1
|
Yurdakul F, Bodur H, Cengiz AK, Durmaz Y, Duruöz MT, Kaya T, Ketenci S, Cüzdan N, Güler T, Günendi Z, Sarıkaya S, Çapkın E, Önder ME, Alkan Melikoğlu M, Güzel R, Şen N, Bora Ayna A, Akgül Ö, Eser E, Ataman Ş. Pandemic of the century: COVID-19 in inflammatory rheumatic diseases of a national cohort with 3,532 patients. Arch Rheumatol 2024; 39:203-212. [PMID: 38933732 PMCID: PMC11196221 DOI: 10.46497/archrheumatol.2024.10313] [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: 04/29/2023] [Accepted: 07/24/2023] [Indexed: 06/28/2024] Open
Abstract
Objectives This study aimed to assess the clinical outcomes and risk factors for severe coronavirus disease 2019 (COVID-19) in patients with inflammatory rheumatic disease (IRD) of a national cohort. Patients and methods The multicenter cross-sectional study was carried out between July 15, 2020, and February 28, 2021. Data collection was provided from a national network database system, and 3,532 IRD patients (2,359 males, 1,173 females; mean age: 48.7±13.9 years; range; 18 to 90 years) were analyzed. Demographics, clinics about rheumatic disease, comorbidities, smoking status, being infected with COVID-19, and the course of the infection were questioned by rheumatology specialists. Results One hundred seventeen patients were infected with COVID-19, the hospitalization rate due to COVID-19 was 58.9%, and the mortality rate was 1.7%. There was no difference between the COVID-19 positive and negative groups in terms of rheumatic disease activities and receiving drugs. It was observed that patients with COVID-19 had worse compliance with isolation rules, and bacillus Calmette-Guérin (BCG) vaccination was less common. The mean age and the rate of smoking of hospitalized COVID-19 patients were higher than those without hospitalization. Conclusion In this cohort, in which real-life data were analyzed, COVID-19 rates in IRD patients were similar to the general population for the same period. Compliance with the isolation rules and BCG vaccination attracted attention as components that reduce the risk of COVID-19 infection. The risk factors for hospitalization were older age and smoking.
Collapse
Affiliation(s)
- Fatma Yurdakul
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Hatice Bodur
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Yıldırım Beyazıt University, Ministry of Health Ankara City Hospital, Ankara, Türkiye
| | - Ahmet Kıvanç Cengiz
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Ondokuz Mayıs University, Samsun, Türkiye
| | - Yunus Durmaz
- Rheumatology Clinic, Karabük Training and Research Hospital, Karabük, Türkiye
| | - Mehmet Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Marmara University, Istanbul, Türkiye
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Türkiye
| | - Sertaç Ketenci
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Ondokuz Mayıs University, Samsun, Türkiye
| | - Nihan Cüzdan
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Hatay Mustafa Kemal University, Hatay, Türkiye
| | - Tuba Güler
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Ankara City Hospital, Ankara, Türkiye
| | - Zafer Günendi
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Gazi University, Ankara, Türkiye
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Bülent Ecevit Üniversitesi, Zonguldak, Türkiye
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Karadeniz Technical University, Trabzon, Türkiye
| | - Mustafa Erkut Önder
- Department of Rheumatology, Aksaray University Training and Research Hospital, Aksaray, Türkiye
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Atatürk University, Erzurum, Türkiye
| | - Rengin Güzel
- Department of Physical Medicine and Rehabilitation, Medicine Faculty of Çukurova University, Adana, Türkiye
| | - Nesrin Şen
- Rheumatology Clinic, Kartal Dr. Lütfi Kırdar Training and Research Hospital, Istanbul, Türkiye
| | - Ata Bora Ayna
- Rheumatology Clinic, Çekirge State Hospital, Bursa, Türkiye
| | - Özgür Akgül
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Manisa Celal Bayar University, Manisa, Türkiye
| | - Erhan Eser
- Department of Public Health, Medicine Faculty of Manisa Celal Bayar University, Manisa, Türkiye
| | - Şebnem Ataman
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Medicine Faculty of Ankara University, Ankara, Türkiye
| |
Collapse
|
2
|
Striani G, Hoxha A, Lorenzin M, Cozzi G, Scagnellato L, Vangelista T, Frizzera F, De Sandre P, Simioni P, Doria A, Ramonda R. The impact of SARS-CoV-2 infection and vaccination on inflammatory arthritis: a cohort study. Front Immunol 2023; 14:1207015. [PMID: 37564642 PMCID: PMC10410443 DOI: 10.3389/fimmu.2023.1207015] [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: 04/17/2023] [Accepted: 07/03/2023] [Indexed: 08/12/2023] Open
Abstract
Objectives To investigate the effects of SARS-CoV-2 infection, as well as short- (within 48 hours) and long-term (within 30 days) adverse events (AEs) of SARS-CoV-2 vaccines, including arthritis flares in a large cohort of patients with inflammatory arthritis (IA). Methods A retrospective cohort study comprising 362 patients: 94 (26%) rheumatoid arthritis, 158 (43.6%) psoriatic arthritis and 110 (30.4%) ankylosing spondylitis; and 165 healthy controls (HC) to ascertain the prevalence and severity of SARS-CoV-2 infection in patients with IA, the rate of AEs associated with SARS-CoV-2 vaccines and disease flares within a month of the vaccination. All patients provided informed consent and data about SARS-CoV-2 infection and/or vaccination status. Results One-hundred-seventeen (32.3%) patients and 39 (23.6%) HC were affected by SARS-CoV-2 infection. Forty (34.2%) patients experienced an IA flare within one month of infection, of whom 3 (7.5%) needed to switch therapy. The prevalence of SARS-CoV-2 infection, disease severity, and hospitalization rate were not significantly different. At least one shot of SARS-CoV-2 vaccine was administered in 331 (91.4%) patients and 147 (89.1%) HC. Within 48 hours, 102 (30.8%) patients developed vaccine-related AEs; 52 (15.7%) patients with >1 vaccine dose experienced an IA flare-up, of whom 12 (23.1%) needed to switch therapy. Conclusions A significantly higher rate of IA flare was observed among patients who contracted SARS-CoV-2 infection vs. those without infection. Patients with IA experienced flares after SARS-CoV-2 vaccination, though it was not statistically significant.
Collapse
Affiliation(s)
- Giovanni Striani
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Ariela Hoxha
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Mariagrazia Lorenzin
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Giacomo Cozzi
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Laura Scagnellato
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | | | - Francesca Frizzera
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Pierino De Sandre
- Internal Medicine Unit, Department of Medicine, San Bortolo Hospital, Vicenza, Italy
| | - Paolo Simioni
- General Internal Medicine and Thrombotic and Hemorrhagic Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Andrea Doria
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine (DIMED), University of Padua, Padua, Italy
| |
Collapse
|
3
|
Pilati Campos IM, Marques M, Peiter GC, Brandalize APC, dos Santos MB, de Melo FF, Teixeira KN. Temporal pattern of humoral immune response in mild cases of COVID-19. World J Biol Chem 2023; 14:40-51. [PMID: 37034134 PMCID: PMC10080547 DOI: 10.4331/wjbc.v14.i2.40] [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: 08/30/2022] [Revised: 12/08/2022] [Accepted: 02/02/2023] [Indexed: 03/24/2023] Open
Abstract
BACKGROUND Understanding the humoral response pattern of coronavirus disease 2019 (COVID-19) is one of the essential factors to better characterize the immune memory of patients, which allows understanding the temporality of reinfection, provides answers about the efficacy and durability of protection against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and consequently helps in global public health and vaccination strategy. Among the patients who became infected with SARS-CoV-2, the majority who did not progress to death were those who developed the mild COVID-19, so understanding the pattern and temporality of the antibody response of these patients is certainly relevant.
AIM To investigate the temporal pattern of humoral response of specific immunoglobulin G (IgG) in mild cases of COVID-19.
METHODS Blood samples from 191 COVID-19 real-time reverse transcriptase-polymerase chain reaction (RT-qPCR)-positive volunteers from the municipality of Toledo/ Paraná/Brazil, underwent two distinct serological tests, enzyme-linked immunosorbent assay, and detection of anti-nucleocapsid IgG. Blood samples and clinicoepidemiological data of the volunteers were collected between November 2020 and February 2021. All assays were performed in duplicate and the manufacturers' recommendations were strictly followed. The data were statistically analyzed using multiple logistic regression; the variables were selected by applying the P < 0.05 criterion.
RESULTS Serological tests to detect specific IgG were performed on serum samples from volunteers who were diagnosed as being positive by RT-qPCR for COVID-19 or had disease onset in the time interval from less than 1 mo to 7 mo. The time periods when the highest number of participants with detectable IgG was observed were 1, 2 and 3 mo. It was observed that 9.42% of participants no longer had detectable IgG antibodies 1 mo only after being infected with SARS-CoV-2 and 1.57% were also IgG negative at less than 1 mo. At 5 mo, 3.14% of volunteers were IgG negative, and at 6 or 7 mo, 1 volunteer (0.52%) had no detectable IgG. During the period between diagnosis by RT-qPCR/symptoms onset and the date of collection for the study, no statistical significance was observed for any association analyzed. Moreover, considering the age category between 31 and 59 years as the exposed group, the P value was 0.11 for the category 31 to 59 years and 0.32 for the category 60 years or older, showing that in both age categories there was no association between the pair of variables analyzed. Regarding chronic disease, the exposure group consisted of the participants without any comorbidity, so the P value of 0.07 for the category of those with at least one chronic disease showed no association between the two variables.
CONCLUSION A temporal pattern of IgG response was not observed, but it is suggested that immunological memory is weak and there is no association between IgG production and age or chronic disease in mild COVID-19.
Collapse
Affiliation(s)
| | - Milena Marques
- Campus Toledo, Universidade Federal do Paraná, Toledo 85.919-899, Paraná, Brazil
| | | | | | | | - Fabrício Freire de Melo
- Campus Anísio Teixeira, Universidade Federal da Bahia, Vitória da Conquista 45029-094, Bahia, Brazil
| | | |
Collapse
|
4
|
Mihic N, Abascal J, Chicharro JL, Segura F, Huurman S, de Aysa BN, Bouza E, Bouza E. Impact and control of the COVID pandemic in an elite sports club: Real Madrid. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:59-64. [PMID: 36336951 PMCID: PMC9910681 DOI: 10.37201/req/072.2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The incidence and risk factors for poor outcome in patients with COVID are well known, as are the protective measures in high-risk populations. In contrast, the epidemiological and clinical behavior of this disease in the population of elite athletes who are the paradigm of good health is poorly understood. Data on COVID in athletes are scarce and have focused preferentially on the consequences on sports performance of confinement measures and on the pathophysiological risks of infected athletes. Real Madrid is a large elite sports institution with facilities in the City of Madrid where 600 athletes train daily. The incidence of COVID during a study period of 671 days of observation in athletes, professional or amateur, working in the institution has been 0,74 per 1,000 days of exposure. The disease has been asymptomatic or oligosymptomatic in all athletes and did not require any hospital admissions. The different teams did not have to suspend any of its sportive commitments for COVID during the study period and there was no evidence of outbreaks of internal transmission between members of the different teams.
Collapse
Affiliation(s)
- Niko Mihic
- Director Medical Services. Real Madrid C.F. Madrid. Spain
| | | | | | | | | | | | - Emilio Bouza
- Eméritus Professor of Medicine. Universidad Complutense. Department of Clinical Microbiology and Infectious Diseases. Hospital General Universitario Gregorio Marañón, Department of Medicine. Universidad Complutense, CIBERES. Ciber de Enfermedades Respiratorias. Madrid. Spain,Correspondence: Prof. Emilio Bouza. MD, PhD, Servicio de Microbiología y E. Infecciosas Hospital General Universitario, Gregorio Marañón Dr. Esquerdo 46, - 28007. Madrid. Spain E mail:
| | | |
Collapse
|
5
|
Roseti L, Grigolo B. COVID-19 and rheumatic diseases: A mini-review. Front Med (Lausanne) 2022; 9:997876. [PMID: 36226148 PMCID: PMC9548696 DOI: 10.3389/fmed.2022.997876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 09/12/2022] [Indexed: 11/13/2022] Open
Abstract
Joint pain and arthralgia can be manifestations of COVID-19, and studies evaluating long COVID symptoms identified the persistence of these disorders. Moreover, some case reports highlighted the development of new inflammatory arthritis in patients with COVID-19, suggesting a possible relation. Viral infections and rheumatic diseases share a documented relationship; they have been associated with genetic and environmental risk factors responsible for some of them. There is crosstalk between viruses and the immune system during the development of several rheumatic diseases. Moreover, infections may participate in the pathogenesis of autoimmune rheumatic diseases and contribute to patient mortality. Therefore, it is crucial to provide a clearer insight into the interaction between viral infections and rheumatic diseases. Here, we provide a mini-review of the current literature with the aim of shedding light on the relationship between COVID-19 and rheumatic or musculoskeletal diseases, which is still unclear. Specifically, we examined several aspects: risk for the rheumatic population of acquiring the virus or developing severe symptoms, similarities of COVID-19 and arthritis, the possible rheumatic consequence of COVID-19, of rheumatic drugs and vaccines, and COVID-19 prevention in rheumatic patients through vaccination.
Collapse
|
6
|
Safety of Biologic-DMARDs in Rheumatic Musculoskeletal Disorders: A Population-Based Study over the First Two Waves of COVID-19 Outbreak. Viruses 2022; 14:v14071462. [PMID: 35891442 PMCID: PMC9316145 DOI: 10.3390/v14071462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/26/2022] [Accepted: 06/27/2022] [Indexed: 12/24/2022] Open
Abstract
This study aims to explore disease patterns of coronavirus disease (COVID-19) in patients with rheumatic musculoskeletal disorders (RMD) treated with immunosuppressive drugs in comparison with the general population. The observational study considered a cohort of RMD patients treated with biologic drugs or small molecules from September 2019 to November 2020 in the province of Udine, Italy. Data include the assessment of both pandemic waves until the start of the vaccination, between February 2020 and April 2020 (first), and between September 2020 and November 2020 (second). COVID-19 prevalence in 1051 patients was 3.5% without significant differences compared to the general population, and the course of infection was generally benign with 2.6% mortality. A small percentage of COVID-19 positive subjects were treated with low doses of steroids (8%). The most used treatments were represented by anti-TNF agents (65%) and anti-IL17/23 agents (16%). More than two-thirds of patients reported fever, while gastro-intestinal symptoms were recorded in 27% of patients and this clinical involvement was associated with longer swab positivity. The prevalence of COVID-19 in RMD patients has been confirmed as low in both waves. The benign course of COVID-19 in our patients may be linked to the very low number of chronic corticosteroids used and the possible protective effect of anti-TNF agents, which were the main class of biologics herein employed. Gastro-intestinal symptoms might be a predictor of viral persistence in immunosuppressed patients. This finding could be useful to identify earlier COVID-19 carriers with uncommon symptoms, eventually eligible for antiviral drugs.
Collapse
|
7
|
Wang F, Ma Y, Xu S, Liu H, Chen Y, Yang H, Shao M, Xu W, Kong J, Chen L, Xu S, Shuai Z, Pan F. Prevalence and risk of COVID-19 in patients with rheumatic diseases: a systematic review and meta-analysis. Clin Rheumatol 2022; 41:2213-2223. [PMID: 35352217 PMCID: PMC8964246 DOI: 10.1007/s10067-022-06087-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/03/2022] [Accepted: 01/29/2022] [Indexed: 02/06/2023]
Abstract
Objectives COVID-19 pandemic has already had a tremendous impact on the process of human society; the survival of mankind and the healthy living environment deterioration with the influence will last for many years. This meta-analysis aims to assess the risk of COVID-19 in patients with rheumatic diseases. Methods PubMed, Web of Science, Embase, China National Knowledge Infrastructure (CNKI), and Chinese Biomedical Database (CBM) were systematically searched with no language restriction up to July 5, 2021. The pooled rates were synthesized by fixed effect model or random effect model depending on heterogeneity. Results A total of 83 articles were included in this meta-analysis. The incidence of COVID-19 in patient with rheumatic diseases was 0.0190 (95% CI: 0.0136-0.0252), and the hospitalization rate, intensive care unit admission rate, mechanical ventilation rate, and case fatality rate of patients with rheumatic diseases infected with COVID-19 were 0.4396 (95% CI: 0.3899-0.4898), 0.0635 (95% CI: 0.0453-0.0836), 0.0461 (95% CI: 0.0330-0.0609), and 0.0346 (95% CI: 0.0218-0.0493), respectively. Conclusions Our research shows that patients with rheumatic diseases have great risk of COVID-19. Differences in COVID-19 incidence, hospitalization rates, and mortality rates in regions were statistically significant. We still need to pay attention to the risk of COVID-19 in patients with rheumatic diseases. Key Points • Although the risk of COVID-19 in patients with rheumatic diseases has been discussed in previous meta-analysis, their research directions were inconsistent, and few studies focus on prevalence or serious outcomes of COVID-19 in patient with rheumatic diseases, while the quality of these articles was variable. • The incidence of COVID-19 and serious clinical outcomes in patients with rheumatic diseases were still high along with differential risks in most regions. • The use of glucocorticoids and conventional synthetic disease-modifying antirheumatic drugs did not affect the hospitalization rate and mortality in rheumatism patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s10067-022-06087-1.
Collapse
Affiliation(s)
- Feier Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Huanhuan Liu
- Department of Clinical Laboratory, the Second Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Yuting Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Hui Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Ming Shao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Wei Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Jiangping Kong
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China
| | - Liwen Chen
- Department of Clinical Laboratory, the Second Hospital of Anhui Medical University, 678 Furong Road, Hefei, Anhui, China
| | - Shengqian Xu
- Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Zongwen Shuai
- Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University, Hefei, 230022, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China. .,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui, China.
| |
Collapse
|
8
|
Affiliation(s)
- Salvatore Pepe
- Heart, Lung and Circulation, Sydney, NSW, Australia; Murdoch Children's Research Institute, Heart Research and Department of Paediatrics, University of Melbourne, Royal Children's Hospital Melbourne, Melbourne, Vic, Australia
| | | | - A Robert Denniss
- Heart, Lung and Circulation, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, and University of Sydney, Sydney, NSW, Australia; Department of Cardiology, Blacktown Hospital, and Western Sydney University, Sydney, NSW, Australia.
| |
Collapse
|