Viagra & anaesthetic drug sold as herbal alternative medicines


This news in Times of India  is just an tip of the iceberg, the reality  of alternative medicine  industry. Toxic substances being sold at exorbitant prices  labelled as herbal substances can be unmasked only if checked  and controlled strictly.  Gullible masses consume these substances without knowing the right dose or right drugs thinking them as herbal products . Assumptions that they are free from side effects is another myth, that goes unsaid.

MUMBAI: The Aurangabad division of FDA has found sildenafil citrate, commonly known as Viagra, and a short-acting anaesthetic drug in two alternative  medicines meant to increase sexual desire and potency that were randomly tested for quality recently. The worrying finding has prompted the drug regulatory body to issue a statewide circular asking its officials to seize any available stock of these drugs- Power up capsules and Tiger king cream. The containers of both the alternative medicines didn’t mention the allopathic components sildenafil and anaesthetic drug (lignocaine hydrochloride), giving rise to fear of serious health consequences in people who might consume them unknowingly. Viagra, in particular, which is given for erectile dysfunction, is supposed to be taken only when prescribed by a specialist as it can react with other ongoing medications and give rise to life-threatening complications. In July, FDA officials raided the office of Srishti Unani Medicine Agency in Aurangabad and found stocks worth Rs 16,000 that had arrived from Saharanpur district of Uttar Pradesh. Tests revealed each Power up capsule contained 49.45mg of Viagra, while Tiger king cream had a significant amount of lignocaine hydrochloride, though only the herbal components were mentioned in the packing material.

The spurious drugs were manufactured in violation of the Drugs and Cosmetics Act. “We will lodge an FIR against Naman India, the UP-based manufacturer, that has been selling these drugs in the name of herbal medicine to gullible consumers,”, joint commissioner, FDA, Aurangabad. He said the department is yet to establish where these drugs were supposed to be distributed, but there is demand from across the state. It was during a raid in the city sometime in 2015 when the department woke up to rampant adulteration of so-called alternative  medicines with allopathic drugs. An official said it was an “industry worth millions” that clandestinely ran out of Tier-2 and 3 cities or slums in metros. “Under the Act, manufacturing of alternative  drugs needs a licence, but there are no legal provisions for distribution and supply. So monitoring becomes a challenge,” said an FDA official. Medically, doctors say, such rackets are not just about making spurious drugs and making a quick buck but messing with people’s lives. “It’s a menace that has existed for years unchecked. Alternative  practitioners charge exorbitant sums for these  medicines that illegally contain sildenafil, which otherwise costs just Rs 30-40 when sold as an allopathy drug.

Homosexuality not a psychiatric disorder:Indian Psychiatry Society (IPS) . criminalization affects mental health: Supreme court


 

The Indian Psychiatry Society (IPS) said homosexuality was not a psychiatric disorder. Coming out in support of decriminalising homosexuality, the IPS said in a statement on Saturday that it recognised “same- sex sexuality as a normal variant of human sexuality much like heterosexuality and bisexuality”. “There is no scientific evidence that sexual orientation can be altered by any treatment and any such attempts may, in fact, lead to low self-esteem and stigmatisation of the person,” the society added. The IPS had, in 2017, constituted a task force on lesbian, gay, bisexual and transgender issues. The task force, now partially reconstituted, continues its work to endorse the stance that homosexuality “should not be considered a mental illness, much less a crime”. It also said its position was in line with that of the American Psychiatric Association and the International Classification of 7/12/2018 Homosexuality not a crime, says Indian Psychiatry Society . Diseases of the World Health Organisation which removed homosexuality from the list of psychiatric disorders in 1973 and 1992 respectively. In 2009, the Delhi High Court had decriminalised Section 377, an order that was set aside by the SC in 2013. In January, the apex court said it would revisit the constitutional validity of Section 377 and referred the matter to a constitution bench.

 

The Supreme Court said  “Once the criminality of consensual gay sex goes away, then related issues like social stigma and discrimination against the LGBTQ community will also go” . Observing that an environment has been created in the Indian society over the years that has led to deep-rooted discrimination against the community, a five-judge constitution bench, hearing petitions seeking decriminalisation of 158-year-old colonial law under Section 377 of the IPC, said discrimination against such people has also adversely impacted their mental health.

The bench then said the LGBTQ (lesbian, gay, bisexual, transgender and queer) community faced the stigma because of the criminality attached to consensual same-sex relationship. “Once the criminality (under section 377) goes, then everything will go (all the bars, social stigma and others),” the benchsaid. “Over the years, we have created an environment in the Indian society which has led to deep-rooted discrimination against people of same sex involved in a consensual relationship and this has impacted their mental health also,” the bench said on the third day of crucial hearing to decide the constitutional validity of Section 377 of the Indian Penal Code (IPC).

 

Section 377 refers to ‘unnatural offences’ and says whoever voluntarily has carnal intercourse against the order of nature with any man, woman or animal, shall be punished with imprisonment for life, or with imprisonment of either description for a term which may extend to 10 years, and shall also be liable to pay a fine. Referring to the provision of the Mental Health Care Act, the bench said, “it also recognises the fact that such persons cannot be discriminated against on the ground of sexual orientation”.

 

On Wednesday, the government had left it to the apex court to test the constitutional validity of section 377 of the IPC which criminalises “consensual acts of adults in private”, urging that issues like gay marriages, adoption and ancillary civil rights of LGBTQ should not be dealt by it.  Govt leaves it to SC’ wisdom to decriminalise gay sex Taking note of the Centre’s submission that other issues like gay marriages, adoption and ancillary civil rights of LGBTQ community should not be dealt, the court said it was not considering all these issues. The bench had said it would test the validity of the law in relation to the consensual sexual acts of two adults and if it decides to strike down the penal provision then it would remove “ancillary disqualification” of LGBTQ community members who can join services, contest elections and form associations. There are  reports of Indian and American psychiatric bodies and said homosexuality was a normal sexual orientation.

 

https://timesofindia.indiatimes.com/india/homosexuality-not-a-crime-says-indian-psychiatry-society/articleshow/64911235.cms

https://timesofindia.indiatimes.com/india/supreme-court-once-criminality-of-section-377-goes-stigma-against-lgbtq-will-also-end/articleshow/64959395.cms

 

India expenditure on health 1 %, of GDP, Lower than Bhutan, Nepal, Sri Lanka


  •  India’s per capita public expenditure on health increased from Rs 621 in 2009-10 to Rs 1,112 (around $16 at current exchange rate) in 2015-16
  • According to National Health Profile (2018), around 43 crore individuals or 34% of the population were covered under any health insurance in 2016-17

It is not difficult to diagnose the ailments of health system. System that requires more input, is suffering  due to  decades of neglect.  It  reflects  a lower priority to health sector.

India’s public health expenditure — 1% of its gross domestic product (GDP) — may have witnessed a marginal improvement from 0.98% in 2014, but it is still way behind even the low-income countries that spend 1.4% on an average, shows National Health Profile 2018.

India is spending even less than some of its neighbors countries such as Bhutan (2.5%), Sri Lanka (1.6%) and Nepal (1.1%), according to the annual report released on Tuesday by the Central Bureau of Health Intelligence, the health intelligence wing of the directorate general of health services in the Union ministry of health and family welfare.

In World Health Organization’s South-East Asian Region, which includes 10 countries, India finishes second last, above only Bangladesh (0.4%), when their health expenditure is compared. Maldives spends 9.4% of its GDP to claim the top spot in the list, followed by Thailand (2.9%).

India’s National Health Policy 2017 proposes raising the public health expenditure to 2.5% of the GDP by 2025.

India currently spends a little over 1% of GDP on health, far below Singapore which has the lowest public spend on health at 2.2% of GDP among countries with significant universal health coverage (UHC) service, according latest National Health Profile (NHP) data.

India’s per capita public expenditure on health increased from Rs 621 in 2009-10 to Rs 1,112 (around $16 at current exchange rate) in 2015-16. However, it is still “nominal”, compared to other countries. Switzerland spends $6944 on health per capita, whereas the US spends $4802 and UK spends$3500.

Government  plans to launch its ambitious National Health Protection Scheme (NHPS)- Ayushman Bharat – to cover over 10 crore poor families with an annual health cover of Rs 5 lakh per family. A successful implementation may bring some positive change to the ailing system.

Real challenge is to provide basic health facilities to remote areas.  Even good preventive care and primary care to under privileged can also  bring a significant change.

 

Digital Gaming addiction defined as a mental disorder by World Health Organisation


  • WHO described the addiction as a “pattern of persistent or recurrent gaming behaviour” that becomes so extensive it “takes precedence over other life interests”
  • Gaming disorder can lead to disturbed sleep patterns, diet problems and deficiency in physical activities

 

Digital Gaming  Addiction

Although   substance addiction with  drugs or alcohol is well recognized, newer  addictive behaviors are now being realized as well. As  digital and vedio gaming has been quite popular now, compulsive gaming and  severe withdrawal symptoms in game addicts are getting commoner. A child/ adult needs more of a  game  to keep him going. If the child does not get more of the game, he becomes irritable and miserable.

If parent try to prohibit gaming, children exhibit  anger, violence, or depression. The children cry, sit in the corner and cries, refuses meals or sleep.

For  compulsive gamers, it is  the fantasy world that makes them feel better.

The lure of a fantasy world is especially pertinent to online role-playing games. These are games in which a player assumes the role of a fictional character and interacts with other players in a virtual world. As  A child can  show his dominance in the game. There fore virtual life becomes more appealing than real life.

possibility of harm: gaming addiction can ruin lives. Children who play few hours per day have  no time left for socializing, studies, or sports. Social development is poor.

In older people or adults  it can have effect on professional life and relationships.

 

Warning signs for  gaming  addiction include:  The important  issue here is  whether one is  able to control  gaming activity or not:

  • Playing for increasing amounts of time
  • Thinking about gaming during other activities
  • to choose gaming to escape from real-life problems, anxiety,  depression
  • Lying to friends and family to conceal gaming
  • Feeling irritable when trying to cut down on gaming

Gaming addicts tend to become isolated, giving up other hobbies and  withdrawn from other activities.

Parents need to be careful

Parents need to be careful and not take it as another routine phase of childhood.  Keep  track of  child’s gaming behavior, including:

  • for how long and frequently  the child plays.
  • Problems resulting from gaming
  • How the child reacts to time limits

to get rid of the game addiction, these children need to be taught about the advantages of real life excitement as opposed to online achievements.

Addiction to digital and video gaming has been classified as a mental health disorder by the World Health Organisation (WHO) in its new International Classification of Diseases (ICD).

The agency described the addiction as a “pattern of persistent or recurrent gaming behaviour” that becomes so extensive it “takes precedence over other life interests

The classification is aimed at alerting health professionals and systems to the existence of this condition and ensuring that people suffering from these conditions can get appropriate help.

Gaming disorder” has three main characteristics. One, that the gaming behaviour takes precedence over other activities to the extent that other activities are pushed to the periphery.

 

If the condition leads to significant distress and impairment in personal, familial, social, educational or occupational functioning.

Gaming disorder can lead to disturbed sleep patterns, diet problems and deficiency in physical activities.

The 11th edition of ICD covers 55,000 injuries, diseases and causes of death. Researchers across the world use it as reference for data, whereas doctors and other medical practitioners use it to diagnose disease and other conditions. The ICD is also used by health insurers in some countries to claim reimbursements based on ICD coding.

Besides, the classification is used by national health program managers; data collection specialists; and others. The new ICD-11 also reflects progress in medicine and advances in scientific understanding.

Smoking in moderation also carries significant risk: World No Tobacco Day


Tobacco and heart disease

Every year, on 31 May, WHO and partners mark World No Tobacco Day (WNTD), highlighting the health and other risks associated with tobacco use, and advocating for effective policies to reduce tobacco consumption.

The focus of World No Tobacco Day 2018 is “Tobacco and heart disease.” The campaign will increase awareness on the:

  • link between tobacco and heart and other cardiovascular diseases (CVD), including stroke, which combined are the world’s leading causes of death;
  • feasible actions and measures that key audiences, including governments and the public, can take to reduce the risks to heart health posed by tobacco.

World No Tobacco Day 2018 coincides with a range of global initiatives and opportunities aimed at addressing the tobacco epidemic and its impact of public health, particularly in causing the death and suffering of millions of people globally

 Tobacco endangers the heart health of people worldwide

Tobacco use is an important risk factor for the development of coronary heart disease, stroke, and peripheral vascular disease.

Despite the known harms of tobacco to heart health, and the availability of solutions to reduce related death and disease, knowledge among large sections of the public that tobacco is one of the leading causes of CVD is low.

Facts about tobacco, heart and other cardiovascular diseases

Cardiovascular diseases (CVD) kill more people than any other cause of death worldwide, and tobacco use and second-hand smoke exposure contribute to approximately 17% of all heart disease deaths. Tobacco use is the second leading cause of CVD, after high blood pressure.

The global tobacco epidemic kills more than 7 million people each year, of which close to 900 000 are non-smokers dying from breathing second-hand smoke. Nearly 80% of the more than 1 billion smokers worldwide live in low- and middle-income countries, where the burden of tobacco-related illness and death is heaviest.

  • Of the nearly 7 million who die each year due to tobacco-related causes, 6 million die from direct tobacco use
  • Another 890,000 are victims of second-hand smoke
  • Roughly half of those who lose their lives to tobacco each year succumb to cardio vascular diseases

Tobacco kills almost 7 million people across the world every year and nearly a million of them are not even smokers. It also costs the world about $1.4 trillion annually in healthcare costs related to tobacco-attributable diseases and in lost productivity due to death and illness.

Of the nearly 7 million who die each year due to tobacco related causes, 6 million die from direct tobacco use while another 890,000 are victims of second-hand smoke, according to the WHO estimates. Roughly half of those who lose their lives to tobacco each year succumb to cardio vascular diseases. In fact, tobacco is one of the major causes for heart diseases accounting for about 17% of all deaths due to them.

This is also true of non-smokers who die from exposure to tobacco smoke. Of the economic costs, around $400 billion is in direct medical care costs and nearly $1 trillion is in indirect costs, representing the value of lost productivity due to premature death and morbidity from exposure to second-hand smoke, the study estimated. The WHO material on tobacco has findings that may come as a surprise to many, particularly to those who use tobacco. For instance, it says that while there is some relationship between how much tobacco you smoke each day and the risk of heart diseases, it is not a linear one.

Thus, smoking even just one cigarette a day incurs half the risk of developing heart disease and stroke incurred by smoking a pack of 20 each day. In short, the idea of smoking in moderation is largely a myth. Similarly, the WHO concludes that there is no evidence to show that electronic nicotine delivery systems like e-cigarettes or vape pens are less harmful than smoking cigarettes in terms of the risk of heart disease.

This is despite the fact that on the whole such devices do contain fewer toxicants. The same caveats hold also for what are called heat-not-burn tobacco products. Another sobering fact is that despite tobacco being a major cause of heart attacks and stroke, a significant proportion of adults in several countries surveyed either do not know this or do not believe it. In India, for instance, 36% did not know or believe that smoking can cause heart attacks while 51% had similar disbelief or ignorance when it came to strokes. China was even worse with 61% of adults disclaiming knowledge of or belief in the connection between smoking and heart attacks and 73% in the connection with stroke. Like smoking, smokeless tobacco too is harmful and carries similar risk of cardio vascular diseases and stroke.
While smokeless tobacco is not a major issue in most parts of the globe, it is a widely prevalent form of tobacco use in parts of the sub-continent, like India and Bangladesh. Thus, while the prevalence of tobacco smoking is lower in India (particularly among women) than in many other large countries, those countries have virtually no use of smokeless tobacco. In India, in contrast, over a quarter of the adult population uses some form of smokeless tobacco.

Eating alone is Important cause of sadness?


As part of Sainsbury’s Living Well Index, developed in partnership with leading researchers Oxford Economics and the National Centre for Social Research, the retailer surveyed more than 8,000 British adults to investigate how people can live better day-to-day.

However, the data gathered inadvertently revealed that the mood of the nation has declined over the last six months with a drop of 0.5 points to an average of 60.7. While much of the drop appears to be linked to seasonal factors such as extreme weather and public transport chaos, the index discovered more surprising reasons for people’s unhappiness.

Interestingly, it found that eating meals alone is strongly associated with unhappiness  other  than having a mental illness. In this case, people who ate by themselves scored 7.9 points lower than the national average, compared with someone who always eats in company.
Mental health was found to have the strongest negative association with wellbeing, with those who reported conditions such as anxiety, depression, panic attacks or compulsive behaviour scoring 8.5 points below the average figure. Other issues associated with unhappiness included limited physical mobility where participants scored 5.4 points lower, while people with a learning disability scored 3.7 points lower.
Conversely, eating with others had one of the highest positive associations with wellbeing with a score 0.22 points higher, alongside having enough time to do enough time to things (0.36),a satisfactory sex life (0.44 higher) and sleeping well (0.93 points higher).
As such, the researchers say their findings highlight the importance of face-to-face contact with improved happiness. This is because other forms of social contact, including talking to neighbors and meeting with friends, were associated with higher happiness scores, while digital interactions such as social media, showed no association at all.

 

Nipah Virus : Karnataka at high alert: suspected cases of rare virus, fanning fears


The Karnataka ( south India) state is on high alert, especially in areas bordering Kerala, after 11 people died of the mysterious Nipah Virus in Kozhikode over the last few days.

The Karnataka Health and Family Welfare Department has directed primary healthcare centres in Chamarajnagar and Mysuru districts, which share the border with Kerala, to be alert and to report any patients from Kerala with suspected Nipah cases. A team from Delhi has been sent to Kerala and based on the report, national guidelines will be issued.

Those travelling to Kerala should be cautious when and if they come in contact with Nipah-infected people. Avoid eating fruits fallen on the ground and drinking raw date palm sap in Kerala. Avoid coming in contact with sick domestic animals and pigs.

Nipah Virus infection is zoonotic, which means the disease has spread from animals to humans, and can causes severe conditions in animals and humans. The natural host of the virus are fruit bats of the Pteropodidae family, Pteropus genus. The virus transmits through direct contact with infected bats, pigs or from other NiV-infected people through touch or body fluids. Disease is contagious and can spread from person-to-person.

The infection in humans can cause a wide range of clinical presentations, from asymptomatic (no symptoms) to acute respiratory syndrome (cough, breathlessness and respiratory distress) and fatal encephalitis (inflammation of the brain). After exposure to virus, symptoms start after an incubation period of 5-14 days. Usual symptoms are fever and headache for 3-10 days followed by drowsiness, confusion, seizures and altered sensorium. Signs and symptoms can progress rapidly to coma and death in 24-48 hours. Nipah Virus encephalitis is fatal with a high mortality rate.

Stressing should be on precautions. The people in affected areas should avoid eating or drinking date palm sap (raw date palm sap, a sweet drink popular in the winter, when the sap is easy to tap from trees pierced with a spigot. A bat clings to a palm tree as it eats sap just above a collection jar). Disease can be prevented by avoiding animals that are known to be infected and using appropriate personal protective equipment.

There is no vaccine for the Nipah virus, carried by fruit bats and spread  through contact with bodily fluids, the World Health Organization (WHO) says. Treatment for the virus, which has a mortality rate of about 70 percent, is supportive care.

Nipah virus scare: prevention and control of deadly virus


The National Virology Institute, Pune, confirmed that the contagious fever that has killed several people in Kozhikode and Malappuram districts over the last fortnight is due to Nipah virus ( NiV). Six more people succumbed to symptoms suspected to be that of Nipah virus on Sunday.
    It is the first detection in Kerala of the Nipah virus which has a high fatality rate and spreads mainly through bats, pigs and other animals. Its symptoms include fever, vomiting, headache, drowsiness, coma and respiratory problems.
Virus has an incubation period of 4 to 18 days. Health workers  need to  take the highest level of protection while handling patients. No specific treatment is available but intensive care support is required.

Origion and History of initial identification:

Nipah virus (NiV) is a member of the family Paramyxoviridae, genus Henipavirus. NiV was initially isolated and identified in 1999 during an outbreak of encephalitis and respiratory illness among pig farmers and people with close contact with pigs in Malaysia and Singapore. Its name originated from Sungai Nipah, a village in the Malaysian Peninsula where pig farmers became ill with encephalitis. Given the relatedness of NiV to Hendra virus,  bat species were quickly singled out for investigation and flying foxes of the genus Pteropus were subsequently identified as the reservoir for NiV .

In the 1999 outbreak, Nipah virus caused a relatively mild disease in pigs, but nearly 300 human cases with over 100 deaths were reported. In order to stop the outbreak, more than a million pigs were euthanized, causing tremendous trade loss for Malaysia. Since this outbreak, no subsequent cases (in neither swine nor human) have been reported in either Malaysia or Singapore.

In 2001, NiV was again identified as the causative agent in an outbreak of human disease occurring in Bangladesh. Genetic sequencing confirmed this virus as Nipah virus, but a strain different from the one identified in 1999. In the same year, another outbreak was identified retrospectively in Siliguri, India with reports of person-to-person transmission in hospital settings (nosocomial transmission). Unlike the Malaysian NiV outbreak, outbreaks occur almost annually in Bangladesh and have been reported several times in India.

Symptoms and investigation

Nipah virus’s (NiV) symptoms in humans are similar to viral fever such as fever, headache and muscle pain. Perhaps, these symptoms should be taken seriously as they were a part of rare viral fever – identified as the Nipah virus (NiV) – that claimed lives in Kerala.

NiV infection is associated with encephalitis (inflammation of the brain) and can lead to disorientation and mental confusion, or coma in some cases – encephalitis may present as acute or late onset. While the later may be difficult to diagnose, those who may have recovered from an acute episode may also have a relapse.

Since the symptoms of Nipah virus are similar to that of influenza, it can be difficult to determine whether the person is affected by NiV based on symptoms alone. According to WHO, procedures for laboratory diagnosis of Nipah virus include a series of tests – serology, histopathology, PCR and virus isolation. Serum Neutralization Test, ELISA, RT-PCR are used for laboratory confirmation. Also, magnetic resonance of the brain can help differentiate Nipah encephalitis from other encephalitis as well as in defining between acute and late-onset or a relapsed form of the disease.

Prevention and control

Till date, there is no effective vaccine for Nipah virus disease, treatment is mostly focused on managing fever and the neurological symptoms. Ribavarin may help alleviate the symptoms of nausea, vomiting, and convulsions. Severely ill patients require hospitalisation and may require the use of a ventilator. Therapeutics and vaccine are said to be under development.

Adopting standard infection control practices is vital in preventing the spread of person-to-person transmission of the disease. As the main strategy is to prevent NiV in humans, establishing appropriate surveillance systems is necessary to detect the disease outbreaks quickly so that appropriate control measures are initiated in time.

Research is needed to better understand the ecology of bats and Nipah virus, investigating questions such as the seasonality of disease within reproductive cycles of bats. Surveillance tools should include reliable laboratory assays for early detection of disease in communities and livestock, and raising awareness of transmission and symptoms is important in reinforcing standard infection control practices to avoid human-to-human infections in hospital settings (nosocomial infection).

A subunit vaccine, using the Hendra G protein, produces cross-protective antibodies against HENV and NIPV has been recently used in Australia to protect horses against Hendra virus. This vaccine offers great potential for henipavirus protection in humans as well.

https://www.cdc.gov/vhf/nipah/prevention/index.html

14 of world’s 15 most polluted cities in India : is crime and pollution related?


The WHO report said 14 of world’s 15 most polluted cities were in India which includes Delhi, Kanpur and Varanasi.  This will need  soul searching  and introspection by every one including policy makers.

Air pollution is related to lung diseases like asthma, emphysema or COPD.  It can have effects on pregnant women, Heart patients and outdoor workers etc.  but another aspect of relationship  of pollution with crime is also coming up, which concerns the psychological aspect.

There is a study  in London which relates pollution and crime rate. Although it appears strange but it gives some thing to ponder. If proved correct it may be dangerous environment to the people living in polluted cities.

A new report by researchers at the London School of Economics (LSE) suggests that crime in the capital is being driven by air pollution.

Their results show more polluted areas will see spikes in crime, particularly for less serious offences.

While the study relies on observational data and therefore cannot make definitive conclusions, it adds to a small but growing body of evidence linking pollution and crime.

Previous experiments have shown that increased levels of particulate matter in the air lead to increased blood levels of stress hormones such as cortisol.

The authors therefore suggest that behavioural changes resulting from increased stress hormone levels may in turn lead to an increased likelihood a person will commit a crime.

This means is that pollution can have a negative effect on people’s ways of thinking, including decision making and the way they think about future punishment.

Higher levels of pollution mean higher levels of cortisol. Higher levels of cortisol affect the way that punishment is being perceived by criminals.

Though the paper has yet to be peer reviewed and published in an academic journal, it has undergone internal peer review at LSE’s Grantham Research Institute on Climate Change and the Environment.

The research is not the first to explore links between air pollution levels and crime.

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