Due to the toxic nature of inhalants, users may develop brain damage of different levels of severity. You will receive the first heart failure and transplantation email in your inbox shortly. Other signs and. Like many mental health disorders, several factors may contribute to development of drug addiction. It is currently regarded as a major healthcare and social issue. V-fib tends to be more closely associated with myocardial infarction5. It is more commonly referred to simply as "having an enlarged heart".It is usually the result of underlying conditions that make the heart work harder, such as obesity, heart valve disease, high blood pressure (hypertension), and coronary artery disease. Signs and symptoms of inhalant use vary, depending on the substance. But heart failure can occur even with a normal ejection fraction. Eventually, this results in enough cumulative cardiac damageand symptoms noticeable enoughto become apparent as a heart attack. Accessed Sept. 2, 2022. Hypertension, or high blood pressure, is a condition in which the heart must work harder than usual to keep blood circulation at acceptable levels. This may be due to the fact that many people who use cannabis also have a history of tobacco-smoking33. 7272 Greenville Ave. 1-800-242-8721 Cardiomegaly (sometimes megacardia or megalocardia) is a medical condition in which the heart becomes enlarged. Seeking medical advice for suspected conditions and/or worrying symptoms such as chest pain resulting from substance abuse is also recommended. However, there was an association between the risk of more minor events (but not major events) and replacement nicotine therapy18. As seen above, these risks are influenced by alcohol abuse in combination with prescription drug intake. Can poor sleep impact your weight loss goals? These may include: A persons outlook will depend on the severity of heart damage they sustain. The science of drug use: A resource for the justice sector. Heart Failure Clinics. There is a problem with The Panettiere family released a statement on Monday, sharing that Jansen died from an "enlarged heart." "Though it offers little solace, the Medical Examiner reported Jansen's sudden passing was due to cardiomegaly (enlarged heart), coupled with aortic valve complications," the family told ABC News. What is naloxone and should everyone have access to it? American Heart Association. Poor blood flow may cause the skin to appear blue (cyanotic). 2021; doi:10.1161/CIRCHEARTFAILURE.120.007759. Armstrong PW, et al. The age and health of the individual. AdCare Hospital Outpatient - Multiple Cities, AdCare Rhode Island Outpatient - Multiple Cities, Resolutions Recovery Residences - Multiple Cities, The editorial staff of American Addiction Centers is made up of credentialed clinical reviewers with hands-on experience in or expert knowledge of ad , Understanding Addiction: Research Studies, State-Funded Drug and Alcohol Rehab Centers, Effects & Dangers of Substance Abuse on the Muscular System. Drugs that may cause or exacerbate heart failure: A scientific statement from the American Heart Association. Kaplan EH, Gottesman RF, Llinas RH, Marsh EB. Older people (who may be at a higher risk of cardiovascular disease) often have an increased probability of drug/alcohol interaction due to age-related decreases in the ability to absorb and metabolize these compounds. Systolic heart failure (also called heart failure with reduced ejection fraction). The following tests may be done: Blood creatinine. This rate, when adjusted for age (65 years or more) was 77.8%. Long-term clinical outcome of major adverse cardiac events in survivors of infective endocarditis: a nationwide population-based study. Hall-Flavin DK (expert opinion). Accessed Aug. 31, 2022. This may also afford the opportunity to address and manage other health problems that may be associated with this, including cardiovascular disease. Learn more about right-sided heart failure here. Screening for substance abuse in those with cardiovascular disease may also be helpful, as may patient education in the course of screening programs for this form of disease itself. This may culminate as tightness and extreme discomfort in the chest, loss of consciousness or even death in severe cases. Vascular effects, like high blood pressure, feed back to the heart and can cause further damage. Heart failure: Could a low sodium diet sometimes do more harm than good? Verquvo (approval letter). "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. Approximately one in five of these people combined heavy alcohol intake with anti-clotting agents and other drugs for cardiovascular disease32. cardiac muscle, arterial walls) that results in reductions of their inherent capacity to carry out their normal functions. Some researchers claim that alcohol consumption is associated with positive effects on cardiovascular health, by promoting the anti-atherosclerosis blood proteins HDL, or high-density lipoproteins11. Heart damage occurs when substances or medical conditions harm heart tissue. Learn more. have pain that spreads to your shoulders, neck, back, jaw or arms feel unwell, sick or sweaty have shortness of breath or are wheezing black out (faint) feel dizzy or light-headed can feel your heart beating (palpitations). A single copy of these materials may be reprinted for noncommercial personal use only. This form of disease may result in brain abnormalities and damage due to interruptions in the supply of oxygen to this organ. If you have a diagnosis of heart failure and if any of the symptoms suddenly become worse or you develop a new sign or symptom, it may mean that existing heart failure is getting worse or not responding to treatment. These include increased heart rate, sweating, and palpitations. Learn more about left-sided heart failure here, Learn more about right-sided heart failure here, Learn about the differences between systolic and diastolic heart failure here, lifestyle changes like regular exercise and weight loss, https://www.cdc.gov/heartdisease/cardiomyopathy.htm, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6033155/#med21476-tbl2-note-0002, https://www.ahajournals.org/doi/pdf/10.1161/cir.0000000000000426, https://www.jacc.org/doi/epdf/10.1016/j.jchf.2017.02.017, https://www.heart.org/en/health-topics/heart-failure/what-is-heart-failure/types-of-heart-failure. American Psychiatric Association. Other prevention strategies include avoiding: Drug-induced heart failure is a broad disease because of the many ways drugs can damage the heart. Signs of heart damage from drugs include: Chest pain Irregular heartbeat Shortness of breath High blood pressure Narrowing of the blood vessels Discomfort in upper parts of the body like the jaw, neck, or arms If a user is showing signs of addiction, then this is the first sign of potential heart failure. Heart failure can be ongoing (chronic), or it may start suddenly (acute). Examples of drugs that have no known mechanism include: Damage to the heart can cause a failure on the left side, right side, or both simultaneously. The group of anticancer drugs called anthracyclines cause and worsen heart damage through long-term oxidative stress. 1-800-AHA-USA-1 A study on patients with heart failure and conditions such as obsessive-compulsive disorder, found that these individuals were at a significantly greater risk of alcohol abuse than similar patients without these personality disorders16. People use cannabis by smoking, eating or inhaling a vaporized form of the drug. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. https://www.merckmanuals.com/professional/pediatrics/problems-in-adolescents/drug-and-substance-use-in-adolescents. Review/update the Atheromatous plaque is mostly composed of cholesterol and blood proteins. 2004-2023 Healthline Media UK Ltd, Brighton, UK, a Red Ventures Company. Accessed Oct. 22, 2020. Our admissions navigators are available to help 24/7 to discuss treatment. Cocaine use and the likelihood of nonfatal myocardial infarction and stroke: data from the Third National Health and Nutrition Examination Survey. This information can help a person spot signs of abuse in a friend, family member, or coworker. A study on the need for hospitalization in approximately 4800 drug users found that 223 of these were admitted to hospital due to cardiovascular disease1. A study including 73 patients with heart failure found that 17.8% of these had a history of alcohol or substance abuse15. Understanding Withdrawal & Detox by Substance. Certain prescription drugs and illicit substances can directly induce or increase the risk of heart damage. Accessed Aug. 15, 2022. Onyeka IN, Beynon CM, Ronkainen K, et al. An Australian study presented at the American Heart Associations Scientific Sessions in 2012 was the first to document these cardiovascular abnormalities in seemingly healthy regular cocaine users long after the immediate effects of cocaine have worn off. headaches, abdominal pain, and nausea impaired judgment and greater risk of some sexually transmitted infections the possibility of added substances (such as talc, poisons, herbicides or other particles) which may cause a toxic reaction. Despite the name, these are not bath products such as Epsom salts. Agrawal PR, Scarabelli TM, Saravolatz L, et al. Below you'll find several examples. This may result in many biochemical abnormalities, which may manifest as symptoms of disease or hormonal imbalance. Pain and stiffness often worsen following rest. information and will only use or disclose that information as set forth in our notice of A = Activity limitation. Coronary artery disease may be known by other names, including ischemic heart disease and coronary heart disease. These forms of substance abuse are linked to increased risk of neurological or cardiovascular disorders30. Some individuals appear to be at higher risk of cardiovascular disease than others. All rights reserved. heart attacks, seizures, and respiratory arrest More about Cocaine - the "perfect heart-attack drug" C = Congestion. Drug addiction (substance use disorder) care at Mayo Clinic. The Genetic Landscape of Cardiomyopathy and Its Role in Heart Failure. Most people receive a diagnosis after it has spread. A multicenter, randomized, double-blind, placebo-controlled trial of the efficacy and safety of the oral soluble guanylate cyclase stimulator. National Center Aghadavoudi O, Eizadi-Mood N, Najarzadegan MR. Substances such as alcohol, marijuana and nicotine also are considered drugs. An intervention presents a loved one with a structured opportunity to make changes before things get even worse and can motivate someone to seek or accept help. https://admin.dea.gov/documents/2020/2020-04/2020-04-13/drugs-abuse. Is recent cannabis use associated with acute coronary syndromes? INDICATIONS Heart Failure In Adults. Drugs, brains, and behavior: The science of addiction. Drug-induced heart failure can occur when drugs affect blood vessels, impairing blood flow to and from the heart. Many forms of arrythmia are not life threatening, but some may precipitate events that lead to a cardiac arrest. When the heart can't pump enough oxygen-rich blood to meet the body's energy needs, a general feeling of tiredness or fatigue sets in. Rapid heartbeat ( arrhythmia) or pounding heartbeat ( heart palpitations ). Doxorubicin causes both early and late heart damage (also called cardiotoxicity). Research shows that cocaine users are at a greater risk of suffering cardiovascular abnormalities because they have thicker heart muscle walls , stiffer arteries, and higher blood pressure than non-users. Other examples include ketamine and flunitrazepam or Rohypnol a brand used outside the U.S. also called roofie. Myocardial infarctions may manifest as pain in the chest area and in stark decreases in heart function that lasts for several minutes. Right-sided heart failure often occurs due to failure on the left side. Drug addiction, also called substance use disorder, is a disease that affects a person's brain and behavior and leads to an inability to control the use of a legal or illegal drug or medicine. If you believe you or someone you love may be struggling with addiction, contact us today at {"props":{"scalar":"","helpline":"true"},"children":""} Or fill in our online insurance verification form to see if insurance may be able to cover the cost of treatment. Evaluation of the patient with suspected heart failure. Common symptoms include painful and swollen joints, fever, chest pain, hair loss, mouth ulcers, swollen lymph nodes, feeling tired, and a red rash which is . Make a donation. In: Integrative Medicine. As illustrated, the combination of both can lead to serious complications and death. As such, they have the potential to disrupt the balance of one or more of these when taken as medications or as performance-enhancing drugs. Sudden death can occur even after a single exposure. This may involve the regular consumption of these beverages in volumes greater than those recommended by the manufacturer and/or health authorities30. Various signs of heart damage from drugs include: Anyone experiencing these symptoms should seek urgent medical assistance. (2017). Emergency room doctors will try to stabilize your condition and determine if your symptoms are due to heart failure or something else. COVID-19: Myocardial injury (adult). These legal substances may include medications indicated for cardiovascular disorders, which often interact to negative effect with alcohol31. AskMayoExpert. Given its complexity, it stands to reason that all kinds of activities and habits can have an effect on the heart, and that cardiovascular troubles can manifest in vastly different ways. Mayo Clinic. In addition to its effects on neurotransmitters, cocaine appears to cause damage and death in cardiac muscle by upsetting the balance of calcium at a cellular level23. The role of substance abuse in the conditions as above will be discussed here in detail. Learn about the types, causes, and treatment, How does a heart attack differ to heart failure? Cannabis abuse and addiction: a contemporary literature review. Opioids are narcotic, painkilling drugs produced from opium or made synthetically. You might not even notice them. You notice red, dark brown, or black stools or urine. This may culminate as tightness and extreme discomfort in the chest, loss of consciousness or even death in severe cases. Morita H, Seidman J, Seidman CE. This can cause blood to build up in the veins supplying the right side of the heart. Circulation: Heart Failure. include protected health information. Cannabis (Marijuana/Pot/Weed) Central Nervous System Depressants (Benzos) Cocaine (Coke/Crack) Gamma-hydroxybutyrate (GHB) Hallucinogens Heroin Inhalants Ketamine Khat Kratom LSD (Acid) MDMA (Ecstasy/Molly) Mescaline (Peyote) Methamphetamine (Crystal/Meth) Over-the-Counter MedicinesDextromethorphan (DXM) Over-the-Counter MedicinesLoperamide The cause of the decreased blood volume or blood pressure should be diagnosed and treated. Substituted cathinones can be eaten, snorted, inhaled or injected and are highly addictive. Contact Us, Hours This can lead to swelling in the lower limbs, abdomen, and organs. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). An analysis of blood samples from 1355 patients indicated that anti-hepatitis C virus antibodies were more likely to be present in those with a history of myocarditis and heart failure20. Neurons use chemicals called neurotransmitters to communicate. Despite manufacturer claims, these are chemical compounds rather than "natural" or harmless products. After myocardial infarction (MI), patients are at a greater risk of heart failure. Clinical review: Major consequences of illicit drug consumption. It may feel like pressure or squeezing in your chest. The sooner you seek help, the greater your chances for a long-term recovery. Concerns about the potential harms of energy drink abuse have arisen in the last few years30. They're often used and misused in search of a "high," or to boost energy, to improve performance at work or school, or to lose weight or control appetite. Another study using data from over 1000 patients with cardiovascular disease found that a history of trauma was associated with substance abuse in this population38. Accessed Sept. 2, 2022. Accessed Oct. 22, 2020. Accessed Oct. 22, 2020. Even so-called recreational cocaine users may have higher blood pressure, stiffer arteries and thicker heart muscle walls than non-users all of which can cause a heart attack. These may be magnified by alcohol abuse, as described above. Weakening of the heart muscle (cardiomyopathy) Heart rhythm problems (arrhythmia) Heart attack Stroke High blood pressure Blood clots Whether you're at risk for heart problems during and after cancer treatment depends on how healthy your heart is and the specific drugs you'll be receiving. These drugs are associated with the increased risk of many conditions and adverse events including a myriad of cardiovascular disorders. When this happens, blood often backs up and fluid can build up in the lungs, causing shortness of breath. In: Ferri's Clinical Advisor 2021. Rapid or irregular heartbeat. Naloxone DrugFacts. https://www.uptodate.com/contents/search. How Viagra became a new 'tool' for young men, Ankylosing Spondylitis Pain: Fact or Fiction. This is the blockage of an artery or vein by a thrombus (large clot). Damage to the left side of the heart impairs its ability to pump blood efficiently to the body. other information we have about you. When this occurs, the heart must work harder to ensure vital organs receive adequate blood supply, putting strain on the heart muscles. In this article, learn about the different types, how to recognize the symptoms, and what treatment to expect. Hu N, Zhang Y, Nair S, Culver BW, Ren J. Damage to your heart muscle from a heart attack may mean that your heart can no longer pump as well as it should. Accessed Aug. 18, 2022. However, a combination of socially unacceptable abuse, safety concerns and other socioeconomic factors have driven them into disrepute and prohibition from widespread use. Less often, these drugs cause . All rights reserved. Stimulants can cause heart failure by increasing blood pressure and directly damaging cells in the heart. If your health care provider prescribes a drug with the potential for addiction, use care when taking the drug and follow instructions. American Psychiatric Association; 2013. https://dsm.psychiatryonline.org. If you are a Mayo Clinic patient, this could National Institute on Drug Abuse. Symptoms may be mild at first or you may think it's a cold or allergy. You can learn more about how we ensure our content is accurate and current by reading our. Blood cholesterol and vascular mortality by age, sex, and blood pressure: a meta-analysis of individual data from 61 prospective studies with 55,000 vascular deaths. Anabolic steroids are linked to the increased risk of many cardiovascular disorders, including29: Anabolic steroids include testosterone and its derivatives29. Mayo Clinic is a not-for-profit organization. These drugs may be effective in reducing blood pressure or cholesterol levels. Make an appointment to see a provider if: If you're not ready to approach a health care provider or mental health professional, help lines or hotlines may be a good place to learn about treatment. National Institute on Drug Abuse. Mayo Clinic does not endorse companies or products. For example, one in five adults aged 18 to 44 who had experienced a stroke in 2005 had abused illicit drugs21. Examples include methylenedioxymethamphetamine, also called MDMA, ecstasy or molly, and gamma-hydroxybutyric acid, known as GHB. Video on Opioid Addiction and Pain Relief Alternatives Opioids are involved in about 115 overdose deaths each day.. Coronary artery disease is the most common form of heart disease and the most common cause of heart failure. The dying patient. Taking some drugs can be particularly risky, especially if you take high doses or combine them with other drugs or alcohol. In addition to general signs of drug use, specific signs of abuse are associated with particular drugs. for Drug addiction (substance use disorder), Mayo Clinic on Incontinence - Mayo Clinic Press, NEW The Essential Diabetes Book - Mayo Clinic Press, NEW Ending the Opioid Crisis - Mayo Clinic Press, FREE Mayo Clinic Diet Assessment - Mayo Clinic Press, Mayo Clinic Health Letter - FREE book - Mayo Clinic Press, Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic School of Continuous Professional Development, Mayo Clinic School of Graduate Medical Education, Book: Mayo Clinic Family Health Book, 5th Edition, Newsletter: Mayo Clinic Health Letter Digital Edition. Some drugs of abuse are associated with unpleasant withdrawal symptoms. Decreased dopamine brain reactivity in marijuana abusers is associated with negative emotionality and addiction severity. Agitation and paranoia. Thromboembolism in a vein may lead to peripheral tissue damage, as above, or pulmonary embolism (also known as PE, in which the blood flow to a portion of the lung is blocked). The Association between Specific Substances of Abuse and Subcortical Intracerebral Hemorrhage Versus Ischemic Lacunar Infarction. The drugs are prescribed to treat Parkinson's, obesity, narcolepsy and attention deficit disorder with hyperactivity (ADHD). For more information and resources, please see: Written by American Heart Association editorial staff and reviewed by science and medicine advisers. This intake is categorized as abuse when it leads to significant impairments in the ability to function in occupational and/or societal terms. Obesity makes heart disease hard to detect and treat Most older people with earliest Alzheimer's signs won't develop dementia New program lowers body weight, blood sugar in people with prediabetes Heart failure sometimes known as congestive heart failure occurs when the heart muscle doesn't pump blood as well as it should. The lower chambers, the more muscular right and left ventricles, pump blood out of the heart. This is a rapid decline in the contraction of heart muscles, resulting in cessations of blood circulation. Accessed Oct. 22, 2020. a location. Accessed July 9, 2021. https://www.heart.org/en/health-topics/heart-failure/warning-signs-of-heart-failure. A consultation may be the first step on the road to recovery from substance abuse. Commonly used drugs charts. "His charisma, warmth, compassion for . https://nida.nih.gov/drug-topics/criminal-justice/science-drug-use-resource-justice-sector. These drugs can produce a "high" similar to marijuana and have become a popular but dangerous alternative. That keeps your heart from working so hard to pump. These proteins, including low-density lipoprotein, facilitate the introduction of cholesterol into arteries, but do not remove it. Armstrong PW, et al. How the drug was consumed smoked, snorted, or injected. Possible complications can include: The key to preventing heart failure is to reduce your risk factors. It is a medical emergency that, without immediate medical intervention, will result in cardiac death within minutes. The fluid buildup can cause shortness of breath and swelling of the legs and feet. These drugs also have neurological effects beside analgesia, which may include euphoria, lethargy, respiratory problems and withdrawal symptoms. However, heart failure can be life-threatening. These drugs have exquisitely pronounced potential for addiction and abuse. Ejection fraction is used to help classify heart failure and guide treatment. Symptoms include: yellowing of your skin and the whites of your eyes elevated liver enzymes. Heavy alcohol consumption is also associated with other cardiovascular conditions and events, including11: Pre-existing cardiovascular disease (alone or in combination with other disorders) may increase the risk of alcohol abuse itself. Joint pain or body aches. Or, you may not realize you are developing heart disease. Smoking is also associated with the increased risk of ischemia and brain hemorrhages6. Taking opioids with alcohol increases this risk. It is also associated with increased uptake of healthcare resources, particularly emergency medicine facilities. information highlighted below and resubmit the form. Which drugs can induce or increase the risk of heart damage and why? Any medical information published on this website is not intended as a substitute for informed medical advice and you should not take any action before consulting with a healthcare professional. These may include37: The use of one or more of these may be ordered by a health professional if a patient presents with cardiovascular symptoms that may be linked with substance abuse37. The effects resulting from cardiovascular drug interactions may include32: Marijuana or cannabis is another (mostly) illicit drug that may play a role in the risk of cardiovascular disease. This is another obstructive cardiovascular condition, in which abnormal levels of coagulation (or blood clotting) results in the formation of large clots within blood vessels. failure content, plus expertise on heart health. Update in Cardiac Arrhythmias and Pacing. information and will only use or disclose that information as set forth in our notice of Some types of heart failure can lead to an enlarged heart. Comparing cardiovascular factors in opium abusers and non-users candidate for coronary artery bypass graft surgery. This was particularly relevant to those with pre-existing cardiovascular disease30. Shih C-J, Chu H, Chao P-W, et al. One particular danger of club drugs is that the liquid, pill or powder forms of these drugs available on the street often contain unknown substances that can be harmful, including other illegally manufactured or pharmaceutical drugs. Hydroxychloroquine, sold under the brand name Plaquenil among others, is a medication used to prevent and treat malaria in areas where malaria remains sensitive to chloroquine.Other uses include treatment of rheumatoid arthritis, lupus, and porphyria cutanea tarda.It is taken by mouth, often in the form of hydroxychloroquine sulfate.. Common side effects may include vomiting, headache, changes . Peripheral artery disease may also result in pain and discomfort (claudication) in the areas affected, and may be detected by the development of blueness (or cyanosis) in the extremities11. Learn more about left-sided heart failure here. ErrorSelect Your doctor can determine how well your heart is pumping by measuring how much blood is pumped out with each beat (ejection fraction). Some researchers assert that this is also influenced by other factors, including stability of abode (e.g. While other anthracyclines (like epirubicin and mitoxantrone) may also cause heart damage, the chances are more common with doxorubicin. Myocardial infarctions may manifest as pain in the chest area and in stark decreases in heart function that lasts for several minutes. Find more information on our content editorial process. Alcohol abuse is a risk factor in the development of hypertension, and this may have a component of genetic susceptibility14. All rights reserved. Drugs of abuse: A DEA resource guide/2020 edition. These are called withdrawal symptoms. Stimulants include amphetamines, meth (methamphetamine), cocaine, methylphenidate (Ritalin, Concerta, others) and amphetamine-dextroamphetamine (Adderall XR, Mydayis). Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. Vericiguat in patients with heart failure and reduced ejection fraction. Possible signs that your teenager or other family member is using drugs include: Signs and symptoms of drug use or intoxication may vary, depending on the type of drug. The disease may also affect other parts of the body, including skin, eyes, lungs . Borlaug BA, et al. These are disruptions of blood vessels in the skull, resulting in bleeding into some spaces around the brain and within the brain. In a healthy heart, the ejection fraction is 50% or higher meaning that more than half of the blood that fills the ventricle is pumped out with each beat. Petit A, Karila L, Lejoyeux M. [Abuse of energy drinks: Does it pose a risk?]. Heart failure. Patient Education Resources for Health Care Professionals. Bed rails typically are divided into three distinct types, according to the FDA. Cannabis often precedes or is used along with other substances, such as alcohol or illegal drugs, and is often the first drug tried. Changes to your tongue, such as it swelling and turning red as a strawberry. Larger numbers of older adults also are seeking treatment for substance abuse and having increased hospitalizations and more visits to emergency departments, up more than 130 percent in 55 to 64-year-olds from 2004 to 2009. Cocaine intake is associated with a stark rise in heart rate, blood pressure and the need for oxygen in heart muscle22. This content does not have an English version. https://www.uptodate.com/contents/search. New Drug Application 214377. The test is free, confidential, and no personal information is needed to receive the result. Examples include: Axitinib (Inlyta) Bevacizumab (Avastin) Dasatinib (Sprycel) Lapatinib (Tykerb) Pazopanib (Votrient) Sorafenib (Nexavar) Sunitinib (Sutent)
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