Review
BibTex RIS Cite
Year 2023, Volume: 13 Issue: 3, 679 - 684, 11.09.2023
https://doi.org/10.33808/clinexphealthsci.1135188

Abstract

References

  • World Health Organization, Europe. Coronavirus Disease (COVID-19) Pandemic. Accessed [7 April 2022]. https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov
  • Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4): 281-286. DOI: 10.1007/s12098-020-03263-6
  • World Health Organization. Coronavirüs Disease (COVID-19). Accessed [7 April 2022]. https://www.who.int/health-topics/coronavirus#tab=tab_1
  • American College of Surgeons. COVID-19: Elective case triage guidelines for surgical care. Accessed [7 April 2022]. https://www.facs.org/covid-19/clinical-guidance/elective-case.
  • Alvino RT, Caughell CM. COVID-19 in the perioperative setting: Applying a hierarchy of controls to prevent transmission. AORN Journal 2021;113(2):147-164. DOI: 10.1002/aorn.13301
  • Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R, Merigliano S, Valmasoni M. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020;79:180-188. DOI: 10.1016/j.ijsu.2020.05.061
  • Zheng MH, Boni L, Fingerhut A. Minimally ınvasive surgery and the novel coronavirus outbreak: Lessons learned in China and Italy. Ann Surg. 2020;272(1):e5-e6. DOI: 10.1097/SLA.0000000000003924
  • van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lıoyd-Smith JO, de Wit E, Munster VJ. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567. DOI: 10.1056/NEJMc2004973
  • American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, American Hospital Association. Joint statement: roadmap for resuming elective surgery after Covid-19 pandemic. AORN; 2020. Accessed [7 April 2022]. https://www.aorn.org/guidelines/aorn-support/roadmap-for-resuming-elective-surgery-after-covid-19
  • Republic of Turkey Ministry of Health. [Internet]. Guidelines for working in health institutions and infection control measures in the COVID-19 Pandemic. March 21, 2019.Accessed [7 April 2022]. https://covid19.saglik.gov.tr/Eklenti/40282/0/covid19-saglikkurumlarindacalismarehberiveenfeksiyonkontrolonlemleripdf.pdf
  • El-Boghdadly K, Cook TM, Goodacre T, Kua J, Denmark S, McNally S, Mercer N, Moonesinghe SR, Summerton DJ. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update. Anaesthesia. 2022;77:580–587. DOI: 10.1111/anae.15699
  • Kamer E, Çolak T. What to do when a patient ınfected with COVID-19 needs an operation: A pre-surgery, peri-surgery and post-surgery guide. Turk J Colorectal Dis. 2020;84(3):301-308. DOI: 10.4274/tjcd.galenos.2020.2020-3-7
  • Al-Balas M, Al-Balas HI, Al-Balas H. Surgery during the COVID-19 pandemic: A comprehensive overview and perioperative care. Am J Surg. 2020;219(6):903-906. DOI: 10.1016/j.amjsurg.2020.04.018
  • Barie PS, Ho VP, Hunter CJ, Kaufman EJ, Narayan M, Pieracci FM, Schubl SD, Heffernan DS, Huston JM. Surgical ınfection society guidance for restoration of surgical services during the Coronavirus Disease-2019 Pandemic. Surg Infect (Larchmt). 2021;22(8):818-827. DOI: 10.1089/sur.2020.421
  • Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, Marini P, Zago M, De Paolis P, Forfori F, Agresta F, Puzziello A, D'Ugo D, Bignami E, Bellini V, Vitali P, Petrini F, Pifferi B, Corradi F, Tarasconi A, Pattonieri V, Bonati E, Tritapepe L, Agnoletti V, Corbella D, Sartelli M, Catena F. Surgery in COVID-19 patients: operational directives. World journal of emergency surgery: WJES 2020;15(1):25. DOI: 10.1186/s13017-020-00307-2
  • American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation. Statement on perioperative testing for the COVID-19 virus. Accessed [7 April 2022a]. https://www.asahq.org/about-asa/newsroom/news-releases/2021/08/asa-and-apsf-statement-on-perioperative-testing-for-the-covid-19-virus.
  • Mihalj M, Carrel T, Gregoric ID, Andereggen L, Zinn PO, Doll D, Stueber F, Gabriel RA, Urman RD, Luedi MM. Telemedicine for preoperative assessment during a COVID-19 pandemic: Recommendations for clinical care. Best practice & research. Clinical anaesthesiology. 2020;34(2):345–351. DOI: 10.1016/j.bpa.2020.05.001
  • American Society of Anesthesiologists and Anesthesia Patient Safety Foundation. Joint statement on elective surgery and anesthesia for patients after COVID-19 infection. Accessed [7 April cited 2022b]. https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesia-for-patients-after-covid-19-infection/
  • Ti LK, Ang LS, Foong TW, NG BSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth. 2020;67(6):756-758. DOI: 10.1007/s12630-020-01617-4
  • De Simone B, Chouillard E, Sartelli M, Biffl W L, Di Saverio S, Moore EE, Kluger Y, Abu-Zidan FM, Ansaloni L, Coccolini F, Leppänemi A, Peitzmann AB, Pagani L, Fraga GP, Paolillo C, Picetti E, Valentino M, Pikoulis E, Baiocchi GL, Catena F. The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper. World journal of emergency surgery: WJES. 2021;16(1):14. DOI: 10.1186/s13017-021-00349-0
  • Nazir N, Gupta S. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in India. Ain-Shams J Anesthesiol. 2021;13(1):30. DOI: 10.1186/s42077-021-00150-w
  • Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP. Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation. Zhonghua Wai Ke Za Zhi 2020;14:E001. DOI: 10.3760/cma.j.issn.0529-5815.2020.0001
  • Pimentel M, Pimentel CB, Wheeler K, Dehmer E, Vacanti JC, Urman RD. Using a pre-procedure COVID-19 huddle to improve operating room safety. Journal of Clinical Anesthesia. 2020;65:109875. DOI: 10.1016/j.jclinane.2020.109875
  • Fransvea P, Sganga G, Cozza V, Di Grezia M, Fico V, Tirelli F, Pepe G, Greca AL. Set up of a dedicated COVID-19 surgical pathway and operating room for surgical emergencies. The Journal of Trauma and Acute Care Surgery. 2020;89(4):e97–e100. DOI: 10.1097/TA.0000000000002852
  • Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, Madkouri R. Patients with Coronavirus 2019 (COVID-19) and surgery: Guidelines and checklist proposal. World Neurosurgery. 2020;139:e769–e773. doi: 10.1016/j.wneu.2020.04.155
  • Carvalho AAG, Aidar ALES, Dos Santos BC, Kuramoto DAB, Pereda MR, Correia RM, Nakano LCU, Amorim JE. Recommendations for use of personal protective equipment (PPE) in surgical procedures during the SARS-Cov pandemic. J Vasc Bras. 2021;16:e20200044. DOI: 10.1590/1677-5449.200044
  • Brindle ME, Gawande A. Managing COVID-19 in surgical systems. Ann Surg. 2020;272(1):e1-e2. DOI: 10.1097/SLA.0000000000003923
  • Kim HJ, Ko JS, Seo H, Kim TY. Guidelines for the control and prevention of coronavirus disease (COVID-19) transmission in surgical and anesthetic settings. Korean journal of anesthesiology 2020;73(4):271–4. DOI: 10.4097/kja.20235
  • Evans HL, Thomas CS, Bell LH, Hink AB, O'Driscoll S, Tobin CD, Salgado CD. Development of a sterile personal protectiveequipment donning and doffing procedureto protect surgical teams from SARS-CoV-2 exposure during the COVID-19 pandemic. Surgical Infections. 2020;21(8):671-6. DOI: 10.1089/sur.2020.140
  • Aygin D, Gül A. COVID-19 and surgical care. Sakarya Tıp Dergisi. 2022;12(2):355-66. DOI: 10.31832/smj.801011
  • Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and surgical practice: Unexpected fatality in perioperative period. Ann Surg. 2020;272(1):e27-e29. DOI: 10.1097/SLA.0000000000003925
  • Gür S, Katran HB, Arpag N. Precautions to be taken before, during and after the operation in the COVID-19 pandemic. THDD. 2021;2(1):77-91.
  • Zhang WJ, Zou FL, Hu DX, Luo HL, Wu LD, Hu JL. SARS-CoV-2: Operating room management strategies and recommendations. Front Med (Lausanne). 2022;9:933799. DOI: 10.3389%2Ffmed.2022.933799
  • Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: An evidence-based approach for optimization of ınfection control and operating room management. Anesthesia and analgesia 2020;131(1):37-42. DOI: 10.1213/ANE.0000000000004829
  • Lıang T. Handbook of COVID-19 prevention and treatment. The first affiliated hospital, China: Zhejiang University School of Medicine; 2020.
  • Ljungqvist O, Nelson G, Demartines N. The Post COVID-19 surgical backlog: Now is the time to ımplement enhanced recovery after surgery (ERAS). World Journal of Surgery. 2020;44(10):3197-3198. DOI: 10.1007/s00268-020-05734-5.

The Effect of the COVID-19 Pandemic on the Surgery Process

Year 2023, Volume: 13 Issue: 3, 679 - 684, 11.09.2023
https://doi.org/10.33808/clinexphealthsci.1135188

Abstract

With this review, it was aimed to discuss the effect of the COVID-19 pandemic on the process before, during and after surgery. Studies that were accessed using the keywords “COVID-19”, “perioperative” and “surgery” in Pubmed and Science Direct and Turkish databases were discussed. The measures taken with the declaration of the pandemic also affected surgical practices, and postponing elective cases other
than emergency and cancer surgery was one of the common measures implemented in many countries. In addition to all these measures and recommendations, the fact that the operating room environment has some unique risk factors draws attention to the process before, during and after the surgery. Guidelines for the measures to be taken in the national and international arena are published in order to plan the workforce of health professionals and to use limited health care resources effectively, as well as to prevent the spread of COVID-19. These measures and recommendations are shaped according to the statistical fluctuation in the number of infected cases and health care resources in countries, and policies and procedures regarding the preoperative, intraoperative and postoperative period are updated. It is extremely important to follow the current literature in order to protect both patients and healthcare professionals involved in the surgical process and to prevent cross-contamination against the COVID-19 virus.

References

  • World Health Organization, Europe. Coronavirus Disease (COVID-19) Pandemic. Accessed [7 April 2022]. https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov
  • Singhal T. A Review of Coronavirus Disease-2019 (COVID-19). Indian J Pediatr. 2020;87(4): 281-286. DOI: 10.1007/s12098-020-03263-6
  • World Health Organization. Coronavirüs Disease (COVID-19). Accessed [7 April 2022]. https://www.who.int/health-topics/coronavirus#tab=tab_1
  • American College of Surgeons. COVID-19: Elective case triage guidelines for surgical care. Accessed [7 April 2022]. https://www.facs.org/covid-19/clinical-guidance/elective-case.
  • Alvino RT, Caughell CM. COVID-19 in the perioperative setting: Applying a hierarchy of controls to prevent transmission. AORN Journal 2021;113(2):147-164. DOI: 10.1002/aorn.13301
  • Moletta L, Pierobon ES, Capovilla G, Costantini M, Salvador R, Merigliano S, Valmasoni M. International guidelines and recommendations for surgery during Covid-19 pandemic: A Systematic Review. Int J Surg. 2020;79:180-188. DOI: 10.1016/j.ijsu.2020.05.061
  • Zheng MH, Boni L, Fingerhut A. Minimally ınvasive surgery and the novel coronavirus outbreak: Lessons learned in China and Italy. Ann Surg. 2020;272(1):e5-e6. DOI: 10.1097/SLA.0000000000003924
  • van Doremalen N, Bushmaker T, Morris DH, Holbrook MG, Gamble A, Williamson BN, Tamin A, Harcourt JL, Thornburg NJ, Gerber SI, Lıoyd-Smith JO, de Wit E, Munster VJ. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med. 2020;382(16):1564-1567. DOI: 10.1056/NEJMc2004973
  • American College of Surgeons, American Society of Anesthesiologists, Association of Perioperative Registered Nurses, American Hospital Association. Joint statement: roadmap for resuming elective surgery after Covid-19 pandemic. AORN; 2020. Accessed [7 April 2022]. https://www.aorn.org/guidelines/aorn-support/roadmap-for-resuming-elective-surgery-after-covid-19
  • Republic of Turkey Ministry of Health. [Internet]. Guidelines for working in health institutions and infection control measures in the COVID-19 Pandemic. March 21, 2019.Accessed [7 April 2022]. https://covid19.saglik.gov.tr/Eklenti/40282/0/covid19-saglikkurumlarindacalismarehberiveenfeksiyonkontrolonlemleripdf.pdf
  • El-Boghdadly K, Cook TM, Goodacre T, Kua J, Denmark S, McNally S, Mercer N, Moonesinghe SR, Summerton DJ. Timing of elective surgery and risk assessment after SARS-CoV-2 infection: an update. Anaesthesia. 2022;77:580–587. DOI: 10.1111/anae.15699
  • Kamer E, Çolak T. What to do when a patient ınfected with COVID-19 needs an operation: A pre-surgery, peri-surgery and post-surgery guide. Turk J Colorectal Dis. 2020;84(3):301-308. DOI: 10.4274/tjcd.galenos.2020.2020-3-7
  • Al-Balas M, Al-Balas HI, Al-Balas H. Surgery during the COVID-19 pandemic: A comprehensive overview and perioperative care. Am J Surg. 2020;219(6):903-906. DOI: 10.1016/j.amjsurg.2020.04.018
  • Barie PS, Ho VP, Hunter CJ, Kaufman EJ, Narayan M, Pieracci FM, Schubl SD, Heffernan DS, Huston JM. Surgical ınfection society guidance for restoration of surgical services during the Coronavirus Disease-2019 Pandemic. Surg Infect (Larchmt). 2021;22(8):818-827. DOI: 10.1089/sur.2020.421
  • Coccolini F, Perrone G, Chiarugi M, Di Marzo F, Ansaloni L, Scandroglio I, Marini P, Zago M, De Paolis P, Forfori F, Agresta F, Puzziello A, D'Ugo D, Bignami E, Bellini V, Vitali P, Petrini F, Pifferi B, Corradi F, Tarasconi A, Pattonieri V, Bonati E, Tritapepe L, Agnoletti V, Corbella D, Sartelli M, Catena F. Surgery in COVID-19 patients: operational directives. World journal of emergency surgery: WJES 2020;15(1):25. DOI: 10.1186/s13017-020-00307-2
  • American Society of Anesthesiologists and the Anesthesia Patient Safety Foundation. Statement on perioperative testing for the COVID-19 virus. Accessed [7 April 2022a]. https://www.asahq.org/about-asa/newsroom/news-releases/2021/08/asa-and-apsf-statement-on-perioperative-testing-for-the-covid-19-virus.
  • Mihalj M, Carrel T, Gregoric ID, Andereggen L, Zinn PO, Doll D, Stueber F, Gabriel RA, Urman RD, Luedi MM. Telemedicine for preoperative assessment during a COVID-19 pandemic: Recommendations for clinical care. Best practice & research. Clinical anaesthesiology. 2020;34(2):345–351. DOI: 10.1016/j.bpa.2020.05.001
  • American Society of Anesthesiologists and Anesthesia Patient Safety Foundation. Joint statement on elective surgery and anesthesia for patients after COVID-19 infection. Accessed [7 April cited 2022b]. https://www.apsf.org/news-updates/asa-and-apsf-joint-statement-on-elective-surgery-and-anesthesia-for-patients-after-covid-19-infection/
  • Ti LK, Ang LS, Foong TW, NG BSW. What we do when a COVID-19 patient needs an operation: operating room preparation and guidance. Can J Anaesth. 2020;67(6):756-758. DOI: 10.1007/s12630-020-01617-4
  • De Simone B, Chouillard E, Sartelli M, Biffl W L, Di Saverio S, Moore EE, Kluger Y, Abu-Zidan FM, Ansaloni L, Coccolini F, Leppänemi A, Peitzmann AB, Pagani L, Fraga GP, Paolillo C, Picetti E, Valentino M, Pikoulis E, Baiocchi GL, Catena F. The management of surgical patients in the emergency setting during COVID-19 pandemic: the WSES position paper. World journal of emergency surgery: WJES. 2021;16(1):14. DOI: 10.1186/s13017-021-00349-0
  • Nazir N, Gupta S. Preparing for a COVID-19 pandemic: a review of operating room outbreak response measures in a large tertiary hospital in India. Ain-Shams J Anesthesiol. 2021;13(1):30. DOI: 10.1186/s42077-021-00150-w
  • Tao KX, Zhang BX, Zhang P, Zhu P, Wang GB, Chen XP. Recommendations for general surgery clinical practice in novel coronavirus pneumonia situation. Zhonghua Wai Ke Za Zhi 2020;14:E001. DOI: 10.3760/cma.j.issn.0529-5815.2020.0001
  • Pimentel M, Pimentel CB, Wheeler K, Dehmer E, Vacanti JC, Urman RD. Using a pre-procedure COVID-19 huddle to improve operating room safety. Journal of Clinical Anesthesia. 2020;65:109875. DOI: 10.1016/j.jclinane.2020.109875
  • Fransvea P, Sganga G, Cozza V, Di Grezia M, Fico V, Tirelli F, Pepe G, Greca AL. Set up of a dedicated COVID-19 surgical pathway and operating room for surgical emergencies. The Journal of Trauma and Acute Care Surgery. 2020;89(4):e97–e100. DOI: 10.1097/TA.0000000000002852
  • Grelat M, Pommier B, Portet S, Amelot A, Barrey C, Leroy HA, Madkouri R. Patients with Coronavirus 2019 (COVID-19) and surgery: Guidelines and checklist proposal. World Neurosurgery. 2020;139:e769–e773. doi: 10.1016/j.wneu.2020.04.155
  • Carvalho AAG, Aidar ALES, Dos Santos BC, Kuramoto DAB, Pereda MR, Correia RM, Nakano LCU, Amorim JE. Recommendations for use of personal protective equipment (PPE) in surgical procedures during the SARS-Cov pandemic. J Vasc Bras. 2021;16:e20200044. DOI: 10.1590/1677-5449.200044
  • Brindle ME, Gawande A. Managing COVID-19 in surgical systems. Ann Surg. 2020;272(1):e1-e2. DOI: 10.1097/SLA.0000000000003923
  • Kim HJ, Ko JS, Seo H, Kim TY. Guidelines for the control and prevention of coronavirus disease (COVID-19) transmission in surgical and anesthetic settings. Korean journal of anesthesiology 2020;73(4):271–4. DOI: 10.4097/kja.20235
  • Evans HL, Thomas CS, Bell LH, Hink AB, O'Driscoll S, Tobin CD, Salgado CD. Development of a sterile personal protectiveequipment donning and doffing procedureto protect surgical teams from SARS-CoV-2 exposure during the COVID-19 pandemic. Surgical Infections. 2020;21(8):671-6. DOI: 10.1089/sur.2020.140
  • Aygin D, Gül A. COVID-19 and surgical care. Sakarya Tıp Dergisi. 2022;12(2):355-66. DOI: 10.31832/smj.801011
  • Aminian A, Safari S, Razeghian-Jahromi A, Ghorbani M, Delaney CP. COVID-19 Outbreak and surgical practice: Unexpected fatality in perioperative period. Ann Surg. 2020;272(1):e27-e29. DOI: 10.1097/SLA.0000000000003925
  • Gür S, Katran HB, Arpag N. Precautions to be taken before, during and after the operation in the COVID-19 pandemic. THDD. 2021;2(1):77-91.
  • Zhang WJ, Zou FL, Hu DX, Luo HL, Wu LD, Hu JL. SARS-CoV-2: Operating room management strategies and recommendations. Front Med (Lausanne). 2022;9:933799. DOI: 10.3389%2Ffmed.2022.933799
  • Dexter F, Parra MC, Brown JR, Loftus RW. Perioperative COVID-19 defense: An evidence-based approach for optimization of ınfection control and operating room management. Anesthesia and analgesia 2020;131(1):37-42. DOI: 10.1213/ANE.0000000000004829
  • Lıang T. Handbook of COVID-19 prevention and treatment. The first affiliated hospital, China: Zhejiang University School of Medicine; 2020.
  • Ljungqvist O, Nelson G, Demartines N. The Post COVID-19 surgical backlog: Now is the time to ımplement enhanced recovery after surgery (ERAS). World Journal of Surgery. 2020;44(10):3197-3198. DOI: 10.1007/s00268-020-05734-5.
There are 36 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Review
Authors

Tülin Yıldız 0000-0002-4981-6671

Cagla Avcu 0000-0002-7786-2288

Publication Date September 11, 2023
Submission Date June 24, 2022
Published in Issue Year 2023 Volume: 13 Issue: 3

Cite

APA Yıldız, T., & Avcu, C. (2023). The Effect of the COVID-19 Pandemic on the Surgery Process. Clinical and Experimental Health Sciences, 13(3), 679-684. https://doi.org/10.33808/clinexphealthsci.1135188
AMA Yıldız T, Avcu C. The Effect of the COVID-19 Pandemic on the Surgery Process. Clinical and Experimental Health Sciences. September 2023;13(3):679-684. doi:10.33808/clinexphealthsci.1135188
Chicago Yıldız, Tülin, and Cagla Avcu. “The Effect of the COVID-19 Pandemic on the Surgery Process”. Clinical and Experimental Health Sciences 13, no. 3 (September 2023): 679-84. https://doi.org/10.33808/clinexphealthsci.1135188.
EndNote Yıldız T, Avcu C (September 1, 2023) The Effect of the COVID-19 Pandemic on the Surgery Process. Clinical and Experimental Health Sciences 13 3 679–684.
IEEE T. Yıldız and C. Avcu, “The Effect of the COVID-19 Pandemic on the Surgery Process”, Clinical and Experimental Health Sciences, vol. 13, no. 3, pp. 679–684, 2023, doi: 10.33808/clinexphealthsci.1135188.
ISNAD Yıldız, Tülin - Avcu, Cagla. “The Effect of the COVID-19 Pandemic on the Surgery Process”. Clinical and Experimental Health Sciences 13/3 (September 2023), 679-684. https://doi.org/10.33808/clinexphealthsci.1135188.
JAMA Yıldız T, Avcu C. The Effect of the COVID-19 Pandemic on the Surgery Process. Clinical and Experimental Health Sciences. 2023;13:679–684.
MLA Yıldız, Tülin and Cagla Avcu. “The Effect of the COVID-19 Pandemic on the Surgery Process”. Clinical and Experimental Health Sciences, vol. 13, no. 3, 2023, pp. 679-84, doi:10.33808/clinexphealthsci.1135188.
Vancouver Yıldız T, Avcu C. The Effect of the COVID-19 Pandemic on the Surgery Process. Clinical and Experimental Health Sciences. 2023;13(3):679-84.

14639   14640