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Momen A, Ali MZ, Hyder Chowdhury NA, Huda RM, Nobi AN, Rahman AU, Alam I, Sayami LA, Alam MA, Hossain MD, Tasneem S. Difficulties to enter the left ventricle during percutaneous transvenous mitral commissurotomy (PTMC)- our experiences of 80 cases with modified techniques. Indian Heart J 2021; 73:612-616. [PMID: 34627578 PMCID: PMC8514396 DOI: 10.1016/j.ihj.2021.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Background Percutaneous transvenous mitral commissurotomy (PTMC) is the standard of treatment for symptomatic severe rheumatic mitral stenosis (MS). PTMC has the standard Inoue technique, but we have to modify the procedure in many technically challenging cases, especially to cross the mitral valve. Methodology Two over-the-wire strategies to enter the LV were taken in 80 complex cases of PTMC. The first one was done by exchanging the J-shaped wire from the balloon, introducing the spring wire into it, and pushing it into LV. The second one-removal of balloon keeping the spring wire in LA and the Mullin's sheath was introduced, and the tip of the wire was pushed into LV, and the balloon was introduced over the wire. We also changed the left atrium (LA) graphy in the RAO view instead of the AP view to facilitating entry into LV. Results We succeeded in 76 (95 %) cases. Strategy one was applied to all but successful in only 25 cases (31 %), and strategy 2 was applied in the remaining. Strategy 1 required less procedural time and fluoroscopic time in comparison to strategy 2 (40 ± 10 vs 60 ± 16 min, 25 ± 7 vs 35 ± 8 min). After modification of taking the LA graphy in RAO view, our rate of facing the difficulties decreased from 21 % to 9 %. Critical MS (31 %) and the giant LA (30 %) were the topmost causes of difficulties. No major complications were recorded. Conclusion Over-the-wire entry into LV is cost-effective, requiring no new equipment and is safe and can be used in complex cases.
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Affiliation(s)
- Abdul Momen
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh.
| | - Md Zulfikar Ali
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Reaz Mahmud Huda
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Abm Nurun Nobi
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Ashraf Ur Rahman
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - Iftequar Alam
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Md Abul Alam
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | | | - Samia Tasneem
- National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
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Marijon E, Mocumbi A, Narayanan K, Jouven X, Celermajer DS. Persisting burden and challenges of rheumatic heart disease. Eur Heart J 2021; 42:3338-3348. [PMID: 34263296 DOI: 10.1093/eurheartj/ehab407] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 05/02/2021] [Accepted: 06/13/2021] [Indexed: 11/13/2022] Open
Abstract
Rheumatic heart disease (RHD) is the result of episodes of acute rheumatic fever with valvular (and other cardiac) damage caused by an abnormal immune response to group A streptococcal infections, usually during childhood and adolescence. As a result of improved living conditions and the introduction of penicillin, RHD was almost eradicated in the developed world by the 1980s. However, being a disease of poverty, its burden remains disproportionately high in the developing world, despite being a fundamentally preventable disease. Rheumatic heart disease generates relatively little attention from the medical and science communities, in contrast to other common infectious problems (such as malaria, HIV, tuberculosis), despite the major cardiovascular morbidity/mortality burden imposed by RHD. This relative neglect and paucity of funding have probably contributed to limited fundamental medical advances in this field for over 50 years. Given the importance of prevention before the onset of major valvular damage, the main challenges for RHD prevention are improving social circumstances, early diagnosis, and effective delivery of antibiotic prophylaxis. Early identification through ultrasound of silent, subclinical rheumatic valve lesions could provide an opportunity for early intervention. Simple echocardiographic diagnostic criteria and appropriately trained personnel can be valuable aids in large-scale public health efforts. In addition, a better understanding of the immunogenic determinants of the disease may provide potential routes to vaccine development and other novel therapies.
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Affiliation(s)
- Eloi Marijon
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - Ana Mocumbi
- Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique.,Instituto Nacional de Saúde, Marracuene, Mozambique
| | - Kumar Narayanan
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Medicover Hospitals, Hyderabad, India
| | - Xavier Jouven
- University of Paris, PARCC, INSERM, Global Health Unit, Paris F-75015, France.,Cardiology Department, European Georges Pompidou Hospital, Paris, France
| | - David S Celermajer
- Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia
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Mutagaywa RK, Wind AM, Kamuhabwa A, Cramer MJ, Chillo P, Chamuleau S. Rheumatic heart disease anno 2020: Impacts of gender and migration on epidemiology and management. Eur J Clin Invest 2020; 50:e13374. [PMID: 32789848 PMCID: PMC7757241 DOI: 10.1111/eci.13374] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 07/27/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND The epidemiology and management of diseases can be influenced by social demographic factors. Gender and migration are among these factors. METHODS We aimed at reviewing the impacts of gender and migration on rheumatic heart disease (RHD) epidemiology and management by a nonsystematic literature review of published studies on RHD worldwide. Our PubMed search terms included RHD pathophysiology, diagnosis, complications, management or prevention, combined with words 'rheumatic mitral stenosis (MS)', 'outcomes after percutaneous balloon mitral valvuloplasty (PBMV)', 'gender or sex difference' and 'migration'. The reporting of this study conforms to SANRA (the Scale for Assessment of Narrative Review Articles) guidelines. RESULTS We retrieved eight studies about the impact of sex on outcomes after PBMV. All of these studies showed a female predominance for RHD. Two studies showed that there is no impact, three studies showed female sex as a predictor of poor outcomes, and the other three showed male sex a predictor of poor outcomes. Although RHD is reported to be eradicated in the developed countries, 2.1% of refugees recently screened for RHD in Italy were found to have subclinical RHD. This prevalence is similar to those found in India (2.0%), Cambodia (2.2%) and Mozambique (3%). CONCLUSIONS There are contradicting results for outcomes after PBMV between males and females. It is not clear whether sex difference plays a role in pathophysiology, diagnosis, management and prognosis of MS. Migration has impacts on epidemiology and management of RHD. Further studies are required in these two fields to explore their relationship to RHD.
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Affiliation(s)
- Reuben K Mutagaywa
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania.,Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Anna-Maria Wind
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Apolinary Kamuhabwa
- School of Pharmacy, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Maarten J Cramer
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Pilly Chillo
- School of Medicine, Muhimbili University of Health and Allied Sciences, Dar Es Salaam, Tanzania
| | - Steven Chamuleau
- Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, University Medical Centre Utrecht, Utrecht, The Netherlands.,Division of Heart and Lung, Department of Cardiology, Faculty of Medicine, Amsterdam University Medical Centre, Amsterdam, The Netherlands
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Adhikari CM, Malla R, Rajbhandari R, Shakya U, Sharma P, Shrestha N, Kc B, Limbu D, Kc MB. Percutaneous transvenous mitral commissurotomy in juvenile mitral stenosis. Cardiovasc Diagn Ther 2016; 6:20-4. [PMID: 26885488 DOI: 10.3978/j.issn.2223-3652.2015.12.07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Percutaneous transvenous mitral commissurotomy (PTMC) is a valid alternative to surgical therapy in selected patients with mitral stenosis. Juvenile mitral stenosis (JMS) varies uniquely from adult rheumatic heart disease (RHD). We aimed to evaluate the efficacy of PTMC in JMS patients. METHODS It was a single centre, retrospective study conducted between July 2013 to June 2015 in Shahid Gangalal National Heart Centre, Kathmandu, Nepal. Medical records of all consecutive patients aged less than 21 years who underwent PTMC were included. Mitral valve area (MVA), left atrial pressure and mitral regurgitation (MR) were compared pre and post procedure. RESULTS During the study period 131 JMS patients underwent PTMC. Seventy (53.4%) were female and 61 (46.6%) were male. Among the 131 patients, 40 (30.5%) patients were below the age of 15 years. Patient age ranged between 9 to 20 years with the mean of 16.3±2.9 years. Electrocardiography (ECG) findings were normal sinus rhythm in 115 (87.7%) patients and atrial fibrillation in 16 (12.3%) patients. Left atrial size ranged from 2.9 to 6.1 cm with the mean of 4.5±0.6 cm. The mean MVA increased from 0.8±0.1 cm(2) to 1.6±0.2 following PTMC. Mean left atrial pressure decreased from their pre-PTMC state of 27.5±8.6 to 14.1±5.8 mmHg. Successful results were observed in 115 (87.7%) patients. Suboptimal MVA <1.5 cm(2) in 11 (8.4%) patients and post-procedure MR of more than moderate MR in 5 (3.8%) patients was the reason for unsuccessful PTMC. CONCLUSIONS PTMC in JMS is safe and effective.
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Affiliation(s)
- Chandra Mani Adhikari
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Rabi Malla
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Rajib Rajbhandari
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Urmila Shakya
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Poonam Sharma
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Nagma Shrestha
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Bishal Kc
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Deepak Limbu
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
| | - Man Bahadur Kc
- 1 Department of Cardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 2 Department of PediatricCardiology, Shahid Gangalal National Heart Centre, Bansbari, Kathmandu, Nepal ; 3 Department of Cardiology, National Academy of Medical Sciences, Bir Hospital Kathmandu, Nepal
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Mocumbi AO. African experiences of humanitarian cardiovascular medicine: the Mozambican experience. Cardiovasc Diagn Ther 2013; 2:246-51. [PMID: 24282722 DOI: 10.3978/j.issn.2223-3652.2012.08.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2012] [Accepted: 08/17/2012] [Indexed: 11/14/2022]
Affiliation(s)
- Ana Olga Mocumbi
- Instituto Nacional de Saúde and Universidade Eduardo Mondlane, Moçambique
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Zühlke L, Mirabel M, Marijon E. Congenital heart disease and rheumatic heart disease in Africa: recent advances and current priorities. Heart 2013; 99:1554-61. [PMID: 23680886 PMCID: PMC3812860 DOI: 10.1136/heartjnl-2013-303896] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2013] [Revised: 04/16/2013] [Accepted: 04/20/2013] [Indexed: 11/17/2022] Open
Abstract
Africa has one of the highest prevalence of heart diseases in children and young adults, including congenital heart disease (CHD) and rheumatic heart disease (RHD). We present here an extensive review of recent data from the African continent highlighting key studies and information regarding progress in CHD and RHD since 2005. Main findings include evidence that the CHD burden is underestimated mainly due to the poor outcome of African children with CHD. The interest in primary prevention for RHD has been recently re-emphasised, and new data are available regarding echocardiographic screening for subclinical RHD and initiation of secondary prevention. There is an urgent need for comprehensive service frameworks to improve access and level of care and services for patients, educational programmes to reinforce the importance of prevention and early diagnosis and a relevant research agenda focusing on the African context.
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Affiliation(s)
- Liesl Zühlke
- Department of Paediatrics, Red Cross War Memorial Children's Hospital and University of Cape Town, Cape Town, South Africa
- Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Mariana Mirabel
- Paris Cardiovascular Research Centre (PARCC–Inserm U970), European Georges Pompidou Hospital, Paris, France
| | - Eloi Marijon
- Paris Cardiovascular Research Centre (PARCC–Inserm U970), European Georges Pompidou Hospital, Paris, France
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7
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Shah B, Sharma M, Kumar R, Brahmadathan KN, Abraham VJ, Tandon R. Rheumatic heart disease: progress and challenges in India. Indian J Pediatr 2013; 80 Suppl 1:S77-86. [PMID: 22941214 DOI: 10.1007/s12098-012-0853-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 06/29/2012] [Indexed: 11/28/2022]
Abstract
Rheumatic heart disease, a neglected disease, continues to be a burden in India and other developing countries. It is a result of an autoimmune sequalae in response to group A beta hemolytic streptococcus (GAS) infection of the pharynx. Acute rheumatic fever (RF), a multisystem inflammatory disease, is followed by rheumatic heart disease (RHD) and has manifestations of joints, skin and central nervous system involvement. A review of epidemiological studies indicates unchanged GAS pharyngitis and carrier rates in India. The apparent decline in RHD rates in India as indicated by the epidemiological studies has to be taken with caution as methodological differences exist among studies. Use of echocardiography increases case detection rates of RHD in population surveys. However, the significance of echo based diagnosis of carditis needs further evaluation to establish the significance. Research in this area through prospective follow up studies will have to be undertaken by the developing countries as the interest of developed countries in the disease has waned due the declined burden in their populations. Prevention of RHD is possible through treatment of GAS pharyngitis (primary prophylaxis) and continued antibiotic treatment for number of years in patients with history of RF to prevent recurrences (secondary prophylaxis). The cost effectiveness and practicality of secondary prophylaxis is well documented. The challenge to any secondary prophylaxis program for prevention of RF in India will be the availability of benzathine penicillin G and dissipation of fears of allergic reactions to penicillin among practitioners, general public and policy makers. The authors review here the progress and challenges in epidemiology, diagnosis and primary and secondary prevention of RF and RHD.
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Affiliation(s)
- Bela Shah
- Division of Non Communicable Diseases, Indian Council of Medical Research, Ansari Nagar, New Delhi, 110029, India
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8
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Abstract
Rheumatic heart disease, often neglected by media and policy makers, is a major burden in developing countries where it causes most of the cardiovascular morbidity and mortality in young people, leading to about 250,000 deaths per year worldwide. The disease results from an abnormal autoimmune response to a group A streptococcal infection in a genetically susceptible host. Acute rheumatic fever--the precursor to rheumatic heart disease--can affect different organs and lead to irreversible valve damage and heart failure. Although penicillin is effective in the prevention of the disease, treatment of advanced stages uses up a vast amount of resources, which makes disease management especially challenging in emerging nations. Guidelines have therefore emphasised antibiotic prophylaxis against recurrent episodes of acute rheumatic fever, which seems feasible and cost effective. Early detection and targeted treatment might be possible if populations at risk for rheumatic heart disease in endemic areas are screened. In this setting, active surveillance with echocardiography-based screening might become very important.
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Affiliation(s)
- Eloi Marijon
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France; Department of Cardiology, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Maputo Heart Institute (ICOR), Maputo, Mozambique.
| | - Mariana Mirabel
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; University College London, London, UK
| | | | - Xavier Jouven
- Paris Cardiovascular Research Centre, INSERM U970, European Georges Pompidou Hospital, Paris, France; Department of Cardiology, European Georges Pompidou Hospital, Paris, France; Paris Descartes University, Paris, France; Maputo Heart Institute (ICOR), Maputo, Mozambique
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Pregnancy-related cardiac complications: A consequence of the burden of rheumatic heart disease in sub-Saharan Africa. Arch Cardiovasc Dis 2011; 104:367-9. [DOI: 10.1016/j.acvd.2011.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/23/2022]
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Marijon E, Iung B. Rheumatic Heart Disease and Percutaneous Mitral Commissurotomy Across the World. Heart Lung Circ 2009; 18:372-3. [DOI: 10.1016/j.hlc.2009.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/06/2009] [Indexed: 11/26/2022]
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12
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Mitral stenosis still a concern in heart valve diseases. Arch Cardiovasc Dis 2008; 101:597-9. [PMID: 19056064 DOI: 10.1016/j.acvd.2008.09.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2008] [Accepted: 09/12/2008] [Indexed: 11/23/2022]
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