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  1. Article ; Online: Advance care plan discussion among parents of children with cerebral palsy.

    Khalid, Farah / Ng Voon, Swee Im / Ong, Lai Choo / Lim, Wei Kang / Li, Limin / Adnan, Azirah / Ganesan, Vigneswari / Teh, Chee Ming / Fong, Choong Yi

    Developmental medicine and child neurology

    2022  Volume 64, Issue 8, Page(s) 1025–1033

    Abstract: Aim: To evaluate parental perception of advance care plan (ACP) discussions in families of Malaysian children with bilateral cerebral palsy (CP) classified in Gross Motor Function Classification System levels IV or V for (1) acceptance of the ACP ... ...

    Abstract Aim: To evaluate parental perception of advance care plan (ACP) discussions in families of Malaysian children with bilateral cerebral palsy (CP) classified in Gross Motor Function Classification System levels IV or V for (1) acceptance of the ACP discussion, (2) feedback on the usefulness of ACP discussion, and (3) exploration of possible factors related to parental acceptance of ACP.
    Method: This was a prospective pre- and post-ACP discussion questionnaire study for parents of children with bilateral CP.
    Results: Sixty-nine patients were recruited to the study; 64 (93%) had at least one additional comorbidity. The median age was 8 years (interquartile range 5 years 1 month-11 years 6 months). Fifty-seven (82.6%) parents found the ACP discussion acceptable, and most reported positive feedback on various components of the discussion (88.4-97.1%). One-third of participants were not comfortable discussing end-of-life care plans. On multivariate analysis, parents who were comfortable discussing end-of-life care plans were more likely to find the ACP discussion acceptable (odds ratio 27.78, 95% confidence interval 2.9-265.1, p = 0.004).
    Interpretation: Most parents of Malaysian children with bilateral CP reported the ACP discussion as both acceptable and beneficial. Parents need to be comfortable about discussing end-of-life care plans for their child to enable the ACP discussion to be an acceptable experience.
    MeSH term(s) Advance Care Planning ; Cerebral Palsy/therapy ; Child ; Family ; Humans ; Infant ; Parents ; Prospective Studies
    Language English
    Publishing date 2022-02-25
    Publishing country England
    Document type Journal Article
    ZDB-ID 80369-8
    ISSN 1469-8749 ; 0012-1622
    ISSN (online) 1469-8749
    ISSN 0012-1622
    DOI 10.1111/dmcn.15184
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  2. Article ; Online: Congenital myasthenic syndrome with novel pathogenic variants in the COLQ gene associated with the presence of antibodies to acetylcholine receptors.

    Tay, Chee Geap / Fong, Choong Yi / Li, Limin / Ganesan, Vigneswari / Teh, Chee Ming / Gan, Chin Seng / Thong, Meow-Keong

    Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia

    2019  Volume 72, Page(s) 468–471

    Abstract: Congenital myasthenic syndrome (CMS) is a heterogeneous group of inherited disorder which does not associate with anti-acetylcholine receptor (AChR) antibody. The presence of AChR autoantibody is pathogenic and highly sensitive and specific for ... ...

    Abstract Congenital myasthenic syndrome (CMS) is a heterogeneous group of inherited disorder which does not associate with anti-acetylcholine receptor (AChR) antibody. The presence of AChR autoantibody is pathogenic and highly sensitive and specific for autoimmune myasthenia gravis (MG). We describe 2 children from unrelated families who presented with hypotonia, ptosis and fatigability in early infancy with anti-AChR antibodies detected via ELISA on 2 separate occasions in the sera. Both were treated as refractory autoimmune MG due to poor clinical response to acetylcholinesterase inhibitor and immunotherapy. In view of the atypical clinical features, genetic studies of CMS were performed and both were confirmed to have novel pathogenic mutations in the COLQ gene. To the best of our knowledge, the presence of anti-AChR antibody in COLQ-related CMS has never been reported in the literature. The clinical presentation of early onset phenotype, and refractoriness to acetylcholinesterase inhibitor and immunotherapy should prompt CMS as a differential diagnosis.
    MeSH term(s) Acetylcholinesterase/genetics ; Autoantibodies ; Child ; Cholinesterase Inhibitors/therapeutic use ; Collagen/genetics ; Collagen/therapeutic use ; Diagnosis, Differential ; Female ; Humans ; Male ; Muscle Proteins/genetics ; Myasthenia Gravis/diagnosis ; Myasthenic Syndromes, Congenital/genetics ; Phenotype ; Receptors, Cholinergic
    Chemical Substances Autoantibodies ; Cholinesterase Inhibitors ; Muscle Proteins ; Receptors, Cholinergic ; Collagen (9007-34-5) ; Acetylcholinesterase (EC 3.1.1.7) ; COLQ protein, human (EC 3.1.1.7)
    Language English
    Publishing date 2019-12-10
    Publishing country Scotland
    Document type Case Reports
    ZDB-ID 1193674-5
    ISSN 1532-2653 ; 0967-5868
    ISSN (online) 1532-2653
    ISSN 0967-5868
    DOI 10.1016/j.jocn.2019.12.007
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  3. Article ; Online: Quality of life of children with tuberous sclerosis complex.

    Fong, Choong Yi / Ng, Kexin / Kong, Ann Nie / Ong, Lai Choo / Rithauddin, Mohamed Ahmad / Thong, Meow Keong / Ganesan, Vigneswari / Heng, Hock Sin / Teh, Chee Ming / Yahya, Norazni

    Archives of disease in childhood

    2019  Volume 104, Issue 10, Page(s) 972–978

    Abstract: Aim: Evaluation of impaired quality of life (QOL) of Malaysian children with tuberous sclerosis complex (TSC) and its possible risk factors.: Method: Cross-sectional study on 68 parents of Malaysian children aged 2-18 years with TSC. QOL was assessed ...

    Abstract Aim: Evaluation of impaired quality of life (QOL) of Malaysian children with tuberous sclerosis complex (TSC) and its possible risk factors.
    Method: Cross-sectional study on 68 parents of Malaysian children aged 2-18 years with TSC. QOL was assessed using proxy-report Paediatric Quality of Life Inventory (PedsQL) V.4.0, and scores compared with those from a previous cohort of healthy children. Parents also completed questionnaires on child behaviour (child behaviour checklist (CBCL)) and parenting stress (parenting stress index-short form). Multiple regression analysis was used to determine sociodemographic, medical, parenting stress and behavioural factors that impacted on QOL.
    Results: The mean proxy-report PedsQL V.4.0 total scale score, physical health summary score and psychosocial health summary score of the patients were 60.6 (SD 20.11), 65.9 (SD 28.05) and 57.8 (SD 19.48), respectively. Compared with healthy children, TSC patients had significantly lower mean PedsQL V.4.0 total scale, physical health and psychosocial health summary scores (mean difference (95% CI): 24 (18-29), 20 (12-27) and 26 (21-31) respectively). Lower total scale scores were associated with clinically significant CBCL internalising behaviour scores, age 8-18 years and Chinese ethnicity. Lower psychosocial health summary scale scores were associated with clinically significant CBCL internalising behaviour scores, Chinese ethnicity or >1 antiepileptic drug (AED).
    Conclusion: Parents of children with TSC reported lower PedsQL V.4.0 QOL scores in all domains, with psychosocial health most affected. Older children, those with internalising behaviour problems, of Chinese ethnicity or on >1 AED was at higher risk of lower QOL. Clinicians need to be vigilant of QOL needs among children with TSC particularly with these additional risk factors.
    MeSH term(s) Asian Continental Ancestry Group ; Child ; Cross-Sectional Studies ; Female ; Humans ; Interpersonal Relations ; Malaysia ; Male ; Quality of Life ; Surveys and Questionnaires ; Tuberous Sclerosis/psychology
    Language English
    Publishing date 2019-05-23
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 524-1
    ISSN 1468-2044 ; 0003-9888 ; 1359-2998
    ISSN (online) 1468-2044
    ISSN 0003-9888 ; 1359-2998
    DOI 10.1136/archdischild-2018-316394
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  4. Article ; Online: GRIN2D variants in three cases of developmental and epileptic encephalopathy.

    Tsuchida, Naomi / Hamada, Keisuke / Shiina, Masaaki / Kato, Mitsuhiro / Kobayashi, Yu / Tohyama, Jun / Kimura, Kazue / Hoshino, Kyoko / Ganesan, Vigneswari / Teik, Keng W / Nakashima, Mitsuko / Mitsuhashi, Satomi / Mizuguchi, Takeshi / Takata, Atsushi / Miyake, Noriko / Saitsu, Hirotomo / Ogata, Kazuhiro / Miyatake, Satoko / Matsumoto, Naomichi

    Clinical genetics

    2018  Volume 94, Issue 6, Page(s) 538–547

    Abstract: N-methyl-d-aspartate (NMDA) receptors are glutamate-activated ion channels that are widely distributed in the central nervous system and essential for brain development and function. Dysfunction of NMDA receptors has been associated with various ... ...

    Abstract N-methyl-d-aspartate (NMDA) receptors are glutamate-activated ion channels that are widely distributed in the central nervous system and essential for brain development and function. Dysfunction of NMDA receptors has been associated with various neurodevelopmental disorders. Recently, a de novo recurrent GRIN2D missense variant was found in two unrelated patients with developmental and epileptic encephalopathy. In this study, we identified by whole exome sequencing novel heterozygous GRIN2D missense variants in three unrelated patients with severe developmental delay and intractable epilepsy. All altered residues were highly conserved across vertebrates and among the four GluN2 subunits. Structural consideration indicated that all three variants are probably to impair GluN2D function, either by affecting intersubunit interaction or altering channel gating activity. We assessed the clinical features of our three cases and compared them to those of the two previously reported GRIN2D variant cases, and found that they all show similar clinical features. This study provides further evidence of GRIN2D variants being causal for epilepsy. Genetic diagnosis for GluN2-related disorders may be clinically useful when considering drug therapy targeting NMDA receptors.
    MeSH term(s) Adolescent ; Alleles ; Amino Acid Sequence ; Brain/abnormalities ; Child ; Child, Preschool ; Developmental Disabilities/diagnosis ; Developmental Disabilities/genetics ; Electroencephalography ; Epilepsy/diagnosis ; Epilepsy/genetics ; Female ; Genetic Variation ; Genotype ; Humans ; Male ; Molecular Dynamics Simulation ; Mutation ; Protein Conformation ; Receptors, N-Methyl-D-Aspartate/chemistry ; Receptors, N-Methyl-D-Aspartate/genetics ; Structure-Activity Relationship
    Chemical Substances GRIN2D protein, human ; Receptors, N-Methyl-D-Aspartate
    Language English
    Publishing date 2018-10-02
    Publishing country Denmark
    Document type Case Reports ; Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 221209-2
    ISSN 1399-0004 ; 0009-9163
    ISSN (online) 1399-0004
    ISSN 0009-9163
    DOI 10.1111/cge.13454
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    Zs.A 413: Show issues Location:
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  5. Article ; Online: Practices associated with serum antiepileptic drug level monitoring at a pediatric neurology clinic: a Malaysian experience.

    Salih, Muhannad R M / Bahari, Mohd Baidi / Hassali, Mohamed Azmi Ahmad / Shafie, Asrul Akmal / Al-Lela, Omer Qutaiba B / Abd, Arwa Y / Ganesan, Vigneswari

    Journal of pharmacy practice

    2013  Volume 26, Issue 3, Page(s) 192–197

    Abstract: Objectives: To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural-metabolic epilepsy.: Methods: It was a retrospective chart review ... ...

    Abstract Objectives: To assess the practices associated with the application of therapeutic drug monitoring (TDM) for antiepileptic drugs (AEDs) in the management of children with structural-metabolic epilepsy.
    Methods: It was a retrospective chart review and included children aged ≥2 years old with structural-metabolic epilepsy, treated with AEDs, and received TDM. The data were extracted from the medical records.
    Results: Thirty-two patients were identified with 50 TDM assays. In two thirds of the assays, "check level" and "recheck level" were the reasons behind the requesting of serum level monitoring of AEDs. Knowledge of serum AED levels led to alterations in the management in 60% of the assays. Thirty-two (76%) pediatrician's actions were consistent with the recommendation of TDM pharmacist. Forty-nine (98%) levels were appropriately indicated. In relation to the appropriateness of sampling time, 9 (18%) levels were not assessed due to missing data. Twenty-seven (54%) levels were appropriately sampled.
    Conclusions: More studies should be designed to improve the component of the current TDM request form, especially in the reason section. By the same token, the number of pointless assays and the costs to the health care system can be reduced both by enhancing and improving the educational standards of the requesting neurologists.
    MeSH term(s) Adolescent ; Anticonvulsants/administration & dosage ; Anticonvulsants/blood ; Anticonvulsants/therapeutic use ; Child ; Child, Preschool ; Drug Monitoring/methods ; Epilepsy/drug therapy ; Female ; Humans ; Malaysia ; Male ; Pharmaceutical Services/organization & administration ; Pharmacists/organization & administration ; Practice Patterns, Physicians'/statistics & numerical data ; Retrospective Studies ; Time Factors
    Chemical Substances Anticonvulsants
    Language English
    Publishing date 2013-06
    Publishing country United States
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1027474-1
    ISSN 1531-1937 ; 0897-1900
    ISSN (online) 1531-1937
    ISSN 0897-1900
    DOI 10.1177/0897190012451926
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    Zs.A 2893: Show issues Location:
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  6. Article ; Online: Cost-effectiveness analysis for the use of serum antiepileptic drug level monitoring in children diagnosed with structural-metabolic epilepsy.

    Salih, Muhannad R M / Bahari, Mohd Baidi / Shafie, Asrul Akmal / Hassali, Mohamed Azmi Ahmad / Al-Lela, Omer Qutaiba B / Abd, Arwa Y / Ganesan, Vigneswari M

    Epilepsy research

    2013  Volume 104, Issue 1-2, Page(s) 151–157

    Abstract: Treatment with antiepileptic drugs is commonly guided by serum level monitoring. Such monitoring requires expensive laboratory equipment and products. However, well-conducted studies on the cost-effectiveness of therapeutic drug monitoring for ... ...

    Abstract Treatment with antiepileptic drugs is commonly guided by serum level monitoring. Such monitoring requires expensive laboratory equipment and products. However, well-conducted studies on the cost-effectiveness of therapeutic drug monitoring for antiepileptic drugs are lacking particularly in patients with structural-metabolic epilepsy. The study aims to assess the cost-effectiveness of serum level monitoring services in the management of children with structural-metabolic epilepsy during the first year of diagnosis. A retrospective cost-effectiveness analysis was conducted from the provider perspective. It included patients attended a paediatric neurology clinic. The effectiveness measures used in this analysis were the number of patients that achieved ≥50% reduction in seizure frequency, and the number of patients with 3-month seizure free. Medical records of the patients were reviewed for the required information. Medical chart/billing data obtained from the hospital were collected to estimate the resources used (One Malaysian Ringgit MYR is equivalent to 0.31 USD). The recruited children were followed for one year following their first visit. The average cost effectiveness ratio for the monitored patients (MYR 2735 per patient that achieved a ≥50% reduction in seizure frequency) was lower than that for non-monitored patients (MYR 2921 per patients that achieved a ≥50% reduction in seizure frequency), with incremental cost-effectiveness ratio of MYR 2357 per one additional patient that achieved a ≥50% reduction in seizure frequency. The average cost effectiveness ratios for monitored and non-monitored group were MYR 8279 and MYR 6433 per patient with a 3-month seizure-free period, respectively, with incremental cost-effectiveness ratio of MYR 29,666 per one additional patient with a 3-month seizure-free period. In terms of the effectiveness measures used, serum level monitoring of antiepileptic drugs was found to be cost-effective. However, the incremental cost-effectiveness ratio was found to be sensitive to the cost of management.
    MeSH term(s) Adolescent ; Anticonvulsants/blood ; Anticonvulsants/economics ; Anticonvulsants/therapeutic use ; Child ; Child, Preschool ; Cost-Benefit Analysis/methods ; Drug Monitoring/economics ; Drug Monitoring/methods ; Epilepsy/blood ; Epilepsy/drug therapy ; Epilepsy/economics ; Female ; Follow-Up Studies ; Humans ; Male ; Retrospective Studies
    Chemical Substances Anticonvulsants
    Language English
    Publishing date 2013-03
    Publishing country Netherlands
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 632939-1
    ISSN 1872-6844 ; 0920-1211
    ISSN (online) 1872-6844
    ISSN 0920-1211
    DOI 10.1016/j.eplepsyres.2012.09.012
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    Zs.A 2193: Show issues Location:
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  7. Article ; Online: Characteristics of seizure frequency among Malaysian children diagnosed with structural-metabolic epilepsy.

    Salih, Muhannad Rm / Bahari, Mohd Baldi / Hassali, Mohamed Azmi Ahmad / Shafie, Asrul Akmal / Al-Lela, Omer Qutaiba B / Abd, Arwa Y / Ganesan, Vigneswari M

    Journal of neurosciences in rural practice

    2012  Volume 3, Issue 3, Page(s) 244–250

    Abstract: Introduction: Seizure-free patients or substantial reduction in seizure frequency are the most important outcome measures in the management of epilepsy. The study aimed to evaluate the patterns of seizure frequency and its relationship with demographics, ...

    Abstract Introduction: Seizure-free patients or substantial reduction in seizure frequency are the most important outcome measures in the management of epilepsy. The study aimed to evaluate the patterns of seizure frequency and its relationship with demographics, clinical characteristics, and outcomes.
    Materials and methods: A retrospective cohort study was conducted at the Pediatric Neurology Clinic, Hospital Pulau Pinang. Over a period of 6 months, the required data were extracted from the medical records using a pre-designed data collection form.
    Results: Seizure frequency showed no significant association with patient's demographics and clinical characteristic. However, significant reduction in seizure frequency from the baseline to the last follow-up visit was only seen in certain subgroups of patients including Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability, and patients with focal seizure. There was no significant association between seizure frequency and rate of adverse events. Polytherapy visits were associated with higher seizure frequency than monotherapy visits (27.97 ± 56.66, 10.94 ± 30.96 attack per month, respectively) (P < 0.001). There was a clear tendency to get antiepileptic drugs used at doses above the recommended range in polytherapy (8.4%) rather than in monotherapy (1.4%) visits (P < 0.001). A significant correlation was found between seizure frequency and number of visits per patient per year (r = 0.450, P < 0.001).
    Conclusion: Among children with structural-metabolic epilepsy, Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability and patients manifested with focal seizure are more responsive antiepileptic drug therapy than the other subgroups of patients.
    Language English
    Publishing date 2012-05-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2601242-X
    ISSN 0976-3155 ; 0976-3147
    ISSN (online) 0976-3155
    ISSN 0976-3147
    DOI 10.4103/0976-3147.102596
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  8. Article ; Online: Medical care costs of newly diagnosed children with structural-metabolic epilepsy: a one year prevalence-based approached.

    Salih, Muhannad R M / Bahari, Mohd Baidi / Shafie, Asrul Akmal / Hassali, Mohamed Azmi Ahmad / Al-lela, Omer Qutaiba B / Abd, Arwa Y / Ganesan, Vigneswari M

    Seizure

    2012  Volume 21, Issue 10, Page(s) 764–769

    Abstract: Purpose: Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population.: Method: This was a prevalence-based ... ...

    Abstract Purpose: Aims of this study were to estimate the first-year medical care costs of newly diagnosed children with structural-metabolic epilepsy and to determine the cost-driving factors in the selected population.
    Method: This was a prevalence-based retrospective chart review that included patients who attended a pediatric neurology clinic in a tertiary referral center in Malaysia. The total first-year medical care costs were estimated from the provider (i.e., hospital) perspective, using a bottom-up, microcosting analysis. Medical chart/billing data (i.e., case reports) obtained from the hospital (i.e., provider) were collected to determine the resources used. Prices or cost data were standardized for the year 2010 (One Malaysian Ringgit MYR is equivalent to 0.26 Euro or 0.32 USD).
    Results: The most expensive item in the costs list was antiepileptic drugs, whereas ultrasound examination represented the cheapest item. Hospitalization and the use of non-antiepileptic drugs were the second and third most costly items, respectively. The cost of therapeutic drug monitoring comprised only a small proportion of the total annual expenditure. None of the demographic variables (i.e., gender, race, and age) significantly impacted the first-year medical care costs. Similarly, child development, seizure type, therapy type (i.e., polytherapy versus monotherapy), and therapeutic drug monitoring utilization were also not associated with the cost of management. The first-year medical care costs positively correlated with seizure frequency (r(s)=0.294, p=0.001). However, the only variable that significantly predict the first-year medical care costs was the type of antiepileptic drugs (R(2)=0.292, F=7.772, p<0.001).
    Conclusion: This investigation was the first cost analysis study of epilepsy in Malaysia. The total first-year medical care costs for 120 patients with structural-metabolic epilepsy were MYR 202,816 (i.e., MYR 1690.13 per patient per year). The study findings highlight the importance of optimizing seizure control in reducing the cost of management.
    MeSH term(s) Child ; Epilepsy/economics ; Epilepsy/epidemiology ; Female ; Health Care Costs ; Humans ; Malaysia/epidemiology ; Male ; Prevalence ; Retrospective Studies
    Language English
    Publishing date 2012-12
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't
    ZDB-ID 1137610-7
    ISSN 1532-2688 ; 1059-1311
    ISSN (online) 1532-2688
    ISSN 1059-1311
    DOI 10.1016/j.seizure.2012.08.005
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    Zs.A 3573: Show issues Location:
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  9. Article: Characteristics of seizure frequency among Malaysian children diagnosed with structural– metabolic epilepsy

    Salih, Muhannad RM / Bahari, Mohd Baidi / Ahmad Hassali, Mohamed Azmi / Shafie, Asrul Akmal / Al-lela, Omer Qutaiba B / Abd, Arwa Y / Ganesan, Vigneswari M

    Journal of Neurosciences in Rural Practice

    2012  Volume 03, Issue 03, Page(s) 244–250

    Abstract: Introduction: Seizure-free patients or substantial reduction in seizure frequency are the most important outcome measures in the management of epilepsy. The study aimed to evaluate the patterns of seizure frequency and its relationship with demographics, ...

    Abstract Introduction: Seizure-free patients or substantial reduction in seizure frequency are the most important outcome measures in the management of epilepsy. The study aimed to evaluate the patterns of seizure frequency and its relationship with demographics, clinical characteristics, and outcomes.
    Materials and Methods: A retrospective cohort study was conducted at the Pediatric Neurology Clinic, Hospital Pulau Pinang. Over a period of 6 months, the required data were extracted from the medical records using a pre-designed data collection form.
    Results: Seizure frequency showed no significant association with patient’s demographics and clinical characteristic. However, significant reduction in seizure frequency from the baseline to the last follow-up visit was only seen in certain subgroups of patients including Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability, and patients with focal seizure. There was no significant association between seizure frequency and rate of adverse events. Polytherapy visits were associated with higher seizure frequency than monotherapy visits (27.97 ± 56.66, 10.94 ± 30.96 attack per month, respectively) (P < 0.001). There was a clear tendency to get antiepileptic drugs used at doses above the recommended range in polytherapy (8.4%) rather than in monotherapy (1.4%) visits (P < 0.001). A significant correlation was found between seizure frequency and number of visits per patient per year (r = 0.450, P < 0.001).
    Conclusion: Among children with structural–metabolic epilepsy, Malays, females, patients <4 years of age, patients with global developmental delay/intellectual disability and patients manifested with focal seizure are more responsive antiepileptic drug therapy than the other subgroups of patients.
    Keywords Pediatrics ; seizure frequency ; structural–metabolic epilepsy
    Language English
    Publishing date 2012-09-01
    Publisher Thieme Medical and Scientific Publishers Private Ltd.
    Publishing place Stuttgart ; New York
    Document type Article
    ZDB-ID 2601242-X
    ISSN 0976-3155 ; 0976-3147
    ISSN (online) 0976-3155
    ISSN 0976-3147
    DOI 10.4103/0976-3147.102596
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