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Management of tinea corporis, tinea cruris, and tinea pedis: A comprehensive review
Alok Kumar Sahoo, Rahul Mahajan
March-April 2016, 7(2):77-86
DOI:10.4103/2229-5178.178099  PMID:27057486
The prevalence of superficial mycotic infection worldwide is 20–25% of which dermatophytes are the most common agents. Recent developments in understanding the pathophysiology of dermatophytosis have confirmed the central role of cell-mediated immunity in countering these infections. Hence, a lack of delayed hypersensitivity reaction in presence of a positive immediate hypersensitivity (IH) response to trichophytin antigen points toward the chronicity of disease. Diagnosis, though essentially clinical should be confirmed by laboratory-based investigations. Several new techniques such as polymerase chain reaction (PCR) and mass spectroscopy can help to identify the different dermatophyte strains. Management involves the use of topical antifungals in limited disease, and oral therapy is usually reserved for more extensive cases. The last few years have seen a significant rise in the incidence of chronic dermatophyte infections of skin which have proven difficult to treat. However, due to the lack of updated national or international guidelines on the management of tinea corporis, cruris, and pedis, treatment with systemic antifungals is often empirical. The present review aims to revisit this important topic and will detail the recent advances in the pathophysiology and management of tinea corporis, tinea cruris, and tinea pedia while highlighting the lack of clarity of certain management issues.
  64,810 7,355 12
Eponymous signs in dermatology
Bhushan Madke, Chitra Nayak
September-December 2012, 3(3):159-165
DOI:10.4103/2229-5178.101810  PMID:23189246
Clinical signs reflect the sheer and close observatory quality of an astute physician. Many new dermatological signs both in clinical and diagnostic aspects of various dermatoses are being reported and no single book on dermatology literature gives a comprehensive list of these "signs" and postgraduate students in dermatology finds it difficult to have access to the description, as most of these resident doctor do not have access to the said journal articles. "Signs" commonly found in dermatologic literature with a brief discussion and explanation is reviewed in this paper.
  59,431 11,042 6
Mantoux test and its interpretation
Surajit Nayak, Basanti Acharjya
January-April 2012, 3(1):2-6
DOI:10.4103/2229-5178.93479  PMID:23130251
The tuberculin skin test is one of the few investigations dating from the 19 th century that are still widely used as an important test for diagnosing tuberculosis. Though very commonly used by physicians worldwide its interpretation always remains difficult and controversial. Various factors like age, immunological status coexisting illness etc influence its outcome, so also its interpretation. Utmost care is required while interpreting the result and giving an opinion. This article has been written with the purpose of elucidating the performance and interpretation of the standard tuberculin test.
  62,236 3,545 29
Nonvenereal penile dermatoses: A retrospective study
Ana Marcos-Pinto, Luís Soares-de-Almeida, João Borges-Costa
March-April 2018, 9(2):96-100
DOI:10.4103/idoj.IDOJ_23_17  PMID:29644193
Context: A variety of nonvenereal diseases can affect the penis and diminish quality of life. Many present similar clinical features and a cutaneous biopsy may be necessary to clarify the diagnosis. Aims: To characterize nonvenereal penile dermatoses with histological confirmation in a southwestern Europe hospital during a 9-year period. Materials and Methods: A retrospective study was conducted. We reviewed all penile biopsies performed between January 1, 2007 and December 31, 2015 and studied the causes of the nonvenereal penile dermatoses. Results: The sample included a total of 108 patients, aged 62.9 (±17.8) years, between 16 years and 96 years of age. Eighteen dermatoses were identified. Inflammatory diseases were present in 65. 7% of patients (71/108) and neoplastic dermatoses in 34. 3% (37/108). Concerning inflammatory dermatoses, the most frequent were Zoon balanitis (27.8%, 30/108), followed by lichen sclerosus (15.7%, 17/108), psoriasis (11.1%, 12/108), and lichen planus (4.6%, 5/108). In patients with psoriasis, 10 had lesions only in the penis, similarly to all patients with lichen planus. The most frequent malignant tumor was squamous cell carcinoma (SCC) (15.7%, 17/108). The most common in-situ tumor was erythroplasia of Queyrat (8.3%, 9/108). A case of basal cell carcinoma (BCC) was found. Kaposi sarcoma and mycosis fungoides on penis were also diagnosed, as an additional form of presentation to their generalized disease. Conclusions: In this study, inflammatory diseases were the most frequently diagnosed dermatoses, while SCC was the most common malignant tumor found. In the majority of psoriasis and lichen planus cases, clinical lesions were only present in the genital area.
  36,353 749 -
An approach to acanthosis nigricans
Meghana Madhukar Phiske
July-September 2014, 5(3):239-249
DOI:10.4103/2229-5178.137765  PMID:25165638
Acanthosis nigricans (AN) is characterized by dark, coarse and thickened skin with a velvety texture, being symmetrically distributed on the neck, the axillae, antecubital and popliteal fossae, and groin folds, histopathologically characterized by papillomatosis and hyperkeratosis of the skin. A high prevalence of AN has been observed recently. Different varieties of AN include benign, obesity associated, syndromic, malignant, acral, unilateral, medication-induced and mixed AN. Diagnosis is largely clinical with histopathology needed only for confirmation. Other investigations needed are fasting lipoprotein profile, fasting glucose, fasting insulin, hemoglobin and alanine aminotransferase for obesity associated AN and radiological investigations (plain radiography, ultrasonography, magnetic resonance imaging/computerized tomography) for malignancy associated AN. The most common treatment modalities include retinoids and metformin.
  29,151 3,028 13
Treatment of nodular scabies with topical tacrolimus
Asit Mittal, Anubhav Garg, Nidheesh Agarwal, Lalit Gupta, Ashok K Khare
January-March 2013, 4(1):52-53
DOI:10.4103/2229-5178.105486  PMID:23437425
  27,191 1,128 3
Acne inversa (Hidradenitis suppurativa): A review with a focus on pathogenesis and treatment
Uwe Wollina, André Koch, Birgit Heinig, Thomas Kittner, Andreas Nowak
January-March 2013, 4(1):2-11
DOI:10.4103/2229-5178.105454  PMID:23439959
Acne inversa (AI) is a disabilitating chronic inflammatory disease with major negative impact on quality of life and significant co-morbidities. This is an important link to insights into immune dysfunction, which stimulated therapeutic approaches like tumor necrosis-α inhibitor therapy. This new off-label drug treatment is particularly beneficial when used in combination with wide excision of inflamed skin and subcutaneous tissue. Retinoids have been reported to be helpful in secondary prevention. The standard of therapy in advanced cases is surgery with wide excisions and healing by secondary intention. This treatment results in significant reduction of complaints and achieves satisfactory body contouring.
  24,617 1,893 16
Melasma update
Rashmi Sarkar, Pooja Arora, Vijay Kumar Garg, Sidharth Sonthalia, Narendra Gokhale
October-December 2014, 5(4):426-435
Melasma is an acquired pigmentary disorder characterized by symmetrical hyperpigmented macules on the face. Its pathogenesis is complex and involves the interplay of various factors such as genetic predisposition, ultraviolet radiation, hormonal factors, and drugs. An insight into the pathogenesis is important to devise treatment modalities that accurately target the disease process and prevent relapses. Hydroquinone remains the gold standard of treatment though many newer drugs, especially plant extracts, have been developed in the last few years. In this article, we review the pathogenetic factors involved in melasma. We also describe the newer treatment options available and their efficacy. We carried out a PubMed search using the following terms "melasma, pathogenesis, etiology, diagnosis, treatment" and have included data of the last few years.
  22,800 3,561 10
Idiopathic calcinosis cutis of the penis
Ram Tainwala, YK Sharma, Niti Gaur
July-December 2010, 1(1):36-38
DOI:10.4103/2229-5178.73258  PMID:23130192
Calcification of the skin occurs in four main forms namely dystrophic, metastatic, iatrogenic and idiopathic. Idiopathic calcinosis cutis of the penis is exceedingly rare as only five cases have been reported till date to the best of our knowledge. Herein, we present another case of this rare entity in a 29-year old man and discuss its probable pathogenic origin.
  24,522 560 1
Topical minoxidil fortified with finasteride: An account of maintenance of hair density after replacing oral finasteride
BS Chandrashekar, T Nandhini, Vani Vasanth, Rashmi Sriram, Shreya Navale
January-February 2015, 6(1):17-20
DOI:10.4103/2229-5178.148925  PMID:25657911
Background: Finasteride acts by reducing dihydrotestosterone levels, thereby inhibiting miniaturization of hair follicles in patients with androgenetic alopecia (AGA). Oral finasteride is associated with side effects such as decreased libido, sexual dysfunction, and gynecomastia. Aim: The aim of the following study is to assess the efficacy of maintaining hair growth with 5% topical minoxidil fortified with 0.1% finasteride in patients with AGA after initial treatment with 5% topical minoxidil and oral finasteride for two years. Materials and Methods: A retrospective assessment was done in 50 male patients aged 20-40 years with AGA. All the patients had been initially treated with topical minoxidil and oral finasteride for a period of two years, after which the oral finasteride was replaced with topical minoxidil fortified with finasteride. Five of 50 patients had discontinued the treatment for a period of 8-12 months and were then resumed with only topical minoxidil fortified with finasteride. The patients' case sheets and photographs were reviewed by independent observers and the efficacy of minoxidil-finasteride combination was assessed. Results: Of the 45 patients who underwent a continuous treatment for AGA, 84.44% maintained a good hair density with topical minoxidil-finasteride combinatio. Of the five patients who discontinued oral finasteride for 8-12 months, four demonstrated good improvement in hair density when treatment was resumed with topical minoxidil-finasteride combination. Conclusion: Topical finasteride can be considered for hair density maintenance after initial improvement with oral finasteride, thereby obviating the indefinite use of oral finasteride.
  22,667 1,081 7
Microneedling: Advances and widening horizons
Aashim Singh, Savita Yadav
July-August 2016, 7(4):244-254
DOI:10.4103/2229-5178.185468  PMID:27559496
Microneedling is a very simple, safe, effective, and minimally invasive therapeutic technique. It was initially introduced for skin rejuvenation, however, now it is being used for a very wide range of indications including acne scar, acne, post-traumatic/burn scar, alopecia, skin rejuvenation, drug delivery, hyperhidrosis, stretch marks, and many more. Moreover, during the last 10 years, many new innovations have been made to the initial instrument, which was used for microneedling. This technique can be combined with other surgical techniques to provide better results. In particular, it is a very safe technique for dark skin types, where risk of postinflammatory pigmentation is very high with other techniques that damage the epidermis. In this review article, we are updating on the different instruments now available for this procedure, and its efficacy when performed alone or in combination with other techniques for various indications.
  20,718 2,926 20
Finasteride and sexual side effects
Venkataram Mysore
January-April 2012, 3(1):62-65
DOI:10.4103/2229-5178.93496  PMID:23130269
Finasteride, a 5-alpha reductase inhibitor, widely used in the medical management of male pattern hairloss, has been reported to cause sexual side effects. This article critically examines the evidence available and makes recommendations as to how a physician should counsel a patient while prescribing the drug.
  21,573 1,112 8
Vitamin C in dermatology
Pumori Saokar Telang
April-June 2013, 4(2):143-146
DOI:10.4103/2229-5178.110593  PMID:23741676
Vitamin C is a potent antioxidant drug that can be used topically in dermatology to treat and prevent changes associated with photoageing. It can also be used for the treatment of hyperpigmentation. Because it is unstable and difficult to deliver into the dermis in the optimum dosage, research is being directed to find stable compounds of Vitamin C and newer methods of delivery of Vitamin C into the dermis.
  18,527 2,100 24
Clinicoepidemiological study of pigmented purpuric dermatoses
Lata Sharma, S Gupta
January-April 2012, 3(1):17-20
DOI:10.4103/2229-5178.93486  PMID:23130254
Background: Pigmented purpuric dermatoses (PPD) are a group of vascular disorders with varied manifestations which cause concern and are resistant to treatment. The literature is still lacking in clinicoepidemiological studies. Aim: To study the epidemiology, etiological, host and environmental factors, clinical manifestations, its variations, and the type prevalent in this part of the world. Materials and Methods: All cases of PPD were selected for the study from Skin and Venereal Disease, Out Patient Department between January 2008 and June 2009. Their history, examination, hematological investigations, and, in a few, histopathology findings were also recorded and data obtained were evaluated statistically. Results: There were 100 cases of PPD of total 55 323 patients (0.18%). There were 79 males and 21 females between 11 and 66 years. They were working as police men, security guards, barber, chemist, teachers, students, farmers, businessmen, and housewives. In a majority, there was a history of prolonged standing in day-to-day work. Purpuric, brownish pigmented, lichenoid or atrophic lesions were seen depending upon the type of PPD on lower parts of one or both lower limbs. Blood investigations were normal. Schamberg's disease was seen in ninety five, Lichen aureus in three, lichenoid dermatosis and Majocchi's disease in one case each. Discussion: Three clinical types of PPD were diagnosed which may represent different features of the same disease. Cell-mediated immunity, immune complexes, capillary fragility, gravitational forces, venous hypertension, focal infection, clothing, contact allergy to dyes, and drug intake have been incriminating factors in the past. Patient's occupation and environmental factors may also be considered contributory in precipitating the disease. Conclusions: The study revealed the problem of PPD in this geographical area, its magnitude, clinical presentation, the type prevalent, and possible aggravating factors to be kept in mind while managing the disease.
  19,299 901 7
Pyoderma gangrenosum: An update
Ramesh M Bhat
January-April 2012, 3(1):7-13
DOI:10.4103/2229-5178.93482  PMID:23130252
Pyoderma gangrenosum (PG) is an uncommon, distinctive cutaneous ulceration which is usually idiopathic, but may be associated with many systemic disorders. The etipathogenesis of of PG is still not well understood. Clinically it is classified into ulcerative, pustular, bullous and vegetative types. A few atypical and rare variants have also been described. The diagnosis mainly depends on the recognition of evolving clinical features as investigations only assist in the diagnosis. In view of this a few criteria have been proposed for the diagnosis of PG. the treatment mainly consists of corticosteroids and immunosuppressive agents. A few new agents have also been tried in the management.
  16,796 1,973 14
Nail as a window of systemic diseases
Archana Singal, Rahul Arora
March-April 2015, 6(2):67-74
DOI:10.4103/2229-5178.153002  PMID:25821724
Certain nail changes are specific for various dermatological disorders. In addition, examination of nails may also provide an insight into more sinister systemic manifestations in the form of both subtle as well as specific changes. These findings may present as a defect of various anatomical components of the nail unit; nail matrix, nail plate and/or nail bed or vasculature. This article is an attempt to equip the dermatologists with a foresight to suspect and diagnose the unapparent systemic connotations that may be possible by a simple but detailed nail examination.
  15,345 1,565 4
Side-effects of topical steroids: A long overdue revisit
Arijit Coondoo, Meghana Phiske, Shyam Verma, Koushik Lahiri
October-December 2014, 5(4):416-425
The introduction of topical steroids (TS) of varying potency have rendered the therapy of inflammatory cutaneous disorders more effective and less time-consuming. However the usefulness of these has become a double edged sword with constantly rising instances of abuse and misuse leading to serious local, systemic and psychological side effects. These side effects occur more with TS of higher potency and on particular areas of the body like face and genitalia.The article reviews the side effects of TS with special mention about peadiatric age group, also includes the measures for preventing the side effects.
  15,247 1,481 30
Parthenium the terminator: An update
Chembolli Lakshmi, CR Srinivas
May-August 2012, 3(2):89-100
DOI:10.4103/2229-5178.96698  PMID:23130280
Parthenium dermatitis is a distressing dermatitis caused by the air borne allergen of the Compositae weed Parthenium hysterophorus. Uncommon presentations, newer insights in pathogenesis and management of this "scourge" are discussed in this article.
  14,938 1,340 3
Current situation of leprosy in India and its future implications
P Narasimha Rao, Sujai Suneetha
March-April 2018, 9(2):83-89
DOI:10.4103/idoj.IDOJ_282_17  PMID:29644191
The global leprosy situation has changed significantly over the last four decades after the introduction of multidrug therapy (MDT) in 1982 with a reduction in prevalence from over 5 million cases in the mid-1980s to less than 200,000 at the end of 2016. The programme in India also saw a reduction from a prevalence rate of 57.8/10,000 in 1983 to less than 1/10,000 by the end of 2005 when India declared to have reached the World Health Organization (WHO) target of elimination as a public health problem. Post 2005, major changes in the programme were made by the National leprosy eradication programme (NLEP) and the global leprosy programme, which may have affected the new case detection (NCD), disability, and child leprosy trends, which continue to show no appreciable regression. This article reviews the current global and Indian leprosy scenario to bring out its achievements and successes, including the impact of Leprosy Case Detection Campaigns (LCDC) on leprosy numbers. The basis and expected benefits of recent introduction of chemo and immune-prophylaxis in the programme are also discussed. It also discusses the shortcomings, the areas of concern, and the need for an inclusive strategy in the Indian leprosy programme that includes an intersectoral collaboration within the country for reaching the desired goal of leprosy eradication.
  14,732 1,526 -
Lichen scrofulosorum: A diagnosis overlooked
Priyanka Singhal, Pankil H Patel, Yogesh S Marfatia
September-December 2012, 3(3):190-192
DOI:10.4103/2229-5178.101817  PMID:23189252
Lichen scrofulosorum, also known as "tuberculosis cutis lichenoides," is a rare tuberculid that presents as a lichenoid eruption of minute papules in children and adolescents with tuberculosis. The lesions are usually asymptomatic, closely grouped, skin-colored to reddish-brown papules, often perifollicular, and are mainly found on the abdomen, chest, back, and proximal parts of the limbs. The eruption is usually associated with a strongly positive tuberculin reaction. Diagnosis of these lesions can be difficult, as they resemble many other dermatological conditions that are often primarily considered. We report a case of lichen scrofulosorum in an adult male without any focus of tuberculosis. He responded promptly to antitubercular therapy with complete clearance of lesions in one month.
  13,922 633 2
Topical rapamycin (sirolimus) for facial angiofibromas
Bhushan Madke
January-March 2013, 4(1):54-57
DOI:10.4103/2229-5178.105488  PMID:23439391
Rapamycin (sirolimus) is a fungal fermentation product that inhibits the proper functioning of a serine/threonine protein kinase in mammalian cells eponymously named mammalian target of rapamycin, or mTOR. Rapamycin is a novel class of anticancer and immunosuppressant drugs targeting the proteins at molecular level. Rapamycin (sirolimus) is routinely incorporated in drug-eluting stents used for cardiac angioplasty. In recent years, rapamycin was found to be efficacious in managing the symptom complex of tuberous sclerosis, i.e. renal angiomyolipoma, giant cell astrocytoma and pulmonary lymphangiomyomatosis. Various investigators have also proved that topically applied rapamycin causes regression of facial angiofibromas, giving better cosmetic results.
  12,797 1,443 17
Progressive cribriform and zosteriform hyperpigmentation: Where are we at present?
Tarang Goyal
October-December 2013, 4(4):264-266
DOI:10.4103/2229-5178.120633  PMID:24350002
  4,862 9,113 1
Efficacy and safety of terbinafine hydrochloride 1% cream vs eberconazole nitrate 1% cream in localised tinea corporis and tinea cruris
Sanjiv V Choudhary, Taru Aghi, Shazia Bisati
April-June 2014, 5(2):128-131
DOI:10.4103/2229-5178.131079  PMID:24860743
Aims: To study and compare the efficacy and safety of topical terbinafine hydrochloride 1% cream and eberconazole nitrate 1% cream in localized tinea corporis and cruris. Methods and Materials: Patients were randomized after considering various inclusion and exclusion criteria into two groups. Group A (treated with terbinafine 1% cream for 3 weeks) and group B (treated with eberconazole 1% cream for 3 weeks). The sample size was of 30 patients with 15 patients in each group. Assessment of clinical improvement, KOH mount and culture was done weekly up to 3 weeks to assess complete cure. Results: On comparison between the two groups, it was observed that eberconazole nitrate 1% cream was as effective as terbinafine hydrochloride 1% cream at the end of first (Non-sisgnificant (NS); P = 0.608, 1.00), second (NS; P = 0.291,0.55), and third (P = 1.00, 1.00) weeks with statistically nonsignificant clinical and mycological values. In both the groups, clinically no significant local side effects were noticed. Conclusions: The newer fungistatic eberconazole nitrate 1% cream was as effective as the fungicidal terbinafine hydrochloride 1% cream. Both the drugs showed good tolerability with no adverse effects.
  12,928 837 1
Biologics use in Indian psoriasis patients
Murlidhar Rajagopalan, Asit Mital
Nov-Dec 2016, 7(6):489-497
DOI:10.4103/2229-5178.193915  PMID:27990383
The biologics currently in use for psoriasis in India are etanercept, infliximab and recently introduced itolizumab and secukinumab. Biosimilars, expected to play a significant role in psoriasis management in future, have also been available for the last few years. Patients with psoriasis may be considered eligible to receive treatment with any of the licensed biologic interventions when they fulfill the eligibility criteria. The decision to proceed with treatment must be made in collaboration with the patient and include a careful assessment of the associated risks and benefits. Etanercept is indicated in moderate to severe psoriasis and moderate to severe psoriatic arthritis with a dose of 25 mg or 50 mg twice weekly. Methotrexate may be recommended as co-medication in certain clinical circumstances, e.g., where it is required for associated arthropathy, or to improve efficacy. Infliximab is indicated in severe psoriasis and moderate to severe psoriatic arthritis. Infliximab therapy should be initiated at a dose of 5 mg/kg at weeks 0, 2 and 6 and disease response assessed at 3 months.In patients who respond, subsequent infusions (5 mg/kg) should be given at 8-week intervals to maintain disease control although long-term data are available only up to 1 year.Interrupted therapy should be avoided given the associated increased risk of infusion reactions and poorer disease control. Itolizumab is indicated in moderate to severe plaque psoriasis. It is given in a dose of 1.6mg/kg iv infusions every 2 weeks for 12 weeks initially and then 1.6mg/kg every 4 weeks up to 24 weeks. Long term data are unavailable. Secukinumab is indicated in moderate to severe plaque psoriasis and psoriatic arthritis.An initial loading dosing regimen of 300 mg secukinumab should be given by subcutaneous injection at weeks 0, 1, 2 and 3 followed by maintenance dose of 300 mg every 4 weeks starting at week 4. To exclude tuberculosis (TB) before anti TNF alfa therapy and therapy with itolizumab, pretreatment chest X-ray and Mantoux skin test currently remain the preferred screening tests in patients not on immunosuppression. During treatment, and for 6 months following discontinuation, a high index of suspicion for TB should be maintained. The effect of secukinumab on TB reactivation is as yet poorly understood, hence, in the Indian scenario, it is better to follow the same guidelines for ruling out latent TB
  11,917 1,493 -
Nephrogenic systemic fibrosis
Bhushan Madke, Uday Khopkar
July-December 2011, 2(2):51-56
DOI:10.4103/2229-5178.85990  PMID:23130224
Nephrogenic systemic fibrosis (NSF) is a relatively new fibrosing disorder which has caught the attention of various specialities in the past decade. NSF is an extremely disabling and often painful condition, affecting up to 13% of the individuals with chronic kidney disease. The administration of a gadolinium chelate contrast agent has been reported to induce the development of NSF, particularly in patients who have acute or chronic renal disease with a glomerular filtration rate (GFR) lower than 30-mL/min/1.73 m 2 and in those with acute renal insufficiency. Mass spectroscopy studies have demonstrated particles of gadolinium in the lesional tissue. The exact pathogenesis of this curious sclerosing condition is unknown. The role of the aberrant targeting of 'circulating fibrocytes' to the peripheral tissues and viscera has been hypothesized. NSF has distinct clinicopathological features in the setting of renal failure and needs to be looked upon as a new entity on the block. The condition is characterized by irregular indurated plaques, with amoeba-like projections and islands of sparing, chiefly on the trunk and extremities. Flexion contractures of fingers, knees, and elbow joints are known to occur in advanced cases of NSF. The course is frequently associated with painful episodes and loss of ambulation. Histopathology shows haphazard arrangement of thickened bundles of collagen, varying amount of mucin, and increased population of fibroblast-like cells in the dermis. Immunohistochemistry shows increased deposition of type-I procollagen and CD 34+ cells having fibroblastic activity. The condition is refractory to treatment with corticosteroids and immunosuppressive agents. Various modalities of therapy such as UVA1 phototherapy, imatinib mesylate, photodynamic therapy, plasmapheresis, extracorporeal photochemotherapy, and high-dose intravenous immunoglobulin have shown a moderate degree of improvement in skin thickness scores. A prudent option is restoration of renal function to normalcy via renal transplantation but to date the outcome of renal transplantation is unknown.
  3,565 9,566 2
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