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Metformin And Dka

Metformin

Metformin

Metformin may rarely cause a serious, life-threatening condition called lactic acidosis. Tell your doctor if you have kidney disease. Your doctor will probably tell you not to take metformin. Also, tell your doctor if you are over 65 years old and if you have ever had a heart attack; stroke; diabetic ketoacidosis (blood sugar that is high enough to cause severe symptoms and requires emergency medical treatment); a coma; or heart or liver disease. Taking certain other medications with metformin may increase the risk of lactic acidosis. Tell your doctor if you are taking acetazolamide (Diamox), dichlorphenamide (Keveyis), methazolamide, topiramate (Topamax, in Qsymia), or zonisamide (Zonegran). Tell your doctor if you have recently had any of the following conditions, or if you develop them during treatment: serious infection; severe diarrhea, vomiting, or fever; or if you drink much less fluid than usual for any reason. You may have to stop taking metformin until you recover. If you are having surgery, including dental surgery, or any major medical procedure, tell the doctor that you are taking metformin. Also, tell your doctor if you plan to have any x-ray procedure in which dye is injected, especially if you drink or have ever drunk large amounts of alcohol or have or have had liver disease or heart failure. You may need to stop taking metformin before the procedure and wait 48 hours to restart treatment. Your doctor will tell you exactly when you should stop taking metformin and when you should start taking it again. If you experience any of the following symptoms, stop taking metformin and call your doctor immediately: extreme tiredness, weakness, or discomfort; nausea; vomiting; stomach pain; decreased appetite; deep and rapid breathing or shortness of breath; dizzi Continue reading >>

Sglt2 Inhibitors Side Effects

Sglt2 Inhibitors Side Effects

Sodium-glucose cotransporter-2 (SGLT2) inhibitors are intended to treat Type 2 diabetes along with diet and exercise. They have also been prescribed for off-label, or unapproved, uses including weight loss. The active ingredients in the drugs are different gliflozin compounds. SGLT2 inhibitors approved for use in the U.S. include: In addition, some medications combine SGLT2 inhibitors with other diabetes drugs. These include: Metformin decreases glucose production in the liver while increasing the body’s ability to absorb glucose. It is often used in conjunction with insulin as well as SGLT2 inhibitors to treat Type 2 diabetes. It carries additional risks of side effects. Linagliptin works by regulating insulin levels after meals. When first approved, SGLT2 inhibitors took a revolutionary approach to controlling blood sugar in diabetic patients. The drugs cause the body to direct excess glucose to the kidneys. From there, it is expelled through a patient’s urine. SGLT2 Inhibitor Side Effects Range from Minor to Life-Threatening While the way SGLT2 drugs work is unique, this can also lead to unique side effects. For example, because the drugs cause excess sugar to escape the body in urine, it can also lead to yeast infections and urinary tract infections. The drugs primarily work in the kidneys, so these drugs are not for people with weak kidney function. Some studies also show these drugs may lead to dangerous kidney infections and kidney failure. Side effects can lead from simple annoyances such as dry mouth to more serious complications including kidney injuries. Common SGLT2 Inhibitor Side Effect Symptoms: Abdominal pain Back pain Constipation Dry mouth Fatigue Increased cholesterol Increased urination Influenza Male and female yeast infections Nausea Thirst Urin Continue reading >>

Hyperglycaemic Crises And Lactic Acidosis In Diabetes Mellitus

Hyperglycaemic Crises And Lactic Acidosis In Diabetes Mellitus

Hyperglycaemic crises are discussed together followed by a separate section on lactic acidosis. DIABETIC KETOACIDOSIS (DKA) AND HYPERGLYCAEMIC HYPEROSMOLAR STATE (HHS) Definitions DKA has no universally agreed definition. Alberti proposed the working definition of “severe uncontrolled diabetes requiring emergency treatment with insulin and intravenous fluids and with a blood ketone body concentration of >5 mmol/l”.1 Given the limited availability of blood ketone body assays, a more pragmatic definition comprising a metabolic acidosis (pH <7.3), plasma bicarbonate <15 mmol/l, plasma glucose >13.9 mmol/l, and urine ketostix reaction ++ or plasma ketostix ⩾ + may be more workable in clinical practice.2 Classifying the severity of diabetic ketoacidosis is desirable, since it may assist in determining the management and monitoring of the patient. Such a classification is based on the severity of acidosis (table 1). A caveat to this approach is that the presence of an intercurrent illness, that may not necessarily affect the level of acidosis, may markedly affect outcome: a recent study showed that the two most important factors predicting mortality in DKA were severe intercurrent illness and pH <7.0.3 HHS replaces the older terms, “hyperglycaemic hyperosmolar non-ketotic coma” and “hyperglycaemic hyperosmolar non-ketotic state”, because alterations of sensoria may be present without coma, and mild to moderate ketosis is commonly present in this state.4,5 Definitions vary according to the degree of hyperglycaemia and elevation of osmolality required. Table 1 summarises the definition of Kitabchi et al.5 Epidemiology The annual incidence of DKA among subjects with type 1 diabetes is between 1% and 5% in European and American series6–10 and this incidence appear Continue reading >>

Diabetes Mellitus

Diabetes Mellitus

Case Scenario 52 male presents to GP with 3/12 lethargy and 2/52 thirsty and drinking more than normal. PMH HTN Drinks alcohol socially, non-smoker BMI 32 Urine Dip: glucose +++ Random Blood Sugar = 13 Contents Diagnosis Risk Factors Complications Investigations Management DKA + HONK Type 1 vs Type 2 Type 1 = Inability to produce insulin (autoimmune process against beta islet pancreas cells) Type 2 = insensitivity to insulin over time Gestational Diabetes = decreased insulin sensitivity during pregnancy Secondary Diabetes: Pancreatic Disease/CF/Chronic Pancreaitis/Pancreatic Ca Steroid use/ antipsychotics/ thiazide diuretics Diagnosis Random Glucose >11.1 mmol/L Fasting Glucose >7 mmol/L 2x Fasting glucose samples to confirm Or presence of symptoms HbA1c >6.5% (48mmol/L) OGTT – two hour glucose after 75g glucose IGT = normal fasting glucose and OGTT between 7-11 IFG = OGTT <7.8 but fasting glucose 6.1 – 6.9 Risk Factors T1: Family Hx, Caucasian/Scandinavian, Juvenile onset T2: High BMI Physical inactivity South Asian/Afro-carribean/middle-eastern Hx of gestational diabetes, IGT, IFG Steroid use PCOS Family Hx Presentation Polyuria Polydipsia Lethargy Recurrent infections Complications DKA (T1) HONK (T2) Presentation - case 67 male admitted feeling generally unwell, SOB, sweating and lethargic over last 2 days. He is a known Type 2 diabetic on insulin with PVD, peripheral neuropathy and previous CVA. His BM is 5.6. ECG showed residual ST elevation in anterior leads with Q wave and reciprocal changes. Echo showed new septal hypokinesia The patient had no history of chest pain Complications Macrovascular: Stroke, MI, PVD Retinopathy, Xanthelasma, Cataracts, Opthalmoplegia, maculopathy Peripheral Neuropathy, Diabetic amyotrophy, neuropathic pain, Autonomic neu Continue reading >>

Chapter 220. Diabetic Ketoacidosis

Chapter 220. Diabetic Ketoacidosis

Diabetic ketoacidosis (DKA) is an acute, life-threatening complication of diabetes mellitus. The incidence and prevalence of diabetes are rising; as of 2005, an estimated 7% of the U.S. population had diabetes. In patients age 60 or older, the prevalence is estimated to be 20.9%.1 DKA occurs predominately in patients with type 1 (insulin-dependent) diabetes mellitus, but unprovoked DKA can occur in newly diagnosed type 2 (non–insulin-dependent) diabetes mellitus, especially in blacks and Hispanics.2 Between 1993 and 2003, the yearly rate of ED visits for DKA per 10,000 U.S. population with diabetes was 64, with a trend toward an increased rate of visits among the black population compared with the white population.3 Europe has a comparable incidence. A better understanding of pathophysiology and an aggressive, uniform approach to diagnosis and management have reduced mortality to <5% of reported episodes in experienced centers.4 However, mortality is higher in the elderly due to underlying renal disease or coexisting infection and in the presence of coma or hypotension. DKA is a response to cellular starvation brought on by relative insulin deficiency and counterregulatory or catabolic hormone excess (Figure 220-1). Insulin is the only anabolic hormone produced by the endocrine pancreas and is responsible for the metabolism and storage of carbohydrates, fat, and protein. Counterregulatory hormones include glucagon, catecholamines, cortisol, and growth hormone. Complete or relative absence of insulin and the excess counterregulatory hormones result in hyperglycemia (due to excess production and underutilization of glucose), osmotic diuresis, prerenal azotemia, worsening hyperglycemia, ketone formation, and a wide-anion gap metabolic acidosis.4 Insulin deficiency. Patho Continue reading >>

Dka Vs Hhns Nclex Questions

Dka Vs Hhns Nclex Questions

This quiz on DKA vs HHNS (Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome) will test you on how to care for the diabetic patient who is experiencing these conditions. As the nurse, you must know typical signs and symptoms of DKA and HHNS, patient teaching, and expected medical treatments. Diabetic Ketoacidosis and Hyperglycemic Hyperosmolar Nonketotic Syndrome (HHNS) are both complication of diabetes mellitus, but there are differences between the two complications that you must know as a nurse. This endocrine teaching series will test your knowledge on how to differentiate between the two conditions, along with a video lecture. This quiz will test you on the following for the NCLEX exam: Signs and Symptoms of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Causes of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Patient education for DKA vs HHNS Treatments of Diabetic Ketoacidosis vs Hyperglycemic Hyperosmolar Nonketotic Syndrome Lecture on DKA vs HHS (NOTE: When you hit submit, it will refresh this same page. Scroll down to see your results.) DKA vs HHS Quiz 1. This complication is found mainly in Type 2 diabetics? 2. A patient is found to have a blood glucose of 375 mg/dL, positive ketones in the urine, and blood pH of 7.25. Which condition is this? 3. Hyperglycemic Hyperosmolar Nonketotic Syndrome would have all of the following signs and symptoms EXPECT? A. Dry mucous membranes B. Polyuria C. Blood glucose >600 mg/dL D. Kussmaul breathing 4. This condition happens gradually and is more likely to affect older adults? 5. A patient has an infection and reports not checking their blood glucose or regularly taking Metformin. What condition is this patient MOST at risk for? A. DKA B. HHNS C. Metabol Continue reading >>

Xigduo Lawsuit

Xigduo Lawsuit

Antidiabetic medications are responsible for harming thousands of people each year in the U.S. A person injured by these medications may face costly medical treatments, permanent disability and the need for long term care. Thousands of lawsuits have been filed in the recent past by patients and family members of patients who have been harmed by antidiabetic medications. Some of these lawsuits have resulted in settlement awards reaching into the hundreds of thousands of dollars for injury or death caused by antidiabetic drugs. Reasons for filing antidiabetic medication lawsuits have included: Company manufactured a defective or dangerous drug Company failed to adequately warn about dangers of drug Company improperly marketed drug Company deliberately concealed knowledge of drug risk Though thousands of lawsuits are filed after injury that is suspected to be caused by diabetic medications, a lawsuit is no guarantee of settlement. Many victims have been awarded financial compensation but each case must be considered individually for its merits. If you or a loved one have been injured by XigDuo XR (dapagliflozin and metformin), you may be eligible for compensation. XigDuo XR warnings XigDuo XR is a combination drug with the active ingredients dapagliflozin and metformin. These individual ingredients can also be found in the brand name medications Farxiga and Glucophage. The FDA has issued a warning regarding XigDuo XR and other SGLT2 inhibitor use. The May 2015 announcement warned of the possibility of patients who had used SGLT2 inhibitors such as Farxiga and XigDuo XR developing diabetic ketoacidosis, a potentially fatal condition. The warning was announced after the agency had received at least 20 serious adverse events regarding DKA after SGLT2 use. One of the active in Continue reading >>

Viewer Comments: Diabetic Ketoacidosis - Symptoms

Viewer Comments: Diabetic Ketoacidosis - Symptoms

I didn't know anything about diabetic ketoacidosis (DKA) until I was admitted into the ICU. Learning about DKA now, I've had moderate DKA on and off for years. I thought my vomiting, stomach pain were the result of metformin and switched to Invokana. I experienced extreme weight loss and dehydration but thought these were normal (Invokana shown to help diabetics lose weight). I have been under extreme financial and emotional stress for the past few years as well. What I would want others to know is that it is difficult to identify DKA from medication side effects; until DKA is at the ICU level. I was given so much potassium and other electrolytes. Stress is also a huge factor for me. While in the ICU my ex-husband (knowing I was in the ICU) started more harassment. The nurses documented an over 100 jump in my blood sugar after a phone call to deal with the harassment. I've started tracking stress and my blood sugar. It is impossible to get control of my blood sugar during high stress. If I add more insulin, I have a dangerous crash later. Keeping a calm environment as much as I can helps. I have type 2 diabetes. I gave myself more than 300 shots. My doctor put me on metformin. This takes the place of insulin shots. There are three different doses. What made it for me was 850 mg per meal. I count my carbohydrates, 60 per meal, and take my pill. I have seen here, folks that have 200, 300, 695 mg/dl of glucose. It is tough to manage, but if you keep to it, you will do well. Check the bottoms of your feet daily. If you are ticklish, you are doing fine. Give up cakes, pies, ice cream and other things high in carbohydrates. If you do, you will be fine. By the way, my average glucose reading is less than 120. Set that as your goal. Have good days! I have been having really dif Continue reading >>

Acid-base And Electrolyte Disorders Associated With The Use Of Antidiabetic Drugs

Acid-base And Electrolyte Disorders Associated With The Use Of Antidiabetic Drugs

Introduction: The use of antidiabetic drugs is expected to substantially increase since diabetes mellitus incidence rises. Currently used antidiabetic drugs have a positive safety profile, but they are associated with certain acid-base and electrolyte abnormalities. The aim of the review is to present the current data regarding the antidiabetic drugs-associated acid-base and electrolyte abnormalities. Areas covered: Sodium-glucose cotransporter 2 (SGLT2) inhibitors have been linked with the scarce, but serious, complication of euglycemic diabetic ketoacidosis, as well as with an increase in serum potassium, magnesium and phosphorus levels. Metformin use has been associated with the development of lactic acidosis, although many studies have doubt the direct link with this serious complication. Additionally, metformin in some studies has been linked with a decrease in serum magnesium levels. Insulin administration is associated with a reduction in serum potassium, magnesium and phosphorus concentration, along with reduced renal magnesium excretion. Pioglitazone is associated with an increase in serum magnesium levels. Current data regarding the pathophysiological mechanisms, precipitants, risk factors and presentation of the above abnormalities are discussed in the present review. Expert opinion: Clinicians should choose appropriately between antidiabetic drugs based not only on their hypoglycemic efficacy and effects on cardiovascular risk but also based on the patient’s specific risk to develop acid-base or electrolyte derangements. Continue reading >>

Apo-metformin

Apo-metformin

NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. What is in this leaflet This leaflet answers some common questions about metformin It does not contain all the available information. It does not take the place of talking to your doctor or pharmacist or diabetes educator. The information in this leaflet was last updated on the date listed on the last page. More recent information on this medicine may be available. You can also download the most up to date leaflet from www.apotex.com.au. All medicines have risks and benefits. Your doctor has weighed the risks of you using this medicine against the benefits they expect it will have for you. Pharmaceutical companies cannot give you medical advice or an individual diagnosis. Keep this leaflet with your medicine. You may want to read it again. What this medicine is used for The name of your medicine is APO-Metformin 500, 850 or 1000 tablets. It contains the active ingredient metformin (as metformin hydrochloride). It is used to treat type 2 diabetes (also called non-insulin dependent diabetes mellitus or maturity onset diabetes) in adults and children over 10 years of age. It is especially useful in those who are overweight, when diet and exercise are not enough to lower high blood glucose levels (hyperglycaemia). For adult patients, metformin can be used alone, or in combination with other oral diabetic medicines or in combination with insulin in insulin requiring type 2 diabetes. Ask your doctor if you have any questions about why this medicine has been prescribed for you. Your doctor may have prescribed this medicine for another reason. This medicine is available only with a doctor's prescription. How it works Metformin lowers high blood glucose by helping your body make better Continue reading >>

Pioglitazone/metformin

Pioglitazone/metformin

Pioglitazone/metformin (also known by the brand names Actoplus Met, Piomet and Politor) is combination of two oral diabetes medications pioglitazone and metformin. The two oral antihyperglycemic agents with different mechanisms of action are used to improve glycemic control in patients with diabetes mellitus type 2. Mechanisms[edit] Pioglitazone is a member of the thiazolidinedione class, it decreases insulin resistance in the periphery and in the liver resulting in increased insulin dependent glucose disposal and decreased hepatic glucose output. Metformin is a member of the biguanide class, improves glucose tolerance in patients with type 2 diabetes, lowering both basal and postprandial plasma glucose. Metformin decreases hepatic glucose production, decreases intestinal absorption of glucose and improves insulin sensitivity by increasing peripheral glucose uptake and utilization. Indication[edit] Pioglitazone/metformin is indicated as an adjunct to diet and exercise: To improve glycemic control in patients with type 2 diabetes, or For patients who are already treated with a separate combination of pioglitazone and metformin, For patients whose diabetes is not adequately controlled with metformin alone, or For patients who have initially responded to pioglitazone alone and require additional glycemic control. Dosage and administration[edit] Recommended dose[edit] Use of antihyperglycemic agents in the management of type 2 diabetes should be individualized on the basis of effectiveness and tolerability. Pioglitazone/metformin should be given with meals; the initial starting dose is either the 15 mg/500 mg or 15 mg/850 mg tablet strength once or twice daily, and gradually titrated after assessing adequacy of therapeutic response, while not exceeding the maximum recommend Continue reading >>

Diabetic Ketoacidosis (dka)

Diabetic Ketoacidosis (dka)

Tweet Diabetic ketoacidosis (DKA) is a dangerous complication faced by people with diabetes which happens when the body starts running out of insulin. DKA is most commonly associated with type 1 diabetes, however, people with type 2 diabetes that produce very little of their own insulin may also be affected. Ketoacidosis is a serious short term complication which can result in coma or even death if it is not treated quickly. Read about Diabetes and Ketones What is diabetic ketoacidosis? DKA occurs when the body has insufficient insulin to allow enough glucose to enter cells, and so the body switches to burning fatty acids and producing acidic ketone bodies. A high level of ketone bodies in the blood can cause particularly severe illness. Symptoms of DKA Diabetic ketoacidosis may itself be the symptom of undiagnosed type 1 diabetes. Typical symptoms of diabetic ketoacidosis include: Vomiting Dehydration An unusual smell on the breath –sometimes compared to the smell of pear drops Deep laboured breathing (called kussmaul breathing) or hyperventilation Rapid heartbeat Confusion and disorientation Symptoms of diabetic ketoacidosis usually evolve over a 24 hour period if blood glucose levels become and remain too high (hyperglycemia). Causes and risk factors for diabetic ketoacidosis As noted above, DKA is caused by the body having too little insulin to allow cells to take in glucose for energy. This may happen for a number of reasons including: Having blood glucose levels consistently over 15 mmol/l Missing insulin injections If a fault has developed in your insulin pen or insulin pump As a result of illness or infections High or prolonged levels of stress Excessive alcohol consumption DKA may also occur prior to a diagnosis of type 1 diabetes. Ketoacidosis can occasional Continue reading >>

Ketoacidosis: A Diabetes Complication

Ketoacidosis: A Diabetes Complication

Ketoacidosis can affect both type 1 diabetes and type 2 diabetes patients. It's a possible short-term complication of diabetes, one caused by hyperglycemia—and one that can be avoided. Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) are two of the most serious complications of diabetes. These hyperglycemic emergencies continue to be important causes of mortality among persons with diabetes in spite of all of the advances in understanding diabetes. The annual incidence rate of DKA estimated from population-based studies ranges from 4.8 to 8 episodes per 1,000 patients with diabetes. Unfortunately, in the US, incidents of hospitalization due to DKA have increased. Currently, 4% to 9% of all hospital discharge summaries among patients with diabetes include DKA. The incidence of HHS is more difficult to determine because of lack of population studies but it is still high at around 15%. The prognosis of both conditions is substantially worsened at the extremes of age, and in the presence of coma and hypertension. Why and How Does Ketoacidosis Occur? The pathogenesis of DKA is more understood than HHS but both relate to the basic underlying reduction in the net effective action of circulating insulin coupled with a concomitant elevation of counter regulatory hormones such as glucagons, catecholamines, cortisol, and growth hormone. These hormonal alterations in both DKA and HHS lead to increased hepatic and renal glucose production and impaired use of glucose in peripheral tissues, which results in hyperglycemia and parallel changes in osmolality in extracellular space. This same combination also leads to release of free fatty acids into the circulation from adipose tissue and to unrestrained hepatic fatty acid oxidation to ketone bodies. Some drugs ca Continue reading >>

Diabetes And Intercurrent Illness

Diabetes And Intercurrent Illness

Professional Reference articles are written by UK doctors and are based on research evidence, UK and European Guidelines. They are designed for health professionals to use. You may find the Pre-diabetes (Impaired Glucose Tolerance) article more useful, or one of our other health articles. Principles The stress of illness can increase basal insulin requirements in all types of people with diabetes. Being ill may also render the person with diabetes unable to monitor and manage their condition as they would normally. Some people with diabetes may associate insulin dosing with eating, so during a period of anorexia or vomiting they may feel that they do not need to take their normal insulin regimen, whereas they ought to maintain it, or even increase the dose. There is also a need to keep up carbohydrate intake. These measures help reduce the risk of diabetic ketoacidosis and poor diabetes control. Patients taking metformin should receive special attention, as continuing this medication during periods of dehydration or acute illness can increase the risk of lactic acidosis or a hyperosmolar hyperglycaemic state. Cornerstones of diabetes management during intercurrent illness (patients on oral hypoglycaemics and/or insulin)[1] Contact a GP or diabetes team who will help with any queries or any uncertainty about what to do. Keep taking insulin and/or most diabetes medications - even when not feeling like eating. The dose of medication may need to be altered. It is advisable to stop taking a SGLT2 inhibitor (eg, dapagliflozin, canagliflozin, empagliflozin) if unwell and unable to eat or drink. If this is the case, it is essential to contact a GP/diabetes team for advice as soon as possible. If using insulin treatment, test blood glucose more often, at least every four hours, Continue reading >>

Sglt2 Inhibitors: Prac Makes Recommendations To Minimise Risk Of Diabetic Ketoacidosis

Sglt2 Inhibitors: Prac Makes Recommendations To Minimise Risk Of Diabetic Ketoacidosis

SGLT2 inhibitors: PRAC makes recommendations to minimise risk of diabetic ketoacidosis Healthcare professionals should be aware of possible atypical cases EMA’s Pharmacovigilance Risk Assessment Committee (PRAC) has finalised a review of SGLT2 inhibitors (a class of type 2 diabetes medicines) and has made recommendations to minimise the risk of diabetic ketoacidosis. Diabetic ketoacidosis is a serious complication of diabetes caused by low insulin levels. Rare cases of this condition, including life-threatening ones, have occurred in patients taking SGLT2 inhibitors for type 2 diabetes and a number of these cases have been atypical, with patients not having blood sugar levels as high as expected. An atypical presentation of diabetic ketoacidosis can delay diagnosis and treatment. Healthcare professionals should therefore consider the possibility of ketoacidosis in patients taking SGLT2 inhibitors who have symptoms consistent with the condition even if blood sugar levels are not high. There are currently three SGLT2 inhibitors authorised in the EU (canagliflozin, dapagliflozin and empagliflozin) and they are available (alone or in combination with metformin) under the following tradenames: Ebymect, Edistride, Forxiga, Invokana, Jardiance, Synjardy, Vokanamet and Xigduo. Patients taking any of these medicines should be aware of the symptoms of diabetic ketoacidosis, including rapid weight loss, nausea or vomiting, stomach pain, excessive thirst, fast and deep breathing, confusion, unusual sleepiness or tiredness, a sweet smell to the breath, a sweet or metallic taste in the mouth, or a different odour to urine or sweat. Patients should contact their healthcare professional if they have any of these symptoms. If diabetic ketoacidosis is suspected or confirmed, treatment Continue reading >>

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