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Latest articles on Coronavirus - Ahead of Print.
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Table of Contents
June 2020
Volume 151 | Issue 6
Page Nos. 505-617
Online since Tuesday, July 21, 2020
Accessed 33,024 times.
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EDITORIAL
Sickle cell disease: Progress made & challenges ahead
p. 505
Isaac Odame, Dipty Jain
DOI
:10.4103/ijmr.IJMR_2064_20
PMID
:32719221
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COMMENTARY
Epicardial adipose tissue: An anatomic component of obesity & metabolic syndrome in close proximity to myocardium & coronary arteries
p. 509
Gjin Ndrepepa
DOI
:10.4103/ijmr.IJMR_2692_19
PMID
:32719222
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WHITE PAPER
White paper on smokeless tobacco & women's health in India
p. 513
Shalini Singh, Pankhuri Jain, Prashant Kumar Singh, K Srinath Reddy, Balram Bhargava
DOI
:10.4103/ijmr.IJMR_537_20
PMID
:32719223
Smokeless tobacco (SLT) use is widespread across many nations and populations, and India shares more than three-quarters of the global burden of SLT consumption. Tobacco use in India has been largely viewed as a male-dominant behaviour. However, evidence from medical, social and behavioural sciences show significant SLT use among women and young girls. This paper highlights key dimensions of SLT use among women in India including prevalence and determinants, the health effects arising from SLT use and cessation behaviours. The paper concludes by providing recommendations with the aim of setting research priorities and policy agenda to achieve a tobacco-free society. The focus on women and girls is essential to achieve the national targets for tobacco control under the National Health Policy, 2017, and Sustainable Development Goals 3 of ensuring healthy lives and promote well-being for all.
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VIEWPOINTS
Occult drug resistance in tuberculosis: Emerging issues, upcoming challenges & possible solutions
p. 522
Baijayantimala Mishra, Prasanta Raghab Mohapatra
DOI
:10.4103/ijmr.IJMR_316_19
PMID
:32719224
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Why there are no effective herbal antidotes against snake venom available in India?
p. 525
Antony Gomes, Sourav Ghosh, Aparna Gomes
DOI
:10.4103/ijmr.IJMR_893_18
PMID
:32719225
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REVIEW ARTICLE
Allergic bronchopulmonary aspergillosis
p. 529
Ritesh Agarwal, Inderpaul S Sehgal, Sahajal Dhooria, Valliappan Muthu, Kuruswamy T Prasad, Amanjit Bal, Ashutosh N Aggarwal, Arunaloke Chakrabarti
DOI
:10.4103/ijmr.IJMR_1187_19
PMID
:32719226
Allergic bronchopulmonary aspergillosis (ABPA) is an inflammatory disease caused by immunologic reactions initiated against
Aspergillus fumigatus
colonizing the airways of patients with asthma and cystic fibrosis. The common manifestations include treatment-resistant asthma, transient and fleeting pulmonary opacities and bronchiectasis. It is believed that globally there are about five million cases of ABPA, with India alone accounting for about 1.4 million cases. The occurrence of ABPA among asthmatic patients in special clinics may be as high as 13 per cent. Thus, a high degree of suspicion for ABPA should be entertained while treating a patient with bronchial asthma, particularly in specialized clinics. Early diagnosis and appropriate treatment can delay (or even prevent) the onset of bronchiectasis, which suggests that all patients of bronchial asthma should be screened for ABPA, especially in chest clinics. The current review summarizes the recent advances in the pathogenesis, diagnosis and management of ABPA.
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POLICY DOCUMENT
Indian Council of Medical Research's International Collaboration & Partnerships; Health Ministry's Screening Committee: Facts, figures & procedures
p. 550
Mukesh Kumar, Harpreet Sandhu, Reema Roshan
DOI
:10.4103/ijmr.IJMR_654_20
PMID
:32719227
There is a great interest among various international agencies/countries in developing partnership with Indian research organizations, particularly with the Indian Council of Medical Research (ICMR) for biomedical research. The ICMR is actively involved in governance and co-ordination of partnerships with several international organizations and agencies. Various MoUs (Memorandum of Understanding)/agreements of ICMR with international partners bring together the researchers and resources towards progression through shared research and innovation agenda. Growing collaboration during recent years is reflected through increased number of internationally funded/technically coordinated research projects in health research. However, for any international collaborative research study to be undertaken in India, certain regulatory requirements are to be fulfilled. This article summarizes the international partnerships of ICMR as well as the details of guidelines regarding submission of international collaborative research projects for the Health Ministry's Screening Committee (HMSC), which is a mandatory requirement before undertaking such projects.
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ORIGINAL ARTICLES
Pathogenic gene expression of epicardial adipose tissue in patients with coronary artery disease
p. 554
Anagha Vinay Sahasrabuddhe, Shailesh U Pitale, Saravana Devi Sivanesan, Purushottam K Deshpande, Swapnil P Deshpande, Atul Daiwile
DOI
:10.4103/ijmr.IJMR_1374_18
PMID
:32719228
Background & objectives
:
Coronary artery disease (CAD), a leading cause of mortality and morbidity worldwide has multifactorial origin. Epicardial adipose tissue (EAT) has complex mechanical and thermogenic functions and paracrine actions
via
various cytokines released by it, which can have both pro- and anti-inflammatory actions on myocardium and adjacent coronaries. The alteration of EAT gene expression in CAD is speculated, but poorly understood. This study was undertaken to find out the difference in gene expression of epicardial fat in CAD and non-CAD patients.
Methods
:
Twenty seven patients undergoing coronary artery bypass graft (CABG) and 16 controls (non-CAD patients undergoing valvular heart surgeries) were included in the study and their EAT samples were obtained. Gene expressions of uncoupling protein-1, monocyte chemoattractant protein-1 (
MCP-1
), adiponectin, adenosine A1 receptor (
ADORA-1
), vascular cell adhesion molecule-1 (
VCAM-1
) and tumour necrosis factor-alpha (
TNF-α
) were studied by real-time reverse transcription-polymerase chain reaction. Glucose, insulin, lipid profile, high-sensitivity C-reactive protein, homocysteine, vitamin D,
TNF-α
and leptin levels were estimated in fasting blood samples and analyzed.
Results
:
Leptin levels were significantly higher in CABG group as compared to controls (
P
<0.05), whereas other metabolic parameters were not significantly different between the two groups.
MCP-1
,
VCAM-1
and
TNF-α
were upregulated in the CABG group as compared to controls. Further, multivariate analysis showed significantly reduced adjusted odds ratio for
MCP-1
[0.27; 95% confidence interval: 0.08-0.91] in the CABG group as compared to controls (
P
<0.05).
Interpretation & conclusions
:
Our findings showed an alteration in EAT gene expression in CAD patients with significant upregulation of
MCP-1
. Further studies with a large sample need to be done to confirm these findings.
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Findings from the 2017 HIV estimation round & trend analysis of key indicators 2010-2017: Evidence for prioritising HIV/AIDS programme in India
p. 562
Damodar Sahu, Pradeep Kumar, Nalini Chandra, Shobini Rajan, DK Shukla, S Venkatesh, Saritha Nair, Anil Kumar, Jitenkumar Singh, Srikanth Reddy, Sheela Godbole, A Elangovan, MK Saha, Sanjay Rai, P.V.M. Lakshmi, T Gambhir, Savina Ammassari, Deepika Joshi, Amitabh Das, Poonam Bakshi, Sabyasachi Chakraborty, Amol Palkar, SK Singh, D.C.S. Reddy, Shashi Kant, Arvind Pandey, M Vishnu Vardhana Rao
DOI
:10.4103/ijmr.IJMR_1619_19
PMID
:32719229
Background & objectives
:
The National AIDS Control Organisation (NACO) and the ICMR-National Institute of Medical Statistics, the nodal agency for conducting HIV estimations in India, have been generating HIV estimates regularly since 2003. The objective of this study was to describe India's biennial HIV estimation 2017 process, data inputs, tool, methodology and epidemiological assumptions used to generate the HIV estimates and trends of key indicators for 2010-2017 at national and State/Union Territory levels.
Methods
:
Demographic Projection (DemProj) and AIDS Impact Modules (AIM) of Spectrum 5.63 software recommended by the United Nations Programme on HIV and AIDS Global Reference Group on HIV Estimates, Modelling and Projections, were used for generating HIV estimations on key indicators. HIV sentinel surveillance, epidemiological and programme data were entered into Estimation Projection Package (EPP), and curve fitting was done using EPP classic model. Finally, calibration was done using the State HIV prevalence of two rounds of National Family Health Survey (NFHS) -3 and -4 and Integrated Biological and Behavioural Surveillance (IBBS), 2014-2015.
Results
:
The national adult prevalence of HIV was estimated to be 0.22 per cent in 2017. Mizoram, Manipur and Nagaland had the highest prevalence over one per cent. An estimated 2.1 million people were living with HIV in 2017, with Maharashtra estimated to have the highest number. Of the 88 thousand annual new HIV infections estimated nationally in 2017, Telangana accounted for the largest share. HIV incidence was found to be higher among key population groups, especially people who inject drugs. The annual AIDS-related deaths were estimated to be 69 thousand nationally. For all indicators, geographic variation in levels and trends between States existed.
Interpretation & conclusions
:
With a slow decline in annual new HIV infections by only 27 per cent from 2010 to 2017 against the national target of 75 per cent by 2020, the national target to end AIDS by 2030 may be missed; although at the sub-national level some States have made better progress to reduce new HIV infection. It calls for reinforcement of HIV prevention, diagnosis and treatment efforts by geographical regions and population groups.
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Proactive preparedness for Cat Que virus: An
Orthobunyavirus
existing in India
p. 571
Anita Shete, Pragya D Yadav, Mangesh Gokhale, Rajlaxmi Jain, Prachi Pardeshi, Triparna Majumdar, Devendra T Mourya
DOI
:10.4103/ijmr.IJMR_1195_18
PMID
:32719230
Background & objectives
:
The presence of Cat Que virus (CQV) in
Culex
mosquitoes and pigs has been reported in China and Vietnam. Due to the spread of similar species of the
Culex
mosquitoes in India, there is a need to understand the replication kinetics of this virus in mosquito models. As a part of preparedness and to identify the presence of this CQV in humans and swine, this study was carried out to develop diagnostic tests.
Methods
:
Serological and molecular diagnostic assays were developed for testing the mosquito population, human and swine serum samples. In this line, RNA-dependent RNA polymerase (
L
), glycoprotein (
M
) and nucleocapsid (
S
) genes-based reverse transcription-polymerase chain reaction (RT-PCR) assays were developed for CQV. Real-time RT-PCR was used for screening of retrospectively collected human serum samples (n=1020) with acute febrile illness during 2014-2017. Simultaneously, an in-house anti-CQV swine and human IgG ELISAs were also developed to detect anti-CQV IgG antibody. Human serum samples (n=883) with post-onset of disease (POD) >4 days and swine serum samples (n=459) were tested for the presence of anti-CQV IgG antibodies. CQV NIV 612,045 isolate was used for susceptibility and replication kinetics experiment using three different species of mosquitoes to understand its behaviour in Indian mosquitoes.
Results
:
All human serum samples (n=1020) screened for the presence of CQV using real-time RT-PCR were found to be negative. Anti-CQV IgG antibody positivity was recorded in two of 883 human serum samples tested. Virus susceptibility experiments indicated that three species of mosquito, namely
Aedes aegypti
,
Culex quinquefasciatus
and
Cx. tritaeniorhynchus
supported multiplication of CQV by intrathoracic as well as artificial membrane/oral feeding routes.
Interpretation & conclusions
:
Anti-CQV IgG antibody positivity in human serum samples tested and the replication capability of CQV in mosquitoes indicated a possible disease causing potential of CQV in Indian scenario. Screening of more human and swine serum samples using these assays is required as a proactive measure for understanding the prevalence of this neglected tropical virus.
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Comparison of efficacy of potassium titanyl phosphate laser & diode laser in the management of inferior turbinate hypertrophy: A randomized controlled trial
p. 578
Subhashini Puducherry Ravichandran, Karthikeyan Ramasamy, Pradipta Kumar Parida, Arun Alexander, Sivaraman Ganesan, Sunil Kumar Saxena
DOI
:10.4103/ijmr.IJMR_424_18
PMID
:32719231
Background & objectives
:
Inferior turbinate hypertrophy (ITH) is a common condition causing nasal obstruction. This study was undertaken to compare the efficacy of potassium titanyl phosphate (KTP) laser and diode laser in the reduction of the turbinate size.
Methods
:
This randomized controlled trial included 209 patients with ITH. Pre-operative symptoms were assessed based on the Nasal Obstruction Symptom Evaluation (NOSE) score. Diagnostic nasal endoscopy was done to rule out other nasal sinuses. Nasal mucociliary clearance was measured by saccharin transit time (STT). Postoperatively, the NOSE score, STT and complications were assessed at days one and two, at one week, one month and three months.
Results
:
Of the 209 patients analyzed at day one, the median NOSE score was 50 in the diode group and 40 in the KTP group, and at three months, 15 in the diode group and five in the KTP group. KTP laser showed a 93 per cent improvement in the NOSE score as compared to 77 per cent improvement shown by diode laser group. Among the intra-operative complications, of the 104 patients in the diode group, 6.73 per cent had burning sensation and 91.43 per cent had bleeding, and of 105 patients in the KTP group, 54.29 per cent had burning sensation and 36.54 per cent had bleeding. Among the post-operative complications in the KTP group, 32 and 34 per cent had bloody nasal discharge on days one and two, compared to 12 and 14 per cent in diode group. Crusting was present in 61 and 49 per cent on days one and two in KTP group as compared to 9 and 15 per cent in diode group, respectively. In the KTP group 30 per cent had synechiae as compared to 10 per cent in diode group.
Interpretation & conclusions
:
KTP laser was more efficacious than diode laser in improving the NOSE scores but with slightly increased rate of complications in early post-operative period. Both the lasers impaired the mucociliary clearance mechanism of the nose till three months of post-operative follow up.
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Distribution of carbapenemase genes in clinical isolates of
Acinetobacter baumannii
& a comparison of MALDI-TOF mass spectrometry-based detection of carbapenemase production with other phenotypic methods
p. 585
Megha Sharma, Lipika Singhal, Vikas Gautam, Pallab Ray
DOI
:10.4103/ijmr.IJMR_1383_18
PMID
:32719232
Background & objectives
:
Carbapenemase-producing
Acinetobacter baumannii
(CRAB) poses a continuous threat to the current antimicrobial era with its alarming spread in critical care settings. The present study was conducted to evaluate the diagnostic potential of phenotypic methods for carbapenemase [carbapenem-hydrolyzing class D β-lactamases (CHDLs) and metallo-β-lactamases (MBLs)] production, by comparing with molecular detection of genes.
Methods
:
One hundred and fifty clinical CRAB isolates collected between August 2013 and January 2014 were studied. Multiplex PCR was performed to identify the carbapenemases produced (class D
bla
OXA-51
,
bla
OXA-23
,
bla
OXA-48,
bla
OXA-58
; class B
bla
VIM
,
bla
NDM-1
,
bla
IMP
; class A
bla
KPC
). Each isolate was evaluated for carbapenemase production by studying the pattern of imipenem hydrolysis using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS).
Results
:
The most commonly encountered carbapenemase genes were
bla
OXA-51
(100%),
bla
OXA-23
(98%),
bla
VIM
(49.3%),
bla
NDM-1
(18.7%) and
bla
OXA-58
(2%). MALDI-TOF MS was able to detect 30.6 per cent carbapenemases within three hours (
P
=0.001 for MBL and
P
>0.05 for CHDL) and 65.3 per cent within six hours (
P
=0.001 for MBL and
P
>0.05 for CHDL).
Interpretation & conclusions
:
MALDI-TOF MS reliably detected carbapenemase activity within a short span of time, thus helping in tailoring patient therapy. MALDI-TOF MS, once optimized, can prove to be a useful tool for timely detection of carbapenemase production by
A. baumannii
and consequently in directing appropriate antimicrobial therapy.
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Role of
LRRK2
variant p.Gly2019Ser in patients with Parkinsonism
p. 592
Dipanwita Sadhukhan, Arindam Biswas, Arunima Bhaduri, Neelanjana Sarkar, Atanu Biswas, Shyamal K Das, Tapas K Banerjee, Kunal Ray, Jharna Ray
DOI
:10.4103/ijmr.IJMR_25_18
PMID
:32719233
Background & objectives
:
Parkinsonian disorder, including Parkinson's disease (PD), is an aetiologically complex neurodegenerative disorder. Mutations in leucine-rich repeat kinase 2 (
LRRK2
) gene have been implicated in an autosomal dominant form of PD with variable penetrance. The identification of a common
LRRK2
variant (p.Gly2019Ser) in dementia with Lewy bodies indicated its potential role in Parkinsonian disorder. The current study was aimed to identify the p.Gly2019Ser variant in Indian patients with Parkinsonian disorder.
Methods
:
The patient group consisting of 412 classical PD patients, 107 PD patients with cognitive impairment, 107 patients with Parkinson plus syndrome and 200 unrelated controls were recruited from eastern part of India. The allele representing p.Gly2019Ser variant was screened by polymerase chain reaction followed by restriction fragment length polymorphism analysis.
Results
:
The p.Gly2019Ser variant was identified in an East Indian young-onset female PD patient in a heterozygous state having several motor and autonomic problems without disturbed cognition. Her younger brother, sister and elder son harbouring the same mutation were asymptomatic carriers for the variant. However, the influence of
DNM3
on decreased disease onset in this family was not clear.
Interpretation & conclusions
:
Identification of the p.Gly2019Ser variant in only one patient among a large number of Indian patients (n=626) with Parkinsonian disorder in our study suggests a limited role of the
LRRK2
variant towards disease pathogenesis.
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Trends & treatment outcomes of multidrug-resistant tuberculosis in Delhi, India (2009-2014): A retrospective record-based study
p. 598
Nandini Sharma, Ashwani Khanna, Shivani Chandra, Saurav Basu, Kamal K Chopra, Neeta Singla, Neeti Babbar, Charu Kohli
DOI
:10.4103/ijmr.IJMR_1048_18
PMID
:32719234
Background & objectives
:
The increase in the burden of multidrug-resistant tuberculosis (MDR-TB) is a matter of grave concern. The present study was undertaken to describe MDR-TB treatment outcome trends in Delhi and their epidemiological correlates, to assess the adequacy of treatment records and to also generate evidence towards influencing and improving practices related to the MDR-TB control programme.
Methods
:
A retrospective record-based study (2009-2014) was conducted in three major drug resistance TB treatment centres of Delhi. Treatment outcomes and adverse effects were extracted from the existing programme records including patients' treatment cards and laboratory registers.
Results
:
A total of 2958 MDR-TB patients were identified from the treatment cards, of whom 1749 (59.12%) were males. The mean (±standard deviation) age was 30.56±13.5 years. Favourable treatment outcomes were reported in 1371 (53.28%) patients, but they showed a declining trend during the period of observation. On binomial logistic regression analysis, patients with age ≥35 yr, male sex and undernourishment (body mass index <18.5) at the time of treatment initiation had a significantly increased likelihood of unfavourable MDR-TB treatment outcome (
P
<0.001).
Interpretation & conclusions
:
The study showed an increasing burden of MDR-TB patients, especially in the young population with increased risk of transmission posing a major challenge in achieving TB elimination targets.
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A survey of clinical practices among oncologists regarding hepatitis B screening in patients with cancer
p. 604
Sridhar Sundaram, Prachi Patil, Manju Sengar, Raosaheb Rathod, Shaesta Mehta
DOI
:10.4103/ijmr.IJMR_2327_18
PMID
:32719235
Background & objectives
:
Screening for hepatitis B prior to the initiation of chemotherapy in patients with cancer is recommended by all major hepatology and oncology societies. This study was aimed to determine the screening practices for hepatitis B among oncologists from India and their experience with hepatitis B reactivation.
Methods
:
A questionnaire-based survey was conducted among oncologists attending the Evidence-Based Medicine Conference at Tata Memorial Centre, Mumbai, India. The questionnaire was developed in keeping with the recent guidelines for hepatitis B reactivation on chemotherapy, with questions regarding demographics, years in practice and hepatitis B screening practices and management. There was 78 per cent response rate to the questionnaire.
Results
:
Most respondents were <35 yr of age (69%), with < five years of experience (39%), practicing in an academic institution (81%). Seventy four per cent respondents always screened their patients with cancer for hepatitis prior to chemotherapy, whereas 19 per cent in special settings and seven per cent never screened; 96 per cent respondents used hepatitis B surface antigen (HBsAg) as a screening test, while 17 per cent also used antibody to hepatitis B core antigen. Sixty one per cent respondents used entecavir or tenofovir for prophylaxis; 70 per cent continued prophylaxis till 6-12 months after completion of chemotherapy, while 21 per cent continued only till the end of chemotherapy.
Interpretation & conclusions
:
More than 25 per cent of the oncologists were not screening their patients with cancer for viral hepatitis prior to cancer-directed therapy, and only 17 per cent of the oncologists used the recommended tests for screening. Better training of oncologists regarding viral hepatitis screening and management is needed.
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Innovative virtual mentoring using the Extension for Community Healthcare Outcomes model for primary care providers for the management of alcohol use disorders
p. 609
Jayant Mahadevan, Lekhansh Shukla, Prabhat Kumar Chand, Miriam Komaromy, Pratima Murthy, Sanjeev Arora
DOI
:10.4103/ijmr.IJMR_1851_18
PMID
:32719236
The number of experts available for the management of alcohol use disorders (AUDs) in rural and underserved areas in India is limited. In this study, a blended training programme was conducted for 26 primary care providers (PCPs) from nine districts of Bihar, in best practices for the management of AUDs. A two weeks on-site training was followed by fortnightly online tele-Extension for Community Healthcare Outcomes (ECHO) clinics for six months using the 'Hub and Spokes' ECHO model, accessible through internet-enabled smartphones. A questionnaire administered at baseline and after six months assessed changes in the PCPs compliance with principles of AUD management. Significant improvements were noted in compliance to principles in the management of AUDs based on self-report. Over the six months period 2695 individuals were screened, of whom 832 (30.8%) had an AUD Identification Test score of more than 16, indicating harmful use or dependence. The PCPs reported retaining 49.1 per cent of the cases for at least one follow up and needed to refer only 80 (3%) cases to specialists for further management. The ECHO model was found to be effective in training PCPs to provide quality healthcare. To confirm these findings, it needs to be tested in a large number of PCPs with a robust study design.
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CLINICAL IMAGE
Oculodermal melanocytosis
p. 613
Kanhaiya Mittal, Shorya Vardhan Azad
DOI
:10.4103/ijmr.IJMR_1950_17
PMID
:32719237
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BOOK REVIEW
Mosaic of autoimmunity: The novel factors of autoimmune diseases
p. 615
Narinder K Mehra
DOI
:10.4103/ijmr.IJMR_1491_19
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