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Guure C, Afagbedzi S. Predicting the effect of sulfadoxine-pyrimethamine uptake by pregnant women on birth weight using a generalized ordered partial proportional odds model. BMC Pregnancy Childbirth 2022; 22:223. [PMID: 35305604 PMCID: PMC8933913 DOI: 10.1186/s12884-022-04565-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 03/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Low birth weight is a public health problem in Africa with the cause attributable to malaria in pregnancy. World Health Organization recommends the use of intermittent preventive treatment in pregnancy (IPTp) with sulfadoxine-pyrimethamine to prevent malaria during pregnancy. The objective of this study was to evaluate the prevalence and trajectories of birth weight and the direct impact and relationship between sulfadoxine-pyrimethamine and birth weight in Ghana since 2003. Method This study used secondary data obtained from the Demographic and Health Survey conducted in Ghana since 2003. Low birth weight was defined as weight < 2500 g irrespective of the gestational age of the foetus, while normal birth weight was between 2500 g to < 4000 g and macrosomia was = > 4000 g. In all the analysis, we adjusted for clustering, stratification and weighting to reduce bias and improve precision of the estimates. Analysis was performed on each survey year as well as the pooled dataset. The generalized ordered partial proportional odds model was used due to violations of the parallel regression model assumptions. Efforts were made to identify all confounding variables and these were adjusted for. Predictive analysis was also executed. Results The overall prevalence of low birth weight was 9% while that of macrosomia was 13%. The low birth weight for 2003 was 12% while in 2008 it was 21% and then 68% in 2014. The mean birth weight of the children in 2014 was 3.16 (3.14, 3.19), 2008 was 3.37 (3.28, 3.45) and 2003 was 3.59 (3.49, 3.69) while that of the pooled data was 3.28 (3.25, 3.30). The adjusted model (taking into consideration all confounding variables) showed that non-uptake of SP could result in 51% odds of giving birth to a low-birth-weight compared with normal birth weight child. An insignificant result was observed between macrosomia and low birth weight. Conclusion There is higher probability that low birth weight could increase over the next couple of years if measures are not taking to reverse the current trajectories. The uptake of sulfadoxine-pyrimethamine should continue to be encouraged and recommended because it has a direct beneficial effect on the weight of the child.
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The Effects of TRX Suspension Training Combined with Taurine Supplementation on Body Composition, Glycemic and Lipid Markers in Women with Type 2 Diabetes. Nutrients 2021; 13:nu13113958. [PMID: 34836211 PMCID: PMC8621658 DOI: 10.3390/nu13113958] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 11/02/2021] [Accepted: 11/03/2021] [Indexed: 11/24/2022] Open
Abstract
Background: We aimed to investigate the effects of an 8-week total-body resistance exercise (TRX) suspension training intervention combined with taurine supplementation on body composition, blood glucose, and lipid markers in T2D females. Methods: Forty T2D middle-aged females (age: 53 ± 5 years, body mass = 84.3 ± 5.1 kg) were randomly assigned to four groups, TRX suspension training + placebo (TP; n = 10), TRX suspension training + taurine supplementation (TT; n = 10), taurine supplementation (T; n = 10), or control (C; n = 10). Body composition (body mass, body mass index (BMI), body fat percentage (BFP)), blood glucose (fasting blood sugar (FBS)), hemoglobin A1c (HbA1c), Insulin, and Insulin resistance (HOMA-IR), and lipid markers (low-density lipoprotein (LDL), high-density lipoprotein (HDL), triglyceride (TG), and total cholesterol (TC)) were evaluated prior to and after interventions. Results: All three interventions significantly decreased body mass, BMI, and BFP with no changes between them for body mass and BMI; however, BFP changes in the TT group were significantly greater than all other groups. FBS was significantly reduced in TP and TT. Insulin concentrations’ decrement were significantly greater in all experimental groups compared to C; however, no between group differences were observed between TT, TP, and T. In regards to HOMA-IR, decreases in TT were significantly greater than all other groups TG, HbA1c, and LDL were reduced following all interventions. HDL values significantly increased only in the TT group, while TC significantly decreased in TP and TT groups. Changes in HbA1c, TG, HDL, and TC were significantly greater in the TT compared to all other groups. Conclusions: TRX training improved glycemic and lipid profiles, while taurine supplementation alone failed to show hypoglycemic and hypolipidemic properties. Notably, the synergic effects of TRX training and taurine supplementation were shown in HbA1c, HOMA-IR, TG, TC, HDL, and BFP changes. Our outcomes suggest that TRX training + taurine supplementation may be an effective adjuvant therapy in individuals with T2D.
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Main Risk Factors of Type 2 Diabetes Mellitus with Nonalcoholic Fatty Liver Disease and Hepatocellular Carcinoma. JOURNAL OF ONCOLOGY 2021; 2021:7764817. [PMID: 34691178 PMCID: PMC8528616 DOI: 10.1155/2021/7764817] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/15/2021] [Indexed: 02/06/2023]
Abstract
Type 2 diabetes mellitus (T2DM) with nonalcoholic fatty liver disease (NAFLD) is a pathological metabolic disease characterized by high ketone lipid based on abnormal lipid metabolism. Compared with patients with single T2DM or NAFLD, T2DM complicated with NAFLD has more complicated pathogenic factors and pathological processes. Hepatocellular carcinoma (HCC), the leading malignancy arising from cirrhosis, is the second most lethal cancer globally. The purpose of this study was to clarify the main risk factors of T2DM with NAFLD and HCC. There are many challenges in the diagnosis and treatment of T2DM patients with NAFLD and HCC. The current gold standard is to adjust treatment strategy, optimize metabolic control, and improve liver phenotype. It is necessary to identify further the risk factors driving the progression of T2DM with NAFLD and HCC and evaluate new therapeutic targets, in addition to exploring the syndromic forms of T2DM combined with NAFLD and providing a theoretical basis for early prevention, diagnosis, and treatment of the disease using traditional Chinese medicine (TCM).
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Bansode B, Marbaniang SP, Prasad JB. Risk factors of diabetes and hypertension among women in Karnataka. Diabetes Metab Syndr 2021; 15:102139. [PMID: 34186342 DOI: 10.1016/j.dsx.2021.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIMS The growth in prevalence of diabetes and hypertension has become a major health issue for women in Karnataka. In India, for the first time, the National Family Health Survey has collected information on diabetes and hypertension across the states within India (NFHS-4, 2015-16). Hence there is the need to estimate the prevalence of diabetes and hypertension among women and the associated risk factors using the national represented data. METHODS This study has used data from the fourth round of the National Family Health Survey, which was conducted in 2015-16. Furthermore, the present study included 26,291 women of Karnataka aged 15-49 years. And data analysis was carried out by univariate, bivariate and Binary Logistic Regression techniques. RESULTS This study revealed a high prevalence of diabetes (6.3%) and hypertension (10.5%) among women in Karnataka. Overweight women were more likely to have diabetes (11.7%) and hypertension (20.6%) than normal and underweight women. The detailed analysis indicated demographic and socio-economic diversity in the burden of diabetes and hypertension. The factors responsible for co-morbidities were the changes in the demographic situation and socio-economic status, overweight and substance use. CONCLUSIONS The findings point to the need for raising awareness about the prevention and management of diabetes and hypertension through health education and community-based disease management programs with the help of trained peers and community health workers.
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Affiliation(s)
| | | | - Jang Bahadur Prasad
- Department of Epidemiology and Biostatistics, KLE University, Belgaum, 590010, Karnataka, India.
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5
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Hur J, Yoo J, Shin D, Baek KH, Park S, Lee KJ. Predictability of Macrosomic Birth based on Maternal Factors and Fetal Aneuploidy Screening Biochemical Markers in Hyperglycemic Mothers. Int J Med Sci 2021; 18:2653-2660. [PMID: 34104097 PMCID: PMC8176187 DOI: 10.7150/ijms.49857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 04/19/2021] [Indexed: 01/16/2023] Open
Abstract
Background: Macrosomic birth weight has been implicated as a significant risk factor for developing various adult metabolic diseases such as diabetes mellitus and coronary heart diseases; it has also been associated with higher incidences of complicated births. This study aimed to examine the predictability of macrosomic births in hyperglycemic pregnant women using maternal clinical characteristics and serum biomarkers of aneuploidy screening performed in the first half of pregnancy. Methods: A retrospective observational study was performed on a cohort of 1,668 pregnant women who 1) had positive outcomes after undergoing 50-g oral glucose challenge test (OGCT) at two university-based hospitals and 2) underwent any one of the following maternal biomarker screening tests for fetal aneuploidy: triple test, quadruple test, and integrated test. Logistic regression-based models for predicting macrosomic births using maternal characteristics and serum biomarkers were developed and evaluated for prediction power. A nomogram, which is a graphical display of the best predictable model, was then generated. Results: The study cohort included 157 macrosomic birth cases defined as birth weight ≥3,820 g, which was equivalent to the top 10 percentile of the modeling cohort. Three primary models solely based on serum biomarkers achieved area under curves (AUCs) of 0.55-0.62. Expanded models, including maternal demographic and clinical factors, demonstrated an improved performance by 25% (AUCs, 0.69-0.73). Conclusion: Our prediction models will help to identify pregnancies with an elevated risk of macrosomic births in hyperglycemic mothers using maternal clinical factors and serum markers from routine antenatal screening tests. Prediction of macrosomic birth at mid-pregnancy may allow customized antenatal care to reduce the risk of macrosomic births.
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Affiliation(s)
- Junguk Hur
- Department of Biomedical Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Jinho Yoo
- YooJin BioSoft Co., Ltd., Goyang, Gyeonggi-do 10403, Korea
| | - Dayeon Shin
- Department of Food and Nutrition, Inha University, Incheon 22212, Korea
| | - Kwang-Hyun Baek
- Department of Biomedical Science, CHA University, Seongnam-Si, Gyeonggi-Do 13488, Korea
| | - Sunwha Park
- Department of Obstetrics and Gynecology, College of Medicine, Ewha Womans University, 1071 Anyangcheon-ro, Yangcheon-gu, Seoul 07985, Korea
| | - Kyung Ju Lee
- Department of Obstetrics and Gynecology, Korea University Medicine, Seoul 02841, Korea.,Department of Public Health, Korea University Graduate School, Seoul 02841, Korea
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Muche AA, Olayemi OO, Gete YK. Effects of gestational diabetes mellitus on risk of adverse maternal outcomes: a prospective cohort study in Northwest Ethiopia. BMC Pregnancy Childbirth 2020; 20:73. [PMID: 32013909 PMCID: PMC6998275 DOI: 10.1186/s12884-020-2759-8] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 01/22/2020] [Indexed: 02/07/2023] Open
Abstract
Background Gestational diabetes mellitus is a leading medical condition woman encounter during pregnancy with serious short- and long-term consequences for maternal morbidity. However, limited evidence was available on potential impacts of gestational diabetes mellitus using updated international diagnostic criteria on adverse maternal outcomes. Therefore, this study aimed to assess the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes in Northwest Ethiopia. Methods A prospective cohort study was conducted among pregnant women followed from pregnancy to delivery. Gestational diabetes mellitus status was determined by using a two-hour 75 g oral glucose tolerance test and based on updated international diagnostic criteria. Multivariable log-binomial model was used to examine the effects of gestational diabetes mellitus on the risk of adverse maternal outcomes. Results A total of 694 women completed the follow-up and included in the analysis. Women with gestational diabetes mellitus had a higher risk of composite adverse maternal outcome (ARR=1.58, 95% CI: 1.22, 2.04), caesarean delivery (ARR=1.67; 95%: 1.15, 2.44), pregnancy induced hypertension (ARR= 3.32; 95%: 1.55, 7.11), premature rupture of membranes (ARR= 1.83; 95%: 1.02, 3.27), antepartum hemorrhage (ARR= 2.10; 95%: 1.11, 3.98) and postpartum hemorrhage (ARR= 4.85; 95%:2.28, 10.30) compared to women without gestational diabetes mellitus. Conclusions Gestational diabetes mellitus increased the risk of adverse maternal outcomes. This implies that maternal care and intervention strategies relating to women with gestational diabetes mellitus should be strengthened.
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Affiliation(s)
- Achenef Asmamaw Muche
- Department of Obstetrics and Gynecology, Pan African University Life and Earth Sciences Institute, College of Medicine, University of Ibadan, Ibadan, Nigeria. .,Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Oladapo O Olayemi
- Department of Obstetrics and Gynecology, College of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Yigzaw Kebede Gete
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
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Yu M, Wang W, Wang H. The Late-Gestational Triglyceride to High-Density Lipoprotein Cholesterol Ratio Is Associated with Neonatal Macrosomia in Women without Diabetes Mellitus. Int J Endocrinol 2020; 2020:7250287. [PMID: 32655633 PMCID: PMC7321524 DOI: 10.1155/2020/7250287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/28/2020] [Accepted: 05/15/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the associations between late-gestational dyslipidemia, expressed as the ratio between triglycerides (TGs) and high-density lipoprotein cholesterol (HDL), and the risk of macrosomia among nondiabetic pregnant women. METHODS In this case-control study, 171 pregnant women who delivered macrosomia newborns were recruited from a total of 1856 nondiabetic pregnant women who delivered a singleton, nonanomalous newborn. A total of 684 normal controls were one-to-four matched by age. Logistic regression analysis was used to analyze the association between the TG/HDL ratio and the neonatal body weight as well as the risk of macrosomia. RESULTS The maternal serum TG and TG/HDL levels were much higher in the macrosomia group, while the maternal serum HDL-C levels were much lower in the macrosomia group than those in the control group. However, the serum total cholesterol (TC) and LDL-C levels were not significantly different between the two groups. Furthermore, maternal TG/HDL levels were positively associated with neonatal body weight. The confounding factors including maternal age, maternal height, gestational age, maternal body mass index (BMI), FPG, SBP, and neonatal sex were adjusted. A positive association between TG/HDL and neonatal body weight was still found. Moreover, the prevalence of macrosomia increased markedly in a dose-dependent manner as with maternal TG/HDL levels increased. CONCLUSIONS Maternal serum TG/HDL levels at late gestation are positively associated with neonatal body weight and the risk of macrosomia in women without DM. Maintaining maternal lipid levels in an appropriate range is important in the context of fetal overgrowth and primary prevention of macrosomia.
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Affiliation(s)
- Mengru Yu
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Key laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Jinan, Shandong, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Wenting Wang
- Department of Obstetrics and Gynecology, The Second Hospital of Shandong University, Jinan, China
| | - Hong Wang
- Department of Obstetrics and Gynecology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
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Manojlović D, Stupin A, Matić A, Mihaljević Z, Novak S, Drenjančević I. The Role of Epoxyeicosatrienoic Acids in Diabetes Mellitus-Induced Impaired Vascular Relaxation of Aortic Rings in Ovariectomized Sprague-Dawley Rats. Int J Endocrinol 2019; 2019:5410108. [PMID: 31049062 PMCID: PMC6458872 DOI: 10.1155/2019/5410108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 02/06/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022] Open
Abstract
AIM The present study was aimed at determining if type 1 diabetes mellitus (DM) affects vascular function and at elucidating the mechanisms mediating vasorelaxation in both nonovariectomized and ovariectomized Sprague-Dawley (SD) rats. MATERIALS AND METHODS Eighty female SD rats were divided into four groups: nonovariectomized healthy (non-OVX-CTR) and diabetic (non-OVX-DM) rats and ovariectomized healthy (OVX-CTR) and diabetic (OVX-DM) rats. Bilateral ovariectomy was performed at the age of 5 weeks, and type 1 DM was induced by streptozotocin at the age of 6 weeks. At the age of 12 weeks, acetylcholine-induced relaxation (AChIR) was assessed in aortic rings in the absence/presence of L-NAME, Indomethacin, and MS-PPOH. Aortic tissue mRNA expression of eNOS, iNOS, COX-1, COX-2, thromboxane synthase 1 (TBXAS1), CYP4A1, CYP4A3, and CYP2J3, as well as plasma oxidative stress, was measured. RESULTS AChIR did not differ in non-OVX-DM rats compared to non-OVX-CTR ones. AChIR was significantly reduced in the OVX-DM group compared to the OVX-CTR group. MS-PPOH did not reduce AChIR in OVX-DM rats as it did in OVX-CTR ones. CYP4a3 mRNA expression in OVX-DM rats was significantly lower compared to that in the OVX-CTR group. CONCLUSIONS Female sex hormones may protect vasorelaxation in type 1 diabetic rats. Type 1 diabetes impairs vasorelaxation in response to ACh in ovariectomized rats (but not in nonovariectomized rats) by affecting vasorelaxation pathways mediated by EETs.
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Affiliation(s)
| | - Ana Stupin
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Pathophysiology, Physiology, and Immunology, Faculty of Dental Medicine and Health, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Anita Matić
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Zrinka Mihaljević
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Sanja Novak
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Ines Drenjančević
- Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
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9
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Chan RSM, Tam WH, Ho ICH, Kwan MWC, Li LS, Sea MMM, Woo J. Randomized trial examining effectiveness of lifestyle intervention in reducing gestational diabetes in high risk Chinese pregnant women in Hong Kong. Sci Rep 2018; 8:13849. [PMID: 30218012 PMCID: PMC6138708 DOI: 10.1038/s41598-018-32285-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 09/05/2018] [Indexed: 11/09/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is of public health concern. This trial examined whether a clinically proven lifestyle modification program (LMP) in early pregnancy was superior to routine antenatal care in improving GDM, maternal and infant outcomes. Chinese pregnant women at risk of GDM (n = 220) were recruited at or before 12-week gestation and randomized to either a LMP group or a routine care control group. Eighty subjects completed a dietitian-led LMP including dietary and exercise components from early pregnancy till 24-week gestation. Data were compared with those of 86 control subjects. Twenty three (26.7%) control subjects and 20 (25.0%) LMP subjects developed GDM (p = 0.798). The proportion of infants born large for gestational age and macrosomia was similar between groups. The LMP group showed a lower proportion of excessive gestational weight gain (GWG). Subgroup analysis suggested that those with higher LMP adherence showed more desirable dietary composition and energy intake, and lower proportion of excessive GWG compared with the low LMP adherence group and the control group. The potential effect of LMP on GDM and other maternal and infant outcomes, in particular GWG, as well as barriers for making lifestyle changes warrant further investigations (ClinicalTrials.gov NCT02368600).
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Affiliation(s)
- Ruth Suk-Mei Chan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
| | - Wing-Hung Tam
- Department of Obstetrics and Gynaecology, The Chinese University of Hong Kong, Hong Kong, China
| | - Ivan Chak-Hang Ho
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Macy Wai-Chi Kwan
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Liz Sin Li
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Mandy Man-Mei Sea
- Centre for Nutritional Studies, The Chinese University of Hong Kong, Hong Kong, China
| | - Jean Woo
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Carroll X, Liang X, Zhang W, Zhang W, Liu G, Turner N, Leeper-Woodford S. Socioeconomic, environmental and lifestyle factors associated with gestational diabetes mellitus: A matched case-control study in Beijing, China. Sci Rep 2018; 8:8103. [PMID: 29802340 PMCID: PMC5970220 DOI: 10.1038/s41598-018-26412-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 05/10/2018] [Indexed: 12/19/2022] Open
Abstract
Gestational diabetes mellitus (GDM) is a common health problem during pregnancy and its prevalence is increasing globally, especially in China. The aim of this study was to investigate socioeconomic, environmental and lifestyle factors associated with GDM in Chinese women. A matched pair case-control study was conducted with 276 GDM women and 276 non-GDM women in two hospitals in Beijing, China. Matched factors include age and pre-pregnancy body mass index (BMI). GDM subjects were defined based on the International Association of Diabetes Study Group criteria for GDM. A conditional logistic regression model with backward stepwise selection was performed to predict the odds ratio (OR) for associated factors of GDM. The analyses of data show that passive smoking at home (OR = 1.52, p = 0.027), passive smoking in the workplace (OR = 1.71, p = 0.01), and family history of diabetes in first degree relatives (OR = 3.07, p = 0.004), were significant factors associated with GDM in Chinese women. These findings may be utilized as suggestions to decrease the incidence of GDM in Chinese women by improving the national tobacco control policy and introducing public health interventions to focus on the social environment of pregnant women in China.
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Affiliation(s)
- Xianming Carroll
- Department of Community Medicine, Mercer University School of Medicine, Macon, USA
| | - Xianhong Liang
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China.
| | - Wenyan Zhang
- Department of Obstetrics and Gynecology, Beijing Chaoyang District Hospital of Maternal and Child Health, Beijing, China
| | - Wenjing Zhang
- Department of Obstetrics, Beijing Chuiyangliu Hospital, Beijing, China
| | - Gaifen Liu
- Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Nannette Turner
- Department of Public Health, Mercer University College of Health Professions, Atlanta, USA
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11
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Utz B, Delamou A, Belaid L, De Brouwere V. Detection and Management of Diabetes during Pregnancy in Low Resource Settings: Insights into Past and Present Clinical Practices. J Diabetes Res 2016; 2016:3217098. [PMID: 27803934 PMCID: PMC5075631 DOI: 10.1155/2016/3217098] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 09/15/2016] [Indexed: 11/17/2022] Open
Abstract
Background. Timely and adequate treatment is important to limit complications of diabetes affecting pregnancy, but there is a lack of knowledge on how these women are managed in low resource settings. Objective. To identify modalities of gestational diabetes detection and management in low and lower middle income countries. Methods. We conducted a scoping review of published literature and searched the databases PubMed, Web of Science, Embase, and African Index Medicus. We included all articles published until April 24, 2016, containing information on clinical practices of detection and management of gestational diabetes irrespective of publication date or language. Results. We identified 23 articles mainly from Asia and sub-Saharan Africa. The majority of studies were conducted in large tertiary care centers and hospital admission was reported in a third of publications. Ambulatory follow-up was generally done by weekly to fortnightly visits, whereas self-monitoring of blood glucose was not the norm. The cesarean section rate for pregnancies affected by diabetes ranged between 20% and 89%. Referral of newborns to special care units was common. Conclusion. The variety of reported provider practices underlines the importance of promoting latest consensus guidelines on GDM screening and management and the dissemination of information regarding their implementation.
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Affiliation(s)
- Bettina Utz
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | | | - Loubna Belaid
- Centre de Recherche Hospitalier, University of Montreal, Montreal, QC, Canada
| | - Vincent De Brouwere
- Department of Public Health, Institute of Tropical Medicine (ITM), Antwerp, Belgium
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12
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Abubakari A, Kynast-Wolf G, Jahn A. Prevalence of abnormal birth weight and related factors in Northern region, Ghana. BMC Pregnancy Childbirth 2015; 15:335. [PMID: 26670886 PMCID: PMC4681076 DOI: 10.1186/s12884-015-0790-y] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Accepted: 12/11/2015] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Birth weight is a crucial determinant of the development potential of the newborn. Abnormal newborn weights are associated with negative effects on the health and survival of the baby and the mother. Therefore, this study was designed to determine the prevalence of abnormal birth weight and related factors in Northern region, Ghana. METHODS The study was a facility-based cross-sectional survey in five hospitals in Northern region, Ghana. These hospitals were selected based on the different socio-economic backgrounds of their clients. The data on birth weight and other factors were derived from hospital records. RESULTS It was observed that low birth weight is still highly prevalent (29.6%), while macrosomia (10.5%) is also increasingly becoming important. There were marginal differences in low birth weight observed across public hospitals but marked difference in low birth weight was observed in Cienfuegos Suglo Specialist Hospital (Private hospital) as compared to the public hospitals. The private hospital also had the highest prevalence of macrosomia (20.1%). Parity (0-1) (p < 0.001), female gender (p < 0.001) and location (rural) (p < 0.001) were significantly associated with decreased risk of macrosomic births. On the other hand, female infant sex (p < 0.001), residential status (rural) (p < 0.001) and parity (0-1) (p < 0.001) were significantly associated with increased risk of low birth weigh. CONCLUSIONS Our findings show that under nutrition (low birth weight) and over nutrition (macrosomia) coexist among infants at birth in Northern region reflecting the double burden of malnutrition phenomenon, which is currently being experienced by developing and transition counties. Both low birth weight and macrosomia are risk factors, which could contribute considerably to the current and future burden of diseases. This may overstretch the already fragile health system in Ghana. Therefore, it is prudent to recommend that policies aiming at reducing diet related diseases should focus on addressing malnutrition during pregnancy and early life.
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Affiliation(s)
- Abdulai Abubakari
- Institute of Public Health, University Hospital, University of Heidelberg, Heidelberg, Germany.
- Community Nutrition Department, School of Allied Health Sciences, University for Development Studies, P.Box TL 1883, Tamale, Ghana.
| | - Gisela Kynast-Wolf
- Institute of Public Health, University Hospital, University of Heidelberg, Heidelberg, Germany.
| | - Albrecht Jahn
- Institute of Public Health, University Hospital, University of Heidelberg, Heidelberg, Germany.
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Ye J, Torloni MR, Ota E, Jayaratne K, Pileggi-Castro C, Ortiz-Panozo E, Lumbiganon P, Morisaki N, Laopaiboon M, Mori R, Tunçalp Ö, Fang F, Yu H, Souza JP, Vogel JP, Zhang J. Searching for the definition of macrosomia through an outcome-based approach in low- and middle-income countries: a secondary analysis of the WHO Global Survey in Africa, Asia and Latin America. BMC Pregnancy Childbirth 2015; 15:324. [PMID: 26634821 PMCID: PMC4669645 DOI: 10.1186/s12884-015-0765-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022] Open
Abstract
Background No consensus definition of macrosomia currently exists among researchers and obstetricians. We aimed to identify a definition of macrosomia that is more predictive of maternal and perinatal mortality and morbidity in low- and middle-income countries. Methods We conducted a secondary data analysis using WHO Global Survey on Maternal and Perinatal Health data on Africa and Latin America from 2004 to 2005 and Asia from 2007 to 2008. We compared adverse outcomes, which were assessed by the composite maternal mortality and morbidity index (MMMI) and perinatal mortality and morbidity index (PMMI) in subgroups with birthweight (3000–3499 g [reference group], 3500–3999 g, 4000–4099 g, 4100–4199 g, 4200–4299 g, 4300–4399 g, 4400–4499 g, 4500–4999 g) or country-specific birthweight percentile for gestational age (50th–74th percentile [reference group], 75th–89th, 90th–94th, 95th–96th, and ≥97th percentile). Two-level logistic regression models were used to estimate odds ratios of MMMI and PMMI. Results A total of 246,659 singleton term births from 363 facilities in 23 low- and middle-income countries were included. Adjusted odds ratios (aORs) for intrapartum caesarean sections exceeded 2.0 when birthweight was greater than 4000 g (2 · 00 [95 % CI: 1 · 68, 2 · 39], 2 · 42 [95 % CI: 2 · 02, 2 · 89], 2 · 01 [95 % CI: 1 · 74, 2 · 33] in Africa, Asia and Latin America, respectively). aORs of MMMI reached 2.0 when birthweight was greater than 4000 g, 4500 g in Asia and Africa, respectively. aORs of PMMI approached to 2.0 (1 · 78 [95 % CI: 1 · 16, 2 · 74]) when birthweight was greater than 4500 g in Latin America. When birthweight was at the 90th percentile or higher, aORs of MMMI and PMMI increased, but none exceeded 2.0. Conclusions The population-specific definition of macrosomia using birthweight cut-off points irrespective of gestational age (4500 g in Africa and Latin America, 4000 g in Asia) is more predictive of maternal and perinatal adverse outcomes, and simpler to apply compared to the definition based on birthweight percentile for a given gestational age. Electronic supplementary material The online version of this article (doi:10.1186/s12884-015-0765-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiangfeng Ye
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China. .,UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Maria Regina Torloni
- Department of Internal Medicine, Post Graduate program of Evidence Based Healthcare, São Paulo Federal University, São Paulo, SP, Brazil.
| | - Erika Ota
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Kapila Jayaratne
- Family Health Bureau, Ministry of Health, 231, De Saram Place, Colombo 10, Sri Lanka.
| | - Cynthia Pileggi-Castro
- Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Eduardo Ortiz-Panozo
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico.
| | - Pisake Lumbiganon
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
| | - Naho Morisaki
- Division of Lifecourse Epidemiology, Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Malinee Laopaiboon
- Department of Biostatistics & Demography, Faculty of Public Health, Khon Kaen University, Khon Kaen, Thailand.
| | - Rintaro Mori
- Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan.
| | - Özge Tunçalp
- UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Fang Fang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
| | - Hongping Yu
- School of Public Health, Guilin Medical College, Guangxi, China.
| | - João Paulo Souza
- Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
| | - Joshua Peter Vogel
- UNDP • UNFPA • UNICEF • WHO • World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Jun Zhang
- Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Koyanagi A, Zhang J, Dagvadorj A, Hirayama F, Shibuya K, Souza JP, Gülmezoglu AM. Macrosomia in 23 developing countries: an analysis of a multicountry, facility-based, cross-sectional survey. Lancet 2013; 381:476-83. [PMID: 23290494 DOI: 10.1016/s0140-6736(12)61605-5] [Citation(s) in RCA: 203] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Macrosomia is a risk factor for adverse delivery outcomes. We investigated the prevalence, risk factors, and delivery outcomes of babies with macrosomia in 23 developing countries in Africa, Asia, and Latin America. METHODS We analysed data from WHO's Global Survey on Maternal and Perinatal Health, which was a facility-based cross-sectional study that obtained data for women giving birth in 373 health facilities in 24 countries in Africa and Latin America in 2004-05, and in Asia in 2007-08. Facilities were selected by stratified multistage cluster sampling and women were recruited at admission for delivery. We extracted data from the medical records with a standardised questionnaire. We used logistic regression with random effects to assess the risk factors for macrosomia and the risks for caesarean section and adverse maternal and perinatal outcomes (assessed by a composite score) in babies with the disorder. FINDINGS Of 290,610 deliveries, we analysed data for 276,436 singleton livebirths or fresh stillbirths. Higher maternal age (20-34 years), height, parity, body-mass index, and presence of diabetes, post-term pregnancy, and male fetal sex were associated with a significantly increased risk of macrosomia. Macrosomia was associated with an increased risk of caesarean section because of obstructed labour and post-term pregnancy in all regions. Additionally, macrosomia was associated with an increased risk of adverse maternal birth outcomes in all regions, and of adverse perinatal outcomes only in Africa. INTERPRETATION Increasing prevalence of diabetes and obesity in women of reproductive age in developing countries could be associated with a parallel increase in macrosomic births. The effect and feasibility of control of diabetes and preconception weight on macrosomia should be investigated in these settings. Furthermore, increased institutional delivery in countries where rates are low could be crucial to reduce macrosomia-associated morbidity and mortality. FUNDING None.
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Wang Z, Kanguru L, Hussein J, Fitzmaurice A, Ritchie K. Incidence of adverse outcomes associated with gestational diabetes mellitus in low- and middle-income countries. Int J Gynaecol Obstet 2013; 121:14-9. [PMID: 23321368 DOI: 10.1016/j.ijgo.2012.10.032] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2012] [Revised: 10/20/2012] [Accepted: 12/18/2012] [Indexed: 12/16/2022]
Abstract
BACKGROUND The contribution of medical conditions such as diabetes mellitus to maternal and neonatal ill-health in low- and middle-income countries is not well documented. OBJECTIVES To ascertain the incidence of adverse outcomes associated with gestational diabetes mellitus (GDM) in these countries. SEARCH STRATEGY Electronic databases were searched between 1990 and 2011. SELECTION CRITERIA Observational, experimental, and quasi-experimental studies reporting adverse outcomes associated with GDM in mothers and their infants in low- and middle-income countries were included. DATA COLLECTION AND ANALYSIS Titles and abstracts were screened, and full-text articles were independently assessed by at least 2 reviewers. Characteristics of studies were tabulated and quality assessment performed. Median and interquartile range (IQR) were computed for each adverse outcome. MAIN RESULTS 25 articles were included from an initial 1282 citations. High median incidences of cesarean (43.8%; IQR, 34.9%-65.9%), neonatal jaundice (17.1%; IQR, 8.5%-22.9%), and macrosomia (17.0%; IQR, 8.3%-32.5%) were reported in women with GDM. CONCLUSIONS The high incidence of some complications of GDM is a concern and may indicate poorer care for women with GDM in low-resource settings. The wide IQRs found indicate uncertainty about the burden of GDM in these settings.
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Affiliation(s)
- Zheng Wang
- Immpact, University of Aberdeen, Aberdeen, UK
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Chakrabarti S, Cheung CC, Davidge ST. Estradiol attenuates high glucose-induced endothelial nitrotyrosine: role for neuronal nitric oxide synthase. Am J Physiol Cell Physiol 2011; 302:C666-75. [PMID: 22135215 DOI: 10.1152/ajpcell.00181.2011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hyperglycemia in diabetes causes increased oxidative stress in the vascular endothelium with generation of free radicals such as superoxide. Peroxynitrite, a highly reactive species generated from superoxide and nitric oxide (NO), induces proinflammatory tyrosine nitration of intracellular proteins under such conditions. The female sex hormone estrogen appears to exert protective effects on the nondiabetic endothelium. However, several studies show reduced vascular protection in women with diabetes, suggesting alterations in estrogen signaling under high glucose. In this study, we examined the endothelial effects of estrogen under increasing glucose levels, focusing on nitrotyrosine and peroxynitrite. Human umbilical vein endothelial cells were incubated with normal (5.5 mM) or high (15.5 or 30.5 mM) glucose before addition of estradiol (E2, 1 or 10 nM). Selective NO synthase (NOS) inhibitors were used to determine the role of specific NOS isoforms. Addition of E2 significantly reduced high glucose-induced increase in peroxynitrite and consequently, nitrotyrosine. The superoxide levels were unchanged, suggesting effects on NO generation. Inhibition of neuronal NOS (nNOS) reduced high glucose-induced nitrotyrosine, demonstrating a critical role for this enzyme. E2 increased nNOS activity under normal glucose while decreasing it under high glucose as determined by its phosphorylation status. These data show that nNOS contributes to endothelial peroxynitrite and subsequent nitrotyrosine generation under high glucose, which can be attenuated by E2 through nNOS inhibition. The altered regulation of nNOS by E2 under high glucose is a potential therapeutic target in women with diabetes.
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Affiliation(s)
- Subhadeep Chakrabarti
- Department of Obstetrics and Gynecology, Women and Children's Health Research Institute, Cardiovascular Research Centre, University of Alberta, Edmonton, Alberta, Canada
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Abstract
Diabetes mellitus (DM) is a lifelong progressive disease. Currently there are more than 285 million DM-affected people worldwide. Globally the prevalence of diabetes continues to rise and is more pronounced in countries with large populations such as China, India and USA. Driving forces behind the epidemic are obesity, aging of the population and longer life expency. Prospective, the majority of diabetic population will be in their six to eight decades of life with the implication of more females than males. Severe micro- and macrovascular complications associated with diabetes lead to a highly increased morbidity and mortality. Therefore, DM is projected to be one of the leading health problems of 21st centuary. Urgent measures are required to reduce the diabetic burden. Thus advanced predictive diagnostic tools and personalized treatment strategies in (pre)diabetic care are critical and should exert beneficial impact on public health.
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Chakrabarti S, Davidge ST. High glucose-induced oxidative stress alters estrogen effects on ERalpha and ERbeta in human endothelial cells: reversal by AMPK activator. J Steroid Biochem Mol Biol 2009; 117:99-106. [PMID: 19635557 DOI: 10.1016/j.jsbmb.2009.07.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 06/18/2009] [Accepted: 07/17/2009] [Indexed: 02/07/2023]
Abstract
Estrogen appears to protect against cardiovascular disease in pre-menopausal women. However, these protective effects are absent in women with diabetes. The hyperglycemia and consequent oxidative stress observed in diabetes cause endothelial dysfunction, but specific effects on endothelial estrogen responses are not known. In this study, we hypothesized that high glucose conditions would alter the regulation of the estrogen receptors (ERs), ERalpha and ERbeta, in endothelial cells, possibly through increased oxidative stress. The role of the AMPK activator AICAR was examined on modulating the effects of high glucose. Cultured human endothelial cells were exposed to physiologically relevant doses of 17-beta-estradiol (E2) for 24h in presence of normal (5.5mM) and high (30.5mM) levels of glucose. Protein levels of estrogen receptors, ERalpha and ERbeta, were measured through western blotting. Oxidative stress was measured by the dihydroethidium (DHE) assay for superoxide. Under normal glucose, E2 increased the levels of ERalpha relative ERbeta; however, high glucose reversed the estrogen effects on endothelial ER expression. AMPK activation restored the physiological estrogen responses, likely through amelioration of oxidative stress. Control of oxidative stress by AMPK activation or anti-oxidants could restore normal estrogen responses even in presence of hyperglycemia.
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