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Dehghani S, Akbarzadeh Pasha B, Karimi A, Afshin A. Severe hyponatremia in an infant with epidermolysis bullosa: a case report. J Med Case Rep 2022; 16:358. [PMID: 36203176 PMCID: PMC9540733 DOI: 10.1186/s13256-022-03601-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 09/04/2022] [Indexed: 11/24/2022] Open
Abstract
Background Epidermolysis bullosa is a rare inherited connective tissue disorder compromising cellular junctions. Blister formation is the first manifestation of epidermolysis bullosa. As cellular adhesion is affected, it can affect many organs. Due to compromised skin integrity, water loss and electrolyte imbalances are prevalent in these patients. However, hypernatremia is the usual observed sodium imbalance rather than hyponatremia. Case presentation The patient was a 48-day-old Iranian male infant born near term. He was diagnosed with epidermolysis bullosa at 1 month of age. The patient was brought to the pediatrics center with apnea and respiratory distress, and was intubated and admitted to the pediatric intensive care unit. His symptoms started 4 days before the admission with vomiting and poor feeding, and the patient later developed loss of consciousness. Vital signs revealed a pulse rate of 154 beats per minute, respiratory rate of 70 per minute, a temporal temperature of 36.5 °C, nondetectable blood pressure, and oxygen saturation of 96%. The patient was anuric at presentation and was rehydrated. Physical examination showed bolus eruptions all over the body but not in mucosal membranes. Important laboratory findings were white blood cell count of 41,000/mm3 with 68% neutrophils, hemoglobin of 10.8 g/dL, platelet count of 856,000/mm2, negative C-reactive protein (CRP), blood sugar of 514 mg/dL, urea of 129 mg/dL, sodium of 98 mg/dL, corrected sodium of 105 mg/dL, potassium of 5.5 mg/dL, serum creatinine of 1.7 mg/dL, and serum procalcitonin of more than 75 ng/mL. Urine analysis revealed many red blood cells. Brain computed tomography demonstrated loss of differentiation between gray and white matter and effacement of cortical sulci suggesting severe cytotoxic edema. We administered 3% hypertonic saline and corrected the plasma sodium levels, and provided the patient with multiple doses of mannitol as well as antibiotics due to the leukocytosis. Subsequently, after 3 days in pediatric intensive care unit, the symptoms of brain edema resolved, and after 4 days, he was weaned from the ventilator and extubated. Later he was discharged from the pediatric intensive care unit. Conclusion This study illustrates the possibility of severe hyponatremia in patients with epidermolysis bullosa to clinicians. Although uncommon, knowledge on such possibilities is vital due to the possible detrimental outcomes for patients.
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Affiliation(s)
- Soheil Dehghani
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.,Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | | | - Amirali Karimi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Pediatric Nephrologist, Pediatric Chronic Kidney Disease Research Center, Tehran University of Medical Sciences, Tehran, Iran.
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Bazargani B, Noparast Z, Khedmat L, Fahimi D, Esfahani ST, Moghtaderi M, Abbasi A, Afshin A, Mojtahedi SY. Efficacy of rituximab therapy in children with nephrotic syndrome: a 10-year experience from an Iranian pediatric hospital. BMC Pediatr 2022; 22:36. [PMID: 35022016 PMCID: PMC8753871 DOI: 10.1186/s12887-022-03109-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 01/05/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
There are controversy results in the optimal management of children with steroid-dependent and steroid-resistant nephrotic syndrome (SDNS, SRNS). This study aimed to determine the efficacy and safety of rituximab (RTX) in these pediatric patients.
Methods
Medical records of 1–18-year-old Iranian children with SDNS (n = 26) and SRNS (n = 22) with a follow-up for at least 24 months were included from 2009 to 2019. The short- and long-term responses to RTX were respectively evaluated to determine the random protein-to-creatinine ratio after 6 and 24 months and classified as complete (CR) and partial (PR) remission or no response.
Results
Male patients (n = 26) were slightly predominate. The median age of patients at the time of RTX therapy was 8.6 ± 4.01 years. At the end of the 6-month follow-up, CR and PR occurred in 23 (47.9%) and 12 (25%) patients, respectively. Of 23 patients with CR, 18 (69.2%) and 5(22.7%) had SDNS and SRNS, respectively (p < 0.005). However, only 18 (37.5%) of patients after 24 months had been in CR. No significant difference in the CR rate was found between the two groups. RTX was more effective when administered during the proteinuria-free period (p = 0.001).
Conclusion
In the short term, RTX significantly was efficient in inducing complete or PR in SDNS and SRNS patients. However, the favorable response rate in a long-term follow-up was insignificantly lower between the two groups.
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Fahimi D, Khedmat L, Afshin A, Jafari M, Bakouei Z, Beigi EH, Kajiyazdi M, Izadi A, Mojtahedi SY. Demographic, clinical, and laboratory factors associated with renal parenchymal injury in Iranian children with acute pyelonephritis. BMC Infect Dis 2021; 21:1096. [PMID: 34689744 PMCID: PMC8543838 DOI: 10.1186/s12879-021-06798-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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Accepted: 10/15/2021] [Indexed: 12/03/2022] Open
Abstract
Background The association between renal parenchyma changes on dimercaptosuccinic acid (DMSA) scans and demographic, clinical, and laboratory markers was assessed in pediatric patients with acute pyelonephritis. Methods A retrospective study of 67 Iranian babies and children aged 1-month to 12-year with APN was conducted between 2012 and 2018. The presence of renal parenchymal involvement (RPI) during APN was determined using technetium-99m DMSA during the first 2 weeks of hospitalization. The association of DMSA results with demographic data, clinical features (hospitalization stay, fever temperature and duration), and laboratory parameters such as pathogen type, and hematological factors (ESR, CRP, BUN, Cr, Hb, and WBC) was evaluated. Results 92.5% of children with an average age of 43.76 ± 5.2 months were girls. Twenty-four children (35.8%) did not have renal parenchymal injury (RPI), while 26 (38.8%) and 17 (25.4%) patients showed RPI in one and both kidneys, respectively. There was no significant association between RPI and mean ESR, CRP, BUN, and WBC. However, there were significant associations between RPI and higher mean levels of Cr, Hb, and BMI. Conclusions Low BMI and Hb levels and increased Cr levels might be indicative of the presence of RPI in children with APN.
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Affiliation(s)
- Daryoosh Fahimi
- Children's Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Jafari
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Zakeyeh Bakouei
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Kajiyazdi
- Department of Pediatric Hematology and Oncology, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Sadeghi P, Izadi A, Mojtahedi SY, Khedmat L, Jafari M, Afshin A, Yarahmadi P, Hosseinali Beigi E. A 10-year cross-sectional retrospective study on Kawasaki disease in Iranian children: incidence, clinical manifestations, complications, and treatment patterns. BMC Infect Dis 2021; 21:368. [PMID: 33874899 PMCID: PMC8056507 DOI: 10.1186/s12879-021-06046-2] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 04/05/2021] [Indexed: 12/31/2022] Open
Abstract
Background Kawasaki disease (KD) as an acute, systemic vasculitis is the leading cause of acquired heart disease in children under the age of 5 years. Methods A 10-year cross-sectional retrospective study was designed to assess 190 Iranian children with KD during 2008–2018. Demographic data, clinical and laboratory manifestations from the onset of symptoms to diagnosis, clinical signs and symptoms, and subsequent treatments were evaluated to predict hospitalization stay, complications, and response to treatment. Results Children with KD had a male-to-female ratio of 1.18:1 and an average age of 36 months. There was an insignificantly more incidence of KD in cold seasons. The most frequent symptoms were fever (92.6%), oral mucus membrane changes (75.8%), bilateral bulbar conjunctival injection (73.7%), polymorphous skin rash (73.2%), peripheral extremity changes (63.7%), and cervical lymphadenopathy (60.0%). The rate of gastrointestinal, cardiac, joint, and hepatic complications was determined to be 38.4, 27.9, 6.8, and 4.2%, respectively. 89.5% of patients received intravenous immunoglobulin (IVIG) plus aspirin as the first line of treatment, while, 16.3% of them needed an extra second line of treatment. Significantly low serum sodium levels and high platelet counts were detected in KD patients with cardiac complications. Cardiac complications often were more encountered in patients who did not respond to the first line of treatment. Higher platelet count, lower serum sodium amount, and C-reactive protein (CRP) level were significantly associated with a need for an additive second line of treatment. A significant relationship between hospitalization stay and hemoglobin level was found. Conclusion As most of the clinical manifestations and complications were following other reports released over the past few years, such data can be confidently used to diagnose KD in Iran. Seasonal incidence and a positive history of recent infection in a notable number of patients may provide clues to understand possible etiologies of KD. Laboratory markers can successfully contribute to health practitioners with the clinical judgment of the need for additional treatments, possible complications, and hospitalization duration.
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Affiliation(s)
- Payman Sadeghi
- Department of Pediatrics, Bahrami Hospital, Tehran University of Medical Sciences, Shahid Kiaee Street (Ghasem Abad), Damavand Street, Tehran, 1641744991, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran.
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Jafari
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Pourya Yarahmadi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children Hospital, Tehran University of Medical Science, Tehran, Iran
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Fahimi D, Khedmat L, Afshin A, Noparast Z, Jafaripor M, Beigi EH, Ghodsi M, Izadi A, Mojtahedi SY. Clinical manifestations, laboratory markers, and renal ultrasonographic examinations in 1-month to 12-year-old Iranian children with pyelonephritis: a six-year cross-sectional retrospective study. BMC Infect Dis 2021; 21:189. [PMID: 33602159 PMCID: PMC7890627 DOI: 10.1186/s12879-021-05887-1] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Upper urinary tract infection (UTI) or pyelonephritis may increase the pathogenesis rate and risk of severe complications in children due to kidney atrophy. OBJECTIVE A set of clinical symptoms, laboratory markers, and ultrasound findings were assessed to achieve the early diagnosis and prognosis of pyelonephritis in hospitalized pediatrics. METHODS A cross-sectional study with 104 Iranian children (95 girls and 9 boys) aged 1 month to 12 years with acute pyelonephritis during 2012-2018 was conducted. The ultrasound examination of kidneys and urinary tract during hospitalization, the incidence of clinical symptoms, and laboratory markers in blood and urine were monitored to identify the best predictive factors of early diagnosis of this bacterial infection. RESULTS Three-fourth of the patients had one of the four clinical symptoms of abdominal pain, constipation, dysuria, and vomiting, while others were asymptomatic. A much frequency of pyuria (88.46%), Escherichia coli in urine (92.31%), leukocytosis (81.73%), and high ESR (> 10 mm/h, 92.30%) and CRP (> 10 mg/L, 82.82%) was observed. The kidney and urinary tract ultrasonography only in 32.7% of children revealed findings in favor of pyelonephritis (cystitis, ureteral stones, and hydronephrosis). CONCLUSION There was a high frequency of clinical signs and laboratory markers associated with pyelonephritis. Ultrasound alone was not an efficient tool to track febrile UTI as most patients presented normal sonography.
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Affiliation(s)
- Daryoosh Fahimi
- Children’s Hospital Medical Centre, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Khedmat
- Health Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Azadeh Afshin
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Noparast
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Jafaripor
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Effat Hosseinali Beigi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Ghodsi
- Department of Pediatric Intensive Care Unit, Bahrami Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Anahita Izadi
- Department of Pediatric Infection Disease, Tehran University of Medical Sciences, Tehran, Iran
| | - Sayed Yousef Mojtahedi
- Department of Pediatric Nephrology, Bahrami Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Pearson-Stuttard J, Bandosz P, Rehm C, Afshin A, Penalvo J, Whitsel I, Micha R, Danaei G, Gaziano T, Conrad Z, Lloyd-Williams F, Mozaffarian D, Capewell S, O’Flaherty M. OP83 Comparing the impact of price change and mass media campaigns on reducing cardiovascular disease mortality and disparities in the US. Br J Soc Med 2016. [DOI: 10.1136/jech-2016-208064.83] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pearson-Stuttard J, Bandosz P, Rehm C, Afshin A, Penalvo J, Whitsel L, Danaei G, Gaziano T, Mozaffarian D, O’Flaherty M, Capewell S. OP51 Comparing the effectiveness of price reduction and mass media campaigns in reducing cvd mortality by targeting fruit and vegetables intake. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.50] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Guzman-Castillo M, Pearson-Stuttard J, Penalvo J, Rehm C, Afshin A, Danaei G, Gaziano T, Mozaffarian D, O’Flaherty M, Capewell S. OP03 Predicting cardiovascular disease mortality rates in the united states in 2030: prospective modelling approaches. Br J Soc Med 2015. [DOI: 10.1136/jech-2015-206256.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Raeeskarami SR, Aghighi Y, Afshin A, Malek A, Zamani A, Ziaee V. Infantile Systemic Hyalinosis: Report of 17-year Experience. Iran J Pediatr 2014; 24:775-8. [PMID: 26019786 PMCID: PMC4442842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 10/29/2014] [Indexed: 12/04/2022]
Abstract
BACKGROUND Infantile Systemic Hyalinosis (ISH) is a very rare autosomal recessive disorder characterized by connective tissue involvement as hyaline deposition in skin, gastrointestinal tract, muscles, glands and other organs. CASES PRESENTATION We report eight Iranian children (4 male and 4 female) with ISH referred to our hospital from 1996 to 2013. The illness had been diagnosed by clinical manifestations and disease progression. Six of them died and two are alive but very sick. CONCLUSION ISH is a very rare disorder with poor prognosis. Seventy five percent of our 8 patients died before 2 years old due to severe diarrhea, malabsorption and/or infection.
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Affiliation(s)
- Seyed Reza Raeeskarami
- Department of Pediatrics,,Valiye-Asr Hospital, Imam Hospital Complex,,Pediatric Rheumatology Research Group, Rheumatology Research Center
| | - Yahya Aghighi
- Department of Pediatrics,,Valiye-Asr Hospital, Imam Hospital Complex
| | - Azadeh Afshin
- Valiye-Asr Hospital, Imam Hospital Complex,,Corresponding Author; Address: Pediatric Ward, Valiasr Hospital, Imam Khomeini Complex, Tehran, Iran, E-mail:
| | - Abdolreza Malek
- Department of Pediatrics, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Zamani
- Department of Pediatrics,,Valiye-Asr Hospital, Imam Hospital Complex
| | - Vahid Ziaee
- Department of Pediatrics,,Pediatric Rheumatology Research Group, Rheumatology Research Center,,Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran
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Motamedi M, Nikoobakht MR, Aloosh M, Ebrahimi Nasrabady S, Afshin A, Orandi A, Talei Khatibi F. Peri-ictal urinary dysfunction in patients with epilepsy: a cross-sectional study. Urol J 2011; 8:222-226. [PMID: 21910102] [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: 05/31/2023]
Abstract
PURPOSE To evaluate the prevalence of peri-ictal urinary symptoms and their association with seizure type in patients with epilepsy. MATERIALS AND METHODS A total of 115 patients with epilepsy were recruited consecutively from neurology clinic between January 2006 and January 2008. Peri-ictal period was defined as the period ranging from 2 minutes prior to seizure attack up to 48 hours after it, and post-ictal period was the time up to 48 hours after regaining consciousness. Peri-ictal urinary complaints were gathered with interview and data were analyzed using Pearson's Chi-square, Fisher's Exact test, and independent sample t test. RESULTS The study population consisted of 57 (49.5%) men and 58 (50.4%) women, with the mean age of 26.83 ± 10.01 years. The frequency of at least one urinary symptom in studied patients was 39.1%. Incontinence, frequency, urgency, retention, and hesitancy were reported by 28 (24.3%), 14 (12.2%), 19 (16.5%), 10 (8.7%), and 8 (7%) patients, respectively. Women expressed more symptoms than men and a higher frequency of peri-ictal retention. Although overall urinary complaints were more frequent in patients with partial seizures, there was a higher frequency of urgency in patients with partial seizure (P = .037). Furthermore, apart from retention, there was no significant correlation between peri-ictal urinary symptoms and the patients' age. CONCLUSION Our findings suggest that peri-ictal urologic dysfunction is a common problem among patients with epilepsy and post-ictal urinary retention might also be considered as a post-ictal deficit (Todd's deficit).
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Affiliation(s)
- Mahmoud Motamedi
- Urology Research Center, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Nikoobakht M, Motamedi M, Ebrahimi Nasrabady S, Khashayar P, Afshin A, Orandi A, Talei Khatibi F. MP-17.03: Evaluation of Voiding Dysfunction in Epileptic Patients. Urology 2009. [DOI: 10.1016/j.urology.2009.07.804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Nikoobakht M, Motamedi M, Orandi A, Ebrahimi Nasrabady S, Orandi A, Afshin A, Tale Khatibi F. POS-01.79: Sexual dysfunction in epileptic patients. Urology 2007. [DOI: 10.1016/j.urology.2007.06.871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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