scholarly journals Efficacy of Intravenous Immunoglobulin in the Management of Guillain Barre Syndrome

1970 ◽  
Vol 28 (2) ◽  
pp. 81-85
Author(s):  
Md Mahbubur Rahman ◽  
Kafiluddin Ahmed
Keyword(s):  
Muscle Power ◽  
Muscle Tone ◽  
Guillain Barre Syndrome ◽  
Control Group ◽  
Control Groups ◽  
Female Ratio ◽  
Sensory Features ◽  
Guillain Barré Syndrome ◽  
Guillain Barré ◽  
And Control

A total number of 40 respondents consisting of 20 subjectsof Guillain barre syndrome in each group treated withintravenous immunoglobulin (case) and without IVIg wereselected during the study period. Out of 20 cases, 12 (60%)were male and 8 (40%) were females, ratio 1.5:1. Majorityof the cases were presented at second or third decade oflife. In control group, 11 (55%) were male and 9 (45%)female, ratio 1.22:1. Majority of the patients had history ofupper respiratory tract infection or acute gastroenteritis 14 weeks preceding illness. All the patients had flaccidparalysis in all four limbs with some sensory features withoutbowel and bladder involvement. Thirteen patients from thecase and control groups developed respiratory failure requiring ICU support. Cerebrospinal fluid study showedalbumin cytological dissociation. Nerve conduction studyshowed features of demyelination, axonal loss or both.There was significant improvement of GBS patientstreated with IVIg in respect of respiratory function,muscle tone, muscle power, jerks and autonomicfunction. ICU stay of patients treated with IVIg wassignificantly shorter. Final outcome of patients treatedwith IVIg showed one death. There was no death incontrol group. The patient died probably due to severityof disease and/or comorbid disease.Key words: Intravenous Ig; Guillain barre syndromeDOI: 10.3329/jbcps.v28i2.5368J Bangladesh Coll Phys Surg 2010; 28: 81-85

Study of Guillain-Barre syndrome etiology in Pakistani patients

2021 ◽  
Author(s):  
Rashid Iqbal ◽  
Muhammad Javaid Asad ◽  
Saima Siddiqi ◽  
Raja Tahir Mahmood ◽  
Muhamamd Baseer Shah ◽  
...  
Keyword(s):  
Cerebrospinal Fluid ◽  
Nerve Conduction ◽  
Treatment Strategies ◽  
Guillain Barre Syndrome ◽  
Clinical Feature ◽  
Interleukin 17 ◽  
Healthy Controls ◽  
Female Ratio ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Objective: To examine clinical features, biochemical markers, demographic features, antecedent infections, frequency and treatment strategies. Methods: This case-control study was conducted at Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan and District Headquarters Hospital (DHQ), Rawalpindi, Pakistan from 2018 to 2020. Ninety consecutive patients of Guillain-Barré syndrome (GBS) and 77 healthy controls were enrolled. Patients were diagnosed by clinical presentation, Nerve conduction study (NCS), Electromyography (EMG), Cerebrospinal fluid analysis (CSF) and biochemical profile. Data was analyzed on IBM SPSS version 23. Results: Symmetrical ascending weakness was the striking clinical feature. Mean age was 40.20±14.90 years and male to female ratio was 2.1:1. Acute inflammatory demyelinating polyneuropathy (AIDP) was found to be the most common electrophysiological variant of GBS (46%). There was considerable difference in Interleukin-17(IL-17) levels between GBS patients 23.12 ± 3.41 pg/ml and healthy controls 8.82 ± 2.49. Mean IL-17 level was markedly increased in GBS patients, P=0.006, P<0.05. Gastrointestinal infection was the most common preceding infection (56.66%). Mean CSF protein was 100.83 g/dl with ± 51.32 standard deviation and albumio cytologic dissociation (ACD) was different in all four variants of GBS, P= 0.005. Conclusion: GBS was presented by all ages. Males were more affected than females. About two third of GBS patients showed an antecedent infection before GBS onset. Increased levels of cytokine (IL-17) showed involvement of autoimmunity. ACD differentiated it from poliomyelitis. Plasmapheresis and intravenous immunoglobulin (IVIG) therapy were used to treat patients. Key words: Guillain-Barré Syndrome; cerebrospinal fluid; albuminocytologic dissociation; nerve conduction studies; variants; electromyography Continuous....

scholarly journals A Case Report on Post COVID -19 Vaccine Associated Guillain–Barré Syndrome

2021 ◽  
pp. 454-458
Author(s):  
S. Hemalatha ◽  
M. Karishma ◽  
J. Bera ◽  
S. Blessy ◽  
J. Thirumaran ◽  
...  
Keyword(s):  
Case Report ◽  
Nerve Conduction ◽  
Muscle Power ◽  
Ventilatory Support ◽  
Infectious Agent ◽  
Guillain Barre Syndrome ◽  
Autonomic Nerves ◽  
Intravenous Immunoglobulin Therapy ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Guillain–Barré syndrome (GBS) is an autoimmune demyelinating illness in which a patient’s immune system attacks and cause deterioration of peripheral nervous system leading to progressive paralysis and polyneuropathy. The exact cause of the GBS is unclear but the main mechanism of behindis the demyelination of nerves especially the motor, sensory, and autonomic nerves which can be triggered by any immunologic or infectious agent. The infectious agent elicits the humoral and cellular mediated immune response due to their molecular mimicry in which the antibodies created against the infection matches with the proteins on the nerve. The characteristic features of Guillain–Barré syndrome are ascending flaccid paralysis, paresthesia, impairment of muscle reflexes, respiratory failureetc. The GBS is diagnosed via nerve conduction studies, lumbar puncture (Cerebrospinal fluid analysis), electromyography, Brighton criteria. Treatments like intravenous immunoglobulin therapy, plasma exchange can ease the symptoms and reduce the duration of the illness. This case report focusing on a 43-year-old female patient admitted seeking ventilatory support for respiratory distress caused by Guillain–Barré Syndrome in a tertiary hospital. Patient had developed limb weakness with ascending paralysis along with facial weakness within a couple of weeks after receiving the COVID -19 vaccination (COVISHIELD)one month back. Patient underwent nerve conduction study and routine monitoring of vital parameters. After conservative management with physiotherapy, ventilation, intravenous immunoglobulins and prophylaxis for pain and DVT patient gradually started improving the muscle power and was discharged to continue the rehabilitation care at home.

scholarly journals Efficacy of therapies in the treatment of Guillain-Barre Syndrome: a network meta-analysis

2020 ◽  
Author(s):  
Jingfeng Lin ◽  
Qiang Gao ◽  
Kang Xiao ◽  
Danfeng Tian ◽  
Wenyue Hu ◽  
...  
Keyword(s):  
Meta Analysis ◽  
Indirect Evidence ◽  
Guillain Barre Syndrome ◽  
Cochrane Library ◽  
Control Group ◽  
Human Beings ◽  
R Software ◽  
Significant Difference ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Abstract Background Guillain-Barre syndrome (GBS) is an acute, paralyzing, inflammatory peripheral nerve disease. For treatments of the Guillain-Barre Syndrome, there are many kinds of therapies for this diseases. For comparing all of the therapies, such as immunoglobulin, plasma exchanging, etc. in the treatment of Guillain-Barre Syndrome(GBS) to better inform clinical practice, we use Network meta analysis to get the outcome of the Guillain-Barre Syndrome. The protocol has been submitted to PROSPERO:CRD: 42019119178. Methods Web of Science, PubMed, Embase, and the Cochrane library were searched for related articles. We identified citations of these and included 26 trials comprising 2434 patients and control group human beings. Network meta-analysis (NMA) was performed with two kinds of outcomes. We carried on R software with gemtc package and JAGS software to calculate results for different therapies. The consistency of direct and indirect evidence was also assessed by R software. Results Concerning for two outcomes, there were no improvement observed in MTP and Pred compared with placebo. PE and IVIg were illustrated to be effective over Placebo. There was no significant difference between different doses and times of PE and IVIg. On consistency examination between direct and indirect evidences, there were no obvious heterogeneity between all of therapies. Funnel plots indicates the possibility of publication bias in this study are small. Conclusion PE or IVIg had a significant efficency for GBS patients. The effects of some combination treatments should be further explored. Corticosteroids had no significant effects on GBS.

scholarly journals PENGARUH PELATIHAN LANGKAH BAYANGAN (SHADOW) MEMINDAHKAN BOLA BULUTANGKIS TERHADAP KELINCAHAN DAN DAYA LEDAK OTOT TUNGKAI

2018 ◽  
Vol 6 (3) ◽  
Author(s):  
Gde Ryan Saputra ◽  
Made Budiawan Budiawan ◽  
Gede Doddy Tisna
Keyword(s):  
Muscle Power ◽  
Vertical Jump ◽  
Control Group ◽  
Control Groups ◽  
Control Group Design ◽  
Group Design ◽  
The Mean ◽  
Leg Muscle ◽  
And Control ◽  
Leg Muscle Power

Penelitian ini bertujuan untuk mengetahui pengaruh pelatihan langkah bayangan (shadow) memindahkan bola bulutangkis terhadap kelincahan dan daya ledak otot tungkai. Jenis penelitian adalah eksperimen semu dengan rancangan the non randomized pretest-posttest control group design. Subjek penelitian sebanyak 20 orang. Kelincahan diukur dengan tes zig-zag run, dan untuk daya ledak otot tungkai menggunakan tes vertical jump, selanjutnya data dianalisis dengan bantuan komputer program SPSS 16.0. Hasil analisis data kelincahan pada kelompok perlakuan langkah bayangan terjadi peningkatan rata-rata gaint score sebesar 0,49 dan pada kelompok kontrol terjadi peningkatan rata-rata gaint score sebesar 0,25. Hasil analisis data daya ledak otot tungkai pada kelompok perlakuan langkah bayangan terjadi peningkatan rata-rata gaint score sebesar 9,1 dan pada kelompok kontrol terjadi peningkatan rata-rata gaint score sebesar 5,0. Hasil uji t-independent variabel kelincahan antara kelompok perlakuan dan kelompok kontrol didapat Thitung sebesar 5,082 dengan signifikansi 0,000 dan untuk variabel daya ledak otot tungkai antara kelompok perlakuan dan kelompok kontrol didapat Thitung sebesar 6,403 dengan signifikansi 0,000. Dari hasil analisis data dan pembahasan dapat disimpulkan bahwa; (1) pelatihan langkah bayangan (shadow) memindahkan bola bulutangkis berpengaruh terhadap peningkatan kelincahan pada siswa putra ekstrakurikuler bulutangkis SMP Negeri 1 Ubud. (2) pelatihan langkah bayangan (shadow) memindahkan bola bulutangkis berpengaruh terhadap peningkatan daya ledak otot tungkai pada siswa putra ekstrakurikuler bulutangkis SMP Negeri 1 Ubud.Kata Kunci : Langkah Bayangan (shadow), kelincahan, daya ledak otot tungkai The aims of this study was to determined the effect of training shadow step moving a shuttlecock to the agility and leg muscle power. Type of research was quasi experiment with the non randomized pre-test-post-test control group design. This research as many as 20 subjacts. Agility measured with a zig-zag run test and Leg muscle power measured with a vertical jump tests, then the data were analyzed with the aid of a computer program SPSS 16.0. The results of the analysis of agility on a shadow step treatment group, the mean of gaint score increased of 0,49, in the control group there was an increase of 0,25. The result of the analysis of leg muscle power on a shadow step treatment group, the mean of gaint score increased of 9,1, in the control group there was an increase of 5,0. The results of t-Independent agility variables between the treatment and control groups obtained Taccount of 5,082 with significance 0,000, leg muscle power variables between the treatment and control groups obtained Taccount of 6,403 with significance 0,000. From the results of the data analysis and discussion, it can be concluded that; (1) shadow step training effect on the increase in agility men's badminton extracurricular of SMPN 1 Ubud. (2) shadow step training effect on the increase in leg muscle power men's badminton extracurricular of SMPN 1 Ubud.keyword : shadow step, agility, leg muscle power

scholarly journals Electrophysiological patterns in patient with Guillain-Barre syndrome

2021 ◽  
Vol 12 (1) ◽  
pp. 16-21
Author(s):  
SM Monowar Hossain ◽  
Zahed Ali ◽  
Mohammad Motiur Rahman ◽  
Md Aolad Hossain ◽  
Pallab Kanti Saha ◽  
...  
Keyword(s):  
Nerve Conduction Study ◽  
Nerve Conduction ◽  
Axonal Neuropathy ◽  
Clinical Findings ◽  
Guillain Barre Syndrome ◽  
Acute Motor Axonal Neuropathy ◽  
Cross Sectional ◽  
Female Ratio ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Background: Guillain-Barre syndrome (GBS) is an acute, frequently severe and fulminant polyradiculoneuropathy that is autoimmune in nature. Incidence and predominant subtypes of GBS differ geographically. Electrophysiology has important role in subtyping GBS. This study aimed to evaluate the electrophysiological findings in patient of GBS. Methods: This was a hospital based cross-sectional descriptive study and conducted at the Department of Neurology in Sir Salimullah Medical College & Mitford Hospital, Dhaka and National Institute of Neurosciences and Hospital, Dhaka during July 2017 to June 2018. Clinically diagnosed 53 patients with GBS were enrolled according to prefixed selection criteria. Detail history taking, clinical examination, nerve conduction study and cerebrospinal fluid (CSF) examination was performed in all cases. Clinical findings, nerve conduction study (NCS) parameters, CSF findings and demographic profiles were evaluated. Results: Mean ± SD age of presentation was 41.64 (±14.56) years and median age was 42.0 years. There were total 33(62 %) males and 20 (38 %) females with male: female ratio of 1.7:1. Clinically two-thirds(62.3%) of patients had both upper and lower limb involvement (62.3%), facial weakness was in 32.1% and 13.2% had bulbar involvement. Acute inflammatory demyelinating polyneuropathy (AIDP), acute motor axonal neuropathy (AMAN) and acute motor sensory axonal neuropathy (AMSAN)were found to be 51%, 32% and 17% respectively. CSFprotein was elevated in most of the patients with a range of 16-725 mg/dl. Highest CSF protein was found in AIDP. Conclusion: Electrophysiological studies play an important role in the early detection; characterization of GBS.In this study, the commonest type of GBS was AIDP. Higher levels of CSF protein, absent H-reflex and Fresponse, sural sparing and unexcitable nerves are more frequently present in AIDP. BIRDEM Med J 2022; 12(1): 16-21

scholarly journals Fulminant Guillain Barre syndrome with recurrent lung collapse

2020 ◽  
Vol 10 (1) ◽  
pp. 127
Author(s):  
Hasif Kolleri ◽  
Mohammed Fardan ◽  
A. Priya ◽  
K. Arun Chander
Keyword(s):  
Muscle Power ◽  
Lower Limbs ◽  
Guillain Barre Syndrome ◽  
Mechanically Ventilated ◽  
Guillain Barré Syndrome ◽  
Brainstem Function ◽  
Upper Respiratory ◽  
Guillain Barré ◽  
Minimal Resistance ◽  
Nasal Regurgitation

Fulminant Guillain-Barré syndrome (GBS) is a rapidly progressive form of polyneuropathy in which patients demonstrate eventual flaccid quadriplegia and an absence of brainstem function. Most patients present initially with a mild upper respiratory or gastrointestinal illness and have non-diagnostic cerebral imaging studies. Here we report the case of child aged 7 who was admitted initially with complaints of weakness of lower limbs lasting for 4-5 hours. He had difficulty in standing and walking, associated with pain in both lower limbs. Flaccid weakness rapidly progressed over 12 hours to involve both upper limbs along with difficulty in swallowing and nasal regurgitation of feeds. He was intubated and mechanically ventilated for respiratory failure. Over the period of time, after confirmation with all the test reports and symptoms, other differential diagnoses were ruled out and fulminant GBS was considered and hence plasmapheresis was started. Over the period of 3 months his muscle power slowly improved. During discharge, he was able to lift limbs against minimal resistance, turn sideways on bed, sit up with minimal support and likewise stand with support.

GUILLAIN-BARRÉ SYNDROME AFTER CHIKUNGUNYA VIRUS INFECTION

2018 ◽  
Vol 23 (45) ◽  
pp. 173-178
Author(s):  
Marco Orsini ◽  
Denise Flávio De Carvalho ◽  
José Teixeira De Seixas Filho ◽  
Rossano Fiorelli ◽  
Eduardo Lima Trajano
Keyword(s):  
Specific Treatment ◽  
Control Measures ◽  
Lower Limbs ◽  
Guillain Barre Syndrome ◽  
Effective Prevention ◽  
Cranial Nerve Palsies ◽  
Guillain Barré Syndrome ◽  
Prevention And Control Measures ◽  
Guillain Barré ◽  
And Control

Background: In Brazilian territory, the most common arboviruses are DENV (Dengue), CHIKV (Chikungunya), and ZIKV (Zica), although others may spread in the country. These arboviruses has also resulted in a number of neurologic diseases such as Guillain-Barré syndrome, meningoencephalitis, myositis and cranial nerve palsies. This article reports the case of a woman, 33 years that suddenly developed shooting fever, muscle pain and ascedent weakness, receiving subsequently the diagnosis of guillain-barré syndrome for probable unspecified viral infection. After a few days of hospitalization, the diagnosis of Guillain-Barre by possible CHIKV fever were confirmed across clinical evaluation, cerebrospinal fluid, electrophysiological findings and the specific titles of IgM for CHIKV. Months after treatment with intravenous immunoglobulin remains with muscle weakness in lower limbs and difficulties in performing daily activities. The article becomes important because chikungunya infection causes a high number of affected individuals, with severe cases (as presented), and implications for health services, mainly due to the absence of specific treatment, vaccines, and effective prevention and control measures.

Plasma Exchange in Five Patients with Acute Guillain Barré syndrome

1981 ◽  
Vol 4 (5) ◽  
pp. 230-233 ◽  
Author(s):  
A.E.J. de Jager ◽  
T.H. The ◽  
C. Th. Smit Sibinga ◽  
P.C. Das
Keyword(s):  
Motor Activity ◽  
Plasma Exchange ◽  
Recovery Phase ◽  
Guillain Barre Syndrome ◽  
Respiratory Care ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Guillain Barré Syndrome ◽  
Group A ◽  
Guillain Barré

During the last 3 years plasma exchanges were undertaken in 5 patients with acute Guillain Barré syndrome (G.B.S.). All the patients were admitted in the intensive respiratory care unit and had received six plasma exchange procedures over two weeks (each procedure consists of 2–3 L exchange). The first patient improved dramatically after the second exchange. Moderate success was obtained in two patients. One patient did not show any effect. The fifth patient received plasma exchange one day after her recovery phase had begun but the course of recovery remained uneffected. The effect of plasma exchange was analysed as the patients’ response to motor activity, and compaired with a historical control group consisting of 50 acute G.B.S. patients admitted in the intensive respiratory care area over the last 25 years. Plasma exchange does not seem to have excerted any significant effect although at any given time the plasma exchange group had higher motor activity than that of the control group. A controlled clinical trial especially in the early phase of the disease is emphasized.

scholarly journals CSF Neurofilament-H Levels as a Potential Prognostic Marker in Patients of Guillain- Barré Syndrome- A Cohort Study

2021 ◽  
Author(s):  
Tanveer Hassan ◽  
Rayees Ahmad Tarray ◽  
Tanzeel Ahmad Wani ◽  
Mushtaq Ahmad Wani ◽  
Zaffar Amin Shah ◽  
...  
Keyword(s):  
Cohort Study ◽  
Guillain Barre Syndrome ◽  
Control Group ◽  
P Value ◽  
Moderate Degree ◽  
Good Outcome ◽  
Poor Outcome ◽  
Outcome Group ◽  
Guillain Barré Syndrome ◽  
Guillain Barré

Introduction: The prognosis of Guillain-Barré Syndrome (GBS) at an early stage with explicit biomarkers is critical to distinguish patients with possibility of poor recovery. Cerebrospinal Fluid (CSF) serves as an impending source for biomarkers that portrays the exact biochemical changes. Aim: To find out if there is any prognostic value of high CSF phosphorylated Neurofilament Heavy subunit (pNf-H) levels, measured during first two weeks of onset of GBS, as assessed by the level of disability at six months after the onset of GBS. Materials and Methods: The cohort study was conducted in the Department of Neurology and Department of Immunology and Molecular Medicine, at the Sher-I-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India, over a period of two years from August 2015 to August 2017. Sixty two patients who satisfied the required diagnostic standards for GBS (study group) and 35 patients with tension-type headache (control group) were selected for the study. After clinical and electrophysiological assessment, CSF samples were collected. A commercially available sandwich enzyme immunoassay kit, manufactured by BioVendor-Laboratorní medicína (Czech Republic), was used for measuring human pNf-H quantitatively. Results: Mean CSF pNf-H level in patients with good outcome was 325.3 pg/mL whereas, in patients with poor outcome it was 3655.2 pg/mL. CSF pNf-H levels were found to be suggestively higher in GBS patients with poor outcome as compared to those with good outcome. Only eight patients in good outcome group had pathologically high CSF Nf-H levels whereas 10 patients in poor outcome group had CSF Nf-H levels ≤730 pg/mL. The odds ratio was 17.1 (95% Confidence Interval (CI) 3.83-76.29). Thus, high CSF Nf-H levels on admission predicted poor outcome in GBS (p-value <0.001). Moderate degree of positive correlation was found between CSF Nf-H levels and outcome (F score) at six months (R=0.684; p-value <0.001). Conclusion: It can be determined that higher values of CSF pNf-H in GBS (acute stage), could serve as a predictive marker indicative of poor prognosis.

scholarly journals Evaluation of Carotid Intima-Media Thickness in Sub-clinical Hypothyroid Patients

2018 ◽  
Vol 19 (2) ◽  
pp. 123
Author(s):  
Farhana Rahman ◽  
Fatema Sultana Haque ◽  
Shankar Kumar Biswas ◽  
Rubina Begum ◽  
Sadia Hossain ◽  
...  
Keyword(s):  
Rank Correlation ◽  
Intima Media Thickness ◽  
Control Group ◽  
Control Groups ◽  
College Hospital ◽  
Cross Sectional ◽  
Female Ratio ◽  
Media Thickness ◽  
The Mean ◽  
And Control

<p><strong>Objective:</strong> Endothelial dysfunction and atherosclerosis may be associated with subclinical hypothyroidism (SCH) in multiple ways. The intima-media thickness of the common carotid artery (CIMT) is an important parameter for early atherosclerotic change. Previously several studies addressed the association between SCH and CIMT. Some studies indicate that SCH might be related to increase CIMT, while other studies revealed no significant association.   The aim of the study was to further examine the relationship between CIMT and SCH patients in our own laboratory setting in Bangladesh.</p><p><strong>Patients and Methods: </strong>This cross sectional study was carried out at the Institute of Nuclear Medicine and Allied Sciences (INMAS), Dhaka Medical College Hospital Campus, Dhaka during the period of January 2016 to October 2016. The study included 56 consecutive patients. Out of 56 patients, 26 were in SCH group and 30 were in euthyroid control group. CIMT was measured in each subject via High resolution B-mode ultrasonography. Data were analyzed between these two groups in respect to age, sex, BMI, and mean CIMT.</p><p><strong>Results: </strong>Out of 56 subjects, 26 were SCH group and 30 were euthyroid control group. Male to female ratio was 3:23 and 9:21 in SCH and control groups respectively. The mean age was 30±7.4 and 32±8.7 years in SCH and control groups respectively. The mean BMI was 25.6±4.7 kg/m<sup>2</sup> in SCH and 25.1±4.1 kg/m<sup>2</sup> in control group. The mean CIMT was significantly (p≤0.05) higher in SCH group (Right-0.80±0.05 mm, Left-0.80±0.07 mm) than control group (Right-0.60±0.05 mm, Left- 0.61±0.05 mm). SCH group was further subdivided into two groups with a cut off value of serum TSH at 10 mIU/L.  The mean CIMT was significantly higher in SCH with TSH above 10 mIU/L than SCH group with TSH less than 10 mIU/L (p≤0.05). Pearson’s rank correlation test showed significant positive correlation between both CIMT and TSH values.</p><p><strong>Conclusion: </strong>Our study showed that CIMT was significantly higher in SCH group than euthyroid control group. The CIMT values were positively correlated with the TSH values. Therefore we may conclude that SCH is an independent risk factor for atherosclerosis  in addition to other  classical risk factors.</p><p>Bangladesh J. Nuclear Med. 19(2): 123-127, July 2016</p>

Sign in / Sign up

Export Citation Format

Share Document