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Baqui AH, Koffi AK, McCollum ED, Roy AD, Chowdhury NH, Rafiqullah I, Ahmed ZB, Mahmud A, Begum N, Ahmed S, Khanam R, Harrison M, Simmons N, Hossen S, Islam M, Quaiyum A, Checkley W, Santosham M, Moulton LH, Saha SK. Impact of national introduction of ten-valent pneumococcal conjugate vaccine on invasive pneumococcal disease in Bangladesh: Case-control and time-trend studies. Vaccine 2021; 39:5794-5801. [PMID: 34465471 DOI: 10.1016/j.vaccine.2021.08.068] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Bangladesh introduced the ten-valent pneumococcal conjugate vaccine (PCV10) into its national immunization program in March 2015 creating an opportunity to assess the real-world impact of PCV on invasive pneumococcal disease (IPD). METHODS Between January 2014 and June 2018, children aged 3-35 months in three rural sub-districts of Sylhet district of Bangladesh were visited every two months to collect morbidity and care-seeking data. Children attending sub-district hospitals with pneumonia, meningitis, or sepsis were assessed for IPD after obtaining informed consent. Blood and cerebrospinal fluid were collected from enrolled children to isolate pneumococcus using culture and molecular test. Children who were age-eligible to receive the PCV and had pneumococcus isolated were enrolled as cases. Four age and sex-matched clinic and community controls were selected for each case within one to two weeks of case identification. Data on immunization status and confounders were collected. PCV coverage was estimated using vaccine coverage surveys. Case-control and incidence trend analyses were conducted to assess the impact of PCV on IPD. RESULTS The community cohort yielded 217,605 child years of observations and 154,773 sick child-visits to study hospitals. Pneumococcus was isolated from 44 children who were age-eligible to receive PCV; these children were enrolled as cases. The cases were matched with 166 community- and 150 clinic-controls. The matched case-control analyses using community-controls showed 83% effectiveness (95% CI: 1.57-97.1%) and clinic controls showed 90% effectiveness (95% CI: -26.0% to 99.1%) of PCV in preventing IPD. Incidence trend analysis estimated vaccine effectiveness at 80.1% (95% CI: 38.4, 93.6). CONCLUSION PCV in this pediatric population in Bangladesh was highly effective in preventing IPD.
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Affiliation(s)
- Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States.
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Eric D McCollum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Global Program in Respiratory Sciences, Department of Pediatrics, Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | | | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), Jackson, MS, United States
| | | | - Arif Mahmud
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - Nazma Begum
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | | | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meagan Harrison
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Nicole Simmons
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Shakir Hossen
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Abdul Quaiyum
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - William Checkley
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States; Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, Baltimore, MD, United States; Center for Global Non-Communicable Disease Research and Training, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Mathuram Santosham
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lawrence H Moulton
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
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Lee AC, Mullany LC, Koffi AK, Rafiqullah I, Khanam R, Folger LV, Rahman M, Mitra DK, Labrique A, Christian P, Uddin J, Ahmed P, Ahmed S, Mahmud A, DasGupta SK, Begum N, Quaiyum MA, Saha SK, Baqui AH. Urinary tract infections in pregnancy in a rural population of Bangladesh: population-based prevalence, risk factors, etiology, and antibiotic resistance. BMC Pregnancy Childbirth 2019; 20:1. [PMID: 31892316 PMCID: PMC6938613 DOI: 10.1186/s12884-019-2665-0] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/06/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Urinary tract infection (UTI) in pregnancy, including asymptomatic bacteriuria, is associated with maternal morbidity and adverse pregnancy outcomes, including preterm birth and low birthweight. In low-middle income countries (LMICs), the capacity for screening and treatment of UTIs is limited. The objective of this study was to describe the population-based prevalence, risk factors, etiology and antimicrobial resistance patterns of UTIs in pregnancy in Bangladesh. METHODS In a community-based cohort in Sylhet district, Bangladesh, urine specimens were collected at the household level in 4242 pregnant women (< 20 weeks gestation) for culture and antibiotic susceptibility testing. Basic descriptive analysis was performed, as well as logistic regression to calculate adjusted odds ratios (aOR) for UTI risk factors. RESULTS The prevalence of UTI was 8.9% (4.4% symptomatic UTI, 4.5% asymptomatic bacteriuria). Risk factors for UTI in this population included maternal undernutrition (mid-upper arm circumference <23 cm: aOR= 1.29, 95% CI: 1.03-1.61), primiparity (aOR= 1.45, 95% CI: 1.15-1.84), and low paternal education (no education: aOR= 1.56, 95% CI: 1.09-2.22). The predominant uro-pathogens were E. coli (38% of isolates), Klebsiella (12%), and staphyloccocal species (23%). Group B streptococcus accounted for 5.3% of uro-pathogens. Rates of antibiotic resistance were high, with only two-thirds of E. coli susceptible to 3rd generation cephalosporins. CONCLUSIONS In Sylhet, Bangladesh, one in 11 women had a UTI in pregnancy, and approximately half of cases were asymptomatic. There is a need for low-cost and accurate methods for UTI screening in pregnancy and efforts to address increasing rates of antibiotic resistance in LMIC.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
| | - Luke C Mullany
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Alain K Koffi
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center (UMMC), 2500 N State St, Jackson, MS, 39216, USA
| | - Rasheda Khanam
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Lian V Folger
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Mahmoodur Rahman
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Dipak K Mitra
- North South University, Plot #15, Block #B, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
- Bill and Melinda Gates Foundation, 440 5th Avenue North, Seattle, WA, 98109, USA
| | - Jamal Uddin
- Save the Children Bangladesh, House No. CWN (A) 35, Road No. 43 Gulshan 2, Dhaka, 1212, Bangladesh
| | - Parvez Ahmed
- Institute of Epidemiology Disease Control and Research, Mohakhali, Dhaka, 1212, Bangladesh
| | - Salahuddin Ahmed
- Projahnmo Research Foundation, House: 37, Road:27, Block: A, Banani, Dhaka, 1213, Bangladesh
| | - Arif Mahmud
- School of Community Health and Policy, Morgan State University, Baltimore, MD, 21251, USA
| | - Sushil K DasGupta
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Nazma Begum
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohammad A Quaiyum
- Maternal and Child Health Division, International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), 68, Shaheed Tajuddin Ahmed Sarani, Mohakhali, Dhaka, 1212, Bangladesh
| | - Samir K Saha
- Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Child Health Research Foundation, Dhaka, 1207, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
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Baqui AH, Lee ACC, Koffi AK, Khanam R, Mitra DK, Dasgupta SK, Uddin J, Ahmed P, Rafiqullah I, Rahman M, Quaiyum A, Koumans EH, Christian P, Saha SK, Mullany LC, Labrique A. Prevalence of and risk factors for abnormal vaginal flora and its association with adverse pregnancy outcomes in a rural district in north-east Bangladesh. Acta Obstet Gynecol Scand 2019; 98:309-319. [PMID: 30346023 PMCID: PMC6389396 DOI: 10.1111/aogs.13492] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 10/02/2018] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The role of screening and treatment for abnormal vaginal flora (AVF) on adverse pregnancy outcomes remains unclear. Using data from women who participated in a population-based cluster randomized trial who were screened and treated for AVF, we report risk factors for AVF and association of persistent AVF with adverse perinatal outcomes. MATERIAL AND METHODS Pregnant women (n = 4221) <19 weeks of gestation provided self-administered mid-vaginal swabs; smears were Nugent-scored. AVF was treated with oral clindamycin; if AVF was present 3 weeks after treatment, persistent AVF was re-treated. We examined risk factors for AVF and the association of persistent AVF with adverse pregnancy outcomes. RESULTS The prevalence of AVF was 16.5%: 9.8% of women had bacterial vaginosis and 6.8% had intermediate flora. Lower economic and educational status of women were associated with increased risk of AVF. One-third of women with AVF had persistent abnormal flora; these women had a higher risk of a composite measure of adverse pregnancy outcomes from 20 to <37 weeks (preterm live birth, preterm still birth, late miscarriage) (relative risk [RR] 1.33, 95% confidence interval [CI] 1.07-1.65) and of late miscarriage alone (RR 4.15, 95% CI 2.12-8.12) compared to women without AVF. CONCLUSIONS In this study in Sylhet District, Bangladesh, rates of AVF and persistent AVF were high and persistent AVF was associated with adverse pregnancy outcomes, with an especially high associated risk for late miscarriage. Further characterization of the microbiome and relative bacterial species density associated with persistent AVF is needed.
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Affiliation(s)
- Abdullah H Baqui
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, Massachusetts, US
| | - Alain K Koffi
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Rasheda Khanam
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | | | - Sushil K Dasgupta
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jamal Uddin
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Parvez Ahmed
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - Mahmoodur Rahman
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abdul Quaiyum
- International Center for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Emilia H Koumans
- Centers for Disease Control and Prevention, Atlanta, Georgia, US
| | | | - Samir K Saha
- Child Health Research Foundation, Dhaka, Bangladesh
| | - Luke C Mullany
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
| | - Alain Labrique
- International Center for Maternal and Newborn Health, Health Systems Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, US
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Lee AC, Mullany LC, Quaiyum M, Mitra DK, Labrique A, Christian P, Ahmed P, Uddin J, Rafiqullah I, DasGupta S, Rahman M, Koumans EH, Ahmed S, Saha SK, Baqui AH. Effect of population-based antenatal screening and treatment of genitourinary tract infections on birth outcomes in Sylhet, Bangladesh (MIST): a cluster-randomised clinical trial. Lancet Glob Health 2019; 7:e148-e159. [PMID: 30554751 PMCID: PMC6293967 DOI: 10.1016/s2214-109x(18)30441-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 07/25/2018] [Accepted: 09/11/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND One-third of preterm births are attributed to pregnancy infections. We implemented a community-based intervention to screen and treat maternal genitourinary tract infections, with the aim of reducing the incidence of preterm birth. METHODS We did an unblinded cluster-randomised controlled trial in two subdistricts of Sylhet, Bangladesh. Clusters were defined as the contiguous area served by a single community health worker, and each cluster comprised several contiguous villages, contained roughly 4000 people, and had about 120 births per year. Eligible participants within clusters were all ever-married women and girls of reproductive age (ie, aged 15-49 years) who became pregnant during the study period. Clusters were randomly assigned (1:1) to the intervention or control groups via a restricted randomisation procedure. In both groups, community health workers made home visits to identify pregnant women and girls and provide antenatal and postnatal care. Between 13 and 19 weeks' gestation, participants in the intervention group received home-based screening for abnormal vaginal flora and urinary tract infections. A random 10% of the control group also received the intervention to examine the similarity of infection prevalence between groups. If present, abnormal vaginal flora (ie, Nugent score ≥4 was treated with oral clindamycin (300 mg twice daily for 5 days) and urinary tract infections with cefixime (400 mg once daily for 3 days) or oral nitrofurantoin (100 mg twice daily for 7 days). Both infections were retreated if persistent. The primary outcome was the incidence of preterm livebirths before 37 weeks' gestation among all livebirths. This trial is registered with ClinicalTrials.gov, number NCT01572532. The trial is closed to new participants, with follow-up completed. FINDINGS Between Jan 2, 2012, and July 28, 2015, 9712 pregnancies were enrolled (4840 in the intervention group, 4391 in the control group, and 481 in the control subsample). 3818 livebirths in the intervention group and 3557 livebirths in the control group were included in the primary analysis. In the intervention group, the prevalence of abnormal vaginal flora was 16·3% (95% CI 15·1-17·6) and that of urinary tract infection was 8·6% (7·7-9·5). The effective coverage of successful treatment in the intervention group was 58% in participants with abnormal vaginal flora (ie, abnormal vaginal flora resolved in 361 [58%] of the 622 participants who initially tested positive), and 71% in those with urinary tract infections (ie, resolution in 224 [71%] of the 317 participants who initially tested positive). Overall, the incidence of preterm livebirths before 37 weeks' gestation did not differ significantly between the intervention and control groups (21·8% vs 20·6%; relative risk 1·07 [95% CI 0·91-1·24]). INTERPRETATION A population-based antenatal screening and treatment programme for genitourinary tract infections did not reduce the incidence of preterm birth in Bangladesh. FUNDING Eunice Kennedy Shriver National Institute of Child Health and Human Development and Saving Lives at Birth Grand Challenges.
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Affiliation(s)
- Anne Cc Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Luke C Mullany
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Mohammad Quaiyum
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | | | - Alain Labrique
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Parul Christian
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Bill & Melinda Gates Foundation, Seattle, WA, USA
| | - Parvez Ahmed
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | - Jamal Uddin
- Independent University, Bangladesh, Dhaka, Bangladesh
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sushil DasGupta
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | - Mahmoodur Rahman
- International Center for Diarrheal Diseases-Bangladesh, Center for Reproductive Health, Dhaka, Bangladesh
| | | | | | - Samir K Saha
- Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Dhaka, Bangladesh
| | - Abdullah H Baqui
- International Center for Maternal and Newborn Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
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Challagundla L, Reyes J, Rafiqullah I, Sordelli DO, Echaniz-Aviles G, Velazquez-Meza ME, Castillo-Ramírez S, Fittipaldi N, Feldgarden M, Chapman SB, Calderwood MS, Carvajal LP, Rincon S, Hanson B, Planet PJ, Arias CA, Diaz L, Robinson DA. Phylogenomic Classification and the Evolution of Clonal Complex 5 Methicillin-Resistant Staphylococcus aureus in the Western Hemisphere. Front Microbiol 2018; 9:1901. [PMID: 30186248 PMCID: PMC6113392 DOI: 10.3389/fmicb.2018.01901] [Citation(s) in RCA: 58] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 07/27/2018] [Indexed: 12/30/2022] Open
Abstract
Clonal complex 5 methicillin-resistant Staphylococcus aureus (CC5-MRSA) includes multiple prevalent clones that cause hospital-associated infections in the Western Hemisphere. Here, we present a phylogenomic study of these MRSA to reveal their phylogeny, spatial and temporal population structure, and the evolution of selected traits. We studied 598 genome sequences, including 409 newly generated sequences, from 11 countries in Central, North, and South America, and references from Asia and Europe. An early-branching CC5-Basal clade is well-dispersed geographically, is methicillin-susceptible and MRSA predominantly of ST5-IV such as the USA800 clone, and includes separate subclades for avian and porcine strains. In the early 1970s and early 1960s, respectively, two clades appeared that subsequently underwent major expansions in the Western Hemisphere: a CC5-I clade in South America and a CC5-II clade largely in Central and North America. The CC5-I clade includes the ST5-I Chilean/Cordobes clone, and the ST228-I South German clone as an early offshoot, but is distinct from other ST5-I clones from Europe that nest within CC5-Basal. The CC5-II clade includes divergent strains of the ST5-II USA100 clone, various other clones, and most known vancomycin-resistant strains of S. aureus, but is distinct from ST5-II strain N315 from Japan that nests within CC5-Basal. The recombination rate of CC5 was much lower than has been reported for other S. aureus genetic backgrounds, which indicates that recurrence of vancomycin resistance in CC5 is not likely due to an enhanced promiscuity. An increased number of antibiotic resistances and decreased number of toxins with distance from the CC5 tree root were observed. Of note, the expansions of the CC5-I and CC5-II clades in the Western Hemisphere were preceded by convergent gains of resistance to fluoroquinolone, macrolide, and lincosamide antibiotics, and convergent losses of the staphylococcal enterotoxin p (sep) gene from the immune evasion gene cluster of phage ϕSa3. Unique losses of surface proteins were also noted for these two clades. In summary, our study has determined the relationships of different clades and clones of CC5 and has revealed genomic changes for increased antibiotic resistance and decreased virulence associated with the expansions of these MRSA in the Western Hemisphere.
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Affiliation(s)
- Lavanya Challagundla
- Department of Data Science, University of Mississippi Medical Center, Jackson, MS, United States
| | - Jinnethe Reyes
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Iftekhar Rafiqullah
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
| | - Daniel O. Sordelli
- Instituto de Investigaciones en Microbiología y Parasitología Médica, Universidad de Buenos Aires and Consejo Nacional de Investigaciones Ciencias y Tecnicas, Buenos Aires, Argentina
| | | | | | - Santiago Castillo-Ramírez
- Programa de Genómica Evolutiva, Centro de Ciencias Génomicas, Universidad Nacional Autónoma de México, Cuernavaca, Mexico
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Cell and Systems Biology, University of Toronto, Toronto, ON, Canada
| | - Michael Feldgarden
- National Center for Biotechnology Information, National Institutes of Health, Bethesda, MD, United States
| | | | - Michael S. Calderwood
- Section of Infectious Disease and International Health, Dartmouth–Hitchcock Medical Center, Lebanon, NH, United States
| | - Lina P. Carvajal
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Sandra Rincon
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - Blake Hanson
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Paul J. Planet
- Children’s Hospital of Philadelphia, University of Pennsylvania, Philadelphia, PA, United States
| | - Cesar A. Arias
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
- Division of Infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, University of Texas Health Science Center, McGovern Medical School, Houston, TX, United States
- Center for Infectious Diseases, School of Public Health, University of Texas Health Science Center, Houston, TX, United States
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics, Universidad El Bosque, Bogota, Colombia
| | - D. Ashley Robinson
- Department of Microbiology and Immunology, University of Mississippi Medical Center, Jackson, MS, United States
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6
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Saha SK, Schrag SJ, El Arifeen S, Mullany LC, Shahidul Islam M, Shang N, Qazi SA, Zaidi AKM, Bhutta ZA, Bose A, Panigrahi P, Soofi SB, Connor NE, Mitra DK, Isaac R, Winchell JM, Arvay ML, Islam M, Shafiq Y, Nisar I, Baloch B, Kabir F, Ali M, Diaz MH, Satpathy R, Nanda P, Padhi BK, Parida S, Hotwani A, Hasanuzzaman M, Ahmed S, Belal Hossain M, Ariff S, Ahmed I, Ibne Moin SM, Mahmud A, Waller JL, Rafiqullah I, Quaiyum MA, Begum N, Balaji V, Halen J, Nawshad Uddin Ahmed ASM, Weber MW, Hamer DH, Hibberd PL, Sadeq-Ur Rahman Q, Mogan VR, Hossain T, McGee L, Anandan S, Liu A, Panigrahi K, Abraham AM, Baqui AH. Causes and incidence of community-acquired serious infections among young children in south Asia (ANISA): an observational cohort study. Lancet 2018; 392:145-159. [PMID: 30025808 PMCID: PMC6053599 DOI: 10.1016/s0140-6736(18)31127-9] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/08/2018] [Accepted: 05/15/2018] [Indexed: 12/11/2022]
Abstract
BACKGROUND More than 500 000 neonatal deaths per year result from possible serious bacterial infections (pSBIs), but the causes are largely unknown. We investigated the incidence of community-acquired infections caused by specific organisms among neonates in south Asia. METHODS From 2011 to 2014, we identified babies through population-based pregnancy surveillance at five sites in Bangladesh, India, and Pakistan. Babies were visited at home by community health workers up to ten times from age 0 to 59 days. Illness meeting the WHO definition of pSBI and randomly selected healthy babies were referred to study physicians. The primary objective was to estimate proportions of specific infectious causes by blood culture and Custom TaqMan Array Cards molecular assay (Thermo Fisher, Bartlesville, OK, USA) of blood and respiratory samples. FINDINGS 6022 pSBI episodes were identified among 63 114 babies (95·4 per 1000 livebirths). Causes were attributed in 28% of episodes (16% bacterial and 12% viral). Mean incidence of bacterial infections was 13·2 (95% credible interval [CrI] 11·2-15·6) per 1000 livebirths and of viral infections was 10·1 (9·4-11·6) per 1000 livebirths. The leading pathogen was respiratory syncytial virus (5·4, 95% CrI 4·8-6·3 episodes per 1000 livebirths), followed by Ureaplasma spp (2·4, 1·6-3·2 episodes per 1000 livebirths). Among babies who died, causes were attributed to 46% of pSBI episodes, among which 92% were bacterial. 85 (83%) of 102 blood culture isolates were susceptible to penicillin, ampicillin, gentamicin, or a combination of these drugs. INTERPRETATION Non-attribution of a cause in a high proportion of patients suggests that a substantial proportion of pSBI episodes might not have been due to infection. The predominance of bacterial causes among babies who died, however, indicates that appropriate prevention measures and management could substantially affect neonatal mortality. Susceptibility of bacterial isolates to first-line antibiotics emphasises the need for prudent and limited use of newer-generation antibiotics. Furthermore, the predominance of atypical bacteria we found and high incidence of respiratory syncytial virus indicated that changes in management strategies for treatment and prevention are needed. Given the burden of disease, prevention of respiratory syncytial virus would have a notable effect on the overall health system and achievement of Sustainable Development Goal. FUNDING Bill & Melinda Gates Foundation.
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Affiliation(s)
- Samir K Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh.
| | - Stephanie J Schrag
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Shams El Arifeen
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Luke C Mullany
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Mohammad Shahidul Islam
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Nong Shang
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Shamim A Qazi
- Department of Child and Adolescent Health and Development, World Health Organization, Geneva, Switzerland
| | - Anita K M Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Zulfiqar A Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | - Pinaki Panigrahi
- Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sajid B Soofi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Nicholas E Connor
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Dipak K Mitra
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Rita Isaac
- Christian Medical College, Bagayam, Vellore, India
| | - Jonas M Winchell
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Melissa L Arvay
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Maksuda Islam
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Yasir Shafiq
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Imran Nisar
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Benazir Baloch
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Furqan Kabir
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Murtaza Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Maureen H Diaz
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | | | - Pritish Nanda
- Asian Institute of Public Health, Bhubaneswar, India
| | | | | | - Aneeta Hotwani
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - M Hasanuzzaman
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Sheraz Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Mohammad Belal Hossain
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Shabina Ariff
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Imran Ahmed
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Syed Mamun Ibne Moin
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Arif Mahmud
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Jessica L Waller
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Iftekhar Rafiqullah
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | | | - Nazma Begum
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Jasmin Halen
- Christian Medical College, Bagayam, Vellore, India
| | - A S M Nawshad Uddin Ahmed
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Bangla Nagar, Dhaka, Bangladesh
| | - Martin W Weber
- Child and Adolescent Health and Development Division, World Health Organization Regional Office for Europe, Copenhagen, Denmark
| | - Davidson H Hamer
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | - Patricia L Hibberd
- Department of Global Health and Center for Global Health and Development, Boston University School of Public Health, Boston, MA, USA
| | | | | | - Tanvir Hossain
- Maternal and Child Health Division, icddr,b, Dhaka, Bangladesh
| | - Lesley McGee
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | | | - Anran Liu
- Centers for Disease Control and Prevention, Respiratory Diseases Branch, Atlanta, GA, USA
| | - Kalpana Panigrahi
- Center for Global Health and Development, College of Public Health, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Abdullah H Baqui
- Johns Hopkins Bloomberg, School of Public Health, Johns Hopkins University, Baltimore, MD, USA
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Shakoor S, Reller ME, LeFevre A, Hotwani A, Qureshi SM, Yousuf F, Islam MS, Connor N, Rafiqullah I, Mir F, Arif S, Soofi S, Bartlett LA, Saha S. Diagnostic methods to determine microbiology of postpartum endometritis in South Asia: laboratory methods protocol used in the Postpartum Sepsis Study: a prospective cohort study. Reprod Health 2016; 13:15. [PMID: 26916013 PMCID: PMC4766642 DOI: 10.1186/s12978-016-0121-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
Background The South Asian region has the second highest risk of maternal death in the world. To prevent maternal deaths due to sepsis and to decrease the maternal mortality ratio as per the World Health Organization Millenium Development Goals, a better understanding of the etiology of endometritis and related sepsis is required. We describe microbiological laboratory methods used in the maternal Postpartum Sepsis Study, which was conducted in Bangladesh and Pakistan, two populous countries in South Asia. Methods/Design Postpartum maternal fever in the community was evaluated by a physician and blood and urine were collected for routine analysis and culture. If endometritis was suspected, an endometrial brush sample was collected in the hospital for aerobic and anaerobic culture and molecular detection of bacterial etiologic agents (previously identified and/or plausible). Discussion The results emanating from this study will provide microbiologic evidence of the etiology and susceptibility pattern of agents recovered from patients with postpartum fever in South Asia, data critical for the development of evidence-based algorithms for management of postpartum fever in the region.
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Affiliation(s)
- Sadia Shakoor
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan. .,Department of Pathology and Laboratory Medicine, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Megan E Reller
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Amnesty LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Aneeta Hotwani
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Shahida M Qureshi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Farheen Yousuf
- Department of Obstetrics and Gynecology, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Mohammad Shahidul Islam
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh.
| | - Nicholas Connor
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh.
| | - Iftekhar Rafiqullah
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh.
| | - Fatima Mir
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Shabina Arif
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Sajid Soofi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Stadium Road, P.O. Box 3500, Karachi, Pakistan.
| | - Linda A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD, USA.
| | - Samir Saha
- The Child Health Research Foundation, Department of Microbiology, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, Bangladesh.
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Lee ACC, Quaiyum MA, Mullany LC, Mitra DK, Labrique A, Ahmed P, Uddin J, Rafiqullah I, DasGupta S, Mahmud A, Koumans EH, Christian P, Saha S, Baqui AH. Screening and treatment of maternal genitourinary tract infections in early pregnancy to prevent preterm birth in rural Sylhet, Bangladesh: a cluster randomized trial. BMC Pregnancy Childbirth 2015; 15:326. [PMID: 26643558 PMCID: PMC4672554 DOI: 10.1186/s12884-015-0724-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 10/27/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Approximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis. METHODS/DESIGN We are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality. IMPLICATIONS/DISCUSSION Findings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings. TRIAL REGISTRATION The study was registered on ClinicalTrials.gov:NCT01572532 on December 15, 2011. The study was funded by NICHD: R01HD066156 .
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Affiliation(s)
- Anne C C Lee
- Department of Pediatric Newborn Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Mohammad A Quaiyum
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Luke C Mullany
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Dipak K Mitra
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Alain Labrique
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Parvez Ahmed
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Jamal Uddin
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Iftekhar Rafiqullah
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Sushil DasGupta
- International Centre for Diarrheal Diseases- Bangladesh, Centre for Reproductive Health, Mohakhali, Dhaka, 1212, Bangladesh
| | - Arif Mahmud
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Emilia H Koumans
- Center for Disease Control, 1600 Clifton Road, Atlanta, GA, 30329, USA
| | - Parul Christian
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA
| | - Samir Saha
- Department of Microbiology, Child Health Research Foundation, Dhaka Shishu Hospital, Sher-E-Banglanagar, Dhaka, 1207, Bangladesh
| | - Abdullah H Baqui
- Department of International Health, International Center for Maternal and Newborn Health; Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA.
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9
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Ladhani K, Lee A, Quaiyum M, Mullany L, Mitra D, Labrique A, Christian P, Ahmed P, Rafiqullah I, Saha S, Baqui A. Prevalence and symptoms of abnormal vaginal flora in rural sylhet,
Bangladesh. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.719] [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: 11/16/2022] Open
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