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COVID-19 clinical course and outcomes in a predominantly black, vulnerable patient population in New York City 纽约市以黑人为主的弱势患者群体的新冠肺炎临床过程和结果
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-04-01 DOI: 10.4103/IJAM.IJAM_116_20
Priyanka Parmar, Alecia James, Sabrina Rosengarten, Alvin Oommen, M. Joseph, Clara Wilson, Rohan Maini, Max Mecklenburg, J. Kim, J. Edwards, M. Nakeshbandi, Igal Breitman, B. Arquilla, Pia Daniel
Introduction: A study examining the impact of social determinants of health on COVID-19 outcomes is necessary to identify which aspects of a vulnerable population make it more susceptible. We describe the epidemiological and clinical characteristics of a patient population disproportionately impacted by COVID-19 and situate the findings within the broader context of health determinants. Materials and Methods: A descriptive study of 527 laboratory-confirmed COVID-19 patients hospitalized from March 12 to April 13, 2020, evaluated patient demographics, comorbidities, presentation, and outcomes. The study took place at an academic medical center serving a low-income, Black community (predominantly Caribbean-born) in Brooklyn, New York. Results: Compared to previous studies, we report a higher median age of 70 (interquartile range 59–80), a higher percentage of Blacks (91%), a higher prevalence of comorbidities (hypertension [83%], diabetes [53%], and obesity [42%]), a higher prevalence of abnormal findings on presentation (altered mental status [30%], Quick sequential organ failure assessment score ≥2 [27%], elevated random-glucose [77%], elevated creatinine [57%]), and a higher incidence of negative in-hospital outcomes (intensive care unit admission [21%], mechanical ventilation [21%], acute kidney injury [31%], acute respiratory distress syndrome [17%] and acute cardiac injury [18%], and age-adjusted fatality rate [40%.]). Conclusions: This study shows the characteristics of a patient population disproportionately impacted by COVID-19. The intersectionality of the Black race, older age, a high prevalence of comorbidities, and residency in a locale severely affected by COVID-19, deserves further consideration to better address health outcomes in vulnerable patient groups. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and Procedural skills, Systems-based practice.
引言:有必要研究健康的社会决定因素对新冠肺炎结果的影响,以确定弱势人群的哪些方面使其更易受感染。我们描述了受新冠肺炎不成比例影响的患者群体的流行病学和临床特征,并将研究结果置于更广泛的健康决定因素背景下。材料和方法:对2020年3月12日至4月13日住院的527名实验室确诊的新冠肺炎患者进行描述性研究,评估患者人口统计学、合并症、表现和结果。这项研究是在纽约布鲁克林一家为低收入黑人社区(主要出生于加勒比海)服务的学术医疗中心进行的。结果:与之前的研究相比,我们报告的中位年龄更高,为70岁(四分位间距为59–80),黑人比例更高(91%),合并症(高血压[83%]、糖尿病[53%]和肥胖[42%])的患病率更高,表现异常的发生率较高(精神状态改变[30%],快速连续器官衰竭评估评分≥2[27%],随机血糖升高[77%],肌酐升高[57%]),以及更高的阴性住院结果发生率(重症监护病房入院[21%]、机械通气[21%],急性肾损伤[31%]、急性呼吸窘迫综合征[17%]和急性心脏损伤[18%],以及年龄调整后的死亡率[40%])。黑人种族的交叉性、年龄较大、合并症的高患病率以及居住在受新冠肺炎严重影响的地区,值得进一步考虑,以更好地解决弱势患者群体的健康结果。本文讨论了以下核心能力:基于实践的学习和改进、患者护理和程序技能、基于系统的实践。
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引用次数: 0
Knowledge, attitude, and practices regarding COVID-19 outbreak among the personnel providing emergency services in India 在印度提供紧急服务的人员对COVID-19疫情的知识、态度和做法
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-04-01 DOI: 10.4103/IJAM.IJAM_2_21
V. Bhushan, Shilpa Rai
Introduction: The threat of contracting coronavirus persists among individuals constantly coming in direct or indirect contact with positive cases. Therefore, this study was conducted to assess the knowledge, attitude, and practices (KAPs) regarding the COVID19 outbreak among the personnel providing emergency services in India and also assess their perception toward government measures during this pandemic. Materials and Methods: An online survey was conducted among individuals providing services during the period of COVID-19 outbreak. A total of 234 people consented to continue with the survey. Data collection was carried out from April 2020 to June 2020. Data analysis was carried out using Chi-square statistics and Fisher-Freeman-Halton test. The level of statistical significance was set at 0.05 with a confidence interval of 95%. Results: Majority of the participants were male and belonged to the age group of 18–54 years. Almost all were aware that COVID-19 is a virus and had knowledge regarding its mode of spread and modes of prevention. Precautions such as covering face with mask, avoiding shaking hands, and washing hands before touching the eyes, nose, and mouth were undertaken by 34.6% of the total participants. Around 70.5% of the males, 53.7% of the females, and 33.3% of the participants from the others' category felt that the funds released by the government to combat corona were efficiently reaching the poor or the needy. Some of the barriers preventing the fair distribution of funds/services to the poor and needy as reported by the participants were corruption, lack of knowledge, delay in delivery and lack of personal protective kits, limited workforce, and no bank account of poor people. Conclusion: KAP of personnel providing emergency services is crucial to the containment of this disease. Understanding of the barriers shall aid policymakers to assess the impact of their preventive programs and also take crucial decisions toward its management. The following core competencies are addressed in this article: Medical knowledge, practice-based learning and improvement, and systems-based practice.
引言:感染冠状病毒的威胁在不断直接或间接接触阳性病例的人中持续存在。因此,本研究旨在评估印度提供紧急服务的人员对2019冠状病毒病疫情的知识、态度和实践(KAP),并评估他们对疫情期间政府措施的看法。材料和方法:对新冠肺炎疫情期间提供服务的个人进行在线调查。共有234人同意继续进行调查。数据收集于2020年4月至2020年6月进行。数据分析采用卡方统计和费雪-弗里曼-哈尔顿检验。统计学显著性水平设定为0.05,置信区间为95%。结果:大多数参与者是男性,属于18-54岁的年龄组。几乎所有人都知道新冠肺炎是一种病毒,并了解其传播模式和预防模式。34.6%的参与者采取了预防措施,如戴口罩、避免握手以及在触摸眼睛、鼻子和嘴巴之前洗手。约70.5%的男性、53.7%的女性和33.3%的其他类别参与者认为,政府为抗击电晕而发放的资金有效地惠及了穷人或有需要的人。与会者报告说,阻碍向穷人和有需要的人公平分配资金/服务的一些障碍是腐败、缺乏知识、延迟交付和缺乏个人防护用品、劳动力有限以及穷人没有银行账户。结论:提供急救服务人员的KAP对控制该疾病至关重要。了解障碍将有助于决策者评估其预防计划的影响,并对其管理做出关键决策。本文讨论了以下核心能力:医学知识、基于实践的学习和改进以及基于系统的实践。
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引用次数: 1
How do physicians and nurses assess and support patient medication adherence? An examination of a rural secondary care hospital in Delhi, India 医生和护士如何评估和支持患者的药物依从性?印度德里一家农村二级护理医院的检查
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-04-01 DOI: 10.4103/IJAM.IJAM_155_20
S. Basu, Ruchira Pangtey, B. Banerjee, Saurabh Kumar
Introduction: Suboptimal medication adherence contributes enormously to patient mortality, morbidity, and related health-care costs. Health-care providers (HCPs) have a pivotal role in supporting medication adherence in their patients through appropriate health communication. We assessed the perspectives and practices of medical doctors and nurses toward the assessment and support for patient medication adherence in Indian health settings. Materials and Methods: We conducted a cross-sectional study at a secondary-care hospital in Delhi. Data were collected from medical doctors, interns, and nursing staff using a self-administered questionnaire on the following domains: Medication Adherence, frequency, methods and tools of assessment, high-risk patient identification and interventions applied to promote adherence. Results: We recruited a total of 117 HCPs. The common modes of assessment of medication adherence used by the HCPs included a general question (78.6%), observing missed appointments (43.6%), and querying for forgetfulness (29.9%). However, none of the HCPs were aware of validated questionnaire (scales) for the assessment of medication adherence. Drug-related adverse effects as a cause of nonadherence were evaluated by 38.3% HCPs only. Conclusions: The development of simple and validated methods for assessing medication adherence applicable in resource-constrained settings along with the curricular training of HCPs on patient adherence and related know-how needs urgent prioritization. The following core competencies are addressed in this article: Practice-based learning and improvement, Systems-based practice, and Interpersonal and communication skills.
引言:次优药物依从性极大地增加了患者的死亡率、发病率和相关的医疗费用。卫生保健提供者(HCP)在通过适当的健康沟通支持患者的药物依从性方面发挥着关键作用。我们评估了医生和护士在印度卫生环境中对患者药物依从性的评估和支持的观点和做法。材料和方法:我们在德里的一家二级护理医院进行了一项横断面研究。使用自我管理问卷从医生、实习生和护理人员那里收集了以下领域的数据:药物依从性、频率、评估方法和工具、高风险患者识别和促进依从性的干预措施。结果:我们共招募了117名HCP。HCP使用的常见药物依从性评估模式包括一般问题(78.6%)、观察错过的预约(43.6%)和询问健忘(29.9%)。然而,没有一名HCP知道用于评估药物依从性的有效问卷(量表)。只有38.3%的HCP将药物相关不良反应作为不依从性的原因进行了评估。结论:开发适用于资源受限环境的简单且有效的药物依从性评估方法,以及HCP关于患者依从性和相关知识的课程培训,迫切需要优先考虑。本文讨论了以下核心能力:基于实践的学习和改进、基于系统的实践以及人际交往和沟通技能。
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引用次数: 0
Nutrition, COVID-19, and vaccines 营养、新冠肺炎和疫苗
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_13_21
H. Gillis, T. Papadimos
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引用次数: 0
Effectiveness of school-based dental health education on knowledge and practices related to emergency management of dental trauma and tooth avulsion: An educational intervention study 学校牙科健康教育对牙外伤和牙撕脱伤应急管理相关知识和实践的有效性:教育干预研究
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_56_19
Y. Srilatha, B. Shekar, N. Krupa
Introduction: Trauma to teeth and jaws are considered major public health problems. The school environment is the most susceptible place for children, to encounter trauma to teeth. Materials and Methods: This interventional study was conducted to evaluate the effectiveness of school-based dental health education (DHE) on knowledge and practices related to emergency management of dental trauma and tooth avulsion among students and teachers of three government and three private schools each selected from two mandals (Mandal is a sub-district which comprises of a cluster of villages and village is the lowest level of administrative sub-division in rural areas of India) of Guntur district. Baseline information was collected from participants using a validated structured questionnaire. DHE on “Dental Trauma and Emergency Management of Tooth Avulsion” was offered using audiovisual aids (Flip charts, Slideshow) by a qualified Public Health Dentist. Subsequently, trained science teachers in each school were requested to undertake health education sessions at monthly interval for the next 3 months. Postintervention data were collected 1 week after initial DHE by public health dentist and 1 week after last reinforcement session by the teacher. Mean knowledge and practice scores were compared using independent sample t-test and Repeated Measures Analysis of Variance. Results: A total of 1180 children (570 males and 602 females, age range: 12–16 years) and 54 teachers (24 males and 30 females, age range: 20–56 years) were included. Mean scores for knowledge and practices increased among students and teachers following intervention with no difference between flipchart and slideshow method. Conclusion: Teachers (preferably science teachers) could be effectively used for DHE provided that they receive proper training and continued education on dental trauma. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Systems-based practice.
牙齿和颌骨外伤被认为是主要的公共卫生问题。学校环境是孩子最容易遇到牙齿外伤的地方。材料与方法:本介入研究旨在评估贡图尔地区三所公立学校和三所私立学校的学生和教师对牙外伤和牙齿撕脱症应急管理相关知识和实践的学校牙科健康教育(DHE)的有效性。这三所学校分别选自两个曼达尔县(曼达尔县是一个由一组村庄组成的街道,而村庄是印度农村地区最低一级的行政分区)。基线信息从参与者使用有效的结构化问卷收集。一名合资格的公共卫生牙医利用视听辅助工具(活动挂图、幻灯片)提供了关于“牙齿创伤和牙齿撕脱的紧急处理”的DHE课程。随后,要求每所学校训练有素的科学教师在今后3个月内每月进行一次健康教育课程。干预后数据由公共卫生牙医在首次DHE后1周和教师在最后一次强化后1周收集。采用独立样本t检验和重复测量方差分析比较平均知识和实践得分。结果:共纳入儿童1180人(男570人,女602人,年龄12 ~ 16岁),教师54人(男24人,女30人,年龄20 ~ 56岁)。干预后学生和教师在知识和实践方面的平均得分均有所提高,而白板法和幻灯片法之间没有差异。结论:教师(最好是理科教师)只要接受适当的牙外伤培训和继续教育,就能有效地应用于DHE。本文讨论了以下核心能力:医学知识、基于实践的学习和改进、基于系统的实践。
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引用次数: 2
What's new in academic medicine? Focus on evolving models of competence in Graduate Medical Education 学术医学有什么新鲜事?关注医学研究生教育中不断发展的能力模式
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_30_21
Nicholas Taylor, N. Defenbaugh, Alaa-Eldin A. Mira, Erin Bendas
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引用次数: 0
De-emphasizing time-based training in the delivery of competency-based medical education for undergraduates in India: Justification, challenges, and potential solutions 在印度为本科生提供以能力为基础的医学教育时,不强调以时间为基础的培训:理由、挑战和潜在的解决方案
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_71_19
S. Shrivastava, P. Shrivastava
In the conventional medical curriculum in India, the duration of medical graduation is 4.5 years, excluding internship. The limitation of time-based advancement can be understood in two ways, either a student is sent to next professional year without attainment of the desired course outcomes or that students spend unnecessary time in a specific professional even after gaining the required outcomes. Acknowledging these limitations and also after realizing the multiple benefits attributed to Competency Based Medical Education (CBME), the same has been implemented in the Indian set-up for undergraduate courses from 2019 batch onwards. In general, CBME advocates against time-based training, especially because not every student can learn at an identical pace. However, adoption of the same strategy (time-variable) in imparting medical education has its own challenges. In India, even though, in principle, we have adopted all principles of CBME, except the time-variability of the course. However, now the same question arises, if all students learn at varying pace, how can we ensure that within a specified time duration, all the students will attain the desired outcomes? Even though, the task at hand is difficult, it can be accomplished, if we all work together in a planned and coordinated manner. In the mission to produce a competent medical graduate within a defined time interval, there is an immense need for better planning, support from administration, active participation of faculty members, involvement of the students, and better collaboration between departments.
在印度的传统医学课程中,医学毕业的期限为4.5年,不包括实习。基于时间的进步的局限性可以从两个方面来理解,要么学生在没有达到预期课程成绩的情况下被送到下一个专业年级,要么学生即使在获得所需成绩后,也会在特定专业上花费不必要的时间。认识到这些局限性,并在意识到基于能力的医学教育(CBME)带来的多重好处后,从2019年开始,印度的本科生课程也实施了同样的做法。总的来说,CBME反对基于时间的培训,尤其是因为不是每个学生都能以相同的速度学习。然而,在医学教育中采用相同的策略(时间变量)也有其自身的挑战。在印度,尽管原则上我们采用了CBME的所有原则,除了课程的时间可变性。然而,现在同样的问题出现了,如果所有学生都以不同的速度学习,我们如何确保在特定的时间内,所有学生都能达到预期的结果?尽管手头的任务很困难,但如果我们大家以有计划和协调的方式共同努力,它是可以完成的。为了在规定的时间间隔内培养出一名合格的医学毕业生,迫切需要更好的规划、行政部门的支持、教师的积极参与、学生的参与以及部门之间更好的合作。
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引用次数: 1
Pandemic and psychological outcomes among health-care practitioners: A cross-sectional study based on current evidence in Indian context amidst COVID-19 医护人员的流行病和心理结果:基于新冠肺炎期间印度背景下现有证据的横断面研究
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_138_20
S. Garg, A. Chauhan, D. Sharma, Sanjeet Singh, K. Bansal
Introduction: The dramatic spread of SARS-Cov-2 and the following fatalities put the health-care practitioners under high pressure and increased workload. Coping mechanisms adapted by health-care practitioners represent a challenge to their psychological resilience. This type of pandemic produces fearful behavior and increases the risk of adverse psychological responses. The aim was to study the prevalence of psychological outcomes and exploring the associated factors among health-care practitioners amidst COVID-19. Materials and Methods: This is a cross-sectional, online survey of 588 health-care practitioners who were fighting against the COVID-19. The survey was applied in August, 2020, using a questionnaire that measures depression, anxiety, and stress. Survey included two sections, sociodemographic characteristics and Depression Anxiety Stress Scale-21 (DASS-21) scale. SPSS 22.0 software package was used for statistical analysis. Binary logistic regression analysis was used to assess the factors associated with psychological problems. Pearson's correlation was also used to assess the correlation among the psychological outcomes themselves. Results: Out of 588 health-care practitioners, 49.65% had depressive symptoms, 41.15% had anxiety symptoms, and 30.95% were distressed. Around 25%–35% of health-care practitioners had moderate-to-severe symptoms. Mean age was 28.78 years, and mean score of DASS-21 was 31.29 (standard deviation SD = 27.07). Binary logistic regression analysis revealed that working as specialists and as frontline workers was significantly associated with different psychological outcomes (anxiety and stress). A statistically significant correlation was found between stress, anxiety, and depression. Conclusions: This study revealed that a large number of health-care practitioners were affected severely by psychological morbidities, which required a mental health professional consultation. These negative outcomes were invisible, inconvenient, and frightening in reality. Therefore, recognition of other risk factors and planning of interventions would be beneficial in reducing the damage to psychological well-being of these practitioners. The following core competencies are addressed in this article: Clinical knowledge, Practice-based learning and improvement, System-based practice.
引言:严重急性呼吸系统综合征冠状病毒2型的急剧传播和随后的死亡使医护人员面临巨大压力,工作量增加。保健从业人员采用的应对机制对他们的心理复原力构成了挑战。这种类型的流行病会产生恐惧行为,并增加不良心理反应的风险。目的是研究新冠肺炎期间医护人员的心理结果患病率,并探讨相关因素。材料和方法:这是一项针对588名抗击新冠肺炎的医护人员的横断面在线调查。该调查于2020年8月进行,使用了一份测量抑郁、焦虑和压力的问卷。调查包括两个部分,社会人口学特征和抑郁-焦虑-压力量表-21(DAS-21)。采用SPSS 22.0软件包进行统计分析。二元逻辑回归分析用于评估与心理问题相关的因素。Pearson相关性也被用来评估心理结果本身之间的相关性。结果:588名医护人员中,49.65%有抑郁症状,41.15%有焦虑症状,30.95%有痛苦症状。大约25%-35%的医护人员有中度至重度症状。平均年龄为28.78岁,DAS-21的平均得分为31.29(标准差SD=27.07)。二元逻辑回归分析显示,作为专家和一线工作者工作与不同的心理结果(焦虑和压力)显著相关。压力、焦虑和抑郁之间存在统计学上显著的相关性。结论:本研究表明,大量医护人员受到心理疾病的严重影响,需要进行心理健康专业咨询。这些负面结果在现实中是看不见的、不方便的和可怕的。因此,认识到其他风险因素并规划干预措施将有助于减少对这些从业者心理健康的损害。本文讨论了以下核心能力:临床知识、基于实践的学习和改进、基于系统的实践。
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引用次数: 0
Emergency mental health calls to first responders following a natural disaster: Examining the effects from Hurricane Harvey 自然灾害后向急救人员发出紧急心理健康电话:检查飓风哈维的影响
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/IJAM.IJAM_71_20
J. Saunders, Deepa Dongarwar, J. Salemi, J. Schulte, David Persse, A. Matin, Sophia Banu, Asim A. Shah
Introduction: Hurricane Harvey which made landfall on August 25, 2017 was a devastating storm that dumped unprecedented amount of rainfall on the area including Houston, Texas, United States of America. There are limited data about emergency service mental health utilization following disaster events. The goal for this project was to examine mental health calls to emergency medical services (EMS) and to the Houston Police Department following Hurricane Harvey. An analysis looking at this utilization following a natural disaster represents an understudied area and can potentially provide information about city services and community psychiatric services in the acute period following the event. Materials and Methods: Total number of calls to the police department and mental health calls to the police department described as crisis intervention calls (Crisis Intervention Team) were obtained from August 1, 2016 to October 31, 2016 and January 1, 2017 to December 31, 2017. Emergency detention orders (EDO) per date were obtained from January 1, 2017 to December 31, 2017. Data for mental health calls based on the primary impression of mental health complaint were obtained from the Houston Fire Department for EMS from January 1, 2016 to December 31, 2017. Results: There was a statistically significant increase in the number of mental health calls to the police following Hurricane Harvey. When comparing the prestorm, active storm, and poststorm period, there was not a statistically significant difference in the number of EDOs or the number of EMS mental health calls. Conclusions: The increase in police mental health calls suggests that there may have been an increase in the acuity of the mental health calls to EMS around in evaluating calls surrounding the period of Hurricane Harvey. The following core competencies are addressed in this article: Medical Knowledge and Patient Care.
简介:2017年8月25日登陆的飓风哈维是一场毁灭性风暴,给包括美国得克萨斯州休斯顿在内的地区带来了前所未有的降雨量。关于灾难事件后紧急服务心理健康利用的数据有限。该项目的目标是检查飓风哈维过后紧急医疗服务(EMS)和休斯顿警察局的心理健康电话。对自然灾害后这种利用情况的分析代表了一个研究不足的领域,可能会在事件发生后的急性期提供有关城市服务和社区精神病服务的信息。材料和方法:从2016年8月1日至2016年10月31日和2017年1月1日到2017年12月31日,获得了被称为危机干预电话(危机干预小组)的警察局电话和警察局心理健康电话的总数。从2017年1月1日至2017年12月31日,获得了每日紧急拘留令(EDO)。2016年1月1日至2017年12月31日,从休斯顿消防局EMS获得了基于心理健康投诉的主要印象的心理健康电话数据。结果:飓风哈维过后,报警的心理健康电话数量在统计上显著增加。在比较风暴前、活跃风暴和风暴后期间,EDO的数量或EMS心理健康电话的数量没有统计学上的显著差异。结论:警方心理健康电话的增加表明,在评估飓风哈维期间的电话时,EMS周围的心理健康电话可能会增加。本文介绍了以下核心能力:医学知识和患者护理。
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引用次数: 1
Subgingival temperature: A forgotten cardinal sign of gingival inflammation 牙龈下温度:一个被遗忘的牙龈炎症的主要迹象
IF 0.6 Q3 MEDICINE, GENERAL & INTERNAL Pub Date : 2021-01-01 DOI: 10.4103/ijam.ijam_147_20
D. Singh, G. Kumar
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引用次数: 0
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