Egyptian Journal of Dermatology and Venereology最新文献

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Hemostatic comedone extraction using a customized micropipette tip and topical hypertonic saline 使用定制的微移液管尖端和局部高渗盐水止血拔粉刺酮
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-09-01 DOI: 10.4103/ejdv.ejdv_35_22
Muhammed Mukhtar
{"title":"Hemostatic comedone extraction using a customized micropipette tip and topical hypertonic saline","authors":"Muhammed Mukhtar","doi":"10.4103/ejdv.ejdv_35_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_35_22","url":null,"abstract":"","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46625121","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
Effect of chronic skin disease on female sexual function (FSF) among married Egyptian women 埃及已婚妇女慢性皮肤病对女性性功能的影响
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-09-01 DOI: 10.4103/ejdv.ejdv_48_22
Tarek El-Ammawi, Rasha Abdel-Aziz, Doaa Taha, Sahar Mohammed
{"title":"Effect of chronic skin disease on female sexual function (FSF) among married Egyptian women","authors":"Tarek El-Ammawi, Rasha Abdel-Aziz, Doaa Taha, Sahar Mohammed","doi":"10.4103/ejdv.ejdv_48_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_48_22","url":null,"abstract":"Background Female sexual dysfunction (FSD) is a term used to describe various sexual problems, such as low desire or interest, diminished arousal, orgasmic difficulties, and dyspareunia. Objectives The aim of the present study was to determine the effect of chronic skin disease on female sexual function among married Egyptian females as well as the prevalence of FSD among them and its effect on their husbands. Patients and methods The study was conducted on 300 sexually active married Egyptian women attending the Dermatology Outpatient Clinic of Minia University Hospital and Kom Elshokafa Clinic (Alexandria). All women were asked to fill out the female sexual function index sheet using the Arabic validated translated version of it. Those with FSD were asked about its effect on their husbands. Results We reported that 234 (78%) women with chronic skin disease had sexual dysfunction. Despite dysfunction being more common among those who had skin disease, compared with nondysfunction, it was not statistically significantly different among most skin diseases. There was a positive correlation between female’s age and percentage of dysfunction. It was found that only 15.9% of those with FSD showed an effect on their partners in the form of decreased libido. Limitations Limitations include the lack of a control group; the standardization of data, which may not be representative of the community, as they related to specific areas; and being a cross-sectional hospital-based study. Conclusion Our study revealed a high prevalence of FSD (78%) among Egyptian married women with chronic skin disease in both Minia and Kom Elshokafa (Alexandria) districts. However, it was not statistically significantly different among most skin diseases, with affection of only 15.9% of their partners.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43433753","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
Systemic lupus erythematosus masquerading as gangrene - an infrequent presentation 伪装成坏疽的系统性红斑狼疮-罕见的表现
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-09-01 DOI: 10.4103/ejdv.ejdv_42_22
Aditi Singh
{"title":"Systemic lupus erythematosus masquerading as gangrene - an infrequent presentation","authors":"Aditi Singh","doi":"10.4103/ejdv.ejdv_42_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_42_22","url":null,"abstract":"Systemic lupus erythematosus (SLE) is an auto-immune disease affecting multiple organs. Among the cutaneous features, digital gangrene is considered to be very rare, occurring in only 1.3% of SLE patients. It is considered to be due to compromised perfusion of digits secondary to vasculitis, vasospasm and thomboembolism. This is the case report of a 35-year-old female who presented with acute blackish discoloration of toes of both feet associated with pain. She had no other features of SLE. But serology came out positive for SLE. The patient responded well to steroids, hydroxychloroquine, antiplatelet and anticoagulant medications and is currently under follow-up. This case report basically shows us that SLE should be considered as a possible differential diagnosis whenever there is a young patient presenting with digital gangrene without any other medical history.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42256639","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
Thymic stromal lymphopoietin: evaluating its role as a new marker related to presence of psoriasis vulgaris and its severity 胸腺基质淋巴生成素:评价其作为寻常型银屑病存在及其严重程度的新标志物的作用
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-09-01 DOI: 10.4103/ejdv.ejdv_7_23
H. Khaled, Y. Elghobashy, Enas M. El Sayed
{"title":"Thymic stromal lymphopoietin: evaluating its role as a new marker related to presence of psoriasis vulgaris and its severity","authors":"H. Khaled, Y. Elghobashy, Enas M. El Sayed","doi":"10.4103/ejdv.ejdv_7_23","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_7_23","url":null,"abstract":"Background Thymic stromal lymphopoietin (TSLP), a proallergic cytokine, and T cell-derived CD40 ligand (CD40L) may collaborate to increase the production of IL-23 in psoriasis patients. One key cytokine, IL-23, is responsible for the unwarranted immune response in psoriasis sufferers. Aim The current study aims to shed light on the possible role of TSLP as a novel biomarker related to presence of psoriasis vulgaris lesions and its severe forms with exclusion of people with atopic dermatitis, allergic rhinitis, rheumatoid arthritis, graft versus host disease (GVHD), blood diseases and patient on anticoagulant therapy as well as pregnant and lactating females. Patients and methods 40 subjects with psoriasis vulgaris participated in the current case-controlled research, whereas 40 healthy volunteers of similar age and gender served as the control group. The degree and extent of the illness were evaluated utilizing the psoriasis area and severity index (PASI) score. Serum was separated after blood samples from the venous blood of the subjects and control participants were taken. As soon as possible, the serum samples were frozen at −20°C. The Sandwich Enzyme-Linked Immunosorbant Assay (ELISA) was utilized to quantify serum TSLP. Results The case group’s serum TSLP levels rose statistically substantially more than those of the control group. In the cases group, there was a statistically strong positive relation between serum TSLP levels and PASI scores (P: < 0.001). There is a statistically strong positive relation between serum TSLP and patients’ age and illness duration, a statistically substantial rise in blood TSLP values in psoriatic arthritis patients and smokers. Conclusion Patients with psoriasis have higher serum TSLP levels, which are proportional to the disease’s severity.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45158007","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
Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars 自体脂肪干细胞联合二氧化碳激光治疗萎缩性线形疤痕的疗效观察
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-09-01 DOI: 10.4103/ejdv.ejdv_2_23
S. Alashry, Sara Fouad, Hassan Fayed, F. El-Chennawi, Mohammed El-kamel, Ibrahim El-Dessouki, R. Shaat
{"title":"Efficacy of autologous adipose-derived stem cells and fractional carbon dioxide laser in the treatment of atrophic linear scars","authors":"S. Alashry, Sara Fouad, Hassan Fayed, F. El-Chennawi, Mohammed El-kamel, Ibrahim El-Dessouki, R. Shaat","doi":"10.4103/ejdv.ejdv_2_23","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_2_23","url":null,"abstract":"Background Atrophic linear scars are scars that exhibit indentation or depression in the skin below the level of the surrounding tissues. Hyperpigmentation or hypopigmentation may be present. They are often caused by surgery, burns, and trauma. Objective To evaluate the efficacy of autologous adipose-derived stem cells (ADSCs) combined with fractional carbon dioxide (CO2) laser in the treatment of atrophic linear scars. Patients and methods This randomized, controlled preliminary study included 20 patients aged 20–45 years of both sexes with facial atrophic linear scars. The patients were randomized systematically into two groups: group A (combined ADSCs and fractional CO2 laser procedure) and group B (fractional CO2 laser only) of 10 patients each. The scar was evaluated using the Vancouver scar scale, along with a subjective satisfaction questionnaire, and ultrasound skin analysis at baseline and 1 month after the third treatment session. Results All participants completed the study. The mean Vancouver scar scale score improved significantly from 3.60±0.69 to 1.20±0.79 and from 2.20±1.03 to 1.60±0.52 with fractional CO2 laser plus ADSCs and CO2 laser procedure, respectively (P<0.001). However, CO2 laser plus ADSCs was significantly superior. Ultrasound skin examination showed a statistically significant increase in dermal collagen density (thickness) in both groups. Conclusion Our study shows that treatment with CO2 laser exposure plus ADSCs is safe and more effective for atrophic linear scar management than CO2 laser exposure alone.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43761241","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
Orthopedic acne: a rare case of Apert’s syndrome 骨科痤疮:阿伯特综合征的罕见病例
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-01-01 DOI: 10.4103/ejdv.ejdv_21_22
Nidhi Kamra, Ankita Tuknayat, Ruchika Juneja
{"title":"Orthopedic acne: a rare case of Apert’s syndrome","authors":"Nidhi Kamra, Ankita Tuknayat, Ruchika Juneja","doi":"10.4103/ejdv.ejdv_21_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_21_22","url":null,"abstract":"Apert’s syndrome is a type 1 acrocephalosyndactyly syndrome presenting predominantly with craniofacial malformations and syndactyly of the hands and feet. A case presenting to the dermatologist with recalcitrant acne on unusual sites and having preauricular skin tags as a previously undescribed clinical feature is being presented and a review of all the cases in dermatological literature has been evaluated.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46675160","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
Managing patients with vitiligo by narrowband–ultraviolet-B and systemic vitamin D: a pilot study 窄带-紫外线-B和全身维生素D治疗白癜风患者的初步研究
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-01-01 DOI: 10.4103/ejdv.ejdv_14_22
Manal Alsabbagh, A. Kassim
{"title":"Managing patients with vitiligo by narrowband–ultraviolet-B and systemic vitamin D: a pilot study","authors":"Manal Alsabbagh, A. Kassim","doi":"10.4103/ejdv.ejdv_14_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_14_22","url":null,"abstract":"Background The role of vitamin D in autoimmune disorders in general and in vitiligo in specific has drawn the attention of many authors recently. Topical vitamin D is known to help in restoring pigmentation in vitiligo. The effect of vitamin D deficiency in vitiligo is still not fully understood. Aim To examine the effect of correcting vitamin D deficiency on the clinical improvement of vitiligo. Setting and design A randomized clinical trial where patients attending the Dermatology Clinic and diagnosed with vitiligo were invited to participate. Patients and methods In all, 26 patients with vitiligo and vitamin D deficiency were recruited, and by simple randomization, they were assigned into one of the 12-week therapeutic groups: a combined therapy of narrowband–ultraviolet-B (NB–UVB) and oral vitamin D, and a monotherapy of oral vitamin D or a monotherapy of NB–UVB. Serum level of vitamin D was measured at three occasions; before and after treatment, and at onset of repigmentation. Statistical analysis: SPSS was used for statistical analysis; A P value of less than 0.05 was considered as statistically significant. Results Patients on a combined therapy of NB–UVB and oral vitamin D required the shortest time for repigmentation (2.4 weeks) compared with monotherapy of vitamin D (4.8 weeks) or phototherapy (6.4 weeks) (P<0.05). However, the relationship between serum vitamin D level and onset of repigmentation was insignificant. Conclusions Replacement of vitamin D might positively influence the course of vitiligo management when combined with phototherapy. Further studies are required to confirm and identify the exact role vitamin D.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46429025","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
Prevalence and characteristics of psoriasis among a sample of preparatory school students in rural Egypt: an exploratory study 埃及农村预科生银屑病的患病率和特征:一项探索性研究
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-01-01 DOI: 10.4103/ejdv.ejdv_2_22
M. El-Komy, K. Sayed, E. El-Desouky, E. Tawfeek, Nesreen M. Aboraia
{"title":"Prevalence and characteristics of psoriasis among a sample of preparatory school students in rural Egypt: an exploratory study","authors":"M. El-Komy, K. Sayed, E. El-Desouky, E. Tawfeek, Nesreen M. Aboraia","doi":"10.4103/ejdv.ejdv_2_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_2_22","url":null,"abstract":"Background/objectives The prevalence of psoriasis shows a worldwide geographic variation ranging from 0 up to 11.8%. This reflects the fact that psoriasis is a complex disease influenced by both genetic and environmental factors. The prevalence of psoriasis in children younger than 18 years of age was reported to be 0.40%; however, data about its true prevalence among children in Egypt and the Middle East region are scanty, especially among younger age groups living in rural areas. This work was performed to explore the prevalence and characteristics of psoriasis among a sample of preparatory school students in a rural community in Fayoum, Egypt. Patients and methods This cross-sectional study included 3061 preparatory school students with ages between 13 and 15 years from five rural public preparatory schools in Fayoum, Sinouris rural district. The demographic and disease-related data were collected by an assisted self-administrated questionnaire sheet. Clinical examination of all recruits was performed, and disease data for patients with psoriasis were recorded, including extent of the disease and psoriasis severity using the psoriasis area and severity index score. Results The prevalence of psoriasis was 0.1% among all of the examined students in the study, with a female-to-male ratio of 3 to 1. The most important triggering factor was changes in seasons and climate, as 50% of the patients worsened in winter. The extent and severity of psoriasis among affected children was mild. Conclusion The prevalence and genetic background of psoriasis was low with only mild forms of psoriasis identified among rural preparatory school students in Fayoum, Sinouris district.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48971498","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
Evaluation of virtual dermatology clinic experience during coronavirus disease 2019 pandemic, advantages, and disadvantages 2019冠状病毒病大流行期间虚拟皮肤科诊所体验的评估、优势和劣势
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-01-01 DOI: 10.4103/ejdv.ejdv_8_22
Eman Almukhadeb, Hend Alotaibi, A. Alturki, Asma AlKheraiji, Amal AlBalbessi, A. Bukhari
{"title":"Evaluation of virtual dermatology clinic experience during coronavirus disease 2019 pandemic, advantages, and disadvantages","authors":"Eman Almukhadeb, Hend Alotaibi, A. Alturki, Asma AlKheraiji, Amal AlBalbessi, A. Bukhari","doi":"10.4103/ejdv.ejdv_8_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_8_22","url":null,"abstract":"Introduction During the current lockdown due to the coronavirus disease 2019 (COVID-19) pandemic, the healthcare system should be modified to reach out to a large number of patients with effective service. Virtual clinics are one possible solution to the challenges healthcare systems face worldwide during the COVID-19 pandemic. Aim To evaluate the experience of the virtual clinic in Dermatology Department at King Khaled University Hospital and to evaluate its advantages and disadvantages, and whether or not this service is practical to apply in the future. Patients and methods To assess the patients’ attitude toward virtual clinics, 1220 patients were offered a phone consultation during May 2020. A questionnaire was drafted with 23 questions sent to all the patients via cellular text. Seven of these questions were related to patient demographics. The remaining questions assessed patient satisfaction, occupational efficiency, and quality of care. Statistical analysis was performed using R v 3.6.3. Sociodemographic characteristics were included as independent variables. Ordinal logistic regression was used to assess patient satisfaction. Multivariate logistic regression was used to assess factors associated with satisfaction. Results Only 115 patients responded to the survey. About 34.8% of them found virtual clinics more comfortable compared with face-to-face visits, and 65.2% were satisfied with the care received through these clinics. However, 34.8% of the patients could not know the appropriate treatment, and 37.4% thought they did not receive all the needed information about their health condition. Overall, 71.3% of the patients were satisfied with the provided diagnosis. The most common reason for nonsatisfaction with virtual clinics was the lack of clinical examination (62.39%) and difficulty communicating with the physician (42.94%). Conclusion Virtual dermatology clinics can provide satisfactory dermatology care services to the patients during COVID-19 and can reduce the risk of exposure and transmission of the virus. These services have optimal occupational efficiency, patient-satisfaction rate, and quality of care.","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48954925","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
Do Egyptian children with beta-thalassemia major have specific cutaneous manifestations? A cross-sectional study 患有-地中海贫血的埃及儿童是否有特定的皮肤表现?横断面研究
IF 0.4
Egyptian Journal of Dermatology and Venereology Pub Date : 2023-01-01 DOI: 10.4103/ejdv.ejdv_32_22
Aya Y Badran, Mostafa M. Embaby, N. Farag, E. S. Abdel‐Karim
{"title":"Do Egyptian children with beta-thalassemia major have specific cutaneous manifestations? A cross-sectional study","authors":"Aya Y Badran, Mostafa M. Embaby, N. Farag, E. S. Abdel‐Karim","doi":"10.4103/ejdv.ejdv_32_22","DOIUrl":"https://doi.org/10.4103/ejdv.ejdv_32_22","url":null,"abstract":"","PeriodicalId":40542,"journal":{"name":"Egyptian Journal of Dermatology and Venereology","volume":null,"pages":null},"PeriodicalIF":0.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"70716131","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
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