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Jain R, Sood S, Randev S, Kumar P, Guglani V. Clinical Profile and Outcome of Severe Acute Respiratory Illness (SARI) in Children Amidst the COVID-19 Pandemic. Cureus 2024; 16:e61902. [PMID: 38978920 PMCID: PMC11228414 DOI: 10.7759/cureus.61902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2024] [Indexed: 07/10/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Beginning in December 2019, COVID-19 rapidly emerged as a global pandemic. Though its severity in children was reported to be less than that in adults, data on its epidemiology in relation to severe acute respiratory illness (SARI) caused by other microbes needed to be generated. This study compares the clinical profile and outcome of children hospitalized with COVID-19-positive and negative SARI. METHODS This is a prospective observational analytical study involving children 1 month to 18 years old, hospitalized with COVID-19-positive and negative SARI during the pandemic. All eligible patients were enrolled after obtaining informed parental consent. Their clinical manifestations, investigations, and outcomes were documented on a predesigned case record form. A nasopharyngeal swab sample for COVID-19 reverse transcription polymerase chain reaction was sent, and results were noted. RESULTS From May 2020 to July 2021, 267 children were hospitalized with a diagnosis of SARI. Out of these, 146 (54.7%) were boys and 78.7% were under five years of age. Other presentations included fever and cough, breathlessness, nausea, vomiting, diarrhea, rash, seizures, and altered sensorium. Twenty-eight patients (10.5%) tested positive for COVID-19. COVID-19 patients were similar in terms of demographic characteristics and presenting symptoms to non-COVID-19 patients but had a lower absolute lymphocyte count (p = 0.019) and higher serum alanine transaminase levels (p = 0.013). Acute respiratory distress syndrome (OR, 4.3; 95% CI, 1.8-10.0), shock (OR, 3.9; 95% CI, 1.9-7.9), and need for intensive care unit admission (OR, 9.9; 95% CI, 6.9-14) were more common in COVID-19 SARI patients. Death occurred in 18% of COVID-19 and 9% of non-COVID-19 patients (p = 0.07). SARI nonsurvivors had significantly lower blood pH and platelet counts than survivors. CONCLUSIONS Comparison of COVID-19-positive and negative SARI patients showed subtle differences between the two groups, with COVID-19-positive children having an increased severity of illness. Also, laboratory evidence of multiorgan dysfunction at admission was associated with higher mortality.
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Affiliation(s)
- Reena Jain
- Pediatrics, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Shivanjali Sood
- Pediatrics, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Shivani Randev
- Pediatrics, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Pankaj Kumar
- Pediatrics, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
| | - Vishal Guglani
- Pediatrics, Government Medical College and Hospital, Chandigarh, Chandigarh, IND
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Stosic M, Plavsa D, Jovanovic V, Veljkovic M, Babic D, Knezevic A, Saponjic V, Dimitrijevic D, Rancic M, Milic M, Adzic-Vukicevic T. Factors associated with COVID-19 among hospitalized patients with severe acute respiratory infections in Serbia, 2022-2023: A test negative case-control study. PLoS One 2024; 19:e0299210. [PMID: 38498428 PMCID: PMC10947665 DOI: 10.1371/journal.pone.0299210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 02/07/2024] [Indexed: 03/20/2024] Open
Abstract
Severe acute respiratory infections (SARI) are estimated to be the cause of death in about 19% of all children younger than 5 years globally. The outbreak of coronaviral disease (COVID-19) caused by SARS-CoV-2, increased considerably the burden of SARI worldwide. We used data from a vaccine effectiveness study to identify the factors associated with SARS CoV-2 infection among hospitalized SARI patients. We recruited SARI patients at 3 hospitals in Serbia from 7 April 2022-1 May 2023. We collected demographic and clinical data from patients using a structured questionnaire, and all SARI patients were tested for SARS-CoV-2 by RT-PCR. We conducted an unmatched test negative case-control study. SARS-CoV-2 infected SARI patients were considered cases, while SARS CoV-2 negative SARI patients were controls. We conducted bivariate and multivariable logistic regression analysis in order to identify variables associated with SARS-CoV-2 infection. We included 110 SARI patients: 74 were cases and 36 controls. We identified 5 factors associated with SARS-CoV-2 positivity, age (OR = 1.04; 95% CI = 1.01-1.07), having received primary COVID-19 vaccine series (OR = 0.28; 95% CI = 0.09-0.88), current smoking (OR = 8.64; 95% CI = 2.43-30.72), previous SARS CoV-2 infection (OR = 3.48; 95% CI = 1.50-8.11) and number of days before seeking medical help (OR = 0.81; 95% CI = 0.64-1.02). In Serbia during a period of Omicron circulation, we found that older age, unvaccinated, hospitalized SARI patients, previously infected with SARS CoV-2 virus and those who smoked, were more likely to be SARS-CoV-2-positive; these patient populations should be prioritized for COVID vaccination.
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Affiliation(s)
- Maja Stosic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragana Plavsa
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Verica Jovanovic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Marko Veljkovic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragan Babic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Aleksandra Knezevic
- Institute for Microbiology and Immunology, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Vladan Saponjic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Dragana Dimitrijevic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
| | - Miljan Rancic
- World Health Organization, Country Office Serbia, Belgrade, Serbia
| | - Marija Milic
- Institute of Public Health of Serbia „Dr Milan Jovanovic Batut“, Belgrade, Serbia
- Department of Epidemiology, Faculty of Medicine, University of Pristina Temporarily Seated in Kosovska Mitrovica, Kosovska Mitrovica, Serbia
| | - Tatjana Adzic-Vukicevic
- COVID Hospital "Batajnica", University Clinical Centre of Serbia, Belgrade, Serbia
- Clinic for Pulmonology, University Clinical Centre of Serbia, Belgrade, Serbia
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Hassan MZ, Islam MA, Shoshi HR, Hossain MK, Shirin T, Chowdhury F. Characterizing deaths among adult patients with severe acute respiratory infection: during the pre- and COVID-19 pandemic periods in Bangladesh, 2018-2022. Trop Med Health 2023; 51:70. [PMID: 38115037 PMCID: PMC10729565 DOI: 10.1186/s41182-023-00565-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 12/11/2023] [Indexed: 12/21/2023] Open
Abstract
BACKGROUND Severe acute respiratory infection (SARI) is a leading cause of mortality globally, peaking during the COVID-19 pandemic. We analyzed SARI-associated deaths during the pre-and-pandemic periods in Bangladesh to identify the contributing factors. METHODS We analyzed data from hospital-based influenza surveillance at nine tertiary-level hospitals in Bangladesh. We considered March 2018-February 2020 as the pre-pandemic period and March 2020-February 2022 as the pandemic period and included adult (≥ 18 years) participants in our study. Surveillance physicians identified WHO-SARI case definition meeting inpatients and collected demographics, clinical characteristics, and outcomes at hospital discharge and 30 days post-discharge. We performed rRT-PCR for influenza and SARS-CoV-2 viruses on collected nasopharyngeal and oropharyngeal swabs. We used multivariable Cox's regression models to calculate the hazard ratio (HR) for factors associated with SARI deaths in these adult patients. RESULTS We enrolled 4392 SARI patients during the pre-pandemic and 3824 SARI patients during the pandemic period. Case fatality ratio was higher during the pandemic: 13.62% (521) [in-hospital: 6.45% (247); post-discharge: 7.17% (274)] compared to pre-pandemic, 6.01% (264) [in-hospital: 2.01% (89), post-discharge: 4% (175)] (p < 0.001). Pre-pandemic, influenza was detected in 14% (37/264) of SARI deaths. Influenza was detected during the pandemic in 2.3% (12/521), SARS-CoV-2 in 41.8% (218/521), and both viruses in only one SARI death. History of smoking and the presence of 1 or more co-morbid conditions independently attributed to SARI deaths in adults in the pre-pandemic period. SARI deaths in such patients were also associated with respiratory difficulties on admission in both pre-pandemic (aHR 2.36; 95% CI:1.65-3.36) and pandemic period (aHR 2.30; 95% CI: 1.57-3.35) after accounting for age, sex, smoking status, presence of 1 or more co-morbid conditions, and detection of influenza and SARS-CoV-2 viruses. CONCLUSIONS During the pandemic, SARI mortality increased; influenza-associated mortality declined, and SARS-CoV-2 caused over a third of SARI deaths. Post-discharge mortality was higher than in-hospital mortality during both periods. Limiting premature discharge and strengthening post-discharge monitoring and nursing services could reduce unexpected deaths. Formative research to better understand post-discharge mortality is essential to reduce SARI deaths.
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Affiliation(s)
- Md Zakiul Hassan
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Mohakhali, Dhaka, Bangladesh.
| | - Md Ariful Islam
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Homayra Rahman Shoshi
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Md Kamal Hossain
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Mohakhali, Dhaka, Bangladesh
| | - Tahmina Shirin
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Fahmida Chowdhury
- Programme for Emerging Infections, Infectious Disease Division, International Centre for Diarrhoeal Disease Research, Bangladesh (Icddr,b), Mohakhali, Dhaka, Bangladesh
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Tasca KI, Alves CG, Grotto RMT, de Moraes LN, Assato PA, Fortaleza CMCB. Dichotomous outcomes vs. survival regression models for identification of predictors of mortality among patients with severe acute respiratory illness during COVID-19 pandemics. Front Public Health 2023; 11:1271177. [PMID: 38125848 PMCID: PMC10732580 DOI: 10.3389/fpubh.2023.1271177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction As the studies predicting mortality in severe acute respiratory illness (SARI) have inferred associations either from dichotomous outcomes or from time-event models, we identified some clinical-epidemiological characteristics and predictors of mortality by comparing and discussing two multivariate models. Methods To identify factors associated with death among all SARI hospitalizations occurred in Botucatu (Brazil)/regardless of the infectious agent, and among the COVID-19 subgroup, from March 2020 to 2022, we used a multivariate Poisson regression model with binomial outcomes and Cox proportional hazards (time-event). The performance metrics of both models were also analyzed. Results A total of 3,995 hospitalized subjects were included, of whom 1338 (33%) tested positive for SARS-CoV-2. We identified 866 deaths, of which 371 (43%) were due to the COVID-19. In the total number of SARI cases, using both Poisson and Cox models, the predictors of mortality were the presence of neurological diseases, immunosuppression, obesity, older age, and need for invasive ventilation support. However, the Poisson test also revealed that admission to an intensive care unit and the COVID-19 diagnosis were predictors of mortality, with the female gender having a protective effect against death. Likewise, Poisson proved to be more sensitive and specific, and indeed the most suitable model for analyzing risk factors for death in patients with SARI/COVID-19. Conclusion Given these results and the acute course of SARI and COVID-19, to compare the associations and their different meanings is essential and, therefore, models with dichotomous outcomes are more appropriate than time-to-event/survival approaches.
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Affiliation(s)
- Karen Ingrid Tasca
- Department of Infectious Diseases, Botucatu Medical School (FMB), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Camila Gonçalves Alves
- Department of Infectious Diseases, Botucatu Medical School (FMB), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
| | - Rejane Maria Tommasini Grotto
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
- Clinical Hospital of Botucatu Medical School (HCFMB), Botucatu, Brazil
| | - Leonardo Nazario de Moraes
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
- Clinical Hospital of Botucatu Medical School (HCFMB), Botucatu, Brazil
| | - Patrícia Akemi Assato
- Department of Biotechnology and Bioprocess, School of Agriculture (FCA), São Paulo State University (Unesp), Botucatu, São Paulo, Brazil
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Murugesan S, Ramamurthi HC, Jacob SM, Govindarajulu S. Clinical characteristics and predictors of COVID-19 in a community sample from urban areas of Chennai, Southern India. Virusdisease 2023; 34:449-455. [PMID: 38046064 PMCID: PMC10686964 DOI: 10.1007/s13337-023-00843-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 09/02/2023] [Indexed: 12/05/2023] Open
Abstract
In early 2020, with the arrival of the first case of COVID-19 in India, the laboratory at The Tamil Nadu Dr. MGR Medical University was recognized as a national testing site and received samples from two zones of Greater Chennai Corporation. This descriptive study analyzed the testing outcomes, along with demographics, self-reported symptoms, potential exposure to COVID-19 that were recorded in Sample Report Forms between June and September 2020. Nasopharygeal/oropharyngeal swabs were tested for SARS CoV-2 by RT-PCR Test. Of the 18,082 samples that were tested, 18% (3267) received a COVID-19 positive RT-PCR result for COVID-19. Among the COVID-19 positives, 40.9% (1336) were females (p < 0.000). Individuals in the age groups 21-30 and 31-40 years included the largest number (767, 23.48% each) of COVID-19 positive cases. The largest number of cases were from those who were classified as Severe Acute Respiratory Illness (SARI) or Influenza Like Illness (ILI) (1657, 50.7%) followed by those who reported direct contact with a COVID-19 lab confirmed case (1163, 35.6%). Among those with symptoms, 1791 (28.9%) tested COVID-19 positive compared to 1476 who were COVID-19 positive and asymptomatic (p < 0.001). Main symptoms were cough (32.1%), fever (48.3%), body ache (21.04%) and sore throat (30.60%). In multivariable analysis, history of SARI/ILI, contact with a confirmed case and having fever, cough and sore throat were the main predictors of being COVID-19 positive. Therefore, clinical and demographic characteristics correlated with COVID-19 positivity. And classification of patients based on self-reported symptoms and risk categories offers a model to prioritize testing and vaccination efforts.
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Affiliation(s)
- Sivapriya Murugesan
- Department of Epidemiology, The Tamil Nadu Dr. MGR Medical University, No. 69, Anna Salai, Chennai, 113 India
| | - Hema C. Ramamurthi
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, USA
| | - Saramma M. Jacob
- Department of Experimental Medicine, The Tamil Nadu Dr. MGR Medical University, No. 69, Anna Salai, Chennai, 113 India
| | - Srinivas Govindarajulu
- Department of Epidemiology, The Tamil Nadu Dr. MGR Medical University, No. 69, Anna Salai, Chennai, 113 India
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de Carvalho FC, da Silva ET, de Almeida WAF, Maroneze MA, Schwartz JDA, Jardim JPV, Peixoto HM. Clinical and epidemiological aspects of severe acute respiratory infection: before and during the first year of the COVID-19 pandemic in Brazil. Trans R Soc Trop Med Hyg 2022; 117:161-173. [PMID: 35929810 PMCID: PMC9384673 DOI: 10.1093/trstmh/trac074] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/09/2022] [Accepted: 07/19/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Widespread respiratory infections with high morbidity rates caused by respiratory viruses represent a significant global public health problem. Our objective was to describe cases and deaths from severe acute respiratory infection (SARI) in Brazil over the past 8 y as well as changes in the distribution and risk of illness and death from SARI before and in the first year of the coronavirus disease 2019 (COVID-19) pandemic (FYP). METHODS We performed a descriptive epidemiological study of hospitalized SARI cases and deaths between 2013 and 2020 in Brazil, separated into pre-pandemic (2013 to 2019) and FYP (2020). We estimate the increase in SARI cases and deaths in the FYP as well as the mortality and infection risks attributable to the FYP (MRAP and IRAP, respectively). RESULTS In 2020, an excess of 425 054 cases and 109 682 deaths was observed, with a significant increase in the risk of falling ill and dying from SARI, with an IRAP of 200.06 and an MRAP of 51.68 cases per 100 000 inhabitants. The increase in SARI cases and deaths was particularly prominent among patients with COVID-19, the elderly, males, those self-identifying as mixed race and patients with heart disease and diabetes. We conclude that an important increase in morbidity and mortality due to SARI was observed in the FYP. More vulnerable groups and those living in the Southeast, North and Center-West regions of the country suffered the most.
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Affiliation(s)
| | - Erica Tatiane da Silva
- Evidence Program for Health Policies and Technologies, Oswaldo Cruz Foundation, Brasilia, Federal District, Brazil
| | | | | | | | | | - Henry Maia Peixoto
- Center of Tropical Medicine, Faculty of Medicine, University of Brasilia, Brasilia, Brazil,National Institute of Science and Technology for Health Technology Assessment, Porto Alegre, Brazil
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Sansone NMS, Boschiero MN, Marson FAL. Epidemiologic Profile of Severe Acute Respiratory Infection in Brazil During the COVID-19 Pandemic: An Epidemiological Study. Front Microbiol 2022; 13:911036. [PMID: 35854935 PMCID: PMC9288583 DOI: 10.3389/fmicb.2022.911036] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 05/26/2022] [Indexed: 01/08/2023] Open
Abstract
BackgroundThe COVID-19 is a significant public health issue, and monitoring confirmed cases and deaths is an essential epidemiologic tool. We evaluated the features in Brazilian hospitalized patients due to severe acute respiratory infection (SARI) during the COVID-19 pandemic in Brazil. We grouped the patients into the following categories: Influenza virus infection (G1), other respiratory viruses' infection (G2), other known etiologic agents (G3), SARS-CoV-2 infection (patients with COVID-19, G4), and undefined etiological agent (G5).MethodsWe performed an epidemiological study using data from DataSUS (https://opendatasus.saude.gov.br/) from December 2019 to October 2021. The dataset included Brazilian hospitalized patients due to SARI. We considered the clinical evolution of the patients with SARI during the COVID-19 pandemic according to the SARI patient groups as the outcome. We performed the multivariate statistical analysis using logistic regression, and we adopted an Alpha error of 0.05.ResultsA total of 2,740,272 patients were hospitalized due to SARI in Brazil, being the São Paulo state responsible for most of the cases [802,367 (29.3%)]. Most of the patients were male (1,495,416; 54.6%), aged between 25 and 60 years (1,269,398; 46.3%), and were White (1,105,123; 49.8%). A total of 1,577,279 (68.3%) patients recovered from SARI, whereas 701,607 (30.4%) died due to SARI, and 30,551 (1.3%) did not have their deaths related to SARI. A major part of the patients was grouped in G4 (1,817,098; 66.3%) and G5 (896,207; 32.7%). The other groups account for <1% of our sample [G1: 3,474 (0.1%), G2: 16,627 (0.6%), and G3: 6,866 (0.3%)]. The deaths related to SARI were more frequent in G4 (574,887; 34.7%); however, the deaths not related to SARI were more frequent among the patients categorized into the G3 (1,339; 21.3%) and G5 (25,829; 4.1%). In the multivariate analysis, the main predictors to classify the patients in the G5 when compared with G4 or G1-G4 were female sex, younger age, Black race, low educational level, rural place of residence, and the use of antiviral to treat the clinical signs. Furthermore, several features predict the risk of death by SARI, such as older age, race (Black, Indigenous, and multiracial background), low educational level, residence in a flu outbreak region, need for intensive care unit, and need for mechanical ventilatory support.ConclusionsThe possible COVID-19 underreporting (G5) might be associated with an enhanced mortality rate, more evident in distinct social groups. In addition, the patients' features are unequal between the patients' groups and can be used to determine the risk of possible COVID-19 underreporting in our population. Patients with a higher risk of death had a different epidemiological profile when compared with patients who recovered from SARI, like older age, Black, Indigenous, and multiracial background races, low educational level, residence in a flu outbreak region, need for intensive care unit and need for mechanical ventilatory support.
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Affiliation(s)
- Nathália Mariana Santos Sansone
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
| | - Matheus Negri Boschiero
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
| | - Fernando Augusto Lima Marson
- Laboratory of Cell and Molecular Tumor Biology and Bioactive Compounds, São Francisco University, Bragança Paulista, Brazil
- Laboratory of Human and Medical Genetics, São Francisco University, Bragança Paulista, Brazil
- *Correspondence: Fernando Augusto Lima Marson ; ; orcid.org/0000-0003-4955-4234
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