Indian Journal of Critical Care Medicine最新文献

{"title":"NETosis Markers, Such as Citrullinated Histones, Myeloperoxidase, and Elastase, should not be Recommended as Predictors of COVID-19 Severity.","authors":"Josef Finsterer","doi":"10.5005/jp-journals-10071-25175","DOIUrl":"10.5005/jp-journals-10071-25175","url":null,"abstract":"<p><p><b>How to cite this article:</b> Finsterer J. NETosis Markers, Such as Citrullinated Histones, Myeloperoxidase, and Elastase, should not be Recommended as Predictors of COVID-19 Severity. Indian J Crit Care Med 2026;30(4):347-348.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 4","pages":"347-348"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13178119/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147964929","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An Observational Study on Diagnostic Accuracy of Lung Ultrasound Compared to High-resolution Computed Tomography Scan of Thorax in Patients Admitted with Respiratory Problems to Critical Care Unit of a Tertiary Care Hospital in Eastern India.","authors":"Antara Dhenki, Sugata Dasgupta, Arpita Choudhury, Tanmoy Mondal, Soma Mukhopadhyay, Jayati Bardhan","doi":"10.5005/jp-journals-10071-25163","DOIUrl":"10.5005/jp-journals-10071-25163","url":null,"abstract":"<p><strong>Background and aim: </strong>Acute respiratory failure in critically ill patients poses a diagnostic challenge, often requiring high-resolution computed tomography (HRCT) of the thorax for definitive diagnosis. However, the inherent risks of transporting hemodynamically unstable patients to the radiology suite necessitate safer bedside alternatives. The objective of the present study was to evaluate the diagnostic yield of both six-zone and extended 12-zone lung ultrasound (LUS) compared to HRCT thorax.</p><p><strong>Patients and methods: </strong>In this cross-sectional observational study conducted on 150 patients, admitted in the critical care unit and surgical intensive care unit (ICU), six-zone and 12-zone LUS were performed within 24 hours of an HRCT thorax for the most common etiologies of respiratory failure. Diagnostic yield of six-zone and 12-zone LUS to HRCT thorax was compared through calculating Cohen's kappa statistic (value ≥ 0.7) being interpreted as indicating strong agreement between two modalities.</p><p><strong>Results: </strong>For consolidation, the 12-zone protocol showed superior sensitivity (0.84 vs 0.76) and negative predictive value (NPV) (0.61 vs 0.47) compared to the six-zone protocol. Agreement with HRCT was \"moderate\" for the six-zone protocol (kappa = 0.52) but \"substantial\" for the 12-zone protocol (kappa = 0.81). For pleural effusion and edema, LUS maintained high sensitivity (>0.85).</p><p><strong>Conclusion: </strong>Both LUS protocols are effective, but the 12-zone protocol significantly improves the diagnostic yield for lung consolidation, providing substantial agreement with HRCT.</p><p><strong>How to cite this article: </strong>Dhenki A, Dasgupta S, Choudhury A, Mondal T, Mukhopadhyay S, Bardhan J. An Observational Study on Diagnostic Accuracy of Lung Ultrasound Compared to High-resolution Computed Tomography Scan of Thorax in Patients Admitted with Respiratory Problems to Critical Care Unit of a Tertiary Care Hospital in Eastern India. Indian J Crit Care Med 2026;30(3):237-243.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"237-243"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177816/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive Care Unit Mortality: Analysis Using Bayesian Approach.","authors":"Amarja Ashok Havaldar, Aswathi Saji, Tinku Thomas, M Selvam, Janin Josy, C S Nandhini, N Madhammal","doi":"10.5005/jp-journals-10071-25170","DOIUrl":"10.5005/jp-journals-10071-25170","url":null,"abstract":"<p><strong>Background and aims: </strong>Sepsis is a leading cause of intensive care unit (ICU) admission and mortality. Although early antibiotic therapy in the emergency department improves outcomes, the clinical impact of delays in ICU-based antibiotic escalation is not well established. This study evaluated the association between time to ICU-based initiation of newly prescribed antibiotics and ICU mortality using a Bayesian analytical framework.</p><p><strong>Patients and methods: </strong>A prospective observational study (2019-2021) was conducted in a tertiary care hospital, including adult patients admitted to the ICU. New antibiotic administration represented an escalation of therapy for suspected new-onset or worsening infection. Delay was defined as the interval between prescription and actual administration. Repeated antibiotic escalation events within patients were analyzed using a Bayesian generalized linear mixed model (GLMM) accounting for within-patient correlation.</p><p><strong>Results: </strong>A total of 695 antibiotic escalation events occurred in 467 patients (mean age 50.6 ± 17.7 years; 61.7% male). The majority of patients received antibiotics within 3 hours of sepsis recognition (90.6%), and 42.8% within 1 hour. Intensive care unit mortality was 25.9%. Each hour delay in administration of newly prescribed ICU antibiotics was associated with increased odds of ICU mortality [posterior odds ratio (OR): 1.13, 95% credible interval (CrI): 1.11-1.15]. Higher mortality was also associated with septic shock, hospital-acquired infection, higher delta sequential organ failure assessment (Δ SOFA), and higher Acute Physiology and Chronic Health Evaluation (APACHE II) Score.</p><p><strong>Conclusion: </strong>Delays in ICU-based antibiotic escalation are associated with increased mortality. Timely escalation may represent an important, modifiable target to improve outcomes in critically ill patients with suspected sepsis.</p><p><strong>How to cite this article: </strong>Havaldar AA, Saji A, Thomas T, Selvam M, Josy J, Nandhini CS, <i>et al</i>. Time to Initiation of Antibiotic Therapy in Critically Ill Patients with Suspected Sepsis and Its Effect on Intensive Care Unit Mortality: Analysis Using Bayesian Approach. Indian J Crit Care Med 2026;30(3):204-210.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"204-210"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177928/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients.","authors":"Ferhan Demirer Aydemir","doi":"10.5005/jp-journals-10071-25160","DOIUrl":"10.5005/jp-journals-10071-25160","url":null,"abstract":"<p><p><b>How to cite this article:</b> Aydemir FD. Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):260.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"260"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bacteriophages: A Long-forgotten Past, or Hope for the Future?","authors":"Umang Agrawal","doi":"10.5005/jp-journals-10071-25167","DOIUrl":"10.5005/jp-journals-10071-25167","url":null,"abstract":"<p><p><b>How to cite this article:</b> Agrawal U. Bacteriophages: A Long-forgotten Past, or Hope for the Future? Indian J Crit Care Med 2026;30(3):185-188.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"185-188"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177965/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965073","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hepatic Elastography in the Intensive Care Unit: Are We Ready to Use It as a Window into Critical Illness?","authors":"Tanmoy Ghatak, Khalid Zafar","doi":"10.5005/jp-journals-10071-25169","DOIUrl":"10.5005/jp-journals-10071-25169","url":null,"abstract":"<p><strong>Background: </strong>The liver is highly susceptible to hemodynamic and inflammatory insults in critical illness, yet conventional biomarkers often detect injury only after it is established. Two-dimensional shear wave elastography (2D-SWE) is a noninvasive bedside tool that quantifies liver stiffness and may offer real-time insights into hepatic congestion and perfusion.</p><p><strong>Aim: </strong>This viewpoint evaluates the current evidence, practical applications, and limitations of integrating 2D-SWE into routine intensive care unit (ICU) practice.</p><p><strong>Main findings: </strong>Emerging data suggest that 2D-SWE can detect hepatic congestion secondary to right heart dysfunction and may identify early sepsis-related liver injury before biochemical changes manifest. It also holds potential for monitoring hepatosplanchnic perfusion in patients on vasopressors. However, widespread adoption is hindered by significant physiological confounders in the ICU (e.g., positive pressure ventilation, edema), a lack of randomized outcome trials, and operational challenges. Currently, its most pragmatic role lies in serial, trend-based monitoring as an adjunct to clinical assessment.</p><p><strong>Conclusion: </strong>While 2D-SWE is a promising physiological tool that can enrich our understanding of shock and organ dysfunction, it is not yet ready to dictate management. High-quality, context-specific research-particularly in high-burden settings like India-is required to transition this technology from hypothesis-generating to practice-changing.</p><p><strong>How to cite this article: </strong>Ghatak T, Zafar K. Hepatic Elastography in the Intensive Care Unit: Are We Ready to Use It as a Window into Critical Illness? Indian J Crit Care Med 2026;30(3):194-195.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"194-195"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177815/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Response: Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients.","authors":"Suresh Kumar Sundaramurthy, Nagarajan Ramakrishnan, Raymond Dominic Savio","doi":"10.5005/jp-journals-10071-25168","DOIUrl":"10.5005/jp-journals-10071-25168","url":null,"abstract":"<p><p><b>How to cite this article:</b> Sundaramurthy SK, Ramakrishnan N, Savio RD. Author Response: Frailty or Vulnerability? Interpreting Clinical Frailty Scale Cutoffs in Critically Ill Cancer Patients. Indian J Crit Care Med 2026;30(3):261.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"261"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177820/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Prospective Observational Study on Renal Resistive Index as an Early Predictor of Hepatorenal Syndrome.","authors":"Deepthi Peter, Cuckoo S Kuruvilla, Jojo K John","doi":"10.5005/jp-journals-10071-25154","DOIUrl":"10.5005/jp-journals-10071-25154","url":null,"abstract":"<p><strong>Background and aims: </strong>Cirrhosis is a major cause of morbidity, frequently leading to complications like hepatorenal syndrome (HRS). Diagnosing HRS is difficult, as serum creatinine (SCr), commonly used to assess renal dysfunction, has significant limitations in cirrhosis. This study explored renal resistive index (RRI) as a potential alternative for early detection of HRS.This study aimed to evaluate the utility of RRI as an early predictor of HRS in cirrhotic adults admitted to a tertiary intensive care unit (ICU).</p><p><strong>Patients and methods: </strong>A prospective observational study was conducted on 78 cirrhotic adult ICU patients. Renal resistive index was measured within 24 hours of admission. Clinical, biochemical, and ultrasound parameters were collected. Statistical analyses included analysis of variance (ANOVA), <i>t</i>-tests, Pearson correlation, logistic regression, and receiver operating characteristic (ROC) analysis.</p><p><strong>Results: </strong>Of 78 patients, 88.5% were male and 78.2% had alcohol-related cirrhosis. Hepatorenal syndrome occurred in 30.8% of cases. Renal resistive index showed a strong correlation with ascites grade, MELD-Na, and Child-Pugh class. Receiver operating characteristic analysis revealed RRI >0.705 had 87.5% sensitivity and 87.0% specificity in predicting HRS. The RRI elevation preceded the SCr rise by 24-48 hours. Backward stepwise conditional logistic regression, however, identified ascitic grade as the independent predictor of HRS (<i>p</i> < 0.001).</p><p><strong>Conclusion: </strong>Although ascitic grade was the sole independent predictor of HRS in our multivariate model, RRI was strongly associated with HRS onset and may offer additional utility alongside clinical parameters for early identification of at-risk patients.</p><p><strong>How to cite this article: </strong>Peter D, Kuruvilla CS, John JK. A Prospective Observational Study on Renal Resistive Index as an Early Predictor of Hepatorenal Syndrome. Indian J Crit Care Med 2026;30(3):231-236.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"231-236"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177823/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Potential Efficacy of Bacteriophage Therapy for the Management of Pressure Ulcers and Its Comparison to Conventional Therapy: A Randomized Controlled Trial.","authors":"Kavita Meena, Rajesh K Meena, Sarita Kumari, Premkumar Thambidurai, Gopal Nath","doi":"10.5005/jp-journals-10071-25143","DOIUrl":"10.5005/jp-journals-10071-25143","url":null,"abstract":"<p><strong>Background and aims: </strong>Pressure ulcers (PUs) are common in physical trauma patients who require prolonged stays in the intensive care unit (ICU). Despite standard preventive and therapeutic measures, healing is often a slow process. Conventional systemic antibiotics offer limited therapeutic benefits due to inadequate tissue penetration and the associated risk of driving antimicrobial resistance. Bacteriophage therapy, with its ability to target resistant and biofilm-associated bacteria, offers a potential \"alternative.\" We aimed to evaluate the efficacy and safety of topical bacteriophage therapy for the management of PUs in critically ill ICU patients and its comparison to conventional therapy.</p><p><strong>Patients and methods: </strong>This prospective, randomized, double-blind controlled trial was conducted in the ICU of a tertiary care center between April 2024 and May 2025. Seventy-six adult patients with grade II-IV PUs were screened, and 68 were enrolled (34 in each group). Group C received conventional therapy, while group B received conventional plus customized topical bacteriophage therapy. Healing was assessed using the Pressure Ulcer Scale for Healing (PUSH) tool; tissue type, exudate amount, and ulcer dimensions were assessed at baseline and on days 5, 7, 14, 21, and 28. The primary objective was to evaluate the efficacy of bacteriophage therapy for the management of PUs. The secondary objective was to observe the safety profile of bacteriophage therapy.</p><p><strong>Results: </strong>Both groups demonstrated healing over time, but group B demonstrated significantly greater improvement as compared to group C. The reduction in the mean PUSH score was higher in group B (<i>p</i> < 0.05). Group B also showed faster epithelialization, an earlier decrease in exudate, and more closed ulcers. These differences became statistically significant from day 7 onward. No adverse events were reported.</p><p><strong>Conclusion: </strong>Topical bacteriophage therapy is a safe and effective adjunct to conventional care in the management of PUs among ICU patients.</p><p><strong>How to cite this article: </strong>Meena K, Meena RK, Kumari S, Thambidurai P, Nath G. Evaluation of the Potential Efficacy of Bacteriophage Therapy for the Management of Pressure Ulcers and Its Comparison to Conventional Therapy: A Randomized Controlled Trial. Indian J Crit Care Med 2026;30(3):196-203.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"196-203"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177854/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit Survivors: A Single-center Observational Study.","authors":"Nupur Bajpai, Kunal C Dubey, Satyabrata R Chowdhoury, Madhumita Nandi, Marim Irene","doi":"10.5005/jp-journals-10071-25147","DOIUrl":"10.5005/jp-journals-10071-25147","url":null,"abstract":"<p><strong>Background and aims: </strong>Limited data are available on the functional impairments of critically ill patients who survive the pediatric intensive care unit (PICU). There is rising interest among clinicians and intensivists in newly acquired functional morbidity among such survivors. The Functional Status Scale (FSS) is an effective tool for assessing functional impairments. Our aim was to assess changes in the functional status of patients at discharge from the PICU and at a 3-month follow-up compared to baseline. We also intended to observe for any residual morbidity at 3 months after discharge from the PICU.</p><p><strong>Patients and methods: </strong>Children aged 2 months to 12 years with a PICU stay of 48 hours or more, or an age-adjusted quick sequential organ failure assessment (qSOFA) score of 2 or less, were included in the study. Functional assessment using the FSS was performed for these patients at PICU admission, during the PICU stay, at discharge from the PICU, and at the 3-month follow-up.</p><p><strong>Results: </strong>We observed that 3.3% of patients had residual morbidity (≥1 increase in FSS scores from baseline) at the 3-month follow-up. Greater functional impairment was noted in the PICU cohort at discharge compared to baseline (<i>p</i> < 0.01) but not at 3 months (<i>p</i> = 0.09). A statistically significant difference was noted in PICU patients shifted for neurological causes (<i>p</i> = 0.007) and those receiving mechanical ventilation (<i>p</i> = 0.019). The score difference at discharge from baseline was more in patients with longer PICU stays (1.5 ± 0.5; <i>p</i> = 0.04).</p><p><strong>Conclusion: </strong>The FSS is an effective tool to evaluate functional impairments among pediatric patients admitted in PICU. Multiple factors, including length of PICU stay, cause of shifting, and modalities of treatment, influence functional impairments.</p><p><strong>How to cite this article: </strong>Bajpai N, Dubey KC, Chowdhoury SR, Nandi M, Irene M. Functional Status Scale as a Measure of Functional Impairment and Residual Morbidity in Pediatric Intensive Care Unit Survivors: A Single-center Observational Study. Indian J Crit Care Med 2026;30(3):225-230.</p>","PeriodicalId":47664,"journal":{"name":"Indian Journal of Critical Care Medicine","volume":"30 3","pages":"225-230"},"PeriodicalIF":2.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13177905/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147965138","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}