[Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers]. / Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores.

BACKGROUND: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to intervene in time if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. OBJECTIVES: To understand of the day to day life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. PATIENTS AND METHODOLOGY: Descriptive and transversal study on IDDM patients between the ages of 3 and 18, treated within the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the 1st survey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient's daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professionals with pupils with IDDM. RESULTS: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were 10 to 14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4; 47% of teachers feel insecure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognise its signs and symptoms and know how to act when they occur. CONCLUSIONS: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certain skills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease.

[Tuberculosis outbreak in a school]. / Brote de tuberculosis en una escuela.

OBJECTIVE: To demonstrate the importance of preventive measures when a case of tuberculosis is detected, identify the causes that favored a tuberculosis outbreak in a school and determine the efficiency of obtaining induced sputum samples. DESIGN: Descriptive, study. SETTING: The Santa Maria de la Providencia school, located in the municipality of Alcala de Henares in Spain. INTERVENTIONS: On April 11, 2005, a case of bacilliform pulmonary tuberculosis was notified in a teacher. Study of contacts in the collective was performed as a programmed intervention. Mantoux skin test and, if positive, chest radiograph were performed in contacts. Treatment of latent or active tuberculosis was recommended according to the result. RESULTS: School exposures were identified and underwent the Mantoux skin test (142 students in years 1, 2, 3, and 4 of compulsory secondary education and 22 teachers). The Mantoux test was positive in 68 students (48 %) and seven teachers (32 %). In seven students with results compatible with active tuberculosis disease, sputum induction was performed and treatment was started. A further two students, identified as contacts, were studied in another center and also started treatment for active tuberculosis disease. Due to the high risk of contagion, study of contacts was extended to the remaining students in compulsory secondary education. In this second phase, 134 students received the Mantoux skin test and seven were Mantoux positive (5.2 %). In all these students, active tuberculosis disease was ruled out. Latent tuberculosis treatment was recommended in all Mantoux-positive contacts.

[Adverse reaction of pseudoephedrine]. / Reacción adversa por seudoefedrina.

We present a case of a 7 years old girl who developed an episode of myoclonic movements and tremors after being medicated with a not well quantified amount of a pseudoephedrine/antihistamine combination. We want to highlight the potential toxicity of pseudoephedrine, usually administered as part of cold-syrup preparations which are used for symptomatic treatment of upper respiratory tract cough and congestion associated with the common cold and allergic rhinitis. Although these products are generally considered to be safe either by physicians and parents, we can't underestimate the potential adverse events and toxic effects that can occur when administering these medications.

[Descriptive study of malaria cases in a general hospital in Madrid between 1996 and 2011]. / Estudio descriptivo de los casos de paludismo en la población pediátrica en un hospital general de Madrid entre 1996 y 2011.

INTRODUCTION: Malaria causes around 863,000 deaths per year, mostly of them in children under 5 years old. MATERIAL AND METHODS: We have reviewed the epidemiological data of malaria cases in a pediatric department in a Hospital in the Community of Madrid, in the period 1996-2011. RESULTS: In the period reviewed, 103 cases of malaria were diagnosed in children under 14 years old. Sixty percent were males and the average age was 4.5 years. In most cases, the infection arose during a visit to relatives in the country of origin. The vast majority did not have malaria prophylaxis. Twenty-five percent of the cases were diagnosed as complicated malaria, the main criteria being hyperparasitemia, of which 80% of the patients did not present any other complications CONCLUSIONS: A high level of suspicion must be maintained in any patient who comes from a malaria endemic area. The key factor responsible for the infection was the lack of chemoprophylaxis.

[Pregnancy in adolescent mothers (between the ages of 15 and 18). Neonatal results]. / Embarazo en madre adolescente (quince a dieciocho años). Resultado neonatal.

A total of 61 infants of adolescent mothers (aged 15 to 18 years) were compared at birth with two control groups of 78 infants born of nonadolescents (aged 19 to 30 years). Control group I were adults mothers, married, with adequate prenatal care, without gestational risk factors, and similar parity to adolescents mothers. Control group II were adult mothers with prenatal care, risk factors during pregnancy, marital status and parity in like proportions to adolescent mothers. Only statistically significant difference was that adolescent mothers delivered infants whose mean weight was 180 g less (p less than 0.01) than infants of group I, and 152 g less (p less than 0.05) than infants of group II. Prematurity, low-birth-weight, low Apgar score, and difficulties at birth, had not greater incidence in adolescent group.

[Clinical and biological impact of environmental pollen on children with pollinosis]. / Repercusiones clínicas y biológicas del polen ambiental sobre los niños con polinosis.

In our area 100% of the pollen allergic children, between 1 and 14 years old, show cutaneous hypersensitivity to grass. The aim of this study was to ascertain whether children who have also a positive skin test to other pollen have a different clinical and biological seasonal behaviour than children with exclusive grass hypersensitivity. Seventy-two of these children answered a questionnaire in which they recorded the days in which they suffered symptoms of pollinosis and the kind of clinical manifestations from the first of April to the twenty sixth of July, 1984. Twenty-four patients were exclusively allergic to grass pollen and forty-eight also showed a positive skin test to other pollens. All patients were aware of and had used many kinds of symptomatic therapy. Therefore this circumstance was not taken into consideration when we evaluated the results. Sixty-one children had also received a pre-seasonal hyposensitization treatment with pollen grass extracts. The serum IgE level was determined in two moments, before and after the seasonal reactivation, in February and July. In sixty-nine cases the skin test diameters of pollen grass were also measured before and after the pollination. The follow-up questionnaire let us know whether the intensity of clinical manifestation was proportional to atmospheric pollen levels and whether the kind of clinical symptomatology was related to any immunological condition of the children. The environmental study and the clinical follow-up during the spring of 1984, of seventy-two children with pollinosis showed that the symptoms were only noticed during the weeks of grass pollination. The other pollen allergies did not cause any clinical presentation. In addition, there was no proportion between the environmental pollen levels and the intensity of the symptoms. The clinical manifestations terminated several weeks before the end of pollination in about 50% of the patients. On the contrary, the other 50% of patients maintained their clinical symptoms while a noticeable amount of pollen persisted in the atmosphere. These groups of children had neither special clinical features nor different serum IgE levels. Nevertheless, the size of the skin test decreased from February until July in the group whose symptomatology terminated before the end of pollination. The five patients who duplicated the serum IgE levels during this same period were the cases who showed clinical symptomatology during more days.(ABSTRACT TRUNCATED AT 400 WORDS)

[Gilbert's syndrome. 3 pediatric cases]. / El síndrome de Gilbert. Tres casos pediátricos.

The study includes three pediatrics patients with Gilbert's syndrome (GS). The diagnosis was made on the basis of a mild unconjugated hyperbilirubinemia in the presence of repeatedly normal liver function test and absence of over signs of hyperhaemolysis. Two test have been also proposed for the diagnosis of GS, namely the hyperbilirubinaemia induced by a reduction in caloric intake, and hyperbilirubinaemia induced by nicotinic acid. In this study a reduction in caloric intake was associated with a greater absolute increase in serum bilirubin concentration. A single determination of bilirubin in parents and brothers of patients, showed high bilirubin in only one parent. The possibility of arriving at a definite diagnosis of GS is important both to the frequent presentation in adolescence with nonspecific symptoms that abdominal recurrent pain, the high incidence of the benign syndrome, and also to reassure the "patient".

Alpha-1 antichymotrypsin levels are actively increased in normal colostrum.

BACKGROUND: It is well known that human colostrum has important antiinflammatory functions. The purpose of the current study was to determine antiprotease levels in colostrum and serum and to assess the importance of local synthesis and the electrophoretic differences in both locations. METHODS: Five protease inhibitors were determined by radical immunodiffusion in colostrum and serum samples taken simultaneously from 50 healthy women, 36 to 72 hours after delivery. RESULTS: Antithrombin II, inter-alpha trypsin inhibitor, and alpha-2 macroglobulin levels were undetectable in colostrum. Mean antitrypsin levels in colostrum were 6% of serum levels, but colostrum alpha-1 antichymotrypsin was higher than expected (0.39+/-0.34 g/l) in relation according to the albumin passive transport, and their mean value was 41% of serum levels. Colostrum antichymotrypsin levels did not correlate with serum antichymotrypsin levels or with colostrum albumin levels. The antichymotrypsin molecule in colostrum had a slower electrophoretic mobility when compared with that of serum antichymotrypsin, and it showed a different pattern in Western blot analysis, with a predominating 80-kDa molecule. CONCLUSIONS: Although the origin of colostral antichymotrypsin is unclear, local production in breast epithelial cells is likely. Antichymotrypsin is increased in colostrum, and its molecule has some characteristic differences, suggesting that it has an important and specific role in infant nutrition during breast milk feeding.

[Natural history of pollinosis in childhood]. / Historia natural de la polinosis en la infancia.

Out of 2.513 clinical files of allergic children, we have found 200 pollen-allergic patients, which represent 7.9% of the total allergic pathology in children, in our environment. We have studied in these 200, the most important epidemiological parameters and the influence that this can cause upon the characteristics of this disease. A male predominance has been found (70%) and it has been discovered that 52% of the total were born in spring (p less than 0.0005). An hundred per cent have shown grass-pollen sensitiveness and 52% have also shown other kinds of pollen hypersensitivity. It has been found familiar allergic background in 76.5% of the cases and in 32.5% familiar allergic history of pollinosis. Unexpectedly, those who were in lack of familiar allergic history began their clinical symptoms earlier; 51.06% before 6 years of age (p less than 0.05). Other kinds of allergic manifestations were found in 51%, being respiratory symptoms the most important (35.5%), followed by the cutaneous (23.5%) and digestive ones (10.5%). Allergy to drugs was found in 10.5%. The more frequent symptoms of pollinosis were in order of importance: rhinitis (86.5%), conjunctivitis (77%), asthma (48%), spasmodic cough (27.5%) and urticaria (4%). Asthma induced by grass-pollen hypersensitivity was equally suffered by the males as by the females, and this was more frequent among the patients who had previously suffered from non-pollinic respiratory allergies.

[Variables influencing duration of hospitalization for urinary tract infection]. / Variables que influyen en la duración de la hospitalización por infección del tracto urinario.

BACKGROUND: The need for hospitalization and its duration in children with urinary tract infections (UTI) are controversial. OBJECTIVE: To analyze the effect of certain clinical factors from the medical records of children hospitalized with UTI to determine which factors have the greatest influence on length of hospital stay. MATERIAL AND METHODS: A retrospective study of the medical records of 93 patients admitted to our department with a diagnosis of UTI between May 1998 and June 2000 was carried out. All cases were confirmed by bacteriological analysis. The variables analyzed included age, sex, duration of fever before and during admission, temperature, length of intravenous antibiotic therapy, administration of aminoglycosides, presence of urinary tract malformations, previous episodes of UTI, and length of hospital stay. RESULTS: The variables with the greatest influence on a length of hospital stay of more than 7 days were age, especially an age of less than 24 months (OR 3.42; 95 % CI 1.2-9) and the number of days with fever during hospitalization (more than 2 days: OR 2.73; 95 % CI 1.07-7.6). CONCLUSION: Patient age significantly influences length of hospital stay in children with UTI. To optimize resources, ambulatory treatment of children with UTI should be encouraged, even in those younger than 2 years.

[Correlation between IGA from colostrum and serum and IGA is closer than between salivary IGA and total IGA]. / Mejor relación de los anticuerpos-IgA calostrales con la IgA total y con los anticuerpos séricos que con los salivares.

Colostrum, serum and saliva were simultaneously obtained from 50 normal mothers. 19-45 years old, 36-72 hours post-delivery. Total IgA level and class-IgA antibodies against 3 common food antigens (lactoglobulin, gliadin and ovalbumin) and 4 types of salmonella (typhi, paratyphi A, B and C) were determined in all samples. The 7 antibodies (Ab) were detected in colostrum, by ELISA, in a higher percentage of samples (88-62%), than in serum (82-34%) and saliva (77-27%). These percentages were higher for food-Ab than for anti-salmonella Ab. The total colostral IgA was close correlated with food-Ab in colostrum (p less than 0.001) and quite poorer with anti-salmonella Ab (p less than 0.05-p less than 0.01). A good correlation was generally also present between Ab from colostrum/serum, but was worse between both secretions (colostrum/saliva). The present results suggest that colostrum specific Ab levels can be predicted, depending on total IgA and the specific Ab from serum.

[Carbon monoxide poisoning. A home accident to remember]. / Intoxicación por monóxido de carbono. Un accidente doméstico a no olvidar.

BASIS: The aim of this paper is to clinically describe a type of intoxication, mainly domestic, which still prevails today and which could even be increasing. MATERIALS AND METHODS: We present ten "toxic accidents" which involved seventeen patients, all under fifteen years of age. The diagnosis was confirmed upon obtaining a level of more than 5% carboxyhemoglobin (CO-Hb) in the blood. RESULTS: The symptomatology included: a sensation described by the patients as dizziness (53%), headache (53%), nausea and vomiting (35%). Sleepiness, fainting, or a faint-like feeling were also frequent (23%). The CO-Hb levels at admission were 28.6% +/- 9 (7.1-39.8). Pulse oximetry was performed in three patients, resulting in normal values. In all of the cases with the exception of one, several members of the family were affected simultaneously and the sources of intoxication were the boilers and/or gas heaters that were installed in the homes. The exception occurred in a home were there was a traditional coal burner. All patients were treated by inhalation of 100% oxygen. This resulted in a mean fall of the CO-Hb level in a two-hour interval to 4.6% +/- 2.1 (0-7.8). CONCLUSIONS: We emphasis the fact that since the symptoms are often nonspecific, a high level of suspicion is necessary in order to make this diagnosis. It is fundamental to keep this type of intoxication in mind when various members of a family present symptoms simultaneously and especially if it occurs during the colder time of the year. Only the determination of the CO-Hb can confirm this suspicion since gasometry and pulseoximetry are useless.

[Serum eosinophil cationic protein in children with allergic and nonallergic inflammation]. / Proteína catiónica eosinófila sérica en niños con inflamación alérgica y no alérgica.

Serum eosinophil cationic protein (ECP) levels increase in inflammation processes with activation of eosinophils. We studied serum ECP in (I) 32 pollinic children without symptoms, in June and October and (II) 10 children with acute asthma crisis. As control groups we included (III) 25 children sent to the hospital with suspected allergic diseases in which an IgE mediated process could be ruled out; (IV) 34 coeliac patients; (V) 15 children with cystic fibrosis and (VI) 48 normal children. The pollinic children had increased figures of ECP in June (21.2 +/- 9.2 micrograms/L) compared to normal controls (p < 0.001) and they continued to have high levels in October (13.5 +/- 9.2 micrograms/L, p < 0.05). The patients with very high ECP (> 20 micrograms/K), in spite of being asymptomatic, showed a negative correlation between ECP/peak-flow (p: 0.038). In addition, in these patients the ECP also had a negative correlation with the recovery of bronchospasm from June to October (p: 0.024). Some asthmatic children also had high ECP, but the results were too heterogeneous to draw any conclusions, possibly due to the drugs received. The ECP was independent of age and sex. It not correlated with serum IgE, nevertheless, in non-atopic patients it did correlate with blood eosinophilia (p < 0.005). In coeliac and cystic fibrosis patients, we did not find ECP to be increased. In conclusion, serum ECP increases in some allergic patients and suspected allergy, but not in all cases. It does not increase in other chronic mucosal inflammations, such as coeliac or cystic fibrosis. It correlates with bronchospasms and would have some value in predicting short-term evolution.

Selective and partial IgA deficiency in an adolescent male with bronchiectasis.

Selective IgA deficiency is the most common primary immunodeficiency. Two types of selective IgA deficiency may be distinguished: the complete form, with IgA level less than 5 mg/dl, and the partial IgA deficiency, with level greater than 5 mg/dl but less than 2 standard deviations below the age-adjusted mean level; 50% of the cases belong to the partial type and half of them may be considered as transient clinical form. Patterns of this condition, are very unsteady: while some patients remain without any symptoms, others present recurrent respiratory and gastrointestinal tract infections. Though respiratory tract infections are the most frequent diseases, and in very few patients are associated bronchiectasis. A twelve-year-old patient with permanent partial IgA deficiency was treated for bronchiectasis in our pneumology and allergy pediatric center. The other serum immunoglobulins, IgG subclass, lymphocytes sub-populations, cell with expression of DR markers and proliferative response to PHA of peripheral blood lymphocytes, were normal. The alpha-1-antitrypsin, Mantoux test (negative), sweat chloride concentration and ciliated nasal epithelium were also normal. Pneumonia, bronchiectasis and meningitis are found in the complete IgA deficiency. The greater part of studies confirm that this severe, chronic and/or recurrent lower respiratory tract diseases are scarcely found in children with partial selective IgA deficiency, although our case states that it can be found. We think that in every patient with bronchiectasis the selective IgA deficiency complete or partial, has to be considered as an isolated etiologic factor.

Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores / Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers

Fundamentos: el cuidado diario del niño y el adolescente con diabetes mellitus insulinodependiente (DMID), fundamental para la evolución a corto y largo plazo de la enfermedad, debe incluir las muchas horas de permanencia en la escuela. La presencia, en el entorno escolar, de personas entrenadas para evitar los riesgos de una intervención tardía ante una complicación aguda, como es la hipoglucemia, y facilitar el buen control de la enfermedad puede ser considerada una necesidad. La presencia de personal sanitario en nuestros centros educativos públicos es escasa al no estar establecida como obligatoria. Objetivos: conocer aspectos de la vida cotidiana de los niños con DMID centrados en su jornada escolar y conocer actitudes de profesores de colegios e institutos frente a alumnos con DMID. Pacientes y método: estudio descriptivo, transversal sobre pacientes con DMID de 3 a 18 años atendidos en el área sanitaria 3 de la Comunidad de Madrid y sus respectivos profesores mediante dos tipos de encuesta: primera encuesta, distribuida por la Fundación para la Diabetes, con 80 preguntas dirigidas a pacientes de 3 a 18 años y sus padres en relación con su vida diaria y el entorno escolar. Segunda encuesta, de elaboración propia, dirigida a profesores de enseñanza primaria y secundaria, que valora cómo viven la presencia de estos alumnos con DMID en el aula. Resultados: del cuestionario dirigido a pacientes y padres, fueron válidas 50 en el área correspondiente a nuestro centro, y destacamos que: la mayor participación fue de los niños de 10 a 14 años; el 86% de los niños saben medirse la glucemia y el 66% sabe administrarse insulina; el 74% no ha tenido problemas de inserción escolar; sin embargo, por edades, hasta le 50% de las menores de 6 años lo han padecido; hasta en el 50% de las ocasiones en que un paciente ha precisado la administración de insulina durante el horario escolar lo ha hecho un familiar; el 66% de las hipoglucemias son resueltas por el paciente; sólo disponen de personal sanitario en el centro educativo el 8% de los pacientes y, por último, el 98% cree oportuno que todos los profesores de niños con diabetes tengan información por escrito de los síntomas y pasos a seguir en caso de hipoglucemia cuando el alumno se incorpora al colegio. Del cuestionario dirigido a profesores, respondido por un 54% (76 de un total de 140), destacamos que: el 71% reconoce tener o haber tenido a un alumno diabético; el grado de conocimiento de los profesores sobre diabetes, valorado con una escala del 1 al 7, muestra una mediana de 3 y una moda de 4; la inseguridad generada por un alumno diabético la atribuyen (un 47%) a la falta de instrucciones explícitas sobre la actuación ante complicaciones concretas; el 97,4% de los profesores dicen saber lo que es una hipoglucemia; sin embargo, sólo el 67,1% conoce los signos y síntomas que genera y un 57% dice saber que debe hacer ante esta situación. Conclusiones: la integración y la aceptación escolar de los alumnos con DMID es buena, percepción compartida por padres y profesores. Estos niños desde muy pequeños se responsabilizan de su enfermedad y adquieren habilidades de autocuidado a edades tempranas, pero necesitan ayuda, y ésta es prestada diariamente desde el entorno familiar incluso durante el horario escolar. En general, los profesores muestran una buena disposición para adquirir habilidades que los capaciten para la eventual ayuda a estos niños; sin embargo, su carencia de conocimientos y la ausencia de personal sanitario en los centros educativos hacen necesaria una más amplia información para mejorar la comprensión y la asunción del problema (AU)

Background: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to interveneintime if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. Objectives: To understand of the day today life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. Patients and methodology: Descriptive and transversal study on IDDM patients between the ages of 3 and18, treated with in the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the1 stsurvey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient’s daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professional swith pupils with IDDM. Results: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were10 to14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4;47% of teachers feel in secure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognize its signs and symptoms and know how to act when they occur. Conclusions: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certains kills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease (AU)