Pub Date : 2023-04-01DOI: 10.4103/injr.injr_197_21
Harpreet Singh, Kusum Yadav, Ritu Sangwan
Background: Fatigue affects 40%–80% patients of rheumatoid arthritis (RA), impairing their quality of life. Objectives: The aim of this study was to assess fatigue by means of Bristol RA Fatigue Multidimensional Questionnaire score (BRAF-MDQ) and correlate it with the disease activity of RA patients. One hundred RA patients (as per American College of rheumatology 1987 criteria) having no underlying other chronic disease were evaluated at baseline (M0), 1 month (M1), and 3 months (M3) for fatigue (using BRAF-MDQ) and disease activity Disease Activity Index 28 (DAS-28) and Clinical Disease Activity Index (CDAI). The correlation between fatigue score and disease activity score was evaluated. Results: Fatigue score (BRAF-MDQ) decreased from 19.28 ± 13.846 at baseline to 17.46 ± 13.56 at M1 and 13.27 ± 11.633 at M3, respectively (P < 0.001). Similarly, there was significant decrease in disease activity of DAS-28 from 4.439 ± 1.41 at baseline to 3.715 ± 1.655 at M1 and 3.668 ± 1.46 at M3; while CDAI reduced from 18.82 ± 14.314 at baseline to 14.16 ± 12.611 at M1 and 11.65 ± 11.769 at M3, respectively (P < 0.001). There was a positive significant correlation (P value < 0.001) between BRAF-MDQ score and DAS-28 score (r = 0.503; 0.687 and 0.680) and CDAI score (r = 0.642,0.728 and 0.732) at baseline, 1 month, and 3 months, respectively. Multivariate analysis showed that CDAI (M0) was a significant factor affecting BRAF-MOQ score at follow-up of 3 months (M3) with beta coefficient of 0.872, P < 0.0001. Conclusion: The results of the present study indicate that fatigue quantum is related to disease activity and should be evaluated at the time of diagnosis. BRAF-MDQ is a simple, yet effective patient reported outcome questionnaire which assessed the fatigue quantum. Routine assessment of fatigue through BRAF-MDQ along with assessment of disease activity will be a holistic approach in management of RA.
{"title":"Assessment of correlation of fatigue in patients of rheumatoid arthritis using bristol rheumatoid arthritis fatigue multidimensional questionnaire score with disease activity – An Indian experience","authors":"Harpreet Singh, Kusum Yadav, Ritu Sangwan","doi":"10.4103/injr.injr_197_21","DOIUrl":"https://doi.org/10.4103/injr.injr_197_21","url":null,"abstract":"Background: Fatigue affects 40%–80% patients of rheumatoid arthritis (RA), impairing their quality of life. Objectives: The aim of this study was to assess fatigue by means of Bristol RA Fatigue Multidimensional Questionnaire score (BRAF-MDQ) and correlate it with the disease activity of RA patients. One hundred RA patients (as per American College of rheumatology 1987 criteria) having no underlying other chronic disease were evaluated at baseline (M0), 1 month (M1), and 3 months (M3) for fatigue (using BRAF-MDQ) and disease activity Disease Activity Index 28 (DAS-28) and Clinical Disease Activity Index (CDAI). The correlation between fatigue score and disease activity score was evaluated. Results: Fatigue score (BRAF-MDQ) decreased from 19.28 ± 13.846 at baseline to 17.46 ± 13.56 at M1 and 13.27 ± 11.633 at M3, respectively (P < 0.001). Similarly, there was significant decrease in disease activity of DAS-28 from 4.439 ± 1.41 at baseline to 3.715 ± 1.655 at M1 and 3.668 ± 1.46 at M3; while CDAI reduced from 18.82 ± 14.314 at baseline to 14.16 ± 12.611 at M1 and 11.65 ± 11.769 at M3, respectively (P < 0.001). There was a positive significant correlation (P value < 0.001) between BRAF-MDQ score and DAS-28 score (r = 0.503; 0.687 and 0.680) and CDAI score (r = 0.642,0.728 and 0.732) at baseline, 1 month, and 3 months, respectively. Multivariate analysis showed that CDAI (M0) was a significant factor affecting BRAF-MOQ score at follow-up of 3 months (M3) with beta coefficient of 0.872, P < 0.0001. Conclusion: The results of the present study indicate that fatigue quantum is related to disease activity and should be evaluated at the time of diagnosis. BRAF-MDQ is a simple, yet effective patient reported outcome questionnaire which assessed the fatigue quantum. Routine assessment of fatigue through BRAF-MDQ along with assessment of disease activity will be a holistic approach in management of RA.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"141 - 146"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48218566","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}
{"title":"Heterozygous E148Q mutation in an Indian family with a milder form of familial mediterranean fever","authors":"M. Abdulla","doi":"10.4103/injr.injr_74_22","DOIUrl":"https://doi.org/10.4103/injr.injr_74_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"170 - 171"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49338015","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}
{"title":"Uncommon cause of progressive dorsomedial right midfoot pain","authors":"V. Sivakumar, V. Indiran","doi":"10.4103/injr.injr_43_22","DOIUrl":"https://doi.org/10.4103/injr.injr_43_22","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"172 - 173"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43209911","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}
{"title":"Lupus and the bottom line: Why we need to talk about the economic impact","authors":"C. Kavadichanda","doi":"10.4103/injr.injr_71_23","DOIUrl":"https://doi.org/10.4103/injr.injr_71_23","url":null,"abstract":"","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"117 - 119"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48708167","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}
Pub Date : 2023-04-01DOI: 10.4103/injr.injr_285_21
V. Shobha, C. Kodishala, S. Chandrashekara, Sharath Kumar, V. Haridas, Vijay K R Rao, R. Jois, M. Daware, Y. Singh, Shweta Singhai, B. Dharmanad, P. Chebbi, R. Subramanian, A. Kamath, Uma Karjiigi, V. Jain, C. Dharmapalaiah, S. Prasad, C. Srinivas, J. Ramya, B. Pinto, Beenish Nazir, Harshini, Mahendranath
Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease with significant functional impairment. Health Assessment Questionnaire-Disability Index (HAQ-DI) is a reliable and validated outcome measure for a variety of arthritides including PsA. Objective: The objective of this study was to assess the disability as an outcome measure in PsA using the Indian version of HAQ (I-HAQ). Methods: The I-HAQ was administered to PsA patients diagnosed as per the Classification Criteria for PsA. The I-HAQ comprises 12 questions (nine basic and three advanced activities of daily living (ADLs), on the standard HAQ format) relevant to the Indian population. Results: In the 549 participants, the mean I-HAQ was 0.31 (0.45) and 48.2% had mild-to-moderate disability (I-HAQ>0–1). Female gender, older age, higher skin, joint scores, and Disease Activity Index for PsA were associated with some disability (I-HAQ>0). Symmetric polyarthritis (0.34) and spondyloarthritis (0.32) had a significantly higher disability compared to other subsets. Analyzing the individual questions of I-HAQ, squatting in the toilet or sitting cross-legged on the floor (r = 0.78), walking 3 km (r = 0.77), and climbing a flight of stairs (r = 0.74) correlated maximally to the total I-HAQ. ADL which was affected most frequently was “climbing a flight of stairs.” I-HAQ was significantly lower in patients who had been on disease-modifying antirheumatic drugs for 6 months or more (P = 0.0001). Conclusions: The Indian version of HAQ-DI could be efficiently employed to assess outcomes in our cohort. Nearly half of the cohort had mild-to-moderate disability suggesting a high burden of inflammation. Higher joint activity scores are strongly associated with disability.
{"title":"Impaired mobility drives disability in psoriatic arthritis – An observational study from Karnataka Psoriatic Arthritis Cohort (KPsAC)","authors":"V. Shobha, C. Kodishala, S. Chandrashekara, Sharath Kumar, V. Haridas, Vijay K R Rao, R. Jois, M. Daware, Y. Singh, Shweta Singhai, B. Dharmanad, P. Chebbi, R. Subramanian, A. Kamath, Uma Karjiigi, V. Jain, C. Dharmapalaiah, S. Prasad, C. Srinivas, J. Ramya, B. Pinto, Beenish Nazir, Harshini, Mahendranath","doi":"10.4103/injr.injr_285_21","DOIUrl":"https://doi.org/10.4103/injr.injr_285_21","url":null,"abstract":"Introduction: Psoriatic arthritis (PsA) is a chronic inflammatory disease with significant functional impairment. Health Assessment Questionnaire-Disability Index (HAQ-DI) is a reliable and validated outcome measure for a variety of arthritides including PsA. Objective: The objective of this study was to assess the disability as an outcome measure in PsA using the Indian version of HAQ (I-HAQ). Methods: The I-HAQ was administered to PsA patients diagnosed as per the Classification Criteria for PsA. The I-HAQ comprises 12 questions (nine basic and three advanced activities of daily living (ADLs), on the standard HAQ format) relevant to the Indian population. Results: In the 549 participants, the mean I-HAQ was 0.31 (0.45) and 48.2% had mild-to-moderate disability (I-HAQ>0–1). Female gender, older age, higher skin, joint scores, and Disease Activity Index for PsA were associated with some disability (I-HAQ>0). Symmetric polyarthritis (0.34) and spondyloarthritis (0.32) had a significantly higher disability compared to other subsets. Analyzing the individual questions of I-HAQ, squatting in the toilet or sitting cross-legged on the floor (r = 0.78), walking 3 km (r = 0.77), and climbing a flight of stairs (r = 0.74) correlated maximally to the total I-HAQ. ADL which was affected most frequently was “climbing a flight of stairs.” I-HAQ was significantly lower in patients who had been on disease-modifying antirheumatic drugs for 6 months or more (P = 0.0001). Conclusions: The Indian version of HAQ-DI could be efficiently employed to assess outcomes in our cohort. Nearly half of the cohort had mild-to-moderate disability suggesting a high burden of inflammation. Higher joint activity scores are strongly associated with disability.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"120 - 125"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48013196","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}
Cardiac tamponade with systemic lupus erythematosus (SLE) is a rare but fatal complication. Although cardiac tamponade is typically managed with pericardiocentesis and medication, there is no definitive treatment for this condition. Herein, we report a case of cardiac tamponade with SLE in a 15-year-old girl. The patient had fever, chest pain, and fatigue for 1 month. She was diagnosed with SLE, and hence, prednisolone treatment was initiated. Her symptoms had alleviated on the 4th day of treatment; however, the following day, she was admitted to our hospital with fever and vomiting. The patient did not show chest pain or dyspnea. She developed hypotension, chest pain, and dyspnea the day after admission. She was diagnosed with cardiac tamponade using echocardiography. After pericardiocentesis, she was administered belimumab and hydroxychloroquine following intravenous methylprednisolone pulses and was maintained with complete remission for 2 years after the discontinuation of prednisolone and mycophenolate mofetil. This case highlights the potential for successful treatment of lupus cardiac tamponade with intravenous methylprednisolone pulses followed by administration of belimumab and hydroxychloroquine.
{"title":"Successful treatment of cardiac tamponade with systemic lupus erythematosus using belimumab and hydroxychloroquine","authors":"Tomoo Kise, S. Fukuyama, Masatsugu Uehara","doi":"10.4103/injr.injr_83_22","DOIUrl":"https://doi.org/10.4103/injr.injr_83_22","url":null,"abstract":"Cardiac tamponade with systemic lupus erythematosus (SLE) is a rare but fatal complication. Although cardiac tamponade is typically managed with pericardiocentesis and medication, there is no definitive treatment for this condition. Herein, we report a case of cardiac tamponade with SLE in a 15-year-old girl. The patient had fever, chest pain, and fatigue for 1 month. She was diagnosed with SLE, and hence, prednisolone treatment was initiated. Her symptoms had alleviated on the 4th day of treatment; however, the following day, she was admitted to our hospital with fever and vomiting. The patient did not show chest pain or dyspnea. She developed hypotension, chest pain, and dyspnea the day after admission. She was diagnosed with cardiac tamponade using echocardiography. After pericardiocentesis, she was administered belimumab and hydroxychloroquine following intravenous methylprednisolone pulses and was maintained with complete remission for 2 years after the discontinuation of prednisolone and mycophenolate mofetil. This case highlights the potential for successful treatment of lupus cardiac tamponade with intravenous methylprednisolone pulses followed by administration of belimumab and hydroxychloroquine.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"161 - 165"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48421936","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}
Mogalapu J. Sumeir, T. George, Vignana Bonela, T. Mani, J. Mathew, O. Abraham, Mohan Jambugulam
Background: Systemic lupus erythematosus (SLE), a rare multisystem disorder with a female preponderance, has a high cost for the care; however, there is no evidence relevant to the Indian setting. The primary objective of our study was to determine the financial burden of the index admission (IA) and subsequent costs during follow-up and ascertain the proportion with a catastrophic health expenditure (CHE). Methodology: This was an observational retrospective cohort study where inpatients of a general medicine ward were recruited from January 2019 to October 2020. Clinical details and costs were obtained from the hospital's electronic records and bills. Patients were telephonically interviewed for follow-up clinical details and costs incurred. A patient-family payer perspective was used. Linear regression analysis was used. Results: Of the 73 patients recruited during the study period, 96% were females and the majority (71%) were admitted through casualty, with 59% of patients having high disease activity (SLE Disease Activity Index >12). The hospital mortality was 9.6%. After a median follow-up of 12 months, there was good quality of life with no difference between the two severity groups. The total cost of the IA was 135,768 INR (94,053–223,954) and it was higher for the severe disease group (P = 0.038). The direct medical costs compromised 83% of admission costs. In the multivariate regression, the duration of hospital and intensive care unit stay were predictors of high cost. The median 6 months follow-up cost was 32,978 (14,240–80,940) and the total calculated annualized cost was 202,124 (136,188–331,508), which was not statistically different between the two groups. There was a CHE among 86% of patient-families. Conclusion: This study demonstrates that there is high morbidity and cost involved in the management of a flare of SLE. However, with appropriate care, there are reasonably good outcomes and quality of life beyond six months.
{"title":"Economic impact, clinical features and outcomes of hospitalised patients with SLE in India","authors":"Mogalapu J. Sumeir, T. George, Vignana Bonela, T. Mani, J. Mathew, O. Abraham, Mohan Jambugulam","doi":"10.4103/injr.injr_30_22","DOIUrl":"https://doi.org/10.4103/injr.injr_30_22","url":null,"abstract":"Background: Systemic lupus erythematosus (SLE), a rare multisystem disorder with a female preponderance, has a high cost for the care; however, there is no evidence relevant to the Indian setting. The primary objective of our study was to determine the financial burden of the index admission (IA) and subsequent costs during follow-up and ascertain the proportion with a catastrophic health expenditure (CHE). Methodology: This was an observational retrospective cohort study where inpatients of a general medicine ward were recruited from January 2019 to October 2020. Clinical details and costs were obtained from the hospital's electronic records and bills. Patients were telephonically interviewed for follow-up clinical details and costs incurred. A patient-family payer perspective was used. Linear regression analysis was used. Results: Of the 73 patients recruited during the study period, 96% were females and the majority (71%) were admitted through casualty, with 59% of patients having high disease activity (SLE Disease Activity Index >12). The hospital mortality was 9.6%. After a median follow-up of 12 months, there was good quality of life with no difference between the two severity groups. The total cost of the IA was 135,768 INR (94,053–223,954) and it was higher for the severe disease group (P = 0.038). The direct medical costs compromised 83% of admission costs. In the multivariate regression, the duration of hospital and intensive care unit stay were predictors of high cost. The median 6 months follow-up cost was 32,978 (14,240–80,940) and the total calculated annualized cost was 202,124 (136,188–331,508), which was not statistically different between the two groups. There was a CHE among 86% of patient-families. Conclusion: This study demonstrates that there is high morbidity and cost involved in the management of a flare of SLE. However, with appropriate care, there are reasonably good outcomes and quality of life beyond six months.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"126 - 133"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46546507","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}
Pub Date : 2023-04-01DOI: 10.4103/injr.injr_136_22
A. Nair, A. Chandhu, M. Zafar, G. Vinodini, B. Yadav, Shivraj Padiyar, A. Ganapati, J. Mathew
Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.
{"title":"Rituximab and COVID-19 infection in patients with autoimmune rheumatic diseases – A real-world study from India","authors":"A. Nair, A. Chandhu, M. Zafar, G. Vinodini, B. Yadav, Shivraj Padiyar, A. Ganapati, J. Mathew","doi":"10.4103/injr.injr_136_22","DOIUrl":"https://doi.org/10.4103/injr.injr_136_22","url":null,"abstract":"Introduction: Safety of rituximab (RTX) in autoimmune rheumatic diseases (AIRDs) has been a concern during this ongoing coronavirus (COVID-19) pandemic. Delayed worsening of COVID symptoms, increased hospital stays, and mortality has been reported among those infected post-RTX. This study describes the occurrence and course of COVID-19 infection among AIRD Indian patients who received RTX during this pandemic. Patients and Methods: Adult patients (≥18 years) with any AIRD, who received RTX between October 2019 and May 2021, were enrolled in this study. Patients satisfying the inclusion criteria were telephonically enquired about contracting confirmed COVID-19, its course, treatment, and outcome. Baseline parameters, immunoglobulin G level, vaccination, and comorbidity status before RTX were compared between the COVID-19 infected and noninfected patients to determine factors affecting the outcome. Results: Out of 1081 patients admitted during the study period, 218 patients received RTX. The mean age of these patients was 40.1 ± 14.2 years and comprised mostly of women (81.7%). Rheumatoid arthritis followed by lupus and anti-neutrophilic cytoplasmic antibodies-associated vasculitis was the predominant AIRD. Among the patients contacted (207/218 [94.9%]), 11 (5.3%) patients reported confirmed COVID-19 infections. Out of these, three (27.3%) had severe COVID-19 and one patient succumbed to it. Others became symptom-free after a mean duration of 14.4 ± 4.7 days of onset of symptoms. No significant difference among the baseline parameters observed predicted COVID-19 susceptibility. Conclusion: Among our AIRD patients treated with RTX, occurrence, and mortality of COVID-19 infection was low. Younger age of our patient cohort and female predominance might have contributed in reducing the severity of SARS-CoV-2 infection.","PeriodicalId":54167,"journal":{"name":"Indian Journal of Rheumatology","volume":"18 1","pages":"154 - 158"},"PeriodicalIF":0.7,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41477202","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}
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