Makedonski medicinski pregled. Revue medicale macedonienne最新文献

{"title":"Color Duplex Sonography Findings of the Carotid Arteries and Associated Risk Factors in Patients with Transient Ischemic Attack","authors":"A. Arsovska, E. Antova, S. Stojcev, Irena Gjorceva, Marija Babunska, Jasmina Mitrevska-Velkov, Igor Isjanovski","doi":"10.1515/mmr-2016-0007","DOIUrl":"https://doi.org/10.1515/mmr-2016-0007","url":null,"abstract":"Abstract Introduction. A transient ischemic attack (TIA) is an acute episode of temporary neurologic dysfunction that typically lasts less than an hour. Atherosclerotic plaques in the carotid arteries may cause TIA by lumen stenosis or plaque-related thromboembolism. The aim of this paper was to analyze the changes of the carotid arteries in patients with TIA and associated risk factors. Methods. A retrospective analysis of 62 TIA patients was performed. Color duplex sonography of the carotid arteries and risk factor assessment was carried out in all patients. Results. We analyzed 15(24%) females and 47(76%) males with TIA, aged 45-79 years. The most frequent risk factor was hypertension, present in 57 patients (91.9%). The most common findings of the extracranial segments of the carotid arteries were atheromatous plaques present in 25.8% and low-grade stenosis (40-59%) visualized in 24.1% of patients. Multiple plaques predominated, mostly localized in the region of bifurcation and the beginning of the internal carotid artery (67.7%), with irregular surface (in 58.1%), heterogenous structure (70.9%) and mostly hypoechogenic (46.8%). Conclusion. These data have demonstrated a significant relationship between carotid artery ultrasound plaque characteristics and TIA occurrence. That is why color duplex sonography of the carotid arteries should be carried out in all TIA patients and risk factors should be evaluated, in order to take appropriate therapeutic measures for prevention of definitive stroke.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"35 - 38"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036093","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":"Surgical Treatment of Patient with Ruptured Dissection of the Thoracic Aorta – Stanford A, De Bakey I – Case Report of the Patient Surgically Treated at UC of State Cardiosurgery – Skopje","authors":"S. Jovev, A. Kolev, S. Dameska, Nadica Mehmedovikj, O. Dzemali, Sasha Kachar, Mirjana Kachar","doi":"10.1515/MMR-2016-0031","DOIUrl":"https://doi.org/10.1515/MMR-2016-0031","url":null,"abstract":"Abstract Introduction. A 59-year-old male patient with dissection of the thoracic aorta, DeBakey I, Stanford A is presented in this case study. We present his symptoms, his preoperative condition, diagnostic procedures, the surgical procedure and his postoperative treatment at the UC of State Cardiosurgery-Skopje. Case report. The surgery was performed two days after establishment of the diagnosis and more than 3 days (72 hours) after the symptoms occured, due to absence of patient’s consent for the surgery. This resulted in more difficult preoperative condition of the patient, surgical procedure harder to perform, and reduced survival expectations. Preoperative risk of predicted mortality from the cardiovascular surgery calculated according to EUROSCORE was 28.6%. Results. In this case study we also present classification, etiology, pathophysiology, and some statistics about the incidence of thoracic aorta dissection and survival rates emphasizing the increased mortality rate in delayed surgical interventions.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"163 - 167"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036595","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":"Single Dose of Magnesium Sulfate as an Adjuvant to General Anesthesia Improves Pain Control, Discomfort and Quality of Sleep Postoperatively","authors":"B. Kuzmanovska, Marija Tolevska, A. Kartalov, M. Srceva, M. Shosholcheva, N. Jankulovski","doi":"10.1515/mmr-2016-0027","DOIUrl":"https://doi.org/10.1515/mmr-2016-0027","url":null,"abstract":"Abstract Introduction. As a N-methyl-D-aspartate receptors antagonist, magnesium may play a role in prevention of pain. The aim of this study was to assess the effects of single dose magnesium sulfate preoperatively on postoperative pain scores, discomfort and quality of sleep. Methods. Forty patients scheduled for elective laparoscopic cholecystectomy were randomized in two groups. Group A received 20 mg/kg magnesium sulfate after the anesthesia induction, prior to surgical incision, and Group B was the control group. Assessment was made for pain at rest in both groups according to VAS (0-10), analgesic consumption, discomfort and quality of sleep during first 48 hours postoperatively. Resultѕ. Compared to control group, magnesium-treated patients had lower postoperative pain at rest according to VAS score (p< 0.05) and consumed less analgesic drugs during the first 48 hours (p<0.05). The magnesium-treated group experienced less discomfort during the first and the second postoperative day. The magnesium-treated group reported no changes in sleeping pattern compared to preoperative sleeping pattern, while the control group showed an increase in insomnia during the first and the second postoperative night, compared to that preoperatively. Conclusion. Perioperative use of magnesium sulfate as an adjuvant to general anesthesia is associated with lower postoperative pain, less analgesic consumption, less discomfort and better sleep in the postoperative period.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"145 - 147"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036574","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":"Some Aspects of Nephrotoxicity of Paracetamol and Ketoprofen in Patients with Rheumathoid Arthritis","authors":"D. Spasovski, S. Genadieva-Stavric, T. Sotirova","doi":"10.1515/mmr-2016-0022","DOIUrl":"https://doi.org/10.1515/mmr-2016-0022","url":null,"abstract":"Abstract Introduction. To determine the effect of initial therapy with Paracetamol and Ketoprofen on glomerular and tubular integrity in rheumatoid arthritis (RA), to quantify nephrotoxicity of these two drugs by measurement of enzymuria, which correlates with the damage of tubular epithelium. Microalbuminuria is used as a marker for glomerular damage, and urine excretion of N-Acetyl-b-D-glucosaminidase (NAG) as an indicator of proximal tubular damage. Methods. Using colorimetric method for determination of NAG, and immunoturbidimetric method for microalbuminuria, samples of 70 participants were examined (35 RA patients treated with Paracetamol only, 35 RA patients treated with Ketoprofen). The follow-up was in 5 time-intervals in the course of 24 weeks. Results. There was a moderate correlation between NAG and microalbuminuria (r=0.16) in the group of patients treated with Paracetamol only, and a moderate correlation (r=0.28) in the group of patients treated with Ketoprofen. NAG enzymuria in size, by number of patients Registered, and time of appearance, was greater and appeared earlier in the Ketoprofen group compared to the Paracetamol group. Conclusions. Ketoprofen is more potent NAG inductor and provokes greater tubular enzymuria than Paracetamol. Results from our study confirm safety in use of Paracetamol and Ketoprofen in everyday clinical practice.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"118 - 124"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036994","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":"Partial Liver Herniation Through the Incisional Defect on Anteriot Abdominal Wall","authors":"A. Gligorievski, Ana Lazarova","doi":"10.1515/mmr-2016-0010","DOIUrl":"https://doi.org/10.1515/mmr-2016-0010","url":null,"abstract":"Abstract Introduction. Ventral hernias are quite common, but liver herniation is an extremely rare case. This type of abdominal protrusion of part of the liver usually occurs through incisional weak spots on the abdominal wall. Incisional herniation of the liver usually occurs 2 to 3 years after an abdominal operation consequently leading to focal weakness of the abdominal wall. Case report. We present an extremely rare case of incisional herniation of part of the left and smaller part of the right liver lobe in a woman aged 64 years, as a consequence of a previous open cholecystectomy, creating a focal abdominal wall weakness. Abdominal CT scan was performed. Analysis of the CT scans, as well as of the reconstruction made in the coronal and sagittal plane was performed. Herniation of the left and the smaller part of the right liver lobe through an incisive focal weakness of the right upper quadrant of the abdominal wall was detected. Discussion. Incisional hernias are delayed complications of abdominal surgery. They can occur anywhere on the abdominal wall and are more frequently encountered in a vertical than in a transverse incision. Typically, incisional hernias occur during the first months following surgery, but later occurrence has been reported as well. Herniation of the liver through the anterior abdominal wall is an extremely rare condition and usually related to previous surgery on the upper abdomen. Due to its rarity it is both a diagnostic and therapeutic challenge. Conclusion. We can conclude that there is a connection between liver herniation through the upper abdominal wall and a previously performed open abdominal surgery. CT is the method of choice for diagnosis of liver herniation through the anterior abdominal wall.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"47 - 51"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036107","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":"Chronic Kidney Disease as a Long-term Consequence of Preeclampsia and Hypertensive Disorders in Pregnancy","authors":"Biljana Gerasimovska Kitanovska, V. Gerasimovska","doi":"10.1515/mmr-2016-0028","DOIUrl":"https://doi.org/10.1515/mmr-2016-0028","url":null,"abstract":"Abstract Introduction. Preeclampsia is a condition characterized by hypertension, proteinuria after 20th week of gestation, dysfunction of other maternal organs or uteroplacentary dysfunction and is associated with short-term renal damage. Recent studies report on potential association of preeclampsia with chronic kidney disease in later life. The aim of this study was to determine this potential association by literature review and our results. Methods. A Pubmed (Medline) literature search on the association of preeclampsia and subsequent chronic kidney disease was carried out. Our study was conducted at the Department of Nephrology of the University Clinical Centre Skopje in 2010 and included women who consulted the Clinic due to hypertension or impaired renal function and who had either preeclampsia or hypertensive disorders in pregnancy. Thirty patients with decreased glomerular filtration that occurred 1-28 years after pregnancy with hypertensive disorder were included in the study. Results. Literature search yielded 227 abstracts, of which 19 papers were selected, and they referred only to chronic kidney disease in the period after delivery in patients with preeclampsia. Various risks for emergence of chronic kidney disease in later life were reported in recent literature, varying from 1.2 to 14 for preeclampsia and in patients with superimposed preeclampsia, the risk was 45 times higher. In our study, risk of reduction in glomerular filtration rate was highest in the first 5 years (OR 3.6, 95% CI 1.06-22.5). Delivery before 27 weeks of gestation insignificantly increased the risk of reduced glomerular filtration in the later period (OR 1.33 95% CI 0.2-8.5). Preeclampsia is not a direct risk factor for chronic kidney disease, however, proteinuria over 0.3 g/24h in the group of patients with hypertension or preeclampsia in pregnancy, increased the risk of reduced glomerular filtration rate by 28 times (OR 28.5, 95% CI 2.7-30.9). Conclusions. Patients with preeclampsia need careful monitoring in postpartal and long-term period, not only for cardiovascular but for chronic kidney disease.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"148 - 152"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1515/mmr-2016-0028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036580","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":"Biomedical Waste Management","authors":"Biljana Shikoska, C. Dimova, Gjorgji Schumanov, V. Vankovski","doi":"10.1515/mmr-2016-0001","DOIUrl":"https://doi.org/10.1515/mmr-2016-0001","url":null,"abstract":"Abstract Medical waste is all waste material generated in health care facilities, such as hospitals, clinics, physician’s offices, dental practices, blood banks, and veterinary hospitals/ clinics, as well as medical research facilities and laboratories. Poor management of health care waste potentially exposes health care workers, waste handlers, patients and the community at large to infection, toxic effects and injuries, and risks polluting the environment. It is essential that all medical waste materials have to be segregated at the point of generation, appropriately treated and disposed of safety.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"1 - 7"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036522","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":"Current Status in Management of Patients with Chronic Lymphocytic Leukemia (CLL) in Republic of Macedonia","authors":"M. Pavkovic, S. Genadieva-Stavric, G. Amzai, T. Sotirova, L. Cevreska, S. Stankovic, A. Stojanovic","doi":"10.1515/mmr-2016-0006","DOIUrl":"https://doi.org/10.1515/mmr-2016-0006","url":null,"abstract":"Abstract Chronic lymphocytic leukemia (CLL) is the most commonly diagnosed type of leukemia in Western Europe and North America, and represents about 30% of all leukemias in adults. CLL is a disease of elderly, who often have multiple comorbidities. These factors affect further treatment decisions, despite the great progress in the therapy of CLL in the last two decades. The aim of this study was to evaluate the current status in the management of patients with CLL in the Republic of Macedonia and to compare it with CLL patients in other western countries. We analyzed 102 patients with CLL referred to our Institution for control and/or treatment in the period from January 2015 to October 2015. Median age of our group of patients at the time of diagnosis was 62.7 years with almost 40% of patients older than 64 years. Male to female ratio was 1.3:1 and 54% of patients were diagnosed in stage “0” according to Rai staging system. Watch and wait was the most common treatment approach (58.8%) at the time of diagnosis, but at the moment of analysis only 33% of patients were still with-out treatment. The most common treatment in this group of CLL patients was FCR protocol with 39.5% of patients treated with an average of 5 cycles of this immunochemotherapeutic regimen. The average time of progression free survival (PFS) in all treated patients was 32.8 months with range between 2-72 months. In summary, clinical characteristics of CLL patient in our clinical settings and the most common therapeutic approach at our Institution do not differ significantly from the characteristics of the average CLL patient in other studies.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"30 - 34"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036566","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":"Dandy Walker and Extreme Macrocephaly Caused by Enormous Occipital Encephalocele","authors":"Vladimir Mirchevski, E. Zogovska, A. Chaparoski, M. Kostov, Michun Micunovic, J. Bushinoska, M. Srceva, Mirko Mishel Mirchevski, Blagoj Shuntov","doi":"10.1515/mmr-2016-0030","DOIUrl":"https://doi.org/10.1515/mmr-2016-0030","url":null,"abstract":"Abstract Introduction. Dandy-Walker syndrome is a congenital brain malformation involving cerebellum with partial and complete vermian agenesis, enlargement of the fourth ventricle and surrounding fluid spaces, cyst formation in posterior cranial fosse pushing tentorium upward [1,2]. Hydrocephalus or an increase in the pressure of the fluid spaces may also be present or other malformation as corpus calosum hypoplasia or agenesia, occipital encephalocele, malformation of the heart, face, limbs fingers and toes [3-5]. The symptoms often occur in early infancy and include slow motor development and progressive enlargement of the skull. The diagnostic is done by ultrasound, CT and MRI [6-11]. The treatment of this syndrome may be complex and sometimes includes various experts such as pediatrician, pediatric neurosurgeon, physiatrist, psychologist, sociologist or others. The treatment consists of treating the associated problems such as hydrocephaly [12-15]. Prognosis of Dandy-Walker syndrome is variable and the morbidity and mortality depends on severity of the syndrome and associated malformations [16]. Aim. The aim of this paper was to demonstrate how severe spontaneous evolution of Dandy-Walker syndrome may be expressed and the problems and dilemmas which may appear related to its treatment. Case report. A six-year-old boy was referred to the neurosurgeon because of the excessive growth of the skull in anteroposterior axis caused by a wide base occipital encephalocele. Although the psychological development was near the low limit of the IQ, the enormous head had not allowed verticalization of the child and further progress of his psychomotor development. The head was so heavy that could not be supported by the child’s neck. Surgical procedure. We performed a cranial skull reduction with primary cranioplasty assisted by a plastic surgeon and Pudentz shunt procedure. Result. The follow-up period lasted two years. The child started to walk, hypotonia and Babinski signs disappeared, communication and his IQ improved. The esthetic results are quite acceptable allowing him better development. Conclusion. The early recognition of anomalies such as Dandy-Walker syndrome with occipital encephalocele using ultrasound may suggest interruption of the pregnancy on time [6-9]. However, the right diagnostic procedure for detecting deformities of the newborn and infant’s head at birth is MRI, and the adequate surgical treatment can prevent abnormal and excessive growth of the skull and disorders in the psychomotor development during child’s growth. A multidisciplinary approach may prevent new disabled individuals in the society.","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"158 - 162"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036591","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":"Heart Damage in Pregnancies Complicated with Preeclampsia: Case Report","authors":"I. Kjaev, S. Jovanova, Jana Nivicka Kjaeva, D. Karadjova, Irena Aleksioska, S. Kjaeva, R. Spasova, Goran Kocoski","doi":"10.1515/mmr-2016-0008","DOIUrl":"https://doi.org/10.1515/mmr-2016-0008","url":null,"abstract":"Abstract Introduction. Heart function in pregnancy is a subject of many debates and studies. A large number of epidemiologic studies have found association between preeclampsia and cardiovascular morbidity/mortality. About 5-8% of deliveries are complicated with preeclampsia. Until recently, heart damage associated with preeclampsia has not been studied. A number of heart difficulties only appear long after the reproduction period has ended. Preeclampsia increases the risk for B stage (asymptomatic) of heart failure. Case report. A 37-year-old pregnant patient, G2P1 27 weeks of gestation, paid her first visit to the Gynecology Outpatient Clinic. She complained on heavy breathing, difficulty with movement and hypertension. She was referred for further evaluation to the Cardiology Outpatient Clinic with a suspicion of gestational hypertension and heart abnormalities. The pregnancy was evaluated several times at the Out-patient Clinics of Gynecology and Cardiology with the diagnosis of gestational hypertension. Echocardiography showed abnormal heart remodeling. In the 36 g.w laboratory findings showed urine dip stick ++,ТА160/110. The diagnosis was changed to preeclampsia. The patient was delivered with a re-caesarean section because of previous S.C and preeclampsia. Postpartum echocardiography confirmed left chamber hypertrophy with persistent hypertension. Results. Clinical cardiovascular complications in preeclampsia continue long after the pregnancy has ended. Studies show that pregnancies with both early and late preeclampsia have an increased risk for asymptomatic left chamber dysfunction/hypertrophy and essential hypertension in the next 2 years after delivery. If the damages are caught early prevention can be started sooner rather than later before patients become symptomatic (C stage of heart failure).","PeriodicalId":86800,"journal":{"name":"Makedonski medicinski pregled. Revue medicale macedonienne","volume":"70 1","pages":"39 - 42"},"PeriodicalIF":0.0,"publicationDate":"2016-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"67036098","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}