Acta Medica Mediterranea最新文献

{"title":"C-Reactive Protein Levels during High Dose Steroid Treatment for COVID-19 Pneumonia","authors":"A. Batırel, E. Korlu, Nurullah Eser, M. Tezcan","doi":"10.32552/2022.actamedica.638","DOIUrl":"https://doi.org/10.32552/2022.actamedica.638","url":null,"abstract":"Objectives: Inflammation is the main cause of systemic damage in SARS-COV2 infections. Steroid treatment has been shown to reduce mortality in COVID-19. However, there is no index to monitor treatment responses to steroids. Here, we evaluated the validity of serial C-reactive-protein (CRP) follow-up for predicting the outcome in the patients receiving steroid therapy.\u0000Material and methods: In our retrospective cohort study, four hundred twenty-five patients were included. All patients received dexamethasone 6 mg/day or equivalent dose of steroid as much as needed with the onset of hypoxia (SaO2 ≤ 93%). We divided patients into two groups according to outcome (deceased/discharged). We then compared demographic, clinical and laboratory features between the groups. Lastly, we evaluated the thresholds of CRP decline associated with COVID-19 associated mortality at 3th, 5th days and at the end of treatment.\u0000Results: COVID 19 associated mortality rate of the cohort was 6.1% (26/425). In multivariate analysis, in which survival was evaluated, parameters related to death due to COVID-19 in the steroid group were high NEWS-2 score (0.82, CI 95 % 0.68-0.97, p=0.02), increased Charlson comorbidity index (0.68,CI 95% 0.51-0.90,p= 0.007) and absolute CRP level at the end of treatment (0.97,CI 95%, p<0.001). In addition, cut-off levels of CRP reduction related to COVID-19-associated mortality during steroid therapy were found as follows: less than 33% (sensitivity 75%, specificity 64.1%) on day 3, less than 43.5% (sensitivity 81.8%, specificity 70.8%) on day 5 and less than 55% at the end of the treatment (sensitivity 80.7%, specificity 71.8%).\u0000Conclusions: Serial CRP measurement from the third day of steroid therapy can be used to predict mortality in COVID-19 patients receiving steroids.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"218 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77243878","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Association Between Comorbidities and a High-Risk Status According to COPD GOLD Groups","authors":"Ümran Özden Sertçelik, A. Sertçelik, K. Huseynova, Aslı Öncel, E. Damadoğlu, L. Çöplü","doi":"10.32552/2022.actamedica.818","DOIUrl":"https://doi.org/10.32552/2022.actamedica.818","url":null,"abstract":"Objective: The natural course of the chronic obstructive pulmonary disease (COPD) is thought to be affected by the severity of COPD, frequency of episodes, as well as the presence of comorbid conditions. It was aimed to explore the effect of comorbid conditions on high-risk status in stable COPD patients.\u0000Material and methods: Study participants consisted of stable COPD patients attending to the pulmonology outpatient unit of a tertiary center between 15th May 2018 and 12th Dec 2019. Demographic data, comorbidities, clinical index scores, modified Charlson comorbidity index score (mCCI), BODE index score, and the Short Form 36 (SF-36) scores as a generic life quality measure were recorded. Global Initiative for Chronic Obstructive Lung Disease (GOLD) groups were determined based on symptoms and exacerbations.\u0000Results: There were 23(25.8%), 31(34.8%), 2(2.2%), and 33(37.1%) patients in GOLD gropus A, B, C, and D, respectively. Among these, A and B groups are considered as low-risk, and C and D groups are considered as high-risk. High risk patients had higher mCCI (p < 0.001) and were more likely to have hypertension (p=0.012), congestive cardiac failure (p=0.029), chronic renal failure (p=0.022), osteoporosis (p=0.001), and anemia (p<0.001). In a logistic regression analysis performed to examine the determinants of high-risk status in COPD-GOLD groups, biomass exposure was found to increase the likelihood of having a high risk-status by 3-fold.\u0000Conclusion: Classification of stable COPD patients according to GOLD groups showed higher mCCI in subjects with high-risk status. Comorbidities and mCCI did not appear to affect the high-risk status. Biomass exposure was associated with an increased risk of having a high-risk status.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"20 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80479124","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 Fear and Anxiety in Patients with Diabetes Mellitus and their Effect on HbA1c","authors":"Çiğdem Tura Bahadır, Serap Özçetinkaya Erdoğan","doi":"10.32552/2022.actamedica.810","DOIUrl":"https://doi.org/10.32552/2022.actamedica.810","url":null,"abstract":"Objective: To determine the severity of fear and anxiety of COVID-19 in diabetic patients and to evaluate their relationship with HbA1c.\u0000Materials and methods: Between December 2020 and March 2021, a total of 249 patients were included in the study. Demographic characteristics, duration of diabetes, glycosylated hemoglobin A1c (HbA1c) values of the patients were recorded. Fear and anxiety related to COVID-19 were evaluated with the validated Turkish version of the Fear of COVID Scale (FCS) and Coronavirus Anxiety Scale (CAS). FCS and CAS were compared between the diabetic group and the control group. The relationship between FCS and CAS and HbA1c, diabetes year, age, gender, educational status, place of residence, and employment status was investigated.\u0000Results: Median level of HbA1c and duration of diabetes mellitus were 7.65% (range 5.4-13.6) and 10 years (range 1-32) respectively. FCS was higher in the diabetic group compared to the control group (p=0.025). There was no significant difference between the diabetic and control groups regarding CAS. There was no relationship between HbA1c and FCS and CAS (p=0.919, r=0.008, p=0.725, r=0.027, respectively). Anxiety was higher in females than males in diabetic groups (p=0.009).\u0000Conclusions: The fear of COVID-19 is higher in diabetic patients compared to the general population. There was no relationship between fear and anxiety of COVID-19 and HbA1c. However, to protect long-term mental health, there should be strategies to detect and reduce the anxiety and fear caused by the pandemic in the services for diabetic patients.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"133 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86334276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Significance of Systemic Immune-Inflammatory Index and Platelet-Neutrophil Ratio on Early Mortality in Septic Shock Patients and their Association with Vitamin D and Parathyroid Hormone Ratio","authors":"H. H. Yeter, A. Topeli","doi":"10.32552/2022.actamedica.856","DOIUrl":"https://doi.org/10.32552/2022.actamedica.856","url":null,"abstract":"Objectives: Sepsis is a life-threatening organ dysfunction characterized by complex pro-inflammatory and anti-inflammatory processes. Vitamin D deficiency is frequently observed in sepsis and associated with worse outcomes. We aimed to evaluate the effect of vitamin D-to-PTH ratio, systemic immune-inflammatory index (SII), and platelet-to-neutrophil ratio (PNR) on mortality in septic shock patients with vitamin D deficiency and insufficiency.\u0000Material and methods: In this cross-sectional study, vitamin D insufficiency was defined as vitamin D levels between 12-20 ng/ml and vitamin D deficiency as < 12 ng/ml. The SII is calculated by multiplying the neutrophil count with the platelet count and dividing the result by the lymphocyte count (N*P/L), and the PNR is calculated by dividing the platelet count by the neutrophil count (P/N). We used receiver operating curve (ROC) analysis, logistic regression analysis, and Kaplan-Meier survival analysis to determine the association between SII, PNR, vitamin D deficiency, vitamin D-to-PTH ratio and early mortality within 7-days.\u0000Results: This study consisted of 39 patients with septic shock. While 11(28%) of patients had vitamin D insufficiency, 28(72%) had vitamin D deficiency. Vitamin D insufficiency was associated with higher levels of SII and PNR than vitamin D deficiency. ROC analysis showed that 0.077 and 67 are cut-off values with the highest sensitivity and specificity for the vitamin D-to-PTH ratio (AUC: 0.77, p=0.01) and SII (AUC: 0.78, p=0.008) to predict early mortality. Both cut-off values were significantly associated with mortality in logistic regression analysis. SII higher than 67 and vitamin D-to-PTH ratio higher than 0.077 were associated with survival in 7-days (91% vs. 60%, p=0.004, and 91% vs. 63%, p=0.006, respectively).\u0000Conclusion: SII was significantly suppressed in patients with vitamin D deficiency which was associated with increased mortality in septic shock. In addition, the decreased level of vitamin D-to-PTH ratio, which could be an indicator of immune balance, may be associated with early mortality in the intensive care unit.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"68 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81113109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of Risk Factors Affecting Progression in Primary Open-Angle Glaucoma and Exfoliation Glaucoma in a Turkish Population","authors":"A. Ağın, M. Irkec, S. Kocabeyoğlu, J. Karakaya","doi":"10.32552/2022.actamedica.799","DOIUrl":"https://doi.org/10.32552/2022.actamedica.799","url":null,"abstract":"Objective: To evaluate the effects of risk factors on progression in primary open-angle glaucoma (POAG) and exfoliation glaucoma (XFG).\u0000Materials and methods: The study included 139 patients with POAG and XFG followed up at Hacettepe University Faculty of Medicine, Department of Ophthalmology, Glaucoma Unit. A number of factors were evaluated through a cross-sectional design for all the patients, including age, sex, hypertension, diabetes, thyroid disease, cardiovascular disease, migraine, alcohol, smoking, family history, affected side, lens status, central corneal thickness (CCT), number of medications, body mass index (BMI), cup-to-disc (C/D) ratio, intraocular pressure (IOP), computerized automated visual field mean deviation (MD), and prior surgery.\u0000Results: The patients were divided into two groups, POAG and XFG, and further divided into the following two subgroups: progressive and non-progressive. Of the patients, 75 (53.9%) had POAG, and 64 (46.1%) had XFG. In the patients followed up, annual MD change was 0.96 ± 1.5 dB/year, baseline MD was −5.06 ± 5.61 dB, and IOP was 15.94 ± 1.93 mmHg. Potential risk factors for progression in the whole group were evaluated, but no significant difference was found between the groups with and without progression for all factors. Subgroup analysis revealed that in the POAG group, BMI was significantly higher in the non-progressive disease subgroup (p=0.01); furthermore, in the XFG group, IOP was significantly higher in the progressive disease subgroup (p=0.02). According to multiple logistic regression analysis, a 1-unit decrease in BMI in the POAG group increased the risk by 1.3 times (p=0.01), and smoking in the XFG group resulted in a 6-fold reduction in the risk of progression (p=0.04).\u0000Conclusion: Although mean IOP was higher in XFG group, the present study found BMI in POAG and smoking in XFG as independent factors that reduced progression in our series.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"183 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72644045","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Dyslipidemia and Hypertension – Journey Mapping in the Philippines","authors":"Alberto A Atilano, E. Llanes, D. Ona, G. Brizuela","doi":"10.32552/2022.actamedica.796","DOIUrl":"https://doi.org/10.32552/2022.actamedica.796","url":null,"abstract":"Literature was reviewed semi-systematically with the purpose of generating Philippines-specific data for the patient journey stages for dyslipidemia and hypertension, namely, awareness, screening, diagnosis, treatment, adherence, and control.\u0000A structured search was conducted on EMBASE and MEDLINE databases for studies published in English in the last 10 years, whose full text was available. An unstructured search was conducted on Google, and websites of health ministries and international organizations, without any limits. The last search was run for dyslipidemia on 12.11.2019 and for hypertension on 28.07.2020. For dyslipidemia, six records out of 590 records were retrieved, and for hypertension, seven records and one unpublished conference presentation out of 160 records retrieved, were included in the final synthesis.\u0000The review estimated that in the Philippines, the prevalence of dyslipidemia was 38.8%, while 59.0% of patients were undergoing treatment, with 44.2% of patients achieving control. Prevalence of hypertension was 27.5% and estimated rates at different stages of patient journey were- awareness- 61.5%, screening- 3.2%, diagnosis- 39.7%, treatment- 65.4%, adherence- 57%, and control- 57.6%. Potential contributory factors for low assessment rates and suboptimal management include low doctor-to-population ratio, inadequate time for screening and counseling, absence of locally validated tools for cardiovascular screening, low awareness and utilization of clinical practice guidelines, and some misperceptions of current treatment recommendations.\u0000Effective training of physicians, patient education initiatives, and multi-sectoral coordination are some of the recommendations to improve the status of management of dyslipidemia and hypertension in the Philippines.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"32 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-12-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89427463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"High-grade Atrioventricular Block Due to Lacosamide and Tizanidine Combination Therapy for Epilepsy and Multiple Sclerosis","authors":"S. Kilic, U. Canpolat","doi":"10.32552/2022.actamedica.779","DOIUrl":"https://doi.org/10.32552/2022.actamedica.779","url":null,"abstract":"Drug-induced atrioventricular (AV) block can be caused by cardiac and non-cardiac medications. The clinical condition may be temporary, persistent, or recurrent. However, there is no standard approach for management and follow-up of patients with drug-induced AV block. Herein, we presented a patient with the diagnosis of epilepsy and multiple sclerosis who admitted to emergency room with epileptic seizure. Temporary advanced AV block was observed on admission and during in-hospital follow-up which was thought to be caused by lacosamide and tizanidine medications and improved after drug discontinuation.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"1 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78499880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Determination of the Glycemic Index Values of the Turkey-Specific Ice Cream","authors":"Nuket Yumuk, Ç. Keskin, Ö. Demir, M. Şahin, A. B. Bahçecioğlu Mutlu, Ş. Canlar, R. Emral, M. Erdoğan, S. Güllü, Vedia Tonyukuk Gedik, N. Baskal, D. Çorapçıoğlu","doi":"10.32552/2022.actamedica.798","DOIUrl":"https://doi.org/10.32552/2022.actamedica.798","url":null,"abstract":"Objective: The glycemic index (GI) is defined as the effect of consumed food on blood glucose relative to the reference food. The aim of this study is to determine the GI value of “Atatürk Orman Çiftliği (AOÇ)” ice cream, which is unique to our country.\u0000Method: This study included 18 adult healthy individuals with normal body mass index (BMI) values (18.5-24.9 kg/m²) (Female/Male: 10/8). Individuals participating in the study were invited to the our outpatient clinic on different days for two weeks to consume 2 test foods (AOC ice cream) and 2 reference foods (glucose) after 12 hours of fasting. Venous blood samples were taken at 0, 15, 30, 45, 60, 90 and 120 minutes after consumption of reference and test foods and glucose values were recorded. The glycemic index value of the test food was calculated by multiplying by 100 the ratio of the sum of the area under the curve obtained from the test food to the sum of the area under the curve obtained from the reference food.\u0000Results: The median values of the area under the curve of the reference food and the test food were 2360.88 (483.75-4132.5) and 475.95 (44.88-1980), respectively (p<0.001). The Glycemic index value of the test foods was 21.46 (4.08-409.3) according to the reference food.\u0000Conclusion: In this study, the glycemic index value of the Turkey-specific “Atatürk Orman Çiftliği” ice cream was found to be 21,46 (4.08-409.3) (Low). These types of foods with a low glycemic index may be preferred to increase the dietary compatibility of the patient with type 2 diabetes, especially at snack meals.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"107 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78054986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phacoemulsification Results of Eyes with Primary Angle Closure and Primary Angle Closure Glaucoma Using the Pentacam System","authors":"Yasemin Ün, Doğukan Cömerter","doi":"10.32552/2022.actamedica.751","DOIUrl":"https://doi.org/10.32552/2022.actamedica.751","url":null,"abstract":"Aim: To evaluate the phacoemulsification results of patients with primary angle closure (PAC) and primary angle closure glaucoma (PACG) using the Pentacam system.\u0000Method: This retrospective cohort study included patients with PAC and PACG who underwent phacoemulsification and intraocular lens implantation between 2018 and 2021 in one tertiary center. Anterior chamber parameters measured using the Pentacam system and gonioscopic and intraocular pressure (IOP) changes were evaluated preoperatively and postoperatively.\u0000Results: Nineteen eyes of 13 patients with PAC and PACG were included in the study. The mean age of the patients was 63.2 years, and 30.8% were male. The mean preoperative and postoperative third-month IOP was 21.0 ± 7.4 mmHg (11-40) and 13.7± 2.5 mmHg (9-18), respectively (p < 0.01). The mean preoperative anterior chamber angle (ACA) measured by the Pentacam system was 21.07 ± 4.16° (13-27). The mean preoperative anterior chamber depth (ACD) and the anterior chamber volume (ACV) measured by the Pentacam system were 1.79 ± 0.24 mm (1.39-2.22) and 72.55 ± 20.64 mm3 (45-109), respectively. The postoperative third-month topographic measurements were as follows: mean angle, 35.76 ± 7.32° (20.1-46.9); mean ACD, 3.52 ± 0.95 mm (1.15-4.46); and mean ACV, 133.21 ± 25.21 mm3 (81-173) (p < 0.01).\u0000Conclusion: Pentacam is a useful system to evaluate anterior segment changes after phacoemulsification in patients with PAC and PACG. Phacoemulsification was found to result in significant IOP reduction in these patients.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"31 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91273432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Widespread Keratosis Pilaris-like eruption Associated with Nilotinib Used for Chronic Myelogenous Leukemia","authors":"Ecem Bostan, Adam Jarbou, S. Ersoy Evans","doi":"10.32552/2022.actamedica.750","DOIUrl":"https://doi.org/10.32552/2022.actamedica.750","url":null,"abstract":"Keratosis pilaris is a skin disorder which is characterized by follicular hyperkeratosis. It is most commonly seen in patients with atopic dermatitis and ichthyosis vulgaris. Abnormal keratinization of the hair follicle leads to plugging and bumpy, rough appearance. Upper extensor arms, thighs, buttocks and cheeks are most commonly affected by the disease. Even though keratosis pilaris is associated with autosomal dominant inheritance; it may also be seen as a side effect of various targeted cancer therapies including BRAF and tyrosine kinase inhibitors. Herein, we would like to present a case of keratosis pilaris that had developed secondary to nilotinib treatment.","PeriodicalId":50891,"journal":{"name":"Acta Medica Mediterranea","volume":"C-17 1","pages":""},"PeriodicalIF":0.3,"publicationDate":"2022-10-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85042551","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}