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Ngokwe ZB, Gimel NKS, Ntep David Bienvenue N, Kalla GCM, Messanga Charles B. Cancrum oris and hemiparesis in a young female patient-a case report. Clin Case Rep 2024; 12:e9111. [PMID: 38911917 PMCID: PMC11192591 DOI: 10.1002/ccr3.9111] [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: 11/07/2023] [Revised: 05/09/2024] [Accepted: 06/11/2024] [Indexed: 06/25/2024] Open
Abstract
Key Clinical Message Noma is still around today and can be deadly if ignored. Prompt identification and comprehensive care are essential for averting permanent impairments and disfigurements. Abstract Noma is a rapid developing orofacial gangrene and a disabling disease that primarily affects young children who live in dangerous conditions. Underlying diseases such as HIV/AIDS and malnutrition can enhance the likelihood of Noma's emergence. This is a case of a 9-year-old girl patient who arrived malnourished and with an ulcerating communicating right mandibular soft tissue lesion as well as right hemiparesis which had an acute onset. The patient was likewise HIV positive discovered upon admission, possibly as a result of vertical transmission, and was an ART (antiretroviral therapy) treatment naive patient. A holistic treatment plan was installed and a positive clinical response was observed. Early treatment is key in Noma management.
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Affiliation(s)
- Zilefac Brian Ngokwe
- Department of Oral Surgery, Maxillofacial Surgery and Periodontology, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé IYaoundeCameroon
- Yaoundé University Teaching HospitalYaoundeCameroon
| | - Nokam Kamdem Stephane Gimel
- Department of Oral Surgery, Maxillofacial Surgery and Periodontology, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé IYaoundeCameroon
- Yaoundé University Teaching HospitalYaoundeCameroon
| | - Ntep Ntep David Bienvenue
- Department of Oral Surgery, Maxillofacial Surgery and Periodontology, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé IYaoundeCameroon
- Yaoundé University Teaching HospitalYaoundeCameroon
| | - Ginette Claude Mireille Kalla
- Yaoundé University Teaching HospitalYaoundeCameroon
- Department of Paediatrics, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé IYaoundeCameroon
| | - Bengondo Messanga Charles
- Department of Oral Surgery, Maxillofacial Surgery and Periodontology, Faculty of Medicine and Biomedical SciencesUniversity of Yaoundé IYaoundeCameroon
- Yaoundé University Teaching HospitalYaoundeCameroon
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Mpinga EK, Srour ML, Moussa MSA, Dupuis M, Kagoné M, Grema MSM, Zacharie NB, Baratti-Mayer D. Economic and Social Costs of Noma: Design and Application of an Estimation Model to Niger and Burkina Faso. Trop Med Infect Dis 2022; 7:119. [PMID: 35878131 PMCID: PMC9317383 DOI: 10.3390/tropicalmed7070119] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 06/08/2022] [Accepted: 06/22/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND While noma affects hundreds of thousands of children every year, taking their lives, disfiguring them and leaving them permanently disabled, the economic and social costs of the disease have not been previously estimated. An understanding of the nature and levels of these costs is much needed to formulate and implement strategies for the prevention and control of this disease, or to mitigate its burden. The objectives of our study were to develop a model for estimating the economic and social costs of noma and to provide estimates by applying this model to the specific contexts of two countries in the "noma belt", namely Burkina Faso and Niger. METHODS Three main approaches were used. The estimation of prevalence levels of potential noma cases and of cases that should receive and actually do receive medical care was carried out using a literature review. The documentary approach made it possible to estimate the direct costs of noma by analyzing the database of a non-governmental organization operating in this field and present in both countries. Indirect costs were estimated using the human capital method and the cost component analysis technique. RESULTS The direct costs of care and management of noma survivors amount to approximately USD 30 million per year in Burkina Faso, compared to approximately USD 31 million in Niger. They mainly include costs for medical treatment, surgery, hospital stays, physiological care, psychological care, social assistance, schooling, vocational training and care abroad. Indirect costs are estimated at around 20 million in lost production costs in Burkina and around 16 million in Niger. Costs related to premature deaths are estimated at more than USD 3.5 billion in Burkina Faso and USD 3 billion in Niger. Finally, the costs to survivors who are unable to marry are around USD 13.4 million in Burkina and around USD 15 million in Niger. Intangible costs were not calculated. CONCLUSIONS The neglect of noma and inaction in terms of prevention and control of the disease have enormous economic and social costs for households, communities and states. Future studies of this kind are necessary and useful to raise awareness and eradicate this disease, which impacts the health and well-being of children and results in lifelong suffering and severe economic and social costs to survivors and their families.
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Affiliation(s)
- Emmanuel Kabengele Mpinga
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
| | | | - Marie-Solène Adamou Moussa
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
| | - Marc Dupuis
- Institute of Higher Education and Research in Healthcare, Lausanne University Hospital and University of Lausanne, 1011 Lausanne, Switzerland;
| | - Moubassira Kagoné
- Centre de Recherche en Santé de Nouna, National Institute of Public Health, Ouagadougou, Burkina Faso;
| | - Maïna Sani Malam Grema
- Faculté des Lettres et Sciences Humaines, University Abdou Moumouni of Niamey, Niamey, Niger;
| | - Ngoyi-Bukonda Zacharie
- Department of Public Health Sciences, Wichita State University, Wichita, KS 67260, USA;
- Faculté des Sciences de la Santé, Université Pédagogique Nationale, Kinshasa-Ngaliema, Democratic Republic of the Congo
| | - Denise Baratti-Mayer
- Institute of Global Health, Faculty of Medicine, University of Geneva, 1202 Geneva, Switzerland; (M.-S.A.M.); (D.B.-M.)
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Farley E, Mehta U, Srour ML, Lenglet A. Noma (cancrum oris): A scoping literature review of a neglected disease (1843 to 2021). PLoS Negl Trop Dis 2021; 15:e0009844. [PMID: 34905547 PMCID: PMC8670680 DOI: 10.1371/journal.pntd.0009844] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 11/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background Noma (cancrum oris) is an ancient but neglected and poorly understood preventable disease, afflicting the most disenfranchised populations in the world. It is a devastating and often fatal condition that requires urgent and intensive clinical and surgical care, often difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and identify research gaps that need to be addressed to evolve our understanding of how to address this disease. Methods We searched 11 databases and collected primary peer reviewed articles on noma in all languages, the final search was conducted on 24th August 2021. The oldest manuscript identified was from 28th March 1843 and the most recently published manuscript was from 3rd June 2021. Search terms included cancrum oris and noma. Data was extracted using a standardised data extraction tool and key areas of interest were identified. The Preferred Reporting Items for Systemic review and Meta-Analyses requirements were followed. Results The review included 147 articles, the majority of the studies (n = 94, 64%) were case reports. Most manuscripts (n = 81, 55%) were published in the 2000s, 49 (33%) were from the 1900s and 17 (12%) from the 1800s. The main areas of interest identified were the history and epidemiology of the disease, noma’s clinical progression and aetiology, treatment regimens, mortality rates and the risk factors for the development of noma. Conclusions Noma has been reported in the literature for hundreds of years; however important gaps in our understanding of the disease remain. Future research should focus on determining the burden and distribution of disease; the true mortality rate, pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment. Noma is a devastating and often fatal condition that mainly affects children in severely disenfranchised communities. Noma is preventable and requires urgent basic medical care in the early stages of disease. Once the disease reaches the last stage, sequelae, survivors require expert surgical care, usually difficult to access as most cases of noma occur in resource-limited settings. We conducted a scoping review of the literature published on noma to understand the size and scope of available research on the disease and to identify research priorities that will evolve our understanding of how to eradicate this disease. Our review showed that noma has been reported in the literature for hundreds of years; however several major gaps in knowledge still exist. There is appreciation among the small community of clinicians and researchers involved in noma care and research that these gaps in knowledge impact on the ability to develop and implement sound evidence-based policies and activities aimed at eradicating noma from communities that continue to be afflicted by this ancient disease. The main focus of future research should be to study the burden and distribution of disease; the true mortality rate, and the pathogenic cause(s) and the factors that influence prognosis and outcomes after treatment.
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Affiliation(s)
- Elise Farley
- Noma Children’s Hospital, Médecins Sans Frontières, Sokoto, Nigeria
- Nudibrink Research Consultancy, Cape Town, South Africa
- * E-mail:
| | - Ushma Mehta
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, Western Cape, South Africa
| | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, The Netherlands
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands
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Isah S, Amirtharajah M, Farley E, Semiyu Adetunji A, Samuel J, Oluyide B, Bil K, Shoaib M, Abubakar N, de Jong A, Pereboom M, Lenglet A, Sherlock M. Model of care, Noma Children's Hospital, northwest Nigeria. Trop Med Int Health 2021; 26:1088-1097. [PMID: 34080264 PMCID: PMC9292046 DOI: 10.1111/tmi.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The Nigerian Ministry of Health has been offering care for noma patients for many years at the Noma Children’s Hospital (NCH) in Sokoto, northwest Nigeria, and Médecins Sans Frontières has supported these initiatives since 2014. The comprehensive model of care consists of four main components: acute care, care for noma sequelae, integrated hospital‐based services and community‐based services. The model of care is based on the limited evidence available for prevention and treatment of noma and follows WHO’s protocols for acute patients and best practice guidelines for the surgical treatment of noma survivors. The model is updated continually as new evidence becomes available, including evidence generated through the operational research studies performed at NCH. By describing the model of care, we wish to share the lessons learned with other actors working in the noma and neglected tropical disease sphere in the hope of guiding programme development.
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Affiliation(s)
| | | | - Elise Farley
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Joseph Samuel
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | - Karla Bil
- Médecins Sans Frontières, Amsterdam, Netherlands
| | | | - Nura Abubakar
- Noma Children's Hospital, Sokoto, Nigeria.,Médecins Sans Frontières, Sokoto, Nigeria
| | | | | | - Annick Lenglet
- Médecins Sans Frontières, Amsterdam, Netherlands.,Department of Medical Microbiology, Radboud University Medical Centre, Nijmegen, The Netherlands
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Miller LE, Shaye DA. Noma and Necrotizing Fasciitis of the Face and Neck. Facial Plast Surg 2021; 37:439-445. [PMID: 33517575 DOI: 10.1055/s-0041-1722894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Necrotizing fasciitis (NF) is part of the class of necrotizing soft tissue infections characterized by rapid fascial spread and necrosis of the skin, subcutaneous tissue, and superficial fascia. If left untreated, NF can rapidly deteriorate into multiorgan shock and systemic failure. NF most commonly infects the trunk and lower extremities, although it can sometimes present in the head and neck region. This review provides an overview of NF as it relates specifically to the head and neck region, including its associated clinical features and options for treatment. Noma, a related but relatively unknown disease, is then described along with its relationship with severe poverty.
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Affiliation(s)
- Lauren E Miller
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts
| | - David A Shaye
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts.,Doctors without Borders, Noma Project, Sokoto, Nigeria
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Bouassalo KM, Mossi EK, Padaro E, Gunepin M, Weber E. Chronic lymphocytic leukemia revealed by a rare complication: Noma. First description from Togo. JOURNAL OF ORAL MEDICINE AND ORAL SURGERY 2019. [DOI: 10.1051/mbcb/2019017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction: Noma is defined as a gangrenous ulcerative stomatitis whose starting point is endobuccal. Its exact etiology remains unknown, but many risk factors have been described (malnutrition, poor hygiene, etc.). Chronic lymphoid leukemia (LLC) is a lymphoproliferative syndrome characterized by medullary proliferation of a B lymphocyte clone. It is not considered as a risk factor for noma disease. Observation: A 43-year-old patient is admitted in the odontostomatology unit of the Dapaong Regional Hospital Centre (Togo) for a deep lesion of the left cheek. The clinical examination allows to conclude the presence of a noma. Biological examinations also show a LLC at Binet stage C. In our patient, the LLC is associated with an immunosuppression and the development of infections due to the late diagnosis of the LLC. Comment: The immunosuppression and the development of infections are described in the literature as risk factors for noma disease. An association between LLC and noma could therefore exist. However, such association has been reported to date only once in the literature in 1976. Conclusion: Our observation suggests that the LLC could be a risk factor for noma disease. However, further studies based on large samples are necessary to conclude a causal association between LLC and noma.
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Noma in an HIV infected patient in Guinea-Bissau: a case report. Infection 2017; 45:897-901. [PMID: 28589415 DOI: 10.1007/s15010-017-1034-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Accepted: 05/30/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Noma is a multifactorial and multibacterial opportunistic infection that initially causes necrotic gingivitis but rapidly spreads to the nearby orofacial tissue resulting in sloughing and severe deformation of the facial structures. The majority of cases are seen in young children under the age of 6 years. Noma is strongly associated with poverty, malnutrition and immunosuppression, and is often preceded by severe systemic infections such as measles and malaria. Only few cases of noma infection in adults have been described. CASE REPORT We present here a case report with a 32-year-old Guinean woman who was diagnosed with noma infection and on that occasion discovered that she was HIV-1 seropositive. After treatment with amoxicillin/clavulanic acid and metronidazole for her noma infection the woman was transferred to the national hospital where antiretroviral treatment was initiated. CONCLUSION Noma is an opportunistic infection and immunodeficiencies such as HIV should always be suspected when presenting in an adult patient.
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Zwetyenga N, See LA, Szwebel J, Beuste M, Aragou M, Oeuvrard C, Martin D, Emparanza A. [Noma]. ACTA ACUST UNITED AC 2015; 116:261-79. [PMID: 26235765 DOI: 10.1016/j.revsto.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/23/2015] [Indexed: 11/30/2022]
Abstract
Noma is a necrotizing ulcerative stomatitis known since Antiquity. It occurs mostly in poor countries, the Sahel countries being the most affected. Each year, several hundred thousand cases are reported. Noma affects especially malnourished children who are less than 6 years old and rarely adults with acquired immunodeficiency (HIV, cancer). Ulcerative lesion is occurring rapidly due to the production of endotoxins by bacteria from oral commensal, telluric and animal origin. Necrotic debridement leads to huge defects: loss of soft tissue (skin, nerves, vessels, eye), bone (maxilla, mandible) and teeth. Death occurs rapidly in a few weeks in 80 % of the cases. In case of survival, the consequences are functional, aesthetic, psychological and social. The goal of the treatment in the acute phase is the patient's survival and the fight against limited mouth opening. The management of the phase of sequela is an anaesthetic, surgical and physiotherapy challenge. Its purpose is the social reintegration of the patient.
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Affiliation(s)
- N Zwetyenga
- Service de stomatologie, chirurgie maxillo-faciale, chirurgie plastique esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire de Dijon, boulevard Delattre-de-Tassigny, 21000 Dijon, France; Laboratoire EA 4268 4IS, université de Franche-Comte, place Saint-Jacques, 35000 Besançon, France.
| | - L-A See
- Service de stomatologie, chirurgie maxillo-faciale, chirurgie plastique esthétique et reconstructrice, chirurgie de la main, centre hospitalier universitaire de Dijon, boulevard Delattre-de-Tassigny, 21000 Dijon, France
| | - J Szwebel
- Service de chirurgie plastique, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - M Beuste
- CHRU, 80054 Amiens cedex 1, France
| | - M Aragou
- Département d'anesthésie, hôpital Saint-Joseph, 185, rue Raymond-Losserand, 75674 Paris, France
| | - C Oeuvrard
- Département d'anesthésie, centre hospitalier universitaire de Dijon, boulevard de Lattre-de-Tassigny, 21000 Dijon, France
| | | | - A Emparanza
- Calle Federico García Lorca, 7, 20014, San Sebastian, Espagne
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Ashok N, Tarakji B, Darwish S, Rodrigues JC, Altamimi MA. A Review on Noma: A Recent Update. Glob J Health Sci 2015; 8:53-9. [PMID: 26573028 PMCID: PMC4873589 DOI: 10.5539/gjhs.v8n4p53] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 06/09/2015] [Indexed: 11/16/2022] Open
Abstract
Noma is a gangrenous infection primarily affecting under developed countries. The aim of this paper was to review all recent articles on noma from January 2003 to August 2014 and briefly update the latest information related to the topic. A literature search was done on PUBMED using the keywords “noma / cancrum oris”. Noma is commonly seen in malnourished children. There has been an increased incidence of noma in HIV patients. Apart from these, noma has also been reported in association with cyclic neutropenia, herpetic stomatitis, leukemia, Down's syndrome and Burkett's disease. Treatment of acute noma includes transfusion of blood and intravenous fluids, administration of antibiotics, putting the patient on a high protein diet and debridement of necrotic areas. Surgical phase is usually initiated 6 to 18 months after a period of quiescence. Although, the mortality rate associated with noma has reduced significantly with the advent of modern generation antibiotics, the functional, cosmetic and psychological challenges associated with the destruction of soft or hard tissues still remains a huge challenge. Adequate steps must be implemented by the government or medical professionals to prevent the disease and provide an early intervention.
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Konsem T, Millogo M, Assouan C, Ouedraogo D. [Evoluting form of cancrum oris, about 55 cases collected at the Academic Hospital Yalgado Ouedraogo of Ouagadougou]. ACTA ACUST UNITED AC 2014; 107:74-8. [PMID: 24566885 DOI: 10.1007/s13149-014-0338-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 01/27/2014] [Indexed: 11/30/2022]
Abstract
The cancrum oris is still an up to date disease in our environment. The death rate and the after effects of this disease make all together the main interest of this survey. In a retrospective survey carried out from January 2003 to December 2012, we colligated 55 cases of progressive cancrum oris followed at the stomatological and maxillofacial surgery at the Academic Hospital Yalgado OUEDRAOGO. On the epidemiological level, we noticed an impact of 5.5 cases per year. The average age of our patients was about 7.64 with a sex ratio of 1.03. Most of the patients were from an underprivileged family (96.4%). On the clinical level, we noticed that most of the patients consulted only after the gangrene had fallen (89.1%) and were seriously affected (67.3%) with a bad oral and dental hygiene (38.1%). The attacks were mainly jugal (25%) and labial (24.1%). The cancrum oris was in most of the cases associated to broncho pneumonitis, malaria and to HIV infection (31.37%). For the medical treatment, we focused on resuscitation, re nutrition, hydro electrolytic rebalancing and antibiotherapy. The surgical treatment was essentially made on the affected areas, controlled skinning and most often followed by sequestrectomy. 81.8% of the patients recovered completely from the infection, 60% had after effect injuries. We recorded a death rate of 14.5%. In order to overcome this disease we need both national and international support.
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Affiliation(s)
- T Konsem
- Service de stomatologie et chirurgie maxillo-faciale du CHU Yalgado Ouedraogo, Ouagadougou, Burkina Faso
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