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The newly-mutated 'Delta Plus' variant is resistant to the monoclonal antibody cocktail treatment for Covid-19 recently authorised in India, the scientists have said.

The highly transmissible Delta variant of Sars-CoV-2 has mutated further to form the ‘Delta Plus’ or ‘AY.1’ variant, the scientists in India have said. They added that there is no immediate cause for concern in India as its incidence in the country is still low.

The already deadly Delta variant led the second wave of the Covid-19 pandemic, and even scuttled UK PM Boris Johnson's plan to open the country from June 21. That date was pushed to July 19 on Monday due to high dominance of the Delta variant in cases being reported in the country.

The newly-mutated 'Delta Plus' variant is resistant to the monoclonal antibody cocktail treatment for Covid-19 recently authorised in India, the scientists said.

Here is everything you need to know about the Delta Plus variant of the coronavirus disease:

The B.1.617.2.1 variant characterised by the acquisition of K417N mutation, according to scientists. The mutation is in the spike protein of Sars-CoV-2, which helps the virus enter and infect the human cells, they said.

The latest research shows that there are two groups of K417N - one of them is internationally distributed and the other one is found on the genome sequences uploaded to global science initiative GISAID by the United States.

By June 7, 63 genomes of 'Delta Plus' variant have been identified on GISAID from Canada, Germany, Russia, Nepal, Switzerland, India, Poland, Portugal, Japan and the US. There are 36 cases of the new variant in the UK and it makes up 6% of all cases in the US.

The earliest sequence of this genome was found in Europe in late March this year.

Allaying fears, immunologist Vineeta Bal said on Monday that there may be some setback in the use of commercial antibody cocktail due to the new variant, but resistance to monoclonal antibody cocktail treatment is not an indication of higher virulence or severity of a disease.

Hawaii said on Monday that a vaccinated Oahu resident who travelled to Nevada last month tested positive for the delta variant of Covid-19.

In its latest report on coronavirus variants, updated till last Friday, the health agency said Delta Plus was present in six genomes from India as of June 7.

The Maharashtra government has sent a substantial number of samples from various districts for genome sequencing to verify if any new mutation of Sars-CoV-2 has taken place. The reports are expected to come by Tuesday. Source : ht

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Good sanitation stops stunting, child deaths

Written by Monday, 18 September 2017 08:40

Contaminated food and water cause more disease outbreaks than dengue, encephalitis, cholera and chikungunya.

More than 650 people were diagnosed with diarrhoea, and 43 of them were admitted to hospitals across six municipal wards in the south-eastern Kolkata on Sunday.

A week later, what caused the outbreak in India’s third-largest city is still not known.

Stool samples of the sick sent to the National Institute of Cholera and Enteric Disease (NICED) in Kolkata were unviable and threw up no conclusions.

“Sample collection and preservation guidelines were not followed at Bagha Jatin State General Hospital, where they were being treated, and the samples failed to give results,” said Dr Shanta Dutta, director of NICED.

The Kolkata outbreak sums up the diarrhoeal disease situation across India – millions are affected by this preventable water-and food-borne infection each year and thousands die, but life goes on in unhygienic surroundings, leaving people vulnerable.

Acute diarrhoeal disease and food poisoning accounted for a third of the 1,714 laboratory-confirmed disease outbreaks in 2017 – including dengue, encephalitis, cholera and chikungunya, among others, according to the Integrated Disease Surveillance Programme (IDSP).

The IDSP data reflects a small fraction of the real numbers. With about 55% of India’s population seeking treatment outside the public sector — 51.4% in the private sector and 3.4% at home — the majority of cases treated at home and in private clinics do not make it to government surveillance records.

Unsafe drinking water, excreta-contaminated food, open defecation, unusable toilets, untreated sewerage and not using soap for handwashing made diarrhoea the third-biggest cause of premature deaths across ages in India in 2016, after heart and lung diseases, according to data from the Global Burden of Disease. It accounts for roughly 10% of the 962,830 deaths of children under five years old in India.

Contaminants galore

While most recorded diarrhoea deaths are from acute dehydration, the disease kills insidiously by causing chronic malnutrition and lowering immunity, which leads to frequent and potentially fatal infections.

“A malnourished and underweight child is more vulnerable to infections and has higher chances of dying of other infections, including pneumonia and tuberculosis,” said Dr Sanghita Bhattacharya, senior public health specialist at the Public Health Foundation of India.

Most malnourishment-related deaths occur in children between nine months and three years old, with infections and hunger — medically defined as “severe acute malnutrition” – claiming most lives.

Acute malnutrition is more common than one would think. About 38.4% children are stunted (low height for age) and 35.7% are underweight (low weight for age), according to the National Family Health Survey-4 (2015-16), which was released last year.

While the problems of stunting and underweight children fell marginally over the past decade, wasting (low weight for height) went up from 19.8% in 2006 to 21% in 2016.

“Poverty and social exclusion are the biggest barriers to preventing infection, which excludes people from the basic information – handwashing, oral rehydration as solution to treat diarrhoea, exclusive breastfeeding etc -- needed to save the child. Mothers care for and feed their children the best they can, but their best is often not enough,” said Dr Bhattacharya.

Simple solutions work, experts say. “Measures such as handwashing with soap are essential to bring down newborn deaths and increase maternal and child survival, and parents as primary caregivers. The community, including aganwadi workers and school teachers, must be involved. Children need a healthy start because by age 3, malnutrition is irreversible and children have already missed essential growth and developmental milestones,” said Dr Yasmin Ali Haque, a Unicef representative in India.

Clean-up act

While bacteria are the most common faecal contaminants, viruses, protozoa and helminths (parasitic worms) in the stools of infected people infect others through soil, water and food.

The absence of safe water, toilets and sewerage treatment facilities add to contamination.

Handwashing with soap and water prevents the transmission of bacteria that cause diarrhoea, show several studies, while using oral rehydration can prevent hospitalisation.

A comparison of handwashing with water, handwashing with soap, and no handwashing after touching door handles and railings in public spaces showed that bacteria of potential faecal origin remained after no handwashing in 44% of the samples, according to a global study published in International Journal of Environmental Research and Public Health.

Handwashing with only water reduced bacteria to 23%, while plain soap and water lowered it to 8%.

According to a more recent study of food handlers last year, handwashing with antimicrobial soap is more effective in removing bacteria (Escherichia coli and Enterococcus faecalis) from soiled hands than washing with water or plain soap.

“Toilets at anganwadis are filthy. Many do not have water  and there is often no soap and water for handwashing at schools, which feeds the cycle of infection,” said Bhattacharya.

“Apart from setting up Nutritional Rehabilitation Centres to treat severely malnourished children and providing nutritious midday meals to schoolchildren, strong monitoring of hygiene practices and toilets at both aganwadi centres and schools is a must to ensure children stay free of infections,” she said. Source : ht

 

 

 

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As per a latest study on patients hospitalised with Covid-19, it has been discovered that two easily measurable signs of health - respiration rate and blood-oxygen saturation are distinctly predictive of higher mortality.

A new study on Covid patients has found that abnormal blood-oxygen levels and breathing rates are strong predictors of poor patient outcomes in hospitals.

The study, published in the journal Influenza and Other Respiratory Viruses, done on 1,095 patients hospitalised with Covid-19, discovered that two easily measurable signs of health, respiration rate, and blood-oxygen saturation are distinctly predictive of higher mortality. Notably, the authors said, anyone who receives a positive Covid-19 screening test can easily monitor for these two signs at home.

This context is lacking in current guidance from the Centers for Disease Control and Prevention, which tells people with Covid-19 to seek medical attention when they experience overt symptoms such as "trouble breathing" and "persistent pain or pressure in the chest" - indications that may be absent even when respiration and blood oxygen have reached dangerous levels, the authors say.

"These findings apply to the lived experience of the majority of patients with Covid-19: being at home, feeling anxious, wondering how to know whether their illness will progress and wondering when it makes sense to go to the hospital," said Dr. Neal Chatterjee of the University of Washington School of Medicine.

Chatterjee and fellow cardiologist Dr. Nona Sotoodehnia were co-lead authors of the paper. They said the findings suggest that, for some people with Covid-19, by the time they feel bad enough to come to the hospital, a window for early medical intervention might have passed.

"Initially, most patients with Covid don't have difficulty breathing. They can have quite low oxygen saturation and still be asymptomatic," said Sotoodehnia. "If patients follow the current guidance, because they may not get short of breath until their blood oxygen is quite low, then we are missing a chance to intervene early with life-saving treatment."

The researchers examined the cases of 1,095 patients age 18 and older who were admitted with Covid-19 to UW Medicine hospitals in Seattle or to Rush University Medical Center in Chicago. The study spanned from March 1 to June 8, 2020. The lone exclusions were people who chose "comfort measures only" at the time of their admission.

While patients frequently had hypoxemia (low blood-oxygen saturation; 91 per cent or below for this study) or tachypnea (fast, shallow breathing; 23 breaths per minute for this study), few reported feelings short of breath or coughing regardless of blood oxygen.

The study's primary measure was all-cause in-hospital mortality. Overall, 197 patients died in the hospital. Compared to those admitted with normal blood oxygen, hypoxemic patients had a mortality risk 1.8 to 4.0 times greater, depending on the patient's blood oxygen levels.

Similarly, compared to patients admitted with normal respiratory rates, those with tachypnea had a mortality risk of 1.9 to 3.2 times greater. By contrast, other clinical signs at admission, including temperature, heart rate, and blood pressure, were not associated with mortality.

Nearly all patients with hypoxemia and tachypnea required supplemental oxygen, which, when paired with inflammation-reducing glucocorticoids, can effectively treat acute cases of Covid-19.

"We give supplemental oxygen to patients to maintain blood oxygen saturation of 92 per cent to 96 per cent. It's important to note that only patients on supplemental oxygen benefit from the life-saving effects of glucocorticoids," Sotoodehnia said. "On average our hypoxemic patients had an oxygen saturation of 91 per cent when they came into the hospital, so a huge number of them were already well below where we would've administered life-saving measures. For them, that care was delayed."

The findings are relevant for family-medicine practitioners and virtual-care providers, who are typically first-line clinical contacts for people who have received a positive Covid-19 test result and want to monitor meaningful symptoms.

"We recommend that the CDC and World Health Organization consider recasting their guidelines to account for this population of asymptomatic people who actually merit hospital admission and care," Chatterjee said. "But people don't walk around knowing WHO and CDC guidelines; we get this guidance from our physicians and news stories."

Sotoodehnia recommended that people with positive Covid-19 test results, particularly those at higher risk of adverse outcomes due to advanced age or obesity, buy or borrow a pulse oximeter and monitor for blood oxygen below 92 per cent. The clip-like devices fit over a fingertip and can be purchased for under USD 20.

"An even simpler measure is respiratory rate - how many breaths you take in a minute. Ask a friend or family member to monitor you for a minute while you're not paying attention to your breathing, and if you hit 23 breaths per minute, you should contact your physician," she said. Source : ht

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Union industry and commerce minister Piyush Goyal and United States Trade representative Katherine Tai held talks on both India and the United States working together on the Trade-Related aspects of Intellectual Property Rights (TRIPS) waiver with a view to ensure that vaccine doses are affordable to all.

Union industry and commerce minister Piyush Goyal on Friday held a virtual meeting with the United States Trade representative Katherine Tai with regard to increasing the availability of vaccine doses against the coronavirus disease (Covid-19) ‘in an inclusive and equitable manner’ to fight against the global pandemic, according to a statement issued by the ministry of commerce and industry.

Goyal and Tai also held talks on both India and the United States working together on the Trade-Related aspects of Intellectual Property Rights (TRIPS) waiver with a view to ensure that vaccine doses are affordable to all.

“The proposal of India on waiver of certain TRIPS provisions to increase global vaccine production in order to take on the challenge of vaccinating the poorest of the poor and saving lives was also discussed. Goyal thanked Tai for the US announcing its support for India’s proposal,” the statement said.

During the meeting, Tai spoke about her backing for the waiver of intellectual property protection for vaccines and text-based negotiations at the World Trade Organization (WTO), which are a part of President Joe Administration’s efforts to expand manufacturing and distribution of vaccines doses across the globe, the office of the US Trade Representative said in a statement.

She also expressed her sympathy towards the worsening situation in India due to the second wave of the pandemic and reasserted United States’ commitment to help the latter during the crisis.

The WTO agreement on TRIPS is a detailed multilateral agreement on intellectual property. In October 2020, India, South Africa and 57 other members of the WTO had proposed a waiver from specific provisions of the TRIPS agreement for the prevention, containment and treatment of the Covid-19 disease, news agency ANI reported.

Last week, the United States government announced its support for a global waiver on patent protections for vaccines in order to boost its supply globally. “This is a global health crisis, and the extraordinary circumstances of the Covid-19 pandemic call for extraordinary measures,” US Trade Representative Tai said in a statement on May 6. The United States government will soon negotiate the terms at the WTO.

However, European leaders and several drug manufactures including Germany’s BioNTech have opposed this move. Ugur Sahin, the chief executive officer (CEO) of BioNTech, which is manufacturing vaccines along with US based Pfizer, told news agency AP on May 10 there is no need to waive patents as manufacturers will be able to produce sufficient vaccine doses to supply to all countries in the coming year. Source : ht

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MMC Act to be implemented in state to control mosquitoes

Written by Thursday, 14 September 2017 06:06

With mosquito-borne diseases on the rise in the state, the public health department is planning to expand the scope of the Mumbai Municipal Corporation Act (MMC Act), 1888, to the entire state to effectively act against offenders allowing mosquito breeding in private spaces.

In a meeting held by state Health Minister Deepak Sawant and senior state health officials on Monday, it was decided to seek the opinion of the law and judiciary department on enforcing sections of the Brihanmumbai Municipal Corporation’s Act in state.

“This will be similar to Bombay Nursing Homes Registration Act initially limited to only Mumbai and later enforced in the entire state,” said Dr Satish Pawar, director at the Directorate of Health Services. The state government plans to pick specific sections from MMC Act, such as reporting of certain communicable diseases, sections on water and sanitation, and legal action taken for allowing mosquito breeding.

The most important section the state hopes to implement is Section 381 of MMC Act that allows civic body to prosecute a person found guilty of allowing mosquito breeding in public or personal space. The fine ranges between Rs 2,000-10,000. Section 381(B) of the Act deals with those who default on making water tanks mosquito proof.
In June, BMC found maximum mosquito breeding in public buildings.

The public works department buildings had 536 non-mosquito proof spots, central railways had 446 spots and central public works department was found with 252 breeding spots. Western railways owned 636 buildings, where 3.7 per cent tanks had no mosquito proofing. Central railways, which owns 577 premises, had a significant 23.5 per cent breeding spots. All government agencies were issued notices by BMC.

“The fine is minimal. Offenders are let off easily which is why we have been asking to increase it to prevent multiple offences,” Dr Rajan Naringrekar, insecticide officer, BMC, said. With monsoon receding and weather conducive for viral infection to multiply, the state is taking special efforts to control malaria and dengue, both spread by mosquito. In Mumbai itself, 271 malaria cases and 102 dengue cases were recorded since September 1.

While malaria is carried by anopheles, dengue is spread by aedes aegypti. Indoors, aedes mosquito breeds in feng-shui plants, flower pots, fish tanks, unused tyres and petri-dishes. “We are expecting a spike in dengue, leptospirosis and gastroenteritis in the coming days because of flooding in Mumbai. Steps have been taken to ensure medicines are adequately stocked,” a civic official said. Dr Pradeep Awate, state epidermiologist, said H1N1 cases have also been high. In the state, 4,628 have been diagnosed with H1N1 infection, including 488 who succumbed until August end.

 

 

 

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Member of Parliament (MP) Kirron Kher has submitted proposals to Union Minister of State for Health and Family Welfare Ashwini Kumar Chaubey, regarding setting up of a 300-bedded trauma centre in Chandigarh, apart from construction of a sports injury centre at Government Medical College and Hospital(GMCH), Sector 32.
A statement issued Tuesday said Kher met Chaubey Monday and submitted the proposals.

“In one of the letter addressed to Chaubey, she mentioned that the Trauma Centre already running at PGIMER is over burdened and not sufficient to cater to the needs of the region (i.e Punjab, Haryana, Himachal Pradesh and Jammu & Kashmir). Construction of the proposed trauma centre is need of the hour. In a separate letter, she has written that Chandigarh Administration has proposed to construct sports injury centre in GMCH, Sector-32,” the statement said. It further said that the project report has already been submitted to the Director General Health Services, Government of India, for approval.

Kher, during the meet, requested Chaubey to look into the matter and arrange requisite approval for the project.
The MP also told Chaubey that Ministry of Health and Family Welfare has already granted its approval regarding setting up of a Trauma Centre as an extension of GMCH. “Chandigarh Administration has already earmarked a plot measuring 9.6 acres for setting up of a Trauma Centre in Sector 53, Chandigarh, and a detailed Project Report (DPR) of the Trauma Centre has also been prepared. Whereas the project related to construction of Sports Injury Centre is pending with the Ministry of Health and Family Welfare, New Delhi, since April 2013,” the statement said.

The statement further stated that GMCH has established itself in the region in the field of sports injuries and on an average is performing 100 surgeries on elite players of different games coming from all over the country.

“Presently, there is only one dedicated Sports Injury Centre in the country which is based at Safdarjung Hospital, New Delhi. Chandigarh Administration has already earmarked a plot measuring 1.43 acres for setting up of this centre. Accordingly, a Detailed Project Report (DPR) of the proposed centre has been prepared. It is felt that setting up of a similar centre in Chandigarh, which caters to the needs of Punjab, Haryana, Himachal Pradesh, Rajasthan, Jammu & Kashmir and Uttarakhand, will go a long way in restoring the health of athletes in the region so that they can go back to the pre-injury level of games at the earliest,” the statement added.

 

 

 

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CHENNAI: AIADMK general secretary V K Sasikala's husband M Natarajan is in a critical condition after sufferingmultiple organ failure on Sunday. Natarajan, 74, has been admitted to Gleneagles Global Health City in Perumbakkam, where he is under intensive care.

According to a medical bulletin released by the hospital administration, Natarajan suffers from chronic liver disease and has been receiving treatment for it for the past six months. "He is admitted at the Liver Intensive Care Unit with decompensated liver disease leading to liver and kidney failure and lung congestion. He is receiving dialysis and other intensive care therapies," the hospital statement said.

Natarajan has been registered with the Tamil Nadu Organ Sharing (TNOS) waiting list for deceased donor liver transplantation. "He is being taken care by a multidisciplinary team of liver specialists headed by Prof. Mohamed Rela," the hospital note said.

According to hospital sources, Natarajan had undergone a dialysis session for more than eight hours on Sunday. This is not the first-time Natarajan has been hospitalised this year. On February 5, he was brought to Apollo Hospitals on Greams Road after complaining of breathing problems.

 

 

 

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Swine flu spurts in Delhi: 1,066 cases last month

Written by Saturday, 19 August 2017 06:15

 

Swine flu has surged sharply in the capital with 1,066 cases being confirmed in the last one month, which is more than four times the number reported during the rest of this year.

The total number of cases till August 13 this year stands at 1,307, more than six times the corresponding period of 2016.

Nationally, 18,855 cases of theH1N1 influenza have been reported this year, claiming 929 lives.

But despite the spurt in cases in the capital, the number of deaths has not risen significantly. "Only four deaths have been reported: two from Delhi and two patients from outside have died," Delhi health minister Satyendra Jain said in the assembly last week. At a review meeting on Friday , Delhi health department officials told their counterparts in the Centre that the city has sufficient training and stocks of medicines to tackle the swine flu outbreak.

Health experts said there was no cause for panic over the sudden spurt in swine flu in Delhi. "People should not panic if they suffer normal viral infection. The high risk groups include people with heart diseases, pregnant women, children below eight years of age, senior citizens, diabetics and kidney disease patients. These patients need special treatment," said a doctor.

Dr Jagdish Prasad, director general of health services, told TOI that the Centre had offered to train doctors of Delhi government and private hospitals on treating swine flu cases. "If any hospital wants training, we can send our doctors," he said. Delhi health minister Sandar Jain said in the as tyendar Jain said in the assembly last week that the government had enough stocks of medicines and vaccines to tackle the outbreak.

"Adequate facilities for treatment are available in Delhi. We have placed orders for advance purchase of medicines," Jain said. He added that there were reserved beds for patients in government hospitals and not even 5% of these beds had been occupied.

The spike in the cases at this time of the year has come as a surprise because swine flu usually peaks in the postmonsoon season and early winter. Some health conscious people have started maintaining caution when they are in public places because the H1N1 virus, which causes swine flu, transmits from human to human.

"The spike in swine flu at this time is also due to infection coming in from states where a very high number of cases have been reported.Such a big outbreak in the month of August is a matter of concern since swine flu usually rises in October and November," said Dr K K Aggrawal, national president of the IMA. The association has planned to launch a poster campaign against swine flu."

 

 

 

 

 

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A study has warned that cloudy drinking water is linked to increased cases of gastrointestinal illness. Cloudiness in water is caused by material floating in it. The undissolved particles may actually provide some protection for harmful pathogens against disinfectants.

Researcher Anneclaire De Roos from Drexel University in Philadelphia, US found associations between acute gastrointestinal illness (AGI) and water turbidity, a term meaning cloudiness or opacity. Turbidity is the cloudiness or haziness of a fluid caused by large numbers of individual particles that are generally invisible to the naked eye, similar to smoke in air.

The results revealed that exposures through drinking water caused a low but detectable number of AGI cases in the regions. There is no clear, alternative explanation for the patterns of associations — particularly when a similar pattern was seen multiple times. Acute gastrointestinal illness could be caused by waterborne pathogens like norovirus, Giardia, or Cryptosporidium and carry symptoms like diarrhoea and vomiting. Researchers looked into a collection of studies that had been done on the topic.

These studies were designed to evaluate risks from contamination of source waters (usually rivers in the cities studied), before the water entered cities’ distribution systems. They found that turbidity of drinking water was linked to increased AGI in multiple studies, and not just when there was increased cloudiness. “As expected, the association between turbidity and AGI was found in cities with relatively high turbidity levels, often in unfiltered drinking water supplies,” De Roos noted.

 

 

 

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AHMEDABAD: Gujaratgovernment and theAhmedabad Municipal Corporation (AMC) once again got a rebuke from Gujarat high court on Wednesday "for taking its direction lightly" in response to a petition seeking prompt measure to curb spread of swine flu, which has already claimed over 200 lives across the state.

A bench headed by Justice M R Shah told government's law officers that everything looks all right on paper, but the reality is different. The court asked the state government to state what measures have been taken to curb the spread of the disease.

The court said that so many people dying of the disease is really serious, and the authorities must take prompt steps in public interest. The court has sought a report in this regard by Monday.

The court also expressed concern about testing facilities and commented whether there is a provision to provide this facility free of cost to the poor.

The court's chiding came after advocate K R Koshti urged the court to issue directions to arrest further damage due to swine flu spread in absence of proper facilities. By adding the issue of swine flu in his last year's PIL to curb vector-borne diseases, the lawyer submitted that the state government and AMC machinery was never prepared to fight against H1N1 virus, and to prevent loss of life.

The PIL has demanded appointment of a committee of experts for field visit to take stock of the situation and to report to the court about the reality.

It seeks directions for creating facilities of diagnosis and free treatment for the poor. It has also asked for compensation for the victims.

Meanwhile, Justice Shah recalled the directions issued last week to AMC to clear roads of stray cattle and garbage.

The judge said that heaps of garbage have not been removed yet, though the authorities had promised to bring in visible change in a week's time.

The PIL stated that despite World Health Organization (WHO) warning, no effective measure has been chalked out by the administration to tackle the outbreak. Till August 15, 208 people died out of total 1,883 swine flu patients in Gujarat.

The petitioner complained that the government has not set up laboratories at districts across the state for testing the virus, and delay caused in diagnosis proves fatal in most cases. The PIL has complained that AMC does not have enough staff in its health department to deal with the situation.

 

 

 

 

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