How likely is it to get salmonella from raw eggs?
By
Dr Miguel Fernandez-Nino PhD
| Reviewed by
Dr Anny Manrich (PhD)
The contents of this article are fact-based except otherwise stated within the article.
Author bio
Dr Miguel Fernández-Niño is a food scientist with expertise in food biochemistry, Food microbiology, synthetic biology, food waste valorisation, and industrial biotechnology. He writes and reviews content on these topics.
Dr. Fernández-Niño’s Highlights:
- Colombian scientist, with a Ph.D. in Biochemical Engineering from the Jacobs University Bremen (Germany).
- Alexander von Humboldt Postdoctoral Fellow at the Leibniz Institute of Plant Biochemistry in Halle (Germany).
- Expertise in using multi-omics approaches (e.g., metabolomics, metagenomics, and metatranscriptomics) to re-engineer products and processes of relevance for the food industry.
- Expertise in designing microorganisms (microbial biofactories and starter cultures) to produce value-added products and food waste valorisation.
“My professional goal is to contribute to the education and research in Food Engineering and Food Biotechnology. The major incentive of my career is to contribute to the diffusion of scientific knowledge in society, thus promoting rational thinking and evidence-based decision-making”- Dr. Fernández-Niño’s, PhD.
Professional Experience:
Dr Fernández-Niño works as an Alexander von Humboldt Postdoctoral Fellow, at the Leibniz Institute of Plant Biochemistry, in Halle (Germany). He leads a project that aims to improve fine-flavour cocoa bean fermentation for local farmers in Colombia through controlled fermentation systems.
Previously, Dr Fernández-Niño worked as a Postdoctoral Fellow on the bio-catalytic synthesis of isoferulic acid (BMBF project) in the same institution.
Dr Fernández-Niño also worked as a Postdoctoral researcher at the Department of Chemical and Food Engineering at Los Andes University in Colombia, working on the development of a platform to produce novel aroma precursor compounds and high value-added products from analysis of cocoa fermentation.
In addition, Dr. Fernández-Niño worked on the assembly of a platform for heterologous polyphenols production in E. coli from analysis of cacao fermentation pathways, in the same institution.
Dr. Fernández-Niño has been an occasional scientific adviser of Casa Luker S.A. (leader in the Colombian chocolate market), working on projects related to the post-harvesting of fine-flavour cocoa. He also worked as instructor and coordinator of the lab course General Biochemistry and Molecular Biology II Lab (Course No. CH02-520121) at Jacobs University Bremen (Germany) and as a Resident Associate in the same institution.
Finally, Dr Miguel Fernández-Niño has experience as Part-Time Assistant Professor, Occasional Professor, and Master Teaching Assistant.
Education:
- 2009 B.Sc. Biologist at Universidad Nacional de Colombia
- 2012 Master in Science – Biochemistry (Thesis “magna cum laude”) at Universidad Nacional de Colombia
- 2017 PhD in Biochemical Engineering at Jacobs University Bremen-Germany
The main publications of Dr Miguel Fernández-Niño are:
Fabio Herrera-Rocha, Miguel Fernández-Niño*, Mónica P. Cala, Jorge Duitama, Andrés Fernando González Barrios (2023) Omics approaches to understand cocoa processing and chocolate flavor development: A review. Food Research International. https://doi.org/10.1016/j.foodres.2023.112555
Fernández-Niño Miguel* and Burgos-Toro Daniela (2022) Engineering microbial biofactories for a sustainable future. Chapter edited by Catalina Correa & Adriana Suarez-Gonzalez in the book: Genomics and the Global Bioeconomy -1st Edition-. ISBN 9780323916011. Publisher: ELSEVIER: https://www.elsevier.com/books/genomics-and-the-global-bioeconomy/patrinos/978-0-323-91601-1
Fabio Herrera-Rocha, Mónica P. Cala, Ana Maria León-Inga, Jenny Lorena Aguirre Mejía, Claudia M. Rodríguez-López, Sergio Leonardo Florez, María José Chica, Héctor Hugo Olarte, Jorge Duitama, Andrés Fernando González Barrios, Miguel Fernández-Niño* (2022) Lipidomic profiling of bioactive lipids during spontaneous fermentations of fine-flavor cocoa. Food Chemistry. Volume 397. 133845, ISSN 0308-8146. https://doi.org/10.1016/j.foodchem.2022.133845.
Díaz-Bustamante ML, Fernández-Niño M, Reyes LH and Alvarez Solano OA (2022) Multiscale Approach to Dairy Products Design. Front. Chem. Eng. 4:830314. doi: https://doi.org/10.3389/fceng.2022.830314.
Ramón E. Jaimez*, Luigy Barragan, Miguel Fernández-Niño*, Ludger A. Wessjohann, George Cedeño-Garcia, Ignacio Sotomayor, Francisco Arteaga, (2022): Theobroma cacao L. cultivar CCN 51: A comprehensive review on origin, genetics, sensory properties, production dynamics, and physiological aspects. PeerJ 10:e12676 https://doi.org/10.7717/peerj.12676.
Fabio Herrera‑Rocha, Mónica P. Cala, Jenny Lorena Aguirre Mejía, Claudia M. Rodríguez‑López, María José Chica, Héctor Hugo Olarte, Miguel Fernández‑Niño* & Andrés Fernando Gonzalez Barrios*. (2021): Dissecting fine‑flavor cocoa bean fermentation through metabolomics analysis to break down the current metabolic paradigm. Scientific Reports 11(21904) DOI: https://doi.org/10.1038/s41598-021-01427-8.
Fernández-Niño, M., Rodríguez-Cubillos, MJ., Herrera-Rocha, F., Anzola, JM., Cepeda-Hernández, ML., Aguirre, L., Chica, MJ., Olarte, HH., Rodríguez, CM., Calderón, D., Ramírez-Rojas, A., Del Portillo, P., Restrepo, S., González Barrios, A.* (2021): Dissecting on-farm industrial fermentations of fine-flavour cocoa through metagenomic analysis. Scientific Reports 11(8638) DOI: https://doi.org/10.1038/s41598-021-88048-3.
Buitrago Mora, HM., Arango Piñeros, M., Espinosa Moreno, D., Restrepo, S., Cardona Jaramillo, JEC., Álvarez Solano, OA., Fernandez-Niño, M., González Barrios, A.* (2019): Multiscale design of a dairy beverage model composed of Candida utilis single cell protein supplemented with oleic acid. Journal of Dairy Science. 102(11) 9749-9762 DOI: https://doi.org/10.3168/jds.2019-16729.
Fernández-Niño, M., Giraldo, D., Gomez-Porras, JL., Dreyer, I., González Barrios, A., Arevalo-Ferro, C.* (2017): A synthetic multi-cellular network of coupled self-sustained oscillators. PLOS ONE 12(6): e0180155 DOI: https://doi.org/10.1371/journal.pone.0180155.
Fernández-Niño, M., Marquina, M. Swinnen, S.,Rodríguez-Porrata, B., Nevoigt, E.*, Ariño, J. (2015):The Cytosolic pH of Individual Saccharomyces cerevisiae Cells Is a Key Factor in Acetic Acid Tolerance. Appl Environ Microbiol 81(22): 7813-7821 DOI: https://doi.org/10.1128/AEM.02313-15.
Swinnen, S., Fernández-Niño, M., González-Ramos, D., van Maris, AJ., Nevoigt, E.* (2014): The fraction of cells that resume growth after acetic acid addition is a strain-dependent parameter of acetic acid tolerance in Saccharomyces cerevisiae. FEMS Yeast Res 14(4): 642-653 DOI: https://doi.org/10.1111/1567-1364.12151.
Conference appearances and other speaking engagements
Selected courses delivered:
Course: Current technologies in the production of chocolates. (20 hours course). Invited as professor by the Department of Chemical and Food Engineering / Faculty of Engineering at Los Andes University-Colombia. July (2021).
Course: Design and assembly of microorganisms for the biomedical industry (20 horas course). Invited as professor by the School of Engineering and Science- Instituto Tecnologico de Monterrey (México). January 15-17 (2019)
Selected oral presentations and conferences:
Conference: Dissecting fine-flavour cocoa bean fermentation through multi-omics approaches. Speaker invited by the Organic Chemistry Department at The University of Buenos Aires -Argentina. Sep. 07 (2022).
Conference: Theobroma cacao L. cultivar CCN 51. Association of Producers of Fine Cocoa and Aroma (APROCAFA), Ecuador. March 15 (2022).
Conference: Biology of probiotics and prebiotics. Speaker invited by the Chemical and Food Engineer Department at Los Andes University-Colombia. June 27 (2020).
Conference: Pandemic food revolution. Speaker invited by the Chemical and Food Engineer Department at Los Andes University-Colombia. May 5 (2020).
Conference: Biochemistry and microbiology of cocoa fermentation. Speaker invited to the elective course: cocoa and Chocolate, organized by Casa Luker and the Department of Chemical Engineering at Los Andes University-Colombia. February 5 and 7 (2019)
Oral presentation: Lipidomic profiling of bioactive lipids during spontaneous fermentation of fine-flavour cocoa. Metabolomics 2022. Valencia, Spain. June 19-23 (2022).
Oral presentation: Exploration of Saccharomyces cerevisiae intra-species diversity for the identification of novel genetic determinants for acetic acid tolerance with the help of pooled-segregant RNA sequencing. ISSY33 International Specialized Symposium on Yeasts at University College Cork, Cork, Ireland, June 24-29. (2017)
You can view some of Dr Miguel’s work below and links to his professional profile.
https://www.researchgate.net/profile/Miguel-Fernandez-Nino
https://www.linkedin.com/in/miguel-fern%C3%A1ndez-ni%C3%B1o-4a064b168/?locale=en_US
https://scholar.google.com/citations?user=JBb1zuoAAAAJ&hl=en
https://orcid.org/0000-0002-8231-7989
https://www.scopus.com/authid/detail.uri?authorId=56123747300
https://loop.frontiersin.org/people/1296449/overview
https://www.intechopen.com/profiles/158295
Reviewer bio
Dr Anny Manrich PhD is a food Engineer with expertise in Food Technology, Natural Polymers, Edible Films, Enzymes, and Nanotechnology. She writes and reviews content on these topics.
Dr Anny Manrich’s Highlights:
- Research and Technology at the Brazilian Agricultural Research Corporation
- PhD in Chemical Engineering with a focus on Biochemistry at the Federal University of Sao Carlos/ Brazil and a one-year scholarship at the Technical University of Munich/ Germany
- Bachelor of Food Engineering at the University of Campinas/ Brazil and a one-year scholarship at the Technical University of Munich/ Germany
“To solve a problem, global vision and multifactorial understanding are necessary. Therefore, in addition to expertise, one should seek multidisciplinary thinking connected with science and reality” – Dr Anny Manrich, PhD.
Professional Experience:
Dr Anny Manrich’s Experience Joining the Brazilian Agricultural Research Corporation, as soon as she completed her doctorate,
Dr Anny Manrich has worked on several projects, including the more than three-year partnership project with BRF, a major food producer in Brazil. As a postdoctoral fellow.
Dr Anny Manrich has also contributed to several business consultancies and research projects of the National Nanotechnology Laboratory System in areas such as food technology, fibres, films and coatings and Nanotechnology; in a very determined way, having a great team relationship, being creative and committed.
Growing concerns about the safe introduction of nanomaterials into today’s life emphasises the need to create regulatory documentation in front of characterising, using and testing them. Dr Anny Manrich worked for two years on a characterization project for nanoscale materials, with the aim of exploring their possible health effects.
Despite not having specific academic training in packaging or polymeric films, Dr Anny Manrich works at the Brazilian Agricultural Research Corporation in areas of edible and biodegradable films produced from agricultural waste and in the development of films with greater resistance to water, having articles published in renowned scientific journals, which demonstrates her multidisciplinary understanding and creativity.
In addition, she worked for four years as a consultant to a food company to develop a line of snacks that are healthy and that add functional ingredients, physiologically active compounds that bring health benefits, made from fruits and vegetables, enabling diet improvement, disease prevention and reduction of nutritional deficiencies.
Dr Anny Manrich participated as a member of the examination board for two Master’s exams and one PhD exam at the Department of Chemical Engineering of the Federal University of São Carlos.
Education:
- 2001 Bachelor in Food Engineering at the State University of Campinas, Brazil
- 1999 One year scholarship at the Technical University of Munich
- 2004 Master in Chemical Engineering at the Federal University of São Carlos, Brazil
- 2012 PhD in Chemical Engineering at the Federal University of São Carlos, Brazil
- 2010 One year scholarship at the Technical University of Munich
The main publications of Dr. Anny Manrich are:
Articles
Manrich, A., Moreira, F. K., Otoni, C. G., Lorevice, M. V., Martins, M. A., & Mattoso, L. H. (2017). Hydrophobic edible films made up of tomato cutin and pectin. Carbohydrate Polymers, 164, 83-91.
Mendes, J. F., Norcino, L. B., Martins, H. H. A., Manrich, A., Otoni, C. G., Carvalho, E. E. N., … & Mattoso, L. H. C. (2020). Correlating emulsion characteristics with the properties of active starch films loaded with lemongrass essential oil. Food Hydrocolloids, 100, 105428.
Norcino, L. B., Mendes, J. F., Natarelli, C. V. L., Manrich, A., Oliveira, J. E., & Mattoso, L. H. C. (2020). Pectin films loaded with copaiba oil nanoemulsions for potential use as bio-based active packaging. Food Hydrocolloids, 106, 105862.
Manrich, Anny, et al. Immobilization of trypsin on chitosan gels: Use of different activation protocols and comparison with other supports. International Journal of Biological Macromolecules 43.1 (2008): 54-61.
Manrich, Anny; Komesu, Andrea ; Adriano, Wellington Sabino; Tardioli, Paulo Waldir ; Giordano, Raquel Lima Camargo . Immobilization and Stabilization of Xylanase by Multipoint Covalent Attachment on Agarose and on Chitosan Supports. Applied Biochemistry and Biotechnology, v. 161, p. 455-467, 2010.
Mendes, J. F., Martins, J. T., Manrich, A., Neto, A. S., Pinheiro, A. C. M., Mattoso, L. H. C., & Martins, M. A. (2019). Development and physical-chemical properties of pectin film reinforced with spent coffee grounds by continuous casting. Carbohydrate polymers, 210, 92-99..
Milessi, T. S., Kopp, W., Rojas, M. J., Manrich, A., Baptista-Neto, A., Tardioli, P. W., … & Giordano, R. L. (2016). Immobilization and stabilization of an endoxylanase from Bacillus subtilis (XynA) for xylooligosaccharides (XOs) production. Catalysis Today, 259, 130-139.
Mendes, J. F., Norcino, L. B., Manrich, A., Pinheiro, A. C. M., Oliveira, J. E., & Mattoso, L. H. C. (2020). Development, physical‐chemical properties, and photodegradation of pectin film reinforced with malt bagasse fibers by continuous casting. Journal of Applied Polymer Science, 137(39), 49178.
Mendes, J. F., Martins, J. T., Manrich, A., Luchesi, B. R., Dantas, A. P. S., Vanderlei, R. M., … & Martins, M. A. (2021). Thermo-physical and mechanical characteristics of composites based on high-density polyethylene (HDPE) e spent coffee grounds (SCG). Journal of Polymers and the Environment, 29, 2888-2900..
Mendes, J. F., Norcino, L. B., Martins, H. H., Manrich, A., Otoni, C. G., Carvalho, E. E. N., … & Mattoso, L. H. C. (2021). Development of quaternary nanocomposites made up of cassava starch, cocoa butter, lemongrass essential oil nanoemulsion, and brewery spent grain fibers. Journal of Food Science, 86(5), 1979-1996.
Manrich, A., Martins, M. A., & Mattoso, L. H. C. (2021). Manufacture and performance of peanut skin cellulose nanocrystals. Scientia Agricola, 79.
Nascimento, V. M., Manrich, A., Tardioli, P. W., de Campos Giordano, R., de Moraes Rocha, G. J., & Giordano, R. D. L. C. (2016). Alkaline pretreatment for practicable production of ethanol and xylooligosaccharides. Bioethanol, 2(1)..
Manrich, Anny, de Oliveira, J. E., Martins, M. A., & Mattoso, L. H. C. Physicochemical and Thermal Characterization of the Spirulina platensis. J. Agric. Sci. Technol. B, v. 10, p. 298-307, 2020.
Book Chapter
Terra, I. A. A., Aoki, P. H., Delezuk, J. A. D. M., Martins, M. A., Manrich, A., Silva, M. J., … & Miranda, P. B. (2022). Técnicas de Caracterização de Polímeros. Nanotecnologia Aplicada a Polímeros, 614.
Conference Papers
Ferreira, L. F., Luvizaro, L. B., Manrich, A., Martins, M. A., Júnior, M. G., & Dias, M. V. (2017). Comparação da estabilidade de suspensões poliméricas de amido/tocoferol e quitosana/tocoferol. In: CONGRESSO BRASILEIRO DE POLÍMEROS, 14., 2017, Águas de Lindóia, SP.
Manrich, A., Hubinger, S. Z., & Paris, E. C. (2017). Citotoxicidade causada por nanomateriais: avaliação do micronúcleo. In: WORKSHOP DA REDE DE NANOTECNOLOGIA APLICADA AO AGRONEGÓCIO, 9., 2017, São Carlos. Anais… São Carlos: Embrapa Instrumentação, 2017. p. 655-658.
Manrich, Anny, et al. Immobilization and Stabilization of Xylanase by multipoint covalent attachment on Glyoxyl Agarose Support. The 31st Symposium on Biotechnology for Fuels and Chemicals. 2009.
Manrich, Anny, et al. Application of immobilized xylanase on hydrolysis of soluble wood hemicelluloses after using microwave and organosolv pre-treatments. The 32nd Symposium on Biotechnology for Fuels and Chemicals. 2010.
You can view some of Dr Anny’s work below and links to her professional profile.
Research Gate: https://www.researchgate.net/profile/Anny-Manrich-2
Scopus: https://www.scopus.com/authid/detail.uri?authorId=23103497100
Google Scholar: https://scholar.google.com/citations?hl=en&user=Ea9qpr0AAAAJ
Linkedin: https://br.linkedin.com/in/anny-manrich-20693129
In this brief guide, we are going to answer the question “how likely is it to get Salmonella from raw eggs”. Moreover, we are going to discuss the health consequences of eating eggs contaminated with Salmonella and tips to reduce the risk of Salmonella infection from raw eggs.
How likely is it to get Salmonella from raw eggs?
The likelihood of getting salmonella from raw eggs varies depending on various factors (1). Here, we summarize some of the most important factors that influence the probability of getting Salmonella:
- Salmonella prevalence: Salmonella bacteria can be present in the intestines of healthy chickens, and some infected hens may transmit the bacteria to their eggs before the shells are formed (2).
The prevalence of Salmonella in eggs can vary, but it has been reduced significantly in many countries through improved farming practices, vaccination programs, and regulatory measures.
- Contamination risk: The risk of Salmonella contamination increases when eggs are laid by infected hens or come into contact with fecal matter containing the bacteria.
Factors such as unsanitary conditions, inadequate cleaning of eggs, and improper handling can contribute to contamination.
- Shell integrity: Salmonella can only penetrate the eggshell if it is contaminated on the outside. Eggs with intact and clean shells have a lower risk of Salmonella contamination compared to those with cracked or dirty shells.
- Temperature and storage: Proper refrigeration of eggs at or below 40°F (4°C) is crucial to inhibit the growth of Salmonella bacteria.
If eggs are stored at higher temperatures or left out at room temperature for extended periods, any existing Salmonella bacteria can multiply and increase the risk of infection (1).
- Consumption methods: Consuming raw or undercooked eggs, such as in dishes like homemade mayonnaise, raw cookie dough, or sunny-side-up eggs with runny yolks, increases the risk of contracting Salmonella (2).
Cooking eggs to an internal temperature of 160°F (71°C) kills Salmonella bacteria and reduces the risk of infection (3).
While the likelihood of getting Salmonella from raw eggs has been reduced in recent years, there is still a small risk involved. So you should always be careful and avoid eating raw eggs, especially if you find any sign of spoilage.
What are the health risks of eating a salmonella-contaminated raw egg?
Eating a Salmonella-contaminated raw egg can lead to salmonellosis, an infection causing symptoms such as diarrhea, abdominal pain, fever, nausea, and vomiting (1).
It can also result in dehydration, gastroenteritis, bacteremia (bacterial infection in the bloodstream), septicemia (severe bloodstream infection), and potentially long-term complications like reactive arthritis or post-infectious irritable bowel syndrome (4).
Proper cooking of eggs is therefore crucial to eliminate Salmonella bacteria and reduce the health risks associated with raw egg consumption.
How long do symptoms of Salmonella poisoning take to appear?
According to the FDA, the symptoms of Salmonella poisoning appear 12 to 72 hours after the consumption of the contaminated food (5).
When do you need to see a doctor after eating eggs contaminated with Salmonella?
In the case of kids
You need to see a doctor if the symptoms include
- Diarrhea that does not go away after one day.
- Vomiting for more than 12 hours in newborns, 1 day in children under the age of 2, or 2 days in other children.
- Dehydration symptoms include not urinating for three hours or longer, having dry lips or tongue, and crying without tears.
- Fever of more than 102 degrees Fahrenheit (39 degrees Celsius).
- Bloody stools
In the case of adults
You need to see a doctor if your symptoms include
- Diarrhea that persists after two days.
- Vomiting that lasts more than two days-
- Dehydration symptoms include little or no urination, severe thirst, a very dry mouth, dizziness or lightheadedness, and urine that is very black.
- Fever of more than 102 degrees Fahrenheit (39 degrees Celsius).
- Bloody stools
How to reduce the chances of getting Salmonella infection from eggs?
You should consider the following tips while buying and storing eggs to reduce the chances of Salmonella infections to some extent:
- Do not buy eggs that have cracks in them.
- It is better to buy pasteurized eggs and egg products (6.).
- The eggs should be refrigerated promptly at about 40 degrees Fahrenheit.
- Cook egg dishes till they reach an internal temperature of 160 degrees Fahrenheit or above (3).
- Make sure that the foods that contain raw or lightly cooked eggs such as tiramisu, hollandaise sauce, etc. should be made using pasteurized eggs.
- Refrigerate the cooked eggs or the foods containing eggs promptly. Never leave cooked eggs or products containing eggs for more than 2 hours at room temperature (1 hour if the outside temperature is 90 degrees Fahrenheit or above).
- Wash hands, the utensils, and the kitchen counter that comes in contact with raw eggs.
- Do not taste or eat any uncooked dough or batter containing raw eggs, such as cookie dough or cake mix. Before consuming, bake uncooked dough and batter.
Conclusion:
In this brief guide, we are going to answer the question “how likely is it to get Salmonella from raw eggs”. Moreover, we are going to discuss the health consequences of eating eggs contaminated with Salmonella and tips to reduce the risk of Salmonella infection from raw eggs.
References:
1. Whiley H, Ross K. Salmonella and Eggs: From Production to Plate. Int J Environ Res Public Heal 2015, Vol 12, Pages 2543-2556 [Internet]. 2015 Feb 26 [cited 2023 Jun 19];12(3):2543–56. Available from: https://www.mdpi.com/1660-4601/12/3/2543
2. Cardoso MJ, Nicolau AI, Borda D, Nielsen L, Maia RL, Møretrø T, et al. Salmonella in eggs: From shopping to consumption—A review providing an evidence-based analysis of risk factors. Compr Rev Food Sci Food Saf [Internet]. 2021 May 1 [cited 2023 Jun 19];20(3):2716–41. Available from: https://ift.onlinelibrary.wiley.com/doi/full/10.1111/1541-4337.12753
3. Juneja VK, Huang L, Yan X. Thermal inactivation of foodborne pathogens and the USDA pathogen modeling program. J Therm Anal Calorim [Internet]. 2011 Apr 1 [cited 2023 May 3];106(1):191–8. Available from: https://akjournals.com/view/journals/10973/106/1/article-p191.xml
4. Cremon C, Stanghellini V, Pallotti F, Fogacci E, Bellacosa L, Morselli-Labate AM, et al. Salmonella Gastroenteritis During Childhood Is a Risk Factor for Irritable Bowel Syndrome in Adulthood. Gastroenterology [Internet]. 2014 Jul 1 [cited 2023 Jun 19];147(1):69–77. Available from: https://www.sciencedirect.com/science/article/abs/pii/S001650851400362X
5. Milaciu M V, Ciumărnean L, Orășan OH, Para I, Alexescu T, Negrean V. Semiology of food poisoning. Int J Bioflux Soc [Internet]. 2015 [cited 2023 May 10];8(2):108–13. Available from: http://hvm.bioflux.com.ro/docs/2015.108-113.pdf
6. Stadelman WJ, Singh RK, Muriana PM, Hou H. Pasteurization of Eggs in the Shell. Poult Sci [Internet]. 1996 Sep 1 [cited 2023 Jun 19];75(9):1122–5. Available from: https://www.sciencedirect.com/science/article/pii/S0032579119443009
