A cardiologist and infectious disease specialist discuss their favorite statin

Cardiologist: What's your favorite statin? Atorvastatin? Rosuvastatin? 

Infectious disease specialist: Cilastatin! 

I onced misspelled it as cilastin and this joke was inspired. Idea credits to Randy Bornmann! 

Just when you lose hope....

(This is a bit of an off-academic post. So if you are on exam season, avoid reading this.)

Being a doctor!..... we all have dreamt of it. Since we were kids we wanted to wear that stethoscope, walk in long hall ways, go to those people with pain and help them...

You wil watch a TV series and when a surgeon would say "Scalpel please!" you feel goosebumps thinking one day you wanna do it...

But there are somedays you just get home or to hostel from medschool or hospital, and you just don't want to do it anymore. You feel like your passion is lost. You feel like you are no more yourself!

YES! We all have gone through this at least once or even more times in our lives. And when you say this, many other medical students will relate to you too.

Whenever you feel so demotivated, just think WHY YOU STARTED THIS AT THE FIRST PLACE? Did you do it by your will? What made you decide this?

For an example, I always wanted to be a doctor, but my will to become a doctor became so strong when my grandpa passed away in a govt hospital because the doctor in charge didn't diagnose that he was having a heart attack. That day I decided I want to be that doctor who will correctly diagnose and treat people to the best capability I can. I wanted to stop anyone else's family member to pass away because of gross incapacity of a doctor.

You may also have a reason like this if you dig inside your mind. And you will find this reason to fire you up again. To make you push through that one more chapter. Go to that one more ward with a wide smile despite you are sleepless and tired.

Find your reason to stay, not to leave! Because once you are on this voyage, you have decided to work for the betterment of the world and the people, and if you quit midway, it's such a waste, my friend!

Many people dream to be in our shoes. If we give it up, we just are ruining a chance of someone else to be a doctor. So make that medschool seat you owned, be worth it.

Another thing! Going through medschool is not a single man's job. It needs hell load of a support. Find this support system in your family, in your significant other, in your friends, and anyone who would give you strength to carry on, and someone who would motivate you, someone who would be there to say "You can do this! I'm with you!".

Medical books are boring, but books are not the only way you can learn anymore in this digital world. You have millions of videos and interactive websites you can find. You have blogs like our www.medicowesome.com where we breakdown big medical info into small pieces and clarify.

Get your stuff together, clean up your workspace. Cleaner table will motivate you to study too. Use some motivating words in front of your workspace, On your phone's wall paper, On your notebooks! Simply everywhere you would see. If someone would judge you for that, make them your motivation too. Stick up a motivating note on their forehead too! 😂 Just kidding! Ya just keep that smile on always!

Life is great! Medical life is even greater! With all its failures, late night cries, exam phobhias, senior bullies, colleague dramas, its all worth it.

Finish your degree...! This pain lasts only few years! Once you are a fully fledged doctor, you can go ahead and be that wonderful human being you always wanted to be! Don't kill that wonderful person even before you get there!!

We are all voyagers of this same hard journey wherever we are in this world! So let's do this! And in any case you need someone to guide you through your academic related depression or demotivation, always count on us here in Medicowesome!

Have a great day and go own that damn degree!!! 😍

Good luck! See ya later!

Yours,

Jay.

Authors' diary: CHADSVasc High

*talking about atrial fibrillation*

ACHOO SYNDROME.

HELLO PEOPLEEEE!

Well this is not a medical joke or something that I made up. This syndrome is legit and very irritatting for the people who suffer from it. As said by Pryse Phillips the acronym is slightly forced but remains the best of the decade.

The acronym ACHOO is for Autosomal Dominant Compelling Helio-Opthalmic Outburst reflex which is basically sneezing in response to looking at a bright light, there can be a burst of 2-10 sneezes at a time.

Photic sneeze reflexes don't seem to make any sense at first. The purpose of sneezing is to clear unwanted irritants or germs from the nose. Bright light produces neither.

The phenomenon was first described in the 1950s, after a French doctor discovered several patients sneezing in response to the light of his ophthalmoscope, (the device doctors use to examine the retina). Further investigation revealed that it wasn't just any light that brought on the sneezing, but sudden flashes. These patients would reliably sneeze when quickly exposed sunlight, flash photography, and, in a few cases, even ultraviolet light.

There is no clear understanding on how photic sneez reflex works and hence a variety of theories have been proposed. 

For us its important to understand the basics of a normal sneez reflex arc.

The opthalmic division of the trigeminal nerve innervates the the nasal mucosa over the nasal septum and the anterior nasal passages. The afferent limb of the reflex arc is carried over the opthalmic nerve and the efferent limb is by the cranial nerves 5 and 7,9,10 and the motor nerves of the cervical and thoracic spinal cord.

The reflex centre is situated in the brainstem and upper spinal cord.

Any stimulation of the afferent limb of this reflex arc by dust or any foreign material sets the reflex arc in action which ultimately makes us sneez!

The primary clinical use of this sneez (sternutatory) reflex is a cross check on the corneal reflex.

Are there any other weird stimuli that cause people to involuntarily sneeze?

• Sneezing induced by feeling full. (One case study of a relatively normal 32-year-old man found that "fullness of the stomach immediately after meals invariably results in three or four uncontrollable sneezes."

• And the weirdest: For some, eating chocolate can induce some unwanted sneezes how barbaric.

Well I hope this information was helpful. So the next time you hear some sneezing (ACHOO!) do remember this phenomenon.

Let's Learn Together.
-Medha Vyas.
x

The Oedipus Complex

The Oedipus Complex has been an ever popular Freudian concept.
Here's a summary of Psychosexual development as per Freud and the Oedipus Complex concept.
I insist you put up with this incestuous concept :p

So Freud was an extraordinary Psychoanalyst and gave the stages of 'Psycho Sexual Development'  in his book 'Interpretation of Dreams'.

There Are 4 stages of Psychosexual development in Freud's opinion that all of us pass through to reach the mature stage eventually.

The 4 stages are :

1. Oral
2. Anal
3. Phallic
Latent period
4. Genital

Remember -
Mnemonic : On A PG break.

If one fails to break through any of these stages , it is said he'd develop specific psychiatric illnesses.
It's important for a child to go through these stages without 'fixation' over any of those.

For example Oral stage fixation Makes you SAD
Schizophrenia
Anxiety
Dependent Personality disorder.

Anal Stage fixation makes you an 'Anal' person.
So you're likely to develop Obsessive Compulsive disorder or Obsessive Compulsive Personality (Ankanastic Personality)

Phallic Stage Fixation is "complex."
So in previous stages , it's been obvious what the object of gratification has been (Mouth and Anus respectively).
This one's slightly more "complex".

So as per Freudian theory , Boys would be sexually fixated on their Mothers, viewing their Fathers as a threat ;
This is called the 'Oedipus Complex'.
And also have Castration anxiety.

The theory says similarly Girls would be sexually fixated on their Fathers , viewing their mothers as a threat ;
This is called the 'Elektra Complex'.
And have Penis Envy.

The Oedipus Complex :
So this stems from the Greek story where Oedipus marries his own mother unkowningly , after he kills his father.

King Laius was the king of Greek city Thebes. He and his wife Jocasta bore a child : Oedipus.
The problem is some Seer prophesized that this child would kill him. And so he sent away his child, who was found and raised in another city by another King. Years later he returned to Thebes and quarreled with an old man and ended up killing him.
After a while he was told that the King had been killed , and that he could take charge of the town if he defeats the Sphinx. He did so, and won the hand of the King's wife Jacosta as well.
Years later he found out the King was actually his Father , and his Wife was his mother.
Here's where the 'Oedipus Complex' gets its name from.

Electra Complex
Stems from another Greek story.
Electra was the daughter of Agamemnon, whose wife killed him.
Electra then avenged her father's death by killing her mother.
(Talk about Daddy's lil girl ;;) )

Another complex is 'Pharoah Complex' where siblings are fixated sexually on each other.

Fixation in Phallic phase leads to Paraphilias and Hysteria.

Hope this wasn't overly disturbing !
Happy studying !
Stay awesome.
~ A.P. Burkholderia

Quick Facts - Swimming associated Diseases.

Hello everybody!
Let's swim through microbiology today and review some swimming related diseases.

Swimming pool conjunctivitis -
Caused by : Adenovirus 3,7 and 14 (tends to occur in children's swimming camps)
                      Chlamydia Trachomatis.

Swimming pool Granuloma -
Caused by Mycobacterium Marinum.

Swimmer's Itch -
Caused by Schistosoma Mansoni.

Swimmer's Ear - Pseudomonas.

Swimming in contaminated water can also cause Primary Amoebic Meningoencephalitis by Naegleria Fowleri which is a free living ameba.

If you come across more eponymous swimming diseases do share.

Let's learn Together!
-Medha.

Quick Facts - Fried Egg Appearance!

Hello everybody!

So the next time you make your own fried egg add some medicine to it!

Here is a list of certain characteristic fried egg appearances that you may Come across:

Mycoplasma Pneumoniae colonies show fried egg colonies on Eaton agar.

Oligodendroglioma cells show a fried egg appearance.

Hairy cell leukemia cells on bone marrow biopsy.

Seminoma and Dysgerminoma  cells on light microscopy.

Parietal cells of the stomach due to acidophilic cytoplasm & large central nuclei also resemble fried egg appearance.

Plasma cells in MULTIPLE MYELOMA

Malassezia furfur 
They also show fried egg appearance on sabourauds dextrose agar with olive oli overlay.

Let's learn Together!
Medha.

Why do newborns have a higher heart rate?

Hey guys!

Have y'll ever wondered why do babies have heart rates as high as 160s?

Answer:
Babies have a high proportion of Body Surface Area to heart than that in adults. Therefore, in order to maintain adequate blood flow, baby's "li'l heart" has to pump more often to cover the "large Body Surface Area"!

I hope y'll find this interesting!

Till then, stay awesome!

-Rippie

Research Update - The Multitasking Brain.

Hello there!

So you must be probably Studying (I assume and if not,you better be!)with your Cellphone besides you,
And you hear the Pinggg!!!
Aha.. GOTHAM needs you!! You shift your focus from the task of studying to the task of on your cellphone,and simultaneously thinking about how good you are at multitasking!

 Well don't pat your Backs yettt.

Although “multitasking” is a popular buzzword, research shows that only 2% of the population actually multitasks efficiently.

Most of us just shift back and forth between different tasks, a process that requires our brains to refocus time and time again — and reduces overall productivity by a whopping 40%.

 Told ya! No need to pat your backs,for decreasing your efficiency. So the next time your Read ,you only Read.

New Tel Aviv University research identifies a brain mechanism that enables more efficient multitasking. 

The key to this is “reactivating the learned memory,” a process that allows a person to more efficiently learn or engage in two tasks in close conjunction.

How does this work???

Starts with - Training the brain.

“When we learn a new task, we have great 

difficulty performing it and learning something else at the same time.

This is due to interference between the two tasks, which compete for the same brain resources.

The research demonstrates that - By pairing the brief reactivation of the original memory with the exposure to a new memory, long-term immunity to future interference was created.

For example- researchers first taught student volunteers to perform a sequence of motor finger movements with Right hand. 

After acquiring this learned motor memory, the memory was reactivated on a different day, during which the participants were required to briefly do some task with their Left hand — with an addition of brief exposure to the same learned motor task being performed by the Right hand.

By utilizing the memory reactivation paradigm, the subjects were able to perform the two tasks without interference.

So well we now have an overview of how the brains circuits are intimately connected and how they can still constantly evolve.

Hope this was helpful.

With this I finish the blog and my cup of tea!!

So much for Multitasking! 

Let's Learn Together.

-Medha 😊

Authors diary: Tip for solving multiple choice questions

So this random tip comes from a fun conversation that I was having with my study partner today.

Authors diary: Have fun while studying

If you are not having fun while studying, you are doing it wrong.

I crack really lame jokes. It keeps me sane :P

Why some people hate cheese!

Hello everybody!

So today let's learn a bit about how our brain circuits work.

Some people hate cheese. Like seriously?
How can you miss the warm fussy feeling you get while eating warm molten cheese in a Fondue!

Well some people might not feel any bit of it and rather feel disgusted when presented with cheese.( I feel bad for them )

Anyway let's see how these things work.

Why aversive to cheese per say? 

Cheese is the food that most frequently triggers aversion. 

 Among those with an aversion to cheese, 20% say they are intolerant to lactose. In 50% of cases, at least one of their family members does not like cheese either. These stats suggested that there is a genetic origin to this aversion, which might be related to lactose intolerance.

To find out what happens in the brain,  people who like cheese and who do not were selected and participated in a functional magnetic resonance imaging (fMRI) study. 

They observed that the ventral pallidum which is activated in people who are hungry was totally inactive in people who had an aversion to cheese but was active for all other food types. Also the Globus Pallidus and Substantia Nigra part ( the reward circuit) was more active in people who had aversion to cheese than in those who do. 

So in conclusion, the areas of reward centres of our brain the Globus Pallidus and Substantia Nigra have two types of neurons with complementary activity , one relating to the rewarding aspect of food and other to it's aversive nature.

So now we have a breif idea as to how the brains are wired differently and how we all our special in our own ways!

Let's learn Together!

-Medha.

Laughter Disorders - It might not be funny!

Hello everybody!

So today I am going to share some information on how laughter has a dark side too.

There are a lot of laughter related disorders and this gets the scientists more Intrigued to understand the neurocircuitry involved in laughter.The actual neural basis of laughter is still not very well known and what we do know about it largely comes from pathological clinical cases.

 So laughter can be classified,
 ranging from genuine and spontaneous to simulated (fake), stimulated (tickling), induced (by drugs) or even pathological.

Some of the laughter related disorders are:

1) Pseudobulbar affect : identified by Charles Darwin, It is characterised by frequent, involuntary and uncontrollable outbursts of laughing and crying. It arises due to disconnection of the descending pathways between the frontal lobes and brainstem.

Some disorders associated with the condition are : Traumatic brain injury, Alzheimer's, Parkinson's Disease, Multiple sclerosis and Most importantly Stroke.

2) Gelatophobia : Fear of being mocked at. It may lead to social ineptness to severe​ depression. It is thought to arise from negative early life experiences if being teased, ridiculed.

Imagining shows us that people who suffer from this condition have poor brain wiring and poor connections between frontal and medial temporal brain areas.

On the continum Gelatophilia is the joy of being laughed at and another related condition Katagelasticism is joy of laughing at others.

3) A twisted sense of humor and laughing at inappropriate times is thought to be an early sign of demetia.

4) Gelastic seizures : rare type of seizure that involves a sudden burst of energy, usually in the form of laughing. Mainly associated with Hypothalamic Hamartoma.

5) Angelman Syndrome : It's a chromosomal disorder affecting the Central Nervous  System.They laugh frequently due to heightened stimulation of parts of Brain involved in laughter.

So these were some pathologies and conditions of abnormal laughter.Do share if you know of any such conditions I may have missed.

So long as there are no underlying illnesses laughter is still the best medicine!

Let's Learn Together!

-Medha.

Nail Changes in Medicine : A Summary

Hi everyone. Just a list of changes you can see in the nails in different systemic Diseases. So let's get nailed ;)

1. Clubbing -
Loss of angle between the nail and the nail fold - More soft and bulbous nail.
Typically indicates Cardio Pulmonary function disturbance :
--> Cardiac conditions like Cyanotic heart disease, Infective endocarditis and Atrial myxoma.
--> Respiratory conditions :
Neoplastic like CA lung ( Esp. Squamous cell CA) , Mesothelioma.
Infective like Bronchiectasis , Abscess , Empyema.
(Non cardiorespiratory causes = Inflammatory bowel disease, Biliary Cirrhois.
Thyroid Acropachy , Acromegaly. )

2. Koilonychia -
Spoon shaped nails.
Strongly indicative of Iron Deficiency anemia or Fungal nail infection.

3. Onycholysis -
Destruction of nail. 
Seen in Psoriasis , Hyperthyroid and Fungal nail infection.

4. Chronic Paronychia -
Inflammation of nail fold. May have swollen nail and discharge with throbbing pain. May occur due to frequent nail biting.

5. Cyanosis -
Can be looked for in nail bed. We have a post on this already.

6. Beau line -
Transverse furrows from temporary arrest of nail growth due to increased stress.
Nails grow at 0.1 mm/d , so furrow distance from the cuticle can be used to time the attack. Can be seen in Malaria , Typhus , Rheumatic fever , Kawasaki.

7. Mees line -
White transverse bands in Arsenic poisoning / Renal failure.

8. Muerhcke's line - 
White parallel lines without furrowing on the nail.
Seen in Hypoalbuminemia.

9. Terry's nails -
Proximal portion of nail is white / pink , tip is reddish brown.
Seen in cirrhosis , CRF

10. Splinter hemorrhage -
Longitudinal Hemorrhage streaks under the nail seen in Infective endocarditis.

What a fun way to get nailed down 😂 Happy studying !
Stay awesome.

~ A.P.Burkholderia.

Non Contraceptive uses of the Condom

Hi everyone. So we know what we use a condom for generally :p
But there are a few non Contraceptive uses for this magical device that prevents babies :').

So here goes -

1. Prevention of STD's.
2. Can be used in Balloon Tamponade to control PPH.
3. Used to cover the USG probe inserted into the female tract.
4. Can be used as a mould for the vagina during Vulvoplasty.
5. Women with Anti Sperm antibodies during the initial phase. (Controversial).

So that's about it.
We know no 5 more reasons to use condoms !
Go get em ; )
Happy studying.
Stay awesome.

~ A.P.Burkholderia

Reversible Causes of Dementia : Mnemonic

Hi everyone ! This is a short post on causes of dementia that can be corrected. This is very important as most causes other than these have no available treatment ! (One Reversible cause of dementia is the Demeantor's kiss ;;) Treat using  Expectro Patronum)

So the medically treatable causes include the following.

Remember : ABCD2E

- Alcoholism
- Vitamin B deficiency - Thiamine / Niacin /B12
- CNS infections - HIV , Chronic Meningoencephalitis , Whipple Disease, Neurosyphilis.
- Depression
- Drug induced
- Endocrine - Thyroid disturbances

Let's look at how these can be corrected medically.
- A = Alcohol abuse. May be a result of Alcoholic delirium/ Wernicke-Korsakoff syndrome. So the management would include giving Thiamine to the patient , and alcohol withdrawal using Disulfiram ans other anti craving drugs like Ondansetron, Acamprosate, Topiramate and Naltrexone.

- Vitamin B Deficiency = Thiamine deficiency we've seen above.
Niacin Deficiency causes 3 D's - Diarrhea , Dermatitis and Dementia. So treat that using Niacin.
B12 Deficiency and possibly folic acid can also cause Dementia.

- CNS Infections = They cause transient cognitive changes that are reversible on treating the disease.

- Depression = may cause depressive pseudodementia or even true dementia. (pseudo dementia = no confabulation or impaired recent memory)

- Drug induced = Chronic use of drugs like BDZ , Opiates and TCA's.

- Endocrine = Hypothyroidism is notorious to cause Dementia.

~~~~~~~~~~~~~~~~~~~~~~~

The surgically correctable causes are below.
Remember = T2 H2

- Tumors  (esp frontal lobe tumors )
- Trauma (Subdural Hematoma)
- Normal Pressure Hydrocephalus (NPH)
- Hydrocephalus

- Tumors are resected surgically.
-  For the hydrocephalus group , ventriculo peritoneal shunting is performed.
- NPH = Triad of symptoms showing Gait disturbances , Urinary incontinence and Dementia. (GUD)

Hope this post helped you and didn't leave you too demented. !  If it did, have some chocolate like Lupin would offer ;;)
Happy studying.
Stay awesome.

~ A.P.Burkholderia

Glycogen Storage Diseases : Mnemonic

Hi everyone.
I'm back with a short post. This one is about Glycogen storage diseases which, again,  we all hate to remember  :'D Hope you like it.

So Remember :

Very Pompously CAMe Her Tears.

1. Very =  Von Gierke's
2. Pompously = Pompe's
3. C = Cori's / Forbe's 
4. A = Anderson
5. M = McArdle's
6. Her = Her's (we'll at least Remember this one :'D)
7. Tears = Tarui's

So that's that.
Now how do we remember which is Muscular and which is hepatic ?
Simple.

Remember :
The Muscular get kissed under the Mistle Toe.

So the ones involving the Muscles are :
Mistle = McArdle
Toe = Tarui's.

Also remember :
Pompeii the city was a wh*re. So it went everywhere and hence Pompe's is both Muscular and Hepatic.

That's all for now. It may seem like a lot of crap to simply memorize these Glycogenosis but you'll realise they form an excellent aid for memory :D and are super important whether you want to do USMLE or Indian PG.
So c'mon ! Burn those Glycogens in your liver and get some Glucose into your head ;)
Stay awesome.
Happy studying.

The GLUT's : Mnemonic

Hello everyone !
I'm back with another short post on biochemistry.
It's about the Glucose transporters which we all hate :D So let's get down to it.

GLUT - Short for Glucose Transporters , are channels present in our body that bring about glucose uptake. They are forms of Facilitated transport mechanism and basically occur across a Concentration gradient.

Now it's important for us to understand their location , function and regulation if we want a good understanding of Glucose metabolism. But this can get a little tedious , hence this post.

There are a total of 4 major GLUTs. Out of which one is dependent on insulin and the others are not.
So first we're doing insulin independent ones.

Remember :

BBB
Kid's LiPs are
PiNK.

~~~~~

GLUT 1 -
Remember : BBB.

B - Blood ( The RBCs)
B - Baby  (So fetal tissue)
B - BBB ( The Blood brain barrier itself )

~~~~~

GLUT 2 -
Remember :  Kid's LiPs

Kid's - Kidneys
Li - Liver
Ps - Pancreatic Beta cells

~~~~~

GLUT 3 -
Remember : PiNK

Pi - Placenta
N - Neurons
K - Kidneys

_____________________________
Now we come to the Dependent one.
~~~~~
GLUT 4 -
Remember :
Father Mother Depend.

Father - Fat
Mother - Muscles ( Cardiac / Skeletal)

Now how do we remember this ?
In general the Mother and Father are who we depend on ! But in biochemistry the mother and father themselves depend on insulin. ! And the baby ( BBB etc) are independent.

Got it ?
Hope this helped.
It's something I've struggled with.
Anyway.
Happy studying. !
Stay awesome

~A.P.Burkholderia

The Burkholderian Culture : From the Authors' Diary

Hello everyone ! I'm A.P.Burkholderia , and I'm back with another post

Now a lot of people have been asking me why my name is that. Some have assumed it's my actual surname (Like our very own IkaN, but that's a whole 'nother story) while others have unraveled the mystery of the Burkholderian terminology (Like the ardent PSM-proponent Jay ). So before any more of you are boggled by this Burkholderian business I figured let's talk about why this organism is fancy enough to earn the charm of being my pen-surname. :P

So Burkholderia is a Gram negative rod. And it is one of a kind - Cause It's a Non Fermenter ! So if you were to make a TSI plate it would give you alkaline in the slant as well as the butt (LOL). Only few other organisms like Pseudomonas and Acinetobacter are non fermenters. So it's a total Aerobe and it can be checked with "High and Leifson Oxidation Fermentation media". Another cool name :D 

It's got 3 different types : 

B. cepacia 

B. mallei 

B. pseudomallei.

Now I love how it's called "Mallei". In Hindi 'Malai' means 'Milk Skin'. I find that hilarious. 

Also, 'Mai Lai' means 'I shall bring '. I find that really funny too. ( Burkholderia , Main Laiii !)

But other than that , it's a pretty serious bug. 

It causes Cepacia syndrome in Cystic Fibrosis,  which presents as a form of Bronchiectasis or Serious pneumonia. 

It can cause Meiloidosis which has a presentation similar to TB and another one called 'Glanders'. 

It shows a safety pin appearance when seen under the microscope on staining with Geimsa. 

Other than this , it's a very hard big to get rid of. 

It's almost resistant to all antibiotics and only the Carbapenems may work ! 

So this is why I love this bug. 

It's cool , it's classy and it's hard to get. :p 

Other than that , I love saying the name! *Burkholderia* 

I might do a video some day on this :p and how to say it right. 

Till then , Ciao! 

Stay awesome. 

*Burkholderia out*

Argyll Robertson Pupil : Mnemonic

Hello everyone ! I'm back with a short and sweet post on Argyll Robertson Pupil.

Mnemonic for Argyll Robertson  Pupil (ARP) :
ARP Accomodation reflex present
PRA Pupillary reflex absent.

It's seen in conditions like Neurosyphilis for which it is extremely specific. 
You could also see it in some form of strokes or Diabetic Neuropathy.

Another similar Pupillary reaction is Aedes pupil. The difference is Aedes is a  dilated pupil while Argyll's is constricted. How to remember this ?
Mnemonic : AeDes.
So Aedes is tonically Dilated.

Hope this helped !
Stay aweosme.
Thanks.