Cri du Chat Syndrome

Types of Cri du Chat Syndrome

There are two main forms of Cri du chat syndrome, distinguished by the genetic mechanism of deletion:

1. Classic 5p Deletion

   • In this form, a contiguous stretch of genetic material from the tip of chromosome 5’s short arm is missing. The size of the missing segment can range from small (just the very end) to large (extending deep into the p arm). Larger deletions generally correlate with more severe? health and developmental issues.

2. Mosaic 5p Deletion

   • Here, some cells carry the deletion on chromosome 5 while others are genetically normal. Because not all cells lack the same genetic material, mosaic individuals often have milder features. The proportion of deleted versus normal cells in various tissues influences the overall severity of symptoms.

Causes and Genetic Mechanisms

Although Cri du chat syndrome results from a single overarching cause—deletion of material on chromosome 5p—it can arise through multiple genetic events and risk factors. Below are 20 distinct mechanisms or contributing factors:

1. De Novo Deletion

   • The deletion occurs for the first time in the affected child’s chromosome during early embryo cell division, with no family history?.

2. Balanced Parental Translocation

   • One parent carries a balanced translocation involving chromosome 5; during gamete formation, this can lead to an unbalanced gamete missing part of 5p.

3. Parental Mosaicism

   • A parent has a mosaic deletion in some germ cells and transmits the deletion only to the child.

4. Ring Chromosome Formation

   • After breakage at both ends of chromosome 5, the ends fuse into a ring, leading to loss of intermediate genetic material.

5. Interstitial Deletion

   • Two breaks occur within the p arm, and the segment between them is lost, rather than the tip alone.

6. Non-Allelic Homologous Recombination

   • Misalignment of similar sequences during meiosis causes unequal crossing over and loss of the 5p segment.

7. Non-Homologous End Joining Errors

   • Improper repair of DNA double-strand breaks joins the wrong ends, excising the intervening 5p region.

8. Meiotic Nondisjunction with Deletion

   • Chromosome 5 mis-segregates, and the resulting gamete loses part of 5p.

9. Advanced Maternal Age

   • Mothers over age 35 have a slightly increased risk of chromosomal abnormalities, including deletions.

10. Advanced Paternal Age

    • Fathers over age 40 may pass on more de novo mutations due to more cell divisions in sperm production.

11. Radiation Exposure

    • High-dose radiation before conception can induce chromosomal breaks and deletions.

12. Chemical Mutagens

    • Exposure to certain chemicals (e.g., benzene) may increase risk of chromosomal breaks in germ cells.

13. Viral? Infections During Gametogenesis

    • Some viruses can interfere with DNA replication or repair, raising deletion risk.

14. In Vitro Fertilization (IVF) Procedures

    • Although rare, assisted reproductive technologies have been associated with slightly higher chromosomal anomaly rates.

15. Consanguinity

    • Parents who are closely related may share rare chromosomal rearrangements that predispose to unbalanced offspring.

16. Parental Environmental Toxins

    • Long-term chemical exposures (e.g., in industry) can damage DNA in gametes.

17. Oxidative Stress in Germ Cells

    • High oxidative stress levels can lead to DNA breaks and faulty repair.

18. Inherited? Microdeletion Syndromes

    • Rarely, a parent may have a very small 5p microdeletion that expands in the child to encompass a larger region.

19. Chromothripsis

    • Catastrophic shattering and reassembly of chromosomes in a single cell division can remove 5p segments.

20. Stochastic Errors in Early Embryogenesis

    • Random mistakes in DNA replication or repair during the first few cell divisions post-fertilization can delete 5p material.

Key Symptoms

Children with Cri du chat syndrome can show a broad spectrum of signs. Below are 20 important symptoms, each explained in simple terms:

1. High-Pitched Cat-Like Cry

   • A distinctive, shrill cry in infancy caused by underdeveloped larynx structures.

2. Low Birth Weight

   • Babies often weigh less than typical newborns, reflecting growth challenges in utero.

3. Feeding Difficulties

   • Poor sucking and swallowing reflexes can make breastfeeding or bottle feeding hard.

4. Hypotonia (Low Muscle Tone)

   • “Floppy” muscles make it difficult for infants to lift their heads or sit up.

5. Microcephaly (Small Head Size)

   • The skull? and brain are smaller than average, often leading to developmental delays.

6. Distinctive Facial Features

   • Round face, wide-set eyes, small jaw, and a flattened nasal bridge are common.

7. Intellectual Disability

   • Most children have mild? to severe learning difficulties and need special education.

8. Delayed Speech

   • Speech may be very limited or absent because of larynx and neurological issues.

9. Behavioral Problems

   • Hyperactivity, aggression, or repetitive movements can occur in childhood.

10. Poor Fine Motor Skills

    • Challenges with tasks like grasping small objects or using utensils.

11. Growth Retardation

    • Children remain shorter than peers through adolescence.

12. Scoliosis?

    • Curvature of the spine may develop due to low muscle tone and skeletal issues.

13. Congenital? Heart Defects

    • Structural heart problems—like ventricular septal defects—occur in ~30% of cases.

14. Respiratory Infections

    • Weak cough? and swallow reflexes raise the risk of repeated lung infections.

15. Strabismus (Crossed Eyes)

    • Misalignment of the eyes that may require corrective surgery or glasses.

16. Hearing Loss

    • Partial hearing impairment is common and can worsen speech delays.

17. Dental Anomalies

    • Small, widely spaced teeth and jaw misalignment can complicate eating and speech.

18. Gastrointestinal Issues

    • Constipation?, reflux, or slow gut movement may necessitate dietary changes.

19. Sleep Disturbances

    • Irregular sleep patterns and breathing pauses are frequent in both infants and older children.

20. Seizure? Disorders

    • Some individuals develop epilepsy?, requiring medication and neurological follow-up.

Diagnostic Tests

A comprehensive evaluation of suspected Cri du chat syndrome involves physical, manual, laboratory, electrodiagnostic, and imaging assessments. Each test is described below in paragraph form.

Physical Examination

1. General Growth Assessment?

   • Measure weight, length, and head circumference against age norms to identify low growth parameters.

2. Dysmorphology Exam

   • A geneticist inspects facial features (round face, micrognathia) and limb proportions for syndrome-specific traits.

3. Neuromuscular Evaluation

   • Assessment of muscle tone and reflexes to confirm hypotonia and delayed motor milestones.

4. Cardiac Auscultation

   • Listening for heart murmurs that might indicate septal defects or other congenital abnormalities.

5. Respiratory Assessment

   • Observe breathing patterns and listen for signs of aspiration or pulmonary congestion.

6. Ophthalmologic Screening?

   • Basic eye alignment and visual tracking tests to detect strabismus or poor ocular control.

Manual Tests

7. Sucking and Swallowing Reflex Test

   • Gently stimulate the lips and palate to gauge feeding reflex strength.

8. Head Control Test

   • Support the infant under the arms and allow the head to fall forward to assess neck muscle power.

9. Gross Motor Milestone Check

   • Encourage rolling, sitting, and crawling to chart motor development against expected timelines.

10. Fine Motor Reach-and-Grasp Test

    • Present small toys to evaluate hand-eye coordination and grasp reflex.

11. Tone Palpation

    • The examiner passively moves limbs to feel muscle resistance, confirming low tone.

12. Balance Response

    • In older children, assess standing balance and walking gait for ataxia? or wide-based stance.

Laboratory and Pathological Tests

13. Karyotype Analysis

    • Culture blood cells, stain chromosomes, and visually inspect under a microscope to detect deletions on 5p.

14. Fluorescence In Situ Hybridization (FISH)

    • Use fluorescent probes targeting 5p regions to confirm and precisely map the deletion.

15. Array Comparative Genomic Hybridization (aCGH)

    • High-resolution test comparing patient DNA to a control to uncover the exact size and location of the missing segment.

16. Parental Chromosome Studies

    • Karyotyping of both parents to check for balanced translocations or mosaicism that could have transmitted the deletion.

17. Complete Blood Count? (CBC?)

    • Evaluate general health, rule out anemia? or infection? in infants with frequent respiratory illnesses.

18. Metabolic Panel

    • Check electrolytes, liver?, and kidney? function to ensure safe medication dosing and detect organ involvement.

19. Thyroid? Function Tests

    • Screen for hypothyroidism?, which can worsen growth and developmental delays.

20. Audiometric Otoacoustic Emissions

    • Measure inner ear function as part of hearing loss assessment in infants.

Electrodiagnostic Tests

21. Electroencephalogram (EEG)

    • Records brain electrical activity to detect seizures or abnormal brain wave patterns.

22. Nerve Conduction Studies

    • Measures the speed of electrical impulses along peripheral nerves to assess any neuropathy.

23. Electromyography (EMG)

    • Records electrical activity of muscles at rest and during contraction to characterize hypotonia.

24. Brainstem Auditory Evoked Response (BAER)

    • Evaluates the pathway from the ear to the brainstem, complementing audiometric tests.

Imaging Tests

25. Head Ultrasound

    • Noninvasive scan through the skull’s soft spots in infants to check for brain structural anomalies.

26. Brain MRI

    • Detailed imaging of brain tissue to identify cortical dysplasia, agenesis of the corpus callosum, or other anomalies.

27. Cranial CT Scan

    • Quick X-ray-based imaging to assess skull shape and detect calcifications.

28. Spinal MRI

    • Evaluate structural spine abnormalities, especially if scoliosis or motor delays are pronounced.

29. Chest X-Ray

    • Examine lung fields and heart size to detect recurrent pneumonia complications and cardiomegaly.

30. Echocardiography

    • Ultrasound of the heart to visualize septal defects, valve abnormalities, and overall function.

31. Abdominal Ultrasound

    • Assess liver, kidneys, and gut for organ malformations that can co-occur in genetic syndromes.

32. Hip Ultrasound

    • Check for developmental dysplasia of the hip in hypotonic infants, who are at higher risk.

33. Bone Age Radiograph

    • Compare hand/wrist X-ray to age norms to gauge skeletal maturation and growth potential.

34. Skeletal Survey

    • Full-body X-rays if there is concern for skeletal dysplasia accompanying the syndrome.

35. Airway Endoscopy

    • Direct fiberoptic visualization of the larynx and vocal cords to explain the characteristic cry.

36. Sleep Study (Polysomnography)

    • Overnight monitoring of breathing, oxygen levels, and sleep stages to detect apnea.

37. CT Angiography of Brain

    • Vascular imaging to rule out rare associated blood vessel anomalies.

38. Renal Doppler Ultrasound

    • Assess kidney blood flow if renal anomalies are suspected on abdominal scanning.

39. Dental Panoramic X-Ray

    • Examine tooth development and jaw structure to plan orthodontic care.

40. Functional MRI (fMRI)

    • Research tool to study brain activation patterns in older children during language or motor tasks.

Non-Pharmacological Treatments

Below are thirty proven supportive approaches, organized into physiotherapy and electrotherapy, exercise therapies, mind-body techniques, and educational self-management strategies.

Physiotherapy & Electrotherapy Therapies

1. Gait Training
   Description: Guided practice of walking patterns using parallel bars or harness support.
   Purpose: Improves balance and strength in the legs.
   Mechanism: Repetitive stepping stimulates neuromuscular pathways, enhancing coordination over time.

2. Range-of-Motion Exercises
   Description: Gentle stretching of joints through their full arcs.
   Purpose: Prevents stiffness and contractures.
   Mechanism: Sustained stretch increases muscle length and joint lubrication.

3. Neuromuscular Electrical Stimulation (NMES)
   Description: Mild electrical pulses applied to muscles.
   Purpose: Supports weak muscles, especially in the lower limbs.
   Mechanism: Electrical currents trigger contractions, strengthening muscle fibers.

4. Balance Board Therapy
   Description: Exercises on an unstable surface to train postural control.
   Purpose: Enhances core stability and proprioception.
   Mechanism: Micro-adjustments during standing recruit deep stabilizer muscles.

5. Hydrotherapy
   Description: Therapeutic exercises performed in warm water pools.
   Purpose: Reduces joint stress while improving muscle tone.
   Mechanism: Buoyancy lessens weight-bearing forces; water resistance challenges muscles.

6. Treadmill Training with Body-Weight Support
   Description: Walking on a treadmill while partly unweighted by a harness.
   Purpose: Safe gait practice for very weak or unsteady children.
   Mechanism: Body-weight unloading allows more steps per session, reinforcing motor patterns.

7. Cryotherapy
   Description: Localized cold application to sore muscles after exercise.
   Purpose: Minimizes inflammation and pain.
   Mechanism: Vasoconstriction reduces swelling and nerve conduction speed.

8. Heating Pads (Thermotherapy)
   Description: Warm compresses on stiff joints before activity.
   Purpose: Loosens muscles for easier movement.
   Mechanism: Heat increases blood flow, relaxing tight tissue.

9. Transcutaneous Electrical Nerve Stimulation (TENS)
   Description: Low-level electrical stimulation for pain relief.
   Purpose: Decreases discomfort associated with spasticity.
   Mechanism: Activates pain-gating fibers, blocking pain signals to the brain.

10. Functional Electrical Stimulation (FES)
    Description: Timed electrical pulses to produce purposeful movements (e.g., hand grasp).
    Purpose: Encourages daily-life tasks like feeding or dressing.
    Mechanism: Synchronizes muscle contractions to imitate natural movement patterns.

11. Vestibular Stimulation
    Description: Gentle rocking or spinning activities under supervision.
    Purpose: Improves head control and spatial awareness.
    Mechanism: Stimulates inner-ear receptors, refining balance reflexes.

12. Weight-Bearing Activities
    Description: Standing or walking with support bars.
    Purpose: Strengthens bones and muscles in hips and legs.
    Mechanism: Mechanical load prompts bone remodeling and muscle growth.

13. Dynamic Bracing
    Description: Elastic orthoses that guide limb movement without rigid support.
    Purpose: Prevents joint deformities while allowing functional motion.
    Mechanism: Continuous elastic tension promotes correct alignment during activity.

14. Mirror Therapy
    Description: Performing movements while watching the reflection of the unaffected limb.
    Purpose: Can trick the brain to improve movement in a weaker side.
    Mechanism: Visual feedback engages motor networks, enhancing neuroplasticity.

15. Muscle Energy Techniques
    Description: Patient-initiated muscle contractions against the therapist’s resistance.
    Purpose: Releases tight muscles and restores joint mobility.
    Mechanism: Isometric contraction followed by relaxation resets muscle length.

 Exercise Therapies

16. Aquatic Treadmill Workouts

17. Seated Elliptical Training

18. Yoga-Based Flexibility Sessions

19. Pilates for Core Strength

20. Resistance-Band Arm Exercises

21. Trampoline Bouncing for Proprioception

22. Stationary Cycling with Adapted Seat

23. Interactive Video-Game Physical Activity

(Each of these uses graded intensity to build cardiovascular fitness, muscle tone, and motor planning.)

Mind-Body Techniques

24. Guided Imagery

25. Breath-Focused Relaxation

26. Music-Therapy Movement

(These approaches reduce anxiety, improve focus, and indirectly support motor learning through calm states.)

Educational Self-Management

27. Parent-Led Carry-Over Programs

28. Goal-Setting Workbooks

29. Home-Exercise Video Tutorials

30. Daily Activity Tracking Logs

(Empowers caregivers to reinforce gains between therapy visits and fosters consistency.)

 Pharmacological Treatments

While Cri du chat has no cure, certain medications manage common symptoms:

1. Levetiracetam (Antiepileptic)
   Dosage: 20–60 mg/kg/day in two doses.
   Timing: Morning and evening.
   Side Effects: Irritability, fatigue.

2. Valproic Acid (Antiepileptic)
   Dosage: 15–30 mg/kg/day.
   Timing: Divided doses.
   Side Effects: Weight gain, tremor, liver enzyme elevation.

3. Lamotrigine (Antiepileptic)
   Dosage: Start 0.5 mg/kg/day, titrate to 5 mg/kg/day.
   Timing: Once daily.
   Side Effects: Rash, headache.

4. Risperidone (Atypical Antipsychotic for behavioral outbursts)
   Dosage: 0.25 mg/day, up to 1.5 mg/day.
   Timing: Bedtime.
   Side Effects: Weight gain, sedation.

5. Methylphenidate (Stimulant for attention issues)
   Dosage: 5 mg twice daily, up to 1 mg/kg/day.
   Timing: Morning and midday.
   Side Effects: Appetite loss, insomnia.

6. Melatonin (Sleep regulator)
   Dosage: 1–3 mg at bedtime.
   Timing: 30 minutes before sleep.
   Side Effects: Daytime drowsiness (rare).

7. Piracetam (Nootropic/Cognitive enhancer)
   Dosage: 40–100 mg/kg/day.
   Timing: Divided doses.
   Side Effects: Nervousness, weight gain.

8. Fluoxetine (SSRI for anxiety behaviors)
   Dosage: 5–10 mg/day.
   Timing: Morning.
   Side Effects: Gastrointestinal upset, insomnia.

9. Baclofen (Muscle relaxant for spasticity)
   Dosage: 5 mg three times daily, up to 80 mg/day.
   Timing: With meals.
   Side Effects: Weakness, dizziness.

10. Diazepam (Benzodiazepine for muscle spasms)
    Dosage: 0.1–0.3 mg/kg/day in divided doses.
    Timing: As needed.
    Side Effects: Sedation, dependence risk.

11. Omeprazole (Gastroesophageal reflux prevention)

12. Domperidone (Prokinetic for feeding difficulties)

13. Montelukast (Asthma management)

14. Albuterol Inhaler (Bronchodilator)

15. Cetirizine (Antihistamine for allergies)

16. Vitamin D (Supplement for bone health)

17. Iron Sulfate (For anemia)

18. Folic Acid (Neural support)

19. Calcium Carbonate (Bone strength)

20. Zinc Sulfate (Immune function)

(Each of these addresses a common complication—seizures, behavior, feeding, sleep, or respiratory issues.)

Dietary Molecular Supplements

1. Omega-3 Fish Oil
   Dosage: 500 mg DHA/EPA daily.
   Function: Supports brain development.
   Mechanism: Anti-inflammatory and membrane-stabilizing effects.

2. L-Carnitine
   Dosage: 50 mg/kg/day.
   Function: Boosts energy metabolism.
   Mechanism: Facilitates fatty acid transport into mitochondria.

3. Choline
   Dosage: 250 mg/day.
   Function: Builds cell membranes and neurotransmitters.
   Mechanism: Precursor for acetylcholine.

4. Vitamin B12
   Dosage: 500 mcg weekly.
   Function: Neural health and red blood cell formation.
   Mechanism: Cofactor in DNA synthesis.

5. Coenzyme Q10
   Dosage: 100 mg twice daily.
   Function: Mitochondrial energy support.
   Mechanism: Electron transport chain cofactor.

6. Magnesium Glycinate
   Dosage: 100 mg daily.
   Function: Muscle relaxation.
   Mechanism: Neuromuscular transmission modulator.

7. Vitamin D3
   Dosage: 1,000 IU daily.
   Function: Bone mineralization.
   Mechanism: Regulates calcium absorption.

8. Probiotics
   Dosage: 5 billion CFU daily.
   Function: Gut health.
   Mechanism: Balances microbiome, reduces GI issues.

9. Glutamine
   Dosage: 0.3 g/kg/day.
   Function: Intestinal support.
   Mechanism: Fuel for enterocytes.

10. N-Acetylcysteine (NAC)
    Dosage: 600 mg twice daily.
    Function: Antioxidant and neuroprotective.
    Mechanism: Precursor to glutathione.

Advanced (Bisphosphonates, Regenerative & Stem-Cell-Based) Therapies

Cri du chat is genetic; bone-targeting bisphosphonates are not standard. However, emerging regenerative approaches include:

1. Experimental Gene Therapy
   Dosage/Delivery: Viral vector injection in research trials.
   Function/Mechanism: Delivers healthy copies of deleted genes to target cells.

2. CRISPR/Cas9 Ex Vivo Editing

3. Induced Pluripotent Stem-Cell (iPSC) Grafts

4. Neurotrophic Factor Infusions

5. Mesenchymal Stem-Cell Transplants

6. Exosome-Based Neural Repair

7. Synthetic mRNA Therapy

8. Biodegradable Scaffolds with Stem Cells

9. Hydrogel-Mediated Gene Delivery

10. Autologous Neural Crest-Derived Stem Cells

(All above are in preclinical or early-phase trials aiming to replace missing gene function or repair neural pathways.)

Surgical Interventions

1. Strabismus Correction
   Procedure: Eye-muscle surgery to align gaze.
   Benefits: Improves binocular vision and appearance.

2. Tonsillectomy & Adenoidectomy
   Procedure: Removal of tonsils/adenoids.
   Benefits: Reduces airway obstruction, sleep apnea.

3. Gastrostomy Tube Placement
   Procedure: Surgical feeding tube into stomach.
   Benefits: Ensures adequate nutrition in severe feeding difficulty.

4. Hernia Repair
   Procedure: Closure of inguinal or umbilical hernias.
   Benefits: Prevents bowel entrapment.

5. Orbital Decompression
   Procedure: Creates space around eyes when increased pressure exists.
   Benefits: Protects optic nerve.

6. Spinal Fusion (for scoliosis)

7. Tympanostomy (ear tubes)

8. Fronto-orbital Remodeling (craniofacial anomalies)

9. Orthognathic Surgery (jaw alignment)

10. Dentofacial Orthotic Implantation

Preventive Measures

1. Prenatal Genetic Screening

2. Early Developmental Surveillance

3. Vaccination Up to Date

4. Nutritional Counseling

5. Sleep Hygiene Practices

6. Regular Vision & Hearing Checks

7. Bone-Health Monitoring

8. Oral-Motor Therapy Introduction

9. Safe Home Environment (fall prevention)

10. Family Education on Seizure First Aid

When to See Doctors

• First Concerned Cry: If high-pitched crying lasts beyond the newborn period.

• Delayed Milestones: No head control by 4 months or no sitting by 9 months.

• Feeding Difficulties: Persistent choking or weight loss.

• Recurrent Ear Infections: More than three within six months.

• Uncontrolled Seizures: Despite first-line antiepileptic treatment.

 What to Do & What to Avoid

• Do create a consistent daily routine to build skills gradually.

• Do involve multidisciplinary teams (physio, speech, occupational).

• Do encourage social interaction with peers.

• Do use visual schedules and simple cues.

• Do adapt toys/environment for safety and accessibility.

• Avoid overstimulation; plan quiet recovery times.

• Avoid prolonged screen time without active engagement.

• Avoid harsh discipline—use positive reinforcement.

• Avoid skipping regular health and therapy appointments.

• Avoid untested supplements or unproven “miracle” cures.

Frequently Asked Questions

1. Q: Is Cri du chat inherited?
   A: Most cases occur spontaneously; only about 10 percent are inherited from a parent with a balanced chromosome rearrangement.

2. Q: What is life expectancy?
   A: Many individuals live into adulthood with proper care, though life span varies.

3. Q: Can children attend mainstream school?
   A: Some can with tailored support and individualized education plans.

4. Q: Are there specific diets recommended?
   A: No special diet, but calorie-dense foods help if feeding is difficult.

5. Q: Does the cat-like cry persist?
   A: It usually fades by 2 years of age as the larynx develops.

6. Q: Is speech possible?
   A: Many use alternative communication (signs, devices); some develop basic words.

7. Q: Are cardiac problems common?
   A: About one-third have congenital heart defects; early echocardiography is advised.

8. Q: What therapies help speech?
   A: Early speech and language therapy, plus augmentative communication tools.

9. Q: How often should I schedule therapies?
   A: Daily home exercises plus weekly professional sessions yield best gains.

10. Q: Will physical growth catch up?
    A: Growth is typically slower; nutritional support and hormone evaluation may help.

11. Q: Can seizures be outgrown?
    A: Some children have fewer seizures over time, but many need lifelong management.

12. Q: Do adults with Cri du chat require special support?
    A: Yes—transition planning for vocational and daily-living skills is crucial.

13. Q: Are behavioral issues part of the syndrome?
    A: Hyperactivity and self-stimulation behaviors are common; behavioral therapies help.

14. Q: Is prenatal diagnosis accurate?
    A: Yes—microarray and FISH testing reliably detect the 5p deletion.

15. Q: Where can families find support?
    A: National and international Cri du chat foundations offer resources and community.

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: June 23, 2025.