Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a10
Tshepang Mabala, Nsekela Leticia Mfuta
Varicella zoster virus (VZV) causes primary infection with varicella (chickenpox) a self-limiting diffuse vesicular rash and establishes latency in dorsal root ganglia. Reactivation of VZV results in a dermatomal vesicular rash known as herpes zoster. In the immunocompromised population, herpes zoster can develop into disseminated disease involving the sensory, peripheral and enteric nervous systems and be associated with extracutaneous manifestations. In this case report, we describe a HIV infected male presenting with Ogilvie syndrome in presence of disseminated herpes zoster with associated pneumonia and hepatitis.
{"title":"Disseminated Herpes Zoster Presenting as Ogilvie Syndrome with Associated Pneumonia and Hepatitis in a Newly Diagnosed HIV Positive Male","authors":"Tshepang Mabala, Nsekela Leticia Mfuta","doi":"10.18772/26180197.2022.v4n1a10","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a10","url":null,"abstract":"Varicella zoster virus (VZV) causes primary infection with varicella (chickenpox) a self-limiting diffuse vesicular rash and establishes latency in dorsal root ganglia. Reactivation of VZV results in a dermatomal vesicular rash known as herpes zoster. In the immunocompromised population, herpes zoster can develop into disseminated disease involving the sensory, peripheral and enteric nervous systems and be associated with extracutaneous manifestations. In this case report, we describe a HIV infected male presenting with Ogilvie syndrome in presence of disseminated herpes zoster with associated pneumonia and hepatitis.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"16 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83746705","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a12
Lynn Morris
Wits Journal of Clinical Medicine Conversations presents Prof Lynn Morris in conversation with Prof Pravin Manga (Editor of the WJCM) about HIV vaccines: https://youtu.be/DgN1ee_sdlc
{"title":"WJCM Conversations","authors":"Lynn Morris","doi":"10.18772/26180197.2022.v4n1a12","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a12","url":null,"abstract":"Wits Journal of Clinical Medicine Conversations presents Prof Lynn Morris in conversation with Prof Pravin Manga (Editor of the WJCM) about HIV vaccines: https://youtu.be/DgN1ee_sdlc","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80337450","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a6
Nana Trusha, M. Black, Farra Green, V. Chibabhai
Background: Pre-analytical errors contribute significantly to the reduced quality of laboratory results and may adversely impact patient management. Appropriate completion of the laboratory requistion form (LRF) by clinical staff is an important element of the pre-analytical phase. As a quality improvement initiative, a sample of LRFs submitted to the Charlotte Maxeke Johannesburg Academic Hospital Microbiology Laboratory was audited. Methods: A pilot study reviewing LRFs for the period 1–18 September 2020 for tissue, pus, sterile site fluids and pus swab specimen types was undertaken. An assessment of the completeness and correctness of information in LRFs was performed. Parameters were assigned to four quality indicator (QI) groups, namely patient identifiers, clinician identifiers, test request and clinical details. Results: An audit of completed LRFs for 172 specimens was performed, suggesting wide variability in the completion of parameters. Clinical details (description of the site of specimen collection, diagnosis and medication) were the most poorly completed components. The contact number of the requesting healthcare worker (HCW) was missing in 91% of requests. The most consistently completed and reliable QI was patient’s details. Other mandatory parameters, including the HCW’s name and practice number, were completed in 95% and 99% of LRFs, respectively. Conclusions: The inconsistent completion of key parameters in the LRF is of concern, and larger studies are warranted to determine the broader implications of our findings. Strategies to improve the completion of microbiology LRFs in this setting include educating the medical staff and students, expanding mandatory fields in the LRF and implementing an electronic requisition system.
{"title":"Do Clinicians Provide the Laboratory with Sufficient Information? An Audit of Microbiology Laboratory Requisition Form Completion","authors":"Nana Trusha, M. Black, Farra Green, V. Chibabhai","doi":"10.18772/26180197.2022.v4n1a6","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a6","url":null,"abstract":"Background: Pre-analytical errors contribute significantly to the reduced quality of laboratory results and may adversely impact patient management. Appropriate completion of the laboratory requistion form (LRF) by clinical staff is an important element of the pre-analytical phase. As a quality improvement initiative, a sample of LRFs submitted to the Charlotte Maxeke Johannesburg Academic Hospital Microbiology Laboratory was audited.\u0000Methods: A pilot study reviewing LRFs for the period 1–18 September 2020 for tissue, pus, sterile site fluids and pus swab specimen types was undertaken. An assessment of the completeness and correctness of information in LRFs was performed. Parameters were assigned to four quality indicator (QI) groups, namely patient identifiers, clinician identifiers, test request and clinical details.\u0000Results: An audit of completed LRFs for 172 specimens was performed, suggesting wide variability in the completion of parameters. Clinical details (description of the site of specimen collection, diagnosis and medication) were the most poorly completed components. The contact number of the requesting healthcare worker (HCW) was missing in 91% of requests. The most consistently completed and reliable QI was patient’s details. Other mandatory parameters, including the HCW’s name and practice number, were completed in 95% and 99% of LRFs, respectively.\u0000Conclusions: The inconsistent completion of key parameters in the LRF is of concern, and larger studies are warranted to determine the broader implications of our findings. Strategies to improve the completion of microbiology LRFs in this setting include educating the medical staff and students, expanding mandatory fields in the LRF and implementing an electronic requisition system.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85386082","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a4
M. Davies, Z. Cassimjee, S. Chiba, C. Dayal, N. Motala
Background: Recipients of outpatient haemodialysis are at an increased risk of acquiring severe SARS-CoV-2 infection. Isolation of infected patients reduces in-centre transmission, but protocols extrapolated from the general population may not be applicable in this setting. We describe the kinetics of an outbreak in a tertiary dialysis centre in Johannesburg, South Africa, to suggest an appropriate isolation strategy. Methods: Retrospective analysis of a clinical database employed to facilitate isolation of exposed and infected patients was undertaken. Modes of transmission, incubation and recovery periods in patients developing SARS-CoV-2 infection were assessed. The effects of factors modulating immune function on incubation and recovery periods were modelled using sigma-restricted partial least squares linear regression. Severity of infection and the outcomes thereof were described to assess the efficacy of the isolation protocols employed. Results: SARS-CoV-2 infection was diagnosed in 24.7% of patients receiving outpatient haemodialysis. Contact with an infected healthcare worker was the leading indication for surveillance swabbing in this cohort (49.12%). Forty per cent of all positive cases had antecedent contact with an infected healthcare worker, and possible patient-to-patient transmission occurred in one case. The median time to the diagnosis of infection following known exposure was 16.5 days. Comorbid diabetes and increasing dialysis vintage were associated with a shorter incubation period. The median time to clearance of infection was 33.5 days. The clinical disease severity prolonged the recovery period. No patient required mechanical ventilation, and there were no deaths during the study period. Conclusion: Haemodialysis patients manifest prolonged incubation and recovery periods. Serial monitoring with RT-PCR swabs may be required to ensure effective isolation.
{"title":"Are Standard COVID-19 Isolation Protocols Appropriate in Haemodialysis Units? A Description of a Novel SARSCoV-2 Coronavirus Outbreak in a Haemodialysis Unit in Johannesburg, South Africa","authors":"M. Davies, Z. Cassimjee, S. Chiba, C. Dayal, N. Motala","doi":"10.18772/26180197.2022.v4n1a4","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a4","url":null,"abstract":"Background: Recipients of outpatient haemodialysis are at an increased risk of acquiring severe SARS-CoV-2 infection. Isolation of infected patients reduces in-centre transmission, but protocols extrapolated from the general population may not be applicable in this setting. We describe the kinetics of an outbreak in a tertiary dialysis centre in Johannesburg, South Africa, to suggest an appropriate isolation strategy.\u0000Methods: Retrospective analysis of a clinical database employed to facilitate isolation of exposed and infected patients was undertaken. Modes of transmission, incubation and recovery periods in patients developing SARS-CoV-2 infection were assessed. The effects of factors modulating immune function on incubation and recovery periods were modelled using sigma-restricted partial least squares linear regression. Severity of infection and the outcomes thereof were described to assess the efficacy of the isolation protocols employed.\u0000Results: SARS-CoV-2 infection was diagnosed in 24.7% of patients receiving outpatient haemodialysis. Contact with an infected healthcare worker was the leading indication for surveillance swabbing in this cohort (49.12%). Forty per cent of all positive cases had antecedent contact with an infected healthcare worker, and possible patient-to-patient transmission occurred in one case. The median time to the diagnosis of infection following known exposure was 16.5 days. Comorbid diabetes and increasing dialysis vintage were associated with a shorter incubation period. The median time to clearance of infection was 33.5 days. The clinical disease severity prolonged the recovery period. No patient required mechanical ventilation, and there were no deaths during the study period.\u0000Conclusion: Haemodialysis patients manifest prolonged incubation and recovery periods. Serial monitoring with RT-PCR swabs may be required to ensure effective isolation.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"21 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89324096","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a7
J. Patricios, R. Saggers, G. Torres
The benefits of regular physical activity (PA) in mitigating the effects of non-communicable diseases have been well described. More recently, highlighted by a global need to protect large populations against the COVID-19 pandemic, the immunoprotective benefits of PA have come to the fore. This commentary explains the biological reasons for PA being an effective preventative tool against a range of diseases and expands upon its physiological effects at an organelle and molecular level. Moreover, the concept of skeletal muscle as an endocrine organ is explained. Available data on the levels of activity in South African adults and children are explored and interventions for improvement recommended.
{"title":"A Pandemic We Continue to Ignore: South Africa’s Disease Burden of Physical Inactivity","authors":"J. Patricios, R. Saggers, G. Torres","doi":"10.18772/26180197.2022.v4n1a7","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a7","url":null,"abstract":"The benefits of regular physical activity (PA) in mitigating the effects of non-communicable diseases have been well described.\u0000More recently, highlighted by a global need to protect large populations against the COVID-19 pandemic, the immunoprotective\u0000benefits of PA have come to the fore. This commentary explains the biological reasons for PA being an effective preventative\u0000tool against a range of diseases and expands upon its physiological effects at an organelle and molecular level. Moreover, the\u0000concept of skeletal muscle as an endocrine organ is explained. Available data on the levels of activity in South African adults\u0000and children are explored and interventions for improvement recommended.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"475 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77140715","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a1
T. Ramsamy, C. Solomon, G. Demetriou
Background: There is a paucity of data in South Africa documenting the various causes of aplastic anaemia (AA), as well as the response to immunosuppressive therapy. Objective: To determine the absolute number of AA cases, possible causes and response to immunosuppressive therapy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH). Method: A retrospective cross-sectional analysis was conducted of all confirmed cases of AA at the CMJAH for the period of January 2014 to June 2019. Results: There were 35 cases of AA for the given study period. Sixty-five percent of the study sample had no identifiable cause for AA and were defined as idiopathic. Twelve patients (34%) had identifiable secondary causes for AA; these included exposure to drugs and toxins, pregnancy, viral infection and auto-immune conditions. All patients were treated with combination immunosuppressive therapy. None of the patients had received a stem-cell transplant. Eighteen percent of patients had a complete response to therapy, 49% had a partial response whilst 29% were refractory to therapy. Four percent of patients relapsed after treatment. Conclusion: AA is a rare disease with significant mortality. All possible secondary causes should be sought with a detailed patient history and relevant investigations. All patients must be treated with the recommended treatment protocol and exposure to offending drugs/toxins should be terminated. Every effort to improve patient follow-up should be made so as to establish concrete data on mortality and long-term complications.
{"title":"Aplastic Anaemia—A South African Context","authors":"T. Ramsamy, C. Solomon, G. Demetriou","doi":"10.18772/26180197.2022.v4n1a1","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a1","url":null,"abstract":"Background: There is a paucity of data in South Africa documenting the various causes of aplastic anaemia (AA), as well as the response to immunosuppressive therapy.\u0000Objective: To determine the absolute number of AA cases, possible causes and response to immunosuppressive therapy at Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).\u0000Method: A retrospective cross-sectional analysis was conducted of all confirmed cases of AA at the CMJAH for the period of January 2014 to June 2019.\u0000Results: There were 35 cases of AA for the given study period. Sixty-five percent of the study sample had no identifiable cause for AA and were defined as idiopathic. Twelve patients (34%) had identifiable secondary causes for AA; these included exposure to drugs and toxins, pregnancy, viral infection and auto-immune conditions. All patients were treated with combination immunosuppressive therapy. None of the patients had received a stem-cell transplant. Eighteen percent of patients had a complete response to therapy, 49% had a partial response whilst 29% were refractory to therapy. Four percent of patients relapsed after treatment.\u0000Conclusion: AA is a rare disease with significant mortality. All possible secondary causes should be sought with a detailed patient history and relevant investigations. All patients must be treated with the recommended treatment protocol and exposure to offending drugs/toxins should be terminated. Every effort to improve patient follow-up should be made so as to establish concrete data on mortality and long-term complications.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83670756","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a8
P. Cooper, S. Cooper
{"title":"Why Parents Refuse Vaccination for Their Children: A South African Perspective","authors":"P. Cooper, S. Cooper","doi":"10.18772/26180197.2022.v4n1a8","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a8","url":null,"abstract":"<jats:p />","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84976313","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a5
T. Sineke, K. Hirasen, M. Loveday, L. Long, D. Evans
Background: The concept of multi-morbidity is typically defined as the concurrent existence of more than one infectious and/or chronic condition in one person. We conducted a systematic review to quantify and describe the extent of multi-morbidities associated with tuberculosis (TB) in South Africa. Methods: This systematic review and meta-analysis were developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA). Searches were conducted in PubMed inclusive of MEDLINE using a combination of keywords ‘Tuberculosis’, ‘HIV’, ‘Diabetes’, as well as other non-communicable disease-related terms. Only studies providing data for South Africa and those published in English from January 2013 to December 2019 were included. Results: A total of 1772 publications were reviewed, of which 81 (4.6%) were identified for full-text review. Of these, 17 (21%) publications, representing 23,839 study participants with at least one multi-morbidity, were included in the final analysis. Human Immunodeficiency Virus (HIV) was the most commonly occurring co-morbidity reported (16/17 publications; 94.1%), followed by diabetes (6/17; 35.3%), smoking (4/17; 23.5%) and alcohol consumption (2/17; 11.8%). Pooled prevalence estimates for co-morbidities were 65% [95% confidence interval (CI): 59–70%], 6% [95% CI: 4–10%], 27% [95% CI: 8–51%] and 73% [95% CI: 70–77%], respectively. Conclusions: HIV is the most common co-morbidity associated with TB in South Africa. However, other prevalent conditions and patient characteristics known to be strongly associated with TB were not consistently reported. Having a holistic understanding of TB and its associated multi-morbidities is critical to prevent further disease development and to manage patients with existing multi-morbidities more effectively.
{"title":"Multi-morbidities Associated with Tuberculosis in South Africa: A Systematic Review of the Literature","authors":"T. Sineke, K. Hirasen, M. Loveday, L. Long, D. Evans","doi":"10.18772/26180197.2022.v4n1a5","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a5","url":null,"abstract":"Background: The concept of multi-morbidity is typically defined as the concurrent existence of more than one infectious and/or chronic condition in one person. We conducted a systematic review to quantify and describe the extent of multi-morbidities associated with tuberculosis (TB) in South Africa.\u0000Methods: This systematic review and meta-analysis were developed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA). Searches were conducted in PubMed inclusive of MEDLINE using a combination of keywords ‘Tuberculosis’, ‘HIV’, ‘Diabetes’, as well as other non-communicable disease-related terms. Only studies providing data for South Africa and those published in English from January 2013 to December 2019 were included.\u0000Results: A total of 1772 publications were reviewed, of which 81 (4.6%) were identified for full-text review. Of these, 17 (21%) publications, representing 23,839 study participants with at least one multi-morbidity, were included in the final analysis. Human Immunodeficiency Virus (HIV) was the most commonly occurring co-morbidity reported (16/17 publications; 94.1%), followed by diabetes (6/17; 35.3%), smoking (4/17; 23.5%) and alcohol consumption (2/17; 11.8%). Pooled prevalence estimates for co-morbidities were 65% [95% confidence interval (CI): 59–70%], 6% [95% CI: 4–10%], 27% [95% CI: 8–51%] and 73% [95% CI: 70–77%], respectively.\u0000Conclusions: HIV is the most common co-morbidity associated with TB in South Africa. However, other prevalent conditions and patient characteristics known to be strongly associated with TB were not consistently reported. Having a holistic understanding of TB and its associated multi-morbidities is critical to prevent further disease development and to manage patients with existing multi-morbidities more effectively.","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"71 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87327754","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}
Pub Date : 2022-03-14DOI: 10.18772/26180197.2022.v4n1a9
Stacey Norsworthy, F. Raal, Farzahna Mohamed
{"title":"Agranulocytosis as a Side-Effect of Carbimazole","authors":"Stacey Norsworthy, F. Raal, Farzahna Mohamed","doi":"10.18772/26180197.2022.v4n1a9","DOIUrl":"https://doi.org/10.18772/26180197.2022.v4n1a9","url":null,"abstract":"<jats:p />","PeriodicalId":75326,"journal":{"name":"Wits journal of clinical medicine","volume":"103 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79415300","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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