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K
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C
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tio
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E
p
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r
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Gen
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a
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Hy
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Ph
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T
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CC B
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C
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Sin
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Dep
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An
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I
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s
titu
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T
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lo
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Scie
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Hea
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S d
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So
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Kesd
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R
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Ma
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m
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s
in
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u
@
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k
-
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ac
.
id
1.
I
NT
RO
D
UCT
I
O
N
A
c
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ea
n
d
eliv
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y
is
a
m
ajo
r
s
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g
ical
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ter
v
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in
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u
ter
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s
an
d
ab
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m
in
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wall
[
1
]
,
[
2
]
.
W
h
en
clin
ically
in
d
icate
d
,
ce
s
ar
ea
n
s
ec
tio
n
(
CS
)
h
as
a
v
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o
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ates
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m
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d
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r
n
s
[
3
]
,
[
4
]
.
Glo
b
ally
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h
o
wev
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,
th
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u
tili
za
tio
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tim
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p
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latio
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T
h
e
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ld
Hea
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Or
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(
W
HO)
r
ep
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ts
th
at
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lo
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C
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ate
h
as
ex
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ed
th
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m
m
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d
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t
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r
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r
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ap
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2
1
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all
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s
wo
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ld
wid
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in
2021
[
5
]
-
[
7
]
.
Su
b
s
tan
tial
r
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io
n
al
v
ar
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n
ex
is
ts
,
with
p
ar
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lar
ly
h
ig
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r
ates
in
th
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Am
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E
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wh
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Evaluation Warning : The document was created with Spire.PDF for Python.
I
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8
8
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6
Hem
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mic
s
ta
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s
a
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in
is
tered
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p
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… (
S
in
d
u
S
in
t
a
r
a
)
467
s
y
s
tem
ca
p
ac
ity
,
a
n
d
clin
ical
p
r
ac
tice
v
ar
iatio
n
s
[
7
]
,
[
8
]
.
I
n
I
n
d
o
n
esia,
n
atio
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al
h
ea
lth
d
ata
in
d
icate
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a
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1
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2
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2
,
with
m
ar
k
e
d
in
ter
p
r
o
v
in
cial
d
is
p
ar
ities
[
9
]
,
[
1
0
]
.
I
n
c
o
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t
r
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class
if
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w
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p
atter
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s
ac
r
o
s
s
r
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s
[
1
1
]
,
[
1
2
]
.
T
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is
in
cr
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s
in
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tr
en
d
h
ig
h
lig
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ts
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e
g
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t
a
ls
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s
af
ety
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q
u
ality
o
f
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ativ
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ater
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al
ca
r
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Alo
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g
s
id
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p
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e
v
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f
ce
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ar
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in
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ly
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ater
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tc
o
m
es
co
m
p
ar
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t
o
g
en
er
al
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n
esth
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[
1
3
]
.
E
v
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with
its
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ts
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p
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ain
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h
ly
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ev
alen
t
an
d
clin
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s
ig
n
if
ican
t
[
1
4
]
,
[
1
5
]
.
Sp
in
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esth
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in
d
u
ce
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h
y
p
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n
,
wh
ic
h
m
ay
co
m
p
r
o
m
is
e
m
ater
n
al
h
em
o
d
y
n
a
m
ic
s
tab
ilit
y
[
1
6
]
,
[
1
7
]
.
Fro
m
a
p
u
b
lic
h
ea
lth
an
d
p
atien
t
s
af
ety
p
er
s
p
ec
tiv
e,
th
is
co
n
d
itio
n
is
o
f
p
ar
ticu
la
r
co
n
ce
r
n
b
ec
au
s
e
u
n
tr
ea
ted
h
y
p
o
ten
s
io
n
ca
n
r
esu
lt
in
m
ater
n
al
s
y
m
p
to
m
s
in
cl
u
d
in
g
n
au
s
ea
a
n
d
v
o
m
itin
g
,
d
izzin
ess
,
d
ec
r
ea
s
ed
co
n
s
cio
u
s
n
ess
,
ca
r
d
io
v
ascu
lar
co
llap
s
e,
an
d
in
s
ev
e
r
e
ca
s
es.
Mo
r
e
im
p
o
r
tan
tly
,
m
ater
n
al
h
y
p
o
te
n
s
io
n
d
u
r
in
g
ce
s
ar
ea
n
d
eliv
er
y
h
as
im
p
licatio
n
s
t
h
at
ex
ten
d
b
ey
o
n
d
in
d
i
v
id
u
al
clin
ical
ev
e
n
ts
.
R
ed
u
ce
d
u
ter
o
p
lace
n
tal
p
er
f
u
s
io
n
ass
o
ciate
d
with
h
y
p
o
ten
s
io
n
m
ay
im
p
ai
r
f
etal
o
x
y
g
en
d
eliv
er
y
an
d
a
d
v
er
s
ely
af
f
ec
t
n
eo
n
atal
o
u
t
co
m
es
[
1
8
]
,
[
1
9
]
.
C
o
n
s
eq
u
e
n
tly
,
s
tr
ateg
ies
f
o
r
p
r
ev
en
tin
g
an
d
m
a
n
ag
in
g
h
y
p
o
ten
s
io
n
ass
o
ciate
d
with
s
p
i
n
al
an
esth
esia
r
ep
r
esen
t
a
cr
i
tical
co
m
p
o
n
e
n
t
o
f
q
u
ality
o
b
s
tetr
ic
an
esth
esia
ca
r
e,
p
ar
ticu
lar
ly
in
h
ea
lth
ca
r
e
s
y
s
tem
s
wi
th
lim
ited
m
o
n
ito
r
in
g
r
eso
u
r
ce
s
an
d
h
ig
h
s
u
r
g
ical
wo
r
k
lo
a
d
s
.
Var
io
u
s
p
r
ev
e
n
tiv
e
an
d
th
er
ap
e
u
tic
s
tr
ateg
ies
h
av
e
b
ee
n
e
v
alu
at
ed
,
in
clu
d
i
n
g
f
lu
i
d
lo
ad
in
g
tech
n
iq
u
es,
p
o
s
itio
n
a
l
in
ter
v
en
tio
n
s
to
r
ed
u
ce
a
o
r
to
ca
v
al
co
m
p
r
ess
io
n
,
an
d
th
e
ad
m
in
is
tr
atio
n
o
f
v
aso
p
r
ess
o
r
ag
en
ts
[
2
0
]
,
[
2
1
]
.
Am
o
n
g
av
ailab
le
v
aso
p
r
ess
o
r
s
,
th
e
m
an
ag
em
e
n
t
o
f
h
y
p
o
ten
s
io
n
in
ce
s
ar
ea
n
s
ec
tio
n
u
n
d
er
s
p
in
al
an
esth
esia
m
o
s
t
co
m
m
o
n
ly
i
n
v
o
lv
es
th
e
u
s
e
o
f
p
h
en
y
lep
h
r
in
e
an
d
ep
h
ed
r
in
e
[
2
2
]
,
[
2
3
]
.
Ph
en
y
lep
h
r
i
n
e,
a
s
elec
tiv
e
α
1
-
ad
r
en
er
g
ic
r
ec
ep
to
r
ag
o
n
is
t,
is
wid
ely
r
ec
o
m
m
en
d
ed
f
o
r
its
ef
f
icac
y
in
m
ain
tain
in
g
b
lo
o
d
p
r
ess
u
r
e
with
m
in
im
al
im
p
ac
t o
n
f
etal
ac
id
–
b
ase
s
tatu
s
in
p
r
o
p
h
y
lactic
p
r
o
to
c
o
ls
[
2
4
]
,
[
2
5
]
.
E
p
h
e
d
r
in
e,
w
h
ich
ex
er
ts
m
ix
ed
α
-
an
d
β
-
ad
r
e
n
er
g
ic
ef
f
ec
ts
,
r
em
ai
n
s
an
im
p
o
r
tan
t
alter
n
ativ
e,
p
ar
ticu
lar
ly
in
s
ettin
g
s
wh
er
e
r
ap
id
r
esto
r
atio
n
o
f
b
lo
o
d
p
r
ess
u
r
e
is
r
eq
u
ir
ed
o
r
wh
er
e
p
h
en
y
le
p
h
r
in
e
av
ailab
ilit
y
is
lim
ited
.
Ho
wev
er
,
clin
ical
p
r
ac
tice
p
atter
n
s
v
ar
y
c
o
n
s
id
er
ab
ly
,
esp
ec
ially
in
r
eso
u
r
ce
-
co
n
s
tr
ain
e
d
h
o
s
p
itals
,
wh
er
e
v
aso
p
r
ess
o
r
s
elec
tio
n
is
o
f
ten
g
u
id
ed
b
y
a
v
ailab
ilit
y
,
clin
ician
p
r
ef
er
en
c
e,
an
d
im
m
ed
iate
h
em
o
d
y
n
a
m
ic
r
esp
o
n
s
e
r
at
h
er
th
an
s
tan
d
ar
d
ize
d
p
r
o
to
co
ls
.
Desp
ite
ex
ten
s
iv
e
r
esear
ch
o
n
v
aso
p
r
ess
o
r
u
s
e
d
u
r
in
g
ce
s
ar
e
an
s
ec
tio
n
,
a
clea
r
r
esear
ch
g
a
p
r
em
ain
s
.
Mo
s
t
co
n
tem
p
o
r
ar
y
s
tu
d
ies
an
d
m
eta
-
a
n
aly
s
es
h
av
e
f
o
cu
s
ed
o
n
r
a
n
d
o
m
ized
co
n
tr
o
lle
d
tr
ials
ev
alu
atin
g
p
r
o
p
h
y
lactic
v
aso
p
r
ess
o
r
in
f
u
s
io
n
s
tr
ateg
ies,
with
o
u
tc
o
m
es
em
p
h
asizin
g
n
e
o
n
atal
a
cid
–
b
ase
s
tatu
s
an
d
h
y
p
o
te
n
s
io
n
in
cid
e
n
ce
[
2
6
]
,
[
2
7
]
.
I
n
co
n
tr
ast,
ev
id
e
n
ce
co
m
p
ar
in
g
th
e
th
er
ap
e
u
tic
ef
f
ec
tiv
e
n
ess
o
f
f
ix
e
d
b
o
lu
s
d
o
s
es
o
f
ep
h
e
d
r
in
e
an
d
p
h
e
n
y
lep
h
r
i
n
e
af
te
r
h
y
p
o
ten
s
io
n
h
as
alr
ea
d
y
o
cc
u
r
r
ed
,
p
ar
tic
u
lar
ly
u
s
in
g
q
u
asi
-
ex
p
er
im
en
tal
d
esig
n
s
in
r
ea
l
-
wo
r
ld
clin
ical
s
ettin
g
s
,
r
em
ain
s
lim
ited
[
2
8
]
.
Fu
r
th
er
m
o
r
e,
d
ata
f
r
o
m
I
n
d
o
n
esian
h
o
s
p
ital
co
n
tex
ts
ar
e
s
ca
r
ce
,
d
esp
ite
d
if
f
er
en
ce
s
in
p
atien
t
ch
ar
ac
ter
is
tics
,
r
eso
u
r
ce
av
ailab
ilit
y
,
an
d
clin
ical
wo
r
k
f
lo
ws th
at
m
ay
in
f
lu
e
n
ce
v
aso
p
r
ess
o
r
p
er
f
o
r
m
a
n
ce
an
d
m
ater
n
al
o
u
tco
m
es.
T
h
er
ef
o
r
e,
th
e
p
r
esen
t
s
tu
d
y
s
ee
k
s
to
ass
ess
th
e
co
m
p
ar
ativ
e
ef
f
ec
tiv
en
ess
o
f
1
0
m
g
ep
h
ed
r
i
n
e
v
er
s
u
s
5
0
m
g
p
h
en
y
lep
h
r
in
e
in
elev
atin
g
s
y
s
to
lic
an
d
d
ias
to
lic
b
lo
o
d
p
r
ess
u
r
e
in
ce
s
ar
e
an
s
ec
tio
n
p
atien
ts
ex
p
er
ien
cin
g
h
y
p
o
ten
s
io
n
in
d
u
ce
d
b
y
s
p
in
al
an
esth
e
s
ia
u
s
in
g
a
q
u
asi
-
ex
p
e
r
im
en
tal
d
esig
n
.
B
y
f
o
cu
s
in
g
o
n
im
m
ed
iate
h
em
o
d
y
n
am
ic
s
tab
ilizatio
n
in
r
o
u
tin
e
clin
ical
p
r
ac
tice,
th
is
s
tu
d
y
s
ee
k
s
to
p
r
o
v
id
e
co
n
tex
t
-
s
p
ec
if
i
c
ev
id
en
ce
to
s
u
p
p
o
r
t
s
af
er
m
ate
r
n
al
ca
r
e
an
d
in
f
o
r
m
v
aso
p
r
es
s
o
r
s
elec
tio
n
in
o
b
s
tetr
ic
an
est
h
esia,
esp
ec
ially
in
r
eso
u
r
ce
-
lim
ited
s
ettin
g
s
.
2.
M
E
T
H
O
D
T
h
e
r
esear
ch
a
d
o
p
te
d
a
q
u
asi
-
ex
p
er
im
en
tal,
n
o
n
-
eq
u
iv
alen
t
co
n
tr
o
l
g
r
o
u
p
ap
p
r
o
ac
h
to
c
o
m
p
ar
e
th
e
th
er
ap
eu
tic
ef
f
ec
ts
o
f
ep
h
e
d
r
i
n
e
an
d
p
h
en
y
lep
h
r
i
n
e
in
ad
d
r
ess
in
g
h
y
p
o
ten
s
io
n
ca
u
s
ed
b
y
s
p
in
al
an
esth
es
ia
d
u
r
in
g
ce
s
ar
ea
n
d
eliv
er
y
.
T
h
e
s
tu
d
y
was
co
n
d
u
cted
b
etw
ee
n
Ma
r
ch
an
d
Ap
r
il
2
0
2
3
a
t
a
s
ec
o
n
d
ar
y
-
lev
el
p
u
b
lic
h
o
s
p
ital
in
No
r
th
Su
m
atr
a,
I
n
d
o
n
esia.
Par
ticip
an
t
s
wer
e
s
elec
ted
u
s
in
g
p
u
r
p
o
s
iv
e
s
am
p
lin
g
an
d
in
clu
d
ed
wo
m
e
n
wh
o
ex
p
er
i
en
ce
d
h
y
p
o
ten
s
io
n
in
t
h
e
co
u
r
s
e
o
f
a
ce
s
ar
ea
n
s
ec
tio
n
a
d
m
in
is
ter
ed
s
p
in
al
an
esth
esia
f
o
llo
win
g
an
i
n
tr
a
th
ec
al
b
lo
ck
d
u
r
in
g
th
e
s
tu
d
y
p
er
io
d
.
A
co
h
o
r
t
o
f
6
0
eli
g
ib
le
p
atien
ts
was
d
iv
id
ed
eq
u
ally
in
to
two
g
r
o
u
p
s
,
wh
er
e
3
0
p
atien
ts
wer
e
tr
e
ated
with
1
0
m
g
in
tr
av
en
o
u
s
e
p
h
ed
r
in
e
1
0
m
g
a
n
d
th
e
r
em
ain
in
g
3
0
p
atien
ts
r
ec
e
iv
ed
5
0
m
g
p
h
en
y
lep
h
r
in
e
.
T
h
e
in
clu
s
io
n
c
r
iter
ia
co
m
p
r
i
s
ed
ce
s
ar
ea
n
s
ec
tio
n
p
atien
ts
wh
o
u
n
d
er
wen
t
s
p
in
al
an
esth
esia
an
d
d
ev
elo
p
e
d
h
y
p
o
ten
s
io
n
in
tr
a
o
p
er
ativ
ely
,
wh
ile
p
atien
ts
wh
o
d
id
n
o
t
ex
p
er
ien
ce
h
y
p
o
t
en
s
io
n
af
ter
s
p
in
al
Evaluation Warning : The document was created with Spire.PDF for Python.
I
SS
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:
2
2
5
2
-
8
8
0
6
I
n
t J Pu
b
lic
Hea
lth
Sci
,
Vo
l.
15
,
No
.
2
,
J
u
n
e
20
26
:
4
6
6
-
4
7
3
468
an
esth
esia
o
r
h
a
d
i
n
co
m
p
let
e
h
em
o
d
y
n
a
m
ic
d
ata
wer
e
ex
clu
d
ed
f
r
o
m
th
e
s
tu
d
y
.
A
ll
ce
s
ar
ea
n
s
ec
tio
n
p
r
o
ce
d
u
r
es
wer
e
p
e
r
f
o
r
m
ed
u
n
d
er
s
p
in
al
a
n
esth
esia
as
th
e
s
tan
d
ar
d
an
esth
etic
tech
n
i
q
u
e.
Sp
in
al
an
esth
esia
was
ad
m
in
is
ter
ed
v
ia
in
tr
at
h
ec
al
in
jectio
n
to
ac
h
iev
e
ad
e
q
u
ate
s
en
s
o
r
y
a
n
d
m
o
to
r
b
l
o
ck
ad
e
f
o
r
s
u
r
g
e
r
y
.
Fo
llo
win
g
s
p
in
al
an
esth
esia,
m
ater
n
al
b
l
o
o
d
p
r
ess
u
r
e
w
as
m
o
n
ito
r
ed
r
o
u
tin
ely
,
a
n
d
h
y
p
o
ten
s
io
n
was
m
an
ag
ed
ac
co
r
d
in
g
to
s
tan
d
ar
d
clin
ical
p
r
ac
tice
u
s
in
g
th
er
ap
e
u
tic
v
aso
p
r
ess
o
r
ad
m
in
is
tr
atio
n
.
On
c
e
h
y
p
o
te
n
s
i
o
n
o
cc
u
r
r
ed
,
p
atien
ts
r
ec
eiv
ed
a
s
tan
d
ar
d
ized
i
n
tr
av
en
o
u
s
b
o
lu
s
co
n
s
is
tin
g
o
f
eith
er
e
p
h
ed
r
i
n
e
1
0
m
g
o
r
p
h
en
y
lep
h
r
i
n
e
5
0
m
g
.
M
a
t
e
r
n
a
l
b
l
o
o
d
p
r
e
s
s
u
r
e,
in
cl
u
d
in
g
s
y
s
t
o
l
i
c
a
n
d
d
i
a
s
t
o
l
ic
v
a
l
u
e
s
,
w
a
s
a
s
s
e
s
s
e
d
a
t
b
a
s
el
i
n
e
(
p
r
e
-
t
e
s
t
)
a
n
d
af
t
e
r
v
a
s
o
p
r
e
s
s
o
r
ad
m
i
n
i
s
t
r
a
t
io
n
(
p
o
s
t
-
t
e
s
t
)
.
A
l
l
d
a
t
a
w
e
r
e
s
u
b
je
c
t
e
d
t
o
e
d
i
t
in
g
,
c
o
d
in
g
,
en
t
r
y
,
an
d
c
l
e
a
n
in
g
p
r
o
c
ed
u
r
e
s
b
e
f
o
r
e
a
n
a
l
y
s
i
s
wa
s
co
n
d
u
c
t
ed
.
S
PS
S
w
a
s
u
t
i
l
i
ze
d
f
o
r
s
t
a
t
i
s
t
i
ca
l
a
n
a
l
y
s
i
s
,
w
h
er
e
p
a
r
t
i
c
ip
a
n
t
c
h
a
r
a
c
te
r
i
s
t
i
c
s
we
r
e
s
u
m
m
ar
i
z
e
d
t
h
r
o
u
g
h
u
n
iv
a
r
i
a
t
e
a
n
a
l
y
s
i
s
a
n
d
g
r
o
u
p
c
o
m
p
a
r
i
s
o
n
s
w
e
r
e
p
e
r
f
o
r
m
e
d
u
s
i
n
g
e
i
th
e
r
th
e
M
a
n
n
–
W
h
i
t
n
ey
U
t
e
s
t
o
r
t
h
e
in
d
ep
en
d
en
t
s
a
m
p
l
e
s
t
-
t
e
s
t
b
a
s
e
d
o
n
t
h
e
d
i
s
t
r
i
b
u
t
i
o
n
o
f
d
a
t
a
.
3.
RE
SU
L
T
S AN
D
D
I
SCU
SS
I
O
N
A
co
h
o
r
t
o
f
6
0
p
atien
ts
wh
o
d
ev
elo
p
e
d
in
tr
a
o
p
er
ativ
e
h
y
p
o
ten
s
io
n
d
u
r
in
g
ce
s
ar
ea
n
d
eliv
er
y
,
p
er
f
o
r
m
ed
a
d
m
in
is
ter
ed
s
p
i
n
al
an
esth
esia
,
wer
e
e
n
r
o
lled
in
t
h
is
r
esear
ch
.
T
h
e
p
ar
ticip
an
ts
wer
e
allo
ca
ted
in
t
o
two
in
ter
v
en
tio
n
g
r
o
u
p
s
o
f
e
q
u
al
s
ize,
with
3
0
p
atien
ts
r
ec
e
iv
in
g
1
0
m
g
o
f
ep
h
e
d
r
in
e
an
d
th
e
r
em
ain
in
g
3
0
ad
m
in
is
ter
ed
5
0
m
g
o
f
p
h
e
n
y
le
p
h
r
in
e.
T
h
e
r
esp
o
n
d
e
n
ts
’
s
o
cio
d
em
o
g
r
ap
h
ic
p
r
o
f
iles
,
in
clu
d
in
g
ag
e,
lev
el
o
f
ed
u
ca
tio
n
,
e
m
p
lo
y
m
en
t statu
s
,
an
d
p
a
r
ity
,
ar
e
s
u
m
m
ar
ized
in
T
ab
le
1
.
As
s
h
o
wn
in
T
ab
le
1
,
m
o
s
t
r
esp
o
n
d
en
ts
in
b
o
th
g
r
o
u
p
s
wer
e
ag
ed
2
0
–
3
5
y
ea
r
s
,
with
a
h
ig
h
er
p
r
o
p
o
r
tio
n
o
b
s
er
v
ed
i
n
t
h
e
e
p
h
ed
r
in
e
g
r
o
u
p
.
Seco
n
d
ar
y
ed
u
ca
tio
n
was
th
e
m
o
s
t
c
o
m
m
o
n
ed
u
ca
tio
n
al
lev
el
in
b
o
th
g
r
o
u
p
s
,
wh
ile
th
e
m
ajo
r
ity
o
f
r
esp
o
n
d
en
ts
wer
e
u
n
em
p
lo
y
ed
.
Mo
s
t
p
ar
ticip
an
ts
h
ad
two
ch
ild
r
en
,
f
o
llo
wed
b
y
t
h
o
s
e
with
th
r
ee
o
r
m
o
r
e
ch
ild
r
en
.
T
h
ese
d
is
tr
ib
u
tio
n
s
in
d
ic
ate
th
at
th
e
o
v
er
all
s
o
cio
d
em
o
g
r
a
p
h
ic
p
r
o
f
iles
o
f
r
esp
o
n
d
e
n
ts
in
th
e
t
wo
in
ter
v
en
tio
n
g
r
o
u
p
s
wer
e
g
en
er
ally
s
im
ilar
.
Ma
ter
n
al
b
lo
o
d
p
r
ess
u
r
e
m
ea
s
u
r
em
en
ts
o
b
tain
ed
b
ef
o
r
e
a
n
d
af
ter
v
aso
p
r
ess
o
r
a
d
m
in
is
tr
atio
n
ar
e
s
u
m
m
ar
ized
in
T
ab
le
2
.
T
ab
l
e
2
d
em
o
n
s
tr
ates
t
h
at
th
e
a
v
e
r
ag
e
s
y
s
to
lic
an
d
d
iast
o
lic
b
l
o
o
d
p
r
ess
u
r
e
v
alu
es
in
cr
ea
s
ed
f
r
o
m
p
r
e
-
test
to
p
o
s
t
-
test
in
b
o
th
in
ter
v
en
tio
n
g
r
o
u
p
s
.
T
h
e
ep
h
ed
r
in
e
g
r
o
u
p
e
x
h
i
b
ited
an
in
cr
ea
s
e
in
s
y
s
to
lic
b
lo
o
d
p
r
ess
u
r
e
f
r
o
m
8
7
.
8
3
m
m
Hg
to
9
8
.
1
3
m
m
H
g
,
wh
er
ea
s
th
e
p
h
en
y
lep
h
r
in
e
g
r
o
u
p
it
in
cr
ea
s
ed
f
r
o
m
8
8
.
0
3
m
m
Hg
to
9
3
.
7
7
m
m
Hg
.
A
s
im
ilar
p
atter
n
was
o
b
s
er
v
ed
f
o
r
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e,
with
h
ig
h
e
r
p
o
s
t
-
test
v
alu
es
co
m
p
ar
ed
t
o
p
r
e
-
test
v
alu
es
in
b
o
th
g
r
o
u
p
s
.
T
h
ese
d
ata
in
d
icate
an
in
c
r
ea
s
e
in
m
ater
n
al
b
lo
o
d
p
r
ess
u
r
e
f
o
llo
win
g
v
aso
p
r
ess
o
r
ad
m
in
is
tr
atio
n
.
T
ab
l
e
1
.
R
esp
o
n
d
e
n
t c
h
ar
ac
ter
is
tics
C
h
a
r
a
c
t
e
r
i
s
t
i
c
s
C
a
t
e
g
o
r
y
Ep
h
e
d
r
i
n
e
1
0
m
g
(
n
=
3
0
)
P
h
e
n
y
l
e
p
h
r
i
n
e
5
0
m
g
(
n
=
3
0
)
A
g
e
20
-
3
5
y
e
a
r
s
2
6
(
8
6
.
7
%)
2
1
(
7
0
.
0
%)
>
3
5
y
e
a
r
s
4
(
1
3
.
3
%)
9
(
3
0
.
0
%)
Ed
u
c
a
t
i
o
n
El
e
m
e
n
t
a
r
y
0
(
0
%)
6
(
2
0
.
0
%)
S
e
c
o
n
d
a
r
y
2
2
(
7
3
.
3
%)
1
7
(
5
6
.
7
%)
H
i
g
h
e
r
8
(
2
6
.
7
%)
7
(
2
3
.
3
%)
Emp
l
o
y
me
n
t
st
a
t
u
s
Emp
l
o
y
e
d
6
(
2
0
.
0
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8
(
2
6
.
7
%)
u
n
e
m
p
l
o
y
e
d
2
4
(
8
0
.
0
%)
2
2
(
7
3
.
3
%)
N
u
mb
e
r
o
f
c
h
i
l
d
r
e
n
0
c
h
i
l
d
1
(
3
.
3
%)
3
(
1
0
.
0
%)
1
c
h
i
l
d
6
(
2
0
.
0
%)
4
(
1
3
.
3
%)
2
c
h
i
l
d
r
e
n
1
5
(
5
0
.
0
%)
1
4
(
4
6
.
7
%)
≥
3
c
h
i
l
d
r
e
n
8
(
2
6
.
7
%)
9
(
3
0
.
0
%)
T
ab
l
e
2
.
Me
an
b
lo
o
d
p
r
ess
u
r
e
d
u
r
in
g
p
r
e
-
test
an
d
p
o
s
t
-
test
V
a
r
i
a
b
l
e
G
r
o
u
p
M
e
a
n
±
s
t
a
n
d
a
r
d
d
e
v
i
a
t
i
o
n
S
y
st
o
l
i
c
b
l
o
o
d
p
r
e
ss
u
r
e
(
p
r
e
-
t
e
st
)
Ep
h
e
d
r
i
n
e
1
0
m
g
87
.
8
3
±
2
.
9
4
2
P
h
e
n
y
l
e
p
h
r
i
n
e
5
0
m
g
88
.
0
3
±
3
.
1
8
9
D
i
a
st
o
l
i
c
b
l
o
o
d
p
r
e
ss
u
r
e
(
p
r
e
-
t
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st
)
Ep
h
e
d
r
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1
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g
59
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5
0
±
2
.
3
5
4
P
h
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n
y
l
e
p
h
r
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n
e
5
0
m
g
59
.
6
3
±
2
.
4
1
9
S
y
st
o
l
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c
b
l
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d
p
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(
p
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)
Ep
h
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d
r
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n
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1
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98
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1
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±
5
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0
4
3
P
h
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n
y
l
e
p
h
r
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e
5
0
m
g
93
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7
7
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9
9
1
D
i
a
st
o
l
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c
b
l
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o
d
p
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Ep
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63
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.
6
4
6
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
-
8
8
0
6
Hem
o
d
yn
a
mic
s
ta
b
iliz
a
tio
n
in
ce
s
a
r
ea
n
s
ec
tio
n
p
a
tien
ts
a
d
m
in
is
tered
s
p
in
a
l
… (
S
in
d
u
S
in
t
a
r
a
)
469
Prio
r
to
co
m
p
ar
ativ
e
a
n
aly
s
is
,
th
e
d
is
tr
ib
u
tio
n
o
f
b
lo
o
d
p
r
ess
u
r
e
d
ata
was
ass
e
s
s
ed
u
s
in
g
th
e
Ko
lm
o
g
o
r
o
v
–
Sm
ir
n
o
v
n
o
r
m
a
lity
ass
e
s
s
m
en
t,
as
d
i
s
p
lay
ed
in
T
ab
le
3
.
As
s
h
o
wn
in
T
ab
le
3
,
all
p
-
v
alu
es
ex
ce
ed
ed
0
.
0
5
,
in
d
icatin
g
th
at
p
r
e
-
test
an
d
p
o
s
t
-
test
s
y
s
to
lic
an
d
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
d
ata
wer
e
n
o
r
m
ally
d
is
tr
ib
u
ted
.
T
h
is
r
esu
lt su
p
p
o
r
t
s
th
e
ap
p
licatio
n
o
f
p
ar
am
etr
ic
s
tatis
tica
l te
s
t
s
f
o
r
g
r
o
u
p
c
o
m
p
ar
is
o
n
s
.
T
h
e
o
u
tco
m
e
o
f
th
e
i
n
d
ep
e
n
d
en
t
s
am
p
les
t
-
test
co
m
p
ar
in
g
b
lo
o
d
p
r
ess
u
r
e
v
alu
es
b
et
wee
n
th
e
ep
h
ed
r
in
e
an
d
p
h
en
y
lep
h
r
i
n
e
g
r
o
u
p
s
is
p
r
esen
ted
in
T
ab
le
4
.
Acc
o
r
d
in
g
to
T
ab
le
4
,
n
o
s
ig
n
if
ican
t
d
if
f
er
en
ce
s
wer
e
o
b
s
er
v
e
d
in
s
y
s
to
lic
o
r
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e
b
etw
ee
n
th
e
two
g
r
o
u
p
s
p
r
i
o
r
to
th
e
in
ter
v
e
n
tio
n
.
I
n
co
n
tr
ast,
th
er
e
wer
e
s
tatis
ticall
y
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
in
s
y
s
to
lic
an
d
d
iast
o
lic
b
l
o
o
d
p
r
es
s
u
r
e,
with
lo
wer
p
-
v
alu
es
in
d
icatin
g
d
if
f
e
r
en
ce
s
b
etwe
en
th
e
ep
h
e
d
r
in
e
an
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[
2
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.
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s
elec
tiv
e
α
₁
-
ag
o
n
is
m
ten
d
s
to
p
r
o
d
u
ce
m
o
r
e
s
tab
le
s
y
s
tem
ic
v
ascu
lar
r
esis
tan
ce
,
wh
er
ea
s
ep
h
e
d
r
in
e’
s
m
ix
ed
ad
r
en
er
g
ic
ac
tiv
ity
m
ay
r
esu
lt
in
g
r
ea
ter
in
cr
ea
s
es
in
ca
r
d
iac
o
u
tp
u
t
th
at
tr
an
s
late
t
o
d
i
f
f
er
e
n
t
h
em
o
d
y
n
am
ic
p
r
o
f
iles
wh
en
ad
m
in
is
ter
ed
th
er
ap
eu
tically
.
T
h
is
p
atter
n
is
co
n
s
is
ten
t
with
th
e
p
r
esen
t
s
tu
d
y
’
s
d
ata
s
h
o
win
g
d
if
f
er
en
tial
s
y
s
to
lic
an
d
d
ias
to
lic
p
r
ess
u
r
e
r
esp
o
n
s
es.
T
h
e
clin
ical
r
elev
an
ce
o
f
th
ese
p
h
y
s
io
lo
g
ic
d
if
f
er
e
n
ce
s
is
u
n
d
er
s
co
r
ed
b
y
th
eir
p
o
ten
tial
im
p
ac
t
o
n
m
ater
n
al
h
em
o
d
y
n
am
ics
an
d
ad
v
er
s
e
ef
f
ec
ts
.
Fo
r
ex
am
p
le,
ep
h
ed
r
in
e’
s
β
-
ad
r
en
e
r
g
i
c
s
tim
u
latio
n
m
ay
in
cr
ea
s
e
h
ea
r
t
r
ate,
wh
ich
co
u
ld
b
e
b
en
ef
icial
o
r
d
etr
im
en
ta
l
d
ep
en
d
in
g
o
n
b
aselin
e
m
ater
n
al
ca
r
d
io
v
ascu
lar
s
tatu
s
.
Ph
en
y
lep
h
r
i
n
e’
s
p
r
ed
o
m
in
an
t
v
aso
c
o
n
s
tr
ictiv
e
ef
f
ec
t
m
ay
lead
to
r
ef
lex
b
r
a
d
y
ca
r
d
ia,
a
p
h
e
n
o
m
en
o
n
d
o
cu
m
e
n
ted
in
o
th
er
c
o
m
p
ar
at
iv
e
s
tu
d
ies.
W
h
ile
n
eo
n
atal
o
u
tco
m
es
wer
e
n
o
t
th
e
p
r
im
ar
y
f
o
cu
s
o
f
th
e
cu
r
r
e
n
t
an
aly
s
is
,
ex
is
tin
g
ev
id
en
ce
s
u
g
g
ests
th
at
r
o
b
u
s
t
m
ain
ten
a
n
c
e
o
f
m
ater
n
al
b
lo
o
d
p
r
ess
u
r
e
with
p
h
en
y
lep
h
r
in
e
d
o
es
n
o
t
c
o
m
p
r
o
m
is
e
n
e
o
n
at
al
Ap
g
ar
s
co
r
es
w
h
en
c
o
m
p
a
r
ed
with
ep
h
ed
r
i
n
e,
f
u
r
th
er
s
u
p
p
o
r
tin
g
its
s
af
ety
p
r
o
f
ile
in
o
b
s
tetr
ic
p
r
ac
tice.
Desp
ite
th
ese
in
s
ig
h
ts
,
th
e
g
en
er
aliza
b
ilit
y
o
f
f
i
n
d
in
g
s
s
h
o
u
ld
b
e
c
o
n
s
id
er
ed
in
lig
h
t
o
f
s
tu
d
y
lim
itatio
n
s
.
As
a
q
u
asi
-
ex
p
er
im
en
tal
s
tu
d
y
p
er
f
o
r
m
ed
in
a
s
in
g
le
clin
ical
s
ettin
g
,
ca
u
s
al
in
f
er
en
ce
s
ar
e
lim
ited
,
an
d
v
ar
iatio
n
s
in
clin
ica
l
p
r
ac
tice
p
atter
n
s
m
a
y
af
f
ec
t
ap
p
licab
ilit
y
.
Mo
r
eo
v
e
r
,
t
h
e
f
o
c
u
s
o
n
b
lo
o
d
p
r
ess
u
r
e
o
u
tco
m
es
with
o
u
t
ad
d
itio
n
al
h
em
o
d
y
n
am
ic
p
ar
a
m
e
ter
s
s
u
ch
as
h
ea
r
t
r
ate
o
r
ca
r
d
iac
o
u
tp
u
t
lim
its
th
e
g
r
an
u
lar
ity
o
f
p
h
y
s
io
lo
g
ic
in
te
r
p
r
etatio
n
.
Nev
er
th
eless
,
th
e
p
r
esen
t
s
tu
d
y
co
n
tr
i
b
u
tes
to
th
e
e
v
o
l
v
in
g
e
v
id
en
ce
b
ase
b
y
d
em
o
n
s
tr
atin
g
d
if
f
er
en
tial
h
em
o
d
y
n
a
m
ic
r
esp
o
n
s
es
to
th
er
ap
eu
tic
v
aso
p
r
e
s
s
o
r
b
o
lu
s
es.
I
t
al
s
o
s
itu
ate
s
t
h
ese
f
in
d
in
g
s
with
in
a
f
r
am
ewo
r
k
s
u
p
p
o
r
ted
b
y
r
ec
en
t
in
ter
n
atio
n
al
r
esear
ch
.
T
h
ese
in
s
ig
h
ts
m
a
y
in
f
o
r
m
v
aso
p
r
ess
o
r
s
elec
tio
n
in
clin
ical
s
ettin
g
s
wh
er
e
th
er
a
p
eu
tic
b
o
l
u
s
ad
m
in
is
tr
atio
n
is
th
e
p
r
im
ar
y
ap
p
r
o
ac
h
to
m
an
ag
in
g
s
p
in
al
an
esth
esia
–
in
d
u
ce
d
h
y
p
o
ten
s
io
n
.
4.
CO
NCLU
SI
O
N
T
h
is
p
r
esen
t
s
tu
d
y
estab
lis
h
es
th
at
b
o
th
ep
h
ed
r
in
e
1
0
m
g
an
d
p
h
en
y
lep
h
r
in
e
5
0
m
g
,
wh
en
ad
m
in
is
ter
ed
as
th
er
ap
e
u
tic
b
o
lu
s
d
o
s
es
af
ter
th
e
in
itiatio
n
o
f
h
y
p
o
ten
s
io
n
ass
o
ciate
d
with
s
p
in
al
an
esth
esia
d
u
r
in
g
ce
s
ar
ea
n
s
ec
tio
n
,
wer
e
ef
f
ec
tiv
e
i
n
in
c
r
ea
s
in
g
m
at
er
n
al
s
y
s
to
lic
-
d
iast
o
lic
b
lo
o
d
p
r
ess
u
r
e.
Ho
wev
er
,
s
ig
n
if
ican
t
d
if
f
er
e
n
ce
s
in
p
o
s
t
-
in
ter
v
en
tio
n
b
lo
o
d
p
r
ess
u
r
e
r
esp
o
n
s
es
wer
e
o
b
s
er
v
ed
b
etwe
en
th
e
two
v
aso
p
r
ess
o
r
s
,
in
d
icatin
g
d
is
t
in
ct
h
em
o
d
y
n
am
ic
p
r
o
f
iles
ass
o
ciate
d
with
ea
ch
ag
en
t.
Fro
m
a
p
r
ac
tical
p
er
s
p
ec
tiv
e,
th
ese
f
in
d
in
g
s
h
av
e
im
p
o
r
ta
n
t
im
p
licatio
n
s
f
o
r
an
esth
etic
m
an
a
g
em
en
t
i
n
clin
ical
s
ettin
g
s
,
p
ar
ticu
lar
ly
in
h
o
s
p
itals
wh
er
e
th
er
ap
eu
tic
b
o
lu
s
ad
m
in
is
tr
atio
n
r
em
ain
s
th
e
p
r
im
ar
y
s
tr
ateg
y
f
o
r
m
a
n
ag
in
g
h
y
p
o
te
n
s
io
n
d
u
r
in
g
s
p
in
al
a
n
esth
esia.
T
h
e
o
b
s
er
v
e
d
d
if
f
er
en
ce
s
in
b
lo
o
d
p
r
ess
u
r
e
r
esp
o
n
s
es
h
ig
h
lig
h
t
th
e
im
p
o
r
tan
ce
o
f
ca
r
e
f
u
l
v
a
s
o
p
r
ess
o
r
s
elec
tio
n
b
ased
o
n
d
esi
r
ed
h
em
o
d
y
n
am
ic
ef
f
ec
ts
,
p
at
ien
t
ch
ar
ac
ter
is
tics
,
an
d
av
ailab
le
r
eso
u
r
ce
s
.
T
h
e
f
in
d
in
g
s
r
ein
f
o
r
ce
th
e
o
n
g
o
i
n
g
u
s
e
o
f
b
o
th
e
p
h
ed
r
i
n
e
an
d
p
h
en
y
lep
h
r
i
n
e
as
ef
f
ec
tiv
e
th
er
ap
e
u
tic
o
p
tio
n
s
,
wh
ile
u
n
d
er
s
co
r
i
n
g
th
at
th
eir
clin
ical
ef
f
ec
ts
ar
e
n
o
t
in
ter
c
h
an
g
ea
b
le.
T
h
e
k
ey
m
ess
ag
e
o
f
th
is
s
tu
d
y
is
th
at
v
aso
p
r
ess
o
r
ch
o
ice
in
f
lu
e
n
ce
s
m
ater
n
al
b
lo
o
d
p
r
ess
u
r
e
r
esp
o
n
s
e
f
o
llo
win
g
s
p
in
al
an
esth
esia
–
in
d
u
ce
d
h
y
p
o
ten
s
i
o
n
,
ev
en
wh
e
n
ad
m
in
is
ter
ed
af
ter
h
y
p
o
ten
s
io
n
h
as
o
cc
u
r
r
e
d
.
T
h
is
em
p
h
asizes
th
e
n
ee
d
f
o
r
clin
ician
s
to
co
n
s
id
er
th
e
p
h
ar
m
ac
o
lo
g
ic
p
r
o
f
ile
o
f
v
aso
p
r
ess
o
r
s
in
r
o
u
tin
e
o
b
s
tetr
ic
an
esth
esia
p
r
ac
tice,
r
ath
er
t
h
an
r
el
y
in
g
s
o
lely
o
n
i
n
s
titu
tio
n
al
h
ab
it
o
r
av
ailab
ilit
y
.
Fu
r
th
er
r
esear
c
h
i
s
r
ec
o
m
m
en
d
e
d
to
ex
p
an
d
u
p
o
n
th
ese
f
in
d
in
g
s
.
T
o
im
p
r
o
v
e
g
en
e
r
aliza
b
ilit
y
,
f
u
tu
r
e
s
tu
d
ies
s
h
o
u
ld
in
co
r
p
o
r
ate
r
an
d
o
m
ized
co
n
tr
o
lled
d
esig
n
s
,
lar
g
er
s
am
p
les,
an
d
m
u
lticen
ter
s
ettin
g
s
.
I
n
ad
d
itio
n
,
th
e
in
c
lu
s
io
n
o
f
b
r
o
ad
e
r
h
em
o
d
y
n
am
ic
p
ar
am
ete
r
s
,
s
u
ch
as
h
ea
r
t
r
ate
an
d
ca
r
d
iac
o
u
t
p
u
t,
as
well
as
m
ater
n
al
an
d
n
eo
n
atal
o
u
tco
m
es,
wo
u
ld
p
r
o
v
id
e
a
b
r
o
a
d
er
p
e
r
s
p
ec
tiv
e
o
n
th
e
clin
ical
im
p
licatio
n
s
o
f
v
aso
p
r
ess
o
r
s
elec
tio
n
in
o
b
s
tetr
ic
an
esth
esia.
F
UNDING
I
NF
O
R
M
A
T
I
O
N
Au
th
o
r
s
s
tate
n
o
f
u
n
d
in
g
in
v
o
lv
ed
.
AUTHO
R
CO
NT
RI
B
UT
I
O
NS ST
A
T
E
M
E
N
T
T
h
is
jo
u
r
n
al
u
s
es
th
e
C
o
n
tr
ib
u
to
r
R
o
les
T
ax
o
n
o
m
y
(
C
R
ed
iT)
to
r
ec
o
g
n
ize
in
d
iv
id
u
al
au
th
o
r
co
n
tr
ib
u
tio
n
s
,
r
ed
u
ce
au
th
o
r
s
h
ip
d
is
p
u
tes,
an
d
f
ac
ilit
ate
co
llab
o
r
atio
n
.
Evaluation Warning : The document was created with Spire.PDF for Python.
I
n
t J Pu
b
lic
Hea
lth
Sci
I
SS
N:
2252
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8
8
0
6
Hem
o
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ta
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a
tio
n
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ce
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a
r
ea
n
s
ec
tio
n
p
a
tien
ts
a
d
m
in
is
tered
s
p
in
a
l
… (
S
in
d
u
S
in
t
a
r
a
)
471
Na
m
e
o
f
Aut
ho
r
C
M
So
Va
Fo
I
R
D
O
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Vi
Su
P
Fu
Sin
d
u
Sin
tar
a
✓
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✓
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An
n
es R
in
d
y
Per
m
an
a
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✓
✓
W
id
ig
d
o
R
ek
s
o
Neg
o
r
o
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Su
r
y
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to
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R
ek
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Priy
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g
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Mu
h
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m
ad
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C
:
C
o
n
c
e
p
t
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a
l
i
z
a
t
i
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M
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M
e
t
h
o
d
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g
y
So
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So
f
t
w
a
r
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Va
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Va
l
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d
a
t
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Fo
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Fo
r
mal
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n
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l
y
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n
v
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so
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r
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D
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D
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r
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r
i
t
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r
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1
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8
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473
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c
a
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a
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:
su
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a
n
to
@
it
sk
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so
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p
ra
o
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n
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a
c
.
id
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k
o
Priy
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a
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ITS
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d
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o
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ly
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ti
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c
a
n
b
e
c
o
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tac
ted
a
t
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m
a
il
:
re
k
o
@itsk
-
so
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p
ra
o
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n
.
a
c
.
i
d
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Mu
h
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m
m
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Ro
d
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sth
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sio
l
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sp
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c
ialist
w
h
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x
p
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rien
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n
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sth
e
sia
se
rv
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s,
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ten
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c
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r
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n
d
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c
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te
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n
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h
r
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ic p
a
in
m
a
n
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g
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m
e
n
t
,
sta
rti
n
g
i
n
2
0
1
8
a
t
th
e
Tk
.
II
d
r
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Arm
y
H
o
sp
it
a
l.
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o
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ra
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,
M
a
lan
g
.
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t
h
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m
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d
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e
d
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ti
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u
n
d
a
n
d
a
sp
e
c
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in
An
e
st
h
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lo
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t
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wijay
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Un
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rsit
y
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M
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h
e
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m
it
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fe
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ffe
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ly
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stit
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o
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d
r.
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p
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M
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la
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g
.
H
e
c
a
n
b
e
c
o
n
tac
ted
a
t
e
m
a
il
:
r
o
d
li
@its
k
-
so
e
p
ra
o
e
n
.
a
c
.
id
.
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