Hydroxychloroquine and Azithromycin Treatment of Hospitalized Patients Infected with SARS-CoV-2 in Senegal from March to October 2020
Fabien Taieb, Khardiata Diallo Mbaye, Billo Tall, Ndèye Aïssatou Lakhe, Cheikh Talla, Daouda Thioub, Amadou Moustapha Ndoye, Daye Ka, Aboubacry Gaye, Viviane Marie-Pierre Cissé Diallo, Ndongo Dia, Pape Samba Ba, Mamadou Cissé, Moustapha Diop, Cheikh Tidiane Diagne, Louise Fortes, Mamadou Diop, Ndèye Maguette Fall, Fatoumata Diène Sarr, Margarite Diatta, Mamadou Aliou Barry, Aboubakar Sidikh Badiane, Abdoulaye Seck, Philippe Dubrous, Ousmane Faye, Inès Vigan-Womas, Cheikh Loucoubar, Amadou Alpha Sall, Moussa Seydi
Journal of Clinical Medicine, doi:10.3390/jcm10132954
As of today, little data is available on COVID-19 in African countries, where the case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 hospitalized patients in Senegal from March to October 20202. We described the clinical characteristics of patients and analysed clinical status (alive and discharged versus hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among adult patients who received HCQ plus AZM and those who did not receive this combination. A total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) patients received a combination of HCQ and AZM. Results showed that the proportion of patient discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC 95% (1.09-2.43)). Factors associated with a lower proportion of patients discharged alive were: age ≥ 60 years (OR: 0.55, IC 95% (0.36-0.83)), having of at least one pre-existing disorder (OR: 0.61, IC 95% (0.42-0.90)), and a high clinical risk at admission following NEWS score (OR: 0.49, IC 95% (0.28-0.83)). Few side effects were reported including 2 cases of cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM combination.
Conflicts of Interest: The authors declare no conflict of interest.
References
Andreani, Le Bideau, Duflot, Jardot, Rolland et al., In vitro testing of combined hydroxychloroquine and azithromycin on SARS-CoV-2 shows synergistic effect, Microb. Pathog,
doi:10.1016/j.micpath.2020.104228Arshad, Kilgore, Chaudhry, Jacobsen, Wang et al., Treatment with hydroxychloroquine, azithromycin, and combination in patients hospitalized with COVID-19, Int. J. Infect. Dis,
doi:10.1016/j.ijid.2020.06.099Bacharier, Guilbert, Mauger, Boehmer, Beigelman et al., Early Administration of Azithromycin and Prevention of Severe Lower Respiratory Tract Illnesses in Preschool Children with a History of Such Illnesses: A Randomized Clinical Trial, JAMA,
doi:10.1001/jama.2015.13896Belayneh, Off-Label Use of Chloroquine and Hydroxychloroquine for COVID-19 Treatment in Africa Against WHO Recommendation, Res. Rep. Trop. Med,
doi:10.2147/rrtm.s269936Bessière, Roccia, Delinière, Charrière, Chevalier et al., Assessment of QT Intervals in a Case Series of Patients with Coronavirus Disease 2019 (COVID-19) Infection Treated with Hydroxychloroquine Alone or in Combination with Azithromycin in an Intensive Care Unit, JAMA Cardiol,
doi:10.1001/jamacardio.2020.1787Cavalcanti, Zampieri, Rosa, Azevedo, Veiga et al., Hydroxychloroquine with or without Azithromycin in Mild-to-Moderate Covid-19, N. Engl. J. Med,
doi:10.1056/NEJMoa2019014Core, R: A Language and Environment for Statistical Computing; R Foundation for Statistical Computing
Dagens, Sigfrid, Cai, Lipworth, Cheung et al., Scope, quality, and inclusivity of clinical guidelines produced early in the covid-19 pandemic: Rapid review, BMJ,
doi:10.1136/bmj.m1936Damle, Vourvahis, Wang, Leaney, Corrigan, Clinical Pharmacology Perspectives on the Antiviral Activity of Azithromycin and Use in COVID-19, Clin. Pharmacol. Ther,
doi:10.1002/cpt.1857Devaux, Rolain, Colson, Raoult, New insights on the antiviral effects of chloroquine against coronavirus: What to expect for COVID-19?, Int. J. Antimicrob. Agents,
doi:10.1016/j.ijantimicag.2020.105938Docherty, Harrison, Green, Hardwick, Pius et al., Features of 20 133 UK patients in hospital with covid-19 using the ISARIC WHO Clinical Characterisation Protocol: Prospective observational cohort study, BMJ,
doi:10.1136/bmj.m1985Gautret, Hoang, Lagier, Raoult, Effect of hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial, an update with an intention-to-treat analysis and clinical outcomes, Int. J. Antimicrob. Agents,
doi:10.1016/j.ijantimicag.2020.106239Gautret, Lagier, Parola, Hoang, Meddeb et al., Hydroxychloroquine and azithromycin as a treatment of COVID-19: Results of an open-label non-randomized clinical trial, Int. J. Antimicrob. Agents,
doi:10.1016/j.ijantimicag.2020.105949Geleris, Sun, Platt, Zucker, Baldwin et al., Observational Study of Hydroxychloroquine in Hospitalized Patients with Covid-19, N. Engl. J. Med
Guan, Ni, Hu, Liang, Ou et al., Clinical Characteristics of Coronavirus Disease 2019 in China, N. Engl. J. Med,
doi:10.1056/NEJMoa2002032Harris, Taylor, Minor, Elliott, Fernandez et al., The REDCap consortium: Building an international community of software platform partners, J. Biomed. Inform
Hoehl, Rabenau, Berger, Kortenbusch, Cinatl et al., Evidence of SARS-CoV-2 Infection in Returning Travelers from Wuhan, China, N. Engl. J. Med,
doi:10.1056/NEJMc2001899Horby, Mafham, Linsell, Bell, Staplin et al., Effect of Hydroxychloroquine in Hospitalized Patients with Covid-19, N. Engl. J. Med,
doi:10.1056/nejmoa2022926Huang, Soleimani, Herasevich, Pinevich, Pennington et al., Clinical Characteristics, Treatment, and Outcomes of Critically Ill Patients With COVID-19: A Scoping Review, Mayo Clin. Proc,
doi:10.1016/j.mayocp.2020.10.022Isaric, Novel Coronavirus (NCoV) Acute Respiratory Infection Clinical Characterisation Data Tool, Version
Lagier, Million, Gautret, Colson, Cortaredona et al., Outcomes of 3,737 COVID-19 patients treated with hydroxychloroquine/azithromycin and other regimens in Marseille, France: A retrospective analysis, Travel Med. Infect. Dis,
doi:10.1016/j.tmaid.2020.101791Liu, Cao, Xu, Wang, Zhang et al., Hydroxychloroquine, a less toxic derivative of chloroquine, is effective in inhibiting SARS-CoV-2 infection in vitro, Cell Discov,
doi:10.1038/s41421-020-0156-0Million, Gautret, Colson, Roussel, Dubourg et al., Clinical efficacy of chloroquine derivatives in COVID-19 infection: Comparative meta-analysis between the big data and the real world, New Microbes New Infect,
doi:10.1016/j.nmni.2020.100709Million, Lagier, Gautret, Colson, Fournier et al., Early treatment of COVID-19 patients with hydroxychloroquine and azithromycin: A retrospective analysis of 1061 cases in Marseille, France, Travel Med. Infect. Dis,
doi:10.1016/j.tmaid.2020.101738Mitjà, Corbacho-Monné, Ubals, Tebé, Peñafiel et al., Hydroxychloroquine for Early Treatment of Adults with Mild Coronavirus Disease 2019: A Randomized, Controlled Trial, Clin. Infect. Dis,
doi:10.1093/cid/ciaa1009Nachega, Ishoso, Otokoye, Hermans, Machekano et al., Clinical Characteristics and Outcomes of Patients Hospitalized for COVID-19 in Africa: Early Insights from the Democratic Republic of the Congo, Am. J. Trop. Med. Hyg,
doi:10.4269/ajtmh.20-1240Pan, Peto, Henao-Restrepo, Preziosi, Sathiyamoorthy et al., Repurposed Antiviral Drugs for Covid-19-Interim WHO Solidarity Trial Results, N. Engl. J. Med,
doi:10.1056/nejmoa2023184Rees, Nightingale, Jafari, Waterlow, Clifford et al., None
Richardson, Hirsch, Narasimhan, Crawford, Mcginn et al., the Northwell COVID-19 Research Consortium. Presenting characteristics, comorbidities, and outcomes among 5700 patients hospitalized with COVID-19 in the New York City Area, JAMA,
doi:10.1001/jama.2020.6775Rosenberg, Dufort, Udo, Wilberschied, Kumar et al., Association of Treatment with Hydroxychloroquine or Azithromycin with In-Hospital Mortality in Patients With COVID-19 in New York State, JAMA,
doi:10.1001/jama.2020.8630Rosenthal, Cao, Gundrum, Sianis, Safo, Risk Factors Associated with In-Hospital Mortality in a US National Sample of Patients With COVID-19, JAMA Netw. Open,
doi:10.1001/jamanetworkopen.2020.29058Simpson, Beever, Challen, De Angelis, Fragaszy et al., The UK's pandemic influenza research portfolio: A model for future research on emerging infections, Lancet Infect. Dis,
doi:10.1016/S1473-3099(18)30786-2Smohas, Coronavirus (COVID-19) Situation Dashboard
Stokkermans, Goyal, Bansal, Trichonas, Chloroquine and Hydroxychloroquine Toxicity
Trape, Pison, Preziosi, Enel, Du Loû et al., Impact of chloroquine resistance on malaria mortality, Comptes Rendus Acad. Sci. Ser. III Sci. Vie,
doi:10.1016/S0764-4469(98)80009-7Trape, Tall, Sokhna, Ly, Diagne et al., The rise and fall of malaria in a west African rural community, Dielmo, Senegal, from 1990 to 2012: A 22 year longitudinal study, Lancet Infect. Dis,
doi:10.1016/S1473-3099(14)70712-1Who Who Director, s Opening Remarks at the Media Briefing on COVID-19-11
Wu, Mcgoogan, Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases from the Chinese Center for Disease Control and Prevention, JAMA,
doi:10.1001/jama.2020.2648Yao, Ye, Zhang, Cui, Huang et al., In Vitro Antiviral Activity and Projection of Optimized Dosing Design of Hydroxychloroquine for the Treatment of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), Clin. Infect. Dis,
doi:10.1093/cid/ciaa237{ 'indexed': {'date-parts': [[2024, 3, 16]], 'date-time': '2024-03-16T23:56:21Z', 'timestamp': 1710633381002},
'reference-count': 46,
'publisher': 'MDPI AG',
'issue': '13',
'license': [ { 'start': { 'date-parts': [[2021, 6, 30]],
'date-time': '2021-06-30T00:00:00Z',
'timestamp': 1625011200000},
'content-version': 'vor',
'delay-in-days': 0,
'URL': 'https://creativecommons.org/licenses/by/4.0/'}],
'content-domain': {'domain': [], 'crossmark-restriction': False},
'abstract': '<jats:p>As of today, little data is available on COVID-19 in African countries, where the '
'case management relied mainly on a treatment by association between hydroxychloroquine (HCQ) '
'and azithromycin (AZM). This study aimed to understand the main clinical outcomes of COVID-19 '
'hospitalized patients in Senegal from March to October 20202. We described the clinical '
'characteristics of patients and analysed clinical status (alive and discharged versus '
'hospitalized or died) at 15 days after Isolation and Treatment Centres (ITC) admission among '
'adult patients who received HCQ plus AZM and those who did not receive this combination. A '
'total of 926 patients were included in this analysis. Six hundred seventy-four (674) (72.8%) '
'patients received a combination of HCQ and AZM. Results showed that the proportion of patient '
'discharge at D15 was significantly higher for patients receiving HCQ plus AZM (OR: 1.63, IC '
'95% (1.09–2.43)). Factors associated with a lower proportion of patients discharged alive '
'were: age ≥ 60 years (OR: 0.55, IC 95% (0.36–0.83)), having of at least one pre-existing '
'disorder (OR: 0.61, IC 95% (0.42–0.90)), and a high clinical risk at admission following NEWS '
'score (OR: 0.49, IC 95% (0.28–0.83)). Few side effects were reported including 2 cases of '
'cardiac rhythmic disorders in the HCQ and AZM group versus 13 in without HCQ + AZM. An '
'improvement of clinical status at 15 days was found for patients exposed to HCQ plus AZM '
'combination.</jats:p>',
'DOI': '10.3390/jcm10132954',
'type': 'journal-article',
'created': {'date-parts': [[2021, 6, 30]], 'date-time': '2021-06-30T14:03:19Z', 'timestamp': 1625061799000},
'page': '2954',
'source': 'Crossref',
'is-referenced-by-count': 7,
'title': 'Hydroxychloroquine and Azithromycin Treatment of Hospitalized Patients Infected with SARS-CoV-2 '
'in Senegal from March to October 2020',
'prefix': '10.3390',
'volume': '10',
'author': [ {'given': 'Fabien', 'family': 'Taieb', 'sequence': 'first', 'affiliation': []},
{'given': 'Khardiata Diallo', 'family': 'Mbaye', 'sequence': 'additional', 'affiliation': []},
{'given': 'Billo', 'family': 'Tall', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ndèye Aïssatou', 'family': 'Lakhe', 'sequence': 'additional', 'affiliation': []},
{'given': 'Cheikh', 'family': 'Talla', 'sequence': 'additional', 'affiliation': []},
{'given': 'Daouda', 'family': 'Thioub', 'sequence': 'additional', 'affiliation': []},
{'given': 'Amadou Moustapha', 'family': 'Ndoye', 'sequence': 'additional', 'affiliation': []},
{'given': 'Daye', 'family': 'Ka', 'sequence': 'additional', 'affiliation': []},
{'given': 'Aboubacry', 'family': 'Gaye', 'sequence': 'additional', 'affiliation': []},
{ 'given': 'Viviane Marie-Pierre',
'family': 'Cissé Diallo',
'sequence': 'additional',
'affiliation': []},
{'given': 'Ndongo', 'family': 'Dia', 'sequence': 'additional', 'affiliation': []},
{'given': 'Pape Samba', 'family': 'Ba', 'sequence': 'additional', 'affiliation': []},
{'given': 'Mamadou', 'family': 'Cissé', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-4957-2264',
'authenticated-orcid': False,
'given': 'Moustapha',
'family': 'Diop',
'sequence': 'additional',
'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0003-2119-9349',
'authenticated-orcid': False,
'given': 'Cheikh Tidiane',
'family': 'Diagne',
'sequence': 'additional',
'affiliation': []},
{'given': 'Louise', 'family': 'Fortes', 'sequence': 'additional', 'affiliation': []},
{'given': 'Mamadou', 'family': 'Diop', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ndèye Maguette', 'family': 'Fall', 'sequence': 'additional', 'affiliation': []},
{'given': 'Fatoumata Diène', 'family': 'Sarr', 'sequence': 'additional', 'affiliation': []},
{'given': 'Margarite', 'family': 'Diatta', 'sequence': 'additional', 'affiliation': []},
{'given': 'Mamadou Aliou', 'family': 'Barry', 'sequence': 'additional', 'affiliation': []},
{'given': 'Aboubakar Sidikh', 'family': 'Badiane', 'sequence': 'additional', 'affiliation': []},
{'given': 'Abdoulaye', 'family': 'Seck', 'sequence': 'additional', 'affiliation': []},
{'given': 'Philippe', 'family': 'Dubrous', 'sequence': 'additional', 'affiliation': []},
{'given': 'Ousmane', 'family': 'Faye', 'sequence': 'additional', 'affiliation': []},
{'given': 'Inès', 'family': 'Vigan-Womas', 'sequence': 'additional', 'affiliation': []},
{ 'ORCID': 'http://orcid.org/0000-0002-9582-4197',
'authenticated-orcid': False,
'given': 'Cheikh',
'family': 'Loucoubar',
'sequence': 'additional',
'affiliation': []},
{'given': 'Amadou Alpha', 'family': 'Sall', 'sequence': 'additional', 'affiliation': []},
{'given': 'Moussa', 'family': 'Seydi', 'sequence': 'additional', 'affiliation': []}],
'member': '1968',
'published-online': {'date-parts': [[2021, 6, 30]]},
'reference': [ { 'key': 'ref1',
'unstructured': '12 January '
'2020http://www.who.int/csr/don/12-january-2020-novel-coronavirus-china/en/'},
{ 'key': 'ref2',
'unstructured': 'WHO WHO Director-General’s Opening Remarks at the Media Briefing on '
'COVID-19-11 March '
'2020https://www.who.int/dg/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020'},
{ 'key': 'ref3',
'unstructured': 'SMoHaS, Coronavirus (COVID-19) Situation '
'Dashboardhttps://cartosantesen.maps.arcgis.com/apps/opsdashboard/index.html#/260c7842a77a48c191bf51c8b0a1d3f6'},
{'key': 'ref4', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijantimicag.2020.106239'},
{'key': 'ref5', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijantimicag.2020.105949'},
{'key': 'ref6', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.tmaid.2020.101791'},
{'key': 'ref7', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciaa237'},
{'key': 'ref8', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmj.m1936'},
{'key': 'ref9', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijantimicag.2020.105938'},
{'key': 'ref10', 'doi-asserted-by': 'publisher', 'DOI': '10.1038/s41421-020-0156-0'},
{'key': 'ref11', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.nmni.2020.100709'},
{'key': 'ref12', 'doi-asserted-by': 'publisher', 'DOI': '10.1002/cpt.1857'},
{'key': 'ref13', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.micpath.2020.104228'},
{'key': 'ref14', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/nejmoa2023184'},
{'key': 'ref15', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2019014'},
{'key': 'ref16', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2012410'},
{'key': 'ref17', 'doi-asserted-by': 'publisher', 'DOI': '10.1093/cid/ciaa1009'},
{'key': 'ref18', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/nejmoa2022926'},
{'key': 'ref19', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jamacardio.2020.1787'},
{'key': 'ref20', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2020.8630'},
{ 'key': 'ref21',
'series-title': 'COVID-19 Clinical Management: Living Guidance 25 January 2021',
'year': '2021'},
{'key': 'ref22', 'doi-asserted-by': 'publisher', 'DOI': '10.2147/rrtm.s269936'},
{'key': 'ref23', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S1473-3099(18)30786-2'},
{ 'key': 'ref24',
'unstructured': 'ISARIChttps://isaric.org/research/covid-19-clinical-research-resources/clinical-characterisation-protocol-ccp/'},
{'key': 'ref25', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMc2001899'},
{ 'key': 'ref26',
'series-title': 'Novel Coronavirus (NCoV) Acute Respiratory Infection Clinical '
'Characterisation Data Tool. Version 1.2 28 JAN 2020',
'year': '2020'},
{'key': 'ref27', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.jbi.2019.103208'},
{ 'key': 'ref28',
'series-title': 'National Early Warning Score (NEWS) 2: Standardising the Assessment of '
'Acute-Ilness Severity in the NHS. Updated Report of a Working Party',
'year': '2017'},
{ 'key': 'ref29',
'series-title': 'R: A Language and Environment for Statistical Computing',
'year': '2020'},
{'key': 'ref30', 'doi-asserted-by': 'publisher', 'DOI': '10.1136/bmj.m1985'},
{'key': 'ref31', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2020.6775'},
{'key': 'ref32', 'doi-asserted-by': 'publisher', 'DOI': '10.1056/NEJMoa2002032'},
{'key': 'ref33', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2015.13896'},
{'key': 'ref34', 'doi-asserted-by': 'publisher', 'DOI': '10.1186/s12916-020-01726-3'},
{'key': 'ref35', 'doi-asserted-by': 'publisher', 'DOI': '10.4269/ajtmh.20-1240'},
{'key': 'ref36', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.tmaid.2020.101738'},
{'key': 'ref37', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.ijid.2020.06.099'},
{ 'key': 'ref38',
'doi-asserted-by': 'publisher',
'DOI': '10.1001/jamanetworkopen.2020.29058'},
{'key': 'ref39', 'doi-asserted-by': 'publisher', 'DOI': '10.1007/s00436-009-1524-8'},
{'key': 'ref40', 'doi-asserted-by': 'publisher', 'DOI': '10.4269/ajtmh.2001.64.12'},
{'key': 'ref41', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S1473-3099(14)70712-1'},
{'key': 'ref42', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/S0764-4469(98)80009-7'},
{ 'key': 'ref43',
'series-title': 'StatPearls',
'article-title': 'Chloroquine and Hydroxychloroquine Toxicity',
'author': 'Stokkermans',
'year': '2021'},
{ 'key': 'ref44',
'unstructured': 'Cardiac Effects and Toxicity of Chloroquine: A Short '
'Update—ScienceDirecthttps://www.sciencedirect.com/science/article/pii/S0924857920302272'},
{'key': 'ref45', 'doi-asserted-by': 'publisher', 'DOI': '10.1016/j.mayocp.2020.10.022'},
{'key': 'ref46', 'doi-asserted-by': 'publisher', 'DOI': '10.1001/jama.2020.2648'}],
'container-title': 'Journal of Clinical Medicine',
'original-title': [],
'language': 'en',
'link': [ { 'URL': 'https://www.mdpi.com/2077-0383/10/13/2954/pdf',
'content-type': 'unspecified',
'content-version': 'vor',
'intended-application': 'similarity-checking'}],
'deposited': { 'date-parts': [[2021, 6, 30]],
'date-time': '2021-06-30T14:46:17Z',
'timestamp': 1625064377000},
'score': 1,
'resource': {'primary': {'URL': 'https://www.mdpi.com/2077-0383/10/13/2954'}},
'subtitle': [],
'short-title': [],
'issued': {'date-parts': [[2021, 6, 30]]},
'references-count': 46,
'journal-issue': {'issue': '13', 'published-online': {'date-parts': [[2021, 7]]}},
'alternative-id': ['jcm10132954'],
'URL': 'http://dx.doi.org/10.3390/jcm10132954',
'relation': {},
'ISSN': ['2077-0383'],
'subject': ['General Medicine'],
'container-title-short': 'JCM',
'published': {'date-parts': [[2021, 6, 30]]}}
