Lumbar Canal Stenosis: A Prospective Clinicoradiologic Analysis

2020 ◽  
Vol 81 (05) ◽  
pp. 387-391
Author(s):  
Nikhil Jain ◽  
Shankar Acharya ◽  
Nitin Maruti Adsul ◽  
Mukesh Kumar Haritwal ◽  
Manoj Kumar ◽  
...  
Keyword(s):  
Back Pain ◽  
Spinal Canal ◽  
Neurogenic Claudication ◽  
Canal Stenosis ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B ◽  
Relationship Of ◽  
The Relationship

Abstract Background Although spinal canal narrowing is thought to be the defining feature for the clinical diagnosis of lumbar canal stenosis, the degree of spinal canal stenosis necessary to elicit neurologic symptoms is not clear. Several studies have been performed to detect an association between a narrow spinal canal and clinical symptoms. Through our prospective study, we compared the radiologic criteria with the clinical criteria using the Oswestry Disability Index (ODI) and assessed how they correlate. Materials and Methods We used the qualitative grading (morphological classification system on magnetic resonance imaging [MRI]) system, dural sac cross-sectional area (DSCA), and sedimentation sign on MRI images and compared them with the Self-Paced Walking Ability (Self-Paced Walking Test) and ODI of the patients in the study. The systems were applied to 85 patients divided into three groups: group A: 43 patients with neurogenic claudication and able to walk < 30 minutes; group B: 11 patients with neurogenic claudication and able to walk > 30 minutes; and group C: 31 patients with simple back pain and no signs of neurologic claudication. Results The mean ODI was 21.19 in group C, 46.50 in group B, and 61.95 in group A. The difference was statistically significant. The mean DSCA was 164.42 mm2 in group C, 49.94 mm2 in group B, and 35.07 mm2 in group A. The difference was statistically significant. The sedimentation sign was negative in 96.8% patients in group C, 54.5% patients in group B, and 32.6% patients in group A. The difference was statistically significant. Group C had 9.3% patients in morphology grade A3, 51.6% in grade A2, and 38.7% patients in grade A1. Group B had 63.6% patients in grade C, 18.2% patients in grade B, 9.1% in grade A4, and 9.1% in grade A3. Group A had 18.6% patients in grade D, 39.5% in grade C, 27.9% in grade B, 11.6% in grade A4, and 2.3% in grade A3. The mean DSCA of group C was significantly different from group A and group B, but the difference of the mean DSCA between group A and group B was not statistically significant. The relationship of ODI to DSCA, ODI to sedimentation sign, and ODI to morphological grading for group C and group A was not statistically significant. The relationship of morphological grading to DSCA was statistically significant for all three groups. Conclusion DSCA, morphological grading, and sedimentation sign are good to excellent radiologic indicators differentiating patients with simple back pain from those with lumbar spinal stenosis. Clinically, ODI is an excellent indicator of the severity of stenosis. But ODI statistically has no significant correlation to any of these radiologic parameters.

Effect Comparison Of MIS-TLIF Under MED and Quadrant Modes in The Treatment of Lu mbar Spinal Stenosis

2021 ◽  
Vol 7 (5) ◽  
pp. 1598-1604
Author(s):  
Chen Qi ◽  
Xia Chen ◽  
Mao Guangfeng ◽  
Chen Chuyong ◽  
Jin Yongming ◽  
...  
Keyword(s):  
Spinal Stenosis ◽  
Lumbar Spinal Stenosis ◽  
Spinal Canal ◽  
Spinal Canal Stenosis ◽  
Surgical Trauma ◽  
Canal Stenosis ◽  
Group A ◽  
The Difference ◽  
Group B ◽  
Lumbar Spinal

Background Lumbar spinal stenosis is one of the common causes of low back and leg pain. Lumbar intervertebral disc degeneration leads to the decrease of intervertebral height, the limitation of vertebral activity, and the biomechanical changes of the lumbar spine, which in turn makes the lumbar anterior convex angle and sacral inclination angle smaller, and the pelvic inclination angle larger, affecting the stress distribution of the lumbar spine aggravating the intervertebral disc degeneration. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. If the spinal canal stenosis is not corrected for a long time, can cause the cauda equina nerve, nerve root compression, resulting in neurogenic intermittent claudication. Surgery can correct lumbar stenosis and reconstruct lumbar stability. But the traditional lumbar fusion trauma is huge, even can aggravate pain, spinal canal stenosis. Therefore, more and more patients are more inclined to MIS-TLIF treatment with less surgical trauma. For single-segment lumbar spinal stenosis, MIS-TLIF has the same effect as open surgery in restoring lumbar interbody height and improving lumbar-pelvis balance. Objective Discussion on the effect difference of minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF) in the treatment of lumbar spinal stenosis by Quadrant and MED methods. Methods A total of 96patients with lumbar spinal stenosis who were scheduled to undergo MIS-TLIF surgery in Our Hospital from January 2017 to October 2020 were selected and divided into group A and group B according to the surgical channel selection scheme, with 48 cases in each group. The patients in group A were treater with MED channel, and the patients in group B were treated with Quadrant channel. The degree of surgical trauma, VAS score before and postoperative, JOA score, lumbar-pelvic imaging parameters and surgical complications were compared between the two methods. Results The operation time of the A group was shorter than that of the group B(P < 0.05). The blood loss, exposure time under X line, drainage flow and down-ground time in A group were lower than those in B group, which had statistical significance (P<0.05) ; A and B groups of patients were compared, the difference was not statistically significant (P>0.05) ; Preoperative, Comparison of VAS scores between A and B groups, the difference was not statistically significant (P>0.05) . On the first day of postoperative, the VAS score of group A was lower than that of groupB, which had statistical significance (P < 0.05). Preoperative, Comparison of JOA scores between A and B groups, the difference was not statistically significant (P>0.05) ; Comparison of JOA scores between 1 month ,3 months and 6 months in Postoperative, the difference was not statistically significant (P>0.05). The JOA scores of the two groups at 1 month, 3 months and 6 months postoperative were significantly lower than those Preoperative (P < 0.05). Six months postoperative, the lumbar anterior convex angle, segmental anterior convex angle and intervertebral height of the two groups were significantly higher than those Preoperative (P<0.05), and the pelvic inclination angle of the two groups was lower than that Preoperative (P<0.05).Conclusion MIS-TLIF in the treatment of patients with lumbar spinal stenosis using MED channel or Quadrant channel operation has curative effect, and there is little difference in the recovery of lumbar-pelvis imaging parameters, but the former has the advantages of less surgical trauma and lower postoperative pain.

Efficacy and Safety of Oral Ivermectin and Topical Permethrin in the Treatment of Scabies

2020 ◽  
Vol 33 (1) ◽  
pp. 41-47
Author(s):  
Mohsena Akhter ◽  
Ishrat Bhuiyan ◽  
Zulfiqer Hossain Khan ◽  
Mahfuza Akhter ◽  
Gulam Kazem Ali Ahmad ◽  
...  
Keyword(s):  
Skin Diseases ◽  
Close Contact ◽  
Randomized Study ◽  
Sarcoptes Scabiei ◽  
Efficacy And Safety ◽  
Common Skin ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Background: Scabies is one of the most common skin diseases in our country. It is caused by the mite Sarcoptes scabiei var hominis, which is an ecto-parasite infesting the epidermis. Scabies is highly contagious. Prevalence is high in congested or densely populated areas. Individuals with close contact with an affected person should be treated with scabicidal which is available in both oral and topical formulations. The only oral but highly effective scabicidal known to date is Ivermectin. Amongst topical preparations, Permethrin 5 % cream is the treatment of choice. Objective: To evaluate the efficacy & safety of oral Ivermectin compared to topical Permethrin in the treatment of scabies. Methodology: This prospective, non-randomized study was conducted at the out-patient department of Dermatology and Venereology of Shaheed Suhrawardy Medical College & Hospital over a period of 6 months, from August 2016 to January 2017. The study population consisted of one hundred patients having scabies, enrolled according to inclusion criteria. They were divided into two groups. group A was subjected to oral Ivermectin and the group B to Permethrin 5% cream. Patients were followed up on day 7 and 14 for assessment of efficacy and safety. Result: The mean scoring with SD in group A (Ivermectin) and group B (Permethrin) were 8.26 ± 2.22 and 7.59 ± 2.01 respectively at the time of observation. The difference between the mean score of the two group is not significant (p=0.117) the mean scoring with SD in group A and group B were 4.54 ± 2.05 and 1.64 ± 1.84 respectively at 7thdays. The difference between the mean score of the two group is significant (p<0.001). The mean scoring with SD in group A and group B were 2.68± 2.35 and .36± 1.10 respectively at 14th day difference between the mean score of the group is significant (p<0.001). Conclusion: Topical application of permethrin 5% cream is more effective and safer than oral Ivermectin in the treatment of scabies. TAJ 2020; 33(1): 41-47

scholarly journals Which Surgical Method is More Effective in the Fifth Metatarsal Base Fracture?

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0002
Author(s):  
Jun-Beom Kim ◽  
Chi Ahn ◽  
Byeong-Seop Park
Keyword(s):  
Clinical Results ◽  
Plate Group ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B ◽  
Clinical And Radiological Results ◽  
Mean Time ◽  
Screw Group

Category: Trauma Introduction/Purpose: The aim of this study was to evaluate and compare the clinical and radiological results of internal fixation with headless cannulated screw and locking compression distal ulna hook plate for the fracture at the base of fifth metatarsal bone, Zone 1. Methods: From April 2012 to April 2015, thirty cases (29 patients) were evaluated retrospectively. The mean follow up periods was 13 months. There were divided two groups based on use of the screw (group A, n=15) or the plate (group B, n=15).We measured the displacement to diastasis of the fracture on the foot oblique radiographs taken pre- and post-operatively in each group, checked the time to bone union and the difference of the reduction distance in each group. Clinical results were evaluated using American Orthopedic Foot and Ankle Society (AOFAS) midfoot score at 12 months postoperative. Results: In group A, the mean time to union was 54.2±9.3 days, the mean displacement to diastasis improved to 0.3±0.4 mm postoperatively (p<0.001), and the mean reduction distance was 2.9±1.0 mm. In group B, the mean time to union was 41.5±7.0 days, the mean displacement to diastasis improved to 0.06±0.2 mm postoperatively (p<0.001), and the mean reduction distance was 4.1±1.6 mm. AOFAS score was verified 97.7±3.4 in group A and 98.2±3.2 in group B. The time to union was significantly different between groups A and B (p=0.01).There were no complications. Conclusion: We suggest that the plate is more effective method for the shorter union time in surgical treatment of fifth metatarsal base fractures.

Cervical malalignment after laminoplasty: relationship to deep extensor musculature of the cervical spine and neurological outcome

2007 ◽  
Vol 7 (6) ◽  
pp. 610-614 ◽  
Author(s):  
Haku Iizuka ◽  
Takashi Nakajima ◽  
Yoichi Iizuka ◽  
Yasunori Sorimachi ◽  
Tsuyoshi Ara ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Neurological Outcome ◽  
Neurological Recovery ◽  
Cervical Lordosis ◽  
Cervical Alignment ◽  
Female Patients ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Relationship

Object The goal of this study was to investigate the relationship between preservation of the insertion of the deep extensor musculature of the cervical spine at C-2 and postoperative cervical alignment, especially differences between cases involving male and female patients, as well as the relationship between the loss of cervical lordosis and neurological outcome after laminoplasty. Methods The authors reviewed the records of 50 patients who underwent laminoplasty to elevate the C-3 lamina with repair of the deep extensor musculature (Group A) and 31 patients who underwent laminoplasty by C-3 dome laminotomy or laminectomy (Group B). They compared the degree of cervical lordosis after laminoplasty with preoperative measurements. Neurological function at last follow-up was also compared with preoperative assessments. Results In Group A, the mean values for pre- and postoperative cervical lordosis were 14.5 and 10.9°, respectively (p > 0.18). In female patients, however, the pre- and postoperative means were 14.4 and 3.7°, respectively (p < 0.004). In Group B, the overall means for pre- and postoperative cervical lordosis were 17.3 and 19.1°, respectively (p > 0.48); the corresponding means for female patients were 15.0 and 14.1° (p > 0.83). The mean percentages of neurological recovery were 54.1% in Group A and 54.8% in Group B. Conclusions Preservation of the insertion of the deep extensor musculature to the C-2 spinous process prevented significant changes in cervical alignment after laminoplasty, even among female patients. Neurological recovery was not affected by the loss of cervical lordosis.

Umbilical vein volume flow in monochorionic twin pairs at 11–14 weeks

2014 ◽  
Vol 42 (4) ◽  
Author(s):  
Maria Angelica Zoppi ◽  
Ambra Iuculano ◽  
Giovanni Monni
Keyword(s):  
Umbilical Vein ◽  
First Trimester ◽  
Volume Flow ◽  
Crown Rump Length ◽  
Normal Outcome ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B ◽  
Group D

AbstractWe investigated the umbilical vein volume flow (UVVF) at 11–14 weeks in monochorionic-diamniotic (MCDA) twins, focusing on the occurrence of complications. We considered 87 MCDA pregnancies. We used “E-flow” to detect the umbilical vein and measured the mean velocities and diameters of veins, also calculating the UVVF. Pregnancies were divided into four groups: a (twin-to-twin transfusion, TTTS); b (selective intrauterine growth restriction, sIUGR); c (discordance of fluid, DF); and d (with “normal” outcome). The main outcome of the study was the assessment of the difference of UVVF between twin 1 and twin 2 (larger and smaller twin). In eight of eight pairs of group a and seven of seven pairs of group b, the UVVF of fetuses 1 were significantly different than fetuses 2 (P<0.05). The UVVFs of fetuses 2 of group a were significantly lower in respect to the UVVFs of fetuses 2 of group d (P<0.05). We provide evidence of an important difference in UVVF in pairs that successively developed TTTS or sIUGR. The smaller fetuses of group a (TTTS) showed a lower venous return than fetuses 2 of group d (normal). First-trimester UVVF is lower in fetuses with a smaller crown-rump length in twin pairs at risk of TTTS or IUGR.

scholarly journals The Role of Using Motorized Diamond Burr Polisher Instrument in Minimizing the Recurrent Rate of Pterygium Excision

2020 ◽  
pp. 129-136
Author(s):  
Sakar Abdulkarim Nidhamalddin
Keyword(s):  
Diamond Polishing ◽  
Corneal Scar ◽  
Group A ◽  
Iop Measurement ◽  
The Mean ◽  
Diamond Burr ◽  
Pterygium Excision ◽  
The Difference ◽  
Group B ◽  
Primary Pterygium

To compare the effects of using motorized diamond burr polisher in pterygium excision versus manual polishing of the corneoscleral bed in reducing the recurrent rate. A prospective, comparative and interventional study of 90 consecutive patients with different grads of primary pterygium, who underwent pterygium excision at Shahid Aso teaching eye hospital in Sulaimani city, between August 2018 till September 2019, which was performed by single surgeon. In group A (45) eyes polishing of the corneoscleral bed done using motorized diamond polishing burr, and in group B (45) eyes using manual crescent blade for polishing. Recurrent rate was evaluated after about (8±2) months postoperatively. Ethical consideration of the risks and the benefits of the procedure was observed for each individual patient. A 90 patients with the mean age of group A (48.84±12.7) years and group B (49.67±12.3) years, complained of different grads of primary pterygium, group A had 31(68.9%) male and 14(31.1%) female, while group B had 22(48.9%) male and 23(51.1%) female. Each individual factors like age, gender, visual acuity, BCVA pre and postoperatively, IOP measurement, dryness of the eye and risk factors like smoking and UV exposure affecting the recurrence were assessed. In both groups the main indication for surgery was sign of irritation. The mean surgical time was calculated and the difference between two groups were significant. After follow-up of average six months the outcomes and recurrent rate were checked, recurrent rate was in group A 1(2.2%) while in group B was 6(13.3%) patients. it significantly decreased. Corneal scar happens in only 1(2.2%) case of group A while in 11(24.4%) cases in group B, Corneal scar was statistically significant. In both groups the change of BCVA was significant but the visual change was more significant in group A in compare to group B. Motorized diamond burr is a safe instrument for polishing the cornea during pterygium excision, it is easy to handle, low price, need lesser operative time, its effect on recurrence postoperatively is significant and beside it leaves lesser corneal scar and early visual recovery postoperatively.   

scholarly journals GESTATIONAL DIABETES

2015 ◽  
Vol 22 (10) ◽  
pp. 1298-1303
Author(s):  
Tayyaba Majeed ◽  
Rabia Adnan ◽  
Irum Mubshar ◽  
Hamis Mahmood ◽  
Kanwal Saba ◽  
...  
Keyword(s):  
Oral Route ◽  
Outcome Study ◽  
Neonatal Hypoglycemia ◽  
Consecutive Sampling ◽  
Pregnant Females ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B ◽  
Study Setting

Objectives: To compare the efficacy of Metformin with insulin in gestationaldiabetes mellitus in terms of fetomaternal outcome. Study Deign: Randomized clinicaltrial study. Setting: Lady Aitchison Hospital Lahore. Period: January 2014 to March 2015.Methodology: Total 500 pregnant females with GDM were included in the study through nonprobability,consecutive sampling. Patients were divided into 2 equal groups (A: B). Patientsin group A were given tablet metformin 500 mg by oral route and group B was administratedregular injection Insulin by subcutaneous route. Results: The mean age of females was32.14±6.13 years. The mean gestational age was 31.07±3.8 weeks. There were 78 (15.6%)females who had 0 parity, 107 (21.4%) females had parity 1, 175 (35%) females had parity2, 95 (19%) females had parity 3, 33 (6.6%) females had parity 4 and 12 (2.4%) femaleshad parity 5.There were 54 (10.8%) cases had PTB, out of which 12 (4.8%) had PTB withmetformin while 42 (16.8%) had PTB with insulin. There were 115 (23%) neonates requiredNICU admission, out of which 37 (14.8%) neonates with metforminand78 (31.2%) neonateswith insulin. There were 87 (17%) neonates who had neonatal hypoglycemia, out of which23 (9.2%) neonates with metformin and64 (25.6%) neonates with insulin. The difference wassignificant between both groups for all fetal outcomes (P<0.05). Conclusion: The metforminis more effective in preventing adverse fetal and maternal outcome as compared to insulin.

scholarly journals Histological study of proportion of cortex and medulla of the ovary in Bangladeshi women

2016 ◽  
Vol 44 (1) ◽  
pp. 8-10
Author(s):  
Hosna Ara Perven ◽  
Abu Sadat Mohammad Nurunnabi ◽  
Dilruba Siddiqua ◽  
Fatema Johora ◽  
Halima Afroz ◽  
...  
Keyword(s):  
Histological Study ◽  
Age Groups ◽  
Age Group ◽  
Cross Sectional ◽  
Medical College ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B ◽  
The Right

This cross sectional, descriptive study was done in the Department of Anatomy, Dhaka Medical College, Dhaka from January to December 2009, to determine the proportion of cortex and medulla of the ovary in di_erent age group of Bangladeshi women. This study was based on collection of 140 ovaries of 70 unclaimed female dead bodies from the morgue of Dhaka Medical College, Dhaka. The samples were divided into three age-groups including A (10-13 years), B (14-45 years) & C (46-52 years). Histological slides were prepared by using routine haematoxylin and eosin stain. Ten best prepared histological slides from each age group were examined to determine the thickness of the cortex and medulla & proportion of the thickness of the cortex and the medulla of the ovary were expressed in percentages. The mean proportion of the cortex and the medulla of the right ovary were found 80.83±0.58% and 19.17±0.58% in group A, 86.95±1.14% and 13.05±1.14% in group B, 70.53±1.53% and 29.47±1.53% in group C respectively. The mean proportion of the cortex and the medulla of the left ovary were found 80.63±0.58% and 19.37±0.58% in group A, 86.78±1.14% and 13.22±1.14% in group B, 70.41±1.50% and 29.59±1.50% in group C respectively. The difference in mean proportion of the cortex and the medulla was not signi_cant in between the ovaries. However, the difference in mean proportion of the cortex and the medulla of the ovary between group A & group B, group A & group C and group B & group C were statistically significant.Bangladesh Med J. 2015 Jan; 44 (1): 8-10

scholarly journals COMPARISON OF EFFICACY OF INJECTABLE STEROIDS VERSUS CONSERVATIVE MANAGEMENT FOR DE QUERVAINS’S TENOSYNOVITIS

2021 ◽  
Vol 12 (3) ◽  
pp. 217-221
Author(s):  
Nasim Ilyas ◽  
Fouzia Hanif ◽  
Rajesh Kumar Panjwani ◽  
Sheikh Kashif Rahim ◽  
Asma Abdul Qadeer ◽  
...  
Keyword(s):  
Conservative Management ◽  
Steroid Injection ◽  
Corticosteroid Injection ◽  
Post Intervention ◽  
De Quervain’S Tenosynovitis ◽  
Management Group ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

BACKGROUND & OBJECTIVE: De Quervain's tenosynovitis is tenosynovitis of the abductor pollicis longus and extensor pollicis brevis tendons, occurs due to chronic overuse of the wrist and hand. To compare effectiveness of steroid injection with conservative management of De Quervains’s tenosynovitis. METHODOLOGY: Randomized prospective study was conducted at the various private orthopedic clinic across Rawalpindi district, along with collaboration of community medicine department, Rawal Institute of health sciences, Islamabad. The study population was divided into two groups, i.e., group A and group B. Group A was given inj. corticosteroid and group B was given conservative management. The severity of pain (Visual analogue scale) and Finkelstein test were recorded on baseline and after 3 weeks follow up. RESULTS: Our study included 96 diagnosed cases of de Quervains tenosynovitis on a positive Finkelstein test; 48 were given corticosteroid injection and 48 were conservatively treated. The mean age in corticosteroid’s injection group was 34.76+6.95 years whereas the mean age in conservative management group was 31.7+8.91 years. Post-intervention 13, 29 patients had a positive Finkelstein test in corticosteroid and conservative groups respectively. Although the difference in pre intervention pain score between the two groups was not statistically significant but significantly lesser pain scores in the corticosteroid group; (p= 0.00). CONCLUSION: Steroid injection produced better results in terms of relief in pain and negative Finkelstein test as compared to conservative treatment.

scholarly journals Weight of the Human Thyroid Gland – A Postmortem Study

1970 ◽  
Vol 9 (1) ◽  
pp. 44-48
Author(s):  
ASM Nurunnabi ◽  
A Alim ◽  
M Sabiha ◽  
B Manowara ◽  
K Monira ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Medical Science ◽  
Age Groups ◽  
Cross Sectional Study ◽  
Human Thyroid ◽  
Cross Sectional ◽  
Group A ◽  
The Mean ◽  
The Difference ◽  
Group B

Context: A cross-sectional study was designed to find out the difference in weight of the thyroid gland of Bangladeshi people in relation to age and sex and to compare with previous local and foreign studies. Materials & Methods: The present study was performed on 60 post mortem human thyroid gland (39 of male and 21 of female) collected from unclaimed dead bodies which were in the morgue under examination in the Department of Forensic Medicine, Dhaka Medical College, Dhaka. The samples were divided into three age-groups including Group A (10-20 years), Group B (21-50 years) & Group C (>50 years) and the weight of the thyroid glands were measured and recorded. Results: The mean weight of the thyroid gland in male was 15.14 gm, 19.20 gm and 14.64 gm and in female was 16.02 gm, 19.03 gm and 14.67 gm in group A, B and C respectively. The mean weight of the thyroid gland was 15.48 gm in group A, 19.15 gm in group B and 14.65 gm in group C. There was no difference in mean weight of the thyroid gland between male and female. The difference in mean weight of the thyroid gland between group A & group B and group B & group C were found statistically significant. The weight of the gland was found to increase from early childhood and puberty up to 50 years of age and then decrease. Key words: Thyroid gland; Weight of thyroid gland. DOI: 10.3329/bjms.v9i1.5230 Bangladesh Journal of Medical Science Vol.09 No.1 Jan 2010 44-48

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