Browse publications by year: 2006

  1. Hilmi I, Tan YM, Goh KL
    World J Gastroenterol, 2006 Mar 07;12(9):1435-8.
    PMID: 16552816
    AIM: To determine the demography and clinical presentation of CD and secondly to determine any differences in the prevalence between the different ethnic groups in a multiracial Asian population.

    METHODS: Patients with CD who were seen in 2001-2003 in the University of Malaya Medical Centre (UMMC) were enrolled in this study. Prevalence of disease was calculated for the group as a whole and by race with hospital admissions per ethnic group as the denominator.

    RESULTS: Thirty-four patients were diagnosed to have CD. Basic demographic data of patients; male:female 17:17; mean age 29.1 years (+/-13.5 years); ethnic group: Malays 5 (14.7%), Chinese 12 (35.3%) and Indians 17 (50%).Twenty-six (76.5%) were diagnosed under the age of 40 and 8 (23.5%) were diagnosed over the age of 40. Location of the disease was as follows:ileocolonic 13 (38.2%), terminal ileum only 9 (26.5%), colon only 8 (23.5%), and upper gastrointestinal 4 (11.8%). Sixteen (47.1%) had penetrating disease, 9 (26.5%) had stricturing disease and 9 (26.5%) had non-penetrating and non-stricturing disease. The hospital admission prevalence of CD was 26.0 overall, Indians 52.6, Chinese 6.9, and Malays 9.3 per 10(5) admissions per ethnic group. The difference between Indians and Malays: [OR 5.67 (1.97, 17.53) P<0.001] was statistically significant but not between the Indians and the Chinese [OR 1.95 (0.89, 4.35) P=0.700]. The difference between the Chinese and the Malays was also not statistically significant. [OR 2.90 (0.95, 9.42) P=0.063].

    CONCLUSION: The clinical presentation of CD is similar to the Western experience. Although the overall prevalence is low,there appears to be a clear racial predominance among the Indians.

    MeSH terms: Adolescent; Adult; Child; Colon/pathology; Crohn Disease/ethnology*; Crohn Disease/epidemiology; Crohn Disease/pathology*; Crohn Disease/surgery; Female; Humans; Ileum/pathology; Malaysia/epidemiology; Male; Middle Aged; Retrospective Studies; Prevalence; Gastrointestinal Tract/pathology; Asian Continental Ancestry Group*
  2. Esa R, Rajah P, Abdul Razak I
    Community Dent Health, 2006 Mar;23(1):15-20.
    PMID: 16555714
    Patient satisfaction is critical for the growth and prosperity of any oral health service or practice. The success of any oral health service can be assessed by an evaluation of the degree of satisfaction/dissatisfaction of its patients.
    MeSH terms: Adolescent; Adult; Clinical Competence; Dental Care/psychology*; Female; Humans; Malaysia; Male; Military Personnel/psychology*; Patient Satisfaction*
  3. Ling SS, Magosso E, Khan NA, Yuen KH, Barker SA
    Drug Dev Ind Pharm, 2006 Mar;32(3):335-45.
    PMID: 16556538
    A liposome system was evaluated for oral delivery of a poorly bioavailable hydrophilic drug. The system was prepared from proliposome, which consisted of negatively charged phosphatidylcholine, whereas cefotaxime was chosen as the model drug. An in vivo study was carried out on nine rats according to a three-way crossover design to compare the oral bioavailability of cefotaxime from the liposomal formulation with that of an aqueous drug solution and a physical mixture of cefotaxime with blank liposomes. The results indicated that the extent of bioavailability of cefotaxime was increased approximately 2.7 and 2.3 times compared with that of the aqueous solution and the physical mixture, respectively. In a separate study, simultaneous determination of cefotaxime in intestinal lymph (collected from the mesenteric lymph duct) and in plasma (collected from the tail vein) revealed that its concentration was consistently higher in the lymph than in the plasma when administered via the liposomal formulation, whereas the reverse was observed with the aqueous solution. Thus, the results indicated that the liposomes system has the potential of increasing the oral bioavailability of poorly bioavailable hydrophilic drugs and also promote their lymphatic transport in the intestinal lymph.
    MeSH terms: Animals; Anti-Bacterial Agents/administration & dosage; Anti-Bacterial Agents/pharmacokinetics*; Biological Availability; Cefotaxime/administration & dosage; Cefotaxime/pharmacokinetics*; Liposomes; Lymphatic System/metabolism*; Male; Particle Size; Phosphatidylcholines/chemistry*; Rats, Sprague-Dawley; Cross-Over Studies; Area Under Curve; Rats
  4. Sim SM, Rasiah RI
    Ann Acad Med Singap, 2006 Feb;35(2):67-71.
    PMID: 16565756
    INTRODUCTION: This paper reports the relationship between the difficulty level and the discrimination power of true/false-type multiple-choice questions (MCQs) in a multidisciplinary paper for the para-clinical year of an undergraduate medical programme.

    MATERIALS AND METHODS: MCQ items in papers taken from Year II Parts A, B and C examinations for Sessions 2001/02, and Part B examinations for 2002/03 and 2003/04, were analysed to obtain their difficulty indices and discrimination indices. Each paper consisted of 250 true/false items (50 questions of 5 items each) on topics drawn from different disciplines. The questions were first constructed and vetted by the individual departments before being submitted to a central committee, where the final selection of the MCQs was made, based purely on the academic judgement of the committee.

    RESULTS: There was a wide distribution of item difficulty indices in all the MCQ papers analysed. Furthermore, the relationship between the difficulty index (P) and discrimination index (D) of the MCQ items in a paper was not linear, but more dome-shaped. Maximal discrimination (D = 51% to 71%) occurred with moderately easy/difficult items (P = 40% to 74%). On average, about 38% of the MCQ items in each paper were "very easy" (P > or =75%), while about 9% were "very difficult" (P <25%). About two-thirds of these very easy/difficult items had "very poor" or even negative discrimination (D < or =20%).

    CONCLUSIONS: MCQ items that demonstrate good discriminating potential tend to be moderately difficult items, and the moderately-to-very difficult items are more likely to show negative discrimination. There is a need to evaluate the effectiveness of our MCQ items.

    MeSH terms: Adult; Choice Behavior; Education, Medical, Undergraduate*; Educational Measurement/methods*; Humans
  5. Tan CS, Chen AH, Au Eong KG
    Ann Acad Med Singap, 2006 Feb;35(2):72-6.
    PMID: 16565757
    INTRODUCTION: During cataract surgery under regional (retrobulbar, peribulbar or sub- Tenon's) or topical anaesthesia, many patients experience a variety of visual sensations in their operated eye intraoperatively. Between 3% and 16.2% of patients are frightened by their intraoperative visual experiences, which may increase the risk of intraoperative complications and affect patients' satisfaction with the surgery. This study aims to determine optometry students' beliefs and knowledge of visual sensations experienced by patients during cataract surgery under regional and topical anaesthesia.

    MATERIALS AND METHODS: A nationwide survey of all Malaysian optometry students using a standardised, self-administered questionnaire.

    RESULTS: All 129 optometry students participated in the survey, giving a 100% response rate. Overall, 26.4% and 29.5% of the students believed that patients undergoing cataract surgery under regional and topical anaesthesia, respectively, may experience no light perception, while 78.3% and 72.9%, respectively, thought that patients would experience light perception. Many respondents also believed that patients might experience a variety of other visual sensations. Of all respondents, 70.5% and 74.4% of students believed that patients undergoing cataract surgery under regional and topical anaesthesia, respectively, may be frightened by their visual experience and 93.0% and 85.3%, respectively, felt that preoperative counselling might help to alleviate this fear.

    CONCLUSION: Many optometry students are aware that patients might encounter a variety of visual sensations during cataract surgery under local anaesthesia. A high proportion of students believe that patients may experience fear as a result of the intraoperative visual sensations and felt that preoperative counselling would be helpful.

    MeSH terms: Adult; Anesthesia, Conduction; Counseling; Fear; Female; Humans; Intraoperative Period; Malaysia; Male; Optometry/education*; Sensation; Visual Perception*
  6. Ang HH, Lee KL
    Food Chem Toxicol, 2006 Aug;44(8):1245-50.
    PMID: 16567029 DOI: 10.1016/j.fct.2006.01.014
    The DCA (Drug Control Authority), Malaysia has implemented the phase three registration of traditional medicines on 1 January 1992. As such, a total of 100 products in various pharmaceutical dosage forms of a herbal preparation found in Malaysia, containing tongkat Ali hitam, either single or combined preparations, were analyzed for the presence of a heavy toxic metal, mercury, using atomic absorption spectrophotometer, after performing a simple random sampling to enable each sample an equal chance of being selected in an unbiased manner. Results showed that 26% of these products possessed 0.53-2.35 ppm of mercury, and therefore, do not comply with the quality requirement for traditional medicines in Malaysia. The quality requirement for traditional medicines in Malaysia is not exceeding 0.5 ppm for mercury. Out of these 26 products, four products have already registered with the DCA, Malaysia whilst the rest, however, have not registered with the DCA, Malaysia.
    MeSH terms: Drug Contamination; Malaysia; Mercury/analysis*; Spectrophotometry, Atomic; Plant Preparations/analysis*; Eurycoma/chemistry*
  7. Namasivayam P, Skepper J, Hanke D
    Plant Cell Rep, 2006 Sep;25(9):887-95.
    PMID: 16568254
    The Brassica napus secondary embryogenesis system requires no exogenous growth regulator to stimulate embryo development. It is stable embryogenically over a long period of culture and has a distinct pre-embryogenic stage. This system was used to investigate the morphological and cellular changes occurring in the embryogenic tissue compared to non-embryogenic tissue using various microscopy techniques. A unique ultrastructural feature designated the extracellular matrix (ECM) was observed on the surface of pre-embryogenic embryoids but not on the non-embryogenic individuals. The ECM layer was found to be dominant in the pre-embryogenic stage and reduced to fragments during embryo growth and development in mature embryogenic tissue. This is a novel aspect of the phenotype previously unreported in the Brassica system. This structure might be linked to acquisition of embryogenic competence.
    MeSH terms: Extracellular Matrix/ultrastructure*; Microscopy, Electron, Scanning; Biomarkers/analysis; Brassica napus/classification; Brassica napus/embryology*; Brassica napus/ultrastructure*; Tissue Culture Techniques; Microscopy, Electron, Transmission
  8. Chan GC, Tang SF
    Singapore Med J, 2006 Apr;47(4):266-70.
    PMID: 16572235
    INTRODUCTION: A study was carried out in a primary healthcare clinic in the Hulu Langat district of Malaysia to assess the parental knowledge, attitudes and antibiotic use for common childhood acute upper respiratory tract infection (URTI).
    METHODS: A cross-sectional study involving 421 parents, who were surveyed by using an interviewer-administered questionnaire, from April to June 2001.
    RESULTS: Approximately 59 percent of parents from this study believed that weather was the main cause of acute URTI of their children, 13 percent thought it was due to food, and only about 27 percent said it was caused by germs. Nearly 68 percent, 69 percent and 76 percent of them believed that antibiotics was helpful in treating the common cold, cough and fever, respectively. 29 percent of parents who thought that their child with acute URTI needed antibiotics were not prescribed with any. On the other hand, 17 percent believed that antibiotics were unnecessary when prescribed. 28 percent of parents had requested for antibiotics, and 93 percent received what they requested for their child with acute URTI. About 31 percent of parents who did not request any antibiotics claimed that private general practitioners habitually prescribed antibiotics. The antibiotic compliance was poor with only 74 percent completing the entire course, with 85 percent of them stopping once they improved symptomatically. 15 percent of parents gave "leftover" antibiotics, 24 percent gave "shared" antibiotics, and 5.5 percent bought antibiotics for their child with acute URTI without consulting a doctor.
    CONCLUSION: This study shows that parents often have inadequate knowledge and misconceptions on antibiotic use for acute URTI in children. Improved parental education may reduce unnecessary antibiotic prescription and antimicrobial resistance in the community.
    Study site: Klinik Kesihatan Batu 9, Hulu Langat, Selangor, Malaysia
    MeSH terms: Acute Disease; Adolescent; Adult; Ambulatory Care Facilities/utilization*; Anti-Bacterial Agents/therapeutic use*; Child; Cross-Sectional Studies; Female; Humans; Health Knowledge, Attitudes, Practice*; Malaysia; Male; Middle Aged; Parents/education; Parents/psychology*; Primary Health Care/utilization*; Surveys and Questionnaires; Respiratory Tract Infections/drug therapy*
  9. Loganathan A, Arumainathan UD, Raman R
    Singapore Med J, 2006 Apr;47(4):271-5.
    PMID: 16572236
    Diagnosis and treatment of acute tonsillitis are one of the most common problems seen at an otorhinolaryngology clinic in both adult and paediatric populations. Much has been written about bacteriology of recurrent tonsillitis but it remains a controversial topic. Despite the fact that tonsillitis is so common, consensus seems to be lacking as to the main causative organism and the differences between children and adults. The tonsillar core bacteriology of 233 patients with recurrent tonsillitis who underwent tonsillectomy from January 2000 to June 2003 is presented.
    Study site: inpatients, University Malaya Medical Centre (UMMC), Kuala Lumpur, Malaysia
    MeSH terms: Acute Disease; Adult; Child; Child, Preschool; Female; Hospitals, University; Humans; Klebsiella pneumoniae/isolation & purification; Malaysia; Male; Prospective Studies; Recurrence; Risk Factors; Staphylococcal Infections/diagnosis*; Staphylococcus aureus/isolation & purification*; Tonsillitis/microbiology*; Tonsillitis/physiopathology
  10. Kamil SM, Mohamad NH, Narazah MY, Khan FA
    Singapore Med J, 2006 Apr;47(4):332-4.
    PMID: 16572249
    We describe a case of dengue haemorrhagic fever with prolonged thrombocytopaenia. A 22-year-old Malay man with no prior illness presented with a history of fever and generalised macular rash of four days duration. Initial work-up suggested the diagnosis of dengue haemorrhagic fever based on thrombocytopaenia and positive dengue serology. Patient recovered from acute illness by day ten, and was discharged from the hospital with improving platelet count. He was then noted to have declining platelet count on follow-up and required another hospital admission on day 19 of his illness because of declining platelet count. The patient remained hospitalised till day 44 of his illness and managed with repeated platelet transfusion and supportive care till he recovered spontaneously.
    MeSH terms: Acute Disease; Adult; Humans; Length of Stay; Male; Patient Readmission; Thrombocytopenia/etiology*; Time Factors; Platelet Transfusion; Severe Dengue/complications*; Severe Dengue/diagnosis*
  11. Alwi M
    Catheter Cardiovasc Interv, 2006 May;67(5):679-86.
    PMID: 16572430 DOI: 10.1002/ccd.20672
    Pulmonary atresia with intact ventricular septum (PAIVS) is a disease with remarkable morphologic variability, affecting not only the pulmonary valve but also the tricuspid valve, the RV cavity and coronary arteries. With advances in interventional techniques and congenital heart surgery, the management of PAIVS continues to evolve. This review is an attempt at providing a practical approach to the management of this disease. The basis of our approach is morphologic classification as derived from echocardiography and angiography. Group A, patients with good sized RV and membranous atresia, the primary procedure at presentation is radiofrequency (RF) valvotomy. Often it is the only procedure required in this group with the most favourable outcome. Patients with severely hypoplastic RV (Group C) are managed along the lines of hearts with single ventricle physiology. The treatment at presentation is patent ductus arteriosus (PDA) stenting with balloon atrial septostomy or conventional modified Blalock Taussig (BT) shunt. Bidirectional Glenn shunt may be done 6-12 months later followed by Fontan completion after a suitable interval. Patients in Group B, the intermediate group, are those with borderline RV size, usually with attenuated trabecular component but well developed infundibulum. The treatment at presentation is RF valvotomy and PDA stenting +/- balloon atrial septostomy. Surgical re-interventions are not uncommonly required viz. bidirectional Glenn shunt when the RV fails to grow adequately (11/2 - ventricle repair) and right ventricular outflow tract (RVOT) reconstruction for subvalvar obstruction or small pulmonary annulus. Catheter based interventions viz. repeat balloon dilatation or device closure of patent foramen ovale (PFO) may also be required in some patients.
    MeSH terms: Algorithms*; Echocardiography; Heart Defects, Congenital/diagnosis; Heart Defects, Congenital/pathology; Heart Defects, Congenital/therapy*; Heart Septal Defects/diagnosis; Heart Septal Defects/pathology; Heart Septal Defects/therapy*; Heart Ventricles/pathology*; Humans; Coronary Angiography; Pulmonary Atresia/diagnosis; Pulmonary Atresia/pathology; Pulmonary Atresia/therapy*
  12. Man Harun S, Faridah Y
    Biomed Imaging Interv J, 2006 Apr;2(2):e11.
    PMID: 21614223 MyJurnal DOI: 10.2349/biij.2.2.e11
    The advent of multislice computed tomography (CT) has revolutionised the performance of body CT and allowed the development of CT angiography (CTA). CTA is a robust and minimally invasive method of visualizing the arterial vascular system. The newer generation of multidetector scans has allowed for shorter scanning times with no respiratory misregistration at peak vascular opacification following peripheral contrast injection. The volume of data obtained from these scans can be further manipulated to generate two-dimensional (2D) and three-dimensional (3D) images with no increase in radiation to the patient. Hence, CTA has gained popularity and importance as the alternative diagnostic tool especially for ill patients in which conventional angiography is inadvisable.We present an infant with coarctation of the aorta and hypoplastic aortic arch, in which CT angiography was used to pinpoint the diagnosis. The CT findings were subsequently confirmed at surgery.
    MeSH terms: Angiography; Aorta, Thoracic; Aortic Coarctation; Humans; Infant; Radiographic Image Enhancement; Radionuclide Imaging; Multidetector Computed Tomography; Computed Tomography Angiography
  13. Bhugaloo A, Abdullah B, Siow Y, Ng Kh
    Biomed Imaging Interv J, 2006 Apr;2(2):e12.
    PMID: 21614224 MyJurnal DOI: 10.2349/biij.2.2.e12
    The primary objective of this study was to evaluate the specificity and sensitivity of diffusion weighted MR imaging (DWI) in the differentiation and characterisation between benign and malignant vertebral compression fractures compared with conventional T1 WI, T2 WI and fat suppressed contrast enhanced T1 WI in the Malaysian population.
    MeSH terms: Sensitivity and Specificity; Spinal Fractures; Diffusion Magnetic Resonance Imaging; Fractures, Compression
  14. Tan G, Abdullah B, Kunanayagam S
    Biomed Imaging Interv J, 2006 Apr;2(2):e13.
    PMID: 21614225 MyJurnal DOI: 10.2349/biij.2.2.e13
    Acquired intra-abdominal arteriovenous fistulas (AVFs) are a rare disorder where the communication most commonly occurs between abdominal aorta and inferior vena cava. Ilio-iliac AVF has been reported previously, but is exceedingly rare. We present a case of spontaneous ilio-iliac AVF in an elderly woman who presented with symptoms of right heart failure where the diagnosis was not considered. The computed tomographic (CT) and angiographic features are described. The current status of management as well as a review of the literature is also presented.
    MeSH terms: Aged; Aneurysm; Angiography; Aorta, Abdominal; Arteriovenous Fistula; Female; Heart Failure; Humans; Tomography, X-Ray Computed; Vena Cava, Inferior
  15. Ramli N, Ho K, Nawawi O, Chong H, Tan C
    Biomed Imaging Interv J, 2006 Apr;2(2):e16.
    PMID: 21614226 DOI: 10.2349/biij.2.2.e16
    BACKGROUND: Leuko-araiosis (LA) and dementia are common geriatric conditions but their pathogenesis and clinical significance are not completely understood. An evaluation of CT perfusion (CTP) in both these conditions can further enhance the understanding of these diseases.

    METHODS: Twenty-one patients with LA and 21 age-matched controls were studied with CTP and assessed for their cognitive function. The subjects were classified into four groups: Group 1, with LA (n = 21); Group 2, without LA (n = 21); Group 3, with dementia (n = 7); Group 4, without dementia (n = 11). The mean cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) values were compared between groups 1 and 2, while mean CBF values were compared between groups 3 and 4.

    RESULTS: Mean white matter CBF was considerably reduced in patients with LA in the frontal region by 42% (p = 0.000), basal ganglia by 37% (p = 0.000) and occipital region by 18% (p = 0.019). The mean white matter CBV was reduced in patients with LA in the frontal region by 36% (p = 0.000) and basal ganglia by 28% (p = 0.017). The mean white matter CBF was dramatically reduced in patients with dementia in the frontal region by 44% (p = 0.000), basal ganglia by 32% (p = 0.038) and occipital regions by 24% (p = 0.001).

    CONCLUSION: The CTP showed reduced white matter CBF and CBV in patients with LA. This is consistent with chronic ischemia as the pathogenesis of LA. The CTP is also a potentially important technique in the diagnosis and management of dementia, because of its ability to reveal cerebral hypoperfusion.

  16. Ahmad Sarji S, Wan Abdullah W, Wastie M
    Biomed Imaging Interv J, 2006 Apr;2(2):e21.
    PMID: 21614228 DOI: 10.2349/biij.2.2.e21
    To examine the role of imaging in diagnosing and assessing fungal infections in paediatric patients undergoing chemotherapy in a facility, which had high fungal air contamination due to adjacent building construction work.
    MeSH terms: Air Pollution; Child; Fungi; Humans; Mycoses
  17. Loke PY, Lee CY
    J Econ Entomol, 2006 Feb;99(1):129-33.
    PMID: 16573333
    Monomorium orientale Mayr (Hymenoptera: Formicidae) is a common structure- and food-infesting ant in Asia. There is only limited information on the biology and habits of this species, especially on the preferred foods and distribution of nutrients in colonies. We conducted a laboratory study on the distribution of carbohydrates, proteins, and lipids, which were represented by respective food sources, in M. orientale colonies. Three colony conditions were applied: normal, with a balanced ratio of castes, queenless (only workers and brood), and broodless (only queens and workers). Food sources were stained to track the flow of the respective food in the colonies. Results revealed that carbohydrates had rapid distribution, with > 60% of the colony indicated in 24 h, in all colony conditions. Queens in all colonies did not feed on protein. Protein showed a more delayed distribution in the brood in all colony conditions; < 10% of the colony fed on protein by 24 h. Only queens in broodless colonies showed signs of feeding on lipid, with < 10% indicated in 24 h. Workers in all colonies fed on lipid as soon as it was delivered, whereas the brood only began to reveal feeding response after 24 h.
    MeSH terms: Animals; Animal Nutritional Physiological Phenomena*; Ants/physiology*; Diet; Dietary Carbohydrates/metabolism; Feeding Behavior; Food Analysis; Proteins/metabolism; Lipid Metabolism
  18. Sugiatno E, Samsudin AR, Ibrahim MF, Sosroseno W
    Biomed Pharmacother, 2006 May;60(4):147-51.
    PMID: 16581222
    The aim of the present study was to determine the effect of nitric oxide (NO) on the production of prostaglandin E2 (PGE2) by a human osteoblast cell line (HOS cells) stimulated with hydroxyapatite. Cells were cultured on the HA surfaces with or without the presence of NO donors (SNAP and NAP) for 3 days. The effect of NO scavenger, carboxy PTIO, or endothelial nitric oxide synthase (eNOS) inhibitor, L-NIO, was assessed by adding this scavenger in the cultures of HA-stimulated HOS cells with or without the presence of SNAP. Furthermore, HOS cells were pre-treated with anti-human integrin alphaV antibody, indomethacin, a non-specific inhibitor, aspirin, a COX-1 inhibitor, or nimesulide, a COX-2 inhibitor, prior to culturing on HA surfaces with or without the presence of SNAP. The levels of PGE2 were determined from the 3 day culture supernatants. The results showed that the production of PGE2 by HA-stimulated HOS cells was augmented by SNAP. Carboxy PTIO suppressed but L-NIO only partially inhibited the production of PGE2 by HA-stimulated HOS cells with or without the presence of exogenous NO. Pre-treatment of the cells with anti-human integrin alphaV antibody, indomethacin or nimesulide but not aspirin suppressed the production of PGE2 by HA-stimulated HOS cells with or without the presence of NO. Therefore, the results of the present study suggest that NO may up-regulate the production of PGE2 by augmenting the COX-2 pathway initiated by the binding between HOS cell-derived integrin alphaV and HA surface.
    MeSH terms: Cell Line; Enzyme Inhibitors/pharmacology; Humans; Nitric Oxide/pharmacology*; Ornithine/analogs & derivatives*; Ornithine/pharmacology; Osteoblasts/drug effects*; Dinoprostone/metabolism*; Durapatite/pharmacology*; Nitric Oxide Donors/pharmacology; S-Nitroso-N-Acetylpenicillamine/pharmacology; Integrin alphaV
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