• 제목/요약/키워드: intestinal parasitic protozoa

검색결과 15건 처리시간 0.021초

Prevalence of Intestinal Parasitic Infections and Associated Risk Factors Among in Children Ilam Town, West Iran

  • Soghra Viesy;Amin Jaydari;Maryam Hataminejad;Marzieh Shadpirouz;Iman Pouladi
    • Pediatric Infection and Vaccine
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    • 제30권3호
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    • pp.141-151
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    • 2023
  • Purpose: Intestinal parasitic infections (IPIs) are a major health problem worldwide, especially in developing countries. According to the literature, children are more likely to get infected due to more frequent exposure to sources of infection. Methods: In this study, we collected 500 fecal samples from children under 15 years of age who referred to labs in Ilam city. All samples were microscopically examined using formalin-ether concentration and Trichrome staining techniques. The results were analyzed using SPSS 20.0. Results: Among 500 investigated samples, 4 types of parasites were detected. Giardia lamblia, Entameba coli, and Blastocystis hominis were identified as intestinal protozoa, and pinworm as intestinal worm. In this study, 23 cases (4.6%) had parasitic infections. 13 patients (2.6%) were infected with Giardia parasite, 4 patients (0.8%) with E. coli, 3 patients (0.6%) with B. hominis and 3 patients (0.6%) had pinworms. Conclusions: The findings of this study showed that the prevalence of IPIs among children aged under 15 years in Ilam is relatively down, which can be attributed of sufficient information of parents and children about the modes of parasite transmission and the important role of carriers in the pathogen cycle.

A Cross-Sectional Study on Intestinal Parasitic Infections in Rural Communities, Northeast Thailand

  • Boonjaraspinyo, Sirintip;Boonmars, Thidarut;Kaewsamut, Butsara;Ekobol, Nuttapon;Laummaunwai, Porntip;Aukkanimart, Ratchadawan;Wonkchalee, Nadchanan;Juasook, Amornrat;Spiraj, Pranee
    • Parasites, Hosts and Diseases
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    • 제51권6호
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    • pp.727-733
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    • 2013
  • Despite the existence of effective anthelmintics, parasitic infections remain a major public health problem in Southeast Asia, including Thailand. In rural communities, continuing infection is often reinforced by dietary habits that have a strong cultural basis and by poor personal hygiene and sanitation. This study presents a survey of the prevalence of intestinal parasitic infections among the people in rural Thailand. The community-based cross-sectional study was conducted in villages in Khon Kaen Province, northeastern Thailand, from July to August 2013. A total of 253 stool samples from 102 males and 140 females, aged 2-80 years, were prepared using formalin-ethyl acetate concentration methods and examined using light microscopy. Ninety-four individuals (37.2%) were infected with 1 or more parasite species. Presence of parasitic infection was significantly correlated with gender (P=0.001); nearly half of males in this survey (49.0%) were infected. Older people had a higher prevalence than younger members of the population. The most common parasite found was Opisthorchis viverrini (26.9%), followed by Strongyloides stercoralis (9.5%), Taenia spp. (1.6%), echinostomes (0.4%), and hookworms (0.4%). The prevalence of intestinal protozoa was Blastocystis hominis 1.6%, Entamoeba histolytica 0.8%, Entamoeba coli 0.8%, Balantidium coli 0.4%, Iodamoeba b$\ddot{u}$tschlii 0.4%, and Sarcocystis hominis 0.4%. Co-infections of various helminths and protozoa were present in 15.9% of the people. The present results show that the prevalence of parasitic infections in this region is still high. Proactive education about dietary habits, personal hygiene, and sanitation should be provided to the people in this community to reduce the prevalence of intestinal parasite infections. Moreover, development of policies and programs to control parasites is needed.

서울지역(地城)의 양내기생충(賜內寄生蟲) 감염상태(感染狀態) 조사(調査) -한양대학병원(漢陽大學病院) 내원환자(來院患者)를 중심으로- (Intestinal Parasite Survey in Seoul by Stool Examination at Hanyang University Hospital)

  • 민득영;안명희;김경민;김춘원
    • Parasites, Hosts and Diseases
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    • 제24권2호
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    • pp.209-212
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    • 1986
  • The present study was undertaken to evaluate the present status of intestinal parasitic infection in Seoul area, Korea. During the period from June 1985 to July 1986, a total of 5,251 stool samples were collected in Department of Clinical Pathology, Hanyang University Hospital and examined by formalin-ether sedimentation technique once for helminth ova and protozoan cysts. The results were summarized as follows: 1. The overall egg positive rate of intestinal helminthes was 2.53%; and 1.43% for Clonorchis sinensis, 0.7% for Trichuris trichiura, 0.13% for Metagonimus yokogawai, 0.06% for hookworm, and 0.02% for Ascaris lumbricoides, Diphyllobothrium latum and Hymenolepis nana, respectively. 2. The overall cyst positive rate of intestinal protozoa was 1.07%. Cyst positive rate was 0.06% for Entamoeba histolytica and 0.13% for Giardia lamblia, respectively. 3. Higher prevalence of intestinal parasitic infection was observed in male and in $21{\sim}50$ year-old groups. 4. The highest prevalence of Clonorchis sinensis infection was observed in 40th age group (3.4%), and male (2.3%) was more infected than female (0.7%) in general.

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한국(韓國)에 있어서의 장내기생충감염(腸內寄生虫感染)의 현황(現況)과 추이(推移) (Current Status and Transition of the Prevalence of Intestinal Parasitic Infections in Korea)

  • 김동찬
    • 농촌의학ㆍ지역보건
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    • 제9권1호
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    • pp.83-108
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    • 1984
  • Out of a total of 58 species of helminthic and protozoan parasitic infections in Korea, so far 38 species were reported as intestinal parasites of man. Quite a few species of the intestinal parasitic infections have long been prevalent throughout the country and this has been a significant public health problem. In this paper, current status and transition of the intestinal parasitic infections in the past years were presented. Chronological reviewing of data show background and prospects of change in the prevalence of infections. In the national prevalence survey on parasitic infections conducted once every five years since 1971, stool examinations were done by both cellophane thick smear and brine flotation techniques. Every egg positive case of Ascaris lumbricoides and Clonorchis sinensis was further examined by Stoll's dilution egg counting technique. In 1981, perianal swab using adhesive cellulose tape was added for Enterobius infection. For protozoan cyst examination conducted by province and city in '81, fecal specimens were fixed in SAF solution and examined by the formalin-ether concentration technique. High prevalence of parasitic infection in ana before the 1960s can be easily understood from the data given by the Ministry of Health and Social Affairs in 1967. From a parasite control point of view, the 1960s was the preparatory period particularly for control of soil-transmitted helminthiasis. Several organizations which have contributed to parasite control were founded in this period and the prevention law of parasitic infections was passed in '66. In the '70s, overall prevalence rates of the common intestinal parasitic infections, which were highly prevalent in the past were turned into reduction phase for the first time. The '80s can be said to be an active control period of parasitic infections. Intestinal helminths According to the reports of the national prevalence survey on parasitic infections, the prevalence of helminthic infections was 84.3%(number of person examined:24,887) in '71, 63.2%(27,178) in '76, and 41.1%(35,018) in '81. By area, the prevalence rate in '81 was 35.1%(20,569) in urban areas and 49.6%(14,447) in rural areas. Intestinal nematodes Ascaris lumbricoides The prevalence of Ascaris infection has decreased significantly in recent years. Among students, the prevalence was 55.4%, in '69 and decreased to 4.7% in '83. In the national prevalence surveys, the prevalence decreased to 13.0% in '81 from 54.9% in '71. By area, the prevalence decreased to 8.5% in '81 from 46.4% in '71 in urban area and 19.4% in '81 from 59.6% in '71 in rural area. By age, the prevalence has become in recent years relatively even in all age groups, although higher prevalence used to be seen in young age groups of around 10 years old, particulary in the highly prevalent rural areas. By sex, the prevalence was higher in the female than in the male. Unfertilized egg positive rates among the ascariasis cases increased gradually up to 55.4% on the average in '81. The intensity of the infection was also significantly decreased. Trichuris trichiura Trichuris infection had also decreased to 23.4% in '81 from 65.4% in '71. By area, the decreasing tendency of the prevalence became faster in urban areas than in the rural areas. The prevalence in urban and rural areas in '71 was 69.7%, and 63.1% respectively and decreased to 19.5% and 29.0% respectively in '81. By age, the prevalence reached a peak at the 10-14 age group and showed relatively even distribution throughout all age groups. By sex, the prevalence was close in young age groups, but in the 30s or over age group, especially in rural area, the prevalence was significantly higher in the female than in the male. The prevalence has much fluctuated depending in the area. The prevalence in rural areas surveyed in the '80s shows a range between 20.9% and 73.7% by locality. It is anticipated that the prevalence of Trichuris infection will drop more rapidly, when mass treatment is conducted. Hookworms Hookworm infection by mostly Ancylostoma duodenale and a few by Necator americanus has decreased to a negligible levels in recent years. In the national prevalence surveys, the prevalence was 10.7% in '71, 2.2% in '76, and 0.5% in '81. The prevalence was higher in rural areas than in urban areas. Wide application of multi-specific anthelminthics in the ascariasis control programmes conducted in the past decade appear to have been effective against hookworm infection. Trichostrongylus orientalis As in the case with hookworm infection, the prevalence of Trichostrongylus infection has reached a negligible levels. In the national prevalence surveys, the prevalence was 7.7% in '71, 1.0% in '76 and 0.2% in '81. Enterobius vermicularis In the national prevalence survey in '81, the egg positive rate was 12.0%. Higher prevalence is expected when examined repeatedly. The prevalence rate was 10.3% in urban area and 14.6% in rural area. In recent surveys conducted in rural areas among schoolchildren, the prevalence was 32.4% in Gimhae Gun in '82 and 64.1% in Yeongyang Gun in '83. By age, the egg positive rate was higher in young age groups of around 10 and sharply decreased in age groups of around 20 and then somewhat increased again in middle age groups. By sex, the prevalence was higher in the female than in the male. Strongyloides stercoralis Strongyloides stercoralis infection has rarely been found in Korea. Three cases were reported in 1914. And 0.1-0.5% were found infected out of 2,642 persons examined at the prisoner-of-war camp on Geojedo in 1956. One case was reported in '54 and '82, respectively. Anisakis spp. No systematic survey has been conducted for anisakiasis In Korea. So far, only several cases have been found 1 case in Seoul in '71, 5 cases in Busan in '81 and 1 case in Busan in '84. Intestinal trematodes Metagonimus yokogawai In the national prevalence survey conducted in 1981, the egg positive rate was 1.24% on the average. High endemic areas are located in the southwestern part of Korea. The prevalence in Hadong Gun was 29.1% on the average in '79. In a survey conducted in 76, the prevalence was 44.0% in Gwangyang, 55.0% in Gogseung and 29.0% in Gurye. The infection is closely correlated with raw sweetfish consumption in these areas. Other intestinal trematodes A human case of Heterophyes heterophyes was reported in 1914. Several species were reported in the '80s : 17 cases of Fibricola seoulensis, 9 cases of Pygidiopsis summa, 8 cases of Heterophyes heterophyes nocens, 1case of Heterophyopsis continua, 2 cases of Stellantchasmus falcatus, 1 case of Stictodora sp., 1 case of Echinostoma hortense, and 4 cases of Echinochasmus japonicus. As the intermediate hosts, snakes and frogs play a role for F.seoulensis and fish for the rest of the species. Intestinal cestodes Taenia saginata and T. solium Egg positive rates in the national prevalence survey were 0.7% in '76 and 1.1% in '81. The prevalence in '81 was 0.6% in urban area and 1.8% in rural area. The proglottid positive rate in Jeju Do was 19.2% on the average. On Udo, Jeju Do in 1983, the egg positive rate among the inhabitants was 2.9%. Hymenolepis nana In the national prevalence survey, egg positive rates were 0.6% in '76 and 0.4% in '81. No difference was seen in the prevalence by area and sex. Hymenolepis diminuta Infected cases were reported : 3 in '64 and I in '66. Egg positive rate in '81 was 0.01% in the national prevalence survey. Diphylobothrium latum So far, about 30 cases have been reported. The cases have been reported more frequently in recent surveys. Mesocestoides sp. A case was reported from a hospitalized patient in Seoul in '67. Spirometra erinacei Two cases were reported in '84 following reidentification of the adult worms collected in '74. Intestinal protozoa Out of a total of 23 species of human protozoan infections in Korea, 13 species were reported as intestinal protozoa : Entamoeba histolytica, E coli, Endolimax nana, Iodamoeba b$\ddot{u}$tschlii, Dientamoeba fragilis, Giardia lamblia, Chilomastix mesnilii, Embadomonas sp., Enteromonas hominis, Trichomonas hominis, Isospora belli, I. Hominis(Sarcocystis hominis), and Balantidium coli. Since the first report on intestinal protozoan infections in 1925, there have been quite a few survey data on the prevalence of the infection. It was found reviewing the data chronologically that up to the early '70s the infection was prevalent around a 30-50%. After that, the protozoan cyst positive rate has shown the tendency of gradual decrease throughout the country. Protozoan cyst survey conducted in Seoul and several provinces in 1981 revealed infection rates of 8.9%(1,310) in Gangweondo, 10.7%(1,703) in Gyenggi Do, 11.7%(1,032) in Jeonra Buk Do, 9.1%(4,116) in Jeonra Nam Do, and 1.4%(5,275) in Seoul. Entamoeba histolytica In the survey conducted by province in '81, the cyst positive rate was 0.8% in Gangweon-do, 0.3% in Gyeonggi Do, 1.4% in both Jeonra Buk Do and Jeonra Nam Do, and 0.2% in Seoul. Giardia lamblia In the survey by province in '81, cyst positive rates were 2.2% in both Gyeonggi Do and Jeonra Buk Do, 1.9% in Jeonra Nam Do, 0.5% in Gangweon Do, and 0.9% in Seoul. Balantidium coli Two cases were reported. One in 1930 and the other in '74. Isospora belli and I. Hominis(Sarcocystis hominis) Isospora belli was reported : 1 case in '56 and 3 cases in '66. I. Hominis, recently identified to be synonymous with Sarcocystis hominis, was reported : 3 cases in '66. Other intestinal protozoa The protozoan parasites other than the above mentioned are generally treated as commensal, although some of them are considered to be pathogenic. The data of '81 show that about 10% of the inhabitants are still infected with protozoa.

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한국농촌(韓國農村)의 기생충성인축공통질환(寄生蟲性人畜共通疾患)의 현황(現況)과 문제점(問題點) (Current Problems of Parasitic Zoonoses in Rural Korea)

  • 임한종
    • 농촌의학ㆍ지역보건
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    • 제15권1호
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    • pp.49-55
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    • 1990
  • Zoonoses are those diseases and infections that are naturally transmitted between vertebrate animals and man. At present, approximately 175 diseases caused by virus, rickettsia, bacteria, protozoa and helminthes as well as some of arthropods and the number is continually increasing. Although zoonoses are generally recognized as significant health problems, the actual prevalence and incidence of zoonotic infections is difficult to determine. Medical services in a rural area are scarce and ill persons may have little chance to see a physician. Furthermore, a lack of physician awareness and of appropriate diagnostic support is made often misdiagnosis. In rural Korea, parasitic disease is still important subject in the field of zoonotic infections considering its number and morbidity. Recently there was conspicuous reduction of soil-transmitted parasitic diseases (i.e. ascariasis. hookworms, trichuriasis), but clonorchiasis. intestinal trematodiases and taeniasis are a considerable problem. This is often significantly related to human behavioral patterns based on socio-economic and cultural conditions and linked with the local biologic and physical environment. The most of all parasitic zoonoses to man and animals are the food-transmitted parasitic diseases, and domestic animals such as dog, cat, pig, as well as fat and some mammals, ruminants and birds are act as reservoir hosts. In the present topics, current problems of parasitic zoonoses caused by protozoan infections (i. e. toxoplasmosis, pneumocystosis and cryptosporidiosis) which are the most common opportunistic in AIDS or immunocompromised persons, trematode infections (i.e. clonorchiasis, paragonimiasis and some intestinal tremadodiases). cestode infections such as cysticercosis and sparganosis, and some nematode infections of anisakiasis, thelaziasis and strongyloidiasis, are discussed here those on the occurrence in man and animals and the source of transmission as well as prevention and control measures in Korea.

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경남 통영군 2개 도서 지역 주민의 장내 기생충 감염 상황 (Intestinal parasite infections among inhabitants in two islands of Tongyeong-gun, Kyeongsangnam-do)

  • 홍성종;우호춘
    • Parasites, Hosts and Diseases
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    • 제28권1호
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    • pp.63-67
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    • 1990
  • 우리 나라 도서 지역의 장내 기생충 감염 현황을 파악하기 위한 조사 연구의 일환으로 1989년 8월과 9월에 경남 통영군 산양면 및 욕지면 도서주민 189명의 대변을 수집하여 셀로판 후층 도말법과 formalin-ether 원심침전법으로 각각 1매 씩의 도말 표본을 만들어 검사하였다. 전체적인 윤충류 충란 양성률은 30.2%이었으며 윤충류 종별 양성률은 펀충 24.3%, 회충 2.1%, 구충 2.1%, 동양모양선충 0.5%, 간흡충 1.1%, 이형흡충류 1.6%, 유·무구조충 2.6%이었으며 원충류 종별 양성률은 람블껄모충 1.6%, 대장아메바 0.5%이었다. 편충란 양성률은 남자(17.1%) 보 다 여자에서 (29.9%) 다소 높았고 연령별로 10∼19세 군에서 가장 높았으며 E.P.G.는 평균 303이었다. 이 조사로 아직도 도서 지역의 장내 윤충류 감염률은 도시나 농촌지역에서 보고된 것보다 비교적 높다는 것을 알 수 있었다.

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전라남도 여천군 남면 연도 주민의 장내 기생충 감염상황 (Statue of Intestinal Parasitic Infections in a Remote Island, Yondo, Jeonranarn-do (Province))

  • 구기수;민득영
    • Parasites, Hosts and Diseases
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    • 제26권4호
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    • pp.275-284
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    • 1988
  • 1988년 2월 및 5월에 전라남도 여천군 남면 소재 연도 주민 1,011명 (남자 507명, 여자 504명)에 대하여 formalin-ether 침전법으로 장내 기생충 감염상환을 조사하고, 장내 윤충란 양성자 의 경우 감염강도를 E.P.G.로 측정한 바 다음과 같은 결과를 얻었다. 주민 1,011명중 398명 (39.4%)이 장내 기생충 양성자이었고 윤충 감염이 372명 (36.8%), 원충 감 염이 56명(5.5%)이었다. 검출된 기생충은 모두 10종으로서 편충란 양성자가 278명(27.5%)으로 가 장 많았고 그 다음이 회충 176명(17.4U, 불수정란 양성자 31명 포함), Taenia sp. 59명(5.8%)이었으며, 대장아메바 3.3%, 람블편모충 1.5%, 왜소아메바 0.8%, 왜소조충 0.4%이었고, 구충, 동 양모양선충 및 이질아메바가 각각 0.2%의 양성률을 보였다. 성별 감염률은 여자가 44.0%로 전 연령군에서 남자 34.7%보다 높았다. 연령별로는 40대가 46.0%로 가장 높았고 10세 미만이 33.1%로 가장 낮았다. 회충란 양성자중 149명의 E.P.G.는 평균 1,876(범위 200∼17,800), 편충 E.P.G. 는 검사자 242명에서 평균 327(범위 200∼1,600)이었다. 장내 기생 윤충의 양성자 572명중 단일 감염은 236명 (63.4%), 2종 감염은 129명 (34.7%), 3종 감염은 7명 (1.9%)이었고, 원충시스트 양성자 56명 중 단일 감염은 53명 (94.6%), 2종 감염은 3명 (5.4%)이었다. 이상의 결과로 보아 낙도 주민의 장내 기생충 감염률은 높음을 알 수 있으며 이의 퇴치를 위하여 생환 주변 환경의 개선, 집단 치료, 보건 교육 등 적극적인 관리가 시급히 수행되어야 할 것으로 생각된다.

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Prevalence and Co-infection of Intestinal Parasites among Thai Rural Residents at High-risk of Developing Cholangiocarcinoma: A Cross-sectional Study in a Prospective Cohort Study

  • Songserm, Nopparat;Promthet, Supannee;Wiangnon, Surapon;Sithithaworn, Paiboon
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권12호
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    • pp.6175-6179
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    • 2012
  • Intestinal parasitic infections (IPIs) are still important to the health of Thai rural residents. IPIs are the cause of many chronic diseases with, for example, opisthorchiasis resulting in progression to cholangiocarcinoma (CCA). This cross-sectional study in a prospective cohort study aimed to examine the prevalence and co-infection of intestinal parasites among Northeastern Thai rural residents, recruited into the Khon Kaen Cohort Study (KKCS), and who were residing in areas of high-risk for developing CCA. On recruitment, subjects had completed questionnaires and provided fecal samples for IPI testing using the formalin ethyl acetate concentration technique. Data on selected general characteristics and the results of the fecal tests were analysed. IPI test results were available for 18,900 of cohort subjects, and 38.50% were found to be positive for one or more types of intestinal parasite. The prevalence of Opisthorchis viverrini (O. viverrini) infection was the highest (45.7%), followed by intestinal flukes (31.9%), intestinal nematodes (17.7%), intestinal protozoa (3.02%), and intestinal cestodes (1.69%). The pattern of different infections was similar in all age groups. According to a mapping analysis, a higher CCA burden was correlated with a higher prevalence of O. viverrini and intestinal flukes and a greater intensity of O. viverrini. Both prevention and control programs against liver fluke and other intestinal parasites are needed and should be delivered simultaneously. We can anticipate that the design of future control and prevention programmes will accommodate a more community-orientated and participatory approach.

Intestinal parasite infections at an institution for the handicapped in Korea

  • Lee, Jong-Weon;Park, Gab-Man;Lee, Du-Ho;Park, Soon-Jung;Yong, Tai-Soon
    • Parasites, Hosts and Diseases
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    • 제38권3호
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    • pp.179-181
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    • 2000
  • Stool and cellotape anal swab examinations were carried out in August 1997 on handicapped people at an institution located in Chorwon-gun, Kangwon-do, Korea. A total of 112 stool samples (78 males and 34 females) revealed three cases of Trichuris trichiura infection and one case of Enterobius vermicularis infection. Other helminth eggs were not detected. The overall prevalence rate was 35.7% (38.5% for males and 29.4% for females). More than two different kinds of parasites were found in 42.0% of the positive stool samples (17 cases). The infection rates for protozoan cysts are as follow : Entamoeba coli (25.0%), E. histoIUtica (1.8%), Endolinax nana (21.4%), Iodoamoeba butschlii (1.8%) and Giardia lamblia (0.9%). In cellotape anal swab examinations (165 samples), the prevalence rate of E. vemicularis was 20.6% (25.7% of males and 9.6% of females). In conclusion, the handicapped people in the institution showed higher infection rates of protozoan parasites and E. vemicularis, possibly due to more accessibility to the infection.

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국내서식 야외 고양이의 기생충 감염 조사 (Intestinal parasite Infections in Stray Cats)

  • 강문일;한동운
    • 한국임상수의학회지
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    • 제20권3호
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    • pp.413-418
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    • 2003
  • This survey of endoparasite infections among stray cats in Korea has been carried out during November 1995 to October 1997. A total of 215 stray cats were collected from SeoulㆍGyeonggi (54), Gangwon (38), Chungchong (34), Jeonla (38), and Gyeoungsang (51) areas. The positive rate of endoparasites was 184 (85.6%) cats among 215. Of isolated parasites, nematodes were the most often detected parasites especially Toxocara cati (102 cats), Ancylostoma tubaeformae (9 cats). The next most often detected parasites were cestodes (60/215; 27.9%) sepecially Spirometra erinaecei (34 cats), Taenia taeniaformis (26 cats). Opisthorchis tenuicollis was found in bile duct (9 cats) and Isospora spp. were identified in 41 cats (19.1 %). In mixed parasite infection, the rate of infections of nematodes, trematodes and protozoas was 3.3%, nematodes and cestodes with 8.8%, nematodes and protozoa with 4.2%, cestodes and protozoa with 1.9%. In parasitic infection by a considering age category, age from 2 to 4 years had the highest infection (92.3%), 1-2 years were 87.6%, over 4 years was 80.0%. 79.6 percents of the stray cats in SeoulㆍKyounggi areas were ranked the 1st in parasite infection. The next was Kyoungsang 76.5%, Kangwon 65.8%, Cholla 63.2% and Chungchong 61.8% in order. Considering age categories from birth to greater than 4 years, parasite infections were most prevalent in cats 2 to 4 years old; other ages seemed to have no effect on prevalence of parasitism. Also sex seemed to have no effect on prevalence of parasitism. In endoparasite infection, nematode and cestode infections were most frequently found, trematode infections were low, coccidiosis was showed very often.