MedicalResearch.com Interview with:Stefano Volpato MD MPH
Department of Medical Sciences, University of Ferrara
MedicalResearch.com: What are the main findings of the study?Dr. Volpato: In this study we evaluated clinical value of handgrip strength assessment in older patients admitted to the hospital for hip fracture. We observed 504 older patients admitted to 4 Italian hospitals for hip surgery, able of walking independently before fracture, and we found a strong, graded and independent association of grip strength, assessed before hip surgery, and the likelihood of functional recovery over the one-year follow-up. The findings reported in our manuscript can be summarized as:
a. handgrip strength significantly correlated with several prognostic factors traditionally considered in clinical practice, such as age, gender, neuro-psychological and functional status, comorbidity level, vitamin D plasma levels, and time before the surgical procedure;
b. logistic regression models showed that handgrip strength was directly associated with higher probability of walking recovery, both at any follow-up (incident walking recovery), and for at least 2 consecutive follow-ups (persistent walking recovery);
b. Kaplan-Meier survival estimates showed that lower grip strength was related to increased mortality after hip surgery;
c. the association between grip performance and walking recovery was clinically relevant and statistically independent of potential confounders.
MedicalResearch.com Interview with:Karen K. Wong, MD MPH
Community Interventions for Infection Control Unit
Division of Global Migration & Quarantine
Centers for Disease Control and Prevention
MedicalResearch.com: What are the main findings of the study?Dr. Wong: There were 830 pediatric influenza-associated deaths reported to CDC during the 2004–2005 through 2011–2012 seasons; deaths occurred in children of all ages, and 43% had no high-risk medical conditions. Of children 6 months of age or older whose vaccination status was known, only 16% had been fully vaccinated with seasonal influenza vaccine.
MedicalResearch.com Interview with:Marcin Sadowski
Świętokrzyskie Cardiology Center, Kielce, Poland
MedicalResearch.com: What are the main findings of the study?Dr. Sadowski: In multivariable analysis, diabetes was an independent risk factor of in-hospital and 1-year mortality in women treated for STEMI.
In women with STEMI and diabetes one-year mortality was significantly lower in those treated with primary percutaneous coronary intervention than in those on optimal medical therapy.
Early and long-term prognoses after STEMI were the worst in diabetic women, compared with non-diabetic women and diabetic men.
MedicalResearch.com Interview with:Lucia Kerti MA
From the Departments of Neurology
Charité–University Medicine, Berlin
MedicalResearch.com: What are the main findings of the study?Answer: The results of our study on 141 healthy older people suggest that chronically higher blood glucose levels may have a negative influence on memory performance even in the absence of type 2 diabetes or even pre-diabetes. Moreover, our findings indicate that elevated blood glucose levels impair the functioning of brain areas like the hippocampus, a structure particularly relevant for memory. An important novel aspect in our study was the additional analysis of diffusion tensor imaging-based mean diffusivity within the hippocampal, which allowed us to obtain information on microstructure. We here provided first-time data of an association between higher blood glucose levels and lower hippocampal microstructure. Decreased hippocampal microstructure as measured by mean diffusivity may reflect a disruption of neuronal membranes and increased extracellular water content, leading to decreased signaling within and between hippocampal cells. Thus, information transfer between cells, indispensable for memory encoding, storage and retrieval, would be compromised. In sum, our data suggest that chronically higher blood glucose levels even within the "normal range" may decrease memory functions, possibly in part mediated by microstructural changes within the hippocampus.
MedicalResearch.com Interview with:Dr. Jian-Jun Liu
Shangdong Provincial Institute of Dermatology and Venereology
MedicalResearch.com: What are the main findings of the study?Answer:
· HLA-B*13:01 is associated with the development of dapsone hypersensitivity syndrome.
· Carrying one copy of HLA-B*13:01 increases one’s risk by 34 times of getting DHS, while carrying two copies increases risk by 100 times as compared to not carrying this allele.
· HLA-B*13:01 has a sensitivity and specificity of above 85% in predicting the risk of DHS, theoretically reducing the risk of DHS by 7 fold when implemented in clinical screening.
MedicalResearch.com Interview with:Andrew S. Lim MD MMSc FRCPC DABPN
Assistant Professor and Clinician Scientist
Division of Neurology, Department of Medicine
Sunnybrook Health Sciences Centre
University of Toronto
MedicalResearch.com: What are the main findings of the study?Dr. Lim: Alzheimer disease (AD) is the result of a confluence of genetic, behavioral, and environmental risk factors. The Apolipoprotein E (APOE) e4 allele is the most common and well established genetic risk factor for Alzheimer Disease. 10-20% of the US population carries the high risk APOE e4 allele, which confers up to a 30% lifetime risk of AD. Meanwhile, previous work had suggested that poor sleep may be a risk factor for AD and that APOE genotype and poor sleep may amplify each other's negative cognitive effects.
We asked the question whether good sleep consolidation (i.e. sound sleep without repeated awakenings) may reduce the effect of APOE on the risk of incident AD and the burden of AD pathology. We studied 698 individuals without dementia participating in the Rush Memory and Aging Project - a longitudinal cohort study of aging and risk factors for AD. We measured sleep consolidation using wrist-watch like devices called actigraphs, and followed participants for up to 6 years, examining them annually for the development of AD. Autopsies were perfumed on 201 participants who died during the follow-up period and we quantified the burden of AD pathology.
During the follow-up period, 98 participants developed AD. As expected, carrying the APOE e4 allele was associated with a higher risk of AD, faster cognitive decline, and a higher burden of AD pathology (amyloid plaques and neurofibrillary tangles) at death. However, better sleep at baseline significantly reduced the negative impact of APOE e4 on the risk of AD, rate of cognitive decline, and burden of neurofibrillary tangle pathology.
MedicalResearch.com Interview with:Meredith Atkinson, MD, MHS
Assistant Professor of Pediatrics
Division of Pediatric Nephrology
Johns Hopkins University School of Medicine
Baltimore, MD 21287
MedicalResearch.com: What are the main findings of the study?Dr. Atkinson: First, among a healthy cross-section of U.S. children, vitamin D deficiency defined as levels below 30 ng/mL (the currently accepted threshold for adequate vs. inadequate vitamin D) were associated with nearly twice the risk for anemia compared to those with sufficient vitamin D levels. Secondly, when we looked specifically at Caucasian and African-American children, we found that children with the lowest vitamin D levels were at increased risk for anemia in both groups, but that the specific vitamin D level below which the anemia risk started to increase was much lower in the African-American children (12 ng/mL) than in the Caucasian children (20 mg/mL).
MedicalResearch.com Interview with:Stefanie Hägg, MB
Folkhälsan Institute of Genetics, Folkhälsan Research Center,
Division of Nephrology, Department of Medicine, Helsinki University
Central Hospital, Helsinki, Finland
MedicalResearch.com: What are the main findings of the study?Answer: We studied the incidence of stroke in a large cohort of patients with type 1 diabetes in Finland. During 36,680 person-years of follow-up, we found that the incidence of total stroke, and the subtypes cerebral infarction and cerebral hemorrhage was 406, 286, and 120 per 100,000 person-years, respectively, which is higher than in the Finnish general population, for whom the incidence of stroke varies between 135 and 236 per 100,000 person years. Furthermore, we studied the impact of two diabetic microvascular complications, diabetic nephropathy and severe diabetic retinopathy, on the risk of stroke, as well as for the subtypes of stroke. The incidence of stroke, cerebral infarction, and cerebral hemorrhage increased with both the presence of severe diabetic retinopathy and with advancing diabetic nephropathy. Furthermore, we found that both diabetic nephropathy and severe diabetic retinopathy increased the risk for all subtypes of stroke, independently of traditional risk factors. A novel finding was that already incipient diabetic nephropathy (microalbuminuria) increased the risk of stroke, cerebral infarction, and cerebral hemorrhage more than 3-fold, compared with patients free of renal disease. The highest risk of stroke was seen in patients with end-stage renal disease.
MedicalResearch.com Interview with:Dr. Jennifer Fay Kawwaas MD
Department of Gynecology and Obstetrics
Emory University School of Medicine, Atlanta, GA, USA
MedicalResearch.com: What are the main findings of the study?Dr. Kawwaas: Using CDC National ART Surveillance System (NASS) data, we found an increasing trend from 2000 to 2010 in the number of donor egg cycles performed annually and in the percentage of donor cycles that resulted in a good outcome, defined as delivery of a full term infant weighing more than 5.5lbs. Donor and recipient ages remained relatively stable at 28 and 41, respectively, over the 11-year period.
Elective single embryo transfer is recommended when the donor is under 35 years old, regardless of recipient’s age; transfer of a single day 5 embryo was associated with an increased chance of good perinatal outcome.
Tubal or uterine factor infertility and non-Hispanic Black race were associated with a lower chance of good perinatal outcome.
MedicalResearch.com Interview with: Jeffrey Weber, M.D, Ph.D.
Senior Researcher, Moffitt Cancer Center
MedicalResearch.com: What are the main findings of the study?Dr. Weber: That the PD-1 blocking antibody nivolumab has a 25% ORR with long duration of response in ipilimumab refractory patients, and that patients with prior grade 3-4 ipilimumab related immune related side effects may be safely treated with nivolumab without reproducing the prior IPI related side effects.
Medicalresearch.com Interview with:David T Harris, Phd
Department of Immunobiology
University of Arizona
PO Box 245221, Tucson, AZ 85724.
MedicalResearch.com: What are the main findings of the study?Dr. Harris: The primary finding of the study was that it was routinely possible to harvest left-over adipose tissue and stem cells from both liposuction and cosmetic procedures, cryopreserve it for prolonged periods of time, and then thaw the tissue later when needed. Frozen and thawed adipose tissue was routinely viable and able to be differentiated into additional fat, as well as bone, cartilage and neuron-like cells. Thus, one can bank adipose tissue and stem cells without first isolating the stem cells allowing one to use the frozen and thawed tissue at later times for both cosmetic applications as well as for regenerative medicine.
MedicalResearch.com Interview with:Ruth Tamrat, Minh-Phuong Huynh-Le, and Madhav Goyal
Johns Hopkins University School of Medicine, MSIV
MedicalResearch.com: What are the main findings of the study?Answer: Despite the known adverse effects of sleep deprivation on recovery from illness, studies have shown that sleep deprivation remains an incompletely addressed problem among inpatients. Behavioral interventions are recommended as first line therapy prior to using pharmacologic therapy due to the adverse side effects of sedative hypnotics. This systematic review sought to identify the efficacy of non-pharmacologic interventions that have been used to improve the sleep of general inpatients. The results of this review demonstrate a lack of high quality evidence regarding the efficacy of these non-pharmacologic interventions in improving the sleep quality or quantity of patients in the hospital.
MedicalResearch.com Interview with:Dr. Gina Agarwal
Assistant Professor Department of Family Medicine
McMaster Family Practice
690 Main Street West
Hamilton , Ontario L8S 1A4
MedicalResearch.com: What are the main findings of the study?Dr. Agarwal: The study findings are just preliminary as of yet, but suggest that the CHAP-EMS program is potentially a feasible and effective health program for seniors housing buildings in urban areas. The program delivered tailored health risk assesments to seniors living in subsidized city housing, also assessing their risk of cardiovascular disease, diabetes and falls using validated tools. Paramedics were trained in how to assess, and deliver risk assessment results and then provide community resource information. Seniors attending the program could drop in any time and were encouraged to come back for follow up sessions. Results of each attendance were forwarded to family doctors to close the loop.
At the 5th month of implementation, we have recorded 241 participant visits by 40 unique participants; 37 had 2 or more visits; 70% had elevated BPs initially; 77.8% of those previously diagnosed hypertensive and 55.8% of those undiagnosed hypertensive had elevated BP; 82.5% had moderate to high CANRISK scores. Preliminary data shows a 32% reduction in EMS calls.
MedicalResearch.com Interview withKatherine Auger, MD, MSc
Assistant Professor of Pediatrics
Division of Hospital Medicine
Cincinnati Children's Hospital Medical Center
MedicalResearch.com: What are the main findings of the study?Dr. Auger: We examined hospitalization rates in infants for pertussis before versus after the recommendation to universally vaccinate all adolescents with Tdap. We used mathematical modeling to predict the number of infant hospitalizations that would be expected without the Tdap vaccine policy. We then compared these predicted numbers to the actual observed numbers of infant hospitalizations. In 3 of the 4 years after Tdap vaccine policy, there were significantly fewer infant hospitalizations for pertussis than expected base on the predictions.
MedicalResearch.com Interview with:Sharon Curhan, MD, ScM
Channing Division of Network Medicine
Brigham and Women's Hospital
Harvard Medical School
Boston, MA 02115
MedicalResearch.com: What are the main findings of the study?Dr. Curhan:The main findings of our study are that higher body mass index and larger waist circumference are associated with an increased risk of acquired hearing loss, and higher level of physical activity is associated with a decreased risk of acquired hearing loss in women. Specifically, after adjusting for potential confounders, compared with women with BMI <25 kg/m2, the relative risk for hearing loss was 25% higher for women with BMI>40. Compared with women with waist circumference <71 cm, the relative risk for hearing loss was 27% higher for women with waist circumference >88 cm. Higher physical activity was inversely related to risk; compared with women in the lowest quintile of physical activity, women in the highest quintile of physical activity had a 17% lower risk of hearing loss. Walking, the most common form of physical activity among these women, was associated with a lower risk; women who walked 2 hours per week or more had a 15% lower risk of hearing loss than women who walked less than one hour per week. These findings provide evidence that maintaining healthy weight and staying physically active, potentially modifiable lifestyle factors, may help reduce the risk of hearing loss.
Researcher, Department of Clinical Science
University of Bergen, Norway
MedicalResearch.com: What are the main findings of this study?Answer: The main findings in this prospective observational cohort study among patients with established coronary artery disease were that a very high intake of omega-3 fatty acids was associated with a reduced risk of acute myocardial infarction in patients with diabetes, but with an increased risk of fatal acute myocardial infarction and with lower glycosylated hemoglobin in those without impaired glucose metabolism.
MedicalResearch.com Interview with: Adrianne Haggins, MD, MS
University of Michigan Health System
Department of Emergency Medicine
Ann Arbor, MI 48109-5303
MedicalResearch.com: What are the main findings of the study?Dr. Haggins: Since the implementation of the Children’s Health Insurance Program (CHIP) in 1997, the last national health care reform that broadly expanded insurance coverage, adolescent use of primary care and specialty care has increased substantially in comparison to no change seen among the comparison group (young adults, who were not covered). Broadening insurance coverage for adolescents did not result in a decrease in emergency department use, while ED use in the comparison group increased over time. (more…)
MedicalResearch.com Interview with:Gigi Cuckler
National Health Statistics Group
Office of the Actuary, CMS
MedicalResearch.com: What are the main findings of the study?Answer: Below we provide the major findings, but it’s important to note that these estimates incorporate two substantial changes from prior projections.
First, the estimates incorporate the June 2012 US Supreme Court ruling that made the Medicaid eligibility expansion under health reform optional for states.
Second, unless otherwise stated, the estimates focus on an outlook for spending in which the scheduled Medicare physician payment rate updates under the Sustainable Growth Rate formula do not occur. The following are highlights from our most recent report:
Over the projection period, 2012-22, national health spending is projected to grow at an average rate of 5.8 percent, which is 1.0 percentage point faster than expected average annual growth in the economy over the period. Consequently, the health share of GDP is projected to increase from 17.9 percent in 2011 to 19.9 percent of the economy by 2022.
In the near term of the projection, through 2013, national health spending growth is expected to remain just under 4.0 percent due to the sluggish economic recovery, continued increases in cost-sharing requirements for the privately insured, and low growth for Medicare and Medicaid.
However, in 2014, national health spending growth is projected to accelerate to 6.1 percent, reflecting the expanded insurance coverage that will become available through the Affordable Care Act.
After 2014 through the remainder of the projection period, national health spending is projected to grow 6.2 percent per year on average, largely as a result of the continued implementation of the coverage expansions under reform, faster projected economic growth, the aging of the population, and the end of the sequester.
While projected health spending growth is faster compared to recent experience, it is still slower than the growth experienced over the longer-term history. (more…)
MedicalResearch.com Interview withProfessor Stefan Priebe, Dipl.-Psych., Dr. med. habil., FRCPsych
Unit for Social and Community Psychiatry
WHO Collaborating Centre for Mental Health Services Development
Queen Mary, University of London
MedicalResearch.com: What are the main findings of the study?Answer: Offering modest financial incentives can help patients to achieve better adherence to anti-psychotic maintenance medication. (more…)
MedicalResearch.com Interview with:Dr. med. Jelena Kornej
Department of Electrophysiology, Heart Center, University of Leipzig, Leipzig, Germany & University of Birmingham Centre for Cardiovascular Sciences, City Hospital,
Birmingham, United Kingdom
MedicalResearch.com: What are the main findings of the study?Answer:The main finding of our analysis was that thromboembolic events after atrial fibrillation (AF) catheter ablation are rare, but all three stroke risk stratification scores, i.e. CHADS2, CHA2DS2-VASc, and R2CHADS2 were associated with thromboembolic risk in anticoagulated population. Furthermore, patients with AF recurrences had increased risk for thromboembolic complications.
MedicalResearch.com Interview with Dr. Kees-Jan Kan PhD
Department of Biological Psychology, VU University
Department of Psychological Methods, University of Amsterdam
MedicalResearch.com: What are the main findings of the study?Answer: We asked ourselves how well theories of intelligence actually predict empirical results. To this end, we reviewed and scrutinized the predictions from intelligence theories and collected relevant results that have been published in the scientific literature over the last decades. The results pertained to intelligence test scores from thousands of subjects across the world. We found that on essential aspects the empirical results were opposite of the predictions from the mainstream theories of intelligence, in which intelligence is interpreted as a biological trait. (more…)
MedicalResearch.com Interview with:Saul Blecker, MD, MHS
Department of Population Health, NYU School of Medicine
Department of Medicine, NYU School of Medicine, New York, NY
MedicalResearch.com: What are the main findings of the study?Dr. Blecker: Inpatient quality of care has focused primarily on patients with acute heart failure, commonly identified by principal discharge diagnosis code. However, patients with heart failure are commonly hospitalized for other causes and should benefit from many of the same treatments.
We found that in our sample, as compared to patients with a principal diagnosis of heart failure, heart failure patients hospitalized with a non–heart failure diagnosis had lower rates of guideline-concordant care, including assessment of left ventricular function and prescription for an ACE inhibitor or ARB, at time of discharge. This is important as our study suggests that these therapies were associated with reduced mortality for patients hospitalized with heart failure, regardless of the reason for hospitalization.
MedicalResearch.com Interview with:Jussi Naukkarinen, M.D., Ph.D
Institute for Molecular Medicine Finland (FIMM)
Nordic EMBL Partnership for Molecular Medicine
and National Institute for Health and Welfare (THL)
Division of Welfare and Health Promotion
Public Health Genomics Unit
and University of Helsinki
School of Medicine Dept. of Medical Genetics
MedicalResearch.com: What are the main findings of the study?Answer: We found in this sample of relatively young, Finnish twins that there are clearly two different kinds of obesity. While most individuals with BMIs in the "obese" category will go on to develop the usual pathologies associated with obesity (namely diabetes, hypertensio, dyslipidemia), a fraction of the obese population seems to be spared. These "metabolically healthy obese" individuals displayed a number of features that were associated with a healthy metabolic profile despite considerable overweight: a capacity for hyperplasia of the adipose tissue (as opposed to just hypertrophy) seemed to be associated with maintained mitochondrial function, lack of inflammation and liver fat. (more…)
MedicalResearch.com Interview withStephan Zipfel MD
Professor of Medicine & Dean of Medical Education
Head Department of Internal Medicine VI
(Psychosomatic Medicine and Psychotherapy)
University Medical Hospital Tuebingen
President of the German College of Psychosomatic Medicine (DKPM)
Co-Director of the centre for nutritional Medicine Tuebingen-Hohenheim
72076 Tuebingen / Germany
MedicalResearch.com: What are the main findings of the study?Prof. Zipfel: Outpatient treatment of adults with anorexia nervosa by either enhanced cognitive-behaviour therapy, focal psychodynamic therapy, or optimised treatment as usual led to relevant weight gains and a decrease in general and eating disorder-specific psychopathology during the course of treatment. These positive effects continued beyond treatment until 12-month follow-up. Most patients completed treatment and the acceptance of both specific therapy approaches was high among both patients and therapists.
MedicalResearch.com Interview with:Eva Aagaard, MD
Associate Professor of Medicine, Assistant Dean for Lifelong Learning, Director of the Academy of Medical Educators, Director of the Center for Advancing Professional Excellence, and Director of Faculty Development in General Internal Medicine at the University of Colorado
MedicalResearch.com: What are the main findings of the study?Dr. Aagaard: We obtained feedback on, and assessed the construct validity and perceived feasibility and utility of, draft Internal Medicine Milestones for Patient Care and Systems-Based Practice used a mixed methods study involving competency committee members in Internal Medicine residency programs. An initial survey assessed participant and program demographics; focus groups obtained feedback on the draft milestones and explored their perceived utility in resident assessment, and an exit survey elicited input on the value of the draft milestones in resident assessment. Thirty-four participants from 17 programs completed surveys and participated in 1 of 6 focus groups. Overall, the milestones were perceived as useful in formative and summative assessment of residents. Participants raised concerns about the length and complexity of some draft milestones and suggested specific changes. The focus groups also identified a need for faculty development. In the exit survey, most participants agreed that the Patient Care and Systems-Based Practice Milestones would help competency committees assess trainee progress toward independent practice.
MedicalResearch.com Interview with:Richard A. Oram, BMBCh, BA(hons), MRCP
NIHR Exeter Clinical Research Facility
University of Exeter Medical School, Barrack Road, Exeter, UK
MedicalResearch.com: What are the main findings of the study?Answer:Historically people with Type 1 diabetes were thought to progress to make absolutely none of their own insulin. Modern assays allow us to measure very low levels of insulin, and using these we can find very tiny amounts of insulin production in most people with Type 1 diabetes even if they have had the disease for many years. (more…)
MedicalResearch.com interview with: Kesava Reddy, PhD, MHA
University Cancer and Diagnostic Centers, Houston, Tex
MedicalResearch.com: What are the main findings of the study?Dr. Reddy: Crude oil spills affect the human health through their exposure to the inherent hazardous chemicals such as para-phenols and volatile benzene. Evidence show that oil spill exposure is associated with multiple adverse health effects and increased cancer risk. In this study, we assessed the adverse health effects of the Gulf oil spill exposure in subjects participating in the clean-up operation along the coast of Louisiana. The findings were compared with those not exposed to the oil spill. We found that platelet counts were notably decreased in the oil spill exposed group. In addition, creatinine and blood urea nitrogen levels were substantially lower in the exposed group, while hemoglobin and hematocrit levels were increased compared to the unexposed subjects. Furthermore, considered indicators of hepatic damage, the serum alkaline phosphatase (ALP), aspartate amino transferase (AST), alanine amino transferase (ALT), levels in the exposed subjects were also elevated. Participants in the oil spill cleanup activity also reported somatic symptoms, with headache reported most frequently, followed by shortness of breath, skin rash, cough, dizzy spells, fatigue, painful joints, night sweats, and chest pain.
Prof. Dr. Gunnar Brix
Division of Medical and Occupational Radiation Protection
Federal Office for Radiation Protection
Institut für Med. Strahlenhygiene
MedicalResearch.com: What are the main findings of the study?Answer: We investigated the cumulative radiation exposure and cancer risk of more than 1200 patients with ischemic heart diseases (IHD) from diagnostic and therapeutic imaging procedures performed 3 month before and 12 month after the date of diagnosis. The major findings were:
87% of patient exposure resulted from heart catheter procedures.
The average cumulative effective dose was 13.3 mSv in males and 10.3 mSv in females. The highest dose was nearly 100 mSv.
The estimated average attributable life-time risk of male and female patients to develop a radiation-induced cancer in their remaining life was 0.09 % and 0.07 %, respectively. This correspond to 1 excess cancer in about 1100 male and 1400 female IHD patients. The highest risk was 0.9 %.
The effective dose is inadequate to characterize individual radiation risks, since neither the age nor the sex of the patient is taken into account. According to our results, cancer risks can vary by a factor of more than 10 for comparable values of the effective dose. (more…)
MedicalResearch.com Interview with:Dr. Elizabeth V. Asztalos, MD, M.Sc., FRCPC
Sunnybrook Health Sciences Centre
2075 Bayview Ave., Room M4 230
Toronto, ON M4N 3M5
MedicalResearch.com What are the main findings of the study?Answer: This study was focused to see if there were differences in the main neurodevelopmental outcomes of children whose mothers had participated in the original MACS trial. We found that there were no differences in the main outcomes of the trial as it related to the aspects of death and/or developmental. (more…)
Privacy & Cookies Policy
Necessary cookies are absolutely essential for the website to function properly. This category only includes cookies that ensures basic functionalities and security features of the website. These cookies do not store any personal information.