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},
"code": "E50",
"name": "Недостаточность витамина A",
"icd_name": "Недостаточность витамина A",
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"age_min": 0,
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0
],
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"slug": "e50_nedostatochnost_vitamina_a",
"lead": "Это патологическое состояние, возникающее вследствие дефицита в организме этого витамина и проявляющееся ухудшением зрения - в первую очередь гемералопией («куриная» слепота), конъюнктивитом, ксерофтальмией, гиперкератозом кожи. ",
"description": "",
"etiology": "<p>Недостаточность витамина А может быть обусловлена нарушением абсорбции витамина в кишечнике при его хронических заболеваниях, целиакии, болезнях печени и поджелудочной железы, железодефицитной анемии, длительном употреблении минерального масла. При потреблении с пищей небольших количеств жира также снижается абсорбция витамина А.</p>\r\n<p>Причиной недостаточности витамина могут быть и чрезмерные потери его организмом. Так, экскреция витамина А увеличивается при раке, болезнях мочевыводящих путей и хронических инфекционных заболеваниях. Низкое потребление белка приводит к недостаточности белка-переносчика и способствует снижению уровня витамина в плазме.</p>",
"pathogenesis": "",
"diagnostics": "<p>При гиповитаминозе А понижено содержание в крови ретинола или каротина (ниже 200 мкг/л), нарушена темновая адаптация, развивается гемералопия. При биомикроскопии глаза на слизистой конъюнктивы могут выявляться белесые и желтоватые мелкие бляшки.</p>",
"treatment": "<p>азначают диету, богатую витамином А и провитаминами, а также препараты ретинола. Растворы ретинола применяют внутрь и в виде внутримышечных инъекций.</p>\r\n<p>Суточная лечебная доза 25 000-100 000 ME ретинола (при приеме внутрь дозу делят на 2-3 приема, больше одной инъекции в сутки обычно не делают), продолжительность курса лечения 2-4 нед. Ретинол содержится в поливитаминных препаратах.</p>",
"prevention": "<p>Профилактика гиповитаминоза А состоит в рациональном питании и назначении внутрь препаратов ретинола (5000-10 000 ME) в течение не менее 2-3 нед. До и после проведенного профилактического курса целесообразно определить содержание в сыворотке крови ретинола или каротина.</p>",
"clinical_picture": "<p>Наблюдаются сухость в полости рта и носа, <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>, ее <a href=\"/symptom/shelushenie_kozhi/\" title=\"Перейти на страницу симптома Шелушение кожи\">шелушение</a>, повышенное <a href=\"/symptom/vypadenie_volos/\" title=\"Перейти на страницу симптома Выпадение волос\">выпадение волос</a>. Ухудшается сумеречное зрение («куриная» <a href=\"/symptom/slepota/\" title=\"Перейти на страницу симптома Слепота \">слепота</a>). Одновременно возможны <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">светобоязнь</a> (<a href=\"/symptom/glaznaya_bol/\" title=\"Перейти на страницу симптома Глазная боль\">боль в глазах</a> при ярком освещении) и ксерофтальмия (сухость конъюнктивы с утратой присущего ей блеска, снижение секреции слезных желез, появление бляшек Искерского - Бито, разбросанных по склере). В наиболее тяжелых случаях воспалительные процессы в роговице могут осложняться ее некротическим размягчением (кератомаляция), что обычно заканчивается слепотой.</p>\r\n<p>Сочетание гемералопии с ксерофтальмией позволяет с высокой достоверностью думать о недостаточности витамина А.</p>",
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},
"code": "E51",
"name": "Недостаточность тиамина",
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0
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"lead": "Заболевание протекающее с накоплением в крови и тканях пировиноградной кислоты, нарушением водного, углеводного, белкового и жирового обменов, сопровождающееся расстройством функций нервной системы, ослаблением сердечной деятельности.",
"description": "",
"etiology": "<p>Возможные причины развития:</p>\r\n<ul>\r\n<li>недостаточное поступление тиамина в организм с пищей;</li>\r\n<li>заболевания толстого и тонкого кишечника;</li>\r\n<li>аномальная активность щитовидной железы.</li>\r\n</ul>\r\n<p>В группе риска находятся алкоголики, больные малярией и ВИЧ-инфекцией.</p>",
"pathogenesis": "",
"diagnostics": "<p>Специалист назначает анализ крови и мочи. Для уточнения диагноза используют определение транскетолазной реакции.</p>",
"treatment": "<p>Как правило, терапия проводится амбулаторно. Во всех случаях больному назначается диета. Все продукты должны быть богаты витамином В1. Помимо этого, витамин вводится внутрь или принимается перорально.</p>\r\n<p>Пациентов с более тяжелыми формами болезни направляют в стационар. В этом случае микроэлемент вводят в организм парентерально по 1 мг наряду с кокарбоксилазой. Одновременно назначают другие витамины группы В.</p>",
"prevention": "<p>С целью профилактики медики рекомендуют потреблять пищу, богатую микроэлементами, особенно витамином В1.</p>",
"clinical_picture": "<p>К ранним проявлениям заболевания относят:</p>\r\n<ul>\r\n<li>неприятные ощущения в животе;</li>\r\n<li>ухудшение памяти;</li>\r\n<li>проблемы со сном;</li>\r\n<li>плохой аппетит;</li>\r\n<li>уменьшение веса;</li>\r\n<li><a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>;</li>\r\n<li><a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>.</li>\r\n</ul>\r\n<p>Необходимо своевременно обращаться к врачу при возникновении подобной симптоматики. При несвоевременном обращении к специалисту развивается тяжелый дефицит витамина В1. Впоследствии наблюдаются нарушения работы мозга, сердца, нервной системы. Во всех ситуациях изменяются процессы обмена в эритроцитах, а уровень микроэлемента в моче резко снижается.</p>\r\n<p>Наблюдается <a href=\"/symptom/onemenie_kozhi/\" title=\"Перейти на страницу симптома Онемение кожи\">покалывание</a> в пальцах нижних конечностей, жжение в стопах, которое усиливается в ночное время суток, также возникают судороги в мышцах икр и появляются боли в стопах. Во многих случаях развития болезни вибрационная чувствительность пальцев ног снижена.</p>",
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{
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},
"code": "E53",
"name": "Недостаточность других витаминов группы B",
"icd_name": "Недостаточность других витаминов группы B",
"gender": 0,
"age_min": 0,
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3
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"periodicity": 4,
"slug": "e53_nedostatochnost_drugih_vitaminov_gruppy_b",
"lead": " Патологическое состояние, обусловленное дефицитом этого витамина в организме и проявляющееся нарушениями преимущественно со стороны нервной системы, сердца и кишечника.",
"description": "",
"etiology": "<p>Гиповитаминоз B1 в развитых странах встречается нередко и наблюдается в основном у больных с хроническими заболеваниями желудочно-кишечного тракта, хроническим алкоголизмом, полиневритами, эндокринными заболеваниями (сахарный диабет, токсический зоб) и др. Недостаточность тиамина часто сочетается с дефицитом других витаминов группы В.</p>",
"pathogenesis": "<p>Витамин B1 хорошо растворяется в воде; кофермент тиаминдифосфат (кокарбоксилаза) играет существенную роль в углеводном обмене. Наряду с этим тиамин участвует в обмене аминокислот, нуклеотидов, ацетилхолина и холинэстеразы. При дефиците витамина В1 в тканях и крови накапливаются недоокисленные продукты: пировиноградная кислота, молочная кислота и др. При этом нарушается деятельность различных отделов нервной системы (особенно периферической нервной системы), скелетных мышц и миокарда, а также функция желудочно-кишечного тракта.</p>",
"diagnostics": "<p>Диагноз гиповитаминоза B1 подтверждается уменьшением содержания тиамина в крови (в сыворотке ниже 5 мкг/л, в эритроцитах ниже 30 мкг/л), резким повышением концентрации пировиноградной кислоты в крови (выше 0,01 г/л) и моче (выше 30 мг/сут), повышением содержания в крови молочной кислоты (выше 200 мг/л). В последнее время с этой целью используют также ряд более сложных современных методов.</p>",
"treatment": "<p>Лечение больных обычно проводится амбулаторно. Рекомендуется диета, богатая тиамином, в сочетании с препаратами тиамина внутрь (50-100 мг/сут) или парентерально (30-60 мг/сут).</p>\r\n<p>Больные с выраженными формами болезни часто нуждаются в стационарном лечении. Парентерально вводят тиамин по 1 мл и кокарбоксилазу. Одновременно назначают другие витамины группы В (рибоксин, пиридоксин, никотиновая кислота) и аскорбиновую кислоту.</p>",
"prevention": "",
"clinical_picture": "<p>Характерны ухудшение аппетита, <a href=\"/symptom/toshnota/\" title=\"Перейти на страницу симптома Тошнота\">тошнота</a>, наклонность к запорам, парестезии в ногах, боль в икроножных мышцах при ходьбе, ухудшение сна, <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, плаксивость, снижение физической и психической работоспособности. Иногда умеренное похудание, лабильность пульса на фоне общей психоэмоциональной лабильности. Язык суховат, живот нерезко вздут, умеренно снижена болевая и глубокая чувствительность в области стоп и голеней, нерезко ослаблены сухожильные рефлексы (больше на ногах).</p>",
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"code": "E55",
"name": "Недостаточность витамина D",
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"lead": "Представляет собой серьезное состояние организма, которое характеризуется нарушением всасывания в организме фосфора и кальция из пищи.",
"description": "",
"etiology": "<p>Люди в возрасте испытывают авитаминоз витамина Д вследствие нарушения работы почек, которые утрачивают способность перерабатывать данный элемент. Существуют также болезни кишечника, которые нарушают всасывание витамина D: Болезнь Крона, муковисцидоз и целиакия. У взрослых людей, страдающих ожирением, также наблюдается нехватка витамина Д.</p>\r\n<p>Нехватка витамина D провоцируются следующими факторами:</p>\r\n<ul>\r\n<li>Пятидесятилетний возраст;</li>\r\n<li>Беременность и период грудного вскармливания;</li>\r\n<li>Смуглая кожа;</li>\r\n<li>Болезни почек и печени;</li>\r\n<li>Применением антацидов;</li>\r\n<li>Веганская и вегетарианская диета.</li>\r\n</ul>",
"pathogenesis": "",
"diagnostics": "<p>Для диагноза у взрослых основное значение имеют данные биохимических лабораторных исследований (снижение содержания неорганического фосфора в крови ниже 30 мг/л; повышение активности щелочной фосфатазы).</p>",
"treatment": "<p>Лечебным препаратом является эргокальциферол, выпускаемый в виде драже по 500 МЕ и масляный раствор по 500 и 1000 МЕ в капсулах (для профилактических целей). С лечебной целью назначают внутрь по 500 - 1000 МЕ в день, курсом, согласно инструкции по лечению рахита. Однако применение витаминов группы D (в силу возможности возникновения токсических гипервитаминозов) требует известной осторожности и должно проводиться под наблюдением врача.</p>",
"prevention": "<p>Если говорить о профилактических мерах характерного недуга, то стоит обязательно отметить, что начинаться они должны с изменения своего привычного рациона. Врач назначает ребенку специальную лечебную диету, которая восполнит нехватку витамина Д. Питаться таким образом необходимо продолжительный период времени, помня о слабых местах организма пациента.Если говорить о лекарственных средствах, способствующих профилактике гиповитаминоза витамина Д, то в данном случае врач назначает поливитаминные комплексы, БАДы и витаминно-минеральные комплексы, также укрепляющие весь организм.</p>\r\n<p> </p>\r\n<p> </p>",
"clinical_picture": "<p>Симптомы у детей – рахит, у взрослых – немотивированная <a title=\"Перейти на страницу симптома Слабость\" href=\"/symptom/slabost/\">слабость</a>, <a title=\"Перейти на страницу симптома Утомляемость\" href=\"/symptom/utomlyaemost/\">утомляемость</a>, деминерализация зубов с быстрым прогрессированием кариеса (особенно у беременных женщин), остеопороз, боль в области костей, в мышцах, парестезии.</p>",
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"etiology": "<p>Причиной развития этого заболевания является дефицит кальция в организме и как следствие нарушение биологических процессов в организме, в регуляции которых принимает участие кальций.</p>",
"pathogenesis": "<p>Кальций (Ca++) – один из биогенных элементов, который необходим для нормального протекания жизненных процессов. Кальций необходим для образования ряда клеточных структур (костной ткани), поддержания нормальной проницаемости наружных клеточных мембран. Ионы Ca++ передают возбуждение на мышечное волокно, активизируя его сокращение, усиливают силу сердечных сокращений, увеличивают фагоцитарную функцию лейкоцитов, активируют систему защитных белков крови, участвуют в ее свертывании. В клетках почти весь Ca++ (99 %) находится в виде соединений с белками, нуклеиновыми кислотами, фосфолипидами и органическими кислотами. В плазме крови только 40 % Ca++ связано с белками. Содержание Ca++ в крови человека регулируется гормонами паращитовидных и щитовидной желез. Важную роль в этих процессах играет витамин D. Всасывание Ca++ происходит в переднем отделе тонкого кишечника. Усвоение Ca++ ухудшается при снижении кислотности в кишечнике и зависит от соотношения Ca++, фосфора и жира в пище. Желчные кислоты ускоряют всасывание Ca++. При дефиците витамина D и при высоком содержании фосфора в пище всасывание Ca++ уменьшается. При недостаточном поступлении Ca++ с пищей (алиментарной недостаточности) нарушаются биологические процессы в организме, в регуляции которых принимает участие кальций, в том числе происходит нарушение формирования скелета и структуры костей (у детей развивается рахит, у взрослых – остеомаляция или нарушение скелета, у стариков – остеопороз, повышенная ломкость костей).</p>",
"diagnostics": "",
"treatment": "<p>Требуется богатая кальцием диета, введение медицинских препаратов кальция.</p>",
"prevention": "<p>Для профилактики гипокальциемии необходимо употреблять в пищу продукты, богатые кальцием и витамином D. Наибольшее количество этого микроэлемента содержится в кунжутном семени, твердых и плавленых сырах, пшеничных отрубях, дрожжах, миндале, фундуке, бобовых. Содержание кальция в молочных продуктах значительно ниже, чем, например, в кунжутном семени, однако их нужно употреблять в достаточном количестве, поскольку из них кальций хорошо усваивается организмом. Продукты питания, богатые витамином D, также должны в достаточном количестве присутствовать в рационе каждого человека. Большое количество этого витамина содержится в кисломолочных продуктах, в растительных маслах, яичных желтках, морепродуктах, особенно в рыбьем жире и печени рыб. Кроме того, витамин D присутствует в овсяной крупе, картофеле и зелени. Кроме поступления с пищей витамин D может синтезироваться в нашем организме самостоятельно под влиянием солнечного света, поэтому в теплое время года необходимо проводить как можно больше времени под солнечными лучами (разумеется, в безопасные часы) с открытой кожей. Помимо витамина D для усвоения кальция необходимы другие витамины (витамины С, К, группы В) и минералы (магний, фосфор, железо, цинк и др.), поэтому рацион каждого человека должен быть сбалансирован. По рекомендации врача можно принимать дополнительно к пище витаминно-минеральные комплексы, содержащие кальций (Витрум, Биомакс, Компливит и др.). Повышена потребность в кальции у детей, беременных и кормящих женщин, а также у людей после 35 лет. Разработаны специальные поливитаминные комплексы для беременных женщин и кормящих матерей, учитывающие повышенную потребность в кальции у женщин в этот период. Для профилактики недостатка кальция и, как следствие, остеопороза, особенно в период менопаузы у женщин, а также у всех людей старше 35–40 лет, рекомендуется прием комбинированных препаратов, содержащих кальций и витамин D (Кальций-D3 Никомед, Кальцемин и др.). Детям препараты кальция назначаются только педиатром. Прием витамина D в профилактической дозе (АкваДетрим) рекомендуется в осенне-зимний период, особенно в областях, где в это время недостаточно солнечного света.</p>",
"clinical_picture": "<p>Общими симптомами, указывающими на возможный дефицит кальция в организме, являются <a href=\"/symptom/slabost/\" title=\"Перейти на страницу симптома Слабость\">слабость</a> и повышенная <a href=\"/symptom/utomlyaemost/\" title=\"Перейти на страницу симптома Утомляемость\">утомляемость</a>. Кожа становится сухой, шелушится, ногти теряют блеск и становятся ломкими. Ухудшается состояние зубов, начинается кариес. Из-за дефицита кальция страдает нервно-мышечная система, сначала появляется чувство онемения пальцев и вокруг рта, затем присоединяются судороги и появляются боли в костях. При продолжительном дефиците кальция развивается остеопороз, повышенная склонность к деформации и переломам костей, особенно у пожилых людей. Наблюдаются и кардиологические проблемы, поскольку кальций необходим для нормального сокращения сердца, в тяжелых случаях может развиться сердечная недостаточность, которая не поддается медикаментозной терапии. При хронической нехватке кальция может развиться субкапсулярная катаракта, степень выраженности которой зависит от длительности гипокальциемии и ее степени. Кроме того, при недостатке этого микроэлемента снижается уровень иммунитета, нарушается свертываемость крови и появляется повышенная <a href=\"/symptom/krovotechenie/\" title=\"Перейти на страницу симптома Кровотечение\">кровоточивость</a>. Недостаток кальция у детей особенно опасен, поскольку он крайне необходим для нормального роста и развития ребенка. При его дефиците нарушается формирование костей и зубов, происходят патологические изменения в хрусталике глаза. Дети страдают нервными расстройствами, повышенной нервной возбудимостью, нередко возникают судороги. Плохая свертываемость крови у ребенка считается одним из самых опасных проявлений гипокальциемии в детском возрасте. У взрослых, которые в детстве испытывали дефицит кальция, повышен риск развития рассеянного склероза.</p>",
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},
"code": "E60",
"name": "Алиментарная недостаточность цинка",
"icd_name": "Алиментарная недостаточность цинка",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3
],
"periodicity": 1,
"slug": "e60_alimentarnaya_nedostatochnost_cinka",
"lead": "отсутствие или недостаток поступления в организм цинка ",
"description": "",
"etiology": "<p>Дефицит цинка может быть вызван нарушением деятельности щитовидной железы, болезнями печени, плохим усвоением, недостатком этого минерала в воде, пище, а также слишком большим количеством фитина в продуктах питания, так как фитин \"связывает\" цинк, затрудняет его усвоение (кстати, нельзя принимать цинк вместе с селеном, так как два этих элемента взаимоисключают друг друга.). Если в пище слишком много белка, это тоже может быть причиной недостатка цинка в организме. При болезнях: рак бронхов, воспалении или раке предстательной железы, других раковых опухолях, лейкозах также происходит перерасход цинка, который необходим для роста клеток.</p>\r\n<p>Добавки кальция и богатый кальцием рацион (молочные продукты) способны снижать усвоение цинка почти на 50%, а кофеин и алкоголь усиленно выводят его из организма.<br /> <br /> Содержание цинка снижается при приеме внутрь противозачаточных средств (пероральных контрацептивов). Кортикостероиды (кортизон, преднизолон), назначаемые при ряде заболеваний (артрит, бронхиальная астма и др.), также снижают уровень цинка.<br /> <br /> Цинк быстро выводится из организма при стрессах, а также под действием ядовитых металлов, пестицидов и др.<br /> <br /> Уровень цинка в организме значительно снижается с возрастом, следовательно, пожилые люди в той или иной мере испытывают дефицит цинка.</p>",
"pathogenesis": "<p>Незаменимость цинка для течения кардинальных процессов жизнедеятельности явно проявляется при возникновении его дефицита. Классическим примером дефицита цинка является энтеропатический акродерматит. Он относится к редким, наследуемым по аутосомно-рецессивному типу заболеваниям. Манифестирует в грудном возрасте и без лечения приводит к смертельному исходу. Полагают, что в результате генетического дефекта в клетках Панета нарушается всасывание цинка в кишечнике. Клинически акродерматит проявляется типичными признаками дефицита цинка. На первый план выступают поражения кожи в виде хронического эритематозно-буллезного дерматита на конечностях и вокруг естественных отверстий тела, частое присоединением вторичного инфицирования, патологией роста ногтей и волос, аллопецией. Характерны тяжелые желудочно-кишечные расстройства с синдромом нарушенного всасывания, глазные симптомы (блефарит, конъюнктивит, <a href=\"/symptom/svetoboyazn/\" title=\"Перейти на страницу симптома Светобоязнь\">фотофобия</a>, помутнение роговицы), нервно-психические нарушения, замедление роста, гипогонадизм, анемия, гепатоспленомегалия, снижение остроты вкуса и обоняния. Дефицит цинка, испытываемый женщиной во время беременности, приводит к широкому спектру врожденных уродств у плода - расщеплению верхней челюсти, верхнего неба, микроцефалии.</p>",
"diagnostics": "<p>Диагностика дефицита цинка основывается на определении уровня цинка в сыворотке крови, эритроцитах, моче, волосах. Наиболее информативным по мнению многих авторов является исследование цинка в сыворотке крови. По данным Карлинского М. В. концентрацию цинка в крови менее 13 мкмоль/л можно расценивать как цинк-дефицитное состояние, а содержание цинка менее 8,2 мкмоль/л является неблагоприятным прогностическим признаком. Однако необходимо учитывать, что не всегда уровень цинка в крови коррелирует с клиническими проявлениями. Так, концентрация цинка в крови может изменяться в течение дня в зависимости от приема пищи, стресса, перенесенной инфекции, при нарушениях забора и хранения крови. Поэтому при диагностике дефицита цинка необходимо учитывать не только концентрацию цинка в сыворотке крови, но и положительную динамику клинических симптомов, а также повышение концентрации цинка в ответ на терапию цинксодержащими препаратами.</p>",
"treatment": "<p>Восполнить дефицит можно с помощью продуктов питания, таких как морепродукты (устрицы, креветки), печень, нежирная говядина, твердые сыры, бобовые, орехи, грибы и ягоды (черника, малина). Кроме того, большинство пищевых добавок и витаминно-минеральных комплексов содержат цинк.</p>",
"prevention": "",
"clinical_picture": "<p>Симптоматика недостаточности цинка чрезвычайно вариабельна. Поражаются самые разные ткани, органы и системы. У таких пациентов могут постепенно возникать: изменения кожи (различные <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">высыпания</a> около естественных отверстий и на конечностях, ухудшение заживления царапин, ссадин и других кожных дефектов, <a href=\"/symptom/izmeneniya_struktury_kozhi/\" title=\"Перейти на страницу симптома Изменения структуры кожи\">сухость кожи</a>); изменения волос (их очаговая потеря, появление красноватого оттенка или уменьшение пигментации) и исчерченность ногтей (поперечные белые полосы); поражение глаз (отек роговицы, иногда ведущий к ее помутнению, <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a> конъюнктивы, катаракта); изменение восприятия вкусов и запахов; утрата аппетита; неврологические расстройства (<a href=\"/symptom/drozhanie/\" title=\"Перейти на страницу симптома Дрожание \">дрожание </a>конечностей, изменение походки и речи, <a href=\"/symptom/demenciya/\" title=\"Перейти на страницу симптома Деменция\">слабоумие</a>, снижение внимания и обучаемости); нарушения поведения (необоснованная <a href=\"/symptom/razdrazhitelnost_i_ozloblenie/\" title=\"Перейти на страницу симптома Раздражительность и озлобление\">раздражительность</a>, пониженное настроение, <a href=\"/symptom/sonlivost/\" title=\"Перейти на страницу симптома Сонливость\">сонливость</a>); затяжные или преждевременные роды, атонические кровотечения в родах; прекращение или задержка роста и полового созревания детей; длительно заживающие язвы на слизистых; склонность к частым инфекционным болезням; <a href=\"/symptom/erektilnaya_disfunkciya/\" title=\"Перейти на страницу симптома Эректильная дисфункция\">импотенция</a>; <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a>.</p>",
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