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Serum fatty acids and progression from dengue fever to dengue haemorrhagic fever/dengue shock syndrome. Br J Nutr 2018; 120:787-796. [PMID: 30105961 DOI: 10.1017/s0007114518002039] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PUFA might modulate inflammatory responses involved in the development of severe dengue. We aimed to examine whether serum PUFA concentrations in patients diagnosed with dengue fever (DF) were related to the risk of progression to dengue haemorrhagic fever/dengue shock syndrome (DHF/DSS). A secondary aim was to assess correlations between fatty acids (FA) and inflammatory biomarkers in patients with DF. We conducted a prospective case-control study nested within a cohort of patients who were diagnosed with DF and followed during the acute episode. We compared the distribution of individual FA (% of total FA) at onset of fever between 109 cases who progressed to DHF/DSS and 235 DF non-progressing controls using unconditional logistic regression. We estimated correlations between baseline FA and cytokine concentrations and compared FA concentrations between the acute episode and >1 year post-convalescence in a subgroup. DHA was positively related to progression to DHF/DSS (multivariable adjusted OR (AOR) for DHA in quintile 5 v. 1=5·34, 95 % CI 2·03, 14·1; P trend=0·007). Dihomo-γ-linolenic acid (DGLA) was inversely associated with progression (AOR for quintile 5 v. 1=0·30, 95 % CI 0·13, 0·69; P trend=0·007). Pentadecanoic acid concentrations were inversely related to DHF/DSS. Correlations of PUFA with cytokines at baseline were low. PUFA were lower during the acute episode than in a disease-free period. In conclusion, serum DHA in patients with DF predicts higher odds of progression to DHF/DSS whereas DGLA and pentadecanoic acid predict lower odds.
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A retrospective cohort study to predict severe dengue in Honduran patients. BMC Infect Dis 2017; 17:676. [PMID: 29020935 PMCID: PMC5637075 DOI: 10.1186/s12879-017-2800-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2017] [Accepted: 10/04/2017] [Indexed: 12/03/2022] Open
Abstract
Background An important challenge in the identification of dengue is how to predict which patients will go on to experience severe illness, which is typically characterized by fever, thrombocytopenia, haemorrhagic manifestations, and plasma leakage. Accurate prediction could result in the appropriate hospital triage of high risk patients. The objective of this study was to identify clinical factors observed within the first 24 h of hospital admission that could predict subsequent severe dengue. Methods We conducted a retrospective cohort study of 320 patients with febrile illness who had confirmation of dengue within one week of admission, using data from the 2009–2010 Honduras Epidemiological Survey for Dengue. The outcome measure was plasma leakage defined using hemoconcentration ≥15% as determined by serial hematocrit testing. We conducted univariable analysis and multivariable logistic regression analysis to construct a predictive model for severe dengue. Results Thirty-four (10.6%) of patients in the 320 patient cohort had hemoconcentration ≥15%. In the final multivariable logistic regression model the presence of ascites, OR 7.29, 95% CI 1.85 to 28.7, and a platelet count <50,000 platelets/mm3 at admission, OR 3.02, 95% CI 1.42 to 6.42, were significantly associated with plasma leakage, while the presence of petechiae, OR 0.24 95% CI 0.080 to 0.73, and headache, OR 0.38, 95% CI 0.15 to 0.95, were negatively associated with leakage. Using an estimated probability of 7% as a threshold for a person being considered a severe case correctly predicted 26 of the 34 severe cases (sensitivity 76.4%) and 201 of the 286 non-severe cases (specificity of 70.3%) for a percentage correctly classified of 70.9%. Conclusion We identified signs and symptoms that can correctly identify a majority of patients who eventually develop severe dengue in Honduras. It will be important to further refine our models and validate them in other populations.
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Pedrosa MS, de Paiva MHP, Oliveira LGFL, Pereira SMS, da Silva CHV, Pompeu JGF. Oral manifestations related to dengue fever: a systematic review of the literature. Aust Dent J 2017; 62:404-411. [DOI: 10.1111/adj.12516] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/02/2017] [Indexed: 11/28/2022]
Affiliation(s)
- MS Pedrosa
- Department of Dentistry; Faculdade Integral Diferencial - FACID
- DeVry Brazil; Teresina Brazil
- Oral Pathology and Maxillofacial Surgery Group - LACPO, Faculdade Integral Diferencial - FACID
- DeVry Brasil; Teresina Brazil
- Centro Educacional Três Irmãs - CETI; Barras Piauí Brazil
| | - MHP de Paiva
- Department of Nursing; Faculdade Integral Diferencial - FACID
- DeVry Brasil; Teresina Brazil
| | - LGFL Oliveira
- Luiz Gustavo Aesthetic Dentistry and Oral Implantology; Teresina Brazil
| | - SMS Pereira
- Deparment of the Post-Graduate Program in Dentistry; CEUMA University; São Luís Brazil
| | - CHV da Silva
- Department of Prosthetic Dentistry and Maxillofacial Surgery; Federal University of Pernambuco - UFPE; Recife Brazil
| | - JGF Pompeu
- Department of Restorative Dentistry; Federal University of Piauí - UFPI; Teresina Brazil
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Fernández E, Smieja M, Walter SD, Loeb M. A predictive model to differentiate dengue from other febrile illness. BMC Infect Dis 2016; 16:694. [PMID: 27876005 PMCID: PMC5120437 DOI: 10.1186/s12879-016-2024-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2016] [Accepted: 11/14/2016] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Dengue is a major public health problem in tropical and subtropical countries and has a presentation similar to other febrile illnesses. Since laboratory confirmation is frequently delayed, the majority of dengue cases are diagnosed based on symptoms. The objective of this study was to identify clinical, hematological and demographical parameters that could be used as predictors of dengue fever among patients with febrile illness. METHODS We conducted a retrospective cohort study of 548 patients presenting with febrile syndrome to the largest public hospitals in Honduras. Patients' clinical, laboratory, and demographic data as well as dengue laboratory detection by either serology or viral isolation were used to build a predictive statistical model to identify dengue cases. RESULTS Of 548 patients, 390 were confirmed with dengue infection while 158 had negative results. Univariable analysis revealed seven variables associated with dengue: male sex, petechiae, skin rash, myalgia, retro-ocular pain, positive tourniquet test, and gingival bleeding. In multivariable logistic regression analysis, retro-ocular pain petechiae and gingival bleeding were associated with increased risk, while epistaxis and paleness of skin were associated with reduced risk of dengue. Using a value of 0.6 (i.e., 60% probability for a case to be positive based on the equation values), our model had a sensitivity of 86.2%, a specificity of 27.2%, and an overall accuracy of 69.2%; allowing for the diagnosis of dengue to be ruled out and for other febrile conditions to be investigated. CONCLUSIONS Among Honduran patients presenting with febrile illness, our analysis identified key symptoms associated with dengue fever, however the overall accuracy of our model was still low and specificity remains a concern. Our model requires validation in other populations with a similar pattern of dengue transmission.
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Affiliation(s)
- Eduardo Fernández
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Marek Smieja
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
- Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada
| | - Stephen D Walter
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada
| | - Mark Loeb
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.
- Institute for Infectious Diseases Research, McMaster University, Hamilton, Ontario, Canada.
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Falconar AKI, Romero-Vivas CME. Simple Prognostic Criteria can Definitively Identify Patients who Develop Severe Versus Non-Severe Dengue Disease, or Have Other Febrile Illnesses. J Clin Med Res 2012; 4:33-44. [PMID: 22383925 PMCID: PMC3279499 DOI: 10.4021/jocmr694w] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2011] [Indexed: 11/26/2022] Open
Abstract
Background Severe dengue disease (SDD) (DHF/DSS: dengue hemorrhagic fever/dengue shock syndrome) results from either primary or secondary dengue virus (DENV) infections, which occur 4 - 6 days after the onset of fever. As yet, there are no definitive clinical or hematological criteria that can specifically identify SDD patients during the early acute febrile-phase of disease (day 0 - 3: < 72 hours). This study was performed during a SDD (DHF/DSS) epidemic to: 1) identify the DENV serotypes that caused SDD during primary or secondary DENV infections; 2) identify simple clinical and hematological criteria that could significantly discriminate between patients who subsequently developed SDD versus non-SDD (N-SDD), or had a non-DENV fever of unknown origin (FUO) during day 0 - 3 of fever; 3) assess whether DENV serotype co-infections resulted in SDD. Methods First serum samples, with clinical and hematological criteria, were collected from 100 patients during the early acute febrile-phase (day 0 - 3: < 72 hours), assessed for DENV or FUO infections by IgM- and IgG-capture ELISAs on paired serum samples and by DENV isolations, and subsequently graded as SDD, N-SDD or FUO patients. Results In this study: 1) Thirty-three patients had DENV infections, predominantly secondary DENV-2 infections, including each SDD (DHF/DSS) case; 2) Secondary DENV-2/-3 and DENV-2/-4 serotype co-infections however resulted in N-SDD; 3) Each patient who subsequently developed SDD, but none of the others, displayed three clinical criteria: abdominal pain, conjunctival injection and veni-puncture bleeding, therefore each of these criteria provided definitively significant prognostic (P < 0.001) values; 4) Petechia, positive tourniquet tests and hepatomegaly, and neutrophilia or leukopenia also significantly identified those who: a) subsequently developed SDD versus N-SDD, or had a FUO; b) subsequently developed SDD versus N-SDD; c) subsequently developed N-SDD versus FUOs, respectively. Conclusions This is the first report of simple definitively prognostic criteria for SDD patients, including the first assessment and confirmation of conjunctival injection. The three definitive clinical criteria used alone, or supported by the other four criteria, could be essential for specifically identifying those patients needing prompt hospital-based therapies to lessen or avert SDD, without unnecessary hospitalization of the other patients. Keywords Dengue virus; Severe dengue; Dengue fever; Diagnostic; Criteria; Hemorrhage; Shock
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Affiliation(s)
- Andrew K I Falconar
- Laboratorio de Enfermedades Tropicales, Departamento de Medicina, Fundacion Universidad del Norte Km5 Antigua Via a Puerto Colombia, Barranquilla, Colombia, South America
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Diaz-Quijano FA, Villar-Centeno LA, Martinez-Vega RA. Predictors of spontaneous bleeding in patients with acute febrile syndrome from a dengue endemic area. J Clin Virol 2010; 49:11-5. [PMID: 20663710 DOI: 10.1016/j.jcv.2010.06.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2010] [Revised: 06/18/2010] [Accepted: 06/21/2010] [Indexed: 01/10/2023]
Abstract
BACKGROUND Spontaneous bleeding is a common complication of dengue and is associated with an increased mortality. OBJECTIVE To evaluate early clinical manifestations and simple laboratory tests as predictors of spontaneous hemorrhage in patients with forms of acute febrile syndrome (AFS) such as dengue from an endemic area. STUDY DESIGN A prospective cohort study was performed including 729 non-bleeding AFS patients who were enrolled during the first 4 days of disease. Basal evaluation included anamnesis, physical examination and complete blood cell count. Follow-up was extended at least until the sixth day of disease. Dengue infection was studied with paired serologic tests and viral isolation. Potential predictors of spontaneous bleeding were evaluated with bivariate and multivariate analysis. RESULTS Incidence of outcome was not significantly different between the dengue group and those with non-dengue AFS. The tourniquet test was not associated with outcome (p=0.38). In a binomial regression model, the following variables were associated with outcome: age between 12 and 45 years (RR=2.22; 95% CI: 1.25-3.94), rash (RR=1.66; 95% CI: 1.25-2.2), vomiting (RR=1.46; 95% CI: 1.16-1.83), temperature >38 degrees C (RR=2.63; 95% CI: 1.6-4.33), leukocyte count <4500/microL (RR=1.87; 95% CI: 1.19-2.96), and platelet count <90.000/microL (RR=1.8; 95% CI: 1.1-2.94). With these variables a risk score was formulated that showed an area under ROC curve of 70.5% (95% CI: 64.9-76.2) to predict spontaneous bleeding. The score was useful for predicting bleeding in both dengue and non-dengue AFS groups. CONCLUSION Some variables evaluated in the first days of disease helped to predict the risk of spontaneous bleeding in patients with dengue and non-dengue AFS.
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Affiliation(s)
- Fredi Alexander Diaz-Quijano
- Grupo de Epidemiología Clínica, Centro de Investigaciones Epidemiológicas, Universidad Industrial de Santander (UIS), Bucaramanga, Colombia.
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Mourão MPG, Lacerda MVG, Macedo VO, Mourão MPG, Lacerda MVG, Macedo VO, Santos JB. Thrombocytopenia in patients with dengue virus infection in the Brazilian Amazon. Platelets 2009; 18:605-12. [PMID: 18041652 DOI: 10.1080/09537100701426604] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Valerio L, Dolors Tenas M, Roure S. El dengue. FMC - FORMACIÓN MÉDICA CONTINUADA EN ATENCIÓN PRIMARIA 2008; 15:556-562. [PMID: 32288495 PMCID: PMC7144501 DOI: 10.1016/s1134-2072(08)75292-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lan NTP, Kikuchi M, Huong VTQ, Ha DQ, Thuy TT, Tham VD, Tuan HM, Tuong VV, Nga CTP, Van Dat T, Oyama T, Morita K, Yasunami M, Hirayama K. Protective and enhancing HLA alleles, HLA-DRB1*0901 and HLA-A*24, for severe forms of dengue virus infection, dengue hemorrhagic fever and dengue shock syndrome. PLoS Negl Trop Dis 2008; 2:e304. [PMID: 18827882 PMCID: PMC2553281 DOI: 10.1371/journal.pntd.0000304] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2007] [Accepted: 08/29/2008] [Indexed: 11/18/2022] Open
Abstract
Background Dengue virus (DV) infection is one of the most important mosquito-borne diseases in the tropics. Recently, the severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), have become the leading cause of death among children in Southern Vietnam. Protective and/or pathogenic T cell immunity is supposed to be important in the pathogenesis of DHF and DSS. Methodology/Principal Findings To identify HLA alleles controlling T cell immunity against dengue virus (DV), we performed a hospital-based case control study at Children's Hospital No.2, Ho Chi Minh City (HCMC), and Vinh Long Province Hospital (VL) in Southern Vietnam from 2002 to 2005. A total of 211 and 418 patients with DHF and DSS, respectively, diagnosed according to the World Health Organization (WHO) criteria, were analyzed for their characteristic HLA-A, -B and -DRB1 alleles. Four hundred fifty healthy children (250 from HCMC and 200 from VL) of the same Kinh ethnicity were also analyzed as population background. In HLA class I, frequency of the HLA-A*24 showed increased tendency in both DHF and DSS patients, which reproduced a previous study. The frequency of A*24 with histidine at codon 70 (A*2402/03/10), based on main anchor binding site specificity analysis in DSS and DHF patients, was significantly higher than that in the population background groups (HCMC 02-03 DSS: OR = 1.89, P = 0.008, DHF: OR = 1.75, P = 0.033; VL 02-03 DSS: OR = 1.70, P = 0.03, DHF: OR = 1.46, P = 0.38; VL 04-05 DSS: OR = 2.09, P = 0.0075, DHF: OR = 2.02, P = 0.038). In HLA class II, the HLA-DRB1*0901 frequency was significantly decreased in secondary infection of DSS in VL 04-05 (OR = 0.35, P = 0.0025, Pc = 0.03). Moreover, the frequency of HLA-DRB1*0901 in particular was significantly decreased in DSS when compared with DHF in DEN-2 infection (P = 0.02). Conclusion This study improves our understanding of the risk of HLA-class I for severe outcome of DV infection in the light of peptide anchor binding site and provides novel evidence that HLA-class II may control disease severity (DHF to DSS) in DV infection. Dengue has become one of the most common viral diseases transmitted by infected mosquitoes (with any of the four dengue virus serotypes: DEN-1, -2, -3, or -4). It may present as asymptomatic or illness, ranging from mild to severe disease. Recently, the severe forms, dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), have become the leading cause of death among children in Southern Vietnam. The pathogenesis of DHF/DSS, however, is not yet completely understood. The immune response, virus virulence, and host genetic background are considered to be risk factors contributing to disease severity. Human leucocyte antigens (HLA) expressed on the cell surface function as antigen presenting molecules and those polymorphism can change individuals' immune response. We investigated the HLA-A, -B (class I), and -DRB1 (class II) polymorphism in Vietnamese children with different severity (DHF/DSS) by a hospital-based case-control study. The study showed persons carrying HLA-A*2402/03/10 are about 2 times more likely to have severe dengue infection than others. On the other hand, HLA-DRB1*0901 persons are less likely to develop DSS with DEN-2 virus infection. These results clearly demonstrated that HLA controlled the susceptibility to severe forms of DV infection.
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Affiliation(s)
- Nguyen Thi Phuong Lan
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
| | - Mihoko Kikuchi
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
- Center of International Collaborative Research, Nagasaki University, Japan
| | - Vu Thi Que Huong
- Laboratory of Arbovirus, Pasteur Institute in Ho Chi Minh City, Vietnam
| | - Do Quang Ha
- Laboratory of Arbovirus, Pasteur Institute in Ho Chi Minh City, Vietnam
| | | | - Vo Dinh Tham
- Children's Hospital No.2, Ho Chi Minh City, Vietnam
| | - Ha Manh Tuan
- Children's Hospital No.2, Ho Chi Minh City, Vietnam
| | - Vo Van Tuong
- Center for Preventive Medicine, Vinh Long Province, Vietnam
| | | | - Tran Van Dat
- Center for Preventive Medicine, Vinh Long Province, Vietnam
| | - Toshifumi Oyama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
| | - Kouichi Morita
- Global COE program, Nagasaki University, Japan
- Department of Virology, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
| | - Michio Yasunami
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
| | - Kenji Hirayama
- Department of Immunogenetics, Institute of Tropical Medicine (NEKKEN), Nagasaki University, Japan
- Center of International Collaborative Research, Nagasaki University, Japan
- Global COE program, Nagasaki University, Japan
- * E-mail:
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Díaz-Quijano FA, Villar-Centeno LA, Martínez-Vega RA. [Early indicators of dengue infection in children]. An Pediatr (Barc) 2006; 64:523-9. [PMID: 16792959 DOI: 10.1157/13089916] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To identify clinical manifestations and laboratory findings useful for the early diagnosis of dengue in children. MATERIALS AND METHODS We prospectively evaluated 125 children (aged 5 to 12 years old) with acute febrile syndrome with no apparent etiology. Paired serologic tests and/or viral culture were performed and dengue infection was confirmed in 40 patients and ruled out in 68 (17 indefinite cases). Early clinical manifestations (within the first 4 days of the disease) in the groups with dengue and other causes of febrile syndrome were compared. Independent indicators of dengue were determined in a multivariate logistic regression analysis. RESULTS When clinical manifestations and complete blood count were considered, the independent indicators of dengue were: absence of nasal discharge, facial flushing, and leukocyte count < or = 4,500/.l. With at least two of these findings, a sensitivity of 67 % and a specificity of 72 % for the diagnosis of dengue were obtained. When coagulation tests were considered, a model for diagnosis was composed of: absence of nasal discharge, leukocyte count < or = 4500/.l, prothrombin time > 14 seconds, and partial thromboplastin time > 29 seconds. Two of these findings suggested a diagnosis of dengue with a sensitivity of 90 % and a specificity of 52.9 %. With at least 3 findings, specificity increased to 89.7 % and sensitivity decreased to 50 %. The presence of the four components of this latter model shows a specificity of 100 %. CONCLUSIONS Some clinical manifestations and simple laboratory tests could aid the early detection of dengue infection in children.
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Affiliation(s)
- F A Díaz-Quijano
- Centro de Investigaciones Epidemiológicas, Facultad de Salud, Universidad Industrial de Santander, Ctra. 32 no. 29-31, Bucaramanga, Colombia.
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