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   2009| January-February  | Volume 75 | Issue 1  
    Online since January 24, 2009

 
 
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REVIEW ARTICLES
Diffuse hair loss in an adult female: Approach to diagnosis and management
Shyam Behari Shrivastava
January-February 2009, 75(1):20-28
DOI:10.4103/0378-6323.45215  PMID:19172026
Telogen effluvium (TE) is the most common cause of diffuse hair loss in adult females. TE, along with female pattern hair loss (FPHL) and chronic telogen effluvium (CTE), accounts for the majority of diffuse alopecia cases. Abrupt, rapid, generalized shedding of normal club hairs, 2-3 months after a triggering event like parturition, high fever, major surgery, etc. indicates TE, while gradual diffuse hair loss with thinning of central scalp/widening of central parting line/frontotemporal recession indicates FPHL. Excessive, alarming diffuse shedding coming from a normal looking head with plenty of hairs and without an obvious cause is the hallmark of CTE, which is a distinct entity different from TE and FPHL. Apart from complete blood count and routine urine examination, levels of serum ferritin and T3, T4, and TSH should be checked in all cases of diffuse hair loss without a discernable cause, as iron deficiency and thyroid hormone disorders are the two common conditions often associated with diffuse hair loss, and most of the time, there are no apparent clinical features to suggest them. CTE is often confused with FPHL and can be reliably differentiated from it through biopsy which shows a normal histology in CTE and miniaturization with significant reduction of terminal to vellus hair ratio (T:V < 4:1) in FPHL. Repeated assurance, support, and explanation that the condition represents excessive shedding and not the actual loss of hairs, and it does not lead to baldness, are the guiding principles toward management of TE as well as CTE. TE is self limited and resolves in 3-6 months if the trigger is removed or treated, while the prognosis of CTE is less certain and may take 3-10 years for spontaneous resolution. Topical minoxidil 2% with or without antiandrogens, finestride, hair prosthesis, hair cosmetics, and hair surgery are the therapeutically available options for FPHL management.
  65,188 2,628 15
BRIEF REPORTS
Comparing the therapeutic effects of finasteride gel and tablet in treatment of the androgenetic alopecia
Zohreh Hajheydari, Jafar Akbari, Majid Saeedi, Leila Shokoohi
January-February 2009, 75(1):47-51
DOI:10.4103/0378-6323.45220  PMID:19172031
Background: Finasteride, a type P-selective 5a-reductase inhibitor, as a causative agent of decreasing dihydroxy testestrone (DHT) level, is effective in the treatment of male androgenic alopecia. Aim: We compared the local and oral finasteride in the treatment of androgenic alopecia. Method: This is a double blind, randomized clinical trial study of 45 male patients, who were referred with alopecia to the private clinics and departments in Boo-Ali Sina Hospital, in Sari. Patients with male androgenic alopecia were selected according to the history and physical examinations. The patients were randomly divided into two: topical finasteride (A) and oral finasteride (B) groups. Topical finasteride group (A) received a topical gel of 1% finasteride and placebo tablets, while the oral finasteride group (B) received finasteride tablets (1 mg) and gel base (without drug) as placebo for 6 months. The patients were followed by clinical observation and recording of side effects prior to the treatment and at the end of first week, and then by a monthly follow-up. The size of bald area, total hair count, and terminal hair were studied. Data were analyzed by descriptive and Chi-square statistical test. Results: The mean duration of hair loss was 18.8±23.10 months. Each month the terminal hair, size of bald area and hair count between the two groups were compared. There were no significant differences between the two groups as a viewpoint of hair thickness, hair counts and the size of bald area. Serial measurements indicated a significant increase in hair counts and terminal hair counts between the two groups. Conclusions: The results of this study showed that the therapeutic effects of both finasteride gel and finasteride tablet were relatively similar to each other.
  38,115 958 16
ORIGINAL ARTICLES
Male sex workers: Are we ignoring a risk group in Mumbai, India?
Santosh Shinde, Maninder Singh Setia, Ashok Row-Kavi, Vivek Anand, Hemangi Jerajani
January-February 2009, 75(1):41-46
DOI:10.4103/0378-6323.45219  PMID:19172030
Background: Male sex workers (MSWs) have recently been recognized as an important risk group for sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) infection. Although there are global studies on MSWs, few such studies describe the behavioral patterns and STIs among this population in India. Methods: MSWs were evaluated at the Humsafar trust, a community based organization situated in suburban Mumbai, India. We report on the demographics, sexual behaviors, and STIs including HIV of these sex workers. Results: Of the 75 MSWs, 24 were men and 51 were transgenders. The mean age of the group was 23.3 (+ 4.9) years. About 15% were married or lived with a permanent partner. Of these individuals, 85% reported sex work as a main source of income and 15% as an additional source. All the individuals reported anal sex (87% anal receptive sex and 13% anal insertive sex). About 13% of MSWs had never used a condom. The HIV prevalence was 33% (17% in men vs 41% in transgenders, P = 0.04). The STI prevalence was 60% (58% in men vs 61% in transgenders, P = 0.8). Syphilis was the most common STI (28%) in these MSWs. HIV was associated with being a transgender (41 vs 17%, P = 0.04), age > 26 years (57 vs 28%, P = 0.04), more than one year of sex work (38 vs 8%, P = 0.05), and income < Rs. 2000 per month (62 vs 27%, P = 0.02). Conclusions: The MSWs have high-risk behaviors, low consistent condom use, and high STI/HIV infections. These groups should be the focus of intensive public health interventions aimed at reduction of risky sexual practices, and STI/HIV prevention and care.
  28,026 586 23
REVIEW ARTICLES
Adverse reactions to cosmetics and methods of testing
PK Nigam
January-February 2009, 75(1):10-19
DOI:10.4103/0378-6323.45214  PMID:19172025
Untoward reactions to cosmetics, toiletries, and topical applications are the commonest single reason for hospital referrals with allergic contact dermatitis. In most cases, these are only mild or transient and most reactions being irritant rather than allergic in nature. Various adverse effects may occur in the form of acute toxicity, percutaneous absorption, skin irritation, eye irritation, skin sensitization and photosensitization, subchronic toxicity, mutagenicity/genotoxicity, and phototoxicity/photoirritation. The safety assessment of a cosmetic product clearly depends upon how it is used, since it determines the amount of substance which may be ingested, inhaled, or absorbed through the skin or mucous membranes. Concentration of ingredients used in the different products is also important. Various test procedures include in vivo animal models and in vitro models, such as open or closed patch test, in vivo skin irritation test, skin corrosivity potential tests (rat skin transcutaneous electrical resistance test, Episkin test), eye irritation tests (in vivo eye irritancy test and Draize eye irritancy test), mutagenicity/genotoxicity tests (in vitro bacterial reverse mutation test and in vitro mammalian cell chromosome aberration test), and phototoxicity/photoirritation test (3T3 neutral red uptake phototoxicity test). Finished cosmetic products are usually tested in small populations to confirm the skin and mucous membrane compatibility, and to assess their cosmetic acceptability.
  19,584 1,417 12
RESIDENT’S PAGE
Fitzpatrick skin typing: Applications in dermatology
Silonie Sachdeva
January-February 2009, 75(1):93-96
DOI:10.4103/0378-6323.45238  PMID:19172048
  19,434 1,220 16
CASE REPORTS
Generalized morphea, lichen sclerosis et atrophicus associated with oral submucosal fibrosis in an adult male
Sarvjit Kaur Virdi, Amrinderjit Singh Kanwar
January-February 2009, 75(1):56-59
DOI:10.4103/0378-6323.45222  PMID:19172033
Generalized morphea is a disease characterized by wide-spread sclerosis of the skin. A 39-year-old man presented with history of multiple pigmented and bound-down plaques on the body along with mucosal involvement. Dermatological examination showed multiple indurated and sclerosed plaques with follicular plugging in few of them and gross thickened eroded and glazed tongue. The constellation of these findings with histopathological correlation led us to diagnosis of this spectrum of cutaneous involvement. The coexistence of localized morphea with lichen sclerosis et atrophicus has been reported earlier but existence of these entities with submucosal fibrosis in a same patient is documented here and is the first of its kind.
  13,364 430 4
ORIGINAL ARTICLES
Trace element levels in alopecia areata
Yasmeen J Bhat, Sheikh Manzoor, AR Khan, Seema Qayoom
January-February 2009, 75(1):29-31
DOI:10.4103/0378-6323.45216  PMID:19172027
Background: Alopecia areata (AA) is a recurrent, nonscarring type of hair loss considered to be an autoimmune process. Though its etiopathology is not fully understood, there are claims that imbalance of trace elements may trigger the onset of AA. Aim: The aim of the present study was to assess the levels of zinc, copper, and magnesium in the serum of AA patients. Methods: Fifty AA patients (34 men and 16 women), and fifty age and sex matched healthy control subjects were studied. Samples were analyzed using atomic absorption spectrometric methods. Results: Serum zinc levels were significantly decreased (P < 0.05) in AA patients whose disease was extensive, prolonged, and resistant to treatment, whereas serum copper and magnesium levels showed insignificant rise compared to controls. Conclusion: We conclude that copper and magnesium levels are not altered in AA, but the decreased zinc levels found in our study may merit further investigation of the relationship.
  9,944 651 10
EDITORIAL
Fate of medical dermatology in the era of cosmetic dermatology and dermatosurgery
Sunil Dogra
January-February 2009, 75(1):4-7
DOI:10.4103/0378-6323.45212  PMID:19172023
  9,991 422 1
NET STUDY
A study of clinicohistopathological correlation in patients of psoriasis and psoriasiform dermatitis
Shilpa Mehta, Archana Singal, Navjeevan Singh, Sambit Nath Bhattacharya
January-February 2009, 75(1):100-100
DOI:10.4103/0378-6323.45241  PMID:19177702
Background: Psoriasis has different clinical variants, which mimic diverse dermatological conditions and may require a histopathological confirmation of the diagnosis. Studies to establish a clinicohistopathological concordance (and its determinants), in psoriasis and psoriasiform dermatitis are lacking . Aims : The present study was designed (a) to correlate the clinicohistopathological features of psoriasis and psoriasiform dermatitis, and (b) to identify determinant(s) that may contribute to the diagnosis of psoriasis and psoriasiform dermatitis. Methods : This was a prospective study involving 100 patients, with a single clinical diagnosis of psoriasis or with psoriasis as one of the differential diagnoses, and its correlation with histopathological features. Results : The clinical features of typical scale (P = 0.0001) and Auspitz's sign (P = 0.0001), and histological evidence of suprapapillary thinning (P = 0.0001) and absent granular cell layer (P = 0.0001) were found to be statistically significant contributors to the clinicohistological concordance in cases of psoriasis. Vertical orientation of collagen bundles (P = 0.0001) and lymphocytic exocytosis (P = 0.003) were found to be significantly associated with diagnosis of psoriasiform dermatitis. Conclusion : The present study reconfirms the diagnostic accuracy of silvery white scale, Auspitz's sign, and Koebner's phenomenon in a clinical setting suggestive of psoriasis. However, in their absence, histological evidence of suprapapillary thinning and absent granular layer, in addition to the Munro microabscess and Kogoj's abscess, may contribute to the diagnosis of psoriasis. Similarly, vertical orientation of collagen bundles and lymphocytic exocytosis may point toward a diagnosis of psoriasiform dermatitis.
  8,654 567 3
BRIEF REPORTS
The rK39 immunochromatic dipstick testing: A study for K39 seroprevalence in dogs and human leishmaniasis patients for possible animal reservoir of cutaneous and visceral leishmaniasis in endemic focus of Satluj river valley of Himachal Pradesh (India)
Nand Lal Sharma, Vikram K Mahajan, Ajit K Negi, Ghanshyam K Verma
January-February 2009, 75(1):52-55
DOI:10.4103/0378-6323.45221  PMID:19172032
Background: The newly recognized endemic focus of leishmaniasis in Satluj river valley of Himachal Pradesh (India) has both localized cutaneous leishmaniasis (LCL) and visceral leishmaniasis (VL) predominantly caused by Leishmania donovani. Rapid rK39 immunochromatographic dipstick test detects circulating antibodies to recombinant K39 antigen of L. donovani-infantum complex and is highly specific/sensitive in diagnosing symptomatic or asymptomatic infection in humans and dogs. Methods: The sera from two VL patients and 13 LCL patients, and 31 dogs were subjected to rK39 immunochromatographic dipstick testing with an aim to identify possible animal reservoir for leishmaniasis in this endemic focus. Results and Conclusion: The positive rapid rK39 immunochromatographic dipstick test in 100% VL and 31.8% LCL patients, and 6.5% dogs suggests that both VL and LCL in this focus are apparently being caused by L. donovani-infantum and that reservoir infection is perhaps being chiefly maintained in asymptomatic dogs. However, it needs corroborative evidence in the form of in-vitro parasite cultivation and/or PCR studies for confirmation. A more elaborate study is recommended.
  7,604 404 10
ORIGINAL ARTICLES
Presentation of early onset psoriasis in comparison with late onset psoriasis: A clinical study from Pakistan
Amer Ejaz, Naeem Raza, Nadia Iftikhar, Arshi Iftikhar, Mohammad Farooq
January-February 2009, 75(1):36-40
DOI:10.4103/0378-6323.45218  PMID:19172029
Background: Early onset psoriasis and late onset psoriasis are known to have different clinical patterns in Caucasian population. However, there is paucity of data among Asian patients. Aims: To compare the clinical presentation of early onset psoriasis with late onset psoriasis in Pakistani population. Methods: During the study period, participating dermatologists filled a pre-tested questionnaire for each patient with psoriasis on first encounter. The questionnaire incorporated information regarding clinical and demographic features of psoriasis including age of onset, clinical type of psoriasis, nail or joint involvement, and PASI score. Patients were then divided into early onset (age of onset <30 years, group I) and late onset (age of onset ≥30 years, group II) psoriasis. Results: Five hundred and fifteen questionnaires were filled and returned for evaluation. There was no statistically significant difference in both groups with regards to gender, family history (P = 0.09), nail (P = 0.69) and joint (P = 0.74) involvement, disease severity (P = 0.68), and clinical type of psoriasis (P = 0.06). No significant difference between disease severities measured by PASI score was observed in the two groups (P = 0.68). Presence of nail involvement was associated with joint disease in both groups (odds ratio 2.8, confidence interval 1.9-4.1). Conclusion: Patients with early and late onset psoriasis in Pakistani population do not show different clinical and demographic features contrary to the Western patients.
  7,375 594 8
HISTORY
Emergence of dermatology in India
Devinder Mohan Thappa, Rashmi Kumari
January-February 2009, 75(1):86-92
DOI:10.4103/0378-6323.45237  PMID:19172047
  6,836 582 2
NET CASE
Osler-Weber-Rendu syndrome: A case report with familial clustering
Sanjiv Grover, RS Grewal, Rajesh Verma, H Sahni, R Muralidhar, Preema Sinha
January-February 2009, 75(1):100-100
DOI:10.4103/0378-6323.45242  PMID:19180693
Osler-Weber-Rendu syndrome, also known as hereditary hemorrhagic telangiectasia, is a rare autosomal dominant disorder manifested by telangiectases of the skin and mucous membranes and arteriovenous malformations of various organ systems. We present a case of Osler-Weber-Rendu syndrome with 11 affected members in her family.
  6,004 275 1
VIEW POINT
Cosmeceuticals: Are they truly worth the cost?
Virendra S Ligade, D Sreedhar, J Manthan, N Udupa
January-February 2009, 75(1):8-9
DOI:10.4103/0378-6323.45213  PMID:19172024
  5,789 462 1
LETTERS TO THE EDITOR
Chrysomya bezziana infestation in a neglected squamous cell carcinoma on the face
Reza Yaghoobi, Nooshin Bagherani
January-February 2009, 75(1):81-82
DOI:10.4103/0378-6323.45234  PMID:19172044
  5,885 212 3
CASE REPORTS
Disseminated cutaneous rhinosporidiosis: Varied morphological appearances on the skin
Rashmi Kumari, Amiya Kumar Nath, R Rajalakshmi, Balaji Adityan, Devinder Mohan Thappa
January-February 2009, 75(1):68-71
DOI:10.4103/0378-6323.45225  PMID:19172036
Rhinosporidiosis is a chronic granulomatous disorder caused by Rhinosporidium seeberi . It frequently involves the nasopharynx and occasionally affects the skin. We report a case of 45-year-old man who had disseminated cutaneous rhinosporidiosis with cutaneous pseudohorn, its base arising from rhinosporidiosis. The case presented with multiple reddish lesions over the nose of six years duration. In the past year, he developed skin lesions over the left arm, forearm, back, and chest. On examination, polymorphic lesions of rhinosporidiosis in form of verrucous plaque, unulcerated tumor, granulomatous growth, and furunculoid lesions were observed. Interestingly, there was a cutaneous horn over the chest which on histopathological examination showed hyperplastic epithelium with numerous globular cysts of varying shape, representing sporangia in different stages of development and transelimination. Computerized tomography scan of the chest showed bilateral opacities suggestive of lung involvement. On the basis of these clinical and histopathological findings, a diagnosis of nasal rhinosporidiosis with cutaneous and systemic dissemination was made.
  5,665 350 9
Retiform hemangioendothelioma with lymph node metastasis: A rare entity
Bhawna Bhutoria, Abantika Konar, Sudipta Chakrabarti, Shikha Das
January-February 2009, 75(1):60-62
DOI:10.4103/0378-6323.45223  PMID:19172034
Retiform hemangioendothelioma (RH) is a rare, recently described, unique kind of low grade angiosarcoma. The tumor is characterized by distinctive arborizing blood vessels that mimic the appearance of rete testis. The tumor chiefly originates from the skin and subcutaneous tissue and has a tendency to recur locally. Only one case with lymph node metastasis has been reported previously. Another such rare case of RH is being reported in an adult female who presented with a subcutaneous nodule, underwent multiple recurrences and uniquely metastasized to regional lymph node.
  5,527 220 11
IMAGES IN CLINICAL PRACTICE
Periungual acquired digital fibrokeratoma
Rashmi Kumari, Devinder Mohan Thappa, Abarna Devi
January-February 2009, 75(1):72-72
DOI:10.4103/0378-6323.45226  PMID:19172037
  5,453 266 1
ORIGINAL ARTICLES
Teledermatology: Clinical case profiles and practical issues
Feroze Kaliyadan, S Venkitakrishnan
January-February 2009, 75(1):32-35
DOI:10.4103/0378-6323.45217  PMID:19172028
Background and Aims: Teledermatology is an area that has shown rapid growth in the recent past. However, not many studies have been conducted with regards to the application of teledermatology in India. Aim of our study was to evaluate the clinical profiles of cases referred for teledermatology consultation at our center, and to assess and compare the different modalities of teledermatology consultations done at our center along with the practical issues related to such a service. Methods: A retrospective study of teledermatology consultations at our center over a 3-year period was carried out. Store-and-forward (SAF), realtime consults (RTC), and hybrid (combining the two) were included.Two trained dermatologists were involved in carrying out the consultations in the referral center. Results: Of the 120 consultations, 68 male and 52 female patients in the age range of 2-77 years were seen. In more than 90% of the cases, teleconsultation was the first contact for the patient with the dermatologist (for the present condition). In 68% of the cases, the reference was for both diagnosis and management, while in the rest, the reference was mainly related to management issues (appropriate diagnosis having already been made). Certainity of diagnosis was maximum for hybrid, SAF, and RTC. Conclusions: Teledermatology can prove valuable as a tool to provide healthcare in areas of shortage of specialists. A hybrid system combining SAF and RTC could be the ideal form of teledermatology consultations in the future. Many practical issues need to be addressed before the effectiveness of teledermatology in India can be fully recognized.
  4,962 304 1
LETTERS TO THE EDITOR
Pulse therapy for pemphigus: The burden of proof
Sanjay Singh, Rahul Chaudhary
January-February 2009, 75(1):82-84
DOI:10.4103/0378-6323.45235  PMID:19172045
  4,772 431 6
QUIZ
Asymptomatic swelling in a 60-year-old scar
Dipankar De, Tarun Narang, Sunil Dogra, Bishan D Radotra, Amrinder J Kanwar
January-February 2009, 75(1):97-99
DOI:10.4103/0378-6323.45239  PMID:19172049
  4,763 222 -
CASE REPORTS
Nephrogenic fibrosing dermopathy
S Ragunatha, Aparna Palit, Arun C Inamadar, Ravindra M Madraki, BR Yelikar
January-February 2009, 75(1):63-67
DOI:10.4103/0378-6323.45224  PMID:19172035
An adult female patient on hemodialysis for chronic renal failure presented with large, brownish, and indurated plaques with bound-down skin on both lower limbs and abdomen along with difficulty in movement of the legs. Histopathological features revealed thick collagen bundles admixed with mucin and intercalating spindle-like cells characteristic of nephrogenic fibrosing dermopathy (NFD). Immunohistochemical study showed prominent CD68 positivity and weak CD34 positivity suggesting that the plaques were more than 20-weeks old. NFD in patients with chronic renal failure of unknown cause is a poor prognostic indicator. Early detection before the development of contracture and prompt treatment of NFD and underlying renal failure may reverse this disabling condition.
  3,797 339 -
LETTERS TO THE EDITOR
Concurrent oral and genital involvement in lichen planus
Asli Eralp, Nur Yuksel, Yesim Kaymak, Mine Canbazoglu, Meral Eksioglu, Omer Gunhan
January-February 2009, 75(1):77-78
DOI:10.4103/0378-6323.45231  PMID:19172041
  3,772 321 -
The reliability of periodic acid-Schiff staining in the diagnosis of onychomycosis
Gurcharan Singh, MS Lavanya
January-February 2009, 75(1):73-73
DOI:10.4103/0378-6323.45227  PMID:19172038
  3,851 240 1
Noncicatricial alopecia due to plaque-type psoriasis of the scalp
Ulker Gul, Secil Soylu, Murat Demiriz
January-February 2009, 75(1):78-80
DOI:10.4103/0378-6323.45232  PMID:19172042
  3,436 237 1
Granulomatous rosacea in Cornelia de Lange syndrome
Ahmed M Eghlileb, Andrew Y Finlay
January-February 2009, 75(1):74-75
DOI:10.4103/0378-6323.45229  PMID:19172039
  3,413 202 1
Localized pemphigus vulgaris on cheeks responding to topical steroids
Archana Singal, Deepika Pandhi
January-February 2009, 75(1):80-81
DOI:10.4103/0378-6323.45233  PMID:19172043
  3,291 222 3
NET LETTER
Polymerase chain reaction is no better than Gram stain for diagnosis of gonococcal urethritis
Abdel-Hamid F El-Gamal, Sultan R.S Al-Otaibi, Abdullah Alshamali, Adel Abdulrazzaq, Nabeel Najem, Abdulwahab Al. Fouzan
January-February 2009, 75(1):101-101
DOI:10.4103/0378-6323.45243  PMID:19177703
  3,229 213 -
LETTERS TO THE EDITOR
Prolonged antimicrobial and oral cyclophosphamide therapy in pemphigus: Need for caution
M Ramam
January-February 2009, 75(1):85-85
DOI:10.4103/0378-6323.45236  PMID:19172046
  2,923 233 3
NET QUIZ
A brownish-red plaque in an adult
Mehmet Harman, Sedat Akdeniz, Gokcen Balci, Ali Kemal Uzunlar
January-February 2009, 75(1):101-101
DOI:10.4103/0378-6323.45244  PMID:19180694
  2,710 212 1
CURRENT BEST EVIDENCE
Current best evidence from dermatology literature
Sowmya Kaimal, Devinder Mohan Thappa
January-February 2009, 75(1):102-104
DOI:10.4103/.45240  
  2,484 266 -
LETTERS TO THE EDITOR
Tanning caused by psoralen-photochemotherpy in Indian skin
Somesh Gupta, C Ajith
January-February 2009, 75(1):76-77
DOI:10.4103/0378-6323.45230  PMID:19172040
  2,559 161 -
EDITORIAL REPORT
Passing the baton
Uday Khopkar
January-February 2009, 75(1):1-1
DOI:10.4103/0378-6323.45267  
  2,280 247 -
EDITORIAL REMARKS
Opening remarks from the new editor
DM Thappa
January-February 2009, 75(1):2-3
DOI:10.4103/0378-6323.45211  
  2,218 198 -
LETTERS TO THE EDITOR
Authors' reply
Manjunath M Shenoy, S Teerthanath, Vimal K Karnaker, BS Girisha, Krishna Prasad, Jerome Pinto
January-February 2009, 75(1):73-74
DOI:10.4103/0378-6323.45228  
  1,740 167 1
Online since 15th March '04
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