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Saleem M, Hayawi L, Barrowman N, BenFadel N, Feberova J, Daboval T. 27 Determinants of referral to developmental resources among neonatal follow-up patients discharged from tertiary neonatal unit from 2005 UNTIL 2014. Paediatr Child Health 2020. [DOI: 10.1093/pch/pxaa068.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Lower gestational age or birth weight and higher rate of neurodevelopmental impairment have been commonly linked to higher need for developmental resources in premature infants. Existing evidence on need for developmental support in premature infants is limited in description of the needs, timing and method of assessment.
Objectives
To identify predictors for the needs for developmental resources among high-risk groups of infants born less than 29 weeks or with a birth weight (BW) less than 1250 grams. Secondarily, to compare the need of referrals to developmental resources and the rate of neurodevelopmental impairment defined as cerebral palsy, global developmental delay, blindness and deafness for this high risk population.
Design/Methods
We conducted a retrospective chart review of premature infants < 29+0 weeks GA or BW < 1250 grams born between January 2005 and December 31st 2014, who had at least one visit at the neonatal follow up clinic. Univariate and multivariate logistic regression analyses were conducted to examine potential predictors for referral to developmental resources.
Results
The study included 687 infants. Within this high risk population, 579 (85.0%) of infants were referred, of these 153 (26.4%) had one referral, 132 (22.8%) had 2 and 294 (50.8%) had 3 or more referral/s to developmental resources. Most frequent referrals were for speech therapy (339, 50.0%) physiotherapy (319, 46.8%) occupational therapy (262, 38.3%) and infant development program (232, 34.1%). The rates of referral to developmental resources decrease with increasing gestational age. Multivariate logistic regressions showed that gestational age (OR: 1.19, 95% CI: 1.05 - 1.35), birth weight (OR: 0.87, 95% CI: 0.77 - 0.99), female gender (OR: 0.70, 95% CI: 0.49 - 0.99), intraventricular hemorrhage grades III-IV (OR: 3.02, 95% CI: 1.28 - 7.16), and days on mechanical ventilator (OR:1.03, 95% CI: 1.01 - 1.05) were predictors for 2 or more referrals to developmental resources. Cerebral palsy was present in 4.4 % of the study population, deafness in 4% and blindness in 0.6%. The rate of referral to developmental resources was 54 (98.2%) among infants with neurodevelopmental impairment (NDI) compared to 522 (83.9%) in infants without NDI (p value= 0.01).
Conclusion
There is substantial need for developmental support among high-risk premature infants. Infants without neurodevelopmental impairments still need significant developmental resources to achieve their outcome.
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Kis H, Lemyre B, Radonjic A, Feberova J. 130 Survival, Short-Term Morbidity of Extremely Low Gestational Age Infants and their Predictors. Paediatr Child Health 2019. [DOI: 10.1093/pch/pxz066.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Hannah Kis
- The University of Ottawa, Faculty of Medicine
- The Children’s Hospital of Eastern Ontario, Research Institute
- The Ottawa Hospital, Research Institute
| | - Brigitte Lemyre
- The Children’s Hospital of Eastern Ontario, Division of Neonatology
- The Ottawa Hospital, Division of Neonatology
- The University of Ottawa, Faculty of Medicine
| | - Aleksandar Radonjic
- The University of Ottawa, Faculty of Medicine
- The Children’s Hospital of Eastern Ontario, Research Institute
- The Ottawa Hospital, Research Institute
| | - Jana Feberova
- The Children’s Hospital of Eastern Ontario, Division of Neonatology
- The Ottawa Hospital, Division of Neonatology
- The University of Ottawa, Faculty of Medicine
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Mackin R, Ben Fadel N, Feberova J, Murray L, Nair A, Kuehn S, Barrowman N, Daboval T. ASQ3 and/or the Bayley-III to support clinicians' decision making. PLoS One 2017; 12:e0170171. [PMID: 28151969 PMCID: PMC5289417 DOI: 10.1371/journal.pone.0170171] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 12/30/2016] [Indexed: 11/18/2022] Open
Abstract
Background Appropriate tools are essential to support a clinician’s decision to refer very preterm infants to developmental resources. Streamlining the use of developmental assessment or screening tools to make clinical decisions offers an alternative methodology to help to choose the most effective way to assess this very high-risk population. Objective To examine the influence of the Ages and Stages Questionnaire-3rd edition (ASQ3) and the Bayley Scales of Infant Development-3rd edition (Bayley-III) scores within a clinically-based decision-making process. Methods This retrospective cohort study includes children born at less than 29 weeks gestation who had completed both psychologist-administered Bayley-III and physician-observed ASQ3 assessments at 18 months corrected age. Theoretical referral decisions (TRDs) based on each assessment results were formulated, using cut-off scores between the lower first and second standard deviation values and below the lower second standard deviation values. TRDs to refer to developmental resources were evaluated in light of the multidisciplinary team’s actual final integrated decisions (FID). Results Complete data was available for 67 children. The ASQ3 and the Bayley-III had similar predictive value for the FID, with comparable kappa values. Comparisons of the physicians’ and psychologists’ TRDs with the FIDs demonstrated that the ASQ3 in conjunction with the medical and socio-familial findings predicted 93% of referral decisions. Conclusion Taking into consideration potential methodological biases, the results suggest that either ASQ3 or Bayley-III, along with socio-environmental, medical and neurological assessment, are sufficient to guide the majority of clinicians’ decisions regarding referral for specialty services. This retrospective study suggests that the physician-supervised ASQ3 may be sufficient to assess children who had been extremely preterm infants for referral purposes. The findings need to be confirmed in a larger, well-designed prospective study to minimize and account for potential sources of bias.
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Affiliation(s)
| | - Nadya Ben Fadel
- University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
| | - Jana Feberova
- University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
| | - Louise Murray
- University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
| | - Asha Nair
- University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
| | - Sally Kuehn
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
| | - Nick Barrowman
- Children’s Hospital of Eastern Ontario Research Institute, Clinical Research Unit, Ottawa, Ontario, Canada
| | - Thierry Daboval
- University of Ottawa, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Department Pediatrics, The Ottawa Hospital, Department of Obstetrics and Gynecology, Ottawa, Ontario, Canada
- * E-mail:
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Richer J, Daoud H, Geier P, Jarinova O, Carson N, Feberova J, Ben Fadel N, Unrau J, Bareke E, Khatchadourian K, Bulman DE, Majewski J, Boycott KM, Dyment DA. Resolution of refractory hypotension and anuria in a premature newborn with loss-of-function of ACE. Am J Med Genet A 2015; 167A:2867. [PMID: 26480306 DOI: 10.1002/ajmg.a.37270] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2015] [Accepted: 07/16/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Julie Richer
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Hussein Daoud
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Pavel Geier
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada.,Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Olga Jarinova
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nancy Carson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Jana Feberova
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nadya Ben Fadel
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Unrau
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eric Bareke
- McGill University and Genome Quebec Innovation Centre, Montréal, Québec, Canada
| | - Karine Khatchadourian
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dennis E Bulman
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - Jacek Majewski
- McGill University and Genome Quebec Innovation Centre, Montréal, Québec, Canada
| | - Kym M Boycott
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
| | - David A Dyment
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada.,Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ontario, Canada
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Jimenez-Rivera C, Gupta A, Feberova J, de Nanassy JA, Boland MP. Successful treatment of neonatal hemochromatosis as gestational alloimmune liver disease with intravenous immunoglobulin. J Neonatal Perinatal Med 2015; 7:301-4. [PMID: 25468619 DOI: 10.3233/npm-14814026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Neonatal hemochromatosis (NH) is a rare, often fatal disorder characterized by liver failure and hepatic and extrahepatic iron overload. Clinical manifestations can occur in utero or immediately after birth. Evidence suggests that most cases are due to a gestational disease with transplacental transfer of maternal IgG antibodies targeting the fetal liver resulting in immune injury. The alloimmune target is believed to be a fetal hepatocyte cell surface antigen, with subsequent complement activation resulting in severe loss of hepatocytes and fetal iron overload. This cascade of events leads to acute liver failure and neonatal death. With gestational alloimmune liver disease (GALD) being the mechanism of liver injury in most cases of NH, a new paradigm of treatment with intravenous immunoglobulin (IVIG) and exchange transfusion has been successfully used. We describe an extremely ill newborn with NH successfully treated with three doses of IVIG.
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Affiliation(s)
- C Jimenez-Rivera
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada University of Ottawa, Ottawa, ON, Canada
| | - A Gupta
- University of Ottawa, Ottawa, ON, Canada
| | - J Feberova
- University of Ottawa, Ottawa, ON, Canada Division of Neonatology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - J A de Nanassy
- University of Ottawa, Ottawa, ON, Canada Department of Pathology, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | - M P Boland
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada University of Ottawa, Ottawa, ON, Canada
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Richer J, Daoud H, Geier P, Jarinova O, Carson N, Feberova J, Ben Fadel N, Unrau J, Bareke E, Khatchadourian K, Bulman DE, Majewski J, Boycott KM, Dyment DA. Resolution of refractory hypotension and anuria in a premature newborn with loss-of-function of ACE. Am J Med Genet A 2015; 167:1654-8. [PMID: 25899979 DOI: 10.1002/ajmg.a.37067] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/05/2015] [Indexed: 11/07/2022]
Abstract
We present the investigation and management of a premature, hypotensive neonate born after a pregnancy complicated by anhydramnios to highlight the impact of early and informed management for rare kidney disease. Vasopressin was used to successfully treat refractory hypotension and anuria in the neonate born at 27 weeks of gestation. Next generation sequencing of a targeted panel of genes was then performed in the neonate and parents. Subsequently, two compound heterozygous deletions leading to frameshift mutations were identified in the angiotensin 1-converting enzyme gene ACE; exon 5:c.820_821delAG (p.Arg274Glyfs*117) and exon24: c.3521delG (p.Gly1174Alafs*12), consistent with a diagnosis of renal tubular dysgenesis. In light of the molecular diagnosis, identification, and treatment of associated low aldosterone level resulted in further improvement in renal function and only mild residual chronic renal failure is present at 14 months of age. Truncating alterations in ACE most often result in fetal demise during gestation or in the first days of life and typically as a result of the Potter sequence. The premature delivery, and serendipitous early treatment with vasopressin, and then later fludrocortisone, resulted in an optimal outcome in an otherwise lethal condition.
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Affiliation(s)
- Julie Richer
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Hussein Daoud
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Pavel Geier
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
- Division of Nephrology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Olga Jarinova
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Nancy Carson
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jana Feberova
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Jennifer Unrau
- Division of Neonatology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Eric Bareke
- McGill University and Genome Quebec Innovation Centre, Montréal, Québec, Canada
| | - Karine Khatchadourian
- Division of Endocrinology, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Dennis E Bulman
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacek Majewski
- McGill University and Genome Quebec Innovation Centre, Montréal, Québec, Canada
| | - Kym M Boycott
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - David A Dyment
- Department of Genetics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Dostalova T, Eliasova H, Gabcova D, Feberova J, Kaminek M. Contemporary skull development - palatal angle analysis. BRATISL MED J 2015; 116:143-6. [PMID: 25869559 DOI: 10.4149/bll_2015_028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The palatal angle is an important angle of the craniofacial complex. It is significant for the diagnosis of craniofacial disorders mainly for nasopharyngeal soft-tissue patterns.Background The dentists and otorhinolaryngologists use this relationship to establish proper treatment mechanics and evaluate facial profile. The aims of this study were to provide comparative cephalometric analyses of historical and contemporary skulls. MATERIALS AND METHOD A total of 190 cephalograms of 2 groups of subjects were evaluated. Dolphin Imaging 11.0 - Cephalometric Tracing Analysis was used for the analysis. Unpaired two-tailed t-test assuming equality of variances was used for all variables (at the significance level p = 0.0001). RESULTS The -modern forensic skulls had larger palatal angle at average value of 8.60 degrees ± 4.35, than that of archeological ones, the average value of which was 6.50 degrees ± 3.92. The difference was found significant. Unpaired two-tailed t-test assuming equality of variances showed that historical and contemporary skulls had statistically significant results. The difference was -2.09 with standard error of 0.60 (95% confidence interval from -3.29 to -0.89). Two-tailed probability attained value of P was less than 0.0001. CONCLUSION The difference between both groups was found significant. An increase in the palatal angle can be directly connected with anterior rotation of upper jaw(Tab. 2, Fig. 5, Ref. 19).
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Samiee-Zafarghandy S, Feberova J, Williams K, Yasseen AS, Perkins SL, Lemyre B. Influence of skin colour on diagnostic accuracy of the jaundice meter JM 103 in newborns. Arch Dis Child Fetal Neonatal Ed 2014; 99:F480-4. [PMID: 25074981 DOI: 10.1136/archdischild-2013-305699] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To assess the diagnostic accuracy of the JM 103 as a screening tool for neonatal jaundice and explore differential effects based on skin colour. METHODS We prospectively compared the transcutaneous bilirubin (TcB) and serum bilirubin (TSB) measurements of newborns over a 3 month-period. Skin colour was assigned via reference colour swatches. Diagnostic measures of the TcB/TSB comparison were made and clinically relevant TcB cut-off values were determined for each skin colour group. RESULTS 451 infants (51 light, 326 medium and 74 dark skin colour) were recruited. The association between TcB and TSB was high for all skin colours (rs>0.9). The Bland-Altman analysis showed an absolute mean difference between the two measures of 13.3±26.4 µmol/L with broad limits of agreement (-39.4-66.0 µmol/L), with TcB underestimating TSB in light and medium skin colours and overestimating in dark skin colour. Diagnostic measures were also consistently high across skin colours, with no clinically significant differences observed. CONCLUSIONS The JM 103 is a useful screening tool to identify infants in need of serum bilirubin, regardless of skin colour. The effect of skin colour on the accuracy of this device at high levels of serum bilirubin could not be assessed fully due to small numbers in the light and dark groups.
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Affiliation(s)
- S Samiee-Zafarghandy
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada Department of Pediatrics, Division of Neonatology, McMaster Children's Hospital, Hamilton, Canada
| | - J Feberova
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada
| | - K Williams
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - A S Yasseen
- Clinical Research Unit, Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - S L Perkins
- Department of Pathology and Laboratory Medicine, The Ottawa Hospital, Ottawa, Canada
| | - B Lemyre
- Department of Obstetrics, Gynecology and Newborn Care, The Ottawa Hospital, Ottawa, Canada
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Kasal P, Janda A, Feberova J, Adla T, Hladikova M, Naidr JP, Potuckova R. Evaluation of health care related web resources based on web citation analysis and other quality criteria. Conf Proc IEEE Eng Med Biol Soc 2007; 2005:2391-4. [PMID: 17282717 DOI: 10.1109/iembs.2005.1616948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Automatic system for ranking of educational health care related web resources based on quality criteria was developed. Automatic retrieval of new web resources from well-known directories followed by their automatic evaluation is a keystone of the system. The system provides this information: a) location of the resource and its author, b) number of back links to the resource, c) checks presence of electronic labels of quality. Currently the system encompasses more than 500 links to educational web resources divided into 47 medical specialities. The resources in all categories are ranked according to their link popularity, the electronic labels of quality are presented. History of link popularity is recorded and might be displayed at every resource. There are 2 language editions. The system operates automatically, the editors check and correct the retrieved values. The described system adds to webcite indexing criteria for objective evaluation of quality of webpages. It is useful for the selection of optimum education resources in health care.
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Affiliation(s)
- P Kasal
- Institute of Medical Informatics, 2nd Medical Faculty, Charles University, Prague, V Uvalu 84 150 06 Prague 5, Czech Republic
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