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Autoantibody Profile and Its Association with Clinical Presentation of Paediatric SLE Patients
Kalyan Benjamin Gomes,
Mohammad Imnul Islam,
Shahana Rahman
Issue:
Volume 5, Issue 4, December 2019
Pages:
178-182
Received:
8 July 2019
Accepted:
12 August 2019
Published:
9 September 2019
Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of various auto antibodies including anti-nuclear antibody, double stranded DNA and antibodies to extractable nuclear antigens (ENA), which include four groups of RNA binding protein namely Sm, RNP, SSA/Ro and SSB/La. The objectives were to detect the frequency and pattern of ANA, frequency of anti- ENA antibodies and association between the clinical presentations with ANA and Anti-ENA antibodies in paediatric SLE patients. It was a cross sectional study and the data was collected from patients fulfilling the ACR 1997 revised criteria of SLE in the Department of Paediatrics, BSMMU, Dhaka, Bangladesh. Among 50 paediatric SLE patients, ANA was positive in 94% of the patients. Homogenous pattern of ANA was the highest (57%) followed by speckled (31%), cytoplasmic (6.6%) and nucleolar (3.3%) patterns. Anti-ds DNA positivity was 86% and anti-ENA positivity was 56% in this study. Among them, anti–RNP was found in 43.5% followed by anti-sm (24%), anti-SSA (24%) and anti-SSB (17%). Anti–RNP antibody was associated with renal and gastrointestinal and Anti–SSA was associated with only gastrointestinal manifestations. ANA, anti ds-DNA, anti ENA positivity were found significantly among paediatric SLE patients and clinical presentation of them had association with Anti-ENA antibodies.
Abstract: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterized by the production of various auto antibodies including anti-nuclear antibody, double stranded DNA and antibodies to extractable nuclear antigens (ENA), which include four groups of RNA binding protein namely Sm, RNP, SSA/Ro and SSB/La. The objectives were to detect the...
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The Rapeutic Effect of Milrinone Combined With Labetalol in Treatment of Severe Cardiopulmonary Failure Caused by Hand, Foot and Mouth Disese
Wenli Li,
Huiyuan Cheng,
Yuliang Cheng
Issue:
Volume 5, Issue 4, December 2019
Pages:
183-186
Received:
18 February 2019
Accepted:
25 July 2019
Published:
18 September 2019
Abstract: Goal research on therapeutic effect of milrinone combined with Labetalol in treatment of severe cardiopulmonary failure induced by Hand, Foot and Mouth disease. Method: 50 cases of stage 3 pediatric patients with Hand, foot and Mouth disease between January 2010 – February 2014, randomly assigned to treatment group vs control group with 28 cases in each group. No statistical difference (p>0.05) was found between two groups in terms of patient age, sex and blood pressure, heart rate. Two groups were treated according to guideline on severe Hand, Foot and Mouth diseases, including supplemental oxygen, blood glucose monitoring, vital sign monitoring, anti-virus, methylprednisolone, lowering intracranial pressure, gama- globulin, milrinone (loading dose 50 ug/kg, slow infusion within 10 minutes, maintenance dose 0.25-0.75 ug/kg/min using micro-infusion pump). Besides above mentioned regular treatment, treatment group received labetalol (1-2 mg/kg/day, oral, q 8 h, Tid, hold when sinus rhythm lower than 20-30% of baseline, normal bp, heart rate between 120-130). Data on heart rate, bp variation, mechanical ventilation, adverse reaction after 24 hour, 48 hour and 72 hour was recorded by x±s and compared using t-test. RESULT: Blood pressure is 109±10.38 24 hours after treatment in treatment group. Heart rate is 132±15.64 beats/minutes. Blood pressure is 91±8.3 mmHg 48 hours after treatment. Heart rate is 122±17.8/minutes. Blood pressure is 89±11.4mmHg 72 hours after treatment. Heart rate is1 02±14.8 beats/minutes.. Blood pressure, heart rate has substantial improvement on treatment group compared with control group. The difference is statistically significant (p<0.05). Comparing mechanical ventilation rate between two group (mechanical ventilation case before initiation of treatment was not taken into account), treatment group only have 1 case (0.04%), whereas control group has 6 cases (24%). Difference between two group is statistically significant, X2=4.37, P<0.05. And no adverse reaction was found. Conclusion: Milrinone combined with Labetalol significantly improves cardio-pulmonary function in cardio -pulmonary failure patient caused by severe hand, foot, mouth disease. Combined treatment significantly prevent disease progression and improves prognosis.
Abstract: Goal research on therapeutic effect of milrinone combined with Labetalol in treatment of severe cardiopulmonary failure induced by Hand, Foot and Mouth disease. Method: 50 cases of stage 3 pediatric patients with Hand, foot and Mouth disease between January 2010 – February 2014, randomly assigned to treatment group vs control group with 28 cases in...
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Early Diagnosis and Successful Treatment of Congenital Huge Hydrometrocolpos Secondary to Low Transverse Vaginal Septum with Obstructive Symptoms
Zelalem Ayichew,
Zerubabel Tegegne,
Mequanint Melesse
Issue:
Volume 5, Issue 4, December 2019
Pages:
187-190
Received:
28 May 2019
Accepted:
1 July 2019
Published:
18 September 2019
Abstract: Obstructive congenital anomalies of the female reproductive tract are rare and usually noticed during adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass and local compressive symptoms. It is very rare for such cases to be symptomatic during early childhood from mucous collection. Congenital hydrometrocolpos (an accumulation of watery fluid in the uterus and vagina) that occurs during fetal period is a very rare condition, only with some case reports. The diagnosis is challenging and usually made late which delays the management resulting poor outcome from local compressive symptoms. We present a case diagnosed with huge congenital hydrometrocolpos secondary to low transverse vaginal septum using ultrasound by experienced radiologist and meticulous genital examination in a 5 day old neonate who had abdominal distention and difficult to pass urine since birth where incision of the septum transvaginally and drainage of the fluid was done to relieve symptoms with successful outcome.
Abstract: Obstructive congenital anomalies of the female reproductive tract are rare and usually noticed during adolescent period for failure to see menses with cyclic abdominal pain, abdominal mass and local compressive symptoms. It is very rare for such cases to be symptomatic during early childhood from mucous collection. Congenital hydrometrocolpos (an a...
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Antibiotic Resistance Pattern in Children with UTI: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh
Md. Atiqul Islam,
Sheuly Begum,
Salina Shaheen Parul,
A. K. M. Tajuddin Bhuyian,
Md. Tazul Islam,
Md. Kariul Islam
Issue:
Volume 5, Issue 4, December 2019
Pages:
191-195
Received:
19 June 2019
Accepted:
31 July 2019
Published:
18 September 2019
Abstract: Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. Occurrences of a first-time symptomatic UTI are highest in boys and girls during the first year of life and markedly decrease after that. Febrile infants younger than 2 months constitute an important subset of children who may present with fever without a localizing source. For resistance knowledge of etiology pathogens of UTIs and their antimicrobial resistance patterns in specific geographical location may help clinicians in choosing the appropriate antimicrobial. Our aim was to assess bacteriological profile and antibiotic resistance pattern in pediatric UTI. A cross sectional study was conducted at Dhaka Shishu Hospital during the period from Feb 2016 to Aug 2016. A total of 147 culture positive UTI patient were considered for analysis. Colony counts for these samples were identified, and the profile of antibiotic resistance was identified. Here, samples with a colony count of ≥105 CFU/mL bacteria were considered positive. A total 147 culture positive UTI patients were enrolled. Here, Escherichia coli (E-coli) was found as the most prevalent isolates 103 (70%) followed by Klebsiella spp. 13.6%, Pseudomonas 5.44%, Enterobacter spp 3.40%, Staphylococcus Aureus 3.40%, Proteus 2.72% and Enterococcus 1.36%. Twelve (12) antimicrobial agents were used for antimicrobial susceptibility testing. The most resistant drugs we found were Colistin (CL) (94.55%), followed by Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%) and Ceftazidime (CTM) (48.98%). None of the drug found was 100% resistance against urinary pathogens. Antimicrobial drug resistance is decreasing among urinary pathogens. We suggest that, empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organism and their antibiotic resistance in a specific area rather than on universal or even national guidelines.
Abstract: Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. Occurrences of a first-time symptomatic UTI are highest in boys and girls during the first year of life and markedly decrease after that. Febrile infants younger than 2 months constitute...
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Whole Exome Sequencing Revealed a Candidate Gene for Finkelstein-Seidlmayer Disease
Gabriel Bronz,
Heinz Gabriel,
Sebastiano Antonio Lava,
Gian Paolo Ramelli,
Manuel Luedeke,
Saskia Biskup,
Carlo Mainetti,
Alessandra Ferrarini
Issue:
Volume 5, Issue 4, December 2019
Pages:
196-199
Received:
6 August 2019
Accepted:
11 September 2019
Published:
26 September 2019
Abstract: Background: Finkelstein-Seidlmayer disease (FSD) is a benign cutaneous small-vessel leukocytoclastic vasculitis syndrome, which normally affects children between 2-60 months in a male-to-female ratio of 2:1. Skin lesions may appear as papules, erythematous macules, or urticaria. They are symmetric, sharp-edged and favouring the face, ears and extremities. Frequently they are targetoid, annular, medallion-like, or cockade. Fever and extracutaneous involvement are rare and spontaneous resolution occurs in 1-3 weeks. Case Information: In 2015, we reported a familial occurrence of FSD. Patients described in that article were the mother and all her three sons. All of them had a history of recurrent and relapsing non-thrombocytopenic, red-to-purpuric skin lesions, with a neonatal-onset. There was no systemic involvement. Anamnestic data revealed that maternal aunt, cousin and grandmother had also a positive history of neonatal onset of an acute cockade purpura and oedema. At that time, we suspected a genetic form of FSD with an autosomal dominant transmission or X-linked inheritance and incomplete penetrance. Method and Results: Blood samples were obtained from all available family members and a whole exome sequencing (WES) was performed on various affected and non-affected members of this family. The genetic analysis identified a common new mutation in the HCK gene. Conclusion: Up now, FSD is considered a sporadic disease and no genetic researches have been published on affected patients. We performed WES on a previously reported familiar case of FSD and the result was a common mutation in HCK gene. We found out the mutation on all the analysed affected and obligate-carrier members of the family. HCK gene encodes for a hematopoietic cell kinase protein, which is a member of the SRC family of cytoplasmic tyrosine kinases (SFK). We propose that HCK gene could be a candidate gene in the pathophysiology of some types of FSD. We also discuss the autosomal dominant transmission and incomplete penetrance of these specific types of disease.
Abstract: Background: Finkelstein-Seidlmayer disease (FSD) is a benign cutaneous small-vessel leukocytoclastic vasculitis syndrome, which normally affects children between 2-60 months in a male-to-female ratio of 2:1. Skin lesions may appear as papules, erythematous macules, or urticaria. They are symmetric, sharp-edged and favouring the face, ears and extre...
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Neonatal Screening for Cystic Fibrosis: A Meta Analysis Study
Ashraf Mahmood,
Divya Rajmohan,
Shahnawaz Hashmi,
Shayan Faiq,
Adewale Plumptre,
Robert Soltes,
Zahir Faruqi,
Lubna Attal
Issue:
Volume 5, Issue 4, December 2019
Pages:
200-208
Received:
11 June 2019
Accepted:
11 September 2019
Published:
9 October 2019
Abstract: Objective: The main goal of this literature review is to investigate and compare the current screening procedures for the diagnosis of cystic fibrosis in neonates. Cystic Fibrosis or CF is a lethal, genetic disease. The disease is neither too widespread nor too rare. There are more than 30,000 CF patients in the United States, and the number of CF carriers is still unidentified. CF affects more than one organ system in patient’s body; due to this, there is no definitive treatment plan for the disease. The cure is dependent on the results of prenatal and postnatal diagnosis. The patients may exhibit all or few symptoms associated with the disease. Sometimes, symptoms are completely absent at the time of birth and become more prevalent with the age. Methods & Materials: We extensively studied the peer-reviewed scientific journals to understand the existing diagnostic and screening methods for cystic fibrosis. During our research, we kept the focus on newborn screening and evaluated the clinical data from previous studies. We retrieved tables and figures from electronic databases to indicate these results more effectively. We also analyzed the available information on sensitivity, specificity, positive predictive value and negative predictive value of these screening programs. Result & Conclusion: The data indicates that sensitivity of neonatal screening programs is less than 90% (or even below 80% in some cases) when only one test is performed. However, sensitivity increases as the multi-stage approach is adopted. Besides, the CF detection rate is also influenced by multiple factors including ethnicity and age of the patient, duration of the study, type of CFTR mutation, nutritional habits, etc. Many studies need to be carried out to determine optimal cutoff values for both IRT and the sweat test. Genomics and computational biology can be used not only in identifying the other important CFTR mutations, but also in evaluating their impact on the patient’s body.
Abstract: Objective: The main goal of this literature review is to investigate and compare the current screening procedures for the diagnosis of cystic fibrosis in neonates. Cystic Fibrosis or CF is a lethal, genetic disease. The disease is neither too widespread nor too rare. There are more than 30,000 CF patients in the United States, and the number of CF ...
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Clinical Improvement After Oral Magnesium Supplementation in Children with Severe Acute Malnutrition-An Observational Study
Abdullah Al Baki,
A. Z. M. Motiur Rahman,
Md. Shohidul Islam Khan,
Md. Arif Rabbany,
Kamrunnaher Shultana,
Dhiman Chowdhury,
Muhammad Ismail Hasan,
Mohammad Morshad Alam,
Md. Mozammel Haque
Issue:
Volume 5, Issue 4, December 2019
Pages:
209-213
Received:
26 August 2019
Accepted:
27 September 2019
Published:
11 October 2019
Abstract: The primary objective of this study was to determine the clinical improvement after oral magnesium (Mg2+) supplementation in severely malnourished children. The specific objectives were to observe the changes in clinical sign-symptoms between Mg2+ supplemented and un-supplemented group and to see serum Mg2+ level before and after oral Mg2+ supplementation. This observational study was conducted in three tertiary level hospitals in Dhaka city involving 60 severely malnourished children of 6-59 months of age by non-probability purposive sampling from July’2016 to June’2018. Children were divided into two groups; Group I was given standard management for severe acute malnutrition according to the national guideline, Group II received similar treatment plus oral Mg2+ supplementation. Improvement of the clinical profile and the serum Mg2+ level was observed in children treated with Mg2+ supplementation. The mean age of Group I children was 21.13±13.02 months and Group II was 22.52±12.13 months. Male female ratio was 1.2:1. Statistically significant improvement was observed in case of nausea/vomiting, appetite, generalized weakness and weight gain (p<0.01). Appearance, diarrhea, skin changes and edema also improved in Mg2+ supplemented group but the results were not significant. Post-treatment serum Mg2+ levels were significantly different in Group I and Group II i.e., 1.52±0.27mg/dL Vs 2.03±0.31mg/dL respectively (p<0.001). It was observed that oral Mg2+ supplementation improved clinical outcome in severely malnourished children. Further large scale randomized control trial is needed to more precisely delineate the beneficial role of oral Mg2+ supplementation in severely malnourished children.
Abstract: The primary objective of this study was to determine the clinical improvement after oral magnesium (Mg2+) supplementation in severely malnourished children. The specific objectives were to observe the changes in clinical sign-symptoms between Mg2+ supplemented and un-supplemented group and to see serum Mg2+ level before and after oral Mg2+ suppleme...
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Paediatric Day Case Surgical Practice at a Tertiary Hospital in Enugu, Nigeria
Chukwubuike Kevin Emeka,
Ozor Ignatius Ikemefuna,
Nduagubam Obinna Chukwuebuka
Issue:
Volume 5, Issue 4, December 2019
Pages:
214-218
Received:
20 September 2019
Accepted:
7 October 2019
Published:
21 October 2019
Abstract: Background: An increasing number of paediatric day case surgeries are being carried out in developing countries due to the benefits of day case surgery and lots of papers are being published. However, there is no published paper on paediatric day case surgery from Enugu State University Teaching Hospital (ESUTH), Enugu. Methodology: This was a prospective study of children who had surgery on day case basis at the paediatric surgery unit of a tertiary hospital in Enugu, south east Nigeria, over a period of one year. Result: Out of the 135 surgeries done during the period of the study, 81 cases were day case surgeries, accounting for 60% of the cases. There were 69 males (85.2%) and 12 females (14.8%). The mean age and weight of the patients was 44.9 months and 16.5 kilograms respectively. The mean duration of surgery was 35.1 minutes while the mean duration of stay in the hospital post-surgery before going home was 5.2 hours. The most common diagnosis was hydrocele and herniotomy/herniorraphy was the most common surgical procedure performed. Conclusion: Paediatric day case surgery constitutes a significant workload of the paediatric surgeon. Herniotomy/herniorraphy was the most common procedure performed and most parents were satisfied. The scope of paediatric day case can be improved and the practice made more effective.
Abstract: Background: An increasing number of paediatric day case surgeries are being carried out in developing countries due to the benefits of day case surgery and lots of papers are being published. However, there is no published paper on paediatric day case surgery from Enugu State University Teaching Hospital (ESUTH), Enugu. Methodology: This was a pros...
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Clinical Profile of Dengue and Predictors of Its Severity Among Children
Sharmin Afroze,
Salim Shakur,
Abrar Wahab,
Salomee Shakur
Issue:
Volume 5, Issue 4, December 2019
Pages:
219-223
Received:
26 September 2019
Accepted:
14 October 2019
Published:
23 October 2019
Abstract: Dengue fever is a self-limiting, systemic viral illness that has a wide range of clinical manifestations. Last year dengue was severe in children with much mortality. This study was aimed to see the clinical profile of dengue and to find out the risk factors for developing severity. This cross sectional study was conducted over four months (June-September, 2018) in Department of Pediatrics of United Hospital Limited. All admitted dengue cases were analyzed. The predictors of developing severity were assessed by comparing variables between classical and severe dengue fever groups. A total of 106 children with Dengue fever were admitted. Mean age was 5.8±3 years with male predominance (60%). Common presentations include fever (100%), flushed appearance (72%), rash (43%), vomiting (39%), abdominal pain (36%), shock (28%) and respiratory distress (23%). In risk factor analysis, overweight (OR: 8.275, CI: 1.378-49.706) and massive serositis (OR: 17.86, CI: 4.733-67.399) were found statistically significant predictors of severe dengue. The overall mortality was 3%. So, overweight children and those patients who develop massive serositis are at increased risk of having severe dengue. Early identification of these features can help physicians to manage these cases judiciously.
Abstract: Dengue fever is a self-limiting, systemic viral illness that has a wide range of clinical manifestations. Last year dengue was severe in children with much mortality. This study was aimed to see the clinical profile of dengue and to find out the risk factors for developing severity. This cross sectional study was conducted over four months (June-Se...
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The Effect of Parenting Style in Junior High School Adolescent’s Self-Esteem
I. Gusti Ayu Trisna Windiani,
Sri Maya,
I. Gusti Ngurah Sanjaya Putra,
Ida Bagus Subanada
Issue:
Volume 5, Issue 4, December 2019
Pages:
224-229
Received:
29 September 2019
Accepted:
14 October 2019
Published:
23 October 2019
Abstract: Self-esteem is important in adolescent, with good self-esteem adolescents able to actualize their potential to create positive social interactions. Self-esteem increases in children, decreases in adolescence and increases in adulthood then declines in old age. The level of self-esteem is influenced by significant people, especially parents. The objective was to prove adolescents from non-democratic parenting style have lower self-esteem than democratic parenting style. The study was conducted in Government Junior High School Denpasar from January until April 2018. Schools were chosen by simple random sampling, meanwhile samples were collected consecutively. Parenting styles was assessed by Kuesioner Pola Asuh Anak (KPAA) and self-esteem by Rosenberg questionnaire. Statistic analysis was performed by Chi-square test followed by multivariate logistic regression analysis, significancy level was set to p<0.05, confident interval (CI) 95%. Total 125 adolescents enrolled in this study, 21 were excluded, 104 samples including 52 adolescents from democratic parenting style and 52 adolescents from non-democratic parenting style. Clinical different was found in mother’s occupation meanwhile bivariate analysis with Chi-square showed significant different of low self-esteem 32.7% in non-democratic, 5.8% in democratic parenting style (p=0.001; RP=5.667, CI: 1.766 to 18.178). Finally multivariate logistic regression analysis showed low self-esteem in adolescent was influenced by non-democratic parenting style. This study concluded non-democratic parenting style is risky to induce low self-esteem in adolescent.
Abstract: Self-esteem is important in adolescent, with good self-esteem adolescents able to actualize their potential to create positive social interactions. Self-esteem increases in children, decreases in adolescence and increases in adulthood then declines in old age. The level of self-esteem is influenced by significant people, especially parents. The obj...
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Congenital Cytomegalovirus Infection Presenting as Pneumonia with Respiratory Distress and Thrombocytopenia
Nipun Shrestha,
Bhabuk Sharma Majagaiya,
Dhruba Shrestha
Issue:
Volume 5, Issue 4, December 2019
Pages:
230-233
Received:
12 August 2019
Accepted:
6 September 2019
Published:
23 October 2019
Abstract: Human Cytomegalovirus (CMV) is a member of Herpes viridae family, that affects most of the human population at some stage of live and is the most common congenital infection causing sensorineural hearing loss and neurodevelopmental delay in newborn. CMV infection may be acquired in a newborn congenitally or after delivery, but except for the congenital infection, other mode of infection rarely result in significant symptoms or sequel in them. Clinical findings of congenital CMV infection include IUGR, hydrops, generalized petechiae, purpura, thrombocytopenia, jaundice, hepatosplenomegaly, pneumonitis, microcephaly, periventricular calcifications, seizures, chorioretinitis, sensorineural hearing loss, bone abnormalities, abnormal dentition, and hypocalcified enamel. Here we present a case of congenital CMV infection who presented with Pneumonia with Respiratory distress and thrombocytopenia. A single, live, term, female child delivered at home developed low grade fever, cough and increased oral secretion at 28 day of life and was initially diagnosed as Pneumonia with respiratory distress with thrombocytopenia. Mother and child, both were investigated for TORCH infection which came out to be positive for CMV infection (child’s serum CMV Ab IgM 94 U/ml). Her CMV Viral Load Real Time PCR tested positive with 56380 copies/ml.
Abstract: Human Cytomegalovirus (CMV) is a member of Herpes viridae family, that affects most of the human population at some stage of live and is the most common congenital infection causing sensorineural hearing loss and neurodevelopmental delay in newborn. CMV infection may be acquired in a newborn congenitally or after delivery, but except for the congen...
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Relationship Between Demand for Emergency Room Care in Newborns and Maternal Counseling About the Main Events in the Neonatal Period
Angelo Carneiro Bonadio,
Raquel Aparecida Oliveira
Issue:
Volume 5, Issue 4, December 2019
Pages:
234-239
Received:
29 August 2019
Accepted:
25 September 2019
Published:
31 October 2019
Abstract: The neonatal period, between the date of birth and twenty-eighth days after birth, is a time when parents face many doubts and anxiety. Even previous experiences are not enough to avoid or diminish parental anxiety. Therefore, parents commonly take their newborns to emergency units to care for simple health disorders. Despite reassuring the parents, this custom can be harmful to the newborns because they get exposed to a wide pathogen circulation environment. Since immunity from vaccination is still not complete, as well as due to the age-specific immunodeficiency, this behavior is risky to the newborns. The study aims to reduce the newborns’ care flow to emergency units using educational interventions in maternity wards. Methodology: This is a descriptive, quantitative and qualitative study, that evaluate the impacts of an educational intervention done by pediatricians, in the municipal maternity of Salto de Pirapora, in the Brazilian countryside. It is based in individual questionnaires, applied before the educational intervention to 99 mothers and newborns’ accompanying parties, in order to understand the most frequent concerns about the main health problems during the neonatal period. A dialogical educative intervention was done in the maternity regarding how and when the newborn should be taken to an emergency unit. The same mothers answered an intervention evaluation questionnaire after the neonatal period; the data of newborns’ care flow towards emergency units before and after the intervention was also compared. The results show that there was a reduction on the emergency services demand. The proportion of patients going to the emergency room was 36.7% on the last year and 30.56% two years before the intervention. The reduction reached about 12.33% after the intervention, an average reduction of 21.3%. The biggest concerns of the participants were: fever 65.63%, choking or suffocating 39.58% and constant crying 33.33%.
Abstract: The neonatal period, between the date of birth and twenty-eighth days after birth, is a time when parents face many doubts and anxiety. Even previous experiences are not enough to avoid or diminish parental anxiety. Therefore, parents commonly take their newborns to emergency units to care for simple health disorders. Despite reassuring the parents...
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Osteoporosis Is a "Silent" Problem in Children’s Sport Medicine
Klyuchnikov S. O.,
Samoylov A. S.,
Pushkina T. A.,
Zholinsky A. V.,
Kravchuk D. A.,
Ogannisyan M. G.,
Sholkova Y. Y.,
Feshchenko V. S.
Issue:
Volume 5, Issue 4, December 2019
Pages:
240-245
Received:
15 July 2019
Accepted:
26 August 2019
Published:
8 November 2019
Abstract: The article is devoted to one of the relevant problems of modern medicine - osteoporosis. Osteoporosis epidemiology, risk factors, diagnostic approaches, which are confirmed in domestic and foreign researches, are discussed. Particular attention is paid to the ambiguity and inconsistency of information on osteoporosis in childhood and adolescence, as well as the lack of convincing studies of this issue in children's sports medicine. The authors analyze the generally accepted approaches to the identification of risk groups for the osteoporosis development in children, the predisposing factors and the complex issues of osteoporosis diagnostics. Paper includes data on own observations of the most complex group of children and adolescents involved in sport, including professional sport. A separate section is devoted to the analysis of prescribed medications for the prevention and treatment of osteoporosis in children and young athletes. The data are presented in accordance with the official information provided by World Anti-Doping Agency (WADA, 2017).
Abstract: The article is devoted to one of the relevant problems of modern medicine - osteoporosis. Osteoporosis epidemiology, risk factors, diagnostic approaches, which are confirmed in domestic and foreign researches, are discussed. Particular attention is paid to the ambiguity and inconsistency of information on osteoporosis in childhood and adolescence, ...
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Lyme Meningitis in Children with Acute Serous Meningitis with no Clinical Signs of Lyme Borreliosis at Presentation
Mojca Rozic,
Andra Leskovec,
Eva Ruzic-Sabljic,
Maja Arnez
Issue:
Volume 5, Issue 4, December 2019
Pages:
246-253
Received:
18 October 2019
Accepted:
5 November 2019
Published:
11 November 2019
Abstract: We evaluate the incidence of Lyme meningitis (LM) in children with acute serous meningitis and compare demographic, clinical and laboratory findings in children with LM and non-LM. During 2004-2005, 122 children fulfilled the inclusion criteria for this prospective clinical study (age < 15 years, meningitis, without typical clinical sign for Lyme borreliosis on admission). Antibodies to B. burgdorferi sensu lato were determined in blood and cerebrospinal fluid (CSF) and isolation of B. burgdorferi sensu lato was performed. LM was confirmed by isolation of B. burgdorferi sensu lato from blood and/or CSF and/or seroconversion to borrelial antigens and/or demonstration of borrelial intrathecal antibody production and/or history of erythema migrans. LM was probable in patients with positive but unchanging borrelial serum antibody titers. LM (83% confirmed, 17% probable) was established in 41 (34%) patients. Demographic, clinical and neurologic findings were comparable between the two groups. Fever and peripheral leukocytosis were more common in non-LM and inappetence and lymphocytic pleocytosis in LM. Borrelial serum IgM and/or IgG was found in 25%, seroconversion in 39%, IgG intrathecal antibody production in 5% and isolation of B. burgdorferi sensu lato from CSF and blood in 41% and 22% of patients, respectively. LM was found in 34% of children with acute serous meningitis. It is impossible to distinguish LM from non-LM only from medical history, clinical examination and basic blood and CSF investigations. For this reason, other signs of Lyme borreliosis and microbiological studies on Lyme borreliosis are compulsory.
Abstract: We evaluate the incidence of Lyme meningitis (LM) in children with acute serous meningitis and compare demographic, clinical and laboratory findings in children with LM and non-LM. During 2004-2005, 122 children fulfilled the inclusion criteria for this prospective clinical study (age < 15 years, meningitis, without typical clinical sign for Lyme borreliosis on admission). Antibodies to B. burgdorferi sensu lato were determined in blood and cerebrosp...
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Balanced Approach to Neonates and Young Infants with Fever
Gihad Alsaeed,
Ibrahim Alsaeed,
Mohamed Alsaeed
Issue:
Volume 5, Issue 4, December 2019
Pages:
254-259
Received:
16 October 2019
Accepted:
7 November 2019
Published:
14 November 2019
Abstract: Fever in early infancy may indicate the presence of an invasive bacterial infection [IBI]. Viral infection is the most common cause of fever in young infants, with Rhinovirus being the most common. Rectal temperature 38°C should be considered as fever. Bacterial infection may be the cause of fever in this age group even in the presence of a clear viral etiology. Evaluation and treatment of febrile infants during the first 3 months of life requires a balanced and cautious approach. After the introduction of vaccines in early infancy, there have been considerable changes in the bacterial pathogens and consecutive changes in the evaluation and empiric treatment of febrile young infants. While full septic screen seems necessary in the evaluation of many febrile young infants, partial septic screen without Lumbar puncture could be better in selected cases. It is the responsibility of the pediatrician to recognize the risk of invasive bacterial infection and to avoid unnecessary investigations at the same time. In this study, we suggest a simple approach that avoids the weak points of the available approach plans. Using clinical examples, we try to simplify this practical challenge.
Abstract: Fever in early infancy may indicate the presence of an invasive bacterial infection [IBI]. Viral infection is the most common cause of fever in young infants, with Rhinovirus being the most common. Rectal temperature 38°C should be considered as fever. Bacterial infection may be the cause of fever in this age group even in the presence of a clear v...
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Initial Hemodynamic Profiles of Children with Dengue Shock Syndrome in Referral Settings
Desy Rusmawatiningtyas,
Putu Aditya Wiguna,
Intan Fatah Kumara,
Nurnaningsih,
Saptadi Yuliarto,
Eggi Arguni,
Antonius Pudjiadi,
Sutaryo
Issue:
Volume 5, Issue 4, December 2019
Pages:
260-266
Received:
16 October 2019
Accepted:
8 November 2019
Published:
19 November 2019
Abstract: Background: Fluid therapy for dengue shock syndrome (DSS) requires a dynamic approach that involves monitoring of the pathophysiological processes as well as the preload, contractility, and afterload assessment during the course dengue infection. Hemodynamically unstable DSS patients received in referral setting often complicated by fluid overload and secondary infection. Objective: This study aims to provide hemodynamic profiles and fluid responsiveness of pediatric patients admitted to the PICU with DSS. Methods: Hemodynamic profiles, laboratories, and demographic data were collected from patients aged 1 month to 18 years old with DSS who were admitted to the Pediatric Intensive Care Unit (PICU) at Dr. Sardjito General Hospital, Yogyakarta, Indonesia from January to December 2016. Hemodynamic profiles were assessed in clinically shock and not clinically shock group at PICU admission using the non-invasive Ultrasonic Cardiac Output Monitor (USCOM). Fluid responsiveness in clinically shock group was evaluated after fluid challenge with 10 ml/kgBW crystalloid or colloid. Results: Eighty six subjects were included in this study. Sixty six subjects were admitted to PICU with clinically shock condition. This group received less intravenous fluid than hemodynamically stable group (6.9 vs 7.52 ml/kgBW/hour respectively), had higher mean hematocrit level (42.09% vs 40.32% respectively), had higher hematocrit level during PICU stay (43.37% vs 42.06% respectively), significantly higher percentage to receive inotropes agent (62,1% vs 5%, p 0,000) and longer duration of inotropes usage (23,5 vs 0 hours, p 0.72). From the clinically shock patients admitted to PICU, only 19,69% were fluid responsive. Other subjects in this group with fluid non responsive state, 90,38% had low inotropic index and high systemic vascular resistance index. Among 8 patients in clinically shock group who died during PICU stay, 6 of them had low cardiac Index, fluid non responsive condition, low inotropic index and high systemic vascular resistance index. Conclusion: Only a small percentage of DSS patients with clinically shock admitted to the PICU were fluid responsive. Majority of DSS cases in children had low inotropy index and high systemic vascular resistance index.
Abstract: Background: Fluid therapy for dengue shock syndrome (DSS) requires a dynamic approach that involves monitoring of the pathophysiological processes as well as the preload, contractility, and afterload assessment during the course dengue infection. Hemodynamically unstable DSS patients received in referral setting often complicated by fluid overload ...
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A Case of Pediatric Cerebral Hemorrhage Complicated with Infective Endocarditis
Keishiro Furuie,
Hiroshi Tamura,
Osamu Matsuo,
Hiroshi Mitsubuchi
Issue:
Volume 5, Issue 4, December 2019
Pages:
267-269
Received:
6 October 2019
Accepted:
4 November 2019
Published:
25 November 2019
Abstract: The mortality rate associated with cerebral hemorrhage as a complication of IE is extremely high despite the development of preventive and antibiotic therapy. We report a 13-year-old female whose previous medical history includes Jeune syndrome and mitral regurgitation. She was taken to a nearby hospital because of high body temperature. She had no symptoms of cold or gastrointestinal disturbance and was diagnosed with upper respiratory tract inflammation. On the subsequent day, she experienced a seizure and was brought to the emergency department of the general hospital. Her head computed tomography (CT) revealed bleeding and mild cerebral edema in the left occipital lobe. A mild systolic murmur was audible upon auscultation. She presented with carious tooth and Janeway lesions. Methicillin-resistant Staphylococcus aureus (MRSA) was positive on blood culture examination, cerebrospinal fluid examination was negative. A diagnosis of IE was established based on the Duke criteria. Antibiotic therapy was administered. Thereafter, the symptoms disappeared without any adverse effects, and antibiotic administration was ended in six weeks. After the discharge, dental treatment was initiated. There was no recurrence of IE at 3 years after the onset, and no sequelae were observed. Although the prevalence of cerebral hemorrhage as a complication of IE is low, the associated mortality rate is extremely high despite the development of preventive and antibiotic therapy. Moreover, there is no consensus regarding the treatment method. In this case, only a conservative treatment was performed without sequelae. Pediatric patients with stroke associated with IE may have better outcome than adults. It is important to suspect IE and to provide immediate or early treatment if fever and central nervous symptoms are observed in cases with underlying heart disease.
Abstract: The mortality rate associated with cerebral hemorrhage as a complication of IE is extremely high despite the development of preventive and antibiotic therapy. We report a 13-year-old female whose previous medical history includes Jeune syndrome and mitral regurgitation. She was taken to a nearby hospital because of high body temperature. She had no...
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Parapneumonic Pleural Effusions Consist of Two Distinct Entities
Issue:
Volume 5, Issue 4, December 2019
Pages:
270-275
Received:
27 October 2019
Accepted:
22 November 2019
Published:
4 December 2019
Abstract: Pleural effusions (PE) complicating pneumonia are usually considered as one entity. But some effusions collect from the start of pneumonia (“sinpneumonic”-SPE), others appear after antibiotics have been started started (“metapneumonic” – MPE). Material, methods. It is a retrospective clinical study (1980-1990s); with new therapies tested over next 20 years. Included are 2561 children with pneumonia (1 month – 14 years); 424 of them had PE, classified as SPE (173) or MPE (251 – 59%). Usual labs and immune complexes levels in blood and PE were studied. Results. Of 281 positive PE S. pneumoniae was identified in 88%, H. influenzae type b – 5%, S. pyogenes – 8%, S. aureus – 4%. MPE was mostly seen in necrotizing pneumonia in under-5 children, particularly with antibiotics started late-after 4th day. MPE starts with initial short drop of temperature that recurs to 39,5-40,5°C and lasts 5-20 days, refractory to antibiotic changes. PE are always serous or serous-fibrinous with WBC <1000/mm3, pH>7.3, glucose >3.0 mmol/l; X-ray show costal pleura fibrin deposition. Initial blood WBC, CRP, procalcitonin levels are elevated, normalizing with necrotic pneumonia resolution. From this point ESR rapidly rises to 40-80 mm/h – a landmark of MPE. We found a much higher levels jf pneumococcal antigens containing immune complexes with complement consumption in MPE, compared to SPE – in both blood and PE. This suggested an immune mechanism of MPE and justified the administration of steroids (prednisolone 1 mg/kg/d for 2-4 days) that stops fever within 1-2 days (100% cases). Full fibrin resorption occurs in 1-2 months, rarely more, making unnecessary fibrinolysis, drainage or thoracoscopy. Conclusions. MPE is an immunopathologic complication of pneumonias’ antibiotic treatment that results from microbial cells destruction by antibiotics liberating an antigen excess favoring immune complexes formation, pleura being the shock organ. Recognition of MPE is paramount for the therapy choice, particularly – steroids, and for reducing invasive procedures.
Abstract: Pleural effusions (PE) complicating pneumonia are usually considered as one entity. But some effusions collect from the start of pneumonia (“sinpneumonic”-SPE), others appear after antibiotics have been started started (“metapneumonic” – MPE). Material, methods. It is a retrospective clinical study (1980-1990s); with new therapies tested over next ...
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Successful Closure of Patent Ductus Arteriosus by Late Pharmacologic Treatment in a Small Preterm Infant
Boro Theodore,
Ouedraogo Paul,
Bama Aime,
Seghda Arthur,
Zagre Nicaise,
Zabsonre Patrice,
Simpore Jacques
Issue:
Volume 5, Issue 4, December 2019
Pages:
276-280
Received:
4 November 2019
Accepted:
28 November 2019
Published:
10 December 2019
Abstract: The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosis and pharmacologic management of patent ductus arteriosus (PDA) could prevent further need for invasive surgery or transcatheter intervention. Pharmacologic treatment for PDA closure in preterm infants is achieved by cyclooxygenase inhibitors (COXi) and paracetamol. However, their effectiveness is fully demonstrated when they are used early within the first week of postnatal life. We report here the case of a severe preterm infant of 27 weeks gestation age with extremely low birth weight (995g), who had a PDA with moderate to severe shunting closed after late administration of intravenous ibuprofen. Ibuprofen was started on postnatal day 40, and the PDA got closed after a three-day course of treatment. No complication related to the treatment was reported. The DA remained closed when the infant was seen on review for echocardiography at the age of six months. Wherever cardiac surgery and transcatheter intervention are not available nor affordable, possible effectiveness of COXi even in case of late diagnosis of PDA, offers an unexpected opportunity to cure at a very cheaper cost, one of the commonest congenital heart disease.
Abstract: The ductus arteriosus (DA) is a temporary communicative pathway that connects the pulmonary artery to the aorta during fœtal life. Although usually closing on its own in the initial days of postnatal life, the persistent patency of the DA is common in preterm or low birth weight babies, and can lead to life-threatening complications. Early diagnosi...
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Differences Between Quality of Life in Children with Infrequent and Frequent Relapse of Nephrotic Syndrome
Ni Putu Eka Suwitri,
I Ketut Suarta,
I Gusti Ayu Trisna Windiani
Issue:
Volume 5, Issue 4, December 2019
Pages:
281-285
Received:
15 November 2019
Accepted:
9 December 2019
Published:
19 December 2019
Abstract: Nephrotic syndrome is a common disease in children. The syndrome consists of massive proteinuria, hypoalbuminemia, edema and hypercholesterolemia which may lead to relapse and remission episodes, thus affect child’s quality of life. The objective was to determine the quality of life difference between children with infrequent and frequent relapse of nephrotic syndrome. This study was an observational analytic study with cross-sectional design, conducted at the Pediatric outpatient clinic in Sanglah Hospital, Denpasar, Indonesia, from January 2016 to January 2017. Independent t-test was performed to assess quality of life differences in patients with infrequent and frequent relapse of nephrotic syndrome, with significancy level p <0.05 and precision set at 95% confidence interval. The quality of life in children was measured by PedsQL 4.0 Generic Core Scales Questionnaire. Subjects consisted of 14 infrequent relapse samples and 14 frequent relapse samples. The average scores of quality of life in children based on their parents’ reports were 85.70 (8.96) from infrequent relapse group and 82.24 (12.56) from the frequent relapse group (p=0.410). Meanwhile, based on the children’s report, the quality of life score were 88.79 (9.30) from infrequent relapse group and 82.59 (12.09) from frequent relapse group (p=0.194). This study concluded that there was no significant difference of physical, emotional, social, school functions subscale scores and quality of life score based on children and parents’ reports in both groups.
Abstract: Nephrotic syndrome is a common disease in children. The syndrome consists of massive proteinuria, hypoalbuminemia, edema and hypercholesterolemia which may lead to relapse and remission episodes, thus affect child’s quality of life. The objective was to determine the quality of life difference between children with infrequent and frequent relapse o...
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Correlation Between Soy Milk Formula Consumption with Plasma Estradiol Level and Growth of Children in Denpasar
I Gusti Ayu Trisna Windiani,
Alice Indradjaja,
I Gusti Agung Ngurah Sugitha Adnyana,
Soetjiningsih
Issue:
Volume 5, Issue 4, December 2019
Pages:
286-290
Received:
6 November 2019
Accepted:
16 December 2019
Published:
24 December 2019
Abstract: Soy milk formula is a formula which contains soybean as a substitute for cow's milk protein. Consumption of soy formula has caused widespread concern especially related to the effect of isoflavones. We aimed to determine the correlation of plasma estradiol level and to compare physical growth in children who consumed soy milk formula with children who consumed cow's milk formula. This was a case-control study of children aged six months to two years old who were treated at pediatric outpatient clinic in Sanglah Hospital and private pediatric outpatient clinic in Denpasar from April to July 2015. Subjects were divided into children who consumed soy milk formula and children who consumed cow’s milk formula. Data regarding physical examination, anthropometric measurements, diet types and estradiol level were obtained. Total 28 subjects enrolled. We found significant difference in estradiol level between the two groups (OR: 0.33; p = 0.001; 95% CI = 0.17 - 0.64). We found no significant difference in sexual development between those two groups (OR: 1.25; p = 0.12; 95% CI = 0.92 - 1.71). Furthermore we found no significantly different in physical growth of subjects who consumed soy milk formula compared to cow's milk formula (p>0.05). Soy milk formula consumption did not associated with significant difference of sexual development and growth in children consuming soy milk compared to cow’s milk. However, it related to increament of estradiol level.
Abstract: Soy milk formula is a formula which contains soybean as a substitute for cow's milk protein. Consumption of soy formula has caused widespread concern especially related to the effect of isoflavones. We aimed to determine the correlation of plasma estradiol level and to compare physical growth in children who consumed soy milk formula with children ...
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Exploration of Vitamin D Supplementation Adjuvant Therapy for Childhood Asthma and the Best Treatment Options
Zhendong Yang,
Xuding Sun,
Jihong Wu,
Gaojun Zhou,
Yingyang Xu,
Xiong Xie,
Kai Guan
Issue:
Volume 5, Issue 4, December 2019
Pages:
291-298
Received:
12 November 2019
Accepted:
12 December 2019
Published:
24 December 2019
Abstract: Vitamin D not only promotes the health of human bones and muscles but also has an important impact on the metabolism of extraskeletal tissues. As a steroid hormone, vitamin D possesses important physiological functions, including cell differentiation and proliferation and immune regulation. Research has shown that vitamin D insufficiency (VDI) or vitamin D deficiency (VDD) can make children susceptible to asthma. Vitamin D has important immunoregulatory functions associated with preventing the occurrence of asthma or the worsening of its symptoms, improving lung function and enhancing glucocorticoid (GCS) action. An increasing number of randomized controlled intervention studies have confirmed that vitamin D affects the occurrence and development of asthmatic diseases. In recent years, accumulating laboratory and clinical research has supported the use of vitamin D as an adjuvant treatment for asthma and has achieved good clinical results. But the clinical outcome of vitamin D in the treatment of asthma is not as impressive as experimental studies. In addition to the complexity of clinical research, it may be related to clinical application methods. In order to combine theory with clinical practice, focused on exploring and selecting the most effective vitamin D adjuvant treatment of asthma, and comprehensively optimizing and applying these methods is beneficial to improve the therapeutic effect. However, there are different opinions regarding the results of the studies.
Abstract: Vitamin D not only promotes the health of human bones and muscles but also has an important impact on the metabolism of extraskeletal tissues. As a steroid hormone, vitamin D possesses important physiological functions, including cell differentiation and proliferation and immune regulation. Research has shown that vitamin D insufficiency (VDI) or v...
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Fluid Overload in Children with Severe Sepsis and Septic Shock
Copana Raul,
Diaz Willmer
Issue:
Volume 5, Issue 4, December 2019
Pages:
299-303
Received:
17 October 2019
Accepted:
20 December 2019
Published:
31 December 2019
Abstract: Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was conducted in 49 hospitalized children with septic shock in the PICU of the Manuel Ascencio Villarroel Children’s Hospital (MAVCH); The patients were divided into two groups according to the FO>10% (22 patients) and<10% (18 patients), for their descriptive analysis we included comparison of means and calculation of the OR. Regarding the water requirements, we observed that the group with FO>10% a mean of 5681ml; while in the group with ISCH<10% the mean was 3297.8ml (p=0.19) during first 72 hours, showing greater overload with the administration of colloids and blood products (p=0.02, p=0.004). Regarding hospital outcomes, was found morbidity associated with FO>10% (respiratory dysfunction, vasopressor requirement and renal replacement therapy); The length of hospitalization and FO were not different in groups (p=0.60), but there was higher mortality of patients with FO>10% (p=0.01, OR: 5.57 IC95% 1.4-21.8). Fluids therapy of in the patient with septic shock constitutes one of the first-line hemodynamic treatments, however in limited resources settings, overload should be avoided, mainly due to associated morbidity during the first 72 hours.
Abstract: Fluid therapy is one pillar of the treatment of septic shock, however, a hydric≥10% of the weight or Fluid Overload (FO>10%) is associated with poor hospital outcomes. The present study aims to determine the FO in patients with septic shock, and its main associations in terms of mortality and morbidity. An observational and descriptive study was co...
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