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1.
Yonsei Medical Journal ; 63(5):430-439, 2022.
Article in English | MEDLINE | ID: covidwho-1834348

ABSTRACT

PURPOSE: Real-world experience with tocilizumab in combination with dexamethasone in patients with severe coronavirus disease (COVID-19) needs to be investigated. MATERIALS AND METHODS: A retrospective cohort study was conducted to evaluate the effect of severity-adjusted dosing of dexamethasone in combination with tocilizumab for severe COVID-19 from August 2020 to August 2021. The primary endpoint was 30-day clinical recovery, which was defined as no oxygen requirement or referral after recovery. RESULTS: A total of 66 patients were evaluated, including 33 patients in the dexamethasone (Dexa) group and 33 patients in the dexamethasone plus tocilizumab (DexaToci) group. The DexaToci group showed a statistically significant benefit in 30-day clinical recovery, compared to the Dexa group (p=0.024). In multivariable analyses, peak FiO2 within 3 days and tocilizumab combination were consistently significant for 30-day recovery (all p<0.05). The DexaToci group showed a significantly steeper decrease in FiO2 (-4.2+/-2.6) than the Dexa group (-2.7+/-2.6;p=0.021) by hospital day 15. The duration of oxygen requirement was significantly shorter in the DexaToci group than the Dexa group (median, 10.0 days vs. 17.0 days;p=0.006). Infectious complications and cellular and humoral immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in the convalescence stage were not different between the two groups. CONCLUSION: A combination of severity-adjusted dexamethasone and tocilizumab for the treatment of severe COVID-19 improved clinical recovery without increasing infectious complications or hindering the immune response against SARS-CoV-2.

2.
BMC Psychiatry ; 22(1):164, 2022.
Article in English | MEDLINE | ID: covidwho-1833292

ABSTRACT

BACKGROUND: CUIDA-TE is an APP that offers transdiagnostic cognitive behavioral therapy focused on enhancing emotion regulation. As a novelty, it incorporates ecological momentary interventions (EMI), which can provide psychological support in real time, when suffering arises. The main goal of the study is to evaluate the efficacy of CUIDA-TE to improve emotion regulation in healthcare workers, a population that has been particularly emotionally impacted by the COVID-19 pandemic. METHODS: In this three-arm, randomized controlled trial (RCT) the study sample will be composed of a minimum of 174 healthcare workers. They will be randomly assigned to a 2-month EMI group (CUIDA-TE APP, n >= 58), a 2-month ecological momentary assessment (EMA) only group (MONITOR EMOCIONAL APP, n >= 58), or a wait-list control group (no daily monitoring nor intervention, n >= 58). CUIDA-TE will provide EMI if EMA reveals emotional problems, poor sleep quality/quantity, burnout, stress, or low perceived self-efficacy when regulating emotions. Depression will be the primary outcome. Secondary outcomes will include emotion regulation, quality of life, and resilience. Treatment acceptance and usability will also be measured. Primary and secondary outcomes will be obtained at pre- and post-intervention measurements, and at the 3-month follow-up for all groups. DISCUSSION: To our knowledge, this is the first RCT that evaluates the efficacy of an APP-based EMI to improve emotion regulation skills in healthcare workers. This type of intervention might ultimately help disseminate treatments and reach a larger number of individuals than traditional face-to-face individual therapies. TRIAL REGISTRATION: ClinicalTrial.gov : NCT04958941 Registered 7 Jun 2021. STUDY STATUS: Participant recruitment has not started.

3.
American Journal of Respiratory & Critical Care Medicine ; 205(9):1084-1092, 2022.
Article in English | MEDLINE | ID: covidwho-1832814

ABSTRACT

Rationale: Chronic cough remains a major and often debilitating symptom for patients with idiopathic pulmonary fibrosis (IPF). In a phase 2A study, inhaled RVT-1601 (cromolyn sodium) reduced daytime cough and 24-hour average cough counts in patients with IPF. Objectives: To determine the efficacy, safety, and optimal dose of inhaled RVT-1601 for the treatment of chronic cough in patients with IPF.

4.
BMJ ; 377:o1118, 2022.
Article in English | MEDLINE | ID: covidwho-1832411
5.
New England Journal of Medicine ; 386(18):1753-1754, 2022.
Article in English | MEDLINE | ID: covidwho-1830284
6.
Complementary Therapies in Medicine ; 67:102824, 2022.
Article in English | MEDLINE | ID: covidwho-1828196

ABSTRACT

INTRODUCTION: Limited treatment options exist for COVID-19 infections;thus, attempts from complementary and alternative systems (CAM) of medicine are being explored as possible therapeutic options. Ayurcov is a formulation made of ingredients mentioned in Ayurveda. These constituents have proven antiviral, detoxifying, immune-modulating, and bio-enhancing properties. The present study was carried out to evaluate the therapeutic effect and safety of Ayurcov in patients with various severity states of COVID-19 infections. METHODS: A randomized, single blinded, controlled trial was carried out in adults diagnosed with mild-to-moderate, and severe COVID-19 infections confirmed by real time reverse transcriptase polymerase chain reaction (rRTPCR) test. The interventional group received three doses of 'Ayurcov'. It is constituted of Haridra Churna (Curcuma longa), Go ark (Bos Indicus Distilled Urine), Sphatika (Alum), Sita (Rock Candy), Godugdham (Bos Indicus Milk) milk, Goghritam (Bos Indicus ghee) on Day 1, as an adjuvant to the standard of care, and the control group received only the standard of care. Key outcomes included: proportion of patients and time taken for symptom resolution, reduction in the rRT-PCR Ct values, safety, and functional status until 42 days after discharge. RESULTS: Ninety patients with mild-to-moderate and 30 patients with severe COVID-19 disease were recruited. It was observed that significantly more proportions of patients receiving Ayurcov had symptom relief much earlier than control group. Additionally, the interventional group showed significantly lower rRT-PCR Ct values. However, a shorter time of resolution of symptoms was observed with the interventional group in the mild to moderate category but not with those having severe symptoms. Similarly, a significantly better functional status was observed with interventional group on days 7 and 28 after discharge. Ayurcov was not observed with higher risks of any adverse/serious adverse events. CONCLUSIONS: Ayurcov as adjuvant with standard of care was associated with significantly earlier resolution of COVID-19 related symptoms than standard of care alone.

7.
Complementary Therapies in Medicine ; 67:102823, 2022.
Article in English | MEDLINE | ID: covidwho-1828195

ABSTRACT

BACKGROUND: A large proportion of individuals who have recovered from an acute COVID-19 infection continue to experience symptoms months later. Post-acute COVID-19 (long-haul COVID-19) can range from serious complications to quality of life symptoms such as fatigue or insomnia. The purpose of this study was to evaluate the potential for inhalation of essential oils to improve energy levels among otherwise healthy female survivors of acute COVID-19 who experience a lack of energy more than five months after recovery. This study was conducted in the United States in late 2021. METHOD: This was a randomized double blind, placebo controlled trial to evaluate the potential for inhalation of Longevity TM, a proprietary essential oil blend manufactured by Young Living Essential Oils (Lehi, Utah, USA), on energy levels among female survivors of COVID-19 who continue to experience fatigue more than 5 months recovery from the acute infection. Forty women were randomized to two groups: intervention and placebo. Both groups inhaled the assigned product twice daily for fourteen consecutive days. Fatigue scores were measured using the Multidimensional Fatigue Symptom Inventory (MFSI). Secondary outcomes included scores on each of the MFSI's ten subscales. RESULTS: Individuals who inhaled the essential oil blend for 2 weeks had significantly lower fatigue scores after controlling for baseline scores, employment status, BMI, olfactory function, and time since diagnosis, with a large effect size (F (1,39) = 6.15, p = .020, partial eta squared = 0.198). Subscale analysis identified subscales of vigor, as well as global, behavioral, general, and mental fatigue as benefiting from the intervention. This study provides evidence that a proprietary aromatherapy blend can significantly improve energy levels among women who are experiencing fatigue after recovering from COVID-19.

8.
Cureus Journal of Medical Science ; 14(4):6, 2022.
Article in English | Web of Science | ID: covidwho-1822582

ABSTRACT

Introduction In Pakistan, the fourth wave of coronavirus disease 2019 (Covid-19) started around July 2021, which was dominated by the Delta variant of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The vaccination drive to immunize the people of Pakistan against Covid-19 was also going on during this period. There were multiple types of vaccines being administered to the people of Pakistan, as the vaccines had been procured from multiple sources. Some people had apprehensions about different vaccines being administered in the country. The purpose of this study was to compare the clinical characteristics and outcome of the patients vaccinated against Covid-19 with those of the non-vaccinated patients during the fourth wave of Covid-19 in Pakistan Naval Ship (PNS) Shifa Hospital. Methods The cross-sectional descriptive study was performed at PNS Shifa Hospital Karachi, from July to October 2021. All the Covid-19 patients treated in PNS Shifa Hospital during the "fourth Covid-19 wave" were interviewed. Their medical records were accessed, and they were followed up till their discharge from the hospital. The vaccinated and non-vaccinated patients were compared for differences in their age or gender distribution, the severity of illness, comorbidities, and mortality. Results There were 884 participants in the study: 664 (75.11%) men and 220 (24.89%) women. There were 493 patients below 40 years of age, 233 were 40-59 years old, and 158 were aged 60 and above. One hundred and sixty-nine patients had one or more comorbidities, including hypertension, diabetes mellitus, ischemic heart disease, various malignancies, bronchial asthma, and chronic kidney disease. There were 63 (7.13%) obese patients, 28 of whom developed severe disease. Five hundred and four (57%) patients were vaccinated and 380 (47%) were non-vaccinated. Among the vaccinated patients, the effect of Covid-19 was mild in 58.37%, moderate in 36.11%, severe in 0.79%, and critical in 4.37%. Among the non-vaccinated patients, the effect of Covid-19 was mild in 40.26%, moderate in 46.58%, severe in 3.16%, and critical in 10%. The difference in disease severity between the two groups was statistically significant (p<0.05). Conclusion Vaccinated Covid-19 patients had significantly lower severity of disease and displayed better outcomes when compared to non-vaccinated patients during the fourth Covid-19 wave dominated by the Delta variant of the SARS-CoV-2 virus.

9.
J Eur Acad Dermatol Venereol ; 36(5):631, 2022.
Article in English | EMBASE | ID: covidwho-1822051
10.
American Family Physician ; 105(2):135-136, 2022.
Article in English | EMBASE | ID: covidwho-1820616
11.
Annals of Internal Medicine ; 175(3):JC33, 2022.
Article in English | EMBASE | ID: covidwho-1818636
12.
Cochrane Database of Systematic Reviews ; 2022(3), 2022.
Article in English | EMBASE | ID: covidwho-1813443

ABSTRACT

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows:. To assess the effectiveness and safety of internet-based cognitive behavioural therapy for preventing postnatal depression.

13.
J Frailty Aging ; 11(2):214-223, 2022.
Article in English | PubMed | ID: covidwho-1811430

ABSTRACT

BACKGROUND: Frailty in older adults is a rapidly growing unmet medical need. It is an aging-related syndrome characterized by physical decline leading to higher risk of adverse health outcomes. OBJECTIVES: To evaluate the efficacy of Lomecel-B, an allogeneic medicinal signaling cell (MSC) formulation, in older adults with frailty. DESIGN: This multicenter, randomized, parallel-arm, double-blinded, and placebo-controlled phase 2b trial is designed to evaluate dose-range effects of Lomecel-B for frailty on physical functioning, patient-reported outcomes (PROs), frailty status, and biomarkers. SETTING: Eight enrolling clinical research centers, including the Miami Veterans Affairs Medical Center. PARTICIPANTS: Target enrollment is 150 subjects aged 70-85 years of any race, ethnicity, or gender. Enrollment criteria include a Clinical Frailty Score of 5 ("mild") or 6 ("moderate"), a 6MWT of 200-400 m, and serum tumor necrosis factor-alpha (TNF-α) ≥2.5 pg/mL. INTERVENTION: A single intravenous infusion of Lomecel-B (25, 50, 100, or 200 million cells) or placebo (N=30/arm). Patients are followed for 365 days for safety, and the efficacy assessments performed at 90, 180, and 270 days. MEASUREMENTS: The primary endpoint is change in 6MWT in the Lomecel-B-treated arms versus placebo at 180 days post-infusion. Secondary and exploratory endpoints include change in: 6MWT and other physical function measures at all time points;PROs;frailty status;cognitive status;and an inflammatory biomarkers panel. A pre-specified sub-study examines vascular/endothelial biomarkers. Safety is evaluated throughout the trial. RESULTS: The trial is conducted under a Food and Drug Administration Investigational New Drug (IND), with Institutional Review Board approval, and monitoring by an NIH-appointed independent Data Safety Monitoring Board. CONCLUSION: This clinical trial investigates the use of a regenerative medicine strategy for frailty in older adults. The results will further the understanding of the potential for Lomecel-B in the geriatric condition of frailty.

14.
BMJ Open ; 12(2):e059711, 2022.
Article in English | PubMed | ID: covidwho-1807416

ABSTRACT

INTRODUCTION: Sleep-time blood pressure correlates more strongly with adverse cardiovascular events than does daytime blood pressure. The BedMed trial evaluates whether bedtime antihypertensive administration, as compared with conventional morning use, reduces major adverse cardiovascular events. METHODS AND ANALYSIS: DesignProspective randomised, open-label, blinded end-point trial.ParticipantsHypertensive primary care patients using blood pressure lowering medication and free from glaucoma.SettingCommunity primary care providers in 5 Canadian provinces (British Columbia, Alberta, Saskatchewan, Manitoba and Ontario) are mailing invitations to their eligible patients. Social media campaigns (Google, Facebook) are additionally running in the same provinces.InterventionConsenting participants are allocated via central randomisation to bedtime vs morning use of all antihypertensives.Follow-up(1) Telephone or email questionnaire at 1 week, 6 weeks, 6 months and every 6 months thereafter, and (2) accessing linked governmental healthcare databases tracking hospital and community medical services.Primary outcomeComposite of all-cause death, or hospitalisation for myocardial infarction/acute-coronary syndrome, stroke or congestive heart failure.Secondary outcomesEach primary outcome element on its own, all-cause hospitalisation or emergency department visit, long-term care admission, non-vertebral fracture, new glaucoma diagnosis, 18-month cognitive decline from baseline (via Short Blessed Test).Select other outcomesSelf-reported nocturia burden at 6 weeks and 6 months (no, minor or major burden), 1-year self-reported overall health score (EQ-5D-5L), self-reported falls, total cost of care (acute and community over study duration) and mean sleep-time systolic blood pressure after 6 months (via 24-hour monitor in a subset of 302 sequential participants).Primary outcome analysisCox proportional hazards survival analysis.Sample sizeThe trial will continue until a projected 254 primary outcome events have occurred.Current statusEnrolment ongoing (3227 randomised to date). ETHICS AND DISSEMINATION: BedMed has ethics approval from six research ethics review boards and will publish results in a peer-reviewed journal. TRIAL REGISTRATION NUMBER: NCT02990663.

15.
J Assoc Physicians India ; 70(4):11-12, 2022.
Article in English | PubMed | ID: covidwho-1801567

ABSTRACT

The coronavirus disease 2019 (COVID-19) virus has spread all over the world. Scientists are trying to discover drugs as effective treatment for patients with COVID-19. So far about 30 drugs have been introduced that one of them is Tocilizumab. Some reports showed a positive effect of Tocilizumab on Saturation of Peripheral Oxygen (SPO2) but results of CT scan in patients in different. In some patients, CT scan showed reduced infiltration, however in other no change was observed. Unfortunately, until now there has been no definitive and effective treatment for patients with COVID-19. Based on evidence of the Tocilizumab's effect on the SARS COV 2, researchers hope this drug will make effective and promising treatment to improve lung tissue inflammation in patients with the fatal COVID-19 virus. The present study provides an overview of respiratory inflammation with COVID-19 and probable effect of Tocilizumab on SARS-COV 2. MATERIAL: A Case Series was conducted on 30 patients, RT-PCR confirmed COVID-19 cases;admitted and kept under observation in medicine ward, ICU or dedicated COVID-19 wards of RNT Medical College and associated group of Hospitals for a duration of 30 days after getting approval from institutional ethics committee if they met inclusion and exclusion criteria. Data was collected from records at the time of admission of these cases. OBSERVATION: In our study on day 1 mean of IL6 was 248.3 and on day 3 after giving injection Tocilizumab mean of IL6 was 138.7 and p value was 0.205 and on day1 mean of serum ferritin was 474.2 and on day 3 after giving injection Tocilizumab mean of serum ferritin was 415.2 and p value was 0.649 and on day 1 mean of LDH was 652 and on day 3 after giving injection Tocilizumab mean of LDH was 389.6 and p value was 0.006 and on day 1 mean of CRP was 100 and on day 3 after giving injection Tocilizumab mean of CRP was 35.95 and p value was 0.006 and out of 30 patient 22 patients were discharged and 8 patients declared death. CONCLUSION: In present study it was interpreted that injection Tocilizumab play an important role in reducing inflammation in COVID 19disease. Tocilizumab have significant role in reducing mortality from COVID 19.

16.
J Assoc Physicians India ; 70(4):11-12, 2022.
Article in English | PubMed | ID: covidwho-1801238

ABSTRACT

Navi Mumbai Municipal Corporation, Covid-19 DCHC and ICU, Navi Mumbai COVID- 19 pandemic has become a leading cause of morbidity and mortality worldwide since the emergence of novel coronavirus SARS-CoV-2 in December 2019. The patterns of imaging abnormalities and data from prior coronavirus outbreaks suggest that patients with severe COVID-19pneumonia are at increased risk of progression to interstitial lung disease and chronic pulmonary vascular disease.We have devised an effective,inexpensive approach for Covid-19 recovering patients to reduce the incidence and severity of these pulmonary complications. MATERIAL: This cross sectional study was conducted across two centres-largest government-run DCHC,Vashi, Navi Mumbai and private tertiary care hospital in Airoli, Navi Mumbai from Nov'20 to Feb'21. IEC approval, consent was obtained.472 patients were enrolled. Demographic,clinical,radiological data was collected.Adults >18yrs who tested Covid-19 RTPCR/ Rapid Antigen Positive, HRCTSS of >10, required home oxygen of 4lts/min and above, ABG established hypoxia,oxygen saturation of 82% to 94%RA, with/without existing comorbidities were included in the study.Covid Rehabilitation Therapy included six alternate day OPD based sessions over twelve days starting three days after the day of discharge from the hospital.Each session included clinical assessment,15 minute intensive chest physiotherapy and breathing exercises followed by 6 minutes of nebulisation with Levosalbutamol+Ipratropium bromide and Budesonide,followed by high flow humidified oxygen therapy of 10lts/min via non breathable mask for 90 minutes along with breathing variation of inhalation:exhalation of 1:2. Oxygen Saturation, Pulse,BP, RR were established at the beginning of every session and the end of the session.6MWT,Chest Xray was obtained at first and sixth session.These factors were used to determine outcome measures in Covid Rehabilitation Therapy. OBSERVATION: Of 472patients, 218(46.2%) were females, 254(53.8%) were males, 179(38%) had baseline saturation 82-85% on RA, 186(40%) had 85-90%, 107(22.6%) had 90-94% RA. 78% have improved to saturation of 98% at the end of last session of therapy,8%improved to 97%,10% to 96%,4% to 95%. 354(75%) patients showed 3/4th resolution of fibrosis on Chest Xray, 70(14.8%) showed 1/2 resolution,48(10.2%) have 1/4 resolution on CXR. 82% patients showed complete normalcy on 6MWT,15% showed partial improvement and 3% have showed no change.82% patients were able to come off home oxygen within 4 days,12% within 10 days and 6% within 21 days of completing therapy.369 patients reported significant reduction in dyspnea,chest pain.The results of therapy are remarkable and we had 0 defaulters.These patients as compared to the ones who didn't opt for the therapy did not have any complications after 1month on follow up versus those who presented with intermittent dyspnea and fatiguability after one month of Covid. CONCLUSION: Covid-19 Rehabilitation Therapy is cost effective,easy and convenient approach to reduce and prevent related pulmonary complications and must be advocated.

17.
International Journal of Surgery ; 100, 2022.
Article in English | EMBASE | ID: covidwho-1799907
18.
Non-conventional in English | WHOIRIS, Grey literature | ID: grc-754192
19.
BMC Public Health ; 22(1): 638, 2022 Apr 01.
Article in English | MEDLINE | ID: covidwho-1793965

ABSTRACT

BACKGROUND: The increased risk of loss to follow-up among TB smokers raises concern over the secondary spread within the community. This study aimed to determine the factors associated with loss to follow-up among TB patients who smoke. METHODS: All registered TB patients who smoke in the state of Selangor between 2013 and 2017 via the Malaysian Tuberculosis Information System (MyTB) database were included for analysis. TB patients who smoke were considered those who are "current smoker" during the notification, while loss to follow-up was defined as a TB patient who had interrupted treatment for 2 months or longer. There were 3 main variable domains included for analysis: sociodemographic profiles, disease profiles, and comorbidities. Logistic regression analysis was used to identify determinants of loss to follow-up among TB patients who smoke. RESULTS: A total of 14.1% (N = 813) of TB patients who smoke loss to follow-up. The determinants of loss to follow-up among TB smokers were working age population aged 32-41 and 42-53 years old (AOR 1.08; 95%CI 1.23,2.08) and (AOR 1.44; 95%CI 1.11,1.87) respectively, Malaysian nationality (AOR 2.34; 95%CI 1.66,3.30), patients staying in urban area (AOR 1.55; 95% CI 1.23,1.97), income level less than RM2160 (AOR 1.59; 95% CI 1.14,2.20), un-employed (AOR 1.30; 95%CI 1.09-1.55), have low education level i.e., secondary school education, primary school education and no formal education (AOR 1.60; 95%CI 1.22,2.10), (AOR 1.73; 95%CI 1.16,2.57) and (AOR 2.29; 95% CI 1.57,3.33) respectively, previously treated TB cases (AOR 2.19; 95% CI 1.71,2.81), active TB case detection methods (AOR 2.06; 95%CI 1.40,3.02), moderate lesion x-ray (AOR 1.60; 95%CI 1.13,2.27) and HIV positive (AOR 1.36; 95%CI 1.02,1.82). All the significant factors gave rise to the final model of determinants, with a predictability of 67.2% (95% CI 65.0,69.3). CONCLUSIONS: The high proportion of loss to follow-up among TB patients who smoke highlight the importance of providing early risk detection that examines the three main domains of risk factors such as socioeconomic, disease profiles and comorbidities. Potential integrated intervention should aim to reduce the proportion of smoking among TB patients through the stop smoking programme together with directly observed therapy (DOT).


Subject(s)
Tuberculosis , Follow-Up Studies , Humans , Malaysia/epidemiology , Registries , Smoking/epidemiology , Tuberculosis/complications , Tuberculosis/epidemiology
20.
Biomedica ; 42(2):1-23, 2022.
Article in English, Spanish | Scopus | ID: covidwho-1791915

ABSTRACT

Introduction: Since the SARS-CoV-2 virus emerged, there have been efforts to develop vaccines to control the COVID-19 pandemic. Objective: Was to assess evidence efficacy and safety of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-Vac rAd26-S/rAd5-S vaccines against the SARS-CoV-2 virus. Materials and methods: We searched in PubMed/MEDLINE, Google Scholar, Cochrane, and the WHO International Clinical Trials Registry Platform on 15 March 2021. We measured the risk of bias of the studies and the quality of the evidence through GRADE profiles. A qualitative and quantitative analysis of the results of clinical trials was presented. Results: We identified 74 studies and included 4 in the review. The efficacy of the BNT162b2, mRNA-1273, ChAdOx1/AZD1222 and Gam-COVID-VacrAd26-S/rAd5-S vaccines against symptomatic COVID-19 was 95.0% (95% CI, 90.3 to 97.6), 94.1% (95% CI, 89.3 to 96.8), 66.7% (95% CI, 57.4 to 74.0), and 91.1% (95% CI, 83.8 to 95.1) respectively, and there was moderate certainty of the evidence due to serious indirectness. The safety profiles were acceptable, data on serious adverse events (summary RR: 0.93;95% CI, 0.77 to 1.12;P =0.16) and deaths from all causes (summary RR: 0.70;95% CI, 0.33 to 1.50;P =0.90) showed no significant differences. Conclusion: The results of this review support the level of evidence for the efficacy and safety of the COVID-19 vaccines that were analyzed. © 2022

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