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  From the Desk of Editor–in–Chief
Dr KK Aggarwal

Padma Shri and Dr B C Roy National Awardee
Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist & Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; National Vice President Elect Elect, Indian Medical Association; Hony Director IMA AKN Sinha Institute (08–09); Hony Finance Secretary National IMA (07–08); Chairman IMA Academy of Medical Specialties (06–07); President Delhi Medical Association (05–06), President IMA New Delhi Branch (94–95, 02–04); Editor in Chief IJCP Group & Hony. Visiting Professor (Clinical Research) DIPSAR

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eMediTube (videos), eMedipics, eMediSlide, eMediLaw

  Editorial …

20th March 2013, Wednesday

Herbal medicines causing kidney failure, bladder cancer in India

These types of news are common in the media and mislead the public that Ayurveda is bad for the country. Most of the herbs that contain aristolochic acid (AA) are Chinese herbs and only one Ayurvedic drug contains AA. However drugs can be adulterated with AA containing herbs. Unless authenticated and proved, these types of researches by UK journals are nothing but a direct attack on Ayurveda.

Aristolochic acid (AA) nephropathy is an interstitial nephritis first described in 1991. A high incidence of cellular atypia and transitional cell cancer of the renal pelvis, ureter, and bladder is associated with this disease.

AA in combination with the vasoconstrictive appetite suppressants, fenfluramine and diethylpropion, diuretics, and other potential nephrotoxins may underlie AA nephropathy. Stimulation of the intrarenal renin-angiotensin system likely contributes to the lesion.

Risk factors include women, toxin dose and a genetically determined predisposition. Patients present with kidney insufficiency and normal or only mildly elevated blood pressure.

In the disease, urinary protein excretion is moderately increased and the sediment reveals only a few red and white cells. Corticosteroids may slow the rate of loss of renal function. Renal transplantation is an effective modality.

It is not clear if AA has been part of the herbal preparations used by all patients in most studies. AA (0.15 mg/tablet) has been used as an immunomodulatory drug for 20 years in Germany by thousands of patients, sometimes in doses comparable to that found in AA-containing slimming regimens; despite this exposure, there is no report relating chronic tubulointerstitial nephritis to AA in Germany.

Fast-developing chronic tubulointerstitial renal disease is caused by combined exposure to both a potent nephrotoxic substance, AA, and to renal vasoconstrictors, fenfluramine/diethylpropion.

Chinese herbs with AA: Aristolochia species of the family Aristolochiaceae are often found in traditional Chinese medicines, e.g. Aristolochia debilis, A. contorta, A. manshuriensis, and A. fangchi. The medicinal parts of each plant (stem, root, fruit) have distinct Chinese names like fangchi (Root) Guang Fang Ji; Aristolochia manshuriensis (Stem) Guan Mu Tong; Aristolochia contorta (Fruit) Ma Dou Ling; Aristolochia debilis (Fruit) Ma Dou Ling; Aristolochia contorta (Herb) Tian Xian Teng; Aristolochia debilis (Herb) Tian Xian Teng and Aristolochia debilis (Root) Qing Mu Xiang.

In Ayurveda, the herb is ARISTOLOCHIA BRACTEOLATA from family ARISTOLOCHIACEAE, SANSKRIT name Keetmari, Dhumrapatra, Kitamari, Visanika and HINDI names: Kiramar, Kitamar, Aulosa, Hukka-bel, Kalipaad.

In April 2001, the FDA identified botanicals known of suspected to contain aristolochic acid, and others as potentially adulterated with species containing aristolochic acid. This potential adulteration can occur when an aristolochic acid containing herb is mistakenly identified as an herb that does not contain aristolochic acid.

For More editorials…

Dr KK Aggarwal
Group Editor in Chief

    eMedinewS Audio PostCard

Stay Tuned with Padma Shri and Dr BC Roy National Awardee Dr KK Aggarwal on

Weight loss may improve sexual health of obese diabetes

Audio PostCard
    Photo Feature (from the HCFI Photo Gallery)

Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Vice-President (Elect) National IMA and Mr. Sandeep Marwah, Chairman, Asian Academy Film & Television Institute, Noida addressing a press conference

 
Dr K K Aggarwal
    National News

Bumper eye harvest in 1 day benefits 22 at AIIMS

NEW DELHI: In a country where lakhs of blind people spend their lifetime waiting for an eye donor, what happened at All India Institute of Medical Sciences on Thursday is nothing short of a miracle. AIIMS, which restarted its eye bank recently, received 22 eyes within 24 hours and transplanted all of them successfully. The recipients included 18 patients admitted at the hospital and four others who had registered themselves and gone back home. "Giving vision to 22 people in a single day is unbelievable. It has been possible only because so many people came forward or accepted our request to donate the organs of their deceased kin," said Dr R V Azad, chief of the RP Eye Center at AIIMS. He said normally the eye bank gets one or two donors daily. "On Thursday, we received 10 eyes through voluntary offers made by the families of donors from Delhi and NCR. The other 12 eyes were received through the Hospital Cornea Retrieval Programme at AIIMS and DDU. The donor age ranged from 23 to 78 years," he added. According to Dr JS Titiyal, professor and head, Cornea, Cataract Refractive Surgery Services at the hospital, all donor eyes were successfully utilized for waiting patients. An eye transplant involves replacing a diseased or scarred cornea with a donor graft. "There were about 18 patients waiting for transplant at the hospital itself, including an 11-month-old born with corneal opacity. Others were called in from their respective homes," he said. Dr Titiyal said surgeries included full thickness keratoplasty—transplantation of corneal material to replace scar tissue which interferes with vision—and partial thickness keratoplasty. "Six patients suffering from corneal damage due to cataract surgeries and viral infection or corneal opacities following ulcers, underwent modern suture-less corneal transplantation, called descemet stripping automated endothelial keratoplasty (DSAEK)," said Dr Namrata Sharma, eye surgeon. (Source: TOI, Mar 19, 2013)

For comments and archives

On a wing and a prayer on World Sparrow Day

MUMBAI: On the occasion of World Sparrow Day, which falls on March 20, Nature Forever Society (NFS) has decided to start a campaign and take it to college campuses and citizens' groups across the city and state. Addressing the declining population of sparrows in the world, NFS will work around the theme of 'Rise for the Sparrows'. "We are urging people to participate in this campaign in their own little way. Since people have very little time for the environment these days, our campaign will give them the opportunity to participate by spending less than 15 minutes on our website or on any social networking website to spread awareness about the same," said Mohammed Dilawar of NFS, who has been working on this project for the past seven years. What makes the campaign special this year is the financial aid provided by a corporate to boost the enthusiasm and work of the activists as well as the common people. "This aid will boost our work towards Nature Forever Society Sparrow Awards where the winners will be awarded cash prizes of Rs 50,000. The funding will help winners carry out vital conservation work undertaken by them and also inspire others to get involved in the movement," added Dilawar. NFS is also taking the awareness drive to other cities, including Ahmedabad where an event has been organized for citizens to come and enquire about conservation methods. (Source: TOI, Mar 19, 2013)

Medical mistakes in Indian movies

Dear all, eMedinewS is starting a special series on ‘Medical mistakes in Indian movies’. We invite all our readers to share with us the following information:

  1. Scene/s where the image of the medical profession has been maligned in an unrealistic manner, or
  2. Scene/s where medical care and approach has been depicted incorrectly, or
  3. Scenes where the medical profession has been portrayed correctly.

Send us the clippings or description of the scenes. This would be a start to a special campaign to rebuild the image of the medical profession.

Certificate courses in 2D and 3D Echocardiography/Fellowship Diploma in non invasive cardiology Contact Dr KK Aggarwal, Moolchand Medcity, email: emedinews@gmail.com

    Be Human Stop Child Abuse (Team IMA for CMAAO)

(http://behumanstopchildabuse.emedinews.in/)

No single method alone should be adopted for age determination. A combination of examination of physical and secondary sexual characteristics, dentition and bone ossification should be taken into consideration before recording the final opinion.

For comments and archives

    Valvular Heart Disease Update

Should surgery be done in elderly patients with aortic stenosis?

Elderly patients have poorer preoperative status and higher operative mortality with aortic valve replacement. However, those who survive the perioperative period often do well and have marked improvement in quality of life. When aortic valve replacement is indicated, a bioprosthetic valve is generally preferred to a mechanical valve in elderly patients in whom life expectancy is shorter than the expected function life of the bioprosthesis.

(Experts: Dr Ganesh K Mani, Dr Yugal Mishra, Dr Deepak Khurana, Dr Rajesh Kaushish, Dr K S Rathor, Dr Sandeep Singh and Dr KK Aggarwal)

 
    International News

(Contributed by Dr Monica and Brahm Vasudev)

Agencies warn of Global TB threat, funding gap

Deadly strains of tuberculosis (TB) resistant to multiple drugs are spreading around the world, and authorities urgently need another $1.6 billion a year to tackle them, global health officials said on Monday. Donors should step up with "significant funding" to help experts track down all existing cases and treat the most serious ones, said the World Health Organisation (WHO) and the Global Fund to Fight AIDS, TB and Malaria in joint statement. (Source: Medscape)

AAN releases new sports concussion guidelines

The American Academy of Neurology (AAN) has released new guidelines on the evaluation and management of sports concussion. The document, which updates 1997 guidelines, is published online March 18 in Neurology, to coincide with presentation here at the AAN 65th Annual Meeting. (Source: Medscape)

Hemostasis valves recalled over risk for air embolism

Vascular Solutions Zerusa Ltd has recalled its Guardian II and Guardian II NC hemostasis valves used in catheterization procedures because specific lots pose a slightly higher risk for air leakages and air embolisms, which can be fatal, according to a company press release posted today on the US Food and Drug Administration (FDA) Web site. (Source: Medscape)

New cancer survivorship guidelines issued by NCCN

For the first time, the National Comprehensive Cancer Network (NCCN) has issued practice guidelines for survivorship (NCCN 18th Annual Conference). (Source: Medscape)

MRI finds possible vascular injury after mild head injury

Using MRI, researchers have detected linear hemorrhagic brain lesions suggestive of primary injury to the vasculature early after mild traumatic brain injury (mTBI), a finding that could have implications for acute treatment. (Source: Medscape)

 
    Twitter of the Day

@DrKKAggarwal: Weight gain after quitting smoking does not increase the risk of heart disease In a study published in Journal... http://fb.me/2wMrBR0Rc

@DrKKAggarwal: One of the most challenging obstacle addicts face is relapse. Pls read this article of our addiction expert http://tinyurl.com/b5dcsyy

 
    Spiritual Update

(Dr KK Aggarwal, Group Editor in Chief, IJCP Group of Publications and eMedinews)

More about Debts

Hindu scriptures have talked about three types of Hrin (debts) – Dev Hrin, Pitra Hrin and Rishi Hrin.

For comments and archives

 
    Infertility Update (Dr Kaberi Banerjee, IVF expert, New Delhi)

What should one expect from treatment of hirsutism?

Hormone treatment generally prevents new terminal hair from developing and may slow the growth rate of existing hair. Once a hormone treatment has proven to be effective, it may be continued indefinitely. Electrolysis or laser can remove any hair remaining after hormone therapy. Because it is usually not possible to cure the hormonal problem that causes hirsutism, ongoing medical treatment is required to manage.

 
    Tat Tvam Asi………and the Life Continues……

(Dr N K Bhatia, Medical Director, Mission Jan Jagriti Blood Bank)

Generating request for transfusion

Each demand of blood/blood component should be raised through Blood Requisition Form (BRF). Along with the BRF, prescribed blood sample(s) should be sent. Blood components cannot be supplied without the prescription of a registered medical practitioner. So every request form should be signed by a registered medical practitioner with his/her proper identification.

Blood Requisition Form (BRF): The BRF should be dully filled and signed by the duty doctor and should be sent to the blood bank along with the blood samples. The BRF should contain the following details:

  • Complete name of patient
  • Age and sex of patient
  • Diagnosis of patient
  • Hospital's Identification Number
  • Ward/Bed number
  • Name of blood/blood component required
  • Quantity (units/volume)of blood/blood component required
  • Date and time of requirement
  • Category of requirement (Planned/Urgent/Life saving emergency)
  • H/o previous transfusion, if any
  • Signature of the doctor

Note

  1. For infants less than 6 months of age, a sample of mother is also required.
  2. Blood component requisition should be sent to blood bank during daytime in planned cases.
  3. After 48 hours of blood transfusion, a fresh blood sample should be sent for cross matching.
  4. If blood/blood component is not required at the time of sending demand, a “Demand Note” (having details of patient and blood/blood component required) should be sent at the time of collecting blood/blood component from the blood bank.

For comments and archives

 
    An Inspirational Story

Money is yours but resources belong to society

This is about an Indian's experience in Germany. Please read it carefully.

Germany is a highly industrialized country. It produces top brands like Benz, BMW, Siemens etc. The nuclear reactor pump is made in a small town in this country. In such a country, many will think its people lead a luxurious life. At least that was my impression before my study trip.

When I arrived at Hamburg, my colleagues who work in Hamburg arranged a welcome party for me in a restaurant. As we walked into the restaurant, we noticed that a lot of tables were empty. There was a table where a young couple was having their meal. There were only two dishes and two cans of beer on the table. I wondered if such simple meal could be romantic, and whether the girl will leave this stingy guy.

There were a few old ladies on another table. When a dish is served, the waiter would distribute the food for them, and they would finish every bit of the food on their plates.

We did not pay much attention to them, as we were looking forward to the dishes we ordered. As we were hungry, our local colleague ordered more food for us.

As the restaurant was quiet, the food came quite fast. Since there were other activities arranged for us, we did not spend much time dining. When we left, there was still about one third of unconsumed food on the table.

When we were leaving the restaurant, we heard someone calling us. We noticed the old ladies in the restaurant were talking about us to the restaurant owner. When they spoke to us in English, we understood that they were unhappy about us wasting so much food. We immediately felt that they were really being too busybody. "We paid for our food, it is none of your business how much food we left behind," my colleague Guy told the old ladies.

The old ladies were furious. One of them immediately took her hand phone out and made a call to someone. After a while, a man in uniform claimed to be an officer from the Social Security Organisation arrived. Upon knowing what the dispute was, he issued us a 50 Mark fine. We all kept quiet. The local colleague took out a 50 Mark note and repeatedly apologised to the officer.

The officer told us in a stern voice, "Order what you can consume, money is yours but resources belong to the society. there are many others in the world who are facing shortage of resources. you have no reason to waste resources."

Our face turned red. We all agreed with him in our hearts. The mindset of people of this rich country put all of us to shame. WE REALLY NEED TO REFLECT ON THIS. We are from country which is not very rich in resources.

To save face, we order large quantity and also waste food when we give others a treat. This lesson taught us a lesson to think seriously about changing our bad habits.

My colleague photo copied the fine ticket and gave a copy to each of us as a souvenir. All of us kept it and pasted on our wall to remind us that we shall never be wasteful.

For comments and archives

 
    Cardiology eMedinewS

Deoxycholic acid may reduce submental fat Read More

Clopidogrel/atorvastatin protect in carotid stenting Read More

 
    Pediatric eMedinewS

High maternal viral load key to vertical transmission of hepatitis B
Read More

Parasacral TENS may have edge for overactive bladder in kids Read More

 
    Rabies Update

Dr. A K Gupta, Author of "RABIES - the worst death", Joint Secretary, Association for Prevention and Control of Rabies in India (APCRI)

Can a rabies vaccine be given to a pregnant woman?

Following animal bite, rabies vaccine can be given to a pregnant woman. Medical termination of pregnancy should not be done as a routine clinical practice.

 
    IJCP Special

Dr Good Dr Bad

Situation: A 13–year–old diabetic child needed to increase his metformin dose.
Dr Bad: Metformin is not given to children.
Dr Good: You can increase up to 2 gms per day.
Lesson: In pediatric patients, metformin is started as an oral dose of 500 mg, administered once–daily. The dose can be increased by 500 mg increments, initially as 500 mg twice-daily, to a maximum daily dose of 2000 mg given as 1000 mg twice-daily (Diabetes Care 2002;25:89)

Make Sure

Situation: A patient with pseudomonas meningitis was not responding.
Reaction: Oh my God! Why was aminoglycoside not added?
Lesson: Make sure that when pseudomonas meningitis is suspected, combination therapy with two antibiotics from different classes to which the isolate is susceptible are given and one antibiotic is an aminoglycoside, unless the use is precluded by nephrotoxicity. The therapy should continue for at least 21 days.

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  Quote of the Day (Dr GM Singh)

The distance between insanity and genius is measured only by success. Bruce Feirstein

 
    Legal Question of the Day (Dr MC Gupta, Advocate & Medico-legal Consultant)

Q. What are your comments regarding the recent judgment whereby a hospital in Tamil Nadu was asked to pay Rs. 3 lakh as compensation because it had no ventilator?

Ans.

  1. You are obviously referring to the judgment reported in The Hindu dated 6-3-2013 whereby the National Consumer Disputes Redressal Commission, New Delhi, has ordered a city hospital and its doctors to pay a compensation of Rs.3 lakh to a person whose wife died due to negligence, which was held to be there in view of the fact that the respondents conducted a major surgery under general anesthesia without taking due care and caution to ensure that critical lifesaving equipment like ventilator were available in case of post-operative complications, which can occur following a major surgery.
    http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/hospital-told-to-pay-rs-3-lakh-for-negligence/article4480545.ece#.UTajS7BqeNo.gmail
  2. One cannot find fault with the judges for holding that life could probably have been saved if there was available a ventilator. No doctor would disagree with such a statement. The same may be equally true about a defibrillator.
  3. The question is—whether there was a duty on the part of the hospital to have a ventilator? Every small private hospital all over India cannot possibly have a ventilator or defibrillator. In any case, if the patient comes in an emergency, the hospital cannot refuse treatment in terms of the CEA, 2010. But such a patient would still be a consumer in terms of the judgment in IMA v. V P Shantha.
  4. As a matter of fact, the Boyle’s Apparatus, which is present in every good OT, is in itself a sort of ventilator. The ventilator is just an automatic machine to ventilate. The same job can be done manually with Boyle’s apparatus and even with an Ambu bag. Yes, in ICU ventilators are required in the ICU because it has patients in prolonged coma. Such patients need to be on an automatic ventilator, which reduces the need for manpower and eliminate human error and fatigue.
  5. Rules have not yet been notified under the CEA, 2010. If the rules say that a hospital is authorized to conduct a surgery like hysterectomy in the absence of a ventilator then that would be a valid argument in defence of the hospital.
  6. The provisions of the Tamil Nadu Private Clinical Establishments Act, 1997, might be relevant in this case.
    http://www.scribd.com/doc/52752395/Tamilnadu-Private-Clinical-Establishments-Act-1997
  7. A question that arises is this—Would a government district hospital be liable in the similar circumstances? Law cannot be different for private and government hospitals covered by the CPA. It is up to the public now to sue government hospitals for similar negligence.
 
    Mind Teaser

Read this…………………

Because of difficulties with hemodialysis, peritoneal dialysis is initiated to treat a female client’s uremia. Which finding signals a significant problem during this procedure?

a. Potassium level of 3.5 mEq/L
b. Hematocrit (HCT) of 35%
c. Blood glucose level of 200 mg/dl
d. White blood cell (WBC) count of 20,000/mm3

Yesterday’s Mind Teaser: A male client in the short-procedure unit is recovering from renal angiography in which a femoral puncture site was used. When providing postprocedure care, the nurse should:

a. Keep the client’s knee on the affected side bent for 6 hours.
b. Apply pressure to the puncture site for 30 minutes.
c. Check the client’s pedal pulses frequently.
d. Remove the dressing on the puncture site after vital signs stabilize.

Answer for yesterday’s Mind Teaser: c. Check the client’s pedal pulses frequently.

Correct answers received from: Dr Jella, Dr KP Chandra, Tukaram Pagad, Dr K Raju, Dr Deepali Chatterjee, Rajiv Kohli, Dr PC Das, Dr (Maj. Gen.) Anil Bairaria, Dr Pankaj Agarwal, Dr Bharat Bhushan Aggarwal, Dr BB Gupta, Dr Arapan Gandhi, Dr Chandresh Jardosh, Muthumperumal Thirumalpillai, Dr Avtar Krishan, Dr Bharat Bhushan Aggarwal.

Answer for 18th March Mind Teaser: a. 1 minute

Correct answers received from: Dr BB Gupta, Dr Avtar Krishan, Dr Kanta jain, Dr Bharat Bhushan Aggarwal.

Send your answer to ijcp12@gmail.com

 
    Laugh a While (Dr GM Singh)

A woman sadly tells her husband: We will not be together in heaven as we may die at different times my dear.

After a pause her husband replied; my dear that is why the place is known as 'Heaven'.

 
    Medicolegal Update

(Dr Sudhir Gupta, Additional Prof, Forensic Medicine & Toxicology, AIIMS)

Right coronary artery supplying blood to the electrical area of heart is called artery of sudden death

  • The most common cause of sudden cardiac death in adults over the age of 40 has been coronary artery atheroma seen in postmortem examination in about 100 cases randomly selected by me in the mortuary of AIIMS.
  • The most common finding at postmortem examination is chronic high-grade stenosis of minimum one segment of a major coronary artery, the arteries which supply the heart muscle with its blood supply. A significant number of cases also have an identifiable clot in a major coronary artery which causes transmural occlusion of that vessel.
  • In 75 out of hundred cases, the clot was found in the right coronary artery supplying the electrical area of heart. Death in these cases is thought to result from a period of transient or prolonged lack of blood supply in the muscle of the heart wall, which induces a ventricular arrhythmia/fibrillation and no changes in the myocardium are seen during postmortem examination.
  • The absence of the histological signs of acute necrosis and a healed infarct are a common finding.
  • Chronic high–grade stenosis causing previous episodes of ischemia and areas of focal fibrosis is seen histologically in the myocardium.
  • Ventricular arrhythmias may arise from a myocardium which has been previously scarred by episodes of ischemia.

For comments and archives

 
    Public Forum

(Press Release for use by the newspapers)

10000 children, teacher and parents will be trained in CPR 10

For the first time, 10000 children, teacher and parents will be trained in Cardiopulmonary Resuscitation 10 (CPR 10) in one day to commemorate World Health Day. The event will be organized on 6th April, 2013, Saturday at SKV School, Yamuna Vihar, East Delhi in association with Directorate of Education, Delhi Government. Never in history have so many people been trained in CPR in one day.

Addressing a press conference, Padma Shri & Dr. BC Roy National Awardee, Dr. KK Aggarwal, President Heart Care Foundation of India and Vice-President (Elect) National IMA said that the Foundation has already trained more than 35000 people and over 5 lives have been saved in the last three months where the general public could save the person’s life after sudden death. A 16-year-old school girl from Birla Vidya Niketan Pushp Vihar saved her uncle and a teacher from SD Public School Pitampura saved her grandmother by doing successful CPR.

Besides hands-only CPR 10 training, on the spot competitions like cartoon, poster, slogan and poem on the subject to sensitize teachers, parents and children will also be organized, said Mr. Sandeep Marwah, Chairman, Asian Academy Film & Television Institute, Noida. Hands-only CPR 10 is based on the mantra – “within 10 minutes of death (earlier the better), for at least next 10 minutes (longer the better), compress the chest of the victim continuously and effectively with a speed of 10x10=100 per minute.

The theme for World Health Day this year is high blood pressure. Cardiovascular disease is the number one cause of death in urban India and over 70% of deaths amongst cardiovascular deaths are linked to hypertension, said Dr. KK Aggarwal. Besides learning CPR 10, school children should also learn about good dietary habits which include, eating more fiber, less salt, zero trans fats and zero refined carbohydrate, he further added.

About HCFI: The only National Not for profit NGO, on whose mega community health education events, Govt. of India has released two National commemorative stamps and one cancellation stamp, and who has conducted one to one training on” Hands only CPR” of 31145 people since 1stNovember 2012.

The CPR 10 Mantra is – “within 10 minutes of death, earlier the better; at least for the next 10minutes, longer the better; compress the centre of the chest of the dead person continuously and effectively with a speed of 10x10 i.e. 100 per minute.”

 
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