{"id":8224,"date":"2023-03-16T19:12:15","date_gmt":"2023-03-16T16:12:15","guid":{"rendered":"https:\/\/gfmg.ua\/new\/?p=8224"},"modified":"2023-03-23T15:49:54","modified_gmt":"2023-03-23T12:49:54","slug":"purpura-vid-nagruzok","status":"publish","type":"post","link":"https:\/\/gfmg.ua\/en\/purpura-vid-nagruzok\/","title":{"rendered":"Purple after physical exertion in children"},"content":{"rendered":"\t\t<div data-elementor-type=\"wp-post\" data-elementor-id=\"8224\" class=\"elementor elementor-8224\" data-elementor-post-type=\"post\">\n\t\t\t\t\t\t<section class=\"elementor-section elementor-top-section elementor-element elementor-element-85079ed elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"85079ed\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column 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elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"08fe369\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-917d9ce\" data-id=\"917d9ce\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-ea4c6ae elementor-widget__width-auto elementor-widget elementor-widget-heading\" data-id=\"ea4c6ae\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">ARTICLE<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-0c47830 elementor-widget elementor-widget-theme-post-title elementor-page-title elementor-widget-heading\" data-id=\"0c47830\" data-element_type=\"widget\" data-widget_type=\"theme-post-title.default\">\n\t\t\t\t\t<h1 class=\"elementor-heading-title elementor-size-default\"><a href=\"\">Purple after physical exertion in children<\/a><\/h1>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-1e983ac elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"1e983ac\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-be64195\" data-id=\"be64195\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-69e9498 elementor-widget elementor-widget-heading\" data-id=\"69e9498\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Exercise-induced purpura, which has also been called \u201cgolfer\u2019s purpura,\u201d is a phenomenon that has been rarely reported in the pediatric literature. This is the first case series in which this benign vasculopathy, which is most often associated with warm weather and high-impact activity, is described. In this series, we describe 5 patients, most of whom had an erythematous purpuric rash above the sock line that extended to the knees and was associated with warm weather and prolonged activity. Exercise-induced purpura may be mistaken for Henoch-Sch\u00f6nlein purpura or as a manifestation of a possible systemic vasculitis. Recognition of this benign condition is vital to avoid an unnecessary workup and a costly evaluation with accompanying anxiety.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-31e5475 elementor-widget elementor-widget-heading\" data-id=\"31e5475\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Abbreviations:\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-3cecd9b elementor-widget elementor-widget-html\" data-id=\"3cecd9b\" data-element_type=\"widget\" data-widget_type=\"html.default\">\n\t\t\t\t\t<div>\n    <ul class=\"circle_mark-list list\">\n        <li>EIP \u2014 exercise-induced purpura<\/li>\n        <li>LCV \u2014 leukocytoclastic vasculitis<\/li>\n    <\/ul>\n<\/div>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-62fe582 elementor-widget elementor-widget-heading\" data-id=\"62fe582\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Exercise-induced purpura (EIP), which has also been called \u201cgolfer\u2019s purpura,\u201d has been described in the adult literature but rarely in the pediatric population. EIP typically appears as a petechial rash and occurs in warm weather after prolonged, weight-bearing activity. It is predominantly localized symmetrically to the lower extremities and typically appears above areas of compression, such as socks. To date, there has only been 1 case of this benign vasculopathy reported, which presented atypically. In this case series, we describe 5 patients with EIP who presented between the ages of 8 and 15 years.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1076856 elementor-widget elementor-widget-heading\" data-id=\"1076856\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case Descriptions\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b2fcf39 elementor-widget elementor-widget-heading\" data-id=\"b2fcf39\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case 1\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-9f88a3c elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"9f88a3c\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-586f015\" data-id=\"586f015\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-2e0dffd elementor-widget elementor-widget-heading\" data-id=\"2e0dffd\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patient 1 was a white boy who presented at the age of 8 years with an episodic petechial rash extending from his ankles to the knees that occurred twice per month for 3 months and lasted for 2 to 3 days at a time. A diagnostic workup revealed a normal complete blood count and erythrocyte sedimentation rate and normal C-reactive protein, creatinine, and urine protein and\/or creatinine levels. He was initially diagnosed with suspected Henoch-Sch\u00f6nlein purpura by the pediatric rheumatologist.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-8dd5f9e elementor-widget elementor-widget-heading\" data-id=\"8dd5f9e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Over the next 2 years, he had recurrent episodes of the rash preceded by sun exposure and high-impact activity. Further laboratory investigations were performed, with normal results (see Table 1). On the basis of the history and negative diagnostic workup, he was diagnosed with EIP. No therapy was initiated.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t<div class=\"elementor-column elementor-col-50 elementor-inner-column elementor-element elementor-element-1f29152\" data-id=\"1f29152\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31368b1 elementor-widget elementor-widget-image\" data-id=\"31368b1\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img fetchpriority=\"high\" decoding=\"async\" width=\"560\" height=\"340\" src=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok.jpg\" class=\"attachment-large size-large wp-image-8214\" alt=\"\" srcset=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok.jpg 560w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok-64x39.jpg 64w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok-300x182.jpg 300w\" sizes=\"(max-width: 560px) 100vw, 560px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-348a0fc elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"348a0fc\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-d2fe29a\" data-id=\"d2fe29a\" data-element_type=\"column\">\n\t\t\t<div class=\"elementor-widget-wrap elementor-element-populated\">\n\t\t\t\t\t\t<div class=\"elementor-element elementor-element-31c5252 elementor-widget elementor-widget-heading\" data-id=\"31c5252\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case 2\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5baf111 elementor-widget elementor-widget-heading\" data-id=\"5baf111\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patient 2 was a Hispanic girl who presented at the age of 8 years with a petechial rash appearing above her sock line and extending to her upper shins. The rash only appeared during warm weather and after prolonged physical activity, including hiking and a 4-day field hockey camp. The rash typically lasted between 2 and 7 days. On the basis of the location of the rash and the history of it occurring in the heat with prolonged activity, a diagnosis of EIP was made. No further diagnostic workup was completed. Naproxen was prescribed but did not help to resolve the rash and was subsequently discontinued.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6954d53 elementor-widget elementor-widget-heading\" data-id=\"6954d53\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case 3\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-d21f7ca elementor-widget elementor-widget-heading\" data-id=\"d21f7ca\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patient 3 was an Asian American girl who presented at the age of 15 years with bilateral ankle and knee pain as well as a nonpruritic, nonpainful petechial rash localized to her bilateral shins. The rash was described to be recurrent during the summer, primarily with high-impact activity and particularly when she was dancing, up to 5 times per week. The rash lasted \u223c1 week per occurrence. Results of her laboratory evaluation were normal except for a urinalysis with trace hemoglobin, which resolved on repeat testing (see Table 1). On the basis of her history and a normal workup, the diagnosis of EIP was made. Topical triamcinolone was trialed for the rash but was discontinued on the basis of the patient reporting pruritis with use of the cream.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-4110607 elementor-widget elementor-widget-heading\" data-id=\"4110607\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case 4\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-a52b486 elementor-widget elementor-widget-heading\" data-id=\"a52b486\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patient 4 was a white girl who presented at the age of 12 years with an intermittent rash for 5 years. The rash appeared as nonpruritic, nonblanching, and nonpalpable erythematous petechiae that extended from her ankles up to her thighs and occasionally on her arms, with the most prominent lesions being just above the sock line. <\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-572e068 elementor-widget elementor-widget-heading\" data-id=\"572e068\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">The rash would last for 3 to 4 days, and the preceding trigger was high-impact activity, including participation in field hockey and lacrosse. The duration of the physical activities was directly related to the intensity of the color and the duration of the rash. <\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-b506119 elementor-widget elementor-widget-heading\" data-id=\"b506119\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Results of laboratory evaluations were normal (see Table 1). A skin biopsy was performed and revealed a perivascular neutrophilic infiltrate with nuclear debris, with hemorrhage and few erythrocyte extravasations most consistent with leukocytoclastic vasculitis (LCV). On the basis of the history of rash occurrence during sports in the warm weather and a normal diagnostic workup, a diagnosis of EIP was made. She was given colchicine as a treatment option, which did not lessen the frequency of episodes and was therefore discontinued.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-07e6fcc elementor-widget elementor-widget-image\" data-id=\"07e6fcc\" data-element_type=\"widget\" data-widget_type=\"image.default\">\n\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<img decoding=\"async\" width=\"623\" height=\"256\" src=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok2.jpg\" class=\"attachment-full size-full wp-image-8208\" alt=\"\" srcset=\"https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok2.jpg 623w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok2-600x247.jpg 600w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok2-64x26.jpg 64w, https:\/\/gfmg.ua\/wp-content\/uploads\/2023\/03\/PurpuraVidNagruzok2-300x123.jpg 300w\" sizes=\"(max-width: 623px) 100vw, 623px\" \/>\t\t\t\t\t\t\t\t\t\t\t\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7e1994c elementor-widget elementor-widget-heading\" data-id=\"7e1994c\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Case 5\n<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-9eff8d6 elementor-widget elementor-widget-heading\" data-id=\"9eff8d6\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">Patient 5 was a white boy who presented at the age of 15 years with an intermittent petechial rash above the sock line extending to the mid-anterior shin that appeared after working in a corn maze during the summer. He reported that his rash normally lasted 4 days. He did not have the rash in cold weather or if he worked for a short period. Results of laboratory evaluations were normal (see Table 1). On the basis of his presentation, the diagnosis of EIP was made. No treatment was initiated.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-6b7d7ad elementor-widget elementor-widget-heading\" data-id=\"6b7d7ad\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<h2 class=\"elementor-heading-title elementor-size-default\">Discussion<\/h2>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-5d6983b elementor-widget elementor-widget-heading\" data-id=\"5d6983b\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">EIP is a benign vasculopathy that can occur in children or adults. This is the first case series in which this entity is described in children. Recognition of the appearance and typical presentation can prevent anxiety and concern by patients and parents as well as an unnecessary and costly workup. The patients in this case series had typical erythematous purpuric rashes in the lower extremities that were associated with warm weather and prolonged activity.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-bfa287e elementor-widget elementor-widget-heading\" data-id=\"bfa287e\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">In the literature, authors have reported this phenomenon in adults, and in 1 case report, in a child. In 2016, Espitia et al performed a review of the literature and identified 99 adult patients, including 16 of their own patients, who had EIP, demonstrating that this is not an uncommon phenomenon in adults. Relapses in this cohort were common (78%), particularly when triggering conditions persisted. A histopathology revealed LCV in 95% of the cases. Kelly et al described 17 adult patients from Australia with these clinical features. The rash, which lasted 2 to 3 days, appeared either with golf (usually only after 18 holes of play) or hiking in warm weather. The mean age at onset was 56 years. Four biopsies in this cohort were consistent with LCV, revealing leukocytoclasis of neutrophils or lymphocytes, red blood cell extravasation, and endothelial cell swelling. Ramelet collected 23 patients from Switzerland with the same clinical features triggered by walking or hiking in warm weather. These patients had erythematous purpura (with occasional urticarial papules) appearing symmetrically on the lower leg. None of the children in our case series had accompanying urticaria. One of youngest published case reports is on a 19-year-old female patient who developed EIP after walking in flip-flops during the summer on a boardwalk. She developed red-purple papules around the outline of her flip-flop sandals. There is only 1 case report of suspected EIP in a child. This 11-year-old boy developed a petechial rash on his back and chest after sports activities. The location of his rash was atypical compared with the location in our case series as well as the typical location in the adult series.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-1f38f34 elementor-widget elementor-widget-heading\" data-id=\"1f38f34\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">In a report from the Netherlands, Prins et al had 58 patients participate in an 80 km march to study the prevalence of skin symptoms. Forty-one patients developed erythema and\/or purpura. Eleven patients had biopsies performed. All 11 biopsies revealed LCV, with mild-to-severe leukocytoclasis as well as granulocytes and mononuclear cells invading the vessels. Three had marginal exocytosis of erythrocytes, and 2 had exocytosis of the infiltrate into the epidermis. The patients we described had a perivascular neutrophilic infiltrate with nuclear debris and erythrocyte extravasation, similar to that described in the adult literature.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-7f9eb58 elementor-widget elementor-widget-heading\" data-id=\"7f9eb58\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">It appears that the combination of activity and heat are the most significant contributing factors for EIP. Exercise in warm conditions may lead to muscular hyperthermia. In addition, the energy produced by muscular use can result in up to a 20-fold increase in muscular arterial flow. Poor augmentation to this high-venous load may cause increased capillary permeability, with leakage of blood cells into the surrounding tissues.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t<div class=\"elementor-element elementor-element-745923d elementor-widget elementor-widget-heading\" data-id=\"745923d\" data-element_type=\"widget\" data-widget_type=\"heading.default\">\n\t\t\t\t\t<p class=\"elementor-heading-title elementor-size-default\">It has been suggested that EIP is a form of exercise-induced capillaritis. This condition has previously been classified as a benign cutaneous variant of LCV. Indeed, the language used to describe these lesions can be confusing. LCV is a histopathologic term to describe the microscopic changes. Cutaneous small-vessel vasculitis may be a more appropriate term to use, with the capillaries being the most frequently involved blood vessels. EIP may be best thought of as benign vasculopathy, not as a primary inflammatory vasculitis. The cutaneous manifestations are caused by exercise-induced venous hypertension and extravasation of red blood cells that, on biopsy, can reveal changes consistent with LCV. Neither our patients nor those in the adult literature were diagnosed with other disorders, and results of serological investigations were normal. Recognition of the typical presentation in children is paramount. EIP is a benign condition that is important to recognize to be able to provide reassurance to the patient and family and to avoid an unnecessary and costly evaluation. It should be noted that if patients have an atypical presentation of EIP, including unusual location of the rash, lack of described environmental and\/or physical triggers, a prolonged duration, or accompanying systemic symptoms, consideration of an alternative diagnosis with an appropriate evaluation is prudent.\n\n<\/p>\t\t\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/div>\n\t\t\t\t\t<\/div>\n\t\t<\/section>\n\t\t\t\t<section class=\"elementor-section elementor-inner-section elementor-element elementor-element-6520ae7 elementor-reverse-mobile elementor-section-boxed elementor-section-height-default elementor-section-height-default wpr-particle-no wpr-jarallax-no wpr-parallax-no wpr-sticky-section-no\" data-id=\"6520ae7\" data-element_type=\"section\">\n\t\t\t\t\t\t<div class=\"elementor-container elementor-column-gap-default\">\n\t\t\t\t\t<div class=\"elementor-column elementor-col-100 elementor-inner-column elementor-element elementor-element-a593085\" data-id=\"a593085\" 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