scholarly journals Clinical efficiency of the combined application of physiotherapeutic technologies and drinking mineral waters in patients with curral skin changes under conditions of insulin resistance

2021 ◽  
Vol 20 (2) ◽  
pp. 147-154
Author(s):  
Christina V. Kazantseva ◽  
Sergey N. Nagornev ◽  
Valery K. Frolkov ◽  
Elena V. Gusakova ◽  
Maria S. Nagorneva
Keyword(s):  
Quality Of Life ◽  
Metabolic Syndrome ◽  
Laser Therapy ◽  
Mineral Water ◽  
Clinical Manifestations ◽  
Main Group ◽  
Mineral Waters ◽  
Control Group ◽  
Combined Application

BACKGROUND: One of the effective and pathogenetically substantiated methods of therapeutic action on cicatricial changes in the skin are laser technologies in combination with collagenases. However, as previous studies have shown, the presence of metabolic syndrome in patients significantly reduces the clinical efficacy of the combined use of laser therapy and phonophoresis of Fermencol. The most reasonable solution in this situation can be scientific research and experience in the practical use of drinking mineral waters, which have a high corrective efficiency in relation to metabolic processes, the course of which is significantly impaired in type II diabetes mellitus and metabolic syndrome. AIMS: Assessment of clinical indicators of cicatricial changes in the skin of patients with metabolic syndrome in the combined application of the method of phonophoresis Fermenkol, fractional photothermolysis and drinking mineral waters. MATERIAL AND METHODS: The study included 60 patients (49 men and 11 women) with cicatricial changes in the skin aged 19 to 50 years, with a confirmed diagnosis of metabolic syndrome. All patients by the method of simple fixed randomization were divided into two groups: the control group (30 people) and the main group (30 people). Both groups received treatment, which included a course of phonophoresis of 0.01% Fermencol gel in combination with the technique of fractional laser therapy. Patients of the main group, in contrast to the control group, in addition to the specified physiotherapeutic treatment received bottled sodium bicarbonate-chloride water Essentuki No. 17 (mineralization 11.8 g/l) at room temperature, 200250 ml three times a day for 1520 minutes before meals for 3 weeks. RESULTS: The addition of physiotherapeutic combined anti-scar therapy with a course of drinking mineral water Essentuki No. 17 in patients with cicatricial changes in the skin in combination with metabolic syndrome was accompanied by a significantly more pronounced clinical effect, assessed by the Vancouver scale and the Dermatological Index of Quality of Life. CONCLUSION: Additional course use of drinking mineral water Essentuki No. 17 is accompanied by a more pronounced dynamics of clinical manifestations of cicatricial deformities of the skin and an indicator of the quality of life of patients, due to the sanogenetic mechanisms of the drinking balneofactor.

scholarly journals New approaches to medical rehabilitation of patients with chronic pancreatitis at hospital stage

2019 ◽  
Vol 18 (2) ◽  
pp. 81-85
Author(s):  
Anna N. Makhinko
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Physical Therapy ◽  
Mineral Water ◽  
Main Group ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Therapeutic Factors ◽  
Standard Drug

The research objective is to study therapeutic effectiveness of the medical rehabilitation program of patients suffering from chronic pancreatitis at the stationary stage with combined use of physical therapeutic factors against the background of standard pharmacotherapy. Materials and methods. In the therapeutic department of City Clinical Hospital No. 1 in Krasnodar there have been examined and treated 159 patients with acute chronic pancreatitis. By simple randomization, 4 groups were formed: the main group (39 people) received a standard drug therapy; the 1st group of comparison (38 people) additionally received physical therapy; the 2nd group of comparison (40 people) got drinking mineral water Slavyanovskaya in addition to the treatment in the 1st group of comparison; in the main group (42 people) the patients received preformed peloido-therapy (PPT) on the cervical collar zone in addition to the treatment in the 2nd group of comparison. All the patients before and after medical rehabilitation underwent clinical and laboratory research, the assessment of quality of life). Results. In the main group leveling of clinical symptoms occurred by 78.2% (p 0.01) on average, in the 1st group of comparison by 71.5% (р 0,01), in the 2nd group of comparison by 62.3% (p 0.01), in the control group by 57.2%. Decrease in anxiety intensity with patients suffering from chronic pancreatitis in case of complex medical rehabilitation (main group) occurred by 47.6% (p 0.01) compared with the data before medical rehabilitation; after additional inclusion physical therapy and drinking mineral water in the treatment complex by 42.6% (p 0.01); in the main group after inclusion complex pharmacotherapy and physical therapy by 34% (p 0.01) and in the control group by 30.7% (p 0.01) after using only standard pharmacotherapy. Positive dynamics of clinical and laboratory indicators was accompanied by significant improvement of quality of life at combined medical rehabilitation. Conclusion. The inclusion of physical therapeutic factors in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis contributes to levelling of clinical manifestations (abdominal pain, dyspepsia, and diarrhoea), significant improvement of excretory function of pancreas, which results in the improvement of quality of life of this category of patients.

Drinking mineral water in the correction of metabolic syndrome in patients with cicatricial skin changes

2021 ◽  
pp. 56-61 ◽  
Author(s):  
V. K. Frolkov ◽  
S. N Nagornev ◽  
K. V. Kazantseva
Keyword(s):  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Water Intake ◽  
Mineral Water ◽  
Clinical Manifestations ◽  
Practical Interest ◽  
Resistance Index ◽  
Mineral Waters ◽  
Skin Changes ◽  
Lipid Metabolism Disorders

The article analyzes the efficiency of complex physiotherapy in combination with internal intake of medium-mineralized water “Essentuki № 17” in patients with cicatricial skin changes in the presence or absence of metabolic syndrome. It was found that internal mineral water intake supplementing physiotherapy effectively corrected carbohydrate and lipid metabolism disorders by reducing the insulin resistance index, which contributed to a greater regression of clinical manifestations of cicatricial skin changes in patients with metabolic syndrome. Meanwhile, in the absence of metabolic syndrome, the course intake of mineral water did not signifi cantly affect complex physiotherapy, although the index of insulin resistance and body weight of patients significantly decreased. It is suggested that, given the presence of nonspecifi c preventive potential of the course of drinking mineral waters intake, there is some theoretical and possibly practical interest in research on pre-course mineral water intake before performing cosmetic operations to accelerate the process of skin regeneration and the formation of scarring in a less pronounced form.

Strengthening the pharmacological potential of drug therapy in treatment of patients with chronic pancreatitis by using therapeutic physical factors

2020 ◽  
pp. 8-14
Author(s):  
R. M. Mallaeva ◽  
A. N. Makhinko ◽  
M. B. Uzdenov
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Drug Therapy ◽  
Clinical Manifestations ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Physical Factors ◽  
Standard Drug ◽  
Pharmacological Potential

The purpose of the study is to improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs. Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG, 39 people) received standard drug therapy; 1st comparison group (GC1; 38 people) additionally received TPF; GC2 (40 people) in addition to treatment in GC1 had drinking mineral water «Slavyanovskaya»; in main group (42 people) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation. Results. In MG, clinical symptomatology leveling was by 78,2% (p<0,01), in GC1 — by 71,5% (p<0,01), GC2 — by 62,3% (p<0,01), CG — by 57,2% (p<0,01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34,4% (p<0,01), after 12 months — by 24,0% (p<0,05); mental — by 32,3% (p<0,01) and 22,5% (p<0,05), respectively. In both comparison groups, positive dynamics was 10–12% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators. Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

scholarly journals THE EFFECT OF NUTRITIONAL THERAPY ON QUALITY OF LIFE INDICATORS FOR PATIENTS WITH GASTRIC CANCER AT THE STAGE OF SURGICAL TREATMENT

2019 ◽  
Vol 6 (3) ◽  
pp. 108-114 ◽  
Author(s):  
A. D. Sergienko ◽  
V. E. Khoronenko ◽  
E. V. Gameeva ◽  
A. B. Ryabov ◽  
V. M. Khomyakov
Keyword(s):  
Quality Of Life ◽  
Gastric Cancer ◽  
Surgical Treatment ◽  
Nutritional Therapy ◽  
Main Group ◽  
Control Group ◽  
Quality Of Life Indicators ◽  
Eortc Qlq C30 ◽  
Eortc Qlq

Purpose of the study. To determine the effect of nutritional deficiency and nutritional therapy on the quality of life of patients with gastric cancer at the stage of surgical treatment. Patients and methods. In Thoracoabdominal Department of P. Herzen Moscow Oncology Research Institute within 2017– 2019 the quality of life at the stage of surgical treatment of gastric malignant neoplasms was evaluated in 62 patients (36 men and 26 women) aged 34 to 79 years (mean age 61.9 ± 9.55). At the outpatient stage, patients were divided into 2 groups: in the 1st (main) group, patients received nutritive support with specialized mixtures for 10 days before hospitalization, in the 2nd (control) group, patients were asked to follow a high-protein diet without adding specialized mixtures. The quality of life assessment was carried out on the basis of the EORTC-QLQ-C30 Questionnaire, which patients received on the day of hospitalization. Patients repeatedly filled in EORTC-QLQ-C30 Questionnaire before discharge from the hospital, which allowed to assess the dynamics of the quality of life indicators of the studied patients. The study groups were comparable in social and medical indicators. Results. The analysis of the survey results showed that the “general state of health” in the studied groups at the stage of hospitalization is estimated �bove average. Also, in both groups there is a positive dynamics in the values of the above indicator before discharge. Patients of the 1st group who received specialized nutritional mixtures, developed the statistical significance of the differences in the assessment of the quality of life upon admission and before discharge. Thus, it can be argued that nutritional therapy had a significant positive impact on the quality of life in terms of “general health”, in contrast to the control group of patients who did not receive specialized nutritional therapy. There was a general tendency toward an increase in the quality of life indicators at admission and before discharge on all scores of the questionnaire in groups. Thisis a positive assessment by patients of their condition after providing them with medical services. In this case, the discomfort from the symptoms accompanying the disease is reduced, which is confirmed by the scoring results. Statistically significant differences in the assessment of symptoms occur in the study group. Patients having received nutritional therapy noted a decrease in pain, an improvement in the processes of assimilation of food, as well as an improvement in well-being, physical condition, an increase in general tone and energy, a surge of strength and a sense of vitality. In “decreased appetite”score the indices of patients in the main group decreased by more than 3 times, i. e. their appetite improved significantly under treatment. Improving appetite in patients of the main group led to an improvement in the functioning of the gastrointestinal tract as a whole. Patients in this group noted an improvement in digestion and bowel movements. Conclusion The study showed that the quality of life of patients with gastric cancer largely depends on their nutritional deficiency, and nutritional therapy at the stages of surgical treatment, in turn, can significantly improve its results, including in the aspect of their perception by patients. Using the general EORTC QLQ-C30 questionnaire is one of the available methods for assessing the quality of life in patients with gastric cancer.

scholarly journals Minimally invasive combined surgical treatment of postcoital cystitis

2020 ◽  
Vol 21 (2) ◽  
pp. 20-25
Author(s):  
J. Sh. Inoyatov ◽  
O. V. Snurnitsyna ◽  
M. V. Lobanov ◽  
O. Yu. Malinina ◽  
Yu. L. Demidko ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Main Group ◽  
Control Group ◽  
Efficacy And Safety ◽  
Study Objective ◽  
Results Of Treatment ◽  
Main Disadvantage ◽  
Combined Technique ◽  
Treatment Profile

Introduction. Urethral transposition remains the most popular operation for postcoital cystitis, however, traumatism and complications, especially such as pudendal neuropathies, dyspareunia and anorgasmia, make us continue to search for effective, but safer techniques.The study objective is to evaluate the efficacy and safety of the proposed treatment of postcoital cystitis, including removal of urethrogymenal adhesions and subsequent paraurethral filler implantation, in comparison with isolated hymenoplasty.Materials and methods. Since 2013, 75 patients with postcoital cystitis have been treated. Patients were divided into two groups: main group – hymenoplasty (removal of urethral adhesions) with paraurethral filler implantation (n = 45), control group – hymenoplasty (n = 30). The gel was injected paraurethrically, fan-shaped, in the volume of 1–2 ml, from a point on the 6-hour conditional dial, creating a gel cushion and thus raising the meautus and distal urethra. To assess the quality of treatment, profile questionnaires were used.Results. In the main group of patient, the quality of life improved in 35 (78 %); in 5 patients, due to the process of biodegradation of the gel during 1 year, the cystitis recidivated, which required the filler reimplantation. In 5 patients, the operation was not effective. In the control group the efficiency of isolated hymenoplasty was noted in 3 (10 %) patients, relapse of cystitis occurred in 27 (90 %) patients, which later required the implantation of a filler. No complications were observed.Conclusions. The suggested combined technique allows to improve the results of treatment of patients with postcoital cystitis. The operation does not carry the risk of damage to the sprigs of the genital nerve, can serve as an alternative to traditional urethral transposition. The main disadvantage is the natural biodegradation of the gel, which may create the need for its reintroduction.

scholarly journals 1% ivermectin in combination therapy regimens for rosacea

2020 ◽  
pp. 17-23
Author(s):  
E. A. Khlystova ◽  
A. L. Savastenko
Keyword(s):  
Quality Of Life ◽  
Comparative Analysis ◽  
Combination Therapy ◽  
Combination Treatment ◽  
Clinical Manifestations ◽  
Life Quality ◽  
Clinical Results ◽  
Control Group ◽  
Before And After

Introduction. The article provides latest data on modern methods of treating rosacea. The results of own clinical observations of patients with moderate to severe papulopustular rosacea receiving combination treatment and a comparative analysis of the efficacy of various therapy regimens are presented.Objective of the study. The aim of the study was to conduct a comparative analysis of the therapeutic efficacy of combination therapy using the ivermectin 1% topical drug combined with systemic therapy drugs (doxycycline, minocycline, isotretinoin).Materials and methods. We observed 37 patients with moderate to severe papulo-pustular rosacea subtype. The patients were divided into 4 groups (A, B, C, D). Patients in the control group received monotherapy with 1% ivemectin topical drug, patients in the other groups received combination therapy (1% ivermectin combined with low-dose doxycycline, minocycline and isotretinoin). The efficacy of the therapy was evaluated by measuring rosacea severity on the Scale for Diagnostic Assessment of Rosacea (SDAR), clinical manifestations according to the IGA (Investigator Global Assessment) criteria, and by assessing the patients' quality of life using the DLQI (Dermatology Life Quality Index) questionnaire before and after 3-month treatment.Results. The comparative analysis of changes in severity indicators of the skin process and quality of life in patients with moderate to severe papulopustular rosacea after topical and combination therapy showed that the results of the treatment in patients receiving combination therapy were more significant than those in the group receiving monotherapy.Conclusion. The concomitant use of 1% ivermectin and systemic drugs is most effective in patients with severe papulopustular rosacea subtype. The combination treatment tailored to the clinical forms and severity of rosacea allows to optimize the clinical results of the therapy, which significantly affects the patients' quality of life and opens up potential for an individual approach in the algorithms for the treatment of rosacea.

scholarly journals Pharmacological potential strengthening of drug therapy in treating patients with chronic pancreatitis by using therapeutic physical factors

2021 ◽  
Vol 19 (5) ◽  
pp. 293-298
Author(s):  
Raziyat M. Mallaeva ◽  
Anna N. Makhinko ◽  
Marat B. Uzdenov
Keyword(s):  
Quality Of Life ◽  
Chronic Pancreatitis ◽  
Drug Therapy ◽  
Clinical Manifestations ◽  
Medical Rehabilitation ◽  
Control Group ◽  
Physical Factors ◽  
Standard Drug ◽  
Pharmacological Potential

Background. The steady increase in the incidence of chronic pancreatitis, its aggressive course in recent years, as well as the insufficient therapeutic effect of standard techniques determine the relevance of the search for new approaches to the treatment and medical rehabilitation of this category of patients. Aims. To improve rehabilitation treatment of patients with chronic pancreatitis (CP) at inpatient stage by strengthening pharmacological potential of drug therapy due to inclusion of therapeutic physical factors (TPF) in therapeutic programs. Materials and methods. 159 patients with acute CP were observed. By simple randomization, 4 groups were formed: the control group (MG; n=39) received standard drug therapy; 1st comparison group (GC1; n=38) additionally received TPF; (GC2, n=40) in addition to treatment in GC1 had drinking mineral water "Slavyanovskaya"; in main group (n=42) in addition to the treatment in GC2 got preformed peloidotherapy on the cervical-collar zone. All the patients underwent the evaluation of clinical score and quality of life before and after medical rehabilitation. Results. In MG, clinical symptomatology leveling was by 78.2% (р 0.01), in GC1 by 71.5% (р 0.01), GC2 by 62.3% (р 0.01), CG by 57.2% (р 0.01) on average immediately after the treatment, which was in a clear correlation with indicators of quality of life. In the long term (in 6 and 12 months), the advantage of combination therapy was noted with the same validity, the preservation of the achieved positive result was mostly noted in the MG: after 6 months the improvement in physical health compared to the initial values was noted by 34.4% (р 0.01), after 12 months by 24.0% (р 0.05); mental by 32.3% (р 0.01) and 22.5% (р 0.05), respectively. In both comparison groups, positive dynamics was 1012% lower, and in the control group, after 6 months, there was only a tendency to improve quality of life indicators. Conclusion. The inclusion of TPF in the programs of the inpatient stage of medical rehabilitation of patients with chronic pancreatitis by strengthening the pharmacological potential of drug therapy contributes to the leveling of clinical manifestations (abdominal pain, dyspepsia and diarrhea), the result of which is an improvement in the quality of life of this category of patients.

scholarly journals QUALITY OF LIFE IN HYPERTENSIVE PATIENTS WITH METABOLIC SYNDROME: INTERRELATION WITH MARKERS OF SYSTEMIC INFLAMMATION

2013 ◽  
Vol 12 (6) ◽  
pp. 5-11 ◽  
Author(s):  
I. D. Bespalova ◽  
V. A. Bychkov ◽  
V. V. Kalyuzhin ◽  
N. V. Ryazantseva ◽  
Yu. A. Medyantsev ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Metabolic Syndrome ◽  
Systemic Inflammation ◽  
Clinical Laboratory ◽  
Control Group ◽  
Hypertensive Patients ◽  
Reactive Protein ◽  
Sf 36 ◽  
Cardiology Clinic

Object of research: to study the interrelation of activity of systemic inflammatory response and quality of life (QOL) and evidence of metabolic disorders in hypertensive patients with metabolic syndrome (MS).Material and methods. We carried out a study of 86 patients with hypertensive disease of II stage in combination with MS and 18 volunteers, who formed the control group. Along with a complete clinical, laboratory and instrumental examination, taken in a specialized cardiology clinic, the study of QOL using the MOS SF-36 questionnaire was carried out, as well as the research of activity of systemic inflammato-ry response.Results. We determined the reverse correlative interrelation of QOL indicators with all MS components, such as abdominal obesity, hyperglycemia, hypertriglyceridemia, the degree of arterial hypertension, but also with the level of markers of systemic inflammation (C-reactive protein, neopterin and fibrinogen), hyperinsulinemia and hyperleptinemia. It was found out that physical functioning (PF) has the strongest interrelations with the maximum number of clinical and laboratory indicators of MS and all the studied markers of systemic inflammation.

scholarly journals Improving the quality of life using physical therapy to correct excess weight in women

2020 ◽  
pp. 76-79
Author(s):  
L. Odiyaka ◽  
T. Baryshok
Keyword(s):  
Quality Of Life ◽  
Mental Health ◽  
Physical Therapy ◽  
Young Women ◽  
Main Group ◽  
Excess Weight ◽  
Control Group ◽  
Physical And Mental Health ◽  
Overweight Women

The article deals with the problem of overweight women and the measures that can influence it. The actual problem of reducing the quality of life of overweight women and the need to take this indicator into consideration when selecting the measures of physical therapy and assessing the quality of their use are raised. The results of the study of changes in quality of life after using of programs of physical therapy for the correction of excess weight are presented. The quality of life of young overweight women was evaluated using the SF-36 survey (physical and mental health). Experimental sample size: 10 females in the main group and 10 females in the control group. Weight loss program and improving the quality of life of young women through physical therapy lasted for 6 months. Programs of physical therapy in the main group was included elements of different directions of aerobics (classical aerobics, power aerobics, aerobics using different tools, aerobics with psycho-regulatory orientation) and nutrition correction. Programs of physical therapy in the control group was also included nutrition correction and fitness workouts with the use of simulators with a focus on strength and cycling. According to recent estimates, at least one in three adults in the world is overweight and almost one in 10 is obese. Being overweight is not only an aesthetic problem, it is a health threat that entails a number of illnesses and complications, reducing the quality of life. Not everyone knows that the risk of health problems manifests itself even with a slight overweight, and increases as you gain weight. For greater results in overweight correction, it is best to use aerobic and anaerobic fitness programs. A comprehensive physical therapy program has significantly improved the health of young women and has had a positive effect on physical and mental health. We have reason to believe that the overweight correction technique of the main group has proven to be more effective in improving the quality of life of women than the control group program.

scholarly journals A Randomized Comparative Study between High-Intensity and Low-Level Laser Therapy in the Treatment of Chronic Nonspecific Low Back Pain

2020 ◽  
Vol 2020 ◽  
pp. 1-6
Author(s):  
Walid Kamal Abdelbasset ◽  
Gopal Nambi ◽  
Saud F. Alsubaie ◽  
Ahmed M. Abodonya ◽  
Ayman K. Saleh ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Low Back Pain ◽  
Back Pain ◽  
Laser Therapy ◽  
High Intensity ◽  
Low Level Laser Therapy ◽  
Control Group ◽  
Low Back ◽  
Level Laser

Objectives. Chronic nonspecific low back pain (chronic nsLBP) is one of the most common musculoskeletal disorders leading to disabilities and physical inactivity. Laser therapy was used in chronic nsLBP treatment; however, no previous studies have assessed the impacts of high-intensity laser therapy (HILT) versus low-level laser therapy (LLLT) on chronic nsLBP. This study compared the effects of HILT versus LLLT on individuals suffering from chronic nsLBP. Methods. The study was a randomized control trial. Sixty individuals with chronic nsLBP were enrolled in this study between May and November 2019. All participants were clinically diagnosed with chronic nsLBP. They were assigned randomly into three groups, 20 in each group. The first group received a program of LLLT, the second group received a program of HILT, and the third did not receive laser therapy (control group). Pain severity, disability, lumbar mobility, and quality of life were assessed before and after 12-week intervention. Results. Both LLLT and HILT groups showed a significant improvement of the Oswestry Disability Index (ODI), visual analogue scale (VAS), lumbar range of motion (ROM), and European Quality of Life (EuroQol) scores ( p > 0.05 ), while the control group did not show significant changes ( p > 0.05 ). Comparison among the three study groups postintervention showed significant differences in the outcome measures ( p > 0.05 ), while comparison between the LLLT and HILT groups showed nonsignificant differences ( p > 0.05 ). Conclusion. There are no different influences of LLLT versus HILT on chronic nsLBP patients. Both LLLT and HILT reduce pain and disability and improve lumbar mobility and quality of life in chronic nsLBP patients.

Sign in / Sign up

Export Citation Format

Share Document