About Rosacea and Essential Prevention

This is a widespread skin condition that usually affects Caucasians. A patients have flushing and redness on their face and may also have small red bumps or pustules. Rosacea can appear on both sexes but seems to affect people between the 30s and 60s. Unfortunately, there is no consensus as to the cause of rosacea, treatments vary and a dermatologist should be consulted. Some treatment tips are to avoid irritating topical lotions and cleansers and to use sunscreens with a minimum SPF 15. Prescription treatments can include both topical and oral medications. A dermatologist may recommend a photorejuvenation treatment. Rosacea can be difficult to treat and many patients are encouraged to follow regimens and be patient. It can take up to 1-2 years to get the disorder under control.

Most people with rosacea are Caucasian and have fair skin. The main symptoms of rosacea include red or pink patches, visible tiny broken blood vessels, small red bumps, red cysts, and pink or irritated eyes. Most people with the disease may not even know they have rosacea or that it is a diagnosable and treatable condition. Many people who have rosacea may just assume they blush or flush easily or are just very sun sensitive.

a number of factors which may play a part have been identified. These include some microorganisms, changes in the blood vessels, climate, and exposure to certain chemicals or foods.

People often describe a tendency to facial flushing which may have begun in childhood, precipitated by factors such as hot drinks, heat or emotions.

Prevention from Rosacea

You can't prevent rosacea, but you can take steps to reduce or control your symptoms long term.

    Continue your treatment plan. Once rosacea improves or clears, you need to continue your maintenance treatment plan as outlined by your doctor. This may mean daily use of topical medications or continuing lifestyle or self-care measures.

    Be gentle to your skin. Wash areas daily with a gentle cleanser and use oil-free, water-based skin care products. Avoid using products that contain skin irritants, such as alcohol.
    Avoid rosacea triggers, if possible. Find out what triggers, if any, worsen your rosacea and take steps to prevent or avoid them. Extreme temperatures, sun exposure, spicy foods, alcohol and stress can all trigger rosacea.

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Unknown prevention, Rosacea, Skin disease

Dengue fever Prevention and Control and Protective Measures

Dengue fever is a viral disease transmitted by mosquitoes. It is commonly found in tropical and subtropical regions including South East Asia, South Asia, the Pacific area, Africa and Central America.

 Dengue fever presents with sudden onset of high fever, severe headache, eye pain, bone and muscle pain, and nausea and vomiting. Rash generally occurs three or four days later. The disease may present in a more severe form, dengue hemorrhagic fever, with bleeding and shock, which may be fatal.

 The best way to prevent dengue fever is to take special precautions to avoid contact with mosquitoes. There are many methods of mosquito control, experts now recommended an "Integrated approach" that is an approach which tries to combine one or more methods with a view to obtaining maximum results with minimum input and also to prevent environmental pollution with toxic chemicals and development of insecticide resistance.

Prevention and Control
At present, the only method of preventing and controlling dengue fever is to eradicate the mosquito population. There are number of ways to combat the vector mosquitoes:
·        Improved water storage practices. Cover all containers to prevent egg laying female mosquitoes access to it.
·        Implement proper solid waste disposal.
·        Eliminate any sources that may collect water such as tins, bottles, plastic food containers and old tires. Mosquitoes breed easily in any source of standing water.
·        Appropriate insecticides, such as larvicide's can be added to water containers and man-made ponds. The insecticides can prevent mosquitoes breeding for several weeks.
·        Always clean and check drains to ensure they are not blocked especially during the rainy season.
·        Breed small mosquito-eating fishes in an artificial pond to eradicate the mosquito larvae.
·        Avoid wearing dark and tight clothing because mosquitoes are attracted to dark colours. Wear loose, white and long clothes, which cover the whole body. Mosquitoes find it difficult to bite through loose clothes than tight fitting clothes.
·        Environmental conditions. It is suggested to sleep under mosquito netting or in a room which has mosquito screens on the windows. Mosquitoes are unlikely to bite in an air-conditioned room and under strong fans. Mosquito coils are also useful to help prevent mosquitoes from entering the room.
·        Avoid reduce outdoor activities during morning and late afternoon because Aedes mosquitoes are daytime feeders.
·        Change at least once a week the water in flower vases and saucers of potted plants to prevent breeding of mosquito. The use of saucers should be avoided whenever possible.
·        Keep all drains free from choke.
·        Top up all defective ground surfaces to prevent the accumulation of stagnant water.
·        Stop storing water along morning walk trails or Government land for irrigation.
·        Make large holes on tyres used as anti-bumping measure in garage or wrap them up with plastic cover to prevent water trapping or use mark(s) on the parking space to prevent bumping instead.
·        Use mosquito screen to prevent the invasion of mosquito.
·        Use insect repellents to provide temporary protection from mosquito bite.
·        Use mosquito coils or aerosols to kill the mosquito directly.

Personal protective measures
Personal protective measures can greatly reduce the risk of being bitten. All varieties of mosquitoes breed in or near water that is stagnant or slow moving. The importance of mosquitoes in transmission of disease makes adequate control of mosquito-breeding sites very important, especially those close to human habitation.

·        The use of mosquito deterrents in bedrooms is effective to reduce the number of mosquitoes in the room, but it does not prevent mosquito bites all together. The chemical deterrent is released through an electronically heated impregnated pad or gel, and its effectiveness depends largely on the size and ventilation of the room.
·        Correct use of mosquito nets (essential if accommodation is not air- conditioned). For added protection for up to 3 months or longer, mosquito nets can be soaked in 1 % solution of PERMETHRIN (or other repellent / insecticide). If resident in a malaria area, curtains can be treated in a similar manner.
·        Use of mosquito coils and "knockdown spray" (containing pyrethoids) - spray insecticide in cool dark places where mosquitoes lurk.
·        Use of an effective mosquito repellent on exposed skin and clothing. DEET (diethylmethylbenzamide) is an effective safe component of good repellents. The actual concentration of DEET varies widely between different manufacturers, and can be as high as 90% (too high for safety). Choose a repellent with between 30-45% DEET and take the following precautions against adverse reactions:

•     apply sparingly and only to exposed skin
•     never apply high concentrations to skin (use those for clothing)
•     do not inhale / swallow repellent or get in eyes or mucous membranes
•     do not apply to hands that may touch eyes or mouth
•     do not apply to wounds, rashes, or abrasions
•     wash repellent off after coming indoors to stay
•     if skin starts to burn, wash repellent off and seek medical advice

 Prevent spread of dengue within the house.     
·        Patients are advised to rest under a mosquito net or use mosquito repellents to prevent mosquito bites as they can be the source of dengue virus during this time.
·        Family members should also take precautions to avoid mosquito bites and eliminate mosquito-breeding sites in and around their homes.
·        Avoid unnecessary communication

 Feeding Habit
·         Day biter with increased biting activity 2 hours after sunrise and several hours before sunset. 
·         Mainly feeds on human beings in domestic and peridomestic situations
·         Bites repeatedly

Resting Habit
    Rests in the domestic and peridomestic situations
    Rests  in the dark corners of the houses, on hanging objects like clothes, umbrella, etc. or under the furniture

BREEDING HABITS
·         Aedes aegypti  mosquito breeds in any  type of man made containers or storage containers having even a small quantity of water
·         Eggs of Aedes aegypti can live without water for more then one year

FAVOURED BREEDING PLACES
Desert coolers, Drums, Jars, Pots, Buckets, Flower vases, Plant saucers, Tanks, Cisterns, Bottles, Tins, Tyres, Roof gutters, Refrigerator drip pans,   Cement blocks, Cemetery urns, Bamboo stumps, Coconut shells, Tree holes and many more places where rainwater collects or is stored.

DONTS
If your platelets count is 50000 or below,
·        Don’t brush your teeth
·        Don’t shave
·        Don’t cuts your nails
·        Don’t do any act in which there is a chance of bleeding

  “Because Aedes mosquitoes usually bite during the day, be sure to take precautions, especially during early morning hours before daybreak and in the late afternoon before dark.”

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Unknown Dengue Fever, prevention, protective

Thyroid Cancer How do Prevention ?

    Prevention for the people who are at high risk-People who have an inherited gene mutation is at increased risk of developing thyroid cancer. These people are advised to opt for prophylactic Thyroidectomy surgery to prevent thyroid cancer. It is advisable to discuss with a genetic counselor who will explain the risk of thyroid cancer and treatment options.
    Prevention for people who live near nuclear power plants-An accident in the nuclear power plant will have an effect on people living near the plant. In the United States people living within a radius of ten miles will receive medication like potassium iodide that will heal the effects of radiation on the thyroid. If an emergency occurs during the stay then the person and their family must take the potassium iodide tablets to prevent the cancer. A local emergency management department will help and provide information regarding to how to survive during a nuclear power plant fall out.

Coping with cancer is challenging task as on hearing that a person who has been diagnosed with thyroid cancer will not be in a mood to react or be over whelmed by fear and anxiety.

Such people can start by gathering as many as information regarding thyroid cancer. They can collect the details such as the stage, type, and treatment options available. They can ask questions regarding the disease and even they will get information on the National Cancer Institute’s site.

They can find out thyroid cancer survivors to make a friendship to share experiences. They can ask doctors about support groups in the area or can connect through internet sites such as the Thyroid Cancer Survivors Association.

A person can keep fit by having a healthy diet full of vegetables and fruits, getting enough sleep every night so that next morning the person will stay fresh, and can do exercise most of days throughout a week.

A diagnosis of cancer can be frightening for a person but if they are willing to change their lifestyle by means of thyroid cancer prevention can have longer life.

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Unknown prevention, Thyroid Cancer

Viral Meningitis Diagnosis Treatment Prevention and Drug therapy

Meningitis is an inflammation of the meninges, the protective membranes that surround the brain and spinal cord.
Signs and Symptoms Viral Meningitis

The symptoms of viral meningitis differ from an infant to an adult.

In newborns, signs and symptoms include:

•     Irritability
•     High-pitched cry
•     Poor feeding
•     Vomiting
•     Fever
•     Seizures
•     Stiffness in neck (a rare problem)

In young children and adults, signs and symptoms include:

•     High fever
•     Severe headache
•     Vomiting or nausea
•     Stiff neck
•     Sensitivity to light
•     Drowsiness
•     Skin rash
•     Confusion
•     Seizures
•     Clouding or loss of consciousness

Diagnosis of viral meningitis

Viral meningitis can be diagnosed by some of the laboratory practices which include a test of spinal fluid obtained with a lumbar puncher (spinal tap). This test is performed by injecting a needle on the back of the patient and the fluid is taken and observed. This test is basically used to distinguish between the infections i.e. viral, bacterial or fungal. There are certain blood tests that need to be performed in order to determine viral meningitis.

Treatment of viral meningitis

There is no such specific treatment for viral meningitis, but there are some of the medications that can be used so as to reduce the effect of viral meningitis to a great extent. Treatment includes rest, hydration, anti-inflammatory medications, and antipyretics. There are different treatment options, which include:

    Prevention- Prevention can be done with proper vaccination against H. influenzae and mumps. Vaccination is given to children, since they have a weaker immune system. It is given to control epidemics in dormitories. Since viral meningitis is contagious, so it is important to wash your hand frequently, so as to reduce the risk of viral meningitis. It is also important to clean the contaminated surfaces with soap and water, in order to stop the spreading of viral meningitis.
    Drug therapy- The dose of the drug differs from one person to another. The treatment of viral meningitis aims at reducing the symptoms of fever and ache.  There are certain antibiotics that are given to the patient which includes ampicillin, cephalosporins, and trimethoprim-sulfamethoxazole. Corticosteroids are also prescribed by the doctor to reduce inflammation or irritation. If seizures occur, then diazepam or phenytoins are prescribed.
    Nutrition and supplements- There are several nutrients that can strengthen the immune system. It is recommended to take multivitamin daily which contains vitamins A, C, E, D, the B-complex vitamins. Omega-3 fatty acids are also prescribed to reduce inflammation and improve immunity. Coenzyme Q10 is prescribed to take at night (at bedtime), as an antioxidant and increase the immune system activity. Alpha-lipoic acid and Resveratrol should be taken twice a day, for antioxidant effects.

One thing should be kept in mind that any disease should not be ignored; rather if needed, take medical assistance. Viral meningitis is not a severe form of meningitis, but if left untreated can lead to a life threatening condition.

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Unknown diagnosis, prevention, Treatment, Viral Meningitis

HIV(AIDS) Transmitted Symptoms Treatments and Prevention

AIDS is the end-stage of HIV infection.it is characterised by life-threatening opportunistic infection and/or cancers that occur in people with otherwise unexplained defect in immunity

How HIV is transmitted

To become infected with HIV, infected blood, semen or vaginal secretions must enter your body. You can't become infected through ordinary contact — hugging, kissing, dancing or shaking hands — with someone who has HIV or AIDS. HIV can't be transmitted through the air, water or via insect bites.

You can become infected with HIV in several ways, including:

    During sex. You may become infected if you have vaginal, anal or oral sex with an infected partner whose blood, semen or vaginal secretions enter your body. The virus can enter your body through mouth sores or small tears that sometimes develop in the rectum or vagina during sexual activity.
    Blood transfusions. In some cases, the virus may be transmitted through blood transfusions. American hospitals and blood banks now screen the blood supply for HIV antibodies, so this risk is very small.
    Sharing needles. HIV can be transmitted through needles and syringes contaminated with infected blood. Sharing intravenous drug paraphernalia puts you at high risk of HIV and other infectious diseases such as hepatitis.
    From mother to child. Infected mothers can infect their babies during pregnancy or delivery, or through breast-feeding. But if women receive treatment for HIV infection during pregnancy, the risk to their babies is significantly reduced.

Symptoms of HIV Infection(AIDS)

The symptoms of HIV infection are the result of HIV attacking the cells of the body's immune system. Early in the disease, many people with HIV infection have no symptoms. Some people may experience flu-like symptoms that occur about four to eight weeks after infection. Symptoms may include swollen glands, fever, headache and fatigue.
These symptoms generally go away within several weeks. There then may be no symptoms for months to as many as ten years or longer after HIV infection. Over this time, HIV gradually destroys the helper T cells of the immune system. This eventually results in symptoms, such as swollen glands that remain enlarged, fatigue, weight loss, recurring fever and yeast infections.

Treatments of HIV(AIDs)

There is no cure for AIDS at this time. However, a variety of treatments are available that can help keep symptoms at bay and improve the quality of life of those who have already developed symptoms.

Antiretroviral therapy suppresses the replication of the HIV virus in the body. A combination of several antiretroviral agents, termed highly active antiretroviral therapy (HAART), has been highly effective in reducing the number of HIV particles in the blood stream, as measured by the viral load (how much virus is found in the blood). Preventing the virus from replicating can help the immune system recover from the HIV infection and improve T-cell counts.

HAART is not a cure for HIV, and people on HAART with suppressed levels of HIV can still transmit the virus to others through sex or sharing of needles. But HAART has been enormously effective for the past 10 years. There is good evidence that if the levels of HIV remain suppressed and the CD4 count remains high (above 200 cells/mcl), life can be significantly prolonged and improved.

However, HIV may become resistant to HAART in patients who do not take their medications on schedule every day. Genetic tests are now available to determine whether a particular HIV strain is resistant to a particular drug. This information may be useful in determining the best drug combination for each individual, and adjusting the drug regimen if it starts to fail. These tests should be performed any time a treatment strategy begins to fail, and prior to starting therapy.

When HIV becomes resistant to HAART, other drug combinations must be used to try to suppress the resistant strain of HIV. There are a variety of new drugs on the market for the treatment of drug-resistant HIV.

Treatment with HAART has complications. HAART is a collection of different medications, each with its own side effects. Some common side effects are nausea, headache, weakness, malaise (a general sick feeling), and fat accumulation on the back ("buffalo hump") and abdomen. When used for a long time, these medications increase the risk of heart attack, perhaps by increasing the levels of fat and glucose in the blood.

Any doctor prescribing HAART should carefully watch the patient for possible side effects associated with the combination of medications the patient takes. In addition, routine blood tests measuring CD4 counts and HIV viral load (a blood test that measures how much virus is in the blood) should be taken every 3 - 6 months. The goal is to get the CD4 count as close to normal as possible, and to suppress the HIV amount of virus in the blood to an undetectable level.

Other antiviral medications are being investigated. In addition, growth factors that stimulate cell growth, such as erthythropoetin (Epogen) and filgrastim (G-CSF or Neupogen) are sometimes used to treat anemia and low white blood cell counts associated with AIDS.

Medications are also used to prevent opportunistic infections (such as Pneumocystis jiroveci pneumonia) if the CD4 count is low enough. This keeps AIDS patients healthier for longer periods of time. Opportunistic infections are treated when they happen.

Methods of prevention

Methods of prevention of HIV/AIDS mentioned in various sources includes those listed below. This prevention information is gathered from various sources, and may be inaccurate or incomplete. None of these methods guarantee prevention of HIV/AIDS.

•     Avoid unprotected sex
•     Avoid multiple sex partners
•     Avoid needle sharing
•     Treatments to prevent mother-infant transmission include:
•         AZT
•         Antiviral agents
•         Multidrug combinations
•         Nevirapine

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Unknown HIV(AIDS), prevention, Symptoms, Transmitted, Treatment

Treatment for Swine Flu Infections and Prevention Measures

The best treatment for swine flu infections in human beings is prevention by vaccination. Work by several researchers and laboratory groups have produced vaccines.

    Nasal Spray vaccine

The foremost vaccine released in early October 2009 was in the form of a nasal spray. It was approved for use in healthy people from the age of 2 to 49 years. The nasal spray consists of weakened H1N1 viruses which do not cause the flu but can transmit it to other persons if not vaccinated. It must not be given to people under the high risk of flu complications such as pregnant women, elderly people above 60 years, people with any chronic medical conditions, etc.

    Flu shot vaccine

Another vaccine developed is in the form of an injection. It is made from the dead H1N1 virus which does not cause the flu in anyone nor does it transmit it to other people. The injection vaccine is approved to be used in people above 6 months of age and is safe on those under the high risk category. This form of the vaccine comes into effect after 2 weeks of the vaccination and in the mean time there may be some flu like symptoms evident in people.

These vaccines are approved by the CDC (Centers for Disease Control and Prevention) after conducting thorough clinical trials to confirm the effectiveness and safety of the vaccination. CDC also recommends to the care givers and medical staff to spread awareness about the guidelines of the vaccine and any updates in the list of vaccination as the contents and advises keep changing due to fast mutation of the flu virus type A.

Antiviral treatment for swine flu

There are two antiviral medicines assumed to prevent and reduce the effects of swine flu infection. These antiviral are:

    Relenza (zanamivir)
    Tamiflu (oseltamivir)

Both of these are used to prevent and reduce the flu A and B symptoms. These medicines should not be taken without consulting the medical practitioners as the swine flu virus has developed a resistance to them. They are not recommended in case the flu symptoms have already been evident for 48 hours or more, although patients who are hospitalized may be treated under the past the 48-hour guidelines. Severe infections in some patients may need supplementary supportive measures such as ventilation support and treatment of other harmful infections like pneumonia which may complicate the case even further. The CDC has confirmed the usage of these antiviral drugs safe for pregnant women and others under the high risk of flu infections.

Swine flu prevention measures

Washing the hands frequently, especially, before touching the nose, eyes and mouth or prior to eating anything is the simplest and best possible preventive measure to avoid swine flu. Soap and water should be used while washing the hands. Alcohol based disinfectant can be used incase soap and water are not available.

Flu viruses, type A, mutate quickly and thus they develop immunity to the vaccine before onset of the next flu season which makes it necessary for a fresh updated vaccination to deal with the mutated virus.

Health officers use information collected from around the world to determine which strains of flu virus are most likely to be prevailing for the period of the upcoming flu season. Companies produce vaccine based on these recommendations.

The effect of flu shot is strongest during the first 6 months after getting a shot. After that, with passage of time the protection it gives begins to diminish.

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Unknown prevention, Swine Flu, Treatment

Malaria Causes Treatment Prevention and Symptoms

Malaria is a communicable protozoal disease caused by sporozoon of the genus plasmodium and transmitted to man by species of infective female anopheles mosquitoes called vectors or carriers.it is characterised by intermittent fever with rigors,enlargment of spleen and secondary anaemia.

Sing and Symptoms Malaria

The symptoms characteristic of malaria include flulike illness with fever, chills, muscle aches, and headache. Some patients develop nausea, vomiting, cough, and diarrhea. Cycles of chills, fever, and sweating that repeat every one, two, or three days are typical. There can sometimes be vomiting, diarrhea, coughing, and yellowing (jaundice) of the skin and whites of the eyes due to destruction of red blood cells and liver cells.

People with severe P. falciparum malaria can develop bleeding problems, shock, liver or kidney failure, central nervous system problems, coma, and can die from the infection or its complications. Cerebral malaria (coma, or altered mental status or seizures) can occur with severe P. falciparum infection. It is lethal if not treated quickly; even with treatment, about 15%-20% die.

Causes of Malaria

The malaria parasite, Plasmodium, is a small, single-cell organism (protozoan) that lives as a parasite in man and a specific species of mosquito (Anopheles).

There are four different types of malaria parasite: Plasmodium falciparum is the cause of fatal malaria, while Plasmodium vivax, Plasmodium ovale and Plasmodium malariae cause more benign types of malaria. Falciparum malaria can kill, but the other forms are much less likely to prove fatal.

There are several stages in the life cycle of the parasite, and by and large these are the same for all four types.

Treatment of Malaria
Medical treatment should be sought immediately.The effectiveness of antimalarial drugs differs with different species of the parasite and with different stages of the parasite's life cycle. Your physician will determine the treatment plan most appropriate for your individual condition.

Drugs include chloroquine, mefloquine, primaquine, quinine, pyrimethamine-sulfadoxine (Fansidar), and doxycycline. Some plasmodium have developed resistance to certain medications, and therefore, alternative medications will be prescribed for you.

Prevention of Malaria
No prophylactic regimen gives complete protection. Speak with your physician or local travel clinic to receive up to date information about the best malaria protection for you. Effectiveness of any given medication varies by the region of the world in which you plan to travel. Effectiveness also varies from year to year, so current information is essential.

Prevention is based on:

    evaluating the risk of exposure to infection
    preventing mosquito bites by using DEET mosquito repellant, bed nets, and clothing that covers most of the body
    chemoprophylaxis (preventive medications)

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Unknown Malaria, prevention, Symptoms, Treatment

Mumps Symptoms Diagnosis Complications and Prevention

This virus only infects human beings, and it spreads the disease, from one person to another by means of sneezing or coughing. This type of virus resides in the mucus of the nose and throat. When the person sneezes or coughs, the virus may fall on hands or be breathed in by another person. The virus gets multiplied within the body, once a person gets infected. The incubation period ranges from 12 and 25 days. So let us see some of the symptoms of mumps in adults.

Symptoms of mumps in adults

The symptoms usually appear between 12-25 days after a person has been exposed to the virus. However, there are 30-40% of the cases that may be asymptomatic and 50% are associated with non-specific respiratory symptoms.
The most common symptoms of mumps in adults are:

    Swelling of parotid gland which is located in front of the ear
    Fever
    Headache
    Sore throat
    Fatigue
    Loss of appetite
    Stiffness in neck
    Pain in the ears
    Abdominal pain
    Pain in the mouth while chewing and talking
    Tenderness the salivary glands close to the jaw

Diagnosis of mumps
Mumps in adults is usually diagnosed based on the symptoms as well as some of the blood tests. A physical examination is also done for the confirmation of the disease. In rare cases, laboratory tests are perform for the diagnosis of mumps. The virus itself is found at any place in the world; as a result, this disease is not even endemic. The mumps virus is also known as the RNA virus, or ribonucleic acid virus, as it belongs to the family paramyxovirus. This virus is present all around in our environment. Children are mostly prone to this virus as compared to the adults, since their immune system is weaker. These viruses are present in the throat, mucus, and nose of an infected person. When a person sneezes, or coughs, the virus gets transmitted to the other person. The droplets of saliva that spray in the air can cause the virus to spread.

Complications of mumps

There are some of the complications associated with mumps, which include:

    Orchitis- It is an inflammatory condition that causes swelling of one or both testicles and it is very painful. It rarely leads to sterility.
    Meningitis- It is another inflammation of the membranes that surrounds the brain and spinal cord. It is also rare in nature but can lead to life threatening.
    Encephalitis- It is an inflammation of the brain, which is caused by a viral infection. It is a serious complication and can lead to life threatening condition.
    Pancreatitis- It is a complication of the mumps that causes swelling of the pancreas.
    Loss of hearing- It is a rare complication of mumps and can cause deafness to both the ears.

Prevention of mumps
is necessary. So it is important to have vaccination against mumps. The symptoms of mumps in adult can also be treated by taking some painkillers, which would normally ease the headache. It is also recommended to drink sufficient water, as it would stop you from being dehydrated.

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Unknown complications, diagnosis, mumps, prevention, Symptoms