scholarly journals Extrusion of Femtosecond Laser-Implanted Intrastromal Corneal Ring Segments in Keratoconic Eyes: Prevalence, Risk Factors, and Clinical Outcomes

2020 ◽  
Vol 2020 ◽  
pp. 1-7 ◽  
Author(s):  
Amr Mounir ◽  
Mahmoud Mohamed Farouk ◽  
Marwa Mahmoud Abdellah ◽  
Engy Mohamed Mostafa
Keyword(s):  
Risk Factors ◽  
Femtosecond Laser ◽  
Corneal Thickness ◽  
Significant Risk ◽  
Sun Exposure ◽  
Vernal Keratoconjunctivitis ◽  
Conjunctival Hyperemia ◽  
Intrastromal Corneal Ring ◽  
The Mean ◽  
Belo Horizonte

Purpose. To evaluate the prevalence, possible risk factors, and clinical results of femtosecond laser implanted intrastromal corneal ring segment (ICRS) extrusion in keratoconic eyes. Patients and Methods. This is a retrospective observational study evaluating 333 eyes of 269 patients who were subjected to femtosecond laser-implanted Keraring ICRS in the Sohag Refractive Center, Sohag, Egypt, from January 2014 to January 2019. The study included eyes with channels created by a femtosecond laser (60 kHz IntraLase femtosecond system; Advanced Medical Optics, Santa Ana, California, USA) with implantation of Keraring intrastromal corneal ring segments (Mediphacos, Belo Horizonte, Brazil). Patient data and causes of Keraring extrusions were identified as being those rings that migrated or showed melting of the cornea with no other reason which required segment removal. Results. Seven eyes were found to fit the criteria of ring extrusion (2.1%) out of the 333 eyes which had Keraring implantation. All extruded rings were from patients with keratoconus grade 3, with eccentric cones, and with femtosecond creation of the tunnel. Four eyes belonging to 3 patients (57.1%) had a history of vernal Keratoconjunctivitis, yet they did not show signs of activity at the time of implantation. They reported excessive rubbing just before they presented with conjunctival hyperemia and foreign body sensation. Five eyes (71.4%) showed chronic sun exposure. The mean minimal corneal thickness was 401.85 μm (range 384–420 μm), while the mean maximum keratometry was 61 D (range 55.18–68.96 D). Most of the extruded rings had large arcs. Six eyes had crosslinking (CXL) at the same session of the Keraring implantation. The simultaneous CXL treatment is considered as a possible significant risk factor for ring extrusion. Conclusion. ICRS is an effective reversible option for patients with keratoconus who are intolerant to hard contact lenses, yet the choice of cases and ring segments is mandatory for satisfactory results. Moreover, meticulous history taking and examination reduces the incidence of complications including extrusion.

Characterizing the Magnitude of and Risk Factors for Functional Limb Lengthening in Patients Undergoing Primary Total Knee Arthroplasty

2021 ◽  
pp. 155633162110091
Author(s):  
Brian P. Chalmers ◽  
Mark LaGreca ◽  
Jacqueline Addona ◽  
Peter K. Sculco ◽  
Steve B. Haas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Total Knee Arthroplasty ◽  
Significant Risk ◽  
Primary Total Knee Arthroplasty ◽  
Limb Lengthening ◽  
Leg Lengthening ◽  
Total Knee ◽  
Plane Deformity ◽  
The Mean ◽  
Primary Total Knee

Background: There is little data on the magnitude and factors for functional leg lengthening after primary total knee arthroplasty (TKA). Questions/Purpose: We sought to determine the incidence of and risk factors for functional leg lengthening after primary TKA. Methods: We retrospectively reviewed consecutive unilateral primary TKAs at a single institution from 2015 to 2018. Of the 782 TKAs included, 430 (55%) were performed in women; the mean age was 66 years, and the mean body mass index was 29 kg/m2. Preoperatively, 541 (69%) knees were varus deformities and 223 (29%) were valgus deformities. Hip to ankle biplanar radiographs were obtained preoperatively and 6 weeks postoperatively for all patients. Two independent researchers measured leg length, coronal plane deformity, lateral knee flexion angle, and overall mechanical alignment on all preoperative and postoperative radiographs. Results: The mean overall ipsilateral functional leg lengthening was 7.0 mm. Seven hundred knees (90%) were overall functionally lengthened, including 462 (59%) knees lengthened >5 mm and 250 (31%) knees lengthened 10 mm or more. A valgus deformity and coronal plane deformity of 10° or more were significant risk factors for increased functional lengthening. Patients with severe valgus deformities (>10°) had the largest amount of functional lengthening, at a mean of 13.5 mm. Conclusion: After primary TKA, 90% of limbs are functionally lengthened, including roughly one-third over a centimeter. Valgus knee deformities and severe deformities (>10°) were significant risk factors for increased limb lengthening.

scholarly journals Differences in Risk Factors for Retinopathy of Prematurity Development in Paired Twins: A Chinese Population Study

2014 ◽  
Vol 2014 ◽  
pp. 1-7 ◽  
Author(s):  
Gordon S. K. Yau ◽  
Jacky W. Y. Lee ◽  
Victor T. Y. Tam ◽  
Stan Yip ◽  
Edith Cheng ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Retinopathy Of Prematurity ◽  
Very Low Birth Weight ◽  
Significant Risk ◽  
The Mean ◽  
Record Review ◽  
Chinese Twins ◽  
Retrospective Medical Record Review

Purpose.To determine the differences in risk factors for retinopathy of prematurity (ROP) in paired twins.Methods.A retrospective medical record review was performed for all paired twins screened for ROP between 2007 and 2012. Screening was offered to very low birth weight (≤1500 grams) and preterm (≤32 weeks) neonates. Twins 1 and 2 were categorized based on the order of delivery. Maternal and neonatal covariates were analyzed using univariate and multivariate regression analyses for both ROP and Type 1 ROP.Results.In 34 pairs of Chinese twins, the mean gestational age (GA) was 30.2 ± 2.0 weeks. In Twin 1, smaller GA (OR = 0.44,P=0.02), higher mean oxygen concentration (OR = 1.34,P=0.03), presence of thrombocytopenia (OR = 1429.60,P<0.0001), and intraventricular hemorrhage (OR = 18.67,P=0.03) were significant risk factors for ROP. For Twin 2, a smaller GA (OR = 0.45,P=0.03) was the only risk factor. There were no significant risk factors for ROP in Twin 1 or Twin 2 on multivariate analysis.Conclusion.In Chinese twin pairs, smaller GA was the only common risk factor for ROP while Twin 1 was more susceptible to the postnatal risks for ROP.

Abstract 2877: Ultra-early Endovascular Embolization Of Ruptured Cerebral Aneurysms Increases The Risk Of Hematoma Growth Unrelated To Aneurysmal Rebleeding

Stroke ◽  
2012 ◽  
Vol 43 (suppl_1) ◽  
Author(s):  
Yusuke Egashira ◽  
Shinichi Yoshimura ◽  
Yukiko Enomoto ◽  
Kiyofumi Yamada ◽  
Takahiko Asano ◽  
...  
Keyword(s):  
Risk Factors ◽  
Significant Risk ◽  
Cerebral Aneurysms ◽  
Female Gender ◽  
Endovascular Embolization ◽  
Anterior Circulation ◽  
Hematoma Growth ◽  
Group 3 ◽  
The Mean ◽  
Systemic Anticoagulation

Background and purpose: Hematoma growth unrelated to aneurysmal rebleeding has been poorly studied, but is not a rare complication following endovascular embolization of ruptured cerebral aneurysms. The aim of this study is to elucidate the possible risk factors for this phenomenon. Methods: We included 101 consecutive patients with subarachnoid hemorrhage (SAH) who underwent endosaccular embolization at our institution within 72 hours of symptom onset in this study. All endovascular procedures were conducted under intraprocedural systemic anticoagulation. Age, gender, hypertension, diabetes, preoperative antiplatelet or anticoagulation use, neurological grade, Fisher computed tomography group, location and size of the aneurysm, the grade of aneurysm occlusion, and timing of endovascular procedure were retrospectively analyzed to find the risk factors for hematoma growth. Results: This series included 32 men (31.7%) and 69 women (68.3%), and the mean age ± SD was 65.5 ± 14.0 years. The mean time ± SD from onset to endovascular procedure was 12.1 ± 14.0 hours. Following the procedure, hematoma growth unrelated to aneurysmal rebleeding occurred in 14 patients (13.9%), and 10 of the 14 patients required surgical removal of hematoma and/or ventriculostomy to control intracranial pressure. All 14 patients had an anterior circulation aneurysm and had Fisher group 3 or 4 SAH. Ultra-early embolization (conducted within 6 hours after onset), female gender, history of hypertension, and poor neurological grade (WFNS grades 4 and 5) were significant risk factors of hematoma growth (p < 0.05 for all) by the univariate logistic analysis. In multivariate analysis, ultra-early embolization (OR, 18.0; 95% CI, 3.26-338; p = 0.0002), and female gender (OR, 9.83; 95% CI, 1.73-187; p = 0.0067) were independent risk factors for this phenomenon. Anterior circulation aneurysm and Fisher group 3 or 4 SAH did not suit for the logistic regression model, but were found to be significant risk factors by chi-square test (p = 0.018 and 0.022, respectively). Conclusions: Ultra-early endovascular embolization for ruptured cerebral aneurysm under systemic anticoagulation increases the risk of growth of hematomas unrelated to aneurysmal rebleeding. In addition, women with anterior circulation aneurysm presenting with dense focal SAH or intracerebral hematoma are at higher risk for this phenomenon.

Significance of dynamic contour tonometry in evaluation of progression of glaucoma in patients with a history of laser refractive surgery

2019 ◽  
Vol 104 (2) ◽  
pp. 276-281 ◽  
Author(s):  
Sang Yeop Lee ◽  
Eun Woo Kim ◽  
Wungrak Choi ◽  
Chan Keum Park ◽  
Sangah Kim ◽  
...  
Keyword(s):  
Refractive Surgery ◽  
Open Angle Glaucoma ◽  
Corneal Thickness ◽  
Significant Risk ◽  
Applanation Tonometry ◽  
Dynamic Contour Tonometry ◽  
Significant Difference ◽  
History Of ◽  
The Mean ◽  
Laser Refractive Surgery

AimsIn this study, we tested the hypothesis that intraocular pressure (IOP) parameters measured by dynamic contour tonometry (DCT) would be more relevant in progression of glaucoma when there is a history of laser refractive surgery (LRS) than the IOP parameters measured by Goldmann applanation tonometry (GAT) or calculated by correction formulae.MethodsNinety-eight eyes in 54 patients with open-angle glaucoma and a history of LRS were included in this retrospective study. IOP was measured by both GAT and DCT during follow-up. Baseline, mean, and peak IOP, IOP fluctuation, and IOP reduction were measured by each tonometry method. Corrected IOP parameters using central corneal thickness and mean keratometry values were also analysed. Clustered logistic regression was used to identify variables correlated with progression of glaucoma. Areas under the curve (AUCs) for correlated variables were also compared.ResultsThe mean DCT value (OR 1.36, p=0.024), peak DCT value (OR 1.19, p=0.02) and pattern SD (OR 1.10, p=0.016) were significant risk factors for progression. There was a significant difference in the predictive ability of the mean DCT and GAT values (AUC 0.63 and 0.514, respectively; p=0.01) and of the peak DCT and GAT values (0.646 and 0.503, respectively, p=0.009). The AUCs for corrected IOP did not exceed those of DCT.ConclusionsIOP measurements were more associated with progression of glaucoma when measurements were obtained by DCT than by GAT or correction formulae in eyes with a history of LRS.

scholarly journals 2272. Evaluation of Clinical Features, Carbapenem Resistance and Risk Factors of Klebsiella Species: A 4-Year Retrospective Study in Turkey

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S777-S778
Author(s):  
Zuhal Umit ◽  
Zumrut Sahbudak Bal ◽  
Gizem Guner ◽  
Gulhadiye Avcu ◽  
Duygu Bozkurt ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Significant Risk ◽  
Carbapenem Resistance ◽  
Steroid Use ◽  
Carbapenem Resistant ◽  
Vitek 2 ◽  
The Mean ◽  
Klebsiella Spp ◽  
Klebsiella Infections

Abstract Background Gram-negative-resistant bacterial infections are increasing due to widespread use of antibiotics. Infections caused by Klebsiella spp. are an important part of healthcare-associated infections and cause morbidity and mortality. The aim of this study was to determine the epidemiological, clinical features, carbapenem resistance rates and risk factors of bloodstream infections of children with Klebsiella spp. Methods In this retropective study, medical records of 85 episodes of 75 patients caused by with Klebsiella spp. bacteriaemia who admitted to Ege University Faculty of Medicine, Pediatric Hospital in Turkey between 2014 and 2017 were evaluated. Conventional biochemical methods were performed using the automated systems of MALDİ-TOFF MS / VITEK 2 (Biomerieux, France). According to EUCAST recommendations, VITEK 2 (Biomerieux, France) automated microdilution method was used in sensitivity tests. Results The mean age of 85 episodes included in the study was 3.49 (±5.4) years. 58% of the patients were male and 42% were female. 18.8% of the patients were premature. The most common service was newborn service (30.6%). Neutropenia was 26% and thrombocytopenia was 55% at the time of diagnosis. Klebsiella pneumonia was 93% and Klebsiella oxytoca was 7%. Carbapenem resistance rate was found to be 30.6% in Klebsiella spp. Carbapenem resistance was found 18% in 2014, 38% in 2015, 42% in 2016 and 25% in 2017. In patients who developed carbapenem-resistant Klebsiella infection, the duration of pre-hospitalization ≥14 days (P = 0.034), the absolute neutrophil count < 100 (P = 0.048) and steroid use (P = 0.025) were statistically significant risk factors. The mean length of hospital stay was 107 (±103) days. Klebsiella spp. attributable mortality due to infection was 14% and crude mortality was 15%. No statistically significant difference was found in patients who developed resistant and susceptible infections. Conclusion Carbapenem resistance in Klebsiella infections was increased. Prolonged hospital stay, neutropenia and steroid use in the last 3 months were identified as significant risk factors for carbapenem-resistant Klebsiella infections. Disclosures All authors: No reported disclosures.

Long Term Follow-Up of Pediatric Sickle Cell Disease Patients with Conditional Velocities on Transcranial Doppler (TCD).

Blood ◽  
2005 ◽  
Vol 106 (11) ◽  
pp. 2338-2338
Author(s):  
Lena Coïc ◽  
Suzanne Verlhac ◽  
Emmanuelle Lesprit ◽  
Emmanuelle Fleurence ◽  
Francoise Bernaudin
Keyword(s):  
Risk Factors ◽  
Color Doppler ◽  
Significant Risk ◽  
Biological Data ◽  
Treatment Intensification ◽  
Significant Difference ◽  
History Of ◽  
The Mean

Abstract Abnormal TCD defined as high mean maximum velocities &gt; 200 cm/sec are highly predictive of stroke risk and justify long term transfusion program. Outcome and risk factors of conditional TCD defined as velocities 170–200 cm/sec remains to be described. Patients and methods Since 1992, 371 pediatric SCD patients (303 SS, 44 SC, 18 Sß+, 6 Sß0) were systematically explored once a year by TCD. The newborn screened cohort (n=174) had the first TCD exploration between 12 and 18 months of age. TCD was performed with a real-time imaging unit, using a 2 MHz sector transducer with color Doppler capabilities. Biological data were assessed at baseline, after the age of 1.5 years and remotely of transfusion or VOC. We report the characteristics and the outcome in patients (n=43) with an history of conditional TCD defined by mean maximum velocities ranging between 170 and 200 cm/s in the ACM, the ACA or the ICA. Results: The mean follow-up of TCD monitoring was 5,5 years (0 – 11,8 y). All patients with an history of conditional doppler were SS/Sb0 (n=43). Mean (SD) age of patients at the time of their first conditional TCD was 4.3 years (2.2) whereas in our series the mean age at abnormal TCD (&gt; 200 cm/sec) occurrence was 6.6 years (3.2). Comparison of basal parameters showed highly significant differences between patients with conditional TCD and those with normal TCD: Hb 7g4 vs 8g5 (p&lt;0.001), MCV 82.8 vs 79 (p=0.047). We also had found such differences between patients with normal and those with abnormal TCD (Hb and MCV p&lt; 0.001). Two patients were lost of follow-up. Two patients died during a trip to Africa. Conditional TCD became abnormal in 11/43 patients and justified transfusion program. Mean (SD) conversion delay was 1.8 (2.0) years (range 0.5–7y). No stroke occurred. 16 patients required a treatment intensification for other indications (frequent VOC/ACS, splenic sequestrations): 6 were transplanted and 10 received HU or TP. Significant risk factors (Pearson) of conversion to abnormal were the age at time of conditional TCD occurrence &lt; 3 y (p&lt;0.001), baseline Hb &lt; 7g/dl (p=0.02) and MCV &gt; 80 (p=0.04). MRI/MRA was performed in 31/43 patients and showed ischemic lesions in 5 of them at the mean (SD) age of 7.1 y (1.8) (range 4.5–8.9): no significant difference was observed in the occurrence of lesions between the 2 groups. Conclusions This study confirms the importance of age as predictive factor of conditional to abnormal TCD conversion with a risk of 64% when first conditional TCD occured before the age of 3 years. TCD has to be frequently controled during the 5 first years of life.

scholarly journals Pattern of growth development of premature children at the age of two and three years in Alexandria, Egypt [Part II]

2021 ◽  
Vol 1 (2) ◽  
pp. 186-193
Author(s):  
Khadiga A. Khalil ◽  
Shahira M. El Amrawy ◽  
Afaf G. Ibrahim ◽  
Nadia A. El Zeiny ◽  
Azza E. Greiw
Keyword(s):  
Risk Factors ◽  
Educational Level ◽  
Growth And Development ◽  
Significant Risk ◽  
Premature Child ◽  
Chronic Nephritis ◽  
The Mean ◽  
Growth Development ◽  
Premature Children ◽  
Age And Sex

Thisis the second part of a paper on a study conducted in Alexandria on 68 premature children. Controls were full-term children, double the number of prematures, and matched by age and sex. The first part presented differences in growth and development in relation to prematurity. This part deals with risk factors for prematurity. The study revealed that low educational level of fathers and parental smoking were significant risk factors for prematurity. The mean age of both parents and mothers’ gravidity were significantly higher for prematures. Other risk factors were identified. Mothers with diabetes and chronic nephritis were more likely to have a premature child

scholarly journals Risk Factors for Recurrent Syndesmotic instability after Syndesmotic Screw Fixation in Rotational Ankle Fractures

2019 ◽  
Vol 4 (4) ◽  
pp. 2473011419S0004
Author(s):  
Sunghyun Lee ◽  
Hoiyoung Kwon
Keyword(s):  
Risk Factors ◽  
Screw Fixation ◽  
Significant Risk ◽  
Ankle Fractures ◽  
Binary Logistic Regression Analysis ◽  
Malleolar Fracture ◽  
Syndesmotic Screw ◽  
Posterior Malleolar Fracture ◽  
The Mean ◽  
Recurrence Group

Category: Ankle Introduction/Purpose: Rotational ankle fractures often have unstable syndesmotic injuries the require reduction and stabilization. Though multiple studies have focused on methods to assess accurate syndesmotic reduction, fairly high rates of recurrent syndesmosis diastasis were reported. However, there was no study to investigate possible risk factors for syndesmosis widening after surgical fixation. The purpose of this study was to identify the risk factors for recurrent syndesmosis widening after screw fixation. We hypothesized that risk factors for recurrence syndesmosis widening could be identified from patient demographic, intraoperative variables and the extent of the pathologic condition associated with fractures. Methods: We performed a retrospective review between 2009 and 2015 of consecutive patients who had sustained rotational ankle fractures with intraoperative evidence of syndesmotic instability requiring syndesmotic reduction and stabilization. The exclusion criteria included syndesmosis screws placed for diabetic neuropathy, skeletal immaturity, tibial pilon fractures, polytrauma, open fracture. Patients were sorted into 2 groups according to the presence of recurrent syndesmosis instability which was defined as a difference in the tibiofibular distance of =2 mm between the injured and uninjured ankles on CT at postoperative 1 year and a positive external rotation test. Furthermore, the statistical analysis by binary logistic regression analysis included the significance of various risk factors including age at surgery, sex, diabetes, smoking, body mass index (BMI), dominant side, type of fracture, associated fracture, initial tibiofibular distance on CT, number and size of screws, cortices. The functional outcomes were assessed with the Foot and Ankle Outcome Score (FAOS). Results: A total 126 patients met the study inclusion criteria and underwent analysis. The overall postoperative recurrent instability rate was 25.4% (without recurrence group: 94 patients, recurrence group: 32). It was significantly affected by the BMI (p=0.018; adjusted odds ratio, OR, = 30, 6.21) and concomitant posterior malleolar fracture (p=0.040, adjusted OR 3.31). The other variables were not found to be significant risk factors. There was a significant improvement in the mean clinical scores at one years postoperatively (both p < 0.001), but the mean scores in the group with recurrence were significantly lower than those in the group without recurrence (p=0.021) Conclusion: Among the risk factors, obesity and concomitant posterior malleolar fracture were significant risk factors for the recurrent syndesmotic instability after syndesmotic screw fixation. The overall results suggest meticulous attention to concomitant posterior malleolar fracture, especially in obese patients.

Clinical effectiveness of intrastromal corneal ring segments among keratoconus patients

2020 ◽  
Vol 1 (3) ◽  
pp. 140-144
Author(s):  
Abdullhamid Alghamdi ◽  
Keyword(s):  
Visual Acuity ◽  
Femtosecond Laser ◽  
Surgical Intervention ◽  
Clinical Effectiveness ◽  
Ophthalmic Examination ◽  
Visual Outcomes ◽  
Intrastromal Corneal Ring ◽  
Uncorrected Visual Acuity ◽  
The Mean

AIM: To evaluate the clinical effectiveness of intrastromal corneal ring segments (ICRS) among the patients suffering from keratoconus. METHODS: A retrospective and non-comparative interventional design had been utilized on the basis of postoperative follow-up among 56 keratoconus patients. Visual acuity was significantly assessed during complete ophthalmic examination of the patients. The femtosecond laser had been used to create the corneal tunnels in 15 eyes; whereas, the corneal tunnels were created in 72 eyes mechanically. RESULTS: The ranges and standard deviations had been used to obtain results. It had been revealed through ophthalmic assessment that the mean preoperative uncorrected visual acuity observed was 1.38±0.37 logarithm of Minimal Angle of Resolution. Moreover, a significant improvement was observed postoperatively in visual acuity by 0.58±0.32 during the 4th month. The improvement was also witnessed in the 16th month by 0.48±0.30. CONCLUSION: The implantation of ICRS is an efficient and effective surgical intervention for the treatment of keratoconus. Thus, identified intervention seems to be associated with appropriate visual outcomes and safety after the development of femtosecond as well as mechanical tunnels.

scholarly journals Complications of Intrastromal Corneal Ring Implantation (Keraring 355°) using a Femtosecond Laser for Channel Creation

2014 ◽  
Vol 3 (2) ◽  
pp. 53-56 ◽  
Author(s):  
Khosrow Jadidi ◽  
Seyed Aliasghar Mosavi ◽  
Farhad Nejat ◽  
Aliagha Alishiri
Keyword(s):  
Side Effects ◽  
Postoperative Complications ◽  
Femtosecond Laser ◽  
Case Series ◽  
Common Complication ◽  
Small Case Series ◽  
Intrastromal Corneal Ring ◽  
Belo Horizonte ◽  
Postoperative Problems ◽  
Corneal Melting

ABSTRACT Purpose To report complications after the implantation of Keraring 355° intrastromal corneal ring (ICR; Mediphacos, Belo Horizonte, Brazil) in keratoconic eyes using a Ziemer LDV femto- second laser (Ziemer AG, Switzerland) for channel creation. Materials and methods Five eyes suffering from keratoconus underwent Keraring 355° insertion using Ziemer LDV for corneal pocket creation. Intraoperative and postoperative complications were recorded. Results While intraoperatively there were no complication, postoperatively all cases showed severe side effects. Conclusion In this small case series, intracorneal ring (Keraring 355°) implantation using a femtosecond laser for channel creation was related to a number of significant postoperative problems in all cases. The most common complication was corneal melting (postoperatively). How to cite this article Jadidi K, Mosavi SA, Nejat F, Alishiri A. Complications of Intrastromal Corneal Ring Implantation (Kera- ring 355°) using a Femtosecond Laser for Channel Creation. Int J Kerat Ect Cor Dis 2014;3(2):53-56.

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