Journal of Tropical Pediatrics最新文献

{"title":"Clinical profile of infants with late onset sepsis admitted in a North East Indian tertiary care center: insights into the uncharted.","authors":"Sugunan Niranjana, Chongtham Shyamsunder Singh, Khuraijam Ranjana Devi, O Okendrajit Singh, Chabungbam Smilie, Sareet Kumari Nandeibam","doi":"10.1093/tropej/fmad031","DOIUrl":"10.1093/tropej/fmad031","url":null,"abstract":"OBJECTIVES To assess the clinical profile of infants with late onset sepsis admitted in a tertiary care hospital in North-East India. METHODS Prospective observational study was carried out in Department of Paediatrics, Regional Institute of Medical Sciences hospital during a period of 2 years (September 2019-August 2021). RESULTS A total of 109 patients were included in the study, of which 80 were community-acquired and 29 infants were hospital-acquired cases of late onset sepsis (LOS). The major risk factors were low socioeconomic status, prematurity, low birth weight, a history of intervention (mechanical ventilation, umbilical venous catheter, total parenteral nutrition, resuscitation) and lack of exclusive breastfeeding. The most common presenting features were decreased feeding, lethargy and respiratory distress. Blood cultures were positive in 33% of patients. Klebsiella was the most common hospital-acquired pathogen while Escherichia coli was the most common isolate in community-acquired cases. Thrombocytopenia was the most common complication. The in-hospital mortality rate was 13.7%. CONCLUSION Low socioeconomic status, low birth weight, prematurity, invasive interventions and lack of exclusive breastfeeding are the major risk factors of LOS. The clinical signs and symptoms are varied and subtle. The mean C-reactive protein in the hospital-acquired group was significantly higher as compared to the community-acquired group. There is substantial morbidity and mortality, resulting in an increased toll on resources, therefore, an aggressive preventive and treatment approach is recommended for late onset sepsis.","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10277901","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":"Tissue expression of the SARS-CoV-2 cell receptor gene ACE2 in children.","authors":"Jiyi Huang,&nbsp;Zhibin Guo,&nbsp;Junkai Duan,&nbsp;Yong Zou,&nbsp;Kuai Chen,&nbsp;Hui Huang,&nbsp;Sheng Zhang,&nbsp;Yunguo Zhou","doi":"10.1093/tropej/fmad027","DOIUrl":"10.1093/tropej/fmad027","url":null,"abstract":"<p><p>Coronavirus disease 2019 (COVID-19) has become a significant global public health problem. Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), which causes the disease, utilizes angiotensin-converting enzyme II (ACE2) as a major functional receptor to enter host cells. No study has systematically assessed ACE2 expression in multiple tissues in children. This study investigated ACE2 expression and ACE2 protein's histological distribution in various organs in paediatric patients (the small intestine, thymus, heart and lungs). Our study revealed that ACE2 was highly expressed in enterocytes of the small intestine and widely expressed in the myocardium of heart tissues. The most notable finding was the positive staining of ACE2 in the Hassall's corpuscles epithelial cells. Negligible ACE2 expression in the lung tissues may contribute to a lower risk of infection and fewer symptoms of pneumonia in children than in adults with COVID-19 infection. These findings provide initial evidence for understanding SARS-CoV-2 pathogenesis and prevention strategies in paediatric clinical practice, which should be applicable for all children worldwide.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10550693","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 sepsis profile in a tertiary-care hospital in Indonesia: a 4-year retrospective study.","authors":"Antonius Hocky Pudjiadi,&nbsp;Nina Dwi Putri,&nbsp;Stephanie Wijaya,&nbsp;Fatima Safira Alatas","doi":"10.1093/tropej/fmad029","DOIUrl":"10.1093/tropej/fmad029","url":null,"abstract":"<p><strong>Aim: </strong>This study aimed to explore the factors contributing to mortality and its management among pediatric sepsis patients at a single center in Indonesia.</p><p><strong>Method: </strong>We conducted a retrospective study of children admitted due to sepsis from January 2015 to December 2019 in an Indonesian tertiary hospital.</p><p><strong>Results: </strong>The mortality rate of pediatric sepsis in our study was 76.1% among 176 records with outcome identified. Mortality was significantly associated with septic shock at triage, number of organ failure, intensive care unit admission, inotropic use, septic shock and severe sepsis during hospitalization. Timing of antibiotic use did not affect mortality. Death within the first 24 h occurred in 41.8% of subjects, mostly due to septic shock.</p><p><strong>Conclusion: </strong>This study illuminates the current state of pediatric sepsis management in our Indonesian hospital, revealing it as inadequate. Findings highlight the need for improved pre-hospital systems and sepsis recognition tools, and wider use of mechanical ventilators and advanced monitoring due to limited pediatric intensive care unit beds. Future research should focus on hospital-specific sepsis protocols to reduce pediatric sepsis mortality rates.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 5","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10225755","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":"Competencies of junior medical doctors in managing seriously ill and injured children: time to rethink our current training approach?","authors":"Louisa Erasmus,&nbsp;Andrew Redfern,&nbsp;Liezl Smit","doi":"10.1093/tropej/fmad025","DOIUrl":"https://doi.org/10.1093/tropej/fmad025","url":null,"abstract":"<p><strong>Background: </strong>The correct treatment of very ill and injured children is critical, yet little is known about the competencies of South African (SA) junior doctors in managing these children.</p><p><strong>Methods: </strong>This survey documents SA junior doctors' reported resuscitation training opportunities, experience, skills and knowledge.</p><p><strong>Results: </strong>A total of 118 doctors (interns, medical officers and registrars) from paediatric departments affiliated with 7 medical schools, participated. Resuscitations were not rare events with 71% (84/118) reporting participation in >10 resuscitations during the preceding 2 years. Yet a third of doctors have not attended an accredited resuscitation training course within the last 2 years; 34% (12/35) medical officers and 29% (18/63) registrars, respectively, with 42% (49/118) of all participants never receiving any formal resuscitation training during employment. Feedback on performance is not standard practice with only 8% (10/118) reporting consistent debriefing after a resuscitation. Although 72% (85/118) reported their resuscitation knowledge as adequate, 56% (66/118) passed the knowledge test.</p><p><strong>Conclusion: </strong>This study recognized missed learning opportunities in junior doctors' training, assessment, debriefing and knowledge which may adversely affect the quality of care in managing paediatric emergencies. This has implications for departmental and post-graduate training programmes.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10652864","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":"Catch-up vaccination and enhanced immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella in children with idiopathic thrombocytopenic purpura.","authors":"Serçin Taşar,&nbsp;Medine Ayşin Taşar,&nbsp;Rukiye Ünsal Saç,&nbsp;Bülent Alioğlu","doi":"10.1093/tropej/fmad026","DOIUrl":"https://doi.org/10.1093/tropej/fmad026","url":null,"abstract":"<p><strong>Background: </strong>Limited data exist about the vaccination of children with idiopathic thrombocytopenic purpura (ITP) against vaccine preventable diseases. This study identified the vaccination status of children with ITP against hepatitis A, hepatitis B, measles, mumps, rubella and varicella, completed the immunization of children with inadequate immunization, re-evaluated post-vaccination antibody titers and identified probable vaccination-related complications.</p><p><strong>Patients and methods: </strong>All of 46 children had chronic ITP were included. Seroconversion of hepatitis A, hepatitis B, varicella, measles, rubella and mumps vaccines was screened. All children with seronegative antibodies against vaccine preventable disease were given a vaccination appointment. Antibody levels were re-measured during a period ranging from 1 to 6 months. Potential complications were detected.</p><p><strong>Results: </strong>There were 46 children with a mean age of 12.25 years. All children had chronic ITP and received intravenous immunoglobulin at least once previously. Considering the vaccination status, 50% (23 children) had vaccinations appropriate for their age, 47.8% (22 children) did not know their vaccination status and 2.2% (1 patient) did not have vaccinations. Seven children (15.2%) were seropositive for all antibody types and the remaining 39 children were scheduled for vaccination. Post-vaccination antibody titers confirmed that all children became seropositive for each disease. There was no complication in any patient.</p><p><strong>Conclusion: </strong>Immunization against hepatitis B, hepatitis A, measles, mumps, rubella and varicella is insufficient in a considerable number of children with ITP, Hepatitis B Virus (HBV) and Hepatitis A Virus (HAV) immunization being the most frequently inadequate. After immunization, adequate seroconversion levels were achievable without complications.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10305331","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":"Knowledge and experiences of healthcare workers in managing children with neurometabolic disorders in a developing country: a cross-sectional study.","authors":"Arushi Gahlot Saini, Bhanudeep Singanamalla, Pradeep Kumar Gunasekaran, Gunjan Didwal, Savita Verma Attri","doi":"10.1093/tropej/fmad023","DOIUrl":"10.1093/tropej/fmad023","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the knowledge and experiences of healthcare workers in the management of neurometabolic disorders.</p><p><strong>Methods: </strong>A cross-sectional study was carried out among the 132 participants of a continued medical education program conducted in the Department of Pediatrics at a tertiary-care teaching hospital. A questionnaire-based feedback form was circulated among the participants, and their responses were analyzed.</p><p><strong>Results: </strong>Ninety-three responses were analyzed. The most common pediatric illnesses identified were infections (91%), nutritional (91%), birth-related injuries (44.4%) and metabolic disorders (44.4%). Consanguinity (81.5%) and genetic heterogeneity (42.4%) were recognized as most important causes of neurometabolic disorders. Important steps identified for prevention were prenatal testing (65.6%) and newborn screening at birth (61%); while for improving the diagnosis were routine availability of metabolic investigations (65.3%) and screening at birth (46.6%). Most respondents (58.7%) expressed discomfort in managing a case with inherited metabolic defect due to a lack of knowledge (46.8%) and diagnostic facilities (44.6%). Despite access to testing in the majority, a high cost of testing was noticed for biochemical and genetic investigations. The majority of participants (73%) considered some of the inherited metabolic disorders as treatable. Dietary substitution (89.3%), enzyme replacement (69%), cofactor replacement (53.6%), gene therapy (35.7%) and regular dialysis (16.7%) were considered the treatment options.</p><p><strong>Conclusion: </strong>In spite of growing awareness of inherited metabolic disorders, there are still gaps in knowledge among healthcare workers. It is challenging to diagnose and manage these disorders. Cost-reduction of diagnostic tests, routine newborn screening and increased educational activities are key challenges to be addressed.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10121507","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":"Disseminated Bacillus Calmette-Guérin infection: role of imaging in the evaluation of complications.","authors":"Ardeshir Rajabi,&nbsp;Gholamreza Pouladfar,&nbsp;Yasamin Dehghan,&nbsp;Zahra Jafarpour,&nbsp;Alireza Dehghan","doi":"10.1093/tropej/fmad024","DOIUrl":"https://doi.org/10.1093/tropej/fmad024","url":null,"abstract":"<p><strong>Background: </strong>The Bacillus Calmette-Guerin (BCG) vaccine is generally used to prevent tuberculosis, particularly meningeal and miliary types, in childhood. This vaccine can rarely cause complications of varying severity, ranging from localized disease to a severe diffuse type known as disseminated BCG infection. Imaging modalities play an important role in the evaluation of different complications of disseminated BCG infection. This study aimed to assess and describe the imaging findings of disseminated BCG infection in order to help clinicians diagnose this life-threatening infection more accurately.</p><p><strong>Methods: </strong>This retrospective study was performed on 44 hospitalized children diagnosed with disseminated BCG infection. The results of radiographs, sonography, computerized tomography (CT) scan and magnetic resonance imaging were compiled in a checklist and were then assessed by a radiology resident and a board-certificated radiologist. The radiological findings from various imaging modalities were presented descriptively and the frequency of different parameters was reported.</p><p><strong>Results: </strong>Axillary lymphadenopathy at the vaccinated side was frequent and was often associated with abscesses. However, abscesses in other body regions were uncommon. The most common abdominal imaging findings were enlarged liver and spleen accompanied by multiple hypoechoic and hypodense nodules on ultrasound and CT scans, respectively. Furthermore, diffuse or multifocal pulmonary opacities were the most frequent findings on chest X-rays and CT scans.</p><p><strong>Conclusion: </strong>Characteristic imaging findings of disseminated BCG infection play a vital role in the early diagnosis of this infection. The study findings demonstrated the importance of radiological imaging in the diagnosis and evaluation of the complications of disseminated BCG infection.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 4","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10174248","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":"Occurrence of Kawasaki disease and neoplasms in temporal proximity-single-center experience and systematic review of literature.","authors":"Aaqib Zaffar Banday,&nbsp;Alisha Babbar,&nbsp;Pratap Kumar Patra,&nbsp;Ankur Kumar Jindal,&nbsp;Deepti Suri,&nbsp;Vignesh Pandiarajan,&nbsp;Amit Rawat,&nbsp;Anju Gupta,&nbsp;Surjit Singh","doi":"10.1093/tropej/fmad022","DOIUrl":"https://doi.org/10.1093/tropej/fmad022","url":null,"abstract":"<p><p>Various factors (e.g., infections) have been postulated to trigger Kawasaki disease (KD) in genetically predisposed individuals. Whether neoplasms can trigger KD is largely unknown due to paucity of data. Herein, we provide a detailed account of KD occurring in temporal proximity (within 6 months) to neoplasms ('neoplasm-KD'). Patients with 'neoplasm-KD' diagnosed/treated at our center from January 1994 to May 2021 were included. Additionally, we performed a systematic literature review (as per PRISMA 2020 guidelines) utilizing PubMed, Web of Science and Scopus databases to retrieve details of all patients with 'neoplasm-KD' reported till June 2021. Patients with multisystem inflammatory syndrome in children were excluded. As all reports pertained to case description(s), risk of bias assessment was not performed. The details of patients with 'neoplasm-KD' were analyzed using SPSS software. Primary and secondary outcomes were occurrence of coronary artery abnormalities (CAAs) and clinical characteristics of 'neoplasm-KD', respectively. A total of 25 patients (data from 18 reports) were included in the 'neoplasm-KD' dataset. The most frequently diagnosed neoplasm was acute lymphoblastic leukemia followed by neuroblastoma and acute myeloblastic leukemia. Overall, CAAs were noted in 48% of patients. Interval between diagnoses of KD and neoplasm was shorter in patients with CAAs as compared to patients with normal coronary arteries (p-value = 0.03). Besides providing a comprehensive description of 'neoplasm-KD', this study raises a possibility that neoplasms might trigger KD. Also, 'neoplasm-KD' may be associated with a higher risk of development of CAAs. However, the small size of 'neoplasm-KD' dataset precludes definitive conclusions regarding this association. Funding: nil. Registration: PROSPERO (CRD42021270458).</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10118182","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":"Cryptosporidium infection and associated risk factors among children from rural areas in Peru: a nested case-control study.","authors":"Jose Luis Paredes,&nbsp;Rafaella Navarro,&nbsp;David Durand,&nbsp;Theresa Jean Ochoa","doi":"10.1093/tropej/fmad021","DOIUrl":"https://doi.org/10.1093/tropej/fmad021","url":null,"abstract":"<p><p>This study aimed to detect the frequency of Cryptosporidium infection and associated risk factors among children from rural areas in Peru. A case-control study was conducted, nested in a cohort in two rural communities that included children between 6 and 13 months who were followed for 6 months. Cases were children whose fecal samples tested positive for Cryptosporidium infection using an immunochromatography test. Logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to analyze risk factors associated with Cryptosporidium infection. Among 72 children, 13 (18%) were cases. Cryptosporidium infection was associated with below secondary education of the mother (OR 7.62, 95% CI 1.50-36.72) and with having more siblings living at home (OR 1.71, 95% CI 1.04-2.82). An important frequency of Cryptosporidium infection among children from rural areas in Peru was reported, more research is needed to understand its true burden and risk factors among children in Peru.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9862408","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":"Skin-to-skin contact and its effect on mothers' postpartum psychological distress and their full-term neonate in Egypt.","authors":"Asmaa A El Sehmawy,&nbsp;Shaimaa Younes Abd Elaziz,&nbsp;Rania Mahfouz Abd Elwahed,&nbsp;Asmaa Abdelghany Elsheikh","doi":"10.1093/tropej/fmad020","DOIUrl":"https://doi.org/10.1093/tropej/fmad020","url":null,"abstract":"<p><strong>Design: </strong>A randomized controlled study was conducted on 400 mothers, who were divided into two groups: 200 mothers who applied skin-to-skin infant care (SSC) for at least 1 h daily for 12 weeks and 200 mothers who performed the usual mother-infant care. The mothers were recruited from the Obstetric Department of Al-Zahraa University Hospital in Cairo, Egypt. The enrolled mothers' infants were assessed for body weight. Sleep hours and frequency of breast milk feeding were evaluated by the mother during the day. All of the mothers who took part in the study were assessed for postoperative pain, wound healing, postpartum depression, anxiety, sleep quality and newborn maternal bonding.</p><p><strong>Results: </strong>There was a significant increase in frequencies of breastfeeding and the body weight at 12 weeks' postnatal age and also an increase in sleep hours in the infants who had SSC. The mothers who performed SSC had good sleep quality in comparison with those who performed the usual infant care; in addition, they had less postoperative pain intensity and proper wound healing apart from better maternal-infant bond, decreased anxiety and decreased depression frequency.</p><p><strong>Conclusion: </strong>SSC was associated with better infant breastfeeding, increased sleep hours in infants and less postpartum psychological burden in mothers.</p>","PeriodicalId":17521,"journal":{"name":"Journal of Tropical Pediatrics","volume":"69 3","pages":""},"PeriodicalIF":2.0,"publicationDate":"2023-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9523514","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}