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Full-Text Articles in Organisms

What? Is Epstein–Barr Virus Infection Linked To Multiple Sclerosis?, Asha Mahajan, Steven B Lippmann Oct 2022

What? Is Epstein–Barr Virus Infection Linked To Multiple Sclerosis?, Asha Mahajan, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Do You Know The Pathophysiology Of Cytokine Storm During Covid-19?, Shameera Shaik Masthan, Deekshitha Turaka, Ahmed Abdelhaleem, Mounica Vorla, Steven B. Lippmann Sep 2022

Do You Know The Pathophysiology Of Cytokine Storm During Covid-19?, Shameera Shaik Masthan, Deekshitha Turaka, Ahmed Abdelhaleem, Mounica Vorla, Steven B. Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


An Unexpected Case Of Herpes Simplex Virus Esophagitis Presenting Amidst Corticosteroid Therapy For An Acute Copd Exacerbation: A Case Report, Aqeel Khanani, Kayvan Mirhadi Sep 2022

An Unexpected Case Of Herpes Simplex Virus Esophagitis Presenting Amidst Corticosteroid Therapy For An Acute Copd Exacerbation: A Case Report, Aqeel Khanani, Kayvan Mirhadi

Advances in Clinical Medical Research and Healthcare Delivery

Herpes simplex virus (HSV) is prevalent worldwide, with a recent report by the World Health Organization estimating that 3.7 billion individuals under the age of 50 have been infected by the virus. After the initial infection, HSV-1 enters a latent phase with the potential for intermittent reactivation, often secondary to episodes of infection, stress, or immunosuppression. Per current literature review, esophageal involvement in the form of herpes simplex virus esophagitis (HSVE) is more commonly associated with immunocompromised patients, such as transplant recipients and HIV-positive individuals. The patient discussed in this report is a 79-year-old female with a past medical history …


What About Anosmia From Covid-19 ?, Sharanya S E Santhi, Sara Elnour, Steven B Lippmann Jul 2022

What About Anosmia From Covid-19 ?, Sharanya S E Santhi, Sara Elnour, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Genetic Diversity Of Cladosporium Species Isolated From Air Of Cairo, Egypt Using Microsatellite Primed Pcr (Mp-Pcr) And Universally Primed Pcr (Up-Pcr) Techniques, Mohammed Salah Abdulrahman, Hamido M. Hefny, Moselhy S. Mansy, Amal A. I. Mekawey Jul 2022

Genetic Diversity Of Cladosporium Species Isolated From Air Of Cairo, Egypt Using Microsatellite Primed Pcr (Mp-Pcr) And Universally Primed Pcr (Up-Pcr) Techniques, Mohammed Salah Abdulrahman, Hamido M. Hefny, Moselhy S. Mansy, Amal A. I. Mekawey

Bulletin of Faculty of Pharmacy Cairo University

The samples were then identified by macroscopic and microscopical methods, Molecular fingerprinting, of Cladosporium strains populations depending on MP-PCR using Primers (AGG) 5 , (CAG) 5 , (GACA) 4 , and (AG) 8 C. In addition, we have applied the UP-PCR technique using L21 and Fok1 Genotyping patterns extracted by MP-PCR showed good discrimination with amplification of (AGG) 5 , (AG) 8 C and (CAG) 5 over (GACA) 4. In addition, L21 primer revealed variability over FOK1 primer. current work indicate that MP-PCR and UP-PCR fingerprinting method are appropriate for characterization of large groups of Cladosporium due to its simplicity


Bio-Insecticide’S Extract Of Scented Root (Polygala Paniculata) In Controlling The Mosquito Aedes Aegypti (L.), Denai Wahyuni, Nila Puspita Sari, Jasril Jasril, Jufrizal Syahri Jun 2022

Bio-Insecticide’S Extract Of Scented Root (Polygala Paniculata) In Controlling The Mosquito Aedes Aegypti (L.), Denai Wahyuni, Nila Puspita Sari, Jasril Jasril, Jufrizal Syahri

Makara Journal of Science

Controlling Aedes aegypti mosquitoes with chemical insecticides causes resistance on humans, environmental residues, and contaminates food and water. Polygala paniculata is a potential alternative to insecticides in controlling Ae. aegypti. This study aimed to determine the effect of the Insecticide Score of P. paniculata extracts on the mortality of Ae. aegypti mosquitoes based on KT50. A total of 20 mosquitoes for each concentration were used to examine the effectiveness of 10%, 15%, 20%, and 25% concentration of P. paniculata extracts compared to a positive and a negative control with four replications. The results showed that P. paniculata extracts …


Treating Cytokine Storm In Patients With Covid-19, Ahmed Abdelhaleem, Deekshitha Turaka, Shameera Shaik Masthan, Steven B Lippmann Jun 2022

Treating Cytokine Storm In Patients With Covid-19, Ahmed Abdelhaleem, Deekshitha Turaka, Shameera Shaik Masthan, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


A Case Report Of Pulmonary Actinomycosis: A Diagnostic Quagmire, Sarah Akbani, Aderinsola O. Ademiluyi, Jonathan Dean, Vinita Mathur May 2022

A Case Report Of Pulmonary Actinomycosis: A Diagnostic Quagmire, Sarah Akbani, Aderinsola O. Ademiluyi, Jonathan Dean, Vinita Mathur

Advances in Clinical Medical Research and Healthcare Delivery

The implications of misdiagnosis can be drastic, especially when the correct diagnosis is treatable. Pulmonary actinomycosis is one of the complications of infection with actinomyces, an anaerobic gram-positive organism that is usually found as a part of the normal flora in the human body infection. It is a very rare disease and is frequently mistaken with other diagnoses owing to its nonspecific presentation. In this report, we present a 67-year-old male with a mass like lesion on a CT scan of his chest that was done due to progressively worsening productive cough, weight loss and fatigue. These symptoms could have …


Antimicrobial Stewardship Meets Transitions Of Care: Defining Length Of Therapy For Community-Acquired Pneumonia (Cap), Christopher Whitman, Sarah E. Moore Pharmd, Matthew Song Pharmd, Bcidp, Brian C. Bohn Pharmd, Bcidp, Ashley M. Wilde May 2022

Antimicrobial Stewardship Meets Transitions Of Care: Defining Length Of Therapy For Community-Acquired Pneumonia (Cap), Christopher Whitman, Sarah E. Moore Pharmd, Matthew Song Pharmd, Bcidp, Brian C. Bohn Pharmd, Bcidp, Ashley M. Wilde

The University of Louisville Journal of Respiratory Infections

Introduction: Hospital-based antimicrobial stewardship efforts have traditionally focused on inpatient settings. Antibiotic prescribing at discharge is often an overlooked area of focus for antimicrobial stewardship programs. Discharge prescribing optimization is necessary to combat antibiotic overuse.

Methods: This was an observational, retrospective cohort study at a four–adult community hospital system. Four hundred adult patients admitted with community-acquired pneumonia and discharged with antibiotics were included. The primary outcome was overall (inpatient and discharge) antibiotic length of therapy. The secondary outcome was percentage of patients discharged on a fluoroquinolone who had not received one in the hospital. Descriptive statistics were utilized.

Results: The …


Covid-19 Case Complicated With Organizing Pneumonia And Pneumothorax: Correspondence, Hammad A. Bhatti, Minh Q. Ho May 2022

Covid-19 Case Complicated With Organizing Pneumonia And Pneumothorax: Correspondence, Hammad A. Bhatti, Minh Q. Ho

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Covid-19, Vaccination, And Heart Transplantation, Forest W. Arnold May 2022

Covid-19, Vaccination, And Heart Transplantation, Forest W. Arnold

The University of Louisville Journal of Respiratory Infections

No abstract provided.


A Fatal Case Of Covid-19 Pneumonia In A Fully Vaccinated Heart Transplant Recipient, Agastya D. Belur, Diana Otero, Christina Dunbar Matos May 2022

A Fatal Case Of Covid-19 Pneumonia In A Fully Vaccinated Heart Transplant Recipient, Agastya D. Belur, Diana Otero, Christina Dunbar Matos

The University of Louisville Journal of Respiratory Infections

The development and administration of mRNA vaccines against SARS-CoV-2 are seeing lower numbers of COVID-19 cases and fatalities among fully vaccinated, immunocompetent adults. We present a case of fatal COVID-19 pneumonia in a heart transplant recipient who had received two doses of mRNA COVID-19 vaccine before the Centers for Disease Control and Prevention had recommended additional doses.


Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md May 2022

Neurosyphilis: A Monkey Among Men, Cameron Rowe Do, Nathan Buckley Do, Bhaskar Chhetri Md, Suresh Paudel Md

Journal of Community Hospital Internal Medicine Perspectives

Neurosyphilis is the progression of the untreated sexually transmitted infection caused by Treponema pallidum. When the initial infection is not adequately treated, progression of primary syphilis can lead to a wide variety of serious health sequelae. While neurosyphilis can appear up to 10-30 years after the initial infection, syphilis can invade the nervous system at any stage of infection and can imitate symptoms of many other diseases. This variety of symptoms is why syphilis has been called “The Great Pretender” or “The monkey among diseases” (12). This is a case report of an 83-year-old female with a history of multiple …


Bartonella Henselea Prosthetic Valve Endocarditis Mimicking Vasculitis: A Case Report With Literature Review, Troy J. Fishman, Efrain Irizarry, Ayesha Kaleem, Robert Yancey, Uma Iyer Apr 2022

Bartonella Henselea Prosthetic Valve Endocarditis Mimicking Vasculitis: A Case Report With Literature Review, Troy J. Fishman, Efrain Irizarry, Ayesha Kaleem, Robert Yancey, Uma Iyer

HCA Healthcare Journal of Medicine

We present one of the first reported cases of Bartonella henselae prosthetic valve endocarditis, which mimicked p-antineutrophil cytoplasmic autoantibody (p-ANCA), an anti-proteinase 3 positive necrotizing glomerulonephritis caused by a cat scratch resulting in temporary dialysis. Documentation of such infections is necessary as zoonotic infections are becoming more prevalent with early identification essential for proper treatment. Although pauci-immune patterns are not a unique finding in bacterial endocarditis associated with glomerulonephritis, they are an atypical finding in Bartonella henselae endocarditis. Furthermore, p-ANCA-associated vasculitis can also be responsible for renal and cardiac disease. Because of the similar disease presentation of different etiologies (autoimmune …


Covid-19 Case Complicated With Organizing Pneumonia And Pneumothorax: A Case Report, Tammy E. Phillips, Hammad A. Bhatti, Minh Q. Ho Apr 2022

Covid-19 Case Complicated With Organizing Pneumonia And Pneumothorax: A Case Report, Tammy E. Phillips, Hammad A. Bhatti, Minh Q. Ho

The University of Louisville Journal of Respiratory Infections

Organizing pneumonia can be idiopathic or caused by multiple etiologies, including viral or bacterial pneumonia, drugs, and autoimmune disorders. It can rarely lead to cyst formation and pneumothorax with the exact mechanism remaining unclear. This case presents a previously healthy 50-year-old male who contracted COVID-19 with subsequent development of organizing pneumonia and pneumothorax. Patients presenting with hypoxic respiratory failure due to COVID-19 should be screened for organizing pneumonia upon discharge. This case also illustrates the importance of following such patients radiologically to monitor interstitial lung disease and consider pneumothorax for patients re-presenting with acute symptoms.


Sotrovimab: Neutralizing Antibody To Combat Covid-19, Aya Allam, Steven Lippmann Apr 2022

Sotrovimab: Neutralizing Antibody To Combat Covid-19, Aya Allam, Steven Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Are Antipyretic Medications Compatible With Sars-Cov-2 Vaccines?, Sharanya S E Santhi, Niguma Rayamajhi, Steven B Lippmann Apr 2022

Are Antipyretic Medications Compatible With Sars-Cov-2 Vaccines?, Sharanya S E Santhi, Niguma Rayamajhi, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


Mucormycosis: Covid-19 And Corticosteroids, Mittal Savaliya, Nivedita Jha, Steven B Lippmann Apr 2022

Mucormycosis: Covid-19 And Corticosteroids, Mittal Savaliya, Nivedita Jha, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

No abstract provided.


The Large And Small Of It: The Microbiome And Metagenomics, Austin Hopkins, Elaina Gollmar, Jessica Fernandez, Shawn Wolf, Austin Hilverding, Andrew M. Roecker Mar 2022

The Large And Small Of It: The Microbiome And Metagenomics, Austin Hopkins, Elaina Gollmar, Jessica Fernandez, Shawn Wolf, Austin Hilverding, Andrew M. Roecker

Pharmacy and Wellness Review

Metagenomics, the analysis of the microbial genome, permits scientists to understand the influences of external sources including diet, metabolism and antibiotics on the human microbiome. Research has revealed the possibility of a core symbiosis between humans and bacteria. The main role of the human microbiome is to aid in digestion, but identified ancillary roles include immunologic homeostasis and infection prevention. Quantifying the composition and variability of the microbiome will help lead to future treatments or preventive strategies against unhealthy change. A variety of methods may be used to define the microbiome, and 16S amplicon sequencing is primarily utilized today. Probiotics …


Pulmonary Post-Acute Sequelae Of Covid-19, Usman Akbar, Shivam Gulati, Johnny Zakhour Md, Alex Glynn, Jose Bordon Feb 2022

Pulmonary Post-Acute Sequelae Of Covid-19, Usman Akbar, Shivam Gulati, Johnny Zakhour Md, Alex Glynn, Jose Bordon

The University of Louisville Journal of Respiratory Infections

Introduction: Persistent symptoms have been observed in a substantial proportion of survivors of COVID-19 since relatively early in the pandemic. Among these post-acute sequelae of COVID-19 (PASC), respiratory symptoms appear to be the most prevalent.

Methods: We conducted a literature review of peer-reviewed publications in English on the clinical and epidemiological features of respiratory PASC in cohorts of 100 or more patients with a follow-up of four weeks or more after acute infection. Included studies reported the prevalence of persistent respiratory symptoms and/or the results of follow-up pulmonary function tests.

Results: On our review included 14 studies across eight countries …


Prevalence And Types Of Drugs Used Among Hepatitis A Patients During Outbreaks Associated With Person-To-Person Transmission, Kentucky, Michigan, And West Virginia, 2016–2019, Megan G. Hofmeister, Alice Asher, Christopher M. Jones, Ryan J. Augustine, Cole Burkholder, Jim Collins, Monique A. Foster, Shannon Mcbee, Erica D. Thomasson, Doug Thoroughman, Mark K. Weng, Philip R. Spradling Feb 2022

Prevalence And Types Of Drugs Used Among Hepatitis A Patients During Outbreaks Associated With Person-To-Person Transmission, Kentucky, Michigan, And West Virginia, 2016–2019, Megan G. Hofmeister, Alice Asher, Christopher M. Jones, Ryan J. Augustine, Cole Burkholder, Jim Collins, Monique A. Foster, Shannon Mcbee, Erica D. Thomasson, Doug Thoroughman, Mark K. Weng, Philip R. Spradling

Journal of Appalachian Health

Background: People who use drugs are at increased risk for hepatitis A virus infection. Since 1996, the Advisory Committee on Immunization Practices has recommended hepatitis A vaccination for people who use drugs. Since 2016, the U.S. has experienced widespread hepatitis A outbreaks associated with person-to-person transmission.

Purpose: To describe the prevalence of drug use, route of use, and drugs used among hepatitis A outbreak-associated patients.

Methods: State outbreak and medical records were reviewed to describe the prevalence, type, and route of drug use among a random sample of 812 adult outbreak-associated hepatitis A patients from Kentucky, Michigan, and West Virginia …


The Aoc In The Age Of Covid—Pandemic Preparedness Planning In The Federal Courts, Zoe Niesel Feb 2022

The Aoc In The Age Of Covid—Pandemic Preparedness Planning In The Federal Courts, Zoe Niesel

St. Mary's Law Journal

The 2020 COVID-19 pandemic created a crisis for American society—and the federal courts were not exempt. Court facilities came to a grinding halt, cases were postponed, and judiciary employees adopted work-from-home practices. Having court operations impacted by a pandemic was not a new phenomenon, but the size, scope, and technological lift of the COVID-19 pandemic was certainly unique.

Against this background, this Article examines the history and future of pandemic preparedness planning in the federal court system and seeks to capture some of the lessons learned from initial federal court transitions to pandemic operations in 2020. The Article begins by …


Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern Feb 2022

Implementation Of A Drive-Through Covid-19 Mass Vaccination Site: Experiences From Louvax–Broadbent In Louisville, Kentucky, Ruth Carrico, Sarah Beth Hartlage, Valenchia Brown Msn, Aprn, Fnp-C, Sarah M. Bishop, Luanne Didelot, William Hayden, Beverly Williams Coleman, Sarah Tan, Delanor Manson, Kellie Kane, Dawn Balcom, Paul Kern

The University of Louisville Journal of Respiratory Infections

Background: Response to the COVID-19 pandemic has required innovative approaches to vaccination, including methods to rapidly and safely immunize communities. A major challenge to such a response involved access to untapped healthcare worker resources. The Louisville, Kentucky, response involved the use of a large volunteer workforce to supplement local public health employees in planning and implementing a large-scale drive-through vaccination event. The objective of this manuscript was to outline processes involved in training a mass immunization workforce and implementating a large-scale COVID-19 community vaccination.

Approach: Competency-based and standardized training was provided for every volunteer before working their shift. Volunteers worked …


The Impact Of Delivery Mode On The Human Microbiome: A Global Perspective, Fizzah Qureshi, Fiza Edhi, Andrew T. Ozga Jan 2022

The Impact Of Delivery Mode On The Human Microbiome: A Global Perspective, Fizzah Qureshi, Fiza Edhi, Andrew T. Ozga

Mako: NSU Undergraduate Student Journal

The mode of childbirth in humans (vaginal or cesarean section) is considered to be one of the most influential factors in the development of gut microbiota of an infant. A microbiome is defined as a collection of microorganisms that are concentrated together in a single location or body site. The genetic material of all microbes, including bacteria, viruses, and fungi, comprises this complex ecosystem. The gut microbiota regulate digestion and strengthen the immune system in humans, helping to maintain homeostasis and are at the early stages of life, dictated by the method of delivery. Vaginal versus cesarean deliveries have increased …


Strong Inferences About Pain In Invertebrates Require Stronger Evidence, Edgar T. Walters Jan 2022

Strong Inferences About Pain In Invertebrates Require Stronger Evidence, Edgar T. Walters

Animal Sentience

Evidence for sentience in animals distantly related to humans is often sought in observations of behavioral and neural responses to noxious stimuli that would be painful in humans. Most proposed criteria for painful sentience in “lower” animals such as decapod crustaceans have no necessary links to the affective (“suffering”) component of pain. The best evidence for painful affect in animals is learned aversion to stimuli associated with noxious experience, and conditioned preference for contexts associated with relief from aversive consequences of noxious experience, as expressed in voluntary behavior. Such evidence is currently lacking for any invertebrate except octopus.


No Difference In Corticosterone Concentrations Between Missouri Three-Toed Box Turtles Living In An Urban And A Rural Site, Bennett A. Lamczyk, Jamie L. Palmer, Corinne P. Kozlowski, Stephen Blake, Sharon L. Deem Jan 2022

No Difference In Corticosterone Concentrations Between Missouri Three-Toed Box Turtles Living In An Urban And A Rural Site, Bennett A. Lamczyk, Jamie L. Palmer, Corinne P. Kozlowski, Stephen Blake, Sharon L. Deem

Human–Wildlife Interactions

Baseline health data for species of conservation concern are important for understanding threats to the long-term viability of populations. One indication of health is physiological stress among individuals. Corticosterone (CORT) is frequently used to quantify stress in free-living reptile populations, as high values may be associated with reduced fitness. Herein, we describe and validate methods for quantifying blood CORT levels in three-toed box turtles (Terrapene mexicana triunguis). We subsequently use this information to evaluate stress levels in 2 populations of free-living three-toed box turtles in Missouri, USA. To our knowledge, this is the first quantification of CORT levels …


Consultation/Liaison Psychiatry During Covid-19, Robert Frierson, Steven B Lippmann Dec 2021

Consultation/Liaison Psychiatry During Covid-19, Robert Frierson, Steven B Lippmann

The University of Louisville Journal of Respiratory Infections

Consultation/liaison psychiatrists care for people with co-existing medical and psychologic difficulties. The coronavirus pandemic is stressful for patients and their psychiatric caregivers. Patients have lost support systems and harbor fears about exposing family to the virus. COVID-19 sometimes exacerbates previous psychiatric conditions, while diminishing intimacy with physicians. Everyone is oversaturated with COVID-19-related news focusing on rising concerns about the illness and about jobs, school, and housing insecurities.

The psychiatrist maintains a hospital presence despite fear of contracting the disease. Challenges include addressing staff morale, evidencing empathy despite telecommunication devices, and treating anxiety, depression, sleep phobias, post intubation flashbacks, COVID-19-induced cognitive …


Eradication Of Enterococcus Faecalis In Conventional Endodontic Retreatments (A Randomized Clinical Trial), Fadl H. Khaled, Roula S. Abiad, Khaled Abd El Galil, Essam Osman Nov 2021

Eradication Of Enterococcus Faecalis In Conventional Endodontic Retreatments (A Randomized Clinical Trial), Fadl H. Khaled, Roula S. Abiad, Khaled Abd El Galil, Essam Osman

BAU Journal - Creative Sustainable Development

Enterococcus faecalis is the most common bacteria isolated in conventional endodontic retreatments. Aim: To compare the impact of three irrigation modalities on the elimination of the isolated microbial strains of Enterococcus faecalis. Materials and Methods: Thirty patients requiring conventional endodontic retreatment for one of their mandibular premolars and tested positive for E. faecalis were chosen. Patients were randomly divided into three groups (n=10) according to the irrigation modality to be used; group I: syringe irrigation (NaOCl 2.625%), group II: NaOCl 2.625%+EndoActivator and group III: NaOCl 2.625%+diode laser. Before obturation, samples S2 were collected and PCR analysis was performed to identify …


Ecthyma Gangrenosum And Panniculitis Secondary To Acute Pseudomonas Myositis Without Bacteremia, Heather Gosnell, Matthew Burke, Joseph Shnouda Oct 2021

Ecthyma Gangrenosum And Panniculitis Secondary To Acute Pseudomonas Myositis Without Bacteremia, Heather Gosnell, Matthew Burke, Joseph Shnouda

HCA Healthcare Journal of Medicine

Introduction

Ecthyma gangrenosum (EG) is a relatively uncommon cutaneous manifestation of an underlying Pseudomonas aeruginosa infection and is clinically described as necrotic with gangrenous ulcers surrounded by erythematous halos. Cases of EG may occur in the absence of bacteremia and have been increasingly reported in literature. Here we present a patient with features of both EG and panniculitis, despite the lack of underlying bacteremia.

Clinical Findings

A 57-year-old male presented to the emergency department with unrelenting right-sided lower back pain and an “itchy and painful” rash of four to five day duration. The patient had an extensive history of intravenous …


A Research Framework For Evaluating Next Generation Sequencing In Community-Acquired Pneumonia, Ashley M. Wilde, Elena Swingler, Sarah E. Moore Pharmd, Brian C. Bohn Pharmd, Matthew Song Pharmd, Bcidp, Ruth Carrico, Julio A. Ramirez Oct 2021

A Research Framework For Evaluating Next Generation Sequencing In Community-Acquired Pneumonia, Ashley M. Wilde, Elena Swingler, Sarah E. Moore Pharmd, Brian C. Bohn Pharmd, Matthew Song Pharmd, Bcidp, Ruth Carrico, Julio A. Ramirez

The University of Louisville Journal of Respiratory Infections

No abstract provided.