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1.
BMC Dermatol ; 20(1): 1, 2020 01 10.
Artigo em Inglês | MEDLINE | ID: mdl-31918687

RESUMO

BACKGROUND: Mycetoma is an uncommon chronic granulomatous infection of cutaneous and subcutaneous tissues that can be caused by filamentous bacteria (actinomycetoma) or fungi (eumycetoma). It is the prerogative of young men between the third and fourth decade and is transmitted through any trauma causing an inoculating point. The classic clinical triad associates a painless hard and swelling subcutaneous mass, multiple fistulas, and the pathognomonic discharge of grains. Although endemic in many tropical and subtropical countries, mycetoma can also be found in non-endemic areas as in Morocco, and causes then diagnosis problems leading to long lasting complications. Therefore, we should raise awareness of this neglected disease for an earlier management. Under medical treatment however, mycetoma has a slow healing and surgery is often needed, and relapses are possible. CASE PRESENTATION: Herein we report a case of a 64 years old patient, with a history of eumycetoma occurring ten years ago treated with oral terbinafine coupled with surgery. A complete remission was seen after 2 years. He presented a relapse on the previous scar 6 months ago. There wasn't any bone involvement in the magnetic resonance imaging (MRI). The patient was put under oral terbinafine with a slow but positive outcome. CONCLUSION: Through this case report, we perform a literature review and highlight the importance of increase awareness of mycetoma in clinical practice especially in non-endemic regions.


Assuntos
Doenças do Pé/diagnóstico , Madurella/isolamento & purificação , Micetoma/diagnóstico , Antifúngicos/uso terapêutico , Diagnóstico Diferencial , Pé/diagnóstico por imagem , Pé/microbiologia , Pé/patologia , Doenças do Pé/microbiologia , Doenças do Pé/patologia , Doenças do Pé/terapia , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Marrocos , Micetoma/microbiologia , Micetoma/patologia , Micetoma/terapia , Doenças Negligenciadas , Medicina Tropical
2.
Epidemiol Infect ; 147: e294, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31637988

RESUMO

Mycetoma is a chronic granulomatous, suppurative and progressive inflammatory disease that usually involves the subcutaneous tissue and bones after traumatic inoculation of the causative organism. In India, actinomycotic mycetoma is prevalent in south India, south-east Rajasthan and Chandigarh, while eumycetoma, which constitutes one third of the total cases, is mainly reported from north India and central Rajasthan. The objective was to determine the epidemiological profile and spectrum of eumycetoma from a tertiary care hospital in Delhi, North India. Thirty cases of eumycetoma were diagnosed by conventional methods of direct microscopy, culture and species-specific sequencing as per standard protocol. The spectrum of fungal pathogens included Exophiala jeanselmei, Madurella mycetomatis, Fusarium solani, Sarocladium kiliense, Acremonium blochii, Aspergillus nidulans, Fusarium incarnatum, Scedosporium apiospermum complex, Curvularia lunata and Medicopsis romeroi. Eumycetoma can be treated with antifungal therapy and needs to be combined with surgery. It has good prognosis if it is timely diagnosed and the correct species identified by culture for targeted therapy of these patients. Black moulds required prolonged therapy. Its low reporting and lack of familiarity may predispose patients to misdiagnosis and consequently delayed treatment. Hence health education and awareness campaign on the national and international level in the mycetoma belt is crucial.


Assuntos
Micetoma/epidemiologia , Doenças Negligenciadas/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/terapia , Doenças Negligenciadas/diagnóstico , Doenças Negligenciadas/terapia , Prognóstico , Estudos Retrospectivos , Adulto Jovem
5.
Cornea ; 37(12): 1590-1592, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30234681

RESUMO

PURPOSE: To report an unusual case of isolated Acremonium eumycetoma presenting as a protuberant mass over the cornea. METHODS: Case report and literature review. RESULTS: A 55-year-old male patient referred to our center with a case of perforated corneal ulcer with uveal tissue prolapse was examined in the casualty department and found to have central melt, approximately 8 mm, along with suspected uveal tissue prolapse. A provisional diagnosis of sloughed corneal ulcer with uveal prolapse was made along with differential diagnoses of fungal ball and infected foreign body granuloma. Tectonic penetrating keratoplasty under general anesthesia was planned. Intraoperatively, the suspected uveal (brown colored) tissue was found to be an epicorneal mass growing over an intact and infiltrated cornea. Histopathological and microbiological analysis of the epicorneal mass and host cornea revealed it to be a fungal ball (mass full of septate hyphae) with growth of Acremonium species on culture. The patient was administered topical and oral antifungal agents postoperatively, in addition to topical antibiotics and cycloplegics. CONCLUSIONS: Isolated corneal Acremonium eumycetoma masquerading as a perforated corneal ulcer with prolapsed uveal tissue is a rare entity. Surgical intervention and appropriate antimicrobial therapy are key to successful outcome.


Assuntos
Acremonium/isolamento & purificação , Córnea/microbiologia , Infecções Oculares Fúngicas/microbiologia , Ceratite/microbiologia , Micetoma/microbiologia , Antifúngicos/uso terapêutico , Córnea/patologia , Infecções Oculares Fúngicas/diagnóstico , Humanos , Ceratite/diagnóstico , Ceratite/terapia , Ceratoplastia Penetrante , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/terapia
6.
PLoS Negl Trop Dis ; 12(5): e0006391, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29746460

RESUMO

Mycetoma, one of the badly neglected tropical diseases, it is a localised chronic granulomatous inflammatory disease characterised by painless subcutaneous mass and formation of multiple sinuses that produce purulent discharge and grains. If untreated early and appropriately, it usually spread to affect the deep structures and bone resulting in massive damage, deformities and disabilities. It can also spread via the lymphatics and blood leading to distant secondary satellites associated with high morbidity and mortality. To date and despite progress in mycetoma research, a huge knowledge gap remains in mycetoma pathogenesis and epidemiology resulting in the lack of objective and effective control programmes. Currently, the available disease control method is early case detection and proper management. However, the majority of patients present late with immense disease and for many of them, heroic substantial deforming surgical excisions or amputation are the only prevailing treatment options. In this communication, the Mycetoma Research Center (MRC), Sudan shares its experience in implementing a new holistic approach to manage mycetoma patients locally at the village level. The MRC in collaboration with Sennar State Ministry of Health, Sudan had established a region mycetoma centre in one of the endemic mycetoma villages in the state. The patients were treated locally in that centre, the local medical and health personals were trained on early case detection and management, the local community was trained on mycetoma advocacy, and environmental conditions improvement. This comprehensive approach had also addressed the patients' socioeconomic constraints that hinder early presentation and treatment. This approach has also included the active local health authorities, community and civil society participation and contributions to deliver the best management. This holistic approach for mycetoma patients' management proved to be effective for early case detection and management, optimal treatment and treatment outcome and favourable disease prognosis. During the study period, the number of patients with massive lesions and the amputation rate had dropped and that had reduced the disease medical and socioeconomic burdens on patients and families.


Assuntos
Saúde Holística , Micetoma/terapia , Adolescente , Adulto , Feminino , Saúde Holística/economia , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/economia , Micetoma/epidemiologia , Sudão/epidemiologia , Adulto Jovem
7.
An Bras Dermatol ; 93(1): 8-18, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29641691

RESUMO

Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.


Assuntos
Micetoma , Diagnóstico Precoce , Humanos , Técnicas Microbiológicas , Micetoma/diagnóstico , Micetoma/epidemiologia , Micetoma/etiologia , Micetoma/terapia
8.
An. bras. dermatol ; 93(1): 8-18, Jan.-Feb. 2018. tab, graf
Artigo em Inglês | LILACS | ID: biblio-887169

RESUMO

Abstract: Mycetoma is a chronic suppurative disease of the skin and subcutaneous tissue, characterized by a symptomatic triad: tumor, fistulas and grains. It can be caused by fungi (eumycetoma) and bacteria (actinomycetoma), with similar clinical features. Diagnosis is based on the clinical presentation and identification of the etiological agents in the tissue, by mycological/bacteriological, histopathological and immunohistochemical tests. It is important to specify the fungal or bacterial etiology, because the treatments are different. An approach that involves early diagnosis, the use of systemic antibiotics or antifungal agents, including surgical removal of lesions, is the basis for the treatment of these diseases. In this review, the most commonly used diagnostic methods and treatments will be discussed. Also, we will review the history of the disease through epidemiological and etiological aspects.


Assuntos
Humanos , Micetoma/diagnóstico , Micetoma/etiologia , Micetoma/terapia , Micetoma/epidemiologia , Técnicas Microbiológicas , Diagnóstico Precoce
9.
J Am Podiatr Med Assoc ; 108(6): 517-522, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30742501

RESUMO

Madura foot is an uncommon invasive soft-tissue infection that foot and ankle specialists encounter. We present two rare cases of Phialemonium and Phaeoacremonium fungi infections of the foot diagnosed in northern California to inform physicians on the presentation and current treatment options for this unique pathology. The two cases presented outline the clinical presentations, diagnostic data, and surgical and antimicrobial interventions. There is a concentration on the antimicrobial options depending on which of the over 20 species is encountered. The pertinent literature and supporting data are reviewed to create an outline for discussion of treatment protocols when faced with these emerging opportunistic infections.


Assuntos
Antifúngicos/uso terapêutico , Emigração e Imigração , Dermatoses do Pé/patologia , Micetoma/patologia , Phialophora/isolamento & purificação , Adulto , California , Dermatoses do Pé/diagnóstico , Dermatoses do Pé/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Micetoma/diagnóstico , Micetoma/terapia , Doenças Raras , Medição de Risco , Índice de Gravidade de Doença , Procedimentos Cirúrgicos Operatórios/métodos
11.
Ann Clin Microbiol Antimicrob ; 16(1): 31, 2017 Apr 14.
Artigo em Inglês | MEDLINE | ID: mdl-28410611

RESUMO

BACKGROUND: Scedosporium apiospermum is an emerging opportunistic filamentous fungus, which is notorious for its high levels of antifungal-resistance. It is able to cause localized cutaneous or subcutaneous infections in both immunocompromised and immunocompetent persons, pulmonary infections in patients with predisposing pulmonary diseases and invasive mycoses in immunocompromised patients. Subcutaneous infections caused by this fungus frequently show chronic mycetomatous manifestation. CASE REPORT: We report the case of a 70-year-old immunocompromised man, who developed a fungal mycetomatous infection on his right leg. There was no history of trauma; the aetiological agent was identified by microscopic examination and ITS sequencing. This is the second reported case of S. apiospermum subcutaneous infections in Hungary, which was successfully treated by surgical excision and terbinafine treatment. After 7 months, the patient remained asymptomatic. Considering the antifungal susceptibility and increasing incidence of the fungus, Scedosporium related subcutaneous infections reported in the past quarter of century in European countries were also reviewed. CONCLUSIONS: Corticosteroid treatment represents a serious risk factor of S. apiospermum infections, especially if the patient get in touch with manure-enriched or polluted soil or water. Such infections have emerged several times in European countries in the past decades. The presented data suggest that besides the commonly applied voriconazole, terbinafine may be an alternative for the therapy of mycetomatous Scedosporium infections.


Assuntos
Antifúngicos/administração & dosagem , Desbridamento , Perna (Membro)/patologia , Micetoma/diagnóstico , Micetoma/terapia , Naftalenos/administração & dosagem , Scedosporium/isolamento & purificação , Idoso , Análise por Conglomerados , DNA Fúngico/química , DNA Fúngico/genética , DNA Espaçador Ribossômico/química , DNA Espaçador Ribossômico/genética , Dermatomicoses/diagnóstico , Dermatomicoses/microbiologia , Dermatomicoses/patologia , Dermatomicoses/terapia , Humanos , Hungria , Hospedeiro Imunocomprometido , Masculino , Microscopia , Micetoma/microbiologia , Micetoma/patologia , Filogenia , Recidiva , Scedosporium/classificação , Scedosporium/citologia , Scedosporium/genética , Análise de Sequência de DNA , Terbinafina , Resultado do Tratamento
13.
Cutis ; 99(2): E11-E15, 2017 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28319638

RESUMO

Mycetoma is a chronic infection that develops after traumatic inoculation of the skin with either true fungi or aerobic actinomycetes. The resultant infections are known as eumycetoma or actinomycetoma, respectively. Although actinomycetoma is rare in developed countries, migration of patients from endemic areas makes knowledge of this condition crucial for dermatologists worldwide. We present a review of the current concepts in the epidemiology, clinical presentation, diagnosis, and treatment of actinomycetoma.


Assuntos
Actinobacteria/isolamento & purificação , Micetoma/terapia , Pele/microbiologia , Doença Crônica , Dermatologia , Humanos , Micetoma/diagnóstico , Micetoma/epidemiologia , Pele/patologia
14.
PLoS Negl Trop Dis ; 11(2): e0005301, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28192433

RESUMO

Mycetoma is caused by the subcutaneous inoculation of filamentous fungi or aerobic filamentous bacteria that form grains in the tissue. The purpose of this study is to describe the epidemiologic, clinic, laboratory, and therapeutic characteristics of patients with mycetoma at the Oswaldo Cruz Foundation in Rio de Janeiro, Brazil, between 1991 and 2014. Twenty-one cases of mycetoma were included in the study. There was a predominance of male patients (1.3:1) and the average patient age was 46 years. The majority of the cases were from the Southeast region of Brazil and the feet were the most affected anatomical region (80.95%). Eumycetoma prevailed over actinomycetoma (61.9% and 38.1% respectively). Eumycetoma patients had positive cultures in 8 of 13 cases, with isolation of Scedosporium apiospermum species complex (n = 3), Madurella mycetomatis (n = 2) and Acremonium spp. (n = 1). Two cases presented sterile mycelium and five were negative. Six of 8 actinomycetoma cases had cultures that were identified as Nocardia spp. (n = 3), Nocardia brasiliensis (n = 2), and Nocardia asteroides (n = 1). Imaging tests were performed on all but one patients, and bone destruction was identified in 9 cases (42.68%). All eumycetoma cases were treated with itraconazole monotherapy or combined with fluconazole, terbinafine, or amphotericin B. Actinomycetoma cases were treated with sulfamethoxazole plus trimethoprim or combined with cycles of amikacin sulphate. Surgical procedures were performed in 9 (69.2%) eumycetoma and in 3 (37.5%) actinomycetoma cases, with one amputation case in each group. Clinical cure occurred in 11 cases (7 for eumycetoma and 4 for actinomycetoma), and recurrence was documented in 4 of 21 cases. No deaths were recorded during the study. Despite of the scarcity of mycetoma in our institution the cases presented reflect the wide clinical spectrum and difficulties to take care of this neglected disease.


Assuntos
Fungos/isolamento & purificação , Micetoma/epidemiologia , Micetoma/patologia , Nocardia/isolamento & purificação , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Antifúngicos/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Desbridamento , Feminino , Fungos/classificação , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Micetoma/microbiologia , Micetoma/terapia , Resultado do Tratamento , Adulto Jovem
15.
Gac Med Mex ; 153(7): 841-851, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-29414948

RESUMO

The eumycetoma is a severely debilitating chronic progressive fungal cutaneous infection. Classic clinical triad is characterized by painless subcutaneous mass, sinus tracts formation and sero-purulent discharge that contain aggregates of fungal hyphae called grains. Any part of the body can have affected, with extension to muscular or bone, even visceral compromised. The eumycetoma is observed in tropical and subtropical countries; In Latin-America, is reported with less frequency. In endemic areas, antibody presence again etiological agents were higher compared with number of people affected, thus it is supposed that individual genetic susceptibility most by exist. Recently, it was reported specific polymorphism in genes CR1, IL-8, NOS2 and chitriosidase, which were associated with development of eumycetoma. The diagnosis is suggested by clinical presentation; the histopathology and microbiology studies, plus radiologic valuation confirmed diagnosis. Madurella mycetomatis is the most informed etiological agent. Using phylogenetic tools new species in genus Madurella were reported; moreover, Trematosphaeria grisea and Pseudallescheria boydii were reclassified. Etiological agent Identification is important, because differences in antifungal susceptibility exist. Eumycetoma treatment includes surgery plus antifungal drugs. Identification of etiological agents is primordial, because antifungal resistance could exist. To development new pharmacological strategies, comprehension of grain formation physiology and drugs effects are necessary.


Assuntos
Micetoma , Ascomicetos/classificação , Predisposição Genética para Doença , Humanos , Madurella/classificação , Micetoma/genética , Micetoma/microbiologia , Micetoma/terapia , Filogenia
16.
Australas J Dermatol ; 58(3): e129-e131, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27270783

RESUMO

Actinomycetomas are soft tissue bacterial infections that are in the differential for unusual masses of the extremities. Typical infectious agents include Actinomyces and Nocardia and are treated with long-term antibiotics. We report a rare case of Gordonia actinomycetoma that was misdiagnosed as Nocardia and subsequently required surgical excision in addition to antibiotic therapy.


Assuntos
Infecções por Actinomycetales/complicações , Infecções por Actinomycetales/terapia , Dermatoses do Pé/microbiologia , Gordonia (Bactéria) , Micetoma/microbiologia , Micetoma/terapia , Infecções por Actinomycetales/microbiologia , Adulto , Erros de Diagnóstico , Feminino , Dermatoses do Pé/terapia , Humanos , Nocardiose/diagnóstico
19.
PLoS Negl Trop Dis ; 10(8): e0004886, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27483367

RESUMO

Mycetoma is a devastating, neglected tropical disease characterised by extensive tissue involvement resulting in destruction, deformities and disabilities in the affected patients. The hand is commonly affected by mycetoma thus compromises its functionality and hinder the patient's daily activities of living. In this communication, we report on 533 patients with hand mycetoma managed over a period of 24 years at the Mycetoma Research Centre, University of Khartoum, Khartoum, Sudan. Eumycetoma was the commonest type of mycetoma (83.3%) encountered. Males were predominately affected (69.2%) with a sex ratio of 2.2:1. The majority of the patients (84%) were young adult below the age of 40 years old at presentation. The generality of patients (86.4%) were from the Sudan mycetoma belt. Children and adolescents (28.1%), farmers (18.2%) and workers (17.4%) were more frequently affected. The majority of patients (67.4%) had disease duration of less than 5 years at presentation. The study, did not document significant history of local trauma, familial tendency, concomitant medical diseases or other predisposing cause for mycetoma in this population. Pain (23.1%) was not a disease feature in this series and 52% of patients had past surgery for mycetoma and recurrence. The right hand was affected most (60.4%), and 64% of them had small lesion at presentation. Conventional x-ray was only helpful in patients with advanced disease and the MRI accurately determined the disease extension. Cytological smears, surgical biopsies histopathological examination and grains culture were the principal diagnostic tools for causative organisms' identification. In the present series it was difficult to determine the treatment outcome due to high patients follow up dropout.


Assuntos
Micetoma/diagnóstico , Micetoma/epidemiologia , Micetoma/terapia , Adulto , Anti-Infecciosos/uso terapêutico , Biópsia , Procedimentos Cirúrgicos Dermatológicos/métodos , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Radiografia , Recidiva , Literatura de Revisão como Assunto , Sudão/epidemiologia , Resultado do Tratamento , Adulto Jovem
20.
Eur Respir J ; 47(1): 45-68, 2016 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-26699723

RESUMO

Chronic pulmonary aspergillosis (CPA) is an uncommon and problematic pulmonary disease, complicating many other respiratory disorders, thought to affect ~240 000 people in Europe. The most common form of CPA is chronic cavitary pulmonary aspergillosis (CCPA), which untreated may progress to chronic fibrosing pulmonary aspergillosis. Less common manifestations include: Aspergillus nodule and single aspergilloma. All these entities are found in non-immunocompromised patients with prior or current lung disease. Subacute invasive pulmonary aspergillosis (formerly called chronic necrotising pulmonary aspergillosis) is a more rapidly progressive infection (<3 months) usually found in moderately immunocompromised patients, which should be managed as invasive aspergillosis. Few clinical guidelines have been previously proposed for either diagnosis or management of CPA. A group of experts convened to develop clinical, radiological and microbiological guidelines. The diagnosis of CPA requires a combination of characteristics: one or more cavities with or without a fungal ball present or nodules on thoracic imaging, direct evidence of Aspergillus infection (microscopy or culture from biopsy) or an immunological response to Aspergillus spp. and exclusion of alternative diagnoses, all present for at least 3 months. Aspergillus antibody (precipitins) is elevated in over 90% of patients. Surgical excision of simple aspergilloma is recommended, if technically possible, and preferably via video-assisted thoracic surgery technique. Long-term oral antifungal therapy is recommended for CCPA to improve overall health status and respiratory symptoms, arrest haemoptysis and prevent progression. Careful monitoring of azole serum concentrations, drug interactions and possible toxicities is recommended. Haemoptysis may be controlled with tranexamic acid and bronchial artery embolisation, rarely surgical resection, and may be a sign of therapeutic failure and/or antifungal resistance. Patients with single Aspergillus nodules only need antifungal therapy if not fully resected, but if multiple they may benefit from antifungal treatment, and require careful follow-up.


Assuntos
Pulmão/diagnóstico por imagem , Aspergilose Pulmonar/diagnóstico , Antifibrinolíticos/uso terapêutico , Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/imunologia , Aspergilose Broncopulmonar Alérgica/terapia , Artérias Brônquicas , Broncoscopia , Doença Crônica , Gerenciamento Clínico , Embolização Terapêutica/métodos , Hemoptise/etiologia , Hemoptise/terapia , Humanos , Imunocompetência , Hospedeiro Imunocomprometido , Aspergilose Pulmonar Invasiva/complicações , Aspergilose Pulmonar Invasiva/diagnóstico , Aspergilose Pulmonar Invasiva/imunologia , Aspergilose Pulmonar Invasiva/terapia , Pulmão/cirurgia , Micetoma/complicações , Micetoma/diagnóstico , Micetoma/imunologia , Micetoma/terapia , Aspergilose Pulmonar/complicações , Aspergilose Pulmonar/imunologia , Aspergilose Pulmonar/terapia , Cirurgia Torácica Vídeoassistida , Tomografia Computadorizada por Raios X , Ácido Tranexâmico/uso terapêutico
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