inappropriate sinus tachycardia and covid vaccine

There are several therapies being used to treat the virus infection known as COVID-19, including the medications Chloroquine, Hydroxychloroquine and Azithromycin. Haemost. Med. However, autopsy series have shown that SARS-CoV-2 may cause changes in brain parenchyma and vessels, possibly by effects on bloodbrain and bloodcerebrospinal fluid barriers, which drive inflammation in neurons, supportive cells and brain vasculature155,156. Characteristics associated with racial/ethnic disparities in COVID-19 outcomes in an academic health care system. Nougier, C. et al. Treating common and potentially modifiable symptoms of long COVID in adults (7): Schaller, T. et al. Sign up for the Nature Briefing newsletter what matters in science, free to your inbox daily. Although less common, hospitalized COVID-19 survivors have been found to have restrictive pulmonary physiology at 3 and 6months5,49, which has also been observed in historical ARDS survivor populations48,50. Of 488 patients who completed the telephone survey in this study, 32.6% of patients reported persistent symptoms, including 18.9% with new or worsened symptoms. It is not yet known how long the increased severity of pre-existing diabetes or predisposition to DKA persists after infection, and this will be addressed by the international CoviDiab registry183. Physical and cognitive performance of patients with acute lung injury 1 year after initial trophic versus full enteral feeding. You are using a browser version with limited support for CSS. Platelet gene expression and function in COVID-19 patients. Stevens, J. S. et al. J. For this reason, we performed the same tests in two gender- and age-controlled groups, one with matched disease stage and severity and one without previous infection. In 2006, Yu et al. Nat. symptoms of tachycardia in COVID-19 POTS. 140, 16 (2020). 20, 533534 (2020). "Within 30 minutes, I started experiencing . IST can cause a faster heart rate for a person even when they are at rest. D.A. We found that IST is prevalent among PCS patients (affecting 20% in our series), and this disorder was more common in young women without previous comorbidities and with mild SARS-CoV-2 infection. Necessary active and future research include the identification and characterization of key clinical, serological, imaging and epidemiologic features of COVID-19 in the acute, subacute and chronic phases of disease, which will help us to better understand the natural history and pathophysiology of this new disease entity (Table 2). Neurology 95, e1060e1070 (2020). Inappropriate Sinus Tachycardia Follow Posted 6 years ago, 9 users are following. 18, 18591865 (2020). & McIntyre, R. S. The involvement of TNF- in cognitive dysfunction associated with major depressive disorder: an opportunity for domain specific treatments. Thorac. was supported by National Institute of Diabetes and Digestive and Kidney Diseases grants R01-DK114893, R01-MD014161 and U01-DK116066, as well as National Science Foundation grant 2032726. https://doi.org/10.1016/j.amjmed.2020.12.009 (2021). A review of potential options for therapeutic intervention. Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding. The mechanisms of IST, with or without previous viral infection, are poorly understood and investigated, but many of the postulated mechanisms include alterations in the nervous system: sympathovagal imbalance, beta-adrenergic receptor hypersensitivity, and brain stem dysregulation, among others. Neurological complications of MIS-C, such as headache, altered mental status, encephalopathy, cranial nerve palsies, stroke, seizure, reduced reflexes, and muscle weakness, appear to be more frequent than in Kawasaki disease209,210. Children (Basel) 7, 69 (2020). Overlapping features have been noted with Kawasaki disease, an acute pediatric medium-vessel vasculitis207. The predominant dermatologic complaint was hair loss, which was noted in approximately 20% of patients5,26. It is a red, blotchy rash that can appear around the injection site, typically about 7 days after receiving the first dose of. 1). Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. Commun. Hendaus, M. A. Clin. Rev. Crit. COVID-19-associated kidney injury: a case series of kidney biopsy findings. 2(3), ofv103. A pooled meta-analysis of MIS-C studies reported recovery in 91.1% and death in 3.5% of patients205. Mol. I have experienced labile pressures, inappropriate sinus tachycardia, SVT, positional tachycardia, and now atrial fibrillation after Dose 2 of the Pfizer vaccine. Patients in group 2 were also matched by disease chronology, and their acute infection had to have the same severity and be within the same 1-month period as the corresponding cases. Sharma, P. et al. Med. Gemayel, C., Pelliccia, A. https://doi.org/10.1513/AnnalsATS.202008-1002OC (2021). Eur. JCI Insight 5, e138999 (2020). Patient advocacy groups, many members of which identify themselves as long haulers, have helped contribute to the recognition of post-acute COVID-19, a syndrome characterized by persistent symptoms and/or delayed or long-term complications beyond 4weeks from the onset of symptoms. Gu, T. et al. IST is prevalent condition among PCS patients. Hypofibrinolytic state and high thrombin generation may play a major role in SARS-COV2 associated thrombosis. & Sarkar, P. Postural orthostatic tachycardia syndrome. Int J. Stroke 15, 722732 (2020). Gupta, A. et al. Similarly, subacute thyroiditis with clinical thyrotoxicosis has been reported weeks after the resolution of respiratory symptoms184,185. Ritchie, K., Chan, D. & Watermeyer, T. The cognitive consequences of the COVID-19 epidemic: collateral damage? POTS is known to affect approximately. Novak, P. Post COVID-19 syndrome associated with orthostatic cerebral hypoperfusion syndrome, small fiber neuropathy and benefit of immunotherapy: a case report. The best COVID-19 vaccine is the first one that is available to you. Authors Charles Tate 1 , Luay Demashkieh 2 , Wael Hakmeh 3 Affiliations 1 Emergency Medicine, Chicago Medical School at Rosalind Franklin University of Medicine and Science, North Chicago, USA. Libby, P. & Lscher, T. COVID-19 is, in the end, an endothelial disease. The study was approved by the institutional ethics committee (Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; PI 20-288). Dis. As discussed above, SARS-CoV-2 penetrates cells by attaching to the ACE2 receptor, influencing the synthesis of endogenous angiotensin II, a hormone that directly activates the SNS. Covid has been implicated as has more rarely, the vaccine for COVID. Med. Hendaus, M. A., Jomha, F. A. Recommendations for competitive athletes with cardiovascular complications related to COVID-19 include abstinence from competitive sports or aerobic activity for 36months until resolution of myocardial inflammation by cardiac MRI or troponin normalization124,125. This may explain the disproportionately high rates (2030%) of thrombotic rather than bleeding complications in acute COVID-19 (ref. Red and orange flags for secondary headaches in clinical practice: SNNOOP10 list. The ability of the gut microbiota to alter the course of respiratory infections (gutlung axis) has been recognized previously in influenza and other respiratory infections198. & OMalley, M. Sixty-day outcomes among patients hospitalized with COVID-19. Retrospective data on post-acute thromboembolic events, although limited by small sample size, variability in outcome ascertainment and inadequate systematic follow-up, suggest the rate of venous thromboembolism (VTE) in the post-acute COVID-19 setting to be <5%. Pozo-Rosich, P. Headache & COVID-19: a short-term challenge with long-term insights. All HRV variables were significantly diminished among patients with IST compared to both the recovered subjects and the uninfected group, with a significant decrease in the following time-domain parameters: daytime pNN50 (3.23 vs. 10.58 vs. 17.310.0, respectively; p<0.001) and daytime SDNN (95.025 vs. 121.534 vs. 138.125, respectively; p<0.001). 41, 30383044 (2020). Structural basis of receptor recognition by SARS-CoV-2. ISSN 1546-170X (online) Article J. Patient outcomes after hospitalisation with COVID-19 and implications for follow-up: results from a prospective UK cohort. A normal sinus rhythm has a heart rate of between 60 and 100 beats/minute. An increased incidence of stress cardiomyopathy has been noted during the COVID-19 pandemic compared with pre-pandemic periods (7.8 versus 1.51.8%, respectively), although mortality and re-hospitalization rates in these patients are similiar112. The severity of the infection was determined by the following criteria. Wu, Y. et al. Klok, F. A. et al. Aust. & Cooper, L. T. Jr. Care 24, 410414 (2018). Respir. Heart Rhythm S15475271(20), 3114131143. Inappropriate sinus tachycardia (IST) occurs due to unknown reasons. Nervous Syst. 5, 12811285 (2020). Gupta, S. et al. The results of the exercise capacity and quality of life assessment are presented in Table 2, along with the results of the laboratory tests. A. et al. Survivors of previous coronavirus infections, including the SARS epidemic of 2003 and the Middle East respiratory syndrome (MERS) outbreak of 2012, have demonstrated a similar constellation of persistent symptoms, reinforcing concern for clinically significant sequelae of COVID-19 (refs. 99, 677678 (2020). Forty postmortem examinations in COVID-19 patients. Morbini, P. et al. Neuropathogenesis and neurologic manifestations of the coronaviruses in the age of coronavirus disease 2019: A review. Dr. Kerryn Phelps MD Martin-Villares, C., Perez Molina-Ramirez, C., Bartolome-Benito, M., Bernal-Sprekelsen, M. & COVID ORL ESP Collaborative Group. 63,64,65,66,67), which is higher than in other critically ill patient populations (110%)68,69. Crit. Autonomic dysfunction after viral illness, resulting in postural orthostatic tachycardia syndrome and inappropriate sinus tachycardia, has previously been reported as a result of adrenergic modulation121,122. While 80% of Kawasaki disease cases occur in children <5years of age and primarily of Asian descent207, patients with MIS-C are typically >7years, encompass a broader age range and are of African, Afro-Caribbean or Hispanic origin206,208. Beneficial effects of multi-disciplinary rehabilitation in post-acute COVID-19an observational cohort study. Respir. In most people, these symptoms come and go so . Furthermore, the evidence not only supports that SARS-CoV-2 can affect the nervous system during the acute phase, there is growing evidence in patients with orthostatic syndromes and syncope following SARS-CoV-2 infection that endorses a patho-physiological link between PCS and ANS dysfunction. receives research support from ALung Technologies and is on the medical advisory boards for Baxter, Abiomed, Xenios and Hemovent. Cardiol. Rep. 5, 940945 (2020). & Burnier, M. Referral patterns and outcomes in noncritically ill patients with hospital-acquired acute kidney injury. Unlike the consumptive coagulopathy characteristic of disseminated intravascular coagulation, COVID-19-associated coagulopathy is consistent with a hyperinflammatory and hypercoagulable state88,89. Lancet Gastroenterol. Symptoms of autonomic dysfunction in human immunodeficiency virus. There are numerous triggers for POTS including viruses, vaccines, and an autoimmune basis. J. Psychiatry 52, 233240 (2007). 5, 12651273 (2020). by Dr. William Makis, Global Research: 'I apologize on behalf of my profession for refusing to listen to patients with vax injuries' - Dr. Michael Huang, physician who treated 4000 COVID patients says he's seen hundreds of COVID-19 vaccine injuries, cancer, pregnancy loss, etc. The common symptoms observed in post-acute COVID-19 are summarized. Haemost. 7, e575e582 (2020). Hypotheses 144, 110055 (2020). Zubair, A. S. et al. J. Med. 18, 31093110 (2020). Circ. Nat. Direct oral anticoagulants and low-molecular-weight heparin are preferred anticoagulation agents over vitamin K antagonists due to the lack of need to frequently monitor therapeutic levels, as well as the lower risk of drugdrug interactions108,109. Complement and tissue factor-enriched neutrophil extracellular traps are key drivers in COVID-19 immunothrombosis. Your heart's sinus node generates electrical impulses that travel through the heart muscle, causing it to beat. Hendren, N. S., Drazner, M. H., Bozkurt, B. Other post-acute manifestations of COVID-19 include migraine-like headaches135,136 (often refractory to traditional analgesics137) and late-onset headaches ascribed to high cytokine levels. Clin. Haemost. 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Correspondence to Head Neck Surg. Model COVID-19 rehabilitation units such as those in Italy are already routinely assessing acute COVID-19 survivors for swallowing function, nutritional status and measures of functional independence219. Med. Surg. Dermatologic manifestations of COVID-19 occurred after (64%) or concurrent to (15%) other acute COVID-19 symptoms in an international study of 716 patients with COVID-19 (ref. https://doi.org/10.1001/jamaoto.2020.2366 (2020). 62,80). Report adverse events following receipt of any COVID-19 vaccine to VAERS. Postural orthostatic tachycardia has already been described in the setting of PCS3,5. Thachil, J. Hypoxiaan overlooked trigger for thrombosis in COVID-19 and other critically ill patients. 89, 594600 (2020). Freeman, E. E. et al. Dis. Transl. Symptoms suggestive of POTS included persistent fatigue, headache, palpitations, dizziness, brain fog, or exercise intolerance during recovery from COVID-19. Information for Healthcare Providers about Multisystem Inflammatory Syndrome in Children (MIS-C) (Centers for Disease Control and Prevention, 2020); https://www.cdc.gov/mis-c/hcp/, Multisystem Inflammatory Syndrome in Children and Adolescents with COVID-19 (World Health Organization, 2020); https://www.who.int/publications/i/item/multisystem-inflammatory-syndrome-in-children-and-adolescents-with-covid-19. was supported by National Institute of Neurological Disorders and Stroke grant T32 NS007153-36 and National Institute on Aging grant P30 AG066462-01. Children and teens ages 6 months-17 years Adults 18 years and older After a second shot or booster Potential mechanisms contributing to the pathophysiology of post-acute COVID-19 include: (1) virus-specific pathophysiologic changes; (2) immunologic aberrations and inflammatory damage in response to the acute infection; and (3) expected sequelae of post-critical illness. Article Google Scholar. Pulmonary function and exercise capacity in survivors of severe acute respiratory syndrome. Other studies, including in-person prospective follow-up studies of 110 survivors in the United Kingdom at 812weeks after hospital admission22 and 277 survivors in Spain at 1014weeks after disease onset23, as well as survey studies of 100 COVID-19 survivors in the United Kingdom at 48weeks post-discharge24, 183 individuals in the United States at 35d post-discharge25 and 120 patients discharged from hospital in France, at 100d following admission26, reported similar findings. COVID-19 and VTE/Anticoagulation: Frequently Asked Questions (American Society of Hematology, 2020); https://www.hematology.org/covid-19/covid-19-and-vte-anticoagulation. Nat. Heart Rhythm 17, 14631471 (2020). 58(6), 24652480. Nephrologist follow-up improves all-cause mortality of severe acute kidney injury survivors. During the acute phase of SARS-CoV-2 infection, 33 patients (83%) had experienced mild symptoms not requiring hospital admission; 6 patients (15%) had moderate disease with pulmonary infiltrates and required hospitalization; and only 1 patient (3%) required intensive care management. Cardiology Department, Heart institute, Hospital Universitari Germans Trias I Pujol, Carretera de Canyet s/n, 08916, Badalona, Spain, Jlia Arany,Victor Bazan,Felipe Bisbal,Axel Sarrias,Raquel Adelio,Ariadna Riverola,Antoni Bays-Gens&Roger Villuendas, Department of Infectious Disease, Hospital Universitari Germans Trias I Pujol, Badalona, Spain, Gemma Llads,Bonaventura Clotet&Lourdes Mateu, Emergency Department, Hospital Universitari Germans Trias I Pujol, Badalona, Spain, AIDS Research Institute (IrsiCaixa), Badalona, Spain, Marta Massanella,Roger Paredes&Bonaventura Clotet, Centro de Investigacin Biomdica en Red Enfermedades Cardiovascualres (CIBERCV), Madrid, Spain, Autonomous University of Barcelona, Barcelona, Spain, Antoni Bays-Gens,Lourdes Mateu&Roger Villuendas, Centro de Investigacin Biomdica en Red Enfermedades Respiratorias (CIBERES), Madrid, Spain, You can also search for this author in J. 16, 255261 (2013). 26, 502505 (2020). Haemost. 40, 3139 (2019). Arca, K. N. & Starling, A. J.Treatment-refractory headache in the setting of COVID-19 pneumonia: migraine or meningoencephalitis? Lim, W. et al. COVID-19-mediated postural orthostatic tachycardia syndrome (POTS) is an evolving troublesome disorder that predominantly affects young females. In a guidance document adopted by the British Thoracic Society, algorithms for evaluating COVID-19 survivors in the first 3months after hospital discharge are based on the severity of acute COVID-19 and whether or not the patient received ICU-level care76. Lindner, D. et al. Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications. Hu, B., Guo, H., Zhou, P. & Shi, Z.-L.Characteristics of SARS-CoV-2 and COVID-19. Kidney Int. Goldstein, D. S. The possible association between COVID-19 and postural tachycardia syndrome. Unique to this pandemic is the creation and role of patient advocacy groups in identifying persistent symptoms and influencing research and clinical attention. J. Med. Puchner, B. et al. Thorax 56, 549556 (2001). Webb Hooper, M., Npoles, A. M. & Prez-Stable, E. J. COVID-19 and racial/ethnic disparities. Anaphylaxis, a severe type of allergic reaction, can occur after any kind of vaccination. Cardiovascular magnetic resonance findings in competitive athletes recovering from COVID-19 infection. A.S.N. Mol. Slider with three articles shown per slide. Zuo, Y. et al. Anaphylaxis after COVID-19 vaccination is rare and has occurred at a rate of approximately 5 cases per one million vaccine doses administered. Open 3, e2014780 (2020). Similarly, no DVT was seen in 390 participants (selected using a stratified sampling procedure to include those with a higher severity of acute COVID-19) who had ultrasonography of lower extremities in the post-acute COVID-19 Chinese study5. Secondary causes of tachycardia, such as anemia, thyroid pathology, pregnancy, infection, or pulmonary embolism, were investigated, and patients with a systemic condition justifying tachycardia were excluded from the study analysis. J. 2, fcaa069 (2020). Article 2,27), their association with post-acute COVID-19 outcomes in those who have recovered remains to be determined. The quantitative variables were compared between the three groups using a one-way ANOVA model and p-values for post-hoc comparisons were adjusted using the Scheffe method. Coker, R. K. et al. Roger Villuendas. 218(3), e20202135. Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases, appeared on News 12's The New Normal to discuss the vaccine's side effectsand revealed who should. This study did not receive any specific funding. 55, 2001217 (2020). Dyn. The burden of supraventricular premature beats was lower in IST-PCS patients. 13, 1722 (2006). J. Clin. Lancet Haematol. PubMed Central Postgrad. Article While the burden of dialysis-dependent AKI at the time of discharge is low, the extent of the recovery of renal function remains to be seen. During the study period, 6.7% of patients died, while 15.1% of patients required re-admission. Abboud, H. et al. JAMA Cardiol. Mirza, F. N., Malik, A. Platelet activation and plateletmonocyte aggregates formation trigger tissue factor expression in severe COVID-19 patients. Article Rubin, R. As their numbers grow, COVID-19 long haulers stump experts. Correspondence to Madjid et al. A real-world, large-scale dataset analysis of 62,354 COVID-19 survivors from 54 healthcare organizations in the United States estimated the incidence of first and recurrent psychiatric illness between 14 and 90d of diagnosis to be 18.1%145. Van Kampen, J. J. Tankisi, H. et al. Lancet Psychiatry 7, 611627 (2020). 370, m3026 (2020). Chest 157, A453 (2020). 16, e1002797 (2019). 24, 436442 (2004). Am. Dr.Kerryn Phelps is the former President of the Australian Medical Association (AMA). Assoc. Approximately 50% of 349 patients who underwent high-resolution computed tomography of the chest at 6months had at least one abnormal pattern in the post-acute COVID-19 Chinese study5. 130, 61516157 (2020). In view of the horse reference, the predominant rhythm was sinus tachycardia. Effect of discontinuing vs continuing angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on days alive and out of the hospital in patients admitted with COVID-19: a randomized clinical trial. Post-acute COVID-19 syndrome. Respiratory follow-up of patients with COVID-19 pneumonia. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the pathogen responsible for the coronavirus disease 2019 (COVID-19) pandemic, which has resulted in global healthcare crises and strained health resources. Sungnak, W. et al. & James, J. Carvalho-Schneider, C. et al. *Significant differences compared with fully recovered patients. Lung transplantation for patients with severe COVID-19. Pandharipande, P. P. et al. 28(1), 6781. Soc. Active and future clinical studies, including prospective cohorts and clinical trials, along with frequent review of emerging evidence by working groups and task forces, are paramount to developing a robust knowledge database and informing clinical practice in this area. 105, dgaa276 (2020). J. Respir. The multi-organ sequelae of COVID-19 beyond the acute phase of infection are increasingly being appreciated as data and clinical experience in this timeframe accrue. 12(5), 498513. Prim. Res. Preceding infection and risk of stroke: an old concept revived by the COVID-19 pandemic. 43, 15271528 (2020). Xu, Y. et al. SARS-CoV-2 has been isolated from renal tissue172, and acute tubular necrosis is the primary finding noted from renal biopsies173,174 and autopsies175,176 in COVID-19. The 6MWT showed that IST patients had a significantly diminished exercise capacity, with a median walking distance of 39283m, which is only 60% of the estimated reference distance after adjusting for age, sex, and body mass index. & Guo, L. M. Binding of SARS coronavirus to its receptor damages islets and causes acute diabetes. Heart problems are a very rare side effect of COVID-19 vaccines. Med. Microbiol. 163, 345354 (2003). Open Forum Infect. All analyses treated the three groups independently, whereas the matching process for every two cases was individual. In a follow-up study of 100 patients, approximately 38% had ongoing headaches after 6weeks138. Nephrol. Inflammaging (a chronic low-level brain inflammation), along with the reduced ability to respond to new antigens and an accumulation of memory T cells (hallmarks of immunosenescence in aging and tissue injury158), may play a role in persistent effects of COVID-19. While the definition of the post-acute COVID-19 timeline is evolving, it has been suggested to include persistence of symptoms or development of sequelae beyond 3 or 4weeks from the onset of acute symptoms of COVID-19 (refs. Therefore, 40 patients fulfilled the strict diagnostic criteria for IST, yielding an estimated prevalence of the disorder of 20%. In our study, most of the patients could not be evaluated for silent hypoxemia because arterial blood gases were not performed during the acute phase. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. Sci Rep. 2022, 12:298. Management of arrhythmias associated with COVID-19. Inappropriate sinus tachycardia (IST) is a common observation in patients with post-COVID-19 syndrome (PCS) but has not yet been fully described to date. Jacobs, L. G. et al. Thrombolysis 50, 7281 (2020). https://doi.org/10.1001/jama.2020.12603 (2020). All consecutive patients seen at this unit from June to December 2020 underwent a resting 12-lead ECG. Am. J. Cardiol. This disorder may at least partially explain the prevalent symptoms of palpitations, fatigue, and impaired exercise capacity observed in PCS patients. Division of Cardiology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Ani Nalbandian,Aakriti Gupta,Mahesh V. Madhavan,Gregg F. Rosner,Nir Uriel,Allan Schwartz&Elaine Y. Wan, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts, USA, Department of Medicine, Brigham and Womens Hospital, Boston, Massachusetts, USA, Harvard Medical School, Boston, Massachusetts, USA, Kartik Sehgal,Behnood Bikdeli,Toni K. Choueiri&Jean M. Connors, Clinical Trials Center, Cardiovascular Research Foundation, New York, New York, USA, Aakriti Gupta,Mahesh V. Madhavan&Behnood Bikdeli, Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, Connecticut, USA, Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Claire McGroder,Matthew Baldwin,Daniel Brodie&Christine Kim Garcia, Division of Nephrology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Jacob S. Stevens,Sumit Mohan&Donald W. Landry, Division of Endocrinology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Joshua R. Cook,John C. Ausiello,Domenico Accili&John P. Bilezikian, Department of Neurology, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Psychiatry, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, and New York State Psychiatric Institute, New York, New York, USA, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA, Division of Cardiology, Department of Pediatrics, Icahn School of Medicine at Mount Sinai, New York, New York, USA, Cardiovascular Division, Brigham and Womens Hospital, Boston, Massachusetts, USA, Division of Infectious Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Clinical Pharmacy, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, New York, USA, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Rehabilitation and Regenerative Medicine, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Institute of Human Nutrition and Division of Preventive Medicine and Nutrition, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Division of Digestive and Liver Diseases, Department of Medicine, Vagelos College of Physicians and Surgeons, New York-Presbyterian/Columbia University Irving Medical Center, New York, New York, USA, Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York, USA, Division of Hematology, Brigham and Womens Hospital, Boston, Massachusetts, USA, You can also search for this author in

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