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Tag: Neurology (journal)

  • Does Your Neighborhood Affect Your Care After a Stroke?

    Does Your Neighborhood Affect Your Care After a Stroke?

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, NOVEMBER 1, 2023

    Newswise — MINNEAPOLIS – People who live in neighborhoods with lower socioeconomic status are less likely to receive clot-busting medications or undergo clot-removing procedures after they have a stroke than people who live in neighborhoods with higher socioeconomic status, according to a study published in the November 1, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

    “These treatments can greatly reduce death and disability from stroke, but previous studies have shown that few people actually receive the treatments,” said study author Amy Ying Xin Yu, MD, of the University of Toronto in Canada. “We wanted to see how socioeconomic disparities play a role, especially in an area where everyone has access to universal health care.”

    The study looked at all people living in Ontario, Canada, who had an ischemic stroke during a five-year period, for a total of 57,704 people. Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

    The study looked to see how many of those people were treated with clot-busting drugs or surgery to remove blood clots.

    Researchers also looked at participants’ neighborhoods and divided them into five groups based on their neighborhoods’ socioeconomic status, which was determined by factors such as the percentage of adults without a high school diploma, unemployment rate and income level.

    A total of 17% of those living in the neighborhoods with the lowest socioeconomic status were treated, compared to 20% of those living in the neighborhoods with the highest socioeconomic status.

    When researchers took into account other factors that could affect treatment, such as age, high blood pressure and diabetes, they found that people in the neighborhoods with the lowest socioeconomic status were 24% less likely to be treated than people in the neighborhoods with the highest socioeconomic status. There was no difference in treatment between the neighborhood with the lowest status and the middle three neighborhoods.

    “Our study underscores the need for tailored interventions to address socioeconomic disparities in access to acute stroke treatments, including educational and outreach programs to increase awareness about the signs and symptoms of stroke in various languages and efforts to distribute resources more equitably across neighborhoods,” Yu said. “Further research is needed to examine the specific causes of these disparities, so we can find ways to address the larger systemic issues that need to be improved to better serve people from under-resourced neighborhoods.”

    A limitation of the study was that researchers did not have information on other factors that could affect stroke treatment, such as the time symptoms started or how severe the stroke was.

    The study was supported by ICES, a health research institute in Ontario; the Heart and Stroke Foundation of Canada; PSI Foundation; and Ontario Health Data Platform.

    Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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  • Both High and Low HDL Cholesterol Tied to Increased Risk of Dementia

    Both High and Low HDL Cholesterol Tied to Increased Risk of Dementia

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, OCTOBER 4, 2023

    Newswise — MINNEAPOLIS – Having either high or low levels of high-density lipoprotein (HDL) cholesterol, or “good” cholesterol, is tied to a small increased risk of dementia in older adults, according to a study published in the October 4, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology. This study does not prove that high or low levels of HDL cholesterol cause dementia; it only shows an association.

    “Previous studies on this topic have been inconclusive and this study is especially informative because of the large number of participants and long follow-up,” said study author Maria Glymour, ScD, of Boston University. “This information allowed us to study the links with dementia across the range of cholesterol levels and achieve precise estimates even for people with cholesterol levels that are quite high or quite low.”

    The study involved 184,367 people from the Kaiser Permanente Northern California Health Plan, with an average age of 70 who did not have dementia at the beginning of the study. For research purposes, they filled out a survey on their health behaviors and had their cholesterol levels measured during routine health care visits an average of 2.5 times in the following two years. They were then followed within the Kaiser healthcare system via electronic health records for an average of nine years. During that time, 25,214 people developed dementia.

    The average HDL cholesterol level was 53.7 milligrams per deciliter (mg/dL). Healthy levels are considered to be above 40 mg/dL for males and above 50 mg/dL for females. Participants were divided into five groups based on their HDL cholesterol levels. People with the highest levels of HDL cholesterol had a 15% higher rate of dementia compared to those in the middle group. Those with the lowest levels had a 7% higher rate of dementia compared to those in the middle group.

    These results took into account other factors that could affect the risk of dementia, such as alcohol use, high blood pressure, cardiovascular disease and diabetes.

    The researchers found only a slight association between low-density lipoprotein, or “bad” cholesterol, and the risk of dementia.

    “The elevation in dementia risk with both high and low levels of HDL cholesterol was unexpected, but these increases are small, and their clinical significance is uncertain,” Glymour said. “In contrast, we found no association between LDL cholesterol and dementia risk in the overall study cohort. Our results add to evidence that HDL cholesterol has similarly complex associations with dementia as with heart disease and cancer.”

    A limitation of the study was that people volunteered to take part in the survey, so they may not be representative of the larger population.

    The study was supported by the National Institute on Aging and the National Institutes of Health.  

    Learn more about dementia at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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  • Can Taking Statins After a Bleeding Stroke Lower Risk of Another Stroke?

    Can Taking Statins After a Bleeding Stroke Lower Risk of Another Stroke?

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, AUGUST 30, 2023

    Newswise — MINNEAPOLIS – People who have had a stroke called an intracerebral hemorrhage who take cholesterol-lowering drugs called statins may have a lower risk of having another stroke, especially ischemic stroke, compared to people who also had an intracerebral hemorrhage but were not taking statins, according to a new study published in the August 30, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

    Intracerebral hemorrhage is caused by bleeding in the brain. Ischemic stroke is caused by a blockage of blood flow to the brain and is the most common type of stroke.

    “Previous research has had mixed results on the risk of stroke in people who are taking statins and have already had a bleeding stroke, so we evaluated this further,” said study author David Gaist, MD, PhD, of the University of Southern Denmark in Odense and a member of the American Academy of Neurology. “We looked at whether use of statins after a bleeding stroke is associated with the risk of any additional stroke, including both those caused by bleeding and by blood clots. We found that those who used statins had a lower risk of stroke, notably ischemic stroke, while there was no change in the risk of bleeding stroke.”

    For the study, researchers looked at health records in Denmark and identified 15,151 people who had a first bleeding stroke.

    People were followed from 30 days after their first bleeding stroke until the first occurrence of another stroke, death, or the end of follow-up, which on average lasted 3.3 years. Researchers used prescription data to determine information on statin use.

    Researchers then compared 1,959 people who had another stroke to 7,400 people who did not have another stroke who were similar in age, sex and other factors. Of those who had another stroke, 757 people, or 39%, took statins compared to 3,044 people, or 41%, of those who did not have a second stroke.

    After adjusting for factors like high blood pressure, diabetes and alcohol use, statin use was associated with a 12% lower risk of another stroke.

    Then they compared 1,073 people who had an ischemic stroke to 4,035 people who did not have another stroke. Of those who had an ischemic stroke, 427 people, or 40%, took statins compared to 1687 people, or 42%, of those who did not have another stroke.

    After adjusting for similar factors, statin use was associated with a 21% lower risk of an ischemic stroke after the initial bleeding stroke.

    They also compared 984 people who had another bleeding stroke to 3,755 people who did not have another stroke. Of those who had a recurrent bleeding stroke, 385 people, or 39%, took statins compared to 1,532 people, or 41%, of those who did not have another stroke.

    After adjustments, researchers did not find a link between statin use and recurrent bleeding stroke.

    “The results of our study are good news for people taking statins who have had a bleeding stroke,” Gaist added. “While we did find a lower risk of having another stroke, it is important to note that when looking at the data more closely, that lower risk was for ischemic stroke. Still, we found no increased risk for bleeding stroke. More studies are needed to confirm our findings.”

    A limitation of the study was that it only included the Danish population, which is primarily people of European ancestry, and may not be generalizable to people from other populations.

    The study was supported by Novo Nordisk Foundation.

    Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.  

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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  • Long COVID Sufferers with Cognitive Complaints and Mental Health Issues Have Changes in Brain Function, New Study Suggests

    Long COVID Sufferers with Cognitive Complaints and Mental Health Issues Have Changes in Brain Function, New Study Suggests

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    Newswise — BALTIMORE, April 26, 2023– Those who experience brain fog, memory issues or other neuropsychiatric symptoms for months after a COVID-19 diagnosis were found to have abnormal brain activity during memory tests on functional magnetic resonance imaging (MRI), according to a new study led by University of Maryland School of Medicine (UMSOM) researchers. 

    Long COVID accompanied with neurological symptoms was associated with less activity in certain brain regions normally used for memory tasks but more activity in other areas of the brain. Findings were published today in the journal Neurology, the medical journal of the American Academy of Neurology.

    “The greater activity occurred outside of the normal working memory brain network. We often see such changes in patients with a brain injury: Deficits in the default mode network of the brain leads to an increase in activity in other regions to help maintain brain function,” said study leader Linda Chang, MD, MS, Professor of Diagnostic Radiology and Nuclear Medicine, and an associate member of the Institute of Human Virology (IHV), at the University of Maryland School of Medicine. “While our study doesn’t prove that COVID caused these brain changes, there appears to be a strong association with these changes and lingering neuropsychiatric symptoms.”  

    An estimated 30 percent of those who had COVID-19 infections develop chronic symptoms known as long COVID. More than half of these patients develop cognitive or psychiatric symptoms with fatigue, difficulty concentrating, feeling depressed and anxious, being among the most prevalent symptoms, according to a report released in January by the Substance Abuse and Mental Health Services Administration. 

    While some patients experience a resolution of these issues within a year or two of diagnosis, others still suffer from daily disability more than three years after the onset of the pandemic. Researchers have been racing to conduct studies to learn more about long COVID in these patients in an attempt to develop better treatments. 

    To conduct the new study, Dr. Chang and her colleagues performed functional MRI scans on 29 patients who had COVID-19 an average of seven months earlier and had at least one ongoing neuropsychiatric symptom like memory loss, depression, or anxiety. Nine of these study participants had COVID-19 infections severe enough to require prior hospitalization. The researchers also conducted brain imaging scans in 21 healthy volunteers who had no history of COVID-19 and were of similar age, health status and vaccination status to those with long COVID. 

    All the participants had tests for thinking and memory skills, emotional health, motor function, as well as measures for symptoms of depression, anxiety, fatigue, and pain. They also had functional MRI brain scans while they performed tests to evaluate their working memory. The scans showed which areas of the brain were active during the tests. 

    “Even though the majority of people who had COVID-19 in our study reported ongoing problems with concentration and memory, they had scores on various tests for thinking skills that were similar to those who had no history of COVID-19,” Chang said. “This could be because their brains were compensating for these deficits by using more of other parts of their networks to maintain their performance.” 

    However, the long COVID group did have poorer scores on tests of dexterity and motor endurance than the non-COVID group. They also reported more negative feelings, such as anger and sadness, and higher levels of stress, and they had lower scores for life satisfaction compared to those who never had COVID. In addition, they had higher scores for depression, anxiety, fatigue and pain than the control group. People in the post-COVID group who had greater changes in their brain activity were more likely to have poorer scores in many of these symptom domains.

    These patients could benefit from neurorehabilitation or psychiatric treatments, and the researchers recommend that doctors consider these approaches to help manage this condition.

    The study had a few caveats:  It was conducted mainly during early part of the pandemic when the Delta variant of the SARS-CoV-2 virus was circulating in the US. Results may not apply to the newer coronavirus variants like Omicron, and it is not known whether these newer variants affect the brain similarly. In addition, since antibody testing was not completed on the people who reported no prior COVID-19, it is possible that they had prior infections or exposure to the virus with no symptoms. 

    The study was funded by the National Institute of Neurological Disorders and Stroke. 

    Other UMSOM faculty, staff and students who served as co-authors on this study include: Meghann Ryan, MS, Huajun Lian, MBBS, PhD, Xin Zhang, MS, Eric Cunningham, BS, Justin Wang, Eleanor Wilson, MD, Edward Herskovits, MD, PhD, Shyam Kottilil, MBBS, PhD, Interim IHV Director, and Thomas Ernst, PhD.

    “While this study provides crucial information on brain function in those who suffer neuropsychiatric symptoms from long COVID, we now need longitudinal follow-up studies to determine whether or when these abnormal imaging patterns will normalize and whether that correlates to a resolution in symptoms,” said UMSOM Dean, Mark T. Gladwin, MD, who is also Vice President for Medical Affairs, University of Maryland, Baltimore, and the John Z. and Akiko K. Bowers Distinguished Professor. 

     

    About the University of Maryland School of Medicine

    Now in its third century, the University of Maryland School of Medicine was chartered in 1807 as the first public medical school in the United States. It continues today as one of the fastest growing, top-tier biomedical research enterprises in the world — with 46 academic departments, centers, institutes, and programs, and a faculty of more than 3,000 physicians, scientists, and allied health professionals, including members of the National Academy of Medicine and the National Academy of Sciences, and a distinguished two-time winner of the Albert E. Lasker Award in Medical Research. With an operating budget of more than $1.3 billion, the School of Medicine works closely in partnership with the University of Maryland Medical Center and Medical System to provide research-intensive, academic, and clinically based care for nearly 2 million patients each year. The School of Medicine has nearly $600 million in extramural funding, with most of its academic departments highly ranked among all medical schools in the nation in research funding. As one of the seven professional schools that make up the University of Maryland, Baltimore campus, the School of Medicine has a total population of nearly 9,000 faculty and staff, including 2,500 students, trainees, residents, and fellows. The combined School of Medicine and Medical System (“University of Maryland Medicine”) has an annual budget of over $6 billion and an economic impact of nearly $20 billion on the state and local community. The School of Medicine, which ranks as the 8th highest among public medical schools in research productivity (according to the Association of American Medical Colleges profile) is an innovator in translational medicine, with 606 active patents and 52 start-up companies. In the latest U.S. News & World Report ranking of the Best Medical Schools, published in 2021, the UM School of Medicine is ranked #9 among the 92 public medical schools in the U.S., and in the top 15 percent (#27) of all 192 public and private U.S. medical schools. The School of Medicine works locally, nationally, and globally, with research and treatment facilities in 36 countries around the world. Visit medschool.umaryland.edu

     

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  • Is the Language You Speak Tied to Outcome After Stroke?

    Is the Language You Speak Tied to Outcome After Stroke?

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, APRIL 12, 2023

    Newswise — MINNEAPOLIS – Studies have shown that Mexican Americans have worse outcomes after a stroke than non-Hispanic white Americans. A new study looks at whether the language Mexican American people speak is linked to how well they recover after a stroke. The study is published in the April 12, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

    “Our study found that Mexican American people who spoke only Spanish had worse neurologic outcomes three months after having a stroke than Mexican American people who spoke only English or were bilingual,” said study author Lewis B. Morgenstern, MD, of the University of Michigan in Ann Arbor and a Fellow of the American Academy of Neurology. “More research is needed into what factors and barriers may influence these worse outcomes.”

    The study involved 1,096 Mexican American people in Corpus Christi, Texas, who had a stroke over a 10-year period. Researchers looked at results three months after the stroke in three areas: neurologic, functional and thinking and memory skills. Neurologic results cover areas such as muscle strength and coordination and problems with speech or vision. Functional results look at how well people can complete their daily activities such as showering and preparing meals.

    The 170 people who spoke Spanish only were compared to the 926 people who spoke English only or were bilingual. Those who spoke Spanish only were older, had received less education and had worse neurologic scores at the time of the stroke than those in the other group.

    Three months after the stroke, the Spanish-only speakers had average neurologic scores of seven, where scores of five to 14 indicate moderate effects from a stroke. The English-only and bilingual speakers had average scores of four, where scores of one to four indicate mild effects. The results remained after researchers adjusted for the differences between the two groups and other factors that could affect stroke risk, such as high blood pressure and diabetes.

    The study found no difference between the two groups in how well they recovered their ability to complete their daily activities or in their thinking and memory skills.

    “We conducted an earlier study in this same community finding that the language people spoke was not associated with any delay in their getting to the hospital or using emergency medical services after an ischemic stroke, so we definitely need more information to determine what is driving the differences in outcomes between these two groups,” Morgenstern said.

    A limitation of the study was that there was a low number of Spanish-only speakers. Also, the majority of Mexican Americans in Corpus Christi are born in the United States, so these results may not be applicable to areas with a larger population of people born outside the United States.

    The study was supported by the National Institutes of Health and the TRANSCENDS (Training in Research for Academic Neurologists to Sustain Careers and Enhance the Numbers of Diverse Scholars) program funded by the National Institutes of Health.  

    Learn more about stroke at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 40,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

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  • Can Diet Combined with Drugs Reduce Seizures?

    Can Diet Combined with Drugs Reduce Seizures?

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    EMBARGOED FOR RELEASE UNTIL 4 P.M. ET, WEDNESDAY, JANUARY 4, 2023

     

    Newswise — MINNEAPOLIS – Following a modified Atkins diet high in fat and low in carbohydrates plus taking medication may reduce seizures in people with tough-to-treat epilepsy, according to a study published in the January 4, 2023, online issue of Neurology®, the medical journal of the American Academy of Neurology.

    “For people with drug-resistant epilepsy, or those who have been unable to find effective treatment to reduce seizures, it’s encouraging to see that there are lifestyle changes that can be combined with standard drug therapy to reduce the number of seizures,” said study author Manjari Tripathi, MD, DM, of All India Institute of Medical Sciences in New Delhi. “Our study found that this combination may reduce the chance of seizures by more than half.”

    The modified Atkins diet is a combination of the Atkins diet and a ketogenic diet that includes food items such as soy products, heavy cream, butter and oils, leafy green vegetables, and animal protein including eggs, chicken, fish, and bacon. While the ketogenic diet has been shown to be effective in reducing seizures, its stringent requirements and restrictions can make it difficult to follow.

    The study involved 160 adults and adolescents who had epilepsy for more than 10 years on average and had at least 27 seizures per month despite trying an average of four antiseizure medications at the maximum tolerated dose. They were randomly assigned to receive either standard drug therapy alone or drugs plus the modified Atkins diet over six months.

    Participants logged their seizures and meals. They were given food lists, sample menus and recipes. Carbohydrate intake was restricted to 20 grams per day. Federal dietary guidelines recommend between 225 and 325 grams of carbs per day.

    After six months, researchers found that 26% of people who had both drug therapy and followed the modified Atkins diet had more than a 50% reduction in seizures compared to only 3% of the people who had drug therapy alone. Four people in the diet group were free of seizures by the end of the study, while no one in the medication-only group was seizure free.

    The study also looked at quality of life, behavior and side effects at six monthsThe group that had drug therapy and followed the modified Atkins diet showed an improvement in all areas compared to the group that had drug therapy alone.

    Tripathi noted that 33% of the participants did not complete the study due to poor tolerance of the diet, lack of benefit or the inability to follow-up in part due to COVID-19. However, Tripathi said tolerance of the modified Atkins diet was better than what is seen with the ketogenic diet.

    “While the modified Atkins diet may be an effective treatment in controlling seizures, further research is needed to identify genetic biomarkers and other factors associated with the response to this diet,” Tripathi added. “This may improve patient care by encouraging targeted precision based  earlier use of this diet.”

    A limitation of the study is that seizures were self-reported or reported by caregivers, so some seizures may not have been reported.

    The study was supported by the Department of Biotechnology, India.

    Learn more about epilepsy at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

    When posting to social media channels about this research, we encourage you to use the hashtags #Neurology and #AANscience.

    The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 38,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.

    For more information about the American Academy of Neurology, visit AAN.com or find us on Facebook, Twitter, Instagram, LinkedIn and YouTube.

     

     

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