West African journal of medicine最新文献

{"title":"The Interplay Between Fibroblast Growth Factor-23 (Fgf-23) and Traditional Biomarkers of Chronic Kidney Disease - Mineral and Bone Disorder.","authors":"R S Ezeugonwa, T A Bamikefa, Y A Ayoola, I O Sanni, R O Alaya, B A Omotoso, M O Hassan, S Adamu, O O Okunola, A A Sanusi, F A Arogundade","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>Chronic kidney disease (CKD) is a global health challenge affecting 11-13% of the world's population. Chronic kidney disease - mineral and bone disorder (CKD-MBD) has been recognized as an important complication of CKD. There has been an increasing interest in fibroblast growth factor 23 (FGF-23), regarding its roles in the pathophysiology, diagnosis, and management of CKD-MBD but its relationship with other biomarkers of CKD-MBD has not been well investigated in sub-Saharan Africa, especially in Nigeria.</p><p><strong>Method: </strong>This study aimed to assess the levels of FGF-23 in patients with kidney disease: Improving Global Outcome (KDIGO) CKD stages 3a to 5 and its relationship with traditional biomarkers of CKD-MBD. One hundred and thirty-eight (138) participants, 103 patients and 35 controls, completed the study. Serum intact parathyroid hormone (iPTH), FGF-23, and calcium among others were measured and a structured, interviewer-administered questionnaire was used to collect data. Data collected were analyzed using the Statistical Package for Social Sciences version 20 (SPSS 20).</p><p><strong>Results: </strong>The mean serum levels of FGF-23 were different between patients (241.05 ± 3.40pg/ml) and the controls (133.66 ± 2.35pg/ml; p=0.009), and the same applied to the mean serum levels of iPTH for patients and controls (56.15 ± 43.48pg/ml vs 20.11 ± 5.57pg/ml, p = 0.009). The FGF-23 levels increased from stages 3 to 5; however, in stage 5 CKD, those on dialysis had lower iPTH and FGF-23 compared to those who were yet to commence dialysis. In the CKD arm, the calcium-phosphate product had a positive correlation with both FGF-23 and iPTH (r = 0.212; p = 0.01, and r = 0.195; p = 0.022, respectively). The prevalence of CKD-MBD increased as CKD progressed through stages 3 to 5 (72%, 90% and 100% respectively).</p><p><strong>Conclusion: </strong>The prevalence of CKD-MBD was very high in this study, the rate progressively increased as GFR declined. FGF-23 showed a weak correlation with Ca x P product but did not correlate with calcium, phosphate, or iPTH.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"36-43"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369302","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":"Quality of Life Assessment Among Patients with Papulosquamous Disorders in Southern Nigeria.","authors":"E A Sokunbi, C R Madubuko, B U Okwara, E O Omatighene, H O Elimian, S O Oiwoh, A N Onunu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Papulosquamous disorders (PSDs) are a broad group of relatively common dermatoses that run a chronic course; usually with unsatisfactory outcomes which impacts on the Quality of Life (QOL) of subjects. Few studies have attempted to quantify their burden on QOL in this environment. This study aims to assess the disease impact on QOL of affected subjects.</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study conducted at the University of Benin Teaching Hospital, Benin City among two hundred subjects with PSDs. Consecutive patients with PSDs were recruited for this study after obtaining ethical approval. The Dermatology Life Quality index (DLQI) questionnaire was used to estimate the impact of these dermatoses on the QOL of subjects. Data was analysed using IBM SPSS version 21.</p><p><strong>Result: </strong>PSDs affected all age groups with a mean age of 40.9 ± 16.4 years. Male: female ratio was 1: 1.30. The mean DLQI score was 9.5 ±5.9. Pityriasis rubra pilaris subject recorded the highest burden with DLQI score of 14.0 ±5.0, followed by psoriasis; 11.7 ± 6.3. Over half (57%) of participants had severe impact on their QOL; 34.0% had \"extremely large\" impact. QOL were similar among gender; but worse in extremes of age. The most commonly affected domains using the DLQI questionnaire were the \"symptoms\" and \"feelings\" domains; with 34% and 21% affected respectively.</p><p><strong>Conclusion: </strong>Most subjects had severe impact on their QOL from these dermatoses; which mostly affected the symptoms and feelings of participants. Efforts to improve treatment outcome through interdisciplinary care alongside psychological assessment should be escalated.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"3-10"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369300","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":"Diagnostic Performance of Xpert MTB/RIF Assay in Adults with Presumed Pulmonary Tuberculosis at Uyo, Nigeria.","authors":"S B Udoette, A E Onukak, U V Ugwu, M O Iroezindu, U S Unigwe, V A Umoh","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Tuberculosis (TB) is a disease of immense public health importance in sub-Saharan Africa. Xpert MTB/RIF assay, a relatively recent, rapid molecular testing modality offers potential solutions to most of the challenges associated with TB diagnosis.</p><p><strong>Objective: </strong>This study determined the diagnostic performance of Xpert MTB/RIF assay in adults with presumed pulmonary tuberculosis (PTB).</p><p><strong>Methods: </strong>This was a descriptive cross-sectional study involving consenting adults with presumed PTB at the University of Uyo Teaching Hospital, Uyo, southern Nigeria. A structured questionnaire was used to collect participants' data. All participants submitted 2 sputum samples (spot and early morning). Sputum smear microscopy, Xpert MTB/RIF assay and mycobacterial culture were done. They also had chest radiography.</p><p><strong>Results: </strong>They were 230 participants in the study. Seventy-nine (34.3%) patients were living with HIV. Xpert MTB/RIF assay detected MTB in 65 (28.3%) patients with 2 (3.1%) of them having rifampicin resistance. M. tuberculosis was isolated from sputum culture in 69 participants while the result was negative in 151 participants. The culture results of these 220 patients were used as the reference standard for the determination of the sensitivity and specificity of Xpert MTB/RIF assay. The overall sensitivity and specificity of the assay were 88.4% and 98.7% respectively. Younger age, longer duration of cough, weight loss, low body mass index (BMI) and positive smear status were independent factors associated with MTB detection using the assay.</p><p><strong>Conclusion: </strong>Xpert MTB/RIF assay is a highly sensitive and specific modality for pulmonary TB diagnosis when compared with mycobacterial culture, which is the gold standard.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"52-60"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369297","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":"A Short Review of Migraine headaches in Nigeria: Epidemiology, Current Challenges, Treatment Approaches, and Future Directions for Improved Management.","authors":"Ayokunle Osonuga, Adewoyin A Osonuga, G C Okoye, Odusoga A Osonuga, Adebayo DaCoasta, Ayotunde C Osonuga, Demilade DaCosta","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and objective: </strong>Migraine, a leading cause of global disability, disproportionately burdens low-resource countries like Nigeria, where healthcare inequities, cultural stigma, and infrastructural gaps hinder effective management. Despite global advances in migraine therapeutics, Nigeria's burden remains understudied, with fragmented data on epidemiology, treatment access, and outcomes.</p><p><strong>Methods: </strong>We conducted a narrative review of the literature on migraines in Nigeria using sources such as PubMed, MEDLINE, African Journals Online (AJOL), and Embase. This review synthesizes a broad range of peer-reviewed articles, regional reports, and gray literature to provide an interpretative overview of the topic.</p><p><strong>Results: </strong>Available evidence suggests that migraine prevalence in Nigeria is estimated at 15-20%, with urban areas reporting rates as high as 26% and a pronounced gender disparity (3:1 female-to-male ratio). Rural regions experience significant underreporting, often attributed to cultural interpretations of migraine symptoms as spiritual phenomena. Most patients rely on over-the-counter analgesics, with 30% developing medication-overuse headaches. Advanced therapies such as triptans and CGRP inhibitors are largely inaccessible due to prohibitive costs.</p><p><strong>Conclusion: </strong>Nigeria's approach to migraine care lags significantly behind global standards, underscoring the need for context-specific innovations. Priority areas include the expansion of telemedicine to overcome specialist shortages, incentives for local medication production, and the integration of traditional healers into formal referral networks. Policy reforms and collaborative efforts among stakeholders are essential to align Nigeria's migraine management with evidence-based practices, ultimately reducing the burden on individuals and the economy.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"67-72"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144476908","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":"Symptoms and Physiological Parameters of Obstructive Sleep Apnoea Patients Diagnosed with a Portable Sleep Monitor: Implications and Challenges.","authors":"N I Nwosu, C V Odinaka, P I Nlewedim, C F Udeh, A G Obiefuna, U C Abazie, C C Onyedum, J C Chukwuka","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Obstructive sleep apnoea is a chronic, debilitating condition that if left undiagnosed and untreated is associated with adverse clinical events. The WatchPAT® is a portable wrist-worn sleep study device that uses peripheral arterial tonometry with pulse oximetry and actigraphy to assess respiratory disturbances. Unlike other level 111 sleep monitors, it measures actual sleep time, distinguishes between REM and Non-REM sleep stages, and thus generates actual apnoea-hypopnoea index.</p><p><strong>Objectives: </strong>The study was done to assess symptoms of obstructive sleep apnoea, evaluate physiological parameters recorded by the sleep monitor and highlight changes encountered in deploying the monitor for diagnosis of sleep apnoeas.</p><p><strong>Methods: </strong>It was a cross-sectional study. A structured Questionnaire was administered to all patients to obtain data regarding their symptoms, co-morbidities and socio demographics. Sleep study was conducted using a Watch-PAT® portable monitor. Data were entered first on Microsoft excel sheet and analysed using SPSS version 25.</p><p><strong>Results: </strong>Thirty-eight participants, mean age 49±14 years (17 to76 years) were studied (females, 73.7%). Thirty-four (89.5%) of them were diagnosed with OSA. Sixteen (47.0%), 9 (26.5%) and 9 (26.5%) had severe, moderate and mild OSA respectively. Commonest symptoms were snoring (85.7%), abrupt awakening accompanied by gasping/choking at night (65.8%) and non-refreshing sleep (60.5%). Memory loss occurred significantly among those with severe OSA compared with mild and moderate OSA (X2=9.920, p=0.007). Seventeen participants (44%) had excessive daytime somnolence (EPSS > 10). Those with severe OSA recorded the lowest minimum pulse (median 42.5, IQR 39.3-51.8), highest maximum pulse (median 130bpm, IQR 114-138), and lowest minimum SPO2 (median 70%, IQR 64.3-80.3). Severe OSA was associated with reduced mean percentage of REM sleep (14.6%) compared to moderate (25.1%) and mild (16.1%) OSA.</p><p><strong>Conclusion: </strong>Diagnosing OSA objectively using a portable sleep monitor such as WatchPAT® is feasible. Snoring (85.7%) was the commonest symptom among those diagnosed with OSA. Physiological parameters obtained from the monitor provide the clinician the requisite information with which to persuade patients of a need for intervention. However, cost of CPAP machine and mandibular advancement device delayed immediate intervention.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"21-28"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369301","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":"A Social Media Survey on the Prevalence of Post-COVID Neurologic Complications Among Nigerians.","authors":"I E Akase, S O Awodumila, C E Nwanmah, O O Ojo, O P Agabi, O Ede, F O Nwaokorie, R A Anyanwu, P S Ghajiga, O Kalejaiye, G S Perez-Giraldo, Z S Orban, M Jimenez, I J Koralnik, N U Okubadejo","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background and objective: </strong>Cultural barriers and perceptual factors that are peculiar among Africans are known to limit the number of people seeking medical care for post-COVID conditions. The aim of this social media survey was to ascertain the burden of post-COVID neurologic complications in Nigeria in individuals with confirmed COVID-19.</p><p><strong>Methods: </strong>We performed a cross-sectional web-based survey of persons with PCR-confirmed or suspected SARS-CoV-2 infection in Nigeria with incident infection between March 2020 and April 2022. Our survey utilized Kobo Toolbox® and was disseminated via several online platforms (including WhatsApp ®, Facebook®, and Twitter (X)®). Participant demographics, COVID-19 symptom profile, SARS-CoV-2 test results, and the occurrence of persistent neurological symptoms were documented.</p><p><strong>Results: </strong>We analyzed the data of 963 participants with confirmed or suspected COVID-19 infection. The mean age was 36.9 ± 9.9 years, and 555/963 (57.6%) were female. Only 174/963 individuals (18.1%) had SARS-CoV-2 PCR confirmation at any point during the pandemic, of which 133 (76.4%) had accompanying symptoms consistent with the case definition. A total of 47/174 (27.0%) of the PCR-positive participants reported post-acute COVID symptoms, and 46/174 (26.4%) had post-COVID neurologic complaints. The most commonly reported symptoms were fatigue (25; 14.4%), generalized body weakness (22; 12.6%), and difficulty remembering things (15; 8.6%). Slightly over half of those with post-COVID symptoms (25/47; 53.2%) sought care, with 21/25 (84%) presenting to a medical facility. Others presented either to a community pharmacy (1/25) or a patent medicine store (3/25) for care.</p><p><strong>Conclusion: </strong>Despite low testing rates in Nigeria, the prevalence of post-COVID neurologic complications is approximately 1 in 4 individuals. Further studies on the prognosis and management of post-COVID neurologic sequelae in Nigeria are warranted.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"29-35"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369295","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":"Addressing the Silent Strain: Unmasking Post-COVID Neurologic Complications in Resource-Limited Settings.","authors":"G E Erhabor","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"42 1","pages":"1-2"},"PeriodicalIF":0.0,"publicationDate":"2025-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144369296","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":"Global Insights into the Impact of Endothelial Dysfunction on Coronary Artery Disease: A Systematic Review.","authors":"A Ismail, K Isyaku, M U Sani","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) is a major global health issue, especially in low- and middle-income countries (LMICs). The dysfunction of the vascular endothelium plays a critical role in CAD progression.</p><p><strong>Objectives: </strong>This systematic review evaluated existing literature on the role of endothelial dysfunction in the progression of CAD.</p><p><strong>Methods: </strong>The review protocol was registered with PROSPERO (CRD42024539722). A comprehensive literature search identified 70 relevant articles. After removing 15 duplicates, 55 studies were screened based on title and abstract, leading to the exclusion of 35 articles that did not meet the inclusion criteria. Finally, 15 studies, encompassing a total of 3,673 subjects (with individual study sample sizes ranging from 14 to 936, and a median of 106), were included in the review.</p><p><strong>Results: </strong>The 15 studies (3,673 subjects, 1998-2023) included 9 cross-sectional, 5 cohort, and 1 retrospective study. CAD diagnosis was confirmed via angiography (10 studies) or other methods like stress ECG and cardiac enzymes. Endothelial dysfunction was assessed using FMD (8 studies) and other techniques. Five studies linked endothelial dysfunction to CAD severity, while cohort studies suggested its role in predicting adverse cardiovascular events, even with normal angiograms.</p><p><strong>Conclusion: </strong>This systematic review highlights the crucial role of endothelial function in CAD and emphasizes the importance of endothelial function in risk assessment, early detection, and guiding treatment decisions in CAD.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"41 12","pages":"1198-1204"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112176","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":"Primary and Delayed Primary Wound Closure in Low Energy Open Tibia Shaft Fracture: Randomized Controlled Study.","authors":"A Adedire, K S Oluwadiya, A Ajibade","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Background: </strong>Traditionally, delayed primary and secondary wound closure are commonly used for the treatment of open fractures especially before the advent of modern antibiotics. Despite the availability of antibiotics, primary wound closure is still not frequently used even for the treatment of low-energy open tibia shaft fractures especially in developing countries.</p><p><strong>Materials and methods: </strong>Sixty-four patients with GustiloAnderson type I and II tibia fractures were recruited for this randomized prospective intervention study to compare the infection rate, duration of wound healing, duration of hospital stay, and cost of treatment between primary and delayed primary wound closure. We randomized 68 patients into two blocks of 34 participants each using a randomization plan generated on the website, randomization.com. Each random number in a sealed serially numbered brown envelope. Clinical information and clinical findings were entered into a proforma, and data obtained were analyzed.</p><p><strong>Results: </strong>The majority of cases, 54 (84.4%), were Gustilo-Anderson type II. The infection rate was higher for primary wound closure (9.6%) than for delayed primary wound closure (3.0%). The mean duration of wound healing was 14.8 (±3.8) days for primary wound closure, which was significantly shorter than the 16.1 (±2.0) days recorded for delayed wound closure (p= 0.08). Also, the mean duration of hospital stay was shorter for patients treated with primary wound closure (4.1 ±3.6) days than for delayed wound closure patients 4.7 (±1.3); with a p value of 0.37. The mean cost of treatment for primary wound closure (N34,487 ±4911.4) was significantly less than that for delayed primary wound closure (N 40,536 ±1709.0), with a p-value of 0.01.</p><p><strong>Conclusion: </strong>Primary wound closure for low-energy open tibia shaft fractures is both more cost-effective and associated with a shorter time to wound healing compared to delayed primary closure. Therefore, primary wound closure should be used for low energy tibia shaft fracture even in low and middle-income countries. KEY WORDS: Open fracture, Tibia shaft, Wound closure, Management.</p>","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"41 12","pages":"1182-1187"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112125","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":"Beyond the Cure: Advancing Towards Holistic Oncology Care Through Multidisciplinary Interventions.","authors":"G E Erhabor","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":23680,"journal":{"name":"West African journal of medicine","volume":"41 12","pages":"1157-1158"},"PeriodicalIF":0.0,"publicationDate":"2024-12-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144112149","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}