• 1.

    Brady OJ, Gething PW, Bhatt S, Messina JP, Brownstein JS, Hoen AG, Moyes CL, Farlow AW, Scott TW, Hay SI, 2012. Refining the global spatial limits of dengue virus transmission by evidence-based consensus. PLoS Negl Trop Dis 6: e1760.

    • Search Google Scholar
    • Export Citation
  • 2.

    Bhatt S et al. 2013. The global distribution and burden of dengue. Nature 496: 504507.

  • 3.

    World Health Organization, 2020. Dengue and severe Dengue. Geneva, Switzerland: WHO. Available at: https://www.who.int/news-room/fact-sheets/detail/dengue-and-severe-dengue. Accessed October 22, 2020.

    • Search Google Scholar
    • Export Citation
  • 4.

    World Health Organization, 2009. Dengue: Guidelines for Diagnosis, Treatment, Prevention and Control: New Edition. Geneva, Switzerland: WHO. Available at: http://www.ncbi.nlm.nih.gov/books/NBK143157/. Accessed October 22, 2020.

    • Search Google Scholar
    • Export Citation
  • 5.

    Simmons CP, Farrar JJ, Nguyen van VC, Wills B, 2012. Dengue. N Engl J Med 366: 14231432.

  • 6.

    Froudarakis ME, 2008. Diagnostic work-up of pleural effusions. Respir Int Rev Thorac Dis 75: 413.

  • 7.

    de Oliveira RVB, Rios LTM, dos Remédios Freitas Carvalho Branco M, Lopes Braga Júnior L, Nascimento JMS, Silva GF, Bandeira KP, 2010. Valor da ultrassonografia em crianças com suspeita de febre hemorrágica do dengue: revisão da literatura. Radiol Bras 43: 401407.

    • Search Google Scholar
    • Export Citation
  • 8.

    Rudralingam V, Footitt C, Layton B, 2017. Ascites matters. Ultrasound Leeds Engl 25: 6979.

  • 9.

    Low GKK, Looi SY, Yong MH, Sharma D, 2018. Predictive and diagnostic test accuracy of ultrasonography in differentiating severe dengue from nonsevere dengue. J Vector Borne Dis 55: 7988.

    • Search Google Scholar
    • Export Citation
  • 10.

    Ibrahim F, Thio THG, Faisal T, Neuman M, 2015. The application of biomedical engineering techniques to the diagnosis and management of tropical diseases: a review. Sensors 15: 69476995.

    • Search Google Scholar
    • Export Citation
  • 11.

    Dewan N, Messu C, Eelkema M, Osorio L, Bakker C, Kirsch J, 2019. A Scoping Review of the Use of Ultrasound in Dengue: Protocol for a Scoping Review. Available at: https://osf.io/v7jqw/. Accessed February 7, 2019.

    • Search Google Scholar
    • Export Citation
  • 12.

    The EndNote Team, 2016, Endnote. Philadelphia, PA: Clarivate Analytics.

  • 13.

    Rayyan QCRI [Internet], 2016. Doha, Qatar: Qatar Computing Research Institute. Available at: https://rayyan.qcri.org/welcome. Accessed January 7, 2019.

  • 14.

    Ouzzani M, Hammady H, Fedorowicz Z, Elmagarmid A, 2016. Rayyan—a web and mobile app for systematic reviews. Syst Rev 5: 210.

  • 15.

    Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG, 2009. Research electronic data capture (REDCap)--a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42: 377381.

    • Search Google Scholar
    • Export Citation
  • 16.

    Whiting PF, Rutjes AWS, Westwood ME, Mallett S, Deeks JJ, Reitsma JB, Leeflang MM, Sterne JA, Bossuyt PM; QUADAS-2 Group, 2011. QUADAS-2: a revised tool for the quality assessment of diagnostic accuracy studies. Ann Intern Med 155: 529536.

    • Search Google Scholar
    • Export Citation
  • 17.

    Microsoft, 2020. Microsoft Excel for Mac. Redmond, WA: Microsoft Corporation.

  • 18.

    Thanachartwet V, Wattanathum A, Sahassananda D, Wacharasint P, Chamnanchanunt S, Khine Kyaw E, Jittmittraphap A, Naksomphun M, Surabotsophon M, Desakorn V, 2016. Dynamic measurement of hemodynamic parameters and cardiac preload in adults with dengue: a prospective observational study. PLoS One 11: e0156135.

    • Search Google Scholar
    • Export Citation
  • 19.

    Parmar JP, Mohan C, Vora M, 2017. Patterns of gall bladder wall thickening in dengue fever: a mirror of the severity of disease. Ultrasound Int Open 3: E76E81.

    • Search Google Scholar
    • Export Citation
  • 20.

    Levaggi ND, Lucas AN, Barletta JA, 2017. Bilateral acute angle closure in a patient with dengue fever: a case report. Arq Bras Oftalmol 80: 266267.

    • Search Google Scholar
    • Export Citation
  • 21.

    Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN, 1998. Dengue haemorrhagic fever: ultrasound as an aid to predict the severity of the disease. Pediatr Radiol 28: 14.

    • Search Google Scholar
    • Export Citation
  • 22.

    Setiawan MW, Samsi TK, Wulur H, Sugianto D, Pool TN, 1998. Epigastric pain and sonographic assessment of the pancreas in dengue hemorrhagic fever. J Clin Ultrasound 26: 257259.

    • Search Google Scholar
    • Export Citation
  • 23.

    Shamim M, 2010. Frequency, pattern and management of acute abdomen in dengue fever in Karachi, Pakistan. Asian J Surg 33: 107113.

  • 24.

    Sudulagunta SR, Sodalagunta MB, Sepehrar M, Bangalore Raja SK, Nataraju AS, Kumbhat M, Sathyanarayana D, Gummadi S, Burra HK, 2016. Dengue shock syndrome. Oxf Med Case Rep 2016: 269272.

    • Search Google Scholar
    • Export Citation
  • 25.

    Weerakoon KGAD, Chandrasekaram S, Jayabahu JPSNK, Gunasena S, Kularatne SAM, 2009. Acute abdominal pain in dengue haemorrhagic fever: a study in Sri Lanka, 2009. Dengue Bull 33: 7074.

    • Search Google Scholar
    • Export Citation
  • 26.

    Asghar J, Farooq K, 2011. Radiological appearance and their significance in the management of dengue hemorrhagic fever. Pak J Med Health Sci 5: 685692.

    • Search Google Scholar
    • Export Citation
  • 27.

    González Cortiñas M, Vidal González D, Cepero Cordero J, Lashley Oliveras ML, 1999. Dengue hemorrágico. Estudio clínico de 200 pacientes. Rev Cuba Med 38: 1318.

    • Search Google Scholar
    • Export Citation
  • 28.

    Martínez López , 2010. Caracterización clinicoepidemiológica y ecográfica de pacientes con dengue confirmado. Medisan 14: 665674. Available at: http://bvs.sld.cu/revistas/san/vol_14_5_10/san11510.htm. Accessed February 28, 2019.

    • Search Google Scholar
    • Export Citation
  • 29.

    Viswanathan V, Andankar P, Gupta N, Singh I, Rajguru M, Laxmivenkateshaiah S, 2017. Simultaneous occurrence of Kawasaki disease and salmonella infection with a positive dengue serology. Pediatr Rheumatol 15: 175.

    • Search Google Scholar
    • Export Citation
  • 30.

    Gupta BK, Nehara HR, Parmar S, Meena SL, Gajraj S, Gupta J, 2017. Acute abdomen presentation in dengue fever during recent outbreak. J Acute Dis 6: 198204.

    • Search Google Scholar
    • Export Citation
  • 31.

    Premaratna R, Bailey MS, Ratnasena BGN, de Silva HJ, 2007. Dengue fever mimicking acute appendicitis. Trans R Soc Trop Med Hyg 101: 683685.

  • 32.

    Yousaf KR, Atiq S, Sheikh QS, Nisar MS, Mansoor Z, Khalid S, 2011. Sonographic features of polyserositis as an adjunct to clinico - pathological parameters in diagnosing and predicting the severity of dengue fever. Pak J Med Health Sci 5: 184189.

    • Search Google Scholar
    • Export Citation
  • 33.

    Rao SV, Jacob GG, Raju NA, Ancheri S, 2016. Spontaneous arterial hemorrhage as a complication of dengue. Indian J Crit Care Med 20: 302304.

  • 34.

    Available at: SciePro/Shutterstock.com.

  • 35.

    Nainggolan L, Wiguna C, Hasan I, Dewiasty E, 2018. Gallbladder wall thickening for early detection of plasma leakage in dengue infected adult patients. Acta Med Indones 50: 193199.

    • Search Google Scholar
    • Export Citation
  • 36.

    Goldberg BB, Goodman GA, Clearfield HR, 1970. Evaluation of ascites by ultrasound. Radiology 96: 1522.

  • 37.

    Lele PP, 1972. Application of ultrasound in medicine. N Engl J Med 286: 13171318.

  • 38.

    Sippel S, Muruganandan K, Levine A, Shah S, 2011. Review article: use of ultrasound in the developing world. Int J Emerg Med 4: 72.

  • 39.

    Arshad K, Sheikh S, Naqvi SUB, Sarwar I, Javaid S, Asghar M, Butt MA, 2015. Frequency of splenomegaly in dengue fever in children. J Ayub Med Coll Abbottabad 27: 356359.

    • Search Google Scholar
    • Export Citation
  • 40.

    Bhasin A, Kumar R, Chandra K, Singal RK, 2013. Dengue fever with myocarditis. J Indian Acad Clin Med 14: 187189.

  • 41.

    Byopadhyay D, Chattaraj S, Hajra A, Mukhopadhyay S, Ganesan V, 2016. A study on spectrum of hepatobiliary dysfunctions and pattern of liver involvement in dengue infection. J Clin Diagn Res 10: OC21OC26.

    • Search Google Scholar
    • Export Citation
  • 42.

    Chacko B, Subramanian G, 2008. Clinical, laboratory and radiological parameters in children with dengue fever and predictive factors for dengue shock syndrome. J Trop Pediatr 54: 137140.

    • Search Google Scholar
    • Export Citation
  • 43.

    Coton T, Debonne JM, Molinier S, Chaudier B, Gras C, Carré D, Raillat A, 1999. Alithiasic cholecystitis and hemorrhagic dengue. Cholecystite Alithiasique Dengue Hemorragique 23: 789790.

    • Search Google Scholar
    • Export Citation
  • 44.

    Gogna A, Pathak S, Dhamija K, Jharyan P, Arora BS, 2015. Changing clinical profile of dengue fever in Delhi in 2011. J Indian Acad Clin Med 16: 2026.

    • Search Google Scholar
    • Export Citation
  • 45.

    Hernez JN, 2015. Case report: acute myocarditis cause death in dengue patient. Am J Trop Med Hyg 93: 434.

  • 46.

    Kalenahalli J, Puja J, Vaddambal GM, Lingappa U, 2012. Hepatic involvement in dengue fever in children. Iran J Pediatr 22: 231236.

  • 47.

    Kuna A, Wroczynska A, Gajewski M, Felczak-Korzybska I, Nahorski WL, 2016. A case of acalculous cholecystitis in the course of dengue fever in a traveller returned from Brazil. Int Marit Health 67: 3841.

    • Search Google Scholar
    • Export Citation
  • 48.

    Marín J, Vilcarromero S, Forshey BM, Celis-Salinas JC, Ramal-Asayag C, Morrison AC, Laguna-Torres A, Casapía M, Halsey ES, 2013. Compromiso gastrointestinal agudo en pacientes con dengue por serotipo 4: comunicación de un caso y revisión de la literatura. Rev Chil Infectol 30: 541547.

    • Search Google Scholar
    • Export Citation
  • 49.

    Meena K, Kumar P, Anita, Paul P, 2013. Acute glomerulonephritis in dengue hemorrhagic fever: a rare case report. Ann Trop Med Public Health 6: 581582.

    • Search Google Scholar
    • Export Citation
  • 50.

    Meltzer E, Heyman Z, Bin H, Schwartz E, 2012. Capillary leakage in travelers with dengue infection: implications for pathogenesis. Am J Trop Med Hyg 86: 536539.

    • Search Google Scholar
    • Export Citation
  • 51.

    Muhammad S, Junaid R, Muneeza N, Yaseen A, Ayesha A, 2016. Clinical spectrum of dengue fever in pediatric age at a tertiary care hospital in Lahore. Esculapio 12: 126129.

    • Search Google Scholar
    • Export Citation
  • 52.

    Rueda E, Méndez A, González G, 2002. Hemophagocytic syndrome associated with dengue hemorrhagic fever. Bioméd Rev Inst Nac Salud 22: 160166.

    • Search Google Scholar
    • Export Citation
  • 53.

    Seervi N, Meena SR, Saluja M, Meena SB, Shringi P, Saini PK, 2017. Hepatic dysfunction in patients of dengue viral infection in Kota region. J Indian Acad Clin Med 18: 1821.

    • Search Google Scholar
    • Export Citation
  • 54.

    Sehgal A, Gupta S, Tyagi V, Bahl S, Singh SK, Puliyel JM, 2002. Gall bladder wall edema is not pathogenic of dengue infection. J Trop Pediatr 48: 315316.

    • Search Google Scholar
    • Export Citation
  • 55.

    Shah S, Rolfe R, Henostroza G, Seas C, 2018. Images in clinical tropical medicine: ultrasound findings of plasma leakage in dengue fever. Am J Trop Med Hyg 99: 13621363.

    • Search Google Scholar
    • Export Citation
  • 56.

    Tahir H, Daruwalla V, Hayat S, 2015. Myocarditis leading to severe dilated cardiomyopathy in a patient with dengue fever. Case Rep Cardiol 2015: 319312.

    • Search Google Scholar
    • Export Citation
  • 57.

    Tee TJ, 2015. Dengue infection with severe acute hepatitis and acalculus cholecystitis: a diagnostic challenge. Am J Gastroenterol 110: S356.

    • Search Google Scholar
    • Export Citation
  • 58.

    The Society of Point of Care Ultrasound, 2017. Guidelines For Point Of Care Ultrasound Utilization In Clinical Practice. Available at: https://spocus.org/wp-content/uploads/2019/12/GUIDELINES-FOR-POINT-OF-CARE-ULTRASOUND-UTILIZATION-IN-CLINICAL-PRACTICE.pdf. Accessed October 24, 2020.

    • Search Google Scholar
    • Export Citation
  • 59.

    Dayana Kumar KR, Halawar RS, 2018. Comparative study of ultrasound findings in seropositive pediatric and adult patients with dengue fever. Radiol Infect Dis 5: 5962.

    • Search Google Scholar
    • Export Citation
  • 60.

    Kularatne SAM, Rajapakse MM, Ralapanawa U, Waduge R, Pathirage LPMMK, Rajapakse RPVJ, 2018. Heart and liver are infected in fatal cases of dengue: three PCR based case studies 11 medical and health sciences 1103 clinical sciences. BMC Infect Dis 18: 681.

    • Search Google Scholar
    • Export Citation
  • 61.

    Ferreira BDC, Correia D, 2018. Ultrasound assessment of hepatobiliary and splenic changes in patients with dengue and warning signs during the acute and recovery phases. J Ultrasound Med 38: 20152024.

    • Search Google Scholar
    • Export Citation
  • 62.

    Nanjundappa RC, Bc VC, 2018. Predicting the severity of dengue fever in children based on ultrasound, peripheral venous lactate and proteinuria. Pediatr Crit Care Med 19: 111112.

    • Search Google Scholar
    • Export Citation
  • 63.

    Rabbani MU, Aslam M, Zaheer MS, Ashraf MU, 2018. Clinical and laboratory profile of dengue fever in a north Indian tertiary hospital. J Assoc Physicians India 66: 3739.

    • Search Google Scholar
    • Export Citation
  • 64.

    Bhargava S, Srivastava S, Gupta A, 2017. Ultrasonographic findings in dengue fever: a retrospective study. J Int Med Sci Acad 30: 7578.

  • 65.

    Jayasundara B, Perera L, de Silva A, 2017. Dengue fever may mislead the surgeons when it presents as an acute abdomen. Asian Pac J Trop Med 10: 1519.

    • Search Google Scholar
    • Export Citation
  • 66.

    Parmar J, Mohan C, Prem Kumar G, Vora M, 2017. Ultrasound is not useful as a screening tool for dengue fever. Pol J Radiol 82: 693700.

  • 67.

    Ramabhatta S, Palaniappan S, Hanumantharayappa N, Begum SV, 2017. The clinical and serological profile of pediatric dengue. Indian J Pediatr 84: 897901.

    • Search Google Scholar
    • Export Citation
  • 68.

    Chak S, Kumar A, 2016. Can radiology play a role in early diagnosis of dengue fever? North Am J Med Sci 8: 100105.

  • 69.

    Acharyya A, Ghosh K, Bhattacharyya A, Ghosh M, Chakraborty S, Ghosh S, Pal M, 2016. The dengue fever and its complication: a scenario in a tertiary-level hospital of greater Kolkata. Ann Trop Med Public Health 9: 9296.

    • Search Google Scholar
    • Export Citation
  • 70.

    Agarwal N, Jain P, 2016. Sonography in dengue fever: an adjunct to clinico-laboratory profile. Indian J Public Health Res Dev 7: 299303.

  • 71.

    Ferno S, Wijewickrama A, Gomes L, Punchihewa CT, Madusanka SD, Dissanayake H, Jeewandara C, Peiris H, Ogg GS, Malavige GN, 2016. Patterns and causes of liver involvement in acute dengue infection. BMC Infect Dis 16: 319.

    • Search Google Scholar
    • Export Citation
  • 72.

    Khurram M, Qayyum W, Umar M, Jawad M, Mumtaz S, Khaar HTB, 2016. Ultrasonographic pattern of plasma leak in dengue haemorrhagic fever. J Pak Med Assoc 66: 260264.

    • Search Google Scholar
    • Export Citation
  • 73.

    Kularatne SAM, Ralapanawa U, Dalugama C, Jayasinghe J, Rupasinghe S, Kumarihamy P, 2018. Series of 10 dengue fever cases with unusual presentations and complications in Sri Lanka: a single centre experience in 2016. BMC Infect Dis 18: 674.

    • Search Google Scholar
    • Export Citation
  • 74.

    Laoprasopwattana K, 2016. Thrombocytopenia is the most important predictive factor of plasma leakage and correlates with plasma leakage severity. Eur J Pediatr 175: 1494.

    • Search Google Scholar
    • Export Citation
  • 75.

    Thein TL et al. 2014. Ultrasound and chest X-ray in an adult patient with dengue. Am J Trop Med Hyg 91: 321.

  • 76.

    Malavige GN et al. 2016. Efficacy of rupatadine in the treatment of acute dengue infection. Am J Trop Med Hyg 95: 34.

  • 77.

    Pothapregada S, Kullu P, Kamalakannan B, Thulasingam M, 2016. Is ultrasound a useful tool to predict severe dengue infection? Indian J Pediatr 83: 500504.

    • Search Google Scholar
    • Export Citation
  • 78.

    Jain D, Rajput R, Pathak V, Mittal A, Jain P, 2017. Changing trends in clinical presentation and biochemical spectrum of dengue fever: an observation of a tertiary care centre. Arch Clin Infect Dis 12: e62221.

    • Search Google Scholar
    • Export Citation
  • 79.

    Malladi SVS, Gone V, Adiraju KP, Chand N, Yadati SR, 2016. Clinical, laboratory profile and outcome of patients with dengue viral infection at a south Indian tertiary care hospital. Int J Infect Dis 45: 445.

    • Search Google Scholar
    • Export Citation
  • 80.

    Mondal R, Pemola Devi N, Jauhari RK, 2016. Studies on symptomatic profiles of dengue fever (DF) vis-à-vis non-dengue fever (NDF) in district Dehradun, uttarakhand. J Commun Dis 48: 1520.

    • Search Google Scholar
    • Export Citation
  • 81.

    Wang Y, Shen Z, Lu X, Zhen Y, Li H, 2018. Sensitivity and specificity of ultrasound for the diagnosis of acute pulmonary edema: a systematic review and meta-analysis. Med Ultrason 1: 3236.

    • Search Google Scholar
    • Export Citation
  • 82.

    Wang CC, Wu CC, Liu JW, Lin AS, Liu SF, Chung YH, Su MC, Lee IK, Lin MC, 2007. Chest radiographic presentation in patients with dengue hemorrhagic fever. Am J Trop Med Hyg 77: 291296.

    • Search Google Scholar
    • Export Citation
  • 83.

    Rodrigues RS, Brum ALG, Paes MV, Póvoa TF, Basilio-de-Oliveira CA, Marchiori E, Borghi DP, Ramos GV, Bozza FA, 2014. Lung in dengue: computed tomography findings. PLoS One 9: e96313.

    • Search Google Scholar
    • Export Citation
  • 84.

    American Institute of Ultrasound in Medicine, 2014. Focused Assessment with Sonography for Trauma (FAST) Examination. Available at: https://www.aium.org/resources/guidelines/fast.pdf. Accessed January 8, 2020.

    • Search Google Scholar
    • Export Citation
  • 85.

    Seif D, Perera P, Mailhot T, Riley D, Mandavia D, 2012. Bedside ultrasound in resuscitation and the rapid ultrasound in shock protocol. Crit Care Res Pract 2012: 503254.

    • Search Google Scholar
    • Export Citation
  • 86.

    Cohen JF et al. 2016. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open 6: e012799.

  • 87.

    Kurjak A, Breyer B, 1986. The use of ultrasound in developing countries. Ultrasound Med Biol 12: 611621.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

 

 

 

Ultrasound in Dengue: A Scoping Review

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  • 1 University of Miami Miller School of Medicine, Miami, Florida;
  • | 2 Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia;
  • | 3 University of Minnesota Medical School, Minneapolis, Minnesota;
  • | 4 University of Minnesota, Health Sciences Libraries, Minneapolis, Minnesota;
  • | 5 Section of Hospital Medicine, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
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ABSTRACT

To improve dengue triage and treatment decisions, the WHO recommends classifying the disease as dengue with or without warning signs or severe dengue. Vascular leakage is a key component of the pathophysiology of severe dengue and is detectable by ultrasound. The objective of this scoping review is to describe the primary literature on the use of ultrasound in dengue, summarize the findings, and identify knowledge gaps. Our database search retrieved 1,489 records which were reduced to 177 studies following eligibility screening. Descriptive analyses were conducted. Results showed most studies are from South Asia (n = 92, 52%) and assessed hospitalized dengue patients (130, 82%). Radiologists were the most reported ultrasonographers (14, 8%), and conventional ultrasound (39, 68%) was preferred over portable (9, 16%). The most common ultrasound findings in dengue were ascites (107, 60%), pleural effusion (102, 58%), and gallbladder wall thickening (97, 55%). However, the lack of a standard protocol to perform the ultrasound examination in dengue patients hinders conclusions about the frequency of ultrasound findings in dengue. Given the progress of current ultrasound technology, a focused point-of-care ultrasound protocol for early detection of vascular leakage in dengue is needed to generate the evidence required for its implementation in routine care.

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Author Notes

Address correspondence to Neelesh Dewan, University of Miami Miller School of Medicine, 9806 Stonebridge Way, Mint Hill, NC 28227. E-mail: neeleshdewan92@gmail.com

Financial support: This work was supported by the following sources: the Doris Duke Charitable Foundation through a grant supporting the Doris Duke International Clinical Research Fellow Program at the University of Minnesota (N. D.); the University of Minnesota’s Center for Global Health and Social Responsibility and the Fulbright U.S. Scholar Program (J. K.); and Universidad del Valle, Cali, Colombia (L. O., D. Z.).

Authors’ addresses: Neelesh Dewan, University of Miami Miller School of Medicine, Miami, FL, E-mail: neeleshdewan92@gmail.com. Daniela Zuluaga and Lyda Osorio, Epidemiology and Population Health Research Group (GESP), School of Public Health, Universidad del Valle, Cali, Colombia, E-mails: dzuluaga1104@gmail.com and lyda.osorio@correounivalle.edu.co. Mary-Ellen Krienke, University of Minnesota Medical School, Minneapolis, MN, E-mail: krien021@umn.edu. Caitlin Bakker, Health Sciences Libraries, University of Minnesota, Minneapolis, MN, E-mail: cjbakker@umn.edu. Jonathan Kirsch, Division of General Internal Medicine, University of Minnesota Medical School, Minneapolis, MN, E-mail: kirsch@umn.edu.

These authors contributed equally to this work.

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