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Sobeeh FG, Eldayem YBA, Khalifa HK. Validity of different scoring systems in prediction of intensive care unit admission and mortality in acute organophosphate poisoning. Toxicol Res (Camb) 2024; 13:tfae107. [PMID: 39021369 PMCID: PMC11249962 DOI: 10.1093/toxres/tfae107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Revised: 06/12/2024] [Accepted: 07/11/2024] [Indexed: 07/20/2024] Open
Abstract
Background Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients. Methods A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis. Results Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC = 0.983) and mortality (AUC = 0.999). Conclusion The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning.
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Affiliation(s)
- Fatma G Sobeeh
- Lecturer of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta University, El-Gash st. Medical Campus The Faculty of Medicine, Tanta, 31527, Egypt
| | - Yara B Abd Eldayem
- Lecturer of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta University, El-Gash st. Medical Campus The Faculty of Medicine, Tanta, 31527, Egypt
| | - Heba K Khalifa
- Assistant Professor of Forensic Medicine & Clinical Toxicology, Faculty of Medicine, Tanta University, El-Gash st. Medical Campus The Faculty of Medicine, Tanta, 31527, Egypt
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Bhakaney PR, Yadav VD, Nagore AA, Kulkarni CA. Resurgence to Life: A Case Report on Inpatient Rehabilitation in Organophosphate Poisoning Followed by Intermediate Syndrome. Cureus 2023; 15:e49069. [PMID: 38125255 PMCID: PMC10731128 DOI: 10.7759/cureus.49069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2023] [Accepted: 11/14/2023] [Indexed: 12/23/2023] Open
Abstract
Organophosphate poisoning (OPP) results from the occupational, accidental, or suicidal intake of organophosphate pesticides (OPs). There is a huge limitation in the available literature on OPP cases and the role of physiotherapy in such cases. We report a case of a 33-year-old farmer, found in a state of ingested insecticide and admitted to the emergency department. The patient had two to three episodes of vomiting, associated with continuous tremors in his hands and legs. Immediately infused with atropine, the patient's general condition deteriorated, and he was intubated with an endotracheal tube. With the signs of long-term intubation, a tracheostomy was done. A respiratory therapy consult was taken for indications of intermediate syndrome and to achieve early weaning. The patient's referral was received in view of the long-term requirement of bronchial hygiene and the need for early ambulation as well as psychological support. Informed consent was taken from the family prior to the commencement of the treatment. Respiratory therapy interventions included body positioning, bronchial hygiene techniques, chest proprioceptive neuromuscular facilitation (PNF) techniques, and mobility exercises to achieve early ambulation. Physiotherapists have the appropriate training, knowledge, and skills to deliver the exercise components and help patients return to their activities of daily living. Significant levels of improvement have been seen in the general condition of the patient. The overall functioning of the patient's health was seen as improved on the scales of consciousness, early mobility in the step-down unit, and quality of life.
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Affiliation(s)
- Pallavi R Bhakaney
- Cardiorespiratory Physiotherapy, Dr. D. Y. Patil College of Physiotherapy, Pune, IND
| | - Vaishnavi D Yadav
- Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Aditi A Nagore
- Cardiorespiratory Physiotherapy, Ravi Nair Physiotherapy College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Elhady MM, Adly SA, Elshebiny HA, Moselhy SS. Detection the severity of organophosphate intoxication using sensitive serum biomarkers S100B and amyloid β (Aβ) in Egyptian subjects. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2023; 30:105194-105201. [PMID: 37713081 PMCID: PMC10579114 DOI: 10.1007/s11356-023-29748-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 09/03/2023] [Indexed: 09/16/2023]
Abstract
Organophosphate (OP) is a compound considered the main leading cause of morbidity and mortality from poisoning worldwide. Serum pseudocholinesterase was evaluated as a diagnostic indicator; it cannot be used to monitor therapy or severity of the intoxication. The rationale of the current study was to evaluate sensitivity, specificity, and cut-off values of serum S100B and amyloid β for neurological affection severity. This study was carried out on sixty OP-impaired patients; in addition, 20 normal controls were included. Serum liver and kidney function tests, malondialdehyde, pseudocholinesterase, and the levels of S100B and amyloid β (Aβ) were determined. Data showed that Pearson's analysis indicated that the serum level of S100B was positively correlated with Aβ. On the contrary, the activity of pseudocholinesterase was negatively correlated with both of S100B and Aβ. Serum ALT, AST, creatinine, urea, acetylcholine, and MDA levels were elevated while pseudocholinesterase activity was reduced in moderate and severe OP intoxication versus control. A drastic elevation (p<0.001) in the levels of S100B and Aβ was performed in the patient group suffering from OP intoxication versus the normal group. The diagnostic statistical validation of targeted parameters in distinguishing between moderate OP intoxication and control clarifies that S100B displayed the best AUC (0.997) followed by Aβ (AUC=0.992), while the diagnostic veracity of S100B and Aβ in setting apart severe OP-intoxicated and normal subjects stated the symmetric efficacy of potential markers. It was concluded that the significant changes in the levels of S100B and Aβ were directly proportional to the degree of severity of OP intoxication.
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Affiliation(s)
- Mostafa M Elhady
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt
| | - Sara A Adly
- Poison Control Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Husam A Elshebiny
- Poison Control Center, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Said S Moselhy
- Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, Egypt.
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Fouad MM, Zawilla NH, Moubarez DA. Successful treatment of intermediate syndrome in a COVID-19 patient with severe organophosphate toxicity. Int J Crit Illn Inj Sci 2023; 13:145-147. [PMID: 38023580 PMCID: PMC10664041 DOI: 10.4103/ijciis.ijciis_84_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 02/07/2023] [Accepted: 02/10/2023] [Indexed: 12/01/2023] Open
Abstract
Organophosphate (OP) poisoning is one of the most common causes of poisoning in the world, due to its easy availability, low cost, and wide occupational exposure. It has a significant death and morbidity rate. Cholinergic syndrome, intermediate syndrome (IMS), and syndrome of delayed polyneuropathy are the three primary syndromes that define OP poisoning. We report the case of a 44-year-old male patient who had a history of OP poisoning by inhalation and later developed altered mental status (AMS). The patient transiently improved and regained consciousness following treatment with atropine and obidoxime. He deteriorated the following day with AMS and generalized muscle weakness consistent with IMS and was intubated for airway protection. Despite further complication by Klebsiella and COVID-19 infections, he recovered to hospital discharge on day 14.
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Affiliation(s)
- Marwa Mohammed Fouad
- Department of Occupational and Environmental Medicine, Cairo University, Cairo, Egypt
| | - Nermin Hamdy Zawilla
- Department of Occupational and Environmental Medicine, Cairo University, Cairo, Egypt
- Department of National Environmental and Clinical Toxicology Research Center, Cairo University, Cairo, Egypt
| | - Doaa Atef Moubarez
- Department of Critical Care Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt
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Ramadori GP. Organophosphorus Poisoning: Acute Respiratory Distress Syndrome (ARDS) and Cardiac Failure as Cause of Death in Hospitalized Patients. Int J Mol Sci 2023; 24:ijms24076658. [PMID: 37047631 PMCID: PMC10094912 DOI: 10.3390/ijms24076658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/22/2023] [Accepted: 03/31/2023] [Indexed: 04/05/2023] Open
Abstract
Industrial production of food for animals and humans needs increasing amounts of pesticides, especially of organophosphates, which are now easily available worldwide. More than 3 million cases of acute severe poisoning are estimated to occur worldwide every year, and even more cases remain unreported, while 200,000–350,000 incidentally or intentionally poisoned people die every year. Diagnostic and therapeutic procedures in organophosphate poisoning have, however, remained unchanged. In addition to several neurologic symptoms (miosis, fasciculations), hypersecretion of salivary, bronchial, and sweat glands, vomiting, diarrhea, and loss of urine rapidly induce dehydration, hypovolemia, loss of conscience and respiratory distress. Within hours, signs of acidosis due to systemic hypoxia can be observed at first laboratory investigation after hospitalization. While determination of serum-cholinesterase does not have any diagnostic value, it has been established that hypoalbuminemia alone or accompanied by an increase in creatinine, lactate, or C-reactive protein serum levels has negative prognostic value. Increased serum levels of C-reactive protein are a sign of systemic ischemia. Protective mechanical ventilation should be avoided, if possible. In fact, acute respiratory distress syndrome characterized by congestion and increased weight of the lung, accompanied by heart failure, may become the cause of death. As the excess of acetylcholine at the neuronal level can persist for weeks until enough newly, locally synthesized acetylcholinesterase becomes available (the value of oximes in reducing this time is still under debate), after atropine administration, intravenous albumin and fluid infusion should be the first therapeutic interventions to reestablish normal blood volume and normal tissue oxygenation, avoiding death by cardiac arrest.
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Mahrous MM, Muhammad MA, Kotb NA, Elattar HMS, Elrewieny NM. Medicolegal study of Egyptian suspicious childhood deaths during 2020-2021. J Forensic Leg Med 2023; 94:102472. [PMID: 36577189 DOI: 10.1016/j.jflm.2022.102472] [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: 08/07/2022] [Revised: 12/16/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022]
Abstract
BACKGROUND Pediatric autopsy is an effective tool for identifying the cause and the manner of death in suspicious childhood deaths. AIM OF THE STUDY To explore the pattern of suspicious childhood deaths during the recent years (2020-2021) in the Egyptian community and to identify the risk factors to avoid them during the childhood period. SUBJECTS AND METHODS One hundred and fifty Egyptian suspicious child death cadavers (less than 18 years old) were autopsied in Zeinhom Morgue during one-year period (2020-2021). Demographic data, circumstances of death, causes and manner of death were defined and statistically analyzed. RESULTS Identity was known in 77.3% of the studied cases, and male to female ratio was 2.2:1. Most of cases were recruited from Cairo and Giza governorates. Adolescents contributed to about one third of the cases. Deaths at home or in hospital were more than outdoor deaths. Seasonal variation was observed as more cases were autopsied during spring and summer. Homicidal deaths (32%) were more in toddlers and adolescents mostly by blunt trauma (58.3%) with signs of violence and resistance or child abuse, mainly in males. The perpetrator was known to be a family member in more than half of the studied cases (56.25%). Accidental deaths (17.3%) were mainly by firearm injuries or poisoning. Suicidal deaths (13.3%) were represented more in adolescents by hanging or by aluminum phosphide poisoning. Natural deaths (13.3%) by bronchopneumonia or leukemia were found in neonates and adolescents. Sudden infant death syndrome (SIDS) (6.7%) was diagnosed by exclusion among neonates and infants only during spring, with equal gender distribution (1:1). Malpractice (6%) leads to death by sepsis or hemorrhage. CONCLUSIONS All manners of death contribute to suspicious death during childhood period, especially during summer and spring. Family members are the perpetrator for most of accidental, homicidal or suicidal deaths. RECOMMENDATIONS Training courses are recommended to parents for proper care and protection of their children to avoid violence, abuse and accidents at home or outdoor.
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Affiliation(s)
- Mai Mohamed Mahrous
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
| | - Mai Ahmad Muhammad
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
| | - Nadia Abdelmonem Kotb
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt
| | | | - Noha Maher Elrewieny
- Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Cairo University, Egypt.
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El-Sarnagawy GN, Ghonem MM, Helal NE. Initial clinical and laboratory parameters triaging non-pharmaceutical acute pediatric poisoned patients for potential adverse outcomes: a three-year retrospective study. Toxicol Res (Camb) 2023; 12:95-106. [PMID: 36866221 PMCID: PMC9972823 DOI: 10.1093/toxres/tfac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/15/2023] Open
Abstract
Identifying high-risk pediatric patients with non-pharmaceutical poisoning is crucial to avoid prospective complications and decrease the evident hospital economic burden. Although the preventive strategies have been well studied, determining the early predictors for poor outcomes remains limited. Therefore, this study focused on the initial clinical and laboratory parameters as a triage of non-pharmaceutical poisoned children for potential adverse outcomes taking the causative substance effects into account. This retrospective cohort study included pediatric patients admitted to Tanta University Poison Control Center from January 2018 to December 2020. Sociodemographic, toxicological, clinical, and laboratory data were retrieved from the patient's files. Adverse outcomes were categorized into mortality, complications, and intensive care unit (ICU) admission. Out of enrolled 1,234 pediatric patients, preschool children constituted the highest percentage of the patients investigated (45.06%), with a female predominance (53.2%). The main non-pharmaceutical agents included pesticides (62.6%), corrosives (19%), and hydrocarbons (8.8%), mainly associated with adverse consequences. The significant determinants for adverse outcomes were pulse, respiratory rate, serum bicarbonate (HCO3), Glasgow Coma Scale, O2 saturation, Poisoning Severity Score (PSS), white blood cells (WBCs), and random blood sugar. The cutoffs of serum HCO3 < 17.55 mmol/l, WBCs >8,650 cells/microliter, and PSS > 2 points were the best discriminators for mortality, complications, and ICU admission, respectively. Thus, monitoring these predictors is essential to prioritize and triage pediatric patients who require high-quality care and follow-up, particularly in aluminum phosphide, sulfuric acid, and benzene intoxications.
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Affiliation(s)
- Ghada N El-Sarnagawy
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
| | - Mona M Ghonem
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
| | - Nadia E Helal
- Department of Forensic Medicine and Clinical Toxicology, Faculty of Medicine, Tanta University, Tanta, 31527, Egypt
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Yousef A, Albuali W, AlOmari M, AlMutairi A, Albuali HW, AlQurashi FO, Alshaqaq HM. Organophosphate Poisoning in a Paediatric Intensive Care Unit: A Retrospective Analysis Based on Ten Years of Experience. Int J Gen Med 2022; 15:6269-6277. [PMID: 35903645 PMCID: PMC9315956 DOI: 10.2147/ijgm.s373707] [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: 05/07/2022] [Accepted: 07/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Organophosphate (OP) poisoning is one of the most common etiologies of poisoning in the pediatric age group. Objective This study aimed to evaluate the demographic characteristics, clinical features, clinical course, and outcomes of children with toxicity from organophosphates admitted to the pediatric intensive care unit. Methods A retrospective review of hospital medical records of all children aged 14 years and younger who were admitted to the PICU with a provisional diagnosis of organophosphate poisoning at King Fahad Hospital of the University (KFHU), Alkhobar, Saudi Arabia, between January 1, 2008, and December 31, 2018, was conducted. Patients with incomplete medical record information or with suspicion or evidence of one or more agents other than organophosphate were excluded from the study. Results Thirty-one patients were enrolled in the study. The median age of the study population was 2 years, and 19 (61%) were males. The majority of patients (68%) had more than one route of organophosphate exposure. Skin exposure was reported in 26 patients (84%). Only three patients (10%) had suicidal organophosphate exposure from organophosphates, while the majority (28 patients; 90%) had accidental poisoning. Bronchorrhea was the most prevalent presenting feature, reported in 28 patients (90%). 17 patients (55%) were treated with intravenous atropine and (45%) were used a combination of pralidoxime with atropine for treatment. Five patients (16%) developed acute respiratory distress syndrome. Twelve patients (39%) needed endotracheal intubation and mechanical ventilation secondary to respiratory failure. Conclusion The presenting features of organophosphate poisoning differ widely in children. Risk factors for mortality for PICU patients with organophosphate poisoning include delayed hospital arrival by more than 1 hour, inhalational route of exposure, need for mechanical ventilation, and high lactate levels in the first 24 hours post-exposure.
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Affiliation(s)
- Abdullah Yousef
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Waleed Albuali
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Mohammed AlOmari
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Abdullah AlMutairi
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hamad W Albuali
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Faisal O AlQurashi
- Department of Pediatrics, College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Hassan M Alshaqaq
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Li Z, Xiao L, Yang L, Li S, Tan L. Characterization of Acute Poisoning in Hospitalized Children in Southwest China. Front Pediatr 2021; 9:727900. [PMID: 34956970 PMCID: PMC8705540 DOI: 10.3389/fped.2021.727900] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 10/08/2021] [Indexed: 01/17/2023] Open
Abstract
Objective: Acute poisoning in children is characterized by regional differences. This study described the basic situation of childhood poisoning in southwest China based on hospitalized cases. Data and Methods: A total of 1,076 acute poisoning cases among hospitalized children admitted to Children's Hospital of Chongqing Medical University from January 2012 to December 2020 were included in this study. Clinical data such as gender, age, living environment, poisonous substance, and cause of poisoning were statistically described. Trends of length of hospital stay, population distribution, poisonous substances, and causes of acute poisoning in the hospitalized children were compared over time. Results: The cohort comprised 588 males and 488 females; 811 cases lived in rural areas and the rest resided in urban areas. Most cases were between early childhood and school age. Poisoning usually occurred at home (973 cases, 90.4%). Pesticides (381 cases, 35.4%) and drugs (275 cases, 25.6%) were the two most common poisonous substances. Two main causes of poisoning were accidental taking (755 cases, 70.2%) and suicide (177 cases, 16.4%). The results of univariate analysis of suicide showed significant correlations among gender, place of residence, age, poisonous substance, and place of suicide (P < 0.001), while living environment (town), age (adolescence), and poisonous substance (pesticide, drug) were independent risk factors (P < 0.05). There was no significant change in the length of hospital stay for poisoning over time. The overall number of hospitalizations presented a decreasing trend, while the number of urban children gradually increased. The proportion of adolescent poisoned children and suicidal children increased in the last 3 years. Conclusion: Optimizing the package and distribution channels of pesticides and drugs, raising safety awareness of children to avoid accidental injuries, and paying attention to children's mental health are measures that are necessary to prevent poisoning in children.
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Affiliation(s)
- Zhu Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Li Xiao
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Department of Hematology and Oncology, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Lin Yang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Shaojun Li
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Liping Tan
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, National Clinical Research Center for Child Health and Disorders, Children's Medical Big Data Intelligent Application Chongqing University Engineering Research Center, Department of Emergency, Children's Hospital of Chongqing Medical University, Chongqing, China
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