Sh. Manoj Pande, Member Staff, Railway Board, Visits NR Divisional Hospital, Lucknow

(right to left) Dr V M Sinha, Chief Med Supdt, Sh Manoj Pande, Member Staff, Rly Board, Mrs Kalpana Pande, Mrs Veena, ADRM and Dr Jagdish Chandra, Addl CMS

This morning, NR Divisional Hospital, Lucknow had a special guest – Sh Manoj Pande, Member Staff (MS), Railway Board and ex-officio Secretary to Govt of India, who was accompanied by his wife, Mrs Kalpana Pande visited the hospital and spent about two hours with the doctors and other medical staff. 

MS was accorded warm welcome by Chief Med Supdt of NR Lucknow Division, Dr V.M. Sinha and her team of doctors. He went around the OPD Block and particularly appreciated the RELHS OPD with adequate waiting area, consultation space, dispensing area, and routine check-ups like Blood Sugar and Blood Pressure measurement. Such an arrangement avoids Sr citizens’ hopping from one place to another. 

MS went around the Radiology Deptt and saw the place where Indian Railway’s first 128 slice MD CT scanner is going to be installed very soon (purchase order already issued).

Thereafter, Dr Jagdish Chandra, Addl CMS (Radiology) gave a power point presentation about the Medical Deptt of Lucknow Division, highlighting its strengths and a wish-list too! There was an audio-visual curtain-raiser about the state-of-the-art CT scanner which is being installed in this hospital. 

Dr Jagdish Chandra, Addl CMS (Radiology) delivered an elaborate presentation

Dr Chandra enlightened the audience that the CT Scanner to be installed is first of its kind in a Govt hospital in the country. Apart from serving Northern Rly, North-Eastern Rly and RDSO railway beneficiaries, once installed this CT scan centre would develop into a centre of excellence which would attract patients from other zones, more so when this would also be able to perform non-invasive Coronary Angiography of patients

Dr Ashish Tripathi, Dr Sanjeev Dixit and Dr Amrendra Kumar delivering talk on HIV/AIDS

Incidentally, today happened to be World AIDS day. Dr Ashish Tripathi, ADMO delivered a talk on the prevalence of  HIV infection and its brief history which was followed by an interactive session on AIDS and HIV by Dr Sanjeev Dixit, Addl CMS (Physician). 

MS was curious to know if it was AIDS that kills the infected person! Dr Dixit explained that AIDS does not kill – these are the opportunistic infections which play havoc with the infected person due to his decreased (compromised) immunity. He further elaborated that early diagnosis is the key since these days we have very effective ART therapy (Anti-Retro Viral Drugs) which can control the progress of the disease to a large extent and patient can lead a long, quality life. He underlined the importance of ABC in prevention of HIV infection – Abstinence, Being faithful to your partner and third being Using Condoms and not indulging in high-risk sexual behaviour. Dr Amrendra Kumar, ACMS(physician) also threw light on some important aspects of this infection. 

MS, Sh Manoj Pande’s addressed the gathering

Mr Pande addressed the gathering and informed that he was always curious to know about the working of Railway Hospitals since it helps decision-making once one is aquainted with ground realities. He shared very useful insights into the Hospital Management Information System (HMIS) and also innovative approach for overcoming security problem in Hospitals by utilising ex-servicemen (re-employed in Rlys) since they have more disciplined demeanor. He also gave practical tips for resolution of other issues involving Medical Officers. 

He informed that very soon new paramedical personnel would be joining the hospital and hence the senior employees already working here should adopt the role of mentors for their fresh counterparts and inspire and motivate them.

Dr V M Sinha, CMS gave the vote of thanks and assured the Member Staff that Divl Hospital, Lucknow will scale new heights in times to come and that she aspires it to be the best hospital in Northern Railway.

After the scientific deliberations were over, MS interacted with all the doctors over a cup of tea and gave a lot of useful tips on resolving personnel issues. Some of the doctors cleared their doubts about some day-to-day medical issues having Personnel implications. Overall, it was a very useful session. 

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Health Camp at Lucknow’s Bal Vihar School Run by NRWWO

A Health Camp was organised on November 16′ 2019 at Railway’s Bal Vihar School at Bandriya Bagh, Lucknow. This school, located in a very posh area,  is run by Northern Railway Women Welfare Organisation (NRWWO).

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About 300 school kids were examined thoroughly by a team comprising of two Paediatricians, Ophthalmologist, ENT specialist and Dentist. 20 underprivileged kids from the shelter home at Charbagh Railway Station run by an NGO, Chetna were also examined.

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Before the children came to the paediatricians, their height and weight were noted down. Thereafter, each child was thoroughly examined by the Sr. Paediatricians – Dr Shubha Srivastava and Dr Urmi Sarkar.

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After examination, the necessary advice was given and medications prescribed which included de-worming Tablet (Albendazole) , Iron, Calcium and B Complex Tablets, wherever required. Importance of good personal hygiene including taking care of nails and hair etc was explained to the children.

I just want to put this fact on record that this School Health Check-up is not a just formality – after various specialists have examined the children, their Health Cards are scrutinised by the Paediatricians who share the findings with their class teachers. Class teachers in turn are motivated to call parents to apprise them about the health needs of their tiny tots – be it preventive, promotive or curative.

Dr Praveen Chopra, Dentist and Dr V M Hyanki, ENT specialist went to all the class rooms and demonstrated good oral hygiene practices to children. As expected, kids are always amazingly receptive. The correct way of tooth brushing was demonstrated to all the school children. Importance of using a tongue-cleaner was emphasised as also the good old practice of rinsing one’s mouth with water after meals.

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Children were explained the dangers of various forms of tobacco products, including Gutkha and Paan Masala and were advised to stay away for these products including Meethi-Supari which is also a “trap” for cultivating a generation of Pan-Masala Chewers. Dr Hyanki told kids to tell their family members to stop using such harmful products. A boy stood up and said – “My papa uses it, I tell him not to use but he still uses it!!” This scholar was asked to be perseverant and not to stop till he succeeds in his mission ! May the good sense prevail upon all those souls who are hooked to such deadly stuff.

During examination of oral cavity of these children, it was noticed that a number of children required minor interventions like removal of some extra tooth, removal of some over-staying milk tooth, and correction of minor defect in alignment of teeth which would otherwise culminate in ‘crooked teeth’. Later on,  correction of such malposed teeth requires considerable resources in terms of manpower and money. So, the urgency of intervention was explained to the children and/or their teachers.

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Early signs of major dental problems 

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Similarly, ENT specialist noticed a lot number of cases with ear wax and a few cases of ‘oozing ears’, in layman’s terminology. Eye specialist noticed some children had refractive error (vision problem) and some cases of Allergic Conjunctivitis. Suitable advice was given.

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Chief Medical Supdt (CMS) of Northern Railway, Lucknow Division, Dr Vishwa Mohini Sinha, a very renowned and popular gynaecologist herself,  under whose dynamic leadership this program was being organised was available throughout for any guidance. She was also interacting with tiny tots.

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CMS, Dr V M Sinha, interacting with small kids

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ADRM (Admn) Dr Veena is having friendly interaction with a little angel 

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Face is not just the Index of mind – it does narrate tell-tale signs of some deficiencies too

Whole team of Railway Hospital was working throughout during this camp – Matron Shaila was doing registration, Hospital Attendants were doing height and weight measurements, giving Vitamin A dose to the children and helping in maintaining queue. I noticed that when shoe laces of two kids were open, Hospital Attendant Suresh started helping kids in tying these knots and teaching them the easy-n-correct way with love and affection. This lil’ kind gesture touched me and without his knowing I dared to take this shot.

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The children are so inquisitive and receptive that after learning correct oral hygiene practice on the dental models, they started practical hands-on and teaching other kids!!

Another boy wanted to know about the fact mask and the way we tie it on face! Our Hosp Attendant, Suresh satisfied his curiosity – boy was happy when his class mates started calling him “Doctor!”.

Such camps bring a pleasant whiff of nostalgic winds for team members too. I remember during my schooling at DAV Amritsar, we also used to be examined like this – but by a single doctor who perhaps used to be all-in-one! I vividly remember during eight or ninth standard during such a check-up, I wanted to talk to that doctor. However,  he was in hurry, and I too hesitated a bit.

After listening to whatever I could utter, he scribbled on a piece of paper “Waterbury’s Tonic”. Back home, I handed over that prescription to my dad who brought it for me! However, question(s) in my mind kept haunting me till I was 20 and found out the answer myself. Anyway, at the camp near my table there was this School Ghanti (Talli )- What a great thing – its ringing always brought 1000 watt smiles on 1000 faces! 

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The author with the most pleasant thing in a School – Talli!! 

While interacting with kids, I was continuously reminded of verses penned by Nida Fazli saab  and Janab Bashir Badr, who have said a lot about upbringing of kids.

बच्चों के छोटे हाथों को चांद सितारे छूने दो 

चार किताबें पढ़ कर वो भी हम जैसे हो जाएंगे

किन राहों से दूर है मंज़िल कौन सा रस्ता आसां है

हम जब थक कर रुक जायेंगे औरों को समझायेंगे 

उन्होंने यह भी क्या खूब कहा है …

धूप में निकलो घटाओं में नहाकर देखो

ज़िंदगी क्या है किताबों को हटाकर देखो 

सिर्फ आंखों से ही दुनिया नहीं देखी जाती

दिल की घड़कन को भी बीनाई बना कर देखो

और जनाब बशीर बद्र भी क्या खूब फ़रमाते हैं –

उड़ने दो परिन्दों को अभी शोख हवा में 

फिर लौट के बचपन के ज़माने नहीं आते 

During this camp, President of NRWWO, Mrs Singh, W/o General Manager, Northern Railway, Sh T P Singh visited the school. She, accompanied by President NRWWO, Lucknow, Mrs Tripathi, W/o of DRM, NR, Lucknow and other members interacted with school children and were curious to know about the health status of kids.

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NRWWO President (Right) accompanied by CMS graced the occasion by her presence 

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NRWWO President, Mrs Singh distributed gifts to the underprivileged children from NGO, Chetna and school uniforms to the school children.

Let me wrap up this post by playing a beautiful evergreen song from the movie Guddi …

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Cure for Gutkha-Panmasala Problems!

I have shared a number of case reports of youngsters- some of them in their teens- on this blog about the serious problems being faced by the people who are hooked to Pan-masala and Gutkha.

Mouth cancer is an extreme – it is almost always preceeded by warning signs which are mostly ignored by the Gutkha chewer. Most frustrating is to find youngsters unable to take food as their mouth is almost closed or mouth opening is so small that it is good enough only for taking liquid diet.

Every other day I get an email from one youngster or the other asking for its cure as their mouth opening has reduced drastically.

So, once again this morning i thought of sharing some facts about the cure of the problems caused due to all these pan-masalas and other smokeless products.

The referral and reimbursement system is quite satisfactory in the organisation for which I am working. However, it is regretted that in spite of this except oral cancers (caused due to tobacco products), I seldom come across people who have been cured of problems like decreased mouth opening etc (with some exceptions of course). Either they don’t take complete treatment and leave mid way or they are unable to leave this deadly habit.

A person who has landed into this problem, just out of ignorance, feels that like most of other health issues, these mouth problems would also vanish with some magic wand in the form of costly medicines for applying in the mouth or by taking some medicines orally.

In fact, they are under the impression that they can continue the habit and simultaneously take treatment. It NEVER works that way, guaranteed ! Still, leaving the habit early and taking necessary treatment from a qualified specialist definitely helps and I have seen improvement in mouth opening in such cases and also healing (to some extent) of chronic oral ulcerations.

When a youngster sends an email to me, I motivate him to kick the habit immediately. Then, he should head towards some nearby Dental College & Hospital where they have all the oral health specialists under one roof who then do treatment planning for the patient. Oral Surgeon is the best specialist to manage such “closed” mouths.

Trust me, if you want, the problems caused by the above habits are so debilitating in some people that they start surviving only on liquids and even are not able to clean or rinse their mouth. Subsequently, even cancer of mouth can develop in these individuals.

In the above paras, i mentioned somewhere that oral cancer can be cured. Of course, it is true, but if detected in time and the person is ready to kick the bad tobacco and pan-masala habits. Even otherwise, after complete treatment of oral cancer, the person suffers so much facial disfigurement and dependence on “feeding by tube”etc,  just to name a few, i swear a reader of this blog can’t even imagine most of these problems.

Having said all this I must remind the readers – “Hope lasts with life.” Nature is great with abundant healing capacity. So, first of all the youngsters should kick this habit and then should be examined by a Dental expert who would refer them to a qualified oral surgeon, if needed. He should meticulously follow the advice of the specialist by taking medicines and applying some medicaments over the “sore” (ulcerated) areas in the mouth. The patient is required to refrain from tobacco in all forms (Bidi/Cigarette also) and take a well balanced diet rich in vitamins. It is advisable to take abundant Vit C in natural form like citrus fruits, gooseberry (Amla) etc. and the patients are advised accordingly.

I wonder if these youngsters listen ..indeed it is quite disappointing to see youngsters waiting at petrol pumps on their motorcycles and putting 2-3 pouches of gutkha/panmasala in one go into their mouth.

God bless them!

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Betel-quid, Pan Masala & Gutkha Banned in UP Govt. Offices

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I came to know about this great news this afternoon.

It is a very bold decision. Great indeed. It requires a lot of courage and conviction.

Being a dental professional, sometimes I do come across dental patients who have their pan, pan-masala, tobacco or gutkha (some of the forms of smokeless tobacco) parked in their cheeks.

They are asked to spit it out and then come back for dental check-up. But my health attendant is very strict in discouraging such tobacco chewers to spit in clinic wash basin.

Not even this, some of the attendants/relatives accompanying the patients are also chewing some of these products when i am attending their patients .

This great news regarding ban of Pan, Pan Masala & Gutkha in Govt Offices of Uttar Pradesh in India was being telecast this afternoon.

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As always happens, reactions also started coming up. Some people were saying that the cleaning process should have started with the Members of Chief Minister’s cabinet, some of whom are quite  fond of all such stuff.

It would surely be a challenge to see in Uttar Pradesh how this ban gets implemented where this pan/gutkha chewing habit has become socially acceptable.

I am working in Lucknow city for the last four years and I have three concerns – first, when I driving my two wheeler and some one travelling in a 2/4 wheeler gets rids of his ‘chewed’ stuff, and I get some droplets on my face, it is damn irritating. Second, when in an office, when I have to speak to a person whose mouth is ‘full’ of this stuff, at that moment, more than the dangers of this habit on his health, I am ‘worried’ about my new shirt getting droplets of his red-coloured saliva. Third, seeing some doctors and medical workers chewing Pan Masala/Gutkha is all the more frustrating.

By the way, right now  i am all the more frustrated due to mosquitoes which are biting me and in between I take a break to ‘get rid of’ one or two such irritants.

Feeling sleepy…goodnight, take care!

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At Times Teeth Are Sacrificed Without Any Fault

During our dental college days we used to be taught in details about the trigeminal neuralgia and its management. Our great teachers used to tell us that this condition is often ignored and goes undiagnosed.

In Trigeminal neuralgia, the facial pain is very severe and neuralgic and patient think that it is due to his bad teeth. These patients somehow find some dentists, at times quacks, who start pulling out their healthy teeth one by one till these patients are rendered totally toothless.

Then these patients narrate this tale that due to this excruciating pain, they got their all the teeth removed but there is no relief.

There are effective way to tackle this pain due to trigeminal neuralgia by various means…medicines, surgery, injection etc.

This thought caught me yesterday after a young man in his early twenties came to me with severe pain in his teeth for the last 7-10 days. He told me that pain is so severe that he is unable to sleep.

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Herpes Zoster needs treatment with Anti-viral medicines for few days…he didn’t receive any treatment

 

I noticed these scars on his face. Since i found his teeth and gums in perfectly healthy condition, i was curious to know about these blister scars on his face.

He told me that about 15 days ago he got severe pain in his ears for about a week which was followed by the blisters on the face which were very painful. While travelling in train, he covered these blisters with his hanky. He noticed that it became all wet and he thought it was the cause of problem. I reassured him.

After that, those blisters started to heal.

Looking at the distribution of the blisters on his face, I suspected that he suffered from Herpes zoster. This condition is viral in nature and it involves the body area supplied by a particular nerve, in this case it was facial nerve.

He just took some medicines from here and there and some injection from some neighborhood doctor. Somehow he passed time till the teeth start aching very badly and he came to me.

He was referred to physician who also suspected Herpes zoster and prescribed some medicines for nerves, nerve-tonics type of medicines along with some strong pain-killer so that he could sleep during night.

This is one of the complications of herpes zoster infection – after the infection, the residual nerve pain continues for variable periods of time — may be weeks, months and years even. He has been advised and reassured accordingly.

This post is just to remind that self medication is dangerous and whenever there is some health issue, it is always prudent to consult a qualified doctor so that proper treatment can be given to ‘nip the evil in the bud’.

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Areca nuts- Smokelss tabacco play havoc with young lives

IMG_20160728_124146This is the dental photograph of a 23 year young man who had come to me with swelling of  face on his right side (involving lower jaw).

IMG_20160728_124041It was noticed that he is not able to open his mouth properly. There was restricted mouth opening as you can see in this picture. The swelling was primarily due to an erupting third molar tooth – this swelling will go away in 3-4 days with a course of antibiotics and analgesic-anti inflammatory medicines. But the trismus (decreased mouth opening) would stay on!

This man had used some products – Pan Masala (mainly comprises of areca nuts or commonly called betel nuts) and Gutkha (made of powdered tobacco). This is a deadly combination. The use of these two products is quite rampant in India.

Because of this habit, people in younger age group are suffering from Oral submucous fibrosis – a precancerous oral condition in which oral opening starts getting lesser and lesser and the oral tissues become very hard -just like dry leather. The patients also develop all type of ulcers in the mouth for which they keep on trying all sorts of gels and drops without any results.

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Oral tissues become pale, blanched out and hard like dry leather- this young man is 23 years old

With times, the oral opening becomes so less… that it becomes difficult to even take meals. Some of the youngsters have to switch over to semi-solid or liquid foods. The other day I saw a young man who was pushing food into the mouth with the help of his fingers.

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This young man also started using these products when he was around 15 years, used it for around 7-8 years, about 10 packets per day. He says he has left this habit about a month ago when he noticed that he is not open his mouth fully.

Inside his mouth, you can notice the oral mucosa has turned pale and has blanched appearance. It becomes so tight and hard that even oral examination becomes quite difficult.

The persons suffering from oral sub mucous fibrosis have difficulty in having any spicy food. It is definitely a precancerous condition and if this harmful habit of areca nut chewing and smokeless tobacco is not kicked off, it can develop into oral cancer.

People hardly listen. They only listen when they are unable to take food or develop oral cancer- generally it is too late by then.

We refer many such cases to the oral and maxillofacial surgeon who is the best person to treat such condition. Regarding treatment, first of all i counsel them to stop this habit. It definitely helps but i don’t remember when i saw any person totally cured of this condition.

What to do? The treatment is quite expensive. Even though we reimburse the full cost of treatment to our patients, with time they are almost always lost to follow-up. Perhaps they get fed up with lengthy treatment which requires lot of perseverance.

I always tell youngsters to stay away from such habits…prevention, prevention, prevention and very early diagnosis when the inside of mouth starts feeling hard is the best policy. Once the problem sets-in, it is just ‘sugar-coated’ talking, nothing beyond that perhaps.

Seeing such patients is definitely a very depressing experience for doctors howsoever we may act ‘detached’!  All the possible warnings- pictorial and graphic- are printed on pouches of these products declaring clearly that its use can cause oral cancer and this habit is lethal.

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This author trying to learn some selfie tricks last night!

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Avoid going to Unqualified Chinese Dentists

Since my childhood days, i have been hearing about china dentists in India. Perhaps in all the cities some chinese dentist are having ‘dental shops’.

I have nothing against chinese doctors who are qualified in Dentistry and have a professional qualification. However, i have noticed during the last few decades that the chinese dentists (china dentists) who are quite popular in some towns are without any qualifications- they have just learnt the art of dentistry.

But practice of dentistry was never a mechanical job..it can never be! It is all about bio-mechanics. We are dealing with human beings and delicate tissues and surrounding structures.

So-called unqualified but “trained-on-job” type of fake dentists dont know anything about biology…just pulling a tooth, packing something in cavities, and fixing the most crude type of dentures is not dentistry. It is butchery– that’s a mild term. We are seeing such quacks daily on Indian road-side.

A qualified and trained dentists knows his limits, he respects the tissues and treats them gently. He takes all the precautions to ensure prevention of cross infection. Otherwise, non knowing ABC of sterilization and asepsis can be lethal for patients.

Such road side dentists are playing with lives by exposing them to deadly diseases like hepatitis B, hepatitis C and HIV infection – just to name a few!

Problem is educated class in India also shy away from road-side quacks but as I said earlier even affluent Indian are quite Ok with chinese doctors (unqualified quacks, some of them with modern dental clinics).

We must remember that these quacks may be very good craftsmen, but that is dangerous if it not supported by sound knowledge of medical sciences.

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Broken tooth in a 27 year old man

Today there was a patient about 27 years old, who fell down 16 years ago and fractured his upper front tooth as you see in this picture. He went to a china doctor in his hometown in Patna and got this crown fitted. This crown became shaky for the last one month and just came out yesterday.

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An Indigenous type of Dowel crown which served him for 16 years..

When i was looking at this crown, i was appreciating the workmanship of that china doctor. The crown has some issues (which are beyond the scope of this post), nevertheless, an artificial crown which served this young man for the last 16 years.

I offered to re-cement it for the time being. But the young man wanted some second opinion is some higher dental centre, since it is quite old now!

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This post is just to highlight the fact that china doctors can be great ‘mechanics’ but as with any non-qualified doctor/dentist, our overall well-being is at stake. We are exposed to so many hazards when we are in their hands.

Take care! Always go to professionally qualified and trained doctors. Your health is in your hands!

PS…I have nothing as such against any qualified dentists from any country. Just felt like sharing my views on dental quacks which sometimes are quite popular amongst Indian people.

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