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| EDITORIAL |
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Genetics of down syndrome: Recent advances |
p. 1 |
K Varadaraj Shenoy
DOI:10.4103/0975-9727.128928 |
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| ORIGINAL ARTICLES |
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Analysis of retinal nerve fiber layer thickness using optical coherence tomography in normal South Indian population |
p. 5 |
V Sowmya, VR Venkataramanan, KP Vishnu Prasad
DOI:10.4103/0975-9727.128933 Introduction: The high resolution optical coherence tomography (OCT) is a new technique, which allows precise measurement of retinal thickness as well visualization of intraretinal layers, particularly the retinal nerve fiber layer (RNFL). RNFL is a very sensitive structure, which gets damaged in various disease processes. Spectral domain OCT has been recently introduced in India and the normative profile of various measurements has not been established for the Indian population. Purpose of this study is to use OCT to evaluate the peripapillary variation in RNFL thickness in normal South Indian population. Materials and Methods: The study groups included 60 eyes of 30 normal individuals who underwent RNFL analysis using Topcon three-dimensional-OCT 2000. Descriptive statistical analysis has been carried out in the present study and significance was assessed at 5% level of significance. Paired t-test was used to obtain the P value. Results: In this study, average nerve fiber layer thickness along the 3.4-mm-diameter circle around the optic nerve head was 111.75 ± 4.83 μm. RNFL thickness was found to be more in the inferior quadrant followed by superior, nasal and temporal quadrant, suggesting that ISNT rule does apply to this subgroup of Indian population. Conclusion: This study concludes that RNFL thickness can be measured effectively using spectral domain OCT and should be considered while evaluating patients for diagnosis and follow-up of glaucoma. The normative data provided by this study may assist in identifying changes in RNFL thickness in glaucoma and other optic nerve diseases in South Indian population.
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Augmenting body mass index and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using body mass index, waist to hip ratio and waist to height ratio |
p. 11 |
Subhash Shahaji Dhole, Vinod D Mundada
DOI:10.4103/0975-9727.128934 Background: Traditionally, a fat child is considered as an "attractive" child and is often referred to as a "healthy" child, one who is likely to survive the rigors of undernourishment and infection. The obesity has been defined as a condition of abnormal or excessive fat accumulation in adipose tissue, to the extent that health may be impaired. Obesity can be seen as the first wave of a defined cluster of non-communicable diseases called "New World Syndrome" creating an enormous socio-economic and public health burden in poorer countries. Objective: Augmenting body mass index (BMI) and waist-height ratio for establishing more efficient obesity percentiles among school-going children by using BMI, waist to hip ratio and waist to height ratio. Materials and Methods: The present cross-sectional study was carried out in the municipal corporation area among school going children during the period of 1 st September 2009-31 st August 2010. We prepared the list of children roll number wise from selected school. From the list of children by systematic random sampling method, we selected 10% children, i.e., 286 government's school children, 114 private schools children and total 400 school children were selected for study. First we selected 10 th roll number and then every 10 th roll number children was included in the study. Those children who were absent on the day of a survey, they were not included. Results and Conclusion: The study conducted among a sample of 400 school children of the municipal corporation area revealed that 30 (7.5%) of the children were overweight, 25 (6.3%) were obese and 345 (86.3%) of them were normal. Out of a total of 400 children screened, 206 (51.5%) were girls and 194 (48.5%) were boys. Among the total girls, 10.2% were overweight and 6.3% were obese, 83.5% were normal. Similarly among total boys 4.6% were overweight and 6.25% were obese, 89.2% were normal. The prevalence of overweight and obesity were higher in girls than boys. Difference in the distribution of children according to sex was not statistically significant. Maximum prevalence of overweight (18%) was found in the 13-14 years age group and prevalence of obesity (9%) was in the same age group. |
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Prevalence of Anemia among rural population living in and around of rural health and training center, Ratua Village of Madhya Pradesh |
p. 15 |
Sanjay Kumar Gupta, Sanjay S Agarwal, Rituja Kaushal, Ambuj Jain, Vineet Kumar Gupta, Neeraj Khare
DOI:10.4103/0975-9727.128936 Introduction: Nutritional anaemia is a worldwide problem with the highest prevalence in developing countries. It is found especially among women of child-bearing age, young children and during pregnancy and lactation. It is estimated to affect nearly two-thirds of pregnant and one-half of non pregnant women in developing countries. Objectives: To study the trend and severity of anaemia among people attending at Ratua RHTC and various socio demographic factors for the same. Materials and Methods: Hospital based cross sectional study. Observation: The trend of anaemia from 2008 to 2011 was in increasing trend, 9%, 15%, 22%, and 27% respectively and in 2012 constant around 26%. Anaemia was more common in females than males, 18% males and 82% females were reported anaemia of various degrees in the study period. Anaemia was highest among 11-25 years of age 42% followed by 26-40 years 23% and lowest among 0-10 years of age 8.69%. Anaemia among elderly was quite higher 15.5%. Most of the males had mild anaemia 16% followed by moderate 6.61% and severe 0.77% in contrast most of the females had moderate anaemia 42% followed by mild 31.35% and severe 3%. Trend of anaemia in female patients were in increasing trend from 2008-2009, than little decreases in 2010 and further decreases in 2011 after that again increases in 2012. Conclusion: Anaemia was significantly higher in females in comparison to males in moderate and severe category. Anaemia was highest among 11-25 years of age group. |
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Assessment of client satisfaction with the services rendered by female health workers (auxiliary nurse midwife) in sub centers of selected primary health centers, Dakshina Kannada District, Karnataka state, India |
p. 19 |
Kunnath Chacko Leena, Berigai Settiappa Shakuntala
DOI:10.4103/0975-9727.128938 Context: Though, India has made impressive growth in providing primary health care, programs and providers have overwhelming emphasis on the quantitative aspect (targets), neglecting quality of services. Client satisfaction represents a key marker for the quality and needs to be studied repeatedly for smooth functioning of the health care systems. Client is the best judge for accurate assessment and overall improvement of quality health care provision through rectification of system weaknesses. Aims: The aim of the following study is to determine client satisfaction with the services rendered by female health workers. Settings and Design: Descriptive survey approach was used to determine satisfaction of 30 clients, 2 from each sub centers chosen during the immunization program about services received from female health workers. Study was conducted in 15 sub centers of Dakshina Kannada district Karnataka state, India. Materials and Methods: The clients of female health workers were identified. Baseline data of clients were collected using a questionnaire and client satisfaction scale was used to assess satisfaction with the services. Ethical clearance and informed consent were obtained and data was collected. Statistical Analysis Used: Descriptive and inferential statistical tests were employed and data were analyzed using SPSS package 13.0 SPSS Inc., 233 South Wacker Drive, 11 th . Floor, Chicago, IL. Results: The overall mean percentage scores of satisfaction 67.81% shows that the clients were only "moderately satisfied." On further analysis of satisfaction scores based on the three domains of satisfaction under consideration it is found that clients were "satisfied" (71.58%) about reproductive and child health (RCH) services, whereas they were "moderately satisfied" (62.13%) about the interpersonal relationship and services other than RCH (66.15%). Conclusions: The study concludes that quality may be improved by paying more attention to the perspectives of clients, improving competencies and skills of providers and improving the working environment by better management, supplies and motivation of staff. |
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Necessity of detection of extended spectrum beta-lactamase, AmpC and metallo-beta-lactamases in Gram-negative bacteria isolated from clinical specimens |
p. 23 |
Mehvash Haider, Meher Rizvi, Nazish Fatima, Indu Shukla, Abida Malik
DOI:10.4103/0975-9727.128939 Background: With increasing incidence of resistance to antibiotics carbapenems are used as the last resort because they are stable even in response to extended spectrum and AmpC beta-lactamases. However, Gram-negative bacilli producing the acquired metallo-beta-lactamases (MBL) are on the rise. Aim: The aim of the following study is to detect phenotypically the presence of extended spectrum beta-lactamase (ESBL), AmpC and MBL in Gram-negative bacteria isolated from clinical specimen. Materials and Methods: Gram-negative isolates from clinical samples were screened and confirmed for the presence of ESBLs by double disk synergy test (DDST), for AmpC by disk approximation assay and for MBL by Modified Hodge Test and imipenem-ethylenediaminetetraacetic acid DDST. Results: Among 251 isolates studied, 138 (54.98%) were ESBL producers, 49 (19.52%) were AmpC producers and 45 (17.93%) were MBL producers. Highest rates of ESBL detection was by Cefoperazone sulbactam (109/138) 78.98%. Out of 92 of the AmpC producing strains 20 (21.73%) were inducible and 72 were stably derepressed (78.26%). Out of 251 strains studied 45 (17.93%) were phenotypically identified as MBL producers, the highest no. being of Pseudomonas aeruginosa. Among the methods employed for detection of MBL production, Hodge test (62.22%) proved better than DDST (40%). Conclusions: High level of antibiotic resistance pattern exists in various clinical isolates. ESBL production should be looked for routinely in Gram-negative bacteria other than Escherichia coli and Klebsiella. A high percentage of derepressed AmpC mutants are noteworthy and alarming. We recommend phenotypic identification methods as routine practice in laboratories as genotypic methods are not cost-effective. |
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The pattern of needle stick injury among health care workers at West Bengal |
p. 29 |
Abantika Bhattacharya, Mausumi Basu, Palash Das
DOI:10.4103/0975-9727.128940 Introduction: Health care workers (HCWs) are at increased risk of infection with blood-borne pathogens; because of occupational exposure. Objectives: The objective of the following study is to assess the occurrence of needle stick injury (NSI) among HCWs, various factors responsible for NSI, the circumstances under which they occur and explored the responses of the HCWs after an injury. Materials and Methods: A descriptive hospital based observational epidemiological study, cross-sectional in design was conducted in indoor and Out-patient Departments of Surgery, Medicine and Gynaecology and Obstetrics of Burdwan Medical College and Hospital from June 2012 to August 2012 using a pre-designed pre-tested semi-structured self-administered anonymous questionnaire among senior residents, junior residents, house-staffs, internees, nursing staff and nursing students and laboratory technicians. Results: 132 (53.0%) reported NSI in the preceding 1 year in the health care facility. Nurses and nursing students had the highest percentage (42.4%). Only 40.2% HCWs were wearing gloves at the time of NSI. Recapping of needles was the most common cause implicated in causing NSI. 49.2% HCWs took action instantly after an NSI. Conclusion: Occurrence of NSI among the HCWs in West Bengal was high. Information, education and communication materials should be displayed prominently at the places of work. |
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Effect of cooking posture on birth weight |
p. 34 |
Yugantara R Kadam, Pragati V Chavan, Randheer V Dhoble, Alka D Gore
DOI:10.4103/0975-9727.128941 Background: Low birth weight is still prevalent and has a multifactorial causation. Indian women in the reproductive age group, usually engage themselves and spend considerable time in cooking. Cooking, when done in a standing position may affect birth weight adversely. Aim and Objective: The goal of this study was to study the postnatal mothers and their newborns to assess the effect of cooking posture on birth weight. Materials and Methods: Study type-cross-sectional study setting: Hospital based. Sample size: 499, study subject: Mothers and their newborns. Inclusion criteria: Those mothers, who are using liquid petroleum gas for cooking, attended ANC Clinic from the first trimester with minimum three antenatal visits, non-anemic at the end of the second trimester, full term and singleton delivery. Exclusion criteria: Those mothers with a history of toxemias of pregnancy, diabetes, tuberculosis etc., delivered pre-term and tobacco chewers. Study period: July 2011 to December 2011, study tools: (i) Questionnaire. (ii) Pediatric weighing machine. Statistical Analysis: Percentages, mean and standard deviation of birth weight, χ2 -test, ANOVA, Z-test. Results: Babies born to mothers cooking in a standing position were 101 g lighter than those born to mothers cooking in a sitting position. Observed difference was significant (z = 2.220, P = 0.027). Multivariate analysis shows significant association between cooking posture and birth weight (P = 0.034). There was a low degree but significant negative correlation between duration of cooking and birth weight in a standing position (r = −0.115, P = 0.045). Conclusion: Cooking posture affects birth weight adversely which is preventable as it is a modifiable risk factor. |
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Practices related to delivery and antenatal care among females in rural block of Haryana, India |
p. 39 |
Meely Panda, Brij Mohan Vashisht
DOI:10.4103/0975-9727.128943 Objectives: The objective of this study was to find out practices related to delivery and antenatal care (ANC) among a group of females in a rural block of Haryana. Materials and Methods: We conducted a study in the block Lakhanmajra, which is a rural field practice area attached to Department of Community Medicine, Post Graduate Institute of Medical Sciences, Rohtak. A total of 210 study subjects were selected out of a cluster sampling and they were interviewed by a pre-tested, semi structured schedule. Results: It was found that only 72% of females received ANC. Tetanus coverage was 95.7% and 4.3% females did not receive even a single dose of tetanus toxoid. More than half of the subjects (55%) were not consuming adequate number of iron folic acid tablets. Almost 24.7% deliveries were conducted at home and nearly 50% of deliveries were in government facility. Still 4.7% deliveries were attended by untrained persons. Conclusion: Uptake of the services provided is far from universal even in settings where they are widely available. Utilization of ANC services and promotion of institutional deliveries should be increased by enhancing awareness among females, ensuring availability of health staff, improving the quality of services in government setups and training of the entire untrained traditional birth attendant. ANC plays a critical role in preparing a woman and her family for child birth by establishing confidence between the woman and her health care provider. |
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Couvade syndrome among 1 st time expectant fathers |
p. 43 |
Thilagavathy Ganapathy
DOI:10.4103/0975-9727.128944 Background: Couvade syndrome reflects physiological changes in men in preparation for fatherhood. Objective: The objective of this study is to analyze the frequency of Couvade symptoms among1st time expectant fathers and their associations with socio-demographic factors. Materials and Methods: An exploratory study was conducted in three Private Maternity Hospitals, Bangalore. A total of 123 low risk 1 st time expectant fathers attending the antenatal clinic along with their low risk term primigravidae at 36-40 weeks of gestation were selected by purposive sampling. Each one of the 1 st time expectant fathers were interviewed on a four points ordinal scale for measurement of Couvade syndrome which included 29 symptoms. Results: The results revealed that 1 st time expectant fathers experienced Couvade syndrome related to physical symptoms - (changes in appetite, flatulence, constipation, indigestion, fatigue, nausea, vomiting, food cravings, diarrhea, abdominal pain, headache, fainting, tooth ache, weight loss, weight gain, back pain, leg cramps, skin problems) and psychological symptoms (insomnia, mood swings, irritability, feeling close to tears, night mares, feeling lonely, helpless, guilty, fear of being alone, resentful and not interested in usual activities). Socio-demographic characteristics were not associated with Couvade syndrome. Conclusions: Health-care providers should anticipate needs and problems of expectant fathers and assist them in working through the challenging aspects of fatherhood. |
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| REVIEW ARTICLES |
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Photodynamic therapy: Truly a marriage between a drug and a light |
p. 48 |
Harveen Singh, Heena Khurana, Harshneet Singh, Manmohit Singh
DOI:10.4103/0975-9727.128946 Microbial biofilms in the oral cavity are involved in the etiology of various oral conditions, including caries, periodontal and endodontic diseases, oral malodor, denture stomatitis, candidiasis and dental implant failures. It is generally recognized that the growth of bacteria in biofilms imparts a substantial decrease in susceptibility to antimicrobial agents compared with cultures grown in suspension. It is therefore not surprising that bacteria growing in dental plaque, a naturally occurring biofilm, show increased resistance to antimicrobial agents. As result there is pronounced interest and keenness in the development of alternate antimicrobial concepts. Therefore, the application of alternative method to eradicate bacteria from periodontal pockets is desirable. One such approach is photodynamic therapy (PDT). The purpose of this review was to evaluate the effectiveness of PDT for periodontitis as an adjunct to non-surgical treatment of scaling and root planning. This review provides an overview of PDT with emphasis on its current status as an antimicrobial therapy to control oral bacteria. Finally, new frontiers of antimicrobial PDT research will be introduced, including targeting strategies that may open new opportunities for the maintenance of bacterial homeostasis in dental plaque, thereby providing the opportunity for more effective disease prevention and control. Thus, the available knowledge of PDT should encourage a more clinically oriented application of this technique. |
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Essential medicine list 2011 |
p. 56 |
Keshab Mukhopadhyay, Ritesh Singh
DOI:10.4103/0975-9727.128947 Medicines are as important as health care workers. In developing countries patients has to travel many miles before seeing a health care professional. Many times they cannot afford medicines prescribed by doctors. Thus, they feel that their interaction with the doctor was futile. Availability of medicines at the point of care is of utmost importance if the public health system of a country is to be strengthened. This increases the confidence of common people in public health system of the country. Due to monetary constraints all the required medicines cannot be given by the government free of cost to its people. There must be a priority list of medicine or otherwise called essential list of medicines. The government should ensure the availability of these medicines at each health post. These medicines are carefully chosen after much deliberation and assessing the health profile of the country. Government of India developed an essential list of medicine in 2011. The last such list was developed in 2003. This paper reviews the essential medical list 2011 of India. |
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Expanded newborn screening: Guiding principles, concerns and relevance |
p. 59 |
Seema Pavaman Sindgikar, Rathika Damodar Shenoy
DOI:10.4103/0975-9727.128951 Since its introduction in 1960s, universal newborn screening (NBS) using the heel-prick dried blood spot samples has become an integral part of public health system in developed countries expanded to pre-symptomatic detection of specific inherited metabolic, endocrine and hematologic disorders. In our country, NBS may become relevant with epidemiological shift and increasing access to technology. Current recommendations include a phased introduction of screening for congenital hypothyroidism, congenital adrenal hyperplasia and glucose 6-phosphate dehydrogenase deficiency. In this review, the guiding principles of NBS, some of the individual disorders, the concerns and relevance to our country are discussed. Establishing a pre- and post-screening care and education are of utmost priority before NBS is adapted into health care system. |
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| CASE REPORTS |
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Synovial chondromatosis of the hip - Management with synovectomy and partial removal of loose bodies: Case study |
p. 64 |
Chavva Shamsunder, Shaik Ajaz Khalid, Vakati Raghavendra Sujit Kumar
DOI:10.4103/0975-9727.128952 Primary synovial chondromatosis is an uncommon disorder, in which involvement of the hip joint is still rare. Clinical symptoms are usually non-specific, clinical diagnosis of synovial chondromatosis of the hip may be difficult and delayed, especially before the ossifying nodules become evident. Currently, the recommended management is surgical removal of the loose bodies and synovectomy without dislocating the hip joint. We report a case of synovial chondromatosis of the hip in a 70 year old male patient, managed with an open synovectomy and removal of the loose bodies. We opine this is an easy and safe method for management of this disorder.
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Case of chronic patellar osteomyelitis |
p. 67 |
Chawa Shamsunder, Shaik Ajaz, Vakati Raghavendra Sujitkumar
DOI:10.4103/0975-9727.128953 Chronic osteomyelitis of patella, a rare clinical entity has been reported mostly in 5-15 years of age group, but is rare in adults. Literature search yields only few cases reported worldwide. We report a case of chronic osteomyelitis of right patella in a 16 year old male with a previous history of trauma. He presented with pus discharging from the right knee with limitation of joint movement. Radiographs showed lytic lesions of complete patella which was confirmed on computed tomography. Since the lesion was grossly spread over the complete patella, patellectomy was done. Our case suggests that chronic osteomyelitis is more likely to be caused by post-traumatic open injury to knee.
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A case of subacute thyroiditis in a patient on adalimumab for treatment of refractory palmo-plantar psoriasis |
p. 70 |
Anca Chiriac, Liliana Foia, Anca E Chiriac, Vlad E Gorduza, Caius Solovan, Piotr Brzezinski
DOI:10.4103/0975-9727.128955 Recent reports indicate different side-effects of the new medication for psoriasis. Adalimumab. Adalimumab is a biologic agent acting as tumor necrosis factor alpha inhibitor. It is wildly used in treating psoriasis, following a national guide treatment. We report a clinical case of subacute thyroiditis induced by adalimumab in a psoriatic patient. A 54-year-old Caucasian female addressed to our dermatology clinic in 2008 with a 3 years history of moderate to severe psoriasis. The patient had been experiencing non-disabling joint pain in both knees and wrists for several years. Her medical history was remarkable for pulmonary sarcoidosis (at the age of 32), arterial hypertension and angina pectoris. The patient was started on adalimumab 40 mg twice monthly with good clinical evolution, but she was diagnosed, a few months after starting the therapy, with subacute thyroiditis with severe evolution, with transitory hyperthyroidism (thyroid stimulating hormone 0.1 uIU/ml). The treatment with adalimumab was discontinued, the symptoms cleared in 3 weeks with non-steroidal anti-inflammatory drugs and a fully recovered thyroid status was obtained in 1 month. The patient continued the psoriatic medication (adalimumab) with no influence on thyroid status. We describe a case of subacute thyroiditis in a psoriatic patient treated with adalimumab, with a very good clinical evolution with non-steroidal anti-inflammatory medication. Liaison between dermatologists and in this case, endocrinologists and rheumatologists, will help to determine the prevalence of these reactions and to provide insights into the very complex mechanisms of both diseases. |
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Hermansky-Pudlak syndrome |
p. 74 |
Prabodh Panchadhyayee, Arnab Saha, Kaushik Saha, Rupam Kumar Ta, Pratik Barma
DOI:10.4103/0975-9727.128956 Hermansky-Pudlak syndrome (HPS) is a rare autosomal recessive disorder characterized by oculocutaneous albinism, bleeding diathesis and lysosomal deposition of ceroid lipofuscin pigment. Interstitial lung disease may also accompany with the disease. Cases are mainly found among individuals with Puerto Rican ancestry. It develops due to defects in the biogenesis and/or function of lysosome-related organelles essential to membrane and protein trafficking. A 30-year-old Hindu male patient with oculocutaneous albinism, strabismus, nystagmus and severe dimness of vision presented to us for severe shortness of breath. Subsequent investigations revealed he had HPS with an advanced stage of pulmonary fibrosis.
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Steroid therapy in Kimura's disease |
p. 77 |
MV Archana, K Varadaraj Shenoy, Elizabeth Varkey Cherian, Kishan Shetty
DOI:10.4103/0975-9727.128958 Kimura's disease is a rare condition and generally presents as non-tender subcutaneous swellings in the head and neck region, primarily seen in young Asian males. We report a case of Kimura's disease, who presented to us with swelling in the head and neck region, histopathological examination confirmed the diagnosis. Investigations showed eosinophilia and raised immunoglobulin E levels. The swelling which recurred after excision subsided following short course of steroid therapy.
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Curse of the "occult gases" in fish meal industry: "Lessons to learn" |
p. 80 |
Jagadish Rao Padubidri, Sanmath Shetty, Chakrapani Mahabala, Raghavendra Aswini Dutt
DOI:10.4103/0975-9727.128960 Stored wet fish consume oxygen and releases noxious gases as they spoil. Various collective gases are released during the process of decomposition such as carbon dioxide, ammonia, hydrogen sulfide, sulfur dioxide, methane etc. Casualties are reported in fish meal industry due to accidental exposure to these invisible toxic gases. We report a rare case of uneventful escape of five workers, accidentally exposed to noxious gases while engaged in fish oil manufacturing tank, in Coastal district of Karnataka, India. The possible combination of noxious gases responsible for acute primary lung injury (acute respiratory distress syndrome) and occupational safety measures to be employed to prevent such accidental exposure have been highlighted.
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| MEDICAL HISTORY PAGE |
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Ian Donald-pioneer of obstetric ultrasound |
p. 83 |
Prema D'Cunha
DOI:10.4103/0975-9727.128962 The ultrasound has become quite commonplace in Obstetrics and Gynaecology.Its advent is however of fairly recent origin. It was pioneered in the late 1950s but has seen a meteoric rise to become the most important discovery of the twentieth century. It was the vision, eloquence and persistence of one man from Glasgow that saw its birth and widespread use. The man was Professor Ian Donald. This is his story, his dream.
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| MEDICAL IMAGES |
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Fraser syndrome |
p. 85 |
Divya Krishnan, K Shreedhara Avabratha, Amitha D'Souza
DOI:10.4103/0975-9727.128965 |
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| WHAT IS NEW? |
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Newer oral anticoagulants |
p. 86 |
Ravichandra Volabailu, Padmaja Udaykumar
DOI:10.4103/0975-9727.128966 |
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| LETTERS TO EDITOR |
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A case of Gianotti-Crosti syndrome |
p. 88 |
Shylaja Someshwar, Hemangi R Jerajani
DOI:10.4103/0975-9727.128967 |
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Ichthyosis uteri: An incidental finding with review of literature |
p. 89 |
Shailja Puri Wahal, Kavita Mardi
DOI:10.4103/0975-9727.128968 |
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Tuberous sclerosis complex |
p. 91 |
Namitha Chathra, M Ramesh Bhat
DOI:10.4103/0975-9727.128969 |
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