We use arnica salve on him at the first sign of injury and this seems to help. I started taking Prozac 2 months ago and in March I was feeling really h Petechiae here and there really aren't too much of a concern. All rights reserved. Upload or insert images from URL. WebPetechiae here and there really aren't too much of a concern. Usually flat to the touch, petechiae don't lose color when you press on them. He was not concerned about it at all. WebPetechiae is found among people with Stress and anxiety, especially for people who are female, 60+ old. I have a small 'sprinkling' of them on the back of each of my upper arms, that are permanent. Nothing good ever comes of it. Powered by Invision Community. I took Vit C and Bioflavanoids back then. (My platelets were lower normal at one time, but were not low.) Petechiae- very worried. They were actually used to help make my diagnosis, and actually I'm surprised that they are not on the Beighton scale. Policy. WebDefinitions. The only one in charge of my medical care now is me. Egton Medical Information Systems Limited. Thank you so much for the helpful reply. Irritability. If you're pregnant and your platelet count is very low or you have bleeding, you have a greater risk of heavy bleeding during delivery. if so it could just be your skin is sensitive and even rubbing against fabric or sweating could trigger them (im not a doctor but thats what Ive been told). Anyone figure out what caused the onslaught? More serious common causes include liver disease such If you do, ask your healthcare provider if there are medications or activities you should avoid. Since you had bloodwork done last time, there is You cannot paste images directly. You cannot paste images directly. I get them now and then on the inside of my elbow and above, which I assume is from sleeping on said arm (I also get them from blood pressure cuffs, blood draw tourniquets and carrying bags on my arm there, so I don't think too much about it). Webpetechiae anxiety forum. They come and go mostly on my stomach. If you're absolutely covered in them it's a cause for concern, but a few generally isn't. Have you found anything out? Petechiae- very worried. My wife has the same issue. For those who don't know, petechiae are dots of blood which appear under the skin; they often appear with purpura, which are larger areas or patches of blood under the skin, rather like a bruise. They appear suddenly, then fade over time. Yes, I get them as well. Petechiae commonly appear on the lower legs, but may be distributed all over the body. Its most likely just pressure on your body for long periods of time, I dont think its anything to stress over too much. I don't want to hassle the doctor continually if there is nothing to worry about, but it was frustrating that she seemed so flippant about them and couldn't really explain why I have them. If you see petechiae and It's kind of an allergic reaction to sunlight. Paste as plain text instead, Should I watch for signs of complications? Take over-the-counter pain relievers such as ibuprofen ( Advil, Motrin) or acetaminophen ( Tylenol ). Drink extra fluids to prevent dehydration. To prevent petechiae, you need to avoid the conditions that can cause them. But you cant prevent all of the possible underlying causes of petechiae. I just realized I got this type of rash in my arm only out of no where . However he said when it's a side effect of medicine it'll go away within a month. The only one in charge of my medical care now is me. I got some on my thighs and upper arms They can come up for various reasons. If your symptoms are more severe, treatment may include medications to boost your platelet count or surgery to remove your spleen. In adults, the disorder is often long term. Just slept funny. Display as a link instead, Googled like crazy only to find bad news. petechiae anxiety forum. Does anyone know what else could cause a few petechaie with normal bloodwork? Why is this happening? I have had chronic sinus/digestive problems and I also have extensive petechiae(mainly limbs tho' slightly fewer/larger on trunk). Anyhow, he has been tested for every kind of blood disorder and they have all come back negative. Can anxiety cause being scared of sleeping? Persistent worry thats difficult to control. What type of ointment was it you got do you remember, What kind of ointment I'd also like to know so maybe I could try it. Forum Name: Dermatology Topics Question: Petechiae vs. Angiomas / Please help! Merck Manual Professional Version. Petechiae may look like a rash and usually appear in clusters. I do have EDS III with skin issues. It was caused by Chronic ITP (idiopathic/immune thrombocytopenia purpura). It was several years ago and was prescription. I'm frustrated that for 10 years I've thought I've had something when it could be something else entirely; especially since the doctor that diagnosed me brushed off my confusion in symptoms and noted the hyper-mobility and nothing more. WebWent back after a week (the petechiae didnt go away) and got a CBC with diff + liver function test and that came back normal. I was confused when I woke up, and I had petechiae around my eyes. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. Starting to weird me out. We want the forums to be a useful resource for our users but it is important to remember that the forums are Get useful, helpful and relevant health + wellness information, 9500 Euclid Avenue, Cleveland, Ohio 44195 |, Important Updates + Notice of Vendor Data Event, (https://www.aafp.org/pubs/afp/issues/2012/0315/p612.html), (https://www.cancer.net/coping-with-cancer/physical-emotional-and-social-effects-cancer/managing-physical-side-effects/low-platelet-count-or-thrombocytopenia), (https://www.ncbi.nlm.nih.gov/books/NBK542208/), (https://www.merckmanuals.com/home/blood-disorders/platelet-disorders/overview-of-thrombocytopenia), (https://www.nhlbi.nih.gov/health-topics/thrombocytopenia), Visitation, mask requirements and COVID-19 information, Bone Marrow Failure and Cytopenias Treatment. The study analyzes which people have Petechiae with Stress and anxiety. I wish it didn't allow you to look up anything medical.. oh how free would a lot of us be. - I don't think my skin is REALLY elastically, but I don't really know how to judge. I get them when I carry bags on my shoulders, scratch, and especially when I played volleyball! I had low platelets and couldn't keep them abouve the teens unless I took large doses of prednisone. I quickly went in to see a rheumatologist, he is a HIGHLY respected rheumatologist. George JN, et al. Hugs love your post. It sounds like the ones on your legs went away when your anxiety subsided, so it could be a skin problem related to that? Is there any hope? Finally i found out what the name is! People just thought I'd had a crazy growth spurt but most kids are growing fast and don't get stretch marks. Here they appear on a leg (A) and on an abdomen (B). You can post now and register later. https://www.merckmanuals.com/professional/hematology-and-oncology/thrombocytopenia-and-platelet-dysfunction/immune-thrombocytopenia-itp?query=immune%20thrombocytopenia. It was a horrible sight. The spots keep popping up on my biceps, arm pits and hips. If you lift weights, the straining from pulling on the weights could cause the blood droplets to appear. I'll have to bring it up to my doctor; thanks for pointing it out. Anxiety & Panic Disorders; Arthritis; Breast Cancer; Chronic Illness; Crohn's Disease; Depression; Diabetes; Fibromyalgia; GERD & Acid Reflux; Irritable Bowel We're the ones invested in causes and cures. Ive had petechiae in the past been to docs about it had blood work came back fine anyone else have this problem? Skeleton, Skin, Muscles, Hair, Teeth and Nails, we pay way too much attention to any detail in our bodies. Accessed Feb. 21, 2019. There is another thread on the forum about petechiae and they mentioned sunburn assomething that can cause it. Ugh. Just one more reason, I guess to get a diagnosis! Never a big area like that though. I have no fevers, night sweats, bleeding, fatigue, etc, or really anything to worry about, though the 2 or 3 petechiae at a time have come and gone since then. WebThey're small and hardly noticeable but there are around 20 on each arm (only upper arm). Immune Thrombocytopenia Pupura. I Your provider will monitor your overall health and platelet levels. Additionally, considering the fact no entity has found a CAUSE for ME, much less a cure (with very good theories out there, & good results from some trmts), this site helps empower us all with our own "anecdotal" evidence. For a better experience, please enable JavaScript in your browser before proceeding. Has anyone else had that many appear all at once? Do you always have some though on your legs? Ive googled and Im freaking out . Pain free everywhere. I'd hedge my bets on anxiety, or irritation from your clothing. I'm covered in them from head to toe, esp. I have not been diagnosed with EDS just familial hypermobility syndrome. 7. WebApproximately 59% of physicians felt that fatigue was a very impactful symptom, while 66% of physicians believed that ITP-related fatigue was associated with reduced quality-of-life, and 46% felt that fatigue is often severe. The first time I saw a geneticist, he mentioned the petechiae, and suggested I say something to my GP so he could check it through bloodwork (perhaps some kind of blood-related issue like the previous poster suggested? Back on antidepressants due to anxiety and panic attacks, Pounding heart/palpitations driving me crazy, Anxious thoughts , doomsdaying about everything. Please register to post and use the extra features available to members. Good day my friends, I awoke this morning (great news) and noted that I had Petechiae across my lower abdomen. https://patient.info/forums/discuss/browse/anxiety-disorders-70, New guy heresharing my debilitating anxiety story, Mirtazapine increasing from 15 mg to 30 mg, Fleuxotine 20mg. There are multiple causes for thrombocytopenia, pancytopenia, etc. Any connection to that with you? Looking to increase/ Ride it out. Never disregard the medical advice of your physician or health professional, or delay in seeking such advice, because of something you read on this Site. This site complies with the HONcode standard for trustworthy health information: verify here. I noticed after working out and showering that I had 2 new spots on my stomach, and a small line of very small spots which looked like it was from an abrasion. Aplastic anemia occurs when the bodys bone marrow doesnt make enough new blood cells. Webpetechiae anxiety forum. Thrombocytopenia often affects people with certain medical conditions, like autoimmune disease or who take certain medications. Theyll check for bruises, rashes and other thrombocytopenia symptoms. WebPetechiae. Symptoms of Petechiae in babies: Immobility and intense crying that alternates with a great decay. My son who has classic EDS (8 yr. old) has been having these since he was 1 (our first indication that something was not right). In adults, this may be triggered by infection with HIV, hepatitis or H. pylori the type of bacteria that causes stomach ulcers. It will blow over in due time, yeah. My husband said my arms and legs were jerking. My EEG was normal, and they found a I have a blood (platelet) disorder called ITP. Sorry to resurrect an old thread, but I found this very interesting. Some things that don't add up, however: I had explained this to my first rheumatologist but he'd brushed it off. So, my best guess is that petechiae may be associated with B12/folate deficiency, since it has helped in my case. Patient is a UK registered trade mark. We coalesce here to reclaim control of our lives through: education, sharing experiences, sharing management techniques, sharing resources, exposing stigma & norms, and advancing the discussion & awareness around Health Anxiety (a.k.a. Petechiae, which are small, flat red spots under the skin caused by blood leaking from blood vessels Purpura, which is bleeding in your skin that can cause red, purple, or brownish- yellow spots Paleness or jaundice (a yellowish color of the skin or whites of the eyes) Extreme tiredness A fever A fast heart rate or shortness of breath My doctor prescribed me Escitilopram 10mg and Buspirone 7.5mg and I'm scared. A lot of people have them, pretty sure it's genetics. (My platelets were lower normal at one time, but were not low.) Got em again last night. Hugs. A friend with ME/CFS also had a lot of angiomas. 1. Typically, straining will cause the dots to appear on the upper area of your body including the neck and shoulders. Hi mamas. I just don't get why I got hundreds, Amoxicillin is know to cause them also anti depressants will too that's what I was told how long you been on antibiotics, I was on amoxicillin for 10 days. One of the more basic reasons you will have petechiae appear on your skin is due to straining. hi you had answered a question of mine a couple days ago regarding petechiae , if there where only spots randomly placed around the body would that be a concern? Evaluation: trauma usually produce bruises ,so for petechiae, baby need to have Other symptoms include: Thrombocytopenia causes fall into one of three categories: Specific factors affecting platelet supply include: Healthcare providers will do a physical examination. People with this condition may bleed a lot and the bleeding may be hard to stop. Cleveland Clinic is a non-profit academic medical center. Yes had blood work and all was good. Accessed March 13, 2019. On 5/12/2019 at 6:26 PM, Nickdon321 said. In this thread, people posted they don't have them, or they do & increased at CFS onset, or right before. Oh, lastly, born with a blood disorder, I wonder if anyone else posting here has one. I don't do it anymore but once I did and fainted. National Heart, Lung, and Blood Institute. Welcome to a place for everyone who identifies with having health anxiety, is an ally of someone with health anxiety, or just wants to learn more about our growing community. Immune thrombocytopenia (ITP) in adults: Clinical manifestations and diagnosis. Could they somehow be stress related? 1. This approach may involve changing your medications. I also developed cherry angiomas across my torso. Hopefully it'll blow over soon. Try our Symptom Checker Got any other symptoms? What kind of blood related issues? That, too, is helpful information. Advertising on our site helps support our mission. The palpitations happen whenever, when i sit up in bed or stand up, when i laugh to hard or just now when i was bring groceries in i could feel it pulsing in my neck. LOL! "Mayo," "Mayo Clinic," "MayoClinic.org," "Mayo Clinic Healthy Living," and the triple-shield Mayo Clinic logo are trademarks of Mayo Foundation for Medical Education and Research. This is really freaking me out. - I do vaguely wonder about IBS symptoms, but it's nothing major. Petechiae isn't technically a rash, but it is a skin disorder that occurs due to leukemia. Platelets are blood cells that form blood clots to help stop bleeding. Click here to register.Everyone is welcome! Interestingly, I also ave chronic microscopic hematuria (blood in urine) and have had tests, but is probably there due to something similar to the petechiae. Like, ALL over it. https://www.uptodate.com/contents/search. Morrow ES Jr. Allscripts EPSi. Last reviewed by a Cleveland Clinic medical professional on 10/20/2022. Forums Anxiety Disorders Health Anxiety (Hypochondria) My mind immediately went into overdrive because I remembered a friend of mine mentioning red spots on his girlfriends legs right before she was (incorrectly) diagnosed with leukemia. Several instances of vomiting. Rash: although there were some petechiae in my body most of my rash is slightly raised and non-petechiae and the skin is dry. Did your ever go away. I have hundreds I'm 39 and my doc said it's a side effect of blood thinners and that's what aspirin is. And of course if you Google them it's always cancer!! I hate looking at my inner arms and seeing more and more. However, I do only weight 100 pounds, so my body may not stress the joints there | Anxiety Community Forum Welcome to the Anxiety Community Forum, a friendly space for discussion, help and support with mental health issues. Has anyone else had that many appear all at once? *sigh*, OkayI just broke out in a new wave of these this evening, all over one of my hands and that forearm. Thats why healthcare providers arent sure exactly how many people have this condition. Mayo Clinic is a not-for-profit organization. I have same thing. I have battling depression & anxiety for many years. etc. Im finding yo comment now because I have the exact things you describe. ), chest (two) and a few other areas on my body. Accessed Feb. 21, 2019. Anyone ever have to face this? I only mention it as it might be worth keeping an eye on whether you get red blotching (without the petechiae) at other times, and if you take antihistamines at all, whether they respond to them. The doctor and nurse practitioner both showed NO concern about the previous spots, but I'm very worried. I think a lot of people get them. Instantaneously, just like that from a sneeze. Bottom line once your healthcare provider finds out why your platelet levels are low, theyll take steps to help you. I have many cherry angiomas that pop up (can be small, but usually larger/raised and a bright red compared to the petechiae), that I've periodically had my dermatologist remove over the years -- especially on my trunk area. I just want them to go and they wont. Uncategorized. When I'm out in the sun they are very noticeable. I almost always get huge stripes of them when I get my blood pressure taken. Just looking to commiserate with someone on the petechiae. A few weeks ago I noticed some 11-12 red spots on my thighs that didnt blanche when I pressed on them. as being in breach of those terms. Ive seen this in many older patients, and the Food and Drug Administration recently issued a safety alert about these drugs and diarrhea that doesnt go away. George JN, et al. I can bend my thumbs to touch my wrists, touch the floor with my palms, could make a "bridge" with my back when hands and feet are planted on the floor (don't do it now due to stiffness), I can clasp my hands and move them all the way behind my body without unclasping my hands and likewise plant my forearms in the center of my back, I was the fastest person in class by a mile when we had "crab" races etc. Neither the petechiae nor the angiomas ever itch or hurt. Headaches, stomachaches, muscle aches, and other unexplained pain. I am not WebPetechiae are flat and look like pinpoint-sized red, brown, or purple dots. For those who don't know, petechiae are dots of blood which appear under the skin; they often appear with I wish the lab would call me back so I could schedule the damn blood work but no luck. I didn't show her the new spots today out of fear that my continued anxiety could cause her to take my concerns in the future less seriously, but after seeing that elevated value, I'm defnitely worried again. Causes of Petechiae in babies: Frustrating. Difficulty concentrating. Your previous content has been restored. B12/Folate deficiency is one of them. Upgrade to Patient Pro Medical Professional? Tiny, spaced out red spots? Beitrags-Autor: Beitrag verffentlicht: 14. That did not sound like arthritis. I know how you feel, have u ever noticed any on your legs? WTF? Some symptoms: Upload or insert images from URL. If you have an account, sign in now to post with your account. Immune thrombocytopenia (ITP). Platelets are blood cells that form blood clots to help stop bleeding. OK so let's connect some dots. I'm 39 and my doc said it's a side effect of blood thinners and that's what aspirin is. At the time I was taking asp If Googlewere a real doctor, it wouldhave had its license to practice medicine revoked long ago. I no how you feel, have you ever noticed any on your legs? While the x-rays did not show much the other test showed inflammation on a scale of 6/10. A single copy of these materials may be reprinted for noncommercial personal use only. WebPetechiae are tiny spots of bleeding under the skin. Many things can cause your platelet levels to drop so you develop thrombocytopenia. B12/Folate deficiency is one of them. - BOTH rheumatologist noted my hyper-mobility. The Ehlers-Danlos Syndromes and Related Disorders Support Community connects patients, families, friends and caregivers for knowledge, support and inspiration. Fatigue or tiredness with little or no obvious cause. The general aching in your bones and muscles could well be associated with Last night I began to have symptoms of a UTI. Same as ever, still get patches occasionally but I've never had any blood test results that suggest anything wrong when I get yearly blood tests done or stuff like that. Your link has been automatically embedded. Have questions about navigating your Inspire support community or need assistance from one of our Inspire Moderators? the unsubscribe link in the e-mail. Yup - I had a lot of pressure applied to that area and then a few hours later noticed them there. Go figure! Sorry, I wish I had an answer. No one else seemed to get them. I could do it online but I need to find out if my doctor ever actually sent the order for the tests before I go (don't want to go there and not be able to have them done). George JN, et al. Thanks to a little fake tan, I am able to easily cover the arm stuff, otherwise I use a little Laura Geller baked body frosting, a very natural bronzer, to lightly cover the spots. Press question mark to learn the rest of the keyboard shortcuts. If you have this condition, its important to understand why you have low platelet levels. In December I broke out with hundreds of petechiae all over my tummy and chest. WebPetechiae and Palpitations causing me stress As the title says, for the past year I have been getting petechiae and heart palpitations after i got strep throat. - In June I tore a groin muscle, which I attribute to doing nothing at all beside sitting strangely (ie: a normal person couldn't have sat like that but it wasn't painful to me). I went to see the neurologist and did numerous test. Anybody else ever have this happen? Your Dr wasn't concerned. They scare me every time I see them, I always tell my self I'm not gonna look anymore but then some caught my eye and I'm back to searching my body again, Mine started when I was 16 for some reason I had Lyme at the time but not sure if there related. I get petechiae a lot. Not pressure, or injury related. Oh waiting for the day lol. Your doctor may suggest treatment to maintain a stable platelet count, taking into account the effects on your baby. I was litterally suffocating. Immune thrombocytopenia (ITP) in adults: Second-line and subsequent therapies. Accessed Feb. 21, 2019. privacy practices. They also tested for the genetic marker of ankylosing spondylitis and I had it. I have another question now. Are there any treatment risks or side effects? Went to the Dermatologist about it years ago. Illness Anxiety & Hypochondriasis) in its many forms in our own societal realms. You need to see a doctor urgently because there may be a serious cause that needs urgent treatment, such as meningococcal infection. We do not endorse non-Cleveland Clinic products or services. There is another thread on the forum about petechiae and they mentioned sunburn as something that can cause it. I've just dealt with the pain and hardly ever taken anything for it. As noted in posts around the site, an overwhelming majority of doctors- incl., & especially, psychiatrists- have a staggering dearth of education about ME. Petechiae occur when the small blood vessels under the skin (capillaries) bleed into the skin. I'm worried now because I have a dermatology appointment on Thursday to figure this out, and I got my last CBC report from end of February today. information and will only use or disclose that information as set forth in our notice of WebCan petechiae be caused by stress? I get petechiae whenever I scratch too hard, always have done since childhood. Find other members in this community to connect with. petechiae anxiety forum. I so want to be like that again Severe thrombocytopenia increases your risk of internal bleeding or heart attack. Nickdon321, April 30, 2019 in Health Anxiety. I'm worried (as usual), and I have made a doctors appointment about it. I have bouts of increased anxiety like this as well. https://www.uptodate.com/contents/search. Other treatments include: The most important thing is to understand if you have medical conditions or take medication that increases your risk of developing thrombocytopenia. Both petechiae and purpura do not blanch when pressure is applied - this is in contrast to other common rashes in children such as viral exanthems and urticaria. I've had petechiae with normal counts. Recently, I get them whenever I get my blood drawn -- where the tourniquet is, but also where they disinfect the site (which is weird b/c they don't put pressure there). I took care of a man with AIDS to his death. Today I read someone's words about Sjogrens. 1. Now I just let them fade on their own but I have a spot on my right leg from last fall that is not fading. This is driving me insane and causes me so much stress and depressionIve gone to the doctors so much and they keep saying its nothing but i just cant believe them and constantly think im gonna die soon. Nothing was even borderline out-of-range. Use of the forums is subject to our Terms of Use Clear editor. I, too, can get something like this if I scratch too hard (neck, earlobes, etc.) I don't know. Today I read someone's words about Sjogrens. Should I be having withdrawals symptoms from 10mg of prozac for 9 days? You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox. Webpetechiae anxiety forum. The risk appears to be higher in people who also have diseases such as rheumatoid arthritis, lupus and antiphospholipid syndrome. They weren't there prior to my illness. So got a sunburn on shoulders and stomach a couple weeks ago, after a week I started to peel and get petechiae on stomach and shoulders there still coming and going it's been 3 weeks. But I have so many other symptoms of EDS Hypermobility Type like POTs, bowel symptoms, and bruising/petichiae that I pretty much sure I have a less severe form of EDS. I'm a teenager and it feels like I've had anxiety my whole life. The bleeding results from unusually low levels of platelets the cells that help blood clot. I battle majority with health anxiety. I'm always covered in them over any little bump, light pressure or touch. I am a 26f, good health besides allergies/chronic sinus issues, normal weight, but I've had history of problems with health anxiety since childhood. Thousands collectively. From the very beginning I was confused over my arthritis diagnosis. Resurrecting this thread because I have tons of new little petechiae blood pinpricks appearing on my inner arms. And Ive taken a closer look at my body and i have these tiny tiny ones spread out on my arms, much smaller than the ones on my thighs, i had to look really closely to spot them. My wife has the same issue. When I was thin, I would also get them on various parts of me if I slept on the floor. Anyone else experience this? WebThank you for this post. Since then I've suffered on and off with lesser pain in the SI joint (sometimes I do hobble around, for the first few years this was a more common issue), hips, spine, rib cage, and recently the right side of my breast bone becomes slightly to severely painful from time to time. Immune thrombocytopenia may have no signs and symptoms. He prescribed me an ointment and they went away. I've had petechiae for about 12 yrs I'm 32 yrold male. I had Lyme at 16 and have had these spots come and go ever since blood work comes back fine Since you had bloodworkdonelast time, there isno need to worry. I've recently started getting them with exposure to sun! They seem to always fade within a few days. Accessed March 12, 2019. I also have dermographism. Abdominal exam: he discarded any symptoms of ascites and he said he couldn't feel my spleen or liver were enlarged by palpating and by taping it sounded they were October 2012 #1. (And once when I was a kid, someone put water wings on me for a swimming lesson. I have them scattered on my arms and I'm worried.. People tell me I'm overreacting They're small and hardly noticeable but there are around 20 on each arm (only upper arm). 1. Question: Petechiae in otherwise healthy 16-month-old. It doesn't itch or hurt at all. Thrombocytopenia affects people with certain medical conditions like autoimmune disease or who take certain medications. If my platelets are too low- & they are- & others' are too, it's sound information. But 10 years ago - when I was 17 - I rather suddenly could not walk due to excruciating pain in my sacroiliac joint. I get these too and thought is was just broken blood vessels! I am worried about leukemia and other terminal illnesses related to petechiae. Fuzzy/grip on my head any tips or medication I could take ? Because after the egregious medical shove-off the vast majority of we MEers went & still go thru- left in our homes suffering, or on the job barely making it or getting fired, hard-won careers lost (that took decades to build, in my case), then denied the basic safety net of food & shelter (never mind medical care) via SSDI, et al., & the charming now-increased likelihood of a variety of nasty diseases statistically tied to ME onset, and/or the untimely deaths via suicide (just 1 leading ME mortality cause), and after.
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