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Al-Asmari AI, Alharbi H, Al-Zahrani AE, Zughaibi TA. Heroin-Related Fatalities in Jeddah, Saudi Arabia, between 2008 and 2018. TOXICS 2023; 11:248. [PMID: 36977013 PMCID: PMC10099738 DOI: 10.3390/toxics11030248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 02/20/2023] [Accepted: 02/27/2023] [Indexed: 06/18/2023]
Abstract
To date, epidemiological studies have not evaluated heroin-related deaths in the Middle East and North African regions, especially Saudi Arabia. All heroin-related postmortem cases reported at the Jeddah Poison Control Center (JPCC) over a 10-year period (21 January 2008 to 31 July 2018) were reviewed. In addition, liquid chromatography electrospray ionization tandem mass spectrometry (LC/ESI-MS/MS) was utilized to determine the 6-monoacetylmorphine (6-MAM), 6-acetylcodeine (6-AC), morphine (MOR), and codeine contents in unhydrolyzed postmortem specimens. Ninety-seven heroin-related deaths were assessed in this study, and they represented 2% of the total postmortem cases at the JPCC (median age, 38; 98% male). In the blood, urine, vitreous humor, and bile samples, the median morphine concentrations were 280 ng/mL, 1400 ng/mL, 90 ng/mL, and 2200 ng/mL, respectively; 6-MAM was detected in 60%, 100%, 99%, and 59% of the samples, respectively; and 6-AC was detected in 24%, 68%, 50%, and 30% of the samples, respectively. The highest number of deaths (33% of total cases) was observed in the 21-30 age group. In addition, 61% of cases were classified as "rapid deaths," while 24% were classified as "delayed deaths." The majority (76%) of deaths were accidental; 7% were from suicide; 5% were from homicide; and 11% were undetermined. This is the first epidemiological study to investigate heroin-related fatalities in Saudi Arabia and the Middle East and North African region. The rate of heroin-related deaths in Jeddah remained stable but increased slightly at the end of the study period. Most patients were heroin-dependent abusers and from the middle-aged group. The availability of urine, vitreous humor, and bile specimens provided valuable information regarding the opioids that were administered and the survival time following heroin injection.
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Affiliation(s)
- Ahmed I. Al-Asmari
- Laboratory Department, Ministry of Health, King Abdul-Aziz Hospital, Jeddah 21442, Saudi Arabia
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Hassan Alharbi
- Poison Control and Forensic Chemistry Center, Ministry of Health, Jeddah 21176, Saudi Arabia
| | | | - Torki A. Zughaibi
- King Fahd Medical Research Center, King Abdulaziz University, Jeddah 21589, Saudi Arabia
- Department of Medical Laboratory Sciences, Faculty of Applied Medical Sciences, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Lihua L, Yuning W, Henghui H, Xiang L, Min J, Zehao L, Lianjie L, Qian L. Retrospective analysis of 217 fatal intoxication autopsy cases from 2009 to 2021: temporal trends in fatal intoxication at Tongji center for medicolegal expertise, Hubei, China. Front Public Health 2023; 11:1137649. [PMID: 37139384 PMCID: PMC10150053 DOI: 10.3389/fpubh.2023.1137649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/27/2023] [Indexed: 05/05/2023] Open
Abstract
This retrospective analysis of fatal intoxication case autopsies was performed at Tongji Center for Medicolegal Expertise in Hubei (TCMEH) from 2009 to 2021 to obtain up-to-date information on intoxication cases. The objective was to describe important data about evolving patterns in intoxication occurrences, enhance public safety policies, and assist forensic examiners and police in more efficient handling of such cases. Analyses based on sex, age, topical exposure routes, toxic agents, and mode of death were performed using 217 records of intoxication cases collected from TCMEH as a sample, and the results were compared with reports previously published (from 1999 to 2008) from this institution. Deaths from intoxications occurred at a higher rate in males than in females and were most common among individuals aged 30-39 years. The most frequent method of exposure was oral ingestion. The causative agents of deadly intoxications have changed when compared to the data from the previous 10 years. For instance, deaths from amphetamine overdoses are becoming more prevalent gradually, whereas deaths due to carbon monoxide and rodenticide intoxication have declined dramatically. In 72 cases, pesticides continued to be the most frequent intoxication cause. A total of 60.4% of the deaths were accidental exposure. Men died from accidents at a higher rate than women, although women were more likely to commit suicide. Particular focus is needed on the use of succinylcholine, cyanide, and paraquat in homicides.
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Argo A, Zerbo S, Buscemi R, Trignano C, Bertol E, Albano GD, Vaiano F. A Forensic Diagnostic Algorithm for Drug-Related Deaths: A Case Series. TOXICS 2022; 10:toxics10040152. [PMID: 35448413 PMCID: PMC9024928 DOI: 10.3390/toxics10040152] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/11/2022] [Accepted: 03/19/2022] [Indexed: 02/06/2023]
Abstract
The best evidence provided in the literature worldwide suggests the importance of harmonizing the investigation in drug-related fatalities. In this study, the application of a multidisciplinary approach in eight cases of drug-related deaths is presented. Although death scene findings could be highly suggestive of drug intoxication, external examination and toxicological screening test alone are insufficient. There are several variables, and it is not always easy to give the proper interpretation of the drug detection. A complete autopsy is necessary to correctly complete organ and tissues sampling for further histological and toxicological studies and obtain body fluids. The use of peripheral blood is recommended to avoid artifacts. The collection of many specimens is warranted to get more responses. The sampling aims to provide a picture of the distribution of the substance in the body. The sample and the selection of the drugs and the matrices to investigate are case-dependent. The presented diagnostic algorithm provides the coroner with all the elements to investigate drug-related deaths and cooperate with toxicologists. Toxicological forensic diagnosis is still extremely heterogeneous in regional and national contexts. Funding for method development, research, networking, facilities, and technologies improvement is mandatory to standardize the toxicological investigation.
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Affiliation(s)
- Antonina Argo
- PROMISE Department, University of Palermo, 90100 Palermo, Italy; (A.A.); (S.Z.); (R.B.)
| | - Stefania Zerbo
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | - Roberto Buscemi
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | - Claudia Trignano
- Department of Health Sciences, University of Florence, 50121 Florence, Italy; (E.B.); (F.V.)
| | - Elisabetta Bertol
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
| | - Giuseppe Davide Albano
- PROMISE Department, University of Palermo, 90100 Palermo, Italy; (A.A.); (S.Z.); (R.B.)
- Correspondence: ; Tel.: +39-3312264328
| | - Fabio Vaiano
- Department of Biomedical Sciences, University of Sassari, 7100 Sassari, Italy;
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Tatar M, Jalali MS, Tak HJ, Chen LW, Araz OM, Wilson FA. Impact of Florida's prescription drug monitoring program on drug- related fatal vehicle crashes: a difference-in-differences approach. Inj Prev 2021; 28:105-109. [PMID: 34162702 DOI: 10.1136/injuryprev-2020-044113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 05/27/2021] [Indexed: 11/04/2022]
Abstract
BACKGROUND Prescription drug use has soared in the USA within the last two decades. Prescription drugs can impair motor skills essential for the safe operation of a motor vehicle, and therefore can affect traffic safety. As one of the epicentres of the opioid epidemic, Florida has been struck by high opioid misuse and overdose rates, and has concurrently suffered major threats to traffic disruptions safety caused by driving under the influence of drugs. To prevent prescription opioid misuse in Florida, Prescription Drug Monitoring Programs (PDMPs) were implemented in September 2011. OBJECTIVE To examine the impact of Florida's implementation of a mandatory PDMP on drug-related MVCs occurring on public roads. METHODS We employed a difference-in-differences approach to estimate the difference in prescription drug-related fatal crashes in Florida associated with its 2011 PDMP implementation relative to those in Georgia, which did not use PDMPs during the same period (2009-2013). The analyses were conducted in 2020. RESULTS In Florida, there was a significant decline in drug-related vehicle crashes during the 22 months post-PDMP. PDMP implementation was associated with approximately two (-2.21; 95% CI -4.04 to -0.37; p<0.05) fewer prescribed opioid-related fatal crashes every month, indicating 25% reduction in the number of monthly crashes. We conducted sensitivity analyses to investigate the impact of PDMP implementation on central nervous system depressants and stimulants as well as cocaine and marijuana-related fatal crashes but found no robust significant reductions. CONCLUSIONS The implementation of PDMPs in Florida provided important benefits for traffic safety, reducing the rates of prescription opioid-related vehicle crashes.
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Affiliation(s)
- Moosa Tatar
- Matheson Center for Health Care Studies, University of Utah Health, Salt Lake City, Utah, USA .,Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
| | - Mohammad S Jalali
- Harvard Medical School, MGH Institute for Technology Assessment, Boston, Massachusetts, USA.,Sloan School of Management, Massachusetts Institute of Technology, Cambridge, Massachusetts, USA
| | - Hyo Jung Tak
- Department of Health Services Research and Administration, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Li-Wu Chen
- Department of Health Sciences, School of Health Professions, University of Missouri, Columbia, Missouri, USA
| | - Ozgur M Araz
- College of Business, University of Nebraska-Lincoln, Lincoln, Nebraska, USA
| | - Fernando A Wilson
- Matheson Center for Health Care Studies, University of Utah Health, Salt Lake City, Utah, USA.,Department of Population Health Sciences, University of Utah, Salt Lake City, Utah, USA
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Sung HG, Li J, Nam JH, Won DY, Choi B, Shin JY. Concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem and risk for suicide: a case-control and case-crossover study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1535-1544. [PMID: 31037540 DOI: 10.1007/s00127-019-01713-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE To evaluate whether the concurrent use of benzodiazepines, antidepressants, and opioid analgesics with zolpidem increases the risk of suicide or triggers suicide compared with the use of zolpidem alone. METHODS We conducted a case-control and case-crossover study using the Korean National Health Insurance Service-National Sample Cohort database. Cases were older than 20 years with a suicide record (International Codes of Disease 10th Revision codes: X-60-X84 and Y87.0 intentional self-harm) between January 1, 2004, and December 31, 2013. For case-control design, ten controls were matched to each case by age, sex, index year, region, income, and health insurance type. For case-crossover analysis, we set hazard period to 60 days and assigned five corresponding sets of control periods of equal length. Exposure was assessed during 60 days before suicide for combinations of benzodiazepines, antidepressants, opioid analgesics with zolpidem against zolpidem alone. We conducted a conditional logistic regression to estimate odds ratios (ORs) and their 95% confidence intervals (CIs). RESULTS In the case-control study, the risk of suicide was 2.80-fold higher in cases taking benzodiazepines and antidepressants with zolpidem than in those taking zolpidem alone (adjusted OR [aOR], 2.80; 95% CI, 1.38-5.70). However, in the case-crossover study, suicide risk showed no significant difference (crude OR [cOR], 0.92; 95% CI, 0.55-1.52) and was underpowered. CONCLUSIONS The results of the traditional case-control study confirmed that the concurrent use of benzodiazepines and antidepressants with zolpidem was associated with an increased risk of suicide compared with the use of zolpidem alone. However, there was no significant difference in the magnitude of risk in the within-person comparison design.
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Affiliation(s)
- Hi Gin Sung
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Junquing Li
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - Dae Yeon Won
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea
| | - BongKyoo Choi
- Department of Medicine and Program in Public Heath, University of California, Irvine, CA, USA
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, 2066 Seobu-ro, Jangan-gu, Suwon, Gyeong gi-do, South Korea.
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Choi B, Sung HG, Nam JH, Shin JY. Zolpidem Use and Suicide Death in South Korea: A Population-Based Case-Control Study. Suicide Life Threat Behav 2019; 49:1653-1667. [PMID: 30883921 DOI: 10.1111/sltb.12548] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 01/15/2019] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To investigate whether zolpidem use is associated with suicide death in adults. METHOD We conducted a case-control study using the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. Cases were adults with a suicide record (ICD-10 codes; X-60-X84, Y87.0) between January 1, 2004 and December 31, 2013. 10 Controls were matched to each case by age, sex, index year, region, income level, and health insurance type. Zolpidem use during 2 years before suicide was quantified. Adjusted odd ratios (aORs) with 95% confidence intervals (CIs) were estimated using conditional logistic regression. RESULTS The percentage of zolpidem users was significantly higher in cases (451 of 1,928 [23.4%]) than in controls (832 of 18,404 [4.5%]). After controlling for potential confounders, zolpidem use was significantly associated with suicide (aORs, 2.09; 95% CI, 1.74-2.52). Dose-response relationships were observed (for trend, p < .0001). Consistent findings were observed when analyses were restricted to suicide death (aORs, 2.08; 95% CI, 1.73-2.51) and nonmedication poisoning suicide death cases (aORs, 2.10; 95% CI, 1.74-2.53). CONCLUSIONS We found a significant and positive association between zolpidem use and suicide. Zolpidem should be prescribed cautiously and with due caution of increased suicide risk.
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Affiliation(s)
- BongKyoo Choi
- Department of Medicine and Program in Public Health, University of California, Irvine, Irvine, CA, USA
| | - Hi Gin Sung
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Jin Hyun Nam
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
| | - Ju-Young Shin
- School of Pharmacy, Sungkyunkwan University, Suwon, South Korea
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Pv A, Jun Wen T, Karuvetil MZ, Cheong A, Cheok C, Kandasami G. Unnatural Death among Treatment Seeking Substance Users in Singapore: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2743. [PMID: 31370374 PMCID: PMC6695629 DOI: 10.3390/ijerph16152743] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/17/2022]
Abstract
Substance use carries a higher risk of unnatural death. A retrospective analysis of 42 treatment seekers between 2011-2015 was conducted through medical record review to understand the profile and circumstances leading to premature deaths. Ninety percent of the subjects were males. The mean age at death was 44.9 (SD ± 13.1). Opioids (52.4%), benzodiazepines (45.2%) and alcohol (35.7%) were the main substances used by the group. Suicide was the most common cause of death (n = 27, 64.3%) followed by accidents (n = 15; 35.7%). Among the suicide cases, alcohol was the main substance used (33.3%) followed by opioids (25.9%). A total of 58.5% (n = 24) deaths occurred within a year of their last visit while 41.5% (n = 17) were dead more than a year after their last visit. Of the total cases (n = 41), 63% had a history of mental illness with depressive disorder (53.8%) being the most common. History of suicide attempts were reported in 34.1% (n = 14) of cases and 50% of the subjects (n = 21) had a history of suicidal ideation. Drug related offences were reported in 57.1% of the subjects, of which 60% (n = 18) committed suicide. The findings support the need for appropriate treatment resources to reduce the untimely deaths among substance users.
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Affiliation(s)
- Asharani Pv
- Research Division, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore.
| | - Tan Jun Wen
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Mohamed Zakir Karuvetil
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Alvin Cheong
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Christopher Cheok
- Forensic Psychiatry, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
| | - Gomathinayagam Kandasami
- National Addictions Management Service, Institute of Mental Health, 10 Buangkok View, Singapore 539747, Singapore
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Tani N, Ikeda T, Michiue T, Oritani S, Morioka F, Ishikawa T. Analysis of psychotropic drug-related deaths in south Osaka. Subst Abuse Rehabil 2018; 9:79-90. [PMID: 30310350 PMCID: PMC6165856 DOI: 10.2147/sar.s163491] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective The aim of this study was to investigate the occurrence of deaths due to psychotropic drugs in south Osaka during a 10-year period and discuss societal factors from a medical viewpoint. Methods Psychotropic drug-related deaths were retrospectively investigated based on the forensic postmortem data of 1,746 decedents in 2005-2014, and we excluded cases in which stimulant drugs were detected. Of these, 133 cases (7.6%) were found to be psychotropic drug-related deaths and were analyzed. Results Psychotropic drug-related deaths occurred in 78 males (59%; age range, 14-95 years) and 55 females (41%; 20-84 years). The direct cause of death was acute drug intoxication in many cases, and of these, acute combined drug intoxication due to the use of multiple drugs accounted for 76% of the deaths. Most of these victims were found to have gastrointestinal and cardiovascular diseases. Cases of psychotropic drug-related deaths had especially poor medical conditions. In addition, tests were positive for blood alcohol in 23% of the cases. Conclusion The descriptive results revealed several factors that may be related to psychotropic drug-related deaths. To prevent drug abuse, several factors were deemed to be important, including improvements in the medical state of an individual, the avoidance of social isolation, and from a medical standpoint, the management of prescription drugs by medical personnel.
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Affiliation(s)
- Naoto Tani
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan, .,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
| | - Tomoya Ikeda
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan, .,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
| | - Tomomi Michiue
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan, .,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
| | - Shigeki Oritani
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
| | - Fumiya Morioka
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
| | - Takaki Ishikawa
- Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan, .,Forensic Autopsy Section, Medico-legal Consultation and Postmortem Investigation Support Center, c/o Department of Legal Medicine, Osaka City University Medical School, Abeno, Osaka, Japan,
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Omond KJ, Langlois NEI, Byard RW. Obesity, Body Mass Index, and Homicide. J Forensic Sci 2016; 62:930-933. [DOI: 10.1111/1556-4029.13374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 10/13/2016] [Accepted: 10/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- Kimberley J. Omond
- School of Medicine; The University of Adelaide; Frome Road Adelaide 5005 SA Australia
| | - Neil E. I. Langlois
- School of Medicine; The University of Adelaide; Frome Road Adelaide 5005 SA Australia
| | - Roger W. Byard
- School of Medicine; The University of Adelaide; Frome Road Adelaide 5005 SA Australia
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