scholarly journals Seroprevalence of Rubella IgG in Pregnant Females

2019 ◽  
Vol 7 (4) ◽  
pp. 295-298
Author(s):  
Huda Rana ◽  
Rijja Chaudhary ◽  
Saeed Alam ◽  
Wajiha Mahjabeen
Keyword(s):  
Cross Sectional Study ◽  
Natural Immunity ◽  
Cross Sectional ◽  
Positive Group ◽  
Group 4 ◽  
Child Bearing ◽  
High Prevalence ◽  
Group 3 ◽  
Group 2 ◽  
Age Range

Objective: To find out the seropositivity of IgG rubella in pregnant women in Pakistan, to assess the prevalence of infection and to estimate the requirement of vaccination.Patients and Methods: In this retrospective cross sectional study total 730 females who visited Salma Kafeel Fertility Clinic (Rawalpindi) for antenatal checkup were inducted. Their age range was 18-45 years. The study was carried out from 2011-2016. ELISA serological testing was used to check the seroprevalence of Rubella IgG.Results: In total the 730 subjects were included in the study and divided in four groups according to their ages. The results were as follows: group 1(18-20yrs) 100% positive, group 2 (21-30yrs) 90.5% positive, group 3 (31-40yrs) 93.5% positive and lastly group 4 (>40yrs) 95%positive. Overall 92.32 % seropositivity was seen while 7.70% were found at risk of developing infection.Conclusion: There is a high prevalence of Rubella in females of child bearing age in Pakistan. This is alarming as it can result in high risk of CRS in newborns and fetal death. Therefore, women planning to become pregnant, who do not have natural immunity to rubella should be vaccinated at least 4 weeks prior to conception.

scholarly journals Sensitivity and Specificity of Belin Ambrosio Enhanced Ectasia Display in Early Diagnosis of Keratoconus

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Shahram Bamdad ◽  
Mohammad Reza Sedaghat ◽  
Masoud Yasemi ◽  
Aliraza Vahedi
Keyword(s):  
Early Diagnosis ◽  
Sensitivity And Specificity ◽  
Study Groups ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Normal Thickness

Purpose. Early diagnosis of keratoconus disease (KCN) is the first priority in the preoperative evaluations of refractive surgery (RS).The aim of this study was to investigate the correlation between findings of Belin Ambrosio enhanced ectasia display (BAD) software and conventional corneal imaging (Orbscan and topography) in the early diagnosis of KCN. Methods. For conducting this cross-sectional study, a total of 1000 eyes were selected from 500 patients that underwent the myopic photorefractive keratectomy surgery and were compared in four study groups during the years 2017–2018. In group 1, all topography, Orbscan, and BAD criteria were normal (65.8%).In contrast, in Group 2, at least one of the topography or Orbscan criteria as well as at least one BAD criterion (12.6%) were abnormal. In Group 3, the eyes had normal Orbscan and topography criteria with at least one abnormal BAD criterion (18.5%). Also, in Group 4, the patients had at least one abnormal Orbscan or topography criterion, but all BAD criteria (3.1%) were normal. Thickness of the thinnest point (TP) of cornea was compared in Pentacam and topography. Data analysis was done by SPSS software (version 21). Results. BAD criteria were normal in 78.5% of all eyes with normal topography and Orbscan criteria (specificity). BAD criteria were also abnormal in 80.2% of eyes (sensitivity). There was also no significant difference between TP in Orbscan and Pentacam. Conclusions. BAD criteria had a relatively acceptable sensitivity and specificity, compared with conventional Orbscan and topography criteria. Thus, BAD criteria can be more effective in the early diagnosis of KCN.

Serum and Bronchoalveolar Lavage Fluid 25(OH)Vitamin D3 Levels in HIV-1 and Tuberculosis: A Cross-Sectional Study from a Tertiary Care Center in North India

2018 ◽  
Vol 16 (2) ◽  
pp. 167-173
Author(s):  
Sanjeev Sinha ◽  
Kartik Gupta ◽  
Dibyakanti Mandal ◽  
B.K. Das ◽  
R.M. Pandey
Keyword(s):  
Vitamin D ◽  
Lavage Fluid ◽  
Cross Sectional Study ◽  
P Value ◽  
Vitamin D Metabolites ◽  
Cross Sectional ◽  
Group 4 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background: Vitamin D is an immunomodulator, and its deficiency is associated with Tuberculosis (TB) infection. Bronchoalveolar lavage fluid (BALF) is a rich milieu of macrophages that form the first line of defense against invading TB bacilli. As there is an increased prevalence of vitamin D deficiency in TB and human immunodeficiency virus-1 (HIV-1) subjects, we intend exploring the possibility of a localized deficiency of vitamin D metabolites in BALF of these patients. Objective: The primary objective was to assess the level of 25D3 in serum and BALF of subjects and look for a significant difference among patients and controls. The secondary objective was to find a correlation between serum and BALF 25D3 levels. Methods: We performed a cross-sectional study with subjects divided into four groups: Controls (group 1), HIV positive without active TB (group 2), active TB without HIV (group 3), and HIV-TB coinfection (group 4). BALF and serum 25D3 levels were compared between the groups. Results: Among the 149 (an immunomodulator) successive subjects enrolled, there were 40 subjects in group 1 (HIV-TB-), 48 in group 2 (HIV+TB-), 37 in group 3 (HIV-TB+), and 24 in group 4 (HIV+TB+). Females constituted 31.6% of the study subjects. In groups 3 and 4, there were significantly lower serum 25D3 levels compared to group 1 (p-value group 3: 0.002; group 4: 0.012). In groups 2, 3, and 4, there were significantly lower BALF 25D3 levels compared to group 1 (p-value group 2: 0.000; group 3: 0.000; group 4: 0.001). There was a significant correlation between serum and BALF 25D3 levels (Spearman’s rank correlation coefficient 0.318, p-value = 0.0001). Conclusion: Lower levels of serum and BALF 25D3 were observed in HIV, TB, and HIV-TB coinfected patients. Localized deficiency of vitamin D metabolites might be associated with increased vulnerability to TB infection.

scholarly journals Prevalence of prediabetes in patients with metabolic risk

2011 ◽  
Vol 129 (5) ◽  
pp. 300-308 ◽  
Author(s):  
Lívia Nascimento de Matos ◽  
Guilherme de Vieira Giorelli ◽  
Amir Saado ◽  
Cristiane Bitencourt Dias
Keyword(s):  
Clinical Laboratory ◽  
Tolerance Test ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Group 4 ◽  
Laboratory Variables ◽  
Group 3 ◽  
Group 2 ◽  
Anthropometric Profile ◽  
Group 1

CONTEXT AND OBJECTIVE: Early diagnosis of prediabetes should be done to avoid complications relating to diabetes mellitus (DM). The aim here was to assess the prevalence of prediabetes among individuals at high risk of developing DM, and to seek variables relating to glucose intolerance (GI) among individuals with normal fasting plasma glucose (FPG). DESIGN AND SETTING: Cross-sectional study at Hospital do Servidor Público Estadual, São Paulo. METHODS: The FPG and glucose tolerance test (GTT) were analyzed, from which the subjects were divided as follows: group 1 (FPG and GTT both normal), group 2 (normal FPG but abnormal GTT), group 3 (abnormal FPG but normal GTT), and group 4 (FPG and GTT both abnormal). The subjects' clinical, laboratory and anthropometric profile was determined. RESULTS: 138 subjects were studied: 44 in group 1, 11 in group 2, 33 in group 3 and 50 in group 4. The prevalence of prediabetes was 68.0%. Group 4 individuals were older than group 1 individuals [69.0 (55.5-74.0) versus 58.9 ± 11.8 years; P < 0.05], with greater prevalence of risk conditions for DM [5.0 (4.0-5.0) versus 4.0 (3.0-5.0); P < 0.05]. Among individuals with normal FPG, GI prevalence was 20.0%. No variables analyzed correlated with GTT. CONCLUSION: The prevalence of prediabetes was 68.0%, and 20.0% of subjects with normal FPG had GI. Although some anthropometric, clinical and laboratory variables have been correlated with DM and prediabetes, none, except for GTT, was able to screen for GI among subjects with normal FPG in the present study

scholarly journals Effect of the Cut-Off Level for Thyroid-Stimulating Hormone on the Prevalence of Subclinical Hypothyroidism among Infertile Mexican Women

Diagnostics ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. 417
Author(s):  
Lidia Arce-Sánchez ◽  
Salvatore Giovanni Vitale ◽  
Claudia Montserrat Flores-Robles ◽  
Myrna Souraye Godines-Enriquez ◽  
Marco Noventa ◽  
...  
Keyword(s):  
Insulin Resistance ◽  
Subclinical Hypothyroidism ◽  
Thyroid Autoimmunity ◽  
Cross Sectional Study ◽  
Thyroid Stimulating Hormone ◽  
Mexican Women ◽  
Cross Sectional ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The primary aim of this study was to compare the prevalence of subclinical hypothyroidism (SCH) using two different cut-off levels for TSH values (≥2.5 mIU/L versus ≥4.1 mIU/L). The secondary objective was to analyze the clinical-biochemical characteristics in women with and without SCH. This was a retrospective cross-sectional study. In total, 1496 Mexican women with infertility were included: Group 1, women with TSH levels ranging between 0.3 and 2.49 mIU/L, n = 886; Group 2, women with TSH between 2.5 and 4.09 mIU/L, n = 390; and Group 3, women with TSH ≥4.1 mIU/L n = 220. SCH prevalence was 40.7% (CI 95%: 38.3–43.3%) with TSH cut-off ≥ 2.5 mIU/L, and 14.7% (CI 95%: 12.7–16.5%) with TSH cut-off ≥ 4.1 mIU/L, (p = 0.0001). The prevalence of overweight was higher in Group 2 than in Groups 1 and 3. Thyroid autoimmunity, obesity and insulin resistance were higher in Group 3 than in Group 1 (p < 0.05). No other differences were observed between groups. Conclusions: The prevalence of SCH in our selected patients increased almost three times using a TSH cut-off ≥ 2.5 mIU/L compared with a TSH cut-off ≥ 4.1 mIU/L. Women with TSH ≥4.1 mIU/L compared with TSH cut-off ≤ 2.5 mIU/L more often presented with obesity, thyroid autoimmunity and insulin resistance.

scholarly journals Depression, anxiety levels and sleep quality indexes among the spouses of people with epilepsy

2021 ◽  
Author(s):  
Halil ONDER ◽  
Ersin Kasim ULUSOY ◽  
Caner BAYDAR ◽  
Mustafa KIRAZ ◽  
Muhammet Okay ORUN ◽  
...  
Keyword(s):  
Sleep Quality ◽  
Sleep Disturbances ◽  
Demographic Data ◽  
Cross Sectional Study ◽  
Control Group ◽  
Cross Sectional ◽  
History Of ◽  
Group 3 ◽  
Group 2 ◽  
Psychiatric Problems

ABSTRACT Background: Psychiatric problems and sleep disturbances are comorbidities that are frequently encountered among people with epilepsy. However, their presence among the spouses of peoples with epilepsy remains to be elucidated. Objective: The objective of this study was to evaluate the spouses of people with epilepsy (PWE), with and without a history of seizures during sleep, in terms of depression, anxiety and sleep quality. Methods: This prospective, cross-sectional study was conducted in three groups of 18 to 65-year-olds. Group 1 consisted of healthy spouses of 127 healthy volunteers without any known neurological disease; group 2 comprised spouses of 63 PWE who had no history of seizure during sleep; and group 3 consisted of spouses of 63 PWE who had a history of at least one seizure during sleep in the course of the previous year. Questionnaires seeking demographic data and the Pittsburgh Sleep Quality Index (PSQI), Beck Depression Inventory and Beck Anxiety Inventory were applied to all participants. Results: The depression scores of the group of spouses of PWE were higher than those of the control group and were higher in group 3 than in group 2 (p = 0.017). The anxiety scores of the group of spouses of PWE were significantly higher than those of the control group, but no difference in anxiety scores was found between group 2 and group 3 (p = 0.170). The mean PSQI score of group 3 was higher than that of group 2 (p = 0.029). However, regression analyses did not show any difference between these groups. Conclusion: We found that the PSQI scores, which reflected sleep quality, were higher among the spouses of PWE who had seizures during sleep and who had more severe epilepsy.

scholarly journals Health-related quality of life and work productivity in UK patients with HER2-positive breast cancer: a cross-sectional study evaluating the relationships between disease and treatment stage

2020 ◽  
Vol 18 (1) ◽  
Author(s):  
Mark Verrill ◽  
Andrew M. Wardley ◽  
Jenny Retzler ◽  
Adam B. Smith ◽  
Catherine Bottomley ◽  
...  
Keyword(s):  
Work Productivity ◽  
Cross Sectional Study ◽  
Her2 Positive ◽  
Activity Impairment ◽  
Cross Sectional ◽  
Related Quality ◽  
Health Related ◽  
Group 3 ◽  
Group 2

Abstract Background The impact of different disease stages and treatment for human epidermal growth factor 2 positive (HER2-positive) breast cancer (BC) on work productivity and health-related quality of life (HRQoL) is poorly understood. Methods This was a UK cross-sectional study of 299 adult patients with HER2-positive early or metastatic BC (NCT03099200). Productivity was assessed using the work productivity and activity impairment scale; HRQoL was measured using EuroQol-5 Dimensions-5 levels (EQ-5D-5L), and Functional Assessment of Cancer Therapy Breast (FACT-G and -B) instruments. Three balanced patient groups were recruited: (1) early BC on treatment post-surgery, (2) early BC after completion of adjuvant treatment, (3) during metastatic BC treatment. Between-group comparisons were performed using an analysis of variance. Results Group 1 comprised 89 patients, Group 2, 108 and Group 3, 102. Age, ethnicity and comorbidities were similar across groups. Patients in Group 3 reported more often being unable to work (significant Bonferroni adjusted p < 0.003). Proportions of employed patients were 50.6%, 50.9% and 27.5% in Groups 1, 2 and 3, respectively. For patients in part-time employment, the number of hours worked was significantly higher in Group 2 patients versus Group 3 (p = 0.002). Group 2 also had significantly lower levels of work absenteeism and overall work impairment compared with Group 1 (p < 0.001). Patients in Group 3 reported worse health utility scores (p ≤ 0.002), moderate or worse problems in the EQ-5D-5L self-care and usual activity domains (p ≤ 0.001), and lower HRQoL as assessed by FACT summary scores (p < 0.001 for FACT-B and -G) than Groups 1 and 2. Poorer HRQoL was significantly associated with higher work impairment (p < 0.001), with the strongest relationships being observed between activity impairment and HRQoL (Pearson’s r: 0.67). Conclusions Metastatic disease and treatment of HER2-positive BC adversely impacted on work productivity and HRQoL. The results of this study support the idea that being able to delay or prevent the metastatic recurrence of BC, for example by extending the time patients are in remission or at early stage of BC, has wider benefits in terms of patient productivity and HRQoL.

scholarly journals Assessment of Anti-SARS-CoV-2 Antibodies Post-Coronavac Vaccination in the Amazon Region of Brazil

Vaccines ◽  
2021 ◽  
Vol 9 (10) ◽  
pp. 1169
Author(s):  
Carlos David Araújo Bichara ◽  
Maria Alice Freitas Queiroz ◽  
Ednelza da Silva Graça Amoras ◽  
Gergiane Lopes Vaz ◽  
Izaura Maria Vieira Cayres Vallinoto ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Cross Sectional Study ◽  
Age Group ◽  
Receptor Binding Domain ◽  
Sectional Study ◽  
Cross Sectional ◽  
Humoral Immune ◽  
High Prevalence ◽  
Group 2 ◽  
Group 1

The present study evaluated the frequency of seropositivity for anti-SARS-CoV-2 (S1 and S2) total antibodies and anti-SARS-CoV-2 (receptor binding domain-RBD-S1) neutralizing antibodies in individuals vaccinated with the immunizing agent Coronavac. This was a cross-sectional study involving 358 individuals divided into two groups. Group 1 consisted of 205 volunteers who were tested for anti-SARS-CoV-2 total antibodies; group 2 consisted of 153 individuals tested for the presence of anti-SARS-CoV-2 neutralizing antibodies. Seropositivity was greater than 70% in both groups, although 17.6% and 20.9% of individuals showed no neutralizing or total antibody reactivity, respectively. The frequency of anti-SARS-CoV-2 total antibodies displayed a significantly different distribution between the sexes but not according to age. The frequency of anti-SARS-CoV-2 neutralizing antibodies was 93.3% (95% CI 68.1–99.8) in the age group from 21 to 40 years but significantly decreased with advancing age, and was 76.2% (95% CI 52.8–91.8) for 41 to 60 years, 72.5% (95% CI 62.8–80.9) for 61 to 80 years, and 46.7% (95% CI 21.3–73.4) for >80 years. Our results reveal a high prevalence of anti-SARS-CoV-2 total antibodies and anti-SARS-CoV-2 neutralizing antibodies in individuals who received both doses of the Coronavac vaccine, suggesting a lower effectiveness of the humoral immune response among those older than 60 years of age, which might be associated with senescence of the immune system.

scholarly journals Pediatric neurodevelopment by prenatal Zika virus exposure: A cross-sectional study of the Microcephaly Epidemic Research Group Cohort

2020 ◽  
Author(s):  
Paula Fabiana Sobral Silva ◽  
Sophie Helena Eickmann ◽  
Ricardo Arraes de Alencar Ximenes ◽  
Ulisses Ramos Montarroyos ◽  
Marília de Carvalho Lima ◽  
...  
Keyword(s):  
At Risk ◽  
Zika Virus ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Group 4 ◽  
Neurological Abnormalities ◽  
Development Delay ◽  
Group 3 ◽  
And Behavior

Abstract Background: The implications of congenital Zika Virus (ZIKV) infections for pediatric neurodevelopment and behavior remain inadequately studied. The aim of this study is to investigate patterns of neurodevelopment and behavior in groups of children with differening severities of ZIKV-related microcephaly and children with prenatal ZIKV exposure in the absence of microcephaly.Methods: We conducted a cross-sectional study, nested in a cohort, of 274 children (aged 10-45 months) who were born during the peak and decline of the microcephaly epidemic in Northeast Brazil. Participants were evaluated between February 2017 and August 2019 at two tertiary care hospitals in Recife, Pernambuco, Brazil. We analyzed the children in four groups assigned based on clinical and laboratory criteria: Group 1 had severe microcephaly; Group 2 had moderate microcephaly; Group 3 had prenatal ZIKVexposure confirmed by maternal RT-PCR testing but no microcephaly; and Group 4 was a neurotypical control group. Groups were evaluated clinically for neurological abnormalities and compared using the Survey of Wellbeing of Young Children (SWYC), a neurodevelopment and behavior screening instrument validated for use in Brazil. Children with severe delays underwent further evaluation with an adapted version of the SWYC.Results: Based on the SWYC screening, we observed differences between the groups for developmental milestones but not behavior. Among the 114 children with severe microcephaly of whom 98.2% presented with neurological abnormalities, 99.1% were ‘at risk of development delay’ according to the SWYC instrument. Among the 20 children with moderate microcephaly of whom 60% presented with neurological abnormalities, 65% were ‘at risk of development delay’. For children without microcephaly, the percentages found to be ‘at risk of developmental delay’ were markedly lower and did not differ by prenatal ZIKV exposure status: Group 3 (N=94), 13.8%; Group 4 (N=46), 21.7%.Conclusions: Among children with prenatal ZIKV exposure, we found a gradient of risk of development delay according to head circumference. Children with severe microcephaly were at highest risk for delays, while normocephalic ZIKV-exposed children had similar risks to unexposed control children. We propose that ZIKV-exposed children should undergo first-line screening for neurodevelopment and behavior using the SWYC instrument. Early assessment and follow-up will enable at-risk children to be referred to a more comprehensive developmental evaluation and to multidisciplinary care management.

Assessment of anti-SARS-CoV-2 antibodies post-Coronavac vaccination in the Amazon region of Brazil

2021 ◽  
Author(s):  
Carlos David Araújo Bichara ◽  
Maria Alice Freitas Queiroz ◽  
Ednelza da Silva Graça Amoras ◽  
Gergiane Lopes Vaz ◽  
Izaura Maria Vieira Cayres Vallinoto ◽  
...  
Keyword(s):  
Immune Response ◽  
Neutralizing Antibodies ◽  
Cross Sectional Study ◽  
Age Group ◽  
Lower Efficiency ◽  
Cross Sectional ◽  
Humoral Immune ◽  
High Prevalence ◽  
Group 2 ◽  
Group 1

Abstract The race to develop a vaccine against SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) has raised questions regarding the safety of immunizers, efficacy regarding the production of neutralizing antibodies, and the longevity of the immune response, especially when related to variables such as sex and age. The present study evaluated the frequency of seropositivity for anti-SARS-CoV-2 (S1 and S2) total antibodies and anti-SARS-CoV-2 (receptor binding domain - RBD - S1) neutralizing antibodies in individuals vaccinated with the immunizing agent Coronavac (Sinovac). This was a cross-sectional study involving 358 individuals divided into two groups. Group 1 consisted of 205 volunteers who were tested for anti-SARS-CoV-2 total antibodies (S1 and S2); group 2 consisted of 153 individuals tested for the presence of anti-SARS-CoV-2 neutralizing antibodies (RBD-S1). Seropositivity was greater than 70% in both groups, though approximately 20% of individuals showed no antibody production. The frequency of anti-SARS-CoV-2 total antibodies (S1 and S2) displayed a significantly different distribution between the sexes but not according to age. The frequency of anti-SARS-CoV-2 (RBD-S1) neutralizing antibodies was 93% in the age group from 21 to 40 years, which was significantly lower with advancing age, to 76% (41 to 60 years), 72% (61 to 80 years) and 47% (>80 years). Our results reveal a high prevalence of anti-SARS-CoV-2 total antibodies (S1 and S2) and anti-SARS-CoV-2 (RBD - S1) neutralizing antibodies in individuals who received both doses of the Coronavac vaccine, suggesting a lower efficiency of the humoral immune response among those older than 60 years of age, which might be associated with senescence of the immune system.

scholarly journals The effect of coronary angiography and femoral access on femoral artery distensibility and elasticity

2021 ◽  
Vol 21 (84) ◽  
pp. e48-e52
Author(s):  
Aylin Güneşli ◽  
◽  
Aynur Acıbuca ◽  
Keyword(s):  
Coronary Angiography ◽  
Femoral Artery ◽  
Long Term Effects ◽  
Cross Sectional ◽  
Femoral Access ◽  
Group 4 ◽  
Significant Difference ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Aim of the study: The aim of this study was to evaluate the long-term effects of access to the femoral artery for the purposes of coronary angiography through the measurement of femoral artery distensibility and elasticity on the accessed and non-accessed sides. Material and methods: This cross-sectional study included patients who underwent femoral angiography at least 1 year previously. Those whose femoral artery was accessed once formed Group 1 (n = 59), those who were accessed twice formed Group 2 (n = 57), those accessed 3 times formed Group 3 (n = 55), and those with more than 3 accesses, Group 4 (n = 60). The groups were compared in respect of femoral artery elasticity and distensibility in the accessed and non-accessed sides. Results: No statistically significant difference was determined in respect of femoral distensibility and elasticity in Group 1 (9.40 ± 0.84 vs 9.48 ± 0.75, p = 0.107 and 0.23 ± 0.03 vs 0.23 ± 0.03, p = 0.433, respectively). However, a significant difference was observed between the two sides in terms of distensibility and elasticity in Group 2 (9.02 ± 0.81 vs 9.23 ± 0.75, and 0.21 ± 0.02 vs 0.22 ± 0.02), in Group 3 (8.49 ± 0.77 vs 9.18 ± 0.9 and 0.19 ± 0.02 vs 0.21 ± 0.02), and in Group 4 (8.14 ± 0.74 vs 9.03 ± 0.81 and 0.16 ± 0.01 vs 0.2 ± 0.02, p <0.001, for all comparisons). Conclusion: While a single access in the femoral artery for coronary angiography does not affect femoral artery elasticity and distensibility, multiple accesses may have adverse effects.

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