190 RELATIONSHIP BETWEEN BLUETONGUE VIRUS INFECTION AND FETAL MORTALITY IN CATTLE

2010 ◽  
Vol 22 (1) ◽  
pp. 253
Author(s):  
C. Ponsart ◽  
J. Gatien ◽  
N. Pozzi ◽  
P. Humblot ◽  
B. Guérin
Keyword(s):  
Bluetongue Virus ◽  
Clinical Symptoms ◽  
Serological Test ◽  
Clinical Signs ◽  
Fetal Mortality ◽  
Chi Square ◽  
Test Elisa ◽  
Veterinary Surgeons ◽  
Record Data ◽  
Pregnancy Status

Infection by Bluetongue virus (BTV) may affect reproductive performance but little is known about its real impact on fertility and occurrence of abortions. The aim of this study was to describe the effects of BTV infection on fetal mortality in 53 herds located in the east of France that were infected by the virus between August and November 2007. In 2008, 2 visits were performed 50 days apart by local veterinary surgeons and pregnancy was checked by ultrasonography. The first visit aimed to record data on pregnancy and infection status and to register clinical signs. A total of 1939 cows were classified within 3 groups: nonpregnant (n = 262), early pregnant (<3 months, n = 1041), and late pregnant (>3 months, n = 636). For each cow, a blood sample was collected approximately 8 days after the first visit and BTV status was determined by ELISA. The rates of clinical symptoms and fetal losses were compared in seronegative and seropositive cows using chi-square tests. Bluetongue status was found positive in 69.5% of the cows (80% of beef v. 67% of dairy cows). Prevalence was highly variable between herds: 19% of herds had 100% of cows with positive serological results and 10 herds presented at least 70% of seronegative results. Clinical signs were reported by farmers in 40% (457/1141) of seropositive cows compared to 20% (90/460) of seronegative cows (P < 0.001). As a consequence, clinical signs should not be considered as a reliable tool for diagnosing BTV infection with enough accuracy. At first visit, ultrasonography was performed in cows that were supposed to be pregnant. At second visit, a positive pregnancy status was confirmed in 78% of the cows, but this proportion was higher in seronegative cows when compared with seropositive cows (81 v. 76%; P < 0.02). This proportion was associated with the presence of clinical signs. Out of 1311 pregnant cows at first visit, only 37 presented a fetal mortality at second pregnancy check (2.8%).The rate of fetal mortality was related to the BTV-seropositive status of cows as well as stage of pregnancy (P < 0.05; Table 1). Calving interval did not differ between seropositive and seronegative females (411 ± 77 days v. 405 ± 82 days; P > 0.10); however, number of AI per conception was significantly higher in seropositive than in seronegative females (2.0 ± 1.2 v. 1.8 ± 1.1; P < 0.001). These results show that a seropositive BTV status assessed by serological test (ELISA) is associated with an increased frequency of fetal mortality in beef and dairy cattle, and with an increased number of AI per conception. Table 1.Rate of fetal mortality observed between 2 pregnancy diagnosis 50 days apart (negative pregnancy check during the 2nd visit in cows which were pregnant at first visit) The authors thank the farmers and veterinarians who participated to this trial, as well as the GDS (Groupements de Defense Sanitaire) organization from Moselle and Meuse departments for collecting the data.

scholarly journals Clinical Features, Diagnosis and Management of Patients with Suspicion of Fascioliasis in Kohgiluyeh and Boyer-Ahmad Province, Southwestern Iran

2020 ◽  
Author(s):  
Abdolali MOSHFE ◽  
Arash ARIA ◽  
Najme ERFANI ◽  
Ali JAMSHIDI ◽  
Bahador SARKARI ◽  
...  
Keyword(s):  
Clinical Features ◽  
Clinical Symptoms ◽  
Epigastric Pain ◽  
Serological Test ◽  
Demographic Data ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Diagnosis And Management ◽  
History Of ◽  
Clinical Signs And Symptoms

Background: In the current study, we described the epidemiological features, clinical presentation, diagnosis and management of patients with suspicion of fascioliasis in Kohgiluyeh and Boyer-Ahmad Province in southwest of Iran.    Methods: Overall, 56 patients with suspicion of fascioliasis, based on their clinical signs and symptoms that referred to Clinic of Internal Medicine in Yasuj city, from 2014 to 2016 were enrolled. Demographic data, history of eating aquatic local plants, the chief complains, and laboratory findings were recorded for each patient. Stool samples were obtained from each case for detection of Fasciola eggs. Moreover, blood samples were taken from each patient and evaluated for detection of anti-Fasciola antibodies by an indirect ELISA. Patients who defined as having fascioliasis were treated with triclabendazole and were followed for at least three months for clinical improvement. Results: Serological test was positive in 5 patients. Of these 5 cases, three cases had a history of ingesting raw aquatic vegetables. The main clinical signs and symptoms in positive cases were; abdominal pain (60%), epigastric pain (40%), anemia (60%), and dermal pruritus (20%). Hypereosinophilia was seen in all of 5 positive cases. No Fasciola egg was found in stool specimens of any of the patients. The fascioliasis cases were treated by triclabendazole and clinical symptoms disappeared in all of 5 cases. Conclusion: Our observation further confirmed Yasuj district as a human endemic area for fascioliasis in Iran. The study also highlighted the importance of clinical features together with eosinophilia, as key parameters, in the diagnosis of human fascioliasis. Clinicians need to be aware of this disease and should keep in mind fascioliasis when hypereosinophilia present in patients in such endemic areas.

scholarly journals Evaluation the efficiency of Trichomonas vaginalis depending on clinical sings , direct examination ,culturing and serological test

2011 ◽  
Vol 8 (1) ◽  
pp. 392-399
Author(s):  
Baghdad Science Journal
Keyword(s):  
Trichomonas Vaginalis ◽  
Clinical Symptoms ◽  
Culture Media ◽  
Serological Test ◽  
Clinical Signs ◽  
Direct Methods ◽  
Laboratory Diagnosis ◽  
Enzyme Linked Immunosorbent Assay ◽  
Indirect Haemagglutination ◽  
Number Of Patients

The adequacy of diagnostic tests, together with trichomoniasis associated clinical symptoms, were investigated in females suffering vaginitis, and they were referred to the Gynecology Department, Al-Yarmouk Teaching Hospital during the period December 2004 – June 2005. The total number of patients was 250 cases (age range: 18 - 52 years), and each patient was examined using a sterile speculum to obtain vaginal swabs for examination. The diagnosis with T. vaginalis was done in many methods. The direct methods included wet and stained (Leishman's stain) examinations and cultivation in different culture media (Kupferberg Trichomonas Broth Base;, Trichomonas Agar Base; TAB and Trichomonas Modified CPLM), while the indirect methods were serological detections of anti-trichomonas antibodies in the sera of patients by using of indirect haemagglutination test (IHAT) and enzyme linked immunosorbent assay (ELISA). The results of this profile were as the following: 1. Out of 250 females with abnormal vaginal discharges, 15 patients (6%) were infected with T. vaginalis. 2. The sensitivity of testing methods was different. It was 66.7 and 13.3% for wet and stained examinations, respectively. In culture examinations, the sensitivity was 60, 80 and 100% for Kupferberg, TAB and CPLM media, respectively, while the sensitivity IHAT and ELISA were 40 and 73.3%, respectively. 3. The clinical sings of infection in women were discharge and itching (46.7%), discharge with itching and dysuria (20.0%), discharge only (13.3%), itching only (13.3%) and discharge with dysuria (6.7%). Therefore we can conclude that impossible to the clinical signs in diagnose of Trichomonasis because of the variation and the laboratory diagnosis is necessary especially the cultivation method.

scholarly journals General Disturbances and their Correlation to the Eruption of Primary Dentition in Children between 5 and 30 Months Age Group of Belgaum City: An Epidemiological Study

2011 ◽  
Vol 2 (1) ◽  
pp. 39-43
Author(s):  
Shobha Deshpande ◽  
Santosh M Sholapurmath ◽  
Shigli L Anand
Keyword(s):  
Clinical Manifestation ◽  
Clinical Symptoms ◽  
Scientific Information ◽  
Clinical Signs ◽  
Signs And Symptoms ◽  
Chi Square ◽  
Number Of Children ◽  
Group A ◽  
Group B ◽  
Group D

ABSTRACT Background and objective The effect of teething on infants health has been debated for at least 5000 years and traditional beliefs on issue have still not been entirely supplemented by scientific finding. This study has tried to gather scientific information of systemic/clinical signs and symptoms in scientific manner. The objectives of this study were: (1) To describe the most frequent objective clinical manifestation during the eruption of primary teeth, e.g. fever, diarrhea, drooling, fever-drooling, fever-diarrhea, drooling-diarrhea. (2) To assess the correlation between systemic symptoms and eruption of various group of teeth, e.g. incisor, canine, molar. Methods The survey was conducted in 500 children between 5 and 30 months and registered at child development center, KLES's Hospital and Medical Research Center, Nehru Nagar, Belgaum, Karnataka. A specially structured questionnaire was applied with face-to-face interview. Information was relayed in yes or no manner of objective manifestation during eruption of primary incisor, canine and molar which included drooling, diarrhea, fever and combination of these symptoms. Data were analyzed by descriptive statistic and Chi-square analyses. Results The study showed more number of children in group A (less than 12 months) manifested drooling symptoms. As the ages advances with group B (between 12 and 18 months), group C (between 18 and 24 months) and group D (above 24 months), clinical manifestation of saliva found to be reduced. The results of study showed that 87.78%; 57.8%; 57.55%; 25.7%; of children with erupting teeth demonstrated general clinical symptoms like drooling, diarrhea and fever. The presence of fever-diarrhea in this study within group A, group B, group C and group D showed highest number of children by the manifestation than any other codes evaluated in the study. Interpretation and conclusion Present data demonstrate association between fever-diarrhea observed in all group consistently when marked numerically. As the age advances the fever-diarrhea from group C (between 18 and 24 months) and group D (above 24 months) rank second and third. This ranking in group A (less than 12 months) and group B (between 12 and 18 months) at its highest position and attributable to lower immunity of infants. Further, virology study should be conducted on subjects to demonstrate any possible occurrence of systemic disturbances.

scholarly journals Evaluation of Clinical Symptoms of Patients with Celiac Disease Referred to Khatamolanbia Clinic in Yazd City in 2014

2020 ◽  
Author(s):  
Mahmoud B Baghbanian ◽  
Mohsen Akhondi-Meybodi
Keyword(s):  
Weight Loss ◽  
Celiac Disease ◽  
Bone Pain ◽  
Clinical Symptoms ◽  
Systemic Disease ◽  
Clinical Signs ◽  
Gastrointestinal Symptoms ◽  
Signs And Symptoms ◽  
Chi Square ◽  
Yazd City

Introduction: The clinical features of celiac disease vary. Common classic signs and symptoms include diarrhea, weight loss, and abdominal distention. Celiac as a systemic disease may suffer people of all ages and with many races and ethnic groups.  Celiac disease also has other symptoms that got less attention. These signs are constipation, bloating, oral plague, bone pain, anemia, Vitiligo, hypocalcemia, hypothyroidism and seizures.  In this study, it was decided to evaluate the prevalence of gastrointestinal and non-gastrointestinal clinical signs of celiac disease. Methods: This descriptive study was conducted on 150 patients with celiac disease referred to Khatamolanbiya Clinic in 2014.The gastrointestinal and non-gastrointestinal clinical signs of the patients were studied. Patients with celiac disease were included who had both positive tissue anti-transglutaminase antibodies and some degree of mucosal atrophy on duodenal mucosal endoscopy. After collecting the data, the coded information was entered into SPSS version 22 software and the results were analyzed using Chi-Square, T and Wilcoxon tests. Results: The results showed that celiac disease in the study was 1.3 times more frequently in women than men. As well as the symptoms of anemia in the population studied (40.67%) had the highest and seizures (0.67%) had the lowest rates. After anemia, hypothyroidism with 26% prevalence was the most prevalent in the community. Diarrhea with 24.7% is the mostcommon in gastrointestinal symptoms   and is the third most common after anemia and hypothyroidism. Conclusion: The results of this study showed that non-gastrointestinal symptoms (bone pain, anemia, vitiligo, hypocalcaemia, hypothyroidism, and seizures) are more common than gastrointestinal symptoms such as diarrhea, steatorrhea, weight loss, nausea, vomiting, abdominal pain, bloating, and oral thrush in patients with celiac disease.

scholarly journals Evaluation of Optimal Antibiotic Use in Children with Gastroenteritis Abstract

2021 ◽  
Author(s):  
Farzad Ferdoosian ◽  
Ardalan Zare ◽  
Majid Aflatoonian
Keyword(s):  
Analytical Study ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Antibiotic Use ◽  
Significant Relation ◽  
Chi Square ◽  
Laboratory Findings ◽  
Viral Diarrhea ◽  
Appropriate Treatment ◽  
Chi Square Test

Introduction: Due to the side effects of overuse of antibiotics, the aim of study was to evaluate the optimal antibiotic use in children with gastroenteritis. Methods: This descriptive-analytical study was conducted on 178 children with gastroenteritis from January to December 2018. Data including age, gender, clinical symptoms and laboratory findings were extracted from records. Results: Out of 178 cases of diarrhea, 32 cases were due to bacteria and 146 cases were due to viruses. The most clinical symptoms in the patients were fever (34.40 %), vomiting (33.2 %) and coryza (13.1%). The most frequency of viral (46.2%) and bacterial diarrhea (32.2%) were seen in autumn season. Antibiotics were used mostly in spring (39 %) and autumn (25 %) seasons. In 14% of cases, the appropriate treatment was not selected. In addition, 50.56 % of treated children were less than 1 years old. No significant relation was also seen between season with bacterial or viral cases (p>0.05). Significant relation was seen between taking antibiotics at admission and clinical signs such as abdominal pain and suspicious food (p<0.01). Data were analyzed throgh SPSS, version16. Chi Square test was used for analysis of data Conclusion: Virus is the main cause of diarrhea in children with gastroenteritis. Moreover, the most frequency of diarrhea was seen in autumn and spring season. However, there was no significant relation between seasons with bacterial and viral cases. It indicates that bacterial and viral diarrhea was not affected by season. For preventing microbial resistance, antibiotic therapy should be administered more carefully in children with diarrhea.

scholarly journals The prevalence of horse trypanosomiasis in Sumba Island, Indonesia and its detection using card agglutination tests

2019 ◽  
Vol 12 (5) ◽  
pp. 646-652
Author(s):  
Wisnu Nurcahyo ◽  
Marlin R. K. Yowi ◽  
Sri Hartati ◽  
Joko Prastowo
Keyword(s):  
Clinical Symptoms ◽  
Clinical Signs ◽  
Trypanosoma Evansi ◽  
Vital Role ◽  
Chi Square ◽  
The People ◽  
Blood Smears ◽  
Potential Risk Factors ◽  
Chi Square Test ◽  
The Government

Background and Aim: Horses have a strategic and vital role to play in the lives of the people of Sumba Island, East Nusa Tenggara Province. They act as social animals that are involved in death ceremonies, horse races, and during pasola, thereby supporting tourism, and are given away as dowry in wedding ceremonies. This study aimed to investigate the prevalence of trypanosomiasis among horses in four districts of Sumba Island by examining clinical symptoms and detecting parasites, antibodies, and other factors that are related to Trypanosoma evansi infection in horses. Materials and Methods: We studied a total of 211 horses that belonged to 88 clinical hobby breeders. Giemsa-colored smears and serum were examined in order to detect antibodies using card-agglutination tests (CATT). The study was conducted during the rainy season that lasted from January to March 2017. Potential risk factors such as the species, sex, origin of the livestock, how the livestock were maintained, and the farmers' knowledge concerning trypanosomiasis were recorded using questionnaires. Data were collected annually for three years from 2010-2012 and repeatedly analyzed by a Chi-square test. Results: Clinical signs of trypanosomiasis were found in 34 horses; blood smears were examined using Giemsa staining and negative preparations were obtained at a frequency of 0.0% (0/211). The CATT results generally showed that 13.3% (28/211) of the samples were seropositive for antibodies to T. evansi; the highest percentage, 16.67% (8/48), of seropositivity was found in the West Sumba District, and the lowest, 12.0% (5/50), was found in Southwest Sumba. The incidence of trypanosomiasis was higher (75% [21/28]) among female hip horses; horses with 1-5 years of experience were more susceptible to a T. evansi infection (46.4% [13/28]). In general, farmers on Sumba Island knew of trypanosomiasis (89.8% [79/88]), and 69.3% (61/88) of the farmers reported that their livestock was sick. This study was the first serological study conducted on trypanosomiasis in horses of Sumba Island after the surra outbreak in 2010-2012. There were 3% of farmers who were willing to provide the government with information on implementing a prevention program and controlling the spread of surra on the island. Conclusion: The diagnoses of surra disease were made based on clinical symptoms and parasitological examinations. CATTs could be used to diagnose T. evansi infection in horses.

The relationship betweenparityand the incident of perinealruptures on women’s physiological maternity

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Evi Rosita ◽  
Siti Nurnaningrum
Keyword(s):  
Public Health ◽  
Health Center ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Midwifery Care ◽  
Public Health Center ◽  
Record Data ◽  
The Relationship ◽  
Very High

There are about 2.8 million incident of perineal rupture in maternal physiological labor. In 2050,it is estimated that the incidence of perineal rupture can be 6.3 million if it is not accompanied by a good midwifery care. In 2016, in Trawas, there was (89%) perineal rupture in primiparas and (57%) perineal rupture in multiparas. Perineal rupture incidences due to parity were still very high. This study aims to analyze the relationship between parity and the incidence of perineal rupture . It is quantitative studyusing a cross sectional approach, by using analysis of physiological maternity women  medical record data from January to April 2017 of 130 peoplein Trawas Public Health Center, Mojokerto Regency.The dataanalysis used was Chi - Square , indicated by p value = 0,000 with ɑ = 0,05. It means that the value of p <ɑ, so H1 is accepted. It can be concluded that there is a relationship between parity and the incidence of perineal rupture on physiological maternity women in Trawas Public Health Center,Mojokerto Regency. Midwives can apply collaboration with patients and their families to have physical and psychologicalpreparation with an alternative of hypnobirthing methods.

scholarly journals Concentrations of canine prostate specific esterase, CPSE, at baseline are associated with the relative size of the prostate at three-year follow-up

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Bodil S. Holst ◽  
Sofia Carlin ◽  
Virginie Fouriez-Lablée ◽  
Sofia Hanås ◽  
Sofie Ödling ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Specific Antigen ◽  
Relative Size ◽  
Clinical Signs ◽  
Serum Concentrations ◽  
Prostatic Disease ◽  
Follow Up Study ◽  
Prostate Size ◽  
Prostate Growth

Abstract Background Enlargement of the prostate is associated with prostatic diseases in dogs, and an estimation of prostatic size is a central part in the diagnostic workup. Ultrasonography is often the method of choice, but biomarkers constitute an alternative. Canine prostate specific esterase (CPSE) shares many characteristics with human prostate specific antigen (PSA) and is related to prostate size. In men with clinical symptoms of prostatic disease, PSA concentrations are related to prostate growth. The aims of the present follow-up study were to evaluate if the concentration of CPSE is associated with future growth of the prostate, and if analysis of a panel of 16 steroids gives further information on prostatic growth. Owners of dogs included in a previous study were 3 years later contacted for a follow-up study that included an interview and a clinical examination. The prostate was examined by ultrasonography. Serum concentrations of CPSE were measured, as was a panel of steroids. Results Of the 79 dogs included at baseline, owners of 77 dogs (97%) were reached for an interview, and 22 were available for a follow-up examination. Six of the 79 dogs had clinical signs of prostatic disease at baseline, and eight of the remaining 73 dogs (11%) developed clinical signs between baseline and follow-up, information was lacking for two dogs. Development of clinical signs was significantly more common in dogs with a relative prostate size of ≥2.5 at baseline (n = 20) than in dogs with smaller prostates (n = 51). Serum concentrations of CPSE at baseline were not associated with the change in prostatic size between baseline and follow-up. Serum concentrations of CPSE at baseline and at follow-up were positively associated with the relative prostatic size (Srel) at follow-up. Concentrations of corticosterone (P = 0.024), and the class corticosteroids (P = 0.0035) were positively associated with the difference in Srel between baseline and follow-up. Conclusions The results support the use of CPSE for estimating present and future prostatic size in dogs ≥4 years, and the clinical usefulness of prostatic size for predicting development of clinical signs of prostatic disease in the dog. The association between corticosteroids and prostate growth warrants further investigation.

scholarly journals Outcomes of Endodontic Therapy Comparing Conventional Sodium Hypochlorite Irrigation with Passive Ultrasonic Irrigation Using Sodium Hypochlorite and Ethylenediaminetetraacetate. A Retrospective Analysis

2016 ◽  
Vol 10 (1) ◽  
pp. 375-381 ◽  
Author(s):  
Moritz Hertel ◽  
Katja Sommer ◽  
Eckehard Kostka ◽  
Sandra Maria Imiolczyk ◽  
Husam Ballout ◽  
...  
Keyword(s):  
Sodium Hypochlorite ◽  
Clinical Symptoms ◽  
Treatment Success ◽  
Success Rates ◽  
Chi Square ◽  
Passive Ultrasonic Irrigation ◽  
Ultrasonic Irrigation ◽  
Endodontic Irrigation ◽  
Group 2

The aim of the present study was to investigate the clinical outcomes of two different standardized endodontic irrigation protocols. It was assumed that the additional use of ethylenediaminetetraacetate (EDTA) and passive ultrasonic irrigation (PUI) would result in an increased rate of absence of symptoms and remission based on the periapical index (PAI) compared to passive irrigation using only sodium hypochlorite (NaOCl). Data and radiographs from 199 teeth retrieved from the institutional endodontic database were analyzed retrospectively. In 106 teeth irrigation was performed using only NaOCl (protocol 1). Ninety-three teeth were irrigated using NaOCl and EDTA (protocol 2). Chlorhexidine (CHX) was additionally used in revision treatments in both groups. All irrigants in group 2 were activated by PUI. Mean follow-up periods were: protocol 1 = 9.2 ± 4.4 and protocol 2 = 6.6 ± 2.5 months (p < 0.0001 (chi-square test). The frequencies of the PAImasterpoint and PAIfollow-up scores did not differ significantly between teeth, which received either protocol 1 or 2 (p = 0.555 and 0.138). Statistical analysis revealed no significant association between treatment success (absence of clinical symptoms and PAIfollow-up = I or PAImasterpoint > PAIfollow-up > I) and the applied protocol (success rates: protocol 1 = 72.6% vs. protocol 2 = 82.8%; p = 0.203). Furthermore, the frequency of extractions did not differ significantly between the two protocols (p = 0.102). No association was found between follow-up time and treatment success (p = 0.888). The hypothesis was not confirmed. Even though the obtained success rate was higher after supplementing the irrigation protocol with EDTA and PUI, no significance was recorded. Hence, protocol 2 was not superior to protocol 1 regarding therapy success, at least within the limited follow-up period. It may be cautiously concluded that sufficient mechanical debridement combined with passive NaOCl irrigation results in comparably high success rates compared to EDTA and PUI.

RENAL HISTOLOGY DURING TREATMENT WITH OXAZOLIDINE-DIONES (TRIMETHADIONE, ETHADIONE, AND PARAMETHADIONE)

PEDIATRICS ◽  
1962 ◽  
Vol 30 (4) ◽  
pp. 601-607
Author(s):  
A. Bergstrand ◽  
C. G. Bergstrand ◽  
N. Engström ◽  
K. M. Herrlin
Keyword(s):  
Electron Microscopy ◽  
Nephrotic Syndrome ◽  
Renal Disease ◽  
Renal Biopsy ◽  
Clinical Symptoms ◽  
Clinical Signs ◽  
Present Knowledge ◽  
Short Report ◽  
Renal Histology ◽  
Renal Changes

Seven patients with petit mal seizures treated with trimethadione, ethadione, or paramethadione for long periods were subjected to renal biopsy at the age of 14½ 16½ years. None of the patients had clinical signs of renal disease at the time of the biopsy, but three of them had previously shown transient hematuria or proteinuria. The renal histology was studied by conventional methods and by electron microscopy, the latter method only including the glomeruli. The changes found must with the present knowledge be regarded as physiological. A short report is given of a patient with phenylketonuria and epilepsy who developed a nephrotic syndrome during treatment with tridione. No definite pathologic renal changes were demonstrated at the when the clinical symptoms had disappeared.

Sign in / Sign up

Export Citation Format

Share Document