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Pace D, Corvaglia F, Lisi C, Galli L, Chiappini E. Extrapulmonary and Drug-Resistant Childhood Tuberculosis: Unveiling the Disease to Adopt the Optimal Treatment Strategy. Pathogens 2023; 12:1439. [PMID: 38133322 PMCID: PMC10745899 DOI: 10.3390/pathogens12121439] [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: 11/02/2023] [Revised: 12/01/2023] [Accepted: 12/08/2023] [Indexed: 12/23/2023] Open
Abstract
Paediatric tuberculosis (TB) is a substantial threat among infectious diseases, particularly considering the high risk of extrapulmonary tuberculosis (EPTB), severe forms of the disease, and the spreading of drug-resistant strains. Describing the characteristics of children with EPTB and those with drug-resistant tuberculosis (DR-TB) and analysing the role of second-line drugs could facilitate the management of these cases. This retrospective study was conducted on 271 children diagnosed with active TB disease (44 EPTB cases, 9 DR-TB cases), originating from diverse geographic areas, who were referred to the infectious disease unit at Meyer Children's Hospital, Florence, Italy, from 2006 to 2022. In most patients, the management of therapies was complicated by the impossibility to obtain drug susceptibility testing (DST) results, which improved over the years: 17/154 (11.04%) children had DST results between 2006 and 2013, and 50/117 (42.73%, p < 0.001) between 2014 and 2022. Second-line drugs were not exclusively administered to DR-TB cases, but also to EPTB cases (20/44, 45.45%). Drugs were generally well tolerated; adverse events occurred in 13 children (13/271, 4.80%) and were generally mild and reversable. Therapies were successful in 267 children (98.52%) considered cured, while 4 (1.48%) presented sequelae. Both univariate and multivariate logistic regression analyses were conducted to investigate factors associated with EPTB, DR-TB, and second-line drugs administration. Originating from Asia emerged as a risk factor associated with both EPTB and DR-TB (p = 0.013 and p = 0.045, respectively). The introduction of GeneXpert tests has significantly improved TB diagnosis and the obtaining of DST results. The administration of second-line therapies should be limited primarily to DR-TB cases, but it is possible that these drugs may also be beneficial in selected EPTB cases.
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Affiliation(s)
| | | | | | | | - Elena Chiappini
- Infectious Disease Unit, Department of Health Sciences, Meyer Children’s Hospital IRCCS, University of Florence, 50121 Florence, Italy; (D.P.)
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Song WM, Li YF, Liu YX, Liu Y, Yu CB, Liu JY, Li HC. Drug-Resistant Tuberculosis Among Children: A Systematic Review and Meta-Analysis. Front Public Health 2021; 9:721817. [PMID: 34490197 PMCID: PMC8416474 DOI: 10.3389/fpubh.2021.721817] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 07/26/2021] [Indexed: 11/23/2022] Open
Abstract
Background: Drug-resistant tuberculosis (DR-TB), especially multidrug-resistant tuberculosis (MDR-TB) is a public health threat. Little is known about estimates of different profiles and rates of DR-TB among children globally. Methods: We did a systematic review and meta-analysis of observational studies reporting DR-TB among children by searching Embase, PubMed, and Scopus databases from January 1, 2000 to October 1, 2020. Publications reporting more than 60 children with bacteriological confirmed tuberculosis and phenotypical drug susceptibility testing (DST) results were included. Pooled proportions of MDR-TB and sub-analysis by age subgroups, regions, economical levels were performed. Results: We identified 4,063 studies, of which 37 were included. Of 23,652 pediatric TB patients, the proportions of DR-TB, MDR-TB, mono-resistant TB, polydrug resistant TB, extensively drug-resistant TB were 13.59% (1,964/14,453), 3.72% (881/23,652), 6.07% (529/8,719), 1.61% (119/7,361), 0.44% (30/6,763), respectively. The pooled proportion of MDR-TB among 23,652 children of 37 studies was 3.7% (95% CI, 3.5-4.0%). Rate of MDR-TB was much lower in high-income countries (1.8%) than that in lower-middle-income countries (6.3%) and upper-middle-income countries (7.3%). More specifically, the rates of MDR-TB were 1.7% in USA, 1.7% in UK, 2.9% in India, 6.0% in South Africa, 9.8% in China, respectively. Conclusions: The burden of DR-TB remains high in children, and there are potential associations between rates of pediatric MDR-TB and national economical levels. More interventions on child TB cases in low-income countries may be urgently needed in future.
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Affiliation(s)
- Wan-mei Song
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yi-fan Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Yun-xia Liu
- Department of Biostatistics, School of Public Health, Shandong University, Jinan, China
| | - Yao Liu
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
| | - Chun-bao Yu
- Katharine Hsu International Research Center of Human Infectious Diseases, Shandong Provincial Chest Hospital, Jinan, China
| | - Jin-yue Liu
- Department of Intensive Care Unit, Shandong Provincial Third Hospital, Jinan, China
| | - Huai-chen Li
- Department of Respiratory and Critical Care Medicine, Shandong Provincial Hospital Affiliated to Shandong University, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- College of Traditional Chinese Medicine, Shandong University of Traditional Chinese Medicine, Jinan, China
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Ali M, Howady F, Munir W, Karim H, Al-Suwaidi Z, Al-Maslamani M, Alkhal A, Elmaki N, Ziglam H. Drug-resistant tuberculosis: an experience from Qatar. Libyan J Med 2020; 15:1744351. [PMID: 32238120 PMCID: PMC7170354 DOI: 10.1080/19932820.2020.1744351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 01/22/2020] [Indexed: 11/16/2022] Open
Abstract
This study was conducted to evaluate the characteristics, treatment outcome and risk factors associated with 223 drug-resistant tuberculosis (DR-TB) cases in the State of Qatar. A descriptive records-based retrospective study was conducted on patients registered at Communicable Disease Centre (CDC), Qatar to all consecutive microbiologically confirmed tuberculosis cases for the period January 2010 - March 2015. Demographic, clinical data, drug-resistance pattern of isolated mycobacteria and treatment outcome was assessed for the patient who completed their treatment in Qatar. Of 3301 patients with positive M. tuberculosis culture were analyzed; 223 (6.7%) were resistant to at least one drug. The overall prevalence of multi-d rug resistant TB (MDR-TB) was 1.2% (n = 38) of patients. A former resident of Indian sub contents was the most common demographic characteristic observed (64.1%). The outcome of treatment was assessed for 85 resistant cases with follow-up after completion of treatment. Cure and relapse rates were 97.6%, and 2.4%, respectively. Drug-resistant TB in Qatar is influenced by migration where the patients were probably infected. Rapid sputum sampling performed in the early stages of the disease, patient isolation, and drug-susceptibility testing should be the standard of care.
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Affiliation(s)
- Maisa Ali
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Faraj Howady
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Waqar Munir
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hanfa Karim
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Zubaida Al-Suwaidi
- National Tuberculosis Reference Laboratory, Hamad Medical Corporation, Doha, Qatar
| | - Muna Al-Maslamani
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Abdullatif Alkhal
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Nada Elmaki
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
| | - Hisham Ziglam
- Department of Infectious Disease, Communicable Diseases Centre, Hamad Medical Corporation, Doha, Qatar
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Gonlugur T, Basol G, Gonlugur U. Tuberculosis drug resistance in Canakkale, Turkey. Cent Eur J Public Health 2020; 28:245. [PMID: 32997482 DOI: 10.21101/cejph.a5284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 07/14/2020] [Indexed: 11/15/2022]
Affiliation(s)
| | - Gulin Basol
- Public Health Agency of Canakkale, Canakkale, Turkey
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Evaluation of clinical and laboratory characteristics of childhood tuberculosis. Turk Arch Pediatr 2020; 55:236-243. [PMID: 33061750 PMCID: PMC7536459 DOI: 10.14744/turkpediatriars.2020.02438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 03/20/2020] [Indexed: 12/03/2022]
Abstract
Aim: Tuberculosis is one of the oldest and most contagious diseases of human history. One- quarter of the world’s population is infected with the tuberculosis bacillus. Childhood tuberculosis does not have a standard clinical and radiologic description. Herein, we aimed to evaluate the clinical, laboratory, and radiologic findings of childhood tuberculosis. Material and Methods: The medical records of 216 patients hospitalized and treated with a diagnosis of TB between January 2015 and July 2019 in the Division of Pediatric Infectious Diseases in our hospital, were examined retrospectively. Results: One hundred twenty-nine (59.7%) of 216 patients who were diagnosed as having TB were female and 87 (40.3%) were male. The age distribution of the patients was 12.3 (range, 0.33–18) years. One hundred sixty-nine patients (78.2%) had pulmonary, 34 (15.7%) had extrapulmonary, 13 had (6%) both pulmonary and extrapulmonary. One hundred forty-three (66.2%) patients had tuberculin skin test positivity. Acid-resistant bacteria were observed in 46 (21.3%) body fluid samples, and culture positivity was observed in 42 (19.4%) samples. The association of pulmonary tuberculosis and extrapulmonary tuberculosis was found with a higher rate in individuals who lived on minimum wage and in patients who had growth and developmental retardation (p=0.001, p<0.001). The hospitalization time was longer in these patients (p=0.027). The hemoglobin and sodium levels were significantly lower in patients who had extrapulmonary tuberculosis (p=0.044, p=0.002). Conclusion: Although the diagnosis of childhood tuberculosis is difficult due to the nonspecific signs and symptoms, it is a preventable and treatable disease.
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Chiappini E, Matucci T, Lisi C, Petrolini C, Venturini E, Tersigni C, de Martino M, Galli L. Use of Second-line Medications and Treatment Outcomes in Children With Tuberculosis in a Single Center From 2007 to 2018. Pediatr Infect Dis J 2019; 38:1027-1034. [PMID: 31397749 DOI: 10.1097/inf.0000000000002410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The incidence of drug-resistant forms of tuberculosis (DR-TB) and the number of children treated with second-line drugs (SLDs) are increasing. However, limited amount of information is available regarding the use of SLDs in this population. METHODS To describe the treatment of pediatric TB with SLDs and factors associated with use of SLDs in children with and without documented DR-TB, records of pediatric TB patients referred to a center in Italy from 2007 to 2018 were reviewed retrospectively. RESULTS Of 204 children diagnosed with active TB during the study period, 42 were treated with SLDs because of confirmed or probable drug resistance (42.8%), adverse reactions to first-line drugs (7.1%), central nervous system involvement (11.9%) or unconfirmed possible drug resistance (38.1%). There were no deaths or adverse reactions to SLDs reported. Treatment was successful in 85.2% children treated with first-line drugs and 92.9% children treated with SLDs. After adjusting for calendar period, the only factor associated with DR-TB was <2 years old [odds ratio (OR): 5.24 for <2 years vs. 5-18 years; P = 0.008]. Factors associated with treatment with SLDs were TB at 2 or more sites (OR: 11.30; P < 0.001), extrapulmonary TB (OR: 8.48; P < 0.001) or adverse reactions to first-line drugs (OR: 7.48; P = 0.002). No differences were noted in age or region of origin. CONCLUSIONS A substantial proportion of TB children were treated with SLDs. The main reason for using SLDs was failure of a first-line drug regimen, suggesting possible DR-TB and underestimation of DR-TB in children. The use of SLD regimens was associated with a high success rate and good tolerability profile.
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Affiliation(s)
- Elena Chiappini
- From the Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Evaluation of Clinical and Laboratory Characteristics of Children with Pulmonary and Extrapulmonary Tuberculosis. ACTA ACUST UNITED AC 2019; 55:medicina55080428. [PMID: 31375006 PMCID: PMC6722557 DOI: 10.3390/medicina55080428] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 07/16/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022]
Abstract
Background and objective: Tuberculosis (TB) is an important public health problem in both developing and developed countries. Childhood TB is also an important epidemiological indicator in terms of forming the future TB pool. The diagnosis of TB is difficult in children due to the lack of a standard clinical and radiological description. We aimed to evaluate and compare the clinical, laboratory, and radiologic findings of childhood pulmonary and extrapulmonary TB. Material and Methods: The medical records of patients hospitalized with the diagnosis of pulmonary tuberculosis (PTB) and extrapulmonary tuberculosis (EPTB) between December 2007 and December 2017 were evaluated retrospectively. Results: There were 163 patients diagnosed with TB with 94 females (57.7%) and 69 males (42.3%). Seventy-three patients (44.8%) had PTB, 71 (43.6%) patients had EPTB, and 19 patients (11.7%) had both PTB and EPTB, called as disseminated TB. Ninety-six (58.9%) patients had tuberculin skin test (TST) positivity and 64 patients (39.3%) had interferon-gamma release assay (IGRA) positivity. Acid-resistant bacteria were observed in 34 (20.9%) body fluid samples and culture positivity was observed in 33 (20.2%) samples. Comparison of PTB, EPTB, and disseminated TB revealed that low socioeconomic status, TB contact, and low body weight were more common in disseminated TB, and TST positivity was more common in PTB. Conclusion: Malnutrition, low socioeconomic status, and TB contact were important diagnostic variables in our study and all three parameters were more common in disseminated TB. Tuberculosis should be considered in patients admitted with different complaints and signs in populations with high TB incidence and low socioeconomic status.
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Matucci T, Galli L, de Martino M, Chiappini E. Treating children with tuberculosis: new weapons for an old enemy. J Chemother 2019; 31:227-245. [DOI: 10.1080/1120009x.2019.1598039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tommaso Matucci
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Luisa Galli
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Maurizio de Martino
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
| | - Elena Chiappini
- Department of Health Sciences, Anna Meyer Children University Hospital, University of Florence, Florence, Italy
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Paediatric Tuberculosis at a Referral Hospital in Istanbul: Analysis of 250 Cases. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6896279. [PMID: 27298827 PMCID: PMC4889790 DOI: 10.1155/2016/6896279] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Revised: 03/30/2016] [Accepted: 05/03/2016] [Indexed: 11/17/2022]
Abstract
Background. Tuberculosis (TB) still remains a growing public health problem globally. TB in children is often diagnosed clinically. Methods. We conducted a retrospective chart review of children with TB from November 2004 through December 2010 to determine the appropriateness of using contact history and diagnostic testing. Results. A total of 250 children with TB were identified. One hundred and sixty-two children had only pulmonary disease while 39 had features of both extrapulmonary and pulmonary TB. Mean age was 7.8 years. Thirty-six patients had known contacts. The index case/cases were first-degree relatives in 75%. Sixteen patients who were symptomless were yielded by contact investigation of newly identified TB cases. Tuberculin skin test positivity was 53.3%. Acid-fast bacilli smear positivity was 13.1%, and culture positivity was 18.7%. Twenty-six patients had histopathology of nonrespiratory specimens (lymph nodes and other tissues) showing granulomatous inflammation and caseous necrosis consistent with TB. Conclusions. Presence of contact history directed us to search for TB in children with nonspecific symptoms even if physical examinations were normal. Some children who were close contacts to TB cases were identified to have TB before development of symptoms.
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Disconnecting the DOTS: misconceptions about the therapeutic paradigm of tuberculosis patients at family healthcare centers in Istanbul. J Public Health (Oxf) 2016. [DOI: 10.1007/s10389-016-0708-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Ates Guler S, Bozkus F, Inci MF, Kokoglu OF, Ucmak H, Ozden S, Yuksel M. Evaluation of pulmonary and extrapulmonary tuberculosis in immunocompetent adults: a retrospective case series analysis. Med Princ Pract 2015; 24:75-9. [PMID: 25341702 PMCID: PMC5588178 DOI: 10.1159/000365511] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 06/26/2014] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE It was the aim of this study to evaluate the demographic factors and clinical features of extrapulmonary tuberculosis (EPTB) compared to those of pulmonary tuberculosis (PTB) among adult immunocompetent patients. SUBJECTS AND METHODS A total of 427 patients with clinically, radiologically and histopathologically confirmed TB were enrolled in the study, in our clinic at a tertiary care hospital in Turkey, during a 5-year period (2007-2012). Patient data were obtained retrospectively. Among the 427 patients, 55 patients with both PTB and EPTB and who were using steroids or had taken immunosuppressive drugs were excluded from the study. RESULTS Of the 372 patients, 227 (61%) were males and 168 (45.2%) had EPTB; 204 (54.8%) patients had PTB. The most frequent sites of EPTB were the lymph nodes (n = 45, 12.1%), pleura (n = 40, 10.7%) and brain (n = 7, 1.8%). The most common symptoms were cough (n = 174, 46.7%), night sweats (n = 127, 34.1%) and fever (n = 123, 33%). Compared to EPTB patients, PTB patients were less likely to have received Bacillus Calmette-Guérin vaccination (odds ratio 0.41, 95% confidence interval 0.2-0.63; p < 0.001). Eighty-one (48.2%) of the EPTB and 146 (71.6%) of the PTB patients were males. Pulmonary involvement was more common among men (n = 146, 71.6%) than among women (n = 58, 28.2%; p = 0.000). CONCLUSION There was a high incidence of EPTB in our study. Early diagnosis of EPTB is crucial for treatment, and atypical presentations of TB should be kept in mind for immunocompetent patients living in endemic areas. Females especially should be investigated for EPTB.
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Affiliation(s)
- Selma Ates Guler
- Department of Infectious Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
- *Dr. Selma Ates Guler, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Hastane cad. No. 50, TR–46000 Kahramanmaras (Turkey), E-Mail
| | - Fulsen Bozkus
- Department of Chest Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Mehmet Fatih Inci
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Omer Faruk Kokoglu
- Department of Infectious Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Hasan Ucmak
- Department of Infectious Diseases, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
| | - Sevinc Ozden
- Department of Department of Microbiology, Necip Fazil State Hospital, Kahramanmaras, Turkey
| | - Murvet Yuksel
- Department of Radiology, Faculty of Medicine, Kahramanmaras Sutcu Imam University, Kahramanmaras, Turkey
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