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Azeez TA, Durotoluwa IM, Makanjuola AI. Diabetes Mellitus as a risk factor for stroke among Nigerians: A systematic review and meta-analysis. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200189. [PMID: 37250184 PMCID: PMC10220413 DOI: 10.1016/j.ijcrp.2023.200189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 05/31/2023]
Abstract
Background Diabetes mellitus is one of the modifiable risk factors for stroke. Stroke is common in Nigeria, but there is a paucity of national data on the frequency of diabetes in stroke. This study aimed to estimate to what extent diabetes a risk factor for stroke in Nigeria. Methods The study design is a systematic review, and the PRISMA guidelines were strictly followed. African Journal Online (AJOL), PubMed, SCOPUS and Google Scholar were systematically searched. The Newcastle-Ottawa scale was used to assess the quality, heterogeneity was determined with the I2 statistic, and the DerSimonian Laird random effect model was selected for the meta-analysis. Results The studies were distributed across different regions of the country. The total sample size was 9397. The weighted average age of the patients with stroke was 53.7 years. The attributable risk of diabetes in stroke, among Nigerian patients, was 0.20 (95% CI: 0.17-0.22; p < 0.0001). The attributable risk has been rising steadily since the advent of the new century, and it is relatively higher in southern Nigeria. Conclusion The attributable risk of diabetes in stroke, among Nigerian patients is high. This varies across the regions but it is rising progressively nationally.
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Kumar A, Ravi R, Sivakumar RK, Chidambaram V, Majella MG, Sinha S, Adamo L, Lau ES, Al’Aref SJ, Asnani A, Sharma G, Mehta JL. Prolactin Inhibition in Peripartum Cardiomyopathy: Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101461. [PMID: 36261102 PMCID: PMC9805509 DOI: 10.1016/j.cpcardiol.2022.101461] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 10/13/2022] [Indexed: 02/03/2023]
Abstract
Heart failure (HF) is one of the leading causes of maternal mortality and morbidity in the United States. Peripartum cardiomyopathy (PPCM) constitutes up to 70% of all HF in pregnancy. Cardiac angiogenic imbalance caused by cleaved 16kDa prolactin has been hypothesized to contribute to the development of PPCM, fueling investigation of prolactin inhibitors for the management of PPCM. We conducted a systematic review and meta-analysis to assess the impact of prolactin inhibition on left ventricular (LV) function and mortality in patients with PPCM. We included English language articles from PubMed and EMBASE published upto March 2022. We pooled the mean difference (MD) for left ventricular ejection fraction (LVEF) at follow-up, odds ratio (OR) for LV recovery and risk ratio (RR) for all-cause mortality using random-effects meta-analysis. Among 548 studies screened, 10 studies (3 randomized control trials (RCTs), 2 retrospective and 5 prospective cohorts) were included in the systematic review. Patients in the Bromocriptine + standard guideline directed medical therapy (GDMT) group had higher LVEF% (pMD 12.56 (95% CI 5.84-19.28, I2=0%) from two cohorts and pMD 14.25 (95% CI 0.61-27.89, I2=88%) from two RCTs) at follow-up compared to standard GDMT alone group. Bromocriptine group also had higher odds of LV recovery (pOR 3.55 (95% CI 1.39-9.1, I2=62)). We did not find any difference in all-cause mortality between the groups. Our analysis demonstrates that the addition of Bromocriptine to standard GDMT was associated with a significant improvement in LVEF% and greater odds of LV recovery, without significant reduction in all-cause mortality.
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Affiliation(s)
- Amudha Kumar
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Ramya Ravi
- Department of Anesthesia and Intensive Care, Chinese university of Hong Kong, Prince of Wales hospital, Shatin, Hong Kong
| | - Ranjith K. Sivakumar
- Department of Anesthesia and Intensive Care, Chinese university of Hong Kong, Prince of Wales hospital, Shatin, Hong Kong
| | - Vignesh Chidambaram
- Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Marie G. Majella
- Department of Community Medicine, Sri Venkateshwaraa Medical College Hospital & Research Center, Pondicherry, India
| | - Shashank Sinha
- Division of Cardiology, Inova Heart and Vascular Institute, Fairfax, VA
| | - Luigi Adamo
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Emily S. Lau
- Division of Cardiology, Massachusetts General Hospital, Boston, MA
| | - Subhi J. Al’Aref
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Aarti Asnani
- Beth Israel Deaconess Medical Center, Harvard Medical School, Cardiovascular Institute, Boston, MA
| | - Garima Sharma
- Department of Medicine, Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jawahar L. Mehta
- Division of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
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Nnate DA, Eleazu CO, Abaraogu UO. Ischemic Heart Disease in Nigeria: Exploring the Challenges, Current Status, and Impact of Lifestyle Interventions on Its Primary Healthcare System. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:211. [PMID: 35010468 PMCID: PMC8751082 DOI: 10.3390/ijerph19010211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 02/07/2023]
Abstract
The burden of ischemic heart disease in Nigeria calls for an evidence-based, innovative, and interdisciplinary approach towards decreasing health inequalities resulting from individual lifestyle and poor socioeconomic status in order to uphold the holistic health of individuals to achieve global sustainability and health equity. The poor diagnosis and management of ischemic heart disease in Nigeria contributes to the inadequate knowledge of its prognosis among individuals, which often results in a decreased ability to seek help and self-care. Hence, current policies aimed at altering lifestyle behaviour to minimize exposure to cardiovascular risk factors may be less suitable for Nigeria's diverse culture. Mitigating the burden of ischemic heart disease through the equitable access to health services and respect for the autonomy and beliefs of individuals in view of achieving Universal Health Coverage (UHC) requires comprehensive measures to accommodate, as much as possible, every individual, notwithstanding their values and socioeconomic status.
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Affiliation(s)
- Daniel A. Nnate
- Department of Nursing and Community Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
- Department of Public Health, Faculty of Health and Social Care, University of Chester, Chester CH1 1SL, UK
| | - Chinedum O. Eleazu
- Department of Chemistry, Biochemistry & Molecular Biology, Alex Ekwueme Federal University Ndufu-Alike, Abakaliki 482131, Ebonyi State, Nigeria;
| | - Ukachukwu O. Abaraogu
- Department of Medical Rehabilitation, University of Nigeria, Enugu 410001, Enugu State, Nigeria;
- Department of Physiotherapy and Paramedicine, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow G4 0BA, UK
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Saliu MA, Salihu A, Mada SB, Owolabi OA. Dyslipidaemia-related cardiovascular risk among pregnant women attending Aminu Kano Teaching Hospital Kano: A longitudinal study. J Taibah Univ Med Sci 2021; 16:870-877. [PMID: 34899132 PMCID: PMC8626804 DOI: 10.1016/j.jtumed.2021.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/26/2021] [Accepted: 07/10/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Maternal dyslipidaemia and atherogenic lipid profiles have undesirable effects on maternal and foetal well-being throughout gestation. This study investigates the changes in serum lipid profiles, the prevalence of dyslipidaemia, and the risk of cardiovascular disease among pregnant women attending the antenatal care unit of the Aminu Kano Teaching Hospital (AKTH), Kano. METHODS A total of 112 pregnant women visiting AKTH in their second trimester were recruited and followed up within their third trimester. The demographic characteristics, daily dietary consumption patterns, and lipid profiles of all women were assessed using standard methods. RESULTS The results revealed that the mean age and gestational age of the pregnant women were approximately 29 ± 6 years and 20 ± 3 weeks, respectively. Most pregnant women were multiparous (76) and multigravida (93). Regarding daily dietary consumption patterns, 20.5%, 63.4%, 13.4%, and 8.0% of the pregnant women consumed nuts, palm oil, butter, and sardines at least one to three times, respectively. Moreover, the serum lipid profiles revealed that the prevalence of dyslipidaemia, hypercholesterolaemia, hypertriglyceridaemia, increased low-density lipoprotein levels, and decreased high-density lipoprotein levels among pregnant women during the second trimester were 69.6%, 19.6%, 36.6%, 18.8%, and 49.1%, respectively. All these parameters significantly increased to 91.8%, 54.1%, 75.3%, 40.0%, and 62.4%, respectively, in the third trimester. Pregnant women showed a high risk of cardiovascular disease in both the second (81.0%) and third (85.0%) trimesters. CONCLUSION Progression from mid-pregnancy to delivery is associated with an increased risk of maternal dyslipidaemia and cardiovascular diseases among pregnant women.
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Affiliation(s)
- Muhammad A. Saliu
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Aliyu Salihu
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Sanusi B. Mada
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
| | - Olumuyiwa A. Owolabi
- Department of Biochemistry, Faculty of Life Sciences, Ahmadu Bello University, Zaria, Nigeria
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Dele-Ojo BF, Raimi TH, Fadare JO, Ajayi EA, Ajayi DD, Ojo OD, Dada SA, Ajayi OA, Ogunmodede JA. Knowledge and Prevalence of Heart Disease Risk Factors Among Staff of a Tertiary Institution in Nigeria. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 41:387-394. [PMID: 33167795 DOI: 10.1177/0272684x20972653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Cardiovascular disease is the most common cause of mortality worldwide. Hence, awareness of cardiovascular risk factors is an essential step towards effective reduction of the disease burden. This study determined the knowledge and prevalence of cardiovascular risk factors among Staff of Ekiti State University. Ado-Ekiti, Nigeria. METHODS A cross-sectional study which comprised of 223 members of staff. RESULTS There were 103 males (46.2%). Low knowledge of heart disease risk factors was found in 68.6% of the respondents. The prevalence of hypertension, diabetes mellitus, overweight, obesity, physical inactivity was 35.4%, 12.1%, 31.8%, 23.3%, and 83% respectively. Family history of hypertension was a predictor of a high level of knowledge. CONCLUSION A low level of knowledge and increasing prevalence of cardiovascular risk factors existed among staff of Ekiti State University, Nigeria. Hence, there should be a step-up of awareness campaigns and promotion of healthy lifestyle among this category of people.
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Affiliation(s)
- B F Dele-Ojo
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - T H Raimi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - J O Fadare
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - E A Ajayi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - D D Ajayi
- Department of Chemical Pathology, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - O D Ojo
- Department of Orthopaedics Surgery, Federal Teaching Hospital, Ido-Ekiti, Nigeria
| | - S A Dada
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - O A Ajayi
- Department of Medicine, Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria
| | - J A Ogunmodede
- Department of Medicine, University of Ilorin, Ilorin, Nigeria
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Opportunistic screening of cardiovascular disease risk factors in community pharmacies in Nigeria: a cross-sectional study. Int J Clin Pharm 2020; 42:1469-1479. [PMID: 32960427 DOI: 10.1007/s11096-020-01112-2] [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: 06/22/2019] [Accepted: 07/25/2020] [Indexed: 10/23/2022]
Abstract
Background Early identification and treatment of cardiovascular disease (CVD) risk factors through screening are crucial in the primary prevention of CVD and reduction in healthcare-related costs. Use of Non-Physician Healthcare-workers including Community Pharmacists has been advocated as an effective and cost-efficient model of healthcare delivery. In Nigeria the use of community pharmacists for mass screening of CVD risk factors has not been explored. Objective We sought to investigate the possibility of mass CVD risk factor screening in community pharmacies by pharmacists. Setting Lagos, Nigeria. Methods Between October and December 2018 eight hundred and eighty-nine apparently healthy participants were screened for obesity, hypertension, diabetes and hypercholesterolaemia in ten community pharmacies. Diabetes and hypercholesterolaemia were screened for using point-of-care testing modalities. A structured questionnaire was used to obtain the socio-demographic data of the participants. Main outcome measures Prevalence of overweight/obesity, hypertension, diabetes, hypercholesterolaemia, smoking and alcohol intake. Results Mean age of the subjects was 56.8 ± 21.1 years. Majority (57.4%) were females. Prevalence of smoking and alcohol intake were 4.3% and 26.7% respectively. 59.7% and 71.5% of males and females were either overweight (BMI ≥ 25 kg/m2) or obese (BMI ≥ 30 kg/m2) respectively. Prevalence of hypertension was 28.2% in all subjects, 30.9% in males and 26.3% in females, p < 0.001. Using BP > 130/80 mmHg prevalence of hypertension was 55.1%. Diabetes was detected in 3% of the subjects while 45.3% had hypercholesterolaemia. In total, 64.1% of the subjects were diagnosed with CVD risk factors for the first time. Conclusion Opportunistic screening for CVD risk factors is possible in community pharmacies and has the ability to detect previously undiagnosed risk factors. This community pharmacy based model could serve as a cost-effective approach to primary prevention of CVD.
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Naheeda P, Sharifullah K, Ullah SS, Azeem AM, Shahzad Y, Kinza W. Development of a cost-effective CVD prediction model using lifestyle factors. A cohort study in Pakistan. Afr Health Sci 2020; 20:849-859. [PMID: 33163052 PMCID: PMC7609114 DOI: 10.4314/ahs.v20i2.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Cardiovascular diseases (CVD) such as hypertension and ischemic heart diseases cause 35 to 40% of deaths every year in Pakistan. Several lifestyle factors such as dietary habits, lack of exercise, mental stress, body habitus (i.e., body mass index, waist), personal habits (smoking, sleep, fitness) and clinical conditions (i.e., diabetes, dyslipidemia and hypertension) have been shown to be strongly associated with the etiology of CVD. Epidemiological studies in Pakistan have shown poor adherence of people to healthy lifestyle and lack of knowledge in adopting healthy alternatives. There are well validated cardiovascular risk estimation tools (QRISK model) that cn predict the probability of future cardiac events. The existing tools are based on laboratory investigations of biochemical test but there is no widely accepted tool available that predicts the CVD risk probability based on lifestyle factors. Aims: Aim of the current study was to develop alternative CVD risk estimation model based on lifestyle factors and physical attributes (without using laboratory investigation) using QRISK model as the gold standard. Study Design: Clinical and lifestyle data of one hundred and sixty subjects were collected to formulate a regression model for predicting CVD risk probability. Methods: Lifestyle factors as independent variables (IV) include BMI, waist circumference, physical activities (stamina, strength, flexibility, posture), smoking, general illnesses, dietary intake, stress and physical characteristics. CVD risk probability of QRISK Intervention computed through clinical variables was used as a dependent variable (DV) in present research. Chronological age was also included in analysis in addition to selected lifestyle factors. Regression analysis, principal component analysis and bivariate correlations were applied to assess the relationship among predictor variables and cardiovascular risk score. Results: Chronological age, waist circumference, BMI and strength showed significant effect on CVD risk probability. The proposed model can be used to calculate CVD risk probability with 72.9% accuracy for the targeted population. Conclusion: The model involves only those features which can be measured without any clinical test. The proposed model is rapid and less costly hence appropriate for use in developing countries like Pakistan.
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Affiliation(s)
- Parveen Naheeda
- School of Electrical Engineering and Computer Science, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Khan Sharifullah
- School of Electrical Engineering and Computer Science, National University of Sciences and Technology (NUST), Islamabad, Pakistan
- Corresponding author: Sharifullah Khan, School of Electrical Engineering and Computer Science, National University of Sciences and Technology (NUST), Islamabad, Pakistan.
| | - Shah Saeed Ullah
- Department of Cardiology, Shifa International Hospital Islamabad, Pakistan
| | - Abbas Muhammad Azeem
- University Institute of Information Technology, PMAS, Arid Agriculture University, Rawalpindi, Pakistan
| | - Younis Shahzad
- School of Electrical Engineering and Computer Science, National University of Sciences and Technology (NUST), Islamabad, Pakistan
| | - Waqar Kinza
- Department of Cardiology, Shifa International Hospital Islamabad, Pakistan
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Ghamri RA, Alzahrani NS, Alharthi AM, Gadah HJ, Badoghaish BG, Alzahrani AA. Cardiovascular risk factors among high-risk individuals attending the general practice at king Abdulaziz University hospital: a cross-sectional study. BMC Cardiovasc Disord 2019; 19:268. [PMID: 31775642 PMCID: PMC6882018 DOI: 10.1186/s12872-019-1261-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 11/15/2019] [Indexed: 02/10/2023] Open
Abstract
Background Cardiovascular disease (CVD) is the primary cause of death worldwide, accounting for 31.0% of all deaths and more than 18 million deaths annually. The 2008 World Health Report indicated that 144 (35%) of the 413 deaths per 100,000 in 2002 in the Kingdom of Saudi Arabia (KSA) were due to CVD. Primary prevention is an important focus of most of the cardiovascular prevention guidelines around the world. In this study, we aimed to describe the prevalence of extrinsic risk factors for CVDs in a high-risk population attending general practice in Jeddah, KSA. Methods We conducted a cross-sectional survey at King Abdulaziz University Hospital in Jeddah. Patients started on lipid-lowering and/or antihypertensive and/or antidiabetes treatments without a history of established cardiovascular disease were interviewed. The questionnaire was adopted from the EUROASPIRE III study. Results Two hundred and fifty high-risk individuals (80.0% female) were interviewed. Overall, 72% of the patients had been diagnosed with hypertension, 61.2% of patients had dyslipidemia, and approximately two-thirds of patients had diabetes mellitus. Most of the patients (88%) were non-smokers. The mean waist circumference of patients was 101.6 ± 14.1 cm, which suggests most were clinically obese. About 54.8% of the patients followed an unhealthy diet and 52.0% were physically inactive. There were significant differences between women and men in relation to dyslipidemia (p = 0.007), unhealthy diet (p = 0.034), being overweight (p = 0.018), and high blood cholesterol (p = 0.002). We observed significantly greater prevalence of hypertension (p = 0.073), unhealthy diet (p = 0.015), being overweight (p = 0.018), and high blood cholesterol (p = 0.000) in those patients with dyslipidemia. Conclusion Our study presents novel findings in the KSA. Women were more likely to have high-risk CVD risk factors compared with their male counterparts in this sample. Gender-specific prevention programs in the KSA should be considered to more appropriately target at-risk individuals, to reduce preventable morbidity and mortality associated with CVDs.
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Affiliation(s)
- Ranya A Ghamri
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia.
| | - Nada S Alzahrani
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Amal M Alharthi
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Hana J Gadah
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Bayan G Badoghaish
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
| | - Azzah A Alzahrani
- Department of Family Medicine, Faculty of Medicine, King Abdulaziz University, P.O. Box: 42806, Jeddah, 21551, Jeddah, Kingdom of Saudi Arabia
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