African Journal of Thoracic and Critical Care Medicine最新文献

{"title":"Severe <i>Mycoplasma pneumoniae</i> infection in a young child: An emerging increase in incidence?","authors":"P Goussard, H Rabie, L Frigati, A Gie, S Irusen, C Jacobs, S Venkatakrishna, S Andronikou","doi":"10.7196/AJTCCM.2024.v30i3.2036","DOIUrl":"10.7196/AJTCCM.2024.v30i3.2036","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e2036"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633446/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814851","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":"Unveiling the pulmonary burden of idiopathic inflammatory myopathies in South Africa.","authors":"Gregory L Calligaro","doi":"10.7196/AJTCCM.2024.v30i3.2682","DOIUrl":"https://doi.org/10.7196/AJTCCM.2024.v30i3.2682","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e2682"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606639/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774791","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":"Vitamin D status in patients with chronic obstructive pulmonary disease at Chris Hani Baragwanath Hospital, Johannesburg, South Africa.","authors":"I Kola, S A van Blydenstein, M Kola, S Kooverjee, S Omar","doi":"10.7196/AJTCCM.2024.v30i3.1041","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1041","url":null,"abstract":"<p><strong>Background: </strong>There has been a growing interest in nutritional/lifestyle factors, including vitamin D, that may affect chronic obstructive pulmonary disease (COPD). Most data are from Caucasian populations and temperate climates, with minimal African data.</p><p><strong>Objectives: </strong>The primary objective was to determine the prevalence of vitamin D deficiency (25-hydroxyvitamin D (25(OH)D) ≤20 ng/mL) and insufficiency (25(OH)D 21 - 29 ng/mL) among patients with COPD. Secondary objectives were to investigate the association between vitamin D and demographic/lifestyle factors, lung function parameters, markers of COPD severity and corticosteroid use.</p><p><strong>Methods: </strong>A prospective, cross-sectional study of 76 patients with COPD was conducted at a tertiary hospital in Johannesburg, South Africa. Patients were interviewed regarding demographic/lifestyle factors, COPD severity markers and corticosteroid therapy. The most recent spirometry result was recorded. Blood samples were taken for measurement of calcium, alkaline phosphatase and vitamin D levels. Patients were stratified according to vitamin D status (deficiency and non-deficiency (25(OH)D >20 ng/mL, i.e. combined insufficiency and adequate levels)), and statistical analysis was performed to assess for associations.</p><p><strong>Results: </strong>The sample included 72% males and 63% black African patients. The prevalences of vitamin D deficiency and insufficiency were 48% (95% confidence interval (CI) 42 - 54) and 35% (95% CI 30 - 41), respectively. A Modified Medical Research Council (mMRC) dyspnoea score ≥2 was associated with a relative risk of 1.34 (95% CI 1.05 - 1.7) for vitamin D deficiency in univariate analysis. In multivariate regression analysis, only sunlight exposure (<1 hour/day) was an independent predictor of vitamin D deficiency (odds ratio 2.4; 95% CI 1.3 - 4.5).</p><p><strong>Conclusion: </strong>There was a high prevalence of suboptimal vitamin D levels in this COPD sample population. A higher mMRC score was associated with an increased risk of vitamin D deficiency, while low sunlight exposure was the only independent predictor of vitamin D deficiency.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> This is the first study to provide prevalence data regarding vitamin D status in COPD patients in sub-Saharan Africa. The study highlights a relationship between vitamin D status and both symptom severity and sunlight exposure.<b>Implications of the findings.</b> Owing to the high prevalence of suboptimal vitamin D status among COPD patients, it may be useful to screen patients for vitamin D deficiency, especially those with a more severe phenotype. There may be scope for further studies to evaluate whether vitamin D supplementation corrects the deficiency and provides any clinical outcome benefit.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1041"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11614389/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774794","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":"What is the cause of the reversed halo sign in this patient?","authors":"W du Plessis","doi":"10.7196/AJTCCM.2024.v30i3.1574","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1574","url":null,"abstract":"","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1574"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633647/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814661","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":"Pulmonary manifestations of the idiopathic inflammatory myopathies in a South African population.","authors":"T Hes, M Wong, M Tikly, N Govind","doi":"10.7196/AJTCCM.2024.v30i3.1663","DOIUrl":"https://doi.org/10.7196/AJTCCM.2024.v30i3.1663","url":null,"abstract":"<p><strong>Background: </strong>Pulmonary complications cause significant morbidity and mortality in patients with idiopathic inflammatory myopathies (IIMs).</p><p><strong>Objectives: </strong>To describe the frequency and spectrum of pulmonary complications in patients with IIMs in South Africa (SA).</p><p><strong>Methods: </strong>A retrospective records review of adult patients with IIMs or clinically amyopathic dermatomyositis (CADM) presenting with respiratory complaints at a tertiary care facility in SA was performed. Clinical features, results of laboratory and pulmonary function tests (PFTs), radiological findings and treatment were recorded.</p><p><strong>Results: </strong>Pulmonary complications were documented in 66 patients. Most patients (n=41; 62.1%) had dermatomyositis, 14 (21.2%) had polymyositis, and 3 (4.5%) had CADM. There were 8 patients with overlap syndromes. Dyspnoea and a dry cough were the most common presenting symptoms, in 52 (78.8%) and 36 (54.5%) patients, respectively. Bibasal crackles were noted in 38 patients (57.6%). Interstitial lung disease (ILD), followed by infection and pulmonary hypertension (PH), were documented in 46 (69.7%), 16 (24.2%) and 9 (13.6%) patients, respectively. Nine patients had microbiologically confirmed pulmonary tuberculosis. Patients who were anti-Jo1 antibody positive (n=16) had higher levels of acute inflammatory markers and muscle enzymes compared with the rest of the patients (p<0.0001). Dyspnoea and bibasal crackles were associated with significantly lower baseline and 12-month lung function parameters. Nonspecific interstitial pneumonia was the most common radiological pattern of ILD, present in 25 (62.5%) of the patients with ILD.</p><p><strong>Conclusion: </strong>ILD was the most prevalent complication in this study of SA patients with IIMs. Pulmonary infections and PH were also significant contributors to morbidity. The presence of dyspnoea and crackles was predictive of lower baseline PFTs in this population.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Pulmonary complications, including interstitial lung disease (ILD) and infections, are significant contributors to morbidity and mortality in patients with idiopathic inflammatory myopathies (IIMs). There is very little research currently available to describe the spectrum of pulmonary manifestations in these patients in an African setting, a lack that this study aimed to address.<b>Implications of the findings.</b> ILD was the most common pulmonary complication in patients with IIMs in this cohort. Signs and symptoms of ILD may be present before symptoms of myositis, and dyspnoea and a dry cough were shown to be predictive of reduced lung volumes. Patients with IIMs on immunosuppressive therapy in our setting are at high risk of infection, particularly tuberculosis.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1663"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606638/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774778","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":"The impact of mild COVID-19 on medium-term respiratory function.","authors":"J van Heerden, H Strijdom, A Parker, B W Allwood, U Lalla, C J Lombard, C F N Koegelenberg","doi":"10.7196/AJTCCM.2024.v30i3.1629","DOIUrl":"10.7196/AJTCCM.2024.v30i3.1629","url":null,"abstract":"<p><strong>Background: </strong>There is a paucity of evidence on the impact of mild COVID-19 on the respiratory system, particularly in non-healthcare seeking individuals.</p><p><strong>Objectives: </strong>To investigate the effects of mild COVID-19 on respiratory function and to identify indicators of decreased lung function.</p><p><strong>Methods: </strong>We conducted a cross-sectional study in 175 non-healthcare-seeking individuals with confirmed acute SARS-CoV-2 infection who did not require hospitalisation. Participants were divided into three groups: those who had pulmonary function tests (PFTs) within 6 months, between 6 and 12 months, and between 12 and 24 months after infection. Each participant underwent spirometry, measurement of the diffusing capacity of the lungs for carbon monoxide (DL_CO ), a 6-minute walking distance test (6MWD) and plethysmography.</p><p><strong>Results: </strong>The mean age of the participants was 44.3 years, and the mean body mass index (BMI) 32.7 kg/m². Forty-six participants had PFTs within 6 months, 64 between 6 and 12 months, and 65 between 12 and 24 months. Lower than expected DL_CO was the most commonly detected abnormality (57%). Spirometry anomalies were noted in 23%, 10% showing an obstructive impairment and 13% a restrictive impairment, confirmed by a total lung capacity <80%. An increased BMI was the only variable that was significantly and independently linearly associated with lower than predicted (<80%) forced vital capacity, forced expiratory volume in the 1st second, DL_CO and 6MWD.</p><p><strong>Conclusion: </strong>DL_CO was low in a considerable proportion of non-healthcare-seeking individuals 2 years after mild COVID-19. A high BMI was found to be significantly and independently associated with lower than predicted PFT results and 6MWD.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> We found that pulmonary function, particularly diffusing capacity, was lower than predicted in a significant proportion of non-healthcare-seeking individuals up to 2 years after mild COVID-19. A high body mass index (BMI) was found to be significantly and independently associated with decreased lung function.<b>Implications of the findings.</b> There is a paucity of evidence on the medium-term effects of mild COVID-19 on the respiratory system in non-healthcare-seeking individuals. We investigated the medium-term effects of mild COVID-19 on the respiratory system, showed lower than predicted lung function, and identified one independent predictor, BMI. Even individuals classified as having 'mild' COVID-19 could have medium-term respiratory sequelae.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1629"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11633238/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142814854","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":"Rituximab therapy in severe connective tissue disease associated interstitial lung disease: A retrospective single-centre observational study.","authors":"U F Seedat, B Christian, P E Boshoff, P Gaylard, G K Schleicher","doi":"10.7196/AJTCCM.2024.v30i3.1431","DOIUrl":"https://doi.org/10.7196/AJTCCM.2024.v30i3.1431","url":null,"abstract":"<p><strong>Background: </strong>Connective tissue disease-associated interstitial lung disease (CTD-ILD) that progresses despite first-line immunosuppressive therapy is a clinical challenge. Rituximab (RTX) is a chimeric monoclonal antibody targeted to CD20+ B cells, resulting in B-cell depletion, and has been used as a salvage therapeutic modality in severe disease.</p><p><strong>Objectives: </strong>To investigate the therapeutic effects and safety of RTX in patients with severe CTD-ILD.</p><p><strong>Methods: </strong>A retrospective observational analysis of patients with severe CTD-ILD treated with salvage RTX therapy and various combinations of immunomodulatory therapy at Wits Donald Gordon Medical Centre, Johannesburg, South Africa, between January 2010 and December 2020 was performed. A total of 19 patients with progressive CTD-ILD, sufficient data, and 24-month follow-up were analysed. The effects of adding salvage RTX to standard drug therapy were investigated with serial pulmonary function testing, high-resolution computed tomography (HRCT) of the chest, and World Health Organization functional class (FC) assessment.</p><p><strong>Results: </strong>At 24-month follow-up from baseline, there was no significant deterioration in forced vital capacity (0.01 L; 95% CI -0.13 - 0.14) (p=0.91) after commencing RTX salvage therapy. Serial HRCT of the chest showed radiological disease stability or improvement in 13 of the 19 patients (68%). FC assessment showed no significant deterioration compared with baseline (p=0.083). No serious adverse drug reactions or deaths were recorded.</p><p><strong>Conclusion: </strong>Salvage RTX therapy, in combination with various immunomodulatory treatments, resulted in disease stability in the majority of patients with severe CTD-ILD over a 24-month period.</p><p><strong>Study synopsis: </strong><b>What the study adds.</b> Connective tissue disease-associated interstitial lung disease (CTD-ILD) is a challenging clinical entity. Rituximab (RTX), a chimeric monoclonal antibody targeted to CD20+ B cells, resulting in B-cell depletion, has been suggested as a potential therapeutic modality in refractory or severe disease. A single-centre experience of RTX salvage therapy in progressive CTD-ILD is presented.<b>Implications of the findings.</b> This small study suggests a possible role for RTX therapy in severe or refractory CTD-ILD.</p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":"30 3","pages":"e1431"},"PeriodicalIF":0.0,"publicationDate":"2024-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11606636/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142774783","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":"Pulmonary hypertension and the potential of ‘drug’ repurposing: A case for African medicinal plants","authors":"S. Jacobs, MSc MB ChB, MSc C Payne, S. Shaboodien, BSc Hons, T. Kgatla, BSc Pretorius, C. Hons, BSc Jumaar, G. Hons, MSc Maarman, PhD O Sanni, G. Maarman","doi":"10.7196/ajtccm.2024.v30i2.1352","DOIUrl":"https://doi.org/10.7196/ajtccm.2024.v30i2.1352","url":null,"abstract":"\u0000\u0000\u0000\u0000Pulmonary hypertension (PH) is a haemodynamic disorder in which elevated blood pressure in the pulmonary circulation is caused by abnormal vascular tone. Despite advances in treatment, PH mortality remains high, and drug repurposing has been proposed as a mitigating approach. This article reviews the studies that have investigated drug repurposing as a viable option for PH. We provide an overview of PH and highlight pharmaceutical drugs with repurposing potential, based on limited evidence of their mechanisms of action. Moreover, studies have demonstrated the benefits of medicinal plants in PH, most of which are of Indian or Asian origin. Africa is a rich source of many medicinal plants that have been scientifically proven to counteract myriad pathologies. When perusing these studies, one will notice that some African medicinal plants can counteract the molecular pathways (e.g. proliferation, vasoconstriction, inflammation, oxidative stress and mitochondrial dysfunction) that are also involved in the pathogenesis of PH. We review the actions of these plants with actions applicable to PH and highlight that they could be repurposed as adjunct PH therapies. However, these plants have either never been tested in PH, or there is little evidence of their actions against PH. We therefore encourage caution, as more research is needed to study these plants further in experimental models of PH while acknowledging that the outcomes of such proof- of-concept studies may not always yield promising findings. Regardless, this article aims to stimulate future research that could make timely contributions to the field.\u0000\u0000\u0000\u0000","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":" 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141678242","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":"The need for smoking cessation counselling and nicotine with- drawal therapy for hospitalised patients: A smoking point preva- lence study at Groote Schuur Hospital, Cape Town, South Africa","authors":"G. Soin, J. Kok, A. Allie, Q. Bhawoodien, K. Dheda, A. Geragotellis, K. Mulisa, A. Sibi, T. Tarwa, F. Leone, R. Van Zyl-Smit","doi":"10.7196/ajtccm.2024.v30i2.1360","DOIUrl":"https://doi.org/10.7196/ajtccm.2024.v30i2.1360","url":null,"abstract":"\u0000\u0000\u0000\u0000Background. South Africa has high tobacco-attributable mortality and a smoking prevalence of 32.5% in males and 25.6% in females. There are limited data on smoking prevalence and desire to quit in hospitalised patients, who have limited access to smoking cessation services.\u0000Objectives. To determine smoking prevalence and the extent of nicotine withdrawal symptoms, using a hospital-wide inpatient survey.\u0000Methods. A 1-day point prevalence survey was conducted at Groote Schuur Hospital, Cape Town. All wards except the haematology isolation, active labour and psychiatry lock-up wards were evaluated. Smoking status, withdrawal symptoms and desire to quit were established.\u0000Results. Smoking status was confirmed in 85.8% of inpatients (n=501/584), of whom 31.9% (n=160) were current smokers; 43.5% (n=101/232) of male and 21.9% (n=59/269) of female inpatients were smokers. Documentation and confirmation of smoking status was highest in the maternity wards (100%) and lowest in the surgical wards (79.6%) and intensive care units (70.0%). Smoking prevalence ranged from 47.6% in male surgical patients to 15.2% in maternity patients. Of the smokers, 54.5% reported being motivated to quit, with a median (interquartile range) Fagerström test for nicotine dependence score of 4 (2 - 6), and 31.4% reported moderate to severe cravings to smoke, highest in the surgical wards.\u0000Conclusion. Smoking prevalence was higher in hospitalised patients than in the local general population. Many inpatients were not interested in quitting; however, a third had significant nicotine withdrawal symptoms. All inpatients who are active smokers should be identified and given universal brief smoking cessation advice. Patients with severe withdrawal symptoms should be allowed to smoke outside, and nicotine withdrawal pharmacotherapy should be provided to those who are bedbound or express a desire to stop smoking during the current admission.\u0000\u0000\u0000\u0000","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":" 28","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141680458","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":"Tracheal necrosis after sandwich immunotherapy and stereotactic body radiotherapy for lung cancer","authors":"S. M. Bennji, B. Jayakrishnan, Z. Al- Hashami, L. Mula-Hussain, R. B. Telugu","doi":"10.7196/ajtccm.2024.v30i2.1620","DOIUrl":"https://doi.org/10.7196/ajtccm.2024.v30i2.1620","url":null,"abstract":"<jats:p>-</jats:p>","PeriodicalId":52847,"journal":{"name":"African Journal of Thoracic and Critical Care Medicine","volume":" 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141677120","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}