Monday, November 15, 2010

Caffeine Withdrawal Symptoms

Caffeine Withdrawal Symptoms
Caffeine withdrawal symptoms are very common sight among many people these days. This is mainly constituted when on an everyday basis, you take in coffee or any other energy drink more than to be recommended for. By constantly drinking large quantities of caffeine everyday, the human body gets ensnared to it.

Caffeine is considered to be highly addictive. Many people face problems when they don't get to enjoy their favorite caffeine for an extended period of time. The results are quite unpleasant. Many people tend to feel very lethargic and experience headaches when they go too long with caffeine.

Ever since the World Health Organization (WHO) announced caffeine withdrawal as an official diagnosis, many people have taken it seriously and started pushing upon themselves major physical distress. Caffeine withdrawal research has mostly been conducted on adults. However, having said this, the research has shown that children too tend to experience these symptoms with no caffeine for a long duration of time.


The most common caffeine withdrawal symptoms list consist of:
  • Frequent headaches
  • Experiencing sleepiness or drowsiness
  • Fatigue, tiredness and dizziness
  • Concentration problems
  • Depressed feeling
  • Anxiety
  • Irritability
  • Nausea

The symptoms usually vary when a caffeine withdrawal symptom takes shape in a person. It can vary from mild to extreme. However, it is noted in recent times that, caffeine withdrawal can create severe depression and even lead to total incapacitation. However, as mentioned before, it occurs only in extreme cases. Headache is the most commonly noted caffeine withdrawal symptom.

The caffeine withdrawal symptoms duration normally takes place after 12 to 24 hours of caffeine. However, recent studies have documented even after 36 hours. Even though longer durations have been observed, recent studies have shown these symptoms ranging from 2 days to 1 week.

Caffeine must be taken in a regulated and regimented format to avoid going through a caffeine withdrawal symptom. Too much of anything is not considered a good thing. The human body will not face any discrepancies or disturbances of caffeine withdrawal symptoms if taken in a controlled manner.

Friday, October 29, 2010

Mold Allergy Symptoms and Treatment

Mold ( which causes mold allergy ) is an organism which can be found in many places, both outdoors and indoors. Mold is well-defined as a form of fungus. It returns nutrients to the environment after breaking down dead materials. It is by the digestion of plant or animal matter, like leaves, wood, paper, dirt, and food that mold is evolved. They are spread in the environment by the dispensation of pint-sized, featherweight spores which travel means of air. It is in wet and dark spaces like basements, garbage cans and piles of rotting leaves that mold grows.
Some of the treatments of mold allergy symptoms are classified as follows:
Immunotherapy:
By undertaking this treatment, almost all allergies are eliminated by the implementation of a series of allergy shots. An example for this by doing an immunotherpay for hay fever. Unfortunately, however, allergy shots are only moderately effective against mold allergy.
Nasal lavage:
The doctor will advise you to wash the nose with salt water to get rid of the aggravating nasal symptoms. For that, you will be needing to develop your own salt or imply a nasal saline spray. You will required to blend 3 teaspoons of salt which doesn't comprise of any iodine with 1 teaspoon of baking soda in a container which you can enclose. After that, you will have to add 1 teaspoon of this blended mixture and combine it with 8 ounces of water to make your saltwater solution. It is best advocated to utilize little salt and baking soda mixture from the next time onwards in case you start to sense any burning or stinging.

Some of the mold allergy symptoms are constituted by sneezing, eyes turning watery, running nose with cold, eyes feeling itchy along with the nose and throat, cough and stomach gas.

Thursday, October 28, 2010

Lockjaw Causes


The term tetanus can also be referred to as lockjaw which is caused by a bacterium called Clostridium tetani. The tightening of the jaw muscles is one of the major symptoms of lockjaw, which will eventually make the jaw hard to function, in turn making speech and swallowing very difficult. If left untreated, lockjaw can even lead to death. However, it is not very often that this happens as various vaccinations are employed for tetanus. Hence, vaccination through Tetanus Toxoid will prevent the infection from cuts from old fences or dirty metal objects is always considered a safer option. 
 
News about lockjaw first broke when it was found out to be more prevalent around horses that were thought to be injured by cuts and wounds,. Horses are considered as a more frequent victims of tetanus. However, Clostridium tetani is found to be in huge sums in soil all over the world. It has the ability to sustain and survive for about 40 years. Hence, lockjaw causes are clearly considered possible as a result of a cut developing from an old nail. 
 
Both TMJ Lockjaw and Lockjaw incidents are constantly reported high in third world countries where inoculations or vaccinations are not routine or frequent. It is in these countries that many newborns, as many as half of the population are the ones affected who cannot afford the cost of vaccination and do not learn to adhere to standards of hygiene and cleanliness. Exposure to tetanus in these countries is mainly owed to the lack of proper care of the umbilical cord stump as Clostridium tetani infects it. 
 
The death rate for lockjaw is quite a significant one when left untreated taking down almost 30% of the adults and 60% of the infants. Neurotoxin plays a vital role in making tetanus for its treachous nature. The jaw isn't the only part affected as the disease takes its toll on all the facial muscles once it is contracted and eventually progresses. Painless paralysis is also a possibility as a result of a stiff created over the back, stomach, and lower body as these parts also can be affected. Tetany is a side effect of the illness as it causes many violent seizures or muscle spasms. People experienceing tetany will find the disease as extremely painful.

Sunday, September 26, 2010

Malaria Causes and its Stages

How malaria disease occur?

The presence of a  parasite called as plasmodium is the main cause for the creation of the disease Malaria in the blood. When an infected mosquito bites a person, this parasite gets transferred to the blood stream. The results could be either moderate or life-threatening at the same time complicated or uncomplicated. Malaria just about is the reason for about 1.5 to 2.7 million deaths resulting from up to 300 to 500 million reported cases of infection every year. It is a overwhelming fact that in specific places up to 40% of little children may die of penetrative malaria.


Malaria symptoms make it simple to find out the infection. A malarial attack usually contains of three stages, the cold stage, the hot stage and the sweating stage.

1. Cold Stage:
In this stage, regardless of the nomal body condition, the infected person goes through a stage of terrible coolness. As a result, the person requests for a blanket or any other material that he could cover himself up in until his shivering stops. consequently, there is severe headache and the skin will also turn cold.

2. Hot Phase:
In this stage, the person starts to feel hot and starts to put aside all the material that he used for covering himself up while feeling cold. This takes place as a result of consequent high fever. This is considered very dangerous in children as it could to serious contractions.

3. Sweating Phase:
As the fever sets to reduce, there is profuse sweating taking place. The level of sweating can be as serious as that the bed may even get soaked at times. You will be wanting to rest and sleep a lot more as you will be feeling very weak.

Malarial attacks may happen once in every 48 hours to 72 hours. The time between each malarial attack varies as the disease caused are by different parasites.

The above-quoted stages or levels are some of the early symptoms of malaria. Another imperative point to be taken into note is the fact that a person who has been infected by malaria before for a prolonged time is almost immune to the disease. However, the same cannot be said about a person who is non-immune. The person will easily fall victim and knuckle under easily to the disease.

Thursday, September 23, 2010

Jaundice Disease Diagnosis and Treatment


Jaundice disease is generally differentiated by the yellow coloration of the skin and the whites of the eyes. This is caused by the increase or gathering of a waste product known as bilirubin in the blood. Jaundice is considered not only as an ailment but, but also as a path to many other related diseases. The yellowish coloring of the skin and the sclera may vary based on the amount of the chemical in the blood. At some situation, if the chemical level is too high, the color of the skin will become brown and not yellow.
Reasons of Jaundice and Symptoms:
Jaundice is caused by high levels of bilirubin in the blood. It is vital that we understand the basic jaundice symptoms and the main factor as to how this material is being despatched into our blood stream. Bilirubin mainly gets along the blood stream with the assistance of the red blood cells. These cells will naturally get botched as they become old. As the blood cells play the role of a mode for haemoglobin, an iron content which carries oxygen to the blood, is then liberated from the spoiled cells. Bilirubin is then formed as a result of the removal of iron.
Jaundice symptoms can also be seen in the liver too. It plays a very imperative role in developing jaundice. The main function of the liver is the removal of waste products from the blood stream. As discussed earlier, bilirubin is a waste product of red blood cells. Similarly, if the functioning of the liver is jeopardized by this bilirubin, jaundice can result. Likewise, the liver must be eradicating bilirubin from the blood stream and excrete it through the faeces. Whenever there is too much of waste products for the liver to remove or when the red blood cells get affected, jaundice occurs. Finally, hindrance in the bile ducts can curtail the flow of bile and bilirubin to decrease.
Some other symptoms of jaundice include itching, which at times can be intense, abdominal pain, loss of appetite, abdominal swelling, as well as by nausea, vomiting, headache, fever, dark-colored urine and light-colored stools.
Jaundice in newborns is very common these days. The yellowing of skin and other tissues of an infant child is known as neonatal jaundice. Appearance of bilirubin level in infants is 85umol/l (5mg/dL). Similarly, jaundice in adults has been usual for a quite long time. In adults , the bilirubin level is nearly 34umol/l (2mg/dL). Jaundice can be detected in newborns is identified by discoloring of the skin with digital pressure so that it exposes the underlying skin and subcutaneous tissue.
Diagnosis and  Treatment of Jaundice to be followed:
Magnetic Resonance Imaging (MRI):
Magnetic resonance imaging scans determines the soft tissues of the abdomen by the employment of magnetization of the body. They are quite comprehensive like CT in the determination of tumors and studying of bile ducts. MRI scans can be altered to locate the bile ducts better than CT scan tests. Thus, they are preferred for determining the cause of bile duct obstruction.
Computerized Tomography (CT or CAT scans):
Computerized Tomography or CT scans are scans that utilize x-rays to analyze the soft tissues of the abdomen. Although they are considered not as effective as ultrasonography in diagnosing gallstones, they do prove efficient in identifying tumors in the liver and the pancreas and dilated bile ducts.
Ultrasonography:
Ultrasonography is an uncomplicated, secure and easily-accessible test which employs sound waves to analyze the organs within the abdomen.
Considering all the above-qouted methods, the treatment of jaundice generally needs a diagnosis of the particular cause of the jaundice and the treatment should be aimed at the particular cause.


Wednesday, September 8, 2010

Malaria Causes, Signs and Diagnosis

Malaria is a fatal disease that accounts for approximately 1.5 to 2.7 million deaths resulting from 300 to 500 million cases of infection every year. In certain regions, up to 40% of toddlers may die of acute malaria.Malaria is an parasitic infection caused by Plasmodium in the blood stream.
The malarial parasite is transferred through the bite of an infected mosquito. It could be mild or severe, complicated or uncomplicated. The infection has signs that make it identifiable. A typical malarial infection consists of three stages with a certain periodicity.
1. Cold Phase - There is a feeling of being cold, irrespective of actual body temperature. The person needs a blanket or other cover and shivers uncontrollably. The skin may feel cold with a severe headache.
2. Hot Phase - There is a high fever and the patient feels hot and may throw off all the blankets. It is particularly dangerous in children because it could lead to contractions.
3. Sweating Phase - There is profuse sweating as the fever ends, the bed may even be soaked. You feel weak and feel to take rest or sleep.
Common Malaria Symptoms are fever, chills, nausea, headaches, sweats, fatigue and vomiting. But the severity of the signs depends on your body's immunity and your overall health. On extreme occasions, malaria can cause problems with the brain and spinal cord i.e., Cerebral Malaria and lead to seizures, or even cause loss of consciousness. Other common symptoms of malaria are dry cough, muscle pain and enlarged spleen. Malaria Symptoms are cyclic and stay for different lengths of time. This is especially true during the initial stages of the disease.
Cyclical attacks - The exact period between attacks differs for the different species that causes malaria. Thus the attacks may occur at anytime between 48 hours to 72 hours.
The appearance of malaria signs depends on the type of plasmodium species. You will get the early symptoms of malaria in 9 to 14 days if you are infected by Plasmodium falciparum; 12 to 18 days for Plasmodium vivax or Plasmodium ovale; 18 to 40 days for Plasmodium malariae. Among all the malarial infections, the infection caused by P. falciparum is the most fatal.
Note that humans who have been exposed to malarial paraistes or infections for a long time and are now partially immune may not exhibit all the symptoms of malaria. But a non immune person will succumb very quickly. The diagnosis of malaria is based on a combination of risk assessment, observing symptoms and medical tests.
Laboratory examinations involve the demonstration of the parasite in a film of blood. It could be a thin film in case of identifying the particular type of parasite causing the disease or a thick film if you need more reliability in finding the parasite. Though the medicinal tests are easy to carry out, they may not be available in all locations, Therefore presumptive treatment, which is treatment based on risk assessment is the most practical approach.

Monday, September 6, 2010

Thalassemia Types, Signs and Cure

Thalassemias are  genetic blood disorders that are inherited and are later passed down the family tree.

Thalassemias obstructs the hemoglobin production in the body which indirectly affects the RBCs. Hemoglobin is the iron rich protein that is found in the RBCs. Haemoglobin is essential for the supply of oxygen to the different regions of the body. It also empties out the carbon dioxide, by carrying it to the lungs from where it is exhaled out.


Kinds of Thalassemia disease:

Hemoglobin A, is a composition of 4 protein chains: Two alpha globin chains and two beta globin chains. The defects in these protein chains lead to two major kinds of thalassemia, called alpha and beta.

1. Alpha Thalassemia:

The alpha thalassemia includess the HBA1 and HBA2 genes, which is inherited in a mendelian recessive type. Alpha thalassemias would end up reducing the production of alpha-globin which results in the decrease in the production of alpha-globin chains, thereby resulting in an excess of β chains among adults and excess γ chains among the newborns.

2. Beta thalassemia:

Beta thalassemias are due to mutations in the HBB gene on chromosome 11 that inherited in an autosomal-recessive fashion. The severity depends on the type of the mutation. The mutation is either a Thalassemia major when any formation of beta chains is prevented or the  thalassemia intermedia if the formation of some beta chain is allowed.



Thalassemia symptoms:

The intensity of the symptoms depends on the severity of the disorder. Lack of oxygen prevails due to insufficient hemoglobin and red blood cells content.

Some of the major signs are:

Headaches
Respiratory disorders
Enlargement of spleen
Fatigue
Jaundice


Thalassemia symptoms are classified based on the mutation:


Alpha thalassemia symptoms:

Alpha thalassemia are silent carriers. The symptoms of the disorder are subtle and are hardly noticed. Lack of alpha globin protein doesn’t affect the hemoglobin and its functionalities.


Beta thalassemia symptoms:

1. Victims of beta thalassemia intermedia have a varied mild to moderate anemia symptoms. The disorder has symptoms similar to sickle cell anemia.  Therefore the diagnosis steps are confused while using the symptom checker.

2. Delayed puberty and slow growth: The anemia can affect a child's growth and     development very much and also affects the puberty

3. Bone related problems. Thalassemia may cause expansion of bone marrow. Bone marrow is the spongy filling inside bones that is made up of blood cells. During the expansion of bone marrows, the bones become wider than usual. Chances are that they become brittle and break easily.

4. An enlarged spleen: Spleen is an organ that helps in fighting infection     and removing unwanted material. For a person with thalassemia, the spleen works very hard resulting in an enlargement spleen thus worsening anemia. Spleen has to be removed when it becomes too large.


Thalassemia Treatment:

Blood transfusion therapy, one of the ways to treat thalassemia major involves blood examination for diagnosis. Splenectomy, iron chelation (as thalassemia minor causes iron deficiency), and allogeneic hematopoietic transplantation therapy is practiced to treat the patients with thalassemia major. Whereas, patients suffering from minor thalassemia have no specific treatments. Folic acid is used to treat certain pregnancy related problems caused by anemia.

Wednesday, September 1, 2010

Stomach Ulcer Symptoms, Diagnosis and Treatment

Stomach ulcer also called as Peptic ulcer or ulcus pepticum or Peptic Ulcer Disease (PUD) is an ulcer that is a mucosal erosion that is greater than or equal to 0.5 cm at an acidic region of gastrointestinal. The stomach ulcers and about 90 percent of other ulcers are caused by Helicobacter pylori. It is spiral-shaped bacterium which lives in the acidic environment of stomach.


Categorization of stomach ulcer:

Stomach ulcer classification depends on the part where the ulcers occur. Ulcers that occur at stomach refers to gastric ulcers and those that occur at Duodenum are called duodenal ulcers. Similarly those occurring at the Oesophagus are called Oesophageal ulcers and the last of its kind, Meckel's Diverticulum ulcers are the ones that form in the Meckel's Diverticulum.

These extremely painful ulcers mostly arise in the duodenum rather than in the stomach. The duodenal ulcers are mostlyusually benign.


Ulcer diet:

It is advisable for the ulcer patients to follow a diet that helps in digestion, doesn't cause irritation and is less in acid content. Some of them include breads, antacids, avoiding caffeine containing foods. Having a good source of protein at each meal and snacks includes also forms a healthy diet.


It is better to avoid Aspirin and other NSAIDs (Nonsteroidal anti-inflammatory) drugs as they can cause or can aggravate the ulcer. NSAIDs or NAIDs are drugs which have analgesic and antipyretic effects. 


Peptic ulcer symptoms:

The primary stomach ulcer symptom that generally occurs is the abdominal pain. The pain is usually the burning or gnawing sensation which extends to the back. The pain is experienced mostly after eating.

Other stomach ulcer symptoms that usually arises are a typical heartburn, a bitter taste in mouth, a sick feeling.

Bloating, abdominal fullness, nausea and copious vomiting are some of the other stomach ulcer symptoms which arises at the stomach region. Severe cases would experience:

Hematemesis: This is a condition of vomitting blood. It can occur as a result of bleeding that arises directly from a gastric ulcer or arises because of damage of the esophagus from continuing vomiting.

Some stomach ulcers are like the gas symptoms that arises as a result of tightness of bowel along with the stomach ulcer. The gas symptoms of blurbing and farting is experienced and accompanied by melena, a symptom where the feces becomes tarry and foul smelling.


Diagnosis of Stomach ulcer:

The diagnostic examinations of peptic ulcer are:

Breath test: This involves a procedure that requires a radioactive carbon atom to detect Heliobacter. pylori.

Blood     test: Confirmation of presence of Heliobacter.     pylori antibodies requires a blood test. The inability to differentiate past exposure and current infection is the only possible flaw in diagnosis via blood test.

Stool     antigen test: Presence of Heliobacter.     pylori is examined in the stool samples in this test.

A small glass of liquid with radioactive carbon as a part of the substance is administered to the patient. This radioactive carbon will be broken down by H. pylori. The breath sample collected less than an hour shall decide if the patient is infected or not. The infected person would have the radioactive carbon substance in the form of carbon dioxide.


Upper gastrointestinal X-ray: Most common test is barium contrast X-ray test of GI tract. The person is made to swallow a white, metallic barium liquid during the time of X- ray. This coats the digestive tract and creates the ulcers more visible.

Endoscopy: The procedure follows an upper GI X-ray. Endoscopy is performed after the     detection of the ulcer.  A long, narrow tube with an inbuilt camera     is threaded down the throat, esophagus, stomach down to the duodenum providing a view of the upper digestive tract, helping the physician to  identify the exact region of ulcer.

Tuesday, August 31, 2010

Scurvy Symptoms, Diagnosis and Treatment

Vitamin C deficiency leads to Scurvy. Vitamin C (chemically known as ascorbic acid) is essential vital for the synthesis of collagen. This leads to the formation of spongy gums, pale skin with spots on the skin, and internal bleeding of mucous membranes.

The spots are more persistent on the thighs. The patient is usually dull, appears pale with sunken eyes and is immobilized partially.


Scurvy causes:

Insufficiency in the intake of vitamin C results in scurvy primarily.  Historically, scurvy usually occured during long sea voyages where sailors won't be able to consume nutritious food that is rich in vitamin C.

Signs and symptoms of scurvy:

Scurvy signs include:

A feel of extreme fatigue and tiredness.

A number of ailments within the body. 

A feeling of discomfort and pain present in the muscles and joints of the body.

The healing time for cuts is more.

Loss of teeth, bleeding of gums.


In extreme cases, the scurvy signs are more painful and aggressive that bleeding occurs in the body's muscles and joints.

 Affects normal growth in children.


Diagnosis of Scurvy:


A physical exam is conducted to find the symptoms. Vitamin C levels are found by using lab tests that analyzes the level of serum ascorbic acid.


The wrong-diagnosis of scurvy leads to vitamin B12 deficiency, so radiological processes are practiced for diagnosing scurvy. This helps in observing the damage that has already been caused by scurvy. As scurvy gets severe, a region of rarefaction occurs at the metaphysis just beneath the white line.


The region of rarefaction generally involves those areas of white line that results in a defect in a triangle shape. This area having multiple microscopic fractures within may collapse along with the impact of the calcified cartilage over the mataphysis shaft. Visualization of the subperiosteal hemorrhages are not possible during the active period. While healing, hemorrhages get calcified and are set to be found readily.


Scurvy treatment:

Orange juice, the standard treatment before the discovery of vitamin C is an effective dietary recommendation for treating infantile scurvy.

Vitamin C when administered via oral or the parenteral method is effective in treating infantile     scurvy.
The medicinal recovery is impressive while implementing pharmacologic treatment. The appetite of the newborn is recovered in a day or two’s time. The symptoms of fever, irritability, tenderness upon palpation, and hemorrhage usually takes seven days or less to cure.

Diet recommendations:

Adequate vitamin C intake can prevent the development of scurvy. The diet requiring vitamin C varies with the age of the person.

Food and Nutrition Board of the National Academy of Sciences and National   Research Council recommends the following diet rich in vitamin C:
  • Babies are to be provided with thirty to forty mg 
  • Children and adults require forty five to sixty five milligram 
  • Pregnant women essentially need seventy milligram 
  • Lactating mothers might require at least ninety to ninety five mg


Fruits and vegetables that are abundant in vitamin C include the following:
  • Berries
  • Cantaloupe 
  • Citrus fruits such as lemon and orange
  • Broccoli 
  • Potatoes
  • Cauliflower 
  • Spinach
  • Cabbage

Monday, August 30, 2010

Tetanus Causes, Signs and Treatment

Tetanus, a curable medical condition called popularly as lockjaw, arises due to extended skeletal muscle contraction. The contamination of wound remains the root cause of infection as it is associated with rust. The rusty rough surface of the metal provides  a perfect habitat for the C. tetani bacteria. When the rusty metal containing the anaerobic C. tetani bacteria pierces the skin, the C. tetani endospore is injected into the the skin.


The endaspore is a temporary non reproductive structure formed by the bacteria which metabolises and infects in its required environment.


Tetanus Symptoms:

The lockjaw symptoms arise mostly at the skeleton muscle of striated type.

The most common sign of the lockjaw disorder is the inability of the patients to move their lower jaw which also is the reason for the origin of name 'lockjaw'.

The incubation period for tetanus varies from nine days to a months time. Shorter incubation period corresponds to severe lockjaw symptoms.


Prevention of lockjaw:

Strangely, prevention measres does not provide immunity to the lockjaw disease because even a lethal dose of tetanus toxin is unable to provoke an immune response.


In children under seven years of age, the tetanus vaccine is usually a combined DPT/DTaP vaccine, including vaccines against pertussis and diphtheria.


For those above the age of seven, the Td vaccine which represents Tetanus and diphtheria vaccine or the Tdap vaccine that represents Tetanus Diphtheria and Acellular Pertussis vaccine is commonly used.


A vaccination with tetanus toxoid could also possibly prevents tetanus. It is recommended that adults receive a booster vaccine every ten years and a standard care is practiced to give these booster vaccines to any patient suffering from a puncture wound or to those who is uncertain of when they were vaccinated previously.


The booster takes up to two weeks for the lockjaw antibodies to be formed which makes it hard to prevent a present and fatal case of tetanus.


Injecting a post exposure tetanus prophylaxis immediately after injury that is more prone to cause tetanus is another way of preventing tetanus. The shots of tetanus prophylaxis have to be given depends upon following factors:
  
The number of years since the infected person has had his last booster
 

The total number of vaccinations against tetanus that the patient has received and the nature of the injury.


Tetanus treatment:

The treatment for lockjaw primarily involves cleaning of the wound.

Surgical debridement is practiced to remove the dead and the infected tissues.
 

Coordination of antibiotic metronidazole reduces the number of bacteria. Once Penicillin was used to treat tetanus, as it involves a risk in increase of spasms. Its recommented to use only at the times of unavaiability of metronidazole.

Restriction     of toxin production nullifies its effects and controls muscle spasms. Robaxin-750 generically called as methacarbamol is a good skeletal muscle relaxant.

It is of high importance for a passive immunization with the tetanus     immunoglobulin or the human anti-tetanospasmin immunoglobulin. Normal human immunoglobein is given in case of unavailability of the required anti-tetanospasmin immunoglobulin.


It is compulsory for all the tetanus victims to be vaccinated against the disease.