Annals of Tropical Paediatrics最新文献

{"title":"Missed opportunities for prevention of tuberculosis in children.","authors":"S M Graham","doi":"10.1179/146532811X13142348016691","DOIUrl":"https://doi.org/10.1179/146532811X13142348016691","url":null,"abstract":"All children with tuberculosis (TB) represent a missed opportunity for preventive therapy — theoretically. Of course, not all children with TB will have an identifiable source case because, in TB-endemic settings, exposure and infection do occur to varying degrees beyond the known, inner circle of the ‘household’. Nonetheless, risk factors for TB infection are well known and include clinical characteristics of the source case such as degree of sputum smear-positivity along with closeness and duration of contact. Risk factors for developing disease following infection are also recognised and the risk to children is greatest in the youngest and the immunosuppressed. These risk factors provide the logic for the importance given to a contact history in the clinical approach to diagnosis of TB in young children and for the universally recommended contact-screening. Contact screening has two main aims: (1) to identify contacts of any age who are symptomatic and so need further investigation and management for possible TB disease, and (2) contacts who do not have active TB disease but require preventive therapy (or chemoprophylaxis) because they are at high risk of disease following infection. Preventive therapy has proven efficacy in significantly reducing the risk of disease in high-risk groups and is widely recommended for child contacts who are young (0–4 years) or HIVinfected irrespective of age. However, proven effectiveness of preventive therapy in child contacts in the high-burden setting is not established because contact-screening and management are rarely implemented. A study by Du Preez et al. in this issue of Annals of Tropical Paediatrics highlights again the lack of routine implementation of chemoprophylaxis while providing original and important data on its potential effectiveness. The data are considerably strengthened by microbiological confirmation of TB diagnosis in all children included in the study. Of those eligible for preventive therapy, the majority (71%) represented a missed, recorded opportunity with the source case commonly being a parent. The study emphasises the importance of young age as an opportunity and as a consequence of missed opportunity. Most identifiable, missed opportunities were in children aged ,3 years. This is expected, given the increased likelihood of the contact being known to the young child compared with older, more socially mobile children. Further, disseminated disease and death were common in this same group of infants and young children. Timely provision of preventive therapy would have prevented up to 200 of the reported TB cases and a number of TB-related deaths. As acknowledged by the authors, a limitation of the study is the uncertain accuracy of the contact history data collected retrospectively from medical records. However, this might have resulted in under-reporting, thereby providing an underestimate of missed opportunities rather than over-reporting because recording was not prospective or","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 4","pages":"297-9"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/146532811X13142348016691","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40117446","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":"Perinatal tuberculosis: four cases and use of broncho-alveolar lavage.","authors":"A Parakh,&nbsp;R Saxena,&nbsp;R Thapa,&nbsp;G R Sethi,&nbsp;S Jain","doi":"10.1179/146532811X12925735813841","DOIUrl":"https://doi.org/10.1179/146532811X12925735813841","url":null,"abstract":"<p><p>Despite the high prevalence of tuberculosis in adults and children, congenital and perinatal forms of tuberculosis are rare. Four patients with perinatal tuberculosis are described. Diagnosis was made by demonstration of acid-fast bacilli (AFB) on broncho-alveolar lavage (BAL) specimens (two cases), gastric aspirate smear (one case) and lymph node fine-needle aspirate (one case). All of the above specimens were subsequently positive on culture. Two infants died of progressive pulmonary failure, and one of the mothers died, despite the institution of anti-tuberculous therapy. BAL specimen examination for AFB is useful in the diagnosis of perinatal tuberculosis, especially in infants with smear-negative gastric aspirate.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"75-80"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/146532811X12925735813841","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29621854","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":"Auto-immune haemolytic anaemia concurrent with Plasmodium vivax infection: a case report.","authors":"R Sitcharungsi,&nbsp;U Anurathapan,&nbsp;N Sirachainan,&nbsp;P Chanthavanich","doi":"10.1179/1465328110Y.0000000003","DOIUrl":"https://doi.org/10.1179/1465328110Y.0000000003","url":null,"abstract":"<p><p>A 7-month-old Myanmar boy was admitted with a 3-day history of fever. He was markedly pale and his temperature was 38·2°C. Peripheral blood smear demonstrated Plasmodium vivax infection with spherocytosis and auto-agglutination of red blood cells. Haematocrit was 16% and reticulocyte count 14·9%. Direct and indirect antiglobulin tests were positive. Antibody analysis was positive for auto-antigen I. P. vivax malaria with auto-immune haemolytic anaemia (AIHA) was diagnosed. He was treated with chloroquine and primaquine for the P. vivax infection, and oral prednisolone for the AIHA. Because of the clinical symptoms of anaemia and mild dyspnoea, blood with the least incompatible red blood cells was transfused. The clinical symptoms and signs improved. At follow-up 3 and 7 weeks after treatment, his haematocrit, reticulocyte count and peripheral blood smear results were within normal limits. Prednisolone was then tapered and stopped. The patient has since been well with no detectable recurrence of AIHA.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"87-91"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328110Y.0000000003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29621856","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":"Exertional rhabdomyolysis after influenza A (H3N2) infection in a basketball player boy.","authors":"E Sevketoglu,&nbsp;B Kural,&nbsp;A E Beskardes,&nbsp;S Hatipoglu","doi":"10.1179/1465328110Y.0000000005","DOIUrl":"https://doi.org/10.1179/1465328110Y.0000000005","url":null,"abstract":"<p><p>A 14-year-old professional basketball player developed symptoms of influenza which was subsequently confirmed to be caused by influenza A (H3N2). He was given a 5-day course of oseltamivir. Two days after completing the course, he resumed basketball and developed rhabdomyolysis associated with acute renal failure and disseminated intravascular coagulation. This appears to be the first report of exercise-induced rhabdomyolysis associated with influenza A (H3N2).</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"93-6"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328110Y.0000000005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29621857","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":"Prevalence of rheumatic heart disease among school-children in Aden, Yemen.","authors":"I A Ba-Saddik,&nbsp;A A Munibari,&nbsp;M S Al-Naqeeb,&nbsp;C M Parry,&nbsp;C A Hart,&nbsp;L E Cuevas,&nbsp;J B S Coulter","doi":"10.1179/1465328110Y.0000000007","DOIUrl":"https://doi.org/10.1179/1465328110Y.0000000007","url":null,"abstract":"<p><strong>Background: </strong>Rheumatic heart disease (RHD) is an important contributor to cardiovascular disease in children and adults in Yemen. This is the first report to determine the prevalence of RHD among school-children in the city of Aden.</p><p><strong>Methods: </strong>A cross-sectional case-finding survey of RHD was conducted in 6000 school-children aged 5-16 years. Echocardiography was undertaken in those with clinical signs of organic heart disease.</p><p><strong>Results: </strong>The prevalence of RHD was 36·5/1000 school-children, which is one of the highest reported among school echocardiography surveys in the world. RHD was more common in 10-16-year-old students. RHD was diagnosed in more than one member of the families of 53 (24·2%) of the children. Mitral regurgitation (MR) was detected in 49·8%, 26·6% had MR with mitral valve prolapse and 17·8% had combined MR and aortic regurgitation. Fifty-eight children were diagnosed with congenital heart disease (CHD), representing a prevalence of 9·7/1000. The main types of CHD were mitral valve prolapse, patent ductus arteriosus, atrial septal defect, pulmonary stenosis and aortic stenosis. Congenital mitral valve prolapse found in 36 children was three times more common in males than females. Children with RHD were more likely to be from low-income families with poor housing and greater overcrowding (49·3%, 39·3% and 64·8%) than children with CHD (44·8%, 32·8% and 48·3%, respectively).</p><p><strong>Conclusions: </strong>The high prevalence of RHD is a major public health problem in Yemen. Urgent screening surveys and an RHD prophylactic programme of appropriate management of group A β-haemolytic streptococcal pharyngotonsilitis are required.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"37-46"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328110Y.0000000007","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29622402","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 role of Helicobacter pylori infection in gastro-oesophageal reflux in Iranian children.","authors":"A Abdollahi,&nbsp;A Morteza,&nbsp;O Khalilzadeh,&nbsp;A Zandieh,&nbsp;M Asgarshirazi","doi":"10.1179/1465328110Y.0000000004","DOIUrl":"https://doi.org/10.1179/1465328110Y.0000000004","url":null,"abstract":"<p><strong>Background: </strong>The relationship between Helicobacter pylori and gastro-oesophageal reflux disease (GORD) in children is controversial.</p><p><strong>Aim: </strong>To determine the role of H. pylori infection and GORD in children living in a region which is endemic for H. pylori infection.</p><p><strong>Methods: </strong>A cross-sectional study was undertaken in 263 children aged 3-18 years, all of whom had symptoms of GORD and underwent upper gastro-intestinal endoscopy. H. pylori status was determined by conventional rapid urease test and Giemsa staining of antral and cardiac biopsies. Biopsies of the oesophagus and gastric mucosa were obtained from the lower oesophagus, the antrum and cardia according to standard protocol.</p><p><strong>Results: </strong>Of the 263 patients, 81 (31·5%) had GORD and 162 (61·5%) had gastritis. There were 59 H. pylori-infected patients (22·4%) and 204 were uninfected. H. pylori infection was detected in 52 (88·1%) of the antral and 10 (1·9%) of the cardiac biopsies. Three (5·1%) of the biopsies revealed infection of both antrum and cardia and in seven (11·8%) only the cardia was infected. The prevalence of H. pylori infection among patients with GORD (13/83, 15%) was significantly lower than in those without GORD (46/180, 26%) (OR 0·54, CI 0·27-0·93, p<0·05). The prevalence of H. pylori infection among those with gastritis (48/162, 30%) was significantly higher than in those without gastritis (11/101, 10·8%) (OR 3·44, CI 1·69-7·015, p<0·001).</p><p><strong>Conclusion: </strong>H. pylori infection might protect against GORD.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"53-7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328110Y.0000000004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29622404","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":"Steroid-unresponsive hypereosinophilic syndrome.","authors":"A Srinivasan,&nbsp;R Lavanya,&nbsp;J Sankar","doi":"10.1179/1465328111Y.0000000027","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000027","url":null,"abstract":"<p><p>Hypereosinophilic syndrome in children is rare and is characterised by sustained over-production of eosinophils. An 11-year-old boy was diagnosed with hypereosinophilic syndrome as per standard criteria. He was treated initially with intravenous methylprednisolone, followed by oral prednisolone, to which he showed a limited response. The highest absolute eosinophil count was 27.0×10(9)/L. He was commenced on imatinib mesylate but, because of no response, he was switched to hydroxyurea combined with low-dose prednisolone to which he showed improvement with decreasing levels of eosinophils.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"273-7"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025429","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":"Long-term immunity after hepatitis B vaccination.","authors":"Rashmi Ranjan Das","doi":"10.1179/1465328111Y.0000000026","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000026","url":null,"abstract":"I read with interest the article by Metodi et al. In a cross-sectional study, the authors found that more than two-thirds of children under 5 years age who had received DPTHB at 4, 8 and 12 weeks of age had protective anti-HBs levels. On this basis, they suggested changes in the hepatitis B immunisation schedule. A few points require comment. The authors found a lower rate of seroprotection in vaccinated children than in those reported from The Gambia and Turkey. They postulated that the variation might be owing to differences in immunisation schedules, with the birth dose being included in both of the latter studies which included younger children than in their study. However, this is not necessarily true if we consider some recent studies. One half of the children who received a birth dose of hepatitis B vaccine did not have evidence of immune memory as measured by development of anamnestic responses to the booster dose 15 years after vaccination. In another study, 5 years after immunisation with a hexavalent vaccine at 3, 5 and 11 months of age, immunological memory was found to have persisted, suggesting that booster doses are not needed. So neither the sero-protection nor the duration of immunity depends upon the schedule administering a birth dose of vaccine. Antibody persistence and duration of protection against infection are directly proportional to the peak antibody concentration after primary immunisation. Although most children with low peak concentrations lose their antibodies within a few years, they are not at risk of hepatitis as long as they have immunological memory for HBsAg. Memory persists beyond the time at which antibodies are present and protects against disease. The authors’ suggestion of a change in the HB immunisation schedule including a dose immediately after birth to improve immunity is also not supported, as found by our study. In a randomised trial comparing two hepatitis B vaccination schedules (0, 6 and 14 weeks and 6, 10 and 14 weeks), we found that 97.3% of infants in the former group were sero-protected with a geometric mean anti-HBs titre (GMT) of 113.78 mIU/ml vs 94.6% in the latter group (GMT 107.04 mIU/ml) (p50.8). Many other studies which include the birth dose of vaccine have reported similar results, although they have used different schedules. The authors also state that immunological response to the HBV vaccine increases with increasing intervals between the first and third doses, but it is the interval between the second and third doses of vaccine which is associated with improved immunity. Usually, the first two doses are sufficient to initiate the production of antibodies against HBsAg, thereby priming the immune system for a secondary response. The third dose stimulates this secondary response, resulting in a further accelerated response and higher antibody titre than after the first two doses. This is the basis for the conventional 0, 1, 6 months schedule. Finally, the authors’ description of red","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 3","pages":"279-80"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"30025430","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":"Relationship of household food insecurity to anaemia in children aged 6-59 months among families in rural Indonesia.","authors":"A A Campbell,&nbsp;N Akhter,&nbsp;K Sun,&nbsp;S De Pee,&nbsp;K Kraemer,&nbsp;R Moench-Pfanner,&nbsp;J H Rah,&nbsp;J Badham,&nbsp;M W Bloem,&nbsp;R D Semba","doi":"10.1179/1465328111Y.0000000038","DOIUrl":"https://doi.org/10.1179/1465328111Y.0000000038","url":null,"abstract":"<p><strong>Background: </strong>Anaemia is a significant global public health problem in developing countries with adverse health effects on young children. Household food insecurity, which reflects a household's access, availability and utilisation of food, has not been well characterised in relation to anaemia in children.</p><p><strong>Objective: </strong>To examine the relationship of household food insecurity with anaemia (Hb <11 g/dl) in children.</p><p><strong>Methods: </strong>In a cross-sectional study of 4940 rural households participating in the Indonesian Nutrition Surveillance System, household food insecurity was measured using a modified 9-item food security questionnaire and related to anaemia in children aged 6-59 months.</p><p><strong>Results: </strong>The proportion of households with an anaemic child was 56·6%. In households with and without anaemic children, the mean (SD) food insecurity score was 1·82 (1·72) vs 1·55 (1·54) (p<0·0001), respectively. In a multivariate logistic regression model, food insecurity score was related to anaemia in children (odds ratio 0·77, 95% confidence interval 0·63-0·95, p=0·01) when the highest quintile of food insecurity score was compared with the lowest quintile, adjusting for potential confounders.</p><p><strong>Conclusion: </strong>A higher household food insecurity score is associated with greater prevalence of anaemia in children in rural families in Indonesia.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 4","pages":"321-30"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328111Y.0000000038","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40117366","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":"Safety and efficacy of deferasirox in multitransfused Indian children with β-thalassaemia major.","authors":"J Chandra,&nbsp;H Chaudhary,&nbsp;H Pemde,&nbsp;V Singh,&nbsp;A K Dutta","doi":"10.1179/1465328110Y.0000000002","DOIUrl":"https://doi.org/10.1179/1465328110Y.0000000002","url":null,"abstract":"<p><strong>Background: </strong>Iron chelation is an important component of management of transfusion-dependent patients with thalassaemia major. Deferasirox is a relatively new oral iron chelator and experience of its use in children is limited.</p><p><strong>Aim: </strong>To report experience with deferasirox in north Indian children with β-thalassaemia major.</p><p><strong>Methods: </strong>This prospective study included 40 patients with transfusion-dependent β-thalassaemia major. The patients were receiving deferiprone alone (37 patients) or deferiprone and desferrioxamine combination (three patients) before commencing deferasirox. Patients were clinically monitored every month. Information on side-effects including gastro-intestinal symptoms, skin rash or discoloration, jaundice and complaints regarding vision and hearing were obtained from patient records. Laboratory investigations included complete blood count and renal and liver function tests estimated at baseline and then every month. Serum ferritin level was estimated at baseline and then every 3 months. The initial dose of deferasirox was 20 mg/kg/body weight and was increased to 25 mg/kg if serum ferritin remained unchanged or increased 3 months after deferasirox therapy.</p><p><strong>Results: </strong>Therapy with deferasirox in 40 children was well tolerated. Gastro-intestinal symptoms were the most common side-effects. Nausea, vomiting and abdominal pain were observed in 25%, 20% and 15% patients, respectively. Skin rashes were seen in 5% cases. We observed greyish-brown pigmentation of the skin in four (10%) children which has not been described before. A non-progressive rise in serum creatinine was observed in 16 (40%) patients. In the majority, however, serum creatinine remained within the normal range. Leucopenia, neutropenia and thrombocytopenia were not observed. None of the side-effects necessitated cessation of the drug therapy. Serum ferritin levels fell in 24 of 32 patients (75%) who received deferasirox for over 1 year from a mean (SD) 6323·37 (2756·5) μg/L to 5458·91 (2301·2) μg/L (p<0·05).</p><p><strong>Conclusions: </strong>Therapy with deferasirox is safe in paediatric patients with thalassaemia major. However, they should be carefully monitored for side-effects.</p>","PeriodicalId":50759,"journal":{"name":"Annals of Tropical Paediatrics","volume":"31 1","pages":"47-51"},"PeriodicalIF":0.0,"publicationDate":"2011-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1465328110Y.0000000002","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"29622403","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}