ResearchPad - family-general-practice https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Prevalence of Gender Disparity in Professional Societies of Family Medicine: A Global Perspective]]> https://www.researchpad.co/article/elastic_article_16497 Introduction

Gender disparity in academic and organizational settings has been the topic of numerous studies, which have attributed under representation of females within medicine to both individual and institutional reasons. The main objective of our study was to assess gender disparity in leadership positions in committees of professional societies of family medicine (FM).

Methods

In this cross-sectional observational study, we collected publicly available information from 3 major FM societies (College of Family Physicians of Canada, the Royal Australian College of General Practitioners, and the World Organization of Family Doctors) and also collected the academic/leadership information for each committee member, including bibliometric parameters of their research productivity.

Results

In total, our sample size was 960 and composed of 58% men (556) and 42% women (404). There was a significant difference found in all the research productivity variables. Men had a greater number of publications, number of citations, years since first publication, years of active research, and had a larger h-index.

Conclusion

In conclusion, gender disparity within FM societies is less significant compared to other professional medical societies and creating an environment that supports women and supports research can aid in achieving gender parity.

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<![CDATA[Prevalence of Abuse in Elders With Psychiatric Morbidity and Its Sociodemographic Association]]> https://www.researchpad.co/article/elastic_article_16490 Objective

Our aim in this study is to assess the prevalence of abuse in elders with psychiatric illness and its association with various sociodemographic variables.

Methods

This cross-sectional comparative study included 300 elderly (aged more than 65 years) patients divided into two groups. Group 1 consisted of 150 patients with psychiatric illnesses presenting to the psychiatry outpatient department (OPD), whereas group 2 comprised 150 patients with somatic illnesses presenting to the OPDs of other departments. Elder Abuse Suspicion Index (EASI) was used as a screening tool for the detection of elder abuse. In patients with suspicion of abuse on EASI, the Actual Abuse Tool was used for confirmation and assessment.

Results

A significantly higher prevalence of abuse was seen in elders with psychiatric illness (21.3%) compared to those with somatic illness (4%). Among sociodemographic variables, a significant correlation was found between elder abuse and gender, literacy, and marital status.

Conclusions

Elder abuse is a serious social problem. Awareness should be raised to improve the attitude and behavior towards seniors. Healthcare professionals, especially in the psychiatry field, should be made more capable of and open towards early detection of and intervention against elder abuse. Further research on this topic in India is highly recommended.

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<![CDATA[Ruptured Right Broad Ligament Ectopic Pregnancy in a Patient With Prior Right Salpingo-Oophorectomy: A Case Report]]> https://www.researchpad.co/article/elastic_article_16403 Ectopic pregnancy can be a life-threatening cause of acute abdomen. Broad ligament pregnancy accounts for 1% of ectopic abdominal pregnancies and complications can be calamitous. This case report highlights a 27-year-old G2P0010 female who presented with amenorrhea and acute right lower quadrant and pelvic pain. By last menstrual period (LMP), she was at seven weeks and two days gestation. Her past surgical history was significant for a prior right salpingo-oophorectomy. The physical examination was significant for severe right lower quadrant tenderness with guarding. The urine pregnancy test was positive with the serum quantitative beta-human chorionic gonadotrophin (Beta hCG) of 28011 MIU/ML (normal range <5 MIU/ML). The transvaginal ultrasonography demonstrated an empty uterus and a gestational sac containing a fetal pole in the right adnexal area. The crown-rump length was 7.2 mm, consistent with six weeks and four days, with a positive fetal heart rate and moderate free fluid in the cul-de-sac. The patient was taken for immediate diagnostic laparoscopy, which was converted to open laparotomy due to active bleeding from the right broad ligament and pelvic wall close to large pelvic vessels. In addition to the hemoperitoneum, intraoperative findings revealed a normal left fallopian tube and ovary and absent right fallopian tube and ovary. Right ureterolysis was done and hemostasis of the bleeding broad ligament and right pelvic sidewall was established. An adherent tissue was dissected from the right broad ligament and sent to pathology. The patient did well postoperatively. The final pathology showed an ectopic pregnancy with immature chorionic villi in the broad ligament. The diagnosis of ectopic pregnancy in the broad ligament is challenging. The location could be close to the major pelvic vessels and anatomic structures like the ureter and bowel, hence, it can cause massive hemorrhage with maternal morbidity and mortality. Diagnosis is often missed preoperatively and made intraoperatively. Hence, we emphasize that this differential be considered in reproductive-aged women who present with atypical presentations of acute abdomen and amenorrhea.

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<![CDATA[Tingles, Tetany, and Electrolyte Derangements]]> https://www.researchpad.co/article/elastic_article_14193 We report a patient who presented with anxiety, hyperventilation, perioral paresthesia, and tingling in the fingers associated with hypomagnesemia, hypocalcemia, and hypokalemia. We discuss the possible mechanistic basis for sequence of events that may have led to this presentation.

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<![CDATA[Successful Conservative Management of Acute Appendicitis in a Coronavirus Disease 2019 (COVID-19) Patient]]> https://www.researchpad.co/article/elastic_article_10711 Appendectomy is the gold standard of treatment for acute appendicitis; however, recent evidence suggests conservative management with intravenous antibiotics may provide similar outcomes and can be used as an alternative in selected patients. Performing appendectomy in acute appendicitis patients with 2019 novel Coronavirus Disease (COVID-19) is challenging, as it involves considerable operative risks for the patients and risks for health care professionals (HCPs) exposed to COVID-19. Medical management eliminates the morbidity and mortality associated with surgery but involves significant risks of treatment failures that, in turn, may lead to perforation, peritonitis, and death. We are reporting a case of a middle-aged man with multiple co-morbidities, who was diagnosed with COVID-19 and acute appendicitis. Our patient received intravenous antibiotics for seven days with a significant improvement in symptoms. Our case report illustrates the implementation of successful conservative treatment for acute appendicitis in COVID-19 patients.

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<![CDATA[The Spectrum of Sleep Disorders Among Children: A Cross-sectional Study at a South Indian Tertiary Care Hospital]]> https://www.researchpad.co/article/N55939edb-8af6-4644-a4dc-8ec6d9f99e5d Introduction

Sleep problems during infancy and early childhood are fairly common and rarely recognized in pediatric practice. These are mostly related to the initiation and maintenance of night-time sleep. Understanding sleep patterns and disorders associated with sleep is challenging, especially in the pediatric age group. This study was done to estimate the magnitude of sleep disorders in children and to evaluate the associated risk factors.

Methods

This cross-sectional study was carried out among 450 children visiting the pediatric outpatient department of Sri Ramachandra Institute of Higher Education and Research, Chennai, India between November 2018 and June 2019. Children with chronic illnesses and a history of physical or mental trauma in the past six months were excluded. The Sleep Disturbance Scale for Children (SDSC) was used to gather information regarding sleep disorders.

Results

It was observed that a majority of the participants (72.2%) slept 9-11 hours per day. Among 46.2% of the participants, the time lag between bedtime and sleep time was less than 15 minutes. Overall, sleep problems were present in 34% of the participants. History of sleep problems in infancy, absence of siblings, and parental presence while sleeping emerged as statistically significant risk factors for childhood sleep disorders (p: <0.05).

Conclusion

We believe our study provides a basis for exploring the pattern and problems associated with sleep behavior among children. There is a need for setting up routine screening measures in pediatric outpatient departments to facilitate early detection of sleep disorders in order to avoid complications.

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<![CDATA[Missed Abortion Presented with Worsening Hyperemesis Gravidarum]]> https://www.researchpad.co/article/Nc9a9cab8-4066-4278-8064-0396d440fd30 Hyperemesis gravidarum (HG) is the most common cause of in-patient hospitalizations during the first half of pregnancy. The etiology of HG has not yet been elucidated, and the treatment is mainly symptomatic. Untreated severe HG can lead to catastrophic maternal complications such as cardiac arrhythmia and death. In contrast, the impact of untreated severe HG on the fetuses remains contradictory. Evidence suggested that HG may increase the risk of a small for gestational age (GA) fetus. We here report a case of 32-year-old nulliparous woman, GA of 14 weeks, who presented with worsening HG and later had a diagnosis of missed abortion. More research is needed to clarify the possibility of HG as a contributory cause of abortion.

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<![CDATA[‘Shawl Sign’ as a Paraneoplastic Dermatosis]]> https://www.researchpad.co/article/N65efda44-6314-4da5-8742-a22a670a2158 Dermatomyositis (DM) is an idiopathic condition characterized by inflammation of muscles and skin lesions. It is often a paraneoplastic manifestation of internal malignancy. Hence, early recognition of this disorder is important. Although not all dermatomyositis are associated with malignancies, the ones with such association regress with the treatment of associated malignancy. In clinical practice, symptoms of muscle weakness can be vague, and skin lesions can be dismissed as sunburn. We present a case of an elder adult female who presented with dermatomyositis as a paraneoplastic syndrome secondary to an underlying Mullerian malignancy.

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<![CDATA[Primary Syphilis Presenting As a Chronic Lip Ulcer]]> https://www.researchpad.co/article/N7ce83909-422e-441f-9d37-a1c882c396e5

Syphilis is usually a sexually transmitted infection caused by the spirochete Treponema pallidum. Primary syphilis classically presents as a painless, ulcerated lesion on the genitals. However, the primary lesion is not restricted to this site and appears wherever the spirochete enters through the skin. The symptomatology and appearance of the primary lesion can also vary. 

We present a case of a 59-year-old man with a primary syphilitic chancre of the lower lip. The patient was referred to the dermatology clinic by their primary care provider after the ulceration failed to heal with antibiotic therapy. A biopsy of the lesion was taken at this time; the diagnosis of syphilis was then made by histologic examination and immunohistochemical staining. Subsequent serologic tests were also positive. Upon prompting, the patient did report a history of sexually transmitted disease but not of syphilis specifically. The patient was treated with penicillin, and there was clinical improvement of the lesion at the follow-up visit.

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<![CDATA[Efficacy and Tolerability of Ashwagandha Root Extract in the Elderly for Improvement of General Well-being and Sleep: A Prospective, Randomized, Double-blind, Placebo-controlled Study]]> https://www.researchpad.co/article/Nbe49d8a2-d159-48f2-8114-3733d98e0106

Background

Ashwagandha is an excellent adaptogen that is being used since ancient times in Ayurvedic medicine. Traditionally, it is used for various ailments and general well-being, including the treatment of geriatric patients. Managing quality of life (QoL) remains a challenge for the elderly population, especially joint pain management, sleep, and general well-being. With a growing global elderly population, QoL management with efficient medication and supplementation is the major healthcare requirement.

Objective

The objective of this study was to assess the safety, efficacy, and tolerability of Ashwagandha (Withania somnifera (L.) Dunal.) root extract on the improvement of general health and sleep in elderly people.

Methods

This 12-week, prospective, randomized, double-blind, placebo-controlled study was conducted on individuals of either gender aged between 65-80 years. Participants were randomized to receive Ashwagandha root extract at a dose of 600 mg/day (n = 25) orally, or identical placebo capsules with the same dose (n = 25) for 12 weeks. Efficacy was assessed using the WHOQOL-BREF questionnaire, sleep quality, mental alertness on rising, and Physician’s Global Assessment of Efficacy to Therapy (PGAET). The safety and tolerability were assessed using the clinical adverse events reporting and Patient's Global Assessment of Tolerability to Therapy (PGATT).

Results

Statistically significant (P<0.0001) improvement was observed in the Ashwagandha treatment group compared to the placebo. The mean (SD) total score of WHOQOL-BREF improved from 140.53 (8.25) at the baseline to 161.84(9.32) at the end of the study. The individual domain scores were also improved. At baseline, the sleep quality and the mental alertness on rising were comparatively low in both the groups. However, upon intervention, a significant increase in the quality of sleep (P<0.0001) and mental alertness (P<0.034) was observed in the Ashwagandha treatment group when compared to the placebo group. Overall improvement was observed for the general wellbeing, sleep quality, and mental alertness in the study population. The experimental group population displayed good tolerability to the test product and it was reported as safe and beneficial by the study participants. 

Conclusion

The study outcomes suggest that Ashwagandha root extract was efficient in improving the QoL, sleep quality, and mental alertness as self-assessed by the elderly participants. The recommended dose used in this study could be effective for the elderly population. 

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<![CDATA[Coronavirus Disease: A Review of a New Threat to Public Health]]> https://www.researchpad.co/article/N4b0a99f9-acbf-4a34-9db0-6813134434e4

In December 2019, several patients from Wuhan, China were admitted to hospitals with symptoms of pneumonia. As the number of patients presenting with similar symptoms started to rise, the causative agent was eventually isolated from samples. It was initially called the 2019 novel coronavirus (2019-nCoV) and has been recently relabelled as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2); the disease it causes has been named coronavirus disease 2019 (COVID-19). Over the next few weeks, the virus spread from Wuhan to affect different provinces in China and, after a few months, it is now present in 109 countries. As of March 10, 2020, there have been 113,702 confirmed cases globally, and 4,012 deaths have been registered. The World Health Organization (WHO) called COVID-19 a pandemic on March 11, 2020. There are multiple drug trials going on with some positive results. However, since no vaccine is available, the best way to combat the virus is by preventive methods.

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<![CDATA[Daith Piercing: Wonder Treatment or Untested Fad?]]> https://www.researchpad.co/article/N5525c877-b531-44c6-812f-87933fcaed97

Daith piercing is a form of body piercing that involves the crux of the ear’s helix. While daith piercing has been used as an esthetic piercing since the 1990s, it is gaining popularity in the general population as an alternative treatment in chronic headaches, especially migraines. Despite its use, the evidence is currently lacking. Postulated hypotheses include vagal neuromodulation vs. placebo effect. We present a case of a 47-year-old female patient suffering from refractory cluster headache who underwent daith piercing. We aim to raise awareness among the general practitioners of this health-related practice prevalent in the community. 

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<![CDATA[Extraocular Sebaceous Carcinoma Presenting As a Nodule over the Zygoma]]> https://www.researchpad.co/article/N5a321087-ee79-405f-9f9e-2a2ff98e75bd

We describe a case of sebaceous carcinoma (SC) in a 75-year-old man who presented with a rapidly growing nodule on the left cheek for four weeks.

A 75-year-old man presented with a crusted non-tender nodule on the left cheek that had been present for six months. The nodule showed rapid growth in the four weeks before the visit. Shave biopsy of the lesion was reported as SC.

SC is a rare but aggressive type of skin cancer that can develop from any sebaceous gland in the body. However, it mostly occurs in the eyelids. In this case, SC developed on the left cheek of the patient, which is an atypical presentation. Extraocular variant of SC has a greater potential to metastasize and has a lower survival rate compared to ocular variant. Early and accurate diagnosis followed by a wide excision surgery or Mohs micrographic surgery carries a favorable prognosis.

Early detection of extraocular variant of SC may be difficult. It is imperative for primary care providers to order a histopathology examination to investigate a rapidly growing mass in the head and neck region where there are numerous sebaceous glands.

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<![CDATA[Clinicians Beware, Ewing’s Sarcoma After 60 Is Elusive and Rare!]]> https://www.researchpad.co/article/N5b31b81c-d09c-4650-b91b-72c6138c3c22

Ewing’s sarcoma is the second most common malignant bone tumor in children, with the worst outcomes seen in patients over the age of 20. However, the onset of the disease is much less common in people over the age of 30. This case represents the diagnostic dilemma posed by an otherwise “straight forward” case of back pain. Keeping the differential diagnosis sufficiently broad to include bone malignancies, so as not to delay diagnosis and treatment, provides the best chance at a positive outcome.

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<![CDATA[Incidence of Hyperuricemia in Patients with Acute Myocardial Infarction – A Case-Control Study]]> https://www.researchpad.co/article/Ne7a49ffc-64ef-414f-b0b4-5c68ed817c2c

Introduction

Various researches have stated the correlation between serum uric acid (sUA) and cardiovascular disease (CVD); however, no local studies are available. In this study, we will determine the prevalence of hyperuricemia in patients with acute myocardial infarction and compare with the control group.

Methods

This case-control study was conducted from March to November 2019 in the tertiary care hospital in Pakistan. In all, 119 patients with acute myocardial infarction were enrolled in this study, and 119 controls were identified from the outpatient department. Their sUA levels were measured within 24 hours of acute myocardial infarction.

Results

The mean sUA levels were significantly higher in patients with acute myocardial infarction (AMI) in comparison to the control group (6.17 ± 2.12 vs. 5.51 ± 1.89, p-value; 0.01). Overall, there were more patients with hyperuricemia in the case group compared to the control group (47.89% vs. 33.6%, p-value = 0.04)

Conclusion

In this study, after adjustment of other known factors, hyperuricemia is associated with AMI. Efforts should be made to include screening for hyperuricemia in patients with a high risk of myocardial infarction.

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<![CDATA[Interventions for Increasing the Quality of Preventive Care at a Free Clinic]]> https://www.researchpad.co/article/Nd9784a8a-5bab-4b1f-b748-3b9dc8ad4364

A quality improvement committee targeted six clinically meaningful measures in order to determine which interventions improved preventative care in a free clinic as well as to qualify for certification as a Patient-Centered Medical Home. Four quality improvement interventions were designed and implemented. The outcomes of these interventions were compared with the national average performance and the Center for Disease Control's Healthy People 2020 goals. All outcomes measured exceeded the national averages, and five out of six outcomes were above the Healthy People 2020 goals. The approach outlined may be used by other free clinics aiming to provide quality preventive care for their patient population and to help obtain Patient-Centered Medical Home certifications.

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<![CDATA[Malassezia (Pityrosporum) Folliculitis Incognito: Malessezia-associated Folliculitis Masked by Topical Corticosteroid Therapy]]> https://www.researchpad.co/article/N18ecb89c-f319-4cae-989a-e465d5c71f57

Malassezia (Pityrosporum) folliculitis usually appears as pruritic monomorphous papules and pustules on the upper back, chest, extensor arms and face. Acne vulgaris, bacterial folliculitis, eosinophilic folliculitis and systemic corticosteroid-induced acne can clinically mimic the fungal-caused acneiform condition. The designation incognito is used to describe tinea or scabies when the characteristic presentation is masqueraded by the application of topical corticosteroid treatment. Application of corticosteroid cream altered the morphology of the skin lesions in a man with Malassezia folliculitis. His cutaneous findings-localized areas of post-inflammatory hyperpigmentation with flattened or completely resolved follicular papules-raised the possibility of partially treated follicular eczema or follicular contact dermatitis. Pathognomonic findings from biopsies of the skin lesions established the diagnosis of Malassezia folliculitis; the condition completely resolved after treatment with topical antifungal shampoo and cream. Similar to tinea incognito and scabies incognito, folliculitis caused by Malassezia yeast in which the cutaneous morphology has been concealed by management with topical corticosteroids should be referred to as Malassezia (Pityrosporum) folliculitis incognito. 

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<![CDATA[The V-Sign: A Simple Radiographic Sign of Shoulder Subluxation]]> https://www.researchpad.co/article/Nbf9db1ae-fe60-48da-93fd-41aff1a2d176

Introduction

Shoulder subluxation is a common finding associated with orthopedic pathology. This study assesses the inter- and intra-observer reliability of a new radiographic sign used to identify glenohumeral subluxation.

Methods

Shoulders of 55 consecutive patients presenting with shoulder pain were reviewed for the presence of a “V-sign”. Three shoulder surgeons reviewed all radiographs at three separate time periods in a randomized fashion. Inter- and intra-observer reliabilities were calculated.

Results

The V-sign was identified in 26 (47%) shoulders. Intra-rater reliability was satisfactory for all the three surgeons, with kappa values of 0.85, 0.78, and 0.77, respectively. Inter-rater reliability was similarly satisfactory, with a value of 0.71. The surgeons demonstrated 100% agreement on the direction of subluxation when a V-sign was documented.

Discussion

The V-sign is a reproducible radiographic sign that can be used to detect glenohumeral subluxation in patients presenting with shoulder pain.

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<![CDATA[Causation and Treatment Algorithms for Elderly Patients who have Fallen in the Twin Tiers]]> https://www.researchpad.co/article/Nf185bfa2-0666-4f75-a583-600d84ff62bd

Introduction

One-third of people aged 65 years of age and older fall annually. Vitamin D is key in maintaining muscle mass and bone structure. The purpose of this quality improvement project is to evaluate the current treatment of elderly patients who experience falls, educate providers on the importance of vitamin D, and measure the changes.

Methods

We obtained baseline data from the electronic medical records (EMR) of patients who had experienced falls from over a two-year period. We also surveyed providers from the departments of internal medicine (IM) and family medicine (FM) to evaluate fall treatment, educated providers on new protocols, reviewed EMRs of patients that had fallen and surveyed FM and IM providers after education.

Results

We found that vitamin D supplementation and home health (HH) referral were marginally improved after education and that significant improvement was found in patients being referred to physical therapy (PT).

Conclusion

Establishing a fall treatment protocol leads to more consistent care among FM and IM providers. Reviewing and updating of the protocol based on outcomes and subsequent research is recommended for improvement in patient care.

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<![CDATA[The Predictive Performance of the STOP-Bang Questionnaire in Obstructive Sleep Apnea Screening of Obese Population at Sleep Clinical Setting]]> https://www.researchpad.co/article/N2022f8f1-3110-469b-9a57-9321987a79c4

Background

The prevalence of obstructive sleep apnea (OSA) is high in the obese population. In this study, it was aimed to fulfill the STOP-Bang questionnaire which is a concise and easy-to-use questionnaire for OSA screening in obese patients.

Materials & methods

This is a retrospective study where the patients, who planned polysomnography, were referred to sleep clinic. Patients were screened for OSA by the STOP-Bang questionnaire. Laboratory polysomnography was performed in 275 patients. Patients with BMI ≥ 30 were taken into study. The screening test was evaluated by three different risk analysis such as, a STOP score, a STOP-Bang score and a modified STOP-Bang score. The predictive parameters (sensitivity, specificity, and positive and negative predictive values) for alternative scoring models in obese patients were analyzed.

Results

In 217 obese patients, a STOP score cutoff of 3 and a STOP-Bang score cutoff of 4 provides a better balance of sensitivity and specificity for all OSA (apnea-hypopnea index [AHI] ≥ 5). The STOP questionnaire revealed a sensitivity of 87.9% and a positive predictive value of 99.5% for patients with all OSA (p: 0.005). The STOP-Bang scoring model revealed a sensitivity of 95.3% and a positive predictive value of 99.5% for patients with all OSA (p < 0.001). The modified STOP-Bang scoring revealed a sensitivity of 95.8% and a positive predictive value of 99.5% for patients with all OSA (p < 0.001). The area under the curve of the STOP-Bang for identifying mild, moderate and severe OSA was 0.581, 0.652 and 0.675, respectively. Whereas according to the STOP-Bang, all morbid obese patients (obesity class III, n: 47) were at high risk of OSA.

Conclusion

This study suggests that the STOP-Bang questionnaire for obstructive sleep apnea screening in obese patients is a high sensitivity and appropriate screening test.

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