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Pal B, Atem TD, Kumari S, Murti K, Kumar R, Pandey K, Siddiqui NA, Dhingra S, Chaudhary V. Ophthalmic adverse effects of miltefosine in the treatment of leishmaniasis: a systematic review. Cutan Ocul Toxicol 2024; 43:190-197. [PMID: 39023122 DOI: 10.1080/15569527.2024.2380311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 06/10/2024] [Accepted: 07/10/2024] [Indexed: 07/20/2024]
Abstract
OBJECTIVE Miltefosine stands as the sole oral medication approved for the treatment of leishmaniasis. The appearance of severe ophthalmic toxicities induced by miltefosine in the context of leishmaniasis treatment is a matter of significant concern. The main objective of this study is to present a comprehensive summary of the ophthalmic adverse effects associated with miltefosine when used in the treatment of leishmaniasis. METHODS A systematic search was performed on PubMed, ScienceDirect, Embase, Scopus, and Google Scholar, covering articles from inception up to June 2023, without language restrictions, to identify relevant studies documenting ocular toxicity following miltefosine treatment for leishmaniasis. RESULTS A total of eight studies involving 31 leishmaniasis patients who developed ocular toxicities while undergoing miltefosine treatment were included in the analysis. These studies were conducted in various regions, with five originating from India, two from Bangladesh, and one from Nepal. Patients presented a spectrum of ophthalmic complications, including uveitis, keratitis, scleritis, and Mooren's ulcer. Commonly reported symptoms included pain, redness, excessive tearing, partial vision impairment, permanent blindness, light sensitivity, and the appearance of white spots on the eye. On average, patients received miltefosine treatment for a duration of 47 days before experiencing the onset of ocular problems. It is important to note that the risk of ocular toxicities increases with prolonged use of miltefosine. CONCLUSIONS Therefore, to mitigate the potential for irreversible damage to the eyes, it is imperative that all individuals undergoing miltefosine therapy undergo regular eye examinations.
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Affiliation(s)
- Biplab Pal
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Tambe Daniel Atem
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Sweta Kumari
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
| | - Krishna Murti
- National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Rishikesh Kumar
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Krishna Pandey
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Niyamat Ali Siddiqui
- Rajendra Memorial Research Institute of Medical Sciences (Indian Council of Medical Research), Agamkuan, Patna, Bihar, IndiaConsultant (Biostatistics)
| | - Sameer Dhingra
- National Institute of Pharmaceutical Education and Research, Hajipur, Bihar, India
| | - Vaibhav Chaudhary
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, India
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Joshi AB, Banjara MR, Das ML, Bist NR, Pant KR, Pyakurel UR, Dahal G, Paudel KP, Das CL, Kroeger A, Aseffa A. Follow-up assessment of visceral leishmaniasis treated patients and the impact of COVID-19 on control services in Nepal. Trop Med Health 2023; 51:57. [PMID: 37864251 PMCID: PMC10588092 DOI: 10.1186/s41182-023-00549-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 10/06/2023] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Follow-up assessment of visceral leishmaniasis (VL) treated cases is important to monitor the long term effectiveness of treatment regimens. The main objective of this study was to identify the gaps and challenges in the follow-up of treated VL cases, to monitor treatment outcome and to assess the impact of COVID-19 on VL elimination services and activities. METHODS Clinicians treating VL patients, district focal persons for VL, and patients treated for VL in seven high endemic districts in Nepal during 2019-2022 were interviewed to collect data on challenges in the follow-up of VL treated patients as per national strategy. RESULTS Follow up status was poor in two districts with the largest number of reported cases. The majority of cases were children under 10 years of age (44.2%). Among 104 VL treated cases interviewed, 60.6% mentioned that clinicians had called them for follow-up but only 37.5% had complied. Among 112 VL treated cases followed up, 8 (7.14%) had relapse and 2 (1.8%) had PKDL. Among 66 cases who had VL during the COVID-19 lock down period, 32 (48.5%) were diagnosed within 1 week; however, 10 (15.1%) were diagnosed only after 4 weeks or more. During the COVID-19 pandemic, there was no active search for VL because of budget constraints and lack of diagnostic tests, and no insecticide spraying was done. CONCLUSION Relapses and PKDL are challenges for VL elimination and a matter of concern. Successful implementation of the national strategy for follow up of treated VL cases requires addressing elements related to patients (awareness, transport, communication) clinicians (compliance) and organization of service delivery (local health worker training and deployment). COVID-19 did not have much impact on VL diagnosis and treatment; however, public health programmes including active case detection and insecticide spraying for vector control were severely reduced.
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Affiliation(s)
- Anand Ballabh Joshi
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur, Kathmandu, 44601, Nepal.
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland.
| | - Murari Lal Das
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Nav Raj Bist
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Krishna Raj Pant
- Public Health and Infectious Disease Research Center (PHIDReC), Kathmandu, Nepal
| | - Uttam Raj Pyakurel
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Gokarna Dahal
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Krishna Prasad Paudel
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Chuman Lal Das
- Epidemiology and Disease Control Division, Department of Health Services, Teku, Kathmandu, Nepal
| | - Axel Kroeger
- Centre for Medicine and Society/Institute for Infection Prevention, Albert-Ludwigs-University, Freiburg, Germany
| | - Abraham Aseffa
- UNICEF/UNDP/World Bank/WHO Special Programme for Research and Training in Tropical Diseases (TDR), Geneva, Switzerland
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Matha K, Calvignac B, Gangneux JP, Benoit JP. The advantages of nanomedicine in the treatment of visceral leishmaniasis: between sound arguments and wishful thinking. Expert Opin Drug Deliv 2020; 18:471-487. [PMID: 33217254 DOI: 10.1080/17425247.2021.1853701] [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: 10/22/2022]
Abstract
Introduction: Although life-threatening if left untreated, visceral leishmaniasis (VL) is still a neglected endemic disease in 98 countries worldwide. The number of drugs available is low and few are in clinical trials. In the last decades, efforts have been made on the development of nanocarriers as drug delivery systems to treat VL. Given the preferential intracellular location of the parasite in the liver and spleen macrophages, the rationale is sturdy. In a clinical setting, liposomal amphotericin B displays astonishing cure rates.Areas covered: A literature search was performed through PubMed and Google Scholar. We critically reviewed the main literature highlighting the success of nanomedicine in VL. We also reviewed the hurdles and yet unfulfilled promises rising awareness of potential drawbacks of nanomedicine in VL.Expert opinion: VL is a disease where nanomedicines successes shine through. However, there are a lot of obstacles on the road to developing more efficient strategies such as targeting functionalization, oral formulations, or combined therapies. And those strategies raise many questions.
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Affiliation(s)
- Kevin Matha
- MINT, Univ Angers, INSERM 1066, CNRS 6021, Université Bretagne Loire, 4 Rue Larrey 49933 Angers cedex 9, France.,CHU Angers, département Pharmacie,4 rue Larrey, 49933 Angers cedex 9, France
| | - Brice Calvignac
- MINT, Univ Angers, INSERM 1066, CNRS 6021, Université Bretagne Loire, 4 Rue Larrey 49933 Angers cedex 9, France
| | - Jean-Pierre Gangneux
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset , (Institut de recherche en santé, environnement et travail) - UMR_S 1085, F-35000 Rennes, France.,Laboratoire de Parasitologie-Mycologie, CHU de Rennes, 2 rue Henri Le Guilloux, 35033, Rennes, France
| | - Jean-Pierre Benoit
- MINT, Univ Angers, INSERM 1066, CNRS 6021, Université Bretagne Loire, 4 Rue Larrey 49933 Angers cedex 9, France.,CHU Angers, département Pharmacie,4 rue Larrey, 49933 Angers cedex 9, France
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Kusumesh R, Ambasta A, Arya LK, Mohan N, Sinha BP, Ravidas V. Keratitis occurring in patients treated with miltefosine for post-kala-azar dermal leishmaniasis. Br J Ophthalmol 2020; 105:1497-1503. [PMID: 32962993 DOI: 10.1136/bjophthalmol-2020-317325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Revised: 08/06/2020] [Accepted: 08/31/2020] [Indexed: 11/03/2022]
Abstract
AIM To describe the characteristic clinical features and management of keratitis in the patients receiving miltefosine for post-kala-azar dermal leishmaniasis (PKDL). METHODS The medical records of five patients with PKDL who presented with keratitis were reviewed retrospectively from April 2018 to December 2019. The evaluation included a thorough medical history including details on drugs used, particularly miltefosine. The drug causality assessment was also performed. The clinical and microbiological characteristics of keratitis were noted. RESULTS The ocular symptoms included pain, redness, watering, photophobia and diminution of vision. Slit-lamp biomicroscopy revealed peripheral, paralimbal, ring-shaped, full-thickness stromal infiltration resulting in ulcerative keratitis in all cases. Two patients had unilateral keratitis, while three had bilateral keratitis. All five patients received miltefosine for an average period of 48 days before the onset of keratitis. The corrected distance visual acuity at presentation ranged from hand movement to 20/125. The causality assessment revealed a 'probable' association between the adverse drug reaction and miltefosine in all patients. Discontinuation of miltefosine and initiation of corticosteroid therapy resulted in resolution of keratitis in all cases. The unilateral keratitis treated with topical corticosteroids had improved outcomes, but poor outcomes were found in the bilateral keratitis. CONCLUSION These observations indicate that prolonged use of miltefosine might cause keratitis that resembles infectious keratitis. Early diagnosis with discontinuation of the drug and initiation of corticosteroid therapy are the key to successful management.
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Affiliation(s)
- Rakhi Kusumesh
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Anita Ambasta
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Lalan Kumar Arya
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Nilesh Mohan
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Bibhuti Prassan Sinha
- Regional Institute of Ophthalmology, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vidyanand Ravidas
- Rajendra Memorial Research Institute of Medical Sciences, Patna, Bihar, India
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Serbate Borges Portela Á, Margotto Bertollo C, da Silva Praxedes MF, Silva Brasileiro SA, Moreira Reis AM, Parreiras Martins MA. Adverse reactions to meglumine antimoniate in Brazilian inpatients with visceral leishmaniases: A case series. J Clin Pharm Ther 2019; 45:573-576. [PMID: 31793023 DOI: 10.1111/jcpt.13089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/30/2019] [Accepted: 11/07/2019] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Adverse drug reactions (ADR) related to the treatment of visceral leishmaniasis (VL) can cause severe clinical complications. We report a case series of ADR in hospitalized VL patients on meglumine antimoniate (MA). CASE DESCRIPTION Seven cases of patients taking MA had at least one objective evidence for suspected ADR, including electrocardiographic, laboratory or clinical alteration. WHAT IS NEW AND CONCLUSION Meglumine antimoniate is highly toxic. Adherence to treatment guidelines is important. Pharmacists working in multidisciplinary teams may contribute to early detection and management of MA therapy-related ADR.
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Affiliation(s)
| | | | - Marcus Fernando da Silva Praxedes
- Faculdade de Farmácia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,Centro de Ciências da Saúde, Universidade Federal do Recôncavo da Bahia, Santo Antônio de Jesus, Brazil
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Mondal D, Kumar A, Sharma A, Ahmed MM, Hasnain MG, Alim A, Huda MM, Rahman R, Alvar J, Ahmed BN, Haque R. Relationship between treatment regimens for visceral leishmaniasis and development of post-kala-azar dermal leishmaniasis and visceral leishmaniasis relapse: A cohort study from Bangladesh. PLoS Negl Trop Dis 2019; 13:e0007653. [PMID: 31415565 PMCID: PMC6711542 DOI: 10.1371/journal.pntd.0007653] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 08/27/2019] [Accepted: 07/23/2019] [Indexed: 11/19/2022] Open
Abstract
Background We investigated the relationship of treatment regimens for visceral leishmaniasis (VL) with post-kala-azar dermal leishmaniasis (PKDL) and visceral leishmaniasis relapse (VLR) development. Methods Study subjects included cohorts of patients cured of VL since treatment with monotherapy by sodium stibogluconate (SSG), miltefosine (MF), paromomycin intramuscular injection (PMIM), liposomal amphotericin B [AmBisome (AMB)] in a single dose (SDAMB) and in multidose (MDAMB), and combination therapies by AMB+PMIM, AMB+MF, and PMIM+MF. Follow up period was 4 years after treatment. Cohorts were prospective except SSG (retrospective) and MF (partially retrospective). We compared incidence proportion and rate in 100-person-4year of PKDL and VLR by treatment regimens using univariate and multivariate analysis. Findings 974 of 984 enrolled participants completed the study. Overall incidence proportion for PKDL and VLR was 12.3% (95% CI, 10.4%–14.5%) and 7.0% (95% CI, 5.6%–8.8%) respectively. The incidence rate (95% CI) of PKDL and VLR was 14.0 (8.6–22.7) and 7.6 (4.1–14.7) accordingly. SSG cohort had the lowest incidence rate of PKDL at 3.0 (1.3–7.3) and VLR at 1.8 (0.6–5.6), followed by MDAMB at 8.2 (4.3–15.7) for PKDL and at 2.7 (0.9–8.4) for VLR. Interpretation Development of PKDL and VLR is related with treatment regimens for VL. SSG and MDAMB resulted in less incidence of PKDL and VLR compared to other treatment regimens. MDAMB should be considered for VL as a first step for prevention of PKDL and VLR since SSG is highly toxic and not recommended for VL. Post-kala-azar Dermal Leishmaniasis (PKDL), a sequale of visceral leishmaniasis (VL), and reappearance VL (visceral leishmaniasis relapse, VLR) are intra-epidemic reservoirs of VL and threats control of VL in long run. Currently there is no strategy for prevention of PKDL and VLR. If a relationship between treatment for VL and development of PKDL and VLR is there, and then selection of proper treatment regimen for VL should prevent PKDL and VLR. So far no study has been carried out to investigate the relationship between treatment regimens for VL and development of PKDL and VLR. The study demonstrated that multi-dose liposomal amphotericin B (AmBisome) defined as MDAMB herein for VL results in least PKDL and VLR among all existing and recommended by WHO treatment regimens for VL. We recommend adaptation of MDAMB in the national visceral leishmaniasis elimination program for VL cases management during subsequent phases of the national program when VL burden is low and hospitalization of VL patients for 3-5-days is now feasible.
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Affiliation(s)
- Dinesh Mondal
- Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
- * E-mail:
| | | | | | - Moshtaq Mural Ahmed
- Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Md. Golam Hasnain
- Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Abdul Alim
- Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - M. Mamun Huda
- Nutrition and Clinical Services Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), 63 Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
| | - Ridwanur Rahman
- Department of Medicine, Shaheed Suhrawardy Medical College, Sher-E-Bangla Nagar, Dhaka, Bangladesh & Universal Medical College Research Centre, Mohakhali, Dhaka, Bangldesh
| | - Jorge Alvar
- Drugs for Neglected Diseases initiative, Chemin Louis-Dunant, Geneva, Switzerland
| | - Be-Nazir Ahmed
- Disease Control Unit, Directorate General of Health Services, Ministry of Health and Family Welfare of Bangladesh, Mohakhali, Dhaka, Bangladesh
| | - Rashidul Haque
- Infectious Disease Division, International Centre For Diarrhoeal Disease Research, Bangladesh (icddr,b), Shaheed Taj Uddin Ahmed Sarani, Mohakhali, Dhaka, Bangladesh
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Den Boer M, Burza S. Reply to Shamim Islam. Clin Infect Dis 2019; 69:190. [DOI: 10.1093/cid/ciy1034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Pijpers J, den Boer ML, Essink DR, Ritmeijer K. The safety and efficacy of miltefosine in the long-term treatment of post-kala-azar dermal leishmaniasis in South Asia - A review and meta-analysis. PLoS Negl Trop Dis 2019; 13:e0007173. [PMID: 30742620 PMCID: PMC6386412 DOI: 10.1371/journal.pntd.0007173] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 02/22/2019] [Accepted: 01/20/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Miltefosine (MF) is the only oral drug available for treatment of visceral leishmaniasis (VL) and post-kala-azar dermal leishmaniasis (PKDL). Although the drug is effective and well tolerated in treatment of VL, the efficacy and safety of MF for longer treatment durations (>28 days) in PKDL remains unclear. This study provides an overview of the current knowledge about safety and efficacy of long treatment courses with MF in PKDL, as a strategy in the VL elimination in South Asia. METHODOLOGY/PRINCIPAL FINDINGS Literature was searched systematically for articles investigating MF treatment in PKDL. A meta-analysis included eight studies (total 324 PKDL patients) to estimate the efficacy of MF in longer treatment regimens (range 6-16 weeks). We found a per-protocol (PP) initial cure rate of 95.2% (95%CI 89.6-100.8) and a PP definite cure rate of 90% (95%CI 81.6-96.3). Descriptive analysis showed that 20% of patients experienced adverse events, which mostly had an onset in the first week of treatment and were likely to get more severe after four weeks of treatment. Gastrointestinal (GI) side effects such as vomiting, nausea, diarrhoea, and abdominal pain were most common. CONCLUSIONS/SIGNIFICANCE Longer treatment regimens with MF are effective in PKDL patients in India, however with the caveat that the efficacy has recently been observed to decline. GI side effects are frequent, although mostly mild or moderate. However, on the basis of limited data, we cannot conclude that longer MF treatment regimens are safe. Moreover, VL and PKDL pharmacovigilance studies indicate a risk for serious adverse events, questioning the safety of MF. The provision of safer treatment regimens for PKDL patients are therefore recommended. Until these regimens are identified, it should be considered to halt the use of MF monotherapy for PKDL in order to preserve the drug's efficacy.
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Affiliation(s)
- Joyce Pijpers
- Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | | | - Dirk R. Essink
- Athena Institute, VU University Amsterdam, Amsterdam, The Netherlands
| | - Koert Ritmeijer
- Public Health Department, Médecins Sans Frontières, Amsterdam, The Netherlands
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