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Das BB, Blackshear CT, Lirette ST, Slaughter MS, Ghaleb S, Moskowitz W, Ghanamah M, Burch PT. Impact of 2016 UNOS pediatric heart allocation policy changes on VAD utilization, waitlist, and post-transplant survival outcomes in children with CHD versus Non-CHD. Clin Transplant 2023; 37:e14843. [PMID: 36494889 DOI: 10.1111/ctr.14843] [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: 08/30/2022] [Revised: 10/18/2022] [Accepted: 10/21/2022] [Indexed: 12/14/2022]
Abstract
AIMS We analyzed the impact of the revised pediatric heart allocation policy on types of ventricular assist device (VAD) utilization, and waitlist (WL) and post-heart transplant (HT) survival outcomes in congenital heart disease (CHD) versus non-CHD patients before (Era-1) and after (Era-2) pediatric heart allocation policy implementation. METHODS We retrospectively reviewed the UNOS database from December 16, 2011, through March 31, 2021, for patients < 18 years old and listed for primary HT. We compared the differences observed between Era-1 and Era-2. RESULTS 5551 patients were listed for HT, of whom 2447(44%) were in Era-1 and 3104(56%) were in Era-2. CHD patients were listed as status 1A unchanged, but the number of patients listed as status 1B decreased in Era-2, whereas the number of non-CHD patients listed as status 1A decreased, but status 1B increased. In Era-2 compared to Era-1, both temporary (1% to 4%, p < .001) and durable VAD (13.6% to 17.8%, p < .001) utilization increased, and the transplantation rate per 100-patient years increased in both groups. The median WL period for CHD patients increased marginally from 70 to 71 days (p = .06), whereas for non-CHD patients it decreased from 61 to 54 days (p < .001). Adjusted 90-day WL survival increased from 84% to 88%, p = .016 in CHD, but there was no significant change in non-CHD patients (p = .57). There was no significant difference in 1-year post-HT survival in CHD and non-CHD patients between Era-1 and Era-2. CONCLUSIONS In summary, after the revised heart allocation policy implementation, temporary and durable VAD support increased, HT rate increased, waitlist duration marginally increased in the CHD cohort and decreased in the non-CHD cohort, and 90-day WL survival probability improved in children with CHD without significant change in 1-year post-HT outcomes. Future studies are needed to identify changes to the policy that may further improve the listing criteria to improve WL duration and post-HT survival.
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Affiliation(s)
- Bibhuti B Das
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Chad T Blackshear
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Seth T Lirette
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mark S Slaughter
- Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Kentucky, USA
| | - Stephanie Ghaleb
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - William Moskowitz
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Mohammad Ghanamah
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
| | - Phillip T Burch
- Heart Center, Mississippi Children's Hospital, University of Mississippi Medical Center, Jackson, Mississippi, USA
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Arash S, Akbari B, Ghaleb S, Kaffashi B, Marouf BT. Preparation of PLA-TPU-Nanoclay composites and characterization of their morphological, mechanical, and shape memory properties. J Mech Behav Biomed Mater 2023; 139:105642. [PMID: 36706650 DOI: 10.1016/j.jmbbm.2022.105642] [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: 06/20/2022] [Revised: 12/17/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
In this study, a combination of polylactic acid polymer and thermoplastic polyurethane with the addition of nano-clay particles was used. The reason for using clay nanoparticles and their strength is the low price and availability of this material. Adding nano-clay particles to the polymer composition improves the mechanical properties of the composite as they will interact with functional groups of the polymer. The results of the FTIR spectroscopy confirmed the presence of three components in the compound indicating that no chemical reactions occurred among the three components during the compounding process. The FE-SEM images taken from the compounds showed that TPU and nano-clay particles were evenly distributed in the PLA matrix. The DMTA results were utilized to determine the transfer temperature of the compounds as well as the storage and loss modulus and the shape memory properties. The XRD spectroscopy was used to determine the crystallinity and exfoliation of the nanoparticles. The mechanical properties of the fabricated polymer compounds were determined. It was found that the sample with 3% by weight of clay nanoparticles had the highest strength, and the sample with 5 wt% of clay nanoparticles had the highest toughness among nanocomposites. According to the hardness measurement, the sample with 5% by weight of clay nanoparticles has the highest hardness amongst all prepared composites. The memory properties of the prepared nanocomposites showed a significant improvement with increasing the amount of nanoparticles. This study showed the suitability and efficiency of PLA, TPU, and clay nanoparticle melt mixing methods in achieving a relatively tough shape memory composite. At the same time, this method is also inexpensive and scalable.
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Affiliation(s)
- S Arash
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - B Akbari
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran.
| | - S Ghaleb
- Department of Life Science Engineering, Faculty of New Sciences and Technologies, University of Tehran, Tehran, Iran
| | - B Kaffashi
- School of Chemical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - B T Marouf
- Department of Materials Science and Engineering, Faculty of Engineering, Urmia University, Urmai, Iran
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Hegazy M, Ghaleb S, Das BB. Diagnosis and Management of Cancer Treatment-Related Cardiac Dysfunction and Heart Failure in Children. Children (Basel) 2023; 10:children10010149. [PMID: 36670699 PMCID: PMC9856743 DOI: 10.3390/children10010149] [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] [Figures] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Revised: 01/05/2023] [Accepted: 01/09/2023] [Indexed: 01/13/2023]
Abstract
It is disheartening for parents to discover that their children have long-term cardiac dysfunction after being cured of life-threatening childhood cancers. As the number of childhood cancer survivors increases, early and late oncology-therapy-related cardiovascular complications continues to rise. It is essential to understand that cardiotoxicity in childhood cancer survivors is persistent and progressive. A child's cancer experience extends throughout his lifetime, and ongoing care for long-term survivors is recognized as an essential part of the cancer care continuum. Initially, there was a lack of recognition of late cardiotoxicities related to cancer therapy. About 38 years ago, in 1984, pioneers like Dr. Lipshultz and others published anecdotal case reports of late cardiotoxicities in children and adolescents exposed to chemotherapy, including some who ended up with heart transplantation. At that time, cardiac tests for cancer survivors were denied by insurance companies because they did not meet appropriate use criteria. Since then, cardio-oncology has been an emerging field of cardiology that focuses on the early detection of cancer therapy-related cardiac dysfunction occurring during and after oncological treatment. The passionate pursuit of many healthcare professionals to make life better for childhood cancer survivors led to more than 10,000 peer-reviewed publications in the last 40 years. We synthesized the existing evidence-based practice and described our experiences in this review to share our current method of surveillance and management of cardiac dysfunction related to cancer therapy. This review aims to discuss the pathological basis of cancer therapy-related cardiac dysfunction and heart failure, how to stratify patients prone to cardiotoxicity by identifying modifiable risk factors, early detection of cardiac dysfunction, and prevention and management of heart failure during and after cancer therapy in children. We emphasize serial longitudinal follow-ups of childhood cancer survivors and targeted intervention for high-risk patients. We describe our experience with the new paradigm of cardio-oncology care, and collaboration between cardiologist and oncologist is needed to maximize cancer survival while minimizing late cardiotoxicity.
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Affiliation(s)
- Mohamed Hegazy
- University of Mississippi Medical Center Program, Jackson, MS 39216, USA
| | - Stephanie Ghaleb
- Division of Pediatric Cardiology, Department of Pediatrics, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA
| | - Bibhuti B Das
- Division of Pediatric Cardiology, Department of Pediatrics, McLane Children’s Baylor Scott and White Medical Center, Baylor College of Medicine-Temple, Temple, TX 76502, USA
- Correspondence: ; Tel.: +1-254-935-4980
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Das BB, Shakti D, Ghaleb S, Akam-Venkata J, Moskowitz WB, Osakwe O, Weiland MD, Arya S, Gajula V, Taylor MB. Racial and Ethnic Disparity in Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 in Mississippi, USA. Clin Pediatr (Phila) 2023; 62:8-16. [PMID: 35801262 PMCID: PMC9720419 DOI: 10.1177/00099228221108591] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We aimed to study the disparity in the clinical profile and outcomes of hospitalized Multisystem Inflammatory Syndrome in Children (MIS-C) patients at our center. The second goal was to examine the temporal association with preceding SARS-CoV-2 infection by race/ethnicity in our community in Mississippi. We found the racial disparity in the prevalence of MIS-C exceeded its temporal association with SARS-CoV-2 infections. We included 51 consecutive MIS-C patients hospitalized, whose median age was 9 (interquartile range [IQR] 5-12) years, 58% were male, 71% were black, 25% were white, and 4% belonged to other groups. We found a delay between onset of symptoms and hospitalization in black patients compared with white patients with a median of 2 (IQR 0-7) vs median of 0 (0-5) urgent care visits (P = .022), respectively. Black patients were hospitalized longer (median 8, IQR 2-39 days) than whites (median 5, IQR 3-14 days), P = .047. A total of 38.9% of blacks and 23.1% of whites were admitted to intensive care unit (P = .498); 36.1% of blacks had severe cardiac involvement vs 23.1% of white patients, P = .531. Future studies of MIS-C are required to improve health equity for children.
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Affiliation(s)
- Bibhuti B. Das
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA,Bibhuti B. Das, Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, 2500 N State St., Jackson, MS 39216, USA.
| | - Divya Shakti
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephanie Ghaleb
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Jyothsna Akam-Venkata
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - William B. Moskowitz
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Onyekachukwu Osakwe
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Michael D. Weiland
- Division of Cardiology, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep Arya
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Viswanath Gajula
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Mary B. Taylor
- Division of Critical Care, Department of Pediatrics, The University of Mississippi Medical Center, Jackson, MS, USA
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Das BB, Ghaleb S, Moskowitz W, Arya S, Taylor M. Posterior reversible encephalopathy syndrome in a pediatric heart transplant recipient with coarctation of aorta. Ann Pediatr Cardiol 2022; 15:518-522. [PMID: 37152513 PMCID: PMC10158466 DOI: 10.4103/apc.apc_235_21] [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] [Received: 12/15/2021] [Revised: 02/16/2022] [Accepted: 03/19/2022] [Indexed: 03/02/2023] Open
Abstract
Posterior reversible encephalopathy syndrome (PRES) is a clinical-radiographic syndrome reported in children with hypertension due to renal diseases, immunosuppression after solid organ transplant, cytotoxic agents for chemotherapy, and many others rare instances. We described PRES in a 6-year-old child with hypertension secondary to an incidental postoperative coarctation of the aorta after heart transplantation (HT). Her blood pressure was well controlled with amlodipine during the outpatient visits and home monitoring of blood pressure, but she had hypertension when presented with neurological symptoms. This case's unique feature is that although PRES has been described after pediatric HT, this is the first case report due to a postoperative coarctation of the proximal descending aorta related to scarring from previous multiple sternotomies leading to inadvertent external compression of the aorta with scar tissue. We discussed the risk factors associated with hypertension before PRES and the correlation of brain magnetic resonance imaging findings with clinical outcomes.
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Affiliation(s)
- Bibhuti B. Das
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Stephanie Ghaleb
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - William Moskowitz
- Department of Pediatrics, Division of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA
| | - Sandeep Arya
- Department of Pediatrics, Division of Critical Care, University of Mississippi Medical Center, Jackson, MS, USA
| | - Mary Taylor
- Department of Pediatrics, Division of Critical Care, University of Mississippi Medical Center, Jackson, MS, USA
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Das B, Ghaleb S, Moskowitz W, Slaughter M, Trivedi J. Impact of the 2016 Organ Procurement and Transplantation Network (OPTN) Pediatric Heart Allocation Policy Change on Use of Durable Ventricular Assist Devices and Heart Transplantation Rates in Children with Congenital Heart Disease versus Cardiomyopathy. J Heart Lung Transplant 2022. [DOI: 10.1016/j.healun.2022.01.249] [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: 11/30/2022] Open
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Nannapaneni H, Ghaleb S, Arya S, Gajula V, Taylor MB, Das BB. Further Evidence of Autosomal Recessive Inheritance of RPL3L Pathogenic Variants with Rapidly Progressive Neonatal Dilated Cardiomyopathy. J Cardiovasc Dev Dis 2022; 9:jcdd9030065. [PMID: 35323613 PMCID: PMC8955827 DOI: 10.3390/jcdd9030065] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/31/2022] [Accepted: 02/17/2022] [Indexed: 01/27/2023] Open
Abstract
Neonatal dilated cardiomyopathy (DCM) is rare with high etiologic heterogeneity. Recently, biallelic, autosomal recessive, pathogenic variants in RPL3L (ribosomal protein L3-like) have been reported in the literature with severe early-onset DCM. In the present brief report, we identified two pathogenic RPL3L variants, each harbored in unaffected heterozygous parents: mother (RPL3L c.1076_1080delCCGTG (p.Ala359Glyfs*4)) and father (RPL3L c.80G > A (p.Gly27Asp)). Pathogenic variants were segregated as autosomal recessive to two offspring born with compound heterozygous RPL3L variants and affected by neonatal DCM. This is the second report in the literature to the best of our knowledge and our findings support the pathogenicity of biallelic RPL3L pathologic variants associated with rapidly progressive neonatal DCM and heart failure with a poor prognosis.
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Affiliation(s)
| | - Stephanie Ghaleb
- Department of Pediatrics, Division of Pediatric Cardiology, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA;
| | - Sandeep Arya
- Department of Pediatrics, Division of Critical Care, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA; (S.A.); (V.G.); (M.B.T.)
| | - Viswanath Gajula
- Department of Pediatrics, Division of Critical Care, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA; (S.A.); (V.G.); (M.B.T.)
| | - Mary B. Taylor
- Department of Pediatrics, Division of Critical Care, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA; (S.A.); (V.G.); (M.B.T.)
| | - Bibhuti B. Das
- Department of Pediatrics, Division of Pediatric Cardiology, Children’s of Mississippi Heart Center, University of Mississippi Medical Center, Jackson, MS 39216, USA;
- Correspondence: ; Tel.: +1-601-984-5250; Fax: +1-601-984-5283
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Ghaleb S, Wittekind SG, Martinez H, Kasten J, Gao Z, Hengehold T, Chin C. Antithymocyte globulin induction therapy and myocardial complement deposition in pediatric heart transplantation. Pediatr Transplant 2021; 25:e13998. [PMID: 33704881 DOI: 10.1111/petr.13998] [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] [Received: 04/21/2020] [Revised: 10/11/2020] [Accepted: 02/16/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Antithymocyte globulin (ATG) consists of polyclonal antibodies directed primarily against human T lymphocytes but may contain antibodies with affinity for other tissues in the transplanted organ, resulting in complement (C4d) deposition. This phenomenon has been demonstrated in endomyocardial biopsies (EMBs) of adult cardiac transplants. We examined the relationship of induction immunosuppression with ATG and C4d deposition in EMB of pediatric cardiac transplants. METHODS Results of C4d immunohistochemistry were available from all EMB of patients transplanted at our center between June 2012 and April 2018 (n = 48) who received induction immunosuppression with either ATG (n = 20) or basiliximab (n = 28) as the standard of care. RESULTS C4d deposition in the first year post-heart transplant was more commonly seen among patients who received ATG induction (20% of EMBs in ATG group vs 1% of EMBs in basiliximab group; p < .0001). C4d deposition related to ATG was observed early post-transplant (50% ATG vs 0% basiliximab on first EMB; p < .0001 and 35% ATG vs 0% basiliximab on the second EMB; p = .0012). While this difference waned by the third EMB (5% ATG vs 0% basiliximab; p = .41), positive C4d staining persisted to the sixth EMB in the ATG group only (6%). CONCLUSION C4d deposition is common on EMB up to 1 year post-pediatric cardiac transplant following ATG induction. This high rate of positive C4d staining in the absence of histologic AMR after ATG induction therapy must be accounted for in making clinical decisions regarding cardiac allograft rejection diagnosis and treatment.
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Affiliation(s)
- Stephanie Ghaleb
- The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Samuel G Wittekind
- The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Hugo Martinez
- The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Jennifer Kasten
- Department of Pathology, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Zhiqian Gao
- The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
| | - Tricia Hengehold
- University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Clifford Chin
- The Heart Institute, Cincinnati Children's Medical Center, Cincinnati, OH, USA
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Ghaleb S, Martinez H, Wittekind S, Witte D, Hengehold T, Chin C. Antithymocyte Globulin Induction is Associated with Complement Deposition in Pediatric Cardiac Transplant Biopsies. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1195] [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: 11/29/2022] Open
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Abstract
Tumors and thrombi are the most common cardiac masses of the right atrium. The use of noninvasive imaging to differentiate between the two can be deceiving, and the clinical judgment of a cardiologist and the emergency of the situation should be partnered to decide on the next step of the management. We present the case of a 29-year-old lady who was receiving neoadjuvant treatment for her rhabdomyosarcoma and was incidentally found to have a very large, very mobile right atrial mass that was protruding in the right ventricle with each cardiac cycle along with findings of a small segmental right lower lobe pulmonary embolism. Along with noninvasive imaging, frozen section analysis procured the wrong diagnosis, and the mass was ultimately found to be a right atrial thrombus on definite pathology review. Exact management of right atrial masses continues to be not well delineated, and when in doubt, final diagnosis might need to be "a posteriori" and based on the treatment response.
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Affiliation(s)
- Stephanie Ghaleb
- 1 Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Bryant Roosevelt
- 2 Department of Pediatric Cardiac Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - James Cnota
- 1 Department of Pediatric Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Silmi A, Usón A, Páramo P, Ramírez JC, Fernández L, Ghaleb S, Rabadán M, Gómez A. [Spermatic cord torsion. Contribution of 23 cases]. Actas Urol Esp 1979; 3:183-94. [PMID: 484302] [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: 12/15/2022]
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