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By: Jeremy Sugarman, M.A., M.D., M.P.H.

  • Harvey M. Meyerhoff Professor of Bioethics and Medicine
  • Professor of Medicine

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There was no evidence of flow obstruction of the superior and inferior vena cavae antibiotic 6 month old discount 3mg ivermectin fast delivery. The largest calibre branch of the dilated left main was a dilated proximal circumflex which supplied the mass bacteria shape discount 3mg ivermectin free shipping, likely representing a thrombosed aneurysm of coronary fistula virus malware removal purchase cheapest ivermectin. There was no delayed enhancement within the body of the mass with high signal intensity along the edge of the mass antimicrobial irrigation order ivermectin 3mg without prescription. Previously noted mobile elements were identified as adjacent right atrial structures (likely displaced Chiari network). Given increased thromboembolic risk, coronary angiography to assess drainage of the mass was arranged. Diagnostic Techniques and Their Most Important Findings: Transthoracic echocardiography: 2D, Doppler, colour Doppler. Identifying cardiac masses and elucidating relationship to surrounding structures. He did well in the post-operative period and was asymptomatic for the succeeding three years. He then came to clinical attention again secondary to symptoms of heart failure and cardiogenic shock. An echocardiogram at that time suggested an extra-cardiac mass lateral to the left ventricular free wall with impingement on diastolic relaxation. The hematoma was subsequently surgically evacuated and he initially did well post operatively. Over the course of the next three years, he progressively developed worsening left and right sided heart failure symptoms with a preserved left ventricular ejection fraction. Serial echocardiography over this time demonstrated progressive tricuspid valve regurgitation, aortic insufficiency, and bi-atrial enlargement. Invasive hemodynamic assessment in the cardiac catheterization laboratory also demonstrated equalization of intracardiac pressures and ventricular interdependence with respiration. Her physical exam was unremarkable except for a systolic click, which prompted an echocardiogram. Diagnostic Techniques and Their Most Important Findings: Her echocardiogram showed a moderate-sized, echo-bright mass within the apex of the right ventricular cavity. Learning Points from this Case: Cardiac lipomas are uncommon, benign primary cardiac tumors composed of mature fat cells. They do not have a defined age or sex distribution and are usually found in the right atrium and left ventricle. The majority of the cardiac lipomas do not cause any symptoms but depending on the size and location, they may cause valvar dysfunction, outflow tract obstruction, or arrhythmias. It showed a low attenuation lesion in the right ventricle that was poorly characterized. Given the prior history of cancer, there was concern for metastasis but right ventricular thrombus could not be excluded. Diagnostic Techniques and Their Most Important Findings: A three dimensional survey was performed to locate the mass and exclude other intra-cardiac masses. Cine images focused on the right ventricle showed reduced regional systolic function along the insertion of the mass, numerous masses within the right ventricle attached to the free wall of the right ventricle, extending from the lateral tricuspid annulus to the insertion site of the moderator band. All of the masses had mobile components that extended into the right ventricular outflow tract. T-2 weighted imaging showed a heterogeneous mass with predominantly high signal intensity and areas of low signal intensity dispersed within the mass. T1 weighted imaging showed an isointense mass with areas of low signal intensity dispersed within the mass. On Dynamic contrast enhanced perfusion imaging, the region of the mass adjacent the right ventricular free wall was perfused but the endocardial surface was not perfused. Post contrast T1 weighted images showed increased signal intensity with areas of low signal intensity dispersed within the mass. Late gadolinium enhancement showed a hyper-intense mass with areas of low signal intensity. High Ti imaging showed the region of the mass adjacent the right ventricular free wall was hyperintense but the endocardial surface was hypointense. Tissue characterization clearly demonstrated a right ventricular tumor with endocardial thrombus. Additional prognostic information was gathered into the embolic potential of these masses and co-existent pulmonary emboli. Carney complex is a rare syndrome which includes cardiac myxoma, hyperactive endocrine neoplasm, spotty pigmented skin, and extra cardiac myxomatous tumors.

Treatment of severe immune thrombocytopenia associated with systemic lupus erythematosus: 59 cases antibiotic resistant bv order ivermectin 3 mg amex. Intravenous immunoglobulin therapy in a patient with lupus serositis and nephritis antibiotic colitis generic ivermectin 3mg mastercard. The stiff-person syndrome: an autoimmune disorder affecting neurotransmission of gamma-aminobutyric acid virus buster cheap ivermectin 3mg with visa. Systemic sclerosis: a systematic review on therapeutic management from 2011 to bacteria exponential growth order ivermectin line 2014. A randomized, double-blind, placebo-controlled trial: intravenous immunoglobulin treatment in patients with diffuse cutaneous systemic sclerosis. A case of diffuse scleroderma successfully treated with high-dose intravenous immune globulin infusion. High-dose intravenous immunoglobulin infusion as treatment for diffuse scleroderma. Intravenous immunoglobulin modulates cutaneous involvement and reduces skin fibrosis in systemic sclerosis: an open-label study. Intravenous immunoglobulin: an emerging treatment for immune-mediated skin diseases. Disabling morphoea of childhoodbeneficial effect of intravenous immunoglobulin therapy. Efficacy of pulsed intravenous immunoglobulin therapy in mixed connective tissue disease. Corticosteroids may improve clinical outcomes during hospitalization for HenochSchonlein purpura. Massive gastrointestinal haemorrhage in isolated intestinal Henoch-Schonlein purpura with response to intravenous immunoglobulin infusion. Intravenous immunoglobulin in Henoch-Schonlein purpura complicated by cerebral hemorrhage. High-dose intravenous immunoglobulin infusion in polyarteritis nodosa: report on one case and review of the literature. A case of common variable immunodeficiency syndrome associated with Takayasu arteritis. Treatment of systemic and renal-limited vasculitic disorders with pooled human intravenous immune globulin. Serologic and clinical response to treatment of systemic vasculitis and associated autoimmune disease with intravenous immunoglobulin. A preliminary trial of high-dose intravenous immunoglobulin to a patient with euthyroid ophthalmopathy. Update on the principles and novel local and systemic therapies for the treatment of non-infectious uveitis. Efficacy of intravenous immunoglobulin therapy in a case of autoimmune-mediated chronic active hepatitis. Quantitative immunoglobulins and IgG subclasses in patients with corticosteroid-dependent reversible airway obstruction. Deficiency of IgG4 in children: association of isolated IgG4 deficiency with recurrent respiratory tract infection. Asthma and selective immunoglobulin subclass deficiency: improvement of asthma after immunoglobulin replacement therapy. An open-label study of high-dose intravenous immunoglobulin in severe childhood asthma. Mechanisms of glucocorticoid reduction in asthmatic subjects treated with intravenous immunoglobulin. Inhibition of IgE production in vitro by intact and fragmented intravenous immunoglobulin. Slight steroid-sparing effect of intravenous immunoglobulin in children and adolescents with moderately severe bronchial asthma. A multicenter, randomized, double-blind, placebo-controlled trial of high-dose intravenous immunoglobulin for oral corticosteroid-dependent asthma. Prospective, double-blind, placebo-controlled, multicentre study on the effect of high-dose, intravenous immunoglobulin in children and adolescents with severe bronchial asthma. Effect of intravenous immunoglobulin on steroid consumption in patients with severe asthma: a double-blind, placebo-controlled, randomized trial. Lowdose intravenous gammaglobulin in the treatment of severe autoimmune urticaria. Chronic urticaria and angioedema as the first presentations of common variable immunodeficiency.

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Treatment techniques and clinical guidelines for photocoagulation of diabetic macular edema infection trichomoniasis cheap ivermectin online amex. Techniques for scatter and local photocoagulation treatment of diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report no antimicrobial killing agent order ivermectin pills in toronto. Impaired color vision associated with diabetic retinopathy: Early Treatment Diabetic Retinopathy Study Report No antimicrobial kitchen countertops purchase ivermectin with a visa. Association of elevated serum lipid levels with retinal hard exudate in diabetic retinopathy antibiotic resistance threats in the united states 2013 discount ivermectin. C-peptide and the classification of diabetes mellitus patients in the Early Treatment Diabetic Retinopathy Study. Aspirin effects on the development of cataracts in patients with diabetes mellitus. Early Treatment Diabetic Retinopathy Study design and baseline patient characteristics. Ophthalmoscopy versus photography -Early Treatment Diabetic Retinopathy Study Report Number 5. Photocoagulation for diabetic macular edema: Early Treatment Diabetic Retinopathy Study Report no. Case reports to accompany Early Treatment Diabetic Retinopathy Study Reports 3 and 4. International Uveitis Study Group Recommendations for the evaluation of intraocular inflammatory disease. Interobserver agreement in grading activity and site of inflammation in eyes of patients with uveitis. In vivo confocal microscopy of keratic precipitates in infectious versus noninfectious uveitis. Poststreptococcal syndrome uveitis: a descriptive case series and literature review. Clinical features and prognosis of herpetic anterior uveitis: a retrospective study of 111 cases. Long term acyclovir use to prevent recurrent ocular herpes simplex virus infection. Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients. Presumed fuchs heterochromic iridocyclitis and Posner-Schlossman syndrome: comparison of cytomegalovirus-positive and negative eyes. Fuchs heterochromic cyclitis: rubella virus antibodies and genome in aqueous humor. Immune-recovery uveitis in patients with cytomegalovirus retinitis taking highly active antiretroviral therapy. Diagnosis of tuberculous uveitis: clinical application of an interferon-gamma release assay. Sub-retinal fibrosis and choroidal neovascularization in Vogt Koyanagi-Harada syndrome. Revised diagnostic criteria for vogt-koyanagi-harada disease: considerations on the different disease categories. Sympathetic ophthalmia: incidence of ocular complications and vision loss in the sympathizing eye. A randomized, masked, cross-over trial of acetazolamide for cystoid macular edema in patients with uveitis. Guidelines for the use of immunosuppressive drugs in patients with ocular inflammatory disorders: recommendations of an expert panel. Recent advances in drug delivery systems for treating ocular complications of systemic diseases. Ocular Oncology this list is not exhaustive and the reading material is recommended and not required. Insulin-like growth factor-1 receptor in uveal melanoma: a predictor for metastatic disease and a potential therapeutic target. The dynamics of serum tumor markers in predicting metastatic uveal melanoma (part 1). Ten year results of transscleral resection of large uveal melanomas:Local tumor control and metastatic rate. Transformation of cell type in uveal melanomas: a quantitative histologic analysis. Systemic therapy for unresectable metastatic melanoma: impact of biochemotherapy on long-term survival. Prognostic biomarkers in uveal melanoma: evidence for a stem cell-like phenotype associated with metastasis. Late radiation failures after iodine 125 brachytherapy for uveal melanoma compared with charged-particle (proton or helium ion) therapy. Estimates of ocular and visual retention following treatment of extra-large uveal melanomas by proton beam radiotherapy. Psychological aspects of cytogenetic testing of uveal melanoma: preliminary findings and directions for future research.

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As IgM antibodies are produced early in the course of disease virus killing robot order ivermectin mastercard, their production decreases a few weeks after infection antibiotics for acne flucloxacillin order ivermectin now. The test is therefore only useful for acute leptospirosis infections antibiotic home remedy order ivermectin with mastercard, but that comprises almost all cases infection white blood cells purchase ivermectin 3 mg amex. The Witness test is affected by vaccination (false positive), but only for a few weeks after vaccination. Due to the low cost of the test, this is more feasible than with some of the other tests. The Witness Leptospira Antibody Test is an in clinic test that can be performed within 10-20 minutes, and utilizes whole blood, plasma or serum. Although a single positive titer can increase suspicion for the disease, it does not often confirm a diagnosis, particularly if the dog has been vaccinated for leptospirosis at any time in their life. To increase the diagnostic utility of the test, acute and convalescent antibody testing should be performed two to four weeks apart. The test will be positive in dogs for months to years after vaccination, therefore may be positive in dogs with up to date vaccination, and also potentially in dogs with out of date vaccination. A negative result is useful in ruling out leptospirosis unless the dog was infected very recently, in which case a false negative is possible. A positive result in a dog confirmed to have never received a Leptospira vaccine confirms leptospirosis. Given the utility of the Witness Leptospira antibody test and its low cost, it is worth using as the primary test for leptospirosis in most cases. However, other approaches are needed if the dog has been vaccinated in the previous few weeks. The goal of the first stage of treatment is to immediately inhibit multiplication of the organism and rapidly reduce fatal complications of infection. The optimal treatment for Leptospirosis is still unknown, as is the optimal duration of antimicrobial therapy. Care must be taken to ensure that the doxycycline pill is completely swallowed, as esophageal erosion can occur readily. Supportive therapy for animals with Leptospirosis depends on the severity of the clinical signs and whether renal or hepatic dysfunction is present. Otherwise, patients should be admitted to hospital and medically managed based on their presenting clinical signs and clinicopathological abnormalities. Treatment with ampicillin alone may not clear renal infection or eliminate the carrier state and chronic shedding. The goal of the second stage of treatment, therefore, is to eliminate the carrier state. The recommendation is, either initially or eventually, two weeks total of doxycycline. When Leptospirosis has been confirmed, all other dogs in the household should be tested, and treated if leptospirosis is confirmed. Subclinical seroconversion has been documented in some dogs living in the same household with dogs with Leptospirosis; this is likely due to exposure to the same environment rather than direct infection from the other dog. The recommended treatment is doxycycline 5mg/kg orally every 12 hours for 14 days. Provided severe respiratory complications are absent from the clinical picture, the prognosis for dogs treated early and aggressively is good. Survival rates of approximately 80% have been reported, both among those dogs treated conservatively and those treated with dialysis. Vaccination Currently, bacterin-based vaccines containing serovars Icterohaemorrhagiae, Canicola, Grippotyphosa and Pomona are available in North America. Vaccines appear to fairly effectively prevent disease from the vaccinated serogroup, and it is possible that there is some crossreactivity to other serogroups. Some vaccines carry the label claim of the prevention of, or aid in the prevention of, urinary shedding. As inactivated bacterins, leptospiral vaccines have been thought to be at increased risk of causing allergenic reactions. In a study of acute vaccine reactions in dogs utilizing a large database, vaccines containing leptospiral antigen were no more reactive than other vaccines for dogs. Consequently, annual vaccination with the four-serovar vaccine is recommended for at-risk dogs, regardless of breed, with the understanding that the definition of at-risk may vary geographically. Annual vaccination for dogs that have recovered from leptospirosis should be considered because such dogs are at risk of ongoing exposure and lifelong immunity may not be provided after natural infection. In fact, in some cases no measurable titre is found after vaccination for some of the serovars in the vaccine. Titres immediately after vaccination can be quite high, in some cases up to 1:12,800. There is no cut off above which one can be confident that a titre is due to natural infection rather than vaccination. Typically, titres decline to <1:100 to 1:200 after about 16 weeks, although there are no detailed studies on the increase and decrease seen over time secondary to vaccination.

Hundreds of major fact updates culled from thousands of student and faculty contributions antibiotics for acne redness purchase ivermectin without a prescription. Complete reorganization of the neurology chapter to antibiotic knee spacers order ivermectin master card better distinguish normal physiology from neuropathology and to bacterial throat infection buy generic ivermectin pills emphasize the special senses antibiotic resistance treatment cheap 3 mg ivermectin fast delivery. Improved Rapid Review section with page numbers to the text, to quickly find these high-yield concepts in context. Updated with more than 100+ new or revised full-color photos to help visualize various disorders, descriptive findings, and basic science concepts. In particular, imaging photos have been labeled and optimized to show both normal anatomy and pathologic findings. The guide also features new evidence-based techniques for efficient and effective test preparation. Real-time Step 1 updates and corrections can also be found exclusively on our blog. We provide special acknowledgment and thanks to the following individuals who made exemplary contributions to this edition through our voting, proofreading, and crowdsourcing platform: Anosh Ahmed, Kashif Badar, Humood Boqambar, Anup Chalise, Wendy Chen, Francis Deng, Anthony J. Febres, Okubit Gebreyonas, Richard Godby, Christina Govas, Eric Irons, Nikhar Kinger, Katherine Kramme, Jonathan Li, Micah Mathai, Nicolaus Mephis, Ryan Meyer, Joseph Mininni, Iraj Nasrabadi, Jimmy Tam Huy Pham, Keyhan Piranviseh, Anthony Purgianto, Casey Joseph Rosenthal, Sana Sheraz, Avinainder Singh, Paul Walden, Isabella Wu, and Xuebao Zhang. For support and encouragement throughout the process, we are grateful to Thao Pham, Jinky Flang, and Jonathan Kirsch, Esq. Thanks to our publisher, McGrawHill, for the valuable assistance of its staff, including Christina Thomas, Jim Shanahan, Laura Libretti, Midge Haramis, and Jeffrey Herzich. Robert Cannon of Textensor Ltd for providing us extensive customization and support for their powerful Annotate. Richard Usatine for his outstanding dermatologic and clinical image contributions. Kristine Krafts for many insightful text and image contributions throughout the extensive revision. For exceptional editorial leadership, enormous thanks to Christine Diedrich, Emma Underdown, and Catherine Johnson. We are also grateful to our medical illustrator, Hans Neuhart, for his creative work on the new and updated illustrations. Lastly, tremendous thanks to Rainbow Graphics, especially David Hommel and Donna Campbell, for remarkable ongoing editorial and production support under time pressure. Louisville Boracay Philadelphia New York City Ann Arbor Pittsburgh San Francisco Tao Le Vikas Bhushan Matthew Sochat Yash Chavda Andrew Zureick Mehboob Kalani Kimberly Kallianos xii General Acknowledgments Each year we are fortunate to receive the input of thousands of medical students and graduates who provide new material, clarifications, and potential corrections through our website and our collaborative editing platform. This has been a tremendous help in clarifying difficult concepts, correcting errata from the previous edition, and minimizing new errata during the revision of the current edition. We have done our best to thank each person individually below, but we recognize that errors and omissions are likely. For submitting contributions and corrections, many thanks to Mohammed Abed, Asif Abidi, John David Adame, Poppy Addison, Onaola Adedeji, Comfort Agaba, Vivian Agumadu, Bilawal Ahmed, Zoey Akah, Hamed Akbari, Pegah Akbari, Marwan Alahiri, Fadi Al-Asadi, Lourdes Alberty, Christian Alch, Erica Alcibiade, Majed Alghamdi, Mohammed Alhaidar, Nasir Alhamdan, Albert Alhatem, Alaa Alibrahim, Mohammed Alsaggaf, Luai M. Alsakaf, Khaled Al-Sawalmeh, Vaidehi Ambai, Kevin An, Anna Anderson, Christopher Anderson, Mehdi Ansari, Nelson Arellano, Gabriel Arom, Immad Attique, Nicholas Austin, Mary Ayad, Cho New Aye, Marwan Azzam, Ram Baboo, Rahaf Baker, Brian Baksa, Vijay Balakrishnan, Vyshnavy Balendra, Melissa Banez, Gauri Barlingay, Ross Barman, Frances M. Marrero Barrera, Josh Barrick, Jason Batey, Priya Batta, Rosemary Noel Beavers, Sean Behan, Jorge Martinez Bencosme, Kene BenOkafor, Elodie Marie Betances, Maria Betances, Shea Bielby, Johnathon Bishop, Aaron Blackshaw, Edgar Blecker, Cary Blum, Peter Boateng, Nwamaka Bob-Ume, Victoria Bone, Stephanie Borinsky, Adam Bortner, Chantal Brand, Shannon Brougher, Sareena Brown, Rob Brumer, Ryan Brunetti, Takur Buck, Alejandro Bugarini, Nimerta Burmhi, James Butz, Jennifer Byrd, Stefan Campbell, Fiorella B. Castillo, Harold Cedeсo, Kenan Celtik, Yusuf Chao, Kyriakos Chatzopoulos, Jessica Chen, Julia Chen, Stephanie Yi-Tsi Chen, Willie Chen, Charlie Cheng, Olivia Cheng, Shani Chibber, Tiffany Chomko, Manita Choudhary, Eric Christie, Melissa Chung, Casey Lane Clark, Beth Clymer, Sam Cochran, Lauren Coleman, Benjamin Comora, Jensyn Cone, Zachary R. Conley, Sarah Corral, Eliana Costantino, Ian Cox, Robert Cox, Crosby Culp, John Cummins, Helen Dainton, Christopher Dallo, Jonathan Dang, Laura Dankovich, Atman Dave, Eric Davied, Joshua Davis, Danielle Davis, Solomon Dawson, Ezra Dayan, Ryan DeAngelis, Kathryn Demitruk, Jessie Dhaliwal, Rahim Dhanani, Travis Dice, Abiot Didana, Cheri Dijamco, Ozan Dikilitas, Isaac M. Dodd, Kirsten Dowling, Mitch Dunklebarger, Khanh Duong, Marco Duverseau, Josh East, Jeremy Eckes, Elise Edoka, Rachel Einarsson, Hannah Eisen, Tyler Emerson, Jon Erdman, Cynthia Estrada, Matthew Fadus, Giselle Falconi, Tabbassum Fayyaz, Ravali Feeramachaneni, Kaveh Fekri, Albert Fernandez, Maria Vanessa Ferrer, Roberto Hurtado Fiel, Nicholas Field, Ryan Finn, Helen Francis, Daniel Franco, Cameron Frederick, Eli Fredman, Sheri Frickey, Gianfranco Frojo, Malak Fuad, James Fuqua, Anita Gade, Sudha Gade, Nicholas Gamboa, Avi Gandi, Jared Gans, Russell Garcia, P. Gayed, Nicholas Geiger, Alejandro Gener, John George, Maikel Ragaei Fahmi Gerges, Imran Ghare, Gaby Ghobrial, Javid Ghomashi, Gino Giannone, Lizz Gilmore, Priscilla Alvarez Gonzalez, Luis Fernando Gonzalez-Ciccarelli, Ashwani Gore, Sophie Gott, Crystal D. Green, Brian Grice, John Grotberg, Li Guiqin, xiii Nita Gupta, Gail Gutman, Samuel Guyer, Natalia Guzmman-Seda, Fuad Habbal, Sean M. Hacking, Erik Haley, Oday Halhouli, Martin Halicek, Isaiah Hammonds, Nicola Hampel, Brian Handal, Roy Handelsman, Jamison Harvey, Hunaid Hasan, Makenzie Hatfield Kresch, Joel Hayden, Mona Hdeib, Kasey Helmlinger, Katy Helms, Michelle Herberts, Cinthia Marie Gonzalez Hernandez, Ariana Hess, Mitchell Heuermann, Richard Hickman, Tiffany Hinojosa, Joyce Ho, M. Hurd, Ibrahim Hyder, David Ianacone, Jouzif Ibrahim, Taylin Im, Saira Iqbal, Josh Isserman, Mimoza Isufi, Kelechi Izunobi, Pegah Jahangiri, Sakshi Jain, Maryam Mohammed Jallo, Mitra Jamshidian, Neetu Jamwal, Paige Jarmuz, Zahran Jdaitawi, Kyu-Jin Jeon, Benjamin Hans Jeuk, Jose F. Johnson, Kai Johnson, Katherine Joltikov, Gavin Jones, Saman Doroodgar Jorshery, Vaidehi Joshi, Shirley Ju, Michael Kagan, Hanna Kakish, Kirill Karlin, Michael Karp, Aaron R. Kaufman, LaDonna Kearse, Sorena Keihani, Shamim Khan, Tamer Khashab, Mitra Khosravi, Amin Khosrowpour, Neharika Khurana, Beom Soo Kim, Christina Kim, Robert Kim, Yoo Jung Kim, Megan King, Vladimer Kitiashvili, David E. Klein, Mohammed Sammy Knefati, George Koch, Noah Kojima, Amol Koldhekar, Samantha Kops, Sai Krishna Korada, Zachary Koretz, Heather Kornmehl, David Kowal, Kathleen Kramer, Akash Kroeger, Elan Krojanker, Matthew Kurian, Anita Kurre, Rachel Kushner, Eustina Kwon, Michael Larson, George Lasker, Evangelia Lazaris, Aaron A. Lebron Burgos, Christina Dami Lee, James Lee, Jennifer Lee, Erica Lee, Rachel Leeman, Ryan Lena, Stacy Leung, Guanqun Li, Yedda Li, Ramon Li, Guohua Liang, Soobin Lim, Meng-Chen Vanessa Lin, Matthew Lippmann, Selina Liu, Alnardo Lora, Yancheng Luo, Ahmed Lutfi, Martin Ma, Ahmad Mahadeen, Nandita N.

Additional information:

References:

  • https://www.who.int/water_sanitation_health/dwq/chemicals/nitratenitrite2ndadd.pdf
  • https://jscholarship.library.jhu.edu/bitstream/handle/1774.2/62690/HOLZMAN-THESIS-2020.pdf?sequence=1
  • https://www.aota.org/-/media/Corporate/Files/ConferenceDocs/onsite-guides/2019-annual-conference-onsite-guide.pdf

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