vitamin b12 deficiency in diabetic patientsvitamin b12 deficiency in diabetic patients

Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). The study does not explore the relationship between various factors and vitamin B12 deficiency, including dietary details, a vegan diet, alcohol history, use of multivitamins etc. Among those who took metformin for at least 1 year, 9 had vitamin B12 level < 240 pg/ml (56.2%); 23 diabetic patients did not get metformin and only 4 had vitamin B12 level < 240 pg/ml (17.4%) (P = 0.014). The questionnaire was piloted on five physicians to determine consistency and validity of the questionnaire. Haeusler S, Parry-Strong A, Krebs JD. Make sure to take a regular intake of this vitamin for diabetes and treatment of other diseases. Such conditions affect the activity of gut cells that in turn reduces the level of vitamin B12 when it passes through it. Methods: Liu et al. The prevalence of vitamin B12 deficiency was 6.6%. An official website of the United States government. The most commonly used oral hypoglycemic agent was gliclizide only in 138 (38.4%) of patients. Unlike diabetes type 1, diabetic patients with type 2 diabetes have a 10% more risk of getting its deficiency. WebVitamin B 12 deficiency, (IR) and those without. Vitamin B12 deficiency due to metformin occurs because it interferes with the complex of B12-IF. Vitamin B12 deficiency is both underdiagnosed and undertreated [ 7, 8 ]. PMC BMJ 2010. c2181. Metab., 101 (2016), pp. Aust Fam Physician. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and nutritional yeast, are fortified. Generally, vitamin B12 supplements start showing their effect after 48 to 72 hours of the initial dose. 2017;65:10616, 20. 405412. The data collection was done in the clinic using a data extraction form. The mean duration of T2DM was 9.88 7.32 years (range: 135 years). Regulate your bodys diabetes level by regulating the amount of vitamin B12. Front Microbiol. Of all the patients 17 were already considered to be deficient in B12. Snchez H, Masferrer D, Lera L, Arancibia E, Angel B, Albala C. Vitamin B12 deficiency associated with high doses of metformin in older people diabetic Nutr Hosp. Unauthorized use of these marks is strictly prohibited. -, Aroda VR, Edelstein SL, Goldberg RB, Knowler WC, Marcovina SM, Orchard TJ, Bray GA, Schade DS, Temprosa MG, White NH, et al. BMC Pharmacol Toxicol. Metformin-induced vitamin B12 deficiency presenting as a peripheral neuropathy South Med J. When IF binds with Vitamin B12, a vitamin B12-IF complex forms, this complex plays a vital role in the absorption of vitamin B12 in your body. The countries in the MENA region now have some of the highest rates of diabetes. Compared with participants with normal Vitamin B12 levels, deficient participants were older (64 vs. 56 years, p=0.014), had longer metformin use duration (7 vs. 4 years, p=0.024), had low haemoglobin (13.4 vs. 12.8; p=0.038) and used acid blockers (p=0.012). Endocrinol. WebVitamin B-12 deficiency anemia is a condition in which your body does not have enough healthy red blood cells, due to a lack (deficiency) of vitamin B-12. Adults with type 2 diabetes and low levels of vitamin B12 could be more likely to experience cardiovascular autonomic neuropathy (CAN), according to new findings. There were only 16 patients (4.4%) who had available serum vitamin B12 levels. Research on the use of vitamin B-12 for specific activities and conditions shows: Most people get enough vitamin B-12 from a balanced diet. Vitamin B12 deficiency symptoms Symptoms due to anaemia These are caused by the Vitamin B12 levels were checked in all the patients and value of 150 pmol/L was taken as normal. In this study, we found that only 4.4% of the study population had available serum vitamin B12 levels, which means that serum levels of vitamin B12 are not routinely requested. When your immune system disturbs, stomach cells fail to produce IF protein that is also required to absorb dietary vitamin B12. Cited by lists all citing articles based on Crossref citations.Articles with the Crossref icon will open in a new tab. Severe peripheral neuropathy has, however, been reported among T2DM patients.Citation5052 This is common among patients on metformin due to drug-induced vitamin B12 deficiency.Citation50,Citation53 Vitamin B12 deficiency causes elevated homocysteine and methylmalonic acid, which has been shown to have potentially toxic effects on neurons. Data is temporarily unavailable. The first possible treatment option is to look at your diet. 2022 Mar 16;58(3):430. doi: 10.3390/medicina58030430. First, one of the most common and most debilitating symptoms of vitamin B12 deficiency is extreme fatigue, tired all the time and in some patients also insomnia. Your message has been successfully sent to your colleague. information submitted for this request. 2010;103:2657, 7. Filioussi K, Bonovas S, Katsaros T. Should we screen diabetic patients using biguanides for megalobastic anemia? It is because diabetics mostly take metformin, which is a well-known treatment of Type-2 diabetes. 2021 Oct 18;2021:8745968. doi: 10.1155/2021/8745968. Federal government websites often end in .gov or .mil. Even though vitamin B-12 is safe if you take too much, it can interact negatively with certain medications. Chloramphenicol, a type of antibiotic, affects how your body responds to B-12. Even though you're taking a large dose of B-12, the medication limits the vitamin's function. A total of 6 of the 16 patients (37.5%) used PPI, and 11 (68.8%) had Vitamin B12 supplementation. Type 2 other information we have about you. We wanted to determine the prevalence of vitamin B12 deficiency in metformin-treated type 2 diabetes mellitus patients. Vitamin B12 deficiency in patients with . https://doi.org/10.1080/16089677.2021.1927586, Medicine, Dentistry, Nursing & Allied Health, Vitamin B12 levels (pmol/l), median (IQR), Duration of metformin use (years), median (IQR). 2012;35:32733, 9. It was thought that the use of PPI contributes to vitamin B12 deficiency,[32] which may add to the vitamin B12 deficiency status of T2DM patients. One such major complication is damage to nerves due to very high blood glucose levels for a long period. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Its all about the vitamin B12 that gets absorbed into our blood from the small intestine. Accessed Jan. 9, 2021. The prevalence of low vitamin B12 status in people with type 2 diabetes receiving metformin therapy in New Zealand--A clinical audit N Z Med J. Wolters Kluwer Health Metformin Treatment: A Potential Cause of Megaloblastic Anemia in Patients with Type 2 Diabetes Mellitus. 2019 Aug;69(Suppl 3)(8):S40-S44. WebVitamin B12 is a water-soluble vitamin involved in DNA synthesis, haematopoiesis and neurological function. (10.3346/jkms.2014.29.7.965) 2019 May 23;7:2050312119853433. doi: 10.1177/2050312119853433. One standard first-line treatment for diabetes is metformin, which was reported to increase the risk for vitamin B12 deficiency. While in anemia, the number of healthy red blood cells to carry out oxygen depletes. government site. Allen LH. Unable to load your collection due to an error, Unable to load your delegates due to an error. Fuchs HE, O'Connell K, Du M, Navarro SL, Brasky TM, Kantor ED. By closing this message, you are consenting to our use of cookies. Causes and pathophysiology of vitamin B12 and folate deficiencies. Such patients are also more vulnerable to pernicious Armenia. Vitamin B12 deficiency is common with increased age, long duration of metformin use and acid blockers. Long term treatment with metformin in patients with type 2 diabetes and risk of vitamin B12 deficiency: randomised placebo controlled trial, Vitamin B12 status of patients treated with metformin: a cross-sectional cohort study, Metformin-associated vitamin B12 deficiency in the elderly, Vitamin B12 in metformin-treated diabetic patients: a cross-sectional study in Brazil, Increased intake of calcium reverses vitamin B12 malabsorption induced by metformin, Autoimmune gastritis in type 1 diabetes: a clinically oriented review, Accuracy of body mass index in diagnosing obesity in the adult general population, Development and validity testing of the neuropathy total symptom score-6: questionnaire for the study of sensory symptoms of diabetic peripheral neuropathy, Diagnosis of cobalamin deficiency: the old and the new, Conclusions of a WHO technical consultation on folate and vitamin B12 deficiencies. WebFrequent doses of metformin can result in vitamin b12 deficiency. The mean serum vitamin B12 level of all 16 patients was 558.46 318.01 pg/mL (range of 1741288 pg/mL). 2016;42:31627, 15. 4 How long do vitamin B12 supplements take to work for diabetes treatment? Unauthorized use of these marks is strictly prohibited. Thus, you can take an intramuscular injection to boost the absorption of vitamin B12 in the blood. This content does not have an English version. [30] Metformin causes gastrointestinal disturbances when started at a higher dose and with long-term use through competitive inhibition or inactivation of Cb1 absorption, alterations in the intrinsic factor levels, interactions with the cubulin endocytic receptor, and antagonism of the calcium-dependent ileal membrane. J. Clin. [Figure 1] A total of 51 (51.0%) order vitamin B12 testing supplementation only if they have symptoms of neuropathy, 9 (9.0%) if patients have anemia, 19 (19.0%) routinely order vitamin B12 testing, and 21 (21.0%) never prescribe vitamin B12 to their patients [Figure 2]. People who don't get enough vitamin B-12 may have a higher risk of neuropathy and other nervous system (neurological) problems. To estimate the prevalence of Vitamin B12 deficiency among patients with diabetes. The https:// ensures that you are connecting to the Severe deficiency (e.g., pernicious anemia) may lead to macrocytic anemia, peripheral neuropathy, and mental-psychiatric disorders [ 9, 10 ]. -, de Jager J, Kooy A, Lehert P, Wulffel MG, van der Kolk J, Bets D, Verburg J, Donker AJ, Stehouwer CD. The .gov means its official. (10.1007/bf00427979) Biochemical B 12 deficiency was defined as serum B 12 concentrations 148 pmol/L and borderline deficiency was defined as >148 to 221 pmol/L. information highlighted below and resubmit the form. Vitamin deficiency anemia is a lack of healthy red blood cells caused by lower than usual amounts of vitamin B-12 and folate. Hallucinations. There are some limitations of this current study. The use of vitamin B12 supplement, duration of T2DM and duration of metformin use was significantly higher among females. Vitamin B12 deficiency is highly prevalent, especially in patients with diabetic neuropathy. (10.1210/jc.2015-3754) Standards of medical care in diabetes Diabetes Care. An estimated sample size of 354 patients was calculated. Vitamin B12 deficiency and diabetic neuropathy are very high among metformin-treated T2DM patients and it is associated with increased GPA, IFA, TNF- and cardiometabolic risk factors (higher LDL and TC and lower HDL). Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? to maintaining your privacy and will not share your personal information without A large percentage of physicians are not aware of the current recommendations of the ADA regarding vitamin B12 supplementation and screening. Results About 29.66% of diabetic patients had confirmed the B12 insufficiency through laboratory tests. No potential conflict of interest was reported by the author(s). Would you like email updates of new search results? Taking omeprazole (Prilosec), lansoprazole (Prevacid) or However, our findings should be interpreted while considering several limitations. Vitamin B12 deficiency was found in 96 (49.1%) of the patients. -, Ko SH, Ko SH, Ahn YB, Song KH, Han KD, Park YM, Ko SH, Kim HS. These symptoms are pain and numbness in the arms, legs, hands, and feet. In those with diabetic neuropathy, altered (low and borderline) vitamin B12 level was 64% (95% CI: 47-78%) compared to 17% (95% CI: 10-26%) in patients without diabetic neuropathy (coefficient: -110.8; CI 95%: -165.8, -59.7). These tests were not used in our setting, not because of their high cost but because they are routinely unavailable. Irritability. However, it may lower vitamin B12 concentrations, which could have hematological or neurological implications. Antiparietal cell antibodies occur in 90% of patients with pernicious anemia but in only 5% of healthy adults. In previous studies, a significant association between vitamin B12 deficiency and low haemoglobin concentration was also reported.Citation44,Citation45 Inadequate vitamin B12 results in ineffective DNA synthesis and impaired erythropoiesis, which may account for significantly low haemoglobin among vitamin B12 deficient patients.Citation46. 5 Howick Place | London | SW1P 1WG. Berchtold P, Bolli P, Arbenz U, Keiser G. Disturbance of intestinal absorption following metformin therapy (observations on the mode of action of biguanides) [in German]. 2003;32:3834, 25. The majority were females (67.2%) and those with type 2 diabetes (92.9%). Endocrinol. September 5, 2016. It has been suggested that healthy people can have low levels of vitamin B12, and much more vitamin B12 deficiency commonly occurs in around 6% of elderly patients aged 60 years with prevalence increasing with age. General multivitamins (6 g) was found to be not enough to correct vitamin B12 deficiency particularly among those with diabetes.[8]. It is believed that malabsorption of vitamin B 12 in diabetic patients, is due to individuals taking metformin therapy per ml (148 or 185 picomoles per liter). The overall median (IQR) HbA1c and haemoglobin were 7.4 (6.49.2) % and 3g/dl. Conclusions In type 2 diabetic patients, treatment with metformin is associated to lower vitamin B 12 plasma levels. Well, vitamin B12 does not play a role in the management of blood glucose levels. Hunt A, Harrington D, Robinson S. Vitamin B12 deficiency Bmj. Recommended articles lists articles that we recommend and is powered by our AI driven recommendation engine. Vitamin B12 deficiency is very serious because it leads to certain complications, including diabetes and anemia. There were 39 diabetic patients, 16 took metformin for at least 1 year. Patients were given a single tablet of B vitamins containing 2.5 milligrams of folic acid, 25 milligrams of vitamin B6 and one milligram of vitamin B12 per day for 36 months or a matching placebo. Registered in England & Wales No. WebVitamin B 12 deficiency, (IR) and those without. Bethesda, MD 20894, Web Policies Vitamin B-12 injections or nasal spray might be prescribed to treat vitamin B-12 deficiency. In addition, female patients had higher levels of vitamin B12 compared to men (coefficient: 49.1; CI 95%: 2.3-95). Please enable it to take advantage of the complete set of features! Facts & Comparisons eAnswers. 1754-1761, 10.1210/jc.2015 Problems concentrating. Objective: 2020 Oct 21;13:3873-3878. doi: 10.2147/DMSO.S270393. Some people are vegetarian or vegan and dont eat animal products at all. Moreover, the risk of vitamin B12 deficiency also increases with increased metformin dose and duration of its use. 2014;29:96572, 13. de Jager J, Kooy A, Lehert P, Wulffele M, van der Kolk J, Bets D, et al Long-term treatment with metformin in patients with type 2 diabetes and risk of vitamin B-12 deficiency: Randomised placebo-controlled trial BMJ. The duration of metformin use is dependent on the patients history and thus subject to recall bias. your express consent. While the recommended daily amount of vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to be safe. Niafar M, Hai F, Porhomayon J, Nader N. The role of metformin on vitamin B12 deficiency: A meta-analysis review Intern Emerg Med. Vitamin B12 The prescription diabetes medication metformin can lead to vitamin B12 deficiency, and up to 30% of people who take metformin may have low B12 levels. You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Nathan DM, Buse JB, Davidson MB, Ferrannini E, Holman RR, Sherwin R, et alAmerican Diabetes Association; European Association for Study of Diabetes. Associations between Vitamin B12 deficiency and age, duration of diabetes mellitus, duration of use and dosage of metformin, and use of PPIs or histamine H2 antagonists were determined using Pearson's correlation test. We took more patients from King Salman Hospital because it has the largest number of registered diabetic patients. Results were expressed as numbers and percentages for categorical variables and as mean and standard deviation (SD) for continuous variables. Its due to metformin therapy that boosts vitamin B12 depletion in the human body. Before 1 The prevalence of vitamin B12 deficiency in diabetes mellitus Also, a single-centre nature of the study limits the generalisation of the study findings. A total of 100 physicians responded and consented to participate in the study. WebVitamin B 12 deficiency, (IR) and those without. Though vitamin B12 is commonly taken to increase energy levels, evidence showing that B12 supplements improve energy levels in people without a deficiency is lacking. 2012;60:5860, 32. There are a few different options as far as how you can treat your vitamin b12 deficiency if you are diabetic. [24] Although vitamin B12 deficiency is a common but not serious condition, it is deemed important to treat patients to avoid neurological impairment even if there may be discordance between the results and clinical features. PN was significantly associated with female gender and poor glycemic control and was not associated vitamin B12 deficiency or metformin use. Regular vitamin B12 assessment may be beneficial, especially among diabetes patients who are old, those taking metformin over a long duration and patients on acid blockers. FOIA Bethesda, MD 20894, Web Policies Vitamin B 12 deficiency was defined as vitamin B 12 300 pg/mL without folate deficiency (folate > 4 ng/mL). Tofu, and feet doses have been found to be safe K, Bonovas,... The most commonly used oral hypoglycemic agent was gliclizide only in 138 ( vitamin b12 deficiency in diabetic patients %.! ( S ) in your inbox boosts vitamin B12 deficiency to nerves to. ( 10.1210/jc.2015-3754 ) Standards of medical care in diabetes diabetes care a well-known treatment of other diseases deviation! Hunt a, Harrington D, Robinson S. vitamin B12 deficiency of 354 patients calculated... A new tab which was reported to increase the risk of vitamin B12 deficiency due metformin... Subject to recall bias supplement, duration of metformin use and acid.. Associated to lower vitamin B 12 plasma levels, unable to load delegates. And as mean and standard deviation ( SD ) for continuous variables of medical in! Subject to recall bias out oxygen depletes patients was 558.46 318.01 pg/mL ( range of 1741288 )!, affects how your body responds to B-12 new tab pg/mL ( range of 1741288 pg/mL.! Piloted on five physicians to determine the prevalence of vitamin B12 deficiency due to metformin occurs it! Negatively with certain medications use was significantly associated with female gender and poor glycemic control was. Who had available serum vitamin B12 deficiency also increases with increased metformin dose and duration metformin! A free Taylor & Francis Online account you can treat your vitamin B12, such vitamin b12 deficiency in diabetic patients breakfast cereals bread. Estimate the prevalence of vitamin B12 depletion in the management of blood glucose levels for a period! The overall median ( IQR ) HbA1c and haemoglobin were 7.4 ( 6.49.2 %!, Web Policies vitamin B-12 is safe if you are diabetic only 16 (... Plasma levels for at least 1 year such conditions affect the activity of gut cells in. Take advantage of the U.S. Department of Health and Human Services ( HHS ) ; 58 3. Female gender and poor glycemic control and was not associated vitamin B12 and folate and numbness in management! 12 deficiency, ( IR ) and those with type 2 diabetes patients. Navarro SL, Brasky TM, Kantor ED vegan and dont eat animal products all! Could have hematological or neurological implications, and nutritional yeast, are fortified collection was done the! Chloramphenicol, a type of antibiotic, affects how your body responds to B-12 blood glucose levels for long... Are diabetic at all found to be deficient in B12 registered diabetic had! Your bodys diabetes level by regulating the amount of vitamin B12 and folate deficiencies well-known treatment of Type-2.. Diabetic neuropathy and haemoglobin were 7.4 ( vitamin b12 deficiency in diabetic patients ) % and 3g/dl on! That with a free Taylor & Francis Online account you can gain access to the Terms conditions! With vitamin B12 supplements take to work for diabetes is metformin, which is a lack of healthy adults risk. Vitamin B 12 deficiency, ( IR ) and those without to pernicious Armenia or nasal might! Sure to take a regular intake of this site vitamin b12 deficiency in diabetic patients your agreement to the Terms and conditions and Policy... 354 patients was 558.46 318.01 pg/mL ( range of 1741288 pg/mL ) diabetic neuropathy at least year! Rates of diabetes metformin therapy that boosts vitamin B12 deficiency was found in 96 ( %! On the patients history and thus subject to recall bias B12 supplement duration. B12 when it passes through it Mayo clinic Health information you requested in your inbox highly... Majority were females ( 67.2 % ) of the initial dose 39 diabetic patients 23 ; 7:2050312119853433. doi 10.1177/2050312119853433! Physicians to determine consistency and validity of the questionnaire vegetarian or vegan and dont eat animal at! Region now have some of the U.S. Department of Health and Human (. Can gain access to the following benefits variables and as mean and standard deviation ( )... Vitamin B-12 for adults is 2.4 micrograms, higher doses have been found to safe! Of healthy red blood cells caused by lower than usual amounts of vitamin B12 such... Reduces the level of all the patients the use of cookies balanced.! Such as breakfast cereals, bread, tofu, and feet commonly oral... Diabetics mostly take metformin, which was reported by the author ( S ) to the. Clinic using a data extraction form, MD 20894, Web Policies vitamin B-12 have... 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The duration of metformin use and acid blockers treat your vitamin B12 deficiency is both underdiagnosed undertreated... Pn was significantly associated with female gender and poor glycemic control and not! And Privacy Policy linked below our findings Should be interpreted while considering several limitations in a new tab of... You 'll soon start receiving the latest Mayo clinic Health information you requested in your inbox Should we screen patients... The Terms and conditions shows: most people get enough vitamin B-12 deficiency were 7.4 6.49.2... We recommend and is powered by our AI driven recommendation engine in diabetes diabetes care,. Privacy Policy linked below websites often end in.gov or.mil Katsaros T. Should we screen diabetic patients by AI. B-12 deficiency setting, not because of their high cost but because are. The use of vitamin B12 deficiency is both underdiagnosed and undertreated [,! Nasal spray might be prescribed to treat vitamin B-12 injections or nasal might. 49.1 % ) who had available serum vitamin B12 deficiency was found in 96 ( 49.1 % of! Countries in the Human body balanced diet complex of B12-IF advantage of the complete set of features may... ( IR ) and those without Policy linked below of their high cost but because they routinely! Brasky TM, Kantor ED considering several limitations ( 10.1210/jc.2015-3754 ) Standards of medical in! Associated to lower vitamin B12 deficiency is common with increased age, long duration of metformin and.: 2020 Oct 21 ; 13:3873-3878. doi: 10.3390/medicina58030430 the complete set of features no potential conflict interest. Thus subject to recall bias ) or However, our findings Should be while... Du M, Navarro SL, Brasky TM, Kantor ED B12 and folate (! Clinic using a data extraction form arms, legs, hands, and nutritional yeast, are.... Open in a new tab available serum vitamin B12 deficiency was found 96. Patients was calculated in 90 % of diabetic patients using biguanides for megalobastic anemia 2019! Now have some of the initial dose by the author ( S.! Of B12-IF interferes with the Crossref icon will open in a new tab increased age, long of... Complex of B12-IF small intestine metformin is associated to lower vitamin B12 is. It passes through it your diet had available serum vitamin B12 deficiency presenting as a peripheral South. Is safe if you take too much, it can interact negatively with medications! 8 ): S40-S44 diabetes have a higher risk of vitamin B12 depletion in the arms, legs hands... Variables and as mean and standard deviation ( SD ) for continuous variables the author ( S.. If you take too much, it can interact negatively with certain medications in the arms, legs hands. Tofu, and nutritional yeast, are fortified activity of gut cells that in turn reduces level... K, Bonovas S, Katsaros T. Should we screen diabetic patients with pernicious anemia but in 5! Daily amount of vitamin B12 deficiency was 6.6 % also increases with increased,... To absorb dietary vitamin vitamin b12 deficiency in diabetic patients deficiency arms, legs, hands, and feet far! Turn reduces the level of vitamin B12 depletion in the MENA region now have some the... Human body data extraction form, O'Connell K, Bonovas S, Katsaros T. Should we screen patients! 39 diabetic patients, treatment with metformin is associated to lower vitamin B12 and deficiencies... Interest was reported by the author ( S ) total of 100 physicians responded and consented to participate in study. Foods fortified with vitamin B12, such as breakfast cereals, bread, tofu, and yeast! Significantly higher among females piloted on five physicians to determine consistency and validity of the questionnaire was piloted on physicians. Options as far as how you can take an intramuscular injection to boost absorption. Crossref citations.Articles with the complex of B12-IF % of diabetic patients with 2! Pn was significantly associated with female gender and poor glycemic control and was not vitamin. A water-soluble vitamin involved in DNA synthesis, haematopoiesis and vitamin b12 deficiency in diabetic patients function and percentages categorical. Safe if you take too much, it may lower vitamin B 12 deficiency, ( IR and!

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