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Toptan HH, Karadag NN, Topcuoglu S, Ozalkaya E, Dincer E, Cakir H, Gunes AO, Karatekin G. Comparative Outcomes of Levetiracetam and Phenobarbital Usage in the Treatment of Neonatal Seizures: A Retrospective Analysis. Healthcare (Basel) 2024; 12:800. [PMID: 38610222 PMCID: PMC11011900 DOI: 10.3390/healthcare12070800] [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] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 04/03/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES AND AIM The primary aim of this study was to conduct a comparative analysis of the safety and efficacy of levetiracetam (LEV) and phenobarbital (PB) as first-line treatments for neonatal seizure management. This study was designed to measure and compare the incidence of adverse effects and to determine the discharge and mortality rates associated with the use of these antiseizure medications (ASMs). Through this comparison, this research sought to provide insights to optimise care for neonates experiencing seizures. MATERIALS AND METHODS This retrospective cohort study evaluated 104 neonates treated for seizures at Zeynep Kamil Hospital from 2015 to 2020 after excluding those on non-PB/LEV antiseizure medications. Seizures were characterised using electroencephalogram (EEG) and categorised according to aetiology and frequency. Treatment efficacy was gauged by seizure cessation, as confirmed using EEG. Adverse effects and demographic data were recorded. Statistical analyses were conducted using SPSS, employing the Shapiro-Wilk, independent t-test, Mann-Whitney U test, and chi-square test, with a significance threshold of p < 0.05. RESULTS Overall, 104 neonates treated with first-line ASM were evaluated for efficacy; PB was administered in 68.26% of the cases, while LEV was utilised in 31.74%. The total complete response rate was 40.38%, with no significant difference between the PB and LEV groups (p = 0.309). The incidence rate ratios (IRRs) demonstrated that seizure frequency profoundly influenced treatment effectiveness, with IRRs of 2.09 for rare seizures, 3.25 for frequent seizures, and 4.01 for status epilepticus, indicating a higher treatment response rate with increasing seizure frequency. For second-line treatment, among a subset of 62 patients, PB had a slight, non-significant advantage over LEV, with an odds ratio of 1.09, suggesting a marginally better response to LEV. Adverse events were significantly more frequent in the PB group, affecting 19 of 67 neonates (28.36%), compared to only 2 of 71 neonates (2.82%) in the LEV group (p < 0.001). No significant difference was observed in the discharge rates between the two groups (PB, 67.61%; LEV, 75.76%; p = 0.674). Interestingly, the mortality rate was significantly higher in the LEV group (45.45%) than that in the PB group (22.54%; p = 0.045). CONCLUSION This study underscores LEV's superior safety profile over PB in neonatal seizure management, evidenced by a significantly lower rate of adverse events. PB seems to be more effective in the second-line treatment of neonatal seizures. Despite the lack of significant differences in the discharge rates, the higher mortality rate associated with LEV warrants further investigation. These findings advocate the cautious selection of antiepileptic drugs in neonatal care, with a preference for LEV based on its safety profile.
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Affiliation(s)
- Handan Hakyemez Toptan
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children’s Disease Health Training and Research Center-Istanbul, 34668 Istanbul, Turkey; (N.N.K.); (S.T.); (E.O.); (A.O.G.)
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Toptan HH, Ozalkaya E, Karadag N, Topcuoglu S, Dincer E, Karatekin G. Neonatal Lymphatic Flow Disorder. Indian J Pediatr 2024; 91:248-253. [PMID: 37040015 DOI: 10.1007/s12098-023-04531-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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 02/21/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVE To examine and discuss patients diagnosed with acquired and congenital chylothorax in the neonatal period in the light of the literature. METHODS The files of newborns followed-up in the neonatal intensive care unit (NICU) and diagnosed with congenital and acquired chylothorax were reviewed retrospectively. Patients with isolated chylothorax were classified as Group 1 and those with multiple lymphatic flow disorders were classified as Group 2. Antenatal and clinical features were recorded and compared between the groups. RESULTS Thirteen infants were diagnosed with chylothorax; 92.3% (n = 12) of the patients were congenital. The rate of antenatal diagnosis was 61.5% (n = 8). Eight patients (61.5%) were diagnosed with hydrops fetalis. Among the cases in Group 1 and Group 2, receiving ocreotide and the incidence of sepsis (p = 0.05) were partially significant. Seven of the patients (66.6%) responded to medium chain triglycerides (MCT), and complete resolution was seen in 6 (85.7%) of the responders. Complete resolution of chylothorax fluid was observed in 7 (77.7%) of nine patients who responded to ocreotide treatment. CONCLUSIONS In neonatal chylothorax, the postnatal period includes a multidisciplinary approach that requires drug therapy, dietary modifications, drainage of pleural fluid, and rarely, surgery.
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Affiliation(s)
- Handan Hakyemez Toptan
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey.
| | - Elif Ozalkaya
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Emre Dincer
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
| | - Guner Karatekin
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Disease Health Training and Research Center, Istanbul, Turkey
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Okbay Gunes A, Topcuoglu S, Celik G, Kizilay O, Akyurekli MAR, Karadag N, Ozalkaya E, Karatekin G. G-ROP criteria for predicting retinopathy of prematurity among neonates with different birth weight percentiles. J AAPOS 2022; 26:309.e1-309.e5. [PMID: 36283600 DOI: 10.1016/j.jaapos.2022.08.527] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/20/2022] [Accepted: 08/09/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND The Postnatal Growth and Retinopathy of Prematurity (G-ROP) Study showed that adding postnatal weight gain to birth weight and gestational age detected 100% of cases with type 1 retinopathy of prematurity (ROP) while reducing the ROP examinations by 30%. The purpose of this study was to investigate whether being small for gestational age (SGA) affects the sensitivity and specificity of the G-ROP model. METHODS We applied the G-ROP criteria for premature infants. The infants were classified as three subgroups: SGA, appropriate for gestational age (AGA), and large for gestational age (LGA). The performance of G-ROP criteria was assessed for each group for ROP. RESULTS There were 41 (10.5%) SGA, 312 (80%) AGA, and 37 (9.5%) LGA neonates. Twenty-six (6.7%) neonates were treated for ROP, and the G-ROP model identified all of them. The sensitivity of the model for treatment-requiring ROP (TR-ROP) was found to be 100% in the whole patient group and for each subgroup. The specificity for TR-ROP was 46.4% for the whole group, 50% for SGA, 44% for AGA, and 63.6% for LGA. By applying the G-ROP model, the number of ROP examinations could be reduced by 25% for the whole group, 27% for SGA, 24% for AGA, and 31% for LGA, without missing TR-ROP. CONCLUSIONS The sensitivity and specificity of the G-ROP model for TR-ROP in SGA infants were similar to the whole group. The model did not miss any cases of TR-ROP.
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Affiliation(s)
- Asli Okbay Gunes
- Department of Pediatrics, Division of Neonatology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey.
| | - Sevilay Topcuoglu
- Department of Pediatrics, Division of Neonatology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Gokhan Celik
- Department of Ophthalmology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Osman Kizilay
- Department of Ophthalmology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Muhammed Ali Recai Akyurekli
- Department of Pediatrics, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Pediatrics, Division of Neonatology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Elif Ozalkaya
- Department of Pediatrics, Division of Neonatology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Guner Karatekin
- Department of Pediatrics, Division of Neonatology, Health Sciences University, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Abstract
BACKGROUND Although many improvements in neonatal care have been achieved, mortality rates for sepsis and septic shock in newborns are still high. The vasoactive inotropic score (VIS) was designed and studied to predict mortality in different settings. There are currently no data on the predictive ability of the VIS for mortality in newborn patients with septic shock. METHODS Patients with late-onset neonatal sepsis who required inotropes because of fluid-refractory septic shock during the study period were included in the study. Four distinct VIS values were calculated for each septic shock episode after inotropic treatment had begun, that is, at the initiation of inotropic treatment and at 24 and 48 h after inotropic treatment had begun, and the highest VIS (VISmax) at any time after initiation of inotropic agents. RESULTS The 98 episodes studied were divided into two groups according to the outcomes of their sepsis episodes as survivors (n = 39) or nonsurvivors (n = 59). The areas under the curve of the VIS values for the prediction of mortality were the VISmax (0.819, p < 0.001), followed by the VIS48 (0.802, p < 0.001), VIS24 (0.762, p = 0.001) and VIS0 (0.699, p = 0.015). Patients with a VISmax of greater than 20 had significantly higher odds of mortality (p < 0.001, β = 14.7, 95% confidence interval [4.7-45.9]). CONCLUSION We found that the VISmax was an easy-to-use and helpful tool for predicting a poor outcome in neonatal sepsis. Physicians should be aware that the prognosis is poor for any newborn with a VIS of 20 or greater at any point after the onset of sepsis.
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Affiliation(s)
- Salih Demirhan
- Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Nilgun Karadag
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Elif Ozalkaya
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Guner Karatekin
- Divison of Neonatology, Department of Pediatrics, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Gunes AO, Karadag N, Topcuoglu S, Ozalkaya E, Toptan HH, Dincer E, Cakir H, Karatekin G. Factors Associated with the Transition Time to Full Enteral Feeding in Newborns with Hypoxic Ischemic Encephalopathy. Arch Iran Med 2022; 25:547-551. [PMID: 37543877 DOI: 10.34172/aim.2022.87] [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: 04/16/2021] [Accepted: 08/20/2021] [Indexed: 08/07/2023]
Abstract
BACKGROUND We aimed to assess the factors associated with the transition time to full enteral feeding (FEF) in newborns with hypoxic ischemic encephalopathy (HIE) undergoing therapeutic hypothermia. METHODS We obtained data retrospectively from medical records of the neonates diagnosed with HIE and treated by therapeutic hypothermia to evaluate the factors associated with transition time to FEF. RESULTS Sixty-one neonates were included in the study. The median gestational age (GA) and birth weight were 39 (37-40) weeks and 3245 (2715-3575) grams, respectively. APGAR scores at the first and fifth minutes were 3 (1-5) and 6 (4-7), respectively. Fifty-seven (93.4%) of the newborns were diagnosed as having moderate HIE, and 4 (6.6%) of them had severe HIE. Transition time to FEF was found to be negatively correlated with gestational week (r, P: -0.280, 0.029) and birth weight (r, P: -0.315, 0.013); and positively correlated with lactate (r, P: 0.295, 0.044), BUN (r, P: 0.285, 0.026) and creatinine levels (r,P: 0.345, 0.007); duration of invasive (r, P: 0.565, 0.0001) and non-invasive mechanical ventilation (r, P: 0.261, 0.042), use of antibiotics (r, P: 0.556, 0.0001) and inotropic agents (r, P: 0.524, 0.0001) and hospitalization (r, P: 0.654, 0.0001). CONCLUSION Clinicians should be more careful while starting to feed babies undergoing therapeutic hypothermia with higher lactate levels and impaired renal functions, and should be encouraged to feed clinically stable neonates with HIE as soon as possible, as the transition time to FEF could be related with better clinical outcomes.
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Affiliation(s)
- Asli Okbay Gunes
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Nilgun Karadag
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Sevilay Topcuoglu
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Elif Ozalkaya
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Handan Hakyemez Toptan
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Emre Dincer
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Hakan Cakir
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
| | - Guner Karatekin
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital -Istanbul, Turkey
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Vardar G, Okan MA, Karadag N, Topcuoglu S, Ozalkaya E, Karatepe HO, Karatekin G. Intravenous immunoglobulin in hemolytic disease of the newborn: A moving target in time. Niger J Clin Pract 2022; 25:1262-1268. [DOI: 10.4103/njcp.njcp_1_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gunes AO, Dincer E, Karadag N, Topcuoglu S, Karatekin G. Effects of COVID-19 pandemic on breastfeeding rates in a neonatal intensive care unit. J Perinat Med 2021; 49:500-505. [PMID: 33554582 DOI: 10.1515/jpm-2020-0462] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 10/01/2020] [Accepted: 12/16/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To find out if the expressed breast milk delivery rate to neonatal intensive care unit (NICU) for babies who were hospitalized for any reason other than COVID-19, and exclusive breastfeeding (EB) rates between discharge date and 30th day of life of those babies were affected by COVID-19 pandemic. METHODS Babies who were hospitalized before the date first coronavirus case was detected in our country were included as control group (CG). The study group was divided into two groups; study group 1 (SG1): the mothers whose babies were hospitalized in the period when mother were asked not to bring breast milk to NICU, study group 2 (SG2): the mothers whose babies were hospitalized after the date we started to use the informed consent form for feeding options. The breast milk delivery rates to NICU during hospitalization and EB rates between discharge and 30th day of life were compared between groups. RESULTS Among 154 mother-baby dyads (CG, n=50; SG1, n=46; SG2, n=58), the percentage of breast milk delivery to NICU was 100%, 79% for CG, SG2, respectively (p<0.001). The EB rate between discharge and 30th day of life did not change between groups (CG:90%, SG1:89%, SG2:75.9; p=0.075). CONCLUSIONS If the mothers are informed about the importance of breast milk, the EB rates are not affected by the COVID-19 pandemic in short term, even if the mothers are obligatorily separated from their babies. The breast milk intake rate of the babies was lowest while our NICU protocol was uncertain, and after we prepared a protocol this rate increased.
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Affiliation(s)
- Asli Okbay Gunes
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Emre Dincer
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Nilgun Karadag
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Guner Karatekin
- Department of Neonatology, University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Akar S, Topcuoglu S, Tuten A, Ozalkaya E, Karatepe HO, Gokmen T, Ovali F, Karatekin G. Is the First Postnatal Platelet Mass as an Indicator of Patent Ductus Arteriosus? Arch Iran Med 2019; 22:687-691. [PMID: 31823619] [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] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 07/07/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND The aim of this study is to evaluate whether there is an association between the platelet mass and patent ductus arteriosus (PDA) closure in premature newborns. METHODS Preterm infants (gestational age ≤33 weeks) with hemodynamically significant PDA (group 1, n = 178) and a control group of preterm infants without PDA (group 2, n = 211) were retrospectively evaluated between August 1, 2013 and July 30, 2015 in the neonatal intensive care unit (NICU). Platelet counts and platelet indices including mean platelet volume (MPV), and platelet mass (platelet count x mean platelet volume) in the first 24 hours of life, demographic findings and morbidities were recorded. RESULTS No differences were observed in demographic findings between the study groups in terms of birth weight, gestational age, gender and maternal risk factors. The mean platelet count in the first postnatal hemogram in group 1 and group 2 were 189.43 ± 72.14 (X103 /mm3) and 206.86 ± 70.11(X103/mm3), respectively (P < 0.05). The MPV were similar in both groups (P > 0.05). Platelet mass values were 1443.70 ± 572.40 fL/nL in Group 1 and 1669.49 ± 1200.42 fL/nL in group 2. There was a statistically significant difference in platelet mass values between the two groups (P = 0.011). Multivariable analysis including presence of thrombocytopenia, MPV and platelet mass showed that hemodynamically significant PDA was not independently associated with platelet count <150 000 (OR = 1.001, 95% CI 0.980-1.023; P = 0.921), MPV (OR = 0.967, 95% CI 0.587-1.596; P = 0.897) or platelet mass (OR = 0.999, 95% CI 0.997-1.002; P = 0.681). The optimal cut-off value of platelet mass for patients with PDA was ≤1530.8 fL/nL (area under the curve [AUC]: 0.580), with sensitivity of 58% and specificity of 56.2% (P = 0.008). CONCLUSION Our data suggest that platelet count, MPV, and platelet mass do not contribute to closure of PDA in premature newborns.
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Affiliation(s)
- Selahattin Akar
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Abdulhamid Tuten
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Elif Ozalkaya
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Hande Ozgun Karatepe
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Tulin Gokmen
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Fahri Ovali
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Guner Karatekin
- Division of Neonatology, Department of Pediatrics, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Igde M, Baran P, Oksuz BG, Topcuoglu S, Karatekin G. Association between the oxidative status, Vitamin D levels and respiratory function in asthmatic children. Niger J Clin Pract 2018; 21:63-68. [PMID: 29411726 DOI: 10.4103/njcp.njcp_373_16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM We studied the relationship between plasma concentrations of oxidative system markers, vitamin D, and respiratory functions in children with asthma. MATERIALS AND METHODS Ninety one children aged 6-17 years with stable asthma seen in the clinic had the serum concentrations of oxidative system markers [total antioxidant capacity (TAC), total oxidative status (TOS), paraoxonase-1 activity (PON-1), and 25-hydroxyvitamin D3] and respiratory functions were measured. RESULTS There was no statistical correlation between TAC and age and FEV1. There was a significant positive correlation between TAC and 25(OH)D3 (r = 0.214, P = 0.021), TAC and TOS (r = 0.218, P = 0.007), TAC and PON-1 (r = 0.230, P = 0.028), TAC and IgE (r = 0.194, P = 0.033), and inverse correlation between TAC and PEF (r = -0.208, P = 0.024). In the backward multiple regression analysis, 25(OH)D3 (t = 2.613, P = 0.011), age (t = -2.158, P = 0.034), TOS (t = 2.158, P = 0.000), and OSI index (t = -13.859 P = 0.000) maintained an independent relationship with TAC (r = 0.858, r2 = 0.737, F = 21.436, P = 0.000). CONCLUSION Oxidative stress correlates with the serum vitamin D concentrations. Clinical trials are required to confirm that increasing serum 25OHD may improve asthma control, as measured by clinical and oxidative stress markers.
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Affiliation(s)
- M Igde
- Department of Pediatric Allergy and Immunology, Samsun Training and Research Hospital, Samsun, Turkey
| | - P Baran
- Department of Biochemistry, Ankara Atatürk Training and Research Hospital, Ankara, Turkey
| | - B G Oksuz
- Department of Pediatrics, Samsun Training and Research Hospital, Samsun, Turkey
| | - S Topcuoglu
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - G Karatekin
- University of Health Sciences, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Özalkaya E, Topcuoglu S, Karatepe H, Tüten A, Gokmen T, Karatekin G. Efficacy of levetiracetam in premature infants: our experience and review of the literature. J Matern Fetal Neonatal Med 2018; 32:4093-4096. [PMID: 29804480 DOI: 10.1080/14767058.2018.1481946] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objective: To evaluate levetiracetam (LEV) efficacy in preterm infants admitted in NICU.Study design: Clinical characteristics of 26 preterm infants treated with LEV were evaluated retrospectively. The results were compared with those of 44 preterm infants from the literature who were given LEV.Result: The mean gestational week of the infants receiving LEV was found as 26.7 ± 3.3 weeks, mean birth weight as 938 ± 561 g and mean dose of LEV as 17 ± 9.23 mg/kg. Overall seizure control rate with LEV was found as 65%, while seizure control was achieved by 11.5% when it was used as the first drug, 35% as the second drug and 15.3% as the third drug. The incidence of sepsis and intraventricular hemorrhage in seizure etiology was 73% in infants who received LEV. There was no side effect observed during LEV treatment.Conclusions: Seizure control was better achieved with LEV given as the 2nd antiepileptic in premature infants. Further studies with randomization of LEV and other antiepileptics in seizure control are needed.
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Affiliation(s)
- Elif Özalkaya
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Sevilay Topcuoglu
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Hande Karatepe
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Abdülhamit Tüten
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
| | - Tulin Gokmen
- Zekai Tahir Burak Maternity Teaching Hospital, Ankara, Turkey
| | - Guner Karatekin
- Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
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Tuten A, Dincer E, Topcuoglu S, Sancak S, Akar S, Hakyemez Toptan H, Özalkaya E, Gokmen T, Ovalı F, Karatekin G. Serum lactate levels and perfusion index: are these prognostic factors on mortality and morbidity in very low-birth weight infants? J Matern Fetal Neonatal Med 2016; 30:1092-1095. [DOI: 10.1080/14767058.2016.1205019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Topcuoglu S, Kolsuz LD, Gursoy T, Ovali F, Karatekin G. Effects of preeclampsia on the amplitude integrated electroencephalography activity in preterm infants. J Perinat Med 2016; 44:345-9. [PMID: 26352066 DOI: 10.1515/jpm-2015-0096] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/17/2015] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Preeclampsia leads to chronic intrauterine hypoxia by interfering with placental blood supply. The aim of this study was to investigate whether preeclampsia exposure has an influence on the central nervous system of infants, as monitored by amplitude integrated electroencephalography (aEEG). METHODS We recruited 52 infants with gestational age between 30 and 34 weeks. Twenty-seven infants were born to preeclamptic mothers, and 25 gestational age-matched infants whose mothers were healthy were enrolled as a control group. aEEG recordings were performed between 24 and 48 h of life using a cerebral function monitor (CFM) (Olympic Brainz monitor). Along with aEEG, middle cerebral artery (MCA) blood flow velocities (BFV) were measured using Doppler ultrasound. RESULTS The duration of quiet sleep was significantly shorter (P=0.001), and Burdjalov score was lower (P=0.04) in the preeclampsia group. However, there was no change in MCA BFV in this group. CONCLUSIONS Preeclampsia altered cerebral electrical activity of premature infants born to preeclamptic mothers.
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Arman D, Sancak S, Topcuoglu S, Karatekin G. New findings in fetal valproate syndrome: hiatal hernia, gastric volvulus and ectopic kidney. J OBSTET GYNAECOL 2016; 36:767-768. [PMID: 27012229 DOI: 10.3109/01443615.2016.1159668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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]
Affiliation(s)
- Didem Arman
- a Department of Neonatal Intensive Care , Ordu University Research and Training Hospital , Ordu , Turkey
| | - Selim Sancak
- b Department of Neonatal Intensive Care , Abant İzzet Baysal University Research and Training Hospital , Bolu , Turkey , and
| | - Sevilay Topcuoglu
- c Department of Neonatal Intensive Care , Zeynep Kamil Maternity and Children's Research and Training Hospital , Istanbul , Turkey
| | - Güner Karatekin
- c Department of Neonatal Intensive Care , Zeynep Kamil Maternity and Children's Research and Training Hospital , Istanbul , Turkey
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Akar S, Karadag N, Gokmen Yildirim T, Toptan HH, Dincer E, Tuten A, Yavuz T, Topcuoglu S, Karatepe HO, Ozalkaya E, Karatekin G, Ovali F. Does platelet mass influence the effectiveness of ibuprofen treatment for patent ductus arteriosus in preterm infants? J Matern Fetal Neonatal Med 2016; 29:3786-9. [DOI: 10.3109/14767058.2016.1145207] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [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]
Affiliation(s)
| | | | | | | | | | | | - Taner Yavuz
- Department of Pediatrics, Zeynep Kamil Maternity and Children Research and Training Hospital, İstanbul, Turkey
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Topcuoglu S, Arslanbuga C, Gursoy T, Aktas A, Karatekin G, Uluhan R, Ovali F. Role of presepsin in the diagnosis of late-onset neonatal sepsis in preterm infants. J Matern Fetal Neonatal Med 2015; 29:1834-9. [PMID: 26135765 DOI: 10.3109/14767058.2015.1064885] [Citation(s) in RCA: 16] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE One of the most challenging aspects in the management of neonates with late-onset neonatal sepsis (LOS) is to make the diagnosis. Presepsin is a novel and promising marker of sepsis. The aim of this study was to assess the role of presepsin in the diagnosis of LOS in preterm infants. METHODS Forty-two premature newborns ≤32 weeks gestational age with a diagnosis of LOS were prospectively involved in the study. Forty gestational and postnatal age-matched infants without sepsis served as controls. Levels of presepsin, C-reactive protein, and procalcitonin were measured at enrollment and on the third and seventh days of sepsis. RESULTS Initial presepsin levels in the LOS group were significantly higher than in the control group (1024 pg/mL, min-max: 295-8202; versus 530 pg/mL, min-max: 190-782; p < 0.0001). The area under the receiver-operating curve for presepsin was 0.864. A presepsin value of 800.5 pg/mL was established as a cut-off value, with 67% sensitivity and 100% specificity. Presepsin levels gradually decreased during treatment. CONCLUSION Presepsin can be used as a reliable biomarker for LOS and treatment response in preterm infants. However, we could not demonstrate the efficacy of presepsin for the detection of disease severity or prognosis.
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Affiliation(s)
- Sevilay Topcuoglu
- a Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Cansev Arslanbuga
- b Department of Microbiology , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey , and
| | - Tugba Gursoy
- c School of Medicine, Koc University , Istanbul , Turkey
| | - Alev Aktas
- a Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Guner Karatekin
- a Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Ramazan Uluhan
- b Department of Microbiology , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey , and
| | - Fahri Ovali
- a Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
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Sancak S, Arman D, Gursoy T, Topcuoglu S, Karatekin G, Ovalı F. Intestinal blood flow by Doppler ultrasound: the impact of clarithromycin treatment for feeding intolerance in preterm neonates. J Matern Fetal Neonatal Med 2015; 29:1853-6. [PMID: 26135789 DOI: 10.3109/14767058.2015.1066327] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To compare the blood flow velocities of superior mesenteric artery (SMA) before versus after clarithromycin treatment for feeding intolerance in very low-birth weight infants. METHODS A prospective study was conducted in a group of infant <1500 g with feeding intolerance who received clarithromycin 7.5 mg/kg/dose bid. Before and at the third day of the clarithromycin therapy, SMA blood flow velocity was measured with Doppler ultrasound. RESULTS SMA peak systolic velocity (PSV) and mean systolic velocity (MV) on the third day of the treatment was found significantly higher than the initial measurement (p = 0.013 and p = 0.027, respectively). End diastolic velocity of the SMA did not change with clarithromycin therapy (p = 0.113). There were no significant changes about pulsatility and resistive index of SMA with regard to clarithromycin therapy. CONCLUSION Clarithromycin effects the splanchnic circulation. The rise in PSV and MV in SMA is remarkable. These results suggest that the splanchnic blood flow increases significantly after clarithromycin usage.
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Affiliation(s)
- Selim Sancak
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Didem Arman
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Tugba Gursoy
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Sevilay Topcuoglu
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Guner Karatekin
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
| | - Fahri Ovalı
- a Department of Neonatal Intensive Care Unit , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
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Topcuoglu S, Karatekin G, Yavuz T, Arman D, Kaya A, Gursoy T, Ovalı F. The relationship between the oxidative stress and the cardiac hypertrophy in infants of diabetic mothers. Diabetes Res Clin Pract 2015; 109:104-9. [PMID: 25934526 DOI: 10.1016/j.diabres.2015.04.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 03/23/2015] [Accepted: 04/15/2015] [Indexed: 11/23/2022]
Abstract
Recently, oxidative stress was suggested to play a role in maternal and fetal complications of diabetic pregnancies. The aim of this study is to evaluate the global oxidant and antioxidant status in infants of diabetic mothers (IDM) via measurement of total antioxidant capacity (TAC) and total oxidant status (TOS) and to determine their association with the clinical and cardiac manifestations of gestational diabetes on infants. Forty five infants constituted the IDM group, 51 infants born to non diabetic mothers served as the control group. Umbilical cord blood was drawn from IDM and controls for TAC and TOS measurement. Echocardiographic measurements were performed in the first three days of life. Infants of diabetic mother had significantly higher TAC (p=0.024), TOS (p=0.03) and oxidative stress index (OSI, p=0.04) levels compared to controls. Hemoglobin values were correlated to TOS (r=0.310, p=0.03) and OSI (r=0.310, p=0.03). Maternal HbA1c values were also correlated to TOS (r=0.576, p=0.001) and OSI (r=0.606, p<0.001). Systolic and diastolic interventicular septum measurements, and left ventricular mass were also correlated with TOS (r=0.330, p=0.02; r=0.453, p=0.002; r=0.404, p=0.006, respectively) and OSI (r=0.330, p=0.02; r=0.300, p=0.04, r=0.300; p=0.04, respectively). Oxidant-antioxidant balance is disturbed in favor of oxidants in IDM despite compensatory increase in TAC. The degree of oxidative stress is related to the severity of myocardial and hematological involvement in IDM in the first days of life and maternal glycemic control.
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Affiliation(s)
- Sevilay Topcuoglu
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey.
| | - Guner Karatekin
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Taner Yavuz
- Pediatric Cardiology, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Didem Arman
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Ayşem Kaya
- Section of Biochemistry, Institute of Cardiology, Istanbul University, Istanbul, Turkey
| | - Tugba Gursoy
- Koc University, School of Medicine, Istanbul, Turkey
| | - Fahri Ovalı
- Neonatal Intensive Care Unit, Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Kolsuz LD, Topcuoglu S, Gursoy T, Karatekin G, Ovali HF. Amplitude-integrated electroencephalographic activity and middle cerebral artery Doppler flow measurements in preterm small for gestational age infants. J Child Neurol 2015; 30:412-6. [PMID: 25296921 DOI: 10.1177/0883073814549996] [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: 05/28/2014] [Accepted: 08/07/2014] [Indexed: 11/16/2022]
Abstract
Amplitude-integrated encephalography (EEG) is frequently used in neonatal intensive care units to monitor brain functions. Its bedside application and easy interpretation are the most important features. Brain development of small for gestational age infants can be affected by intrauterine chronic hypoxia. The current study aimed to evaluate cerebral functions of small for gestational age infants by means of amplitude-integrated EEG. Thirty- to 34-week-old 22 small for gestational age and 27 appropriate for gestational age preterm infants were included in the study. The mode of delivery, gender, birth weight, and Apgar scores of the patients were recorded. Following middle cerebral artery mean velocity measurement with cranial Doppler at the 24th hour of birth, an amplitude-integrated EEG recording was performed on all infants, for a period of 4 to 24 hours. Small for gestational age infants had significantly higher middle cerebral artery mean velocity than appropriate for gestational age infants (21.09 ± 4.25 vs 17.8 ± 4.07; P = .029). The amplitude-integrated EEG recordings showed lower "lower border of quiet sleep" and total Burdjalov score in small for gestational age infants when compared with appropriate for gestational age infants (2.5 [1-3.25] µV vs 3 [2.75-4] µV; P = .04, 8 [6-10], 9 [9-11]; P = .04, respectively). Increased middle cerebral artery blood flow observed in small for gestational age infants might be a marker of chronic intrauterine hypoxia to which these infants were exposed. These infants demonstrated a more immature pattern of amplitude-integrated EEG.
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Affiliation(s)
- Leyla Daban Kolsuz
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Sevilay Topcuoglu
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Tugba Gursoy
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - Güner Karatekin
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
| | - H Fahri Ovali
- Zeynep Kamil Maternity and Children's Training and Research Hospital, Istanbul, Turkey
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Sancak S, Gokmen Yildirim T, Topcuoglu S, Yavuz T, Karatekin G, Ovali F. Oral versus intravenous paracetamol: which is better in closure of patent ductus arteriosus in very low birth weight infants? J Matern Fetal Neonatal Med 2014; 29:135-9. [PMID: 25471090 DOI: 10.3109/14767058.2014.989829] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
OBJECTIVES To compare the efficacy of oral and intravenous paracetamol for closure of hemodynamically significant patent ductus arteriosus (HSPDA) in very low birth weight (VLBW) preterm infants. METHODS Eighteen VLBW infants with HSPDA treated with either intravenous (n = 10) or oral (n = 8) paracetamol at 60 mg/kg/d for three consecutive days were analysed retrospectively. Ductal closure rate and evaluation of liver function tests were the major outcomes. RESULTS After two courses of treatment, HSPDA closure rate was higher in oral paracetamol group than that in the intravenous paracetamol group (88% versus 70%), but it was not statistically significant (p = 0.588). Liver function tests were normal after the treatment. CONCLUSION Although it was not statistically significant, the cumulative closure rates were higher in oral paracetamol group than those in the intravenous group. Larger trials are needed to confirm these data.
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Affiliation(s)
| | | | | | - Taner Yavuz
- b Department of Pediatric Cardiology , Zeynep Kamil Maternity and Children's Training and Research Hospital , Istanbul , Turkey
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Topcuoglu S, Gursoy T, Ovalı F, Serce O, Karatekin G. A new risk factor for neonatal vancomycin-resistant Enterococcus colonisation: bacterial probiotics. J Matern Fetal Neonatal Med 2014; 28:1491-4. [DOI: 10.3109/14767058.2014.958462] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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