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1.
J Assoc Physicians India ; 70(5): 11-12, 2022 May.
Article in English | MEDLINE | ID: mdl-35598133

ABSTRACT

OBJECTIVES: To determine the association of eNOS (T786C and 27bp VNTR) gene polymorphism with the risk of type II diabetes mellitus and diabetic nephropathy in North India. METHODS: The prospective case control study was conducted over a period of 18 months. A total of 100 patients of Type 2 Diabetes Mellitus (A1: 50 cases without Diabetic nephropathy-DN and 50 cases with DN) aged 18-75 years and 50 healthy adults as control (Group B) were included. The endothelial nitric oxide gene variant (T786C and 27bp VNTR) genotypes and alleles were studied. Odds ratio with 95% CI was calculated for genotype and alleles for the occurrence of diabetes and DN. p value of less than 0.05 was considered as significant. RESULTS: With Bb as reference(27bp VNTR), the odds ratio for Ab in the three groups (A1,A2,B) was 2.243, 1.545 and 0.746 respectively; and for Aa was 3.043, 3.058 and 1.878 respectively; with TT as reference (T786C), it was 1.573, 1.55 and 1.055 respectively for TC; and for CC it was 2.121, 2.063 and 2.348 respectively. The OR was comparable among the study groups and control for all genotypes and alleles (p>0.05). CONCLUSION: In conclusion, there was a trend towards higher predilection of DN with aa genotype and a allele in 27 VNTR, CC genotype and C allele of -786T>C polymorphism however it was not found to be statistically significant. Future large sample studies are required to account for the ethnic variation for a clearer association of the genes and their associated risk with Diabetes and its complications.


Subject(s)
Diabetes Mellitus, Type 2 , Diabetic Nephropathies , Nitric Oxide Synthase Type III , Adolescent , Adult , Aged , Case-Control Studies , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/genetics , Diabetic Nephropathies/complications , Diabetic Nephropathies/genetics , Genetic Predisposition to Disease , Genotype , Humans , Middle Aged , Nitric Oxide Synthase Type III/genetics , Polymorphism, Genetic , Risk Assessment , Young Adult
2.
J Emerg Trauma Shock ; 10(3): 154-161, 2017.
Article in English | MEDLINE | ID: mdl-28855780

ABSTRACT

The government of India has done remarkable work on commissioning a government funded prehospital emergency ambulance service in India. This has both public health implications and an economic impact on the nation. With the establishment of these services, there is an acute need for standardization of education and quality assurance regarding prehospital care provided. The International Joint Working Group has been actively involved in designing guidelines and establishing a comprehensive framework for ensuring high-quality education and clinical standards of care for prehospital services in India. This paper provides an independent expert opinion and a proposed framework for general operations and administration of a standardized, national prehospital emergency medical systems program. Program implementation, operational details, and regulations will require close collaboration between key stakeholders, including local, regional, and national governmental agencies of India.

3.
Int J Crit Illn Inj Sci ; 7(2): 79-83, 2017.
Article in English | MEDLINE | ID: mdl-28660160

ABSTRACT

There have been multiple incidents where doctors have been assaulted by patient relatives and hospital facilities have been vandalized. This has led to mass agitations by Physicians across India. Violence and vandalism against health-care workers (HCWs) is one of the biggest public health and patient care challenge in India. The sheer intensity of emotional hijack and the stress levels in both practicing HCWs and patient relative's needs immediate and detail attention. The suffering of HCWs who are hurt, the damage to hospital facilities and the reactionary agitation which affects patients who need care are all together doing everything to damage the delivery of health care and relationship between a doctor and a patient. This is detrimental to India where illnesses and Injuries continue to be the biggest challenge to its growth curve. The expert group set by The Academic College of Emergency Experts and The Academy of Family Physicians of India makes an effort to study this Public Health and Patient Care Challenge and provide recommendations to solve it.

4.
Int J Crit Illn Inj Sci ; 4(3): 200-8, 2014 Jul.
Article in English | MEDLINE | ID: mdl-25337481

ABSTRACT

Biomarker science brings great promise to clinical medicine. This is especially true in the era of technology miniaturization, rapid dissemination of knowledge, and point-of-care (POC) implementation of novel diagnostics. Despite this tremendous progress, the journey from a candidate biomarker to a scientifically validated biomarker continues to be an arduous one. In addition to substantial financial resources, biomarker research requires considerable expertise and a multidisciplinary approach. Investigational designs must also be taken into account, with the randomized controlled trial remaining the "gold standard". The authors present a condensed overview of biomarker science and associated investigational methods, followed by specific examples from clinical areas where biomarker development and/or implementation resulted in tangible enhancements in patient care. This manuscript also serves as a call to arms for the establishment of a truly global, well-coordinated infrastructure dedicated to biomarker research and development, with focus on delivery of the latest discoveries directly to the patient via point-of-care technology.

5.
Am J Hosp Palliat Care ; 31(2): 139-47, 2014 Mar.
Article in English | MEDLINE | ID: mdl-23455328

ABSTRACT

INTRODUCTION: This study aims to ascertain attitudes of health care workers on end-of-life care (EOLC) issues and to highlight the disparity that exists in countries with different backgrounds. METHODS: It is a cross-sectional questionnaire survey across heterogeneous health care providers in India, Chile, the United Kingdom, and the Netherlands using an indigenously prepared questionnaire considering regional variations, covering different areas of EOLC. RESULTS: Of the 109 participants, 68 (62.4%) felt that cardiopulmonary resuscitation should be done selectively, 25 (22.9%) had come in contact with at least 1 patient who had asked them to hasten death, and 36 (33%) felt that training was insufficient to prepare them for skills in issues of EOLC. CONCLUSION: To avoid cumbersome through well-meant interventions, it is important that the caregiving team is aware of the patient's own wishes with respect to EOLC issues.


Subject(s)
Attitude of Health Personnel , Health Personnel/psychology , Social Values , Terminal Care/psychology , Adult , Cardiopulmonary Resuscitation/psychology , Chile , Cross-Cultural Comparison , Cross-Sectional Studies , Euthanasia/psychology , Female , Health Personnel/statistics & numerical data , Humans , India , Male , Netherlands , Personal Autonomy , Practice Patterns, Physicians' , Suicide, Assisted/psychology , Surveys and Questionnaires , United Kingdom , Withholding Treatment
6.
Indian J Med Res ; 137(2): 283-94, 2013 Feb.
Article in English | MEDLINE | ID: mdl-23563371

ABSTRACT

Medical college faculty, who are academicians are seldom directly involved in the implementation of national public health programmes. More than a decade ago for the first time in the global history of tuberculosis (TB) control, medical colleges of India were involved in the Revised National TB Control Programme (RNTCP) of Government of India (GOI). This report documents the unique and extraordinary course of events that led to the involvement of medical colleges in the RNTCP of GOI. It also reports the contributions made by the medical colleges to TB control in India. For more than a decade, medical colleges have been providing diagnostic services (Designated Microscopy Centres), treatment [Directly Observed Treatment (DOT) Centres] referral for treatment, recording and reporting data, carrying out advocacy for RNTCP and conducting operational research relevant to RNTCP. Medical colleges are contributing to diagnosis and treatment of human immunodeficiency virus (HIV)-TB co-infection and development of laboratory infrastructure for early diagnosis of multidrug-resistant and/or extensively drug-resistant TB (M/XDR-TB) and DOTS-Plus sites for treatment of MDR-TB cases. Overall, at a national level, medical colleges have contributed to 25 per cent of TB suspects referred for diagnosis; 23 per cent of 'new smear-positives' diagnosed; 7 per cent of DOT provision within medical college; and 86 per cent treatment success rate among new smear-positive patients. As the Programme widens its scope, future challenges include sustenance of this contribution and facilitating universal access to quality TB care; greater involvement in operational research relevant to the Programme needs; and better co-ordination mechanisms between district, state, zonal and national level to encourage their involvement.


Subject(s)
Antitubercular Agents/therapeutic use , Extensively Drug-Resistant Tuberculosis/drug therapy , Extensively Drug-Resistant Tuberculosis/epidemiology , Mycobacterium tuberculosis/pathogenicity , Coinfection , Education, Medical , Extensively Drug-Resistant Tuberculosis/complications , Extensively Drug-Resistant Tuberculosis/microbiology , Extensively Drug-Resistant Tuberculosis/physiopathology , HIV Infections/complications , HIV Infections/epidemiology , Humans , India
7.
Indian J Nephrol ; 23(1): 18-23, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23580800

ABSTRACT

To explore the association between high molecular weight apo(a) isoforms and lipoprotein(a) [Lp(a)] in chronic kidney disease (CKD) and the effect of maintenance hemodialysis (MHD), plasma Lp(a) and apo(a) isoforms were determined in age and sex-matched CKD stage 4 and stage 5 patients (repeated after 4 weeks of MHD) and healthy controls (n = 18). Median Lp(a) increased with severity of CKD. Upon HMW apo(a) isoform stratification, Lp(a) in S2 isoform group was 37.6 mg/dl in CKD stage 4 and 64.0 mg/dl in stage 5 (P < 0.024 and P < 0.001 vs. controls), whereas in S3 + S4 group there was no significant increase. Following MHD, Lp(a) also decreased significantly only in the S2 group. Increase in Lp(a) in CKD patients with HMW apo(a) isoforms is mainly restricted to S2 isoform group, furthermore, decrease in Lp(a) levels in response to MHD is also seen in this group only.

8.
Cell Prolif ; 44(1): 10-8, 2011 Feb.
Article in English | MEDLINE | ID: mdl-21199006

ABSTRACT

OBJECTIVES: Stem cell factor receptor, c-kit, is considered to be the master signalling molecule of haematopoietic stem cells. It develops the orchestral pattern of haematopoietic cell lineages, seen by its varying degree of omnipresence in progenitors, lineage committed and mature cells. We have investigated the effect of over-expressing c-kit on early recovery of the haematopoietic compartment, in irradiated hosts. MATERIALS AND METHODS: Normal bone marrow cells (BMCs) were transfected with Kit(wt) (wild-type c-kit) or its variant Kit(mu) (asp814tyr) by electroporation. Lethally irradiated mice were transplanted with normal or transfected congeneic BMCs. The effect of ectopic expression of c-kit on haematopoietic cell recovery was determined by analysing donor-derived cells. Furthermore, effects of both types of c-kit over-expression on progenitor and lineage-committed cells were examined by flow cytometric analysis of Sca-1 and lineage-committed (Lin(+)) cells respectively. RESULTS: Hyper-activating Kit(mu) significantly improved recovery of the haematopoietic system in irradiated hosts. In vivo results showed that the donor-derived c-kit(+) cell population was increased to more than 3-fold in the case of Kit(mu)-transfected cells compared to normal and Kit(wt) over-expressing BMCs. In general, survival of progenitor and committed cell was improved in the Kit(mu) over-expressing system compared to the other two cohorts. CONCLUSION: These results suggest that recruitment of the hyper-activating variant of c-kit (Kit(mu)) lead to early recovery of the bone marrow of lethally irradiated mice.


Subject(s)
Hematopoietic System/chemistry , Mutation , Proto-Oncogene Proteins c-kit/genetics , Regeneration , Animals , Bone Marrow Cells/chemistry , Bone Marrow Cells/radiation effects , Bone Marrow Transplantation , Cell Lineage , Electroporation , Mice , Mice, Inbred C57BL , Proto-Oncogene Proteins c-kit/analysis , Proto-Oncogene Proteins c-kit/pharmacology
10.
J Assoc Physicians India ; 57: 595-6, 2009 Aug.
Article in English | MEDLINE | ID: mdl-20209722

ABSTRACT

Sternum is resistant to infections and thus infrequent site of osteomyelitis. Involvement of sternum by Mycobacterium tuberculosis is rare. We report case of 37-year-old male with isolated tuberculosis of the sternum, a 14-year-old girl with tuberculosis of the sternum and Potts spine and a 55-year-old male with tubercular sinus of the sternum, three different presentations of the same disease.


Subject(s)
Sternum , Tuberculosis, Osteoarticular/diagnosis , Adult , Child , Female , Humans , Male , Middle Aged
11.
Indian J Public Health ; 51(2): 107-11, 2007.
Article in English | MEDLINE | ID: mdl-18240471

ABSTRACT

The burden of diabetes mellitus across the world especially in India is substantial, and much of the morbidity and mortality is due to development of diabetic complications. Control of blood glucose is important to reduce occurrence of these complications. Measurement of glycated haemoglobin values provides valuable information about long term glycemic control, and is recommended for routine monitoring by several clinical guidelines on diabetes. Monitoring and appropriate management have been shown to improve outcomes in patients with diabetes in other parts of the world. However, the adoption of glycated hemoglobin as part of routine monitoring of diabetes patients in India will need to answer issues of availability, affordability and accessibility.


Subject(s)
Diabetes Complications/prevention & control , Diabetes Mellitus, Type 2/blood , Glycated Hemoglobin/analysis , Health Services Accessibility/organization & administration , Public Health , Blood Glucose/analysis , Chronic Disease , Diabetes Mellitus, Type 2/complications , Diabetes Mellitus, Type 2/economics , Guideline Adherence , Health Services Accessibility/economics , Humans , India
12.
J Assoc Physicians India ; 49: 375-6, 2001 Mar.
Article in English | MEDLINE | ID: mdl-11291982

ABSTRACT

A 30 years male patient, having typical symptoms of mumps, presented with acute cerebellar ataxia two days after the onset of parotid enlargement. The neurological symptoms showed complete recovery over the subsequent six weeks, suggestive of para-infectious cerebellar demyelination due to mumps.


Subject(s)
Cerebellar Diseases/etiology , Encephalitis, Viral/etiology , Mumps/complications , Adult , Cerebellar Diseases/cerebrospinal fluid , Cerebellar Diseases/diagnosis , Encephalitis, Viral/cerebrospinal fluid , Encephalitis, Viral/diagnosis , Humans , Male
13.
J Neurol Sci ; 183(1): 89-93, 2001 Jan 15.
Article in English | MEDLINE | ID: mdl-11166801

ABSTRACT

Renal transplant recipients are at risk of developing various infectious and non-infectious complications affecting the central nervous system (CNS). There is paucity of data regarding the spectrum of CNS complications and the epidemiology of infective agents varies according to geographical location. We retrospectively studied the spectrum of CNS complications seen in 792 renal allograft recipients followed up at this tertiary care centre in north India over a 19-year period. Autopsy findings of 78 allograft recipients who died in the hospital were also reviewed and included. The brain was examined in 22 of these patients. Overall, 79 (10%) patients developed some form of CNS dysfunction with a mortality rate of 60.8%. CNS infections occurred in 31 renal allograft recipients (3.9% of total) and accounted for the largest group (39.2%). Fungi were the commonest etiological agents (21 patients) and were associated with a 70% mortality, with cryptococcal meningitis occurring in 12, mucormycosis in six, aspergillosis in one, and other unusual fungal infections in the remaining two patients. All patients with mucormycosis had a fatal outcome. The second largest group comprised of patients with non-uremic encephalopathies (23 patients, 29.1%) with metabolic encephalopathy occurring in 13, toxic encephalopathy in nine and hypertensive encephalopathy in one patient) and was associated with an overall mortality rate of 60.9%. Cerebrovascular accidents occurred in 12 patients (15.2%) and were associated with a mortality of 91.7%. Other CNS complications included treatment related complications in four (5.1%), primary CNS lymphomas in three (3.8%), and miscellaneous complications in six patients (7.6%). Patients with non-cryptococcal fungal infections of the CNS, hepatic and toxic encephalopathy and those with cerebrovascular accidents had the worst outcome. There was no relationship between the development of infection or stroke and the type of maintenance immunosuppression used. We conclude that complications involving the CNS occur in 10% of all renal transplant recipients and are associated a with high mortality, warranting early diagnosis and aggressive treatment.


Subject(s)
Central Nervous System Infections/etiology , Kidney Transplantation/adverse effects , Lymphoma/etiology , Postoperative Complications , Tropical Climate/adverse effects , Adolescent , Adult , Chi-Square Distribution , Humans , Kidney Transplantation/mortality , Retrospective Studies
14.
Indian J Med Sci ; 55(9): 491-4, 2001 Sep.
Article in English | MEDLINE | ID: mdl-11887299

ABSTRACT

In recent years, substantial evidence has accumulated to unambiguously implicate high plasma fibrinogen levels as a major cardiovascular risk factor. An open prospective and randomised pilot study was therefore undertaken in mild to moderate hypertensives to evaluate the effect of various antihypertensive drugs viz enalapril, felodipine and prazosin on the blood pressure and plasma fibrinogen levels. The systolic and diastolic blood pressures were determined at 0, 4 and 8 weeks whereas plasma fibrinogen assays were done at baseline and at the end of the 8th week of treatment in all the drug-treated groups. It was observed that although all the three drugs effectively controlled blood pressure, only enalapril significantly reduced plasma fibrinogen levels. Due to this additional effect, enalapril has potential to control two major cardiovascular risk factors--hypertension and high plasma fibrinogen levels--simultaneously.


Subject(s)
Antihypertensive Agents/therapeutic use , Fibrinogen/drug effects , Hypertension/blood , Hypertension/drug therapy , Female , Fibrinogen/metabolism , Humans , Male , Middle Aged , Pilot Projects , Prospective Studies , Risk Factors
15.
Natl Med J India ; 13(3): 121-4, 2000.
Article in English | MEDLINE | ID: mdl-11558109

ABSTRACT

BACKGROUND: Immunodeficiency explains the very high frequency of bacterial infections in patients with chronic renal failure (CRF), which leads to high mortality and morbidity, despite improved therapeutic interventions. Among several factors, the decreased functional capacity of phagocytic leucocytes appears to be responsible for the defective host defence mechanisms against infection in CRF. We evaluated both oxygen-dependent and oxygen-independent microbicidal activity of neutrophils isolated from uraemic patients. METHODS: Forty patients with CRF (20 with mild-to-moderate CRF and 20 with advanced CRF) along with 20 age- and sex-matched healthy controls were studied. The assessment of phagocytic capability, ability to produce superoxide (O2.-) anion and H2O2, myeloperoxidase and granule-specific hydrolytic enzymes such as acid phosphatase, cathepsin D and lysozyme activity of the patient's neutrophils were performed to study their bactericidal activity. RESULTS: The phagocytic index (PI) in the control group was found to be 50.38 (4.58). It was significantly reduced in both mild-to-moderate CRF and advanced CRF, as compared to controls. In mild-to-moderate and advanced CRF patients, O2.- production by resting polymorphonuclear neutrophils (PMN) was low. Also, on stimulation with PMA the O2.- production showed a relative reduction as compared to controls. H2O2 production by resting PMN from CRF patients was unaltered but on stimulation with PMA, the quantum of increase was significantly lower. A marked reduction in the level of intracellular myeloperoxidase activity in PMN was noted in CRF patients. Of the three intracellular lysosomal enzymes assayed, cathepsin D level was increased in the PMN of mild-to-moderate CRF patients; acid phosphatase level was elevated significantly in the PMN of both mild-to-moderate and advanced CRF patients. However, no change in lysozyme levels was observed. CONCLUSION: With increasing severity of uraemia, neutrophils from uraemic patients showed progressive impairment of phagocytic ability. Impairment of oxygen-dependent microbicidal mechanisms was indicated by a decrease in O2.- and H2O2 production. Increased activity of lysosomal enzymes such as cathepsin D and acid phosphatase suggest a state of neutrophil activation in uraemia. It is likely that the immunodeficiency state in uraemics is partly due to reduced bactericidal activity of the neutrophil cell population.


Subject(s)
Neutrophils/physiology , Uremia/immunology , Adolescent , Adult , Cathepsin D/metabolism , Humans , Hydrogen Peroxide/metabolism , Middle Aged , Phagocytosis , Superoxides/metabolism
17.
J Assoc Physicians India ; 47(2): 189-91, 1999 Feb.
Article in English | MEDLINE | ID: mdl-10999087

ABSTRACT

Quantitative estimation of urinary enzymes has been advocated as a more sensitive marker than conventional renal function tests to assess radio-contrast media induced nephrotoxicity. We studied 27 subjects with normal renal functions who underwent abdominal aortography for varied indications. Among these, 8 also required selective renal arteriography and 3 underwent arch aortography in addition. Sodium iothalamate was used as a radio-contrast medium and the average amount injected was 73 ml (45 to 120 ml) per subject. Standard renal function assessment including urinalysis, 24 hour urinary protein excretion, creatinine clearance done both before and after aortography did not show any significant alteration. Urinary excretion of tubular enzymes including leucine aminopeptidase (LAP), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT) and maltase (MAL) was estimated before and 2, 24 and 48 hours after aortography. All enzymes showed a significant rise at 2 hours. Urinary excretion of LAP, ALP and GGT peaked at 24 hours after aortography without a further change in MAL levels. Enzymuria returned to baseline values 48 hours following the procedure. It is concluded that an increase in the urinary excretion of the brush-border enzymes within 24 hours of contrast media administration may suggest an early nephrotoxicity.


Subject(s)
Angiography/adverse effects , Enzymes/urine , Kidney Tubules/drug effects , Radiopharmaceuticals/adverse effects , Renal Artery/diagnostic imaging , Adolescent , Adult , Angiography/methods , Child , Contrast Media/adverse effects , Female , Humans , Kidney Function Tests , Kidney Tubules/enzymology , Male , Middle Aged , Probability , Reference Values , Risk Assessment
18.
Indian J Psychiatry ; 41(4): 374-6, 1999 Oct.
Article in English | MEDLINE | ID: mdl-21430815

ABSTRACT

A 12-year-old girl presented with complaint of passing very 'scanty' amount of urine, approximately 50 ml every alternate day for the last five years. She had been admitted for investigations several times in different hospitals in the past. On evaluation, she was found to have no abnormality related to the urinary tract. Detailed psychiatric assessment revealed the factitious nature of her symptoms, suggesting the diagnosis of factitious disorder with physical symptoms.

19.
J Assoc Physicians India ; 44(2): 109-11, 1996 Feb.
Article in English | MEDLINE | ID: mdl-10999062

ABSTRACT

The effect of chronic captopril therapy on serum angiotensin converting enzyme (ACE) was studied in 30 patients with essential hypertension. Patients were assessed for serum ACE levels serially every week for 4 weeks. Thirty healthy individuals served as controls. The basal serum ACE level among hypertensives (57.4 +/- 37.2 u/l) was found to be significantly higher (p < 0.001) than the controls (33.3 +/- 8.8 u/l). One week after starting captopril therapy, serum ACE levels fell to almost half the basal values (p < 0.001). However, thereafter, it rose to levels higher than the basal level even though the blood pressure remained well controlled. Our study suggests that besides its action on ACE, captopril may lower the blood pressure by other mechanisms as well.


Subject(s)
Angiotensin-Converting Enzyme Inhibitors/administration & dosage , Captopril/administration & dosage , Hypertension/drug therapy , Hypertension/enzymology , Peptidyl-Dipeptidase A/drug effects , Adult , Aged , Blood Pressure Determination , Female , Follow-Up Studies , Humans , Hypertension/diagnosis , Male , Middle Aged , Peptidyl-Dipeptidase A/blood , Reference Values , Treatment Outcome
20.
ASAIO J ; 41(3): M698-703, 1995.
Article in English | MEDLINE | ID: mdl-8573895

ABSTRACT

Gastrointestinal complications are responsible for substantial morbidity and mortality among renal allograft recipients in developing countries. During a 10 year period, 166 (62.6%) of 265 allograft recipients developed gastrointestinal complications. This figure reflects the high incidence of infectious complications, especially acute diarrheas. Also notable was the incidence of esophageal candidiasis (7.2%), ischemic colitis (2.6%), and gastrointestinal and peritoneal tuberculosis (3.0%). Almost one quarter of the complications developed in the first 6 months after transplantation. Mortality was the highest with acute ischemic colitis (100%), pancreatitis (60%), and upper gastrointestinal hemorrhage (40%). Improvements in standards of living and sanitary conditions, pre transplant evaluation and assessment of risk factors, prophylaxis with anti ulcer drugs, early diagnosis, and appropriate treatment are needed to decrease the frequency and severity of gastrointestinal complications in renal allograft recipients.


Subject(s)
Gastrointestinal Diseases/etiology , Kidney Transplantation/adverse effects , Adolescent , Adult , Colitis/etiology , Developing Countries , Diarrhea/etiology , Esophagitis/etiology , Female , Gastrointestinal Diseases/epidemiology , Gastrointestinal Hemorrhage/etiology , Humans , India/epidemiology , Ischemia/etiology , Male , Middle Aged , Pancreatitis/etiology
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