Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency
Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising t...
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| Autor*in: |
Usha Devi Rajendran [verfasserIn] Chinnathambi Kamalarathnam [verfasserIn] |
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| Format: |
E-Artikel |
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| Sprache: |
Englisch |
| Erschienen: |
2018 |
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| Schlagwörter: |
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| Übergeordnetes Werk: |
In: Journal of Clinical and Diagnostic Research - JCDR Research and Publications Private Limited, 2009, 12(2018), 5, Seite SC06-SC09 |
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| Übergeordnetes Werk: |
volume:12 ; year:2018 ; number:5 ; pages:SC06-SC09 |
| Links: |
Link aufrufen |
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| DOI / URN: |
10.7860/JCDR/2018/33977.11552 |
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| Katalog-ID: |
DOAJ068596774 |
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| 520 | |a Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. | ||
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10.7860/JCDR/2018/33977.11552 doi (DE-627)DOAJ068596774 (DE-599)DOAJd7c04102f9b54ac395c36a5a0bab5960 DE-627 ger DE-627 rakwb eng Usha Devi Rajendran verfasserin aut Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. congenital adrenal hyperplasia growth mortality shock Medicine R Chinnathambi Kamalarathnam verfasserin aut In Journal of Clinical and Diagnostic Research JCDR Research and Publications Private Limited, 2009 12(2018), 5, Seite SC06-SC09 (DE-627)789478048 (DE-600)2775283-5 0973709X nnns volume:12 year:2018 number:5 pages:SC06-SC09 https://doi.org/10.7860/JCDR/2018/33977.11552 kostenfrei https://doaj.org/article/d7c04102f9b54ac395c36a5a0bab5960 kostenfrei https://jcdr.net/articles/PDF/11552/33977_CE(RA1)_F(T)_PF1(AGAK)_PFA(AK)_PN(SS).pdf kostenfrei https://doaj.org/toc/2249-782X Journal toc kostenfrei https://doaj.org/toc/0973-709X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2018 5 SC06-SC09 |
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10.7860/JCDR/2018/33977.11552 doi (DE-627)DOAJ068596774 (DE-599)DOAJd7c04102f9b54ac395c36a5a0bab5960 DE-627 ger DE-627 rakwb eng Usha Devi Rajendran verfasserin aut Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. congenital adrenal hyperplasia growth mortality shock Medicine R Chinnathambi Kamalarathnam verfasserin aut In Journal of Clinical and Diagnostic Research JCDR Research and Publications Private Limited, 2009 12(2018), 5, Seite SC06-SC09 (DE-627)789478048 (DE-600)2775283-5 0973709X nnns volume:12 year:2018 number:5 pages:SC06-SC09 https://doi.org/10.7860/JCDR/2018/33977.11552 kostenfrei https://doaj.org/article/d7c04102f9b54ac395c36a5a0bab5960 kostenfrei https://jcdr.net/articles/PDF/11552/33977_CE(RA1)_F(T)_PF1(AGAK)_PFA(AK)_PN(SS).pdf kostenfrei https://doaj.org/toc/2249-782X Journal toc kostenfrei https://doaj.org/toc/0973-709X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2018 5 SC06-SC09 |
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10.7860/JCDR/2018/33977.11552 doi (DE-627)DOAJ068596774 (DE-599)DOAJd7c04102f9b54ac395c36a5a0bab5960 DE-627 ger DE-627 rakwb eng Usha Devi Rajendran verfasserin aut Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. congenital adrenal hyperplasia growth mortality shock Medicine R Chinnathambi Kamalarathnam verfasserin aut In Journal of Clinical and Diagnostic Research JCDR Research and Publications Private Limited, 2009 12(2018), 5, Seite SC06-SC09 (DE-627)789478048 (DE-600)2775283-5 0973709X nnns volume:12 year:2018 number:5 pages:SC06-SC09 https://doi.org/10.7860/JCDR/2018/33977.11552 kostenfrei https://doaj.org/article/d7c04102f9b54ac395c36a5a0bab5960 kostenfrei https://jcdr.net/articles/PDF/11552/33977_CE(RA1)_F(T)_PF1(AGAK)_PFA(AK)_PN(SS).pdf kostenfrei https://doaj.org/toc/2249-782X Journal toc kostenfrei https://doaj.org/toc/0973-709X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2018 5 SC06-SC09 |
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10.7860/JCDR/2018/33977.11552 doi (DE-627)DOAJ068596774 (DE-599)DOAJd7c04102f9b54ac395c36a5a0bab5960 DE-627 ger DE-627 rakwb eng Usha Devi Rajendran verfasserin aut Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency 2018 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. congenital adrenal hyperplasia growth mortality shock Medicine R Chinnathambi Kamalarathnam verfasserin aut In Journal of Clinical and Diagnostic Research JCDR Research and Publications Private Limited, 2009 12(2018), 5, Seite SC06-SC09 (DE-627)789478048 (DE-600)2775283-5 0973709X nnns volume:12 year:2018 number:5 pages:SC06-SC09 https://doi.org/10.7860/JCDR/2018/33977.11552 kostenfrei https://doaj.org/article/d7c04102f9b54ac395c36a5a0bab5960 kostenfrei https://jcdr.net/articles/PDF/11552/33977_CE(RA1)_F(T)_PF1(AGAK)_PFA(AK)_PN(SS).pdf kostenfrei https://doaj.org/toc/2249-782X Journal toc kostenfrei https://doaj.org/toc/0973-709X Journal toc kostenfrei GBV_USEFLAG_A SYSFLAG_A GBV_DOAJ GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2005 GBV_ILN_2009 GBV_ILN_2011 GBV_ILN_2014 GBV_ILN_2055 GBV_ILN_2111 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 12 2018 5 SC06-SC09 |
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Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency |
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Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. |
| abstractGer |
Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. |
| abstract_unstemmed |
Introduction: More than 95% of cases of Congenital Adrenal Hyperplasia (CAH) are due to 21-hydroxylase deficiency. This enzyme deficiency can present as either severe classic form or the non classic form. Severe classic forms present early in life and include the salt wasting and simple virilising types. Data regarding the clinical profile and particularly follow up of the neonates admitted with this deficiency are lacking in developing countries. Aim: To study the clinical profile, predictors of outcome and anthropometric parameters at follow up of neonates admitted with classical 21-hydroxylase deficiency. Materials and Methods: This observational study (retrospective part for clinical profile and predictors of outcome, prospective cross-sectional assessment of height, weight, z scores and adequacy of treatment on follow up) included 40 neonates admitted with classical 21-hydroxylase deficiency to newborn ward of Institute of Child Health, Tertiary Neonatal Teaching Hospital in Chennai, South India from September 2006 to September 2016. Descriptive statistics were used to describe baseline variables. Results: Out of 40 neonates, 22 presented with salt wasting and 18 with simple virilising type. Five babies were lost to follow up. Eight babies with the salt wasting and one with simple virilising form of CAH passed away on follow up. Presence of shock/ severe dehydration, hyponatraemia (Na<125), weight loss in the salt wasting group at admission was not statistically significant predictors of their death. Poor compliance to medication was significantly higher in the parents who lost their children on follow up. Twenty-six children were present for recording anthropometric data after all the losses to follow up. Conclusion: A high index of suspicion of CAH in babies with typical clinical features will prevent any delay in diagnosis and treatment. Not only the acute management, but adequate counseling, compliance to medication and growth monitoring are also of utmost importance in managing these children. |
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Clinical Profile, Predictors of Death and Anthropometric Follow up in Neonates with Classical 21-Hydroxylase Deficiency |
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https://doi.org/10.7860/JCDR/2018/33977.11552 https://doaj.org/article/d7c04102f9b54ac395c36a5a0bab5960 https://jcdr.net/articles/PDF/11552/33977_CE(RA1)_F(T)_PF1(AGAK)_PFA(AK)_PN(SS).pdf https://doaj.org/toc/2249-782X https://doaj.org/toc/0973-709X |
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