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Health Care

EMERGENCY CARDIAC CARE @ DESUN Hospital

CARDIAC EMERGENCY Team at DESUN HOSPITAL is quick to respond to any Heart Related Emergency Patient 24 Hours and 365 Days and even at Midnight. Just CALL DESUN EMERGENCY at 9051715171 to get necessary help regarding admission at DESUN Emergency.  Any Heart related emergency like HEART ATTACK, CHEST PAIN, Breathing Difficulty, Discomfort in Chest, Loss of Consciousness DESUN has facility to delivery TIMELY TREATMENT.

Modern 4th Generation CATH-LAB for Angiogram and ANGIOPLASTY, OT for Emergency Surgeries, ICU with individual ventilator for each bed and Experienced Team of Specialist Doctors, Cardiac Surgeons and Expert Medical Teams helps to delivery Success even Emergency and Critical Cases.

Ambulance Assistance, Specialist Doctors and other facilities makes DESUN one of the most recommended hospital during medical emergencies.

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DESUN perform Radial Angiogram and Radial Angioplasty is suitable cases where the procedure is performed through wrist and not through groin area making it much minimal painful and the healing is much faster. There is much less chance of post surgery complications and the patients can get back to normal life much sooner. Desun uses High quality STENTS and Stents are charged at Government of India approved Rates.

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Dual Chamber Pacemaker surgery at DESUN is very popular where the patient gets DUAL CHAMBER High Quality AMERICAN PACEMAKER at an affordable cost. Dual Chamber pacemaker helps people to be more agile than Single Chamber Pacemaker and reduces much hindrance is leading a regular life.

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Cardiac Devices related surgeries are also done at DESUN Hospital, to mention ICD-Single Chamber, ICD- Double Chamber, Cardiac Resynchronization Therapy, Cardiac Resynchronization Therapy -D

Minimally Invasive Heart Bypass (small Cut Heart Bypass popularly known) is performed at DESUN Hospital. Minimally Invasive Heart Bypass helps is much faster healing post surgery and the post surgery complications are much less. The patient recovers faster and there is only a small mark. The person can get back to regular life much faster than traditional heart bypass.

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Desun aims to deliver high quality cardiac Treatment at an affordable cost and with this aim DESUN Hospital is ever enhancing the Cardiac Emergency Facility, Preventive Cardiac Care Facilities and Cardiac OPD. The regular developments in the hospital have largely helped DESUN to fulfill their aim of delivering heart related critical and emergency patient’s timely treatment.

DESUN Hospital has more than 100 heart related surgery facilities and few to mention are Arterial Heart Bypass (LIMA-RIMA Y) , Heart Valve Replacement, Hole in Heart etc

Cardiac OPD : Desun Cardiac OPD is attended is experienced cardiologists and cardiac surgeons and it is easy to visit the OPD through both online through website and offline booking (walking to hospital or over phone) and get cardiac consultation as per prior appointment

Preventive Cardiac Care: DESUN hospital Preventive Cardiac Care department and facilities includes OPD for consultation with cardiologists and cardiac surgeons, various heart and cardiac related medical test. Even tests that can predict chances of heart attack in near future. Superspeciality Test APOA 1 & APOB (2 Parameters) The ratio of APOA 1 & APOB indicates the chances of heart attack in the future. There are also modern Procedures like ANGIOGRAM (CAG) to check blocked or narrowed blood vessels of heart.

Useful Links

Cardiac Tests: https://www.desunhospital.com/list-of-desun-health-checks.php

Cardiac Surgeries: https://www.desunhospital.com/heart-related.php

24 Hours Emergency: https://www.desunhospital.com/index.php

DESUN OPD : https://www.desunhospital.com/doctor-list-2.php

 

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Health Care

CELEBRATE DIWALI –Responsibly: Spread Awareness and Happiness

Precaution and Safety During Diwali – The Festival of Lights and Prayers.

Diwali is the festival of lights, prayers, happiness and also people decorate houses and public buildings with lot of colourful lights and do visit each other to share good wishes on Diwali. This religious festival is celebrated all over India and in many countries of the world with fervor.  

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During this festival of Diwali other than religious ceremonies and prayer we witness a lot of lighting and fireworks. The lighting includes diyas (earthen pots filled with oil or clarified butter [ghee] and there is fire lit on it) , candles, electrical lighting.  We also see fanush (flying fire lights) and firecrackers.  In places there are temporary structures (pandals) are created with cloths, bamboo, tent material for people to assemble, eat and also for prayer and worship.

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The presence of so much of things that are inflammable and fire calls for the need of adequate fire safety measures and firefighting equipment.

The high-rises in the urban area, more populated localities, roads and increase in density of population in rural area clubbed with road traffic restrictions, lack of freeways and more vehicles on road make it difficult for fire tenders (fire brigade) to reach the place of accident quickly. Medical help, doctors and ambulances may also take little more time depending on availability and road conditions.  

Happy Deepavali festival Lights - by David Sifry - FLICKR

It is imperative to take suitable precaution to avoid accidents due to fire, electricity and burns on these times. 

 

Some of the precaution and safety

Deepawali Lamp Indian Diwali Celebration Lights                  fireworks-587512_960_720                  Sparkles_phuljhari_fireworks_on_DIWALI,_festival_of_lights

 

LIGHTING

FIREWORKS

HEALTH

Do not places diyas, candles and other open flames near electrical equipments, inflammable material. Buy fireworks that are allowed by the appropriate authority. Do not buy or burn banned fireworks. People with asthma, respiratory problems do follow medical advice. People with cardiac or neurological problems do take required protection against sound etc .
Keep an eye on the open flames of diyas and candles Buy fireworks from licensed manufacturers only. Unlicensed cheap quality fireworks can be dangerous, toxic and harmful. Do keep a bucket of clean water, ointment for burns, cleaning antiseptic lotion (mild on skin), a thick blanket and easily accessible water connection and pipe ready near the place for burning fireworks.
Keep an eye of children and old people while they are near the open flames Follow the sound decibel limits while bursting fireworks. Keep the phone number of a Hospital with Burns Ward and Emergency near at hand, in your cell phone, smart phone. Keep the app downloaded.
Do keep pets away from diyas and candles Follow safety and usage instructions as it is while bursting fireworks, aerial fireworks.   Keep fire extinguisher ready and in good condition, water jets and sprinklers in working condition, fire exit etc clean so that people can access them quickly.
Only use good quality electrical lighting. Buy products of licensed brands only. During fire-shows do not cross the safety lines, stay in the protected area and enjoy the fire-show. Get mock fire drill done couple of times before Diwali day in your office, apartment, club, community area etc
Do take the service of a licensed electrician for large scale lighting. For home lighting use the lights as per safety instructions. Check fuses, electrical connections, wires well before installing the electrical lighting. Fumes of low quality fireworks can be toxic. Asthma and patients with respiratory problems, allergy need to take precaution as per medical advice. Heart patients and people with neurological problems are advised to take required protection against sound. Drive carefully. Never drink or consume (alcohol and other intoxicating materials) and drive. Do not over speed, follow traffic rules. Help others on streets. Give way to Ambulance and other appropriate vehicles. Be a responsible driver and citizen.
Low quality decorative lights can be toxic and harmful for children, aged people, pets and healthy adults too. Do not burn firecrackers near LPG cylinders, electrical transformers, shops and on streets. Take precaution, prevent and protest against harming animals, animal nests and street dogs while burning fire crackers.

 

Celebrate Diwali responsibly, spread awareness and happiness.

People Awareness Post by DESUN Hospital on Diwali.

DESUN Hospital has 24 Hours Emergency Department with Modern Burns Unit. The Emergency set up is robust and quick to action with 24 Hours Medical Staff, Specialist Doctors, Ambulance Assistance all over Kolkata, Siliguri and Other Districts of West Bengal and near by Locations. Desun Kolkata is a superspeciality Hospital with 28 Medical Departments and NABH accreditation.  

Emergency Phone : DESUN Kolkata – 9051715171 | DESUN Siliguri : 9051640000

Website : DESUN Kolkata | DESUN Siliguri  | ANDROID APP 

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Health Care

Latest Cardiac Surgeries: High Success Rate in Critical and Emergency Surgeries

Cardiac Health Today

Today cardiac problems is even impacting the mid age generation in India. The urban and semi urban cities and towns are adding to the number of patients. Mostly working professionals in their mid 40’s are at times victims of sudden heart attacks or diagnosed for cardiac problems by cardiologists or cardiac surgeons while checking for chest pain, blackouts and extreme fatigue with little activity.

Heart Collage

DESUN Hospital Cardiac Care Facility

Desun Hospital has state of art facilities for managing any cardiac emergency and also for latest heart surgeries. The cost is affordable; the hospital has facility for cashless mediclaim (PPN listed hospital) and also payment in EMI facility (Equal Monthly Installments) for expensive cardiac surgeries.

Cardiac Emergency

Cardiac Emergency management success rate is very high due to a strong medical emergency management foundation created by Desun. The medical emergency management quick response teams consist of doctors, surgeons, medical staff and hospital administration people. The quick response starts from attending the calls received on the dedicated emergency phone number, providing ambulance assistance, initial diagnosis, hospital admission if required and emergency OT as per the diagnosis.

Desun Chest Pain Center

Desun Hospital Chest Pain Center is a facility to help people with good medical facility in case of Chest Pain. The emergency team is quick to respond and it combines experienced cardiologists, cardiac surgeons, medical test facilities and expert medical staff. It is open 24 Hours to provide medical management and discharging patients as they get stable and the required diagnosis is done. There is also facility for hospitalization as per requirement.

Latest Cardiac Surgeries

Desun hospital has experienced doctors, expert medical teams to manage critical cardiac cases and deliver excellence in terms of medical management, heart surgeries and procedures like angioplasty, heart bypass surgery, permanent pacemaker surgery , heart valve replacement etc.

The LATEST Surgeries and procedures include LIMA-RIMA Y, Radial Angioplasty, Radial Angiogram, High quality stents, pacemakers and cardiac devices.

LIMA-RIMA Y or Arterial Heart Bypass is done by using the arteries and not the veins. This heart bypass done lasts longer and helps the person to lead a healthy and normal life for a long time.

Coronary Angioplasty Stents: Desun Hospital only uses high quality American Company Manufactured Stents. The stents are FDA and Government of India approved and the stents cost as per Government of India regulated price.

Radial Angiogram: Radial Angiogram is done through the wrist area and not the groin area. This angiogram process helps in faster healing, much less pain and assures more safety from post procedure complications and infections.

Permanent Pacemaker Surgery:  Desun hospital has facility for Dual Chamber Pacemaker surgery and also cardiac devices. Cardiac pacemaker surgeries that help people to get back to regular life sooner and lead a normal day to day life post surgery.

Desun Hospital has NABH accreditation and is a superspeciality hospital.

PHONE : Emergency (24 Hours) 90 5171 5171 | 83340 31345 | 86977 21124 | Android App | Website : www.desunhospital.com | Heart Related Surgeries

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Health Care

Ejection Fraction- One of the parameters to know healthy heart

The fact you could only decipher while going through the few illegible lines written on your prescription that you have (LVEF). In everyday life non-medical persons are not well aware of this term LVEF.

Human Heart

Do you know what LVEF is? Did your physician explain this term to you? In case you are not explained …

LVEF is Left Ventricular Ejection Fraction. Ejection fraction is a measurement that is done for determining that how well your heart pumps with each beat. During each cycle of heart beat the heart contracts and relaxes.  When the heart contracts it ejects an amount of blood from the 2 ventricles, when the heart relaxes the ventricles are filled with blood again. During contraction the total amount of blood is not transferred from the ventricles. Ejection Fraction is used to measure the percentage of blood pumped out during each heat beat.

As the left ventricle is the main pumping chamber therefore Ejection Fraction is only measured in Left Ventricle and that is how it is denoted at LVEF or Left Ventricular Ejection Fraction

Normal LVEF = 55% and above

Reduced LVEF = 50% and below

Ejection Fraction Measurement What does it Mean
55-70% Normal
40-55% Below Normal
Less than 40% May confirm diagnosis of heart failure
<35% Patient may be at risk of life-threatening irregular heartbeats

Reasons of decreased LVEF

  1. Weak heart muscles
  2. A damaged heart due to Heart Attack
  3. Problems in the valves of the heart
  4. Chronic uncontrolled blood pressure

How is Ejection Fraction measured?

Ejection Fraction can be measured through 4 different ways

  1. ECG – Echocardiography
  2. Angiogram
  3. MRI
  4. CT Scan of the heart

But an important fact is that, Ejection Fraction is just one parameter to measure the functioning of heart. People having normal Ejection Fraction can have a heart ailment. Consult your physician in case of any heart ailment.

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Health Care

Do’s and Don’ts during and after an earthquake, be safe

What is an earthquake in simple terms?

Earthquake is sudden light to heavy shaking of the earth surface due to breakage of rock deep within the earth. This is associated with shaking of the earth’s surface and usually lasts for few seconds to few minutes.

How earthquake impacts normal life?

The sudden shaking of the earth’s surface shakes and send tremors across buildings, roads, bridges and people walking or sitting inside homes or road. We can feel the shaking and the sudden impact creates panic and if it is heavy and lasts for few minutes there can damage to life and property as they may fall, topple, break and crack. People and animals may get injured by things falling, or by getting off-balance.

There can floods due to damage in dams, tsunami etc.

Electrical and fire hazards if they are not disconnected immediately, internet and mobile network disruption etc .

There can be multiple earthquakes?

Heavy or strong earthquakes that are noted high on Richter Scale and have large area inside the earth impacted usually repeats as strong aftershocks that are mostly not as strong the primary earthquake. There can aftershocks that can impact people and life for next few days and machine recorded aftershocks for much longer period of time.

Earthquake Do's and Don'ts
Earthquake Do’s and Don’ts

Living in earthquake risk zones?

Do always keep a handbag or easy to carry bag ready with required medicines, regular medicines, water bottles, some clothing, some dry food, insurance, medical , bank and all other required government identification papers or photocopies handy and well arranged. Also keep some money, bank cards, hospital and medical cards ready.

Build houses and get construction done as per safety directives only

If you have undergone some disaster response training , do keep practice and have community drills at times

Particularly for Heart and Nuero patients

Heart patients can suffer shock or mental physical impact due to the panic because of an earthquake

It is important to keep them stable with medicines and mental support

If required they may need medical help as soon as the earthquake is over

For nuero patients mental and physical support is important. We need to keep them calm and assured that all is fine and soon things get better. If on wheel chairs, bed they should be on standby mode so that it do not move and cause panic.

Usual  do’s and don’ts  during an earthquake?

If indoors it is better to take shelter under a strong table or such flat object

If outdoors stay away from windows, high rises, electric polls, hoardings and try to stand in an area that is clear around like an open ground etc

Do not use lifts, use stairs

Do not take shelter or stand close to even low storied building, parapets , bus stands etc

If driving do stop in an open place and try stay inside car

Do not light fire, matchstick and lighters.

Turn of electrical mains, cooking gas ovens and all other electrical equipments

Do not panic, rush and run

What to do immediately after an earthquake?

As soon as you recover and get okay after an earthquake check for people around you, if they are injured

Call medical help lines as you see a seriously injured person; do not move the person if not necessary

Give First Aid to people who need it

Do not us phone immediately as people in real need are already in large numbers, additional calls may further congest networks

Check for cracks in the building

Leave the building as there are chances of aftershocks , wait for some time, take note of radio messages other information sources before we move inside the home or premises

Do not drive if not necessary

Health Awareness Article by Desun Hospital and Heart Institute

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Health Care

Dangers of NSAIDs and Anticoagulants for Heart Patients – Get Prescription from Experienced Cardiologists

It’s scary but true that India has emerged as hub of heart diseases since few years which is going to take the shape of epidemic in near future. By the year 2020 heart diseases will be the cause of 1/3rd of total deaths in India. In a recent survey it is found that heart diseases in India occurs 10-15 years earlier than in the west. Thanks to our unhealthy lifestyle, increasing stress and lack of physical activity.But above all, an important cause of heart disease in India is wrong use of blood thinners or better known as Non-Steroidal Anti-Inflammatory drugs or NSAIDs

NSAIDs or blood thinners are the most commonly prescribed medicines in case of heart ailments regarding blocked arteries or those who have a history of arterial stroke. They make the blood thinner than its usual form so that it can flow freely through the arteries. However, when it is used regularly in case of any chest pain without proper diagnosis it may lead to prolonged illness.

Any medicine if not taken under proper medical advice may be harmful. In case of anticoagulants the risk is far more as it’s concerned with blood that flows throughout our body. Whenever there is a slight chest pain or exhaustion if we take blood thinners as painkillers, it will just be a relief not a solution. Blood thinners cannot stop heart attacks but delays it making it more risky to handle later.

Dangers of NSAIDs and Anticoagulants for Heart Patients
Dangers of NSAIDs and Anticoagulants for Heart Patients

What are blood thinners? What is their function?

The liquid ‘blood’ is a mixture of proteins, nutrients, enzymes, hormones wastes and gases which makes it thick. The medicines that make the blood thinner than usual so that it can flow freely through arteries and veins are collectively called ‘blood thinners’. They are usually of 2 types’anticoagulants and anti-platelet drugs, like ‘Aspirin’ or ‘Clopidogrel’. These medicines reduces the risk of heart attack and stroke.

When are blood thinners prescribed?

Blood Thinners or NSAIDs are prescribed to those who has a history of arterial stroke, in case of heart diseases or blood vessel illness like:

  • An abnormal heart rhythm called atrial fibrillation
  • Heart valve surgery
  • Congenital heart defects

Our heart gets the much needed oxygen-rich blood through arteries.Heart attack occurs due to the death of heart muscle resulting from lack of blood supply.

When these arteries get clogged due to plaque or fats, (blockages) blood cannot flow freely through them to reach the heart, chest pain occurs with exhaustion. Blood thinning drugs make the blood thin so that they can pass freely through the clogged arteries. Taking it as a pain killer will kill the pain for the time being but will not repair the clogged arteries. If the blood fails to reach the heart because of the block then the heart muscle will die causing heart attack.

When does the blood thinners harm us?

Blood thinning drugs makes the blood thin but does not cure the clogged arteries for which heart attack occurs. So it can be said, blood thinners are temporary relief but not a permanent solution. It cannot stop heart attack because blood thinners cannot cure the clogged arteries for which angioplasty is the solution. In case of major block a heart bypass is needed.

Along with the usage of blood thinners one needs to maintain a healthy lifestyle so that arteries do not get clogged further. If we fail to do so, the risk increases as because the arteries get more clogged with plague. As one point of time thinning of blood will not help resulting a heart attack.

What are the side effects of blood thinning medicines?

Using blood thinners as a painkiller aggravates problems. By regular use one can be vulnerable to hemorrhages or excessive bleeding as the blood will take time to clot. Blood clotting is a lifesaving factor in case of cuts or bruises. In this case blood loss will be faster which may be fatal for the victim.

Other side effects of using these drugs are

  1. Passing of blood in the urine
  2. Passing of blood in the faeces
  3. Passing of blood while vomiting
  4. Intestinal bleeding
  5. Chest pain or breathlessness
  6. Passing of blood while coughing
  7. Dizziness with severe headache
  8. Muscle weakness
  9. Hair loss
  10. Rashes
  11. In women , heavy blood flow during menstruation

What can be done with it?

Stop taking blood thinners as pain killers.  If there is chest pain or exhaustion go for a health checkup. Chest pain may be due to various reasons; heart ailment, indigestion and many others. Just gulping down pills without knowing the actual reason will never help. But right solution in right time with right step always helps.To nip the problem from the bud don’t gulp down the pills, but get a cardiac checkup and if advised by the doctor go for an angiogram.

Angiogram or CAG is an x-ray image of the arteries to find out if there are any blockages in heart. If any blockage is found proper treatment can be done to get rid of the problem.

Don’t have time to go for a checkup?

One of the important reasons of heart disease as discussed earlier is the increasing amount of stress and workload so much so, that there is no time to get a checkup done when needed. Moreover if an angiogram is prescribed there is no time to go for it.

Desun Hospital at EM Bypass does painless angiogram through radial route and within 6 hours patient is discharged with reports and CD. So long hospital stay is not required at all.

Points to remember:

  • NSAIDs or blood thinning medicines are not painkillers.
  • Blood thinnersshould be used under instructions of an expert.
  • Blood Thinnersare just a temporary relief not a solution in case of ill heart.
  • Sooner or later surgical intervention will be required in case of clogged arteries. Delaying the problem with pills will prove risky.
  • Consumption of blood thinnersas pain killers can have grave effects later.
  • Stop taking blood thinners and get an angiogram done for your safety.

The information shared in the blog is on the basis of internal survey of patient history, done at DESUN over the period of time. It has been found that majority of the patients admitted at DESUN for treatment of heart attack, regularly consumed anticoagulants without expert’s advice.

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Health Care

Impact of Emotion on Health and Heart

Emotion is a strong feelings that a person experiences due to the impact of  situations , mood and relationship with others.

Emotions are closely related to our physical health and mental health. Emotional disturbance or feelings of being emotionally disturbed can have certain negative impact on our health.

Chronic stress can have an adverse effect on the hormone balance and can result in depleting of certain chemicals in brain that are required for feeling happy. Chronic stress and badly managed emotions and feelings can also impact our lifespan in a negative way.

Some usual negative impact on health

  1. Headaches
  2. Insomnia or sleep disturbances
  3. Lightheadedness
  4. Frequent tiredness
  5. High Blood Pressure
  6. Change in eating habits , sudden excess intake or no intake
  7. Palpitation (feel like the heart is too quick)
  8. General weakness
  9. Lack of concentration , accuracy
  10. Shortness of breath
  11. Stiffness in neck and body
  12. Stomach upsets

Not well management of emotion, especially anger can result in heart related problems, high blood pressure, hypertension, weak immunity, infections and slow healing.

Impact of Stress on Health and Heart
Impact of Stress on Health and Heart

How can we help?

Unable to forgive, dissatisfaction and being too rigid at times can make us susceptible chronic stress and emotional disturbance.

So simply by practicing an attitude of forgiveness, having gratitude and developing a flexible thought process people can help them to reduce the impact of negative emotion.

Medical help?

Yes medical intervention under appropriate guidance of doctors and psychiatrists can be beneficial.

If one has suffered or suffering from chronic stress may undergo some medical tests of heart, general health or as per prescription , may also require monitoring of blood pressure, blood sugar levels (for diabetics or hypoglycemic) etc .

Proper intake of prescription medicines is also required.

Psychological counseling, general health and taking help of specialist doctors as per problems of heart, gastro etc is also advisable.

Alternate helps?

Mind training, good diet, yoga, meditation and diverting mind into things we like to do that are relaxing and fun like sports, pursuing a hobby or working for a good cause can also help.

Anger, love etc are common feelings and part of our life  that do come with their own share of happiness and sorrow that erupts out of fulfillment of desire and expectation or rejection and not fulfillment of desire etc. this results in development of  certain emotional state of mind that impacts our mental and physical health. It is better to be aware and try to get things under control as early as possible to avoid any major future damage of health.

Health Awareness Post, wish to see everyone happy and healthy. Share the information and help others.

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Awards & Recognitions

New Cath-Lab Inaugurated at Desun Hospital & Heart Institute

The Brand New Cath-Lab at DESUN (Inset: Adjoining Cath-Lab Monitoring Room)

DESUN Hospital & Heart Institute, Eastern India’s leading address in quality healthcare and medical services, opens a new digital Cath-Lab.

This is the 2nd Cath-Lab at DESUN and houses the same state-of-the-art equipment and cutting edge facilities as its predecessor.

Speaking of the new Cath-Lab, Mr. Sajal Dutta, Chairman and Managing Director, said, “This is just a small step in DESUN’s continuing pursuit of excellence and in its relentless endeavor to provide everybody with better quality medical services, at prices that everybody can afford.

DESUN boasts of some of the best medical facilities in Eastern India and a massive infrastructure that is truly unparalleled in the region. With a fully equipped and dedicated Heart Institute and 28 other Multispecialty Departments, DESUN Hospital & Heart Institute is India’s youngest hospital to achieve the prestigious NABH (National Accreditation Board for Hospitals & Healthcare Providers) accreditation awarded by the Govt. of India. NABH accreditation is a rare and difficult accomplishment that has been achieved by only a handful of other hospitals till date, such as Escorts (Delhi), Lilavati and Hinduja (Mumbai).

As another mark of its excellence, DESUN Hospital & Heart Institute has been recognized as one of India’s Best Hospitals in a recent nationwide survey conducted by leading national newsmagazine The WEEK in association with reputed market research agency HANSA. DESUN was named among India’s Best Superspeciality Hospitals and again, among the best hospitals of India for Emergency Care.

Opening of the new Digital Cath-Lab is a small step in DESUN’s rapid progress in improving infrastructure and expanding its service portfolio. However, it will make a big difference in the quality and availability of cutting-edge surgical services for millions of those living in Kolkata and its adjoining areas.