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Chen Y, Ma Y, Qin J, Wei X, Yang Y, Yuan Y, Yan F, Huo X, Han L. Blood pressure variability predicts poor outcomes in acute stroke patients without thrombolysis: a systematic review and meta-analysis. J Neurol 2024; 271:1160-1169. [PMID: 38036920 DOI: 10.1007/s00415-023-12054-w] [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: 08/06/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Stroke is a significant medical condition, and blood pressure stands out as the most prevalent treatable risk factor associated with it. Researches link blood pressure variability (BPV) with stroke; however, the specific relationship between with the outcomes of stroke patients remains unclear. As blood pressure variability and mean blood pressure are interrelated, it remains uncertain whether BPV adds additional information to understanding the outcome of acute stroke patients. OBJECTIVE To systematically review studies investigating the association between blood pressure variability and prognosis in acute stroke patients. METHODS Embase, PubMed, Web of Science, and the Cochrane Library were searched for English language full-text articles from the inception to 1 January 2023. Stroke patients aged ≥ 18 years were included in this analysis. Stroke types were not restricted. RESULTS This meta-analysis shows that higher systolic blood pressure variability is linked to a higher risk of poor outcome, including function disability, mortality, early neurological deterioration, and stroke recurrence, among acute stroke patients without thrombolysis. A higher diastolic blood pressure variability is linked with to a higher risk of mortality and functional disability. CONCLUSIONS This review reveals that blood pressure variability is a novel and clinically relevant risk factor for stroke patients' outcome. Future studies should investigate how best to measure and define BPV in acute stroke. Larger studies are warranted to provide more robust evidence in this area.
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Affiliation(s)
- Yajing Chen
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yuxia Ma
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- The First Clinical Medical College of Lanzhou University, Lanzhou, 730030, Gansu Province, China.
| | - Jiangxia Qin
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoqin Wei
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yiyi Yang
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Yue Yuan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Fanghong Yan
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China
| | - Xiaoning Huo
- The Third People's Hospital of Lanzhou, No.130 Jianlan New Village, Lanzhou, Gansu Province, China
| | - Lin Han
- Evidence-Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, Gansu Province, China.
- Department of Nursing, Gansu Provincial Hospital, No. 204 Donggang West Road, Lanzhou, Gansu Province, China.
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Kakaletsis N, Ntaios G, Milionis H, Karagiannaki A, Chouvarda I, Dourliou V, Chytas A, Hatzitolios AI, Savopoulos C. Prognostic significance of 24-h blood pressure and variability indices in the outcome of acute ischaemic stroke. Intern Med J 2023; 53:1137-1146. [PMID: 35666577 DOI: 10.1111/imj.15834] [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: 12/08/2021] [Accepted: 05/29/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The association between blood pressure (BP) levels and BP variability (BPV) following acute ischaemic stroke (AIS) and outcome remains controversial. AIMS To investigate the predictive value of systolic BP (SBP) and diastolic BP (DBP) and BPV measured using 24-h ambulatory blood pressure monitoring (ABPM) methods during AIS regarding outcome. METHODS A total of 228 AIS patients (175 without prior disability) underwent ABPM every 20 min within 48 h from onset using an automated oscillometric device (TM 2430, A&D Company Ltd) during day time (7:00-22:59) and night time (23:00-6:59). Risk factors, stroke subtypes, clinical and laboratory findings were recorded. Mean BP parameters and several BPV indices were calculated. End-points were death and unfavourable functional outcome (disability/death) at 3 months. RESULTS A total of 61 (26.7%) patients eventually died. Multivariate logistic regression analysis revealed that only mean night-time DBP (hazard ratio (HR): 1.04; 95% confidence interval (CI): 1.00-1.07) was an independent prognostic factor of death. Of the 175 patients without prior disability, 79 (45.1%) finally met the end-point of unfavourable functional outcome. Mean 24-h SBP (HR: 1.03; 95% CI: 1.00-1.05), day-time SBP (HR: 1.02; 95% CI: 1.00-1.05) and night-time SBP (HR: 1.03; 95% CI: 1.01-1.05), SBP nocturnal decline (HR: 0.93; 95% CI: 0.88-0.99), mean 24-h DBP (HR: 1.08; 95% CI: 1.03-1.13), day-time DBP (HR: 1.07; 95% CI: 1.03-1.12) and night-time DBP (HR: 1.06; 95% CI: 1.02-1.10) were independent prognostic factors of an unfavourable functional outcome. CONCLUSIONS In contrast with BPV indices, ABPM-derived BP levels and lower or absence of BP nocturnal decline in the acute phase are prognostic factors of outcome in AIS patients.
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Affiliation(s)
- Nikolaos Kakaletsis
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - George Ntaios
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Haralampos Milionis
- Department of Internal Medicine, Medical School, University of Ioannina, University Hospital of Ioannina, Ioannina, Greece
| | - Anastasia Karagiannaki
- Department of Internal Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa, Greece
| | - Ioanna Chouvarda
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Dourliou
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Achileas Chytas
- Laboratory of Medical Informatics, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos I Hatzitolios
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
| | - Christos Savopoulos
- First Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, AHEPA University Hospital, Thessaloniki, Greece
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Abiri A, Chou EF, Qian C, Rinehart J, Khine M. Intra-beat biomarker for accurate continuous non-invasive blood pressure monitoring. Sci Rep 2022; 12:16772. [PMID: 36202815 PMCID: PMC9537243 DOI: 10.1038/s41598-022-19096-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
Accurate continuous non-invasive blood pressure (CNIBP) monitoring is the holy grail of digital medicine but remains elusive largely due to significant drifts in signal and motion artifacts that necessitate frequent device recalibration. To address these challenges, we developed a unique approach by creating a novel intra-beat biomarker (Diastolic Transit Time, DTT) to achieve highly accurate blood pressure (BP) estimations. We demonstrated our approach’s superior performance, compared to other common signal processing techniques, in eliminating stochastic baseline wander, while maintaining signal integrity and measurement accuracy, even during significant hemodynamic changes. We applied this new algorithm to BP data collected using non-invasive sensors from a diverse cohort of high acuity patients and demonstrated that we could achieve close agreement with the gold standard invasive arterial line BP measurements, for up to 20 min without recalibration. We established our approach's generalizability by successfully applying it to pulse waveforms obtained from various sensors, including photoplethysmography and capacitive-based pressure sensors. Our algorithm also maintained signal integrity, enabling reliable assessments of BP variability. Moreover, our algorithm demonstrated tolerance to both low- and high-frequency motion artifacts during abrupt hand movements and prolonged periods of walking. Thus, our approach shows promise in constituting a necessary advance and can be applied to a wide range of wearable sensors for CNIBP monitoring in the ambulatory and inpatient settings.
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Affiliation(s)
- Arash Abiri
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - En-Fan Chou
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - Chengyang Qian
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA
| | - Joseph Rinehart
- Department of Anesthesiology & Perioperative Care, University of California, Irvine Medical Center, Orange, CA, USA
| | - Michelle Khine
- Department of Biomedical Engineering, University of California Irvine, Irvine, CA, 92697, USA.
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4
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Flower A, Vasiliu D, Zhu T, Andris R, Abubakar M, Fairchild K, Zanelli S, Matsumoto J, Mathur AM, Delos J, Vesoulis Z. Low Variability of Blood Pressure Predicts Abnormal Electroencephalogram in Infants with Hypoxic Ischemic Encephalopathy. Am J Perinatol 2022; 39:288-297. [PMID: 32819015 PMCID: PMC7895863 DOI: 10.1055/s-0040-1715822] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study aimed to evaluate the role of an objective physiologic biomarker, arterial blood pressure variability, for the early identification of adverse short-term electroencephalogram (EEG) outcomes in infants with hypoxic-ischemic encephalopathy (HIE). STUDY DESIGN In this multicenter observational study, we analyzed blood pressure of infants meeting these criteria: (1) neonatal encephalopathy determined by modified Sarnat exam, (2) continuous mean arterial blood pressure (MABP) data between 18 and 27 hours after birth, and (3) continuous EEG performed for at least 48 hours. Adverse outcome was defined as moderate-severe grade EEG at 48 hours. Standardized signal preprocessing was used; the power spectral density was computed without interpolation. Multivariate binary logistic regression was used to identify which MABP time and frequency domain metrics provided improved predictive power for adverse outcomes compared with standard clinical predictors (5-minute Apgar score and cord pH) using receiver operator characteristic analysis. RESULTS Ninety-one infants met inclusion criteria. The mean gestational age was 38.4 ± 1.8 weeks, the mean birth weight was 3,260 ± 591 g, 52/91 (57%) of infants were males, the mean cord pH was 6.95 ± 0.21, and 10/91 (11%) of infants died. At 48 hours, 58% of infants had normal or mildly abnormal EEG background and 42% had moderate or severe EEG backgrounds. Clinical predictor variables (10-minute Apgar score, Sarnat stage, and cord pH) were modestly predictive of 48 hours EEG outcome with area under curve (AUC) of 0.66 to 0.68. A composite model of clinical and optimal time- and frequency-domain blood pressure variability had a substantially improved AUC of 0.86. CONCLUSION Time- and frequency-domain blood pressure variability biomarkers offer a substantial improvement in prediction of later adverse EEG outcomes over perinatal clinical variables in a two-center cohort of infants with HIE. KEY POINTS · Early outcome prediction in HIE is suboptimal.. · Patterns in blood pressure physiology may be predictive of short-term outcomes.. · Early time- and frequency-domain measures of blood pressure variability predict short-term EEG outcomes in HIE infants better than perinatal factors alone..
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Affiliation(s)
- Abigail Flower
- School of Data Science, University of Virginia, Charlottesville, VA
| | - Daniel Vasiliu
- Department of Mathematics, College of William & Mary, Williamsburg, VA
| | - Tianrui Zhu
- Department of Mathematics, College of William & Mary, Williamsburg, VA
| | - Robert Andris
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Maryam Abubakar
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Karen Fairchild
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Santina Zanelli
- Department of Pediatrics, University of Virginia, Charlottesville, VA
| | - Julie Matsumoto
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA
| | - Amit M. Mathur
- Division of Neonatal-Perinatal Medicine, Saint Louis University, St. Louis, MO
| | - John Delos
- Department of Physics, College of William & Mary, Williamsburg, VA
| | - Zachary Vesoulis
- Department of Pediatrics, Washington University St. Louis, St. Louis, MO
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Wang Y, Liu L, Tao H, Wen L, Qin S. TRPC6 participates in the development of blood pressure variability increase in sino-aortic denervated rats. Heart Vessels 2020; 35:1755-1765. [PMID: 32844288 DOI: 10.1007/s00380-020-01682-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 08/14/2020] [Indexed: 11/25/2022]
Abstract
Increased blood pressure variability (BPV) has been proved to be associated with cardiovascular morbidity and mortality. It is of great significance to elucidate the mechanism of BPV increase. The cation channel transient receptor potential canonical 6 (TRPC6) is involved in a series of cardiovascular disease. Our experiment aimed to explore the role of TRPC6 in the development of BPV increase. Sino-aortic denervation (SAD) operation was applied to establish the model of BPV increase in rats. The BPV was presented as the standard deviation to the mean of systolic or diastolic blood pressure every 1 h during 12 h of the light period. SAD was performed in male Sprague Dawley (SD) rats at the age of 10 weeks. At 8 weeks after SAD operation, the hemodynamic parameters were determined non-invasively via a Rodent Blood Pressure Analysis System. The TRPC6 expressions in myocardial and thoracic aortic tissue was determined utilizing Western Blot, immunofluorescence and quantitative RT-PCR. The expression of TRPC3 was detected as well. To investigate whether TRPC6 was a causative factor of BPV increase in SAD rats, TRPC6 activator and inhibitor with three progressively increasing doses were intraperitoneally injected to the SAD rats. We found that SAD rats presented significant augmentation of systolic and diastolic BPV with no change of BP level and heart rate. The mRNA and protein expression levels of TRPC6 in myocardial and thoracic aortic tissue in SAD rats were substantially increased, but there was no obvious change in TRPC3 expression. The systolic and diastolic BPV increase were dose-dependently exacerbated after TRPC6 activation with GSK1702934A but were dose-dependently attenuated after TRPC6 inhibition with SAR7334. In Conclusion, the TRPC6 (but not TRPC3) expressions in myocardial and thoracic aortic tissue were substantially increased in SAD rats, and TRPC6 probably played an important role in the development of BPV elevation.
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Affiliation(s)
- Yu Wang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Ling Liu
- Department of Anesthesiology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Hongmei Tao
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Li Wen
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China
| | - Shu Qin
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People's Republic of China.
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Saleem Y, Nogueira RG, Rodrigues GM, Kim S, Sharashidze V, Frankel M, Al-Bayati A, Bianchi N, Haussen DC. Acute Neurological Deterioration in Large Vessel Occlusions and Mild Symptoms Managed Medically. Stroke 2020; 51:1428-1434. [DOI: 10.1161/strokeaha.119.027011] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
It is unclear which factors predict acute neurological deterioration in patients with large vessel occlusion and mild symptoms. We aim to evaluate the frequency, timing, and potential predictors of acute neurological deterioration ≥4 National Institutes of Health Stroke Scale (NIHSS) points in medically managed patients with large vessel occlusion and mild presentation.
Methods—
Single-center retrospective study of patients with consecutive minor stroke (defined as NIHSS score of ≤5 on presentation) and large vessel occlusion from January 2014 to December 2017. Primary outcome was acute neurological deterioration ≥4 NIHSS points during the hospitalization. Secondary outcomes included ΔNIHSS (defined as discharge minus admission NIHSS score).
Results—
Among 1133 patients with acute minor strokes, 122 (10.6%) had visible occlusions on computed tomography angiography/magnetic resonance angiography. Twenty-four (19.7%) patients had ≥4 points deterioration on NIHSS at a median of 3.6 (1–16) hours from arrival. No clinical or radiological predictors of acute neurological deterioration ≥4 NIHSS points were observed on multivariable analysis. Rescue endovascular thrombectomy was performed more often in the ones with acute neurological deterioration ≥4 NIHSS points compared with patients with no deterioration (54% versus 0%;
P
<0.001). Acute neurological deterioration ≥4 NIHSS points was associated with ΔNIHSS ≥4 points (33% versus 4.9%;
P
<0.01) and a trend toward lower independence rates at discharge (50% versus 70%;
P
=0.06) compared with the group with no deterioration. In patients with any degree of neurological worsening, patients who underwent rescue thrombectomy were more likely to be independent at discharge (73% versus 38%;
P
=0.02) and to have a favorable ΔNIHSS (−2 [−3 to 0] versus 0 [−1 to 6];
P
=0.05) compared with the ones not offered rescue thrombectomy.
Conclusions—
Acute neurological deterioration ≥4 NIHSS points was observed in a fifth of patients with large vessel occlusion and mild symptoms, occurred very early in the hospital course, impacted functional outcomes, and could not be predicted by any of the studied clinical and radiological variables. Rescue thrombectomy was associated with improved clinical outcomes at discharge in patients with neurological deterioration.
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Affiliation(s)
- Yasir Saleem
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Raul G. Nogueira
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Gabriel M. Rodrigues
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Song Kim
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Vera Sharashidze
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Michael Frankel
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Alhamza Al-Bayati
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Nicolas Bianchi
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
| | - Diogo C. Haussen
- From the Emory University/Grady Memorial Hospital- Marcus Stroke and Neuroscience Center, Atlanta, GA
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Thatikonda N, Khandait V, Shrikhande A, Singh K. Role of 24-Hr Blood Pressure Variability as a Target Therapeutic Risk Factor for Poor Functional Outcome of Acute Ischemic Stroke. Ann Indian Acad Neurol 2020; 23:25-31. [PMID: 32055118 PMCID: PMC7001437 DOI: 10.4103/aian.aian_373_19] [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] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/20/2019] [Accepted: 09/29/2019] [Indexed: 11/23/2022] Open
Abstract
Background and Purpose: The present study aims to evaluate the role of blood pressure variability (BPV) as a target therapeutic risk factor for poor outcome of ischemic stroke by finding the association between the two and by finding the population attributable risk (PAR) of BPV compared to other baseline outcome predictors. Methods: A prospective observational study was carried out at GMCH, Nagpur, India from January to June 2019 in 75 patients diagnosed with acute ischemic stroke. BP was recorded hourly for the first 24 hours of admission and base line factors were collected along with measurement of stroke severity. BPV was measured by index of average real-time variability (ARV) while discharge outcome was measured by Barthel Index. Results: 36.5% of patients had poor outcome at discharge. A significant association was found between 24-hr ARV of systolic BP and poor outcome (P = 0.002, 95% CI = 2.22-23.5). Five factors were found to be independent outcome predictors on multiple logistic regression (OR, 95% CI): age (1.07, 1.03–1.10), NIHSS score (1.12, 1.04–1.27), on admission SBP (5.12, 4.01–16.23), on admission RBS (2.23, 1.92–6.49) and 24 Hr ARV-SBP (9.65, 3.02–20.1). The PAR of 24 hr ARV-SBP was 23.6%, second only to NIHSS score (26.4%). Conclusions: Reduction in BP variability might have a beneficial impact on the outcome of patients with acute ischemic stroke. There is further scope to explore optimum therapeutic strategies to minimize BPV in the management of acute ischemic stroke.
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Affiliation(s)
- Nithisha Thatikonda
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Vinod Khandait
- Department of Medicine, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Aditya Shrikhande
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
| | - Krittika Singh
- Undergraduate Medical Student, Govt. Medical College Nagpur, MUHS, Nagpur, Maharashtra, India
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