• Congenital Muscular Dystrophy (CMD) is a progressive muscular disorder characterized by muscle wasting, formation of excess connective tissue in the muscles, and possibly abnormal nerve conduction. (wisdompanel.com)
  • Clinical signs associated with Congenital Muscular Dystrophy, identified in the Italian Greyhound, will be present by a few months of age in affected dogs. (wisdompanel.com)
  • Histopathology may show general signs of muscular dystrophy and endomysial fibrosis, and immunofluorescent staining for alpha 2 laminin will show an absence of staining. (wisdompanel.com)
  • A carrier dog with one copy of the Congenital Muscular Dystrophy (Discovered in the Italian Greyhound) variant can be safely bred with a clear dog with no copies of the Congenital Muscular Dystrophy (Discovered in the Italian Greyhound) variant. (wisdompanel.com)
  • LAMA2 nonsense variant in an Italian Greyhound with congenital muscular dystrophy. (wisdompanel.com)
  • Muscle contractures can occur for many reasons, such as paralysis, muscular atrophy, and forms of muscular dystrophy. (wikipedia.org)
  • Some congenital myopathies, such as Bethlem myopathy and Ullrich congenital muscular dystrophy, cause muscle contractures to develop. (wikipedia.org)
  • SMAs were first described in the 1890s, by Guido Werdnig, a physician from the University of Vienna, in his lecture "On a Case of Muscular Dystrophy with Positive Spinal Cord Findings. (medscape.com)
  • Serum creatine kinase levels may be elevated but usually not to the extent that they are elevated in persons with muscular dystrophy. (medscape.com)
  • Calpain-3-related limb-girdle muscular dystrophy R1 (also known as LGMD2A) is an autosomal recessive limb-girdle muscular dystrophy characterized by progressive, symmetrical weakness of the proximal limb and girdle muscles (mainly those around the hips and shoulders) without heart involvement or intellectual disability. (nih.gov)
  • LGMD2A is the most common form of limb-girdle muscular dystrophy, accounting for about 30 percent of cases. (nih.gov)
  • Pelvifemoral limb-girdle muscular dystrophy (also known as Leyden-Mobius LGMD) is the most frequently observed subtype. (nih.gov)
  • B) Intermediate dystrophin staining in a patient with Becker muscular dystrophy. (medscape.com)
  • C) Absent dystrophin staining in a patient with Duchenne muscular dystrophy. (medscape.com)
  • Progression of muscular dystrophy occurs in 5 stages. (medscape.com)
  • Limb girdle muscular dystrophy (LGMD) is a group of genetic muscle disorders which are mainly characterized by weakness and wasting of the muscles of the pelvic and pectoral girdles. (symptoma.com)
  • Muscle biopsy is often helpful to determine if weakness is caused by muscular dystrophy, an inherited disorder, or by other acquired causes of muscle degeneration such as from inflammation or toxic exposure. (symptoma.com)
  • Generally, the first symptom that people with limb-girdle muscular dystrophy will notice is muscle weakness that causes trouble walking, resulting in a 'waddling' gait and difficulty climbing stairs or getting up from chairs. (symptoma.com)
  • Some mutations can cause both a myofibrillar myopathy and a muscular dystrophy phenotype. (symptoma.com)
  • Congenital muscular dystrophy (CMD) refers to a group of genetic muscle diseases that become apparent within the first two years after birth. (mdaquest.org)
  • Becker muscular dystrophy is in the category of inherited muscle wasting diseases caused by a gene abnormality (mutation) that results in deficient or abnormal production of the dystrophin protein (dystrophinopathies). (ericpedersen.org)
  • Becker muscular dystrophy follows x-linked recessive inheritance so it mostly affects males, but some females are affected. (ericpedersen.org)
  • Becker muscular dystrophy usually begins in the teens or early twenties and symptoms vary greatly between affected individuals. (ericpedersen.org)
  • Symptoms of Becker muscular dystrophy usually begin in the teens or late twenties. (ericpedersen.org)
  • The progression of BMD is slower and more variable than Duchenne muscular dystrophy but usually results in the need for a wheel chair. (ericpedersen.org)
  • Becker muscular dystrophy is caused by abnormalities (mutations) in the DMD gene that is responsible for the production of the dystrophin protein. (ericpedersen.org)
  • The DMD gene is located on the X chromosome and Becker muscular dystrophy follows x-linked recessive inheritance. (ericpedersen.org)
  • Becker muscular dystrophy occurs in approximately 1 in 30,000 male births. (ericpedersen.org)
  • Symptoms of the following disorders can be similar to those of Becker muscular dystrophy (BMD). (ericpedersen.org)
  • Duchenne muscular dystrophy is an x-linked recessive genetic disease that is also caused by mutations in the DMD gene. (ericpedersen.org)
  • The DMD gene mutations that cause Duchenne muscular dystrophy result in little or no dystrophin protein to be made. (ericpedersen.org)
  • Limb-girdle muscular dystrophy is a group of inherited, progressive disorders that are characterized by weakness and of muscles of the hip and shoulder areas. (ericpedersen.org)
  • Muscular Dystrophy Campaign sponsored workshop: recommendation for respiratory care of children with SMA type II and III. (medscape.com)
  • Muscular-level etiologies of foot drop include muscular dystrophy, Charcot-Marie-Tooth disease, and post-polio syndrome. (ptproductsonline.com)
  • Myotonic dystrophy (DM) is considered a subgroup of myopathy and the most common type of muscular dystrophy that begins in adulthood. (rxharun.com)
  • Novel TRAPPC11 Mutations in a Chinese Pedigree of Limb Girdle Muscular Dystrophy Limb girdle muscular dystrophies (LGMDs) are a heterogeneous group of genetic myopathies leading primarily to proximal muscle weakness . (symptoma.com)
  • Muscular dystrophy refers to group of hereditary diseases that weakens the muscles associated with movements. (stgeorgeorthopaedics.com.au)
  • Muscular dystrophy is caused by defective genes. (stgeorgeorthopaedics.com.au)
  • There is no specific treatment for any form of muscular dystrophy but certain medications, physical therapy and assistive devices can slow the progress of some forms of muscular dystrophy. (stgeorgeorthopaedics.com.au)
  • Muscular dystrophy can occur at infancy or childhood. (stgeorgeorthopaedics.com.au)
  • It is the most common kind of muscular dystrophy affecting only boys, between the ages of 2 to 6. (stgeorgeorthopaedics.com.au)
  • Becker muscular dystrophy is a neuromuscular condition that causes progressive weakness of the skeletal muscles and commonly affects the heart muscle, making cardiac problems a characteristic. (mdqld.org.au)
  • Congenital muscular dystrophy (CMD) is a term for a group of muscular dystrophies present at birth or that appear early during infancy. (mdqld.org.au)
  • A baby born with congenital muscular dystrophy is weak at birth and may have breathing and swallowing problems. (mdqld.org.au)
  • First described in 1902, distal muscular dystrophy is a class of muscular dystrophies that primarily affect distal muscles. (mdqld.org.au)
  • DMD (Duchenne muscular dystrophy) is the most common form of muscular dystrophy. (mdqld.org.au)
  • Emery-Dreifuss muscular dystrophy is a genetic, degenerative disease primarily affecting the muscles used for movement. (mdqld.org.au)
  • The term limb-girdle muscular dystrophy (LGMD) refers to a group of over 20 muscular dystrophies. (mdqld.org.au)
  • Myotonic dystrophy (DM), also known as Steinert's disease, is the most common form of adult muscular dystrophy. (mdqld.org.au)
  • These include Charcot-Marie-Tooth disease type 2B, 7 forms of dilated cardiomyopathy, 8 both autosomal dominant and autosomal recessive forms of Emery-Dreifuss muscular dystrophy, 9, 10 limb girdle muscular dystrophy type 1B, 11 Dunnigan-type familial partial lipodystrophy, 12- 14 and Hutchinson-Gilford progeria. (bmj.com)
  • Thanks to advances in many areas of medicine, such as cardiology and pulmonology, people with Duchenne muscular dystrophy (DMD) in the 21st century are living longer than in previous decades, often well into adulthood. (mda.org)
  • Muscular Dystrophy, Emery-Dreifuss" is a descriptor in the National Library of Medicine's controlled vocabulary thesaurus, MeSH (Medical Subject Headings) . (umassmed.edu)
  • A heterogenous group of inherited muscular dystrophy without the involvement of nervous system. (umassmed.edu)
  • This graph shows the total number of publications written about "Muscular Dystrophy, Emery-Dreifuss" by people in this website by year, and whether "Muscular Dystrophy, Emery-Dreifuss" was a major or minor topic of these publications. (umassmed.edu)
  • Below are the most recent publications written about "Muscular Dystrophy, Emery-Dreifuss" by people in Profiles. (umassmed.edu)
  • Signs can include poor body condition with generalized muscle atrophy, muscular weakness, decreased reflexes, a stiff and short-strided gait, decreased appetite and regurgitation. (wisdompanel.com)
  • These therapies may also improve blood flow and slow muscle weakness and atrophy. (medlineplus.gov)
  • Spinal muscular atrophy (SMA) is a genetic condition that causes muscle weakness and atrophy (when muscles get smaller). (kidshealth.org)
  • Soon after, Professor Johann Hoffmann from Heidelberg University presented a paper describing a syndrome of progressive atrophy, weakness, and death during the early childhood period of siblings with genetically normal parents. (medscape.com)
  • CMDs belong to the larger group of disorders known as muscular dystrophies, which are characterized by weakness and degeneration of the voluntary muscles in the body that control intentional movements. (mdaquest.org)
  • In general, CMD is characterized by decreased muscle tone (hypotonia), progressive muscle weakness and degeneration (atrophy), abnormal locking of joints (contractures), spinal rigidity, and delays in reaching motor milestones such as rolling over, sitting up, or standing without assistance. (mdaquest.org)
  • Muscle weakness and atrophy occur disproportionately on both sides of the body. (advancedpsy.com)
  • Symptoms include pharyngeal muscle weakness (muscles that are involved in swallowing), weak facial muscles, progressive loss of speech, and tongue muscle atrophy. (advancedpsy.com)
  • A rare form of spinal muscular atrophy characterized by the neonatal onset of severe hypotonia areflexia profound weakness multiple congenital contractures facial dysmorphic features (myopathic face with open tent-shaped mouth) cryptorchidism and mild skeletal abnormalities (i.e. kyphosis scoliosis) that is often preceded by polyhydramnios and reduced fetal movements in utero and followed by bone fractures shortly after birth. (globalgenes.org)
  • Progressive muscular atrophy is caused by degeneration of the lower motor neurones leading to muscle weakness and wasting, progressive bulbar palsy affects either the upper or lower neurones in the bulbar region, resulting in dysarthria and dysphagia and lastly primary lateral sclerosis, where upper neurone damage results in spastic paralysis of the limbs, however this is extremely rare (Motor Neurone Disease Association, 2004). (nmmra.org)
  • spinal muscular atrophy patients present muscle weakness, orthopedic problems, nutritional complications and respiratory impairment. (bvsalud.org)
  • Muscle weakness in spinal muscular atrophy is caused by the loss of nerve cells that transmit signals from the brain and spinal cord to the muscles. (mysmateam.com)
  • Muscle weakness generally worsens over time , meaning people may lose functionality as spinal muscular atrophy progresses. (mysmateam.com)
  • Problems with respiratory function can occur in spinal muscular atrophy because of weakness in the muscles that control breathing. (mysmateam.com)
  • Clinical features include weakness of the hip and shoulder girdle, difficulty walking , spinal abnormalities including scoliosis, lordosis and kyphosis, and cardiomyopathy. (symptoma.com)
  • Spinal muscular atrophy (SMA) is a rare genetic condition characterized by progressive muscle weakness and atrophy. (smanewstoday.com)
  • These SMA conditions also are characterized by muscle weakness and atrophy. (smanewstoday.com)
  • As a result, muscles do not get the electrical signals that normally tell them to move, resulting in muscle weakness and ultimately leading to muscle atrophy over time. (smanewstoday.com)
  • Inflammatory myopathies are a group of muscle diseases that involve chronic muscle inflammation and muscle weakness. (stgeorgeorthopaedics.com.au)
  • Kugelberg Welander spinal muscular atrophy (also known as Wohlfart-Kugelberg-Welander syndrome or mild SMA) is a milder form of SMA, with symptoms typically presenting after age 18 months. (medscape.com)
  • As the motor neurons die off, your muscles start to weaken and atrophy (waste away). (medlineplus.gov)
  • They have chronic shortening of muscles or tendons (called contractures). (medlineplus.gov)
  • Chronic toe walking leads to muscle contracture due to the lack of calf muscles being adequately stretched. (wikipedia.org)
  • For example, in the case of partial paralysis (i.e. poliomyelitis) the loss of strength and muscle control tend to be greater in some muscles than in others, leading to an imbalance between the various muscle groups around specific joints. (wikipedia.org)
  • Case in point: when the muscles which dorsiflex (flex the foot upward) are less functional than the muscles which plantarflex (flex the foot downward) a contracture occurs, giving the foot a progressively downward angle and loss of flexibility. (wikipedia.org)
  • Because the muscles don't move, they get smaller (or atrophy). (kidshealth.org)
  • Muscular atrophy affecting muscles in the distal portions of the extremities. (nih.gov)
  • Between different muscular dystrophies, the muscles affected, age of onset, disease severity and inheritance pattern can vary greatly. (mdaquest.org)
  • Shortening of muscle fibers can result in the inability to move certain muscles (contractures). (ericpedersen.org)
  • Patients with spinal muscular atrophy experience a progressive loss of motor function that usually affects the legs before it does the arms, and the proximal muscles before the distal ones. (medscape.com)
  • Normally, messages from nerve cells in the brain, called upper motor neurons, are transmitted to nerve cells in the brainstem and spinal cord called lower motor neurons and from there to particular muscles. (advancedpsy.com)
  • In patients who have undergone surgical interventions in the back area or who have suffered chronic back pain, the paravertebral muscles can atrophy up to 80% with respect to that of the healthy side, facilitating an asymmetric distribution of loads, muscular overload or distal and the appearance of new painful episodes. (fortunetelleroracle.com)
  • These patients lose skeletal muscle fibres as a result of the disease but are also thought to atrophy due to disuse of the muscles (Kilmer, 1998). (nmmra.org)
  • Idiopathic inflammatory myopathies is the name given to a non-hereditary group of conditions caused by inflammation in the muscles or associated tissue. (mdqld.org.au)
  • ALS is a motor neuron disease , which is a group of neurological disorders that selectively affect motor neurons , the cells that control voluntary muscles of the body. (wikipedia.org)
  • The muscles and tendons undergo atrophy (waste away) and contract, which can ultimately cause contractures of the affected hand or foot. (medicinenet.com)
  • There can be joint and bone deformities and contractures (permanently fixed, tight muscles and joints). (anatomic.us)
  • A adolescence-adult electroclinical syndrome that is characterized by brief, involuntary twitching of a muscle or a group of muscles (myoclonus) early in the morning with onset between 12 and 18 years. (xenbase.org)
  • What are the types of spinal muscular atrophy (SMA) and what are their symptoms? (medlineplus.gov)
  • What Are the Signs & Symptoms of Spinal Muscular Atrophy? (kidshealth.org)
  • Long-term complications such as muscular and cardiac symptoms as well as liver fibrosis/cirrhosis and hepatocellular carcinoma may have a severe impact on prognosis and quality of life. (nih.gov)
  • The characteristic and common symptoms of muscle contracture are pain and limitation of movement, both parameters offer a wide range of severity because in some cases the contractures go from being minor annoyances without impediment to completely disabling injuries. (fortunetelleroracle.com)
  • A correct diagnosis interprets the symptoms manifested by the patient, later the diagnosis focuses on the palpation of the affected area in search of muscular bulges with greater tension, a muscular rod offers a certain resistance to palpation while the fingers slide over it and finding a point with greater resistance means that that specific point of the muscle fibers is contracted. (fortunetelleroracle.com)
  • Symptoms often first appear in early childhood and include joint contractures which restrict movement of the neck, ankles and/or elbows. (mdqld.org.au)
  • Care of olivopontocerebellar atrophy (OPCA) is directed to the treatment of symptoms. (medscape.com)
  • Congenital distal spinal muscular atrophy. (beds.ac.uk)
  • The autosomal dominant neuromuscular disorders are characterized by a congenital-onset, static, or later-onset progressive peripheral neuropathy with variable combinations of laryngeal dysfunction (i.e., vocal fold paresis), respiratory dysfunction, and joint contractures. (beds.ac.uk)
  • A muscle imbalance between an agonist and antagonist muscle can occur due to a neurological disorder, spinal cord injury, myopathy, and our lifestyle/postural habits. (wikipedia.org)
  • In Bethlem myopathy 1, contractures presenting in infancy may resolve by age 2 years, but reoccur as the disease progresses, typically by late of the first decade or early teens. (wikipedia.org)
  • Myofibrillar myopathy refers to a genetically heterogeneous group of muscular disorders characterized by a pathologic morphologic pattern of myofibrillar degradation and abnormal accumulation of proteins involved with the sarcomeric Z disc (summary by Foroud et al. (beds.ac.uk)
  • Spinal muscular atrophies (SMAs) represent a rare group of inherited disorders that cause progressive degeneration of the anterior horn cells of the spinal cord. (medscape.com)
  • 5q spinal muscular atrophy (5q SMA) is one of the most common autosomal recessive disorders in the Russian Federation. (bvsalud.org)
  • Motor Neuron Diseases (MNDs) are a group of progressive neurological disorders that destroy motor neurons, the cells that control essential voluntary muscle activities such as speaking, walking, breathing and swallowing. (advancedpsy.com)
  • Motor Neurone Disease (MND) is a group of disorders with unknown origin. (nmmra.org)
  • Some primary muscle disorders may be characterised by muscle hypertrophy rather than atrophy. (vin.com)
  • A group of disorders characterized by degeneration and loss of motor neurons. (vin.com)
  • For a group of muscle-wasting disorders, see Motor neuron diseases . (wikipedia.org)
  • Available at https://www.ninds.nih.gov/health-information/disorders/olivopontocerebellar-atrophy . (medscape.com)
  • Spinal muscular atrophy (SMA) is caused by successive motor unit degeneration. (medscape.com)
  • Progressive Muscular Atrophy (PMA) is marked by slow but progressive degeneration of only the lower motor neurons. (advancedpsy.com)
  • Motor neurone disease results in degeneration of the anterior horn cells of the spinal cord, which affects the lower motor neurones, the corticospinal tracts, affecting the upper motor neurones and certain motor nuclei of the brainstem, leading to bulbar palsy (Stokes, 1998). (nmmra.org)
  • Spinal muscular atrophy (SMA) is a reces- stands out as a noninvasive and painless method, sive, autosomal neuromuscular disease character- which has already been adopted by other authors ized by degeneration of anterior horn spinal cord while evaluating SMA patients13, or children and motor cells and brain stem neurons1-5. (bvsalud.org)
  • Selective muscle hypertrophy may exacerbate contractures and postural instability. (wikipedia.org)
  • Peripheral nerve and muscle diseases result in varying degrees of paresis, muscle atrophy, hyporeflexia, and hypotonia. (vin.com)
  • The condition is chronic and progressive, leading to muscle fibrosis and atrophy as well as potential joint contractures, limb and spinal deformities, mobility difficulties, and exercise intolerance. (wisdompanel.com)
  • the five that are more severe have short stature that varies from mild to severe with progressive spinal deformity and involvement of the long bones and pelvis. (beds.ac.uk)
  • Muscle atrophy, caused by a progressive loss of the anterior horn cells in the spinal cord, is universal. (medscape.com)
  • The first method of intervention of a contracture is its prevention and for this a good warm-up must be carried out in order to prepare the muscle before the effort, a progressive programming in intensity of the loads also helps from less to more. (fortunetelleroracle.com)
  • Cerebral palsy (CP) is an umbrella term denoting a group of non-progressive, non-contagious motor conditions that cause physical disability in human development, chiefly in the various areas of body movement. (anatomic.us)
  • A disparate group of seemingly unrelated diseases with different affected organ systems has been attributed to lamin A/C mutations. (bmj.com)
  • This essay will examine the benefits of physiotherapy using evidence based practice for different types of exercise programmes, management of spasticity, respiratory function and management of contractures. (nmmra.org)
  • Motor neurons are a type of nerve cell in the spinal cord and lower part of the brain. (medlineplus.gov)
  • These contractures are different from cramps, because they are not elicited by the nerve, but by intrinsic mechanisms in the muscle itself and are silent on electromyography. (wikipedia.org)
  • This stimulus occurs on a voluntary basis, when we want to generate a movement, or involuntarily as a consequence of a reflection (usually defensive), but sometimes also due to malfunctioning nerve, causing what we call Contracture (involuntary contraction sustained over time). (lapicosajewelry.com)
  • Joint contractures develop, and joints may become misaligned. (msdmanuals.com)
  • There are several types of paralysis that can result from neurological damage, such as a stroke or spinal cord injury, including spastic paralysis (produced by increased muscle tone) and flaccid paralysis (caused by reduced muscle tone). (nouveausante.com)
  • Stroke and spinal cord injury are the two main causes of paralysis. (nouveausante.com)
  • You can distinguish between spastic and flaccid paralysis by being aware of how the neurological system influences muscular movement. (nouveausante.com)
  • Studies show that the leading causes of paralysis are spinal cord injuries and strokes, which account for 33.7% and 27.3% of cases, respectively. (nouveausante.com)
  • After a spinal cord injury, paralysis occurs because damaged nerves' capacity to communicate with the brain is disrupted. (nouveausante.com)
  • Depending on the size and location of the lesion, those who survive a stroke or spinal cord injury may experience either spastic paralysis or flaccid paralysis. (nouveausante.com)
  • Meningocele diagnosis is made when there is a pouch of cerebral spinal fluid (the liquid that cushions the brain and spine) protruding on the back over the spine. (christopherreeve.org)
  • Myelomeningocele diagnosis is a pouch on the back that includes cerebral spinal fluid and part of the spinal cord and nerves. (christopherreeve.org)
  • In the metabolic myopathies of GSD-V (McArdle disease) and GSD-VII (Tarui disease), temporary muscle contractures develop in response to impending muscle damage associated with the ATP (energy) deficiency. (wikipedia.org)
  • Patients with spinal muscular atrophy (SMA) should have frequent follow-up care for symptomatic control of their disease. (medscape.com)
  • and seven children without the disease in Group II of 9 (9-12) years, weighing 31.0 (27.8-54.1) kg. (bvsalud.org)
  • Spinal muscular atrophy (SMA) is a neurodegenerative disease produced by low levels of Survival Motor Neuron (SMN) protein that affects alpha motoneurons in the spinal cord. (mdpi.com)
  • As dysphagia progresses with olivopontocerebellar atrophy (OPCA), a pureed diet or enteral feeding may be required. (medscape.com)
  • Muscle contracture, as its name indicates, is a continuous and involuntary contraction of the muscle or some of its fibers that appear when making an effort, this manifests as a bulging of the area that develops pain and alterations in the normal function of the muscle. (fortunetelleroracle.com)
  • If spasticity is left untreated, contractures can occur. (wikipedia.org)
  • This type of transient contracture has also been called pseudomyotonia. (wikipedia.org)
  • Pulmonary function assessment in patients with spinal muscular atrophy type II and type III. (medscape.com)
  • Training improves oxidative capacity, but not function in Spinal Muscular Atrophy Type III. (medscape.com)
  • to verify the body composition and chest expansion of type II and III spinal muscular atrophy patients. (bvsalud.org)
  • Patients with type III get to three point of SMA children suffer from stunted develop- walking, wether or not they maintain this ability ment due to nutritional, muscular, postural and res- throughout adulthood1-3,6,7. (bvsalud.org)
  • Evaluation of the correct functioning of the ATLAS 2020 exoskeleton (research prototype) in the rehabilitation treatment of Type II spinal muscular atrophy. (marsibionics.com)
  • You may have seen some news recently about Zolgensma, a gene therapy that just got approval from the FDA for use in patients with Type 1 Spinal Muscular Atrophy (SMA). (mtm-cnm.org)
  • [ 6 ] Maintaining the patient's joint mobility is very important because the goal is to decrease the incidence of contractures. (medscape.com)
  • The Excerpta Medica MND Advisory Group (1999) has stated four principles for general management for these patients. (nmmra.org)
  • NMES can help retard atrophy and assist patients in relearning to contract the anterior tibialis muscle. (ptproductsonline.com)
  • patients with spinal muscular atrophy presented higher adiposity and lower chest expansion. (bvsalud.org)
  • At times, olivopontocerebellar atrophy (OPCA) patients may require enteral feeding to decrease the risk of aspiration. (medscape.com)
  • Cerebral palsy refers to a group of nonprogressive conditions characterized by impaired voluntary movement or posture and resulting from prenatal developmental malformations or perinatal or postnatal central nervous system damage. (msdmanuals.com)