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Phần 5: Cập nhật một số nghiên cứu về bệnh ấu trùng giun lươn ở người

Ký sinh trùng giun lươn là một trong những bệnh ký sinh trùng cơ hội trên các bệnh nhân có bệnh lý nền, hệ thống miễn dịch suy yếu như nhiễm trùng HIV/AIDS, đái tháo đường, bệnh hệ thống, hội chứng chuyển hóa, lao phổi, ung thư, các bệnh nhân đang dùng thuốc chống ung thư, các bệnh nhân viêm khớp mạn tính, cần sử dụng thuốc corticoides dài ngày, các bệnh lý viêm đa khớp mạn tính,…đều có cơ hội cao cho nhiếm ấu trùng giun lươn Strongyloides stercoralis.

Đặc biệt trên các cơ địa đó, chúng thường gây ra hội chứng tăng nhiễm dẫn đến bệnh nhân thường mắc các biến chứng nặng hơn và dễ dẫn đến tử vong cao. Nhân đây, chúng tôi xin cập nhật một số nghiên cứu liên quan đến nhiễm trùng loài ký sinh trùng này với các yếu tố nguy cơ cao dễ dẫn đến nhiễm.

Evaluation of faecal culture as a method of diagnosis of strongyloides stercoralis and experimental infection of albino rats by filariform larvae.

Salem SA, Azab ME, Abdel Baki MH, Bebars MA.J Egypt Soc Parasitol. 1984 Jun;14(1):229-35. No abstract available. PMID: 6736705 Similar articles Select item 26275275440.

Cervical strongyloidiasis in an immunocompetent patient: A clinical surprise.

Panda S, Kar A, Das U, Rout N.Indian J Pathol Microbiol. 2015 Jul-Sep;58(3):389-91. doi: 10.4103/0377-4929.162927.PMID: 26275275 Free Article Similar articles

Acute strongyloidiasis: a rarity. Chronic strongyloidiasis: a time bomb!

Caumes E, Keystone JS.J Travel Med. 2011 Mar-Apr;18(2):71-2. doi: 10.1111/j.1708-8305.2010.00492.x. Epub 2011 Feb 7. No abstract available. PMID: 21366788 Free Article Similar articles Select item 28377220442.

Estimating occurrence of Strongyloides stercoralis in the Caribbean island countries: Implications for monitoring and control.

Ketzis JK, Conan A.Acta Trop. 2017 Jul;171:90-95. doi: 10.1016/j.actatropica.2017.03.037. Epub 2017 Apr 1.PMID: 28377220 Similar articles Select item 9656674443.

[A case of pleuritis caused by strongyloides in a carrier of T-cell lymphoma virus type I (HTLV-I)].

Oya H, Mori S, Tsuchihashi H, Kurono A, Mizoguchi A, Kawabata M, Arimura K, Osame M.Nihon Kokyuki Gakkai Zasshi. 1998 Mar;36(3):262-7. Japanese. PMID: 9656674 Similar articles Select item 27310213444.

Notes from the Field: Strongyloidiasis at a Long-Term-Care Facility for the Developmentally Disabled - Arizona, 2015.

Jones JM, Hill C, Briggs G, Gray E, Handali S, McAuliffe I, Montgomery S, Komatsu K, Adams L.MMWR Morb Mortal Wkly Rep. 2016 Jun 17;65(23):608-9. doi: 10.15585/mmwr.mm6523a5.PMID: 27310213 Free Article Similar articles Select item 24890756445.

Strongyloides stercoralis disseminated infection in a patient misdiagnosed with chronic asthmatic bronchitis.

Wang Y, Ma Y, Xu Y, Zhu B, Guo H.J Microbiol Immunol Infect. 2016 Feb;49(1):154-6. doi: 10.1016/j.jmii.2014.04.007. Epub 2014 Jun 2. No abstract available. PMID: 24890756 Free Article Similar articles Select item 9228487446.

Strongyloides stercoralis infection in a patient with Crohn's disease.

Pasqualini L, Crotti D, Scarponi A, Vaudo G, Mannarino E.Eur J Clin Microbiol Infect Dis. 1997 May;16(5):401-3. No abstract available. PMID: 9228487 Similar articles Select item 11127344447.

Community control studies o­n Strongyloides infection in a model island of Okinawa, Japan.

Toma H, Shimabukuro I, Kobayashi J, Tasaki T, Takara M, Sato Y.Southeast Asian J Trop Med Public Health. 2000 Jun;31(2):383-7.PMID: 11127344 Similar articles Select item 7353987448.

Strongyloides stercoralis-like infection in a dog.

Malone JB, Breitschwerdt EB, Little MD, Ochoa R, Wolf KA.J Am Vet Med Assoc. 1980 Jan 15;176(2):130-3.PMID: 7353987 Similar articles Select item 7660426449.

Household aggregation of Strongyloides stercoralis infection in Bangladesh.

Conway DJ, Hall A, Anwar KS, Rahman ML, Bundy DA.Trans R Soc Trop Med Hyg. 1995 May-Jun;89(3):258-61.PMID: 7660426 Similar articles Select item 7993534450.

[Prevalence of Strongyloides stercoralis infection in childhood. Orán, Salta, Argentina].

Taranto NJ, Bonomi de Filippi H, Orione O.Bol Chil Parasitol. 1993 Jul-Dec;48(3-4):49-51. Spanish. PMID: 7993534 Similar articles Select item 9385354451.

SLE with death from acute massive pulmonary hemorrhage caused by disseminated strongyloidiasis.

Setoyama M, Fukumaru S, Takasaki T, Yoshida H, Kanzaki T.Scand J Rheumatol. 1997;26(5):389-91.PMID: 9385354 Similar articles Select item 30230751452.

Limit of molecular detection of strongyloides stercoralis parasite performing.two PCR protocols.

Badr MS, El-Askary HM, Elmalawany M, Kamal R, Alsamra N.J Egypt Soc Parasitol. 2016 Dec;46(3):549-556.PMID: 30230751 Similar articles Select item 24871626453.

Fatal Strongyloides hyper-infection in a patient with myasthenia gravis.

Saraei M, Hosseinbigi B, Shahnazi M, Bijani B.Infection. 2014 Dec;42(6):1039-42. doi: 10.1007/s15010-014-0637-x. Epub 2014 May 29.PMID: 24871626 Similar articles Select item 19071966454.

Finding ancient parasite larvae in a sample from a male living in late 17th century Korea.

Shin DH, Chai JY, Park EA, Lee W, Lee H, Lee JS, Choi YM, Koh BJ, Park JB, Oh CS, Bok GD, Kim WL, Lee E, Lee EJ, Seo M.J Parasitol. 2009 Jun;95(3):768-71. doi: 10.1645/GE-1763.1.PMID: 19071966 Similar articles Select item 8361437455.

Recurrent bacterial meningitis associated with strongyloides hyperinfection.

Mak DB.Med J Aust. 1993 Sep 6;159(5):354. No abstract available. PMID: 8361437 Similar articles Select item 1568804456.

Strongyloides stercoralis hyperinfection.

Purvis RS, Beightler EL, Diven DG, Sanchez RL, Tyring SK.Int J Dermatol. 1992 Mar;31(3):160-4. Review. No abstract available. PMID: 1568804 Similar articles Select item 16304332457.

Strongyloides hyperinfection presenting as acute respiratory failure and gram-negative sepsis.

Newberry AM, Williams DN, Stauffer WM, Boulware DR, Hendel-Paterson BR, Walker PF.Chest. 2005 Nov;128(5):3681-4.PMID: 16304332 Free PMC Article Similar articles Select item 11107239458.

Disseminated Strongyloides stercoralis Infection in an AIDS Patient: The Role of Suppressive Therapy.

Levi GC, Kallás EG, Ramos Moreira Leite K.Braz J Infect Dis. 1997 Mar;1(1):48-51.PMID: 11107239 Similar articles Select item 3418169459.

Evaluation of different methods of cultivation of filariform larvae of Strongyloides stercoralis.

Mohamed NH, Salem SA, Azab ME, el Kadery AA, Sabry NM.J Egypt Soc Parasitol. 1988 Dec;18(2):717-21. No abstract available. PMID: 3418169 Similar articles Select item 26035061460.

Effect of dilution of stool soluble component o­n growth and development of Strongyloides stercoralis.

Anamnart W, Intapan PM, Pattanawongsa A, Chamavit P, Kaewsawat S, Maleewong W.Sci Rep. 2015 Jun 2;5:10749. doi: 10.1038/srep10749.PMID: 26035061 Free PMC Article Similar articles

Experimental disseminated strongyloidiasis in Erythrocebus patas. II. Immunology.

Genta RM, Harper JS 3rd, Gam AA, London WI, Neva FA.Am J Trop Med Hyg. 1984 May;33(3):444-50.PMID: 6731676 Similar articles Select item 1565315462.

The Strongyloides hyperinfection syndrome.

Jamil SA, Hilton E.N Y State J Med. 1992 Feb;92(2 ):67-8. No abstract available. PMID: 1565315 Similar articles Select item 28562417463.

Strongyloides stercoralis in solid organ transplantation: early diagnosis gets the worm.

Mobley CM, Dhala A, Ghobrial RM.Curr Opin Organ Transplant. 2017 Aug;22(4):336-344. doi: 10.1097/MOT.0000000000000428. Review.PMID: 28562417 Similar articles Select item 7962235464.

Acute nonspecific illness in an AIDS patients with dysphagia.

Perazella MA, Sadigh M.Hosp Pract (Off Ed). 1994 Nov 15;29(11):39, 43, 47. No abstract available. PMID: 7962235 Similar articles Select item 11435631465.

Endemic strongyloidiasis o­n the Spanish Mediterranean coast.

Sánchez PR, Guzman AP, Guillen SM, Adell RI, Estruch AM, Gonzalo IN, Olmos CR.QJM. 2001 Jul;94(7):357-63.PMID: 11435631 Similar articles Select item 29425193466.

Accuracy of molecular biology techniques for the diagnosis of Strongyloides stercoralis infection-A systematic review and meta-analysis.

Buonfrate D, Requena-Mendez A, Angheben A, Cinquini M, Cruciani M, Fittipaldo A, Giorli G, Gobbi F, Piubelli C, Bisoffi Z.PLoS Negl Trop Dis. 2018 Feb 9;12(2):e0006229. doi: 10.1371/journal.pntd.0006229. eCollection 2018 Feb. Review.PMID: 29425193 Free PMC Article Similar articles Select item 10220761467.

[Strongyloidiasis and HTLV-I infection].

Calderón E, Capote FJ, Medrano FJ, Soriano V.Med Clin (Barc). 1999 Feb 27;112(7):279. Spanish. No abstract available. PMID: 10220761 Similar articles Select item 2600524468.

A case of Strongyloides stercoralis in central Louisiana.

Holcombe DJ.J La State Med Soc. 1989 Oct;141(10):22-4.PMID: 2600524 Similar articles Select item 8154005469.

Reduced efficacy of chemotherapy might accumulate concurrent HTLV-1 infection among strongyloidiasis patients in Okinawa, Japan.

Sato Y, Shiroma Y, Kiyuna S, Toma H, Kobayashi J.Trans R Soc Trop Med Hyg. 1994 Jan-Feb;88(1):59. No abstract available. PMID: 8154005 Similar articles Select item 16929879470.

Not your typical strongyloides infection: a literature review and case study.

Foreman EB, Abraham PJ, Garland JL.South Med J. 2006 Aug;99(8):847-52.PMID: 16929879 Similar articles Select item 26126559471.

Strongyloides stercoralis infection and antenatal care.

Hays R, McDermott R.Med J Aust. 2015 Jul 6;203(1):18-9. No abstract available. PMID: 26126559 Similar articles Select item 26258603472.

Strongyloides stercoralis infection in patients with systemic lupus erythematosus: diagnosis and prevention of severe strongyloidiasis.

de Souza JN, Inês Ede J, Santiago M, Teixeira MC, Soares NM.

Int J Rheum Dis. 2016 Jul;19(7):700-5. doi: 10.1111/1756-185X.12644. Epub 2015 Aug 10.

PMID: 26258603 Similar articles Select item 8438116473.

[Chronic abdominal pain and eosinophilia in a patient from Southern Italy].

Hanck C, Holzer RB.

Schweiz Rundsch Med Prax. 1993 Feb 16;82(7):186-8. German.

PMID: 8438116 Similar articles Select item 16734908474.

Intestinal strongyloidiasis and hyperinfection syndrome.

Vadlamudi RS, Chi DS, Krishnaswamy G.

Clin Mol Allergy. 2006 May 30;4:8.

PMID: 16734908 Free PMC Article Similar articles Select item 626279475.

Strongyloides stercoarlis--hyperinfection.

Boyd WP Jr, Campbell FW, Trudeau WL.

Am J Trop Med Hyg. 1978 Jan;27(1 Pt 1):39-41.

PMID: 626279 Similar articles Select item 23936693476.

Fatal strongyloides hyperinfection complicating a gram-negative sepsis after allogeneic stem cell transplantation: a case report and review of the literature.

Izquierdo I, Briones J, Lluch R, Arqueros C, Martino R.

Case Rep Hematol. 2013;2013:860976. doi: 10.1155/2013/860976. Epub 2013 Jul 10.

PMID: 23936693 Free PMC Article Similar articles Select item 19820762477.

[Strongyloides stercoralis infection in renal transplant recipients].

Beltrán Catalán S, Crespo Albiach JF, Morales García AI, Gavela Martínez E, Górriz Teruel JL, Pallardó Mateu LM.

Nefrologia. 2009;29(5):482-5. doi: 10.3265/Nefrologia.2009.29.5.4525.en.full. Spanish.

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[Strongyloides stercoralis: an insidious oddity].

Bos AJ, Jie C, Sie MC.

Ned Tijdschr Geneeskd. 1993 Dec 18;137(51):2669-70. Dutch. No abstract available.

PMID: 8278005 Similar articles Select item 22860137479.

Is human immunodeficiency virus infection a risk factor for Strongyloides stercoralis hyperinfection and dissemination.

Siegel MO, Simon GL.

PLoS Negl Trop Dis. 2012;6(7):e1581. doi: 10.1371/journal.pntd.0001581. Epub 2012 Jul 31. No abstract available.

PMID: 22860137 Free PMC Article Similar articles Select item 9892542480.

Strongyloides stercoralis infection: unknown transmission or late recrudescence?

Giacometti A, Cirioni O, Drenaggi D, Compagnucci P, Quarta M, Fortuna M, Scalise G.

J Infect. 1998 Nov;37(3):306-7. No abstract available.

PMID: 9892542 Similar articles

Rapid method of concentrating Strongyloides stercoralis larvae in masses in fecal materials].

Ionescu H.

Rev Ig Bacteriol Virusol Parazitol Epidemiol Pneumoftiziol Bacteriol Virusol Parazitol Epidemiol. 1985 Apr-Jun;30(2):161-8. Romanian. No abstract available.

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Strongyloidiasis in a patient with IgA deficiency.

Leung VK, Liew CT, Sung JJ.

Trop Gastroenterol. 1995 Oct-Dec;16(4):27-30.

PMID: 8854952 Similar articles Select item 24358173483.

Detrimental effect of water submersion of stools o­n development of Strongyloides stercoralis.

Anamnart W, Pattanawongsa A, Intapan PM, Morakote N, Janwan P, Maleewong W.

PLoS o­ne. 2013 Dec 16;8(12):e82339. doi: 10.1371/journal.pone.0082339. eCollection 2013.

PMID: 24358173 Free PMC Article Similar articles Select item 9424936484.

[Strongyloides stercoralis (Bavay, 1876) Stiles et Hassall, 1902 (Nematoda)--intestinal roundworm. III. Morphology and anatomy].

Soroczan W.Wiad Parazytol. 1997;43(2):143-54. Review. Polish. No abstract available. PMID: 9424936 Similar articles Select item 8023505485.

[Strongyloidosis. I. Specific and nonspecific skin lesions].

Soroczan W.Wiad Parazytol. 1994;40(1):45-51. Review. Polish. PMID: 8023505 Similar articles Select item 28112060486.

Parasitological versus molecular diagnosis of strongyloidiasis in serial stool samples: how many?

Dacal E, Saugar JM, Soler T, Azcárate JM, Jiménez MS, Merino FJ, Rodríguez E.J Helminthol. 2018 Jan;92(1):12-16. doi: 10.1017/S0022149X17000050. Epub 2017 Jan 23.PMID: 28112060 Similar articles Select item 9441201487.

[Hyperinfection by Strongyloides stercoralis and other pathogens in a patient with chronic obstructive airways disease].

Gómez J, Plaza V, Muñoz C, Franquet T.Med Clin (Barc). 1997 Nov 1;109(15):609. Spanish. No abstract available. PMID: 9441201 Similar articles Select item 10767825488.

Strongyloides stercoralis: ultrastructural study of newly hatched larvae within human duodenal mucosa.

Dionisio D, Manneschi LI, di Lollo S, Orsi A, Tani A, Papucci A, Esperti F, Leoncini F.J Clin Pathol. 2000 Feb;53(2):110-6.PMID: 10767825 Free PMC Article Similar articles Select item 10438074489.

Fatal strongyloidosis following corticosteroid therapy in a patient with chronic idiopathic thrombocytopenia.

Suvajdzic N, Kranjcić-Zec I, Jovanović V, Popović D, Colović M.Haematologia (Budap). 1999;29(4):323-6.PMID: 10438074 Similar articles Select item 10622101490.

Disseminated strongyloidiasis arising from a single dose of dexamethasone before stereotactic radiosurgery.

Thomas MC, Costello SA.Int J Clin Pract. 1998 Oct;52(7):520-1.PMID: 10622101 Similar articles Select item 17366869491.

Strongyloidiasis stercoralis: is it a health problem in Saudi Arabia?

Al-Mathal EM.J Egypt Soc Parasitol. 2006 Aug;36(2 Suppl):27-30.PMID: 17366869 Similar articles Select item 8602184492.

Images in clinical medicine. Strongyloides stercoralis infestation.

Brenneck J, Mattia A.N Engl J Med. 1996 May 2;334(18):1173. No abstract available. PMID: 8602184 Free Article Similar articles Select item 14652568493.

Endoscopic and histopathologic findings of Strongyloides stercoralis infection in a patient with AIDS.

Overstreet K, Chen J, Rodriguez JW, Wiener G.Gastrointest Endosc. 2003 Dec;58(6):928-31. No abstract available. PMID: 14652568 Similar articles Select item 22552237494.

Image of the month: Strongyloides stercoralis infection in the colon.

Koczka CP.Am J Gastroenterol. 2012 May;107(5):655. doi: 10.1038/ajg.2012.101. No abstract available. PMID: 22552237 Similar articles Select item 24150672495.

Simple solutions to Strongyloides stercoralis infection.

Ross KE, O'Donahoo FJ, Garrard TA, Taylor MJ.

BMJ. 2013 Oct 22;347:f6294. doi: 10.1136/bmj.f6294. No abstract available.

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Strongyloides stercoralis.

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Contreras SN, Barreiro Alonso E, Liguori Ljoka ME, Díaz Trapiella A.

Semergen. 2017 Jan - Feb;43(1):e6-e8. doi: 10.1016/j.semerg.2016.03.007. Epub 2016 Apr 14. Spanish. No abstract available.

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The neurons of class ALD mediate thermotaxis in the parasitic nematode, Strongyloides stercoralis.

Lopez PM, Boston R, Ashton FT, Schad GA.

Int J Parasitol. 2000 Sep;30(10):1115-21.

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Strongyloides stercoralis in routine Papanicolaou-stained sputum smears.

Humpherys K, Hieger LR.

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Experimental infection of human subject with Strongyloides species.

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Possible Strongyloides stercoralis infection diagnosed by videocapsule endoscopy in an immunocompetent patient with devastating diarrhea.

Xouris D, Vafiadis-Zoumbulis I, Papaxoinis K, Bamias G, Karamanolis G, Vlachogiannakos J, Ladas SD.

Ann Gastroenterol. 2012;25(3):268-270.

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Strongyloides stercoralis: Global Distribution and Risk Factors.

Schär F, Trostdorf U, Giardina F, Khieu V, Muth S, Marti H, Vounatsou P, Odermatt P.

PLoS Negl Trop Dis. 2013 Jul 11;7(7):e2288. doi: 10.1371/journal.pntd.0002288. Print 2013. Review.

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Strongyloides fülleborni infections in man in Zambia.

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Rapid development of migratory, linear, and serpiginous lesions in association with immunosuppression.

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J Am Acad Dermatol. 2014 Jun;70(6):1130-4. doi: 10.1016/j.jaad.2013.11.036. Review.

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Severe strongyloidiasis: a systematic review of case reports.

Buonfrate D, Requena-Mendez A, Angheben A, Muñoz J, Gobbi F, Van Den Ende J, Bisoffi Z.

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[Two cases of Strongyloides stercoralis infection].

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Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2013 Feb;31(1):80. Chinese. No abstract available.

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Cytologic detection of Enterobius vermicularis and Strongyloides stercoralis in routine cervicovaginal smears and urocytograms.

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Strongyloides stercoralis hyperinfection in a patient with the acquired immune deficiency syndrome.

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Images of the month: A case of strongyloidiasis presenting as a colonic mass.

Sethi S, Kheraj R, Sethi N, Wadhwa V.

Am J Gastroenterol. 2014 Jan;109(1):20. doi: 10.1038/ajg.2013.448. No abstract available.

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[Strongyloides stercoralis].

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Strongyloidiasis masquerading as inflammatory bowel disease in a patient with lupus erythematosis: a case report.

Hayden GM, Atlas SA.

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An Analysis of Clinical Characteristics of Strongyloides stercoralis in 70 indigenous patients in Iran.

Sharifdini M, Kia EB, Ashrafi K, Hosseini M, Mirhendi H, Mohebali M, Kamranrashani B.

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[Combined infection of Strongyloides stercoralis in a case of Hodgkin's disease].

Lu F, Ye LP, Zhu ZH.

Zhongguo Ji Sheng Chong Xue Yu Ji Sheng Chong Bing Za Zhi. 2010 Apr;28(2):1 p preceding table of contents. Chinese. No abstract available.

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Rare Case of Strongyloides stercoralis Hyperinfection in a Greek Patient with Chronic Eosinophilia.

Kechagia M, Stamoulos K, Skarmoutsou N, Katsika P, Basoulis D, Martsoukou M, Pavlou K, Fakiri EM.

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Growth of the genital primordium as a marker to describe a time course for the heterogonic larval development in Strongyloides stercoralis.

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Tokuda Y.

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Molecular Diagnosis of Strongyloides stercoralis Infection by PCR Detection of Specific DNA in Human Stool Samples.

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Genome-Wide Analyses of Individual Strongyloides stercoralis (Nematoda: Rhabditoidea) Provide Insights into Population Structure and Reproductive Life Cycles.

Kikuchi T, Hino A, Tanaka T, Aung MP, Afrin T, Nagayasu E, Tanaka R, Higashiarakawa M, Win KK, Hirata T, Htike WW, Fujita J, Maruyama H.

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Perit Dial Int. 2017 Nov-Dec;37(6):662. doi: 10.3747/pdi.2017.00107. No abstract available.

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Schistosomiasis and Strongyloidiasis Recommendations for Solid-Organ Transplant Recipients and Donors.

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Akiyama MJ, Brown JD.

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Strongyloidiasis Outside Endemic Areas: Long-term Parasitological and Clinical Follow-up After Ivermectin Treatment.

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Generalized serpiginous eruption during immunosuppressive treatment for leprosy reactive neuritis.

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A Case of Strongyloidiasis: An Immigrant Healthcare Worker Presenting with Fatigue and Weight Loss.

Grewal T, Azizi H, Kahn A, Shakir Z, Takkouche S, Aung KN, Lois W, Hasan M.Case Rep Infect Dis. 2017;2017:6718284. doi: 10.1155/2017/6718284. Epub 2017 Jun 28.PMID: 28744381 Free PMC Article Similar articles Select item 2402923577.

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Prevalence of strongyloidiasis in Latin America: a systematic review of the literature.

Buonfrate D, Mena MA, Angheben A, Requena-Mendez A, Muñoz J, Gobbi F, Albonico M, Gotuzzo E, Bisoffi Z; COHEMI Project Study Group.Epidemiol Infect. 2015 Feb;143(3):452-60. doi: 10.1017/S0950268814001563. Epub 2014 Jul 3. Review.PMID: 24990510 Similar articles Select item 11280656579.

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Strongyloides stercoralis hyperinfection in patient with autoimmune hepatitis and purpura fulminans.

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Colorectal Cancer Associated with Strongyloides stercoralis Colitis.

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[Human infestation by Strongyloides stercoralis in Portuguese territory; notes of 54 autochthonous cases metropolis].

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The Health Effects of Strongyloidiasis o­n Pregnant Women and Children: A Systematic Literature Review.

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Strongyloides mirzai infection in a green tree python.

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Microbiology problem.

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