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Or not to see if you will be able to introduce yourself or not. I think I will start by introducing myself and then my fellow colleagues, my lovely colleagues, they will introduce themselves and we would really appreciate if everybody who is attending the thing, they would just just drop a message in, in the in the chat, just to introduce themselves and then we'll take it from there. So my name is Hamza. I am one of the junior clinical fellows working at Princes Roy University Hospitals in the Ent Department. And we will be running a six session series of the Ent course which we have named Ent on call. And obviously, we believe that if you take all the all the sessions of this series, which obviously will be presented by very experienced senior clinical fellows of our department, then obviously, it will be be very beneficial for you guys and with, with, with every session after every session, obviously, we'll be getting feedback from you guys. And obviously, if there is any room for, from for improvement, we will be working on that too. Um So yeah, I think, I think let's let's take it from there. So I will let my fellow colleagues to introduce themselves and then so will be starting the session very soon afterwards. Enjoy everyone. Good luck. Thank you, Hamsa. Um Hi, my name is Neha. I'm also one of the uh gene fellows in Princess Royal University Hospital. I'm working in ENT Department. Me and Hamza decided to conduct the six session ENT teaching series for all the Sh OS and junior doctors out there um to help them how to mind their bleep. So today's session is about acute neck swelling. Um We very often stumble upon these things in any everywhere, in fact. So um today, our senior clinical fellow doctor Subhash Pata will be taking a session about acute neck swellings for us. So let's start. Ok. Hi. Hi everyone. Thank you, Nara. Thank you Hanja for the interruption and for letting me present in this uh for, for this course. So introducing myself, I am a senior uh working as a senior clinical fellow in the department of a university hospital. So as I said earlier, I'll be presenting uh acute neck swelling today, I'll try to cover the most common neck swellings that we encounter in the ent uh with bleed and A&E and I'll try to give a brief uh introduction, brief clinical presentations and then brief management options. So before starting, uh I think everybody has their microphone off. So uh let us keep the microphone off at the end of the presentation, uh we will have some time for a question and answer and that and during that time, you can just ask the questions. So otherwise you can also write the questions in the chat box. That is also an option. Uh Sorry, sorry, I will just take over for, for a while. So I will be um so while Seba is delivering the lecture, obviously, I will be taking care of the chat. So if you guys have any questions, anything, just put it on the chart and I will be taking care of that. OK. OK. So far I shall I start? OK. OK, doctor. So thank you uh Hamza. So today uh the first uh uh session uh first course of the session is acute neck swelling. So now let's go ahead with acute neck swelling. So initially what I have put in my first slide is I just want to overview the gross anatomy, general anatomy uh just to give an idea that where the swelling might arise from neck to neck swelling. So the first, so first picture is showing the various level of the lymph nodes in neck. As we might all be familiar, there are six level of the lymph nodes, seven level of the lymph nodes in the neck, submental submandibular, upper cervical, middle, cervical, lower cervical. This is uh the posterior triangle and the supraclavicular and the anterior triangle. So, lymph nodes are one of the most common cause for the swelling in the neck. After those there are few glands, the salivary glands, as you can see here in the second picture, the parotid gland, submandibular gland and sublingual gland. These are the ones are also associated with uh various kind of the swelling in the neck. And then there is another gland called thyroid gland in the center of the neck. Oh So this is also on one of the swelling which is associated with the swelling in the neck. Apart from that, the swellings can arise from the skin can arise from fossa, can arise from fat, can arise from larynx. So these are few of the common places from where the swelling can arise. The next slide, what we I have done is just try to briefly overline the differentials that we should be careful if anybody presents with the swelling. First, I have boot abscess because that is one of the most common thing we encounter in a and then there would be cellulitis, lymphadenitis, the cysts that get infected, then there comes hematoma, seroma, the cancer that we need to be very careful about. And then the cyst lipoma lymphadenopathy. The last option, the fifth number is mostly chronic, but we might come across them. The patient might have noticed the swelling a few days back and they might turn up in the ana as well. Now, going ahead with the neck abscesses. So neck abscess, abscess, as we all know is the collection of pus in a space which is not lined by fifth helium. So the neck abscess can occur anywhere in the neck. It can be lateral neck. It can occur in the central neck. Upper. It can occur in the upper part of the neck, uh as well as the lower part of the neck. These can arise uh as uh discussed previous from the previously from the lymph node. They can be an infection in the overlying cyst, like the thyroglossal duct, cyst, branchial cleft, cyst and sebaceous cyst. If these cysts get infected, they might turn into abscess and sometimes they might be a result of the abscess, uh post collection in the salivary gland. Most of them, all of them uh are usually present, usually have a similar presenting features. The patient will come to us uh complaining of a painful swelling in the part of their neck. They might be having some systemic feature like fever. Uh and those, and then when we do the examination, we will feel a red hot swelling in the neck, which is most of the night fluctuant. That means there is some collection inside it. If the uh swelling is superficial most of the times, even if we don't do the CT scan, it's OK. OK. To go ahead with the uh incision and drainage. But doing a CT scan would give us a various idea, doing a scan would give us various idea about the extent of the swelling and the nature of the swelling. So it's better to go uh with the CT scan to find out if it's uh collection of the pus or if it's uh any he hemorrhagic swelling. So that we don't end up in doing a incident drainage for hemorrhagic uh swelling. After the CT scan, the management line is to drain the abscess. Whenever there is a pus, we should always try to drain it and then antibiotics uh to uh to cover the remaining infection in the abscess cavity. And I said earlier, it might be uh infected in uh bronchial cys cyst. Then we later on deal with the primary pathology, we can send the patient home and then maybe after 2 to 3 months, we can call him back and then we deal with the primary pathology which could be TG cyst, which could be branchial cyst because at that time, we are only doing the uh incident drainage and can counsel the patient that if he is having swelling before he might need to come back to us and we might need to treat the pathology. So most of the time doing the incision and drainage is straight for what we don't need to see any area or uh we don't need to consider any anatomical landmarks. Uh We just need to do the incision over the most uh flu most fluctuant or most prominent area of the abscess, apart from one of the swelling, one of the abscess in the submandibular area. If the swelling or abscess in the submandible area, we need to be very much careful while doing incision and drainage. So in this area, there is a nerve, we call it a marginal mandibular branch of the facial nerve which just traverses here. So if we are to give incision in this area, we should be very careful. We give the incision to finger right below the margin of the mandible so that we avoid the injury to that knob because that might lead to the serious disfigurement of the angle of the mouth. So, in this swelling, we should be very careful while doing the incision and drainage. So that's why that's why I have put this photograph uh for a special men moving ahead to our next thing. Now, this is not the outside neck swelling. This is one of the swelling inside of the neck and this is the, I think one of the mostly encountered swelling, uh mostly encounter abscesses that comes to our daily practice. We call it peritonsillar abscess. Peritonsillar abscess, by definition is the collection of the pus in the peritonsillar space. If this is the tonsils, this is the peritonsillar space. So peritonsillar abscess is the collection of pus in the peritonsillar space. The patient would present with the symptoms like sore throat, painful, swallow, dysphagia, Christmas, hot potato voice, and sometimes with a fever or systemic features. The most important thing we need to be careful is to differentiate it from the acute tonsillitis because the presenting symptoms for peritonsillar abscess and acute tonsillitis are in most scenarios similar. So how do you differentiate is by examination mostly with the examinations? This is the picture showing the acu tonsillitis. As we can see in acu tonsillitis, both the tonsils will be enlarged or congested. There won't be any unilateral swelling, peritonsillar abscess. On the other hand, is always unilateral and it will present with the unilateral swelling. If we see this picture, it will present with a unilateral swelling, the uvula will be deviated to other side. So whenever the uvula is deviated to other side, we must have a suspicion in our mind that no, it can be something else. It uh can be it uh should be something else other than the acu tosti. So there comes the peritonsillar abscess. This is the picture showing the peritonsillar abscess in the person with the peritonsillar abscess. The management option is same whenever there is first, we need to drain it. So drainage is uh also done. There are a few landmarks we need to remember because this is the part of the drainage we do uh as a junior clinical fellow uh is done on a very routine basis. So there is a landmark where we should aim to puncture. If we draw our imaginary line from the base of the uvula and anterior tonsillar pillar, somewhere around here. This is the side where we should aim to puncture while draining a peritonsillar abscess. The drainage is being done with the serine. The drainage is being done with the skull pill. But there are especially designed forceps called Quincy Forcep, which can be used if available for drainage because they have a guarded tip which doesn't let them go more than one centimeter. Because if we go more than one centimeter, there is always a risk that we might injure the great vessels which are just behind the post tonsillary space. So uh we should always be careful not to put the needle or any instrument. We are using more than uh 1 to 2 centimeters. So it's always better to use the forceps. If we have got them after drainage, we can see the patient, we can observe the patient for 23 hours. And if the patient is eating fine, we can discharge the patient on the oral antibiotics and it should be fine. In most of the cases going a ahead after peritoneal apsis. There are uh various deep neck space, uh infections and abscess like retropharyngeal abscess, peripharyngeal apsis. So, these are the abscess that occurs in the spaces which are deep in the neck and mostly they are inside. Sometimes the para this is the example, this is a picture showing parapharyngeal apsis where we can see the outside swelling just around the uh angle of the mandible. It usually presents with a similar finding like that of the peritonsillar abscess, uh the Christmas will be there, there will be swelling, there will be tenderness in the neck. Uh in the swelling, there will be painful, movement of the neck. The swelling, swallowing will be painful, uh painful. And sometimes the this kind of abscess might present with the difficulty in breathing. Mostly if the retropharyngeal abscess goes down. So this is the picture showing retropharyngeal abscess. This is the area where the retro uh the posterior part of the uh part of the oropharynx is swollen as you can as you can see here. So this uh gives the picture of the retropharyngeal apsis. These kind of abscesses are sometimes very much uh widespread, uh spread, widespread and they might go into down into me. And so we should have a uh aggressive uh management uh approach planned. We should do a CT scan or any form of any modality of imaging. And then we should always plan the patient to be drained under general anesthesia. And after that, we can continue which we have to continue the patient on IV antibiotics or maybe oral antibiotics. Then comes one of the very important uh swelling around the uh neck, upper neck, uh angle of the mandible, I would say, which is called Ludwig's Angina. This is uh one of the serious condition in a way that it is very rapidly spreading cellulitis and it takes no time to spread from the upper part of the neck into the lower part of the neck and then into the first thing. And the next thing it can cause uh since it will involve the airway, it can uh always lead to the breathing difficulty. As we can see the space, this is the space where the abscess takes place in the myelo muscles area. So it can push the tongue base behind and it, it can obstruct the airway. So this kind of patient might land up in the difficulty in breathing, might land up in complete uh cessation of breathing in no time. So these kind of abscesses should be also uh approved very aggressively and treated very aggressively. They usually present in people who are diabetic immunocompromised with poor dental hygiene. As we can see here, there is a gross swelling from one side of the angle of the mandible to other side of the angle of the mandible. If we examine inside one of the most permanent finding that we find in this patient is elevated floor of the mouth. So if we see any any swelling in the submental submandibular area that is on bilateral side and then there is floor uh swollen floor of the mouth, we should be very cautious that it can be Ludwig angina. So in this patient, we have to do imaging and we have to aggressively manage the patient and immediate surgical uh intervention would also be required in these cases. So uh this kind of swelling, it comes to us uh we should be very careful about them and we should uh just try to deal with them very aggressively. The neck swelling. Next, very important swelling would be a thyroid hematoma, uh which is mostly following uh the thyroidectomies. So, if we have any patients who had undergone, who has undergone thyroid, we should be very careful regarding this uh this kind of neck swelling. If the patient who has uh just undergone thyroids in 1 to 2 days come uh comes back to us or he is uh if the patient is in the hospital and complains of difficulty in breathing and we, when you see the neck, we see there is some swelling, there is some collection. Yeah, the picture sometimes might appear like this one, then we should suspect there is some bleeding going inside the thyroid. The bleeding from the post thyroid area is particularly very uh uh dangerous or very life threatening because there is a very weak membrane which is called hydroid membrane. So when there is a bleeding, it might go inside, not it, it usually don't need to be obvious outside. It might go inside and compress the airway, that patient might end up in stride and a complete respiratory blockage. So these kinds of the patients should be also carefully handled. If we, if uh there is a patient of a recent thyroid surgery history and comes to us with the difficulty in breathing and we see the uh swelling in the neck, we should directly escalate him to for intubation or maybe possible surgical exploration uh that should be done because in no time that patient will end up in and then we won't be able to intubate him as well. The other swelling is perot seroma, hematoma. So these are not that much life threatening. If this kind of swelling, this kind of swelling usually happens. Uh after the palliative surgery, there is a collection of the blood, there is a collection of secretions. In case of seromas, these are uh most likely not fatal. And in this kind of swelling, we can do compression bandaging and in sometimes we might need to uh remove few of the sutures and then drain the collection inside. There is another uh abscess in the same area, the parotid abscess and another one perioral abscess. So these two kind of abscess occur in the similar site. As we can see here, there is a slight difference between them. In case uh of the para swelling, the swelling is para abscess. The swelling is not always never fluctuated. The parotid abscess is always formed to touch. So it might uh be very difficult for us to uh diagnose a parotid abscess clinically. However, in the case of preauricular abscess, it's tender, it's uh fluctuant, uh it's same like any other abscess uh in the body and usually it has opening which we call sinus. Usually it is in the preexisting preauricular sinus parotid abscess has to be uh has to be decided on, has to be decided on the suspicion on the clinical uh basis. If we see tender swelling in the parotid area and it's uh firm and it looks uh inflamed, then we should think that it might be parotid abscess and doing uh imaging would be very helpful. And then obviously, if there is pus, we need to drain the pus under general anesthesia. And these are some of the uh other inflammatory abscess like uh parotitis, Xylo adenitis, xyloa, these are also uh of common occurrence. Uh This picture is showing the bilateral enlargement of the cheek area. This is the common finding in parotitis. So it's mostly viral condition. Uh So most of the time we don't need to do uh anything. Uh yeah, antibiotic also not needed. Most of the time we can uh do plenty of fluid and then we can do nss uh this is another picture showing some mandibular glands, ait uh in these cases. Also, we need to see the patient, we need to do the scan, we need to see whether there is pus collection or not. And then we need to uh give you antibiotics. Most of the cases they will resolve, sometimes they might be associated with the stones or any sort of the things that is obstructing the duct. And in those cases, we went to say we'll see them in the clinic and then we'll deal with them. But in a setting, they can be just discharged on IV antibiotics and maybe imaging to rule out if there is pus collection or not. I now coming uh to the ear area. The ear area also is the one of the most common side that comes to our uh day to day clinical practice. Uh They come on a regular basis uh to our A&E we get regular call from them, you know, from our GP practice. So there are two kinds of swelling. We should be very careful about. One is mastoid abscess or masis and another is acu externa with abscesses. Looking at the picture. If we see mastoiditis or mastoid abscess is the condition in which the bony wall of the mastoid has been braced and then the abscess is coming out of the bone. While in the case of acute externa, the bony wall is intact, all the abscess uh is happening just outside the bony wall. So there are a few differences is we need to be careful about because uh if we are able to separate mast iois and acu externa, then the complete management protocol is different. So we need to, we should be able to differentiate them on the clinical findings. Like if you see the shape of the pinna in mastoiditis, it is forward and downward, it will go forward, that means laterally and downward. While in acute transection, it will only go forward. If we look at the discharge. In most editions, the discharge is coming from uh inside the ear. So it is most of the time mucoid. However, in uh FSIS or acu external discharge is pent. At the same time, there are other findings like sagging of the ea wall and tm congestion, uh which is the findings in acute muscularis. Well, they are not there infero these findings are uh very important to do in the clinical basis. And then obviously, we can go for a CT scan. CT scan will obviously differentiate if the collection is in the master space or is in the uh uh external ear. If uh it is the mastoiditis, then we need to admit the patient do IV antibiotics. We need to do a CT master and drainage uh with the cortical Masur which might be required or sometimes might not be required. While in case of acute externa, we can only do the Z pack in axonal canal. And we might need to do the drainage of the abscess if required after the after the muscularis. The second a the second swelling that we find in the ear region are pinna abscess, perichondritis, uh pinna hematoma or seroma. These are the uh swelling area. Uh we can see in the pinna uh this is abscess, pin abscess, this is a hematoma. This these two shows the seroma. So whenever there is any collection in the pinna patient uh will present to us with a history of might present to us with a history of trauma or a history of some infection in the ear in those cases. What we might need to do is I'm very sorry. Everyone I think there, there has been some, there has been some problem with uh Subash uh connection which I can see. Obviously I would just allow him a few, a few minutes to see if he's able to rejoin or not. Hopefully, we, we'll be sorting it out very soon. Thank you for hanging in there. Yeah. So, so far, if anybody has any questions or any um confusions, you can just put your messages into the chart and obviously we'll be taking care of that and hi, sorry, sorry. I got a call from uh A&E that's why. Sorry. No problem. So I'll, I'll leave it with you. Subha OK. OK. Then uh so we uh in the pin now. So any swelling, uh we are seeing in the pin now. So the patient will come to A&E with a complaint of swelling in the Pinar reason. Uh The swelling looks somewhat like this in the Pinar region. Uh It can be hematoma, it can be uh seroma or it can be pinna abscess. So any swelling in the pin, now, we should be very much careful because uh since the blood supply to the cartilage comes from the overlying skin in this kind of the swelling, the overlying skin is just uh put up away from the cartilage. So the blood supply to the cartilage might be hampered and it might lead to permanent cartilage, deformity, something like this, we call cauliflower air. So if this happens, there is very less we can do and it is very difficult condition to treat, or it will be very difficult to make the ear, ear look proper. The pena look uh normal like before. So this kind of uh swelling in the penis should also be treated uh very urgently. If we see any of these things, uh we need to drain them first, depending on the drainage and depending on the condition, we might need to apply the splint or not. And then obviously, we need to give them good antibiotic cover. Uh If really, if this uh that is abscess or perichondritis, and then we need to keep an eye on them to see if the cartilage is uh getting healthy or cartilage is getting uh necrosis or not. If that's the case, then we might need to debride the cartilage and we might need to salvage the amount of the cartilage that is remaining. Another swelling is not in the neck, but since it's in the ent and it's one of the very common swelling. So I would like to uh just give a brief uh introduction about it as well. So that's septal hematoma or septal abscess. Uh It's the swelling uh in between the cartilage and the mucoperichondrium of the septum. It's mostly following a trauma or surgery and it's rarely spontaneous. So what happens is if there is any trauma, there occurs a bleeding and it collects, gets collected between the cartilage and the mucoperichondrium leading to the complete obstruction of the bilateral nasal cavity. And this might uh lead to the nasal obstruction. So the patient usually comes to us with a bilateral nasal obstruction and pain. Sometimes if this abscess, if we see these kind of the patient, if we see any patient of the nasal trauma, we need to uh rule out the septal lapses because again, there is a septal cartilage and if we are not able to rule it out, and if we are not able to drain it, it might decrease the blood supply to the cartilage and and lead to the necrosis of the cartilage. So we should be able to uh exclude this uh findings at the earliest while uh to exclude them. The most uh important thing that we rely upon is a clinical examination. So, uh the patient will mostly come with the bilateral nasal obstruction. And when uh when doing clinical examination, while doing rhinoscopy, we'll see swelling, bogey, swelling in both part of the uh both sides of the nostrils while touching them, they will be fluctuate. So sometimes we can, we might get confused with the DNS, the septal deviation, which will look similar to this kind. But DNS we need to uh differentiate because it is mostly un lateral and if it does the DNS, it will feel bony hard, it won't feel fluctuant. So that is the way how we can uh uh differentiate between DNS and the septal uh hematoma. So, whenever we see septal hematoma, the management option would be to drain the abscess and sometimes we might need to put the back as well in the nose. And then this pack will uh just prevent the abscess from recollecting and it will uh just align the uh muco pericardium with the septal cartilage. So these were the few of the most common swelling that uh we encounter in everyday ent uh A&E or ent ent life. So there uh I also would like to just make everyone aware of the red flex signs. So obviously, with any lump anywhere in our body or in head and neck area, we should always be aware of the reflex. And if these are the signs, we always should need to escalate the patient, we always uh should get a review from a senior person the way the few of the reflex and the various reflex and can be if the swelling has done recently, hard, painful of the swelling is fixed, then it's the time that we need to do some imaging or we need to do a biopsy. If it is associated with otalgia, dysphagia, striar of voice, and it suggests that it might have been crossing upon a nerve. And then we might need to think that. Ok. Now, this is the time that we need to get a opinion from uh, anyone senior, we might need to do a, a biopsy or imaging if it's associated on unexplained weight loss, night sweats fever or I, and if there are any cranial palsies in Children, we also take uh the presence of the supraclavicular mass, any lumps larger than two centimeter and previous history of malignancy as reflex lines. If these are present, we should be very careful because these uh can have some sinister outcome. So we should always be very careful. If with the swelling of the neck, with these uh reflex hands out there, then we might need to do imaging, we might need to escalate them to a senior person and then we might need to deal with them very carefully. So this uh is the end of my presentation. Hope. Uh I was able to give a brief information about the neck swelling and hope. Uh I was able to make everyone understand if there are any questions now would be the time I would be happy to uh answer the question as far as I can. Yeah. Right. So thank you so much for um for such a wonderful uh presentation. Me myself has been working in the ent department for almost a year now, but this presentation has, has enhanced my information about about the the the casualties that you can use, you know, encounter in the A&E on daily basis and it was, I think it was very, very, very beneficial for me and I really hope that it was beneficial for all the other participants too. Um Where I understand that there were so many, so many Ls since it was our first presentation, I would want to thank you. Uh Thank everyone to, to uh to hang in there to, to bear with us and support us with this, with this, with this thing that we have just, just um presented. And Yeah. Right. So if any questions, um if any questions, I think now is the time that you can uh put the questions in on the chart and obviously, Ash and myself, we'll be happy to answer your queries and your confusions. You response. OK. OK. My OK. Yeah. So I don't see any questions in the, in the, in the chat of us. That means well done. You have done it, you have done it in a way that people have understood, understood the thing. And then obviously, if they have understood that has served the purpose, thank you so much for taking the time out and for such a wonderful presentation. Um I'm very happy that we were able to, you know, uh through this thing. We are, we were able to have uh our fellow uh colleagues to get a better understanding of how the acute E ND things can be managed in, in, in a better way. Thank you. So much for that. I think, I think let's just wait for a couple of minutes if that's ok to see if anybody wants to put in any question. If note, then um we will be sending the feedback forms and then obviously, once you guys send the feed feedback forms back then, um we'll be sending out the certificates. So, yeah, I see your, I see your uh message arun we'll be sending in the feedback forms very soon. And then afterwards we'll be uh once, once you've submitted the feedback form, then obviously afterwards we'll, we'll, we'll be sending out the certificates. Thank you so much. So I can see a question from uh sorry to interrupt. Uh There is a question. OK. So there is a question from Helen. Uh She's asking that uh septal hematoma, is it uh always via incision and drainage or can we aspirate like uh so the an answer to that would be Helen. Uh We can aspirate it like quiz, but the chances of recollection are very much. So it's always better to aspirate first to confirm its sepsis or hematoma and then put a small nick there and then uh drain everything out and then put back in both of the nose so that it doesn't uh get collected again. So that is the best thing to do. Uh Otherwise there are chances that if we only do aspiration and if you leave like that, the whole of the aspiration as we have seen in many cases of the Quincy as well. It gets collected. Quincy apart from being in the mouth, which is a very mobile structure. We talk, we use all the muscles but in the nose, there won't be any movement. So chances of it getting closed are much. So it would always be better to give an incision behind and then drain everyone. Hope I have answered your question. Helen. OK. Thumbs up. Your microphone is off, I think. Sorry. Thank you. Thank you so much. So, um yeah, I think Helen is happy with your, with your uh answer. So I see that Ashok and Arun they have um some queries. So, Ashok, regarding the slides, I believe when we finish the session, um I believe we'll be able to put the, put the slides on for you, for you guys to have a look later on. I mean, I understand that it's not very easy for, for uh people, for anyone to retain um as much information as was in this um in this presentation. So yes, we'll be uploading the presentation afterwards on the portal. And if um by any chance we are not able to do so, I would recommend that you guys put in your email addresses, your official uh or your personal email addresses. And I will make sure that we send this presentation to all of the people who have attended, attended this um uh this series and arun. So uh to answer your question, it will be as far as I understand what you're trying to ask is that how this program will run? So, basically, we have, we have decided that we will do six sessions over the period of three months, which will be 222 sessions every month. So, um we will be conducting two sessions every month. And then at the end of those six sessions, obviously, I understand that your understanding of acute setting and how to handle your belief while you, while you're on go will be enhanced a lot. Uh So regarding, regarding how to um register yourself for the sessions, uh we'll be, we'll be putting on the uh dates for the next sessions on the, on the official Facebook page of mind the bleep and also been be advertising the thing on me to two. So we have not decided the dates for the future um for the future uh sessions, we only have decided the date for the next session which is going to run tomorrow, which will be regarding epistaxis, which will be uh conducted by other uh fellow colleague of, of ours. And regarding the other sessions, the sessions to follow. Obviously, once we have the, we have the dates, we will be advertising that thing on official Facebook page of uh mind the bleep and also on meal. I hope that answers your query tomorrow. Ok. Yeah. Ok, no problem, no problem. I in fact, you are very welcome. Uh And the, the organizers and obviously the speakers, we would like to thank you for trusting us with your time, you know, um registering for this session and giving us this opportunity to, to help you that, right? So I think, I think if you guys don't have any questions, I would, I would like to thank you all for being such a lovely audience and to support our, our uh initiative to run this series. And then once we have ended this session, I will be sending in the feedback forms for you guys to give us a thorough feedback of how we can improve. What was good for you, what we can improve and how we can take it, uh you know, and, and how, how we can improve it. And afterwards, obviously, we will be sending in the certificate of attendance, which obviously is very important for everyone. I understand. Um Right. So, so that will be all for today and for all who have registered for tomorrow, we'll see you guys again tomorrow. If you have not, I would really recommend that you do because the, the information that will be delivered tomorrow will be other uh will will be another uh things. So see. All right. So thank you everyone for coming in and have a lovely evening and then we'll see you tomorrow. Ok? Thank you. Thank you. Thank you very much. No problem. Thank you everyone. Thank you. Bye bye. Yeah, time five I see.