Y. Potchoo, Mouhoudine Yérima, Tante T. Gnandi, M. Salou, Aboudoulatif Diallo, Batoyema Bakoma, A. Nyansa, M. Prince-david
{"title":"Analysis of Adverse Reactions Related to Drugs and Vaccines Received at the National Centre for Pharmacovigilance from 2009 to 2016 in Togo","authors":"Y. Potchoo, Mouhoudine Yérima, Tante T. Gnandi, M. Salou, Aboudoulatif Diallo, Batoyema Bakoma, A. Nyansa, M. Prince-david","doi":"10.4236/pp.2018.98027","DOIUrl":"https://doi.org/10.4236/pp.2018.98027","url":null,"abstract":"Objectives: To assess the received suspected adverse events occurring upon treatment with drugs and vaccines, at National Centre for Pharmacovigilance, in Togo, from 2009 to 2016. Methods: A crossover study was conducted in order to collect data about patients, drugs, suspected adverse events and notifiers. Suspected adverse events were classified using Med DRA 19.1. Notification’s circumstances were classified into Public Health Programs’ campaigns and routine practice. Data were collated into Excel spreadsheet and processed with SPSS software. Key Findings: Regional distribution is irregular. Of the 322 collected report forms, paramedics have notified 60.8% of the cases. Adult patients were the most represented (70.2%). Public Health Programs campaigns provided 72.6% versus 27.4% for routine practice including Neglected Tropical Diseases (41.4%), immunization (27.7%), tuberculosis (25.9%) and 4.5% for HIV. Skin disorders were the most prevalent suspected adverse events (147 sheets; 45.7%) followed by general disorders and administration site disorders (29.8%) and gastro-intestinal disorders (12.7%). General anti-infective drugs for systemic use, antiparasites, and insecticides were the most reported class of medications (161 sheets; 44.7%). Conclusions: A thorough follow-up of pharmacovigilance launched activities is needed to build a sustainable adverse effect’s surveillance system and routine practice has to be strengthened.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90569096","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Ryuichiro Hosoya, Ippei Tanaka, R. Ishii‐Nozawa, T. Amino, T. Kamata, Seiichi Hino, H. Kagaya, Y. Uesawa
{"title":"Risk Factors for Cancer Chemotherapy-Induced Hiccups (CIH)","authors":"Ryuichiro Hosoya, Ippei Tanaka, R. Ishii‐Nozawa, T. Amino, T. Kamata, Seiichi Hino, H. Kagaya, Y. Uesawa","doi":"10.4236/PP.2018.98026","DOIUrl":"https://doi.org/10.4236/PP.2018.98026","url":null,"abstract":"Background: Hiccups are common somatic side effects of medication. Our previous analysis of the clinical risk factors for hiccups identified chemotherapy as a factor related to hiccup risk. Therefore, in the present study, we investigated the risk factors for hiccups associated with chemotherapy. Methods: We included all patients who received cancer chemotherapy and were hospitalized at the Musashino Red Cross Hospital between April 2014 and December 2014. We investigated patient demographics, physical characteristics, and other clinical factors to identify the risk factors for chemotherapy-induced hiccups (CIH). We conducted univariate and multivariable analysis to compare the CIH group and the non-CIH and determined risk factors of CIH. Results: Hiccups were identified in 48 of 292 patients with an incidence rate of 16.4%. Univariate analysis revealed that the male gender, pain, and nausea and vomiting were related to CIH. It also showed that cisplatin, pemetrexed, gemcitabine, etoposide, dexamethasone, and metoclopramide were related to CIH.A correlation which was found with doses of cisplatin, pemetrexed, gemcitabine, and etoposide. Multivariable analysis identified male gender (OR, 72.69; 95% CI, 6.95 - 757.64), nausea and vomiting (OR, 52.01; 95% CI, 3.93 - 447.13), dexamethasone (OR, 4.55; 95% CI, 1.12 - 16.91), cisplatin (OR, 3.84; 95% CI, 1.52 - 9.70), and etoposide (OR, 3.72; 95% CI, 1.14 - 12.11) as independent risk factors for hiccups. Conclusions: The present study is the first one to report risk factors for the development of CIH. Our results suggest that male gender, having nausea, and the drugs dexamethasone, cisplatin, and etoposide are important risk factors for CIH. These results may assist in elucidation of the underlying mechanisms and guide therapy to reduce hiccup risk.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80341361","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck
{"title":"Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 1—Biological and Treatment Factors","authors":"R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck","doi":"10.4236/PP.2018.98023","DOIUrl":"https://doi.org/10.4236/PP.2018.98023","url":null,"abstract":"The most frequent adverse event in the healthcare delivery system is acquisition of an infection within a healthcare facility. Since infection control measures are known, simple, and low-cost, we examine why the problem of healthcare-associated infections persists. Hundreds of millions of patients each year are affected by a healthcare-associated infection, with negative medical outcome and financial cost. It is a major public health problem even in countries with advanced healthcare systems. This is a bit perplexing, given that hygienic practices have been known and actively promoted. The objective is to address the question: doesn’t the use of disinfection, sterilization, handwashing, and alcohol rubs prevent the spread of pathogenic organisms? We conclude that the persistent high prevalence of nosocomial infections despite known hygienic practices is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered in Part 2). A new approach is presented in Part 3.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85394200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck
{"title":"Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 3—Application of Human Factors Engineering to an Ozone Hand Sanitizer","authors":"R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck","doi":"10.4236/pp.2018.98025","DOIUrl":"https://doi.org/10.4236/pp.2018.98025","url":null,"abstract":"Compliance to hand-hygiene guidelines in healthcare facilities remains disappointingly low for a variety of human-factors (HF) reasons. A device HF-engineered for convenient and effective use even under high-workload conditions could contribute to better compliance, and consequently to reduction in healthcare-acquired infections. We present an overview of the efficacy of a passive hand-spray device that uses solubilized ozone—a strong, safe, non-irritant biocide having broad-spectrum antimicrobial properties—on glass surface, pigskin, and synthetic human skin matrix.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80963326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck
{"title":"Persistence of Healthcare-Associated (Nosocomial) Infections Due to Inadequate Hand Hygiene: Part 2—Human Factors","authors":"R. Raffa, J. Pergolizzi, R. Taylor, Sanjib Choudhuri, Robert Rodenbeck","doi":"10.4236/PP.2018.98024","DOIUrl":"https://doi.org/10.4236/PP.2018.98024","url":null,"abstract":"A healthcare-associated infection (defined as an infection acquired within a healthcare facility), such as due to transmission via medical equipment or by healthcare providers is the most frequent adverse event in the healthcare delivery system. But why does the problem persist, when infection control measures are known, simple, and low-cost? We reviewed some biological- and treatment-factors in Part 1, and we now review some human-factors. Healthcare-associated infections are a major public health problem even in advanced healthcare systems. They affect hundreds of millions of patients each year, and are responsible for increased morbidity, mortality, and financial burden. This is perplexing, since good-hygiene practices are known and promoted. Disinfection, sterilization, handwashing, and alcohol rubs should be more effective, but human-factors interfere. The persistent high prevalence of nosocomial infections, despite known hygienic practices, is attributable to two categories of factors: biological and inherent shortcomings of some practices (considered in Part 1), and human factors (considered here). A new approach is considered in Part 3.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-08-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81058834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hyunjin Kim, Shin-Hee Kim, Semi Kim, Jae-Sung Ahn, Ju‐Seop Kang
{"title":"Clinical Pharmacokinetic and Bioequivalence Studies of Two Brands of Cephradine in Healthy Korean Using HPLC Method","authors":"Hyunjin Kim, Shin-Hee Kim, Semi Kim, Jae-Sung Ahn, Ju‐Seop Kang","doi":"10.4236/PP.2018.97022","DOIUrl":"https://doi.org/10.4236/PP.2018.97022","url":null,"abstract":"The goal of our research was to compare the pharmacokinetics and evaluate the bioequivalence of two brands of cephradine 500 mg capsules in 24 normal Korean volunteers. The plasma samples were acquired at 13 time points for 8 h after administration. The concentrations of cephradine in human plasma were measured by a high-performance liquid chromatography (HPLC). Isocratic mobile phase which consisted of acetonitrile, methanol, and 20 mM potassium phosphate (15/5/80, v/v/v, pH 3.48) was used to separate the analytical column cosmosil cholester (250 × 4.6 mm, 3 μm). Analytes were detected in ultraviolet (260 nm). The novel analytical method was described as simple sample preparation, a short retention time (less than 6 min) and making it suitable for use in clinical trials. Pharmacokinetic parameters, such as AUC0-t (20.54 vs 18.42 μg·h/mL), AUC0-infinity (21.22 vs 19.14 μg·h/mL), Cmax (12.69 vs 12.81 μg/mL), Tmax (1.22 vs 0.92 h), half-life (1.02 vs 1.13 h), extrapolation (3.22% vs 3.75%), and Ke (0.73 vs 0.69 h–1) were determined for the reference and test drugs in plasma. Pharmacokinetic parameters with a 90% confidence interval were 87% - 95% for AUC0-t and 91% - 115% for Cmax. They were satisfied within the bioequivalence range 80% - 125% of the KFDA guidelines. Therefore, our HPLC method was well applied in a bioequivalence and pharmacokinetic study of two formulations in normal subjects.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75172128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Diuretic Effect of Cymbopogon jwarancusa after Single and Multiple Doses in Rats","authors":"Sarah Khan, S. Afroz, R. Khan","doi":"10.4236/pp.2018.97019","DOIUrl":"https://doi.org/10.4236/pp.2018.97019","url":null,"abstract":"Diuretics are \u0000efficaciously used in management of various clinical emergencies like hypertension, \u0000heart failure, cirrhosis, hypercalciuria, hematuria and nephrotic syndrome. Cymbopogon jwarancusa is an aromatic \u0000perennial grass used in both traditional and Unani system of medicine to \u0000eradicate diseases like colds, seasonal fever, asthma, tuberculosis, rheumatic \u0000pain, back pain, toothache and nervous disorders. C. jwarancusa essential oils are used in perfumery, soap, \u0000detergents, medicines and pharmaceutical industry. Monoterpenes and \u0000sesquiterpenes constitute the highest composition in essential oil of C. jwarancusa. The present was designed \u0000to compare the diuretic activity of C. \u0000jwarancusa after single and multi-doses. Furosemide (20 mg/kg) was used as \u0000reference drug and 10% DMSO was used as vehicle. Diuretic activity was noticed \u0000by measuring urine volume and calculating diuretic and Lipchitz values. Maximum \u0000diuretic response was observed at 500 mg/kg of extract after both single and \u0000multi-dose administration. On basis of results it may be concluded that C. jwarancusa may be used as diuretic agent.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85538328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hideyuki Suga, Yuichi Ichimura, Satomi Otsuka, K. Sugaya, M. Oda, H. Saitoh
{"title":"Limited Effect of Intravenously Administered Indoxyl Sulfate, a Uremic Toxin, on the Hepatic Transport of Pravastatin in Normal Rats","authors":"Hideyuki Suga, Yuichi Ichimura, Satomi Otsuka, K. Sugaya, M. Oda, H. Saitoh","doi":"10.4236/pp.2018.97021","DOIUrl":"https://doi.org/10.4236/pp.2018.97021","url":null,"abstract":"Indoxyl \u0000sulfate (IS) is a typical uremic toxin that extensively accumulates in the \u0000plasma of patients with seriously impaired renal function. This study seeks to clarify whether IS exerts a potent modulating effect on the hepatic \u0000transport of pravastatin, which is a substrate of both organic anion \u0000transporting peptides (OATPs) and multidrug resistance-associated protein (Mrp) \u00002 in rats. When IS is administered intravenously to the normal rats at a dose of 120 μmol/kg; plasma \u0000IS levels are approximately 600 μM after 2 min and 100 μM after 120 min. In rats with \u0000acute renal failure (ARF) induced by cisplatin, the area under the curve (AUC) \u0000was more than 2.5-fold greater compared with that in the normal rats, indicating \u0000that IS accumulates in ARF rats. Intravenously administered pravastatin almost \u0000disappeared from the plasma by 60 min post-administration and approximately 55% \u0000of dose was excreted in the bile within 60 min. This result suggested that \u0000pravastatin was efficiently taken up from the sinusoid into hepatocytes via rat \u0000OATPs on the sinusoidal membrane and preferentially transported in the bile \u0000mediated by Mrp2 on the canalicular membrane. IS administered intravenously at \u0000a dose of 120 μmol/kg caused neither an increase in plasma pravastatin levels \u0000nor a decrease in its biliary excretion. In conclusion, the present results \u0000demonstrate that single intravenous administration of IS does not interfere \u0000with the hepatic transport of pravastatin directly in vivo, which is at variance with the results of previous in vitro studies.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81481112","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bernhard Langer, Michael Kieper, S. Laube, J. Schramm, Sophia J. Weber, Alexander Werwath
{"title":"Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology","authors":"Bernhard Langer, Michael Kieper, S. Laube, J. Schramm, Sophia J. Weber, Alexander Werwath","doi":"10.4236/PP.2018.97020","DOIUrl":"https://doi.org/10.4236/PP.2018.97020","url":null,"abstract":"Aim: As the \u0000primary aim of this study, we analysed whether the quality of advice provided \u0000by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up \u0000study) could actually be increased using a single written performance feedback \u0000given to each pharmacy in 2014. The secondary aim of the follow-up examination \u0000was to analyse whether the quality of advice differed depending on the \u0000professional group providing the advice. Methodology: To ensure the least possible \u0000distortion in the comparison between the baseline and the follow-up studies, the \u0000study design used for the follow-up examination in 2017 was not changed \u0000compared to the baseline examination in 2014. The data for the follow-up \u0000examination were therefore collected using the simulated patient method in all \u000021 pharmacies in a city in the north-east of Germany. Three female and two male \u0000test buyers used four different scenarios for self-medication of acute \u0000diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There \u0000were significant differences between the overall results from the baseline \u0000study (2014) and the follow-up study (2017) (Wilcoxon signed rank test; z = –2.065, p = 0.039, r = 0.225). In the overall \u0000average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points \u0000whereas in 2014 they achieved 3.3 (37%). The quality \u0000of advice between the professional groups did not show any significant \u0000differences (Kruskal-Wallis test: χ2(2) \u0000= 1.946; p = 0.378, r = 0.027). Conclusions: The quality of advice for \u0000acute diarrhoea in adults declined over time. A written performance feedback \u0000intended to improve the quality proved ineffective. Interventions with a far \u0000greater impact are required to achieve an improvement in the quality of advice \u0000provided.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85739367","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
J. Nussberger, A. Dubach, A. Turpeinen, H. Vapaatalo
{"title":"Lactotripeptides Inhibiting ACE1 Elevate the Plasma Bradykinin Concentration Acutely in a Placebo-Controlled, Double-Blind, Cross-Over, 4-Week Trial in Healthy Volunteers","authors":"J. Nussberger, A. Dubach, A. Turpeinen, H. Vapaatalo","doi":"10.4236/PP.2018.97017","DOIUrl":"https://doi.org/10.4236/PP.2018.97017","url":null,"abstract":"This placebo-controlled, double-blind, cross-over \u0000intervention with twelve normotensive healthy volunteers tested the effects of \u0000milk products containing either 5 or 50 mg \u0000of ACE1-inhibitory lactotripeptides (isolecine-proline-proline, Ile-Pro-Pro, and valine-proline-proline, \u0000Val-Pro-Pro) and placebo milk drink (with similar taste) on plasma bradykinin \u0000levels. The subjects consumed one of the three test products in a random order, \u0000double-blinded, and four-week trial. On the \u0000first day (day 1) and on the last day (day 29) i.e. after four weeks’ treatment with one of \u0000the products, the acute effect with the same single dose was assayed. Other \u0000markers of the renin-angiotensin-aldosterone system (RAAS) were measured from \u0000plasma four times on the same days when we also assessed daytime urinary \u0000excretion of biomarkers of endothelial function. Neither acute nor prolonged \u0000administration of the ACE-1 inhibiting peptide drinks significantly lowered \u0000blood pressure of the normotensive subjects. The most important finding was the \u0000dose-dependent, and linear increase in plasma \u0000bradykinin concentrations after acute dosing on the first day; it was nearly \u0000statistically significant also on the day 29 (p 0.06). Other indicators of RAAS or endothelial function did not differ \u0000from those of placebo after the acute or prolonged treatments. Our results \u0000suggest that even weak inhibitors of ACE-1, such as the lactotripeptides \u0000Ile-Pro-Pro and Val-Pro-Pro, are able to diminish the breakdown of bradykinin \u0000and therefore increase plasma bradykinin levels. This may partly explain the \u0000blood pressure lowering and vasodilatory effects of lactotripeptides, shown by \u0000us earlier in mildly hypertensive subjects.","PeriodicalId":19875,"journal":{"name":"Pharmacology & Pharmacy","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2018-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91284761","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}