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Online Discussion: Tracking new emerging diseases and the next pandemic

This Years Flu - Event Date: December 20 2008 - May 25 2009

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Johnray1 View Drop Down
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    Posted: December 20 2008 at 10:56am
 TO ALL, I have read what medclinician has said about their experience with the flu and I wish them the best luck. Has any one else heard anything about this years "Flu"? I  heard part of a report on CNN that this years "Flu" was suppose to be extemely nasty and dangerous.Does any one know anything about this to back this up or to disprove it?Johnray1
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Johnray... This year's flu...so far (they say it is early and the biggie for the entire flu season could change)

At this point it is the H1N1 Flu that is hitting hard.
Doctors have been told to use antivirals on flu patients.



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source

http://www.cidrap.umn.edu/cidrap/content/influenza/general/news/sep0508resistance.html




Dutch patient dies from Tamiflu-resistant H1N1 virus

Lisa Schnirring and Robert Roos * Staff Writers

Sep 5, 2008 (CIDRAP News) – Amid concern about rising resistance to oseltamivir (Tamiflu) in influenza A/H1N1 viruses, a Dutch team this week reported the death of a leukemia patient who was infected with an H1N1 virus that was resistant to the antiviral drug.

In a letter in this week's New England Journal of Medicine (NEJM), the Dutch authors said the case suggests that oseltamivir-resistant H1N1 viruses can cause disease, despite evidence from animal studies that the resistance mutation makes the viruses much less dangerous. The letter said the man's virus was also resistant to amantadine, an older antiviral drug.

On Aug 20, the World Health Organization (WHO) reported that 31% of influenza A/H1N1 isolates from 16 countries that conducted recent tests carried the H274Y mutation, which confers resistance to oseltamivir. Resistance levels ranged from 100% (10 of 10 isolates) in Australia to 13% (4 of 32 isolates) in Chile.

Emergence of the oseltamivir-resistant H1N1 virus was first noted in Norway in January, and since then researchers have found the virus in 35 countries, including the United States and Canada.

The spread of the oseltamivir-resistant H1N1 virus has puzzled experts because it has not been clearly linked to treatment with the drug.

In the case report, authors from Erasmus University Medical Center in Rotterdam wrote that a 67-year-old man who was on chemotherapy in a 3-year battle with chronic lymphocytic leukemia was hospitalized with shortness of breath, a dry cough, and fever. On his second hospital day, he experienced acute respiratory failure, and his physicians placed him on a ventilator and started empirical antibiotic treatment.

Computed tomography (CT) revealed that the patient had patchy lung infiltrates, and tests on samples from his respiratory tract showed he had influenza A/H1N1.

On the sixth hospital day the man received oseltamivir, but by day 13 physicians discontinued the drug because sequence analysis of the virus revealed the H274Y mutation and there was no decrease in the viral load.

The authors reported that the mutation was found in samples obtained before the patient began oseltamivir therapy. The man's family and the hospital record revealed that he had had no contact with patients who were taking oseltamivir.

On the 15th hospital day the man's doctors prescribed amantadine, and after a few days his neutrophil count increased, a sign of bone marrow recovery, the group reported.

On day 20 doctors took the patient off the ventilator and instituted zanamivir treatment. However, 2 days later the man had respiratory failure again, and his medical team put him back on the ventilator and discontinued zanamivir therapy. (Like osteltamivir, zanamivir is a neuramnidase inhibitor, but no increase in zanamivir resistance has been reported recently.)

By day 26 physicians detected no influenza virus, but did note that sequence analysis showed an amantadine-resistance mutation in the viral M2 protein (L26F). They wrote that recovery of the immune system was probably responsible for clearing the virus, because the patient had received only three doses of zanamivir.

A repeat CT scan taken on day 28 showed that pulmonary infiltrates had progressed. Because of the man's poor prognosis, the ventilator was removed on day 34, and he died 3 days later.

The authors cited animal studies indicating that oseltamivir resistance leaves H1N1 viruses "severely compromised." Despite these reports, they wrote, "the case we describe suggests that this oseltamivir-resistant virus can be pathogenic, at least in an immunocompromised patient."

In an editorial published by Eurosurveillance in January, authorities said resistant viruses with the H274Y mutation had been seen in previous flu seasons but were rare and did not spread easily. But the more recent H1N1 isolates with the mutation were "fitter" and were spreading in the community, they wrote.

Van der Vries E, Van den Berg B, Schutten M. Fatal oseltamivir-resistant influenza virus infection. N Engl J Med 2008 Sep 4;359(10):1074-76 [Full text]

See also:

Aug 25 CIDRAP News story "H1N1 viruses growing more resistant to Tamiflu"




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Johnray I think you are an M.D. person and I am not. So feel free to comment or correct anything misstated here. I was going to post this on Skye's flu thread - but since Bluebird just was in ER at the hospital - I will relate what is going on with her in SW West Virginia - which even on the official map is noted, I think as having some type of flu outbreaks...

It is one month later. It has taken Skye 30 days to recover from the flu. He was given a Z-pak, drank a lot fluid, was not hungry and ate poorly, and it went systemic - eye infection yellow discharge, throat, and with Vitamin C, (ask your doctor whether to take C and how much) and a lot of love from Bluebird who one of the most devoted women to her child I have ever known, he is afebrile and just a little sick.

However Bluebird is headed to the clinic, is very ill, and spiked a high temp with serious lung congestion and wheezing. Five more members of our family have it, and today my brother in law came down with it.

In my case, it went systemic, and I am still fighting what seems to be a stomach flu component.  Point.

I have posted this to follow up on what happened and to say this...

(time passed)

Bluebird called me and two of the clinics here are shut down. She managed to get into ER and they were going to start steroid injections. The doctor stated 'it is a virus and I see no point in giving you a Z-pak to treat other bacterial infections. End result. Bluebird did not have the injection and did get the Z-pak. Skye was given Z-pak and it seemed to help him a few weeks ago.

Reference Michael Osterholm's article concerning the use of steroids with inflamed lungs.  also one of our own AFT  advisors post cupcake mom -

quote

Other infections besides H5N1 also are known to cause a cytokine storm in the lungs, and produce a syndrome called ARDS (Acute Respiratory Distress Syndrome).  It is still very hard to treat even with modern medicine, and the mortality rate is about 40% or so.  Corticosteroids are virtually always tried but so far with so-so results.  Steroids were given to at least some of the H5N1 patients who died (according to the WHO reports) without having much effect.  The treatment is basically to give agents that may kill the organism, while ventilating the heck out of the person. 

This is controversial - I am not an M.D. ask your doctor about the use of steroids for this real LUNG flu - Bluebird declined.

This flu is very contagious.  It also lasts a long time. We'll let the experts figure it out. We are hearing H1N1 - and we are also hearing this strain has mutated.

Skye is still sick, but stable. It would appear that the medical people we have seen here are not able to put in a box a flu that lasts for 30 days or more.

What I had took 3-7 days  to incubate from a teacher who just got out of the hospital and came to our lab. It has lasted for me almost 45 days. All of this is specific to people we know and our personal experience. What we had seems to drop into the lungs in 4-5 days and produces higher fevers, (mine was 103 - Skye's up to 105, Bluebirds 102 plus) Bluebird completelly lost her voice and could not even talk but in a whisper, and Skye had yellow mucous coming out of his eyes.

It's nasty stuff.

Take care all. Mommy (Bluebird) could hardly breath at 4 a.m. today, but is out of distress now.

For now, it did not appear they were admitting many people for this flu to the hospital.

Any doctors who want to post here... especially one here on line as an advisers.. feel free to comment.

Medclinician
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Post Options Post Options   Thanks (0) Thanks(0)   Quote vmd Quote  Post ReplyReply Direct Link To This Post Posted: December 23 2008 at 12:53pm
Been distracted for a while. Just wanna wish y'all the best. OMG!45days! I'm sooo out of the loop. Thanks x 100 for keeping me/us up on what you're going through.
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Originally posted by Mary08 Mary08 wrote:

Johnray... This year's flu...so far (they say it is early and the biggie for the entire flu season could change)

At this point it is the H1N1 Flu that is hitting hard.
Doctors have been told to use antivirals on flu patients.

Try COLD MD....very effective over the counter meds...ClapRC

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Medclinician,since I posted last,I have learned more about this Flu. It does not seem to be in my area yet. But I called around some and the areas that this flu is in,it is putting people in hospitals and they are very sick. It is in Bluefield,WV which is not far from you. As far as the steroid injection for the inflammed lungs goes,,that does work and some times it is necessary in order to save the patients life,but this is always a flip side to most things and there is to this.Steroids injections will help inflammed lungs and inflammed any thing but it does this by depressing your own immune system so that it is not respondeing to the infection,but since it suppresses your own immune system,it sets you up for what we refer to as a "super infection", and that is usually fatal, (bacteria loves to eat steroids and the bacteria gets  very strong,) so we try not to use it,but sometimes we have no joice. Steriods injections does not kill any virus and it does not kill and bacteria. --As far as how much Vitamin C to take,there is no upper limit,it is not toxic,but when you take enough to cause diarrhea,your body can not use any Vitamin C that day,but  unless you are taking Buffered Vitamin C,you will get sick at you stomach before you get diarrhea,but it will not hurt you.---I hate to hear of some of your family and you being very sick.I wish all of you the best to you and yours in life and good health.Johnray1
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Originally posted by reality check reality check wrote:

Originally posted by Mary08 Mary08 wrote:

Johnray... This year's flu...so far (they say it is early and the biggie for the entire flu season could change)

At this point it is the H1N1 Flu that is hitting hard.
Doctors have been told to use antivirals on flu patients.

Try COLD MD....very effective over the counter meds...ClapRC



She tried theraflu and it almost killed her off last night. It made her feel better and breathe better but when it wore off at 4:30 a.m. she could hardly breath at all. It is not a cold. It is in her deep lungs and she can't even talk. This was a general hospital- not the military hospital I go to. They have used anti-virals on me in the past and it helped.

Not to be dramatic, but this is my wife RC. And she is pretty bad off and we have a small child. She is not a lab rat. She is a person. Skye would be pretty messed up without a mother. I wish I had been married to her during Vietnam then she would have medical with me now. Going to some of these ERs is pretty bad. So far of all the people we know, they have not given out any antivirals at all. Once they gave Skye Amoxicillin.

Has anyone else in this forum except me been given an antiviral. One of the two clinics said they were backed up until January 15. That was the soonest she could see a doctor.

Seems weird.

Of course, you would have to be here to appreciate the fact these people aren't going around sneezing. They are standing in hallways deep coughing their lungs out. I have been in medicine for 35 years. I have seen a lot. I have had HIV patients,pertussis,some of the nastiest TB and cancers. I worked Kaiser for years and at Stanford. Small town hospitals can be scary.

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Originally posted by Johnray1 Johnray1 wrote:

Medclinician,since I posted last,I have learned more about this Flu. It does not seem to be in my area yet. But I called around some and the areas that this flu is in,it is putting people in hospitals and they are very sick. It is in Bluefield,WV which is not far from you. As far as the steroid injection for the inflammed lungs goes,,that does work and some times it is necessary in order to save the patients life,but this is always a flip side to most things and there is to this.Steroids injections will help inflammed lungs and inflammed any thing but it does this by depressing your own immune system so that it is not respondeing to the infection,but since it suppresses your own immune system,it sets you up for what we refer to as a "super infection", and that is usually fatal, (bacteria loves to eat steroids and the bacteria gets  very strong,) so we try not to use it,but sometimes we have no joice. Steriods injections does not kill any virus and it does not kill and bacteria. --As far as how much Vitamin C to take,there is no upper limit,it is not toxic,but when you take enough to cause diarrhea,your body can not use any Vitamin C that day,but  unless you are taking Buffered Vitamin C,you will get sick at you stomach before you get diarrhea,but it will not hurt you.---I hate to hear of some of your family and you being very sick.I wish all of you the best to you and yours in life and good health.Johnray1


much thanks JohnRay. I knew you would come through on this. It does sound like spinning the wheel.. the steroid stuff.. Yes we are not far from Bluefield. It is the real deal here. You all, are fortunate you do not have it in your area.

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Post Options Post Options   Thanks (0) Thanks(0)   Quote homescoolmama Quote  Post ReplyReply Direct Link To This Post Posted: December 23 2008 at 4:44pm

My 20 yr old daughter has been sick for over  2 months now with a similar flu, high fever at first, intense chest congestion, moved up to her head and sinuses, nothing helped, she was put on amoxicillin - heavy dose for 10 days about 3 weeks into it. That did nothing she went back to an ENT specialist at my urging this week and he put her on something that seems to be working finally after 2 1/2 months. At its worst she couldn't breathe and when it went up to her head and sinus she was blowing out HUGE mucous wads, I have never ever seen anything like that. The new med is Biaxin XL 500 mg.. Oh and one other thing, there was a point about 4 weeks into it where she felt reasonably ok and she went to ask if they would give her a flu shot and they said that as long as she was fever free it would be fine, so she did get the shot. It was thimerosal free and she had no reaction to it that we could notice....

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Post Options Post Options   Thanks (0) Thanks(0)   Quote homescoolmama Quote  Post ReplyReply Direct Link To This Post Posted: December 23 2008 at 5:07pm
Here is the info on Biaxin XL

Biaxin XL

Common Name
clarithromycin

DIN (Drug Identification Number)

02244756 BIAXIN XL 500MG

How does this medication work? What will it do for me?

Clarithromycin is a macrolide antibiotic used to treat infections caused by certain bacteria. It works by killing or stopping the growth of bacteria that may cause certain throat infections such as tonsillitis, sinus infections, lung infections such as pneumonia, and skin infections such as impetigo and cellulitis. It is also used in combination with other medications to kill H. Pylori, a bacteria known to cause ulcers in the digestive tract.

It seems to be working wonders for now, we'll se what happens when she stops taking it...
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Penham Quote  Post ReplyReply Direct Link To This Post Posted: December 23 2008 at 6:17pm
All 3 of us had some type of respiratory thing within the past month. 13 year old got it first, I took her to the ER, she was given a steroid breathing treatment, antibiotics Levaquin (sp?) and steroids to take at home, breathing treatment every 4 hours for the first 2 days. She cleared up in about 5 days. Then I came down with it, I went to the ER and was given Erythromycin and steroids, which did nothing. I was back in the ER within a week and then put on Levaquin and more steroids. I did well on this until I finished the meds then got sick again as soon as I went off the meds. So finally was able to go to my regular doctor on a weekday instead of a weekend and got Azithromycin and more steroids which worked but not all the way, so back again and ANOTHER round of Azithromycin, the Zpack usually knocks anything out, but the doctor said it was taking two round of Azithromycin to knock this out. Plus we have a nebulizer at home, so our breathing didn't get as bad as some. Then hubby got it, he goes to a different doctor, his doctor put him on Azithromycin and steroids and gave him refills to start with, told hubby that whatever it was that was going around was taking two rounds of antibiotics to knock it out. We got all the antibiotics, but he didn't have to use both rounds, so now we have some extra.
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I really want to thank homescoolmama and Penham because I was really beginning to wonder.. well you get this weird flu - and it lasts really long - and the doctors are kinda at a loss what to do.  I showed Bluebird the posts and you know, it is corny, but it helped. I mean, the thing is... you survived - it was bad - but late at night when she is wheezing and taking her meds and wondering...
 
It is the kinda thing that's gonna get us through the Pandemic. The community thing. I talked to the lady who helped write the Pandemic Flu Plan for Virginia and she was very into the idea of little communities all over kinda cut off and working together (not getting to close to each other when sick) but as I write what I must finish - I have learned so much from the people on this site especially. We have another meeting coming for Christmas with the people 'near Bluefield' West Virginia - and we are planning and talking about checking on each other and how we will work it if the little white trucks with red crosses don't show up and
we have to deal with something like this that is meaner in terms of people not making it.
 
So - vaporizer on - Skye almost better - and knowing.. we are not alone.
 
Thank you.
 
Medclinician and family
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Post Options Post Options   Thanks (0) Thanks(0)   Quote abcdefg Quote  Post ReplyReply Direct Link To This Post Posted: December 23 2008 at 9:05pm
My daughters boyfriend   has this nasty sinus infection.  I told you all my aunt has it in Rocherster, and they are considering surgery. Third week of antibiotic for her, fourth type of anti biotic. Now here in NC, I am hearing about sinus infections, I am wondering, could this virus, start as a cold, infect the sinus, and then through post nasal drip, get into the bronchial tree? I am pretty sure it can. My advise is, get treated for that cold the minut it goes to long or whatever your symtoms of sinus infection are and do not, wait for it to get to the lugns and throat.
Since my Mom passed away many years ago, from a common bacteria that went super bug, I get real nervous, when I hear of things that do not respond to anti biotics. I know these people have the infections, because they did cat scans to find out.
Usually if you have seen your Dr. and they have you on a anti biotic and it is not working, they wiil switch you to a new one, without having to go back in. Also, Mucinex otc or the store brand which is much cheaper, is good for moving that crap out of the lungs, make sure to drink plenty of water with it. Theraflu is good, but some of the stuff that makes the nasal passages shrink cause the bronchi to shrink making breathing harder.
Also, be careful with humidity, there is a fine line between getting the level right and too much. Too much, you get that heavy water laden air into the lungs and it sits there, when you are infected and your lungs do not work just right.  One thing that is so simple and works well, is the Vicks type stuff, I used to  boil water and then put a plop of it, in a pan, and it would fill the room with that vapor and it made you feel open.
Let me know, if anyone is hearing about this Sinus stuff, that I know is from the Midwest to NC. Anytime Mayo gets concerned, I listen. God bless you all.
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I think that the Sinus virus sure sounds like what you guys have. I am also on some Amoxicillin and steriods, I have had to slow my back off on the steroids down. It does not seem that bad for me, but I took the tons of vitamin C in the begiining. I know it makes virus hard to live.
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Good point Med ..on checking with people who have been through it.  Have had family stay with us and recover more positively knowing there is light at the end of the tunnel.  There are a lot of odd viruses put there.  We have used 3 drops of tea tree oil in a steaming sink with towel over head...early on.  This has improved my breathing, thyme leaf tea.  The triaminic patches are very good, helped me with breathing.

There is so much talk out there...Doctors are shooting in the dark...they all give amox. which does not work and then...wonders, you have to go back again, (how nice that is... to go sit in a waiting room of sick people twice)...I was really not up for that.   Here is some info... sounds like you have flu down there...but no testing...as this article mentions.
Hope you all feel better by xmas day.



please read entire article here-
http://www.cbc.ca/health/story/2008/12/22/flu-resistant.html


Doctors face dilemma treating resistant flu this season



Last Updated: Monday, December 22, 2008
The Canadian Press


excerpt-

...Given that in reality little point-of-care testing is done to determine whether a patient actually has influenza, let alone which variety of the bug is behind the illness, the resistance situation could see doctors making choices that lead to treatment failure this season.

"This is a very challenging situation," Dr. Tim Uyeki, deputy chief of influenza surveillance and prevention for the U.S. Centers for Disease Control admitted about the bizarre resistance picture coming into focus in the early days of the flu season.

"It definitely adds to the complexity of trying to manage influenza," Dr. Maria Zambon, head of the respiratory viruses unit of Britain's Health Protection Agency, agreed in an interview.

In the face of these early results, the CDC issued a health alert Friday to bring the U.S. medical community up to speed and recommend changes in the usage of flu drugs for the time being.

The upshot? When in doubt — and when the patient's age and health permits — use the only other option, the drug zanamivir, which is sold under the brand name Relenza. So far, all influenza A viruses (H1N1 and H3N2 are subtypes of influenza A) as well as influenza B viruses seem to be susceptible to zanamivir.

Oseltamivir could be used in combination with one of the adamantane drugs, but should only be used alone when local surveillance shows the viruses circulating are likely to be H3N2 or influenza B, the CDC guidance says.

As U.S. surveillance suggests most disease there so far this season is being caused by the H1N1 viruses, zanamivir appears to be a better bet than oseltamivir — or at least it is for patients who can use it. Zanamivir isn't licensed for use in children under seven years of age, and can't be used by people with chronic underlying airways disease or who can't manage the drug's inhalation device.
Vaccine well-matched

While they struggle to craft guidance for doctors, both the CDC and the Public Health Agency of Canada have a straightforward piece of advice for the public: Get a flu shot. This year's vaccine is well-matched to the H1N1 viruses and the majority of H3N2 viruses currently making the rounds.

On the issue of antivirals, Canadian authorities aren't yet offering new treatment advice to the medical community in this country, though they are closely monitoring the situation, said Dr. Arlene King, director general for the Public Health Agency of Canada's centre for immunization and respiratory infectious diseases.


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Post Options Post Options   Thanks (0) Thanks(0)   Quote Penham Quote  Post ReplyReply Direct Link To This Post Posted: December 24 2008 at 6:15am

The docs explained to us is is NOT the flu, but starts as a viral thing and cannot be treated with antibiotics, BUT once it gets to a certain point and the sinus problems get bad enough and the  nasal drip and all that goes into the lungs and bronchial tubes and causes infection, then the antibiotics and steroids will clear it up and if you don't catch it soon enough it will turn to pneumonia. So initially it is a virus, but ends up as something else, at least this is their take on it where I see the doctor.

I also forgot to mention my oldest adult daughter also had it and had it worse than the rest of us. She was off work for a week and was also sick the two weekends before and after, not fully recovered, but no more sick time and went back to work. She was also on 3 different types of antibiotics, and 3 times to the doctor, the last time she went in they gave her Levaquin, and a shot of Rocephin (sp? I know it's a strong antibiotic) a steriod shot and oral steroids, and breathing treatments to take at home every 4 hours, which she is still taking at work and she is finally getting better. Although very exhausted.
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Penham... Did they say what type of virus?  I feel like that is a lot of drugs for a no name virus... I was told the same thing, I may have to go for the Biaxin.  This is going into months.  The flu is so bad you need not ask...is this a flu?  puts one flat for 7-10 days.  Has anyone had vertigo as a symptom?
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Post Options Post Options   Thanks (0) Thanks(0)   Quote Penham Quote  Post ReplyReply Direct Link To This Post Posted: December 24 2008 at 11:14am
No, they didn't have a name for the virus. As far as not being the flu, the syptoms are different as there are no all over achy body feelings like when you have the flu, how every muscle in your body just aches. With this you just feel like crap and the fever is low grade not high grade, so there is a few differences than in the "real" flu.
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Post Options Post Options   Thanks (0) Thanks(0)   Quote homescoolmama Quote  Post ReplyReply Direct Link To This Post Posted: December 24 2008 at 11:49am
My daughter had vertigo and in the beginning could not get out of bed, I went over and kept her hydrated and fed...Intense fatigue, muscle tirednes/aches, trouble breathing...
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