Edin Kabil

RESEARCH, TEACHING, or OTHER INTERESTS

Anesthesiology and Pain Medicine, Critical Care and Intensive Care Medicine, Cardiology and Cardiovascular Medicine

Scopus Publications

Justification of Screening for Peripheral Arterial Disease in the Elderly Population Through Clinical and Financial Cost-benefit Analysis
Muhamed Djedovic, Bedrudin Banjanovic, Amel Hadzimehmedagic, Ilirijana Karabdic, Tarik Selimovic, Damir Kurtagic, Edin Kabil, and Slavenka Straus
ScopeMed
Background: Peripheral arterial disease (PAD) is a chronic condition of reduced blood flow through the arteries. Early detection and prevention of PAD, especially in at-risk populations, is crucial to reducing morbidity and mortality. Objective: The aim of the study was to examine the clinical feasibility of vascular ultrasound screening for early detection of PAD, as well as potential financial savings through preventive measures. Methods: The study was conducted as a prospectively designed cross-sectional study with retrospective sample analysis, in which the sample consisted of 826 patients over 60 years of age, of both sexes, divided into two groups, conducted from January 2023 to May 2024. Results: The study included 826 patients aged 60 and over, divided into two groups after ultrasound examination of the arteries (Group A with atherosclerosis /63.8%/; Group B - without atherosclerosis /36.2%/). The average age was 65.44±5.9 years, 60-65 years was 64.3%, and over 65 years was 35.7%. A statistically significant difference was recorded between the analyzed groups in terms of comorbidities and risk factors. We found that age, gender, hypertension, hyperlipidemia, diabetes, smoking and chronic obstructive disease have a significant relationship with the degree of atherosclerosis. Multivariate analysis showed that the age of the subjects, hyperlipidemia, hypertension and smoking are significant predictors of atherosclerosis. The prevalence for hemodynamically significant stenosis of ACI/ACC was 5.0%, for peripheral arteries 4.2%, the prevalence of aneurysm abdominal aorta (>3 cm) was 2.3%, and 0.5% for diameter >5 cm. Conclusion: The results show the high efficiency of ultrasound diagnostics in identifying asymptomatic patients with advanced atherosclerosis, emphasizing the need for better organization of preventive programs, which could lead to potential savings in healthcare costs through earlier detection and treatment.


Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates: insights from a single-centre, single-surgeon study conducted in Bosnia and Herzegovina
Nermir Granov, Amel Hadžimehmedagić, Armin Šljivo, Tarik Selimović, Damir Kurtagić, Edin Kabil, Muhamed Djedović, and Arian Abdulkhaliq
Medical Association of Zenica-Doboj
<p><strong>Aim<br /></strong> To analyse the correlation between different surgical methodologies employed in valve diseases treatment and their subsequent impact on the duration of hospitalization. <br /><strong>Methods<br /></strong> This retrospective study conducted at the Clinical Centre of the University of Sarajevo analysed medical records of 163 valve disease patients treated between January 2019 and November 2022. The patients were divided into two groups: 77 had openheart valve surgery and 86 underwent minimally invasive cardiac surgery (MICS). <br /><strong>Results<br /></strong> The mean duration of the surgical procedures was 3.9±1.3 hours, with conventional open-heart surgery requiring an average of 3.6±1.1 hours and minimally invasive cardiac surgery (MICS) procedure 4.2±1.5 hours. No substantial disparities were found in the total length of hospitalization between the two groups, as both conventional (8.2±4.5 days) and MICS (8.7±7.0 days) demonstrated similar duration. Similarly, the total duration of intensive care unit (ICU) stay displayed similarity, with conventional surgery patients staying an average of 3.9±2.8 days and MICS patients of 4.2±4.1 days. The pattern of blood transfusion and fresh-frozen plasma usage revealed higher rates in the conventional valve surgery group comparing to the MICS group. <br /><strong>Conclusion<br /></strong> Minimally invasive valve surgery, despite slightly longer operative times, resulted in lower blood transfusion requirements and comparable hospitalization and ICU stay.</p>


Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience
Nermir Granov, Armin Šljivo, Ermina Mujičić, Damir Rebić, Alen Džubur, Edin Begić, Tarik Selimović, Zlatan Zvizdić, Almir Fajkić, Asmir Jonuzi,et al.
Medical Association of Zenica-Doboj
<p><strong>Aim <br /></strong>This is the first research in Bosnia and Herzegovina presenting minimally invasive coronary artery bypass grafting surgery<br />(MICS CABG) experience, advantages, and outcomes as compared to conventional surgery (OPEN CABG).<br /><strong>Methods</strong> <br />This retrospective cross-sectional study was conducted between January 2019 and November 2022 and included patients<br />with indication for surgical revascularization.<br /><strong>Results</strong> <br />Among 237 patients, males predominated, 182 (76.7%), with a mean body mass index (BMI) of 28.4±3.9, median The Society of Thoracic Surgery Risk (STS) score of 1.55 (0.8, 4.0), short term STS score of 11.2 (6.8, 23.7), mean age of 64.8±8.7 (ranging 41-83) years, 122 (51.4%) underwent OPEN CABG and 115 (48.6%) MICS CABG. MICS CABG took less time (p<0.001; OPEN 3.5±0.8h; MICS 2.8±0.8h) and needed less mechanical ventilation (p<0.001, OPEN 17.3±11.9h; MICS 13.0±12.5h) than OPEN CABG. Even though there was no difference in hospitalization length between groups (OPEN (7.5±3.2), MICS (7.1±4.0)), patients receiving MICS (2.9±1.5) spent less time in the ICU (p=0.0013) than OPEN CABG (3.6±2.8). OPEN CABG used also more blood derivatives, red blood cells (OPEN 292 vs MICS 55), plasma (OPEN 270 vs MICS 86) and platelets (OPEN 71 vs MICS 28).<br /><strong>Conclusion</strong> <br />Patients undergoing MICS CABG in Bosnia and Herzegovina had less mechanical ventilation hours and less ICU duration compared to OPEN CABG even though the hospitalization duration was very similar. MICS CABG takes less time to be conducted, has fewer CPRs postoperatively, uses less blood derivatives including red blood cells, plasma and platelets.</p>


Minimally invasive mini-thoracotomy access as a surgical method in state-of-the-art treatment of single-vessel coronary heart disease
Edin Kabil, Nermir Granov, Ilirijana Haxibeqiri-Karabdić, Sanja Grabovica, Ermina Mujičić, Slavenka Štraus, Bedrudin Banjanović, and Muhamed Djedović
Medical Association of Zenica-Doboj
<p><strong>Aim <br /></strong>To compare outcomes of two different surgical techniques of coronary artery bypass grafting (CABG) for treating isolated left anterior descending (LAD) coronary artery disease by full median sternotomy technique vs. minimally invasive approach via left anterior mini-thoracotomy.<br /><strong>Methods</strong> <br />This retrospective, observational study, which included 61 elective patients, was conducted at the Clinic for Cardiovascular Surgery of the Clinical Centre of the University of Sarajevo in the period from June 2019 to January 2022. Patients were divided in two groups according to the operative technique used, the sternotomy CABG group of 30 patients where the access considered full median sternotomy, and the minimally invasive CABG group where left anterior mini-thoracotomy was performed. The groups were compared by previously defined primary and secondary clinical postoperative outcomes.<br /><strong>Results</strong> <br />Out of 61 patients, the majority was males, 50 (82%). The analysis of the outcomes of the minimally invasive CABG surgery showed significantly shorter operative times (p=0.001), less postoperative drainage (p=0.001) and transfusion requirements, shorter mechanical ventilation duration (p=0.0001), low major adverse cardiac and cerebrovascular events rates, as well as shorter Intensive Care Unit stay days with mean of 3.3±1.442 days (p=0.025), but no total hospital stay days with mean of 6.7±1.832 days (p=0.075) compared to sternotomy CABG group.<br /><strong>Conclusion</strong> <br />Minimally invasive approach for CABG surgery in treating isolated single vessel LAD disease, together with the fasttrack protocol, offers a reasonable alternative to full median sternotomy, leading to faster patients’ overall recovery and improving the quality of life. </p>


Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes
Ilirijana Karabdic, Slavenka Strauss, Nermir Granov, Amel Hadzimehmedagic, Edin Kabil, Muhamed Djedovi, Damir Kurtagic, and Behija Berberovic
ScopeMed
Background: Coronary artery disease (CAD) is a major public health issue and a leading cause of death globally. It is one of the most common indications for surgical intervention. There are a lot of different techniques, including CABG, which consists of two approaches: sternotomy and mini-thoracotomy. Different techniques have been developed to improve surgical outcomes, including the use of machine for extracorporal circulation (on-pump) or without it (off-pump). Objective: The objective of this study was to assess whether off-pump CABG offers superior short-term outcomes compared to traditional on-pump CABG in patients undergoing isolated CABG.. Methods: In period between 2022 – 2023, we performed CABG operation in 80 patients. CABG was performed either on- pump or off-pump. Results: The results have shown advantages and disadvantages of one or another type of CABG. We were comparing the duration of surgical procedure, time on mechanical ventilation, drainage volume, neurological incidents, time to discharge, indication for repeat revascularization and mortality between two groups. Conclusion: The choice of surgical technique should be based on individual patient factors, including comorbidities and surgical risks. It is important to say that OPCABG is more challenging than ONCABG, and it is very important that OPCABG is done by skilled, experienced and confident surgeon, which contributes to better outcome and survival.


How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?
Slavenka Straus, Ilirijana Karabdic, Sanja Grabovica, Amel Hadzimehmedagic, Muhamed Djedovic, Edin Kabil, Tarik Selimovic, and Nermir Granov
ScopeMed
Background: Cardiosurgical patients can be often anemic, and preoperative anaemia is associated with increased postoperative complications, as well as morbidity and mortality. Objective: The present study was conducted aiming to determine the influence of lower preoperative hematocrit values on the early postoperative recovery of patients undergoing elective off-pump coronary artery bypass grafting (OPCABG). Methods: Our retrospective study included 150 patients who underwent elective OPCABG surgery from September 2021 to December 2022 at the Clinic for Cardiovascular Surgery University of Sarajevo. Patients were divided into two groups, anemic and non-anemic, with anemia defined as hemoglobin level <130g/l males and <120g/l females. Study observed comorbidities and early postoperative data. Results: Overall prevalence of anemia in OPCABG patients was 36,6%, more frequent among older patients. Comorbidities as chronic obstructive pulmonary disease, hypertension, ejection fraction was quite similar in both groups, but body mass index was significantly higher in the group of patients with anemia (29.9% vs 28.4%). In early recovery period, vasopressors were more used in patients with anemia (63.6% vs 42.1%) and their doses were higher. Total drainage was higher in patients with anemia (744.45±45.72 ml vs 681.58±349.06 ml). Number of transfusions was higher in the group of patients with anemia: red blood cells (0.89±1.29 vs 0.29±0.84; p<0,05), fresh frozen plasma (0.65±1.13 vs 0.41±1.15; p<0,05) and platelets (0.11±0.57 vs 0,07±0.42; p>0,05). Duration of mechanical ventilation was longer in patients with anemia compared to non-anemic patients (623-91±259.83 minutes vs 469±191.13 minutes). Atrial fibrillation occurred more often in patients with anemia (12.7 vs 7.4%). Length of stay in the intensive care unit was without significant difference. Conclusion: Based on our findings, patients who underwent elective OPCABG with lower than normal hematocrit, needed more blood and blood products, more vasopressor drugs in higher doses, longer mechanical ventilation, all which can prolong the patient’s recovery and increase the cost of treatment.


Non Invasive Detection of Coronary Sinus Flow Changes over Time after CABG
Bedrudin Banjanovic, Ilirijana Karabic, Slavenka Straus, Nermir Granov, Edin Kabil, Malik Jakirlic, Ilijaz Pilav, and Muhamed Djedovic
ScopeMed
Background: Coronary New blood in the vascular bed after Coronary Artery Bypass Grafting (CABG) may represent a turning point between ischemia and normal tissue nutrition. Its quantification can help to better understand coronary artery hemodynamics after revascularization. Objective: Quantification of coronary sinus blood flow changes over time after Coronary Artery Bypass Grafting (CABG) using Transthoracic Echocardiography (TTE). Methods: Prospective basic research, with repeated measurements on hospital sample of 61 patients whom CABG was conducted. We performed TTE recordings to measure CS flow before and two times after CABG (1 and 6 postoperative day). We measure CS diameter, Velocity Time Integral (VTI) and systemic hemodynamic data. Data needed for LV mass calculation were recorded once. During statistical analysis we define: α = 0,01, β = 0,01 (power = 1- β β= 0,99), Sample size = 60, Effect size= 0,68. We used ANOVA for Repeated Measures as main statistical test in SPSS. Results: Preoperatively we found low overall CS flow of 181 ±72 ml/min (0,68 ±0,30 ml/gram-LV/min). After surgery there was constant increase of CS flow from 276 ±79 ml/min (1,13 ±0,35 ml/gram-LV/min) first postoperative day, to 355 (±99) ml/min (1,30 ±0,46 ml/gram-LV/min) sixth postoperative day. Discussion: Amount of new blood was statistically significant after CABG with P&lt;0,001. Same result was found after classifying patients per number of graft received, with the highest amount of new blood after four bypasses. Amount of new blood was not different if patient gets two or three bypasses. Conclusion: There was significantly new amount of blood in coronary bed after CABG, with constant increase over first 6 days.


Left Ventricular Free Wall Rupture after Acute Myocardial Reinfarction Due to In-Stent Thrombosis in COVID-19 Patient
Alen Karic, Ilirijana Karabdic, Edin Kabil, Sanja Grabovica, Slavenka Straus, Ervin Busevac, Alma Krajinovic, Bedrudin Banjanovic, Muhamed Djedovic, and Nermir Granov
ScopeMed
Background: Acute left ventricular free wall rupture (LVFWR) is a life-threatening complication of myocardial infarction that requires urgent intervention. Surgical repair has continued to be the treatment of choice. Studies suggest a posterolateral or inferior infarction is more likely to result in free wall rupture than an anterior infarction. LVFWR generally results in death within minutes of the onset of recurrent chest pain, and on average was associated with a median survival time of 8 hours. Prompt diagnosis and management can lead to successful treatment for LVFWR. Objective: The aim of this article was to present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Case report: We present an emergency case with an LVFWR in a COVID-19 patient who suffers from AMI and was treated with PCI stents in the ramus intermedius and circumflex coronary artery. Although dual antiplatelet therapy introduction and good outcome of PCI were achieved, soon after instant thrombosis of both stents appear to result in transmural necrosis and LVFWR. Urgent catheterization was performed and diagnosed in-stent thrombosis where the ventriculography confirmed LVFWR of the posteroinferior wall. Urgent surgery was performed. Transmural necrosis was noticed alongside the incision line. The incision is sawn with 4 U-stitches (Prolen 2.0 with Teflon buttressed stitches). Another layer of fixation was made by Prolen 2.0 running stitches reinforced with Teflon felts from both sides. A large PTFE patch was fixed to epicardium over the suture line by Prolen 6.0 running stitch and BioGlue was injected in-between patch and LV (Figures 8 and 9). After aortic cross-clamp removal, the sinus rhythm was restored. Conclusion: Despite the high mortality, the urgency and the complexity of surgical treatment the early diagnosis plays a key role in the management of postinfarction LVFWR patients presenting a case of preserved postoperative left ventricular function and accomplished good functional status, as presented in our case.


Surgical coronary revascularization on-pump versus off-pump in patients with stenosis of the main tree of the left coronary artery and carotid stenosis
Emir Kabil
Academy of Sciences and Arts of Bosnia and Herzegovina
OBJECTIVE The aim of this study was to show perioperative complications of CABG procedure with and without cardiopulmonary bypass (CPB) in patients with combined coronary and carotid disease. PATIENTS AND METHODS This retrospective survey included patients with left main stenosis greater than 50% and carotid stenosis over 50%, who had undergone CABG without carotid endarterectomy at the BH Heart Centre, from May 2009 to May 2014. The patients were divided into two groups according to the surgical method used. Group A consisted of 50 patients who underwent surgery without CPB and the second group of 50 patients with CPB, conformed according to gender, ejection fraction values, EuroSCORE and the number of bypass grafts performed. RESULTS Analysis of the basic results indicates significant differences between the groups in the time spent on a respirator or time in the ICU, the amount of postoperative bleeding or compensated blood, as well as subsequent complications. The overall incidence of neurological complications showed a difference in the observed groups. CONCLUSION With ever easier technical performance, complete planned revascularization and the quality of performed grafts, the conditions have been created for a comparative analysis. According to the results we can say that CABG without CPB has a number of advantages over the other method, in patients with the combined disease.

RECENT SCHOLAR PUBLICATIONS

Perioperative Ultrasound Flow Evaluation in Grafts and Native Vessel during CABG
B Banjanović, E Kabil, N Kadrić, E Mujanović, M Dilić, M Kulić, S Djedović, ...
IntechOpen 2024



Comparison between conventional open-heart valve surgery and minimally invasive valve replacement surgery regarding the length of hospital stay and usage of blood derivates
N Granov, A Hadžimehmedagić, A Šljivo, T Selimović, D Kurtagić, E Kabil, ...
Medicinski Glasnik 21 (1) 2024



Mean arterial pressure as predictor of outcome in patients with ruptured abdominal aortic aneurysm.
A Hadžimehmedagić, T Selimović, D Kurtagić, I Haxibeqiri-Karabdić, ...
Medical Journal/Medicinski Žurnal 29 (4) 2023



Comparison of the early recovery of patients in the intensive care unit after the coronary artery bypass surgery using the conventional on-pump method compared to the off-pump
S Štraus, A Hadžimehmedagić, I Haxhibeqiri-Karabdić, E Kabil, N Granov, ...
Medical Journal/Medicinski Žurnal 29 (4) 2023



Acute kidney injury after open surgical treatment of ruptured aortic aneurysm.
A Hadžimehmedagić, M Djedović, E Kabil, B Banjanović, ...
Medical Journal/Medicinski Žurnal 29 (2) 2023



Minimally invasive mini-thoracotomy access as a surgical method in state-of-the-art treatment of single-vessel coronary heart disease.
E Kabil, N Granov, I Haxibeqiri-Karabdić, S Grabovica, E Mujii, ...
Medicinski Glasnik 20 (1) 2023



Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes
BB I. Karabdic, Slavenka Strauss, Nermir Granov, Amel Hadzimehmedagic, Edin ...
Acta Informatica Medica 2023



How Important Impact of Low Level of Hematocrit Can Be on Outcome in Patients Undergoing Off Pump Coronary Artery Bypass Surgery?
NG S. Štraus, I. Karabdic, S. Grabovica, Amel Hadzimehmedagic, Muhamed ...
Acta Informatica Medica 2023



Minimally invasive coronary artery bypass (MICS CABG) in Bosnia and Herzegovina: a single centre, single surgeon cohort experience
N Granov, A Šljivo, E Mujičić, D Rebić, A Džubur, E Begić, T Selimović, ...
Med Glas (Zenica) 20 (2), 122-127 2023



Non invasive detection of coronary sinus flow changes over time after CABG
B Banjanovic, IH Karabic, S Straus, N Granov, E Kabil, M Jakirlic, I Pilav, ...
Acta Informatica Medica 30 (3), 220 2022



The Effect of Severe Contralateral Carotid Stenosis or Occlusion on Early Outcomes after Carotid Endarterectomy
M Djedovic, A Hadzimehmedagic, N Granov, I Haxhibeqiri-Karabdic, ...
Open Access Macedonian Journal of Medical Sciences 10 (B), 1642-1647 2022



Our experiences in the treatment of anterior chest wall infections (2015-2021)
B Banjanovic, IH Karabic, S Straus, N Granov, E Kabil, M Jakirlic, I Pilav, ...
Materia Socio-medica 34 (2), 142 2022



Left ventricular free wall rupture after acute myocardial reinfarction due to in-stent thrombosis in COVID-19 patient
A Karic, I Haxhibeqiri-Karabdic, E Kabil, S Grabovica, S Straus, ...
Acta Informatica Medica 30 (1), 76 2022



THE ROLE OF TRANSESOPHAGEAL ECHOCARDIOGRAPHY IN MINIMALLY INVASIVE CARDIAC SURGERY
Z Lazovic, BH Berberovic, LD Mustafie, B Banjanovic, E Kabil, M Djedovic, ...
Acta Medica Saliniana 52, 67-67 2022



THE ROLE OF ECHOCARDIOGRAPHY IN CHRONIC HEART FAILURE PATIENTS
Z Lazovic, BH Berberovic, LD Mustafic, IH Karabdic, B Banjanovic, E Kabil, ...
Acta Medica Saliniana 52, 66-66 2022



MINIMALLY INVASIVE CARDIAC SURGERY IN CLINICAL CENTRE UNIVERSITY OF SARAJEVO DURING COVID-19 PANDEMIC
N Granov, IH Karabdic, B Banjanovic, A Karic, H Vila, E Kabil, M Djedovic, ...
Acta Medica Saliniana 52, 64-64 2022



How does preoperative anemia impact on the outcome of on-pump coronary artery bypass surgery patients?
S Grabovica, S Straus, E Mujicic, N Granov, E Kabil
ANESTHESIA AND ANALGESIA 133 (3 S_ SUPPL), 308-308 2021



LEVOSIMENDAN IN PREOPERATIVE PRECONDITIONING PATIENT WITH SEVERE AORTIC STENOSIS AND LEFT VENTRICULAR DYSFUNCTION
LD Mustafići, B Berberovići, Z Lazovići, N Granovi, E Kabili, B Banjanovići, ...
Acta Medica Saliniana 51, 26-27 2021



ABDOMINAL AORTIC ANEURYSM SURGERY AND HORSESHOE KIDNEY
M Djedovic, A Hadzimehmedagic, N Rustempasic, N Granov, E Kabil, ...
Acta Medica Saliniana 51, 29-30 2021



FAST TRACK PROTOCOL FOR MINIMAL INVASIVE REDO CARDIAC ARTERY BYPASS REVASCULARIZATION
N Granov, E Mujičić, S Štraus, S Grabovica, M Djedović, L Divović, ...
Acta Medica Saliniana 51, 29-29 2021

MOST CITED SCHOLAR PUBLICATIONS

Our experiences in the treatment of anterior chest wall infections (2015-2021)
B Banjanovic, IH Karabic, S Straus, N Granov, E Kabil, M Jakirlic, I Pilav, ...
Materia Socio-medica 34 (2), 142 2022
Citations: 7



Surgical coronary revascularization on-pump versus off-pump in patients with stenosis of the main tree of the left coronary artery and carotid stenosis.
E Kabil, B Banjanović, E Mujanović
2017
Citations: 6



Left ventricular free wall rupture after acute myocardial reinfarction due to in-stent thrombosis in COVID-19 patient
A Karic, I Haxhibeqiri-Karabdic, E Kabil, S Grabovica, S Straus, ...
Acta Informatica Medica 30 (1), 76 2022
Citations: 4



Off pump Versus On pump Coronary Artery Bypass Grafting: Short-term Outcomes
BB I. Karabdic, Slavenka Strauss, Nermir Granov, Amel Hadzimehmedagic, Edin ...
Acta Informatica Medica 2023
Citations: 3



Minimally invasive mini-thoracotomy access as a surgical method in state-of-the-art treatment of single-vessel coronary heart disease.
E Kabil, N Granov, I Haxibeqiri-Karabdić, S Grabovica, E Mujii, ...
Medicinski Glasnik 20 (1) 2023
Citations: 2



Non invasive detection of coronary sinus flow changes over time after CABG
B Banjanovic, IH Karabic, S Straus, N Granov, E Kabil, M Jakirlic, I Pilav, ...
Acta Informatica Medica 30 (3), 220 2022
Citations: 2



The acute respiratory distress syndrome after major cardiac surgery-Case report
K Edin, M Ermina, Š Slavenka, G Nermir, B Banjanović, G Sanja
Cardiothorac Vasc Sci 1 (1), 1-3 2017
Citations: 1



AORTA NO-TOUCH TECHNIQUE FOR THIRD TIME CORONARY ARTERY BYPASS GRAFTING (RE-RE-CABG)
E Mujanović, J Bergsland, B Banjanović, E Kabil, ...

Citations: 1