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Tokoyoda T, Inagaki T, Aoki Y, Okamoto T, Nakajima T, Yano D. Minimal change nephrotic syndrome diagnosed with acute femoral thromboembolism and successfully salvaged limb: a case report. CEN Case Rep 2023; 12:357-361. [PMID: 36773197 PMCID: PMC10620369 DOI: 10.1007/s13730-023-00774-x] [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: 12/15/2022] [Accepted: 01/29/2023] [Indexed: 02/12/2023] Open
Abstract
A 64-year-old man visited the outpatient department of our hospital for the first time due to bilateral lower limb edema, which he noticed 1 week before the visit. Pain suddenly developed in the left lower limb while the patient was in the waiting room. Nephrotic syndrome was suspected based on blood and urine test results. Acute arterial thromboembolism in the left lower limb associated with hypercoagulation due to nephrotic syndrome was suspected, and a diagnosis was made using computed tomography angiography. Arterial thrombectomy was urgently performed, and the limb was salvaged without sequelae. Based on renal biopsy, minimal change nephrotic syndrome was diagnosed, and the patient underwent remission induction with steroid therapy. Heparin was drip infused and apixaban was orally administered to prevent recurrent thrombosis. Nephrotic syndrome in the acute phase is often complicated by thrombosis. Particularly, arterial thromboembolism requires prompt treatment, and prophylactic anticoagulation therapy needs to be considered.
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Affiliation(s)
- Tomoaki Tokoyoda
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan.
| | - Takahiro Inagaki
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Yuki Aoki
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Takeshi Okamoto
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Takashi Nakajima
- Department of Nephrology, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
| | - Daisuke Yano
- Department of Cardiovascular Surgery, Nagoya Ekisaikai Hospital, 4-66 Shonencho, Nakagawaku, Nagoya City, Aichi Prefecture, Japan
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2
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Han X, Zhao P, Wang Z, Ji X, Zhao M. Acute lower extremity arterial thrombosis associated with nephrotic syndrome in adults: case series and literature review. BMC Nephrol 2023; 24:318. [PMID: 37884862 PMCID: PMC10605977 DOI: 10.1186/s12882-023-03374-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Nephrotic syndrome (NS) is a condition associated with hypercoagulability. Thromboembolic events are a well-recognized complication of NS. Venous thrombosis is well known, while arterial thrombosis, which is more severe, occurs less frequently and is mainly reported in children in the literature. The aim of this study was to understand these rare adult cases of NS associated with acute lower extremity arterial thrombosis and draw attention to them to prevent misdiagnosis and delayed treatment. METHODS From January 2011 and October 2022, we conducted a retrospective study of patients with NS and arterial thrombosis. Their clinical manifestations, imaging characteristics, treatments and outcomes were analyzed and compared, and a literature review was performed. RESULTS Nine adults with NS and acute lower limb arterial thrombosis were described. In seven of these patients, six had fresh thrombi that preceded the NS diagnosis, while one had a history of NS for 14 years and previously underwent an emergency thrombectomy. Three of the seven patients eventually underwent above-knee amputations, and the other four underwent arterial revascularization with satisfactory recovery of lower-extremity perfusion. In addition to the seven patients mentioned above, the other two received successful anticoagulant treatment, as the thrombosis was present only in the popliteal artery. CONCLUSION Acute lower extremity arterial thrombosis is a rare but serious and potentially lethal complication in patients with NS, and early recognition and appropriate management are crucial for good patient outcomes.
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Affiliation(s)
- Xinqiang Han
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Peng Zhao
- Department of Minimally Invasive Interventional Therapy Center, Qingdao Municipal Hospital, 256600, Qingdao, Shandong, China
| | - Zhu Wang
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Xingang Ji
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China
| | - Mengpeng Zhao
- Department of Interventional Medicine and Vascular, Binzhou Medical University Hospital, 256603, Binzhou, Shandong, China.
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3
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Sirvent AE, Urzola-Rodríguez G, Lorenzo A, Callejas-Martínez R, Saiz A, Calle-García L, Molina-Ordás Á, Rodríguez-Gómez A, Martin-Varas C, Fernández-Reyes-Luis MJ. Arterial thrombosis in a patient with nephrotic syndrome and antithrombin Cambrigde II. Nefrologia 2023; 42:729-731. [PMID: 36870820 DOI: 10.1016/j.nefroe.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 03/06/2023] Open
Affiliation(s)
- Ana Esther Sirvent
- Servicio de Nefrología, Complejo Asistencial de Segovia, Segovia, Spain.
| | | | - Alicia Lorenzo
- Servicio de Hematología, Complejo Asistencial de Segovia, Segovia, Spain
| | | | - Ana Saiz
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
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Sirvent AE, Urzola-Rodríguez G, Lorenzo A, Callejas-Martínez R, Saiz A, Calle-García L, Molina-Ordás Á, Rodríguez-Gómez A, Martin-Varas C, Fernández-Reyes-Luis MJ. Arterial thrombosis in a patient with nephrotic syndrome and antithrombin Cambrigde II. Nefrologia 2021; 42:S0211-6995(21)00006-0. [PMID: 33593604 DOI: 10.1016/j.nefro.2020.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/12/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ana Esther Sirvent
- Servicio de Nefrología, Complejo Asistencial de Segovia, Segovia, España.
| | | | - Alicia Lorenzo
- Servicio de Hematología, Complejo Asistencial de Segovia, Segovia, España
| | | | - Ana Saiz
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, España
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Fujinaga S, Sakuraya K. Spontaneous femoral artery thrombosis in childhood-onset nephrotic syndrome. Pediatr Int 2019; 61:526-527. [PMID: 31090123 DOI: 10.1111/ped.13842] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2018] [Revised: 02/14/2019] [Accepted: 03/14/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Shuichiro Fujinaga
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
| | - Koji Sakuraya
- Division of Nephrology, Saitama Children's Medical Center, Saitama, Japan
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Erben Y, Miller SM, Sumpio BJ, Dillon BJ, Lee AI, Blume P, Sumpio BE, Mena-Hurtado C. Acute Limb Ischemia in an 8-Year-Old Patient: A Case Report. Ann Vasc Surg 2018; 51:327.e1-327.e8. [PMID: 29655809 DOI: 10.1016/j.avsg.2018.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/19/2018] [Accepted: 02/19/2018] [Indexed: 10/17/2022]
Abstract
We report the case of an 8-year-old patient with a history of nephrotic syndrome, who presented to the emergency department with right foot pain. The patient's mother described intermittent pain that woke her son from sleep and was accompanied by the foot turning purple and becoming cold to touch. Physical examination revealed capillary refill of over 10 seconds in the right and less than 2 seconds in the left foot. Ankle-brachial indices (ABIs) were 0.0 on the right and 0.96 on the left. The patient was admitted and started on therapeutic intravenous heparin. After consultation with his parents, right lower extremity angiography and thrombolysis was performed over 2 days. He subsequently underwent fasciotomy and amputation of the tip of all 5 toes. Eighteen months later, there is no leg length discrepancy, he is walking with foot inserts and has normal ABIs bilaterally.
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Affiliation(s)
- Young Erben
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT.
| | - Samuel M Miller
- Warren Alpert Medical School at Brown University, Providence, RI
| | - Brandon J Sumpio
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT
| | - Brian J Dillon
- Section of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Alfred I Lee
- Section of Hematology, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Peter Blume
- Department of Orthopedic Surgery and Anesthesia, Yale University School of Medicine, New Haven, CT; Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
| | - Bauer E Sumpio
- Section of Vascular and Endovascular Surgery, Yale University School of Medicine, New Haven, CT
| | - Carlos Mena-Hurtado
- Department of Cardiovascular Medicine, Yale University School of Medicine, New Haven, CT
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7
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Thrombose artérielle du membre inférieur sur un syndrome néphrotique. Nephrol Ther 2017; 13:248-250. [DOI: 10.1016/j.nephro.2016.07.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 06/09/2016] [Accepted: 07/21/2016] [Indexed: 11/19/2022]
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8
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Tachamo N, Dhital R, Timilsina B, Nazir S, Lohani S, Poudel DR. Popliteal arterial thrombosis in nephrotic syndrome: a case report. J Community Hosp Intern Med Perspect 2017. [PMID: 28634522 PMCID: PMC5463665 DOI: 10.1080/20009666.2017.1286814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thrombosis is a frequent cause of morbidity and mortality in patients with nephrotic syndrome (NS). Though venous thromboses are common in NS, arterial thromboses are relatively rare. Commonly involved arteries include coronary, iliac, femoral, renal, cerebral, pulmonary, mesenteric, and axillary arteries, and the aorta. Arterial thromboses are associated with poor prognosis; treatment options are limited and patients may not always be amenable to treatment. We present the case of a 39-year-old female with NS who presented with thigh pain and was found to have sub-acute popliteal artery thrombosis.
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Affiliation(s)
- Niranjan Tachamo
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Rashmi Dhital
- Department of Medicine, Universal College of Medical Sciences, Bhairahawa, Nepal
| | - Bidhya Timilsina
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Salik Nazir
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Saroj Lohani
- Department of Medicine, Reading Health System, West Reading, PA, USA
| | - Dilli Ram Poudel
- Department of Medicine, Reading Health System, West Reading, PA, USA
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Lee SJ, Park JY, Ryu SK, Choi JW, Chae WY, Ryu HY, Yoo MS, Bak YS. Pulmonary thromboembolism combined with intracardiac thrombus occurred during the steroid reduction in nephrotic syndrome patient. Yeungnam Univ J Med 2016. [DOI: 10.12701/yujm.2016.33.1.25] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Se Jin Lee
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Sung Kee Ryu
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Jae Woong Choi
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Won Young Chae
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Hee Yun Ryu
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Min Seok Yoo
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
| | - Yoon Suk Bak
- Department of Internal Medicine, Eulji Medical Center, Eulji University School of Medicine, Seoul, Korea
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The Risk Factors of Avascular Necrosis in Patients with Systemic Lupus Erythematosus: a Meta-analysis. Inflammation 2014; 37:1852-64. [DOI: 10.1007/s10753-014-9917-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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11
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Javaid MM, Grigoriou A, Katsianos D, Kon SP. Nephrotic and anti-phospholipid syndromes: multisystem conditions associated with acute myocardial infarction in young patients. J Ren Care 2011; 38:9-14. [PMID: 21917124 DOI: 10.1111/j.1755-6686.2011.00249.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Acute myocardial infarction is relatively uncommon in patients under the age of 40 years. Unlike the older patients where rupture of coronary artery atherosclerotic plaque is the main underlying pathology, the pathogenesis in younger patients can be varied and may require different diagnostic and therapeutic approaches. Hypercoagulable state associated with nephrotic syndrome and antiphospholipid syndrome can lead to the development of occlusive coronary artery thrombus in absence of atherosclerotic coronary artery disease. Acute myocardial infarction in such a setting can sometimes be the first manifestation of an underlying disease. We describe a case of myocardial infarction in a young man with both nephrotic and antiphospho-lipid syndromes and present a brief literature review.
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Affiliation(s)
- Muhammad M Javaid
- Department of Nephrology, King's College Hospital NHS Foundation Trust, London, United Kingdom.
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12
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Abstract
OBJECTIVE To identify associated factors for the development of osteonecrosis of a femoral head (ON) in patients with systemic lupus erythematosus (SLE). METHODS We conducted a retrospective nested case-control study from SLE patients who attended the Rheumatology Clinic at Phramongkutklao Hospital from 1992-2008. Cases were defined as SLE patients, who had clinically apparent ON (confirmed by plain radiographs or magnetic resonance imaging). For each case, a control was selected and matched to the case by age and disease duration. The main outcome measure was the odds ratio (OR) of ON among SLE patients. The clinical and laboratory variables thought to be risk factors of ON variables were compared between patients who did and did not develop ON. Significant and clinically relevant variables were then examined by a stepwise logistic regression model. RESULTS Of 186 SLE patients, we identified 41 patients who developed ON during the course of follow-up. Twenty patients were available for data analysis. From the univariate analysis, incidence of renal involvement and the use of steroids (recorded as evidenced by maximum and mean daily prednisolone dose) were significantly higher in the ON group than in controls. The use of antimalarials was significantly lower in patients with ON than in controls. No difference in disease activity, lipid profiles or anticardiolipin antibody was found between groups. In the logistic regression, the presence of renal involvement remained as a positive associated factor for ON (OR = 7.80, CI = 1.249-48.748, P = 0.028) and the use of antimalarial drugs was a negative associated factor for ON (OR = 0.09, CI = 0.009-0.961, P = 0.046). CONCLUSION The presence of renal involvement was associated with ON and the antimalarial use may have a protective effect for ON in Thai patients with SLE. The findings from this study further support the use of antimalarial drugs in SLE patients.
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Huang JB, Yang WC, Yang AH, Lee PC, Lin CC. Arterial Thrombosis due to Minimal Change Glomerulopathy Secondary to Nonsteroidal Anti-Inflammatory Drugs. Am J Med Sci 2004; 327:358-61. [PMID: 15201652 DOI: 10.1097/00000441-200406000-00012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors report a 49-year-old woman who had been treated with diclofenac for her back pain. Nephrotic syndrome followed by occlusion of the right profound femoral and popliteal arteries occurred. Successful thrombectomy was performed. Another nonsteroidal anti-inflammatory drug (NSAID) was administered by injection during hospitalization. Renal biopsy showed minimal change glomerulopathy (MCG). Remission was delayed despite large-dose steroid administration. The delayed remission in this patient may be caused by impaired renal function and the possible effect of a second period of NSAID administration. The authors present the first case of femoral arterial thrombosis associated with nephrotic syndrome secondary to NSAID-associated MCG. Careful history-taking and physical examination may detect early causes and complications of nephrotic syndrome. Any rechallenge of NSAID should be avoided.
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Affiliation(s)
- Jeng-Bin Huang
- Division of Nephrology, Department of Medicine, Veterans General Hospital-Taipei and School of Medicine, National Yang-Ming University, Taipei, Taiwan, Republic of China
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Yun YW, Chung S, You SJ, Lee DK, Lee KY, Han SW, Jee HO, Kim HJ. Cerebral infarction as a complication of nephrotic syndrome: a case report with a review of the literature. J Korean Med Sci 2004; 19:315-9. [PMID: 15082913 PMCID: PMC2822321 DOI: 10.3346/jkms.2004.19.2.315] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Arterial thrombosis is relatively rare compared with venous thrombosis in nephrotic syndrome. However, the assessment of its pathogenesis and risk factors in individual patient with nephrotic syndrome is necessary to allow appropriate prophylactic management because it is a potentially serious problem. Hereby, with review of the literature, we report a case of a 53 yr-old man with cerebral infarction associated with nephrotic syndrome due to focal segmental glomerulosclerosis during the course of treatments with diuretics and steroid. It reveals that the hypercoagulable state in nephrotic syndrome can be associated with cerebral infarction in adults. Prophylactic anticoagulants can be considered to reduce the risk of serious cerebral infarction in nephrotic patients with risk factors such as severe hypoalbuminemia and on diuretics or steroid treatment, even in young patients regardless of types of underlying glomerular diseases.
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Affiliation(s)
- Yeo Wook Yun
- Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Sungjin Chung
- Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Sun-Jin You
- Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Dong Kyu Lee
- Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Kyu-Yong Lee
- Department of Neurology, Hanyang University, Seoul, Korea
| | - Sang-Woong Han
- Department of Internal Medicine, Hanyang University, Seoul, Korea
| | - Heng Ok Jee
- Department of Thoracic and Cardiovascular Surgery, Hanyang University, Seoul, Korea
| | - Ho-Jung Kim
- Department of Internal Medicine, Hanyang University, Seoul, Korea
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15
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Affiliation(s)
- N P Singh
- Department of Medicine, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi, India
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