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Blank E, Gilbert DL, Wu SW, Larsh T, Elmaghraby R, Liu R, Smith E, Westerkamp G, Liu Y, Horn PS, Greenstein E, Sweeney JA, Erickson CA, Pedapati EV. Accelerated Theta Burst Transcranial Magnetic Stimulation for Refractory Depression in Autism Spectrum Disorder. J Autism Dev Disord 2024:10.1007/s10803-024-06244-2. [PMID: 38744742 DOI: 10.1007/s10803-024-06244-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Major depressive disorder (MDD) disproportionately affects those living with autism spectrum disorder (ASD) and is associated with significant impairment and treatment recidivism. METHODS We studied the use of accelerated theta burst stimulation (ATBS) for the treatment of refractory MDD in ASD (3 treatments daily x 10 days). This prospective open-label 12-week trial included 10 subjects with a mean age of 21.5 years, randomized to receive unilateral or bilateral stimulation of the dorsolateral prefrontal cortex. RESULTS One participant dropped out of the study due to intolerability. In both treatment arms, depressive symptoms, scored on the Hamilton Depression Rating Scale scores, diminished substantially. At 12 weeks post-treatment, full remission was sustained in 5 subjects and partial remission in 3 subjects. Treatment with ATBS, regardless of the site of stimulation, was associated with a significant, substantial, and sustained improvement in depressive symptomatology via the primary outcome measure, the Hamilton Depression Rating Scale. Additional secondary measures, including self-report depression scales, fluid cognition, and sleep quality, also showed significant improvement. No serious adverse events occurred during the study. Mild transient headaches were infrequently reported, which are expected side effects of ATBS. CONCLUSION Overall, ATBS treatment was highly effective and well-tolerated in individuals with ASD and co-occurring MDD. The findings support the need for a larger, sham-controlled randomized controlled trial to further evaluate efficacy of ATBS in this population.
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Affiliation(s)
- Elizabeth Blank
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Donald L Gilbert
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Steve W Wu
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Travis Larsh
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rana Elmaghraby
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Rui Liu
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Elizabeth Smith
- Division of Behavioral Medicine and Child Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Grace Westerkamp
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Yanchen Liu
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Paul S Horn
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Ethan Greenstein
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - John A Sweeney
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Ernest V Pedapati
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
- Division of Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.
- Department of Psychiatry, University of Cincinnati College of Medicine, Cincinnati, OH, United States.
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Romanowicz M, Croarkin KS, Elmaghraby R, Skime M, Croarkin PE, Vande Voort JL, Shekunov J, Athreya AP. Machine Learning Identifies Smartwatch-Based Physiological Biomarker for Predicting Disruptive Behavior in Children: A Feasibility Study. J Child Adolesc Psychopharmacol 2023; 33:387-392. [PMID: 37966360 PMCID: PMC10698791 DOI: 10.1089/cap.2023.0038] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2023]
Abstract
Objective: Parents frequently purchase and inquire about smartwatch devices to monitor child behaviors and functioning. This pilot study examined the feasibility and accuracy of using smartwatch monitoring for the prediction of disruptive behaviors. Methods: The study enrolled children (N = 10) aged 7-10 years hospitalized for the treatment of disruptive behaviors. The study team completed continuous behavioral phenotyping during study participation. The machine learning protocol examined severe behavioral outbursts (operationalized as episodes that preceded physical restraint) for preparing the training data. Supervised machine learning methods were trained with cross-validation to predict three behavior states-calm, playful, and disruptive. Results: The participants had a 90% adherence rate for per protocol smartwatch use. Decision trees derived conditional dependencies of heart rate, sleep, and motor activity to predict behavior. A cross-validation demonstrated 80.89% accuracy of predicting the child's behavior state using these conditional dependencies. Conclusion: This study demonstrated the feasibility of 7-day continuous smartwatch monitoring for children with severe disruptive behaviors. A machine learning approach characterized predictive biomarkers of impending disruptive behaviors. Future validation studies will examine smartwatch physiological biomarkers to enhance behavioral interventions, increase parental engagement in treatment, and demonstrate target engagement in clinical trials of pharmacological agents for young children.
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Affiliation(s)
- Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Children's Research Center, Rochester, Minnesota, USA
| | - Kyle S. Croarkin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Rana Elmaghraby
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Michelle Skime
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Paul E. Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Children's Research Center, Rochester, Minnesota, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer L. Vande Voort
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Children's Research Center, Rochester, Minnesota, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Children's Research Center, Rochester, Minnesota, USA
| | - Arjun P. Athreya
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Mayo Clinic Children's Research Center, Rochester, Minnesota, USA
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
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Chochol MD, Gandhi K, Elmaghraby R, Croarkin PE. Harnessing Youth Engagement With Mental Health TikTok and Its Potential as a Public Health Tool. J Am Acad Child Adolesc Psychiatry 2023; 62:710-712. [PMID: 36773699 DOI: 10.1016/j.jaac.2022.11.015] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 11/02/2022] [Accepted: 02/02/2023] [Indexed: 02/10/2023]
Abstract
At different institutions, we were seeing the same trend-TikTok arising more in discussion during appointments. It is hard to accurately quantify the mental health-related content on Tik-Tok because it is ever-increasing. Nevertheless, national news outlets have reported on the worrisome trend of self-diagnosis of mental health disorders via TikTok. In 2018, Shafi et al. described the importance of understanding the role of social media in adolescents' lives.1 Four years later, that role continues to evolve and to become ever more prominent. As of September 2021, 25% of TikTok users were 10 to 19 years old and 22.4% were 20 to 29 years old. That is an estimated 172,250,000 users.2 As of February 2022, #anxiety registers 11.7 billion, #ADHD 9.4 billion, #BPD 3.9 billion, #depressed 3.6 billion, #bipolar 2.1 billion, and #DID 1.5 billion views.
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Affiliation(s)
| | - Kriti Gandhi
- Children's National Medical Center, Washington, DC
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Leffler JM, Romanowicz M, Brennan E, Elmaghraby R, Caflisch S, Lange H, Kirtley AT. Integrated Case Presentation Seminar: Bridging Parallel Fields to Improve Psychiatry and Psychology Learner Experience. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01522-z. [PMID: 36869965 PMCID: PMC9984746 DOI: 10.1007/s10578-023-01522-z] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/05/2023]
Abstract
Daily clinical practice of mental health professionals often requires interaction between providers from diverse training and professional backgrounds. Efforts to engage mental health trainees across disciplines are necessary and have had varied outcomes. The current study reviews the development and implementation of a monthly one-hour integrated case presentation seminar (ICPS) as part of independent psychology and psychiatry two-year fellowships at a Midwestern teaching hospital. The training integrated a semi-structured seminar to facilitate case presentation within a group setting. The focus of the seminar was to allow for exposure to conceptualization, diagnostic, and treatment strategies and skills, as well as science-based practice techniques for trainees. Learner survey results and the sustained offering of the seminar suggest the format and goals of the seminar are feasible and acceptable. Based on the current preliminary findings, similar training programs may find benefit in strategies to enhance integrated training opportunities for psychiatry and psychology trainees.
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Affiliation(s)
- Jarrod M Leffler
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Elle Brennan
- Division of NeuroBehavioral Health, Akron Children's Hospital, 215 W. Bowery St, Akron, OH, 44308, USA
| | - Rana Elmaghraby
- Department of Psychiatry, University of Washington, Seattle, WA, USA
- Behavioral Health Services, Sea Mar Community Center, Washington Sea Mar Community Health Centers, 14508 NE 20th Ave. Suite #305, Vancouver, WA, 98686, USA
| | - Sara Caflisch
- University of Wisconsin-Eau Claire, Eau Claire, WI, USA
| | - Hadley Lange
- Minnesota Epilepsy Group, 225 Smith Ave N #201, St. Paul, MN, USA
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Elmaghraby R, Daas M, Elnajjar A, Elkady R. Cultural Considerations in Working with Arab American Youth. Child Adolesc Psychiatr Clin N Am 2022; 31:719-732. [PMID: 36182220 DOI: 10.1016/j.chc.2022.06.007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is limited literature on Arab American mental health, particularly among youth. This chapter will provide an overview of the Arab American/MENA population, their migration to the United States, traditional Arab culture and values, Arab American youth identity, acculturation and acculturation stress, the impact of discrimination on Arab American youth, mental illness in Arab American youth, and cultural variables to consider in seeking help. This chapter will provide recommendations and cultural considerations when working with Arab American youth.
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Affiliation(s)
- Rana Elmaghraby
- Sea Mar Community Health Centers, 14508 NE 20th Avenue, Suite #305, Vancouver, WA 98686, USA; University of Washington, Seattle, WA, USA.
| | - Magdoline Daas
- Community Health Network Indianapolis, 6950 Hillsdale Court, Indianapolis, IN 46250, USA; Osteopathic Medical School-Marian University, 6950 Hillsdale Court, Indianapolis, IN 46250, USA
| | - Alaa Elnajjar
- Bradley Hospital, Alpert Medical School of Brown University, 5775 Post Road, #297, East Greenwich, RI 02818, USA
| | - Rasha Elkady
- University of Missouri School, of Medicine, One Hospital Drive, DC 067.00, Columbia, MO 65212, USA
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Elmaghraby R, Sun Q, Ozger C, Shekunov J, Romanowicz M, Croarkin PE. A Systematic Review of the Safety and Tolerability of Theta Burst Stimulation in Children and Adolescents. Neuromodulation 2022; 25:494-503. [PMID: 35670061 PMCID: PMC8617062 DOI: 10.1111/ner.13455] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 01/25/2021] [Revised: 04/04/2021] [Accepted: 04/19/2021] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Theta burst stimulation (TBS) is often used in clinical practice and research protocols for adults with neuropsychiatric disorders. There are substantial knowledge gaps related to the application of TBS in children and adolescents. This systematic review examined the safety and tolerability of TBS in children and adolescents. MATERIALS AND METHODS A systematic review of human TBS studies in children and adolescents was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The following inclusion criteria were applied: 1) articles in English language only; 2) studies that included child and adolescent participants (up to 21 years of age); 3) studies that administered intermittent TBS or continuous TBS or both to participants; 4) studies that had an outcome measure; and 5) availability of full text material. The primary outcome measures were tolerability and safety. When feasible, the clinical effects were reviewed. RESULTS Twenty relevant articles met the criteria for inclusion. The reported adverse events were mild and similar to what is noted in adult studies. The most common symptom was headache. One case report described a seizure induced by TBS. Collectively, the studies were heterogeneous but the methodologic quality of randomized trials was high. CONCLUSIONS TBS interventions in children may have similar safety, tolerability, and feasibility as compared to adults. However, long-term, follow-up studies of TBS are lacking. Future dose-ranging studies with systematic assessment of adverse events will be important in the translation of findings with TBS from adults to youth.
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Affiliation(s)
- Rana Elmaghraby
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Qi Sun
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Can Ozger
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Julia Shekunov
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Magdalena Romanowicz
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA
| | - Paul E Croarkin
- Department of Psychiatry and Psychology, Mayo Clinic College of Medicine and Science, Rochester, MN, USA.
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Bhikram T, Elmaghraby R, Abi-Jaoude E, Sandor P. An International Survey of Health Care Services Available to Patients With Tourette Syndrome. Front Psychiatry 2021; 12:621874. [PMID: 33716822 PMCID: PMC7953144 DOI: 10.3389/fpsyt.2021.621874] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/05/2021] [Indexed: 12/13/2022] Open
Abstract
Objective: Tourette syndrome (TS) is a neuropsychiatric disorder that is highly associated with several comorbidities. Given the complex and multifaceted nature of TS, the condition is managed by a wide variety of practitioners in different disciplines. The goal of this study was to investigate health service delivery and care practices by clinicians who see TS patients across different geographic settings internationally. Methods: A comprehensive questionnaire was developed to assess clinical care resources for patients with TS and was sent to clinicians in Canada (CA), the United States (US), Europe (EU), and the United Kingdom (UK). Responses were compared quantitatively between geographic regions. Results: The majority of respondents, regardless of region, reported that fewer than 40% of their case-load are patients with tics. The accessibility of TS services varied among regions, as indicated by differences in wait times, telemedicine offerings, comorbidity management and the availability of behavioral therapies. First-line pharmacotherapy preferences varied among physicians in different geographical regions with CA respondents preferring alpha-2-adrenergic agonists and respondents from the UK and EU preferring dopamine receptor antagonists. Discussion: The results suggest that there is a scarcity of specialized TS clinics, potentially making access to services challenging, especially for patients newly diagnosed with TS. Differences in regional pharmacotherapeutic preferences are reflected in various published treatment guidelines in EU and North America. The lack of dedicated specialists and telemedicine availability, coupled with differences in comorbidity management, highlight the need for interprofessional care and holistic management to improve health care delivery to patients with TS.
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Affiliation(s)
- Tracy Bhikram
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
| | - Rana Elmaghraby
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Youthdale Treatment Centre, Toronto, ON, Canada
| | - Elia Abi-Jaoude
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Paul Sandor
- Department of Psychiatry, University Health Network and University of Toronto, Toronto, ON, Canada
- Youthdale Treatment Centre, Toronto, ON, Canada
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Nour I, Elmaghraby R, Shehata R, El-Refaey A, Aldomiaty H, Mosbah A, Shouman B, Nasef N. Selective head cooling and acute kidney injury in neonates with hypoxic ischemic encephalopathy. J Neonatal Perinatal Med 2019; 13:21-30. [PMID: 31561395 DOI: 10.3233/npm-180200] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The reno-protective effect of therapeutic hypothermia in infants with hypoxic ischemic encephalopathy (HIE) is still debatable. We aimed to study the effect of therapeutic hypothermia on the development and progress of acute kidney injury (AKI) in neonates with HIE. METHODS Thirty full term infants with HIE were equally distributed between cooling group (selective head cooling) or non-cooling group (late presentation after 6 hours of birth). Serum creatinine, urine output (UOP), serum neutrophil gelatinase-associated lipocalin (NGAL), and serum cystatin C were measured at baseline, day 4 and day 10 of life. RESULTS The incidence of AKI as per Acute Kidney Injury Network (AKIN) criteria was comparable in cooling and non-cooling groups (40% versus 53%, respectively). Serum creatinine and UOP were significantly improved on day-4 and day-10 samples compared to base-line samples in both groups regardless of cooling. Therapeutic hypothermia was associated with a significant reduction in serum NGAL, but not cystatin C, level in day-4 and day-10 samples compared to the non-cooling group. Serum NGAL and cystatin C did not show a significant decline in day-4 and day-10 samples compared to baseline samples in both the cooled and non-cooled groups indicating an ongoing AKI. CONCLUSIONS Therapeutic hypothermia was associated with less renal impairment when compared to infants with HIE who were not cooled. Continuing kidney injury may persist in asphyxiated newborns despite improvement in serum creatinine and UOP. TRIAL REGISTRATION NUMBER NCT02683915.
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Affiliation(s)
- I Nour
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - R Elmaghraby
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
| | - R Shehata
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
| | - A El-Refaey
- Nephrology Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - H Aldomiaty
- Nephrology Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - A Mosbah
- Department of Clinical Pathology, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - B Shouman
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
| | - N Nasef
- Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt.,Department of Pediatrics, Faculty of Medicine, University of Mansoura, Mansoura, Egypt
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