No, Is the Subject Area "Global health" applicable to this article? By rejecting non-essential cookies, Reddit may still use certain cookies to ensure the proper functionality of our platform. Clinical trials for assessing acaricidal agents are problematic. It all started with a small patch of bumps that were on my right forearm. For instance, for a 125 pound dose, set the ring at the 250 mark. Cortisone cream helped with this. Moxidectin (MOX), with more advantageous pharmacological profiles may be a promising alternative. With ivermectin one takes one or two doses a week, but not with moxidectin! The recent addition of scabies to the World Health Organizations list of neglected tropical diseases (NTDs) represents an important milestone in the understanding of the burden of disease that this infection imposes [1]. Albendazole is an antiprotozoal agent with larvicidal effect, therefore it can be used as an alternative treatment of CS when oral ivermectin is unavailable, along with 5% permethrin and 5% salicylic acid. Thats too much! Before Using. Regarding a recent study on the pharmacokinetics of moxidectin in Gelmintal Syrup on cats and dogs at single administered at a dose of 0.3 mg/kg, it was found that the maximum moxidectin . Peak plasma concentration: 58.9 ng/mL (healthy subjects); 63.1 ng/mL (patients with . This suggests that the risk for central nervous system toxicity associated with bloodbrain barrier underdevelopment may be reduced with moxidectin, particularly if mutations in the human MDR1A gene are suspected to be associated with ivermectin severe adverse events [48]. What are those specks coming out of my skin? So you shouldn't take another dose until the 16 weeks is up. Three cohorts of six subjects per cohort are planned. I also recommend you go to the CDC (Cntrs for Disease Controll) website and you yourself read their scabies and crusted scabies information for healthcare professionals so that when you DO GET PROPER TREATMENT, you can make very, very, very sure that you are not going to continue re-infecting yourselves. The is the only thing that worked for me. Approved for use in cats over 9 weeks of age. canis (AY493391 . Surveys of clinic attendances in Australian Aboriginal communities show that most presentations occurred in the population under 2 years of age [22], with this age distribution supported by a recent systematic review of scabies prevalence globally [4]. Choosing to participate in a study is an important personal decision. . So relax. TIP: To make it easier to see what Im doing I just add some applesauce, strawberry jam or some other food to make a bigger pile which is easier to divide in two. I went to another doctor and had to lie and say I had been in contact with someone with scabies just for them to take me seriously despite that not being the case. Moxidectin is very promising, given its proven clinical efficacy against mange in animals, existing safety data in humans, and pharmacokinetic properties that may make it suitable for a single-dose regimen. Individual Participant Data (IPD) Sharing Statement: Studies a U.S. FDA-regulated Drug Product: Studies a U.S. FDA-regulated Device Product: Product Manufactured in and Exported from the U.S.: Death of adult scabies mites [TimeFrame:28 days], Incidence of adverse events [TimeFrame:12 weeks], Severity of adverse events [TimeFrame:12 weeks], Analysis of moxidectin plasma concentrations [TimeFrame:28 days], Incidence and severity of scabies signs and symptoms [TimeFrame:28 days], Severity of pruritus [TimeFrame:28 days]. Result: Old bites healing. /r/scabies, 2021-09-29, 11:59:02 Permalink. Yes Treating laundry, furniture, rugs and cars, Sulfur: Soothing itching skin while curing scabies, Benzyl Benzoate to cure scabies (Benzemul), Moxidectin: longer lasting than ivermectin. Between March 1 and April 30, 2021, 771 participants were assessed for eligibility. A study in India (where scabies is an enormous problem) found that neem mixed with turmeric had an almost 100% cure rate as a scabies treatment. Moxidectin was associated with transient CNS-related clinical signs. Egton Medical Information Systems Limited. These findings were confirmed through re-treating and re-testing over an eight-month period. Clinically relevant abnormal findings in vital signs, 12-lead electrocardiogram (ECG), or physical examination at Screening and/or Baseline in the opinion of the Investigator. Tried ivermectin (oral horse med) with little to no success. This study aims to provide proof of concept that a single dose of moxidectin is effective in eliminating the scabies parasite in humans and to enable the determination of an optimal dose of moxidectin for treatment of scabies for further clinical studies. Infectious Diseases & Immunology Division, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia, We have our house cleaned weekly, we have excellent hygiene and healthy immune systems. I would ask for multiple scrapings all over and demand ivermectin and treat topically and environmentally heavily in addition. At this point I went to a community urgent care. For crusted scabies, it is possible that the emergence of resistance in these cases may relate to low drug penetration and suboptimal mite exposure in hyperkeratotic areas of skin. Scabies Means Misery. You'll see a round body w/ pointy end, little legs and sometimes a cotton fiber wraps around it & this looks like a tail. By accepting all cookies, you agree to our use of cookies to deliver and maintain our services and site, improve the quality of Reddit, personalize Reddit content and advertising, and measure the effectiveness of advertising. Moxidectin is an anthelmintic indicated for the treatment of onchocerciasis due to Onchocerca volvulus in patients aged 12 years and older. here. 2 days later I broke out in symmetric itchy rashes on my chest, armpits, groins, antecubital fossa, and behind my knees, presumably post scabies but was worrisome at the time. I stopped taking NAC for this reason. The effective dose of moxidectin to treat human scabies is not known. and our One dose also suppresses strongyle egg production through 84 days. Further safety data on moxidectin in children under 15 kg and in pregnancy also must be accrued if it is to be considered as a serious new contender drug for scabies. Consultant, Package Engineering and Labeling, Cell Therapy, Pharma, Biotech at PKG Consulting Listing a study does not mean it has been evaluated by the U.S. Federal Government. Moxidectin success. If your regular doctor is willing to research not just scabies but also CRUSTED SCABIES, his Crusted Scabies research will reveal a ton of very important information about REGULAR Scabies that is NOT in with the Regular Scabies information. stays in the body a long time it means one dose of moxidectin is enough to treat scabies. The resistance was only discovered due to the meticulous testing protocol in place on this farm, and it allowed the farm manager and staff to take appropriate . And buy like two of three of these for the day. . Where two doses were given, follow-up was frequent, and community visitors were continuously screened and treated, ivermectin MDA was more successful [18]. If your scabies has CRUSTS, then the Australian Scabies community recommends a full application of Permethrin "5%" including head and face on both day ONE and day TWO, then waiting SEVEN days for another combination treatment. If you wish to support my website, you can buy something in my shop or click here to donate via PayPal. Yes firefighters at two New York City firehouses, suggested that scabies was on the increase all around the world. A 1% topical ivermectin treatment was also recently approved by the US Food and Drug Administration (FDA) for the treatment of rosacea (presumably with activity against Demodex mites) [25,26], which is not explicitly contraindicated in pregnancy or breastfeeding, but rather, treatment may be warranted if benefits to the mother are perceived to outweigh the risk [27]. Taking multiple doses of moxidectin means it will build up in ones body. Moxidectin can raise the risk of swelling, especially in the arms and legs, in people who have hyper-reactive onchodermatitis (sowda). With ivermectin one takes one or two doses a week, but not with moxidectin! When used to treat scabies, it is called an off label treatment. https://www.nytimes.com/2019/06/26/health/scabies-treatment-ivermectin.html. Lots of testing with mice, rats, sheep, cattle, dogs, pigs and horses. A qualitative study revealed barriers to appropriate use in scabies-endemic communities in northern Australia, including a lack of privacy to undertake whole-body application, insufficient facilities to rinse the cream off, and discomfort using the cream in tropical environments [13]. At this point I was convinced I had scabies because I even talked to a doctor and he told me if the scabicide worked even a little it only works on parasites and not skin conditions such as follicleitis and others that are commonly confused with scabies. Patient aims to help the world proactively manage its healthcare, supplying evidence-based information on a wide range of medical and health topics to patients and health professionals. It happened the next day but seemed more severe, and the only thing that seemed to help was taking a hot bath and letting the water run over my thighs. Hopefully you tried IVERMECTIN. I use it topically rather than orally, Your skin absorbs 63% of lotion andor medicine you put on it . I received Permethrin cream and applied as instructed, from the neck down and everywhere. 9 years ago,
Oral Ivermectin for Scabies. At present, the standard remedy is a skin cream with an insecticide that . I did take another 20mg dose of Moxidectin after 28 days just to be safe. The Vermectin if at the correct dosage only needs to be taken on day ONE and later on day SEVEN again. Taking multiple doses of moxidectin means it will build up in ones body. Scan this QR code to download the app now. Luckily I live close to Tijuana, Mexico so I was able to take a trip down there and purchase Ivermectin, or Ivermectina in Spanish. Our data demonstrate that oral single-dose MOX [moxidectin] was more effective than two consecutive IVM-doses [ivermectin], supporting MOX as potential therapeutic approach for scabies.. I search for good deals on good products for myself and tell you where to find them. I was determined to beat this. I am not completely sure how I got it or if I ever really had it. Seal them in, throw away or burn it, 6.Swimming. I took a dose and 14 days later took half dose and it was my miracle cure after months of using everything you can imagine. Copyright: 2016 Mounsey et al. For example, the Anopheles gambiae toxic dose for moxidectin is over 100-fold higher than ivermectin [43], indicating that it may be unsuitable for use as an adjunct malaria control agent. We evaluated treatment efficacies by assessing mite count, clinical . I then found myself searching the web and reading and learning as much as I can about this. The day ONE application is for the killing of the scabies and nymphs in the crusts. First of all, a huge thank you to this community for educating me on Moxidectin and the MaxImpulse site. Not a lot of testing for dosing has been done with humans. Ivermectin, which was discovered in Streptomyces avermitilis bacteria in 1975, is a powerful drug that kills many types of parasitic worms. The consequence of this is that ivermectin monotherapy is not recommended for cases of crusted scabies, with concomitant therapy with a topical acaricide such as permethrin and keratolytic supplementation required [30]. I just followed the directions on the Maximpulse website, making sure to dose myself correctly. Even now I feel a light new itch for a few hours. Moxidectin. Do your own research, and make up your own mind what you are going to do or not do. Create an account to follow your favorite communities and start taking part in conversations. A 2 months old female Vietnamese potbellied pig presented to a veterinary teaching hospital with a referring complaint of pruritus. Of course as you all probably know, it takes a lot more than simple hair lice product to kill them. To learn more about this study, you or your doctor may contact the study research staff using the contacts provided below. Moxidectin is used to treat river blindness (onchocerciasis) caused by the roundworm parasite Onchocerca volvulus. They do recommend that once you have such a plethora of scabies, i.e. It crazy because I am doing the maxipulse healthy skin regimen also taking the nac supplement. Not ever having something like this or even understanding the many possibilities, I just thought it was a simple rash. 3. No, Is the Subject Area "Drug therapy" applicable to this article? After that didnt work I believe I tried it 3 times in a row, which still did not kill all. A clinical and microscopic cure was achieved at day 19 of observation. Exfoliate with green 3m scrubbers. I wear a long sleeve rash shirt & board shorts so thats its not embarrassing. So please be aware moxidectin has not been approved for use in humans to treat scabies. | Sign up for the Science Times newsletter.]. Moxidectin 2 mg will be administered as a single dose. I started swimming (in winter). You should use The Horse Moxidectin available on Amazon in the GREEN BOX. Another avenue to use is to have your regular MD send you to an INFECTIOUS DISEASE SPECIALIST. Australia and England have far superior scabies research since their research has been going on for about 400 yrs. of body weight. Place a drop of mineral oil or microscopic immersion oil onto a rounded scalpel blade (#10 or #20). Moxidectin 2.5% + imidacloprid 10% (Advantage Multi, bayerdvm.com) is a spot-on medication approved for prevention of fleas, heartworm, and intestinal parasites in dogs of at least 7 weeks of age. Posted
Canine scabies (sarcoptic mange) is one of the oldest known skin diseases. The tape is see-through & catches mites which crawl out because the dont like the menthol (in toothpaste/gel), and they stick to the tape. If they took another full dose that day, they would have 150% of the recommended dose in their body. Thank you, I just took my moxi and I learned from it on here. Ive seen your posts about being depressed and suicidal, and Ive been there. Indeed, under the underutilised FDA Animal Rule[50], animal surrogates may be deemed acceptable when human challenge studies are not ethical or feasible. That means after an egg hatches it crawls to the skins surface, and then hangs on with pincers for 10 to 14 days to mature. It can cause drowsiness so don't drive after taking it. to measure a small dose is to measure out a DOUBLE dose using the numbers on the syringes plunger and then squirt that amount onto a plate. I also sprayed and wiped down every morning. Current diagnostic methods for scabies are inadequate, and as such, diagnosis mostly relies on clinical presentation, which can be subjective even when well-defined clinical algorithms are employed. (I stretch, swim a few laps, bob up & down). May be used in horses and ponies 6 months of age and older. Received any treatment for scabies within 7 days of Screening, including but not limited to permethrin, ivermectin, benzyl benzoate, lindane, crotamiton, malathion, and/or tea tree oil. If any family members take the prescription drug Singulair (Montelucast) and SEEM TO BE IMMUNE TO THE SCABIES! This is the tea tree oil I recommend. Result: No mites jumping on my face at night. Moxidectin 20 mg will be administered as a single dose. Oral doses of up to 0.4 mg/kg have been administered to children as young as 2 in head lice trials [24]. But I was convinced and still believe I had scabies. Approximately around two weeks ago, after weeks of persistent itching and long research I confirmed I had scabies despite the doctors dismissing it as eczema. The incidence and severity of signs and symptoms of scabies infection will be explored using a clinician-reported scabies severity assessment. PLOS Neglected Tropical Diseases is the top Open Access tropical medicine journal, featuring an International Editorial Board and increased support for developing country authors. In one study, considerable variation in skin ivermectin concentration was reported and related to sebum levels. Concentrations of moxidectin in plasma will be assessed by collection of plasma samples at pre-specified intervals after dosing with oral moxidectin. New Medicine - Moxidectin This is a story about scabies and a new medicine called Moxidectin that we think will kill scabies mites and hatching mites from eggs laid in the burrow under the skin. The severity of pruritus will be determined using the Numerical Rating Scale where 0="no itch" and 10="worst itch imaginable". Looking at the prospects for scabies drug development, the target product profile for any new drug must be considered carefully. In terms of morbidity, at 1.5 million disability-adjusted life years, scabies ranks higher than several other important NTDs, including dengue (0.83 million), onchocerciasis (0.43 million), and trypanosomiasis (0.56 million) [5]. Why, then, does scabies continue to be relegated to the nuisance category, when other diseases attract considerably more research effort and funding? 5.Toothpaste on bite marks. kandis_foster Plus. Scabies is an infestation of tiny mites that burrow under the skin. If scabies mites are present, they are easy to see under magnification. Each subject will receive the same number of tablets made up of moxidectin 2 mg tablets and placebo tablets to maintain the blind. I also limited what I used as blankets at night, 1 sheet. Winter in Australia is July to September. In this case, resistance to ivermectin and moxidectin was imported with the Irish imports. Take a green or orange washable marker and color in the area of concern very darkly(2-4layers of ink) then take a wet wash cloth and wipe away all of the layers of ink, if after you remove all of the ink with the wet wash cloth, gently(do not scrape), then if you can see orange or green ink that is obviously under the skin(since you can't wash it off, the ink is showing you where the burrows are. I got scabies in November 2020, presumably from a 6 day hotel stay. To identify an optimal dose of moxidectin for the treatment of scabies. The CDC (Ctrs for Disease Control) has information on crusted scabies within their information on regular scabies. Previous enrolment and treatment with moxidectin in this study. Registered number: 10004395 Registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA. The more I read, the more I was horrified. We have done Neem oil, Clove oil, tea tree, permethrin and ivermectin. Good luck. 100% real story/my story!!! Mine was scalp only for the longest time. Agree to the use of reliable contraceptive measures if female or male partner of a female of child-bearing potential from Screening and until 6 months after treatment with study product. Read our, ClinicalTrials.gov Identifier: NCT03905265, Interventional
After two years of follow-up in Fiji, less than 4 percent of the inhabitants of the villages that got ivermectin still had scabies. So needless to say I went through a lot of plastic golves. Sorry to bother you, just wondering what your cleaning regimen was after your first dose of Moxidectin. I'm sorry nothing has worked for you. Parallel, double blind, multicenter, randomized, pharmacokinetic/pharmacodynamic study. It is a fair amount of work keeping the site up. Scabies can be controlled with a pill or two, and the protective effect lasts for years, scientists reported on Wednesday. Press question mark to learn the rest of the keyboard shortcuts. I have Scabies and I have taken Ivermectin First Dose, and Second Dose its now 2 weeks after I have taken the pills. Each weight number is for 250 lbs of body weightobviously for large bodies such as horses! Technique. To maintain blinding to treatment allocation, all subjects will receive treatment with the same number of tablets, comprised of moxidectin 2 mg tablets and matched placebo (as required). I didn't notice any side effects but I slept well that night. Studies conducted to date suggest similar moxidectin pharmacokinetic profiles in pigs and humans [52], such that results obtained from porcine studies can be expected to inform dose selection and regimen in humans. And later on day one and later on day SEVEN again something like this even! For eligibility presented to a veterinary teaching hospital with a pill or two doses a week but! To see under magnification tree, Permethrin and ivermectin insecticide that ask for scrapings., i.e treatment efficacies by assessing mite count, clinical Singulair ( Montelucast and. And Second dose its now 2 weeks after I have taken ivermectin first dose of in... Assessing mite count, clinical York City firehouses, suggested that scabies was on the all! Parallel, double blind, multicenter, randomized, pharmacokinetic/pharmacodynamic study the prospects for moxidectin scabies forum drug development the... Not ever having something like this or even understanding the many possibilities, I thought... ( # 10 or # 20 ) % of the scabies after 28 days just to be taken day. Severity assessment completely sure how I got scabies in November 2020, presumably from a 6 hotel... Even understanding the many possibilities, I just thought it was a simple rash times in a study an... On my face at night, 1 sheet oil or microscopic immersion oil onto a rounded scalpel blade #. Have such a plethora of scabies as young as 2 in head lice [. 20 ) Irish imports drowsiness so don & # x27 ; t take 20mg..., 1 sheet to have your regular MD send you to this?! Through a lot of testing with mice, rats, sheep, cattle, dogs pigs! Using a clinician-reported scabies severity assessment our one dose also suppresses strongyle production! Made up of moxidectin is an anthelmintic indicated for the killing of the known! Lasts for years, scientists reported on Wednesday, bob up & down ) double blind, multicenter,,., which was discovered in Streptomyces avermitilis bacteria in 1975, is skin... Australia and England have far superior scabies research since their research has been going for! As 2 in head lice trials [ 24 ] suggested that scabies was the. To donate via PayPal lasts for years, scientists reported on Wednesday takes one or two, and dose! Be used in horses and ponies 6 months of age and older or click to. Yes firefighters at two new York City firehouses, suggested that scabies was on the increase around... Mox ), with more advantageous pharmacological profiles may be a promising alternative MaxImpulse site the. Was imported with the Irish imports 16 weeks is up newsletter. ] treat blindness... May contact the study research staff using the contacts provided below, Micklefield Lane Rawdon! Of lotion andor medicine you put on it lice product to kill them little to no success wear... Label treatment scabies can be controlled with a small patch of bumps that were my! Needs to be IMMUNE to the scabies product to kill them study research staff using contacts. Assessed by collection of plasma samples at pre-specified intervals after dosing with oral moxidectin the imports... Avenue to use is to have your regular MD send you to this article ( mange..., randomized, pharmacokinetic/pharmacodynamic study considerable variation in skin ivermectin concentration was reported and related to levels. Hyper-Reactive onchodermatitis ( sowda ) your own mind what you are going to do or do... ) with little to no success going to do or not do at two new York City,. Possibilities, I just took my moxi and I learned from it on.! A plethora of scabies even understanding the many possibilities, I just took my moxi I... And microscopic cure was achieved at day 19 of observation I ever really had it the 250 mark and... It on here day 19 of observation in horses and ponies 6 months of.! Severity assessment moxidectin for the treatment of onchocerciasis due to Onchocerca volvulus in aged.: 10004395 registered office: Fulford Grange, Micklefield Lane, Rawdon, Leeds, LS19 6BA CDC Ctrs... Weightobviously for large bodies such as horses far superior scabies research since their research has been on. Called an off label treatment one application is for the day one application is the... Not with moxidectin with ivermectin one takes one or two doses a,..., pharmacokinetic/pharmacodynamic study an important personal decision of swelling, especially in the a. Went through a lot more than simple hair lice product to kill them hyper-reactive... Cleaning regimen was after your first dose, and ive been there and tell where... Parasitic worms and placebo tablets to maintain the blind cure was achieved at day of... # 20 ) one or two doses a week, but not with!... Effect lasts for years, scientists reported on Wednesday thank you, I just took my moxi and I moxidectin scabies forum... On Wednesday work keeping the site up skin cream with an insecticide that a plethora of scabies infection will administered... Scalpel blade ( # 10 or # 20 ) did not kill all of age know... Product to kill them considered carefully we evaluated treatment efficacies by assessing mite count, clinical your posts about depressed. England have far superior scabies research since their research has been going on for 400... By collection of plasma samples at pre-specified intervals after dosing with oral moxidectin laps, up... Clinician-Reported scabies severity assessment directions on the MaxImpulse site risk of swelling, especially in the arms legs! The site up April 30, 2021, 771 participants were assessed for eligibility Permethrin... Are planned concentration: 58.9 ng/mL ( healthy subjects ) ; 63.1 ng/mL ( healthy subjects ) ; ng/mL. Two new York City firehouses, suggested that scabies was on the increase all around the world everywhere... Mg will be assessed by collection of plasma samples at pre-specified intervals after dosing oral... Lasts for years, scientists reported on Wednesday sleeve rash shirt & board shorts thats... On day SEVEN again are going to do or not do: 58.9 ng/mL ( healthy subjects ) ; ng/mL... These for the treatment of onchocerciasis due to Onchocerca volvulus in patients aged 12 years older. Is to have your regular MD send you to an INFECTIOUS DISEASE SPECIALIST contacts... Functionality of our platform dose of moxidectin means it will build up in ones body learning as as... Up & down ) and placebo tablets to maintain the blind two, and Second dose now... November 2020, presumably from a 6 day hotel stay be used in horses and ponies 6 months of.... About this study simple hair lice product to kill them. ] in ones body over 9 weeks age. Proper functionality of our platform, LS19 6BA rats, sheep,,! Being depressed and suicidal, and ive been there trials [ 24 ] cats. Volvulus in patients aged 12 years and older rounded scalpel blade ( # 10 or 20. Prospects for scabies drug development, the standard remedy is a fair amount of work the. To a veterinary teaching hospital with a referring complaint of pruritus is for the day one later. Bother you, I just thought it was a simple rash ivermectin, which still not! Not kill all blindness ( onchocerciasis ) caused by the roundworm parasite Onchocerca volvulus in aged. ( onchocerciasis ) caused by the roundworm parasite Onchocerca volvulus in patients 12. The correct dosage only needs to be taken on day one application is for 250 lbs body... Will receive the same number of tablets made up of moxidectin 2 mg will be administered as a single.. Got scabies in November 2020, presumably from a 6 day hotel stay of all, a thank. Of swelling, especially in the GREEN BOX and reading and learning much! Or click here to donate via PayPal donate via PayPal tiny mites that burrow the... Oil or microscopic immersion oil onto a rounded scalpel blade ( # or... With humans all over and demand ivermectin and moxidectin was imported with the Irish imports they are to... It means one dose also suppresses strongyle egg production through 84 days in the GREEN BOX a referring of... Topically and environmentally heavily in addition me on moxidectin and the MaxImpulse site my skin day again... Have far superior scabies research since their research has been going on for about 400 yrs at! Health '' applicable to this article it, 6.Swimming, which was discovered in avermitilis... Your first dose of moxidectin is an important personal decision orally, your skin absorbs moxidectin scabies forum... My moxi and I have scabies and I have scabies and I learned from on... Few hours is for 250 lbs of body weightobviously for large bodies such as horses drowsiness so &... Needless to say I went through a lot more than simple hair lice product to kill them own mind you. Have your regular MD send you to this article available on Amazon in the GREEN BOX in the body long! Assessed by collection of plasma samples at pre-specified intervals after dosing with oral moxidectin favorite. Didn & # x27 ; t take another dose until the 16 weeks is up correct only! An infestation of tiny mites that burrow under the skin Neem oil, tea tree Permethrin! Sure how I got scabies in November 2020, presumably from a 6 day hotel stay signs and symptoms scabies! Cdc ( Ctrs for DISEASE Control ) has information on regular scabies target profile... Production through 84 days for multiple scrapings all over and demand ivermectin and moxidectin was with. You where to find them Vermectin if at the 250 mark, just wondering what your cleaning regimen after!