Revista da Sociedade Brasileira de Medicina Tropical最新文献

{"title":"Dengue Mimickers: Which Clinical Conditions Can Resemble Dengue Fever?","authors":"Luis Arthur Brasil Gadelha Farias, Lourrany Borges Costa, Pedro Pinheiro de Negreiros Bessa, Glaura Fernandes Teixeira de Alcântara, Jobson Lopes de Oliveira, Thalita do Nascimento Silva, Giuliana de Fátima Lima Morais, Lauro Vieira Perdigão Neto, Luciano Pamplona Góes Cavalcanti","doi":"10.1590/0037-8682-0334-2024","DOIUrl":"10.1590/0037-8682-0334-2024","url":null,"abstract":"<p><p>Epidemics and outbreaks caused by the dengue virus pose risks to populations and have high mortality rates, causing burdens and economic costs worldwide. Brazil recently experienced an explosive increase in the number of dengue cases and fatalities. Dengue is an acute febrile illness that can progress to severe forms. It affects more than 100 countries, presenting ongoing challenges in Brazil and globally since its identification. Other conditions may be overlooked or mistaken for dengue. The most important differential diagnoses are other infectious diseases and rheumatological, hematological, gastroenterological, and neurological disorders. In this article, we discuss the primary differential diagnoses of dengue and offer a literature review highlighting the key clinical differences among clinicians. This review emphasizes the critical importance of differentiating dengue fever from infectious diseases such as meningococcemia and malaria and autoimmune and rheumatological conditions such as systemic lupus erythematosus to ensure timely and appropriate management.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":"e002062024"},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654470/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142854753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ecological Importance of Breeding Sites in Atlantic Forest Fragments: A Focus on Culicidae Diversity with Particular Attention to Vector Species.","authors":"Shayenne Olsson Freitas Silva, Cecilia Ferreira de Mello, Letícia de Mattos Pavão, Hélcio Reinaldo Gil-Santana, Jeronimo Alencar","doi":"10.1590/0037-8682-0108-2024","DOIUrl":"10.1590/0037-8682-0108-2024","url":null,"abstract":"<p><strong>Background: </strong>Vector distribution influences arbovirus persistence. This study examined the diversity of mosquito breeding sites in an Atlantic Forest fragment in Rio de Janeiro, Brazil.</p><p><strong>Methods: </strong>Mosquito specimens were collected at Fazenda dos Cordeiros, Silva Jardim, Brazil. Tire, plastic, bamboo, and sapucaia traps were evaluated for oviposition preferences using ecological indices.</p><p><strong>Results: </strong>Tire traps had the highest density. Bamboo traps showed the highest diversity. Plastic container was the most divergent site. The key recorded vector species included Aedes albopictus and Haemagogus leucocelaenus.</p><p><strong>Conclusions: </strong>Identifying the breeding sites that contribute the most to mosquito density is essential for optimizing control strategies.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":"e007152024"},"PeriodicalIF":1.8,"publicationDate":"2024-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654466/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142855071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effectiveness and Safety of Direct-Acting Antivirals in the Treatment of Chronic Hepatitis C: A Real-life Study in Northeastern Brazil.","authors":"Elodie Bomfim Hyppolito, Alberto Novaes Ramos, Larissa Peixoto Teixeira, Arthur Machado Bezerra, Lucas Arruda Mendes, Taynara Lais Silva, José Milton de Castro Lima, Érico Antonio Gomes de Arruda, Eder Janes Guerra, Maria Macedo Saraiva Tavares, Carlos Eduardo Pereira Lima, Ticiana Mota Esmeraldo, Francisco Sérgio Rangel de Paula Pessoa, Alessandra Maria Montalverne Pierre, Karla Brandão Pereira, Antônio Haroldo Araújo Filho, Lívia Melo Carone Linhares, Anderson Fuentes Ferreira, Roberto da Justa Pires Neto","doi":"10.1590/0037-8682-0192-2024","DOIUrl":"10.1590/0037-8682-0192-2024","url":null,"abstract":"<p><strong>Background: </strong>This study aimed to evaluate the effectiveness and safety of direct-acting antivirals (DAAs) for hepatitis C treatment by measuring sustained virologic response (SVR) and serious adverse events to help design effective interventions for reducing disease prevalence.</p><p><strong>Methods: </strong>This was a retrospective, observational, real-life study of patients with chronic hepatitis C receiving DAA treatment in the state of Ceará, Brazil. Data were collected in REDCap and analyzed using R® software by the Student's t, chi-square, and Fisher's exact tests, with a significance level of 5%.</p><p><strong>Results: </strong>In this study, 1075 patients who were diagnosed with hepatitis C infection between October 2015 and October 2023 were included. The mean age of the participants was 56.6 ± 11 years and 60.2% were men. The sample included 51 HIV-infected patients (6.6%), 166 (15,4%) liver transplant recipients, 34 (3,1%) kidney transplant recipients, and 446 patients with cirrhosis (41.4%). The overall SVR rate was 96.4%. The sofosbuvir/daclatasvir/ribavirin regimen used in 354 (32.9%) patients achieved an SVR of 96%. The cure rate was 96.5%, with a lower SVR in patients with cirrhosis (93.4%) than in those with less severe fibrosis (97.9%) (p=0.0015). Serious adverse events associated with ribavirin use occurred in 3.5% of patients.</p><p><strong>Conclusions: </strong>DAA treatment for hepatitis C achieved SVR in real life in all patient profiles, including transplant recipients, HIV carriers, and patients with cirrhosis. Although these drugs are safe, a few decompensated patients with cirrhosis died during treatment.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654468/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142740382","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Triatomines in the city: A study of Rhodnius neglectus in Jaboticabal, São Paulo, Brazil, and its epidemiological implications.","authors":"Tiago Belintani, Jader de Oliveira, Vinícius Fernandes de Paiva, Jociel Klleyton Santos Santana, Isabella Maxwell Paulino Fernandes, Jonathan Silvestre Gomes, Estevam Guilherme Lux Hoppe, João Aristeu da Rosa","doi":"10.1590/0037-8682-0133-2024","DOIUrl":"10.1590/0037-8682-0133-2024","url":null,"abstract":"<p><strong>Background: </strong>Chagas disease, a significant global health concern rooted in social inequalities and political oversights, remains a challenging public health issue impacting millions worldwide. The increasing detection of triatomines, the vectors of Chagas disease, in urban areas complicates the situation.</p><p><strong>Methods: </strong>This study investigated the incidence of Rhodnius neglectus in the urban areas of Jaboticabal, São Paulo, Brazil, following several reports and previous collections of triatomines in the city. An educational approach was adopted, distributing informational materials and engaging the community through social networks to generate notifications that would enable the identification of triatomines. Specimens were collected using various methods, including passive surveillance actions, light traps, and active searches in palm trees.</p><p><strong>Results: </strong>Rhodnius neglectus was found in urban areas, invading homes in Jaboticabal, and was identified in palm trees. The educational approach led to the collection of 93 triatomines. Colonization was observed in a residence, with eggs, nymphs, and a concerning record of blood-feeding on a resident child. The houses where specimens were captured often had nearby palm trees with birds and nests, facilitating the passive transport of these insects and increasing the risk of invasion due to light attraction. No triatomines infected with Trypanosoma cruzi were identified.</p><p><strong>Conclusions: </strong>These findings emphasize the need for preventive measures to reduce the prevalence of R. neglectus in urban environments. The data elucidate the occurrence of R. neglectus in the city of Jaboticabal, associated with its potential behavioral adaptation in urban environments, underscoring the need for innovative control strategies.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654749/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Research techniques to expand the diagnosis, macroelimination, and microelimination of hepatitis C in local contexts.","authors":"Geisa Perez Medina Gomide, Fernanda Carolina Camargo, Cristina da Cunha Hueb Barata de Oliveira","doi":"10.1590/0037-8682-0150-2024","DOIUrl":"10.1590/0037-8682-0150-2024","url":null,"abstract":"<p><strong>Background: </strong>Local studies are essential to determine the prevalence and risk factors of hepatitis C.</p><p><strong>Methods: </strong>We conducted a mixed methods study aimed at strengthening hepatitis C elimination efforts in Brazil, with concomitant triangulation of techniques and integration of qualitative and quantitative approaches.</p><p><strong>Results: </strong>The study resulted in the development of the following technical-technological products: a) institutional documents, b) organization of committees, c) mobilization strategies, d) models for improving intersectoral awareness, e) decision-making flowcharts, f) forms, and g) health service protocols and search strategies.</p><p><strong>Conclusions: </strong>The application of these research techniques generated valuable knowledge that could be adopted in various regions across Brazil, particularly in areas with economic and sociocultural diversity.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654744/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"TNF-expressing CD1d+ monocytes are associated with the activation of CD4- CD8- T cells in patients with Chagas cardiomyopathy.","authors":"Carolina Cattoni Koh, Teresiama Velikkakam, Eula Graciele Amorim Neves, Nayara Ingrid Medeiros, Juliana Assis Gomes, Silvana de Araújo Silva, Kenneth John Gollob, Maria do Carmo Pereira Nunes, Walderez Ornelas Dutra","doi":"10.1590/0037-8682-0181-2024","DOIUrl":"10.1590/0037-8682-0181-2024","url":null,"abstract":"<p><strong>Background: </strong>Chagas disease cardiomyopathy is characterized by intense immune activation, with double-negative (DN) T cells as key producers of inflammatory cytokines. CD1d is an antigen-presenting molecule involved in the activation of DN T cells.</p><p><strong>Methods: </strong>We characterized CD1d+ monocytes from patients with cardiac (CARD) and indeterminate (IND) disease using flow cytometry.</p><p><strong>Results: </strong>CARD CD1d+ monocytes exhibited higher expression of TNF, TNF-receptor, PDL-1, and Fas-L compared to those from IND. These monocytes correlated with TNF expression by DN T-cells in CARD but not in IND.</p><p><strong>Conclusions: </strong>CD1d+ monocytes from CARD are inflammatory and associated with DN T-cell activation, confirming that CD1d is a target for modulating inflammation in Chagas cardiomyopathy.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chromoblastomycosis in Brazil: A review of 450 published cases.","authors":"Layala Stefane de Paula Barbosa, Yury Raphaell Coringa de Souza, Caroline Suemi Sasaki, Daniel Wagner Dos Santos, Luana Rossato","doi":"10.1590/0037-8682-0132-2024","DOIUrl":"10.1590/0037-8682-0132-2024","url":null,"abstract":"<p><p>Chromoblastomycosis is a skin infection caused by melanized fungi that primarily affects rural workers. This study aimed to analyze the clinical and epidemiological manifestations of chromoblastomycosis in Brazil through an extensive literature review. A review of case reports or series of cases in English and Portuguese was conducted using the SciELO, LILACS, SCOPUS, PubMed, and Web of Science databases from 1963 to 2022. A total of 46 articles involving 450 patients were identified, among which, 83.1% were male rural workers with a mean age of 52.2 years. The clinical manifestations were most commonly observed in the lower extremities (78.7%). The most frequent clinical presentations of the disease were verrucous lesions and plaques. Fonsecaea and Rhinocladiella spp. were the most common agents responsible for chromoblastomycosis. Most cured cases were treated with itraconazole, either as monotherapy or in combination with other antifungals, surgery, or cryosurgery. Chromoblastomycosis affects hundreds of rural workers in Brazil, leading to financial disabilities as well as personal and family losses. It is essential to prioritize epidemiological surveillance and ensure the early diagnosis of this disease to reveal its true prevalence, guide resource allocation, improve diagnosis, ensure early treatment, and implement preventive measures.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654747/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682624","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spotted fever diagnosis using molecular methods.","authors":"Helen Gonçalves Marques, Anna Julia Ribeiro, Anna Karolina de Oliveira Alfenas Gadelha, Carlos Ananias Aparecido Resende, Daniela Regiane da Silva, Débora Patrícia Martins de Deus, Isabelle Caroline Dos Santos Barcelos, Isabela Maia Pereira, Iago Tadeu Santos de Paula, Lucas Da Silva Lopes, Líria Souza Silva, Mariana Campos da Paz Lopes, Miguel Angel Chávez-Fumagalli, Eduardo Antônio Ferraz Coelho, Rodolfo Cordeiro Giunchetti, Ana Alice Maia Gonçalves, Alexsandro Sobreira Galdino","doi":"10.1590/0037-8682-0226-2024","DOIUrl":"10.1590/0037-8682-0226-2024","url":null,"abstract":"<p><p>Rickettsiosis is a disease caused by bacteria belonging to the genus Rickettsia, and is a potentially fatal zoonotic disease of great medical and veterinary importance. Given the urgent need to develop new diagnostic methods for detecting this disease, the present review aimed to evaluate the number of publications dedicated to the identification of Rickettsia spp. in human samples using molecular methods, such as polymerase chain reaction and its variations. To this end, a bibliographical survey covering articles published in the past ten years was conducted using the PudMed platform with the keywords \"spotted fever\" and \"Rickettsia,\" both combined with \"diagnosis.\" A growing number of publications in this area reflects an increasing interest in research, especially since 2015. From 2015 to February 2024, several promising results were tested and many studies were able to detect the genetic sequences of interest. Therefore, the absence of a standard diagnosis method highlights the critical need for developing an effective technique capable of accurately detecting the etiological agent and ensuring accurate diagnosis of the disease.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654745/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk Factors for Acute Rheumatic Disease: Exploring Factors at Individual and Collective Levels.","authors":"Renata Fonseca Mendoza, Antonio Mutarelli, Bernardo Fonseca Mendoza, José Augusto Almeida Barbosa, Rodrigo Liberato de Oliveira, Bruno Ramos Nascimento, Alexandre Negrão Pantaleão, Isabella Moreira Gonzalez Fonseca, Matheus Assunção Rabello de Oliveira, Airandes de Sousa Pinto, Andrea Beaton, Maria Carmo Pereira Nunes","doi":"10.1590/0037-8682-0139-2024","DOIUrl":"10.1590/0037-8682-0139-2024","url":null,"abstract":"<p><p>Acute rheumatic fever (ARF) is a complex disease with several clinical manifestations. Its most significant long-term complication is valvular heart damage, commonly referred to as chronic rheumatic heart disease. The risk of ARF varies globally, with over 80% of cases occurring in low- and middle-income countries, highlighting the role of socioeconomic factors. A comprehensive understanding of the risk factors associated with ARF and its clinical, genetic, and sociodemographic mediators can help clinicians identify high-risk individuals, develop effective management strategies, enhance target screening and active case-finding initiatives, and ultimately improve patient outcomes. This review aimed to provide an overview of ARF and its global burden, focusing on the established and potential risk factors associated with its development.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11654748/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682628","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Sociodemographic aspects, time series and high-risk clusters of malaria in the extra-Amazon region of Brazil: a 22-year study.","authors":"Rosália Elen Santos Ramos, Erica Santos Dos Reis, Leticia Pereira Bezerra, Maria Wilma da Silva Lima, Ana Paula Sampaio Feitosa, Luiz Carlos Alves, Israel Gomes de Amorim Santos, Fábio André Brayner","doi":"10.1590/0037-8682-0564-2023","DOIUrl":"10.1590/0037-8682-0564-2023","url":null,"abstract":"<p><strong>Background: </strong>Malaria is an acute febrile parasitic disease that significantly impacts global public health. In Brazil, the most studied endemic area for the disease is the Amazon region. This study aims to analyze temporal, spatial, and spatiotemporal patterns of malaria in the extra-Amazon region of Brazil over a 22-year period.</p><p><strong>Methods: </strong>We conducted a time-series study from 2001 to 2022, encompassing both autochthonous and imported cases. Time trend analysis was employed to assess fluctuations in incidence rates over the years. Spatial clusters of infection risk were identified using the Local Moran Index and Kulldorff's scan.</p><p><strong>Results: </strong>A total of 18,633 malaria cases were identified in the extra-Amazon region, including 1,980 autochthonous, 13,836 imported, and 2,817 of unknown origin. During the first period (2001-2011), 1,348 autochthonous and 9,124 imported cases were reported. In the second period (2012-2022), there were 632 autochthonous and 4,712 imported cases. The state of Espírito Santo exhibited a decreasing trend but maintained the highest incidence rates throughout the study. The number of municipalities at high risk for autochthonous cases declined, with Espírito Santo, Minas Gerais, and Piauí having the most municipalities with high rates. For imported cases, the federative units with the highest numbers in both periods were Ceará, Distrito Federal, Goiás, Minas Gerais, Piauí, and Paraná.</p><p><strong>Conclusions: </strong>The data reveal the areas most affected by malaria and thus of highest priority for implementing control strategies.</p>","PeriodicalId":21199,"journal":{"name":"Revista da Sociedade Brasileira de Medicina Tropical","volume":"57 ","pages":""},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11656533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142625390","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}