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Khazaie H, Aghazadeh M, Zakiei A, Maazinezhad S, Tavallaie A, Moghbel B, Azarian M, Mozafari F, Norouzi E, Sweetman A, Sharafkhaneh A. Co-morbid Insomnia and Sleep Apnea (COMISA) in a large sample of Iranian: prevalence and associations in a sleep clinic population. Sleep Breath 2024:10.1007/s11325-024-03102-4. [PMID: 39186100 DOI: 10.1007/s11325-024-03102-4] [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: 01/22/2024] [Revised: 04/25/2024] [Accepted: 07/01/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Sleep apnea (SA) and insomnia (INS) are prevalent sleep disorders among referrals to sleep clinics. People with comorbid insomnia and sleep apnea (COMISA) suffer both disorders simultaneously. The epidemiology of COMISA is not well known in the Middle East including Iran. We hypothesized that COMISA is prevalent in metropolitan sleep clinic cohorts in Iran. METHOD The records of patients aged < 95 years referred to sleep disorders centers in four large metropolitan areas including Kermanshah, Tabriz, Shiraz, and Ahvaz were examined. Polysomnography (PSG) was performed in all these patients in specialized centers and the results were scored by a trained technician and interpreted by a sleep specialist. SA was defined as an Apnea-Hypopnea Index (AHI ≥ 5), INS was defined by psychiatrists according to self-report and clinical interviews, and COMISA was defined if both disorders were present. Participants with neither condition were included in as comparator group. One-way ANOVAs, correlation, and linear/logistic regression analyses were used. RESULTS This study included 1807 patients (Mean age 49.3, SE ± 13.7; 38.8% Female). Comparator, INS, SA and COMISA made up 7.2%, 16%, 50.2% and 26.6% of the sample, respectively. Logistic regression analyses showed that male gender, older age, and increasing neck circumference, but not BMI, were associated with COMISA. Epworth Sleepiness Scale scores were lower in INS (5.39 ± 5.78) compared to the other three groups. CONCLUSION COMISA is a prevalent condition in metropolitan sleep centers in Iran among participants referred to sleep centers. The data showed that male gender and age were associated significantly with COMISA.
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Affiliation(s)
- Habibolah Khazaie
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mirza Aghazadeh
- Valisar Sleep Disorders Center, Tabriz, East Azerbaijan, Iran
| | - Ali Zakiei
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
| | - Soroush Maazinezhad
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | | | - Mehrnaz Azarian
- Department of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Farina Mozafari
- Valisar Sleep Disorders Center, Tabriz, East Azerbaijan, Iran
| | - Ebrahim Norouzi
- Sleep Disorders Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran.
- Department of Physical Education, Farhangian University, P.O. Box 14665-889, Tehran, Iran.
| | - Alexander Sweetman
- Adelaide Institute for Sleep Health, Flinders University, South Australia, Australia
| | - Amir Sharafkhaneh
- Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, TX, USA
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Njiro BJ, Ndumwa HP, Waithera HW, Chande R, Julius W, Mashili F, Mwita JC, Swahn MH, Staton C, Francis JM. Epidemiology of non-communicable diseases among professional drivers in LMICs: a systematic review and meta-analysis. Health Promot Int 2024; 39:daae087. [PMID: 39215468 PMCID: PMC11364521 DOI: 10.1093/heapro/daae087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
Abstract
This systematic review collected evidence on the burden of non-communicable diseases (NCDs) among professional drivers and reported on the most common factors that increase the risk of NCDs in this specific population in low- and middle-income countries (LMICs). The protocol for this systematic review was registered in the International Prospective Register of Systematic Reviews (PROSPERO). We conducted a thorough search on PubMed/MEDLINE, EMBASE, Scopus, Global Health, Web of Science and Africa-wide information databases on 11 May 2023. We adapted the Joanna Briggs Institute (JBI) tool to assess the quality of the studies. We estimated the prevalence of hypertension, prediabetes, diabetes mellitus (DM), overweight and obesity among professional drivers using a random effect model to compute pooled and subgroup analyses. In addition, we conducted a narrative synthesis of the risk factors and recommendations presented in the included studies. Forty-one studies, including 48 414 study participants, met the criteria for inclusion. The pooled prevalence of hypertension, DM and obesity among professional drivers was 36.7% [95% confidence interval (CI): 31.8-41.6%], 15.2% (95% CI: 7.0-23.4%) and 27.2% (95% CI: 18.7-35.8%), respectively. Unsupportive environment, work stress, sedentary lifestyle, consumption of unhealthy foods and shift work were the most common modifiable risk factors reported. Our findings also show a significant burden of hypertension, DM and obesity among professional drivers in LMICs. The prevalence of DM and obesity was two- and three-fold higher than findings in general populations, respectively. Our findings indicate an urgent need for tailored interventions for different occupation-related risk factors for NCDs among professional drivers in LMICs.
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Affiliation(s)
- Belinda J Njiro
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Harrieth P Ndumwa
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Hannah Wanjiku Waithera
- Division of Epidemiology and Biostatistics, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Rehema Chande
- Directorate of Library Services, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - William Julius
- Directorate of Library Services, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Fredirick Mashili
- Department of Physiology, School of Biomedical Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Julius C Mwita
- Department of Internal Medicine, University of Botswana and Princess Marina Hospital, Gaborone, Botswana
| | - Monica H Swahn
- Wellstar College of Health and Human Services, Kennesaw State University, Kennesaw, GA, USA
| | - Catherine Staton
- Department of Emergency Medicine, Duke School of Medicine/Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Joel Msafiri Francis
- Department of Family Medicine and Primary Care, University of the Witwatersrand, Johannesburg, South Africa
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Kim T, Kang J. Relationship between obstructive sleep apnea, insulin resistance, and metabolic syndrome: a nationwide population-based survey. Endocr J 2023; 70:107-119. [PMID: 36171092 DOI: 10.1507/endocrj.ej22-0280] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
We aimed to identify the association between obstructive sleep apnea (OSA), insulin resistance (IR), and metabolic syndrome (MetS) in a nationwide population-based sample. A total of 7,900 adults with information on the STOP-Bang score and MetS (3,341 men and 4,469 women) were identified from the dataset of the Korea National Health and Nutrition Examination Survey 2019-2020. The association between OSA, IR, MetS, and its components was estimated using complex sample logistic regression analysis with adjustments for age, body mass index, residence, smoking status, alcohol consumption, household income, education, and the presence of diabetes. Participants with a high OSA score were more likely to have IR (odds ratio [OR] 2.78, 95% confidence interval [CI] 1.96-3.95 in men and OR 2.64, 95% CI 0.55-12.80 in women), MetS (OR 6.05, 95% CI 4.23-8.69 in men and OR 4.20, 95% CI 1.23-15.70 in women), and components of MetS, compared to individuals with a low OSA score. Compared to premenopausal women, postmenopausal women had a more intense association between OSA and IR (OR 1.78, 95% CI 0.13-24.43 for premenopausal women and OR 3.64, 95% CI 0.60-22.28 for postmenopausal women) and MetS (OR 2.58, 95% CI 0.23-29.55 for premenopausal women and OR 5.36, 95% CI 1.42-20.21 for postmenopausal women). OSA was associated with abdominal obesity and hypertension in premenopausal women, while all components of MetS were associated with OSA in postmenopausal women. Further studies are necessary to elucidate the underlying mechanisms of these findings.
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Affiliation(s)
- Taeyun Kim
- Department of Internal Medicine, The Armed Forces Goyang Hospital, Goyang, Republic of Korea
| | - Jihun Kang
- Department of Family Medicine, Kosin University College of Medicine, Kosin University Gospel Hospital, Busan, Republic of Korea
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Ahn YH, Lee S, Kim SR, Lim J, Park SJ, Kwon S, Kim H. Factors associated with different levels of daytime sleepiness among Korean construction drivers: a cross-sectional study. BMC Public Health 2021; 21:2014. [PMID: 34740335 PMCID: PMC8571888 DOI: 10.1186/s12889-021-12062-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Accepted: 10/20/2021] [Indexed: 12/16/2022] Open
Abstract
Background Commercial vehicle accidents are the leading cause of occupational fatalities and an increased risk of traffic accidents is associated with excessive fatigue, other health problems as well as poor sleep during work. This study explores individual and occupational factors associated with different levels of daytime sleepiness and identifies their association with driving risk among occupational drivers working at construction sites. Methods This cross-sectional and correlational study adopted a self-reported questionnaire of Korean construction drivers (N = 492). The data were collected from October 2018 to February 2019 using a battery of six validated instruments about participants’ sociodemographic, health-related, and occupational characteristics. One-way ANOVA and multinomial logistic regression were conducted using IBM SPSS WIN/VER 25.0, with a two-tailed alpha of .05. Results Based on the Epworth Sleepiness Scale, “moderate” (31.7%) and “severe” (10.2%) daytime sleepiness groups were identified. There were significant differences in break time, driving fatigue, depressive symptom, subjective sleep quality, physical and mental health, and driving risk among the three groups (all p-values < .001). Driving fatigue (Adjusted Odds Ratio [aOR] = 1.08, 1.17), depressive symptoms (aOR = 0.91, 0.98), subjective sleep quality (aOR = 1.18 in moderate only), and driving over the speed limit (aOR = 1.43, 2.25) were significant factors for determining “moderate” and “severe” daytime sleepiness groups, respectively. Conclusion A significant number of construction drivers experience excessive daytime sleepiness; thus it is important to reduce the negative impact of driving fatigue and other factors on daytime sleepiness. Our study findings suggest that occupational health care providers should pay attention to development and implementation of health management interventions to reduce driving fatigue that incorporate the drivers’ physical, mental, and occupational factors. Professional organizations need to establish internal regulations and public policies to promote health and safety among occupational drivers who specifically work at construction sites.
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Affiliation(s)
- Yong Han Ahn
- School of Architecture and Architectural Engineering, Hanyang University-ERICA, Room #210, Engineering II, 55 Hanyangdaehak-ro, Sangnok-gu, 15588, Ansan, Gyeonggi-do, Republic of Korea
| | - Sangeun Lee
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL, 60602, USA
| | - Su Ryeon Kim
- College of Architecture, Texas A&M University, College Station, Texas, TX, 77840, USA
| | - Jeeyeon Lim
- College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - So Jin Park
- Department of Smart City Engineering, Hanyang University-ERICA, Ansan, Gyeonggi-do, Republic of Korea
| | - Sooyoung Kwon
- Sejong City Center for Infectious Diseases Control and Prevention, 5F 503, 19 Horyeoul-ro (Sejong City Hall), 30150, Sejong-si, Republic of Korea
| | - Heejung Kim
- College of Nursing, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea. .,Mo-Im Kim Nursing Research Institute, Yonsei University, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.
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Ebrahimi MH, Jahanfar S, Shayestefar M. The Relationship between the Metabolic Syndrome and the Risk of Obstructive Sleep Apnea Evaluated by STOP-Bang Questionnaire in Professional Drivers in Shahroud, Iran, in 2020: A Case-Control Study. J Obes Metab Syndr 2021; 30:55-62. [PMID: 33582659 PMCID: PMC8017324 DOI: 10.7570/jomes20105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 12/05/2020] [Accepted: 01/20/2021] [Indexed: 11/02/2022] Open
Abstract
Background The present study was conducted to investigate the relationship between metabolic syndrome and the risk of respiratory and sleep disorders in professional drivers. Methods This case-control study was conducted on professional drivers in Shahroud, Iran. The snoring, tiredness during daytime, observed apnea, high blood pressure, body mass index, age, neck circumference, gender (STOP-Bang) questionnaire was first used to assess obstructive sleep apnea (OSA). Then, based on the questionnaire scores, the participants were divided into two groups: those with and those without OSA. The relationship between this disorder and metabolic syndrome was then studied. Data were analyzed using descriptive and analytical tests (P<0.05). Results Based on the STOP-Bang questionnaire, 214 drivers with a high risk of OSA and 214 drivers with low risk were recruited for the study. According to the Adult Treatment Panel III criteria, 204 drivers (47.7%) had metabolic syndrome. There was a significant relationship between driver's license class and the risk of OSA. Metabolic syndrome components including fasting blood sugar, triglycerides, and hypertension, but not high-density lipoprotein cholesterol, were able to predict OSA in the professional drivers. Conclusion Given the high prevalence of metabolic syndrome and OSA, especially in drivers of high risk who may spend long hours transporting good and operating passenger vehicles, screening and treating these disorders are crucial in this part of the population. The researchers recommend holding regular training sessions about these disorders for professional drivers.
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Affiliation(s)
- Mohammad Hossein Ebrahimi
- Environmental and Occupational Health Research Center, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shayesteh Jahanfar
- MPH Program, School of Health Sciences, Central Michigan University, MI, USA
| | - Mina Shayestefar
- School of Allied Medical Sciences, Semnan University of Medical Sciences, Semnan, Iran
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Validation of the STOP-Bang questionnaire for screening of obstructive sleep apnea in the general population and commercial drivers: a systematic review and meta-analysis. Sleep Breath 2021; 25:1741-1751. [PMID: 33507478 PMCID: PMC8590671 DOI: 10.1007/s11325-021-02299-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/05/2021] [Accepted: 01/15/2021] [Indexed: 02/06/2023]
Abstract
Purpose Obstructive sleep apnea (OSA) is a critical occupational health concern, but is often undiagnosed in the general population and commercial drivers. The STOP-Bang questionnaire is a simple, reliable tool to screen for OSA, which could improve public health in a cost-effective manner. The objective of this systematic review and meta-analysis is to assess the validity of the STOP-Bang questionnaire to detect OSA in these key populations. Methods We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, Journals @ Ovid, Web of Science, Scopus, and CINAHL for relevant articles from 2008 to March 2020. The quality of studies was appraised using Cochrane Methods criteria. To calculate pooled predictive parameters, we created 2 × 2 contingency tables and performed random-effects meta-analyses. Results Of 3871 citations, five studies that evaluated STOP-Bang in the general population (n = 8585) and two in commercial drivers (n = 185) were included. In the general population, prevalence of all OSA (AHI ≥ 5), moderate-to-severe OSA (AHI ≥ 15), and severe OSA (AHI ≥ 30) was 57.6%, 21.3%, and 7.8% respectively. In commercial drivers, the prevalence of moderate-to-severe OSA was 37.3%. The trends of high sensitivity and negative predictive value of a STOP-Bang score ≥ 3 illustrates that the questionnaire helps detect and rule out clinically significant OSA in the general population and commercial drivers. Conclusion This meta-analysis demonstrates that the STOP-Bang questionnaire is a valid and effective screening tool for OSA in the general population and commercial drivers. Trial registration PROSPERO No. CRD42020200379; 08/22/2020 Supplementary Information The online version contains supplementary material available at 10.1007/s11325-021-02299-y.
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Arora T, Al-Houqani M. Comparison of commonly used screening tools for determining obstructive sleep apnea amongst aviation employees. Sleep Med 2020; 77:332-336. [PMID: 32839087 DOI: 10.1016/j.sleep.2020.07.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 07/02/2020] [Accepted: 07/06/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Epidemiological evidence suggests the prevalence of Obstructive Sleep Apnea (OSA) ranges 9-38%. Multiple screening tools are used to aid diagnosis. In professions that require high levels of attentiveness, safety, and responsibility for other's lives, inaccuracies and biases are probable for self-reported data. We sought to assess the best screening tool for OSA amongst aircraft pilots and air traffic controllers (ATCs). METHODS Data were collected as part of routine clinical care for patients presenting to Sleep Disorders Specialized Clinic. A total 1384 patients attended the clinic (2012-2018), of which 254 were either pilots or ATCs. Patients responded to three questionnaires, regularly used for OSA screening: 1) Epworth Sleepiness Scale (ESS); 2) Berlin Questionnaire (BQ); 3) STOP-BANG Questionnaire (SBQ). We used non-parametric ROC analysis, sensitivity, and specificity measures, along with positive and negative predictive values (PPV/NPV) to determine the most accurate diagnostic instrument. RESULTS The ROC (95% CI) for the ESS, BQ, and SBQ was 0.49 (0.39-0.59), 0.58 (0.49-0.67), and 0.56 (0.47-0.65), respectively. When the SBQ was used in combination with the ESS, the sensitivity was high at 100% (78.2-100.0), as were the PPV and NPV, 83.3% (58.6-96.4) and 100.0 (2.5-100.0), respectively. CONCLUSION The SBQ, in combination with the ESS, was the most reliable diagnostic tool for OSA in pilots and ATCs. Physicians should prioritize use of these screening tools for predicting OSA when assessing those working in the aviation industry and similar occupational groups, such as drivers. Given the scarcity of literature in this population, we recommend future studies replicate ours to either confirm or refute the findings.
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Affiliation(s)
- Teresa Arora
- Zayed University, College of Natural & Health Sciences, Abu Dhabi, United Arab Emirates
| | - Mohammed Al-Houqani
- College of Medicine & Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.
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Izadpanah P, Asadian F, Jangjou A. Association of Serum Renalase Levels and Renalase rs10887800 Polymorphism with Unstable Angina Pectoris Patients Having Metabolic Syndrome. Diabetes Metab Syndr Obes 2020; 13:3249-3259. [PMID: 32982355 PMCID: PMC7501982 DOI: 10.2147/dmso.s265773] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/19/2020] [Indexed: 12/22/2022] Open
Abstract
PURPOSE An increased risk of cardiovascular mortality and morbidity has been linked with metabolic syndrome (MetS), described as the secondary risk reduction target. These patients are predisposed to high complication levels such as unstable angina-pectoris (USAP) by MetS. As with the role of renalase in the regulation of blood pressure (BP), the study was carried out to determine the levels of renalase circulation in patients with USAP and MetS (USAP+MetS), as well as the association of renalase gene (RNLS) rs10887800 polymorphism and USAP and MetS susceptibility. PATIENTS AND METHODS A total of 134 patients with USAP+MetS and 134 control subjects were recruited in this case-control study. RESULTS Renalase was found to have a significantly higher level in USAP+MetS patients (23.28 ± 4.09 µg/dL) than in healthy ones (20.81 ± 2.73 µg/dL) (P < 0.001). Also, it was shown that renalase sensitivity and specificity values for the early diagnosis of USAP and MetS seemed to be 53.7% and 76.9, respectively. Moreover, the value for renalase area under curve (AUC) was 0.654 (95% CI: 0.58-0.72). The frequency of rs10887800 AG and GG genotypes of RNLS gene was significantly higher in USAP+MetS patients than in control subjects, suggesting that this genotype might be a risk factor against USAP+MetS (OR = 2.114 [95% CI 1.113-4.016]; P = 0.022) and (OR = 2.057 [95% CI 1.011-4.186]; P = 0.047), respectively. CONCLUSION The present results showed that renalase serum levels increased in USAP and MetS patients. Moreover, the RNLS rs10887800 was reported to be associated with a higher risk of USAP+MetS.
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Affiliation(s)
- Peyman Izadpanah
- Cardiology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Fatemeh Asadian
- Department of Medical Laboratory Sciences, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ali Jangjou
- Emergency Medicine Department, Shiraz University of Medical Sciences, Shiraz, Iran
- Correspondence: Ali Jangjou Emergency Medicine Department, Shiraz University of Medical Sciences, Shiraz, IranTel +98-9173157555 Email
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