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1.
An. pediatr. (2003. Ed. impr.) ; 92(4): 241.e1-241.e11, abr. 2020. mapas, graf, tab
Artigo em Espanhol | IBECS | ID: ibc-186847

RESUMO

El 31 de diciembre de 2019, la Comisión Municipal de Salud y Sanidad de Wuhan (provincia de Hubei, China) informó sobre la existencia de 27 casos de neumonía de etiología desconocida con inicio de síntomas el 8 de diciembre, incluyendo 7 casos graves, con exposición común a un mercado de marisco, pescado y animales vivos en la ciudad de Wuhan. El 7 de enero de 2020, las autoridades chinas identificaron como agente causante del brote un nuevo tipo de virus de la familia Coronaviridae, denominado temporalmente «nuevo coronavirus», 2019-nCoV. El 30 de enero de 2020 la Organización Mundial de la Salud (OMS) declara el brote una Emergencia Internacional. El día 11 de febrero la OMS le asigna el nombre de SARS-CoV2 e infección COVID-19 (Coronavirus Infectious Disease). El Ministerio de Sanidad convoca a las Sociedades de Especialidades para la elaboración de un protocolo clínico de manejo de la infección. La Asociación Española de Pediatría nombra un grupo de trabajo de las Sociedades de Infectología Pediátrica y Cuidados Intensivos Pediátricos que se encargan de elaborar las presentes recomendaciones con la evidencia disponible en el momento de su realización


On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus», 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them


Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Adolescente , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Coronavirus/classificação , Coronavirus/genética , Reação em Cadeia da Polimerase em Tempo Real , Índice de Gravidade de Doença , Sociedades Médicas , Espanha
3.
An Pediatr (Barc) ; 92(4): 241.e1-241.e11, 2020 Apr.
Artigo em Espanhol | MEDLINE | ID: mdl-32173188

RESUMO

On 31 December 2019, the Wuhan Municipal Committee of Health and Healthcare (Hubei Province, China) reported that there were 27 cases of pneumonia of unknown origin with symptoms starting on the 8 December. There were 7 serious cases with common exposure in market with shellfish, fish, and live animals, in the city of Wuhan. On 7 January 2020, the Chinese authorities identified that the agent causing the outbreak was a new type of virus of the Coronaviridae family, temporarily called «new coronavirus¼, 2019-nCoV. On January 30th, 2020, the World Health Organisation (WHO) declared the outbreak an International Emergency. On 11 February 2020 the WHO assigned it the name of SARS-CoV2 and COVID-19 (SARS-CoV2 and COVID-19). The Ministry of Health summoned the Specialties Societies to prepare a clinical protocol for the management of COVID-19. The Spanish Paediatric Association appointed a Working Group of the Societies of Paediatric Infectious Diseases and Paediatric Intensive Care to prepare the present recommendations with the evidence available at the time of preparing them.


Assuntos
Infecções por Coronavirus , Surtos de Doenças , Pandemias , Administração dos Cuidados ao Paciente , Pediatria , Pneumonia Viral , Betacoronavirus , Criança , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Humanos , Pandemias/prevenção & controle , Pediatria/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Guias de Prática Clínica como Assunto , Espanha
5.
An. pediatr. (2003. Ed. impr.) ; 91(3): 206.e1-206.e13, sept. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-186735

RESUMO

La ecografía a pie de cama (EPC) se ha convertido en los últimos años en una herramienta imprescindible para la práctica clínica. La EPC debe entenderse como una extensión de la exploración física habitual que, sin sustituirla, la complementa y la enriquece. La EPC permite al clínico responder preguntas concretas sobre el diagnóstico, entender mejor la fisiopatología, orientar el tratamiento o realizar procedimientos invasivos con mayor seguridad. A pesar de su integración en muchos centros y en las diferentes subespecialidades pediátricas, no disponemos de recomendaciones específicas que establezcan los objetivos formativos en las distintas áreas de capacitación, la metodología de entrenamiento o la certificación de competencias en pediatría. Estos elementos son imprescindibles para que la EPC pueda implementarse en la práctica diaria con garantías de eficiencia y seguridad. Este artículo aborda las principales aplicaciones de la EPC en pediatría mediante una revisión no sistemática por parte de expertos en diferentes áreas de la práctica clínica en España. Además, se discute acerca de la falta de planes formativos a nivel estatal, contando con la aportación de la experiencia de Estados Unidos. En vista de la situación actual de la EPC, en nuestra opinión es urgente que se establezcan recomendaciones basadas en la evidencia para el entrenamiento en EPC que sirvan como base para el desarrollo de planes formativos y la integración de la EPC en el programa formativo de la especialidad


Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training


Assuntos
Humanos , Pediatras/educação , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Internato e Residência/métodos , Espanha , Especialização
6.
An Pediatr (Barc) ; 91(3): 206.e1-206.e13, 2019 Sep.
Artigo em Espanhol | MEDLINE | ID: mdl-31395389

RESUMO

Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training.


Assuntos
Pediatria/educação , Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/métodos , Humanos , Internato e Residência/métodos , Espanha , Especialização
9.
Am J Perinatol ; 35(5): 503-508, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29183098

RESUMO

INTRODUCTION: Percutaneous central venous catheter (CVC) insertion is a challenging procedure in neonates, especially in preterm infants. OBJECTIVE: This study aims to describe the technical success and safety profile of ultrasound (US)-guided brachiocephalic vein (BCV) cannulation in neonates. METHODS: Prospective observational study. Neonates admitted to the neonatal intensive care unit (NICU) in whom US-guided cannulation of the BCV was attempted were eligible. Outcomes included first attempt success rate, the overall success rate, the number of attempts, the cannulation time, immediate mechanical complications, catheter indwelling days, and late complications. RESULTS: A total of 40 procedures in 37 patients were included. Median weight and age at the time of cannulation were 1.85 kg (0.76-4.8) and 13 days (3-31), respectively. First attempt and overall success rates were 29 (72.5%) and 38 (95%), respectively. No major complications were observed. Catheter-associated infection rate was 2.4/1,000 catheter days. There were no difference in outcomes between low weight preterm infants (<1.5 kg) and the rest of the cohort. There was no linear relationship between weight at time of insertion and the number of puncture attempts (r = 0.250; p = 0.154) or cannulation time (r = 0.257; p = 0.142). CONCLUSION: US-guided cannulation of the BCV may be considered in acutely ill neonates, including small preterm infants, who need a large bore CVC.


Assuntos
Veias Braquiocefálicas , Infecções Relacionadas a Cateter/etiologia , Cateterismo Venoso Central/métodos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Ultrassonografia de Intervenção , Cateterismo Venoso Central/efeitos adversos , Cateteres Venosos Centrais/efeitos adversos , Feminino , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Masculino , Estudos Prospectivos , Espanha
10.
Crit Ultrasound J ; 9(1): 12, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28608268

RESUMO

Percutaneous cardiac intervention is an invasive diagnostic and therapeutic technique which carries a significant complication rate. Although the usefulness of EFAST protocol is widely recognised, this paper will attempt to explore a modified approach involving a focused examination on the retroperitoneal (r-EFAST). We have provided examples of 3 cases where r-EFAST was used to detect retroperitoneal bleeding in critical situations.

11.
An. pediatr. (2003. Ed. impr.) ; 86(6): 344-349, jun. 2017. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-163360

RESUMO

Introducción: La ecografía a pie de cama es cada vez más utilizada por los pediatras que tratan a niños críticos. El objetivo del estudio es describir la disponibilidad, el uso y la formación específica existente para esta técnica en las UCIP de nuestro entorno. Material y métodos: Se realizó un estudio descriptivo transversal multicéntrico mediante una encuesta en línea. Resultados: Se identificaron 51 UCIP en nuestro país, el 64,7% respondió a la encuesta. El 53,1% dispone de ecógrafo propio, el 25% lo comparte con otras unidades ubicándose en la unidad y el 21,9% dispone de él pero está ubicado en otra unidad. La disponibilidad de ecógrafo no se relacionó con el tamaño, la complejidad asistencial o el número de ingresos anuales. El 35% emplea la ecografía diariamente; esto se relacionó con la ubicación del ecógrafo en la unidad (p = 0,026), con la realización de trasplantes (p = 0,009), la disponibilidad de ECMO (p = 0,006) y con el número de ingresos anuales (p = 0,015). El 45,5% tiene menos del 50% de sus médicos con formación específica; el 18,2% ha formado a todos sus médicos. La presencia de más del 50% de médicos formados se asoció con mayor utilización a diario (p = 0,033) y con su uso para evaluar la función cardiaca (p = 0,033), la volemia (p = 0,004) o la presencia de líquido intraabdominal (p = 0,021). Conclusiones: La ecografía a pie de cama es una técnica frecuentemente disponible en las UCIP españolas. La formación específica para su uso es hasta el momento heterogénea pero debe servir para potenciar su implantación (AU)


Introduction: Point-of-care (bedside) ultrasound is being increasingly used by paediatricians who treat critically ill children. The aim of this study is to describe its availability, use, and specific training in Paediatric Intensive Care Units in Spain. Material and methods: A descriptive, cross-sectional, multicentre study was performed using an online survey. Results: Of a total of 51 PICUs identified in our country, 64.7% responded to the survey. Just over half (53.1%) have their own ultrasound machine, 25% share it, with other units with the usual location in the PICU, and 21.9% share it, but it is usually located outside the PICU. Ultrasound machine availability was not related to size, care complexity, or number PICU admissions. The ultrasound was used daily in 35% of the units, and was associated with location of the machine in the PICU (P = .026), the existence of a transplant program (P = .009), availability of ECMO (P = .006), and number of admissions (P = .015). 45.5% of PICUs has less than 50% of the medical staff specifically trained in bedside ultrasound, and 18.2% have all their medical staff trained. The presence of more than 50% of medical staff trained was associated with a higher rate of daily use (P = .033), and with specific use to evaluate cardiac function (P = .033), intravascular volume estimation (P = .004), or the presence of intra-abdominal collections (P = .021). Conclusions: Bedside ultrasound is frequently available in Spanish PICUs. Specific training is still variable, but it should serve to enhance its implementation (AU)


Assuntos
Humanos , Criança , Cuidados Críticos/métodos , Ultrassonografia , Testes Imediatos/organização & administração , Unidades de Terapia Intensiva Pediátrica/organização & administração , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Capacitação Profissional
12.
An Pediatr (Barc) ; 86(6): 344-349, 2017 Jun.
Artigo em Espanhol | MEDLINE | ID: mdl-27436571

RESUMO

INTRODUCTION: Point-of-care (bedside) ultrasound is being increasingly used by paediatricians who treat critically ill children. The aim of this study is to describe its availability, use, and specific training in Paediatric Intensive Care Units in Spain. MATERIAL AND METHODS: A descriptive, cross-sectional, multicentre study was performed using an online survey. RESULTS: Of a total of 51 PICUs identified in our country, 64.7% responded to the survey. Just over half (53.1%) have their own ultrasound machine, 25% share it, with other units with the usual location in the PICU, and 21.9% share it, but it is usually located outside the PICU. Ultrasound machine availability was not related to size, care complexity, or number PICU admissions. The ultrasound was used daily in 35% of the units, and was associated with location of the machine in the PICU (P=.026), the existence of a transplant program (P=.009), availability of ECMO (P=.006), and number of admissions (P=.015). 45.5% of PICUs has less than 50% of the medical staff specifically trained in bedside ultrasound, and 18.2% have all their medical staff trained. The presence of more than 50% of medical staff trained was associated with a higher rate of daily use (P=.033), and with specific use to evaluate cardiac function (P=.033), intravascular volume estimation (P=.004), or the presence of intra-abdominal collections (P=.021). CONCLUSIONS: Bedside ultrasound is frequently available in Spanish PICUs. Specific training is still variable, but it should serve to enhance its implementation.


Assuntos
Sistemas Automatizados de Assistência Junto ao Leito , Ultrassonografia/estatística & dados numéricos , Criança , Estudos Transversais , Humanos , Unidades de Terapia Intensiva Pediátrica , Espanha
16.
Rev Med Inst Mex Seguro Soc ; 49(2): 225-31, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21703153

RESUMO

Outpatient visits for medical attention because of Diabetes mellitus in the Instituto Mexicano del Seguro Social became very important for the magnitude that it represents. There is a clear increasing tendency for the coming years. The available data indicates a higher frequency and increased demand of women. Higher number of patients is observed between 40 and 59 years old. However, earlier age groups present considerable amount of cases. Having the number of patients allows knowing the average of consultations per patient, this parameter allows having an estimate of the follow up by the physician and it must be part of the evaluation of the medical attention programs. Diabetes mellitus is strongly associated with obesity, this condition affects a high percentage of diabetic patients in the Institution and weight loss must be encouraged.


Assuntos
Assistência Ambulatorial , Diabetes Mellitus/terapia , Necessidades e Demandas de Serviços de Saúde , Atenção Primária à Saúde , Humanos
17.
Rev Med Inst Mex Seguro Soc ; 49(1): 109-15, 2011.
Artigo em Espanhol | MEDLINE | ID: mdl-21513670

RESUMO

Mortality is an indicator that allow us to evaluate HIV infection control programs. From the middle of the last decade, mortality presents a tendency to decrease in the population covered by the Instituto Mexicano del Seguro Social). In relation to gender and age group the most affected are men between 25 to 44 years of age with mortality rates ranging from 30 to 12 by 100,000 men (1995 to 2009 respectively). In 2009, at least half of the Delegaciones (administrative units by State) present larger mortality rates than the institutional average, particularly Campeche with 14.9 by 100,000 men. It is clear that introduction of control measures against the disease from infected people represents a modification in the course of the illness in the population covered by IMSS.


Assuntos
Síndrome de Imunodeficiência Adquirida/mortalidade , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Infecções por HIV/mortalidade , Instalações de Saúde , Humanos , Masculino , México , Pessoa de Meia-Idade , Adulto Jovem
18.
Rev Med Inst Mex Seguro Soc ; 47(4): 367-76, 2009.
Artigo em Espanhol | MEDLINE | ID: mdl-20553640

RESUMO

OBJECTIVE: To determine the prevalence of tobacco consumption (TC) and frequency according to demographics and health aspects. METHODS: A cross-sectional study from the Mexican Family Life Survey Project was conducted. The past and present TC according to sociodemo-graphic variables and the presence of chronic diseases (CD) were achieved. RESULTS: The prevalence of TC in the past was 21.4 % with a male/female ratio of 2.5. Nowadays TC was 15.2 % and the ratio between male/female was 2.6 (23.0: 8.9); exposure levels by age decreased at present. Out of the total smokers in the past 71 % continue with the habit, 75 % began TC before the age of 20. In the 15 to 19 years group, 50 % of them started before the age of 14. The highest cigarette pack consumption mean was 2.5 per week and for the present smokers was 1.8; the prevalence for CD in the smoking population was above 20 %; present smoking diminished in those with a history of CD, especially cancer and heart disease. CONCLUSIONS: The prevalence of past and present TC is lower than that reported in other studies in the Mexican population, because of how the exposure to TC was measure.


Assuntos
Fumar/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Previdência Social , Adulto Jovem
19.
Gac Med Mex ; 144(2): 105-10, 2008.
Artigo em Espanhol | MEDLINE | ID: mdl-18590030

RESUMO

OBJECTIVE: Compare the clinical course of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). MATERIAL AND METHODS: Cross-sectional study among seropositive cases reported by the Northern Veracruz District IMSS Office in 2004. We analyzed the epidemiology, symptomology, clinical findings and disease progression. We calculated frequencies, proportions and averages. Clinical data and disease progression were compared. RESULTS: We studied 404 patients, divided into three groups: 75 with CD, 120 DHF and 212 cases with no hemorrhagic data although displaying Dengue with Thrombocytopenia (DwT). General symptoms were much less common among Dengue cases. Abdominal pain, hepatomegaly and splenomegaly were more frequent among patients with DHF. Fluid leakage and hemorrhaging were observed in 75% and 46%, respectively, of the latter group. The history of prior infection was proportional. All patients presenting DHF showed thrombocytopenia, though only 3% showed hemoconcentration. The mean value for hematocrit was low (p=0.02) and the platelet count greater (p<0.001) among Dengue cases. Hemoglobin concentration showed no difference. The average time between disease onset and appearance of thrombocytopenia was similar in DHF cases (4.3+/- 1.6 days) and Dengue with Thrombocytopenia (4.3+/-1.6); even though, contrary to these, in the first group fluid leakage (3.7+/-1.8) and hemorrhaging (3.4+/-1.7) were previously identified. CONCLUSIONS: Our results confirm the presence of cases showing atypical disease course, without external hemorrhaging data but showing significant thrombocytopenia that may go unnoticed and worsen disease progression.


Assuntos
Dengue Grave/classificação , Dengue Grave/diagnóstico , Adulto , Estudos Transversais , Feminino , Humanos , Masculino
20.
Gac. méd. Méx ; 144(2): 105-110, mar.-abr. 2008. tab, ilus
Artigo em Espanhol | LILACS | ID: lil-568116

RESUMO

Objetivo: Comparar el comportamiento clínico del dengue clásico (DC) y dengue hemorrágico (DH). Material y métodos: Estudio transversal en casos seropositivos de la Delegación Veracruz Norte del Instituto Mexicano del Seguro en 2004. Se analizaron antecedentes epidemiológicos, sintomatología, parámetros clínicos y evolución. Se obtuvieron frecuencias, proporciones y promedios. Se compararon datos clínicos y tiempos de evolución. Resultados: Estudiamos 404 pacientes integrados en tres grupos: 75 con DC, 120 con DH y 212 sin datos hemorrágicos pero con plaquetopenia (DcP). Los síntomas generales fueron menos frecuentes en los casos de dengue; el dolor abdominal, hepatomegalia y esplenomegalia fueron más comunes en los que presentaron hemorragias. El escape de líquidos y hemorragias ocurrieron en 75 y 46% de este último grupo. Los antecedentes de infección previa fueron semejantes. Todos los enfermos de DH presentaron plaquetopenia y 3%, hemoconcentración. La media del hematócrito fue menor (p=0.02) y el conteo plaquetario mayor (p<0.01) en los de DC. La hemoglobina no mostró diferencias. El promedio entre el inicio de la enfermedad y la aparición de plaquetopenia fue similar en los casos con DH (4.3±1.6 días) y DcP (4.3±1.6); aunque, a diferencia de éstos, en los primeros el escape de líquidos (3.7±1.8) y hemorragias (3.4±1.7) se identificaron previamente. Conclusiones: Los resultados demuestran la presencia de casos con una evolución atípica, sin datos hemorrágicos externos pero con trombocitopenia importante que puede pasar desapercibida y predisponer el agravamiento del cuadro.


OBJECTIVE: Compare the clinical course of Dengue Fever (DF) and Dengue Hemorrhagic Fever (DHF). MATERIAL AND METHODS: Cross-sectional study among seropositive cases reported by the Northern Veracruz District IMSS Office in 2004. We analyzed the epidemiology, symptomology, clinical findings and disease progression. We calculated frequencies, proportions and averages. Clinical data and disease progression were compared. RESULTS: We studied 404 patients, divided into three groups: 75 with CD, 120 DHF and 212 cases with no hemorrhagic data although displaying Dengue with Thrombocytopenia (DwT). General symptoms were much less common among Dengue cases. Abdominal pain, hepatomegaly and splenomegaly were more frequent among patients with DHF. Fluid leakage and hemorrhaging were observed in 75% and 46%, respectively, of the latter group. The history of prior infection was proportional. All patients presenting DHF showed thrombocytopenia, though only 3% showed hemoconcentration. The mean value for hematocrit was low (p=0.02) and the platelet count greater (p<0.001) among Dengue cases. Hemoglobin concentration showed no difference. The average time between disease onset and appearance of thrombocytopenia was similar in DHF cases (4.3+/- 1.6 days) and Dengue with Thrombocytopenia (4.3+/-1.6); even though, contrary to these, in the first group fluid leakage (3.7+/-1.8) and hemorrhaging (3.4+/-1.7) were previously identified. CONCLUSIONS: Our results confirm the presence of cases showing atypical disease course, without external hemorrhaging data but showing significant thrombocytopenia that may go unnoticed and worsen disease progression.


Assuntos
Humanos , Masculino , Feminino , Adulto , Dengue Grave/classificação , Dengue Grave/diagnóstico , Estudos Transversais
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