{"title":"Narrative medicine in the art of healing in clinical practice","authors":"Nandani De Silva","doi":"10.4038/cmj.v68i1.9797","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9797","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269801","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}
Karthik Sritharan, D. L. Bandara, P. H. G. J. Pushpakumara
No abstract available
无摘要
{"title":"Awareness and oral care provided by intensive care nurses – a multicentred, cross-sectional study","authors":"Karthik Sritharan, D. L. Bandara, P. H. G. J. Pushpakumara","doi":"10.4038/cmj.v68i1.9707","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9707","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267365","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}
Thivandika Jayasundera, B. Piyasiri, Ranjuka Ubayasiri, E. Corea, Yashangi Wagaarachchige
No abstract available
无摘要
{"title":"A rarity of an uncommon entity; 2 case reports of mycotic aneurysm in melioidosis","authors":"Thivandika Jayasundera, B. Piyasiri, Ranjuka Ubayasiri, E. Corea, Yashangi Wagaarachchige","doi":"10.4038/cmj.v68i1.9498","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9498","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139269715","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}
F. Nasim, M. Fasrina, Sunil Bowattage, Wickramasooriyage K. Kularatne, V. J. Kobbegala
Background: Acute hemorrhagic leukoencephalitis (AHLE) is a rare fulminant entity of acute disseminated leukoencephalitis (ADEM) that has a rapidly progressive polysymptomatology corresponding to areas of brain affected. It’s characterized by rapid cognitive decline, coma or even rapid death. It is postulated to be a post infective immune mediated monophasic demyelinating disease. Diagnosis is clinical supported by CSF and MRI findings. It is challenging to differentiate the disease from MDEM (multiphasic demyelinating encephalomyelitis) and multiple sclerosis during the initial presentation.Case presentation: Here we report a case of a 36-yearold Sri Lankan Sinhalese lady who presented with seizure following febrile illness followed by gross right sided hemiparesis later progressing to mutism and cognitive decline. Her CSF showed pleocytosis 12/cumm with 5% polymorphs, red cells, mildly high proteins with normal glucose and positive oligoclonal bands. MRI showed evidence of multiple focal supra and infratentorial signal abnormalities and gyral thickening with hemorrhages, largest lesions being in left frontal region with mass effect but no herniation. She was diagnosed with AHLE and treated with high dose IV methyl prednisolone later converting to oral prednisolone tapering regime. She was continued on intravenous cefotaxime and acyclovir as per meningoencephalitis. Improvement with steroids was dramatic with complete neurological recovery, minimal sequel and no recurrences at 6 months follow up.Conclusion: The case is a representation of a very rare entity of an infrequently reported disease which needs high degree of clinical suspicion with early imaging for aggressive and early immunosuppressive treatment that may hinder progression to commonly described sequel including coma, death or residual neurology. The predictions on future MDEM or MS on first presentation and overlap are areas that need further exploration.
{"title":"Acute hemorrhagic leukoencephalitis in a young female with excellent response to corticosteroids","authors":"F. Nasim, M. Fasrina, Sunil Bowattage, Wickramasooriyage K. Kularatne, V. J. Kobbegala","doi":"10.4038/cmj.v68i1.9677","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9677","url":null,"abstract":"Background: Acute hemorrhagic leukoencephalitis (AHLE) is a rare fulminant entity of acute disseminated leukoencephalitis (ADEM) that has a rapidly progressive polysymptomatology corresponding to areas of brain affected. It’s characterized by rapid cognitive decline, coma or even rapid death. It is postulated to be a post infective immune mediated monophasic demyelinating disease. Diagnosis is clinical supported by CSF and MRI findings. It is challenging to differentiate the disease from MDEM (multiphasic demyelinating encephalomyelitis) and multiple sclerosis during the initial presentation.Case presentation: Here we report a case of a 36-yearold Sri Lankan Sinhalese lady who presented with seizure following febrile illness followed by gross right sided hemiparesis later progressing to mutism and cognitive decline. Her CSF showed pleocytosis 12/cumm with 5% polymorphs, red cells, mildly high proteins with normal glucose and positive oligoclonal bands. MRI showed evidence of multiple focal supra and infratentorial signal abnormalities and gyral thickening with hemorrhages, largest lesions being in left frontal region with mass effect but no herniation. She was diagnosed with AHLE and treated with high dose IV methyl prednisolone later converting to oral prednisolone tapering regime. She was continued on intravenous cefotaxime and acyclovir as per meningoencephalitis. Improvement with steroids was dramatic with complete neurological recovery, minimal sequel and no recurrences at 6 months follow up.Conclusion: The case is a representation of a very rare entity of an infrequently reported disease which needs high degree of clinical suspicion with early imaging for aggressive and early immunosuppressive treatment that may hinder progression to commonly described sequel including coma, death or residual neurology. The predictions on future MDEM or MS on first presentation and overlap are areas that need further exploration.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270190","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}
Shalinie Nirma Malintha, Prasanna Siriwardena, M. Weerasinghe
Objectives: To assess the adherence and factors associated with oral antibiotic prescriptions among adults in state sector primary care while assessing the intention to use leftover antibiotics (LOAB).Methodology: A descriptive cross sectional study was conducted in outpatient departments including 407 adults (18-75) using an interviewer administered questionnaire at consultation and a telephone interview at due completion of antibiotic. Adherence was measured by a self-report supplemented by remaining pill count. Factors associated with adherence were determined. The statistical significance was considered as p≤0.05.Results: Adherence to antibiotic prescription was 45.5%. Female gender (p=0.029, OR=1.86) and awareness on the current antibiotic prescription (p=0.000, OR=6.37) were positive associations. Adherence was inversely proportionate to increasing daily dosage frequency (p=0.001). Patient’s belief, they can stop medicine once they feel better (p=0.000), fast improvement of symptoms with medication (p=0.000), interference to lifestyle by the antibiotic dosage schedule (p=0.000) and using LOAB in the past (p=0.000,) were negatively associated. Of the non-adherent patients 20.3% intended to use LOAB later.Conclusions: Adherence to oral antibiotic prescriptions was poor. Patient’s gender, patient beliefs and practices towards medicine and complexity of dosage schedule were associated factors. Patient awareness on the current prescription promoted adherence. Intension to use LOAB was high.Recommendations: Primary care prescribers should make patients aware on antibiotic prescriptions while using less complex regimens.
{"title":"Adherence to antibiotics among adults at state sector primary care in a district of Sri Lanka – a descriptive cross sectional study","authors":"Shalinie Nirma Malintha, Prasanna Siriwardena, M. Weerasinghe","doi":"10.4038/cmj.v68i1.9602","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9602","url":null,"abstract":"Objectives: To assess the adherence and factors associated with oral antibiotic prescriptions among adults in state sector primary care while assessing the intention to use leftover antibiotics (LOAB).Methodology: A descriptive cross sectional study was conducted in outpatient departments including 407 adults (18-75) using an interviewer administered questionnaire at consultation and a telephone interview at due completion of antibiotic. Adherence was measured by a self-report supplemented by remaining pill count. Factors associated with adherence were determined. The statistical significance was considered as p≤0.05.Results: Adherence to antibiotic prescription was 45.5%. Female gender (p=0.029, OR=1.86) and awareness on the current antibiotic prescription (p=0.000, OR=6.37) were positive associations. Adherence was inversely proportionate to increasing daily dosage frequency (p=0.001). Patient’s belief, they can stop medicine once they feel better (p=0.000), fast improvement of symptoms with medication (p=0.000), interference to lifestyle by the antibiotic dosage schedule (p=0.000) and using LOAB in the past (p=0.000,) were negatively associated. Of the non-adherent patients 20.3% intended to use LOAB later.Conclusions: Adherence to oral antibiotic prescriptions was poor. Patient’s gender, patient beliefs and practices towards medicine and complexity of dosage schedule were associated factors. Patient awareness on the current prescription promoted adherence. Intension to use LOAB was high.Recommendations: Primary care prescribers should make patients aware on antibiotic prescriptions while using less complex regimens.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139266766","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}
B. C. Lakmini, Himali Erandathie Ratnayake, N. Atapattu
Background: The clinical presentation of hypopituitarism varies from asymptomatic to circulatory compromise. The late diagnosis may cause significant mortality and morbidity. There is scant data on the clinical profile.Method: A cross-sectional descriptive analysis was carried out on diagnosed children with hypopituitarism at the endocrinology unit of Lady Ridgeway Hospital for Children, Sri Lanka, from 2013-2021. The presence and progression of pituitary hormonal deficiency were ascertained.Results: Out of the total 94 children with hypopituitarism, 52 had congenital hypopituitarism with a median presenting age of 5.86 years (IQR 3-9). Short stature was the commonest presentation (59.6%). Multiple pituitary hormone deficiency (MPHD) was seen in 27 (51.91%). MPHD was associated with the presence of postnatal risk factors (OR 2.036, 95% CI 1.94-3.786) and MRI Imaging abnormalities in hypothalamic-pituitary morphogenesis (OR 1.768, 95% CI 1.087-2.874). 90.4% with GHD, 46.2% with ACTH deficiency, and 40.4% with TSH deficiency had the mean age of presentation 6.54 years, 6.11 years, and 5.56 years respectively. Of the children above 13 years, 57% showed hypogonadism. Hypoplastic anterior pituitary (40.4%) was the commonest MRI abnormality. Out of the 42 children with brain tumours, 25 (59.52%) had craniopharyngioma, and 13 (31%) had Medulloblastoma, while MPHD was seen in 32 (76.2%). Hormone deficiency at the presentation was seen in 57.1%.Conclusion: Comprehensive evaluation and periodic screening are mandatory for the timely diagnosis of MPHD.
{"title":"Clinical characteristics of pituitary hormone deficiency in children: A single centre experience","authors":"B. C. Lakmini, Himali Erandathie Ratnayake, N. Atapattu","doi":"10.4038/cmj.v68i1.9502","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9502","url":null,"abstract":"Background: The clinical presentation of hypopituitarism varies from asymptomatic to circulatory compromise. The late diagnosis may cause significant mortality and morbidity. There is scant data on the clinical profile.Method: A cross-sectional descriptive analysis was carried out on diagnosed children with hypopituitarism at the endocrinology unit of Lady Ridgeway Hospital for Children, Sri Lanka, from 2013-2021. The presence and progression of pituitary hormonal deficiency were ascertained.Results: Out of the total 94 children with hypopituitarism, 52 had congenital hypopituitarism with a median presenting age of 5.86 years (IQR 3-9). Short stature was the commonest presentation (59.6%). Multiple pituitary hormone deficiency (MPHD) was seen in 27 (51.91%). MPHD was associated with the presence of postnatal risk factors (OR 2.036, 95% CI 1.94-3.786) and MRI Imaging abnormalities in hypothalamic-pituitary morphogenesis (OR 1.768, 95% CI 1.087-2.874). 90.4% with GHD, 46.2% with ACTH deficiency, and 40.4% with TSH deficiency had the mean age of presentation 6.54 years, 6.11 years, and 5.56 years respectively. Of the children above 13 years, 57% showed hypogonadism. Hypoplastic anterior pituitary (40.4%) was the commonest MRI abnormality. Out of the 42 children with brain tumours, 25 (59.52%) had craniopharyngioma, and 13 (31%) had Medulloblastoma, while MPHD was seen in 32 (76.2%). Hormone deficiency at the presentation was seen in 57.1%.Conclusion: Comprehensive evaluation and periodic screening are mandatory for the timely diagnosis of MPHD.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139267522","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}
Meranthi Fernando, S. Tillakaratne, B. Gunetilleke, Chamila Liyanage, C. Appuhamy, Aruna Weerasuriya, Janaki Dissanayake, Rohan Siriwardana
Liver transplant (LT) is the standard therapy for medically refractory acute liver failure (ALF). Finding a deceaseddonor graft in an emergency is challenging and often overcome by living-donation. Blood group matching is practised for LT though ABO-incompatible liver transplant (ABOi-LT) is performed inselected circumstances. We report an infant who underwent successful ABOincompatible living donor LT for ALF of unknown aetiology. This being the country’s first ABOi-LT, the youngest LT recipient to date and the youngest receiving emergency LT for ALF; we describe the novel experience at a resource-limited setting in Sri Lanka (SL).
{"title":"An ABO-incompatible living donor liver transplant in an infant with acute liver failure in the Sri Lankan setting","authors":"Meranthi Fernando, S. Tillakaratne, B. Gunetilleke, Chamila Liyanage, C. Appuhamy, Aruna Weerasuriya, Janaki Dissanayake, Rohan Siriwardana","doi":"10.4038/cmj.v68i1.9714","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9714","url":null,"abstract":"Liver transplant (LT) is the standard therapy for medically refractory acute liver failure (ALF). Finding a deceaseddonor graft in an emergency is challenging and often overcome by living-donation. Blood group matching is practised for LT though ABO-incompatible liver transplant (ABOi-LT) is performed inselected circumstances. We report an infant who underwent successful ABOincompatible living donor LT for ALF of unknown aetiology. This being the country’s first ABOi-LT, the youngest LT recipient to date and the youngest receiving emergency LT for ALF; we describe the novel experience at a resource-limited setting in Sri Lanka (SL).","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139268635","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}
Amodha Medagedara, D. C. S. K. Kotalawala, Shehan Williams
No abstract available
无摘要
{"title":"Mirror writing – A case of dissociative (conversion) disorder","authors":"Amodha Medagedara, D. C. S. K. Kotalawala, Shehan Williams","doi":"10.4038/cmj.v68i1.9198","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9198","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270523","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}
Ashan Rabinath Fernando, O. Basnayake, S. Sivaganesh
Indications for red cell transfusion among general surgical patients have changed over time. Despite a scarcity in evidence, many international guidelines advocate a restrictive transfusion protocol.Objectives: To describe the red cell transfusion practices including transfusion thresholds in general surgical wards of a tertiary hospital in Sri Lanka.Methods: A descriptive cross-sectional study was done in all general surgical units of the National Hospital of Sri Lanka, Colombo. All patients transfused with red cell products for a 3-month period from 1/5/2017-1/8/2017 were included in the study. Indications for transfusion, haemoglobin at transfusion and the number of units transfused was the primary data recorded.Results: A total of 196 patients were included in the study. Most transfusions 79.08% (n=155) were for elective reasons. Most elective transfusions were to facilitate chronic extremity wound healing (52.2%, n=81). Most emergency transfusions were for intraoperative bleeding (31.7%, n=13). The majority (73.5%, n=114) of elective transfusions occurred at a Hb of 7-10 g/dL. The mean number of RBC units transfused in elective circumstances for a Hb of 7-10 g/dL was 1.59. A pre-transfusion blood picture was not available in over 85% (n=132) of elective transfusions. Only a single febrile non-haemolytic transfusion reaction was reported.Conclusions: The study revealed substantial divergence of red cell transfusion thresholds in perioperative practice when compared with international guidelines, nonadherence to rational practice such as obtaining a blood picture prior to elective transfusion and therefore the need to formulate local guidelines. It also highlighted the transfusion burden of diabetic foot disease.
{"title":"Perioperative transfusion of red cell products in patients operated at general surgical units of National Hospital of Sri Lanka","authors":"Ashan Rabinath Fernando, O. Basnayake, S. Sivaganesh","doi":"10.4038/cmj.v68i1.9299","DOIUrl":"https://doi.org/10.4038/cmj.v68i1.9299","url":null,"abstract":"Indications for red cell transfusion among general surgical patients have changed over time. Despite a scarcity in evidence, many international guidelines advocate a restrictive transfusion protocol.Objectives: To describe the red cell transfusion practices including transfusion thresholds in general surgical wards of a tertiary hospital in Sri Lanka.Methods: A descriptive cross-sectional study was done in all general surgical units of the National Hospital of Sri Lanka, Colombo. All patients transfused with red cell products for a 3-month period from 1/5/2017-1/8/2017 were included in the study. Indications for transfusion, haemoglobin at transfusion and the number of units transfused was the primary data recorded.Results: A total of 196 patients were included in the study. Most transfusions 79.08% (n=155) were for elective reasons. Most elective transfusions were to facilitate chronic extremity wound healing (52.2%, n=81). Most emergency transfusions were for intraoperative bleeding (31.7%, n=13). The majority (73.5%, n=114) of elective transfusions occurred at a Hb of 7-10 g/dL. The mean number of RBC units transfused in elective circumstances for a Hb of 7-10 g/dL was 1.59. A pre-transfusion blood picture was not available in over 85% (n=132) of elective transfusions. Only a single febrile non-haemolytic transfusion reaction was reported.Conclusions: The study revealed substantial divergence of red cell transfusion thresholds in perioperative practice when compared with international guidelines, nonadherence to rational practice such as obtaining a blood picture prior to elective transfusion and therefore the need to formulate local guidelines. It also highlighted the transfusion burden of diabetic foot disease.","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139270562","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 : 2023-08-24DOI: 10.4038/cmj.v68isi1.9733
Dileep De Silva, Madawa Chandrathilake, Nilanthi De Silva
No abstract available
没有摘要
{"title":"Human resources for health in Sri Lanka over the post-independence period: key issues","authors":"Dileep De Silva, Madawa Chandrathilake, Nilanthi De Silva","doi":"10.4038/cmj.v68isi1.9733","DOIUrl":"https://doi.org/10.4038/cmj.v68isi1.9733","url":null,"abstract":"No abstract available","PeriodicalId":9777,"journal":{"name":"Ceylon Medical Journal","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135465787","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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