scholarly journals Comparative Efficacy of Phenobarbitone versus levetiracetam in the initial treatment of neonatal seizure

2020 ◽  
Vol 27 (2) ◽  
pp. 182-189
Author(s):  
Md Tafazzal Hossain Khan ◽  
Mohammed Mahfuzur Rahman ◽  
Manisha Banerjee ◽  
Md Zahir Uddin ◽  
Nurun Nahar ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Hospital Stay ◽  
Initial Treatment ◽  
Randomized Control Trial ◽  
Neurodevelopmental Outcome ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
College Hospital ◽  
Medical College ◽  
Randomized Control

Neonatal seizures are common in the first month of life and may impair neurodevelopmental outcome. Phenobarbitone (PB) currently represents the anti epileptic drug (AED) of choice, despite related to cognitive impairment in human subjects and limited efficacy. Intravenous levetiracetam is increasingly being used in the neonatal period to treat seizures. Presently, insufficient data about the efficacy and safety of intravenous levetriacetam in neonates, we have structured a randomized control trial with levetiracetam in the initial treatment of acute neonatal seizure. Objective: To find out the efficacy of levtiraracetam for controlling the convulsions in acute neonatal seizures compared to phenobarbitone. Methodology: The study was a randomized control trial. A total of 100 neonates from 0 day to 28 days of age irrespective of sex with clinical presentation of neonatal seizures admitted in the special care baby unit (SCABU) of Dhaka Medical College Hospital were included in the study and were randomly assigned to either levetiracetam or Phenobarbitone group after matching inclusion and exclusion criteria. The outcome variables were seizure control, times taken to be seizure free, and hospital stay. Outcome was evaluated through routine monitoring up to 48 hours and followed up to discharge or death. Result: The study groups were almost similar with respect to their demographic characteristics like age, sex and gestational age. According to maternal obstetric data i.e- antenatal care (ANC), modes of delivery in the both groups were statistically not significant. Seizures status was nonsignificant in both groups. The study demonstrated that controlling the seizure with levetiracetam & Phenobarbitone were 66.0% and 34.0% respectively. Length of the hospital stay was shorter in levetiracetam group. Eventually the phenobarbitone group required more than one drug to control seizures.. But immediate adverse effect was not significant in both groups. Conclusion: The study concluded that levetiracetum significantly control the convulsion in comparison to phenobarbitone as first line antiepileptic drug in the initial treatment of acute neonatal seizures. Both the modalities of treatment were found to have no adverse effect. J Dhaka Medical College, Vol. 27, No.2, October, 2018, Page 182-189

scholarly journals A prospective study to determine etiology, clinical profile and neurodevelopmental outcome of neonatal seizures admitted in newborn unit of Chengalpattu Medical College and Hospital, Tamil Nadu, India

2019 ◽  
Vol 6 (2) ◽  
pp. 527
Author(s):  
Yalaguraswami B. Kolkar ◽  
Madhivannan Sailavasan
Keyword(s):  
Prospective Study ◽  
Apgar Score ◽  
Tamil Nadu ◽  
Neurodevelopmental Outcome ◽  
Neonatal Seizure ◽  
Developmental Outcome ◽  
Neonatal Seizures ◽  
Neurological Assessment ◽  
Medical College ◽  
A Prospective Study

Background: Newborn with neonatal seizures is at risk of neurodevelopmental delay. The aim of this study was to determine the factors affecting the adverse outcome of neonatal seizures and to study the significant factors associated with poor neurodevelopmental outcome in neonatal seizures.Methods: This was a prospective study done at neonatal intensive care unit (NICU) in Chengalpattu Medical College during the period from June 2017 to September 2018. A total of 110 neonates with seizures admitted in NICU from first hour of life to 28 days of age were included in the study. Detailed history was collected in preformed proforma, and followed up to one year and neurological assessment done at 4th month, 8th month and 1 year. The Hammersmith infant neurological examination (HINE) was done at 4 and 8 month and the Bayley–III assessment was done at 1 year of age to determine the neurodevelopment outcome.Results: Out of 110 newborns with seizures, 86 cases were followed up to 1 year of age. Neurological assessment done by HINE determined abnormal neurodevelopment in 33.6% neonates. Bayley-III scale assessment found cognitive delay in 10.9%, language delay in 20%, motor delay in 5.55%, socio-emotional delay in 30%, and adoptive delay in 31.8% cases. Delayed developmental outcome is significantly associated with onset of seizures, frequency of seizure, poor 5 minute Apgar score, abnormal EEG, and hypoxic ischemic encephalopathy (HIE).Conclusions: The delayed developmental outcome high among the neonates with subtle and myoclonic seizures. Mortality and neurological impairment was after neonatal seizure is associated with Onset and frequency of seizures, low Apgar score at 5 min, findings of USG cranium, CT brain, EEG, and HIE.

scholarly journals Study on etiology and clinical course of neonatal seizures and their outcome

2019 ◽  
Vol 6 (5) ◽  
pp. 1985
Author(s):  
Abdul Mohid Syed ◽  
Y. Shasidhar Reddy ◽  
Gangadhar B. Belavadi
Keyword(s):  
Seizure Activity ◽  
Clinical Course ◽  
Neonatal Seizure ◽  
Neonatal Seizures ◽  
College Hospital ◽  
Diffuse Brain Injury ◽  
Medical College ◽  
Prolonged Seizure ◽  
Intracranial Bleed ◽  
Focal Injury

Background: The aim was to explore etiology, clinical course of neonatal seizure sand their and outcome in Narayana Medical College Hospital, Nellore, Andhra Pradesh, India.Methods: Retrospective study of 65 neonates from 1 month to 1 year diagnosed with epilepsy between November 2016 to August 2018.Results: Most common type of seizures seen are subtle (40%), followed by multifocalclonic (20%), tonic (21%), focal clonic (9.2%), clonic (7.7%) and myoclonic (1.6%). Most common cause of neonatal seizures was HIE (41.5%), followed by hypoglycemia (13.8%), intracranial bleed (10.8%), septicemia (10.8%), hypocalcemia (7.7%). The morality percentage is high (18.2%) when seizures occurred before 12 hours, when seizures occurred between 24-48 hrs it is 14.3%, and mortality was least when seizures occurred between 2-6 days (12.5%). Seizures are common in stage IIHIE (81.5%) compared to Stage I &Stage III. Seizures with adverse outcome are generalized myoclonic and focal clonic seizures. Focal clonic and focal tonic seizures are most often associated with focal injury. Generalized tonic seizures, motor automatism and some myoclonic seizures are associated with diffuse brain injury. Prolonged seizure activity, seizures lasting for many days, repetitive seizures, and the need for multiple anticonvulsants to control seizure activity are associated with an increased mortality.Conclusions: Authors conclude that prompt recognition, evaluation and treatment of these neonatal events are important in improving the survival of neonates with seizures. 

scholarly journals Randomized Controlled Trial between Levetiracetam and Phenobarbital in the Treatment of Neonatal Seizure due to Perinatal Asphyxia

2018 ◽  
Vol 42 (2) ◽  
pp. 67-72
Author(s):  
Abu Faisal Md Pervez ◽  
Md Fakhrul Amin Badal ◽  
SM Nurun Nabi ◽  
Mohammad Kamrul Hassan Shabuj ◽  
Sanjoy Kumer Dey ◽  
...  
Keyword(s):  
Adverse Effect ◽  
Randomized Controlled Trial ◽  
Adverse Effects ◽  
Perinatal Asphyxia ◽  
Controlled Trial ◽  
Common Adverse Effect ◽  
Neonatal Seizure ◽  
College Hospital ◽  
Antiepileptic Agent ◽  
Randomized Controlled

Background: Seizure occurs more frequently in neonatal period and incidence of seizure is 50%-68% in perinatal asphyxia. At present phenobarbital is the drug of choice for treating neonatal seizure, which has some adverse effects on neurodevelopment status. Levetiracetam is a novel antiepileptic agent well-tolerated and effective in focal, generalized and neonatal seizure as well and lacks the adverse effects like phenobarbital. The present study was undertaken to compare the safety and efficacy of levetiracetam to phenobarbital in the treatment of neonatal seizure due to perinatal asphyxia.Methodology: This interventional study (Randomized Controlled Trial) was conducted in Department of Neonatology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka and Dhaka Medical College Hospital, Dhaka, Bangladesh from 1st January’ 2014 to 30th June’ 2015. Intravenous levetiracetam injection, 50 mg/kg loading followed by 10 mg/kg 8 hourly maintenance was used and phenobarbital intravenous 20-40 mg/kg loading and 2.5 mg/kg/dose 12 hourly maintenance was given as per institutional protocol.Results: Sixty-nine term asphyxiated neonates (intention to treat population) provided analyzable data. Seizure control was found significantly higher (p = 0.011) higher in levetiracetam group in comparison to phenobarbital group (71% vs 40%). Need for more than one drug was significantly lower in levetiracetan group (p=0.011). Adverse effects were found significantly (p=0.001) lower in levetiracetam group (9% vs 43%). No serious adverse effect was observed in any group and most common adverse effect was somnolence in both group followed by irritability. Restlessness, sedation and shallow breathing were found only in phenobarbital group.Conclusion: Levetiracetam is more effective and safe in comparison to phenobarbital in the treatment of neonatal seizure due to perinatal asphyxia.Bangladesh J Child Health 2018; VOL 42 (2) :67-72

scholarly journals Comparison of the efficacy of Solifenacin Succinate and Tolterodine for the treatment of overactive bladder syndrome

2017 ◽  
Vol 8 (2) ◽  
pp. 231-234
Author(s):  
Mohammad Monsur Hallaz ◽  
BH Nazma Yasmeen ◽  
Nadia Sultana ◽  
Mahfuza Akter ◽  
Nurul Alam Basher
Keyword(s):  
Overactive Bladder ◽  
Extended Release ◽  
Private Hospital ◽  
Overactive Bladder Syndrome ◽  
College Hospital ◽  
Medical College ◽  
Release Preparation ◽  
Solifenacin Succinate ◽  
Randomized Control ◽  
New Generation

Background : Overactive Bladder Syndrome(OAB) is not an uncommon problem. Although exact incidence of this disease in our country is not known but a significant number of people suffering from this disease seek treatment at the Urology department of different hospitals. At present two common antimuscarinic drug Solifenacin Succinate and Tolterodine are available in our country for the treatment of OAB.Objective : To compare the efficacy of Solifenacin Succinate and Tolterodine to treat OAB.Methodology : This hospital based randomized control trial was conducted in the Department of Urology, Dhaka Medical College Hospital, Dhaka and a private hospital from January 2009 to December 2010 to compare the efficacy of two new generation antimuscarinics, Solifenacin succinate and Tolterodine at their recommended doses for the treatment of OAB.Results : After 3 months of treatment it has clearly shown that Solifenacin is more effective in reducing OAB symptoms compared with extended release preparation of Tolterodine. This include statistically significant reduction in episodes of frequency, urgency, urge incontinence, nocturia and significant improvement of voided volume.Northern International Medical College Journal Vol.8(2) January 2017: 231-234

scholarly journals Management of Symptomatic Renal Cysts by Laparoscopy: Our Initial Experience

2020 ◽  
Vol 21 (2) ◽  
pp. 137-139
Author(s):  
Mohammad Mahfuzur Rahman Chowdhury ◽  
AKM Shahadat Hossain ◽  
Rifat Zaman ◽  
Prodyut Kumar Saha ◽  
Hafiz Al Asad ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Hospital Stay ◽  
Renal Cysts ◽  
Standard Of Care ◽  
Drain Tube ◽  
College Hospital ◽  
Medical College ◽  
Cyst Recurrence ◽  
The Mean

Introduction and objective: Over the last decade laparoscopic surgery has been popularized and developed to such an extent that it can be considered gold standard for many types of procedures in urology. Currently the majority of operations in urologic field can be performed by laparoscopy. This is because it is as effective as open surgery, but associated with less postoperative pain, shorter hospital stay, faster recovery and has better cosmetic result. The aim of the study is to evaluate the results of our experience of treating symptomatic renal cysts by laparoscopy. Materials and methods: This prospective study was conducted from January 2015 to December 2017 in the Department of Urology in a single unit of Dhaka Medical College Hospital. All the patients were admitted through out-patient department. Among them those who fulfilled the criteria were selected for laparoscopic surgery. All patients were diagnosed by ultrasonography and computed tomography to determine the Bosniak classification of the cyst & informed written consent was taken. Total five laparoscopic decortication of renal cysts were performed and the results of our experience were compared with data from published article. Pain and cyst recurrence were assessed during the follow-up. Results: Our study described the results of 05 laparoscopic decortication of renal cysts. All procedures were completed successfully by transperitoneal approach, with no major intraoperative and postoperative complications. There was a placement of drain tube in one patient. The mean (range) operative duration was 68 (40–110) min, affected by the site and number of cysts decorticated. The mean post operative hospital stay was 1.8 (1- 3) days. All patients were symptom-free and no sign of recurrence during the follow-up. Conclusion: Laparoscopic decortication of symptomatic renal cysts should be the standard of care and it is feasible with conventional laparoscopic instruments and gives a better cosmetic outcome. Bangladesh Journal of Urology, Vol. 21, No. 2, July 2018 p.137-139

scholarly journals Assessment of developmental outcome of neonatal seizures at NICU of tertiary care centre hospital

2016 ◽  
Vol 4 (1) ◽  
pp. 100
Author(s):  
Swati Saral ◽  
Pawan Ghanghoria
Keyword(s):  
Tertiary Care ◽  
Preterm Neonates ◽  
Developmental Outcome ◽  
Neonatal Seizures ◽  
Tertiary Care Centre ◽  
College Hospital ◽  
Face To Face ◽  
Medical College ◽  
The Face ◽  
Centre Hospital

Background: Seizures are relatively common among first month of life. New-born with neonatal seizures are at risk of developmental delay. The objective of this study was to assess the developmental outcome of neonatal seizures and to study the factors associated with delayed developmental outcome in neonatal seizures.Methods: A prospective observational Study was conducted in 71 term and preterm neonates with documented seizure admitted in Medical college hospital, Jabalpur. A predesigned pretested questionnaire was used. The face to face interview technique was used for collection of data by mother, followed by clinical examination of newborn and investigations were done. DDST II was used for developmental assessment of neonates. Results: Neonates with delayed developmental outcome are 42.62%. Delayed developmental outcome is significantly associated with male sex, low birth weight, prematurity and multiple frequencies of seizures.Conclusions: The delayed developmental outcome was high among neonatal seizures. 

scholarly journals Comparison of standard and tubeless percutaneous nephrolithotomy for renal calculi: a prospective randomized control trial

2019 ◽  
Vol 6 (4) ◽  
pp. 185
Author(s):  
Manu Muraleedharan Kamalakshi ◽  
Vasantharaja Ramasamy ◽  
Darsan Sadasivan ◽  
Sunil Raveendran ◽  
Selvam Paramasivam ◽  
...  
Keyword(s):  
Postoperative Pain ◽  
Hospital Stay ◽  
Randomized Control Trial ◽  
Renal Stones ◽  
Renal Calculi ◽  
Analgesic Requirement ◽  
Operative Duration ◽  
Significant Difference ◽  
Randomized Control ◽  
Tubeless Pcnl

<p class="abstract"><strong>Background:</strong> In the current era of minimally invasive interventions, the mainstay of treatment of renal stones larger than 2 cm is Percutaneous nephrolithotomy (PCNL). PCNL underwent various evolutionary changes minimizing morbidity to the patients. We prospectively compared the outcome of tubeless PCNL (without nephrostomy drainage tube) to reduce the pain and discomfort caused by tube with standard PCNL in the treatment of renal stones.</p><p class="abstract"><strong>Methods:</strong> In this Randomized control trial (RCT), we divided patients satisfying the inclusion criteria of consenting for trial, single access puncture, less than 3 stones each less than 3 cm, operative duration of less than 2 hours into two groups, standard PCNL (group 1) and tubeless PCNL (group 2) with 25 patients each. Randomization and group assignment were done after complete clearance of renal stones.</p><p class="abstract"><strong>Results:</strong> Patient’s age, gender, sides of stone and stone size were comparable between two groups (standard versus tubeless PCNL). Postoperative hemoglobin drop, bleeding, pyrexia, urine leak, and blood transfusion requirement did not show a statistically significant difference between the two groups. Analgesic requirement (190 mg versus 80 mg of tramadol), operative duration (49.80 min versus 38.60 min), postoperative pain score (6/10 versus 3.64/10-visual analog scale) and duration of hospital stay (68.48 hours versus 41.12 hours) showed statistically significant difference favoring tubeless PCNL.</p><p class="abstract"><strong>Conclusions: </strong>Tubeless PCNL may be a safe, acceptable and effective modality of treatment for renal calculi in carefully selected patients comparing standard PCNL resulting in less operative duration, lower postoperative pain, reduced analgesic requirement and shorter hospital stay.</p>

scholarly journals Outcome of Clubfoot Correction at ‘Walk for Life’ Clinic of Mymensingh Medical College Hospital: A Four Year Review

2019 ◽  
Vol 44 (3) ◽  
pp. 132-137
Author(s):  
F Rahman ◽  
MH Chowdhury ◽  
H Kabir ◽  
J Alam ◽  
J Uddin ◽  
...  
Keyword(s):  
Initial Treatment ◽  
Treatment Cycle ◽  
Dropout Rate ◽  
Ponseti Method ◽  
Medical College Hospital ◽  
College Hospital ◽  
Achilles Tenotomy ◽  
Medical College ◽  
Treatment Data ◽  
Initial Correction

Background: Every year in Bangladesh an estimated 3500 - 4000 children are born with a clubfoot deformity, which is approximately one of every 1000 children born in Bangladesh. Left untreated, the condition leads to lifelong deformity causing individual disability and potential unproductivity. Affected children grow up as burden to the family and ultimately leads to significant poverty. Methods: This study was conducted at the ‘Walk for Life’ (WFL) clinic Mymensingh Medical College Hospital (MMCH) during February 2011 to December 2014.The non-surgical Ponseti method was applied by the orthopaedic surgeon and physiotherapist. Follow-up for relapsed deformity in children who were treated in 2011 occurred in 2015. Results: A total of 577 children comprised of 175 (30.32%) female and 402 (69.7%) male, a gender rati o F: 2.29 M. Completions of treatment data were available for 471 children, as 106 had dropped out at different stages of the treatment cycle. Sadly, 12 children had died. In 440 (76.4%) children, the parents’ monthly income approximated Tk. 5000, and 364 (82.8%) lived in tin shed houses. The parents with lowest incomes predominated for children with clubfoot. Most parents 383(66.4%) were labourers, small business and service workerswith the lowest income. A family history of clubfoot deformity was found in 8.3%, of which 2.8% were cousins, 1.7% were an uncle.The average number of corrective plaster casts applied before the tenotomy was 3.32% in 477 children. In 73.0% of childrenthree to six casts were used for initial correction. An Achilles tenotomy was performed in 81.0% children, 18% did undergo a tenotomy and one child had multiple tenotomies.Four years following of initial treatment, 99 children were reviewed, and 98 were walking and running. Parents’ satisfaction was 96.0%. Thirteen percent children showed relapse signs. Most of the children treated at the WFL clubfoot clinic were walking normally four years after initial treatment. Conclusion: The Ponseti method is found to be very effective and especially for a developing country like Bangladesh. Poverty and housing condition may play a role in clubfoot disease. The dropout rate across the treatment cycle was 18.4%, warranting closer evaluation. The patronage of the Glencoe Foundation WFL clinics since 2009, played an important role in relieving thousands of Bangladeshi children from disability. Bangladesh Med Res Counc Bull 2018; 44: 132-137

scholarly journals Preterm Very Low-Birth Weight Babies: Outcome of Admitted Newborns at a Community-Level Medical College Hospital in Bangladesh

1970 ◽  
Vol 26 (3) ◽  
pp. 128-134
Author(s):  
ASM Nawshad Uddin Ahmed ◽  
MA Rob ◽  
Ferdous Rahman ◽  
Redwanur Rahman ◽  
Nazmul Huda
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Hospital Stay ◽  
Gestational Age ◽  
Very Low Birth Weight ◽  
Birth Asphyxia ◽  
Medical College Hospital ◽  
Community Level ◽  
College Hospital ◽  
Medical College

y, mainly due to infections and complications of prematurity. The present article is a descriptive analysis of the most common reasons for hospital admission of VLBW infants, morbidity during hospital stay, and their immediate outcome at a community level medical college hospital in Bangladesh. Sixty VLBW neonates (< 1,500 grams weight), 37 males and 23 females, < 72 hours of age were enrolled prospectively from March 2005 to February 2007; 4 babies were excluded. Thirty-four babies were hospital born and 26 home delivered cases admitted postnatally. The mean birth weight and gestational age of the newborns were 1270 ± 169 grams and 30.9 ± 2.9 weeks respectively. Forty-one of 60 cases (68.3%) mothers received at least one antenatal care visit. Common clinical presentations were prematurity alone (36.7%) and its complications like delayed crying (25.0%), feeding problem (23.3%), lethargy (16.7%), hypothermia (10.0%) and respiratory problem (8.3%). The commonest morbidity during hospital stay was neonatal hyperbilirubinemia requiring phototherapy (26.7%), apnoea of prematurity (15.0%), and septicaemia (11.7%). The overall survival rate was 56.7%; most of the deceased cases were those < 1250 grams (15/28, 53.6%) and < 30 weeks of gestation (17/30, 56.7%). No infant with a birth weight < 850 grams or a gestational age < 28 weeks survived. The most common cause of death was birth asphyxia (38.5%), followed by extreme prematurity (26.9%), and septicaemia (19.2%). Very low birth weight infants had relatively higher survival rates probably due to low infection rate. DOI: 10.3329/jbcps.v26i3.4196 J Bangladesh Coll Phys Surg 2008; 26: 128-134

scholarly journals Outcome of microbiologically proven pneumonia by nasopharyngeal aspirate of infant attending in a tertiary care hospital

2018 ◽  
Vol 9 (1) ◽  
pp. 267-270
Author(s):  
Marium Begum ◽  
Dipa Saha ◽  
Mahmuda Hasan ◽  
Wahida Hasin ◽  
Nadira Sultana ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Fatality ◽  
Coagulase Negative Staphylococcus ◽  
Care Hospital ◽  
Nasopharyngeal Aspirate ◽  
Prolonged Hospital Stay ◽  
College Hospital ◽  
Medical College ◽  
Prolonged Hospital

Background : In Bangladesh, recent estimates suggests that 22% of under-five death and 13.1% of neonatal death is due to pneumonia. Its etiology usually remains unknown and problems is increasing with drug resistant infections.Objective : The aim of this study is to evaluate the outcome of microbiologically proved pneumonia of the infant by nasopharyngeal aspirate culture.Methods : This prospective study was conducted at the Department of Pediatrics and Neonatology, Addin Medical college hospital, Dhaka from January to July 2015. A total of 30 hospitalized infants of either sex with pneumonia fulfilling the WHO criteria and radiologically confirmed were enrolled in the study. Child with congenital heart disease or chronic respiratory disease, who did not give consent were excluded from the study. The study cases were divided into three groups on their final outcome as improved, not improved (prolonged hospital stay) and expired.Results : Among 30 study cases mean age was 39.7±45 days, most of them were male 19 (63%); case fatality rate was 10%. Organisms were isolated from 47.3% cases of nasopharyngeal aspirate culture, among them Gram-ve bacteria were 10 (34%), gram +ve 3 (10%) and fungal 1(3.3%). Mixed bacterial growth were 4(13%) and no growth were 12(40%) cases. Acinetobacter was found in 8 (26.7%), Coagulase negative staphylococcus 2(6.7%). Additionally, MRSA, pseudomonas and E.coli species were identified in 1 (3.3%), 1 (3.3%), and 1 (3.3%) of the cases respectively. All infant who had gram +ve 3(100%) and fungal 1(100%) growth on their nasopharyngeal culture were improved. On the other hand, among the gram –ve cases mortality rate was high 2(20%) and also required prolonged hospital stay 2(20%). Among the cases who had mixed organism 2(50%) of them were improved and 2(50%) required prolonged hospital stay. Majority of the cases were improved 10(83%) those who had no growth on their NPA culture followed by 1(8.3%) had prolonged hospitalization and 1(8.3%) was died.Conclusion : Infant with severe pneumonia having younger age were at greater risk of mortality. Gram – ve organism in nasopharyngeal aspirate culture indicated poorer outcome and required prolonged hospital stay.Northern International Medical College Journal Vol.9(1) July 2017: 267-270

Sign in / Sign up

Export Citation Format

Share Document