Vet Finals

@VetFinals

Hello final years! Welcome to tonight’s #vetfinals session

with Kate Griffiths on Pruritis in small animals, thank you

to Kate for providing us with this useful session. We will

begin at 8pm #dermatology #whysoitchy

6:47 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Hello. Hope you are ready to think about pruritic dogs…

#vetfinals

6:59 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Hello final years! Welcome to tonight’s #vetfinals session

with Kate Griffiths on Pruritis in small animals, thank you to

Kate for providing us with this useful session. We will begin

at 8pm #dermatology #whysoitchy

Pruritus in Small Animals with Kate Griffiths64 Items

Created by VetFinals Powered by

Vet Finals

@VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

1 7:01 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Hello final years! Welcome to tonight’s #vetfinals session

with Kate Griffiths on Pruritis in small animals, thank you to

Kate for providing us with this useful session. We will begin

at 8pm #dermatology #whysoitchy

Andrew Prince

@PathlessWig2060

Ask for a more detailed history, how long has it been

going on for, any other itching or skin complaints before,

does owner or any ther person in the house ahve similar

lesions, does any other animals in the house also have

lesions, whats their ectoparasite treatment, #vetfinals

7:02 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Replying to @VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

C Tickner

@CharTicks

Thorough history: has he had this or skin disease before,

flea/parasite treatment what and when, otherwise

well/any other probs #vetfinals

7:03 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Replying to @VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

Vet Finals

@VetFinals

Great - Derm Hx – include history of prior skin

disease/treatments, ectoparasite control, involvement of

in-contact animals/people #vet finals

Take a history re general health Hx #vetfinals

1 7:04 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Replying to @VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

Vet Finals

@VetFinals

So...No prior derm disease until truncal crusting 6 weeks

ago, resolved with 3 wk course clindamycin. On

sarolaner every 4 wks #vetfinals

7:05 PM - Apr 30, 2019

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Vet Finals

@VetFinals

•Recent otitis, resolved with Surolan. No lesions on in-

contact people. Good general health. Slight weight gain

recently. So now what will you do? #vetfinals

7:05 PM - Apr 30, 2019

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Dave Charles

@djccharles

#vetfinals Detailed Hx incl- any other locations, constant

or on/off itching, how does the O rank it on a 1-10,

parasite treatment used, any past skin disease? Is O

affected? Single or multi pet household, if multi are

others affected? Any changes in diet or environment at

home?

7:06 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Replying to @VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

Claire Potter

@Yumdat

Ask about dietary/environmental changes/previous

episodes? Ask about flea treatments, any other dogs

with similar lesions in the household or any lesions on the

person? Do a thorough clinical examination, possibly

take some samples from the lesion for cytology.

#vetfinals

1 7:08 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Replying to @VetFinals

A 9yo MN Gordon Setter, Blu, presents with history of

inguinal pruritus of 2 weeks’ duration. What will you do?

#vetfinals

Andrew Prince

@PathlessWig2060

Clinical examination, looking for dermatology issues, see

if there is any other skin issues, on legs, between toes,

etc #vetfinals

7:08 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

•Recent otitis, resolved with Surolan. No lesions on in-

contact people. Good general health. Slight weight gain

recently. So now what will you do? #vetfinals

Vet Finals

@VetFinals

Image of left inguinum. Dull coat.No other lesions. Ears

NAD. General exam NAD except BCS 6/9. What are your

top differentials? #vetfinals

7:08 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

Atopic dermatitis

Food allergic dermatitis

ectoparasites (lower down as treated with

sarolaner)#vetfinals

1 7:12 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Image of left inguinum. Dull coat.No other lesions. Ears

NAD. General exam NAD except BCS 6/9. What are your

top differentials? #vetfinals

Vet Finals

@VetFinals

Good! Remember most common causes of pruritus are

infections, ectoparasites and hypersensitivities – check

you’ve thought of these… #vetfinals

7:13 PM - Apr 30, 2019

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Ben Smith

@BenSmit96918936

Bacterial (deep?)pyoderma, malasezia #vetfinals

7:13 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

What are your differentials for the lesion shown? That will

help guide your tests #vet finals

Vet Finals

@VetFinals

Good - investigate further - owner fed up with coming to

the surgery! #vetfinals

7:14 PM - Apr 30, 2019

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Vet Finals

@VetFinals

remember to rule out ectoparasites and infections first!

Then consider allergies (onset a bit late for

environmental atopy) #vetfinals

7:15 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Coat brushings, combings, superficial and deep skin

scrapings, trichograms all unremarkable. Woods lamp –

ve #vetfinals

7:15 PM - Apr 30, 2019

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Dave Charles

@djccharles

Bacterial pyoderma, Malassezia, Hypothyroidism.

Ectoparasites - less likely as O reports regular treatment

#vetfinals

7:16 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Image of left inguinum. Dull coat.No other lesions. Ears

NAD. General exam NAD except BCS 6/9. What are your

top differentials? #vetfinals

Shannon McCall

@Shannon44771562

Pyoderma - Skin scrapes, impression smear

Hypothyroid, HAC - endocrine testing

Food allergy dermatitis - food trial

Contact dermatitis

Dermatophytosis - culture, woodslamp

Neoplasia - biopsy#vetfinals

1 7:16 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

What are your differentials for the lesion shown? That will

help guide your tests #vet finals

Vet Finals

@VetFinals

Cytology... What is your inference and why? #vetfinals

1 7:16 PM - Apr 30, 2019

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Ben Smith

@BenSmit96918936

Still doesn’t rule out ectoparasite or dermatophytosis

#vetfinals

7:16 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Coat brushings, combings, superficial and deep skin

scrapings, trichograms all unremarkable. Woods lamp –ve

#vetfinals

Ben Smith

@BenSmit96918936

Decent sample with abundant neutrophils present. Some

cocci closely localised to neutrophil nucleus, occasional

rods and malasezia #vetfinals

7:19 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Cytology... What is your inference and why? #vetfinals

Vet Finals

@VetFinals

Well done - intracellular cocci (in neutrophil) - what does

this mean and how will you proceed? #vetfinals

7:19 PM - Apr 30, 2019

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Shannon McCall

@Shannon44771562

Active bacterial infection - send sample for culture and

sensitivity. Treat with clindamycin while you wait for the

results. May have been deep pyoderma and 3 weeks

treatment may not have been suffice or may be

resistant to Clindamycin #vetfinals

7:21 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Well done - intracellular cocci (in neutrophil) - what does

this mean and how will you proceed? #vetfinals

Andrew Prince

@PathlessWig2060

There is an active coccal infection so there seems to be

some form of pyoderma, looking at the dog it seems to

be a superficial, so want to treat with antibiotics, but

pyodermas are secondary to another issue, so search

for that #vetfinals

7:22 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Well done - intracellular cocci (in neutrophil) - what does

this mean and how will you proceed? #vetfinals

Vet Finals

@VetFinals

Yes - pyoderma - will be secondary - and chlorhexidine a

good treatment. Remember to only use antibiotics for

superficial pyoderma if topical antiseptics not viable

#vetfinals

1 7:23 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Can treat empirically without culture in this case in this

case as not using antibiotics #vetfinals

7:24 PM - Apr 30, 2019

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Vet Finals

@VetFinals

So you treat with local chlorhexidine washes, and lesions

and pruritus fully resolve. What do you infer from this?

#vetfinals

7:25 PM - Apr 30, 2019

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Ben Smith

@BenSmit96918936

The bacterial infection caused the pruritus #vetfinals

7:26 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

So you treat with local chlorhexidine washes, and lesions

and pruritus fully resolve. What do you infer from this?

#vetfinals

Vet Finals

@VetFinals

Yes, need to look for underlying cause… Any thoughts?

#vetfinals

7:27 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

As it is a recurrent cause (truncal crusting and otitis),

need to look into a cause of these, can do blood testing

for endocrine issues, can do a food trial with a novel

protein source or hydrolysed diet #vetfinals

7:28 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

So you treat with local chlorhexidine washes, and lesions

and pruritus fully resolve. What do you infer from this?

#vetfinals

Ben Smith

@BenSmit96918936

Cutaneous adverse food reaction, atopy,

immunosuppression #vetfinals

7:28 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Yes, need to look for underlying cause… Any thoughts?

#vetfinals

Dave Charles

@djccharles

can consider diet trial 6-8wk (novel protein/ specific diet)

& run bloods to screen for endocrine disease to start

investigation into underlying dz #vetfinals

7:30 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Yes, need to look for underlying cause… Any thoughts?

#vetfinals

Vet Finals

@VetFinals

Underlying allergies less likely now as no pruritus after

resolution of infection, Also environmental atopy unlikely

as older dog at onset (though not always the case!)

#vetfinals

1 7:30 PM - Apr 30, 2019

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Ben Smith

@BenSmit96918936

Problem: weight gain, dull coat

System: endocrine#vetfinals

7:31 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Underlying allergies less likely now as no pruritus after

resolution of infection, Also environmental atopy unlikely

as older dog at onset (though not always the case!)

#vetfinals

Vet Finals

@VetFinals

and serum biochemistry (fasted). Any thoughts? - and

what next?#vetfinals

7:32 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Raised cholesterol and clinical presentation (remember

dull coat, weight gain, no pruritus after resolution of

infection..) all support hypothyroidism.

Blodd results:

Total T4: 5.1 nmol/l (N 10.0-55.0)

TSH: 1.89ng/ml (N 0.01-0.60)

Diagnosis? #vetfinals

7:35 PM - Apr 30, 2019

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C Tickner

@CharTicks

hypothyroidism leading to immunocompromise leading

to pyoderma..start on thyroxine #vetfinals

7:37 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Raised cholesterol and clinical presentation (remember

dull coat, weight gain, no pruritus after resolution of

infection..) all support hypothyroidism.

Blodd results:

Total T4: 5.1 nmol/l (N 10.0-55.0)

TSH: 1.89ng/ml (N 0.01-0.60)

Diagnosis? #vetfinals

Vet Finals

@VetFinals

Yes - hypothyroidism confirmed! Remember underlying

systemic immunosuppressive diseases when infections

seen in older animals, particularly if no prior derm Hx..

#vetfinals

3 7:37 PM - Apr 30, 2019

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Vet Finals

@VetFinals

How will you treat Blu? Monitoring? #vetfinals

7:37 PM - Apr 30, 2019

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Ben Smith

@BenSmit96918936

What is the mechanism for hypothyroidism

immunosuppression? #vetfinals

7:38 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Yes - hypothyroidism confirmed! Remember underlying

systemic immunosuppressive diseases when infections

seen in older animals, particularly if no prior derm Hx..

#vetfinals

Vet Finals

@VetFinals

Yes. Treatment usually oral levo-thyroxine tablets q12h.

Monitor clinical response (HR, demeanour). Measure

peak TT4 levels after 2-3 weeks and adjust. As you say,

coat will be much slower to respond #vetfinals

1 7:39 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Then continue to monitor long term, gradually reducing

frequency to every 3-6 months #vetfinals

7:40 PM - Apr 30, 2019

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Vet Finals

@VetFinals

And now Ben, another pruritic dog! 9mo ME old cross

breed ex rescue, BIOP 3 weeks. Intense generalised

pruritus in past week #vetfinals

7:41 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Good general health. No ectoparasite treatment given.

No other pets.

Derm exam: erythematous papules on ventrum.

Alopecia, erythema, crust on perineum. Continuous

scratching. Gen exam: NAD #vetfinals

7:41 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Differentials? #vetfinals

7:42 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

Demodecosis

Any other parasites - fleas, sarcoptes

A bit too young for allergies#vetfinals

1 7:43 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Differentials? #vetfinals

C Tickner

@CharTicks

demodex, secondary pyoderma (bacteria/malassezia),

environmetnal atopy, FAD #vetfinals

7:44 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Differentials? #vetfinals

Vet Finals

@VetFinals

Yes, well done - allergies possible and certainly

ectoparasites (esp fleas, Sarcoptes, Demodex,) and don't

forget secondary infections (pyoderma/Malassezia)!

#vetfinals

1 7:46 PM - Apr 30, 2019

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Vet Finals

@VetFinals

so what next? #vetfinals

7:46 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

Deep skin scrapes, impression smears on papules, treat

for ectoparasites #vetfinals

7:47 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

so what next? #vetfinals

Dave Charles

@djccharles

Aim to rule out parasites - coat brush / hair pluck, skin

scrape (deep as suspect demodex).

Impression smear?

Trial treatment with ectoparasticides #vetfinals

7:48 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

so what next? #vetfinals

Vet Finals

@VetFinals

Yes - try to establish what's going on as accurately as

you can so you get an improvement asap without

guessing!

So...

Coat comb/brush negative.

Cytology – scant neutrophils, on papules

Wood’s lamp –ve, trichograms NAD

Deep skin scrapings (x100) #vetfinals

2 7:49 PM - Apr 30, 2019

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Vet Finals

@VetFinals

On skin scraping..#vetfinals

7:50 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

Ah, its sarcoptes, everyone wave #vetfinals

1 7:51 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

On skin scraping..#vetfinals

Vet Finals

@VetFinals

Correct! Sarcoptes - remember this particularly if

pruritus marked...

Diagnosis and advice to owner? #vetfinals

7:52 PM - Apr 30, 2019

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Andrew Prince

@PathlessWig2060

Sarcoptes with secondary pyoderma (deep?), need to

put animal on 4-6 weeks of systemic antibiotics

(clindamycin, amoxyclav), make sure treatment with

ectoparasitacides is up to date #vetfinals

7:54 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Correct! Sarcoptes - remember this particularly if pruritus

marked...

Diagnosis and advice to owner? #vetfinals

Vet Finals

@VetFinals

Yes - certainly zoonotic/ contagious. Selamectin,

moxidectin, amitraz all licensed Tx. And treat incontacts.

Any other licensed treatments out there? #vetfinals

7:55 PM - Apr 30, 2019

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Grace Harker

@gracecatriona

#vetfinals treat environment, destroy bedding and treat

with insecticidal spray

7:56 PM - Apr 30, 2019

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Vet Finals @VetFinals · Apr 30, 2019

Correct! Sarcoptes - remember this particularly if pruritus

marked...

Diagnosis and advice to owner? #vetfinals

Vet Finals

@VetFinals

Yes, sarolaner and afoxolaner licensed now. Well done!

#vetfinals

1 7:57 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Yes, If very pruritic can give short course of

prednisolone. Also clear any secondary infection, if

present. #vetfinals

7:59 PM - Apr 30, 2019

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Vet Finals

@VetFinals

Ivermectin is not licensed. It's effective vs sarcoptes but

poor safety profile - we now have lots of safer and

effective options! #vetfinals

2 8:01 PM - Apr 30, 2019

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Vet Finals

@VetFinals

So that's it - very well done - see, you can do it!!

Good night, good luck and thanks for your participation!

#vetfinals

4 8:02 PM - Apr 30, 2019

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