Loading…

Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates

Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 pa...

Full description

Saved in:
Bibliographic Details
Published in:Journal of clinical medicine 2022-04, Vol.11 (9), p.2439
Main Authors: Almarashda, Amna Mohamed Juma, Rabbani, Syed Arman, Kurian, Martin Thomas, Cherian, Ajith
Format: Article
Language:English
Subjects:
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883
cites cdi_FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883
container_end_page
container_issue 9
container_start_page 2439
container_title Journal of clinical medicine
container_volume 11
creator Almarashda, Amna Mohamed Juma
Rabbani, Syed Arman
Kurian, Martin Thomas
Cherian, Ajith
description Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age > 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p < 0.001), Hb < 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils > 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes < 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium < 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium < 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea > 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH > 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.
doi_str_mv 10.3390/jcm11092439
format article
fullrecord <record><control><sourceid>proquest_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9100822</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2663027775</sourcerecordid><originalsourceid>FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883</originalsourceid><addsrcrecordid>eNpdkUlLBDEUhIMoKurJuwS8CNqapbdcBGlXEBS3a3idTjsZuztjkhHGu__bDC6M5pJH6qOol0Jom5JDzgU5GqueUiJYysUSWmekKBLCS768MK-hLe_HJJ6yTBktVtEaz7I8z3K-jj6qzgxGQYerEThQQTvjg1H-AN8Z_4LP45N1HrfW4Xv9FtUwwzA0-DbiPSgbRtrBZIbNgC-tn5gAnXnXDa5unq5OEyrwLQSjh-DnRITx42BC1E8c1PisNw6C9ptopYXO663vewM9np89VJfJ9c3FVXVynai4bEi0qokgddGokjNSEqrjQFJBgLYlqVuaQatSljZZU-Y6a6hQKWVpK2rVtHF7voGOv3wn07rXjYq5HHRy4kwPbiYtGPlXGcxIPts3KWj8Pcaiwd63gbOvU-2D7I1Xuutg0HbqJcvzNOYqWRbR3X_o2E7dENebU5ywoijm1P4XpZz13un2Nwwlct6wXGg40juL-X_Znz75J-eYoj4</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2663027775</pqid></control><display><type>article</type><title>Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates</title><source>PubMed Central Free</source><source>Publicly Available Content Database</source><source>Coronavirus Research Database</source><creator>Almarashda, Amna Mohamed Juma ; Rabbani, Syed Arman ; Kurian, Martin Thomas ; Cherian, Ajith</creator><creatorcontrib>Almarashda, Amna Mohamed Juma ; Rabbani, Syed Arman ; Kurian, Martin Thomas ; Cherian, Ajith</creatorcontrib><description>Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age &gt; 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p &lt; 0.001), Hb &lt; 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils &gt; 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes &lt; 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium &lt; 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium &lt; 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea &gt; 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH &gt; 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.</description><identifier>ISSN: 2077-0383</identifier><identifier>EISSN: 2077-0383</identifier><identifier>DOI: 10.3390/jcm11092439</identifier><identifier>PMID: 35566563</identifier><language>eng</language><publisher>Switzerland: MDPI AG</publisher><subject>Asymptomatic ; Clinical medicine ; Comorbidity ; Coronaviruses ; COVID-19 vaccines ; Diabetes ; Disease prevention ; Drug therapy ; Emergency medical care ; Ethics ; Hospitals ; Laboratories ; Length of stay ; Patients ; Risk factors ; Severe acute respiratory syndrome coronavirus 2 ; Ventilators</subject><ispartof>Journal of clinical medicine, 2022-04, Vol.11 (9), p.2439</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><citedby>FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883</citedby><cites>FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883</cites><orcidid>0000-0002-8454-8158</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2663027775/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2663027775?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,885,25753,27924,27925,37012,37013,38516,43895,44590,53791,53793,74412,75126</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/35566563$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Almarashda, Amna Mohamed Juma</creatorcontrib><creatorcontrib>Rabbani, Syed Arman</creatorcontrib><creatorcontrib>Kurian, Martin Thomas</creatorcontrib><creatorcontrib>Cherian, Ajith</creatorcontrib><title>Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates</title><title>Journal of clinical medicine</title><addtitle>J Clin Med</addtitle><description>Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age &gt; 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p &lt; 0.001), Hb &lt; 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils &gt; 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes &lt; 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium &lt; 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium &lt; 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea &gt; 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH &gt; 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.</description><subject>Asymptomatic</subject><subject>Clinical medicine</subject><subject>Comorbidity</subject><subject>Coronaviruses</subject><subject>COVID-19 vaccines</subject><subject>Diabetes</subject><subject>Disease prevention</subject><subject>Drug therapy</subject><subject>Emergency medical care</subject><subject>Ethics</subject><subject>Hospitals</subject><subject>Laboratories</subject><subject>Length of stay</subject><subject>Patients</subject><subject>Risk factors</subject><subject>Severe acute respiratory syndrome coronavirus 2</subject><subject>Ventilators</subject><issn>2077-0383</issn><issn>2077-0383</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>COVID</sourceid><sourceid>PIMPY</sourceid><recordid>eNpdkUlLBDEUhIMoKurJuwS8CNqapbdcBGlXEBS3a3idTjsZuztjkhHGu__bDC6M5pJH6qOol0Jom5JDzgU5GqueUiJYysUSWmekKBLCS768MK-hLe_HJJ6yTBktVtEaz7I8z3K-jj6qzgxGQYerEThQQTvjg1H-AN8Z_4LP45N1HrfW4Xv9FtUwwzA0-DbiPSgbRtrBZIbNgC-tn5gAnXnXDa5unq5OEyrwLQSjh-DnRITx42BC1E8c1PisNw6C9ptopYXO663vewM9np89VJfJ9c3FVXVynai4bEi0qokgddGokjNSEqrjQFJBgLYlqVuaQatSljZZU-Y6a6hQKWVpK2rVtHF7voGOv3wn07rXjYq5HHRy4kwPbiYtGPlXGcxIPts3KWj8Pcaiwd63gbOvU-2D7I1Xuutg0HbqJcvzNOYqWRbR3X_o2E7dENebU5ywoijm1P4XpZz13un2Nwwlct6wXGg40juL-X_Znz75J-eYoj4</recordid><startdate>20220426</startdate><enddate>20220426</enddate><creator>Almarashda, Amna Mohamed Juma</creator><creator>Rabbani, Syed Arman</creator><creator>Kurian, Martin Thomas</creator><creator>Cherian, Ajith</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>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</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>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0002-8454-8158</orcidid></search><sort><creationdate>20220426</creationdate><title>Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates</title><author>Almarashda, Amna Mohamed Juma ; Rabbani, Syed Arman ; Kurian, Martin Thomas ; Cherian, Ajith</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2022</creationdate><topic>Asymptomatic</topic><topic>Clinical medicine</topic><topic>Comorbidity</topic><topic>Coronaviruses</topic><topic>COVID-19 vaccines</topic><topic>Diabetes</topic><topic>Disease prevention</topic><topic>Drug therapy</topic><topic>Emergency medical care</topic><topic>Ethics</topic><topic>Hospitals</topic><topic>Laboratories</topic><topic>Length of stay</topic><topic>Patients</topic><topic>Risk factors</topic><topic>Severe acute respiratory syndrome coronavirus 2</topic><topic>Ventilators</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Almarashda, Amna Mohamed Juma</creatorcontrib><creatorcontrib>Rabbani, Syed Arman</creatorcontrib><creatorcontrib>Kurian, Martin Thomas</creatorcontrib><creatorcontrib>Cherian, Ajith</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health &amp; Medical Collection</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>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central Korea</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>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Journal of clinical medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Almarashda, Amna Mohamed Juma</au><au>Rabbani, Syed Arman</au><au>Kurian, Martin Thomas</au><au>Cherian, Ajith</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates</atitle><jtitle>Journal of clinical medicine</jtitle><addtitle>J Clin Med</addtitle><date>2022-04-26</date><risdate>2022</risdate><volume>11</volume><issue>9</issue><spage>2439</spage><pages>2439-</pages><issn>2077-0383</issn><eissn>2077-0383</eissn><abstract>Data on the clinical characteristics, severity and management of COVID-19 from the Middle East region, especially the United Arab Emirates (UAE), is very limited. We studied the clinical characteristics, laboratory biomarkers, risk factors for severity and pharmacotherapy of hospitalized COVID-19 patients in this single-center, analytical cross-sectional study conducted in a secondary care hospital of the UAE. A total of 585 patients were included in the study (median age, 49 years (IQR, 39−59); 66% male). Age &gt; 45 years (OR = 2.07, 95% CI: 1.04−4.14, p = 0.040), male gender (OR = 3.15, 95% CI: 1.52−6.51, p = 0.002), presentation symptoms such as fever (OR = 3.68, 95% CI:1.34−10.11, p = 0.011) and shortness of breath/dyspnea (OR = 5.36, 95% CI: 2.69−10.67, p &lt; 0.001), Hb &lt; 13 g/dL (OR = 3.17, 95% CI: 1.51−6.65, p = 0.002), neutrophils &gt; 7 × 103/mcL (OR = 4.89, 95% CI: 1.66−14.37, p=0.004), lymphocytes &lt; 1 × 103/mcL (OR = 7.78, 95% CI: 1.01−60.19, p = 0.049), sodium &lt; 135 mmol/L (OR = 5.42, 95% CI: 1.05−27.95, p = 0.044), potassium &lt; 3.6 mmol/L (OR = 3.36, 95% CI: 1.03−11.01, p = 0.045), urea &gt; 6.5 mmol/L (OR = 3.37, 95% CI: 1.69−6.73, p = 0.001) and LDH &gt; 227 IU/L (OR = 6.26, 95% CI: 1.61−24.32, p = 0.008) were independent predictors of the severity of COVID-19. Antivirals (524, 89.6%) and corticosteroids (358, 61.2%) were prescribed for the management of COVID-19. In conclusion, older age, male gender, presentation symptoms such as fever and dyspnea, low hemoglobin, neutrophilia, lymphopenia, hyponatremia, hypokalemia, elevated levels of urea and lactate dehydrogenase were found to be independent risk factors for severe COVID-19. The pharmacotherapy of COVID-19 patients in our study was diverse, and the medications were prescribed based on the clinical condition of the patients.</abstract><cop>Switzerland</cop><pub>MDPI AG</pub><pmid>35566563</pmid><doi>10.3390/jcm11092439</doi><orcidid>https://orcid.org/0000-0002-8454-8158</orcidid><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2077-0383
ispartof Journal of clinical medicine, 2022-04, Vol.11 (9), p.2439
issn 2077-0383
2077-0383
language eng
recordid cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_9100822
source PubMed Central Free; Publicly Available Content Database; Coronavirus Research Database
subjects Asymptomatic
Clinical medicine
Comorbidity
Coronaviruses
COVID-19 vaccines
Diabetes
Disease prevention
Drug therapy
Emergency medical care
Ethics
Hospitals
Laboratories
Length of stay
Patients
Risk factors
Severe acute respiratory syndrome coronavirus 2
Ventilators
title Clinical Characteristics, Risk Factors for Severity and Pharmacotherapy in Hospitalized COVID-19 Patients in the United Arab Emirates
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2024-12-29T20%3A07%3A08IST&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=Clinical%20Characteristics,%20Risk%20Factors%20for%20Severity%20and%20Pharmacotherapy%20in%20Hospitalized%20COVID-19%20Patients%20in%20the%20United%20Arab%20Emirates&rft.jtitle=Journal%20of%20clinical%20medicine&rft.au=Almarashda,%20Amna%20Mohamed%20Juma&rft.date=2022-04-26&rft.volume=11&rft.issue=9&rft.spage=2439&rft.pages=2439-&rft.issn=2077-0383&rft.eissn=2077-0383&rft_id=info:doi/10.3390/jcm11092439&rft_dat=%3Cproquest_pubme%3E2663027775%3C/proquest_pubme%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c339t-ecb090b7dc8320801ec830490a1f80bf15afc424d5d86e5d19c4124f9bcdf0883%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=2663027775&rft_id=info:pmid/35566563&rfr_iscdi=true