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Chong B, Yaow C, Chin YH, Ng CH, Goh R, Kong G, Muthiah M, Sukmawati I, Lukito AA, Chan MY, Khoo CM, Mehta A, Dimitriadis GK, Chew NWS. Higher risk of adverse cardiovascular outcomes in women with type 2 diabetes mellitus: an umbrella review of systematic reviews. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Previous studies have shown that females with type 2 diabetes mellitus (T2DM) may have an excess mortality risk compared to males. Furthermore, other studies have reported sex differences in managing cardiovascular risk factors, such as controlling hypertension and hypercholesterolemia.
Purpose
With the growing evidence from systematic reviews examining the sex differences in cardiovascular outcomes for patients with T2DM, an umbrella review is an essential next step to synthesising and assessing the strength of the available evidence.
Methods
Medline and Embase were searched from inception till 7th August 2022 for systematic reviews and meta-analyses studying the effects of sex on cardiovascular outcomes in T2DM patients. Results from reviews were synthesised with a narrative synthesis, with a tabular presentation of findings and forest plots for reviews that performed a meta-analysis. AMSTAR 2 tool was used to assess the methodological quality of included reviews, while the GRADE assessment was used to assess the quality of evidence for outcomes.
Results
A total of 28 studies evaluating sex differences in cardiovascular outcomes were included. Females with T2DM had a higher risk of developing coronary heart disease (CHD; RRR 1.52, 95%CI 1.32–1.76, p<0.001), acute coronary syndrome (ACS; RRR 1.38, 95%CI 1.25–1.52, p<0.001), and heart failure (RRR 1.09, 95%CI 1.05–1.13, p<0.001) than males. In terms of mortality outcomes, females had a higher risk of all-cause mortality (RRR 1.13, 95%CI 1.07–1.19, p<0.001), cardiac mortality (RRR 1.49, 95%CI 1.11–2.00, p=0.009) and CHD mortality (RRR 1.44, 95%CI 1.20–1.73, p<0.001) as compared to males. In patients undergoing percutaneous coronary intervention, females reported higher odds of MACE (OR 1.49, 95%CI 1.07–2.07, p=0.020) and all-cause mortality (OR 1.71, 95%CI 1.46–2.00, p<0.001) compared to males. Females in Asia (RRR 1.12, 95%CI 1.03–1.21, p=0.006) and North America (RRR 1.10, 95%CI 1.08–1.12, p<0.001) were at increased risk of all-cause mortality while females in Western countries had an increased risk for cardiac death (RRR 1.84, 95%CI 1.45–2.32, p<0.001) compared to males. Six reviews were rated as high in quality; eight reviews were rated as moderate, and fourteen reviews were rated as low in quality. Regarding the quality of outcomes, all outcomes in non-interventional studies had a moderate quality of evidence, while all outcomes in interventional studies achieved a high quality of evidence.
Conclusions
This umbrella review evaluated the quality of meta-analyses and demonstrated that females with T2DM have a higher risk of cardiovascular outcomes than their male counterparts. Future studies examining the sex differences in outcomes should attempt to address the heterogeneity and epidemiological factors for a better quality of evidence. Policymakers should consider sex-specific differences in implementing effective tailored strategies to tackle T2DM.
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Affiliation(s)
- B Chong
- National University of Singapore , Singapore , Singapore
| | - C Yaow
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - R Goh
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - M Muthiah
- National University Hospital , Singapore , Singapore
| | - I Sukmawati
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - A A Lukito
- Pelita Harapan University, Department of Cardiology , Tangerang , Indonesia
| | - M Y Chan
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
| | - C M Khoo
- National University Hospital, Division of Endocrinology, Department of Medicine , Singapore , Singapore
| | - A Mehta
- VCU Health Pauley Heart Center, Division of Cardiology, Department of Internal Medicine , Richmond , United States of America
| | - G K Dimitriadis
- King's College London, Obesity, Type 2 Diabetes and Immunometabolism Research Group, Department of Diabetes , London , United Kingdom of Great Britain & Northern Ireland
| | - N W S Chew
- National University Heart Centre, Department of Cardiology , Singapore , Singapore
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Chew N, Ng CH, Tan D, Kong G, Lin CX, Chin YH, Foo R, Chan M, Muthiah M. Global burden of metabolic diseases: data from Global Burden of Disease 2000-2019. A cosortium of metabolic disease. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The growing prevalence of metabolic diseases is a major concern. We sought to examine the global trends and mortality of metabolic diseases using estimates from the Global Burden of Diseases, Injuries and Risk Factors Study (GBD) 2019.
Methods
Global estimates of prevalence, deaths, and disability-adjusted life year (DALYs) from 2000-2019 were examined for metabolic diseases (type 2 diabetes mellitus [T2DM], hypertension, and nonalcoholic fatty liver disease [NAFLD]). For metabolic risk factors (hyperlipidemia and obesity), estimates were limited to mortality and DALYs. Death rates was compared across sex, World Health Organisation regions and Socio-demographic Index (SDI) quintiles. Age-standardised prevalence and death rates were presented per 100,000 population with 95% uncertainty intervals (UI).
Findings
From 2000 to 2019, prevalence rates increased for all metabolic diseases, with the most pronounced increase in high SDI countries. In 2019, the mean (95%UI) age-standardised prevalence per 100,000 population was estimated to be 15,023 (13,493-16,764) for NAFLD, 5,283 (4,864–5,720) for T2DM and 234 (171-313) for hypertension. The highest age-standardised death rates were observed in obesity (62·59 [39·92-89·13]; males, 66·55 [39·76-97·21]; females. 58·14 [38·53-81·39]), followed by hyperlipidemia (56·51 [41·83-73·62]; males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), T2DM (18·49 [17·18-19·66], males, 67·33 [50·78-86·43]; females, 46·50 [32·70-62·38]), hypertension (15·16 [11·20-16·75]; males, 14·95 [10·32-16·75]; females, 15·05 [11·51-17·09]) and NAFLD (2·09 [1·61-2·60]; males, 2·38 [1·82-3·02]; females, 1·82 [1·41-2·27]). Mortality rates decreased over time in hyperlipidemia (-154%), hypertension (-52%) and NAFLD (-52%), but not in T2DM and obesity. The highest mortality for metabolic diseases was found in Eastern Mediterranean, and low to low-middle SDI countries.
Conclusion
The global prevalence of metabolic diseases has risen over the past two decades regardless of SDI. Attention is needed to address the unchanging mortality rates attributed to metabolic disease and the regional, socioeconomic, and sex disparities in mortality from metabolic disease.
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Affiliation(s)
- N Chew
- National University Health System , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - D Tan
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - C X Lin
- National University Heart Centre , Singapore , Singapore
| | - Y H Chin
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - M Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
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Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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Chew N, Tan EX, Tan CH, Lim WH, Xiao JL, Chin YH, Syn N, Low TT, Wong R, Yip J, Siddiqui MS, Muthiah M. A network meta-analysis on the vasomodulators for portopulmonary hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In patients with portopulmonary hypertension (PoPH) who are eligible and awaiting liver transplant, guidelines recommend lowering pulmonary pressures with vasomodulators as a bridge to transplant. However, efficacy of each vasomodulator class as a bridge to transplant remains unknown.
Purpose
This review compares the use of endothelin receptor antagonists (ERA), phosphodiesterase type-5 inhibitors (PDE5-I), prostacyclin (PC) and combination therapy in its pulmonary pressure-lowering effects and pre-transplant mortality in this strictly selected subset of patients.
Methods
A search conducted on Medline and Embase on articles relating to vasomodulator use in PoPH for pulmonary pressure-lowering effects and mortality. Network analysis was conducted to summarize the evidence. Surface under the cumulative ranking curve (SUCRA) was used to rank treatments.
Results
Ten studies with 180 patients were included. SUCRA analysis demonstrated largest mean pulmonary artery pressure (mPAP) and pulmonary vascular resistance (PVR) lowering effects in ERA and combination therapy, followed by PDE5-I and PC. mPAP-lowering effects were largest in ERA (MD −19.440, CI: −62.280 to 23.400) and combination therapy (MD −18.223, CI: −29.677 to −6.770) when compared to PDE5-I (table 1). Pre-transplant mortality were comparable between ERA, PDE5-I and combination therapy. Both ERA (RR:0.349. CI: 0.137–0.891) and PDE5-I (RR: 0.279, CI: 0.091–0.854) had significantly lower mortality than PC (table 2).
Conclusion
This meta-analysis provides preliminary evidence that ERA have shown larger pulmonary pressure-lowering effects than PDE5-I in PoPH patients who were eligible for LT. Both ERA and PDE5-I have comparable mortality outcomes, with unfavorable outcomes in PC users.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Health System, Singapore, Singapore
| | - E X Tan
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
| | - C H Tan
- National University of Singapore, Singapore, Singapore
| | - W H Lim
- National University of Singapore, Singapore, Singapore
| | - J L Xiao
- National University of Singapore, Singapore, Singapore
| | - Y H Chin
- National University of Singapore, Singapore, Singapore
| | - N Syn
- National University of Singapore, Singapore, Singapore
| | - T T Low
- National University Heart Centre, Singapore, Singapore
| | - R Wong
- National University Heart Centre, Singapore, Singapore
| | - J Yip
- National University Heart Centre, Singapore, Singapore
| | - M S Siddiqui
- Virginia Commonwealth University, Division of Gastroenterology and Hepatology, Richmond, United States of America
| | - M Muthiah
- National University Hospital, Division of Gastroenterology and Hepatology, Singapore, Singapore
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Lee MH, Ng CH, Chin YH, Muthiah M, Foo FJ, Chong CS. Incidence of SARS-CoV-2 infection in inflammatory bowel disease. J Gastroenterol Hepatol 2020; 35:2021-2022. [PMID: 32779774 PMCID: PMC7404756 DOI: 10.1111/jgh.15191] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 07/20/2020] [Indexed: 01/22/2023]
Affiliation(s)
- M H Lee
- Department of Biological Sciences, Faculty of Science, National University of Singapore, Singapore
| | - C H Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Y H Chin
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - M Muthiah
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore
| | - F J Foo
- Department of General Surgery, Sengkang General Hospital, Singapore
| | - C S Chong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Colorectal Surgery, Department of Surgery, National University Hospital, Singapore
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Hartono JL, Koh T, Lee GH, Tan PS, Muthiah M, Aw MM, Madhavan K, Kow A, Lim KB. Predictors of Non-adherence to Immunosuppressive Therapy in Asian Liver Transplant Recipients. Transplant Proc 2018; 49:1419-1424. [PMID: 28736016 DOI: 10.1016/j.transproceed.2017.02.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 02/23/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Adherence to immunosuppressive medications has been shown to affect post-transplant outcomes. We aimed to determine the level of adherence to immunosuppressive therapy in liver transplant (LT) recipients and to elucidate factors associated with it, as well as patient preferences on the dosing schedule. METHODS LT recipients were recruited during transplant clinic follow-up. A validated Morisky 8-item questionnaire was completed by patients to assess their adherence to immunosuppressive therapy. Adherence was determined by the sum of the responses to the questionnaire. Low, medium, and high adherence were defined by a Morisky score of >2, 1 to 2, and 0, respectively. Data on the patient's socio-economic and clinical background, dosing schedule of immunosuppressant medications, and patient preferences were included in the questionnaire. RESULTS A total of 107 LT recipients were approached and 75 completed the questionnaire. The majority of patients (48/74, 64.9%) preferred a once-daily medication regimen. The proportion of high adherence was 24/75 (32.0%), medium adherence was 51/75 (42.7%), and low adherence was 19/75 (25.3%). Multivariate analysis showed younger age and post-transplant duration >5 years as independent predictors for low adherence. Among low-adherence patients, 16/19 (84.2%) patients were on a twice-daily regimen, and, of these, 14/16 (87.5%) preferred their medications to be reduced to once daily. CONCLUSIONS A significant proportion (68%) of LT recipients had low to moderate adherence to medications, with younger age and longer post-transplant duration of >5 years as independent predictors. Early identification of at-risk patients is essential to allow implementation of measures to improve adherence. Simplifying medication regimens to once daily is a potential way to improve adherence.
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Affiliation(s)
- J L Hartono
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore
| | - T Koh
- Department of Pharmacy, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - G H Lee
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - P S Tan
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - M Muthiah
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - M M Aw
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Department of Pediatrics, Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - K Madhavan
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - A Kow
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Hepatobiliary and Pancreatic Surgery, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore
| | - K B Lim
- Yong Yoo Lin School of Medicine, National University of Singapore, Singapore; Division of Gastroenterology and Hepatology, National University Health System, Singapore; National University Centre for Organ Transplantation, National University Health System, Singapore.
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Muthiah M. Maithriya Amarasinghe. Assoc Med J 2013. [DOI: 10.1136/bmj.f5459] [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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Lee HJ, Nguyen YTC, Muthiah M, Vu-Quang H, Namgung R, Kim WJ, Yu MK, Jon S, Lee IK, Jeong YY, Park IK. MR traceable delivery of p53 tumor suppressor gene by PEI-functionalized superparamagnetic iron oxide nanoparticles. J Biomed Nanotechnol 2012; 8:361-71. [PMID: 22764405 DOI: 10.1166/jbn.2012.1407] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Cancer gene therapy involves the replacement of missing or altered genes with healthy ones. In this paper, we have proposed tumor suppressor gene-carrying superparamagnetic iron oxide nanoparticles (SPIONs) for anti-cancer gene therapy. Thermally crosslinked SPIONs (TCL-SPIONs) were conjugated with branched polyethylenimine (PEI 1800 Da) by EDC-NHS chemistry for p53 plasmid DNA delivery. The morphology of the bPEI conjugated TCL-SPIONs (bPEI-TCL-SPION) and pDNA-loaded bPEI-TCL-SPION nanoparticles was measured using transmission electron microscopy (TEM). The particle sizes of the pDNA-loaded bPEI-TCL-SPION nanoparticles were also confirmed by dynamic light scattering, and ranged from 100 to 130 nm, depending on the molar charge ratio. The fluorescently labeled pDNA was complexed with bPEI-TCL-SPION and its intracellular internalization was investigated using confocal microscopy. The p53 plasmid-loaded bPEI-TCL-SPION nanoparticles achieved significantly higher p53 tumor suppressor gene expression and cellular viability compared to positive controls. The expressed wild-type p53 protein suppressed tumor cell proliferation as compared to the mutant control. When transgene expression of the p53 tumor suppressor gene was evaluated at the mRNA level and quantified using real-time PCR, the results were highly dependent on the molar charge ratio (N/P) as well as the cancer cell type. SPIONs internalized within cancer cells were tracked by magnetic resonance (MR) imaging. It was concluded that bPEI-TCL-SPION could be used as efficient gene delivery carriers that can be tracked by MR imaging.
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Affiliation(s)
- H J Lee
- Department of Biomedical Sciences, Research Institute of Medical Sciences, Chonnam National University Medical School, Gwangju 501-746, South Korea
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Muthiah M. Sharif Anwar Hussain. West J Med 2010. [DOI: 10.1136/bmj.c1289] [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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Ganesh N, Rajan PS, Muthiah M, Byju P, Ganesan K. Pictorial CME. A racemose arteriovenous malformation characterized by dilatation and tortuosity of retinal vessels. J Assoc Physicians India 2002; 50:1404. [PMID: 12583471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- Nalini Ganesh
- Department of Medicine, Madurai Medical College, Govt. Rajaji Hospital, Madurai 625 020, Tamilnadu
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Affiliation(s)
- M Muthiah
- Pennsylvania State University College of Medicine, Harshey, USA
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Sinniah D, Muthiah M, Lin HP, Somasundaram K. Review of Wilms' tumour in Malaysian children. Singapore Med J 1981; 22:24-7. [PMID: 6264629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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