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Category Archives: Eczema

AbbVie’s positive eczema study drags down Regeneron’s shares – Reuters

Posted: September 7, 2017 at 5:50 pm

(Reuters) – AbbVie Inc said on Thursday its experimental drug to treat adults with moderate-to-severe eczema met the main goal in a mid-stage study, dragging down shares of rival U.S. biotech firm Regeneron Pharmaceuticals Inc.

Eczema, also known as atopic dermatitis, is a chronic skin inflammation, which in severe cases causes constant and often unbearable itching.

Regenerons eczema drug, Dupixent, was approved by the U.S. Food and Drug Administration in March.

AbbVies mid-stage trial data for its drug, upadacitinib, seemed comparable to Dupixents late-stage data, but the difference in the two studies sample sizes made direct comparisons imprecise, Jefferies analyst Berin Amin said.

Nonetheless, we expect upadacitinib to compete with Dupixent, Amin added.

Upadacitinib showed a statistically significant improvement in reducing both the severity of eczema in patients and the amount of body area affected by the disease, AbbVie said.

Shares of AbbVie, which plans a late-stage study for upadacitinib next year, were up 2.8 percent at $79.23 in late morning trading.

Regenerons shares were down 5.2 percent at $474.08.

Reporting by Akankshita Mukhopadhyay in Bengaluru; Editing by Sai Sachin Ravikumar

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AbbVie shares rally on positive eczema study, competitor Regeneron drops – Investing.com

Posted: at 5:50 pm

Investing.com – AbbVie Inc ‘s (NYSE:) shares climbed on Thursday after the company announced that its mid-stage trial data for its drug, upadacitinib, to treat moderate-to-severe eczema met its primary endpoint.

The study showed positive results for upadacitinib with no new safety signals detected, and all doses achieved the primary endpoint of greater mean percentage change from baseline in eczema area and severity index versus a placebo. Clear or almost clear skin was achieved by 50 percent of patients receiving 30 mg once-daily dose of upadacitinib.

Upadacitinib is being studied as a once-a-day therapy in eczema (atopic dermatitis) and across multiple immune-mediated diseases.

AbbVies shares jumped on the news, but Regeneron Pharmaceuticals shares fell on the potential for new competition for Regeneron’s eczema drug, Dupixent, which was approved by the U.S. Food and Drug Administration in March.

AbbVies shares were recently up 6.2%, Regenerons were down 6%.

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AbbVie shares rally on positive eczema study, competitor Regeneron drops – Investing.com

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New AstraZeneca, Amgen Biotech Drug Offers Broad Asthma Relief – New York Times

Posted: September 6, 2017 at 5:45 pm

Injections for severe asthma have opened up a multibillion-dollar market as competing drugmakers have raced to develop antibody-based medicines for the 15 percent or more of patients who do poorly even on the latest inhalers.

Despite treatment advances in recent decades, their asthma is still not well controlled by standard therapy, which consists of inhaled steroids and drugs to open the airways.

Nucala and Teva’s Cinqair are two recently approved new injectable drugs and AstraZeneca’s benralizumab is likely to join them soon, since it is awaiting approval in the fourth quarter of this year.

Sanofi’s Dupixent, already approved for severe eczema, is a bit further behind but is widely seen as a strong contender.

However, all these new medicines only appear to help people with certain types of severe asthma, by targeting specific inflammatory chemicals made in the body that drive asthma, making them suitable for subgroups of patients.

Tezepelumab is different because it acts further upstream in the inflammatory cascade responsible for asthma by blocking the action of a cell-signalling protein called thymic stromal lymphopoietin (TSLP).

That means it can help a wider range of patients and could be a “game-changer”, according Tom Keith-Roach, head of AstraZeneca’s respiratory, inflammation and autoimmune business.

Biotech drugs for severe asthma are already worth $2 billion (1.53 billion pounds) in annual sales and Keith-Roach believes there is significant scope for growth since currently only about 10 percent of patients who might benefit are getting them.

Tezepelumab, like Dupixent, is also being developed for eczema.

The results of the Phase IIb asthma study, which were published online by the New England Journal of Medicine, will also be presented at the European Respiratory Society annual meeting in Milan next week.

(Reporting by Ben Hirschler; Editing by Mark Potter)

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Dealing with eczema – Metro

Posted: September 4, 2017 at 7:44 pm

(Picture: Getty)

I hear stop scratching at least once a day.

For someone with eczema its one of the most annoying things. Do you not think Id stop if I could? Im certainly not itching because its fun.

According to the National Eczema Society, however,one in twelve adults have eczema, which is no small figure for something so misunderstood.

Put in the most simple terms, people with eczema produce less fat and oil in their skin. This means they have less of a barrier against bacteria and infection, and skin can become cracked and inflamed. Everyone experiences this differently, with some having red patches, some getting itchy, and some getting weeping or bleeding sores (or a mixture of those).

While eczema cant be cured it can be managed, and finding the right combination of treatments means you wont feel like a flaky, sore mess.

These are every eczema suffers best friend, and act an as everyday moisturiser to help reduce moisture loss from the skin. My weapon of choice is Doublebase Gel, which comes in huuuuge pump bottles and I douse my whole body in up to three times a day.

Ive devised a handy system for applying mine, but it sounds ridiculous to anyone that doesnt require efficient post-shower moisturising. Each part of my body gets a different pump dosage: Four for each arm, two for each calf, etc. Its important to find a way that works for you so that you keep up with your regimen, as the drier your skin gets, the more likely it is to get infected.

You can be prescribed emollients, or use readily available options like E45, Cetraben, or Eucerin. Steer clear of using aqueous cream for this purpose, however, as they contain sodium lauryl sulphate which can do more harm than good.

For more severe eczema, your GP might prescribe you a steroid cream or ointment. One of the milder versions you may recognise hydrocortisone which is safe for use on children and on the face. Depending on the severity of your condition and where youre affected, there are different strengths. Some also come with anti-microbial ingredients if your skin is already infected.

As someone whos been on some pretty harsh creams (holla at my Dermovate gang), I cant stress enough the importance of following doctors instructions. Some of these can thin the skin, so they should only be used during a flare-up in the way youve been told to use them.

Similarly, if youre discontinuing use, speak to your pharmacist or GP, as in some cases you can experience a steroid flare-up which is super painful.

All your hard work can be undone in this stage, so you have to be very careful with what you use to wash.

Most shower gels have some form of surfactant/sulphate, which is what takes the dirt off your body in a foam to wash it away. There are plenty of variants of these, with some being more irritating than others. If you can find a low sulphate gel, or one that has no SLS, itll probably be a lot gentler.

In any good chemist youll be able to find loads of options like Oilatum, that keep you clean without stripping natural oils.

Some people find that avoiding certain things helps them avoid flare-ups. Very cold or hot weather can have an effect, as can they type of clothes you wear and the laundry detergent you use. Try to stick to cotton clothing where possible, and use a non-bio washing detergent specifically for sensitive skin.

Keep a diary of eczema triggers, which could be pets or cleaning products, and do what you can to stay away from them.

On top of your skin regime, many people have started changing their diet to improve their skin. Replacing dairy with hemp milk has been recommended online, and so has avoiding gluten.

Essentially, its such an individual skin condition that theres never going to be a one-size fits all solution. The main thing is to keep your skin as hydrated as possible (even if that means waking up earlier in the morning) and trying different things until you find something that works for you.

And for you non-eczema sufferers: Stop telling us to stop itching!

MORE: Mother praises miracle 3.99 cream which cured daughters painful eczema within a week

MORE: Fitness blogger shares photo of the reality of having eczema

MORE: 17 things people with eczema are tired of hearing

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Dealing with eczema – Metro

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SKIN HEALTH: Skin condition research | Post Life … – The Fort Campbell Courier

Posted: September 1, 2017 at 5:46 am

For more than 17 million people in the United States living with severe eczema a condition that results in dry, itchy rashes and disqualifies many from military service the mystery behind its cause may be all too familiar. Thanks to researchers at the Uniformed Services University of Health Sciences and National Institutes of Health, certain patients may understand more about their condition.

Studying these disorders, especially when we can define the disease based on a single mutation, is incredibly informative because you can learn a lot, said Andrew Snow, assistant professor in the department of pharmacology and molecular therapeutics at USU, and senior co-author of a study recently published in the journal Nature Genetics.

In this study, mutations in a gene known as CARD11 were identified as one underlying cause for severe eczema. The discovery led the researchers to ask whether excess glutamine can help correct some of the allergy-related defects in patients immune cells. The testing was done with T cells, known as the conductors of the bodys immune response against infections, from one patient in a lab, and the results were promising. Additional work with the NIH to study whether symptoms for patients with similar mutations improve with glutamine supplements a readily available product in stores is likely, Snow said.

Severe eczema can run in Families, which suggests a genetic cause, said Snow. One by one, Snow and NIH allergist Dr. Joshua Milner received referrals for patients who had mutations in the same gene totaling eight patients from four different Families.

However, such treatments are not a cure for the cause of the disease, particularly if its a genetic cause, Snow said.

During the study, researchers discovered these CARD11 mutations can prevent T cells from being able to do their jobs normally. The mutations prevent the cells from taking in enough glutamine, which is needed for T cells to maintain their proper function. This may help explain why some patients with severe eczema have a history of pneumonia, warts, and other types of lung and skin infections, Snow said.

While a mutation in the CARD11 gene is only one possible cause for severe eczema, its discovery can influence new therapies. Current treatments, including over-the-counter and prescription pills or creams, focus on bringing down the inflammation and relieving the itching.

Jeffrey Stinson, a former USU graduate student in Snows laboratory, who is currently at the National Institute of Standards and Technology and co-author on the study, said the possibility of having something so easily accessible as a targeted form of treatment would be an incredible achievement for those living with severe eczema and other allergic symptoms.

This genetic condition is considered rare, but its important to acknowledge the impact that findings from small, basic research studies like this can have in the medical field, Stinson said, stressing that the research would not be possible without the time and participation of the Families who volunteer. Thanks to their dedication, we have new and exciting possibilities for advancement before us.

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SKIN HEALTH: Skin condition research | Post Life … – The Fort Campbell Courier

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SkinSmart Antimicrobial debuts with eczema and wound care … – Drug Store News

Posted: August 31, 2017 at 11:44 am

MINNEAPOLIS SkinSmart Antimicrobial is a new skincare brand launching over-the-counter solutions for eczema and wound care. SkinSmart is powered by hypochlorous, an ingredient that has been used in specialty wound care for years to help heal chronic skin conditions, wounds and burns. Previously this formula was only available with a prescription, the company reported.

The SkinSmart Antimicrobial skin cleanser for Eczema Therapy product represents a new technology with no topical steroids (commonly found in eczema care, like hydrocortisone), no limits on use, in an easy to use clear spray that has no side effects. SkinSmart Antimicrobial’s Hypochlorous technology is a new solution in over-the-counter products for people seeking relief from eczema symptoms. It was awarded the National Eczema Association’s Seal of Acceptance, SkinSmart noted.

SkinSmart Antimicrobial’s wound & skin cleanser for Wound Therapy technology is ideal for the daily preventative antimicrobial cleansing of at-risk feet, and it helps heal wounds, infections, rashes and other minor skin conditions. These afflictions can be a result of underlying medical conditions that require paying close attention to both preventing and treating wounds, or even skin infections that occur from obesity.

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Daniel Boey On His Own Eczema: Let’s Show The World We Can Lead Fabulous Lives! – Weekender Singapore

Posted: August 28, 2017 at 11:40 am

Lobster, he offers voluntarily when touched on the subject of name-calling.

Seated at rooftop destination Aura that overlooks some of Singapores iconic landmarks, Daniel Boey is casually clad in black with eyes that twinkle behind eyeglasses that are seemingly designed to embody a fashionable pair of ski goggles something only Singapores Godfather of Fashion can pull off.

He continues: If people call you names, laugh about it. Because if youre going get affected by it, at the end, the only one who is going to be harmed is you.

And boy oh boy is Boey laughing all the way to the realm of publishing with a hilarious tell-all memoir that documents his adventures of eczema, rash, sinus and allergies.

From his childhood days when his mother foraged fervently for a cure to that one time he suffered a fainting spell in the army, the fashion guru reveals every rash-related story in his second book, Behind Every *itch Is A Back Story. But are these stories a bit T.M.I?

I literally have to tell myself that if Im going to write this kind of book, it has to be a very honest book, no half measures about it, he candidly shares. There are certain stories that I write, then Im like: What if people knew about this are they going to change their perception of me? But at the end of the day, if people are going to judge you because of this, then theyre not really people I want in my life.

Boeys twinkle has intensified to a flash of conviction, rebellion if we may, illustrating the innate grit that led him to his revered standing in the fashion industry a ruthlessly image-driven world where a skin-peeling, red-touting, sinus-sniffing newcomer will most likely fall prey to the wolves of malice and cattiness.

But like Destinys Child, Boey is a survivor. And his latest book is a testament to that.

Behind Every *itch Is A Backstory ($28) is available atKinokuniya, Times, MPH and Popular bookstores.

What inspired you to write your second book?

When I wrote my first book (The Book Of Daniel: Adventures Of A Fashion Insider in 2015), I hadnt plan on writing a chapter about my allergies. All my close friends said this is such an integral part of your life; you have to include this chapter. So I wrote the chapter in as an afterthought. It was a very hard chapter to write because you dont know how much to reveal and how people are going perceive you after that, but surprisingly that chapter was one of the chapters that resonated most with people.

Then these four NTU students approached me for their Final-Year-Project. They were doing a project with the National Skin Centre called Starting From Scratch. After I did that, I realised this is a story that really needs to be told. A story that people need to read about not just for other people suffering from eczema, but also those who do not suffer eczema. I think a lot of people have pre-conceived notions of eczema sufferers. Like the first thing I want to tell them is its not contagious, youre not going to get it by touching another person with eczema.

Could you briefly describe the creative process of the book?

This was quite hard to write because what do you say? How honest do you want to be, what kind of stories do you want to tell, what stories to put in and what stories to leave outand I must say I wrote it and re-wrote it, and wrote certain parts many times before getting the tone right.

If I sound really bitchy and snarky, this means I havent come to terms with my condition. And if you want the book to be inspirational, you must set a tone that: I got this condition so what? I can sit back and laugh at myself about all these horrible things that happen to me, if I dont let it affect me and just laugh at it, then it just goes over my head.

You have punctuated the book with stylish editorial visuals. Tell us more on that.

I was inspired by George Michael, he was the first musician who did a music video where he didnt appear and instead, he peppered it with supermodels. We have rash, we have sinus, so lets be glamourous about it. Theres always a way to interpret it. I worked very closely with the creative team, I was telling them what I was writing about, and they interpret that in a visual form.

The visuals were literally planned as I was writing. On hindsight, we should have waited till I finished, then we wouldnt have to shoot so many pictures and drop so many pictures! (laughs) But it was a whole process and the more pictures we shot, the more in-depth feel they have of the book as well It was kind of nice to see my stories to be interpreted by another person.

While those who are inflicted with the same skin condition can definitely relate to your book, how does it appeal to the rest of us? What can we take away from it?

If youre so perfect in that way, hopefully, you have a bit more empathy for people who are less perfect than you and realise that life is not hunky-dory for everyone. Likewise with us, we may suffer from eczema,acne and all that, therell always be someone with a worst condition than us. We should not see ourselves as victims.

Eczema has put you a through a rather hellish time growing up, and now youre baring it all in this book. How does putting a spotlight on this vulnerable side make you feel?

Ill be lying if I said it was an easy project. It was quite scary. I literally have to tell myself that if Im going to write this kind of book, it has to be a very honest book, no half measures about it. You have to be honest about it. If you want eczema-sufferers to able to relate to you, you have to be honest, you cant lie about these things because they are going through the same thing as you. It might be a completely different kind of feel, or they may have different experiences, but the emotional part of it is still the same.

Out of all your eczema-ridden stories, was there one that defined the rest of your life? Could you share more?

I dont really think there is one, every single attack that happened at different stages of my life taught me something. From the time I had a heatstroke in the army and the attack in the university to all the attacks in the fashion industry and even the latest attack when everyone thought I had aids and was going to die, whatever that happened in the different stages of my life you are in a different mindset, and it touches something new.

Is there a valuable lesson youve taken away from having eczema?

You are responsible for your own life. If you get an attack and then crumble and hide from the world, the only one who is going to feel miserable is yourself. You just have to force yourself. You decide what you wanted to do, make of your own life. If youre gonna wither away and hide, you make that decision.

If you can, would you ever wish that you didnt have eczema?

Yes. But if not for my condition, I dont think I would have worked that hard. I think everything that happens in your life is for a reason and it drives you on. And all these obstacles that were put in my way were meant to make me a stronger person.

Any words of advice to an eczema sufferer from another?

At the end of the day, we are saddled with this condition. Theres nothing we can do about it, eczema cannot be cured. I would say learn as much as you can about this condition. Ive learnt as much about what triggers my eczema, what helps me calm down. The more you know about this condition, the better equipped you are to fight it.

Lastly, do you have a personal hack or tip to combat the onslaught of eczema breakouts?

I would say drink a lot of water. If I feel like Im going to break out, I drink so much that I force myself to pee. I think that by peeing out my toxins, I feel better. And also moisturise!

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When eczema gets you banned from driving a rideshare – Malay Mail Online

Posted: August 23, 2017 at 2:42 am

AUGUST 23 Imagine being plagued with a constant itch, to the point you often find yourself scratching yourself absentmindedly or even in your sleep.

Welcome to the life of someone with eczema. My friend has severe eczema to the point he scratches a lot and has scabs all over his body. While it looks unsightly, it isnt actually contagious.

Just this week, however, one of his rideshare passengers (hes currently a fulltime rideshare driver) reported him to the service and he was suspended just because his skin scared people.

There isnt actually one kind of eczema its the common name given to a group of conditions that can cause skin to become itchy and inflamed. While many people can manage the condition with the appropriate treatments, there are some who find living with it a struggle.

Eczema can easily flare up without warning triggers can include a change of diet, stress, a change in weather, exposure to allergens.

What saddens me is that isnt the first time my friend had his driver status revoked it was the second time. Despite reinstating his account previously after explaining himself and presenting a doctors letter, said service suspended his account again this time without letting him explain himself.

When asked why he was even booted out of the system before being allowed to plead his case, he was informed it was to apparently to give his condition time to recover.

That is ridiculous. Eczema doesnt just clear up on a whim. While people with mild eczema might get some symptom relief with topical creams and medications, people with severe eczema arent as lucky.

There is no magic cure for eczema; what might work for one person might not work for another. My friend also happens to be allergic to quite a few things including seafood and cat dander, which means he relies a lot on antihistamines. But antihistamines also suppress immune reactions, which brings about a whole host of reactions.

Believe me, my friend has tried pretty much anything and everything but his unique set of health issues (beside eczema) make things very hard. Its very likely hell have to rely on medication for the rest of his life.

So before you instinctively jerk away from someone with what you might think is some communicable skin disease, perhaps ask. It could very well just be eczema, complications from allergies or just a bad rash.

In the meantime my poor friend is going to lose his current livelihood just because a passenger couldnt be bothered to ask why his skin was raw and peeling. Life is unfair like that but heres hoping he gets his account back and people would exercise more compassion.

* This is the personal opinion of the columnist.

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Fend off Psoriasis and Eczema with Simple, Inexpensive …

Posted: August 20, 2017 at 8:45 am

Eczema (atopic dermatitis), and the closely associated psoriasis, are two very common skin problems.

Both eczema and psoriasis are potentially allergic conditions that can be triggered by environmental factors and dozens of other external irritants like:

While psoriasis is most often linked with external allergic triggers, eczema is often caused by food allergies.

However, although theyre different diseases and have varying triggers, their treatments have many commonalities. .

Eczema is the itch that rashes, meaning, theres really no rash until you start scratching the itchy area. Hence, the first thing you need to do is to stop scratching!

Addressing the itch — As anyone with eczema will attest, this is easier said than done. But fortunately, there IS a really simple, inexpensive way to relieve the itch: Simply put a saltwater compress over the itchy area.

Youll want to use a high quality natural salt, such as Himalayan salt. Simply make a solution with warm water, soak a compress, and apply the compress over the affected area. Youll be amazed to find that the itching will virtually disappear!

Another method that can be helpful for reducing or stopping the itch is EFT.

Proper skin hydration When working with any type of skin condition, you need to make sure your skin is optimally hydrated. Skin creams are rarely the answer here, but rather youll want to hydrate your skin from the inside out by consuming high quality, animal-based omega-3 fats in your diet.

Your best sources for omega-3s are animal-based fats like krill oil or fish oil. I also find it helpful to include a bit of gamma linoleic acid, typically in the form of primrose oil, as this works remarkably well for eczema. Products like krill for women are good for both sexes for this condition as they have both fatty acids.

Plant-based omega-3s like flax and hemp seed, although decent omega-3 sources in general, will not provide the clinical benefit you need to reduce inflammation and swelling in your skin.

Secondly, youll want to reduce your exposure to harsh soaps and drying out your skin with excessive bathing. Use a very mild soap when you cleanse your skin, especially in the winter to avoid stripping your skin of moisture.

Taking care of your gut = Taking care of your skin Many dont realize this, but the health and quality of your skin is strongly linked to the health of your gut. I recommend taking a high quality probiotic to ensure optimal digestive health. Fermented foods can be used as well, but are neither as common nor as easy to use.

Diet and skin quality Food allergies play an enormous role in eczema. In my experience, the most common offending agent is wheat, or more specifically, gluten. Avoiding wheat and other gluten-containing grains is therefore a wise first step.

If you were to visit my clinic outside of Chicago as a new patient, one of the first steps we would advise would be to go on a gluten-free diet for a number of weeks and carefully observe any health improvements. This is an enormously common problem and many of our patients are surprised to find how much improvement they actually achieve from this step.

Avoiding grains will also reduce the amount of sugar in your system, which will normalize your insulin levels and reduce any and all inflammatory conditions you may have, including inflammation in your skin.

Other common allergens include milk and eggs. I recommend you do an elimination trial with these foods as well. You should see some improvement in about a week, sometimes less, after eliminating them from your diet if either of them is causing you trouble.

Basking in the sun Vitamin D in the form of sun exposure is your best friend when dealing with either of these skin conditions, but its especially helpful for psoriasis.

I produced a one-hour lecture that explains the health benefits of this long under-appreciated vitamin, so if you havent seen it already, I strongly recommend you take the time to watch this free video now.

Ideally, youll want to get your vitamin D from appropriate sunshine exposure because UVB radiation on your skin will not only metabolize vitamin D, but will also help restore ideal skin function. High amounts of UVB exposure directly on affected skin but not so much to cause sunburn! will greatly improve the quality of your skin.

However, if you cant get sufficient amounts of sun during the winter months, a high quality safe tanning bed can suffice. A safe tanning bed will provide the optimized forms of UVA and UVB wavelengths, without dangerous magnetic skin balance.

You dont have to use expensive, dangerous medicines to treat eczema or psoriasis!

Steroid creams especially, are clearly something youll want to avoid, because although they work initially, you will tend to rapidly develop tolerance to them. These creams contain synthetic steroids, which are absorbed into your skin, and can wreak serious havoc with your adrenal system.

So please, avoid steroid creams and other potentially dangerous medications for these skin conditions and use these natural methods instead. Youll find they work almost all the time, especially if you diligently apply them.

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Doctor: Eczema medications for children could have long-term side effects – WTSP 10 News

Posted: at 8:45 am

A doctor says children using the skin medication for eczema may have problems later.

Shannon Valladolid, WTSP 11:36 PM. EDT August 19, 2017

Eczema causes the skin to become inflamed.

Kids can have a lot to deal with. School, sports, bullies, the list goes on.

But imagine also dealing with this as well: severe eczema.

Five-year-old Allison and 11-year-old Imaan may be different ages, but they have one thing in common.

I have eczema and I can only eat and wear certain things, says Imaan.

One time my friend told me she didn’t like the look of my eczema on me, says Allison.

This is what their eczema looked like before getting on medication.

The girls suffer from eczema.

Both girls said they felt excruciating pain.

I got hospitalized twice. Even when I took a shower, every time water went on me it hurt and there was cuts everywhere, says Imaan.

Dr. Seth Forman with Forward Clinical Trials has been treating the girls for their skin condition.

But while they’re breathing a sigh of relief now, Forman says these strong medications they’re on could have long term side effects.

The medications that are available right now can cause kidney dysfunction, liver toxicity and other effects to the immune system, says Dr. Forman.

Forman conducts many clinical trials on a wide array of skin conditions like rosacea and psoriasis. He’s been pushing to change current regulations that limit young children from being a part of these trials.

We need these newer medications to be approved by the FDA and we need more companies to do research with children, he says. So, we can avoid using these medications.

Right now, those newer medications can be used on adults but not children.

So, in the meantime, girls like Allison and Imaan might have to pay the price in the future for clear skin.

RELATED: Local clinical trials may offer more options for psoriasis patients

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