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JSM Women's Health

A Case Report on Successful Detoxification during Pregnancy of a 20 Year Old Patient with Complex Social Issues, by a Multidisciplinary Team

Case Report | Open Access Volume 2 | Issue 2 |

  • 1. Department of Obstetrics and Gynaecology, University Hospitals Leicester, UK
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Corresponding Authors
Sonia Agarwal, Department of Obstetrics and Gynaecology, University Hospitals Leicester, Kensington Building, Infirmary Square, Leicester, LE15WW, UK, Tel: 441-16255923; Fax: 0116 2585923
Abstract

A 20year patient was first encountered by the Obstetric team at twenty-two weeks pregnant when she presented with signs and symptoms of a deep vein thrombosis; she was diagnosed with extensive bilateral external iliac DVT and was managed by a multidisciplinary team for the treatment of thrombosis and detoxification by a Methadone programme. A variety of social factors had led her to heroin addiction: her parent was a drug addict. She had been raised by numerous foster carers until she then found her mother who introduced her to drug addiction. Her partner was violent and forced her to be a commercial sex worker and she lived in a community where substance misuse was rampant.

During this pregnancy, the Obstetric care and MDT support helped this patient to successfully detoxification from her heroin addiction and the use of other illicit substances. She had a normal vaginal delivery of a healthy infant, which was immediately taken into care. Post-natal follow up ensured abstinence of illicit substances and an opportunity for this patient to change her lifestyle and social setup.

This case report is a success story of a patient who initially sought medical help in desperate and life-threatening circumstances. It highlights the importance of a multidisciplinary approach in the successful management of a high risk pregnancy and a detoxification programme. This case required a holistic and patient-centred approach to the antenatal care, along with willingness to change and determination from the patient herself.

Keywords

Substance misuse; MDT; Social support; Antenatal care; Detoxification

Citation

Marinatti T, Bartha M, Gomes Junior SC, Lopes Moreira ME (2017) Breastfeeding and Vertical Exposure to Zika Virus: A Literature Review. JSM Women’s Health 2(2): 1007.

ABBREVIATIONS

ZIKAV: Zika virus;

PCR: polymerase chain reaction;

WHO: World Health Organization

INTRODUCTION

In November 2014 and early 2015, the Zika virus (ZIKAV), a new virus transmitted by the Aedes aegypti mosquito, started to spread in Brazil. The manifestations were similar to those of dengue fever, with low fever, itching exanthema in the body, and conjunctivitis. Other symptoms included myalgia and mild joint pain [1,2]. A higher prevalence of microcephaly cases and central nervous system abnormalities was observed, associating cases of neurological changes with the virus [ZIKAV originated from Asia and Africa and spread throughout French Polynesia in 2013, with some cases in Chile [5]. In May 2015, 1.5 million people were affected by ZIKAV in the northeastern region of Brazil. The virus spread throughout South America, Central America, and the Caribbean, alarming the Pan American Health Organization. More than 4,500 microcephaly cases were confirmed in February 2016, and a worldwide epidemic of ZIKAV was announced, with confirmed cases in Europe [6]. The idea of correlating ZIKAV with microcephaly began as a result of a surge in the number of infected cases and newborns with reduced cephalic perimeter with no apparent cause, which initiated research and notification3,4].

ZIKAV originated from Asia and Africa and spread throughout French Polynesia in 2013, with some cases in Chile [5]. In May 2015, 1.5 million people were affected by ZIKAV in the northeastern region of Brazil. The virus spread throughout South America, Central America, and the Caribbean, alarming the Pan American Health Organization. More than 4,500 microcephaly cases were confirmed in February 2016, and a worldwide epidemic of ZIKAV was announced, with confirmed cases in Europe [6]. The idea of correlating ZIKAV with microcephaly began as a result of a surge in the number of infected cases and newborns with reduced cephalic perimeter with no apparent cause, which initiated research and notification

Diagnosis is through polymerase chain reaction (PCR) and virus segregation in blood samples. The PCR technique allows to accurately identify the causative agent’s DNA in the patient’s blood samples. It operates by amplifying a specific fragment of the DNA molecule thousands of times in just a few hours [5,13]

The ZIKAV epidemic has raised questions about the transmission, prevention, and consequences of the disease, including some questions about breastfeeding and reproduction planning. Due to the extent and diversity of the cases, infected infants need to undergo an interdisciplinary follow-up by neurologists, pediatricians, speech therapists, physiotherapists, occupational therapists, psychologists, and social workers, to address different issues. Moreover, early evaluation and stimulation of neuropsychomotor function are essential to provide a better prognosis [5,15]

Considering the increased incidence of ZIKAV in Brazil and the association of swallowing disorders in newborns with congenital ZIKAV syndrome, a speech pathologist is necessary to evaluate the baby’s feeding problems and stomatognathic functions, stimulate these functions, and design an appropriate intervention plan for each case, following the recommendation of the World Health Organization (WHO) [16], which is exclusive breastfeeding in the first 6 months of life for the overall development of the newborn and food security.

Considering the controversy surrounding the pathology of ZIKAV with unknown means of transmission, this literature review was conducted to build knowledge for action, allowing a stance on breastfeeding in ZIKAV cases and providing basis for both professional recommendations and performance of the mother regarding breastfeeding

 

METHODOLOGY

This literature review aimed to group knowledge about breastfeeding and ZIKAV exposure in articles published between January 2014 and April 2017. The following combined keywords in English, Portuguese, and Spanish were used to identify articles on the topic in the Medline, SciELO, Bireme, Cochrane, and Embase databases: fonoaudiologia “Zika e amamentação”, “Zika e aleitamento materno”, “Zika e alimentação”, “Zika and breastfeeding”, “Zika and feeding”, “Zika y lactancia materna”, and “Zika y alimentacion”

We found 85 studies published in English and Portuguese in Medline, Bireme, and Embase, as shown in Figure 1. No studies were found in SciELO and Cochrane. Furthermore, no studies on ZIKAV related to speech therapy were found in any of these scientific databases. Among the 85 articles, the following were excluded: duplicate articles (13), nonscientific publications (9), articles not related to the subject (20), and unavailable articles (5). Thus, 47 articles were excluded, and the remaining 38 articles that addressed the subject of ZIKAV and breastfeeding were selected (Figure 1).

We established a guiding question, “What is the stance of the existing literature on breastfeeding in cases of ZIKAV exposure?” After article selection, we observed and analyzed the 38 articles, and classified the approach of each study based on the guiding question, as follows: has no stance on breastfeeding, is in favor, is against, and explains the need for further studies on the subject.

RESULTS

Among the analyzed studies are shown in Table 1, 34.21% [5,10,14,17-26] investigated the presence of ZIKAV RNA in breast milk but had no stance on breastfeeding or lactation.

However, 28.94% [16,27-36] were in favor of breastfeeding and explained that despite the presence of ZIKAV in human milk, there is no scientific evidence of infants being infected through breastfeeding. Meanwhile, 18.42% [6,37-42] affirmed the possibility of contamination and were against breastfeeding, whereas 18.42% [43-49] explained the importance of further studies in this area (Figure 2).

DISCUSSION

In this literature review, a large proportion of the articles reported that breastfeeding is essential in all nations and should be treated as a public policy based on the benefits it brings in the short, medium, and long term, being advantageous to both the baby and the mother [16,27,36,50,51]

The WHO guidelines on breastfeeding reinforce that even in cases of suspected or confirmed ZIKAV infection, breastfeeding should be supported and encouraged. Exclusive breastfeeding is recommended from 1 hour after childbirth up to 6 months of age, to be continued with complementary foods up to 2 years of age or more [16,17,36]. Mothers and infants may need help in the breastfeeding process, and newborns with congenital ZIKAV syndrome may have swallowing disorders, requiring speech therapy to start and continue breastfeeding.

One study analyzed the milk of a mother with confirmed ZIKAV infection [18] and showed virus replication in breast milk. However, the newborn was not infected even though it was breastfed. Due to this study, some authors [6,37-42] supposed that breastfeeding may be a transmission vector, knowing that some diseases caused by flaviviruses of the same family with ZIKAV, such as dengue fever and other diseases, can be transmitted through breastfeeding [46]. However, until recently, there is no scientific evidence of this transmission route for ZIKAV.

One study analyzed the milk of a mother with confirmed ZIKAV infection [18] and showed virus replication in breast milk. However, the newborn was not infected even though it was breastfed. Due to this study, some authors [6,37-42] supposed that breastfeeding may be a transmission vector, knowing that some diseases caused by flaviviruses of the same family with ZIKAV, such as dengue fever and other diseases, can be transmitted through breastfeeding [46]. However, until recently, there is no scientific evidence of this transmission route for ZIKAV.

Breastfeeding helps in cognitive, affective, and social development, besides being a species/specific food, that is, “a living substance of great complexity, with specific composition for human species, containing fats, proteins, vitamins, water, sugar, enzymes, iron, antibodies and iron in exact proportions for the nutritional needs of the human baby” [52], which is easily digested and absorbed. Breastfeeding also contributes to the reduction of infant mortality and has prevented 823,000 deaths annually from children under 5 years of age by increasing their immunity and preventing diseases such as diarrhea and respiratory problems, otitis, and malocclusions [50,51] Breastfeeding is also an economic policy that is sustainable, since it does not generate expenses or pollute the environment. It is renewable, natural, and free [50,51]. Current evidence suggests that the benefits of breastfeeding outweigh the risks of ZIKAV transmission through breast milk

During breastfeeding, mothers and babies require assistance, as they commonly have difficulties establishing this practice [53]. Speech therapists have the competence to accompany the mother and baby in their feeding mishaps, evaluate their stomatognathic functions, encourage them, and tailor the intervention plan for each case [54]. Because of these findings, we searched the databases for any correlation between the work of speech therapists, breastfeeding, and ZIKAV infection; however, the search showed no studies focused on this correlation. Although this area is a “recent” subject, the search result encourages further research.

In Brazil, the region most affected by ZIKAV has been the southeast, followed by the northeast, midwest, south, and north [55]. The recommended/performed approaches throughout Brazil encourage breastfeeding, multidisciplinary follow-up, and early neuropsychomotor stimulation. The innovations in this pathology has promoted the search for new knowledge and approaches.step to foster research funding and enable clarification on the infection, forms of transmission, and whether breastfeeding is a possible transmission vector, providing information for the population of pregnant women and newborns with congenital ZIKAV syndrome.

FINAL CONSIDERATIONS

ZIKAV is detected in breast milk, but breast milk has not been considered a transmission vector due to the lack of virus replication studies that prove this relationship. The guidelines for mothers with suspected or confirmed ZIKAV infection and for newborns with congenital ZIKAV syndrome have been as follows: breastfeeding, early stimulation of neuropsychomotor development, and follow-up with a speech therapist and a multidisciplinary team [56].

Due to the lack of research addressing speech pathology in the follow-up of these cases, we suggest that research be conducted on this approach, building theoretical knowledge produced by clinical practice and considering the generation of microcephaly cases that may occur due to the ZIKAV epidemic in recent years.

Further studies are needed to clarify whether breastfeeding is a possible transmission vector. The virus’ RNA has already been identified in breast milk, but there is no proven case of this route of infection. Moreover, we suggest long-term research to clarify the dynamic process of breastfeeding and to better understand questions regarding the duration of RNA presence in human milk, viral load, and long-term follow-up for breastfed babies.

REFERENCES

1. Brito CA, Brito CC, Oliveira AC, Rocha M, Atanásio C, Asfora C, et al. Zika in Pernambuco: rewriting the first outbreak. Rev Soc Bras Med Trop. 2016; 49: 553-558.

2. Pinto Junior LV, Luz K, Parreira R, Ferrinho P. [Zika virus: a review to clinicians]. Acta Med Port. 2015; 28; 760-765.

3. Mlakar J, Korva M, Tul N, Popovi? M, Poljšak-Prijatelj M, Mraz J, et al. Zika virus associated with microcephaly. N Engl J Med. 2016; 374: 951-958.

4. Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, Bispo de Filippis AM. Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol. 2016; 47: 6-7.

5. Chan JF, Choi GK, Yip CC, Cheng VC, Yuen KY. Zika fever and congenital Zika syndrome: an unexpected emerging arboviral disease. J Infect. 2016; 72: 507-524.

6. Wahid B, Ali A, Rafique S, Idrees M. Zika: as an emergent epidemic. Asian Pac J Trop Med. 2016; 9: 723-729.

7. Petersen E, Wilson ME, Touch S, McCloskey B, Mwaba P, Bates M, et al. Rapid spread of Zika virus in the Americas--implications for public health preparedness for mass gatherings at the 2016 Brazil Olympic Games. Int J Infect Dis. 2016; 44: 11-15.

8. Foy BD, Kobylinski KC, Chilson Foy JL, Blitvich BJ, Travassos da Rosa A, Haddow AD, et al. Probable non–vector-borne transmission of Zika virus, Colorado, USA. Emerg Infect Dis. 2011; 17: 880-882.

9. Musso D, Roche C, Robin E, Nhan T, Teissier A, Cao-Lormeau VM. Potential Sexual Transmission of Zika Virus. Emerg Infect Dis. 2015; 21: 359-361.

10. Besnard M, Lastère S, Teissier A, Cao-Lormeau VM, Musso D. Evidence of perinatal transmission of Zika virus, French Polynesia, Euro Surveill. 2014; 19.

11. Schuler-Faccini L, Ribeiro EM, Feitosa IM, Horovitz DD, Cavalcanti DP, Pessoa A, et al. Possible association between Zika virus infection and microcephaly - Brazil, 2015. MMWR Morb Mortal Wkly Rep. 2016; 65: 59-62.

12. Chang C, Ortiz K, Ansari A, Gershwin ME. The Zika outbreak of the 21st century. J Autoimmun. 2016; 68: 1-13.

13. Marano G, Pupella S, Vaglio S, Liumbruno GM, Grazzini G. Zika virus and the never-ending story of emerging pathogens and transfusion medicine. Blood Transfus. 2015;

14. 95-100. 14.Possas C. Zika: what we do and do not know based on the experiences of Brazil. Epidemiol Health. 2016; 38: e2016023.

15. Eickmann SH, Carvalho MD, Ramos RC, Rocha MÂ, Linden Vv, Silva PF. [Zika virus congenital syndrome]. Cad. Saúde Pública. 2016; 32.

16. Organização Mundial da Saúde. Amamentação no contexto do vírus Zika - Orientações provisórias. WHO/ZIKV/MOC/16.5. 2016.

17. Russell K, Oliver SE, Lewis L, Barfield WD, Cragan J, Meaney-Delman D, et al. Update: Interim guidance for the evaluation and management of infants with possible congenital Zika virus infection - United States, August 2016. MMWR Morb Mortal Wkly Rep. 2016; 65: 870-878.

18. Dupont-Rouzeyrol M, Biron A, O’Connor O, Huguon E, Descloux E. Infectious Zika viral particles in breastmilk. Lancet. 2016; 387: 1051.

19. Ghebreyesus A, Hungary MS. Public health round-up. Bull World Health Organ. 2016; 94: 560-561.

20. Hennessey M, Fischer M, Staples JE. Zika virus spreads to new areas— region of the Americas, May 2015–January 2016. MMWR Morb Mortal Wkly Rep. 2016; 65.

21. Sampathkumar P, Sanchez LJ. Zika virus in the Americas: a review for clinicians. Mayo Clin Proc. 2016; 91: 514-521.

22. Malone RW, Homan J, Callahan MV, Glasspool-Malone J, Damodaran L, Schneider Ade B, et al. Zika virus: medical countermeasure development challenges. PLoS Negl Trop Dis. 2016; 10: e0004530.

23. Boeuf P, Drummer HE, Richards JS, Scoullar MJL, Beeson JG. The global threat of Zika virus to pregnancy: epidemiology, clinical perspectives, mechanisms, and impact. BMC Med. 2016; 14: 112.

24. Zachary A. Klase, Svetlana Khakhina, Adriano De Bernardi Schneider, Michael V. Callahan, Jill Glasspool-Malone, and Robert Malone. Zika fetal neuropathogenesis: etiology of a viral syndrome. PLoS Negl Trop Dis. 2016; 10: e0004877.

25. Blázquez AB, Saiz JC. Neurological manifestations of Zika virus infection. World J Virol. 2016; 5: 135-143.

26. Fleming-Dutra KE, Nelson JM, Fischer M, Staples JE, Karwowski MP, Mead P, et al. Update: Interim Guidelines for Health Care Providers Caring for Infants and Children with Possible Zika Virus Infection-- United States, February 2016. MMWR Morb Mortal Wkly Rep. 2016; 65: 182-187.

27. Drabkin A. Zika Virus (Stat consult: a quick review of common conditions, using the best global evidence). Clinical Advisor. 2016; 19: 107.

28. Maestre AM, Caplivski D, Fernandez-Sesma A. Zika virus: more questions than answers. EBioMedicine. 2016; 5: 2-3.

29. Duff E. International news - April 2016. Midwifery. 2016; 35: 78-82.

30. Lockwood CJ. Zika virus and microcephaly. Contemporary OB/GYN. 2016; 61: 6.

31. Falcao MB, Cimerman S, Luz KG, Chebabo A, Brigido HA, Lobo IM, et al. Management of infection by the Zika virus. Ann Clin Microbiol Antimicrob. 2016; 15: 57.

32. Lazear HM, Diamond MS. Zika virus: new clinical syndromes and its emergence in the Western Hemisphere. J Virol. 2016; 90: 4864-4875.

33. Pfaender S, Vielle NJ, Ebert N, Steinmann E, Alves MP, Thiel V. Inactivation of Zika virus in human breast milk by prolonged storage or pasteurization. Virus Res. 2017; 228: 58-60.

34. Sharma A, Lal SK. Zika virus: transmission, detection, control, and prevention. Front Microbiol. 2017; 8: 110.

35. Hajra A, Bandyopadhyay D, Hajra SK. Zika virus: A global threat to humanity: A comprehensive review and current developments. N Am J Med Sci. 2016; 8: 123-128.

36. Organização Mundial da Saúde. Guideline: infant feeding in areas of Zika virus transmission. Geneva. 2016.

37. Jamali MSR, Bayrami S, Jamali MS, Golrokhi R, Golsoorat PF, Seyed AS. Zika virus: review of literature. Asian Pacific Journal of Tropical Biomedicine. 2016; 6: 989-994.

38. Patterson J, Sammon M, Garg M. Dengue, Zika and chikungunya: emerging arboviruses in the New World. West J Emerg Med. 2016; 17: 671-679.

39. Mishra B, Behera B. The mysterious Zika virus: adding to the tropical flavivirus mayhem. J Postgrad Med. 2016; 62: 249-254.

40. Saiz JC, Vázquez-Calvo Á, Blázquez AB, Merino-Ramos T, Escribano-Romero E, Martín-Acebes MA. Zika virus: the latest newcomer. Front Microbiol. 2016; 7: 496.

41. Ibrahim NK. Zika virus: epidemiology, current phobia and preparedness for upcoming mass gatherings, with examples from World Olympics and Pilgrimage. Pak J Med Sci.2016; 32: 1038-1043.

42. Passi D, Sharma S, Dutta SR, Ahmed M. Zika virus diseases – the new face of an ancient enemy as global public health emergency (2016): brief review and recent updates. Int J Prev Med. 2017; 8: 6.

43. Wooton AK. Zika virus: an emerging threat to travelers. J Nurse Pract. 2016; 12: e237-e238.

44. Cavalcanti MG, Cabral-Castro MJ, Gonçalves JL, Santana LS, Pimenta ES, Peralta JM. Zika virus shedding in human milk during lactation: an unlikely source of infection? Int J Infect Dis. 2017; 57: 70-72.

45. Plourde AR, Bloch EM. A literature review of Zika virus. Emerg Infect Dis. 2016; 22: 1185-1192.

46. Wang JN, Ling F. Zika virus infection and microcephaly: evidence for a causal link. Int J Environ Res Public Health. 2016; 13: E1031.

47. German Advisory Committee Blood (Arbeitskreis Blut), Subgroup ‘Assessment of Pathogens Transmissible by Blood’. Zika virus (ZIKV). Transfus Med Hemother. 2016; 43: 436-446.

48. Waddell LA, Greig JD. Scoping review of the Zika virus literature. PLoS One. 2016; 11: e0156376.

49. Marrs C, Olson G, Saade G, Hankins G, Wen T, Patel J, et al. Zika virus and pregnancy: a review of the literature and clinical considerations. Am J Perinatol. 2016; 33: 625-639.

50. Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, et al. Why invest, and what it will take to improve breastfeeding practices? Lancet. 2016; 387: 491-504.

51. Victora CG, Bahl R, Barros AJ, França GV, Horton S, Krasevec J, et al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet. 2016; 387: 475-490.

52. Almeida EA, Martins Filho J. O contrato precoce mãe-filho e sua contribuição para o sucesso do aleitamento materno. Revista de Ciências Médicas. 2004; 13: 381-388.

53. Almeida J, Luz S, Ued F. Apoio ao aleitamento materno pelos profissionais de saúde: revisão integrativa da literatura. Rev. Paul. Pediatr. 2015; 33: 355-362.

54. Medeiros A, Sá T, Alvelos C, Novais D. Intervenção fonoaudiológica na transição alimentar de sonda para peito em recém-nascidos do Método Canguru. Audiol., Commun. Res. 2014; 19: 95-103.

55. Portal Brasil [homepage na internet] Saúde divulga o primeiro balanço com casos de zika no país.

56. Brasil. Ministério da Saúde, Secretaria de Atenção à Saúde, Diretrizes de estimulação precoce: crianças de zero a 3 anos com atraso no desenvolvimento neuropsicomotor decorrente de microcefalia. Brasília: Ministério da Saúde. 2016.

Received : 12 Sep 2017
Accepted : 04 Nov 2017
Published : 06 Nov 2017
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Launched : 2014
JSM Sexual Medicine
ISSN : 2578-3718
Launched : 2016
Annals of Vascular Medicine and Research
ISSN : 2378-9344
Launched : 2014
JSM Biotechnology and Biomedical Engineering
ISSN : 2333-7117
Launched : 2013
Journal of Hematology and Transfusion
ISSN : 2333-6684
Launched : 2013
JSM Environmental Science and Ecology
ISSN : 2333-7141
Launched : 2013
Journal of Cardiology and Clinical Research
ISSN : 2333-6676
Launched : 2013
JSM Nanotechnology and Nanomedicine
ISSN : 2334-1815
Launched : 2013
Journal of Ear, Nose and Throat Disorders
ISSN : 2475-9473
Launched : 2016
JSM Ophthalmology
ISSN : 2333-6447
Launched : 2013
Journal of Pharmacology and Clinical Toxicology
ISSN : 2333-7079
Launched : 2013
Annals of Psychiatry and Mental Health
ISSN : 2374-0124
Launched : 2013
Medical Journal of Obstetrics and Gynecology
ISSN : 2333-6439
Launched : 2013
Annals of Pediatrics and Child Health
ISSN : 2373-9312
Launched : 2013
JSM Clinical Pharmaceutics
ISSN : 2379-9498
Launched : 2014
JSM Foot and Ankle
ISSN : 2475-9112
Launched : 2016
JSM Alzheimer's Disease and Related Dementia
ISSN : 2378-9565
Launched : 2014
Journal of Addiction Medicine and Therapy
ISSN : 2333-665X
Launched : 2013
Journal of Veterinary Medicine and Research
ISSN : 2378-931X
Launched : 2013
Annals of Public Health and Research
ISSN : 2378-9328
Launched : 2014
Annals of Orthopedics and Rheumatology
ISSN : 2373-9290
Launched : 2013
Journal of Clinical Nephrology and Research
ISSN : 2379-0652
Launched : 2014
Annals of Community Medicine and Practice
ISSN : 2475-9465
Launched : 2014
Annals of Biometrics and Biostatistics
ISSN : 2374-0116
Launched : 2013
JSM Clinical Case Reports
ISSN : 2373-9819
Launched : 2013
Journal of Cancer Biology and Research
ISSN : 2373-9436
Launched : 2013
Journal of Surgery and Transplantation Science
ISSN : 2379-0911
Launched : 2013
Journal of Dermatology and Clinical Research
ISSN : 2373-9371
Launched : 2013
JSM Gastroenterology and Hepatology
ISSN : 2373-9487
Launched : 2013
Annals of Nursing and Practice
ISSN : 2379-9501
Launched : 2014
JSM Dentistry
ISSN : 2333-7133
Launched : 2013
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