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Article ; Online: The Effect of the Gut Microbiota on Transplanted Kidney Function.

Przybyciński, Jarosław / Drożdżal, Sylwester / Wilk, Aleksandra / Dziedziejko, Violetta / Szumilas, Kamila / Pawlik, Andrzej

International journal of molecular sciences

2023 Volume 24, Issue 2

Abstract: The intestinal microflora is extremely important, not only in the processes of absorption, digestion and biosynthesis of vitamins, but also in shaping the immune and cognitive functions of the human body. Several studies demonstrate a correlation between ...

Abstract	The intestinal microflora is extremely important, not only in the processes of absorption, digestion and biosynthesis of vitamins, but also in shaping the immune and cognitive functions of the human body. Several studies demonstrate a correlation between microbiota composition and such events as graft rejection, kidney interstitial fibrosis, urinary tract infections, and diarrhoea or graft tolerance. Some of those changes might be directly linked with pathologies such as colonization with pathogenic bacterial strains. Gut microbiota composition also plays an important role in metabolic complications and viral infections after transplantation. From the other side, gut microbiota might induce graft tolerance by promotion of T and B regulatory cells. Graft tolerance induction is still an extremely important issue regarding transplantology and might allow the reduction or even avoidance of immunosuppressive treatment. Although there is a rising evidence of the pivotal role of gut microbiota in aspects of kidney transplantation there is still a lack of knowledge on the direct mechanisms of microbiota action. Furthermore, some of those negative effects could be reversed by probiotics of faecal microbiota trapoinsplantation. While diabetes and hypertension as well as BKV and CMV viremia are common and important complications of transplantation, both worsening the graft function and causing systemic injuries, it opens up potential clinical treatment options. As has been also suggested in the current review, some bacterial subsets exhibit protective properties. However, currently, there is a lack of evidence on pro- and prebiotic supplementation in kidney transplant patients. In the current review, we describe the effect of the microbiota on the transplanted kidney in renal transplant recipients.
MeSH term(s)	Humans ; Gastrointestinal Microbiome ; Kidney ; Kidney Transplantation/adverse effects ; Immunosuppressive Agents ; Virus Diseases ; Bacteria
Chemical Substances	Immunosuppressive Agents
Language	English
Publishing date	2023-01-09
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms24021260
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Article ; Online: Role of Endothelial Glucocorticoid Receptor in the Pathogenesis of Kidney Diseases.

Przybyciński, Jarosław / Drożdżal, Sylwester / Domański, Leszek / Dziedziejko, Violetta / Pawlik, Andrzej

International journal of molecular sciences

2021 Volume 22, Issue 24

Abstract: Glucocorticoids, as multifunctional hormones, are widely used in the treatment of various diseases including nephrological disorders. They are known to affect immunological cells, effectively treating many autoimmune and inflammatory processes. ... ...

Abstract	Glucocorticoids, as multifunctional hormones, are widely used in the treatment of various diseases including nephrological disorders. They are known to affect immunological cells, effectively treating many autoimmune and inflammatory processes. Furthermore, there is a growing body of evidence demonstrating the potent role of glucocorticoids in non-immune cells such as podocytes. Moreover, novel data show additional pathways and processes affected by glucocorticoids, such as the Wnt pathway or autophagy. The endothelium is currently considered as a key organ in the regulation of numerous kidney functions such as glomerular filtration, vascular tone and the regulation of inflammation and coagulation. In this review, we analyse the literature concerning the effects of endothelial glucocorticoid receptor signalling on kidney function in health and disease, with special focus on hypertension, diabetic kidney disease, glomerulopathies and chronic kidney disease. Recent studies demonstrate the potential role of endothelial GR in the prevention of fibrosis of kidney tissue and cell metabolism through Wnt pathways, which could have a protective effect against disease progression. Another important aspect covered in this review is blood pressure regulation though GR and eNOS. We also briefly cover potential therapies that might affect the endothelial glucocorticoid receptor and its possible clinical implications, with special interest in selective or local GR stimulation and potential mitigation of GC treatment side effects.
MeSH term(s)	Animals ; Diabetic Nephropathies/metabolism ; Endothelium, Vascular/metabolism ; Glucocorticoids/metabolism ; Humans ; Podocytes/metabolism ; Receptors, Glucocorticoid/metabolism ; Wnt Signaling Pathway
Chemical Substances	Glucocorticoids ; Receptors, Glucocorticoid
Language	English
Publishing date	2021-12-10
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2019364-6
ISSN	1422-0067 ; 1422-0067 ; 1661-6596
ISSN (online)	1422-0067
ISSN	1422-0067 ; 1661-6596
DOI	10.3390/ijms222413295
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Article ; Online: Cardiac Delirium Index for Predicting the Occurrence of Postoperative Delirium in Adult Patients After Coronary Artery Bypass Grafting.

Lechowicz, Kacper / Szylińska, Aleksandra / Listewnik, Mariusz / Drożdżal, Sylwester / Tomska, Natalia / Rotter, Iwona / Kotfis, Katarzyna

Clinical interventions in aging

2021 Volume 16, Page(s) 487–495

Abstract: Background: Postoperative delirium (POD) is a serious complication of cardiac surgery. It is an acute neuropsychiatric syndrome. The aim of this study was to analyze the CARDEL Index, composed of advancing age, preoperative glycated hemoglobin and the ... ...

Abstract	Background: Postoperative delirium (POD) is a serious complication of cardiac surgery. It is an acute neuropsychiatric syndrome. The aim of this study was to analyze the CARDEL Index, composed of advancing age, preoperative glycated hemoglobin and the platelet-to-WBC ratio (PWR) previously described and calculated, using a different patient database, to assess its usefulness as a marker for predicting postoperative delirium after coronary artery by-pass grafting (CABG). Methods: A retrospective analysis of 1098 patients who underwent, isolated CABG procedures between 2017 and 2019 was performed. Results: Within the study group, 164/1098 (14.93%) patients were diagnosed with delirium. Preoperative inflammatory parameters were elevated in patients with delirium: White Blood Cell count (p=0.003), Neutrophil count (p=0.016) and C-reactive protein (p<0.001). A decrease in preoperative PWR was shown in patients with delirium (p=0.008). Delirious patients spent more time mechanically ventilated (p<0.001) and had longer hospitalization times (p=0.002). Mortality at 1 year was significantly higher in patients with POD (p<0.001). The CARDEL Index in this study group for POD detection has the largest area under the curve (AUC) of 0.664 (p<0.001) and a cut-off value of 8.08. Conclusion: CARDEL Index may be treated as a potentially valuable tool for delirium prediction in patients after CABG.
MeSH term(s)	Aged ; Biomarkers/blood ; C-Reactive Protein/analysis ; Coronary Artery Bypass/adverse effects ; Delirium/blood ; Delirium/etiology ; Female ; Humans ; Male ; Middle Aged ; Postoperative Complications/epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors
Chemical Substances	Biomarkers ; C-Reactive Protein (9007-41-4)
Language	English
Publishing date	2021-03-17
Publishing country	New Zealand
Document type	Journal Article
ZDB-ID	2364924-0
ISSN	1178-1998 ; 1176-9092
ISSN (online)	1178-1998
ISSN	1176-9092
DOI	10.2147/CIA.S302526
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Article: COVID-19-The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection.

Kotfis, Katarzyna / Lechowicz, Kacper / Drożdżal, Sylwester / Niedźwiedzka-Rystwej, Paulina / Wojdacz, Tomasz K / Grywalska, Ewelina / Biernawska, Jowita / Wiśniewska, Magda / Parczewski, Miłosz

Pharmaceuticals (Basel, Switzerland)

2021 Volume 14, Issue 1

Abstract: In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO). The clinical course of the disease is unpredictable but may lead to severe acute respiratory infection (SARI) ... ...

Abstract	In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO). The clinical course of the disease is unpredictable but may lead to severe acute respiratory infection (SARI) and pneumonia leading to acute respiratory distress syndrome (ARDS). It has been shown that pulmonary fibrosis may be one of the major long-term complications of COVID-19. In animal models, the use of spironolactone was proven to be an important drug in the prevention of pulmonary fibrosis. Through its dual action as a mineralocorticoid receptor (MR) antagonist and an androgenic inhibitor, spironolactone can provide significant benefits concerning COVID-19 infection. The primary effect of spironolactone in reducing pulmonary edema may also be beneficial in COVID-19 ARDS. Spironolactone is a well-known, widely used and safe anti-hypertensive and antiandrogenic medication. It has potassium-sparing diuretic action by antagonizing mineralocorticoid receptors (MRs). Spironolactone and potassium canrenoate, exerting combined pleiotropic action, may provide a therapeutic benefit to patients with COVID-19 pneumonia through antiandrogen, MR blocking, antifibrotic and anti-hyperinflammatory action. It has been proposed that spironolactone may prevent acute lung injury in COVID-19 infection due to its pleiotropic effects with favorable renin-angiotensin-aldosterone system (RAAS) and ACE2 expression, reduction in transmembrane serine protease 2 (TMPRSS2) activity and antiandrogenic action, and therefore it may prove to act as additional protection for patients at highest risk of severe pneumonia. Future prospective clinical trials are warranted to evaluate its therapeutic potential.
Language	English
Publishing date	2021-01-17
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2193542-7
ISSN	1424-8247
ISSN	1424-8247
DOI	10.3390/ph14010071
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Article ; Online: Kidney damage from nonsteroidal anti-inflammatory drugs-Myth or truth? Review of selected literature.

Drożdżal, Sylwester / Lechowicz, Kacper / Szostak, Bartosz / Rosik, Jakub / Kotfis, Katarzyna / Machoy-Mokrzyńska, Anna / Białecka, Monika / Ciechanowski, Kazimierz / Gawrońska-Szklarz, Barbara

Pharmacology research & perspectives

2021 Volume 9, Issue 4, Page(s) e00817

Abstract: Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available drugs with anti-inflammatory and analgesic properties. Their mechanism of action is associated with the enzymes of the arachidonic acid cycle (cyclooxygenases: COX-1 and COX-2). The ... ...

Abstract	Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available drugs with anti-inflammatory and analgesic properties. Their mechanism of action is associated with the enzymes of the arachidonic acid cycle (cyclooxygenases: COX-1 and COX-2). The cyclooxygenase pathway results in the formation of prostanoids (prostaglandins [PGs], prostacyclins, and thromboxanes). It affects various structures of the human body, including the kidneys. Medical literature associates the usage of NSAIDs with acute kidney injury (AKI), tubulointerstitial nephritis (TIN), as well as nephrotic syndrome and chronic kidney disease (CKD). AKI associated with the chronic consumption of NSAIDs is mainly attributed to pharmacological polytherapy and the presence of cardiovascular or hepatic comorbidities. The pathomechanism of AKI and CKD is associated with inhibition of the biosynthesis of prostanoids involved in the maintenance of renal blood flow, especially PGE2 and PGI2. It is suggested that both COX isoforms play opposing roles in renal function, with natriuresis increased by COX-1 inhibition followed by a drop in a blood pressure, whereas COX-2 inhibition increases blood pressure and promotes sodium retention. TIN after NSAID use is potentially associated with glomerular basement membrane damage, reduction in pore size, and podocyte density. Therefore, nephrotic proteinuria and impairment of renal function may occur. The following article analyzes the association of NSAIDs with kidney disease based on available medical literature.
MeSH term(s)	Acute Kidney Injury/chemically induced ; Animals ; Anti-Inflammatory Agents, Non-Steroidal/adverse effects ; Humans ; Nephritis, Interstitial/chemically induced ; Renal Insufficiency, Chronic/chemically induced
Chemical Substances	Anti-Inflammatory Agents, Non-Steroidal
Language	English
Publishing date	2021-08-03
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2740389-0
ISSN	2052-1707 ; 2052-1707
ISSN (online)	2052-1707
ISSN	2052-1707
DOI	10.1002/prp2.817
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Article ; Online: COVID-19—The Potential Beneficial Therapeutic Effects of Spironolactone during SARS-CoV-2 Infection

Katarzyna Kotfis / Kacper Lechowicz / Sylwester Drożdżal / Paulina Niedźwiedzka-Rystwej / Tomasz K. Wojdacz / Ewelina Grywalska / Jowita Biernawska / Magda Wiśniewska / Miłosz Parczewski

Pharmaceuticals, Vol 14, Iss 1, p

2021 Volume 71

Abstract	In March 2020, coronavirus disease 2019 (COVID-19) caused by SARS-CoV-2 was declared a global pandemic by the World Health Organization (WHO). The clinical course of the disease is unpredictable but may lead to severe acute respiratory infection (SARI) and pneumonia leading to acute respiratory distress syndrome (ARDS). It has been shown that pulmonary fibrosis may be one of the major long-term complications of COVID-19. In animal models, the use of spironolactone was proven to be an important drug in the prevention of pulmonary fibrosis. Through its dual action as a mineralocorticoid receptor (MR) antagonist and an androgenic inhibitor, spironolactone can provide significant benefits concerning COVID-19 infection. The primary effect of spironolactone in reducing pulmonary edema may also be beneficial in COVID-19 ARDS. Spironolactone is a well-known, widely used and safe anti-hypertensive and antiandrogenic medication. It has potassium-sparing diuretic action by antagonizing mineralocorticoid receptors (MRs). Spironolactone and potassium canrenoate, exerting combined pleiotropic action, may provide a therapeutic benefit to patients with COVID-19 pneumonia through antiandrogen, MR blocking, antifibrotic and anti-hyperinflammatory action. It has been proposed that spironolactone may prevent acute lung injury in COVID-19 infection due to its pleiotropic effects with favorable renin–angiotensin–aldosterone system (RAAS) and ACE2 expression, reduction in transmembrane serine protease 2 (TMPRSS2) activity and antiandrogenic action, and therefore it may prove to act as additional protection for patients at highest risk of severe pneumonia. Future prospective clinical trials are warranted to evaluate its therapeutic potential.
Keywords	COVID-19 ; SARS-CoV-2 ; coronavirus ; pandemic ; spironolactone ; potassium canrenoate ; Medicine ; R ; Pharmacy and materia medica ; RS1-441
Subject code	610
Language	English
Publishing date	2021-01-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: COVID-19: The Influence of ACE Genotype and ACE-I and ARBs on the Course of SARS-CoV-2 Infection in Elderly Patients.

Sieńko, Jerzy / Kotowski, Maciej / Bogacz, Anna / Lechowicz, Kacper / Drożdżal, Sylwester / Rosik, Jakub / Sietnicki, Marek / Sieńko, Magdalena / Kotfis, Katarzyna

Clinical interventions in aging

2020 Volume 15, Page(s) 1231–1240

Abstract: Since the beginning of 2020, the whole world has been struggling with the pandemic of Coronavirus Disease 2019 (COVID-19) caused by a novel coronavirus SARS-CoV-2. The SARS-CoV-2 infection depends on ACE2, TMPRSS2, and CD147, which are expressed on host ... ...

Abstract	Since the beginning of 2020, the whole world has been struggling with the pandemic of Coronavirus Disease 2019 (COVID-19) caused by a novel coronavirus SARS-CoV-2. The SARS-CoV-2 infection depends on ACE2, TMPRSS2, and CD147, which are expressed on host cells. Several studies suggest that some single nucleotide polymorphisms (SNPs) of ACE2 might be a risk factor of COVID-19 infection. Genotypes affect ACE2 structure, its serum concentration, and levels of circulating angiotensin (1-7). Moreover, there is evidence that ACE genotype affects the outcomes of acute respiratory distress syndrome (ARDS) treatment, the most severe consequence of SARS-CoV-2 infection. COVID-19 morbidity, infection course, and mortality might depend on ACE D allele frequency. The aim of this narrative review was to analyze and identify the mechanisms of ACE-I and ARBs with particular emphasis on angiotensin receptors and their polymorphism in the light of COVID-19 pandemic as these medications are commonly prescribed to elderly patients. There is no direct evidence yet for ACE-I or ARBs in the treatment of COVID-19. However, for those already taking these medications, both the European Society of Cardiology and the American College of Cardiology recommend continuing the treatment, because at present, there is no clear clinical or scientific evidence to justify the discontinuation of ACE-I or ARBs. Individualized treatment decisions should be based on the clinical condition and co-morbidities of each patient.
MeSH term(s)	Aged ; Animals ; Betacoronavirus ; Comorbidity ; Coronavirus Infections/genetics ; Coronavirus Infections/therapy ; Eye Diseases, Hereditary ; Gene Frequency ; Genotype ; Humans ; Pandemics ; Pneumonia, Viral/genetics ; Pneumonia, Viral/therapy ; Retinal Diseases
Keywords	covid19
Language	English
Publishing date	2020-07-21
Publishing country	New Zealand
Document type	Journal Article ; Review
ZDB-ID	2364924-0
ISSN	1178-1998 ; 1176-9092
ISSN (online)	1178-1998
ISSN	1176-9092
DOI	10.2147/CIA.S261516
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Article: COVID-19: Pain Management in Patients with SARS-CoV-2 Infection-Molecular Mechanisms, Challenges, and Perspectives.

Drożdżal, Sylwester / Rosik, Jakub / Lechowicz, Kacper / Machaj, Filip / Szostak, Bartosz / Majewski, Paweł / Rotter, Iwona / Kotfis, Katarzyna

Brain sciences

2020 Volume 10, Issue 7

Abstract: Since the end of 2019, the whole world has been struggling with the pandemic of the new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). Available evidence suggests that pain is a common symptom during Coronavirus Disease 2019 (COVID-19). ... ...

Abstract	Since the end of 2019, the whole world has been struggling with the pandemic of the new Severe Acute Respiratory Syndrome Coronavirus (SARS-CoV-2). Available evidence suggests that pain is a common symptom during Coronavirus Disease 2019 (COVID-19). According to the World Health Organization, many patients suffer from muscle pain (myalgia) and/or joint pain (arthralgia), sore throat and headache. The exact mechanisms of headache and myalgia during viral infection are still unknown. Moreover, many patients with respiratory failure get admitted to the intensive care unit (ICU) for ventilatory support. Pain in ICU patients can be associated with viral disease itself (myalgia, arthralgia, peripheral neuropathies), may be caused by continuous pain and discomfort associated with ICU treatment, intermittent procedural pain and chronic pain present before admission to the ICU. Undertreatment of pain, especially when sedation and neuromuscular blocking agents are used, prone positioning during mechanical ventilation or extracorporeal membrane oxygenation (ECMO) may trigger delirium and cause peripheral neuropathies. This narrative review summarizes current knowledge regarding challenges associated with pain assessment and management in COVID-19 patients. A structured prospective evaluation should be undertaken to analyze the probability, severity, sources and adequate treatment of pain in patients with COVID-19 infection.
Keywords	covid19
Language	English
Publishing date	2020-07-20
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2651993-8
ISSN	2076-3425
ISSN	2076-3425
DOI	10.3390/brainsci10070465
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Article ; Online: FDA approved drugs with pharmacotherapeutic potential for SARS-CoV-2 (COVID-19) therapy.

Drożdżal, Sylwester / Rosik, Jakub / Lechowicz, Kacper / Machaj, Filip / Kotfis, Katarzyna / Ghavami, Saeid / Łos, Marek J

Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy

2020 Volume 53, Page(s) 100719

Abstract: In December 2019, a novel SARS-CoV-2 coronavirus emerged, causing an outbreak of life-threatening pneumonia in the Hubei province, China, and has now spread worldwide, causing a pandemic. The urgent need to control the disease, combined with the lack of ... ...

Abstract	In December 2019, a novel SARS-CoV-2 coronavirus emerged, causing an outbreak of life-threatening pneumonia in the Hubei province, China, and has now spread worldwide, causing a pandemic. The urgent need to control the disease, combined with the lack of specific and effective treatment modalities, call for the use of FDA-approved agents that have shown efficacy against similar pathogens. Chloroquine, remdesivir, lopinavir/ritonavir or ribavirin have all been successful in inhibiting SARS-CoV-2 in vitro. The initial results of a number of clinical trials involving various protocols of administration of chloroquine or hydroxychloroquine mostly point towards their beneficial effect. However, they may not be effective in cases with persistently high viremia, while results on ivermectin (another antiparasitic agent) are not yet available. Interestingly, azithromycin, a macrolide antibiotic in combination with hydroxychloroquine, might yield clinical benefit as an adjunctive. The results of clinical trials point to the potential clinical efficacy of antivirals, especially remdesivir (GS-5734), lopinavir/ritonavir, and favipiravir. Other therapeutic options that are being explored involve meplazumab, tocilizumab, and interferon type 1. We discuss a number of other drugs that are currently in clinical trials, whose results are not yet available, and in various instances we enrich such efficacy analysis by invoking historic data on the treatment of SARS, MERS, influenza, or in vitro studies. Meanwhile, scientists worldwide are seeking to discover novel drugs that take advantage of the molecular structure of the virus, its intracellular life cycle that probably elucidates unfolded-protein response, as well as its mechanism of surface binding and cell invasion, like angiotensin converting enzymes-, HR1, and metalloproteinase inhibitors.
MeSH term(s)	Animals ; Anti-Bacterial Agents/administration & dosage ; Anti-Bacterial Agents/metabolism ; Antibodies, Monoclonal, Humanized/administration & dosage ; Antibodies, Monoclonal, Humanized/metabolism ; Antimalarials/administration & dosage ; Antimalarials/metabolism ; Antiviral Agents/administration & dosage ; Antiviral Agents/metabolism ; COVID-19/metabolism ; Clinical Trials as Topic/methods ; Cytochrome P-450 CYP3A Inhibitors/administration & dosage ; Cytochrome P-450 CYP3A Inhibitors/metabolism ; Drug Approval/methods ; Drug Therapy, Combination ; Humans ; Hydroxychloroquine/administration & dosage ; Hydroxychloroquine/metabolism ; SARS-CoV-2/drug effects ; SARS-CoV-2/metabolism ; United States/epidemiology ; COVID-19 Drug Treatment
Chemical Substances	Anti-Bacterial Agents ; Antibodies, Monoclonal, Humanized ; Antimalarials ; Antiviral Agents ; Cytochrome P-450 CYP3A Inhibitors ; Hydroxychloroquine (4QWG6N8QKH)
Keywords	covid19
Language	English
Publishing date	2020-07-15
Publishing country	Scotland
Document type	Journal Article ; Review
ZDB-ID	1474513-6
ISSN	1532-2084 ; 1368-7646
ISSN (online)	1532-2084
ISSN	1368-7646
DOI	10.1016/j.drup.2020.100719
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Article ; Online: Acute and Chronic Pain Learning and Teaching in Medical School-An Observational Cross-Sectional Study Regarding Preparation and Self-Confidence of Clinical and Pre-Clinical Medical Students.

Lechowicz, Kacper / Karolak, Igor / Drożdżal, Sylwester / Żukowski, Maciej / Szylińska, Aleksandra / Białecka, Monika / Rotter, Iwona / Kotfis, Katarzyna

Medicina (Kaunas, Lithuania)

2019 Volume 55, Issue 9

Abstract: Background and objectives: ...

Abstract	Background and objectives:
MeSH term(s)	Adult ; Clinical Competence/standards ; Clinical Competence/statistics & numerical data ; Cross-Sectional Studies ; Education, Medical/standards ; Education, Medical/statistics & numerical data ; Female ; Humans ; Male ; Pain Management/methods ; Pain Management/standards ; Pain Management/statistics & numerical data ; Poland ; Schools, Medical/organization & administration ; Schools, Medical/statistics & numerical data ; Self Efficacy ; Students, Medical/psychology ; Students, Medical/statistics & numerical data ; Surveys and Questionnaires
Language	English
Publishing date	2019-08-26
Publishing country	Switzerland
Document type	Journal Article ; Observational Study
ZDB-ID	2188113-3
ISSN	1648-9144 ; 1010-660X
ISSN (online)	1648-9144
ISSN	1010-660X
DOI	10.3390/medicina55090533
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