Publications by authors named "Maryam Edalatifard"

14 Publications

  • Page 1 of 1

Interpretation of Hematological, Biochemical, and Immunological Findings of COVID-19 Disease: Biomarkers Associated with Severity and Mortality.

Iran J Allergy Asthma Immunol 2021 Feb 11;20(1):46-66. Epub 2021 Feb 11.

Department of Biostatistics and Social Medicine, Zanjan University of Medical Sciences, Zanjan, Iran.

The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) spread rapidly all over the world in late 2019 and caused critical illness and death in some infected patients. This study aimed at examining several laboratory factors, especially inflammatory and immunological mediators, to identify severity and mortality associated biomarkers. Ninety-three hospitalized patients with confirmed coronavirus disease 2019 (COVID-19) were classified based on disease severity. The levels of biochemical, hematological, immunological, and inflammatory mediators were assessed, and their association with severity and mortality were evaluated. Hospitalized patients were mostly men (77.4%) with an average (standard deviation) age of 59.14 (14.81) years. The mortality rate was significantly higher in critical patients (85.7%). Increased serum levels of blood sugar, urea, creatinine, uric acid, phosphorus, total bilirubin, serum glutamic-oxaloacetic transaminase, serum glutamic-oxaloacetic transaminase, lactic dehydrogenase, C-reactive protein, ferritin, and procalcitonin were significantly prevalent (p=0.002, p<0.001, p<0.001, p=0.014, p=0.047, p=0.003, p<0.001, p<0.001, p<0.001, p<0.001, P<0.001, and p<0.001, respectively) in COVID-19 patients. Decreased red blood cell, hemoglobin, and hematocrit were significantly prevalent among COVID-19 patients than healthy control subjects (p<0.001 for all). Troponin-I, interleukin-6, neutrophil/lymphocyte ratio (NLR), procalcitonin, and D-dimer showed a significant association with the mortality of patients with specificity and sensitivity more than 60%. Age, sex, underlying diseases, blood oxygen pressure, complete blood count along with C-reactive protein, lactic dehydrogenase, procalcitonin, D-dimer, and interleukin-6 evaluation help to predict the severity and required management for COVID-19 patients. Further investigations are highly recommended in a larger cohort study for validation of the present findings.
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http://dx.doi.org/10.18502/ijaai.v20i1.5412DOI Listing
February 2021

Reply: Is high-dose glucocorticoid beneficial in COVID-19?

Eur Respir J 2021 04 15;57(4). Epub 2021 Apr 15.

Rheumatology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

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http://dx.doi.org/10.1183/13993003.00324-2021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7898159PMC
April 2021

Clinical Characteristics and Outcomes of 905 COVID-19 Patients Admitted to Imam Khomeini Hospital Complex in the Capital City of Tehran, Iran.

Arch Iran Med 2020 11 1;23(11):766-775. Epub 2020 Nov 1.

Cancer Research Center, Cancer Institute of Iran, Tehran University of Medical Sciences, Tehran, Iran.

Background: We studied the clinical characteristics and outcomes of 905 hospitalized coronavirus disease 2019 (COVID-19) patients admitted to Imam Khomeini Hospital Complex (IKHC), Tehran, Iran.

Methods: COVID-19 patients were recruited based on clinical symptoms and patterns of computed tomography (CT) imaging between February 20 and March 19. All patients were tested for the presence of COVID-19 RNA. The Poisson regression model estimated the incidence rate ratio (IRR) for different parameters.

Results: The average age (± standard deviation) was 56.9 (±15.7) years and 61.77% were male. The most common symptoms were fever (93.59%), dry cough (79.78%), and dyspnea (75.69%). Only 43.76% of patients were positive for the RT-PCR COVID-19 test. Prevalence of lymphopenia was 42.9% and more than 90% had elevated lactate dehydrogenase (LDH) or C-reactive protein (CRP). About 11% were severe cases, and 13.7% died in the hospital. The median length of stay (LOS) was 3 days. We found higher risks of mortality in patients who were older than 70 years (IRR = 11.77, 95% CI 3.63-38.18), underwent mechanical ventilation (IRR = 7.36, 95% CI 5.06-10.7), were admitted to the intensive care unit (ICU) (IRR = 5.47, 95% CI 4.00-8.38), tested positive on the COVID-19 test (IRR = 2.80, 95% CI 1.64-3.55), and reported a history of comorbidity (IRR = 1.76, 95% CI 1.07-2.89) compared to their corresponding reference groups. Hydroxychloroquine therapy was not associated with mortality in our study.

Conclusion: Older age, experiencing a severe form of the disease, and having a comorbidity were the most important prognostic factors for COVID-19 infection. Larger studies are needed to perform further subgroup analyses and verify high-risk groups.
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http://dx.doi.org/10.34172/aim.2020.102DOI Listing
November 2020

Coronavirus and Its effect on the respiratory system: Is there any association between pneumonia and immune cells.

J Family Med Prim Care 2020 Sep 30;9(9):4729-4735. Epub 2020 Sep 30.

Advance Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: With a new mutation, coronavirus has now become an important pandemic that gripped the entire world. Coronavirus infection often begins in the nasopharynx and destroys the olfactory epithelium. Despite many studies, little progress has been made in the treatment of coronavirus. This study aimed to further investigate the pathogenicity of coronavirus to reduce its infection by examining the virus function in the body and its stages of infection.

Material And Methods: With the aim of investigating the coronavirus and its effect on the human respiratory system from 1992 to 2020, this study examined the coronavirus and its different aspects and tried to answer whether there is an association between pneumonia and immune cells. This study was conducted in April 2020 and to obtain the related papers on the characteristics of the virus, Nature, ISC Pubmed, Medline WHO, NCBI, and PsycINFO databases were used. Out of 284 papers, 53 were used in this study.

Result: Studies have shown that avoiding infected areas and strengthening the immune system inhibit the virus to bind the mucosal layers. Given the important role of acquired immunity and lymphocytes against coronavirus, it is necessary to pay attention to boost the immune system in adults and the elderly. Antioxidants help reduce the oxidative stress and inflammation in the immune system thus help it regenerate better. The results showed that children are susceptible to the virus though have lower mortality and clinical manifestations than adults.

Conclusion: The vaccine should receive further attention and in the long run, antiviral drugs and broad-spectrum vaccines are produced for infectious diseases.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_763_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652206PMC
September 2020

Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial.

Eur Respir J 2020 12 24;56(6). Epub 2020 Dec 24.

Rheumatology Research Center, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran

Introduction: There are no determined treatment agents for severe COVID-19. It is suggested that methylprednisolone, as an immunosuppressive treatment, can reduce the inflammation of the respiratory system in COVID-19 patients.

Methods: We conducted a single-blind, randomised controlled clinical trial involving severe hospitalised patients with confirmed COVID-19 at the early pulmonary phase of the illness in Iran. The patients were randomly allocated in a 1:1 ratio by the block randomisation method to receive standard care with methylprednisolone pulse (intravenous injection, 250 mg·day for 3 days) or standard care alone. The study end-point was the time of clinical improvement or death, whichever came first. Primary and safety analysis was done in the intention-to-treat (ITT) population.

Results: 68 eligible patients underwent randomisation (34 patients in each group) from April 20, 2020 to June 20, 2020. In the standard care group, six patients received corticosteroids by the attending physician before the treatment and were excluded from the overall analysis. The percentage of improved patients was higher in the methylprednisolone group than in the standard care group (94.1% 57.1%) and the mortality rate was significantly lower in the methylprednisolone group (5.9% 42.9%; p<0.001). We demonstrated that patients in the methylprednisolone group had a significantly increased survival time compared with patients in the standard care group (log-rank test: p<0.001; hazard ratio 0.293, 95% CI 0.154-0.556). Two patients (5.8%) in the methylprednisolone group and two patients (7.1%) in the standard care group showed severe adverse events between initiation of treatment and the end of the study.

Conclusions: Our results suggest that methylprednisolone pulse could be an efficient therapeutic agent for hospitalised severe COVID-19 patients at the pulmonary phase.
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http://dx.doi.org/10.1183/13993003.02808-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7758541PMC
December 2020

Changes in heart rate variability (HRV) in patients with severe and moderate obstructive sleep apnea before and after acute CPAP therapy during nocturnal polysomnography.

Sleep Sci 2020 Apr-Jun;13(2):97-102

Tehran University of Medical Sciences, Imam Khomeini Hospital - Tehran - Iran.

Introduction: Obstructive sleep apnea is an important risk factor for cardiovascular disease. Noninvasive positive pressure ventilation is the standard treatment of this disease, and it can reduce mortality in patients. Dysfunction of the autonomic system is one of the reasons for an increased risk of cardiovascular disease in these patients. The purpose of the present study was to investigate the effect of positive airway pressure (PAP) therapy on heart rate variability (HRV) indices.

Methods: The study population was comprised of 55 patients, who underwent nocturnal polysomnography for the diagnosis of obstructive sleep apnea and PAP titration on the same night. The levels of continuous positive airway pressure (CPAP) and bilevel positive airway pressure were adjusted to relieve obstructive sleep apnea, hypopnea, and desaturation. The patients' heart changes and cardiac characteristics were recorded before and after the start of routine CPAP therapy. Finally, the cases' sleep and polysomnography tests were analyzed and interpreted in collaboration with a sleep specialist and their cardiac changes with the aid of a cardiologist before and after treatment with CPAP.

Results: The participants were 55 patients at a mean age of 57.04±12.9 years. There were 34 (61.8%) male and 21 (38.2%) female cases. PAP therapy on the same night resulted in a decreased standard deviation of the N-N interval index (p=0.036) and a low-frequency index (=0.021), as well as increased high-frequency index (<0.001) and low frequency / high frequency ratios (=0.008).

Conclusion: Our findings indicate a relative improvement in the activity of the autonomic system in patients with obstructive sleep apnea after 1 night of PAP therapy. Overwhelming evidence suggests that improvement in the sympathetic balance can reduce the risk of cardiovascular disease in patients.
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http://dx.doi.org/10.5935/1984-0063.20200003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384525PMC
August 2020

Evaluation of forced oscilometry technique's parameters in severe obstructive sleep apnea patients without breathing disorder.

J Family Med Prim Care 2020 Mar 26;9(3):1492-1496. Epub 2020 Mar 26.

Advance Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Background: Forced oscillometry technique (FOT) is a noninvasive technique that measures reactance and resistance capacity of the lung and is a practical and less time-consuming technique for respiratory effort assessment. Recently, FOT has provided beneficial data regarding the screening of the patients with obstructive sleep apnea (OSA) and assessing the disease progression. The current study aimed to evaluate the correlation of FOT parameters with severity of the apnea-hypnea index (AHI).

Methods: In the current case series, all patients who had a body mass index ranging between 30 and 35, suffering severe OSA with AHI of more than 30 times per hour, were enrolled. Patients underwent FOT before treatment to measure the following FOT parameters: Respiratory resistance at 5 and 20 Hz (R5 and R20, respectively), resistance difference between R5 and R20, reactance at 5 Hz (X5), and resonant frequency (Fres).

Results: In the current study, 22 patients were enrolled; whereas 12 (54.5%) were male and 10 (45.5%) were female with a mean age of 5.27 ± 4.34. A statistically significant, strong negative correlation was observed between Fres and AHI, during Pearson correlation analysis ( (20) =0.59, < 0.0001). However, the relationship between the AHI and R5, R20, R5-R20 and X5 was not statistically significant. Similarly, the multiple regression model showed that, only Fres variable added statistically significantly to the prediction, = 0.01.

Conclusion: FOT is a useful tool in evaluation of AHI severity in patients suffering OSA and can be used as a diagnostic material in monitoring and management of these patients.
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http://dx.doi.org/10.4103/jfmpc.jfmpc_954_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7266221PMC
March 2020

Therapeutic effects of nebulized verapamil on chronic obstructive pulmonary disease: A randomized and double-blind clinical trial.

Clin Respir J 2020 Apr 20;14(4):370-381. Epub 2020 Jan 20.

Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Objectives: In this study, we assessed the clinical effect of inhaled verapamil on hospitalized COPD patients in a randomized and double-blind study.

Method: COPD patients randomly received 10 mg of inhaled verapamil or 4 cc nebulized distilled water (DW) as placebo.

Results: Twenty patients enrolled in each group with no difference in baseline characteristics. Mean age was 64.95 ± 8.9 and 66.9 ± 10.74 years in verapamil and control group; respectively, (P > 0.05). The mean dyspnea score was 6.4 ± 1.2 and 6.2 ± 1.8 in the verapamil and control group, respectively and decreased to 4.9 ± 1.3 and 5.7 ± 1.8 after the intervention. The mean change in the verapamil group was significantly higher, (22.43% ± 10.6% vs 8.7% ± 12.1%), P = 0.00. Unlike the control group, the FEV1 value in the verapamil group significantly increased and reached to 1.17 ± 0.4 L from 1.03 ± 0.4. There was a significant decrease in airway resistance in both groups after intervention. However, neither total lung capacity and residual volume nor forced vital capacity changed significantly. Moreover, oxygen saturation in the verapamil group changed 4.8% ± 2.5% and this improvement in the control group was 1.8 ± 1 (P = 0.00). Smoker subjects, ones with PAP more than 35 mm Hg and obese patients benefit from verapamil.

Conclusion: The beneficial impact of inhaled verapamil on the diminishing of dyspnea score along with its bronchodilatory effect would make this selective calcium blocker agent a therapeutic option in COPD.
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http://dx.doi.org/10.1111/crj.13142DOI Listing
April 2020

Effects of High-Dose Vitamin D Replacement on the Serum Levels of Systemic Inflammatory Biomarkers in Patients with Acute Exacerbation of Chronic Obstructive Pulmonary Disease.

COPD 2019 08 25;16(3-4):278-283. Epub 2019 Sep 25.

Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences , Tehran , Iran.

Chronic Obstructive Pulmonary Disease (COPD) is associated with increased inflammatory responses to noxious particles, which can be further enhanced during Acute Exacerbation of COPD (AECOPD). Considering the important immunoregulatory function of vitamin D, high prevalence of Vitamin D Deficiency (VDD) in COPD patients and a negative link between vitamin D levels and inflammatory biomarkers, suggests the seemingly interesting mechanism of vitamin D effects on inflammation resolution during the conventional treatment of AECOPD. The admitted AECOPD patients with VDD were recruited and randomly allocated to receive either 300,000 IU of intramuscular vitamin D ( = 35) or placebo ( = 35). Primary outcomes included inflammation resolution dynamics, which were assessed by monitoring the serum levels of IL-6, IL-8, and hs-CRP. Symptom recovery was evaluated based on the modified Medical Research Council (mMRC) dyspnea scale on the 1st and 6th days of admission. Secondary outcomes included the length of hospital stay (LOS) and 30-day mortality rates. Inflammatory biomarkers were highest at Day 1. Baseline vitamin D levels were 11.25 ± 3.09 and 10.59 ± 3.90 ng/ml ( = 0.45), which reached 11.35 ± 3.16 and 18.17 ± 4.24 by Day 6 ( < 0.001) in the placebo and, vitamin-D groups, respectively. IL-6 levels significantly decreased in the vitamin-D vs. placebo group on the 6 day ( = 0.02); however, no significant differences were observed in IL-8 ( = 0.15) and hs-CRP ( = 0.24) levels, mMRC scale ( = 0.45), LOS ( = 0.20), and mortality rates ( = 0.61). Vitamin D replacement as adjunctive therapy may accelerate inflammation resolution in hospitalized AECOPD patients. Further studies were needed to establish vitamin D exact role on inflammation resolution in AECOPD.
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http://dx.doi.org/10.1080/15412555.2019.1666812DOI Listing
August 2019

Role of Vitamin D Replacement on Health Related Quality of Life in Hospitalized Patients with "Acute Exacerbation of Chronic Obstructive Pulmonary Disease".

Iran J Pharm Res 2018 ;17(2):801-810

Department of Internal Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.

Burden of Chronic Obstructive Pulmonary Disease (COPD) is substantial and increasing in the world. There are controversial reports regarding vitamin D supplementation in COPD. We investigated relationship between vitamin D3 (Cholecalciferol) supplementation with Health Related Quality of Life (HRQOL) and symptom recovery in AECOPD patients with concurrent Vitamin D Deficiency (VDD). A placebo-controlled randomized clinical trial was designed. AECOPD patients with VDD were randomly allocated to receive either vitamin D 300,000 IU (n = 35) or placebo (n = 35) by intramuscular injection. Primary outcomes included the HRQOL assessed by St. George's Respiratory Questionnaire (SGRQ), and the symptom recovery evaluated by the modified Medical Research Council (mMRC) Dyspnea scale, determined at baseline and at days 30 and 120 post-intervention. Secondary endpoints were length of hospital stay (LOS), rehospitalization and mortality rates. Sixty-two patients, 30 patients in the vitamin D and 32 patients in the placebo groups, with mean ± SD age of 63.42 ± 8.48 years accomplished the study. Baseline vitamin D levels in the vitamin D and placebo groups were 10.59 ± 3.39 and 11.12 ± 3.17 ng/mL, respectively. These levels reached 36.85 ± 11.80 and 12.30 ± 3.66 in the vitamin D and placebo groups, respectively, at day 120 ( 0.001). Correction of vitamin D levels in the intervention group resulted in statistically significant improvement in patients' HRQOL by day 120 compared to that of the placebo group ( 0.001); however no significant difference was observed in LOS, rehospitalization, and mortality rates. Single parenteral high dose of vitamin D as adjunctive therapy could improve HRQOL in hospitalized AECOPD patients with deficient levels of vitamin D.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5985196PMC
January 2018

Imaging suggestive, but symptoms atypical.

Cleve Clin J Med 2017 01;84(1):25-26

Assistant Professor of Emergency Medicine, Department of Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran.

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http://dx.doi.org/10.3949/ccjm.84a.15144DOI Listing
January 2017

Midazolam Plus Haloperidol as Adjuvant Analgesics to Morphine in Opium Dependent Patients: A Randomized Clinical Trial.

Curr Drug Abuse Rev 2016 ;9(2):142-147

Department of Emergency Medicine, Dr. Shariati Hospital, Tehran University of Medical Sciences. Iran.

Background: Tolerance to opioids among opium-dependent patients creates obstacles for proper pain management of these patients in the emergency department (ED). The aim of the present study was to investigate the efficacy of intramuscular (IM) haloperidol plus midazolam on morphine analgesia among opium-dependent patients.

Methods: Opium-dependent adults who were admitted to the ED for new-onset severe pain in the limbs or abdomen (within 24 hours of admission and a pain score of over six, using a numerical rating scale [NRS]) were recruited. Participants were randomly assigned into two groups. Group A received morphine 0.05 mg/kg intravenously (IV) and a mixture of midazolam 2.5 mg and haloperidol 2.5 mg (diluted in 5 cc of distilled water, IM); group B received morphine 0.05 mg/kg IV and distilled water 5 cc, IM. Measured outcomes were related to: 1) pain intensity; 2) total doses of morphine; 3) changes in hemodynamic status and level of consciousness of patients. NRS scores (zero to 10) before and one, three and six hours following intervention, as well as total doses of morphine, were recorded.

Results: We recruited 68 males (78.16%) and 19 females (21.83%). The mean age was 38.28±6.59 years. The pain score in group A declined more rapidly over six hours than that in group B. Moreover, as compared to group B, the amount of morphine use decreased significantly in group A.

Conclusion: Based on the present data, adding haloperidol plus midazolam to morphine for pain management improved pain scores and lowered morphine consumption among opium-dependent patients.
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http://dx.doi.org/10.2174/1874473710666170106122455DOI Listing
May 2018

Medical students' attitudes towards early clinical exposure in Iran.

Int J Med Educ 2016 Jun 19;7:195-9. Epub 2016 Jun 19.

Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, Iran.

Objective: This study was carried out to investigate the medical students' attitudes towards early clinical exposure at Tehran University of Medical Sciences.

Methods: A cross-sectional study was conducted during 2012-2015. A convenience sample of 298 first- and second-year students, enrolled in the undergraduate medical curriculum, participated in an early clinical exposure program. To collect data from medical students, a questionnaire consisting of open-ended questions and structured questions, rated on a five-point Likert scale, was used to investigate students' attitudes toward early clinical exposure.

Results: Of the 298 medical students, 216 (72%) completed the questionnaires. The results demonstrated that medical students had a positive attitude toward early clinical exposure. Most students (80.1%) stated that early clinical exposure could familiarize them with the role of basic sciences knowledge in medicine and how to apply this knowledge in clinical settings. Moreover, 84.5% of them believed that early clinical exposure increased their interest in medicine and encouraged them to read more. Furthermore, content analysis of the students' responses uncovered three main themes of early clinical exposure, were considered helpful to improve learning: "integration of theory and practice", "interaction with others and professional development" and "desire and motivation for learning medicine".

Conclusions: Medical students found their first experience with clinical setting valuable. Providing clinical exposure in the initial years of medical curricula and teaching the application of basic sciences knowledge in clinical practice can enhance students' understanding of the role they will play in the future as a physician.
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http://dx.doi.org/10.5116/ijme.5749.78afDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4939216PMC
June 2016

Possible unaware intoxication by anticoagulant rodenticide.

J Res Pharm Pract 2014 Oct;3(4):142-4

Department of Internal Medicine, Imam-Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.

Superwarfarin toxicity may be a serious problem. It needs high clinical suspicious in patients with bleeding diathesis without hematologic or liver diseases even in patients with apparent negative history of warfarin or other anticoagulant accessibility. Here we reported a patient with a negative history of any medical diseases or drug administration who was referred with generalized ecchymosis. Increased international normalized ratio and decreased vitamin K-dependent coagulation factors were detected in this patient. His hematologic and liver evaluations were normal. Clinical pharmacist emphasis in taking history revealed using anticoagulant rodenticide all over the farm the patient lived in that might result in unaware intoxication in this patient who suffered dementia.
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http://dx.doi.org/10.4103/2279-042X.145394DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4262861PMC
October 2014