This is a case of a 93 year old patient who presented with a syncopal episode due to infra-nodal atrio-ventricular block (AVB) which required placement of a permanent pacemaker (PPM). The initial pre-procedure chest x-ray (CXR) showed an elevated left hemidiaphragm with shifting of the heart to the right making PPM implant challenging.
{"title":"Permanent Pacemaker Implantation Challenged by an Elevated Left Hemidiaphragm","authors":"Farla Louis","doi":"10.31579/2690-8794/055","DOIUrl":"https://doi.org/10.31579/2690-8794/055","url":null,"abstract":"This is a case of a 93 year old patient who presented with a syncopal episode due to infra-nodal atrio-ventricular block (AVB) which required placement of a permanent pacemaker (PPM). The initial pre-procedure chest x-ray (CXR) showed an elevated left hemidiaphragm with shifting of the heart to the right making PPM implant challenging.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74750033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
This paper seeks to give a better understanding of the influence of age, creatinine level, duration of diabetes, glucose level and pulse rate on diabetic-induced sexual dysfunction among people. The study employed two-way MANOVA with balanced samples of 115 each. Prior to the analysis, univariate and multivariate normality, linearity, equality of error and covariance matrices, and multicollinearity assumptions were satisfied. Significance was attained for both sex and marital status (P < 0.05), though their interaction effect was not significant (P > 0.05). Wald’s test for individual groups confirmed the hypothetical decision of MANOVA, though independent T2 failed to report significance for marital status. Under the parameter estimation, it was ascertained that the difference between the groups was in terms of age and creatinine levels of people. The model is also considered credible since bootstrap estimates converged to the empirical estimates. Even though this paper did not exhaust all metabolic and comorbid factors relating to diabetes, it is hoped that it provides an insight into some circumstances in the evolution of diabetes.
{"title":"Influence of Determinants of Diabetes on Sexual Quality using Discriminant Functions","authors":"A. Alhassan","doi":"10.31579/2690-8794/063","DOIUrl":"https://doi.org/10.31579/2690-8794/063","url":null,"abstract":"This paper seeks to give a better understanding of the influence of age, creatinine level, duration of diabetes, glucose level and pulse rate on diabetic-induced sexual dysfunction among people. The study employed two-way MANOVA with balanced samples of 115 each. Prior to the analysis, univariate and multivariate normality, linearity, equality of error and covariance matrices, and multicollinearity assumptions were satisfied. Significance was attained for both sex and marital status (P < 0.05), though their interaction effect was not significant (P > 0.05). Wald’s test for individual groups confirmed the hypothetical decision of MANOVA, though independent T2 failed to report significance for marital status. Under the parameter estimation, it was ascertained that the difference between the groups was in terms of age and creatinine levels of people. The model is also considered credible since bootstrap estimates converged to the empirical estimates. Even though this paper did not exhaust all metabolic and comorbid factors relating to diabetes, it is hoped that it provides an insight into some circumstances in the evolution of diabetes.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83693914","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The case of a 68-year-old female patient, without comorbidities, with a diagnosis of a large parapharyngeal abscess on the left, was reported by a neck CT scan, which evolved with spontaneous drainage and complete resolution of the peritonsillar bulging, completing the therapeutic plan with antibiotic therapy, without abscess recurrence. Clinical suspicion, associated with neck CT, is an indispensable item in the design of early treatment, in order to avoid complications.
{"title":"Spontaneous Drainage of Large Parapharyngeal Abscess","authors":"Camilla Melotti Berkembrock","doi":"10.31579/2690-8794/081","DOIUrl":"https://doi.org/10.31579/2690-8794/081","url":null,"abstract":"The case of a 68-year-old female patient, without comorbidities, with a diagnosis of a large parapharyngeal abscess on the left, was reported by a neck CT scan, which evolved with spontaneous drainage and complete resolution of the peritonsillar bulging, completing the therapeutic plan with antibiotic therapy, without abscess recurrence. Clinical suspicion, associated with neck CT, is an indispensable item in the design of early treatment, in order to avoid complications.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78614406","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyponatremia, defined as a serum sodium level less than 135 mg/mL, can be euvolemic, hypovolemic, or hypervolemic. Its presentation can be subtle or severe depending on whether the hyponatremia is acute or chronic. This case investigates a geriatric patient who suffered diarrhea and hyponatremia following a course of ferrous sulfate pills for anemia treatment. Given that ferrous sulfate pills usually result in constipation, this presentation was abnormal. Literature review and comparison to prior atypical situations resulted in the conclusion that the patient’s diarrhea was likely a result of her Crohn’s diagnosis. The subsequent resulting hyponatremia was likely due to this diarrhea coupled with her prescription thiazide diuretic which can cause hyponatremia as a common side effect. This report allows for physicians to understand potential causes behind atypical electrolyte abnormalities in their patients and hence, find an effective treatment plan.
{"title":"A Case Report of Atypical Hyponatremia Caused by Diarrhea Following a Course of Ferrous Sulfate Supplements","authors":"L. Ranasinghe","doi":"10.31579/2690-8794/058","DOIUrl":"https://doi.org/10.31579/2690-8794/058","url":null,"abstract":"Hyponatremia, defined as a serum sodium level less than 135 mg/mL, can be euvolemic, hypovolemic, or hypervolemic. Its presentation can be subtle or severe depending on whether the hyponatremia is acute or chronic. This case investigates a geriatric patient who suffered diarrhea and hyponatremia following a course of ferrous sulfate pills for anemia treatment. Given that ferrous sulfate pills usually result in constipation, this presentation was abnormal. Literature review and comparison to prior atypical situations resulted in the conclusion that the patient’s diarrhea was likely a result of her Crohn’s diagnosis. The subsequent resulting hyponatremia was likely due to this diarrhea coupled with her prescription thiazide diuretic which can cause hyponatremia as a common side effect. This report allows for physicians to understand potential causes behind atypical electrolyte abnormalities in their patients and hence, find an effective treatment plan.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87160958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The research and analysis from smoking must be from several points of view. Nevertheless the smoking economic burden by morbidity must be strongly researched since the Health Economy. The usefulness from postgraduate course about this subject offer the opportunity to generalize the whole knowledge obtained. Thus more health professional will be better capacitated to make better measures from the smoking economic impact over the Public Health. Objective: To design a postgraduate trainer course about the measurement from the smoking economic burden by morbidity. Materials and methods: Were used the inductive – deductive and the comparative as theoretical methods. As empiric method was used the bibliographic research. Results: The suggested course has the particularity of be contextualized agree to general learning needs from health professionals related to the smoking economic control. The course has the characteristic that each subject is supported by the previous. Conclusion: Was designed a postgraduate trainer course for health professionals related with the smoking economic control. The course is agreed to general learning needs from health professionals related to the smoking economic control.
{"title":"The smoking economic burden by morbidity","authors":"F. Hernández","doi":"10.31579/2690-8794/051","DOIUrl":"https://doi.org/10.31579/2690-8794/051","url":null,"abstract":"Background: The research and analysis from smoking must be from several points of view. Nevertheless the smoking economic burden by morbidity must be strongly researched since the Health Economy. The usefulness from postgraduate course about this subject offer the opportunity to generalize the whole knowledge obtained. Thus more health professional will be better capacitated to make better measures from the smoking economic impact over the Public Health. Objective: To design a postgraduate trainer course about the measurement from the smoking economic burden by morbidity. Materials and methods: Were used the inductive – deductive and the comparative as theoretical methods. As empiric method was used the bibliographic research. Results: The suggested course has the particularity of be contextualized agree to general learning needs from health professionals related to the smoking economic control. The course has the characteristic that each subject is supported by the previous. Conclusion: Was designed a postgraduate trainer course for health professionals related with the smoking economic control. The course is agreed to general learning needs from health professionals related to the smoking economic control.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85722337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgical alterations in the normal biliary anatomy is technically challenging. We describe the case of a 73-year-old patient with an afferent limb syndrome secondary to a Whipple procedure for pancreatic cancer, in which a percutaneous rendezvous technique assisted in the endoscopic metallic stent placement with favorable outcome.
{"title":"Rendezvous for afferent limb syndrome","authors":"Ivan Mendez","doi":"10.31579/2690-8794/049","DOIUrl":"https://doi.org/10.31579/2690-8794/049","url":null,"abstract":"Endoscopic retrograde cholangiopancreatography (ERCP) in patients with surgical alterations in the normal biliary anatomy is technically challenging. We describe the case of a 73-year-old patient with an afferent limb syndrome secondary to a Whipple procedure for pancreatic cancer, in which a percutaneous rendezvous technique assisted in the endoscopic metallic stent placement with favorable outcome.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78971659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mink's role in nature is important. Since mink is a carnivorous species, there are small mammals such as crayfish, snakes, turtles, small birds, mice, rabbits, insects, and crustaceans in the food chain. The most important of the practices that threaten the life of the mink is the cutting of the trees where the mink lives for furniture or energy production. Another threat is that their fur is made into clothes, as in Denmark, where 1 billion dollars of exports are made annually. However, the recent acceptance of the covid virus as a host to humans resulted in 17 million minks being buried in the mass grave in just the first week, and then the entire culling of them. Here it is not the resignation of a responsible prime minister. It is the threat that the mink, which forms part of the food chain, will suddenly increase the population of small birds, which play a key role in world food production. Of course, the purpose here is not to blame everyone unconsciously. However, instead of interfering with the chain in nature, the mink should be kept under quarantine by considering the antibody formed in the bodies of the mink as a treatment tool. Now the world should be prepared for unexpected adverse effects, such as the growing bird population with the disappearance of those 17 million minks. The species that need to be increased in the fight against Covid-19 are bats, the main source of the virus. Because bats may have carried a combination of SARS and MERS viruses from the same source in the past as a defense mechanism to adapt to nature with the depletion of water flies in the world with the restriction of water resources. The presence of any population in nature that is more than normal may further limit the use of a biosource present in nature. Every intervention in nature inevitably confronts humanity. As an alternative thought, it may be suggested that minks should not be considered as a commercial purpose in human life or should be restricted.
{"title":"We need to Overpopulate Bats not Birds for Prevention of Covid 19 totally","authors":"C. Koyunoğlu","doi":"10.31579/2690-8794/054","DOIUrl":"https://doi.org/10.31579/2690-8794/054","url":null,"abstract":"Mink's role in nature is important. Since mink is a carnivorous species, there are small mammals such as crayfish, snakes, turtles, small birds, mice, rabbits, insects, and crustaceans in the food chain. The most important of the practices that threaten the life of the mink is the cutting of the trees where the mink lives for furniture or energy production. Another threat is that their fur is made into clothes, as in Denmark, where 1 billion dollars of exports are made annually. However, the recent acceptance of the covid virus as a host to humans resulted in 17 million minks being buried in the mass grave in just the first week, and then the entire culling of them. Here it is not the resignation of a responsible prime minister. It is the threat that the mink, which forms part of the food chain, will suddenly increase the population of small birds, which play a key role in world food production. Of course, the purpose here is not to blame everyone unconsciously. However, instead of interfering with the chain in nature, the mink should be kept under quarantine by considering the antibody formed in the bodies of the mink as a treatment tool. Now the world should be prepared for unexpected adverse effects, such as the growing bird population with the disappearance of those 17 million minks. The species that need to be increased in the fight against Covid-19 are bats, the main source of the virus. Because bats may have carried a combination of SARS and MERS viruses from the same source in the past as a defense mechanism to adapt to nature with the depletion of water flies in the world with the restriction of water resources. The presence of any population in nature that is more than normal may further limit the use of a biosource present in nature. Every intervention in nature inevitably confronts humanity. As an alternative thought, it may be suggested that minks should not be considered as a commercial purpose in human life or should be restricted.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82483744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Concomitant narcolepsy and sleep apnea (SA) can be present in the same patient. We present a patient with recurrent episodes of syncope and subsequent falls, which were found to be due to narcolepsy and Obstructive Sleep Apnea (OSA). She was initially treated with continuous positive airway pressure (CPAP) but continued to have symptoms sustaining injury. Her symptoms resolved with placement of a permanent pacemaker (PPM) implant and to date has not had any recurrence.
{"title":"Recurrent Syncope in a patient with Sleep Apnea and Narcolepsy resolved after Permanent Pacemaker Implant","authors":"Farla Jean-Louis, G. Upadhya, Asma Syed","doi":"10.31579/2690-8794/027","DOIUrl":"https://doi.org/10.31579/2690-8794/027","url":null,"abstract":"Concomitant narcolepsy and sleep apnea (SA) can be present in the same patient. We present a patient with recurrent episodes of syncope and subsequent falls, which were found to be due to narcolepsy and Obstructive Sleep Apnea (OSA). She was initially treated with continuous positive airway pressure (CPAP) but continued to have symptoms sustaining injury. Her symptoms resolved with placement of a permanent pacemaker (PPM) implant and to date has not had any recurrence.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87984519","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The strategy of price liberalization and privatization had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatization policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.
{"title":"A prescription for improvement: Health and Safety Measures","authors":"A. Omer","doi":"10.15520/jmrhs.v2i4.41","DOIUrl":"https://doi.org/10.15520/jmrhs.v2i4.41","url":null,"abstract":"The strategy of price liberalization and privatization had been implemented in Sudan over the last decade, and has had a positive result on government deficit. The investment law approved recently has good statements and rules on the above strategy in particular to pharmacy regulations. Under the pressure of the new privatization policy, the government introduced radical changes in the pharmacy regulations. To improve the effectiveness of the public pharmacy, resources should be switched towards areas of need, reducing inequalities and promoting better health conditions. Medicines are financed either through cost sharing or full private. The role of the private services is significant. A review of reform of financing medicines in Sudan is given in this study. Also, it highlights the current drug supply system in the public sector, which is currently responsibility of the Central Medical Supplies Public Corporation (CMS). In Sudan, the researchers did not identify any rigorous evaluations or quantitative studies about the impact of drug regulations on the quality of medicines and how to protect public health against counterfeit or low quality medicines, although it is practically possible. However, the regulations must be continually evaluated to ensure the public health is protected against by marketing high quality medicines rather than commercial interests, and the drug companies are held accountable for their conduct.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85430205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: There is a need for laboratories to participate in EQA schemes to achieve a harmonization of test results and to improve serological testing and research on COVID-19 and SARS-CoV-2. The Boditech iCHROMA point of care immunoassay analyser has a Covid-19 antibody assay for the qualitative determination of IgG antibodies in human whole blood/serum/plasma. The National Institute for Biological Standards and Control (NIBSC) in the United Kingdom has a portfolio of reference and research reagents, including reagents for EQA that are available to laboratories to help them set up and develop accurate diagnostic tests for SARS-CoV-2 assays. Objectives: To determine the performance of the Boditech iCHROMA Covid-19 IgG antibody assay using the external quality control material provided by the UK NIBSC (National Institute for Biological Standards and Control). Results: The Boditech iCHROMA Covid-19 IgG assay using the cut off index >1.1, reported the results of the 33 positive control samples as positive with index range from 19.50 – 29.00, with a mean of 23.75 and standard deviation of SD of 2.53. It also reported the results of the 33 negative control samples as negative with an index range of 0.00 for all samples. Conclusion: The performance of the Boditech iCHROMA Covid-19 IgG antibody assay using external quality control material from the UK NIBSC was very good, confirming the precision of the Boditech iCHROMA Covid 19 IgG antibody method.
{"title":"Performance of the Boditech iCHROMA Covid-19 IgG antibody assay with the external quality control for UK NIBSC (National Institute of Biological Standards and Control)","authors":"J. B. Bolodeoku","doi":"10.31579/2690-8794/048","DOIUrl":"https://doi.org/10.31579/2690-8794/048","url":null,"abstract":"Background: There is a need for laboratories to participate in EQA schemes to achieve a harmonization of test results and to improve serological testing and research on COVID-19 and SARS-CoV-2. The Boditech iCHROMA point of care immunoassay analyser has a Covid-19 antibody assay for the qualitative determination of IgG antibodies in human whole blood/serum/plasma. The National Institute for Biological Standards and Control (NIBSC) in the United Kingdom has a portfolio of reference and research reagents, including reagents for EQA that are available to laboratories to help them set up and develop accurate diagnostic tests for SARS-CoV-2 assays. Objectives: To determine the performance of the Boditech iCHROMA Covid-19 IgG antibody assay using the external quality control material provided by the UK NIBSC (National Institute for Biological Standards and Control). Results: The Boditech iCHROMA Covid-19 IgG assay using the cut off index >1.1, reported the results of the 33 positive control samples as positive with index range from 19.50 – 29.00, with a mean of 23.75 and standard deviation of SD of 2.53. It also reported the results of the 33 negative control samples as negative with an index range of 0.00 for all samples. Conclusion: The performance of the Boditech iCHROMA Covid-19 IgG antibody assay using external quality control material from the UK NIBSC was very good, confirming the precision of the Boditech iCHROMA Covid 19 IgG antibody method.","PeriodicalId":10427,"journal":{"name":"Clinical Medical Reviews and Reports","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2020-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90656130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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