Revista clinica espanola最新文献

{"title":"Measles outbreak transmission in the ER waiting room: the role of vaccination","authors":"A. Hernández-Aceituno ,&nbsp;I. Falcón García ,&nbsp;E. Marrero Marichal ,&nbsp;D. Sanabria Curbelo ,&nbsp;Á. Torres Lana ,&nbsp;E. Larumbe-Zabala","doi":"10.1016/j.rceng.2024.10.002","DOIUrl":"10.1016/j.rceng.2024.10.002","url":null,"abstract":"<div><h3>Background</h3><div>Measles is one of the most contagious infectious diseases. Spain was declared free of endemic measles transmission in 2017. However, less than half of EU/EEA countries have achieved vaccination coverage goals and measles outbreaks have been reported recently, some of them in healthcare facilities. The aim of this study was to present an outbreak in the pediatric emergency (ER) waiting room affecting a vaccinated healthcare worker.</div></div><div><h3>Methods</h3><div>Descriptive study of an outbreak whose transmission occurred in the pediatric ER waiting room of a tertiary level hospital on the island of Tenerife (Canary Islands) in April 2024.</div></div><div><h3>Results</h3><div>Between April 23 and May 12, 2024, four PCR-confirmed measles cases were identified, resulting in 407 contacts in healthcare center waiting rooms. One of the cases was a 26-year-old male nurse who had been correctly vaccinated with two doses of measles, mumps, and rubella vaccine during childhood. Between May 7 and 10, during his infective period, he took two two-and-a-half-hour flights and lived together with nine people during a trip. No evidence of infection has been identified among the individuals with whom he lived neither the passengers and crew of the two flights.</div></div><div><h3>Conclusions</h3><div>In the emergency waiting room, an unvaccinated girl gave measles to two infants who were not yet old enough to be vaccinated and to a nurse who had been properly vaccinated as an infant. Despite generating more than 300 close contacts, the nurse did not infect anyone, suggesting that vaccination may help prevent both infection and transmission of measles.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 646-649"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142378773","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":"Clinical features, management in the emergency department and mortality of acute heart failure episodes in patients with chronic obstructive pulmonary disease","authors":"N. Ivars ,&nbsp;Pere Llorens ,&nbsp;A. Alquézar ,&nbsp;J. Jacob ,&nbsp;B. Rodríguez ,&nbsp;M. Guzmán ,&nbsp;L. Serrano Lázaro ,&nbsp;M.C. Martínez Picón ,&nbsp;L. Cuevas Jiménez ,&nbsp;Ò. Miró ,&nbsp;on behalf of ICA SEMES research group","doi":"10.1016/j.rceng.2024.10.003","DOIUrl":"10.1016/j.rceng.2024.10.003","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aims to analyse differences in clinical and therapeutic management for patients with chronic obstructive pulmonary disease (COPD) who present to the emergency department with acute heart failure (AHF). Additionally, it examines mortality rates during such episodes.</div></div><div><h3>Methods</h3><div>We included patients diagnosed with AHF at 50 Spanish emergency departments from 2012 to 2022 who also had COPD. We compared their baseline characteristics, decompensation episodes, and emergency department management with those of AHF patients without COPD during the same period. We collected data on in-hospital and 30-day all-cause mortality, investigating differences between the two groups using crude and adjusted logistic regression models.</div></div><div><h3>Results</h3><div>A total of 21,694 AHF patients were analysed (median age = 83 years, 56% female), including 4,942 (23%) with COPD. COPD patients were generally younger and more frequently male, with a higher prevalence of comorbidities (excluding valve disease and dementia, which were more common in non-COPD patients). They exhibited a worse respiratory functional class (NYHA) but a better overall functional capacity (Barthel Index). Decompensation in COPD patients was more often triggered by infection and less frequently by tachyarrhythmia, hypertensive crisis, or acute coronary syndrome. While there were differences in clinical findings in the emergency department, the severity assessed by the MEESSI-AHF Scale was similar across both groups. In terms of emergency department management, a higher proportion of COPD patients received oxygen therapy, non-invasive ventilation, bronchodilators, corticosteroids, and antibiotics, while fewer received intravenous nitroglycerin, and they were hospitalized more frequently. In-hospital mortality rates were 8.1% for patients with COPD and 7.5% for those without (OR = 1.088, 95% CI = 0.968–1.224), with 30-day mortality rates of 11.0% and 10.0%, respectively (OR = 1.111, 95% CI = 1.002–1.231). After adjusting for clinical characteristics, decompensation episodes, and emergency department management, these odds ratios decreased to 1.040 (95% CI = 0.905–1.195) and 1.080 (95% CI = 0.957–1.219), respectively.</div></div><div><h3>Conclusion</h3><div>Patients with AHF and COPD exhibit distinct clinical and therapeutic management characteristics in the emergency department and require more frequent hospitalization. Although they show higher crude 30-day mortality, this is attributable to their differing clinical profiles rather than the presence of COPD itself.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 634-645"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142407373","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":"Association between autoimmune diseases and Alzheimer’s disease: analysis using big data tools","authors":"A.M. Diezma-Martín ,&nbsp;M.I. Morales-Casado ,&nbsp;L. Jiménez-Díaz ,&nbsp;J.D. Navarro-López ,&nbsp;B. Mondéjar-Marín ,&nbsp;J. Parra-Serrano ,&nbsp;A. Vadillo-Bermejo ,&nbsp;C. Marsal-Alonso ,&nbsp;P. Beneyto-Martín","doi":"10.1016/j.rceng.2024.09.003","DOIUrl":"10.1016/j.rceng.2024.09.003","url":null,"abstract":"<div><h3>Objective</h3><div>The objective is to analyze the prevalence of Alzheimer's disease in patients with and without a diagnosis of different autoimmune diseases and the possible association between both pathologies.</div></div><div><h3>Patients and methods</h3><div>A multicenter, retrospective, cohort study was conducted to study the prevalence of Alzheimer’s disease among patients diagnosed with various autoimmune diseases compared to the general population. Data from electronic medical records from the Castilla-La Mancha healthcare system were analyzed using Natural Language Processing through the Savana Manager® artificial intelligence clinical platform. A total of 1,028,356 patients were analyzed, including 28,920 individuals with Alzheimer's disease and 999,436 control patients.</div></div><div><h3>Results</h3><div>Out of the 12 autoimmune diseases analyzed, 5 showed a significant association with Alzheimer's disease with p &lt; 0.05. Myasthenia gravis had an increased prevalence of AD with OR 1.49 (95% CI 1.11–2), systemic lupus erythematosus with OR 2.42 (95% CI 2.02–2.88), rheumatoid arthritis with OR 1.38 (95% CI 1.24–1.54), polymyalgia rheumatica with OR 2.01 (95% CI 1.08–2.23), and pernicious anemia with OR 2.06 (95% CI 1.59–2.66). The remaining autoimmune diseases analyzed did not show a higher prevalence of Alzheimer's disease compared to the general population.</div></div><div><h3>Conclusions</h3><div>There may be an association between certain systemic autoimmune diseases and Alzheimer's disease. Further studies are needed to confirm our findings, establish causality, and explore the underlying mechanisms of this association.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 10","pages":"Pages 627-633"},"PeriodicalIF":0.0,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309572","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":"Anemia of inflammation and iron metabolism in chronic diseases","authors":"S. Conde Díez ,&nbsp;R. de las Cuevas Allende ,&nbsp;E. Conde García","doi":"10.1016/j.rceng.2024.09.002","DOIUrl":"10.1016/j.rceng.2024.09.002","url":null,"abstract":"<div><div>Anemia of Inflammation begins with the activation of the immune system and the subsequent release of cytokines that lead to an elevation of hepcidin, responsible for hypoferremia, and a suppression of erythropoiesis due to lack of iron. The anemia is usually mild/moderate, normocytic/normochromic and is the most prevalent, after iron deficiency anemia, and is the most common in patients with chronic diseases, in the elderly and in hospitalized patients. Anemia can influence the patient’s quality of life and have a negative impact on survival. Treatment should be aimed at improving the underlying disease and correcting the anemia. Intravenous iron, erythropoietin and prolyl hydroxylase inhibitors are the current basis of treatment, but future therapy is directed against hepcidin, which is ultimately responsible for anemia.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 598-608"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142279","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":"Clinical perspective of anti-HMGCR immune-mediated necrotizing myopathy: analysis of three cases","authors":"J.P. de la Fuente Peñaloza ,&nbsp;L. Quintana Cabezas ,&nbsp;M.C. Yubini Lagos","doi":"10.1016/j.rceng.2024.08.005","DOIUrl":"10.1016/j.rceng.2024.08.005","url":null,"abstract":"","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 623-625"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116802","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":"Soluble receptor for advanced glycation end-products positively correlated to kidney injury with coronary heart disease","authors":"Lu Chen ,&nbsp;Xiang-Jun Zeng ,&nbsp;Xin-Ying Guo ,&nbsp;Jian Liu ,&nbsp;Feng-He Du ,&nbsp;Cai-Xia Guo","doi":"10.1016/j.rceng.2024.08.001","DOIUrl":"10.1016/j.rceng.2024.08.001","url":null,"abstract":"<div><h3>Aims</h3><div>Coronary heart disease (CHD) patients with changed serum soluble receptor for advanced glycation end products (sRAGE) will experience microalbuminuria and even kidney dysfunction. However, the role of sRAGE for microalbuminuria in CHD is still not established. This study aimed to evaluate the association between sRAGE and early kidney dysfunction in CHD patients.</div></div><div><h3>Materials and methods</h3><div>In this cross-sectional study, sRAGE and urinary albumin-to-creatinine ratio (uACR) were measured in hospitalized CHD patients who have undergone coronary arteriography to evaluate the distinction and correlation between sRAGE and uACR.</div></div><div><h3>Results</h3><div>There were 127 CHD patients (mean age: 63.06 ± 10.93 years, 93 males) in the study, whose sRAGE were 1.83 ± 0.64 μg/L. The sRAGE level was higher in kidney injury group (uACR ≥ 30 mg/g) compared with no kidney injury group (uACR &lt; 30 mg/g) [(2.08 ± 0.70 vs. 1.75 ± 0.61) μg/L, <em>P</em> &lt; 0.05]. Moreover, the positive correlation between serum sRAGE and uACR was significant in CHD patients (<em>r</em> = 0.196, <em>P</em> &lt; 0.05). Binary logistic regression suggests sRAGE as a predictor for microalbuminuria in CHD patients [Odd Ratio = 2.62 (1.12–6.15), <em>P</em> &lt; 0.05)]. The area under the receiver operating characteristic curve (AUC) of sRAGE is higher than that of the traditional indicators of renal function such as creatinine and estimated glomerular filtration rate, indicating sRAGE might have a good performance in evaluating early kidney injury in CHD patients [AUC is 0.660 (0.543–0.778), <em>P</em> &lt; 0.01)].</div></div><div><h3>Conclusions</h3><div>Serum sRAGE was positively correlated to uACR and might serve as a potential marker to predict early kidney injury in CHD patients.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 580-587"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141915012","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":"Strategic framework for the Spanish Society of Internal Medicine. 2025-2029. Executive summary on guaranteeing person-centered care in a high value National Health System","authors":"J. Carretero Gómez ,&nbsp;M.M. Chimeno Viñas ,&nbsp;J.M. Porcel Pérez ,&nbsp;M. Méndez Bailón ,&nbsp;P. Pérez Martínez ,&nbsp;M.T. Herranz Marín ,&nbsp;F.J. Elola Somoza ,&nbsp;en nombre de los miembros de los comités para el proceso de reflexión estratégica de laSEMI","doi":"10.1016/j.rceng.2024.09.005","DOIUrl":"10.1016/j.rceng.2024.09.005","url":null,"abstract":"<div><h3>Aims</h3><div>To design a strategic framework for the policy and activity of the Spanish Society of Internal Medicine (SEMI).</div></div><div><h3>Methods</h3><div>Expert consensus. Participation through expert committees and consultation of internists on the proposed strategic lines.</div></div><div><h3>Results</h3><div>The SEMI's motto was changed to “comprehensive care for patients.” Seven strategic lines were defined: Contribute to the transformation of the health system; participate in university teaching; guarantee comprehensive healthcare for patients; provide internal medicine residents and internists with the skills to practice in 21st century healthcare; promote research and the generation of scientific evidence in internal medicine; incorporate technological innovation and digital tools; position the SEMI as a model institution for healthcare policy.</div></div><div><h3>Conclusions</h3><div>SEMI seeks to be a key player in the transformation of the Spanish healthcare system.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 609-622"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142309573","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":"Delayed diagnosis and missed opportunities in the early detection of atrial fibrillation: a cross-sectional study","authors":"F. Richard Espiga ,&nbsp;M. Almendro Delia ,&nbsp;F. Caballero Martínez ,&nbsp;D. Monge Martín ,&nbsp;F. Neria Serrano ,&nbsp;R. Quirós López","doi":"10.1016/j.rceng.2024.08.002","DOIUrl":"10.1016/j.rceng.2024.08.002","url":null,"abstract":"<div><h3>Introduction</h3><div>We analysed the frequency of atrial fibrillation (AF) delayed diagnosis and the factors associated with it in newly diagnosed patients.</div></div><div><h3>Methods</h3><div>This was a descriptive, cross-sectional, multicentre study. Data were collected from newly diagnosed patients with AF through medical records review and interviews during cardiology, internal medicine, primary care and emergency department consultations in Spain.</div></div><div><h3>Results</h3><div>A total of 201 physicians participated in the study (64.2% cardiologists, 21.4% internists). 948 patients (58% men; mean age 72.8 years) were included. In 41.8% of patients, AF was classified as paroxysmal at diagnosis, 30.9% as persistent and 27.3% as permanent. The diagnosis was coincidental in 37%. It was considered that a delayed diagnosis occurred in 49.3% of patients. This delay was associated with the presence of permanent or persistent AF, older age or valvular disease. 74.8% of patients had some contact with the healthcare system in the preceding year. The diagnosis could have been established between 1 and 6 months earlier in 50.7% of cases and more than six months earlier in 20.1%. 54.4% of the patients had experienced AF compatible symptomatology previously. Of these, 32.6% had a consultation without a diagnosis.</div></div><div><h3>Conclusions</h3><div>In a significant proportion of AF cases, there is a diagnostic delay. Many people with compatible symptoms neither seek consultations nor contact the healthcare system facilities. Consequently, the opportunity for early diagnosis is lost.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 560-568"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116803","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":"Results of the implementation of the DP-TRANSFERS project in Catalonia: a translational method to improve diabetes screening and prevention in primary care","authors":"J.J. Cabré ,&nbsp;F. Barrio ,&nbsp;J. Vizcaíno ,&nbsp;A. Martínez ,&nbsp;T. Mur ,&nbsp;R. Sagarra ,&nbsp;S. Dalmau","doi":"10.1016/j.rceng.2024.08.003","DOIUrl":"10.1016/j.rceng.2024.08.003","url":null,"abstract":"<div><h3>Introduction</h3><div>DP-TRANSFERS is a translational lifestyle intervention project, which follows a previous protocol described in the DE-PLAN-CAT study.</div></div><div><h3>Objective</h3><div>Analyze the feasibility of reproducing the intensive intervention and estimating the effect of translation in real conditions of clinical practice in primary care.</div></div><div><h3>Methodology</h3><div>Implementation of the face-to-face group intervention adjusted to 2 years. After screening, the intervention consisted of a basic module and a continuity module. Stratifying by clusters (health centers), a representative sample (centers, professionals and participants) was evaluated (FINDRISC &gt; 11 and/or prediabetes) from 2016 to 2020. The effect of the intervention on the incidence of diabetes was analyzed.</div></div><div><h3>Results</h3><div>The intervention, feasible in 95 of 123 centers, involved 343 of 647 professionals. Of 2381 subjects screened, 1713 participated in the basic module, with 1186 participants completing the first year and 776 completing the second. 121 participants (7.06%) were diagnosed with diabetes: 77 (4.49%) during the first year; 44 (2.57%) during the second.</div><div>The bivariate analysis showed that those subjects in whom diabetes affected differed in: previous glycemic status, A1c, HDL-cholesterol, FINDRISC score and adherence to the Mediterranean diet, and in the differences between the beginning and end of the study of: body weight, BMI and abdominal circumference.</div></div><div><h3>Conclusions</h3><div>The intensive intervention substantially reduced (23.6%) the incidence of diabetes compared to that previously estimated in standardized intervention. The following acted as protective factors: a better glycemic status, lower baseline risk, elevated HDL-cholesterol, or achieving a reduction in weight or abdominal circumference during the study.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 569-579"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142116804","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":"Position paper on retinal arterial occlusion. SEMI-SERV","authors":"R. García-Alonso ,&nbsp;L. Arias-Barquet ,&nbsp;L. Castilla Guerra ,&nbsp;M. Martín Asenjo ,&nbsp;A.J. Gómez-Escobar ,&nbsp;E. Gutierrez-Sánchez ,&nbsp;J. Pagán Escribano ,&nbsp;A. Lorenzo Hernández ,&nbsp;O. Madridano Cobo ,&nbsp;F. Jaén Águila ,&nbsp;M.E. Salguero Cámara ,&nbsp;N. Muñoz Rivas","doi":"10.1016/j.rceng.2024.09.001","DOIUrl":"10.1016/j.rceng.2024.09.001","url":null,"abstract":"<div><div>The retina is an organ frequently affected by ischemic changes. Retinal arterial occlusion can be considered the equivalent of stroke, in terms of presentation, management and treatment. In addition to a specific ophthalmological treatment systemic management is essential with an appropriate study and control of cardiovascular risk factors considering these patients of a very high cardiovascular risk.</div><div>In this consensus document we aim to provide an update on this relatively frequent pathology in our practices, considering the importance of an early and systematic action.</div></div>","PeriodicalId":94354,"journal":{"name":"Revista clinica espanola","volume":"224 9","pages":"Pages 588-597"},"PeriodicalIF":0.0,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142142280","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}