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Laparoscopic Bariatric Surgery!

Dr. Nimisha S Kantharia 87% (10 ratings)
MBBS, MS - General Surgery, DNB, FNB - Minimal Access Surgery, MRCS, FIAGES, FMAS.Laparoscopy, FALS Bariatric Surgery
Laparoscopic Surgeon, Mumbai
Laparoscopic Bariatric Surgery!

Laparoscopic Bariatric Surgery Bariatric surgery is a group of surgical procedures that bariatric surgeons’ resort to in order to treat obesity. Bariatric surgery is not a form of cosmetic or plastic surgery. Surgery is done on the digestive tract, particularly the stomach and/or intestine, and basically follows the principle of restricting the amount of food that the stomach can hold to reduce the amount of body fat and excess weight.

Bariatric surgery may also help to shed weight by decreasing the absorption of certain nutrients by the body. Sometimes, there may be an interplay of both these processes to put a brake on obesity. Bariatric surgery also gives rise to favourable hormonal changes, suching as decreasing ghrelin - the appetite hormone, and increasing anti-diabetic hormone

The most common bariatric surgery procedures are Sleeve Gastrectomy and Gastric Bypass surgeries. These procedures are conducted by laparoscopic technique, through four to five tiny incisions or cuts. Let’s discuss some of the laparoscopic bariatric surgery briefly:

1) Laparoscopic Gastric Bypass

A small stomach pouch is created and joined to the small intestine, around 100-150 cm away from its beginning. This results in two pathways, one for the food which passes from esophagus/food-pipe into the stomach pouch and then to the small intestine (it is called 'bypass’ as the food does not enter and hence 'bypasses' the remaining large portion of stomach and first 100-150 cm of small intestine).

The acid produced by larger remnant stomach, bile produced by liver and the other digestive juices travels along the bypassed route, and mixes with the food at a later point than normal digestive pathway.

2) Laparoscopic Sleeve Gastrectomy

This procedure achieves its weight-loss objective by removing about 70 per cent of the stomach. The remaining portion of stomach resembles a tube-like structure about the size and shape of a banana.

The surgery is done by laparoscopically. The surgeon uses a laparoscope to visualize the stomach and surgical instruments to maneuver inside in order to remove majority of the stomach. There is no intestinal component to this surgery. Sleeve gastrectomy helps to achieve weight loss objective by reducing food intake as well as by its effect on a number of hormones that control hunger, blood sugar etc.

Studies suggest that it can be as effective as the gastric bypass method for weight loss. Laparoscopic Bariatric Surgery is done for obesity after thorough clinical evaluation of the candidate, including assessment of other obesity associated illness like diabetes, high blood pressure, sleep apnea, high cholesterol levels, fatty liver disease, among others.

Certain blood tests, vitamin levels and x-rays, ECG, etc will be done before surgery. After surgery a step-wise, tailored nutrition program will be advised. In the initial few months after surgery, frequent follow up is recommended. Later half-yearly and then annual follow up is a must for optimal results.

Laparoscopic Bariatric Surgery is very effective in treating obesity, as well as the complications due to obesity such as diabetes, high blood pressure, sleep apnea, etc. These are some of the different types of surgeries that can help fight obesity. Doctors guide their patients about the type of surgery that is most suitable for them.

Open Heart Surgery - What All Should You Know

Dr. Amar Nath Shaw 92% (10 ratings)
MCh (CTVS)
Cardiothoracic Vascular Surgery, Patna
Open Heart Surgery - What All Should You Know

Open heart surgery is a complicated heart procedure. Howeevr, it is still an important surgical procedure to fix critical heart ailments.

Here is a quick fact-checker about this procedure:

  • The Coronary Artery Bypass Graft or CABG is one of the frequently performed procedures in the open-heart surgery space. This is a procedure that is related to fixing the blocked arteries of the heart. A study conducted by the National Institutes of Health revealed that most patients who had undergone CABG become angina-free within a span of five years.
  • Many hospitals refuse to share any data related to the surgery. It makes sense to run a background check on the surgeon who is scheduled to perform the procedure. Society of Thoracic Surgery lists all doctors and the number of procedures they have performed in this space.
  • This is one of the few surgeries where a doctor needs to make a deep incision close to 2-2.5 inch through the breastbone to separate muscle and get access to the heart.
  • The recent trend is that the doctor can achieve the same result with beating heart CABG where heart does not need to be stopped just to avoid the complications of heart lung machine Once the procedure is over, the doctor closes the incision made through the breastbone with sternal wires. Subsequently, the patient is taken off from the heart-lung machine.
  • The patient might find himself tangled with many tubes as he wakes for the first time after the surgery. These wires take the fluid out of the body. They serve as a temporary pacemaker for the patient.
  • It is important to get a clarification from the surgeon as to from which location of the body would the veins be taken from to perform CABG. Most doctors prefer the vein from the leg.
  • The patient is kept in an ICU for a couple of days before he is shifted to the general ward where he spends close to a couple of weeks before he is released. After the patient gets home, the typical recovery time for the patient is approximately 6-8 weeks.
  • One has to usually deal with heightened emotions after an open-heart surgery. 

Multivessel Stenting Vs Bypass Surgery - Which Is Better?

Dr. Sachin Hundekari 85% (10 ratings)
MBBS, MD - Medicine, DNB (Cardiology)
Cardiologist, Pune
Multivessel Stenting Vs Bypass Surgery - Which Is Better?

The results of a study conducted by the Department of Medicine, University of Ulsan, Korea, show that multivessel coronary stenting can be performed with a high success rate along with an acceptable clinical outcome. Coronary stenting has proven itself to be an accepted means for treating of obstructed coronary arteries. The need for multivessel coronary stenting has been inflated because of the larger number of patients with unfavourable cardiac profiles. Conventionally, bypass surgery is regarded as a standard means for relieving angina in cardiac patients with multivessel coronary disease as it could lead to a downright revascularization. Further, it also allows a prolongation of lifespan in a specified subgroup of patients.

How are they performed?

Despite the coming of modern generation of stents, patients with multiple stringent arteries in the heart receiving coronary after bypass have recovered better than those whose arteries were grafted with balloon angioplasty or stenting. This report is presented in the 64th Annual Scientific Session in the American College of Cardiology. This report echoes past studies which shows that patients afflicted with multiple narrowed arteries receive better results with coronary artery bypass grafting, which is also known as CABG or bypass heart surgery. In case of multivessel stenting, which is known as angioplasty or percutaneous coronary intervention or PCI, a stent is put within the arteries to hold it wide open and facilitate the flow of blood.

Which one is better?

In a new study, it is reported that patients with new stents are susceptible to 47% higher risk of any of the outcomes like death or cardiac arrest as compared to patients who undergo bypass surgery. In CABG, a vein or artery from other parts of the body is grafted on the constricted coronary artery for allowing easy blood flow to and from heart. This study reinforces present regulations that recommend CABG to treat patients with substantial constrictions in various arteries, a condition often termed as multivessel coronary artery ailment.

Renowned cardiologist Seung Jung Park from Asan Medical Centre in Seoul, South Korea opines that CABG is still a much preferred option on the basis of their medical data. Another study known as Bypass Surgery Versus Everolimus - Eluting Stent Implantation for Multivessel Coronary Artery Disease or BEST trial deserves mention. It is one of the two randomly controlled trials for comparing bypass to angioplasty since the introduction of modernised stents that emits medication, which would prevent blood clot.

This study was implemented on 880 patients at 27 healthcare centres in four countries. Each patient had multivessel coronary artery disease and were determined to be equally eligible to go through either of the methods. Half of these patients were randomly chosen to be given angioplasty with everolimus-eluting stents, and the other half received bypass surgery.

All the patients were tracked for about five years and during this prolonged follow up, angioplasty was related to a considerable upsurge in the incidence of myocardial infarction, target vessel revascularization and often death. Because, it is a more invasive process, bypass surgery is normally recommended only for patients afflicted with higher-risk constrictions in more than one artery.

If you are one of these patients and this concern plagues you, it is recommended to talk to your cardiologist without much delay.

5 people found this helpful

Multivessel Stenting Vs Bypass Surgery - Which Should Be Preferred?

Dr. Nikhil Pendse 88% (10 ratings)
MCh - Cardio Thoracic & Vascular Surgery, MBBS, MS - General Surgery
Cardiologist, Bhopal
Multivessel Stenting Vs Bypass Surgery - Which Should Be Preferred?

The results of a study conducted by the Department of Medicine, University of Ulsan, Korea, show that multivessel coronary stenting can be performed with a high success rate along with an acceptable clinical outcome. Coronary stenting has proven itself to be an accepted means for treating of obstructed coronary arteries. The need for multivessel coronary stenting has been inflated because of the larger number of patients with unfavourable cardiac profiles. Conventionally, bypass surgery is regarded as a standard means for relieving angina in cardiac patients with multivessel coronary disease as it could lead to a downright revascularization. Further, it also allows a prolongation of lifespan in a specified subgroup of patients.

How are they performed: Despite the coming of modern generation of stents, patients with multiple stringent arteries in the heart receiving coronary after bypass have recovered better than those whose arteries were grafted with balloon angioplasty or stenting. This report is presented in the 64th Annual Scientific Session in the American College of Cardiology. This report echoes past studies which shows that patients afflicted with multiple narrowed arteries receive better results with coronary artery bypass grafting, which is also known as CABG or bypass heart surgery. In case of multivessel stenting, which is known as angioplasty or percutaneous coronary intervention or PCI, a stent is put within the arteries to hold it wide open and facilitate the flow of blood.

Which one is better: In a new study, it is reported that patients with new stents are susceptible to 47% higher risk of any of the outcomes like death or cardiac arrest as compared to patients who undergo bypass surgery. In CABG, a vein or artery from other parts of the body is grafted on the constricted coronary artery for allowing easy blood flow to and from heart. This study reinforces present regulations that recommend CABG to treat patients with substantial constrictions in various arteries, a condition often termed as multivessel coronary artery ailment.

Renowned cardiologist Seung Jung Park from Asan Medical Centre in Seoul, South Korea opines that CABG is still a much preferred option on the basis of their medical data. Another study known as Bypass Surgery Versus Everolimus - Eluting Stent Implantation for Multivessel Coronary Artery Disease or BEST trial deserves mention. It is one of the two randomly controlled trials for comparing bypass to angioplasty since the introduction of modernised stents that emits medication, which would prevent blood clot.

This study was implemented on 880 patients at 27 healthcare centres in four countries. Each patient had multivessel coronary artery disease and were determined to be equally eligible to go through either of the methods. Half of these patients were randomly chosen to be given angioplasty with everolimus-eluting stents, and the other half received bypass surgery.

All the patients were tracked for about five years and during this prolonged follow up, angioplasty was related to a considerable upsurge in the incidence of myocardial infarction, target vessel revascularization and often death. Because, it is a more invasive process, bypass surgery is normally recommended only for patients afflicted with higher-risk constrictions in more than one artery.

If you are one of these patients and this concern plagues you, it is recommended to talk to a cardiologist without much delay.

1677 people found this helpful

Bariatric Surgery - How Does It Benefit Diabetes Patients?

Dr. Anjanjyoti Sarma 90% (434 ratings)
MCh(Minimally Invasive & Robotic Surgery), MS - Surgical, MBBS
General Surgeon, Guwahati
Bariatric Surgery - How Does It Benefit Diabetes Patients?

Diabetes is a gnawing problem that affects millions throughout the world. It is a disorder that if overlooked can lead to serious diseases; cardiovascular ailments, problems related to vision, kidney problems and many more. While medication tries to regulate your blood sugar levels, it is not always unfailing.

Medication along with changes in your diet and lifestyle can still not improve your condition in certain cases. At times it is hard to increase the insulin production in a person's body even after administering medicines solely known for their efficacy. Such kind of diabetic patients can therefore benefit from a Bariatric surgery.

What is a Bariatric surgery?

Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity. Obesity in combination with diabetes can make a person's life miserable. The treatment of one can come in the way of curing the other. A diabetic patient who also suffers from obesity usually finds it hard to lose weight in spite of exercising or being on diet.

Surgery comes to their rescue. This kind of surgery should be fallen back upon as the lender of last resort that is to say when other solutions have not helped. Bariatric surgery is always performed under skilled supervision. It might include reduction of the size of your stomach, removal of a portion of the stomach, or even gastric bypass surgery.

How does Bariatric surgery help reduce Diabetes?

Diabetes can be of three basic kinds;

Type 1 diabetes in which the body produces no amount of insulin.

Type 2 diabetes in which the body produces an insufficient amount of insulin or Gestational diabetes that pregnant women tend to contract.

Bariatric surgery proves to be very advantageous for patients of Type 2 diabetes:

1. Surgery lowers blood sugar levels considerably. Research shows people with acute diabetes made huge improvements after having undergone a Bariatric surgery. Their blood sugar levels dropped by a noticeable percentage and they felt healthier. Reduced blood sugar is an almost immediate effect in some while for others it does take some time.

2. Bariatric surgery exercises a control over cholesterol, blood pressure and triglyceride levels.

3. The impressive benefits of this operation for a Type 2 diabetes patient are not superficial or temporary. If the patient adheres to the lifestyle prescribed by a doctor, takes medication regularly and follows the basics of post- operative care he or she is likely to remain beyond the ambit of this metabolic disorder.

4. It successfully takes care of ailments resulting from diabetes.

5. Bariatric surgery can eliminate the need for medication or it can reduce the dosage of medicines you take.

1790 people found this helpful

Gastric Bypass Surgery - Everything You Should Know!

Dr. Sudhir Jadhav 90% (12 ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery, MS - General Surgery, Fellowship In Minimally Invasive Bariatric Surgery
Laparoscopic Surgeon, Pune
Gastric Bypass Surgery - Everything You Should Know!

Gastric bypass is a kind of bariatric surgery, which helps in weight loss. This surgery aims to make changes so that your stomach becomes smaller than it used to be. This limits the amount of food you consume and effectively helps you to reduce weight.

Are you fit for the surgery?

Not everybody can go in for this surgery. Your doctor will recommend this surgery after careful evaluation. These are the parameters based on which your doctor will make a decision-

• Your medical history - If you suffer from sleep apnoea, heart ailments, liver diseases, kidney stones or if you have blood clots then you might have to undergo the surgery.

• Your psychological status - Sometimes obesity is the outcome of certain psychological ailments. A doctor will first ensure that these conditions are addressed before you go under the knife.

How is the surgery performed?

Gastric bypass operation is performed under general anaesthesia so you will be asleep for the entire duration of the surgery and it will be pain-free. The surgery is done laparoscopically. Tiny incisions are made through which scope and fine surgical instruments are introduced into the abdominal cavity. The camera guides the surgeon by providing live images from inside the body. Laparoscopic gastric surgery is advantageous because the wound heals faster and does not leave any marks.

Sometimes your surgeon might opt for an open surgery where she/he makes a large incision to reach the stomach.

There are two major steps to the surgery-

• The aim of the surgery is to make the stomach smaller so the surgeon divides it into two portions with staples. The food that you eat will go into the upper part (the pouch) of the stomach. The reduced upper stomach can hold at the most 28 grams of food so you are forced to eat less than usual. This will help you lose weight.

• The other step is the bypass surgery. After the pouch is created, the surgeon links it to the small intestine through the small hole in the pouch. This way, food will pass directly from the pouch to the small intestine. The surgery takes around 3-4 hours. You will be kept under observation for a couple of days and you will be released from the hospital in a week.

Gastric bypass operation is an effective and simple surgery that can help you reach your weight goals when you have a very high BMI and most other dietary restrictions have not been successful.

3772 people found this helpful

Acute Coronary Syndrome - How To Manage It?

Dr. Deepesh Venkatraman 85% (10 ratings)
MBBS Bachelor of Medicine and Bachelor of Surgery, DNB-Cardialogist, DM - Cardiology
Cardiologist, Bangalore
Acute Coronary Syndrome - How To Manage It?

The word acute coronary syndrome refers to a group of symptoms that are caused by blockage of the blood flow to the heart muscles.  The most common result of this is myocardial infarction or heart attack as it is popularly called. Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives. 

Symptoms:  The tell-tale signs of a heart attack are as follows:
- Chest pain and discomfort usually described as a tightness or burning in the chest region
- Pain along the left side of the shoulder and neck, going up into the jaw, down to the arm
- Nausea and vomiting 
- Profuse sweating 
- Difficulty breathing 
- Dizzy or fuzzy feeling 
- Tired, extreme fatigue
- Anxious, apprehensive feeling 

However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks, and depending on severity, either they go on with life as usual or can have a fatal attack.

Diagnosis: Once you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis.  In addition to a detailed examination and history, the following two tests will be performed.

- Electrocardiogram (ECG): A 12-lead ECG will measure electrical activity of the heart and identify irregular electrical activity which is indicative of a myocardial infarction.

- Blood tests:  Presence of certain enzymes in the blood, CK-MB and troponin, are indicative of a heart attack.  A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.

- In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.


Management:  Once diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function. 

- Dissolve the clot - Using thrombolytics like clopedigrol 

- Nitroglycerin - To dilate the blood vessels and improve blood flow, especially to the heart muscles

- Anticoagulant therapy - Blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.

- Blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ACE) inhibitors are also used

- Statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.
In very severe cases, angioplasty and stenting or coronary bypass surgery may be required.

Educating people on how to identify a heart attack and manage it is very useful and can help save lives.
 

2573 people found this helpful

How To Recover Quickly After Heart Surgery?

Dr. Akhter Ahmad Ganai 92% (10 ratings)
MS, Fellowship in Minimal Access Surgery, Fellowship of Indian Association of Gastrointestinal Endo Surgeons (FIAGES), FALS(Fellow Advanced Laparoscopic Surgery)
General Surgeon, Srinagar
How To Recover Quickly After Heart Surgery?

Once the heart surgery is complete, the initial recovery process from the wounds and incisions can take almost two months. The doctor will give you instructions on how to take care of yourself post-surgery so you recuperate faster and be back in the pink of health.

Road to recovery

  1. The first step is to take care of the wounds; make sure that you keep the area of the incision dry. Avoid taking baths for the first few days. If you notice any sign of infection such as redness around the area, pus oozing out or high fever, then do not waste time consult a doctor. Experiencing symptoms such as the breastbone shifting and cracking when you move should not be disregarded at all.
  2. Post-surgical pain is another area that you need to address. The area adjoining the incision can be painful till the first few weeks pass and there may be pain and stiffness in the surrounding muscles as well. In case of a bypass surgery, the legs may hurt if the veins from the legs were used as grafts. The pain and the soreness will recede with time.
  3. Avoid heavy activity for the first two months post-surgery. Start with small tasks, and gradually build up your activity levels so that the body gets used to it. Avoid activities such as standing for 15 minutes or more at the same place and lifting heavy things. Make sure to consult your physiotherapist before you start with light exercises such as walking.
  4. The recovery process also depends on the type of food you eat; because eating healthy food can certainly rev up the recovery process. Initially, you may not feel like eating much, so get your appetite up in a gradual manner. It is best to avoid any junk meal at this point in time as that can adversely affect your body’s metabolism even further. It is important that you get the required amount of rest so that your body can recuperate.
2821 people found this helpful

Blockages In Heart Arteries - What Should You Know?

Dr. Aman Makhija 87% (10 ratings)
DM - Cardiology, MBBS, MD - Medicine, Training in Electrophysiology
Cardiologist, Delhi
Blockages In Heart Arteries - What Should You Know?

Blockage in heart is a common term used for narrowing of coronary arteries. Coronary arteries are vessels, which supply blood and thus oxygen and food to continuously working heart muscles. Heart muscles, which are not tired working from the birth till death, however, cannot sustain long without blood supply.

A reduction in blood supply gives rise to ischemia of heart muscles commonly manifested as chest discomfort or angina. A sudden complete shutdown of blood supply leads to heart attack leading to permanent damage to heart (if blood flow not reestablished promptly).

But what causes these arteries to block? Deposition of LDL cholesterol (low density cholesterol) in inner surface of coronary arteries is the primary reason of these blockages. LDL a normal component of blood (upto certain limit) starts depositing in arteries as early as 10 years of age!

Deposition of billions of LDL molecules over several years on inner surface of arteries gives rise to visible narrowings in these arteries. Flow ahead of these narrowings is reduced in proportion to the narrowing. At a level of 70 % narrowing the flow is reduced to give ischemia (and angina) during exercise. Gradually increasing degree of narrowing reduces the exercise needed for ischemia and angina; a narrowing of more than 90 % can give symptoms at rest. A sudden clot formation at any of these stages can block the flow suddenly giving a heart attack.

If LDL is a normal component of blood, why it is deposited in the arteries at first place?
LDL above a certain limit in blood starts depositing in the arteries. DiabetesHypertensionsmoking, less exercise and genetics makes it more sticky thus making narrowing faster. This is why these risk elements need to be properly attended for prevention from heart disease.

For treatment medicines are important for stopping the progression of narrowings; angioplasty is a method of fast resolution of blockage; and bypass surgery is the method of creating a whole new blood supply for the affected part of the heart.

Acute Coronary Syndrome - How To Diagnose It?

Dr. Avadhesh Khare 89% (49 ratings)
MBBS, DM - Cardiology, MD - Medicine
Cardiologist, Bhopal
Acute Coronary Syndrome - How To Diagnose It?

The word acute coronary syndrome refers to a group of symptoms that are caused by blockage of the blood flow to the heart muscles.  The most common result of this is myocardial infarction or heart attack as it is popularly called. Reduced blood flow leads to death of some portion of the heart muscle wall. While the word heart attack sounds almost fatal, it need not be the case. Knowing how to identify an attack and being aware of some simple measures can help save lives. 

Symptoms

The tell-tale signs of a heart attack are as follows:

  1. Chest pain and discomfort usually described as a tightness or burning in the chest region
  2. Pain along the left side of the shoulder and neck, going up into the jaw, down to the arm
  3. Nausea and vomiting 
  4. Profuse sweating 
  5. Difficulty breathing 
  6. Dizzy or fuzzy feeling 
  7. Tired, extreme fatigue
  8. Anxious, apprehensive feeling 

However, be also aware that there are a lot of people who experience a silent heart attack. Women, obese, elderly, and diabetic patients can have silent attacks, and depending on severity, either they go on with life as usual or can have a fatal attack.

Diagnosis

Once you are doubtful of a heart attack, the next step is to reach the closest medical facility for a diagnosis.  In addition to a detailed examination and history, the following tests will be performed.

  1. Electrocardiogram (ECG): A 12-lead ECG will measure electrical activity of the heart and identify irregular electrical activity which is indicative of a myocardial infarction.
  2. Blood tests:  Presence of certain enzymes in the blood, CK-MB and troponin, are indicative of a heart attack.  A complete electrolyte profile also will be done, and increase or decrease of some electrolytes is helpful in diagnosing a heart attack.
  3. In addition to these two, chest radiography, cardiac angiography, echocardiogram, stress test, and computed coronary tomography may also be required to confirm the diagnosis.

Management

Once diagnosed, the first step would be to relieve the symptoms, negate the effects of reduced blood flow, and restore cardiac function. 

  1. Dissolve the clot - Using thrombolytics like clopedigrol 
  2. Nitroglycerin - To dilate the blood vessels and improve blood flow, especially to the heart muscles
  3. Anticoagulant therapy - Blood thinners are usually used to avoid blood clot formation; aspirin and heparin are the most commonly used agents.
  4. Blood pressure maintaining drugs like beta blockers and/or angiotensin-converting enzyme (ACE) inhibitors are also used
  5. Statins are used to reduce the amount of cholesterol in the blood and stabilize plaque deposits.

In very severe cases, angioplasty and stenting or coronary bypass surgery may be required.

Educating people on how to identify a heart attack and manage it is very useful and can help save lives.
 

2785 people found this helpful
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