scholarly journals A randomized comparative study of effect of intramuscular valathemate bromide (epidosin) and intramuscular camylofin dihydrochloride (anafortan) on cervical dilatation in labour

2021 ◽  
Vol 10 (12) ◽  
pp. 4488
Author(s):  
Dinesh Mehra ◽  
Madhubala Chouhan ◽  
Shatendra Goyal
Keyword(s):  
Pain Relief ◽  
Comparative Study ◽  
Pain Score ◽  
Active Phase ◽  
Cervical Dilatation ◽  
Study Group ◽  
Medical College ◽  
Group I ◽  
Group Ii ◽  
Vertex Presentation

Background: Our aim is to search for a good cervical dilating agent which is not only more efficacious in cervical dilatation but also effective in relieving pain during labour with no or very little harmful effects on mother and foetus.Methods: The type of study was simple randomized comparative study. The present study was conducted in R. N. T. Medical College, Udaipur between October 2019 and December 2020. 118 patients were selected randomly. Two groups were made each consisting of 59 patients. First group received intramuscular camylofin dihydrochloride, second group received intramuscular (IM) valethamate bromide. Patients included in study group were: primigravidae/multigravidae, singleton full term gestation (37-40 weeks) with vertex presentation, cervical dilatation of ≥3 cm and patient excluded from study group with preclampsia, eclampsia, antepartum haemorrhage, any obstetric complications: cephalo pelvic disproportion, abnormal presentations.Results: Mean duration of active phase of first stage of labor was shorter in group I (313.17 minutes) than in group II (356.3 minutes) but not statistically significant. Mean cervical dilatation rate was significantly more in group I (2.02 cm/hour) than group II (1.81 cm/hour). Anafortan was effective in pain relief with mean pain score 5.31±1.06 while mean pain score for epidosin group was 7.37±1.07.Conclusions: In our study we observed that intramuscular camylofin dihydrochloride (anafortan) was more efficacious than IM valethamate bromide (epidosin) in shortening the duration of labor as well as in pain relief.

scholarly journals Comparison Intra Articular Steroid vs. Hydraulic Distention for the Treatment of Frozen Shoulder

2013 ◽  
Vol 1 (1) ◽  
pp. 3-9 ◽  
Author(s):  
GP Singh
Keyword(s):  
Pain Relief ◽  
Teaching Hospital ◽  
Frozen Shoulder ◽  
College Teaching ◽  
Muscle Relaxants ◽  
Medical College ◽  
Group I ◽  
Normal Sleep ◽  
Group Ii

Background Frozen shoulder is a chronic fibrosing condition of the capsule of the shoulder joint. OBJECTIVE The objective of the study was to compare the result of treatment of frozen shoulder by Hydraulic Distention under local anesthesia with steroid and intra articular steroid alone. Sample Size: 60 patients were taken in this study and were divided into two groups. Duration and Setting: The study was conducted in 2005-2006 treated in the department of orthopaedic, Janaki medical college Teaching Hospital, Janakpur. Materials and Methods: It was a prospective, observational, comparative and clinical study. Sixty patients were selected from Dhanusha District of Janakpur, Nepal. They were divided into two groups. Since January 2005 to January 2006 periods in the department of orthopedics surgery, Janaki Medical College & Teaching Hospital, Janakpur. The Group I was treated by hydraulic distention of glenohumeral joint with 50ml normal saline with steroid, oral medicines (analgesics and muscle relaxants) and exercises. Patients in group II were treated by intra-articular steroid followed by oral medicines (analgesics and muscle relaxants) and exercises. Results: The average age of patients in group I was 52 ± 2.16 years and 50 ± 2.03 in group II. There were 37 (63%) females and 23 (37%) males in our study. Female to male ratio was 1.7:1. All patients in group noted immediate pain relief with excellent return of range of motion (ROM) and resumption of normal sleep. At the end of 45 days of follow up all patients had returned to their normal daily activities. Most of them got excellent ROM and pain relief. All patients in group II noted immediate pain relief and resumption of almost normal sleep. At the end of 45 days of follow up most of the patient presented with good relief of pain but could not return to most of their normal activities because of less improvement in ROM. Conclusions: Hydraulic distension technique is quick, safe and gives early results, so it should be considered first for the treatment of frozen shoulder. DOI: http://dx.doi.org/10.3126/jucms.v1i1.8415   Journal of Universal College of Medical Sciences Vol.1(1) 2013: 3-9

scholarly journals A Prospective Study on the Relationship Between Cervical Dilatation at Initial Presentation in Labour and Subsequent Outcome in Nulliparous Women

2014 ◽  
Vol 13 (1) ◽  
pp. 39-41
Author(s):  
Smriti Kona Kabiraj ◽  
Juthi Bhowmik ◽  
Haradhan Deb Nath
Keyword(s):  
Caesarean Section ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Fetal Distress ◽  
Cervical Dilatation ◽  
P Value ◽  
Nulliparous Women ◽  
Group I ◽  
Increased Risk ◽  
Group Ii

Background: The spontaneous birth of a live infant can convey a huge degree of both satisfaction and achievement for both the mother and her partner. Many factors influence the variation in rates of caesarean section among hospitals throughout the world. These included patients’ demographic characteristics, underlying medical and obstetric complication, hospital facilities, hospital practice and physician practice style. Objective: The present study was planned to determine how the outcome of women change with timing of admission either in active or latent phase of spontaneous labour.Methods: This was a prospective observational study, which was conducted at labour ward, department of Obstetrics and Gynaecology, BSMMU hospital and DMCH Dhaka, from February 1, 2008 to August 30, 2008, where data were collected prospectively. Patients with any medical or obstetric complications, rupture of membrane antenatally diagnosed fetal anomalies or death and with prior caesarean section were excluded from the study. Patients with cervical dilatation at less than 4cm were in group I. On the other hand, patients with cervical dilatation of 4 cm or more in active phase and these types of patients were allocated in group II.Results: Outcome differences were compared using chi-square(X2) test, fishers exact test, A ‘p’ value <0.05 considered significant. Main outcome variables were duration of labour, mode of delivery, indication for caesarean section, need for oxytocin, labour analgesia, Apgar score <7, maternal PPH and postpartum hospital stay. A total 500 patients were enrolled during the study period. Of them 308 patients were (61.6%) in group I and 192 patients (38.4%) in group II. Dystocia was the main indication for caesarean delivery in early admitted group which was 58.6% and fetal distress in late admitted group which was 37.5%. Second commonest indication for caesarean section was fetal distress which was 31.6% in group I and dystocia 50.0% in group II). Oxytocin for augmentation was used in 70.0% in group I and 30.0% in group II.Conclusion: It is shown that early admission to the hospital in low-risk women may negatively affect the outcome of labour and are at increased risk of prolonged labour, more oxytocin used, increased rate of caesarean section.DOI: http://dx.doi.org/10.3329/cmoshmcj.v13i1.19417

scholarly journals The Role of Partograph in the Outcome of Spontaneous Labor

2014 ◽  
Vol 9 (1) ◽  
pp. 52-57 ◽  
Author(s):  
U Sanyal ◽  
S Goswami ◽  
P Mukhopadhyay
Keyword(s):  
Active Phase ◽  
Singleton Pregnancy ◽  
Group Iii ◽  
Medical College ◽  
Group I ◽  
Group Ii ◽  
One Year ◽  
Labour Room ◽  
The Right

Aims: The objective of the paper is to study the role of partogram in the outcome of spontaneous labour in primigravidae at term with singleton pregnancy and vertex as the presenting part. Methods: This prospective observational study was carried out in the labour room of the department of Gynaecology and Obstetrics of Medical College & Hospital, Kolkata, over a period of one year i.e. from June 2011 to May 2012 after obtaining approval from the institutional ethical committee. Analysis of the progress of labour was done in five hundred women with the help of modified WHO partograph. The study population was divided into three groups. Group I had a total observed duration of active stage six hours or less and their cervicograph remained on or to the left of the alert line. Group II had total observed duration of active phase between more than six hours and less than ten hours and their cervicograph remained between the alert and action line. Group III, who had the duration of observed active phase more than 10 hours, had their cervicograph crossing the action line. The different types of abnormal labor were studied. The maternal and fetal outcomes were assessed. Results: 80.8% of the women belonged to group I, 15.2% to group II and 4% to group III. Surgical interference increased as the labour curve moved to the right of the alert line. Use of partogram helped in overall reduction in the duration of labour. Timely intervention reduced the incidence of prolonged labour and its sequelae. 19.2% of the women showed abnormal labour . Severe complications were successfully averted. There were no cases of maternal death, puerperal sepsis, ruptured uterus or fresh still births. Overall neonatal mortality rate was also reduced. Conclusions: The use of modified WHO partograph significantly improves the outcome of labour in both maternal & neonatal perspective. The WHO partograph should be used in all maternity units with incorporated management guidelines. DOI: http://dx.doi.org/10.3126/njog.v9i1.11189 NJOG 2014 Jan-Jun; 2(1):52-57

scholarly journals Impact of Timing of Admission in Labour on Subsequent Outcome

2013 ◽  
Vol 2 (1) ◽  
pp. 21-28 ◽  
Author(s):  
Junnu Rayen Janna ◽  
Saleha Begum Chowdhury
Keyword(s):  
Caesarean Section ◽  
Hospital Stay ◽  
Apgar Score ◽  
Caesarean Delivery ◽  
Active Phase ◽  
Cervical Dilatation ◽  
Group I ◽  
Significant Difference ◽  
Group Ii ◽  
Latent Phase

To examine the effect of timing at which women admitted either in active or latent phase of spontaneous labour on subsequent outcome. This cross-sectional study was conducted at labour ward, department of Obstetrics and Gynaecology, BSMMU hospital, Dhaka, Bangladesh, from August 2007 to November 2007, where data were collected prospectively. A total of 60 women with term, singletone pregnancy, cephalic presentation with spontaneous onset of labour admitted in labour either in active or latent phase were selected for evaluation. Patients with any medical or obstetric complications, rupture of membrane, antenatally diagnosed foetal anomalies or death and with prior caesarean section were excluded from the study. Patients with cervical dilatation at less than 4cm were categorized as latent phase and were in group I. On the other hand, patients with cervical dilatation of 4 cm or more were marked as in active phase and were allocated in group II. Baseline characteristics were compared. Outcome differences were compared using chi-square(X2) test, t test, fisher’s exact test, A ‘p’ value <0.05 considered significant.  Duration of labour, mode of delivery, indication for caesarean section, need for oxytocin, labour analgesia, Apgar score <7, birth weight of baby, maternal PPH and postpartum hospital stay. A total of 60 patients were enrolled during the study period. Of them 35 patients (58.3%)were in group I and 25 patients (41.7%) in group II. Duration of labour was more in early admitted group compared to late admitted group (mean± SD 17.0 ± 2.8 vs 14.3 ± 2.4). Latent phase women needed more caesarean delivery than active phase women (62.9% vs 28.0%). Dystocia was the main indication for caesarean delivery in the present study which was 68.2% and 28.6% in early and late admitted group respectively. Second commonest indication for caesarean section was foetal distress (6 in group I and 5 in group II). Oxytocin for augmentation was used in 62.9% in group I and 56.0% in group II and nulliparae women were the one who needed more augmentation (40.0% in group I, 36.0% in group II). Mean foetal weight between two groups did not reach any significant difference (p>0.05). Apgar score <7 shows insignificant difference between two groups. PPH was found in 5.7% cases and all were from group I. Total postpartum hospital stay was significantly longer in group I than group II (p<0.05). t is shown that early admission to the hospital in low-risk women may negatively affect the outcome of labour and are at increased risk of prolonged labour, more need for analgesia, increased rate of caesarean section, increased PPH and postpartum hospital stay. DOI: http://dx.doi.org/10.3329/cbmj.v2i1.14177 Community Based Medical Journal Vol.2(1) 2013 21-28

TO COMPARE THE EFFICACY OF DROTAVERINE HYDROCHLORIDE AND VALETHAMATE BROMIDE IN SHORTENING OF THE FIRST STAGE OF LABOUR AT OBSTETRICS AND GYNAECOLOGY DEPARTMENT OF JLNMCH, BHAGALPUR, BIHAR

2021 ◽  
pp. 80-82
Author(s):  
Archana Jha ◽  
Satyendra Kumar ◽  
[Prof.] Usha Kumari ◽  
Debarshi Jana
Keyword(s):  
Side Effects ◽  
Average Duration ◽  
Average Rate ◽  
Mode Of Delivery ◽  
Active Phase ◽  
Cervical Dilatation ◽  
Group I ◽  
Active Labour ◽  
Drotaverine Hydrochloride ◽  
Group Ii

Background: To compare the efcacy of Drotaverine Hydrochloride and Valethamate Bromide in shortening of the rst stage of Labor. Drotaverine is more effective in regards of shorten the 1st stage of labor, rate of cervical dilatation with less side effects in compare to Valethamate Bromide. Methods:Two Hundred demographically similes woman with full term pregnancy in active labour were included in the study and divided into two groups viz. First Group: 100 women were given injection Drotaverine Hydrochloride (Drotin) 40 mg intramuscularly at 3-4 cm dilation at two hour interval. Second Group: 100 women were given injection Valethamate Bromide Intramuscularly at 3-4 cm dilation at one hour interval. Maximum three injections were given in both the groups. Comparative analysis was carried out as regards to duration of various stages of labor, rate of cervical dilatation, mode of delivery, side effects and feto-maternal outcome. Results: In Group-I Average duration of active phase of rst stage of labor was 149.78 minutes. In Primigravida it was 170.22 minutes and 129.35 minutes in Multigravida. In Group II Average duration of active phase of rst stage of labor was 294.62 minutes. In Primigravida it was 321.71 minutes and 267.54 minutes in Multigravida. Average rate of cervical dilatation in Group-I was 2.81cm/hour. In Primigravida it was 2.50 cm/hour while in Multi gravid it was 3.33cm/hour. In Group-II average rate was 1.42 cm/hour, in Primigravida it was 1.30 cm/hour and in Multigravida1.57 cm/hour. Conclusions: Drotaverine signicantly shorten the duration of rst stage of labor and found to be safe with no adverse effect on the mother and fetus.

Impact of maternal thyroid disease on neonatal thyroid status

2020 ◽  
Vol 0 (0) ◽  
Author(s):  
Lakshmi Venugopalan ◽  
Aishwarya Rajan ◽  
Hemchand. K. Prasad ◽  
Anupama Sankaran ◽  
Gnanabalan Murugesan ◽  
...  
Keyword(s):  
Congenital Hypothyroidism ◽  
Thyroid Stimulating Hormone ◽  
Study Group ◽  
Thyroid Status ◽  
Case Identification ◽  
Group I ◽  
Group Ii ◽  
Maternal Thyroid ◽  
Heel Prick ◽  
Stimulating Hormone

AbstractObjectivesPrevalence of Maternal and congenital hypothyroidism is on the rise. To present the thyroid stimulating hormone screening results in babies born to hypothyroid mothers and assess the burden, aetiology of hypothyroidism in these babiesMethodsAll antenatal mothers attending our hospital during the study period were enrolled into the study. Group I includes 249 term babies born to hypothyroid mothers and group II comprises 2154 newborns born to mothers who are euthyroid. Heel prick thyroid stimulating hormone was done for all newborns on day 3 for both groups. Confirmatory venous testing was done for all for babies in group I and screen positives belonging to group II. Evaluation and therapy done as per standard guidelines.ResultsThyroid stimulating hormone values in the two groups are presented. There was significant correlation between peak maternal thyroid stimulating hormone and neonatal day 3 heel prick in group I (r=0.7, P<0.05). The prevalence of positive screening test in groups I and II was 3.8 and 1.03% (p<0.05) whereas corresponding values for confirmed disease was 4.3 and 0.6%, respectively (p<0.05). Aetiological evaluation revealed both transient hypothyroidism (33.3%) and permanent hypothyroidism (66.6%).Conclusion4.3% of babies born to hypothyroid mothers develop congenital hypothyroidism; aetiology being both transient and permanent. A venous test by 3 weeks is helpful in these babies to improve case identification.

scholarly journals A prospective study on effectiveness of drotaverine in acceleration of labor

2019 ◽  
Vol 2 (3) ◽  
pp. 137-141
Author(s):  
Padma Raj Dhungana ◽  
Rajesh Adhikari ◽  
Prem Raj Pageni ◽  
Apsara Koirala ◽  
Anand Nepal
Keyword(s):  
Prospective Study ◽  
Drug Administration ◽  
Active Phase ◽  
Delivery Mode ◽  
Normal Delivery ◽  
Group I ◽  
Vacuum Delivery ◽  
Drotaverine Hydrochloride ◽  
The Mean ◽  
Group Ii

Background: Labor is a naturally occurring physiological process associated with uterine contractions, effacement, dilatation of cervix and descent of presenting part. Drotaverine hydrochloride is a non-anticholinergic isoquinoline derivative which acts by elevating intracellular cyclic Adenosine Mono Phosphate (cAMP) and cyclic Guanosine Mono Phosphate (cGMP) promoting smooth muscle relaxation. Materials and Method: This was a hospital based prospective study on effectiveness of Drotaverine Hydrochloride on enhancing dilatation of cervix and acceleration of active phase of labor. The sample size was 100. Fifty cases of women in active phase of labor received injection drotaverine hydrochloride 40 mg (group i) and fifty cases of women did not receive any drug (group ii) among those at term with singleton pregnancy and vertex presentation. Variables like maternal age, interval between administration of drug and delivery, mode of delivery, apgar score at 5 minutes, NCU (Neonatal Care Unit) admission and neonatal outcomes were recorded. Data analysis was done with the help of SPSS program. Results: The mean interval between drug administration to delivery in primipara and multipara in group i was 3.05 hours and 2.31 hours while in group ii was 4.5 hours and 3.75 hours respectively. The mean interval between drug administration and delivery was shorter in both groups of multipara. In group i, 96% had normal delivery and 4 % had vacuum delivery and in group ii 90% and 10% had normal delivery and vacuum delivery respectively. None of the participants had caeserian section. There were no perinatal mortalities. Conclusion: The administration of drug Drotaverine Hydrochloride is effective in shortening duration of labor with favorable feto-maternal outcome.  

Comparative analysis of the effectiveness of surgical techniques for the treatment of Miller Class I gingival recessions

2021 ◽  
Vol 26 (2) ◽  
pp. 150-157
Author(s):  
R. R. Farkhshatova ◽  
L. P. Gerasimova ◽  
I. T. Yunusov
Keyword(s):  
Connective Tissue ◽  
Soft Tissues ◽  
Platelet Rich Plasma ◽  
Class I ◽  
Study Group ◽  
Connective Tissue Graft ◽  
Group I ◽  
Autologous Platelet Rich Plasma ◽  
Group Ii ◽  
Autologous Platelet

Relevance. It is currently relevant to study and compare the effectiveness of the autologous connective tissue grafts and the combination of collagen-based and autologous platelet-rich plasma in the surgical treatment of Miller Class I gingival recessions.Materials and methods. We examined and treated 48 (20 male (41.67%) and 28 female (58.33%)) patients aged from 25 to 40 years with Miller Class I gingival recessions. All gingival recessions were treated surgically using a modified twolayer tunnel technique. The patients were divided into two groups according to the graft type. Group I (24 patients (50%) had a connective tissue graft from the hard palate. Group II (24 patients (50%) used the combination of the autologous platelet-rich plasma and 3D collagen matrix Fibromatrix for the regeneration of oral soft tissues. We removed the sutures on the 14th day. The patients were followed up on the 7th and 14th days and in 1.3 months.Results. 48 Miller Class I gingival recessions were treated between 2018 and 2020. The depth of gingival recessions averaged 3.5 ± 1.13 mm before treatment. The level of the attached keratinized gingiva regarding the cementoenamel junction significantly (p < 0.001) improved in both groups after the surgery. The width and thickness of the keratinized gingiva best increased in group II. The mean effectiveness of gingival recession treatment was 84% in study group I and 96% – in study group II. Pain syndrome, fibrinous plaque and soft tissue edema were insignificant in group II.Conclusion. The combination of the autologous platelet-rich plasma and Fibromatrix, collagen 3D matrix, for the regeneration of the oral soft tissues is a more effective technique for the treatment of Miller Class I gingival recessions. This technique has several advantages. It is minimally invasive, less painful, soft tissue postoperative swelling is less and the received volume of the attached keratinized gums is larger than with a connective tissue graft. 

Comparison of the Effects of Low Dose Methylprednisolone and Metoclopramide on Nausea and Vomiting and Respiratory Complications after Adenotonsillectomy

2021 ◽  
Vol 15 (9) ◽  
pp. 2753-2756
Author(s):  
Shahid Adalat Chaudhry ◽  
Madiha Zafar ◽  
Usman Zeeshan ◽  
Mubashar Iqbal ◽  
Arooj Fatima ◽  
...  
Keyword(s):  
Side Effects ◽  
Pain Score ◽  
Low Dose ◽  
Operative Time ◽  
Oral Intake ◽  
Respiratory Complications ◽  
Group I ◽  
Male Patients ◽  
Group Ii ◽  
Mean Time

Objective: The aim of this study is to compare the effects of low dose methylprednisolone and metoclopramide on nausea, vomiting and respiratory complications after adenotonsillectomy. Study Design: Retrospective study Place and Duration: The study was conducted in Divisional Headquarter Teaching Hospital, Mirpur AJK for duration of six months from December 2020 to May 2021. Methods: Total 150 patients of both genders underwent adenotonsillectomy presented in this study. Patients were aged between 3-15 years. Detailed demographics of enrolled cases age, sex and weight were recorded after taking informed written consent. Patients were equally divided into two groups. Group I had 75 patients and received 1 mg/kg IV methylpredinosolone and group II received 0.15 mg/kg metoclopramide among 75 patients. Post-operative effects on PONV were assessed and compared among both groups in terms of oral intake time, vomiting episodes, respiratory complications and side effects. Mean pain score was calculated by VAS. Complete data was analyzed by SPSS 23.0 version. Results: There were 40 (53.3%) females and 35 (46.7%) males in group I with mean age 9.43±1.44 years while in group II 42 (56%) were females and 33 (44%) were male patients with mean age 8.04±3.36 years. Mean weight of the patients in group I was 23.08±4.61 kg and in group II mean body weight was 22.11±6.84 kg. Mean operative time in group I was 27.41±8.53 min and in group II mean time was 28.17±6.34 min. Post-operative frequency of vomiting and nausea was lower in group I 14 (18.7%) and 16 (21.3%) as compared to group II 21 (28%) and 24 (34%). Low pain score was found in group I 1.71±6.11 as compared to group II 3.02±4.09. Time to oral intake was higher in group II 2.98±3.48 hours as compared to group I 1.09±7.51 hours. Rate of respiratory complications and side effects were significantly higher in group II. Conclusion: We concluded in this study that the use of methylpredinosolone was effective among patients those underwent for adenotonsillectomy in terms of post-operative frequency of PONV, pain, respiratory complications and side effects. Except this low dose of methylpredinosolone were effective in earlier tolerance of oral intake. Keywords: Adenotonsillectomy, Metoclopramide, Methylpredinosolone, Oral Intake

scholarly journals TO STUDY THE ONSET AND PROGRESSION OF AIRWAY ABNORMALITY IN TERMS OF ALTERATION IN PFT IN ASYMPTOMATIC SMOKERS.

2019 ◽  
Vol 3 (11) ◽  
Author(s):  
Dr. Hitesh Kumar Solanki ◽  
Dr. Omnath P Yadav ◽  
Dr. Anita J Gojiya
Keyword(s):  
Lung Function ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Medical College ◽  
Group I ◽  
Significant Difference ◽  
History Of ◽  
Young Smokers ◽  
The Mean ◽  
Group Ii

The study was conducted in department of physiology, B J Medical College, Ahmedabad from Mar. 2012 to Feb. 2013. This was a cross-sectional study to evaluate the effect of smoking on lung   function and serum lipids in asymptomatic smokers   and comparable non   smokers. The mean of the various spirometric parameters were calculated of the subjects for both the groups. The mean FVC in group I and group II was 2.60 ± 0.62 L and 4.10 ± 0.64L respectively. The mean FEV1 in group I was 1.91 ± 0.57L and     3.19 ± 0.77L in group II Group I had mean FEF25% - 75% and PEFR of 1.98 ± 0.67L/sec and 4.50 ± 1.57L/sec respectively. Group II had mean FEF25 – 75% of 4.22 ± 1.23L/sec and a mean PEFR of 7.22 ± 1.42L/sec. In young smokers and asymptomatic, still the spirometric values were significantly deranged as compared to controls. Even smokers with history of less pack years of smoking also had significant abnormalities of lung function. All he spirometric values in the two groups had statistically highly significant difference and were higher in non-smokers as compared to smokers. The spirometric values were reduced in smokers with history of smoking for as low as two pack years. Keywords: Progression, PFT, Asymptomatic & Smokers

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