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Cureus Nov 2021Methemoglobinemia is a severely dangerous condition that can be induced by congenital mutations or can be acquired. One of the ways to acquire methemoglobinemia is by...
Methemoglobinemia is a severely dangerous condition that can be induced by congenital mutations or can be acquired. One of the ways to acquire methemoglobinemia is by using topical anesthetics during procedures, such as nasogastric (NG) tube placement, transesophageal echocardiogram (TEE), esophagogastroduodenoscopies (EGD), and during endoscopic retrograde cholangiopancreatography (ERCP). Herein, we present the case of a 35-year-old lady who presented to the hospital for an initial hysterectomy. However, due to topical anesthetic use during an NG tube placement, she developed methemoglobinemia. She then developed hypoxia, an altered mental status, and had elevated methemoglobinemia levels. She denied any previous episode of methemoglobinemia and had no family history of the condition as well. She was rapidly given methylene blue, which resolved her symptoms and induced normal methemoglobin levels on subsequent arterial blood gas analysis. Those who are unknowingly susceptible to developing methemoglobinemia and receive anesthetics during hospital procedures are at risk for serious adverse effects and clinical deterioration if not treated correctly. Therefore, it is important to recognize the clinical signs of methemoglobinemia as soon as they appear and have the required treatment readily available, as any delay could result in dangerous consequences for the patient.
PubMed: 34881122
DOI: 10.7759/cureus.19259 -
Cureus May 2022Background Lichen planus (LP) is a pathology that affects the skin and the mucosa. The lips are rarely involved but represent a diagnostic challenge in those cases....
Background Lichen planus (LP) is a pathology that affects the skin and the mucosa. The lips are rarely involved but represent a diagnostic challenge in those cases. Oral lichenoid lesions (OLL) are defined as lesions that resemble oral lichen planus (OLP) but do not fully meet the clinical and/or histologic criteria for OLP. This study aimed to present our case series and to study the correlation between the location of the lesion and the dental factor (resin composite, amalgams, crowns, abrasive teeth, and mandibular crossbite) that could cause the lesion. Methods We conducted a retrospective observational study of 23 patients with LP/OLL of the lips treated in the Department of Oral Mucosal Pathology of the Department of Stomatology and Maxillofacial Surgery of the Pitié-Salpêtrière Hospital in Paris between January 2017 and February 2021. We noted the location of the lesion (upper, lower, or both lips), medical history, treatments, smoking habits, and the aspect of the teeth facing the lesion. Patients received a local corticoid treatment and were monitored via follow-up. Results Sixteen patients had lesions on the upper lip, two on the lower lip, and five on both lips, and most patients (n = 14, 60.1%) had a dental factor facing the lesion (e.g., abrasive teeth, resin composites, dental crowns, and mandibular crossbite). Six patients received clobetasol propionate, and 15 patients received a preparation combining betamethasone and benzocaine (Orabase, ConvaTec, Deeside, UK). Fourteen patients returned for post-treatment follow-up consultations approximately two months after treatment. Seven patients saw clinical improvement, five had partial improvement, and two had no improvement. Conclusions Lesions of the labial mucosa appear to be a rare condition in LP/OLL. The difference between LP and OLL can be difficult, even with histological analysis. Its pathogenesis remains unknown, although some studies found evidence of lichenoid reactions of the lips in contact with dental composite restorations. In our study, 14 of our patients had a dental factor facing the lesions. However, our study failed to show a correlation between the presence of an inducing factor and the lesion. In a future study, the potential effect of dental inducing factor removal could be studied. This topic requires further investigations, particularly regarding the inducing factor and the optimal therapeutic approach.
PubMed: 35591890
DOI: 10.7759/cureus.25012 -
Anesthesia Progress 2016A randomized, nonblinded clinical trial compared the effectiveness of an application method of a fast-acting refrigerant topical agent to a 20% benzocaine gel topical.... (Comparative Study)
Comparative Study Randomized Controlled Trial
A randomized, nonblinded clinical trial compared the effectiveness of an application method of a fast-acting refrigerant topical agent to a 20% benzocaine gel topical. In a split-mouth design, right and left anterior middle superior alveolar injections (N = 30) were administered with a 27-gauge needle at least 24 hours apart with preinjection topicals. Using a cotton-tipped applicator, a refrigerant topical was applied for 5 seconds and 20% benzocaine gel for 2 minutes on opposite sides at 2 separate appointments. Subjects self-reported pain perception after each injection using a visual analog scale (VAS). The mean VAS ratings demonstrated no significant difference between the 5-second application of the refrigerant (M = 16.2, SD = 17.7) and the 2-minute application of 20% benzocaine topical gel anesthetic (M = 17.9, SD = 18.2). Fifty-seven percent of the subjects reported greater pain reduction with the refrigerant, 33% reported greater pain reduction with 20% benzocaine, and 10% reported no difference. Results suggest the described method of application of a refrigerant as an oral topical anesthetic has a faster onset and provides similar benefit in pain reduction compared with 20% benzocaine gel. The refrigerant was easy to accomplish and well received by subjects, indicating potential for routine use in dentistry.
Topics: Adult; Aged; Anesthesia, Dental; Anesthetics; Anesthetics, Local; Benzocaine; Cross-Over Studies; Cryoanesthesia; Drug Combinations; Female; Gels; Humans; Hydrocarbons, Fluorinated; Injections; Lidocaine; Male; Middle Aged; Pain Measurement; Time Factors; Young Adult
PubMed: 27269661
DOI: 10.2344/0003-3006-63.2.55 -
Indian Journal of Dental Research :... 2023The key to successful management of a child in the dental clinic depends greatly on providing painless anaesthesia. Topical anaesthesia using bioadhesive patches may be...
CONTEXT
The key to successful management of a child in the dental clinic depends greatly on providing painless anaesthesia. Topical anaesthesia using bioadhesive patches may be a breakthrough in this field.
AIMS
The purpose of the study was to compare the efficacy of Benzocaine and Lidocaine bioadhesive patches in reducing pain associated with various minor oral surgical procedures in children.
METHODS AND MATERIALS
Hundred subjects, aged 6-9 years, requiring various minor oral surgical procedures such as extractions of primary teeth, nerve blocks, mucocele excision or drainage of abscesses were divided equally into Groups 1 and 2. In Group 1, custom fabricated Benzocaine patches were placed for 5 minutes at the target site prior to the procedure, and in Group 2, Lidocaine patches were used in the same manner. Each subject completed a visual analogue scale (VAS) and Wong-Baker Faces pain scale (FPS) after each procedure. Pulse rate and saturation of peripheral oxygen were assessed using pulse oximeter. The duration of the study was from September 2014 to September 2015.
STATISTICAL ANALYSIS USED
The statistical analysis was done using paired t test, ANOVA and Bonferroni post hoc analysis. P value less than 0.05 were considered as statistically significant.
RESULTS
A significant difference in pain scores was observed favouring the use of Benzocaine over Lidocaine patches (P < 0.05). However, no significant differences in pulse oximeter readings were observed.
CONCLUSIONS
A statistically significant reduction in pain rating scores was observed in the Benzocaine group after a five-minute application of the patch.
Topics: Humans; Child; Benzocaine; Anesthetics, Local; Lidocaine; Pain; Oral Surgical Procedures; Double-Blind Method
PubMed: 37787201
DOI: 10.4103/ijdr.ijdr_192_21 -
The Cochrane Database of Systematic... Jan 2005Obesity is closely related to type 2 diabetes and long-term weight reduction is an important part of the care delivered to obese persons with diabetes. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Obesity is closely related to type 2 diabetes and long-term weight reduction is an important part of the care delivered to obese persons with diabetes.
OBJECTIVES
To assess the efficacy of pharmacotherapy for weight loss in adults with type 2 diabetes.
SEARCH STRATEGY
Computerized searches were performed of MEDLINE (January 1966 to May 2004), EMBASE (January 1974 to May 2004, Web of Science (January 1981 to May 2004, and other electronic bibliographic databases, supplemented with hand searches of reference lists and selected journals.
SELECTION CRITERIA
Randomized, controlled trials were included where pharmacotherapy was used as the primary strategy for weight loss among adults with type 2 diabetes. Published and unpublished literature in any language and with any study design was included.
DATA COLLECTION AND ANALYSIS
Two reviewers abstracted data and the quality of included studies was evaluated by assessing potential attrition, as well as selection and measurement bias, and a Jadad score was obtained. Effects were combined using a random effects model.
MAIN RESULTS
A sufficient number of studies were available for a quantitative synthesis for fluoxetine, orlistat, and sibutramine. Twenty two randomized controlled trials were included in the review, with a total of 296 participants for fluoxitine, 2036 for orlistat, and 1047 for sibutramine. Pharmacotherapy produced modest reductions in weight for fluoxetine (5.1 kg (95% confidence interval [CI], 3.3 - 6.9) at 24 to 26 weeks follow up; orlistat 2.0 kg (CI, 1.3 - 2.8) at 12 to 57 weeks follow-up, and sibutramine 5.1 kg (CI, 3.2 - 7.0) at 12 to 52 weeks follow-up. Glycated hemoglobin also modestly and significantly reduced for fluoxetine and orlistat. Gastrointestinal side effects were common with orlistat; tremor, somnolence and sweating with fluoxetine; and palpitations with sibutramine. Some studies, using a variety of study designs, were available on other drugs and a significant decrease in weight was noted in three studies of mazindol, one of phenmetrazine, two of phentermine. No studies were identified that fit inclusion criteria for pseudophedrine, ephedra, sertraline, yohimbine, amphetamine or its derivatives, bupropion, topiramate, benzocaine, threachlorocitric acid, sertraline, and bromocriptine.
AUTHORS' CONCLUSIONS
Fluoxetine, orlistat, and sibutramine can achieve statistically significant weight loss over 12 to 57 weeks. The magnitude of weight loss is modest, however, and the long-term health benefits remain unclear. The safety of sibutramine is uncertain. There is a paucity of data on other drugs for weight loss or control in persons with type 2 diabetes.
Topics: Adult; Anti-Obesity Agents; Appetite Depressants; Cyclobutanes; Diabetes Mellitus, Type 2; Fluoxetine; Humans; Lactones; Obesity; Orlistat; Randomized Controlled Trials as Topic; Weight Loss
PubMed: 15674929
DOI: 10.1002/14651858.CD004096.pub2 -
The Cochrane Database of Systematic... Jul 2018Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ear wax (cerumen) is a normal bodily secretion that can become a problem when it obstructs the ear canal. Symptoms attributed to wax (such as deafness and pain) are among the commonest reasons for patients to present to primary care with ear trouble.Wax is part of the ear's self-cleaning mechanism and is usually naturally expelled from the ear canal without causing problems. When this mechanism fails, wax is retained in the canal and may become impacted; interventions to encourage its removal may then be needed. Application of ear drops is one of these methods. Liquids used to remove and soften wax are of several kinds: oil-based compounds (e.g. olive or almond oil); water-based compounds (e.g. sodium bicarbonate or water itself); a combination of the above or non-water, non-oil-based solutions, such as carbamide peroxide (a hydrogen peroxide-urea compound) and glycerol.
OBJECTIVES
To assess the effects of ear drops (or sprays) to remove or aid the removal of ear wax in adults and children.
SEARCH METHODS
We searched the Cochrane ENT Trials Register; Cochrane Register of Studies; PubMed; Ovid Embase; CINAHL; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 23 March 2018.
SELECTION CRITERIA
Randomised controlled trials (RCTs) in which a 'cerumenolytic' was compared with no treatment, water or saline, an alternative liquid treatment (oil or almond oil) or another 'cerumenolytic' in adults or children with obstructing or impacted ear wax.
DATA COLLECTION AND ANALYSIS
We used the standard methodological procedures expected by Cochrane. The primary outcomes were 1) the proportion of patients (or ears) with complete clearance of ear wax and 2) adverse effects (discomfort, irritation or pain). Secondary outcomes were: extent of wax clearance; proportion of people (or ears) with relief of symptoms due to wax; proportion of people (or ears) requiring further intervention to remove wax; success of mechanical removal of residual wax following treatment; any other adverse effects recorded and cost. We used GRADE to assess the quality of the evidence for each outcome; this is indicated in italics.
MAIN RESULTS
We included 10 studies, with 623 participants (900 ears). Interventions included: oil-based treatments (triethanolamine polypeptide, almond oil, benzocaine, chlorobutanol), water-based treatments (docusate sodium, carbamide peroxide, phenazone, choline salicylate, urea peroxide, potassium carbonate), other active comparators (e.g. saline or water alone) and no treatment. Nine of the studies were more than 15 years old.The overall risk of bias across the 10 included studies was low or unclear.
PRIMARY OUTCOME
proportion of patients (or ears) with complete clearance of ear waxSix studies (360 participants; 491 ears) contributed quantitative data and were included in our meta-analyses.Active treatment versus no treatmentOnly one study addressed this comparison. The proportion of ears with complete clearance of ear wax was higher in the active treatment group (22%) compared with the no treatment group (5%) after five days of treatment (risk ratio (RR) 4.09, 95% confidence interval (CI) 1.00 to 16.80); one study; 117 ears; NNTB = 8) (low-quality evidence).Active treatment versus water or salineWe found no evidence of a difference in the proportion of patients (or ears) with complete clearance of ear wax when the active treatment group was compared to the water or saline group (RR 1.47, 95% CI 0.79 to 2.75; three studies; 213 participants; 257 ears) (low-quality evidence). Two studies applied drops for five days, but one study only applied the drops for 15 minutes. When we excluded this study in a sensitivity analysis it did not change the result.Water or saline versus no treatmentThis comparison was only addressed in the single study cited above (active versus no treatment) and there was no evidence of a difference in the proportion of ears with complete wax clearance when comparing water or saline with no treatment after five days of treatment (RR 4.00, 95% CI 0.91 to 17.62; one study; 76 ears) (low-quality evidence).Active treatment A versus active treatment BSeveral single studies evaluated 'head-to-head' comparisons between two active treatments. We found no evidence to show that one was superior to any other.Subgroup analysis of oil-based active treatments versus non-oil based active treatmentsWe found no evidence of a difference in this outcome when oil-based treatments were compared with non-oil-based active treatments.
PRIMARY OUTCOME
adverse effects: discomfort, irritation or painOnly seven studies planned to measure and did report this outcome. Only two (141 participants;176 ears) provided useable data. There was no evidence of a significant difference in the number of adverse effects between the types of ear drops in these two studies. We summarised the remaining five studies narratively. All events were mild and reported in fewer than 30 participants across the seven studies (low-quality evidence).Secondary outcomesThree studies reported 'other' adverse effects (how many studies planned to report these is unclear). The available information was limited and included occasional reports of dizziness, unpleasant smell, tinnitus and hearing loss. No significant differences between groups were reported. There were no emergencies or serious adverse effects reported in any of the 10 studies.There was very limited or no information available on our remaining secondary outcomes.
AUTHORS' CONCLUSIONS
Although a number of studies aimed to evaluate whether or not one type of cerumenolytic is more effective than another, there is no high-quality evidence to allow a firm conclusion to be drawn and the answer remains uncertain.A single study suggests that applying ear drops for five days may result in a greater likelihood of complete wax clearance than no treatment at all. However, we cannot conclude whether one type of active treatment is more effective than another and there was no evidence of a difference in efficacy between oil-based and water-based active treatments.There is no evidence to show that using saline or water alone is better or worse than commercially produced cerumenolytics. Equally, there is also no evidence to show that using saline or water alone is better than no treatment.
Topics: Adult; Antipyrine; Benzocaine; Carbamide Peroxide; Carbonates; Cerumen; Child; Chlorobutanol; Choline; Dioctyl Sulfosuccinic Acid; Drug Combinations; Ear Canal; Ethanolamines; Humans; Hygiene; Peroxides; Pharmaceutical Solutions; Plant Oils; Potassium; Randomized Controlled Trials as Topic; Salicylates; Sodium Chloride; Surface-Active Agents; Urea; Water
PubMed: 30043448
DOI: 10.1002/14651858.CD012171.pub2 -
Drug Design, Development and Therapy 2021Betel nuts have long been used in traditional Chinese medicine. In our study, the bioactive components of betel nut were systematically investigated, and the main...
BACKGROUND
Betel nuts have long been used in traditional Chinese medicine. In our study, the bioactive components of betel nut were systematically investigated, and the main components and their target genes in the treatment of depression were predicted.
METHODS
The metabolites of the kernels and peels were analyzed with a UPLC-MS/MS system. Mass spectrometry outcomes were annotated by MULTIAQUANT. "Compound-disease targets" were utilized to construct a pharmacology network.
RESULTS
A total of 873 metabolites were identified, with a high abundance of flavonoids, alkaloids, and phenols. Moreover, the abundance of flavonoids, alkaloids, and phenols in the kernel was significantly higher than that in the peel. A high abundance of catechin, arginine, and phenylalanine was detected in the kernel, while a high abundance of arginine, arecoline, and aminobutyric acid was detected in the peel. Catechins and cyanoside were the most abundant flavonoids in the kernel and peel, respectively. Arecoline was the most abundant alkaloid. A total of 111 metabolites showed a significant difference between the kernels and peels. The relative abundance of 40 differential metabolites was higher than 100,000, including 14 primary metabolites, 12 flavonoids, 4 phenols, and 4 alkaloids. Among the 40 high abundance metabolites, 20 were higher in the kernel and 20 in the peel. In addition, the enrichment of metabolic pathways found that the kernel and peel of the fruit adopted different metabolic pathways for the synthesis of flavonoids and alkaloids. Network pharmacology prediction showed that 93 metabolites could target 141 depression-related genes. The main components of betel nut intervention in depression were predicted to include L-phenylalanine, protocatechuic acid, okanin, nicotinic acid, L-tyrosine, benzocaine, syringic acid, benzocaine, phloretic acid, cynaroside, and 3,4-dihydroxybenzaldehyde.
CONCLUSION
Betel nuts are rich in natural metabolites, and some of these metabolites can participate in the intervention of depression. In addition, the metabolites showed distinct characteristics between the kernel and peel. Therefore, it is necessary to comprehensively and rationally use betel nuts.
Topics: Alkaloids; Antidepressive Agents; Areca; Chromatography, High Pressure Liquid; Computational Biology; Depression; Flavonoids; Humans; Metabolomics; Network Pharmacology; Phenols; Tandem Mass Spectrometry
PubMed: 34880597
DOI: 10.2147/DDDT.S335312 -
Anais Da Academia Brasileira de Ciencias 2017The present study aimed to evaluate the effects of benzocaine and tricaine methanesulfonate on oxidative stress parameters of juvenile tambaqui tissues. Fish (n=80) were...
The present study aimed to evaluate the effects of benzocaine and tricaine methanesulfonate on oxidative stress parameters of juvenile tambaqui tissues. Fish (n=80) were anesthetized with benzocaine (100 mg L-1) or tricaine (240 mg L-1) and two control groups were used (non-anesthetized fish and fish exposed to ethanol-only). After anesthetic induction 10 fish/anesthetic were euthanized after 3, 12 and 24 hours post-anesthesia and tissue samplings (gills, liver and brain) were performed. Samples were submitted to analyses of enzyme activity glutathione-S-transferase (GST), cellular lipid peroxidation (TBARS) and total antioxidant capacity (ACAP). ACAP increased in gills of benzocaine treatment after 12 hours. The liver showed a reduction in ACAP of tricaine treatment after 12 hours. Both anesthetic treatments showed an increase of ACAP at 24 hours compared to control group. The activity of the GST enzyme increased in the gills for treatments benzocaine and tricaine after 3 and 12 hours. Liver showed increased GST activity (benzocaine after 24 hours and tricaine after 3 and 24 hours). Lipid damage decreased in gills (both anesthetics) and brain (tricaine) after 24 hours. The results demonstrate that benzocaine and tricaine did not cause oxidative damage in juvenile tambaqui under the experimental conditions herein established.
Topics: Aminobenzoates; Anesthetics; Animals; Benzocaine; Brain; Fishes; Gills; Liver; Oxidative Stress
PubMed: 28746612
DOI: 10.1590/0001-3765201720160823 -
The Journal of Physiology Oct 2016Zebrafish provide a unique opportunity to investigate in vivo sensory transduction in mature hair cells. We have developed a method for studying the biophysical...
KEY POINTS
Zebrafish provide a unique opportunity to investigate in vivo sensory transduction in mature hair cells. We have developed a method for studying the biophysical properties of mature hair cells from the lateral line of juvenile zebrafish. The method involves application of the anaesthetic benzocaine and intubation to maintain ventilation and oxygenation through the gills. The same approach could be used for in vivo functional studies in other sensory and non-sensory systems from juvenile and adult zebrafish.
ABSTRACT
Hair cells are sensory receptors responsible for transducing auditory and vestibular information into electrical signals, which are then transmitted with remarkable precision to afferent neurons. The zebrafish lateral line is emerging as an excellent in vivo model for genetic and physiological analysis of hair cells and neurons. However, research has been limited to larval stages because zebrafish become protected from the time of independent feeding under European law (from 5.2 days post-fertilization (dpf) at 28.5°C). In larval zebrafish, the functional properties of most of hair cells, as well as those of other excitable cells, are still immature. We have developed an experimental protocol to record electrophysiological properties from hair cells of the lateral line in juvenile zebrafish. We found that the anaesthetic benzocaine at 50 mg l(-1) was an effective and safe anaesthetic to use on juvenile zebrafish. Concentrations up to 300 mg l(-1) did not affect the electrical properties or synaptic vesicle release of juvenile hair cells, unlike the commonly used anaesthetic MS-222, which reduces the size of basolateral membrane K(+) currents. Additionally, we implemented a method to maintain gill movement, and as such respiration and blood oxygenation, via the intubation of > 21 dpf zebrafish. The combination of benzocaine and intubation provides an experimental platform to investigate the physiology of mature hair cells from live zebrafish. More generally, this method would allow functional studies involving live imaging and electrophysiology from juvenile and adult zebrafish.
Topics: Anesthetics, Local; Animals; Benzocaine; Electrophysiological Phenomena; Lateral Line System; Mice; Sensory Receptor Cells; Zebrafish
PubMed: 27161862
DOI: 10.1113/JP271794 -
Journal of the American Dental... May 2013The authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief... (Comparative Study)
Comparative Study Randomized Controlled Trial
An evaluation of 10 percent and 20 percent benzocaine gels in patients with acute toothaches: efficacy, tolerability and compliance with label dose administration directions.
BACKGROUND
The authors evaluated the efficacy and tolerability of 10 percent and 20 percent benzocaine gels compared with those of a vehicle (placebo) gel for the temporary relief of toothache pain. They also assessed the compliance with the label dose administration directions on the part of participants with toothache pain.
METHODS
Under double-masked conditions, 576 participants self-applied study gel to an open tooth cavity and surrounding oral tissues. Participants evaluated their pain intensity and pain relief for 120 minutes. The authors determined the amount of gel the participants applied.
RESULTS
The responders' rates (the primary efficacy parameter), defined as the percentage of participants who had an improvement in pain intensity as exhibited by a pain score reduction of at least one unit on the dental pain scale from baseline for two consecutive assessments any time between the five- and 20-minute points, were 87.3 percent, 80.7 percent and 70.4 percent, respectively, for 20 percent benzocaine gel, 10 percent benzocaine gel and vehicle gel. Both benzocaine gels were significantly (P ≤ .05) better than vehicle gel; the 20 percent benzocaine gel also was significantly (P ≤ .05) better than the 10 percent benzocaine gel. The mean amount of gel applied was 235.6 milligrams, with 88.2 percent of participants applying 400 mg or less.
CONCLUSIONS
Both 10 percent and 20 percent benzocaine gels were more efficacious than the vehicle gel, and the 20 percent benzocaine gel was more efficacious than the 10 percent benzocaine gel. All treatments were well tolerated by participants. Practical Implications. Patients can use 10 percent and 20 percent benzocaine gels to temporarily treat toothache pain safely.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Anesthetics, Local; Benzocaine; Child; Double-Blind Method; Female; Gels; Humans; Male; Medication Adherence; Middle Aged; Pain Measurement; Patient Satisfaction; Pharmaceutical Vehicles; Placebos; Self Administration; Time Factors; Toothache; Treatment Outcome; Young Adult
PubMed: 23633700
DOI: 10.14219/jada.archive.2013.0154