Clinical and microbiological aspects of vaginal microbiota at pregnant with threat of late miscarriages during treatment with vaginal gestagens forms

2017 ◽  
pp. 68-73
Author(s):  
I.P. Polishchuk ◽  
Keyword(s):  
Pregnant Women ◽  
Therapeutic Effect ◽  
Local Treatment ◽  
Vaginal Microbiota ◽  
Control Group ◽  
Before And After ◽  
Low Efficiency ◽  
Late Miscarriage ◽  
Microbiological Aspects ◽  
Micronized Progesterone

The objective: was to examine the effectiveness of treatment of late miscarriage threat by micronized form of progesterone for 100 mg – 3 times a day in the form of gelatin pills and vaginal tablets with lactose. Patients and methods. Under our supervision there were 70 pregnant women with normocenosis of vagina (NCV) without extragenital pathology, which were not performed systemic or local treatment with antibacterial drugs in the last 4 weeks. Among them 25 pregnant women with TLSM treated by gelatin tablets of micronized progesterone (GTP) (group 1); 25 pregnant women with TLSM, treated by vaginal micronized progesterone tablets (VPT) (2nd group) and 20 healthy women with physiological pregnancy – PV (control group). The distribution of women in the group adhered to the principles of randomization. The age of examined women ranged from 19 to 32 years, most pregnant women were aged under 30 years (89.02%). General clinical examination was carried out according to the standard scheme according to the Order MH of Ukraine № 620. Results. During the research we have determined the colpocytologcal dynamics and state of vaginal microbiota in pregnant women with threatened late miscarriage with initial vaginal normocenosis before and after treatment whit vaginal forms of progesterone. Conclusion. The received results showed low efficiency of micronized progesterone gelatin dragee at threat of the late miscarriage that at small therapeutic effect has led to the development of vaginal dysbiosis in all surveyed. In contrast, the use of micronized progesterone vaginal tablets – the maximally rapid therapeutic effect without disturbance of vaginal normocenosis. Key words: the threat of a late miscarriage, vaginal micronized forms of progesterone.

Influence Counseling with Smart Calendar Media (Kalpin) to Knowledge and Attitude of Pregnant Women about First 1000 Days of Life

2019 ◽  
Vol 1 (1) ◽  
pp. 11-15
Author(s):  
Yanik Muyassaroh ◽  
Ana Afifah
Keyword(s):  
Pregnant Women ◽  
Bivariate Analysis ◽  
Control Group ◽  
Nutrition Counseling ◽  
Lecture Method ◽  
Before And After ◽  
Post Test ◽  
Good Nutrition ◽  
Knowledge And Attitude ◽  
Analytic Design

Malnutrition in pregnant women has an impact on the health of the next generation. Therefore, nutrition counseling first 1000 days of life needs to be given. Good nutrition during the period of 1000 days starting from early pregnancy until the child’s second birthday. This study aims to determine the effect of counseling with “Kalpin” or Smart Calendar on knowledge and attitude of pregnant women about the first 1000 days of life. This type of research is a comparative analytic design with pre-test and post-test control group. Nutrition counseling activities carried out by the lecture method using a smart calendar. Measurement of knowledge and attitude of pregnant women perfomed twice: before and after the extension granted. Analysis of the data used were bivariate analysis test Independent T-Test and Mann Whitney. The result shows influence of counseling about first 1000 days of life with Kalpin to knowledge (p = 0,000) and attitude of pregnant woman (p = 0,000) about first 1000 days of life. For health service can be a new input in efforts to improve the quality of service with realization the Program Healthy Indonesia that include first 1000 days of life.

scholarly journals Modern view on the problem of optimization of therapy in pregnant women with functional cervical insufficiency

2018 ◽  
Vol 22 (1) ◽  
pp. 173-177
Author(s):  
V. F. Oleshko
Keyword(s):  
Blood Serum ◽  
Pregnant Women ◽  
Main Group ◽  
Control Group ◽  
Cervical Insufficiency ◽  
Progesterone Concentration ◽  
Therapeutic Dosage ◽  
Hormonal Balance ◽  
Magnesium Orotate ◽  
Micronized Progesterone

A functional cervical insufficiency plays an important role in the etiology of miscarriage and premature birth. The aim of research was to estimate the hormonal balance indexes during the course of pregnancy in pregnant women with functional cervical insufficiency and to correct the revealed violations in order to prevent obstetric complications. 101 pregnant women with confirmed diagnosis of a functional cervical insufficiency in term of gestation 22–32 weeks of pregnancy (the main group) and 34 pregnant women and women in labor with physiological condition of the cervix (the control group) were examined. The content of estradiol, progesterone, cortisol and prolactin was examined in the blood serum. On the second stage of examination 63 pregnant women obtained general basic therapy (I main group) and 38 pregnant women (II main group) received a developed treatment complex which included progesterone support by the micronized progesterone 200–400 mg twice a day up to 34–35 weeks of pregnancy, magnesium support by the magnesium orotate dehydrate in the therapeutic dosage and arginine glutamate in the therapeutic dosage. The correction of cervical insufficiency was performed with the help of a cervical pessary (according to indications). The examination of hormonal balance revealed an accurate decease of progesterone concentration on the background of high concentration of estradiol and increased levels of stress-associated hormones. Propitious influence of the developed therapy is proved by increase of progesterone concentration in the blood serum, normalization in stress-associated hormones balance according to gestational age. All this provideded the decrease of specific weight of threatened preterm labors, placental dysfunction, vaginitis, bacterial vaginosis and delay the labors up to 38–39 weeks of gestation in 97,4% of pregnant women (82,5% in the I main group). Prescription of micronized progesterone, magnesium orotate dehydrate, arginine glutamate to pregnant women with a cervical insufficiency is reasonable and effective one comparing with general and traditional therapy.

scholarly journals The Effect of Educational Media Development in Increasing Knowledge and Attitudes on Pregnancy Complications at Sayang Rakyat Hospital in Makassar

2020 ◽  
Vol 8 (T2) ◽  
pp. 196-199
Author(s):  
Stang Stang ◽  
Debora Selin ◽  
Suriah Suriah ◽  
Sumarni Marwang ◽  
Hasanuddin Ishak
Keyword(s):  
Pregnant Women ◽  
Intervention Group ◽  
Control Group ◽  
Educational Media ◽  
Media Development ◽  
Pregnancy And Childbirth ◽  
Knowledge And Attitudes ◽  
Before And After ◽  
Quasi Experimental ◽  
Increasing Knowledge

BACKGROUND: Each pregnancy and childbirth has complication risks. These complications are accompanying pathological incidences that might cause maternal mortality. AIM: This research aims to determine the effect of educational media development in increasing knowledge and attitudes about complications of pregnancy and childbirth in pregnant women. METHODS: This research method passed through several stages as follows: First stage consisted of the development of educational media (leaflets), and second stage consisted of development test with leaflet media using a quasi-experimental research design. The samples were Trimester I to Trimester III pregnant women who visited Sayang Rakyat Hospital Makassar, which consisted of 30 people as intervention group and 30 people as control group. The intervention group was provided leaflets while the control group was provided books on maternal and child health. Data analysis used Wilcoxon Signed Ranks Test and Mann–Whitney test. RESULTS: The results showed that there are differences in case of knowledge and attitudes of pregnant women regarding complications of pregnancy and childbirth before and after being provided with leaflet intervention with a value of p = 0.000. Likewise, there are differences in the case of knowledge and attitudes of pregnant women regarding pregnancy and childbirth complications between the intervention and control groups with p = 0.041 and 0.001, respectively. CONCLUSION: Educational media on knowledge and attitudes about complications of pregnancy and childbirth has a positive effect in pregnant women at Sayang Rakyat Hospital in Makassar.

scholarly journals EFFECT OF HEALTH PROMOTION AND WHATSAPP REMINDER TO SELF EFFICACY OF ADHERENCE CONSUME FE TABLETS PREGNANT WOMEN

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Dyah Dyah Dewi ◽  
Wiwik Wiwik Kusumawati ◽  
Ismarwati Ismarwati Ismarwati
Keyword(s):  
Health Promotion ◽  
Pregnant Women ◽  
Self Efficacy ◽  
Intervention Group ◽  
Sampling Technique ◽  
Control Group ◽  
Control Group Design ◽  
Significant Difference ◽  
Before And After ◽  
The Government

Background: Maternal Mortality Rate (MMR) as an indicator of maternal health during pregnancy, childbirth, and childbirth. Anemia contributes 20% to the incidence of maternal deaths caused by bleeding during labor. The government prevents anemia by giving iron tablets at least 90 tablets for pregnant women. However, the prevalence of anemia remains high, because of the low adherence in consuming Fe tablets every day. Self-efficacy adherence is a predictor of health behavior and adherence to treatment.Objective: To improve adherence with self-efficacy in consuming Fe tablets in pregnant women with health promotion and WhatsApp reminder in Yogyakarta City Health Center.Method: This study used a quasi-experiment method with a pre-test post-test non-equivalent control group design. The sample amounted to 59, the sampling technique used was consecutive sampling which was taken by random sampling technique in which samples were taken alternately to determine the intervention group and the control group.Results: There were significant differences in the self efficacy score between the intervention groups (Mean = 6.30, SD = 8.11) and the control group (Mean = 0.89, SD = 7.83) with t-test = 2.60 and ρ = 0.012.Conclusion: There is a significant difference in self-efficacy adherence with consuming Fe tablets in pregnant women before and after being given health promotion and WhatsApp reminder intervention and control groups. Health service agencies can consider the combined service between health promotion and WhatsApp reminder to improve self-efficacy in adhering to consuming Fe tablets in increasing Hb levels in anemic pregnant women.

Великі акушерські синдроми – сучасні можливості профілактики

2018 ◽  
pp. 67-72
Author(s):  
T.G. Romanenko ◽  
◽  
O.M. Sulimenko ◽  
Keyword(s):  
Statistical Analysis ◽  
High Risk ◽  
Pregnant Women ◽  
Fetal Distress ◽  
Placental Insufficiency ◽  
Control Group ◽  
Fetal Growth Retardation ◽  
Prophylactic Measures ◽  
Pathological Pregnancy ◽  
Micronized Progesterone

The objective: was to reduce the incidence and severity of the development of «Great Obstetrical Syndromes»: miscarriage of pregnancy, placental insufficiency, fetal growth retardation and / or fetal distress, preeclampsia, premature detachment of a normally located placenta, premature delivery, by developing an algorithm for prophylaxis during pregnancy in women at high risk for their development. Materials and methods. Clinical and statistical analysis of pregnancy in 88 pregnant women with high risk of decompensation of placental insufficiency was conducted. Depending on the method of preventing complications, 2 groups were formed. The I group included 58 pregnant women who were offered the following algorithm: micronized progesterone 200 mg PV from 6 to 20 weeks of gestation; from 21 to 26 weeks of gestation and from 31 to 36 weeks; phleboprotector with ultra-micronized fractions of bioflavonoids (Flego) 15 ml per os; with subsequent appointment from 21 to 26 weeks of gestation; and from 31 to 36 weeks. Group II included 30 pregnant women who had abandoned any proposed prophylactic measures. The control group consisted of 30 healthy pregnant women. Clinical and statistical analysis of pregnancy in the study groups was conducted. During statistical processing, personal computer and software Microsoft Excel XP and Statistica 6.0 Windows, methods of descriptive statistics, correlation analysis were used. The reliability of the difference between the indicators is estimated by the Student-Fisher criterion. Results. The method of prophylaxis of «Great Obstetrical Syndromes» by sequential administration from the early stages of pregnancy of micronized progesterone with the following appointment – from the second trimester of pregnancy – showed a high efficacy of the phleboprotector, which is manifested in a significantly lower number of cases of preeclampsia in the main group of 3.5% (2) versus 50% (15) in the control group, placental insufficiency was 13.8% (8) versus 100% (30); fetal growth retardation was 5.2% (3) versus 56.7% (17); fetal distress was 3.5% (2) versus 43 , 3% (13), preterm labor 1.7% (1) versus 13.3% (4) and in the absence of premature detachment normal but located on the placenta, severe forms of preeclampsia and placental insufficiency. Conclusions. Pregnant of «Great Obstetrical Syndromes» risk groups need timely prophylactic measures to reduce the likelihood of a pathological pregnancy and improve perinatal outcomes. The proposed prophylaxis scheme significantly lowered the incidence of large obstetric syndromes and improved neonatal outcomes. Key words: great obstetrical syndromes, pathological pregnancy, placental dysfunction, phleboprotector.

scholarly journals Use of Noninvasive Cerclage in Combination of Micronized Progesterone in Miscarriage Of Multifetal Pregnancy

2017 ◽  
Vol 24 (4) ◽  
Author(s):  
Iryna Nikitina ◽  
Alla Boychuk ◽  
Valentina Kondratiuk ◽  
Tatyana Babar
Keyword(s):  
High Risk ◽  
Pregnant Women ◽  
The State ◽  
Control Group ◽  
Group I ◽  
Prophylactic Measures ◽  
Neonatal Adaptation ◽  
Group Ii ◽  
Multifetal Pregnancy ◽  
Micronized Progesterone

We represent the results of the combined method of treatment and prevention of miscarriage in women with a multiple pregnancy and a high risk of the threat of termination the pregnancy because of using the obstetric unloading pessaries, combined with micronized progesterone. The efficiency of this method of treatment is evidenced by the rapid elimination of clinical symptoms of threatened abortion, accelerating the regression of ultrasound markers, reducing the number of complications in of pregnant women and reducing the time of their stay in hospital.Goal: To evaluate the effectiveness of the handling the obstetric pessary in combination with micronized progesterone at women with multifetal pregnancy and a high risk of miscarriage.Materials and methods. We analyzed 120 cases of multifetal pregnancies with signs of miscarriage within the terms from 16 to 28 weeks. The first group of the examined women was: 40 pregnant women with twins and signs of miscarriage, who in the scheme of treatment and prophylactic measures were offered to use the unloading obstetric pessaries in combination with continuous therapy by natural micronized progesterone until 36 weeks of pregnancy. The second group included 40 pregnant women with twins, who were laid seam on the cervix because of istmicocervical insufficiency and were applied short-term courses of therapy by gestagens. The control group comprised 40 pregnant women with twins at the age of 16-28 weeks of pregnancy who were conducted the therapy about the threat of miscarriage according to the current clinical protocols (Order of the Ministry of Health of Ukraine No. 624). It was carried out the analysis of the course of pregnancy, childbirth, the postpartum period and the state of neonatal adaptation in the surveyed groups.Results of the research and their discussion. In the first group, urgent childbirth occurred in 34 (85%) cases, in group II in 29 (72.5%) cases, in control group – in 25 (62.5%) cases. Cesarean delivery was performed in 7 (17.5%) patients of group I pregnant women, in 9 (22.5%) of group II patients and in 11 (27.5%) in the pregnant group. When studying the state of neonatal adaptation of newborns in the examined groups, the following results were obtained. The average weight of the newborns in group I was 3245 ±280 g, in group II 2865 ±365 g, in the control group - 2975 ±325 g (p>0.05). The evaluation of the state of newborns on the Apgar scale, respectively at the 1st and 5th minutes, was respectively: in newborns of the I group, 7.5 ± 1.4 and 8.4 ± 1.3 points, in group II - 7.3 ± 1.6 and 8.2 ± 1.1 points, in the control group – 7.2 ± 1.6 and 8.6 ± 1.2 (р 1-р 2> 0.05).Conclusions. Comprehensive prophylaxis of non-pregnancy in multiple pregnancies, combining the use of a traumatic cardiac cervix with the help of unloading obstetric pussies with progesterone preparations, allows prolonging pregnancy, preventing the development of prematurity, contributes to the improvement of perinatal indicators.

scholarly journals Educational workshops about bonding with the fetus during pregnancy: a clinical trial

2021 ◽  
Vol 42 ◽  
Author(s):  
Priscila Costa ◽  
Paula Rosenberg de Andrade ◽  
Bruna Arends Roschel Tomaz ◽  
Samara Macedo Cordeiro ◽  
Danielle Castro Jansen ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Child Development ◽  
Usual Care ◽  
Pregnant Women ◽  
Randomized Clinical Trial ◽  
Gestational Age ◽  
Health Clinic ◽  
Control Group ◽  
Before And After ◽  
Experimental Group

ABSTRACT Objective: To verify if participation in educational workshops about bonding with the fetus influences the adoption of practices of interaction with the baby by pregnant women. Method: Randomized clinical trial conducted in a health clinic. The experimental group participated in educational workshops designed for the pregnant couple and the control group received usual care. The practices of interaction with the fetus were evaluated before and after the intervention. Results: 19 pregnant women participated in the study. There was a positive correlation between higher gestational age and the interaction with the fetus (p = 0.016), and between younger mothers and the practice of touching or poking the baby (p = 0.019). There was an increase in the interaction with the fetus in the control and experimental groups (p= 0.024). Conclusion: Educational workshops are strategies for sharing knowledge about fetuses' sensory skills and to foster bonding and child development since pregnancy.

scholarly journals Soaking Feet Hydrotherapy Using Warm Water to Improve Quality of Sleeping Among Pregnant Women

2021 ◽  
pp. 16-23
Author(s):  
Ayu Wulandari ◽  
Gita Kostania
Keyword(s):  
Sleep Quality ◽  
Pregnant Women ◽  
Sampling Technique ◽  
Warm Water ◽  
Control Group ◽  
Quality Of Sleep ◽  
Control Group Design ◽  
Before And After ◽  
The Difference

Sleep is a basic need that must be fulfilled by humans. Sleep disorders often occur in pregnant women which has an impact on the quality of sleep. This study aims to identify the effect of soaking feet with warm water on the quality of sleep for pregnant women. This study used a quasi-experiment design with a nonequivalent control group design approach. The sampling technique used total sampling with 40 respondents who were in accordance with the eligible criteria. Interventions are given for 7 consecutive days. Measurement of sleep quality score using the Pittsburgh Sleep Quality Index questionnaire. The difference in sleep quality scores was analyzed by Mann Whitney test, and scores of each component were analyzed by using Wilcoxon test.The results of this study indicate the influence of soaking feet with warm water on sleep quality of respondents before and after the intervention (p = 0.007; α = 5%). From these results, it can be said that there was an increase in quality of sleep after soaking the feet with warm water. Hydrotherapy by soaking feet with warm water can be applied by pregnant women to improve sleep quality.

scholarly journals Konseling Materi Teknik Menyusui Terhadap Perilaku Pemberian Asi Esklusif Di Kabupaten Mamuju Provinsi Sulawesi Barat

2020 ◽  
Vol 11 ◽  
pp. 78
Author(s):  
Dina Mariana ◽  
Satriani G ◽  
Idayati Idayati
Keyword(s):  
Pregnant Women ◽  
Exclusive Breastfeeding ◽  
Postnatal Care ◽  
Intervention Group ◽  
Control Group ◽  
P Value ◽  
Purposive Sampling ◽  
Before And After ◽  
Breastfeeding Counseling ◽  
Quasi Experiment

Breast milk is the best food in the early age of a baby's life. The purpose of the research was to assess the effect of breastfeeding counseling by strengthened breastfeeding techniques on the behavior of exclusive breastfeeding for mothers in Mamuju. This type of research was experimental with a Quasi experiment design using a non random control group pretest-posttest design. Time of research was in May - July 2019. The population were all pregnant women whose pregnancy was trimester III. Samples were third trimester pregnant women in the Puskesmas Beru - Beru and Puskesmas Tampa Padang whose matched the sample’s criteria. Samples were 32 mothers using purposive sampling. The results showed the differences in knowledge about exclusive breastfeeding, after had done intervention group (p value = 0.02) it had a difference in knowledge about exclusive breastfeeding mothers compared to the control samples after the intervention (p value = 0,000); it didn’t have different in attitudes about Exclusive breastfeeding before and after the intervention in samples, and after researcher did counseling on the practice of exclusive breastfeeding toward mothers (p = 0.027). Breastfeeding counseling was needed for pregnant women and postpartum mothers by strengthened breastfeeding technique which practiced in Antenata Care and Postnatal Care by midwives to improve the behavior of exclusive breastfeeding in Mamuju. Keywords: counseling; breastfeeding techniques; behavior of exclusive breastfeeding ABSTRAK Air Susu Ibu (ASI) merupakan makanan terbaik pada awal usia kehidupan bayi. Tujuan penelitian untuk menilai pengaruh Konseling Menyusui dengan penguatan materi teknik menyusui terhadap perilaku pemberian ASI Esklusif pada ibu di Kabupaten Mamuju. Jenis penelitian adalah eksperimental dengan rancangan Quasi experiment menggunakan desain non randomized control group pretest-posttest.Waktu penelitian pada bulan mei - juli 2019. Populasi adalah semua ibu hamil yang usia kehamilannya trisemester III. Sampel adalah ibu hamil trisemester III di Puskesmas Beru - Beru dan Puskesmas Tampapadang yang memenuhi kriteria sampel. Jumlah sampel = 32 orang menggunakan tehnik purposive sampling. Hasil penelitian menunjukan ada perbedaan pengetahuan tentang ASI Eksklusif sebelum dan sesudah intervensi pada kelompok intervensi p = 0,02; ada perbedaan pengetahuan tentang ASI Eksklusif antara kelompok intervensi dibandingkan kelompok kontrol sesudah intervensi (p = 0,000) ; tidak ada perbedaan sikap tentang ASI Eksklusif sebelum dan sesudah intervensi pada kelompok dan tidak ada perbedaan sikap tentang ASI Eksklusif antara kelompok intervensi dengan kelompok kontrol ; ada pengaruh konseling terhadap praktek pemberian ASI Eksklusif pada Ibu (p =0,027). Perlu upaya konseling menyusui pada ibu hamil dan ibu postpartum dengan penguatan materi teknik menyusui secara berkesinambungan pada pelayanan Antenata Care dan Postnatal Care oleh bidan sehingga meningkatkan perilaku pemberian ASI Esklusif di Kabupaten Mamuju. Kata kunci: konseling; teknik menyusui; perilaku pemberian ASI eksklusif

scholarly journals Efficiency evaluation of the improved treatment and prevention complex in pregnant women after assisted reproductive technologies

2021 ◽  
pp. 26-31
Author(s):  
V.O. Beniuk ◽  
L.M. Vygivska ◽  
I.V. Maidannyk ◽  
T.V. Kovaliuk ◽  
O.O. Chorna ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Assisted Reproductive Technologies ◽  
First Trimester ◽  
Reproductive Technologies ◽  
Control Group ◽  
Significant Difference ◽  
Β Hcg ◽  
Arginine Aspartate ◽  
Micronized Progesterone

Study objective: to determine the role and effectiveness of the proposed therapeutic and preventive complex and psychoemotional correction of hormonal disorders in the pregnancy dynamics after assisted reproductive technologies (ART) to improve the antenatal observation and prevention of obstetric and perinatal complications.Materials and methods. The study included 299 pregnant women: the main group included 249 women whose pregnancy occurred as an ART result; the control group included 50 pregnant women with spontaneous pregnancy. Therapeutic and prophylactic complex for pregnant women after ART included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, ω3-polyunsaturated fatty acids and long-term psychological correction on the eve of the ART program, at 8–10, 16–18 and 28–30 weeks of pregnancy. Results. There was a significant increase in the β-chorionic gonadotropin (β-hCG) level in women of the study groups in the first trimester of pregnancy against the background of the proposed treatment. Mean β-HCG value at 7–8 weeks of gestation in the subgroup IA exceeded the subgroup IB by 37% (p <0.05), in subgroup IIA it exceeded the subgroup IIB by 33% (p <0.05). The mean β-hCG value in subgroups IIIA and IIIB did not have a significant difference in the dynamics of the first trimester compared with the control group and among themselves (p >0.05).Mean progesterone value at 7–8 weeks of gestation in subgroup IA increased by 38% in comparison with pregnant women who received the conventional treatment complex (p <0.05), in subgroup IIA it was 73% higher than in subgroup IIB (p <0.05). There was no significant difference in the progesterone level in subgroups IIIA and IIIB in the dynamics of the first trimester.The average cortisol value at 23–24 weeks of pregnancy in subgroup IA decreased by 42% (p <0.05), in pregnant women with endocrine infertility against the background of the proposed treatment complex it was 62% less than in subgroup IIB (p <0.05). The average cortisol level in women with a male factor of infertility was 63% lower than in subgroup IIIB against the background of the proposed complex (p <0.05).Conclusion. Advanced therapy with micronized progesterone in combination with magnesium saturation, L-arginine aspartate, folic acid, ω-3 polyunsaturated fatty acids, as well as long-term psychoemotional correction is appropriate and effective compared to conventional therapy for pregnant women.

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