A 67-year-old female presented with vague abdominal pain, renal failure, and sepsis. A CT scan without contrast was obtained and subcutaneous fluid was seen along with a large calcified gallstone. After antibiotics, fluid resuscitation and dialysis, the patient was taken to the operating room where a large subcutaneous abscess was found. The abdominal wall was debrided and an open cholecystectomy was attempted. Because of dense adhesions and inflammation, a cholecystostomy tube was placed. The patient required a skin graft after her abdominal wall debridement. Her gallbladder was removed 4 months later. This patient presented with a rare complication of acute cholecystitis - gallbladder rupture into the subcutaneous tissues. In this manuscript, we discuss this case and the literature.
{"title":"Acute Cholecystitis Presenting as a Subcutaneous Abscess and Sepsis","authors":"E. Thompson, Gilberto A. Garza, Jacob D Miller","doi":"10.21885/wvmj.2019.6","DOIUrl":"https://doi.org/10.21885/wvmj.2019.6","url":null,"abstract":"A 67-year-old female presented with vague abdominal pain, renal failure, and sepsis. A CT scan without contrast was obtained and subcutaneous fluid was seen along with a large calcified gallstone. After antibiotics, fluid resuscitation and dialysis, the patient was taken to the operating room where a large subcutaneous abscess was found. The abdominal wall was debrided and an open cholecystectomy was attempted. Because of dense adhesions and inflammation, a cholecystostomy tube was placed. The patient required a skin graft after her abdominal wall debridement. Her gallbladder was removed 4 months later. This patient presented with a rare complication of acute cholecystitis - gallbladder rupture into the subcutaneous tissues. In this manuscript, we discuss this case and the literature.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"28 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91456028","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Msiv Joseph Watson, Kristen M. Craig, Tanya Fancy, Daniel Merenda, C. Whiteman, Mph Melinda J. Sharon
Angioedema of the upper airway can pose a challenge in emergency airway management. The semi-awake fiberoptic nasotracheal intubation is an uncommonly performed procedure that allows for the establishment of a definitive airway without removing the patient’s airway reflexes, protecting against the cannot intubate-cannot oxygenate scenario. Although common teaching in emergency medicine training, fiberoptic nasotracheal intubations are rarely performed. We report a case of a successful intubation in a patient with an acute upper airway obstruction later found due to angioedema. Emergency physicians should have routine training and access to fiberoptic equipment to provide optimal patient care.
{"title":"Fiberoptic Nasotracheal Intubation in the Emergency Department for Severe Upper Airway Obstruction","authors":"Msiv Joseph Watson, Kristen M. Craig, Tanya Fancy, Daniel Merenda, C. Whiteman, Mph Melinda J. Sharon","doi":"10.21885/WVMJ.2019.4","DOIUrl":"https://doi.org/10.21885/WVMJ.2019.4","url":null,"abstract":"Angioedema of the upper airway can pose a challenge in emergency airway management. The semi-awake fiberoptic nasotracheal intubation is an uncommonly performed procedure that allows for the establishment of a definitive airway without removing the patient’s airway reflexes, protecting against the cannot intubate-cannot oxygenate scenario. Although common teaching in emergency medicine training, fiberoptic nasotracheal intubations are rarely performed. We report a case of a successful intubation in a patient with an acute upper airway obstruction later found due to angioedema. Emergency physicians should have routine training and access to fiberoptic equipment to provide optimal patient care.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"42 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86546165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Apathetic thyrotoxicosis is an atypical manifestation of thyrotoxicosis characterized by depression, lethargy, and weakness.1 Patients are often elderly and have no known history of hyperthyroidism. Typical symptoms of hyperthyroidism such as hyperkinetic motor activity and exophthalmos are often absent. In the classical description, apathetic thyrotoxicosis is a distinct clinical entity, however the end stage presentation of typical thyrotoxicosis may result in apathy with considerable overlap in clinical features. This unique case illustrates a scenario in which untreated typical thyrotoxicosis progressed to an apathetic state, thus suggesting that apathetic thyrotoxicosis and end stage untreated thyrotoxicosis may be variations of the same disease process rather than distinct clinical entities. Here we present a 53 year old woman with typical Graves’ disease, treated initially with methimazole. She developed methimazole-induced agranulocytosis, requiring cessation of treatment. After a period of inadequate treatment, she represented in a clinically apathetic state, with biochemically uncontrolled hyperthyroidism. Following emergent medical stabilization, she successfully underwent definitive total thyroidectomy.
{"title":"An Atypical Presentation of Apathetic Thyrotoxicosis Requiring Thyroidectomy In The Acute Setting","authors":"M. Koh, Md Mph Facs Melissa LoPinto","doi":"10.21885/WVMJ.2019.2","DOIUrl":"https://doi.org/10.21885/WVMJ.2019.2","url":null,"abstract":"Apathetic thyrotoxicosis is an atypical manifestation of thyrotoxicosis characterized by depression, lethargy, and weakness.1 Patients are often elderly and have no known history of hyperthyroidism. Typical symptoms of hyperthyroidism such as hyperkinetic motor activity and exophthalmos are often absent. In the classical description, apathetic thyrotoxicosis is a distinct clinical entity, however the end stage presentation of typical thyrotoxicosis may result in apathy with considerable overlap in clinical features. This unique case illustrates a scenario in which untreated typical thyrotoxicosis progressed to an apathetic state, thus suggesting that apathetic thyrotoxicosis and end stage untreated thyrotoxicosis may be variations of the same disease process rather than distinct clinical entities. Here we present a 53 year old woman with typical Graves’ disease, treated initially with methimazole. She developed methimazole-induced agranulocytosis, requiring cessation of treatment. After a period of inadequate treatment, she represented in a clinically apathetic state, with biochemically uncontrolled hyperthyroidism. Following emergent medical stabilization, she successfully underwent definitive total thyroidectomy.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81967579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Msiii Alexander C. Schlarb, A. S. Martin, Timothy A. VanHoose, R. Zagoria
{"title":"Chlamydia trachomatis Associated Fitz-Hugh-Curtis Syndrome","authors":"Msiii Alexander C. Schlarb, A. S. Martin, Timothy A. VanHoose, R. Zagoria","doi":"10.21885/wvmj.2019.1","DOIUrl":"https://doi.org/10.21885/wvmj.2019.1","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"70 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78766897","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Rahul Sangani, MD, Lana Winkler, MD, Zalak Patel, MD
{"title":"Pulmonary Involvement in Sjögren’s Syndrome: Lymphocytic Interstitial Pneumonia Transforming into Lymphoma","authors":"Rahul Sangani, MD, Lana Winkler, MD, Zalak Patel, MD","doi":"10.21885/wvmj.2019.8","DOIUrl":"https://doi.org/10.21885/wvmj.2019.8","url":null,"abstract":"","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"19 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90347701","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jasmyn E. Atalla, BS, Ross D. DeChant, MD, Lynne J. Goebel, MD, FACP, Corresponding Author: Maurice A. Mufuson, MD, MACP
Studies show high rates of physicians believing that they should treat relatives and themselves In this study, we compared such attitudes in surveys conducted in 2017 and 2012 among similar populations of physicians who attended Internal Medicine, Pediatrics, Family Medicine, and OB/ GYN Grand Rounds. Fewer respondents in 2017 prescribed medications to relatives without an examination. Similar numbers of residents and faculty in both years believed they should treat their relatives. Fifty-nine percent treated relatives for minor illnesses, a significant decrease from 75.3% in 2012. About half of physicians treated themselves for minor illnesses in both years. Although 73% of current respondents had a primary care physician (PCP), a significantly higher proportion of men had PCPs (p-0.04) in 2017 in contrast to a significantly higher proportion of women in 2012 (p=0.01). The overall frequency of residents and faculty physicians who treat relatives and themselves decreased in the past five years and less treat without examination. However, too many physicians continue this practice, despite the ethical admonitions of the AMA and ACP. More education is required to convince physicians not to treat relatives and themselves. Further research is needed to determine why men now have PCPs more often than women.
{"title":"A five-year follow up of doctors treating relatives and themselves","authors":"Jasmyn E. Atalla, BS, Ross D. DeChant, MD, Lynne J. Goebel, MD, FACP, Corresponding Author: Maurice A. Mufuson, MD, MACP","doi":"10.21885/wvmj.2019.14","DOIUrl":"https://doi.org/10.21885/wvmj.2019.14","url":null,"abstract":"Studies show high rates of physicians believing that they should treat relatives and themselves In this study, we compared such attitudes in surveys conducted in 2017 and 2012 among similar populations of physicians who attended Internal Medicine, Pediatrics, Family Medicine, and OB/ GYN Grand Rounds. Fewer respondents in 2017 prescribed medications to relatives without an examination. Similar numbers of residents and faculty in both years believed they should treat their relatives. Fifty-nine percent treated relatives for minor illnesses, a significant decrease from 75.3% in 2012. About half of physicians treated themselves for minor illnesses in both years. Although 73% of current respondents had a primary care physician (PCP), a significantly higher proportion of men had PCPs (p-0.04) in 2017 in contrast to a significantly higher proportion of women in 2012 (p=0.01). The overall frequency of residents and faculty physicians who treat relatives and themselves decreased in the past five years and less treat without examination. However, too many physicians continue this practice, despite the ethical admonitions of the AMA and ACP. More education is required to convince physicians not to treat relatives and themselves. Further research is needed to determine why men now have PCPs more often than women.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"4 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87997667","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Michael J. Niemann, Ryan Sprouse, MD, CAQSM, George D. Harris, MD, MS, CAQSM, Nathan T. Fiore
The incidence and prevalence of sport-related concussion has increased over the past decade as a result of an increase in athletic participation, improved diagnostic methods, and an overall increased awareness of the symptoms and signs of concussions. This is a retrospective study identifying high school athletes in the Eastern Panhandle of West Virginia who participated in baseline and post-concussion neurocognitive ImPACT testing from 2008-2017. A total of p40 unique first post injury tests were performed, and a total of 9,850 unique baseline tests were perlormed. The athletes were baseline tested at the beginning of their freshman and junior years. New students and any student who had had a concussion in the previous year were tested prior to starting, their respective sport season. The number of post-concussion tests was compared to the number of baseline tests and stratified each year by age, sex, and sport. Comparing our findings with the incidence by sport reported in the medical literature demonstrated that the same sports identified as being the highest and lowest risk were generally congruent with the sports reported to be the highest and lowest risk in two large literature reviews » B. The notable exception was cheerleading; our study found it to be among the sports with a higher incidence of concussion. A review of the literature demonstrated that cheerleaders, like participants in other contact sports, are at significant risk for concussion. Previously concussion rates in cheerleading bad been reported to be relatively low (4- 6% of cheerleading injuries) compared to other injuries and compared to concussion rates in other sports. However, concussions were noted to be the most common cheerleading injury, accounting for 31.1% of injuries. " and also reported that the number and rate of cheerleading related concussions had increased by 290% from 2001 to 2012.
{"title":"Concussions in High School Sports in the Eastern Panhandle of West Virginia 2008-2017","authors":"Michael J. Niemann, Ryan Sprouse, MD, CAQSM, George D. Harris, MD, MS, CAQSM, Nathan T. Fiore","doi":"10.21885/wvmj.2019.12","DOIUrl":"https://doi.org/10.21885/wvmj.2019.12","url":null,"abstract":"The incidence and prevalence of sport-related concussion has increased over the past decade as a result of an increase in athletic participation, improved diagnostic methods, and an overall increased awareness of the symptoms and signs of concussions. This is a retrospective study identifying high school athletes in the Eastern Panhandle of West Virginia who participated in baseline and post-concussion neurocognitive ImPACT testing from 2008-2017. A total of p40 unique first post injury tests were performed, and a total of 9,850 unique baseline tests were perlormed. The athletes were baseline tested at the beginning of their freshman and junior years. New students and any student who had had a concussion in the previous year were tested prior to starting, their respective sport season. The number of post-concussion tests was compared to the number of baseline tests and stratified each year by age, sex, and sport. Comparing our findings with the incidence by sport reported in the medical literature demonstrated that the same sports identified as being the highest and lowest risk were generally congruent with the sports reported to be the highest and lowest risk in two large literature reviews » B. The notable exception was cheerleading; our study found it to be among the sports with a higher incidence of concussion. A review of the literature demonstrated that cheerleaders, like participants in other contact sports, are at significant risk for concussion. Previously concussion rates in cheerleading bad been reported to be relatively low (4- 6% of cheerleading injuries) compared to other injuries and compared to concussion rates in other sports. However, concussions were noted to be the most common cheerleading injury, accounting for 31.1% of injuries. \" and also reported that the number and rate of cheerleading related concussions had increased by 290% from 2001 to 2012.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"626 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76808061","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Herpes simplex virus (HSV) infections are ubiquitous in the population in the more than half of all people seropositive HSV-2. While these in cause oral or genital lesions, anywhere on the body Herpetic whitlow class painful swollen, vesicular lesion of the digits due to HSV infection. In some instances, however, the skin lesion of HSV may appear atypical. In the following report, we describe a unique case of a hemorrhagic, pustular appearing herpetic whitlow infection of the hand. This report serves to remind physicians to consider the diagnosis of HV for a painful skin lesion of the hand, as herpetic whitlow can mimic more serious conditions and early detection can limit the spread of the disease.
{"title":"Painful Hemorrhagic Lesion of Right Palm","authors":"Lauryn Falcone, PhD, Omid Jalali, MD, Corresponding Author: Roxann Powers, MD","doi":"10.21885/wvmj.2019.13","DOIUrl":"https://doi.org/10.21885/wvmj.2019.13","url":null,"abstract":"Herpes simplex virus (HSV) infections are ubiquitous in the population in the more than half of all people seropositive HSV-2. While these in cause oral or genital lesions, anywhere on the body Herpetic whitlow class painful swollen, vesicular lesion of the digits due to HSV infection. In some instances, however, the skin lesion of HSV may appear atypical. In the following report, we describe a unique case of a hemorrhagic, pustular appearing herpetic whitlow infection of the hand. This report serves to remind physicians to consider the diagnosis of HV for a painful skin lesion of the hand, as herpetic whitlow can mimic more serious conditions and early detection can limit the spread of the disease.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"23 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83237339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Scott Shapiro, MD, Brian Wiseman, BS, Brian Kellermeyer, MD, Michele Carr, MD, DMD, PhD, Stephen Wetmore MD, MBA, Adam Cassis, MD
Sudden sensorineural hearing loss (SSNHL) is an acute loss of hearing due to poorly understood insults to the inner ear. SSNHL is a medical emergency warranting urgent referral to an otolaryngology specialist because hearing outcomes are improved with steroid treatment that must be administered soon after the onset of hearing loss to be effective, making early diagnosis and triage essential to salvaging hearing. This prospective study catalogued the timeline of the onset of hearing loss, diagnosis, treatment, and settings where care was administered for patients with SSNHL. We diagnosed 21 patients with SSNHL in the otolaryngology specialty clinics of West Virginia University over a 6 month time period. Nine of those patients (42.9%) were diagnosed outside of the window for treatment. The most common cause of delayed diagnosis was inappropriate treatment and triage in the primary care setting, As the quality of life burden of hearing loss is quite significant, improving recognition and triage in the primary care setting would allow for more patients with SSNHL to undergo treatment, improving hearing outcomes and quality of life.
{"title":"Delays in care of sudden sensorineural hearing loss, an unrecognized emergency","authors":"Scott Shapiro, MD, Brian Wiseman, BS, Brian Kellermeyer, MD, Michele Carr, MD, DMD, PhD, Stephen Wetmore MD, MBA, Adam Cassis, MD","doi":"10.21885/wvmj.2019.3","DOIUrl":"https://doi.org/10.21885/wvmj.2019.3","url":null,"abstract":"Sudden sensorineural hearing loss (SSNHL) is an acute loss of hearing due to poorly understood insults to the inner ear. SSNHL is a medical emergency warranting urgent referral to an otolaryngology specialist because hearing outcomes are improved with steroid treatment that must be administered soon after the onset of hearing loss to be effective, making early diagnosis and triage essential to salvaging hearing. This prospective study catalogued the timeline of the onset of hearing loss, diagnosis, treatment, and settings where care was administered for patients with SSNHL. We diagnosed 21 patients with SSNHL in the otolaryngology specialty clinics of West Virginia University over a 6 month time period. Nine of those patients (42.9%) were diagnosed outside of the window for treatment. The most common cause of delayed diagnosis was inappropriate treatment and triage in the primary care setting, As the quality of life burden of hearing loss is quite significant, improving recognition and triage in the primary care setting would allow for more patients with SSNHL to undergo treatment, improving hearing outcomes and quality of life.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"59 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80247833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
bjective: Direct Acting Antiviral (DAA) drugs have been recently approved by the Food and Drug Administraation for children with HCV infection (FDA news release, April 7, 2017). We describe the first two HCV- infected children from Kentucky treated successfully with DAA drugs from a research protocol. Methods: The charts of two children with HCV infections were reviewed. Once adolescent age was achieved (12 years), both children (one naïve and one experienced) were treated for eight weeks with Sofosbuvir and Ledipasvir (Harvoni) and were monitored. Their aminotransferases and HCVRNA levels were followed before and after treatment. Results: Both children were followed for their HCV infections since infancy. Both children achieved SVR at the end of therapy, one achieved SVR 12 weeks post therapy. The second patient is still on follow up post treatment. Conclusion: This is the first report of children treated with DAA drugs not under a research protocol. We suggest the eightweek treatment may be sufficient to achieve SVR in children. Patient advocacy groups and government agencies should pressure the insurance companies to approve DAA therapy for HCVinfected children.
{"title":"Sofosbuvir and Ledipasvir (Harvoni) treatment for hepatitis C in Children","authors":"Yoram Elitsur, MD","doi":"10.21885/wvmj.2019.11","DOIUrl":"https://doi.org/10.21885/wvmj.2019.11","url":null,"abstract":"bjective: Direct Acting Antiviral (DAA) drugs have been recently approved by the Food and Drug Administraation for children with HCV infection (FDA news release, April 7, 2017). We describe the first two HCV- infected children from Kentucky treated successfully with DAA drugs from a research protocol. Methods: The charts of two children with HCV infections were reviewed. Once adolescent age was achieved (12 years), both children (one naïve and one experienced) were treated for eight weeks with Sofosbuvir and Ledipasvir (Harvoni) and were monitored. Their aminotransferases and HCVRNA levels were followed before and after treatment. Results: Both children were followed for their HCV infections since infancy. Both children achieved SVR at the end of therapy, one achieved SVR 12 weeks post therapy. The second patient is still on follow up post treatment. Conclusion: This is the first report of children treated with DAA drugs not under a research protocol. We suggest the eightweek treatment may be sufficient to achieve SVR in children. Patient advocacy groups and government agencies should pressure the insurance companies to approve DAA therapy for HCVinfected children.","PeriodicalId":23032,"journal":{"name":"The West Virginia medical journal","volume":"6 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79407476","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：