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| {{Pericarditis}} | | {{HIV induced pericarditis}} |
| | '''For patient information, click [[HIV induced pericarditis (patient information)|here]]''' |
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| {{CMG}}; '''Associate Editor-In-Chief:''' [[Varun Kumar]], M.B.B.S.; [[Lakshmi Gopalakrishnan]], M.B.B.S. | | {{CMG}}; {{AE}} {{RG}} |
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| ==Overview==
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| A wide variety of cardiovascular complications are seen in advanced [[HIV]] infected patients. The most common are:
| | ==[[HIV induced pericarditis overview|Overview]]== |
| :*[[Pericarditis]] <ref name="pmid3181175">Corallo S, Mutinelli MR, Moroni M, Lazzarin A, Celano V, Repossini A et al. (1988) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3181175 Echocardiography detects myocardial damage in AIDS: prospective study in 102 patients.] ''Eur Heart J'' 9 (8):887-92. PMID: [http://pubmed.gov/3181175 3181175]</ref> <ref name="pmid2926051">Himelman RB, Chung WS, Chernoff DN, Schiller NB, Hollander H (1989) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=2926051 Cardiac manifestations of human immunodeficiency virus infection: a two-dimensional echocardiographic study.] ''J Am Coll Cardiol'' 13 (5):1030-6. PMID: [http://pubmed.gov/2926051 2926051]</ref> <ref name="pmid1464334">De Castro S, Migliau G, Silvestri A, D'Amati G, Giannantoni P, Cartoni D et al. (1992) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=1464334 Heart involvement in AIDS: a prospective study during various stages of the disease.] ''Eur Heart J'' 13 (11):1452-9. PMID: [http://pubmed.gov/1464334 1464334]</ref> <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref> <ref name="pmid7586308">Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al. (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7586308 Pericardial effusion in AIDS. Incidence and survival.] ''Circulation'' 92 (11):3229-34. PMID: [http://pubmed.gov/7586308 7586308]</ref> <ref name="pmid9458682">Estok L, Wallach F (1998) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=9458682 Cardiac tamponade in a patient with AIDS: a review of pericardial disease in patients with HIV infection.] ''Mt Sinai J Med'' 65 (1):33-9. PMID: [http://pubmed.gov/9458682 9458682]</ref>
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| :*[[Myocarditis]]
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| :*[[Cardiomyopathy]]
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| :*[[Pulmonary hypertension]]
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| :*[[Coronary artery disease]]
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| | ==[[HIV induced pericarditis historical perspective|Historical Perspective]]== |
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| ==Epidemiology and demographics== | | ==[[HIV induced pericarditis classification|Classification]]== |
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| Pericardial diseases in the form of [[pericardial effusion]] or [[cardiac tamponade]]<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref><ref name="pmid2721281">{{cite journal| author=Stotka JL, Good CB, Downer WR, Kapoor WN| title=Pericardial effusion and tamponade due to Kaposi's sarcoma in acquired immunodeficiency syndrome. | journal=Chest | year= 1989 | volume= 95 | issue= 6 | pages= 1359-61 | pmid=2721281 | doi= | pmc= | url= }} </ref><ref name="pmid1582323">{{cite journal| author=Karve MM, Murali MR, Shah HM, Phelps KR| title=Rapid evolution of cardiac tamponade due to bacterial pericarditis in two patients with HIV-1 infection. | journal=Chest | year= 1992 | volume= 101 | issue= 5 | pages= 1461-3 | pmid=1582323 | doi= | pmc= | url= }} </ref><ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref> have been recognized as a complication since HIV infection was first reported in 1981.
| | ==[[HIV induced pericarditis pathophysiology|Pathophysiology]]== |
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| *In a small autopsy study, '''24% cases''' reported major cardiac pathology <ref name="pmid3973269">{{cite journal| author=Cammarosano C, Lewis W| title=Cardiac lesions in acquired immune deficiency syndrome (AIDS). | journal=J Am Coll Cardiol | year= 1985 | volume= 5 | issue= 3 | pages= 703-6 | pmid=3973269 | doi= | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis causes|Causes]]== |
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| *The incidence of [[pericardial effusion]] in patients with asymptomatic AIDS was '''11% per year before''' the introduction of effective [[highly active antiretroviral therapy]] (HAART). The 6 month survival rate of AIDS patients with effusion was significantly shorter (36%) than the survival rate without effusions (93%). This shortened survival rate remained statistically significant after adjustment for lead-time bias and was independent of [[CD4 count]] and albumin level<ref name="pmid7586308">{{cite journal| author=Heidenreich PA, Eisenberg MJ, Kee LL, Somelofski CA, Hollander H, Schiller NB et al.| title=Pericardial effusion in AIDS. Incidence and survival. | journal=Circulation | year= 1995 | volume= 92 | issue= 11 | pages= 3229-34 | pmid=7586308 | doi= | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis differential diagnosis|Differentiating HIV induced pericarditis from other Diseases]]== |
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| *The incidence of AIDS-related cardiac disease is very high in Africa in comparison to that seen in the developed countries. In the period from 1993 to 1999 in Burkina Faso, '''79%''' of AIDS patients exhibited cardiac involvement, whereas in an Italian study in the period from 1992 to 1995, the incidence of AIDS-related cardiac disease was '''6.5%'''<ref name="pmid15124176">{{cite journal| author=Pugliese A, Gennero L, Vidotto V, Beltramo T, Petrini S, Torre D| title=A review of cardiovascular complications accompanying AIDS. | journal=Cell Biochem Funct | year= 2004 | volume= 22 | issue= 3 | pages= 137-41 | pmid=15124176 | doi=10.1002/cbf.1095 | pmc= | url= }} </ref>.
| | ==[[HIV induced pericarditis epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[HIV induced pericarditis risk factors|Risk Factors]]== |
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| ==Pathophysiology== | | ==[[HIV induced pericarditis screening|Screening]]== |
| Patients with advanced [[HIV]] have pericardial involvement at some point and the most common abnormality is [[pericardial effusion]]<ref name="pmid14533546">{{cite journal| author=Barbaro G| title=Pathogenesis of HIV-associated cardiovascular disease. | journal=Adv Cardiol | year= 2003 | volume= 40 | issue= | pages= 49-70 | pmid=14533546 | doi= | pmc= | url= }} </ref>.
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| :*Asymptomatic effusions are mostly small and '''idiopathic'''.
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| :*In advanced HIV disease, effusions are a part of '''generalized seroeffusive process''' involving pleural and peritoneal surfaces, possibly related to enhanced cytokine expression, resulting in moderate to large effusions.
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| :*[[Congestive heart failure]], [[Kaposi sarcoma]], and [[Tuberculosis]] are '''independently''' associated with moderate to large effusions.
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| ==Etiology==
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| It is often difficult to identify the etiology of [[pericardial effusion]] in HIV-infected patients.
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| The common organisms isolated are:
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| :*'''Mycobacterium tuberculosis''' which is the most common etiology for pericardial effusion in African HIV-infected patients.<ref name="pmid16330703">{{cite journal| author=Mayosi BM, Burgess LJ, Doubell AF| title=Tuberculous pericarditis. | journal=Circulation | year= 2005 | volume= 112 | issue= 23 | pages= 3608-16 | pmid=16330703 | doi=10.1161/CIRCULATIONAHA.105.543066 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16330703 }} </ref><ref name="pmid16781213">{{cite journal| author=Sudano I, Spieker LE, Noll G, Corti R, Weber R, Lüscher TF| title=Cardiovascular disease in HIV infection. | journal=Am Heart J | year= 2006 | volume= 151 | issue= 6 | pages= 1147-55 | pmid=16781213 | doi=10.1016/j.ahj.2005.07.030 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=16781213 }} </ref>
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| :*'''Staphylococcus aureus''' <ref name="pmid3467225">Stechel RP, Cooper DJ, Greenspan J, Pizzarello RA, Tenenbaum MJ (1986) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3467225 Staphylococcal pericarditis in a homosexual patient with AIDS-related complex.] ''N Y State J Med'' 86 (11):592-3. PMID: [http://pubmed.gov/3467225 3467225]</ref> <ref name="pmid8306779">Decker CF, Tuazon CU (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8306779 Staphylococcus aureus pericarditis in HIV-infected patients.] ''Chest'' 105 (2):615-6. PMID: [http://pubmed.gov/8306779 8306779]</ref>,
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| :*'''Cryptococcus neoformans''',<ref name="pmid4045235">Schuster M, Valentine F, Holzman R (1985) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=4045235 Cryptococcal pericarditis in an intravenous drug abuser.] ''J Infect Dis'' 152 (4):842. PMID: [http://pubmed.gov/4045235 4045235]</ref> and
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| :*'''Herpes simplex''' <ref name="pmid3035442">Freedberg RS, Gindea AJ, Dieterich DT, Greene JB (1987) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=3035442 Herpes simplex pericarditis in AIDS.] ''N Y State J Med'' 87 (5):304-6. PMID: [http://pubmed.gov/3035442 3035442]</ref>.
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| '''Supportive trial data:'''
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| *A retrospective study <ref name="pmid7781340">Flum DR, McGinn JT, Tyras DH (1995) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=7781340 The role of the 'pericardial window' in AIDS.] ''Chest'' 107 (6):1522-5. PMID: [http://pubmed.gov/7781340 7781340]</ref> of 29 patients with AIDS-related pericardial effusion who underwent fluid cultures and pericardial biopsy, etiology was established only in 7% patients. The causes included:
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| ::*[[Mycobacterium tuberculosis]] (1%),
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| ::*[[Staphylococcus aureus]] (1%), and
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| ::*Neoplasms (2% adenocarcinoma and 3% [[lymphoma]])
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| *Another study that evaluated pericardial effusions in 17 patients with HIV <ref name="pmid8017317">Hsia J, Ross AM (1994) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=8017317 Pericardial effusion and pericardiocentesis in human immunodeficiency virus infection.] ''Am J Cardiol'' 74 (1):94-6. PMID: [http://pubmed.gov/8017317 8017317]</ref>, revealed etiologic evidence in 5 patients of which 2 were found to have lymphoma, and 1 each had staphylococcus aureus, mycobacterium tuberculosis, and fungal infection.
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| | ==[[HIV induced pericarditis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| | [[HIV induced pericarditis diagnostic study of choice|Diagnostic study of choice]] | [[HIV induced pericarditis history and symptoms|History and Symptoms]] | [[HIV induced pericarditis physical examination|Physical Examination]] | [[HIV induced pericarditis laboratory findings|Laboratory Findings]] | [[HIV induced pericarditis electrocardiogram|Electrocardiogram]] | [[HIV induced pericarditis x ray|X-Ray Findings]] | [[HIV induced pericarditis echocardiography and ultrasound|Echocardiography and Ultrasound]] | [[HIV induced pericarditis CT scan|CT-Scan Findings]] | [[HIV induced pericarditis MRI|MRI Findings]] | [[HIV induced pericarditis other imaging findings|Other Imaging Findings]] | [[HIV induced pericarditis other diagnostic studies|Other Diagnostic Studies]] |
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| ====History and symptoms:==== | | ==Treatment== |
| The frequency and severity of the above symptoms varies with the stage of the infection and the degree of involvement of the [[pericardium]].
| | [[HIV induced pericarditis medical therapy|Medical Therapy]] | [[HIV induced pericarditis interventions|Interventions]] | [[HIV induced pericarditis surgery|Surgery]] | [[HIV induced pericarditis primary prevention|Primary Prevention]] | [[HIV induced pericarditis secondary prevention|Secondary Prevention]] | [[HIV induced pericarditis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[HIV induced pericarditis future or investigational therapies|Future or Investigational Therapies]] |
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| *Majority of the are '''asymptomatic''' and present with an increase in the cardiac silhouette on chest x-ray.
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| *Symptomatic patients present with the following:
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| ::*[[Chest pain]]: characteristically sharp and pleuritic in nature, exacerbated by inspiration and relieved by sitting up and leaning forward.
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| ::*[[breathlessness]]
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| ::*[[Malaise]]
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| ::*[[Fever]]
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| ::*[[Cough]]
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| ::*[[Ankle edema]] and/or [[ascites]]
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| *About a third of patients with symptomatic [[pericardial effusion]] can develop signs of [[cardiac tamponade]]. <ref name="pmid10047635">Chen Y, Brennessel D, Walters J, Johnson M, Rosner F, Raza M (1999) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=10047635 Human immunodeficiency virus-associated pericardial effusion: report of 40 cases and review of the literature.] ''Am Heart J'' 137 (3):516-21. PMID: [http://pubmed.gov/10047635 10047635]</ref>
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| '''Echocardiogram demonstrating swinging motion of the heart in cardiac tamponade:'''
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| <youtube v=U4xQ3-VRiNg/>
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| ====Physical Examination:====
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| '''Vitals:'''
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| *[[Tachycardia]],
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| *[[pulsus paradoxus]] and
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| *[[hypotension]] (in [[cardiac tamponade]]),
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| '''Neck:'''
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| *[[Jugular venous distension]] with a prominent Y descent and [[Kussmaul's sign]] may be present.
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| <youtube v=uB1c2zvkaew/>
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| '''Chest:'''
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| *[[Ewart's sign]]: Dullness to percussion beneath the angle of left scapula from compression of the left lung by pericardial fluid may be present.
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| *'''Pericardial knock'''
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| <youtube v=Jtk2vVgQuU0/>
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| *'''[[Pericardial rub]]'''
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| <youtube v=Yb-JDZGGVK4/>
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| '''Abdomen:'''
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| *[[Hepatomegaly]]
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| *[[ascites]]
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| *[[Hepatojugular reflux]] may be present
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| <youtube v=4LIaUCJP2Hc/>>
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| '''Extremities:''' [[Ankle edema]]
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| ==References==
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| {{reflist|2}}
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| [[Category:Cardiology]]
| | ==Case Studies== |
| [[Category:Diseases involving the fasciae]]
| | [[HIV induced pericarditis case study one|Case #1]] |
| [[Category:Inflammations]]
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| [[Category:Emergency medicine]]
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| [[Category:Infectious disease]] | |
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| {{WH}}
| | [[Category: (name of the system)]] |
| {{WS}}
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