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Wozniak H, Tabah A, Barbier F, Ruckly S, Loiodice A, Akova M, Leone M, Conway Morris A, Bassetti M, Arvaniti K, Ferrer R, de Bus L, Paiva JA, Bracht H, Mikstacki A, Alsisi A, Valeanu L, Prazak J, Timsit JF, Buetti N. Hospital-acquired bloodstream infections in critically ill cirrhotic patients: a post-hoc analysis of the EUROBACT-2 international cohort study. Ann Intensive Care 2024; 14:70. [PMID: 38698291 PMCID: PMC11065852 DOI: 10.1186/s13613-024-01299-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 04/19/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND Hospital-acquired bloodstream infections are common in the intensive care unit (ICU) and have a high mortality rate. Patients with cirrhosis are especially susceptible to infections, yet there is a knowledge gap in the epidemiological distinctions in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients in the ICU. It has been suggested that cirrhotic patients, present a trend towards more gram-positive infections, and especially enterococcal infections. This study aims to describe epidemiological differences in hospital-acquired bloodstream infections between cirrhotic and non-cirrhotic patients hospitalized in the ICU regarding infection sources, microorganisms and mortality. METHODS Using prospective Eurobact-2 international cohort study data, we compared hospital-acquired bloodstream infections sources and microorganisms in cirrhotic and non-cirrhotic patients. The association between Enterococcus faecium and cirrhosis was studied using a multivariable mixed logistic regression. The association between cirrhosis and mortality was assessed by a multivariable frailty Cox model. RESULTS Among the 1059 hospital-acquired bloodstream infections patients included from 101 centers, 160 had cirrhosis. Hospital-acquired bloodstream infection source in cirrhotic patients was primarily abdominal (35.6%), while it was pulmonary (18.9%) for non-cirrhotic (p < 0.01). Gram-positive hospital-acquired bloodstream infections accounted for 42.3% in cirrhotic patients compared to 33.2% in non-cirrhotic patients (p = 0.02). Hospital-acquired bloodstream infections in cirrhotic patients were most frequently caused by Klebsiella spp (16.5%), coagulase-negative Staphylococci (13.7%) and E. faecium (11.5%). E. faecium bacteremia was more frequent in cirrhotic patients (11.5% versus 4.5%, p < 0.01). After adjusting for possible confounding factors, cirrhosis was associated with higher E. faecium hospital-acquired bloodstream infections risk (Odds ratio 2.5, 95% CI 1.3-4.5, p < 0.01). Cirrhotic patients had increased mortality compared to non-cirrhotic patients (Hazard Ratio 1.3, 95% CI 1.01-1.7, p = 0.045). CONCLUSIONS Critically ill cirrhotic patients with hospital-acquired bloodstream infections exhibit distinct epidemiology, with more Gram-positive infections and particularly Enterococcus faecium.
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Affiliation(s)
- Hannah Wozniak
- Division of Critical Care, Department of Acute Medicine, University Hospital of Geneva, University of Geneva, Geneva, Switzerland.
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
| | - Alexis Tabah
- Intensive Care Unit, Redcliffe Hospital, Brisbane, Australia
- Queensland Critical Care Research Network (QCCRN), Brisbane, QLD, Australia
- Queensland University of Technology, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - François Barbier
- Service de Médecine Intensive-Réanimation, Centre Hospitalier Régional d'Orléans, Orléans, France
| | - Stéphane Ruckly
- Université de Paris, INSERM, IAME UMR 1137, Paris, 75018, France
- ICUREsearch, Biometry, Fontaine, 38600, France
| | | | - Murat Akova
- Department of Infectious Diseases, Hacettepe University School of Medicine, Ankara, Turkey
| | - Marc Leone
- Department of Anesthesiology and Intensive Care Unit, Hospital Nord, Aix Marseille University, Assistance Publique Hôpitaux Universitaires de Marseille, Marseille, France
| | - Andrew Conway Morris
- Division of Anaesthesia, Department of Medicine, University of Cambridge, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 0QQ, UK
- Division of Immunology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge, Cb2 1QP, UK
- JVF Intensive Care Unit, Addenbrooke's Hospital, Cambridge, Hills Road, Cambridge, CB2 0QQ, UK
| | - Matteo Bassetti
- Infectious Diseases Clinic, Department of Health Sciences, University of Genoa and Ospedale Policlinico San Martino, Genoa, Italy
| | - Kostoula Arvaniti
- Intensive Care Unit, Papageorgiou University Affiliated Hospital, Thessaloníki, Greece
| | - Ricard Ferrer
- Intensive Care Department, SODIR-VHIR Research Group, Vall d'Hebron University Hospital, Barcelona, Spain
| | - Liesbet de Bus
- Department of Critical Care Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Internal Medicine and Paediatrics, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Jose Artur Paiva
- Intensive Care Medicine Department, Centro Hospitalar Universitário São João (CHUSJ), Porto, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto (FMUP), Porto, Portugal
| | - Hendrik Bracht
- Central Interdisciplinary Emergency Medicine, University Hospital Ulm, Ulm, Germany
| | - Adam Mikstacki
- Faculty of Health Sciences, Poznan University of Medical Sciences, Poznan, Poland
- Department of Anaesthesiology and Intensive Therapy, Regional Hospital in Poznan, Poznan, Poland
| | - Adel Alsisi
- ICU Department, Prime Hospital, Dubai, United Arab Emirates
- Critical Care Department, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Liana Valeanu
- Cardiac Anesthesiology and Intensive Care Department I, Emergency Institute for Cardiovascular Diseases Prof. Dr. C. C. Iliescu, Bucharest, Romania
| | - Josef Prazak
- Department of Intensive Care Medicine, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Jean-François Timsit
- Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France
- Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, Paris, France
| | - Niccolò Buetti
- Université Paris- Cité, INSERM, IAME UMR 1137, Paris, 75018, France
- Infection Control Program and World Health Organization Collaborating Centre on Patient Safety, Faculty of Medicine, University Hospitals, University of Geneva, Geneva, Switzerland
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Garrouste-Orgeas M, Marché V, Pujol N, Michel D, Evin A, Fossez-Diaz V, Perruchio S, Vanbésien A, Verlaine C, Copel L, Kaczmarek W, Birkui de Francqueville L, Michonneau-Gandon V, de Larivière E, Poupardin C, Touzet L, Guastella V, Mathias C, Mhalla A, Bouquet G, Richard B, Gracia D, Bienfait F, Verliac V, Ranchou G, Kirsch S, Flahault C, Loiodice A, Bailly S, Ruckly S, Timsit JF. Incidence and risk factors of prolonged grief in relatives of patients with terminal cancer in French palliative care units: The Fami-Life multicenter cohort study. Palliat Support Care 2023:1-10. [PMID: 36878669 DOI: 10.1017/s1478951523000111] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
Abstract
OBJECTIVES Psychological consequences of grief among relatives are insufficiently known. We reported incidence of prolonged grief among relatives of deceased patients with cancer. METHODS Prospective cohort study of 611 relatives of 531 patients with cancer hospitalized for more than 72 hours and who died in 26 palliative care units was conducted. The primary outcome was prolonged grief in relatives 6 months after patient death, measured with the Inventory Complicated Grief (ICG > 25, range 0-76, a higher score indicates more severe symptoms) score. Secondary outcomes in relatives 6 months after patient death were anxiety and depression symptoms based on Hospital Anxiety and Depression Scale (HADS) score (range 0 [best]-42 [worst]), higher scores indicate more severe symptoms, minimally important difference 2.5. Post-traumatic stress disorder symptoms were defined by an Impact Event Scale-Revised score >22 (range 0-88, a higher score indicates more severe symptoms). RESULTS Among 611 included relatives, 608 (99.5%) completed the trial. At 6 months, significant ICG scores were reported by 32.7% relatives (199/608, 95% CI, 29.0-36.4). The median (interquartile range ICG score) was 20.0 (11.5-29.0). The incidence of HADS symptoms was 87.5% (95% CI, 84.8-90.2%) at Days 3-5 and 68.7% (95% CI, 65.0-72.4) 6 months after patient's death, with a median (interquartile range) difference of -4 (-10 to 0) between these 2 time points. Improvement in HADS anxiety and depression scores were reported by 62.5% (362/579) relatives. SIGNIFICANCE OF RESULTS These findings support the importance of screening relatives having risk factors of developing prolonged grief in the palliative unit and 6 months after patient's death.
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Affiliation(s)
- Maité Garrouste-Orgeas
- IAME, INSERM, Université de Paris, Paris, France
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
- Medical Unit, French British Hospital, Levallois-Perret, France
| | | | - Nicolas Pujol
- Research Department Palliative Care Unit, Jeanne Garnier Institution, Paris, France
| | - Dominique Michel
- Palliative Care Unit, Reuilly Diaconesses Fondation, Rueil Malmaison, France
| | - Adrien Evin
- Palliative Care Unit, University Teaching Hospital, Nantes, France
| | | | | | | | | | - Laure Copel
- Palliative Care Unit, Diaconesses Croix Saint Simon Hospital, Paris, France
| | | | | | | | | | | | - Licia Touzet
- Palliative Care Unit, University Teaching Hospital, Lille, France
| | - Virginie Guastella
- Palliative Care Unit, University Teaching Hospital, Clermont Ferrand, France
| | - Carmen Mathias
- Palliative Care Unit, Mulhouse Sud Alsace Hospital Network, Mulhouse, France
| | - Alaa Mhalla
- Palliative Care Unit, Albert Chenevier Hospital, Créteil, France
| | | | - Bruno Richard
- Palliative Care Unit, University Teaching Hospital, Montpellier, France
| | - Dominique Gracia
- Palliative Care Unit, General Hospital, Salon-de-Provence, France
| | - Florent Bienfait
- Palliative Care Unit, University Teaching Hospital, Angers, France
| | - Virginie Verliac
- Palliative Care Unit, Saintonge General Hospital, Saintes, France
| | - Gaelle Ranchou
- Palliative Care Unit, General Hospital, Périgueux, France
| | - Sylvie Kirsch
- Palliative Care Unit, Bligny Hospital, Briis-Sous-Forges, France
| | - Cécile Flahault
- Laboratory of Psychopathology and Health Process, Paris University Paris, Boulogne-Billancourt, France
| | | | | | | | - Jean-François Timsit
- IAME, INSERM, Université de Paris, Paris, France
- Medical and infectious diseases ICU (MI2), APHP Bichat Hospital, Paris, France
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Buetti N, Patrier J, Le Hingrat Q, Loiodice A, Bouadma L, Visseaux B, Timsit JF. Risk Factors for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Detection in Blood of Critically Ill Patients. Clin Infect Dis 2021; 72:e690-e691. [PMID: 32875309 PMCID: PMC7499490 DOI: 10.1093/cid/ciaa1315] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France
| | - Juliette Patrier
- Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Quentin Le Hingrat
- Paris University, AP-HP, Hôpital Bichat-Claude-Bernard, IAME, INSERM, Laboratoire de Virologie, Paris, France
| | - Ambre Loiodice
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France
| | - Lila Bouadma
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France.,Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
| | - Benoit Visseaux
- Paris University, AP-HP, Hôpital Bichat-Claude-Bernard, IAME, INSERM, Laboratoire de Virologie, Paris, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, Team DeSCID, Paris, France.,Medical and Infectious Diseases Intensive Care Unit (MI2), Bichat-Claude Bernard Hospital, AP-HP, Paris, France
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Buetti N, Souweine B, Mermel L, Mimoz O, Ruckly S, Loiodice A, Mongardon N, Lucet JC, Parienti JJ, Timsit JF. Concurrent systemic antibiotics at catheter insertion and intravascular catheter-related infection in the ICU: a post hoc analysis using individual data from five large RCTs. Clin Microbiol Infect 2020; 27:1279-1284. [PMID: 33152538 DOI: 10.1016/j.cmi.2020.10.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 10/20/2020] [Accepted: 10/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Data on the impact of systemic antibiotics at the time of catheter insertion are scarce. Therefore, we assessed the association between concurrent antibiotic administration at insertion and short-term catheter-related infections. METHODS We used individual data gathered from five large, randomized, controlled ICU trials. We analysed adult patients who required arterial, short-term central venous or dialysis catheter insertion in the ICU. The effect of antibiotics at insertion on major catheter-related infection (MCRI), catheter-related bloodstream infection (CRBSI) and colonization was estimated using multivariate marginal Cox and propensity score models. RESULTS We included 10 269 patients and 18 743 catheters from 36 ICUs. Antibiotic use was ongoing at the time of 11 361 catheter insertions (60.6%). After adjusting for well-known risk factors for intravascular catheter infection, we observed a similar risk for MCRI (HR 0.83, 95%CI 0.62-1.10, p 0.19) and CRBSI (HR 0.85, 95%CI 0.60-1.22, p 0.38) between the antibiotic and no-antibiotic groups. A confirmatory analysis using propensity score showed consistent results. No specific antibiotic subclasses reduced the risk of MCRI. Non-fermenting Gram-negative bacilli were more frequently observed in the antibiotic group. CONCLUSIONS Ongoing antibiotic administration at the time of catheter insertion was not associated with a decrease risk of catheter-related infections and should not be carried out for preventing such infections. Our results bring new insights to antimicrobial stewardship in critically ill patients and may direct empirical antimicrobial therapy if an intravascular catheter infection is suspected.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, F-75006, Paris, France; Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Bertrand Souweine
- Medical ICU, Gabriel-Montpied University Hospital, Clermont-Ferrand, France
| | - Leonard Mermel
- Division of Infectious Diseases, Rhode Island Hospital and Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
| | - Olivier Mimoz
- Service des Urgences Adultes and SAMU 86, Centre Hospitalier Universitaire de Poitiers, Poitiers, France, Université de Poitiers, Poitiers, France, Inserm U1070, Poitiers, 86021, France
| | | | - Ambre Loiodice
- ICURESEARCH, 6B avenue de Romans, Saint Marcellin, France
| | - Nicolas Mongardon
- Service d'Anesthésie-Réanimation Chirurgicale, Hôpitaux Universitaires Henri Mondor, DMU CARE, Assistance Publique-Hôpitaux de Paris (AP-HP), Inserm U955 équipe 3, Faculté de Santé, Université Paris-Est Créteil, Créteil, France
| | - Jean-Christophe Lucet
- University of Paris, INSERM, IAME, F-75006, Paris, France; AP-HP, Infection Control Unit, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
| | - Jean-Jacques Parienti
- Department of Biostatistics and Clinical Research and Department of Infectious Diseases, Caen University Hospital, Caen, 14000, France; EA2656 Groupe de Recherche sur l'Adaptation Microbienne (GRAM 2.0), Université Caen Normandie, Caen, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, F-75006, Paris, France; Medical and Infectious Diseases Intensive Care Unit, AP-HP, Bichat-Claude Bernard University Hospital, 46 rue Henri Huchard, 75877, Paris Cedex, France
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5
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Buetti N, Wicky PH, Le Hingrat Q, Ruckly S, Mazzuchelli T, Loiodice A, Trimboli P, Forni Ogna V, de Montmollin E, Bernasconi E, Visseaux B, Timsit JF. SARS-CoV-2 detection in the lower respiratory tract of invasively ventilated ARDS patients. Crit Care 2020; 24:610. [PMID: 33066801 PMCID: PMC7562762 DOI: 10.1186/s13054-020-03323-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 10/04/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Data on SARS-CoV-2 load in lower respiratory tract (LRT) are scarce. Our objectives were to describe the viral shedding and the viral load in LRT and to determine their association with mortality in critically ill COVID-19 patients. METHODS We conducted a binational study merging prospectively collected data from two COVID-19 reference centers in France and Switzerland. First, we described the viral shedding duration (i.e., time to negativity) in LRT samples. Second, we analyzed viral load in LRT samples. Third, we assessed the association between viral presence in LRT and mortality using mixed-effect logistic models for clustered data adjusting for the time between symptoms' onset and date of sampling. RESULTS From March to May 2020, 267 LRT samples were performed in 90 patients from both centers. The median time to negativity was 29 (IQR 23; 34) days. Prolonged viral shedding was not associated with age, gender, cardiac comorbidities, diabetes, immunosuppression, corticosteroids use, or antiviral therapy. The LRT viral load tended to be higher in non-survivors. This difference was statistically significant after adjusting for the time interval between onset of symptoms and date of sampling (OR 3.78, 95% CI 1.13-12.64, p = 0.03). CONCLUSIONS The viral shedding in LRT lasted almost 30 days in median in critically ill patients, and the viral load in the LRT was associated with the 6-week mortality.
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Affiliation(s)
- Niccolò Buetti
- University of Paris, INSERM, IAME, F-75006, Paris, France. .,Ente Ospedaliero Cantonale, Locarno Community Hospital, Locarno, Switzerland. .,Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
| | - Paul-Henri Wicky
- Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France
| | - Quentin Le Hingrat
- University of Paris, INSERM, IAME, F-75006, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de virologie, F-75018, Paris, France
| | | | - Timothy Mazzuchelli
- Ente Ospedaliero Cantonale, Locarno Community Hospital, Locarno, Switzerland
| | - Ambre Loiodice
- University of Paris, INSERM, IAME, F-75006, Paris, France
| | - Pierpaolo Trimboli
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland.,Clinic of Endocrinology and Diabetology, Lugano and Mendrisio Regional Hospital, Ente Ospedaliero Cantonale, Lugano, Switzerland
| | | | - Etienne de Montmollin
- University of Paris, INSERM, IAME, F-75006, Paris, France.,Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France
| | - Enos Bernasconi
- Ente Ospedialiero Cantonale, Division of Infectious Diseases, Regional Hospital Lugano, Lugano, Switzerland
| | - Benoit Visseaux
- University of Paris, INSERM, IAME, F-75006, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de virologie, F-75018, Paris, France
| | - Jean-François Timsit
- University of Paris, INSERM, IAME, F-75006, Paris, France.,Medical and Infectious Diseases ICU (MI2), Bichat-Claude Bernard Hospital, AP-HP, 75018, Paris, France
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Garavelli L, Pedori S, Zanacca C, Caselli G, Loiodice A, Mantovani G, Ammenti A, Virdis R, Banchini G. Albright's hereditary osteodystrophy (pseudohypoparathyroidism type Ia): clinical case with a novel mutation of GNAS1. Acta Biomed 2005; 76:45-8. [PMID: 16116826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Albright's hereditary osteodystrophy is characterized by ectopic calcification and ossification, round face, short hands and feet with short terminal phalanges, short metacarpals (especially 4th and 5th) and absence of the 4th knuckle (brachydactyly type E). Here we describe a case that recently came to our attention of a girl suffering from seizures caused by hypocalcaemia, in which the clinical diagnosis of Albright's hereditary osteodystrophy and Pseudohypoparathyroidism (PHP) (Pseudohypoparathyroidism Ia) was confirmed by DNA molecular analysis. This analysis revealed a novel mutation of GNAS 1, resulting in the nonsense mutation of exon 13 (CAG-->TAG, codon 384). This result expands the spectrum of GNAS1 mutations associated with this disorder.
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Affiliation(s)
- Livia Garavelli
- Department of Pediatrics, S. Maria Nuova Hospital, Reggio Emilia, Italy.
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