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Ríos-Barnés M, Velasco-Arnaiz E, Fortuny C, Benavides M, Baquero-Artigao F, Muga O, Del Valle R, Frick MA, Bringué X, Herrero S, Vilas J, Alonso-Ojembarrena A, Castells-Vilella L, Rojo P, Blázquez-Gamero D, Esteva C, Sánchez E, Alarcón A, Noguera-Julian A. Renal Function Impairment in Children With Congenital Cytomegalovirus Infection: A Cross-sectional Study. Pediatr Infect Dis J 2024; 43:257-262. [PMID: 38063508 DOI: 10.1097/inf.0000000000004176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
BACKGROUND We aimed to determine the prevalence and severity of glomerular and tubular renal dysfunction by means of urinalysis in infants and toddlers with congenital cytomegalovirus infection (cCMV) and their association with cCMV disease, viruria and antiviral treatment. METHODS This cross-sectional study was done using the Spanish Registry of Congenital Cytomegalovirus Infection. First-morning urine samples were collected from January 2016 to December 2018 from patients <5 years old enrolled in Spanish Registry of Congenital Cytomegalovirus Infection. Samples were excluded in case of fever or other signs or symptoms consistent with acute infection, bacteriuria or bacterial growth in urine culture. Urinary protein/creatinine and albumin/creatinine ratios, urinary beta-2-microglobulin levels, hematuria and CMV viruria were determined. A 0.4 cutoff in the urinary albumin/protein ratio was used to define tubular (<0.4) or glomerular (>0.4) proteinuria. Signs and symptoms of cCMV at birth, the use of antivirals and cCMV-associated sequelae at last available follow-up were obtained from Spanish Registry of Congenital Cytomegalovirus Infection. RESULTS Seventy-seven patients (37 females, 48.1%; median [interquartile range] age: 14.0 [4.4-36.2] months) were included. Symptom-free elevated urinary protein/creatinine and albumin/creatinine ratios were observed in 37.5% and 41.9% of patients, respectively, with tubular proteinuria prevailing (88.3%) over glomerular proteinuria (11.6%). Proteinuria in the nephrotic range was not observed in any patients. In multivariate analysis, female gender was the only risk factor for tubular proteinuria (adjusted odds ratio = 3.339, 95% confidence interval: 1.086-10.268; P = 0.035). cCMV disease at birth, long-term sequelae, viruria or the use of antivirals were not associated with urinalysis findings. CONCLUSIONS Mild nonsymptomatic tubular proteinuria affects approximately 40% of infants and toddlers with mostly symptomatic cCMV in the first 5 years of life.
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Affiliation(s)
- María Ríos-Barnés
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Eneritz Velasco-Arnaiz
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Clàudia Fortuny
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)
| | - Marta Benavides
- Pediatric Infectious Diseases Unit, Hospital Universitario La Paz
| | - Fernando Baquero-Artigao
- Pediatric Infectious Diseases Unit, Hospital Universitario La Paz
- La Paz Research Institute (IdiPAZ), Universidad Autónoma de Madrid (UAM)
- Centro de Investigación Biomédica en Red en Enfermedades Infecciosas (CIBERINFEC), Madrid, Spain
| | - Oihana Muga
- Department of Pediatrics, Hospital de Donostia, San Sebastián, Spain
| | - Rut Del Valle
- Department of Pediatrics, Hospital Infanta Sofía, Madrid, Spain
| | - Marie Antoinette Frick
- Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona, Spain
| | - Xavier Bringué
- Department of Pediatrics and Neonatal Unit, Hospital Universitario Arnau de Vilanova, Lleida, Spain
| | - Susana Herrero
- Department of Pediatrics, Hospital Sant Llàtzer, Palma de Mallorca, Spain
| | - Javier Vilas
- Department of Pediatrics, Hospital de Pontevedra, Pontevedra, Spain
| | - Almudena Alonso-Ojembarrena
- Neonatal Intensive Care Unit, Biomedical Research and Innovation Institute of Cádiz (INiBICA), Research Unit, Hospital Puerta del Mar, Cádiz, Spain
| | - Laura Castells-Vilella
- Department of Pediatrics and Neonatal Unit, Hospital General de Cataluña, Barcelona, Spain
| | - Pablo Rojo
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid, Spain
| | - Cristina Esteva
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Molecular Microbiology Unit, Hospital Universitari Sant Joan de Déu
| | | | - Ana Alarcón
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Department of Neonatology, Hospital Sant Joan de Déu, Neonatal Brain Group, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Antoni Noguera-Julian
- From the Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Pediatric Infectious Diseases Department, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Centre for Biomedical Network Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Departament de Cirurgia i Especialitats Medicoquirúrgiques, Facultat de Medicina i Ciències de la Salut, Universitat de Barcelona, Barcelona, Spain
- Translational Research Network in Pediatric Infectious Diseases (RITIP)
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Cobo-Vázquez E, Aguilera-Alonso D, Carbayo T, Figueroa-Ospina LM, Sanz-Santaeufemia F, Baquero-Artigao F, Vázquez-Ordoñez C, Carrasco-Colom J, Blázquez-Gamero D, Jiménez-Montero B, Grasa-Lozano C, Cilleruelo MJ, Álvarez A, Comín-Cabrera C, Penin M, Cercenado E, Del Valle R, Roa MÁ, Diego IGD, Calvo C, Saavedra-Lozano J. Epidemiology and clinical features of Streptococcus pyogenes bloodstream infections in children in Madrid, Spain. Eur J Pediatr 2023:10.1007/s00431-023-04967-5. [PMID: 37140702 DOI: 10.1007/s00431-023-04967-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/24/2023] [Accepted: 03/31/2023] [Indexed: 05/05/2023]
Abstract
Studies have shown increased invasive Group A Streptococcus (GAS) disease, including bloodstream infections (GAS-BSI). However, the epidemiological data of GAS-BSI are limited in children. We aimed to describe GAS-BSI in children in Madrid, over 13 years (2005-2017). Multicenter retrospective cohort study from 16 hospitals from Madrid, Spain. Epidemiology, symptomatology, laboratory, treatment, and outcome of GAS-BSI in children ≤ 16 years were analyzed. 109 cases of GAS-BSI were included, with incidence rate of 4.3 episodes/100,000 children attended at the emergency department/year. We compared incidence between two periods (P1: 2005-June 2011 vs P2: July 2011-2017) and observed a non-significant increase along the study period (annual percentage change: + 6.0% [95%CI: -2.7, + 15.4]; p = 0.163). Median age was 24.1 months (IQR: 14.0-53.7), peaking during the first four years of life (89/109 cases; 81.6%). Primary BSI (46.8%), skin and soft tissue (21.1%), and osteoarticular infections (18.3%) were the most common syndromes. We compared children with primary BSI with those with a known source and observed that the former had shorter hospital stay (7 vs. 13 days; p = 0.003) and received intravenous antibiotics less frequently (72.5% vs. 94.8%; p = 0.001) and for shorter duration of total antibiotic therapy (10 vs. 21 days; p = 0.001). 22% of cases required PICU admission. Factors associated with severity were respiratory distress, pneumonia, thrombocytopenia, and surgery, but in multivariate analysis, only respiratory distress remained significant (adjusted OR:9.23 [95%CI: 2.16-29.41]). Two children (1.8%) died. Conclusion: We observed an increasing, although non-significant, trend of GAS-BSI incidence within the study. Younger children were more frequently involved, and primary BSI was the most common and less severe syndrome. PICU admission was frequent, being respiratory distress the main risk factor. What is known: • In recent decades, several reports have shown a worldwide increase in the incidence of invasive Group A streptococcal disease (GAS), including bloodstream infection (BSI). Recently, there have been a few reports showing an increase in severity as well. • There needs to be more information on the epidemiology in children since most studies predominantly include adults. What is new: • This study, carried out in children with GAS-BSI in Madrid, shows that GAS-BSI affects mostly younger children, with a broad spectrum of manifestations, needing PICU admission frequently. Respiratory distress was the leading risk factor for severity, whereas primary BSI seemed to be less severe. • We observed an increasing, although non-significant, trend of GAS-BSI incidence in recent years (2005-2017).
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Affiliation(s)
- Elvira Cobo-Vázquez
- Department of Pediatrics, Hospital Universitario Fundación de Alcorcón, Servicio de Pediatría, Calle Budapest Nº1, 28922, Alcorcón, Madrid, Spain
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - David Aguilera-Alonso
- PhD Program in Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón. CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Servicio de Pediatría, Calle de O'Donnell, Madrid, 28009, Madrid, Spain.
| | - Tania Carbayo
- Department of Neonatology, Hospital Universitario, 12 de Octubre, Madrid, Spain
| | | | | | - Fernando Baquero-Artigao
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | | | - Jaime Carrasco-Colom
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario La Moraleja, Madrid, Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Daniel Blázquez-Gamero
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12). Universidad Complutense, RITIP, Madrid, Spain
| | | | - Carlos Grasa-Lozano
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
- Department of Pediatrics, Hospital Universitario de Fuenlabrada, Fuenlabrada, Madrid, Spain
| | - María José Cilleruelo
- Department of Pediatrics, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, Spain
| | - Ana Álvarez
- Department of Pediatrics, Hospital Universitario de Getafe, Getafe, Madrid, Spain
| | - Cristina Comín-Cabrera
- Department of Pediatrics, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, Spain
| | - María Penin
- Department of Pediatrics, Hospital, Universitario Príncipe de Asturias, Alcalá de Henares, Madrid, Spain
| | - Emilia Cercenado
- Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón, CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
| | - Rut Del Valle
- Department of Pediatrics, Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Madrid, Spain
| | - Miguel Ángel Roa
- Department of Pediatrics, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain
| | | | - Cristina Calvo
- Department of Infectious Diseases and Tropical Pediatrics, Hospital Universitario La Paz and IdiPaz Foundation, Madrid, Spain
- RITIP, Translational Research Network in Pediatric Infectious Diseases, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Autónoma, Madrid, Spain
| | - Jesús Saavedra-Lozano
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, CIBER de enfermedades infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Universidad Complutense, Madrid, Spain
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Herreros ML, Barrios A, Sánchez A, Del Valle R, Pacheco M, Gili P. Urine collection methods in precontinent children treated at the paediatric emergency department. Acta Paediatr 2023; 112:550-556. [PMID: 36463432 DOI: 10.1111/apa.16614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Revised: 11/29/2022] [Accepted: 12/01/2022] [Indexed: 12/05/2022]
Abstract
AIM To describe the urine collection methods used in precontinent children presenting at the Paediatric Emergency Department (PED) and compare results and contamination rates. METHODS Retrospective observational cohort study that included 1678 urine cultures collected in infants <24 months of age between January 2016 and December 2019. Urine cultures were compared based on collection technique, sex and patient age. RESULTS In total, 60.4% of samples were collected by clean-catch urine collection (CCUC), 26.4% by urethral catheterisation (UC) and 13.2% by urine bag (UB). Contamination rates were 2.9% (95% CI 1.3, 4.4) for UC, 11.3% (95% CI 9.3, 13.2) for CCUC and 23.4% (95% CI 17.8, 29.0) for UB. Significant differences in contamination rates were found between UC and CCUC in the 6-12-month age group (1.9% [95% CI 0.0-4.0] versus 12.0% [95% CI 7.2-16.8] [p < 0.0009]), and between UC and UB for all ages. CONCLUSIONS CCUC is the most common method for urine culture collection in infants <24 months of age at the PED in our centre. UC has the lowest contamination rates, but significant differences were only observed between CCUC and UC in the 6-12-month age group. CCUC is a non-invasive alternative for urine collection in infants.
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Affiliation(s)
- María Luisa Herreros
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Ana Barrios
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Aida Sánchez
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Rut Del Valle
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Mónica Pacheco
- Hospital Universitario Infanta Sofía, San Sebastián de los Reyes, Spain.,Universidad Europea, Madrid, Spain
| | - Pablo Gili
- Hospital Universitario Fundación Alcorcón, Alcorcon, Spain
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Cobos‐Carrascosa E, Ballesteros Á, Aguilera‐Alonso D, Mesa JM, García‐Sánchez P, Navarro I, Alonso‐Cadenas JA, Bermejo A, Sabrido G, Martinez‐Campos L, González‐Posada AF, Illán‐Ramos M, Lorente J, Jiménez AB, Del Valle R, Domínguez‐Rodríguez S, Tagarro A, Moraleda C. Manifestations and clinical phenotypes are not specific enough to predict SARS-CoV-2 infection in symptomatic children. Acta Paediatr 2022; 111:1974-1977. [PMID: 35657111 PMCID: PMC9347920 DOI: 10.1111/apa.16441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/19/2022] [Accepted: 06/01/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Elena Cobos‐Carrascosa
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
| | - Álvaro Ballesteros
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
| | - David Aguilera‐Alonso
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics, Hospital General Universitario Gregorio Marañón, Unidad de Investigación Materno‐Infantil Fundación Familia Alonso (UDIMIFFA) Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid Spain
- CIBER en Enfermedades Infecciosas (CIBERINFEC) Instituto de Salud Carlos III Madrid Spain
| | - Juan Miguel Mesa
- Pediatric Department Hospital Universitario Infanta Sofía, Pediatrics Research Group Madrid Spain
| | | | - Ignacio Navarro
- Pediatric Department Hospital Universitario Infanta Sofía, Pediatrics Research Group Madrid Spain
- Fundation for Biomedical Research Hospital Infanta Sofía and Hospital del Henares Madrid Spain
| | | | - Amanda Bermejo
- Pediatric Department Hospital Universitario de Móstoles Madrid Spain
| | - Gema Sabrido
- Pediatric Department Hospital Universitario Rey Juan Carlos Madrid Spain
| | | | | | - Marta Illán‐Ramos
- Pediatric Department Hospital Universitario Clínico San Carlos Madrid Spain
| | - Jorge Lorente
- Pediatric Infectious Diseases Unit, Emergency Pediatric Department Hospital Universitario Gregorio Marañón Madrid Spain
| | - Ana Belén Jiménez
- Pediatric Department Hospital Universitario Fundacion Jimenez Diaz Madrid Spain
| | - Rut Del Valle
- Pediatric Department Hospital Universitario Infanta Sofía, Pediatrics Research Group Madrid Spain
- Fundation for Biomedical Research Hospital Infanta Sofía and Hospital del Henares Madrid Spain
- Universidad Europea Madrid Spain
| | - Sara Domínguez‐Rodríguez
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
| | - Alfredo Tagarro
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
- Pediatric Department Hospital Universitario Infanta Sofía, Pediatrics Research Group Madrid Spain
- Fundation for Biomedical Research Hospital Infanta Sofía and Hospital del Henares Madrid Spain
- Universidad Europea Madrid Spain
| | - Cinta Moraleda
- Fundation for Biomedical Research Hospital 12 de Octubre Instituto de Investigación 12 de Octubre (imas12) Madrid Spain
- Pediatric Infectious Diseases Unit, Department of Pediatrics Hospital Universitario 12 de Octubre, Pediatric Research and Clinical Trials Unit (UPIC), RITIP (Translational Research Network in Pediatric Infectious Diseases) Madrid Spain
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Capocasale E, Busi N, Valle RD, Mazzoni MP, Bignardi L, Maggiore U, Buzio C, Sianesi M. Octreotide in the Treatment of Lymphorrhea After Renal Transplantation: A Preliminary Experience. Transplant Proc 2006; 38:1047-8. [PMID: 16757259 DOI: 10.1016/j.transproceed.2006.03.040] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Lymphorrhea is a minor complication after kidney transplantation but may develop into a lymphocele and prolong hospital stay. Treatment is conservative based on percutaneous drainage until lymphatic leakage cessation. It has been reported that octreotide has beneficial effects to treat lymphorrhea after axillary node dissection and excision of lymphatic malformations. The aim of this study was to report preliminary experience about octreotide treatment in lymphorrea after kidney transplantation. MATERIALS AND METHODS This retrospective study included 20 recipients of cadaveric kidney allografts with posttransplant lymphorrhea including 10 treated with instillation of povidone iodate solution, and the other 10 with octreotide (0.1 mg three times a day subcutaneously). We reviewed the daily amount of fluid collection, duration of lymphorrhea, complications, lymphocele formation, rejection episodes, graft outcomes, and hospital stay. RESULTS The average duration of lymphorrhea was 8.5 (+/-4.5) and 16.3 (+/-7.3) days for the octreotide versus the povidone groups, respectively (P = .001). No complications occurred among the octreotide group, while three lymphoceles grew among patients treated with povidone solution. No differences were observed for acute rejection episodes or renal function between the groups. No octreotide-related adverse events were noted. CONCLUSION The mean length of lymphorrhea was lower with octreotide versus iodate povidone solution treatment. There was a shorter hospital stay and minor patient discomfort. In conclusion, lymphatic leakage after kidney transplantation may be successfully managed by octreotide administration.
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Affiliation(s)
- E Capocasale
- General Surgery and Organ Transplantation, University of Parma, Italy
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