{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,2]],"date-time":"2026-01-02T07:34:22Z","timestamp":1767339262008,"version":"build-2065373602"},"reference-count":56,"publisher":"MDPI AG","issue":"7","license":[{"start":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T00:00:00Z","timestamp":1689724800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>The potentially fatal COVID-19 pandemic has been associated with a largespectrum of clinical presentations. Beyond the classical pulmonary manifestations, gastrointestinal tract-related symptoms suchas nausea, diarrhea, abdominal distention and pain have been observed in patients, as a consequence of the binding of SARS-CoV-19 to Angiotensin-converting Enzyme 2 (ACE2) receptors in the gastrointestinal (GI) tract. The early recognition ofspecific imaging features, including hepatobiliary involvement, pancreatic involvement, development of solid organ infarcts, ischemic bowel changes and vascular occlusion, plays a key role through the course of the disease. Also, suspicious symptoms, especially in critically ill patients with clinical and biochemical markers of hypovolemia, necessitate timely imaging for bleeding complications. The aim of this pictorial review is to illustrate the spectrum of the GIimaging findings in patients with COVID-19. Awareness of diagnostic imaging hallmarks is crucial to optimize the management of these patients.<\/jats:p>","DOI":"10.3390\/medicina59071332","type":"journal-article","created":{"date-parts":[[2023,7,19]],"date-time":"2023-07-19T21:20:14Z","timestamp":1689801614000},"page":"1332","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Gastrointestinal Imaging Findings in the Era of COVID-19: A Pictorial Review"],"prefix":"10.3390","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6672-0727","authenticated-orcid":false,"given":"Xanthippi","family":"Mavropoulou","sequence":"first","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Elisavet","family":"Psoma","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angeliki","family":"Papachristodoulou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-8754-221X","authenticated-orcid":false,"given":"Nikoletta","family":"Pyrrou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ekaterini","family":"Spanou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Alexandratou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Sidiropoulou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anastasia","family":"Theocharidou","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vasileios","family":"Rafailidis","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Theofilos","family":"Chrysanthidis","sequence":"additional","affiliation":[{"name":"Infectious Diseases Division, First Internal Medicine Department, School of Medicine, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Panos","family":"Prassopoulos","sequence":"additional","affiliation":[{"name":"Department of Clinical Radiology, AHEPA University Hospital of Thessaloniki, Aristotle University of Thessaloniki, 54634 Thessaloniki, Greece"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"4910","DOI":"10.1007\/s00330-020-06880-z","article-title":"Characteristic CT Findings Distinguishing 2019 Novel Coronavirus Disease (COVID-19) from Influenza Pneumonia","volume":"30","author":"Wang","year":"2020","journal-title":"Eur. Radiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"388","DOI":"10.1016\/j.jinf.2020.02.016","article-title":"Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):A multi-center study in Wenzhou city, Zhejiang, China","volume":"80","author":"Yang","year":"2020","journal-title":"J. Infect."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1017","DOI":"10.1038\/s41591-020-0968-3","article-title":"Extrapulmonary manifestations of COVID-19","volume":"26","author":"Gupta","year":"2020","journal-title":"Nat. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1111\/apt.15731","article-title":"Review article: Gastrointestinal features in COVID-19 and the possibility of faecal transmission","volume":"51","author":"Tian","year":"2020","journal-title":"Aliment. Pharmacol. Ther."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1053\/j.gastro.2020.04.045","article-title":"Prevalence and Characteristics of Gastrointestinal Symptoms in Patients With Severe Acute Respiratory Syndrome Coronavirus 2 Infection in the United States: A Multicenter Cohort Study","volume":"159","author":"Redd","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"667","DOI":"10.1016\/S2468-1253(20)30126-6","article-title":"Manifestations and prognosis of gastrointestinal and liver involvement in patients with COVID-19: A systematic review and meta-analysis","volume":"5","author":"Mao","year":"2020","journal-title":"Lancet Gastroenterol. Hepatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"102463","DOI":"10.1016\/j.jaut.2020.102463","article-title":"Assessing ACE2 expression patterns in lung tissues in the pathogenesis of COVID-19","volume":"112","author":"Li","year":"2020","journal-title":"J. Autoimmun."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"631","DOI":"10.1002\/path.1570","article-title":"Tissue distribution of ACE2 protein, the functional receptor for SARS coronavirus. A first step in understanding SARS pathogenesis","volume":"203","author":"Hamming","year":"2004","journal-title":"J. Pathol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"E207","DOI":"10.1148\/radiol.2020201908","article-title":"Abdominal imaging findings in COVID-19: Preliminary observations","volume":"297","author":"Bhayana","year":"2020","journal-title":"Radiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1158","DOI":"10.21037\/qims-20-463","article-title":"Abdomen CT findings in a COVID-19 patient with intestinal symptoms and possibly false negative RT-PCR before initial discharge","volume":"10","author":"Guo","year":"2020","journal-title":"Quant. Imaging Med. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"100326","DOI":"10.1016\/j.ejro.2021.100326","article-title":"Abdominal gastrointestinal imaging findings on computed tomography in patients with COVID-19 and correlation with clinical outcomes","volume":"8","author":"Horvat","year":"2021","journal-title":"Eur. J. Radiol. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1831","DOI":"10.1053\/j.gastro.2020.02.055","article-title":"Evidence for Gastrointestinal Infection of SARS-CoV-2","volume":"158","author":"Xiao","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1940","DOI":"10.1148\/rg.2015150125","article-title":"CT evaluation of acute enteritis and colitis: Is it infectious, inflammatory, or ischemic?","volume":"35","author":"Childers","year":"2015","journal-title":"Radiographics"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"844","DOI":"10.1111\/jth.14768","article-title":"Abnormal coagulation parameters are associated with poor prognosis in patients with novel coronavirus pneumonia","volume":"18","author":"Tang","year":"2020","journal-title":"J. Thromb. Haemost."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1016\/j.acra.2020.05.016","article-title":"Acute Mesenteric Ischemia in Severe Coronavirus-19 (COVID-19): Possible Mechanisms and Diagnostic Pathway","volume":"27","author":"Parry","year":"2020","journal-title":"Acad. Radiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"408","DOI":"10.2214\/AJR.08.1138","article-title":"CT diagnosis of acute mesenteric ischemia from various causes","volume":"192","author":"Furukawa","year":"2009","journal-title":"Am. J. Roentgenol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"632","DOI":"10.1148\/radiology.199.3.8637978","article-title":"Acute Mesenteric Ischemia: Diagnosis with Contrast-enhanced CT\u2019","volume":"199","author":"Taourel","year":"1996","journal-title":"Radiology"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1016\/j.jcol.2020.05.011","article-title":"Perforated acute abdomen in a patient with COVID-19: An atypical manifestation of the disease","volume":"40","author":"Viana","year":"2020","journal-title":"J. Coloproctol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1797","DOI":"10.1007\/s00384-020-03627-6","article-title":"Bowel perforation in a Covid-19 patient: Case report","volume":"35","author":"Parolini","year":"2020","journal-title":"Int. J. Color. Dis."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1016\/j.clinimag.2020.05.013","article-title":"Extrapulmonary manifestations of COVID-19: Radiologic and clinical overview","volume":"66","author":"Behzad","year":"2020","journal-title":"Clin. Imaging"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1002\/jmv.25825","article-title":"The presence of SARS-CoV-2 RNA in the feces of COVID-19 patients","volume":"92","author":"Chen","year":"2020","journal-title":"J. Med. Virol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"766","DOI":"10.14309\/ajg.0000000000000620","article-title":"Clinical characteristics of COVID-19 patients with digestive symptoms in Hubei, China: A descriptive, cross-sectional, multicenter study","volume":"115","author":"Pan","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Zhang, H., Kang, Z., Gong, H., Xu, D., Wang, J., Li, Z., Cui, X., Xiao, J., Meng, T., and Zhou, W. (2020). The digestive system is a potential route of 2019-nCov infection: A bioinformatics 1 analysis based on single-cell transcriptomes 2. bioRxiv.","DOI":"10.1101\/2020.01.30.927806"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"198","DOI":"10.1186\/s43055-020-00317-9","article-title":"Diagnostic value of abdominal sonography in confirmed COVID-19 intensive care patients","volume":"51","author":"Abdelmohsen","year":"2020","journal-title":"Egypt. J. Radiol. Nucl. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"731436","DOI":"10.3389\/fmed.2021.731436","article-title":"Drug-Induced Liver Injury in COVID-19 Patients: A Systematic Review. Frontiers in Medicine","volume":"8","author":"Sodeifian","year":"2021","journal-title":"Front. Media"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1016\/j.dld.2020.09.010","article-title":"COVID 19 and liver: An A\u2013Z literature review","volume":"53","author":"Metawea","year":"2021","journal-title":"Dig. Liver Dis."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1016\/j.amsu.2020.08.027","article-title":"Acute acalculous cholecystitis on a COVID-19 patient: A case report","volume":"58","author":"Mattone","year":"2020","journal-title":"Ann. Med. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e11524","DOI":"10.1016\/j.heliyon.2022.e11524","article-title":"Acute acalculous cholecystitis in hospitalized patients in intensive care unit: Study of 5 cases","volume":"8","author":"Mossaab","year":"2022","journal-title":"Heliyon"},{"key":"ref_29","unstructured":"Whitcomb, D.C. (2023, May 14). Acute Pancreatitis [Internet], Available online: https:\/\/pubmed.ncbi.nlm.nih.gov\/16707751\/."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1016\/j.jiph.2022.01.003","article-title":"COVID-19 induced acute pancreatitis after resolution of the infection","volume":"15","author":"Almutairi","year":"2022","journal-title":"J. Infect. Public Health"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"e237903","DOI":"10.1136\/bcr-2020-237903","article-title":"Coronavirus disease-19 (COVID-19) associated with acute necrotising pancreatitis (ANP)","volume":"13","author":"Kumaran","year":"2020","journal-title":"BMJ Case Rep. CP"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1575","DOI":"10.2460\/ajvr.67.9.1575","article-title":"Isolation and characterization of a coronavirus from pigeons with pancreatitis","volume":"67","author":"Qian","year":"2006","journal-title":"Am. J. Vet. Res."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1567","DOI":"10.1016\/j.pan.2020.10.035","article-title":"Coronavirus disease 2019 and the pancreas","volume":"20","author":"Samanta","year":"2020","journal-title":"Pancreatology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1053\/j.gastro.2020.03.065","article-title":"Gastrointestinal Manifestations of SARS-CoV-2 Infection and Virus Load in Fecal Samples From a Hong Kong Cohort: Systematic Review and Meta-analysis","volume":"159","author":"Cheung","year":"2020","journal-title":"Gastroenterology"},{"key":"ref_35","first-page":"507","article-title":"Involvement of the exocrine pancreas during COVID-19 infection and possible pathogenetic hypothesis: A concise review Myc-mediated cell competition in cancer View project","volume":"28","author":"Zippi","year":"2020","journal-title":"Infez. Med."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Abramczyk, U., Nowaczy\u0144ski, M., S\u0142omczy\u0144ski, A., Wojnicz, P., Zatyka, P., and Kuzan, A. (2022). Consequences of COVID-19 for the Pancreas. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23020864"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Sinagra, E., Shahini, E., Crispino, F., Macaione, I., Guarnotta, V., Maras\u00e0, M., Testai, S., Pallio, S., Albano, D., and Facciorusso, A. (2022). COVID-19 and the Pancreas: A Narrative Review. Life, 12.","DOI":"10.3390\/life12091292"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"695","DOI":"10.1097\/MEG.0000000000002160","article-title":"Clinical course and outcome among patients with acute pancreatitis and COVID-19","volume":"33","author":"Kumar","year":"2021","journal-title":"Eur. J. Gastroenterol. Hepatol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"870","DOI":"10.1080\/00365521.2021.1922751","article-title":"A bimodal pattern of the onset of COVID-19 related acute pancreatitis supports both the cytotoxic and immune-related pathogenesis\u2014A systematic review","volume":"56","author":"Bircakova","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1467","DOI":"10.1080\/00365521.2021.1971757","article-title":"Acute pancreatitis in patients with COVID-19 is more severe and lethal: A systematic review and meta-analysis","volume":"56","author":"Mutneja","year":"2021","journal-title":"Scand. J. Gastroenterol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1656","DOI":"10.1016\/j.hpb.2021.03.003","article-title":"Impact of SARS-CoV-2 pandemic on pancreatic cancer services and treatment pathways: United Kingdom experience","volume":"23","author":"McKay","year":"2021","journal-title":"HPB"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ejim.2020.05.002","article-title":"Bleeding in COVID-19 severe pneumonia: The other side of abnormal coagulation pattern?","volume":"77","author":"Conti","year":"2020","journal-title":"Eur. J. Intern. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"281","DOI":"10.1016\/j.ijcard.2020.08.103","article-title":"Unusual arterial thrombotic events in Covid-19 patients","volume":"323","author":"Chousterman","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"149","DOI":"10.4329\/wjr.v13.i6.149","article-title":"Thoracic imaging outcomes in COVID-19 survivors","volume":"13","author":"Js","year":"2021","journal-title":"World J. Radiol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1116","DOI":"10.1515\/cclm-2020-0188","article-title":"Prominent changes in blood coagulation of patients with SARS-CoV-2 infection","volume":"58","author":"Han","year":"2020","journal-title":"Clin. Chem. Lab. Med."},{"key":"ref_46","first-page":"001747","article-title":"Multisystemic Infarctions in COVID-19: Focus on the Spleen","volume":"7","author":"Pessoa","year":"2020","journal-title":"Eur. J. Case Rep. Intern. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s13244-022-01266-9","article-title":"Imaging features of COVID-19-associated secondary sclerosing cholangitis on magnetic resonance cholangiopancreatography: A retrospective analysis","volume":"13","author":"Ghafoor","year":"2022","journal-title":"Insights Imaging"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"104","DOI":"10.2214\/AJR.20.23617","article-title":"Hypercoagulability in Patients with Coronavirus Disease (COVID-19): Identification of Arterial and Venous Thromboembolism in the Abdomen, Pelvis, and Lower Extremities","volume":"216","author":"Dane","year":"2021","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"24","DOI":"10.37549\/AR2650","article-title":"Abdominal Presentation of COVID-19","volume":"49","author":"Hellinger","year":"2020","journal-title":"Appl. Radiol."},{"key":"ref_50","doi-asserted-by":"crossref","unstructured":"Prasoppokakorn, T., Kullavanijaya, P., and Pittayanon, R. (2022). Risk factors of active upper gastrointestinal bleeding in patients with COVID-19 infection and the effectiveness of PPI prophylaxis. BMC Gastroenterol., 22.","DOI":"10.1186\/s12876-022-02568-4"},{"key":"ref_51","first-page":"920","article-title":"Does COVID-19 increase the incidence of spontaneous rectus sheath hematoma?","volume":"28","year":"2022","journal-title":"Ulus. Travma Acil Cerrahi Derg."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Mackiewicz-Milewska, M., Sakwi\u0144ska, K., Cisowska-Adamiak, M., Szymku\u0107-Bukowska, I., Ratuszek-Sadowska, D., and Mackiewicz-Nartowicz, H. (2022). Bleeding into the Abdominal and Ilio-Lumbar Muscles\u2014A Rare Complication in the Course of COVID-19: Analysis of Four Cases and a Literature Review. J. Clin. Med., 11.","DOI":"10.3390\/jcm11164712"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"487","DOI":"10.1016\/j.gastha.2022.02.021","article-title":"Clinical and Endoscopic Outcomes in COVID-19 Patients with Gastrointestinal Bleeding","volume":"1","author":"Ashktorab","year":"2022","journal-title":"Gastro Help Adv."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1609","DOI":"10.14309\/ajg.0000000000000805","article-title":"Gastrointestinal Bleeding in Patients With Coronavirus Disease 2019: A Matched Case-Control Study","volume":"115","author":"Martin","year":"2020","journal-title":"Am. J. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/j.ajg.2021.05.008","article-title":"Massive gastrointestinal bleeding in a patient with COVID-19","volume":"22","author":"Mohamed","year":"2021","journal-title":"Arab. J. Gastroenterol."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1186\/s43055-021-00433-0","article-title":"Gastrointestinal tract imaging findings in confirmed COVID-19 patients: A non-comparative observational study","volume":"52","author":"Abdelmohsen","year":"2021","journal-title":"Egypt. J. Radiol. Nucl. Med."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1332\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:15:01Z","timestamp":1760127301000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/59\/7\/1332"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,19]]},"references-count":56,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["medicina59071332"],"URL":"https:\/\/doi.org\/10.3390\/medicina59071332","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2023,7,19]]}}}