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Annals of Neonatology Journal
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  This is an Open Access Journal Open Access journal
ISSN (Online) 2636-3569
Published by Minia University Homepage  [1 journal]
  • The Egyptian Health Council: A Step Forward in the Right Way

    • Abstract: On March 2022, The Egyptian health council (EHC) law No. 12 for 2022 was issued promulgating a law establishing and organizing the Egyptian health council (EHC). It aims to organize the fields of health in Egypt in the areas of post-university education and specialized training, rehabilitation and development of the scientific and clinical level for all health workers. The main targets of this council are developing the level of medical education and health training for all health workers - especially physicians- in various medical specialties and testing them to verify that they are qualified efficient for safe medical and health practice. As well as achieving integration and cooperation in the field of health training, between the council and the various scientific agencies and scientific societies either local or international. Finally the council will be responsible for permitting a license to practice the profession to all physicians. Many challenges are facing this work which needs more and more effort and decisions to overcome economic, financial or logistic challenges. How to unify all of different visions and missions of all medical agencies and scientific committees in one system is the most challenging. To achieve all of targets of EHC; cooperation is mandatory between the council and the different scientific committees and agencies.  Finally we may ask ourselves; will the Egyptian health council (EHC) be able to unite the different medical practice in one system' We hope that.In conclusion: The Egyptian health council (EHC) law was issued to organize the fields of health in Egypt as regarding health workers especially the physicians training and education. Many economic, financial or logistic challenges are facing it. Cooperation is mandatory between the council and other agencies and different scientific committees to reach to the targets. Will the Egyptian health council (EHC) be able to unite the different medical practice in one system' We hope that.
       
  • Maternal and Neonatal Benefits of Prophylactic Administration of Vitamin K
           Before Elective Cesarean Section; A Randomized Control Trial

    • Abstract: Background: We aimed to assess the efficacy of prenatal prophylactic maternal vitamin k administration in decreasing blood loss during and after elective cesarean section (CS) and its effects on neonatal outcomes. Methods: A clinical trial included 200 pregnant women planned for elective CS, were randomized into two equal groups. The study group included 100 women who received vitamin K (10 mg) intramuscularly once daily for three days before elective CS, while the control group included 100 women who did not have vitamin K before CS. Maternal PT, PC, APTT, and hematocrit were evaluated pre-and postoperatively. Maternal blood loss during CS was assessed by counting the soaked gauzes. Vitamin K levels in the umbilical cord, neonatal APGAR score, and the neonatal PT and PC were measured. Results: Postoperative PT and APTT of women in the vitamin K group were shorter than the control group (p<0.001). Also, women's postoperative PC and hematocrit in the vitamin K group were higher than that of the control group (p<0.001). Neonates who received vitamin K had significantly shorter PT, higher PC, and less bleeding than the control group (p<0.001). Cord blood vitamin K levels in the group who received vitamin K were considerably higher than in the controls (p<0.001). Conclusion: Administration of prophylactic vitamin K had a beneficial effect on maternal bleeding tendency but to somewhat added no value in neonates as both PT and PC values were within normal despite of significant differences in both groups.
       
  • The Relationship between Isolated Oligohydramnios at Term and Labor Mode:
           A Prospective-Observational Study

    • Abstract: Objective: To assess the relationship of between isolated oligohydramnios at the last few weeks of pregnancy with mode of delivery and evaluate its role in failure of induction of labor and its role in increase rate of caesarian section.Study design: This is a prospective-observational study included 70 pregnant women, 35 of them with normal amount of liquor (control group), and the other 35 pregnant women with isolated oligohydramnios diagnosed according to ultrasound criteria (amniotic fluid index (AFI) of 5 cm, single deepest pocket of 2 cm) (study group) , all pregnant women at (37-40 weeks) of gestation, attended the ante-natal care unit (ANC) unit in Nu'man teaching hospital and the outpatient private clinics in Hay Aljameaa/ Al-Harthya in Baghdad from December 2020 till April 2021.Results: Study group includes 35 pregnant women with isolated oligohydramnios and the control group includes 35 pregnant women with normal AFI after matching of other inclusion criteria (maternal age, parity and gestational age) for both groups, there is a significant difference between the study and control group in mode of delivery as the highest percent of women with IO delivered by cesarean section (68.57%) while the highest percent of women with normal AFI delivered vaginally (74.29%). There is a statistical difference in the rate of cesarean section due to abnormal doppler study before induction of labor (p value= 0.0500), there is significant difference in mean birth weigh between both study groups (P-value= 0.0380), with the statistically significant differences in Apgar score at 1 minute and 5 minutes ≥7/10 (P-value = 0.0047, 0.0253) respectively. With high level of significance about neonatal intensive care unit admission (NICU) > 24 hrs (P-value= 0.0110).Conclusions: Pregnancies with isolated oligohydramnios are associated with increased rate of development of fetal distress, meconium-stained liquor, rate of caesarean delivery, NICU admission and low birth weight. Rate of cesarean for fetal distress is increased because of increased rate of induction of labor in women with oligohydramnios. The study does not suggest any root for delivery of pregnancies with IO, It is better to give the patient chance of spontaneous labor (if there is no fetal distress) with close monitoring for the fetal heart rate during labor. Cesarean section is indicated for IO with fetal distress at any stage of labor to decrease perinatal morbidity and mortality. Further studies may be required to evaluate the long-term consequences of isolated oligohydramnios.
       
  • Predictive Value of Heart Rate Observation (HeRO) Score for Sepsis in
           Preterm Neonates

    • Abstract: Background: Neonates admitted to neonatal intensive care units (NICU) are at an increased risk to develop sepsis, especially preterm neonates because of their immature immune systems. Early detection of sepsis, before pronounced clinical deterioration, would allow earlier administration of supportive treatments and antibiotics this will improve morbidity and lead to favorable outcomes.Objective: The aim of this study was to determine the effectiveness of HeRO score to detect neonatal sepsis in preterm neonatesMethods: This prospective observational study included 170 preterm infants. All studied neonates were subjected to HeRO scores initially and throughout hospital stay. Confirmation of neonatal sepsis was done by withdrawal of positive C-reactive protein (CRP) and positive blood culture.Results: The studied neonates were divided into initial septic group and non-septic neonates; HeRO score showed statistically significant increase in septic patients than non-septic (median (IQR) 2 (2-3) vs. 1 (0-1) respectively for day 1 of admission (p <0.001) and 2 (1-2) vs 0 (0-1) on day 4 of admission (p <0.001) with a cut off value of > 1 in both day 1 and 4 with sensitivity and specificity 92.75% & 98.02% for day 1 and 65.22 % and 85.15% in day 4 respectively. Conclusion: Heart Rate Observation (HeRO) Score can be used for early detection of neonatal sepsis in preterm neonates.
       
  • Analytical Study of Different Modes of Continuous Positive Airway Pressure
           (CPAP) in Management of Respiratory Distress Syndrome (RDS) in Preterm
           Neonates

    • Abstract: Background: Respiratory distress syndrome (RDS), is the single most important cause of morbidity and mortality in preterm infants. In infants with progressive respiratory insufficiency, intermittent positive pressure ventilation (IPPV) with surfactant has been the usual treatment, but it is invasive, potentially resulting in airway and lung injury. Continuous positive airway pressure (CPAP) has been used for the prevention and treatment of respiratory distress syndrome, as well as for the prevention of apnoea, and in weaning from IPPV.Objective: To evaluate the effect of different types of CPAP in treatment of preterm neonates with respiratory distress syndrome in Al-Azhar (Assiut) university hospital neonatal intensive care unit (NICU). Patients and methods: This was a prospective study, conducted at Al-Azhar (Assiut) university hospital NICU. The study included 60 preterm neonates with respiratory distress syndrome divided into 3 groups: (1st group); 20 cases on nasal CPAP; (2nd group); 20 cases on nasopharyngeal CPAP and (3rd group); 20 cases on mask CPAP from March 2021 to November 2021. Results: The results of our study showed significant difference between the three groups regarding complications, nasal irritation and problems in fixation as it occur in (10%, 10%, 85%) respectively of cases in mask group and (90%, 85%, 85%) respectively in nasal group and (90%, 0%,0%) respectively in nasopharyngeal group with p value < 0.001 in all. There was also a significant difference between the three groups regarding to response to treatment with P value < 0.04.Conclusions: CPAP is one of the effective treatments of RDS leading to significant improvement of outcome, reducing hospital stay and the need for invasive mechanical ventilation with its harmful adverse effects and thus the case fatality rate of RDS cases and so the overall mortality rate of the NICU.
       
  • Newborn Screening for Congenital Hypothyroidism and Congenital Adrenal
           Hyperplasia in Egypt

    • Abstract: Two disorders, congenital adrenal hyperplasia (CAH) and congenital hypothyroidism (CH), when untreated, can lead to devastating, irreversible and fatal outcomes. Permanent cognitive impairment, growth failure and dysmorphic features are seen in congenital hypothyroidism (CH) and early infant death in males with salt loosing CAH (as most females are discovered by presence of atypical genitalia, while males appeared normal).Newborn screening (NBS) for congenital hypothyroidism (CH) was more rapidly adopted throughout Egypt, while NBS for congenital adrenal hyperplasia (CAH) was recently added.Early treatment of CAH is much simpler with taking a pill a day unlike CAH requiring multiple medication doses, and possibly surgery apart from enteral and parenteral stress doses during adrenal crisis.Early newborn screening specifically for those two disorders has a great importance for early diagnosis, early intervention and prevention of catastrophic outcomes.
       
  • Gentle Human Touch (GHT) may Potentiate the Analgesic Efficacy of Topical
           Anesthetic and other Non-Pharmacological Measures During Retinopathy of
           Prematurity Screening: A Prospective Study

    • Abstract: Background: There is a global increase in the incidence of retinopathy of prematurity (ROP). As the most common cause of childhood blindness, a routine screening protocol was established for preterm neonates, in which unfortunately, the screening process involves several painful interventions.Aim of work: Comparing the analgesic efficacy of oral 10% dextrose, breast milk, and sterile water with or without gentle human touch (GHT) during retinopathy of prematurity (ROP) screening.Patients and methods: 90 preterms undergoing ROP screening were divided into groups: EBM (n = 30) (GI), 10% dextrose (n = 30)(GII) or sterile water (n = 30) (GIII), a minute before examination. Premature infant pain profile (PIPP) was assessed before and after GHT.Results: Saturation was statistically significant between GI and GIII (P=0.000) and between GII and GIII (P=0.025) before GHT. After GHT Peak heart rate and increase in heart rate from baseline were statistically significant between G(I) and G(III) (P=0.000), between G(I) and G(II) regarding increase in heart rate (P=0.000) and between G(II)and (III) regarding peak heart rate (P=0.019). Mean PIPP was significant for individual group (P = 0.000) before and after GHT.Conclusions: GHT and a topical anesthetic potentiate the analgesic efficacy of non-pharmacological measures during retinopathy of prematurity (ROP) screening.
       
  • Severe Hyperbilirubinemia in Term and Late Preterm Newborns: An
           Evidence-Based Clinical Practice Guideline Adapted for The Use in Egypt
           Based on The ‘Adapted ADAPTE’ Methodology

    • Abstract: Background: The presented evidence-based clinical practice guideline (CPG) is proposed as a National CPG using an evidence-based and formal CPG adaptation methodology. The purpose of this study was to adapt the international CPGs’ recommendations for term and late preterm neonates with severe hyperbilirubinemia to suit the healthcare system in the Egyptian context. This CPG provides a framework for prediction, prevention and management of severe hyperbilirubinemia in newborn infants of 35 or more weeks of gestation. The quality of evidence and strength of recommendations are indicated. The guideline adaptation group was chosen from various Egyptian Universities. There was an active involvement of a Multidisciplinary Review Committee following a standardized process. The Neonatology Guideline Adaptation Group (NGAG) was assigned individual health questions to cover the different sections of the required CPG. A literature search for source CPGs was carried out. The NGAG studied several guidelines. Critical appraisal was done by AGREE II (Appraisal of Guidelines for Research and Evaluation) Instrument to rate and select the appropriate guidelines. Results: The NGAG decided to adapt mainly the American Academy of Pediatrics Guideline (2004, 2009 & 2011) and for the questions which were not answered; the best and most relevant evidence available was used. Implementation tools were sought for to facilitate the application of the adapted CPG. Conclusion: The finalized CPG offers healthcare providers with applicable evidence-based guidance for severe neonatal hyperbilirubinemia in the Egyptian context. The Adapted ADAPTE method emphasized the value of collaborative clinical and methodological expert groups’ efforts for adaptation of national guidelines.
       
  • The Rule of Inhaled Salbutamol on The Outcome of Transient Tachypnea of
           Newborn

    • Abstract: Background: Transient Tachypnea of newborn is one of the most common respiratory problems in newborns. The cause of development of TTN is failure of transition from intrauterine to extra uterine life due to delay in absorption of lung fluids.Objective: studying the effect of inhaled salbutamol on outcome of transient tachypnea of newborn. Patients and Methods: This prospective study was attended at department of neonatology at El Azhar (Assuit) University & Sohag Teaching Hospital: Group I (50 cases): infants in this group receive salbutamol inhalation. Group II (50 cases): infants in this group don`t receive salbutamol inhalation.Results: There were insignificant differences between two groups as regard needing of oxygen support and duration of oxygen as in salbutamol group lower number of cases needs oxygen support and cases that need it had lower duration versus no salbutamol group (P-Value < 0.001). There was a significant decrease in enteral feeding   initiation time (P-value < 0.001)  and hospital stay among cases received salbutamol versus no salbutamol (P-value <0.0001). Conclusion: The current study indicated that administration of salbutamol in treatment of TTN patients causes improvement in the clinical parameters, as well as the initiation of oral feeding, a reduction in the need for oxygen therapy, a reduction in the need for advanced respiratory support and the duration of hospitalization
       
  • The Value of Routine Cranial Ultrasound in Preterm Neonates Less Than 37
           Weeks: A Prospective Analytical Study

    • Abstract: Background: Cranial ultrasound is a safe imaging modality that does not require sedation and can be performed bedside in preterm.Objective: To evaluate the value of routine cranial ultrasound as a routine screening in preterm neonates.Patients and methods: This was a prospective observational comparative study conducted on 50 preterm infants less than 37 weeks gestational age admitted to the Neonatal Intensive Care Unit (NICU). The cranial ultrasound (CUS) was done to all neonates in the first 4 to7 days of life & repeated at 10 to 14 days of life for detection of any cranial ultrasound abnormality and follow up for these abnormalities if present. They were divided into two groups: group I included cases with normal cranial ultrasound and group II included cases with abnormal cranial ultrasound.Results: Intraventricular hemorrhage was the most abnormal CUS findings (26.3%); followed by periventricular leukomalacia (15.8%) then intra cerebral hemorrhage, hydrocephalous & holoprosencephaly (10.5%). There was significant decrease of hemoglobin levels, significant increase in prothrombin time (P≤0.001 for all), partial thromboplastin time (P- 0.003), international normalized ratio levels ( P-0.002) in neonates with abnormal CUS. There were significant increase in cases with apnea (P≤0.001), cyanosis (P- 0.017) and pallor (P-0.001) in cases with abnormal US.Conclusions: Global routine cranial ultrasonography screening for all preterm neonates even if asymptomatic or not among at-risk population is highly valuable, cheap, and applicable tool investigation for detection of many neurological disorders like intraventricular hemorrhage, periventricular leukomalacia and intracerebral hemorrhages.
       
  • Tandom Mass Spectrometry in Neonates Suspected to have Inborn Errors of
           Metabolism

    • Abstract: Background: Inborn errors of metabolism (IEM) are a diverse collection of genetic abnormalities that are a significant source of illness and death in children.Objectives: To determine the prevalence of IEM in newborns with suspected IEM and to diagnosis IEM as soon as feasible to reduce morbidity and death in ill neonates.Subjects and methods: the study included 50 neonates were admitted to Minia University's Neonatal Intensive Care Unit (NICU) between January 2021 and January 2022 with sepsis-like symptoms (lethargy, hypoactivity, poor suckling, and poor crying), as well as convulsions, persistent metabolic acidosis, persistent vomiting, or a history of previous sib death from an unknown cause, or clinical deterioration in a previously healthy neonate. Result: Out of 50 neonates, eighteen patients (36%) were diagnosed as having IEM. Urea cycle defect was the commonest IEM diagnosed in 7 (14%) cases, followed by suspected organic academia in 4(8%) cases then MSUD in 2 (4%). TMS confirmed the diagnosis of IEM in 11 out of 18 patients diagnosed with IEM. The other seven cases that had IEM were diagnosed by using other clinical and laboratory investigation. 20 (40%) of the patients had a history of siblings' deaths, whereas 3 (6%) had no history of siblings' deaths (diagnosed with IEM).Conclusions: IEM is a common cause of neonatal illness in the NICU. IEM studies should be performed regularly in NICUs for babies until national newborn screening can be introduced in Egypt, and they should be done jointly rather than one by one, to maximize patient survival and decrease death and morbidity. 
       
  • Incidence & Risk Factors for The Development of Transfusion-Associated
           Necrotizing Enterocolitis in Preterm Infants After Packed red Blood Cells
           Transfusion. A Prospective-Observational Study

    • Abstract: Background: Necrotizing enterocolitis (NEC) is a progressing inflammatory disease that is associated with high rates of morbidity and mortality in preterm babies. Transfusion-associated necrotizing enterocolitis (TANEC) is described as NEC where symptoms &/or signs start within 48 hours of blood or packed red blood cells (PRBCs) transfusion.Objective: To determine the incidence of TANEC in preterms admitted to our neonatal intensive care unit & to identify the possible risk factors.Methods: Sixty (60) preterms were conducted in this prospective observational study, they received packed red blood cells (PRBCs) transfusion due to different indications admitted to the NICU of the department of Pediatrics, Cairo University hospitals for a 6-months-duration and monitoring group of preterms who developed TANEC and compare all the possible risk factors.Results: Out of the 60 preterms enrolled in the study, 13 (21.7%) preterms developed NEC within 48 hours after PRBCs transfusion. According to modified Bell´s staging for NEC: 7 preterms were diagnosed as stage I , 2 preterms were diagnosed as stage IIA, and 4 preterms in stage IIB, none of them required any surgical interventions, and no mortalities were detected among them. Low Apgar scores at 5 and 10 minutes & gestational age and low birth weight were highly statistically significant variants between both groups.Conclusion: Keeping preterms receiving nothing per oral before, during & after PRBCs transfusion showed statistically significant protection against TANEC. The most significant alarming sign was the occurrence of episodes of apnea 12 hours after transfusion with a highly significant value.
       
  • Effect of Phototherapy on Electrolytes, Liver and Kidney Functions during
           Treatment of Neonatal Hyperbilirubinemia. A Prospective-Analytical Study

    • Abstract: Background: Neonatal jaundice is a frequent problem affecting the newborn with various etiologies. Although phototherapy is considered the standard treatment for neonatal hyperbilirubinemia, it has some complications, as erythematous rashes, diarrhea, hyperthermia and electrolyte disturbance.Objective: To assess the effect of phototherapy on liver enzymes, renal functions, and serum electrolytes in jaundiced neonates before and after phototherapy and to assess changes in biochemical parameters according to mode of treatment including using Bilisphere then phototherapy, IVIG & Bilisphere then phototherapy and phototherapy only. Methods: One hundred neonates with unconjugated hyberbilirubinemia were enrolled. Jaundiced neonates were placed under phototherapy at a distance of 45-50 cm. Laboratory investigations were done before and after phototherapy.Results: Mean (± SD) TSB and DSB significantly declined after phototherapy with p value <0.001. Also, Mean (± SD) levels of AST and ALT showed statistically significant decrease after phototherapy (p<0.001). In addition, Mean (± SD) creatinine and urea levels showed statistically significant decrease after phototherapy (p<0.001).We also found statistically significant decrease in potassium and Calcium levels (p-value < 0.001) after treatment. As regards mode of treatment, we found a statistical significant decrease in TSB, creatinine and calcium among the different modes of treatment (p<0.001).Conclusion: Neonatal hyperbilirubinemia is considered a treatable condition and much of its ill-effects can be eliminated by proper intervention. However, continuous observation of electrolytes as potassium, sodium and calcium is needed as disturbance in their levels is of concern.
       
  • Evaluation of The Role of Ambroxol in Treatment of Respiratory Distress
           Syndrome: A Prospective Randomized - Controlled Trial

    • Abstract: Background: RDS was reported to be the most common cause of morbidity and mortality among preterm neonates.Objective: This study aimed to evaluate the effects of postnatal intravenous ambroxol    for infant diagnosed with mild to moderate RDS.Patients and methods: This study includes 40 preterm neonates, who were submitted to complete history taking, clinical examination, and initial investigations. All babies were followed up clinically, ABG testing, and x-ray imaging. All neonates in the intervention group (2nd group), (20 cases) were received i.v. ambroxol    for 5 days beside routine RDS management, while the control group (1st group), (20 cases) were received the routine management for RDS.Results: There were non-significant differences between the two groups as regard sex, birth weight, residence (urban or rural) mode of delivery and gestational age (P-values 0.752, 0.825, 0.749, 0.749, and 0.548 respectively). There were non-significant differences between the two groups as regard Apgar score at 1 and 5 minutes (P-values 0.879, 0.871 respectively). After treatment, there were significant differences between both groups as regard PCO2 (mmHg), SaO2%, PaO2 mmHg. The need for M.V and CPAP and its duration, hospital stay, and death rate significantly decreased in neonates who received ambroxol.Conclusion: Giving intravenous ambroxol to preterm newborns with RDS improves gas exchange and reduces the requirement for and duration of mechanical ventilation, CPAP, oxygen therapy, and overall hospital stay.
       
  • Comparison Between Oral Zinc and Agar with Phototherapy in The Treatment
           of Neonatal Jaundice: A Prospective Clinical Trial Study

    • Abstract: Background: Neonatal jaundice is a major neonatal health hazard and this calls for the importance of studying effective treatment for it.Objective: To evaluate the efficacy of phototherapy, oral zinc salts and agar      on the treatment of neonatal jaundice in term and late-preterm at-risk neonates.Methods: This study is a prospective randomized clinical trial study included a total of 75 neonates with indirect hyperbilirubinemia during the period from March 2019 to April 2020 who were allocated randomly to 3 groups (n=25 per each): Group (I) included neonates received phototherapy alone, group (II) that included neonates received phototherapy and oral zinc salts and group (III) that included neonates received phototherapy and oral Agar     . Total serum bilirubin (TSB) level was measured on admission, as well as 24, 48, 72 and 84 hours after the intervention. Hospital stay, feeding status, complications and risk factors for neonatal jaundice were assessed.Results: A significant reduction was recorded in TSB after 24 and 48 hours in all groups and the reduction was more significant in neonates of group (II) who received oral zinc with phototherapy and group (III) who received agar with phototherapy compared to group (I) who received only phototherapy (p < 0.01). However after 72 and 84 hours, the total serum bilirubin (TSB) levels were almost similar among all groups, but it still continue to decline. Hospital stay duration was significantly shorter (p < 0.01) in the group that received phototherapy and zinc compared to the groups that received phototherapy only and the group that received phototherapy and agar     .Conclusion: Administration of oral zinc or agar besides phototherapy was safe and can be more effective in the treatment of neonatal Jaundice due to indirect hyperbilirubinemia compared to receiving phototherapy alone.
       
  • What to Know about Neonatal Alloimmune Thrombocytopenia (NAIT) '

    • Abstract: Neonatal alloimmune thrombocytopenia (NAIT) is the most common cause of severe thrombocytopenia in full-term newborns. In the mother and fetus with incompatible platelet antigens, there is a risk of developing anti-platelet alloimmunization. It corresponds to Rhesus (Rh) alloimmunization in pathophysiology. These platelet alloantibodies pass trans-placentally into fetal circulation and cause fetal platelet destruction. Although its presentation may be isolated thrombocytopenia, some affected infants may suffer major hemorrhages, including intracranial hemorrhage (ICH), which may occur as early as 16 weeks of gestational age, and the first pregnancy may not be spared. Death or neurologic impairment occurs in up to 25% of the affected infants. NAIT is managed both ante- and postnatally. Postnatal management of NAIT depends upon the platelet count and the neonate's clinical condition. At the same time, antenatal management of NAIT aims to ameliorate fetal thrombocytopenia in subsequent pregnancies after diagnosis of NAIT in a previous pregnancy and thus prevent fetal and neonatal ICH.
       
  • Acknowledgement for Reviewing

    • Abstract: The Editor-in-Chief expresses his gratitude to the following individuals, who reviewed manuscripts for Annals of Neonatology from Vol. 1 to Vol. 5.
       
 
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