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Zahidin MA, Mohd Noor NH, Johan MF, Abdullah AD, Zulkafli Z, Edinur HA. A Review on Secondary Immune Thrombocytopenia in Malaysia. Healthcare (Basel) 2021; 10:healthcare10010038. [PMID: 35052202 PMCID: PMC8774929 DOI: 10.3390/healthcare10010038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Revised: 12/12/2021] [Accepted: 12/22/2021] [Indexed: 12/21/2022] Open
Abstract
Immune thrombocytopenia (ITP) is an acquired autoimmune disease that occurs in adults and children. In Malaysia, the clinical practice guideline (CPG) for the management of ITP was issued in 2006, which focused almost exclusively on primary ITP (pITP), and only a few secondary ITP (sITP) forms were addressed. All published (twenty-three) sITP articles among children and adults in Malaysia, identified on the academic databases were retrieved. The articles were published between 1981 and 2019, at a rate of 0.62 publications per year. The publications were considered low and mainly focused on rare presentation and followed-up of secondary diseases. This review revealed that sITP in Malaysia is commonly associated with autoimmune diseases (Evan’s syndrome, SLE and WAS), malignancy (Kaposi’s sarcoma and breast cancer) and infection (dengue haemorrhagic fever, Helicobacter pylori and hepatitis C virus). The relationship between ITP and autoimmune diseases, malignancy and infections raise the question concerning the mechanism involved in these associations. Further studies should be conducted to bridge the current knowledge gap, and the further information is required to update the existing CPG of management of ITP in Malaysia.
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Affiliation(s)
- Muhamad Aidil Zahidin
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
| | - Noor Haslina Mohd Noor
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.H.M.N.); (Z.Z.)
| | - Muhammad Farid Johan
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
| | - Abu Dzarr Abdullah
- Department of Medicine, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
| | - Zefarina Zulkafli
- Department of Haematology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia; (M.A.Z.); (M.F.J.)
- Transfusion Medicine Unit, Hospital Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia
- Correspondence: (N.H.M.N.); (Z.Z.)
| | - Hisham Atan Edinur
- Forensic Science Programme, School of Health Sciences, Health Campus, Universiti Sains Malaysia, Kubang Kerian 16150, Kelantan, Malaysia;
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Karajacob AS, Al-Maleki AR, Tay ST. Revisiting oral thrush in South-East Asian patients: A review of published studies (2000-2020). J Oral Pathol Med 2021; 51:98-105. [PMID: 34859509 DOI: 10.1111/jop.13266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/03/2021] [Accepted: 11/25/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Oral thrush, a clinical condition due to an overgrowth of Candida yeasts in the oral cavity, is prominent in patients with immunosuppression. As recent updates on oral thrush in South-East Asian (SEA) countries are lacking, this review aimed to address the epidemiology, clinical features and distribution of Candida species, based on published studies in SEA countries over the last two decades. METHODS Published studies on oral candidiasis (2000-2020) were retrieved from PubMed, Scopus, ISI Web of Science and Google Scholar databases to provide information on the incidence and factors affecting oral thrush cases in SEA countries. RESULTS A total of 22 cross-sectional studies involving 3697 subjects from five SEA countries were reviewed in this study. The most frequently reported population were human immunodeficiency virus (HIV)-infected patients. The overall incidence rates amongst HIV-infected patients ranged from 20.7% to 97.0%, while incidence rates ranging from 0% to 72.7% were recorded for non-HIV-infected populations. Pseudomembranous candidiasis and erythematous candidiasis were the most common clinical presentations of oral thrush lesions. Candida albicans was the most common species identified in SEA studies. As oral thrush assessments were made merely based on clinical diagnosis, culture results were not available for most studies. CONCLUSION This review highlights that most studies reporting on oral candidiasis in SEA countries were based on HIV-positive patients. Data are still lacking on oral candidiasis amongst non-HIV immunocompromised and immunocompetent patients. Increasing awareness on the diagnosis, treatment and consequences of this infection, and improved laboratory methods are essential for the management of oral candidiasis in this region.
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Affiliation(s)
| | - Anis Rageh Al-Maleki
- Faculty of Medicine, Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Sun Tee Tay
- Faculty of Medicine, Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia
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Lai S, Tan L, Hussin H, Salleh AA, Bakrin IH. Colesional cutaneous talaromycosis (penicilliosis) and Kaposi sarcoma in an HIV-infected patient. Clin Case Rep 2021; 9:e04639. [PMID: 34849222 PMCID: PMC8607800 DOI: 10.1002/ccr3.4639] [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: 06/21/2021] [Revised: 07/08/2021] [Accepted: 07/09/2021] [Indexed: 11/06/2022] Open
Abstract
HIV-infected patients are at high risk of multiple pathologies. Accurate identification of multiple colesional pathologies is critical for the patient management. We report a distinctive case of colesional cutaneous talaromycosis and Kaposi sarcoma. Prudent histopathological examination and judicious use of adjunct diagnostic test are essential for the diagnosis.
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Affiliation(s)
- Shau‐Kong Lai
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSelangorMalaysia
| | - Lii‐Jye Tan
- Department of Forensic PathologyHospital Raja Permaisuri Bainun, Jalan Raja Ashman ShahIpohPerakMalaysia
| | - Huzlinda Hussin
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSelangorMalaysia
| | | | - Ikmal Hisyam Bakrin
- Department of Pathology, Faculty of Medicine and Health SciencesUniversiti Putra MalaysiaSelangorMalaysia
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Mustafayev K, Mete B, Kutlubay Z, Tanakol A, Şahin Özdemir M, Garashova D, Balkan İİ, Saltoglu N, Tabak ÖF. Dermatological lesions among people living with HIV in Turkey. Int J STD AIDS 2021; 33:55-62. [PMID: 34565234 DOI: 10.1177/09564624211043711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to document the dermatoses and their relationships with CD4+ T lymphocyte counts and clinical stages of disease among people living with HIV followed by our Clinical Department, to investigate the effect of antiretroviral therapy (ART) on findings and to compare with real-world data. Medical records of people living with HIV were analyzed retrospectively in our outpatient clinic from January 2005 to June 2017. A total of 500 patient files were examined. 179 patients with dermatoses were included in the study. Demographic data, clinical and laboratory findings, dermatological findings, type and distribution of lesions, serological and histopathological examinations, diagnosis, treatment, and follow-up of patients were transferred to data forms. 84.4% of the patients were male and the mean age was 38.65 ± 11.6 years. The median CD4+ T lymphocyte count was 253/mm3 (range:0-1067). At least one dermatosis was present in 69.3% of the patients. Compared with their median CD4+ T lymphocyte counts, the ratio of CD4+ T lymphocytes was significantly lower in the group with three or more dermatoses (p = 0.019). Condyloma acuminatum (15.1%), drug eruption (13.4%), seborrheic dermatitis (11.7%), oral candidiasis (11.2%), dermatophytoses (11.2%), syphilis (8.4%), Kaposi's sarcoma (8.4%), and telogen effluvium (8.4%) were the most common dermatoses. Kaposi sarcoma (KS), oral candidiasis, onychomycosis, and molluscum contagiosum were significantly higher in the CD4+ T lymphocyte <200/mm³ group when CD4+ T lymphocyte threshold value was determined as 200/mm³. Compared with other TDF/FTC-containing regimens, a significantly higher proportion of alopecia was reported in patients receiving TDF/FTC/EVG/c (p = 0.007). Dermatoses may be a good clinical marker for detecting clinical stage and diagnosing HIV infection; also, there may be a significant increase in the number of dermatoses in advanced stages. Although there are only a few studies in the literature, it should be kept in mind that ART-associated alopecia rates may increase nowadays when ART is targeted at everyone.
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Affiliation(s)
- Khalis Mustafayev
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Bilgül Mete
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Zekayi Kutlubay
- Department of Dermatology and Venerology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ali Tanakol
- Department of Dermatology and Venerology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Meryem Şahin Özdemir
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Dilruba Garashova
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - İlker İnanç Balkan
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Neşe Saltoglu
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
| | - Ömer Fehmi Tabak
- Department of Infectious Diseases and Clinical Microbiology, 532719Istanbul University-Cerrahpasa, Cerrahpasa School of Medicine, Istanbul, Turkey
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Boushab BM, Malick Fall FZ, Ould Cheikh Mohamed Vadel TK, Ould Cheikh Melaïnine ML, Maazouz MV, Savadogo M, Basco LK. Mucocutaneous manifestations in human immunodeficiency virus (HIV)-infected patients in Nouakchott, Mauritania. Int J Dermatol 2017; 56:1421-1424. [PMID: 28960268 DOI: 10.1111/ijd.13737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Revised: 06/12/2017] [Accepted: 07/22/2017] [Indexed: 11/26/2022]
Abstract
BACKGROUND Mucocutaneous manifestations are one of the first clinical signs in patients infected with human immunodeficiency virus (HIV). To the best of our knowledge, there has been no previous study describing dermatologic manifestations in Mauritanians infected with HIV. The aim of the present study was to determine the profiles of mucocutaneous manifestations in relation to CD4 T cell count in HIV-positive Mauritanian patients. METHODS A total of 86 adult patients aged > 18 years old attending the Ambulatory Treatment Center of the National Hospital of Nouakchott, Mauritania, with newly diagnosed HIV and who were not under antiretroviral treatment were included in the study in 2015. Dermatologic manifestations were documented before initiating antiretroviral treatment. RESULTS Most of the included patients were in clinical stage 3 of the World Health Organization classification at initial diagnosis, with the mean CD4 T cell count (± SD) of 514 ± 319 cells/mm3 (range, 2-1328 cells/mm3 ), and 19 of 86 (22.1%) patients had CD4 T cell counts below 200 cells/mm3 . More than half (64%) of newly diagnosed HIV-infected patients had dermatoses, including the following: pruritic papular eruption (44.2%), seborrheic dermatitis (4.7%), Kaposi's sarcoma (3.5%), extensive xerosis cutis (2.3%), drug-induced skin reactions (1.2%), and various infectious dermatoses (dermatophyte infections [16.3%], oral candidiasis [11.6%], herpes zoster [8.1%], and scabies [2.3%]). A low CD4 T cell count (< 200 cells/mm3 ) was significantly correlated (P < 0.05) with the presence of following dermatoses: dermatophytosis, oral candidiasis, Kaposi's sarcoma, seborrheic dermatitis, and extensive xerosis cutis. CONCLUSION Mucocutaneous lesions occur throughout the course of HIV infection, and dermatologic findings in Mauritanian HIV-positive patients are similar to those of patients in other countries. Early detection of skin disorders in some patients may help establish the diagnosis of HIV and management of HIV-associated diseases, limiting the cost of care in low-resource countries.
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Affiliation(s)
- Boushab M Boushab
- Department of Internal Medicine and Infectious Diseases, Kiffa Regional Hospital, Assaba, Mauritania
| | - Fatim-Zahra Malick Fall
- School of Medicine, National Institute of Hepatology-Virology in Nouakchott, Nouakchott, Mauritania
| | | | | | - Mohamed V Maazouz
- Outpatient Department, Hospital Center of Nouakchott, Nouakchott, Mauritania
| | - Mamoudou Savadogo
- Department of Infectious Diseases, University Teaching Hospital Yalgado Ouédrago, Ouagadougou, Burkina Faso
| | - Leonardo K Basco
- Research Unit of Emerging Infectious and Tropical Diseases (URMITE), Institut de Recherche pour le Développement 198, Institut Hospitalo-Universitaire - Méditerranée Infection, Aix-Marseille University, Marseille, France
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Abstract
Skin lesions can be the presenting signs for HIV disease and are among the most prevalent manifestations throughout the course of HIV disease. Correlation of skin diseases and HIV disease staging has long been recognized and used to guide medical management in resource-limited settings. The purpose of this paper is to give a review of common skin infections presented in HIV-infected patients. Common skin infections presenting in HIV-infected patients include viral, fungal, mycobacterial, and bacterial infections, along with skin infestation. Key diagnostic points correlate with certain HIV disease staging for many skin diseases. These can help facilitate appropriate diagnosis and referral by health care personnel when treating HIV-infected patients who have skin lesions. Knowledge of common skin manifestations found in HIV-infected patients is essential for all health care personnel who work in the HIV field. Most skin infections presenting in HIV-infected patients can be treated effectively if the correct diagnosis and appropriate referral are made promptly.
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Affiliation(s)
- N Phanuphak
- The Thai Red Cross AIDS Research Centre, 104 Rajdumri Road, Pathumwan, Bangkok 10330, Thailand.
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Cheong WK, Yeung CK, Torsekar RG, Suh DH, Ungpakorn R, Widaty S, Azizan NZ, Gabriel MT, Tran HK, Chong WS, Shih IH, Dall'Oglio F, Micali G. Treatment of Seborrhoeic Dermatitis in Asia: A Consensus Guide. Skin Appendage Disord 2016; 1:187-96. [PMID: 27386464 DOI: 10.1159/000444682] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 02/12/2016] [Indexed: 11/19/2022] Open
Abstract
Seborrhoeic dermatitis (SD) is common in Asia. Its prevalence is estimated to be 1-5% in adults. However, larger population-based studies into the epidemiology of SD in Asia are lacking, and the aetiology of SD may differ widely from Western countries and in different parts of Asia. In addition, clinically significant differences between Asian and Caucasian skin have been reported. There is a need to define standardized clinical diagnostic criteria and/or a grading system to help determine appropriate treatments for SD within Asia. With this in mind, experts from India, South Korea, Taiwan, Malaysia, Vietnam, Singapore, Thailand, the Philippines, Indonesia, and Italy convened to define the landscape of SD in Asia at a meeting held in Singapore. The consensus group developed a comprehensive algorithm to aid clinicians to recommend appropriate treatment of SD in both adults and children. In most cases, satisfactory therapeutic results can be accomplished with topical antifungal agents or topical corticosteroids. Non-steroidal anti-inflammatory agents with antifungal properties have been shown to be a viable option for both acute and maintenance therapy.
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Affiliation(s)
| | - Chi Keung Yeung
- Division of Dermatology, Department of Medicine, University of Hong Kong, Hong Kong
| | - Raghunandan Govind Torsekar
- Department of Dermatology, Rajiv Gandhi Medical College and Chatrapathi Shivaji Maharaj Hospital, Kalwa, Thane, India
| | - Dae Hun Suh
- Department of Dermatology, Seoul National University College of Medicine, Seoul, South Korea
| | - Rataporn Ungpakorn
- Skin and Aesthetic Lasers Clinic, Bumrungrad International Hospital, Bangkok, Thailand
| | - Sandra Widaty
- Department of Dermato-Venereology and Medical Education Department, Universitas Indonesia, Kota Depok, Indonesia
| | - Noor Zalmy Azizan
- Department of Dermatology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - Maria Teresita Gabriel
- Department of Dermatology, Research Institute for Tropical Medicine, Manila, Philippines
| | - Hau Khang Tran
- National Hospital of Dermatology and Venereology, Hanoi, Vietnam
| | - Wei Sheng Chong
- Dermatology Unit, Department of General Medicine, Khoo Teck Puat Hospital, Singapore, Singapore
| | - I-Hsin Shih
- Department of Pediatric Dermatology, Chang Gung Children's Hospital, Taipei, Republic of China
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Tzung TY, Yang CY, Chao SC, Lee JYY. Cutaneous manifestations of human immunodeficiency virus infection in Taiwan. Kaohsiung J Med Sci 2004; 20:216-24. [PMID: 15233232 DOI: 10.1016/s1607-551x(09)70109-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Cutaneous manifestations are common and often the presenting feature of human immunodeficiency virus (HIV) infection, but a comprehensive study of HIV-associated skin lesions is not available in Taiwan. We reviewed all skin lesions in all HIV patients diagnosed in our department between 1990 and 1998 to document the spectrum of skin manifestations, the frequency of each disorder, and their relationship with CD4 counts. A total of 64 HIV patients were studied, including 38 with acquired immunodeficiency syndrome (AIDS) (CD4 < 200 x 10(6) cells/L) and 26 who had not developed AIDS (non-AIDS). There were 142 episodes of skin conditions representing 25 different skin diseases, including oral candidiasis (15% in non-AIDS vs 71% in AIDS patients), drug eruptions, herpes simplex, seborrheic dermatitis, dermatophytosis, herpes zoster, secondary syphilis, condyloma acuminatum, Kaposi's sarcoma (16% among AIDS patients), hairy leukoplakia, and molluscum contagiosum (13% among AIDS patients), in decreasing order. Several unusual cases are briefly described, including verrucous herpes infection, condyloma-like molluscum contagiosum, and AIDS-associated pigmented erythroderma. In our study, 70% of all HIV patients had skin diseases, with an average of 2.2 conditions per patient (3.2 in AIDS patients vs 0.7 in non-AIDS patients; p < 0.001). A broad spectrum of HIV-associated skin diseases was observed in our series. The frequency of HIV-associated skin disease was 92% in AIDS patients and 39% in non-AIDS patients; 78% of skin lesions in AIDS patients were diagnosed when CD4 counts were below 100 x 10(6) cells/L.
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Affiliation(s)
- Tien-Yi Tzung
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Watanabe A, Kawajiri M, Ikezoe K, Osoegawa M, Murai H, Ochi H, Taniwaki T, Kira JI. HTLV-1-associated myelopathy/tropical spastic paraparesis accompanied with psoriasis. J Neurol Sci 2004; 221:95-7. [PMID: 15178221 DOI: 10.1016/j.jns.2004.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2003] [Revised: 01/05/2004] [Accepted: 02/18/2004] [Indexed: 11/22/2022]
Abstract
Two adult females developed HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) and psoriasis. Both showed chronic progressive paraparesis and sharply demarcated erythematous scaling plaques on their extremities and trunk. One patient had polymyositis while in the other anti-thyroid antibodies, antinuclear antibodies and SS-A antibody, all autoantibodies, were positive. Both patients were treated by intramuscular injections of interferon-alpha for 2 to 4 weeks, resulting in amelioration of paraparesis. After the therapy psoriasis and polymyositis markedly improved in one patient without any additional therapy, while in the other simultaneous use of topical corticosteroids was effective. This is the first report to describe occurrences of psoriasis in HAM/TSP patients. Although there are several reports indicating interferon-alpha induces or exacerbates psoriasis, our experience suggests that psoriasis associated with HAM/TSP can be successfully managed even during interferon-alpha therapy.
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Affiliation(s)
- Akihiro Watanabe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University, Fukoada 812-8582, Japan
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