to treatment initiation. Interferon-based antiviral treatment was initiated in more than one third of chronic HCV infected patients visiting university hospitals, who were young, employed, HCV genotype 2, and with abnormal ALT without HCC, in Korea.
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Affiliation(s)
- Sang Soo Lee
- Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Republic of Korea
| | - Sook-Hyang Jeong
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Eun Sun Jang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Young Seok Kim
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Soonchunhyang University College of Medicine, Bucheon, Republic of Korea
| | - Youn Jae Lee
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Eun Uk Jung
- Department of Internal Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - In Hee Kim
- Department of Internal Medicine, Chonbuk National University Hopital, Chonbuk National University College of Medicine, Chonju, Republic of Korea
| | - Si Hyun Bae
- Department of Internal Medicine, The Catholic University of Korea Seoul Saint Mary's Hospital, The Catholic University of Korea College of Medicine, Seoul, Republic of Korea
| | - Han Chu Lee
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
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Papatheodoridis G, Sypsa V, Kantzanou M, Nikolakopoulos I, Hatzakis A. Estimating the treatment cascade of chronic hepatitis B and C in Greece using a telephone survey. J Viral Hepat 2015; 22:409-15. [PMID: 25209157 DOI: 10.1111/jvh.12314] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/08/2014] [Indexed: 12/13/2022]
Abstract
Accurate diagnosis and treatment rates for chronic hepatitis B (HBV) and C virus (HCV) infections are usually missing. Aim of this study was to estimate the HBV and HCV treatment cascade (proportion and absolute numbers of tested, aware/unaware, infected and treated) in Greek adults. A telephone survey was conducted in a sample representative of the Greek adult general population. Prevalence rates were age-standardized for the Greek adult population and corrected for high-risk individuals not included in the survey. Of the 9974 participants, 5255 (52.7%) had been tested for HBV and 2062 (20.7%) for HCV with the proportion varying according to age and being higher in middle-age groups (P < 0.001). HBsAg was reported positive in 111/5255 (2.11%) and anti-HCV in 26/2062 (1.26%) tested cases. The age-adjusted prevalence was estimated to be 2.39% for HBV and 1.79% for HCV. Taking into account individuals at high risk for viral hepatitis not included in the survey, the 'true' prevalence was estimated to be 2.58% for HBV and 1.87% for HCV. Anti-HBV and anti-HCV treatment had been taken by 36/111 (32.4%) chronic HBV and 15/26 (57.7%) chronic HCV patients. In conclusion, almost 50% of chronic HBV and 80% of chronic HCV patients in Greece may be unaware of their infection, while only 32% or 58% of diagnosed chronic HBV or HCV patients, respectively, have been ever treated. Therefore, intensive efforts are required to improve the efficacy of screening for HBV and particularly for HCV as well as to reduce the barriers to treatment among diagnosed patients.
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Affiliation(s)
- G Papatheodoridis
- Department of Gastroenterology, Athens University Medical School, Laiko General Hospital, Athens, Greece
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Hsu YC, Wu CY, Lin JT. Hepatitis C Virus Infection, Antiviral Therapy, and Risk of Hepatocellular Carcinoma. Semin Oncol 2015; 42:329-38. [DOI: 10.1053/j.seminoncol.2014.12.023] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Prospective, observational real-life study on eligibility for and outcomes of antiviral treatment with peginterferon α plus ribavirin in chronic hepatitis C. Dig Liver Dis 2015; 47:151-6. [PMID: 25483909 DOI: 10.1016/j.dld.2014.11.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2014] [Revised: 10/30/2014] [Accepted: 11/04/2014] [Indexed: 12/11/2022]
Abstract
BACKGROUND We aimed to investigate eligibility, reasons for treatment discontinuation and characteristics of chronic hepatitis C patients with treatment failure to peginterferon/ribavirin in clinical practice. METHODS 1128 chronic hepatitis C patients, from 45 Italian Hepatology centres, were enrolled in this phase-4, prospective, observational study from January 2009 to February 2010. RESULTS 687/1118 patients (61.4%) were eligible for antiviral treatment, of which 598 (87.0%) agreed with the physician's decision. Outcome information was available in 500/598 patients, among whom 348 (69.6%) completed treatment. Treatment was discontinued in 152 patients due to: lack of response (28.9%), personal reasons (29.6%), adverse events (38.2%), and decompensation (1.3%). Sustained virological response was obtained in 263/500 (52.6%), 71 (14.2%) relapsed and 61 (12.2%) were non-responders. Treatment outcome was not available in 105 (21%): lost while receiving treatment (33.3%), lost during follow-up (25.7%), withdrawn for adverse events (19.1%) or for administrative reasons (21.9%). CONCLUSION In clinical practice, only 61% of chronic hepatitis C patients are considered eligible for peginterferon/ribavirin. Of these, 13% refuse treatment. Approximately 30% do not complete the scheduled treatment and, despite this, the sustained virological response rate is similar to that of randomized-controlled trials. In the era of new antiviral combinations, these findings have important implications for assessing eligibility and estimating drop-out rates.
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Papatheodoridis GV, Tsochatzis E, Hardtke S, Wedemeyer H. Barriers to care and treatment for patients with chronic viral hepatitis in Europe: a systematic review. Liver Int 2014; 34:1452-63. [PMID: 24750532 DOI: 10.1111/liv.12565] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 04/17/2014] [Indexed: 12/17/2022]
Abstract
BACKGROUND & AIMS Despite the availability of effective therapies for hepatitis B (HBV) and C virus (HCV), only a minority of these patients receive treatment. We systematically reviewed published data on barriers to management for chronic HBV/HCV patients in Europe. METHODS Literature search to identify studies including adult patients with chronic HBV/HCV infection from European countries and data on barriers to treatment. RESULTS Twenty-five studies including 6253 chronic HBV and 19,014 HCV patients were identified, of which only two were from Eastern Europe. The mean rate of no treatment in HBV patients was 42% being higher in North-Western European countries than Italy (56% vs. 39%, P < 0.001). Immigrants represented the most common barrier to HBV treatment. The mean rate of no treatment in HCV RNA-positive patients was 57%, being highest in Romania (89%), intermediate in France (79%) and lower though still high in other European countries (52%, P < 0.001). The predominant barriers to HCV treatment were lack of financial resources in Romania and direct/indirect limitations of interferon-alfa and/or parenteral drug and alcohol abuse in other countries. The mean rate of no treatment was highest in HCV RNA-positive parenteral drug users (72%) and intermediate in those with HCV-HIV co-infection (64%). CONCLUSIONS A substantial proportion of diagnosed chronic HBV and the majority of diagnosed HCV patients remain untreated. The rates and most importantly the reasons of barriers to treatment in chronic HBV/HCV patients vary widely among European countries supporting the need for country-specific national strategies, resource allocation and implementation of global management policies.
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Affiliation(s)
- George V Papatheodoridis
- Department of Gastroenterology, Athens University Medical School, Laiko General Hospital of Athens, Athens, Greece
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