Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia
Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis af...
Ausführliche Beschreibung
Autor*in: |
Yasuda, Masako [verfasserIn] Moriwaki, Katsuyuki [verfasserIn] Tsutsumi, Yasuo M. [verfasserIn] |
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E-Artikel |
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Sprache: |
Englisch |
Erschienen: |
2021 |
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Übergeordnetes Werk: |
Enthalten in: JA clinical reports - Berlin : Springer, 2015, 7(2021), 1 vom: 20. Apr. |
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Übergeordnetes Werk: |
volume:7 ; year:2021 ; number:1 ; day:20 ; month:04 |
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DOI / URN: |
10.1186/s40981-021-00440-0 |
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Katalog-ID: |
SPR043818129 |
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520 | |a Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. | ||
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650 | 4 | |a Neuromuscular blocking agents |7 (dpeaa)DE-He213 | |
650 | 4 | |a Adrenaline (epinephrine) |7 (dpeaa)DE-He213 | |
650 | 4 | |a Skin tests |7 (dpeaa)DE-He213 | |
650 | 4 | |a General anesthesia |7 (dpeaa)DE-He213 | |
700 | 1 | |a Moriwaki, Katsuyuki |e verfasserin |4 aut | |
700 | 1 | |a Tsutsumi, Yasuo M. |e verfasserin |4 aut | |
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10.1186/s40981-021-00440-0 doi (DE-627)SPR043818129 (DE-599)SPRs40981-021-00440-0-e (SPR)s40981-021-00440-0-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE Yasuda, Masako verfasserin aut Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 Moriwaki, Katsuyuki verfasserin aut Tsutsumi, Yasuo M. verfasserin aut Enthalten in JA clinical reports Berlin : Springer, 2015 7(2021), 1 vom: 20. Apr. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:7 year:2021 number:1 day:20 month:04 https://dx.doi.org/10.1186/s40981-021-00440-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2021 1 20 04 |
spelling |
10.1186/s40981-021-00440-0 doi (DE-627)SPR043818129 (DE-599)SPRs40981-021-00440-0-e (SPR)s40981-021-00440-0-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE Yasuda, Masako verfasserin aut Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 Moriwaki, Katsuyuki verfasserin aut Tsutsumi, Yasuo M. verfasserin aut Enthalten in JA clinical reports Berlin : Springer, 2015 7(2021), 1 vom: 20. Apr. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:7 year:2021 number:1 day:20 month:04 https://dx.doi.org/10.1186/s40981-021-00440-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2021 1 20 04 |
allfields_unstemmed |
10.1186/s40981-021-00440-0 doi (DE-627)SPR043818129 (DE-599)SPRs40981-021-00440-0-e (SPR)s40981-021-00440-0-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE Yasuda, Masako verfasserin aut Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 Moriwaki, Katsuyuki verfasserin aut Tsutsumi, Yasuo M. verfasserin aut Enthalten in JA clinical reports Berlin : Springer, 2015 7(2021), 1 vom: 20. Apr. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:7 year:2021 number:1 day:20 month:04 https://dx.doi.org/10.1186/s40981-021-00440-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2021 1 20 04 |
allfieldsGer |
10.1186/s40981-021-00440-0 doi (DE-627)SPR043818129 (DE-599)SPRs40981-021-00440-0-e (SPR)s40981-021-00440-0-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE Yasuda, Masako verfasserin aut Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 Moriwaki, Katsuyuki verfasserin aut Tsutsumi, Yasuo M. verfasserin aut Enthalten in JA clinical reports Berlin : Springer, 2015 7(2021), 1 vom: 20. Apr. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:7 year:2021 number:1 day:20 month:04 https://dx.doi.org/10.1186/s40981-021-00440-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2021 1 20 04 |
allfieldsSound |
10.1186/s40981-021-00440-0 doi (DE-627)SPR043818129 (DE-599)SPRs40981-021-00440-0-e (SPR)s40981-021-00440-0-e DE-627 ger DE-627 rakwb eng 610 ASE 610 ASE Yasuda, Masako verfasserin aut Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia 2021 Text txt rdacontent Computermedien c rdamedia Online-Ressource cr rdacarrier Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 Moriwaki, Katsuyuki verfasserin aut Tsutsumi, Yasuo M. verfasserin aut Enthalten in JA clinical reports Berlin : Springer, 2015 7(2021), 1 vom: 20. Apr. (DE-627)84410051X (DE-600)2842877-8 2363-9024 nnns volume:7 year:2021 number:1 day:20 month:04 https://dx.doi.org/10.1186/s40981-021-00440-0 kostenfrei Volltext GBV_USEFLAG_A SYSFLAG_A GBV_SPRINGER SSG-OLC-PHA GBV_ILN_20 GBV_ILN_22 GBV_ILN_23 GBV_ILN_24 GBV_ILN_31 GBV_ILN_39 GBV_ILN_40 GBV_ILN_60 GBV_ILN_62 GBV_ILN_63 GBV_ILN_65 GBV_ILN_69 GBV_ILN_73 GBV_ILN_74 GBV_ILN_95 GBV_ILN_105 GBV_ILN_110 GBV_ILN_151 GBV_ILN_161 GBV_ILN_170 GBV_ILN_206 GBV_ILN_213 GBV_ILN_230 GBV_ILN_285 GBV_ILN_293 GBV_ILN_602 GBV_ILN_2014 GBV_ILN_4012 GBV_ILN_4037 GBV_ILN_4112 GBV_ILN_4125 GBV_ILN_4126 GBV_ILN_4249 GBV_ILN_4305 GBV_ILN_4306 GBV_ILN_4307 GBV_ILN_4313 GBV_ILN_4322 GBV_ILN_4323 GBV_ILN_4324 GBV_ILN_4325 GBV_ILN_4338 GBV_ILN_4367 GBV_ILN_4700 AR 7 2021 1 20 04 |
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Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA.</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Anaphylaxis</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Anti-bacterial agents</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Neuromuscular blocking agents</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Adrenaline (epinephrine)</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">Skin tests</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="650" ind1=" " ind2="4"><subfield code="a">General anesthesia</subfield><subfield code="7">(dpeaa)DE-He213</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Moriwaki, Katsuyuki</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="700" ind1="1" ind2=" "><subfield code="a">Tsutsumi, Yasuo M.</subfield><subfield code="e">verfasserin</subfield><subfield code="4">aut</subfield></datafield><datafield tag="773" ind1="0" ind2="8"><subfield code="i">Enthalten in</subfield><subfield code="t">JA clinical reports</subfield><subfield code="d">Berlin : Springer, 2015</subfield><subfield code="g">7(2021), 1 vom: 20. 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Yasuda, Masako |
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Yasuda, Masako ddc 610 misc Anaphylaxis misc Anti-bacterial agents misc Neuromuscular blocking agents misc Adrenaline (epinephrine) misc Skin tests misc General anesthesia Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia |
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610 ASE Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia Anaphylaxis (dpeaa)DE-He213 Anti-bacterial agents (dpeaa)DE-He213 Neuromuscular blocking agents (dpeaa)DE-He213 Adrenaline (epinephrine) (dpeaa)DE-He213 Skin tests (dpeaa)DE-He213 General anesthesia (dpeaa)DE-He213 |
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Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia |
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concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia |
title_auth |
Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia |
abstract |
Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. |
abstractGer |
Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. |
abstract_unstemmed |
Background Prophylactic antibiotics and neuromuscular blocking agents (NMBA) are two of the major causative agents of anaphylaxis after induction of anesthesia. Case presentation One female and one male patients (aged 29 and 69 years, respectively) had Ring and Messmer scale grade III anaphylaxis after administration of prophylactic antibiotics following induction of anesthesia. They showed typical hemodynamic and respiratory features of life-threatening anaphylaxis. Postoperative skin tests in these two patients were positive for antibiotics and concurrently positive for rocuronium. Conclusions Our present report suggests the possibility that both prophylactic antibiotics and NMBA concurrently and synergistically enhance anaphylactic reaction and the necessity to differentiate an immune mechanism from non-immune mechanisms when anesthesiologists encounter concurrent positive skin tests for both antibiotics and NMBA. |
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Concurrent positive skin tests to prophylactic antibiotics and rocuronium in two patients with life-threatening anaphylaxis after induction of anesthesia |
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7.4006615 |