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İNSAN ÜREME SİSTEMİ’NE COVID19 TEHDİDİ

Year 2022, Volume: 5 Issue: 1, 36 - 42, 27.02.2022

Abstract

Çin’in Wuhan kentinde ortaya çıkan ve eğitim, sağlık, ekonomi gibi birçok alanda büyük değişiklikler yapan Koronavirüs bütün dünyayı etkisi altına aldı. 2021 yılına geldiğimizde ise, Koronavirüsle yapılan mücadele kapsamında bir yandan dünya genelinde aşılama çalışmaları yapılırken bir yandan da virüsün insan sistemleri üzerine etkileri araştırılmaya devam etmektedir. İnsan sistemleri üzerine yapılan araştırma alanlarından biri de üreme sistemidir. Koronavirüsün ekspresse olduğu ACE2 (anjiyotensin dönüştürücü enzim 2) ve TMPRSS2 (transmembran serin proteaz 2) gibi yapılara baktığımız zaman insan üreme sistemi üzerine etkileri çok daha iyi anlaşılmaktadır.
Koronavirüs nedenli karantina sürecinde hayatlarımıza giren ve beraberinde belirsizliğin de yol açtığı stresin; hem in vitro fertilizasyon çalışmalarındaki hem de insan üreme sistemi üzerindeki etkileri uzun yıllardır bilinmektedir. Yapılan çalışmalar Koronavirüsün insan üreme sisteminde bulunan hormonların miktarını ve yoğunluğunu değiştirdiğini göstermektedir. Koronavirüsün hayatımıza getirdiği stres, vücudu enfekte etmesi ve tedavisi insan üreme sistemi için bir takım potansiyel riskler oluşturmaktadır. Makalede de bu potansiyel riskler doğrultusunda yapılan araştırmalar derlenmiştir.

ABSTRACT
Coronavirus, which emerged in Wuhan, China has made major changes in many fields such as education, health, and economy, has influenced the world. When we come to 2021, while vaccination studies are carried out throughout the world within the scope of the fight against coronavirus, on the other hand, the effects of the virus on human systems are being investigated. One of the research areas on human systems is the reproductive system.
When we look at the structures such as ACE2 (angiotensin converting enzyme 2) and TMPRSS2 (transmembrane serine protease 2) that coronavirus expresses, their effects on the human reproductive system are much better understood.
The stress that entered our lives during the quarantine process due to coronavirus and also caused by uncertainty; Both in vitro fertilization studies and its effects on the human reproductive system have been known for many years. Studies show that the coronavirus changes the amount and density of hormones in the human reproductive system. The stress that the coronavirus brings to our lives, its infection and treatment pose some potential risks for the human reproductive system. In the article, researches conducted in line with these potential risks are compiled

References

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  • 3. Kharbach Y, Khallouk A. Male genital damage in COVID-19 patients: Are available data relevant? Asian Journal of Urology, 21 June 2020, https://doi.org/10.1016/j.ajur.2020.06.005
  • 4. Sun J. The hypothesis that SARS-CoV-2 affects male reproductive ability by regulating autophagy. Med Hypotheses. 2020 Oct;143:110083. doi: 10.1016/j.mehy.2020.110083. Epub 2020 Jul 10. PMID: 32679425; PMCID: PMC7347466.
  • 5. Aitken, RJ. COVID-19 and human spermatozoa—Potential risks for infertility and sexual transmission?. Andrology. 2020; 00: 1– 5. https://doi.org
  • 6. Madjunkov, Dviri, M. & Librach, et al. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res 13, 140 (2020). https://doi.org
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  • 9. Hamdi, Bendayan, Huyghe et al. COVID-19 and andrology: Recommendations of the French-speaking society of andrology (Société d’Andrologie de langue Française SALF). Basic and clinical andrology 2020; 30(1), 1-6.
  • 10. Al-Lami, RA, Urban, RJ, Volpi, E., Algburi, A., & Baillargeon, J. (2020). Cinsiyet Hormonları ve Yeni Korona Virüsü Bulaşıcı Hastalık (COVID-19). Mayo Clinic bildirileri , 95 (8), 1710–1714. https://doi.org
  • 11. Gazi Sağlık Bilimleri Dergisi 2020:5(3):1-7 Derleme COVID-19 PANDEMİSİNİN KADIN FERTİLİTESİ ÜZERİNE ETKİLERİ Cemile Merve SEYMEN <http://www.dergipark.org.tr/tr/pub/issue>
  • 12. Cattrini, Bersanelli, Latocca. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers 2020; 12(8), 2325. https://doi.org
  • 13. Ünal, Mehmet Altay. Varolan İlaç Etken Maddelerinin COVID-19’a Karşı Etkinliklerinin In-Siliko, In-Vitro ve In-Vivo Olarak İncelenmesi, Ankara Üniversitesi Kök Hücre Enstitüsü, ( 2 Nisan 2020).
  • 14. Li R, Yin T, Fang F, et al. Potential risks of SARS-CoV-2 infection on reproductive health. Reprod Biomed Online. 2020;41(1):89-95. doi:10.1016/j.rbmo.2020.04.018
  • 15. Bölüm adı. Multidisipliner COVID-19 Bursa Tabip Odası Sürekli Tıp Eğitimi Pandemi Kitabı. Ed. Heper Cem.Bursa Tabip Odası Yayınları. Temmuz 2020, Bursa. Sayfa 420. Available: < https://www.bto.org.tr/yayinlar/multidisipliner-covid
  • 16. Dolatabadi A A, Zarchii S R. The effect of prescription of different Dexamethasone doses on reproductive system, Biomedical Research (2015) Volume 26, Issue 4. https://doi.org/10.1111/and.13464
  • 17. COVID-19 Tedavisinde Kullanılan İlaçlara Gelişen İstenmeyen İlaç Reaksiyonları, Türkiye Ulusal Allerji ve Klinik İmmünoloji Derneği,https://www.aid.org.tr/covid-19-tedavisinde-kullanilan-ilaclara-gelisen-istenmeyen-ilac-reaksiyonlari/
  • 18. ( Koray, G. Ö. K., Osman, K. Ö. S. E., & Özden, S. Gebelikte Coronavirüs Enfeksiyonu (COVID-19) ve Yönetimi. Sakarya Tıp Dergisi, 10(2), 348-358.)
  • 19. Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, Critchley HOD. Pregnancy and COVID-19. Physiol Rev. 2021 Jan 1;101(1):303-318. doi: 10.1152/physrev.00024.2020. Epub 2020 Sep 24. PMID: 32969772; PMCID: PMC7686875.
  • 20. Williams, Namazova-Baranova, L, et al. The importance of continuing breastfeeding during coronavirus disease-2019: In support of the World Health Organization statement on breastfeeding during the pandemic. The Journal of Pediatrics 2020; 223, 234. doi: 10.1016/j.jpeds.2020.05.009
  • 21. Palalioglu RM, Mahammadaliyeva A, Erbiyik HI, Muhcu M. COVID-19 in third trimester may not be as scary as you think, it can be innocent: Evaluating vertical transmission from a COVID-19 positive asymptomatic pregnant woman with early membrane rupture. J Obstet Gynaecol Res. 2021 Feb;47(2):838-842. doi: 10.1111/jog.14584. Epub 2020 Dec 1. PMID: 33258171; PMCID: PMC7753417.
  • 22. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020 Jun;222(6):521-531. doi: 10.1016/j.ajog.2020.03.021. Epub 2020 Mar 23. PMID: 32217113; PMCID: PMC7270569.
  • 23. Schwartz DA. The Effects of Pregnancy on Women With COVID-19: Maternal and Infant Outcomes. Clin Infect Dis. 2020 Nov 19;71(16):2042-2044. doi: 10.1093/cid/ciaa559. PMID: 32392330; PMCID: PMC7239237.
  • 24. Ali A, Rashid Z, Zhou J, Zubair Yousaf M, Galani S, Ashraf A, Al-Ghanim KA, Al-Suliman E, Ahmed Z, Farooq M, Virik P, Kaimkhani ZA, Al-Mulhm N, Mahboob S, Dong M, Huang Q. Evaluating antibody response pattern in asymptomatic virus infected pregnant females: Human well-being study. J King Saud Univ Sci. 2021 Jan;33(1):101255. doi: 10.1016/j.jksus.2020.101255. Epub 2020 Dec 2. PMID: 33288976; PMCID: PMC7709611
  • 25. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057-1072. doi: 10.17179/excli2017-480. PMID: 28900385; PMCID: PMC5579396.
  • 26. İntergroup resource allocation. Sci Rep. 2019 Dec 9;9(1):18620. doi: 10.1038/s41598-019-54954-w. PMID: 31819104; PMCID: PMC6901446.
  • 27. Aktan G, Doğru-Abbasoğlu S, Küçükgergin C, Kadıoğlu A, Ozdemirler-Erata G, Koçak-Toker N. Mystery of idiopathic male infertility: is oxidative stress an actual risk? Fertil Steril. 2013 Apr;99(5):1211-5. doi: 10.1016/j.fertnstert.2012.11.045. Epub 2012 Dec 17. PMID: 23254182.
  • 28. Sezgin H., Hocaoğlu Ç., İnfertilitenin Psikiyatrik Yönü, Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2014;6(2):165-184 doi:10.5455/cap.20131001091415
  • 29. Erdemir F, Atılgan D. Mesleklerin Üreme ve Cinsel Sağlığa Olan Etkileri. İçinde: Çayan S, Ayyıldız A, Yaman Ö ve ark. Çevrenin Erkek Cinsel ve Üreme Sağlığına Etkisi ve Korunma Yolları. 1. baskı. İstanbul. Yıl:2010. Sayfa; 93-126.
  • 30. Atasever İ, Sis Çelik. Prenatal Stresin Ana-Çocuk Sağlığı Üzerine Etkisi, Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 2018;21(1):60-68. Available: https://dergipark.org.tr/en/download/article-file/464386
  • 31. David A. Schwartz; An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med 1 July 2020; 144 (7): 799–805. doi: https://doi.org
  • 32. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395 (10226): 809 –815.
  • 33. Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9 (1). doi: 10.21037/tp.2020.02.06
  • 34. MMA Khan, MN Khan, MG Mustagir, J Rana, MR Haque, MM Rahman. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes. MedRxiv. In press. https://doi.org/10.1101/2020.03.31.20049304
  • 35. Groner, de Carvalho, Camillo, et al. Effects of Covid-19 on male reproductive system. International braz j urol : official journal of the Brazilian Society of Urology, 47(1), 185–190. https://doi.org/10.1590/s1677-5538.ibju.2021.99.04
  • 36. Yan Jing, Li Run-Qian, Wang Hao-Ran et al. Potential influence of COVID-19/ACE2 on the female reproductive system, Molecular Human Reproduction, Volume 26, Issue 6, June 2020, Pages 367–373, https://doi.org
  • 37. Haghpanah, A, Masjedi, F, Alborzi, S, et al. Potential mechanisms of SARS‐CoV‐2 action on male gonadal function and fertility: Current status and future prospects. Andrologia. 2021; 53:e13883. https://doi.org/10.1111/and.13883

COVID19 THREAT TO HUMAN REPRODUCTIVE SYSTEM

Year 2022, Volume: 5 Issue: 1, 36 - 42, 27.02.2022

Abstract

References

  • 1. Hoffmann M, Kleine-Weber H, Schroeder S, et al. SARS-CoV-2 Cell Entry Depends on ACE2 and TMPRSS2 and Is Blocked by a Clinically Proven Protease Inhibitor. Cell. 2020;181(2):271-280.e8. doi:10.1016/j.cell.2020.02.052
  • 2. Adiga SK, Tholeti P, Uppangala S, Kalthur G, Gualtieri R, Talevi R. Fertility preservation during the COVID-19 pandemic: mitigating the viral contamination risk to reproductive cells in cryostorage. Reprod Biomed Online. 2020 Dec;41(6):991-997. doi: 10.1016/j.rbmo.2020.09.013. Epub 2020 Sep 15. PMID: 33032909; PMCID: PMC7490241.
  • 3. Kharbach Y, Khallouk A. Male genital damage in COVID-19 patients: Are available data relevant? Asian Journal of Urology, 21 June 2020, https://doi.org/10.1016/j.ajur.2020.06.005
  • 4. Sun J. The hypothesis that SARS-CoV-2 affects male reproductive ability by regulating autophagy. Med Hypotheses. 2020 Oct;143:110083. doi: 10.1016/j.mehy.2020.110083. Epub 2020 Jul 10. PMID: 32679425; PMCID: PMC7347466.
  • 5. Aitken, RJ. COVID-19 and human spermatozoa—Potential risks for infertility and sexual transmission?. Andrology. 2020; 00: 1– 5. https://doi.org
  • 6. Madjunkov, Dviri, M. & Librach, et al. A comprehensive review of the impact of COVID-19 on human reproductive biology, assisted reproduction care and pregnancy: a Canadian perspective. J Ovarian Res 13, 140 (2020). https://doi.org
  • 7. Akhigbe RE, Hamed MA. Possible links between COVID-19 and male fertility. Asian Pac J Reproad [serial online] 2020 [cited 2021 Jan 13];9:211-4. Available from: htpp://www.apjr.net/text.asp?2020/9/5/211/294662
  • 8. Ayşegül Yurt, Mustafa Saygın. Corona Virus (Covid-19) ve Üreme Sistemi İlişkisi. SDÜ Sağlık Bilimleri Dergisi / Cilt 11 Sayı 3 / 2020 http://www.dergipark.org.tr/tr/pub/issue
  • 9. Hamdi, Bendayan, Huyghe et al. COVID-19 and andrology: Recommendations of the French-speaking society of andrology (Société d’Andrologie de langue Française SALF). Basic and clinical andrology 2020; 30(1), 1-6.
  • 10. Al-Lami, RA, Urban, RJ, Volpi, E., Algburi, A., & Baillargeon, J. (2020). Cinsiyet Hormonları ve Yeni Korona Virüsü Bulaşıcı Hastalık (COVID-19). Mayo Clinic bildirileri , 95 (8), 1710–1714. https://doi.org
  • 11. Gazi Sağlık Bilimleri Dergisi 2020:5(3):1-7 Derleme COVID-19 PANDEMİSİNİN KADIN FERTİLİTESİ ÜZERİNE ETKİLERİ Cemile Merve SEYMEN <http://www.dergipark.org.tr/tr/pub/issue>
  • 12. Cattrini, Bersanelli, Latocca. Sex Hormones and Hormone Therapy during COVID-19 Pandemic: Implications for Patients with Cancer. Cancers 2020; 12(8), 2325. https://doi.org
  • 13. Ünal, Mehmet Altay. Varolan İlaç Etken Maddelerinin COVID-19’a Karşı Etkinliklerinin In-Siliko, In-Vitro ve In-Vivo Olarak İncelenmesi, Ankara Üniversitesi Kök Hücre Enstitüsü, ( 2 Nisan 2020).
  • 14. Li R, Yin T, Fang F, et al. Potential risks of SARS-CoV-2 infection on reproductive health. Reprod Biomed Online. 2020;41(1):89-95. doi:10.1016/j.rbmo.2020.04.018
  • 15. Bölüm adı. Multidisipliner COVID-19 Bursa Tabip Odası Sürekli Tıp Eğitimi Pandemi Kitabı. Ed. Heper Cem.Bursa Tabip Odası Yayınları. Temmuz 2020, Bursa. Sayfa 420. Available: < https://www.bto.org.tr/yayinlar/multidisipliner-covid
  • 16. Dolatabadi A A, Zarchii S R. The effect of prescription of different Dexamethasone doses on reproductive system, Biomedical Research (2015) Volume 26, Issue 4. https://doi.org/10.1111/and.13464
  • 17. COVID-19 Tedavisinde Kullanılan İlaçlara Gelişen İstenmeyen İlaç Reaksiyonları, Türkiye Ulusal Allerji ve Klinik İmmünoloji Derneği,https://www.aid.org.tr/covid-19-tedavisinde-kullanilan-ilaclara-gelisen-istenmeyen-ilac-reaksiyonlari/
  • 18. ( Koray, G. Ö. K., Osman, K. Ö. S. E., & Özden, S. Gebelikte Coronavirüs Enfeksiyonu (COVID-19) ve Yönetimi. Sakarya Tıp Dergisi, 10(2), 348-358.)
  • 19. Wastnedge EAN, Reynolds RM, van Boeckel SR, Stock SJ, Denison FC, Maybin JA, Critchley HOD. Pregnancy and COVID-19. Physiol Rev. 2021 Jan 1;101(1):303-318. doi: 10.1152/physrev.00024.2020. Epub 2020 Sep 24. PMID: 32969772; PMCID: PMC7686875.
  • 20. Williams, Namazova-Baranova, L, et al. The importance of continuing breastfeeding during coronavirus disease-2019: In support of the World Health Organization statement on breastfeeding during the pandemic. The Journal of Pediatrics 2020; 223, 234. doi: 10.1016/j.jpeds.2020.05.009
  • 21. Palalioglu RM, Mahammadaliyeva A, Erbiyik HI, Muhcu M. COVID-19 in third trimester may not be as scary as you think, it can be innocent: Evaluating vertical transmission from a COVID-19 positive asymptomatic pregnant woman with early membrane rupture. J Obstet Gynaecol Res. 2021 Feb;47(2):838-842. doi: 10.1111/jog.14584. Epub 2020 Dec 1. PMID: 33258171; PMCID: PMC7753417.
  • 22. Dashraath P, Wong JLJ, Lim MXK, Lim LM, Li S, Biswas A, Choolani M, Mattar C, Su LL. Coronavirus disease 2019 (COVID-19) pandemic and pregnancy. Am J Obstet Gynecol. 2020 Jun;222(6):521-531. doi: 10.1016/j.ajog.2020.03.021. Epub 2020 Mar 23. PMID: 32217113; PMCID: PMC7270569.
  • 23. Schwartz DA. The Effects of Pregnancy on Women With COVID-19: Maternal and Infant Outcomes. Clin Infect Dis. 2020 Nov 19;71(16):2042-2044. doi: 10.1093/cid/ciaa559. PMID: 32392330; PMCID: PMC7239237.
  • 24. Ali A, Rashid Z, Zhou J, Zubair Yousaf M, Galani S, Ashraf A, Al-Ghanim KA, Al-Suliman E, Ahmed Z, Farooq M, Virik P, Kaimkhani ZA, Al-Mulhm N, Mahboob S, Dong M, Huang Q. Evaluating antibody response pattern in asymptomatic virus infected pregnant females: Human well-being study. J King Saud Univ Sci. 2021 Jan;33(1):101255. doi: 10.1016/j.jksus.2020.101255. Epub 2020 Dec 2. PMID: 33288976; PMCID: PMC7709611
  • 25. Yaribeygi H, Panahi Y, Sahraei H, Johnston TP, Sahebkar A. The impact of stress on body function: A review. EXCLI J. 2017 Jul 21;16:1057-1072. doi: 10.17179/excli2017-480. PMID: 28900385; PMCID: PMC5579396.
  • 26. İntergroup resource allocation. Sci Rep. 2019 Dec 9;9(1):18620. doi: 10.1038/s41598-019-54954-w. PMID: 31819104; PMCID: PMC6901446.
  • 27. Aktan G, Doğru-Abbasoğlu S, Küçükgergin C, Kadıoğlu A, Ozdemirler-Erata G, Koçak-Toker N. Mystery of idiopathic male infertility: is oxidative stress an actual risk? Fertil Steril. 2013 Apr;99(5):1211-5. doi: 10.1016/j.fertnstert.2012.11.045. Epub 2012 Dec 17. PMID: 23254182.
  • 28. Sezgin H., Hocaoğlu Ç., İnfertilitenin Psikiyatrik Yönü, Psikiyatride Güncel Yaklaşımlar-Current Approaches in Psychiatry 2014;6(2):165-184 doi:10.5455/cap.20131001091415
  • 29. Erdemir F, Atılgan D. Mesleklerin Üreme ve Cinsel Sağlığa Olan Etkileri. İçinde: Çayan S, Ayyıldız A, Yaman Ö ve ark. Çevrenin Erkek Cinsel ve Üreme Sağlığına Etkisi ve Korunma Yolları. 1. baskı. İstanbul. Yıl:2010. Sayfa; 93-126.
  • 30. Atasever İ, Sis Çelik. Prenatal Stresin Ana-Çocuk Sağlığı Üzerine Etkisi, Anadolu Hemşirelik ve Sağlık Bilimleri Dergisi, 2018;21(1):60-68. Available: https://dergipark.org.tr/en/download/article-file/464386
  • 31. David A. Schwartz; An Analysis of 38 Pregnant Women With COVID-19, Their Newborn Infants, and Maternal-Fetal Transmission of SARS-CoV-2: Maternal Coronavirus Infections and Pregnancy Outcomes. Arch Pathol Lab Med 1 July 2020; 144 (7): 799–805. doi: https://doi.org
  • 32. Chen H, Guo J, Wang C, et al. Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records. Lancet. 2020; 395 (10226): 809 –815.
  • 33. Zhu H, Wang L, Fang C, et al. Clinical analysis of 10 neonates born to mothers with 2019-nCoV pneumonia. Transl Pediatr. 2020; 9 (1). doi: 10.21037/tp.2020.02.06
  • 34. MMA Khan, MN Khan, MG Mustagir, J Rana, MR Haque, MM Rahman. COVID-19 infection during pregnancy: a systematic review to summarize possible symptoms, treatments, and pregnancy outcomes. MedRxiv. In press. https://doi.org/10.1101/2020.03.31.20049304
  • 35. Groner, de Carvalho, Camillo, et al. Effects of Covid-19 on male reproductive system. International braz j urol : official journal of the Brazilian Society of Urology, 47(1), 185–190. https://doi.org/10.1590/s1677-5538.ibju.2021.99.04
  • 36. Yan Jing, Li Run-Qian, Wang Hao-Ran et al. Potential influence of COVID-19/ACE2 on the female reproductive system, Molecular Human Reproduction, Volume 26, Issue 6, June 2020, Pages 367–373, https://doi.org
  • 37. Haghpanah, A, Masjedi, F, Alborzi, S, et al. Potential mechanisms of SARS‐CoV‐2 action on male gonadal function and fertility: Current status and future prospects. Andrologia. 2021; 53:e13883. https://doi.org/10.1111/and.13883
There are 37 citations in total.

Details

Primary Language Turkish
Subjects Clinical Sciences
Journal Section Derleme
Authors

Elif Gelenli Dolanbay 0000-0002-7553-5435

Ayşe Yıldız This is me 0000-0001-7343-8140

Hakan Aydemir This is me 0000-0001-6996-6274

Serhat Acar This is me 0000-0001-8961-185X

Hira Ersan This is me 0000-0003-1020-1917

Yusuf Akar This is me 0000-0002-0156-3791

Ferhat Baki This is me 0000-0002-9458-6801

Publication Date February 27, 2022
Submission Date May 19, 2021
Acceptance Date February 27, 2022
Published in Issue Year 2022 Volume: 5 Issue: 1

Cite

AMA Gelenli Dolanbay E, Yıldız A, Aydemir H, Acar S, Ersan H, Akar Y, Baki F. İNSAN ÜREME SİSTEMİ’NE COVID19 TEHDİDİ. Acta Med Nicomedia. February 2022;5(1):36-42. doi:10.53446/actamednicomedia.939176

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