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0 | This was a 13-year-old boy monitored in the unit since 2017-10-04 for stage V Chronic Kidney Disease (CKD) following a primary nephrotic syndrome by Segmental and Focal Glomerulosclerosis (FSGS) cortico-resistant and cyclo-resistant since he was 11 years old. | [
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2 | He weighed 32kg and measured 131cm with a normal BMI for his age. | [
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3 | He had delayed pubertal development (P1G3). | [
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4 | Faced with signs of intolerance in uremia, he first received two successive sessions of haemodialysis then three sessions per week for over 3 months in an adult center. | [
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8 | On day 2 after insertion, the patient had a fever at 39oC, abdominal pain and greenish vomiting. | [
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13 | The nasal swab isolated Staphylococcus aureus. | [
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20 | After the infection period, an equilibration Test (PET test) revealed a Hyper-permeable peritoneal membrane with D/P creatinine at 0.91. | [
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25 | After a second month of observation, the patient complained of abdominal pain at the day hospital. | [
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31 | She reported a deep dull aching pain in the right iliac fossa that has been progressively becoming worse. | [
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32 | She had no associated vomiting or change in bowel habits. | [
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33 | She reported no weight loss. | [
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41 | There were no liver lesions or lymphadenopathy noted. | [
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44 | An impression of appendiceal mucocele was made after the surgeon and the radiologist carefully analysed the CT scan. | [
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56 | Histopathology report *All slide sections are stained with Haematoxylin & Eosin (H/E) X50: low power viewing) : the appendiceal wall shows a flattened and misplaced epithelium (on top) as well as marked fibrosis surrounding a focus of dystrophic calcification (blue stained material in the centre of the image) X100 and... | [
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57 | Marked fibrosis beneath the epithelial lining is readily apparent. | [
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58 | *Fibrosis and chronic inflammation are secondary changes due to luminal compression in a long-standing disease. | [
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59 | A 68-year-old female was diagnosed with stage IV non-small cell lung adenocarcinoma and was started on pembrolizumab. | [
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61 | Extensive workup to rule out hypercoagulable, autoimmune and vascular disease was unremarkable except for mild elevation of ANA and ESR. | [
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62 | The symptoms quickly progressed into dry gangrene within four weeks and did not respond to medical or surgical treatment. | [
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63 | Pembrolizumab was subsequently discontinued due to progression of metastatic disease. | [
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64 | The patient refused further interventions and transitioned to hospice care where she expired after two months. | [
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65 | A 9 year old male patient who was apparently well until about 10 months prior to presentation when he was observed to have developed a painless right scrotal swelling. | [
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66 | The swelling steadily increased in size and never reduced. | [
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70 | There was neither history of haematuria in the past nor during the course of the illness. | [
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73 | A diagnosis of a right vaginal hydrocoele was made and the parent was counseled for surgery. | [
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76 | Intraoperative findings include hydrocoele with multiple cysts, flat testis and thickened spermatic cord. | [
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79 | Histology revealed fibrocollagenous tissue containing numerous granulomata in a background of dense admixed eosinophilic rich inflammatory infiltrates. | [
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81 | The presence of terminal spine confirmed Schistosoma haematobium and a diagnosis of schistosomiasis was made. | [
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83 | Patient 1 A two-month-old boy had been hospitalized in pediatric surgery unit for suspected tracheo-osefageal fistula. | [
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84 | He was referred from another hospital with the diagnosis of recurrent aspiration pneumonia unresponsive to antibiotic therapy. | [
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85 | On the admission, he had tachypnea and subfebrile fever on physical examination. | [
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97 | Patient 2 A fourteen-month-old boy with the diagnosis of gastroesophageal reflux disease was admitted to our hospital with complaints of vomiting and diarrhea for amonth. | [
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98 | On admission, his physical examination revealed fever (38.4 ° C). | [
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99 | Because of the prolonged diarrhea and vomiting, patient was hospitalized and further investigated. | [
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109 | The initial lesion was unknown. | [
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110 | Complaints of itching is unknown due to patient's decreased of consciousness state. | [
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113 | History of diabetes mellitus was absent. | [
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114 | Patient had a history of syphilis with HIV infection and got therapy of intramuscular injection 2.4 million unit of benzathine penicillin G for three consecutive weeks. | [
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119 | Dermatological examination of the posterior trunk region found hyperpigmented macules accompanied by crust, squama and erythematous macules. | [
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120 | Based on the history taking and physical examination, the patient was diagnosed with sepsis, suspected meningoencephalitis, hypoalbuminemia, community-acquired pneumonia, and cutaneous candidiasis. | [
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123 | For the cutaneous candidiasis, patient was treated with miconazole cream twice daily in the morning and evening and fusidic acid cream for 14 days. | [
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131 | Data from the history taking, physical examination, and supporting examinations concluded a diagnosis of cutaneous candidiasis caused by Candida kefyr. | [
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135 | A 67-year-old aboriginal woman with severe chronic obstructive pulmonary disease and hypercapnic respiratory failure underwent right trans-tibial (below the knee) amputation for severe foot gangrene. | [
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136 | An aggressive rehabilitation program of conditioning exercises and gait training utilizing oxygen therapy was initiated. | [
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138 | A rehabilitation program improved her strength, endurance and stump contracture, and she was able to walk for short distances with the prosthesis. | [
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140 | We report the case of a 38-year-old obese female with a body mass index (BMI) of 35, with no known comorbidity. | [
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141 | She reported diarrhea accompanied by fever three weeks before, which revealed a COVID-19 infection, for which she was treated at home without complications. | [
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143 | The physical examination revealed: Glasgow coma scale 15/15; blood pressure: 127/80mmhg; heart rate: 100 beats/min; respiratory rate: 30 cycles/min; 87% SaO 2 in ambient air; crackling and wheezing rales at the base of the left lung. | [
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144 | Cardiovascular examination was normal, there was no evidence of deep vein thrombosis. | [
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148 | The chest computed tomography with and without injection of contrast product found multifocal ground glass foci (10-25% impairment) of the two pulmonary hemi fields located under pleural with segmental and sub-segmental left pulmonary embolism. | [
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150 | The electrocardiogram found a sinus tachycardia with incomplete right bundle branch block, anteroseptoapical and inferior negative T wave, S1Q3 aspect. | [
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151 | The transthoracic ultrasound showed an acute pulmonary heart without right ventricule dysfonction, pulmonary hypertension at 54 mmhg with dilated lower vein cave. | [
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152 | We retained the diagnosis of pulmonary embolism at low intermediate risk on recovered COVID-19 infection. | [
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155 | A 14-year-old teenager with no particular pathological history, apart from moderate obesity with a body mass index (BMI) of 31 kg/m 2, was admitted for a class IV dyspnea according to the New York Heart Association (NYHA\) classification with sudden chest pain. | [
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159 | The evolution was characterized by a progressive worsening of dyspnea and the appearance of palpitations and chest pain. | [
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161 | Auscultation found regular tachycardia with no audible murmur, no signs of right or left heart failure, no sign of deep vein thrombosis. | [
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164 | It showed a mass on its side wall, a pulmonary hypertension at 50 mmHg, with a paradoxical septum. | [
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166 | The computed tomography (CT) angiogram of the chest showed a bilateral massive pulmonary embolism without parenchymal lesions. | [
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172 | As part of the etiological assessment of her pulmonary embolism, a venous doppler of the lower limbs with an abdominal ultrasound was normal. | [
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173 | Biological assessment for thrombophilia (C protein, S protein, antithrombin) or autoimmune disease (anti-cardiolipin antibody immunoglobulin M (IgM) and immunoglobulin G (IgG), anti-nuclear antibody, anti-DNA antibody) was negative as well. | [
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175 | Clinical improvement with regression of acute pulmonary heart disease, pulmonary hypertension and right ventricular mass was noted. | [
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179 | As she suffered from acute respiratory distress syndrome and required mechanical ventilation, a nasojejunal feeding tube was placed by transnasal endoscopic technique. | [
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181 | Half a month later, she had a high fever and abdominal distension. | [
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185 | The patient had been in good health until six months prior when he developed cough and intermittent fever. | [
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186 | He was admitted with a clinical diagnosis of pneumonia for which unspecified antibiotic therapy was given with transient improvement. | [
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188 | A chest radiograph showed right upper lobe consolidation with volume loss, right para-tracheal and left hilar adenopathy and bilateral fine reticulonodular opacification. | [
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189 | A Gene ®Xpert™(MTB/RIF) performed on fasting gastric aspirates was negative. | [
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191 | His condition continued to deteriorate; he developed a mass on the right upper chest wall and was referred to our facility three months into tuberculosis (TB) treatment, for evaluation of suspected malignancy. | [
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192 | At presentation, he had persistent fever and cough with dyspnea that disrupted feeding. | [
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193 | The cough was scantily productive of white sputum. | [
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194 | Progressive swelling had been noted on the right chest wall and there was marked weight loss. | [
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196 | There had been no contact with domestic livestock or birds nor with any person with tuberculosis. | [
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2,
2,
2,
2,
2,
2,
2,
2,
2,
2,
0,
2
] | [
"O",
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"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"B-Disorders",
"O"
] |
197 | He was HIV negative. | [
"He",
"was",
"HIV",
"negative",
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] | [
2,
2,
0,
1,
2
] | [
"O",
"O",
"B-Disorders",
"I-Disorders",
"O"
] |
199 | He had no conjunctival pallor or jaundice. | [
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"had",
"no",
"conjunctival",
"pallor",
"or",
"jaundice",
"."
] | [
2,
2,
2,
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0,
2,
2,
2
] | [
"O",
"O",
"O",
"O",
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] |
201 | He had a firm, tender, diffuse swelling on the right upper chest wall with fluctuant areas, that over subsequent days developed draining sinuses with no discharging granules. | [
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205 | Blood cultures and pus swab cultures of the draining sinuses showed no growth. β D Glucan and galactomannan assays were not available. | [
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"O",
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] |
217 | She presented to the clinic because of the gastroenteritis in pregnancy and was managed with intravenous fluids, metronidazole and haematinics. | [
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221 | Placental was antero-fundal and there was polyhydramnios (AFI of 205mm). | [
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] |
222 | There was gross incompatibility between the biparietal diameter and the femur length which prompted the diagnosis of some form of skeletal dysplasia. | [
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"O",
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223 | She was referred for comprehensive fetal anomaly scan. | [
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] | [
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] |
224 | The repeat scan showed remarkable lordosis and the skull had a clover leaf appearance. | [
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"O",
"O",
"O",
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"O"
] |
228 | Polyhydramnios was still present and single pocket of amniotic fluid measured 10cm. | [
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"O",
"O",
"O",
"O",
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"O",
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] |
233 | Abdominal examination revealed a baby in breech presentation. | [
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"breech",
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] | [
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2,
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"O",
"O",
"O",
"B-Disorders",
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"O"
] |
237 | Polyhydramnios was confirmed during artificial rupture of membranes; liquor was pot-wine coloured and the fetus was eventually expelled by breech delivery with a weight of 2.9kg. | [
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] |
247 | There wasassociated metaphyseal flaring. | [
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] | [
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2,
0,
1,
2
] | [
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"O"
] |
248 | A diagnosis of Thanatophoric dysplasia type II was made. | [
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] | [
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"O",
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"I-Disorders",
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"O",
"O",
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] |
249 | A five-year-old girl presented to the pediatric emergency room with acute onset of pain of the right lower limb, coldness of the limb and inability to use the limb. | [
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] |
250 | The patient was given benzathine penicillin intramuscular injection on the same limb for acute on chronic tonsillitis 8 hours prior to presentation. | [
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251 | The right lower limb pain was associated with coldness of the limb and dark discoloration. | [
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252 | The pain and discoloration were said to be getting worse with time. | [
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253 | However, there was no history of fevers, trauma, sickle cell disease or bleeding tendencies. | [
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255 | The leg was cold with weak popliteal and dorsalis pedis pulses compared to the contralateral limb. | [
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] |
258 | A diagnosis of compartment syndrome of the right thigh secondary to Nicolau syndrome was made. | [
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] |
264 | An emergency fasciotomy was done 24hrs after presentation after surgeons reviewed the patient and intra-op findings were osteofascial compartment bulging on first incision with free clear fluid and minimal bleeding as shown in Figure 2. | [
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] |
266 | The acute kidney injury (AKI) was managed conservatively by restricting fluid intake and avoiding nephrotoxic drugs. | [
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"O",
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] |
270 | A diagnosis of dry gangrene was made and patient was planned for a below knee amputation but parents denied consent. | [
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"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O"
] |
273 | The swelling worsened with intense pain in the right thigh and right thigh skin started developing blisters. | [
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"O",
"O",
"O",
"O",
"O",
"O",
"O",
"B-Disorders",
"O"
] |
274 | A diagnosis of dry gangrene with superimposed wet gangrene was made 13 days after fasciotomy as indicated in Figure 3. | [
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"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O",
"O"
] |
276 | Patient developed convulsions which were attributed to raised body temperatures. | [
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"O",
"O",
"O",
"O",
"O",
"O",
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"O"
] |
284 | A thirteen month-old male patient was referred to department of pediatric gastroenterology of Rabat Children's Hospital with the chief complaint of hepatosplenomegaly associated with hydrocephalus. | [
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"O"
] |
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