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Gomides APM, de Albuquerque CP, da Mota LMH, Devidé G, Dias LH, Duarte ALBP, Giovelli RA, Karnopp TE, de Lima HD, Marinho A, de Oliveira MS, Omura F, Ranzolin A, Resende G, Ribeiro FM, Ribeiro SLE, de Carvalho Sacilotto N, Dos Santos WG, Shinjo SK, de Sousa Studart SA, Teixeira FPS, Yazbek MA, Ferreira GA, Monticielo OA, Paiva E, Pileggi GCS, Dos Reis-Neto ET, de Medeiros Pinheiro M, Marques CDL. Factors associated with hospitalizations for Covid-19 in patients with rheumatoid arthritis: data from the Reumacov Brazil registry. Adv Rheumatol 2022; 62:13. [PMID: 35505408 PMCID: PMC9062867 DOI: 10.1186/s42358-022-00244-5] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 04/10/2022] [Indexed: 12/02/2022] Open
Abstract
Background Patients using immunosuppressive drugs may have unfavorable results after infections. However, there is a lack of information regarding COVID-19 in these patients, especially in patients with rheumatoid arthritis (RA). Therefore, the aim of this study was to evaluate the risk factors associated with COVID-19 hospitalizations in patients with RA. Methods This multicenter, prospective cohort study is within the ReumaCoV Brazil registry and included 489 patients with RA. In this context, 269 patients who tested positive for COVID-19 were compared to 220 patients who tested negative for COVID-19 (control group). All patient data were collected from the Research Electronic Data Capture database. Results The participants were predominantly female (90.6%) with a mean age of 53 ± 12 years. Of the patients with COVID-19, 54 (20.1%) required hospitalization. After multiple adjustments, the final regression model showed that heart disease (OR = 4.61, 95% CI 1.06–20.02. P < 0.001) and current use of glucocorticoids (OR = 20.66, 95% CI 3.09–138. P < 0.002) were the risk factors associated with hospitalization. In addition, anosmia was associated with a lower chance of hospitalization (OR = 0.26; 95% CI 0.10–0.67, P < 0.005). Conclusion Our results demonstrated that heart disease and the use of glucocorticoids were associated with a higher number of hospital admissions for COVID-19 in patients with RA. Trial registration: Brazilian Registry of Clinical Trials - RBR-33YTQC. Supplementary Information The online version contains supplementary material available at 10.1186/s42358-022-00244-5.
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Affiliation(s)
| | | | | | - Guilherme Devidé
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Laiza Hombre Dias
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | - Raquel Altoé Giovelli
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Thais Evelyn Karnopp
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Hugo Deleon de Lima
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Adriana Marinho
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | - Felipe Omura
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Aline Ranzolin
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Gustavo Resende
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | | | | | | | - Samuel Katsuyuki Shinjo
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | | | - Michel Alexandre Yazbek
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | - Odirlei A Monticielo
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | - Eduardo Paiva
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
| | | | | | | | - Claudia D L Marques
- Faculdade de Ciências da Educação e Saúde, Centro Universitário de Brasília, Brasília, Brazil
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Marques CDL, Ribeiro SLE, Albuquerque CP, de Sousa Studart SA, Ranzolin A, de Andrade NPB, Dantas AT, Mota GD, Resende GG, Marinho AO, Angelieri D, Andrade D, Ribeiro FM, Omura F, Silva NA, Rocha Junior L, Brito DE, Fernandino DC, Yazbek MA, Souza MPG, Ximenes AC, Martins ASS, Castro GRW, Oliveira LC, Freitas ABSB, Kakehasi AM, Gomides APM, Reis Neto ET, Pileggi GS, Ferreira GA, Mota LMH, Xavier RM, de Medeiros Pinheiro M. COVID-19 was not associated or trigger disease activity in spondylarthritis patients: ReumaCoV-Brasil cross-sectional data. Adv Rheumatol 2022; 62:45. [PMID: 36419163 PMCID: PMC9685130 DOI: 10.1186/s42358-022-00268-x] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Accepted: 09/27/2022] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To evaluate the disease activity before and after COVID-19 and risk factors associated with outcomes, including hospitalization, intensive care unit (ICU) admission, mechanical ventilation (MV) and death in patients with spondylarthritis (SpA). METHODS ReumaCoV Brazil is a multicenter prospective cohort of immune-mediated rheumatic diseases (IMRD) patients with COVID-19 (case group), compared to a control group of IMRD patients without COVID-19. SpA patients enrolled were grouped as axial SpA (axSpA), psoriatic arthritis (PsA) and enteropathic arthritis, according to usual classification criteria. RESULTS 353 SpA patients were included, of whom 229 (64.9%) were axSpA, 118 (33.4%) PsA and 6 enteropathic arthritis (1.7%). No significant difference was observed in disease activity before the study inclusion comparing cases and controls, as well no worsening of disease activity after COVID-19. The risk factors associated with hospitalization were age over 60 years (OR = 3.71; 95% CI 1.62-8.47, p = 0.001); one or more comorbidities (OR = 2.28; 95% CI 1.02-5.08, p = 0.001) and leflunomide treatment (OR = 4.46; 95% CI 1.33-24.9, p = 0.008). Not having comorbidities (OR = 0.11; 95% CI 0.02-0.50, p = 0.001) played a protective role for hospitalization. In multivariate analysis, leflunomide treatment (OR = 8.69; CI = 95% 1.41-53.64; p = 0.023) was associated with hospitalization; teleconsultation (OR = 0.14; CI = 95% 0.03-0.71; p = 0.01) and no comorbidities (OR = 0.14; CI = 95% 0.02-0.76; p = 0.02) remained at final model as protective factor. CONCLUSIONS Our results showed no association between pre-COVID disease activity or that SARS-CoV-2 infection could trigger disease activity in patients with SpA. Teleconsultation and no comorbidities were associated with a lower hospitalization risk. Leflunomide remained significantly associated with higher risk of hospitalization after multiple adjustments.
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Affiliation(s)
| | | | | | | | | | - Nicole Pamplona Bueno de Andrade
- grid.8532.c0000 0001 2200 7498Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Andrea T. Dantas
- grid.411227.30000 0001 0670 7996Hospital das Clínicas – Universidade Federal de Pernambuco, Recife, Brazil
| | - Guilherme D. Mota
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gustavo G. Resende
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Danielle Angelieri
- grid.414644.70000 0004 0411 4654Hospital dos Servidores de São Paulo – IAMSPE, São Paulo, Brazil
| | - Danieli Andrade
- grid.11899.380000 0004 1937 0722Hospital das Clínicas, Universidade de São Paulo, São Paulo, Brazil
| | - Francinne M. Ribeiro
- grid.412211.50000 0004 4687 5267Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Abraão, Brazil
| | - Felipe Omura
- Clínica Omura Medicina Diagnóstica, São Paulo, Brazil
| | - Nilzio A. Silva
- grid.411195.90000 0001 2192 5801Faculdade de Medicina da Universidade Federal de Goiás, Goiânia, Brazil
| | - Laurindo Rocha Junior
- grid.419095.00000 0004 0417 6556Instituto de Medicina Integral Professor Fernando Figueira -IMIP, Recife, Brazil
| | - Danielle E. Brito
- grid.411216.10000 0004 0397 5145Universidade Federal da Paraíba, João Pessoa, Brazil
| | - Diana C. Fernandino
- grid.411198.40000 0001 2170 9332Universidade Federal de Juiz de Fora, Juiz de Fora, Brazil
| | - Michel A. Yazbek
- grid.411087.b0000 0001 0723 2494Hospital de Clínicas da Universidade Estadual de Campinas- UNICAMP, Campinas, Brazil
| | - Mariana P. G. Souza
- grid.415169.e0000 0001 2198 9354Santa Casa de Belo Horizonte, Belo Horizonte, Brazil
| | | | - Ana Silvia S. Martins
- grid.411284.a0000 0004 4647 6936Hospital de Clínicas, Universidade Federal de Uberlândia, Uberlândia, Brazil
| | - Glaucio Ricardo W. Castro
- grid.413214.10000 0004 0504 2293Hospital Governador Celso Ramos – Santa Catarina, Florianópolis, Brazil
| | | | | | - Adriana M. Kakehasi
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Edgard Torres Reis Neto
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gecilmara S. Pileggi
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
| | - Gilda A. Ferreira
- grid.8430.f0000 0001 2181 4888Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Licia Maria H. Mota
- grid.7632.00000 0001 2238 5157Programa de Pós-Graduação em Ciências Médicas, Faculdade de Medicina, Universidade de Brasília (PPGCM-FM-UnB), Brazil, Brasília, DF Brazil ,grid.411215.2Hospital Universitário de Brasília (HUB-UnB-EBSERH), Brasília, DF Brazil
| | - Ricardo M. Xavier
- grid.8532.c0000 0001 2200 7498Hospital de Clínicas de Porto Alegre – Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Marcelo de Medeiros Pinheiro
- grid.411249.b0000 0001 0514 7202Universidade Federal de São Paulo, Rua Borges Lagoa, 913/ 51-53, Vila Clementino, São Paulo, SP CEP: 04038-034 Brazil
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Sattui SE, Conway R, Putman MS, Seet AM, Gianfrancesco MA, Beins K, Hill C, Liew D, Mackie SL, Mehta P, Neill L, Gomez G, Salinas MIH, Maldonado FN, Mariz HA, de Sousa Studart SA, Araujo NC, Knight A, Rozza D, Quartuccio L, Samson M, Bally S, Maria AT, Chazerain P, Hasseli R, Müller-Ladner U, Hoyer BF, Voll R, Torres RP, Luis M, Ribeirio SLE, Al-Emadi S, Sparks JA, Hsu TYT, D'Silva KM, Patel NJ, Wise L, Gilbert E, Almada MV, Duarte-García A, Ugarte-Gil M, Jacobsohn L, Izadi Z, Strangfeld A, Mateus EF, Hyrich KL, Gossec L, Carmona L, Lawson-Tovey S, Kearsley-Fleet L, Schaefer M, Sirotich E, Hausmann JS, Sufka P, Bhana S, Liew JW, Grainger R, Machado PM, Wallace ZS, Yazdany J, Robinson PC. Outcomes of COVID-19 in patients with primary systemic vasculitis or polymyalgia rheumatica from the COVID-19 Global Rheumatology Alliance physician registry: a retrospective cohort study. Lancet Rheumatol 2021; 3:e855-e864. [PMID: 34778843 PMCID: PMC8570701 DOI: 10.1016/s2665-9913(21)00316-7] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Background Patients with primary systemic vasculitis or polymyalgia rheumatica might be at a high risk for poor COVID-19 outcomes due to the treatments used, the potential organ damage cause by primary systemic vasculitis, and the demographic factors associated with these conditions. We therefore aimed to investigate factors associated with COVID-19 outcomes in patients with primary systemic vasculitis or polymyalgia rheumatica. Methods In this retrospective cohort study, adult patients (aged ≥18 years) diagnosed with COVID-19 between March 12, 2020, and April 12, 2021, who had a history of primary systemic vasculitis (antineutrophil cytoplasmic antibody [ANCA]-associated vasculitis, giant cell arteritis, Behçet's syndrome, or other vasculitis) or polymyalgia rheumatica, and were reported to the COVID-19 Global Rheumatology Alliance registry were included. To assess COVID-19 outcomes in patients, we used an ordinal COVID-19 severity scale, defined as: (1) no hospitalisation; (2) hospitalisation without supplemental oxygen; (3) hospitalisation with any supplemental oxygen or ventilation; or (4) death. Multivariable ordinal logistic regression analyses were used to estimate odds ratios (ORs), adjusting for age, sex, time period, number of comorbidities, smoking status, obesity, glucocorticoid use, disease activity, region, and medication category. Analyses were also stratified by type of rheumatic disease. Findings Of 1202 eligible patients identified in the registry, 733 (61·0%) were women and 469 (39·0%) were men, and their mean age was 63·8 years (SD 17·1). A total of 374 (31·1%) patients had polymyalgia rheumatica, 353 (29·4%) had ANCA-associated vasculitis, 183 (15·2%) had giant cell arteritis, 112 (9·3%) had Behçet's syndrome, and 180 (15·0%) had other vasculitis. Of 1020 (84·9%) patients with outcome data, 512 (50·2%) were not hospitalised, 114 (11·2%) were hospitalised and did not receive supplemental oxygen, 239 (23·4%) were hospitalised and received ventilation or supplemental oxygen, and 155 (15·2%) died. A higher odds of poor COVID-19 outcomes were observed in patients who were older (per each additional decade of life OR 1·44 [95% CI 1·31-1·57]), were male compared with female (1·38 [1·05-1·80]), had more comorbidities (per each additional comorbidity 1·39 [1·23-1·58]), were taking 10 mg/day or more of prednisolone compared with none (2·14 [1·50-3·04]), or had moderate, or high or severe disease activity compared with those who had disease remission or low disease activity (2·12 [1·49-3·02]). Risk factors varied among different disease subtypes. Interpretation Among patients with primary systemic vasculitis and polymyalgia rheumatica, severe COVID-19 outcomes were associated with variable and largely unmodifiable risk factors, such as age, sex, and number of comorbidities, as well as treatments, including high-dose glucocorticoids. Our results could be used to inform mitigation strategies for patients with these diseases. Funding American College of Rheumatology and the European Alliance of Associations for Rheumatology.
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Affiliation(s)
- Sebastian E Sattui
- Department of Medicine, Division of Rheumatology, Hospital for Special Surgery, New York, NY, USA
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard Conway
- Department of Rheumatology, St James's Hospital, Dublin, Ireland
| | | | - Andrea M Seet
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Milena A Gianfrancesco
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | | | - Catherine Hill
- Rheumatology Unit, The Queen Elizabeth Hospital, Woodville, SA, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - David Liew
- Department of Rheumatology, Austin Health, Melbourne, Australia
- Department of Medicine, University of Melbourne, VIC, Australia
| | - Sarah L Mackie
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
- Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Puja Mehta
- Centre for Inflammation and Tissue Repair, UCL Respiratory, University College London, UK
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Lorna Neill
- Polymyalgia Rheumatica and Giant Cell Arteritis Scotland, Perth, Scotland, UK
| | - Gimena Gomez
- Research Unit Argentine Society of Rheumatology, Buenos Aires, Argentina
| | | | | | | | | | - Nafice Costa Araujo
- Instituto de Assistencia Medica ao Servidor Publico Estadual de Sao Paulo, Sao Paulo, Brazil
| | - Ann Knight
- Rheumatology, Institute of Medical Sciences, Uppsala University, Uppsala, Sweden
| | - Davide Rozza
- Epidemiology Research Unit, Italian Society for Rheumatology, Milan, Italy
| | - Luca Quartuccio
- Clinic of Rheumatology, Department of Medicine, University of Udine, School of Rheumatology, Santa Maria della Misericordia Academic Hospital, Udine, Italy
| | - Maxime Samson
- Department of Internal Medicine and Clinical Immunology, Dijon University Hospital, Dijon, France
| | - Stéphane Bally
- Nephrology and Dialysis Service, Metropole Savoie Hospital Center, Chambery, France
| | - Alexandre Tj Maria
- Department of Internal Medicine and Multi-Organic Diseases, Saint-Eloi University Hospital of Montpellier, Montpellier, France
| | - Pascal Chazerain
- Department of Rheumatology and Internal Medicine, Diaconesses Croix Saint Simon Hospital, Paris, France
| | - Rebecca Hasseli
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Ulf Müller-Ladner
- Department of Rheumatology and Clinical Immunology, Campus Kerckhoff, Justus Liebig University Giessen, Bad Nauheim, Germany
| | - Bimba F Hoyer
- Department of Rheumatology and Clinical Immunology, Clinic for Internal Medicine I, University Hospital Schleswig-Holstein, Kiel, Germany
| | - Reinhard Voll
- Department of Rheumatology and Clinical Immunology, University Medical Center, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Germany
| | - Rita Pinheiro Torres
- CEDOC, Nova Medical School, Lisbon, Portugal
- Rheumatology Service, Egas Moniz Hospital, Lisboa Occidental Hospital Centre, Lisbon, Portugal
| | - Mariana Luis
- Department of Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- School of Medicine, Universidade de Coimbra, Coimbra, Portugal
| | | | | | - Jeffrey A Sparks
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Tiffany Y-T Hsu
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kristin M D'Silva
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Naomi J Patel
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Leanna Wise
- Los Angeles County Hospital, Los Angeles, CA, USA
- University of South California Medical Center, Los Angeles, CA, USA
| | - Emily Gilbert
- Division of Rheumatology, Mayo Clinic Health System, Jacksonville, FL, USA
| | | | - Alí Duarte-García
- Division of Rheumatology, Mayo Clinic Health System, Rochester, MN, USA
| | - Manuel Ugarte-Gil
- School of Medicine, University Cientifica del Sur, Lima, Peru
- Rheumatology Department, Hospital Guillermo Almenara Irigoyen, EsSalud, Lima, Peru
| | - Lindsay Jacobsohn
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Zara Izadi
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Anja Strangfeld
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Elsa F Mateus
- Portuguese League Against Rheumatic Diseases, Lisbon, Portugal
| | - Kimme L Hyrich
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- National Institute of Health Research Manchester Biomedical Research Centre, University of Manchester, Manchester, UK
- National Institute of Health Research Manchester Biomedical Research Centre, Manchester University NHS Trust, Manchester, UK
| | - Laure Gossec
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris France
- Department of Rheumatology, Pitié-Salpêtrière Hospital, AP-HP, Sorbonne Université, Paris, France
| | | | - Saskia Lawson-Tovey
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, University of Manchester, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | | | - Martin Schaefer
- German Rheumatism Research Center, Epidemiology and Health Care Research, Berlin, Germany
| | - Emily Sirotich
- McMaster University, Hamilton, ON, Canada
- Canadian Arthritis Patient Alliance, Toronto, ON, Canada
| | - Jonathan S Hausmann
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
- Boston Children's Hospital, Boston, MA, USA
| | | | | | - Jean W Liew
- Boston University School of Medicine, Boston, MA, USA
| | | | - Pedro M Machado
- Centre for Rheumatology and Department of Neuromuscular Diseases, University College London, UK
- National Institute for Health Research, University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
- Department of Rheumatology, Northwick Park Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Zachary S Wallace
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Jinoos Yazdany
- Department of Medicine, Division of Rheumatology, University of California, San Francisco, CA, USA
| | - Philip C Robinson
- University of Queensland, Brisbane, QLD, Australia
- Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
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