By Dr. F.E. Dias
An epidemic affects a high proportion of a population at the same time, and with respect to disease, it means an outbreak that spreads quickly and regionally affects a disproportionate number of people. Pandemics are epidemics that spread across wide geographical areas such as nations and continents. It should be a matter of interest to us that, according to information prevailing and incessant regarding the pandemic, we are said to be in the middle of, the proportion of, shall we say patients, as routinely identified via PCR tests, who show no symptoms of COVID-19 greatly outweigh those that do.
Let us first understand what we are talking about. Coronaviruses are a family (Coronaviridae) of viruses that can cause the common cold, SARS (attributed to SARS-CoV) and MERS (attributed to MERS-CoV), the latter two being qualified as Severe Acute and Middle East respectively. The respiratory malady we refer to as the common cold can also be caused by other virus types including rhinoviruses, influenza viruses, adenoviruses and several others, often in combination, with about 200 causal viral variants identified thus far, and many causative agents not yet identified.
Whereas for what is called the common cold there is no clear link between pathogen and disease, the beta-coronavirus named SARS-CoV-2, whatever its origins, is specified as the cause of the coronavirus disease 2019 or COVID-19, common symptoms of which are fever, cough, fatigue and many others such as shortness of breath, muscle ache, runny nose and nausea to name a few, symptoms similar to those of the common cold, influenza and other febrile diseases and allergy response. The virus usually spreads via respiratory droplets released from a carrier individual, hence the muzzles we wear while the dogs stare at us pondering at the turning of tables. So, SARS-CoV-2 is our virus and COVID-19 is the associated series of clinical symptoms, called the disease.
What about the testing to find out whether the symptoms you have can be attributed to SARS-CoV-2? There are three pertinent types of tests. One is the nucleic acid amplification via polymerase chain reaction (PCR) test which is used today with the claim that it diagnoses the disease. That is, one is given to understand that it says whether you, even when asymptomatic, are infected and thereby contagious. The other two are antigen and antibody tests. Let us understand.
Antibodies, also known as immunoglobulins, are proteins produced by the B-lymphocytes in the immune system to latch on to foreign substances and consequently remove them from the body, thereby protecting from the potent harm that the foreign substance could have caused. Such foreign substances as recognised by the antibodies are called antigens, which could be toxins or components of pathogens such as the spike glycoproteins of the Coronavirus that help it to enter the host. Detection of the specific antibodies in serum does indicate that the specific antigen has entered the body but since the production of antibodies may occur days or weeks after the antigen has entered and may continue its presence for a significant period after the antigen no longer poses a threat, it does not indicate that you are at that moment likely to develop disease or to infect others. It is not diagnostic by that understanding but will be useful for assessing the durability of vaccine response or of naturally acquired immunity.
Antigens then are substances capable of eliciting an immune response. The antigen test – which is familiar to us as, the rapid test that provides a result in 15 minutes, detects the aforementioned surface protein fragments specific to the virus. While other factors such as the test kit source and competency of swabber and tester do matter, these tests provide a positive result usually when there is high or near-peak viral load. By this point, the symptoms may have begun to appear, and the individual is most contagious. It is fast, cheap and fairly simple, but could be considered as a test for infectiousness than one for infection.
The polymerase chain reaction is used to replicate a segment of DNA so that quantity sufficient for detection and analysis is produced. The SARS-CoV-2 virus has single-stranded RNA as its genetic material. Reverse transcription (RT) converts RNA into DNA. In each cycle of replication, the quantity of the gene sequence of interest is doubled so that after 40 replication cycles, a single sequence of nucleic acid would have multiplied a trillion times, that is a million of millions. The technique was developed by Dr. Kary Mullis in the eighties and he received the Nobel prize for chemistry in 1993 on account of its vast applications in genetics, microbiology, forensic science and medicine. Even Hollywood used PCR on fossilised DNA to revive and populate the Jurassic Park!
But how is the technique connected to the disease? The protocol published in January 2020 by the WHO, for public health laboratories to use in the detection of SARS-CoV-2, is based on real-time RT-PCR. A paper describing this methodology, now referred to as the Corman-Drosten paper, was subsequently submitted to the journal Eurosurveillance. It was published within 24 hours of submission, raising questions regarding the peer-review process, and two of the authors were members of the editorial board of the same journal. The protocol was consequently used in ~70 percent of tests globally and by a hundred governments and is called the gold standard for COVID-19 testing. We know it as the PCR test which if it turns out positive makes you a patient, understood to be infected and contagious, and all that follows.
The PCR test as conducted as per WHO guidelines is binary qualitative in that it returns a positive or negative result after the pre-decided number of replication cycles have been performed. The number of cycles is known as the positivity threshold or cycle threshold (cT) and is the determinant of sensitivity. The Corman-Drosten protocol does not define the threshold but appears to suggest the use of 45 replications.
Independent analyses of PCR test results against the inoculation and culture of the same samples showed that for 35 replication cycles, less than three percent produced positive cultures. That is, for a cT of 35, 97 percent of PCR test results that came out positive were, in fact, false positives. On this basis, 97 percent of ‘COVID-19 cases’ were not infected with SARS-CoV-2. For cT values above 35, the data approaches the asymptote and indicates 100 percent false positives. Most lab reports do not indicate the cT used in their test but 30 to 45 is usual.
In November 2020, a group of scientists formally pointed out flaws in the Corman-Drosten protocol. Apart from not defining the cT, there were factors such as atypically high concentrations of primer (replication initiators) that cause increased unspecific binding and product amplication, substantial variability and error in test process design that could lead, inter alia, to other Coronaviruses being detected or for residual fragments of viral RNA to be sufficient to indicate the presence of the whole virus. Such residuals may quite well be indications of a battle won by the immune system against last week’s common cold. Also, the genetic code considered for the development of the test protocol was based on theoretical or in silico sequences supplied by a Chinese laboratory since the authors at that time did not have access to infectious or inactivated SARS-CoV-2 or its isolated genomic RNA.
In January 2021, reportedly one hour after the Biden inauguration, the WHO issued a notice urging caution in the interpretation of PCR test results, stating that their protocol is merely an aid for diagnosis and that assay specifics and clinical observations need to be considered. Since it followed that it was no longer the gold standard for diagnosis, a person who tested positive on a flawed PCR protocol conducted with a meaninglessly high cT would not thereby be classified as infected or having the disease. Since then, the COVID-19 numbers have substantially reduced, at least in the USA. Eventually, in July 2021, the CDC announced that it has requested the FDA to withdraw its request for emergency use authorization of this PCR test as a diagnostic tool for the detection of SARS-CoV-2, admitting that it cannot distinguish between CoViD-19 and influenza.
There is the virus and its mutations. It causes illness, and complications and even death particularly when co-morbidities pre-exist. Precautions need to be taken to protect from infection, especially among those with weaker immune systems such as the elderly. Action needs to be pursued to eradicate the pathogen and even to prevent others being developed. And yet, the world has completed a revolution around the sun since the WHO declared COVID-19 to be a pandemic in March 2020. The world has undergone a revolution as a consequence of this declaration and is still reeling from it. The question is, however, whether the pandemic was indeed a pandemic after all, at least until the vaccination campaigns began.
Corman-Drosten paper – https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2020.25.3.2000045
WHO adoption – Protocol V2 (who.int)
WHO original – Diagnostic testing for SARS-CoV-2 (who.int)
WHO change – WHO Information Notice for IVD Users 2020/05
CDC withdrawal – https://www.cdc.gov/csels/dls/locs/2021/07-21-2021-lab-alert-Changes_CDC_RT-PCR_SARS-CoV-2_Testing_1.html
If you have a heart, say no to tobacco!
BY Dr. Gotabhya Ranasinghe
(MBBS, MD, FCCP, FRCP, FAPSIC, FACC, FESC)
Consultant in General & Interventional Cardiology, NHSL
Tobacco harms practically all of the body’s organs and is a key risk factor for heart disease!
Smoking can impact all aspects of the cardiovascular system, including the heart, blood, and blood vessels. I know from my experience over the years that about 25% of the patients who seek treatment from me for heart conditions smoke.
Is there a strong link between smoking and heart disease?
Of course, there is! Smoking definitely contributes to heart disease. The majority of smokers experience heart attacks.
Some claim that the only people at risk for heart attacks or strokes are those who are classified as heavy smokers. Although this is the case, did you know that smoking even one or two cigarettes a day might result in heart attacks?
Young smokers are on the rise, which unfortunately brings more cardiac patients between the ages of 20 and 25 to the cardiology unit.
Why is tobacco poison for your heart?
The harmful mix of more than 7,000 chemicals in cigarette smoke, including nicotine and carbon monoxide, can interfere with vital bodily functions when inhaled.
When you breathe, your lungs absorb oxygen and pass it on to your heart, which then pumps this oxygen-rich blood to the rest of your body through the blood arteries. However, when the blood that is circulated to the rest of the body picks up the toxins in cigarette smoke when you breathe it in, your heart and blood arteries are harmed by these substances, which could result in cardiovascular diseases.
What does cigarette smoke do to your heart?
Atherosclerosis (Building up of cholesterol deposits in the coronary artery)
Endothelium dysfunction leads to atherosclerosis. The inner layer of coronary arteries or the arterial wall of the heart both function improperly and contribute to artery constriction when you smoke cigarettes. As a
result, the endothelium-cell barrier that separates the arteries is breached, allowing cholesterol plaque to build up. It’s crucial to realize that smoking increases the risk of endothelial dysfunction in even those who have normal cholesterol levels.
The plaque accumulated in the arteries can burst as a result of continued smoking or other factors like emotional stress or strenuous exercises. Heart attacks occur when these plaque rupture and turn into clots.
Coronary artery spasm
Did you know you can experience a spasm immediately after a puff of smoke?
A brief tightening or constriction of the muscles in the wall of an artery that supplies blood to the heart is referred to as a coronary artery spasm. Part of the heart’s blood flow can be impeded or reduced by a spasm. A prolonged spasm can cause chest pain and possibly a heart attack.
People who usually experience coronary artery spasms don’t have typical heart disease risk factors like high cholesterol or high blood pressure. However, they are frequent smokers.
An erratic or irregular heartbeat is known as an arrhythmia. The scarring of the heart muscle caused by smoking can cause a fast or irregular heartbeat.Additionally, nicotine can cause arrhythmia by speeding up the heart rate.
One of the best things you can do for your heart is to stop smoking!
Did you know the positive impacts start to show as soon as you stop smoking?
After 20 minutes of quitting smoking, your heart rate begins to slow down.
In just 12 hours after quitting, the level of carbon monoxide in your blood returns to normal, allowing more oxygen to reach your heart and other vital organs.
12 to 24 hours after you stop smoking, blood pressure levels return to normal.
Your risk of developing coronary heart disease decreases by 50% after one year of no smoking.
So let us resolve to protect and improve heart health by saying no to tobacco!
Religious cauldron being stirred; filthy rich in abjectly poor country
What a ho ha over a silly standup comedian’s stupid remarks about Prince Siddhartha. I have never watched this Natasha Edirisuriya’s supposedly comic acts on YouTube or whatever and did not bother to access derogatory remarks she supposedly introduced to a comedy act of hers that has brought down remand imprisonment on her up until June 6. Speaking with a person who has his ear to the ground and to the gossip grape wine, I was told her being remanded was not for what she said but for trying to escape consequences by flying overseas – to Dubai, we presume, the haven now of drug kingpins, money launderers, escapees from SL law, loose gabs, and all other dregs of society.
Of course, derogatory remarks on any religion or for that matter on any religious leader have to be taboo and contraveners reprimanded publicly and perhaps imposed fines. However, imprisonment according to Cassandra is too severe.
Just consider how the Buddha treated persons who insulted him or brought false accusations against him including the most obnoxious and totally improbable accusation of fatherhood. Did he even protest, leave along proclaim his innocence. Did he permit a member of the Sangha to refute the accusations? Not at all! He said aloud he did not accept the accusations and insults. Then he asked where the accusations would go to? Back to sender/speaker/accuser. That was all he said.
Thus, any person or persons, or even all following a religion which is maligned should ignore what was said. Let it go back and reside with the sayer/maligner. Of course, the law and its enforcers must spring to action and do the needful according to the law of the land.
One wonders why this sudden spurt of insults arrowed to Buddhism. Of course, the aim is to denigrate the religion of the majority in the land. Also perhaps with ulterior motives that you and Cass do not even imagine. In The Island of Wednesday May 31, MP Dilan Perera of Nidahas Janatha Sabawa (difficult to keep pace with birth of new political parties combining the same words like nidahas and janatha to coin new names) accused Jerome Fernando and Natasha E as “actors in a drama orchestrated by the government to distract people from the real issues faced by the masses.”
We, the public, cannot simply pooh pooh this out of hand. But is there a deeper, subtler aim embedded in the loose talk of Jerome and his followers? Do we not still shudder and shake with fear and sympathy when we remember Easter Sunday 2019 with its radical Muslim aim of causing chaos? It is said and believed that the Muslim radicals wanted not only to disrupt Christian prayer services on a holy day but deliver a blow to tourism by bombing hotels.
Then their expectation was a backlash from the Sinhalese which they hoped to crush by beheading approaching Sinhala avenging attackers with swords they had made and stacked. This is not Cass’ imagination running riot but what a Catholic Priest told us when we visited the Katuwapitiya Church a couple of weeks after the dastardly bombing.
It is believed and has been proclaimed there was a manipulating group led by one demented person who egged the disasters on with the double-edged evil aim of disrupting the land and then promising future security if … Hence, we cannot be so naïve as to believe that Jerome and Natasha were merely careless speakers. Who knows what ulterior moves were dictated to by power-mad black persons and made to brew in the national cauldron of discontent? Easiest was to bring to the boil religious conflict, since the races seem to be co-living harmoniously, mostly after the example of amity set before the land and internationally of Sri Lankans of all races, religions, social statuses and ages being able to unite during the Aragalaya.
We have already suffered more than our fair share of religious conflict. The LTTE exploded a vehicle laden with bombs opposite the Dalada Maligawa; shot at the Sacred Bo Tree, massacred a busload of mostly very young Buddhist monks in Aranthalawa. This was on June 2, 1987, particularly pertinent today. They killed Muslims at prayer in a mosque in Katankudy after ethnically cleansing Jaffna and adjoining areas of Muslim populations.
The Sinhalese, led by ultra-nationalists and drunken goons ravaged Tamils in 1983 and then off and on conflicted with Muslims. Hence the need to nip all and every religious conflict in the bud; no preachers/ Buddhist monks/overzealous lay persons, or comedians and media persons to be allowed to malign religions and in the name of religion cause conflict, least of all conflagration.
Comes to mind the worst case of religious intolerance, hate, revenge and unthinkable cruelty. Cass means here the prolonged fatwa declared against Salman Rushdie (1947-), British American novelist of Indian origin who had a ransom set aside for his life declared by the then leader of Iran, Ruhollah Khomeini, soon after Rushdie’s novel Satanic Verses was published in 1988. The British government diligently ensured his safety by hiding him in various places. After nearly two decades of tight security around him, he ventured to the US on an invited visit. He settled down in New York, believing he was now safe from the fatwa and mad men. It was not to be. In New York on stage to deliver a lecture in 2022, Rushdie was set upon by a lone assailant who stabbed him in the eye, blinding him in that eye and necessitating his wearing an eye band. What on earth was his crime? Writing a fictitious story to succeed many he had written and won prizes for like the Booker.
Religious fanaticism must never be permitted to raise its devilish head wherever, whenever.
Farmer’s fabulously rich son
Often quoted is the phrase coined by the Tourist Board, Cass believes, to describe Sri Lanka. Land like no other. It was completely complementary and justified when it was first used. We were an almost unique island where every prospect pleased, particularly its smiling, easy going people and the wonderful terrain of the land with varying altitudes, climates and fauna and flora.
Then with the decline of the country engineered and wrought by evil, self-gratifying politicians, their sidekicks and dishonest bureaucrats, disparities became stark. Sri Lanka is now in the very dumps: bankrupt, its social, economic and sustainability fabric in shreds and people suffering immensely. But since it is a land like no other with a different connotation, only certain of its population suffer and undergo deprivation and hardship. Others live grand even now and have money stashed high in–house and overseas in banks, businesses and dubious off shore dealings. Some lack the few rupees needed to travel in a bus but most political bods drive around in luxury cars; infants cry for milk and children for a scrap of bread or handful of rice. Plain tea is drunk by many to quell pangs of hunger while the corrupt VIPs quaff champaign and probably have exotic foods flown over from gourmet venues.
And most of those who drive luxury cars, eat and drink exotically and live the GOOD life, did not inherit wealth, nor earn it legitimately. Young men who had not a push bike to ride or Rs 25 to go on a school trip to Sigiriya are now fabulously wealthy. Cass does not want to list how they demonstrate immense wealth possession now.
One case in the news is Chaminda Sirisena, who seems to be very, very wealthy, wearing a ring that is valued at Rs 10 million, and then losing it to cause severe damnation to its stealer. Goodness! Cass cannot even imagine such a ring. Well, he lost it and 5,000 US $ and Rs 100,000. The suspect is his personal security guard. Having never heard of this brother of the ex Prez and he not being the paddy multimillionaire owning hotels, Cass googled. Here is short reply, “Chaminda Sirisena. Owner Success Lanka Innovative Company, Sri Lanka, 36 followers, 36 connections. (The last two bits of info completely incomprehensible and no desire at all to verify). He sure is comparable to Virgin Airways Branson and other top global entrepreneurs to become so wealthy being a son of a man who served in WWII and was given a small acreage to cultivate paddy in Polonnaruwa. When his brother Maitripala became Prez of Sri Lanka it was with pride the comparison was brought in to the American President who moved from log cabin to the White House.
Hence isn’t our beloved, now degraded Sri Lanka, a land like no other with Midases around?
We now have another maybe thief to worry about. No further news of the poor mother whose life was quashed for the sake of a gold ring, leaving three children motherless and probably destitute. When we were young, we were told very early on that if we lost anything it was more our fault; we were careless and placed temptation to less fortunate persons. The Tamil woman who died after being in remand was such a one who needed extra protection from temptation. To Cass her employer is more to blame for the probable theft and for the tragedy that followed.
Snakes of Sri Lanka
By Ifham Nizam
Snake bites are a serious public health issue in Sri Lanka. It has been estimated that nearly 80,000 snake bites occur here every year.Due to fear and poor knowledge, hundreds of thousands of snakes, mostly non-venomous ones, are killed by humans each year.The state spends more than USD 10 million a year on treating snake bite patients.
According to health sector statistics between 30,000 and 40,000 snake bite patients receive treatment in hospitals annually, says Dr. Anjana Silva, who is Professor in Medical Parasitology, Head/ Department of Parasitology, Faculty of Medicine and Allied Sciences, Rajarata University.
To date, 93 land and 15 sea snake species have been recorded from Sri Lanka. While all 15 sea snakes are venomous, only 20% of the land snakes are venomous or potentially venomous.
The term, ‘venomous snakes’ does not mean they cause a threat to human lives every time they cause a bite. The snakes of highest medical importance are the venomous ones which are common or widespread and cause numerous snakebites, resulting in severe envenoming, disability or death,” says Dr. Silva who is also Adjunct Senior Research Fellow – Monash Venom Group,Department of Pharmacology, Faculty of Medicine, Nursing and Health Sciences, Monash University and Research Associate- South Asian Clinical Toxicology Research Collaboration, Faculty of Medicine, University of Peradeniya.
Only five snakes could be considered to be of the highest medical importance in Sri Lanka: Russell’s viper, Indian krait, Sri Lankan cobra, Merrem’s hump-nosed viper and Saw-scaled viper. All but Merrem’s hump-nosed vipers are covered by Indian Polyvalent antivenom, the only treatment available for snake bites in Sri Lanka.
There are another five snake species with secondary medical importance, which are venomous snakes and capable of causing morbidity, disability or death, but the bites are less frequent due to various reasons (Sri Lankan krait, Highland Hump-nosed viper, Lowland hump-nosed pit viper, Green-pit viper and Beaked sea snake)
The snakes of highest medical importance in Sri Lanka are as follows:
- Russell’s viper (Daboia russelii) (Sinhala: Thith Polanga/ Tamil: Kannadi viriyan)
Medically the most important snake in Sri Lanka. It is found throughout South Asia. It is responsible for about 30% of snake bites in Sri Lanka and also about 70% of deaths due to snake bites in Sri Lanka.
Some 2-5% bites by Russell’s viper are fatal. Widely distributed throughout the country up to the elevations of 1,500m from sea level. Highly abundant in paddy fields and farmlands but also found in dry zone forests and scrub lands. Bites occur more during the beginning and end of the farming seasons in dry zone. It can grow up to 1.3m in length. Most bites are reported during day time.
Over 85% of the bites are at the level of or below the ankle. It is a very aggressive snake when provoked. Spontaneous bleeding due to abnormalities in blood clotting and kidney failure have life-threatening effects.
- The Sri Lankan Russell’s vipers cause mild paralysis as well, which is not life threatening. Indian Polyvalent antivenom covers Russell’s viper envenoming. Deaths could be due to severe internal bleeding and acute renal failure.
- Indian Krait (Bungarus caeruleus) (Sinhala: Thel Karawala/ Maga Maruwa; Tamil: Yettadi virian/ Karuwelan Pambu)
It is distributed in India, Sri Lanka, Nepal, Bangladesh, Pakistan and Afghanistan. It is found across the lowland semi-arid, dry and intermediate zones of Sri Lanka. Almost absent in the wet zone. Usually, a non-offensive snake during the daytime; however, it could be aggressive at night.
Common kraits slither into human settlements at night looking for prey. People who sleep on the ground are prone to their bites.
Most common krait bites do occur at night. Bites are more common during the months of September to December when the north-east monsoon is active. Most hospital admissions of krait bites follow rainfall, even following a shower after several days or months without rain.
Since most bites do occur while the victim is asleep, the site of bite could be in any part of the body.
As bite sites have minimal or no effects, it would be difficult to find an exact bite site in some patients. Bite site usually is painless and without any swelling. Causes paralysis in body muscles which can rapidly lead to life threatening respiratory paralysis (breathing difficulty).
- Sri Lankan Cobra (Naja polyoccelata; Naja naja) Sinhala: Nagaya; Tami: Nalla pambu
Sri Lankan cobra is an endemic species in Sri Lanka. It is common in lowland (<1200m a.s.l), close to human settlements. Cobras are found on plantations and in home gardens, forests, grasslands and paddy fields. It is the only snake with a distinct hood in Sri Lanka.
Hood has a spectacle marking on the dorsal side and has two black spots and the neck usually has three black bands on the ventral side. When alarmed, cobras raise the hood and produce a loud hiss.
Cobra bites could occur below the knee. They are very painful and lead to severe swelling and tissue death around the affected place. Rapidly progressing paralysis could result from bites, sometimes leading to life-threatening respiratory paralysis (breathing difficulty). Deaths could also be due to cardiac arrest due to the venom effects.
- Merrem’s hump-nosed viper (Hypnale hypnale) Sinhala: Polon Thelissa/ Kunakatuwa; Tamil: Kopi viriyan.
Small pit-vipers grow up to 50cm in length. Head is flat and triangular with a pointed and raised snout. They are usually found coiled, they keep the heads at an angle of 45 degrees. Merrem’s Hump-nosed viper (Hypnale hypnale) is the medically most important Hump-nosed viper as it leads to 35-45% of all snake bites in Sri Lanka.
Merrem’s Hump-nosed vipers are very common in home gardens and on plantations and grasslands. Bites often happen during various activities in home gardens and also during farming activities in farmlands in both dry and wet zones. Hands and feet (below the ankle) are mostly bitten. Bites can often lead to local swelling and pain and at times, severe tissue death around the bite site may need surgical removal of dead tissue or even amputations. Rarely, patients could develop mild blood clotting abnormalities and acute kidney failure. Although rare, deaths are reported due to hypnale bites.
- Saw-scaled viper (Echis carinatus), Sinhala: Weli Polanga; Tamil: Surutai Viriyan
This species is widely distributed in South Asia. However, in Sri Lanka, it is restricted to dry coastal regions such as Mannar, Puttalam, Jaffna peninsula and Batticaloa. In Sri Lanka, this snake grows upto 40-50cm. It is a nocturnal snake which is fond of sand dunes close to the beach. It could be found under logs and stones during daytime. Bites are common during January and February.
It is a very aggressive snake. A distinct, white colour ‘bird foot shape’ mark or a ‘diamond shape’ mark could be seen over the head. When alarmed, it makes a hissing sound by rubbing the body scales. Although this snake causes frequent severe envenoming and deaths in other countries, its bites are relatively less severe in Sri Lanka. Bites could lead to mild to moderate swelling and pain on the affected place and blood clotting abnormalities and haemorrhage and rarely it could lead to kidney failure.
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