Journal of Sheikh Zayed Medical College最新文献_第7页

Risk Factors of Esophageal Adenocarcinoma at Karachi, Pakistan 巴基斯坦卡拉奇地区食管腺癌的危险因素分析

Journal of Sheikh Zayed Medical College Pub Date : 2020-07-11 DOI: 10.47883/JSZMC.V11I2.78

Humera Jabeen, S. Shamim, Farheen Danish, Lubna Avesi, Aneela Tabassum, Amin Fahim

{"title":"Risk Factors of Esophageal Adenocarcinoma at Karachi, Pakistan","authors":"Humera Jabeen, S. Shamim, Farheen Danish, Lubna Avesi, Aneela Tabassum, Amin Fahim","doi":"10.47883/JSZMC.V11I2.78","DOIUrl":"https://doi.org/10.47883/JSZMC.V11I2.78","url":null,"abstract":"Background: The esophagus is exposed to various factors being on the beginning of the gastrointestinal tract. Pathologies of esophagus vary from epithelial erosions to deep muscular involvement and from mild inflammation to cancers. \u0000Objective: To determine the risk factors like gender, smoking and gastro esophageal reflux disease for esophageal adenocarcinoma. \u0000Methodology: This comparative cross sectional study was carried out at Pathology department of Al-Tibri Medical College and Dow University of Health Sciences, Karachi, fromApril to September, 2018. After ERC approval 88 human subjects were selected through non-probability sampling using inclusion and exclusion criteria 22 subjects as controls (group-I) and 22 individuals withBarrett’s esophagus (Group-II), 22 patients with dysplasia(Group-III) and 22 known patients of esophageal adenocarcinoma (Group-IV). Risk factors like age, gender involvement, smoking and gastroesophageal reflux disease (GERD) were evaluated among these groups in terms of frequency and percentage, mean and standard deviation. \u0000Results: Overall males were 70 (79.55%) and females were 18(21.45%), similar fractions were observed as smokers and non-smokers and GERD but age ranged different in different study groups and 40 (45.54%) belonged to age range of 51-60 years. Mean age was 43±6, 56±2, 61±4 and 63±3 years, for groups I, II, III and IV respectively (p=0.00). Sex (p=0.1) and smoking (p=0.3) were not significantly associated with esophageal adenocarcinoma whereas, age (p=0.00) and GERD status (p=0.00) were significantly associated with esophageal adenocarcinoma in this study. \u0000Conclusion: We found that age, gastroesophageal reflux disease were significantly associated with development of adenocarcinoma of esophagus in our study.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114407391","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Predictive role of Natural Anticoagulants in Prognosis of Chronic Liver Disease in Pediatric Age Group 天然抗凝剂对儿童慢性肝病预后的预测作用

Journal of Sheikh Zayed Medical College Pub Date : 2020-07-07 DOI: 10.47883/jszmc.v11i01.76

S. Ajmal, Hina Sehar, Saleha Zafar, Saima Farhan, N. Ahmad, M. Riza

{"title":"Predictive role of Natural Anticoagulants in Prognosis of Chronic Liver Disease in Pediatric Age Group","authors":"S. Ajmal, Hina Sehar, Saleha Zafar, Saima Farhan, N. Ahmad, M. Riza","doi":"10.47883/jszmc.v11i01.76","DOIUrl":"https://doi.org/10.47883/jszmc.v11i01.76","url":null,"abstract":"Background: In asymptomatic peadiatric patients, cirrhosis is considered to be compensated, with or without gastroesophageal varices, it may be decompensated. Both Antithrombin III, Protein C and D dimers are sensitive markers of liver disease. \u0000Objective: To determine the frequency of compensated and decompensated cirrhosis in cirrhotic peadiatric patients and compare the status of protein C, Antithrombin lll deficiency and D-dimer in both groups. \u0000Methodology: In this cross sectional study, 80 peadiatric patients suspected to have cirrhosis were included, from November, 2015 to April, 2016, by non-probability convenience sampling. Variables included were; compensated and decompensated chronic liver disease, Antithrombin III, D dimer and Protein C, as natural anticoagulents. Data was analyzed by SPSS 13. \u0000Results: Out of 80 patients, 70 (87.5%) were in the compensated phase of cirrhosis. Mean Antithrombin III showed significant reduction in patients with decompensated cirrhosis (50.0±4.05%) when compared with patients with compensated liver disease (84.52 ±15.36%). Mean Protein C level exhibited also significant reduction in the decompensated patient groups (40±4.7%) when compared with the compensated group of patients (77.92±6.67%). The mean D-dimer levels showed significantly higher levels only in patients with signs of decompensated cirrhosis (840±11.85μg/L) when compared with compensated disease (629±6.29). \u0000Conclusion: Our study concluded that the natural anticoagulants Antithrombin III, Protein C and D dimer, reflect hepatocellular impairment in both compensated as well as decompensated peadiatric patients of cirrhosis. However, these are markedly decreased in decompensated disease except for D dimer. \u0000Key words: Cirrhosis, Anti-thrombin III, Protein C, Protein S, D-dimer.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"30 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-07-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130686194","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Acoustic and Speech Perceptual Evaluation of health related Quality of Life among adults with Chronic Suppurative Otitis Media 慢性化脓性中耳炎成人健康相关生活质量的声学和言语感知评价

Journal of Sheikh Zayed Medical College Pub Date : 2020-06-29 DOI: 10.47883/jszmc.v11i01.84

T. Nomani, A. Rehman, Munaza Hayat, Farhan Akbar, M. A. Anwar, Salma Ambreen Shahab, Muhammad Saad Faisal

{"title":"Acoustic and Speech Perceptual Evaluation of health related Quality of Life among adults with Chronic Suppurative Otitis Media","authors":"T. Nomani, A. Rehman, Munaza Hayat, Farhan Akbar, M. A. Anwar, Salma Ambreen Shahab, Muhammad Saad Faisal","doi":"10.47883/jszmc.v11i01.84","DOIUrl":"https://doi.org/10.47883/jszmc.v11i01.84","url":null,"abstract":"Background: Chronic Suppurative Otitis Media, patients suffer from hearing loss causing communication problems and social withdrawal. \u0000Objective: To assess the acoustic iand speech perceptual evaluation iof health related quality of life among adults iwith Chronic Suppurative Otitis Media. \u0000Methodology: This cross sectional study was performed in ENT/Audiology Departments of District Headquarter Hospital, Hafizabad and Saqib Bashir General Hospital, Hafizabad, from March, 2015 to September, 2018, after the approval of synopsis. Covenient sampling method was used to induct 101 patients with Chronic Suppurative Otitis Media meeting inclusion criteria. Pure itone audiometry and speech audiometry were performed. A statement based questionnaire COMOT-15 was used to measure the scoring difference in cases. \u0000Results: The mean age of patients was 33±10 years and 53 (52.47%) were male. Out of 101 patients,the speech deficit was moderate in 7 (6.93%) patients, moderately severe in 19 (18.81%), severe in 42 (41.58%) and speech deficit was profound in 33 (32.67%) patients. There were 10 (9.90%) patients with conductive type of hearing loss, 91 (90.09%) with mixed type of hearing loss. Chronic Otitis Media Outcome Test-15 (COMOT-15), overall score was between 41-50 in 11 (10.89%) patients, 51-60 in 62 (61.38%) patients and Chronic Otitis Media Outcome Test-15 (COMOT-15) overall score was between 61-70 in 28 (27.72%) patients. \u0000Conclusion: This study showed that speech deficit was severe to profound in majority of patients with Chronic Suppurative Otitis Media. Mixed type of hearing loss is commonest type of deafness and very high scores were observed on COMOT-15 scale, which reflects a significant impairment in quality of life.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129919901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A Clinical Practice Audit of Laparoscopic Cholecystectomy at our Institute 我院腹腔镜胆囊切除术的临床审计

Journal of Sheikh Zayed Medical College Pub Date : 2020-06-18 DOI: 10.47883/JSZMC.V11I01.15

Noreen Kousar, M. Ghafoor, Muhammad Iqbal, M. Tariq

{"title":"A Clinical Practice Audit of Laparoscopic Cholecystectomy at our Institute","authors":"Noreen Kousar, M. Ghafoor, Muhammad Iqbal, M. Tariq","doi":"10.47883/JSZMC.V11I01.15","DOIUrl":"https://doi.org/10.47883/JSZMC.V11I01.15","url":null,"abstract":"ABSTRACT \u0000Background: Laparoscopic cholecystectomy has replaced open surgery in the treatment of symptomatic cholecystolithiasis. \u0000Objective: To evaluate the clinical practices and outcome of laparoscopic cholecystectomy at our institute. \u0000Methodology: This was a cross sectional study, conducted at Surgical Unit II, Sheikh Zayed Hospital, Rahim yar khan, from November 2018 to October 2019. Sample size: 100 patients undergoing standard laparoscopic cholecystectomy selected by non probability sampling. All the patients of laparoscopic cholecystectomy during the study period having a clinical diagnosis of acute and chronic cholecystitis were included, whereas patients who had previously undergone midline abdominal operations, ventral hernias, with evidence of common bile duct pathology, having bleeding disorders and hepatitis were excluded. Study variables were operating time, duration of hospital stay, frequency of operative and post-operative complications. \u0000Results: There were 85 females and 15 males. Mean age was 40 ± 1.2 years. In this study, 68% patients were having chronic cholecystitis due to cholelithiasis whereas 32% were having acute cholecystitis. Abdominal ultrasound showed multiple stones in 82% and single stone in 18% patients. Adhesions in 30%, Mucocele in 1% and empyema in 2% patients was reported. Gall bladder was perforated in 12% patients and 8% patients converted to open procedure. The mean operative time for laparoscopic cholecystectomy was 71.2+ 2.6 minute. The post operative complications were; wound infection in 4%, shoulder pain 1% and surgical emphysema 1%. The mean hospital stay was 1.38 days. \u0000Conclusion: Laparoscopic Cholecystectomy proved a safe procedure in term of operative and post operative complications in our setup.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"18 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"121981780","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Morphological and Biochemical Analysis of Gallstones in Lahore, Pakistan. 巴基斯坦拉合尔地区胆结石形态及生化分析。

Journal of Sheikh Zayed Medical College Pub Date : 2020-06-17 DOI: 10.47883/JSZMC.V11I01.25

Anam Zahra, Muhammad Zain ul Abadin, U. Rahman, S. H. Changazi, S. Bhatti, U. I. Butt, Mustansar Iqbal

{"title":"Morphological and Biochemical Analysis of Gallstones in Lahore, Pakistan.","authors":"Anam Zahra, Muhammad Zain ul Abadin, U. Rahman, S. H. Changazi, S. Bhatti, U. I. Butt, Mustansar Iqbal","doi":"10.47883/JSZMC.V11I01.25","DOIUrl":"https://doi.org/10.47883/JSZMC.V11I01.25","url":null,"abstract":"Introductions: Gallstones are formed within the gallbladder or in biliary tract. They can be termed as cholesterol stones whose major constituent is cholesterol or pigment stones which mainly are composed of bilirubin or there can be calcium and oxalate stones too. The aim of this study was to establish the composition of stones found within the gallbladder after cholecystectomy for symptomatic gallstones. \u0000Material and Methods: This study was conducted in a tertiary care hospital (Services Hospital Lahore) from 1st August-2017 to 30th June-2018. After examining the physical characteristics of the stones (color, number, shape and surface) were analyzed by semi- quantitative colorimetric analysis. Demographic data, morphology of stones and the percentage different chemical components were noted on pre-established performa and analyzed by SPSS software version 22. \u0000Results: A total 200 people were recruited in the study. The mean age of the patients was 37.82 ± 11.67 years. 90% patients were female and 10% patients were males. 10% cases had solitary stone while 90% cases had multiple stones. 25% patients had light brown stones, 30% had dark brown stones, 35% had gray stones and 10% had black stones. 85% cases had mixed stones whereas 15% had cholesterol stones. The mean percentages by weight of calcium, cholesterol, iron, phosphorus and bilirubin were 50± 10.59%, 27.45± 11.57%, 14.3± 6.28%, 13.25± 8.36% and 5.1± 2.46% respectively. \u0000Conclusion: It is concluded that gallstone disease is common in third decade of life and mixed stones is the most frequent variety of gallstones and calcium is the most abundant substrate of the gallstone","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123039465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Spectrum of Oral Lesions in a Tertiary Care Teaching Hospital 三级护理教学医院口腔病变谱

Journal of Sheikh Zayed Medical College Pub Date : 2020-06-03 DOI: 10.47883/jszmc.v10i4.55

S. Tariq, Y. Khan, Uzma Shaheen, A. R. Qaisrani, A. Rasheed, Mulazim Hussain

{"title":"Spectrum of Oral Lesions in a Tertiary Care Teaching Hospital","authors":"S. Tariq, Y. Khan, Uzma Shaheen, A. R. Qaisrani, A. Rasheed, Mulazim Hussain","doi":"10.47883/jszmc.v10i4.55","DOIUrl":"https://doi.org/10.47883/jszmc.v10i4.55","url":null,"abstract":"Bbackground: Oral Lesions are increasingly reported in literature now a days. Objective: To determine the spectrum of oral lesions reporting at tertiary care hospital in Lahore. Methodology: This study was conducted in the department of Pathology, University of Lahore teaching hospital from March 2018 to March 2019. It was a descriptive cross-sectional study. Study duration was 1-year and total 34 cases were included in the study. For categorical data frequencies and percentages were calculated and data was presented in tables, bar and pie charts. Microphotographs were also illustrated. Results: A total number of 34 cases of oral lesions, were included in the present study. Age ranged from 8 years to 76 years with a mean of 30.39 years. Out of total 34 cases, 16 (47.06%) were females and 18 (52.94%) were males. Female to male ratio was 0.8:1. In patients above 25 years of age, 6 (17.6%) were neoplastic and 28 (82.4%) were non-neoplastic. Out of 6 neoplastic lesions, 5 (83.3%) were in males and 1 (16.6%) was in female. The sites of involvement of various lesions included buccal mucosa 12 (35%), followed by mandible 11 (33.3%), lip 3 (8.8%), palate 3 (8.8%) and maxilla 5 (14.7%). Conclusion: Benign lesions are more common and malignant lesions are only found in older patients with squamous cell carcinoma the commonest oral lesion noted in this study. Histopathological typing and differentiation of neoplastic from non-neoplastic lesions is mandatory for the proper management of patients.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"13 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-06-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"125431030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 2

Nanotechnology – A promising prospect for cancer diagnostics and therapeutics 纳米技术-癌症诊断和治疗的一个有希望的前景

Journal of Sheikh Zayed Medical College Pub Date : 2020-05-30 DOI: 10.47883/jszmc.v10i4.90

引用次数: 0

Comparison of Outcome with or without Peritoneum Closure in Females undergoing Elective Caesarean Section 女性择期剖宫产术后腹膜闭合与不闭合的效果比较

Journal of Sheikh Zayed Medical College Pub Date : 2020-05-13 DOI: 10.47883/jszmc.v10i4.75

Rabbia Ashraf, Saira Fayyaz, Farah Siddique, H. Masood, Aqeela Zahra, A. Ahsan

引用次数: 0

Incidental Finding of Raised Random Blood Sugar in Cases Presenting with Erectile Dysfunction 在出现勃起功能障碍的病例中偶然发现随机血糖升高

Journal of Sheikh Zayed Medical College Pub Date : 2020-05-10 DOI: 10.47883/jszmc.v10i4.65

Farhan M Qureshi, I. Hussain, Shayan Rahim Kanjoo

{"title":"Incidental Finding of Raised Random Blood Sugar in Cases Presenting with Erectile Dysfunction","authors":"Farhan M Qureshi, I. Hussain, Shayan Rahim Kanjoo","doi":"10.47883/jszmc.v10i4.65","DOIUrl":"https://doi.org/10.47883/jszmc.v10i4.65","url":null,"abstract":"Background: Background: Erectile dysfunction is quite widely present in our populations, as men wish to maintain sexual desire and function despite aging. Objective: To determine the frequency of raised random blood sugar in cases presenting with erectile dysfunction. Methodology: Study design; Cross sectional study. Place of study; Department of Urology, Sheikh Zayed Hospital, Rahim Yar Khan. Duration; January to December 2018. In this study, all the consecutive male cases, with age 20 years or more, presenting with erectile dysfunction of at least one month or more, were included. Raised BSR was labelled when there was a level of random blood sugar was more than 140 mg/dl. Results: In the present study, there were 100 males with erectile dysfunction, with mean age of 48.67±5.13 year. Raised BSR was seen in 24 (24%) out of 100 cases. There was no significant difference in terms of age, and BMI in both groups, with p values of 0.87 and 0.91 respectively. Raised BSR was significantly high in cases that had duration of erectile dysfunction more than 3 months where it was seen in 21 (31.34%) of cases as compared to 3 (9.09%) of cases with duration less than this with p value of 0.01. Conclusion: Raised random blood sugar is common in cases with erectile dysfunction and seen in every one out of four cases and is significantly high in cases with duration of erectile function more than 3 months.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129811010","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

Comparison of Outcome of Early Versus Delayed Hemisoleus Flap Coverage of Open Wound Over the Middle One Third of Leg after Fracture of Tibia 胫骨骨折后小腿中三分之一开放性创面早期与延迟半骨瓣覆盖效果比较

Journal of Sheikh Zayed Medical College Pub Date : 2020-05-09 DOI: 10.47883/jszmc.v10i4.83

Muhammad Usman, Muhammad Saad Faisal, M. A. Channa, Barira Bashir

{"title":"Comparison of Outcome of Early Versus Delayed Hemisoleus Flap Coverage of Open Wound Over the Middle One Third of Leg after Fracture of Tibia","authors":"Muhammad Usman, Muhammad Saad Faisal, M. A. Channa, Barira Bashir","doi":"10.47883/jszmc.v10i4.83","DOIUrl":"https://doi.org/10.47883/jszmc.v10i4.83","url":null,"abstract":"Background: Fracture of tibia are quite common and wound coverage is usually needed in its management. Objective: To compare the outcome of early versus delayed hemisoleus flap coverage, of open wound over the middle one third of leg after fracture of tibia. Methodology: This randomized controlled trial, was conducted over a year, in the Department of Plastic Surgery, Nishtar Hospital, Multan, including 240 patients, with open tibial shaft fractures, who had early (Group A) or delayed coverage (Group B). Both the groups were compared for outcome parameters (excellent, good, fair and poor) used by Haq et al, at six weeks after the procedure. Chi-square test was applied for test of significance. P-value < 0.05 was considered significant. Data was analyzed with the help of SPSS version 20. Results: In group A, excellent, good, fair and poor outcome, were seen in 48 (40%), 45 (37.5%), 25 (20.8%) and 2 (1.7%) patients, respectively. In group B, excellent, good, fair and poor outcome, were seen in 0 (0%), 60 (50%) patients, 18 (15%) and 42 (35%) patients, respectively. The results were statistically significant on comparison of the two groups (p <0.05). Conclusion: Early coverage of open tibial shaft fracture results in higher frequency of excellent and good outcome as compared to delayed coverage.","PeriodicalId":171893,"journal":{"name":"Journal of Sheikh Zayed Medical College","volume":"84 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2020-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114570119","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0