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Excessive Masturbation in Female Linked to Sex Exhaustion

May 22, 2015

Excessive Masturbation in Female May Cause Sex Exhaustion

masturbationExploring one’s body is a good thing. Growing up and seeing things changing on your body is often met by the need to know what happens when you lay your hand at a particular part of the body. One of the things that people do to help them identify themselves sexually is to masturbate. Most teens begin this behavior fuelled by mere curiosity but since everything that gives pleasure beckons repeated acts, a person may overindulge in this behavior. Most of individuals who are sexually addicted have masturbated, and though to many people masturbation may serve as a quick fix; a means to release sexual tension, it has its shares of the dark clouds. Masturbation has been linked to sex exhaustion. Though sexual exhaustion has always been overlooked as a problem of men mostly associated with over-ejaculation women too can suffer the same predicament if they over stimulate themselves.

Though it is good to explore one’s body and fully express one’s sexuality there are limits to this for the sake of safety and general well-being and therefore this information should never be treated as any malicious dossier that is aimed at taking away the will of women to enjoy themselves sexually by stimulating themselves. When this is done excessively it causes myriads of problems. Sexual exhaustion is one of the major side effects that over masturbation has been associated with. Sexual exhaustion may be overlooked but it is by itself a host of many ailments that may affect the health of any woman who is indulging in over masturbation adversely. It can manifest itself in many ways. It can impair a woman’s mental faculties as well as hinder healthy relationships. Sexual exhaustion may also a woman’s physical responsiveness, making them sluggish and weak.

contrary to what many people believe, sexual exhaustion is not a problem that will be felt immediately you masturbate but it is a gradual process therefore you may not even be able to monitor its advances. Due to this fact many women will suffer from this situation and suffer for a long time without treatment or even diagnosis. most women who are treated of this condition often report too late when the condition has caused more harm, normally it take more than a year for your body’s chemical composition to be back in good condition after a long time struggle with sexual exhaustion.

What causes sexual exhaustion?

When a woman masturbates excessively, the levels of prolactin and dopamine will be chronically elevated. The conversion of dopamine to norepinephrine/epinephrine leads to pituitary-ovarian functional disorders and sexual exhaustion symptoms. Female sexual exhaustion is a serious ailment that like other drug addiction can cause inflammation of arteries, constricting blood flow to the brain. When the arteries are inflamed, they become narrow and that leads to high pressure within the vessels resulting in hypertension, headaches, migraine, blurred version, gum inflammation, sleeping disorder, ear ringing, brain disorders, body or joint pains and inflammation, liver and kidney inflammation, and uterus, cervix, bladder and urethra disorders. All these side effects can be dealt with effectively by stopping or rather reducing the frequency of self-stimulation.

Sexual exhaustion is generally a host of many conditions but all is even worse for pregnant women. This is because at the height of orgasm, the uterus and cervix stretches and causes excessive COX-2 mRNA expression which produces excessive amounts of the inflammatory hormone prostaglandin E-2. Prostaglandin E-2 enlarges the cervical opening and induces labor prematurely. This statement is backed up by a case in which a pregnant woman induced labor by masturbating, the child was delivered on the way to hospital but couldn’t survive as it was 5 months prematurely delivered. This happened in 2005 and served as evidence that masturbation can cause death of unborn child. As to be expected the mother of the child couldn’t forgive herself and turned to the abuse of drugs that she eventually became addicted to. If you are aware of the side effects of drug addiction then you can know that the effects of sexual exhaustion are nearly the same and therefore any precautions should be taken to help mitigate its effects on a woman’s health.

As for those who are not pregnant, you are not off the hook, engaging in excessive masturbation leads to excessive orgasm which in turn causes exhaustion to the ovarian function and induce menstrual disorders. Excessive masturbation involves excessive vaginal or cervical abrasion and uterine contraction which in conjunction with excessive amounts of the stress neurohormone epinephrine in the bloodstream, can stimulate progesterone release from the ovaries in an attempt to counterbalance the production of prostaglandin E-2, thus culminating into the problems mentioned above.

How can this be remedied?

masturbationFrom what we have learnt, it is now evident that excessive sexual activity has more problems than benefits to be reaped, therefore there is need to remedy it. To do this, you can stop masturbating for some time and let the body heal itself after which you can begin once again but at a much lower frequency. Again masturbation should not be your sole means of deriving sexual pleasure but a person should also engage in sexual intercourse much more than she does masturbate.

You can also consider going through a nervous detoxification process with natural herbs. This will help stabilize the serotonin and GABA nervous control, and boost prostaglandin E-1/E-3 and Nitric Oxide production for healing. It also helps rejuvenate and replenish the body. Herbs such as ginseng and horny goat weed are very helpful in this process.

Finally, sex addiction is not a light matter. It’s a problem that is still holding many women captive .This problem needs to be treated effectively through integrative medicine. Dr. Dalal Akoury (MD) is an expert at this. Call her on (843) 213-1480 for help.

Excessive Masturbation in Female May Cause Sex Exhaustion

 

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Striatum Methamphetamine Toxicity

March 22, 2015

Methamphetamine Toxicity in the Striatum

The striatum is a crucial part of the brain. This part of the brain plays very important roles but it can be adversely affected by the use of stimulants and other drugs of leisure. Substances such as cocaine and methamphetamine produce their primary effects inside the brain by boosting the presence of dopamine which is a neurotransmitting chemical that activates the pleasure-producing neurons contained within the limbic system. As stated above the limbic system includes the hippocampus, along with several other brain structures. According to the results of two separate studies published in 2008 in the Journal of Neuroscience and Biological Psychiatry, the presence of either cocaine or methamphetamine alters normal adult neurogenesis inside the hippocampus and damages this region’s ability replenish its neuron supply.  It is no longer news that methamphetamine intoxication causes long-lasting damage to dopamine nerve endings in the striatum. However the mechanisms underlying this neurotoxicity are not yet known but oxidative stress has been linked to it.

methamphetamine

 

Microglia are the major antigen-presenting cells in brain and when activated, they secrete an array of factors that cause neuronal damage. Astoundingly, very little work has been directed at the study of microglial activation as part of the methamphetamine neurotoxic cascade. It has been report that methamphetamine activates microglia in a dose-related manner and along a time course that is coincident with dopamine nerve ending damage. Through tests done on mice scientists have discovered that prevention of methamphetamine toxicity by maintaining treated mice at low ambient temperature prevents drug-induced microglial activation. MPTP (1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine) not only damages dopamine nerve endings and cell bodies but also  causes extensive microglial activation in striatum as well as in the substantia nigra. Contrastingly, methamphetamine causes neither microglial activation in the substantia nigra nor dopamine cell body damage.

Dopamine transporter antagonists do not mimic the effect of methamphetamine on microglia. Hyperthermia, a prominent and dangerous clinical response to methamphetamine intoxication, has been also ruled out as the cause of microglial activation. Together, these data suggest that microglial activation represents an early step in methamphetamine-induced neurotoxicity. Other neurochemical effects resulting from methamphetamine-induced overflow of dopamine into the synapse, but which are not neurotoxic, do not play a role in this response.

Methamphetamine use on the rise despite effects

The use of methamphetamine has been on the rise despite the fact that it is a powerful stimulant drug that has adverse effects when abused as most people do. According to the UN Office on Drugs and Crime reported recently that abuse of amphetamines, including designer drugs such as methamphetamine and 3, 4-methylenedioxymethamphetamine, now exceeds that of cocaine and heroin on a global scale. This presents no sign that its use will decline any soon. Past researchers were able to establish a fact that methamphetamine causes persistent reductions of function in dopamine nerve endings of animals and humans. Methamphetamine neurotoxicity has been under intense study for over 20 years, but still there is much that still remains to be learned about how this dangerous drug causes damage to dopamine nerve endings. The theory that revolves around oxidative stress has been at the top of the speculations. Drug-induced oxidative stress is an attractive construct that can account for many of the effects of methamphetamine on the dopamine nerve ending such as inhibition of tyrosine hydroxylase activity as well as reductions in the dopamine transporter and the vesicle monoamine transporter. This may even be an early event that leads eventually to methamphetamine-induced apoptosis. However, the source of the reactant species that mediate methamphetamine-induced damage is not known.

methamphetamine

Due to their crucial roles they play in mediating the mediating damage to the nervous system, Microglia has attracted considerable attention. Immune like in many ways  these interesting cells become activated by damage and then transmigrate to sites of injury where they can secrete an array of factors  like cytokines, prostaglandins, nitric oxide, and superoxide that are known to have detrimental effects on neurons. However, the role of microglia in methamphetamine-induced damage to the dopamine system has received little attention. In 1994 a researcher, Bowyer and his colleagues noted for the first time that methamphetamine resulted in activation of microglia in striatum of treated rats. These investigators concluded that microglia were increased in response to nerve ending damage and were not apparently a cause of it.  Recently, another research was conducted to give an in-depth analysis of the effect of methamphetamine on striatal gene expression. Numerous genes linked to microglia were activated significantly within hours of methamphetamine intoxication, suggesting the possibility that microglial activation occurs earlier in the methamphetamine toxic cascade than previously thought.

Today there are researchers who are building on the initial analysis of methamphetamine and report the pharmacological characterization of microglial activation by methamphetamine in striatum. As mentioned before, striatum is an area dense in dopamine nerve endings and is known to be targeted for damage by methamphetamine. Microglial activation coincides with the onset of methamphetamine-induced damage in striatum and the extent of this effect is related to the degree of damage to dopamine nerve endings. Numerous nontoxic effects exerted by methamphetamine, such as inhibition of the DAT, increases in synaptic levels of dopamine, activation of D1 and/or D2 DA receptors, and hyperthermia, cannot explain methamphetamine-induced microglial activation.

Finally, this is still a dark area and there is need for more literature so as to establish the mechanism of methamphetamine toxicity on the striatum. Needless to say, Drug abuse, addiction and independence are problems that people grapple with every day. These problems need to be treated effectively through integrative medicine. Dr. Dalal Akoury (MD) is an expert at this.  Call her on (843) 213-1480 for help.

Methamphetamine Toxicity in the Striatum

 

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Stem Cell Therapy Used By Pro Athletes to Heal Injuries

March 6, 2015

Stem Cell Therapy Used By Pro Athletes to Heal Injuries

The intriguing medicinal abilities of the stem cell therapy seem to have got embraced by athletes.  today there are athletes who are using the stem cell therapy to help heal joint related injuries that they get in the course of playing their games and ultimately reduce their ability to play as well as they ought to. Stem cell therapy seems to be a game changing strategy in treating injuries that would rather be complicated treating with surgery alone. however despite the known benefits of the stem cell therapy and its exceptional relief it offers to patients given that it is the most versatile approach to treatment of diseases, It has not got into mainstream medical treatments for sports medicine and most of the time the teams do not pay for the costs incurred by athletes who opt to get treated through the stem cell therapy needless to mention it is still not recognized in the US. Despite these some athletes have chosen to tap into the immense potential of stem cell therapy to heal their respective injuries.

Chris Johnson, 28 is one of the many of NFL players who have opted to have their injuries a stem cell therapy treatment having heard of the amazing potential of the stem cell therapy when he visited orthopedic surgeon James Andrews in January, 2014 to fix his ailing left knee. Johnson had suffered a torn meniscus while in action for the Titans. When Dr. James Andrews presented him with the idea of stem cell therapy he decided to give it a try.

Knee injuries

“When I tore my meniscus and played the season out, through the wear and tear, I lost a lot of cartilage,” says Johnson, who was signed by the Jets to bring explosiveness to their offense. “When you put the stem cells in, it might be able to help rebuild that cartilage in your knee. Hopefully, it makes your knee better for even more years.” he adds.

Having agreed to have the therapy done, Johnson had stem cells siphoned from bone marrow with along needle from the iliac crest of his pelvis and had these stem cells injected directly on his injured knee. This was done with hopes that the stem cells will not only work as anti-inflammatory agents but also hasten the healing of the knee by repairing the torn meniscus.

Stem cell therapy is popular among NFL Players

Evidently, Johnson is not the only athletes who have used the stem cell therapy to heal his injury. Another Pro athlete, Peyton Manning is reported to have tried a stem-cell treatment in Europe in 2011, which was his final year with the Colts with an aim of fast-tracking his recovery from neck surgery.  another athlete, Prince Amukamara, Giants cornerback had a slow-healing broken metatarsal treated with stem cells by a foot specialist in North Carolina after his team’s Super Bowl XLVI run. One NFL linebacker paid $6,000 a pop for a 1-milliliter vial of donated placenta tissue containing stem cells to be injected into each of his beat-up knees this offseason but asked for his name not to be used in this story because he didn’t tell his team’s medical staff. This shows how amazing the stem cell therapy is in view of these pro-athletes.

It is reported that stem cell therapy has become more popular with NFL athletes, as it now stands, of the 32 teams, hundreds of the players have got stem cell treatment for their various injuries. This averages to six players per team which is impressive, however the stem cell therapy is still not a mainstream treatment and it still is somehow a shadow that is not understood by many. however, evidence of the stem cell therapy’s usefulness in treating athletes’ injuries is so far largely anecdotal, NFL teams often will not pick up the bill for players, and the overseas market for treatments not approved in the U.S. makes the whole field seem somewhat taboo but this has not discouraged the athletes which may mean that they have seen some benefits with the therapy.

Knee injuriesThe sports doctors have been recently pushing for the NFL teams to pick the bills that athletes incur while getting the stem cell therapy and to shun this view of stem cell therapy as farfetched. Dr. Andrews who is an expert in biologics – term refers to substances that are produced in living systems such as humans, animals and microorganisms, rather than manufactured like drugs is an important in this push. it is expected that when the US embraces the stem cell treatment for the athletes then the sport doctors like Dr. Andrews will be able to offer their star-studded clientele more of these treatments more effectively in the U.S. in this agenda the retired NFL players will be studied to prove how well the stem cell therapy works in treating arthritis of the knee, this is a more regenerating approach to treatment of injuries.

“We have had one big revelation in sports medicine over the last 50 years, and that was the arthroscope,” Andrews says. “I’ve been looking for the next wave, and I think the biologics, particularly stem-cell therapy and enhancement of the healing properties, will be it.”

“We’ve been saying that since the new decade of this new millennium, so we’re already behind.” he concludes.

Finally, Stem cell therapy is a promising treatment for orthopedic diseases; you may tap into the unique medicinal properties of the stem cells to help you beat orthopedic conditions. Visit us at AWAREmed Health and Wellness Resource Centre at Myrtle Beach, South Carolina. Dr. Dalal Akoury (MD) an expert in integrative and regenerative medicine will be able to help.

Stem Cell Therapy Used By Pro Athletes to Heal Injuries

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IV NAD: The Best Addiction Treatment

March 1, 2015

IV NAD Is the Best Addiction Treatment

After a long term use of drugs of abuse as a result of addiction to the drugs, the body’s cells, tissues, organs and neurotransmitters will be affected adversely by the drugs. It is therefore important to correct this during treatment therapy. NAD IV therapy can be used to replenish the drained enzymes and target brain restoration

What is IV  NAD?

NAD is an abbreviation of Nicotinamide adenine dinucleotide. It is a coenzyme that is present in all living cells. The compound is a dinucleotide, this simply means that it consists of two nucleotides joined through their phosphate groups. One nucleotide contains an adenine base and the other nicotinamide. Nicotinamide adenine dinucleotide exists in two forms, an oxidized and reduced form abbreviated as NAD+ and NADH respectively. It is therefore safe for us to say that NADH is a reduced form of NAD. IV NAD is a crucial coenzyme in metabolism.  In metabolism, nicotinamide adenine dinucleotide is involved in redox reactions, carrying electrons from one reaction to another. The coenzyme is, therefore, found in two forms in cells: NAD+ is an oxidizing agent – it accepts electrons from other molecules and becomes reduced. This reaction forms NADH, which can then be used as a reducing agent to donate electrons. These electron transfer reactions are the main function of NAD. Therefore there is need for a balance between the NADH and the NAD to maintain a favorable environment for homeostasis. Apart from its functions in electron transfer, the NAD has other functions in the body such as being a substrate of enzymes that add or remove chemical groups from proteins, in posttranslational modifications.  Owing to its importance on performing these functions, the enzymes involved in IV NAD metabolism have been targeted to help come up with drugs that could heal different complications.

IV NAD

The IV NAD and the NADH are crucial in the production of energy in the mitochondria. What happens after eating is that the vitamins, minerals, carbohydrates, proteins and fats from our diet provide the building blocks to our bodies. Energy that is produced from citric acid cycle makes NAD and links it to hydrogen forming NADH which enters the electron transport chain in the mitochondria and is sparked with oxygen which breaks the nutrients to give energy through oxidation. This energy enables the heart to beat sufficiently and enable muscle contraction providing cellular energy that is required by the body cells to function. The energy that is produced is also used by the brain therefore if the level of NADH is low then the brain will not function well at the same time if NAD level is low then production of energy will be low. There is need to establish a favorable ratio between the NAD and NADH since without a good balance of the two then there will be fatigue and depression which are factors that mostly deter addicts from quitting using their substances of abuse.

In most cases IV NAD deficiency is first evident in brain-related symptoms of poor concentration, difficulty focusing, and attention deficit disorders. If the energy shortage lasts long enough, brain neurons cannot synthesize neurotransmitters. When this occurs, the molecules of consciousness such as serotonin, dopamine, and noradrenaline are affected. Anxiety, depression, sleep disturbance and other mood changes can then arise. These are not good for addicts as they may trigger them to use drugs as escapade. Many addicts got trapped after trying using drugs as self-medication against fatigue and depression. This even lowers NAD level even further and it is a continuous vicious cycle. It is also important to note that the crucial enzymes that catalyze the Citric Acid Cycle are inhibited and may get destroyed by chemical toxins that create oxidative or free radical damage. The sources of this damage are substances of abuse like cigarette smoke, drugs, and chronic stress. This problem may also be caused by exposure to myriads of toxins.

IV NAD the best therapy for addiction

Nicotinamide Adenine Dinucleotide often abbreviated as NAD is a metabolic co-enzyme and is charged with the important job of structuring, repairing, and remodeling every cell in the body. Drug use often leads to destruction of many cells and nerves in the body and therefore any addiction treatment therapy must seek to restore the health of the damaged tissues in order to give a lasting healing effect on the client. It is therefore important that there are adequate levels of NAD in the body.

IV NAD

IV NAD deficiency in the body can be corrected by having an IV NAD therapy. This will not only increase the production of energy but will also increase the level of NADH which is critical for enzymatic action. The IV NAD goes straight to receptors in the brain and so is not digested in the stomach. Another reason for ensuring balance between NAD/NADH is that the correct ratios will help in restoring damaged neurotransmitters by drugs. It is a detoxifier that works faster as it takes only few days rather than weeks or months to flush out stored drugs from the body and its organs, replenish balance in the brain, and reverse damage. Results can be mental clarity, cognitive function increase, focus and concentration returns, more energy, better mood, positive outlook.

And finally, AWAREmed Health and Wellness Resource Center  encourages addicts to come for addiction recovery .We have qualified doctors who will see to it that every addict is helped to break the bond of addiction and enjoy life of freedom. Dr. Dalal Akoury (MD) is committed to availing help to every patient. Call on her at Myrtle Beach, South Carolina for help.

IV NAD Is the Best Addiction Treatment

 

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Weight loss the right tool for preventing High blood pressure

January 22, 2015

Weight loss the right tool for preventing High blood pressure – Does weight loss prevent complications

Weight loss is the right tool for preventing High blood pressure

Weight loss is the right tool for preventing High blood pressure in the society today. the kind of diet is also very important.

Over the years high blood pressure has been a serious health concern not just for the people who have been diagnosed with the disease but also their loved ones. Having a friend or relative suffering from this health condition can be very frustrating and the sooner it is treated the better. Therefore if you have been diagnosed with high blood pressure you might be worried about taking medication to bring your condition to a manageable level. To help you achieve this it is important to note that weight loss the right tool for preventing high blood pressure. When you exercise this with the help of professionals, you will be in a better position of recovering from this health condition much faster. That is why doctor Dalal Akoury, Founder of AWAREmed Health and Wellness Resource Center, is offering her exclusive NER Recovery Treatment to all people across the globe including other physicians and health care professionals through training, clinical apprenticeships, webinars and seminars. If you have any problem concerning weight loss you can schedule for a meeting with doctor Akoury for a truly and successful recovery treatment program.

Doctor Akoury explains that lifestyle can play an important role in treating your high blood pressure. If you successfully control your blood pressure with a healthy lifestyle, you may avoid, delay or reduce the need for medication. The following are some of the lifestyle changes you can make to lower your blood pressure and keep it down.

Weight loss the right tool for preventing High blood pressure – Lose extra pounds and watch your waistline

Did you know that blood pressure increases as weight increases and that losing just 10 pounds (4.5 kilograms) can help reduce your blood pressure? In general, the more weight you lose, the lower your blood pressure. Losing weight also makes any blood pressure medications you’re taking more effective. When you visit doctor Akoury in her office she will up on evaluating your condition, she will be able to determine your target weight and the best way to achieve it. Remember that besides losing, you should also keep an eye on your waistline. Carrying too much weight around your waist can put you at greater risk of high blood pressure. I dearly the risk vary with gender, with risk for men being high when their waist measurement is 102 centimeter and women at 89 centimeters.

Weight loss the right tool for preventing High blood pressure – Exercise regularly

The benefits of being active are almost instant. If for example you exercise for at least half an hour like 4-5 days weekly, your blood pressure will come down by 4-9 mm of mercury. For those with prehypertension, systolic pressure between 120 and 139 or diastolic pressure between 80 and 89, exercise can help you avoid developing full-blown hypertension. If you already have hypertension, regular physical activity can bring your blood pressure down to safer levels. Doctor Akoury will help you develop an exercise program and advice you professionally as to whether you need minimal or restricted exercise. When doing exercise, it is important that you spread the program through the week and not to push everything for the weekend.

Weight loss the right tool for preventing High blood pressure – Eat a healthy diet

What you are feeding on is equally very important. Foods rich in whole grains, fruits, vegetables and low-fat dairy products and skimps on saturated fat and cholesterol can be very helpful in lowering your blood pressure by up to 14 mm Hg. We appreciate that it isn’t easy to change your eating habits all over sudden; therefore to help you cope the following suggestions will be very helpful:

  • Keep a food diary – having a record of what you eat is very important, it can shed surprising light on your true eating habits. Keenly observe what you eat, to what quantity, when you eat and why.
  • Consider boosting potassium – Potassium can lessen the effects of sodium on blood pressure. The best source of potassium is food, like fruits and vegetables, rather than supplements. This is one area where doctor Akoury will advise about the potassium level that’s best for you.
  • Be a smart shopper – Make a shopping list before heading to the supermarket to avoid picking up junk food. Read food labels when you shop and stick to your healthy-eating plan when you’re dining out, too.
Weight loss the right tool for preventing High blood pressure – Reduce sodium in your diet

These are very necessary and remember that even a small reduction in the sodium in your diet can reduce blood pressure by 2 to 8 mm Hg. The recommendations for reducing sodium are:

  • Limit sodium to 2,300 milligrams (mg) a day or less.
  • A lower sodium level 1,500 mg a day or less — is appropriate for people 51 years of age or older, and individuals of any age who are African-American or who have high blood pressure, diabetes or chronic kidney disease.

The following guide lines will be helpful in decreasing sodium in your diet:

  • Track how much salt is in your diet – Keep a food diary to estimate how much sodium is in what you eat and drink each day.
  • Read food labels – If possible, choose low-sodium alternatives of the foods and beverages you normally buy.
  • Eat fewer processed foods – Potato chips, frozen dinners, bacon and processed lunch meats are high in sodium.
  • Don’t add salt – Just 1 level teaspoon of salt has 2,300 mg of sodium. Use herbs or spices, rather than salt, to add more flavor to your foods.
  • Ease into it – If you don’t feel like you can drastically reduce the sodium in your diet suddenly, cut back gradually. Your palate will adjust over time.
Weight loss the right tool for preventing High blood pressure – Limit the amount of alcohol you drink

Alcohol can be both good and bad for your health. In small amounts, it can potentially lower your blood pressure by 2 to 4 mm Hg. nonetheless that protective effect is lost if you drink too much alcohol. It is however better that if you don’t normally drink alcohol, you shouldn’t start drinking as a way to lower your blood pressure. There’s more potential harm than benefit to drinking alcohol. Remember that alcohol is addictive and generally not good for health. Besides raising the blood pressure by several points, it can also reduce the effectiveness of high blood pressure medications. Finally the key to unlocking the problem of blood pressure is primarily resting on weight loss. This is what the experts at AWAREmed Health and Wellness Resource Center under Doctor Akoury’s care does best. All you need to start the journey of recovery is to schedule for an appointment with doctor Akoury today.

Weight loss the right tool for preventing High blood pressure – Does weight loss prevent complications

 

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