• However, there is a lack of evidence from trials showing that splenectomy improves survival and decreases morbidity in sickle cell disease. (medscape.com)
  • Functional hyposplenism is a condition accompanying many diseases such as sickle cell disease, celiac disease, alcoholic liver disease, hepatic cirrhosis, lymphomas and autoimmune disorders. (hippokratia.gr)
  • FH is a term first used a few decades ago (1969) when Pearson et al, in the USA 1 identified some children suffering from sickle cell disease, who presented with the same clinical course as in splenectomised patients, despite the fact that their spleen had not yet been removed (their spleen was in fact enlarged due to their illness). (hippokratia.gr)
  • Laparoscopic splenectomy can also be warranted in other benign conditions, including other types of thrombotic purpura, hereditary spherocytosis, major and intermediate thalassemia with secondary hypersplenism or severe anemia, sickle cell disease, and refractory autoimmune hemolytic anemia. (medscape.com)
  • The purpose of this study was to define the hematologic response to total splenectomy (TS) or partial splenectomy (PS) in children with hereditary spherocytosis (HS) or sickle cell disease (SCD). (aku.edu)
  • Many of the altitude-related episodes in patients with sickle cell disease can be safely treated with supportive care rather than with splenectomy. (medscape.com)
  • The clinical impact of MTHFR polymorphism on the vascular complications of sickle cell disease. (cdc.gov)
  • Proliferative retinopathy and maculopathy are two independent conditions in sickle cell disease: Is there a role of blood rheology?1. (cdc.gov)
  • Progressive Decline in Estimated GFR in Patients With Sickle Cell Disease: An Observational Cohort Study. (cdc.gov)
  • Polymorphisms in genes that affect the variation of lipid levels in a Brazilian pediatric population with sickle cell disease: rs662799 APOA5 and rs964184 ZPR1. (cdc.gov)
  • My clinic includes all types of hematologic disorders, ranging from anemia, clotting/bleeding disorders, and low blood counts to complex malignancies such as leukemia, myelodysplastic syndrome, myeloma, and lymphoma. (stanford.edu)
  • Analysis of operative indications in the series of Nores et al revealed that patients with hematologic conditions were typically explored for complications of those conditions (69%), especially patients with nonmalignant conditions (90%), whereas patients with hematologic malignancies often (47%) underwent surgery for acute symptoms. (medscape.com)
  • In another study, 8 patients with hematologic malignancies received a two (2) hour infusion of LEUSTATIN Injection (0.12 mg/kg). (nih.gov)
  • TheIntroduction later step is unique to splenic function since splenectomy results in similar accumulations of naïve B cells, reduction of memory B cells and Treatment of malignancies with allogeneic peripheral blood stem well-known susceptibilities to select infections [12]. (fliphtml5.com)
  • Phase I trial of a genetically engineered interleukin-2 fusion toxin (DAB486IL-2) as a 6 hour intravenous infusion in patients with hematologic malignancies. (uchicago.edu)
  • In addition, splenectomy enables pathologic diagnosis in lymphoproliferative disorders such as splenic marginal zone lymphoma or hairy cell leukemia. (medscape.com)
  • Low-dose radiotherapy has been used as palliative care for splenomegaly in patients with hematologic disorders such as primary myelofibrosis. (medscape.com)
  • Laparoscopic splenectomy is becoming the standard procedure for benign splenic disorders including hematologic diseases and hypersplenism. (sages.org)
  • Laparoscopic splenectomy is indicated for various benign hematologic diseases, malignant hematologic diseases, secondary hypersplenism, and other anatomical disorders of the spleen. (medscape.com)
  • As no randomized clinical trials, case control or cohort studies regarding splenectomy in these disorders were found in the literature, recommendations for each disease were based on expert opinion and were subsequently critically revised and modified by the Splenectomy in Rare Anemias Study Group, which includes hematologists caring for both adults and children. (haematologica.org)
  • Additionally, AIHA can be secondary to systemic autoimmune diseases and lymphoproliferative disorders, whose treatments may further increase the infectious risk. (encyclopedia.pub)
  • The major cause of this disease is old age, genetic disorders, and lifestyle factors. (pronursingtutors.com)
  • An understanding of the factors surrounding women's and men's health, infections, and hematologic disorders can be critically important to disease diagnosis and treatment in these areas. (pronursingtutors.com)
  • This importance is magnified by the fact that some diseases and disorders manifest differently based on the sex of the patient. (pronursingtutors.com)
  • How they may affect the patient physical ability and findings Learning Objectives Students will: Analyze concepts and principles of pathophysiology across the life span Analyze processes related to women's and men's health, infections, and hematologic disorders Identify racial/ethnic variables that may impact physiological functioning Evaluate the impact of patient characteristics on disorders and altered physiology Learning Resources Required Readings (click to expand/reduce) McCance, K. L. & Huether, S. E. (2019). (bestnursingwritingservices.com)
  • Sexually transmitted infections - Research priorities for new challenges.Concepts of Women's and Men's Health, Infections, and Hematologic Disorders Essay. (bestnursingwritingservices.com)
  • The response includes accurate, clear, and detailed explanations of the processes related to women's and men's health, infections, and hematologic disorders and is supported by evidence and/or research, as appropriate, to support the explanation. (bestnursingwritingservices.com)
  • Other diseases, including congenital heart disease, lung disease, liver disease and connective tissue disorders like scleroderma and lupus, can lead to the development of pulmonary hypertension. (phsa.co.za)
  • Secondary erythrocytosis occurs due to arterial hypoxemia in chronic pulmonary disease, smoking, some neoplasms or hemoglobin disorders. (fundacionmapfre.org)
  • Purpura is a disease included in the large group of hemorrhagic disorders and is distinguished by cutaneous hemorrhage and blood loss from mucous membranes and internal organs, which is always related to vascular or platelet alterations 2 . (bvsalud.org)
  • Dr. Mistry, who was born in Kenya and grew up in England, has additional clinical interests in such areas as liver disorders of lipid metabolism (such as Neimann Pick disease, cholesterol ester storage disease), alpha 1 antitrypsin deficiency, porphyrias, and undiagnosed liver diseases in the younger patients. (yalemedicine.org)
  • However, the feasibility and safety of laparoscopic splenectomy for nodular and cystic splenic lesions are yet to be elucidated. (sages.org)
  • Twelve patients with splenic nodular or cystic lesions who underwent laparoscopic splenectomy between April 2003 and June 2018 were retrospectively reviewed, in which patient factors (age, sex), lesion factors (diagnosis, size, number) and surgical factors (procedures, operation time, blood loss, postoperative complication, postoperative hospital stay) were assessed. (sages.org)
  • Laparoscopic splenectomy for the nodular and cystic lesion is safe and feasible. (sages.org)
  • With the advent of minimally invasive techniques, laparoscopic splenectomy has become a standard procedure for elective removal of the spleen for most indications. (medscape.com)
  • Indications for laparoscopic splenectomy are the same for open splenectomy except when emergent splenectomy and exploratory laparotomy for traumatic injuries are needed. (medscape.com)
  • The most common benign hematologic disease treated with laparoscopic splenectomy is immune thrombocytopenia purpura, and it is recommended when medical therapy, including steroids and intravenous gammaglobulin, fail or long-term steroids are needed. (medscape.com)
  • Laparoscopic splenectomy for malignant diseases of the spleen can be used for diagnostic or therapeutic reasons. (medscape.com)
  • Contraindications to laparoscopic splenectomy are similar to contraindications for all laparoscopic surgeries. (medscape.com)
  • General anesthesia is required for laparoscopic splenectomy. (medscape.com)
  • A standard laparoscopic tray is used for a laparoscopic splenectomy, including laparoscopic scissors and atraumatic graspers. (medscape.com)
  • The most common indications for therapeutic splenectomy include hereditary spherocytosis, immune thrombocytopenia (ITP), or autoimmune hemolysis where the splenomegaly is refractory to front line therapy and causing significant discomfort due to massive splenomegaly or complicated hypersplenism. (medscape.com)
  • p class=\'abstract\'>Cyclic thrombocytopenia (CTP) is a rare disease of periodic platelet count oscillations. (stanford.edu)
  • The hematopoietic system is also believed to be a common target for the SARS-CoV-2 virus, with lymphopenia and mild thrombocytopenia being the primary hematologic presentations. (amjcaserep.com)
  • The degree of thrombocytopenia has also been seen to affect the overall severity of the disease [2], with an increased risk of in-hospital mortality [3]. (amjcaserep.com)
  • These infections are often serious and life-threatening and they can lead to the 'overwhelming post-splenectomy infection syndrome' (OPSI). (hippokratia.gr)
  • The integrity and proper function of the spleen are considered important for the protection against infectious diseases in the adult. (hippokratia.gr)
  • The first splenectomy was performed by Andirano Zaccarello in 1549 on a young woman with an enlarged spleen who survived for 6 years after surgery. (medscape.com)
  • As damaged red blood cells passing through the red pulp of the spleen are removed by splenic macrophages, splenectomy is one possible therapeutic approach to the management of severely affected patients. (haematologica.org)
  • Splenectomy has been suggested as a possible therapeutic approach to manage severely affected patients, based on the evidence that abnormal or damaged red blood cells passing through the spleen red pulp are removed by the splenic macrophage system. (haematologica.org)
  • For an infarcted spleen with any of the above-mentioned complications, splenectomy is required. (medscape.com)
  • Whereas a unilocular abscess can be managed successfully in select cases with percutaneous catheter drainage, some authors advocate splenectomy in all cases of splenic infarct and abscess, questioning the utility of preserving the residual, partially functioning spleen. (medscape.com)
  • One of the causes of relapse after splenectomy in patients with ITP is the presence of an accessory spleen. (scitechnol.com)
  • Herein, we present a patient who relapsed 3 months after splenectomy and whose accessory spleen was detected 6 years post-splenectomy and at the third abdominal ultrasonography (USG) examination. (scitechnol.com)
  • For CML, this may include surgery to remove the spleen (splenectomy) if it becomes too enlarged. (patientresource.com)
  • The spleen is a highly vascular organ that participates in hematologic and immune homeostasis. (thebloodproject.com)
  • The spleen also uniquely contributes toGraft Versus Host Disease (GVHD) complete B cell memory [11]. (fliphtml5.com)
  • [ 20 ] Of note, splenic marginal zone lymphoma secondary to hepatitis C can often resolve with treatment of the viral hepatitis, and cases not associated with hepatitis C can be treated with rituximab monotherapy thereby sparing the complications of splenectomy. (medscape.com)
  • Splenectomies were performed without intraoperative or postoperative complications of Grade ?b or more by Clavien-Dindo classification except for 2 cases with postoperative pancreatic fistulas which were Grade A by International study group of postoperative pancreatic fistula (ISGPF). (sages.org)
  • However, except for hereditary spherocytosis for which the effectiveness of splenectomy has been well documented, the efficacy of splenectomy in other anemias within this group has yet to be determined and there are concerns regarding short- and long-term infectious and thrombotic complications. (haematologica.org)
  • The indications that warrant surgical intervention include hematologic complications for the underlying disease process and persistent symptoms, such as sepsis, abscess, hemorrhage, or persistent pseudocyst formation. (medscape.com)
  • Complications, such as bleeding or pseudocyst formation, also may be amenable to splenic salvage using techniques of partial splenectomy. (medscape.com)
  • Notably, splenectomy was the only factor associated with severe infectious complications (grade ≥ 3). (encyclopedia.pub)
  • It is advisable to take inside the car, in a visible place, a report including the data on the disease, and the treatment, in case road assistance should be required for the occurrence of complications while driving or in the event of an accident. (fundacionmapfre.org)
  • The treatment is aimed at controlling complications, with transfusions in cases of serious anemia, splenectomy, and palliative therapy. (fundacionmapfre.org)
  • Splenectomy has a decreasing number of indications, but can still be used to help control or stage the underlying disease in cases of splenomegaly. (medscape.com)
  • Splenectomy is occasionally indicated to help control or stage the underlying disease in cases of splenomegaly. (medscape.com)
  • [ 26 ] Bruns et al reported that low-dose splenic irradiation produced hematologic response and long-term relief of splenic pain in four of five patients with symptomatic congestive splenomegaly. (medscape.com)
  • Exam revealed no other findings such as jaundice, cutaneous stigmata of chronic liver disease, ascites, or splenomegaly. (e-cmh.org)
  • Splenomegaly most often occurs as a secondary manifestation of a primary disease process. (thebloodproject.com)
  • Splenectomy is also indicated for the treatment of chronic, severe hypersplenism refractory to upfront medical therapy. (medscape.com)
  • 3 Includes active solid-organ cancer, active hematologic cancer, solid-organ transplant, bone marrow/stem cell transplant, HIV infection, congenital immunodeficiency syndrome, use of an immunosuppressive medication within the last 30 days, splenectomy, graft-versus-host disease (currently or in the past), or any other condition that causes moderate or severe immunosuppression. (cdc.gov)
  • Our hypothesis about a splenic stem cell contributionor maintained survival compared to bone marrow transplants, to PBSCT also derives from the observation that G-CSF mobilizationsalthough graft versus host disease (GVHD) still occurs [1]. (fliphtml5.com)
  • Splenectomy, rituximab and thrombopoietin receptor agonists are currently make up the most effective second-line treatments. (scitechnol.com)
  • Options with the most robust evidence include splenectomy, rituximab and thrombopoietin receptor agonists. (mja.com.au)
  • Rheumatoid arthritis (RA) is a systemic disease characterized by symmetrical inflammation of joints, yet may involve other organ systems. (basicmedicalkey.com)
  • Rheumatoid arthritis (RA) is the most common systemic inflammatory disease characterized by symmetrical joint involvement. (basicmedicalkey.com)
  • We report a confirmed case of Candidatus Neoehrlichia mikurensis infection in a woman in Spain who had a previous hematologic malignancy. (cdc.gov)
  • 2 Defined as at least one discharge diagnosis for solid malignancy, hematologic malignancy, rheumatologic or inflammatory disorder, other intrinsic immune condition or immunodeficiency, or organ or stem cell transplant. (cdc.gov)
  • 2 Peliosis hepatis is found in association with wasting disease, liver and renal transplantation, hematologic malignancy, 1 human immunodeficiency virus (HIV) infection, 3 advanced tuberculosis, 4 bartonella infection, 4 and many drugs including anabolic steroids 5 and oral contraceptives. (e-cmh.org)
  • In fact, FH can lead to a series of clinical manifestations which are described under the term of post-splenectomy syndrome. (hippokratia.gr)
  • The Splenectomy in Congenital Hemolytic Anemia (SICHA) consortium registry collected hematologic outcomes of children with CHA undergoing TS or PS to 1 year after surgery. (aku.edu)
  • Liver disease in which the normal microcirculation, the gross vascular anatomy, and the hepatic architecture have been variably destroyed and altered with fibrous septa surrounding regenerated or regenerating parenchymal nodules. (lookformedical.com)
  • Blood tests check the oxygen levels in the blood, they observe liver and kidney function, and they identify whether the patient has collagen vascular disease, thyroid problems, signs of infection or HIV antibodies. (phsa.co.za)
  • Early atherosclerotic and thrombotic disease occurring with stroke, myocardial infarction and peripheral vascular disease are characteristic. (fundacionmapfre.org)
  • Although the usual disease course is chronic, some patients will enter a remission spontaneously. (basicmedicalkey.com)
  • Several authors have reported that peliosis hepatis develops in association with chronic wasting disease or prolonged use of anabolic steroids or oral contraceptives. (e-cmh.org)
  • Since then, several case series and individual cases of patients with Candidatus N. mikurensis infections have been described, mainly in persons who were immunosuppressed because of hematologic neoplasms, splenectomies, or immunosuppressive drug treatment ( 3 - 9 ). (cdc.gov)
  • Centers for Disease Control and Prevention. (cdc.gov)
  • The Centers for Disease Control and Prevention (CDC) cannot attest to the accuracy of a non-federal website. (cdc.gov)
  • The MMWR series of publications is published by the Epidemiology Program Office, Centers for Disease Control and Prevention (CDC), Public Health Service, U.S. Depart- ment of Health and Human Services, Atlanta, GA 30333. (cdc.gov)
  • Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease characterized by elevated pulmonary artery pressure with no apparent cause. (medscape.com)
  • Equally important, the echocardiogram helps to exclude secondary causes of, or contributors to, pulmonary hypertension, such as left-sided heart disease (eg, left ventricular dysfunction, valvular heart disease). (medscape.com)
  • It is known that smoking and pulmonary disease may increase risk. (basicmedicalkey.com)
  • Pulmonary Hypertension, or PH, is a disease affecting the arteries of the lungs. (phsa.co.za)
  • Disease-modifying antirheumatic drugs (DMARDs) or biologic agents should be started early in the course of the disease and shortly after diagnosis of RA. (basicmedicalkey.com)
  • An understanding of the symptoms of alterations in systems based on these characteristics is a critical step in diagnosis and treatment of many diseases. (pronursingtutors.com)
  • He has a particular interest in Gaucher disease, an inherited disorder in which fatty substances build up in certain organs. (yalemedicine.org)
  • Beyond the platelet count, the decision to treat is affected by individual bleeding risk, disease stage, side effects of treatment, concomitant medications, and patient preference. (mja.com.au)
  • Between February 1986 and March 1990, 56 patients with relapsed Hodgkin's disease treated with high-dose cyclophosphamide, carmustine, and etoposide (CBV) received an autologous peripheral stem cell transplantation (PSCT) rather than an autologous bone marrow transplantation (ABMT) because each patient had a marrow abnormality, either hypocellularity or tumor involvement. (shengsci.com)
  • The patient underwent a splenectomy that showed histological and immunochemical evaluations consistent with presence of LCA. (annexpublishers.co)
  • Analysis of the genetic variants associated with recurrent thromboembolism in a patient with hemoglobin H disease following splenectomy: A case report. (cdc.gov)
  • Therapeutic phlebotomy may be indicated for hemochromatosis, polycythemia vera, porphyria cutanea tarda, and polycythemia secondary to arterio-venous fistulae, cyanotic congenital heart disease or cor pulmonale. (aetna.com)
  • Idiopathic Thrombocytopenic Purpura (ITP) is a hematological disease characterized by decreased number of blood platelets. (bvsalud.org)
  • thus, after splenectomy or in the functionally hyposplenic state, RBCs with these inclusions and acanthocytes (a type of malformed RBC) appear in the peripheral circulation. (msdmanuals.com)
  • If rapid splenic sequestration of transfused RBCs necessitates more transfusions, a splenectomy may be performed. (doctor-clinic.org)
  • Treatment of splenic sequestration involves conservative management with blood transfusions/exchange transfusions to reduce the number of sickled red blood cells, or splenectomy. (medscape.com)
  • Splenectomy, if full, will prevent further sequestration and if partial, may reduce the recurrence of acute splenic sequestration crises. (medscape.com)
  • Hematologic outcomes after total splenectomy and partial splenectomy f" by Brian R. Englum, Jennifer Rothman et al. (aku.edu)
  • Serum soluble interleukin-2 receptor is associated with clinical and pathologic disease status in hairy cell leukemia. (uchicago.edu)
  • For children with HS, all hematologic measures improved after TS, including a 4.1g/dl increase in hemoglobin. (aku.edu)
  • Clinical phenotype genotype correlation in children with hemoglobin H disease in Zhuhai area of China]. (cdc.gov)
  • Variability of hemoglobin F expression in hemoglobin EE disease: hematological and molecular analysis. (cdc.gov)
  • Study of the genotypic and hematological feature of hemoglobin H disease in West Guangxi area]. (cdc.gov)
  • Telomere shortening correlates with disease severity in hemoglobin H disease patients. (cdc.gov)
  • Circulatory overload occurs in patients with anemia and with heart disease, where the transfusion causes congestive heart failure requiring specific treatment. (fundacionmapfre.org)
  • In September 2020, stage IV-B germinal center diffuse large B-cell lymphoma was diagnosed in a splenectomy specimen from a 68-year-old woman. (cdc.gov)
  • CLL can be grouped with small lymphocytic lymphoma (SLL) as one disease with two clinical presentations. (wikipedia.org)
  • Rheumatoid factors have not been identified as pathogenic, nor does the quantity of these circulating antibodies always correlate with disease activity. (basicmedicalkey.com)
  • In light of this exams, of the elevated value of PCR (8.59 mg/dL) and negativity of tumor (CEA, CA 19-9, CA 15-3, CA-125, NSE) and autoimmune markers (ANA, ENA, rheumatoid factor, anticitrullina antibodies) a lymphoproliferative disease was suspected, and a splenectomy was recommended. (annexpublishers.co)
  • Currently, IPT is considered an autoimmune disease and its etiology is related to immunological mechanisms such as antibodies and antiplatelet immunoglobulin in the blood 16 . (bvsalud.org)
  • Rocket Pharmaceuticals , a New York-based, clinical-stage company, developing first-in-class gene therapies for rare and devastating inherited diseases announced clearance of Investigational New Drug (IND) by the FDA for RP-L301 gene therapy . (rootsanalysis.com)
  • A spectrum of clinical liver diseases ranging from mild biochemical abnormalities to ACUTE LIVER FAILURE, caused by drugs, drug metabolites, and chemicals from the environment. (lookformedical.com)
  • In addition to his clinical work, Dr. Mistry is director of the Yale Lysosomal Disease Center and the internationally recognized Gaucher Disease Treatment Center. (yalemedicine.org)
  • He has published extensively in top-rated journals and led numerous international clinical trials for treatment of rare diseases. (yalemedicine.org)
  • Known clinically significant liver disease . (ucsd.edu)
  • Other measured hematologic and biochemical parameters, including procalcitonin, were within reference ranges. (cdc.gov)
  • All laparoscopic splenectomies were performed without tumor rupture during the procedure. (sages.org)
  • With the outbreak of infectious diseases, more and more attention has been paid to surveillance and early warning work. (bvsalud.org)
  • Timely and accurate monitoring data is the basis of infectious diseases prevention and control. (bvsalud.org)
  • Effective early warning methods for infectious diseases can improve the timeliness and sensitivity of early warning work. (bvsalud.org)
  • This paper briefly introduces the intelligent early warning model of infectious diseases, summarizes the emerging surveillance and early warning methods of infectious diseases, and seeks the possibility of diversified surveillance and early warning in different epidemic stages and different outbreak scenarios of infectious diseases. (bvsalud.org)
  • This paper puts forward the idea of constructing a diversified method system of infectious diseases surveillance and early warning based on multi-stages and multi-scenarios and discusses the future development trend of infectious diseases surveillance and early warning, in order to provide reference for improving the construction level of infectious diseases surveillance and early warning system in China. (bvsalud.org)
  • National Center for Infectious Diseases. (cdc.gov)
  • Epidemiologic data suggest that a genetic predisposition and exposure to unknown environmental factors may be necessary for expression of the disease. (basicmedicalkey.com)
  • [14] The disease most commonly occurs in people over the age of 65, due to the accumulation of genetic mutations that occurs over time. (wikipedia.org)
  • RP-L301 is a lentiviral vector (LVV)-based gene therapy for the treatment of Pyruvate Kinase Deficiency (PKD) , a genetic rare disease. (rootsanalysis.com)
  • My research is focused on the discovery of novel treatments and mechanisms of genetic liver diseases, and developing biomarkers to monitor patients," he says. (yalemedicine.org)
  • Unlike those with the Leach phenotype of common hereditary elliptocytosis (see above), there is a clinically significant reduction in both disease severity and prevalence of malaria in those with SAO. (wikipedia.org)
  • [17] Less commonly, the disease comes to light only after the cancerous cells overwhelm the bone marrow, resulting in low red blood cells, neutrophils, or platelets. (wikipedia.org)
  • Splenectomy and bone marrow uansplantation have been tried, but their effectiveness has not been confirmed. (doctor-clinic.org)
  • Control of inflammation is the key to slowing or preventing disease progression as well as managing symptoms. (basicmedicalkey.com)
  • The manifestations of the disease [1] have varied, including simple upper respiratory tract symptoms, headaches, myalgia, complicated lower respiratory tract involvement leading to development of acute respiratory distress syndrome and even requiring intubation, viral myocarditis, and gastrointestinal symptoms, including nausea, vomiting, and diarrhea. (amjcaserep.com)
  • On the other hand, infections can occur also as consequence of the disease and its treatments. (encyclopedia.pub)
  • However, Candidatus N. mikurensis can cause disease (neoehrlichiosis) in immunocompetent persons or cause asymptomatic infections ( 10 , 11 ). (cdc.gov)
  • This vaccine protects against invasive bacteremic disease, although existing data suggest that it is less effective in protecting against other types of pneumococcal infections. (cdc.gov)
  • Children with SCD have smaller changes in their hematologic parameters. (aku.edu)
  • Some less occurring toxicities of PD-1/PDL-1 inhibitors include eye, cardiac, neurological, and hematologic toxicities. (rroij.com)