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Ceribelli A, De Santis M, Isailovic N, Gershwin ME, Selmi C. The Immune Response and the Pathogenesis of Idiopathic Inflammatory Myositis: a Critical Review. Clin Rev Allergy Immunol 2017; 52:58-70. [PMID: 26780034 DOI: 10.1007/s12016-016-8527-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The pathogenesis of idiopathic inflammatory myositis (IIMs, including polymyositis and dermatomyositis) remains largely enigmatic, despite advances in the study of the role played by innate immunity, adaptive immunity, genetic predisposition, and environmental factors in an orchestrated response. Several factors are involved in the inflammatory state that characterizes the different forms of IIMs which share features and mechanisms but are clearly different with respect to the involved sites and characteristics of the inflammation. Cellular and non-cellular mechanisms of both the immune and non-immune systems have been identified as key regulators of inflammation in polymyositis/dermatomyositis, particularly at different stages of disease, leading to the fibrotic state that characterizes the end stage. Among these, a special role is played by an interferon signature and complement cascade with different mechanisms in polymyositis and dermatomyositis; these differences can be identified also histologically in muscle biopsies. Numerous cellular components of the adaptive and innate immune response are present in the site of tissue inflammation, and the complexity of idiopathic inflammatory myositis is further supported by the involvement of non-immune mechanisms such as hypoxia and autophagy. The aim of this comprehensive review is to describe the major pathogenic mechanisms involved in the onset of idiopathic inflammatory myositis and to report on the major working hypothesis with therapeutic implications.
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Affiliation(s)
- Angela Ceribelli
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
- BIOMETRA Department, University of Milan, Milan, Italy
| | - Maria De Santis
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - Natasa Isailovic
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy
| | - M Eric Gershwin
- Division of Rheumatology, Allergy, and Clinical Immunology, University of California Davis, Davis, CA, USA
| | - Carlo Selmi
- Division of Rheumatology and Clinical Immunology, Humanitas Research Hospital, via A. Manzoni 56, 20089, Rozzano, MI, Italy.
- BIOMETRA Department, University of Milan, Milan, Italy.
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Dhagat PK, Singh S, Jain M, Singh SN, Sharma RK. Thoracic Sarcoidosis: Imaging with High Resolution Computed Tomography. J Clin Diagn Res 2017; 11:TC15-TC18. [PMID: 28384959 DOI: 10.7860/jcdr/2017/24165.9459] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Accepted: 11/01/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Sarcoidosis is a disease of unknown aetiology that primarily affects the lungs. Clinical and radiological findings with demonstration of non caseating granulomas on pathology is utilised for diagnosing the disease. AIM To assess and evaluate the features of thoracic sarcoidosis on High Resolution Computed Tomography (HRCT) chest. MATERIALS AND METHODS A total of 40 (31 males and 9 females) cases of pulmonary sarcoidosis in a period of three years were included in this study. Patients underwent detailed clinical evaluation, imaging, Pulmonary Function Tests (PFT) and pathological confirmation of disease. Chest radiograph was obtained in all patients. HRCT was done on 16 slice Computed Tomography (CT) using 1 mm slice thickness and high spatial frequency algorithm for image re-construction. Images were viewed and evaluated using appropriate lung and mediastinal windows. The lymph nodes were classified as hilar and mediastinal with Maximum Short Axis Diameter (MSAD) more than 10 mm taken as cut-off for enlargement. Pulmonary opacities were classified as nodules (micronodules 1-4 mm and macronodules >5 mm), reticular opacities, fibrotic lesions, ground glass opacities and consolidations. Nodule distribution classified as perilymphatic centrilobular and random. Repeat scanning done on follow up or as clinically indicated. RESULTS A total of five patients had Stage I disease, 24 patients had Stage II disease, eight patients had Stage III disease and three patients had stage IV disease. Mediastinal lymphdenopathy present in 29 patients. Bilateral hilar adenopathy was the predominant pattern seen in 22 patients. Lung parenchymal lesions excluding end stage disease noted in 32 patients. The characteristic HRCT lung parenchymal involvement of micronodules with a perilymphatic distribution was seen in 26 patients. HRCT features of predominant upper and middle lobe distribution seen in majority of patients. Documented atypical lesions and the characteristic features of end stage lung disease on HRCT noted in a small subset of patients. HRCT was superior to chest radiography for evaluating the features, pattern and distribution of the parenchymal lesions and mediastinal lymph nodes, for assessing the stage and activity of the disease and in aiding detection of subtle parenchymal lesions which are liable to be missed on conventional imaging. CONCLUSION Thoracic sarcoidosis can have varied presentations. HRCT is superior to conventional CT for the detection and characterisation of the lung parenchymal lesions.
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Affiliation(s)
- Peeyush Kumar Dhagat
- Associate Professor, Department of Radiology, Base Hospital , Delhi Cantt, New Delhi, India
| | - Sarvinder Singh
- Associate Professor, Department of Respiratory Medicine, Base Hospital , Delhi Cantt, New Delhi, India
| | - Megha Jain
- Senior Resident, Department of Radiology, Army College of Medical Science , New Delhi, India
| | | | - Rajat Kumar Sharma
- Assistant Professor, Department of Radiology, Base Hospital , Delhi Cantt, New Delhi, India
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Abstract
Granulomas of the skin may be classified in several ways. They are either infectious or non-infectious in character, and they contain areas of necrobiosis or necrosis, or not. Responsible infectious agents may be mycobacterial, fungal, treponemal, or parasitic organisms, and each case of granulomatous dermatitis should be assessed histochemically for those microbes. In the non-infectious group, examples of necrobiotic or necrotizing granulomas include granuloma annulare; necrobiosis lipoidica; rheumatoid nodule; and lupus miliaris disseminates faciei. Non-necrobiotic/necrotizing and non-infectious lesions are exemplified by sarcoidosis; foreign-body reactions; Melkersson-Rosenthal syndrome; Blau syndrome; elastolytic granuloma; lichenoid and granulomatous dermatitis; interstitial granulomatous dermatitis; cutaneous involvement by Crohn disease; granulomatous rosacea; and granulomatous pigmented purpura. Histiocytic dermatitides that do not feature granuloma formation are peculiar reactions to infection, such as cutaneous malakoplakia; leishmaniasis; histoplasmosis; lepromatous leprosy; rhinoscleroma; lymphogranuloma venereum; and granuloma inguinale.
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Affiliation(s)
- Mark R Wick
- Section of Dermatopathology, Division of Surgical & Cytological Pathology, University of Virginia Medical Center, Charlottesville, VA, USA.
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Neurosarcoidosis: a clinical approach to diagnosis and management. J Neurol 2016; 264:1023-1028. [PMID: 27878437 PMCID: PMC5413520 DOI: 10.1007/s00415-016-8336-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Accepted: 11/07/2016] [Indexed: 10/25/2022]
Abstract
Sarcoidosis is a rare but important cause of neurological morbidity, and neurological symptoms often herald the diagnosis. Our understanding of neurosarcoidosis has evolved from early descriptions of a uveoparotid fever to include presentations involving every part of the neural axis. The diagnosis should be suspected in patients with sarcoidosis who develop new neurological symptoms, those presenting with syndromes highly suggestive of neurosarcoidosis, or neuro-inflammatory disease where more common causes have been excluded. Investigation should look for evidence of neuro-inflammation, best achieved by contrast-enhanced brain magnetic resonance imaging and cerebrospinal fluid analysis. Evidence of sarcoidosis outside the nervous system should be sought in search of tissue for biopsy. Skin lesions should be identified and biopsies taken. Chest radiography including high-resolution computed tomography is often informative. In difficult cases, fluorodeoxyglucose positron emission tomography and gallium-67 imaging may identify subclinical disease and a target for biopsy. Symptomatic patients should be treated with corticosteroids, and if clinically indicated other immunosuppressants such as hydroxychloroquine, azathioprine, cyclophosphamide or methotrexate should be added. Anti-tumour necrosis factor alpha therapies may be considered in refractory disease but caution should be exercised as there is evidence to suggest they may unmask disease.
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Hu Y, Yibrehu B, Zabini D, Kuebler WM. Animal models of sarcoidosis. Cell Tissue Res 2016; 367:651-661. [PMID: 27807704 DOI: 10.1007/s00441-016-2526-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/10/2016] [Indexed: 11/29/2022]
Abstract
Sarcoidosis is a debilitating, inflammatory, multiorgan, granulomatous disease of unknown cause, commonly affecting the lung. In contrast to other chronic lung diseases such as interstitial pulmonary fibrosis or pulmonary arterial hypertension, there is so far no widely accepted or implemented animal model for this disease. This has hampered our insights into the etiology of sarcoidosis, the mechanisms of its pathogenesis, the identification of new biomarkers and diagnostic tools and, last not least, the development and implementation of novel treatment strategies. Over past years, however, a number of new animal models have been described that may provide useful tools to fill these critical knowledge gaps. In this review, we therefore outline the present status quo for animal models of sarcoidosis, comparing their pros and cons with respect to their ability to mimic the etiological, clinical and histological hallmarks of human disease and discuss their applicability for future research. Overall, the recent surge in animal models has markedly expanded our options for translational research; however, given the relative early stage of most animal models for sarcoidosis, appropriate replication of etiological and histological features of clinical disease, reproducibility and usefulness in terms of identification of new therapeutic targets and biomarkers, and testing of new treatments should be prioritized when considering the refinement of existing or the development of new models.
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Affiliation(s)
- Yijie Hu
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada.,Department of Cardiovascular Surgery, Institute of Surgical Research, Daping Hospital, Third Military Medical University, Chongqing, China
| | - Betel Yibrehu
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Diana Zabini
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada
| | - Wolfgang M Kuebler
- Keenan Research Centre for Biomedical Science, St. Michael's Hospital, Toronto, ON, Canada. .,Departments of Surgery and Physiology, University of Toronto, Toronto, ON, Canada. .,Institute of Physiology, Charité - Universitätsmedizin Berlin, Charitéplatz 1, 10117, Berlin, Germany.
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Mohammad Y, Haffar L, Adib A, Hamdan Z, Dubaybo B. [Two cases of endobronchial tuberculosis]. REVUE DE PNEUMOLOGIE CLINIQUE 2016; 72:155-160. [PMID: 26776869 DOI: 10.1016/j.pneumo.2015.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 06/29/2015] [Accepted: 08/31/2015] [Indexed: 06/05/2023]
Affiliation(s)
- Y Mohammad
- Damascus University Hospital, 17th April, Damascus, Syria; Lattakia University Hospital, Tishreen University POB1479, Lattakia, Syria.
| | - L Haffar
- Damascus University Hospital, 17th April, Damascus, Syria
| | - A Adib
- Damascus University Hospital, 17th April, Damascus, Syria
| | - Z Hamdan
- Damascus University Hospital, 17th April, Damascus, Syria
| | - B Dubaybo
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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Abstract
PURPOSE OF REVIEW Sarcoidosis is a multisystem inflammatory disease, characterized by the presence of noncaseating granulomas. Ocular inflammation is often the first manifestation of the disease, and uveitis can be the driving force for treatment. The goal of this review was to provide an update on the relationship between ocular and systemic disease, with a particular focus on cardiac sarcoidosis. RECENT FINDINGS Chest radiograph remains the best imaging tool for sarcoidosis, although newer modalities, such as whole-body PET scan, cardiac MRI, and chest computed tomography (CT), may provide additional valuable information in select populations. Ocular sarcoidosis is a marker for vascular endothelial dysfunction and increased arterial rigidity. Choroidal involvement is associated with an increased risk of cardiac disease requiring intervention. Cardiac disease continues to be underdiagnosed in patients with sarcoidosis, although it remains a leading cause of death. SUMMARY Sarcoidosis is a systemic disease, and ophthalmologists should continually assess patients for extraocular manifestations. Although no screening guidelines exist, baseline ECGs on asymptomatic patients might identify those at risk for adverse cardiac events. Patients with symptoms of cardiac disease, including palpitations, chest pain, and dyspnea, should have an evaluation by a cardiologist.
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Meillier A, Commodore M. Sarcoidosis: a diagnostic challenge in atypical radiologic findings of unilateral lymphadenopathy. Oxf Med Case Reports 2015; 2015:376-7. [PMID: 26719811 PMCID: PMC4689979 DOI: 10.1093/omcr/omv068] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 11/13/2015] [Accepted: 11/17/2015] [Indexed: 12/23/2022] Open
Abstract
Sarcoidosis is a chronic systemic disease with a wide array of clinical findings. Given that the clinical symptoms are not pathognomonic, chest radiographs have become essential to the initial diagnosis and choice of treatment modality. Diagnosis hinges on ruling out alternative diagnoses; sometimes, advanced radiologic techniques and histopathology are required. On this occasion, we present a case of a patient with generalized symptoms, no significant chest radiograph findings and lymphadenopathy where advanced imaging and pathology assisted in the diagnosis.
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Affiliation(s)
- Andrew Meillier
- Department of Medicine , Temple University Hospital , Philadelphia, PA , USA
| | - Marius Commodore
- Department of Medicine , Temple University Hospital , Philadelphia, PA , USA
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Lingner H, Großhennig A, Flunkert K, Buhr-Schinner H, Heitmann R, Tönnesmann U, van der Meyden J, Schultz K. ProKaSaRe Study Protocol: A Prospective Multicenter Study of Pulmonary Rehabilitation of Patients With Sarcoidosis. JMIR Res Protoc 2015; 4:e134. [PMID: 26679102 PMCID: PMC4704944 DOI: 10.2196/resprot.4948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 08/19/2015] [Accepted: 09/20/2015] [Indexed: 01/16/2023] Open
Abstract
Background Available data assessing the efficacy of pulmonary rehabilitation for patients with chronic sarcoidosis are scant; for Germany, there are none at all. Objective To gain information about the benefit of in-house pulmonary rehabilitation for patients with chronic sarcoidosis and for the health care system, we intend to collect data in a prospective multicenter “real-life” cohort trial. Methods ProKaSaRe (Prospektive Katamnesestudie Sarkoidose in der pneumologischen Rehabilitation) [Prospective Catamnesis Study of Sarcoidosis in Pulmonary Rehabilitation] will assess a multimodal 3-week inpatient pulmonary rehabilitation program for adult patients with chronic sarcoidosis over a 1-year follow-up time. Defined specific clinical measurements and tests will be performed at the beginning and the end of the rehabilitation. In addition, questionnaires concerning health-related quality of life and the patients’ symptoms will be provided to all patients. Inclusion criteria will be referral to one of the 6 participating pulmonary rehabilitation clinics in Germany for sarcoidosis and age between 18 and 80 years. Patients will only be excluded for a lack of German language skills or the inability to understand and complete the study questionnaires. To rule out seasonal influences, the recruitment will take place over a period of 1 year. In total, at least 121 patients are planned to be included. A descriptive statistical analysis of the data will be performed, including multivariate analyses. The primary outcomes are specific health-related quality of life (St George’s Respiratory Questionnaire) and exercise capacity (6-minute walk test). The secondary outcomes are several routine lung function and laboratory parameters, dyspnea scores and blood gas analysis at rest and during exercise, changes in fatigue, psychological burden, and generic health-related quality of life (36-item Short Form Health Survey). Results Funding was obtained on October 12, 2010; enrollment began on January 15, 2011 and was completed by January 14, 2012. Results are anticipated late summer 2015. Conclusions Due to the large number of participants, we expect to obtain representative findings concerning the effectiveness of pulmonary rehabilitation for patients with sarcoidosis and to provide a dataset of assessed objective and subjective short- and long-term changes due to pulmonary rehabilitation. The results should form the basis for the planning of a randomized controlled trial. Trial Registration German Clinical Trials Register: DRKS00000560; https://drks-neu.uniklinik-freiburg.de/ drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00000560 (Archived by WebCite® at http://www.webcitation.org/6dKb5X87R)
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Affiliation(s)
- Heidrun Lingner
- Centre for Public Health and Healthcare, Hannover Medical School, Hannover, Germany
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Frye BC, Schupp JC, Köhler TL, Müller-Quernheim J. [Diagnosis and treatment of sarcoidosis. Current standards]. Internist (Berl) 2015; 56:1346-52. [PMID: 26563335 DOI: 10.1007/s00108-015-3757-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Sarcoidosis is a granulomatous disease that mainly affects the lungs and intrathoracic lymph nodes; however, virtually any organ can be affected. As an orphan disease, recommendations are mainly based on observational or small randomized studies as well as experts' opinion. Diagnosing sarcoidosis requires proof of non-necrotizing granulomas in patients with a compatible symptomatic pattern and the exclusion of other granulomatous diseases. Granulomas can be detected best in the lungs or intrathoracic lymph nodes. Therefore, bronchoscopy and endobronchial ultrasound with biopsies of lymph nodes are the major tools to diagnose sarcoidosis. Frequently, close follow-up and symptomatic therapy are sufficient to allow for spontaneous resolution. In case of functional organ impairment, cardial or CNS involvement, or other complications, steroid therapy is necessary with a starting dose of 0.5 mg/kg body weight that should be tapered-off over 6-12 months. Steroid-refractory disease can be treated by adding methotrexate or azathioprine, two drugs long known in sarcoidosis treatment. Monoclonal antibodies against TNF and lung transplantation are further therapeutic options.
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Affiliation(s)
- B C Frye
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J C Schupp
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - T L Köhler
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland
| | - J Müller-Quernheim
- Klinik für Pneumologie, Department Innere Medizin, Universitätsklinikum Freiburg, Killianstr. 5, 79106, Freiburg, Deutschland.
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Rajapreyar I, Langlois E. Cardiac Sarcoidosis: Sorting Fact from Fiction in This Rare Cardiomyopathy. CARDIOVASCULAR INNOVATIONS AND APPLICATIONS 2015. [DOI: 10.15212/cvia.2015.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Ask K, Hambly N, Kolb MRJ. Biomarkers in interstitial lung disease: moving towards composite indexes and multimarkers? CURRENT PULMONOLOGY REPORTS 2015. [DOI: 10.1007/s13665-015-0123-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vaidya PJ, Leuppi JD, Chhajed PN. The evolution of flexible bronchoscopy: From historical luxury to utter necessity!! Lung India 2015; 32:208-10. [PMID: 25983403 PMCID: PMC4429379 DOI: 10.4103/0970-2113.156212] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Preyas J Vaidya
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
| | - Joerg D Leuppi
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Department of Medicine, Kantonsspital Liestal, University of Basel, Basel, Switzerland. E-mail:
| | - Prashant N Chhajed
- Institute of Pulmonology, Medical Research and Development, Mumbai, Maharashtra, India ; Lung Care and Sleep Centre, Fortis Hospitals, Mumbai, Maharashtra, India
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