Loading…
Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil
The polyomaviruses that infect humans, JC virus (JCV) and BK virus (BKV), can establish persistent infections in the cells that make up the renal system, causing nephritis and BKV-associated nephropathy in up to 10% of renal transplant patients, and of these, 90% lose the graft and return for hemodi...
Saved in:
Published in: | Tropical medicine and infectious disease 2022-12, Vol.8 (1), p.9 |
---|---|
Main Authors: | , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that this one cites |
Online Access: | Get full text |
Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
cited_by | |
---|---|
cites | cdi_FETCH-LOGICAL-c447t-ec09cd36212200cb10b4c999dcd83eee23f7c1e0c6d9d456a4cdecbd6aafccb73 |
container_end_page | |
container_issue | 1 |
container_start_page | 9 |
container_title | Tropical medicine and infectious disease |
container_volume | 8 |
creator | da Costa, Scheila do Socorro Vasconcelos Ávila Monteiro, Jacqueline Cortinhas Viegas, Ana Paula do Vale de Sá, Keyla Santos Guedes da Cruz, Silvia Regina Lima, Sandra Souza Vallinoto, Izaura Maria Vieira Cayres Costa, Igor Brasil Vallinoto, Antonio Carlos Rosário |
description | The polyomaviruses that infect humans, JC virus (JCV) and BK virus (BKV), can establish persistent infections in the cells that make up the renal system, causing nephritis and BKV-associated nephropathy in up to 10% of renal transplant patients, and of these, 90% lose the graft and return for hemodialysis. This study aimed to determine the prevalence of polyomaviruses (PyV) in the population with chronic kidney disease (CKD), classified into three groups (conservative, dialysis, and transplanted) and a control group. Urine samples were collected from 290 individuals, including 202 patients with CKD and 88 from the control group. PyV screening was performed by PCR amplification of a fragment of the VP1 region, and the JCV and BKV species were distinguished through enzymatic digestion with the restriction endonuclease
from the amplification of a TAg region. All amplification products were visualized on a 3% agarose gel. The prevalence of PyV infection was correlated with clinical-epidemiological variables using the chi-squared and Fisher's exact tests. In the group with CKD, the prevalence of PyV was 30.2%, a higher rate being observed in conservative patients (36.66%; 22/60), followed by dialysis patients (30.48%; 25/82), and transplanted patients (20%; 12/60). In the control group, the prevalence was 46.59% (41/88). The differentiation between species revealed that JCV was present in 77.8% and BKV in 22.2% of the group with CKD. The prevalence of infection was higher in male patients (59.32%), whose most common pathology was systemic arterial hypertension (35.59%). In the group of transplanted patients, there was a statistically significant association between infection and the use of the immunosuppressant azathioprine (
= 0.015). The prevalence of PyV infection was higher in the control group than in the group with CKD, being predominant in males and in patients with systemic arterial hypertension. |
doi_str_mv | 10.3390/tropicalmed8010009 |
format | article |
fullrecord | <record><control><sourceid>proquest_doaj_</sourceid><recordid>TN_cdi_doaj_primary_oai_doaj_org_article_7701a2425b004d46bc9b13f4cf508cc5</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><doaj_id>oai_doaj_org_article_7701a2425b004d46bc9b13f4cf508cc5</doaj_id><sourcerecordid>2768241037</sourcerecordid><originalsourceid>FETCH-LOGICAL-c447t-ec09cd36212200cb10b4c999dcd83eee23f7c1e0c6d9d456a4cdecbd6aafccb73</originalsourceid><addsrcrecordid>eNplks9uEzEQxlcIRKvSF-CALHHhQMD2er3rCxIN_0IrEQk4W97xbONoY6e2ExTehmfhxXCaUrVwsjX-5qeZz19VPWX0VV0r-jrHsHZgxhXajjJKqXpQHXPBxETWUj68cz-qTlNaFgXrGioFfVwdlarsFJPHVZ5H3JoRPSAJA_k8JcZbcnZO5mHchZXZurhJZOYHhOyCJ86TuckOfU7kh8sLMl3E4B2Qc2c97sg7l9Ak3OvyAsnXbPI1eG7i718vyVk0P934pHo0mDHh6c15Un3_8P7b9NPk4svH2fTtxQSEaPMEgSqwteSMc0qhZ7QXoJSyYLsaEXk9tMCQgrTKikYaARaht9KYAaBv65NqduDaYJZ6Hd3KxJ0OxunrQoiX2sTsYETdtpQZLnjTUyqskD2ontWDgKGhHUBTWG8OrPWmL55DcSCa8R70_ot3C30Ztlp1krWtKoAXN4AYrjaYsl65BDiOxmPYJM1b2ZU_o_V-7uf_SJdhE32xaq9qeSdl0xUVP6gghpQiDrfDMKr3GdH_Z6Q0Pbu7xm3L30TUfwBUI7xo</addsrcrecordid><sourcetype>Open Website</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2767286658</pqid></control><display><type>article</type><title>Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil</title><source>Publicly Available Content (ProQuest)</source><source>PubMed Central</source><creator>da Costa, Scheila do Socorro Vasconcelos Ávila ; Monteiro, Jacqueline Cortinhas ; Viegas, Ana Paula do Vale ; de Sá, Keyla Santos Guedes ; da Cruz, Silvia Regina ; Lima, Sandra Souza ; Vallinoto, Izaura Maria Vieira Cayres ; Costa, Igor Brasil ; Vallinoto, Antonio Carlos Rosário</creator><creatorcontrib>da Costa, Scheila do Socorro Vasconcelos Ávila ; Monteiro, Jacqueline Cortinhas ; Viegas, Ana Paula do Vale ; de Sá, Keyla Santos Guedes ; da Cruz, Silvia Regina ; Lima, Sandra Souza ; Vallinoto, Izaura Maria Vieira Cayres ; Costa, Igor Brasil ; Vallinoto, Antonio Carlos Rosário</creatorcontrib><description>The polyomaviruses that infect humans, JC virus (JCV) and BK virus (BKV), can establish persistent infections in the cells that make up the renal system, causing nephritis and BKV-associated nephropathy in up to 10% of renal transplant patients, and of these, 90% lose the graft and return for hemodialysis. This study aimed to determine the prevalence of polyomaviruses (PyV) in the population with chronic kidney disease (CKD), classified into three groups (conservative, dialysis, and transplanted) and a control group. Urine samples were collected from 290 individuals, including 202 patients with CKD and 88 from the control group. PyV screening was performed by PCR amplification of a fragment of the VP1 region, and the JCV and BKV species were distinguished through enzymatic digestion with the restriction endonuclease
from the amplification of a TAg region. All amplification products were visualized on a 3% agarose gel. The prevalence of PyV infection was correlated with clinical-epidemiological variables using the chi-squared and Fisher's exact tests. In the group with CKD, the prevalence of PyV was 30.2%, a higher rate being observed in conservative patients (36.66%; 22/60), followed by dialysis patients (30.48%; 25/82), and transplanted patients (20%; 12/60). In the control group, the prevalence was 46.59% (41/88). The differentiation between species revealed that JCV was present in 77.8% and BKV in 22.2% of the group with CKD. The prevalence of infection was higher in male patients (59.32%), whose most common pathology was systemic arterial hypertension (35.59%). In the group of transplanted patients, there was a statistically significant association between infection and the use of the immunosuppressant azathioprine (
= 0.015). The prevalence of PyV infection was higher in the control group than in the group with CKD, being predominant in males and in patients with systemic arterial hypertension.</description><identifier>ISSN: 2414-6366</identifier><identifier>EISSN: 2414-6366</identifier><identifier>DOI: 10.3390/tropicalmed8010009</identifier><identifier>PMID: 36668916</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>BK virus ; chronic kidney disease ; Creatinine ; Hemodialysis ; Hypertension ; Immune system ; Immunosuppressive agents ; Infections ; JC virus ; Kidney diseases ; Kidney transplants ; Polyomaviruses ; Viruses</subject><ispartof>Tropical medicine and infectious disease, 2022-12, Vol.8 (1), p.9</ispartof><rights>2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2022 by the authors. 2022</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c447t-ec09cd36212200cb10b4c999dcd83eee23f7c1e0c6d9d456a4cdecbd6aafccb73</cites><orcidid>0000-0003-1135-6507 ; 0000-0001-6950-589X ; 0000-0003-2600-4109</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2767286658/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2767286658?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25751,27922,27923,37010,37011,44588,53789,53791,74896</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/36668916$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>da Costa, Scheila do Socorro Vasconcelos Ávila</creatorcontrib><creatorcontrib>Monteiro, Jacqueline Cortinhas</creatorcontrib><creatorcontrib>Viegas, Ana Paula do Vale</creatorcontrib><creatorcontrib>de Sá, Keyla Santos Guedes</creatorcontrib><creatorcontrib>da Cruz, Silvia Regina</creatorcontrib><creatorcontrib>Lima, Sandra Souza</creatorcontrib><creatorcontrib>Vallinoto, Izaura Maria Vieira Cayres</creatorcontrib><creatorcontrib>Costa, Igor Brasil</creatorcontrib><creatorcontrib>Vallinoto, Antonio Carlos Rosário</creatorcontrib><title>Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil</title><title>Tropical medicine and infectious disease</title><addtitle>Trop Med Infect Dis</addtitle><description>The polyomaviruses that infect humans, JC virus (JCV) and BK virus (BKV), can establish persistent infections in the cells that make up the renal system, causing nephritis and BKV-associated nephropathy in up to 10% of renal transplant patients, and of these, 90% lose the graft and return for hemodialysis. This study aimed to determine the prevalence of polyomaviruses (PyV) in the population with chronic kidney disease (CKD), classified into three groups (conservative, dialysis, and transplanted) and a control group. Urine samples were collected from 290 individuals, including 202 patients with CKD and 88 from the control group. PyV screening was performed by PCR amplification of a fragment of the VP1 region, and the JCV and BKV species were distinguished through enzymatic digestion with the restriction endonuclease
from the amplification of a TAg region. All amplification products were visualized on a 3% agarose gel. The prevalence of PyV infection was correlated with clinical-epidemiological variables using the chi-squared and Fisher's exact tests. In the group with CKD, the prevalence of PyV was 30.2%, a higher rate being observed in conservative patients (36.66%; 22/60), followed by dialysis patients (30.48%; 25/82), and transplanted patients (20%; 12/60). In the control group, the prevalence was 46.59% (41/88). The differentiation between species revealed that JCV was present in 77.8% and BKV in 22.2% of the group with CKD. The prevalence of infection was higher in male patients (59.32%), whose most common pathology was systemic arterial hypertension (35.59%). In the group of transplanted patients, there was a statistically significant association between infection and the use of the immunosuppressant azathioprine (
= 0.015). The prevalence of PyV infection was higher in the control group than in the group with CKD, being predominant in males and in patients with systemic arterial hypertension.</description><subject>BK virus</subject><subject>chronic kidney disease</subject><subject>Creatinine</subject><subject>Hemodialysis</subject><subject>Hypertension</subject><subject>Immune system</subject><subject>Immunosuppressive agents</subject><subject>Infections</subject><subject>JC virus</subject><subject>Kidney diseases</subject><subject>Kidney transplants</subject><subject>Polyomaviruses</subject><subject>Viruses</subject><issn>2414-6366</issn><issn>2414-6366</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><sourceid>DOA</sourceid><recordid>eNplks9uEzEQxlcIRKvSF-CALHHhQMD2er3rCxIN_0IrEQk4W97xbONoY6e2ExTehmfhxXCaUrVwsjX-5qeZz19VPWX0VV0r-jrHsHZgxhXajjJKqXpQHXPBxETWUj68cz-qTlNaFgXrGioFfVwdlarsFJPHVZ5H3JoRPSAJA_k8JcZbcnZO5mHchZXZurhJZOYHhOyCJ86TuckOfU7kh8sLMl3E4B2Qc2c97sg7l9Ak3OvyAsnXbPI1eG7i718vyVk0P934pHo0mDHh6c15Un3_8P7b9NPk4svH2fTtxQSEaPMEgSqwteSMc0qhZ7QXoJSyYLsaEXk9tMCQgrTKikYaARaht9KYAaBv65NqduDaYJZ6Hd3KxJ0OxunrQoiX2sTsYETdtpQZLnjTUyqskD2ontWDgKGhHUBTWG8OrPWmL55DcSCa8R70_ot3C30Ztlp1krWtKoAXN4AYrjaYsl65BDiOxmPYJM1b2ZU_o_V-7uf_SJdhE32xaq9qeSdl0xUVP6gghpQiDrfDMKr3GdH_Z6Q0Pbu7xm3L30TUfwBUI7xo</recordid><startdate>20221223</startdate><enddate>20221223</enddate><creator>da Costa, Scheila do Socorro Vasconcelos Ávila</creator><creator>Monteiro, Jacqueline Cortinhas</creator><creator>Viegas, Ana Paula do Vale</creator><creator>de Sá, Keyla Santos Guedes</creator><creator>da Cruz, Silvia Regina</creator><creator>Lima, Sandra Souza</creator><creator>Vallinoto, Izaura Maria Vieira Cayres</creator><creator>Costa, Igor Brasil</creator><creator>Vallinoto, Antonio Carlos Rosário</creator><general>MDPI AG</general><general>MDPI</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>5PM</scope><scope>DOA</scope><orcidid>https://orcid.org/0000-0003-1135-6507</orcidid><orcidid>https://orcid.org/0000-0001-6950-589X</orcidid><orcidid>https://orcid.org/0000-0003-2600-4109</orcidid></search><sort><creationdate>20221223</creationdate><title>Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil</title><author>da Costa, Scheila do Socorro Vasconcelos Ávila ; Monteiro, Jacqueline Cortinhas ; Viegas, Ana Paula do Vale ; de Sá, Keyla Santos Guedes ; da Cruz, Silvia Regina ; Lima, Sandra Souza ; Vallinoto, Izaura Maria Vieira Cayres ; Costa, Igor Brasil ; Vallinoto, Antonio Carlos Rosário</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c447t-ec09cd36212200cb10b4c999dcd83eee23f7c1e0c6d9d456a4cdecbd6aafccb73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>BK virus</topic><topic>chronic kidney disease</topic><topic>Creatinine</topic><topic>Hemodialysis</topic><topic>Hypertension</topic><topic>Immune system</topic><topic>Immunosuppressive agents</topic><topic>Infections</topic><topic>JC virus</topic><topic>Kidney diseases</topic><topic>Kidney transplants</topic><topic>Polyomaviruses</topic><topic>Viruses</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>da Costa, Scheila do Socorro Vasconcelos Ávila</creatorcontrib><creatorcontrib>Monteiro, Jacqueline Cortinhas</creatorcontrib><creatorcontrib>Viegas, Ana Paula do Vale</creatorcontrib><creatorcontrib>de Sá, Keyla Santos Guedes</creatorcontrib><creatorcontrib>da Cruz, Silvia Regina</creatorcontrib><creatorcontrib>Lima, Sandra Souza</creatorcontrib><creatorcontrib>Vallinoto, Izaura Maria Vieira Cayres</creatorcontrib><creatorcontrib>Costa, Igor Brasil</creatorcontrib><creatorcontrib>Vallinoto, Antonio Carlos Rosário</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Public Health Database</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>AUTh Library subscriptions: ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content (ProQuest)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><jtitle>Tropical medicine and infectious disease</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>da Costa, Scheila do Socorro Vasconcelos Ávila</au><au>Monteiro, Jacqueline Cortinhas</au><au>Viegas, Ana Paula do Vale</au><au>de Sá, Keyla Santos Guedes</au><au>da Cruz, Silvia Regina</au><au>Lima, Sandra Souza</au><au>Vallinoto, Izaura Maria Vieira Cayres</au><au>Costa, Igor Brasil</au><au>Vallinoto, Antonio Carlos Rosário</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil</atitle><jtitle>Tropical medicine and infectious disease</jtitle><addtitle>Trop Med Infect Dis</addtitle><date>2022-12-23</date><risdate>2022</risdate><volume>8</volume><issue>1</issue><spage>9</spage><pages>9-</pages><issn>2414-6366</issn><eissn>2414-6366</eissn><abstract>The polyomaviruses that infect humans, JC virus (JCV) and BK virus (BKV), can establish persistent infections in the cells that make up the renal system, causing nephritis and BKV-associated nephropathy in up to 10% of renal transplant patients, and of these, 90% lose the graft and return for hemodialysis. This study aimed to determine the prevalence of polyomaviruses (PyV) in the population with chronic kidney disease (CKD), classified into three groups (conservative, dialysis, and transplanted) and a control group. Urine samples were collected from 290 individuals, including 202 patients with CKD and 88 from the control group. PyV screening was performed by PCR amplification of a fragment of the VP1 region, and the JCV and BKV species were distinguished through enzymatic digestion with the restriction endonuclease
from the amplification of a TAg region. All amplification products were visualized on a 3% agarose gel. The prevalence of PyV infection was correlated with clinical-epidemiological variables using the chi-squared and Fisher's exact tests. In the group with CKD, the prevalence of PyV was 30.2%, a higher rate being observed in conservative patients (36.66%; 22/60), followed by dialysis patients (30.48%; 25/82), and transplanted patients (20%; 12/60). In the control group, the prevalence was 46.59% (41/88). The differentiation between species revealed that JCV was present in 77.8% and BKV in 22.2% of the group with CKD. The prevalence of infection was higher in male patients (59.32%), whose most common pathology was systemic arterial hypertension (35.59%). In the group of transplanted patients, there was a statistically significant association between infection and the use of the immunosuppressant azathioprine (
= 0.015). The prevalence of PyV infection was higher in the control group than in the group with CKD, being predominant in males and in patients with systemic arterial hypertension.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>36668916</pmid><doi>10.3390/tropicalmed8010009</doi><orcidid>https://orcid.org/0000-0003-1135-6507</orcidid><orcidid>https://orcid.org/0000-0001-6950-589X</orcidid><orcidid>https://orcid.org/0000-0003-2600-4109</orcidid><oa>free_for_read</oa></addata></record> |
fulltext | fulltext |
identifier | ISSN: 2414-6366 |
ispartof | Tropical medicine and infectious disease, 2022-12, Vol.8 (1), p.9 |
issn | 2414-6366 2414-6366 |
language | eng |
recordid | cdi_doaj_primary_oai_doaj_org_article_7701a2425b004d46bc9b13f4cf508cc5 |
source | Publicly Available Content (ProQuest); PubMed Central |
subjects | BK virus chronic kidney disease Creatinine Hemodialysis Hypertension Immune system Immunosuppressive agents Infections JC virus Kidney diseases Kidney transplants Polyomaviruses Viruses |
title | Prevalence of JC and BK Polyomavirus Infection in Patients with Chronic Kidney Disease in the State of Pará, Brazil |
url | http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-14T00%3A40%3A34IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_doaj_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Prevalence%20of%20JC%20and%20BK%20Polyomavirus%20Infection%20in%20Patients%20with%20Chronic%20Kidney%20Disease%20in%20the%20State%20of%20Par%C3%A1,%20Brazil&rft.jtitle=Tropical%20medicine%20and%20infectious%20disease&rft.au=da%20Costa,%20Scheila%20do%20Socorro%20Vasconcelos%20%C3%81vila&rft.date=2022-12-23&rft.volume=8&rft.issue=1&rft.spage=9&rft.pages=9-&rft.issn=2414-6366&rft.eissn=2414-6366&rft_id=info:doi/10.3390/tropicalmed8010009&rft_dat=%3Cproquest_doaj_%3E2768241037%3C/proquest_doaj_%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c447t-ec09cd36212200cb10b4c999dcd83eee23f7c1e0c6d9d456a4cdecbd6aafccb73%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2767286658&rft_id=info:pmid/36668916&rfr_iscdi=true |