Monday, 7 September 2015

[www.keralites.net] One sided wrist and locking of thump

 

A friend of mine of 65 years suffering from one sided wrist pain extending towards the the thump and not able bend the thump without pain. Can anybody suggest a remedy or treatment for it.


 

Have anybody gone through such pain.

J john


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[www.keralites.net] Shocking Cancer Information

 

Shocking Cancer Information


Written by a doctor who suffers from cancer and he uses alternative rather than conventional medicine that involves chemo etc. Good to share with family and friends.

Cancer treatment is about making money...provoking thoughts
I posted this article, which may have some provoking thoughts:

The below is absolutely 100% true and as a doctor I have been telling people this for 15 years now. No one wants to listen. Folks need to wake up. Cancer treatment is about making money. It is a 120 billion dollar a year industry in the United States alone and estimated to be a 600 billion dollar a year industry worldwide.

A successful cancer case according to the American Cancer Society and the American College of Oncology and Hematology means that the person survives for 5 years. Both the American Cancer Society and the American College of Oncology and Hematology admit that a person is likely to survive cancer for 7 to 10 years even if they do absolutely NOTHING. Of course, only the doctors get those magazines - not you, the cancer patient.

Alternative medicine's track record of curing cancer is 10 times higher than that of conventional medicine. Note that I say CURE.

Remember another thing.

A TUMOR is just a symptom.

It is not the cause of cancer.
Science is cause and effect. Remove the cause and the effect disappears.
I am in my third battle with cancer right now. I have not done any chemotherapy or radiation or surgery for any of my bouts with cancer.

I survived leukemia, I survived Non Hodgkins Lymphoma and now I have Glioblastoma which is supposedly an incurable form of brain cancer.

I was given two months to live 5 months ago.

I have been
using Chinese herbs, high doses of vitamin C, acupuncture, chiropractic, homeopathy and nutritional changes.

Yes, at first it got worse. It had metastasized to my lymph nodes, my lungs and my bones.

As of this week, I am happy to say that there is no evidence now of any cancer in my lymph system or my bones.

I had 6 tumors in my lungs, now there are only two. The tumors in my brain have shrunken tremendously. I never did any of their chemo, radiation or surgery.

Here is a very interesting statistic that you can only have access to by being a doctor.

Every year more than 1,000 doctors oncologists (cancer doctors) are diagnosed with cancer. Less than 10% of them choose to do the treatment that they have been giving to their patients.

Sort of like the fact that less than 25% of all pediatricians vaccinate their own children because of the fact that the risk of sudden death

or serious side effects from the vaccination is higher than the risk of catching the disease one is being vaccinated for.

This is not bullshit people - it is truth.

Medicine is about money, not about your health and the system traps people, especially the elderly, disabled and poor into a deadly treatment regime that puts them in an early grave. Meanwhile, all the jet set billionaires are flying off to Europe and paying big bucks for alternative treatments and getting cured.


Does alternative medicine work all the time?

No. Of course not. Nothing works all the time. But there is a reason for that. You don't die until it's your time to die. Nothing can make you live longer than that time.

However quality of life comes into play.

Those cancer patients who use alternative therapies for their cancer, yet still die from the illness, suffer a much higher quality of life.

They die able to spend time with their families and even recognize their family members.

They don't become emaciated like those who do chemotherapy or radiation do and rarely is a person who goes under the treatment of chemotherapy able to recognize anyone for the last few days of their lives.

Their bodies become ravaged to the point that you can't even recognize them either. They suffer at a much much higher rate and they have one let down after another as doctors tell them, ahhh - it's looking good, only to tell them on the next visit it's looking worse, you need more chemo and radiation.

What is criminal about this is that

YOUR DOCTORS KNOW THIS SHIT.

I took an oath as a physician. I have always followed it. That has certainly not made me successful financially as a doctor because I have consistently refused to go along with conventional medicine's bullshit.

Read the below carefully. It may indeed make a difference in your life.

Rick Cantrell, PhD, MD, PsyD

AFTER YEARS OF TELLING PEOPLE CHEMOTHERAPY IS THE ONLY WAY TO TRY ('TRY', BEING THE KEY WORD) TO ELIMINATE CANCER, JOHNS HOPKINS IS FINALLY STARTING TO TELL YOU THERE IS AN ALTERNATIVE WAY .

Cancer Update from Johns Hopkins :

1. Every person has cancer cells in the body. These cancer cells do not show up in the standard tests until they have multiplied to a few billion. When doctors tell cancer patients that there are no more cancer cells in their bodies after treatment, it just means the tests are unable to detect the cancer cells because they have not reached the detectable size.

2. Cancer cells occur between 6 to more than 10 times in a person's lifetime.

3. When the person's immune system is strong the cancer cells will be destroyed and prevented from multiplying and forming tumors.

4. When a person has cancer it indicates the person ha nutritional deficiencies. These could be due to genetic, but also to environmental, food and lifestyle factors.

5. To overcome the multiple nutritional deficiencies, changing diet to eat more adequately and healthy, 4-5 times/day and by including supplements will strengthen the immune system.

6. Chemotherapy involves poisoning the rapidly-growing cancer cells and also destroys rapidly-growing healthy cells in the bone marrow, gastrointestinal tract etc, and can cause organ damage, like liver, kidneys, heart, lungs etc.

7.. Radiation while destroying cancer cells also burns, scars and damages healthy cells, tissues and organs.

8. Initial treatment with chemotherapy and radiation will often reduce tumor size. However prolonged use of chemotherapy and radiation do not result in more tumor destruction.

9. When the body has too much toxic burden from chemotherapy and radiation the immune system is either compromised or destroyed,hence the person can succumb to various kinds of infections and complications.

10. Chemotherapy and radiation can cause cancer cells to mutate and become resistant and difficult to destroy.
Surgery can also cause cancer cells to spread to other sites.

11. An effective way to battle cancer
is to starve the cancer cells by not feeding it with the foods it needs to multiply.

*CANCER CELLS FEED ON:-

A. Sugar substitutes like NutraSweet, Equal, Spoonful, etc are made with Aspartame and it is harmful.

A better natural substitute would be Manuka honey or molasses, but only in very small amounts.

Table salt has a chemical added to make it white in color Better alternative is Bragg's aminos or seasalt.

B. Milk causes the body to produce mucus, especially in the gastro-intestinal tract.

Cancer feeds on mucus.

By cutting off milk and substituting with unsweetened soy milk cancer cells are being starved.

C. Cancer cells thrive in an acid environment.

A meat-based diet is acidic and it is best to eat fish, and a little othermeat, like chicken.

Meat also contains livestock antibiotics, growth hormones and parasites, which are all harmful, especially to people with cancer.

D. A diet made of 80% fresh vegetables and juice, whole grains, seeds, nuts and a little fruits help put the body into an alkaline environment.

About 20% can be from cooked food including beans. Fresh vegetable juices provide live enzymes that are easily absorbed and reach down to cellular levels within 15 minutes to nourish and enhance growth of healthy cells.

To obtain live enzymes for building healthy cells try and drink fresh vegetable juice (most
vegetables including bean sprouts) and eat some raw vegetables 2 or 3 times a day.
Enzymes are destroyed at temperatures of 104 degrees F (40 degrees C)..

E. Avoid coffee, tea, and chocolate, which have high caffeine Green tea is a better alternative and has cancer fighting properties. Water-best to drink purified water, or filtered, to avoid known toxins and heavy metals in tap water.

Distilled water is acidic, avoid it.

12. Meat protein is difficult to digest and requires a lot of digestive enzymes.

Undigested meat remaining in the intestines becomes putrefied and leads to more toxic buildup.

13. Cancer cell walls have a tough protein covering.

By refraining from or eating less meat it frees moreenzymesto attack the protein walls of cancer cells and allows the body's killer cells to destroy the cancer cells.

14. Some supplements build up the immune system

(IP6, Flor-ssence, Essiac, anti-oxidants, vitamins, minerals, EFAs etc.) to enable the bodies own killer cells to destroy cancer cells..

Other supplements like vitamin E are known
to cause apoptosis, or programmed cell death, the body's normal method of disposing of damaged, unwanted, or unneeded cells.
15. Cancer is a disease of the mind, body, and spirit.
A proactive and positive spirit will help the cancer warrior be a survivor.

Anger, un-forgiveness and bitterness put the body into a stressful and acidic environment.

Learn to have a loving and forgiving spirit.

Learn to relax and enjoy life.

16. Cancer cells cannot thrive in an oxygenated environment.

Exercising daily, and deep breathing help to get more oxygen down to the cellular level. Oxyge therapy is another means employed to destroy cancer cells.

1. No plastic containers in micro.
2. No water bottles in freezer.
3. No plastic wrap in microwave..


Johns Hopkins has recently sent this out in its newsletters. This information is being circulated at Walter Reed Army Medical Center as well. Dioxin chemicals cause cancer, especially breast cancer. Dioxins are highly poisonous to the cells of our bodies.

 

Don't freeze your plastic bottles with water in them as this releases dioxins from the plastic. Recently, Dr Edward Fujimoto, Wellness Program Manager at Castle Hospital , was on a TV program to explain this health hazard. He talked about dioxins and how bad they are for us.

He said that we should not be heating our food in the microwave using plastic containers. This especially applies to foods that contain fat. He said that the combination of fat, high heat, and plastics releases dioxin into the food and ultimately into the cells of the body.

Instead, he recommends using glass, such as Corning Ware, Pyrex or ceramic containers for heating food. You get the same results, only without the dioxin.

So such things as TV dinners, instant ramen and soups, etc., should be removed from the container and heated in something else.

Paper isn't bad but you don't know what is in the paper. It's just safer to use tempered glass, Corning Ware, etc. He reminded us that a while ago some of the fast food restaurants moved away from the foam containers to paper The dioxin problem is one of the reasons.

Please share this with your whole email list.........................

Also, he pointed out that plastic wrap, such as Saran, is just as dangerous when placed over foods to be cooked in the microwave.

As the food is nuked, the high heat causes poisonous toxins to actually melt out of the plastic wrap and drip into the food.

Cover food with a paper towel instead.


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[www.keralites.net] MANAGEMENT OF HYPO THYROIDISM IN AYURVEDA

 

Management of Hypothyroidism in Ayurveda

by Dr V V Lakshmi Prasuna

The incidence of Hypothyroidism is increasing day by day, and there is increasing demand to treat the disease through the Ayurvedic system of medicine, as it is completely natural and safe. Hypothyroidism can be treated effectively if we understand the disease and select the proper drugs, according to the condition and exact aetiology of the disease.

There has been slow advancement in the knowledge of thyroid disorders since the dawn of the 20th century. Awareness of the thyroid gland can be traced back as far as the first century AD when Galen, a famous Greek doctor, provided a brief description of this gland. He suggested that it functioned to lubricate the larynx, a view that was accepted for a long time. In 1656 Thomas Wharton named the thyroid, from the Greek word thyreos meaning 'Oblong shield'. He suggested that the purpose of the thyroid was to beautify the neck by giving it a rounder contour through filling the vacant spaces around the larynx.[1] 

Function of Thyroid Gland and Hormone

Even up to 1880, the thyroid was proposed as a receptacle of worms, or even a vascular shunt, to cushion the brain against a sudden increase in blood flow. The definite function of the thyroid as a controller of metabolism was studied and confirmed by George Murray, Hector Mackenzie and Edward Fox .[1, 2, 3]  
 

Thyroid-Gland
Thyroid-Gland

The major function of the thyroid hormones is to stimulate the synthesis of protein once they have entered the cell nucleus. Another important function is to stimulate the activity of the cell's mitochondria. These intracellular organelles are the sites at which there is a controlled exchange of energy. Some energy is conserved for the body's functioning, while the remainder is dissipated as heat. The proportion of energy devoted to each of these processes is controlled by the thyroid hormones.[4]                
 

Cells respond to the thyroid hormone with an increase in metabolic activity. Metabolic activity, or metabolism, is a term used to describe the processes in the body that produce energy, and the chemical substances necessary for cells to grow, divide to form new cells, and perform other vital functions.[4, 5]

In the Rig Veda {the first of a collection of sacred ancient Hindu texts) the first Rik starts with the 'agni meele purohitam' meaningagni is purohita, the conductor of rituals to protect the pura or this body.[6]  The term agni means fire, which is a prime and ultimate factor in the maintenance of life. In vachaspatyamagni is defined as 'nayate parinamayateeti' that which brings changes in an organism or a substance, indicating it is a key factor in transformation of consumed ahara viharadi dravyas of vijateeya(heterogeneous) origin into sajateeya (homogenous) nature. Since agni is a derivative of teja mahabhoota, it carries to paka in which the inherent feature is change. The term metabolism, which literally means change, is used to refer to all the chemical and energy transformations that occur in the body, which is nothing but the function of agni viz. 'Nayate parinaaamyateeti'.[6]

Hypothyroidism results when the thyroid gland fails to produce enough of the thyroid hormone, due to structural or functional impairment that significantly impairs its output of hormones - this leads to the hypo metabolic state of hypothyroidism. This tends to slow down the body's functions. The thyroid gland controls metabolism through the production of thyroid hormone. Hypothyroidism occurs when the thyroid gland does not produce enough thyroid hormones.[7]

Main Causes of Hypothyroidism

The main causes of hypothyroidism can be classified [8] into:

1. Primary (thyroid failure): Hypothyroidism, caused by the inability of the thyroid gland to make T3 and T4, is called primary hypothyroidism;
Primary hypothyroidism is a condition of decreased hormone production by the thyroid gland. It accounts for 95% of hypothyroidism cases; only five percent or less are suprathyroid in origin. The most common cause of primary hypothyroidism is:
       i) Iodine deficiency;  
      ii) AITDs (Autoimmune thyroid diseases);
      iii) Drugs; 
      iv) Iatrogenic; 
      v) Congenital. 
Transient hypothyroidism includes silent and part partum thyroiditis.

2. Secondary (due to pituitary TSH deficit); 
3. Tertiary (due to hypothalamic deficiency of TRH). 
           
Hypothyroidism is one of the most undiagnosed and misdiagnosed diseases, as its clinical features are notorious. Hypothyroidism doesn't have any characteristic symptoms, and many symptoms of this condition can occur in people with other diseases.  Vertigo, mood disturbances, easy fatigability, tiredness, lethargy, slowness of memory, intellect and thought were the early symptoms, and Parasthesias, muscle cramps, weakness, muscles stiffness and aching were the main complaints of the chronic cases.[9]
                     
 

Ayurveda and the Thyroid Gland

There is no direct mention of the thyroid gland in Ayurveda, but a disease by the name Galaganda, characterized by neck swelling, is well known. The first description of neck swelling was mentioned in Atharva Veda (the last of the four Vedas) by the name apachi.  Charaka mentioned the disease under 20 sleshma vikaras.[10] Sushruta {renowned ancient Indian surgeon}in Sareera Sthana has mentioned that of the seven layers of the skin, the sixth layer Rohini is the seat of Galaganda.[11] In Nidana Sthana he described Galaganda as two encapsulated small or big swellings in the anterior angle of the neck, which hang like scrotum, [12] whereas Charaka mentioned Galaganda as a solitary swelling.[13]
          
The climatic conditions, water supply, dietary conditions, etc., are mentioned as the main aetiological factors. Susrutha  stated that rivers flowing towards east might give rise to the occurrence of Galaganda.[14] Bhela described that Sleepda and Galaganda are more common in prachya desa (eastern part) of the country, and that persons consuming
predominantly fish are liable to develop Galgaganda.[15] Harita Samhitakara described the role ofdustambu (contaminated water) and krimi dosha (infection) in the precipitation of Galaganda.[16] Kashyapa Samhitakara added that any part of the country that is cold, damp, with densely grown long trees, water stagnation and heavy rains may be prone for the development of Galaganda .[17]

A case of Galaganda attended with difficult respiration, a softening of the whole body, weakness, a non relish for, loss of voice, as well as the one which is more than of a year's standing should be abandoned by the physicians to be incurable.[18]  Although these facts were mentioned centuries ago, it is still an accepted fact that environmental factors, especially iodine, plays an important role in the functioning of the thyroid gland. Any imbalance in iodine metabolism can upset the thyroid condition; either too much or too little iodine can result in the development of goitre. So the areas where the soil is depleted, also the soil content in which food grows, the drinking water and goitrogenic foods, play a vital role in disease process. As far as consuming fish or any seafood goes, all a rich source of iodine, an excess may be a causative factor.[19]

From the above description we can say that Galaganda is a condition related to thyroid gland. But hypothyroidism is not just a local disease; it has many symptoms related to many systems. So it is better not to restrict hypothyroidism with Galaganda as mentioned in the classics.

Planning of Treatment                    

''Vikaranamakusalo na jihriyat kadachana Nahi sarva vikaranam namoto asti dhrivasthitih''.[20]
- Cha Chi. 18/44
                   
Ayurveda doesn't emphasize the exact nomenclature of the diseases; rather it insists on diagnosis of the constitutional status of the disease as mentioned in Charaka.[20] 

Based on Ayurvedic principles, the following are the main causes for hypothyroidism.
 

  1. Genetical and hereditary defects come under Adibala Pravritta Vyadhis,[21] so no treatment is suggested;
  2. Congenital defects come under Janmabala Pravritta Vyadhis [21] (the disease present from birth itself, i.e. congenital defects). Thyroid gland Agenesis, Dysgenesis, Ectopic thyroid gland come under this category;
  3. Iodine deficiency is the main common cause for hypothyroidism. So 'Sarvadha sarva bhavanam samanyam vriddhikaranam'[22] applies here;
  4. Auto immunity is another common cause, so immuno modulatory drugs are recommended here;
  5. Side-effects of surgery and radiation: Kasta Sadhya [23] (difficult to treat);
  6. For transient hypothyroidism no specific treatment is required;
  7. If there is functional loss of thyroid tissue, or functional defects, thyroid stimulatory drugs are beneficial;
  8. Selection of drugs acting at various levels:[24]
  • At Hypo-thalamo pituitary level: anti-stress drugs, Medhya Rasayana [25] drugs, Nasyakarma [25] may be beneficial;
  • At thyroid gland level: thyroid stimulatory drugs are recommended here; 
  • At metabolism level: Deepana, Pacahana, Lekhana [25] drugs which pep-up body metabolism is recommended;  
  • Immuno modulatory drugs for autoimmune related hypothyroidism.
'Samprapti vighatana' [6] is one of the main principles of treatment. Whatever may be the aetiology of the disease, it results in under-active condition of the thyroid gland and, ultimately, the slowing down of the body's metabolism. So the treatment should aim to stimulate the thyroid gland. Thyroid stimulatory drugs like Guggul should be selected to treat the disease.

As symptoms of hypothyroidism are notorious, symptomatic treatment is based to suit individual cases, i.e. sthoulya (obesity), menstrual irregularities, etc.

Pathyapathya {Regimes to be followed during Treatments}

Eating goitrogenic foods such as rapeseed, cabbage, Brussels sprouts, broccoli, cauliflower, sweet potatoes, maize, lima beans, soya and pearl millet should be limited. These foods contain natural goitrogens, which are chemicals that cause the enlargement of the thyroid gland by interfering with thyroid hormone synthesis. Cooking is known to make the goitrogens elements less effective, but it would be wise not eat these foods raw.[27]

Smoking depresses TH levels and produces chronic underlying hypothyroidism. Research shows that nicotine increases the synthesis of T3 from T4 in the brain, while alcohol and opiates block the breakdown of T3 in the brain.

Foods that contain iodine, such as kelp, beetroot, radish, parsley, potatoes, fish, oatmeal and bananas, should be kept in the diet.     

Vihara

Another important factor in the treatment of hypothyroidism is exercise. Exercise increases tissue sensitivity to the thyroid hormone, and stimulates thyroid gland secretion. An exercise regime of between 15-20 minutes per day benefits hypothyroidism. This exercise needs to be strenuous enough to raise the heartbeat, such as walking, swimming, running and cycling, except in the case of who also have generalized hypotonia, as they may be at risk of ligamental injury, particularly from excessive force across joints.  Physical and emotional stress inhibits thyroid gland secretion due to reduction of thyrotrophin output. So reduction of stress is essential for proper functioning of the gland.

Yoga [28]                  

Sarvangasana {shoulder stand}is the most suitable and effective asana for the thyroid gland. Enormous pressure is placed on the gland by this powerful posture. As the thyroid gland has a large blood supply, pressure has a dramatic effect on its function, improving circulation and squeezing out stagnant secretions. Also beneficial after Sarvangasanais the practice of Matsyasana (fish pose) and Halasna (plough pose).  Other effective asanas include Surya Namaskara(Sun salutation), Pavanamuktasana (wind relieving pose) with emphasis on head and neck exercises, Supta Vajrasana(sleeping thunderbolt pose) and all backward bending asanas.

Pranayam [28]

 The most effective pranayama is ujjayi. It acts on the throat, and its relaxing and stimulating effects are most probably due to stimulation of ancient reflex pathways within the throat area, which are controlled by the brain stem and hypothalamus. Surya, Chandra, Nadi Sodhana pranayama (right, left and alternate nostril breathing) is useful in re-balancing metabolism.

References

1. Prasuna VVL Dr. PG Scholar. Dept of Kaya Chikitsa under the guidance of  Chander P Dr. Professor and HoD. PG Dept of Kaya Chikitsa. Dr BRKR Govt Ayurvedic College. Hyderabad. India.  MD Thesis 2008. Clinical study on the effect of Kanchanara Guggulu and Shigru Patra Kwath on Hypothyroidism.
2. Hudhes AF. A History of Endocrinology. Journal of the History of Medicine and Allied Sciences. 1977.
3. Felig P and Lawrence A.  Endocrinology and Metabolism. Frohman. McGraw-Hill Professional. 2001. 
4. Chutterjee CC. Human Physiology.  Medical Allied Agency.  Calcutta. India. 1988.
5. Best and Taylor. Physiological Basis of Medicinal Practice. 1974 edition.
6. Srinivasulu M Dr. Concept of Ama in Ayurveda. Chowkambha Sanskrit Series Office. Varanasi. India. 1992.
7. Shepard MC and Franklyn GA. Eds. Clinical Endocrinolgy and Diabetes. Churchill Livingston. 1988.
8. Davidson's principles and practice of medicine. Churchill Livingston. 17th edition. London. 1995.
9. Current Medical Diagnosis and Treatment. Prentice-Hall International. 1991.
10. Charaka. Charaka. Samhita Sutra Sthana. 20th chapter-17th sloka.  V. Ramaswamy and Sons. Madras, India.
11. Sushruta. Sushruta Samhita (Sushruta Sareera Sthana.4/4).
12. Sushruta. Sushruta Samhita (Sushruta.Nidana11).
13. Charaka. Charaka Samhita (Charaka Chikitsa 11).
14. Sushruta. Sushruta Samhita (prachya nadi).
15 i)Bhela Samhita. "Sleepada galagandam cha prachysteshu drishyate." Bhela Samhita.
    ii)Bhela Samhita. "Matsya anna bhojino nityam prachyaah syu kapha bittinah sleepdam galagandam cha prachya sastheshu drishyate."
16. Hareeta.  Hareeta Samhita. "Dustambu panaka............krimijadosha ganasha gandat."
17. Kashyapa Samhita. Kashyapa Khila Sthana. 25th  chapter.
18. Vagbhata, Astanga Hridayam, Chowkhamba Orientalia. 9th edition. 2002. 
19. Harrisons Principles of Internal Medicine. 15th edition. McGraw-Hill Medical Publishing Division.
20. Charaka. Charaka Samhita Chikitsa Sthana. Vavilla Ramaswamy and Sons. Madras. India.
21. Sushruta Samhita. Sushruta Sutra Sthanam. 24th chapter-4th sloka.
22. Charaka. Charaka Sutra Sthanam. 3rd chapter.
23. Charaka. Charaka Sutra Sthanam. 10th chapter -17, 18 slokas.
24. Ayurvedic Conference on Disorders of Thyroid. Organized by Rashtreeya Ayurveda Vidya Peeth. National Academy of Ayurveda. Research Papers. 2001.
25. Dravya Guna Vijnan, Acharya Priyavrat Sharma, Chowkhambha Vidya Bhavan, and Varanasi. 1978. 
       a) Deepana: which stimulates agni;
       b) Pachana: which helps in digestion;

       c) Lekhana: which scrapes away unwanted impurities;
       d) Rasayana: which ameliorates aging and disease;
       e) Nasya: nasal application of medicine.
26. Vagbhta. Astanga Sangraha Nidana Sthana. 2nd chapter-4th sloka.
27. Prasuna VVL Dr. PG Scholoar. Professor and HoD. PG Dept of Kaya Chikitsa under the guidance of Chander P Dr. Dr BRKR Govt Ayurvedic College. MD Thesis.
Clinical study on the effect of Kanchanara Guggulu and Shigru Patra Kwath on Hypothyroidism. Hyderabad. India.
28. www.Ayurvedaforyou.com treatment of thyroid disorders.

 

    
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