Loading…

Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018

Guillain-Barré syndrome (GBS) is the leading cause of non-polio acute flaccid paralysis worldwide, emphasizing the importance of epidemiological studies on this condition. Therefore, well-designed epidemiological studies in different populations can provide a better understanding of the characterist...

Full description

Saved in:
Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-11, Vol.15 (11), p.e48703-e48703
Main Authors: Almalki, Shahad, Alghamdi, Lama, Khayyat, Jumana, Harun, Rawan T, Alyousef, Mayar, Hakeem, Rana, Alsamiri, Sarah, Alrefaie, Zienab, Bamaga, Ahmed K
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-c300t-a2313563772a3883b807a0494091b1a7aaf4a913f85aa45142970b6517ffe5a23
container_end_page e48703
container_issue 11
container_start_page e48703
container_title Curēus (Palo Alto, CA)
container_volume 15
creator Almalki, Shahad
Alghamdi, Lama
Khayyat, Jumana
Harun, Rawan T
Alyousef, Mayar
Hakeem, Rana
Alsamiri, Sarah
Alrefaie, Zienab
Bamaga, Ahmed K
description Guillain-Barré syndrome (GBS) is the leading cause of non-polio acute flaccid paralysis worldwide, emphasizing the importance of epidemiological studies on this condition. Therefore, well-designed epidemiological studies in different populations can provide a better understanding of the characteristics of patients with GBS and the nature of the disease. To our knowledge, no previous study has attempted to describe the characteristics of patients with GBS in Kingdom of Saudi Arabia (KSA) based on disease subtypes and clinical features in both adult and pediatric patients. This study aimed to assess the frequencies of GBS subtypes and their relationships with patient characteristics and clinical data in a tertiary hospital in Jeddah, KSA. This was a retrospective review of patients diagnosed with GBS between January 2000 and January 2018 at King Abdulaziz University Hospital (KAUH), a tertiary center in Jeddah, KSA. In total, 47 patients with GBS (median age: seven years for pediatric and 36 years for adult patients) were included in the current study. There were six male and three female pediatric patients and 19 male and 19 female adult patients. Among patients with GBS who were classified into a specific electrophysiological subtype (n = 28), 13 (46.2%) had acute inflammatory demyelinating polyneuropathy (AIDP), 11 (39%) had an axonal subtype, and four (14%) had Miller Fisher syndrome (MFS). Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. AIDP was the most frequent type of GBS, followed by the axonal type. Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. GBS type did not show a relationship with ICU admission or mechanical ventilation use. There was no association between specific therapies and different GBS subtypes and no significant difference in outcomes between different patterns of clinical presentation. Intravenous immunoglobulin (IVIg) and plasma exchange (PE) treatments both had the same efficacy in relation to outcomes for patients with GBS.
doi_str_mv 10.7759/cureus.48703
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10641031</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2890362405</sourcerecordid><originalsourceid>FETCH-LOGICAL-c300t-a2313563772a3883b807a0494091b1a7aaf4a913f85aa45142970b6517ffe5a23</originalsourceid><addsrcrecordid>eNpdkc9u1DAQxi1ERattb5yRJS4cNu04jmPnhJaF_oFKrVQqjtYkcXZdZePFdiptH4O34Dl4MbxsqQqnGcm_-TzffIS8ZnAspahOmtGbMRwXSgJ_QQ5yVqpMMVW8fNbvk6MQ7gCAgcxBwiuyz2VVipzzA_JjvkSPTTTehmibQF1HrzFaM8RAP1pcDC6Yln6zcUnPRtv3aIfsA3r_6ye92QytdytDMdIvdljQWd2OPT7YB3o72Hvjg40beu7C2kbsp_SzaVtcTukNjq2lM4-1xSk9TRI0T-vR6FJl6pDsddgHc_RYJ-T29NPX-Xl2eXV2MZ9dZg0HiBnmnHFRcilz5ErxWoFEKKoCKlYzlIhdgRXjnRKIhWBFXkmoS8Fk1xmRpifk_U53PdYr0zbJssder71dod9oh1b_-zLYpV64e82gLBik3yfk3aOCd99HE6Je2dCYdKTBuDHoXFXAy7wAkdC3_6F3bvRD8relkg0h2FZwuqMa70LwpnvahoHeBq53ges_gSf8zXMHT_DfePlvapCm_Q</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2895635511</pqid></control><display><type>article</type><title>Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018</title><source>PubMed Central Free</source><source>Publicly Available Content Database</source><creator>Almalki, Shahad ; Alghamdi, Lama ; Khayyat, Jumana ; Harun, Rawan T ; Alyousef, Mayar ; Hakeem, Rana ; Alsamiri, Sarah ; Alrefaie, Zienab ; Bamaga, Ahmed K</creator><creatorcontrib>Almalki, Shahad ; Alghamdi, Lama ; Khayyat, Jumana ; Harun, Rawan T ; Alyousef, Mayar ; Hakeem, Rana ; Alsamiri, Sarah ; Alrefaie, Zienab ; Bamaga, Ahmed K</creatorcontrib><description>Guillain-Barré syndrome (GBS) is the leading cause of non-polio acute flaccid paralysis worldwide, emphasizing the importance of epidemiological studies on this condition. Therefore, well-designed epidemiological studies in different populations can provide a better understanding of the characteristics of patients with GBS and the nature of the disease. To our knowledge, no previous study has attempted to describe the characteristics of patients with GBS in Kingdom of Saudi Arabia (KSA) based on disease subtypes and clinical features in both adult and pediatric patients. This study aimed to assess the frequencies of GBS subtypes and their relationships with patient characteristics and clinical data in a tertiary hospital in Jeddah, KSA. This was a retrospective review of patients diagnosed with GBS between January 2000 and January 2018 at King Abdulaziz University Hospital (KAUH), a tertiary center in Jeddah, KSA. In total, 47 patients with GBS (median age: seven years for pediatric and 36 years for adult patients) were included in the current study. There were six male and three female pediatric patients and 19 male and 19 female adult patients. Among patients with GBS who were classified into a specific electrophysiological subtype (n = 28), 13 (46.2%) had acute inflammatory demyelinating polyneuropathy (AIDP), 11 (39%) had an axonal subtype, and four (14%) had Miller Fisher syndrome (MFS). Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. AIDP was the most frequent type of GBS, followed by the axonal type. Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. GBS type did not show a relationship with ICU admission or mechanical ventilation use. There was no association between specific therapies and different GBS subtypes and no significant difference in outcomes between different patterns of clinical presentation. Intravenous immunoglobulin (IVIg) and plasma exchange (PE) treatments both had the same efficacy in relation to outcomes for patients with GBS.</description><identifier>ISSN: 2168-8184</identifier><identifier>EISSN: 2168-8184</identifier><identifier>DOI: 10.7759/cureus.48703</identifier><identifier>PMID: 37965233</identifier><language>eng</language><publisher>United States: Cureus Inc</publisher><subject>Apheresis ; Ataxia ; Bacterial infections ; Diabetic neuropathy ; Gastrointestinal surgery ; Guillain-Barre syndrome ; Infections ; Intensive care ; Medical prognosis ; Neurology ; Patients ; Pediatrics ; Physical therapy ; Poliomyelitis ; Proteins ; Systematic review ; Ventilators</subject><ispartof>Curēus (Palo Alto, CA), 2023-11, Vol.15 (11), p.e48703-e48703</ispartof><rights>Copyright © 2023, Almalki et al.</rights><rights>Copyright © 2023, Almalki et al. This work is published under https://creativecommons.org/licenses/by/3.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Copyright © 2023, Almalki et al. 2023 Almalki et al.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c300t-a2313563772a3883b807a0494091b1a7aaf4a913f85aa45142970b6517ffe5a23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2895635511/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2895635511?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,44590,53791,53793,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37965233$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Almalki, Shahad</creatorcontrib><creatorcontrib>Alghamdi, Lama</creatorcontrib><creatorcontrib>Khayyat, Jumana</creatorcontrib><creatorcontrib>Harun, Rawan T</creatorcontrib><creatorcontrib>Alyousef, Mayar</creatorcontrib><creatorcontrib>Hakeem, Rana</creatorcontrib><creatorcontrib>Alsamiri, Sarah</creatorcontrib><creatorcontrib>Alrefaie, Zienab</creatorcontrib><creatorcontrib>Bamaga, Ahmed K</creatorcontrib><title>Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018</title><title>Curēus (Palo Alto, CA)</title><addtitle>Cureus</addtitle><description>Guillain-Barré syndrome (GBS) is the leading cause of non-polio acute flaccid paralysis worldwide, emphasizing the importance of epidemiological studies on this condition. Therefore, well-designed epidemiological studies in different populations can provide a better understanding of the characteristics of patients with GBS and the nature of the disease. To our knowledge, no previous study has attempted to describe the characteristics of patients with GBS in Kingdom of Saudi Arabia (KSA) based on disease subtypes and clinical features in both adult and pediatric patients. This study aimed to assess the frequencies of GBS subtypes and their relationships with patient characteristics and clinical data in a tertiary hospital in Jeddah, KSA. This was a retrospective review of patients diagnosed with GBS between January 2000 and January 2018 at King Abdulaziz University Hospital (KAUH), a tertiary center in Jeddah, KSA. In total, 47 patients with GBS (median age: seven years for pediatric and 36 years for adult patients) were included in the current study. There were six male and three female pediatric patients and 19 male and 19 female adult patients. Among patients with GBS who were classified into a specific electrophysiological subtype (n = 28), 13 (46.2%) had acute inflammatory demyelinating polyneuropathy (AIDP), 11 (39%) had an axonal subtype, and four (14%) had Miller Fisher syndrome (MFS). Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. AIDP was the most frequent type of GBS, followed by the axonal type. Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. GBS type did not show a relationship with ICU admission or mechanical ventilation use. There was no association between specific therapies and different GBS subtypes and no significant difference in outcomes between different patterns of clinical presentation. Intravenous immunoglobulin (IVIg) and plasma exchange (PE) treatments both had the same efficacy in relation to outcomes for patients with GBS.</description><subject>Apheresis</subject><subject>Ataxia</subject><subject>Bacterial infections</subject><subject>Diabetic neuropathy</subject><subject>Gastrointestinal surgery</subject><subject>Guillain-Barre syndrome</subject><subject>Infections</subject><subject>Intensive care</subject><subject>Medical prognosis</subject><subject>Neurology</subject><subject>Patients</subject><subject>Pediatrics</subject><subject>Physical therapy</subject><subject>Poliomyelitis</subject><subject>Proteins</subject><subject>Systematic review</subject><subject>Ventilators</subject><issn>2168-8184</issn><issn>2168-8184</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>PIMPY</sourceid><recordid>eNpdkc9u1DAQxi1ERattb5yRJS4cNu04jmPnhJaF_oFKrVQqjtYkcXZdZePFdiptH4O34Dl4MbxsqQqnGcm_-TzffIS8ZnAspahOmtGbMRwXSgJ_QQ5yVqpMMVW8fNbvk6MQ7gCAgcxBwiuyz2VVipzzA_JjvkSPTTTehmibQF1HrzFaM8RAP1pcDC6Yln6zcUnPRtv3aIfsA3r_6ye92QytdytDMdIvdljQWd2OPT7YB3o72Hvjg40beu7C2kbsp_SzaVtcTukNjq2lM4-1xSk9TRI0T-vR6FJl6pDsddgHc_RYJ-T29NPX-Xl2eXV2MZ9dZg0HiBnmnHFRcilz5ErxWoFEKKoCKlYzlIhdgRXjnRKIhWBFXkmoS8Fk1xmRpifk_U53PdYr0zbJssder71dod9oh1b_-zLYpV64e82gLBik3yfk3aOCd99HE6Je2dCYdKTBuDHoXFXAy7wAkdC3_6F3bvRD8relkg0h2FZwuqMa70LwpnvahoHeBq53ges_gSf8zXMHT_DfePlvapCm_Q</recordid><startdate>20231112</startdate><enddate>20231112</enddate><creator>Almalki, Shahad</creator><creator>Alghamdi, Lama</creator><creator>Khayyat, Jumana</creator><creator>Harun, Rawan T</creator><creator>Alyousef, Mayar</creator><creator>Hakeem, Rana</creator><creator>Alsamiri, Sarah</creator><creator>Alrefaie, Zienab</creator><creator>Bamaga, Ahmed K</creator><general>Cureus Inc</general><general>Cureus</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</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></search><sort><creationdate>20231112</creationdate><title>Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018</title><author>Almalki, Shahad ; Alghamdi, Lama ; Khayyat, Jumana ; Harun, Rawan T ; Alyousef, Mayar ; Hakeem, Rana ; Alsamiri, Sarah ; Alrefaie, Zienab ; Bamaga, Ahmed K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c300t-a2313563772a3883b807a0494091b1a7aaf4a913f85aa45142970b6517ffe5a23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Apheresis</topic><topic>Ataxia</topic><topic>Bacterial infections</topic><topic>Diabetic neuropathy</topic><topic>Gastrointestinal surgery</topic><topic>Guillain-Barre syndrome</topic><topic>Infections</topic><topic>Intensive care</topic><topic>Medical prognosis</topic><topic>Neurology</topic><topic>Patients</topic><topic>Pediatrics</topic><topic>Physical therapy</topic><topic>Poliomyelitis</topic><topic>Proteins</topic><topic>Systematic review</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Almalki, Shahad</creatorcontrib><creatorcontrib>Alghamdi, Lama</creatorcontrib><creatorcontrib>Khayyat, Jumana</creatorcontrib><creatorcontrib>Harun, Rawan T</creatorcontrib><creatorcontrib>Alyousef, Mayar</creatorcontrib><creatorcontrib>Hakeem, Rana</creatorcontrib><creatorcontrib>Alsamiri, Sarah</creatorcontrib><creatorcontrib>Alrefaie, Zienab</creatorcontrib><creatorcontrib>Bamaga, Ahmed K</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Health and Medical</collection><collection>ProQuest Central (purchase pre-March 2016)</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 &amp; Medical Complete (Alumni)</collection><collection>Health &amp; Medical Collection (Alumni Edition)</collection><collection>Publicly Available Content Database</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><jtitle>Curēus (Palo Alto, CA)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Almalki, Shahad</au><au>Alghamdi, Lama</au><au>Khayyat, Jumana</au><au>Harun, Rawan T</au><au>Alyousef, Mayar</au><au>Hakeem, Rana</au><au>Alsamiri, Sarah</au><au>Alrefaie, Zienab</au><au>Bamaga, Ahmed K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018</atitle><jtitle>Curēus (Palo Alto, CA)</jtitle><addtitle>Cureus</addtitle><date>2023-11-12</date><risdate>2023</risdate><volume>15</volume><issue>11</issue><spage>e48703</spage><epage>e48703</epage><pages>e48703-e48703</pages><issn>2168-8184</issn><eissn>2168-8184</eissn><abstract>Guillain-Barré syndrome (GBS) is the leading cause of non-polio acute flaccid paralysis worldwide, emphasizing the importance of epidemiological studies on this condition. Therefore, well-designed epidemiological studies in different populations can provide a better understanding of the characteristics of patients with GBS and the nature of the disease. To our knowledge, no previous study has attempted to describe the characteristics of patients with GBS in Kingdom of Saudi Arabia (KSA) based on disease subtypes and clinical features in both adult and pediatric patients. This study aimed to assess the frequencies of GBS subtypes and their relationships with patient characteristics and clinical data in a tertiary hospital in Jeddah, KSA. This was a retrospective review of patients diagnosed with GBS between January 2000 and January 2018 at King Abdulaziz University Hospital (KAUH), a tertiary center in Jeddah, KSA. In total, 47 patients with GBS (median age: seven years for pediatric and 36 years for adult patients) were included in the current study. There were six male and three female pediatric patients and 19 male and 19 female adult patients. Among patients with GBS who were classified into a specific electrophysiological subtype (n = 28), 13 (46.2%) had acute inflammatory demyelinating polyneuropathy (AIDP), 11 (39%) had an axonal subtype, and four (14%) had Miller Fisher syndrome (MFS). Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. AIDP was the most frequent type of GBS, followed by the axonal type. Patients required prolonged hospitalization of approximately 20 ± 22 days (2.83 ± 3.11 weeks). Patients with MFS were more likely to have higher cytoalbuminologic dissociation than those with other subtypes. GBS type did not show a relationship with ICU admission or mechanical ventilation use. There was no association between specific therapies and different GBS subtypes and no significant difference in outcomes between different patterns of clinical presentation. Intravenous immunoglobulin (IVIg) and plasma exchange (PE) treatments both had the same efficacy in relation to outcomes for patients with GBS.</abstract><cop>United States</cop><pub>Cureus Inc</pub><pmid>37965233</pmid><doi>10.7759/cureus.48703</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2168-8184
ispartof Curēus (Palo Alto, CA), 2023-11, Vol.15 (11), p.e48703-e48703
issn 2168-8184
2168-8184
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_10641031
source PubMed Central Free; Publicly Available Content Database
subjects Apheresis
Ataxia
Bacterial infections
Diabetic neuropathy
Gastrointestinal surgery
Guillain-Barre syndrome
Infections
Intensive care
Medical prognosis
Neurology
Patients
Pediatrics
Physical therapy
Poliomyelitis
Proteins
Systematic review
Ventilators
title Characteristics of Patients Diagnosed With Guillain-Barré Syndrome at King Abdulaziz University Hospital, Jeddah, Saudi Arabia, From 2000 to 2018
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-25T17%3A46%3A06IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_pubme&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Characteristics%20of%20Patients%20Diagnosed%20With%20Guillain-Barr%C3%A9%20Syndrome%20at%20King%20Abdulaziz%20University%20Hospital,%20Jeddah,%20Saudi%20Arabia,%20From%202000%20to%202018&rft.jtitle=Cur%C4%93us%20(Palo%20Alto,%20CA)&rft.au=Almalki,%20Shahad&rft.date=2023-11-12&rft.volume=15&rft.issue=11&rft.spage=e48703&rft.epage=e48703&rft.pages=e48703-e48703&rft.issn=2168-8184&rft.eissn=2168-8184&rft_id=info:doi/10.7759/cureus.48703&rft_dat=%3Cproquest_pubme%3E2890362405%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c300t-a2313563772a3883b807a0494091b1a7aaf4a913f85aa45142970b6517ffe5a23%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2895635511&rft_id=info:pmid/37965233&rfr_iscdi=true