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1. A single-oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve outcomes in the COVID-19 disease: the COVID-VIT-D—a randomised multicentre international clinical trial

Author

Jorge B. Cannata-Andía, Augusto Díaz-Sottolano, Pehuén Fernández, Carmen Palomo-Antequera, Pablo Herrero-Puente, Ricardo Mouzo, Natalia Carrillo-López, Sara Panizo, Guillermo H. Ibañez, Carlos A. Cusumano, Carolina Ballarino, Vicente Sánchez-Polo, Jacqueline Pefaur-Penna, Irene Maderuelo-Riesco, Jesús Calviño-Varela, Mónica D. Gómez, Carlos Gómez-Alonso, John Cunningham, Manuel Naves-Díaz, Walter Douthat, José L. Fernández-Martín, and the COVID-VIT-D trial collaborators

Subjects
SARS-CoV-2, COVID-19 disease, Cholecalciferol, Vitamin D, Medicine
Abstract

Abstract Background Vitamin D status has been implicated in COVID-19 disease. The objective of the COVID-VIT-D trial was to investigate if an oral bolus of cholecalciferol (100,000 IU) administered at hospital admission influences the outcomes of moderate-severe COVID-19 disease. In the same cohort, the association between baseline serum calcidiol levels with the same outcomes was also analysed. Methods The COVID-VIT-D is a multicentre, international, randomised, open label, clinical trial conducted throughout 1 year. Patients older than 18 years with moderate-severe COVID-19 disease requiring hospitalisation were included. At admission, patients were randomised 1:1 to receive a single oral bolus of cholecalciferol (n=274) or nothing (n=269). Patients were followed from admission to discharge or death. Length of hospitalisation, admission to intensive care unit (ICU) and mortality were assessed. Results In the randomised trial, comorbidities, biomarkers, symptoms and drugs used did not differ between groups. Median serum calcidiol in the cholecalciferol and control groups were 17.0 vs. 16.1 ng/mL at admission and 29.0 vs. 16.4 ng/mL at discharge, respectively. The median length of hospitalisation (10.0 [95%CI 9.0–10.5] vs. 9.5 [95%CI 9.0–10.5] days), admission to ICU (17.2% [95%CI 13.0–22.3] vs. 16.4% [95%CI 12.3–21.4]) and death rate (8.0% [95%CI 5.2–12.1] vs. 5.6% [95%CI 3.3–9.2]) did not differ between the cholecalciferol and control group. In the cohort analyses, the highest serum calcidiol category at admission (>25ng/mL) was associated with lower percentage of pulmonary involvement and better outcomes. Conclusions The randomised clinical trial showed the administration of an oral bolus of 100,000 IU of cholecalciferol at hospital admission did not improve the outcomes of the COVID-19 disease. A cohort analysis showed that serum calcidiol at hospital admission was associated with outcomes. Trial registration COVID-VIT-D trial was authorised by the Spanish Agency for Medicines and Health products (AEMPS) and registered in European Union Drug Regulating Authorities Clinical Trials (EudraCT 2020-002274-28) and in ClinicalTrials.gov ( NCT04552951 ).

Published
2022
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2. Características clínicas y epidemiológicas de pacientes hospitalizados por infección por SARS-CoV-2 en dos hospitales en Córdoba

Author

Emanuel José Saad, María Antonella Correa Barovero, Federico Ariel Marucco, Silvina Trinidad Rodríguez Bonazzi, Ayelén Tarditi Barra, Melani Zlotogora, Sofía María Villada, Augusto Douthat y Barrionuevo, María Celeste Heredia, Juan Pablo Caeiro, Pehuén Fernández, and Ricardo Arturo Albertini

Subjects
infecciones por coronavirus, neumonía, pacientes internos, pronóstico, betacoronavirus, Medicine, Medicine (General), R5-920
Abstract

Introducción: La enfermedad COVID-19 muestra una marcada heterogeneidad en su curso clínico, habiéndose descripto algunos factores que se asocian un peor pronóstico. El conocimiento del comportamiento de la enfermedad en el escenario local es de gran relevancia para permitir un mejor abordaje. Métodos: Estudio retrospectivo en dos hospitales de la ciudad de Córdoba, Argentina, de pacientes de 18 años o más hospitalizados por infección activa por SARS-CoV-2, desde marzo a octubre del año 2020. Resultados: Se incluyeron 448 pacientes, de los cuales el 95.75% correspondieron a neumonía COVID-19. La mayoría de los episodios ocurrieron en hombres (63.6%), la mediana de edad fue 63 años (RIC:53-75), y las comorbilidades más frecuentes fueron hipertensión arterial (55.1%), obesidad (31.7%) y diabetes mellitus (28.1%). Requirieron ingreso a unidad de cuidados intensivos 162 pacientes (36.2%) y 66 (14.7%), asistencia respiratoria mecánica. Fallecieron 67 pacientes (15%) dentro de los primeros 30 días de seguimiento. En el análisis multivariado la única variable independiente predictora de mortalidad a los 30 días fue la edad (Odds ratio ajustado [ORa]=1.08, IC95%=1.04-1.11, p

Published
2021
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3. Acute kidney injury care units. Risk factors and mortality

Author

Jessica Betiana Rechene, Pehuén Fernández, and Walter Douthat

Subjects
fallo renal agudo, insuficiencia renal aguda, factores de riesgo, mortalidad, unidades de cuidados intensivos, Medicine, Specialties of internal medicine, RC581-951
Abstract

Introduction: Acute kidney injury (AKI) is a very common complication among patients in critical conditions and it is associated with a high morbidity and mortality rate. Objectives: The aims of this study were the following: analyze the incidence, risk factors and mortality related to AKI in patients in critical conditions, as well as to determine the incidence of RRT (renal replacement therapy) requirement. Methods: A prospective cohort observational study was performed. Patients admitted to the intensive care units of the Hospital Privado Universitario de Córdoba (Private Medical College Hospital of Córdoba) in 2016, between January and March, were included. A 7-day follow-up was conducted. Results: There were 150 patients included in this study. Incidence of AKI was of 44.7% (n=67). Causes of AKI were prerenal in 70.1% (n=47) of cases; whereas 73.1% (n=49) of patients were admitted due to some pathology. Risk factors for AKI found through multivariate analysis were Chronic Kidney Disease (CKD) and a high SOFA score. Adjusted for other variables, patients with CKD are four times more likely to suffer from AKI (adjusted OR= 4.76; 95% CI= 1.93-11.75; p=0.001), whereas for each additional point in the SOFA score, risk was 25% higher (adjusted OR=1.25; 95% CI=1.08-1.44; p=0.003). The same analysis showed that the mortality variables were the use of vasopressors and AKI. AKI patients had a mortality risk six times higher over time (adjusted HR=6.33; 95% CI= 1.41-28.4, p=0.016). Conclusion: Presence of CKD and a high SOFA score were the risk factors which triggered AKI, whereas AKI was an independent risk factor for short-term mortality.

Published
2018

4. Peritonitis in peritoneal dialysis. Epidemiology, risk factors, inclusion of BACTEC™ in traditional culture systems, and long-term mortality

Author

Pehuén Fernández, Fabián Ledesma, Walter Douthat, Carlos Chiurchiu, Mario Vilaró, Caludio Abiega, Jorge De la Fuente, and Javier De Arteaga

Subjects
peritonitis, diálisis peritoneal, diálisis renal, factores de riesgo, métodos de cultivo, mortalidad, BACTEC™, Medicine, Specialties of internal medicine, RC581-951
Abstract

Introduction: Peritonitis is the most common complication in peritoneal dialysis (PD), with an effect on morbidity and mortality. The aim of this study was to analyze epidemiology, risk factors, implementation of the BACTEC™ blood culture system and mortality of peritoneal dialysis-associated peritonitis. Methods: In this retrospective, cohort study, all the patients who started PD between 1992 and 2017 at Hospital Privado Universitario de Córdoba (Córdoba Private Medical College Hospital) were included. Results: The total number of patients was 159, 63 (39.62%) of which had suffered from peritonitis at least once and 96 (60.38%) had never had it. The global peritonitis rate was 0.37 episodes per patient-year. The risk factors for peritonitis were the following: a history of hemodialysis before PD (OR=3.18; CI 95%=1.41-7.14; p=0.0051) and hypoalbuminemia (OR=3.10; CI 95%=1.36-7.06; p=0.0071). The implementation of the BACTEC™ system increased the percentage of positive blood cultures (from 73.55% to 96.55%; p=0.0076). The most frequent isolates were MSSA (23.66 %) and GNB (20.61 %). Differences were found between the 1992-2006 and 2006-2017 periods in the Candida isolates (1.49 % and 9.38 %; p=0.0448) and the “other bacteria” group (1.49 % and 9.38 %; p=0.0448). Although peritonitis patients showed a higher mortality rate (55.56 % versus 38.58 %; p=0.0480), the multivariate analysis revealed that this condition was not a mortality independent risk factor. Conclusion: The risk factors for peritonitis were hemodialysis prior to PD and hypoalbuminemia. The use of the BACTEC™ system increased the percentage of positive blood cultures. After 2006 the number of isolates from the Candida and the “other bacteria” groups was higher. Peritonitis was not a long-term mortality independent risk factor.

Published
2017

5. Biomarkers of bone and mineral disorders (FGF-23, fetuin-A) and vascular calcification scores as predictive tools for cardiovascular death in dialysis patients, at 10 years of follow-up

Author

Pehuén, Fernández, Walter, Douthat, Mauro, Castellano, Gabriela, Cardozo, Gabriela, Garay, Javier, de Arteaga, Carlos, Chiurchiu, and Jorge, de la Fuente

Subjects
Minerals, alpha-2-HS-Glycoprotein, Infectious and parasitic diseases, RC109-216, RC581-607, vascular calcifications, mortality, bone and mineral metabolism, Fibroblast Growth Factor-23, Renal Dialysis, chronic renal failure, Humans, Kidney Failure, Chronic, Medicine, Prospective Studies, fgf 23, Immunologic diseases. Allergy, Vascular Calcification, fetuin a, Biomarkers, Follow-Up Studies
Abstract

Cardiovascular disorders represent the leading cause of death in dialysis patients. Alterations of bone and mineral metabolism (BMM) and vascular calcifications play a fundamental role in it. The objective of this study was to evaluate the predictive role on cardiovascular mortality of the measurement of biomarkers of BMM and vascular calcifications. A prospective cohort study was performed. All prevalent patients on chronic dialysis in September 2009 at our institution, who completed the total of the complementary studies, were studied. BMM biomarkers were measured (FGF 23, fetuin A, PTH, calcium and phosphorus) and the vascular calcifications were evaluated using the Kauppila and Adragao scores. Follow-up was carried out until 1/1/2019, death or transplant. Of the 30 patients included, 7 (23.3%) died due to cardiovascular causes. The follow-up time was 44.1 ± 30.4 (range = 1.4-112) months. The Adragao score was the only predictive variable of long-term cardiovascular mortality (area under the curve = 0.82; 95% CI 0.64-0.94; p0.001). The best cut-off point was 5 (sensitivity = 85.7%; specificity = 78.3%). It was also an independent risk factor for cardiovascular mortality adjusted for age, diabetes mellitus, coronary heart disease, aortic calcifications, time spent on dialysis and follow-up time (adjusted OR = 1.77; 95% CI = 1.06-2.96; p = 0.028). The vascular calcifications quantified from the Adragao score were the only independent predictor of long-term cardiovascular mortality. This score represents a simple, useful and superior tool to the biomarkers of BMM.Los trastornos cardiovasculares representan la primera causa de muerte en los pacientes en diálisis. Las alteraciones del metabolismo óseo y mineral (MOM) y las calcificaciones vasculares juegan un papel fundamental en la misma. El objetivo de este estudio fue evaluar el rol predictor sobre la mortalidad cardiovascular de la medición de los biomarcadores del MOM y las calcificaciones vasculares. Se realizó un estudio de cohorte prospectivo. Se estudiaron todos los pacientes prevalentes en diálisis crónica en septiembre del 2009 en nuestra institución que completaron el total de los estudios complementarios. Se midieron biomarcadores del MOM (FGF 23, fetuína A, PTH, calcio y fósforo) y se evaluaron las calcificaciones vasculares mediante los scores de Kauppila y de Adragao. Se realizó un seguimiento hasta el 1/1/2019, la muerte o el trasplante. De los 30 pacientes incluidos, 7 (23.3%) fallecieron por causa cardiovascular. El tiempo de seguimiento fue de 44.1 ± 30.4 (rango = 1.4-112) meses. El score de Adragao fue la única variable predictiva de muerte cardiovascular a largo plazo (área bajo la curva = 0.82; IC95% = 0.64-0.94; p0.001). El mejor punto de corte fue de 5 (sensibilidad = 85.7%; especificidad = 78.3%). Además, fue un factor de riesgo independiente de muerte cardiovascular ajustado por edad, diabetes mellitus, enfermedad coronaria, calcificaciones aorticas, tiempo de permanencia en diálisis y tiempo de seguimiento (OR ajustado = 1.77; IC95% = 1.06-2.96; p = 0.028). Las calcificaciones vasculares cuantificadas a partir del score de Adragao fueron el único predictor independiente de mortalidad cardiovascular a largo plazo. Este score representa una herramienta simple, útil y superior a los biomarcadores del MOM.

Published
2021

6. Glomerulopathies after vaccination against COVID-19. Four cases with three different vaccines in Argentina

Author

Javier de Arteaga, Jorge de la Fuente, María Emilia García Chiple, Walter Douthat, Pehuén Fernández, Carlos Chiurchiu, and María Luján Alaye

Subjects
Vaccination, 2019-20 coronavirus outbreak, Coronavirus disease 2019 (COVID-19), Nephrology, business.industry, Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), MEDLINE, Medicine, business, Virology, Letter to the Editor
Published
2021

7. Acute kidney injury in hospitalized patients due to COVID-19

Author

Pehuén Fernández, Emanuel José Saad, María Celeste Heredia, Juan Pablo Maldonado, Sofía María Villada, Walter Douthat, María Antonella Correa Barovero, Silvina Trinidad Rodríguez Bonazzi, Ayelén Tarditi Barra, Federico Ariel Marucco, Ricardo Arturo Albertini, Jorge de la Fuente, Melani Zlotogora, Augusto Douthat, and Juan Pablo Caeiro

Subjects
medicine.medical_specialty, Respiratory distress, business.industry, medicine.medical_treatment, Incidence (epidemiology), Acute kidney injury, Retrospective cohort study, medicine.disease, Intensive care unit, law.invention, Sepsis, law, Internal medicine, medicine, Renal replacement therapy, business, Kidney disease
Abstract

The incidence of acute kidney injury (AKI) in hospitalized patients with coronavirus disease 2019 (COVID-19) is variable, being associated with worse outcomes. The objectives of the study were to evaluate the incidence, risk factors and impact of AKI in subjects hospitalized for COVID-19 in two third- level hospitals in Córdoba, Argentina.A retrospective cohort study was conducted. 448 adults who were consecutively hospitalized for COVID-19 between March and the end of October 2020 at Hospital Privado Universitario de Córdoba and Hospital Raúl Angel Ferreyra were included. The incidence of AKI was 19% (n = 85). 50.6% presented AKI stage 1 (n=43), 20% stage 2 (n=17) and 29.4% stage 3 (n=25, of which 18 required renal replacement therapy). In the multivariate analysis, the variables that were independently associated with AKI were: age (adjusted Odd ratio -aOR- =1.30, 95%CI=1.04-1.63, p=0.022), history of chronic kidney disease (aOR=9.92, 95%CI=4.52-21.77, pIn conclusion, the incidence of AKI in adults hospitalized for COVID-19 was 19% and had a clear impact on morbidity and mortality. Local predisposing factors for AKI were identified.

Published
2021

8. Filtrado glomerular estimado por fórmulas en pacientes obesos

Author

Pehuén Fernández, Jorge de la Fuente, Mario Campazzo, Pablo Luján, Carlos Chiurchiu, Javier de Arteaga, and Walter Douthat

Subjects
Gynecology, 03 medical and health sciences, medicine.medical_specialty, 0302 clinical medicine, business.industry, medicine, 030212 general & internal medicine, 030204 cardiovascular system & hematology, business
Abstract

Resumen Introduccion Estimar el filtrado glomerular (FG) en sujetos obesos es un desafio. Analizamos el rendimiento de las formulas de estimacion en esta poblacion. Material y metodos Estudio de corte transversal que incluyo a 100 sujetos con diversos grados de obesidad, evaluados entre 2008 y 2015. Se midio el FG con iotalamato (patron de referencia) y se estimo con formulas basadas en creatinina serica: Cockroft Gault, MDRD, CKD-EPI, MCQ y CKD-MCQ (promedio de estas). Se creo un score de performance global (S-P-Global) con puntajes, para unificar todos los criterios de analisis. Resultados En obesidad grado i (n = 53) la formula de mejor rendimiento fue CKD-MCQ (sesgo 1,6 ± 17,4 ml/min × 1,73 m 2 ; correlacion [r] = 0,87; area bajo la curva [AUC] = 0,978; sensibilidad [S] = 100% y especificidad [E] = 87,8%). En obesidad grado ii (n = 25) las de menor sesgo fueron MCQ y CKD-MCQ (1,8 ± 22.3 y –4,4 ± 21,9 ml/min × 1,7 3m 2 ), esta ultima con mayor r (r = 0,89) e igual AUC, S, y E (AUC = 0,976; S = 85,7%; E = 100%). En obesidad grado iii (n = 22), MDRD fue la de menor sesgo (–0,2 ± 31,1 ml/min × 1,73 m 2 ) y CKD-MCQ la de mayor r y AUC (r = 0,66; AUC = 0,929); con igual S y E (S = 80%; E = 94.1%) que MDRD. CKD-MCQ fue la unica ecuacion en la que no se hallaron diferencias significativas con el patron de referencia, en ninguno de los grados de obesidad; y en el S-P-Global fue la que mayor puntaje obtuvo (39/48). Conclusion La formula de mayor rendimiento global para estimar el FG en sujetos con diversos grados de obesidad fue CKD-MCQ.

Published
2017

9. Infecciones urinarias en el primer año postrasplante renal

Author

Paula Vilella, Juan Pablo Maldonado, Pehuen Fernández, María Fernanda Flores, Camila De Bernardi, Karen Y Vilte Velazquez, Daniela Hernández, Jorge Luis De La Fuente, and Emanuel José Saad

Subjects
trasplante de riñón, infecciones urinarias, infecciones, huésped inmunocomprometido, Medicine, Medicine (General), R5-920
Abstract

Introducción: Las infecciones del tracto urinario (ITU) constituyen la infección más frecuente en los trasplantados renales (TR). El objetivo principal fue determinar las características clínicas y microbiológicas de las ITU que ocurren durante el primer año posterior al TR. Metodología: Estudio de cohorte retrospectivo, donde se incluyeron pacientes mayores 18 años que recibieron un TR entre 2009-2020 en dos hospitales de la ciudad de Córdoba. A través del registro en las historias clínicas se realizó seguimiento de los pacientes durante el primer año postrasplante y se analizaron los que presentaron al menos un episodio de ITU. Resultados: En el período de estudio, se realizaron 568 TR, de los cuales 207(36,4%) tuvieron al menos un episodio de ITU. En total hubo 419 episodios de ITU, 6(1,4%) episodios de ITU polimicrobianos, se identificaron un total de 426 microorganismos en total en los urocultivos. Del total de episodios 206(49,2%) ocurrieron entre los 31-180 días postrasplante. El principal agente etiológico fue E. coli con 225 aislamientos(52,8%) seguido de Klebsiella sp. con 94(22,1%). El 52,1% del total de episodios fueron causados por microorganismos multirresistentes (MMR). Entre los aislamientos de E. coli, 94(41,8%) fueron MMR. El principal factor de riesgo asociado a ITU por MMR fue el antecedente de ITUs recurrentes (RR=1,62; IC95%=1,29-2,02; p

Published
2023
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10. Hepatitis E virus infection in hemodialysis patients: A prospective analysis

Author

Carla Cristani, Guadalupe Di Cola, Jose D. Debes, Fernando Diehl, Andrea Bolomo, Domingo Balderramo, María Belén Pisano, Pehuén Fernández, Viviana Ré, James S. Leathers, Jorge de la Fuente, and Maribel G. Martinez‐Wassaf

Subjects
0301 basic medicine, medicine.medical_specialty, HEMODIALYSIS, CIENCIAS MÉDICAS Y DE LA SALUD, medicine.medical_treatment, MEDLINE, Argentina, Ciencias de la Salud, 03 medical and health sciences, Prospective analysis, 0302 clinical medicine, Renal Dialysis, Internal medicine, medicine, Hepatitis E virus, Humans, Prospective Studies, Prospective cohort study, ARGENTINA, business.industry, Incidence (epidemiology), Incidence, Hepatitis E, medicine.disease, Enfermedades Infecciosas, 030104 developmental biology, Nephrology, HEPATITIS E, Kidney Failure, Chronic, 030211 gastroenterology & hepatology, Hemodialysis, business, Hepatitis E virus infection
Abstract

This study highlights variations in HEV serological status inpatients with ESRD undergoing HD.To assess the dynamics of HEV infection in thispopulation, we prospectively evaluated individuals with end-stagerenal disease (ESRD) undergoing HD at a private hospital in Cordoba, Argentina, between November 2014 and November 2017. Fil: Pisano, María Belén. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; Argentina Fil: Leathers, James. Vanderbilt University School Of Medicine; Estados Unidos Fil: Balderramo, Domingo. Hospital Privado Centro Médico de Córdoba; Argentina Fil: Diehl, Fernando. Hospital Privado Centro Médico de Córdoba; Argentina Fil: Bolomo, Andrea. Hospital Privado Centro Médico de Córdoba; Argentina Fil: Fernández, Pehuen. Hospital Privado Centro Médico de Córdoba; Argentina Fil: Martínez Wassaf, Maribel. Laboratorios Clínicos Especializados- Lace; Argentina Fil: Cristani, Carla. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina Fil: Di Cola Bucciarelli, Guadalupe. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; Argentina. Universidad Católica de Córdoba. Facultad de Ciencias Químicas; Argentina Fil: De la Fuente, Jorge. Hospital Privado Centro Médico de Córdoba; Argentina Fil: Debes, José D.. Universidad de Minnesota; Estados Unidos Fil: Ré, Viviana Elizabeth. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Universidad Nacional de Cordoba. Facultad de Medicina. Instituto de Virología; Argentina

Published
2018

11. Enzyme Replacement Therapy in Pregnant Women with Fabry Disease: A Case Series

Author

Segundo Pastor Fernández, Pehuén Fernández, Shunko Oscar Fernández, Tabaré Fernández, Jacqueline Griselda Mariela Gonzalez, and Cinthia Claudia Fernández

Subjects
0301 basic medicine, Pregnancy, Pediatrics, medicine.medical_specialty, business.industry, Breastfeeding, Enzyme replacement therapy, medicine.disease, Fabry disease, Article, 03 medical and health sciences, 030104 developmental biology, 0302 clinical medicine, medicine, 030212 general & internal medicine, Adverse effect, business
Abstract

Fabry disease is a rare inherited lysosomal storage disorder caused by the deficiency of the enzyme alpha-galactosidase A. There is uncertainty regarding the safety of enzyme replacement therapy during pregnancy. We describe the course and outcome of seven pregnancies in six patients with Fabry disease who continued or reinitiated enzyme replacement therapy during pregnancy. No adverse events, in both mothers and children, were observed.

Published
2018

12. Trypanosoma cruzi, organ transplant related

Author

Jorge de la Fuente, Pehuén Fernández, Florencia Bonisconti, Ana Belén Latzke, Juan Pablo Caeiro, Carlos Chiurchiu, and Sebastián Caliva

Subjects
0301 basic medicine, medicine.medical_specialty, biology, business.industry, 030106 microbiology, MEDLINE, biology.organism_classification, Bioinformatics, Case Illustrated, Organ transplantation, 03 medical and health sciences, Infectious Diseases, medicine, business, Trypanosoma cruzi
Published
2017

13. Hydrocele Caused by Peritoneal Fluid Leakage through Inguinal Canal

Author

Pehuén Fernández, J. de Arteaga, Carlos Chiurchiu, J. de la Fuente, and Walter Douthat

Subjects
Ascitic fluid, medicine.medical_specialty, business.industry, medicine.medical_treatment, Peritoneal fluid, Urology, General Medicine, medicine.disease, Inguinal canal, Peritoneal dialysis, medicine.anatomical_structure, Nephrology, Hydrocele, medicine, Hernia, business, Leakage (electronics)
Published
2017

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