Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Bhanu K Bhakhri

"The Journal of Clinical and Diagnostic Research (JCDR) has been in operation since almost a decade. It has contributed a huge number of peer reviewed articles, across a spectrum of medical disciplines, to the medical literature.
Its wide based indexing and open access publications attracts many authors as well as readers
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Faculty, Pediatric Medicine
Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



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Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
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Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




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Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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Best regards,
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Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




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Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
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Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011

Important Notice

Original article / research
Year : 2007 | Month : June | Volume : 1 | Issue : 3 | Page : 110 - 115

Study Of Clinical Profile Of Malaria At KMC Hospital, Attavar,India

CHOWTA M N, CHOWTA K N

Department of Pharmacology,Kasturba Medical College, Mangalore- 575001

Correspondence Address :
Corresponding Author Dr. Mukta N Chowta,
Assistant Professor, Department of Pharmacology,Kasturba Medical College, Mangalore- 575001. Phone No. 0824-2445858, Email: muktachowta@yahoo.co.in

Abstract

Introduction India being a vast country with different geographical regions, the pattern of diseases may vary from place to place. The present study was undertaken to study the clinical features, complications, and response to treatment in a tertiary care hospital.

Methodology A prospective analysis of adult patients suffering from malaria was carried out at KMC hospital, Attavar during the year 2002-2003. Diagnosis of the patients was based on clinical features and by peripheral smear. The mode of presentation, clinical course, laboratory investigations, antimalarials administered, and complications were recorded. The response to treatment was noted both clinically and by repeating peripheral blood smear examinations.

Results Out of the 54 patients, 39 were males and 15 females. The age group of the patients ranged from 17 to 65 years. Fever was present in all the patients. 51.55 % of patients complained of headache and 31.55 % had vomiting. Jaundice was observed in 11 patients. Cough was also a complaint in four patients. Symptoms of gastritis were observed in two patients and two other patients had diarrhoea. Anaemia was present in 20 patients. Out of the 54 patients, 31.48% had infection with P.falciparum, 33.33% with P.vivax, and 29.62% had mixed infection. Chloroquine resistance was observed in nine patients. Complications were seen in 10 patients.

Conclusion Injudicious use and inadequate dosage of the available drugs need to be curbed. To achieve the global aim of malaria control, we must carry out an epidemiological survey to monitor the progression of resistance while planning an effective antimalarial strategy.

Malaria, a most serious vector-borne disease, is one of the major causes of illness and death in tropical and subtropical regions of the world. In addition to the direct effects it exerts by increasing premature mortality and morbidity, it is responsible for considerable economic wastage owing to lost man power and treatment costs.

These constitute a serious impediment to the economic development of countries in which this disease is endemic(1).
The plasmodium species have staged a devastating global comeback by imposing an alarming burden on the healthcare system. The worldwide prevalence of malaria is estimated to be approximately 300 to 500 million clinical cases each year and is endemic in 101 countries. It remains the world’s most important tropical parasite disease and kills more people than any other communicable disease except tuberculosis. Malaria has an estimated mortality of 1 million per year(2). Although there has been a decline in the total number of cases in India, plasmodium falciparum registered a significant increase. The mortality in malaria is due to plasmodium falciparum(3).
The epidemiological situation of malaria has shown a gradual deterioration in India. There has also been a quantum jump in the incidence of falciparum cases of malaria. It has also become apparent that chloroquine resistance of malaria has become a global problem, is perhaps one of the important causes of malarial resurgence, and needs update studies in all the states of India. This will help to form the effective therapeutic strategies to control its associated mortality and morbidity(4).
The morbidity and mortality associated with malaria has been held in check by the widespread availability of cheap and effective antimalarial drugs. However, the development of resistance to these drugs may represent the significant important threat to the health of the people in tropical countries.
Awareness of atypical presentation is important to detect cases of malaria in endemic areas. India being a vast country with different geographical regions, the pattern of the disease may vary from one place to the other. The present study was undertaken to study the clinical features, complications, and response to treatment in a tertiary care hospital.

Material and Methods

A prospective analysis of adult patients suffering from malaria was carried out at KMC hospital, Attavar during the year 2002-2003. Both males and females were included in the study. The diagnosis of the patients was based on clinical features and by peripheral smear. The mode of presentation, clinical course, treatment history, laboratory investigations reports, antimalarials administered, response to therapy, and complications were recorded. Fever clearance period was defined as the number of days required for the abatement of fever after starting the antimalarials.
Response to treatment was noted both clinically and also by repeating peripheral blood smear examinations. Sensitivity to Chloroquine was noted as per the WHO guidelines for extended field tests (1973)(5). Chloroquine resistance has been defined as the ability of the malarial parasite to survive and/or multiply despite administration and absorption of the drug given in doses equal or higher than usually recommended but within the tolerance of the subject (6).

It has been observed that if the features of malaria and slide positivity reappear within two weeks of treatment, the condition can be called recrudescence due to resistance. If the features recur between two and four weeks it may be due to either relapse or recrudescence. If the features occur after 4 weeks, it is most probably due to relapse.
Statistical analysis was done using chi square tests for catagorical variables. P value of less than 0.05 was considered significant.

Results

Out of the 54 patients, 39 (72.22%) were males and 15 (27.77%) were females in the age group of 17 to 65 years. Sexwise distribution of patients is statistically significant (p=0.025). Fever was present in all the patients (Statistically highly significant, p<0.001). The duration of fever was around 2 to 7 days. 51.55% of the patients complained of headache and 31.55% had vomiting. Jaundice was observed in 11(20.37%) patients. Cough was also a complaint in four patients. Symptoms of gastritis were seen in two patients and two other patients had diarrhoea. Anaemia was present in 20 patients (37.03%) in addition to fever. All other presenting symptoms are statistically not significant(Table/Fig 1).
Out of the 54 patients, 31.48% had infection with P.falciparum, 33.33% with P. vivax and 29.62% had mixed infection. Three patients received empirical treatment without the smear being positive (Table/Fig 2). Distribution of species is not statistically significant (p=1). Recurrent infections were observed in seven patients and two patients had recrudescence. Chloroquine resistance was seen in nine patients.
Complications were seen in 10 patients. The complications are cerebral malaria in one patient, pancreatitis in one patient, derangement of liver function in five patients, renal impairment in one patient, and thrombocytopenia in two patients. (Table/Fig 3). Incidence of complications were statistically not significant (p=0.20) There was no death reported in the present study. All the patients responded to treatment. Patients with chloroquine resistance received other antimalarials. The average duration required for smear negativity (parasite clearance time) was 3 to 5 days, and the average fever clearance period was 2 to 5 days. Apart from chloroquine, quinine was given to 5 patients, artemether to 12 patients; pyrimethamine/sulfdoxine combination to 17 patients. Sixteen patients also received doxycycline.

Discussion

The considerable morbidity and mortality in falciparum malaria is mainly due to its protean manifestations, multiorgan involvement and delay in diagnosis and failure of administration of treatment promptly and adequately. The emergence of gradually spreading drug resistance adds to the seriousness of the problem(7),(8).It is important for the clinician in tropical countries to be alert to the symptoms and signs that may progress to the life-threatening disease of falciparum malaria. Awareness of atypical presentation is important to detect cases of malaria in endemic areas where a careful search for the malarial parasite in the peripheral blood film should be undertaken in all the patients demonstrating clinical problems. The clinical suspicion alone can be the basis of an effective antimalarial drug.
A study from Jamshedpur in Jharkhand state of India has described the atypical presentation of falciparum malaria comprising convulsion in 28.55 %, abdominal pain in 5.7 %, hemiplegia in 2.8 %, generalized weakness and palpitation in 5.5 % of cases(9). In the present study, patients demonstrated atypical symptoms, such as cough, diarrhea, and gastritis. The sequestrations of erythrocytes containing metabolically highly active parasites in the vascular beds of internal organs can explain almost all the pathological events in severe and complicated falciparum malaria. Malarial parasite also induce the release of cytokines (TNF-alfa, IL-1.IL-6), initiating many of the symptoms and signs of malaria(10).
Anaemia is an important cause for high morbidity and mortality in falciparum malaria. Pathogenesis of anaemia in malaria is multifactorial. A complex chain of pathological processes involving parasite-mediated RBC destruction, marrow suppression, and accelerated removal of non-parasitised RBCs have all been implicated. In one study from Orissa, 86.7 % had anemia and 10 % had severe anaemia(11). The present study demonstrated anaemia in 20 (37.07%) patients.
Two of our patients had decreased platelet count. Thrombocytopenia is a common observation in falciparum malaria with spontaneous recovery on treatment. The mechanism suggested includes DIC
or excessive removal of platelets by the reticuloendothelial system(12).
The present study showed hyperbilirubinemia in 11 patients. Hyperbilirubinaemia in falciparum malaria
results from intravascular haemolysis of parasitized RBCs, hepatic dysfunction, and an element of microangiopathic haemolysis due to DIC(13).
Cerebral malaria is an important complication of falciparum malaria. Cerebral malaria was seen in one of the patients in the present study. The onset of coma may be sudden, often following a generalized seizure or gradual initial drowsiness, confusion, disorientation, delirium or agitation followed by unconsciousness(14).
Chloroquine remains the drug of first choice in P. vivax malaria because of its low cost, good tolerance, suitability for pregnant women and young children and easy availability. P. vivax resistance to chloroquine can pose a significant treatment problem because mefloquine and halofantrine, although effective, have not been studied in large number of vivax patients. Mefloquine, though marketed, is expensive as compared to chloroquine. Sulfadoxine-pyrimethamine, which works well against chloroquine resistant P. falciparum, is inexpensive but less efficacious against P.vivax. Pregnant women and children with resistant P.vivax pose yet another problem. Quinine is difficult to administer, and primaquine is contraindicated in pregnancy(15).
Malaria is a threat to almost half the world’s population, and the presence of MDR strains of falciparum pose a significant health problem. This problem has been further compounded b

References

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Hazra BR, Saha SK, Choudury RS, Ghosh MB, Das H. Resistance of malaria to Chloroquine at culcutta. JAPI, 1998; 46(10); 846-8.
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Sharma VP. Reemergence of malaria in India. Indian J. Med. Sci. 1996; 103; 26-45..
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Mehta SR. Falciparum malaria-210 cases, JAPI 1986:34; 119-210.
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Deb T, Mohanty RK, Ravi K, Bhagat BM. Atypical presentations of falciparum malaria. JAPI, 1992; 40;381-4.
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Bate CA, Taverne S, Playfair JH. Malarial parasite induces TNF production by macrophage. Immunology 1988; 64; 227-31.
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Sharma SK, Das RK, Das PK. Haematological and coagulation profile in acute falciparum malaria. JAPI, 1992:40; 581-3.
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Beale PJ, Cormack JD, Oldrey TB. Thrombocytopenia in malaria with immunoglobulin (IgM) changes. BMJ 1972; 1; 345-9..
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Srivatava A, Khanduri A , Lautakia S, Pandey R, Choudhary G. Falciparum malaria with acute liver failure. Trop. Gastroenterol. 1996;19;172-4
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Mehta SR, Naidu G, Chandar V, Singh IP, Johri S, Ahuja RC. Falciparum malaria-present day problems: an experience with 425 cases: JAPI 1989; 37; 264-7.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3]

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