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ORIGINAL ARTICLE
Year : 2016  |  Volume : 37  |  Issue : 3  |  Page : 190-197  

Evaluation of the effect of Kanchnara Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri (tonsillitis) in children


Department of Kaumarbhritya, IPGT and RA, Gujarat Ayurved University, Jamnagar, Gujarat, India

Date of Web Publication30-Jan-2018

Correspondence Address:
Dr. Tarak R Adhvaryu
Department of Kaumarbhritya, IPGT and RA, Gujarat Ayurved University, Jamnagar - 361 008, Gujarat
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ayu.AYU_91_14

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   Abstract 


Introduction: Tonsillitis is a common illness in the childhood period. There are about 7,455,494 cases of tonsillitis in India per year. Tonsillitis can be compared with Tundikeri in Ayurveda. In the present study, Kanchnara Guggulu tablets and Pratisarana of Tankana-Madhu were selected. Aim: To evaluate the effect of Kanchnar Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri in children. Materials and Methods: In the present study, a total of 31 patients aged between 5 and 16 years attending the outpatient department of Kaumarbhritya Department and Shalakya Tantra Department were registered. Among them, 26 patients completed the treatment. Kanchnara Guggulu tablets were administered orally in Group A and in Group B, Pratisarana with Tankana-Madhu was done along with the oral administration of Kanchnara Guggulu tablets. Results: The results showed that in Group A, 21.43% of patients got complete remission, 42.86% of patients got marked improvement and 35.71% of patients got moderate improvement. In Group B, 25% of patients got complete remission, 58.33% of patients got marked improvement and 16.67% of patients got moderate improvement. Conclusion: Both the groups showed highly significant results in all cardinal and associated features of Tundikeri. Kanchnara Guggulu and Tankana-Madhu Pratisarana are a safe and effective modality for the treatment of Tundikeri.

Keywords: Kanchnara Guggulu, Pratisarana, Tonsillitis, Tundikeri


How to cite this article:
Adhvaryu TR, Patel K S, Kori V K, Rajagopala S, Manjusha R. Evaluation of the effect of Kanchnara Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri (tonsillitis) in children. AYU 2016;37:190-7

How to cite this URL:
Adhvaryu TR, Patel K S, Kori V K, Rajagopala S, Manjusha R. Evaluation of the effect of Kanchnara Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri (tonsillitis) in children. AYU [serial online] 2016 [cited 2018 Jul 19];37:190-7. Available from: http://www.ayujournal.org/text.asp?2016/37/3/190/224186




   Introduction Top


Tonsillitis is a common illness in the childhood period resulting from pharyngitis. A person of any sex and age may fall victim to bacterial infection, leading to tonsillitis. It is a common condition with nearly all children being infected at least once.[1] There are about 7,455,494 cases of tonsillitis in India per year and about 200,000 tonsillectomies are performed in India per year.[2] Any infection in a growing child usually hampers the immune system and the routine growth and development and when there are repeated attack, it is seen more. Recurrent tonsillitis is seen commonly in children and this has many adverse effects on the normal growth and development of the child among these missing school days; economic burden of treatment, etc. are few to name. The repeated tonsillitis wherein the tonsil gland gets inflamed and enlarged repeatedly, after treatment the size remains same though the inflammation subsides which leads to obstruction in the throat both to airways and digestive tract, which may pose problems in deglutition later. Besides medical management with antibiotics, the only other option is surgical removal of tonsils.

A disease which is similar to tonsillitis in clinical presentation in Ayurveda is Tundikeri which is described under Mukha Roga. Dealing with the treatment of the disease Tundikeri particularly, Acharya Sushruta mentions that Tundikeri is the Bhedya Roga and it should be treated as per the line of treatment of the disease Galashundika.[3] All drugs should have the properties such as Lekhana, Shothahara, Sandhaniya, Ropana, Rakta Stambhana and Vedana Sthapana. The drug Kanchnar Guggulu has all the above properties and it is indicated in the conditions such as Granthi, Apachi, Galaganda and Shotha. Therefore, the present study was planned to evaluate the effect of Kanchnar Guggulu and Tankana-Madhu Pratisarana in the management of Tundikeri (tonsillitis).


   Materials and Methods Top


Patients who fulfilling the inclusion criteria were selected from the outpatient Department of Kaumarbhritya and Shalakya Tantra of IPGT and RA. The ethical clearance for the same trial in children was obtained from the institutional ethics committee (Ref-PGT/7-A/2012-13/1964 dated: 21-09-2012). Trial was registered in the Clinical Trial Registry of India (CTRI), Reg. no. CTRI/2013/05/003635 (Registered on: 13/05/2013).

Inclusion criteria

Children aged between 5 to 16 years with sign and symptoms of Tundikeri (tonsillitis) belonging to either sex were included.

Exclusion criteria

  • Patients aged below 5 years and above 16 years were excluded.


Laboratory investigations

  1. Blood: Hemoglobin percent, total leukocyte count, differential leukocyte count, erythrocyte sedimentation rate (ESR), and absolute eosinophil count
  2. Urine: Routine and microscopic
  3. Stool: Routine and microscopic
  4. Throat swab.


Plan of intervention

  • Group A: Kanchnara Guggulu tablets were administered orally
  • Group B: Pratisarana of Tankana-Madhu was done along with oral administration of Kanchnara Guggulu tablets.


All the ingredients were procured from the Pharmacy, Gujarat Ayurved University (GAU), Jamnagar and authenticated by the Pharmacognosy Laboratory, IPGT and RA, GAU, Jamnagar.

Drug, dose and duration of the different groups are summarized in [Table 1].
Table 1: Drug, dose, and duration

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According to the Clark's rule,



After completion of treatment, follow-up was carried out for 6 weeks.

Criteria for assessment

The effect of therapy was assessed by subjective as well as objective criteria, before and after the treatment. Special scoring pattern was prepared to assess each sign and symptom [Table 2].
Table 2: Criteria for scoring pattern

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Criteria for overall assessment

Overall effect of therapy was assessed by below-given criteria:

  1. Complete remission: One hundred percent improvement in clinical signs and symptoms
  2. Marked improvement: More than 75% improvement in clinical signs and symptoms
  3. Moderate improvement: More than 50% and up to 75% improvement in clinical signs and symptoms
  4. Mild improvement: More than 25% and up to 50% improvement in clinical signs and symptoms
  5. No improvement: Equal to or less than 25% improvement in clinical signs and symptoms.


Statistical analysis

For the analysis of data, paired and unpaired t-test were applied, respectively, for thorough statistics within the group and comparison between the groups, and P < 0.05 or P < 0.01 was considered as statistically significant, P < 0.001 as highly significant, and P > 0.05 as insignificant.


   Observations and Results Top


A total of 31 patients (16 patients in Group A and 15 patients in Group B) were registered in the present study. Among them, 14 patients in Group A and 12 patients in Group B completed the treatment. Two patients were discontinued in Group A and three patients discontinued in Group B. One patient discontinued due to irregular visit. One discontinued due to transfer of his father out of Gujarat. One patient did not came for after treatment evaluation.

In the clinical study, maximum number (45.16%) of patients belong to the age group of 7–10 years. Majority of the patients were males (67.74%), belong to Hindu religion (96.77%), had completed primary education (67.74%) and were from middle-class family (87.10%).

The cardinal features reported were Toda (pricking pain) (100%), Shotha (inflammation) (100%), Daha (burning sensation) (41.94%) and Jwara (fever) (41.94%). Associated symptoms reported were Raaga (redness) (100%), Aruchi (anorexia) (67.74%), dysphagia (87.10%), sore throat (61.29%), halitosis (45.16%), hoarseness of voice (45.16%) and enlargement of lymph node (100%).

In Group A, mean hemoglobin (Hb) percent was 11.56 g/dl, mean total leukocyte count was 7742.9/cmm, mean neutrophil count was 49.21%, mean lymphocyte count was 42.86%, mean eosinophil count was 5.57%, mean monocyte count was 2.36%, mean ESR was 13.71 mm after 1st h, and absolute eosinophil count was 439.29/cmm. In Group B, mean Hb was 12.01 g/dl, mean total leukocyte count was 8658.3/cmm, mean neutrophil count was 52.83%, mean lymphocyte count was 39.33%, mean eosinophil count was 4.92%, mean monocyte count was 2.92%, mean ESR was 11.50 mm after 1st h, and mean absolute eosinophil count was 387.50/cmm. There was no any abnormality detected in urine routine and microscopic investigations. Microbiological investigations of the throat swabs in Group A showed the presence of Gram-positive cocci in 93.75% of the patients and Gram-negative short rods in 93.75% of patients, fungal filaments in 75% of the patients and fungal hyphae in 68.75% of patients. Microbiological investigations of the throat swabs in Group B showed the presence of Gram-positive cocci in 100% of the patients and Gram-negative short rods in 100% of patients, fungal filaments in 53.33% of the patients, and fungal hyphae in 46.67% of patients.

Effect of therapies

On cardinal features

In Toda, statistically highly significant (P < 0.001) reduction of 87.88% and 90% was observed in Group A and Group B, respectively. In Shotha, Group A and Group B showed statistically highly significant (P < 0.001) reduction of 70.59% and 77.14%, respectively. In Daha, statistically highly significant reduction (P < 0.001) of 81.82% and 90% was observed in Group A and Group B, respectively. Jwara was relieved 100% in both the groups [Table 3] and [Table 4].
Table 3: Effect of therapy on cardinal symptoms in Group A

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Table 4: Effect of therapy on cardinal symptoms in Group B

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On associated features

In Raaga, statistically highly significant (P < 0.001) reduction of 84.62% and 91.30% was observed in Group A and Group B, respectively. In Aruchi, Group A and Group B showed statistically highly significant (P < 0.001) reduction of 84.21% and 83.33%, respectively. In dysphagia, statistically highly significant (P < 0.001) reduction of 77% and 86.36% was observed in Group A and Group B, respectively. In sore throat, statistically highly significant (P < 0.001) reduction of 71% and 76.19% was observed in Group A and Group B, respectively. In halitosis, Group A and Group B showed statistically highly significant (P < 0.001) reduction of 70% and 80%, respectively. In hoarseness of voice, statistically highly significant (P < 0.001) reduction of 73% and 80% was observed in Group A and Group B, respectively. In size of lymph node, statistically highly significant (P < 0.001) reduction of 85% and 81.82% was observed in Group A and Group B, respectively [Table 5] and [Table 6].
Table 5: Effect of therapy on associated symptoms in Group A

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Table 6: Effect of therapy on associated symptoms in Group B

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On hematological parameters

In Hb percent, Group A showed statistically insignificant (P > 0.05) decrease (0.99%) and Group B showed statistically insignificant (P > 0.05) increase (1.73%). In total leukocyte count, statistically insignificant (P > 0.05) increase by 15.22% and 2.21% was observed in Group A and Group B, respectively. In neutrophil count, statistically insignificant (P > 0.05) increase by 0.58% and 3.31% was observed in Group A and Group B, respectively. In lymphocyte count, statistically insignificant (P > 0.05) increase by 2.33% was observed in Group A and statistically insignificant (P > 0.05) decrease by 4.24% was observed in Group B. In eosinophil count, statistically insignificant (P > 0.05) decrease by 23.08% was observed in Group A and statistically insignificant (P > 0.05) increase by 3.39% was observed in Group B. In monocyte count, no change was observed in Group A and statistically insignificant (P > 0.05) decrease by 8.57% was observed in Group B. In ESR, statistically insignificant (P > 0.05) increase by 26.04% was observed in Group A and statistically insignificant (P > 0.05) decrease by 2.90% was observed in Group B. In absolute eosinophil count, statistically insignificant (P > 0.05) decrease by 23.58% was observed in Group A and statistically insignificant (P > 0.05) increase by 12.90% was observed in Group B [Table 7] and [Table 8].
Table 7: Effect of therapy on hematological parameters in Group A

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Table 8: Effect of therapy on hematological parameters in Group B

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On microbiological parameters

There was statistically insignificant (P > 0.05) reduction (17.86%) in Gram-positive cocci observed in Group A and statistically insignificant (P > 0.05) reduction (44.83%) observed in Group B. There was statistically insignificant (P > 0.05) reduction (13.33%) in Gram-negative rods observed in Group A and statistically insignificant (P > 0.05) reduction (25.81%) observed in Group B. There was statistically insignificant (P > 0.05) reduction (50%) observed in fungal filaments in both the groups. There was statistically insignificant (P > 0.05) reduction (66.67%) in fungal hyphae in both the groups [Table 9] and [Table 10].
Table 9: Effect of therapy on microbiological parameters in Group A

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Table 10: Effect of therapy on microbiological parameters in Group B

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Overall effect of the therapy

In Group A, 21.43% of patients had complete remission, 42.86% of patients had marked improvement and 35.71% of patients had moderate improvement. In Group B, 25% of patients had complete remission, 58.33% of patients had marked improvement and 16.67% of patients had moderate improvement [Figure 1].
Figure 1: Overall effect of therapy

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   Discussion Top


In the present study, majority of the patients were from the age group of 7–10 years. As the lymphoid tissue of Waldeyer's ring is most immunologically active between 4 and 10 years of age with a decrease after puberty may be the reason behind the recurrent infection of tonsils in children. 67.74% had primary school education. It shows that this age group is more susceptible to tonsillitis.[4] Children are also more exposed to crowd at school and this increases the chance of spread of infection. There is natural dominancy of Kapha Dosha in childhood [5] and Tundikeri which is a Kapha Pradhana disease is more prone in children. In the present study, maximum patients, i.e. 87.10%, belonged to middle class. Financial condition does not directly produce any disease, but it affects the nutritional status and immunity of the child.

Statistically highly significant (P < 0.001) improvement was found in all the cardinal features of the disease Tundikeri in both the groups, but comparative data between the group were statistically insignificant (P > 0.05) [Table 11]. Toda occurs due to Vata Dosha and Kanchnara Guggulu and Tankana both have Vatahara property. Both the drugs have Shothahara property and Pratisarana is also an Upakrama of Vranashotha.[6] Therefore, Shotha was subsided in both the groups. Daha occurs due to vitiation of Pitta Dosha.[7] Majority of ingredients of Kanchnara Guggulu have Tikta and Kashaya Rasa which pacify Pitta Dosha[8] and it showed better result when combined with Pratisaraniya drug. Jwara was relieved in 100% of patients in both the groups. It may be due to Dipana and Pachana properties of both the drugs which correct Mandagni, thereby increasing the digestive power and removes the Ama condition present in Jwara.[9]
Table 11: Comparative effect of Group A and Group B on chief complaints

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Statistically highly significant (P > 0.001) improvement was observed in all the associated symptoms in both the groups. Raaga is the feature of inflammation which occurs due to vitiation of Pitta and Rakta. Both the formulations have Shothahara, Pittahara, and Rakta Shodhana properties, hence reduction in Raaga was observed. Aruchi is produced by Mandagni and intervention has Dipana and Pachana properties which correct Mandagni and helps to correct Aruchi. Dysphagia occurs in Tundikeri due to the inflammation and enlargement of tonsils. Kanchnara Guggulu has Shothahara property which results in relieving dysphagia. Better result was found in Group B due to the effect of Pratisarana drugs which showed better result in relieving Shotha and reduces dysphagia. As Kanchnara Guggulu is mentioned for the treatment for Granthi, Apachi, and Gandamala, it may have effect on lymph glands and this was the reason for the reduction in enlargement of lymph nodes. Comparative data of all the associated symptoms were statistically insignificant (P > 0.05) [Table 12].
Table 12: Comparative effect of Group A and Group B on associated symptoms

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In all the laboratory parameters, effect of both the groups was statistically insignificant (P > 0.05) and comparative data were also statistically insignificant (P > 0.05) [Table 13] and [Table 14].
Table 13: Comparative effect of therapy on hematological parameters

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Table 14: Comparative effect of therapy on microbiological parameters

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Probable mode of action of drugs

The mode of action of any Ayurvedic drug is based on Samprapti Vighatana of that particular disease. Samprapti Vighatana is also said to be the line of treatment. To understand the mode of action of drug, we have to think upon Samprapti Ghataka and how drug breaks the chain of that Samprapti. Ayurvedic pharmacodynamics and pharmacokinetics are based on the principle of Rasa-Panchaka, i.e. Rasa, Guna, Virya, Vipaka and Prabhava. According to these parameters, probable mode of action of Kanchnara Guggulu is discussed below.

Majority of the ingredients of Kanchnara Guggulu have Tikta, Kashaya, Madhura Rasa; Ushna Virya; Katu Vipaka; Laghu, Ruksha, Ushna, Tikshna Gunas and Tridoshahara and Shothahara property. Due to Tikta, Kashaya Rasa, Laghu and Ruksha Guna, Kanchnara Guggulu subsides the aggravated Kapha Dosha.[10] Due to Ushna Virya, it subsides Vata and Kapha Dosha. Pitta Dosha is subsided by the Tikta, Kashaya, and Madhura Rasa properties of the drug. Due to its Ushna Virya and Laghu, Ruksha Guna, it stimulates the Agni and due to its Ushna, Tikshna, Laghu Guna and Ushna Virya, it removes Srotorodha and vitiation of Rakta Dhatu is normalized by Tikta, Kashaya and Madhura Rasa properties of the drugs. Tundikeri occurs due to vitiation of Kapha and Rakta and due to above properties, Kanchnara Guggulu decreases the vitiated Kapha and Rakta and hence, it is effective in reducing the signs and symptoms of Tundikeri and inflammation of tonsils.

Probable mode of action of Tankana-Madhu Pratisarana

Ayurveda explains that Rasa acts when it comes to contact with mouth, Vipaka acts after digestion and Virya acts at both level internally and externally. Hence, for the mode of action of Pratisarana drug, we have to rely on Rasa and Virya of drug. Tankana has Katu Rasa, Ushna Virya and Ruksha, Tikshna Guna. Madhu has Madhura, Kashaya Rasa, Laghu, Ruksha Guna, Shita Virya and Madhura Vipaka. Madhu also has Yogavahi property which acts as a Sahapana of Tankana. Tankana has Kaphahara property.[11] Due to Katu Rasa, Ushna Virya and Ruksha, Tikshna Guna and due to Ushna Virya, it also subsides aggravated Vata Dosha.[12] It also stimulates Dhatvagni when applied locally. Due to its Ushna Virya and Ruksha, Tikshna Guna, it opens the microchannels and removes the Srotorodha. Due to the Lekhana property, it corrodes the hypertrophied muscle tissue. Due to its Ruksha Guna, it has Kledahara property.[13] Due to its Katu Rasa, it causes “Shonita Sanghatam Bhinatti[14] (clears the obstruction in Raktavaha Srotas).


   Conclusion Top


Tonsillitis shows close similarity with Tundikeri. Both the groups showed highly significant results in all cardinal and associated features of Tundikeri. However, both the groups showed insignificant effect in laboratory parameters. Hence, Kanchnara Guggulu and Tankana-Madhu Pratisarana are safe and effective modality for the treatment of Tundikeri.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Woolford TJ, Hanif J, Washband S, Hari CK, Ganguli LA. The effect of previous antibiotic therapy on the bacteriology of the tonsils in children. Int J Clin Pract 1999;53:96-8.  Back to cited text no. 1
    
2.
Available from: http://www.rightdiagnosis.com/c/chronic_tonsillitis/stats-country.htm. [Last accessed on 2013 Dec 01].  Back to cited text no. 2
    
3.
Acharya YT, editor. Sushruta Samhita of Sushruta, Chikitsa Sthan. Reprint Edition. Ch. 22. Ver. 57. Varanasi: Chaukhambha Surabharti Prakashana; 2012. p. 484.  Back to cited text no. 3
    
4.
Kliegman R, Bonita M, Joseph S, Nina F, Richard E, editors. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, PA: Elsevier; 2012. p. 1396.  Back to cited text no. 4
    
5.
Acharya YT, editor. Charaka Samhita of Agnivesha, Chikitsa Sthana. Reprint Edition. Ch. 30. Ver. 311. Varanasi: Chaukhambha Surabharti Prakashana; 2011. p. 647.  Back to cited text no. 5
    
6.
Acharya YT, editor. Sushruta Samhita of Sushruta, Chikitsa Sthan. Reprint Edition. Ch. 1. Ver. 8. Varanasi: Chaukhambha Surabharti Prakashana; 2012. p. 397.  Back to cited text no. 6
    
7.
Arundatta, Hemadri, editor. Astanga Hridayam of Vagbhata, Sutra Sthana. Reprint 9th edition. Ch. 12. Ver. 51. Varanasi: Chaukhamba Orientalia; 2005. p. 201.  Back to cited text no. 7
    
8.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint Edition. Ch. 1. Ver. 66. Varanasi: Chaukhambha Surabharti Prakashana; 2011. p. 18.  Back to cited text no. 8
    
9.
Arundatta, Hemadri, editor. Astanga Hridayam of Vagbhata, Chikitsa Sthana. Reprint 9th ed., Ch. 1. Ver. 1. Varanasi: Chaukhamba Orientalia; 2005. p. 543.  Back to cited text no. 9
    
10.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint Edition. Ch. 20. Ver. 19. Varanasi: Chaukhambha Surabharti Prakashana; 2011. p. 115.  Back to cited text no. 10
    
11.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint Edition. Ch 20. Ver. 19. Varanasi: Chaukhambha Surabharti Prakashana; 2011. p. 115.  Back to cited text no. 11
    
12.
Arundatta, Hemadri, editor. Astanga Hridayam of Vagbhata, Sutra Sthana. Reprint 9th edition. Ch. 9. Ver. 19. Varanasi: Chaukhamba Orientalia; 2005. p. 169.  Back to cited text no. 12
    
13.
Arundatta, Hemadri, editors. Astanga Hridayam of Vagbhata, Sutra Sthana. Reprint. 9th ed., Ch. 1. Ver. 18. Varanasi: Chaukhamba Orientalia; 2005. p. 12.  Back to cited text no. 13
    
14.
Acharya YT, editor. Charaka Samhita of Agnivesha, Sutra Sthana. Reprint Edition. Ch. 26. Ver. 43. Varanasi: Chaukhambha Surabharti Prakashana; 2011. p. 144.  Back to cited text no. 14
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8], [Table 9], [Table 10], [Table 11], [Table 12], [Table 13], [Table 14]



 

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