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Dalinkeviciene E, Gradauskiene B, Sakalauskaite S, Petruliene K, Vaiciuniene R, Skarupskiene I, Bastyte D, Sauseriene J, Valius L, Bumblyte IA, Ziginskiene E. Immune Response after Anti-SARS-CoV-2 mRNA Vaccination in Relation to Cellular Immunity, Vitamin D and Comorbidities in Hemodialysis Patients. Microorganisms 2024; 12:861. [PMID: 38792691 PMCID: PMC11123711 DOI: 10.3390/microorganisms12050861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/19/2024] [Accepted: 04/20/2024] [Indexed: 05/26/2024] Open
Abstract
In the global threat of SARS-CoV-2, individuals undergoing maintenance dialysis represent a vulnerable population with an increased risk of severe COVID-19 outcomes. Therefore, immunization against SARS-CoV-2 is an essential component of healthcare strategy for these patients. Existing data indicate that they tend to exhibit a reduced immune response to vaccines compared to the general population. Our study aimed to assess both humoral and cellular immune responses following two doses of an anti-SARS-CoV-2 mRNA vaccine, an ability to maintain adequate antibody titers over time, and potential relations with vitamin D, comorbidities and other factors in hemodialysis patients based on a single center experience. A total of 41/45 patients (91.1%) responded to the second dose of the anti-SARS-CoV-2 mRNA vaccine. The titer of anti-SARS-CoV-2 IgG class antibodies and levels of T cells three to four weeks after vaccination were lower in dialysis patients than in healthy controls. Antibodies titer in dialysis patients had a positive correlation with B lymphocytes and was related to cardiovascular diseases. The level of CD4+ cells had a negative correlation with hemodialysis vintage, as did the vitamin D level with post-vaccination seroconversion and decline in anti-SARS-CoV-2 antibodies titer during six months after vaccination. Hemodialysis patients had decreased amounts of CD4+ and CD8+ cells and lower levels of anti-SARS-CoV-2 antibodies than healthy controls. Therefore, chronic hemodialysis could lead to diminished cellular immunity and humoral immune response to the anti-SARS-CoV-2 mRNA vaccination and reduced protection from COVID-19. Comorbidity in cardiovascular diseases was associated with a lower level of specific anti-SARS-CoV-2 antibody titer. Vitamin D may be important in maintaining stable levels of anti-SARS-CoV-2 antibodies, while the duration of dialysis treatment could be one of the factors decreasing anti-SARS-CoV-2 antibody titer and determining lower CD4+ cell counts.
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Affiliation(s)
- Egle Dalinkeviciene
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
| | - Brigita Gradauskiene
- Department of Immunology and Allergology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania;
| | - Sandra Sakalauskaite
- Laboratory of Immunology, Department of Immunology and Allergology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (S.S.); (D.B.)
| | - Kristina Petruliene
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
| | - Ruta Vaiciuniene
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
| | - Inga Skarupskiene
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
| | - Daina Bastyte
- Laboratory of Immunology, Department of Immunology and Allergology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (S.S.); (D.B.)
| | - Jolanta Sauseriene
- Department of Family Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (J.S.); (L.V.)
| | - Leonas Valius
- Department of Family Medicine, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (J.S.); (L.V.)
| | - Inga Arune Bumblyte
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
| | - Edita Ziginskiene
- Department of Nephrology, Lithuanian University of Health Sciences, LT-50161 Kaunas, Lithuania; (K.P.); (R.V.); (I.S.); (I.A.B.); (E.Z.)
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Moguem Soubgui AF, Ndeme Mboussi WS, Kojom Foko LP, Embolo Enyegue EL, Koanga Mogtomo ML. Exploring demographical, clinical, and dietary determinants of vitamin D deficiency among adults in Douala, Cameroon during the COVID-19 era. Heliyon 2024; 10:e24926. [PMID: 38352796 PMCID: PMC10862520 DOI: 10.1016/j.heliyon.2024.e24926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 12/28/2023] [Accepted: 01/17/2024] [Indexed: 02/16/2024] Open
Abstract
Background and aim Vitamin D deficiency (VDD) is a global public health problem in African populations. This study aimed at determining the prevalence, characteristics, and determinants of VDD in the era of SARS-CoV-2/COVID-19. This study was conducted from January to September 2022 in seven health facilities in Douala, Cameroon. Methods A structured, pre-tested questionnaire was administered to each participant to collect participants' information. Molecular detection of the SARS-CoV-2 genome was done. A serum level of 25-hydroxyvitamin D < 20 ng/mL was used to diagnose VDD. Results A total of 420 participants were included in the study. A Serum levels of 25(OH) vitamin D were reduced in SARS-CoV-2 (+) patients as compared to SARS-CoV-2 (-) patients (21.69 ± 5.64 ng/mL vs 42.09 ± 20.03 ng/mL, p < 0.0001). The overall prevalence of VDD was 10.2 %. SARS-CoV-2 (+) individuals had nearly two times more risk of being VDD compared to SARS-CoV-2 (-) individuals (aRR = 1.81, p < 0.0001). The risk of VDD was reduced by 46 % and 71 % in those consuming cocoa bean or powder regularly (aRR = 0.54, p = 0.03) and rarely (aRR = 0.29, p = 0.02) as compared to those never consuming it. Likewise, the risk of VDD was reduced by 59 % and 78 % in those consuming sardine fish regularly (aRR = 0.47, p = 0.002) and rarely (aRR = 0.22, p = 0.03). Overall, the association between VDD and SARS-CoV-2 infection was consistent, i.e., reduced risk of VDD in SARS-CoV-2 (-) individuals, after stratification for confounding variables. Conclusion This study outlined a high burden of VDD, a strong link between VDD and SARS-CoV-2, and suggests the possible utility of vitamin D supplementation for COVID-19 patients in Cameroon.
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Affiliation(s)
| | - Wilfried Steve Ndeme Mboussi
- Department of Biochemistry, Faculty of Sciences, The University of Douala, Cameroon
- Centre de Recherche et d’Expertise en Biologie, Douala, Cameroon
| | - Loick Pradel Kojom Foko
- Centre de Recherche et d’Expertise en Biologie, Douala, Cameroon
- Department of Animal Organisms, Faculty of Science, The University of Douala, Cameroon
| | | | - Martin Luther Koanga Mogtomo
- Department of Biochemistry, Faculty of Sciences, The University of Douala, Cameroon
- Centre de Recherche et d’Expertise en Biologie, Douala, Cameroon
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Liu LT, Tsai JJ. Unveiling COVID-19 treatment strategies for immunocompromised individuals: Therapeutic innovations and latest findings. Int J Rheum Dis 2024; 27:e14900. [PMID: 38287550 DOI: 10.1111/1756-185x.14900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 01/31/2024]
Affiliation(s)
- Li-Teh Liu
- Department of Medical Laboratory Science and Biotechnology, College of Medical Technology, Chung-Hwa University of Medical Technology, Tainan City, Taiwan
| | - Jih-Jin Tsai
- Tropical Medicine Center, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
- School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City, Taiwan
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Bhat AA, Afzal O, Agrawal N, Thapa R, Almalki WH, Kazmi I, Alzarea SI, Altamimi ASA, Kukreti N, Chakraborty A, Singh SK, Dua K, Gupta G. A comprehensive review on the emerging role of long non-coding RNAs in the regulation of NF-κB signaling in inflammatory lung diseases. Int J Biol Macromol 2023; 253:126951. [PMID: 37734525 DOI: 10.1016/j.ijbiomac.2023.126951] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 08/30/2023] [Accepted: 09/09/2023] [Indexed: 09/23/2023]
Abstract
Public health globally faces significant risks from conditions like acute respiratory distress syndrome (ARDS), chronic obstructive pulmonary disease (COPD), and various inflammatory lung disorders. The NF-κB signaling system partially controls lung inflammation, immunological responses, and remodeling. Non-coding RNAs (lncRNAs) are crucial in regulating gene expression. They are increasingly recognized for their involvement in NF-κB signaling and the development of inflammatory lung diseases. Disruption of lncRNA-NF-κB interactions is a potential cause and resolution factor for inflammatory respiratory conditions. This study explores the therapeutic potential of targeting lncRNAs and NF-κB signaling to alleviate inflammation and restore lung function. Understanding the intricate relationship between lncRNAs and NF-κB signaling could offer novel insights into disease mechanisms and identify therapeutic targets. Regulation of lncRNAs and NF-κB signaling holds promise as an effective approach for managing inflammatory lung disorders. This review aims to comprehensively analyze the interaction between lncRNAs and the NF-κB signaling pathway in the context of inflammatory lung diseases. It investigates the functional roles of lncRNAs in modulating NF-κB activity and the resulting inflammatory responses in lung cells, focusing on molecular mechanisms involving upstream regulators, inhibitory proteins, and downstream effectors.
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Affiliation(s)
- Asif Ahmad Bhat
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura 302017, Mahal Road, Jaipur, India
| | - Obaid Afzal
- Department of Pharmaceutical Chemistry, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al Kharj 11942, Saudi Arabia
| | - Neetu Agrawal
- Institute of Pharmaceutical Research, GLA University, Mathura, UP, India
| | - Riya Thapa
- School of Pharmacy, Suresh Gyan Vihar University, Jagatpura 302017, Mahal Road, Jaipur, India
| | - Waleed Hassan Almalki
- Department of Pharmacology, College of Pharmacy, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Imran Kazmi
- Department of Biochemistry, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia.
| | - Sami I Alzarea
- Department of Pharmacology, College of Pharmacy, Jouf University, Sakaka, Al-Jouf, Saudi Arabia
| | | | - Neelima Kukreti
- School of Pharmacy, Graphic Era Hill University, Dehradun 248007, India
| | - Amlan Chakraborty
- Faculty of Biology, Medicine and Health, The University of Manchester, Oxford Road, Manchester M13 9PL, UK; Cardiovascular Disease Program, Biomedicine Discovery Institute and Department of Pharmacology, Monash University, Clayton, VIC 3800, Australia
| | - Sachin Kumar Singh
- School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab, 144411, India; Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo 2007, Australia
| | - Kamal Dua
- Faculty of Health, Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo 2007, Australia; Discipline of Pharmacy, Graduate School of Health, University of Technology Sydney, NSW 2007, Australia.
| | - Gaurav Gupta
- Center for Global Health research (CGHR), Saveetha Institute of Medical and Technical Science, Saveetha University, Chennai, India
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Wierzbicka A, Semik-Gurgul E, Świątkiewicz M, Szmatoła T, Steg A, Oczkowicz M. Changes in DNA Methylation and mRNA Expression in Lung Tissue after Long-Term Supplementation with an Increased Dose of Cholecalciferol. Int J Mol Sci 2023; 25:464. [PMID: 38203636 PMCID: PMC10778667 DOI: 10.3390/ijms25010464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/22/2023] [Accepted: 12/26/2023] [Indexed: 01/12/2024] Open
Abstract
Maintaining an appropriate concentration of vitamin D is essential for the proper functioning of the body, regardless of age. Nowadays, there are more and more indications that vitamin D supplementation at higher than standard doses may show protective and therapeutic effects. Our study identified differences in the body's response to long-term supplementation with cholecalciferol at an increased dose. Two groups of pigs were used in the experiment. The first group received a standard dose of cholecalciferol (grower, 2000 IU/kg feed, and finisher, 1500 IU/kg feed), and the second group received an increased dose (grower, 3000 IU/kg feed, and finisher, 2500 IU/kg feed). After slaughter, lung samples were collected and used for RRBS and mRNA sequencing. Analysis of the methylation results showed that 2349 CpG sites had significantly altered methylation patterns and 1116 (47.51%) identified DMSs (Differentially Methylated Sites) were related to genes and their regulatory sites. The mRNA sequencing results showed a significant change in the expression of 195 genes. The integrated analysis identified eleven genes with DNA methylation and mRNA expression differences between the analyzed groups. The results of this study suggested that an increased vitamin D intake may be helpful for the prevention of lung cancer and pulmonary fibrosis. These actions may stem from the influence of vitamin D on the expression of genes associated with collagen production, such as SHMT1, UGT1A6, and ITIH2.The anti-cancer properties of vitamin D are also supported by changes in KLHL3 and TTPA gene expression.
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Affiliation(s)
- Alicja Wierzbicka
- Department of Animal Molecular Biology, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland; (A.W.); (E.S.-G.); (T.S.); (A.S.)
| | - Ewelina Semik-Gurgul
- Department of Animal Molecular Biology, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland; (A.W.); (E.S.-G.); (T.S.); (A.S.)
| | - Małgorzata Świątkiewicz
- Department of Animal Nutrition and Feed Science, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland;
| | - Tomasz Szmatoła
- Department of Animal Molecular Biology, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland; (A.W.); (E.S.-G.); (T.S.); (A.S.)
- Center for Experimental and Innovative Medicine, The University of Agriculture in Kraków, Rędzina 1c, 30-248 Kraków, Poland
| | - Anna Steg
- Department of Animal Molecular Biology, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland; (A.W.); (E.S.-G.); (T.S.); (A.S.)
| | - Maria Oczkowicz
- Department of Animal Molecular Biology, National Research Institute of Animal Production, ul. Krakowska 1, 32-083 Balice, Poland; (A.W.); (E.S.-G.); (T.S.); (A.S.)
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Abdulrahman S, Al-Balushi N, Holdcroft-Long J, Khan U, Ravindran B, Das S, Rajkumar AP. Correlates of poor clinical outcomes related to COVID-19 among older people with psychiatric illness - a mixed methods study. Int J Psychiatry Med 2023; 58:493-509. [PMID: 37528759 PMCID: PMC10111158 DOI: 10.1177/00912174231171220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023]
Abstract
OBJECTIVE COVID-19 may lead to a range of clinical outcomes among older people with psychiatric and medical conditions. Evidence guiding management of future outbreaks among this vulnerable population in psychiatric hospital settings are sparse. In this study, we examined the correlates of poor clinical outcomes related to COVID-19 and explored the perspectives of COVID-19 survivors hospitalized in psychiatry settings. METHOD The correlates of poor clinical outcomes related to COVID-19 were examined using a retrospective chart review of 81 older people hospitalized in psychiatry settings. Correlates of clinical outcomes related to COVID-19 were assessed by multiple logistic regression models. In addition, the perspectives of 10 COVID-19 survivors were explored by qualitative interviews. The qualitative data was subject to thematic analysis. RESULTS Although 25.9% (n = 21) participants were asymptomatic, there was high COVID-19 related mortality (14.8%; n = 12). Vitamin-D deficiency, anticholinergic burden, and isolation policies within psychiatric wards were significantly (p < 0.05) related to COVID-19 related deaths. In qualitative interviews, participants emphasized the importance of strengthening local support networks and making vaccination centers more accessible. CONCLUSIONS Reducing anticholinergic prescriptions and improving isolation policies may help to mitigate poor clinical outcomes. Future research investigating the impact of vitamin-D supplementation on COVID-19 related outcomes is warranted.
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Affiliation(s)
| | - Naser Al-Balushi
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
- Department of Behavioural Medicine, College of Medicine & Health Science, Sultan Qaboos University, Al Khod, Muscat, Sultanate of Oman
| | | | - Uzma Khan
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Bipin Ravindran
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Sujata Das
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
| | - Anto P Rajkumar
- Nottinghamshire Healthcare NHS Foundation trust, Nottingham, United Kingdom
- Institute of Mental Health, Mental Health and Clinical Neurosciences Academic Unit, University of Nottingham, Nottingham, United Kingdom
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Nicolae M, Mihai CM, Chisnoiu T, Balasa AL, Frecus CE, Mihai L, Lupu VV, Ion I, Pantazi AC, Nelson Twakor A, Andrusca A, Cambrea CS, Arghir IA, Lupu A, Arghir OC. Immunomodulatory Effects of Vitamin D in Respiratory Tract Infections and COVID-19 in Children. Nutrients 2023; 15:3430. [PMID: 37571367 PMCID: PMC10421518 DOI: 10.3390/nu15153430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/25/2023] [Accepted: 07/27/2023] [Indexed: 08/13/2023] Open
Abstract
Acute respiratory tract infections (ARTIs) are one of the main reasons that the pediatric population goes to the doctor. The connection between ARTI and vitamin D (VD) is currently debated by the medical community, and so far, there has been little agreement with regard to the ideal level of 25(OH)D concentration that would provide protection for the respiratory tract, or the effectiveness of its administration in the treatment of respiratory infections. The purpose of this literature review was to bring attention to the immunomodulatory and antiviral function of vitamin D and its relation to the respiratory system by examining the main ARTIs, including SARS-CoV-2. The latter has affected the pediatric population in different ways, from asymptomatic patients to severe forms with multisystem inflammatory syndrome in children (MIS-C). Although there are not much clinical data on the SARS-CoV-2 disease in the pediatric population worldwide, we tried to find out whether there is a connection between the severity of this disease, other ARTIs, and vitamin D supplementation. We also aimed to find out if 25OHD deficiency had an adverse effect on the evolution of the disease and the recovery period in the case of younger patients affected by COVID-19. For this literature review, the PICO framework was selected as the methodological approach. Our results demonstrated many methods by which this vitamin may lower the risk of ARTI with regard to the COVID-19 infection. Despite these significant advancements, more research is needed to support the idea that 25(OH)D concentration can influence the evolution of respiratory tract infections in children.
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Affiliation(s)
- Maria Nicolae
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Cristina Maria Mihai
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Tatiana Chisnoiu
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Adriana Luminita Balasa
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Corina Elena Frecus
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Larisia Mihai
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Vasile Valeriu Lupu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Irina Ion
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Alexandru Cosmin Pantazi
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | | | - Antonio Andrusca
- Department of Pediatrics, County Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania (I.I.)
- Department of Pediatrics, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Claudia Simona Cambrea
- Department of Infectious Diseases, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Ioan Anton Arghir
- Department of Pneumophtisiology, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
| | - Ancuta Lupu
- Department of Pediatrics, “Grigore T. Popa” University of Medicine and Pharmacy, 700115 Iasi, Romania
| | - Oana Cristina Arghir
- Department of Pneumophtisiology, Faculty of General Medicine, “Ovidius” University, 900470 Constanta, Romania
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