scholarly journals Implications of congenital heart disease on growth and development of paediatric cardiac surgical patients

2021 ◽  
Author(s):  
Mohammad Abdallah Khasawneh ◽  
Ashraf Fadel Mohammad ◽  
Safwan G. Al-Fawares ◽  
Odai Almomani ◽  
Fadi Al-Husban
Keyword(s):  
Cardiac Surgery ◽  
Nutritional Status ◽  
World Health ◽  
Surgical Patients ◽  
Perioperative Outcomes ◽  
Average Weight ◽  
Z Score ◽  
Patients Âgés ◽  
Icu Stay ◽  
Paediatric Patients

Background: To identify the prevalence, predictors and implications of malnutrition and failure to thrive (FTT) in paediatric cardiac surgical patients.Methods: Observational retrospective analysis of data of paediatric patients presenting for cardiac surgery at Queen Alia heart institute/Amman/Jordan between April 2020 and October 2020. Patients' ages, anthropometric measurements, diagnoses, type of surgical intervention, ICU stay and perioperative outcomes were recorded on a special form designed for the purpose of this study. Prevalence of malnutrition based on world health organization (WHO) and centers for disease control (CDC) growth charts was determined using height-for-age z-score (HAZ) and percentile, weight-for-age z-score (WAZ) and percentile, weight-for-height z-score (WHZ) and percentile. BMI was used for patients above 2 years of age in 109 paediatric cardiac surgical patients. Prevalence of malnutrition and FTT was examined according to age category and cardiac pathology). Patients were divided according to heart pathology into cyanotic and acyanotic CHD.Results: One hundred and nine pediatric cardiac surgical patients were presented for cardiac surgery (59 males and 50 females). Patients' age ranged from 2 days to 17 years (mean 3.7 years, SD±4.5 years). Patients' body weight ranged from 2.7 to 70 kg (mean 14.98 kg, SD±14.2 kg). Average weight percentile was 19.26 (SD±20.01) and ranged between 0.1 and 88.5 and the average Z-score for weight was -1.274±1.037 (mean±SD). The overall height percentile for the all patients with CHD averaged 18.53±17.1 (mean±SD) and the average Z-score for height was -1.1029±0.743 (mean±SD). Prevalence of isolated malnutrition and FTT was 33.2% and 20.2%. Normal nutritional status was found in 46.78%. Cyanotic type CHD was more commonly associated with FTT (p=0.001), longer cardiopulmonary bypass (p=0.001), higher intraoperative lactate (p=0.012) and aortic cross clamp times (p=0.001). Patients with malnutrition and FTT had average ICU stay of 4.32±2.219 days and averaged 4.772±2.065 days (mean±SD) respectively, which was almost double of the ICU stay of patients who had normal nutritional status 2.32±2.261 days (mean±SD).Conclusions: Prevalence of malnutrition and FTT is high in paediatric patients with CHD at time of presentation for surgery. Predicting factors for malnutrition and FTT are cyanotic type of CHD and smaller age. Malnutrition was associated with longer ICU stay.

scholarly journals Assessment of Nutritional Status of Preschool Children: Head Circumference and Other Anthropometric Indices

2019 ◽  
Vol 44 (3) ◽  
pp. 152-159
Author(s):  
K Yeasmin ◽  
T Yeasmin
Keyword(s):  
Preschool Children ◽  
Standard Deviation ◽  
Nutritional Status ◽  
Head Circumference ◽  
Reference Population ◽  
World Health ◽  
Z Score ◽  
Cross Sectional ◽  
Important Indicator ◽  
The Mean

Background: Undernutrition is one of the major responsible factors of morbidity and mortality among preschool children in the most developing countries. Weight for age Z-score (WAZ), height for age Z-score (HAZ) and weigh for height Z-score (WHZ) are widely used for indicating nutritional status of children. Therefore, the study was conducted to interpret the nutritional status based on head circumference for age z score (HCAZ), WAZ, HAZ and WHZ among children aged from 36 to 71 months in Rajshahi City area, Bangladesh. Methods: This cross-sectional study included one thousand and thirty five preschool children. Of them, 538 were boys and 497 were girls. Data were collected during the period of March 2017 to March 2018, using multistage random sampling method. Head circumference (HC) was measured (cm) and HC-for-age Z-score (HCAZ) was calculated according to World Health Organization recommendations. Z-score values of HC <-2 standard deviation below from the reference population were considered as undernourished. Z score -3 <HC< -2 standard deviation were taken as moderately undernourished whereas, ‘≤−3’ standard deviation were considered as severely undernourished, respectively. Results: Among boys the mean age and HC were 53.58 ± 10.68 and 48.62 ± 1.87 whereas, among girls the mean age and HC were 51.35 ± 11.17 and 48.00 ± 1.84 respectively. According to HC, the rate of moderate and severe malnourished children among boys were 33.3 % and 6.3% and among girls 30% and 13.5% respectively. The prevalence of malnutrition was higher according to HC for age in comparison to other parameters. The study revealed that 33.3% and 12.4% stunted, 41.3% and 12.7% underweight and 41.9% and 9.5% wasted children were moderately malnourished and severely malnourished according to HC respectively. The relationship between these three indicators and HC for age were statistically significant. Conclusion: As head circumference (HC) is a reliable physical index of both past nutritional situation and brain development and important indicator for measuring nutritional status, routine measurement and intervention for assessing and removing undernutrition is to be recommended. Bangladesh Med Res Counc Bull 2018; 44: 152-159

scholarly journals Hubungan antara Asupan Gizi dengan Status Gizi Remaja Putri

2021 ◽  
Vol 12 (3) ◽  
pp. 411
Author(s):  
Putu Intan Hartaningrum ◽  
Ni Ketut Sutiari ◽  
Lina Anggaraeni Dwijayanti
Keyword(s):  
Multivariate Analysis ◽  
Nutritional Status ◽  
Adolescent Girls ◽  
Significant Relationship ◽  
Nutritional Intake ◽  
World Health ◽  
Bivariate Analysis ◽  
P Value ◽  
Fat Intake ◽  
Z Score

<p>Three burdens of malnutrition, namely undernutrition, overnutrition, and lack of macronutrients are problems faced by adolescents in Indonesia. Nutritional problems related to development and growth are often experienced by adolescents because the adolescent's body requires more energy and nutrients than children. Previous studies on nutritional intake and nutritional status in adolescents reported inconsistent results. This study aims to determine the relationship between nutritional intake and nutritional status in adolescent girls in Buleleng Bali. This study uses a cross-sectional analytic observational design conducted in two high schools in Buleleng Regency with 163 respondents. The instruments used in this study were a questionnaire, 2x24 hour food recall, weight measurement with a weight scale, height measurement with a mechanical meter, and the World Health Organization (WHO) AnthroPlus software to calculate the body mass index by age (z-score). Spearman correlation test was performed for bivariate analysis and multiple linear regression for multivariate analysis. Bivariate analysis showed that the variables of fat intake (p-value=&lt;0,001) and total energy intake (p-value=0,008) showed a significant correlation with the z-score. In multivariate analysis, the variable that showed a significant relationship with the z-score was fat intake (β=0,023, 95%CI=0,013-0,033, p-value=&lt;0,001). Nutritional intake that has a significant relationship with nutritional status in adolescent girls in Buleleng Regency is fat intake. Limitation of fat consumption needs to be done.</p>

scholarly journals Relationship between food insecurity and nutritional status of Brazilian children under the age of five

2013 ◽  
Vol 16 (4) ◽  
pp. 984-994 ◽  
Author(s):  
Leonardo Pozza dos Santos ◽  
Denise Petrucci Gigante
Keyword(s):  
Nutritional Status ◽  
Food Insecurity ◽  
World Health ◽  
Nutritional Indices ◽  
Z Score ◽  
Worldwide Web ◽  
Health Organization ◽  
Brazilian Children ◽  
Height For Age ◽  
Weight For Age

OBJECTIVE: The aim of this study was to investigate the relationship between food insecurity and nutritional status of Brazilian children. METHODS: The National Demographic and Health Survey 2006 database is available on the worldwide web. Thus, the analyzed variables were obtained in this study, including nutritional indices, food insecurity and other socioeconomic and demographic variables. The height-for-age, weight-for-age and weight-for-height indices were evaluated as the Z-score of the World Health Organization reference curves. Food insecurity was defined by using the Brazilian Food Insecurity Scale. Averages of three indices according to the presence of food insecurity were analyzed, including other variables. Linear regression evaluated the effect of food insecurity on the Z-score of the three nutritional indices. RESULTS: The sample included 4,817 children, out of whom 7% had deficit in height, 7% were overweight and 47% had food insecurity. It was found that the average of height-for-age, weight-for-age and weight-for-height were -0.31, 0.12 and 0.40, respectively, being lower among children with food insecurity. CONCLUSION: The regression analysis showed that children living with some level of food insecurity have worse rates of height-for-age, even controlling for demographic and socioeconomic factors.

Serial application of the Cardiac Surgery Score (CASUS) to cardiac surgical patients

2010 ◽  
Vol 58 (S 01) ◽  
Author(s):  
A Badreldin ◽  
M Heldwein ◽  
T Bossert ◽  
K Hekmat
Keyword(s):  
Cardiac Surgery ◽  
Surgical Patients

HUBUNGAN PENDIDIKAN DAN STATUS EKONOMI DENGAN STATUS GIZI IBU HAMIL TRIMESTER III DI PUSKESMAS SOSIAL PALEMBANG TAHUN 2012

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Tirta Anggraini Tirta Anggraini
Keyword(s):  
Nutritional Status ◽  
Pregnant Women ◽  
Health Center ◽  
Economic Status ◽  
Social Health ◽  
World Health ◽  
Third Trimester ◽  
Chi Square ◽  
Cross Sectional ◽  
Health Organization

ABSTRACT According to the World Health Organization (WHO), maternal nutritional status at the time of growth and during pregnancy can affect fetal growth and development. Based on (IDHS) survey of 2007 AKI Indonesia at 228 per 100,000 live births, although this figure is still the highest in Asia. Social health center in Palembang in 2011 the number of pregnant women with good nutritional status of 67 men (97.1%). factors that influence the nutritional status of pregnant women is the temperature of the environment, economic status, habits and views of women to food, age, education, and health status. The purpose of this study is a known relationship education and economic status with nutritional status of pregnant women in the third trimester of Social Health Center Palembang in 2012. This study uses analytic survey with cross sectional approach. The population in this study were all third trimester pregnant women who visit the health center Social Palembang in May 2012, with a sample of 30 respondents. Sampling in this study with non-random methods with techniques Accidental Sampling. Data analysis carried out univariate and bivariate statistics with Chi-Square test with significance level α = 0.05. The results showed than 30 respondents there (73.3%) of respondents that good nutritional status, higher education (76.7%), and high economic status (70.0%). The results of this study showed no significant association education and economic status with nutritional status of pregnant women in the third trimester of Social Health Center Palembang in 2012. From the results of this study, researchers hope to improve the health care workers, especially health services in Antenatal Care services pay more attention to maternal risk of poor nutritional status.   ABSTRAK Menurut World Health Organization (WHO), status gizi ibu hamil pada waktu pertumbuhan dan selama hamil dapat mempengaruhi pertumbuhan dan perkembangan janin. Berdasarkan (SDKI) survei terakhir tahun 2007 AKI Indonesia sebesar 228 per 100.000 Kelahiran Hidup, meskipun demikian angka tersebut masih tertinggi di Asia.  Di Puskesmas Sosial Palembang tahun 2011 jumlah ibu hamil yang berstatus gizi baik sebesar 67 orang (97,1%). faktor-faktor yang mempengaruhi status gizi ibu hamil adalah suhu lingkungan, status ekonomi, kebiasaan dan pandangan wanita terhadap makanan, usia, pendidikan, dan status kesehatan. Tujuan penelitian ini adalah diketahuinya hubungan pendidikan dan status ekonomi dengan status gizi ibu hamil trimester III di Puskesmas Sosial Palembang tahun 2012. Penelitian ini menggunakan metode survey analitik dengan pendekatan cross sectional. Populasi pada penelitian ini adalah semua ibu hamil trimester III yang berkunjung di Puskesmas Sosial Palembang pada bulan Mei tahun 2012, dengan jumlah sampel 30 responden. Pengambilan sampel pada penelitian ini dengan metode non random dengan teknik Accidental Sampling. Analisa data dilakukan secara univariat dan bivariat dengan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian menunjukkan dari 30 responden terdapat (73,3%) responden yang berstatus gizi baik, pendidikan tinggi (76,7%), dan status ekonomi tinggi (70,0%). Hasil penelitian ini menunjukkan ada hubungan yang bermakna pendidikan dan status ekonomi dengan status gizi ibu hamil trimester III di Puskesmas Sosial Palembang tahun 2012. Dari hasil penelitian ini, peneliti berharap petugas pelayanan kesehatan dapat meningkatkan pelayanan kesehatan terutama dalam pelayanan Antenatal Care lebih memperhatikan kehamilan ibu yang berisiko status gizi buruk.

HUBUNGAN ANTARA PENDIDIKAN DAN SOSIAL EKONOMI KELUARGA DENGAN STATUS GIZI BALITA DI PUSKESMAS KERAMASAN PALEMBANG TAHUN 2012

2019 ◽  
Vol 2 (1) ◽  
Author(s):  
Dini Kesumah Dini Kesumah
Keyword(s):  
Nutritional Status ◽  
World Health Organization ◽  
Health Center ◽  
World Health ◽  
P Value ◽  
Chi Square ◽  
Cross Sectional ◽  
Highly Educated ◽  
Health Organization ◽  
Nutritional Status Of Children

ABSTRACT According to World Health Organization Health Organization (WHO) in 2005 showed 49% of deaths occur in children under five in developing countries. Nutritional problems can not be done with the medical and health care approach alone. Causes related to malnutrition that maternal education, socioeconomic families, poor environmental sanitation, and lack of food supplies. This study aims to determine the relationship between education and socioeconomic status of families with nutrition survey using a cross sectional analytic approach, with a population of all mothers of children under five who visited the health center in Palembang Keramasan Accidental sampling Sampling the number of samples obtained 35 respondents. Variables include the study independent and dependent variables and univariate analysis using Chi-Square test statistic with a significance level α = 0.05. The results from 35 respondents indicate that highly educated mothers earned as many as 16 people (45.7%), and middle and upper income families as many as 12 people (34.3%) and bivariate test results show that highly educated respondents toddler nutritional status good for 81.3% (13 people) is larger than the less educated respondents balitanya good nutritional status 26.3% (5 persons) as well as respondents who have middle and upper socioeconomic families with good nutritional status of children at 91.7% ( 11 people) is larger when compared to respondents who have family socioeconomic medium with good nutritional status of children at 30.4% (7 people). Statistical tests show that education has a significant relationship with nutritional status of children P value = 0.004 and socioeconomic families have a meaningful relationship with nutritional status of children P value = 0.002. Based on the results of the study suggested the health professionals in the health center should further improve the education, information about the importance of nutrition to the development of the child in the mothers through the selection and processing of good food and a good diet through health centers and integrated health.   ABSTRAK  Menurut badan kesehatan World Health Organization (WHO) tahun 2005 menunjukkan 49% kematian yang terjadi pada anak dibawah umur lima tahun di negara berkembang. Masalah gizi ini tidak dapat dilakukan dengan pendekatan medis dan pelayanan kesehatan saja. Penyebab yang berhubungan dengan kurang gizi yaitu pendidikan ibu, sosial ekonomi keluarga, sanitasi lingkungan yang kurang baik,dan kurangnya persediaan pangan. Penelitian ini bertujuan untuk mengetahui hubungan antara pendidikan dan sosial ekonomi keluarga dengan status gizi balita dengan menggunakan metode survei analitik pendekatan secara Cross Sectional, dengan populasi semua ibu yang memiliki anak balita yang berkunjung ke Puskesmas Keramasan Palembang dengan pengambilan sampel secara Accidental Sampling diperoleh jumlah sampel 35 responden. Variabel penelitian meliputi variabel independen dan dependen serta analisis univariat menggunakan uji statistik Chi-Square dengan tingkat kemaknaan α = 0,05. Hasil penelitian ini menunjukkan dari 35 responden didapatkan ibu yang berpendidikan tinggi sebanyak 16 orang  (45,7%), dan keluarga yang berpenghasilan menengah keatas sebanyak 12 orang (34,3%) dan hasil uji bivariat menunjukkan bahwa responden yang berpendidikan tinggi status gizi balitanya baik sebesar 81,3% (13 orang) lebih besar bila dibanding responden yang berpendidikan rendah status gizi balitanya baik 26,3% (5 orang) serta responden yang mempunyai sosial ekonomi keluarga menengah keatas dengan status gizi balita baik sebesar 91,7% (11 orang) lebih besar bila dibanding responden yang mempunyai sosial ekonomi keluarga menengah kebawah dengan status gizi balita baik sebesar 30,4% (7 orang). Uji statistik menunjukkan bahwa pendidikan mempunyai hubungan yang bermakna dengan status gizi balita P value = 0,004 dan sosial ekonomi keluarga mempunyai hubungan yang bermakna dengan status gizi balita P value = 0,002. Berdasarkan hasil penelitian disarankan pada petugas kesehatan di Puskesmas hendaknya lebih meningkatkan penyuluhan-penyuluhan tentang pentingnya gizi terhadap tumbuh kembang anak pada ibu-ibu melalui cara pemilihan dan pengolahan bahan makanan yang baik serta pola makanan yang baik melalui kegiatan Puskesmas dan Posyandu.

Nutritional Status of Pediatric Patients in Ramathibodi Hospital Using the WHO Child Growth Standard and the Thai Growth Reference

2020 ◽  
Vol 103 (10) ◽  
pp. 1099-1106
Keyword(s):  
Nutritional Status ◽  
Pediatric Patients ◽  
Chronically Ill ◽  
Child Growth ◽  
World Health ◽  
Healthy Children ◽  
Growth Standard ◽  
Growth Reference ◽  
Child Growth Standard

Background: The appropriate assessment of nutritional status in children is an essential aspect of health supervision. Currently, there are two references used for growth assessment in Thailand. The WHO child growth standard, which has been widely used since 2007, and the Thai growth reference developed by the Ministry of Public Health, which has been used since 1998. However, there were very few studies that made a direct comparison between both tools. Objective: To compare the nutritional status of healthy pediatric patients in Ramathibodi Hospital assessed by the World Health Organization (WHO) child growth standard and the Thai growth reference. Materials and Methods: The present study was a cross-sectional study. The data were collected from all pediatric patients registered in the outpatient department (OPD) of Faculty of Medicine, Ramathibodi Hospital between January 2013 and December 2018. All healthy children (aged 0 to 15 years) were included. Exclusion criteria of possibly chronically ill children were defined by those who were 1) visiting subspecialty clinics, 2) OPD and emergency room (ER) visits more than ten times per year, 3) having ICD-10 of chronic conditions, or 4) had been admitted in the hospital during the study. The weight and height or length data were extracted from the Electronic Medical Record system. All data were analyzed by the Stata Statistical Software focusing on age and sex-specific Z-scores, which references the WHO child growth standard and the Thai growth reference. Results: Sixty-two thousand one hundred four OPD visits were divided into 31,662 OPD visits for boys and 30,442 OPD visits for girls. Percent of weight for age and height or length for age more than +2 Z-score of both boys and girls when using the Thai growth reference was greater than that using the WHO child growth standard, especially for children aged 0 to 12 months. The Thai growth reference classified as overweight were approximately 10.26% to 31.12% more than using the WHO child growth standard. There was no difference in classification of height by both standards. Conclusion: There was a difference in classification of nutritional status between the Thai growth reference and the WHO child growth standard. Keywords: Nutritional status, Pediatric growth reference, Assessment tool, Overweight

scholarly journals Tracheostomy in Postoperative Pediatric Cardiac Surgical Patients—The Earlier, the Better

2021 ◽  
Author(s):  
Chalattil Bipin ◽  
Manoj K. Sahu ◽  
Sarvesh P. Singh ◽  
Velayoudam Devagourou ◽  
Palleti Rajashekar ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Cardiac Surgery ◽  
Hospital Stay ◽  
Pediatric Patients ◽  
Tertiary Care ◽  
Surgical Patients ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Surgical Intensive Care ◽  
Nutrition Supplementation

Abstract Objectives This study was aimed to assess the benefits of early tracheostomy (ET) compared with late tracheostomy (LT) on postoperative outcomes in pediatric cardiac surgical patients. Design Present one is a prospective, observational study. Setting The study was conducted at a cardiac surgical intensive care unit (ICU) of a tertiary care hospital. Participants All pediatric patients below 10 years of age, who underwent tracheostomy after cardiac surgery from January2019 to december2019, were subdivided into two groups according to the timing of tracheostomy: “early” if done before 7 days or “late” if done after 7 days postcardiac surgery. Interventions ET versus LT was measured in the study. Results Out of all 1,084 pediatric patients who underwent cardiac surgery over the study period, 41 (3.7%) received tracheostomy. Sixteen (39%) patients underwent ET and 25 (61%) underwent LT. ET had advantages by having reduced risk associations with the following variables: preoperative hospital stay (p = 0.0016), sepsis (p = 0.03), high risk surgery (p = 0.04), postoperative sepsis (p = 0.001), C-reactive protein (p = 0.04), ventilator-associated pneumonia (VAP; p = 0.006), antibiotic escalation (p = 0.006), and antifungal therapy (p = 0.01) requirement. Furthermore, ET was associated with lesser duration of mechanical ventilation (p = 0.0027), length of ICU stay (LOICUS; p = 0.01), length of hospital stay (LOHS; p = 0.001), lesser days of feed interruption (p = 0.0017), and tracheostomy tube change (p = 0.02). ET group of children, who had higher total ventilation-free days (p = 0.02), were decannulated earlier (p = 0.03) and discharged earlier (p = 0.0089). Conclusion ET had significant benefits in reduction of postoperative morbidities with overall shorter mechanical ventilation, LOICUS, and LOHS, better nutrition supplementation, lesser infection, etc. These benefits may promote faster patient convalescence and rehabilitation with reduced hospital costs.

Dental Caries Severity and Nutritional Status of Nigerian Preschool Children

2021 ◽  
pp. 238008442110021
Author(s):  
O.O. Olatosi ◽  
A.A. Alade ◽  
T. Naicker ◽  
T. Busch ◽  
A. Oyapero ◽  
...  
Keyword(s):  
Early Childhood ◽  
Dental Caries ◽  
Nutritional Status ◽  
Early Childhood Caries ◽  
Z Score ◽  
Cross Sectional ◽  
Risk Of Death ◽  
Malnourished Children ◽  
Z Scores ◽  
Childhood Caries

Introduction: Malnutrition in children is one of the most prevalent global health challenges, and malnourished children have a higher risk of death from childhood diseases. Early childhood caries (ECC) is the most common chronic disease of childhood. Complications from ECC such as pain, loss of tooth/teeth, and infection can undermine a child’s nutrition and growth. Aim: This study aims to evaluate the severity of decay, missing, and filled tooth (dmft) by nutritional status using the z scores of the anthropometric measurements: height for age (HFA), weight for age (WFA), weight for height (WFH), and body mass index for age (BMIA) among children with ECC in Nigeria. Study Design: This is a cross-sectional study conducted in 5 local government areas (LGAs) in Lagos State, Nigeria. A multistage sampling technique was used. Results: A total of 273 cases of ECC were included in the analyses (mean age 4.19 ± 0.96 y). Overall, the mean dmft was 3.04 ± 2.28, and most (96%) were accounted for by untreated decay. The distribution of dmft within the different z score categories of BMIA (<–3 = severely wasted, –2 to –3 = wasted, –2 to +2 = normal, +2 to +3 = overweight and >+3 = obese) showed the highest dmft scores among the combined severely wasted and wasted groups, lowest among children with normal z scores, and intermediate in the overweight and obese groups. There was a significant negative correlation between BMIA z score, WFH z score, and dmft ( r = −0.181, P < 0.05 and r = −0.143, P < 0.05, respectively). However, the correlations between HFA z score, WFA z score, and dmft were positive but not significant ( r = 0.048, P = 0.44 and r = 0.022, P = 0.77, respectively). Conclusion: Our study showed an increased severity of dental caries among severely wasted or wasted children with ECC compared to those of normal or overweight. Knowledge Transfer Statement: The results from this study will raise awareness among clinicians and policy makers on the need for a primary prevention program for early childhood caries in countries with high burden of malnutrition and limited resources. Also, it will help draw the attention of clinicians to the caries status of malnourished children that can be managed to improve the nutritional outcomes.

Sign in / Sign up

Export Citation Format

Share Document