Pakistan Journal of Medical & Health Sciences最新文献

{"title":"Comparison of Ferrous Sulphate Versus Iron Polymaltose Complex in the Treatment of Iron Deficiency Anemia in Children","authors":"Saeed Zaman, Masud Khan, Samina Tabussam, S. Nawaz, A. Ayub, S. Shah","doi":"10.53350/pjmhs221610308","DOIUrl":"https://doi.org/10.53350/pjmhs221610308","url":null,"abstract":"Objective: To compare the efficacy of ferrous sulphate versus iron Polymaltose complex (IPC) in the treatment of iron deficiency anemia (IDA) in children. Study Design: Randomized controlled trial. Place and Duration: Department of Pediatrics, Combined Military Hospital, Kharian Pakistan from Jan 2019 to Mar 2020. Methodology: A total of 150 children with IDA were included. At baseline, blood sample was obtained for assessment of hemoglobin level. Then children were randomly divided in two groups. In Group-A (n=75), patients were given ferrous sulphate while in In Group-B (n=75), IPC was given. After 12-weeks of treatment, hemoglobin level was assessed. Efficacy was labeled as “yes” if there was 2 g/dl hemoglobin improvement. Results: In a total of 150 children, the mean age in Group-A was 6.56±2.33 years and 6.05±2.78 years in Group-B. In group A, there were 37 (49.3%) males and 38 (50.7%) females while in Group-B there were 35 (46.7%) males and 40 (53.3%) females. At baseline in group A, the mean hemoglobin level was 6.07±1.12 g/dl while in group B, it was 6.16±1.14 g/dl. After 12-weeks, in Group-A the mean hemoglobin level was 9.44±1.61 g/dl whereas in Group-B, it was 8.83±2.01 g/dl (p=0.0420). There was insignificant difference observed for efficacy in both groups (p-value = 0.051). Practical Implications: Both IPC and ferrous sulphate resulted in significant rise in hemoglobin levels but ferrous sulphate showed better results in comparison to IPC. Conclusion: Although in comparison to IPC, ferrous sulphate resulted in significantly better rise in hemoglobin levels among children with IDA, but overall efficacy between the two studied drugs was relatively similar. Keywords: Ferrous sulphate, iron Polymaltose complex, iron deficiency anemia.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123671713","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":"Supracondylar Displaced Fracture of Elbow in Children Treated with Closed Reduction and Percutaneous K Wire Fixation","authors":"Aqeel Moazzam, Agha Momin, K. Saeed, N. Mughal, Muhammad Akhtar","doi":"10.53350/pjmhs221610328","DOIUrl":"https://doi.org/10.53350/pjmhs221610328","url":null,"abstract":"Objective: To compare the closed reduction and percutaneous K wire fixation method outcomes in the treatment of supracondylar displaced fracture of elbow in children. Study Design: Prospective study Place and Duration of Study: Department of Orthopaedics, Arif Memorial Teaching Hospital, Lahore from 2nd April 2021 to 31st September 2021. Methodology: One hundred and seventy children were included. Those children having supracondylar displaced fractures of elbow with a grade 3 were included in the study as participant. K wires of 1.5-2cm were used after closed reductions were satisfactorily achieved. Padded-Back slabs at posterior position of elbow were applied. At 2 weeks’ suture removal and pin configuration was also observed. Callus production was observed through radiological x ray images. Results: Majority of the children belonged to the age group of 6-10 years. There were 59.4% males while 40.58% were females. Within the total number of cases 55% were administered two lateral parallel K wires while 45% were administered cross K wire. Pin tract infection was formed in 2.5% of lateral K wire cases while it was observed in only 1.2 % of Cross wire cases. Most of the children got the fracture while playing a sport. The recovery phase was of 3.5 months while fracture joined in a mean value of 1 month. Conclusion: Lateral percutaneous pin technique for the management of supracondylar fracture of humerus bone is a more suitable method and offers same results without involvement of iatrogenic ulnar nerve injury. Keywords: Humerus, Ulnar nerve, Pin method, K-wire, Deformation","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"717 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130073787","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":"Randomized Controlled Clinical Trial to Examine the Efficacy of Oral Midazolam in Post Operative Pain Reduction in Patients Undergoing Laparoscopic Cholecystectomy","authors":"F. Siddiqui, M. Umer, Hiba Moazzam, Sarosh ., Umar Soomro, Shahtaj A Shah","doi":"10.53350/pjmhs221610430","DOIUrl":"https://doi.org/10.53350/pjmhs221610430","url":null,"abstract":"Background: Stressful conditions like surgery and anesthesia trigger neuroendocrine pathway activation, which can have dangerous hemodynamic effects on the patient. One method for minimizing these hemodynamic consequences is maintaining an optimum level of anesthesia. Another option is giving patients a pharmaceutical formulation that modifies how anesthetic agents react. Objective: The current study sought to determine if preoperative oral midazolam could reduce postoperative pain scores and the occurrence of Rescue Analgesia in patients undergoing laparoscopic cholecystectomy. Methods: This is a single-blinded randomized controlled study conducted at the Surgery department of Jinnah Medical College Hospital, Korangi Karachi, on patients undergoing laparoscopic cholecystectomy. Through simple random sampling, participants were divided into two study groups, control (n=32) and 7.5mg receiving preoperative oral midazolam-intervention group. After surgery, the VAS pain score in both group participants was measured at 2, 8, 12, and 24 hours. The frequency of rescue analgesia and duration of hospital stay was also observed. Standard deviation, mean, chi-square test, and T-test was performed to determine the variation in both groups by using SPSS version 26. The P value ≤0.005 was measured significant. Results: No significant difference in the postoperative pain score after oral administration of midazolam in the intervention group compared to the control group at 2, 12, and 24 hrs intervals. Except at 8-hour intervals, a significant change of 0.004 was observed in both study groups. A significant variation of 0.008 was observed in the duration of hospital stay in the intervention group when compared with the control group. Lastly, in the present study, no significant difference in the frequency of rescue analgesics was observed in both study groups. Practical implication: This study will help out to determine the right dosage of oral midazolam which might effectively be used in managing post-operative pain in laparoscopic cholecystectomy patients. Conclusion: Orally administeredmidazolam was not efficient in lowering the pain score in patients undergoing laparoscopic cholecystectomy. Keywords: Midazolam, Post-operative pain, Laparoscopic cholecystectomy, Local anesthetics","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"87 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114207355","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":"Real World Data about the Characteristics of Adult Diabetes Mellitus Patients Visiting Outpatient Department of a Tertiary Care Hospital","authors":"S. Khatoon, Ghazanfer Ali, Sher Ali, Maria Zafer, Amber Ghaffar","doi":"10.53350/pjmhs221610294","DOIUrl":"https://doi.org/10.53350/pjmhs221610294","url":null,"abstract":"Objective: To find our characteristics of adult diabetes mellitus (DM) patients visiting outpatient department (OPD) of a tertiary care hospital. Study Design: Observational, cross-sectional study. Place and Duration: Outpatient department of Medicine, Pakistan Institute of Medical Sciences, Islamabad Pakistan from October 2021 to March 2022. Methodology: We included a total of 200 patients. Inclusion criteria were patients of both genders aged 18 to 70 years having type-1 and type-2 diabetes mellitus with a disease duration history of at least 6 months visiting outpatient department. Socio-demographic data along with DM related characteristics including family history of DM, types of DM, types of medications being used and fasting/postprandial blood glucose levels were recorded. Frequency of various DM related complications at the time of enrollment were also noted. Results: In a total of 200 patients of DM, 129 (64.5%) were male and 71 (35.5%) female. Overall, mean age was 45.03±12.46 years while 91 (45.5%) patients were aged between 31 to 45 years. Mean BMI was 23.33±4.75 kg/m2. Positive family history of diabetes was found in 98 (49.0%) patients. Type-1 diabetes mellitus was reported by 13 (6.5%) patients while remaining 187 (93.5%) patients had type-2 diabetes mellitus. Mean Duration of diabetes was 7.65±7.60 years. There were 91 (45.5%) patients who were using oral plus injectable/insulin medications. Overall, mean fasting blood glucose was 148±49.06 mg/dl while mean 2-hour postprandial blood glucose was 235.07±58.80 mg/dl. Neuropathy was the most common diabetes related complications noted in 91 (45.5%) while gastrointestinal related complications were the 2nd most frequent complications observed in 31 (15.5%). Practical Implications: Vast majority of the DM patients reported hyperglycemia during routine follow ups which arises the need to revisit current management strategies. Conclusion: Majority of the patients with DM were male, middle aged and belonged to urban areas of residence. Nearly half of the DM patients reported neuropathy related complications. Keywords: Diabetes mellitus, neuropathy, hyperglycemia, insulin.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical & Health Sciences","volume":"5 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114182001","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":"Quantification of Endothelin-1 Gene Expression in the Diabetic Patients' Type II (DMT2) with Cardiovascular Disease","authors":"Mervat Kamil Kadhim, Alaa Mohammad Hasson Al-Husseini","doi":"10.53350/pjmhs221610423","DOIUrl":"https://doi.org/10.53350/pjmhs221610423","url":null,"abstract":"The goal of this study is to see if there's a link between diabetes type 2 problems and endothelin-1 overexpression (ET-1). Where (90) blood samples from participants were obtained and divided into three groups: a first group representing individuals with (Hypertensive DMT2) and a second group representing (Hypertensive DMT2with CVD,), while the third group was represented by a control group. mRNA was extracted from blood samples then converted to cDNA by using the (qPCR) technique. When comparing the levels of ET-1 in the (hypertensive DMT2 and hypertensive DMT2with CVD groups ) to the control group, the results showed a significant difference (p<0.05), The current study analyzed the ET-1 gene in type 2 diabetes and cardiovascular disease, which could be a new target for early CVD therapy in the future. Keywords: endothelin-1gene, diabetes type II, cardiovascular disease, , endothelial dysfunction","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130055994","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":"Comparison of Surgical Outcomes of Fistulotomy and Fistulectomy for the Management of Simple Low Fistula-In-ANO","authors":"Naeem Ghaffar, Mudassar Ali, Kamran Abbas","doi":"10.53350/pjmhs221610254","DOIUrl":"https://doi.org/10.53350/pjmhs221610254","url":null,"abstract":"Objective: This study is done to compare the fistulotomy and fistulectomy for the treatment of fistulas in ano. This study is designed for the comparison of these surgical procedures to find out their results. Materials and methodology: this study was done at the surgery department of Sir Ganga Ram hospital Lahore during Jan 2021 to Dec 2021. 60 patients were included in this study and they were divided in two groups each of 30 participants. The group 1 patients were treated with fistulotomy while those of group 2 were selected for fistulectomy surgeries. The patients aged 20 years to 65 years were part of this study who were admitted to the department of surgery for planned fistulas operations. Before surgery Consent was taken from the patients themselves or by their close relatives.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"50 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116289570","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":"Determining Efficacy of Tranexamic Acid in Reducing Post Partum Haemorrhage in Elective Cesarean Section Patients Evaluating in Referance to Fall in Haemoglobin","authors":"J. Gulzar, S. Zahra, I. Aftab, Nayab Amir, Rana Muhammad Naeem Liaqat, Ayesha Iqbal","doi":"10.53350/pjmhs221610456","DOIUrl":"https://doi.org/10.53350/pjmhs221610456","url":null,"abstract":"Obstetrical haemorrhage is a potentially fatal clinical manifestation of either vaginal delivery or caesarean section. According to reports, it is responsible for almost fifty percent of all pregnancy - related deaths. The prevalence of caesarean section (CS) has dramatically upped in both low income as well as in developed nations, thereby increasing the likelihood of obstetrical haemorrhage. The rationale of this study is that it is important to evaluate the efficacy and safety of TA on blood loss with LSCS. Methods: Cases were separated into two subgroups: case: (A) and control: (B). In the operating theater, participants were given A and B packages to choose from, the contents of whom were only known to the nurse in charge of drug preparation. All meds were injected by an anesthetist who was not in charge of supervising or assessing the patients. Results: Comparison of both %age reduction in Hb levels (>10%) after treatment shows that in Group A 6(20%) and in Group B 15(50%) had >10% reduction in Hb levels after treatment, p-value=0.015. Conclusion: TA administration reduced dramatically the bleeding throughout CS, the proportion of patients who lost more than 1000 mL of blood, and the requirement for supplemental uterotonic substances. As a result, TA can be employed very safely and successfully in patients receiving caesarean section.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"160 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"127395485","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":"Assessment of Neurocognitive Effect in Patients Undergoing Cardiopulmonary Bypass: A Prospective Longitudinal Study","authors":"Ahmed Jamal, Usman Iqbal, Aroosa Amjad, R. Iqbal, A. Abdullah","doi":"10.53350/pjmhs221610238","DOIUrl":"https://doi.org/10.53350/pjmhs221610238","url":null,"abstract":"Objective: To assess neurocognitive effects in patients who underwent cardiopulmonary bypass. Study Design & Setting: Using non probability purposive sampling, a prospective study design was used to collect the data from in tertiary care hospitals with 60 beds in ICU. Methodology: Patients who underwent CPB having no history of psychological and mental illness was recruited for the said study. We used a short test of global mental status to measure cognitive performance called the “Mini-Mental State Examination (MMSE)”.Wilcoxon test was used to analyze the pre- and post-operative changes over MMSE. The Folstein test, often known as the mini-mental state examination (MMSE), is a 30-point survey that has been widely used in clinical and research contexts to evaluate cognitive impairment. Different parameters; temporal, spatial, alternate, recognition, and recall were evaluated. P-value ≤0.05 was considered as significant. Results: In this study, a significant fall in spatial, temporal, short term recall, long term recall, object recognition, alternate, reading, writing, read and act, and drawing in post-operative MMSE scores was observed as compared to pre-operative. However, there was no significant change in command so there is little or no effect on command parameters in pre-operative and post-operative cardiopulmonary bypass patients. There was a significant difference between pre-operation and post-operation total scores i.e., a fall in the ‘total’ score of neurocognition occurred after cardiopulmonary bypass. Practical implication Study finding may be used for practical implications in managing neurocognitive outcome in patients undergoing cardiopulomonary bypass. Conclusion: This research concludes that neurocognition is affected in patients who underwent CPB, with CPB itself a bigger risk factor in causing postoperative neurocognitive dysfunction. Keywords: Cardiopulmonary bypass, Mental health, Neurocoagnitive impairment, POCD","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125284452","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":"Prevalence of Hemorrhoids Signs and Symptoms among Pregnancies at Maternity Teaching Hospitals in Mosul City","authors":"Rana Mohammed Jasim","doi":"10.53350/pjmhs221610406","DOIUrl":"https://doi.org/10.53350/pjmhs221610406","url":null,"abstract":"Objective: Estimate to the prevalence of hemorrhoids Signs and Symptoms among pregnancies in maternity teaching hospitals in Mosul city. Material: Descriptive study was conducted in maternity teaching hospital 20to30 September 2022 . A purposive sample that consists of (64) patients , chosen according to the criteria . Their age ranges between (15-44) years. A questionnaire was developed for purposive of study & included 3 parts is consist of part one demographic data and part three is composed of (7) items . The overall questions included (28) items. Results: The age groups is between(20-24) years and constituted Prevalence (29.7%), In addition the age groups is between (25-29) years and constituted (29.7%) Most of samples were females constitute of Prevalence (60%) of the total samples. In regard with residence city Prevalence (76.6%) .In regard with levels of education elementary Prevalence (20.3%) .In regard with occupation housewife Prevalence (65.6%) high percentage. Conclusion: This study concluded that the Age, Residence, occupation a variables are the most socio- demographic variables that were associated prevalence of hemorrhoids Signs and Symptoms among pregnancies and the level of education variable.High percent from total sample were in residence city it constitute of Prevalence (76,6%). With regard to the occupation housewife were living urban areas and constitutes Prevalence (65,6%) and there are many high associations among some variables prevalence of hemorrhoids Signs and Symptoms among pregnancies and the age significant. Keywords: Prevalence, Hemorrhoids, Pregnancies.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"32 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129742903","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":"Incidence of Metallo Beta-Lactamase Producing Pseudomonas Aeruginosa in Diabetes and Cancer Patients","authors":"Henna Khalid, M. Riaz, Sara Najeeb, N. Kiran","doi":"10.53350/pjmhs221610356","DOIUrl":"https://doi.org/10.53350/pjmhs221610356","url":null,"abstract":"Objective: Estimate to the prevalence of hemorrhoids Signs and Symptoms among pregnancies in maternity teaching hospitals in Mosul city. Material: Descriptive study was conducted in maternity teaching hospital 20to30 September 2022 . A purposive sample that consists of (64) patients , chosen according to the criteria . Their age ranges between (15-44) years. A questionnaire was developed for purposive of study & included 3 parts is consist of part one demographic data and part three is composed of (7) items . The overall questions included (28) items. Results: The age groups is between(20-24) years and constituted Prevalence (29.7%), In addition the age groups is between (25-29) years and constituted (29.7%) Most of samples were females constitute of Prevalence (60%) of the total samples. In regard with residence city Prevalence (76.6%) .In regard with levels of education elementary Prevalence (20.3%) .In regard with occupation housewife Prevalence (65.6%) high percentage. Conclusion: This study concluded that the Age, Residence, occupation a variables are the most socio- demographic variables that were associated prevalence of hemorrhoids Signs and Symptoms among pregnancies and the level of education variable.High percent from total sample were in residence city it constitute of Prevalence (76,6%). With regard to the occupation housewife were living urban areas and constitutes Prevalence (65,6%) and there are many high associations among some variables prevalence of hemorrhoids Signs and Symptoms among pregnancies and the age significant. Keywords: Prevalence, Hemorrhoids, Pregnancies.","PeriodicalId":296492,"journal":{"name":"Pakistan Journal of Medical &amp; Health Sciences","volume":"16 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2022-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131496905","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}