Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales

Objetivo: comparar los resultados de 6 pruebas clínicas con el cuestionario FIQ-R en los pacientes con fibromialgia. Metodología: El estudio tuvo un diseño descriptivo transversal, se obtuvieron medidas de tendencia central y dispersión adecuadas para cada variable. Se presentan los resultados en ta...

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Autores:: Perico-Franco, Hugo Efraín

Tipo de recurso:: Work document

Fecha de publicación:: 2019

Institución:: Universidad Nacional de Colombia

Repositorio:: Universidad Nacional de Colombia

Idioma:: spa

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repository_id_str
dc.title.spa.fl_str_mv	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
title	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
spellingShingle	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales Medicina física y rehabilitación fibromialgia pruebas clínicas FIQ-R funcionalidad fibromyalgia clinical tests FIQ-R Function
title_short	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
title_full	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
title_fullStr	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
title_full_unstemmed	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
title_sort	Evaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionales
dc.creator.fl_str_mv	Perico-Franco, Hugo Efraín
dc.contributor.advisor.spa.fl_str_mv	Ortiz-Corredor, Fernando
dc.contributor.author.spa.fl_str_mv	Perico-Franco, Hugo Efraín
dc.contributor.researchgroup.spa.fl_str_mv	Grupo de Investigación en Fisiatría, Electrodiagnóstico y Enfermedades Neuromusculares
dc.subject.ddc.spa.fl_str_mv	Medicina física y rehabilitación
topic	Medicina física y rehabilitación fibromialgia pruebas clínicas FIQ-R funcionalidad fibromyalgia clinical tests FIQ-R Function
dc.subject.proposal.spa.fl_str_mv	fibromialgia pruebas clínicas FIQ-R funcionalidad
dc.subject.proposal.eng.fl_str_mv	fibromyalgia clinical tests FIQ-R Function
description	Objetivo: comparar los resultados de 6 pruebas clínicas con el cuestionario FIQ-R en los pacientes con fibromialgia. Metodología: El estudio tuvo un diseño descriptivo transversal, se obtuvieron medidas de tendencia central y dispersión adecuadas para cada variable. Se presentan los resultados en tablas de doble entrada y en gráficos adecuados dependiendo de la variable. Para la comparación de las pruebas clínicas con el FIQ-R y la prueba de marcha en 2 minutos, se realizó un análisis bivariado. Se realizaron coeficientes de correlación según el tipo de variable, entre la escala de FIQ-R y las pruebas clínicas y finalmente se realizó un análisis de árboles de clasificación y regresión para identificar subgrupos de la enfermedad. Resultados: se evaluaron 447 mujeres con edad promedio de 51.45 años (Rango 21 - 77 años). Se obtuvo una correlación entre las variables FIQ-R y levantarse y sentarse durante 30 segundos (r=-0,42, p-valor <0.0001) y Up & Go test (r= 0,41, p-valor <0.0001). La correlación de la variable prueba de 2 minutos con las variables velocidad de marcha y levantarse y sentarse 30s fue r:= 0,49 y 0,62 respectivamente, Finalmente, la variable Antecedente de caídas presento pobres correlaciones con todas las variables. Conclusión: La funcionalidad medida por pruebas clínicas se correlaciona de forma moderada con el FIQ-R, con los análisis CART se demuestra que a peor desempeño funcional mayor probabilidad de severidad. El riesgo de caídas no se puede predecir con ninguna de las pruebas utilizadas en este estudio
publishDate	2019
dc.date.issued.spa.fl_str_mv	2019-01-29 2020-01-29
dc.date.accessioned.spa.fl_str_mv	2020-01-30T16:50:26Z
dc.date.available.spa.fl_str_mv	2020-01-30T16:50:26Z
dc.type.spa.fl_str_mv	Documento de trabajo
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dc.type.version.spa.fl_str_mv	info:eu-repo/semantics/acceptedVersion
dc.type.coar.spa.fl_str_mv	http://purl.org/coar/resource_type/c_8042
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dc.identifier.uri.none.fl_str_mv	https://repositorio.unal.edu.co/handle/unal/75541
url	https://repositorio.unal.edu.co/handle/unal/75541
dc.language.iso.spa.fl_str_mv	spa
language	spa
dc.relation.references.spa.fl_str_mv	Aparicio, V. A., Ruiz, J. R., Aranda, P., & Tercedor, P. (2013). Fitness testing as a discriminative tool for the diagnosis and monitoring of fibromyalgia. Scandinavian Journal of Medicine and Science in Sports, 23(4), 415–423. https://doi.org/10.1111/j.1600-0838.2011.01401.x Assumpção, A., Sauer, J., Mango, P., & Marques, A. P. (2010). Physical function interfering with pain and symptoms in fibromyalgia patients. CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 28(Suppl. 63), S57–S63. Atzeni, F., Talotta, R., Masala, I. F., Giacomelli, C., Conversano, C., Nucera, V., … Bazzichi, L. (2019). Review One year in review 2019 : fibromyalgia, 3–10. Bennett, R. M., Friend, R., Jones, K. D., Ward, R., Han, B. K., & Ross, R. L. (2009). The Revised Fibromyalgia Impact Questionnaire ( FIQR ): validation and psychometric properties. Arthritis Research and Therapy, 11(4), 1–14. https://doi.org/10.1186/ar2783 Berger, A., Dukes, E., Martin, S., Edelsberg, J., & Oster, G. (2007). Characteristics and healthcare costs of patients with fibromyalgia syndrome. International Journal of Clinical Practice, 61(9), 1498–1508. https://doi.org/10.1111/j.1742-1241.2007.01480.x Bidonde, J., Aj, B., Cl, S., Tj, O., Sy, K., Sm, G., … Hja, F. (2017). Aerobic exercise training for adults with fibromyalgia ( Review ), (6). https://doi.org/10.1002/14651858.CD012700.www.cochranelibrary.com Bidonde, J., Busch, A., Webber, S., Schachter, C., Danyliw, A., Overend, T., … Rader, T. (2014). Aquatic exercise training for fibromyalgia ( Review ). Cochrane Database of Systematic Reviews, (10). https://doi.org/10.1002/14651858.CD011336 Bohannon, R. W., Wang, Y., Otr, L., & Gershon, R. C. (2015). Two-Minute Walk Test Performance by Adults 18 to 85 Years : Normative Values , Reliability , and Responsiveness. Archives of Physical Medicine and Rehabilitation, 96(3), 472–477. https://doi.org/10.1016/j.apmr.2014.10.006 BUTLAND, R. J. A., PANG, J., GROSS, E. R., WOODCOCK, A. A., & GEDDES, D. M. (1982). Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal, 284(6329), 1607–1608. Carbonell-Baeza, A., Aparicio, V. A., Chillón, P., Femia, P., Delgado-Fernández, M., & Ruiz, J. R. (2011). Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia. CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 29(Suppl. 69), S97–S103. Caro, X. J., Galbraith, R. G., & Winter, E. F. (2018). Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. European Journal of Rheumatology, 5(4), 104–110. https://doi.org/10.5152/eurjrheum.2018.17109 Castro-Piñero, J., Aparicio, V. A., Estéves-Lopez, F., Álvarez-Gallardo, I. C., Borges-Cosic, M., Soriano-maldonado, A., … Segura-Jimenez, V. (2010). The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia : The al-Ándalus Project. International Journal of Sports Medicine, 38(05), 359–369. Clauw, D. J. (2014). Fibromyalgia A Clinical Review. JAMA, 311(15), 1547–1555. https://doi.org/10.1001/jama.2014.3266 Collado-Mateo, D, Gallego-Diaz, J. M., Adsuar, J. C., Domínguez-Muñoz, F. J., Olivares, P. R., & Gusi, N. (2015). Fear of Falling in Women with Fibromyalgia and Its Relation with Number of Falls and Balance Performance. BioMed Research International, 589014. Collado-Mateo, Daniel, Domínguez-Muñoz, F. J., Adsuar, J. C., Merellano-Navarro, E., Olivares, P. R., & Gusi, N. (2016). Reliability of the Timed Up and Go Test in Fibromyalgia. Rehabilitation Nursing, (1991), 1–5. https://doi.org/10.1002/rnj.307 Costa, S., Gamundí, A., Miranda, J. G. V., França, L. G. S., Santana, C. N. De, & Montoya, P. (2017). Altered Functional Performance in Patients with Fibromyalgia. Frontiers in Human Neuroscience, 11(January), 1–9. https://doi.org/10.3389/fnhum.2017.00014 Estévez-lópez, F., Álvarez-gallardo, I., Segura-Jiménez, V., Soriano-Maldonado, A., Borges-Cosic, M., Pulido-Martos, M., … Geenen, R. (2018). The discordance between subjectively and objectively measured physical function in women with fibromyalgia : association with catastrophizing and self-efficacy cognitions . The al-Ándalus project. Disability and Rehabilitation, 40(3), 329–337. https://doi.org/10.1080/09638288.2016.1258737 Fernandes, G., Jennings, F., Vieira, M., Cabral, N., Buosi, P., Natour, J., & Letı, A. (2016). Swimming Improves Pain and Functional Capacity of Patients With Fibromyalgia : A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 97(8), 1269–1275. Góes, S. M., Leite, N., Shay, B. L., Homann, D., Stefanello, J. M. F., & Rodacki, A. L. F. (2012). Clinical Biomechanics Functional capacity , muscle strength and falls in women with fi bromyalgia ☆. JCLB, 27(6), 578–583. https://doi.org/10.1016/j.clinbiomech.2011.12.009 Grayston, R., Czanner, G., Elhadd, K., Goebel, A., & Frank, B. (2019). A systematic review and meta-analysis of the prevalence of small fiber pathology in fibromyalgia: Implications for a new paradigm in fibromyalgia etiopathogenesis. Seminars in Arthritis and Rheumatism, 48, 933–940. https://doi.org/10.1016/j.semarthrit.2018.08.003 GURALNIK, J., FERRUCCI, L., SIMONSICK, E., SALIVE, M., & WALLACE, R. (1995). Lower-extremity function in persons over the age of 70 years as a predictor of subsequent disability. The New England Journal of Medicine, 332(9), 556–561. Heidari, F., Afshari, M., & Moosazadeh, M. (2017). Prevalence of fibromyalgia in general population and patients, a systematic review and meta-analysis. Rheumatology International, 37(9), 1527–1539. https://doi.org/10.1007/s00296-017-3725-2 Intemann, T., Aparicio, V. A., Ruiz, J. R., & Ortega, F. B. (2017). Physical fitness reference standards in fibromyalgia : The al- Andalus project, 1477–1488. https://doi.org/10.1111/sms.12741 Jones, C. J., Rikli, R. E., & Beam, W. C. (1999). A 30-s Chair-Stand Test as a Measure of Lower Body Strength in Community-Residing Older Adults A 30-s Chair-Stand Test as a Measure of Lower Body. Research Quarterly for Exercise and Sport, 70(2), 113–119. https://doi.org/10.1080/02701367.1999.10608028 Kibar, S., Yıldız, E., Ay, S., Evcik, D., & Ergin, E. S. (2015). New Approach in Fibromyalgia Exercise Program : A Preliminary Study Regarding the Effectiveness of Balance Training. Archives of Physical Medicine and Rehabilitation, 96(9), 1576–1582. Luciano, J. V, Forero, C. G., Cerda, M., Pen, T., Ferna, R., Cuesta-vargas, A. I., … Garcı, J. (2016). Functional Status , Quality of Life , and Costs Associated With Fibromyalgia Subgroups A Latent Profile Analysis. The Clinical Journal of Pain, 32(10), 829–840. https://doi.org/10.1097/AJP.0000000000000336 Mannerkorpi, K., Svantesson, U., & Broberg, C. (2006). Relationships Between Performance-Based Tests and Patients’ Ratings of Activity Limitations, Self-Efficacy, and Pain in Fibromyalgia. Archives of Physical Medicine and Rehabilitation, 87(February), 259–264. https://doi.org/10.1016/j.apmr.2005.10.013 Pérez-de-Heredia-Torres, M., Huertas-Hoyas, E., Martínez-Piédrola, R., Palacios-Ceña, D., & Alegre-Ayala, J. (2017). Balance deficiencies in women with fibromyalgia assessed using computerised dynamic posturography : a cross-sectional study in Spain. BMJ Open, 7(e016239). https://doi.org/10.1136/bmjopen-2017-016239 Phelan, E. A., Mahoney, J. E., Voit, J. C., & Stevens, J. A. (2015). Assessment and Management of Fall Risk in Primary Care Settings. Medical Clinics of North America, 99(2), 281–293. https://doi.org/10.1016/j.mcna.2014.11.004 Rutledge, D. N., Martinez, A., Traska, T. K., & Rose, D. J. (2012). Fall experiences of persons with fibromyalgia over 6 months. Journal of Advanced Nursing, 69(2), 435–448. https://doi.org/10.1111/j.1365-2648.2012.06026.x Sevimli, D., Kozanoglu, E., Guzel, R., & Doganay, A. (2015). The effects of aquatic, isometric strength-stretching and aerobyc exercise on physical and psychological parameters of female patients with fibromyalgia syndrome. Journal of Physical Therapy Science, 27(6), 1781–1786. Soriano-maldonado, A., Henriksen, M., Aparicio, V. A., Carbonell-baeza, A., Amris, K., Ruiz, J. R., & Delgado-ferna, M. (2015). Association of Physical Fitness With Fibromyalgia Severity in Women : The al-Ándalus Project. Archives of Physical Medicine and Rehabilitation, 96(9), 1599–1605. Talotta, R., Bazzichi, L., Franco, M. Di, Casale, R., Batticciotto, A., Gerardi, M. C., … Casale, R. (2017). One year in review 2017 : fibromyalgia. Clinical and Experimental Rheumatology, 35(Suppl. 105), S6–S12. Wolfe, F., Clauw, D. J., Fitzcharles, M., Don, L., Häuser, W., Katz, R. S., … Winfield, J. B. (2011). Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies : A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia Criteria and Severity Scales for Clinical and Epidemiological Studies : A Modification of the ACR Preliminary Diagnostic Criteria for Fibromyalgia, 38(6). https://doi.org/10.3899/jrheum.100594 Wolfe, F., Clauw, D. J., Fitzcharles, M., Goldenberg, D. L., Häuser, W., Katz, R. L., … Walitt, B. (2016). 2016 Revisions to the 2010 / 2011 fibromyalgia diagnostic criteria. Seminars in Arthritis and Rheumatism, 46(3), 319–329. https://doi.org/10.1016/j.semarthrit.2016.08.012 Wolfe, F., Clauw, D. J., Fitzcharles, M., Goldenberg, D. O. N. L., Katz, R. S., Mease, P., … Winfield, J. B. (2010). The American College of Rheumatology Preliminary Diagnostic Criteria for Fibromyalgia and Measurement of Symptom Severity. Arthritis Care and Research, 62(5), 600–610. https://doi.org/10.1002/acr.20140 Wolfe, F., & Häuser, W. (2011). Fibromyalgia diagnosis and diagnostic criteria. Annals of Medicine, 43(April), 495–502. https://doi.org/10.3109/07853890.2011.595734 Wolfe, F., Smythe, H. A., Yunus, M. B., Bennett, R. M., Bombardier, C., Goldenberg, D. O. N. L., … Sheon, R. P. (1990). THE AMERICAN COLLEGE OF RHEUMATOLOGY 1990 CRITERIA FOR THE CLASSIFICATION OF FIBROMYALGIA Report of the Multicenter Criteria Committee. Arthritis and Rheumatism, 33(2), 160–172.
dc.rights.spa.fl_str_mv	Derechos reservados - Universidad Nacional de Colombia
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dc.rights.license.spa.fl_str_mv	Atribución-NoComercial 4.0 Internacional
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dc.coverage.sucursal.spa.fl_str_mv	Universidad Nacional de Colombia - Sede Bogotá
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spelling	Atribución-NoComercial 4.0 InternacionalDerechos reservados - Universidad Nacional de ColombiaAcceso abiertohttp://creativecommons.org/licenses/by-nc/4.0/info:eu-repo/semantics/openAccesshttp://purl.org/coar/access_right/c_abf2Ortiz-Corredor, Fernando316d115c-94b3-4179-909f-8fb07fbc9f29-1Perico-Franco, Hugo Efraín7d0893f6-b539-40f9-a320-2023c43e14f9Grupo de Investigación en Fisiatría, Electrodiagnóstico y Enfermedades Neuromusculares2020-01-30T16:50:26Z2020-01-30T16:50:26Z2019-01-292020-01-29https://repositorio.unal.edu.co/handle/unal/75541Objetivo: comparar los resultados de 6 pruebas clínicas con el cuestionario FIQ-R en los pacientes con fibromialgia. Metodología: El estudio tuvo un diseño descriptivo transversal, se obtuvieron medidas de tendencia central y dispersión adecuadas para cada variable. Se presentan los resultados en tablas de doble entrada y en gráficos adecuados dependiendo de la variable. Para la comparación de las pruebas clínicas con el FIQ-R y la prueba de marcha en 2 minutos, se realizó un análisis bivariado. Se realizaron coeficientes de correlación según el tipo de variable, entre la escala de FIQ-R y las pruebas clínicas y finalmente se realizó un análisis de árboles de clasificación y regresión para identificar subgrupos de la enfermedad. Resultados: se evaluaron 447 mujeres con edad promedio de 51.45 años (Rango 21 - 77 años). Se obtuvo una correlación entre las variables FIQ-R y levantarse y sentarse durante 30 segundos (r=-0,42, p-valor <0.0001) y Up & Go test (r= 0,41, p-valor <0.0001). La correlación de la variable prueba de 2 minutos con las variables velocidad de marcha y levantarse y sentarse 30s fue r:= 0,49 y 0,62 respectivamente, Finalmente, la variable Antecedente de caídas presento pobres correlaciones con todas las variables. Conclusión: La funcionalidad medida por pruebas clínicas se correlaciona de forma moderada con el FIQ-R, con los análisis CART se demuestra que a peor desempeño funcional mayor probabilidad de severidad. El riesgo de caídas no se puede predecir con ninguna de las pruebas utilizadas en este estudioObjective: to compare 6 clinical test results with FIQ-R questionnaire in fibromyalgia patients. Methods: it was a cross sectional study, mean, median, quartiles and standard deviation was measured. To compare clinical test, FIQ-R, and 2 minutes walk test it was used a bivariate analysis and Pearson’s coefficient correlation. Finally it was used a CART analysis to identify disease subgroups. Results: 447 women with fibromyalgia with 51.45 years old mean age (Range 21-77 years) FIQ-R - stand up and sit down in 30sec r=0,42, p <0.0001. FIQ.R – Up& Go test r=0,41, p <0.0001. 2mwt – gait speed, - stand up and sit down 30sec r= 0,49 y 0,62. Fall antecedent has a weak correlation with all the clinical test. Conclusions: the function measured in fibromyalgia was moderate correlated with the FIQ-R questionnaire, the CART analysis demonstrate that a worst performance on clinical test predict a high severity score in the FIQ-R. The fall history cannot predict with the clinical tests used here.Especialista en Medicina Física y Rehabilitación.69application/pdfspaMedicina física y rehabilitaciónfibromialgiapruebas clínicasFIQ-Rfuncionalidadfibromyalgiaclinical testsFIQ-RFunctionEvaluación de la funcionalidad en fibromialgia: caracterización de subgrupos funcionalesDocumento de trabajoinfo:eu-repo/semantics/workingPaperinfo:eu-repo/semantics/acceptedVersionhttp://purl.org/coar/resource_type/c_8042Texthttp://purl.org/redcol/resource_type/WPUniversidad Nacional de Colombia - Sede BogotáUniversidad Nacional de Colombia - Sede BogotáAparicio, V. A., Ruiz, J. R., Aranda, P., & Tercedor, P. (2013). Fitness testing as a discriminative tool for the diagnosis and monitoring of fibromyalgia. Scandinavian Journal of Medicine and Science in Sports, 23(4), 415–423. https://doi.org/10.1111/j.1600-0838.2011.01401.x Assumpção, A., Sauer, J., Mango, P., & Marques, A. P. (2010). Physical function interfering with pain and symptoms in fibromyalgia patients. CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 28(Suppl. 63), S57–S63. Atzeni, F., Talotta, R., Masala, I. F., Giacomelli, C., Conversano, C., Nucera, V., … Bazzichi, L. (2019). Review One year in review 2019 : fibromyalgia, 3–10. Bennett, R. M., Friend, R., Jones, K. D., Ward, R., Han, B. K., & Ross, R. L. (2009). The Revised Fibromyalgia Impact Questionnaire ( FIQR ): validation and psychometric properties. Arthritis Research and Therapy, 11(4), 1–14. https://doi.org/10.1186/ar2783 Berger, A., Dukes, E., Martin, S., Edelsberg, J., & Oster, G. (2007). Characteristics and healthcare costs of patients with fibromyalgia syndrome. International Journal of Clinical Practice, 61(9), 1498–1508. https://doi.org/10.1111/j.1742-1241.2007.01480.x Bidonde, J., Aj, B., Cl, S., Tj, O., Sy, K., Sm, G., … Hja, F. (2017). Aerobic exercise training for adults with fibromyalgia ( Review ), (6). https://doi.org/10.1002/14651858.CD012700.www.cochranelibrary.com Bidonde, J., Busch, A., Webber, S., Schachter, C., Danyliw, A., Overend, T., … Rader, T. (2014). Aquatic exercise training for fibromyalgia ( Review ). Cochrane Database of Systematic Reviews, (10). https://doi.org/10.1002/14651858.CD011336 Bohannon, R. W., Wang, Y., Otr, L., & Gershon, R. C. (2015). Two-Minute Walk Test Performance by Adults 18 to 85 Years : Normative Values , Reliability , and Responsiveness. Archives of Physical Medicine and Rehabilitation, 96(3), 472–477. https://doi.org/10.1016/j.apmr.2014.10.006 BUTLAND, R. J. A., PANG, J., GROSS, E. R., WOODCOCK, A. A., & GEDDES, D. M. (1982). Two-, six-, and 12-minute walking tests in respiratory disease. British Medical Journal, 284(6329), 1607–1608. Carbonell-Baeza, A., Aparicio, V. A., Chillón, P., Femia, P., Delgado-Fernández, M., & Ruiz, J. R. (2011). Effectiveness of multidisciplinary therapy on symptomatology and quality of life in women with fibromyalgia. CLINICAL AND EXPERIMENTAL RHEUMATOLOGY, 29(Suppl. 69), S97–S103. Caro, X. J., Galbraith, R. G., & Winter, E. F. (2018). Evidence of peripheral large nerve involvement in fibromyalgia: a retrospective review of EMG and nerve conduction findings in 55 FM subjects. European Journal of Rheumatology, 5(4), 104–110. https://doi.org/10.5152/eurjrheum.2018.17109 Castro-Piñero, J., Aparicio, V. A., Estéves-Lopez, F., Álvarez-Gallardo, I. C., Borges-Cosic, M., Soriano-maldonado, A., … Segura-Jimenez, V. (2010). The Potential of Established Fitness Cut-off Points for Monitoring Women with Fibromyalgia : The al-Ándalus Project. International Journal of Sports Medicine, 38(05), 359–369. Clauw, D. J. (2014). Fibromyalgia A Clinical Review. 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W5pbyBww7pibGljby4gU2kgbm8gZnVlc2UgZWwgY2FzbywgYWNlcHRvIHRvZGEgbGEgcmVzcG9uc2FiaWxpZGFkIHBvciBjdWFscXVpZXIgaW5mcmFjY2nDs24gZGUgZGVyZWNob3MgZGUgYXV0b3IgcXVlIGNvbmxsZXZlIGxhIGRpc3RyaWJ1Y2nDs24gZGUgZXN0b3MgYXJjaGl2b3MgeSBtZXRhZGF0b3MuCkFsIGhhY2VyIGNsaWMgZW4gZWwgc2lndWllbnRlIGJvdMOzbiwgdXN0ZWQgaW5kaWNhIHF1ZSBlc3TDoSBkZSBhY3VlcmRvIGNvbiBlc3RvcyB0w6lybWlub3MuCg==

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