Volume : 7, Issue : 12, December - 2018

The Prescribing Pattern of Anti-Epileptic Drugs in a tertiary care hospital in central India

Dr. Makrand Hirve, Dr. Pritesh Goutam

Abstract :

<p>&nbsp;</p> <p class="MsoNormal" style="margin-right:6.05pt;text-align:justify;text-justify:&#10;inter-ideograph;line-height:150%"><b style="mso-bidi-font-weight:normal"><span style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,&quot;serif&quot;">Aim:<span style="letter-spacing:-.15pt"> </span></span></b><span style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,&quot;serif&quot;">To<span style="letter-spacing:-.1pt"> </span><span style="letter-spacing:.05pt">s</span><span style="letter-spacing:-.05pt">t</span>udy<span style="letter-spacing:-.15pt"> </span>the<span style="letter-spacing:-.15pt"> </span>prescr<span style="letter-spacing:-.05pt">i</span><span style="letter-spacing:.05pt">b</span><span style="letter-spacing:-.05pt">i</span>ng<span style="letter-spacing:-.45pt"> </span><span style="letter-spacing:.1pt">p</span>at<span style="letter-spacing:-.05pt">t</span>ern<span style="letter-spacing:-.25pt"> </span>of<span style="letter-spacing:-.15pt"> </span>a<span style="letter-spacing:.1pt">n</span><span style="letter-spacing:-.05pt">t</span>iepilep<span style="letter-spacing:-.05pt">t</span>ic<span style="letter-spacing:-.45pt"> </span>drugs<span style="letter-spacing:-.25pt"> </span><span style="letter-spacing:-.05pt">i</span>n a<span style="letter-spacing:-.1pt"> </span>semi<span style="letter-spacing:&#10;-.2pt"> </span>urban<span style="letter-spacing:-.25pt"> </span>area<span style="letter-spacing:-.2pt"> </span><span style="letter-spacing:.1pt">b</span>y<span style="letter-spacing:-.15pt"> </span>general<span style="letter-spacing:-.3pt"> </span>practit<span style="letter-spacing:.05pt">i</span>oners<o:p></o:p></span></p> <p class="MsoNormal" style="margin-right:4.4pt;text-align:justify;text-justify:&#10;inter-ideograph;line-height:150%"><b style="mso-bidi-font-weight:normal"><span style="font-size:10.0pt;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&#10;&quot;Times New Roman&quot;,&quot;serif&quot;">Mater<span style="letter-spacing:-.05pt">i</span>als<span style="letter-spacing:1.95pt"> </span><span style="letter-spacing:.1pt">a</span>nd Method<span style="letter-spacing:-.05pt">s</span>:<span style="mso-spacerun:yes">&nbsp; </span></span></b><span style="font-size:10.0pt;&#10;mso-bidi-font-size:11.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;&#10;letter-spacing:-.05pt">T</span><span style="font-size:10.0pt;mso-bidi-font-size:&#10;11.0pt;line-height:150%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;;letter-spacing:&#10;.05pt">h</span><span style="font-size:10.0pt;mso-bidi-font-size:11.0pt;&#10;line-height:150%;font-family:&quot;Times New Roman&quot;,&quot;serif&quot;">is <span style="letter-spacing:.15pt"><span style="mso-spacerun:yes">&nbsp;</span></span>is <span style="letter-spacing:.15pt"><span style="mso-spacerun:yes">&nbsp;</span></span>an <span style="letter-spacing:.15pt"><span style="mso-spacerun:yes">&nbsp;</span></span>o<span style="letter-spacing:-.05pt">b</span>servati<span style="letter-spacing:-.05pt">o</span>nal<span style="letter-spacing:1.9pt"> </span>st<span style="letter-spacing:-.05pt">u</span>dy <span style="letter-spacing:.05pt"><span style="mso-spacerun:yes">&nbsp;</span></span><span style="letter-spacing:-.05pt">w</span><span style="letter-spacing:.1pt">h</span>erein<span style="letter-spacing:2.05pt"> </span>pat<span style="letter-spacing:-.05pt">i</span>en<span style="letter-spacing:-.05pt">t</span>s <span style="letter-spacing:.05pt"><span style="mso-spacerun:yes">&nbsp;</span>s</span><span style="letter-spacing:-.05pt">u</span>f<span style="letter-spacing:-.05pt">f</span>ering<span style="letter-spacing:2.1pt"> </span><span style="letter-spacing:-.05pt">f</span>r<span style="letter-spacing:.1pt">o</span>m <span style="letter-spacing:.05pt"><span style="mso-spacerun:yes">&nbsp;</span></span>epi<span style="letter-spacing:-.05pt">l</span>ep<span style="letter-spacing:-.05pt">s</span>y <span style="letter-spacing:.1pt">a</span><span style="letter-spacing:-.05pt">t</span>te<span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.05pt">d</span><span style="letter-spacing:-.05pt">i</span>ng<span style="letter-spacing:1.7pt"> </span>ge<span style="letter-spacing:-.05pt">n</span>eral<span style="letter-spacing:1.85pt"> </span><span style="letter-spacing:-.05pt">p</span>ract<span style="letter-spacing:-.05pt">i</span><span style="letter-spacing:.05pt">t</span>i<span style="letter-spacing:-.05pt">o</span>ners<span style="letter-spacing:1.6pt"> </span><span style="letter-spacing:-.05pt">i</span>n<span style="letter-spacing:2.05pt"> </span>a<span style="letter-spacing:2.0pt"> </span>tertiary care hospital<span style="letter-spacing:1.9pt"> </span>we<span style="letter-spacing:-.05pt">r</span>e<span style="letter-spacing:1.85pt"> </span>a<span style="letter-spacing:-.05pt">n</span>a<span style="letter-spacing:-.05pt">l</span>yze<span style="letter-spacing:-.05pt">d</span>.<span style="letter-spacing:1.75pt"> </span><span style="letter-spacing:-.05pt">T</span><span style="letter-spacing:.05pt">o</span>tally<span style="letter-spacing:1.8pt"> </span><span style="letter-spacing:-.05pt">1</span>00<span style="letter-spacing:1.9pt"> </span>pre<span style="letter-spacing:-.05pt">s</span>crip<span style="letter-spacing:-.05pt">t</span>i<span style="letter-spacing:-.05pt">o</span><span style="letter-spacing:.1pt">n</span>s<span style="letter-spacing:1.6pt"> </span>were anal<span style="letter-spacing:-.05pt">y</span>zed. <b style="mso-bidi-font-weight:&#10;normal">Resu<span style="letter-spacing:-.05pt">l</span><span style="letter-spacing:&#10;.05pt">t</span>s:<span style="letter-spacing:.05pt"> </span></b><span style="letter-spacing:-.05pt">1</span><span style="letter-spacing:.05pt">0</span>0<span style="letter-spacing:.15pt"> </span>p<span style="letter-spacing:.1pt">a</span><span style="letter-spacing:-.05pt">t</span>ie<span style="letter-spacing:.1pt">n</span><span style="letter-spacing:-.05pt">t</span>s<span style="letter-spacing:.1pt"> </span>were<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">i</span><span style="letter-spacing:.05pt">n</span>cl<span style="letter-spacing:-.05pt">u</span><span style="letter-spacing:.05pt">d</span>ed in<span style="letter-spacing:.25pt"> </span>t<span style="letter-spacing:-.05pt">h</span>e<span style="letter-spacing:.3pt"> </span>s<span style="letter-spacing:-.05pt">t</span>udy<span style="letter-spacing:.15pt"> </span><span style="letter-spacing:-.05pt">o</span><span style="letter-spacing:.05pt">u</span>t<span style="letter-spacing:.15pt"> </span><span style="letter-spacing:.1pt">o</span>f<span style="letter-spacing:.2pt"> </span>wh<span style="letter-spacing:-.05pt">i</span>ch<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">5</span>1<span style="letter-spacing:.2pt"> </span>were<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">m</span>ales<span style="letter-spacing:.1pt"> while</span><span style="letter-spacing:.15pt"> </span>49<span style="letter-spacing:.2pt"> </span>were<span style="letter-spacing:.15pt"> </span>fema<span style="letter-spacing:-.05pt">l</span>es. <span style="letter-spacing:-.05pt">Eighty two</span> pat<span style="letter-spacing:-.05pt">i</span>ents<span style="letter-spacing:.45pt"> </span>were<span style="letter-spacing:.55pt"> </span><span style="letter-spacing:-.05pt">u</span><span style="letter-spacing:.05pt">s</span>ed<span style="letter-spacing:.5pt"> </span>on<span style="letter-spacing:-.05pt">l</span>y<span style="letter-spacing:.55pt"> </span><span style="letter-spacing:-.05pt">o</span>l<span style="letter-spacing:-.05pt">d</span>er<span style="letter-spacing:-.05pt">/</span>c<span style="letter-spacing:.1pt">o</span><span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.05pt">v</span>e<span style="letter-spacing:-.05pt">n</span>t<span style="letter-spacing:-.05pt">i</span>onal<span style="letter-spacing:.05pt"> </span>AED<span style="letter-spacing:-.1pt">s</span>.<span style="letter-spacing:.45pt"> </span><span style="letter-spacing:-.05pt">G</span>TCS<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">w</span>as<span style="letter-spacing:.3pt"> </span>the<span style="letter-spacing:.4pt"> </span>pre<span style="letter-spacing:-.05pt">d</span>o<span style="letter-spacing:-.05pt">m</span>i<span style="letter-spacing:-.05pt">n</span>ant <span style="letter-spacing:-.05pt">f</span><span style="letter-spacing:.1pt">o</span>rm<span style="letter-spacing:.2pt"> </span>of<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:-.05pt">s</span>eiz<span style="letter-spacing:-.05pt">u</span>re<span style="letter-spacing:.25pt"> </span>type<span style="letter-spacing:.3pt"> </span>pre<span style="letter-spacing:-.05pt">s</span>ented<span style="letter-spacing:.05pt"> </span>(<span style="letter-spacing:-.1pt">88</span><span style="letter-spacing:-.05pt">%</span>)<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">f</span><span style="letter-spacing:.1pt">o</span>llo<span style="letter-spacing:-.05pt">w</span>ed<span style="letter-spacing:.15pt"> </span>by<span style="letter-spacing:.35pt"> </span>o<span style="letter-spacing:-.05pt">t</span>her ty<span style="letter-spacing:-.05pt">p</span>es. A<span style="letter-spacing:.1pt"> </span>t<span style="letter-spacing:-.05pt">o</span>tal <span style="letter-spacing:.1pt">o</span>f<span style="letter-spacing:.05pt"> </span>280 AE<span style="letter-spacing:-.05pt">D</span>s were<span style="letter-spacing:&#10;.1pt"> </span><span style="letter-spacing:-.05pt">p</span>resc<span style="letter-spacing:-.05pt">r</span>i<span style="letter-spacing:-.05pt">b</span>ed<span style="letter-spacing:-.2pt"> </span>to<span style="letter-spacing:.1pt"> </span>a<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.1pt">a</span>l<span style="letter-spacing:.1pt"> </span>of<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">1</span><span style="letter-spacing:.05pt">0</span>0<span style="letter-spacing:.05pt"> </span>pa<span style="letter-spacing:-.05pt">t</span>ie<span style="letter-spacing:-.05pt">n</span>ts. <span style="letter-spacing:-.05pt">T</span><span style="letter-spacing:.1pt">h</span>e<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:.05pt">p</span><span style="letter-spacing:-.05pt">a</span>tte<span style="letter-spacing:-.05pt">r</span>n<span style="letter-spacing:.15pt"> </span><span style="letter-spacing:-.05pt">o</span>f<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:-.05pt">AED</span>s<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:.1pt">p</span><span style="letter-spacing:-.1pt">r</span>esc<span style="letter-spacing:-.1pt">r</span><span style="letter-spacing:.1pt">i</span><span style="letter-spacing:-.05pt">be</span>d <span style="letter-spacing:.1pt">i</span>s<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:.05pt">p</span>r<span style="letter-spacing:-.05pt">es</span>e<span style="letter-spacing:-.05pt">n</span>ted<span style="letter-spacing:.05pt"> </span><span style="letter-spacing:-.05pt">i</span>n<span style="letter-spacing:.4pt"> </span><span style="letter-spacing:-.05pt">Ta</span><span style="letter-spacing:.05pt">b</span>le<span style="letter-spacing:.2pt"> </span>2<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:.05pt">o</span>f<span style="letter-spacing:.25pt"> </span><span style="letter-spacing:.05pt">1</span><span style="letter-spacing:-.05pt">0</span>0 pat<span style="letter-spacing:-.05pt">i</span>ents,<span style="letter-spacing:&#10;.2pt"> </span>80 pati<span style="letter-spacing:.1pt">e</span>nts<span style="letter-spacing:.25pt"> </span>were<span style="letter-spacing:.3pt"> </span>prescribed<span style="letter-spacing:.25pt"> </span>on<span style="letter-spacing:-.05pt">l</span>y<span style="letter-spacing:.4pt"> </span>conve<span style="letter-spacing:-.1pt">n</span>tion<span style="letter-spacing:.1pt">a</span>l /<span style="letter-spacing:.5pt"> </span><span style="letter-spacing:.1pt">o</span><span style="letter-spacing:-.05pt">l</span>der<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:.05pt">A</span><span style="letter-spacing:-.05pt">E</span>Ds. <span style="letter-spacing:-.05pt">O</span><span style="letter-spacing:.05pt">n</span><span style="letter-spacing:-.05pt">l</span>y<span style="letter-spacing:.4pt"> </span>5<span style="letter-spacing:.55pt"> </span>p<span style="letter-spacing:.1pt">a</span>t<span style="letter-spacing:-.05pt">i</span>e<span style="letter-spacing:.1pt">n</span><span style="letter-spacing:-.05pt">t</span>s<span style="letter-spacing:.35pt"> </span><span style="letter-spacing:-.05pt">w</span>e<span style="letter-spacing:.05pt">r</span>e<span style="letter-spacing:.4pt"> </span>on<span style="letter-spacing:.5pt"> </span>newer<span style="letter-spacing:.35pt"> </span>AEDs<span style="letter-spacing:.35pt"> </span>monotherapy. Newer<span style="letter-spacing:&#10;.35pt"> </span><span style="letter-spacing:-.05pt">A</span>EDs <span style="letter-spacing:-.05pt">w</span>ere<span style="letter-spacing:-.15pt"> </span>u<span style="letter-spacing:-.05pt">s</span>ed<span style="letter-spacing:-.15pt"> </span>as<span style="letter-spacing:-.15pt"> </span>add<span style="letter-spacing:-.15pt"> </span>o<span style="letter-spacing:-.05pt">n</span>-t<span style="letter-spacing:-.05pt">h</span>erapy<span style="letter-spacing:-.4pt"> </span>in<span style="letter-spacing:-.05pt"> </span>6 <span style="letter-spacing:-.05pt">p</span>at<span style="letter-spacing:-.05pt">i</span>ents. <span style="letter-spacing:-.05pt">M</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.1pt">o</span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">h</span>era<span style="letter-spacing:-.05pt">p</span>y (5<span style="letter-spacing:-.05pt">2%</span>)<span style="letter-spacing:1.75pt"> </span>was <span style="letter-spacing:.15pt"><span style="mso-spacerun:yes">&nbsp;</span></span><span style="letter-spacing:-.05pt">p</span>rescr<span style="letter-spacing:-.05pt">i</span><span style="letter-spacing:.05pt">b</span>ed<span style="letter-spacing:2.1pt"> </span><span style="letter-spacing:-.05pt">mo</span>re <span style="letter-spacing:.2pt"><span style="mso-spacerun:yes">&nbsp;</span></span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.1pt">h</span>an <span style="letter-spacing:.2pt"><span style="mso-spacerun:yes">&nbsp;</span></span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">h</span>e po<span style="letter-spacing:-.05pt">l</span>y<span style="letter-spacing:&#10;-.05pt">t</span>herap<span style="letter-spacing:-.05pt">y </span>(4<span style="letter-spacing:-.05pt">8%</span>). <span style="letter-spacing:-.05pt">Ph</span>eny<span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.1pt">o</span><span style="letter-spacing:-.05pt">i</span>n<span style="letter-spacing:1.15pt"> </span>was<span style="letter-spacing:1.95pt"> </span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">h</span>e<span style="mso-spacerun:yes">&nbsp; </span><span style="letter-spacing:-.05pt">mo</span>st<span style="letter-spacing:1.9pt"> </span>co<span style="letter-spacing:-.05pt">m</span>m<span style="letter-spacing:-.05pt">o</span><span style="letter-spacing:.1pt">n</span><span style="letter-spacing:-.05pt">l</span>y<span style="letter-spacing:1.75pt"> </span>prescribed<span style="letter-spacing:&#10;1.8pt"> </span><span style="letter-spacing:-.05pt">d</span>rug<span style="letter-spacing:1.95pt"> </span>as<span style="letter-spacing:2.05pt"> </span>mo<span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">h</span>erapy<span style="letter-spacing:1.7pt"> </span><span style="letter-spacing:-.05pt">f</span><span style="letter-spacing:.05pt">o</span>llowed<span style="letter-spacing:1.85pt"> </span>by phe<span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">b</span>arbi<span style="letter-spacing:-.05pt">t</span>o<span style="letter-spacing:-.05pt">n</span>e.<span style="letter-spacing:-.3pt"> </span><b style="mso-bidi-font-weight:normal">Conc<span style="letter-spacing:-.05pt">l</span><span style="letter-spacing:.05pt">u</span>sion:<span style="mso-spacerun:yes">&nbsp; </span></b><span style="letter-spacing:-.05pt">O</span><span style="letter-spacing:.05pt">u</span>r<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">s</span>t<span style="letter-spacing:-.05pt">u</span><span style="letter-spacing:.05pt">d</span>y<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">r</span>e<span style="letter-spacing:.05pt">v</span><span style="letter-spacing:-.1pt">e</span>aled<span style="letter-spacing:.05pt"> </span><span style="letter-spacing:-.05pt">t</span><span style="letter-spacing:.05pt">h</span>at<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:.1pt">t</span><span style="letter-spacing:.05pt">h</span>e<span style="letter-spacing:.25pt"> </span><span style="letter-spacing:-.05pt">c</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">n</span><span style="letter-spacing:.05pt">v</span><span style="letter-spacing:-.05pt">e</span><span style="letter-spacing:.05pt">n</span><span style="letter-spacing:-.05pt">ti</span><span style="letter-spacing:.1pt">o</span><span style="letter-spacing:.05pt">n</span><span style="letter-spacing:-.1pt">a</span>l<span style="letter-spacing:-.05pt"> </span><span style="letter-spacing:-.15pt">A</span>E<span style="letter-spacing:-.05pt">D</span>s<span style="letter-spacing:.2pt"> </span><span style="letter-spacing:-.05pt">ar</span>e<span style="letter-spacing:.3pt"> still most </span><span style="letter-spacing:-.05pt">c</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">mm</span><span style="letter-spacing:.05pt">o</span><span style="letter-spacing:-.05pt">nly</span> us<span style="letter-spacing:-.05pt">e</span>d <span style="letter-spacing:&#10;.05pt"><span style="mso-spacerun:yes">&nbsp;</span></span>AEDs and <span style="letter-spacing:.1pt"><span style="mso-spacerun:yes">&nbsp;</span></span>use <span style="letter-spacing:.05pt"><span style="mso-spacerun:yes">&nbsp;</span></span><span style="letter-spacing:-.05pt">o</span>f <span style="letter-spacing:.15pt"><span style="mso-spacerun:yes">&nbsp;</span></span>n<span style="letter-spacing:-.1pt">e</span><span style="letter-spacing:-.05pt">w</span>er<span style="mso-spacerun:yes">&nbsp; </span><span style="letter-spacing:-.05pt">A</span>E<span style="letter-spacing:&#10;-.05pt">D</span>s<span style="letter-spacing:2.3pt"> </span>is <span style="letter-spacing:.1pt"><span style="mso-spacerun:yes">&nbsp;</span></span>s<span style="letter-spacing:.1pt">t</span><span style="letter-spacing:-.05pt">il</span>l <span style="letter-spacing:-.05pt">low even at tertiary level</span>.<span style="letter-spacing:.05pt"> </span>This<span style="letter-spacing:.15pt"> </span>m<span style="letter-spacing:-.05pt">a</span>y<span style="letter-spacing:.3pt"> </span>be<span style="letter-spacing:.3pt"> </span>be<span style="letter-spacing:-.05pt">c</span>a<span style="letter-spacing:-.05pt">us</span>e<span style="letter-spacing:.1pt"> </span>of<span style="letter-spacing:.4pt"> </span>la<span style="letter-spacing:-.1pt">c</span>k<span style="letter-spacing:.3pt"> </span><span style="letter-spacing:-.05pt">o</span>f<span style="letter-spacing:.35pt"> </span>e<span style="letter-spacing:-.05pt">x</span>pe<span style="letter-spacing:-.1pt">r</span>i<span style="letter-spacing:-.05pt">e</span><span style="letter-spacing:.05pt">n</span>ce <span style="letter-spacing:-.05pt">i</span>n<span style="letter-spacing:.4pt"> </span>u<span style="letter-spacing:-.05pt">si</span>ng ne<span style="letter-spacing:-.05pt">we</span>r<span style="letter-spacing:&#10;.35pt"> </span><span style="letter-spacing:-.05pt">AED</span>s<span style="letter-spacing:.4pt"> </span>and<span style="letter-spacing:.45pt"> </span><span style="letter-spacing:-.05pt">cost factor as most of the population attending epilepsy clinic is from </span>lo<span style="letter-spacing:-.05pt">we</span>r<span style="letter-spacing:-.2pt"> </span>soc<span style="letter-spacing:-.05pt">i</span>o<span style="letter-spacing:-.05pt">e</span>c<span style="letter-spacing:-.05pt">on</span><span style="letter-spacing:.05pt">o</span>mic<span style="letter-spacing:-.65pt"> </span>gr<span style="letter-spacing:-.05pt">o</span>up.<o:p></o:p></span></p>