1
|
Mariscal-Aguilar P, Gómez-Carrera L, Bonilla G, Díaz-Almirón M, Gayá F, Carpio C, Zamarrón E, Fernández-Velilla M, Torres I, Esteban I, Regojo R, Villamañán E, Prados C, Álvarez-Sala R. Air pollution exposure and its effects on idiopathic pulmonary fibrosis: clinical worsening, lung function decline, and radiological deterioration. Front Public Health 2024; 11:1331134. [PMID: 38269380 PMCID: PMC10806203 DOI: 10.3389/fpubh.2023.1331134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/18/2023] [Indexed: 01/26/2024] Open
Abstract
Introduction Major urban pollutants have a considerable influence on the natural history of lung disease. However, this effect is not well known in idiopathic pulmonary fibrosis (IPF). Aim This study aimed to investigate the effects of air pollution on clinical worsening, lung function, and radiological deterioration in patients with IPF. Methods This exploratory retrospective cohort study included 69 patients with IPF, monitored from 2011 to 2020. Data on air pollution levels, including carbon monoxide (CO), nitrogen dioxide (NO2), particulate matter ≤ 2.5 μM (PM2.5), ozone (O3), and nitrogen oxides (NOx), were collected from the nearest air quality monitoring stations (<3.5 km from the patients' homes). Patient outcomes such as clinical worsening, lung function decline, and radiological deterioration were assessed over various exposure periods (1, 3, 6, 12, and 36 months). The statistical analyses were adjusted for various factors, including age, sex, smoking status, and treatment. Results There was an association between higher O3 levels and an increased likelihood of clinical worsening over 6 and 36 months of exposure (odds ratio [OR] and 95% confidence interval [CI] = 1.16 [1.01-1.33] and OR and 95% CI = 1.80 [1.07-3.01], respectively). Increased CO levels were linked to lung function decline over 12-month exposure periods (OR and 95% CI 1.63 = [1.01-2.63]). Lastly, radiological deterioration was significantly associated with higher CO, NO2, and NOx levels over 6-month exposure periods (OR and 95% CI = 2.14 [1.33-3.44], OR and 95% CI = 1.76 [1.15-2.66] and OR and 95% CI = 1.16 [1.03-1.3], respectively). Conclusion This study suggests that air pollution, specifically O3, CO, NO2, and NOx, could affect clinical worsening, lung function, and radiological outcomes in patients with IPF. These findings highlight the potential role of air pollution in the progression of IPF, emphasizing the need for further research and air quality control measures to mitigate its effects on respiratory health.
Collapse
Affiliation(s)
- Pablo Mariscal-Aguilar
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Luis Gómez-Carrera
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Department of Medicine, Madrid, Spain
| | - Gema Bonilla
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Mariana Díaz-Almirón
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Francisco Gayá
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Carlos Carpio
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Department of Medicine, Madrid, Spain
| | - Ester Zamarrón
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - María Fernández-Velilla
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Radiology, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Torres
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Radiology, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Esteban
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - Rita Regojo
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Pathology, Hospital Universitario La Paz, Madrid, Spain
| | - Elena Villamañán
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - Concepción Prados
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Department of Medicine, Madrid, Spain
| | - Rodolfo Álvarez-Sala
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Instituto de investigación del Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Universidad Autónoma de Madrid, Department of Medicine, Madrid, Spain
| |
Collapse
|
2
|
Ueno K, Kaneko H, Kamiya K, Okada A, Itoh H, Konishi M, Sugimoto T, Suzuki Y, Matsuoka S, Fujiu K, Michihata N, Jo T, Takeda N, Morita H, Ako J, Node K, Yasunaga H, Komuro I. Association of early acute-phase rehabilitation initiation on outcomes among patients aged ≥90 years with acute heart failure. J Am Geriatr Soc 2023; 71:1840-1850. [PMID: 36856063 DOI: 10.1111/jgs.18283] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 01/13/2023] [Accepted: 01/15/2023] [Indexed: 03/02/2023]
Abstract
BACKGROUND Data on the potential benefit of acute-phase rehabilitation initiation in very old (aged ≥90) patients with acute heart failure (AHF) have been scarce. METHODS We retrospectively analyzed data from the Diagnosis Procedure Combination database, which is a nationwide inpatient database. This study included patients hospitalized for heart failure (HF) from January 2010 to March 2018, those aged ≥90 years, who had a length of stay of ≥3 days, New York Heart Association (NYHA) class of ≥II, and had not undergone major procedures under general anesthesia. Propensity score matching and generalized linear models were used to compare in-hospital mortality, length of stay, 30-day readmission rate due to HF, all-cause 30-day readmission, and improvement in activities of daily living (ADL) between patients with and without an acute-phase rehabilitation initiation, which is defined as the rehabilitation initiation within 2 days after hospital admission. RESULTS Acute-phase rehabilitation was initiated in 8588 of 41,896 eligible patients. Propensity score matching created 8587 pairs. Patients with acute-phase rehabilitation initiation have lower in-hospital mortality (9.0% vs. 11.2%, p < 0.001). Acute-phase rehabilitation initiation was associated with lower in-hospital mortality (odds ratio, 0.778; 95% confidence interval, 0.704-0.860). Patients with acute-phase rehabilitation initiation have a shorter median length of stay (17 days vs. 18 days, p < 0.001), lower 30-day readmission rate due to HF (5.5% vs. 6.4%, p = 0.011) and all-cause 30-day readmission (10.2% vs. 11.2%, p = 0.036), and better ADL improvement (49.7% vs. 46.9%, p < 0.001). Subgroup analysis revealed consistent results (sex, body mass index, NYHA class, and Barthel Index). CONCLUSIONS The acute-phase rehabilitation initiation was associated with improved short-term clinical outcomes in patients aged ≥90 years with AHF.
Collapse
Affiliation(s)
- Kensuke Ueno
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Hidehiro Kaneko
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Kentaro Kamiya
- Department of Rehabilitation, School of Allied Health Sciences, Kitasato University, Kanagawa, Japan
| | - Akira Okada
- Department of Prevention of Diabetes and Lifestyle-Related Diseases, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Hidetaka Itoh
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Masaaki Konishi
- Department of Medical Science and Cardiorenal Medicine, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Tadafumi Sugimoto
- Department of Clinical Laboratory, Mie University Hospital, Mie, Japan
| | - Yuta Suzuki
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- Department of Rehabilitation Sciences, Graduate School of Medical Sciences, Kitasato University, Kanagawa, Japan
| | - Satoshi Matsuoka
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Cardiology, New Tokyo Hospital, Matsudo, Japan
| | - Katsuhito Fujiu
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
- The Department of Advanced Cardiology, The University of Tokyo, Tokyo, Japan
| | - Nobuaki Michihata
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Taisuke Jo
- The Department of Health Services Research, The University of Tokyo, Tokyo, Japan
| | - Norifumi Takeda
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Morita
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| | - Junya Ako
- Department of Cardiovascular Medicine, Kitasato University School of Medicine, Kanagawa, Japan
| | - Koichi Node
- Department of Cardiovascular Medicine, Saga University, Saga, Japan
| | - Hideo Yasunaga
- The Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Issei Komuro
- The Department of Cardiovascular Medicine, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
3
|
Mariscal-Aguilar P, Gómez-Carrera L, Carpio C, Zamarrón E, Bonilla G, Fernández-Velilla M, Torres I, Esteban I, Regojo R, Díaz-Almirón M, Gayá F, Villamañán E, Prados C, Álvarez-Sala R. Relationship between air pollution exposure and the progression of idiopathic pulmonary fibrosis in Madrid: Chronic respiratory failure, hospitalizations, and mortality. A retrospective study. Front Public Health 2023; 11:1135162. [PMID: 36969686 PMCID: PMC10036896 DOI: 10.3389/fpubh.2023.1135162] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 02/20/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionAir pollution has a significant impact on the morbidity and mortality of various respiratory diseases. However, this has not been widely studied in diffuse interstitial lung diseases, specifically in idiopathic pulmonary fibrosis.ObjectiveIn this study we aimed to assess the relationship between four major air pollutants individually [carbon monoxide (CO), nitrogen dioxide (NO2), ozone (O3), and nitrogen oxides (NOx)] and the development of chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.MethodsWe conducted an exploratory retrospective panel study from 2011 to 2020 in 69 patients with idiopathic pulmonary fibrosis from the pulmonary medicine department of a tertiary hospital. Based on their geocoded residential address, levels of each pollutant were estimated 1, 3, 6, 12, and 36 months prior to each event (chronic respiratory failure, hospital admission and mortality). Data was collected from the air quality monitoring stations of the Community of Madrid located <3.5 km (2.2 miles) from each patient's home.ResultsThe increase in average values of CO [OR 1.62 (1.11–2.36) and OR 1.84 (1.1–3.06)], NO2 [OR 1.64 (1.01–2.66)], and NOx [OR 1.11 (1–1.23) and OR 1.19 (1.03–1.38)] were significantly associated with the probability of developing chronic respiratory failure in different periods. In addition, the averages of NO2, O3, and NOx were significantly associated with the probability of hospital admissions due to respiratory causes and mortality in these patients.ConclusionAir pollution is associated with an increase in the probability of developing chronic respiratory failure, hospitalization due to respiratory causes and mortality in patients with idiopathic pulmonary fibrosis.
Collapse
Affiliation(s)
- Pablo Mariscal-Aguilar
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- *Correspondence: Pablo Mariscal-Aguilar
| | - Luis Gómez-Carrera
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Carlos Carpio
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Ester Zamarrón
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Gema Bonilla
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - María Fernández-Velilla
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Radiology, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Torres
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Radiology, Hospital Universitario La Paz, Madrid, Spain
| | - Isabel Esteban
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Pathological Anatomy, Hospital Universitario La Paz, Madrid, Spain
| | - Rita Regojo
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Pathological Anatomy, Hospital Universitario La Paz, Madrid, Spain
| | | | - Francisco Gayá
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - Elena Villamañán
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Department of Pharmacy, Hospital Universitario La Paz, Madrid, Spain
| | - Concepción Prados
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| | - Rodolfo Álvarez-Sala
- Department of Respiratory Medicine, Hospital Universitario La Paz, Madrid, Spain
- Research Institute of Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
- Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
| |
Collapse
|
4
|
Antar SA, Saleh MA, Al-Karmalawy AA. Investigating the possible mechanisms of pirfenidone to be targeted as a promising anti-inflammatory, anti-fibrotic, anti-oxidant, anti-apoptotic, anti-tumor, and/or anti-SARS-CoV-2. Life Sci 2022; 309:121048. [PMID: 36209833 PMCID: PMC9536875 DOI: 10.1016/j.lfs.2022.121048] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/23/2022] [Accepted: 10/02/2022] [Indexed: 01/10/2023]
Abstract
Pirfenidone (PFD) is a non-peptide synthetic chemical that inhibits the production of transforming growth factor-beta 1 (TGF-β1), tumor necrosis factor-alpha (TNF-α), platelet-derived growth factor (PDGF), Interleukin 1 beta (IL-1β), and collagen 1 (COL1A1), all of which have been linked to the prevention or removal of excessive scar tissue deposition in many organs. PFD has been demonstrated to decrease apoptosis, downregulate angiotensin-converting enzyme (ACE) receptor expression, reduce inflammation through many routes, and alleviate oxidative stress in pneumocytes and other cells while protecting them from COVID-19 invasion and cytokine storm. Based on the mechanism of action of PFD and the known pathophysiology of COVID-19, it was recommended to treat COVID-19 patients. The use of PFD as a treatment for a range of disorders is currently being studied, with an emphasis on outcomes related to reduced inflammation and fibrogenesis. As a result, rather than exploring the molecule's chemical characteristics, this review focuses on innovative PFD efficacy data. Briefly, herein we tried to investigate, discuss, and illustrate the possible mechanisms of actions for PFD to be targeted as a promising anti-inflammatory, anti-fibrotic, anti-oxidant, anti-apoptotic, anti-tumor, and/or anti-SARS-CoV-2 candidate.
Collapse
Affiliation(s)
- Samar A Antar
- Department of Pharmacology and Biochemistry, Faculty of Pharmacy, Horus University, New Damietta 34518, Egypt.
| | - Mohamed A Saleh
- Department of Clinical Sciences, College of Medicine, University of Sharjah, Sharjah 27272, the United Arab Emirates; Department of Pharmacology and Toxicology, Faculty of Pharmacy, Mansoura University, Mansoura 35516, Egypt
| | - Ahmed A Al-Karmalawy
- Pharmaceutical Chemistry Department, Faculty of Pharmacy, Ahram Canadian University, 6th of October City, Giza 12566, Egypt.
| |
Collapse
|
5
|
McCarthy C, Keane MP. Contemporary Concise Review 2021: Interstitial lung disease. Respirology 2022; 27:539-548. [PMID: 35513341 PMCID: PMC9320947 DOI: 10.1111/resp.14278] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 04/28/2022] [Indexed: 11/30/2022]
Abstract
The last 2 years have presented previously unforeseen challenges in pulmonary medicine. Despite the significant impact of the SARS‐CoV‐2 pandemic on patients, clinicians and communities, advances in the care and understanding of interstitial lung disease (ILD) continued unabated. Recent studies have led to improved guidelines, better understanding of the role for antifibrotics in fibrosing ILDs, prognostic indicators and novel biomarkers. In this concise contemporary review, we summarize many of the important studies published in 2021, highlighting their relevance and impact to the management and knowledge of ILD.
Collapse
Affiliation(s)
- Cormac McCarthy
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| | - Michael P Keane
- Department of Respiratory Medicine, St. Vincent's University Hospital, Dublin, Ireland.,School of Medicine, University College Dublin, Dublin, Ireland
| |
Collapse
|
6
|
Carr ZJ, Yan L, Chavez-Duarte J, Zafar J, Oprea A. Perioperative Management of Patients with Idiopathic Pulmonary Fibrosis Undergoing Noncardiac Surgery: A Narrative Review. Int J Gen Med 2022; 15:2087-2100. [PMID: 35237071 PMCID: PMC8882471 DOI: 10.2147/ijgm.s266217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/11/2022] [Indexed: 11/23/2022] Open
Affiliation(s)
- Zyad J Carr
- Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, 06510, USA
- Correspondence: Zyad J Carr, Department of Anesthesiology, Yale University School of Medicine, 333 Cedar St. TMP-3, New Haven, CT, 06520, USA, 333 Cedar St. TMP-3 Email
| | - Luying Yan
- Yale University School of Medicine, New Haven, CT, 06520, USA
| | - Jose Chavez-Duarte
- Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Jill Zafar
- Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, 06510, USA
| | - Adriana Oprea
- Yale University School of Medicine, New Haven, CT, 06520, USA
- Department of Anesthesiology, Yale New Haven Hospital, New Haven, CT, 06510, USA
| |
Collapse
|
7
|
Khor YH. Preoperative pirfenidone in idiopathic pulmonary fibrosis: A wound and injury enigma. Respirology 2021; 26:524-526. [PMID: 33890384 DOI: 10.1111/resp.14068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 04/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Yet H Khor
- Department of Respiratory and Sleep Medicine, Austin Health, Heidelberg, Victoria, Australia.,Institute for Breathing and Sleep, Heidelberg, Victoria, Australia.,Faculty of Medicine, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|