Genetic diversity of Influenza B virus in 2009–2010 and 2010–2011 in Tunisia
The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains. The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infec...
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| Veröffentlicht in: | Médecine et maladies infectieuses 2013-08, Vol.43 (8), p.337-344 |
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| creator | El Moussi, A. Ben Hadj Kacem, M.A. Ledesma, J. Pozo, F. Teresa Cuevas, M. Casas, I. Slim, A. |
| description | The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains.
The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009–2010 and in 2010–2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing.
The two influenza B Tunisian strains of the 2009–2010 season belonged to the Victoria lineage, whereas 2010–2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases.
Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.
Caractériser les souches de la grippe B ayant récemment circulées en Tunisie afin de déceler les nouvelles mutations en comparaison avec les souches de référence.
Dans le cadre de la surveillance épidémiologique de la grippe, 19 patients présentant des symptômes liés à l’infection des voies respiratoires se sont révélés infectés par le virus de la grippe B durant les deux saisons 2009–2010 et 2010–2011. L’identification ainsi que la détection des mutations dans le segment codant l’hémagglutinine des virus grippaux ont été réalisées au laboratoire par la technique de RT-PCR en temps réel et le séquençage.
Il s’est avéré que les deux souches Tunisiennes de la grippe B de la saison 2009–2010 appartiennent à la lignée Victoria, alors que les souches de la saison 2010–2011 sont des deux lignées B/Victoria/2/87 et B/Yamagata/16/88 avec une dominance de la lignée Yamagata (76 %). Cette étude a permis d’identifier des mutations à l’origine de substitutions d’acide aminé : T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V et K253R dans la lignée B-Yamagata ; L58P, N75K, K109N, N165K, S172P et K257R dans la lignée B-Victoria. Ces mutations sont spécifiques de groupes d |
| doi_str_mv | 10.1016/j.medmal.2013.06.005 |
| format | Article |
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The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009–2010 and in 2010–2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing.
The two influenza B Tunisian strains of the 2009–2010 season belonged to the Victoria lineage, whereas 2010–2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases.
Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.
Caractériser les souches de la grippe B ayant récemment circulées en Tunisie afin de déceler les nouvelles mutations en comparaison avec les souches de référence.
Dans le cadre de la surveillance épidémiologique de la grippe, 19 patients présentant des symptômes liés à l’infection des voies respiratoires se sont révélés infectés par le virus de la grippe B durant les deux saisons 2009–2010 et 2010–2011. L’identification ainsi que la détection des mutations dans le segment codant l’hémagglutinine des virus grippaux ont été réalisées au laboratoire par la technique de RT-PCR en temps réel et le séquençage.
Il s’est avéré que les deux souches Tunisiennes de la grippe B de la saison 2009–2010 appartiennent à la lignée Victoria, alors que les souches de la saison 2010–2011 sont des deux lignées B/Victoria/2/87 et B/Yamagata/16/88 avec une dominance de la lignée Yamagata (76 %). Cette étude a permis d’identifier des mutations à l’origine de substitutions d’acide aminé : T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V et K253R dans la lignée B-Yamagata ; L58P, N75K, K109N, N165K, S172P et K257R dans la lignée B-Victoria. Ces mutations sont spécifiques de groupes de variants Tunisiens. La majorité des virus de la lignée Yamagata étudiés (69 %) sont associés à des cas graves.
L’analyse moléculaire régulière des différentes souches de la grippe B circulant en Tunisie s’avère utile pour détecter de nouvelles mutations capables de modifier le phénotype des souches grippales.</description><identifier>ISSN: 0399-077X</identifier><identifier>EISSN: 1769-6690</identifier><identifier>DOI: 10.1016/j.medmal.2013.06.005</identifier><identifier>PMID: 23876206</identifier><identifier>CODEN: MMAIB5</identifier><language>eng</language><publisher>Paris: Elsevier SAS</publisher><subject>Amino Acid Sequence ; Amino Acid Substitution ; B/Victoria lineage ; B/Yamagata lineage ; Biological and medical sciences ; Disease Outbreaks ; Genetic Variation ; Grippe B ; Hemagglutinins, Viral - chemistry ; Hemagglutinins, Viral - genetics ; Human viral diseases ; Humans ; Infectious diseases ; Influenza B virus ; Influenza B virus - genetics ; Influenza B virus - isolation & purification ; Influenza, Human - epidemiology ; Influenza, Human - virology ; Influenza B ; Lignée B-Victoria ; Lignée B-Yamagata ; Medical sciences ; Molecular Sequence Data ; Mutation ; Phylogeny ; Phylogénie ; Point Mutation ; Population Surveillance ; Real-Time Polymerase Chain Reaction ; RNA, Viral - genetics ; Sequence Alignment ; Sequence Homology, Amino Acid ; Sequencing ; Séquençage ; Tunisia - epidemiology ; Viral diseases ; Viral diseases of the respiratory system and ent viral diseases</subject><ispartof>Médecine et maladies infectieuses, 2013-08, Vol.43 (8), p.337-344</ispartof><rights>2013 Elsevier Masson SAS</rights><rights>2014 INIST-CNRS</rights><rights>Copyright © 2013 Elsevier Masson SAS. All rights reserved.</rights><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c425t-c2d17a312eb2a399097387f80ed606cd1dabbd5ad8a54d30853db66dec7aaee73</citedby><cites>FETCH-LOGICAL-c425t-c2d17a312eb2a399097387f80ed606cd1dabbd5ad8a54d30853db66dec7aaee73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S0399077X13001686$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3536,27903,27904,65309</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=27683648$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/23876206$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>El Moussi, A.</creatorcontrib><creatorcontrib>Ben Hadj Kacem, M.A.</creatorcontrib><creatorcontrib>Ledesma, J.</creatorcontrib><creatorcontrib>Pozo, F.</creatorcontrib><creatorcontrib>Teresa Cuevas, M.</creatorcontrib><creatorcontrib>Casas, I.</creatorcontrib><creatorcontrib>Slim, A.</creatorcontrib><title>Genetic diversity of Influenza B virus in 2009–2010 and 2010–2011 in Tunisia</title><title>Médecine et maladies infectieuses</title><addtitle>Med Mal Infect</addtitle><description>The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains.
The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009–2010 and in 2010–2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing.
The two influenza B Tunisian strains of the 2009–2010 season belonged to the Victoria lineage, whereas 2010–2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases.
Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.
Caractériser les souches de la grippe B ayant récemment circulées en Tunisie afin de déceler les nouvelles mutations en comparaison avec les souches de référence.
Dans le cadre de la surveillance épidémiologique de la grippe, 19 patients présentant des symptômes liés à l’infection des voies respiratoires se sont révélés infectés par le virus de la grippe B durant les deux saisons 2009–2010 et 2010–2011. L’identification ainsi que la détection des mutations dans le segment codant l’hémagglutinine des virus grippaux ont été réalisées au laboratoire par la technique de RT-PCR en temps réel et le séquençage.
Il s’est avéré que les deux souches Tunisiennes de la grippe B de la saison 2009–2010 appartiennent à la lignée Victoria, alors que les souches de la saison 2010–2011 sont des deux lignées B/Victoria/2/87 et B/Yamagata/16/88 avec une dominance de la lignée Yamagata (76 %). Cette étude a permis d’identifier des mutations à l’origine de substitutions d’acide aminé : T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V et K253R dans la lignée B-Yamagata ; L58P, N75K, K109N, N165K, S172P et K257R dans la lignée B-Victoria. Ces mutations sont spécifiques de groupes de variants Tunisiens. La majorité des virus de la lignée Yamagata étudiés (69 %) sont associés à des cas graves.
L’analyse moléculaire régulière des différentes souches de la grippe B circulant en Tunisie s’avère utile pour détecter de nouvelles mutations capables de modifier le phénotype des souches grippales.</description><subject>Amino Acid Sequence</subject><subject>Amino Acid Substitution</subject><subject>B/Victoria lineage</subject><subject>B/Yamagata lineage</subject><subject>Biological and medical sciences</subject><subject>Disease Outbreaks</subject><subject>Genetic Variation</subject><subject>Grippe B</subject><subject>Hemagglutinins, Viral - chemistry</subject><subject>Hemagglutinins, Viral - genetics</subject><subject>Human viral diseases</subject><subject>Humans</subject><subject>Infectious diseases</subject><subject>Influenza B virus</subject><subject>Influenza B virus - genetics</subject><subject>Influenza B virus - isolation & purification</subject><subject>Influenza, Human - epidemiology</subject><subject>Influenza, Human - virology</subject><subject>Influenza B</subject><subject>Lignée B-Victoria</subject><subject>Lignée B-Yamagata</subject><subject>Medical sciences</subject><subject>Molecular Sequence Data</subject><subject>Mutation</subject><subject>Phylogeny</subject><subject>Phylogénie</subject><subject>Point Mutation</subject><subject>Population Surveillance</subject><subject>Real-Time Polymerase Chain Reaction</subject><subject>RNA, Viral - genetics</subject><subject>Sequence Alignment</subject><subject>Sequence Homology, Amino Acid</subject><subject>Sequencing</subject><subject>Séquençage</subject><subject>Tunisia - epidemiology</subject><subject>Viral diseases</subject><subject>Viral diseases of the respiratory system and ent viral diseases</subject><issn>0399-077X</issn><issn>1769-6690</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2013</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkMGK1TAUhoM4ONfRNxDpRphNOydpm7QbQYdxHBgQYQR34TQ5hVx60zFpL4yreQdfwGeZR_FJTO1Vd7pKwvnOn5-PsRccCg5cnm2LHdkdDoUAXhYgC4D6EdtwJdtcyhYesw2UbZuDUp-P2dMYtwAisfCEHYuyUVKA3LCPl-Rpciazbk8huukuG_vsyvfDTP4rPnx_m-1dmGPmfCYA2h_335aMDL3Nlsv65sv4ZvYuOnzGjnocIj0_nCfs07uLm_P3-fWHy6vzN9e5qUQ95UZYrrDkgjqBqSe0KpXqGyArQRrLLXadrdE2WFe2hKYubSelJaMQiVR5wk7X3NswfpkpTnrnoqFhQE_jHDWvAVQLshb_R6tf-VW1oNWKmjDGGKjXt8HtMNxpDnrxrrd69a4X7xqkTt7T2svDD3OXxn-WfotOwKsDgNHg0Af0xsW_nJJNKasmca9XjpK6vaOgo3HkDVkXyEzaju7fTX4CM2ihgQ</recordid><startdate>20130801</startdate><enddate>20130801</enddate><creator>El Moussi, A.</creator><creator>Ben Hadj Kacem, M.A.</creator><creator>Ledesma, J.</creator><creator>Pozo, F.</creator><creator>Teresa Cuevas, M.</creator><creator>Casas, I.</creator><creator>Slim, A.</creator><general>Elsevier SAS</general><general>Elsevier</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>7T2</scope><scope>7T7</scope><scope>7U2</scope><scope>7U9</scope><scope>8FD</scope><scope>C1K</scope><scope>FR3</scope><scope>H94</scope><scope>P64</scope><scope>RC3</scope></search><sort><creationdate>20130801</creationdate><title>Genetic diversity of Influenza B virus in 2009–2010 and 2010–2011 in Tunisia</title><author>El Moussi, A. ; Ben Hadj Kacem, M.A. ; Ledesma, J. ; Pozo, F. ; Teresa Cuevas, M. ; Casas, I. ; Slim, A.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c425t-c2d17a312eb2a399097387f80ed606cd1dabbd5ad8a54d30853db66dec7aaee73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2013</creationdate><topic>Amino Acid Sequence</topic><topic>Amino Acid Substitution</topic><topic>B/Victoria lineage</topic><topic>B/Yamagata lineage</topic><topic>Biological and medical sciences</topic><topic>Disease Outbreaks</topic><topic>Genetic Variation</topic><topic>Grippe B</topic><topic>Hemagglutinins, Viral - chemistry</topic><topic>Hemagglutinins, Viral - genetics</topic><topic>Human viral diseases</topic><topic>Humans</topic><topic>Infectious diseases</topic><topic>Influenza B virus</topic><topic>Influenza B virus - genetics</topic><topic>Influenza B virus - isolation & purification</topic><topic>Influenza, Human - epidemiology</topic><topic>Influenza, Human - virology</topic><topic>Influenza B</topic><topic>Lignée B-Victoria</topic><topic>Lignée B-Yamagata</topic><topic>Medical sciences</topic><topic>Molecular Sequence Data</topic><topic>Mutation</topic><topic>Phylogeny</topic><topic>Phylogénie</topic><topic>Point Mutation</topic><topic>Population Surveillance</topic><topic>Real-Time Polymerase Chain Reaction</topic><topic>RNA, Viral - genetics</topic><topic>Sequence Alignment</topic><topic>Sequence Homology, Amino Acid</topic><topic>Sequencing</topic><topic>Séquençage</topic><topic>Tunisia - epidemiology</topic><topic>Viral diseases</topic><topic>Viral diseases of the respiratory system and ent viral diseases</topic><toplevel>online_resources</toplevel><creatorcontrib>El Moussi, A.</creatorcontrib><creatorcontrib>Ben Hadj Kacem, M.A.</creatorcontrib><creatorcontrib>Ledesma, J.</creatorcontrib><creatorcontrib>Pozo, F.</creatorcontrib><creatorcontrib>Teresa Cuevas, M.</creatorcontrib><creatorcontrib>Casas, I.</creatorcontrib><creatorcontrib>Slim, A.</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>Health and Safety Science Abstracts (Full archive)</collection><collection>Industrial and Applied Microbiology Abstracts (Microbiology A)</collection><collection>Safety Science and Risk</collection><collection>Virology and AIDS Abstracts</collection><collection>Technology Research Database</collection><collection>Environmental Sciences and Pollution Management</collection><collection>Engineering Research Database</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>Genetics Abstracts</collection><jtitle>Médecine et maladies infectieuses</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El Moussi, A.</au><au>Ben Hadj Kacem, M.A.</au><au>Ledesma, J.</au><au>Pozo, F.</au><au>Teresa Cuevas, M.</au><au>Casas, I.</au><au>Slim, A.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Genetic diversity of Influenza B virus in 2009–2010 and 2010–2011 in Tunisia</atitle><jtitle>Médecine et maladies infectieuses</jtitle><addtitle>Med Mal Infect</addtitle><date>2013-08-01</date><risdate>2013</risdate><volume>43</volume><issue>8</issue><spage>337</spage><epage>344</epage><pages>337-344</pages><issn>0399-077X</issn><eissn>1769-6690</eissn><coden>MMAIB5</coden><abstract>The authors had for aim to characterize influenza B strains having circulated in Tunisia to identify new mutations and compare them with reference strains.
The epidemiological surveillance of influenza allowed identifying 19 patients with symptoms related to respiratory infection, who had been infected by influenza B strains isolated in several regions of Tunisia in 2009–2010 and in 2010–2011. Laboratory identification and detection of mutations in the segment encoding hemagglutinin of influenza viruses was performed by real time PCR and sequencing.
The two influenza B Tunisian strains of the 2009–2010 season belonged to the Victoria lineage, whereas 2010–2011 season strains belonged to B/Victoria/2/87 and B/Yamagata/16/88 lineages with a dominance of the Yamagata lineage (76%). This study allowed identifying amino acid substitutions: T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V and K253R in the B/Yamagata lineage; L58P, N75K, K109N, N165K, S172P and K257R into the B/Victoria lineage. These mutations were specific of Tunisian groups of variants. Most influenza B-Yamagata lineage viruses (69%) were associated with severe cases.
Molecular analysis of the various influenza B strains circulating in Tunisia is useful to detect new mutations that can modify the phenotype of influenza strains.
Caractériser les souches de la grippe B ayant récemment circulées en Tunisie afin de déceler les nouvelles mutations en comparaison avec les souches de référence.
Dans le cadre de la surveillance épidémiologique de la grippe, 19 patients présentant des symptômes liés à l’infection des voies respiratoires se sont révélés infectés par le virus de la grippe B durant les deux saisons 2009–2010 et 2010–2011. L’identification ainsi que la détection des mutations dans le segment codant l’hémagglutinine des virus grippaux ont été réalisées au laboratoire par la technique de RT-PCR en temps réel et le séquençage.
Il s’est avéré que les deux souches Tunisiennes de la grippe B de la saison 2009–2010 appartiennent à la lignée Victoria, alors que les souches de la saison 2010–2011 sont des deux lignées B/Victoria/2/87 et B/Yamagata/16/88 avec une dominance de la lignée Yamagata (76 %). Cette étude a permis d’identifier des mutations à l’origine de substitutions d’acide aminé : T121A, S150I, N165Y, T181A, G183R, D196N, S229D, M251V et K253R dans la lignée B-Yamagata ; L58P, N75K, K109N, N165K, S172P et K257R dans la lignée B-Victoria. Ces mutations sont spécifiques de groupes de variants Tunisiens. La majorité des virus de la lignée Yamagata étudiés (69 %) sont associés à des cas graves.
L’analyse moléculaire régulière des différentes souches de la grippe B circulant en Tunisie s’avère utile pour détecter de nouvelles mutations capables de modifier le phénotype des souches grippales.</abstract><cop>Paris</cop><pub>Elsevier SAS</pub><pmid>23876206</pmid><doi>10.1016/j.medmal.2013.06.005</doi><tpages>8</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 0399-077X |
| ispartof | Médecine et maladies infectieuses, 2013-08, Vol.43 (8), p.337-344 |
| issn | 0399-077X 1769-6690 |
| language | eng |
| recordid | cdi_proquest_miscellaneous_1500790652 |
| source | MEDLINE; Elsevier ScienceDirect Journals |
| subjects | Amino Acid Sequence Amino Acid Substitution B/Victoria lineage B/Yamagata lineage Biological and medical sciences Disease Outbreaks Genetic Variation Grippe B Hemagglutinins, Viral - chemistry Hemagglutinins, Viral - genetics Human viral diseases Humans Infectious diseases Influenza B virus Influenza B virus - genetics Influenza B virus - isolation & purification Influenza, Human - epidemiology Influenza, Human - virology Influenza B Lignée B-Victoria Lignée B-Yamagata Medical sciences Molecular Sequence Data Mutation Phylogeny Phylogénie Point Mutation Population Surveillance Real-Time Polymerase Chain Reaction RNA, Viral - genetics Sequence Alignment Sequence Homology, Amino Acid Sequencing Séquençage Tunisia - epidemiology Viral diseases Viral diseases of the respiratory system and ent viral diseases |
| title | Genetic diversity of Influenza B virus in 2009–2010 and 2010–2011 in Tunisia |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T19%3A23%3A57IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_cross&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Genetic%20diversity%20of%20Influenza%C2%A0B%20virus%20in%202009%E2%80%932010%20and%202010%E2%80%932011%20in%20Tunisia&rft.jtitle=Me%CC%81decine%20et%20maladies%20infectieuses&rft.au=El%20Moussi,%20A.&rft.date=2013-08-01&rft.volume=43&rft.issue=8&rft.spage=337&rft.epage=344&rft.pages=337-344&rft.issn=0399-077X&rft.eissn=1769-6690&rft.coden=MMAIB5&rft_id=info:doi/10.1016/j.medmal.2013.06.005&rft_dat=%3Cproquest_cross%3E1500790652%3C/proquest_cross%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=1430853442&rft_id=info:pmid/23876206&rft_els_id=S0399077X13001686&rfr_iscdi=true |