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Kridin M, Zloto O, Kridin K, Cohen AD, Mann O, Weinstein O. The association of uveitis with hepatitis B and hepatitis C viruses: a large-scale population-based study. Eye (Lond) 2023; 37:720-724. [PMID: 35352013 PMCID: PMC9998628 DOI: 10.1038/s41433-022-02037-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 02/25/2022] [Accepted: 03/15/2022] [Indexed: 12/14/2022] Open
Abstract
PURPOSE To examine the association of uveitis with hepatitis B (HBV) and hepatitis C (HCV) chronic infections METHOD: This is a population-based cross-sectional study. The study encompassed 13,183 consecutive patients with uveitis and 65,331control subjects. The prevalence of chronic HBV and HCV infections was compared between patients diagnosed with uveitis and age-, sex-, and ethnicity-matched controls. Lifetime prevalence rates of HBV and HCV were calculated for patients with uveitis and control individuals. Odds ratio (OR) for HBV and HCV was evaluated across different strata. RESULTS The lifetime prevalence rate of chronic HBV infection was greater in patients with uveitis than in controls (1.2% vs. 0.8%, respectively; P < 0.001). The association of HBV with uveitis was statistically significant among individuals older than 40 years of age, both sexes, and individuals of Jewish ethnicity. The lifetime prevalence of HCV was comparable between patients with uveitis and controls (0.8% vs. 0.7%, respectively; P = 0.189). Thus, no independently significant association was found between uveitis and HCV (fully-adjusted OR, 1.15; 95% CI, 0.93-1.42; P = 0.211). CONCLUSIONS Uveitis is associated with HBV. The association was more prominent among older and Jewish patients. Patients with uveitis may benefit from screening for HBV. An association between uveitis and HCV has not been found.
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Affiliation(s)
- Mouhammad Kridin
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Ofira Zloto
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel.
- Goldschleger Eye Institute, Sheba Medical Center, Tel-Hashomer, Israel.
| | - Khalaf Kridin
- Lübeck Institute of Experimental Dermatology, University of Lübeck, Lübeck, Germany
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
- Unit of Dermatology, Baruch Padeh Poria Medical Center, Tiberias, Israel
| | - Arnon D Cohen
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Oran Mann
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
| | - Orly Weinstein
- Clalit Health Services, Tel-Aviv, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Ben-Gurion Ave, Beer Sheva, Israel
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Chopra A, Nautiyal A, Kalkanis A, Judson MA. Drug-Induced Sarcoidosis-Like Reactions. Chest 2018; 154:664-677. [PMID: 29698718 DOI: 10.1016/j.chest.2018.03.056] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 03/28/2018] [Accepted: 03/30/2018] [Indexed: 01/02/2023] Open
Abstract
A drug-induced sarcoidosis-like reaction (DISR) is a systemic granulomatous reaction that is indistinguishable from sarcoidosis and occurs in a temporal relationship with initiation of an offending drug. DISRs typically improve or resolve after withdrawal of the offending drug. Four common categories of drugs that have been associated with the development of a DISR are immune checkpoint inhibitors, highly active antiretroviral therapy, interferons, and tumor necrosis factor-α antagonists. Similar to sarcoidosis, DISRs do not necessarily require treatment because they may cause no significant symptoms, quality of life impairment, or organ dysfunction. When treatment of a DISR is required, standard antisarcoidosis regimens seem to be effective. Because a DISR tends to improve or resolve when the offending drug is discontinued, this is another effective treatment for a DISR. However, the offending drug need not be discontinued if it is useful, and antigranulomatous therapy can be added. In some situations, the development of a DISR may suggest a beneficial effect of the inducing drug. Understanding the mechanisms leading to DISRs may yield important insights into the immunopathogenesis of sarcoidosis.
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Affiliation(s)
- Amit Chopra
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY.
| | - Amit Nautiyal
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
| | - Alexander Kalkanis
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, 401 Military and VA Hospital, Athens, Greece
| | - Marc A Judson
- Department of Medicine, Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, NY
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Kosikowska U, Biernasiuk A, Korona-Głowniak I, Kiciak S, Tomasiewicz K, Malm A. The Association of Chronic Hepatitis C with Respiratory Microbiota Disturbance on the Basis of Decreased Haemophilus Spp. Colonization. Med Sci Monit 2016; 22:625-32. [PMID: 26912163 PMCID: PMC4771098 DOI: 10.12659/msm.895544] [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] [Indexed: 12/05/2022] Open
Abstract
Background Haemophilus species are the most common microbiota in humans. The aim of this paper was to investigate Haemophilus spp., mainly H. parainfluenzae prevalence, in the upper respiratory tract of chronic hepatitis C (CHC-positive) patients with or without therapy using pegylated interferon alfa and ribavirin. Material/Methods We collected 462 samples from 54 healthy people and 100 CHC-positive patients at various stages: before (group A), during (group B), and after (group C) antiviral therapy. Identification of bacterial isolates including biotypes and antimicrobials susceptibility was accomplished by means of standard microbiological methods. Results In 70.4% of healthy people (control group) and in 27.0% of CHC-positive patients, the presence of haemophili, mainly H. parainfluenzae was observed, and those differences were statistically significant (p<0.0001). Statistically significant differences in Haemophilus spp. colonization were also observed among healthy people and CHC-positive patients from group A (p=0.0012) and from B or C groups (p<0.0001). Resistance to ampicillin in beta-lactamase-positive isolates and multidrug resistance (MDR) of H. parainfluenzae was detected mainly in group A. Conclusions The obtained data suggest that chronic hepatitis C, together with antiviral therapy, may influence the respiratory tract microbiota composition as found using haemophili, mainly H. parainfluenzae.
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Affiliation(s)
- Urszula Kosikowska
- Chair and Department of Pharmaceutical Microbiology with Laboratory for Microbiological Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Anna Biernasiuk
- Chair and Department of Pharmaceutical Microbiology with Laboratory for Microbiological Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Izabela Korona-Głowniak
- Chair and Department of Pharmaceutical Microbiology with Laboratory for Microbiological Diagnostics, Medical University of Lublin, Lublin, Poland
| | - Sławomir Kiciak
- Department of Infectious Diseases, Medical University of Lublin, Lublin, Poland
| | | | - Anna Malm
- Chair and Department of Pharmaceutical Microbiology with Laboratory for Microbiological Diagnostics, Medical University of Lublin, Lublin, Poland
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O’Day R, Gillies MC, Ahlenstiel G. Ophthalmologic complications of antiviral therapy in hepatitis C treatment. World J Gastroenterol 2013; 19:8227-8237. [PMID: 24363513 PMCID: PMC3857445 DOI: 10.3748/wjg.v19.i45.8227] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Accepted: 10/22/2013] [Indexed: 02/06/2023] Open
Abstract
Antiviral therapy consisting of interferon-alpha and ribavirin for chronic hepatitis C infection is associated with multi-system side-effects. Ophthalmologic complications are common and can be classified into two groups: interferon-associated retinopathy and atypical adverse events. Interferon-associated retinopathy has been investigated by multiple observational studies that have found widely divergent results. The clinical importance of this complication is, consequently, controversial. This review examines the literature with the specific goal of identifying the most important ophthalmologic issues facing the hepatologist prescribing antiviral therapy. Accordingly, it assesses the incidence of interferon-associated retinopathy, as well as its risk factors, pathogenesis, clinical manifestations and options for management using data from the observational studies. The likely benefit of a screening program, especially one targeting patients with the highest risk of developing interferon-associated retinopathy, is analysed. Atypical ophthalmologic adverse events occur less frequently than interferon-associated retinopathy during antiviral therapy for chronic hepatitis C infection. They often, however, lead to irreversible vision loss. We examine the reports of these adverse events - in individual case reports or case series and in the observational studies investigating interferon-associated retinopathy - to describe the spectrum of these adverse events, the likely outcome for patients and to highlight the most important areas of future clinical research.
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Buss G, Cattin V, Spring P, Malinverni R, Gilliet M. Two cases of interferon-alpha-induced sarcoidosis Koebnerized along venous drainage lines: new pathogenic insights and review of the literature of interferon-induced sarcoidosis. Dermatology 2013; 226:289-97. [PMID: 23886768 DOI: 10.1159/000346244] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/26/2012] [Indexed: 11/19/2022] Open
Abstract
Sarcoidosis is a systemic granulomatous disorder of unknown origin commonly affecting the lung, the lymphoid system and the skin. We report here two cases of cutaneous sarcoidosis in two former intravenous drug users following interferon (IFN)-α and ribavirin therapy for chronic hepatitis C. Both patients developed skin sarcoidosis along venous drainage lines of both forearms, coinciding with the areas of prior drug injections. The unique distribution of the skin lesions suggests that tissue damage induced by repeated percutaneous drug injections represents a trigger for the local skin manifestation of sarcoidosis. Interestingly, skin damage was recently found to induce the local expression IFN-α, a well-known trigger of sarcoidosis in predisposed individuals. Here we review the literature on sarcoidosis elicited in the context of IFN-α therapy and propose a new link between the endogenous expression of IFN-α and the induction of disease manifestations in injured skin.
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Affiliation(s)
- G Buss
- Division of Immunology and Allergology, University of Lausanne, Lausanne, Switzerland
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Slim J, Afridi MS. Managing adverse effects of interferon-alfa and ribavirin in combination therapy for HCV. Infect Dis Clin North Am 2013; 26:917-29. [PMID: 23083824 DOI: 10.1016/j.idc.2012.08.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
This article focuses on the adverse effects of hepatitis C therapy, which includes pegylated interferon alfa-2a or -2b with ribavirin. The hepatitis C virus provider should remain cognizant of the various organ systems that can be affected, which adverse effects should be addressed with the help of an expert, and the presentation of symptoms as they occur throughout the course of therapy. A systems-based approach should help to characterize the nature of the adverse effects that patients experience, and also to determine when patients should be further investigated by a consultant.
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Affiliation(s)
- Jihad Slim
- St. Michaels Medical Center, 111 Central Avenue, Newark, NJ 07102, USA.
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Unilateral ocular sarcoidosis associated with interferon therapy. Tzu Chi Med J 2011. [DOI: 10.1016/j.tcmj.2011.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Morley AMS, O'Sullivan E, Thaung C, Malhotra R. Sarcoid-related dacryoadenitis following treatment with interferon alpha and ribavarin for hepatitis C. Orbit 2011; 30:27-9. [PMID: 21281076 DOI: 10.3109/01676830.2010.535951] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Sarcoidosis is an increasingly well-recognised complication of interferon therapy for hepatitis C infection, primarily manifesting with cutaneous or pulmonary involvement. However, we present an unusual case of sarcoid-related dacryoadenitis in a 67-year-old Caucasian lady following such treatment. The literature relating to ophthalmic presentations of interferon-related sarcoidosis is reviewed, and the potential for confusion with interferon-induced thyroid- associated orbitopathy is discussed.
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Affiliation(s)
- Ana M S Morley
- Corneoplastic Unit, Queen Victoria Hospital, East Grinstead, UK
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López V, Molina I, Monteagudo C, Jordá E. Cutaneous sarcoidosis developing after treatment with pegylated interferon and ribavirin: a new case and review of the literature. Int J Dermatol 2011; 50:287-91. [DOI: 10.1111/j.1365-4632.2010.04728.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Gayet AR, Plaisance P, Bergmann JF, Mouly S. Development of sarcoidosis following completion of treatment for hepatitis C with pegylated interferon-{alpha}2a and ribavirin: a case report and literature review. Clin Med Res 2010; 8:163-7. [PMID: 20852086 PMCID: PMC3006563 DOI: 10.3121/cmr.2010.886] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Sarcoidosis is a chronic inflammatory multisystem disease of unknown etiology. We report on a woman, aged 57 years, presenting with typical sarcoidosis occurring two months after completion of a six-month course of interferon-α and ribavirin for chronic hepatitis C virus infection. The current observation is interesting with regard to the time elapsed between the occurrence of symptoms and antiviral treatment withdrawal, and spontaneous recovery after ten months of follow-up. Pathophysiological mechanisms involved in the development of antiviral therapy-induced sarcoidosis are discussed.
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Affiliation(s)
- Albéric-Rembrandt Gayet
- Emergency Department, Assistance Publique-Hôpitaux de Paris, Lariboisière Hospital, Paris, France.
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Abstract
UNLABELLED BASIC: To describe the main characteristics and treatment of sarcoidosis in patients with chronic hepatitis C virus (HCV) infection. METHODS Retrospective cohort study of patients with chronic HCV infection and sarcoidosis at our tertiary institution. RESULTS Eleven cases (eight women, three men) fulfilled the criteria for sarcoidosis. Four cases belong to our population of 3194 (0.12%) HCV patients seen in our department between 2001 and 2008. In five cases, sarcoidosis was triggered by antiviral therapy (consisted of interferon-alpha monotherapy in one case and combined therapy with interferon-alpha and ribavirin in four cases) and developed from 23 to 82 months after completion of therapy in three cases. For these patients, pulmonary adenopathies were found in three patients while two presented cutaneous involvement, one had uveitis and one presented both arthritis and extrapulmonary lymphadenopathies. Two patients received systemic corticosteroids with a favourable outcome. Four treatment-naive patients developed sarcoidosis. Two had pulmonary disease, one had medullar involvement, one had superficial lymphadenopathy and one had arthralgia. Three patients received systemic corticosteroids with chronic outcome in all cases. One of the two patients with an earlier history of sarcoidosis experienced a benign relapse that resolved spontaneously. CONCLUSION Clinical manifestations of sarcoidosis may occur in HCV patients, especially during or after treatment with immunotherapy. In our experience, sarcoidosis triggered by antiviral therapy was more frequent after completion of therapy, but concording with literature, presented a benign outcome. In sarcoidosis, seen in treatment-naive HCV patients, systemic corticosteroids had to be used more often and outcome was less favourable.
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Ophthalmologic complications in children with chronic hepatitis C treated with pegylated interferon. J Pediatr Gastroenterol Nutr 2010; 51:183-6. [PMID: 20512062 PMCID: PMC2910798 DOI: 10.1097/mpg.0b013e3181b99cf0] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVES Interferon treatment for chronic viral hepatitis C (HCV) has been associated with the development of retinopathy in 19% to 29% of adults. Our purpose is to describe the ophthalmologic complications of pegylated interferon-alpha2a with either placebo or ribavirin in children with chronic HCV (the PEDS-C trial). MATERIALS AND METHODS Prospective, comprehensive ophthalmologic examinations including slit lamp at enrollment and after 24 and 48 weeks of treatment of 114 children participating in a randomized clinical trial. RESULTS One hundred and twenty-eight children were screened for entry, of whom 123 had an eye examination and no child had existing retinal disease. One hundred fourteen children were eligible and were treated. One hundred ten children had an eye examination at 24 weeks and 103 children at 48 weeks. Three of 114 subjects (2.6%) developed documented (n = 2) or possible (1) serious eye complications. One subject developed evidence of ischemic retinopathy (cotton-wool spots) by week 24, 1 developed uveitis by week 48, and 1 reported at week 48 transient (<4 hours) monocular blindness that had occurred at week 36 with a subsequent normal examination at week 48. CONCLUSIONS Ophthalmologic complications are infrequent in children who are treated with pegylated interferon-alpha2a for HCV (2%-3%). Because of the potential severity of ischemic retinopathy and uveitis, prospective ocular assessment should remain part of the monitoring strategy for children who are treated with interferon for HCV.
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Hashemi N, Rossi S, Navarro VJ, Herrine SK. Safety of peginterferon in the treatment of chronic hepatitis C. Expert Opin Drug Saf 2009; 7:771-81. [PMID: 18983223 DOI: 10.1517/14740330802423291] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Combination of 'pegylated' interferons (IFNs) plus ribavirin, the standard treatment of chronic hepatitis C (CHC), is frequently associated with side effects. Anticipation, recognition and proper management of these side effects are important to ensure compliance with therapy and achievement of sustained virologic response. OBJECTIVE To illustrate the side effect profile of pegIFN-alpha in the treatment of CHC. METHODS Studies and abstracts were identified through a computerized, English language literature search. Key search terms included peginterferon and CHC. Information available only in abstract form was retrieved from national and international hepatology associations. RESULTS Most adverse events occurring with combination therapy can be anticipated and managed appropriately; therefore, premature discontinuation of therapy owing to side effects is not required in most patients.
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Affiliation(s)
- Nikroo Hashemi
- Thomas Jefferson University, Division of Gastroenterology and Hepatology, Philadelphia, PA, USA
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Current World Literature. Curr Opin Rheumatol 2009; 21:85-92. [DOI: 10.1097/bor.0b013e32832355a7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Interferon-alpha-associated presumed ocular sarcoidosis. Graefes Arch Clin Exp Ophthalmol 2008; 247:675-80. [PMID: 19034483 DOI: 10.1007/s00417-008-1002-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2008] [Revised: 11/01/2008] [Accepted: 11/05/2008] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Interferon alpha, used in the treatment of different viral, autoimmune and malignant diseases, is known to induce a variety of side effects. Recently, induction of sarcoidosis during interferon therapy has been reported. We analyzed patients for uveitis, possibly induced by interferon alpha. METHODS We report on three patients who had developed typical signs of ocular sarcoidosis under treatment with interferon alpha for chronic hepatitis C virus infection. In two patients, conventional interferon alpha was used and in another one, pegylated interferon alpha-2b. All patients additionally received ribavirin. RESULTS In all three cases, panuveitis was diagnosed. The mean duration of interferon treatment before development of uveitis was 10 months. Clinically, all patients demonstrated granulomatous panuveitis with choroidal granulomas of various sizes. In one case, the uveitis developed together with renal failure, fever and malaise. In this patient, an elevated ACE level was detected. In another patient, the diagnosis of sarcoid induced uveitis was confirmed by positive chest CT scan. The intraocular inflammation was managed with a reduction of the interferon dosage. The therapy with ribavirin was not changed. All patients received topical steroids. Systemic steroids were applied only in the case with systemic disease manifestations. CONCLUSIONS Uveitis can be a sign of sarcoidosis induced by interferon alpha. Further studies are required to support the observation that with early diagnosis the prognosis of uveitis seems to be good.
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2008. [DOI: 10.1002/pds.1489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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