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        Genomics Precision Diagnostic > Prenatal > Oligohydramnios Precision Panel

        Oligohydramnios Precision Panel

        Oligohydramnios is defined as an abnormally low volume of amniotic fluid. Amniotic fluid is crucial for fetal development and growth, serving the foetus as protection from trauma and infection as well as helping in the development of fetal lungs.
        Overview
        Indication
        Clinical Utility
        Genes & Diseases
        Methodology
        References

        Overview

        • Oligohydramnios is defined as an abnormally low volume of amniotic fluid. Amniotic fluid is crucial for fetal development and growth, serving the foetus as protection from trauma and infection as well as helping in the development of fetal lungs. Normal amniotic fluid varies, on average it can reach up to 800-1000mL. An excess of amniotic fluid is termed polyhydramnios, decreased amniotic fluid is oligohydramnios. It occurs in approximately 11% of all pregnancies. Causes of oligohydramnios include rupture of membranes, fetal urinary tract blockage (renal agenesis, posterior urethral valves or polycystic kidney disease) which can have a genetic background associated with other genetic conditions. The mortality is high, especially if it is diagnosed during the first trimester as it can increase the risk for chest wall fixation and pulmonary hypoplasia.  

        • The Igenomix Oligohydramnios Precision Panel can be used to make a directed and accurate differential diagnosis of oligohydramnios and uncover the genetics underlying this clinical sign ultimately leading to a better management and achieve a healthy baby at home. It provides a comprehensive analysis of the genes involved in this disease using next-generation sequencing (NGS) to fully understand the spectrum of relevant genes involved.  

        Indication

        • The Igenomix Oligohydramnios Precision Panel is indicated for those patients with clinical and ultrasound findings of oligohydramnios presenting with: 
          • Abdominal discomfort 
          • Amniotic fluid index < 7cm 
          • Fetal structure survey revealing congenital abnormalities

        Clinical Utility

        The clinical utility of this panel is: 

        • The genetic and molecular confirmation for an accurate clinical diagnosis of a symptomatic patient.  
        • Early initiation of treatment with a multidisciplinary team for hospitalization and obstetric management in case of preterm delivery and provide adequate hydration. 
        • Risk assessment of asymptomatic family members according to the mode of inheritance. 

        Genes & Diseases

        See all genes and diseases

        GENE 

        OMIM DISEASES 

        INHERITANCE* 

        % GENE COVERAGE 

        HGMD** 

        ACE 

        Renal Tubular 
        Dysgenesis 

        AR 

        88.42 

        40 of 44 

        AGT 

        Essential Hypertension,
        Renal Tubular 
        Dysgenesis 

        AR,MU 

        100 

        16 of 18 

        AGTR1 

        Essential Hypertension,
        Renal Tubular 
        Dysgenesis 

        AR,MU 

        100 

        8 of 8 

        ALB 

        Congenital Analbuminemia 

        AR 

        100 

        41 of 41 

        ALG8 

        Congenital Disorder Of
        Glycosylation Type 
        Ih,
        Polycystic Liver Disease
        With Or Without Kidney
        Cysts
         

        AD,AR 

        99.5 

        22 of 22 

        ALG9 

        Congenital Disorder Of
        Glycosylation, Type Il,
        Polycystic Kidney Disease
        Potter Type I,
        With 
        Microbrachycephaly,
        Hypertelorism And 
        Brachymelia 

        AR 

        99.99 

        6 of 6 

        ALX4 

        Craniosynostosis, Enlarged 
        Parietal 
        Foramina, 
        Frontonasal 
        Dysplasia-Alopecia-Genital
         
        Anomalies Syndrome,
         
        Isolated Scaphocephaly,
        Potocki-Shaffer 
        Syndrome 

        AD,AR 

        99.94 

        25 of 25 

        AMER1 

        Osteopathia Striata With
        Cranial Sclerosis Syndrome
         

        X,XD,G 

        99.45 

        NA of NA 

        ASCL1 

        Congenital Failure of
        Autonomic Control,
        Haddad Syndrome
         

        AD 

        97.86 

        1 of 4 

        ATRX 

        Alpha-Thalassemia 
        Myelodysplasia Syndrome,
        Mental 
        Retardation-Hypotonic
         Facies Syndrome, 
        Carpenter-Waziri Syndrome,
         
        Chudley-Lowry-Hoar Syndrome,
        Holmes-
        Gang Syndrome, 
        Juberg-Marsidi Syndrome,
        Smith-
        Fineman-Myers Syndrome 

        X,XR,XD,G 

        98.5 

        NA of NA 

        B9D1 

        Joubert Syndrome,
        Meckel Syndrome
         

        AR 

        90.23 

        11 of 11 

        B9D2 

        Meckel Syndrome 

        AR 

        84.81 

        4 of 5 

        BMPER 

        Diaphanospondylodysostosis 

        AR 

        99.98 

        22 of 22 

        BNC2 

        Congenital Lower
        Urinary
        Tract Obstruction,
        Posterior Urethral Valve
         

        AD 

        98.85 

        14 of 14 

        BRCA1 

        Fanconi Anemia
         
        Complementation
         Group S 

        AD,AR,MU 

        98.97 

        2783 of 2894 

        BRCA2 

        Fanconi Anemia 
        Complementation Group D1,
         
        Medulloblastoma,
        Wilms Tumor, 
        Nephroblastoma 

        AD,AR,MU 

        98.51 

        3343 of 3451 

        BRIP1 

        Fanconi Anemia 
        Complementation Group J 

        AD,AR 

        94.97 

        235 of 237 

        BUB1B 

        Mosaic Variegated 
        Aneuploidy Syndrome 

        AD,AR 

        99.84 

        30 of 31 

        C1QBP 

        Combined Oxidative
        Phosphorylation Deficiency
         

        AR 

        99.89 

        6 of 6 

        CC2D2A 

        Coach Syndrome,
        Joubert Syndrome,
        Meckel Syndrome,
         

        AR 

        99.43 

        98 of 100 

        CEP290 

        Bardet-Biedl Syndrome,
        Joubert Syndrome,
        Leber Congenital Amaurosis,
        Meckel Syndrome,
        Senior-
        Loken Syndrome 

        AR 

        96.47 

        293 of 327 

        CEP55 

        Anhydramnios,
        Renal
        Dysplasia,
         
        Cerebellar Hypoplasia 
        And 
        Hydranencephaly,
        Meckel 
        Syndrome 

        AR 

        99.22 

        3 of 3 

        CERT1 

        Autosomal
        Dominant Mental
        Retardation
         

        AD 

        99.98 

        8 of 8 

        CHRM3 

        Absence of Abdominal
        Muscles With Urinary
        Tract Abnormality And
        Cryptorchidism,
        Prune Belly Syndrome
         

        AR 

        99.8 

        4 of 4 

        CLTCL1 

         

         

        100 

        22 of 22 

        COG5 

        Congenital Disorder
        Of Glycosylation Type III
         

        AR 

        100 

        19 of 19 

        COQ2 

        Coenzyme Q10 Deficiency,
        Multiple System Atrophy,
        Leigh Syndrome With
        Nephrotic Syndrome
         

        AD,AR 

        99.61 

        37 of 38 

        COQ7 

        Primary Coenzyme Q10
         
        Deficiency 

        AR 

        99.71 

        6 of 6 

        CPT2 

        Carnitine Palmitoyltransferase 
        II 
        Deficiency 

        AD,AR 

        99.99 

        116 of 116 

        CSPP1 

        Joubert Syndrome,
        Meckel 
        Syndrome 

        AR 

        98.32 

        29 of 30 

        DHPS 

        Neurodevelopmental
        Disorder With Seizures
        And Speech And Walking
        Impairment
         

        AR 

        99.85 

        4 of 4 

        DOCK6 

        Adams-Oliver Syndrome 

        AR 

        98.06 

        37 of 37 

        DONSON 

        Microcephaly-Micromelia
         
        Syndrome 

        AR 

        98.14 

        26 of 27 

        EFEMP2 

        Autosomal Recessive
         Cutis Laxa 

        AR 

        99.99 

        17 of 17 

        ERCC4 

        Fanconi Anemia 
        Complementation Group Q,
        Xeroderma Pigmentosum
        Complementation Group F,
        Progeroid Syndrome,
        Cockayne Syndrome Type 1
         

        AR 

        99.68 

        69 of 72 

        ERGIC1 

        Arthrogryposis Multiplex 
        Congenita 

        AR 

        100 

        2 of 2 

        EXOSC9 

        Pontocerebellar Hypoplasia
         Type 1d 

        AR 

        99.86 

        2 of 2 

        FANCA 

        Fanconi Anemia 

        AR 

        95.17 

        497 of 502 

        FANCB 

        Fanconi Anemia 
        Complementation Group B, 
        Vacterl Association With
        Hydrocephalus
         

        X,XR,G 

        95.53 

        NA of NA 

        FANCC 

        Fanconi Anemia
        Complementation Group C
         

        AR 

        100 

        75 of 75 

        FANCD2 

        Fanconi Anemia
        Complementation Group D2
         

        AR 

        100 

        62 of 63 

        FANCE 

        Fanconi Anemia
        Complementation Group E
         

        AR 

        97 

        17 of 18 

        FANCF 

        Fanconi Anemia
        Complementation Group F
         

        AR 

        99.31 

        17 of 18 

        FANCG 

        Fanconi Anemia
        Complementation Group G
         

         

        100 

        94 of 94 

        FANCI 

        Fanconi Anemia
        Complementation Group I
         

        AR 

        100 

        53 of 54 

        FANCL 

        Fanconi Anemia
        Complementation Group L
         

        AR 

        100 

        25 of 26 

        FANCM 

        Fanconi Anemia,
        Male Infertility With
        Azoospermia Or 
        Oligozoospermia 
        Due To Single Gene
        Mutation
         

        AR 

        99.73 

        59 of 61 

        FARSB 

        Rajab Interstitial Lung
        Disease With Brain
        Calcifications
         

        AR 

        99.94 

        4 of 4 

        FBLN5 

        Autosomal Dominant
        and Recessive Cutis 
        Laxa 

        AD,AR 

        97.43 

        23 of 23 

        FBN1 

        Acromicric Dysplasia,
        Ectopia 
        Lentis,
        Geleophysic Dysplasia,
        Marfan 
        Lipodystrophy
         Syndrome,
        Marfan 
        Syndrome,
         
        Mass Syndrome, 
        Stiff Skin Syndrome,
        Weill-
        Marchesani Syndrome, 
        Shprintzen-Goldberg Syndrome 

        AD 

        100 

        2836 of 2845 

        FGF20 

        Bilateral Renal
         
        Hypodysplasia/Aplasia 

        AR 

        99.76 

        2 of 2 

        GATA6 

        Atrial Septal Defect,
        Atrioventricular Septal Defect,
         
        Conotruncal Heart
        Malformations,
        Truncus Arteriosus Communis,
        Pancreatic Agenesis
        And Congenital
        Heart Defects, Tetralogy Of Fallot
         

        AD,AR 

        84.19 

        66 of 84 

        GLI3 

        Greig Cephalopolysyndactyly
        Syndrome, Congenital
        Hypothalamic Hamartoma
        Syndrome, Pallister-Hall
        Syndrome, 
        Acrocallosal 
        Syndrome
         

        AD,AR 

        100 

        231 of 231 

        GMPPB 

        Muscular
        Dystrophy-Dystroglycanopathy
        (Congenital With Brain
        And 
        Eyeanomalies),
        Congenital Muscular
        Dystrophy With Cerebellar
        Involvement, Congenital
        Myasthenic Syndromes
        With Glycosylation Defect,
        Limb-Girdle Muscular
        Dystrophy,
        Muscle-Eye-Brain Disease
         

        AR 

        99.95 

        53 of 53 

        GNPTAB 

        Mucolipidosis II Alpha/Beta,
        Mucolipidosis III Alpha/Beta 

        AR 

        100 

        279 of 280 

        GREB1L 

        Bilateral Renal 
        Hypodysplasia/Aplasia 

        AD 

        97.94 

        41 of 41 

        HBA1 

        Alpha-thalassemia,
        Heinz Body 
        Anemia,
         
        Hemoglobin H Disease,
        Hb Bart’s Hydrops Fetalis
         

        AD 

        98.87 

        125 of 152 

        HBA2 

        Alpha-thalassemia,
        Heinz Body
        Anemias,
        Hemoglobin H Disease,
        Hb Bart’s Hydrops Fetalis
         

        AD 

        74.46 

        118 of 231 

        HNF1B 

        Noninsulin-Dependent
        Diabetes Mellitus,
        Renal Cysts And Diabetes
        Syndrome, Hnf1b-Related
        Autosomal Dominant
        Tubulointerstitial Kidney
        Disease
         

        AD 

        100 

        219 of 220 

        HSPA9 

        Sideroblastic Anemia,
        Even-Plus Syndrome
         

        AD,AR 

        99.72 

        14 of 14 

        HYMAI 

        Transient Neonatal
        Diabetes Mellitus,
        Paternal Uniparental
         
        Disomy Of Chromosome 

        AD 

        na 

        na 

        INVS 

        Nephronophthisis,
        Senior-
        Loken Syndrome 

        AR 

        99.9 

        38 of 38 

        ITGA8 

        Bilateral Renal 
        Hypodysplasia/Aplasia 

        AR 

        99.68 

        7 of 7 

        KIF14 

        Meckel Syndrome,
        Autosomal Recessive
        Primary Microcephaly
         

        AR 

        99.84 

        18 of 18 

        LARS2 

        Hydrops, Lactic Acidosis,
        And Sideroblastic 
        Anemia,
        Perrault Syndrome
         

        AR 

        99.99 

        20 of 20 

        LHX1 

        17q12 Microdeletion
         Syndrome 

         

        100 

        6 of 6 

        LIFR 

        Stuve-Wiedemann
         Syndrome 

        AR 

        99.81 

        33 of 33 

        MAD2L2 

        Fanconi Anemia
        Complementation Group V
         

        AR 

        99.91 

        1 of 1 

        MBTPS2 

        Ichthyosis Follicularis,
        Atrichia, And Photophobia
        Syndrome, Keratosis
        Follicularis Spinulosa 
        Decalvans, Osteogenesis
        Imperfecta, Type XIX,
         
        Bresek Syndrome 

        X,XR,G 

        100 

        NA of NA 

        MKS1 

        Bardet-Biedl Syndrome,
        Joubert Syndrome,
        Meckel Syndrome
         

        AR 

        99.98 

        49 of 49 

        MYH3 

        Arthrogryposis, Contractures,
        Pterygia And 
        Spondylocarpostarsal
         Fusion Syndrome, 
        Digitotalar Dysmorphism,
        Freeman-Sheldon Syndrome,
        Sheldon-Hall Syndrome
         

        AD,AR 

        100 

        46 of 47 

        NALCN 

        Congenital Contractures
        Of The Limbs And Face,
        Hypotonia, And Developmental
        Delay, 
        Digitotalar Dysmorphism,
        Freeman-Sheldon Syndrome
         

        AD,AR 

        99.97 

        69 of 69 

        NEK8 

        Nephronophthisi,
        Renal-Hepatic-Pancreatic Dysplasia
         

        AR 

        100 

        24 of 24 

        NEK9 

        Arthrogryposis,
        Perthes Disease,
        And Upward Gaze Palsy,
        Lethal Congenital
        Contracture Syndrome
         

        AR 

        99.98 

        4 of 4 

        NPHP3 

        Meckel Syndrome,
        Nephronophthisis,
        Renal-Hepatic-Pancreatic
        Dysplasia ,
        NPHP3-Related
        Meckel-like Syndrome,
        Senior-
        Loken Syndrome 

        AR 

        99.99 

        84 of 84 

        OSGEP 

        Galloway-Mowat Syndrome 

        AR 

        99.17 

        19 of 19 

        PALB2 

        Fanconi Anemia
         
        Complementation Group N 

        AD,AR 

        98.78 

        601 of 617 

        PBX1 

        Congenital Anomalies
        Of Kidney And Urinary
        Tract Syndrome With Or
        Without Hearing Loss,
        Abnormal Ears, Or
        Developmental Delay
         

        AD 

        98 

        18 of 18 

        PDSS2 

        Coenzyme Q10 Deficiency,
        Leigh Syndrome With
        Nephrotic Syndrome
         

        AR 

        99.99 

        6 of 6 

        PGAP2 

        Hyperphosphatasia With
        Mental Retardation
        Syndrome
         

        AR 

        99.99 

        11 of 11 

        PGAP3 

        Hyperphosphatasia With
        Mental Retardation Syndrome
         

        AR 

        97 

        19 of 20 

        PHOX2B 

        Congenital Failure of
        Autonomic Control,
        Neuroblastoma With
        Hirschsprung Disease,
        Haddad Syndrome, 
        Ondine Syndrome 

        AD 

        90.74 

        58 of 71 

        PIGL 

        Zunich Neuroectodermal
        Syndrome, Chime Syndrome, 
        Hyperphosphatasia-Intellectual
        Disability Syndrome
         

        AR 

        86 

        11 of 13 

        PIGO 

        Hyperphosphatasia 
        With Mental Retardation
        Syndrome
         

        AR 

        99.93 

        21 of 21 

        PIGV 

        Hyperphosphatasia
         With Mental Retardation 

        AR 

        99.99 

        16 of 16 

        PIGW 

        Hyperphosphatasia 
        With Mental
        Retardation Syndrome
         

        AR 

        99.52 

        6 of 6 

        PIGY 

        Hyperphosphatasia 
        With Mental
        Retardation Syndrome
         

        AR 

        100 

        1 of 2 

        PKHD1 

        Autosomal Recessive
        Polycystic Kidney Disease
         

        AR 

        99.97 

        582 of 585 

        PLAGL1 

        Paternal Uniparental 
        Disomy Of Chromosome 

         

        95.56 

        2 of 2 

        POR 

        Antley-Bixler Syndrome
        With Genital Anomalies
        And Disordered Steroidogenesis,
        Congenital Adrenal Hyperplasia
        Due To Cytochrome P450
        Oxidoreductase Deficiency
         

        AD,AR 

        99.98 

        67 of 68 

        PUF60 

        Verheij Syndrome, 8q24.3
        Microdeletion Syndrome,
        Intellectual Disability-Cardiac
        Anomalies-Short Stature-Joint
        Laxity Syndrome
         

        AD 

        100 

        30 of 30 

        RAD51 

        Fanconi Anemia Complementation
         Group R, Familial
         Congenital Mirror Movements 

        AD 

        99.98 

        16 of 16 

        RAD51C 

        Fanconi Anemia 
        Complementation Group O 

        AR 

        100 

        130 of 130 

        REN 

        Familial Juvenile 
        Hyperuricemic Nephropathy,
        Renal Tubular
        Dysgenesis 

        AD,AR 

        100 

        23 of 23 

        RET 

        Congenital Failure of
        Autonomic Control,
        Hirschsprung Disease,
        Haddad Syndrome,
        Hirschsprung Disease,
        Bilateral Renal Agenesis
         

        AD 

        100 

        453 of 454 

        RFWD3 

        Fanconi Anemia
        Complementation Group W
         

        AR 

        99.99 

        2 of 2 

        RNU4ATAC 

        Lowry-Wood Syndrome,
        Microcephalic 
        Osteodysplastic
         Primordial Dwarfism Type I, 
        Roifman Syndrome 

        AR 

        na 

        na 

        RPGRIP1 

        Cone-Rod Dystrophy, 
        Leber Congenital Amaurosis,
        Meckel 
        Syndrome 

        AR 

        99.33 

        146 of 159 

        RPGRIP1L 

        Coach Syndrome,
        Meckel Syndrome,
        Joubert Syndrome
        With Renal Defect,
        Meckel Syndrome
         

        AR 

        99.96 

        52 of 52 

        SEC24D 

        Cole-Carpenter 
        Syndrome 

        AR 

        99.97 

        14 of 14 

        SLC25A24 

        Fontaine Progeroid
        Syndrome, 
        Gorlin-Chaudhry-Moss
        Syndrome
         

        AD 

        99.59 

        2 of 2 

        SLX4 

        Fanconi Anemia
        Complementation Group P
         

        AR 

        99.92 

        76 of 76 

        TALDO1 

        Transaldolase Deficiency 

        AR 

        95 

        13 of 14 

        TBCK 

        Infantile Hypotonia
        With Psychomotor
        Retardation And
        Characteristic Facies
         

        AR 

        99.95 

        15 of 15 

        TCTN2 

        Joubert Syndrome,
        Meckel Syndrome
         

        AR 

        100 

        14 of 14 

        TCTN3 

        Joubert Syndrome, 
        Orofaciodigital 
        Syndrome IV,
         
        Orofaciodigital
         Syndrome Type VI 

        AR 

        99.99 

        13 of 13 

        TMEM107 

        Meckel Syndrome,
        Orofaciodigital
        Syndrome XVI,
        Meckel Syndrome
         

        AR 

        100 

        3 of 3 

        TMEM216 

        Meckel Syndrome,
        Joubert Syndrome With Oculorenal Defect,
         
        Orofaciodigital
         Syndrome Type VI 

        AR 

        98.74 

        8 of 8 

        TMEM231 

        Meckel Syndrome,
        Joubert Syndrome
        With Oculorenal
        Defect, 
        Orofaciodigital
        Syndrome
        Type III
         

        AR 

        98.63 

        20 of 21 

        TMEM67 

        Bardet-Biedl Syndrome,
        Coach Syndrome,
        Joubert Syndrome,
        Meckel Syndrome,
        Nephronophthisis,
         
        Rhyns Syndrome 

        AR 

        96.93 

        177 of 179 

        TMEM70 

        Mitochondrial Complex V (ATP  Synthase) 
        Deficiency, TMEM70-Related Mitochondrial 
        Encephalo-Cardio-Myopathy 

        AR 

        100 

        22 of 24 

        TRIP4 

        Congenital Muscular
        Dystrophy,
        Spinal Muscular
        Atrophy With
        Congenital Bone
        Abnormalities
         

        AR 

        99.92 

        3 of 3 

        UBE2A 

        X-linked Syndromic Mental Retardation 

        X,XR,G 

        99.99 

        NA of NA 

        UBE2T 

        Fanconi Anemia
        Complementation Group T
         

        AR 

        100 

        4 of 4 

        WDPCP 

        Bardet-Biedl
        Syndrome,
        Congenital Heart
        Defects, Hamartomas
        Of Tongue, And
        Polysyndactyly,
        Meckel Syndrome
         

        AR 

        99.3 

        8 of 8 

        WDR73 

        Galloway-Mowat Syndrome,
        Camos Syndrome
         

        AR 

        95.71 

        14 of 14 

        WNT4 

        46,XX Sex Reversal With
        Dysgenesis Of Kidneys,
        Adrenals, And Lungs,
        Mullerian Aplasia And Hyperandrogenism,
         
        Serkal Syndrome 

        AD,AR 

        100 

        8 of 8 

        XRCC2 

        Fanconi Anemia 
        Complementation Group U 

        AR 

        98.39 

        28 of 28 

        * Inheritance: AD: Autosomal Dominant; AR: Autosomal Recessive; X: X linked; XLR: X linked Recessive; Mi: Mitochondrial; Mu: Multifactorial 

        ** HGMD: Number of clinically relevant mutations according to HGMD

        Methodology

        References

        See scientific referrals

        Dias, T., Sairam, S., & Kumarasiri, S. (2014). Ultrasound diagnosis of fetal renal abnormalities. Best practice & research. Clinical obstetrics & gynaecology, 28(3), 403–415. https://doi.org/10.1016/j.bpobgyn.2014.01.009 

        Gimpel, C., Avni, F. E., Bergmann, C., Cetiner, M., Habbig, S., Haffner, D., König, J., Konrad, M., Liebau, M. C., Pape, L., Rellensmann, G., Titieni, A., von Kaisenberg, C., Weber, S., Winyard, P., & Schaefer, F. (2018). Perinatal Diagnosis, Management, and Follow-up of Cystic Renal Diseases: A Clinical Practice Recommendation With Systematic Literature Reviews. JAMA pediatrics, 172(1), 74–86. https://doi.org/10.1001/jamapediatrics.2017.3938 

        Sahin, E., Madendag, Y., Tayyar, A., Sahin, M., Col Madendag, I., & Acmaz, G. et al. (2017). Perinatal outcomes in uncomplicated late preterm pregnancies with borderline oligohydramnios. The Journal Of Maternal-Fetal & Neonatal Medicine, 31(23), 3085-3088. doi: 10.1080/14767058.2017.1364722 

        Magann, E., Haas, D., Hill, J., Chauhan, S., Watson, E., & Learman, L. (2011). Oligohydramnios, Small for Gestational Age and Pregnancy Outcomes: An Analysis Using Precise Measures. Gynecologic And Obstetric Investigation, 72(4), 239-244. doi: 10.1159/000324570 

        Leung J. C. (2014). Inherited renal diseases. Current pediatric reviews, 10(2), 95–100. https://doi.org/10.2174/157339631002140513101755 

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