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Takashima K, Iwasa M, Ando W, Uemura K, Hamada H, Mae H, Maeda Y, Sugano N. Magnetic resonance imaging screening for osteonecrosis of the femoral head after coronavirus disease 2019. Mod Rheumatol 2024; 34:813-819. [PMID: 37804206 DOI: 10.1093/mr/road095] [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: 07/05/2023] [Revised: 09/25/2023] [Accepted: 09/27/2023] [Indexed: 10/09/2023]
Abstract
OBJECTIVES Systemic steroid administration has been suggested for the treatment of coronavirus disease 2019 (COVID-19), but the occurrence of osteonecrosis of the femoral head (ONFH) was one of the concerns for this treatment. This study aimed to use magnetic resonance imaging (MRI) to assess the incidence of ONFH after the treatment for COVID-19. METHODS The study included 41 patients who were hospitalized and treated for pneumonia or other COVID-19-induced diseases. We conducted interviews with these patients regarding hip pain and performed MRI screenings for ONFH. The incidence and timing of ONFH after COVID-19 treatment were investigated. RESULTS Of the 41 patients, one died of pneumonia and the remaining patients did not complain of hip pain. MRI screening was performed for 26 patients, and asymptomatic ONFH was detected in one patient (3.8%) whose ONFH appeared 1 month after the COVID-19 infection. CONCLUSIONS Our MRI screening of ONFH in post-COVID-19 patients revealed asymptomatic ONFH, which would not have been identified without active screening. Physicians should be aware that ONFH may occur in patients after treating COVID-19.
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Affiliation(s)
- Kazuma Takashima
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Makoto Iwasa
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Wataru Ando
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
- Department of Orthopaedic Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Keisuke Uemura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Hamada
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hirokazu Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yuki Maeda
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Sugano
- Department of Orthopaedic Medical Engineering, Osaka University Graduate School of Medicine, Osaka, Japan
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2
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Hassan AAA, Khalifa AA. Femoral head avascular necrosis in COVID-19 survivors: a systematic review. Rheumatol Int 2023; 43:1583-1595. [PMID: 37338665 PMCID: PMC10348993 DOI: 10.1007/s00296-023-05373-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Accepted: 06/13/2023] [Indexed: 06/21/2023]
Abstract
The current systematic review aimed to document published cases of femoral head avascular necrosis (FHAVN) post-COVID-19, to report the COVID-19 disease characteristics and management patients received, and to evaluate how the FHAVN were diagnosed and treated among various reports. A systematic literature review was performed per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines through a comprehensive English literature search on January 2023 through four databases (Embase, PubMed, Cochrane Library, and Scopus), including studies reporting on FHAVN post-COVID-19. Fourteen articles were included, ten (71.4%) were case reports, and four (28.6%) case series reported on 104 patients having a mean age of 42.2 ± 11.7 (14:74) years, in which 182 hip joints were affected. In 13 reports, corticosteroids were used during the COVID-19 management plan for a mean of 24.8 ± 11 (7:42) days, with a mean prednisolone equivalent dose of 1238.5 ± 492.8 (100:3520) mg. A mean of 142.1 ± 107.6 (7:459) days passed between COVID-19 diagnosis and FHAVN detection, and most of the hips were stage II (70.1%), and concomitant septic arthritis was present in eight (4.4%) hips. Most hips (147, 80.8%) were treated non-surgically, of which 143 (78.6%) hips received medical treatment, while 35 (19.2%) hips were surgically managed, 16 (8.8%) core decompression, 13 (7.1%) primary THA, five (2.7%) staged THA and three (1.6%) had first stage THA (debridement and application of antibiotic-loaded cement spacer). The outcomes were acceptable as regards hip function and pain relief. Femoral head avascular necrosis post-COVID-19 infection is a real concern, primarily attributed to corticosteroid usage, besides other factors. Early suspicion and detection are mandatory, as conservative management lines are effective during early stages with acceptable outcomes. However, surgical intervention was required for progressive collapse or patients presented in the late stage.
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Affiliation(s)
| | - Ahmed A. Khalifa
- Orthopedic Department, Qena Faculty of Medicine, South Valley University, Kilo 6 Qena-Safaga Highway, Qena, Egypt
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3
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Bialik VE, Karateev AE, Bialik EI, Makarov MA, Makarov SA, Roskidailo AA, Nesterenko VA, Lila AM, Malygina MA. Avascular necrosis of the epiphyses of bones in patients who have had SARS-CoV-2 infection: Clinical observations and a narrative review of literature data. RHEUMATOLOGY SCIENCE AND PRACTICE 2022. [DOI: 10.47360/1995-4484-2022-535-545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The SARS-CoV-2 coronavirus pandemic is a leading medical problem that is in the focus of attention of representatives of all medical specialties. In addition to fighting the COVID-19 infection itself, the task of preventing and treating a wide range of complications arising after the disease is becoming increasingly urgent. One of these complications is avascular necrosis (AN) of bone tissue – a severe pathology that leads to serious suffering, a decrease in the quality of life and disability of patients. For the period from 2020 to 2022 there are 9 reviews in the world literature devoted to the pathogenesis, clinical features and treatment possibilities of this complication. During the same period, 5 articles were published describing clinical observations of AN after suffering COVID-19.The purpose of this work is to demonstrate our own clinical observations, as well as to review the available literature data on the problem of AN after COVID-19 infection. Based on the analysis, it can be concluded that AN after SARS-CoV-2 infection most often develops in the femoral head (>50% of cases), occurs regardless of the severity of the disease and the cumulative dose of glucocorticoids used in the acute period of the disease. It seems advisable to perform an MRI of the hip joints at least once every 3 months for all patients who have had COVID-19 in severe and moderate form during the first year after convalescence.
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Affiliation(s)
- V. E. Bialik
- V.A. Nasonova Research Institute of Rheumatology
| | | | - E. I. Bialik
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | | | | | | | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology; Russian Medical Academy of Continuous Professional Education of the Ministry of Healthcare of the Russian Federation
| | - M. A. Malygina
- N.V. Sklifosovskiy Research Institute for Emergency Medicine
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4
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Dar-Odeh N, Bobamuratova DT, Alnazzawi A, Babkair H, Jambi S, Abu-Hammad A, Abu-Hammad O. Jaw-related complications in COVID-19 patients; a systematic review. Cranio 2022:1-8. [PMID: 35083956 DOI: 10.1080/08869634.2022.2031438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The aim of this review was to highlight jaw-related complications in COVID-19 manifestations, their etiology, and prevention methods. METHODS A systematic review of literature was conducted. MEDLINE/PubMed, and Google Scholar were searched for the following keywords: "COVID-19" "Oral manifestations", "Musculoskeletal patients", "Mandible", "Jaw", "Osteonecrosis", "MRONJ", and "dry socket". RESULTS Only nine articles were included in this review. Jaw-related disorders associated with COVID-19 were dry socket, osteonecrosis, and orofacial pain related to temporomandibular joint disorders (TMD) and giant cell arteritis (GCA). CONCLUSION COVID-19 potentially predisposes to osteonecrosis due to thrombotic inflammatory phenomena caused by the disease itself or its therapeutic modalities. All jaw osteonecrosis cases reported so far in relation to COVID-19 affected the upper jaw. Orofacial pain in COVID-19 patients was related to TMD and GCA. Clinical evidence-based studies are required to investigate the actual prevalence and possible correlation between COVID-19 and jaw-related disorders.
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Affiliation(s)
- Najla Dar-Odeh
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
| | | | - Ahmad Alnazzawi
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Hamzah Babkair
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | - Safa Jambi
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
| | | | - Osama Abu-Hammad
- College of Dentistry, Taibah University, Al Madinah Al Munawara, Saudi Arabia
- School of Dentistry, University of Jordan, Amman, Jordan
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5
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[Aseptic osteonecrosis of the medial femoral condyle in a patient with acute SARS-CoV-2 infection]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:664-666. [PMID: 34586423 PMCID: PMC8479260 DOI: 10.1007/s00113-021-01082-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 08/12/2021] [Indexed: 02/07/2023]
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6
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Krez A, Lane J, Heilbronner A, Park-Min KH, Kaneko K, Pannellini T, Mintz D, Hansen D, McMahon DJ, Kirou KA, Roboz G, Desai P, Bockman RS, Stein EM. Risk factors for multi-joint disease in patients with glucocorticoid-induced osteonecrosis. Osteoporos Int 2021; 32:2095-2103. [PMID: 33877383 PMCID: PMC8056829 DOI: 10.1007/s00198-021-05947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 04/01/2021] [Indexed: 12/24/2022]
Abstract
UNLABELLED This study investigated risk factors for osteonecrosis involving multiple joints (MJON) among glucocorticoid-treated patients. The best predictor of MJON was cumulative oral glucocorticoid dose. Risk of MJON was 12-fold higher in patients who had a second risk factor for osteonecrosis. Further research is needed into strategies for prevention of MJON. INTRODUCTION Osteonecrosis (ON) is a debilitating musculoskeletal condition in which bone cell death can lead to mechanical failure. When multiple joints are affected, pain and disability are compounded. Glucocorticoid treatment is one of the most common predisposing factors for ON. This study investigated risk factors for ON involving multiple joints (MJON) among glucocorticoid-treated patients. METHODS Fifty-five adults with glucocorticoid-induced ON were prospectively enrolled. MJON was defined as ON in ≥ three joints. Route, dose, duration, and timing of glucocorticoid treatment were assessed. RESULTS Mean age of enrolled subjects was 44 years, 58% were women. Half had underlying conditions associated with increased ON risk: systemic lupus erythematosus (29%), acute lymphoblastic leukemia (11%), HIV (9%), and alcohol use (4%). Mean daily oral dose of glucocorticoids was 29 mg. Average cumulative oral dose was 30 g over 5 years. The best predictor of MJON was cumulative oral glucocorticoid dose. For each increase of 1,000 mg, risk of MJON increased by 3.2% (95% CI 1.03, 1.67). Glucocorticoid exposure in the first 6 months of therapy, peak dose (oral or IV), and mean daily dose did not independently increase risk of MJON. The risk of MJON was 12-fold in patients who had a second risk factor (95% CI 3.2, 44.4). CONCLUSIONS Among patients with glucocorticoid-induced ON, cumulative oral dose was the best predictor of multi-joint disease; initial doses of IV and oral glucocorticoids did not independently increase risk. Further research is needed to better define optimal strategies for prevention and treatment of MJON.
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Affiliation(s)
- A Krez
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - J Lane
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - A Heilbronner
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K-H Park-Min
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - K Kaneko
- Arthritis and Tissue Degeneration Program, David Z. Rosensweig Genomic Research Center, Hospital for Special Surgery, New York, NY, USA
| | - T Pannellini
- Research Division, Hospital for Special Surgery, New York, NY, USA
| | - D Mintz
- Department of Radiology and Imaging, Hospital for Special Surgery, New York, NY, USA
| | - D Hansen
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - D J McMahon
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - K A Kirou
- Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
| | - G Roboz
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - P Desai
- Department of Hematology and Oncology, Weill Cornell Medical Center, New York, NY, USA
| | - R S Bockman
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA
| | - E M Stein
- Endocrinology Service, Hospital for Special Surgery, 535 East 70th Street, New York, NY, USA.
- Metabolic Bone Disease Service, Hospital for Special Surgery, New York, NY, 10021, USA.
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Abstract
BACKGROUND COVID-19 is an emergent infection, the long-term complications of which are still under study. While hypercoagulability is a common feature in severe cases, the incidence of ischemic complications such as osteonecrosis remains unknown. Previous studies on SARS-CoV1 found an increase in osteonecrosis 3-36 months after infection, and it is still unclear if this was related to the use of corticosteroids or to the virus itself. METHODS We introduce a 78-year-old woman who complained of right knee pain and swelling a month after COVID-19 infection onset. Her knee radiography showed no significant changes compared to previous ones. MRI, on the other hand, found osteonecrosis in the internal femoral condyle. No coagulation abnormalities were found in blood tests. RESULTS While knee replacement should be her main treatment, it will be long delayed due to the pandemic. In the meantime, we increased her tapentadol and salicylic acid doses and gave her home exercises to improve functionality. CONCLUSION In the follow-up after COVID-19, any muscular or joint pain with unusual characteristics should be carefully examined.
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Gutman MJ, Patel MS, Vannello C, Lazarus MD, Parvizi J, Vaccaro AR, Namdari S. What was the Prevalence of COVID-19 in Asymptomatic Patients Undergoing Orthopaedic Surgery in One Large United States City Mid-pandemic? Clin Orthop Relat Res 2021; 479:1691-1699. [PMID: 33720056 PMCID: PMC8277266 DOI: 10.1097/corr.0000000000001697] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 02/03/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Many patients with coronavirus disease 2019 (COVID-19) are asymptomatic. The prevalence of COVID-19 in orthopaedic populations will vary depending on the time and place where the sampling is performed. The idea that asymptomatic carriers play a role is generalizable but has not been studied in large populations of patients undergoing elective orthopaedic surgery. We therefore evaluated this topic in one large, metropolitan city in a state that had the ninth-most infections in the United States at the time this study was completed (June 2020). This work was based on a screening and testing protocol that required all patients to be tested for COVID-19 preoperatively. QUESTIONS/PURPOSES (1) What is the prevalence of asymptomatic COVID-19 infection in patients planning to undergo orthopaedic surgery in one major city, in order to provide other surgeons with a framework for assessing COVID-19 rates in their healthcare system? (2) How did patients with positive test results for COVID-19 differ in terms of age, sex, and orthopaedic conditions? (3) What proportion of patients had complications treated, and how many patients had a symptomatic COVID-19 infection within 30 days of surgery (recognizing that some may have been missed and so our estimates of event rates will necessarily underestimate the frequency of this event)? METHODS All adult patients scheduled for surgery at four facilities (two tertiary care hospitals, one orthopaedic specialty hospital, and one ambulatory surgery center) at a single institution in the Philadelphia metropolitan area from April 27, 2020 to June 12, 2020 were included in this study. A total of 1295 patients were screened for symptoms, exposure, temperature, and oxygen saturation via a standardized protocol before surgical scheduling; 1.5% (19 of 1295) were excluded because they had COVID-19 symptoms, exposure, or recent travel based on the initial screening questionnaire, leaving 98.5% (1276 of 1295) who underwent testing for COVID-19 preoperatively. All 1276 patients who passed the initial screening test underwent nasopharyngeal swabbing for COVID-19 via reverse transcription polymerase chain reaction before surgery. The mean age at the time of testing was 56 ± 16 years, and 53% (672 of 1276) were men. Eighty-seven percent (1106), 8% (103), and 5% (67) were tested via the Roche, Abbott, and Cepheid assays, respectively. All patients undergoing elective surgery were tested via the Roche assay, while those undergoing nonelective surgery received either the Abbott or Cepheid assay, based on availability. Patients with positive test results undergoing elective surgery had their procedures rescheduled, while patients scheduled for nonelective surgery underwent surgery regardless of their test results. Additionally, we reviewed the records of all patients at 30 days postoperatively for emergency room visits, readmissions, and COVID-19-related complications via electronic medical records and surgeon-reported complications. However, we had no method for definitively determining how many patients had complications, emergency department visits, or readmissions outside our system, so our event rate estimates for these endpoints are necessarily best-case estimates. RESULTS A total of 0.5% (7 of 1276) of the patients tested positive for COVID-19: five via the Roche assay and two via the Abbott assay. Patients with positive test results were younger than those with negative results (39 ± 12 years versus 56 ± 16 years; p = 0.01). With the numbers available, we found no difference in the proportion of patients with positive test results for COVID-19 based on subspecialty area (examining the lowest and highest point estimates, respectively, we observed: trauma surgery [3%; 2 of 68 patients] versus hip and knee [0.3%; 1 of 401 patients], OR 12 [95% CI 1-135]; p = 0.06). No patients with negative preoperative test results for COVID-19 developed a symptomatic COVID-19 infection within 30 days postoperatively. Within 30 days of surgery, 0.9% (11 of 1276) of the patients presented to the emergency room, and 1.3% (16 of 1276) were readmitted for non-COVID-19-related complications. None of the patients with positive test results for COVID-19 preoperatively experienced complications. However, because some were likely treated outside our healthcare system, the actual percentages may be higher. CONCLUSION Because younger patients are more likely to be asymptomatic carriers of disease, surgeons should emphasize the importance of taking proper precautions to prevent virus exposure preoperatively. Because the rates of COVID-19 infection differ based on city and time, surgeons should monitor the local prevalence of disease to properly advise patients on the risk of COVID-19 exposure. Further investigation is required to assess the prevalence in the orthopaedic population in cities with larger COVID-19 burdens. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Michael J. Gutman
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Manan S. Patel
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Mark D. Lazarus
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Javad Parvizi
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Surena Namdari
- Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Korompoki E, Gavriatopoulou M, Hicklen RS, Ntanasis-Stathopoulos I, Kastritis E, Fotiou D, Stamatelopoulos K, Terpos E, Kotanidou A, Hagberg CA, Dimopoulos MA, Kontoyiannis DP. Epidemiology and organ specific sequelae of post-acute COVID19: A narrative review. J Infect 2021; 83:1-16. [PMID: 33992686 PMCID: PMC8118709 DOI: 10.1016/j.jinf.2021.05.004] [Citation(s) in RCA: 93] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 02/07/2023]
Abstract
Objectives “Long COVID”, a term coined by COVID-19 survivors, describes persistent or new symptoms in a subset of patients who have recovered from acute illness. Globally, the population of people infected with SARS-CoV-2 continues to expand rapidly, necessitating the need for a more thorough understanding of the array of potential sequelae of COVID-19. The multisystemic aspects of acute COVID-19 have been the subject of intense investigation, but the long–term complications remain poorly understood. Emerging data from lay press, social media, commentaries, and emerging scientific reports suggest that some COVID-19 survivors experience organ impairment and/or debilitating chronic symptoms, at times protean in nature, which impact their quality of life. Methods/Results In this review, by addressing separately each body system, we describe the pleiotropic manifestations reported post COVID-19, their putative pathophysiology and risk factors, and attempt to offer guidance regarding work-up, follow-up and management strategies. Long term sequelae involve all systems with a negative impact on mental health, well-being and quality of life, while a subset of patients, report debilitating chronic fatigue, with or without other fluctuating or persistent symptoms, such as pain or cognitive dysfunction. Although the pathogenesis is unclear, residual damage from acute infection, persistent immune activation, mental factors, or unmasking of underlying co-morbidities are considered as drivers. Comparing long COVID with other post viral chronic syndromes may help to contextualize the complex somatic and emotional sequalae of acute COVID-19. The pace of recovery of different aspects of the syndrome remains unclear as the pandemic began only a year ago. Conclusions Early recognition of long-term effects and thorough follow-up through dedicated multidisciplinary outpatient clinics with a carefully integrated research agenda are essential for treating COVID-19 survivors holistically.
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Affiliation(s)
- Eleni Korompoki
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece; Divison of Brain Sciences, Imperial College London, London, United Kingdom.
| | - Maria Gavriatopoulou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Rachel S Hicklen
- Research Medical Library, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1460, Houston TX 77030, United States.
| | - Ioannis Ntanasis-Stathopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Efstathios Kastritis
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Despina Fotiou
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Kimon Stamatelopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece
| | - Evangelos Terpos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece.
| | - Anastasia Kotanidou
- Department of Critical Care Medicine and Pulmonary Services, Evangelismos Hospital, National and Kapodistrian University of Athens, Athens 11528, Greece.
| | - Carin A Hagberg
- Division of Anesthesiology, Critical Care and Pain Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
| | - Meletios A Dimopoulos
- Department of Clinical Therapeutics, School of Medicine, National and Kapodistrian University of Athens, Athens 11528, Greece.
| | - Dimitrios P Kontoyiannis
- Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, United States.
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