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   2017| April-June  | Volume 7 | Issue 2  
    Online since May 8, 2017

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Autologous platelet-rich plasma versus corticosteroid in the management of elbow epicondylitis: A randomized study
Ankit Varshney, Rajesh Maheshwari, Anil Juyal, Atul Agrawal, Prabhnoor Hayer
April-June 2017, 7(2):125-128
DOI:10.4103/2229-516X.205808  PMID:28584745
Introduction: Elbow epicondylar tendinitis is a common problem for patients whose activities require strong gripping or repetitive wrist movements in the day-to-day activities of life. Histologic specimens from chronic cases confirm that tendinitis is not an acute inflammatory condition but rather a failure of the normal tendon repair mechanism associated with angiofibroblastic degeneration. Tendon regeneration may be improved by injecting autologous growth factors obtained from the patient's own blood. Autologous growth factors can be injected with autologous whole blood or platelet-rich plasma (PRP). Materials and Methods: A randomized study with 83 patients was done. The study population comprised two groups. Group A (n = 50) treated with local steroid injection and Group B (n = 33) treated with autologous PRP. Patients were allocated randomly using computer-generated random number table. The base-line evaluation was done using visual analog score (VAS) and modified Mayo performance index for elbow (MAYO). Re-evaluation was after 1, 2, and 6 months of the procedure. Statistical analysis was done using independent t-test. Results: Six months after treatment with PRP, patient's with elbow epicondylitis had a significant improvement in their VAS (P < 0.05) and MAYO (P < 0.05) in contrast to steroid, whereas no statistical difference was found between the two groups at 1 and 2 months after intervention. Conclusion: Treatment of patients with epicondylitis with PRP reduces pain and significantly increases function, exceeding the effect of corticosteroid injection.
  16 3,207 545
Study of lipid peroxidation, nitric oxide end product, and trace element status in type 2 diabetes mellitus with and without complications
Sanjukta Mishra, Bana Bihari Mishra
April-June 2017, 7(2):88-93
DOI:10.4103/2229-516X.205813  PMID:28584737
Background: Oxidative stress has become a real entity in etiopathogenesis of Type 2 diabetes mellitus (DM). It may result from steady flux of free radicals and lipid peroxides in vivo. Malondialdehyde (MDA) is a stable end product of lipid peroxidation. Accumulative evidences suggest that hyperglycemia in Type 2 DM can produce major changes in nitric oxide (NO) production as well as in its action. Alteration in metabolism of trace elements is also observed in DM. Objective: To evaluate oxidative stress, status of NO, and trace elements zinc (Zn) and magnesium (Mg) in type 2 DM and to correlate these parameters with disease process. Materials and Methods: Ninety-two cases with diabetes were included in the study, out of which 51 were type 2 DM without any complication and 41 were type 2 DM with complications. Fifty-one nondiabetic healthy controls from hospital staff were selected for the study. Blood samples were collected after an overnight fast for estimation of fasting plasma glucose, postprandial glucose, glycated hemoglobin (HbA1c), lipid profile, trace element status, MDA, and NO. Results: Study revealed a rise in MDA levels in both uncomplicated and complicated cases with diabetes (2.47 ± 0.53, 3.98 ± 0.42 nmol/ml, respectively) as compared to controls (1.43 ± 0.23 nmol/ml), which was statistically significant (P < 0.05). The mean levels of NO, Zn, and Mg were significantly lower in both the diabetic groups than the control group (P < 0.05). MDA showed a significant positive correlation with plasma glucose, lipid profile parameters (except high-density lipoprotein cholesterol), and significant negative correlation with Zn (r = −0.44, P< 0.05) and Mg (r = −0.31, P< 0.05). NO levels were correlated significantly with plasma glucose, dyslipidemia, and HbA1c (P < 0.05). The effects of glycemic status on trace element concentrations were evident from a significant negative correlation between Zn and Mg with fasting plasma glucose and HbA1c. Conclusion: Findings of the present study may establish the role of hyperglycemia, oxidative stress, impaired NO, and trace elements in pathogenesis and long-term vascular complications of type 2 DM.
  15 3,084 423
Maternal near-miss audit: Lessons to be learnt
Meenakshi Kalhan, Srishti Singh, Anita Punia, Jai Prakash
April-June 2017, 7(2):85-87
DOI:10.4103/2229-516X.205815  PMID:28584736
Mother and child constitute a large, vulnerable, and a priority group as the risk is involved with childbearing in women and of growth and development in children. For every woman who dies from pregnancy or childbirth-related causes, it is estimated that twenty more suffer from pregnancy-related illness or experience other severe complications. These women who nearly escape death are categorized under “near miss” which has been defined as “a woman who nearly died but survived a complication that occurred during pregnancy, childbirth or within 42 days of termination of pregnancy.” Maternal near-miss audits give us an opportunity to study the cases which were almost similar to those where maternal deaths happened; thus, their review may give concrete evidence of reasons/deficiencies in health care leading to severe complications and even grave consequences as maternal deaths. Near-miss audits will allow the care of critically ill women to be analyzed, deficiencies in the provision of care to be identified, and comparison within and between institutions and, ultimately, improve the quality of obstetric care and further reduce maternal morbidity and mortality.
  9 2,581 523
Impact of preoperative echocardiography on perioperative management in geriatric hip trauma: A retrospective observational study
Chhavi Sawhney, Vivek Trikha, Sai Janani, Sukhminder Jit Singh Bajwa, Vijay Sharma, Menaal Khanna
April-June 2017, 7(2):104-107
DOI:10.4103/2229-516X.205816  PMID:28584740
Background and Aim: Hip fractures are associated with a significant risk of morbidity and mortality in the elderly population. Current guidelines propose that these patients should be operated as early as possible. Preoperative cardiac investigations, especially echocardiography, have been considered to delay surgery with few changes in the patient management. The present study has been conducted to evaluate whether preoperative echocardiography improve or worsen the prognosis in such hip trauma surgery. Materials and Methods: In this retrospective study, we reviewed the records of elderly patients with hip trauma operated in the tertiary care trauma center of our institute over a period of 1 year. Out of 120 patients, preoperative echocardiography was done in 30 patients. We compared the patients for whom echocardiography was done with the patients who did not undergo echocardiography. Descriptive statistical methods were used to analyze the results and observations. Results: We observed that preoperative transthoracic echocardiography led to an escalation in cardiac medication in 53% patients when compared with 23.3% in patients who did not undergo echocardiography. No preoperative cardiac intervention was done in any patient. However, there was a delay of 2.5 days in surgery in the echocardiography group as compared to the patients of nonechocardiography group. Rate of regional anesthesia was comparable in both the groups (54% vs. 56.6%). Conclusions: In the present study, it was observed that echocardiography significantly delays surgery without a significant change in preoperative cardiac medication or anesthesia technique. This may have a potential possible adverse effect on the outcome in geriatric hip trauma which was not observed to a significant limit in the present study as the study was not a longitudinal study. For “fast tracking” of geriatric hip trauma, institutional guidelines should be developed depending on the resources available.
  7 2,447 334
Expression of human papillomavirus dna and p53 polymorphisms through polymerase chain reaction in normal mucosa and oral leukoplakia individuals with deleterious oral habits
Atmakuri Shanmukha Ramya, Sumit Majumdar, T Mahesh Babu, Divya Uppala, Baratam Srinivas, Ayyagari Kameswara Rao
April-June 2017, 7(2):134-138
DOI:10.4103/ijabmr.IJABMR_57_16  PMID:28584747
Context: Oral leukoplakia (OL) is a well-recognized precancerous lesion with various etiological factors. Most commonly deleterious oral habits such as tobacco smoking and viral etiologies mainly human papillomavirus (HPV) play an important role. p53 polymorphisms mostly homozygous Arginine (Arg) allele has a greater risk of degradation by HPV. Hence, HPV infection and p53 polymorphisms may act as synergistic factors for increased the risk of malignant transformation in oral precancerous lesions. Aims: The aim of this study is to evaluate the risk of OL and its malignant transformation due to infection by HPV and p53 polymorphisms in the oral biopsy samples through polymerase chain reaction (PCR). Subjects and Methods: A total of 40 individuals were involved– 10 individuals were controls without deleterious habits, 15 were controls with deleterious habits, and 15 were with histologically confirmed OL individuals with deleterious habits. PCR and restriction fragment length polymorphism using sma1 enzyme were carried out to evaluate the expression of HPV and p53 polymorphisms. Statistical Analysis Used: Chi-square test, Fischer's exact t-test, and odds ratio. Results: (1) HPV DNA expression was higher in Leukoplakia individuals than controls. (2) p53 genotype with homozygous Arg was more in HPV-infected individuals. Conclusions: To conclude HPV infected OL cases were mostly with Arg/Arg type of p53 polymorphism.
  4 2,295 262
C-reactive protein: A prognostic indicator
Mandeep Kaur
April-June 2017, 7(2):83-84
DOI:10.4103/ijabmr.IJABMR_63_17  PMID:28584735
  3 2,239 364
Performance characteristics of kidney injury molecule-1 in relation to creatinine, urea, and microalbuminuria in the diagnosis of kidney disease
Musalula Sinkala, Mildred Zulu, Trevor Kaile, Marah Simakando, Chisanga Chileshe, Doris Kafita, Panji Nkhoma
April-June 2017, 7(2):94-99
DOI:10.4103/2229-516X.205811  PMID:28584738
Context: The diagnosis and evaluation of impaired renal function remains a challenge owing to lack of reliable biomarker for assessment of kidney function. The existing panel of biomarkers currently displays several limitations, and recently kidney injury molecule-1 (KIM-1) has been suggested as a sensitive biomarker of renal function and proposed to enter clinical practice. Aims: This study was conducted to determine the diagnostic value of serum creatinine, urea, and microalbuminuria (MAU) in relation to the novel biomarker, KIM-1. Materials and Methods: Serum creatinine, urea, MAU, and KIM-1 were measured in forty individuals with and forty without kidney disease. Data were analyzed using multivariate methods of assessing diagnostic efficiency, test agreement, condition effects, and variability. Results: The area under the receiver-operator characteristic curve revealed a diagnostic advantage of creatinine (0.924 ± 0.0066) and urea (0.925 ± 0.0068) over MAU (0.880 ± 0.078) and KIM-1 (0.35 ± 0.124). Overall diagnostic efficiency was higher for creatinine and urea (89.5% and 90.9%, respectively), followed by MAU (85.7%) and then KIM-1 (56.3%). Logistic regression analysis showed that creatinine and urea (R2 = 0.75 and R2 = 0.72, respectively, P< 0.001 for both) were better predictors of kidney disease than MAU (R2 = 0.64, P< 0.001) and KIM-1 (R2 = 0.046, P = 0.116). Further analysis of agreement showed that urea had an excellent agreement with creatinine (kappa r = 0.835, P< 0.001), with KIM-1 (kappa r = –0.198, P = 0.087) showing a poor agreement with creatinine. Conclusion: Our results indicate that elevated serum creatinine and urea above specific cutoff points reliably identifies patients with acute kidney injury or chronic kidney disease. However, more researches are warranted to further validate the diagnostic efficiency and application of MAU and for KIM-1 before its implementation in clinical practice.
  3 2,384 325
Papilliferous Keratoameloblastoma: A Rare Case Report
Ajit Singh Rathore, Saurabh Juneja, Neha Khurana, Devi Charan Shetty
April-June 2017, 7(2):139-142
DOI:10.4103/ijabmr.IJABMR_136_16  PMID:28584748
Ameloblastoma is true odontogenic tumor of epithelial origin, which is described as locally aggressive with varying chances of recurrence. It is believed to derive from enamel organ, remnants of dental lamina, lining of odontogenic cysts, or basal cells of oral epithelium. Radiologically, it may present as unilocular or multilocular radiolucency commonly. Although conventional ameloblastoma presents typical histological features as described by Vickers and Gorlin, few unusual variants have been reported with different histological patterns. However, the clinical and biological behavior of these lesser known variants has not been established yet due to the scarcity of cases reported. Here, we report an extremely rare case of papilliferous ameloblastoma in a young male patient with 2-year follow-up and presenting with unusual histological presentation than conventional ameloblastoma.
  2 2,253 183
Adverse drug events in patients with mental disorder in an ambulatory setting
Naveen Kumar, Sangeeta Sharma, Vinod Kapoor
April-June 2017, 7(2):108-111
DOI:10.4103/2229-516X.205822  PMID:28584741
Background: Although adverse drug events (ADEs) among inpatients occur frequently and are widely studied, few data are available on ADEs among outpatients with mental disorders. Aims: To determine the rates, types, and severity of ADEs in patients with mental disorder. Materials and Methods: Cross-sectional survey of patients with mental disorder attending outpatient department. Data were collected over a period of 6 months. Results: A total of 400 patients (217 schizophrenia patients, 127 bipolar affective disorder patients, and 56 patients of depression) with a mean age of 32.1 ± 9.7(±standard deviation) participated in the study. Patients suffering from schizophrenia and all nonadherent patients reported significantly more ADEs (P < 0.05). Out of 343 patients (86%) who reported at least one ADE, majority (87%) reported central nervous system ADEs followed by weight gain (48%), gastro-intestinal (28%), skin (4%), cardiovascular (1%), and sexual dysfunctions (0.3%). Out of 673 ADEs reported, sedation (41%) and weight gain (25%) were reported most commonly. Most ADEs reported (76%) were mild; however, there were no life-threatening, fatal, or serious ADEs. The medication classes most frequently involved in ADEs were antipsychotics (72%) followed by sedatives (44%), antimanic drugs (32%), and antidepressants (27%). Patients on atypical antipsychotic drugs reported significantly more body weight gain (P < 0.05). More than three drugs were prescribed in 49% of patients who reported ADEs. Conclusion: The study data indicate high prevalence of ADEs in the outpatients on psychotropic medications.
  2 2,014 220
Benign and malignant thyroid gland diseases in the patients with primary hyperparathyroidism
Mehmet Celik, Sibel Guldiken, Semra Ayturk, Buket Yilmaz Bulbul, Ebru Tastekin, Nuray Can, Atakan Sezer, Funda Ustun, Ahmet Kucukarda
April-June 2017, 7(2):117-120
DOI:10.4103/2229-516X.205806  PMID:28584743
Introduction: This study aimed to evaluate concurrently detected thyroid pathologies in the patients who underwent surgery for primary hyperparathyroidism (PHPT). Materials and Methods: In this study, we retrospectively analyzed the files of the patients who underwent surgery for PHPT between 2012 and 2015. Pre- and post-operative laboratory examination results and preoperative radiological and nuclear medicine findings of the patients were retrospectively recorded. Results: A total number of 41 patients with PHPT were divided into two groups as the Group 1 with PHPT and benign thyroid pathology (21 patients) and the Group 2 with PHPT and malignant thyroid pathology (20 patients). In Group 1, 18 and 3 of 21 patients were females and males, respectively. Group 2 included 15 male and 5 female patients. The mean age of the patients was found to be 55.6 and 53.9 years in Group 1 and Group 2, respectively. Both groups were matched for age and gender. In terms of thyroid pathology, 20 of 41 patients (48.7%) who underwent total thyroidectomy for PHPT were found to have thyroid papillary carcinoma while benign pathologic conditions were detected in 21 (51.3%) individuals. Conclusions: Cooccurrence of thyroid diseases and PHPT is common. Therefore, all the patients should preoperatively be evaluated for the presence of thyroid pathology to determine the technique of parathyroid surgery.
  2 2,045 196
Evaluation of serum c-reactive protein levels in subjects with aggressive and chronic periodontitis in comparison with healthy controls: A clinico-biochemical study
Vijayalakshmi Bolla, P Santha Kumari, Surendra Reddy Munnangi, D Sunil Kumar, Y Durgabai, Pradeep Koppolu
April-June 2017, 7(2):121-124
DOI:10.4103/2229-516X.205814  PMID:28584744
Aim: Evaluation and comparison of serum C-reactive protein (CRP) levels in subjects with chronic and aggressive periodontitis. Materials and Methods: Based on the periodontal status, 45 subjects were selected and divided into three groups. Group I - subjects with clinically healthy periodontium, Group II - generalized aggressive periodontitis (GAP), and Group III - chronic periodontitis (CP). Blood samples were collected from subjects for measurement of CRP. Periodontal parameters include plaque index (PI), gingival index, bleeding index (BI), probing pocket depth (PPD), and clinical attachment loss (CAL) were assessed. CRP levels were assessed by means of a commercially available high sensitivity-CRP enzyme immunoassay kit. Results: CRP levels were increased in Group III (6.0671 ± 3.15639 mg/L) and Group II subjects (4.5453 ± 2.88116 mg/L) compared to the Group I (1.0180 ± 0.94069 mg/L). CRP levels showed a positive correlation with all clinical parameters in Group I subjects. BI (r = 0.073), PI (r = 0.120) showed a positive correlation with CRP level in Group II and a positive correlation was also seen for PI (r = 0.492), PPD (r = 0.340), CAL (r = 0.160), and CRP level in Group III subjects. Conclusion: The mean CRP levels were found to be greater in CP compared to GAP subjects, but there was no statistically significant difference.
  2 2,466 307
Profile of lymphadenopathy: An institutional based cytomorphological study
Aneeta Singh Malhotra, Mega Lahori, Arti Nigam, Arvind Khajuria
April-June 2017, 7(2):100-103
DOI:10.4103/2229-516X.205812  PMID:28584739
Introduction: Lymphadenopathy is one of the most common clinical presentations of patients attending the outdoor department of a hospital. Lymph node aspiration is of great value for the diagnosis of lymphadenitis, lymphomas, and metastatic carcinoma. Materials and Methods: In this study, we have reported the pattern of cytological diagnosis on fine-needle aspiration cytology (FNAC) of lymphadenopathy cases in Jammu region of Jammu and Kashmir state of India. The mean age of all the patients in this study was 21.67 years. The most common site of lymphadenopathy was cervical region (71.79%) followed by axillary region (11.11%). Results: Tubercular lymphadenitis (44.02%) was the single most common cause of lymphadenopathy followed by reactive lymphadenitis (42.64%), metastatic lesions (9.40%), and malignant lymphoma (4.70%). The sensitivity of 94.49%, positive predictive value of 96.26%, and diagnostic accuracy of 91.15% was achieved in our study. Conclusion: This study highlights the role of FNAC as a simple, inexpensive, relatively painless, rapid, repeatable, and reliable method of investigation for lymphadenopathy, especially in outpatient departments, peripheral hospitals, and dispensaries.
  2 2,959 339
Screening of patients with chronic medical disorders in the outpatient department for depression using handheld computers as interface and patient health questionnaire-9 as a tool
Vaibhav Kumar Ingle, Ijya Pandey, Akash Ranjan Singh, Abhijit Pakhare, Sanjeev Kumar
April-June 2017, 7(2):129-133
DOI:10.4103/2229-516X.205809  PMID:28584746
Background and Objectives: Depression, especially in concurrence with chronic medical disorders, is highly prevalent worldwide. An average between 9.3% and 23% of patients with one or more chronic disease have co-morbid depression. This comorbid depression has the worst health scores of all the disease states. Despite this, patients with chronic medical disorders are not commonly screened for depression. Lack of objective screening by health-care providers as well as lack of infrastructure (time/space/personnel) probably contributes to gross underdiagnosis of depression. This issue can be addressed using short objective depression screening score (Patient Health Questionnaire-9 [PHQ-9]) (validated in native languages, e.g., Hindi) and paperless self-administered interface on handheld computer (tablet), which is the objective of the study. Subjects and Methods: One hundred consecutive patients with chronic medical disorders visiting our medicine outpatient department were screened for depression using tablets with PHQ-9 Hindi on a self-administered interface. Results: The overall prevalence of depression was found to be 25% (95% confidence interval 16.6–34.8). Nearly half of the patients with depression had moderate depression (PHQ-9 score 10–14) while rest had moderately severe or very severe depression (PHQ-9 score >14). Association of depression was not found to be statistically significant with age, duration of disease, gender, the type of disease, or the number of disease. Majority of patients rated ease of the use of tablet interface (on a visual analog scale) as very easy (approx 95%). All the patients were able to complete the tablet screener without assistance, answering all of the questions. The median time of completion with interquartile range was 4 (3–5) min. Majority of the patients (63%) completed the questionnaire within 5 min while rest completed it in 5–10 min. Conclusions: It is feasible to use tablets with PHQ-9 questionnaire in native language for screening depression in chronic medical disorders. With high prevalence of comorbid depression, any comprehensive care of patients with chronic medical disorders will not be possible, unless such patients are screened and treated for depression. A self-administered screening questionnaire for depression on handheld tablets can prove to be a handy tool to achieve above aim.
  2 3,414 210
Accessory flexor carpi ulnaris and bilaterally variant vascular anatomy of upper limb: An unusual presentation
Sulochana Sakthivel, Suman Verma
April-June 2017, 7(2):143-145
DOI:10.4103/ijabmr.IJABMR_326_16  PMID:28584749
We report a rare combination of variations in the upper limb of a human cadaver. Accessory flexor carpi ulnaris with absent palmaris longus was observed in the left forearm during routine dissection of a male cadaver. Variant vascular pattern was observed bilaterally. Brachial artery bifurcated at a higher level. Ulnar artery gave rise to persistent median artery (PMA) which pierced the median nerve and accompanied it deep into flexor retinaculum to terminate as two common palmar digital arteries. Superficial palmar arch was not formed as the PMA did not anastomose with either the radial or ulnar artery. Radial artery was small and deep palmar arch was mainly contributed by the deep branch of ulnar artery. Awareness of these coexistent variations in the forearm and hand is anatomically as well as clinically important in reconstructive hand surgeries.
  1 2,647 144
Rupture of noncommunicating rudimentary horn of uterus
Sunil Kumar Juneja, Shweta Gupta, Pooja Tandon, Neha Gumber
April-June 2017, 7(2):146-147
DOI:10.4103/ijabmr.IJABMR_112_16  PMID:28584750
Rudimentary horn pregnancy though an extremely rare condition can be associated with high morbidity. We report a case of ruptured noncommunicating rudimentary horn with unicornuate uterus.
  1 2,013 166
Antepartum hemorrhage: A retrospective analysis from a northern nigerian teaching hospital
Idris Usman Takai, Badia Maje Sayyadi, Hadiza Shehu Galadanci
April-June 2017, 7(2):112-116
DOI:10.4103/2229-516X.205819  PMID:28584742
Background: Antepartum hemorrhage (APH) contributes significantly to maternal and perinatal morbidity and mortality globally, particularly in the developing world like ours. Prevention, early detection, and prompt management cannot be overemphasized to significantly reduce the morbidity and mortality associated with this condition. Objectives: The study is aimed at determining the prevalence, etiology, sociodemographic characteristics, and the fetomaternal outcome of pregnancies complicated by APH in Aminu Kano Teaching Hospital, Kano. Materials and Methods: A 5 years retrospective study of all pregnancies complicated by APH at Aminu Kano Teaching Hospital, Kano, Nigeria, between January 1, 2009, and December 31, 2013, was conducted. Results: A total of 224 cases of APH were recorded out of the 18,273 cases admitted for delivery during the study period, giving an institutional prevalence rate of 1.2%. Two hundred and eighteen folders were retrieved and analyzed giving a retrieval rate of 97.3%. The mean gestational age at presentation was 35.3 ± 2 weeks and the most common causes were abruptio placenta and placenta previa constituting 68.3% and 30.0%, respectively. Sociodemographic characteristics associated with the occurrence of APH included age, booking status, parity, and socioeconomic status. The peak prevalence of APH was observed in the 35–39 year age group accounting for 33.0%. There were 123 live births and 92 stillbirths. The cesarean section rate was 53.5%. Major complications were intrauterine fetal deaths in 42.8%, postpartum hemorrhage in 24.2% of cases, and anemia necessitating blood transfusion in 61.5%. There were three maternal deaths all due to abruptio placentae during the study period giving a case specific fatality rate of 2%. Conclusion: The prevalence of APH in our setting is high. The major causes were abruptio placenta and placenta previa. The major fetal complication was intrauterine fetal death, and the major maternal complications were postpartum hemorrhage and anemia with consequent high blood transfusion rate. Early detection, provision of antenatal care, and emergency obstetric care services can reduce the negative effects of APH.
  1 6,902 816
A conjecture as to the physiological origins of yawning
Kenneth Martin Dolkart
April-June 2017, 7(2):148-148
DOI:10.4103/2229-516X.205818  PMID:28584751
  - 1,717 121