Journal of Clinical Sciences最新文献

{"title":"Thoracotomy in children: A decade review of indications and outcomes","authors":"E. Ogunleye, O. Olusoji, O. Adekola","doi":"10.4103/jcls.jcls_67_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_67_22","url":null,"abstract":"Background: Thoracotomy in children is relatively rare compared to adults. It can be very challenging due to the peculiar anatomy and physiology in this age group. The objective of the study was to study the indications, outcomes, and complications following thoracotomy. Methods: This was a retrospective analysis of the medical charts of neonates, infants, and children who had undergone thoracotomy under general anesthesia from January 2011 to December 2020 at our institution. Furthermore, we searched for the childhood thoracic diseases necessitating thoracotomy; the indications and complications following thoracotomy, as well as, the quality of life following thoracotomy. The children had either posterolateral or lateral thoracotomy, which spared the latissimus dorsi and/or serratus anterior. Data collected included demographics, surgical intervention, duration of intensive care unit admission, postoperative complications, and clinical outcome. Results: Out of the 39 patients, a majority were female 20 (51.3%), the most common indication for thoracotomy was congenital anomalies in 25 (64.1%) patients (lung malformations, 35.9% and patent ductus arteriosus, 28.2%), followed by foreign body aspiration (20.21%). Postoperative complications were seen in 15 (38.5%), out of whom 3 (20%) had atelectasis, chylothorax in 1 (6.7%), and wound dehiscence in 2 (13.3%). The 30-day mortality was 12.8%. The quality of life as assessed by Karnofsky performance status within 6–12 months after discharge in 32 children was 100 and in two patients (90). Conclusion: The most common indication and complication following thoracotomy at our institution was congenital anomalies in 25 (64.1%) patients (lung malformations, 35.9% and patent ductus arteriosus, 28.2%), and atelectasis, respectively. The 30-day mortality after thoracotomy was 12.8%.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80391581","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":"Psychological burden of care in parents/caregivers of children with surgical conditions – A local experience","authors":"Olumide A. Elebute, E. Campbell, Adesoji O. Ademuyiwa, Chibuike Ihediwa, C. Bode","doi":"10.4103/jcls.jcls_79_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_79_22","url":null,"abstract":"Background: There is a paucity of literature on the psychological burden on parental caregivers of children with surgical conditions. Knowledge of the peculiar psychological challenges faced by the parents or caregivers could help to advocate for the incorporation of a psychologist or psychiatrist as part of a multidisciplinary approach to patient care. Methods: This is a cross-sectional study over 6 months on caregivers of pediatric surgical patients at the Lagos University Teaching Hospital. Zarit Caregiver Burden Scale (ZCBS) and the General Health Questionnaire – 28 (GHQ-28) were used to obtain data on the burden of care and psychiatric morbidity. Data obtained were analyzed using SPSS (version 23). A ZCBS score ≥21 and a GHQ-28 value above 4 were considered significant. Results: A total of 120 caregivers were recruited for the study. The mean GHQ score was 6.3 (standard deviation [SD] ±5.9), whereas the mean ZCBS was 24.96 (SD ± 14.67). Sixty (50.0%) caregivers had a GHQ score over 4 and 71 (59.2%) had a ZCBS score ≥21. Conclusions: The care of children undergoing surgical procedures is associated with a significant burden and psychological distress among first-degree family caregivers. There is a need for further studies to know the pattern of their psychologically ill health as this could impede their quality of care.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74625649","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":"Predictors of depression and malnutrition among older persons attending primary healthcare centres in South Western Nigeria","authors":"B. Akodu, Samuel Akinwunmi, T. Ladi-Akinyemi, I. Baiyeroju, A. Onajole","doi":"10.4103/jcls.jcls_24_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_24_22","url":null,"abstract":"Background: Malnutrition and depression have been found to be prevalent in the older persons and often lead to preventable adverse complications. Depression has been shown to be associated with malnutrition. This study was aimed at determining the predictors of depression and malnutrition among older persons attending selected primary health-care centers (PHC) in Kosofe local government area in Lagos, Nigeria. Methods: This was a descriptive cross-sectional study carried out among older persons attending PHC in Kosofe local government, Lagos. A multi-stage random technique was used to select the 219 participants from the PHC centers. Data were collected using a structured interviewer-administered questionnaire and analyzed using Epi Info 7.1. Chi-square was used to test the association between Socio-demographic characteristics and nutritional status, body mass index and depression, and one-way ANOVA was used to test for the association between anthropometric parameters and malnutrition. Associations were statistically significant if P < 0.05. Results: It was found that 57.9% were malnourished or at risk of malnutrition. The study showed that 47.1% of the participants were depressed. There was a significant association (<0.001) between the malnutrition and the level of depression. There was a statistically significant association between family support (P ≤ 0.001), malnutrition (P ≤ 0.001), and depression. There was statistically significant association between the height (P = 0.009), weight (P = 0.001), waist–hip ratio (P = 0.036), and the malnutrition. Remarkably, there was statistically significant association between the waist (P = 0.023) and hip circumference (P = 0.047) and their level of depression. Conclusion: The results from this study revealed a high prevalence of malnutrition and depression among older persons. Therefore, health providers working in PHC centers should have a high index of suspicion for depression among older persons with malnutrition.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85151576","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":"The burden of personal protective equipment and its effect on the work efficiency in health-care workers","authors":"B. Vaidiyanathan, S. Amalanathan, Satish Chokalingam, Kumaran Alias Ramesh Colbert, Irudhayaraj Joseph, Prathiba Kishore","doi":"10.4103/jcls.jcls_78_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_78_22","url":null,"abstract":"Introduction: Personal protective equipment (PPE) has become a necessity in the COVID pandemic for containing, protecting, and preventing the spread of the virus among the health-care workers; however, there are limitations to its use due to its associated adverse effects. The objective is to determine the adverse effects of PPE and its effect on work efficiency in health-care workers. Methods: This is a single-center descriptive cross-sectional survey done among 384 health-care workers by a consecutive sampling method. A semi-structured questionnaire was sent through the Google platform and the data were analyzed using SPSS 20. Results: 79.7% of study participants reported irritability and 59.9% had difficulty reading and writing during working hours in PPE, both factors had a significant association with their work efficiency (P = 0.019, P = 0.031). A feeling of being in a closed tight environment (85.7%), headache (71.95%), difficulty in drawing samples and intravenous cannulation (60.2%), and difficulty in adjusting the ventilatory settings and infusion pumps (39%) were reported by the study participants. However, these factors did not affect their work efficiency. On multivariate analysis, most health-care workers (HCWs) in the intensive care unit had more adverse effects than the others posted in other clinical areas. Conclusion: Our survey has identified several factors affecting HCWs during their working hours. These physical and cognitive adverse effects need to be alleviated to maintain a healthy, productive, and efficient work environment. We need to encourage reporting and find ways to mitigate their difficulties regarding PPE.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83056017","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":"Clinical characteristics and outcome of patients admitted during the first and second waves of COVID-19 pandemic at a Tertiary Hospital in Lagos, Nigeria","authors":"I. Akase, P. Akintan, E. Otrofanowei, O. Olopade, G. Olorunfemi, A. Opawoye, F. Alakaloko, U. Ima-Edomwonyi, Y. Akinbolagbe, O. Agabi, Danladi Nmadu, G. Akinbode, A. Olasope, A. Ogundare, A. Bolarinwa, Oluwakemi Awojumobi-Otokiti, P. Enajeroh, M. Karami, C. Esezobor, Y. Oshodi, Oluwole Ayotunde, W. Adeyemo, C. Bode","doi":"10.4103/jcls.jcls_57_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_57_22","url":null,"abstract":"Introduction: Clinical data on the differences in presentation and outcome of admitted COVID-19 patients in Nigeria are limited. This study aimed to compare the first and second waves of the COVID-19 pandemic in a Tertiary Hospital in Lagos and describe the clinical differences between the waves, the severity of COVID-19, and the mortality differences. Methods: The study was a retrospective review of the medical records of all children and adults admitted to the Lagos University Teaching Hospital (LUTH) COVID-19 Isolation and Treatment Centre during the first wave (from April 2020 to October 2020) and second wave (from December 2020 to April 2021). The clinical characteristics (including COVID severity) and outcome among admitted patients during the two waves were compared. Results: Between April 2020 and April 2021, 602 patients were admitted to LUTH for COVID-19. Patients in the first wave were significantly younger (43 vs. 54.5 years), more in number (53.8% vs. 46.2%), and had a higher proportion of health-care workers than those in the second wave (14.5% vs. 6.5%). Comorbidities were present in more than half of the patients hospitalized for COVID-19 infection (51.0%). This proportion was much higher during the pandemic's second wave (41.7% vs. 61.9%, P < 0.001). The most common comorbidity found in hospitalized patients was hypertension (37.0%). Patients admitted during the second wave had shorter stays (11 vs. 7 days) and similar mortality rates (10.2% vs. 10.8%). Conclusion: The first and second waves had comparable mortality rates though patients in the first wave were younger and there were more healthcare providers in the cohort. Patients admitted to the second wave however had more comorbidities but shorter lengths of stay which may suggest a better understanding of the infection and better outcome.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78058602","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":"Correlation between the International Prostate Symptom Score and sonographic parameters in patients with symptomatic benign prostate enlargement","authors":"Kehinde Apata, E. Jeje, K. Tijani, A. Ogunjimi, R. Ojewola, A. Adeyomoye","doi":"10.4103/jcls.jcls_21_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_21_22","url":null,"abstract":"Background: Benign prostate enlargement is a common urological condition in the aging male that causes lower urinary tract symptoms (LUTS). The study was aimed at determining the correlation between International Prostate Symptom Score (IPSS) and sonographic parameters in a cohort of men attending the outpatient urology clinic of our teaching hospital. Methods: One hundred and fifty consecutive patients who met the inclusion criteria were enrolled into the study. The severity of LUTS was assessed using the IPSS questionnaire. Prostate volume (PV), bladder wall thickness (BWT), and postvoid residual (PVR) were determined via transabdominal ultrasound using Toshiba Nemino XG (Osaka Japan) with probe frequency 3.5MHz. The data were collected into a pro forma and analyzed using SPSS version 22 (IBM SPSS, Chicago, IL, USA). The data were subjected to Pearson's correlation and P < 0.05 was considered statistically significant. Results: The 150 patients who were enrolled had an age range of 46–85 years, while the mean age was 63.37 ± 9.45 years. The mean total IPSS was 17.58 ± 7.69. The PV, BWT, and PVR had a mean of 71.96 ± 48.75 ml, 4.63 ± 1.99 mm, and 48.01 ± 59.17, respectively. There was a weak correlation between the total IPSS and PV (r = 0.118; P = 0.149), BWT (r = 0.174; P = 0.03), and PVR (r = 0.118; P = 0.151). Correlating voiding and storage symptoms with PV showed a poor correlation. There was a statistically significant correlation between voiding symptoms and BWT (r = 0.255; P = 0.002). Conclusion: There was no correlation between total IPSS and PV with PVR. Total IPSS and voiding symptom scores had a statistically significant positive correlation with BWT.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73861093","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":"Telemedicine system for the diagnosis and management of invasive fungal infections in Nigeria","authors":"S. Nwaneri, R. Oladele","doi":"10.4103/jcls.jcls_86_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_86_22","url":null,"abstract":"Background: Invasive fungal infections are not usually suspected by clinicians in our setting resulting in avoidable deaths, morbidity, and irrational/misuse of antibiotics. Unfortunately, there are few specialists of Medical Mycology in Nigeria working in very few centers where fungal infections can effectively be managed. This article describes a telemedicine system designed to provide an electronic consultation platform for the diagnosis and management of invasive fungal infections in Nigeria. Methods: The telemedicine center was designed and implemented using state-of-the-art technologies comprising hardware and software components. The center includes a high-resolution 60-inch liquid-crystal display smart television, an Intel Core i3 Desktop Computer, webcam system, a broadband Internet connection, and a backup electricity supply. The system currently uses the Zoom platform to establish virtual connections with collaborators as well as patients. Results: Since its inception, the center has managed 34 serious patients whose managing clinicians have called in for consultation. The establishment of the center has led to increased collaboration with other specialists in clinical mycology across Africa and Europe. Patient outcome has also been impacted positively because of consultation provided on diagnosis and antifungal therapy. The center has further accelerated the exchange of knowledge and ideas between health-care practitioners in Africa on the management of invasive fungal infections. Conclusions: Therefore, telemedicine center has been immensely beneficial for the management of patients suffering from invasive fungal infections in Nigeria.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84765363","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":"Analysis of spirometric variables with increasing body mass index in normal and overweight healthy individuals","authors":"Ilham Jaleel, H. Ahamed","doi":"10.4103/jcls.jcls_41_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_41_22","url":null,"abstract":"Background: The relationship between the parameters of body mass index (BMI) and lung function has been established by numerous studies done earlier. Those studies have been done mainly on obese individuals, but only a very few studies have been done in people with normal BMI or overweight group. Our aim is to analyze the various spirometric variables, namely forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), forced expiratory flow (FEF 25%–75%), and peak expiratory flow rate (PEFR), with respect to increase in the BMI in otherwise normal healthy subjects. Methods: The present study design is a randomized experimental parallel-group study. Sixty individuals who were otherwise healthy without any respiratory illness were selected for this study. Their anthropometric measurements were taken. Based on WHO classification, the subjects were grouped as follows: Group I with a BMI of 18.5–24.9 as a normal weight group and Group II with a BMI of 25–29.9 as the overweight group. Using Medispiror, the spirometric variables were determined. Analysis of spirometric variables, namely FEV1, FVC, FEF 25%–75%, and PEFR, were all done using the appropriate statistical method. Results: The results showed that there was a significant decrease in all spirometric variables except PEFR with an increase in BMI. However, the decrease in FVC was relatively more than the decrease in FEV1. Conclusion: This study can be concluded that there is a significant decrease in spirometric variables, namely FEV1, FVC, and FEF 25%–75%, as the BMI increases even in normal individuals who are not obese.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83089514","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":"Rhabdomyolysis: A rare and often-missed complication of diabetic ketoacidosis","authors":"Khadijah Oleolo-Ayodeji, Helen Salako, Olaolu Moronkola, E. Oyenusi, A. Oduwole","doi":"10.4103/jcls.jcls_46_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_46_22","url":null,"abstract":"A 19-year-old male with type 1 diabetes mellitus (diagnosed at 12 years of age) was brought to the emergency room with fever and altered sensorium. His compliance with his insulin regimen was questionable. Examination revealed a Glasgow Coma Scale of 5/15, sluggishly-reacting pupils, severe dehydration, and fever (temperature 38.8°C). Vital signs at the upper limit of normal, urethral catheter drained dark red urine with output of 1–2 ml/kg/hr. Laboratory investigations showed hyperglycemia (250 mg/dL), ketonuria (+) hematuria (+++) and proteinuria (++), and glycated hemoglobin (HbA1C) – 9.6%. Full blood count showed leukopenia, neutrophilia, and thrombocytopenia. Deranged electrolytes included hypernatremia, metabolic acidosis, and hypophosphatemia with elevated urea and blood urea nitrogen. Serum creatinine kinase (CK) was elevated. A diagnosis of diabetic ketoacidosis (DKA) with rhabdomyolysis (RM) and raised intracranial pressure was made and he was managed with adequate fluid resuscitation, osmotic diuresis, glycemic control, platelet transfusion, and antibiotics with clinical improvement. Normal CK levels were documented 3 months later. RM is a rare complication of DKA. High index of suspicion should be maintained for prompt detection and management to prevent potential complications, especially acute kidney injury.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89906076","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":"Correlation between Lund-Mackay CT scan score and Sinonasal Outcome Test-20 symptoms score in the evaluation of chronic rhinosinusitis","authors":"Yakubu Shirama, Auwal Adamu, K. Iseh, S. Ahmed, S. Baba, S. Ma'aji","doi":"10.4103/jcls.jcls_54_22","DOIUrl":"https://doi.org/10.4103/jcls.jcls_54_22","url":null,"abstract":"Background: Computed tomographic (CT) scan is important in the evaluation of chronic rhinosinusitis (CRS). The usefulness of CT scan in predicting the severity of symptoms is still debatable. The aim of this study is to determine the correlation between a CT scan scoring and the severity of clinical symptoms in patients with CRS. Methods: A cross-sectional study of patients with clinically diagnosed CRS. Their symptoms severity was assessed using the Sinonasal Outcome Test-20 (SNOT-20) scoring system. All eligible patients had CT scans using BrightSpeed (GE) computed tomographic scanner. The CT scan findings of each subject were scored according to the Lund-Mackay scoring system. The correlation between the CT score and the SNOT-20 symptom score was determined. Results: There were 120 participants comprised 70 (58.3%) males and 50 (41.7%) females with male: female ratio of 1.4:1. The mean and standard deviation of SNOT-20 were 38.9 ± 17.5 (range: 6–81) and that of Lund-Mackay score were 9.8 ± 5.5 (range: 0–24). There was statistical significant correlation between Lund-Mackay score and SNOT-20 score (r = 0.653 P = 0.000). The correlation was strongest in relation to nasal symptom domain (r = 0.746, P = 0.000), but it was weak with the facial symptom domain (r = 0.225, P = 0.013). Conclusion: This study found a strong positive correlation between the Lund-Mackay score and SNOT-20 symptoms score among patients with CRS.","PeriodicalId":15490,"journal":{"name":"Journal of Clinical Sciences","volume":null,"pages":null},"PeriodicalIF":0.1,"publicationDate":"2022-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74907436","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}