Journal of Bangladesh College of Physicians and Surgeons最新文献

{"title":"Staging Investigations in Early-Stage Breast Cancer Patients: Are Clinically Significant and Rational?","authors":"Shahida Alam, Mollah Md Abu Sayed, Md Ashiqur Rahman, Khadija Rahman","doi":"10.3329/jbcps.v42i1.70640","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70640","url":null,"abstract":"Introduction: Multiple studies have demonstrated that the yield of imaging for distant metastatic disease is low in patients with early-stage breast cancer without signs and symptoms of metastatic disease. So, a study was carried out to assess the clinical significance and usefulness of staging investigations in newly diagnosed early-stage breast cancer patients.\u0000Materials and method: A retrospective review of medical records of 171 patients with early-stage (stage I & II) breast cancer referred to the Tumor Board & Radiation Oncology department of NICRH and one private hospital after having surgery & adjuvant chemotherapy during the two-year period (January 2019-December 2020), were performed. The staging investigations the patients underwent perioperatively and the value of those in detecting metastasis were evaluated.\u0000Result:  All patients had chest radiography and routine blood tests performed preoperatively. Postoperative chest radiography evaluation in various frequencies were done in 156 (91.22%) patients. CT scans of the chest were performed in 13 patients (7.6%). One patient (0.64%), who had complained of cough was diagnosed with pulmonary metastasis after evaluation. An ultrasonogram (USG) of the whole abdomen was done preoperatively in 135 patients (78.9%) & postoperatively and subsequently in 162 patients (94.7%) in various frequencies and CT scans of the abdomen were done in 7 patients (4.1%). No metastasis was detected by USG or CT scan of the abdomen. Bone scan was done in 53 patients (31%). Four patients (4/53) were diagnosed with bony metastases out of which 2 had symptoms of bone pain. Routine bone scan can picked up 2(3.7%) bone metastases in asymptomatic patients.\u0000Conclusion:  Staging investigations for distant metastases in newly diagnosed early-stage breast cancer patients in the absence of signs and symptoms of metastatic disease have low yield, not evidence-based, not cost-effective and thus not recommended.\u0000J Bangladesh Coll Phys Surg 2024; 42: 38-42","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"83 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440387","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between Vitamin D deficiency and serum anti-mullerian hormone in infertile women: a cross sectional comparative study","authors":"Sharbari Dey, Shakeela Ishrat, Parveen Fatima, Farzana Islam, Rowshan Ara, E. R. Nandi","doi":"10.3329/jbcps.v42i1.70637","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70637","url":null,"abstract":"Background: Reproductive failure is a significant public health concern. Vitamin D influences steroidogenesis and ovarian follicular development. AMH has a crucial role in the regulation of follicular recruitment and oocyte development. Several studies have recently shown that serum AMH is affected by several factors including obesity, serum leptin and serum vitamin D. Results from studies are conflicting with some suggesting that vitamin D status is associated with ovarian reserve, whereas other studies have not found any significant correlation between vitamin D and AMH levels. \u0000Objective: To evaluate the association between vitamin D deficiencies with serum anti-mullerian hormone in infertile women.\u0000Materials and methods: The study population was the infertile women of 20-34 years of age. The women having serum anti-mullerian hormone levels ≤ 1 ng/ml were grouped as diminished ovarian reserve and those having serum anti-mullerian hormone levels > 1 ng/ml were grouped as normal ovarian reserve. Serum anti-mullerian hormone and serum vitamin D levels were measured at the same day.\u0000Result: Vitamin D deficiency was defined when vitamin D levels were ≤ 20ng/ml. All infertile women with normal and diminished ovarian reserve are deficient in vitamin D. The mean serum AMH was 1.42±1.49 in vitamin D level ≤20 ng/ml and 3.14± .45 in vitamin D level >20 ng/ml. Bivariate analysis was done to see that vitamin D deficiency was significantly more (calculated odds ratio 4.40) in those with diminished ovarian reserve. There was significant positive correlation between serum vitamin D level and serum anti-mullerian hormone.\u0000Conclusion: Vitamin D deficiency is associated with low serum anti-mullerian hormone in infertile women.\u0000J Bangladesh Coll Phys Surg 2024; 42: 19-24","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"70 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Knowledge, Attitude and Practice of Prevention of Thalassaemia of the Parents of Children with Thalassaemia attending in a Tertiary Care Hospital in Bangladesh","authors":"Fardoushi Begum, Mst Farhana Shirin, Md Abu Sayed, L. Sharmin, Md. Belal Uddin","doi":"10.3329/jbcps.v42i1.70623","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70623","url":null,"abstract":"Introduction: Inherited disorder of Hemoglobin is widely distributed throughout the world. Among them, Thalassaemia is a common disorder with widespread geographical distribution.\u0000Objectives: The objective of the study was to determine the level of knowledge, attitude and practice of thalassaemia prevention among parents of children with Thalassaemia.\u0000Methodology: This was a descriptive cross sectional study. This study was conducted in inpatient and outpatient department  of paediatrics, Rajshahi Medical College Hospital over a period of July 2020 to June 2021. 45 parents of children with thalassaemia were purposively selected as study subjects.  Informed written consent were obtained from the parents before enrollment in the study.  Data were collected on variables of interest. All the findings were recorded and analyzed. Statistical  analysis were done using statistical package for social science (SPSS) software version 21.\u0000Result: Total 45 parents of children with thalassaemia were enrolled in the study. Among the informants, 73.3% (total 33) were mother and 26.6% (total 12) were father.  77.7% (total 35) children were from rural areas and 22.22% (total 10) were from urban areas. All the study population received knowledge  about thalassaemia from the physicians. Knowledge of the parents about the disease, its treatment options and methods of its prevention were assessed by likert scale questionnaire. 22.22%  parents had adequate knowledge , 64.44% had average knowledge and 13.33% had inadequate knowledge about the disease. 60% parents had adequate knowledge 31.11% had average knowledge and 8.89% had inadequate knowledge about prevention of thalassaemia.  Attitude of all the parents (100%) were positive.\u0000Conclusion: Most of the parents have adequate knowledge and positive attitude for thalassaemia prevention and they can serve as resource for spreading awareness about thalassaemia in community.\u0000J Bangladesh Coll Phys Surg 2024; 42: 6-11","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"1 6","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439664","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Study between Two Fractions of 9Gy & Three Fractions of 7Gy High Dose Rate Brachytherapy Following Concurrent Chemo Radiotherapy in Patients with Locally Advanced Carcinoma of Uterine Cervix","authors":"Jannatul Ferdous, Altaf Hossain, Sarowat Sultana, Touhida Akter, M. N. Haque","doi":"10.3329/jbcps.v42i1.70641","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70641","url":null,"abstract":"Introduction: Traditionally, a judicious combination of external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT) is the widely accepted primary modality of treatment for locally advanced carcinoma of the cervix. Although the recommendation ofAmerican Brachytherapy Society is <7.5 Gyfor individual fraction and four to eight should be the range of fractions; however, literature showed high dose rate (HDR) brachytherapy of two fractions of 9Gyresults in acceptable toxicity without compromising the local control.\u0000 Methods: This was a Prospective Quasi-Experimental study, conducted in Department of Radiation Oncology, National Institute of Cancer Research and Hospital, Mohakhali, Dhaka from July 2018 to June 2019. Patients with Clinically diagnosed and histopathologically proven squamous cell carcinoma of uterine cervix in locally advanced stage (FIGO stage IIB to IVA) were selected. Total 60 patients were enrolled according to selection criteria and allocated in to group. Both arm was received 50Gy EBRT in 25 fractions with concurrent inj.Cisplatin 40 mg/m2 weekly. Then Arm A was given HDR Brachytherapy 9Gy in each fraction for 2 fractions and Arm B was given HDR Brachytherapy 7Gy in each fraction for 3 fractions. Then treatment responses, locoregional control of disease and acute toxicities were compared between groups.\u0000Result:Follow up at 6 months after completion of treatment, complete remission was 90% and 86% respectively for arm A and arm B. The overall complete response was 88%. The common toxicities associated with treatment were bladder and rectal toxicities, skin reaction, small bowel toxicity and haematologic complications which were managed well. During follow up after 6 months, 3 patients in arm A and 2 patients in arm B developed grade II bladder toxicities and only 2 patients in arm A developed rectal grade II toxicities, but there was no rectal toxicity in arm B.\u0000Conclusions: Present study showed that a total dose of 18 Gy ICRT in two fractions of 9 Gy over 2 weeks is equally effective in short term local control with acceptable toxicities in comparison with a total dose of 21 Gy in three fractions of 7 Gy ICRT.\u0000J Bangladesh Coll Phys Surg 2024; 42: 49-56","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"86 24","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139440579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case report on Arrhythmogenic Right Ventricular Dysplasia","authors":"Safia Binte Rabbani, Mir Nesaruddin Ahmed, Fazilatunnesa Malik, R. Rana, Md Shamim Chowdhury","doi":"10.3329/jbcps.v42i1.70650","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70650","url":null,"abstract":"Arrhythmogenic cardiomyopathy (AC) is a genetic disease characterized by fibro-fatty replacement of either ventricles in isolation or in combination. It may cause tachyarrhythmias to sudden cardiac death, especially in young adult. When ventricular tachycardia (VT) is the principal manifestation then the condition is termed as arrhythmogenic right ventricular dysplasia (ARVD). Here we present a case of  ARVD in a 36 years old hypertensive male who presented with sudden onset of  chest tightness, palpitations, breathing difficulty, dizziness for 20 minutes. In emergency department his electrocardiogram (ECG) showed sustained VT. After 200 joule DC cardioversion he was reverted to sinus rhythm, then resting ECG showed T-wave inversion (TWI) in V1-V3 along with epsilon wave. His  echocardiogram also revealed dilated right ventricle (RV) along with hypertrabeculation, RV wall motion abnormality and low RV ejection fraction (EF), his coronaries were normal on coronary angiogram (CAG). He was discharged from the hospital after Implantable Cardioverter Defibrilator (ICD) implantation with beta-blocker and advised to restrict excessive physical activity.\u0000J Bangladesh Coll Phys Surg 2024; 42: 86-91","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439950","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endotracheal Tube Cuff Pressures and Incidence of Postoperative Sore Throat","authors":"U. H. S. Khatun","doi":"10.3329/jbcps.v42i1.70661","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70661","url":null,"abstract":"Abstract not available\u0000J Bangladesh Coll Phys Surg 2024; 42: 4-5","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"65 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441103","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cervical Cerclage: Prolonging Gestational Period for Successful Pregnancy Outcome","authors":"Afroza Akhter, A. H. M. A. Habib, Shahjad Hossain Md Al Momen, Sudipto Deb Nath","doi":"10.3329/jbcps.v42i1.70659","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70659","url":null,"abstract":"Background: Cervical Cerclage may be an effective treatment option in true cervical insufficiency. Cervical function plays a crucial role to protect growing fetus in utero in maintaining successful pregnancy. As the gestational weeks progress, the cervix undergoes dynamic changes, including softening and shortening, to accommodate fetal growth.   \u0000Objective: The objective of this study is to evaluate the effectiveness and outcome of cervical cerclage placement as a preventive measure against recurrent pregnancy loss and preterm delivery and its complications, to analyze pregnancy outcomes among participants who received cervical cerclage and to investigate the relationship between cervical cerclage and pregnancy outcome based on gestational age.\u0000Method and Materials: The study was conducted over three years at CMH, Jashore and Ibn Sina Hospital Jashore, utilizing a retrospective and longitudinal interventional approach. Ethical approval was obtained before commencing the study, which involved 92 cases undergoing mid-trimester cervical cerclage. Cervical length measurements, cervical cerclage using the McDonald technique, and subsequent medical management were performed with outcome analyzed using descriptive statistics and odds ratio. Data were analyzed retrospectively through SPSS data analysis tool.\u0000Result: 45.65% of patients experienced term deliveries, while 33.70% had preterm deliveries, with 20.65% facing abortions. Distinct inclusion criteria unveiled diverse outcomes, such as recurrent pregnancy loss cases showing 40.82% preterm and 38.78% term deliveries. Odds ratios highlighted cervical length's significance, with a 0.25 ratio indicating reduced preterm risk. Interestingly, 61.69% of preterm births occurred between 34 and 36 weeks. Maternal outcomes indicated low incidence rates of hemorrhage (4.8%), infections (1.1%) and cervix laceration (2.4%).\u0000Conclusion: The study underscores cervical cerclage's potential in enhancing full-term pregnancies, particularly for patients with cervical incompetence. While highlighting its success, the study also acknowledges associated risks and complications.\u0000J Bangladesh Coll Phys Surg 2024; 42: 57-62","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"36 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139441440","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Epidermoid Cyst in Submental Region: A Rare Case Report","authors":"S. M. A. Sadat, Taslima Akter Chowdhury, Asadur Rahman, S. N. Rita","doi":"10.3329/jbcps.v42i1.70652","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70652","url":null,"abstract":"Epidermoid cyst, specially in large size is one of the rare lesions of maxillofacial region, affects submental and sublingual region. The cyst develops from the entrapment of pluripotent ectodermal and mesodermal primordia, in the embryonic lines of fusion, when first and second branchial arches of each fuse in the midline, between third and fourth weeks of intrauterine life. After entrapment, this tissue shows gradual proliferation and ultimately transform to a cyst. A 19-year-old-boy presented with such a midline painless large swelling in the submental and sublingual region with diagnosis of epi dermoid cyst. After enucleation, the patient didn’t show any recurrence after 2 years follow up.\u0000J Bangladesh Coll Phys Surg 2024; 42: 92-96","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"18 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439058","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Left ventricular hypertrophy (LVH) in different stages of chronic kidney disease (CKD) patients and its correlation with anaemia","authors":"Omma Tahara, Pradip K Dutta","doi":"10.3329/jbcps.v42i1.70638","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70638","url":null,"abstract":"Background : Chronic kidney disease (CKD) is a public health problem that increases the risk of cardiovascular morbidity and mortality. Heart failure with preserved ejection fraction characterized by left ventricular hypertrophy (LVH) and diastolic dysfunction is a common cardiovascular complication of CKD. Anaemia is present in both dialysis & non dialysis CKD patients. Anaemia causes left ventricular hypertrophy (LVH) which in turn leads to increases morbidity and mortality in CKD, even before progression of chronic kidney disease (CKD) to end stage renal disease (ESRD). Our study is aimed at to evaluate the prevalence of left ventricular hypertrophy (LVH) and its correlation with anaemia in hospitalized CKD patients.\u0000Materials and Methods : A cross-sectional study was done on 50 patients of different stages of CKD admitted in the chittagong medical college hospital (CMCH). All the clinical data were reviewed and recorded. Data was analyzed by SPSS-18 and p value <0.05 was considered statistically significant.\u0000Results : Majority of study population 64% was male, 36% was female. Most of the male patient (40%) of the study population were having abnormal left ventricular mass index (>130 gm/m2). More patients with severe left ventricular hypertrophy were found in stage 5 of CKD in female and male which was 8 and 23 respectively. Regarding correlation of Hb% with LVMI there was a significant negative correlation was found (r= -0.420, p = 0.003) between them means if Hb% decreases LVMI level increases. It was also found in male and female patients separately ( for male r = -0.778, p = 0.001 and for female r = -0.746, p = 0.001).\u0000Conclusion : Anemia is widely prevalent in our CKD patients. Severity of anemia is correlated to left ventricular hypertrophy in these patients. Hence correction of anemia early in these group of patients can halt or prevent cardiovascular morbidity and mortality.\u0000J Bangladesh Coll Phys Surg 2024; 42: 25-30","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Pelvic Radiation on Haematopoeitic and Gastrointestinal Syndromes: a Prospective & Observational Study","authors":"Shaila Sharmin, Sk Golam Mostafa, Md Moynul Islam, Shamima Afroz Trina, Anannya Sarkar","doi":"10.3329/jbcps.v42i1.70639","DOIUrl":"https://doi.org/10.3329/jbcps.v42i1.70639","url":null,"abstract":"Radiotherapy may induce irreversible damage on healthy tissues surrounding the tumor. It has been reported that the majority of patients receiving pelvic radiation therapy show early or late tissue reactions of graded severity as radiotherapy affects not only the targeted tumor cells but also the surrounding healthy tissues. This prospective, observational study was conducted to observe the effects of pelvic radiation on haematopoeitic and gastrointestinal syndromes. It was done in Radiation Oncology department of National Institute of Cancer Research and Hospital, Dhaka between July 2011 to June  2012. The study participants were all patients getting pelvic radiation in the concerned department. A blood profile was done before radiotherapy. Clinical evaluation as per RTOG Guideline was done to access the gastrointestinal syndromes. Then, pelvic radiation was started and CBC was done and recorded weekly as well as gastrointestinal toxicity grading. Main outcome measures were hemoglobin, TC of WBC, nausea, vomiting, diarrhea. Before treatment the mean hemoglobin % was 11.0±1.1 mg/dl, during 4th week of treatment it 10.37±0.7 mg/dl.The mean TC of WBC was found 11107.4±13481.4 mm3, during 4th week of treatment the mean TC of WBC was found 7550.6±2514.6 mm3.Nausea and vomiting increased upto 3rd week but decline in subsequent follow-up. 42% patients had diarrhea during 2ndand 3rd week of treatment, 20.0% in 4thweek and only 2.0% found in 5th week. It can be said that hematopoetic and gastrointestinal syndromes are significantly correlated in patients undergoing pelvic radiation following 4th week of follow up reports.\u0000J Bangladesh Coll Phys Surg 2024; 42: 31-37","PeriodicalId":105305,"journal":{"name":"Journal of Bangladesh College of Physicians and Surgeons","volume":"5 2","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139439331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}