Turner Syndrome – A distinctive group of woman

 

Turner syndrome

Women with Turner Syndrome (TS) are a distinctive group of women who require specialized medical and obstetrical/gynecological care. TS is found in approximately 1 in 2,500 pregnancies and is the result of the loss or partial loss of an X chromosome. Normally women’s chromosomes are 45XX and with TS it will be 45X. Because of this missing chromosome women with TS can look slightly different and can have an array of possible medical conditions such as:

  • cardiovascular disease which could be the result of a congenital anomaly
  • osteoporosis
  • hypothyroidism
  • abnormal lipids
  • diabetes

Pediatricians and pediatric endocrinologists usually follow these patients closely during childhood and adolescence, initiating estrogen to begin puberty and normal development. Conception and pregnancy offer unique conditions which will require individualized intense care by a team of specialists and preconception counseling is a must. Because of the higher risks for various medical conditions, TS patients need to be followed carefully throughout their lives.

-Dr. P

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Hair Loss – Its Cycle, Most Common Causes, and the Effect of Stress on It

Hair Loss 7…..I would like to start a discussion of hair loss in women.  This is a common condition for many women.  By age 50, 50% of women will suffer from this problem.  Another term for significant hair loss is alopecia, and affected women can suffer great anxiety and stress.

…..There are two types of alopecia: scarring and non-scarring.  Scarring alopecia can be found in discoid lupus erythematosus and other conditions.  The scar formation destroys the hair follicle, thus causing the hair loss.  These patients should see a dermatologic specialist as soon as possible.  On the other hand, in non-scarring alopecia, the hair follicles are not permanently destroyed, and so the hair loss may be reversible.

What Cycle Does Your Hair Bear Throughout Your Life?

…..Let us start with the hair growth cycle.  There are three phases of this cycle: anagen (growth phase), catagen (transitional or resting phase), and telogen (testing or shedding phase).

…..In the anagen phase, the hair grows, and 80 to 90% of all hair follicles are included in this phase.  This growth pattern can last for 2-3 years, and the length of time is genetically determined.

…..The catagen phase lasts only for 2-3 weeks.  In this resting phase, only 1 to 3% of the scalp follicles are included.

…..The last phase is the telogen phase.  This is when hair is shed usually at a normal rate of 75-100 hairs per day, and it lasts for about 3-4 months.  So it is important to remember that it is natural for some hair loss every day!

Why Is Hair Loss Harrowing You?  What is the Cause?

For most patients, a careful history of their hair loss will give a good indication of the cause.  There are many questions to be considered; the following are some of them:

  •  Is the loss diffuse or is it in a specific area?  If it is in a specific area, it is important to delineate the location.
  • Hair care techniques and the products used can provide important Hair Loss 4information.  Are chemical straighteners being used?
  •  Are cornrows part of a new style of yours or have they been used for some time?  Traction alopecia has been seen with the cornrows hairstyle.
  • During a physical exam, the scalp should be carefully inspected.  Is there any scaling, inflammation, or reddish areas?

…..In the areas of the hair loss, if there are hair follicles then you are dealing most likely with non-scarring alopecia.  If there are no follicles then this could be scarring alopecia, and this patient should be sent to a dermatologist, who will consider a biopsy.  The hair should be evaluated for its length, thickness, and fragility.  Lastly, a pull test could be performed, which will help determine if active shedding is taking place.

Women: Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

Is the Stress in Your Mind Causing Stress on Your Hair?

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…..Remember how our mothers always told us that stress could cause so many 

problems and make us feel terrible?  As always, our mothers were right.  For women, a severe illness, psychological stress, or having a baby are inciting stressful events that can cause physical effects.  One of these effects is hair loss.

.…..Usually 90% of our hair is in the growth phase, with 10% in the resting phase.  Keep in mind that some hairs are always shedding in the resting phase, and it is usually a small and regular amount.

…..Telogen Effluvium (TE) is a condition of diffuse hair loss that is caused by an identifiable stressful life situation; three of those situations were stated above.  In TE, 70% of hairs are in the growth phase and 30% in the resting phase.  This results in about 3 times as many resting phase hairs being shed daily.  The hair loss is gradual and diffuse and may be similar in appearance to the loss associated with the female patterned hair loss called androgenic alopecia (AGA).

…..With TE, a woman usually is aware of shedding, but with AGA, the loss is gradual, and shedding is not usually a complaint that is presented.  Also with TE, the loss may not become apparent for several months after the stressful event.

…..To treat TE, you must first identify and resolve the stress the body has been subjected to.  With pregnancy or an acute illness, the hair loss is usually self-limiting with complete recovery within 6 months after having the baby or recovering from the illness.  When TE is caused from psychological stress, since the treatment and recovery can take some time, the hair recovery can also involve a prolonged period.

Four Reasons Why Your Hair Could Be Losing

…..Now we will close our discussion of hair loss in women with a few more causes.

…..Traction Alopecia is hair loss from excessive pulling at the hair roots over a prolonged period of time.  The loss occurs where the hair is pulled in one direction, for example, by a ponytail or a cornrow pattern of braids.  The treatment is usually just discontinuing the particular hairstyles, and in time, the problem resolves.

…..Tinea Capitis is caused by a fungal infection of the hair shaft.  It is most common in children.  However, it can be found in immunocompromised adults such as AIDS patients and patients receiving chemotherapy.  The presentation is usually a round patch of hair loss associated with pruritis and scaling.  The diagnosis is made with cultures and the examination of scrapings along the border of the lesion.  The usual treatment is oral antifungals.

…..Trichotillomania is classified as an impulse control disorder.  It involves compulsive and repetitive pulling or plucking of the hair, which leads to noticeable hair loss.  Patients have described feeling tension before pulling out the hair, and the tension is relieved after the hair is pulled out.  This condition is usually managed by a trained mental health professional.

…..Anagen Effluvium involves an acute loss of scalp and body hair when the growth phase of hair is disrupted.  This occurs mostly with patients on chemotherapy.  Because 80 to 90% of hair is in the growth phase, this hair loss is dramatic and diffuse.  The loss usually begins 1-3 weeks after the chemotherapy is started, and the hair returns typically 3-6 months after the treatment is finished.  The initial hair that returns may differ from the patient’s usual hair, but these changes are mostly temporary.  Permanent hair loss from this condition is usually rare.

…..I hope this information on hair loss in women has been enlightening and helpful.

-Dr. P

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Are You at a High Risk for Lung Cancer?

Last week, I spent the day attending a conference at the Icahn School of Medicine at Mount Sinai in New York City.  It was called Lung Cancer Screening: A Paradigm Shift in Primary Care.  The main focus was on the changing thoughts and new protocols for screening for lung cancer in high risk patients.  Of course I looked at the course through my OB/GYN glasses, and here are some of the points I took home:lungs brown and pink

  • Lung cancer is the #1 cancer killer in the United States, and it is now found as often in women as it is in men.
  • Therefore, for women in the United States, lung cancer is the #1 cancer killer, and its numbers are greater than breast, ovarian, and uterine cancer combined.
  • Smoking and exposure to passive smoke are the main causes of lung cancer.
  • Finding lung cancer at an early stage and having it removed can give an overall cure rate of 80% at the Stage 1 level.
  • Low-dose lung screening CAT scans can pick up these early cancers, and the radiation exposure can be low, thus decreasing the radiation exposure risks.
  • With the new thoracic laparoscopic surgical techniques, post-op pain and recovery time have been greatly reduced.

The questions that need to be resolved are many.  When do you start the screening process?  In the high risk patient, do you screen yearly?  How do you define who is the high risk patient?  How are the scans paid for?

I left the conference more determined than ever to try to help my patients stop smoking and to help the younger ones not to start.  If you do smoke and have been smoking for a while, please speak to your health care providers to see if these new developments may be of help for you.  The lung cancer screening protocols are evolving so keep your eyes and ears open!

-Dr. P

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Postmenopausal Women – Preventing Your Urinary Tract Infections


…..
Postmenopausal women are at an increased risk for urinary tract infections (UTIs) because of a decrease in their estrogen levels.  This lower hormone state is associated with specific physical and physiologic changes that increase this risk:Postmenopausal Women – Preventing Your Urinary Tract Infections

  • Thinning of the mucosa of the vulva (vaginal tissue)
  • Changing of the normal bacteria that usually inhabit the vagina, especially a decrease in lactobacillus colonization
  • An increase in the pH of the vagina
  • Vaginal colonization of E. coli.

…..There have been multiple studies which have found a decrease in these UTIs with the use of estrogen intravaginal creams.  There are many variations on the types of estrogen used and many commercial products available.

…..If you are in the menopausal time of your life and suffer from recurrent UTIs, ask your medical professional about the possible use of a vaginal estrogen preparation.

-Dr. P

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Two Reasons Why You Should Not Drink Alcohol During Pregnancy

Water Pouring from Bottle…..Alcohol is a teratogen!  A teratogen is a drug or any other substance that can affect the development of an embryo and can lead to birth defects or other developmental problems.  Fetal alcohol syndrome (FAS) is a constellation of physical, behavioral, and cognitive abnormalities in children resulting from a mother drinking alcohol during a pregnancy.

…..The Centers for Disease Control and Prevention report that the rates for FAS in the United States range from 0.2 to 2 cases per 1000 live births.  A less severe form of this problem, called fetal alcohol spectrum disorders (FASD), might be 3 times this rate.

…..There is always the question about how much alcohol will cause a problem.  Will low levels of alcohol consumption during pregnancy cause harm?  What do low levels of alcohol mean?  Will a small amount be OK?

…..It is important to remind ourselves that FAS and FASD are entirely preventable.  These syndromes are not seen if a pregnant woman does not drink alcohol during her pregnancy.  It is for this reason that the Surgeon General of the U.S. and the American College of Obstetricians and Gynecologists direct health care clinicians to advise patients to abstain from alcohol completely during pregnancy.

-Dr. P

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A Way to Help Determine the Status of Your Weight

Weight control is a major concern for most of us.  As menopause approaches, many women experience an increase in their weight, with about 70% being overweight.  Body mass index (BMI) is a commonly used calculation that quantifies where our weight is, and when using this classification, about 50% of perimenopausal and menopausal women are considered obese.

Using a person’s height and weight, body mass index can be calculated, giving us a guide to where we stand with regards to our weight.  A BMI of 24 to 29 is considered overweight, and over 30 is obese.  Let us look at where some weights fall:

  • At 5 ft. 1 in. a BMI of 24 to 29 corresponds to a weight of 130 to 150 lbs.
  • At 5 ft. 1 in. a BMI of 30 corresponds to a weight of 160 lbs.
  • At 5 ft. 6 in. a BMI of 24 to 29 corresponds to 155 to 180 lbs.
  • At 5 ft. 6 in. a BMI of 30 corresponds to a weight of 185 lbs.

Remember that this BMI number is not an exact measurement of body fat but it alerts us to where our weight status lies and gives us an indication of our risks for developing the complications of obesity.  These include diabetes, hypertension, heart disease, and many other medical conditions.

BMI Chart Larger

-Dr. P

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One Possible Way to Decrease Your Chance of Developing Alzheimer’s Disease

One Possible Way Decrease Alzheimer’s Smaller BlogI recently came upon an article which touched upon a walking program that could decrease the chance of developing Alzheimer’s disease.  Some studies have suggested that by walking about a mile each day, you can dramatically decrease your risk.

It seems that this decreases the mental losses by improving Reduce Alzheimer's Diseasethe blood flow to the brain and therefore keeping the brain cells healthier.  So one of the easiest exercises available to all, again shows great benefit.

Let us then begin a review of this exercise!

  • There are very few medical conditions that prevent us from walking.  Of course, always check with your medical professional before starting a new program.  Beginning at a slow pace in a safe area is a perfect way to start.
  • Good walking footwear is important, and replacement every 6 months or when the cushion of the heal wears is a must.
  • You should start with a few minutes of a mild warm-up with mild stretching.

-Dr. P

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Breast Cancer – Early Detection Can Save Your Life

…..October is Breast Cancer Awareness Month, and hopefully we are all aware of the high risk of breast cancer that surrounds us.  We know that 1 in 8 women will develop breast cancer in their lifetime, and all of us have someone close who has suffered with this cancer.  In my own family, we lost Mary Ann’s mom, who was my wife’s mother, to this terrible disease.

…..Early detection saves lives, and it is all of our responsibility to encourage the special women whom we love to practice good breast health, which should include:

  • Monthly self breast examsBreast Cancer Pink Ribbon Patch
  • At a minimum of once a year, breast exams from your health care provider
  • Yearly mammograms starting at age 40
  • Special follow-up programs if there is a strong family history of breast cancer

…..As a gynecologist, breast health has been a daily and major part of my professional life.  I encourage all of my patients to be their own best advocates when it comes to breast health.  Do your self-exams.  Do the recommended breast studies.  Once the studies are done, get the results and understand what the results are.  Do the follow-up studies and follow-up consults that are advised.  If there is a problem, see the breast specialists.  Get second opinions if there is ever a doubt.  Let us all work together to defeat this foe!

-Dr. P

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Gonorrhea – A Condition Which Often Lacks Symptoms

…..teenage depression - teen woman sitting thinkingNext in my series about sexually transmitted infections in adolescents, we will be discussing gonorrhea.

…..Gonorrhea is a common STI in the adolescent and young adult population (15 to 25).  There are about 750,000 cases each year, with women having a slightly higher rate than men.  We should use the same targeted screening that is used for chlamydial infections (with all women under 25 being tested).  The same risk factors are associated with gonorrhea and chlamydia, and with both, more than 50% of women are asymptotic.

…..When there are symptoms, they may include vaginal discharge, pelvic pain, or pain with urination.  Again, if there is a delay in diagnosing and implementing the treatment of an infection, severe pelvic problems can develop.

…..There are specific antibiotic protocols for treatment that are available.  These days, consideration must be made for antibiotic resistance, which has been developing.  Lastly, with all persons found to have gonorrhea, there should be testing for HIV, syphilis, and chlamydia.

-Dr. P

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How a Sonogram Can Determine if Your Pregnancy Is Normal or Abnormal

…..OHow a Sonogram Can Determine if Your Pregnancy is Normal or Abnormalver the last 30 years, ultrasound has changed dramatically in how we evaluate early pregnancy.  Transvaginal sonography has allowed us to assess early gestation with better clarity.

…..The gestational sac is the first visible sign of a normal
intrauterine pregnancy.  This should be seen with the transvaginal sonogram by 5 weeks after the last menstrual period. The earliest embryonic structure is the yolk sac, and likewise, this can be seen as early as the end of the 5th week.  Evaluating the yolk sac is important because it can point to problems in a pregnancy. If it is not present at this early time, or if the shape is irregular or large, this can be the first sign of a nonviable pregnancy.

…..Near the 6th week from the last menstrual period, the embryo should be seen attached to the yolk sac, and fetal heart activity should be noted between the 6th and 7th week. When the gestational sac is approximately 2 cm, an embryo should be seen, and if it is not identified at this time, a blighted ovum is confirmed.

…..There are specific sonographic signs of a problem pregnancy:

  • A small gestational sac around the embryo
  • If the embryo does not increase in size by 1 mm per day
  • A fetal heart beat at a rate of less than 120 beats per minute after 7 weeks of gestation.

…..Let us end this review on a positive note. If a patient has no abnormal symptoms, normal fetal heart activity, and 7 weeks of gestation has been reached, then there is a 99% chance of a successful pregnancy.

-Dr. P

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The Concern of Getting the Flu Shot During Pregnancy – FAQs Answered

…..Let me give you some information to cover some of the questions that patients frequently ask.  This information is from the American College of Obstetrics and Gynecology, the American Medical Association, and the Society for Maternal-Fetal Medicine. It is from the form given to obstetricians to give to thSyringe for Flu Concern Patch Blog Post Paint3eir patients.

…..If you get vaccinated during your pregnancy, your unborn starts to get some protection during this period. This also gives the newborn a degree of protection in the first few months of life when their vaccinations have not been begun.

…..Safety, of course, is the main concern of all mothers. Flu vaccines have been given safely to millions of pregnant women for more than 50 years and are endorsed by the above medical societies.

…..The question of mercury in some of the vaccines is always a concern. Thimerosal, a type of mercury, is a type of preservative used in trace amounts in some vaccines and has not been shown to be harmful to a pregnant woman or her unborn child.  Also, it does not cause autism. Again, this is from the above mentioned medical societies. Remember, if you are still concerned about being given preservatives during your pregnancy, there are single-dose flu vaccines that are mercury-free, so speak to your medical professional.

…..Lastly, you must begin the discussion about the flu vaccine with your caregiver now. Ask all your questions, become informed, and let us all be protected… and you cannot get the flu from the flu vaccine!

-Dr. P

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Why Should You Get a Flu Shot Each Year?

…..The influenza vaccine comes in two types:

  • Inactivated, or killed vaccine, which is given by injection with a needle
  • Live, or attenuated (weakened) vaccine, which is sprayed into the nostril

…..The influenza viruses are always changing, and so each year scientists try to determine which viruses are going to cause the flu that year. In other words, a new vaccine is put together each year to prevent the flu for that season. It is for this reason that an annual vaccination is recommended.  After a person receives the vaccine injection, it takes about two weeks for the protection to develop, and the protection lasts for about a year.

Why Should You Get a Flu Shot Each Year

…..Some inactivated influenza vaccines contain a preservative called thimerosal while some vaccines are thimerosal-free. This has been a concern for many, but it has been shown not to be harmful to a pregnant woman or her baby, according to the American College of Obstetrics and Gynecology.

…..The U.S. Department of Health and Human Services recommends that all people 6 months of age and older should get the flu vaccine. Vaccination is especially important for people at a higher risk of severe influenza, including their close contacts.  Some of these close contacts can be healthcare workers and children younger than 6 months.

…..You should get the vaccine as soon as it is available for the new season. Even though most influenza occurs from October through May, the flu season can occasionally come earlier, so get the protection as early as possible.

-Dr. P

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Women: Your Most Common Cause of Hair Loss

…..More about hair loss in women…Women Your Most Common Cause of Hair Loss

…..The most common cause of hair loss in women is androgenetic alopecia (AGA), which is also known as female pattern hair loss.  This is a genetic disease that can be inherited on many genes, but it does not affect everyone who carries the genes.  By menopause, 40% of all women will be affected in some way.  It is identified as a gradual onset of diffuse hair loss.

…..The problem’s basis is the male hormone found in all women.  It attaches to sites on the hair follicles and affects the follicles that are genetically susceptible.  These follicles have a shortening of the growth phase, and the hair from these follicles are short and thinner than normal ones.

…..Again, hair loss in women is generally diffuse, and there is usually a preservation of the frontal hairline.  This is distinct from male pattern hair loss, with frontal peak and top loss.  AGA’s onset is usually gradual with no specific bare areas.  There does not appear to be an increase in shedding because the hair growth does not become less but is only affected.

…..At the medical exam, the scalp should be examined for redness, signs of infection, and scarring.  A family history should be taken to look for a similar condition in other family members.  Usually, there is not an endocrine cause for this problem, but if general hirsutism accompanies the finding, then a full hormonal investigation should be started.

…..The only FDA-approved treatment is the topically applied vasodilator called Minoxidil (Rogaine).  It comes in an over-the-counter preparation of 2% and 5% foam or liquid, which are all effective.  There seems to be better results with the 5%, but there may be an increased chance of local irritation.  How it specifically works is uncertain but there seems to be an increased growth phase, and the hairs grow longer and stronger.  Remember, the treatment is 2x per day and forever.  When you stop, the hair you gained will be lost.  Lastly, you may not see any results for 3-4 months, so patience is needed.

-Dr. P

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Unraveling the Urinary Tract Infection (UTI)

…..UTIIn my practice, urinary tract infections are among the most common problems that I see.  It is estimated that 60 to 70% of all women will experience a UTI in their lifetime and that half will have a first time infection by the time they are 35.

…..Most women know they have a “bladder infection” because of the symptoms they experience.  These symptoms include:

  • Pain with urination
  • Increased urgency to urinate, with many times passage of just a few drops of urine
  • Increased frequency of urination
  • Pain, pressure, and/or fullness in the lower abdomen

…..If the infection of the urinary tract system has risen above the bladder and into the kidney, the symptoms change.  The patient appears to be sicker with more severe symptoms, which include:

  • Tender flank pain over the area of the kidneys
  • Fever and chills
  • Nausea and vomiting

…..Although the diagnosis of a UTI is usually made by a patient’s complaints, dipstick urine tests are commonly used to help confirm the diagnosis.  These tests look for certain markers in the urine that point to a UTI.  Dipstick urine tests are not totally conclusive.

…..The standard to confirm a UTI is the urine culture and sensitivity test at the laboratory.  This test will diagnose the bacteria causing the infection, and it will also provide the susceptibility of the bacteria to certain antibiotics.  The disadvantage of this test is the cost and the 48 hours it takes to get back the information.

…..There are many risk factors in pre-menopausal women for a UTI.  A few of these are:

  • Frequent or recent sexual activity
  • Past history of a UTI
  • Increased number of vaginal deliveries
  • Obesity
  • Diabetes

-Dr. P

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Vitamin D – More Important Than You May Think!

…..This past year has seen the discovery of vitamin D deficiency in a large portion of our population.  In my office, we never measured the value before but now I speak about low vitamin D many times a day. Today you will be given some basic points, and over the next few blogs you will have a good understanding of the situation.

  • Vitamin D is important to maintain bone health.
  • Some studies have reported that being low on vitamin D can be related to heart problems, cancer, diabetes, and autoimmune disease.  However, few true clinical trials have been taken.
  • Too much vitamin D should be avoided because of possible harm and lack of beneficial evidence.
  • The best measurement for the deficiency is the value of 25(OH)D in the blood.  The supplementation of the vitamin should be given to reach a target 25(OH)D value.

…..This is a start of your vitamin D education!

Vitamin D Benefits

-Dr. P

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