Journal of Tropical Pediatrics最新文献

{"title":"Clinical Profile and Outcome of Children with Scrub typhus: A Tertiary Care Centre Observation.","authors":"Ashok Singh, Priyanka Dua, Om Prakash Mishra, Anu, Sweta Sharma, Sweta Singh, Anu Anu, Ashok Kumar","doi":"10.1093/tropej/fmag017","DOIUrl":"https://doi.org/10.1093/tropej/fmag017","url":null,"abstract":"<p><strong>Objective: </strong>Scrub typhus is an acute febrile illness and often can present with multi-organ dysfunction. The primary objective of the study was to find out its clinical presentation and associated complications and secondary objectives for the response to therapy in relation to severity of disease and observe the mortality.</p><p><strong>Methods: </strong>This was a prospective observational study conducted in children, aged 1 - 18 years, with diagnosis of scrub typhus at a tertiary -care center. The diagnosis of Scrub typhus was based on compatible clinical presentation and positive specific IgM antibody titer.</p><p><strong>Results: </strong>Seventy children with scrub typhus (males 67.1%), median age of 9 years (interquartile range 5 - 13) presented with fever (100%), abdominal pain (54.2%), vomiting (38.6%), cough (32.8%), and rash (22.8%). On examination, hepatomegaly (67.1%), pallor (61.4%), conjunctival congestion (60%) and splenomegaly (52.8%) were the predominant features. Nearly half of cases had fluid retention (45.7%), with respiratory distress (38.5%), myocarditis (31.4%), secondary hemophagocytic lymphohistiocytosis (28.6%), shock (25.7%), acute kidney injury (18.6%), and encephalitis (18.6%). Parenteral doxycycline was given along with supportive measures such as oxygen therapy, respiratory support, diuretic, and vasopressors. Patients having three or four of severe manifestations (fluid retention, myocarditis, shock and hemophagocytic lymphohistiocytos) had almost 17 - 18 times probability of late response to doxycycline in contrast to those who had two severe features (nearly 14 times, P = 0.001). Mortality was in 4.3% of cases.</p><p><strong>Conclusion: </strong>Scrub typhus is a serious infection presenting with multi-system involvement. Prompt therapy with Doxycycline along with supportive therapy help in better outcome.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction to: Peer Training Increases the Level of Knowledge on Sexual and Reproductive Health in Adolescents.","authors":"","doi":"10.1093/tropej/fmag024","DOIUrl":"https://doi.org/10.1093/tropej/fmag024","url":null,"abstract":"","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147690990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiac alterations associated with multisystem inflammatory syndrome in children related to COVID-19: a cross-sectional study from the Colombian Caribbean.","authors":"Melissa Rivero Roca, Gennys Gutiérrez Ramírez, Aida Luz Figueroa Reyes, Mauricio Guerrero Román, Jaime Plazas Román, Carlos M Ardila","doi":"10.1093/tropej/fmag029","DOIUrl":"https://doi.org/10.1093/tropej/fmag029","url":null,"abstract":"<p><p>Multisystem inflammatory syndrome in children (MIS-C) is a severe hyperinflammatory condition that follows SARS-CoV-2 infection, characterized by persistent fever and multi-organ dysfunction. Cardiac involvement occurs in 67%-80% of cases, representing a critical clinical concern. Data from tropical and Caribbean regions remain limited in the global MIS-C literature. We conducted a cross-sectional study with retrospective data collection at Hospital Infantil Napoleón Franco Pareja, Colombia. Included patients were <18 years with a MIS-C diagnosis per WHO/CDC/RCPCH criteria and positive SARS-CoV-2 serology. Cardiac involvement was defined by elevated troponin, abnormal echocardiography, or electrocardiogram changes. Among n = 105 patients (median age 5 years, 61% male), cardiac involvement occurred in 25.7% (n = 27). The median number of affected organ systems was 4 (IQR: 3-4). Coronary artery dilation was the predominant cardiac finding (37.0% of cardiac cases), followed by mitral regurgitation and elevated troponin (both 33.3%). No patients showed left ventricular ejection fraction <55%. Treatment included corticosteroids (92.4%), acetylsalicylic acid (91.4%), and immunoglobulin (70.5%). All patients survived to discharge (100% survival). One-month follow-up revealed persistent coronary dilation in 2.9%. MIS-C affects multiple organ systems with coronary artery dilation as the predominant cardiac manifestation in our population. Favorable acute outcomes were observed with the current management protocols, including 100% survival and brief hospitalizations. However, persistent cardiac abnormalities in a subset of patients emphasize the need for systematic cardiac surveillance. These findings from a tropical Caribbean population provide insights applicable to resource-limited settings in other low- and middle-income countries.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Acceptability and efficacy of low-dose zinc with or without probiotics in acute watery diarrhoea-a prospective comparative study.","authors":"Praveen Kumar P, Podhini Jegadeesan, Shanthi Ananthakrishnan","doi":"10.1093/tropej/fmag025","DOIUrl":"https://doi.org/10.1093/tropej/fmag025","url":null,"abstract":"<p><p>Acute watery diarrhoea (AWD) has not been well-treated with 20 mg elemental zinc, primarily because of adverse symptoms like vomiting. In contrast to 20 mg of zinc, this study sought to determine whether a lower dose of zinc, with or without probiotics, is as beneficial as 20 mg of zinc, yet tolerated better. The aim of this study was to compare the acceptability and efficacy of low-dose zinc (10 mg) with or without probiotics to the acceptability and efficacy of standard-dose zinc (20 mg) in children diagnosed with AWD. A prospective comparative study was conducted among children aged 6 months to 5 years with AWD at a tertiary healthcare centre. Eligible children were randomized into three groups: Group Z20 and Z10 were administered zinc acetate 20 mg/day and 10 mg/day, respectively, and Group Z10P with 10 mg/day with probiotics. Caregivers were followed daily via telephonic interviews for 14 days to record symptoms, adverse reactions, and treatment completion. Data were analyzed using Kruskal-Wallis test, one-way ANOVA, and the chi-square test. A total of 147 children were enrolled (49 in each group). The mean duration of AWD at enrollment was 3 ± 1.5 days, and the mean frequency was 5 ± 2 episodes/day. There was no significant difference in the mean duration of diarrhoea among the groups. The most common adverse reactions reported was vomiting (85%). Diarrhoea resolved within 3 days in 22.4% of Group Z10P, 10.2% of Group Z20, and 2% of Group Z10 (P = .03). Low-dose zinc (10 mg/day) was less effective than 20 mg zinc in controlling AWD. However, the combination of 10 mg zinc with probiotics significantly improved efficacy.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147775209","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A growing crisis of neonatal hyperosmolar-hypernatremic dehydration during heat waves: clinical insights from a semi-arid region.","authors":"Swasthi Kabi Satpathy, Choudri Muzafar Paswal, Arun Kumarendu Singh, Neeraj Gupta, Sushil Kumar Choudhary","doi":"10.1093/tropej/fmag028","DOIUrl":"https://doi.org/10.1093/tropej/fmag028","url":null,"abstract":"<p><p>Hyperosmolar-hypernatremic dehydration (HHND) is a life-threatening yet preventable neonatal condition, often due to inadequate breastfeeding. The recent North Indian heat wave heightened dehydration risks, necessitating an evaluation of extreme temperatures' impact on neonatal hydration. This retrospective study analysed neonates admitted to a tertiary care level 3 neonatal intensive care unit (NICU) at AIIMS Jodhpur between April and June 2024. Case records were reviewed, and details on maternal age, feeding practices, presenting complaints, biochemical profile, and outcome were studied. The 2024 (April-May) heat wave led to a threefold increase in NICU admissions for HND compared to the previous 2 years, with cases rising from 2 to 3 per year to 10. Primigravida mothers accounted for 70% of the cases. The mean age of presentation was 6.7 days. Affected neonates experienced weight loss ranging from 11% to 33%, with serum sodium levels between 149 and 185 mEq/l and plasma osmolarity reaching 370-450 mOsm/l. Six neonates required peritoneal dialysis (PD) due to encephalopathy/anuria. One developed aortic thrombosis with lower limb gangrene, necessitating thrombolytic therapy. MRI abnormalities were observed in one case. Despite intensive management, one neonate succumbed to sepsis. Extreme environmental heat significantly heightens the risk of hyperosmolar-hypernatremic dehydration (HND) in neonates. Proactive neonatal monitoring, early breastfeeding support, and parental education are critical to preventing dehydration and its complications, especially in tropical and resource-limited settings, where extreme heat, early discharge, and limited lactation support increase neonatal vulnerability. Judicious fluid management targeting plasma osmolarity and timely intervention with PD in severe cases can optimize survival and neurological outcomes, underscoring the need for heightened vigilance during heat waves.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147817061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transforming habits, transforming health: a behaviour-centred WASH intervention in the urban slums of Darjeeling, India.","authors":"Aarif Hussain, Sampriti Samanta, Sharmistha Bhattacherjee","doi":"10.1093/tropej/fmag026","DOIUrl":"https://doi.org/10.1093/tropej/fmag026","url":null,"abstract":"<p><p>Water, sanitation, and hygiene (WASH) promotion helps to prevent common childhood illnesses through behaviour change. The study assessed the effectiveness of a WASH education in improving household WASH practices in an urban slum of Darjeeling, West Bengal. A quasi-experimental intervention involving interactive discussions, role-playing, and live demonstrations was conducted among 75 households with children under 10 years of age. Baseline and endline behaviours were compared for any significant changes. A composite WASH score was applied to assess the intervention's effect between baseline and endline. Post-WASH intervention, significant improvements in water handling, sanitation, and hygiene behaviours were observed (P-value <.05). Key changes included increased use of clean, covered water containers, improved sanitation practices, safe waste disposal, and better personal hygiene. Overall, the mean WASH score rose significantly from baseline to endline (11.40 ± 5.25 vs 17.20 ± 5.28 respectively; P = .000). The prevalence of common childhood illnesses was assessed at baseline and at endline, with a statistically significant reduction in diarrhoea and skin infections at endline (P = .001 for both). Socioeconomic status was a significant predictor of behaviour change (adjusted R2=0.17, P-value <.05). Community-based WASH interventions significantly improved WASH practices among children and caregivers and reduced childhood diarrhoea and skin infections in urban slums of Darjeeling.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147674525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of academic performance of primary school children presenting with strabismus and/or amblyopia in Nigeria with age- and sex-matched classmates.","authors":"Glory C Ojinnaka, Onochie I Okoye, Ngozi C Ojinnaka, Ifeoma R Ezegwui","doi":"10.1093/tropej/fmag027","DOIUrl":"https://doi.org/10.1093/tropej/fmag027","url":null,"abstract":"<p><p>To compare the academic performance of urban primary school children with strabismus and/or amblyopia seen at the Eye Clinic of University of Nigeria Teaching Hospital (UNTH), Ituku-Ozalla, Enugu, Nigeria, with that of their controls. In this comparative cross-sectional study, conducted in 2022, 92 primary school children with strabismus and/or amblyopia were consecutively recruited from UNTH Ituku-Ozalla, Enugu. They were compared with 92 age- and sex-matched classmates from schools who had normal visual acuity (6/6) and no strabismus. The academic performance of participants was evaluated using the average of individual subject scores in Mathematics, English, Science, and Social Studies, and the average overall scores in the three terms of an academic session. Scores of ≥75%, were classified as high academic performance; 50%-74%, was classified as average; and scores of <50%, was classified as poor. Student's t-test was used for comparison of means. The chi-square test/Fisher's exact test, as appropriate, was used for categorical variables. The level of statistical significance was set at P < .05. Patients and controls had an average overall score of 84.52 ± 11.35 and 83 ± 12.56, respectively, with no statistically significant difference. The majority of the patients (81.5%) had high academic performance. The lowest mean score was in mathematics for both groups. Patients had high academic performance with no statistically significant difference between that of the patients and their controls. Of all the school topics, both patient and control groups had the lowest mean scores in mathematics, with patients scoring lower than the controls.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 3","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147723100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Burden, challenges, and control of malaria among under-5s in Nigeria.","authors":"Lenz Nwachinemere Okoro, Innocent Ayesiga, Michael Oppong Yeboah, Naya Gadzama Bulus, Jonathan Mawutor Gmanyami, Esther Ladidi Ismaila, Ovye Ahgu, Elijah Ogbu Otokpa, Eneh Nchiek Edet, Joy Malle Dogo, Tom Didimus Ediamu, Lorna Atimango, Isaac Isiko","doi":"10.1093/tropej/fmag014","DOIUrl":"https://doi.org/10.1093/tropej/fmag014","url":null,"abstract":"<p><p>Malaria remains a leading cause of morbidity and mortality among children under five years in Nigeria, a country accounting for over a quarter of global malaria cases. Despite the availability of interventions, Nigeria continues to face persistent challenges in controlling malaria, especially in the under-five population, thus, the need for this review. This narrative review synthesizes peer-reviewed literature, national reports, and policy documents published since 2010. A structured search was conducted across PubMed, Google Scholar, Scopus, and relevant grey literature from the WHO, UNICEF, and the Nigerian Ministry of Health. The review adhered to SANRA guidelines to ensure methodological rigour and focused on studies reporting malaria epidemiology, interventions, and control efforts targeting children under five in Nigeria. Findings revealed a high malaria burden among children in Nigeria, with notable regional disparities. Northern states report the highest prevalence, with rural areas disproportionately affected. Contributing factors include socioeconomic deprivation, climate variability, and suboptimal coverage of interventions. Key challenges include diagnostic limitations, drug resistance, and inconsistent use of preventive measures. While interventions such as long-lasting insecticidal nets (LLINs), intermittent preventive therapy, and indoor residual spraying have shown effectiveness, gaps remain in coverage and implementation. Innovations in diagnostics, vaccines, and surveillance systems are promising but underutilized. Despite progress, Nigeria faces multifaceted challenges in malaria control among under-fives. A coordinated, multisectoral response involving innovative strategies, stronger health systems, and policy reforms is essential. Attention must also be directed to enhancing the acceptability, fidelity, and longevity of these interventions.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147290115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinico-etiological profile and prognostic factors of acute febrile encephalopathy in children: a prospective study from Indian subcontinent.","authors":"Chandrika Azad, Nidhi Singla, Jasmine Singh, Vishal Guglani, Ravinder Kaur, Shivangi Sharma, Sukhvinder Singh, Anjali Yadav","doi":"10.1093/tropej/fmag018","DOIUrl":"https://doi.org/10.1093/tropej/fmag018","url":null,"abstract":"<p><p>Acute febrile encephalopathy (AFE) is a common neurological emergency in all age groups. In tropical regions, long-standing infections such as Japanese encephalitis and bacterial meningitis continue to be major causes of AFE, while changing presentations of familiar infections and newly emerged diseases like COVID-19 are also becoming increasingly notable. To describe various clinical presentations, etiology and mortality of AFE in pediatric age group. This prospective observational study was undertaken in a tertiary care institute of Northern India from April 2022 to April 2023. Children aged 1 month to 18 years presenting to the pediatric emergency department with fever of <2 weeks duration and altered sensorium lasting >24 hours were eligible for inclusion. A total of 100 patients (49% males) with AFE were enrolled. The mean (SD) duration of encephalopathy was 1.39 (0.69) days. The most frequent etiologies were viral encephalitis (17%), dengue encephalopathy (12%), and hepatic encephalopathy (9%). The peak incidence occurred between August and November. The overall case fatality rate was 33%. Under-5 children with severe acute malnutrition (SAM) had the highest fatality rate (56%, 9/16). Among survivors, 16% (11/67) had poor functional outcomes. Higher odds of mortality were observed in patients with a Glasgow coma scale score <8, hypoglycemia at admission, requirement for mechanical ventilation or inotropic support, and presence of multiorgan dysfunction. AFE demonstrates a predictable seasonal pattern and is associated with high mortality and morbidity, particularly in under-5 children with SAM, who represent the most vulnerable group.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147498881","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A systematic review and meta-analysis of the diagnostic accuracy of ultrasound in the diagnosis of paediatric tuberculosis.","authors":"Isabelle Munyangaju, Lucía Carratalà-Castro, Dulce Osório, Jacob Bigio, Kondwelani John Mateyo, Bryan J Vonasek, Danilo Buonsenso, Quique Bassat, Xavier Serres-Créixams, Isabelle Thierry-Chef, Alberto Garcia-Basteiro, Madhukar Pai, Elisa Lopez-Varela","doi":"10.1093/tropej/fmag021","DOIUrl":"https://doi.org/10.1093/tropej/fmag021","url":null,"abstract":"<p><p>Diagnosing tuberculosis (TB) in children is challenging due to non-specific symptoms, paucibacillary disease, and difficulty producing sputum. Chest X-rays (CXRs), though widely used, are often inaccessible in low-resource settings and involve radiation. Ultrasound (US) is a radiation-free, portable, and potentially low-cost alternative that can detect pulmonary and extrapulmonary TB features. However, its diagnostic accuracy in paediatric TB remains unclear. This systematic review and meta-analysis assessed US diagnostic performance for paediatric TB across anatomical sites. Following PRISMA-DTA guidelines, we searched five databases through May 2025. Studies were included if they involved children under 15 with presumptive TB and reported US diagnostic accuracy data. Data extraction, quality assessment (QUADAS-2), and meta-analyses using a bivariate random-effects model were conducted. Graham's TB classification served as the reference standard. CXR was used as a comparator where available, with agreement assessed via Cohen's kappa. Of 17 019 records, 7 studies involving 945 children met inclusion criteria. Pooled US sensitivity was 52% (95% CI: 46-58%), and specificity was 76% (95% CI: 67-83%). US showed high specificity but low sensitivity across most features, including abdominal lymphadenopathy and pericardial effusion; pleural effusion had slightly higher sensitivity (18%). Agreement with CXR was moderate (kappa 0.24-0.42). Variability in US protocols, operator skills, and reference standards limited generalizability. Only one study had low risk of bias across all QUADAS-2 domains. US is a promising adjunct for paediatric TB diagnosis in resource-limited settings, but standardization and validation are needed to improve its standalone utility.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"72 2","pages":""},"PeriodicalIF":1.1,"publicationDate":"2026-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147494182","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}