Egyptian Journal of Haematology最新文献

{"title":"ADAMTS13 levels in sickle cell anaemia: is there a change between steady-state and vaso-occlusive crisis?","authors":"A. Kingsley, Essien Ofonime, Akaba Edakabasi","doi":"10.4103/ejh.ejh_24_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_24_21","url":null,"abstract":"Background Sickle cell anaemia (SCA) is a hypercoaguable state characterized by a significant alternation in haemostatic parameters which may predispose to increased risk of vas-occlusive crisis (VOC). The role of ADAMTS13 in the pathogenesis of VOC has not been fully investigated in our environment. Objective The objective of this study is to evaluate the level of ADAMTS13 in SCD subject in Calabar and to determine their role in the pathogenesis of vaso-occlusive crisis. Materials and methods This is a comparative study carried out at the University of Calabar Teaching Hospital (UCTH), Calabar. In all, 60 SCA patients were evaluated in VOC and steady states well are 50 apparently healthy controls. ADAMTS13 Ag was evaluated using Assaypro enzyme-linked immunosorbent assay kits with LOT Nos 04222167 R. Data were analyzed with IBM SPSS Chicago software version 21. The study was approved by the UCTH Institution Ethical Review Board. Results The mean ages of the SCA subjects and controls were 23.5 + 7.2 yrs and 26.5 + 5.6 years respectively (P=0.706). There were 23 (38.3%) males in the SCA group and 21 (42.0%) females in the controls. There was no significant difference in their sex distribution (P=0.063). The mean (SD) of ADAMTS13 in VOC, steady-state, and controls were 0.61 + 0.10 ug/l, 0.44 + 0.06 ug/l, and 0.62 + 0.10 ug/l respectively. ADAMTS13 levels did not differ significantly across the groups (P=0.270). Conclusion ADAMTS13 level is not elevated both in steady-state and vaso-occlusive crisis","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"26 - 34"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48064770","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":"Effect of iron deficiency on cell-mediated immunity in adults","authors":"Sara S. Ghonaim, Fawzia Abo Ali, N. Mahmoud, Mayada Mahmoud, Doaa Elzoghby, E. Ahmed","doi":"10.4103/ejh.ejh_60_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_60_21","url":null,"abstract":"Background Iron plays a vital role in immune system development, integrity, as well as proper function through its growth-promoting and differentiation-inducing properties in immune cells and its interference with cell-mediated immune effector pathways and cytokine activities. In the past few decades, several studies have found that iron deficiency markedly affects the immune system. However, data on the effect of iron deficiency on immune function are still confusing and contradictory. Aim To assess the effect of iron-deficiency anemia on cell-mediated immunity. Patients and methods The percentage and count of T-lymphocytes (CD3+) and their CD4+ and CD8+ subsets and CD4+/CD8+ ratio were evaluated in 25 iron-deficient and 15 healthy adult women. The effect of iron therapy on the same parameters was also assessed in patients after correction of anemia. Results In our study, there was no statistically significant difference between patient and control groups regarding CD3+, CD4+, and CD8+ cell counts and percentages and CD4+/CD8+ ratio, with no statistically significant difference after iron therapy. However, it was found that serum ferritin level was significantly positively correlated with CD4+/CD8+ ratio and CD4+ cell percentage and absolute count and significantly negatively correlated with CD8+ cell percentage. Conclusion Iron deficiency has no effect on cell-mediated immunity with respect to quantitative changes in T-lymphocyte subsets and CD4/CD8 ratio.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"66 - 73"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44691808","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":"Prognostic value of renin gene expression in acute myeloid leukemia","authors":"Mohamed Abd-ElGawad, YomnaM El-Meligui, Mohamed Abdelmonem, Roxan E Shafik, Nevine F. Shafik","doi":"10.4103/ejh.ejh_18_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_18_21","url":null,"abstract":"Aims To evaluate the renin gene (RG) expression pattern in newly diagnosed patients with acute myeloid leukemia (AML), aiming to figure out its prognostic value in correlation with clinical characteristics and outcomes of the chemotherapy course. Settings and design This study was clinical trial performed in the National Cancer Institute (NCI), Cairo University. Patients and methods We investigated the expression of the RG in 90 patients with AML using real-time PCR. Levels of RG were correlated with the different patients’ characteristics and outcomes of chemotherapy. Statistical analysis used χ2 test and Student t test were used to compare between RG positive and negative groups. SPSS software was used to perform the statistical analysis. Results RG presented in 90 (72%) patients with AML. Both renin positive and negative populations showed no statistically significant difference, regarding all clinical parameters evaluated and the prognostic outcomes. Positive gene patients were associated with nonsignificantly lower percentages of bone marrow and peripheral blood blasts (P=0.534 and 0.074, respectively). In addition, they showed nonsignificant difference regarding the incidence of all types of cytogenetics (P=0.467) and the same results for Flt3 gene expression (P=0.751). Moreover, they showed nonsignificant difference regarding complete response rates, relapse rates, and survival rates (P=0.473, 0.636, and 0.152, respectively). Conclusion RG expression has no significant role in determining the prognosis of patients with AML. This includes different prognostic outcomes, including response to treatment, survival rates, relapses, and disease-free periods.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"3 - 10"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41899276","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":"Adult idiopathic thrombotic thrombocytopenic purpura therapeutic modalities and outcome: 15 years’ experience","authors":"N. Esheba, M. Aboelnasr, Waleed A Elrefaey","doi":"10.4103/ejh.ejh_44_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_44_21","url":null,"abstract":"Background Thrombotic thrombocytopenic purpura (TTP) is a rare hematological disease that results in fatality if not treated. The studies on TTP are scarce; most of them have small numbers of patients. Since not enough data on Egyptian patients with TTP can be found in the literature, we carried out this retrospective study to define the therapeutic modalities and outcome of these patients. Patients and methods We studied the records of patients clinically diagnosed with TTP from 2006 to 2020. Twenty-nine patients were diagnosed with TTP. However, full records were available only for 22 patients. The primary outcome of the study was the 1-year survival. Other outcomes were the factors on which the survival seemed to depend on such as age, platelet count, lactate dehydrogenase (LDH), serum creatinine, hemoglobin, reticulocytic %, plasma volume exchange (PVE), days to start of treatment, and indirect bilirubin. Results Platelet count change was negatively correlated with both the number of plasma exchange sessions and the days to start of treatment, but it was positively correlated with the volume of plasma exchange. Univariate analysis identified factors associated with better survival of the patients: LDH, reticulocytic percent, days to start of treatment, serum creatinine, PVE, and hemoglobin level. The multivariate analysis revealed that the independent factors affecting the survival were LDH, reticulocytic percent, hemoglobin level, and age. Conclusion Early suspicion and intervention with therapeutic plasma exchange for TTP are associated with better outcomes in these patients. One and a half PVE is associated with better response than 1 PVE.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"60 - 65"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48335230","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":"Pulmonary hypertension and right ventricular function in the sickle cell populace","authors":"Opeyemi O. Oni, A. Adebiyi, A. Aje, T. Akingbola","doi":"10.4103/ejh.ejh_39_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_39_21","url":null,"abstract":"Background Sickle cell anemia (SCA) is a recognized cause of heart failure and pulmonary hypertension (PHT). However, the effect of PHT of right ventricular (RV) function has not been well elucidated. Objective To determine the effect of PHT on RV function in patients with SCA. Patients and methods Cases were adults with SCA with PHT. Controls were patients with SCA without PHT. All patients were recruited in a steady state. Echocardiography was done according to the recommendation of the American Society for Echocardiography. Measures of RV function used were RV fractional area change, peak tricuspid annular systolic velocity (S′), and tricuspid annular plane systolic excursion. PHT was estimated from tricuspid regurgitation jet velocities. Mean pulmonary arterial pressures more than 20 mmHg were said to have PHT. Results Of 86 patients, 14 had PHT. The mean values of RV systolic function (RV fractional area change, S′, and tricuspid annular plane systolic excursion) were not significantly different between cases and controls. Transtricuspid A was faster, with the E deceleration time shorter in those with PHT. Loud P2, PR interval, and waist–hip ratio (especially in women) correlate directly with PHT, whereas systolic blood pressure, early E deceleration time, and a history of hemolytic crisis correlated inversely with PHT. Systolic blood pressure and loud P2 are independent predictors of PHT in this study. Conclusion PHT had a prevalence of 16.3% in patients with SCA in this study. There is no significant effect of PHT on RV systolic function in patients with SCA.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"18 - 25"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48629843","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":"Covid-19 in patients with sickle cell disease","authors":"Wesam Moafa, Nouf Aldhamdi, Sami A. Alhazmi, Gassem Gohal, Weam Moafa, Abdulaziz H. Alhazmi","doi":"10.4103/ejh.ejh_40_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_40_21","url":null,"abstract":"Background During the COVID-19 pandemic, patients with sickle cell disease (SCD) were categorized as a high-risk group, as they might develop a series of life-threatening complications owing to systemic vasculopathy and their modulated immune system. In this review, 20 articles published between December 2019 and January 2021 were included, which reported cases of patients with SCD diagnosed with COVID-19. Patients and methods A total of 343 patients with SCD worldwide were included (mean age is 25 years). Overall, 56% of the study population was female. A total of 322 patients had symptoms; 193 patients presented with vaso-occlusive crises and COVID-19 symptoms. Moreover, 15% reported only vaso-occlusive crises symptoms without COVID-19 symptoms. Typical acute chest syndrome symptoms were reported in 27 patients. Results Overall, 79% of the population was admitted to hospitals. Blood transfusion was received by 51%, and 23% needed oxygen. Mortality was reported in 18 (5%) patients. The outcome of COVID-19 in patients with SCD did not significantly differ from the general population and seems better compared with the other vulnerable groups. Conclusion Proinflammatory status in patients with SCD and frequent use of some medications, such as hydroxyurea, can explain this outcome and could be the reason for reduced COVID-19 complications in patients with SCD. Further molecular studies are needed to understand how SARS-CoV-2 could affect patients with SCD.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"11 - 17"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45317115","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":"An evaluation of thrombocytopenia cases in the hematology clinic of the Ankara Numune Training and Research Hospital","authors":"Oznur Sari, Ümit Üre","doi":"10.4103/ejh.ejh_56_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_56_21","url":null,"abstract":"Background Thrombocytopenia is a major disease that requires the referral of outpatient and hospitalized patients to hematology specialists. Objectives The present study aims to evaluate the laboratory and transfusion statuses of adult patients admitted to our hospital and receiving outpatient/inpatient treatment and diagnosed with thrombocytopenia (<100 × 109/l). Design Single-center, retrospective, laboratory-based study. Patients and methods In the study, after obtaining permission of the hospital’s Non-Invasive Clinical Research Ethics Committee, the information of patients diagnosed with thrombocytopenia (platelet count <100 × 109/l) and who were examined and treated in the outpatient/inpatient settings between 2008 and 2010 were retrospectively analyzed using patient files and the hospital electronic database. Sample size A total of 1020 patients diagnosed with thrombocytopenia. Results The patients were divided into groups according to the most common diagnoses for diseases associated with thrombocytopenia (hematological malignancy, disseminated intravascular coagulation (DIC)-sepsis, immune thrombocytopenia (ITP), infection, and chronic liver disease (n=708). Chemotherapy-induced, drug-induced, nutritional (B12, folate deficiency, etc.), OKIT, pregnancy-induced thrombocytopenias and other less common causes of thrombocytopenia were evaluated in a separate group (n=312). It was found that female patients were more frequently diagnosed with ITP (71.7 vs. 28.3%). Sex distributions were similar in other groups. The highest mean age (71 years: 50/80) was observed in patients with DIC-sepsis, whereas the lowest mean age was found in patients with ITP (40 years: 30/57) (P<0.001). It was found that the most frequent need for transfusion developed in patients diagnosed with acute myeloid leukemia, acute lymphoblastic leukemia, and aplastic anemia. Conclusion In this study, it was determined that the prevalence of thrombocytopenia was highest in patients diagnosed with hematological malignancy, ITP, and DIC-sepsis, respectively. In cases of hematological malignancy, the need for replacement of blood products is considered to be inevitable during the treatment process of the underlying disease compared with other clinical conditions.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"35 - 43"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46815379","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":"Evaluation of platelet surface glycoproteins in inherited thrombocytopathy: relationship with bleeding severity","authors":"M. Osman, Hanan Abd El-Azeem, O. Afifi, M. Abdou, Khalid I. Elsayh, Asmaa M. Zahran, Azza Abdelaal","doi":"10.4103/ejh.ejh_54_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_54_21","url":null,"abstract":"Background Glanzmann’s thrombasthenia (GT) and Bernard-Soulier syndrome (BSS) are genetic bleeding syndromes characterized by defects in platelet aggregometry. Although these disorders are classified to be rare, their exact prevalence is still unknown; however, they are more frequent in communities where consanguineous marriages are common. Aim To study platelet surface glycoproteins expression using flow cytometry and to examine their correlation with bleeding severity using International Society of Thrombosis and Hemostasis–Bleeding Assessment Tools (ISTH-BAT) as bleeding score of choice. Patients and methods This case–control study included 51 patients with bleeding disorders recruited from the Department of Pediatric Hematology, Assiut University Hospital, in addition to 36 apparently healthy age- and sex-matched controls. All patients were tested for complete blood count (CBC), prothrombin time, partial thromboplastin time, platelet aggregation, and platelets surface glycoprotein analysis by flow cytometry. ISTH-BAT was used to register bleeding data for patients. Results GT and BSS had some similarities regarding the presentation and bleeding severity, but when CBC, platelet aggregation studies, and flow cytometric analysis were done, differentiation became much easier. GT patients showed a decrease in the expression of CD41 and CD61. Type I GT patients had more bleeding severity than type II and type III. BSS patients showed a decrease in expression of CD42b. There are correlations between the bleeding severity and CD41 in GT, and between the severity and CD42b in BSS. Conclusion Flow cytometric studies of platelet glycoproteins have great values in diagnosing BSS and GT, and further classifying GT cases into its three types. ISTH-BAT is a useful tool when dealing with platelet function disorders and has good sensitivity and ability to determine the severity.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"44 - 51"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46727527","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 megaloblastic anemia in geriatrics in Lagos State, Nigeria","authors":"A. Akinbami, A. Bamiro, I. Uche, M. Suleiman, A. Benjamin, O. Kareem, A. Odebiyi, A. Oduniyi","doi":"10.4103/ejh.ejh_64_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_64_21","url":null,"abstract":"Background Deficiency in some of the water-soluble vitamins such as vitamin B9 (folate) and vitamin B12 (cobalamin) is associated with multiple diseases seen in the elderly, for example, anemia, dementia, Alzheimer’s disease, cancers, and osteoporosis. This study, using enzyme-linked immunosorbent assay, aimed to determine the serum levels of vitamins B9 (folate) and B12 (cobalamin)/homocysteine in the elderly. Packed cell volume and mean corpuscular volume were correlated with these vitamins. Materials and methods This was a descriptive, cross-sectional study done at the geriatric clinic of Lagos State University Teaching Hospital (LASUTH) Ikeja, Lagos, Nigeria. Following the receipt of the Institution’s Ethics Committee approval, elderly participants, aged 65 years and above were recruited consecutively. Their blood was collected into EDTA and plain bottles for the determination of full blood count and folate and vitamin B12/homocysteine, respectively. Data were analyzed with the Statistical Package for the Social Sciences (SPSS) version 23.0. The P value was set at less than or equal to 0.05. Results A total of 90 participants were recruited consisting of 50 (55.6%) females and 40 (44.4%) males. The overall mean folate, vitamin B12, and homocysteine were 7.64 ± 2.39 ng/ml, 514 ± 237.95 pg/ml, and 8.37 ± 6.88, respectively. Only 2.2 and 1.1% of the elderly had vitamin 12 and folate deficiencies, respectively, and 13.3% had elevated homocysteine. Packed cell volume was statistically significantly correlated with folate, vitamin B12, mean corpuscular volume, and homocysteine (P=0.001). Conclusion Vitamin B12 and folate deficiencies are uncommon in the elderly population in Lagos. The incidence of hyperhomocysteinemia is also low among them.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"52 - 59"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42942486","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":"Methylenetetrahydrofolate reductase C677T polymorphism across acute leukemia","authors":"R. Frikha","doi":"10.4103/ejh.ejh_20_21","DOIUrl":"https://doi.org/10.4103/ejh.ejh_20_21","url":null,"abstract":"Background Methylenetetrahydrofolate reductase (MTHFR) is the key enzyme for folate metabolism and also plays a role in DNA biosynthesis and the epigenetic process of DNA methylation. MTHFR gene polymorphisms, mainly the C677T, have been implicated as risk factors for several types of cancers such as the acute leukemia (AL). Main body of the abstract This study was conducted to examine the extent of the association between MTHFR C677T polymorphism and AL across a comprehensive literature of meta-analysis. Relevant English-language literature was searched and retrieved from PubMed using the terms MTHFR, the C677T polymorphism, and AL. Several parameters have been studied in the assessment of correlation between AL and the MTHFR polymorphism, such as folate intake, ethnicity, age, and sex. Nevertheless, the results are contrasting. Short conclusion Comprehensive analysis of MTHFR C677T in AL may be helpful and provide new insights for a personalized therapy based on the human genotype.","PeriodicalId":42139,"journal":{"name":"Egyptian Journal of Haematology","volume":"47 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41837554","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}