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International Journal of Advances in Medicine
Number of Followers: 0  

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ISSN (Print) 2349-3925 - ISSN (Online) 2349-3933
Published by Medip Academy Homepage  [12 journals]
  • Characteristics of confirmed COVID-19 patients receiving treatment at
           Sanglah hospital for January-February 2022

    • Authors: Novinna Kusumawati, Pande Made Andikayasa, Gede Oky Aryanthana, Ida Bagus Ngurah Rai, Ni Wayan Candrawati Kusumawardhani, Ida Ayu Jasminarti Dwi, Ni Luh Putu Eka Arisanti, I. Gede Ketut Sajinadiyasa, Putu Andrika
      Pages: 1165 - 1170
      Abstract: Background: The ongoing mutation of the COVID-19 virus causes an increase in transmission and a decrease in vaccine effectiveness. COVID-19 cases since the end of 2021 have continued to increase, and data on the characteristics of patients with confirmed COVID-19 at Sanglah hospital for this period is not yet available. Therefore, this study aims to determine the characteristics of confirmed COVID-19 patients who received treatment at Sanglah hospital from January to February 2022.Methods: This study is a descriptive study using a cross-sectional approach taken from medical record data.Results: There were 276 COVID-19 patient subjects with an average age of 53 years, consisting of 51.1% male and 48.9% female. Most occupations are private employees, 29.0%. The 39.5% of patients had mild symptoms, and 5.8% had critical symptoms. Cough (51.8%) and fever (40.6%) were the main clinical symptoms, and chronic kidney disease was the most common comorbidity at 16.7%. As many as 46.0% of COVID-19 patients have received vaccines at least 2x, and 2.9% of patients are previous COVID-19 survivors.Conclusions: The characteristics of confirmed COVID-19 patients who received treatment at Sanglah hospital in January and February 2022 were more male than female, with the most jobs as private employees. Most patients have mild to moderate symptoms with a chief complaint of cough. Almost half of the patients have been vaccinated at least 2x. Most of them are not COVID-19 survivors.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223017
      Issue No: Vol. 9, No. 12 (2022)
  • Recent trends in the patterns of dyslipidemia and management strategy in
           newly diagnosed patients of type 2 diabetes mellitus-2

    • Authors: Dixit Patel, Nilanj Dave, Vinob Kalkoti, Mithilesh Nayak
      Pages: 1171 - 1176
      Abstract: Background: Objective of the study was to evaluate the patterns of dyslipidaemia in newly diagnosed type 2 diabetes mellitus-2 (T2DM) patients and to understand the initial management options utilised by the treating physician.Methods: The real world, retrospective, observational REcent trends in the patterns of dyslipidemia and Management strategy in newly diAgnosed Patients of type 2 diabetes mellitus-2 (REMAP-2) study was conducted at various centers including hospitals, clinics, and health care institutes across India between Apr-2021 and Mar-2022. Clinicians at the respective center captured the data in REMAP-2 study data capture form. Dyslipidemia was considered as: total cholesterol >200 mg/dl, low density lipoprotein cholesterol (LDL-C) >100 mg/dl, high density lipoprotein cholesterol (HDL-C) <40 mg/dl, or triglyceride >150 mg/dl.Results: Of 9605 newly diagnosed T2DM patients with dyslipidemia, 68.94% (n=6622) had mixed dyslipidemia. The mean age was 53.8 years. Majority of the patients were males (63.3%), had family history of diabetes (52.5%), physical activity category of ‘not very active’ or ‘lightly active’ (79.33%), and were overweight or obese (58.9%). About 25.9% of the patients were smokers. Hypertension (72.33%) was the most common comorbidity followed by coronary artery disease (23.44%). The mean glycated hemoglobin (HbA1c) was 8.3%. The most commonly prescribed antidiabetic medication was metformin (87.71%), while lipid lowering therapy was atorvastatin (77.79%).Conclusions: This study on newly diagnosed T2DM patients with dyslipidemia found that majority of the patients had hypertriglyceridemia, family history of diabetes and were physically inactive. More than half of T2DM patients were either overweight or obese. More than 2/3rd of the patients had mixed dyslipidemia. Statins were prescribed to the majority of these patients and atorvastatin was the most commonly prescribed statin in Indian T2DM patients with dyslipidemia.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20222978
      Issue No: Vol. 9, No. 12 (2022)
  • Indian prevalence of familial hypercholesterolemia demystified by applying
           Dutch lipid clinic network criteria

    • Authors: Akshay Kacharu Barde, Sumit Sethi, Mohan Bhargav, Swati Waghdhare
      Pages: 1177 - 1182
      Abstract: Background: Dyslipidemia is a growing problem in India, with familial hypercholesterolemia (FH) being an under diagnosed and under treated cause of the same. FH is a common genetic disorder associated with high LDL cholesterol, leading to premature CAD and peripheral vascular diseases. The prevalence of FH is 1 in 250 individuals. True global prevalence of FH is underestimated. The prevalence of FH in Indian population is still unknown.Methods: A total 4000 patients who had tested their lipid profile at Max hospital, between Aug 2017-Aug 2019 were screened. Out of these we found 530 patients with LDL cholesterol ≥155 mg/dl. Amongst these, 90 patients consented for clinic visit and examination, and thus enrolled and   assessed for FH using the Dutch lipid clinic network (DLCN) criteria. Based on scores, patients were diagnosed as definite, probable, possible, or no FH. Other risk factors known to cause dyslipidemia such as smoking, diabetes mellitus and hypertension were excluded.Results: In a general population of 4000 patients, 4 individuals were detected with definite FH, showing a prevalence of 1 in 1000 (0.1%). Out of the enrolled 90 patients with high LDL cholesterol, 4 (4.44%) were diagnosed as definite, 14 (15.56%) as probable, 33 (36.67%) as possible, and 39 (43.33%) as unlikely FH.Conclusions: Prevalence of FH appears to be much higher among Indians with high LDL cholesterol. Therefore, it should not be ignored in individuals with high LDL cholesterol. To detect patients with FH, routine screening with simple DLCN criteria may be effectively used.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223018
      Issue No: Vol. 9, No. 12 (2022)
  • Risk of progression to overt hypothyroidism in Indian patients with
           subclinical hypothyroidism: a prospective observational study

    • Authors: Shailendra Kumar Singh, Rina Singh, Santosh Kumar Singh, Mir Asif Iquebal, Sarika Jaiswal, Pradeep Kumar Rai
      Pages: 1183 - 1187
      Abstract: Background: Subclinical hypothyroidism (SCH) is a common endocrine disorder but spontaneous course of SCH in India is lacking. The aim of the study is to determine the spontaneous course of SCH and to identify the risk factors, which enhances the occurrence of overt hypothyroidism (OH).Method: This is a real world prospective observational study. 58 SCH were followed up six monthly for one year to determine the course of SCH.Results: After one year of follow up 11 (18.97%) patients progressed to OH. 37 (63.79%) remained in subclinical hypothyroid category. In 10 (17.29%) patients TSH (thyrotropin) normalized. Rate of progression (odds ratio: 4.58; 95% CI: 1.14, 18.28) was significantly more in anti-thyroid peroxidase (TPO) positive group as compared to anti-TPO negative group.Conclusions: This first data from India clearly shows that SCH has a variable course. Rate of progression to OH is high (18.97%) in Indian SCH patients. In a cohort of 58 patients followed for one year only the presence of anti-TPO antibody was predictive of OH. The initial risk stratification can identify patients with SCH at greatest risk for progression to OH in which treatment is mandatory.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223019
      Issue No: Vol. 9, No. 12 (2022)
  • Admission HbA1c value as a prognostic marker in patients admitted with

    • Authors: Vaibhav Jain, Suraj S. Hegde
      Pages: 1188 - 1193
      Abstract: Background: Diabetes mellitus has been firmly established as a risk factor for the prognosis of COVID-19. However, the impact of pre-COVID-19 glycemic control on prognosis is yet to be fully understood. Our study aimed to establish the effect of HbA1c at admission on the outcome of patients admitted with COVID-19.Methods: It was a prospective observational study of admitted adult patients with confirmed SARS-CoV-2 infection in a tertiary care centre based on data collected from the medical record section using the patient data registry between April 2021 to June 2021. Information regarding demographic and clinical features, laboratory values, and hospital outcomes was collected and analysed.Results: 182 patients admitted to the hospital with COVID-19 during the study period were included, their mean age was 48.75 years, the mean HbA1c was 6.1. Males accounted for 69.8% (127) of the sample population. 41.2% (75) were known diabetics. 44.8% (81) were known hypertensives. The mortality rate overall was 25.3% (46). 63.7% (116) had HbA1c values >6.5. High HbA1c values was associated with longer duration of hospital stay (p=0.032), higher levels of inflammatory markers, increased need for mechanical ventilation (p=0.001), higher mortality rate (p=0.001).Conclusions: Patients with COVID-19 with poor glycemic control as evidenced by admission HbA1c levels were found to have more severe disease course with increased level of inflammatory markers, longer duration of hospital stay and higher risk of mortality. 
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223020
      Issue No: Vol. 9, No. 12 (2022)
  • Duchenne muscular dystrophy: case series of rare inherited muscular

    • Authors: I. Gusti Ayu Sri Mahendra Dewi, Desak Made Cittarasmi Saraswati Seputra
      Pages: 1194 - 1197
      Abstract: Duchenne muscular dystrophy (DMD) is a rare muscular disorder caused by mutation of gene encoding dystrophin protein which required for maintaining muscle stability during contraction. DMD occurs in 1 in 5000 male live births and characterized by progressive muscular weakness associated with motor development delay, loss of independent ambulation, respiratory failure, and cardiomyopathy. We present a case series of 3 DMD patients who were diagnosed at Prof. dr. I.G.N.G. Ngoerah general hospital, Denpasar over a period of four years (2019-2022). Clinical manifestation of patients includes progressive weakness of lower extremities and difficulty to stand up from sitting position. Physical examination revealed pseudohypertrophy of calf, winged scapula, positive Gower’s sign, and waddling gait in all three cases. Supporting examination showed an increase of alanine transaminase and aspartate transaminase 5.6 times and 6.1 times the upper limit of normal, respectively. Definitive diagnosis of all patient was made based on immunohistochemistry staining which revealed an absent of dystrophin protein around muscle membrane.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223021
      Issue No: Vol. 9, No. 12 (2022)
  • Expression of DOG 1 and correlation with Ki-67 and tumor characteristics
           in GIST: case series analysis in a tertiary care center

    • Authors: Danita G. S. Edwin, Nithin Diwagar K., Ganthimathy Sekhar
      Pages: 1198 - 1202
      Abstract: Gastrointestinal stromal tumours (GISTs) are the most common non epithelial, mesenchymal tumours of the gastrointestinal tract and amount to 1 to 3% of all gastrointestinal tumours. Histologically, GISTs demonstrate considerable morphologic variation. The aim of the study was to evaluate the histo-morphological features of GIST and the expression of DOG1 and KI-67 in these tumours. Eleven cases of GISTs received during a five-year period at a tertiary care centre were analysed for their demographic parameters, morphology and risk stratification. Immunohistochemistry for DOG1 and Ki67 was performed for all the eleven cases. In this study there was a female preponderance with the mid -fifties being the median age of presentation. The stomach and small intestine were the common sites of involvement. The histologic type was predominantly spindle cell with a few cases of mixed tumours. DOG 1 was positive in all the tumours and Ki-67 index was markedly elevated in the epithelioid cell type and in the high-risk category of tumours. DOG 1 holds good as an important marker for clinically suspected GIST diagnosis and Ki-67 expression correlates with the risk stratification of the tumour and can be a good prognostic factor.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223003
      Issue No: Vol. 9, No. 12 (2022)
  • Safety of oral graded challenges as a diagnostic approach hypersensitivity
           reaction to anti-tuberculosis drugs: a case report

    • Authors: Putu Aditya Dwipayana, Ketut Suryana
      Pages: 1203 - 1206
      Abstract: Tuberculosis (TB) still becomes a significant health problem in developing countries, especially in Indonesia. Allergy to antitubercular drugs is a real hindrance to the management of TB. The first-line anti-TB drug (ATD) is still the most effective TB drug, but it can have some side effects. One of these side effects is drug hypersensitivity reactions (DHR) which can affect a patient's compliance. The recommended diagnostic approach to DHR is a graded challenge by introducing drugs safely and optimally under a threshold dose until the usual daily dose is reached. We present a case of DHR to ATB drug and oral graded challenge as the diagnosis approach.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223022
      Issue No: Vol. 9, No. 12 (2022)
  • Molluscum contagiosum could become an early sign of HIV infection

    • Authors: Ni Luh Raka M. Hardiani, Ketut Suryana, Kadek A. Suhardinatha
      Pages: 1207 - 1210
      Abstract: HIV is a type of virus that attack the immune system, causing it unable to function normally and putting the person in a condition called immunocompromised and is vulnerable to lots of infection. People living with HIV are prone to complications if there is persisting infection and inflammation. One of the inflammation markers is the neutrophil-lymphocyte ratio (NLR). Complication on the skin is one of the frequently happened. One of it is Molluscum contagiosum. Molluscum contagiosum caused by virus infection which target the epidermal layer of the skin that result in formation of round, umbilicated, painless papule or nodule. In this case report, we present a male, 49 years old which has complained of persistent fatigue and diarrhea. There is multiple rounds, skin-colored, painless papules on his face and neck since 6 month ago which keep increasing. Laboratory result show decrease in hemoglobin and high neutrophil lymphocyte ratio. In HIV, the NLR value has a significant negative correlation with the CD4 amount. The existence of molluscum contagiosum in an adult with unknown HIV status need to be considered as a possibility of an immunocompromised especially if accompanied with other conditions. In the patient with HIV, with the existence of Molluscum contagiosum, the possibility of decreasing CD4 and increasing viral load need to be suspected. The patient’s obedience in consuming ARV also needs a careful attention.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223023
      Issue No: Vol. 9, No. 12 (2022)
  • Granulicatella adiacens infective endocarditis

    • Authors: Arun Kumar Alagesan, Tirumalasetty Sriharsha, Raghav J., Vikrannth V., Kannan R., Meenakshi K.
      Pages: 1211 - 1214
      Abstract: Infective endocarditis is an unconventional infectious disease nonetheless life-threatening. A roundabout of 3% to 5% cases of Streptococcal infective endocarditis is caused by nutritionally variant Streptococci (NVS). Granulicatella species is one of the atypical causes of infective endocarditis. In this context, the authors are disclosing a case of infective endocarditis in an underlying rheumatic heart disease patient, caused by Granulicatella adiacens. The patient had breathlessness for the past four months, on and off fever for two months anew and mid-diastolic murmur with vegetation in aortic valve as appeared by echocardiogram. The blood cultures were tested positive for Granulicatella adiacens. The patient was successfully treated with intravenous vancomycin for a period of six weeks. 
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20222958
      Issue No: Vol. 9, No. 12 (2022)
  • A rare case of traumatic intramural hematoma in pediatric age group
           successfully managed with expectant approach

    • Authors: Elizabeth Kurian, Jijo Joseph, Geido Davis Thomas, Rajeev Anand
      Pages: 1215 - 1217
      Abstract: Acute colonic intramural hematoma is a rare clinical entity. In most cases reported in literature a surgical management is used. Here we present a case of an 8-year-old boy who was found to have a colonic intramural hematoma following a fall from bicycle. Considering the age of the child and hemodynamic stability a conservative management was adopted and the child was successfully managed.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20222989
      Issue No: Vol. 9, No. 12 (2022)
  • Double chambered right ventricle with ruptured sinus of Valsalva: rare

    • Authors: Jaya Lalwani, Lokesh Kumar, Rameshwar ., Jagadeesan M.
      Pages: 1218 - 1221
      Abstract: Valsalva sinus aneurysm (SVAs) and double-chambered right ventricle (DCRV) is an uncommon congenital heart defect and are usually associated with ventricular septal defect (VSD) in 50% to 60% of patient’s population. The current case report had documented a 59 years old hypertensive asymptomatic male with a known case of SVAs presented to our hospital following device closure for 6 months. On examination, the patient was diagnosed to have DCRV induced by SVAs prior to the closure along with other factors. However, to the best of our knowledge, this is the first case report on DCRV induced by SVAs in synergy with other associated multifactors and without VSD among the Indian population.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223024
      Issue No: Vol. 9, No. 12 (2022)
  • An interesting case of melioidosis: a mimicry of pulmonary tuberculosis

    • Authors: Manoj Sivasamy, Shreenidhi R., Nishaanth M. K., Jagadeesan M., Prasanna Karthik S.
      Pages: 1222 - 1223
      Abstract: Melioidosis is caused by Burkholderia pseudomallei which is a soil-dwelling aerobic bacterium reported mostly in tropical and subtropical areas, especially in Asia (Southeast) and Australia (Northern part). Melioidosis is a severe infection that can manifest as chronic debilitating pneumonia mimics pulmonary tuberculosis. Here, we reported a case of melioidosis, in 51-year-old men with poorly controlled type 2 diabetes mellitus. The patient recovered with appropriate intravenous antibiotics and supportive medications.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223025
      Issue No: Vol. 9, No. 12 (2022)
  • Neuromyelitis optica presenting as neurogenic bladder

    • Authors: C. P. Aryadevi, Geethika Pradeep, P. V. Bhargavan, Shiji P. V.
      Pages: 1224 - 1227
      Abstract: Neuromyelitis optica (NMO) is an immune mediated disease of central nervous system primarily affecting optic nerves, spinal cord and brain stem. This case report describes a 24-year-old male with no comorbidities presented with high grade fever followed by proximal lower limb weakness and bilateral hydrouretero nephrosis without any lower urinary tract obstruction. He had clinical features of conus- cauda lesion with MRI spine showing features of longitudinally extensive transverse myelitis (LETM) and brain MRI showing involvement of splenium of corpus callosum. He improved with steroid therapy with in a period of 2 weeks and oral steroid was tapered of and stopped within a period of two months. There was no relapse of symptoms so far.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223026
      Issue No: Vol. 9, No. 12 (2022)
  • A confounding case of pancytopenia

    • Authors: Vignesh C., Mahendra kumar K.
      Pages: 1228 - 1229
      Abstract: Tuberculosis is one of the major health problems in the developing countries like India. Due to its nonspecific presentation, extra pulmonary TB is diagnosed at later stages.It is an important differential diagnosis for pyrexia of unknown origin (PUO). A 54-year-old male came to hospital with complaints of fever, pain abdomen (on and off), easy fatiguability, reduced appetite, weight loss, breathlessness on exertion for 8 months who completely recovered after starting anti-tubercular therapy.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223027
      Issue No: Vol. 9, No. 12 (2022)
  • Characteristic of cardiac and neurological forms of non-polio enterovirus

    • Authors: Mehul Hitesh Sadadiwala, Potapchik A. L., Matsiyeuskaya N. V.
      Pages: 1230 - 1235
      Abstract: Enterovirus infections (EVI) are ubiquitous and generally present with mild symptoms and have a favorable prognosis with full recovery. But sometimes it can be challenging to diagnose mixed forms of EVI which can result in fatal outcomes. An interesting case report on a patient admitted to the Grodno Regional infectious diseases clinical hospital. The patient was diagnosed with enteroviral infection. Histological slides of the brain, heart, lung and other systemic organs were prepared on autopsy and are presented in this scientific paper. Generalized EVI in mixed form can cause primary lesions of the brain (destructive edema), the heart (necrotizing cardiomyopathy), and sepsis while also affecting other organ systems. This can lead to unfavorable outcomes similar to that in our case report. Mixed form EVI (meningitis, myocarditis, and sepsis) can progress rapidly towards an adverse course, with the development of severe life-threatening complications. We strongly suggest that mandatory PCR screening for EVI should be carried out in young individuals with sepsis-like diseases and with a fever of unexplained origin at the time of presentation.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223028
      Issue No: Vol. 9, No. 12 (2022)
  • Hoffman’s syndrome-a rare neurological presentation of hypothyroid

    • Authors: Tirumalasetty Sriharsha, A. Arun Kumar, Raghav Raj J., N. Monika Reddy, Vikrannth V., Vinod Raghavan, Kannan Rajendran
      Pages: 1236 - 1238
      Abstract: Hoffman's syndrome is a rare form of hypothyroid myopathy, which causes proximal muscle weakness and pseudohypertrophy of muscles. It is a complication of untreated or uncontrolled Hypothyroidism.The neurological manifestations of hypothyroidism usually occur late in the course of disease. It is quite rare to present with neurological manifestations in the earlier stage of disease. Very few cases of Hoffman’s syndrome were reported from India. Here we report a case of 27-year-old male who presented to the medicine OPD with initial symptoms of proximal muscle weakness, fatigue and calf muscle hypertrophy. On further evaluation patient was found to have hypothyroid myopathy in the form of Hoffman’s syndrome.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223029
      Issue No: Vol. 9, No. 12 (2022)
  • Data bias in precision medicine

    • Authors: Indira Singha Laishram
      Pages: 1239 - 1241
      Abstract: Precision medicine is poised to increasingly improve health outcomes for more people in the near future. In contrast to the more traditional reactive methods of disease treatment, precision medicine is a customizable treatment and disease prevention approach that is tailored for the individual. Artificial intelligence (AI) using sophisticated algorithms and machine learning (ML) tools powers these precision medicine processes. These algorithms analyze big data collected from multiple sources over the past decades to aid physicians to make data-backed critical clinical decisions. However, studies have shown that unintentional biases in the source data and in the process can affect these precision medicine efforts.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20223030
      Issue No: Vol. 9, No. 12 (2022)
  • Lateral medullary syndrome: an unwanted ischemia to identify early

    • Authors: Priyadarshi Prajjwal, Pugazhendi Inban, Abhijit Nagre, Mujtaba Hussain Shah, Ansh Chaudhary, Raunak Ranjan, Bhupendra Chaudhary
      Pages: 1242 - 1246
      Abstract: Lateral medullary syndrome also referred to as Wallenberg syndrome, posterior inferior cerebellar artery (PICA) syndrome, or vertebral artery syndrome is a cluster of neurological symptoms and signs brought on by obstructions in the blood vessels supplying the medulla, which causes ischemia or infarction of the brainstem. The vertebral artery or the posterior inferior cerebellar artery are the arteries most frequently affected with lateral medullary syndrome. The most prevalent symptom is transient ischemic attack (TIA) with dizziness or vertigo and atherosclerosis in the posterior cerebral circulation being the most common cause. Lateral Medullary Syndrome patients suffer from strokes or infarction and also present with vomiting, nausea, gait impairment, instability, hoarseness, and swallowing difficulties. Depending on the particular nuclei and fibers involved, different indications will appear. CT/MRI imaging is used to diagnose conditions. The majority of management is supportive, including risk factor reduction for additional ischemia events as well as speech and occupational therapy following an acute intervention. In this review article, we discuss the etiopathogenesis and factors leading to lateral medullary syndrome along with a comprehensive discussion on its clinical features, challenges in diagnosis, and treatment.
      PubDate: 2022-11-23
      DOI: 10.18203/2349-3933.ijam20222959
      Issue No: Vol. 9, No. 12 (2022)
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Heriot-Watt University
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