scholarly journals Musculoskeletal Corticosteroid Injection during COVID-19 Pandemic in Sabah: Is It Safe?

2021 ◽  
Vol 2021 ◽  
pp. 1-6
Author(s):  
Mohamad Azwan Aziz ◽  
Redzal Abu Hanifah ◽  
Azmi Mohamed Mohd Nahar
Keyword(s):  
Sports Medicine ◽  
Corticosteroid Injection ◽  
Well Being ◽  
Careful Consideration ◽  
Immunosuppressive Drug ◽  
Health Clinic ◽  
Injection Pain ◽  
Severe Acute Respiratory Infection ◽  
History Of ◽  
The Mean

Musculoskeletal corticosteroid injection is commonly used as an adjunct to help patients in pain management. In this current COVID-19 pandemic, many clinicians would differ from this treatment as steroid is considered an immunosuppressive drug and could risk the patient of developing severe adverse effects if contracting COVID-19. This is a retrospective study based in Sabah, Malaysia, examining the prevalence of COVID-19 infection following musculoskeletal corticosteroid injection from 1 December 2019 until 30 June 2020 in the sports medicine clinic and the orthopedic clinic. Patients who received musculoskeletal corticosteroid injection were called by telephone and asked about visits to the emergency department or government health clinic for influenza-like illness symptoms or severe acute respiratory infection that would require screening of COVID-19. Thirty-five patients who responded to the call were included, with mean ages of 47.9 years ± 15.1. 52% were male respondents, while 48% were female. 25% of them were diabetics, and 2.9% of them had a history of lymphoproliferative disorders. The mean pain score before injection was 6.74 ± 1.03 and after injection pain was 2.27 ± 1.63. In this study, there were 11.4% (n = 4) with minor complications of steroid injection, that is, skin discoloration. Nonetheless, there were no severe complications due to corticosteroids reported. There were no reported cases of COVID-19 among the respondents following corticosteroid injection. Musculoskeletal pain would affect a person’s well-being and activities; thus, its management requires that careful consideration with risk-benefit analysis be made before administering musculoskeletal corticosteroid injection during COVID-19 pandemic.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  
Keyword(s):  
Pain Score ◽  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Mean Value ◽  
Injection Pain ◽  
P Value ◽  
Duration Of Symptoms ◽  
De Quervain’S Tenosynovitis ◽  
Minimum Age ◽  
The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

scholarly journals Outcome of combined surgical and intralesional steroids injection therapy for management of ear keloid

2020 ◽  
Vol 9 (1) ◽  
pp. 43-48
Author(s):  
Amir Bajracharya
Keyword(s):  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Surgical Excision ◽  
Good Alternative ◽  
Injection Therapy ◽  
Treatment Modalities ◽  
Aesthetic Outcome ◽  
Intralesional Corticosteroid ◽  
History Of ◽  
The Mean

Background: Ear keloid is one of the challenging problems that affect people of different races with substantial aesthetic outcomes. Various types of treatment modalities, including intralesional corticosteroid injection are advocated to lower recurrence following excision. Objectives: To investigate the efficacy of a combined excision and postoperative intralesional triamcinolone acetonide (TA) injection for treating ear keloid patients. Methodology: This was a descriptive study done to observe the outcome of combined approach of surgical and intra-lesional steroids injection therapy for ear keloids. Age, sex, site, size, duration, recurrence, and aesthetic outcome were evaluated. Results: A total of 18 patients representing 19 ear keloids, with one case having bilateral and 3 pediatric cases were included from February 2018 to January 2019.The mean age was 22 years with female to male ratio of 5:1, site were left sided 9 (50%), right 8 (44%) and 1(6%) bilateral. About 10 (53%) cases were at helix, and 9(47%) at ear lobule. Mean length of ear keloid was 1.53 cm with range of 0.5-3cm and mean breath 1.39cm with the range of 0.5-2.5 cm. The mean duration of ear keloid was 9.47 months. 2 (11%) cases showed a history of recurrence. Injection triamcinolone acetonide hypersensitivity was noted by 1 (5.3%) patient. Evaluation for all patients with aesthetic outcome was mean ± standard deviation (4.38±1.025). Conclusion: Management of ear keloid using the combination of surgical excision and intra-lesional steroids injection therapy can be a good alternative option with low recurrence rate.

scholarly journals Burnout and Sense of Coherence in Dentistry Students of Karachi

2021 ◽  
Vol 30 (03) ◽  
pp. 170-177
Author(s):  
Fasiha Moin Kazi ◽  
◽  
Shoaib Ahmed ◽  
Shama Asghar
Keyword(s):  
At Risk ◽  
Sense Of Coherence ◽  
Medical Condition ◽  
Well Being ◽  
Relationship Status ◽  
Chronic Medical Condition ◽  
P Value ◽  
Psychiatric Condition ◽  
History Of ◽  
The Mean

OBJECTIVE: This study aimed to assess burnout and sense of coherence levels in dentistry students of Karachi. METHODOLOGY: A cross-sectional study involving 361 students from four renowned dental colleges in Karachi was carried out. The students were distributed a questionnaire derived from the Mayo Clinic Well-being Index (WBI) and a modified 13-item Antonovsky's Sense of Coherence Scale (SOC scale). They were stratified on the basis of gender, age, professional year, institution, relationship status, history of chronic medical condition and history of chronic psychiatric condition. Scores for the WBI and SOC scale were calculated. For the WBI, a score of >4 was a sign that an individual was at risk of developing burnout or other severe outcomes. A high or low total score on the SOC scale demonstrated whether the individual was able to cope with his environment or not. MS Excel and SPSS version 23 were used for data compilation and statistical analysis. Descriptive statistics were calculated. Chi-square test of independence was applied to gauge any association between the strata and outcome variables. After determination of statistical difference, Mann Whitney-U Test and Kruskal Wallis Test were applied to compare the means where a significant association was found. A p-value of 0.05 or less was considered significant. RESULTS: The mean WBI score was found to be 4.07. Around 64% respondents were at-risk of burnout (score > 4). A greater percentage of females was at risk (66%) as compared to males (50%). Third professional students were found to be the most affected (77% with WBI score > 4 and 9% in the low coherence category). The mean SOC score was found to be 36.39 (moderate levels of coherence). Overall, around 4-9% of each professional year students exhibited a low sense of coherence. Age, relationship status, institution and a history of chronic medical and/or psychiatric condition were not found to have a significant association with the outcome variables (p>0.05). CONCLUSION: A significant number of dentistry students are at risk of burn-out and suffer from a low sense of coherence. The risk factors need to be evaluated and solutions need to be found to create a healthy and conducive environment for the growth and learning of the students. More research needs to be focused on gathering data related to the well-being of dentistry students. KEYWORDS: Burnout, sense of coherence, well-being index, dentistry.

scholarly journals Loss of Appetite in Adult Patients: Effectiveness and Safety of an Appetite Stimulating Medication in an Open-Label, Investigator-Initiated Study in India

2022 ◽  
Vol 2022 ◽  
pp. 1-7
Author(s):  
S. Nagaraj
Keyword(s):  
Negative Impact ◽  
Well Being ◽  
Open Label ◽  
Serious Adverse Events ◽  
Significant Safety ◽  
History Of ◽  
Associated Conditions ◽  
Suitable Treatment ◽  
The Mean ◽  
Loss Of Appetite

Loss of appetite (LOA) may have a negative impact on a patient’s well-being owing to loss of nutrition and associated conditions. The current study assessed the effects of an appetite-stimulating medication containing multivitamins, lysine, and zinc in Indian patients with a history of LOA. Using an investigator-initiated, single-center, open-label, single-arm design, we evaluated the effectiveness and safety of the appetite-stimulating medication (15 mL) in 50 male or female patients (18–55 years old) attending the outpatient department, with a confirmed diagnosis of LOA after two weeks of therapy and assessed the change in Council on Nutrition Appetite Questionnaire (CNAQ) score and safety of the medication after two weeks of treatment. CNAQ scores were presented as mean (standard deviation (SD)). The mean age of patients was 42.1 years, with the majority (66%) being males. At weeks 1 and 2, a statistically significant improvement was observed in the mean CNAQ scores of 25.48 (5.10) and 25.48 (4.29), respectively, vs. baseline (22.08 (2.76); P  ≤ 0.0001 both). Majority of the patients had CNAQ appetite scores of 17–28 at baseline (94%), week 1 (66%), and week 2 (78%) of treatment. For patients with acute and chronic illness, a statistically significant improvement was observed in the mean CNAQ score at week 1 (26.75 (3.69), P  = 0.0256; 25.24 (5.33), P  = 0.0004) and at week 2 (26.63 (3.46), P  = 0.0027; 25.26 (4.43), P  ≤ 0.0001) from baseline (21.88 (3.31) and 22.12 (2.69), respectively). No serious adverse events were reported during the study. The study findings suggest that appetite-stimulating medication containing multivitamins, lysine, and zinc could be a suitable treatment option for the management of LOA with no significant safety concerns.

Revisiting the Natural History of Chronic Scaphoid Nonunions: A Retrospective Study of 20 Cases

2021 ◽  
Author(s):  
J. Terrence Jose Jerome
Keyword(s):  
Retrospective Study ◽  
Natural History ◽  
Functional Outcome ◽  
Grip Strength ◽  
Scaphoid Nonunion ◽  
Proximal Pole ◽  
Degenerative Arthritis ◽  
Level Of Evidence ◽  
History Of ◽  
The Mean

Abstract Background The natural history of scaphoid nonunion is the development of degenerative arthritis. A lot of information is still unclear about this progression. The purpose of this study is to analyze patients with scaphoid nonunions who had not received any kind of treatment and to assess the functional outcome. Materials and Methods This is a retrospective study that analyzed the patients with chronic scaphoid nonunions between 2009 and 2019. None of the patients received any treatment. The age at the time of injury, examination, pattern of fracture, types of scaphoid nonunion, symptoms, and duration of nonunion were noted. Diagnosis was confirmed by radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI). Scapholunate and radiolunate angles were recorded. Pain score, modified mayo wrist score, grip strength, range of movement, and the functional outcome of these scaphoid nonunions were analyzed. A statistical correlation between the scaphoid nonunion presentations and the functional outcome was assessed. Results The mean age of the patients was 62 years (range: 35–82 years.). There were 17 male and 3 female patients. There were 9 waist and 11 proximal pole scaphoid nonunions. The mean duration of scaphoid nonunion was 34 years (range: 10–62 years). None of the patients had avascular necrosis (AVN) of the proximal scaphoid. The age at examination, gender, side of injury, fracture pattern (waist/proximal pole), fracture displacement ≤ 1 mm or > 1 mm, nonunion duration, and radiographic arthritic parameters had no significant impact on the functional outcome. Conclusions Untreated chronic scaphoid nonunion leads to the development of degenerative arthritis over a period of years, which is still unpredictable. Most of the patients become aware of the nonunion following a precedent injury or other reasons. Most of the patients have fair/good functional outcome despite reduced range of movements and grip strength. Many do not favor surgical intervention in the course of nonunion. Chronic nonunions open a lot of unanswered questions. Clinical relevance There have been numerous studies on the treatment aspects of scaphoid nonunion, with little knowledge about certain people with nonunion who did not have any kind of treatment. The demographics, clinical findings, and radiological parameters do confirm the progression of these nonunion to arthritis, but most of them had fair-to-good outcome throughout their life. It opens our thinking about the real need of treatment in such nonunions and raises numerous questions about the disease. Level of evidence This is a Level IV study.

Beérkezett könyvek

2005 ◽  
Vol 60 (3) ◽  
pp. 425-427
Author(s):  
Csaba Pléh
Keyword(s):  
Social Interaction ◽  
Cognitive Science ◽  
Evolutionary Psychology ◽  
Well Being ◽  
General Intelligence ◽  
Human Thought ◽  
Number Of Genes ◽  
History Of ◽  
Origin Of Mind ◽  
The Mind

Ádám György: A rejtozködo elme. Egy fiziológus széljegyzetei Carpendale, J. I. M. és Müller, U. (eds): Social interaction and the development of knowledge Cloninger, R. C.: Feeling good. The science of well being Dunbar, Robin, Barrett, Louise, Lycett, John: Evolutionary psychology Dunbar, Robin: The human story. A new history of makind's evolution Geary, D. C.: The origin of mind. Evolution of brain, cognition and general intelligence Gedeon Péter, Pál Eszter, Sárkány Mihály, Somlai Péter: Az evolúció elméletei és metaforái a társadalomtudományokban Harré, Rom: Cognitive science: A philosophical introduction Horváth György: Pedagógiai pszichológia Marcus, G.: The birth of the mind. How a tiny number of genes creates the complexities of human thought Solso, R. D.: The psychology of art and the evolution of the conscious brain Wray, A. (ed.): The transition to language

Probiotics in gastroenterology – from a different angle

2013 ◽  
Vol 154 (8) ◽  
pp. 294-304 ◽  
Author(s):  
György Miklós Buzás
Keyword(s):  
Side Effects ◽  
Beneficial Effect ◽  
Analytical Data ◽  
Well Being ◽  
Gastrointestinal Diseases ◽  
Convincing Evidence ◽  
Probiotic Treatment ◽  
History Of ◽  
Irritable Bowel

After a short overview of the history of probiotics, the author presents the development of human intestinal microflora based on the newest genetic data and the microbiological features of main probiotics. The indications of probiotic administration have been defined and extended in recent years. The author reviews significant results of probiotic treatment in some gastrointestinal diseases based on meta-analytical data. Probiotics are useful in preventing and treating diarrhoea caused by antibiotics and Clostridium difficile caused diarrhoea. In the treatment of Helicobacter pylori infection, preparations containing certain Lactobacillus,Bifidobacterium strains or Saccaromyces boulardii could enhance by 5–10% the rate of successful eradication and reduce the incidence and severity of the side effects. Some symptoms of irritable bowel syndrome and thus the quality of life can be improved by probiotics. Their beneficial effect in ulcerative colitis was proven, while in Crohn’s disease has not yet been defined. The use of probiotics is not included in guidelines, with the exception of the Maastricht IV/Florence consensus. For each disease it is advisable to use probiotics containing strains only with proven beneficial effect. The efficiency of preparations containing mixed strains has not yet been properly investigated. The author reviews the rare but potentially serious side effects of probiotics. In Hungary, there are many probiotic preparations available which can be purchased in pharmacies without prescription: their use is more empirical than evidence-based. The European Food Safety Authority has recently rejected claims for probiotics to be classed as medicines given the lack of convincing evidence on the effects of probiotics on human health and well-being. Clearly, further research is needed to collect evidence which could be incorporated into the international guidelines. Orv. Hetil., 2013, 154, 294–304.

Faktor-Faktor Determinan yang melatar belakangi Kehamilan Remaja di Desa Pandansari Kecamatan Poncokusumo Kabupaten Malang

2020 ◽  
Vol 7 (2) ◽  
pp. 247-255
Author(s):  
Maria Magdalena Setyaningsih ◽  
Emy Sutiyarsih
Keyword(s):  
Sex Education ◽  
Teen Pregnancy ◽  
Teenage Pregnancy ◽  
Well Being ◽  
Case Control ◽  
Control Group ◽  
Case Group ◽  
The Family ◽  
History Of ◽  
First Time

Kehamilan remaja adalah kehamilan yang terjadi pada remaja berusia kurang dari 20 tahunan. Kehamilan remaja memberikan banyak kerugian bagi kesehatan, mental dan psikologis, kesejahteraan ekonomi dan peluang karier, kemiskinan dan prospek kehidupan masa depan remaja. Tujuan penelitian mengidentifikasi faktor determinan yang melatarbelakangi terjadinya kehamilan remaja. Jenis penelitian adalah penelitian analitik kategorik jenis survei kuantitatif dengan desain case control. Populasi semua perempuan yang bertempat tinggal di wilayah dusun Wonosari, Sukosari, dan Krajan Pandansari dan pernah/sedang hamil pertama kali pada usia kurang dari 20 tahun. Teknik pengambilan sampel cluster random sampling besar sampel 73. Berdasarkan hasil model akhir analisis multivariat, diketahui bahwa variabel pendidikan, riwayat kehamilan remaja pada keluarga dan usia menikah merupakan variabel yang berhubungan dengan kejadian kehamilan remaja setelah dikontrol oleh variabel akses informasi, responden berpendidikan rendah memiliki peluang 20,8 kali lebih tinggi, responden yang memiliki riwayat kehamilan remaja pada keluarga memiliki peluang 14,9 kali lebih tinggi, responden yang menikah pada usia <20 tahun memiliki peluang 12,1 kali lebih tinggi, responden dengan pemahaman yang kurang baik terkait penggunaan kondom memiliki peluang 5,9 kali lebih tinggi untuk terjadi kehamilan remaja. Oleh karena itu perlu dibangun karakter buiding, sosial karakter suport untuk para ibu remaja dan keluarga sehingga terbangun interaksi yang baik dalam keluarga yang dilandasi dengan pendidikan dan pemahaman yang baik tentang Pendidikan seksualitas. Teen pregnancy is a pregnancy that occurs in adolescents aged less than 20 years old. Teen pregnancy provides many disadvantages for health, mental, psychological, economic well-being, career opportunities, poverty, and the future life. The aim of the study was to identify the determinants underlying teen pregnancy incidence. This study was a quantitative study with categorical analytic method. The study design used a case control with two comparison groups. The groups were control group and case group. The population in this study was all women who lived in the Wonosari, Sukosari, and Krajan Pandansari district and had or were pregnant for the first time at the age of less than 20 years old. Seventy three respondents were recruited using cluster sampling technique. The case group consists of women who were or had pregnant for the first time at the age of less than 20 years old and their children are currently aged ≤ 1 years old. The control group consists of women who were pregnant for the first time at the age of > 20 years old. The data was collected using a questionnaire. The findings showed that education, history of teen pregnancy in family and the age of marriage were related to the incidence of teen pregnancy after being controlled by information access. Low-educated respondents had 20.8 times higher chance of experiencing teen pregnancy; respondents with a history of teen pregnancy in the family had 4.9 times higher chance of experiencing teen pregnancy; respondents who were married at the age of < 20 years old had 12.1 times higher chance of experiencing teen pregnancy; respondents with poor understanding of condom use had 5.9 times higher chance of teenage pregnancy. In conclusion, the findings suggest to build good interactions in the family based on education and a good understanding of sex education.

Health and Medicine in the Islamic Tradition

1990 ◽  
Vol 7 (1) ◽  
pp. 89-90
Author(s):  
Dennis Michael Warren
Keyword(s):  
Health Care ◽  
Medical Care ◽  
Human Health ◽  
Well Being ◽  
Islamic Tradition ◽  
Medical Tradition ◽  
Islamic Thought ◽  
History Of ◽  
Relationship Of ◽  
The Relationship

The late Dr. Fazlur Rahman, Harold H. Swift Distinguished Service Professor of Islamic Thought at the Oriental Institute of the University of Chicago, has written this book as number seven in the series on Health/Medicine and the Faith Traditions. This series has been sponsored as an interfaith program by The Park Ridge Center, an Institute for the study of health, faith, and ethics. Professor Rahman has stated that his study is "an attempt to portray the relationship of Islam as a system of faith and as a tradition to human health and health care: What value does Islam attach to human well-being-spiritual, mental, and physical-and what inspiration has it given Muslims to realize that value?" (xiii). Although he makes it quite clear that he has not attempted to write a history of medicine in Islam, readers will find considerable depth in his treatment of the historical development of medicine under the influence of Islamic traditions. The book begins with a general historical introduction to Islam, meant primarily for readers with limited background and understanding of Islam. Following the introduction are six chapters devoted to the concepts of wellness and illness in Islamic thought, the religious valuation of medicine in Islam, an overview of Prophetic Medicine, Islamic approaches to medical care and medical ethics, and the relationship of the concepts of birth, contraception, abortion, sexuality, and death to well-being in Islamic culture. The basis for Dr. Rahman's study rests on the explication of the concepts of well-being, illness, suffering, and destiny in the Islamic worldview. He describes Islam as a system of faith with strong traditions linking that faith with concepts of human health and systems for providing health care. He explains the value which Islam attaches to human spiritual, mental, and physical well-being. Aspects of spiritual medicine in the Islamic tradition are explained. The dietary Jaws and other orthodox restrictions are described as part of Prophetic Medicine. The religious valuation of medicine based on the Hadith is compared and contrasted with that found in the scientific medical tradition. The history of institutionalized medical care in the Islamic World is traced to awqaf, pious endowments used to support health services, hospices, mosques, and educational institutions. Dr. Rahman then describes the ...

(Preprint)

2018 ◽  
Author(s):  
Natalia Banasik ◽  
Dariusz Jemielniak ◽  
Wojciech P?dzich
Keyword(s):  
Medical Condition ◽  
Extended Period ◽  
Well Being ◽  
Marginal Effect ◽  
Life Duration ◽  
Significant Difference ◽  
The Mean ◽  
Academic Teachers ◽  
Length Of Life ◽  
The Impact

BACKGROUND There have been mixed results of the studies checking whether prayers do actually extend the life duration of the people prayed for. Most studies on the topic included a small number of prayers and most of them focused on people already struggling with a medical condition. Intercessory prayer’s influence on health is of scholarly interest, yet it is unclear if its effect may be dependent on the number of prayers for a named individual received per annum. OBJECTIVE We sought to examine if there is a noticeable increased longevity effect of intercessory prayer for a named individual’s well-being, if he receives a very high number of prayers per annum for an extended period. METHODS We retrieved and conducted a statistical analysis of the data about the length of life for 857 Roman Catholic bishops, 500 Catholic priests, and 3038 male academics from the US, France, Italy, Poland, Brazil, and Mexico. We obtained information for these individuals who died between 1988 and 2018 from Wikidata, and conducted an observational cohort study. Bishops were chosen for the study, as they receive millions of individual prayers for well being, according to conservative estimates. RESULTS There was a main effect for occupation F(2, 4391) = 4.07, p = .017, ηp 2 = .002, with pairwise comparisons indicating significant differences between the mean life duration of bishops (M=30489) and of priests (M=29894), but none between the academic teachers (M=30147) and either of the other groups. A comparison analysis between bishops from the largest and the smallest dioceses showed no significant difference t(67.31)=1.61, p = .11. Our main outcome measure is covariance of the mean length of life in each of the categories: bishops, priests, academic teachers, controlled for nationality. CONCLUSIONS The first analysis proved that bishops live longer than priests, but due to a marginal effect size this result should be treated with caution. No difference was found between the mean length of life of bishops from the largest and the smallest dioceses. We found no difference between bishops and male academics. These results show that the impact of intercessory prayers on longevity is not observable.

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