Research Article
BibTex RIS Cite

COVID-19 Ön Tanısı Olan Çocuk Hastaların Klinik Özellikleri ile Tedavi Sonuçlarının Değerlendirilmesi

Year 2022, Volume: 24 Issue: 2, 162 - 169, 30.08.2022

Nadide Melike Sav Sevim Türay Şükriye Özde Şükrü Öksüz

https://doi.org/10.18678/dtfd.1098928
Cited By: 1

Abstract

Amaç: Çocuklarda koronavirüs hastalığı 2019 (coronavirus disease 2019, COVID-19)'un epidemiyolojik özellikleri ve bulaşma yolları henüz tam olarak anlaşılamamıştır. Bu çalışmada, COVID-19 şüphesiyle takip edilen PCR testi negatif ve pozitif olan hastalarda klinik, laboratuvar ve radyolojik bulgular ve tedavi yaklaşımlarının geriye dönük olarak değerlendirilmesi amaçlanmıştır.
Gereç ve Yöntemler: Bu çalışma, COVID-19 ön tanısı ile ayaktan veya yatarak tedavi gören 18 yaş altı 317 hasta ile yapılmıştır. Tüm hastalar klinik seyir, hastalık şiddeti, ek hastalıkları, demografik özellikler, laboratuvar ve radyodiagnostik testler, tedavi özellikleri ve sonuçları açısından değerlendirildi.
Bulgular: COVID-19 şüphesi olan hastaların 133’ünde (%42) PCR testi pozitif ve 184’ünde (%58) negatifti. PCR pozitif ve negatif hastaların sırasıyla 78’inde (%58,6) ve 51’inde (%27,7) temas öyküsü vardı (p<0,001). PCR-negatif grupta hastaneye yatış oranı daha yüksek iken (p=0,020), PCR-pozitif grupta hastanede kalış süresi daha uzundu (p=0,037). Beyaz kan hücresi sayısı (p=0,001), trombosit sayısı (p=0,037), nötrofil sayısı (p=0,015) ve laktat düzeyi (p=0,025) PCR pozitif grupta anlamlı düzeyde düşüktü.
Sonuç: COVID-19'u düşündüren semptomları olan çocukların erken tespiti ve izolasyonu, hastalığın yayılmasını sınırlamak için önemlidir. Özellikle pediatrik hastalarda vakanın COVID-19 olup olmadığını klinik olarak anlamak başlangıçta zor olabilir. PCR testi COVID- 19 tanısında altın standarttır. Salgının yaygınlığı, şiddeti ve komplikasyonları göz önüne alındığında şüpheli hastaları başlangıçta COVID-19 hastası gibi değerlendirmek uygun bir yaklaşım olacaktır.

Keywords

COVID-19 SARS-CoV-2 çocukluk çağı

References

  • Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207.
  • Tan W, Zhao X, Ma X, Wang W, Niu P, Xu W, et al. A novel coronavirus genome identified in a cluster of pneumonia cases - Wuhan, China 2019-2020. China CDC Wkly. 2020;24;2(4):61-2.
  • who.int [Internet]. World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations: scientific brief. [Cited: 2022 March 20]. Available from: https://apps.who.int/iris/handle/10665/331601
  • saglik.gov.tr [Internet]. Republic of Türkiye Ministry of Health. COVID-19 Information Platform. [Cited: 2022 March 20]. Available from: https://covid19.saglik.gov.tr/
  • Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;15;395(10223):514-23.
  • Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
  • CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-6.
  • Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al.; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in children. N Engl J Med. 2020;382(17):1663-5.
  • Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4.
  • Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260-3.
  • Fang F, Luo XP. [Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives]. Zhonghua Er Ke Za Zhi. 2020;58(2):81-5. Chinese
  • Cristiani L, Mancino E, Matera L, Nenna R, Pierangeli A, Scagnolari C, et al. Will children reveal their secret? The coronavirus dilemma. Eur Respir J. 2020;55(4):2000749.
  • Liu J, Ji H, Zheng W, Wu X, Zhu JJ, Arnold AP, et al. Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17β-oestradiol-dependent and sex chromosome-independent. Biol Sex Differ. 2010;1(1):6.
  • Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6):e20200702.
  • Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med. 2020;382(9):872-4.
  • Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York City. J Pediatr. 2020;223:14-9.e2.
  • Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020:e201346.
  • Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics. 2018;38(3):719-39.
  • Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296(2):E115-7.
  • Harwood R, Sinha I. Diagnosis of COVID-19 in children: the story evolves. BMC Med. 2020;18(1):158.
  • Mukherjee S, Pahan K. Is COVID-19 gender-sensitive? J Neuroimmune Pharmacol. 2021;16(1):38-47.
  • Di Stadio A, Della Volpe A, Ralli M, Ricci G. Gender differences in COVID-19 infection. The estrogen effect on upper and lower airways. Can it help to figure out a treatment? Eur Rev Med Pharmacol Sci. 2020;24(10):5195-6.
  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
  • Naumenko V, Turk M, Jenne CN, Kim SJ. Neutrophils in viral infection. Cell Tissue Res. 2018;371(3):505-16.
  • Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
  • Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529-39.
  • Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;24;12(1):8.
  • Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020;57(9):820-6.
  • Ma X, Liu S, Chen L, Zhuang L, Zhang J, Xin Y. The clinical characteristics of pediatric inpatients with SARS-CoV-2 infection: A meta-analysis and systematic review. J Med Virol. 2021;93(1):234-40.
  • Allahverdiyev S, Quisi A, Harbalıoğlu H, Alıcı G, Genç Ö, Yıldırım A, et al. The neutrophil to lymphocyte ratio and in-hospital all-cause mortality in patients with COVID-19. Eur J Ther. 2020;26(3):251-6.
  • Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: the past, present, and future. Hematology Am Soc Hematol Educ Program. 2017;2017(1):660-6.
  • Hatherill M, McIntyre AG, Wattie M, Murdoch IA. Early hyperlactataemia in critically ill children. Intensive Care Med. 2000;26(3):314-8.
  • Batra P, Dwivedi AK, Thakur N. Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics. Int J Crit Illn Inj Sci. 2014;4(3):247-52.
  • Gefen AM, Palumbo N, Nathan SK, Singer PS, Castellanos-Reyes LJ, Sethna CB. Pediatric COVID-19-associated rhabdomyolysis: a case report. Pediatr Nephrol. 2020;35(8):1517-20.
  • Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res. 2020;21(1):74.
  • Zheng F, Tang W, Li H, Huang YX, Xie YL, Zhou ZG. Clinical characteristics of 161 cases of coronavirus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci. 2020;24(6):3404-10.
  • Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689-96.
  • Chen LL, Hsu CW, Tian YC, Fang JT. Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome. Int J Clin Pract. 2005;59(10):1162-6.

Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19

Year 2022, Volume: 24 Issue: 2, 162 - 169, 30.08.2022

Nadide Melike Sav Sevim Türay Şükriye Özde Şükrü Öksüz

https://doi.org/10.18678/dtfd.1098928
Cited By: 1

Abstract

Aim: The epidemiological characteristics and modes of transmission of coronavirus disease 2019 (COVID-19) in children are not yet fully understood. In this study, it was aimed to evaluate clinical, laboratory, and radiological findings and treatment approaches in patients with negative and positive PCR tests among those with suspected COVID-19 retrospectively.
Material and Methods: This study was conducted with 317 patients under 18 years of age, who received outpatient or inpatient treatment with a pre-diagnosis of COVID-19. All patients were assessed for clinical course, disease severity, comorbidity, demographic characteristics, laboratory and radiodiagnostic tests, treatment characteristics, and outcomes.
Results: The PCR test was positive in 133 (42%) and negative in 184 (58%) of the patients with suspected COVID-19. There was a history of contact in 78 (58.6%) and 51 (27.7%) of the PCR-positive and negative patients, respectively (p<0.001). While the PCR-negative group had a higher rate of hospitalization (p=0.020), hospital stay was longer in PCR-positive cases (p=0.037). The white blood cell count (p=0.001), platelet count (p=0.037), neutrophil count (p=0.015), and lactate level (p=0.025) were significantly lower in the PCR-positive group.
Conclusion: Early detection and isolation of children with symptoms suggestive of COVID-19 are important to limit the spread of the disease. It can be challenging initially to clinically understand whether the case has COVID-19, especially in pediatric patients. PCR test is the gold standard in the diagnosis of COVID-19. Considering the prevalence, severity, and complications of the outbreak, it would be a proper approach to initially evaluate suspected patients as COVID-19 patients.

Keywords

COVID-19 childhood SARS-CoV-2

References

  • Li Q, Guan X, Wu P, Wang X, Zhou L, Tong Y, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med. 2020;382(13):1199-207.
  • Tan W, Zhao X, Ma X, Wang W, Niu P, Xu W, et al. A novel coronavirus genome identified in a cluster of pneumonia cases - Wuhan, China 2019-2020. China CDC Wkly. 2020;24;2(4):61-2.
  • who.int [Internet]. World Health Organization. Modes of transmission of virus causing COVID-19: implications for IPC precaution recommendations: scientific brief. [Cited: 2022 March 20]. Available from: https://apps.who.int/iris/handle/10665/331601
  • saglik.gov.tr [Internet]. Republic of Türkiye Ministry of Health. COVID-19 Information Platform. [Cited: 2022 March 20]. Available from: https://covid19.saglik.gov.tr/
  • Chan JF, Yuan S, Kok KH, To KK, Chu H, Yang J, et al. A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster. Lancet. 2020;15;395(10223):514-23.
  • Wu Z, McGoogan JM. Characteristics of and important lessons from the coronavirus disease 2019 (COVID-19) outbreak in China: Summary of a report of 72 314 cases from the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239-42.
  • CDC COVID-19 Response Team. Coronavirus disease 2019 in children - United States, February 12-April 2, 2020. MMWR Morb Mortal Wkly Rep. 2020;69(14):422-6.
  • Lu X, Zhang L, Du H, Zhang J, Li YY, Qu J, et al.; Chinese Pediatric Novel Coronavirus Study Team. SARS-CoV-2 Infection in children. N Engl J Med. 2020;382(17):1663-5.
  • Li W, Moore MJ, Vasilieva N, Sui J, Wong SK, Berne MA, et al. Angiotensin-converting enzyme 2 is a functional receptor for the SARS coronavirus. Nature. 2003;426(6965):450-4.
  • Wrapp D, Wang N, Corbett KS, Goldsmith JA, Hsieh CL, Abiona O, et al. Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation. Science. 2020;367(6483):1260-3.
  • Fang F, Luo XP. [Facing the pandemic of 2019 novel coronavirus infections: the pediatric perspectives]. Zhonghua Er Ke Za Zhi. 2020;58(2):81-5. Chinese
  • Cristiani L, Mancino E, Matera L, Nenna R, Pierangeli A, Scagnolari C, et al. Will children reveal their secret? The coronavirus dilemma. Eur Respir J. 2020;55(4):2000749.
  • Liu J, Ji H, Zheng W, Wu X, Zhu JJ, Arnold AP, et al. Sex differences in renal angiotensin converting enzyme 2 (ACE2) activity are 17β-oestradiol-dependent and sex chromosome-independent. Biol Sex Differ. 2010;1(1):6.
  • Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 among children in China. Pediatrics. 2020;145(6):e20200702.
  • Phan LT, Nguyen TV, Luong QC, Nguyen TV, Nguyen HT, Le HQ, et al. Importation and human-to-human transmission of a novel coronavirus in Vietnam. N Engl J Med. 2020;382(9):872-4.
  • Chao JY, Derespina KR, Herold BC, Goldman DL, Aldrich M, Weingarten J, et al. Clinical characteristics and outcomes of hospitalized and critically ill children and adolescents with coronavirus disease 2019 at a tertiary care medical center in New York City. J Pediatr. 2020;223:14-9.e2.
  • Tagarro A, Epalza C, Santos M, Sanz-Santaeufemia FJ, Otheo E, Moraleda C, et al Screening and severity of coronavirus disease 2019 (COVID-19) in children in Madrid, Spain. JAMA Pediatr. 2020:e201346.
  • Koo HJ, Lim S, Choe J, Choi SH, Sung H, Do KH. Radiographic and CT features of viral pneumonia. Radiographics. 2018;38(3):719-39.
  • Fang Y, Zhang H, Xie J, Lin M, Ying L, Pang P, et al. Sensitivity of chest CT for COVID-19: comparison to RT-PCR. Radiology. 2020;296(2):E115-7.
  • Harwood R, Sinha I. Diagnosis of COVID-19 in children: the story evolves. BMC Med. 2020;18(1):158.
  • Mukherjee S, Pahan K. Is COVID-19 gender-sensitive? J Neuroimmune Pharmacol. 2021;16(1):38-47.
  • Di Stadio A, Della Volpe A, Ralli M, Ricci G. Gender differences in COVID-19 infection. The estrogen effect on upper and lower airways. Can it help to figure out a treatment? Eur Rev Med Pharmacol Sci. 2020;24(10):5195-6.
  • Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, et al; China Medical Treatment Expert Group for COVID-19. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med. 2020;382(18):1708-20.
  • Naumenko V, Turk M, Jenne CN, Kim SJ. Neutrophils in viral infection. Cell Tissue Res. 2018;371(3):505-16.
  • Wu C, Chen X, Cai Y, Xia J, Zhou X, Xu S, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-43.
  • Channappanavar R, Perlman S. Pathogenic human coronavirus infections: causes and consequences of cytokine storm and immunopathology. Semin Immunopathol. 2017;39(5):529-39.
  • Xu H, Zhong L, Deng J, Peng J, Dan H, Zeng X, et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. Int J Oral Sci. 2020;24;12(1):8.
  • Meena J, Yadav J, Saini L, Yadav A, Kumar J. Clinical features and outcome of SARS-CoV-2 infection in children: A systematic review and meta-analysis. Indian Pediatr. 2020;57(9):820-6.
  • Ma X, Liu S, Chen L, Zhuang L, Zhang J, Xin Y. The clinical characteristics of pediatric inpatients with SARS-CoV-2 infection: A meta-analysis and systematic review. J Med Virol. 2021;93(1):234-40.
  • Allahverdiyev S, Quisi A, Harbalıoğlu H, Alıcı G, Genç Ö, Yıldırım A, et al. The neutrophil to lymphocyte ratio and in-hospital all-cause mortality in patients with COVID-19. Eur J Ther. 2020;26(3):251-6.
  • Zarychanski R, Houston DS. Assessing thrombocytopenia in the intensive care unit: the past, present, and future. Hematology Am Soc Hematol Educ Program. 2017;2017(1):660-6.
  • Hatherill M, McIntyre AG, Wattie M, Murdoch IA. Early hyperlactataemia in critically ill children. Intensive Care Med. 2000;26(3):314-8.
  • Batra P, Dwivedi AK, Thakur N. Bedside ABG, electrolytes, lactate and procalcitonin in emergency pediatrics. Int J Crit Illn Inj Sci. 2014;4(3):247-52.
  • Gefen AM, Palumbo N, Nathan SK, Singer PS, Castellanos-Reyes LJ, Sethna CB. Pediatric COVID-19-associated rhabdomyolysis: a case report. Pediatr Nephrol. 2020;35(8):1517-20.
  • Zhang G, Zhang J, Wang B, Zhu X, Wang Q, Qiu S. Analysis of clinical characteristics and laboratory findings of 95 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a retrospective analysis. Respir Res. 2020;21(1):74.
  • Zheng F, Tang W, Li H, Huang YX, Xie YL, Zhou ZG. Clinical characteristics of 161 cases of coronavirus disease 2019 (COVID-19) in Changsha. Eur Rev Med Pharmacol Sci. 2020;24(6):3404-10.
  • Qiu H, Wu J, Hong L, Luo Y, Song Q, Chen D. Clinical and epidemiological features of 36 children with coronavirus disease 2019 (COVID-19) in Zhejiang, China: an observational cohort study. Lancet Infect Dis. 2020;20(6):689-96.
  • Chen LL, Hsu CW, Tian YC, Fang JT. Rhabdomyolysis associated with acute renal failure in patients with severe acute respiratory syndrome. Int J Clin Pract. 2005;59(10):1162-6.
There are 38 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Research Article
Authors

Nadide Melike Sav 0000-0003-1520-6426

Sevim Türay 0000-0001-6002-052X

Şükriye Özde 0000-0002-0053-6222

Şükrü Öksüz 0000-0002-4893-5564

Publication Date August 30, 2022
Submission Date April 5, 2022
Published in Issue Year 2022 Volume: 24 Issue: 2

Cite

APA Sav, N. M., Türay, S., Özde, Ş., Öksüz, Ş. (2022). Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19. Duzce Medical Journal, 24(2), 162-169. https://doi.org/10.18678/dtfd.1098928
AMA Sav NM, Türay S, Özde Ş, Öksüz Ş. Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19. Duzce Med J. August 2022;24(2):162-169. doi:10.18678/dtfd.1098928
Chicago Sav, Nadide Melike, Sevim Türay, Şükriye Özde, and Şükrü Öksüz. “Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19”. Duzce Medical Journal 24, no. 2 (August 2022): 162-69. https://doi.org/10.18678/dtfd.1098928.
EndNote Sav NM, Türay S, Özde Ş, Öksüz Ş (August 1, 2022) Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19. Duzce Medical Journal 24 2 162–169.
IEEE N. M. Sav, S. Türay, Ş. Özde, and Ş. Öksüz, “Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19”, Duzce Med J, vol. 24, no. 2, pp. 162–169, 2022, doi: 10.18678/dtfd.1098928.
ISNAD Sav, Nadide Melike et al. “Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19”. Duzce Medical Journal 24/2 (August 2022), 162-169. https://doi.org/10.18678/dtfd.1098928.
JAMA Sav NM, Türay S, Özde Ş, Öksüz Ş. Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19. Duzce Med J. 2022;24:162–169.
MLA Sav, Nadide Melike et al. “Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19”. Duzce Medical Journal, vol. 24, no. 2, 2022, pp. 162-9, doi:10.18678/dtfd.1098928.
Vancouver Sav NM, Türay S, Özde Ş, Öksüz Ş. Evaluation of Clinical Features and Treatment Results of Pediatric Patients With Pre-Diagnosis of COVID-19. Duzce Med J. 2022;24(2):162-9.

Cited By

Clinical Features and Treatment Outcomes of COVID-19 Admissions in the Can Tho City Hospital of Tuberculosis and Respiratory Diseases, Vietnam: A Hospital-Based Observational Study
Healthcare
https://doi.org/10.3390/healthcare11111632
 Download Cover Image
Creative Commons License
Duzce Medical Journal is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.