Adjunctive Argatroban or Eptifibatide Shows No Benefit with Thrombolysis in Thrombectomy Patients: JAMA

A recent study published in the Journal of American Medical Association revealed that adding argatroban or eptifibatide to intravenous thrombolysis did not improve reperfusion rates or clinical outcomes in patients undergoing endovascular thrombectomy. The findings from the Multi-Arm Optimization of Stroke Thrombolysis (MOST) trial was conducted between 2019 and 2023. The study followed patients for 90 days, assessing outcomes in a blinded fashion.

Of 5,376 patients screened for eligibility, 4,332 did not meet inclusion criteria and another 530 were either not consented or excluded for other reasons. Ultimately, 514 patients were randomized into the trial. Among them, 254 were planned for thrombectomy, where 110 received placebo, 31 argatroban (a direct thrombin inhibitor), and 113 eptifibatide (a glycoprotein platelet inhibitor).

Of these, 219 patients ultimately underwent thrombectomy. Their average age was 68 years, and 53% were women. The trial measured recovery using the utility-weighted modified Rankin Scale (UW-mRS) at 90 days, where higher scores indicate better functional outcomes. Mean scores were 6.68 (95% CI, 5.98–7.39) in placebo group, 6.47 (95% CI, 5.79–7.15) in eptifibatide group and 5.35 (95% CI, 4.13–6.58) in argatroban group

These results show no significant improvement in clinical outcomes with the addition of either drug compared to placebo. Reperfusion success was defined by a Thrombolysis in Cerebral Infarction (TICI) score of 2b/2c/3 on completion angiography. The rates of good reperfusion were 83% (83 of 92 patients) for placebo, 84% (82 of 98 patients) for eptifibatide and 63% (17 of 27 patients) for argatroban. Rates of symptomatic intracranial hemorrhage were similar across all groups, indicating no excess bleeding risk with the experimental agents.

The results highlight that adding blood-thinning agents like argatroban or eptifibatide to intravenous thrombolysis does not improve outcomes in patients undergoing thrombectomy. However, this study suggest that future studies might explore whether these agents could benefit patients who are not candidates for intravenous thrombolysis. Overall, the findings of the MOST trial provide crucial clarity in refining acute stroke care strategies, showing that for now, standard intravenous thrombolysis followed by thrombectomy remains the optimal pathway.

Source:

Rines, I., Adeoye, O., Barreto, A. D., Broderick, J., Carrozzella, J., Chen, H., Concha, M., Elm, J., Grotta, J. C., Jasne, A. S., Khatri, P., Roy, A., Vagal, A., Wintermark, M., Yoo, A. J., Derdeyn, C. P., & MOST Investigators. (2025). Intravenous argatroban or eptifibatide in patients undergoing mechanical thrombectomy: A subgroup analysis of the MOST randomized clinical trial: A subgroup analysis of the MOST randomized clinical trial. JAMA Neurology. https://doi.org/10.1001/jamaneurol.2025.2794

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Gout Patients Face Higher Risk of Chronic Opioid Use, VA Study Finds

Researchers have found in a Veterans Health Administration study that individuals with gout are significantly more likely to be prescribed chronic opioids compared to those without gout, with an adjusted hazard ratio of 1.30. Thus Gout Patients Face Higher Risk of Chronic Opioid Use. This study was published in the Arthritis Care & Research journal by Lindsay N. and colleagues.

Despite the fact that opioids are often prescribed for the treatment of acute flares of gout, the long-term consequences of opioid exposure for patients with gout have not been well established. Long-term opioid use is linked to serious adverse health consequences, including dependence and overdose. In order to bridge this gap, investigators conducted a large matched cohort study within the VA system to assess whether gout patients are at higher risk for chronic opioid prescription relative to non-gout patients.

This was a matched cohort investigation based on national VA data. Patients who had gout were identified by validated diagnostic codes and matched to up to 10 non-gout controls according to age, sex, and year of VA entry. The main outcome was receipt of chronic opioids, measured using a validated administrative algorithm.

Statistical analysis was carried out with the help of multivariable Cox regression, after controlling for demographic variables, comorbidities, and treatment variables. Further, subgroup analyses were performed in the population of gout patients to determine independent predictors of chronic opioid exposure.

Results

  • The cohort was followed up for a mean of 4.52 years. Among them, 6.9% of patients with gout and 3.8% of non-gout controls received chronic opioids.

  • Following covariate adjustment, receipt of chronic opioids remained associated with gout, with an adjusted hazard ratio (aHR) of 1.30 (95% CI: 1.28–1.32).

  • 6.9% of gout patients compared to 3.8% of controls were exposed to chronic opioids.

  • 30% increased adjusted risk of exposure to chronic opioids in gout (aHR 1.30).

  • Median follow-up: 4.52 years.

  • Increased risk groups: women, younger patients, non-Hispanic Black patients, rural residents, smokers, underweight/obese patients, and those with increased comorbidity.

  • Rheumatology referral and urate-lowering treatment were associated with increased odds of chronic opioid fills.

This research proved that patients with gout are at significantly greater risk for chronic opioid exposure than those without gout. The risk was heightened in particular populations, such as women, racial minorities, rural dwellers, and individuals with higher comorbidities. These findings underscore the imperative to optimize gout treatment approaches and to examine whether optimizing disease care can decrease opioid dependence.

Reference:

Helget LN, England BR, Roul P, et al. Chronic Opioids in Gout: A Matched Cohort Study from the Veteran’s Health Administration. Arthritis Care Res (Hoboken). Published online August 4, 2025. doi:10.1002/acr.25622

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Ostomy-Related AKI Linked to Higher Mortality and MAKE Risk, suggests study

Researchers have ascertained in a new study that Ostomy-AKI patients have more complex outcomes and higher mortality compared to General-AKI. The study draws attention to the fact that Ostomy-AKI is strongly associated with hypovolemia, more severe AKI staging, and a 2.5 times higher risk of major adverse kidney events (MAKE) at 30-90 days, including mortality, dialysis requirement, or severe kidney function decrease. The study was published in the journal of Kidney Medicine by Juan A. and colleagues.

Ostomies, made most often after cancer resections, can yield high fluid output, which puts patients at risk of dehydration and renal injury. The evidence from this study is crucial in identifying how such patients clinically differ from patients with AKI of other causes.

The retrospective cohort study was conducted at the Hospital Civil of Guadalajara between February 2020 and October 2023 and included 84 patients with ostomy-associated acute kidney injury (Ostomy-AKI) and 348 patients with general acute kidney injury (General-AKI). Ostomy-AKI patients were more frequently male compared to General-AKI patients (78.7% vs 56.2%), with a median interval of 2.3 months between ostomy formation and the development of AKI.

The primary indication for ostomy creation was cancer, accounting for 46% of cases. Clinically, patients with Ostomy-AKI had a mean ostomy output of 980 ml/day (range: 760–1700 ml), and 82.9% required fluid adjustment during management. The primary endpoints evaluated were major adverse kidney events (MAKE) at 10 days (MAKE10) and at 30–90 days (MAKE30–90), defined as death, initiation of new dialysis, or a ≥25% decline in estimated glomerular filtration rate (eGFR).

Key Findings

Etiology of AKI:

• Hypovolemia was more frequent in Ostomy-AKI (48.9% vs 24.5%)

Severity of AKI (Stage 3):

• Ostomy-AKI: 82.9%

• General-AKI: 63.9%

MAKE at 10 days (MAKE10):

• Both groups: 94% (no difference)

MAKE at 30–90 days (MAKE30-90):

• Ostomy-AKI: 65.9%

• General-AKI: 49.3%

• Mortality (30–90 days):

• Ostomy-AKI: 59.5%

• General-AKI: 37%

• Ostomy-AKI doubled the risk of death (OR 2.757, CI 1.273–5.973, p=0.01)

Risk of MAKE30-90:

• Ostomy-AKI increased the risk 2.4 times (OR 2.403, CI 1.090–5.299, p=0.03)

Compared to General-AKI, Ostomy-AKI patients have a greater frequency of hypovolemia, more severe AKI, and adverse long-term outcomes, such as 59.5% mortality and a 2.5-fold increase in MAKE risk at 30–90 days. The findings emphasize the importance of aggressive kidney care in patients after recent ostomy surgery to minimize the burden of kidney complications and promote survival.

Reference:

Gómez-Fregoso, J. A., Zaragoza, J. J., González-Duarte, J. A., Nuño-Guzmán, C. M., Hernández-Barajas, E. M., Andrade-Jorge, Z., Leon, J. C., Padilla-Armas, J. L., Ornelas-Ruvalcaba, R. L., Cabrera-Aguilar, J. S., Chávez-Alonso, G., Villalvazo-Maciel, E., Orozco-Chan, C. E., Rodríguez-García, G., Navarro-Blackaller, G., Medina-González, R., Gallardo-González, A. M., Alcantar-Vallin, L., Abundis-Mora, G. J., … Chávez-Iñiguez, J. S. (2025). Severe acute kidney injury associated with intestinal ostomies. Kidney Medicine, 101093, 101093. https://doi.org/10.1016/j.xkme.2025.101093

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NEET PG 2025: DME Assam invites applications for incentive marks to doctors for remote service, details

GUWAHATI: DME Assam has invited NEET PG 2025 qualified candidates, who have served at least one year in designated ‘remote and difficult areas’ of Assam, to apply for additional marks in PG medical admissions.

Applications with required documents must be submitted by hand at the DME office between August 23 and September 6, 2025.

In its notice, the NBE notified that the candidates eligible for admission into postgraduate medical courses under the Medical Colleges of Assam (Regulation of Admission into PG Degree and Diploma Courses) Rules,2021 and have secured cut off scores in NEET-PG-2025 or above as declared by the National Board of Examinations and have served in the remote & difficult areas as mentioned below are directed to apply in prescribed format (which will be available in the official website of the DME Assam from 23rd August, 2025), to the undersigned along with the information/documents mentioned below for awarding additional marks as per the PG Admission Rule and submit the same to the office of the undersigned (2nd floor, Room No. 5) on or before 6th September, 2025, during office hours by hand.

No further application will be considered by this office after the last date of submission (i.e. 6th September, 2025). Applications sent via Post/ E-mail shall not be accepted. Candidates are also requested to collect their receipt of acknowledgement at the time of submission of their forms.

The relevant rule in this regard is as follows:

“Candidates who serve for at least one year continuously in the “remote and difficult areas” under Department/NHM/ public authority/agency created by Government shall be given weightage in the marks as an incentive upto of 3% of the marks obtained in the Entrance Examination against completion of each year of service in the “remote and difficult areas” on or before 31st May of that session subject to maximum of 9% (i.e. for three years of service or above).

Provided that marks obtained after inclusion of additional marks shall not exceed the total marks of the Entrance Examination.

Provided that necessary certification about the service rendered by a candidate shall be obtained by candidates from the competent authorities notified by the Department for this purpose (in Appendix II)”.

The aspiring candidates are requested to visit the official website of DME Assam from time to time for any update in this regard.

REMOTE & DIFFICULT AREAS IN ASSAM (As per the Medical Colleges of Assam (Regulation of Admission into Post Graduate Degree and Diploma Courses) Rules, 2021 notification in the Assam Gazette dated the 6th December/ 2021.

“Remote and Difficult Area” means an area which is situated in the two hill Districts of Assam i.e. North Cachar Hills and Karbi Anglong District as well as remote areas namely, Dhemaji District, Sadia Sub-division, Majuli district, Dhakuakhana Sub-division and South Salmara district other than the head quarters of the said Districts/Sub-division”. However all concerned candidates are requested to go through the original gazette notification thoroughly.

SUBMISSION OF APPLICATION:- All the applications with necessary enclosures are to be submitted within 6th September, 2025 during office hours. No application will be accepted after this date.

IMPORTANT NOTE :

♦ Candidates must submit the following information/documents with the application :-

1. Completed APPENDIX-II with signature of concerned authority.

2. Copy of the Appointment letter showing appointment in ‘remote & difficult areas’.

3. Charge taking over & handing over reports of the posting of ‘remote & difficult areas’.

4. Period of service in ‘remote & difficult areas’.

5. Roll No. , Marks & All India rank of NEET-PG-2025.

To view the official notice click here: https://medicaldialogues.in/pdf_upload/noticeforawardingaddlmarksinneet-pg-2025-1-298603.pdf

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HC slams Tamil Nadu Medical Council for ignoring expert committee report, quashes order exonerating hospital

Chennai: The Madras High Court recently quashed an order of the Tamil Nadu Medical Council (TNMC) exonerating a hospital from medical negligence charges.

Noting that the order was passed by the Council without considering the report of the State Government Appointed Committee, the HC bench comprising Justice N. Anand Venkatesh ordered, “the impugned proceedings of the first respondent (medical council) dated 12.12.2023 are quashed. The matter is remitted back to the file of the first respondent with a direction to the first respondent to conduct the enquiry based on the report that has been submitted by the Committee and pass a reasoned order, within a period of twelve weeks from the date of receipt of a copy of this order.”

The case goes back to 2020 when the petitioner’s father was admitted to the treating hospital. Later, the patient was discharged, and immediately thereafter, he fell ill and was once again admitted to the hospital, where he developed severe infection and was administered antibiotic drugs.

As a consequence, allegedly, the patient’s kidney failed, and he had to undergo dialysis until his demise on 01.09.2020. Aggrieved, the petitioner filed a complaint before the Tamil Nadu Medical Council to conduct an inquiry and take action.

In his plea before the High Court, the petitioner alleged that Tamil Nadu Medical Council exonerated the hospital, holding that there was no medical negligence, without considering the report submitted by the State Government Appointed Committee.

The expert committee consisted of a team of doctors from Coimbatore Medical College and Hospital. The committee, after taking note of the case history, concluded, “With multiple sites of infections, the relevant consultants could have preferably discussed and decided on single / double antimicrobial agents which are effective for all the sources of infection. Thereby, poly pharmacy and frequent antibiotic changes could have possibly been avoided.”

Further, the committee held, “Patient had polyserositis. CB NAAT assay from two sites were weakly positive. Since patient was very sick and already diagnosed with prostate cancer, and being put on multiple antibiotics, ATT could have been deferred.”

While considering the plea, the HC bench noted that the petitioner’s grievance was that the state medical council had passed the order without assigning reasons and without dealing with the complaint given by the petitioner as well as the report submitted by the Committee.

“On carefully going through the impugned proceedings of the first respondent, it is seen that the first respondent has straightaway rendered a finding that there was no professional misconduct on the part of the doctors in the fourth respondent hospital. There is nothing to show that the first respondent had applied their mind on the report that was submitted by the team of doctors constituted by the Coimbatore Medical College and Hospital, Coimbatore. That apart, there is also no indication as to whether the first respondent applied their mind on the specific allegations made by the petitioner. Hence, such order, which lacks reasons, has to be necessarily interfered with by this Court,” observed the Court.

Accordingly, it quashed the Council’s order dated 12.12.2023 and remitted the matter back to the Council with a direction to conduct the inquiry based on the report that had been submitted by the committee, and pass a reasoned order within twelve weeks.

To view the order, click on the link below:

https://medicaldialogues.in/pdf_upload/madras-hc-medical-council-298772.pdf

Also Read: Newborn’s Thumb Severed after delivery: HC orders Rs 7.5 lakh compensation

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DCI directs dental colleges to upload MDS, PG diploma admissions by September 8, details

New Delhi: The Dental Council of India (DCI) has issued a notification directing all dental colleges to upload details of students admitted in MDS and PG Diploma courses for the academic session 2025-26 on the official DCI portal using their allotted login credentials.

As per the revised NEET counseling schedule, the last date for uploading student data and joining is September 8, 2025 (midnight), failing which such admissions will not be recognized under the Dentists Act.

As per the Revised Counseling Schedule issued by the MCC for Online Counseling (Allotment Process) for NEET 50% AIQ and 100% Deemed / Central Universities & State Quota seats for MDS Courses for the academic year – 2025, the MCC has declared the commencement of academic session and last date for joining is 8th September, 2025 for the academic year 2025-26 for MDS Courses.

“Accordingly, the college authorities of all dental colleges are hereby directed to upload the details of students, admitted in MDS / PG Diploma Course(s) at their dental institution for the academic session 2025-26, on DCI Website, using their already allotted login credentials for admissions (https://portal.dciindia.gov.in/login), on or before the last date of joining i.e. is 8th September, 2025 (12:00 midnight), positively. If the college authorities claim any admission after 12:00 midnight of 8th September, 2025, then Section 10B of the Dentists (Amendment) Act, 1993 and/or Section 16A of the Dentists Act, 1948, as the case may be, shall be attracted and it shall be presumed that the college authorities have not admitted such student(s) in MDS / PG Diploma Course(s) at their college for the academic session 2025-26,” the notice read.

In order to ensure smooth uploading the details of students and to avoid the unnecessary delay, undue pressure and technical fault on network, in uploading the details of the students at the last moment of cut-off date, each and every dental institutions shall make its efforts to upload the details of students gradually, immediately after the date of joining of student of each round of counseling, but not later than 12.00 Midnight of 8th September, 2025 in any circumstance. In other words, the college shall not wait for uploading the details of its students for last moment of cut-off date and the details would be uploaded by the college after each round of counseling.

Moreover, it has come to notice that some dental colleges upload the details of students who are not admitted in their college, because of which the college where the student has actually taken admission is unable to upload the details. Colleges are hereby strictly warned to upload the details of only the genuine and bonafide admissions of their college. The onus of furnishing true, correct and authentic information is upon the college concerned and in case of furnishing any wrong / incorrect information, it shall be open to DCI to initiate action against / penalize the college, the notice read.

 Only the uploaded details of students on DCI portal shall be forwarded to the State Dental Councils / Tribunals for addition of MDS / PG Diploma Qualification.

“It is also inform you that only uploaded details of students on DCI Website shall be considered and any detail of students received in any other format viz. e-mail or hard copy shall not be considered at all, therefore, you are requested not to send the subject details through e-mail or post or any other mode. It is also stated that no request for extension of time to upload the above details of students or any other excuse or reason of technical fault, etc. shall be considered, therefore, you are again requested to ensure and make available all arrangements at your end to complete the above task, in time, so as to avoid any litigation and to enable this Council to take necessary action in a time bound manner,” the DCI added.

To view the full official notice click here: https://medicaldialogues.in/pdf_upload/lno4420-public-circular-298561.pdf

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Caught on Camera: ASHA Worker allegedly slaps Medical Officer at Sikar PHC

Jaipur: In a shocking case of violence against medical professionals, a medical officer at the Primary Health Centre (PHC) in Kochchur, Sikar, was allegedly slapped by an ASHA worker on Friday. The health department has ordered an inquiry, and the accused has been arrested.  

The incident occurred after the doctor issued a notice to the ASHA worker, Santosh Devi from Sub Centre Ganora, for not providing tuberculosis (TB) medicines to a patient. Upset over the notice, she allegedly entered the OPD while the doctor was attending patients, misbehaved with him, and assaulted him.

A video of the incident has gone viral on social media, reportedly showing the ASHA worker shouting at the doctor, misbehaving with him and then suddenly slapping him out of rage. 

Also read- Doctors at Delhi’s Govt Hospital go on strike after MLA allegedly assaults on-duty doctor

Following the incident, the doctor filed a complaint against the ASHA worker at the police station. Based on the complaint, an FIR was registered, and the accused has been arrested. She was presented before the magistrate and was sent to jail.

Reacting strongly, the All Rajasthan In-Service Doctors Association (ARISDA) condemned the attack. An office-bearer told TOI, “Is it possible for someone like an ASHA worker to behave in such a manner? She is not fit to remain in medical service and should be terminated immediately. The state ARISDA is committed to ensuring justice for the doctor.”

The health department has assured that the matter will be investigated thoroughly. “The doctor issued a notice to the ASHA worker for allegedly not providing TB drugs to a patient. She was not happy with the notice served to her. We will investigate the case to find out more details,” said a senior health department official in Sikar. 

Also read- Caught on camera: GMC Srinagar 3rd year PG medico slapped by patient’s attendant

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Donor, Recipient die after liver transplant; Health Dept issues notice to Sahyadri Hospital

Pune: A woman who had donated a part of her liver to her husband tragically died after he passed away following a transplant surgery at Sahyadri Hospital in Pune, raising serious concerns about post-transplant complications. In response to the incident, the Maharashtra health department has issued a notice to the hospital, an official said.

The transplant took place on August 15 at the Deccan branch of Sahyadri Hospital, a well-known speciality facility. The patient, a 49-year-old man suffering from advanced liver disease, underwent the surgery with a liver donation from his wife.

“We have issued a notice to the hospital and sought details of the recipient and the donor, their video recordings, and the line of treatment. The hospital has been asked to furnish all the details by 10 am on Monday,” he said, reports PTI.

The family had pinned all their hopes on the surgery, even taking out a ₹12 lakh loan to fund the procedure. However, their worst nightmare unfolded just days later. The recipient passed away just two days after the procedure, on August 17. Four days later, on August 21, the donor also died, adding to the family’s heartbreak.

The couple leaves behind two children — a 20-year-old son and a daughter currently studying in Class VII. The recipient had been employed at a private company and was facing financial difficulties in recent times.

Also Read:Patient dies after alleged expired glucose injection: Consumer court clears nursing home of negligence

Speaking to the Indian Express, the brother of the deceased woman said, “This year, my brother-in-law found it difficult to pay the annual fee of Rs 40,000 for his daughter’s school. The management allowed him to pay it in instalments.” The loan, he said, has to be repaid, which is now another cause of concern for the family.

He said they had chosen Sahyadri Hospital because it is considered a specialty hospital, and questioned how the donor could have died and what went wrong in the case of his brother-in-law. A post-mortem was conducted at Sassoon Hospital, and once the report is received, they plan to approach an expert committee to investigate possible medical negligence. 

He mentioned that his sister, a homemaker, did not have diabetes or hypertension, and that his brother-in-law had stopped drinking nearly 10 years ago. The surgery was conducted on August 15, and within a few hours, his brother-in-law passed away. While the family had been mentally prepared for his death due to his critical condition, his sister’s death came as a complete shock. After the surgery, she was shifted to the ICU for observation and was never discharged. Doctors had stated prior to the surgery that there was a 5% risk, but the family has now lost her.

Speaking to TOI, he said, “We had not informed our sister about her husband’s death as it would have traumatised her. Her condition deteriorated on Thursday night, and she was put on dialysis. We were informed about her death on Friday afternoon. We are not convinced by the doctors’ answers. We are waiting for the post-mortem report. Once we get it, we will file a police complaint and submit all documents to the medical negligence committee for investigation.”

In a statement issued on Saturday, Sahyadri Hospital said, “We deeply empathise with the patients’ family in this time of immense loss. Liver transplant is one of the most complex procedures, and in this case, the recipient was a high-risk patient with end-stage liver disease. As per protocol, the family was fully counselled about the risks in advance. The surgeries were carried out following standard medical protocols. Unfortunately, the recipient developed cardiogenic shock after the transplant and could not be revived despite all efforts. The donor initially recovered well, but later on the sixth-postoperative day, developed sudden hypotensive shock with subsequent multi-organ dysfunction, which could not be controlled even with advanced treatment. We remain committed to providing the highest standards of care and extend our deepest empathy to the bereaved family during this tragic time,” reports Indian Express.

Dr. Yellapa Jadhav, the medical superintendent of Sassoon General Hospital, said that when a family suspects medical negligence, they must file a complaint with the police. He explained that only after such a complaint can the police request an enquiry, upon which the hospital would initiate an investigation into the case.

Also Read:Woman, newborn die during botched delivery at nursing home; 3 arrested

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Genetic testing of IVF embryos can help women over 35 conceive faster

Genetic testing of IVF-created embryos could help more women over 35 have a baby in less time, a clinical trial by researchers from King’s College London, King’s College Hospital, and King’s Fertility has found.

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Evidence, not ideology, must guide preventive health care, say experts

A recent review of the Canadian Task Force on Preventive Health Care underscores the need for expert bodies to produce evidence-based guidance and that Canada should ensure a renewed task force is adequately funded and supported, argues a commentary in the Canadian Medical Association Journal.

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