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On Sep 2018




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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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Lucknow
On Sep 2018




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On Aug 2018




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"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



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.
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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.
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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
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : November | Volume : 16 | Issue : 11 | Page : WC05 - WC08 Full Version

Efficacy of 70% Glycolic Acid Peel versus 30% Salicylic Acid Peel in the Treatment of Mild to Moderate Acne Vulgaris: A Retrospective Study


Published: November 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/57286.17124
S Pavithra, K Gopalakrishnan, Jeevithan Shanmugam

1. Assistant Professor, Department of Dermatology Venereology and Leprosy (DVL), KMCHIHSR, Coimbatore, Tamil Nadu, India. 2. Associate Professor, Department of Dermatology Venereology and Leprosy (DVL), KMCHIHSR, Coimbatore, Tamil Nadu, India. 3. Professor, Department of Community Medicine, KMCHIHSR, Coimbatore, Tamil Nadu, India.

Correspondence Address :
Dr. K Gopalakrishnan,
Associate Professor, Department of Dermatology Venereology and Leprosy (DVL), KMCHIHSR, 99, Avinashi Road, Coimbatore, Tamil Nadu, India.
E-mail: gopukris83@gmail.com

Abstract

Introduction: Chemical peels have become a useful modality in the management of acne in addition to topical and systemic medications. Studies done to evaluate the effectiveness of peels have compared only lower concentration of Glycolic Acid (GA) (35%) and Salicylic Acid (SA) peels. Higher concentrations of glycolic acid i.e., (70%) are reported to be safe and more effective than lower concentrations. Despite reported advantages of higher concentration of glycolic acid peel, no published data is available regarding its efficacy, safety and tolerability in comparison with other peels.

Aim: To compare the effectiveness of 70% GA peel with 30% SA peel in the management of mild to moderate acne.

Materials and Methods: The present study was a cross-sectional retrospective study conducted from December 2021 to April 2022 in which, 60 participants were enrolled. They were diagnosed with mild to moderate acne, based on the Indian Acne Alliance (IAA) grading system and all of them underwent chemical peel treatment. Among them, 30 had received 70% GA peel (group 1) and 30 had received 30% SA peel (group 2). The number of sittings and the individual lesional count at baseline and at each sitting were recorded. Acne lesional count (sum of comedones, papules, pustules, and nodules) was recorded at baseline, and at two, four, six and eight weeks. Categorical variables were presented as frequency and percentages. Continuous variables were presented as Mean±Standard deviation.

Results: There was a significantly greater decrease in mean acne lesional count in group 2 from the baseline of 25.73 to 13.83 at the end of 2nd week in comparison to group 1, wherein the values reduced from 26.30 to 17.73 (p-value of 0.003). At the end of eight weeks, the mean acne lesional count of both groups (group 1-2.17 and group 2-1.50, p-value of 0.097) were comparable.

Conclusion: Higher concentration of GA (70%) has comparable effectiveness to 30% SA peel in management of mild to moderate acne. SA peel has an advantage of earlier decrease in lesional count.

Keywords

Alpha hydroxy acid, Chemical peeling, Lesional count

Acne is one of the most common skin ailments among young adults (1). It is a source of significant distress due its sequelae like Postinflammatory Hyperpigmentation (PIH) and scarring. Regular use of topical and systemic antiacne medications can be difficult in the fast-paced life. Chemical skin peeling has become a valuable tool in addressing not only in remission of acne but also its sequelae. Alpha hydroxy and beta hydroxy acid are the two commonest peels used widely (2). Alpha hydroxy acids have been extensively studied in the management of acne (3). GA, is an alpha hydroxy acid which thins the stratum corneum, promotes epidermolysis and disperses basal layer melanin (4). It is commonly used in the lower concentration of 35%. Higher concentrations i.e., 70% GA causes epidermal separation and stimulation of dermal collagen (5). Repeated application of it also causes dermal thickening and improvement in acne scars (6). SA, a beta hydroxy acid peel has comedolytic effect owing to its lipophilic action and dissolves intercellular cement. It also has anti-inflammatory property by inhibiting arachidonic acid. It has self-precipitating property and thereby does not cause deep injuries and has high safety profile. All these make SA peel the most preferred in the management of acne (7). The most effective concentration of it is 30% and usually requires multiple sittings done every 2-3 weeks (8).

There are several studies published which have compared 35% GA against 30% SA peel and other combination peels (9). Higher concentration of GA (70%) are being routinely used by dermatologist when lower concentration does not give desired results and are as safe as lower concentrations and no serious adverse effects are reported (10). To the best of our knowledge, comparative studies between higher concentration of GA (70%) and SA peels have not been published in the English literature, hence, the present study was undertaken to compare the efficacy of 70% GA and 30% SA peel in the treatment of acne vulgaris.

Material and Methods

A cross-sectional retrospective study was undertaken in the Department of Dermatology, using the data available in the case files of patients who underwent peel treatment for acne. The duration of the study was from December 2021 to April 2022 using the data collected between January 2021 to November 2021. Institutional Ethical Committee (IEC) approval was obtained (42/IHEC/2021/KMCHIHSR). The case files were retained in the hospital and at each visit details including clinical findings and procedures done were updated.

Inclusion criteria: Patients clinically diagnosed with mild and moderate acne using IAA (Table/Fig 1) grading of acne (11). From this population, records of those who had underwent chemical peel treatment with either 70% GA or 30% SA at two weekly intervals, and had mild and moderate acne vulgaris, were included in the study.

Exclusion criteria: Patients who were on any acne inducing medications, and who had taken oral Isotretinoin in the past six months were excluded from the study.

Peel Protocol

The following protocol is routinely followed in all patients undergoing peel treatment.

Each session of chemical peeling is always performed by a trained dermatologist. After obtaining informed consent, the demographic and clinical data including individual lesional count was entered into their case files at baseline and at every subsequent sitting. With the patient in supine position the face is degreased with an alcohol swab. Surgical cap is used to pull back the hair and cover the ears. The corners of the eyes and nasal crease is protected with petroleum jelly. Single coat of peeling agent was applied with cotton tipped applicator or peel brush on full face and left till end points.

For 70% GA peel, mild burning and mild erythema is the end point and sodium bicarbonate solution is the neutraliser. For 30% SA, pseudo frosting is the end point and chilled water is the neutraliser. Finally, face is washed with running water. No priming agents were used. Post peel sunscreen lotions are applied, and strict sun protection advise given to the patients.

Sample size: The clinical findings of all patients undergoing chemical peel treatment, as maintained in their respective case files, were recorded. The demographic data and clinical data including the counts of individual acne lesions at baseline and at every subsequent peel session were noted. Overall, 67 eligible datasets (32 received 70% GA peel and 35 received 30% SA peel) were considered. After this screening, seven data-sets were excluded due to presence of truncal acne (two had received GA peel and five had received SA peel). Finally, 30 participants were included as study participants- Group 1 (GA peel, n=30) and Group 2 (SA peel, n=30).

Data Collection

An excel sheet was created to compile demographic details like age, sex, and duration of acne. Clinical details including number of comedones, papules, pustules, and nodules at baseline, and at two, four, six and eight weeks were also taken. These data were extracted from the individual patient case files maintained in the hospital.

Evaluation of baseline and response: Acne lesional counting (recording the number of each type of acne lesions-comedones, papule, pustule, and nodule), and their sum total at each sitting was taken as the parameter to assess the response to treatment. Lesional counting, though time consuming is an objective, more accurate assessment method compared to other grading systems, since it can measure the response to treatment to individual lesions (12).

Statistical Analysis

The data entered in excel was analysed using Statistical Package for the Social Sciences (SPSS) software version 26.0. Categorical variables were presented as frequency and percentages. Continuous variables were presented as Mean±Standard deviation. Chi-square test was used to measure the association between qualitative demographic variables to check for the comparability of the data. Independent sample t-test was used to measure the mean values 6between both the groups with respect to each type of acne lesions. Analysis of Variance (ANOVA) was used to find the mean difference between each lesion within the group with respect to time (2,4,6,8 weeks), p-value <0.05 was statistically significant.

Results

There was no significant difference between both the groups with respect to age, gender and duration of symptoms, mean acne lesional count, mean number of papules, pustules, comedones and nodules at the start of the study (Table/Fig 2).

There was a significant reduction in the mean acne lesional count (Table/Fig 3) and mean count of comedones, papules and pustules from second week onwards in group 2 (Table/Fig 4). However, at the end of eight week, the reduction in mean acne lesional count was similar in both groups (Table/Fig 3),(Table/Fig 4). Since nodules were not present in either group after the end of two weeks, no significant difference between the groups could be ascertained with respect to nodules. When compared within the groups, there was a significant reduction in all the parameters measured for each fortnight (Table/Fig 3). Three participants who received 70% GA peel had developed burning sensation, erythema, and scaling on the next day of peel. They were managed with non comedogenica emollient application during daytime and low potent topical corticosteroid cream once daily application at bedtime. The side-effects resolved within a weeks’ time. The baseline status and the clinical improvement seen post eight weeks of therapy for a patient in GA peel group are shown in (Table/Fig 5)a,b respectively. (Table/Fig 6)a,b depict a patient’s baseline and post-treatment response in SA group, respectively.

Discussion

Acne vulgaris is one among the most common sufferings of adolescents and young adults. Many do not seek treatment considering it as a common age-related issue and end up in postacne complications, like, pigmentation and scarring. Prevention of such complications by appropriate and early treatment is of paramount importance. The therapeutic goal aims at reducing sebum secretion, correcting the ductal hypercornificaftion, reducing Cutibacterium acnes colonisation and preventing the release of inflammatory mediators all of which contribute to the pathogenesis of acne. A study done by Khee HJ et al., evaluated the effectiveness and safety of 70% GA along with Vitamin C serum topical application in the management of acne scars. They reported excellent safety profile and statistically significant improvement in postacne scarring. However, the study did not intend to evaluate the effectiveness of GA peel on active acne lesions (10).

Sharma P et al., evaluated the efficacy of peels as a sole therapy in the management of active acne. They compared 35% GA peel vs 30% SA peel by treating 200 grade 1 and 2 acne patients with 100 patients in each group. Both the peels were effective as monotherapy in the treatment of acne and 30% SA peel was better in reducing comedones, papules and pustules but it caused more burning, erythema, and dryness in comparison to 35% GA peel (13). Another study that compared 35% GA peel with Salicyclic-10%, Mandelic acid and Phytic acid combination peel concluded that all three peels were effective in the treatment of mild to moderate acne in Asian population and all were well tolerated (9). To the best of our knowledge, studies comparing 70% GA peel with other peels have not been published in the English literature. Hence, the present study evaluated the effectiveness of 70% GA peel in comparison with 30% SA peel in mild to moderate acne.

The present study infers that 70% GA peel was well tolerated by the participants and only three reported side-effects like erythema and burning sensation which was resolved within a week. This was in line with study done by Khee HJ et al., (10). The SA peel was also well tolerated in this study in contrast to Sharma P et al., wherein they reported more erythema, burning and dryness in comparison to GA peel (13). This could be due to differences in peel application technique and delayed or inadequate washing of peel after achieving endpoint. A significantly higher reduction in the number of comedones, papules and pustules from second week onwards in SA group in comparison to GA group was noted. This observation was similar to the study by Sharma P et al., (13). But in contrast a report by Goel B et al., showed there was not much difference between the 30% SA group and 35% GA group at the end of two weeks (14). This could be due to inherent difference in the severity of acne and response to peel treatment in the population and other unforeseen confounding factors. However, at the end of eight weeks, the reduction in acne lesional count and individual lesional count were similar in both groups in the present study. This was in line with studies published by Sarkar R et al., Sharma P et al., and Goel B et al., wherein at the end of their respective studies both 30% SA and 35% GA peels had similar outcome (9),(13),(14).

Limitation(s)

The sample size selected was kept to a number minimum required for a study, keeping in mind the high dropout rates because of multiple sessions of peel treatments required.

Conclusion

Both higher concentration of GA (70%) and 30% SA peels are effective in the management of mild to moderate acne with SA peel having an advantage of earlier decrease in lesional count. Though higher concentration of GA peel are reported to improve postacne scarring and PIH further studies are needed to confirm this.

References

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Yeung CK, Teo LH, Xiang LH, Chan HH. A community-based epidemiological study of acne vulgaris in Hong Kong adolescents. Acta Derm Venereol. 2002;82(2):104-07. Doi: 10.1080/00015550252948121. PMID: 12125936. [crossref] [PubMed]
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Kessler E, Flanagan K, Chia C, Rogers C, Glaser DA. Comparison of alpha- and beta-hydroxy acid chemical peels in the treatment of mild to moderately severe facial acne vulgaris. Dermatol Surg. 2008;34(1):45-50; discussion 51. Doi: 10.1111/j.1524-4725.2007.34007.x. Epub 2007 Dec 5. PMID: 18053051. [crossref] [PubMed]
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Ilknur T, Biçak MU, Demirtas¸ og? lu M, Ozkan S. Glycolic acid peels versus amino fruit acid peels in the treatment of melasma. Dermatol Surg. 2010;36(4):490-95. Doi: 10.1111/j.1524-4725.2010.01481.x. Epub 2010 Feb 19. PMID: 20187899. [crossref] [PubMed]
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Bernstein EF, Lee J, Brown DB, Yu R, Van Scott E. Glycolic acid treatment increases type I collagen mRNA and hyaluronic acid content of human skin. Dermatol Surg. 2001;27(5):429-33. Doi: 10.1046/j.1524-4725.2001.00234.x. PMID: 11359487. [crossref] [PubMed]
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DOI and Others

DOI: 10.7860/JCDR/2022/57286.17124

Date of Submission: Jun 11, 2022
Date of Peer Review: Jul 20, 2022
Date of Acceptance: Sep 14, 2022
Date of Publishing: Nov 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

PLAGIARISM CHECKING METHODS:
• Plagiarism X-checker: Jun 15, 2022
• Manual Googling: Sep 08, 2022
• iThenticate Software: Sep 12, 2022 (11%)

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