Indian pediatrics最新文献

{"title":"Empirical Antibiotic Therapy for the Management of Empyema Thoracis in Children: A Systematic Review.","authors":"Meenakshi Malik, N S Chithambaram, Jasmeet Kaur, Suhas P Kulkarni, Amber Kumar, S Vinaykumar, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00424-2","DOIUrl":"10.1007/s13312-026-00424-2","url":null,"abstract":"<p><strong>Context: </strong> Empyema thoracis necessitates timely empirical antibiotic therapy while awaiting confirmation of microbial etiology. However, there is no evidence-based guidance on this applicable to the Indian context.</p><p><strong>Objective: </strong> To systematically review existing literature on empirical antibiotic therapy in empyema and to contribute to an evidence-based guideline for managing childhood empyema in India.</p><p><strong>Evidence acquisition: </strong> A comprehensive search was conducted across PubMed, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, OpenGrey and four clinical trial registries. Studies (any design) describing empirical antibiotic therapy in pediatric empyema were examined to determine the appropriateness of the choice(s) on the basis of the organisms identified subsequently. Clinical outcomes based on antibiotic choices were also evaluated, as was the need to change the empirical choice(s).</p><p><strong>Results: </strong> The literature search retrieved 15,887 citations. Following de-duplication and a three-step screening process, 17 studies were included. Cloxacillin was the empirical antibiotic in 10/17 studies (638 children) and was deemed an appropriate choice in six studies (419 children) as Staphylococcus aureus was the dominant pathogen identified. Third-generation cephalosporins were used in 9/17 studies (444 children) and deemed appropriate empirical therapy in four studies (283 children). There was insufficient and inconsistently reported data on clinical outcomes, need to change empirical antibiotics and the overall impact of the empirical therapy on patient-centric outcomes.</p><p><strong>Conclusion: </strong> There is considerable variability in empirical antibiotic selection, but cloxacillin and ceftriaxone were appropriate choices in six and four studies, respectively.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"765-777"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149001744","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early Versus Late(r) Administration of Intrapleural Fibrinolytic Therapy in Children with Empyema: A Systematic Review and Meta-Analysis.","authors":"Davinder Kaur, Ketan Kumar, Pravakar Mishra, Narayan Santuka, Anshula Tayal, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00395-4","DOIUrl":"10.1007/s13312-026-00395-4","url":null,"abstract":"<p><strong>Context: </strong>Although intrapleural fibrinolytic therapy (IPFT) is frequently used in empyema thoracis, there is lack of clarity regarding the ideal timing of its administration.</p><p><strong>Objective: </strong>To synthesize evidence comparing early IPFT (i.e. at presentation, or as early as feasible, but within 24 h of confirmation of empyema), versus late(r) instillation (i.e. after 24 h of confirmation of empyema) in children with empyema, for the purpose of framing an evidence-based guideline recommendation.</p><p><strong>Evidence acquisition: </strong>We searched for randomized controlled trials (RCTs) comparing early versus late(r) IPFT in children (< 18y) with confirmed empyema, through five databases of published literature viz. PubMed, EMBASE, the Cochrane Library, Web of Science (WOS), and Scopus, two grey literature databases (ProQuest and OpenGrey), and four clinical trial registries. There were no restrictions or filters used. A three-step approach was implemented to screen and select studies eligible for inclusion. The patient-centric outcomes evaluated were indicators of treatment failure, clinical outcomes, pulmonary function tests, adverse events and cost of therapy. We planned to calculate pooled odds ratios (OR), and mean differences (MDs) with 95% confidence intervals (CIs) for dichotomous and continuous outcomes respectively. The certainty of evidence was to be assessed using the GRADE approach.</p><p><strong>Results: </strong>The comprehensive search identified 3,110 citations, however there was no RCT addressing the review question.</p><p><strong>Conclusions: </strong>There are no RCTs comparing early versus late(r) use of fibrinolytic therapy in childhood empyema. Well-designed randomized controlled trials are required to address the question. Evidence-based guidance on the question must use additional considerations, until RCT evidence is available.</p><p><strong>Trial registration: </strong>The protocol of the systematic review was registered in the PROSPERO database (ID: CRD42024516041) on March 03, 2024.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"797-806"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148421043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Efficacy, Safety, and Cost of Different Intrapleural Fibrinolytic Agents for the Management of Empyema Thoracis in Children: A Systematic Review.","authors":"Meenakshi Malik, Sonia Bhatt, Sarika Gupta, Hardeep Kaur, Mounika Reddy, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00422-4","DOIUrl":"10.1007/s13312-026-00422-4","url":null,"abstract":"<p><strong>Context: </strong>Pediatric empyema thoracis is a serious complication of bacterial pneumonia, and poses management challenges due to the absence of evidence-based guidelines on optimal treatment approaches. Intrapleural fibrinolytic agents are frequently used to enhance pleural drainage and avoid surgical intervention in pediatric empyema thoracis; however, the comparative efficacy, safety, and cost-effectiveness of different fibrinolytic agents remain uncertain.</p><p><strong>Objective: </strong>To systematically evaluate and compare the efficacy, safety, and cost of different intrapleural fibrinolytic agents in children with empyema thoracis, to develop evidence-based recommendations for informing clinical decision-making.</p><p><strong>Evidence acquisition: </strong>A systematic search of PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, ProQuest, OpenGrey, and four clinical trial registries was done, from their inception. Studies were eligible for inclusion in the systematic review if they were randomized controlled trials (RCT) including children under 18 years old with empyema thoracis (defined by any standard definition), comparing different fibrinolytic agents such as streptokinase, urokinase, and tissue plasminogen activator. The main outcomes included treatment failure, need for surgery, serious adverse events, and short-term clinical outcomes. Other outcomes were length of hospital stay, symptom duration, and cost.</p><p><strong>Results: </strong>A total of 3110 records was identified; after de-duplication, 2022 unique citations were screened. A three-step screening process identified no RCT meeting the eligibility criteria. The available studies had other study designs, or lacked pediatric data.</p><p><strong>Conclusions: </strong>Current evidence is insufficient to determine the most effective and safe fibrinolytic agent for pediatric empyema thoracis. There is an urgent need for well-designed, comparative pediatric trials to support evidence-based treatment guidelines.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"814-820"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148792390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical Practices for Management of Empyema Thoracis in Children: A Survey of Pediatricians in India.","authors":"Joseph L Mathew, Venkatesh Chandrasekaran, Ketan Kumar, Satnam Kaur, Meenakshi Girish","doi":"10.1007/s13312-026-00340-5","DOIUrl":"10.1007/s13312-026-00340-5","url":null,"abstract":"<p><strong>Objective: </strong>This survey was conducted to explore the current status of empyema thoracis management practices of pediatricians in India, as a prelude to developing evidence-based guidelines for managing empyema.</p><p><strong>Methods: </strong>A questionnaire examining various aspects of empyema management (diagnosis, investigations, treatment, monitoring and follow-up) was prepared, refined, and pilot-tested. It was disseminated to pediatricians across the country, through a Google form link, using email and a social media platform. Responses were collated, analyzed, and presented with descriptive statistics.</p><p><strong>Results: </strong>Ninety-four complete responses were received, mostly from pediatricians in teaching/ tertiary-care hospitals. There were significant variations in all aspects of empyema management. There was overuse of computed tomography (CT) scan (27%) and pleural fluid Cartridge Based Nucleic Acid Amplification Test (CBNAAT) (61%) in children with pleural effusion. Whilst > 80% pediatricians used ceftriaxone empirically for pneumonia and empyema, co-amoxiclav (18%), vancomycin (56%), and teicoplanin or linezolid (16%) were also used for empyema. Less than three quarters of respondents used intercostal drainage appropriately. 25% pediatricians routinely used intrapleural fibrinolytic therapy (most often streptokinase); 37% did not use it at all. The common indications were septations/loculations on ultrasonography (57%), thick pus (38%), and persisting clinical features (33%). The duration of antibiotics ranged from < 4 weeks (18%), 4-6 weeks (59%), and > 6 weeks (15%). The indications for surgical referral also varied widely, as did monitoring during therapy, and post-treatment follow-up protocols.</p><p><strong>Conclusion: </strong>There are significant variations in all facets of empyema management amongst pediatricians working in diverse Indian healthcare settings, underscoring the need for evidence-based guideline recommendations.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"720-726"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147769813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Skin Dryness: Interpreting the Clinical Significance of Adhesive Selection in Preterm Neonates.","authors":"Mohnish Darshan, Arun Sabavath, Ajay Vaidya","doi":"10.1007/s13312-026-00432-2","DOIUrl":"https://doi.org/10.1007/s13312-026-00432-2","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":""},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108962","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Molecular Methods With Culture for Identifying Microbial Etiology in Pediatric Empyema Thoracis: A Systematic Review of Diagnostic Test Accuracy.","authors":"Abhishek Purohit, Pallab Chatterjee, Hema Mittal, Madhu S Pujar, Sanjiv Singh Rawat, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00438-w","DOIUrl":"10.1007/s13312-026-00438-w","url":null,"abstract":"<p><strong>Context: </strong>Determining the microbial etiology in children with empyema thoracis can guide optimal treatment of individual children, and rational antimicrobial use in institutions. Culture methods and molecular diagnostic technologies are available, but there is no evidence-based guideline addressing the optimal diagnostic technology.</p><p><strong>Objective: </strong>This systematic review was undertaken to compare molecular diagnostic methods with culture methods for determining microbial etiology in children with empyema.</p><p><strong>Evidence acquisition: </strong>Literature search was undertaken in seven databases and four clinical trial registries, to identify diagnostic test accuracy (DTA) studies or diagnostic randomized controlled trials, comparing molecular methods with culture, for establishing the microbiological etiology of empyema. The outcomes were diagnostic accuracy parameters. Risk-of-bias and certainty of evidence were evaluated using the GRADE approach.</p><p><strong>Results: </strong>Nine DTA studies were included, however data from eight could be pooled. The pooled sensitivity of polymerase chain reaction (PCR) in pleural fluid specimens was 0.98 (95% CrI 0.91-0.99), and specificity 0.49 (95% CrI 0.19-0.75). The likelihood ratio of a positive result (LR+) was 1.90 (95% CrI 1.20-3.88), whereas LR- was 0.05 (95% CrI 0.01-0.23). Positive predictive value ranged from 0.11 to 1.0, and negative predictive value from 0.90 to 1.0. The diagnostic odds ratio was 38.23 (95% CrI 5.66-231.81). The overall risk of bias and overall applicability concerns were low in 3/8 studies and unclear in 5/8. The certainty of evidence was very low.</p><p><strong>Conclusion: </strong>Pleural fluid PCR has high sensitivity compared to culture, but moderate specificity. The optimal choice needs considerations beyond the comparative diagnostic accuracy.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":"63 10","pages":"747-756"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149108924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pediatric Empyema Thoracis: Making the Evidence Gaps Visible.","authors":"Kamal Kumar Singhal, Varinder Singh","doi":"10.1007/s13312-026-00440-2","DOIUrl":"10.1007/s13312-026-00440-2","url":null,"abstract":"","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"704-705"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149074291","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Early Intrapleural Fibrinolytic Therapy, Versus Administration After Failure of Intercostal Drainage in Children with Empyema Thoracis: A Systematic Review.","authors":"Lovely Jain, Satnam Kaur, Somu Sivabalan, Sanjay Bafna, Dipti Agarwal, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00380-x","DOIUrl":"10.1007/s13312-026-00380-x","url":null,"abstract":"<p><strong>Context: </strong>Intrapleural fibrinolytic therapy (IPFT) is widely used in pediatric empyema thoracis. Some physicians administer it early (when empyema is confirmed) whereas others try it after intercostal drainage (ICD) has failed. The optimal timing of IPFT administration is unclear.</p><p><strong>Objective: </strong>To compare early IPFT (i.e. as an initial therapy when empyema is diagnosed), versus IPFT administered after failure of ICD, in children with empyema thoracis.</p><p><strong>Evidence acquisition: </strong>Literature search was conducted through PubMed, EMBASE, Scopus, Web of Science, Cochrane Library, and two grey literature databases. Additional searches in four clinical trials registries, and hand-searching were conducted. The goal was to identify randomized controlled trials (RCT) comparing early IPFT (as an initial therapy, upon the diagnosis of empyema), versus delayed IPFT (i.e. administered after failure of ICD), in children with empyema thoracis (diagnosed by standard criteria). The outcomes recorded were clinical recovery, need for surgery, hospital stay, and safety.</p><p><strong>Results: </strong>The literature search yielded 2907 citations across the 11 databases examined. However, there were no RCTs directly addressing the review question. Indirect evidence from pediatric trials suggested that early IPFT may reduce pleural thickening and hospital stay, although decrease in surgery was not demonstrated consistently. In contrast, some observational studies reported high success rates with IPFT administered after failure of ICD, with avoidance of surgery in many cases.</p><p><strong>Conclusion: </strong>There is no RCT evidence comparing the initial administration of IPFT versus administration after failure of ICD. Well-designed RCTs are urgently needed.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"807-813"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148345213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy, Safety, and Long-Term Outcomes of Shorter (≤ 4 Weeks) Versus Longer (> 4 Weeks) Antibiotic Therapy in Pediatric Empyema Thoracis: A Systematic Review.","authors":"Lovely Jain, Dipti Agarwal, Sanjay Bafna, Satnam Kaur, Somu Sivabalan, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00397-2","DOIUrl":"10.1007/s13312-026-00397-2","url":null,"abstract":"<p><strong>Context: </strong>Although antibiotics remain the cornerstone of empyema thoracis management, the optimal duration of therapy in children remains uncertain. Prolonged antibiotic courses are frequently used despite limited evidence supporting their necessity; potentially increasing healthcare costs, medication-related adverse effects, and the risk of antimicrobial resistance.</p><p><strong>Objective: </strong>To evaluate the available evidence on the efficacy, safety, and clinical outcomes of shorter (≤ 4 weeks) versus longer (> 4 weeks) total antibiotic treatment durations (from initiation to cessation) in children with empyema, with the aim of informing evidence-based guidance.</p><p><strong>Evidence acquisition: </strong>A systematic search of PubMed, EMBASE, the Cochrane Library, Scopus, Web of Science, ProQuest, OpenGrey, and four major clinical trial registries was conducted. Randomized controlled trials enrolling children (< 18 years) with empyema defined by standard criteria, and comparing different durations of antibiotic therapy were eligible. Outcomes of interest included resolution of disease, relapse, need for additional interventions, re-hospitalization, adverse events, long-term clinical outcomes, and cost. All key steps of the review were undertaken by two reviewers working independently.</p><p><strong>Results: </strong>The search yielded 20,353 records. After excluding 5497 duplicate citations, 14,856 unique citations were screened using a three-step process. A total of 18 citations were short-listed for full-text examination. However, there were no randomized controlled trials fulfilling the eligibility criteria. Although several observational studies were identified, these were ineligible for inclusion.</p><p><strong>Conclusion: </strong>The optimal duration of antibiotic therapy for children with empyema thoracis remains uncertain, due to paucity of randomized controlled trials comparing shorter versus longer treatment courses.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"778-786"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148436426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predictors of Failure of Medical Management in Children with Empyema Thoracis: A Systematic Review.","authors":"Meenakshi Sachdeva, Kanchankumar Bhagyawant, Pawan Kalyan, Soumi Kundu, Shetanshu Srivastava, Pranita Pradhan, Joseph L Mathew","doi":"10.1007/s13312-026-00357-w","DOIUrl":"10.1007/s13312-026-00357-w","url":null,"abstract":"<p><strong>Context: </strong>Children with empyema thoracis often respond to medical management, but some do not, and require surgical intervention. Prediction of failure of medical management will help to guide further management and plan surgical intervention.</p><p><strong>Objective: </strong>To systematically review literature for clinical, radiological, laboratory, or microbiological predictors, associated with failure of medical management or the need for surgery in children with empyema thoracis.</p><p><strong>Evidence acquisition: </strong>A systematic search was conducted in seven databases (PubMed, Embase, Cochrane Library, Scopus, Web of Science, ProQuest, and Open Grey) and four trial registries. Observational studies exploring predictors of treatment failure in empyema thoracis were eligible. Two reviewers independently screened the studies, extracted the data, and assessed the risk of bias. Data were analyzed in accordance with the review protocol.</p><p><strong>Results: </strong>Amongst 12,311 citations identified, seven studies were included. One study identified three statistically significant predictors of medical treatment failure, viz. immediate ICU admission: OR (95%CI) 1.95 (1.18, 3.22); absence of complex septations on ultrasonography: 1.72 (1.21, 2.47); and positive blood culture: 2.8 (1.54, 5.07). Another study reported that \"continuing pus discharge for ≥ 10 days after chest tube insertion\" and \"persistence of loculations on ultrasonography or CT scan despite fibrinolytic therapy\" prompted surgical intervention. The presence of fever was identified as a significant predictor, although its duration and grade were not reported. The evidence had very low overall certainty, being limited by small, single-center, retrospective studies with heterogeneous designs, population, and outcome definitions, limiting generalizability.</p><p><strong>Conclusions: </strong>Current evidence did not identify any clinically meaningful predictors of the failure of medical management (or need for surgery) in children with empyema thoracis.</p>","PeriodicalId":13291,"journal":{"name":"Indian pediatrics","volume":" ","pages":"821-834"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147972225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}