Comparative Study of effectiveness of mobilization with movement (MWM) and End range mobilization (ERM) techniques in frozen shoulder

2018 ◽  
Vol 4 (4) ◽  
pp. 519-522
Author(s):  
Jeyakumar S ◽  
Jagatheesan Alagesan ◽  
T.S. Muthukumar
Keyword(s):  
Range Of Motion ◽  
Frozen Shoulder ◽  
Type I ◽  
Mean Values ◽  
Functional Activities ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Frozen shoulder is disorder of the connective tissue that limits the normal Range of motion of the shoulder in diabetes, frozen shoulder is thought to be caused by changes to the collagen in the shoulder joint as a result of long term Hypoglycemia. Mobilization is a therapeutic movement of the joint. The goal is to restore normal joint motion and rhythm. The use of mobilization with movement for peripheral joints was developed by mulligan. This technique combines a sustained application of manual technique “gliding” force to the joint with concurrent physiologic motion of joint, either actively or passively. This study aims to find out the effects of mobilization with movement and end range mobilization in frozen shoulder in Type I diabetics. Materials and Methods: 30 subjects both male and female, suffering with shoulder pain and clinically diagnosed with frozen shoulder was recruited for the study and divided into two groups with 15 patients each based on convenient sampling method. Group A patients received mobilization with movement and Group B patients received end range mobilization for three weeks. The outcome measurements were SPADI, Functional hand to back scale, abduction range of motion using goniometer and VAS. Results: The mean values of all parameters showed significant differences in group A as compared to group B in terms of decreased pain, increased abduction range and other outcome measures. Conclusion: Based on the results it has been concluded that treating the type 1 diabetic patient with frozen shoulder, mobilization with movement exercise shows better results than end range mobilization in reducing pain and increase functional activities and mobility in frozen shoulder.

scholarly journals Home physiotherapy with vs. without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty

Arthroplasty ◽  
2021 ◽  
Vol 3 (1) ◽  
Author(s):  
Sanjay Bhalchandra Londhe ◽  
Ravi Vinod Shah ◽  
Amit Pankaj Doshi ◽  
Shubhankar Sanjay Londhe ◽  
Kavita Subhedar ◽  
...  
Keyword(s):  
Total Knee Arthroplasty ◽  
Range Of Motion ◽  
Knee Arthroplasty ◽  
Forgotten Joint Score ◽  
Group A ◽  
Manipulation Under Anaesthesia ◽  
Total Knee ◽  
The Mean ◽  
Group B ◽  
Discharge From Hospital

Abstract The aim of this retrospective cohort study was to compare home physiotherapy with or without supervision of physiotherapist for assessing manipulation under anaesthesia after total knee arthroplasty. Methods A total of 900 patients (including 810 females and 90 males) who had undergone total knee arthroplasty were divided into group A (n = 300) and group B (n = 600). Patients in group A had home physiotherapy on their own after discharge from hospital. The physiotherapist did not visit them at home. Patients in group B received home physiotherapy under supervision of physiotherapist for 6 weeks after discharge from hospital. Patients’ age, range of motion of the knee, and forgotten joint score-12 were assessed. A p < 0.05 was considered statistically significant. Results In group A, the mean age was 69.1 ± 14.3 years (range: 58 to 82 years); in group B, the mean age was 66.5 ± 15.7 years (range: 56 to 83 years) (p > 0.05). Preoperatively, the mean range of motion of the knee in group A and B was 95.8° ± 18.1° and 95.4° ± 17.8°, respectively (p > 0.05). The mean forgotten joint score-12 of group A and B were 11.90 ± 11.3 and 11.72 ± 12.1 (p > 0.05), respectively. Six weeks after total knee arthroplasty, the mean ROM of the knee in group A and B was 109.7° ± 22.3° and 121° ± 21.5°, respectively (p < 0.05). The mean postoperative forgotten joint score-12 of the group A and B was 24.5 ± 16.4 and 25.6 ± 17.4, respectively (p > 0.05). The rate of manipulation under anaesthesia was 3% in group A and 0.2% in group B (p < 0.05). Conclusion After total knee arthroplasty, frequent physiotherapist’s instruction helps the patients improve knee exercises and therefore decrease the risk of revision surgery. The home physiotherapy under supervision of physiotherapist lowers the rate of manipulation under anaesthesia. Level of evidence Therapeutic study, Level IIa.

scholarly journals Influence of Ulnar Bow Sign on Surgical Treatment of Missed Bado Type I Monteggia Fracture in Children

2020 ◽  
Author(s):  
Shijie Liao ◽  
Tiantian Wang ◽  
Qian Huang ◽  
Yun Liu ◽  
Rongbin Lu ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Radial Head ◽  
Monteggia Fracture ◽  
Type I ◽  
Ulnar Osteotomy ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Stable Reduction

Abstract PurposeThe present study aimed to explore the influence of ulnar bow on the surgical treatment of Bado type I missed Monteggia fracture in children.MethodsThis study is a retrospective review of 24 patients between November 2010 and March 2019. All patients were treated with open reduction of the radial head and ulnar opening wedge osteotomy without annular ligament reconstruction. The mean interval between injury onset and surgery was five months (range: 2–12 months). The average age of participants at the time of surgery was 6.4 years (range: 3–10 years). We evaluated the maximum ulnar bow (MUB) and MUB position (P-MUB) via radiography. The patients were divided into middle group (group A: 14 cases, MUB located at 40% to 60% of the distal ulna) and distal group (group B: 10 cases, MUB located at 20% to 40% from the distal end of the ulna) based on P-MUB. The mean period of follow-up was 37 months (range: 6–102 months).ResultsAt the last follow-up, all the children showed stable reduction of the radial head, and the flexion function of elbow joint improved after operation (P<0.05). Group A presented a larger the ratio of maximum ulnar bow(R-MUB) and angle of ulnar osteotomy(OA) than group B (P<0.05). There was statistically significant difference between group A and Group B in the P-MUB (P < 0.05). The osteotomy angle was positively correlated with the R-MUB (R2 =0.497,P=0.013), The osteotomy angle was positively correlated with the P-MUB (R2=0.731,P=0.000), The R-MUB is proportional to the P-MUB (R2 =0.597,P=0.002). The regression equation of P-MUB and osteotomy angle: Angle=7.064+33.227* P-MUB (R2=0.459, P =0.000).ConclusionWhen the ulnar bow is positioned at the middle ulna, a stable reduction of radial head need to be achieved through a larger angle in the ulnar osteotomy. If the position of maximum ulnar bow (P-MUB) is closer to the middle of the ulna or the ratio of maximum ulnar bow (R-MUB) is larger, the osteotomy angle is larger.

The Effect of Gongronema Latifolum (Utazi) on Some Haematological Parameters of Rabbit

2020 ◽  
Author(s):  
Obeagu Emmanuel Ifeanyi
Keyword(s):  
Mean Value ◽  
Control Group ◽  
Mean Values ◽  
Platelet Counts ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
Differential White Blood Cell ◽  
Group D ◽  
Gongronema Latifolium

The hematological features of Gongronema latifolium, aqueous leaves extract was evaluated using standard methods. After 10 days of consecutive infusions into 9 experimental animals (rabbits). The rabbits were monitored and the following parameters determined; hemoglobin (HB), PCV, Platelet, WBC, Differential White Blood Cell. The Rabbits were grouped into 4, one consisting of control (group A), group B was fed with 0.5 mg/kg, group C with 1.0 mg/kg, and Group D with 1.5mg/kg of the aqueous extract of Gongronemalatifolium. The mean values obtained for hemoglobin estimation for the control group is 5.9 ± 4.1 g/dl, 9.1 ± 2.9 g/dl for group B 10.2 ± 1.8 g/dl for group C and 12.8 ± 0.1 g/dl for group D with no significant increase on the PCV estimation, the mean value for the control (group A) is 17.7 ± 12.3%, 27.3 ± 8.7% for group B, group C (30.6 ± 5.4%) and D (28.4 ± 0.3) show increase that statistically significant (p > 0.01). the platelet counts of group C (600 ± 0 x 109/L) and D(600 ± 0 x 109/L) show significant increase (p > 0.01) when compared with the control (600 ± 00). But the platelet value of group B (550 ± 50 x 109/L) shows no difference. No significant changes were observed in the White Blood Counts of the test groups B (3.5 ± 0.5 x 109/L), C (1.9 + 2.1 x 109/L) and D(3.6 ± 0.4) when compared with the control group (2.9 ± 1.9). The values obtained from the differential White Blood Counts (Neutrophils, Lymphocytes, Eosinophils and Monocytes) were not significant. Therefore, Gongronemalatifolium, when properly taken as a nutritional diet, causes beneficial changes on hemoglobin, packed cell volumes and platelet counts of consumers.

Urinary excretion of glycated protein determined with a specific radioimmunoassay

1991 ◽  
Vol 37 (4) ◽  
pp. 504-507 ◽  
Author(s):  
Chizuko Ukita ◽  
Mitsushige Nishikawa ◽  
Akira Shouzu ◽  
Mitsuo Inada
Keyword(s):  
Urinary Excretion ◽  
Normal Subjects ◽  
Mean Values ◽  
Specific Radioimmunoassay ◽  
Glycated Protein ◽  
Highly Sensitive ◽  
Significant Difference ◽  
Group A ◽  
The Mean ◽  
Group B

Abstract We developed a simple and highly sensitive RIA for glycated protein (GP), and used it to measure GP in serum and urine from 15 normal controls and 30 diabetics (14 with urinary excretion rate of albumin, Ualb less than 15 micrograms/min, group A; nine with 15 less than or equal to Ualb less than or equal to 150 micrograms/min, group B; and seven with Ualb greater than 150 micrograms/min, group C). The mean serum concentration of GP was above normal in all groups of diabetics, and the mean glycation ratios of serum protein (SGP) were higher in groups B and C than in normal subjects. Urinary concentrations of GP also were increased in groups B and C, although the glycation ratio of urinary protein (UGP) was decreased in group C. Consequently, the selectivity of urinary excretion of GP (UGP/SGP) was significantly decreased in group C. Moreover, there was a significant difference in the mean values of selectivity between groups of patients with various degrees of retinopathy. We suggest that measurements of serum and urinary GP are useful to evaluate the progression of diabetic complications.

scholarly journals A Comparative Study of Steroid Injection With or Without Lignocaine in Treating Frozen Shoulder

2018 ◽  
Vol 5 (1) ◽  
pp. 22-28 ◽  
Author(s):  
Alok Pandey ◽  
B Shrestha ◽  
K M Shrestha
Keyword(s):  
Range Of Motion ◽  
Steroid Injection ◽  
Frozen Shoulder ◽  
Equal Frequency ◽  
Steroid Injections ◽  
Shoulder Range Of Motion ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Dominant Side

BACKGROUND: Treatment of Frozen shoulder (Adhesive Capsulitis) is mainly nonoperative. Intra-articular steroid injections and physiotherapy are one of the most effective and useful treatment. Even though intra-articular steroid injections are very effective in inflammatory phase of the disease; patients are reluctant to move their affected shoulder for fear of pain. Thus, they do not follow exercise program properly resulting in poor outcomes.OBJECTIVE: If pain could be reduced, outcome of treatment can improve. Lignocaine, when combined with steroid injection, plays an important role in immediate improvement of pain and active range of motion thereby increasing the overall result. MATERIALS & METHODS: 100 patients with frozen shoulder were selected according to predetermined inclusion and exclusion criteria. After randomization by sealed envelope technique, patients were divided into Group A and Group B. Group A patients were injected with 2 ml (80 mg) of methylprednisolone and 3 ml of 1% Lignocaine, and Group B patients were injected with 2 ml (80 mg) of methylprednisolone and 3 ml of Distilled water in the affected shoulder via standard posterior approach. Then half an hour of standard shoulder range of motion (ROM) exercise regimen was performed under supervision. Pre injection and post injection pain level was scored by Visual Analogue Score (VAS) and Subjective satisfaction score (SSS). Shoulder exercises were taught and home based physiotherapy was carried out by patients themselves. They were also prescribed oral analgesics for 5 days and were followed at 1, 3, and 6 weeks. At every follow up visit, they were assessed for improvement via Constant-Murley Score (CMS).RESULTS: The mean age of this study in group A and group B was 56.46 years (SD 10.05) and 57.18 years (SD 8.87) respectively (P0.70). There were 31 male and 19 female in group A as compared to group B where there was 26 males and 24 females (P0.41). In both the groups, maximum number of patients presented at around 10 weeks. In both the groups left side dominated right side with equal frequency (33 left sides and 17 right sides) (P 1.00) and non dominant side outnumbered dominant side with near equal frequency (P 1.00). After the intervention, excellent result in SSS was observed only in group A whereas maximum patients of Group B had only fair result (42 patients). There was statistically significant difference between two groups in terms of pain; Activity of daily living (ADL) and Range of motion (ROM). Patients in group A were able to carry more weight than group B.   In CMS 1 and 6 week total, there was statistically highly significant difference between two groups. CONCLUSION: Even though steroid and physical exercises play important role in managing frozen shoulder, addition of lignocaine to steroid injection seems to be helpful. It relieves immediate pain on movement and improves exercise compliance thereby improving early outcomes. Evaluation of long term benefits of lignocaine injection needs further studies. Journal of Universal College of Medical Sciences (2017) Vol.05 No.01 Issue 15, Page: 22-28 

Surgical outcomes in adult patients with syringomyelia associated with Chiari malformation Type I: the relationship between scoliosis and neurological findings

2007 ◽  
Vol 6 (3) ◽  
pp. 216-221 ◽  
Author(s):  
Atsushi Ono ◽  
Futoshi Suetsuna ◽  
Kazumasa Ueyama ◽  
Toru Yokoyama ◽  
Shuichi Aburakawa ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Clinical Status ◽  
Japanese Orthopaedic Association ◽  
Foramen Magnum ◽  
Neurological Dysfunction ◽  
Type I ◽  
Chiari Malformation Type I ◽  
Group A ◽  
The Mean ◽  
Group B

Object The clinical characteristics of pediatric scoliosis associated with syringomyelia have been reported in previous studies, but scoliosis associated with syringomyelia in adults is rarely treated, and there is a paucity of detailed studies. In the present study of adult syringomyelia associated with Chiari malformation Type I, the authors investigated the relationships among the syrinx, scoliosis, and neurological data. Methods The population was composed of 27 patients (≥ 20 years of age) who underwent foramen magnum decompression for the treatment of syringomyelia. The patients were divided into two groups: those with scoliosis of 10° or more (Group A) and those without scoliosis (Group B). The authors assessed the length of the syrinx, duration of morbidity, and clinical status before and after surgery based on the Japanese Orthopaedic Association (JOA) Scale. There were 15 cases in Group A and 12 in Group B. The mean length of the syrinx was 12.8 vertebral bodies (VBs) in Group A and 7.2 VBs in Group B. The mean duration of morbidity was 14.2 years in Group A and 6.8 years in Group B. The mean preoperative JOA score was 10.1 in Group A and 14.4 in Group B, whereas the mean postoperative JOA scores were 11.9 and 15.8, respectively. There were significant differences between Groups A and B in length of the syrinx, duration of morbidity, and pre- and postoperative JOA scores. Conclusions In patients with syringomyelia and scoliosis the syringes spanned a greater number of VBs, the duration of morbidity was greater, neurological dysfunction was more severe, and surgical results were poorer. Scoliosis could be a predicting factor of the prognosis in patients with syringomyelia and Chiari malformation Type I.

Tethered cord syndrome in adults

2011 ◽  
Vol 15 (3) ◽  
pp. 258-270 ◽  
Author(s):  
Jörg Klekamp
Keyword(s):  
Spinal Cord ◽  
Tethered Cord ◽  
Tethered Cord Syndrome ◽  
Neurological Deficits ◽  
Short Term ◽  
Group A ◽  
The Mean ◽  
Group B

Object The treatment of tethered cord syndromes in adults is discussed regarding the natural history and surgical indications. The author analyzes data obtained in patients who were diagnosed with a tethered cord in adulthood and either underwent surgical or conservative therapy between 1991 and 2009. Methods Since 1991, data obtained in 2515 patients with spinal cord pathologies were entered into the spinal cord database, and prospective follow-up was performed through outpatient visits and questionnaires. Of the 2515 patients, 85 adults with a tethered cord syndrome formed the basis of this study. The tethering effect was caused either by a split cord malformation, a thick filum terminale, a conus medullaris lipoma with extradural extension, or various combinations of these mechanisms. The mean age of the patients was 46 ± 13 years (range 23–74 years) and the mean follow-up duration was 61 ± 62 months. Two groups were distinguished based on the absence (Group A, 43 patients) or presence (Group B, 42 patients) of an associated lipoma or dysraphic cyst (that is, dermoid, epidermoid, or neurenteric cyst). Surgery was recommended for patients with symptoms only. Short-term results were determined within 3 months of surgery, whereas long-term outcomes (clinical recurrences) were evaluated using Kaplan-Meier statistics. Results For all patients, pain was the most common major complaint. Severe neurological deficits were rare. In Group A, 20 of 43 patients underwent surgery, whereas in Group B 23 of 42 patients underwent surgery. Among individuals who did not undergo surgery, 17 patients refused surgery and 25 patients underwent recommended conservative treatment. Short-term postoperative results indicated a significant improvement of pain and a stabilization of neurological symptoms. Long-term results showed a good prognosis in patients in whom first-time (that is, nonrevision) surgery achieved successful untethering, with a 10-year rate of neurological stabilization in 89% of Group A and a 10-year rate of neurological stabilization in 81% of Group B patients. The benefit of secondary operations in Group B was limited, with eventual clinical deterioration occurring in all patients within 10 years. For patients treated conservatively, follow-up information could be obtained in 33 of 42 patients. Twenty-eight patients remained in stable clinical condition. Only 5 of the conservatively treated patients experienced clinical deterioration over time; in 4 of these individuals with deterioration, surgery had been recommended but was refused by the patient. The clinical recurrence rate in all conservatively treated patients was 21% after 10 years. With a recommendation for surgery this figure rose to 47% within 5 years. Conclusions Surgery in adult patients with a tethered cord syndrome should be reserved for those with symptoms. In surgically treated patients, pain relief can often be achieved, and long-term neurological stabilization tends to persist more often than it does in conservatively treated patients. A conservative approach is warranted, however, in adult patients without neurological deficits. Revision surgery in patients with complex dysraphic lesions should be performed in exceptional cases only.

scholarly journals Weight reduction improves immune system and inflammatory cytokines in obese asthmatic patients

2020 ◽  
Vol 20 (2) ◽  
pp. 897-902
Author(s):  
Fadwah M Al-Sharif ◽  
Shehab M Abd El-Kader ◽  
Ziyad A Neamatallah ◽  
Afnan M AlKhateeb
Keyword(s):  
Immune System ◽  
Systemic Inflammation ◽  
Weight Reduction ◽  
Inflammation Markers ◽  
Mean Values ◽  
Asthmatic Patients ◽  
Asthma Patients ◽  
Group A ◽  
The Mean ◽  
Group B

Background: Activation of immunological and systemic inflammation markers are common in obesity and asthma. Objective: The target of this study was to assess impact of weight reduction on immunological and systemic inflammation markers in obese asthma patients. Material and methods: Eighty asthmatic patients of both sex; their age and body mass index (BMI) mean were 38.72 ± 7.14 year and 32.65 ± 3.18 Kg/m2 respectively. Exclusion criteria included smokers, infections, vaccinations, cancer, surgery, immune system disorders and medications that may influence immune system function as anti-inflammatory medications, analgesics and anti-depressant. All subjects were randomly enrolled in weight reduction group (group A) or control group (group B). Results: The main findings in the present study indicated that weight reducing program in group (A) was associated with significant reduction in the mean values of IL6, TNF-α, and IL8 in addition to significant increase in the mean values of CD4 and CD8 cell count . However, findings of group (B) showed no significant changes. Moreover, Comparison between both groups at the end of the study revealed significant differences. Conclusion: Weight reduction improved immunological and systemic inflammation markers in obese asthma patients. Keywords: Bronchial asthma; cytokines; obesity; immune system; weight reduction.

scholarly journals Assessment of the impact of Hold-Relax and Contract-Relax techniques on the compression pain threshold in patients with lateral humeral epicondylitis

2018 ◽  
Vol 12 (4) ◽  
pp. 15-21
Author(s):  
Szymon Wyszyński ◽  
Sylwia Stiler-Wyszyńska
Keyword(s):  
Range Of Motion ◽  
Pain Threshold ◽  
Muscle Group ◽  
Range Of Movement ◽  
Radiocarpal Joint ◽  
Group A ◽  
The Mean ◽  
Group B ◽  
The Impact ◽  
Lateral Humeral Epicondylitis

Background. The method of proprioceptive neuromuscular paving (PNF) is unique in that it has its own principles of working with the patient. The overriding therapeutic goal during PNF therapy is to work on a lost function that is important for the patient. Objective. The aim of the study was to assess the impact of Hold-Relax and Contract-Relax techniques on the compression pain threshold in patients with lateral humeral epicondylitis. Material and method. The study involved 60 patients aged 47.8 ± 4.3 with inflammation of the lateral humeral epicondyle. There were 35 women and 25 men in the study group. In each examined person it was the first incident of lateral humeral epicondylitis. In each of the probands, subjective and physical physiotherapeutic examination was carried out. 41 left and 19 right limbs were tested. Measurements were made under standard conditions. Among the physiotherapeutic tests performed were: examination of the range of motion, assessment of the compression pain threshold using an algometer, and pain assessment during extension and radial deviation of the wrist with a load. The study of the range of movement was carried out using an electronic goniometer. Then, the subjects were randomly divided into two groups: group "A" in which the Hold-Relax technique was performed on the muscle group that extends and radially deviates the wrist and group "B" in which Contract-Relax was applied to the same muscle group. The therapy lasted 30 minutes and was continued for the next 10 days. In each group, apart from the mentioned techniques, physiotherapy treatments were applied as indicated. After the therapy, the tests that preceded the therapies were repeated. The obtained results were placed in the database and subjected to statistical analysis using the Statistica program. Results. The mean extent of the extension movement in the radiocarpal joint before the therapy in group "A" was 45.7 ± 4.7 while in group "B" it was 40.1 ± 3.79. After treatment, the mean range of motion increased in the "A" group to 67.46 ± 8.69 and in the "B" group to 71.6 ± 8.3. In both groups, changes were observed at the statistically significant level p = 0. Conclusion. 1. The use of both the Hold-Relax and Contract-Relax techniques had an impact on the change of the compression pain threshold.2. The use of Hold Relax and Contract Relax techniques has an impact on increasing the range of motion in patients with lateral epicondylitis.

scholarly journals SUPERSTITIOUS BEHAVIOR AMONG JUDO, TAEKWONDO AND BOXING PLAYERS

2016 ◽  
Vol 20 (2) ◽  
pp. 50-59
Author(s):  
Dureja Gaurav ◽  
Singh Gagandeep
Keyword(s):  
Sampling Technique ◽  
College Level ◽  
Mean Values ◽  
Superstitious Behavior ◽  
Group A ◽  
The Mean ◽  
Level Of Significance ◽  
Group B ◽  
Post Hoc ◽  
Affiliated Colleges

Purpose: The present study was designed to measure superstitious behavior among Judo, Taekwondo and Boxing players. Material: Thirty (N=30) male inter-college level players with the age group of 19-25 years were selected through purposive sampling technique to act as subjects from affiliated colleges of Panjab University, Chandigarh. They were further divided into three groups: Group-A [Judo (n=10)], Group-B [Taekwondo (n=10)] and Group-C [Boxing (n=10)]. One Way Analysis of Variance (ANOVA) was applied to find out the differences among judo, taekwondo and boxing players. Where F values found significant, Least Significant Differences (LSD) Post-hoc test was applied to find out the direction and degree of difference. Results: The level of significance was set at 0.05. The result revealed significant differences among judo, taekwondo and boxing players on the sub parameters: clothing and appearance, preparation, team ritual and coach. However, no significant differences have been observed on the sub-parameters fetish, game/competition, prayer and parameter superstitious (Total). Conclusions: The obtained results showed significant differences on the sub-parameter Coach among Judo, Taekwondo and Boxing players. While calculating the mean values of entire groups, it has been observed that Boxing players demonstrate significantly better on the sub-parameter Coach. Therefore, it can be ascertained that Boxing players are more confident that coach bring a lucky charm to our game.

Sign in / Sign up

Export Citation Format

Share Document