Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

[Shiloh]

Source: http://www.greaterkashmir.com/news/2...village-55.asp

Mysterious disease outbreak in Kupwara village
8 Children Disabled In One Month
SHAHID RAFIQ

Tumina (Kupwara), Mar 13: At least eight children in this frontier village, about 32 kms from Kupwara, have been disabled in past one month due to outbreak of a mysterious disease.
Residents of snowbound Tumina village nestled in Shamsbari mountain range are finding it hard to tackle the crisis as more and more children are getting disabled with each passing day. ?Doctors are unable to diagnose the disease properly and treat the patients. People are making rounds of SKIMS and other medical institutions but to no avail,? parents of two patients told Greater Kashmir.
They said their children are unable to speak and it seems that their nervous system, liver, eyes and brain have got affected.
Similarly parents of three other children said, ?Hands and feet of our children have started bending and their arms and legs have stopped working as a result they are unable to stand, work and eat.?
Parents said they have been running from pillar to post to get their children treated but doctors are unable to treat them. ?We rushed these patients to SKIMS Soura. Doctors told us to get some tests done but technicians at SKIMS expressed their inability saying that there are no facilities in the hospital for these tests,? said Farooq Ahmad a parent, adding, ?Our children have been badly hit by this mysterious disease. Authorities are not paying any heed towards our plight...?

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village

Health Services team visits Tumina, Kupwara
3/14/2012 7:18:54 PM
KUPWARA, Mar 14: A team from Directorate of Health Services, Kashmir visited the Tumina village of Kupwara district where from a child was diagnosed with Wilson?s disease, a genetic disorder, at SKIMS, Soura. The Chief Medical Officer, Kupwara reported few other children suffering the similar symptoms and the Director, Health Services, Kashmir sent a team from IDSP/Epidemiology, Srinagar to the affected area.

The team examined the patients and interacted with their parents and other villagers.

The team collected blood samples from the patients besides, collecting samples from local tube wells for relevant tests.
...

http://www.tninews.com/newsdet.aspx?q=56004

What is Wilson disease?
Wilson disease is a genetic disorder that prevents the body from getting rid of extra copper. A small amount of copper obtained from food is needed to stay healthy, but too much copper is poisonous. In Wilson disease, copper builds up in the liver, brain, eyes, and other organs. Over time, high copper levels can cause life-threatening organ damage.

Who gets Wilson disease?
People who get Wilson disease inherit two abnormal copies of the ATP7B gene, one from each parent. Wilson disease carriers, who have only one copy of the abnormal gene, do not have symptoms. Most people with Wilson disease have no known family history of the disease. A person's chances of having Wilson disease increase if one or both parents have it.
About one in 40,000 people get Wilson disease.1 It equally affects men and women. Symptoms usually appear between ages 5 to 35, but new cases have been reported in people aged 2 to 72 years.
1 Olivarez M, Caggana M, Pass KA, Ferguson P, Brewer GJ. Estimate of the frequency of Wilson's disease in the US Caucasian population: a mutation analysis approach. Annals of Human Genetics. 2001;65:459?463.

What causes Wilson disease?
Wilson disease is caused by a buildup of copper in the body. Normally, copper from the diet is filtered out by the liver and released into bile, which flows out of the body through the gastrointestinal tract. People who have Wilson disease cannot release copper from the liver at a normal rate, due to a mutation of the ATP7B gene. When the copper storage capacity of the liver is exceeded, copper is released into the bloodstream and travels to other organs?including the brain, kidneys, and eyes.

What are the symptoms of Wilson disease?
Wilson disease first attacks the liver, the central nervous system, or both.
A buildup of copper in the liver may cause ongoing liver disease. Rarely, acute liver failure occurs; most patients develop signs and symptoms that accompany chronic liver disease, including
swelling of the liver or spleen
jaundice, or yellowing of the skin and whites of the eyes
fluid buildup in the legs or abdomen
a tendency to bruise easily
fatigue

A buildup of copper in the central nervous system may result in neurologic symptoms, including
problems with speech, swallowing, or physical coordination
tremors or uncontrolled movements
muscle stiffness
behavioral changes

Other signs and symptoms of Wilson disease include
anemia
low platelet or white blood cell count
slower blood clotting, measured by a blood test
high levels of amino acids, protein, uric acid, and carbohydrates in urine
premature osteoporosis and arthritis
Kayser-Fleischer rings result from a buildup of copper in the eyes and are the most unique sign of Wilson disease. They appear in each eye as a rusty-brown ring around the edge of the iris and in the rim of the cornea. The iris is the colored part of the eye surrounding the pupil. The cornea is the transparent outer membrane that covers the eye.

...

http://digestive.niddk.nih.gov/ddiseases/pubs/wilson/

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease

Health Services team visit Kupwara

...
The water samples were tested at Public Health Laboratory, IDPS, Barzulla and at Public Health Engineering Lab at Zainakote. However, the tests revealed higher led content in water while copper content in water was found within permissible limits,? the spokesman said.
The team advised the locals to use boiled water only.

http://www.greaterkashmir.com/news/2012/Mar/15/health-services-team-visit-kupwara-41.asp

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease

Wilson disease is genetic and causes a buildup of copper, not lead. It is likely that these children are also experiencing lead poisoning with lead levels in the drinking water at 50 times permissible levels. - Ro


Wilson?s disease disables 8 children in Kupwara village
Published:3/15/2012 1:00:00 PMUpdated: 3/15/2012 11:05:36 AMBy: SHABIR IBN YUSUF Filed Under: srinagar

SRINAGAR, Mar 15: Wilson?s disease outbreak has rendered eight children disabled and a dozen are also in grip in Tumina Chowkibal village of frontier district of Kupwara. Administration says they are tackling the issue and said the disease has been caused by drinking water of bore wells in the area.
According to the residents, the hands and feet of these eight children have been deformed and their arms and legs have stopped working as a result they are unable to stand, work and eat. They said their children are unable to speak and it seems that their nervous system, liver, eyes and brain have been affected.
The disease has also attacked dozen children and their body parts have stopped normal functioning.
...

The cases were reported to health authorities in the last week of February and a team of doctors visited the village. They took the water samples from the bore wells and blood samples of the affected children and their parents.
The doctors have got water tested and it has been found that there is heavy presence lead in the water that the villagers are taking. According to officials of health department, there were 2.5 points of lead and in normal water it must not exceed to 0.05 points.
...
The officials alleged that the water has not been tested by the PHE department before digging the bore wells. ?Excessive lead in body has affected the growth of cells and it has paralyzed the normal function of body parts,? said a senior doctor who visited the village. ?The villagers have been asked not to take the bore well water and water of Khmel that passes near the village.?
...

http://www.kashmirtimes.com/news.aspx?ndid=30766&ct=srinagar

[alert]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

Can we send something to ProMED here? They just unleashed:

http://www.promedmail.org/

Published Date: 2012-03-16 12:50:26
Subject: PRO> Undiagnosed illness, children - India (JK) RFI
Archive Number: 20120316.1072361

UNDIAGNOSED ILLNESS, CHILDREN - INDIA (JAMMU & KASHMIR) REQUEST FOR INFORMATION
************************************************** *****************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: Tue 13 Mar 2012
Source: Greater Kashmir [edited]

http://www.greaterkashmir.com/news/2012/Mar/14/mysterious-disease-outbreak-in-kupwara-village-55.asp

At least 8 children in [the frontier village of Tumina], about 32 km [20 mi] from Kupwara, have been disabled in the past one month due to an outbreak of a mysterious disease.

Residents of snowbound Tumina village nestled in Shamsbari mountain range are finding it hard to tackle the crisis as more and more children are getting disabled with each passing day. "Doctors are unable to diagnose the disease properly and treat the patients. People are making rounds of SKIMS [Sher-i-Kashmir Institute of Medical Sciences] and other medical institutions but to no avail," parents of 2 patients told Greater Kashmir.

They said their children are unable to speak and it seems that their nervous system, liver, eyes, and brain have got affected. Similarly parents of 3 other children said, "Hands and feet of our children have started bending and their arms and legs have stopped working; as a result they are unable to stand, work, and eat." Parents said they have been running from pillar to post to get their children treated but doctors are unable to treat them. "We rushed these patients to SKIMS Soura. Doctors told us to get some tests done but technicians at SKIMS expressed their inability saying that there are no facilities in the hospital for these tests," said a parent, adding, "Our children have been badly hit by this mysterious disease. Authorities are not paying any heed towards our plight."

Residents said that after repeated reminders and representations a team of doctors comprising Dr Nazir Ahmad and Dr Masrat Iqbal Nodal officer Integrated Disease Surveillance Project (IDSP) Kupwara visited the village 10 days ago and took the water samples from the bore wells and blood samples of the affected children and their parents. "Neither any medicine was given nor was report of the samples returned," they said.

Locals are up in arms against the officials of PHE [Public Health Engineering] department. "Our area has vast water resources like Chowkibal stream but the PHE department dug 8 bore wells around 250 feet [75 m] deep each at the whopping cost of Rs 2.50 crore [1 crore=10 million; about USD 500 000]. Without testing the water of bore wells they handed these to the residents of Tumina village with a population of 1500 souls. There could be several more cases of same disease as the entire village has been using the water of these bore wells since 2009."

The Sarpanch [elected head] of Tumina village appealed to Chief Minister Omar Abdullah and Union Health Minister Ghulam Nabi Azad to intervene and send a special team of doctors to the affected village and treat the children so that their lives are saved.

When contacted, Director Health Dr Saleem-ul-Rehman said, "The Directorate has not received any report from the concerned CMO [Chief Medical Officer], BMO [Block Medical Officer], or concerned IDSP unit. I have shot a letter to them. We are planning to send a team of doctors to the area to asses the ground situation."

[Byline: Shahid Rafiq]

--
Communicated by:
ProMED-mail from HealthMap alerts
<promed@promedmail.org>

[An apparently disabling illness is affecting a number (at least 8) of children in this rural area of Kashmir. It is difficult to discern the nature of the illness from the scant details available in this report, but it appears to be evading diagnosis at medical facilities. There is no mention of fatalities. The illness affecting mentation suggests an encephalitis, but the mention of "bending" of hands and feet might suggest arthritis or arthralgias. Given the elevation of the region and time of year, mosquito-borne infections seem unlikely. An intoxication or nutritional cause might be possible. ProMED-mail would like to hear from anyone with knowledge of the situation.

The HealthMap/ProMED-mail interactive map of India can be seen at http://healthmap.org/r/1_R2. Kupwara is located about 90 km [56 mi] from the state capital Srinagar. - Mod.LM]

[India reports half-a-dozen outbreaks of undiagnosed disease every year -- see below-- and we never see a final diagnosis. If the National Institute of Virology does not have the capability to diagnose them, CDC Atlanta or the Institut Pasteur of Paris would be glad to receive samples. - Mod.JW]

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

A much earlier report;

Rare disease grips Kupwara village
Saturday, 03 Mar 2012 at 10:03

State IDSP lab unable to check metal content of water

Shahjahan Afzal
Kupwara, March 03: People of Tumina village of north Kashmir?s Kupwara district are worried with at least five local children, including a class 10 girl student, catching a rare disease.

Authorities are yet to come out with a report of water samples they took a week back from the village wells to ascertain the copper content.
When contacted, State Nodal Officer Integrated Disease Surveillance Project (IDSP), Dr Rehana told Rising Kashmir that the state IDSP lab is not able to check even the metal content of the water. She added that the disease is not water borne.
Some of the symptoms shown by the affected people are: abnormal posture of arms and legs, difficulty in moving arms and legs, impairment of speech, shaking arms or hands, uncontrollable movement and weakness.
Based on the symptoms, experts declared that it was a rare disease called Wilson's disease. The disease, according to them, causes the body to take in and keep too much of copper.
?The deposits of copper cause tissue damage, which causes the affected organs to stop working properly,? they say.
Suffering from speech and limb impairment, Rizwan Farooq (10) of Sarpanch Mohall Tumina has been discharged untreated from neurology department of SKIMS Soura a fortnight ago while as Danish Mehmood (11) of Haji Mohala Tumina, suffering from uncontrolled movement and weakness for the past 10 days, is presently receiving treatment at SKIMS.
While declaring the disease as Wilsons? Disease, diagnostic reports received from Lal Path Labs Delhi has revealed 99.22 per cent copper rate in the body of one of the patients, which as per the physicians can lead to permanent disability.
A team from department of communication and capacity development unit in association with WENTEP declared water of the village wells unfit for drinking purposes owing to overconcentration of ammonia, and iron content and unpleasant taste/odor of the water.
...

http://www.risingkashmir.com/news/rare-disease-grips-kupwara-village-23072.aspx

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

I just sent all three reports that I just found.

[alert]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

http://www.promedmail.org/

Published Date: 2012-03-16 23:55:50
Subject: PRO/AH/EDR> Undiagnosed illness, children - India (02): (JK) Wilson's disease
Archive Number: 20120316.1072848

UNDIAGNOSED ILLNESS, CHILDREN - INDIA (02): (JAMMU & KASHMIR) WILSON'S DISEAS
************************************************** **************************
A ProMED-mail post

http://www.promedmail.org

ProMED-mail is a program of the
International Society for Infectious Diseases

http://www.isid.org

Date: 3 Mar 2012
Source: Rising Kashmir [edited]

http://www.risingkashmir.com/news/rare-disease-grips-kupwara-village-23072.aspx

Rare disease grips Kupwara village
----------------------------------
State IDSP lab unable to check metal content of water

People of Tumina village of north Kashmir's Kupwara district are worried with at least 5 local children, including a class 10 girl student, catching a rare disease.

Authorities are yet to come out with a report of water samples they took a week back from the village wells to ascertain the copper content. When contacted, State Nodal Officer Integrated Disease Surveillance Project (IDSP), Dr Rehana told Rising Kashmir that the state IDSP lab is not able to check even the metal content of the water. She added that the disease is not water borne.

Some of the symptoms shown by the affected people are: abnormal posture of arms and legs, difficulty in moving arms and legs, impairment of speech, shaking arms or hands, uncontrollable movement and weakness.

Based on the symptoms, experts declared that it was a rare disease called Wilson's disease. The disease, according to them, causes the body to take in and keep too much of copper.

"The deposits of copper cause tissue damage, which causes the affected organs to stop working properly," they say.

Suffering from speech and limb impairment, Rizwan Farooq (10) of Sarpanch Mohall Tumina has been discharged untreated from neurology department of SKIMS Soura a fortnight ago while as Danish Mehmood (11) of Haji Mohala Tumina, suffering from uncontrolled movement and weakness for the past 10 days, is presently receiving treatment at SKIMS.

While declaring the disease as Wilsons' Disease, diagnostic reports received from Lal Path Labs Delhi has revealed 99.22 per cent copper rate in the body of one of the patients, which as per the physicians can lead to permanent disability.

A team from department of communication and capacity development unit in association with WENTEP declared water of the village wells unfit for drinking purposes owing to overconcentration of ammonia, and iron content and unpleasant taste/odor of the water.

IDSP was launched by Union Minister of Health & Family Welfare in November 2004. It is a decentralized, State based Surveillance Program in the country. It is intended to detect early warning signals of impending outbreaks and help initiate an effective response in a timely manner.

Major components of the project are : (1) Integrating and decentralization of surveillance activities; (2) Strengthening of public health laboratories; (3) Human Resource Development - Training of State Surveillance Officers, District Surveillance Officers, Rapid Response Team, other medical and paramedical staff; and (4) Use of Information Technology for collection, collation, compilation, analysis and dissemination of data.

Tumina residents allege that the PHE department throw bore wells open for public in the village without checking copper content of the water.

A local physician, wishing not to be named, suggested that the health department should carry out intensive and mass surveillance of the local populace so that the disease could be controlled as quickly as possible.

As the health department has prohibited use of bore well water, locals in the absence of water, boil snow piled in their backyards for drinking purpose.

MLA Kupwara, Mir Saifullah lashed out at health authorities for "half hearted" measures. Questioning the delay in the IDSP report, he demanded that an expert team of doctors be sent to the area to carry out extensive examination of whole population immediately.

He also demanded alternative water supply for the locality.

Meanwhile, CMO Kupwara assured that a team of doctors will visit the area soon to take stock of the situation.
--
Communicated by:
Ronan Kelly" http://www.wilsonsdisease.org/wilson...scherrings.php

Portions of this comment have been extracted from:
http://digestive.niddk.nih.gov/ddiseases/pubs/wilson/ and http://www.wilsonsdisease.org/wilson...-treatment.php


References:
(1)Olivarez M, Caggana M, Pass KA, Ferguson P, Brewer GJ. Estimate of the frequency of Wilson's disease in the US Caucasian population: a mutation analysis approach. Annals of Human Genetics. 2001;65:459–463. -- Mod.TG]

[Ronan Kelly]

Re: Mysterious disease outbreak in Kupwara village - possibly Wilson disease and lead poisoning

The comment portion of the proMED post has been changed and now reads;


[Wilson's disease is a genetic disorder that prevents the body from getting rid of extra copper. A small amount of copper obtained from food is needed to stay healthy, but too much copper is poisonous. In Wilson's disease, copper builds up in the liver, brain, eyes, and other organs. Over time, high copper levels can cause life-threatening organ damage.

People who get Wilson's disease inherit two abnormal copies of the ATP7B gene, one from each parent. Wilson's disease carriers, who have only one copy of the abnormal gene, do not have symptoms. Most people with Wilson's disease have no known family history of the disease. A person's chances of having Wilson's disease increase if one or both parents have it.

About one in 40,000 people get Wilson's disease.(1) It affects men and women equally. Symptoms usually appear between ages 5 to 35, but new cases have been reported in people aged 2 to 72 years.

Wilson's disease is caused by a buildup of copper in the body. Normally, copper from the diet is filtered out by the liver and released into bile, which flows out of the body through the gastrointestinal tract. People who have Wilson disease cannot release copper from the liver at a normal rate, due to a mutation of the ATP7B gene. When the copper storage capacity of the liver is exceeded, copper is released into the bloodstream and travels to other organs?including the brain, kidneys, and eyes.

Wilson's disease first attacks the liver, the central nervous system, or both.

A buildup of copper in the liver may cause ongoing liver disease. Rarely, acute liver failure occurs; most patients develop signs and symptoms that accompany chronic liver disease, including: swelling of the liver or spleen, jaundice, or yellowing of the skin and whites of the eyes, fluid buildup in the legs or abdomen, a tendency to bruise easily, fatigue

A buildup of copper in the central nervous system may result in neurologic symptoms, including: problems with speech, swallowing, or physical coordination, tremors or uncontrolled movements, muscle stiffness, behavioral changes,

Other signs and symptoms of Wilson's disease include: anemia, low platelet or white blood cell count, slower blood clotting, measured by a blood test, high levels of amino acids, protein, uric acid, and carbohydrates in urine, premature osteoporosis and arthritis

Kayser-Fleischer rings result from a buildup of copper in the eyes and are the most unique sign of Wilson's disease. They appear in each eye as a rusty-brown ring around the edge of the iris and in the rim of the cornea. The iris is the colored part of the eye surrounding the pupil. The cornea is the transparent outer membrane that covers the eye.

Wilson's disease is diagnosed through a physical examination and laboratory tests.

During the physical examination, a doctor will look for visible signs of Wilson disease. A special light called a slit lamp is used to look for Kayser-Fleischer rings in the eyes. Kayser-Fleischer rings are present in almost all people with Wilson's disease who show signs of neurologic damage but are present in only 50 percent of those with signs of liver damage alone.

Laboratory tests measure the amount of copper in the blood, urine, and liver tissue. Most people with Wilson disease will have a lower than normal level of copper in the blood and a lower level of corresponding ceruloplasmin, a protein that carries copper in the bloodstream. In cases of acute liver failure caused by Wilson disease, the level of blood copper is often higher than normal. A 24-hour urine collection will show increased copper in the urine in most patients who display symptoms. A liver biopsy?a procedure that removes a small piece of liver tissue?can show if the liver is retaining too much copper. The analysis of biopsied liver tissue with a microscope detects liver damage, which often shows a pattern unique to Wilson disease.

Genetic testing may help diagnose Wilson's disease in some people, particularly those with a family history of the disease.

Wilson's disease can be misdiagnosed because it is rare and its symptoms are similar to those of other conditions.

Wilson's disease requires lifelong treatment to reduce and control the amount of copper in the body.

Initial therapy includes the removal of excess copper, a reduction of copper intake, and the treatment of any liver or central nervous system damage.

The drugs d-penicillamine (Cuprimine) and trientine hydrochloride (Syprine) release copper from organs into the bloodstream. Most of the copper is then filtered out by the kidneys and excreted in urine. A potential major side effect of both drugs is that neurologic symptoms can become worse?a possible result of the newly released copper becoming reabsorbed by the central nervous system. About 20 to 30 percent of patients using d-penicillamine will also initially experience other reactions to the medication, including fever, rash, and other drug-related effects on the kidneys and bone marrow. The risk of drug reaction and neurologic worsening appears to be lower with trientine hydrochloride, which should be the first choice for the treatment of all symptomatic patients.

Pregnant women should take a lower dose of d-penicillamine or trientine hydrochloride during pregnancy to reduce the risk of birth defects. A lower dose will also help reduce the risk of slower wound healing if surgical procedures are performed during childbirth.

Zinc, administered as zinc salts such as zinc acetate (Galzin), blocks the digestive tract?s absorption of copper from food. Zinc removes copper too slowly to be used alone as an initial therapy for people who already have symptoms, but it is often used in combination with d-penicillamine or trientine hydrochloride. Zinc is safe to use at full dosage during pregnancy.

Maintenance therapy begins when symptoms improve and tests show that copper has been reduced to a safe level. Maintenance therapy typically includes taking zinc and low doses of either d-penicillamine or trientine hydrochloride. Blood and urine should be monitored by a health care provider to ensure treatment is keeping copper at a safe level.

People with Wilson's disease should reduce their dietary copper intake. They should not eat shellfish or liver, as these foods may contain high levels of copper. Other foods high in copper?including mushrooms, nuts, and chocolate?should be avoided during initial therapy but, in most cases, may be eaten in moderation during maintenance therapy. People with Wilson disease should have their drinking water checked for copper content and should not take multivitamins that contain copper.

If the disorder is detected early and treated effectively, people with Wilson disease can enjoy good health.

Wilson's disease is a very treatable condition. With proper therapy, disease progress can be halted and oftentimes symptoms can be improved. Treatment is aimed at removing excess accumulated copper and preventing its reaccumulation. Treatment for Wilson's disease is a lifelong process. Patients may become progressively sicker from day to day, so immediate treatment can be critical. Treatment delays may cause irreversible damage.

Chelation therapy drugs approved for treating Wilson's disease include penicillamine (Cuprimine? and Depen?) and trientine (Syprine? and Trientine Dihydrochloride) Both of these drugs act by chelation or binding of copper, causing its increased urinary excretion.

Mettalothionein inducer drugs approved for treating Wilson disease are (Galzin?) in the USA and (Wilzin?) in Europe. Zinc acts by blocking the absorption of copper in the intestinal tract. This action both depletes accumulated copper and prevents its reaccumulation. Zinc's effectiveness has been shown by more than 30 years of considerable experience overseas. A major advantage of zinc therapy is its lack of side effects.

This is generally a type of genetic disease, so it is difficult to understand how so many people in the village are having the same clinical signs. If it is truly Wilson?s disease, then one explanation would be those having clinical signs probably have the autosomal recessive gene, which may mean the genetic diversity within this population is not very great [due to inbreeding].

It would be important to have the water and other dietary local staples checked for copper, but equally important is to rule out other causes of hepatic cirrhosis.

A Kayser-Fleischer Ring may be seen at: http://www.wilsonsdisease.org/wilson...scherrings.php

Portions of this comment have been extracted from:

http://digestive.niddk.nih.gov/ddiseases/pubs/wilson/ and http://www.wilsonsdisease.org/wilson...-treatment.php
References:

(1)Olivarez M, Caggana M, Pass KA, Ferguson P, Brewer GJ. Estimate of the frequency of Wilson's disease in the US Caucasian population: a mutation analysis approach. Annals of Human Genetics. 2001;65:459?463. -- Mod.TG]

See Also

ndiagnosed illness, children - India (JK) RFI 20120316.1072361]
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