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Falahatkar R, Falahatkar S, Khajavi Gaskarei MA, Afzalipoor M, Mojtahedi A, Aligolighasemabadi N, Deilami A, Mirzaei Dahka S, Keivanlou MH, Jafari A. The global, prevalence, and risk factors of postoperative fever after percutaneous nephrolithotomy: A systematic review and meta-analysis. Asian J Urol 2024; 11:253-260. [PMID: 38680584 PMCID: PMC11053330 DOI: 10.1016/j.ajur.2022.04.008] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2022] [Accepted: 04/26/2022] [Indexed: 05/01/2024] Open
Abstract
Objective This study aimed to explore the global, prevalence, and risk factors of fever after percutaneous nephrolithotomy (PCNL) by conducting a systematic review and meta-analysis. Methods The high-sensitivity searching was conducted without time limitation until December 30, 2020 in Web of Sciences, Scopus, and PubMed based on inclusion and exclusion criteria. Results The prevalence rates of fever and sepsis among patient undergoing PCNL were estimated 9.5% (95% confidence interval [CI]: 9.3%-9.7%), and 4.5% (95% CI: 4.2%-4.8%), respectively. Nephrostomy tube was used in 9.96% (95% CI: 9.94%-9.97%) of patients. The mean preoperative white blood cells of patients were 6.401×109/L; 18.3% and 4.55% of patients were considered as the positive urinary culture and pyuria, respectively. About 20.4% of patients suffered from residual stones. The odds ratios (ORs) of fever in patients who suffering from diabetes mellitus, hydronephrosis, staghorn stones, and blood transfusion were 4.62 (95% CI: 2.95-7.26), 1.04 (95% CI: 0.81-1.34), 2.57 (95% CI: 0.93-7.11), and 2.65 (95% CI: 1.62-4.35), respectively. Patients who underwent PCNL in prone position were more likely to develop fever (OR: 1.23; 95% CI: 0.75-2.00) than patients in supine position. Conclusion The current study showed that patients who suffer from diabetes mellitus, hydronephrosis, staghorn stones, nephrostomy tube or double-J stent, blood transfusion, and also patients who underwent PCNL in prone position surgery are more likely to develop a postoperative fever after PCNL.
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Affiliation(s)
- Reza Falahatkar
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | - Siavash Falahatkar
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | | | | | - Ali Mojtahedi
- Microbiology Department, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Neda Aligolighasemabadi
- Department of Internal Medicine, School of Medicine, Guilan University of Medical Siences, Rasht, Iran
| | - Ahmad Deilami
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | - Samaneh Mirzaei Dahka
- School of Nursing and Midwifery, Guilan University of Medical Sciences, Guilan, Rasht, Iran
| | | | - Alireza Jafari
- Urology Research Center, Guilan University of Medical Sciences, Guilan, Rasht, Iran
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Sipal T, Senocak I, Ataman M, Yuvanç E, Yilmaz E. Percutaneous nephrolithotomy in patients with incidental encountered purulent urine at initial puncture. Urolithiasis 2023; 51:107. [PMID: 37597097 DOI: 10.1007/s00240-023-01481-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 08/04/2023] [Indexed: 08/21/2023]
Abstract
We are reporting the 39 patients' outcomes who underwent percutaneous nephrolithotomy and purulent urine encountered at the initial steps of surgery. Of 873 patients who underwent PCNL, 48 had purulent fluid during the initial puncture. After excluding those at risk for infection, we studied 39 patients' preoperative and postoperative variables-including postoperative day (POD) 1, 3, 5 fevers. In group 1, 21 patients had a nephrostomy tube placed, and PCNL was postponed. In group 2, 18 patients had successful stone removal in the first session. All surgeries were successful, with no septic events during follow-up. No significant differences in preoperative variables were found. 14% and 22% of patients in groups 1 and 2 had infected fluid (p = 0.470). Four patients in group 1 (19%) and seven patients in group 2 (38.9%) had a high fever (≥ 38 C) on POD1 (p = 0.171), and 1 (5%) in group 1 and 3 (17%) in group 2 had high fever on POD 3 (p = 0.22). No patients remained with high fever on POD5. Mild sepsis was diagnosed in 9.5% of group 1 and 16% of group 2 (p = 0.820), and hospitalization time differed significantly (p < 0.001). Stone size and operation time were correlated with postoperative fever, and prolonged hospital stays were associated with positive blood cultures and postponed procedures. PCNL with proper technique and antibiotics can lead to quicker recovery and reduced hospitalization time in selected patients with pus in their pelvicalyceal system.
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Affiliation(s)
- Timucin Sipal
- Kırıkkale Üniversitesi, Tıp Fakültesi, Kırıkkale-Ankara Yolu 7. Km.Yahşihan, Kırıkkale, Turkey.
| | - Ibrahim Senocak
- Kırıkkale Üniversitesi, Tıp Fakültesi, Kırıkkale-Ankara Yolu 7. Km.Yahşihan, Kırıkkale, Turkey
| | - Mirac Ataman
- Kırıkkale Üniversitesi, Tıp Fakültesi, Kırıkkale-Ankara Yolu 7. Km.Yahşihan, Kırıkkale, Turkey
| | - Ercan Yuvanç
- Kırıkkale Üniversitesi, Tıp Fakültesi, Kırıkkale-Ankara Yolu 7. Km.Yahşihan, Kırıkkale, Turkey
| | - Erdal Yilmaz
- Kırıkkale Üniversitesi, Tıp Fakültesi, Kırıkkale-Ankara Yolu 7. Km.Yahşihan, Kırıkkale, Turkey
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Que B, Tu Q, Shi J, Wan Z, Li Y, Zhou R, Yu H, Gan J, Yu J. Effects of Transcutaneous Electrical Acupoint Stimulation on Systemic Inflammatory Response Syndrome of Patients after Percutaneous Nephrolithotomy: A Randomized Controlled Trial. Evid Based Complement Alternat Med 2021; 2021:5909956. [PMID: 34422076 DOI: 10.1155/2021/5909956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 07/27/2021] [Accepted: 08/03/2021] [Indexed: 11/21/2022]
Abstract
Purpose Transcutaneous electrical acupoint stimulation (TEAS) is widely used. However, no study evaluated TEAS on systemic inflammatory response syndrome (SIRS) of patients after percutaneous nephrolithotomy (PCNL). The study was to evaluate TEAS on SIRS of patients after PCNL. Methods 67 patients were enrolled and divided into group TEAS and group sham TEAS. Data were collected from 60 participants finally. In the study, TEAS or sham TEAS on bilateral Shenshu (BL23), Yinlingquan (SP9), Hegu (LI4), and Neiguan (PC6) was performed continuously throughout the procedure. The primary outcome included the incidence of systemic inflammatory response syndrome (SIRS) within 48 h after surgery. The secondary outcomes included the serum levels of inflammatory cytokines, hemodynamics changes, complications, and hospital stay after surgery. The serum levels of tumor necrosis factor- (TNF-) α and interleukin- (IL-) 6, mean arterial pressure (MAP), and heart rate (HR) at 30 min before anesthesia (T0), the time after surgery (T1), 24 h postoperation (T2), and 48 h postoperation (T3) were recorded. The consumption of analgesic during surgery was also recorded, as well as the complications and duration of hospital stay after PCNL. Results The incidence of SIRS in group TEAS was lower than group sham TEAS (30% vs. 6.67%, p=0.023). Compared with the sham TEAS group, both levels of TNF-α and IL-6 at T1, T2, and T3 were lower in the TEAS group (p < 0.05). The levels of MAP and HR in sham TEAS at T1, T2, and T3 were markedly higher than that in the TEAS group (p < 0.05). The total consumption of propofol and remifentanil during surgery in group TEAS was lower than that in the sham TEAS group. The incidence of hypotension, hypertension, emergence agitation, and postoperative nausea and vomiting (PONV) was also lower in group TEAS after PCNL (p < 0.05). Conclusions TEAS could effectively reduce the incidence of SIRS and inflammatory cytokines for patients who underwent PCNL. In addition, TEAS helped to maintain the hemodynamic stability and cut down the consumption of analgesics during PCNL, reducing the complications after PCNL.
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Tan F, Gan X, Deng Y, Li X, Guo N, Hei Z, Zhu Q, Chen ZG, Zhou S. Intraoperative dexmedetomidine attenuates postoperative systemic inflammatory response syndrome in patients who underwent percutaneous nephrolithotomy: a retrospective cohort study. Ther Clin Risk Manag 2018; 14:287-293. [PMID: 29497305 PMCID: PMC5818878 DOI: 10.2147/tcrm.s157320] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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] [Indexed: 01/31/2023] Open
Abstract
Purpose Dexmedetomidine (DEX) has been reported to attenuate inflammation in rats. The present retrospective cohort study aimed to investigate whether intraoperative administration with DEX could reduce the incidence of postoperative systemic inflammatory response syndrome (SIRS) in patients following percutaneous nephrolithotomy (PCNL). Patients and methods A total of 251 patients were included in the analysis. Among these patients, 175 received intravenous DEX infusion during the intraoperative period and 76 did not. The primary outcome measures were the incidences of postoperative SIRS and fever. Secondary outcomes included patient-controlled analgesia (tramadol) requirements, length of postoperative hospitalization stay, serum creatinine (Scr) and serum blood urea nitrogen (BUN) concentration, and adverse events (bradycardia, hypotension, renal artery thrombosis). Results Administration of DEX not only significantly attenuated the incidence of SIRS and fever (P=0.029, P=0.042, respectively), but also reduced analgesia requirements (P=0.028). The length of postoperative hospitalization stay, Scr and BUN concentration, and adverse events did not differ significantly between the two groups. Further univariate and multivariate logistic regression analysis indicated that intraoperative DEX administration was a protective factor against SIRS after PCNL (OR 0.476 [95% CI: 0.257-0.835]; P=0.019). Conclusion Intraoperative administration of DEX might be associated with reductions in the incidences of SIRS and fever after PCNL.
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Affiliation(s)
- Fang Tan
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China.,Department of Anesthesiology, The Seventh Affiliated Hospital of Sun Yat-sen University, Shenzhen, People's Republic of China
| | - Xiaoliang Gan
- Department of Anesthesiology, Zhongshan Ophthalmic Center of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Yingqing Deng
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Xiaoyun Li
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Na Guo
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Ziqing Hei
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Qianqian Zhu
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Zhuang-Gui Chen
- Department of Pediatric Intensive Care Unit, Department of Pediatrics, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
| | - Shaoli Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, People's Republic of China
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Wollin DA, Joyce AD, Gupta M, Wong MYC, Laguna P, Gravas S, Gutierrez J, Cormio L, Wang K, Preminger GM. Antibiotic use and the prevention and management of infectious complications in stone disease. World J Urol 2017; 35:1369-79. [DOI: 10.1007/s00345-017-2005-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/10/2017] [Indexed: 11/26/2022] Open
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Abstract
Significant literature has an impact on the reader. Reading the novella Heart of Darkness by Joseph Conrad as a young boy rose emotions comparable to those I felt when losing a patient after percutaneous nephrolithotomy (PCNL) as a grown up. The case of a 37-year-old woman with bilateral staghorn and a fatal outcome after PCNL is presented and alternatives are discussed.
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Affiliation(s)
- Peter Alken
- Department of Urology, Mannheim University Hospital, Mannheim, Germany
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8
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Xu G, He Y, Zhao H, Jiang X, Feng G, Yang W, Xu W, Xie Q, Li X. Mini-nephroscope combined with pressure suction: an effective tool in MPCNL for intrarenal stones in patients with urinary tract infections. Urolithiasis 2016; 44:445-50. [DOI: 10.1007/s00240-016-0859-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2015] [Accepted: 01/19/2016] [Indexed: 01/28/2023]
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Koras O, Bozkurt IH, Yonguc T, Degirmenci T, Arslan B, Gunlusoy B, Aydogdu O, Minareci S. Risk factors for postoperative infectious complications following percutaneous nephrolithotomy: a prospective clinical study. Urolithiasis 2014; 43:55-60. [PMID: 25269441 DOI: 10.1007/s00240-014-0730-8] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 09/23/2014] [Indexed: 01/09/2023]
Abstract
The aim of the study was to assess the preoperative and intraoperative potential risk factors for infectious complications after percutaneous nephrolithotomy (PCNL). A total of 303 patients who underwent PCNL for renal stones were included in the recent study. A detailed history including past renal surgery, nephrostomy insertion and recurrent urinary infection were obtained from all patients. Preoperative urine culture, renal pelvic urine culture and stone culture were obtained from all patients. The intraoperative data were prospectively noted. All patients were followed up postoperatively for signs of systemic inflammatory response syndrome (SIRS) and sepsis. In 83 (27.4%) of the patients, SIRS was observed and of these patients 23 (7.6%) were diagnosed as sepsis. Escherichia coli was the most common organism detected in cultures, followed by Pseudomonas aeruginosa, Enterococcus and Klebsiella spp. in all patients. By multivariate logistic regression analysis, presence of infection stone, stone burden and recurrent urinary tract infection were associated with both SIRS and sepsis development. Presence of infection stone, stone burden ≥800 mm(2) and recurrent urinary tract infection can be identified as independent predictors for the development of SIRS and sepsis.
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Affiliation(s)
- Omer Koras
- Department of Urology, Izmir Bozyaka Training and Research Hospital, Izmir, Turkey
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Abstract
Since its introduction into the endourologist's armamentarium almost 40 years ago, percutaneous nephrolithotomy (PCNL) has become the standard of care for patients with large-volume nephrolithiasis. Postoperative infection is one of the most common complications of the procedure, and postoperative sepsis is one of the most detrimental. A number of factors have been found to increase the risk of postoperative sepsis. These include patient characteristics that are known preoperatively, such as urine culture obtained from the bladder or from the renal pelvis if percutaneous access to the renal pelvis is obtained in advance to the procedure. Neurogenic bladder dysfunction secondary to spinal cord injury and anatomical renal abnormalities, such as pelvicalyceal dilatation, have also been associated with increased incidence of fever and sepsis after the procedure. Several intraoperative factors, such as the average renal pressure sustained during PCNL and the operative time, also seem to increase the risk of sepsis. Finally, the contribution of postoperative factors, such as presence of a nephrostomy tube or a urethral catheter, has also been investigated. A short preoperative course of antibiotics has been found to significantly decrease the rate of postoperative fever and sepsis. Novel agents targeted at sepsis prevention and treatment, such as anti-endotoxin antibodies and cholesterol-lowering drugs statins, are currently under investigation.
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Affiliation(s)
- Fan Cheng
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Weimin Yu
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xiaobin Zhang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Sixing Yang
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yue Xia
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
| | - Yuan Ruan
- Department of Urology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China
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Abstract
Infectious complications are one of the most frequent and feared adverse medical events in percutaneous nephrolithotomy. They represent a dangerous and life-threatening condition, especially when postoperative septicemia or severe sepsis develops. In order to limit morbidity and mortality it is crucial to recognize preoperative and intraoperative risk factors that could be clear contributors to an adverse infectious event; those factors are mainly immunosuppression caused by some comorbidities, presence of urinary infection or colonization, stone characteristics, obstruction, long-lasting operation, and high intrapelvic pressure during nephrolithotomy. Close observation during the immediate and early postoperative period must be established and a high index of suspicion must be maintained to identify a major complication. The early recognition and prompt multidisciplinary management of sepsis is mandatory to optimize the final outcome. Appropriate therapy is a continuum of management of infection, ranging from adequate drainage and broad-spectrum antibiotics to aggressive fluid resuscitation and invasive monitoring with medical management in the intensive care setting until the causative agent is found and eradicated.
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Affiliation(s)
- Oscar Negrete-Pulido
- Nuevo Hospital Civil de Guadalajara, Universidad de Guadalajara and Instituto de Endourologia , Hospital Puerta de Hierro, Zapopan, Mexico
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Falahatkar S, Panahandeh Z, Ashoori E, Akbarpour M, Khaki N. What Is the Difference Between Percutaneous Nephrolithotomy in Patients with and without Previous Open Renal Surgery? J Endourol 2009; 23:1107-10. [DOI: 10.1089/end.2008.0630] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | | | - Negin Khaki
- Urology Research Center, Razi Hospital, Rasht, Iran
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Gonen M, Turan H, Ozturk B, Ozkardes H. Factors affecting fever following percutaneous nephrolithotomy: a prospective clinical study. J Endourol 2008; 22:2135-8. [PMID: 18811569 DOI: 10.1089/end.2008.0139] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To evaluate the preoperative and intraoperative factors that might affect development of fever following percutaneous nephrolithotomy (PCNL) and to investigate the clinical significance of intraoperative microbiologic evaluation in managing postoperative infectious complications. PATIENTS AND METHODS Sixty-one consecutive patients who had undergone PCNL between October 2006 and June 2007 were prospectively recruited into the study. Preoperative urine cultures and intraoperative stone and pelvic urine cultures were obtained from all patients. Postoperatively, patients were closely monitored for fever and other signs of systemic inflammatory response syndrome. RESULTS Of 61 patients, 10 (16.8%) had at least one body temperature recorded at 38 degrees C (group 1), the remaining patients were afebrile (group 2). Fever was associated with a systemic inflammatory response syndrome in one patient (1.6%); in that patient, the antibiotic regimen was altered. There were statistically significantly more positive stone culture results for patients in group 1 than there were for patients in group 2 (5/10 versus 9/51, P < 0.05). There were statistically significantly more positive pelvic urine culture results for patients in group 1 than there were for patients in group 2 (3/10 versus 2/51, P < 0.05). Patients in group 1 also had longer operative times and larger stone burdens than did patients in group 2. CONCLUSIONS Intraoperative microbiologic evaluation may be important in postoperative antibiotic selection and should be routinely used.
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Affiliation(s)
- Murat Gonen
- Department of Urology, Baskent University Konya Research and Practice Cente, Konya, Turkey.
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Aghamir SMK, Mojtahedzadeh M, Meysamie A, Atharikia D, Izadpanah F, Sheikhvatan M. Comparison of Systemic Stress Responses Between Percutaneous Nephrolithotomy (PCNL) and Open Nephrolithotomy. J Endourol 2008; 22:2495-500. [DOI: 10.1089/end.2008.0319] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Mojtaba Mojtahedzadeh
- Department of Anesthesiology and Pharmacotherapy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alipasha Meysamie
- Department of Epidemiology, Tehran University of Medical Sciences, Tehran, Iran
| | - Davood Atharikia
- Department of Urology, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Izadpanah
- Department of Anesthesiology and Pharmacotherapy, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
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