Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.
Identifieur interne : 000618 ( Main/Exploration ); précédent : 000617; suivant : 000619Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.
Auteurs : P. Cardinal-Fernández [Espagne] ; E. Garcia Cuesta ; J. Barberán ; J F Varona ; A. Estirado ; A. Moreno ; J. Villanueva ; M. Villareal ; O. Baez-Pravia ; J. Menéndez ; P. Villares ; A. L Pez Escobar ; J. Rodríguez-Pascual ; C. Almirall ; E. Domínguez ; C. Pey ; A. Ferreiro ; M. Revilla Amores ; N. Sánchez ; S. Ruiz De Aguiar ; J M CastellanoSource :
- Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia [ 1988-9518 ] ; 2021.
Abstract
OBJECTIVE
Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19.
METHODS
This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments.
RESULTS
One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant.
CONCLUSIONS
Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.
DOI: 10.37201/req/050.2021
PubMed: 34008930
Affiliations:
Links toward previous steps (curation, corpus...)
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Castillo Olivares, s/n, CP 28250, Torrelodones, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Garcia Cuesta, E" sort="Garcia Cuesta, E" uniqKey="Garcia Cuesta E" first="E" last="Garcia Cuesta">E. Garcia Cuesta</name></author><author><name sortKey="Barberan, J" sort="Barberan, J" uniqKey="Barberan J" first="J" last="Barberán">J. Barberán</name></author><author><name sortKey="Varona, J F" sort="Varona, J F" uniqKey="Varona J" first="J F" last="Varona">J F Varona</name></author><author><name sortKey="Estirado, A" sort="Estirado, A" uniqKey="Estirado A" first="A" last="Estirado">A. Estirado</name></author><author><name sortKey="Moreno, A" sort="Moreno, A" uniqKey="Moreno A" first="A" last="Moreno">A. Moreno</name></author><author><name sortKey="Villanueva, J" sort="Villanueva, J" uniqKey="Villanueva J" first="J" last="Villanueva">J. Villanueva</name></author><author><name sortKey="Villareal, M" sort="Villareal, M" uniqKey="Villareal M" first="M" last="Villareal">M. Villareal</name></author><author><name sortKey="Baez Pravia, O" sort="Baez Pravia, O" uniqKey="Baez Pravia O" first="O" last="Baez-Pravia">O. Baez-Pravia</name></author><author><name sortKey="Menendez, J" sort="Menendez, J" uniqKey="Menendez J" first="J" last="Menéndez">J. Menéndez</name></author><author><name sortKey="Villares, P" sort="Villares, P" uniqKey="Villares P" first="P" last="Villares">P. Villares</name></author><author><name sortKey="L Pez Escobar, A" sort="L Pez Escobar, A" uniqKey="L Pez Escobar A" first="A" last="L Pez Escobar">A. L Pez Escobar</name></author><author><name sortKey="Rodriguez Pascual, J" sort="Rodriguez Pascual, J" uniqKey="Rodriguez Pascual J" first="J" last="Rodríguez-Pascual">J. Rodríguez-Pascual</name></author><author><name sortKey="Almirall, C" sort="Almirall, C" uniqKey="Almirall C" first="C" last="Almirall">C. Almirall</name></author><author><name sortKey="Dominguez, E" sort="Dominguez, E" uniqKey="Dominguez E" first="E" last="Domínguez">E. Domínguez</name></author><author><name sortKey="Pey, C" sort="Pey, C" uniqKey="Pey C" first="C" last="Pey">C. Pey</name></author><author><name sortKey="Ferreiro, A" sort="Ferreiro, A" uniqKey="Ferreiro A" first="A" last="Ferreiro">A. Ferreiro</name></author><author><name sortKey="Revilla Amores, M" sort="Revilla Amores, M" uniqKey="Revilla Amores M" first="M" last="Revilla Amores">M. Revilla Amores</name></author><author><name sortKey="Sanchez, N" sort="Sanchez, N" uniqKey="Sanchez N" first="N" last="Sánchez">N. Sánchez</name></author><author><name sortKey="Ruiz De Aguiar, S" sort="Ruiz De Aguiar, S" uniqKey="Ruiz De Aguiar S" first="S" last="Ruiz De Aguiar">S. Ruiz De Aguiar</name></author><author><name sortKey="Castellano, J M" sort="Castellano, J M" uniqKey="Castellano J" first="J M" last="Castellano">J M Castellano</name></author></titleStmt><publicationStmt><idno type="wicri:source">PubMed</idno><date when="2021">2021</date><idno type="RBID">pubmed:34008930</idno><idno type="pmid">34008930</idno><idno type="doi">10.37201/req/050.2021</idno><idno type="wicri:Area/Main/Corpus">000008</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Corpus" wicri:corpus="PubMed">000008</idno><idno type="wicri:Area/Main/Curation">000008</idno><idno type="wicri:explorRef" wicri:stream="Main" wicri:step="Curation">000008</idno><idno type="wicri:Area/Main/Exploration">000008</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en">Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.</title><author><name sortKey="Cardinal Fernandez, P" sort="Cardinal Fernandez, P" uniqKey="Cardinal Fernandez P" first="P" last="Cardinal-Fernández">P. Cardinal-Fernández</name><affiliation wicri:level="3"><nlm:affiliation>Pablo Cardinal-Fernández, Intensive care unit coordinator, HM Torrelodones University Hospital, Av. Castillo Olivares, s/n, CP 28250, Torrelodones, Madrid, Spain. pablocardinal@hotmail.com.</nlm:affiliation><country xml:lang="fr">Espagne</country><wicri:regionArea>Pablo Cardinal-Fernández, Intensive care unit coordinator, HM Torrelodones University Hospital, Av. Castillo Olivares, s/n, CP 28250, Torrelodones, Madrid</wicri:regionArea><placeName><settlement type="city">Madrid</settlement><region nuts="2" type="region">Communauté de Madrid</region></placeName></affiliation></author><author><name sortKey="Garcia Cuesta, E" sort="Garcia Cuesta, E" uniqKey="Garcia Cuesta E" first="E" last="Garcia Cuesta">E. Garcia Cuesta</name></author><author><name sortKey="Barberan, J" sort="Barberan, J" uniqKey="Barberan J" first="J" last="Barberán">J. Barberán</name></author><author><name sortKey="Varona, J F" sort="Varona, J F" uniqKey="Varona J" first="J F" last="Varona">J F Varona</name></author><author><name sortKey="Estirado, A" sort="Estirado, A" uniqKey="Estirado A" first="A" last="Estirado">A. Estirado</name></author><author><name sortKey="Moreno, A" sort="Moreno, A" uniqKey="Moreno A" first="A" last="Moreno">A. Moreno</name></author><author><name sortKey="Villanueva, J" sort="Villanueva, J" uniqKey="Villanueva J" first="J" last="Villanueva">J. Villanueva</name></author><author><name sortKey="Villareal, M" sort="Villareal, M" uniqKey="Villareal M" first="M" last="Villareal">M. Villareal</name></author><author><name sortKey="Baez Pravia, O" sort="Baez Pravia, O" uniqKey="Baez Pravia O" first="O" last="Baez-Pravia">O. Baez-Pravia</name></author><author><name sortKey="Menendez, J" sort="Menendez, J" uniqKey="Menendez J" first="J" last="Menéndez">J. Menéndez</name></author><author><name sortKey="Villares, P" sort="Villares, P" uniqKey="Villares P" first="P" last="Villares">P. Villares</name></author><author><name sortKey="L Pez Escobar, A" sort="L Pez Escobar, A" uniqKey="L Pez Escobar A" first="A" last="L Pez Escobar">A. L Pez Escobar</name></author><author><name sortKey="Rodriguez Pascual, J" sort="Rodriguez Pascual, J" uniqKey="Rodriguez Pascual J" first="J" last="Rodríguez-Pascual">J. Rodríguez-Pascual</name></author><author><name sortKey="Almirall, C" sort="Almirall, C" uniqKey="Almirall C" first="C" last="Almirall">C. Almirall</name></author><author><name sortKey="Dominguez, E" sort="Dominguez, E" uniqKey="Dominguez E" first="E" last="Domínguez">E. Domínguez</name></author><author><name sortKey="Pey, C" sort="Pey, C" uniqKey="Pey C" first="C" last="Pey">C. Pey</name></author><author><name sortKey="Ferreiro, A" sort="Ferreiro, A" uniqKey="Ferreiro A" first="A" last="Ferreiro">A. Ferreiro</name></author><author><name sortKey="Revilla Amores, M" sort="Revilla Amores, M" uniqKey="Revilla Amores M" first="M" last="Revilla Amores">M. Revilla Amores</name></author><author><name sortKey="Sanchez, N" sort="Sanchez, N" uniqKey="Sanchez N" first="N" last="Sánchez">N. Sánchez</name></author><author><name sortKey="Ruiz De Aguiar, S" sort="Ruiz De Aguiar, S" uniqKey="Ruiz De Aguiar S" first="S" last="Ruiz De Aguiar">S. Ruiz De Aguiar</name></author><author><name sortKey="Castellano, J M" sort="Castellano, J M" uniqKey="Castellano J" first="J M" last="Castellano">J M Castellano</name></author></analytic><series><title level="j">Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia</title><idno type="eISSN">1988-9518</idno><imprint><date when="2021" type="published">2021</date></imprint></series></biblStruct></sourceDesc></fileDesc><profileDesc><textClass></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en"><p><b>OBJECTIVE</b></p><p>Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19.</p></div><div type="abstract" xml:lang="en"><p><b>METHODS</b></p><p>This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments.</p></div><div type="abstract" xml:lang="en"><p><b>RESULTS</b></p><p>One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant.</p></div><div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b></p><p>Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.</p></div></front></TEI><pubmed><MedlineCitation Status="Publisher" Owner="NLM"><PMID Version="1">34008930</PMID><DateRevised><Year>2021</Year><Month>05</Month><Day>19</Day></DateRevised><Article PubModel="Print-Electronic"><Journal><ISSN IssnType="Electronic">1988-9518</ISSN><JournalIssue CitedMedium="Internet"><PubDate><Year>2021</Year><Month>May</Month><Day>19</Day></PubDate></JournalIssue><Title>Revista espanola de quimioterapia : publicacion oficial de la Sociedad Espanola de Quimioterapia</Title><ISOAbbreviation>Rev Esp Quimioter</ISOAbbreviation></Journal><ArticleTitle>Clinical characteristics and outcomes of 1,331 patients with COVID-19: HM Spanish Cohort.</ArticleTitle><ELocationID EIdType="pii" ValidYN="Y">cardinal19may2021</ELocationID><ELocationID EIdType="doi" ValidYN="Y">10.37201/req/050.2021</ELocationID><Abstract><AbstractText Label="OBJECTIVE" NlmCategory="OBJECTIVE">Spain is one of the European countries most affected by the COVID-19 pandemic. Epidemiologic studies are warranted to improve the disease understanding, evaluate the care procedure and prepare for futures waves. The aim of the study was to describe epidemiologic characteristics associated with hospitalized patients with COVID-19.</AbstractText><AbstractText Label="METHODS" NlmCategory="METHODS">This real-world, observational, multicenter and retrospective study screened all consecutive patients admitted to 8 Spanish private hospitals. Inclusion criteria: hospitalized adults (age≥18 years old) with clinically and radiologically findings compatible with COVID-19 disease from March 1st to April 5th, 2020. Exclusion criteria: patients presenting negative PCR for SARS-CoV-2 during the first 7 days from hospital admission, transfer to a hospital not belonging to the HM consortium, lack of data and discharge against medical advice in emergency departments.</AbstractText><AbstractText Label="RESULTS" NlmCategory="RESULTS">One thousand and three hundred thirty-one COVID-19 patients (medium age 66.9 years old; males n= 841, medium length of hospital stayed 8 days, non-survivors n=233) were analyzed. One hundred and fifteen were admitted to intensive care unit (medium length of stay 16 days, invasive mechanical ventilation n= 95, septic shock n= 37 and renal replacement therapy n= 17). Age, male gender, leukocytes, platelets, oxygen saturation, chronic therapy with steroids and treatment with hydroxychloroquine/azithromycin were independent factors associated with mortality. The proportion of patients that survive and received tocilizumab and steroids were lesser and higher respectively than those that die, but their association was not significant.</AbstractText><AbstractText Label="CONCLUSIONS" NlmCategory="CONCLUSIONS">Overall crude mortality rate was 17.5%, rising up to 36.5% in the subgroup of patients that were admitted to the intensive care unit. Seven factors impact in hospital mortality. No immunomodulatory intervention were associated with in-hospital mortality.</AbstractText><CopyrightInformation>©The Author 2021. Published by Sociedad Española de Quimioterapia. This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0)(https://creativecommons.org/licenses/by-nc/4.0/).</CopyrightInformation></Abstract><AuthorList CompleteYN="Y"><Author ValidYN="Y" EqualContrib="Y"><LastName>Cardinal-Fernández</LastName><ForeName>P</ForeName><Initials>P</Initials><AffiliationInfo><Affiliation>Pablo Cardinal-Fernández, Intensive care unit coordinator, HM Torrelodones University Hospital, Av. Castillo Olivares, s/n, CP 28250, Torrelodones, Madrid, Spain. pablocardinal@hotmail.com.</Affiliation></AffiliationInfo></Author><Author ValidYN="Y" EqualContrib="Y"><LastName>Garcia Cuesta</LastName><ForeName>E</ForeName><Initials>E</Initials></Author><Author ValidYN="Y" EqualContrib="Y"><LastName>Barberán</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Varona</LastName><ForeName>J F</ForeName><Initials>JF</Initials></Author><Author ValidYN="Y"><LastName>Estirado</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Moreno</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Villanueva</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Villareal</LastName><ForeName>M</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Baez-Pravia</LastName><ForeName>O</ForeName><Initials>O</Initials></Author><Author ValidYN="Y"><LastName>Menéndez</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Villares</LastName><ForeName>P</ForeName><Initials>P</Initials></Author><Author ValidYN="Y"><LastName>López Escobar</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Rodríguez-Pascual</LastName><ForeName>J</ForeName><Initials>J</Initials></Author><Author ValidYN="Y"><LastName>Almirall</LastName><ForeName>C</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Domínguez</LastName><ForeName>E</ForeName><Initials>E</Initials></Author><Author ValidYN="Y"><LastName>Pey</LastName><ForeName>C</ForeName><Initials>C</Initials></Author><Author ValidYN="Y"><LastName>Ferreiro</LastName><ForeName>A</ForeName><Initials>A</Initials></Author><Author ValidYN="Y"><LastName>Revilla Amores</LastName><ForeName>M</ForeName><Initials>M</Initials></Author><Author ValidYN="Y"><LastName>Sánchez</LastName><ForeName>N</ForeName><Initials>N</Initials></Author><Author ValidYN="Y"><LastName>Ruiz de Aguiar</LastName><ForeName>S</ForeName><Initials>S</Initials></Author><Author ValidYN="Y"><LastName>Castellano</LastName><ForeName>J M</ForeName><Initials>JM</Initials></Author></AuthorList><Language>eng</Language><PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType></PublicationTypeList><ArticleDate DateType="Electronic"><Year>2021</Year><Month>05</Month><Day>19</Day></ArticleDate></Article><MedlineJournalInfo><Country>Spain</Country><MedlineTA>Rev Esp Quimioter</MedlineTA><NlmUniqueID>9108821</NlmUniqueID><ISSNLinking>0214-3429</ISSNLinking></MedlineJournalInfo><CitationSubset>IM</CitationSubset><KeywordList Owner="NOTNLM"><Keyword MajorTopicYN="N">COVID-19</Keyword><Keyword MajorTopicYN="N">SARS-CoV-2</Keyword><Keyword MajorTopicYN="N">epidemiology</Keyword><Keyword MajorTopicYN="N">pandemic</Keyword></KeywordList></MedlineCitation><PubmedData><History><PubMedPubDate PubStatus="entrez"><Year>2021</Year><Month>5</Month><Day>19</Day><Hour>9</Hour><Minute>40</Minute></PubMedPubDate><PubMedPubDate PubStatus="pubmed"><Year>2021</Year><Month>5</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate><PubMedPubDate PubStatus="medline"><Year>2021</Year><Month>5</Month><Day>20</Day><Hour>6</Hour><Minute>0</Minute></PubMedPubDate></History><PublicationStatus>aheadofprint</PublicationStatus><ArticleIdList><ArticleId IdType="pubmed">34008930</ArticleId><ArticleId IdType="doi">10.37201/req/050.2021</ArticleId></ArticleIdList></PubmedData></pubmed><affiliations><list><country><li>Espagne</li></country><region><li>Communauté de Madrid</li></region><settlement><li>Madrid</li></settlement></list><tree><noCountry><name sortKey="Almirall, C" sort="Almirall, C" uniqKey="Almirall C" first="C" last="Almirall">C. Almirall</name><name sortKey="Baez Pravia, O" sort="Baez Pravia, O" uniqKey="Baez Pravia O" first="O" last="Baez-Pravia">O. Baez-Pravia</name><name sortKey="Barberan, J" sort="Barberan, J" uniqKey="Barberan J" first="J" last="Barberán">J. Barberán</name><name sortKey="Castellano, J M" sort="Castellano, J M" uniqKey="Castellano J" first="J M" last="Castellano">J M Castellano</name><name sortKey="Dominguez, E" sort="Dominguez, E" uniqKey="Dominguez E" first="E" last="Domínguez">E. Domínguez</name><name sortKey="Estirado, A" sort="Estirado, A" uniqKey="Estirado A" first="A" last="Estirado">A. Estirado</name><name sortKey="Ferreiro, A" sort="Ferreiro, A" uniqKey="Ferreiro A" first="A" last="Ferreiro">A. Ferreiro</name><name sortKey="Garcia Cuesta, E" sort="Garcia Cuesta, E" uniqKey="Garcia Cuesta E" first="E" last="Garcia Cuesta">E. Garcia Cuesta</name><name sortKey="L Pez Escobar, A" sort="L Pez Escobar, A" uniqKey="L Pez Escobar A" first="A" last="L Pez Escobar">A. L Pez Escobar</name><name sortKey="Menendez, J" sort="Menendez, J" uniqKey="Menendez J" first="J" last="Menéndez">J. Menéndez</name><name sortKey="Moreno, A" sort="Moreno, A" uniqKey="Moreno A" first="A" last="Moreno">A. Moreno</name><name sortKey="Pey, C" sort="Pey, C" uniqKey="Pey C" first="C" last="Pey">C. Pey</name><name sortKey="Revilla Amores, M" sort="Revilla Amores, M" uniqKey="Revilla Amores M" first="M" last="Revilla Amores">M. Revilla Amores</name><name sortKey="Rodriguez Pascual, J" sort="Rodriguez Pascual, J" uniqKey="Rodriguez Pascual J" first="J" last="Rodríguez-Pascual">J. Rodríguez-Pascual</name><name sortKey="Ruiz De Aguiar, S" sort="Ruiz De Aguiar, S" uniqKey="Ruiz De Aguiar S" first="S" last="Ruiz De Aguiar">S. Ruiz De Aguiar</name><name sortKey="Sanchez, N" sort="Sanchez, N" uniqKey="Sanchez N" first="N" last="Sánchez">N. Sánchez</name><name sortKey="Varona, J F" sort="Varona, J F" uniqKey="Varona J" first="J F" last="Varona">J F Varona</name><name sortKey="Villanueva, J" sort="Villanueva, J" uniqKey="Villanueva J" first="J" last="Villanueva">J. Villanueva</name><name sortKey="Villareal, M" sort="Villareal, M" uniqKey="Villareal M" first="M" last="Villareal">M. Villareal</name><name sortKey="Villares, P" sort="Villares, P" uniqKey="Villares P" first="P" last="Villares">P. Villares</name></noCountry><country name="Espagne"><region name="Communauté de Madrid"><name sortKey="Cardinal Fernandez, P" sort="Cardinal Fernandez, P" uniqKey="Cardinal Fernandez P" first="P" last="Cardinal-Fernández">P. Cardinal-Fernández</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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