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Nair VS, Anusuya N, Sankar K, Sathiyanathan D, Sane VD, Kanagasabapathy T. Effect of Local Anaesthesia with and without Adrenaline on Blood Glucose Concentration in Patients Undergoing Tooth Extractions - A Comparative Study. Ann Maxillofac Surg 2022; 12:123-127. [PMID: 36874768 PMCID: PMC9976855 DOI: 10.4103/ams.ams_136_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 09/13/2022] [Accepted: 11/14/2022] [Indexed: 01/12/2023] Open
Abstract
Introduction Local anaesthesia (LA) is the usual drug used in dentistry to reduce intraoperative pain. The efficacy of lignocaine is improved by adding adrenaline as a vasoconstrictor. Adrenaline decreases the systemic absorption of LA and reduces blood loss during the surgical procedure. The study was conducted to observe the effect of adrenaline on blood glucose concentration in patients undergoing tooth extraction. Materials and Methods The study was conducted on 100 patients needing multiple teeth extraction. On the first appointment, extraction was done using lignocaine without adrenaline (plain), and for the second appointment, extraction was done using lignocaine with adrenaline (1:200,000). Serial blood glucose estimations were carried out at identical intervals on both occasions. Results Significant difference in blood glucose level was noted when the patients received lignocaine with adrenaline before administration and after 10 min/20 min intervals (P < 0.05). Discussion Constant vigilance and prudence are recommended while using lignocaine with adrenaline in patients suffering from diabetes mellitus.
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Affiliation(s)
- Vivek Sunil Nair
- Department of Oral and Maxillofacial Surgery, Bharathi Vidyapeeth Deemed University Dental College, Pune, India
| | - N Anusuya
- Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Pondicherry, India
| | - K. Sankar
- Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Pondicherry, India
| | - D. Sathiyanathan
- Department of Oral and Maxillofacial Surgery, Grace Dental Clinic, Chennai, India
| | - Vikrant Dilip Sane
- Department of Oral and Maxillofacial Surgery, Bharathi Vidyapeeth Deemed University Dental College, Pune, India
| | - Thirumurugan Kanagasabapathy
- Department of Oral and Maxillofacial Surgery, Mahatma Gandhi Postgraduate Institute of Dental Sciences, Pondicherry, India
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Nassif N, Noueiri B. Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Balanced Diabetic Children. Int J Clin Pediatr Dent 2021; 14:212-216. [PMID: 34413594 PMCID: PMC8343672 DOI: 10.5005/jp-journals-10005-1907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Pediatric dentists, while treating diabetic patients, have a major concern about the occurrence of hypo- or hyperglycemia complications. So far, no dental care protocol is elaborated to help practitioners in creating a safe environment for their patients. This study aims to evaluate the blood glucose level (BGL) fluctuation in type 1 diabetic children according to the type of the delivered treatment and its duration, to outline guidance for predicting the occurrence of a hypo- or hyperglycemia complication. Materials and methods A cross-sectional approach was conducted on 70 balanced diabetic children aged between 7 years and 12 years old (32 females and 38 males) in the Department of Pediatric Dentistry at the Lebanese University in Beirut. Only the patients having a BGL between 70 mg/dL and 300 mg/dL could undergo dental treatment. The gender, the duration of the dental session (≤30 or >30 minutes), the BGLs at the baseline and the end of the session were noted. The types of the performed dental treatment were classified as simple, and unpleasant acts. Results For the female group, only eight sessions lasted ≤30 minutes. The results of simple and unpleasant interventions >30 minutes showed that BGLs before and after treatment were almost identical (p > 0.05). In the male group, for the simple acts >30 minutes, the BGL showed a significant fluctuation (p = 0.02). Conclusion Dentists must be aware of signs of discomfort in balanced type 1 diabetic children to avoid severe complications. This study highlights a new range of BGLs (70–300 mg/dL) that allows safe dental treatment. How to cite this article Nassif N, Noueiri B. Dental Treatment Effect on Blood Glucose Level Fluctuation in Type 1 Balanced Diabetic Children. Int J Clin Pediatr Dent 2021;14(2):212–216.
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Affiliation(s)
- Nahla Nassif
- Department of Pediatric Dentistry, School of Dentistry, Lebanese University, Beirut, Lebanon
| | - Balsam Noueiri
- Department of Pediatric Dentistry, School of Dentistry, Lebanese University, Beirut, Lebanon
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Guimaraes CC, Lopes LC, Bergamaschi CDC, Ramacciato JC, Silva MT, Araújo JDO, de Andrade NK, Motta RHL. Local anaesthetics combined with vasoconstrictors in patients with cardiovascular disease undergoing dental procedures: systematic review and meta-analysis. BMJ Open 2021; 11:e044357. [PMID: 34266837 PMCID: PMC8286772 DOI: 10.1136/bmjopen-2020-044357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 06/15/2021] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVES There is a lack of evidence about the use of local anaesthetics (LAs) in patients with cardiovascular diseases (CVD) in dental procedures. Thus, this study evaluated the safety of using LA with vasoconstrictor to determine the risk of cardiovascular events in patients with CVD. DESIGN Systematic review and meta-analysis. METHODS We have searched in Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (via Ovid), EMBASE (via Ovid), Healthstar (via Ovid), CINAHL, Web of Science and ClinicalTrials.gov for randomised controlled trials (RCTs) up to January 2020. We have included RCTs involving adults with CVD within two groups: intervention group with LA with vasoconstrictor and control group with LA without vasoconstrictor. The primary outcomes assessed were death, mortality by a specific cause, stroke, acute myocardial infarction, hospitalisation, pain, bleeding and arrhythmias. The secondary outcomes were ST segment depression, anxiety, adverse effects and changes in haemodynamic parameters. The data were pooled using random effects meta-analyses and the confidence in the estimates was verified using the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Ten RCTs (n=478 participants) were included. Most of them had a high risk of bias. There were more cases of pain and bleeding in groups without vasoconstrictor. Meta-analysis demonstrated a decrease in the systolic blood pressure with the use of LA with vasoconstrictor (standard mean difference -0.95, 95% CI -1.35 to -0.55) after procedure. Overall, for the other outcomes assessed there was no statistical difference. The quality of evidence was considered low according to the GRADE profile. CONCLUSIONS The results suggest that the use of LA with vasoconstrictors (epinephrine in low doses) is safe in patients with some types of CVD. However, the low quality of evidence demonstrated that literature needs further studies in order to confirm these results. PROTOCOL REGISTRATION PROSPERO (CRD42016045421).
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Affiliation(s)
- Caio Chaves Guimaraes
- Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | - Luciane Cruz Lopes
- Department of Pharmaceutical Sciences, Universidade de Sorocaba, Sorocaba, Brazil
| | | | - Juliana Cama Ramacciato
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
| | | | | | | | - Rogério Heládio Lopes Motta
- Division of Pharmacology, Anesthesiology and Therapeutics, Faculdade São Leopoldo Mandic, Instituto de Pesquisas São Leopoldo Mandic, Campinas, Brazil
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Seminario-Amez M, González-Navarro B, Ayuso-Montero R, Jané-Salas E, López-López J. USE OF LOCAL ANESTHETICS WITH A VASOCONSTRICTOR AGENT DURING DENTAL TREATMENT IN HYPERTENSIVE AND CORONARY DISEASE PATIENTS. A SYSTEMATIC REVIEW. J Evid Based Dent Pract 2021; 21:101569. [PMID: 34391560 DOI: 10.1016/j.jebdp.2021.101569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 02/16/2021] [Accepted: 03/28/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Coronary disease and Hypertension are highly prevalent health problems worldwide, with the latter being one of the most common diseases in patients visiting dental clinics. Local anesthetics (LAs) with vasoconstrictor agents (VC) are known to be commonly used in dental practice. For the above-mentioned reasons, dentists should know how to adapt and treat patients with these hazardous conditions. OBJECTIVE The aim of this study was to find out if the use of local anesthetics (LAs) in combination with vasoconstrictor (VC) agents in dental treatment presents a risk in patient with a known history of Hypertension and/or Coronary disease. MATERIALS AND METHODS This systematic review was conducted in accordance with The PRISMA guidelines and registered on the PROSPERO database (CRD42020187369). The search strategy was based on Mesh terms, Boolean operator AND, and the PICO model. It was designed to identify all the randomized clinical trials (RCTs) published in the last 30 years, which assessed whether the use of LA with VC agents in dental treatment produces a significant increase/decrease in hemodynamics in patients with known history of Hypertension and/or Coronary disease. The Cochrane Collaboration's tool was used to assess risk of bias of the included RCTs. RESULTS An initial electronic search resulted in 87 papers; however only 9 RCTs met the inclusion criteria. There was a total of 482 subjects (N = 482), of which 412 had a known history of Hypertension or Coronary disease. CONCLUSIONS According to the literature reviewed, the use of 1 to 2 cartridges of local anesthetics with 1:80,000, 1:100,000 or 1:200,000 epinephrine in patients with controlled Hypertension and/ or Coronary disease is safe. Randomized clinical trials are essential in determining the safety or risks associated with the use of LAs with VC agents in patients with poorly controlled Hypertension and Coronary disease.
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Affiliation(s)
- Maria Seminario-Amez
- DDS, Master Degree in Oral Medicine, Oral Surgery and Implantology, School of Dentistry, University of Barcelona, Barcelona, Spain
| | - Beatriz González-Navarro
- PhD, DDS, Master Degree in Oral Medicine, Oral Surgery and Implantology, Assistant Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - Raul Ayuso-Montero
- PhD, DDS, Master Degree in Oral Rehabilitation, Associate Professor of Prosthodontics, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain.
| | - Enric Jané-Salas
- PhD, MD, DDS. Aggregate Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Barcelona, Spain
| | - José López-López
- PhD, DDS, MD, Professor of Oral Pathology, School of Dentistry, University of Barcelona - Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, Medical-Surgical Area and Medical Director of Dentistry Hospital, University of Barcelona, Barcelona, Spain
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Meneses-Santos D, Amorim KS, Dantas ACGC, da Silva RP, de Araújo JSM, Groppo FC, Souza LMA. Comparison of two vasoconstrictors on glycemic levels in diabetic patients. Clin Oral Investig 2020; 24:4591-4596. [PMID: 32440938 DOI: 10.1007/s00784-020-03327-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 05/05/2020] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate glycemic levels in diabetic patients before, during, and after extractions using 2% lidocaine with 1:100,000 epinephrine (Lido/Epi) and 3% prilocaine with 0.03 IU/mL felypressin (Prilo/Fely). MATERIALS AND METHODS A double-blind, randomized clinical trial was conducted to evaluate changes in body parameters and glycemic levels in diabetic patients undergoing two anesthetic protocols during dental extractions. During surgery, we evaluated blood pressure (BP), heart rate (HR), saturation (SpO2), and capillary glycemic levels (Gly). These parameters were measured at the following surgical moments: basal, 30 min after medication, incision, tooth removal, suture, and 30 and 60 min after anesthesia. RESULTS Data analysis showed no differences between the groups considering age, weight, and time spent in surgery. Increased systolic BP and decreased diastolic BP were observed in the lido/epi group. No difference was observed in the prilo/fely group among the surgical moments or between the groups regarding BP. No difference was observed in HR and SpO2 between the groups at any surgical moment. However, differences were found when compared the differences in glycemic and basal levels in both groups with greater decreases in blood glucose values for the lido/epi group. In anxiety level evaluation, there was no difference between the different surgical moments. CONCLUSION Thus, both lido/epi and prilo/fely (maximum 3.6 mL) can be safely used in controlled diabetic patients CLINICAL RELEVANCE: The use of lidocaine associated with epinephrine did not increase glycemic levels but leads to decrease over time when associated with an anxiety reduction protocol, offering some advantage over prilocaine plus felypressin for diabetic patients.
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Affiliation(s)
- Daniela Meneses-Santos
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil.
| | - Klinger Souza Amorim
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Anne Caroline Gercina Carvalho Dantas
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
| | - Ricardo Pedro da Silva
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
| | - Jaiza Samara Macena de Araújo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Francisco Carlos Groppo
- Pharmacology, Anesthesiology and Therapeutics Department of the Piracicaba Dental School, University of Campinas, 901 Limeira Avenue, Piracibaba, São Paulo, 13414-903, Brazil
| | - Liane Maciel Almeida Souza
- Oral surgery and anesthesiology area of Dentistry Department, Federal University of Sergipe, St Cláudio Batista, s/n. Bairro Sanatório, Cidade Nova, Aracaju, Sergipe, 49060-108, Brazil
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Singh V, Thepra M, Kirti S, Kumar P, Priya K. Dexmedetomidine as an Additive to Local Anesthesia: A Step to Development in Dentistry. J Oral Maxillofac Surg 2018; 76:2091.e1-2091.e7. [PMID: 29964002 DOI: 10.1016/j.joms.2018.05.037] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Revised: 05/30/2018] [Accepted: 05/30/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The study aimed to compare the effect of dexmedetomidine added to lidocaine against epinephrine added to lidocaine on local anesthetic potency and to look for future prospects of dexmedetomidine as an additive to local anesthesia in dentistry. MATERIALS AND METHODS The study included 25 healthy volunteers in whom extraction of all first premolars was scheduled as part of their orthodontic treatment plan. In this split-mouth, double-blind, crossover, randomized controlled trial, patients were randomized into 2 groups: Group 1 received injection lidocaine plus dexmedetomidine, and group 2 was administered lidocaine plus epinephrine. Patients were assessed for the onset of action of anesthesia, duration of analgesia, pain perception, and vital signs. RESULTS The mean values (±standard deviations) for the onset of anesthetic action in groups 1 and 2 were 113 ± 24.9 and 141 ± 34.8 seconds, respectively, for the mandible. For the maxilla, the mean values were 113 ± 24.9 seconds for group 1 and 165 ± 43.8 seconds for group 2. The duration of anesthesia was longer in group 1 (lidocaine plus dexmedetomidine), in which the requirement for the first analgesic on request was seen after a longer time interval, when compared with group 2 (lidocaine plus epinephrine). Pain perception elicited statistically significant results with less perception of pain in group 1 (lidocaine plus dexmedetomidine). The vital parameters remained stable, and the results were not statistically significant. CONCLUSIONS In this study, we observed that the addition of dexmedetomidine to lidocaine for maxillary and mandibular nerve blocks significantly prolonged the block duration and shortened the onset of action, as well as improved postoperative analgesia in terms of the need for fewer analgesics in the postoperative period. Furthermore, the vital parameters remained stable and no complications were encountered. The findings were supportive of the use of dexmedetomidine as an adjunct to local anesthetics in dental procedures.
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Affiliation(s)
- Virendra Singh
- Head, Department of Oral and Maxillofacial Surgery, Post Graduate Institute of Dental Sciences, Rohtak, India.
| | - Manju Thepra
- Resident, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Shruti Kirti
- Resident, Post Graduate Institute of Dental Sciences, Rohtak, India
| | - Prashant Kumar
- Senior Professor, Department of Anaesthesiology, Post Graduate Institute of Medical Sciences, Rohtak, India
| | - Kannu Priya
- Resident, Post Graduate Institute of Dental Sciences, Rohtak, India
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Dougall A, Hayes M, Daly B. A systematic review of the use of local analgesia in medically compromised children and adolescents. Eur Arch Paediatr Dent 2017; 18:331-343. [DOI: 10.1007/s40368-017-0304-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2017] [Accepted: 09/06/2017] [Indexed: 11/30/2022]
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Végh D, Somogyi A, Bányai D, Lakatos M, Balogh M, Al-Khrasani M, Fürst S, Vizi E, Hermann P. Effects of articaine on [ 3 H]noradrenaline release from cortical and spinal cord slices prepared from normal and streptozotocin-induced diabetic rats and compared to lidocaine. Brain Res Bull 2017; 135:157-162. [DOI: 10.1016/j.brainresbull.2017.10.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 10/12/2017] [Accepted: 10/16/2017] [Indexed: 11/29/2022]
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Kaur P, Bahl R, Kaura S, Bansal S. Comparing hemodynamic and glycemic response to local anesthesia with epinephrine and without epinephrine in patients undergoing tooth extractions. Natl J Maxillofac Surg 2017; 7:166-172. [PMID: 28356688 PMCID: PMC5357929 DOI: 10.4103/0975-5950.201370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Lignocaine with epinephrine as local anesthetic (LA) provides hemostasis and decreases the risk of systemic toxicity. The purpose of the present study was to investigate and compare the response of lignocaine with and without epinephrine to evaluate hemodynamic and metabolic response in normotensive and type II controlled diabetic patients. MATERIAL AND METHODS A total of 50 patients (25 healthy and 25 controlled type II diabetics) undergoing multiple tooth extractions (age group of 20-80 years) were included in this prospective, randomised, clinical study. On their first visit, the patients were given 2% lignocaine HCl with 1:200,000 epinephrine, and 2% lignocaine HCl was given on the second visit, to carry out tooth extractions. Blood pressure (BP), pulse rate, oxygen saturation, and blood glucose estimations were done at definite intervals (before, immediately after, and 20 min after the administration of LA) on both the visits. RESULTS The increase in blood glucose concentration following the administration of 2% lignocaine HCl with 1:200,000 epinephrine was statistically significant (P < 0.05) in controlled diabetic patients. Statistically significant variability in diastolic BP (DBP) was also noted in controlled diabetic patients. Both systolic BP and DBPs were statistically significantly elevated after the administration of 2% lignocaine HCl. CONCLUSION 2% lignocaine HCl with 1:200,000 epinephrine in type II diabetics and 2% lignocaine HCl should be used with caution in normotensive as well as type II controlled diabetic patients.
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Affiliation(s)
- Paramjot Kaur
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Rashi Bahl
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Sameer Kaura
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
| | - Sumit Bansal
- Department of Oral and Maxillofacial Surgery, Baba Jaswant Singh Dental College and Research Institute, Ludhiana, Punjab, India
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