Showing 19 results for Alavi
Seyed Mohammad Alavi , Shahram Shokri ,
Volume 3, Issue 1 (1-2012)
Abstract
Background: Previous studies have demonstrated the value of serum procalcitonin (PCT) as a marker of bacterial infection, as well as the rapid decrease in its concentration with appropriate antibiotic treatment. The aim of this study was to determine the variation in serum PCT levels over time during the treatment of acute bacterial meningitis (ABM) in adults.
Methods: In this prospective analytical study, 36 acute meningitis patients (26 males and 10 females) with mean age of 38.4±20.1 years were studied. Among them, 17 patients with fever and neck stiffness and CSF profiles consistence, ABM was treated by appropriate antibiotic regimen. We measured PCT serum levels before and after 24 and 72 hours after initiation of treatment. Decrease in the body temperature and feeling of well being were the clinical criteria for treatment response. The data were collected and analyzed.
Results: Serum level of PCT in the beginning of treatment, 24 and 72 hours after initiation of treatment was 2.58±4.62, 2.50±4.6 and 1.52±3.03 ng/ml, respectively. Difference in PCT initially and 24 h later was 0.044±0.08 (p=0.025) and after 72 h was 1.74±2.92 (p=0.013). The mean of PCT level was greater in patients not improving (5.34±4.42 vs. 2.08±3.46).
Conclusion: Although decreasing PCT was low in 24 h after treatment, this decrement is more significant after 72 h. PCT serum level may be used as a follow up of treatment response in ABM.
Seyed Mohammad Alavi, Mohammad Mehdi Khoshkhoy,
Volume 3, Issue 2 (1-2012)
Abstract
Background: A number of former studies have shown that tuberculosis (TB) is higher in diabetes mellitus (DM) patients than non-diabetics. Both DM and TB are major public health problems in Iran, and because of the lack of investigation in this field in the region, we conducted this study to evaluate the prevalence of DM in admitted pulmonary tuberculosis patients.
Methods: The medical files of documented tuberculosis cases and DM patients hospitalized in Infectious Diseases Ward in Razi Hospital in Ahvaz, southwest Iran from 2008 to 2010 were reviewed. The study population was divided into 2 groups as DM-TB and non-DM-TB. The data in the two groups were compared.
Results: One hundred and forty eight TB cases [36 (24.3%) DM cases with the mean age of 56.6±12.7 years, and 112 (75.7%) non-DM with mean age of 44.8±18.3 years] were studied. The estimated odds ratio (OR) of the association between DM and tuberculosis was 2.65 [(95% confidence interval (CI), 1.77 to 3.95), p<0.001]. There was significant difference in HIV infection, illicit drug use and imprisonment between the two groups (p<0.05).
Conclusion: We found that the frequency of DM in TB patients in the region is more prevalent than it was expected. Tuberculosis had positive association to DM. DM might be an important risk factor for developing tuberculosis.
Seyed Mohammad Alavi, Manoochehr Makvandi, Saied Najafi-Fard, Leila Alavi,
Volume 3, Issue 4 (1-2012)
Abstract
Background: Both influenza A virus (IAV) and respiratory syncytial virus (RSV) cause acute respiratory infection (ARI) in infants and young children. This study was conducted to determine Influenza A virus and its co infection with RSV among the hospitalized children with ARI.
Methods: A total of 153 throat samples of the hospitalized young children aged between below one year and 5 years with the clinical signs of ARI were collected from the different hospitals in Khuzestan from June 2009 to April 2010. The samples were tested for Influenza A viruses by real time PCR. Positive IAV samples were tested for influenza A sub type H1N1 and for RSV by the nested PCR.
Results: In this study, from the total 153 samples, 35 samples (22.9%) including 15 (42.8%) females and 20 (57.2%) males were positive for influenza A viruses. From the 35 positive samples for IAV, 14 were positive for swine H1N1 subtype. All the positive samples for influenza showed negative for RSV infection which revealed no coinfection with RSV. The prevalence of influenza A among age/sex groups was not significant.
Conclusion: Influenza A is a prevalent viral agent isolated from young children with ARI. Influenza A subtype H1N1 was accounted for the 40 percent all laboratory-proven diagnoses of influenza in 2009. No evidence of coinfection of influenza A and RSV has been observed in the present study.
Seyed Mohammad Alavi , Leila Alavi,
Volume 4, Issue 2 (1-2013)
Abstract
Background: The treatment of human brucelosis is controversial. The purpose of this study was to search published clinical trial papers to provide a simple and effective treatment in brucellosis.
Methods: Many studies on brucellosis treatment in a twenty- year span from 1993 to 2012 were searched in PubMed, Web of Science (ISI), Scopus, Google Scholar, Magiran, Iranmedex and SID. The studies that were searched and classified in groups according to combination therapy and monotherapy and their results in treatment outcome were compared. Regimens with lower treatment failure or relapse were considered as more suitable for brucellosis treatment.
Results: The comparison of combined doxycycline and rifampicin (DR) with a doxycycline plus streptomycin (DS) favors the latter regimen. The combined doxycycline/co-trimoxazole (DCTM) showed similar effect with DR. The treatment with the combined regimen including quinolones was similar to DR but with higher relapse rates. Higher relapse rate was searched in monotherapy (13% vs. 4.8%) and in short-term (less than 4 weeks) treatment regimen (22% vs. 4.8%), respectively. Although in children, clinical trials were limited but showed cotrimoxazole plus rifampin for six weeks was the best treatment regimen.
Conclusion: In uncomplicated brucellosis in adult patients, doxycycline-aminoglycoside combination is the first choice with doxycycline- rifampin and doxycycline-cotrimoxazole should be the alternative regimens. The other oral regimens including quinolones may be considered as alternatives. Cotrimoxazole plus rifampin for six weeks may be the regimen of choice for the treatment of patients younger than 8 years old. Gentamicin for 5 days plus cotrimoxazole for six weeks may be a suitable alternative regimen.
Seyed-Mohammad Alavi, Mohammad Nadimi, Gholam Abbas Zamani,
Volume 4, Issue 3 (1-2013)
Abstract
Background: Although infectious diseases are the most common sources for the fever of unknown origin (FUO), but the spectrum of infectious diseases is changing overtime. The purpose of the study was to define the clinical spectrum and changing the pattern of FUO.
Methods: This existing data based study was undertaken from 2007 to 2011. One hundred-six patients fulfilling the modified criteria for FUO referred in a teaching hospital in Ahvaz were enrolled for analysis. The data extracted from the patient's medical files and etiologic agents caused FUO to be assessed.
Results: Infections were the most common cause of FUO in 48.4% of the patients. Among the infections, the most important causes of FUO were represented by extra-pulmonary tuberculosis 15 (31.9%), osteomyelitis 10 (21.3%) and abdominal abscesses 6 (12.8%).
Conclusion: The pattern of FUO in the region is thought to be changed to extra pulmonary TB and osteomyelitis. Tuberculosis is still the leading cause of FUO in our region.
Batool Sharifi-Mood, Maliheh Metanat, Roya Alavi-Naini, Asad Shakeri, Zakaria Bameri, Maryam Imani,
Volume 4, Issue 3 (1-2013)
Abstract
Nasal carriage of methicillin-resistant staphylococcus aureus among ICU personnel working at Zahedan University, southeastern Iran
Seyed Mohammad Alavi, Ramin Jamshidian, Shokrolah Salmanzadeh,
Volume 4, Issue 4 (1-2013)
Abstract
Comparative study on toxoplasma serology among HIV positive and HIV negative illicit drug users in Ahvaz, Iran
Seyed Mohammad Alavi, Roohangiz Nashibi ,
Volume 5, Issue 1 (1-2014)
Abstract
Abstract
Background: Nasal tuberculosis (NTB) is rare, but it can be caused by either a pulmonary disease or a retrograde involvement of the nose by lupus vulgaris of the facial skin. In this study, we present a case of NTB with an ulcerative lesion in her left nasal cavity.
Case presentation: A 56 years old woman presented with an ulcerative lesion in her left nasal cavity. The patient exhibited no clinical evidence of any systemic diseases. Peripheral leucocyte count (CBC) was normal but erythrocyte sedimentation rate was elevated. Mantoux' test elicited 25 mm reaction after 72 hr. Chest x-ray was normal. Pathological evaluation of the lesion revealed the caseating granulomas, epithelioid cells, lymphocytes, and a few giant cells. These findings suggested a diagnosis of tuberculosis. The patient was cured after 6 months treatment with standard regimen of tuberculosis.
Conclusion: Although, nasal tuberculosis is rare, it should be considered in the differential diagnosis of patients with chronic nasal symptoms and ulcerative lesions of the nose.
Mostafa Alavi-Moghadam , Mirmohammad Miri, Majid Mokhtari, Mehran Kouchek, Reza Goharani, Mohammad Sistanzad , Saeed Safari, Mehrdad Solouki,
Volume 5, Issue 3 (5-2014)
Abstract
Incidence of imipenem-resistant Acinetobacter baumannii in a general intensive care unit (ICU)
Seyed Mohammad Alavi, Pejman Bakhtiyariniya, Mehdi Eghtesad, Shokrollah Salmanzadeh,
Volume 5, Issue 4 (9-2014)
Abstract
Abstract
Background: Soil dust has been debated about its effects on public
health and the challenge is brought about tuberculosis (TB). The purpose of
this study was to investigate the influence of soil dust on pulmonary
tuberculosis (PTB) prevalence and its control indices.
Methods: The medical files of patients in Khuzestan Health Center
were reviewed. The control group included the PTB patients registered from 2005
to 2006 (before soil dust), and case group consisted of PTB patients who were registered
from 2007 to 2010 (after soil dust exposure). The diagnosis of tuberculosis was
based on National Tuberculosis Program (NTP).
Results: The mean age of control and case group was 42 (18-80)
years and 40 (13-99) years, respectively. The prevalence of pulmonary TB
in the control and case group was 537 (12.5 per 100000 population) and 465
(11.0 per 100000 population), respectively. Exposure to dust did not increase
the prevalence of TB. The prevalence was higher in women than men (298, 41.8%
vs. 336, 48.2%), in children than adult group (31, 4.3% vs. 53, 7.3%), in urban
than rural inhabitants (448, 63% vs.496, 71.1%) and in family contacts than
solitary contamination (60, 8.4% vs. 97, 13.9%). The rate of treatment failure,
TB relapse, and MDR-TB in controls and cases were (1.4%, 1.4%, 1%) and (7%,
5.5%, 4.6%), respectively. Dust exposure had significant effect on treatment
outcome.
Conclusion: Although soil dust exposure had no significant effect
on TB prevalence, but significantly affected the prevalence of TB respecting to
age, sex, residential area and closed contact. In addition resulted in more
treatment failure, development of MDR TB and relapse.
Seyed Mohammad Alavi, Shokrollah Salmanzadeh, Pejman Bakhtiarinia, Ali Albagi, Fatemeh Hemmatnia, Leila Alavi,
Volume 6, Issue 4 (10-2015)
Abstract
Background: Knowledge about childhood tuberculosis (TB) in Iran is limited. This study aimed to determine the proportion of tuberculosis in children living in Khuzestan in southwest of Iran and its treatment outcomes.
Methods: In this retrospective study, the child’s medical records registered in national TB program (NTP) unit of Khuzestan Health Center (KHC) for TB treatment from 2005 to 2010 were studied. Data including demographic, clinical presentation, laboratory test results, and treatment outcomes were extracted from the files and were analyzed.
Results: Of total 4104 new TB cases registered in KHC, 203 (4.9%) were children. The mean age was 10.7±4.3 years, and 75.7% of them were females. More than 84% of TB children cases were 10 years or older, whereas, young children (< 5 years old) accounted for 5.6%. Of the total studied cases, 57.1% were pulmonary TB and 42.9% were extra pulmonary, 91.7% were successfully treated and 8.3% had poor treatment outcome. The main risk factors for poor treatment outcome were: age <5 years (OR: 0.17, 95% CI, 0.04-0.76), low body weight (OR: 0.08, 95% CI, 0.01-0.60), household contact with cases of TB treatment failure (OR: 0.13, 95% CI, 0.03-0.52), and exposure to cigarette smoke odor inside the home (OR: 0.17, 95% CI, 0.05-0.56).
Conclusion: The proportion of pediatric TB in the region was lower than expected. The treatment success rate was higher than the rate defined in NTP. Special attention should be given to children aged less than five years, low body weight, contact with TB treatment failure cases, and exposure to cigarette smoke.
Seyed-Mohammad Alavi, Shokrollah Salmanzadeh, Hajar Abbasifar,
Volume 7, Issue 2 (4-2016)
Abstract
Background: Prompt diagnosis and treatment of latent tuberculosis (TB) infection (LTBI) are needed to control TB. The aim of the study was to compare the performance of Quanti FERON-TB test (QFT) with conventional TST for the diagnosis of LTBI.
Methods: In this analytical - comparison study, we enrolled 87 nurses working in teaching hospitals in Ahvaz. All study subjects were tested by TST. TST results were interpreted as positive if induration was more than 10 mm. If the level of QFT after stimulation was equal or greater than 0.35 IU/ml, test was considered as positive. Data were analyzed with SPSS program. QFT results compared with induration in TST and its relation to all variables were investigated.
Results: The rate of LTB diagnosis by TST and QFT was 31% and 35.6%, respectively. There was no significant difference between TST and QFT in LTB diagnosis (P=0.62). Among the 56 subjects who were TST- negative, 14 cases (approximately 25%) were QFT- positive and 42 (75%) were QFT- negative. Among the 31 cases (35.6%) that had TST- positive, 13 (42%) were QFT-positive and 18 (58%) were QFT- negative. The overall percent agreement was 63.2% (k=0.139, P=0.69), discordance %=15.9-20.7, sensitivity= 41.5% and specificity=75.5%.
Conclusion: Diagnostic value of QFT is similar to TST, when there is strong clinical and epidemiological evidence of LTB in a nurse with negative TST, adding QFT to diagnostic evaluation is associated with increased rate of LTB diagnosis.
Seyedmohammad Alavi, Leila Alavi,
Volume 7, Issue 4 (10-2016)
Abstract
Background: Human toxoplasmosis is an important zoonotic infection worldwide which is caused by the intracellular parasite Toxoplasma gondii (T.gondii). The aim of this study was to review briefly the general aspects of toxoplasma infection in in Iranian health system network.
Methods: We searched published toxoplasmosis related articles in English databases including Science Direct, Pub Med, Scopus, Google Scholar, Magiran, Iran Medex, Iran Doc and Scientific Information Database (SID) for toxoplasmosis.
Results: Out of 1267 articles from the English and Persian databases search, 40 articles were suitable with our research objectives and so were selected for the study. It is estimated that at least a third of the world human population is infected with T.gondii, suggesting it as one of the most common parasitic infections through the world. Maternal infection during pregnancy may affect dangerous outcome for the fetus, or even cause intrauterine death. Reactivation of a previous infection in immunocompromised patient such as drug induced, AIDS and organ transplantation can cause life-threating central nervous system infection. Ocular toxoplasmosis is one of the most important causes of blindness, especially in individuals with a deficient immune system.
Conclusion: According to the increasing burden of toxoplasmosis on human health, the findings of this study highlight the appropriate preventive measures, diagnosis, and management of this disease.
Seyyedabbas Hashemi, Seyyedmoayed Alavian, Mohammad Gholami-Fesharaki,
Volume 7, Issue 4 (10-2016)
Abstract
Background: Transient elastography (TE) is a new modality for the diagnosis of liver fibrosis caused by various etiologies. This study was conducted to determine the accuracy of TE in detecting the different stages of liver fibrosis in non-alcoholic fatty liver disease (NAFLD) patients.
Methods: MEDLINE/PubMed, Embase, Ovid, Cochrane Library, American College of Physicians (ACP) Journal Club, Google Scholar, Database of Abstracts of Reviews of Effects, and Web of Science that evaluated the liver stiffness by means of TE and liver biopsy were enrolled in this systematic review and meta-analysis. Published articles were extracted from 2002 to March 2015.
Results: A total of 7 articles from 114 papers were included which consisted of 698 patients. The results indicated that when F ≥3, the outcomes were 93.7% (95% confidence interval (CI): 92-95.5), 91.1% (95% CI: 89-93.2), 82.4% (95% CI: 79.9-84.9), and 95.9% (95% CI: 94.4-97.4) for sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV), respectively. With fibrosis stage ≥4, it has reached the sensitivity of 96.2 % (95% CI: 94.5-97.8), a specificity of 92.2% (95% CI: 89.9-94.6), a PPV of 5.5% (95% CI: 51.2-59.8) and NPV of 98.5% (95% CI: 97.4-99.5).
Conclusion: We concluded that as the pathological fibrosis increases, the sensitivity, specificity and NPV of TE in the diagnosis of fibrosis improves in NAFLD patients. TE can be considered as a unique alternative instead of liver biopsy in NAFLD patients and it has an important role in the exclusion of liver cirrhosis. More studies are required to confirm the results.
Mohammad Ebrahim Ghamar-Chehreh, Shahram Agah, Hossein Khedmat, Aghdas Aaghaei, Seyed-Moayed Alavian,
Volume 8, Issue 4 (7-2017)
Abstract
Background: Hepatitis B (HB) vaccination is a recommended procedure in all dialysis patients, but its efficacy has not been perfect. In the current study, we aimed to conduct a comprehensive review of the literature to find and pool data of the randomized trials evaluating the impact of serum albumin levels on the immunogenicity of HB vaccination in dialysis patients.
Methods: Literature searches were conducted by the Medline and Google Scholar. The key words used included ‘Hepatitis B’, ‘Vaccine’, ‘Dialysis’, ‘Hemodialysis’, and ‘Albumin’. Data of serum albumin levels regarding seroresponse to HB vaccine in clinical trials have been achieved and analyzed. Finally, data from 17 clinical trials have been pooled and analyzed.
Results: One thousand six hundred eighty-two dialysis patients (1212 seroconverted) were included in the meta-analysis. Analysis of response to HB vaccination in our dialysis population showed a significant relationship to their serum albumin levels (p<0.001, z= 5.23). Regarding the dialysis mode, serum albumin level was only a significant interfering factor in hemodialysis patients versus continuous ambulatory peritoneal dialysis (CAPD) (HD group: p<0.001, I2=88.5%, χ2=95.28 (d.f. = 11); CAPD (±HD) group: χ2= 2.21; P=0.697, I2= 0%, d.f.= 4).
Conclusion: The data showed a significant effect for the levels of serum albumin on the immunogenicity of HB vaccine in dialysis patients. Moreover, stratification of data upon dialysis mode showed that this association is only available for hemodialysis patients, and not those on peritoneal dialysis.
Heidar Sharafi, Seyed Hoda Alavian, Bita Behnava, Mohammad Saeid Rezaee-Zavareh, Mehri Nikbin, Seyed Moayed Alavian,
Volume 11, Issue 1 (1-2020)
Abstract
Background: Treatment of hepatitis C virus (HCV) infection with recently introduced direct-acting antiviral agents (DAA) is effective and safe, however there is little known regarding safety and efficacy of generic DAAs in the real-life clinical setting. This study aimed to evaluate the efficacy and safety of generic sofosbuvir/ledipasvir (SOF/LDV) in a real-life clinical experience.
Methods: In this prospective cohort study, patients with chronic HCV infection who referred to Middle East Liver Diseases (MELD) Center were included. Based on the patients’ condition, they were treated with SOF/LDV fixed-dose combination with or without ribavirin (RBV) for 12 or 24 weeks.
Results: A total of 30 (M/F: 19/11) patients with chronic HCV genotype 1 infection with a mean age of 49.8 years were treated with generic SOF/LDV with (9 patients) or without (11 patients) RBV for 12 (27 patients) or 24 (3 patients) weeks. Ten (33.3%) had cirrhosis and 13 (43.3%) with a previous history of treatment with interferon (IFN)-based regimens. Among the 30 patients, 26 (86.7%, 95% CI=70.3%-94.7%) achieved a rapid virologic response, 30 (100%, 95% CI=88.7%-100%) achieved the end of treatment response and 30 (100%, 95% CI=88.7%-100%) achieved a sustained virologic response. No severe treatment adverse event was observed however, 6 (20%) patients experienced mild to moderate adverse events.
Conclusion: The treatment of HCV genotype 1 infection with generic SOF/LDV found to be safe and effective even in patients with cirrhosis and previous history of treatment with IFN-based treatments.
Hossein Khoshrang, Cyrus Emir Alavi, Siamak Rimaz, Ali Mirmansouri, Farnoush Farzi, Gelareh Biazar, Zahra Atrkarroushan, Nazanin Sabet Khadem,
Volume 12, Issue 4 (Autumn 2021)
Abstract
Background: Pediatric patients feel significant fear and anxiety when undergoing surgeries. The ideal drug and its administration route have not been found yet. The aim of this study was to compare the efficacy and safety of intranasal (IN) ketamine and midazolam as premedication in children.
Methods: We studied 71 eligible pediatric patients undergoing elective urologic surgeries, aged 2 to 6 years. The degree of sedation and separation scores was compared between the two groups. Additionally, hemodynamic parameters, before premedication, after induction of anesthesia, and during surgery were documented and compared between two groups. Postoperatively, any side effect was recorded as well.
Results: Finally, the data from 71 children were analyzed. Recovery time was significantly longer in group K (ketamine) compared to group M (midazolam); 27.86±4.42 vs 38.19± 6.67 minutes respectively (P=0.01). No significant difference was observed in terms of sedation score between two groups of K & M; 3.29±0.78 vs 3 ±0.71 respectively (P=0.17), and not regarding separation score; 2.51±0.61 & 2.31 ±0.52 respectively (P=0.01). Vital signs were kept within the physiological limits in both groups with no marked fluctuations.
Conclusion: To produce sedation in young children, both midazolam and ketamine were effective and safe by IN route.
Mahtab Ramezani, Omidvar Rezaei, Ilad Alavi Darzam, Mohammadreza Hajiesmaeili, Mahdi Amirdosara, Leila Simani, Abbas Aliaghaei,
Volume 13, Issue 0 (Covid 19 Supplement 2 2022)
Abstract
Background: We evaluated the levels of the tumor necrosis factor-α (TNF-α), interleukin-1β (IL-1β), and caspase-3 in the cerebrospinal fluid (CSF) and serum of COVID-19 patients to improve our knowledge about underlying mechanisms caused by this virus in central nervous system involvement.
Case Presentation: This case series study included six COVID-19 patients from March 26, 2020, to April 17, 2020, and six healthy control patients. CSF and serum levels of TNF-α, IL-1β, and caspase-3 have been assayed using monoclonal antibodies-based ELISAs.
Patients with COVID-19 had significantly higher level of IL-1β, TNF-α, and caspase-3 in serum (239.16±35.73 pg/ml, 100.50±12.49 pg/ml, 3.58±0.11pg/ml, p < 0.001) and CSF (146.66±17.55 pg/ml, 63.16±14.68 pg/ml,3.22±0.03pg/ml, p<0.001), respectively as compared to control. In addition, our results showed that these biomarkers were significantly higher in serum compared with CSF of the COVID-19 patients (p<0.001).
Conclusion: This study provides essential information for understanding the pathogenesis of COVID-19 infection and sheds light on the potential mechanisms of virus transmission. The obtained data could be useful for designing new prevention and treatment strategies for COVID-19.
Masoud Mardani, Ilad Alavi Darazam, Abdolreza Babamahmoodi,
Volume 13, Issue 0 (Covid 19 Supplement 2 2022)
Abstract
Background: The most common causes of immunodeficiency are iatrogenic and the result of the widespread use of therapies which modulates the immune system, whether they are planned or haphazardly. Mucormycosis is an invasive fungal disease which is usually secondary to immunosuppression, diabetic ketoacidosis, and long-term use of antibiotics, corticosteroids, and cytotoxic drugs. There are researches which show patients with coronavirus disease 2019 (COVID-19), especially severely ill or immunocompromised, are more likely to suffer from invasive fungal infections. Patients with diabetes are at a higher risk for severe COVID-19 outcomes. However, there has been no clear evidence on the relationship between pre-diabetes state and mucormycosis as a complication of SARS-CoV-2 infection so far.
Case Presentation: Here, we report a case of sino-orbital mucormycosis in a pre-diabetic 54-year-old female without any underlying diseases. The patient suffered from COVID-19 pneumonia. She received 8 mg dexamethasone for 12 days. Afterwards, she returned three days after her discharge with a complaint of pre-orbital cellulitis, unilateral facial numbness and decreased visual acuity. Therefore, after primary diagnostic imaging, she was regarded as a candidate for invasive surgical intervention and was consequently treated with a combination of liposomal amphotericin B, radical recurrent surgery and posaconazole.
Conclusion: It is very important to consider patients who are in the pre-diabetic state or possibly immunocompromised before prescribing steroids. The patients should be examined for invasive fungal infections in post-discharge period.
