emedinews
Head Office: 39 Daryacha, Hauz Khas Village, New Delhi, India. e-mail: emedinews@gmail.com, Website: www.ijcpgroup.com
FIRST NATIONAL DAILY eMEDICAL NEWSPAPER OF INDIA
eMedinewS is now available online on www.emedinews.in or www.emedinews.org
Dr KK Aggarwal

From the Desk of Editor in Chief
Padma Shri and Dr B C Roy National Awardee

Dr KK Aggarwal
President, Heart Care Foundation of India; Sr Consultant Physician, Cardiologist and Dean Medical Education Moolchand Medcity; Chairman Ethical Committee Delhi Medical Council; Chairman (Delhi Chapter) International Medical Sciences Academy; 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 of Publications & Hony. Visiting Professor (Clinical Research) DIPSAR


31st July, 2010, Saturday

For regular emedinews updates follow at www.twitter.com/DrKKAggarwal

Unani and Ayurveda Docs Can Conduct Surgery: Madras HC

A TOI report covered the news that" the Madras High Court has said that registered practitioners in Siddha, Ayurveda, Homeopathy and Unani are eligible to practise Surgery, Obstetrics and Gynecology, Anesthesiology, ENT, Ophthalmology, etc. Justice F M Ibrahim Kalifulla, passing orders on a contempt of court petition filed by the Tamil Nadu Siddha Medical Graduates Association, also said penal action against such practitioners who dabbled in allopathy should be "dropped forthwith."

The ruling runs contrary to a recent order delivered by another judge on a petition filed by two Unani practitioners who sought similar relief. In February this year, Justice K K Sasidharan had held that practitioners of Indian system of medicines should not practise allopathy, and that there was nothing wrong if police takes action against those who attempt to practice allopathy without valid qualification.

While passing orders on Thursday, Justice Kalifulla took note of a June 29 circular of the government, which, citing section 17(3)B of the Indian Medicine Central Council Act 1970, said institutionally qualified practitioners of Siddha, Ayurveda, Unani and homeopathy are eligible to practise the respective system with modern scientific medicine "including surgery and obstetrics and gynecology, anesthesiology, ENT, etc. based on the training and teaching."

Some questions come to mind:

  1. What about pre op antibiotics, do they have them?
  2. What about IV fluids? 
  3. What about dressing materials and dresing solutions, will they be different?
  4. What about sutures?
  5. Will they be ultimately allowed to put drug eluting stents?
  6. What about drugs like mannitol and all other life saving drugs required in the OT? Which anaesthesia will they use?
  7. Who will teach them surgery, the allopathic surgeons or their own surgeons?

Dr KK Aggarwal
Editor in Chief
drkkaggarwal Dr K K Aggarwal on Twitter
Krishan Kumar Aggarwal Dr k k Aggarwal on Facebook  

 

Photo Feature (From HCFI file)


This press conference was held on July 2009, organised by Heart Care Foundation of India to announce the dates of BSNL Dil ka Darbar.

In the Photo Mrs. Abheeta Khanna, Cricketer Madan Lal, Padma Shri and Dr B C Roy National Awardee Dr K K Aggarwal, and  Mr Chetan Chauhan, Cricketer.

Dr k k Aggarwal

 

News and views

National

Study links calcium pills to heart risk (Kounteya Sinha, TNN, excerpts)

Calcium pills could increase chances of suffering a cardiac arrest, claims a new study. An international panel of researchers -- many of them from New Zealand's Aberdeen and Auckland University -- claim those who take calcium supplements to improve bone density face a 30% higher risk of heart attacks. It could also increase the risk of minor episodes of stroke and mortality. The researchers, who published their study in the British Medical Journal (BMJ) on Friday, came to the conclusion after reviewing 11 random controlled trials of calcium supplements, which involved 12,000 patients.

The findings were consistent across trials, and were independent of age, gender and types of supplement. The researchers maintained calcium supplements could rapidly increase calcium levels in blood, leading to arterial disease.

Interestingly, the study has been rubbished by Indian doctors, arguing such episodes of heart attacks could occurr in the West since calcium intake in diet is anyway optimum, thanks to the food habit. Most Indians, the doctors said, are calcium deficient.

Dr Ambrish Mittal, president of Endocrine Society of India, said, "This study applies to the Westerners, who are calcium rich." "Except Haryana, Punjab and western Uttar Pradesh, the intake of dairy products -- a rich source of calcium -- are abysmally low across the country" 

"While, a healthy adult may require 900 mg of calcium a day, a staple Indian diet provides just about 400 mg, that also if the individual has two glasses of milk along with paneer, cheese and curd with every meal. Hence, it is premature to say popping a 500-mg of calcium pill a day will cause heart attacks,"

Dr Sushil Sharma, president of the Arthritis Foundation of India, said the normal level of calcium in human body should be between 8.8 mg/dl-10.8 mg/dl per 100 ml of blood. If it goes above 10.8 mg/dl, it could cause hypocalcaemia and cause heart attacks. But, that only happens when a diet provides optimum calcium requirement and on top of that an individual is taking a 500-mg pill.

Ian Reid of the University of Auckland, disagreed with the Indian doctors' assertions. He claimed that calcium supplements are not necessarily the ideal way to protect bones since that could reduce chances of fractures by only around 10%.

President of Heart Care Foundation of India and cardiologist Dr K K Agarwal, who is also attached to Moolchand Hospital, said, "Around 1,500 mg of calcium intake a day is recommended for women and senior citizens in India. But, Indians largely suffer from acute deficiency of Vitamin D required for absorption of calcium. That's why the 40+ population needs to take calcium pills daily for good bone health."

emedinews update: 

 Concern that high dietary calcium increases the risk of nephrolithiasis in otherwise healthy patients is unfounded. Calcium supplements have been associated with an increased risk of kidney stones. The WHI trial described above also reported an increased risk of kidney stones in postmenopausal women who were supplemented with calcium and vitamin D when compared to placebo. In the Nurses' Health Study, a higher dietary calcium intake was associated with a lower incidence of stone disease (multivariate relative risk 0.65 for highest versus lowest quintile of calcium intake) while calcium supplements were associated with a small increase in risk (relative risk 1.2 in supplement users compared with nonusers). Other potential side effects of high calcium intake include dyspepsia and constipation. In addition, calcium supplements interfere with the absorption of iron and thyroid hormone, and therefore these medications should be taken at different times. There may be benefits of calcium supplementation unrelated to bone such as a reduction in weight, blood pressure and in serum cholesterol concentrations (of about 5 percent) in patients with mild to moderate hypercholesterolemia.  

 

Emergencies covered in cashless insurance  (TOI News, Excerpts)

As per public sector insurance companies, cashless treatment will be extended to all hospitals in emergency and trauma cases. During a healthcare meeting with CII New India Assurance Company chairman M Ramadoss said a patient who requires emergency and trauma services will be attended to through the cashless scheme in all TPA-empanelled hospitals. Third-party administrators have been instructed to provide this facility to those hospitals which are not part of the preferred provider network of hospitals which are recognised by insurance companies.

Emergency and trauma cases will have to be certified by TPAs. There are 24 TPAs  linked with the General Insurance Public Association. Planned or elective surgeries such as bypass, knee replacement and cataract among others, do not fall under the category of emergency or trauma cases.

Cases such as accidents or treatments that require immediate admission to ICU will termed as emergency or trauma cases. If a person suffers a sudden heart complication or a stroke and has to be immediately shifted to an ICCU for treatment or surgery. in such cases, the insurance will have to extend the benefits of cashless scheme to the patient.


10-day cashless deadline (TOI, Excerpts)


The four major public sector health insurance companies, which control 80% of the business, have now set a 10-day deadline for four major chains of hospitals — Apollo, Fortis, Max and Medanta — to come up with their packages for common treatments to avail cashless services. The withdrawal of cashless service was a delayed action against hospitals that were allegedly overcharging for treatment.

The four PSU insurers met CEOs of the four major hospitals in the capital and appointed an action committee comprising chief of Max Hospital chain and CEO of Third Party Administrator to devise packages for common treatments.  The IRDA chief said his information bureau, where all mediclaim reports were archived, showed that while average charges for a medical procedure under the reimbursement category was Rs 25,000, the same went up to Rs 33,000 in cashless scheme. This amply demonstrated how hospitals inflated bills at the cost on insurance companies.

Briefing media on a CII platform, Dr Naresh Trehan of Medanta said cashless is not a major issue though we have restored this facility for emergency, trauma and all ICU admissions for all customers. The facility was continuing for all corporate clients, he said. He denied all hospitals are engaged in over-charging. Punish those who are guilty, he said but, as opposed to IRDA chief, he was against setting up of health regulator. The health care industry is best left to self- regulate than constitute another regulator to create further confusion, he added.

International

Neck pain can be caused by a simple injury or strain, or a more serious health problem. (Dr. GM Singh)

Here are signals that your neck pain should be evaluated by a doctor:

• When it’s severely painful.
• When it doesn’'t let up over time.
• When it shoots down the arms and legs, in addition to the neck.
• When it’s accompanied by headache, weakness, a tingling sensation or numbness.

Biomarkers Found for Postmenopausal Cardiovascular Disease

New biomarkers for stroke and coronary heart disease (CHD) have been identified. Research published in BioMed Central’s open access journal Genome Medicine found after analysis of blood protein data from the Women’s Health Initiative cohorts that beta–2 microglobulin (B2M) levels were much elevated in postmenopausal women with CHD, and insulin–like growth factor binding protein 4 (IGFBP4) was strongly associated with stroke.

Protein Identified that Can Result in Fragile Bones

According to researchers from Medical College of Georgia, too little of a protein called neogenin may lead to a smaller skeleton during development and sets the stage for a more fragile bone framework lifelong.

FDA Panel to Vote on antiplatelet Ticagrelor

According to FDA reviewers, ticagrelor, the antiplatelet drug appears more effective than clopidogrel for patients with acute coronary syndrome. The FDA’s Cardiovascular and Renal Drugs Advisory Committee –– which is made up of outside experts –– will take a vote whether to recommend approval of a twice-daily tablet of ticagrelor to reduce the thrombotic event–rate in patients with acute coronary syndromes, including unstable angina, non–ST segment elevation myocardial infarction (NSTEMI), and ST segment elevation myocardial infarction (STEMI). Two other drugs –– clopidogrel (Plavix) and prasugrel (Effient) are approved for similar indications.

 

Legal Column

Forensic Column (Dr Sudhir Gupta, Associate Professor, Forensic Medicine & Toxicology, AIIMS)

Should Doctors interact with the Media? (Cont…)

The British Medical Association in its handbook of medical ethics 1981 suggested that those doctors able to comment authoritatively on medical subject should be prepared to do so in order that the public may be informed. Those doctors able to help the public with information should regard talking to media as an extension of the noble medical profession/practice. Further BMA 1981, suggests that in the field of General Health Education the name and the relevant qualifications of the Doctor may be given to lend added authority. The Medical Council of India also permits Doctors to write/deliver public lecture/give talks on Radio/appear oin television and grant press interviews in matters of public health which will promote health education to the public at large.

 

Experts’ Views

Question of the Day

How to evaluate and treat a patient with angina–like pain that originates in the esophagus? (Dr. Shobna Bhatia, Mumbai)

At least one–third of patients referred to a cardiologist or admitted to a coronary care unit because of angina–like chest pain will have cardiac causes excluded. In most, an alternative etiology is not apparent. Lack of a specific diagnosis may lead to ongoing anxiety, changes in lifestyle and frequent medical consultations if the patient continues to worry on acount of suspicion of a serious heart disease. Such patients should be evaluated for esophageal disease, although the cost–effectiveness of this approach is not known.

Initial investigations include a Barium esophagogram and/or upper GI endoscopy to screen for gross esophageal dysmotility and esophagitis. Frequently esophageal motility studies are required to establish an esophageal cause for the pain. In many of these patients, abnormalities of esophageal motility can be documented, suggesting that esophageal dysfunction may be responsible for the pain.

Of more diagnostic importance, however, is the demonstration that "provoking" the esophagus with acid perfusion, balloon distention or cholinergic stimulation reproduces the patient’s pain.

Both pH and esophageal pressure can be monitored over 24 hours. This method is probably more sensitive and specific than conventional tests, but the equipment is expensive and the test is of limited value in patients with infrequent pain attacks.

Management of angina–like chest pain of esophageal origin should be directed at the specific pathophysiological process.

  • If the pain is triggered by GER, then antireflux treatment may be quite helpful.

  • If the pain is due to esophageal spasm, smooth–muscle relaxants such as nitrates, calcium channel blockers, hydralazine and anticholinergics should help, although few controlled clinical trials have demonstrated any significant benefit.

  • Tricyclic antidepressants in relatively low dosage have been shown to be beneficial and should be tried in patients with incapacitating symptoms when other forms of treatment have failed. These are most likely to be useful in patients with abnormal visceral nociception, or the so–called irritable esophagus.

Many of these patients will have a significant functional overlay with many other somatic complaints. Simple re–assurance is probably the most important part of treatment. Symptoms usually improve once the patient is given a positive diagnosis and no longer fears that underlying heart disease is the cause.

 

Advantages of Breastfeeding

Advantages of Breastfeeding (Dr. Satwika Sinha, MMC, Khammam)

Benefits for Infants

Breastfeeding protects against infections.

• Diarrhea
• Haemophilus influenzae
• Enhances vaccine response
• NEC (necrotizing enterocolitis)
• Otitis media
• Herpes simplex
• Respiratory syncytical virus (RSV) respiratory Infections

 

Public Forum (Press Release for use by the newspapers)

Oranges and lemon good for high BP

Increasing levels of potassium in the diet may lower a person's risk of developing high blood pressure and may decrease blood pressure in people who already have high blood pressure said Padma Shri and Dr B C Roy National Awardee Dr KK Aggarwal, President Heart Care Foundation of India & MTNL Perfect Health Mela.

A healthy intake of potassium is one reason why vegetarians and isolated populations have a very low incidence of heart disease.

In isolated societies consuming diets low in sodium and high in fruits and vegetables, and which therefore have high levels of potassium, hypertension affects only 1 percent of the population. In contrast, in industrialized societies, where people consume diets high in processed foods and large amounts of dietary sodium, 1 in 3 persons have hypertension.

The typical urban Indian diet contains about double the sodium and half the potassium that is currently recommended in dietary guidelines.

The American Heart Association recommends intake of 4.7 grams per day of potassium. An increase in potassium with a decrease in sodium is probably the most important dietary choice (after weight loss) that should be implemented to reduce cardiovascular disease.

Diets containing at least 500 to 1,000 milligrams magnesium daily and more than 800 milligrams of calcium daily may help lower blood pressure and the risk of developing high blood pressure, reports a study in Journal of Clinical Hypertension.

Citrus fruits are rich sources of potassium.

 

Commonwealth Medical Association 

(Dr. S. Arulrhaj, MD., FRCP (Glasg), President)

I took over as President, CMA on 24th November 2007. It is a tenure of 3 years. CMA works in collaboration with Commonwealth Secretariat, Foundation, WHO and the UN.

Aims and Functions of CMA

  • Providing technical advice and co–operation to National Medical Associations in developing countries
  • Enabling National Medical Associations to participate and co–operate with other appropriate organizations and among themselves in projects designed to improve the health and welfare of their communities
  • Assisting National Medical Associations to formulate and to enforce principles of medical ethics with special reference to the protection of human rights
  • Co–operating with National Medical Associations in the provision, where appropriate, of continuing professional development, including distance learning for doctors isolated in small island areas and other deprived condition.
  • Communicating with member associations regularly on news and information about developments in the field of health with special reference to the situation in developing countries of the Commonwealth.
  • Co–operating with the work of the Commonwealth Health Ministers and with relevant programmes of the United Nations.
  • Establishing a Trust and/or such appropriate body for the purposes of enhancing the goals and objectives set out above.
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An Inspirational Story

I Was Never Promised

I know as I sit here, I was never promised an easy life.

I was never promised happiness or comfortability.

I was never promised a roof over my head or food to eat on a daily basis.

I was never promised that my family or I would be healthy and I was never promised that I would develop friendships that I hold dearly.

I was never promised that today would be free and that I would have to exchange a day of my life for it.

I was never promised that I will make a better tomorrow and with the utmost humility, make a difference in many people's lives.

I was never promised clothing to wear on a daily basis and a washing machine and dryer to clean and dry them.

I was never promised a direction in life and I certainly was not afforded a road map to get to where I belong.

I was never promised the luxury of an automobile or the money to put gas in it.

I was never promised that I would live in a modest home and fill it with the essentials to make a house, a home.

I was never promised, but I do promise, to never take for granted the things that have been so graciously given to me in my life…

I will give thanks on a daily basis for everything and everyone I touch and that touches me.

I, as I sit here writing this to you, know in a blink of an eye, that all of these things that I have can be gone.

Gratitude, Gratitude, Gratitude…

 

IJCP Special

Dr Good Dr Bad

Situation: A patient with acute heart attack was unfit for reperfusion therapy.
Dr Bad: Start 60 mg prasugrel.
Dr Good: Chew 300 mg aspirin and 300 mg clopidogrel.
Lesson: For patients who are unable to receive reperfusion therapy, start clopidogrel 300 mg instead of prasugrel.

Make Sure

Situation: An adult with small intestinal diarrhea of long duration was diagnosed as celiac disease.
Reaction: Oh my God! Why was celiac not diagnosed early.
Lesson: Make sure that celiac disease should always be kept in mind when evaluating patients with chronic small intestinal illness.

Mnemonic of the Day

Pituitary Deficiency: Sequence of Loss of hormones
Remember: Go look for the adenoma please

• GH
• LH
• FSH
• TSH
• ACTH
• Prolactin (Except Sheehan’s syndrome in which prolactin is the first to be affected.
(Contributed by Dr Varesh Nagrath)

Are you fit to fly?

Surgery

Patients with colostomies are not at increased risk in flight, but increased fecal output resulting from intestinal distention may occur. A larger bag or frequent changes may be necessary.

 

International Medical Science Academy Update (IMSA)

HPV vaccine

The optimal rate control goal for patients with atrial fibrillation on rate control strategy is uncertain. The randomized RACE II trial, compared lenient rate–control strategy (resting heart rate <110/minute) or strict rate–control strategy (resting heart rate <80/minute and heart rate during moderate exercise <110/minute). There was no significant difference between the two groups in the primary composite outcome (cardiovascular death, hospitalization for heart failure, and stroke, systemic embolism, bleeding, and life–threatening arrhythmic events) at three years. However, there were nearly nine times as many visits to achieve rate the control target(s) in those assigned to strict control. (N Engl J Med 2010;362:1363.)

 

Drug Update

List of Approved drugs from 01.01.2010 TO 30.4.2010

Drug Name

Indication

DCI Approval Date

Buclizine HCl 25mg Tablet (Additional Indication)

For the symptomatic treatment of various allergic conditions (rhinitis, conjunctivitis and urticaria) and for prevention and treatment of motion sickness

16–Jan–10

 

Medi Finance

Q. If a hospital wants to raise funds by making a loan, which market should it go to, money market or capital market and why?

Ans. The capital market should be preferred because interest is allowed as expenditure in computing taxable income.

 

Lab Medicine (Dr Arpan Gandhi and Dr Navin Dang)

Erythropoietin

To help differentiate between different types of anemia and to determine whether the amount of erythropoietin being produced is appropriate for the level of anemia present.

 

Lateral thinking

Read this …

Cycle  ……………………

Cycle ……………………

Cycle ……………………

Send in your answer to emedinews@gmail.com

The answer for yesterday’s puzzle: "Cross road"

Correct answers were received from:
Dr. Sunita Kalra, Dr. Vijay Kansal

Correct answers received for 29th July 2010 Puzzle from:
Dr. Rajesh Pai Kasturi

 

Humor Section

Jokes

How is a hospital gown like insurance?
You're never covered as much as you think you are.

Funny One Liner

Asked my new girlfriend what sort of books she’s interested in, she said: Check books.

 

Readers Responses

  1. Padma Shri Dr KK Aggarwal, I was in Germany, Zurich, Geneva and Paris for more than 15 days of this month. I was there with a Government of India/Ministry of Civil Aviation officials for attending a meeting/workshop of International Air Traffic Association (IATA). I deliberated there the necessary/mandatory steps required to be taken in medical management with human face/dignity of corpse in situation of mass casually in case of air accident with the medical jurist/coroners of Switzerland. Every day I used to read the e medinews in the office of European coroners, who appreciated a lot this daily medical e–paper and it is true that this e-paper keep us attached with our Indian medical fraternity on day–to–day basis in abroad too. I congratulate you for this unparallel contribution to the medical professionals of this country. Dr Sudhir Gupta


  2. Dear sir, I would like to place before you a proposal that we should invite any suggestion required related with health legislation/medico–legal problem faced by medical professionals/by our readers for our opinion/advice in the interest of prudent medical practice/reduced litigation/embarrassment in medical practice? And strengthen the ethical aspect of medical practice. We may take one question/query every week with our best legitimated/ethical answer with required references? This is for your consideration……thanking you with my warm regards: Dr Sudhir Gupta


  3. Respected Dr Aggarwal Ji, Thanks for the wonderful and informative mail letter. I am disappointed with the advice of Dr Pradeep Sharma MD, FAMS, Professor, RP Centre, AIIMS, New Delhi, India. Every qualified person whether he/she is a vaidya hakim or homeopath must have a right to prefix ‘dr’ with the name, as everyone of them is providing services to the mankind to people who are sufferring. This kind of advice will divide the society. I am also thankful for your literature on ALLOVEDA. Please keep continue this topic. Every doctor has to become an ALLOVEDIC DOCTOR. Supreme Court/Parliament should pass this type of orders. Thanks: Dr. Harimohan Goel, BAMS and Dr.Sumeet Goel, BAMS Tilak Road, Picture Palace, Mussoorie, 248179. Uttarakhand

     
  4. To, Dr K K Aggarwal, Chief Editor.eMedinews, Sir, I am extremely grateful for taking up my cause in emedinews. The various points raised by you are extremely relevant & I really appreciate that you want IMA to take the matter to the higher court. It is really unfortunate that an honest & true statement of mine was not considered worth believing by the honorable forum. I consider it my duty to apprise you of the fact sheet of the incident. On 23/9/2005, at around 8.45pm, I was in my Pediatrics Chamber treating a child of febrile seizure. Suddenly there was a hue & cry outside on the road in front of my clinic at C3/ 95, Janakpuri, New Delhi. After giving IV Diazepam to the convulsing child when I  came out , I came to know that an injured person in unconscious state was lying on road & had been taken on stature to Orchid Hospital , at C3/91, Janakpuri by the people assembled there, which is only few seconds away from my clinic. I neither had the occasion to see the person nor was the person ever brought for the treatment inside my clinic. There was no delay as the person was declared 'brought dead' at 8.45 pm at Orchid Hospital.
    I am deeply pained & in a state of mental shock due to all this. How can we be accountable for anything happening on the road or in our neighborhood especially when the affected person has been moved to a hospital immediately, even before the doctor could reach him?
    Sir, I shall be highly obliged if you publish these facts in your daily bulletin.

    Thanks & regards Dr A K Manocha, M D (Pediatrics), C3/95, Janakpuri New Delhi 110058
 

Forthcoming Events

eMedinewS Events: Register at emedinews@gmail.com

5th September: 3 PM to 5 PM – A dialogue with His Holiness Dalai Lama at Parliament Street Annexe in association with Acharya Sushil Muni Ahimsa Peace Award Trust

26th September: BSNL Dil ka Darbar A day–long interaction with top cardiologists of the city. 8 AM – 5 PM at MAMC Auditorium, Dilli Gate.

17th MTNL Perfect Health Mela 2010 Events: Venue: NDMC Ground Laxmi Bai Nagar, New Delhi

24th October, Sunday: Perfect Health Darbar, Interaction with top Medical experts of the city from 8 AM to 5 PM
30th October, Saturday: eMedinewS Update from 8 AM to 5 PM
29th October, Friday: Divya Jyoti Inter Nursing College/ School Competitions/ Culture Hungama
30th October, Saturday: Medico Masti Inter Medical College Cultural festival from 4 PM to
10 PM
31st October, 2010, Sunday:
Perfect Health Darbar, An interaction with top Cardiologists

eMedinews Revisiting 2010

The 2nd eMedinewS – revisiting 2010 conference will be held at Maulana Azad Medical College, New Delhi on January 2, 2011. The event will have a day–long CME, Doctor of the Year awards, Cultural Hungama and Live Webcast. Suggestions are invited.

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