JournalTOCs

Emergency Medicine International
Number of Followers: 8

This is an Open Access Journal

Open Access journal
ISSN (Print) 2090-2840 - ISSN (Online) 2090-2859
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Exploration of the Challenges of COVID-19 from the Perspective of
Emergency Medicine Specialists
- Abstract: Background. Emergency physicians are at the forefront of the medical system in the face of the COVID-19 crisis. Identifying the challenges, along with the strategies and effective measures implemented by them in the face of the COVID-19 crisis, can be a roadmap for future crisis management planning. This study aims to explain the challenges faced by emergency physicians regarding COVID-19. Methods. This study is a qualitative content analysis. Data were collected using individual and semistructured interviews. Twenty-seven emergency medical specialists in Fars University of Medical Sciences, Iran, participated in the study by purposive sampling method and were interviewed using semistructured interviews. Results. Participants’ experience of COVID-19 led to the extraction of four main themes, including structural factors, threats to the health of the medical team, fluctuations of extremism and wastage in the face of COVID-19, and the country’s policymaking hierarchy. Conclusions. Emergency physicians face challenges such as structural factors, health threats, extreme fluctuations, and national policymaking. To avoid surprises and threats, they must predict acute scenarios, provide necessary equipment, address skilled manpower shortages, and adopt appropriate management policies. This includes culture-building, cross-sector coordination, planning, and efficient management to prevent virus spread.
  PubDate: Sat, 25 May 2024 13:05:00 +000
ICD-10 Classification in the Practice of Emergency Medical Teams: New
Insights
- Abstract: The role of the emergency medical system is to provide assistance to every person in a state in the event of a sudden threat to health and life. Emergency medical teams (EMTs) are an important element of this system, making diagnoses based on the International Classification of Diseases (ICD-10). The study was aimed at analysing the causes of EMT intervention based on groups of diagnoses codified according to the ICD-10. The analysis was based on data from 116,278 EMT interventions in central-eastern Poland in 2017-2019. The research showed that EMT most often made diagnoses based on groups of ICD-10 codes: R00-R99-Symptoms, signs, and abnormal clinical and laboratory findings, not elsewhere classified (39.11%); S00-T98-Injury, poisoning, and certain other consequences of external causes (18.23%); and I00-I99-Diseases of the circulatory system (15.57%). The analysis of the obtained results showed statistically significant differences () regarding the area of intervention (urban, rural), sex, age of the patient, and the method of completion of the activities by EMTs in relation to the group of ICD-10 diagnoses for the diagnosis. The conducted study showed the actual reasons for EMT calls. The use of the ICD-10 classification has practical application in EMTs, as it enables the identification of a disease or health problem.
  PubDate: Thu, 16 May 2024 11:50:00 +000
Does Point-of-Care Ultrasound Affect Fluid Resuscitation Volume in
Patients with Septic Shock: A Retrospective Review
- Abstract: Background. Fixed, large volume resuscitation with intravenous fluids (IVFs) in septic shock can cause inadvertent hypervolemia, increased medical interventions, and death when unguided by point-of-care ultrasound (POCUS). The primary study objective was to evaluate whether total IVF volume differs for emergency department (ED) septic shock patients receiving POCUS versus no POCUS. Methods. We conducted a retrospective observational cohort study from 7/1/2018 to 8/31/2021 of atraumatic adult ED patients with septic shock. We agreed upon a priori variables and defined septic shock as lactate ≥4 and hypotension (SBP
  PubDate: Mon, 06 May 2024 10:05:00 +000
Validation of Difficult Airway Physiological Score (DAPS) in Critically
- Abstract: Background. Critically ill patients have increased risk of cardiovascular collapse following endotracheal intubation due to physiological instability. This study aims to validate the Difficult Airway Physiological Score (DAPS) in adults to predict the risk of serious outcomes in the emergency department of a tertiary care private hospital. Methods. This is a cohort study conducted in the emergency department (ED) from 2021 to 2022. Difficult Airway Physiological Score (DAPS) was derived from a sample of 1021 patients through a retrospective study. The variables in the score were age, gender, time of intubation, vitals and vomiting at presentation, pH
  PubDate: Tue, 23 Apr 2024 14:05:01 +000
Are We Overusing Coagulation Studies in the Emergency Department'
- Abstract: Background and Objectives. Blood tests are often indiscriminately requested in the Emergency department (ED) and many EDs have preset orders that are usually performed at triage before clinical assessment to improve the flow of patients through the department. We conducted this study to evaluate the frequency of requests for coagulation profile, the incidence of abnormal coagulation profiles and the unnecessary use of coagulation profile testing in our institution. Methods. This retrospective observational study, conducted in the ED of King Saud University Medical City (KSUMC) in Riyadh, Saudi Arabia, during July and August of 2021(2 months) examined coagulation profile requests. Patients’ demographic data (age and gender), medical and clinical history (presenting complaint, comorbidities, and diagnosis), the use of antiplatelets or anticoagulant agents and laboratory values for PT, APTT, and INR were collected. We calculated the total cost of unnecessary coagulation profile testing based on the independent assessment of two ED consultants. Results. Of 1,754 patients included in the study, 811 (46.2%) were males and 943 (53.8%) were females, with a mean age of 42.1 ± 18.5 years. There were 29 (1.7%) patients with liver disease and 21 (1.2%) patients had thromboembolic disease. The majority of the patients’ results were within normal levels of PT (n = 1,409, 80.3%), APTT (n = 1,262, 71.9%), and INR (n = 1,711, 97.4%). Evidence of active bleeding was detected in 29 patients (1.7%). Among patients with bleeding only one had an abnormal INR (3.01) and was on warfarin. Forty-six (2.6%) patients had elevated INR level. Cohen’s kappa between the two consultants was recorded at 0.681 (substantial agreement) in their assessment of the appropriateness of coagulation tests requests and both consultants believed that 1,051 tests (59.9%) were not indicated and were unnecessary. The expected annual cost saving if the unnecessary tests were removed would be around SAR 1,897,200 (approximately US$ 503,232) which is about SAR 180000 (US$ 48000)/1000 patients. Conclusion. This study showed that coagulation tests are overused in the ED. More than half of coagulation profile tests in our study population were deemed unnecessary and associated with significant cost. Targeted testing based on specific patient presentation and medical history can guide physicians in wisely choosing who needs coagulation studies.
  PubDate: Tue, 23 Apr 2024 11:05:00 +000
Subarachnoid Haemorrhage Incidence Pattern Analysis with Circular
Statistics
- Abstract: Knowledge about biological rhythms of diseases may not only help in understanding the pathophysiology of diseases but can also help health service policy makers and emergency department directors to allocate resources efficiently. Aneurysmal subarachnoid haemorrhage (SAH) has high rates of morbidity and mortality. The incidence of SAH has been attributed to patient-related factors such as characteristics of aneurysms, smoking, and hypertension. There are studies showing that the incidence of aneurysmal SAH appears to behave in periodic fashions over long time periods. However, there are inconsistencies in the literature regarding the impact of chronobiological factors such as circadian, seasonal, and lunar cycle factors on the occurrence of SAH. In this study, we focused on the analysis of a temporal pattern of SAH (infradian rhythms) with a novel approach using circular statistical methods. We aimed to see whether there is a circular pattern for the occurrence of SAH at all and if so, whether it can be related to known temporal patterns based on available literature. Our study did not support the notion that aneurysmal subarachnoid haemorrhages occur on any specific day in a cycle with specific lengths up to 365 days including specific weekdays, full moon, equinoxes, and solstices. Hence, we found no relationship between SAH incidence and timing. Study in larger populations using similar circular statistical methods is suggested.
  PubDate: Tue, 16 Apr 2024 09:05:00 +000
Healthcare Decision-Making in a Crisis: A Qualitative Systemic Review
Protocol
- Abstract: Background. Throughout history, communities have faced outbreaks of infectious diseases and other natural and man-made disasters that pose significant threats to lives, public health, and business continuity. Many of these disasters are crises that require critical decisions to be made in a short, crucial time with limited information and unforeseen circumstances amidst panic, fear, and shock. The COVID-19 pandemic is a recent example, with public leaders responding to and formulating strategies to attenuate the relentless waves of transmission and surges in resource demands. The pandemic underscored the importance of understanding how healthcare leaders make decisions in-crisis and what factors healthcare leaders prioritize in their decision-making process. Methods/Design. PubMed(NLM), Embase(Ovid), Scopus(Elsevier), Business Source(EBSCOhost), and ProQuest will be searched for primary qualitative studies published in English to explore the multi-faceted decision-making processes of healthcare leaders during a public health crisis. A meta-ethnographic approach will synthesize insights into healthcare leaders’ experiences and perspectives and generate a conceptual theory of decision-making in crisis. Discussion. Understanding how healthcare leaders make critical decisions during public health crises takes advantage of the lessons learned to inform how future health crises are managed. (This systematic review is registered in PROSPERO: CRD42023475382).
  PubDate: Fri, 12 Apr 2024 10:05:00 +000
Health Status of Nonemergency Patients in the Emergency Department Using
the EQ-5D
- Abstract: Background. Emergency department (ED) overcrowding is influenced by several factors including the hospital’s capacity, staff, patient discharges, and community resources. The number of annual ED visits has increased, with patients’ medical needs exceeding emergency capacity, resulting in a widespread concern about emergency room overcrowding. Nonemergency patients tend to use large amounts of emergency medical resources, which is one reason for ED overcrowding. Most patients consider their medical cases urgent, whereas medical professionals consider many cases to be nonemergency. Only a few studies have examined self-rated health among nonemergency patients. Methods. This cross-sectional study was conducted in the ED of a tertiary hospital in China using the European Quality of Life Five-Dimensional Questionnaire to investigate the health status of nonemergency patients. Results. Among the 545 respondents, 246 (45.14%) self-assessed their health as excellent, 186 (34.13%) as very good, 70 (12.84%) as good, 32 (5.87%) as average, and 11 (2.02%) as poor. Problems related to pain/discomfort were reported by 317 (58.17%) participants, 214 (39.27%) responded that they had problems related to daily activities, 212 (38.90%) responded that they felt anxious or depressed, 211 (38.35%) responded that they had problems related to self-care, and some or extreme problems related to mobility were stated by 193 people (35.41%). Conclusions. Nonemergency patients generally reported good health. Pain/discomfort was the most significant factor affecting the health of nonemergency patients, followed by limitation of daily activities. The duration of illness onset and self-rated health status were common factors influencing the health status of nonemergency patients. This trial is registered with ChiCTR1900023578.
  PubDate: Sun, 31 Mar 2024 04:50:00 +000
A Single High-Sensitivity Cardiac Troponin T Strategy for Ruling Out
Myocardial Infarction
- Abstract: Background. Ruling out acute myocardial infarction (AMI) in the emergency department (ED) is challenging. Studies have shown that a high-sensitivity cardiac troponin T (hs-cTnT)
  PubDate: Mon, 25 Mar 2024 14:50:00 +000
The Diagnostic Evaluation of the SINEH Cardiopulmonary Triage Scale and
the Emergency Severity Index in the Emergency Department: A Comparative
Study
- Abstract: Introduction. The diagnostic evaluation of the emergency severity index (ESI) in the triage of patients with cardiopulmonary complaints has a high sensitivity but a low specificity in the emergency department (ED). Therefore, triage scales with more accurate diagnostic evaluation are required. As a result, accuracy of the SINEH triage scale (SinTS) and the ESI was compared to compare mistriage of critically ill patients with cardiopulmonary complaints. Methods. This descriptive, analytical and cross-sectional study was conducted between December 2022 and April 2023. In this study, two nurses independently examined each patient using two triage scales. The admission unit and length of hospital stay were also recorded. The outcome was classified as high-risk admission (cardiac care unit and intensive care unit) and low-risk admission (internal unit or discharge from the ED). Undertriage and overtiage were defined as high-risk admission with triage level 3 and 4 and low-risk admission with triage level 1 or 2, respectively. A panel of experts evaluated content validity of SinTS and kappa designating agreement on relevance reported. The inter-rater reliability of two scales was also reported. Results. Finally, the study included 145 patients. The average age of the patients studied was 61.35 years. SinTS has a total mistriage of 29.63%, with 4.13% being undertriage and 25.5% being overtriage. In ESI, the total mistriage is 66.8%, with 1.3% being undertriage and 65.5% being overtriage. The undertriage of the two scales did not differ significantly by admission unit (), but the overtriage of the two methods did (). The sensitivity, specificity, and accuracy of SinTS were 86.3%, 63.37%, and 72.27%, respectively, while those of ESI were 95.4%, 5.94%, and 32.79%, respectively. Conclusion. SINEH triage scale has achieved the optimal accuracy in recognizing the acuity of the patients with chest pain and dyspnea by using SpO2, pressure of end-tidal carbon dioxide, troponin I, and peak expiratory flow. When triaging patients with chest pain and dyspnea, SinTS may exhibit a higher level of accuracy compared to ESI. More research is needed to improve accuracy of triage scales in patient with cardiopulmonary complaints.
  PubDate: Fri, 22 Mar 2024 12:20:00 +000
Surge Capacity of Taipei’s Regional Emergency Medical System during
COVID-19: A System Dynamics Approach
- Abstract: Background. The community transmission of COVID-19 has caused the breakdown of the regional emergency medical system (REMS), impacting the rights and care of regional patients with acute and severe conditions. This study proposes a model for the surge capacity of REMS to plan for readiness and preparedness during challenging events that overload capacity. Methods. The surge capacity of REMS during the COVID-19 pandemic was studied. The data collection included 26 hospitals that received the data. To simulate the dynamics of Taipei’s REMS surge capacity, we observed its ability to treat COVID-19 patients with moderate to severe acute respiratory distress syndrome (ARDS). This will involve monitoring the stock of ventilators, physicians, and nurses within the subsystem loops. Results. Healthcare managers and administrators can use the overload model and hypothetical scenarios to develop new scenarios with different demands on surge capacity. The REMS system capacity model can be used as an aid to guide planning and cross-checking for address Prepare to plan. Conclusions. We combined data regarding the availability of ventilators, physicians, nurses, specialized beds, and general acute care beds in our simulations. Thus, our simulations, with support from a well-established regional command and management structure, could help REMS achieve the optimal surge capacity.
  PubDate: Thu, 14 Mar 2024 06:35:00 +000
The Predictive Role of Lactate in the Emergency Department in Patients
with Severe Dyspnea
- Abstract: Objective. An accurate identification of patients at the need for prioritized diagnostics and care are crucial in the emergency department (ED). Blood gas (BG) analysis is a widely available laboratory test, which allows to measure vital parameters, including markers of ventilation and perfusion. The aim of our analysis was to assess whether blood gas parameters in patients with dyspnea at an increased risk of respiratory failure admitted to the ED can predict short-term outcomes. Methods. The study group eventually consisted of 108 patients, with available BG analysis. The clinical and laboratory parameters were retrospectively evaluated, and three groups were distinguished—arterial blood gas (ABG), venous blood gas (VBG), and mixed blood gas. The primary endpoint was short-term, all-cause mortality during the follow-up of median (quartile 1–quartile 3) 2 (1–4) months. The independent risk factors for mortality that could be obtained from blood gas sampling were evaluated. Results. The short-term mortality was 35.2% (38/108). Patients who died were more frequently initially assigned to the red triage risk group, more burdened with comorbidities, and the median SpO2 on admission was significantly lower than in patients who survived the follow-up period. In the multivariable analysis, lactate was the strongest independent predictor of death, with 1 mmol/L increasing all-cause mortality by 58% in ABG (95% CI: 1.01–2.47), by 80% in VBG (95% CI: 1.13–2.88), and by 68% in the mixed blood gas analysis (95% CI: 1.22–2.31), what remained significant in VBG and mixed group after correction for base excess. In each group, pH, pO2, and pCO2 did not predict short-term mortality. Conclusions. In patients admitted to the ED due to dyspnea, at risk of respiratory failure, lactate levels in arterial, venous, and mixed blood samples are independent predictors of short-term mortality.
  PubDate: Thu, 29 Feb 2024 14:50:00 +000
Comparison of Clinical Characteristics, Therapy, and Short-Term Prognosis
between Blunt and Penetrating Abdominal Trauma: A Multicentric
Retrospective Cohort Study
- Abstract: Objective. Large-scale studies on the characteristics and management of abdominal trauma in megacities in China are lacking. The aim of this study was to analyze and present the clinical patterns and treatment status of abdominal trauma in regional medical centers. Methods. Cases of abdominal trauma treated at seven medical centers in Beijing from 2010 to 2021 were collected. Clinical information about age, sex, injury cause, geographic distribution, abbreviated injury scale/injury severity score (AIS/ISS) value, injury-hospital time, preoperative time, surgically identified organ injuries, type of surgery, causes of reoperation and 90-day mortality was included in this study. Clinical characteristics, treatment methods, and short-term prognoses (90-days survival) were compared between blunt abdominal trauma (BAT) and penetrating abdominal trauma (PAT) cases. Non-normally distributed data are described as medians (IQR), and the Mann‒Whitney U test was performed; qualitative data were analyzed using the test. Univariate and multivariate survival analyses were performed by the Cox proportional hazards model. Results. A total of 553 patients (86.98% male) with a median age of 36.50 (27.00–48.00) years were included. The BAT group had a significantly higher proportion of serious injury (), lower initial hemoglobin level (1), and a lower laparoscopy surgery rate () compared to the PAT group. Additionally, more BAT cases were from the area around Beijing () and a longer injury-regional hospital time (10.47 (5.18–22.51) hours vs. 7.00 (3.80–15.38) hours, ). In the hollow viscus injury subgroup, the BAT group had a significantly longer injury-regional hospital time and preoperative time compared to the PAT group (injury-regional hospital time: 10.23 (6.00–21.59) hours vs. 7.07 (3.99–13.85) hours, ; preoperative time: 3.02 (2.01–5.58) hours vs. 2.81 (1.85–3.63) hours, ). The overall 90-day mortality was 11.9%, and longer injury-regional hospital time (HR: 1.01, 95% CI: 1.00–1.02, ), receipt of ICU treatment (HR: 4.69, 95% CI: 2.54–8.65, ), and severe ISSs (ISS > 25 vs. ISS
  PubDate: Tue, 13 Feb 2024 12:05:01 +000
Strategies for Oxygen Ecosystems in Middle-Income Countries: A Review and
Case Study from Lebanon
- Abstract: The COVID-19 pandemic led to a surge of critically ill patients and a sudden increase in the need for oxygen treatment worldwide. Pre-existing gaps in oxygen systems became apparent, and governments, multilateral agencies, and other partners scrambled to increase the production, supply, and use of oxygen to meet this need. The importance of an oxygen ecosystem that is appropriate for the local context became clear. This review describes strategies for oxygen ecosystems in middle-income countries, with specific experiences from Lebanon, following the authors’ extensive assessment of the country’s oxygen ecosystem, on behalf of the government and UNICEF. In the assessment, fifteen governmental hospitals were visited and evaluated using the UNICEF Oxygen System Planning Tool, discussions were held with key stakeholders, and documents were reviewed. An optimal oxygen ecosystem needs to take into consideration the production of oxygen and delivery to facilities, the maintenance system within facilities, and the clinical use of oxygen. Lebanon, a lower-middle income country in the Middle East, is contending with an extensive economic crisis affecting the health system. Eighteen recommendations for strengthening the oxygen ecosystem in Lebanon that are relevant for other middle-income countries include the establishment of a National Oxygen Committee, installation of additional oxygen plants, strengthened systems for maintenance and electricity supply, increased production, procurement and supply chain resilience, improved training and human resources, the use of data collection and regular information to guide the ecosystem, and integration of oxygen into the rest of the health system.
  PubDate: Fri, 02 Feb 2024 08:50:00 +000
Our Surgical Results in Popliteal and Infrapopliteal Artery Injuries: 21
Cases without Amputation
- Abstract: Objectives. Popliteal and infrapopliteal artery injuries have significant morbidity and mortality rates, especially in terms of amputation. In our study, we aimed to evaluate patients who operated due to popliteal and infrapopliteal vascular injuries in our clinic. Patients and Methods. Between 2016 and 2023; 21 patients who were operated in our clinic due to popliteal and infrapopliteal artery injuries were retrospectively evaluated. Results. 2 of the patients were female (9.5%) and 19 were male (90.5%). Age ranges were 21–78. The causes of injury were gunshot wounds in 9 patients (42.86%), blunt trauma in 7 patients (33.33%), and sharp object injuries in 5 patients (23.80%). Reversed saphenous vein interposition in 7 patients (33.33%), primary repair in 6 patients (28.57%), 6 mm polytetrafluoroethylene graft (PTFE) interposition in 3 patients (14.28%), end-to-end anastomosis in 2 patients (9.52%), saphenous-PTFE composite graft interposition in 2 patients (9.52%), and embolectomy in 1 patient (4.76%) were performed. Arterial ligation was not performed. Simultaneous orthopedic intervention was performed in 8 patients. Fasciotomy was performed in 3 patients. Venous repair was performed in 5 patients with venous injuries. Vein ligation was not performed. Mortality was observed postoperatively in 1 patient. No patient developed amputation. Foot drop developed with nerve damage in 2 patients. Conclusion. Mortality and morbidity rates may increase in popliteal and infrapopliteal artery injuries in cases of hemodynamic disorder, simultaneous bone fracture, multivessel injury, and nerve transection. These rates can be reduced by appropriate surgical repair and ensuring hemodynamic stability.
  PubDate: Wed, 24 Jan 2024 10:05:00 +000
Retracted: Effect of Hyperbaric Oxygen Therapy on Sleep Quality, Drug
Dosage, and Nerve Function in Patients with Sleep Disorders after Ischemic
Cerebral Stroke
- PubDate: Wed, 24 Jan 2024 07:11:29 +000
Retracted: Application of Doctor-Nurse-Patient Co-Decision-Making Nursing
Intervention Based on Evidence-Based Problems in the Rehabilitation of
Acute Ankle Lateral Collateral Ligament Injury
- PubDate: Wed, 24 Jan 2024 07:11:27 +000
Retracted: Short-Term and Long-Term Curative Effect of Partial Hepatectomy
on Ruptured Hemorrhage of Primary Liver Cancer after TAE
- PubDate: Wed, 24 Jan 2024 07:11:26 +000
Retracted: Application Effect of the 6S Care Model in Sterilization in the
Department of Stomatology and Its Impact on the Incidence of Nosocomial
Infection
- PubDate: Wed, 24 Jan 2024 07:11:24 +000
Retracted: Effects of Self-Made Prescription Compound Rhodiola on the
Ultrastructure of Podocytes in Rats with Type 2 Diabetic Nephropathy
- PubDate: Wed, 24 Jan 2024 07:11:22 +000
Retracted: Study of the Significance of Thromboelastography Changes in
Patients with Dyslipidemia
- PubDate: Wed, 24 Jan 2024 07:11:21 +000
Retracted: Clinical Analysis on the Effects of Tandospirone Citrate
Assisted by Drawing Therapy on Medication Compliance and Sleep Quality in
Patients with Anxiety Disorders
- PubDate: Wed, 24 Jan 2024 07:11:19 +000
Retracted: Predictive Value of Preoperative Dynamic Contrast-Enhanced MRI
Imaging Features in Breast Cancer Patients with Postoperative Recurrence
Time
- PubDate: Wed, 24 Jan 2024 07:11:17 +000
Retracted: Clinical Effect of Minimally Invasive Percutaneous Pedicle
Screw Internal Fixation Combined with Injured Vertebrae Bone Grafting in
the Treatment of Thoracolumbar Fractures in Orthopedic Surgery
- PubDate: Wed, 24 Jan 2024 07:11:16 +000
Retracted: Preparation of PCL Electrospun Fibers Loaded with Cisplatin and
Their Potential Application for the Treatment of Prostate Cancer
- PubDate: Wed, 24 Jan 2024 07:11:14 +000
Retracted: Clinical Effect of Hufu Copper Scraping on Shoulder-Hand
Syndrome after Stroke
- PubDate: Wed, 24 Jan 2024 07:11:13 +000
Retracted: Clinicopathological Features of 166 Cases of Invasive Ductal
Breast Carcinoma and Effect of Primary Tumor Location on Prognosis after
Modified Radical Mastectomy
- PubDate: Wed, 24 Jan 2024 07:11:11 +000
Retracted: Serum IMA and LP-PLA2 Levels in Patients with Coronary Heart
Disease and Their Correlation with the Degree of Myocardial Ischaemia and
Their Diagnostic Value
- PubDate: Wed, 24 Jan 2024 07:11:09 +000
Retracted: Comparison of Curative Effect between PFNA and PCCP in the
Treatment of Femoral Intertrochanteric Fractures
- PubDate: Wed, 24 Jan 2024 07:11:07 +000
Retracted: Biochemical Behaviours of Salmeterol/Fluticasone Propionate in
Treating Asthma and Chronic Obstructive Pulmonary Diseases (COPD)
- PubDate: Wed, 24 Jan 2024 07:11:06 +000

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