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Hassan MA, Mohamed IA, Omar AA, Adan ZM, Garba B, Badawi OH. Sildenafil Use and Cigarette Smoking Associated with Intracerebral Hemorrhage: A Rare Case Report. Vasc Health Risk Manag 2024; 20:21-26. [PMID: 38222901 PMCID: PMC10787546 DOI: 10.2147/vhrm.s443995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 01/05/2024] [Indexed: 01/16/2024] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a serious condition characterized by bleeding within the brain tissue. Although the use of sildenafil, a vasodilator agent for erectile dysfunction, has been associated with rare cases of ICH, the combination of sildenafil usage and smoking as risk factors for ICH has not yet been reported. This case report describes the occurrence of ICH in a patient with a history of both sildenafil usage and heavy smoking. Case Presentation A 53-year-old male, with a history of smoking and regular sildenafil use, was brought to the emergency department due to loss of consciousness with right-side weakness, he initially experienced with nausea, vomiting and dizziness after taking sildenafil 100mg tablet once. The Glasgow Coma Score (GCS) was 10 with side hemiparesis. Non-contrast CT revealed left thalamic acute hemorrhage with ventricular extension. Furthermore, a head CT angiography ruled out any vascular anomalies after that the patient was admitted to the intensive care unit (ICU) for conservative management. After three days on clinical and neurological improvement, the patient was transferred to the inpatient ward for further management, monitoring and physiotherapy. On day 6, the patient was discharged and planned for flow up. Conclusion This rare case highlights the need for further research and awareness regarding the potential risks associated with the combination of sildenafil and heavy smoking. Healthcare professionals should carefully evaluate the individual risk factors of patients, educate them about potential complications, and consider alternative treatments if necessary. Additionally, patients should be encouraged to quit smoking and adopt a healthy lifestyle to minimize the risk of cerebrovascular events.
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Affiliation(s)
- Mohamed Abdulahi Hassan
- Department of Internal Medicine and Intensive Care Unit, Dr. Sumait Hospitals Affiliated of SIMAD University, Mogadishu, Somalia
- Department of Medicine and Surgery of Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Ibrahim Abdullahi Mohamed
- Department of Internal Medicine and Intensive Care Unit, Dr. Sumait Hospitals Affiliated of SIMAD University, Mogadishu, Somalia
| | - Abdullahi Abdirahman Omar
- Department of Internal Medicine and Intensive Care Unit, Dr. Sumait Hospitals Affiliated of SIMAD University, Mogadishu, Somalia
| | - Zakaria Mohamed Adan
- Department of Internal Medicine and Intensive Care Unit, Dr. Sumait Hospitals Affiliated of SIMAD University, Mogadishu, Somalia
| | - Bashiru Garba
- Department of Public Health, Faculty of Medicine and Health Sciences, SIMAD University, Mogadishu, Somalia
| | - Omar Hassan Badawi
- Department of Radiology, Dr. Sumait Hospitals affiliated of SIMAD University, Mogadishu, Somalia
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Wagner-Altendorf TA, Boppel T, Herzog R, Münte TF. Sudden headache due to perimesencephalic subarachnoid hemorrhage after self-medication with 200 mg sildenafil: Case report and discussion. Clin Neurol Neurosurg 2020; 194:105844. [DOI: 10.1016/j.clineuro.2020.105844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 10/24/2022]
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3
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Spinal cord intramedullary hemorrhage (hematomyelia) after use of sildenafil: A very rare complication. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.635056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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4
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Ellis R, Kailavasan M, Bazo A. Subarachnoid haemorrhage following first use of Sildenafil. JOURNAL OF CLINICAL UROLOGY 2019. [DOI: 10.1177/2051415818770340] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Level of evidence: Not applicable for this case report.
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Affiliation(s)
- Ricky Ellis
- Urology Department, Nottingham University Hospitals, UK
| | | | - Alvaro Bazo
- Urology Department, Nottingham University Hospitals, UK
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5
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Uneda A, Hirashita K, Yunoki M, Yoshino K, Date I. Pituitary adenoma apoplexy associated with vardenafil intake. Acta Neurochir (Wien) 2019; 161:129-131. [PMID: 30542775 DOI: 10.1007/s00701-018-3763-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/04/2018] [Indexed: 11/29/2022]
Abstract
Vardenafil is a potent phosphodiesterase-5 (PDE-5) inhibitor used in the treatment of erectile dysfunction. Several cases of stroke related to the use of PDE-5 inhibitors have been reported. Here, we describe the case of a 51-year-old man with headache and right ophthalmoplegia subsequent to vardenafil consumption. Computed tomography and magnetic resonance imaging showed a suprasellar mass with hemorrhage suggesting pituitary apoplexy. He underwent transsphenoidal resection of the pituitary mass. Histopathology confirmed the diagnosis of a necrotic pituitary adenoma with hemorrhage. This report suggests a possible association between pituitary apoplexy and vardenafil use. In patients with preexisting pituitary adenoma, vardenafil may enhance the risk of pituitary apoplexy. Although headache is the most commonly reported side effect of vardenafil, pituitary apoplexy should be considered in the differential diagnosis of a patient with headache and ophthalmoplegia subsequent to vardenafil intake.
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Affiliation(s)
- Atsuhito Uneda
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan.
- Department of Neurological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Koji Hirashita
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Masatoshi Yunoki
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Kimihiro Yoshino
- Department of Neurosurgery, Kagawa Rosai Hospital, Marugame, Kagawa, Japan
| | - Isao Date
- Department of Neurological Surgery, Dentistry, and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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Duarte DV, Restrepo-Méndez MC, Silveira MFD. Prevalence of erectile dysfunction oral drugs use in a city of southern Brazil. CIENCIA & SAUDE COLETIVA 2017; 22:2763-2770. [PMID: 28793090 DOI: 10.1590/1413-81232017228.24952015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 03/23/2016] [Indexed: 12/25/2022] Open
Abstract
The last decade has seen a breakthrough in the treatment of erectile dysfunction (ED) with the advent of phosphodiesterase-5 inhibitors. There are few population-based observational studies on the prevalence of use of these drugs. We conducted a cross-sectional population-based study in the city of Pelotas (Brazil). Our sample comprised 1,082 men aged 20 years or older who answered a confidential and self-administered questionnaire. Prevalence of EDD use was 5% (IC95% = 4%;7%). ED and advanced age were strongly associated with a higher prevalence of EDD use. ED prevalence in men who used EDD was 68%, which was much higher than the one found in the entire sample (27%). The use of EDD was more frequently reported among separated men, respondents with higher level of education and those without ED. A high proportion of respondents (68%) did not seek medical advice on the use of EDD. Sildenafil was the most commonly used drug (38%) but non-regulated and non-evidence-based drugs were also frequently used (14%). Prevalence of EDD use is higher among individuals with ED, opposing to the notion of recreational use of EDD.
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Affiliation(s)
- Daniel Vanti Duarte
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
| | - María Clara Restrepo-Méndez
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
| | - Mariângela Freitas da Silveira
- Departamento Materno-Infantil, Faculdade de Medicina, Universidade Federal de Pelotas. Av. Duque de Caxias 250, Fragata. 96030-001 Pelotas RS Brasil.
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Giammattei L, Mantovani G, Carrabba G, Ferrero S, Di Cristofori A, Verrua E, Guastella C, Pignataro L, Rampini P, Minichiello M, Locatelli M. Pituitary apoplexy: considerations on a single center experience and review of the literature. J Endocrinol Invest 2016; 39:739-46. [PMID: 26733212 DOI: 10.1007/s40618-015-0424-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 12/11/2015] [Indexed: 11/30/2022]
Abstract
PURPOSE To present a single-center experience on pituitary tumor apoplexy and a review of literature focusing on predisposing and precipitating factors. METHODS Clinical presentation of our series of cases. Contemporary published literature is also reviewed. RESULTS The definition of this syndrome has not been consistent although now the majority of authors agree to definite it as an acute condition caused by hemorrhage or infarction of a pre-existing pituitary adenoma. Different predisposing and precipitating factors have been described in literature; among these antithrombotic and anticoagulant drugs, seem to play relevant roles. The clinical cases observed in our clinic confirm these data and suggest a probable association between elderly patients taking anticoagulant therapy and pituitary apoplexy adenoma. CONCLUSION Pituitary tumor apoplexy remains a challenging disease in relation to difficulties in correct diagnosis and thus in appropriate treatment. Antithrombotic/anticoagulant therapy may have an important role as precipitating factor. When a pituitary disorder is known, great care should be taken in the prescription of anticoagulant therapy.
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Affiliation(s)
- L Giammattei
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - G Mantovani
- Unit of Endocrinology - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - G Carrabba
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - S Ferrero
- Unit of Pathology - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Italy
| | - A Di Cristofori
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy
| | - E Verrua
- Unit of Endocrinology - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - C Guastella
- Unit of Otolaringology - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - L Pignataro
- Unit of Otolaringology - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - P Rampini
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - M Minichiello
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
- Department of Pathophysiology and Organ Transplantation, University of Milan, Milan, Italy.
| | - M Locatelli
- Unit of Neurosurgery - Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
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Abstract
Sildenafil is one of the most commonly used drugs for the treatment of erectile dysfunction. To date, we found five reported cases of intracerebral bleeding and two reported cases of subarachnoid hemorrhage related to sildenafil use. We report a 49-year-old hypertensive and diabetic patient who presented with acute pulmonary edema and loss of consciousness following ingestion of 100 mg of sildenafil prior to sexual intercourse. He was not previously aware of the presence of an aneurysm and had no family history of it. Computed tomography of his head revealed a subarachnoid hemorrhage due to rupture of a saccular aneurysm with subsequent repeat hemorrhage within a few hours of presentation. A sudden increase in blood pressure led to pulmonary edema. Studies have shown that sildenafil acts on phosphodiesterase-1, -2 and -5 receptors and leads to a secondary increase in intracerebral circulation and vasodilatory effects, leading to sympathetic overactivity which increases the risk for intracranial bleeding.
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Affiliation(s)
- Avinash Adiga
- Texas Tech University Health Science Center, Lubbock, Texas
| | - Hawa Edriss
- Texas Tech University Health Science Center, Lubbock, Texas
| | - Kenneth Nugent
- Texas Tech University Health Science Center, Lubbock, Texas
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9
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Sexual activity as a trigger for intracranial hemorrhage. Acta Neurochir (Wien) 2016; 158:189-95. [PMID: 26589958 DOI: 10.1007/s00701-015-2643-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 11/13/2015] [Indexed: 12/17/2022]
Abstract
BACKGROUND Intracranial hemorrhage (ICH) has been reported in association with sexual activity. A case-series of patients with ICH following sexual activity is presented to further elucidate the role of the physiologic sexual response as a trigger of ICH. METHOD A retrospective review of the medical record was performed, identifying patients presenting with ICH temporally related to sexual activity. Clinical and radiographic data were collected and reported. RESULTS Sixteen patients presented with non-traumatic ICH temporally related to sexual activity. Eight (50 %) patients presented with aneurysmal subarachnoid hemorrhage, four (25 %) with angiogram-negative subarachnoid hemorrhage, two (12.5 %) with a ruptured arteriovenous malformation, and two (12.5 %) with an intracerebral basal ganglia hemorrhage. Overall average age was 49.9 (range, 28-74) years. Sexual activity involved male-female intercourse in 14 (87.5 %) patients and masturbation in 2 (12.5 %) patients. CONCLUSIONS Sexual-activity-related ICH is rare and includes various etiologies. The human sexual response in associated with dramatic increases in arterial blood pressure, which likely underlies the association.
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10
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Nonaneurysmal subarachnoid hemorrhage after udenafil intake. J Stroke Cerebrovasc Dis 2013; 22:e647-9. [PMID: 23643478 DOI: 10.1016/j.jstrokecerebrovasdis.2013.04.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 04/05/2013] [Accepted: 04/06/2013] [Indexed: 11/22/2022] Open
Abstract
We report a 67-year-old man who presented with severe headache after taking 50 mg of udenafil, a new phosphodiesterase 5 inhibitor. Computed tomographic imaging of the brain revealed a small amount of acute subarachnoid hemorrhage localized around basal cisterns (anterior to midbrain and pons). There were no aneurysms in the cerebral arteries, although vein of Galen stenosis was suspected after magnetic resonance venography. This case anecdotally suggests that phosphodiesterase 5 inhibition might trigger perimesencephalic subarachnoid hemorrhage with venous hypertension possibly associated with vein of Galen stenosis.
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11
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Cannizzaro E, Cannizzaro C, Lopez G, Lo Coco D. Stroke after tadalafil use. Neurol Sci 2013; 34:1843-4. [DOI: 10.1007/s10072-013-1324-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 01/23/2013] [Indexed: 10/27/2022]
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Sheikh-Taha M, Alaywa RA. Subarachnoid hemorrhage associated with tadalafil. Am J Health Syst Pharm 2011; 68:1195-6. [DOI: 10.2146/ajhp100506] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Marwan Sheikh-Taha
- School of Pharmacy Lebanese American University P.O. Box 36 Byblos, Lebanon
| | - Rayan Abu Alaywa
- School of Pharmacy Lebanese American University P.O. Box 36 Byblos, Lebanon
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Byoun HS, Lee YJ, Yi HJ. Subarachnoid Hemorrhage and Intracerebral Hematoma due to Sildenafil Ingestion in a Young Adult. J Korean Neurosurg Soc 2010; 47:210-2. [PMID: 20379474 DOI: 10.3340/jkns.2010.47.3.210] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2009] [Revised: 07/20/2009] [Accepted: 01/06/2010] [Indexed: 11/27/2022] Open
Abstract
Sildenafil citrate (Viagra(R); Pfeizer US Pharmaceutical Group, New York, NY, USA) is a potent vasodilating agent to treat male erectile dysfunction. Among its adverse effects, hemorrhagic stroke has not been widely reported yet. We present a case of a 33-year-old healthy man who ingested 50 mg sildenafil a half hour before onset of headache, nervousness and speech disturbance. Head computed tomogram of this stuporous man showed huge intracerebral hemorrhage and thick subarachnoid hemorrhage, but angiography failed to disclose any vascular anomalies. Subsequent surgical procedure was followed, and rehabilitation was provided thereafter. Sildenafil seems to act by redistributing arterial blood flow, and concurrent sympathetic hyperactivity, which lead to such hemorrhagic presentation. Extreme caution should be paid on even in a young adult male patient wven without known risk factors.
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Affiliation(s)
- Hyoung-Soo Byoun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
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Abstract
Despite limited evidence from clinical studies, anticoagulant drugs such as vitamin K antagonists (VKA) (e.g., warfarin or phenprocoumon) are widely used in the background treatment of patients with pulmonary arterial hypertension (PAH). According to current guidelines, they are generally accepted as efficacious drugs, although their efficacy is neither supported by randomised controlled trials, nor formally approved by regulatory agencies for use in the specific PAH indication. The use of these drugs is not without problems, as a paradoxical situation has to be managed in the treatment of this condition. On one hand, thrombosis is one of the key pathophysiologic features of PAH (besides vasoconstriction, proliferation and inflammation). On the other hand, the incidence of bleeding events is increased in PAH patients. This applies particularly to PAH that is related to connective tissue diseases, congenital heart disease and chronic thromboembolic pulmonary hypertension. In patients receiving VKA, caution must be observed in particular when concomitantly using prostanoids or sildenafil. Similarly, VKA doses have to be adjusted according to the labelling when using sitaxentan concomitantly. Regular International Normalized Ratio monitoring contributes to the safety of PAH patients on VKA.
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Affiliation(s)
- C F Opitz
- DRK Kliniken Berlin Köpenick, Berlin.
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15
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Current awareness: Pharmacoepidemiology and drug safety. Pharmacoepidemiol Drug Saf 2009. [DOI: 10.1002/pds.1644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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