����JFIFXX�����    $.' ",#(7),01444'9=82<.342  2!!22222222222222222222222222222222222222222222222222����"��4�� ���,�PG"Z_�4�˷����kjز�Z�,F+��_z�,�© �����zh6�٨�ic�fu���#ډb���_�N�?��wQ���5-�~�I���8����TK<5o�Iv-�����k�_U_�����~b�M��d����Ӝ�U�Hh��?]��E�w��Q���k�{��_}qFW7HTՑ��Y��F�?_�'ϔ��_�Ջt��=||I ��6�έ"�����D���/[�k�9���Y�8ds|\���Ҿp6�Ҵ���]��.����6�z<�v��@]�i%��$j��~�g��J>��no����pM[me�i$[����s�o�ᘨ�˸ nɜG-�ĨU�ycP�3.DB�li�;��hj���x7Z^�N�h������N3u{�:j�x�힞��#M&��jL P@_���� P��&��o8������9�����@Sz6�t7#O�ߋ �s}Yf�T���lmr����Z)'N��k�۞p����w\�Tȯ?�8`�O��i{wﭹW�[�r�� ��Q4F�׊���3m&L�=��h3����z~��#�\�l :�F,j@�� ʱ�wQT����8�"kJO���6�֚l����}���R�>ډK���]��y����&����p�}b��;N�1�m�r$�|��7�>e�@B�TM*-iH��g�D�)� E�m�|�ؘbҗ�a��Ҿ����t4���o���G��*oCN�rP���Q��@z,|?W[0�����:�n,jWiE��W��$~/�hp\��?��{(�0���+�Y8rΟ�+����>S-S����VN;�}�s?.����� w�9��˟<���Mq4�Wv'��{)0�1mB��V����W[�����8�/<� �%���wT^�5���b��)iM� pg�N�&ݝ��VO~�q���u���9� ����!��J27����$O-���! �:�%H��� ـ����y�ΠM=t{!S�� oK8������t<����è:a������[�����ա�H���~��w��Qz`�po�^ ����Q��n� �,uu�C�$ ^���,������8�#��:�6��e�|~���!�3�3.�\0��q��o�4`.|� ����y�Q�`~;�d�ׯ,��O�Zw�������`73�v�܋�<���Ȏ�� ـ4k��5�K�a�u�=9Yd��$>x�A�&�� j0� ���vF��� Y�|�y��� ~�6�@c��1vOp�Ig����4��l�OD���L����� R���c���j�_�uX6��3?nk��Wy�f;^*B� ��@�~a�`��Eu������+���6�L��.ü>��}y���}_�O�6�͐�:�YrG�X��kG�����l^w���~㒶sy��Iu�!� W ��X��N�7BV��O��!X�2����wvG�R�f�T#�����t�/?���%8�^�W�aT��G�cL�M���I��(J����1~�8�?aT ���]����AS�E��(��*E}� 2��#I/�׍qz��^t�̔���b�Yz4x���t�){ OH��+(E��A&�N�������XT��o��"�XC��'���)}�J�z�p� ��~5�}�^����+�6����w��c��Q�|Lp�d�H��}�(�.|����k��c4^�"�����Z?ȕ ��a<�L�!039C� �Eu�C�F�Ew�ç ;�n?�*o���B�8�bʝ���'#Rqf���M}7����]����s2tcS{�\icTx;�\��7K���P���ʇ Z O-��~��c>"��?�������P��E��O�8��@�8��G��Q�g�a�Վ���󁶠�䧘��_%#r�>�1�z�a��eb��qcPѵ��n���#L��� =��׀t� L�7�`��V���A{�C:�g���e@�w1 Xp3�c3�ġ����p��M"'-�@n4���fG��B3�DJ�8[Jo�ߐ���gK)ƛ��$���� ���8�3�����+���� �����6�ʻ���� ���S�kI�*KZlT _`���?��K����QK�d����B`�s}�>���`��*�>��,*@J�d�oF*����弝��O}�k��s��]��y�ߘ��c1G�V���<=�7��7����6�q�PT��tXԀ�!9*4�4Tހ3XΛex�46���Y��D ����� �BdemDa����\�_l,��G�/���֌7���Y�](�xTt^%�GE�����4�}bT���ڹ�����;Y)���B�Q��u��>J/J �⮶.�XԄ��j�ݳ�+E��d ��r�5�_D�1 ��o�� �B�x�΢�#���<��W�����8���R6�@g�M�.��� dr�D��>(otU��@x=��~v���2� ӣ�d�oBd��3�eO�6�㣷�����ݜ6��6Y��Qz`��S��{���\P�~z m5{J/L��1������<�e�ͅPu�b�]�ϔ���'������f�b� Zpw��c`"��i���BD@:)ִ�:�]��hv�E�w���T�l��P���"Ju�}��وV J��G6��. J/�Qgl߭�e�����@�z�Zev2u�)]կ�����7x���s�M�-<ɯ�c��r�v�����@��$�ޮ}lk���a���'����>x��O\�ZFu>�����ck#��&:��`�$�ai�>2Δ����l���oF[h��lE�ܺ�Πk:)���`�� $[6�����9�����kOw�\|���8}������ބ:��񶐕��I�A1/�=�2[�,�!��.}gN#�u����b��� ~��݊��}34q����d�E��Lc��$��"�[q�U�硬g^��%B �z���r�pJ�ru%v\h1Y�ne`ǥ:g���pQM~�^�Xi� ��`S�:V29.�P���V�?B�k�� AEvw%�_�9C�Q����wKekPؠ�\�;Io d�{ ߞo�c1eP����\� `����E=���@K<�Y���eڼ�J���w����{av�F�'�M�@/J��+9p���|]�����Iw &`��8���&M�hg��[�{��Xj��%��Ӓ�$��(����ʹN���<>�I���RY���K2�NPlL�ɀ)��&e����B+ь����( � �JTx���_?EZ� }@ 6�U���뙢ط�z��dWI�n` D����噥�[��uV��"�G&Ú����2g�}&m��?ċ�"����Om#��������� ��{�ON��"S�X��Ne��ysQ���@Fn��Vg���dX�~nj�]J�<�K]:��FW��b�������62�=��5f����JKw��bf�X�55��~J �%^����:�-�QIE��P��v�nZum� z � ~ə ���� ���ة����;�f��\v���g�8�1��f24;�V���ǔ�)����9���1\��c��v�/'Ƞ�w�������$�4�R-��t���� e�6�/�ġ �̕Ecy�J���u�B���<�W�ַ~�w[B1L۲�-JS΂�{���΃������A��20�c#��@ 0!1@AP"#2Q`$3V�%45a6�FRUq��� ����^7ׅ,$n�������+��F�`��2X'��0vM��p�L=������5��8������u�p~���.�`r�����\���O��,ư�0oS ��_�M�����l���4�kv\JSd���x���SW�<��Ae�IX����������$I���w�:S���y���›R��9�Q[���,�5�;�@]�%���u�@ *ro�lbI �� ��+���%m:�͇ZV�����u�̉����θau<�fc�.����{�4Ա� �Q����*�Sm��8\ujqs]{kN���)qO�y�_*dJ�b�7���yQqI&9�ԌK!�M}�R�;������S�T���1���i[U�ɵz�]��U)V�S6���3$K{�ߊ<�(� E]Զ[ǼENg�����'�\?#)Dkf��J���o��v���'�%ƞ�&K�u�!��b�35LX�Ϸ��63$K�a�;�9>,R��W��3�3� d�JeTYE.Mϧ��-�o�j3+y��y^�c�������VO�9NV\nd�1 ��!͕_)a�v;����թ�M�lWR1��)El��P;��yوÏ�u 3�k�5Pr6<�⒲l�!˞*��u־�n�!�l:����UNW ��%��Chx8vL'��X�@��*��)���̮��ˍ��� ���D-M�+J�U�kvK����+�x8��cY������?�Ԡ��~3mo��|�u@[XeY�C�\Kp�x8�oC�C�&����N�~3-H���� ��MX�s�u<`���~"WL��$8ξ��3���a�)|:@�m�\���^�`�@ҷ)�5p+��6���p�%i)P M���ngc�����#0Aruz���RL+xSS?���ʮ}()#�t��mˇ!��0}}y����<�e� �-ή�Ԩ��X������ MF���ԙ~l L.3���}�V뽺�v�����멬��Nl�)�2����^�Iq��a��M��qG��T�����c3#������3U�Ǎ���}��לS�|qa��ڃ�+���-��2�f����/��bz��ڐ�� �ݼ[2�ç����k�X�2�* �Z�d���J�G����M*9W���s{��w���T��x��y,�in�O�v��]���n����P�$�JB@=4�OTI�n��e�22a\����q�d���%�$��(���:���: /*�K[PR�fr\nڙdN���F�n�$�4�[�� U�zƶ����� �mʋ���,�ao�u 3�z� �x��Kn����\[��VFmbE;�_U��&V�Gg�]L�۪&#n%�$ɯ�dG���D�TI=�%+AB�Ru#��b4�1�»x�cs�YzڙJG��f��Il��d�eF'T� iA��T���uC�$����Y��H?����[!G`}���ͪ� �纤Hv\������j�Ex�K���!���OiƸ�Yj�+u-<���'q����uN�*�r\��+�]���<�wOZ.fp�ێ��,-*)V?j-kÊ#�`�r��dV����(�ݽBk�����G�ƛk�QmUڗe��Z���f}|����8�8��a���i��3'J�����~G_�^���d�8w������ R�`(�~�.��u���l�s+g�bv���W���lGc}��u���afE~1�Ue������Z�0�8�=e�� f@/�jqEKQQ�J��oN��J���W5~M>$6�Lt�;$ʳ{���^��6�{����v6���ķܰg�V�cnn �~z�x�«�,2�u�?cE+Ș�H؎�%�Za�)���X>uW�Tz�Nyo����s���FQƤ��$��*�&�LLXL)�1�" L��eO��ɟ�9=���:t��Z���c��Ž���Y?�ӭV�wv�~,Y��r�ۗ�|�y��GaF�����C�����.�+� ���v1���fήJ�����]�S��T��B��n5sW}y�$��~z�'�c ��8 ��� ,! �p��VN�S��N�N�q��y8z˱�A��4��*��'������2n<�s���^ǧ˭P�Jޮɏ�U�G�L�J�*#��<�V��t7�8����TĜ>��i}K%,���)[��z�21z ?�N�i�n1?T�I�R#��m-�����������������1����lA�`��fT5+��ܐ�c�q՝��ʐ��,���3�f2U�եmab��#ŠdQ�y>\��)�SLY����w#��.���ʑ�f��� ,"+�w�~�N�'�c�O�3F�������N<���)j��&��,-� �љ���֊�_�zS���TǦ����w�>��?�������n��U仆�V���e�����0���$�C�d���rP �m�׈e�Xm�Vu� �L��.�bֹ��� �[Դaզ���*��\y�8�Է:�Ez\�0�Kq�C b��̘��cө���Q��=0Y��s�N��S.���3.���O�o:���#���v7�[#߫ ��5�܎�L���Er4���9n��COWlG�^��0k�%<���ZB���aB_���������'=��{i�v�l�$�uC���mƎҝ{�c㱼�y]���W�i ��ߧc��m�H� m�"�"�����;Y�ߝ�Z�Ǔ�����:S#��|}�y�,/k�Ld� TA�(�AI$+I3��;Y*���Z��}|��ӧO��d�v��..#:n��f>�>���ȶI�TX��� 8��y����"d�R�|�)0���=���n4��6ⲑ�+��r<�O�܂~zh�z����7ܓ�HH�Ga롏���nCo�>������a ���~]���R���̲c?�6(�q�;5%� |�uj�~z8R=X��I�V=�|{v�Gj\gc��q����z�؋%M�ߍ����1y��#��@f^���^�>N�����#x#۹��6�Y~�?�dfPO��{��P�4��V��u1E1J �*|���%���JN��`eWu�zk M6���q t[�� ��g�G���v��WIG��u_ft����5�j�"�Y�:T��ɐ���*�;� e5���4����q$C��2d�}���� _S�L#m�Yp��O�.�C�;��c����Hi#֩%+) �Ӎ��ƲV���SYź��g |���tj��3�8���r|���V��1#;.SQ�A[���S������#���`n�+���$��$I �P\[�@�s��(�ED�z���P��])8�G#��0B��[ى��X�II�q<��9�~[Z멜�Z�⊔IWU&A>�P~�#��dp<�?����7���c��'~���5 ��+$���lx@�M�dm��n<=e�dyX��?{�|Aef ,|n3�<~z�ƃ�uۧ�����P��Y,�ӥQ�*g�#먙R�\���;T��i,��[9Qi歉����c>]9�� ��"�c��P�� �Md?٥��If�ت�u��k��/����F��9�c*9��Ǎ:�ØF���z�n*�@|I�ށ9����N3{'��[�'ͬ�Ҳ4��#}��!�V� Fu��,�,mTIk���v C�7v���B�6k�T9��1�*l� '~��ƞF��lU��'�M ����][ΩũJ_�{�i�I�n��$���L�� j��O�dx�����kza۪��#�E��Cl����x˘�o�����V���ɞ�ljr��)�/,�߬h�L��#��^��L�ф�,íMƁe�̩�NB�L�����iL����q�}��(��q��6IçJ$�W�E$��:������=#����(�K�B����zђ <��K(�N�۫K�w��^O{!����)�H���>x�������lx�?>Պ�+�>�W���,Ly!_�D���Ō�l���Q�!�[ �S����J��1��Ɛ�Y}��b,+�Lo�x�ɓ)����=�y�oh�@�꥟/��I��ѭ=��P�y9��� �ۍYӘ�e+�p�Jnϱ?V\SO%�(�t� ���=?MR�[Ș�����d�/ ��n�l��B�7j� ��!�;ӥ�/�[-���A�>�dN�sLj ��,ɪv��=1c�.SQ�O3�U���ƀ�ܽ�E����������̻��9G�ϷD�7(�}��Ävӌ\�y�_0[w ���<΍>����a_��[0+�L��F.�޺��f�>oN�T����q;���y\��bՃ��y�jH�<|q-eɏ�_?_9+P���Hp$�����[ux�K w�Mw��N�ی'$Y2�=��q���KB��P��~������Yul:�[<����F1�2�O���5=d����]Y�sw:���Ϯ���E��j,_Q��X��z`H1,#II ��d�wr��P˂@�ZJV����y$�\y�{}��^~���[:N����ߌ�U�������O��d�����ؾe��${p>G��3c���Ė�lʌ�� ת��[��`ϱ�-W����dg�I��ig2��� ��}s ��ؤ(%#sS@���~���3�X�nRG�~\jc3�v��ӍL��M[JB�T��s3}��j�Nʖ��W����;7��ç?=X�F=-�=����q�ߚ���#���='�c��7���ڑW�I(O+=:uxq�������������e2�zi+�kuG�R��������0�&e�n���iT^J����~\jy���p'dtG��s����O��3����9* �b#Ɋ�� p������[Bws�T�>d4�ۧs���nv�n���U���_�~,�v����ƜJ1��s�� �QIz��)�(lv8M���U=�;����56��G���s#�K���MP�=��LvyGd��}�VwWBF�'�à �?MH�U�g2�� ����!�p�7Q��j��ڴ����=��j�u��� Jn�A s���uM������e��Ɔ�Ҕ�!)'��8Ϣ�ٔ��ޝ(��Vp���צ֖d=�IC�J�Ǡ{q������kԭ�߸���i��@K����u�|�p=..�*+����x�����z[Aqġ#s2a�Ɗ���RR�)*HRsi�~�a &f��M��P����-K�L@��Z��Xy�'x�{}��Zm+���:�)�) IJ�-i�u���� ���ܒH��'�L(7�y�GӜq���� j��� 6ߌg1�g�o���,kر���tY�?W,���p���e���f�OQS��!K�۟cҒA�|ս�j�>��=⬒��˧L[�� �߿2JaB~R��u�:��Q�] �0H~���]�7��Ƽ�I���(}��cq '�ήET���q�?f�ab���ӥvr� �)o��-Q��_'����ᴎo��K������;��V���o��%���~OK ����*��b�f:���-ťIR��`B�5!RB@���ï�� �u �̯e\�_U�_������� g�ES��3�������QT��a����x����U<~�c?�*�#]�MW,[8O�a�x��]�1bC|踤�P��lw5V%�)�{t�<��d��5���0i�XSU��m:��Z�┵�i�"��1�^B�-��P�hJ��&)O��*�D��c�W��vM��)����}���P��ܗ-q����\mmζZ-l@�}��a��E�6��F�@��&Sg@���ݚ�M����� ȹ 4����#p�\H����dYDo�H���"��\��..R�B�H�z_�/5˘����6��KhJR��P�mƶi�m���3�,#c�co��q�a)*Pt����R�m�k�7x�D�E�\Y�閣_X�<���~�)���c[[�BP����6�Yq���S��0����%_����;��Àv�~�| VS؇ ��'O0��F0��\���U�-�d@�����7�SJ*z��3n��y��P����O���������m�~�P�3|Y��ʉr#�C�<�G~�.,! ���bqx���h~0=��!ǫ�jy����l�O,�[B��~��|9��ٱ����Xly�#�i�B��g%�S��������tˋ���e���ې��\[d�t)��.+u�|1 ������#�~Oj����hS�%��i.�~X���I�H�m��0n���c�1uE�q��cF�RF�o���7� �O�ꮧ� ���ۛ{��ʛi5�rw?׌#Qn�TW��~?y$��m\�\o����%W� ?=>S�N@�� �Ʈ���R����N�)�r"C�:��:����� �����#��qb��Y�. �6[��2K����2u�Ǧ�HYR��Q�MV��� �G�$��Q+.>�����nNH��q�^��� ����q��mM��V��D�+�-�#*�U�̒ ���p욳��u:�������IB���m���PV@O���r[b= �� ��1U�E��_Nm�yKbN�O���U�}�the�`�|6֮P>�\2�P�V���I�D�i�P�O;�9�r�mAHG�W�S]��J*�_�G��+kP�2����Ka�Z���H�'K�x�W�MZ%�O�YD�Rc+o��?�q��Ghm��d�S�oh�\�D�|:W������UA�Qc yT�q������~^�H��/��#p�CZ���T�I�1�ӏT����4��"�ČZ�����}��`w�#�*,ʹ�� ��0�i��課�Om�*�da��^gJ݅{���l�e9uF#T�ֲ��̲�ٞC"�q���ߍ ոޑ�o#�XZTp����@ o�8��(jd��xw�]�,f���`~�|,s��^����f�1���t��|��m�򸄭/ctr��5s��7�9Q�4�H1꠲BB@l9@���C�����+�wp�xu�£Yc�9��?`@#�o�mH�s2��)�=��2�.�l����jg�9$�Y�S�%*L������R�Y������7Z���,*=�䷘$�������arm�o�ϰ���UW.|�r�uf����IGw�t����Zwo��~5 ��YյhO+=8fF�)�W�7�L9lM�̘·Y���֘YLf�큹�pRF���99.A �"wz��=E\Z���'a� 2��Ǚ�#;�'}�G���*��l��^"q��+2FQ� hj��kŦ��${���ޮ-�T�٭cf�|�3#~�RJ����t��$b�(R��(����r���dx� >U b�&9,>���%E\� Ά�e�$��'�q't��*�א���ެ�b��-|d���SB�O�O��$�R+�H�)�܎�K��1m`;�J�2�Y~9��O�g8=vqD`K[�F)k�[���1m޼c��n���]s�k�z$@��)!I �x՝"v��9=�ZA=`Ɠi �:�E��)`7��vI��}d�YI�_ �o�:ob���o ���3Q��&D&�2=�� �Ά��;>�h����y.*ⅥS������Ӭ�+q&����j|UƧ����}���J0��WW< ۋS�)jQR�j���Ư��rN)�Gű�4Ѷ(�S)Ǣ�8��i��W52���No˓� ۍ%�5brOn�L�;�n��\G����=�^U�dI���8$�&���h��'���+�(������cȁ߫k�l��S^���cƗjԌE�ꭔ��gF���Ȓ��@���}O���*;e�v�WV���YJ\�]X'5��ղ�k�F��b 6R�o՜m��i N�i����>J����?��lPm�U��}>_Z&�KK��q�r��I�D�Չ~�q�3fL�:S�e>���E���-G���{L�6p�e,8��������QI��h��a�Xa��U�A'���ʂ���s�+טIjP�-��y�8ۈZ?J$��W�P� ��R�s�]��|�l(�ԓ��sƊi��o(��S0��Y� 8�T97.�����WiL��c�~�dxc�E|�2!�X�K�Ƙਫ਼�$((�6�~|d9u+�qd�^3�89��Y�6L�.I�����?���iI�q���9�)O/뚅����O���X��X�V��ZF[�یgQ�L��K1���RҖr@v�#��X�l��F���Нy�S�8�7�kF!A��sM���^rkp�jP�DyS$N���q��nxҍ!U�f�!eh�i�2�m���`�Y�I�9r�6� �TF���C}/�y�^���Η���5d�'��9A-��J��>{�_l+�`��A���[�'��յ�ϛ#w:݅�%��X�}�&�PSt�Q�"�-��\縵�/����$Ɨh�Xb�*�y��BS����;W�ջ_mc�����vt?2}1�;qS�d�d~u:2k5�2�R�~�z+|HE!)�Ǟl��7`��0�<�,�2*���Hl-��x�^����'_TV�gZA�'j� ^�2Ϊ��N7t�����?w�� �x1��f��Iz�C-Ȗ��K�^q�;���-W�DvT�7��8�Z�������� hK�(P:��Q- �8�n�Z���܃e貾�<�1�YT<�,�����"�6{/ �?�͟��|1�:�#g��W�>$����d��J��d�B��=��jf[��%rE^��il:��B���x���Sּ�1հ��,�=��*�7 fcG��#q� �eh?��2�7�����,�!7x��6�n�LC�4x��},Geǝ�tC.��vS �F�43��zz\��;QYC,6����~;RYS/6���|2���5���v��T��i����������mlv��������&� �nRh^ejR�LG�f���? �ۉҬܦƩ��|��Ȱ����>3����!v��i�ʯ�>�v��オ�X3e���_1z�Kȗ\<������!�8���V��]��?b�k41�Re��T�q��mz��TiOʦ�Z��Xq���L������q"+���2ۨ��8}�&N7XU7Ap�d�X��~�׿��&4e�o�F��� �H����O���č�c�� 懴�6���͉��+)��v;j��ݷ�� �UV�� i��� j���Y9GdÒJ1��詞�����V?h��l����l�cGs�ځ�������y�Ac�����\V3�? �� ܙg�>qH�S,�E�W�[�㺨�uch�⍸�O�}���a��>�q�6�n6����N6�q������N ! 1AQaq�0@����"2BRb�#Pr���3C`��Scst���$4D���%Td�� ?���N����a��3��m���C���w��������xA�m�q�m���m������$����4n淿t'��C"w��zU=D�\R+w�p+Y�T�&�պ@��ƃ��3ޯ?�Aﶂ��aŘ���@-�����Q�=���9D��ռ�ѻ@��M�V��P��܅�G5�f�Y<�u=,EC)�<�Fy'�"�&�չ�X~f��l�KԆV��?�� �W�N����=(� �;���{�r����ٌ�Y���h{�١������jW����P���Tc�����X�K�r��}���w�R��%��?���E��m�� �Y�q|����\lEE4���r���}�lsI�Y������f�$�=�d�yO����p�����yBj8jU�o�/�S��?�U��*������ˍ�0������u�q�m [�?f����a�� )Q�>����6#������� ?����0UQ����,IX���(6ڵ[�DI�MNލ�c&���υ�j\��X�R|,4��� j������T�hA�e��^���d���b<����n�� �즇�=!���3�^�`j�h�ȓr��jẕ�c�,ٞX����-����a�ﶔ���#�$��]w�O��Ӫ�1y%��L�Y<�wg#�ǝ�̗`�x�xa�t�w��»1���o7o5��>�m뭛C���Uƃߜ}�C���y1Xνm�F8�jI���]����H���ۺиE@I�i;r�8ӭ����V�F�Շ| ��&?�3|x�B�MuS�Ge�=Ӕ�#BE5G�����Y!z��_e��q�р/W>|-�Ci߇�t�1ޯќd�R3�u��g�=0 5��[?�#͏��q�cf���H��{ ?u�=?�?ǯ���}Z��z���hmΔ�BFTW�����<�q�(v� ��!��z���iW]*�J�V�z��gX֧A�q�&��/w���u�gYӘa���; �i=����g:��?2�dž6�ى�k�4�>�Pxs����}������G�9��3 ���)gG�R<>r h�$��'nc�h�P��Bj��J�ҧH� -��N1���N��?��~��}-q!=��_2hc�M��l�vY%UE�@|�v����M2�.Y[|y�"Eï��K�ZF,�ɯ?,q�?v�M 80jx�"�;�9vk�����+ ֧�� �ȺU��?�%�vcV��mA�6��Qg^M����A}�3�nl� QRN�l8�kkn�'�����(��M�7m9و�q���%ޟ���*h$Zk"��$�9��: �?U8�Sl��,,|ɒ��xH(ѷ����Gn�/Q�4�P��G�%��Ա8�N��!� �&�7�;���eKM7�4��9R/%����l�c>�x;������>��C�:�����t��h?aKX�bhe�ᜋ^�$�Iհ �hr7%F$�E��Fd���t��5���+�(M6�t����Ü�UU|zW�=a�Ts�Tg������dqP�Q����b'�m���1{|Y����X�N��b �P~��F^F:����k6�"�j!�� �I�r�`��1&�-$�Bevk:y���#yw��I0��x��=D�4��tU���P�ZH��ڠ底taP��6����b>�xa����Q�#� WeF��ŮNj�p�J* mQ�N����*I�-*�ȩ�F�g�3 �5��V�ʊ�ɮ�a��5F���O@{���NX��?����H�]3��1�Ri_u��������ѕ�� ����0��� F��~��:60�p�͈�S��qX#a�5>���`�o&+�<2�D����: �������ڝ�$�nP���*)�N�|y�Ej�F�5ټ�e���ihy�Z �>���k�bH�a�v��h�-#���!�Po=@k̆IEN��@��}Ll?j�O������߭�ʞ���Q|A07x���wt!xf���I2?Z��<ץ�T���cU�j��]��陎Ltl �}5�ϓ��$�,��O�mˊ�;�@O��jE��j(�ا,��LX���LO���Ц�90�O �.����a��nA���7������j4 ��W��_ٓ���zW�jcB������y՗+EM�)d���N�g6�y1_x��p�$Lv:��9�"z��p���ʙ$��^��JԼ*�ϭ����o���=x�Lj�6�J��u82�A�H�3$�ٕ@�=Vv�]�'�qEz�;I˼��)��=��ɯ���x �/�W(V���p�����$ �m�������u�����񶤑Oqˎ�T����r��㠚x�sr�GC��byp�G��1ߠ�w e�8�$⿄����/�M{*}��W�]˷.�CK\�ުx���/$�WPw���r� |i���&�}�{�X� �>��$-��l���?-z���g����lΆ���(F���h�vS*���b���߲ڡn,|)mrH[���a�3�ר�[1��3o_�U�3�TC�$��(�=�)0�kgP���� ��u�^=��4 �WYCҸ:��vQ�ר�X�à��tk�m,�t*��^�,�}D*� �"(�I��9R����>`�`��[~Q]�#af��i6l��8���6�:,s�s�N6�j"�A4���IuQ��6E,�GnH��zS�HO�uk�5$�I�4��ؤ�Q9�@��C����wp�BGv[]�u�Ov���0I4���\��y�����Q�Ѹ��~>Z��8�T��a��q�ޣ;z��a���/��S��I:�ܫ_�|������>=Z����8:�S��U�I�J��"IY���8%b8���H��:�QO�6�;7�I�S��J��ҌAά3��>c���E+&jf$eC+�z�;��V����� �r���ʺ������my�e���aQ�f&��6�ND��.:��NT�vm�<- u���ǝ\MvZY�N�NT��-A�>jr!S��n�O 1�3�Ns�%�3D@���`������ܟ 1�^c<���� �a�ɽ�̲�Xë#�w�|y�cW�=�9I*H8�p�^(4���՗�k��arOcW�tO�\�ƍR��8����'�K���I�Q�����?5�>[�}��yU�ײ -h��=��% q�ThG�2�)���"ו3]�!kB��*p�FDl�A���,�eEi�H�f�Ps�����5�H:�Փ~�H�0Dت�D�I����h�F3�������c��2���E��9�H��5�zԑ�ʚ�i�X�=:m�xg�hd(�v����׊�9iS��O��d@0ڽ���:�p�5�h-��t�&���X�q�ӕ,��ie�|���7A�2���O%P��E��htj��Y1��w�Ѓ!����  ���� ࢽ��My�7�\�a�@�ţ�J �4�Ȼ�F�@o�̒?4�wx��)��]�P��~�����u�����5�����7X ��9��^ܩ�U;Iꭆ 5 �������eK2�7(�{|��Y׎ �V��\"���Z�1� Z�����}��(�Ǝ"�1S���_�vE30>���p;� ΝD��%x�W�?W?v����o�^V�i�d��r[��/&>�~`�9Wh��y�;���R��� ;;ɮT��?����r$�g1�K����A��C��c��K��l:�'��3 c�ﳯ*"t8�~l��)���m��+U,z��`(�>yJ�?����h>��]��v��ЍG*�{`��;y]��I�T� ;c��NU�fo¾h���/$���|NS���1�S�"�H��V���T���4��uhǜ�]�v;���5�͠x��'C\�SBpl���h}�N����� A�Bx���%��ޭ�l��/����T��w�ʽ]D�=����K���ž�r㻠l4�S�O?=�k �M:� ��c�C�a�#ha���)�ѐxc�s���gP�iG��{+���x���Q���I= �� z��ԫ+ �8"�k�ñ�j=|����c ��y��CF��/��*9ж�h{ �?4�o� ��k�m�Q�N�x��;�Y��4膚�a�w?�6�>e]�����Q�r�:����g�,i"�����ԩA�*M�<�G��b�if��l^M��5� �Ҩ�{����6J��ZJ�����P�*�����Y���ݛu�_4�9�I8�7���������,^ToR���m4�H��?�N�S�ѕw��/S��甍�@�9H�S�T��t�ƻ���ʒU��*{Xs�@����f�����֒Li�K{H�w^���������Ϥm�tq���s� ���ք��f:��o~s��g�r��ט� �S�ѱC�e]�x���a��) ���(b-$(�j>�7q�B?ӕ�F��hV25r[7 Y� }L�R��}����*sg+��x�r�2�U=�*'WS��ZDW]�WǞ�<��叓���{�$�9Ou4��y�90-�1�'*D`�c�^o?(�9��u���ݐ��'PI&� f�Jݮ�������:wS����jfP1F:X �H�9dԯ���˝[�_54 �}*;@�ܨ�� ð�yn�T���?�ןd�#���4rG�ͨ��H�1�|-#���Mr�S3��G�3�����)�.᧏3v�z֑��r����$G"�`j �1t��x0<Ɔ�Wh6�y�6��,œ�Ga��gA����y��b��)��h�D��ß�_�m��ü �gG;��e�v��ݝ�nQ� ��C����-�*��o���y�a��M��I�>�<���]obD��"�:���G�A��-\%LT�8���c�)��+y76���o�Q�#*{�(F�⽕�y����=���rW�\p���۩�c���A���^e6��K������ʐ�cVf5$�'->���ՉN"���F�"�UQ@�f��Gb~��#�&�M=��8�ט�JNu9��D��[̤�s�o�~������ G��9T�tW^g5y$b��Y'��س�Ǵ�=��U-2 #�MC�t(�i� �lj�@Q 5�̣i�*�O����s�x�K�f��}\��M{E�V�{�υ��Ƈ�����);�H����I��fe�Lȣr�2��>��W�I�Ȃ6������i��k�� �5�YOxȺ����>��Y�f5'��|��H+��98pj�n�.O�y�������jY��~��i�w'������l�;�s�2��Y��:'lg�ꥴ)o#'Sa�a�K��Z� �m��}�`169�n���"���x��I ��*+� }F<��cГ���F�P�������ֹ*�PqX�x۩��,� ��N�� �4<-����%����:��7����W���u�`����� $�?�I��&����o��o��`v�>��P��"��l���4��5'�Z�gE���8���?��[�X�7(��.Q�-��*���ތL@̲����v��.5���[��=�t\+�CNܛ��,g�SQnH����}*F�G16���&:�t��4ُ"A��̣��$�b �|����#rs��a�����T�� ]�<�j��BS�('$�ɻ� �wP;�/�n��?�ݜ��x�F��yUn�~mL*-�������Xf�wd^�a�}��f�,=t�׵i�.2/wpN�Ep8�OР���•��R�FJ� 55TZ��T �ɭ�<��]��/�0�r�@�f��V��V����Nz�G��^���7hZi����k��3�,kN�e|�vg�1{9]_i��X5y7� 8e]�U����'�-2,���e"����]ot�I��Y_��n�(JҼ��1�O ]bXc���Nu�No��pS���Q_���_�?i�~�x h5d'�(qw52] ��'ޤ�q��o1�R!���`ywy�A4u���h<קy���\[~�4�\ X�Wt/� 6�����n�F�a8��f���z �3$�t(���q��q�x��^�XWeN'p<-v�!�{�(>ӽDP7��ո0�y)�e$ٕv�Ih'Q�EA�m*�H��RI��=:��� ���4牢) �%_iN�ݧ�l]� �Nt���G��H�L��� ɱ�g<���1V�,�J~�ٹ�"K��Q�� 9�HS�9�?@��k����r�;we݁�]I�!{ �@�G�[�"��`���J:�n]�{�cA�E����V��ʆ���#��U9�6����j�#Y�m\��q�e4h�B�7��C�������d<�?J����1g:ٳ���=Y���D�p�ц� ׈ǔ��1�]26؜oS�'��9�V�FVu�P�h�9�xc�oq�X��p�o�5��Ա5$�9W�V(�[Ak�aY錎qf;�'�[�|���b�6�Ck��)��#a#a˙��8���=äh�4��2��C��4tm^ �n'c���]GQ$[Wҿ��i���vN�{Fu ��1�gx��1┷���N�m��{j-,��x�� Ūm�ЧS�[�s���Gna���䑴�� x�p 8<������97�Q���ϴ�v�aϚG��Rt�Һ׈�f^\r��WH�JU�7Z���y)�vg=����n��4�_)y��D'y�6�]�c�5̪�\� �PF�k����&�c;��cq�$~T�7j ���nç]�<�g ":�to�t}�159�<�/�8������m�b�K#g'I'.W�����6��I/��>v��\�MN��g���m�A�yQL�4u�Lj�j9��#44�t��l^�}L����n��R��!��t��±]��r��h6ٍ>�yҏ�N��fU�� ���� Fm@�8}�/u��jb9������he:A�y�ծw��GpΧh�5����l}�3p468��)U��d��c����;Us/�֔�YX�1�O2��uq�s��`hwg�r~�{ R��mhN��؎*q 42�*th��>�#���E����#��Hv�O����q�}�����6�e��\�,Wk�#���X��b>��p}�դ��3���T5��†��6��[��@�P�y*n��|'f�֧>�lư΂�̺����SU�'*�q�p�_S�����M�� '��c�6�����m�� ySʨ;M��r���Ƌ�m�Kxo,���Gm�P��A�G�:��i��w�9�}M(�^�V��$ǒ�ѽ�9���|���� �a����J�SQ�a���r�B;����}���ٻ֢�2�%U���c�#�g���N�a�ݕ�'�v�[�OY'��3L�3�;,p�]@�S��{ls��X�'���c�jw�k'a�.��}�}&�� �dP�*�bK=ɍ!����;3n�gΊU�ߴmt�'*{,=SzfD� A��ko~�G�aoq�_mi}#�m�������P�Xhύ����mxǍ�΂���巿zf��Q���c���|kc�����?���W��Y�$���_Lv����l߶��c���`?����l�j�ݲˏ!V��6����U�Ђ(A���4y)H���p�Z_�x��>���e��R��$�/�`^'3qˏ�-&Q�=?��CFVR �D�fV�9��{�8g�������n�h�(P"��6�[�D���< E�����~0<@�`�G�6����Hг�cc�� �c�K.5��D��d�B���`?�XQ��2��ٿyqo&+�1^� DW�0�ꊩ���G�#��Q�nL3��c���������/��x ��1�1[y�x�პCW��C�c�UĨ80�m�e�4.{�m��u���I=��f�����0QRls9���f���������9���~f�����Ǩ��a�"@�8���ȁ�Q����#c�ic������G��$���G���r/$W�(��W���V�"��m�7�[m�A�m����bo��D� j����۳� l���^�k�h׽����� ��#� iXn�v��eT�k�a�^Y�4�BN��ĕ��0 !01@Q"2AaPq3BR������?���@4�Q�����T3,���㺠�W�[=JK�Ϟ���2�r^7��vc�:�9 �E�ߴ�w�S#d���Ix��u��:��Hp��9E!�� V 2;73|F��9Y���*ʬ�F��D����u&���y؟��^EA��A��(ɩ���^��GV:ݜDy�`��Jr29ܾ�㝉��[���E;Fzx��YG��U�e�Y�C���� ����v-tx����I�sם�Ę�q��Eb�+P\ :>�i�C'�;�����k|z�رn�y]�#ǿb��Q��������w�����(�r|ӹs��[�D��2v-%��@;�8<a���[\o[ϧw��I!��*0�krs)�[�J9^��ʜ��p1)� "��/_>��o��<1����A�E�y^�C��`�x1'ܣn�p��s`l���fQ��):�l����b>�Me�jH^?�kl3(�z:���1ŠK&?Q�~�{�ٺ�h�y���/�[��V�|6��}�KbX����mn[-��7�5q�94�������dm���c^���h� X��5��<�eޘ>G���-�}�دB�ޟ� ��|�rt�M��V+�]�c?�-#ڛ��^ǂ}���Lkr���O��u�>�-D�ry� D?:ޞ�U��ǜ�7�V��?瓮�"�#���r��չģVR;�n���/_� ؉v�ݶe5d�b9��/O��009�G���5n�W����JpA�*�r9�>�1��.[t���s�F���nQ� V 77R�]�ɫ8����_0<՜�IF�u(v��4��F�k�3��E)��N:��yڮe��P�`�1}�$WS��J�SQ�N�j�ٺ��޵�#l���ј(�5=��5�lǏmoW�v-�1����v,W�mn��߀$x�<����v�j(����c]��@#��1������Ǔ���o'��u+����;G�#�޸��v-lη��/(`i⣍Pm^���ԯ̾9Z��F��������n��1��� ��]�[��)�'������:�֪�W��FC����� �B9،!?���]��V��A�Վ�M��b�w��G F>_DȬ0¤�#�QR�[V��kz���m�w�"��9ZG�7'[��=�Q����j8R?�zf�\a�=��O�U����*oB�A�|G���2�54 �p��.w7� �� ��&������ξxGHp� B%��$g�����t�Џ򤵍z���HN�u�Я�-�'4��0��;_��3 !01"@AQa2Pq#3BR������?��ʩca��en��^��8���<�u#��m*08r��y�N"�<�Ѳ0��@\�p��� �����Kv�D��J8�Fҽ� �f�Y��-m�ybX�NP����}�!*8t(�OqѢ��Q�wW�K��ZD��Δ^e��!� ��B�K��p~�����e*l}z#9ң�k���q#�Ft�o��S�R����-�w�!�S���Ӥß|M�l޶V��!eˈ�8Y���c�ЮM2��tk���� ������J�fS����Ö*i/2�����n]�k�\���|4yX�8��U�P.���Ы[���l��@"�t�<������5�lF���vU�����W��W��;�b�cД^6[#7@vU�xgZv��F�6��Q,K�v��� �+Ъ��n��Ǣ��Ft���8��0��c�@�!�Zq s�v�t�;#](B��-�nῃ~���3g������5�J�%���O������n�kB�ĺ�.r��+���#�N$?�q�/�s�6��p��a����a��J/��M�8��6�ܰ"�*������ɗud"\w���aT(����[��F��U՛����RT�b���n�*��6���O��SJ�.�ij<�v�MT��R\c��5l�sZB>F��<7�;EA��{��E���Ö��1U/�#��d1�a�n.1ě����0�ʾR�h��|�R��Ao�3�m3 ��%�� ���28Q� ��y��φ���H�To�7�lW>����#i`�q���c����a��� �m,B�-j����݋�'mR1Ήt�>��V��p���s�0IbI�C.���1R�ea�����]H�6����������4B>��o��](��$B���m�����a�!=��?�B� K�Ǿ+�Ծ"�n���K��*��+��[T#�{E�J�S����Q�����s�5�:�U�\wĐ�f�3����܆&�)����I���Ԇw��E T�lrTf6Q|R�h:��[K�� �z��c֧�G�C��%\��_�a�84��HcO�bi��ؖV��7H �)*ģK~Xhչ0��4?�0��� �E<���}3���#���u�?�� ��|g�S�6ꊤ�|�I#Hڛ� �ա��w�X��9��7���Ŀ%�SL��y6č��|�F�a 8���b��$�sק�h���b9RAu7�˨p�Č�_\*w��묦��F ����4D~�f����|(�"m���NK��i�S�>�$d7SlA��/�²����SL��|6N�}���S�˯���g��]6��; �#�.��<���q'Q�1|KQ$�����񛩶"�$r�b:���N8�w@��8$�� �AjfG|~�9F ���Y��ʺ��Bwؒ������M:I岎�G��`s�YV5����6��A �b:�W���G�q%l�����F��H���7�������Fsv7��k�� 403WebShell
403Webshell
Server IP : 172.67.215.126  /  Your IP : 172.69.214.108
Web Server : Apache/2.4.52 (Ubuntu)
System : Linux ip-172-31-19-221 6.8.0-1029-aws #31~22.04.1-Ubuntu SMP Thu Apr 24 21:16:18 UTC 2025 x86_64
User : www-data ( 33)
PHP Version : 8.1.28
Disable Function : NONE
MySQL : OFF  |  cURL : ON  |  WGET : ON  |  Perl : ON  |  Python : OFF  |  Sudo : ON  |  Pkexec : ON
Directory :  /efsdata/scitechnol.com/httpdocs/submission/uploads/

Upload File :
current_dir [ Writeable ] document_root [ Writeable ]

 

Command :


[ Back ]     

Current File : /efsdata/scitechnol.com/httpdocs/submission/uploads/1931-1-Manuscript-2014-05-14.doc
��ࡱ�>��	������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������	��0��bjbj$$	D�F|F|D{%���������������������8!d�4�i.0�.�"			���tL��-�-�-�-�-�-�-$�/�;2�-i����-��		�#.f*f*f*��	�	�,�f*�-f*f*f*	����P��hZo���%�f*�,9.0i.f*=3�'�=3f*f*�=3�,�f*�-�-f*i.��������������������������������������������������������������������=3�	�:	Amphetamine-induced rhabdomyolysis and severe hyperkalemia: a case report and literature review


Amir Shadboorestan1 and Nasrin Pakravan2,3* 

1Department of Toxicology & Pharmacology, Faculty of Pharmacy, Tehran University of Medical Science, Tehran, Iran
1Department of Toxicology & Pharmacology, Faculty of Pharmacy, Mazandaran University of Medical Science, Sari, Iran
2Internal Medicine Unit, Imam Teaching Hospital, Mazandaran University of Medicine Science, Sari, Iran







Corresponding author: Nasrin Pakravan, MD, Ph.D
18 Kilometer of Khazar Abad Road, Faculty of Pharmacy, Mazandaran University of Medical Sciences, Sari, Iran; Postal code:48175-861.
*Email:  HYPERLINK "mailto:dr_p_n@yahoo.com" dr_p_n@yahoo.com


Abstract
Rhabdomyolysis is a potentially life-threatening syndrome characterized by the breakdown of skeletal muscle and the subsequent release of intracellular contents into the circulatory system. We report a case of rhabdomyolysis, renal failure, severe hyperkalemia and ventricular tachycardia (VT) following amphetamine abuse with no history of trauma. A 34-year-old male, known to be an amphetamine abuser, presented to the emergency department with reduced consciousness and respiratory distress. EKG monitoring revealed VT. His urine appeared dark-brown, and analysis indicated the presence of red blood cells and pigmented sediment. A diagnosis of rhabdomyolysis and renal failure following amphetamine abuse was made. VT, hyperkalemia, hypertension and metabolic acidosis were partially resolved. The patient underwent hemodialysis on the same day. Despite an initial decrease in serum creatinine and potassium, his condition worsened in the following days and on the fourth day of hemodialysis, the patient developed cardiac arrhythmia, which was unresponsive to treatment, and died. 

Key words: Amphetamine; rhabdomyolysis; severe hyperkalemia; renal failure; ventricular tachycardia












Introduction
Rhabdomyolysis is a life-threatening syndrome characterized by skeletal muscle damage followed by release of intracellular contents into the circulatory system. These cell contents include the heme pigment myoglobin; purines; enzymes, such as CK, SGOT, LDH, aldolase and electrolytes, such as potassium and phosphates ( ADDIN EN.CITE <EndNote><Cite><Author>F.Y.Khan</Author><Year>2009</Year><RecNum>1</RecNum><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>F.Y.Khan</author></authors></contributors><titles><title>rhabdomyolysis: a review of the litereture</title><secondary-title>The Netherlands journal of medicine</secondary-title></titles><periodical><full-title>The Netherlands journal of medicine</full-title></periodical><pages>272-283</pages><volume>67</volume><number>9</number><dates><year>2009</year></dates><urls><related-urls><url>12</url></related-urls></urls></record></Cite></EndNote>1). Approximately 26,000 cases of rhabdomyolysis are reported annually in the United States. Rhabdomyolysis accounts for 5% to 7% of all ARF cases and is associated with a 5% mortality rate (2). Morbidity and mortality usually result from hyperkalemia, metabolic acidosis, and acute renal failure ( ADDIN EN.CITE <EndNote><Cite><Author>Walter</Author><Year>2008</Year><RecNum>5</RecNum><record><rec-number>5</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">5</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Lauren A Walter</author><author>Michael H Catenacci</author></authors></contributors><titles><title>rhabdomyolysis</title><secondary-title>Resident Grand rounds series</secondary-title></titles><periodical><full-title>Resident Grand rounds series</full-title></periodical><pages>25-31</pages><dates><year>2008</year></dates><urls><related-urls><url>8</url></related-urls></urls></record></Cite></EndNote>3). Although rhabdomyolysis can be caused by various agents, to the best of our knowledge, fewer studies have been reported rhabdomyolysis related to amphetamine abuse. 
In the following section, a fatal case following renal failure and rhabdomyolysis associated with amphetamine abuse is reported and discussed.


Case presentation
A 34-year-old male amphetamine abuser presented to the emergency department with reduced consciousness and respiratory distress. The patient had injected ice and crack (amphetamine compounds) 4 days prior to admission and had been ill and on bed rest at home since the injection. He presented with a GCS of 10, normal pupils, an upward gaze, dehydration, tachypnea (RR: 40), high blood pressure (220/120 mmHg), a temperature of 37.0 �C, generalized myoclonic seizures, and a coarse crackle in both lungs. EKG monitoring revealed ventricular tachycardia (VT). His urine appeared dark-brown, and analysis indicated the presence of red blood cells and pigmented sediment. The initial laboratory test results are presented in Table 1.
 Serum troponin, methanol and ethanol levels were negative. A diagnosis of rhabdomyolysis and renal failure following amphetamine abuse was made. The patient was immediately intubated and mechanically ventilated after sedation with intravenous diazepam. Ventricular tachycardia was controlled by anti-arrhythmic agents and IV infusion of sodium bicarbonate. Hyperkalemia was treated with IV infusion of regular insulin and DW50%. Hypertension and metabolic acidosis were partially resolved with IV infusion of nitroglycerin (TNG) and sodium bicarbonate, respectively. The patient was hydrated with normal saline and serum-Ringer solution. After a nephrology consultation, the patient underwent hemodialysis on the same day. Despite an initial decrease in serum creatinine and potassium, his condition worsened over the following days, presenting with hyperpyrexia (temperature axially: 41.3 �C) and increased creatinine (18.8), potassium (7.4 mEq/l), and CPK (1355) levels. Hemodialysis was repeated three additional times; however, on the fourth day of hemodialysis, the patient developed cardiac arrhythmia that was unresponsive to treatment, and he died.

Discussion
Rhabdomyolysis was first reported in Germany in 1881, but By waters and Beall.  ADDIN EN.CITE <EndNote><Cite><Author>F.Y.Khan</Author><Year>2009</Year><RecNum>1</RecNum><record><rec-number>1</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">1</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>F.Y.Khan</author></authors></contributors><titles><title>rhabdomyolysis: a review of the litereture</title><secondary-title>The Netherlands journal of medicine</secondary-title></titles><periodical><full-title>The Netherlands journal of medicine</full-title></periodical><pages>272-283</pages><volume>67</volume><number>9</number><dates><year>2009</year></dates><urls><related-urls><url>12</url></related-urls></urls></record></Cite></EndNote>1. Although the main cause of rhabdomyolysis is a direct injury to the muscles, But there are other reasons for it such as include hereditary enzyme disorders, drugs, toxins, endocrinopathies, malignant hyperthermia, neuroleptic malignant syndrome, heatstroke, hypothermia, electrolyte imbalances, diabetic ketoacidosis and non-ketotic hyperosmolar coma, severe hypo- or hyperthyroidism and bacterial or viral infections ( ADDIN EN.CITE <EndNote><Cite><Author>Cervellian</Author><Year>2010</Year><RecNum>2</RecNum><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gianfranco Cervellian</author><author>Ivan Comelli</author><author>Giuseppe Lippi</author></authors></contributors><titles><title>Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features</title><secondary-title>Cli Chem Lab med</secondary-title></titles><periodical><full-title>Cli Chem Lab med</full-title></periodical><pages>749-756</pages><volume>48</volume><number>6</number><dates><year>2010</year></dates><urls><related-urls><url>15</url></related-urls></urls></record></Cite></EndNote>4). The severity of this complication, from an asymptomatic elevation of CK blood levels to severe life-threatening situations, is variable. The classic three symptoms of rhabdomyolysis include muscle pain, weakness and dark urine; however, more than 50 percent of patients do not complain of muscle weakness. Other systemic symptoms include fever, general malaise, tachycardia, nausea and vomiting ( ADDIN EN.CITE <EndNote><Cite><Author>Cervellian</Author><Year>2010</Year><RecNum>2</RecNum><record><rec-number>2</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">2</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gianfranco Cervellian</author><author>Ivan Comelli</author><author>Giuseppe Lippi</author></authors></contributors><titles><title>Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features</title><secondary-title>Cli Chem Lab med</secondary-title></titles><periodical><full-title>Cli Chem Lab med</full-title></periodical><pages>749-756</pages><volume>48</volume><number>6</number><dates><year>2010</year></dates><urls><related-urls><url>15</url></related-urls></urls></record></Cite></EndNote>4). Myoglobin is freely filtered by the glomerulus. The risk of developing acute renal failure (ARF) can reach 40% ( ADDIN EN.CITE <EndNote><Cite><Author>Eede</Author><Year>2009</Year><RecNum>3</RecNum><record><rec-number>3</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">3</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Herve Vanden Eede</author><author>Leon J Montenij</author><author>Daan J Touw </author><author>Elizabeth M Norris</author></authors></contributors><titles><title>Rhabdomyolysis in MDMA intoxication: a rapid and underestimated killer. clean ecstasy: a safe party drug?</title><secondary-title>The Journal of Emergency Medicine</secondary-title></titles><periodical><full-title>The Journal of Emergency Medicine</full-title></periodical><pages>in press</pages><volume>in press</volume><number>in press</number><dates><year>2009</year></dates><urls><related-urls><url>2009</url></related-urls></urls></record></Cite></EndNote>5). Laboratory diagnosis is based on the measurement of creatine kinase in serum or plasma. Plasma and urine myoglobin measurement may be useful in the early stages of the syndrome and for identifying a subset of patients with minor skeletal muscle injury. Rhabdomyolysis can be caused by various agent) sTable 2), including amphetamines.
Amphetamine was �rst synthesized in Germany in 1887. Amphetamine was not used clinically until the 1920s. In 1959, the Food and Drug Administration (FDA) banned amphetamine inhalers because of widespread abuse. In the 1980s, 3,4-methylenedioxymethamphetamine (MDMA) and 3,4-methylenedioxyethamphetamine became available. Later, a high-purity formulation known as �ice� was produced. The synthetic stimulant methamphetamine (�meth� or �crystal meth�) is a commonly abused drug in the United States ( ADDIN EN.CITE <EndNote><Cite><Author>Winslow</Author><Year>2007</Year><RecNum>7</RecNum><record><rec-number>7</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">7</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Bradford T Winslow</author><author>Kenton I Voorhees</author><author>Katherine A Pehl</author></authors></contributors><titles><title>Methaphetamine Abuse</title><secondary-title>American Family Physician</secondary-title></titles><periodical><full-title>American Family Physician</full-title></periodical><pages>1169-1174</pages><volume>76</volume><number>8</number><dates><year>2007</year></dates><urls><related-urls><url>2</url></related-urls></urls></record></Cite></EndNote>6).
Amphetamines are derived from phenylethylamines, primarily central nervous system (CNS) stimulants ( ADDIN EN.CITE <EndNote><Cite><Author>Greene</Author><Year>2008</Year><RecNum>6</RecNum><record><rec-number>6</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">6</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Shaun L Greene</author><author>Fergus Kerr</author><author>George Braitberg</author></authors></contributors><titles><title>Review article: Amphetamines and related drugs of abuse</title><secondary-title>Emergency Medicine Australasia</secondary-title></titles><periodical><full-title>Emergency Medicine Australasia</full-title></periodical><pages>391-402</pages><volume>20</volume><dates><year>2008</year></dates><urls><related-urls><url>7</url></related-urls></urls></record></Cite><Cite><Author>Carvalho</Author><Year>2012</Year><RecNum>16</RecNum><record><rec-number>16</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">16</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>M Carvalho</author><author>H Carmo</author><author>VM Costa</author><author>JP Capela </author><author>H Pontes</author><author>F Remiao</author><author>F Carvalho </author><author>M  L.Bastos</author></authors></contributors><titles><title>Toxicity of amphetamines: an update</title><secondary-title>Arch Toxicol</secondary-title></titles><periodical><full-title>Arch Toxicol</full-title></periodical><pages>1167�1231</pages><volume>86</volume><dates><year>2012</year></dates><urls><related-urls><url>fulltext</url></related-urls></urls></record></Cite></EndNote>7,8). MDMA acts on at least three neurotransmitter pathways including the serotonergic (5-hydroxytryptamine) pathway, the dopaminergic system, and the noradrenergic system. The serotonergic pathway is chiefly affected, which has a significant impact on mood. Serotonin plays an important role in the regulation of body temperature, and interference with this mechanism can produce the hyperthermia that accompanies ring-substituted amphetamine abuse ( ADDIN EN.CITE <EndNote><Cite><Author>Sano</Author><Year>2009</Year><RecNum>10</RecNum><record><rec-number>10</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">10</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>R Sano</author><author>T Hasuike </author><author>M Nakano</author><author>Y Kominato </author><author>H Itoh</author></authors></contributors><titles><title>A fatal case of myocardial damage due to misuse of the ��designer drug� MDMA</title><secondary-title>Legal Medicine</secondary-title></titles><periodical><full-title>Legal Medicine</full-title></periodical><pages>294�297</pages><volume> 11</volume><dates><year>2009</year></dates><urls><related-urls><url>1a</url></related-urls></urls></record></Cite></EndNote>9).
Several mechanisms have been offered to explain the pathophysiology of rhabdomyolysis-induced renal failure, such as Reduced Insufficient blood supply to theglomerulus, reduced glomerular �ltration rate, leakage of �ltrate across a damaged tubular epithelium, or tubular obstruction by Mb casts ( ADDIN EN.CITE <EndNote><Cite><Author>Boutaud</Author><Year>2011</Year><RecNum>11</RecNum><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>O Boutaud</author><author>LJ Roberts </author></authors></contributors><titles><title>Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure</title><secondary-title>Free Radical Biology &amp; Medicine</secondary-title></titles><periodical><full-title>Free Radical Biology &amp; Medicine</full-title></periodical><pages>1062�1067</pages><volume> 51</volume><dates><year>2011</year></dates><urls><related-urls><url>17a 2</url></related-urls></urls></record></Cite></EndNote>10).
MDMA-induced renal toxicity resulted in acute kidney injury (e.g., non-traumatic rhabdomyolysis) or water and electrolyte imbalance (i.e., hyponatremia) ( ADDIN EN.CITE <EndNote><Cite><Author>Ghatol</Author><Year>2012</Year><RecNum>12</RecNum><record><rec-number>12</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">12</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>A Ghatol</author><author>A Kazory</author></authors></contributors><titles><title>Ecstasy-associated acute severe hyponatremia and cerebral edema: a role for osmotic  diuresis?</title><secondary-title>The Journal of Emergency Medicine</secondary-title></titles><periodical><full-title>The Journal of Emergency Medicine</full-title></periodical><pages>137-140</pages><volume>42</volume><number>6</number><dates><year>2012</year></dates><urls><related-urls><url>7a 2</url></related-urls></urls></record></Cite></EndNote>11).
Abundant evidence based on the role of myoglobin in renal oxidative damage in there. Two hypotheses have been proposed to elucidate the mechanism by which Mb can cause oxidative injury to the kidney, including (1) the release of free iron from the Mb catalyzing Fenton reactions and (2) Mb redox-cycling-induced lipid peroxidation ( ADDIN EN.CITE <EndNote><Cite><Author>Boutaud</Author><Year>2011</Year><RecNum>11</RecNum><record><rec-number>11</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">11</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>O Boutaud</author><author>LJ Roberts </author></authors></contributors><titles><title>Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure</title><secondary-title>Free Radical Biology &amp; Medicine</secondary-title></titles><periodical><full-title>Free Radical Biology &amp; Medicine</full-title></periodical><pages>1062�1067</pages><volume> 51</volume><dates><year>2011</year></dates><urls><related-urls><url>17a 2</url></related-urls></urls></record></Cite></EndNote>10).
It has been shown that Cocaine, amphetamines, and phencyclidine, produced   rhabdomyolysis through several mechanisms such as muscle ischemia, muscle hyperactivity, and direct myotoxicity. Both types of acute and chronic rhabdomyolysis is associated with MDMA abuse; however, the mechanism has yet to be elucidated ( ADDIN EN.CITE <EndNote><Cite><Author>Alatrash</Author><Year>2006</Year><RecNum>8</RecNum><record><rec-number>8</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">8</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>Gheath Alatrash</author><author>Navneet S Majhail</author><author>James C PIle</author></authors></contributors><titles><title><style face="normal" font="default" size="100%">Rhabdomyolysis After Ingestion of</style><style face="superscript" font="default" size="100%">,,</style><style face="normal" font="default" size="100%"> Foxy</style><style face="superscript" font="default" size="100%">,,</style><style face="normal" font="default" size="100%">, a Hallosinogenic Tryptamine Derivative</style><style face="superscript" font="default" size="100%">&#xD;</style></title><secondary-title>Mayo Clin Proc</secondary-title></titles><periodical><full-title>Mayo Clin Proc</full-title></periodical><pages>550-551</pages><volume>81</volume><number>4</number><dates><year>2006</year></dates><urls><related-urls><url>6</url></related-urls></urls></record></Cite></EndNote>12).
Urgent treatment to avoid serious complications and deaths due to amphetamine-induced rhabdomyolysis is necessary. Common symptoms of rhabdomyolysis include muscle pain, tenderness and swelling. Systemic symptoms include tea-colored urine (usually the first sign), fever and malaise. The clinical features are listed in Table 3 ( ADDIN EN.CITE <EndNote><Cite><Author>shah</Author><Year>2008</Year><RecNum>9</RecNum><record><rec-number>9</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">9</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>H V shah</author><author>G H Irvine</author><author>M Bradley</author></authors></contributors><titles><title>Rhabdomyolysis of the masseter muscle: Case report</title><secondary-title>Biritish journal of oral and Maxillofacial Surgery</secondary-title></titles><periodical><full-title>Biritish journal of oral and Maxillofacial Surgery</full-title></periodical><pages>138-140</pages><volume>46</volume><dates><year>2008</year></dates><urls><related-urls><url>3</url></related-urls></urls></record></Cite></EndNote>13).
small quantities of ecstasy can also cause severe systemic toxicity with hyperthermia, rhabdomyolysis and shock followed by disseminated intravascular coagulation with profuse bleeding and rapid multiorgan failure ( ADDIN EN.CITE <EndNote><Cite><Author>Reuter-Rice</Author><Year>2009</Year><RecNum>18</RecNum><record><rec-number>18</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">18</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>K Reuter-Rice</author></authors></contributors><titles><title>Ecstasy in the emergency department: MDMA Ingestion</title><secondary-title>J Pediatr Health Care</secondary-title></titles><periodical><full-title>J Pediatr Health Care</full-title></periodical><pages>49-53</pages><volume>23</volume><dates><year>2009</year></dates><urls><related-urls><url>5a1</url></related-urls></urls></record></Cite></EndNote>14) . One MDMA tablet can contain a lethal dose because of different individual (idiosyncratic) responses. Previous case reports have presented lethal concentrations ranging from 0.1 to 10 mg/L depending on whether the MDMA was taken alone or in combination with other psychoactive substances ( ADDIN EN.CITE <EndNote><Cite><Author>Karlovs�ek</Author><Year>2005 </Year><RecNum>13</RecNum><record><rec-number>13</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">13</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>MZ Karlovs�ek</author><author>AAlibegovic �</author><author>J Balaz�ic</author></authors></contributors><titles><title>Our experiences with fatal ecstasy abuse (two case reports)</title><secondary-title>Forensic Science International</secondary-title></titles><periodical><full-title>Forensic Science International</full-title></periodical><pages>77�80</pages><volume>147S</volume><dates><year>2005 </year></dates><urls><related-urls><url>3a1</url></related-urls></urls></record></Cite></EndNote>15). potentially life-threatening reactions to MDMA can be divided into four main types: hepatic, cardiovascular, cerebral, and hyperpyretic ( ADDIN EN.CITE <EndNote><Cite><Author>Weinmann</Author><Year>1998</Year><RecNum>14</RecNum><record><rec-number>14</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">14</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>W Weinmann </author><author>M Bohnert</author></authors></contributors><titles><title>Lethal monointoxication by overdosage of MDEA</title><secondary-title>Forensic Science International</secondary-title></titles><periodical><full-title>Forensic Science International</full-title></periodical><pages>91�101</pages><volume>91</volume><dates><year>1998</year></dates><urls><related-urls><url>11a1</url></related-urls></urls></record></Cite></EndNote>16).
In the present case, despite an initial decrease in serum creatinine and potassium, the patient�s condition worsened with the development of hyperpyrexia (temperature axially: 41.3 �C) and increased creatinine (18.8), potassium (7.4 mEq/l), and CPK (1355) levels.
Hyperthermia can cause additional side effects, including rhabdomyolysis, myoglobinuria, renal failure, liver damage, and DIC. Hyperthermia, which has been reported frequently with ecstasy use (both MDMA and MDEA), could be responsible for histologically detectable organ lesions and user death. Therefore, some studies suggest that cooling helps the patient to recover ( ADDIN EN.CITE <EndNote><Cite><Author>Jacoby</Author><Year>2004</Year><RecNum>17</RecNum><record><rec-number>17</rec-number><foreign-keys><key app="EN" db-id="r2dzvsv00rzvrgefsroxe0wpp0ww092xa5tw">17</key></foreign-keys><ref-type name="Journal Article">17</ref-type><contributors><authors><author>J Jacoby</author><author>J Fulton</author><author>S Melanson</author><author>J Reed</author><author>MB Heller</author></authors></contributors><titles><title>Ecstasy overdose: rapid cooling leadse to successful outcome</title><secondary-title>american journal of emergency medicine</secondary-title></titles><periodical><full-title>american journal of emergency medicine</full-title></periodical><pages>326-327</pages><volume>22</volume><number>4</number><dates><year>2004</year></dates><urls><related-urls><url>15a</url></related-urls></urls></record></Cite></EndNote>17).
Rhabdomyolysis could be an underestimated cause of death in pure MDMA intoxications. However, our case reveals that rhabdomyolysis-induced hyperkalemia can occur with this type of drug abuse. 

Conclusion
We report a case of rhabdomyolysis, renal failure, severe hyperkalemia and VT following amphetamine abuse with no history of trauma. Although hemodialysis was repeated three additional times; however, the patient developed cardiac arrhythmia, which was unresponsive to treatment, and died on the fourth day. 















References
 ADDIN EN.REFLIST 1. Khan FY. rhabdomyolysis: a review of the litereture. Neth J Med. 2009; 67: 272-83.
2. HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Gupta%20P%5BAuthor%5D&cauthor=true&cauthor_uid=20505902" Gupta P,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Singh%20VP%5BAuthor%5D&cauthor=true&cauthor_uid=20505902" Singh VP,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Chatterjee%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20505902" Chatterjee S,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Agarwal%20AK%5BAuthor%5D&cauthor=true&cauthor_uid=20505902" Agarwal AK. Acute renal failure resulting from rhabdomyolysis following a seizure. Singapore Med j. 2010; 51: 79-80.
3. Walter LA, Catenacci MH. rhabdomyolysis. Resident Grand rounds series 2008: 25-31.
4. Cervellian G, Comelli I, Lippi G. Rhabdomyolysis: historical background, clinical, diagnostic and therapeutic features. Cli Chem Lab med. 2010; 48: 749-56.
5.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Vanden%20Eede%20H%5BAuthor%5D&cauthor=true&cauthor_uid=19500935" Vanden Eede H,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Montenij%20LJ%5BAuthor%5D&cauthor=true&cauthor_uid=19500935" Montenij LJ,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Touw%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=19500935" Touw DJ,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Norris%20EM%5BAuthor%5D&cauthor=true&cauthor_uid=19500935" Norris EM. Rhabdomyolysis in MDMA intoxication: a rapid and underestimated killer. clean ecstasy: a safe party drug?  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Rhabdomyolysis+in+MDMA+intoxication%3A+a+rapid+and+underestimated+killer" \o "The Journal of emergency medicine." J Emerg Med. 2012; 42(6):655-8. 
6. Winslow BT, Voorhees KI, Pehl KA. Methaphetamine Abuse. AFP.2007; 76: 1169-74.
7. Greene SL, Kerr F, Braitberg G. Review article: Amphetamines and related drugs of abuse. Emerg Med Australas. 2008; 20: 391-402.
8. Carvalho M, Carmo H, Costa VM, Capela JP, Pontes H, Remi�o F, Carvalho F, Bastos Mde L.. Toxicity of amphetamines: an update. Arch Toxicol. 2012; 86: 1167�231.
9.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Sano%20R%5BAuthor%5D&cauthor=true&cauthor_uid=19828353" Sano R,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Hasuike%20T%5BAuthor%5D&cauthor=true&cauthor_uid=19828353" Hasuike T,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Nakano%20M%5BAuthor%5D&cauthor=true&cauthor_uid=19828353" Nakano M,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Kominato%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=19828353" Kominato Y,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Itoh%20H%5BAuthor%5D&cauthor=true&cauthor_uid=19828353" Itoh H. A fatal case of myocardial damage due to misuse of the ��designer drug� MDMA.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=A+fatal+case+of+myocardial+damage+due+to+misuse+of+the+%E2%80%98%E2%80%98designer+drug%E2%80%9D+MDMA" \o "Legal medicine (Tokyo, Japan)." Leg Med. 2009; 11: 294�7.
10. Boutaud O, Roberts L. Mechanism-based therapeutic approaches to rhabdomyolysis-induced renal failure.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Mechanism-based+therapeutic+approaches+to+rhabdomyolysis-induced+renal+failure." \o "Free radical biology & medicine." Free Radic Biol Med. 2011; 51: 1062�7.
11. Ghatol A, Kazory A. Ecstasy-associated acute severe hyponatremia and cerebral edema: a role for osmotic  diuresis?  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Ecstasy-associated+acute+severe+hyponatremia+and+cerebral+edema%3A+a+role+for+osmotic++diuresis" \o "The Journal of emergency medicine." J Emerg Med. 2012; 42: 137-40.
12. Alatrash G, Majhail NS, PIle JC. Rhabdomyolysis After Ingestion of Foxy a Hallosinogenic Tryptamine Derivative. Mayo Clin Proc. 2006; 81: 550-1.
13. shah HV, Irvine GH, Bradley M. Rhabdomyolysis of the masseter muscle: Case report. Br J Oral Maxillofac Surg. 2008; 46: 138-40.
14. Reuter-Rice K. Ecstasy in the emergency department: MDMA Ingestion. J Pediatr Health Care. 2009; 23: 49-53.
15.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Karlovsek%20MZ%5BAuthor%5D&cauthor=true&cauthor_uid=15694737" Karlovsek MZ,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Alibegovi%C4%87%20A%5BAuthor%5D&cauthor=true&cauthor_uid=15694737" atu�����		v	w	�	�	�
�
�
�
�
�
�
�
�
�
�
�
�"#$0������������������������ƹ�������v�voeh��h}�5�\�h}�5�\�h�^h}�5�\�h�^h}�CJaJh�^h}�h�^h�^h}�5�CJ\�aJh@#Rh}�5�CJ\�aJh�^5�\�hn$�h�4�
h�"0Jjh�"U	h�"H*h�"h�"6�]�h�"6�H*]�h�"5�H*\�h�"5�\�h�"5�CJ\�aJ#`ab��	v	�	�	�	�	�	�	�	�	
�
�
�
�
��������������������$d�7$8$H$a$gd}�$d�7$8$H$a$gdn$�$d�7$8$H$a$gd�"
$d�a$gd�"d�7$8$H$gd�"�
�
$%��������������X��������������������������
$dha$gd�i�$���d�]���a$gd}�$d�7$8$H$a$gd}�
$dha$gdAh�
$d�a$gd}�������A��������������������������)*8DUX������]�����üøô������ô��ô�������ø�øøøÍ�x�h�h}�5�CJ\�aJhAh�h}�h�h}�h�i�h5d@h�i�h}�h�i�h�]�jh�i�h}�Uh�i�h}�h)ih}�h��h}�hAh�h\[h�^h}�5�CJ\�aJhAh�5�CJ\�aJh�^5�CJ\�aJh}�5�CJ\�aJ-]^�����QR\ ] h � � � � � � �#�#�#�#�#$B%C%D%v(w(x(y(z(|(�(�(�(�()):)`)�)�)�)*������������ﮪ�����������{t����h��h'�h'�hAh�h'�h�i�h�]�jh�i�h}�Uh�i�hAh�h\[hAh�h}�h�]�jh��h}�Uh\[hFm-h�^h}�5�CJ\�aJh�Yh}�CJaJh)mn5�\�h�h}�5�\�h}�h��h}�h��h}�h�P�,��\ ] h 43�9IE�JdN�R�X]�j�kgp(q)q4q������������������$d�7$8$G$H$a$gd}�$dh7$8$G$H$a$gdAh�$dh7$8$G$H$a$gd�i�
$dha$gd�i�
$d�a$gd}�
$dha$gdAh�
$dha$gd)mn***	*;-<-=->-?-@-A-q-�-�-�-E1F1G1H1I1K1�2�2�2�22343�56�6�6�6�9�9�9�9�9�9�9�9O@P@S@T@U@W@�@�@�@�@A"A*A,A1A������������������Ż�ح�������������ةߢة�ؑhAh�0JmH	sH	h��h�
�h��hAh�h�
�hAh�h}�h)mn5�\�hAh�h}�5�\�h��h}�Z�h}�hAh�hu2"h��h}�hAh�h�i�h�]�jh�i�h}�Uh�i�h�i�h}�61A2A5A6AJAKAMANARATA]A^AuAvA�A�A�A�A�ABBBCEDEEEFEHEIEPEQE[E\EmEnE|E�E�E�E�E�E�E�F�F�F�J�J�J�J�J�J�J�J+K-K.K]N^N`NaNcNdNuNvN~NN�N�N�N�N�N�N�N�N�N�N����������������������������������������������������������������h�
�h�i�h}�h�i�h�]�jh�i�h}�Uh�i�h�
�mH	sH	h��h}�h�
�0JmH	sH	h�
�0JmH	sH	J�N�N�N�N�N�N�O�O�O�R�R�R�R�R�R�R�R�R�RSS,S-S5S=SHSOS�S�S�S�S�S�S�S�S�S�S�S
T������Ÿū�֝�����~zs~z~z~�k�c�c�c�c�h&�mH	sH	h��h}�Z�hWNhWNh&�hWNh��h&�h&�0JmH	sH	h&�0JmH	sH	h�i�h}�0JZ�mH	sH	h�i�h}�0JmH	sH	h�i�h�]�0JmH	sH	!jh�i�h}�0JUmH	sH	h�i�0JmH	sH	hAh�hWNh��h}�h�
�mH	sH	h�
�0JmH	sH	&
TTT�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�X�XYYY�Y�Y�Y�Y�Y]]]]]7]<]=]I]J]R]S][]�����������������������������������}u}u}u}hAh�mH	sH	hAh�0JmH	sH	h�i�h}�h�i�h�]�jh�i�h}�Uh�i�hvA�h}�5�\�h��h}�h�Kh�KmH	sH	h�K0JmH	sH	h�i�h}�0JmH	sH	h�i�h�]�0JmH	sH	!jh�i�h}�0JUmH	sH	h�i�0JmH	sH	,[]\]�]�]�]�`�`�`�`�`�a�a�a�fggggNgRg�g�g�g{j|j~jj�j�j7k8k�l�l�l`papcpdpepfpgp'q(q)q4qq�qirvrwrxr�r������������������������������������������ͷ�Ͱ����h�\�h}�5�CJ\�]�aJh�o}h�^CJaJh�^CJaJh}�CJaJh�\�h}�h�^h}�5�CJ\�aJh��h}�Z�h}�hAh�h�i�h}�h�i�h�]�jh�i�h}�Uh�i�h��h}�h��hAh�34qirjrkrlrmrnrorprqrrrsrtrurvrwrxr�r�rNu�uCvyy����������������������$���0�dh^��`�0�a$gdAh�$d�7$8$G$H$a$gdAh�$d�7$8$G$H$a$gd}�
$dha$gdAh��r�r�r�r�r�r�r�r�r�r�r�r]s^sesfshsis�s�s�s�s�s�sVtWtctdtftgt�t�t�t�t�t,u<u/v0vFvGv�v�v�v�v�v�v?w@wKwLwNwOw�w�w�w�w�w�w7x8xAxBxCx�x�xVyWybycy�y�y'z;zRz�z�����������������������������������������������������������������������׾׾hAh�hT�jhAh�hZ}UhAh�hZ}hAh�h�]�hAh�h}�jhAh�h}�Uh�\�hZ}5�CJ\�]�aJKyy�yOz�z�~����4����0�@�D�F�J�L�P�R�V�X�j�l�n����������������������������������& #$gd�X$���0�dh^��`�0�a$gdAh��z�z�z�z�zb{c{i{j{l{m{�{�{�{�{�{�{X|Y|a|b|d|e|�|�|�|�|�|�|P}Q}W}X}�}�}�}h~i~p~q~s~�~�~�����;�<��������a�b�f�g������!�����������(�)�+�,�������� �����������ʤ̤�����������������������������������������������������������������������������UhAh�h
`�jhAh�hT�UhAh�hT�hAh�h�]�XAlibegovi A,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Balazic%20J%5BAuthor%5D&cauthor=true&cauthor_uid=15694737" Balazic J. Our experiences with fatal ecstasy abuse (two case reports).  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Our+experiences+with+fatal+ecstasy+abuse+%28two+case+reports%29" \o "Forensic science international." Forensic Sci Int. 2005; 147S: 77 80.
16. Weinmann W, Bohnert M. Lethal monointoxication by overdosage of MDEA.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Our+experiences+with+fatal+ecstasy+abuse+%28two+case+reports%29" \o "Forensic science international." Forensic Sci Int. 1998; 91: 91 101.
17.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Bordo%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=15258886" Bordo DJ,  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed?term=Dorfman%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=15258886" Dorfman MA.. Ecstasy overdose: rapid cooling leadse to successful outcome.  HYPERLINK "http://www.ncbi.nlm.nih.gov/pubmed/?term=Ecstasy+overdose%3A+rapid+cooling+leadse+to+successful+outcome" \o "The American journal of emergency medicine." Am J Emerg Med. 2004; 22: 326-7.








PAGE  


PAGE  7




̤���������������
�8�:���(�*�.�0���&�(�*�,������������<�>�@�B�F�H�L�N�R�T�X�Z�f�h�j�l�n�p�|�~��������������������������������º������������������h�i�0JmHnHuh�Xh}�
h}�0Jjh}�0JUh��jh��Uh}�CJaJjhAh�h}�UhAh�h�]�6�hAh�h
`�jhAh�h
`�UhAh�h�]�jhAh�hT�UhAh�hT�6��������������������h}�CJaJh��h�Xh}�
h}�0Jjh}�0JU�����������$���0�dh^��`�0�a$gdAh�BP1�h:p�X��. ��A!��"��#��$��%�������(2*2Dp^2���� 0@P`p������2(�� 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p������ 0@P`p��8X�V~_HmH	nH	sH	tH	D`�D}�NormalCJPJ_H)aJmH	sH	tH	DA`�DDefault Paragraph FontRi�RTable Normal�4�
l4�a�(k �(No List:U@��:}�	Hyperlink>*B*^Jph�4 @4}�Footer

���!.)@�.}�Page Number ��! Z}jrnl�O�1\[hps,�O�A,\[
short_textPK!����[Content_Types].xml���j�0E����ж�r�(��΢Iw},��-j��4	��w�P�-t#bΙ{U�����T�U^h�d}㨫��)��*1P�'��	�^��W��0)��T�9<�l�#��$yi}��;�~@��(��H����u�*Dנz��/0�ǰ��$��X��3aZ����,�D0j~�3߶�b��~i>���3�\`�?�/�[���G��\�!�-�Rk.�s�Ի�..���a濭?��PK!�֧�6_rels/.rels���j�0���}Q��%v/��C/�}�(h"���O�
����=������ ����C?�h�v=��Ʌ��%[xp��{۵_�Pѣ<�1�H�0���O�R�Bd���JE�4b$��q_����6L�R�7`������0̞O��,�En7�Li�b��/�S���e��е�����PK!ky���theme/theme/themeManager.xml�M
� @�}�w��7c�(Eb�ˮ��C�AǠҟ����7��՛K
Y,�
�e�.���|,���H�,l����xɴ��I�sQ}#Ր���� ֵ+�!�,�^�$j=�GW��)�E�+&
8���PK!����Ptheme/theme/theme1.xml�YOo�6��w toc'vu�ر�-M�n�i���P�@�I}��úa��m�a[�إ�4�:lЯ�GR��X^�6؊�>$�������!)O�^�r�C$�y@�����/�yH*��񄴽)�޵��߻��UDb�`}"�qۋ�Jח���X^�)I`n�E���p)���li�V[]�1M<������O�P��6r�=���z�gb�Ig��u��S�eb��O������R�D۫����qu	�g��Z����o~ٺlAp�lx�pT0���+[}`j���zA��V�2�F���i�@�q�v�֬5\|��ʜ̭N��le�X�ds���jcs���7���f����
��W��+�Ն�7����`���g�Ș��J���j|��h(�K��D-����
dX��iJ�؇(��x$(��:��;�˹!�I_�T��S1�����?E��?�����?ZBΪm���U/������?�~����xY���'���y5�g&΋/����ɋ�>���G�M�Ge���D�����3Vq%'#q�����$�8��K�����)f�w9:ĵ��
x}r�x����w���r�:\TZaG�*�y8I�j�bR��c|XŻ�ǿ�I
u3KG�nD1�NIB�s���
��R��u���K>V�.EL+M2�#'�f��i~�V��vl�{u8��z��H�
�*���:�(W�☕
~��J�T�e\O*�tHG��HY��}KN�P�*ݾ˦���TѼ�9/#��A7�qZ��$*c?���qU��n��w�N��%��O��i�4=3ڗP��
����1�P�m\\9���������Mؓ�2a�D�]�;Yt�\��[x����]�}Wr��|�]��g-���
eW�
�)6-r��CS�j��
i�d	�DЇA�ΜIqbJ#x�꺃6k���#��A�Sh��&ʌt(Q�%��p%m��&]�caSl=�X�����\P�1�Mh�9�M��V�dDA��aV�B��[݈fJ�íP|8�քA�V^��f
�H��n���-��"�d>�z��n��NJ�	�ة�>�b���&����2��v����Kyϼ��D:����,AGm��\nz��i�Ù��.uχYC�6�OMf��3o�r��$��5�����NH�T[XF64�T,ќ���M0�E)`#�5�XY�`�פ;��%�1�U�٥m;���R>QD����D�cp�U�'��&LE�/p���m���%]�����8fi��r�S4�d7y\�`�J�n���ί�I�R��3U�~7+���׸#��m�q�BiD���������i*�L6�9�m�Y&���i���HE��=(K&�N!V�.K�e�LD�ĕ�{D	����vEꦚde��NƟ��e�(�MN9ߜR�6����&3(��a���/D��U�z�<�{ˊ�Y��ȳ����V���)�9�Z[��4^n��5���!J��?��Q�3�eBo�C����M����m<�.�vp�����IY�f���Z�Y_p�[�=al-�Y�}Nc͙���ŋ4vfa��vl����'S��A�8�|�*u�{��-�ߟ0%M0�7%����<���ҍ���PK!
ѐ��'theme/theme/_rels/themeManager.xml.rels��M
�0���wooӺ�&݈Э���5
6?$Q��
�,.�a��i����c2�1h�:�q��m��@RN��;d�`��o7�g�K(M&$R(.1�r'J��ЊT���8��V�"��AȻ�H�u}��|�$�b{��P����8�g/]�QAsم(����#��L�[������PK-!����[Content_Types].xmlPK-!�֧�6+_rels/.relsPK-!ky���theme/theme/themeManager.xmlPK-!����P�theme/theme/theme1.xmlPK-!
ѐ��'�	theme/theme/_rels/themeManager.xml.relsPK]�
<?xml version="1.0" encoding="UTF-8" standalone="yes"?>
<a:clrMap xmlns:a="http://schemas.openxmlformats.org/drawingml/2006/main" bg1="lt1" tx1="dk1" bg2="lt2" tx2="dk2" accent1="accent1" accent2="accent2" accent3="accent3" accent4="accent4" accent5="accent5" accent6="accent6" hlink="hlink" folHlink="folHlink"/>j{�����	$$$'�]*1A�N
T[]�r�z̤����BEFHIJKLNPVW�
�4qyy����CDGMOX������������Cv x ";%=%�%E)G)�,�/�/�/O6S68C;E;q<�?�?-@]C`C�D�G�GI�M�M�NRR�R�U�U�V�YZ�Z{]~]�_`ccc�e�e�e]fefhf�f�f�fVgcgfg�g�gFi�i�i�i?jKjNj�j�j�j7kAk�kVlbl�mbninln�n�n�nXoaodo�o�o�oPpWp�phqpq�q�r�r;s�st�uv(v+v�v�v�v#w-wmw	xxzxy'y@y�y�y�y,z7zyz {/{B{j{X��Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q����Q��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X��X�̕� '!�!����8�@�����������0�(	�
��B
�S����	?���.	OLE_LINK5	OLE_LINK6_GoBack
OLE_LINK11
OLE_LINK10	OLE_LINK3	OLE_LINK4
OLE_LINK99OLE_LINK100OLE_LINK103OLE_LINK101OLE_LINK102
OLE_LINK85
OLE_LINK86
OLE_LINK89
OLE_LINK90
OLE_LINK88
OLE_LINK87
OLE_LINK91
OLE_LINK92
OLE_LINK14
OLE_LINK15
OLE_LINK16
OLE_LINK17
OLE_LINK18
OLE_LINK19
OLE_LINK20
OLE_LINK21
OLE_LINK24
OLE_LINK25
OLE_LINK28
OLE_LINK29
OLE_LINK30
OLE_LINK31
OLE_LINK32
OLE_LINK33
OLE_LINK34
OLE_LINK35
OLE_LINK36
OLE_LINK37
OLE_LINK40
OLE_LINK41
OLE_LINK42
OLE_LINK43
OLE_LINK44
OLE_LINK45������������^�^�c�c�g�gzhzhDkDk�l�l�l�l�m�mZpZp�q�q�r�r�t�t0w0wmwmw;z;zk{	

 !"#$%&'()*+,-vv��$$�������\\�_�_�c�c*h*h�h�h�k�k�l�l&m&m�m�m�p�p�q�q9s9suukwkwxxwzwzk{".:z�AK���	$*KU������m{��%\f��=KT`��cgpy{�����$2����*8��^g����!/��<H����cm�����hv����L\v�������#!1!A%J%e%o%)�)�)�)�)�)H*V*w*x*�*�*�/�/�6�6�6�677};�;�;�;�;�;�;<<< <'<�?�?@*@�C�C�D�D�D�DH,H�H�H�H�H�MN&N4NoR}R�R�R�Z�Z�]�]I^S^k^n^�^�^�^�^z_�_gcuc�c�c�c�cHdVdndzd�d�d�e�e�e�e�e�ehh\hehjhxh�h�h�h�h�h�hi"i#i'iDkRk�l�l�l�l�l�l'm,m1m:mRmZm^mcmqmwm�m�m�m�m�m�m�m�m�m�m�q�q�q�q�r�r�r�r�rs1s9st't+t2t7t;t@tNtitwtxt�t�t�t�t�t�t�tuu~u�u4x<x@xGxRxbxfxpx[zazD{F{G{I{J{L{M{O{P{h{k{����|+~+�e�e�e�e�g+h,hMhjhxhiBi�k�k'm;m<mNm�m�m�m�msq�q�r�r(s9s	ttOtTt�t�t�t�tu3u�u�u�u�u*y;y>y@y2{B{D{F{G{I{J{L{M{O{P{h{k{333333333333333333333333333���������ZZ����������BCy z "">%@%q%q%�%�%H)I)F*F*~**�*�*�,�,�/�/�/�/�/�/�/�/T6U6�6�6,71788F;H;o<q<�?�?+@-@aCcC�D�D�G�G
II�M�M�N�NRR�R�R�U�U�V�VZZZZNZRZ�Z�Z]�]�_�_dcec'd'dveve�e�eB{B{C{D{D{F{G{G{I{J{L{M{O{P{h{k{)��F?�8"Z\q)%�:	�O�W)�;�F?�{��O�$�8"�Wg#�O�$@�Lq)%:1�o�7')�3Y<+�7'OvAAC�^@�L:	�OZ\':�S@�LvD�W34�qR.f^AC�^�{��J�ds�hs�h':�S�G�h��ZnOvAa�n3Y<+:1�og#34�q;\��Zn-�,��"�^�d�eu2"@E#Fm-5d@)]E�KWN�X\[I`�%a�	l)mnrdxZ}�BHj�T�%=�5p���n$�"5�T�](��
�'��P��]�
`��T�S7�Ah�T9�/��i��4�&�}��|�D{F{��EN.Libraries QG<ENLibraries><Libraries><item>amir.enl</item></Libraries></ENLibraries>�@�ecec�3ececd*,<=WY�vj{x@x2xl@xFx�@xbx�@x���Unknown������������G��*�Ax�	�Times New Roman5��Symbol3.��*�Cx�	�Arial7.���@	�CalibriA���$B�Cambria Math"q���h��G�s%g
�e�h>�e�h>�!�������24d{{3�Q���HX	�?����������������������}�2!xx���_Amphetamine-induced rhabdomyolysis and severe hyperkalemia: a case report and literature reviewAmirhosseinCE����Oh��+'��0����$8	DP
p|
������`Amphetamine-induced rhabdomyolysis and severe hyperkalemia: a case report and literature reviewAmirhosseinNormal.dotmCE13Microsoft Office Word@8M%@I���@�8JZo�e�h����՜.��+,��D��՜.��+,���Hhp|�������
�(��>{`Amphetamine-induced rhabdomyolysis and severe hyperkalemia: a case report and literature reviewTitle8 8@_PID_HLINKS�A��1-�hhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Ecstasy+overdose%3A+rapid+cooling+leadse+to+successful+outcomeV
1M�chttp://www.ncbi.nlm.nih.gov/pubmed?term=Dorfman%20MA%5BAuthor%5D&cauthor=true&cauthor_uid=15258886V
R%}ahttp://www.ncbi.nlm.nih.gov/pubmed?term=Bordo%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=15258886V
Szihttp://www.ncbi.nlm.nih.gov/pubmed/?term=Our+experiences+with+fatal+ecstasy+abuse+%28two+case+reports%29V
Swihttp://www.ncbi.nlm.nih.gov/pubmed/?term=Our+experiences+with+fatal+ecstasy+abuse+%28two+case+reports%29V
.tbhttp://www.ncbi.nlm.nih.gov/pubmed?term=Balazic%20J%5BAuthor%5D&cauthor=true&cauthor_uid=15694737V
(^qjhttp://www.ncbi.nlm.nih.gov/pubmed?term=Alibegovi%C4%87%20A%5BAuthor%5D&cauthor=true&cauthor_uid=15694737V
I"nehttp://www.ncbi.nlm.nih.gov/pubmed?term=Karlovsek%20MZ%5BAuthor%5D&cauthor=true&cauthor_uid=15694737V
k�http://www.ncbi.nlm.nih.gov/pubmed/?term=Ecstasy-associated+acute+severe+hyponatremia+and+cerebral+edema%3A+a+role+for+osmotic++diuresisV
PDhyhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Mechanism-based+therapeutic+approaches+to+rhabdomyolysis-induced+renal+failure.V
Ye�http://www.ncbi.nlm.nih.gov/pubmed/?term=A+fatal+case+of+myocardial+damage+due+to+misuse+of+the+%E2%80%98%E2%80%98designer+drug%E2%80%9D+MDMAV
ob_http://www.ncbi.nlm.nih.gov/pubmed?term=Itoh%20H%5BAuthor%5D&cauthor=true&cauthor_uid=19828353V
u_chttp://www.ncbi.nlm.nih.gov/pubmed?term=Kominato%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=19828353V
d\ahttp://www.ncbi.nlm.nih.gov/pubmed?term=Nakano%20M%5BAuthor%5D&cauthor=true&cauthor_uid=19828353V
3Ybhttp://www.ncbi.nlm.nih.gov/pubmed?term=Hasuike%20T%5BAuthor%5D&cauthor=true&cauthor_uid=19828353V
tV_http://www.ncbi.nlm.nih.gov/pubmed?term=Sano%20R%5BAuthor%5D&cauthor=true&cauthor_uid=19828353V
RSrhttp://www.ncbi.nlm.nih.gov/pubmed/?term=Rhabdomyolysis+in+MDMA+intoxication%3A+a+rapid+and+underestimated+killerV
gCPbhttp://www.ncbi.nlm.nih.gov/pubmed?term=Norris%20EM%5BAuthor%5D&cauthor=true&cauthor_uid=19500935V
4M`http://www.ncbi.nlm.nih.gov/pubmed?term=Touw%20DJ%5BAuthor%5D&cauthor=true&cauthor_uid=19500935V
;Jdhttp://www.ncbi.nlm.nih.gov/pubmed?term=Montenij%20LJ%5BAuthor%5D&cauthor=true&cauthor_uid=19500935V
X7Ghhttp://www.ncbi.nlm.nih.gov/pubmed?term=Vanden%20Eede%20H%5BAuthor%5D&cauthor=true&cauthor_uid=19500935V
2^Dchttp://www.ncbi.nlm.nih.gov/pubmed?term=Agarwal%20AK%5BAuthor%5D&cauthor=true&cauthor_uid=20505902V
cAehttp://www.ncbi.nlm.nih.gov/pubmed?term=Chatterjee%20S%5BAuthor%5D&cauthor=true&cauthor_uid=20505902V
K?>ahttp://www.ncbi.nlm.nih.gov/pubmed?term=Singh%20VP%5BAuthor%5D&cauthor=true&cauthor_uid=20505902V
Wk;`http://www.ncbi.nlm.nih.gov/pubmed?term=Gupta%20P%5BAuthor%5D&cauthor=true&cauthor_uid=20505902V
;	mailto:dr_p_n@yahoo.comV
	

 !"#$%&'()*+,-./0123456789:;<=>?@ABCDEFGHIJKLMNOPQRSTUVWXY����[\]^_`a����cdefghijklmnopqrstuvwxyz{����}~������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������Root Entry��������	�F���hZo���Data
������������Z1Table����b=3WordDocument����D�SummaryInformation(������������|DocumentSummaryInformation8����������CompObj������������y������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������������
����	�F'Microsoft Office Word 97-2003 Document
MSWordDocWord.Document.8�9�q

Youez - 2016 - github.com/yon3zu
LinuXploit