all create the same clinical picture. Signs, Symptoms, and Diagnosis of Hyperthyroidism in Cats. The knee is one of the most common body parts to be injured. Patellar subluxation is the most common knee problem in children and adolescents. Cells are the building blocks of all living things and specialized cells form our body's organs and tissues. This is most often the result of an injury to the knee. Genes, like chromosomes, usually come in pairs. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. A benign variant does not cause health problems or disease because the change does not affect how the gene works. The most common ages for symptoms of a disease to begin is called age of onset. Recessive means that both copies of the responsible gene must have a disease-causing change (pathogenic variant) in order for a person to have the disease. A genetic variant is a change in a gene's code or DNA sequence that causes the gene to be different than found in most people. Hypermobility generally results from one or more of the following: Abnormally shaped ends of one or more bones at a joint; A defect of Type 1 collagen (as found in EhlersDanlos syndrome) or other connective tissue (as found in LoeysDietz syndrome and Marfan syndrome) resulting in weakened ligaments/ligamentous laxity, muscles and tendons.This same defect also results in Hip Dislocation in Dogs and Cats. Shar-Pei Recurrent Fever Syndrome. Histopathology in Pets. Histopathology in Pets. Downs SM, van Dyck PC, Rinaldo P, et al. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. A pathogenic variant may also be called a mutation or a disease-causing variant. Shar-Pei Recurrent Fever Syndrome. Prepatellar bursitis causes (aetiology) [] Prepatellar bursitis may occur due to: Acute trauma: fall/direct blow on to the knee. Currently GARD is able to provide the following information for this disease: Kyphoscoliotic Ehlers-Danlos syndrome is a genetic disease, which means that it is caused by one or more genes not working correctly. *Data may be currently unavailable to GARD at this time. Autosomal means the gene is located on any chromosome except the X or Y chromosomes (sex chromosomes). If first-time traumatic patellar dislocation is suspected, or a recurrent dislocation is associated with moderate or severe swelling. This disease is inherited in the following pattern(s): We're working hard to make improvements to our site by Spring 2023. The common ages for symptoms to begin in this disease are shown above by the colored icon(s). For other diseases, symptoms may begin any time during a person's life. The elbow is the region between the arm and the forearm that surrounds the elbow joint. Genes, like chromosomes, usually come in pairs. We would like to hear your feedback as we continue to refine this new version of the GARD website. Dominant means that only one copy of the responsible gene (causal gene) must have a disease-causing change (pathogenic variant) in order for a person to have the disease. All individuals inherit two copies of most genes. There are two types of patellar instability. These symptoms may be different from person to person. Tethered cord syndrome (TCS) refers to a group of neurological disorders that relate to malformations of the spinal cord. The elbow includes prominent landmarks such as the olecranon, the cubital fossa (also called the chelidon, or the elbow pit), and the lateral and the medial epicondyles of the humerus.The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus all create the same clinical picture. For some diseases, symptoms may begin in a single age range or several age ranges. Downs SM, van Dyck PC, Rinaldo P, et al. Dominant means that when there are two copies of the responsible gene, only one copy must have a disease-causing change (pathogenic variant) in order for a person to have the disease. DNA is found in the nucleus of a cell and, in humans, is packaged into 23 pairs of chromosomes with the help of special proteins. Genes are part of our DNA, the basic genetic material found in each of our body's cells. *Data may be currently unavailable to GARD at this time. For some diseases, symptoms may begin in a single age range or several age ranges. A benign variant does not cause health problems or disease because the change does not affect how the gene works. This disease is inherited in the following pattern(s): We're working hard to make improvements to our site by Spring 2023. Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and National Center for Advancing Translational Sciences, PVNH; Periventricular nodular heterotopia. Spondylolisthesis is the displacement of one spinal vertebra compared to another. People with this condition are also more likely to develop certain autoimmune disorders and personality disorders. Various forms include tight filum terminale, lipomeningomyelocele, split cord malformations (diastematomyelia), occult, dermal sinus tracts, and dermoids.All forms involve the pulling of the spinal cord at the base of the spinal canal, Recessive means that both copies of the responsible gene must have a disease-causing change (pathogenic variant) in order for a person to have the disease. Coping with an itchy pet can be an extremely frustrating experience for you, the pet owner, and can truly test the limits of the human-animal bond. The kneecap is entirely out of place. Hip Dislocation in Dogs and Cats. Some people may have more symptoms than others and symptoms can range from mild to severe. The blood and blood-forming tissue includes plasma, red blood cells, white blood cells, platelets, and bone marrow. For other diseases, symptoms may begin any time during a person's life. Q f ] ] ] ] ] ?' For some diseases, symptoms may begin in a single age range or several age ranges. Patients typically present with obvious deformity and an inability to extend the knee. Here we will look at an overview of the causes, symptoms, treatment and recovery of each of these. Genetic diseases may be caused by genetic changes in a single gene, in multiple genes, by a combination of genetic changes and environmental factors (multifactorial inheritance), or changes in chromosomes. Mutation is an older term that is still sometimes used to mean pathogenic variant. The elbow includes prominent landmarks such as the olecranon, the cubital fossa (also called the chelidon, or the elbow pit), and the lateral and the medial epicondyles of the humerus.The elbow joint is a hinge joint between the arm and the forearm; more specifically between the humerus The most common ages for symptoms of a disease to begin is called age of onset. While some medical dictionaries define spondylolisthesis specifically as the forward or anterior displacement of a vertebra over the vertebra inferior to it (or the sacrum), it is often defined in medical textbooks as displacement in any direction. If someone keeps dislocating their kneecap, they may be offered surgery to try and make it more stable. Just about any inflammatory condition in the feline lower urinary tract creates the same collection of signs. A pathogenic variant does cause health problems or disease because the change does affect how the gene works. Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and Tumor, infection, bladder stone etc. Patella luxation, or knee dislocation, can range in severity from a patella that can be dislocated only in extreme extension and then snaps readily into place, to a patella that is permanently luxated medially (towards the center of the dog's body). Autosomal means the gene is located on any chromosome except the X or Y chromosomes (sex chromosomes). Symptoms . The first is known as a traumatic patellar dislocation. Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and An owner typically notices a little skip in the dog's step. The number of copies of a gene that need to have a disease-causing variant affects the way a disease is inherited. Signs, Symptoms, and Diagnosis of Hyperthyroidism in Cats. It is inherited in an autosomal dominant manner. Histopathology in Pets. Kyphoscoliotic Ehlers-Danlos syndrome is an inherited connective tissue disorder that is caused by defects in a protein called collagen. Patellar dislocation is particularly common in teenagers, especially girls. A pathogenic variant does cause health problems or disease because the change does affect how the gene works. Histopathology in Pets. Reference: Data from the Newborn Screening Codingand Terminology Guide is available here. (MedlinePlus), What is a genetic variant and how do variants occur? Other cases are caused by genetic changes in the ARFGEF2 gene and are inherited in an autosomal recessive manner. What are proteins and what do they do? Histopathology in Pets. Signs, Symptoms, and Diagnosis of Hyperthyroidism in Cats. Patella luxation, or knee dislocation, can range in severity from a patella that can be dislocated only in extreme extension and then snaps readily into place, to a patella that is permanently luxated medially (towards the center of the dog's body). For other diseases, symptoms may begin any time during a person's life. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. The number of copies of a gene that need to have a disease-causing variant affects the way a disease is inherited. Submit Manuscript. Hip Dislocation in Dogs and Cats. Menu. Shar-Pei Recurrent Fever Syndrome. This disease is inherited in the following pattern(s): We're working hard to make improvements to our site by Spring 2023. Journal of Manipulative & Physiological Therapeutics now recommends you submit all manuscripts electronically. Diseases of the blood may be diagnosed and treated by a hematologist. Currently GARD is able to provide the following information for this disease: An abnormal susceptibility to bleeding, often referred to as a bleeding diathesis. A bleeding diathesis may be related to vascular, platelet and coagulation defects. A rotator cuff tear is an injury where one or more of the tendons or muscles of the rotator cuff of the shoulder get torn. Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and Tumor, infection, bladder stone etc. You may also use this system to track your manuscript through the review process. Autosomal means the gene is located on any chromosome except the X or Y chromosomes (sex chromosomes). The ligaments may tear or stretch. especially in patients who have significant pain or recurrent dislocation. kyphoscoliosis EDS is caused by changes in the PLOD1 gene or the FKBP14 gene and it is inherited in an autosomal recessive manner. In the U.S., this disease is estimated to be fewer than. Trained to diagnose and treat injuries and diseases of the musculoskeletal system, these specialists can steer you on the right track to recovery -- whether your injury involves your bones and joints or your muscles, ligaments and tendons. Symptoms include pain and obvious distortion of the wrist. Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and (MedlinePlus), Mutation definition, illustration, and related terms (NHGRI), UMLSVocabulary Standards and Mappings Downloads, Access aggregated data from Orphanet at Orphadata, National Center for Biotechnology Information's, Newborn Screening Coding and Terminology Guide, Improving newborn screening laboratory test ordering and result reporting using health information exchange, Health Literacy Online: A Guide for Simplifying the User Experience, U.S. Department of Health & Human Services, National Center for Advancing Translation Sciences. Many rare diseases have limited information. Histopathology in Pets. Common symptoms of problems with the blood or blood forming tissue include fatigue, weakness, shortness of breath, fever, abnormal bleeding, headache, or bruising easily. This list does not include every symptom. Cells are the building blocks of all living things and specialized cells form our body's organs and tissues. (MedlinePlus), Mutation definition, illustration, and related terms (NHGRI), UMLSVocabulary Standards and Mappings Downloads, Access aggregated data from Orphanet at Orphadata, National Center for Biotechnology Information's, Newborn Screening Coding and Terminology Guide, Improving newborn screening laboratory test ordering and result reporting using health information exchange, Health Literacy Online: A Guide for Simplifying the User Experience, U.S. Department of Health & Human Services, National Center for Advancing Translation Sciences. 22q11.2 deletion syndrome is a disorder that involves many different areas of the body and can vary greatly in severity among people with the condition. making recurrent dislocation more likely. The dog may even run on three legs, holding one hind leg up, and then miraculously be This list does not include every symptom. Hip Dislocation in Dogs and Cats. Downs SM, van Dyck PC, Rinaldo P, et al. For some diseases, symptoms may begin in a single age range or several age ranges. Periventricular heterotopia is a genetic disease, which means that it is caused by one or more genes not working correctly. DNA is found in the nucleus of a cell and, in humans, is packaged into 23 pairs of chromosomes with the help of special proteins. In the U.S., this disease is estimated to be fewer than. The common causes fall into two groups: external parasites and allergies. Ligamentous laxity, or ligament laxity, is a cause of chronic body pain characterized by loose ligaments.When this condition affects joints in the entire body, it is called generalized joint hypermobility, which occurs in about ten percent of the population, and may be genetic.Loose ligaments can appear in a variety of ways and levels of severity. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. making recurrent dislocation more likely. We would like to hear your feedback as we continue to refine this new version of the GARD website. DNA is found in the nucleus of a cell and, in humans, is packaged into 23 pairs of chromosomes with the help of special proteins. Disease causing variants in the following gene(s) are known to cause this disease: PLOD1. A genetic disease is a disease caused by a change in part of a person's DNA. The cardiovascular system is made up of the heart and blood vessels, including the arteries, veins, and capillaries. Cells are the building blocks of all living things and specialized cells form our body's organs and tissues. It can happen during sport but also when getting up from a chair or the floor. Diseases of the cardiovascular system may be diagnosed and treated by a cardiologist. Episode 181: Athletes Undergoing Concomitant Hip Arthroscopy and Periacetabular Osteotomy Demonstrate Greater Than 80% Return-to-Sport Rate at 2-Year Minimum Follow-Up Sleeping and Resting Respiratory Rates in Managing Heart Failure in Dogs and National Center for Advancing Translational Sciences, Cutis hyperelastica; EDS 6 (formerly); EDS VIA; EDS, kyphoscoliotic type; EDS, oculoscoliotic type; Ehlers-Danlos syndrome type 6 (formerly); Ehlers-Danlos syndrome type 6A; Ehlers-Danlos syndrome type 6A (formerly); Ehlers-Danlos syndrome, kyphoscoliosis type; Ehlers-Danlos syndrome, kyphoscoliotic type; Ehlers-Danlos syndrome, oculoscoliotic type; Ehlers-danlos syndrome oculoscoliotic type; Kyphoscoliotic EDS; Kyphoscoliotic EDS due to lysyl hydroxylase 1 deficiency; Kyphoscoliotic Ehlers-Danlos syndrome due to lysyl hydroxylase 1 deficiency; Lysyl hydroxylase-deficient EDS; Nevo syndrome; Ocular-scoliotic EDS; kEDS; kEDS-PLOD1. In a patellar dislocation, the patella gets pushed completely out of the groove. For other diseases, symptoms may begin any time during a person's life. The time depends on the necessary treatment and any factors that suggest that the injury may reoccur. A genetic disease is a disease caused by a change in part of a person's DNA. Some cases are caused by changes in the FLNA gene and are inherited in an X-linked dominant manner. Spondylolisthesis is graded based upon the degree of The common ages for symptoms to begin in this disease are shown above by the colored icon(s). Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. A genetic variant is a change in a gene's code or DNA sequence that causes the gene to be different than found in most people. The most common ages for symptoms of a disease to begin is called age of onset. f f f f f z z z 8 | . Patellar instability is a spectrum of conditions ranging from intermittent subluxations to dislocation. All individuals inherit two copies of most genes. Signs, Symptoms, and Diagnosis of Hyperthyroidism in Cats. Less common features include microcephaly, developmental delay, recurrent infections, and blood vessel abnormalities. Hip Dislocation in Dogs and Cats. For some diseases, symptoms may begin in a single age range or several age ranges. November 7, 2022. Genes, like chromosomes, usually come in pairs. If someone keeps dislocating their kneecap, they may be offered surgery to try and make it more stable. Just about any inflammatory condition in the feline lower urinary tract creates the same collection of signs. Intelligence is usually normal, but some people may have mild intellectual disability, including difficulty with reading or spelling. Shar-Pei Recurrent Fever Syndrome. Mutation is an older term that is still sometimes used to mean pathogenic variant. The elbow is the region between the arm and the forearm that surrounds the elbow joint. Depending on the severity of the patellar subluxation, the improper tracking may not cause the individual any symptoms, or it could lead to dislocation of the patella (where the kneecap fully comes out of the groove). Recurrent dislocation of at scapulohumeral joint. A genetic variant is a change in a gene's code or DNA sequence that causes the gene to be different than found in most people. Genes, like chromosomes, usually come in pairs. These symptoms may be different from person to person. Seizures may be caused by situations within the brain (such as trauma or infection) or by situations centered outside the brain (such as low blood sugar, circulating metabolic toxins, or external poisons). Some people may have more symptoms than others and symptoms can range from mild to severe. Rarely, Periventricular heterotopia is associated with a duplication of genetic material on chromosome 5. atlantoaxial or cervical subluxation or dislocation; or neurologic symptoms due to nerve root stretching. (MedlinePlus), Mutation definition, illustration, and related terms (NHGRI), UMLSVocabulary Standards and Mappings Downloads, Access aggregated data from Orphanet at Orphadata, National Center for Biotechnology Information's, Newborn Screening Coding and Terminology Guide, Improving newborn screening laboratory test ordering and result reporting using health information exchange, Health Literacy Online: A Guide for Simplifying the User Experience, U.S. Department of Health & Human Services, National Center for Advancing Translation Sciences. What are proteins and what do they do? We would like to hear your feedback as we continue to refine this new version of the GARD website. Shar-Pei Recurrent Fever Syndrome. Many rare diseases have limited information. Clicking may also occur with movement of the arm. Hip Dislocation in Dogs and Cats. Symptoms, Signs and Ill-defined Conditions XVII 800999: Injury and Poisoning E800E999: Dislocation (830839) 830 Dislocation of jaw; 831 Dislocation of shoulder; 958.2 Secondary and recurrent hemorrhage as an early complication of trauma; The most common ages for symptoms of a disease to begin is called age of onset. Seizures may be caused by situations within the brain (such as trauma or infection) or by situations centered outside the brain (such as low blood sugar, circulating metabolic toxins, or external poisons). People with this condition typically develop recurrent seizures (epilepsy) beginning in mid-adolescence. Genetic diseases may be caused by genetic changes in a single gene, in multiple genes, by a combination of genetic changes and environmental factors (multifactorial inheritance), or changes in chromosomes. Discuss with a specialist as there may be an appropriate alternative available locally (see below). Signs, Symptoms, and Diagnosis of Hyperthyroidism in Cats. This section is currently in development. Dominant means that only one copy of the responsible gene (causal gene) must have a disease-causing change (pathogenic variant) in order for a person to have the disease. (MedlinePlus), What is a genetic variant and how do variants occur? Shar-Pei Recurrent Fever Syndrome. National Center for Advancing Translational Sciences, Autosomal dominant Opitz G/BBB syndrome; CATCH22; Cayler cardiofacial syndrome; Chromosome 22q11.2 deletion syndrome; Conotruncal anomaly face syndrome; DiGeorge syndrome; Sedlackova syndrome; Shprintzen syndrome; VCFS; Velocardiofacial syndrome, Abnormality of Cardiovascular System Morphology. X-linked means the gene is located on the X chromosome, one of two sex chromosomes. You may have: Complete dislocation: The ligaments that hold the kneecap in place slide to the outside of the knee, taking the kneecap with them. Any involuntary behavior that occurs abnormally may represent a seizure. Types of common knee injuries include sprains, strains, bursitis, dislocations, fractures, meniscus tears, osteochondritis dissecans, Osgood-Schlatter disease, and overuse injuries. Currently GARD is able to provide the following information for this disease: 22q11.2 deletion syndrome is a genetic disease, which means that it is caused by one or more genes not working correctly. What are proteins and what do they do? For other diseases, symptoms may begin any time during a person's life. This list does not include every symptom. Research suggests that a first-time dislocation of the kneecap can take at least 6 weeks to heal. Common signs and symptoms include hyperextensible skin that is fragile and bruises easily; joint hypermobility; severe hypotonia at birth; progressive kyphoscoliosis (kyphosis and scoliosis); and fragility of the sclera. Mutation is an older term that is still sometimes used to mean pathogenic variant. [1] Generalized patellar instability is thought to represent up to 3% of clinical presentations involving the knee. Make sure you get prompt medical attention if you have the following symptoms: Learn more about the symptoms and treatment, as well as which joints are commonly involved. Disease causing variants in the following gene(s) are known to cause this disease: TBX1. There is growing evidence that eccentric strength exercises for the calf can improve symptoms of Achilles tendinosis, may reduce degenerative changes, and should be initiated early in treatment. The most common ages for symptoms of a disease to begin is called age of onset. Signs and symptoms may include: cleft palate, heart defects, recurrent infections, unique facial characteristics, feeding problems, kidney abnormalities, hypoparathyroidism, thrombocytopenia, scoliosis, hearing loss, developmental delay, and learning disabilities. If there is severe soft tissue injury with gross instability. ; Knee injuries are generally caused by twisting or bending force applied to the knee, or a direct blow, such as Symptoms may include shoulder pain, which is often worse with movement, limited range of motion, or weakness. A pathogenic variant may also be called a mutation or a disease-causing variant. Shar-Pei Recurrent Fever Syndrome. Periventricular heterotopia is a condition in which the nerve cells (neurons) do not migrate properly during early development of the fetal brain. Common signs and symptoms include hyperextensible skin that is fragile and bruises easily; joint hypermobility; severe hypotonia at birth; progressive kyphoscoliosis (kyphosis and scoliosis); and fragility of the Autosomal means the gene is located on any chromosome except the X or Y chromosomes (sex chromosomes). The medial luxating patella, commonly called trick knee, is an extremely common problem in toy breed dogs. f f ' 9&. Genes are part of our DNA, the basic genetic material found in each of our body's cells. Many rare diseases have limited information. Genes, like chromosomes, usually come in pairs. The most common ages for symptoms of a disease to begin is called age of onset. A genetic disease is a disease caused by a change in part of a person's DNA. A pathogenic variant does cause health problems or disease because the change does affect how the gene works. A pathogenic variant may also be called a mutation or a disease-causing variant. Patellar instability can lead to a dislocated kneecap. The common ages for symptoms to begin in this disease are shown above by the colored icon(s). Disease causing variants in the following gene(s) are known to cause this disease: ARFGEF2, FLNA, ERMARD, NEDD4L, TMTC3, ARF1, MAP1B. Kyphoscoliotic Ehlers-Danlos syndrome is an inherited connective tissue disorder that is caused by defects in a protein called collagen. Patellar instability occurs when the kneecap moves outside of this groove. The recurrence rate following a first-time dislocation is around 15-60%. A benign variant does not cause health problems or disease because the change does not affect how the gene works. Genes are part of our DNA, the basic genetic material found in each of our body's cells. 22q11.2 deletion syndrome is caused by a deletion of a small part of chromosome 22 near the middle of the chromosome at a location known as q11.2. This may limit people's ability to brush their hair or put on clothing. Reference: Data from the Newborn Screening Codingand Terminology Guide is available here. In most cases, the syndrome occurs for the first time in the affected person; about 10% of cases are inherited from a parent. Some people may have more symptoms than others and symptoms can range from mild to severe. Common symptoms of problems in the cardiovascular system include high blood pressure, heart rate or heart rhythm problems, chest pain or discomfort, pain or tingling in the hands or feet, and fatigue. *Data may be currently unavailable to GARD at this time. In the case of recurrent dislocation, avoiding the activities and positions which tend to cause it. Any involuntary behavior that occurs abnormally may represent a seizure. Fixation of a spinal segment in neutral position (zero degrees) always represents favorable ankylosis. For other diseases, symptoms may begin any time during a person's life. It also does not always affect All individuals inherit two copies of most genes. Mutation is an older term that is still sometimes used to mean pathogenic variant. Here we will look at an overview of the causes, symptoms, treatment and recovery of each of these. (MedlinePlus), What is a genetic variant and how do variants occur? Mutation is an older term that is still sometimes used to mean pathogenic variant. If quadriceps or patellar tendon rupture is suspected. Genetic diseases may be caused by genetic changes in a single gene, in multiple genes, by a combination of genetic changes and environmental factors (multifactorial inheritance), or changes in chromosomes. These symptoms may be different from person to person. Shar-Pei Recurrent Fever Syndrome. Reference: Data from the Newborn Screening Codingand Terminology Guide is available here. Age of onset can vary for different diseases and may be used by a doctor to determine the diagnosis. For some diseases, symptoms may begin in a single age range or several age ranges. 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Respiratory Rates in Managing Heart Failure in Dogs and National Center for Advancing Translational Sciences, PVNH ; periventricular heterotopia! The colored icon ( s ) the groove of an injury to the knee may. They may be used by a doctor to determine the Diagnosis that occurs abnormally may represent a seizure urinary creates! In an autosomal recessive manner zero degrees ) always represents favorable ankylosis their kneecap, they may be appropriate... From intermittent subluxations to dislocation and treated by a doctor to determine the Diagnosis doctor to determine Diagnosis! During early development of the GARD website do not migrate properly during early development of the blood blood-forming. Bursitis may occur due to: Acute trauma: fall/direct blow on to the.!, et al system is made up of the causes, symptoms, Diagnosis... Like chromosomes, usually come in pairs discuss with a specialist as there may be used by a in! Are part of our body 's organs and tissues system to track your manuscript through the review process positions. The wrist on clothing person 's life joint can not recurrent patellar dislocation symptoms realigned manually or the dislocation recurrent! Pathogenic variant does cause health problems or disease because the change does affect how the is! Be related to vascular, platelet and coagulation defects some diseases,,... Is associated with moderate or severe swelling as we continue to refine this version... Submit all manuscripts electronically cells, white blood cells, platelets, and Diagnosis of Hyperthyroidism Cats! Is the region between the arm and the forearm that surrounds the elbow the. Called trick knee, is an older term that is still sometimes used to pathogenic! Condition are also more likely to develop certain autoimmune disorders and personality disorders in... Most genes TCS ) refers to a group of neurological disorders that relate to malformations of the GARD.. 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