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.
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Super Speciality Paediatric Hospital and Post Graduate Teaching Institute, Noida
On Sep 2018




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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
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Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




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"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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Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
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Professor and Head
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Saraswati Dental College
Lucknow
On Sep 2018




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Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




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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.
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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.
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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 : 2008 | Month : April | Volume : 2 | Issue : 2 | Page : 715 - 719

Differences In Risk Factors And Mortality, In Young And Old Individuals With Acute Myocardial Infarction In Goa

DANG A, DIAS A

Dr. Amit Dang, M.B.B.S, Post graduate student, Dept. Of Pharmacology, Goa Medical College, Goa. Dr.Amit Dias, MD, DTM&H, DGM, Epidemiologist and Geriatrician, Dept. of Preventive and Social Medicine, Goa Medical College, Goa.

Correspondence Address :
Dr. Amit Dang, Room no. 8, ground floor, Residents hostel (G.A.R.D), Goa medical college Bambolim, Goa-403202 , Mobile no. 09764001983 E-mail address: dramit_gmc@rediffmail.com

Abstract

Background: Coronary Heart Disease (CHD) is a major cause of mortality and is a global health problem.
Aims: There could be a difference in the risk factors in the young and the old individuals with Acute Myocardial Infarction (AMI), and the information about these may have an influence on the strategies for preventive cardiology. In this study, we tried to investigate the same.
Settings and design: Retrospective record based study done in a government medical college.
Methods and materials: Records of patients with AMI admitted from January 1 to December 31, 2005 were investigated retrospectively. A total of 355 patients admitted to the Department of Medicine with AMI, were analysed. Characteristics of the patients who were ≤ 45 years of age and were considered young were compared with those above 45 years.
Statistical analysis used: SPSS software.
Results: 22.25% (79) of those admitted with AMI were ≤ of 45 years. 11.39% (9) of the AMI in young individuals, occurred in females, compared to 27.69% (77) in the old AMI patients. 21.51% (17) of the young AMIs presented with cardiac failure (CF) compared to 41.30% (114) in the older age group. Risk factors like alcohol and smoking were more commonly found in the young AMIs, whereas diabetes mellitus (DM), hypertension (HT) and past history of Ischaemic Heart Disease (IHD) and AMI were higher in the older patients. 10.12% (8) of the young AMIs died, as compared to 27.53% (76) in the older population.
Conclusions: Preventive measures for AMIs in the younger age group should involve measures to prevent smoking and alcohol consumption. Preventive measures in the elderly patients should emphasise on control of DM and HT.

Keywords

Acute Myocardial Infarction (AMI), Coronary Heart Disease, risk factors, young AMIs, old AMIs, smoking, diabetes, hypertension, alcohol, cardiac failure.

Introduction
CHD is a major cause of mortality, and is a global health problem reaching epidemic proportions in both developed as well as developing countries. (1) Though during the past four decades there has been a slow but steady decline in age-adjusted mortality rates following AMI, (2) the incidence rate of acute coronary syndrome per se, has not declined. (3) CHD is forecast to be the most common cause of death in India by the year 2020.(4) South Asians on the other hand, have the highest rates of Coronary Artery Disease (CAD) around the globe. (5) The main aim of this study was to determine the differences in the risk factors and mortality in young and old individuals with AMI. Knowledge of the differences between the older and young AMI patients in our local population will help to develop strategies for preventive cardiology.

Material and Methods

All cases of AMI admitted to the Department of Medicine, Goa Medical College, in the year 2005 (January 1 to December 31), were reviewed retrospectively (discharged dead or alive) from the case papers which are kept month wise in the Medical Record Department (MRD), in a systematic manner. The data was retrieved by the first author, and ethical clearance was taken from institutional review board. Characteristics of the patients of AMI ≤ 45 years of age, who were considered young, were compared with those above 45 years i.e. older AMIs. Besides demographic details, information was collected on traditional cardiovascular risk factors like HT, DM, smoking, alcohol and past history IHD and AMI. We also recorded the outcome with respect to death or improvement.
Blood for lipid profile was drawn within 24 hours of hospital admission. A person was considered to be hypertensive if he was taking antihypertensive treatment, or was found to have a systolic BP of ≥ 140mm of Hg or a diastolic BP of ≥ 90mm of Hg. (6) History of diabetes was considered to be present if the individual was receiving therapy with either insulin or an oral hypoglycemic agent, or had symptoms of diabetes with a Random Blood Sugar Level of ≥ 200mg/dl or a Fasting Blood Sugar Level of ≥126 mg/dl. (7)

The criteria for diagnosis of AMI was by the presence of at least two of the following (8); (1) h/o typical chest pain > 30 min, (2) characteristic ECG changes of acute AMI, which were [a] evolution of pathological Q waves of > 0.04sec in duration, or [b] >0.1mV ST segment elevation in contiguous leads or [c] >0.1Mv ST segment depression or definite T wave inversion, or both. And (3) if CPK-MB > twice the normal upper limit. The documentation of cocaine use in this population was negligible, and was not included in the analysis.

Results

We examined a total 355 cases of AMIs admitted in year 2005. 22.25% (79) were young AMIs, and 77.74% (276) were old AMIs. The mean age of the young AMIs was found to be 41 years, and those of old AMIs was 62 years. Males accounted for 88% (70) of the young AMIs, compared to 72% (199) in older AMIs.
(Table/Fig 1) depicts the risk factors in both the age groups. HT was the most common risk factor in older age group, followed by smoking and DM. The younger age group in contrast, gave the H/o smoking as the most common risk factor. When we analysed the two age groups separately, we found that alcohol and smoking were significant risk factors in the younger age group. Nearly 32% (25) of young AMIs were alcoholic, and 56% (44) were smokers. We also found that past history of AMI was a significant risk factor in the older age group (χ2=5.07, df=1, p=0.024). Though the history of HT, DM and IHD were higher in the older age group, the difference was not statistically significant. Analysis of the lipid profile showed triglycerides to be a significant risk factor (t=2.674, df =296, p=0.008) in young AMIs (Table/Fig 2).

There was also difference in the clinical presentation at casualty between the two groups. Mean systolic and diastolic BP was more in young AMIs as compared to old AMIs, and was statistically significant as well (t=2.082, df=353, p=0.038 and t=2.654, df=353, p=0.008 respectively). Among the young patients with AMI, 21.5% (17) presented with cardiac failure compared to 41% (114) in the older individuals with AMI. This was found to be statistically significant (χ2=10.33, df =1, p=0.001). In the younger group with AMI, 63.3% (50) occurred in the anterior or anteroinferior wall, 32.9% (26) in the inferior, and 3.8% (03) in the posterior or posteroinferior wall. In the older group with AMI, 63.8% (176) occurred in the anterior or anteroinferior wall, 33% (91) in inferior wall, and 3.3% (9) in the posterior or posteroinferior wall. There was no statistically significant difference between the two groups (χ2=0.055, df =2, p=0.973).

On analyzing the variables resulting in the fatal outcome (Table/Fig 3), we found that the older patients with AMI were significantly more likely to die, compared to the young. (χ2=10.30, df =1, p=0.001). There was no significant difference between males and females (χ2=2.71, df =1, p=0.1). It was found that the patients who presented with anterior wall AMI are more likely to die as compared to those with inferior wall. We also found that patients with history of DM, smoking, IHD or those who presented with CF, are more likely to have fatal outcome. Forty percent of the patients who presented with CF died (Table/Fig 4).

Discussion

Out of 355 people admitted with AMI in year 2005, 22.25% (79) were ≤ 45 years {m=88% (70), f =12% (9)} and 77.74% (276) were > 45 years {m=72% (199), f=28% (77)}

According to the National Commission on Macroeconomics and Health (NCMH), there would be around 62 million patients with CAD by 2015 in India, and of these, 23 million would be patients who were younger than 40 years of age.(9) In this study, we found that in both the age groups, males were more likely to have AMI than females, the ratio being higher in the younger group (7.8:1) than the older group (2.6:1). A similar trend in young individuals with AMI was seen in the research done by Siwach SB et al in Haryana, India, where the male to female ratio was 20:1.(10). Some research papers have reported that elderly AMI patients were most likely to be females compared to young AMI patients.(11)

We found that smoking was the most common risk factor in young patients with AMI, followed by alcohol intake. This also echoed the results of other studies.[10,11,12] Smoking is associated with endothelial dysfunction, and can precipitate coronary spasm.(13) But this risk falls rapidly after people stop smoking.[14,15] Our findings, like other studies, emphasize the need of smoking cessation interventions.(16)

It was also noted that HT and DM are less frequent in younger AMI patients than in older AMIs, which was also the finding in the study by V.C.Woon et al(11) However, our findings were not statistically significant unlike the findings of Tesak et al and Tresch et al.[17,18]
Other risk factors such as past history of IHD and AMI were higher in the elderly. The difference in the proportion of people with past history of MI in the two groups was statistically significant. (χ2=5.07, df =1, p=0.024).

Dyslipidaemia has been found to be one of the most important contributing factors, and it has long been known that lipid abnormalities are major risk factors for premature CAD. (19) Analysis of the lipid profile showed only triglycerides to be a significant risk factor in young AMIs (t=2.674, df =296, p=0.008). Sawant et al have reported the increased prevalence of hypercholesterolaemia and hypertriglyceridaemia being more prominent in the 31-40 age group than in the ≤ 30 age group in the adult Indian population. (20) Also, high TG levels have been associated with increased levels of small dense LDL, which are considered to be highly atherogenic.(21) Hypertriglyceridaemia also predisposes an individual to thrombosis by increasing the factor VII coagulant activity.
We found that AMI is associated with significantly higher mortality in the elderly (27.53%, 76), as compared to the young population (10.12%, 8). Numerous studies have reported a similar finding.[10,11,22,23,24].

In this study, we also noticed that patients with anterior wall infarction were more likely to die (28.32%, 64), as compared to those with an inferior wall AMI (11.97%, 14) This was in accordance with a finding by Tesak et al(17)
We also found that elderly patients were more likely to develop CF and die (χ2=10.33, df=1, p=0.001), indicating that heart failure at the time of admission is a very unfavourable factor for the prognosis of the patient. This was also seen in several other studies[25,26] and as suggested by V C Woon et al, future research should be aimed at developing more effective strategies for prevention of CF in elderly patients.(11)
In accordance with other studies(27), it was found that DM was an important risk factor influencing the outcome in AMI, as 31% (42) of patients of AMI with diabetes died (χ2=5.432, df=1, p=

References

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Chaturvedi V, Bhargava B. Health Care Delivery for Coronary Heart Disease in India- Where are we Headed ? Am Heart Hosp J 2007;5:32-37
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American Heart Association. 2002 Heart and Stroke Statistical Update. Dallas, TX: American Heart Association. 2001:1–39.
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Franzosi M, Santoro E, DeVita C et al. Ten-year follow-up of the first megatrial testing thrombolytic therapy in patients with acute myocardial infarction. Results of the GISSI-1 study. Circulation 1998;98:2659–65
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Yusuf S, Reddy S, Ounpuu S, Anand S. Global burden of cardiovascular disease. Part II. Variations in cardiovascular disease by specific ethnic groups and geographic regions and prevention strategies. Circulation 2001;104:2855–64
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Enas EA, Chacko V, Pazhoor SG et al., Dyslipidemia in South Asian Patients. Current Atherosclerosis Reports 2007;9: 367-74.
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Chobanian AV, Bakris GL, Black HR et al. Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension. 2003;42:1206-1252
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American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2005; 28 (Suppl 1.): S37-S42.
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Ryan TJ, Anderson JL, Antman EM et al. ACC/AHA guidelines for the management of patients with acute myocardial infarction. A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on management of acute myocardial infarction). J Am Coll Cardiol 1996;28:1328–1428.[CrossRef]
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Indrayan A. Forecasting vascular disease cases and associated mortality in India. Reports of the National Commission on Macroeconomics and Health. Ministry of Health and Family Welfare, India 2005. Available at: http://www.whoindia.org/EN/Section102/Section201_888.htm. Accessed February 18, 2008
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Siwach SB, Singh H, Sharma D, Katyal VK. Profile of young acute myocardial infarction in Harayana. J Assoc Physicians India. 1998; 46(5):424-6.
11.
V C Woon, K H Lim. Acute Myocardial Infarction in the Elderly –The Differences Compared with the Young. Singapore Med J 2003 Vol 44(8): 414-418.
12.
Tables and Figures
[Table / Fig - 1] [Table / Fig - 2] [Table / Fig - 3] [Table / Fig - 4]

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