Indian Journal of Nephrology最新文献

{"title":"Impact of Noncommunicable Diseases and Heat Stress on Estimated Glomerular Filtration Rate in Security Officers at a Tertiary Care Hospital in South India.","authors":"Elenjickal E John, Anna T Valson, Reena George, Phanny J Grace, Parimala Anthony, Nisha Jose, Selvin S R Mani, Joseph Johny, Rizwan Alam, Manish Lalwani, Jeethu Joseph Eapen, Sabina Yusuf, Athul Thomas, Suceena Alexander, Vinoi George David, Pamela Christudoss, Joy Mammen, Santosh Varughese","doi":"10.25259/ijn_386_23","DOIUrl":"10.25259/ijn_386_23","url":null,"abstract":"<p><strong>Background: </strong>The job profile of security officers in tropical countries involves prolonged standing in hot conditions causing heat stress as well as complications of sedentary lifestyle. The objectives of this study were to estimate the prevalence of noncommunicable diseases and heat stress in security officers and analyze factors affecting heat stress and estimated glomerular filtration rate (eGFR).</p><p><strong>Materials and methods: </strong>This was an observational cross-sectional study conducted among security personnel working at a tertiary care hospital in South India during the hottest months of March to May 2020. Screening camps were conducted during which anthropometric measurements were taken and blood was collected for hemoglobin, creatinine, and fasting glucose estimation. Urine dipstick analysis for glucose, protein, pH, and red and white blood cells were done on early morning voided sample. Heat stress was assessed by a validated 18-item questionnaire called heat strain score index (HSSI). A structured questionnaire was prepared for surveillance of risk factors of noncommunicable diseases.</p><p><strong>Results: </strong>A total of 678 security officers were screened. Majority (659/678, 97.2%) were men and mean age of the cohort was 45.4 ± 9.2 years. Fifty-two percent (355/678) of participants were engaged in outdoor work for a median duration of 6 (IQR, 0-8) hours/day. Prevalence of obesity, diabetes, hypertension, and chronic kidney disease (CKD) were 70.9, 25.5, 15.9 and 1.3 percentage, respectively. Half of the cohort (324/678) had definite heat stress and 0.9% (6/678) developed CKD of undetermined etiology. Heat stress was higher in those working outdoors and longer employment duration and lower in those with abdominal obesity. eGFR was lower in older officers, smokers, hypertensives, and those with longer employment duration, but was unaffected by HSSI scores.</p><p><strong>Conclusion: </strong>Kidney function was unaffected by high levels of heat stress experienced by security personnel working at a tertiary hospital in South India. Future studies are needed to understand the pathomechanisms of differential impacts of heat stress on kidney function of agricultural various worker categories.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"243-252"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11885958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition Compass: Guiding Patients with Chronic Kidney Disease Across Ages.","authors":"Sukanya Govindan, Arpana Iyengar, Subashri Mohanasundaram, P S Priyamvada","doi":"10.25259/IJN_222_2024","DOIUrl":"10.25259/IJN_222_2024","url":null,"abstract":"<p><p>Malnutrition, encompassing both undernutrition and overnutrition, is prevalent among patients with chronic kidney disease (CKD). It is influenced by a myriad of factors, including dietary restrictions, metabolic irregularities, inflammation, and comorbidities. It leads to increased morbidity, mortality, and diminished quality of life. In children, malnutrition hinders growth and development, particularly during infancy and early childhood. This article provides a comprehensive overview of current terminologies delineating undernutrition and overnutrition in CKD, and discusses age-specific nutritional assessment tools. It delves into macro- and micronutrient prescriptions tailored for both adults and children with CKD, emphasizing special considerations such as low and very low protein diets. A focus on the nutrient content of Indian foods is also provided, alongside available nutritional supplements, with insights into enteral feeding and the fortification of feeds in young children. Distinctive nuances in nutritional therapy between adults and children are elucidated throughout the article, drawing upon established guidelines, including Kidney Disease Outcomes and Quality Initiative (KDOQI) 2009 and 2020 and KDIGO CKD 2024 guidelines as well as Pediatric Renal Nutrition Task Force clinical practice recommendations, to inform dietary management strategies for individuals across the lifespan living with CKD.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"187-197"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Anemia in Dialysis-Dependent Chronic Kidney Disease: Systematic Review and Meta-Analysis of Randomized Controlled Trials.","authors":"Jyoti Tyagi, Manveen Kaur, Samiksha Ingale, Raja Ramachandran, Priti Meena, Divya Bajpai, Soumyadeep Bhaumik","doi":"10.25259/ijn_379_23","DOIUrl":"10.25259/ijn_379_23","url":null,"abstract":"<p><p>Hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) are oral drugs for patients with renal anemia. This study aimed to synthesize evidence on HIF-PHIs for anemia in dialysis-dependent chronic kidney disease (DD-CKD) patients. We searched PubMed, CINAHL, and Cochrane Central Register of Controlled Trials databases and trial registries for randomized controlled trials (RCTs) reporting HIF-PHIs versus erythropoietin-stimulating agents (ESA) for anemia in DD-CKD patients. Two authors independently conducted screening, data extraction, and assessed risk of bias. We used RevMan 5.3 software for meta-analysis using standard methods. Certainty of evidence was assessed by Grading of Recommendations, Assessment, Development, and Evaluations (GRADE). We included 20 RCTs involving 14,999 patients with anemia of kidney disease. The studies included roxadustat (n = 9), daprodustat (n = 5), vadadustat (n = 2), molidustat (n = 2), enarodustat (n = 1), and desidustat (n = 1). Overall, daprodustat as an alternative to ESAs reported a substantial net benefit while roxadustat showed more damage than benefit as compared to ESAs. While other HIF inhibitors demonstrated little to no difference or small benefit, daprodustat reduces the need for intravenous iron supplementation up to 52 weeks as compared to ESAs [Odds Ratio (OR): 0.77 (95% CI 0.53-1.13); p = 0.18; two studies; 674 participants; moderate certainty evidence]. Roxadustat increased treatment-emergent adverse events up to 6-52 weeks as compared to ESAs [OR: 1.45 (95% CI 1.08-1.96); p = 0.01; six studies; 1715 participants; moderate certainty evidence]. The study provided evidence on the use of HIF-PHIs for treating renal anemia in DD-CKD patients as an alternative to ESAs.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"198-216"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883309/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Peritoneal Dialysis in India is Dying-Is Weaning from the Ventilator Likely?","authors":"Tarun Kumar Jeloka, Narayan Prasad, Amit Gupta","doi":"10.25259/IJN_548_2024","DOIUrl":"10.25259/IJN_548_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"123-126"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883328/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How to Give Dietary Advice to Patients with Kidney Disease?","authors":"Archana Sinha, Narayan Prasad","doi":"10.25259/IJN_139_2024","DOIUrl":"10.25259/IJN_139_2024","url":null,"abstract":"<p><p>Patients with chronic kidney disease (CKD) display a variety of metabolic and nutritional irregularities, with majority of patients already being malnourished before starting dialysis. The screening, assessment and monitoring of nutritional status using an amalgamation of valid, complementary methods is crucial. Early and suitable dietary intervention is vital for preventing, diagnosing and treating malnutrition. All the misconceptions and myths about diet and food need to be resolved. Patient-centric realistic meal plans and dietary counseling are initiated at the early stages of CKD and the commencement of dialysis, with regular follow-ups on an ongoing basis with diet diaries that help prevent malnutrition. This review article will discuss the practical and simple dietary approaches for counseling patients to increase dietary compliance and meet the recommended requirements.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"178-186"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883307/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585562","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Standard and Global Coagulation Tests in Hemodialysis Patients.","authors":"Smita Divyaveer, Sarah Chahal, Madhuri Kashyap, Madhumita Premkumar, Kushal Kekan, Arunima Sen, Kanchan Prajapati, Prabhat Chauhan, Ritika Bansal, Arun Prabhahar, Jasmina Ahluwalia, Narender Kumar, Nabhajit Mallik, Deepy Zohmangaihi, Harbir Singh Kohli","doi":"10.25259/ijn_473_23","DOIUrl":"10.25259/ijn_473_23","url":null,"abstract":"<p><strong>Background: </strong>Chronic kidney disease (CKD) is associated with an increased tendency of bleeding and thrombosis. There are multiple factors that interact with each other to cause either in CKD patients. Conventional or standard coagulation tests (SCT) have several limitations. Global coagulation test (GCT), such as Sonoclot, gives a real-time detailed analysis of coagulation status.</p><p><strong>Materials and methods: </strong>This is a prospective observational cross-sectional study of 50 adult CKD stage 5D (dialysis) patients conducted from January 2020 to January 2022. Clinical details were noted and blood samples were taken for conventional and global coagulation tests prior to dialysis. Correlation between SCT and GCT as well as clinical hemostatic events was analyzed.</p><p><strong>Results: </strong>Fifty patients were enrolled. Bleeding and thrombosis occurred in 7 and 5 patients, respectively. There was a significant correlation between some SCT and GCT parameters. None of the SCT parameter derangement was associated with any thrombotic episodes except increased fibrinogen level which was associated with thrombotic events. On the contrary, patients with hypocoagulability according to SCT actually had thrombotic events. Parameters of GCT, such as clot rate, time to peak, and platelet function were significantly associated with thrombotic episodes.</p><p><strong>Conclusion: </strong>SCT and GCT parameters do not correlate with each other. SCT is not associated with clinically significant bleeding and thrombotic events. Some GCT parameters are associated with thrombotic events. GCT are real time and are better than SCT to reflect the coagulation status in patients on dialysis.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"259-264"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883323/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anti-Glomerular Basement Membrane Antibody Disease: Clinicopathologic Profile and Outcomes.","authors":"Manoj Kumar, Varadharajan Jayaprakash, Natarajan Gopalakrishnan, Thanigachalam Dineshkumar, Ramanathan Sakthirajan, Jeyachandran Dhanapriya","doi":"10.25259/IJN_110_2024","DOIUrl":"10.25259/IJN_110_2024","url":null,"abstract":"<p><strong>Background: </strong>Anti-glomerular basement membrane antibody disease is a rare autoimmune disease caused by antibodies to α3 chain of type 4 collagen. Patients presenting with severe renal involvement requiring dialysis have poor response to treatment.</p><p><strong>Materials and methods: </strong>We conducted a retrospective and prospective study at Institute of Nephrology, Madras Medical College, Chennai, India by analyzing the data of patients with biopsy-proven anti-GBM antibody disease treated from January 2013 to December 2019.</p><p><strong>Results: </strong>There were 2,949 kidney biopsies in the study period and 92 showed crescentic glomerulonephritis (GN). Of those, 20 patients (10 males) had anti-GBM antibody disease. Mean age was 40.75 ± 14.75 years. Rapidly progressive renal failure was the most common mode of presentation (95%); five (25%) patients had diffuse alveolar hemorrhage (DAH) and nineteen patients (95%) required dialysis at presentation. Seven patients (35%) were positive for anti-neutrophil cytoplasmic antibody (anti-myeloperoxidase in six and anti-proteinase 3 in one). Of the twelve patients (60%) who received immunosuppression (cyclophosphamide, steroids, and plasma exchange), two patients (10%) attained remission, and two patients (10%) expired due to sepsis. Crescentic GN was the predominant pathology in kidney biopsy in 19 patients (95%). Mesangial hypercellularity with deposition of IgA and C3 in mesangium was present in one patient.</p><p><strong>Conclusion: </strong>In our study, anti-GBM antibody disease accounted for 21.7% of crescentic GN. Majority of patients presented late, requiring dialysis. Patient survival was 90%, while renal survival was only 10%. One patient had co-occurrence of IgA nephropathy with anti-GBM antibody disease.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"265-269"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585556","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitors for Treatment of Anemia in Chronic Kidney Disease: Guidelines for South Asia.","authors":"Abi Abraham, Alan Almeida, Anil Kumar Bhalla, Arpita Ray Chaudury, Arup Ratan Dutta, Ashwani Gupta, Bharat Shah, Biswajeet Roy, Budithi Subbarao, Chula Herath, Cynthia Amrutha, Dibya Singh Shah, Dilip Kumar Pahari, Dinesh Khullar, Divya Bajpai, Guruvulu Venkata Simaladinne, Jatin Kothari, Jyoti Tyagi, Inika Sharma, Kamal Shah, Manish Malik, Manisha Sahay, Manjuri Sharma, Manoj Gumber, Melemadathil Sreelatha, Mangesh Tiwaskar, Manveen Kaur, Muhammed Rafiqul Alam, Natarajan Gopalakrishnan, Narayan Prasad, Nivedita Kamath, Priti Meena, Prem Prakash Varma, Pratik Das, Raja Ramachandran, Raj Kumar Sharma, Reena George, Salil Jain, Samiksha Ingale, Sandeep Moola, Sandip Kumar Bhattacharya, Sanjay D'Cruz, Sanjeev Gulati, Sanjiv Saxena, Sankaran Sundar, Shivnarayan Acharya, Shyam Bihari Bansal, Siddini Vishwanath, Sishir Gang, Sree Bhushan Raju, Sreejith Parameswaran, Soumyadeep Bhaumik, Sri Venkata Madhu, Suceena Alexander, Tarun Jeloka, Tarun Kumar Saha, Tonmoy Das, Urmila Anandh, Umesh Khanna, Virat Bhatia, Vishal Saxena, Vijay Kher, Vasundhara Raghavan, Vivekanand Jha","doi":"10.25259/ijn_389_23","DOIUrl":"10.25259/ijn_389_23","url":null,"abstract":"<p><p>This guideline addresses the use of hypoxia-inducible factor prolyl hydroxylase inhibitors (HIF-PHIs) in patients >18 years with chronic kidney disease (CKD) and anemia in South Asia (Bangladesh, Bhutan, Nepal, India, Pakistan, Sri Lanka). It also summarizes recommendations for anemia treatment for individual HIF-PHI molecules under two categories: dialysis-dependent and non-dialysis-dependent CKD patients. The recommendations do not apply to pediatric (≤12 years) and adolescent (12 to 18) patients or those with primary anemia or anemia secondary to other causes such as blood loss, cancer (any type), polycystic kidney disease and infectious diseases.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"129-167"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Jogger's Nephritis\" After Pilgrimage.","authors":"Lia Sarah Anish, Aishwarya P Lakshmi, S Mathini, R Ram","doi":"10.25259/IJN_480_2024","DOIUrl":"10.25259/IJN_480_2024","url":null,"abstract":"","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"313-314"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585554","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Glomerulonephritis After Renal Transplatation in South Asia - Single Center Experience Over 5 Decades.","authors":"Sabina Yusuf, Suceena Alexander, Sanjeet Roy, Grace Rebekah, Elenjickal Elias John, Athul Thomas, Jeethu Joseph Eapen, Vinoi George David, Santosh Varughese","doi":"10.25259/IJN_39_2024","DOIUrl":"10.25259/IJN_39_2024","url":null,"abstract":"<p><strong>Background: </strong>With significant advances in the understanding of transplant immunology and a reduction in rejection rates, significant improvements in kidney allograft survival have been seen. The problem of recurrent and denovo glomerular diseases after transplantation affecting graft outcomes remains and is poorly characterized. This study aimed to analyze the incidence, characteristics, and outcomes of glomerulonephritis (GN) after kidney transplant in the Indian subcontinent.</p><p><strong>Materials and methods: </strong>Data on patients who underwent kidney transplants in our hospital from 1971 to 2018 was analyzed. Patients who had biopsy proven glomerulonephritis after transplant were included in the study. Demographic factors, characteristics of glomerulonephritis after transplant, and patient and graft outcomes were studied.</p><p><strong>Results: </strong>Post-transplant glomerulonephritis was seen in 177 out of 3630 (4.8%) patients. IgA nephropathy (IgAN) was the most common type, followed by focal segmental glomerulosclerosis (FSGS) and thrombotic microangiopathy (TMA). Patients with IgAN and FSGS were younger, and native kidney disease was unknown in the majority (70% in IgAN and 40% in FSGS). Glomerulonephritis was the most common cause of graft loss. A serum creatinine level of ≥2 mg/dL at 1 year post-transplant was significantly associated with the risk of death and graft loss. In addition, the occurrence of glomerulonephritis within a year of transplant and cytomegalovirus (CMV) infection were found to be significant risk factors for death and graft loss, respectively.</p><p><strong>Conclusion: </strong>Post transplant glomerulonephritis can significantly impact patient and graft outcomes. Understanding its etiology and pathogenesis is crucial to enabling its prevention and management and improving the outcomes of kidney transplantation.</p>","PeriodicalId":13359,"journal":{"name":"Indian Journal of Nephrology","volume":"35 2","pages":"270-276"},"PeriodicalIF":0.8,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11883335/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143585561","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}