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Porosnicu TM, Sirbu IO, Oancea C, Sandesc D, Bratosin F, Rosca O, Jipa D, Boeriu E, Bandi SSS, Pricop M. The Impact of Therapeutic Plasma Exchange on Inflammatory Markers and Acute Phase Reactants in Patients with Severe SARS-CoV-2 Infection. Medicina (Kaunas) 2023; 59:medicina59050867. [PMID: 37241099 DOI: 10.3390/medicina59050867] [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] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/28/2023]
Abstract
Background and Objectives: Due to the poor prognosis and the very high mortality rate associated with severe SARS-CoV-2 infections, various regimens have been tried to stop the evolution of the inflammatory cascade, such as immunomodulatory therapy and plasma clearance of the acute phase reactants involved. Therefore, the objective of this review was to analyze the effects of using therapeutic plasma exchange (TPE), also known as plasmapheresis, on the inflammatory markers of critically ill COVID-19 patients admitted to the intensive care unit (ICU). Materials and Methods: A thorough scientific database search was performed, and it included a review of articles published on PubMed, Cochrane Database, Scopus, and Web of Science from the beginning of the COVID-19 pandemic in March 2020 until September 2022 that focused on the treatment of SARS-CoV-2 infections using plasma exchange for patients admitted to the ICU. The current study included original articles, reviews, editorials, and short or special communications regarding the topic of interest. Results: A total of 13 articles were selected after satisfying the inclusion criterion of three or more patients enrolled with clinically severe COVID-19 that were eligible for TPE. From the included articles, it was observed that TPE was used as a last-resort salvage therapy that can be regarded as an alternative treatment method when the standard management for these patients fails. TPE significantly decreased the inflammatory status as measured by Interleukin-6 (IL-6), C-reactive protein (CRP), lymphocyte count, and D-dimers, as well as improving the clinical status measured with PaO2/FiO2 and duration of hospitalization. The pooled mortality risk reduction after TPE was 20%. Conclusions: There are sufficient studies and evidence to show that TPE reduces inflammatory mediators and improves coagulation function and the clinical/paraclinical status. Nevertheless, although it was shown that TPE decreases the severe inflammatory status without significant complications, the improvement of survival rate remains unclear.
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Affiliation(s)
- Tamara Mirela Porosnicu
- Doctoral School, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Ioan Ovidiu Sirbu
- Center for Complex Network Sciences, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Cristian Oancea
- Center for Research and Innovation in Precision Medicine of Respiratory Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Dorel Sandesc
- Department of Anesthesia and Intensive Care, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Felix Bratosin
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ovidiu Rosca
- Department XIII, Discipline of Infectious Disease, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Daniel Jipa
- Intensive Care Unit, "Pius Brinzeu" Emergency Clinical County Hospital, 300723 Timisoara, Romania
| | - Estera Boeriu
- Department of Pediatrics, Discipline of Pediatric Oncology and Hematology, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Satya Sai Sri Bandi
- Malla Reddy Institute of Medical Sciences, Suraram Main Road 138, Hyderabad 500055, India
| | - Marius Pricop
- Discipline of Oral and Maxillo-Facial Surgery, Faculty of Dental Medicine, "Victor Babes" University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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Mukherjee A, Kumar G, Turuk A, Bhalla A, Bingi TC, Bhardwaj P, Baruah TD, Mukherjee S, Talukdar A, Ray Y, John M, Khambholja JR, Patel AH, Bhuniya S, Joshi R, Menon GR, Sahu D, Rao VV, Bhargava B, Panda S. Vaccination saves lives: a real-time study of patients with chronic diseases and severe COVID-19 infection. QJM 2023; 116:47-56. [PMID: 36053197 PMCID: PMC9494346 DOI: 10.1093/qjmed/hcac202] [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] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/16/2022] [Accepted: 08/16/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES This study aims to describe the demographic and clinical profile and ascertain the determinants of outcome among hospitalized coronavirus disease 2019 (COVID-19) adult patients enrolled in the National Clinical Registry for COVID-19 (NCRC). METHODS NCRC is an on-going data collection platform operational in 42 hospitals across India. Data of hospitalized COVID-19 patients enrolled in NCRC between 1st September 2020 to 26th October 2021 were examined. RESULTS Analysis of 29 509 hospitalized, adult COVID-19 patients [mean (SD) age: 51.1 (16.2) year; male: 18 752 (63.6%)] showed that 15 678 (53.1%) had at least one comorbidity. Among 25 715 (87.1%) symptomatic patients, fever was the commonest symptom (72.3%) followed by shortness of breath (48.9%) and dry cough (45.5%). In-hospital mortality was 14.5% (n = 3957). Adjusted odds of dying were significantly higher in age group ≥60 years, males, with diabetes, chronic kidney diseases, chronic liver disease, malignancy and tuberculosis, presenting with dyspnoea and neurological symptoms. WHO ordinal scale 4 or above at admission carried the highest odds of dying [5.6 (95% CI: 4.6-7.0)]. Patients receiving one [OR: 0.5 (95% CI: 0.4-0.7)] or two doses of anti-SARS CoV-2 vaccine [OR: 0.4 (95% CI: 0.3-0.7)] were protected from in-hospital mortality. CONCLUSIONS WHO ordinal scale at admission is the most important independent predictor for in-hospital death in COVID-19 patients. Anti-SARS-CoV2 vaccination provides significant protection against mortality.
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Affiliation(s)
| | | | - Alka Turuk
- Indian Council of Medical Research, New Delhi, India
| | - Ashish Bhalla
- Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | | | - Pankaj Bhardwaj
- All Indian Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | | | - Subhasis Mukherjee
- College of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, India
| | | | - Yogiraj Ray
- Infectious Disease And Beliaghata Hospital, Kolkata, West Bengal, India
| | - Mary John
- Christian Medical College, Ludhiana, Punjab, India
| | | | | | - Sourin Bhuniya
- All India Institute Of Medical Sciences, Bhubaneswar, India
| | - Rajnish Joshi
- All India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, India
| | - Geetha R Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Damodar Sahu
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | - Vishnu Vardhan Rao
- National Institute of Medical Statistics, Indian Council of Medical Research, Delhi, India
| | | | | | - NCRC Study team
MishraPuspendraMCANational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaPanchalYashminPGDISADNational Institute of Medical Statistics, Indian Council of Medical Research, Delhi, IndiaSharmaLokesh KumarPhDIndian Council of Medical Research, New Delhi, IndiaAgarwalAnupMBBSMedstar Health, Baltimore, Maryland, United States of AmericaPuriG DMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSuriVikasMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaSinglaKaranMDPostgraduate Institute of Medical Education & Research, Chandigarh, IndiaMesipoguRajaraoMDGandhi Medical College, Telangana, IndiaAedulaVinaya SekharMDGandhi Medical College, Telangana, IndiaMohiuddinMohammed AyazMDGandhi Medical College, Telangana, IndiaKumarDeepakMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaSaurabhSumanMDAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaMisraSanjeevMChAll Indian Institute of Medical Sciences, Jodhpur, Rajasthan, IndiaKannaujePankaj KumarMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaKumarAjitMDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaShuklaArvindPhDAll Indian Institute of Medical Sciences, Raipur Chhattisgarh, IndiaPalAmitavaMDCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaChakrabortyShreetamaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaDuttaMoumitaMScCollege of Medicine and Sagore Dutta Hospital, Kolkata, West Bengal, IndiaMondalTanushreeMDMedical College, Kolkata, West Bengal, IndiaChakravortySarmisthaMScMedical College, Kolkata, West Bengal, IndiaBhattacharjeeBoudhyanMDMedical College, Kolkata, West Bengal, IndiaPaulShekhar RanjanDTCDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaMajumderDebojyotiMDInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaChatterjeeSubhrangaMBBSInfectious Disease And Beliaghata Hospital, Kolkata, West Bengal, IndiaAbrahamAbinMDChristian Medical College, Ludhiana, Punjab, IndiaVargheseDivyaMDChristian Medical College, Ludhiana, Punjab, IndiaThomasMariaMDChristian Medical College, Ludhiana, Punjab, IndiaShahNiteshMDCIMS Hospital, Ahmedabad, IndiaPatelMineshMDCIMS Hospital, Ahmedabad, IndiaMadanSurabhiMDCIMS Hospital, Ahmedabad, IndiaDesaiAnitaPhDNational Institute Of Mental Health And Neurosciences, Bangalore, Karnataka, IndiaM LKala YadhavMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaRMadhumathiMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaG SChetnaMDBowring & Lady Curzon Medical College & Research Institute, Bangalore, Karnataka, IndiaOjhaU KMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaJhaRavi RanjanShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaKumarAvinashMDShaheed Nirmal Mahato Medical College, Dhanbad, Jharkahnd, IndiaPathakAshishPhDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSharmaAshishMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaPurohitManjuMDRD Gardi Medical College, Ujjain, Madhya Pradesh, IndiaSarangiLisaMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaRathMaheshMDHi Tech Medical College and Hospital, Bhubaneswar, IndiaShahArti DDNBDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaKumarLavleshMDDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaPatelPrinceeMBBSDhiraj Hospital & Sumandeep Vidyapeeth, Vadodara, Ahmedabad, IndiaDulhaniNaveenMDLate BRK Memorial Medical College, Jagdalpur, Chhattisgarh, IndiaDubeSimmiMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaShrivastavaJyotsnaMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaMittalArvindMDGandhi Medical College, Bhopal, Madhya Pradesh, IndiaPatnaikLipilekhaMDInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSahooJagdish PrasadDMInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaSharmaSumitaInstitute of Medical Sciences & SUM Hospital, Siksha ‘O’ Anusandhan deemed to be University, Bhubaneswar, IndiaKatyalV KMD, FACCPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaKatyalAshimaMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaYadavNidhiMDPandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, Haryana, IndiaUpadhyayRashmiMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaSaurabhMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSrivastavaAnuragMDGovernment Institute of Medical Sciences, Noida, Uttar Pradesh, IndiaSutharNilay NMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaShahNehal MMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaRajvanshKrutiMDSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaPurohitHemangMScSmt. NHL, Municipal Medical College, Ahmedabad, Gujarat, IndiaMohapatraPrasanta RaghabMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaPanigrahiManoj KumarMDAll India Institute Of Medical Sciences, Bhubaneswar, IndiaSaigalSaurabhMD, EDICAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaKhuranaAlkeshMDAll India Institute Of Medical Sciences, Bhopal, Madhya Pradesh, IndiaPanchalManishaMDGMERS Medical College Himmatnagar, Gujarat, IndiaAnderpaMayankMDGMERS Medical College Himmatnagar, Gujarat, IndiaPatelDhruvMBBSGMERS Medical College Himmatnagar, Gujarat, IndiaSalgarVeereshMDGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaAlgurSantoshMBBSGulbarga Institute of Medical Sciences, Kalburagi, Karnataka, IndiaChoudhuryRatnamalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaRaoMangalaMDSt. Johns Medical College, Bengaluru, Karnataka, IndiaDNithyaMScSt. Johns Medical College, Bengaluru, Karnataka, IndiaGuptaBal KishanMDS.P.Medical College, Bikaner, Rajasthan, IndiaKumarBhuvaneshMDS.P.Medical College, Bikaner, Rajasthan, IndiaGuptaJigyasaMBBSS.P.Medical College, Bikaner, Rajasthan, IndiaBhandariSudhirMDSMS Medical College, Jaipur, Rajasthan, IndiaAgrawalAbhishekMDSMS Medical College, Jaipur, Rajasthan, IndiaShameemMohammadMD, FRCPJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaFatimaNazishMDJN Medical College Aligarh Muslim University, Aligarh, Uttar Pradesh, IndiaPalaStarMDNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaNongpiurVijayDMNorth Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, IndiaChatterjiSoumyadipDMTata Medical Centre, Kolkata, West Bengal, IndiaMukherjeeSudiptaFNBTata Medical Centre, Kolkata, West Bengal, IndiaShivnitwarSachin KMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaTripathySrikanthMDDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaLokhandePrajaktaMPHDr D Y Patil Medical college Hospital and Research centre, Pune, Maharashtra, IndiaDanduHimanshuMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaGuptaAmitMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaKumarVivekMDKing George Medical University, Lucknow, Uttar Pradesh, IndiaSharmaNikitaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaVohraRajatMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaPaliwalArchanaMDMahatma Gandhi Medical College, Jaipur, Rajasthan, IndiaKumarM PavanMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaRaoA BikshapathiMDKakatiya Medical College, MGM Hospital Warangal, Telangana, IndiaKikonNyanthungPGDPHMDepartment of Health & Family Welfare, Government of Nagaland, Nagaland, IndiaKikonRhondemoMScIHCommunity Health Initiative, Nagaland, IndiaManoharKMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaRajuY SathyanarayanaMDNizam’s Institute of Medical Sciences, Punjagutta, Hyderabad, IndiaMadhariaArunMSESI Hospital and Gayatri Hospital, Raipur, Chhattisgarh, IndiaChakravartyJayaMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaChaubeyManaswiMDInstitute of Medical sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, IndiaBandaruRajiv KumarMDESIC medical College, Sanathnagar, Hyderabad. IndiaMirzaMehdi AliDMESIC medical College, Sanathnagar, Hyderabad. IndiaKatariaSushilaMDMedanta-The Medicity, Gurugram, Haryana, IndiaSharmaPoojaMedanta-The Medicity, Gurugram, Haryana, IndiaGhoshSoumitraMDInstitute of Postgraduate Medical Education & Research, Kolkata, West BengalHazraAvijitMDInstitute of Postgraduate Medical Education & Research, Kolkata, West Bengal
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Ramonfaur D, Aguirre-García GM, Diaz-Garza CA, Torre-Amione G, Sanchez-Nava VM, Lara-Medrano R, Ramírez-Elizondo MT, Esparza-Sandoval AC, Ortega-Hernández FJ, Martínez-Reséndez MF. Early increase of serum ferritin among COVID-19 patients is associated with need of invasive mechanical ventilation and with in-hospital death. Infect Dis (Lond) 2022; 54:810-818. [PMID: 35854671 DOI: 10.1080/23744235.2022.2101691] [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: 01/08/2023] Open
Abstract
BACKGROUND COVID-19 may trigger an acute hyperinflammatory syndrome characterised by heightened levels of acute phase reactants and is associated with adverse outcomes among hospitalised individuals. The relationship between 48-hour changes in acute phase reactants and adverse outcomes is unclear. This study evaluated the relationship between change in four acute phase reactants (interleukin-6, procalcitonin, ferritin, and C-reactive protein), and the risk for in-hospital death and invasive mechanical ventilation. METHODS A retrospective cohort among 2,523 adult patients hospitalised with COVID-19 pneumonia was conducted. Changes in IL-6, procalcitonin, ferritin, and CRP from admission to 48 h after admission were recorded. Delta was calculated using the difference in each acute phase reactant at admission and at 48-hours. Delta in acute phase reactants and the risk for in-hospital death and invasive mechanical ventilation was assessed using logistic regression models adjusting for demographics and comorbidities. RESULTS Patients with both admission and 48-hour measurement for interleukin-6 (IL-6) (n = 541), procalcitonin (n = 828), ferritin (n = 1022), and C-reactive protein (CRP) (n = 1919) were included. Baseline characteristics were similar across all four populations. Increases in ferritin associated with a heightened risk of in-hospital death (OR 1.00032; 95%CI 1.00007- 1.00056; p < .001) and invasive mechanical ventilation (OR 1.00035; 95%CI 1.00014- 1.00055; p = .001). Therefore, for every 100 ng/mL increase in ferritin, the odds for in-hospital death and invasive mechanical ventilation increase by 3.2% and 3.5%, respectively. CONCLUSIONS Delta in ferritin is associated with in-hospital death and invasive mechanical ventilation. Other acute phase reactants were not associated with these outcomes among COVID-19 inpatients.
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Affiliation(s)
- Diego Ramonfaur
- Harvard Medical School, Division of Postgraduate Medical Education, Boston, MA, USA
| | - Gloria M Aguirre-García
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Carlos A Diaz-Garza
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Guillermo Torre-Amione
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Victor M Sanchez-Nava
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Reynaldo Lara-Medrano
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - María T Ramírez-Elizondo
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Alejandra C Esparza-Sandoval
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Francisco J Ortega-Hernández
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico
| | - Michel F Martínez-Reséndez
- School of Medicine and Health Sciences, Instituto Tecnológico y de Estudios Superiores de Monterrey, Monterrey, Mexico.,Epidemiological Surveillance Unit, Hospital San Jose-Tec Salud, Monterrey, Mexico
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