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Ghaemi B, Hashemi SJ, Kharrazi S, Moshiri A, Kargar Jahromi H, Amani A. Photodynamic therapy-mediated extirpation of cutaneous resistant dermatophytosis with Ag@ZnO nanoparticles: an efficient therapeutic approach for onychomycosis. Nanomedicine (Lond) 2022; 17:219-236. [PMID: 35118874 DOI: 10.2217/nnm-2021-0138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Aim: The aim of this study was to determine whether photodynamic therapy of resistant onychomycosis with Ag@ZnO nanoparticles can promote the treatment procedure and extirpates the recurrence of fungal infection. Methods: Ag@ZnO nanoparticles (NPs) under UVB-radiation were applied to treat T. rubrum and T. mentagrophytes in vitro through photodynamic therapy. In vivo therapeutic efficacy, biocompatibility and biodistribution of Ag@ZnO NPs were studied. Results: 40 μg/ml of UVB-activated Ag@ZnO NPs showed 100% antifungal activity against dermatophytosis in vitro and in vivo followed by complete growth prevention by degeneration of spores and mycelium after 180 days, while posed biocompatibility. Conclusion: This study showed the superiority of photodynamic therapy with Ag@ZnO NPs followed by proper regeneration of the skin with Zinc ion of the shell.
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Affiliation(s)
- Behnaz Ghaemi
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, 1417755469, Iran
| | - Seyed Jamal Hashemi
- Department of Medical Mycology & Parasitology, School of Public Health, Tehran University of Medical Sciences,Tehran, 1417755469, Iran.,Food Microbiology Research Centre, Tehran University of Medical Sciences, Tehran, 1417755469, Iran
| | - Sharmin Kharrazi
- Department of Medical Nanotechnology, School of Advanced Technologies in Medicine (SATiM), Tehran University of Medical Sciences, Tehran, 1417755469, Iran
| | - Arfa Moshiri
- Microbiology Research Centre, Pasteur Institute of Iran, Tehran, 1417755469, Iran.,Laboratory of Experimental Therapies in Oncology, IRCCS Istituto Giannina Gaslini, Genova, Italy
| | - Hossein Kargar Jahromi
- Research Centre for Non-Communicable Disease, Jahrom University of Medical Sciences, Jahrom, Iran
| | - Amir Amani
- Natural Products & Medicinal Plants Research Centre, North Khorasan University of Medical Sciences, Bojnurd, Iran.,Medical Biomaterial Research Centre, Tehran University of Medical Sciences, Tehran, 1417755469, Iran
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Zhou LL, Nurmohamed S, Au S, Beecker J, Green P, Robertson L, Mydlarski R. The Canadian Dermatology Association's Top Five Choosing Wisely Canada Recommendations. J Cutan Med Surg 2020; 24:461-467. [PMID: 32431167 DOI: 10.1177/1203475420928904] [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: 11/15/2022]
Abstract
INTRODUCTION In this article, we present the Canadian Dermatology Association's (CDA) Choosing Wisely Canada (CWC) list of top "Five Things Physicians and Patients Should Question in Dermatology" and the evidence in support of each recommendation. METHODS Using a nominal technique, the CDA Working Group and Task Force generated an initial list based on literature review and expert consultation. After several rounds of list refinement via a modified Delphi process, a final list of recommendations was generated. These were approved by the CDA Board of Directors, presented at the CDA 93rd Annual Conference in 2018, and published by CWC in 2019. RESULTS The top five recommendations are as follows: (1) Don't routinely prescribe antibiotics for bilateral lower leg redness and swelling; (2) Don't routinely prescribe topical combination corticosteroid/antifungal products; (3) Don't routinely use topical antibiotics on a surgical wound; (4) Don't prescribe systemic antifungals without mycological confirmation of dermatophyte infection; and (5) Don't use oral antibiotics for acne vulgaris for more than 3 months without assessing efficacy. DISCUSSION This list of recommendations aims to encourage both physicians and patients to reevaluate ineffective, yet common, practices in treating dermatologic conditions. These recommendations represent actionable changes in practice, and therefore have considerable potential to enhance value-based care in dermatology. CONCLUSIONS This list was developed to identify tangible changes in practice within dermatology that may reduce inefficiencies, prevent potential patient harm, and improve care. Future advocacy work may include updates, feedback obtainment, and patient care handouts, to continue to promote value-based healthcare and best practices.
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Affiliation(s)
- Linghong Linda Zhou
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Sabrina Nurmohamed
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Sheila Au
- 8166 Department of Dermatology and Skin Science, University of British Columbia, Vancouver, Canada
| | - Jennifer Beecker
- 6363 Division of Dermatology, Department of Medicine, University of Ottawa, Ottawa Hospital Research Institute, ON, Canada
| | - Peter Green
- 12361 Division of Dermatology, Department of Medicine, Dalhousie University, Halifax, NS, Canada
| | - Lynne Robertson
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
| | - Regine Mydlarski
- 2129 Division of Dermatology, Department of Medicine, University of Calgary, AB, Canada
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Yamaguchi H. Potential of Ravuconazole and its Prodrugs as the New OralTherapeutics for Onychomycosis. Med Mycol J 2017; 57:E93-E110. [PMID: 27904057 DOI: 10.3314/mmj.16-00006] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Onychomycosis is a fungal infection of the nail apparatus caused by dermatophytes, Candida and non-dermatophytic molds. It is highly prevalent in the general population worldwide and also responsible for significant morbidity and complications and does not usually cure itself. Thus, the condition needs to be treated in view of physical and psychological problems produced. Currently, oral medications using terbinafine are the most effective therapy, but it has relatively limited therapeutic success, particularly for long-term management. Such existing oral therapies are associated with high recurrence rates and treatment failure, as well as with potential adverse events and drug-drug interactions. In the light of these issues, development of more efficacious and safer alternatives for the treatment of onychomycosis is warranted.Ravuconazole and its prodrugs are promising new drug candidates for oral therapy of onychomycosis, among which a water-soluble prodrug, mono-lysine phosphoester derivative (E1224 or BFE1224) is in the most advanced stage of clinical development; a Phase II dose-finding study has been successfully completed and Phase III comparative studies are in progress in Japan.This review aims to summarize our current status of knowledge and information on ravuconazole and its prodrugs, particularly BFE1224, as the potential oral treatment option for onychomycosis. It also summarize the clinical features of onychomycosis with particular stress on its etiology, epidemiology, and current therapeutic options and their limitations. Given its clinical usefulness, BFE1224 may become a valuable addition to the current armamentarium for the treatment of onychomycosis.
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Gupta AK, Hall S, Zane LT, Lipner SR, Rich P. Evaluation of the efficacy and safety of tavaborole topical solution, 5%, in the treatment of onychomycosis of the toenail in adults: a pooled analysis of an 8-week, post-study follow-up from two randomized phase 3 studies. J DERMATOL TREAT 2017; 29:44-48. [DOI: 10.1080/09546634.2017.1329510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Aditya K. Gupta
- Department of Medicine, University of Toronto, Toronto, Canada
- Mediprobe Research Inc., London, Canada
| | - Steve Hall
- Medical Affairs, Sandoz Pharmaceuticals Inc., Princeton, NJ, USA
| | - Lee T. Zane
- Anacor Pharmaceuticals Inc., Palo Alto, CA, USA
| | - Shari R. Lipner
- Department of Dermatology, Weill Cornell Medicine, New York, NY, USA
| | - Phoebe Rich
- Oregon Dermatology and Research, Portland, OR, USA
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Efinaconazole Topical Solution, 10%: Factors Contributing to Onychomycosis Success. J Fungi (Basel) 2015; 1:107-114. [PMID: 29376902 PMCID: PMC5753103 DOI: 10.3390/jof1020107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Revised: 06/23/2015] [Accepted: 06/24/2015] [Indexed: 11/16/2022] Open
Abstract
To provide an adequate therapeutic effect against onychomycosis, it has been suggested that topical drugs should have two properties: drug permeability through the nail plate and into the nail bed, and retention of their antifungal activity in the disease-affected areas. Only recently has the importance of other delivery routes (such as subungual) been discussed. Efinaconazole has been shown to have a more potent antifungal activity in vitro than the most commonly used onychomycosis treatments. The low keratin affinity of efinaconazole contributes to its effective delivery through the nail plate and retention of its antifungal activity. Its unique low surface tension formulation provides good wetting properties affording drug delivery both through and under the nail. High antifungal drug concentrations have been demonstrated in the nail of onychomycosis patients, and effectiveness of efinaconazole topical solution, 10% confirmed in two large well-controlled multicenter Phase 3 clinical studies in patients with mild-to-moderate disease.
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Abstract
Background Onychomycosis has several clinical presentations and is caused by various infectious organisms. Objective To provide guidance for selection of appropriate treatment. Methods The literature on onychomycosis management was reviewed to generate an evidence-based decision tree. Results and Conclusion Several options are available: terbinafine, itraconazole, fluconazole, ciclopirox 8% nail lacquer, efinaconazole 10% nail solution, and laser therapy. Further studies on lasers are needed before use can be recommended. Nondermatophyte molds or mixed infection can be managed with terbinafine or itraconazole with or without topicals. Itraconazole, fluconazole, and efinaconazole can be used for Candida infection. For dermatophytes, topicals can be considered for mild to moderate onychomycosis. For moderate to severe cases, any oral monotherapy can be used; however, we suggest terbinafine if there is a possibility of a drug interaction. These recommendations can be applied for all ages, immune function, or metabolic status, but proper monitoring and contraindications should be taken into consideration.
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Affiliation(s)
- Aditya K. Gupta
- From the Department of Medicine, University of Toronto, Toronto, ON, and Mediprobe Research Inc., London, ON
| | - Maryse Paquet
- From the Department of Medicine, University of Toronto, Toronto, ON, and Mediprobe Research Inc., London, ON
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Pollak RA. Efinaconazole topical solution, 10%: the development of a new topical treatment for toenail onychomycosis. J Am Podiatr Med Assoc 2014; 104:568-73. [PMID: 25514267 DOI: 10.7547/8750-7315-104.6.568] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Toenail onychomycosis is a common disease with limited treatment options; treatment failure and relapse are frequently encountered. Many patients experience long-standing disease affecting multiple toenails, with substantial discomfort and pain. Although some patients might prefer a topical therapy, efficacy with ciclopirox nail lacquer has been disappointing. METHODS Efinaconazole topical solution, 10% is the first topical triazole antifungal agent specifically developed for the treatment of onychomycosis. This paper reviews the preclinical and clinical data on efinaconazole topical solution, 10%. RESULTS Efinaconazole has a broad spectrum of antifungal activity in vitro and is more potent than ciclopirox against common onychomycosis pathogens. It has a more optimal keratin affinity than ciclopirox, and it exhibits significantly greater in vivo activity owing to its superior nail penetration. Mycologic cure rates at week 52 were 55.2% (study 1) and 53.4% (study 2) with efinaconazole topical solution, 10% compared with 16.8% and 16.9%, respectively, with vehicle (P<.001 for both). In addition, efinaconazole is well tolerated. CONCLUSIONS Efinaconazole topical solution, 10% may likely become a preferred topical agent for the management of mild-to-moderate onychomycosis.
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Abstract
INTRODUCTION Onychomycosis is a very common fungal infection of the nail apparatus; however, it is very hard to treat, even when the causative agent is identified, and usually requires prolonged systemic antifungal therapy. Until the 1990s, oral treatment options included only griseofulvin and ketoconazole, and the cure rate was very low. New generations of antimycotics, such as fluconazole, itraconazole and terbinafine have improved treatment success. METHODS Literature was identified by performing a PubMed Ovid MEDLINE, Ovid EMBASE, EBSCO CINAHL, and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS) search. Prospective and randomized clinical trials were chosen to be included in this review. Forty-six trials were included. RESULTS Fluconazole, itraconazole and terbinafine are effective in the treatment of onychomycosis and have a good safety profile. When a dermatophyte is the pathogen, terbinafine produces the best results. For Candida and nondermatophyte infections, the azoles, mainly itraconazole, are the recommended therapy. CONCLUSION In the majority of the studies, terbinafine treatment showed a higher cure ratio than the other drugs for dermatophyte onychomycosis.
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Kozhichkina NV. Etiology of foot mycosis and onychomycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2013. [DOI: 10.25208/vdv573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents data from Russian and foreign sources related to the etiology of foot mycosis and onychomycosis. In spite of the substantial spread of data by countries and regions of the world, dermatophytes play a leading part in the etiology of foot mycosis and onychomycosis, and Trichophyton rubrum is found in most studies in more than one half of all cases. Yeast-like fungi of the Candida genus as well as mold fungi belong to less frequent pathogens of foot mycosis. However, they play a greater role in countries with hot and humid climate such as Brazil, Indonesia, Columbia and India. These data are important for the determination of organizational measures aimed at the early diagnostics of patients, timely treatment and implementation of anti-epidemic and disinfectant measures.
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Gupta AK, Brintnell W. Ozone gas effectively kills laboratory strains ofTrichophyton rubrumandTrichophyton mentagrophytesusing anin vitrotest system. J DERMATOL TREAT 2012; 25:251-5. [DOI: 10.3109/09546634.2012.714456] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Faizullina YV, Silina LV, Faizullin VA. Efficiency of the therapy of onychomycosis with irunine (based on the results of a multicenter study conducted in 2010 and 2011). VESTNIK DERMATOLOGII I VENEROLOGII 2012. [DOI: 10.25208/vdv670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a multi-center study of the clinical efficiency of the use of Irunine ® (itraconazole) for the treatment of 1,340 patients with onychomycosis. Patients were administered two capsules (100 mg) of Irunine ® twice a day after a meal for 7 days (as a pulse therapy) with a three-week break. The duration of treatment was 3—5 months. Clinical recovery was achieved in 74.9% of cases, and stable improvement was observed in 23.4% of patients.
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Evaluation of the morphological effects of TDT 067 (terbinafine in Transfersome) and conventional terbinafine on dermatophyte hyphae in vitro and in vivo. Antimicrob Agents Chemother 2012; 56:2530-4. [PMID: 22354309 DOI: 10.1128/aac.05998-11] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TDT 067 is a novel, carrier-based dosage form of terbinafine in Transfersome (1.5%) formulated for topical delivery of terbinafine to the nail, nail bed, and surrounding tissue. We examined the effects of TDT 067 and conventional terbinafine on the morphology of dermatophytes. Trichophyton rubrum hyphae were exposed to TDT 067 or terbinafine (15 mg/ml) and examined under white light, scanning electron microscopy (SEM), and transmission electron microscopy (TEM). Subungual debris from patients treated with TDT 067 in a clinical trial was also examined. Exposure of T. rubrum hyphae to TDT 067 led to rapid and extensive ultrastructural changes. Hyphal distortion was evident as early as 4 h after exposure to TDT 067. After 24 h, there was complete disruption of hyphal structure with few intact hyphae remaining. Exposure to terbinafine resulted in morphological alterations similar to those seen with TDT 067; however, the effects of TDT 067 were more extensive, whereas a portion of hyphae remained intact after 24 h of exposure to terbinafine. Lipid droplets were observed under TEM following 30 min of exposure to TDT 067, which after 24 h had filled the intracellular space. These effects were confirmed in vivo in subungual debris from patients with onychomycosis who received topical treatment with TDT 067. The Transfersome in TDT 067 may potentiate the action of terbinafine by delivering terbinafine more effectively to its site of action inside the fungus. Our in vivo data confirm that TDT 067 can enter fungus in the nail bed of patients with onychomycosis and exert its antifungal effects.
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Cambuim IIFN, Macêdo DPC, Delgado M, Lima KDM, Mendes GP, Souza-Motta CMD, Lima DMM, Fernandes MJ, Magalhães OMC, Queiroz LAD, Neves RP. Avaliação clínica e micológica de onicomicose em pacientes brasileiros com HIV/AIDS. Rev Soc Bras Med Trop 2011; 44:40-2. [DOI: 10.1590/s0037-86822011000100010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 09/16/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUÇÃO: Onicomicoses são comuns em pacientes imunocomprometidos embora espécies emergentes tenham sido verificadas, modificado o perfil epidemiológico desta micose. Assim, o objetivo desta pesquisa é avaliar o perfil clínico e micológico da onicomicose em pacientes com infecção pelo HIV/AIDS. MÉTODOS: Amostras clínicas foram coletadas, processados para exame direto e a cultura mantida a temperatura de 30°C e 37ºC durante 15 dias. RESULTADOS: Dos 100 pacientes, 32 apresentavam onicomicose. Os agentes isolados foram Candida albicans, C. parapsilosis, C. tropicalis, C. guilliermondii, Trichophyton rubrum, T. mentagrophytes, Fusarium solani, Scytalidium hialinum, S. japonicum, Aspergillus niger, Cylindrocarpon destructans e Phialophora reptans. CONCLUSÕES: Onicomicoses em HIV/AIDS apresentam variadas manifestações clínicas e podem ser causadas por fungos emergentes. As peculiaridades apresentadas pelos diferentes agentes de origem fúngica justificam a necessidade de identificação ao nível da espécie, com a finalidade de orientar uma melhor abordagem terapêutica e minimizar a exposição desses pacientes a condições de risco de uma infecção disseminada.
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Sánchez-Regaña M, Sola-Ortigosa J, Alsina-Gibert M, Vidal-Fernández M, Umbert-Millet P. Nail psoriasis: a retrospective study on the effectiveness of systemic treatments (classical and biological therapy). J Eur Acad Dermatol Venereol 2010; 25:579-86. [DOI: 10.1111/j.1468-3083.2010.03938.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kubanova AA, Kozhichkina NV, Kubanova AA, Kozhichkina NV. Binafin in treatment of nail mycosis. VESTNIK DERMATOLOGII I VENEROLOGII 2010. [DOI: 10.25208/vdv850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
The article presents the results of a direct open-label study of the efficacy and safety of BINAFIN® for treatment of foot and hand
nail mycoses in 30 patients. Patients were administered one pill (250 mg) of BINAFIN® a day on a daily basis for 3-5 months.
Clinical and anti-mycosis efficacy was achieved in 92.6% cases of foot and hand nail mycoses.
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Pföhler C, Hollemeyer K, Heinzle E, Altmeyer W, Graeber S, Müller CSL, Stark A, Jager SU, Tilgen W. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry: a new tool in diagnostic investigation of nail disorders? Exp Dermatol 2009; 18:880-2. [DOI: 10.1111/j.1600-0625.2008.00838.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Many functional, demographic, and immunologic changes associated with aging are responsible for increasing the incidence and severity of infectious diseases in the elderly. Management is complicated by age-related organ system changes. Because many of the elderly are on multiple medications for underlying illnesses, antimicrobial therapy needs to be chosen keeping drug interactions and adverse events in mind. Common infections seen in the elderly are infections of skin and soft tissue, urinary tract, respiratory tract, and gastrointestinal tract. Organized and well-funded programs to address infectious disease issues in the elderly are the only way to improve care.
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Affiliation(s)
- Tin Han Htwe
- Division of Infectious Diseases, Southern Illinois University School of Medicine, Post Box 19636, Springfield, IL 62794-9636, USA
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