Asian Journal of Medical Sciences最新文献

{"title":"Study of acute kidney injury in children with nephrotic syndrome in a rural tertiary care hospital","authors":"Babita Khichar, Rakhi Jain, Meetu Yadav","doi":"10.3126/ajms.v15i5.62711","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62711","url":null,"abstract":"Background: Acute kidney injury (AKI) is a common comorbidity in critically ill children and is associated with an increased risk of morbidity and mortality in children with nephrotic syndrome. The etiology of AKI in nephrotic syndrome is complex and multifactorial.\u0000Aims and Objectives: To determine the proportion, risk factors, and outcomes of patients with AKI in children hospitalized with nephrotic syndrome.\u0000Materials and Methods: This cross-sectional study was done on children between 1 month and 14 years of age attending the pediatric department for 1 year from October 2020 to June 15, 2022. Detailed history, physical examination, and investigations were done in children with nephrotic syndrome as per pro forma. Information was collected on demographic variables, vital signs, anthropometry, diagnosis, comorbidities, therapies, presence of hypovolemia, sepsis or shock, use of diuretics or nephrotoxic medications, need for oxygen, mechanical ventilation, vasopressors or renal replacement therapy, length of hospital stay, and outcome at discharge. For those children having AKI, clinical outcomes were measured in terms of duration of hospital stay, recovery of S.creatinine, and urine output.\u0000Results: A total of 64 patients with nephrotic syndrome were enrolled in this study. Fifteen patients had AKI (23.4%) among children with nephrotic syndrome. The most common etiology being sepsis accounting for 4 out of 15 (26.7%) of total cases followed by acute respiratory distress syndrome (13.3%), nephrotoxic medications (13.3%), renal parenchymal disease (13.3%), Post-streptococcal glomerulonephritis (13.3% each) and Sickle cell disease with nephritis and acute fulminant hepatitis (6.7%). There was significantly more mortality among subjects with stage 2 (14.3%) and 3 (14.3%) kidney disease.\u0000Conclusion: AKI is common in our children with nephrotic syndrome and the main risk factors of AKI include sepsis, gross hematuria, urinary tract infections, peritonitis, and exposure to potentially nephrotoxic medications. There is a need to identify the patients with nephrotic syndrome at risk of AKI and apply strategies to prevent AKI in focused at-risk groups.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"16 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141034305","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}

{"title":"Prevalence of different gallbladder pathologies and usefulness of mucin histochemistry in early diagnosis of metaplasia and carcinoma of gallbladder","authors":"Joydip Sen, S. Chakrabarti, Urvee Sarkar, Saugata Kumar Bhattacharya, R. Mustaphi, Dr.Ruplekha Mitra, Associate Professor Mustaphi","doi":"10.3126/ajms.v15i5.61974","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.61974","url":null,"abstract":"Background: Non-neoplastic and neoplastic diseases of gallbladder are most prevalent in northern and north-eastern states of Uttar Pradesh, Bihar, Orissa, West Bengal, and Assam in India. Chronic cholecystitis, the most common pathology of gallbladder is often associated with metaplasia of epithelium, leading to increased susceptibility to malignant transformation. Along with histopathological examination, mucin histochemistry is useful in early detection of metaplasia and thereby predicting metaplasia-dysplasia-carcinoma sequence.\u0000Aims and Objectives: The objective of this study was to estimate the prevalence of neoplastic and non-neoplastic diseases of gallbladder and to determine the usefulness of mucin histochemistry in early diagnosis of metaplasia and carcinoma of gallbladder.\u0000Materials and Methods: A cross-sectional observational study was conducted in R. G. Kar Medical College, Kolkata, over a period of 18 months. Total 401 cholecystectomy specimens were studied. In every case, following sequence of examinations was performed-gross examinations, histopathological examination, and mucin histochemistry.\u0000Results: All the available information was meticulously documented in tables and charts, software was used to calculate the statistical significance and efficacy of mucin histochemistry as a diagnostic tool.\u0000Conclusion: We found that mucin histochemistry is statistically significant and has positive predictive value in early diagnosis of metaplasia and carcinoma of gallbladder.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"222 S721","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141039857","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}

{"title":"Netiquette and social media engagement of doctors: A renaissance in health-care delivery","authors":"Madhavi Gajula, Bhanupriya S Pande, Bhuvana Gajula, Shwetha Hariba","doi":"10.3126/ajms.v15i5.62469","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62469","url":null,"abstract":"Background: Netiquette is the term used for online etiquette or Internet etiquette. It refers to a set of guidelines, acceptable for communication. With the advent of the pandemic and online taking the major stage for discharging the majority of professional duties, proper netiquette practices among professionals are the basic necessity.\u0000Aims and Objectives: The aims and objectives of the study are to assess the knowledge regarding netiquette and its practices among health-care professionals (HCPs) and to determine the factors associated with social media engagement among doctors.\u0000Materials and Methods: A cross-sectional observational study was conducted for 2 months, consisting of a total of 64 participants. A pre-tested, semi-structured questionnaire was used to collect data on netiquette and its practices, the professional involvement of health-care personnel in delivering health care, and their encounter with online trolls and harassment.\u0000Results: On analysis, it was found that 74.3% had knowledge about netiquette and its practices, however, very few had knowledge about cyberspace usage. Around 68.3% of the participants were unaware of the American Medical Association social media policy for HCPs, guiding the Internet usage for discharging their professional duties. Only 29.7% observed proper netiquette practices to avoid being cyber-bullied. Very few of the study participants faced online troll and harassment and they chose to reply to troll by facts rather than staying quiet. An in-depth study can be done by creating an awareness program as an intervention.\u0000Conclusion: Netiquette and its practices are the key to online consultations and practices among HCPs. There is a need to create awareness among them by conducting workshops on the same.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"100 3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141057018","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}

{"title":"Comparative evaluation of sequential and premixed administration of hyperbaric bupivacaine with fentanyl in subarachnoid block for lower limb surgeries – A randomized prospective study","authors":"Jaya Subbu, Vikram M. Shivappagoudar, Bindu George, Karthik Jain","doi":"10.3126/ajms.v15i5.62574","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62574","url":null,"abstract":"Background: Subarachnoid block is the most commonly used anesthetic technique for lower limb surgeries. Fentanyl is very often combined with hyperbaric bupivacaine as an adjuvant. This study was conducted to compare the block characteristics by administrating bupivacaine and fentanyl in a sequential and premixed manner.\u0000Aims and Objectives: The primary objective was to compare the effects of hyperbaric bupivacaine and fentanyl administered either as a premixed solution or sequentially on block characteristics-onset of sensory and motor blockade, regression of block and duration of analgesia. The secondary objective was to study the hemodynamic changes and adverse effects.\u0000Materials and Methods: A total of 72 patients scheduled to undergo lower limb surgery were allocated to three groups. Patients in Group A received 15 mg of 0.5 % bupivacaine heavy (H), followed by 25 mcg of fentanyl intrathecally using different syringes. Group B received 25 mcg of fentanyl, followed by 15 mg of 0.5% bupivacaine H in a separate syringe. Group C received premixed 0.5 % bupivacaine H 15 mg and fentanyl 25 mcg in single syringe. The block characteristics-onset and regression of sensory and motor blockade, duration of analgesia, and adverse effects were studied.\u0000Results: The mean time (minutes) taken for onset of sensory block was 2.40±0.51 in group A, 4.80±0.53 in Group B and 6.70±0.50 in Group C. Mean time (minutes) taken for onset of motor block was 4.35±0.43 in Group A, while it was 5.64±0.65 and 7.32±0.64 in Groups B and C, respectively. Two segment regression and duration of motor blockade were found to be longer in Group A.\u0000Conclusion: Sequential intrathecal administration of bupivacaine followed by fentanyl has a faster onset and prolonged duration of block when compared to the premixed group.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"209 S649","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141040217","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}

{"title":"Attitude and behavior regarding millet consumption in children with type 1 diabetes mellitus","authors":"Anjali Verma, Kusum Lata, S. Verma, Shilpi Rani, Ashish Kumar, Pilli Naveen Kumar","doi":"10.3126/ajms.v15i5.62291","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62291","url":null,"abstract":"Background: Millets are highly nutritious with a low glycemic index when compared to rice and wheat in terms of proteins, minerals, vitamins, and antioxidants, still the consumption rates of wheat and rice are higher than millets.\u0000Aims and Objectives: The present study aimed to know the attitudes, preferences, and perceptions about millet consumption in children with type 1 diabetes mellitus (T1DM).\u0000Materials and Methods: Caregivers of children with T1DM of age group 2–14 years were included in the study. Data regarding the preference, attitude, frequency, benefit in controlling blood sugar levels, and barriers to millet consumption among children were collected using the open-ended questionnaire filled out by caregivers.\u0000Results: Out of 86 caregivers enrolled, only 35 (41%) respondents knew about millets. In the index study, they were aware of pearl millet (94%) and sorghum (26%) mainly. Only 11.6% of the respondents recorded daily consumption of millets, 15.1% consumed millets 3–4 times in a week, 39.3% did once weekly, and 33.7% rarely. The major reasons behind non-consumption were non-palatability and expensive products. Only 29.1% of the respondents knew the role of millets in controlling blood sugar levels and reducing complications. Very few (7%) subjects knew about the new millet-based biscuits and other products.\u0000Conclusion: To increase the consumption of healthy millets by children with T1DM, it is suggested to develop various products to enhance palatability, providing knowledge on health benefits of millets, and widespread availability of millets.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"36 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141036966","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}

{"title":"Posterior urethral valve in neonates - overview in a tertiary care center","authors":"S. Natarajan, Shankar Mohan","doi":"10.3126/ajms.v15i5.63516","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.63516","url":null,"abstract":"Background: Posterior urethral valves are a unique obstructive pathology occurring in male children. Although known to present during various age groups when diagnosed in the neonatal period itself the outcome is better.\u0000Aims and Objectives: To study the incidence, clinical presentation, investigations, and management of neonates with posterior urethral valves and compare with literature.\u0000Materials and Methods: Retrospective study of neonates admitted to Government Mohan Kumaramangalam Medical College Hospital in South India for 1 year from August 2022 to July 2023.\u0000Results: Of a total of 16 cases studied the age of incidence of posterior urethral valve is 1–28 days with antenatally detected in nine cases. Fulguration was done in all 14 cases with vesicostomy in one case, bilateral ureterostomy in one case, and death in one case.\u0000Conclusion: Posterior urethral valve is a rare neonatal disease which is most often diagnosed antenatally. The investigations and modalities of management in our institution are inline with other studies in literature.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"23 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044693","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}

{"title":"Diaphragm ultrasound: A predictor of extubation in head injury patients","authors":"Anusha Rao Uchila, Aafaque Ahmad Anjum, Naresh Tirpude, Dr. Anusha Rao Uchila","doi":"10.3126/ajms.v15i5.62510","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.62510","url":null,"abstract":"Background: Timing is critical when determining if a patient can be successfully extubated. The criteria for obtaining the optimal time for extubation are bare minimum and subject to variability. There are not many studies that are done to use diaphragm function or diaphragm thickness (Tdi) to have any role in extubation outcome as success or failure.\u0000Aims and Objectives: The aims and objectives of the study are to apply diaphragmatic ultrasound as a predictor of extubation to reduce morbidity and mortality in these patients.\u0000 Materials and Methods: This study was conducted as a prospective single-blind study among patients admitted in post-anesthesia care unit and surgical intensive care unit, Department of Anesthesiology at Trauma care Centre during the study period of June 2019–November 2021. The ultrasonographer was informed of the intensivist’s decision to start weaning. Tdi is measured at end expiration and end inspiration. The percent change in Tdi between end expiration and end inspiration (ΔTdi%) was calculated as (Tdi end inspiration–Tdi end expiration/Tdi end expiration) ×100.\u0000Results: Mean age was 46.2±15.2 years, ranging from 18 to 66 years. Tdi was above 30 in 64% cases, whereas Tdi% at end of expiration was above 0.17 cm in 62% cases. Weaning was successful in 78% cases whereas weaning failed in 22% cases. Weaning success rate was significantly associated with higher Tdi at end expiration (≥0.17 cm) (P<0.05).\u0000Conclusions: Timely weaning off is very important. Delayed weaning may lead to further infection and complications. Diaphragmatic ultrasound plays a vital role in extubating the patient. Ultrasound-guided Tdi and diaphragm motion can be used as a predictor for timely extubation. Diaphragmatic thickness reflects the strength of diaphragm and hence would help us to estimate a successful extubation.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"73 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141032471","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}

{"title":"A comparison of internal jugular vein cannulation versus supraclavicular brachiocephalic vein cannulation using ultrasound guidance","authors":"Zulfiqar Ali, Abdul Waheed Mir, Iqra Nazir, Sajad Hussain Arif, Altaf Mir, Mir Mohsin, Zoya Sehar, Shahid Ahmad Mir","doi":"10.3126/ajms.v15i5.64139","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.64139","url":null,"abstract":"Background: Ultrasound has become the standard of care for the insertion of central venous catheters (CVCs) in the intensive care unit. With the introduction of ultrasonography in CVC insertion, there has been an improvement in the success rate and a dramatic decrease in the rate of complications.\u0000Aims and Objectives: The aim of this study was to compare the safety and ease of insertion of ultrasonically guided cannulation of the internal jugular vein (IJV) with that of the supraclavicular subclavian vein (SCV) in adult patients undergoing various surgical procedures.\u0000Materials and Methods: All the patients in whom central venous cannulation was planned were assigned to two groups. Group I underwent ultrasound-guided IJV while as Group II underwent cannulation ultrasound-guided SCV cannulation. A comparison was made between the two groups, of the success rates, durations of procedure, number of attempts at needle redirections, difficulties if any during insertion of guidewires, and the complications encountered.\u0000Results: The IJV group had a higher proportion of first-attempt success (93.2% versus 62.7%). The IJV group had a lesser incidence (3.2%) of complications such as guidewire progression and needle redirections compared with SCV (15.2%). The frequency of adverse events did not differ between the two study groups with an incidence in 3.2% in IJV group and 9.6% in the subclavian group. Higher first-attempt success rates and fewer procedural complications were seen with ultrasound-guided IJV.\u0000Conclusion: IJV central venous catheterization is an easier and less invasive and less risky procedure for patients.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"8 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141058173","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}

{"title":"Pruritic urticarial papules and plaques of pregnancy: An unusual case report from a tertiary care hospital of the Eastern part of India","authors":"Soumyadeep Mahapatra, Anindita Maiti","doi":"10.3126/ajms.v15i5.26302","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.26302","url":null,"abstract":"Pruritic urticarial papules and plaques of pregnancy (PUPPP) is a rare dermatitis of unknown etiology first diagnosed in 1979. It occurs most commonly in the 3rd trimester of pregnancy. Postpartum presentation is extremely rare. Treatment modalities mostly involve the relief of symptoms. We are going to report here one case of a 24-year-old primigravid female who presented in the 9th month of the gestational period with generalized pruritic eruptions in a tertiary care hospital in the Eastern part of India. These eruptions were erythematous, hyperpigmented, and papular, which began within the striae distensae of the abdomen and progressively spread on the skin of upper and lower limbs, trunk, and buttocks. After the delivery of a full-term male child, there was an aggravation of the symptoms such as itching and disturbed sleep. There was also increased spread of the lesions over the skins of the mentioned areas, which persisted for 6 weeks of the postpartum period. The lesions and associated symptoms gradually subsided with topical application of corticosteroids and hydroquinone along with oral antihistaminic for prolonged periods. Our objective behind reporting this case is to make clinicians aware of PUPPP as a differential diagnosis of peripartum and postpartum pruritic eruptions for prolonged periods.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"2 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141038402","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}

{"title":"A cross-sectional assessment of obesity among medical students of central India","authors":"Arpit Verma, S. Chauhan, A. Lazarus, Saket Kale","doi":"10.3126/ajms.v15i5.63561","DOIUrl":"https://doi.org/10.3126/ajms.v15i5.63561","url":null,"abstract":"Background: Obesity is one of the leading public health problems, emerging and evolving across the ages from childhood, adolescence, young adults, and middle age to the geriatric sphere of life. The young adult age group also includes the special population of medical students with possible unique stressors and risk factors requiring special attention.\u0000Aims and Objectives: The current study was planned with the objectives of studying obesity among medical students with a focus on determining the prevalence of obesity problem and associated socioeconomic level and lifestyle variables; dietary calorie intake and physical activity.\u0000Materials and Methods: The current study is a cross-sectional survey conducted using a pre-tested, semi-structured questionnaire among MBBS students of central India. A total of 400 students were interviewed. Body mass index (BMI) was used to identify and the World Health Organization classification (WHO) was used to categorize the students in nutritional levels. Physical activity level was assessed using the General Practice Physical Activity Questionnaire. Socioeconomic status (SES) was assessed using the Modified Prasad Classification and All India Consumer Price Index. Dietary calorie intake was assessed using 24-h oral questionnaire method.\u0000Results: The current study finds a prevalence of 7.5% obesity among medical students with another 10% in the pre-obese category as per the WHO classification. It was also found that Male gender, inactivity, and upper SES were significantly associated with the obesity prevailing in this special population of medical students.\u0000Conclusion: The current study concludes that obesity/pre-obesity is an important problem prevalent among medical students with association with sedentary lifestyle and high SES; thus, recommends screening students for lifestyle disease, dietary modification, change in sedentary lifestyle, and recreational activities to reduce stress.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"37 18","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141044838","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}