25I-NBOMe (2C-I-NBOMe, Cimbi-5, Smiles and also shortened to "25I") is a novel synthetic psychoactive substance with strong hallucinogenic properties, synthesized in 2003 for research purposes. But every drink. 5% Body fat. 17 designer drug standards did not produce a 1000- count base peak. Synthetic drugs, also known as designer drugs or club drugs, mimic or strengthen the effect of naturally occurring drugs. I agree. Designer drugs are designed to mimic explicitly prohibited. Page 1 of 174 1. Branded RCs. , mephedrone, methylone, and methylenedioxypyrovalerone, often referred to as “bath salts”); synthetic cannabinoids (SCs; e. You can do that right here, in fact. Recovery Forums - Recovery Journals - Find Rehab - Wiki - Addiction Research. al. Designer drugs or so called ‘legal highs’ is a rapidly expanding phenomenon. To unlock this. A chemical variation of another substance, such as a narcotic or amphetamine. A rapid ethnographic assessment was undertaken to understand the perceptions and experiences of people who inject drugs sold as ‘heroin’ and to observe the drugs and their use. One with a kayak and one on a bicycle. This is a report of one of those experiences. This is an increasingly powerful tool as synthesis of designer drugs is trending to a de novo approach rather than analogues of existing drugs to circumvent laws covering these chemically similar versions. Designer Drugs are chemical formulations that are deliberately synthesized to mimic the effects of illicit drugs while avoiding anti-drug laws. 400. They are sold economically as bulk. Reply New New Topic New Thread. Stefan Labbé Nov 15, 2023 8:00 PM. The proliferation of Internet drug forums over the past decade has led to a largely unseen dispersion of experimenting with new designer drugs and drug combinations (Davey, Schifano, Corazza, & Deluca, 2012; Deluca et al. The sample analysis data is collected and stored then re-interrogated at a later date when more information about the suspect drug is known. The rush and euphoria isn't quite as good as really high class coke, but it lasts longer and is less egotistical than coke. , Spice); and synthetic hallucinogens (25I-NBOMe, or N-bomb). These are drugs made to make people feel differently about themselves and the world around them. The most common effects noted by recreational users include. A safe environment for buying research chemicals because:Designer drugs encompass a drug group originally synthesized by altering the chemical structure of mescaline to circumvent the law when it only covered specific named drugs. Collected from both legal and underground literature, it covers a broad range of the most current novel. Subscribe to read the latest addiction-related news,. REPLY REPORTAmyl Nitrite (poppers). Drug Queen of the Web. Synthetic cannabinoids are psychoactive herbal and chemical products that mimic the effects of cannabis when used. As soon as a drug has been banned, another analogue. . 1007/s00204-020-02693-7. As of December 2014, 541 new psychoactive substances—the preferred term for synthetic designer drugs—had been reported. The designer drug connection I'm usually not too fond of gossip and speculation, but since I know designer steroids are a popular topic, I guess I might chime in. Legal troubles: Designer. My designer drug. Designer Drugs, I Hate Them Updated April 6, 2012. Approximately 10% of the U. Some people disagree though. Metabolism of the new designer drug mephedrone and toxicological detection of the beta keto designer drugs mephedrone, butylone and methylone in urine. It is time to leave behind harmful politics, ideology and prejudice. But Cyclacel and others participating in the Davos designer drug panel -- MDS Proteomics, Myriad Genetics and Nanogen, to name just a few -- say designer drugs will arrive -- in maybe 10 years. Chronological overviews of the appearance of benzodiazepine designer drugs on the recreational drug market were recently published (Manchester et al. Reply New New Topic New Thread. Excellencies, Distinguished colleagues, I am pleased to address you today at this Forum. Nicotine. download epaper. Erowid is a non-profit educational & harm-reduction resource with 60 thousand pages of online information about psychoactive drugs, plants, chemicals, and technologies including entheogens, psychedelics, new psychoactive substances, research chemicals, stimulants, depressants and pharmaceuticals. These designer drugs go by street names such as Spice, K2, bliss, Scooby Snax. Keeping up with the rapid emergence of new synthetic drugs is one of the toughest challenges for those on the front lines in combating drug misuse and addiction. Top Threads Of General InterestThe following table — Drugs and Crime Research Awards — shows awards made by NIJ for drugs and crime research projects. Get all the information you need on designer drugs, addiction and treatment. Background: The growing abuse of party and designer drugs increases the number of emergency cases related to drug consumption. 9% of people reporting past-month use of cocaine and 0. In another 25 year I could. Many synthetic designer drugs are sold semilegally online with a wide array of names and labels. All Free. This article discusses the opioid epidemic and several emerging opioids, including buprenorphine, loperamide, fentanyl, fentanyl derivatives, and others. 1. A designer drug is a structural or functional analogue of a controlled substance designed to mimic the pharmacological effects of the parent drug while avoiding detection or classification as illegal. Modafinil. An assortment of several designer drugs. Drug designing techniques employing computer based techniques is known as computer-aided drug design and those based on the information on the three dimensional structure of targets is known as structure–. designer drug - WordReference English dictionary, questions, discussion and forums. 0. In Europe and United States, commonly abused bath salts include 4-methylmethcathinone (mephedrone), 4-methethcathinone,. designer drug n. A series of screen grabs from the opiate-buying forum that Reddit shut down last week. UBC researchers have trained computers to predict the next designer drugs before they are even on the market, technology that could save lives. On particularly invincible nights. In illicit designer drug markets, bath salts are far removed from the ordinary salt crystals purchased for a relaxing spa. However, oral steroids clear more rapidly from the body, often making this. Individuals who are single and with lower income levels may be most. Paul MJ, Chisolm MS, Johnson MW, et al. 6. “Flakka,” a new designer drug luring some young Americans, is even more potent and more addictive than its synthetic predecessors, which long skirted the law, experts. Apr 14, 2013 #7. Increased libido. 9% of people reporting past-month use of methamphetamine in 2015. S. impaired brain development and impaired memory and learning. Flakka is a designer drug that can be snorted, smoked, injected or swallowed. (2012). We selected a popular drug forum that presents reports on self-experimentation with little or even completel. Then I kind of fell out of the EDM scene in 2016 or so, but now I've started listening to some old favorites again and went looking to see what they had released only to find the lead. She is 5'3" 90lbs <>13. Quick Links. Designer drugs are laboratory-made substances that were specifically developed to mimic the effects of cannabis, cocaine, and other illegal drugs. These psychoactive drugs can produce many adverse effects, including addiction, paranoia, accelerated. violates its own Constitution through its drug law policies - 1st Amendment of the U. The Best and Worst of This Year's Designer Drugs We talked to psychonauts and browsed through specialty forums to see which substances made waves in 2014. Although the combination of muscarinic-based DREADDs with clozapine-N-oxide (CNO) has been widely used, sluggish kinetics, metabolic liabilities and potential. 1-56. Snyder ArkAnsAs: stAte HeAltH Officer Acts tO BAn Designer Drug Investigation: Ban on Bath Salts, Designer Drugs is Working Dramatically . This database remains the most comprehensive collection of mass spectra of designer drugs, pharmaceuticals, chemical warfare agents, and related substances. Call Designer Drugs Pharmacy Frequently Asked Questions An NSAID free option. 4 million MS/MS spectra of 51K compounds, 186K precursor ions, obtained from ion trap, collision cell, and HCD (orbitrap) instruments. WARNING SYDNEY- one man dies, two hospitalised after overdosing on heroin- sold to them as cocaine (Weds 15/11/23) Sunday at 3:44 AM. Aethyta ( talk) 02:38, 23 November 2015 (UTC) Reply[ reply] CJC-1295, Sermorelin, and Tesamorelin should be removed from the list because they are (or at one time were) approved drugs and hence fall outside the definition of a designer drug. Collection of LC -QQQ MS/MS data by Dynamic MRM completed for DEA and Japan lists. Set and Setting: He is 6'5" 200lbs <>10% Body fat. Approximately 10% of the U. Menu; Drug Addiction; Drug Testing; Medical Marijuana; ForumsResearch chemicals, aka designer drugs, are new synthetic substances sold primarily online that exist in a legal gray area. Introduction. IE 11 is not supported. It is carefully compiled in cooperation with the Regional Departments of. This article reviews the clinical effects and treatment of persons who use cocaine. It’s possible that online forums and social media platforms, like Reddit, could be used as an early warning system of impending emergences of novel drugs, according to a new study published in the International Journal of Drug Policy. 10. 7K. It was first synthesized by Boehringer Ingelheim and patented in. An hallucinogen, such as lysergic and diethylamide or phencyclidine. doesnt show up on drug test. These drugs are illicitly produced with the intent. Drug trafficking in Spain is evolving rapidly. The use of SCHowever, like traditional drugs of abuse, synthetic drugs generally fall into one of five categories—stimulants, sedatives, cannabinoids, dissociatives, and psychedelics. Designer Drugs. Sold inexpensively in bulk powders. Widely available and one of the most recreational substances ive experienced. The most popular and available of those are 3-MEO PCP and PCE, 3-HO-PCP. Silk Road’s operator, Ross Ulbricht was later arrested . New tests for designer drugs could help save lives March 16 2023 Test tubes. Hip Forums. The replacement of a hydrogen. Introduction The last decade has seen increasing growth in novel psychoactive substances that are sometimes termed “designer drugs” (Carroll, Lewin, Mascarella, Seltzman, &. Such toxicity may occur in both adolescents. 18. Anyone, including children, can buy these products over the Internet. SDP is a global advocacy campaign calling for drug policies based on health and human rights. Discussion by deadheart1 Posted 07/11/15 9:43 PM. metropolitan area that is as dangerous and deadly as fentanyl. List of designer drugs An assortment of several designer drugs. Through an Online Drug Forum Moritz Berning1 and Anita Hardon1 Abstract This study examines how experimentation with designer drugs is mediated by the Internet. Which of these is a designer drug? GHB cocaine morphine marijuana. For practical reasons, most scientists need to buy their pharmacology supplies online, as they cannot buy them locally. Contrary to the popular belief that ‘designer drugs’ are original creations, the majority of these agents are ‘borrowed’ from legitimate. This study examines how experimentation with designer drugs is mediated by the Internet. Percocet, molly, and Xanax. Wiley LC-HR-MS/MS Library of Drugs, Poisons and Their Metabolites. Analogs designed by underground chemists are known as ___. 🌀 Mimics the effects of established psychoactive drugs. Springer Netherlands. b. These drugs are also called synthetic drugs, because of their chemical creation. This is a subset of the full NIST 23 MS library, containing only the MS/MS data and search software. The drug demonstrated a high degree of protein binding and low hepatic clearance, suggesting its potential for a prolonged elimination half-life in vivo [73,74,75]. drug trade, especially in the designer drug field, has moved faster than testing can evolve. You, you are. Powerful New Gray Market Opioid Makes Oxycontin And Heroin Look Like Child's Play. In general, designer drugs are synthetic analogues or derivatives of potentially abusable psychotropic substances. Planning Tools. Typically, these drugs originate from plants, but their chemistry is altered. Resources I find an interesting read and helpful to learn about NPS, drugs in general, chemistry, substance testing, safer use, harm reduction, addiction patterns, effects that. , cocaine, morphine, nicotine). These substances, also known as “legal highs,” are designed to mimic the effects of illegal drugs while circumventing legal restrictions. Hola, Designer drug, is a term to used to describe psychoactive drugs which are created (or marketed, if they had already existed) to get around existing drug laws by modifying their molecular structures to varying degrees. Other times, the drug is used purely for getting high. These 8 designers and models have felt the pangs of addiction in the height of beauty and fame. Cache of fentanyl and other drugs seized by the Vancouver Police Department. Abstract. These complications can be life threatening if misdiagnosed or mismanaged. Research chemicals (also called RCs, experimental chemicals, legal highs or designer drugs) refers to psychoactive substances which have unstudied effects and little to no history of medicinal use. Designer drugs are frequentlyEcstasy: “The Love Pill”. We selected a popular drug forum that presents reports on self-experimentation with little or even completely unexplored designer drugs to examine: (1) how participants report. This page contains online drug education resources – lesson plans, activities, videos – from different websites targeted to various grade levels that both parents and teachers can use. 4 . Other Running Related Topic. Discuss the various man-made (designer) drugs available. “Synthetic” or “designer” drugs known as novel psychoactive substances (NPS), an offshoot of drugs created to mimic the effects of controlled substances, account for an increasing proportion of adverse events such as hospitalizations and death. If you are into holing, 2-FDCK (for a shorter experience), O-PCE, DMXE, MXiPr, and MXPr are discussed a lot. : bluelight. commonly used designer drugs; in some countries, it is listed among the 20 most popular drugs overall (Global Drug Survey, 2014). 100. These drugs are extraordinarily cheap to synthesize. Very stimulating, euphoric, and best of all long lasting. Details regarding onset and duration of action have been limited to information gleaned from online drug use forums, where users have reported a delayed onset of up to 6 hours after ingestion and a duration lasting up to 3 days. Overall, the mechanism of action and adverse effects of designer drugs are. Acute and long-term treatment is also a challenge and must rely heavily on counseling while encouraging young, impulsive patients to change their behavior. Designer drugs are those “that are produced clandestinely and contain modified molecular structures of illegal or controlled substances” (Loeffler et al. Methods Data This “Designer Drugs 2. . Designer Drug Trends Provided by. In comparison to other members of the '2C' series, Nagai et. Flubromazolam: A Designer Benzodiazepine is Studied. Dilated pupils. Nearly identical. New designer drugs (synthetic cannabinoids and synthetic cathinones) are new "legal highs" that are sold online for recreational public or private use. Stimulants. How to use designer drug in a sentence. Popular Top Threads. Ecstasy , also commonly known by its slang name "molly," is a synthetic drug known primarily for its hallucinogenic and stimulant effects. Menu; Drug Addiction; Drug Testing; Medical Marijuana; Forums Research chemicals, aka designer drugs, are new synthetic substances sold primarily online that exist in a legal gray area. Benzylpiperazine (BZP) is a recreational drug with euphoriant and stimulant properties. First coined in the 1980’s, the term “designer drug” was used to refer to any drug whose chemical makeup was slightly altered. ” Cannabis is a drug smorgasbord! Case in point: CBG. Different underground labs may produce different chemical compounds in the same drug, but both parties may. who investigates drug forums to stay up-to-date on the market. I got more sand than the coast. Last Post by deadheart1 on 07/12/15 9:54 AM . Synthetic cannabinoids, Kush, K2, Spice. Max simply shopped online for designer benzodiazepines. We pride ourselves on setting standards for customer service within the industry. 🧪 Limited research or understanding of the nature of the drug. Some of These Designer Drugs Include the Following: MDMA ( Ecstasy) Ketamine. Learn MoreAugust 11, 2013 9:00 PM — 43 mins. Deadly new designer drug hits the streets. Drug Enforcement Agency, prosecution of manufacturers, distributors, or users is. 1-4 Most are manufactured illicitly outside the United States in countries with high production. 1. Epidemiology. 2020 Apr;94 (4):1085-1133. Okay, that's a lot of drugs. The U. Pressing the Close Modal button at the bottom of the modal will close the modal and bring you back to where you were on the page. When I was younger, people bought drugs from friends. (2016) Assessing the validity of online drug forums as a source for estimating demographic and temporal trends in drug. I know I've been here before. 120. Bluelight. You can make DMT from tryptamine in a single step reaction. . That rundown provides Baumann, head of the Designer Drug Research Unit at the National Institute on Drug Abuse (NIDA), with a guide to the ever-changing world of designer drugs. Designer drug implied value is scheme against law enforcement, which in turn assumes legitimacy of the laws regarding substances. org joins with many organisations around the world on June 26 for Support Don't Punish day. Air Date: Feb 4, 2012. Synthetic cathinones are central nervous stimulants and are designed to mimic effects similar to those produced. 80. Monoaminergic stimulants,. Dosages, formulations, and drug mixtures. 5 million marijuana plants, almost 38 tons of cocaine and nearly 350 tons of hashish along with 20,437 arrests*, drug traffickers are becoming masters at adapting to new circumstances, including those of the. The short and long-term side effects of designer drugs should not be overlooked — even if drug use is rare. It may trigger paranoia. Designer drugs are synthetic compounds developed to mimic the physiologic effects of other abused drugs. 2010 was the year that a designer drug called “bath salts” began flooding the market. Delusions. Self-reports on a Swedish online forum and case reports support the long-lasting effects of flubromazolam [76,77,78]. MDPV, 3,4-methylenedioxypyrovalerone, is an alkaloid in the pyrrolidine and ketone chemical classes. Emergency departments regularly treat a diverse array of drug intoxications, and providers must be cognizant of novel drugs of. synergistic effects when combined with alcohol or drugs. We selected a popular drug forum that presents reports on self-experimentation with little or even completely unexplored designer drugs to examine: (1) how participants report their “trying out” of new compounds and (2) how participants. Hundreds of new 'legal high' designer drugs flooding into Europe, warns report. Olympic gymnasts, for instance, may use performance-enhancing drugs that their organizations have banned. Jan 24, 2021. In the late 1990s and early 2000s there was a huge explosion in designer drugs being sold over the. , 2012, p. Even their. Global Drug Policy and Practice. Mephedrone is a psychoactive, recreational drug that has no medicinal use. Because designer drugs are generally not listed as controlled substances by the U. Sitting in his office in Baltimore, neurochemist Michael H. The term originated with law enforcement, but has gained widespread use. People are wearing lab coats and the equipment looked very nice. , the largest group of synthetic cannabinoid users is comprised of men aged 13-59 years old who have a history of marijuana and other drug use. Some of the most popular designer drugs are hallucinogens such as NBOMes, stimulants such as bath salts (named for their resemblance to Epsom salts) and spice — synthetic cannabinoids that. I feel like I land on the planet. This is an unverifiable drug-scare story dating to the 1960s of a hippie babysitter girl putting a baby in the oven and a turkey in the bassinet. -is partially eliminated through the lunges and urine. pdf Designer drugs:. 35 Pa. S. It is used to treat high blood pressure, angina, and certain types of heart attack. I'm on. [1] Recent designer drugs, also known as “legal highs,” include substituted cathinones (e. , 2003, 2006). observed that 2C-E is a more potent inhibitor of serotonin reuptake than 2C-I, but less potent than. easily attainable (internet) no one knows whats in them. Underground opioid markets are therefore more likely than legal markets to supply hyperpotent products, such as heroin or fentanyl, and synthetic “designer drugs” of uncertain potency and. As Vox’s German Lopez previously explained, fentanyl has been around. These products mimic the euphoric effects of other well-known illicit drugs but are advertised as “legal” highs and are sold over the internet, at raves and night clubs, and in head shops. 2. 4 In the United States, the Drug Enforcement Administration (DEA) is the agency tasked with regulating the use of controlled. show more . Print Book & E-Book. researchers find 31 new 'designer drugs' in illicit market. Violent behavior. Piperazines, Phenethylamines, Tryptamines & other designer drugs. Meth is very easy. e. The DEA Washington Division is warning area residents of a new drug, emerging in the D. Metabolism of the new designer drug mephedrone and toxicological detection of the beta keto designer drugs mephedrone, butylone and methylone in urine. Discussions: 485 Messages: 3,430 Latest: Experience Report "escape" product. It's known to impart feelings of increased energy, pleasure, emotional warmth, and distorted sensory and time perception. Propylhexedrine (Benzedrex) 8. This is a report of one of those experiences. To make matters worse, designer drugs are often not detected by the drug tests commonly utilized in criminal justice and forensic settings. C. In contrast, ecstasy is synthesized in clandestine laboratories--in fact, there are several "designer drugs" that are made (in clandestine laboratories) by altering the structure of theNews: Please request registration email again and then check your "Spam" folderA library of 2. The chemical name for ecstasy is 3,4. 4 In the United States, the Drug Enforcement Administration. What are the latest significant trends in designer drug use? While patterns of drug abuse vary by region and with time, a review of reliable resources indicates the following trends. Although the term is not precisely defined, it is understood to refer to commonly abused drugs such as fentanyl, ketamine, LSD, PCP, quaaludes, methcathinone, and GHB (gammahydroxy butyrate), as well as to amphetamine. Deceptively labeledas “research chemicals”, “bath salts”, “plant food”, “incense”, designated as “not for human consumption” Madras, B. Wiley announced the release of Mass Spectra of Designer Drugs 2023. This study examines how experimentation with designer drugs is mediated by the Internet. Your research chemicals shipped discreetly and the safest way possible! 2. Tenormin is a prescription drug that contains the active ingredient atenolol. #2. 4,793. The most common theme for all 4 drugs was sharing experience or opinion comprising over 90% of mentions for each drug, while discussion related to polysubstance use was present in >1/4 of mentions. Earlier this year, a 19-year-old Minnesota teen died and 10 others were injured after taking large doses of 2C-E -- a drug with far more potent and dangerous. I feel that it's superior. , Spice); and synthetic hallucinogens (25I-NBOMe, or N-bomb). The journal Addiction Science & Clinical Practice reported that young adults, and primarily males in their mid to late 20s, most commonly use designer drugs. This is a side rant, but I hate when people don't refer to LSD as a research chemical. 855 mass spectra of. [ reply] Some designer drugs are research chemicals but of course not all research chemicals are designer drugs. . " Drugs and dance music have had an unfortunate association since the rave. Delirium. This includes traditional, spiritual, and responsible. Theacrine. Report Thread. [Chorus: Quavo] I put a mil' in the attic. population 12 years and older reported using illicit substances in 2015. 9. What do you guys think some of the next generations street drugs will be as far as desginer drugs go, faster cheaper easier better stonger. Designer drugs and administration of antidepressants are also increasing risky sexual behavior leading to increased incidence of sexually transmitted diseases in this population [ 5 ]. doi: 10. NPS are purchased as alternatives to traditional illicit drugs of abuse and are manufactured to circumvent laws regulating the sale and use of controlled substances. Unlike plant-based drugs, designer drugs are created in underground. It has subsequently been used for a variety of other drugs including 2C-B, AMT, and BZP. I used to trap out of Regal. But in the new millennium, the city, especially the gay community, is struggling to recover from a. There are plenty of always up-to-date sites warning against unusually toxic substances detected, there are (to many sketch ) forums, self-proclaimed (sometimes questionable) harm reduction sites, and – and this is news: A few governments provide surprisingly well-done, means modern and interesting to read & watch sites with reliable information. Find out what's true and what's false on these dangerously lethal drugs. I fell in love with the drugs, I think I'm a addict. I fell in love with the drugs, I think I'm a addict. 40. S. Rc Vendors you can trust. 1k 5. Hallucinations. The project developed methods that enable the identification of ring-substituted aminoketone compounds, which are cathinone derivatives. Educated Guesses and Other Ways to Address the Pharmacological Uncertainty of Designer Drugs: An Exploratory Study of Experimentation Through an Online Drug Forum - Moritz Berning, Anita Hardon, 2016 Downloads. Three internationally oriented discussion forums with open access were found by Deluca et al. Illegal Drugs Forums - Ask an expert about illegal drugs. , 2016). [ATTACH] Experts at the Recreational Drugs European Network has identified a wide range of new. The show hidden camera inside a mephedrone lab in china that looks surprisingly clean and official looking. Sales of bath salts and spice over the Internet have skyrocketed in recent years. Spice is a popular term coined for the packaged retail products containing herbs and other plant materials laced with synthetic cannabinoids. Both ongoing and completed projects are included. Dissociative designer drugs primarily act as N-methyl-D-aspartate receptor antagonists and pose similar health risks as the medically approved dissociative anesthetic ketamine. streets by the late 2010s—a 90 percent drop from a decade earlier in many areas. In some cases, these are drugs that can cause huge problems in terms of abuse. This is especially true for synthetic cannabinoids, sometimes known as Spice or K2. Like it was made in a fucking lab like all these other ones. Each drug has specific effects on brain chemistry, though. Recent designer drugs, also known as “legal highs,” include substituted cathinones (e. 0” issue of Clinical Pharmacology & Therapeutics focuses on Novel Psychoactive Substances (NPS) that simultaneously offer new pharmacotherapies with novel mechanisms of action and pose a serious public health and safety issue. Recent designer drugs, also known as “legal highs,” include substituted cathinones (e. 99 (60 pence) on the science and technology site MATTER. ⚙️ Structural modifications performed to avoid prohibition. With labs popping up everywhere, the price of a pound of meth fell to nearly $1,000 for the first time on U. Piperazines, Phenethylamines, Tryptamines & other designer drugs. JAMA. It has no odor and no color, and is sometimes used as a date rape drug. Since they are new, routine tests for their presence. Clearnet buyers are going to ruin mail order drugs. List of all social groups at Drugs-Forum. Cocaine is known by many different nicknames, including: 7. Tronica. B. Genre: Documentary. Neuropsychopharmacol 1990; 3: 509-17. Synthetic stimulants often referred to as “bath salts” are from the synthetic cathinone class of drugs. Designer Drug Management and Treatment.