#@pediatrics

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Dr. Maron   Jill Maron, MD, MPH Chief of Pediatrics Executive Director, Mother Infant Research Institute Vice Chair, Pediatric Research, Tufts Medical Center Women & Infants Hospital of Rhode Island   MedicalResearch.com: What is the background for this study? Response: The Genomic Medicine for Ill Neonates and Infants (GEMINI) trial was designed to be the first comparative study to explore the diagnostic yield, clinical utility and time to diagnosis between whole genomic sequencing (WGS) and a targeted genomic sequencing panel specifically designed to detect gene disorders that present in early life. GEMINI was a US based study that enrolled 400 hospitalized infants, along with their available parents, suspected of having an undiagnosed genetic diagnosis. Every participant underwent testing on each platform simultaneously, allowing us to better understand the limitations and advantages of each approach. MedicalResearch.com: What are the main findings? Response:  GEMINI found that genomic sequencing technologies were able to identify at least one pathogenic, likely pathogenic, or highly suspicious VUS in 51% of enrolled patients < 1 year of life. These diagnostic yields are comparable to other recently reported studies (range 25-50%). However, while the targeted test returned results sooner than whole genomic sequencing (6 days vs. 3 days), WGS had nearly double the diagnostic yield (49% v 27%). Thus, in these high-risk infants suspected of having a genetic disorder, WGS was >10 times more likely to make a diagnosis compared to the targeted test. This disparity is partly due to the large number of infants who were found to have structural variants not detected by the targeted test and/or gene variants not currently included on the targeted test.  MedicalResearch.com: What should readers take away from your report? Response: There were many aspects to the GEMINI study that made it unique. Not only was it the first study to perform a comparative analysis of the diagnostic yield, clinical utility, and time to diagnosis between WGS and a targeted neonatal genomic sequencing test, but it also included detection of a suspicious VUS in calculating diagnostic yield. A suspicious VUS was defined as a variant found in a gene suspected of causing the presenting phenotype and was reported to the clinical care team to inform medical management. In a number of these cases, care was modified based on this reporting. Most importantly, when both tests detected the same genetic variant, their interpretation on the importance of the findings were different 40% of the time. MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: The broad Inclusion criteria in GEMINI reinforced our lack of understanding of early life presentation of many genetic diseases. GEMINI identified 134 novel variants among infants < 1 year of age and the ultimate diagnosis was only suspected by consulting geneticists 33% of the time. Many variants detected by WGS were not identified by the targeted test and would not have been detected even if whole exome sequencing had been performed. The overall result of these data suggest that WGS has a higher diagnostic yield in these high risk populations. It should also be noted that surveyed clinicians highly valued access to these genetic platforms, even if a diagnosis was not made. GEMINI did highlight differences in variant classification that can occur between laboratories despite having access to the same clinical and phenotypical data for interpretation. Clinicians need to be cognizant that it is the interpretation of the genome that drives diagnostic rates, not simply the sequencing. Thus, a negative report by one laboratory may not be recapitulated by another. GEMINI serves as a reminder that while our technology has streamlined the pipeline from sequencing to variant call, much work remains on how to best standardize the interpretation of the genome to better inform clinical care. MedicalResearch.com: Is there anything else you would like to add? Any disclosures? Response: This study strongly supports the position that Medicaid and Commercial Insurance carriers should cover WGS (whose costs are decreasing as the technology improves). The early diagnosis should also open tremendous opportunities for industry to develop many other novel genomic approaches to successfully treat many genetic disorders, many of which are currently fatal. All disclosures are listed in the JAMA article.   Citation: Maron JL, Kingsmore S, Gelb BD, et al. Rapid Whole-Genomic Sequencing and a Targeted Neonatal Gene Panel in Infants With a Suspected Genetic Disorder. JAMA. 2023;330(2):161–169. doi:10.1001/jama.2023.9350 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

Response:  A brief summary of the findings of our study is as follow: almost all of the toddlers who participated in an eye tracking study who showed low levels of attention to motherese speech received a diagnosis of autism from a clinical psychologist who was blind to their eye tracking results.  This is a notable finding because each eye tracking test can be completed in about a minute. A more detailed and comprehensive summary of our study is as follows:  653 toddlers aged 1 to 3 years old participated in an eye tracking study. Toddlers were presented with two videos on a screen: one of a woman speaking in motherese, and one non-human scene (either a busy highway or a movie of abstract shapes and numbers with accompanying electronic music). The videos were available for one minute, and the toddlers used their eyes to control which video played at a given time. If any given toddler looked at the actress speaking in motherese less than 30% of the time, the probability that they would receive a diagnosis of autism from a licensed clinical psychologist blind to their eye tracking score was 94%. Findings also showed that the toddlers that attended to motherese speech less than 30% of the time also had more challenges with speaking, cognition and social behavior, pointing to the importance of attending to human speech during early development. It is important to note that only about a third of children who received a diagnosis of autism ‘failed’ the motherese eye tracking test, highlighting that eye tracking can detect a special subtype of ASD.  In this case, the subtype are children who shy away from attending to speech. This is one of the only studies to use ‘gaze contingent’ eye tracking technology which allows the toddler to control what movie they saw, giving us great insight into what interests them. Finally, it is important to note that there were many toddlers who received a diagnosis of autism from a psychologist who ‘passed’ the motherese eye tracking test.  These toddlers tended to have better language and social behavior and highlights the fact that eye tracking can shed light on a both a toddlers strengths as well as their weaknesses and may be a particularly powerful tool for predicting a child’s clinical course.  MedicalResearch.com: What should readers take away from your report? There are 2 key take aways from this research: - If a toddler between 12-48 months doesn’t appear to pay attention to parents while they are speaking to him/her, this could be an early warning sign of autism and warrants a follow up with a qualified professional. - Autism can be accurately diagnosed in a subset of children using new eye tracking technology in just a few minutes. This finding helps us to re-think how autism is diagnosed, and opens up unprecedented opportunity to access diagnoses in remote areas where there are no clinicians available and to fast track participation in autism-relevant treatment.  MedicalResearch.com: What recommendations do you have for future research as a results of this study? Response: Future research should push the boundaries of what eye tracking technology can do to help children with autism and families. For example, scientists could possibly test whether or not treatment recommendations based on a child’s eye gaze profile accelerates gains in treatment faster than standard of care treatment. Disclosures: All of the research reported in the study was funded by the National Institute of Mental Health. Dr. Pierce has a patent pending through the University of California, San Diego that incorporates the eye tracking tests. Dr. Pierce received a donation from the ACES Innovation Fund to examine new ways to leverage eye tracking technology that could benefit children and families. Citations: - Maenner MJ, Shaw KA, Bakian AV, et al. Prevalence and Characteristics of Autism Spectrum Disorder Among Children Aged 8 Years - Autism and Developmental Disabilities Monitoring Network, 11 Sites, United States, 2018. MMWR Surveill Summ. Dec 3 2021;70(11):1-16. doi:10.15585/mmwr.ss7011a1 - Courchesne E, Gazestani VH, Lewis NE. Prenatal Origins of ASD: The When, What, and How of ASD Development. Trends in neurosciences. 2020;43(5):326-342. doi:10.1016/j.tins.2020.03.005 - Pierce K, Gazestani VH, Bacon E, et al. Evaluation of the Diagnostic Stability of the Early Autism Spectrum Disorder Phenotype in the General Population Starting at 12 Months. JAMA Pediatr. Jun 1 2019;173(6):578-587. doi:10.1001/jamapediatrics.2019.0624 - Pierce K, Wen TH, Zahiri J, et al. Level of Attention to Motherese Speech as an Early Marker of Autism Spectrum Disorder. JAMA Netw Open. 2023;6(2):e2255125. doi:10.1001/jamanetworkopen.2022.55125 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

Molluscum DermNet image Response: Molluscum Contagiosum (MC) is an infection caused by molluscipoxvirus. It is difficult to study since the virus only survives in human skin, and therefore there isn’t an animal or cell model to study potential treatments. Molluscum lesions appear as raised, domed shaped skin-colored lesions and can occur anywhere on the body but are most common on the face, neck, arms, legs, and abdomen. Sometimes there are few lesions, but clusters of several lesions can appear. Children are the most likely to get molluscum, and the virus is highly contagious, transmitted by direct contact with infected skin or contaminated objects, like towels, linens and toys. Scratching can cause autoinoculation which is when a person reinfects themself. MC is very common, impacting an estimated 6 million adults and mostly children in the US each year. In 2010, there was an estimated 122 million cases worldwide. It occurs primarily in humid and warm climates, and transmission via swimming pools and bathtubs may be possible. Therefore, molluscum is often called “water warts.” Many physicians may take a “watch and wait” approach since the virus may clear on its own. However, it can take months to up to 5 years for some to experience complete clearance, In the meantime, the person is still highly contagious and may spread the virus to others, particularly children. Lesions can be bothersome, causing itching and sometimes a secondary infection. There is also a psychosocial component. In a recent study, 1 in 10 children with molluscum experienced a major quality of life issue. Berdazimer Gel, 10.3% is a potential first-in-class topical controlled-nitric oxide releasing medication containing Berdazimer (sodium), a new chemical entity, and the active ingredient in berdazimer gel 10.3%. The mechanism of action of berdazimer in the treatment of molluscum is unknown, but in vitro lab studies show that the nitric oxide, released when berdazimer is combined with a hydrogel, may impede viral replication and perhaps help body’s natural immune response against molluscum. MedicalResearch.com:  What are the main findings? Response: Berdazimer Sodium in Molluscum Patients with Lesions (B-SIMPLE) 4 was a multi-center, vehicle controlled double blind phase 3 randomized clinical trial conducted in 55 clinics in the United States to understand if berdazimer, 10.3% had a statistically positive impact on clearance of MC. The primary efficacy endpoint was complete clearance of all MC lesions at week 12. Safety and tolerability measures included adverse event frequency and severity and assessment of local skin reactions and scarring. B-SIMPLE 4 enrolled the largest number of molluscum patients ever studied in a Phase 3 interventional trial, 891 with 444 receiving berdazimer and 447 receiving vehicle. The data showed that Novan’s potential first-in-class topical controlled-nitric oxide releasing medication was significantly more effective than vehicle in completely clearing lesions associated with the highly contagious viral skin disease at 12 weeks. No treatment-related serious adverse events were reported. The multicenter, vehicle-controlled, double blind study included patients 6 months or older with 3 to 70 raised MC lesions. Patients were randomized to treatment with berdazimer gel, 10.3% or vehicle gel, applied as a thin layer to all lesions once daily for 12 weeks. At the end of 12 weeks, 32.4% of patients in the berdazimer group achieved complete clearance of lesions as compared to 19.7% in the vehicle group. MedicalResearch.com: What should readers take away from your report? Response: Molluscum Contagiosum is highly contagious and can be transmitted via skin-to-skin contact with someone who has molluscum bumps on their skin or contaminated objects.  For this reason, children with molluscum may be unable to participate in sports (wrestling), sleepovers, swimming and other social activities for fear of spreading the virus to others. The lesions may become irritated and red and be unsightly, creating anxiety. In addition, if the MC lesions are scratched or rubbed, they can spread to other parts of the body and even become infected with bacteria. Healing the lesions more quickly reduces both the risk of infection and further spread of MC to others. MedicalResearch.com: What should readers take away from your report? Is it necessary to treat them? Response: These results demonstrate the promise of berdazimer gel, 10.3% as a potential first and only prescription medication for molluscum. If approved,  berdazimer gel 10.3% could offer molluscum patients and their caregivers the ease of at-home self-application. Since so many patients go untreated due to limited options, this will be a breakthrough in molluscum treatment. MedicalResearch.com: Is there anything else you would like to add? Response: These results demonstrate the promise of berdazimer gel, 10.3% as a potential first and only prescription medication for molluscum. If approved,  berdazimer gel 10.3% could offer molluscum patients and their caregivers the ease of at-home self-application. Since so many patients go untreated due to limited options, this will be a breakthrough in molluscum treatment. Citation: A randomized controlled pilot study of autoinoculation versus 35% trichloroacetic acid for the treatment of molluscum contagiosum Kachhawa, Dilip et al. Journal of the American Academy of Dermatology, Volume 0, Issue 0 DOI: https://doi.org/10.1016/j.jaad.2022.02.066 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Midya Vishal Midya, PhD, MStat Postdoctoral Researcher Icahn School of Medicine at Mount Sinai  MedicalResearch.com:  What is the background for this study?    Response: Non-alcoholic fatty liver disease (NAFLD) is the most common liver disease in children in the U.S., Europe and other world regions, currently affecting 1 in every 10 children, and 1 in every 3 children with obesity in the U.S. The rate of pediatric NAFLD has more than doubled in recent decades following the epidemic rates also noted for childhood obesity. There is increasing interest in the role that environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals (EDCs) cause liver injury and damage; but, until now, the potential effects of prenatal EDC mixture exposures in pediatric NAFLD had not been studied. MedicalResearch.com:  What are the main findings? Response: In this study, we measured 45 chemicals in the blood or urine from 1,108 pregnant women from six European countries and found that maternal exposure to several environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals commonly used in consumer and industrial products increases risk for NAFLD in the child. Environmental chemical exposures may play in NAFLD etiology, since several animal studies have shown that prenatal exposures to endocrine-disrupting chemicals are known to interfere with the hormone systems and pass through the placenta from the mother to the fetus altering fetal programming and development. Examples of chemicals we investigated include perfluoroalkyl substances (PFAS), also known as “forever chemicals”, used in nonstick cookware and food packaging, and polybrominated diphenyl ethers (PBDEs) used as flame retardants in furniture and infant products. Other chemical classes we studied include pesticides, plastics, and toxic metals. When the children reached the ages of 6 to 11 years old, we measured the levels of liver enzymes and cytokeratin-18 that indicate risk for NAFLD in the children’s blood, finding elevated levels of those biomarkers in children who had been more highly exposed to environmental chemicals, and especially to persistent organochlorine pesticides, PFAS, PBDEs, and metals, during pregnancy. MedicalResearch.com: What should readers take away from your report? Response: It is important to be aware of the health risks that endocrine-disrupting chemicals pose for the mother and the developing fetus and possible ways to avoid these exposures. Some effective ways in reducing exposure to EDCs in pregnancy and early childhood include avoiding the use of products that contain them, such as plastic containers, bottles, packaging and toys, canned food and beverages, fast/processed foods, non-stick cookware, pesticides and cosmetics, and consuming fresh and organic foods whenever possible. However, EDCs are ubiquitous in consumer products and the environment, and there are many sources of exposure that are beyond the control of individuals. Therefore, policy changes are sorely needed, such as banning the use of EDCs in consumer products and requiring companies to disclose what chemicals are in a product. This would let consumers make informed choices for their health. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: NAFLD is now diagnosed in children as young as 2 years of age, and NAFLD in childhood is associated with increased risk for severe chronic liver disease later in adulthood. We need more research and longitudinal studies to elucidate the potential effects of early life EDC exposures on pediatric NAFLD and its progression to more severe liver diseases such as non-alcoholic steatohepatitis (NASH), liver cirrhosis and liver cancer. We also need further research to understand how environmental chemical exposures may interact with our genes, diet and social factors in the development of pediatric liver disease. This information will be informative in designing more effective early life prevention and intervention strategies to reverse the current NAFLD epidemic in children and subsequently adults in the future. MedicalResearch.com: Is there anything else you would like to add?  Response: We are deeply grateful to all researchers and research staff of the HELIX consortium and all the participating families in the HELIX cohorts. This study was funded by the U.S. National Institute of Environmental Health Sciences (NIEHS) and the European Community’s Seventh Framework Programme. Citation Midya V, Colicino E, Conti DV, et al. Association of Prenatal Exposure to Endocrine-Disrupting Chemicals With Liver Injury in Children. JAMA Netw Open. 2022;5(7):e2220176. doi:10.1001/jamanetworkopen.2022.20176     The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

Dr. Dumitriu Dani Dumitriu, MD, PhD Assistant Professor of Pediatrics (in Psychiatry) The Sackler Institute for Developmental Psychobiology Columbia University, New York MedicalResearch.com: What is the background for this study? What are the main findings?  Response: A lot of research has focused on the effects of COVID-19 in various vulnerable populations, such as elderly individuals, immunocompromised patients, and individuals with severe comorbidities. However, one vulnerable population that has remained relatively understudied are the infants exposed to maternal COVID-19 disease during pregnancy. While early on in the pandemic we and other groups showed reassuring data on low risk of vertical transmission, meaning the passing of the virus from mother-to-infant is rare, this does not necessarily mean that these infants wouldn't experience long-term consequences related to the maternal infection through other means. We know from other viral illness that maternal illness, most commonly through the activation of her immune system, can lead to a cascade of events that affect fetal development. This is why a large number of physicians and researchers at Columbia University spearheaded the COVID-19 Mother Baby Outcomes (COMBO) Initiative -- to look at potential long-term health effects on both infants and mothers. Given data from other viral illnesses during pregnancy, we expected to see a negative impact on the development of infants who had been exposed to maternal COVID-19 disease in pregnancy. However, to our surprise, we saw absolutely no effect of maternal infection with SARS-CoV-2 on infant neurodevelopment at 6 months assessed through a standard pediatric screening test called the ASQ-3. Thanks to our large COMBO team, we were fortunate that co-first author Dr. Lauren Shuffrey had used the same screening tool at age 6 months in a different study of babies born at our hospital in the three years prior to the pandemic. Dr. Shuffrey and co-first author Dr. Morgan Firestein could therefore compare our cohort of infants born during the pandemic to this historical cohort, and when we did, we found that infants born during the pandemic, irrespective of maternal infection, scored slightly lower on motor and social skills. Their scores were not dramatically different and in our sample of a few hundred infants this did not translate to an overall higher proportion of infants that "failed" this screening test, but these differences nevertheless warrant careful attention give the prevalence of this disease. MedicalResearch.com: What should readers take away from your report? Response: The scientific and medical communities have mostly speculated that infants born to mothers who contract COVID-19 during pregnancy might show neurodevelopmental decrements. This translates to potential impact on millions of children born worldwide over the last two years. Our study, however, points to potential impact on the neurodevelopment of infants born during the pandemic irrespective of maternal infection, which - if replicated - would translate to potential impact on hundreds of millions of children born since the onset of the pandemic, with potential for significant public health consequences. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: We have a duty to continue to monitor the infants born during the pandemic. Our study highlights that we need to study these infants broadly, not only those exposed to the virus either in utero or after birth. We also need to now begin to investigate the mechanisms that contribute to the observed neurodevelopmental decrements, including maternal pre- and postnatal stress, changes in healthcare delivery and access, and worldwide socioeconomic changes. MedicalResearch.com: Is there anything else you would like to add? Response: It is important to note that our study does not necessarily mean that these infants will suffer long-term consequences. Firstly, the effects we saw were small. Secondly, this is still a very early developmental timepoint and because lots happens in the first few years of life, scores on an assessment at 6 months are poor predictors of long-term outcomes. Thirdly, and most importantly, if our findings replicate and birth during the pandemic indeed negatively impacts neurodevelopment, because this is such an early timepoint there are lots of opportunities to intervene and get these babies onto the right developmental trajectory. The brains of 6-month-old infants are very plastic, very malleable, so by talking, singing, playing, and interacting with them and finding safe ways to take them out of the home more often, parents can absolutely help mitigate potential issues down the road. The authors report no conflicts of interest related to this study. A full list of disclosure is included in the article. Citation: Shuffrey LC, Firestein MR, Kyle MH, et al. Association of Birth During the COVID-19 Pandemic With Neurodevelopmental Status at 6 Months in Infants With and Without In Utero Exposure to Maternal SARS-CoV-2 Infection. JAMA Pediatr. Published online January 04, 2022. doi:10.1001/jamapediatrics.2021.5563   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.     Read the full article

Dr. Bullard Jared Bullard MD FRCPC Associate Professor, Departments of Pediatrics & Child Health and Medical Microbiology & Infectious Diseases Max Rady College of Medicine Rady Faculty of Health Sciences Cadham Provincial Laboratory Children’s Hospital Research Institute of Manitoba MedicalResearch.com: What is the background for this study? Response: Children are well known to transmit epidemic/endemic respiratory viruses like influenza. Initial public health policy was based on that children were likely to transmit SARS-CoV-2 effectively within a community and subsequently in-person school and extracurricular activities were suspended. Initial research did not show a clear association with children driving transmission. The purpose of our study was to take respiratory samples from both children and adults with COVID-19 (all had SARS-CoV-2 detected by RT-PCR) and compare those samples by their ability to grow in cell culture and amount of virus in samples. We took 175 samples from children (97 younger than 10 years of age and 78 between 11-17 years) and compared them to 130 adult samples from the same communities in Manitoba experiencing outbreaks of COVID-19.  MedicalResearch.com: What are the main findings? Response: Samples from children were significantly less likely to grow in cell culture compared to adult samples (19% in children 0-10 years, 23% in children 11-17 years versus 44% in adults). In addition, the amount of virus in positive cell cultures was significantly less in children compared to adults. With over a 50% lower cell culture positivity rate and less virus when compared to adults, our findings support that children are unlikely to the primary drivers of the COVID-19 pandemic. MedicalResearch.com: What should readers take away from your report? Response: Our findings support the increasing evidence that children are less likely to transmit SARS-CoV-2/COVID-19 within household, school or community settings. Children benefit from in-person school and extracurricular activities. These benefits must be weighed carefully against the risks to the overall health, development and well-being of children by limiting school and activities to community spread of COVID-19.  MedicalResearch.com: What recommendations do you have for future research as a result of this work?  Response: Many different strains of SARS-CoV-2 circulated throughout Manitoba for the duration of the study so we know that our findings apply to a variety of types. Recently, variants of concern (VOCs) have become the predominant strain in many parts of the world including Canada. We also know that VOCs are more infectious and can cause more severe disease. It still remains unclear if VOC’s biology is divergent enough from prior strains to transmit effectively in children. Further studies are currently underway. MedicalResearch.com: Is there anything else you would like to add? Response: It’s important to recognize that children can still be infected with SARS-CoV-2 and develop COVID-19. Fortunately, their disease tends to be mild. Even though they are less likely to transmit SARS-CoV-2 to other children or adults, it is still possible. Children should stay home when sick, wash or sanitize their hands frequently and distance when possible. Masks are another good addition. Citation: Infectivity of severe acute respiratory syndrome coronavirus 2 in children compared with adults Jared Bullard, Duane Funk, Kerry Dust, Lauren Garnett, Kaylie Tran, Alex Bello, James E. Strong, Santina J. Lee, Jillian Waruk, Adam Hedley, David Alexander, Paul Van Caeseele, Carla Loeppky and Guillaume Poliquin CMAJ April 09, 2021 cmaj.210263; DOI: https://doi.org/10.1503/cmaj.210263 The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article