Prevalence and severity of Coronavirus disease 2019 (COVID-19) in Transfusion Dependent and Non-Transfusion Dependent β-thalassemia patients and effects of associated comorbidities: an Iranian nationwide study.
Identifieur interne : 000238 ( Main/Curation ); précédent : 000237; suivant : 000239Prevalence and severity of Coronavirus disease 2019 (COVID-19) in Transfusion Dependent and Non-Transfusion Dependent β-thalassemia patients and effects of associated comorbidities: an Iranian nationwide study.
Auteurs : Mehran Karimi [Iran] ; Sezaneh Haghpanah [Iran] ; Tahereh Zarei [Iran] ; Azita Azarkeivan [Iran] ; Afshan Shirkavand [Iran] ; Sara Matin [Iran] ; Maryam Akavan Tavakoli [Iran] ; Zohre Zahedi [Iran] ; Vincenzo De Sanctis [Italie]Source :
- Acta bio-medica : Atenei Parmensis [ 2531-6745 ] ; 2020.
Descripteurs français
- KwdFr :
- Adolescent (MeSH), Adulte (MeSH), Adulte d'âge moyen (MeSH), Betacoronavirus (MeSH), Comorbidité (MeSH), Enfant (MeSH), Femelle (MeSH), Humains (MeSH), Infections à coronavirus (transmission), Infections à coronavirus (épidémiologie), Iran (épidémiologie), Jeune adulte (MeSH), Mâle (MeSH), Pandémies (MeSH), Pneumopathie virale (transmission), Pneumopathie virale (épidémiologie), Pronostic (MeSH), Prévalence (MeSH), Sujet âgé (MeSH), Surveillance de la population (MeSH), Taux de survie (tendances), Transfusion sanguine (MeSH), Transmission de maladie infectieuse (prévention et contrôle), bêta-Thalassémie (thérapie), bêta-Thalassémie (épidémiologie), Études rétrospectives (MeSH), Études transversales (MeSH).
- MESH :
- prévention et contrôle : Transmission de maladie infectieuse.
- tendances : Taux de survie.
- thérapie : bêta-Thalassémie.
- épidémiologie : Infections à coronavirus, Iran, Pneumopathie virale, bêta-Thalassémie.
- Adolescent, Adulte, Adulte d'âge moyen, Betacoronavirus, Comorbidité, Enfant, Femelle, Humains, Jeune adulte, Mâle, Pandémies, Pronostic, Prévalence, Sujet âgé, Surveillance de la population, Transfusion sanguine, Études rétrospectives, Études transversales.
English descriptors
- KwdEn :
- Adolescent (MeSH), Adult (MeSH), Aged (MeSH), Betacoronavirus (MeSH), Blood Transfusion (MeSH), Child (MeSH), Comorbidity (MeSH), Coronavirus Infections (epidemiology), Coronavirus Infections (transmission), Cross-Sectional Studies (MeSH), Disease Transmission, Infectious (prevention & control), Female (MeSH), Humans (MeSH), Iran (epidemiology), Male (MeSH), Middle Aged (MeSH), Pandemics (MeSH), Pneumonia, Viral (epidemiology), Pneumonia, Viral (transmission), Population Surveillance (MeSH), Prevalence (MeSH), Prognosis (MeSH), Retrospective Studies (MeSH), Survival Rate (trends), Young Adult (MeSH), beta-Thalassemia (epidemiology), beta-Thalassemia (therapy).
- MESH :
- geographic , epidemiology : Iran.
- epidemiology : Coronavirus Infections, Pneumonia, Viral, beta-Thalassemia.
- prevention & control : Disease Transmission, Infectious.
- therapy : beta-Thalassemia.
- transmission : Coronavirus Infections, Pneumonia, Viral.
- trends : Survival Rate.
- Adolescent, Adult, Aged, Betacoronavirus, Blood Transfusion, Child, Comorbidity, Cross-Sectional Studies, Female, Humans, Male, Middle Aged, Pandemics, Population Surveillance, Prevalence, Prognosis, Retrospective Studies, Young Adult.
Abstract
BACKGROUND
Coronavirus disease 2019 (COVID-19) outbreak is a global and challenging disease that is accompany with mortality and morbidity.
AIM OF STUDY
We evaluated the prevalence and the impact of comorbidities in thalassemia Iranian patients affected by COVID-19. Methods: A multicenter, retrospective, cross-sectional study was conducted across all comprehensive thalassemia centers in Iran, from January to June 15th, 2020.
RESULTS
Forty-three confirmed COVID-19 thalassemia patients (32 TDT, and 11 NTDT) were detected. The mean age of patients was 35.3 ± 11.5 years (range 9 - 67); 21 females and 22 males. Overall, 78.1% of TDT and 90.9% of NTDT patients were complicated with at least one comorbidity (P: 0.656). The overall mortality rate of thalassemia patients with COVID-19 was 18.6% while 27.3% was in NTDT patients compared to 15.6% in TDT patients (P:0.401). The dead group had a non-significant higher frequency of endocrinopathies compared to the recovered group (62.5% versus 45.7% P:0.457). Ten female thalassemia patients with positive COVID-19 had hypogonadism, six patients were receiving hormone replacement therapy and all of them recovered (zero death) compared to two deaths from 4 patients who were not receiving hormone replacement therapy (P:0.133). Furthermore, the prevalence of COVID-19 in NTDT patients was significantly higher than the general population (45 per 10,000 versus 22.29 per 10,000 respectively, P:0.018) while the prevalence of TDT was almost similar to the normal population (P:0.539). The mortality rate of COVID-19 was 4.71% in the normal Iranian population compared to 18.6% in β-thalassemias (P: <0.001) at the same date.
CONCLUSIONS
It is important to acknowledge that β-thalassemia patients, especially young adults/adults, have a chronic condition which may contribute to increase susceptibility to SARS-CoV-2 infection. A higher susceptibility to the infection was observed in patients with NTDT and in untreated hypogonadal female thalassemic patients. However, to confirm these data, more accurate designed studies are needed.
DOI: 10.23750/abm.v91i3.10155
PubMed: 32921705
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<author><name sortKey="Karimi, Mehran" sort="Karimi, Mehran" uniqKey="Karimi M" first="Mehran" last="Karimi">Mehran Karimi</name>
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<author><name sortKey="Haghpanah, Sezaneh" sort="Haghpanah, Sezaneh" uniqKey="Haghpanah S" first="Sezaneh" last="Haghpanah">Sezaneh Haghpanah</name>
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<author><name sortKey="Azarkeivan, Azita" sort="Azarkeivan, Azita" uniqKey="Azarkeivan A" first="Azita" last="Azarkeivan">Azita Azarkeivan</name>
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<author><name sortKey="Karimi, Mehran" sort="Karimi, Mehran" uniqKey="Karimi M" first="Mehran" last="Karimi">Mehran Karimi</name>
<affiliation wicri:level="1"><nlm:affiliation>Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran. vdesanctis@libero.it.</nlm:affiliation>
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<profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Adolescent (MeSH)</term>
<term>Adult (MeSH)</term>
<term>Aged (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Blood Transfusion (MeSH)</term>
<term>Child (MeSH)</term>
<term>Comorbidity (MeSH)</term>
<term>Coronavirus Infections (epidemiology)</term>
<term>Coronavirus Infections (transmission)</term>
<term>Cross-Sectional Studies (MeSH)</term>
<term>Disease Transmission, Infectious (prevention & control)</term>
<term>Female (MeSH)</term>
<term>Humans (MeSH)</term>
<term>Iran (epidemiology)</term>
<term>Male (MeSH)</term>
<term>Middle Aged (MeSH)</term>
<term>Pandemics (MeSH)</term>
<term>Pneumonia, Viral (epidemiology)</term>
<term>Pneumonia, Viral (transmission)</term>
<term>Population Surveillance (MeSH)</term>
<term>Prevalence (MeSH)</term>
<term>Prognosis (MeSH)</term>
<term>Retrospective Studies (MeSH)</term>
<term>Survival Rate (trends)</term>
<term>Young Adult (MeSH)</term>
<term>beta-Thalassemia (epidemiology)</term>
<term>beta-Thalassemia (therapy)</term>
</keywords>
<keywords scheme="KwdFr" xml:lang="fr"><term>Adolescent (MeSH)</term>
<term>Adulte (MeSH)</term>
<term>Adulte d'âge moyen (MeSH)</term>
<term>Betacoronavirus (MeSH)</term>
<term>Comorbidité (MeSH)</term>
<term>Enfant (MeSH)</term>
<term>Femelle (MeSH)</term>
<term>Humains (MeSH)</term>
<term>Infections à coronavirus (transmission)</term>
<term>Infections à coronavirus (épidémiologie)</term>
<term>Iran (épidémiologie)</term>
<term>Jeune adulte (MeSH)</term>
<term>Mâle (MeSH)</term>
<term>Pandémies (MeSH)</term>
<term>Pneumopathie virale (transmission)</term>
<term>Pneumopathie virale (épidémiologie)</term>
<term>Pronostic (MeSH)</term>
<term>Prévalence (MeSH)</term>
<term>Sujet âgé (MeSH)</term>
<term>Surveillance de la population (MeSH)</term>
<term>Taux de survie (tendances)</term>
<term>Transfusion sanguine (MeSH)</term>
<term>Transmission de maladie infectieuse (prévention et contrôle)</term>
<term>bêta-Thalassémie (thérapie)</term>
<term>bêta-Thalassémie (épidémiologie)</term>
<term>Études rétrospectives (MeSH)</term>
<term>Études transversales (MeSH)</term>
</keywords>
<keywords scheme="MESH" type="geographic" qualifier="epidemiology" xml:lang="en"><term>Iran</term>
</keywords>
<keywords scheme="MESH" qualifier="epidemiology" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
<term>beta-Thalassemia</term>
</keywords>
<keywords scheme="MESH" qualifier="prevention & control" xml:lang="en"><term>Disease Transmission, Infectious</term>
</keywords>
<keywords scheme="MESH" qualifier="prévention et contrôle" xml:lang="fr"><term>Transmission de maladie infectieuse</term>
</keywords>
<keywords scheme="MESH" qualifier="tendances" xml:lang="fr"><term>Taux de survie</term>
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<keywords scheme="MESH" qualifier="therapy" xml:lang="en"><term>beta-Thalassemia</term>
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<keywords scheme="MESH" qualifier="thérapie" xml:lang="fr"><term>bêta-Thalassémie</term>
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<keywords scheme="MESH" qualifier="transmission" xml:lang="en"><term>Coronavirus Infections</term>
<term>Pneumonia, Viral</term>
</keywords>
<keywords scheme="MESH" qualifier="trends" xml:lang="en"><term>Survival Rate</term>
</keywords>
<keywords scheme="MESH" qualifier="épidémiologie" xml:lang="fr"><term>Infections à coronavirus</term>
<term>Iran</term>
<term>Pneumopathie virale</term>
<term>bêta-Thalassémie</term>
</keywords>
<keywords scheme="MESH" xml:lang="en"><term>Adolescent</term>
<term>Adult</term>
<term>Aged</term>
<term>Betacoronavirus</term>
<term>Blood Transfusion</term>
<term>Child</term>
<term>Comorbidity</term>
<term>Cross-Sectional Studies</term>
<term>Female</term>
<term>Humans</term>
<term>Male</term>
<term>Middle Aged</term>
<term>Pandemics</term>
<term>Population Surveillance</term>
<term>Prevalence</term>
<term>Prognosis</term>
<term>Retrospective Studies</term>
<term>Young Adult</term>
</keywords>
<keywords scheme="MESH" xml:lang="fr"><term>Adolescent</term>
<term>Adulte</term>
<term>Adulte d'âge moyen</term>
<term>Betacoronavirus</term>
<term>Comorbidité</term>
<term>Enfant</term>
<term>Femelle</term>
<term>Humains</term>
<term>Jeune adulte</term>
<term>Mâle</term>
<term>Pandémies</term>
<term>Pronostic</term>
<term>Prévalence</term>
<term>Sujet âgé</term>
<term>Surveillance de la population</term>
<term>Transfusion sanguine</term>
<term>Études rétrospectives</term>
<term>Études transversales</term>
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<front><div type="abstract" xml:lang="en"><p><b>BACKGROUND</b>
</p>
<p>Coronavirus disease 2019 (COVID-19) outbreak is a global and challenging disease that is accompany with mortality and morbidity.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>AIM OF STUDY</b>
</p>
<p>We evaluated the prevalence and the impact of comorbidities in thalassemia Iranian patients affected by COVID-19. Methods: A multicenter, retrospective, cross-sectional study was conducted across all comprehensive thalassemia centers in Iran, from January to June 15th, 2020.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>RESULTS</b>
</p>
<p>Forty-three confirmed COVID-19 thalassemia patients (32 TDT, and 11 NTDT) were detected. The mean age of patients was 35.3 ± 11.5 years (range 9 - 67); 21 females and 22 males. Overall, 78.1% of TDT and 90.9% of NTDT patients were complicated with at least one comorbidity (P: 0.656). The overall mortality rate of thalassemia patients with COVID-19 was 18.6% while 27.3% was in NTDT patients compared to 15.6% in TDT patients (P:0.401). The dead group had a non-significant higher frequency of endocrinopathies compared to the recovered group (62.5% versus 45.7% P:0.457). Ten female thalassemia patients with positive COVID-19 had hypogonadism, six patients were receiving hormone replacement therapy and all of them recovered (zero death) compared to two deaths from 4 patients who were not receiving hormone replacement therapy (P:0.133). Furthermore, the prevalence of COVID-19 in NTDT patients was significantly higher than the general population (45 per 10,000 versus 22.29 per 10,000 respectively, P:0.018) while the prevalence of TDT was almost similar to the normal population (P:0.539). The mortality rate of COVID-19 was 4.71% in the normal Iranian population compared to 18.6% in β-thalassemias (P: <0.001) at the same date.</p>
</div>
<div type="abstract" xml:lang="en"><p><b>CONCLUSIONS</b>
</p>
<p>It is important to acknowledge that β-thalassemia patients, especially young adults/adults, have a chronic condition which may contribute to increase susceptibility to SARS-CoV-2 infection. A higher susceptibility to the infection was observed in patients with NTDT and in untreated hypogonadal female thalassemic patients. However, to confirm these data, more accurate designed studies are needed.</p>
</div>
</front>
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<Month>09</Month>
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<Abstract><AbstractText Label="BACKGROUND">Coronavirus disease 2019 (COVID-19) outbreak is a global and challenging disease that is accompany with mortality and morbidity.</AbstractText>
<AbstractText Label="AIM OF STUDY">We evaluated the prevalence and the impact of comorbidities in thalassemia Iranian patients affected by COVID-19. Methods: A multicenter, retrospective, cross-sectional study was conducted across all comprehensive thalassemia centers in Iran, from January to June 15th, 2020.</AbstractText>
<AbstractText Label="RESULTS">Forty-three confirmed COVID-19 thalassemia patients (32 TDT, and 11 NTDT) were detected. The mean age of patients was 35.3 ± 11.5 years (range 9 - 67); 21 females and 22 males. Overall, 78.1% of TDT and 90.9% of NTDT patients were complicated with at least one comorbidity (P: 0.656). The overall mortality rate of thalassemia patients with COVID-19 was 18.6% while 27.3% was in NTDT patients compared to 15.6% in TDT patients (P:0.401). The dead group had a non-significant higher frequency of endocrinopathies compared to the recovered group (62.5% versus 45.7% P:0.457). Ten female thalassemia patients with positive COVID-19 had hypogonadism, six patients were receiving hormone replacement therapy and all of them recovered (zero death) compared to two deaths from 4 patients who were not receiving hormone replacement therapy (P:0.133). Furthermore, the prevalence of COVID-19 in NTDT patients was significantly higher than the general population (45 per 10,000 versus 22.29 per 10,000 respectively, P:0.018) while the prevalence of TDT was almost similar to the normal population (P:0.539). The mortality rate of COVID-19 was 4.71% in the normal Iranian population compared to 18.6% in β-thalassemias (P: <0.001) at the same date.</AbstractText>
<AbstractText Label="CONCLUSIONS">It is important to acknowledge that β-thalassemia patients, especially young adults/adults, have a chronic condition which may contribute to increase susceptibility to SARS-CoV-2 infection. A higher susceptibility to the infection was observed in patients with NTDT and in untreated hypogonadal female thalassemic patients. However, to confirm these data, more accurate designed studies are needed.</AbstractText>
</Abstract>
<AuthorList CompleteYN="Y"><Author ValidYN="Y"><LastName>Karimi</LastName>
<ForeName>Mehran</ForeName>
<Initials>M</Initials>
<AffiliationInfo><Affiliation>Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Haghpanah</LastName>
<ForeName>Sezaneh</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zarei</LastName>
<ForeName>Tahereh</ForeName>
<Initials>T</Initials>
<AffiliationInfo><Affiliation>Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Azarkeivan</LastName>
<ForeName>Azita</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Zafar Adult Thalassemia Clinic, Blood Transfusion Research Center, High Institute for Research and Education in Transfusion Medicine, Tehran, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Shirkavand</LastName>
<ForeName>Afshan</ForeName>
<Initials>A</Initials>
<AffiliationInfo><Affiliation>Medical Physicist, Pardis Noor Medical Imaging Center, Tehran, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Matin</LastName>
<ForeName>Sara</ForeName>
<Initials>S</Initials>
<AffiliationInfo><Affiliation>Pediatric Department, Jahrom University of Medical Sciences, Jahrom, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Tavakoli</LastName>
<ForeName>Maryam Akavan</ForeName>
<Initials>MA</Initials>
<AffiliationInfo><Affiliation>Anatomy Sciences Department, Iran University of Medical Sciences, Tehran, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>Zahedi</LastName>
<ForeName>Zohre</ForeName>
<Initials>Z</Initials>
<AffiliationInfo><Affiliation>Hematology research Center, Shiraz University of Medical Sciences, Shiraz, Iran. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
<Author ValidYN="Y"><LastName>De Sanctis</LastName>
<ForeName>Vincenzo</ForeName>
<Initials>V</Initials>
<AffiliationInfo><Affiliation>Quisisana Hospital, Ferrara. vdesanctis@libero.it.</Affiliation>
</AffiliationInfo>
</Author>
</AuthorList>
<Language>eng</Language>
<PublicationTypeList><PublicationType UI="D016428">Journal Article</PublicationType>
<PublicationType UI="D016448">Multicenter Study</PublicationType>
</PublicationTypeList>
<ArticleDate DateType="Electronic"><Year>2020</Year>
<Month>09</Month>
<Day>07</Day>
</ArticleDate>
</Article>
<MedlineJournalInfo><Country>Italy</Country>
<MedlineTA>Acta Biomed</MedlineTA>
<NlmUniqueID>101295064</NlmUniqueID>
<ISSNLinking>0392-4203</ISSNLinking>
</MedlineJournalInfo>
<SupplMeshList><SupplMeshName Type="Disease" UI="C000657245">COVID-19</SupplMeshName>
<SupplMeshName Type="Organism" UI="C000656484">severe acute respiratory syndrome coronavirus 2</SupplMeshName>
</SupplMeshList>
<CitationSubset>IM</CitationSubset>
<MeshHeadingList><MeshHeading><DescriptorName UI="D000293" MajorTopicYN="N">Adolescent</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000328" MajorTopicYN="N">Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000368" MajorTopicYN="N">Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D000073640" MajorTopicYN="Y">Betacoronavirus</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D001803" MajorTopicYN="Y">Blood Transfusion</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D002648" MajorTopicYN="N">Child</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015897" MajorTopicYN="N">Comorbidity</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018352" MajorTopicYN="N">Coronavirus Infections</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000635" MajorTopicYN="N">transmission</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D003430" MajorTopicYN="N">Cross-Sectional Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D018562" MajorTopicYN="N">Disease Transmission, Infectious</DescriptorName>
<QualifierName UI="Q000517" MajorTopicYN="Y">prevention & control</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D005260" MajorTopicYN="N">Female</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D006801" MajorTopicYN="N">Humans</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D007492" MajorTopicYN="N" Type="Geographic">Iran</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="N">epidemiology</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008297" MajorTopicYN="N">Male</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D008875" MajorTopicYN="N">Middle Aged</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D058873" MajorTopicYN="N">Pandemics</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011024" MajorTopicYN="N">Pneumonia, Viral</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000635" MajorTopicYN="N">transmission</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011159" MajorTopicYN="Y">Population Surveillance</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015995" MajorTopicYN="N">Prevalence</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D011379" MajorTopicYN="N">Prognosis</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D012189" MajorTopicYN="N">Retrospective Studies</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D015996" MajorTopicYN="N">Survival Rate</DescriptorName>
<QualifierName UI="Q000639" MajorTopicYN="N">trends</QualifierName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D055815" MajorTopicYN="N">Young Adult</DescriptorName>
</MeshHeading>
<MeshHeading><DescriptorName UI="D017086" MajorTopicYN="N">beta-Thalassemia</DescriptorName>
<QualifierName UI="Q000453" MajorTopicYN="Y">epidemiology</QualifierName>
<QualifierName UI="Q000628" MajorTopicYN="N">therapy</QualifierName>
</MeshHeading>
</MeshHeadingList>
</MedlineCitation>
<PubmedData><History><PubMedPubDate PubStatus="received"><Year>2020</Year>
<Month>07</Month>
<Day>06</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="accepted"><Year>2020</Year>
<Month>07</Month>
<Day>06</Day>
</PubMedPubDate>
<PubMedPubDate PubStatus="entrez"><Year>2020</Year>
<Month>9</Month>
<Day>14</Day>
<Hour>5</Hour>
<Minute>47</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="pubmed"><Year>2020</Year>
<Month>9</Month>
<Day>15</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
<PubMedPubDate PubStatus="medline"><Year>2020</Year>
<Month>9</Month>
<Day>23</Day>
<Hour>6</Hour>
<Minute>0</Minute>
</PubMedPubDate>
</History>
<PublicationStatus>epublish</PublicationStatus>
<ArticleIdList><ArticleId IdType="pubmed">32921705</ArticleId>
<ArticleId IdType="doi">10.23750/abm.v91i3.10155</ArticleId>
</ArticleIdList>
</PubmedData>
</pubmed>
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