Tag Archives: Health risks of obesity

The Association between Obesity and Cancer

The Association between Obesity and Cancer: The known truths between obesity and the various types of cancer

The Association between Obesity and Cancer

The Association between Obesity and Cancer can be a very big threat to good health if not addressed in time. Talk to your doctor in good time for advice.

At the mention of the disease cancer, people frown and stress and worries settle in. The condition becomes even worse when the patients struggling with this health condition are also obese or overweight. Experts all over the world are very much concern with the prevalence of obesity that is threatening to get out of hand. Unless we take some decisive action today, obesity is going to be the number one threat to health owing to its close association with other chronic diseases like cancer. In our previous article we discussed the relationship between obesity and some types of cancer, and we want to continue with the same in this article so that we can all be ready to eliminate the two conditions from our societies. We spoke to doctor Dalal Akoury a medical professional in various medical disciplines. Doctor Akoury is the MD and founder of AWAREmed Health and Wellness Resource Center a health facility whose primary objective is to help people transform their individual’s lives through increasing awareness about health and wellness and by empowering them to finding their own inner healing power. This is something that she has done for over two decades making one of the most experience professionals you can trust with your treatment. As you consider calling doctor Akoury, let us continue with the discussion about the association between obesity and cancer.

The Association between Obesity and Cancer: Obesity and Colorectal cancer

Being obese or overweight is closely associated with increased risk of colorectal cancer in men. This is mostly facilitated by the distribution of body fat especially with the abdominal obesity giving the clear evidence of an association with colon cancer risk. This is also seen in women but with little significance. However the use of MHT is likely to modify the association in postmenopausal women. A number of mechanisms have been proposed to account for the association of obesity with increased colon cancer risk. One hypothesis is that high levels of insulin or insulin-related growth factors in obese people may promote colon cancer development. High BMI is also associated with rectal cancer risk, but the increase in risk is more modest.

The Association between Obesity and Cancer: Obesity and kidney cancer

Obesity has been consistently associated with renal cell cancer, which is the most common form of kidney cancer, in both men and women. The mechanisms by which obesity may increase renal cell cancer risk are not well understood. High blood pressure is a known risk factor for renal cell cancer, but the relationship between obesity and kidney cancer is independent of blood pressure status. High levels of insulin may play a role in the development of the disease.

The Association between Obesity and Cancer: Obesity and Esophageal cancer

Overweight and obese people are about twice as likely as people of healthy weight to develop a type of esophageal cancer called esophageal adenocarcinoma. Most studies have observed no increased risk, or even a decline in risk, with obesity for the other major type of esophageal cancer, squamous cell cancer. The mechanisms by which obesity may increase risk of esophageal adenocarcinoma are not well understood. However, overweight and obese people are more likely than people of normal weight to have a history of gastro-esophageal reflux disease or Barrett esophagus, which are associated with an increased risk of esophageal adenocarcinoma. It is possible that obesity exacerbates the esophageal inflammation that is associated with these conditions.

Obesity and pancreatic cancer – Many studies have reported a slight increase in risk of pancreatic cancer among overweight and obese individuals. Waist circumference may be particularly important factor in the association of overweight and obesity with pancreatic cancer.

Obesity and thyroid cancer Increasing weight has been found to be associated with an increase in the risk of thyroid cancer. However it is not very clear what the mechanism might be.

Obesity and gallbladder cancer The risk of gallbladder cancer increases with increasing BMI. The increase in risk may be due to the higher frequency of gallstones, a strong risk factor for gallbladder cancer, in obese individuals.

Is there any possibility that avoiding weight gain decreases the risk of cancer?

This is very interesting acknowledges doctor Akoury, nonetheless the only way to ascertain this is through running a controlled clinical trials. A number of NIH-funded weight loss trials have in the past demonstrated that people can lose weight and that losing weight reduces their risk of developing chronic diseases, such as diabetes, while improving their risk factors for cardiovascular disease. It is also worth noting that the result emanating from the last trials, the NIC workshop findings demonstrated that it would not be feasible to conduct a weight loss trial of prevention of cancer. The question that follows would be why? The reason is a simple one that is the effect of weight loss trial of other chronic diseases would be demonstrated and the trial consequently stopped so that the public could be informed of the benefits before the effect on the prevention of cancer would become evident.

Therefore, most data about whether losing weight or avoiding weight gain prevents cancer come mainly from cohort and case-control studies. Data from these types of studies, called observational studies, can be difficult to interpret because people who lose weight or avoid weight gain may be different in other ways from people who do not, just as obese people may differ from lean people in other ways than BMI. That is, it is possible that these other differences explain their different cancer risk.

Nevertheless, many observational studies have shown that people who have a lower weight gain during adulthood have a lower risk of:

A more limited number of observational studies have examined the relationship between weight loss and cancer risk, and a few have found decreased risks of breast cancer and colon cancer among people who have lost weight. However, most of these studies have not been able to evaluate whether the weight loss was intentional or related to underlying health problems. It is because of such findings that made doctor Akoury to create AWAREmed Health and Wellness Resource Center with a sole objective of transforming each individual’s life through increasing awareness about health and wellness and by empowering individuals to find their own inner healing power. If you want a more personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms, then you need to schedule for that appointment with doctor Akoury today.

The Association between Obesity and Cancer: The known truths between obesity and the various types of cancer

 

 

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The real benefits of losing excess weight

The real benefits of losing excess weight: The health benefits are instant

The real benefits of losing excess weight

The real benefits of losing excess weight is clearly evident from the BMI chart. You live a healthy life if you have a healthy weight

The most precious gift we can have in life is good health. This gift is seriously under threat from all corners of life and a lot is being done to restore the desired situation. One single problem appears to be contributing to the deterioration of people’s health in the current generation. I am talking about the problem of overweight. It is one single unit but it provokes a host of so many other life threatening  conditions including coronary complications, high blood pressure, type 2 diabetes, pregnancy complications just to highlight a few. The question therefore that we must address is how best can we solve the problem and what are the real benefits of losing weight? To help us put these to perspective, doctor Dalal Akoury a medical professional of over two decades the MD and founder of AWAREmed Health and Wellness Resource Center, is going to be sharing with us her experience in offering solutions to obese and overweight to the suffering global communities.

The prevalence of obesity and overweight is currently graduating into epidemic and very government is getting concern about the rate at which this is causing peoples health discomfort. Guided by the suffering of many doctor Akoury made a decision to form this facility center whose main objective is to transform lives professionally through increasing awareness about health and wellness and by empowering people either collectively as a group or individually into finding their own inner healing power. This kind of professionalism can only be got from this facility and it would be very important that you schedule for an appointment with doctor Akoury today to be part of people applauding her excellent treatment modes. In the meantime it will interest you to note that Dr. Akoury’s practice focuses on personalized medicine through healthy lifestyle choices that deal with primary prevention and underlying causes instead of patching up symptoms. You will not be able to know all this if you are still talking from the outside. It is time that you walk in and get treated with the experts only at AWAREmed Health and Wellness Resource Center.

You may be wondering what it will take when you register for treatment with doctor Dalal Akoury. Doctor Akoury says that losing weight is not all about engaging in an intensive work out program or a taxing diet plan. In fact very little activities we often ignore are actually very beneficial as well. This is demonstrated by the fact that the health benefits of losing weight will begin to manifest even before you begin seeing the actual physical benefits or changes. And whereas many people often take the benefits of losing weight to be reflected on the physical, the real benefits are always channeled to improving the quality of health. The significance of losing weight will be seen first in the in the improvement of health even before it is revealed on the physical. It is regrettable that up to now it is still not very clear on how we can quantify the a mount of health that has been added as a result of losing weight, but it is evident that there is great improvement of health. In many instances “if not all” people often feel better and have more energy while others will experience an enhancement in their self-worth. Ordinarily any weight above of BMI 30 is not healthy and is considered overweight or obesity. Therefore a reduction in that would generate so many health benefits including:

The real benefits of losing excess weight: Your Heart and Your Life Improve

It will interest you to know that of the benefits of losing weight, the greatest beneficiary is the heart. There is almost immediate reduction of risks of heart attack and beyond. Like I was saying never get worried or get discouraged in taking part in weight loss program because the benefits are torching on the core organs of the body. Remember that even that slight weight loss which ordinarily would be seen as negligible means more energy and the ability to more activities. Taking little weight loss activities over time will boost your confidence and become an incentive to graduate from one level to another. The ultimate goal is that your general life quality is enhanced in all dimensions.  My encouragement to you is, never be discouraged. Your best asset is your health and anything affecting it should be your greatest concern. Therefore take your time and improve the quality of your health by scheduling for an appointment with doctor Dalal Akoury anything touching on losing weight and you will never regret having done so.

The real benefits of losing excess weight: Almost Instant Gratification

The heart is one such organ whose functions are very pertinent to life. Guarding and protecting its proper functionalities is not negotiable. Just the mere fact that you’re overweight can exact pressures to your heart, which can lead to a multitude of health complications, including heart disease. Like I had said never under estimate the little weight you lose. For sure you don’t need to take off say 50 pounds to see an improvement. Losing as little as 10 pounds can lower your blood pressure and begin to ease the pressures. I know that the load of discouragement can be too heavy on you but a visit to AWAREmed Health and Wellness Resource Center will be your starting point for ultimate weight loss recovery process. At this facility, doctor Akoury will upon taking you through an evaluation process on your health and suitability to go through the weight loss program, she will focus natural treatment options that are tailored to helping the patient to have his or her normality reinstated by dealing with the known root causes of the problem.

The real benefits of losing excess weight: Losing weight Better Numbers in 30 Days

Watching what you eat will have the biggest impact on your blood pressure, but exercise is also an essential ingredient for success. Working out can lower blood pressure by as much as five to seven points. And you can see these results just one month after boosting your activity. Always prioritize some 30 minutes of simple physical activities each day. For instance light intensity exercises like walking, dancing, cycling, jogging and swimming are simple ways to develop a culture of exercising and begin seeing promising changes.

Finally our main concern remains to be losing weight and the benefits associated with it. These benefits are up for grubs but am not promising that it will be easy. There will be challenges on the way and doctor Dalal Akoury and her team of experts will be there to helping you overcome them in the most friendly and professional way.

The real benefits of losing excess weight: The health benefits are instant

 

 

 

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Addressing Sexual Problems arising from Overweight

Addressing Sexual Problems arising from Overweight: The relationship between sex and overweight

Addressing Sexual Problems arising from Overweight

Addressing Sexual Problems arising from Overweight. Being obese has several disadvantages when it comes to sexual life. Treatment is therefore necessary in good time.

I find it very difficult to understand why people shy away from talking about sex. Sex is a gift and a good one for that matter. If one has a problem with sex in whichever way, it should be discussed openly. If you are shy about it they let me encourage you not to because everyone of us is a product of sex. I have noticed that there are various reasons why sex is not what it is to many people. There is a lot of quite discomfort from many people either because they are not getting the satisfaction from their partners or they themselves are the problem and interest is quickly running out. It is because of this growing concern that doctor Dalal Akoury is persuaded to take the lead role in addressing the sexual problems arising from overweight. This has become necessary because sex today is not just meant for producing babies but it is for several other things including pleasure and some cases assign of unity in married couples.

There are very many reasons why the desire to have sex may die in some people, but as for the purpose of this article, we are going to narrow it down to obesity as a factor of sexual problem people face across the globe. The problem on weight gain is becoming a thorn in many people’s flesh and this is even affecting their sexual relationship. The question many are asking is why? In response to this, obesity is associated with a ray of other diseases like diabetes, heart disease and hypertension health conditions which can affect ones sexuality immensely. Therefore, when administering treatment to these health conditions, careful attention must be taken to ensure that such medication does not complicate the whole issue further. Such medications are capable of triggering lack of libido and erectile dysfunction among other sex-related problems. Doctor Akoury says that because of the prevalence on obesity and weight gain in our societies today, immediate solution should be found to bring back the sexual life in most relationships. Now let us consider the following conditions that are believed to be the biggest culprit in creating sexual problems.

Addressing Sexual Problems arising from Overweight: Erectile dysfunction

Obese men are at high risk of suffering from erectile dysfunction or impotency due to health complications associated with obesity like high cholesterol, hypertension and diabetes. These complications can inhibit efficient blood flow to all parts of the body including the penis which then results in weak erection. Various studies have also demonstrated that even losing a little amount of weight can help beat the condition and bring back your ability to keep your sexual fulfillment obligations.

Addressing Sexual Problems arising from Overweight: Hormonal imbalance leading to low libido

  • Obesity is directly linked to hormonal imbalance and lower testosterone levels, which in turn can inhibit sexual desires in both men and women.
  • Another issue is that increased body fat leads to more sex hormone binding globulins (SHBG) in the system which is a natural chemical that binds to testosterone meaning that there is less of the sex hormone left to handle the demands of a normal sex life.
  • There is also evidence to suggest that obesity in young boys can lead to fatigue and development of male breasts.
  • In young girls it can lead to PCOD, irregular menstrual cycle and thyroid problems.
  • Obesity can cause certain abnormalities in women’s eggs which may leads to infertility.
  • Obesity also causes excess insulin production and PCOD (a condition where the periods are irregular and ovaries produce small, immature eggs instead of healthy mature ones).
  • Obese women are also likely to suffer from failed pregnancies and miscarriages than regular weighing ones.
  • Obesity is directly associated with infertility in men due to its effects on the sperms.

Addressing Sexual Problems arising from Overweight: Infertility

Addressing Sexual Problems arising from Overweight: Obesity and related diseases that hinder sex

Being obese, and more so if when there is an accumulation of fat around the central abdomen will most likely experience a host of health conditions which can impact negatively on their sexual lives. The experience can arise due to physiological or psychological reasons or due to medicines taken for the disease. Diabetes, heart disease, cancer, hypertension, depression, dementia and other ailments all affect your sexual functioning. In fact, one of the most tell-tale symptoms of diabetes is erectile dysfunction.

Medicines too, ranging from anti-depressants to those used to treat heart conditions, high blood pressure and cholesterol can lead to sexual issues like impotence, decreased sex drive, ejaculation problems and even delayed or no orgasms.

Less sex positions

Sadly, the absolute logistics of sex can change when one or both partners are fat and can make coitus in some positions particularly hard. The popular missionary position is out-of-bounds if the male partner is too heavy. And if both partners are obese, then the central abdominal area can prevent proper penetration. The rear entry style which is more popular among the obese can also cause problems because the woman usually has to spend a long amount of time on her knees. Spooning, a sex position where partners lie side by side is also hard for fat people. However, fat people shouldn’t fret and there are multitudes of positions that they can try with their partners.

Lack of stamina

Obesity is often associated with laziness and a sedentary lifestyle. And this may often percolate into their sex lives as well. In men, it will also significantly decrease the time they can maintain an erection. Now that you are enlighten of the possible sexual complications arising from being obese or overweight, it would be very important that corrective measures are taken on your part if you are obese. The good news about this condition is that it can be fixed if only you could schedule for an appointment with doctor Dalal Akoury today for treatment. Do this and you will never regret it because the outcome will not only deliver back your sexual life but also your whole life.

Addressing Sexual Problems arising from Overweight: The relationship between sex and overweight

 

 

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Understanding the Effects of Obesity before Pregnancy

Understanding the Effects of Obesity before Pregnancy: Planning for your Health before and during pregnancy

Understanding the Effects of Obesity before Pregnancy

Understanding the Effects of Obesity before Pregnancy at an early stage before it happens is very healthy for the delivery of children with healthy weight.

I remember when the maker first created the earth, before man he made available healthy food to help man in developing the land for more production. That assignment of producing more has been done to the disadvantage of human life. All the healthy fresh healthy fruits and vegetables are now being passed through chemicals all in the name of adding value to them. The concept of value addition to our food items today is not working well to humanity. In fact all the processed foods are categorized as unhealthy food. This is not what the maker intended for his creation. With our own hands we have succeeded in creating for us more problems. It is no wonder our obese mothers continue to give birth to obese children or children with high risk of being obese in future. There is always great joy for parents to bring forth healthy children. And because of our actions, we have to make certain adjustment when planning to get pregnant if this joy is to become a reality. We are therefore obligated into understanding the effects of obesity before pregnancy for us to bring forth healthy children.

We are aware that the issue of weight gain is developing in a very high speed to the point that all the world health organizations are getting concern of the emerging trend of weight gain. Recently the world health organization (WHO) listed obesity as one of the serious global health problem in the twenty first century. This confirms the magnitude of the problem at hand and it means that time has come for us to be very aggressive and bring this problem to manageable levels. But before we enter into the discussion, let us bring us up to speed with what we are talking about. Obesity is a health condition in which an accumulation of excessive body fat work to impair health and increase morbidity and mortality.

The most commonly use method of measuring obesity is body mass index (BMI) where an individual will be considered to be overweight if their BMI is between 25 and 30 kg/m2 while those with more than 30 kg/m2 are considered to be obese. The effects of obesity can be very frustrating not just to the victim, but also to the people close to them. It is therefore very important that we have this problem addressed in good time so that our mothers and unborn children can be safe from all the health complications associated with being overweight or obese.

According to WHO the prevalence of obesity in pregnancy cut across 1.8 to 25.3% with effects of obesity before and during pregnancy constituting a major risk factor for both maternal and fetal complications. While appreciating that children born of obese mothers may become obese in their childhood and develops metabolic syndrome in their adulthood, it is possible to address some of the issues relating to obesity during pregnancy since at this time mothers will be more willing to accept certain changes in their lifestyle like a well-balanced diet and bit of indulgence in physical activities. It will take a lot of commitment for this to be successfully done since many people are not very keen on keeping fit. However with guidance and help from the experts at AWAREmed Health and Wellness Resource Center under the able leadership of doctor Dalal Akoury this won’t be a problem. You can schedule for an appointment with her today and your life and that of the unborn child will be safe not just during the pregnancy period but even in their lifetime.

Understanding the Effects of Obesity before Pregnancy: Are you planning to get Pregnant?

Doctor Akoury says that it is very important that women planning to get pregnant in the near future should make effort to maintaining normal body weight to avoid any health complication that may come as a result of being overweight or obese. The benefits of doing this are primarily to save lives because these two conditions (obesity and pregnancy) can cause a woman to have a reduced fertility in all dynamics meaning that when observed in both natural conception and conception achieved by assisted reproduction techniques (ARTs). In many instances when subfertility is observed in obese women, it is always occasioned partially due to the decrease in frequency or complete absence of ovulation.

The dominant cause of an ovulation is polycystic ovary syndrome (PCOS), which is characterized by central visceral obesity in 40% of the cases. Moreover, in a wider context of metabolic disorders,

  • Low concentration of serum
  • High-density lipoprotein (HDL) cholesterol
  • High concentration of triglycerides
  • Low-density lipoprotein (LDL) cholesterol
  • Increased concentrations of plasminogen activator inhibitor-1 (PAI-1) tend to co-exist.

All these metabolic derangements increase the risk of developing:

  • Arterial hypertension
  • Coronary heart disease and
  • Thrombosis

In addition, hyperinsulinemia promotes the production of testosterone and Δ4-androstendione from the theca cells in the ovary and results in a condition of hyperandrogenemic anovulation, with a phenotype characterized by hirsutism, obesity, acne, seborrhoea and hair loss.

Understanding the Effects of Obesity before Pregnancy: What to do before pregnancy?

There are certain important things that you need to consider when you’re planning to get pregnant, for instance emphasis needs to be out in normalizing your weight. You should neither be over or underweight because having normal weight is not only good for conception but also for the outcome of the pregnancy. While appreciating that most pregnancies are not planned it is very important that you consult a specialist on how to lose weight during this time. Doctor Dalal Akoury can be of help to you if only you can reach out for her professional assistance. I would like to encourage you to schedule for an appointment with her today and escape from the devastating health conditions arising due to being overweight or obese.

Understanding the Effects of Obesity before Pregnancy: Planning for your Health before and during pregnancy

 

 

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Economical Imbalance and the fight of Obesity

Economical Imbalance and the fight of Obesity: What is derailing the Fight?

Economical Imbalance and the fight of Obesity

Economical Imbalance and the fight of Obesity. The foods that leads to obesity may be appealing and appetizing but their attractiveness only serve to attract diseases

Where I come from there is a wise say that the fingers are never the same. This phrase is used in reference of our diverse economic differences. Much as we are putting effort to have a comfortable life, we will never have it all. Some people will have more than enough and others will have enough while another may not have at all. That is life and it is part of us. This introduction of the wise saying ushers us into our discussion of the economical imbalance and the fight of obesity. If you are wondering how this is a factor, then you are at the right place because by the time we are done, you will be well equipped with all the relevant information you need to know declares doctor Dalal Akoury the MD and founder of AWAREmed Health and Wellness Resource Center. We are all aware that the problem of obesity and weight gain is a serious threat to life. This problem is never discriminative as it can affect anyone irrespective of status. Both the rich and the poor are vulnerable and variance is what we want to find out from the experts at AWAREmed Health and Wellness Resource Center.

Economical Imbalance and the fight of Obesity: Food security

Talking of food security a lot is being done to ensure that everyone something to eat. However the different economical factor does not allow equality in this. There are those who will have plenty and those who may not have at all. That is why we have the rich and the poor because of the economical line drown between then by virtue of their earnings. It is true that the rich has plenty and can access best quality of food as they may wish. On the other hand, the poor who live from hand to mouth has not heard of the word quality. This is a vocabulary which is non-existent in their dictionary and a luxury they can’t afford. Their unsteady income can only allow them to feed subject to availability. The three triangular meals is not known to them and this impacts negatively on their weight and general well-being.

Economical Imbalance and the fight of Obesity: Limited food budgets and choices

The economical imbalance in the world today is being felt majorly by the poor. While the poor are drawing their budget for food, they are often faced with difficult choices to make. That little must take them through to the next time they get another pay which in many cases is not guaranteed. Situations like this are frustrating to them and the result often leads to indulgence in certain unhealthy behaviors. Due to this constrain, they will opt for much durable elements and processed foods which are rich in fats and energy like sugar, cereals, potatoes and processed meat products. They will definitely see fruits and vegetables as luxuries they can’t afford simply they are perishable and will not last until their next pay duration. The bad news is that such food they go for are never healthy and introduces to high risk of weight gain and being obese.

Their places of residence also act to their disadvantage in the sense that, getting healthy food is not easily accessible. They are literally surrounded with a chain of small food stores stocking very unhealthy stuff like cheap, high fat foods. Further to this they live a very stressful life where due to inabilities to meet certain obligations like footing bills like rent and we all know the consequences of stress.

Economical Imbalance and the fight of Obesity: Limited physical activities

Taking of good health which is the most valuable asset one can ever have. But to the poor this may not be the case since good health is not all about health foods but also being active physically. Their economic situation does not allow them to access the gym facilities for active physical activities. The absent of continuous body exercise is recipe for weight gain and obesity. They cannot afford to organize children’s events outside school making their children to be less active physically. This is evidence because of inflexible work schedule, lack of transportation or unmet needs for child care, poor parents find it hard to support extra activities for their children. Leaving kids in front of the television is often all stressed poor parents can manage. This inability is not helpful as it only help increasing the risk of overweight and obesity.

Economical Imbalance and the fight of Obesity: Food deprivation and overeating

Those who are eating less or skipping meals to stretch food budgets may over-eat when food does become available, resulting in chronic ups and downs in food intake that can contribute to weight gain. Cycles of food restriction or deprivation also can lead to an unhealthy preoccupation with food and metabolic changes that promote fat storage.

The “feast or famine” situation is especially a problem for low-income parents, particularly mothers, who often restrict their food intake and sacrifice their own nutrition in order to protect their children from hunger. Such a coping mechanism puts them at risk for obesity and research shows that parental obesity, especially maternal obesity, is in turn a strong predictor of childhood obesity.

Economical Imbalance and the fight of Obesity: High levels of stress

Low-income families, including children, may face high levels of stress due to the financial and emotional pressures of food insecurity, low-wage work and luck of access to health care, inadequate and long-distance transportation, poor housing, neighborhood violence, and other factors.  Research has linked stress to obesity in youth and adults, including (for adults) stress from job-related demands and difficulty paying bills. Stress may lead to weight gain through stress-induced hormonal and metabolic changes as well as unhealthful eating behaviors.  Stress, particularly chronic stress, also may trigger anxiety and depression, which are both associated with child and adult obesity.

This is a very painful truth that economical imbalance can be a serious contributor to weight gain and obesity. Like I had said our fingers are not the same and will never be. It means that this problem is likely to recur from one generation to another. However there are things that you can do despite of your economic situation to defeat this problem of obesity. You can schedule for an appointment with doctor Dalal Akoury a re-known medical doctor specializing on addiction and obesity. She has been in the practice for over two decades and her vast experience will be very beneficial for you if only you can take that step today.

Economical Imbalance and the fight of Obesity: What is derailing the Fight?

 

 

 

 

 

 

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