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[PMID]: 28370090
[Au] Autor:Sanyal AJ; Boyer TD; Frederick RT; Wong F; Rossaro L; Araya V; Vargas HE; Reddy KR; Pappas SC; Teuber P; Escalante S; Jamil K
[Ad] Address:Department of Medicine, Virginia Commonwealth University, Richmond, VA, USA.
[Ti] Title:Reversal of hepatorenal syndrome type 1 with terlipressin plus albumin vs. placebo plus albumin in a pooled analysis of the OT-0401 and REVERSE randomised clinical studies.
[So] Source:Aliment Pharmacol Ther;45(11):1390-1402, 2017 Jun.
[Is] ISSN:1365-2036
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: The goal of hepatorenal syndrome type 1 (HRS-1) treatment is to improve renal function. Terlipressin, a synthetic vasopressin analogue, is a systemic vasoconstrictor used for the treatment of HRS-1, where it is available. AIM: To compare the efficacy of terlipressin plus albumin vs. placebo plus albumin in patients with HRS-1. METHODS: Pooled patient-level data from two large phase 3, randomised, placebo-controlled studies were analysed for HRS reversal [serum creatinine (SCr) value ≤133 µmol/L], 90-day survival, need for renal replacement therapy and predictors of HRS reversal. Patients received intravenous terlipressin 1-2 mg every 6 hours plus albumin or placebo plus albumin up to 14 days. RESULTS: The pooled analysis comprised 308 patients (terlipressin: n = 153; placebo: n = 155). HRS reversal was significantly more frequent with terlipressin vs. placebo (27% vs. 14%; P = 0.004). Terlipressin was associated with a more significant improvement in renal function from baseline until end of treatment, with a mean between-group difference in SCr concentration of -53.0 µmol/L (P < 0.0001). Lower SCr, lower mean arterial pressure and lower total bilirubin and absence of known precipitating factors for HRS were independent predictors of HRS reversal and longer survival in terlipressin-treated patients. CONCLUSIONS: Terlipressin plus albumin resulted in a significantly higher rate of HRS reversal vs. albumin alone in patients with HRS-1. Terlipressin treatment is associated with improved renal function. (ClinicalTrials.gov identifier: OT-0401, NCT00089570; REVERSE, NCT01143246).
[Mh] MeSH terms primary: Albumins/therapeutic use
Hepatorenal Syndrome/drug therapy
Lypressin/analogs & derivatives
Vasoconstrictor Agents/therapeutic use
[Mh] MeSH terms secundary: Adult
Clinical Trials, Phase III as Topic
Drug Therapy, Combination
Female
Humans
Lypressin/therapeutic use
Male
Middle Aged
Randomized Controlled Trials as Topic
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS
[Nm] Name of substance:0 (Albumins); 0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1709
[Cu] Class update date: 170904
[Lr] Last revision date:170904
[Js] Journal subset:IM
[Da] Date of entry for processing:170404
[St] Status:MEDLINE
[do] DOI:10.1111/apt.14052

  2 / 1395 MEDLINE  
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[PMID]: 28161219
[Au] Autor:Ragot C; Gerbaud E; Boyer A
[Ad] Address:Service de Réanimation Médicale, CHU Bordeaux, Bordeaux, France.
[Ti] Title:Terlipressin in refractory shock induced by diltiazem poisoning.
[So] Source:Am J Emerg Med;35(7):1032.e1-1032.e2, 2017 Jul.
[Is] ISSN:1532-8171
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Poisoning caused by calcium-channels blockers (CCB) can cause refractory vasoplegic shock, resulting in multiple-organ failure and death despite maximal therapy including high doses of vasopressors. We report one CCB-induced refractory shock complicated with lactate acidosis despite very high doses of epinephrine and norepinephrine. The hemodynamic status of the patient dramatically improved after intermittent boluses of terlipressin, which corrected the acidosis.
[Mh] MeSH terms primary: Calcium Channel Blockers/poisoning
Critical Care
Diltiazem/poisoning
Drug Overdose/drug therapy
Lypressin/analogs & derivatives
Multiple Organ Failure/chemically induced
Vasoconstrictor Agents/therapeutic use
[Mh] MeSH terms secundary: Diltiazem/therapeutic use
Drug Overdose/complications
Female
Humans
Lypressin/therapeutic use
Middle Aged
Multiple Organ Failure/drug therapy
Treatment Outcome
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Calcium Channel Blockers); 0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin); EE92BBP03H (Diltiazem)
[Em] Entry month:1710
[Cu] Class update date: 171004
[Lr] Last revision date:171004
[Js] Journal subset:IM
[Da] Date of entry for processing:170206
[St] Status:MEDLINE

  3 / 1395 MEDLINE  
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[PMID]: 28052382
[Au] Autor:Gifford FJ; Morling JR; Fallowfield JA
[Ad] Address:Department of Hepatology, Royal Infirmary of Edinburgh, Edinburgh, UK.
[Ti] Title:Systematic review with meta-analysis: vasoactive drugs for the treatment of hepatorenal syndrome type 1.
[So] Source:Aliment Pharmacol Ther;45(5):593-603, 2017 Mar.
[Is] ISSN:1365-2036
[Cp] Country of publication:England
[La] Language:eng
[Ab] Abstract:BACKGROUND: Hepatorenal syndrome type 1 (HRS1) is a functional, rapidly progressive, potentially reversible form of acute kidney injury occurring in patients with cirrhosis. Characterised by intense renal arterial vasoconstriction, it carries a very poor prognosis. There is a significant unmet need for a widely approved, safe and effective pharmacological treatment. AIM: To re-evaluate efficacy and safety of pharmacological treatments for HRS1, in the light of recently published randomised controlled trials (RCTs). METHODS: MEDLINE (OvidSP), EMBASE, PubMed and Cochrane registers were searched for RCTs reporting efficacy and adverse events related to pharmacological treatment of HRS1. Search terms included: 'hepatorenal syndrome', 'terlipressin', 'noradrenaline', 'octreotide', 'midodrine', 'vasopressin', 'dopamine', 'albumin' and synonyms. Comparison of vasoactive drugs vs. placebo/no treatment, and two active drugs were included. Meta-analysis was performed for HRS1 reversal, creatinine improvement, mortality and adverse events. RESULTS: Twelve RCTs enrolling 700 HRS1 patients were included. Treatment with terlipressin and albumin led to HRS1 reversal more frequently than albumin alone or placebo (RR: 2.54, 95% CI: 1.51-4.26). Noradrenaline was effective in reversing HRS1, but trials were small and nonblinded. Overall, there was mortality benefit with terlipressin (RR: 0.79, 95% CI: 0.63-1.01), but sensitivity analysis including only trials with low risk of selection bias weakened this relationship (RR: 0.87, 95% CI: 0.71-1.06). Notably, there was a significant risk of adverse events with terlipressin therapy (RR: 4.32, 95% CI: 0.75-24.86). CONCLUSIONS: Terlipressin treatment is superior to placebo for achieving HRS1 reversal, but mortality benefit is less clear. Terlipressin is associated with significant adverse events, but infusion regimens may be better tolerated. There is continued need for safe and effective treatment options for hepatorenal syndrome.
[Mh] MeSH terms primary: Hepatorenal Syndrome/drug therapy
Liver Cirrhosis/drug therapy
Vasoconstrictor Agents/therapeutic use
[Mh] MeSH terms secundary: Albumins/therapeutic use
Creatinine/metabolism
Humans
Lypressin/analogs & derivatives
Lypressin/therapeutic use
Prognosis
Randomized Controlled Trials as Topic
Treatment Outcome
[Pt] Publication type:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Nm] Name of substance:0 (Albumins); 0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin); AYI8EX34EU (Creatinine)
[Em] Entry month:1708
[Cu] Class update date: 170922
[Lr] Last revision date:170922
[Js] Journal subset:IM
[Da] Date of entry for processing:170105
[St] Status:MEDLINE
[do] DOI:10.1111/apt.13912

  4 / 1395 MEDLINE  
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[PMID]: 27766555
[Au] Autor:Michel J; Hofbeck M; Spiller G; Renk H; Kumpf M; Neunhoeffer F
[Ad] Address:Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital, Hoppe-Seyler-Str. 1, 72076, Tuebingen, Germany. joerg.michel@med.uni-tuebingen.de.
[Ti] Title:Safety and Efficacy of Terlipressin in Pediatric Distributive Shock: A Retrospective Analysis in 20 Children.
[So] Source:Paediatr Drugs;19(1):35-41, 2017 Feb.
[Is] ISSN:1179-2019
[Cp] Country of publication:Switzerland
[La] Language:eng
[Ab] Abstract:INTRODUCTION: Data are still lacking about the use of terlipressin or vasopressin in the treatment of pediatric patients who are in a state of therapy-refractory shock. OBJECTIVE: The aim of this study was to evaluate the effect of terlipressin on hemodynamics in children with distributive shock and to describe any severe side effects. METHODS: Consecutive patients (n = 20) with catecholamine-resistant distributive shock who were treated with terlipressin were retrospectively enrolled in this study. We analyzed response in terms of mean arterial blood pressure, heart rate, vasoactive inotropic score (VIS), urinary output, and serum lactate. RESULTS: The hemodynamics of 12 children significantly improved within 6 h of commencing terlipressin (mean blood pressure increase of ≥20 % without VIS increase, or mean blood pressure increase of ≥10 % with VIS decrease of ≥10 %). The hemodynamics of eight patients did not improve, regardless of treatment dosage or duration. More children died in the responders group (n = 7 [58.3 %]) than in the non-responders group (n = 2 [25.0 %]), but this was not statistically significant. Two patients (one in each group) who received high dosages of terlipressin developed rhabdomyolysis. One case of Takotsubo cardiomyopathy was observed, which could be related to terlipressin. CONCLUSIONS: Although treatment with terlipressin resulted in rapid positive hemodynamic responses in some children, it did not seem to have a positive effect in other pediatric patients. Therefore, the possible benefits of terlipressin should be always weighed against potential severe adverse effects.
[Mh] MeSH terms primary: Lypressin/analogs & derivatives
Shock/drug therapy
Vasoconstrictor Agents/therapeutic use
[Mh] MeSH terms secundary: Adolescent
Catecholamines/therapeutic use
Child
Child, Preschool
Female
Heart Rate/drug effects
Hemodynamics
Humans
Hypotension/drug therapy
Hypotension/physiopathology
Infant
Infant, Newborn
Lypressin/adverse effects
Lypressin/therapeutic use
Male
Retrospective Studies
Shock/physiopathology
Systemic Inflammatory Response Syndrome/drug therapy
Systemic Inflammatory Response Syndrome/physiopathology
Treatment Failure
Vasoconstrictor Agents/adverse effects
Young Adult
[Pt] Publication type:JOURNAL ARTICLE
[Nm] Name of substance:0 (Catecholamines); 0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1704
[Cu] Class update date: 171113
[Lr] Last revision date:171113
[Js] Journal subset:IM
[Da] Date of entry for processing:161022
[St] Status:MEDLINE
[do] DOI:10.1007/s40272-016-0199-8

  5 / 1395 MEDLINE  
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[PMID]: 27464593
[Au] Autor:Wong F; Pappas SC; Boyer TD; Sanyal AJ; Bajaj JS; Escalante S; Jamil K; REVERSE Investigators
[Ad] Address:Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: florence.wong@utoronto.ca.
[Ti] Title:Terlipressin Improves Renal Function and Reverses Hepatorenal Syndrome in Patients With Systemic Inflammatory Response Syndrome.
[So] Source:Clin Gastroenterol Hepatol;15(2):266-272.e1, 2017 02.
[Is] ISSN:1542-7714
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:BACKGROUND & AIMS: Patients with systemic inflammatory response syndrome (SIRS) along with decompensated cirrhosis and renal dysfunction have a poor prognosis and a lower response to treatment. We evaluated the effect of SIRS on the response of hepatorenal syndrome type 1 (HRS-1) to terlipressin. METHODS: We performed a retrospective study of data from a trial of the effects of terlipressin (1 mg every 6 hours or placebo with concomitant albumin) in 198 patients with HRS-1, performed at 50 investigational sites in the United States and 2 in Canada from October 2010 through February 2013. We identified patients with 2 or more criteria for SIRS, without untreated infections (28 received terlipressin and 30 received placebo), and patients with less than 2 criteria for SIRS (control subjects). Primary endpoints included HRS reversal (a decrease in serum level of creatinine to ≤1.5 mg/dL), confirmed HRS reversal (defined as 2 serum creatinine levels ≤1.5 mg/dL, ≥ 48 hours apart), and survival for 90 days after treatment. RESULTS: Baseline characteristics were similar between groups, apart from slightly higher white blood cell counts and heart rates, and slightly lower serum levels of bicarbonate in patients with SIRS versus without SIRS. HRS was reversed in 42.9% of patients who received terlipressin with SIRS (12/28) versus 6.7% of patients who received placebo (2/30) (P = .0018); confirmed HRS reversal occurred in 32.1% of patients who received terlipressin with SIRS (9/28) versus 3.3% who received placebo (1/30) (P = .0048). A larger proportion of patients with SIRS who received terlipressin survived for 90 days without a transplant (13/28; 46.4%) than patients with SIRS who received placebo (7/30; 23.3%) (P = .076). CONCLUSIONS: In an analysis of data from a placebo-controlled study, we found that terlipressin improved renal function and reversed HRS in a higher proportion of patients with HRS-1 and SIRS than patients who received albumin plus placebo. ClincialTrials.gov, number NCT 01143246.
[Mh] MeSH terms primary: Hepatorenal Syndrome/drug therapy
Lypressin/analogs & derivatives
Systemic Inflammatory Response Syndrome/drug therapy
Vasoconstrictor Agents/therapeutic use
[Mh] MeSH terms secundary: Aged
Canada
Female
Hepatorenal Syndrome/complications
Humans
Lypressin/therapeutic use
Male
Middle Aged
Placebos/administration & dosage
Retrospective Studies
Survival Analysis
Systemic Inflammatory Response Syndrome/complications
Treatment Outcome
United States
[Pt] Publication type:CONTROLLED CLINICAL TRIAL; JOURNAL ARTICLE; MULTICENTER STUDY; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Name of substance:0 (Placebos); 0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1709
[Cu] Class update date: 171113
[Lr] Last revision date:171113
[Js] Journal subset:IM
[Da] Date of entry for processing:160729
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE

  6 / 1395 MEDLINE  
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[PMID]: 28868464
[Au] Autor:Fernandes SR; Baldaia C; Gonçalves AR
[Ad] Address:Gastroenterology and Hepatology Department, Hospital Santa Maria, Centro Hospitalar de Lisboa Norte, Lisbon, Portugal.
[Ti] Title:Genital Ischemia in a Patient Under Terlipressin Therapy.
[So] Source:GE Port J Gastroenterol;23(4):224-225, 2016 Jul-Aug.
[Is] ISSN:2341-4545
[Cp] Country of publication:Switzerland
[La] Language:eng
[Pt] Publication type:JOURNAL ARTICLE
[Em] Entry month:1709
[Cu] Class update date: 170907
[Lr] Last revision date:170907
[St] Status:PubMed-not-MEDLINE
[do] DOI:10.1016/j.jpge.2015.11.001

  7 / 1395 MEDLINE  
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[PMID]: 27932181
[Au] Autor:Won YJ; Lim BG; Chung D; Park E; Kim H; Lee IO; Kong MH
[Ad] Address:Department of Anesthesiology and Pain Medicine, Korea University Guro Hospital, Korea University College of Medicine, Seoul, Korea.
[Ti] Title:Use of Terlipressin in an Elderly Patient With Moderate Aortic Valve Stenosis Accompanied by Episodic Atrial Fibrillation During Liver Transplantation: A Case Report.
[So] Source:Transplant Proc;48(9):3203-3206, 2016 Nov.
[Is] ISSN:1873-2623
[Cp] Country of publication:United States
[La] Language:eng
[Ab] Abstract:Anesthesia for patients with moderate aortic stenosis accompanied by atrial fibrillation during high-risk surgery such as liver transplantation remains a challenge in maintaining control of heart rate and maintenance of cardiac output. The action of terlipressin on vasopressin receptors (mainly V1 receptors) leads to splanchnic vasoconstriction and is the key mechanism responsible for increasing systemic vascular resistance and reducing heart rate. We report successful anesthetic management using low-dose terlipressin infusion in an elderly patient who had moderate aortic stenosis with atrial fibrillation during urgent deceased-donor liver transplantation.
[Mh] MeSH terms primary: Anesthetics/therapeutic use
Aortic Valve Stenosis/complications
Atrial Fibrillation/complications
Liver Transplantation/methods
Lypressin/analogs & derivatives
[Mh] MeSH terms secundary: Aged
Female
Humans
Lypressin/therapeutic use
Male
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Anesthetics); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1704
[Cu] Class update date: 170817
[Lr] Last revision date:170817
[Js] Journal subset:IM
[Da] Date of entry for processing:161210
[St] Status:MEDLINE

  8 / 1395 MEDLINE  
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[PMID]: 27871159
[Au] Autor:Kim SM; Song IH
[Ad] Address:Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Korea.
[Ti] Title:[Acute Kidney Injury in Cirrhotic Patients with Portal Hypertension].
[So] Source:Korean J Gastroenterol;68(5):237-244, 2016 Nov 25.
[Is] ISSN:2233-6869
[Cp] Country of publication:Korea (South)
[La] Language:kor
[Ab] Abstract:Acute kidney injury (AKI) is one of the most common manifestations encountered in clinical practice. It is associated with high morbidity and mortality in cirrhotic pre- and post-transplantation patients. Hepatorenal syndrome (HRS), a special form of AKI in cirrhotic patients, was recognized as a consequence of renal vasoconstriction from systemic/renal hemodynamic alterations developed in advanced cirrhosis with portal hypertension. Recently, multiple factors-such as infection/inflammation, underlying glomerulonephritis, bile cast, or increased abdominal pressure-have been considered to contribute to renal dysfunction in cirrhotic patients, which were presumed to induce HRS. Moreover, in addition to changing the definition of AKI in the nephrologic guidelines, the new AKI definition for early diagnosis and intervention based on characteristics of liver cirrhosis has been proposed in an international meeting. This article provides a comprehensive and recent review of AKI definition, laying out the topics in accordance with the pathophysiologic mechanisms and therapeutic interventions of AKI in cirrhotic patients with portal hypertension.
[Mh] MeSH terms primary: Acute Kidney Injury/diagnosis
Hypertension, Portal/pathology
Liver Cirrhosis/pathology
[Mh] MeSH terms secundary: Acute Kidney Injury/etiology
Acute Kidney Injury/therapy
Biomarkers/blood
Creatinine/blood
Humans
Hypertension, Portal/complications
Kidney Transplantation
Liver Cirrhosis/complications
Lypressin/analogs & derivatives
Lypressin/therapeutic use
Serum Albumin/therapeutic use
[Pt] Publication type:JOURNAL ARTICLE; REVIEW
[Nm] Name of substance:0 (Biomarkers); 0 (Serum Albumin); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin); AYI8EX34EU (Creatinine)
[Em] Entry month:1705
[Cu] Class update date: 170817
[Lr] Last revision date:170817
[Js] Journal subset:IM
[Da] Date of entry for processing:161123
[St] Status:MEDLINE
[do] DOI:10.4166/kjg.2016.68.5.237

  9 / 1395 MEDLINE  
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[PMID]: 27824220
[Au] Autor:Khandelwal A; Gupta D; Haldar R; Rai A
[Ad] Address:Department of Anaesthesiology, Sanjay Gandhi Post Graduate Institute Of Medical Sciences (Sgpgims), Lucknow, Uttar Pradesh, India. ankurchintus@gmail.com.
[Ti] Title:Isolated lower limb gangrene: a caveat of terlipressin therapy.
[So] Source:Anaesthesiol Intensive Ther;48(5):370-372, 2016.
[Is] ISSN:1731-2515
[Cp] Country of publication:Poland
[La] Language:eng
[Mh] MeSH terms primary: Gangrene/etiology
Lower Extremity
Lypressin/analogs & derivatives
Vasoconstrictor Agents/adverse effects
[Mh] MeSH terms secundary: Aged
Humans
Lypressin/adverse effects
Lypressin/therapeutic use
Male
Vasoconstrictor Agents/therapeutic use
[Pt] Publication type:CASE REPORTS; JOURNAL ARTICLE
[Nm] Name of substance:0 (Vasoconstrictor Agents); 50-57-7 (Lypressin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1703
[Cu] Class update date: 170817
[Lr] Last revision date:170817
[Js] Journal subset:IM
[Da] Date of entry for processing:161109
[St] Status:MEDLINE
[do] DOI:10.5603/AIT.a2016.0049

  10 / 1395 MEDLINE  
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[PMID]: 27643543
[Au] Autor:Castellanos-González M; Marzal-Alfaro MB; Díaz-Sánchez A; Martos MG
[Ad] Address:Department of Dermatology and Venereology, Hospital del Sureste, Arganda del Rey, Madrid, Spain.
[Ti] Title:Linear IgA bullous dermatosis due to vancomycin and cutaneous necrosis due to terlipressin in the same patient.
[So] Source:Indian J Dermatol Venereol Leprol;82(6):723-726, 2016 Nov-Dec.
[Is] ISSN:0973-3922
[Cp] Country of publication:India
[La] Language:eng
[Mh] MeSH terms primary: Anti-Bacterial Agents/adverse effects
Antihypertensive Agents/adverse effects
Lypressin/analogs & derivatives
Skin Diseases/chemically induced
Vancomycin/adverse effects
[Mh] MeSH terms secundary: Humans
Linear IgA Bullous Dermatosis/chemically induced
Lypressin/adverse effects
[Pt] Publication type:CASE REPORTS; LETTER
[Nm] Name of substance:0 (Anti-Bacterial Agents); 0 (Antihypertensive Agents); 50-57-7 (Lypressin); 6Q205EH1VU (Vancomycin); 7Z5X49W53P (terlipressin)
[Em] Entry month:1705
[Cu] Class update date: 170531
[Lr] Last revision date:170531
[Js] Journal subset:IM
[Da] Date of entry for processing:160920
[St] Status:MEDLINE
[do] DOI:10.4103/0378-6323.190845


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