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Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi

Yıl 2019, Cilt: 4 Sayı: 1, 19 - 23, 20.01.2019

Öz






Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi

 

Amaç: Bu çalışmanın amacı ankilozan spondilit (AS) hastalarında yorgunluk, hastalığa özgü indeksler ile yaşam kalitesi arasındaki ilişkiyi incelemekti. Gereç ve Yöntem: Kesitsel tipteki çalışmamıza Dokuz Eylül Üniversitesi Romatoloji ve İmmunoloji polikliniğinde takip edilen AS hastaları katıldı. Hastalık aktivitesinin değerlendirilmesi amacıyla Bath Ankilozan Spondilit Hastalık Aktivite İndeksi (BASDAİ), fonksiyonel seviyenin değerlendirilmesinde Bath Ankilozan Spondilit Fonksiyonel İndeksi (BASFİ) ve spinal mobilitenin değerlendirilmesinde Bath Ankilozan Spondilit Metroloji İndeksi (BASMİ) kullanıldı. Yorgunluğun değerlendirilmesinde BASDAİ’nin yorgunluğu değerlendiren maddesi kullanıldı. Yaşam kalitesi Ankilozan Spondilit Yaşam Kalitesi Anketi (ASQoL) kullanılarak değerlendirildi. Hastalığa özgü indeksler, yorgunluk ve yaşam kalitesi arasındaki ilişkinin incelenmesi amacıyla Spearman korelasyon analizi kullanıldı. Bulgular: Çalışmamızda 85 AS hastası değerlendirildi. Yorgunluk ile BASDAİ arasında mükemmel (rho=.809, p<.001), BASFİ ile BASDAİ arasında iyi (rho=.665, p<.001), BASFİ ile yorgunluk arasında orta (rho=.561, p<.001) ve BASFİ ile BASMİ arasında orta (rho=.455, p<.001) dereceli korelasyon bulundu. Yaşam kalitesi ile BASDAİ arasında orta (rho=.523, p<.001), yaşam kalitesi ile BASFİ arasında orta (rho=.508, p<.001) ve yaşam kalitesi ile yorgunluk arasında orta dereceli (rho=.464, p<.001) korelasyon bulunurken, yaşam kalitesi ile BASMİ arasında düşük dereceli (rho=.280, p=.009) korelasyon bulundu.
Sonuç: Ankilozan spondilit hastalarında yorgunluk, hastalık aktivitesi, spinal mobilite ve yaşam kalitesinin ilişkili olduğu görüldü.


Anahtar
Kelimeler: 
Ankilozan Spondilit, yorgunluk, yaşam kalitesi

 

The Investigation of The Relationship Between Disease Specific Indexes, Fatigue and Quality of Life in Ankylosing Spondylitis Patients

 

Objective: The aim of this study was to investigate the relationship between fatigue, disease-specific indexes and quality of life in ankylosing spondylitis (AS) patients. Material and Methods: In our cross-sectional study, AS patients who were followed in Dokuz Eylul University Rheumatology and Immunology outpatient clinic were included. Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) was used for the evaluation of disease activity, Bath Ankylosing Spondylitis Functional Index (BASFI) was used for the evaluation of functional level, Bath Ankylosing Spondylitis Metrology Index (BASMI) was used to evaluate spinal mobility. For evaluation of fatigue, fatigue-assessing item of BASDAI was used. Quality of life was assessed by using the Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL). Spearman correlation analysis was used to examine the relationship between disease specific indexes, fatigue and quality of life. Findings: Eighty-five AS patients were evaluated in our study. Excellent correlation was detected between fatigue and BASDAI (rho=.809, p<.001), good correlation was found between BASFI and BASDAI (rho=.665, p<.001) moderate correlations were found between BASFI and fatigue (rho=.561, p<.001), and BASFI and BASMI (rho=.455, p<.001). There was moderate correlation between quality of life and BASDAI (rho=.523, p<.001), moderate correlation between quality of life and BASFI (rho=.508, p<.001), moderate correlation between quality of life and fatigue (rho=.464, p<.001). Low correlation was found between quality of life and BASMI (rho=.280, p=.009). Conclusion: It was found that fatigue, disease activity, spinal mobility and quality of life were correlated in ankylosing spondylitis patients.

Keywords: Ankylosing Spondylitis, fatigue, quality of life


Kaynakça

  • Akkoc, Y., Karatepe, A. G., Akar, S., Kirazli, Y., & Akkoc, N. (2005). A Turkish version of the bath ankylosing spondylitis disease activity index: reliability and validity. Rheumatology international, 25(4), 280-284.
  • Alkan, B. M., Fidan, F., Erten, Ş., Aksekili, H., Alemdar, A., Eroğlu, E., et al. (2013). Fatigue and correlation with disease-specific variables, spinal mobility measures, and health-related quality of life in ankylosing spondylitis. Modern rheumatology, 23(6), 1101-1107.
  • Almodóvar, R., Zarco, P., Collantes, E., González, C., Mulero, J., FernándezSueiro, J., et al. (2009). Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER). Clinical & Experimental Rheumatology, 27(3), 439.
  • Ariza-Ariza, R., Hernández-Cruz, B., & Navarro-Sarabia, F. (2003). Physical function and health- related quality of life of Spanish patients with ankylosing spondylitis. Arthritis care & research, 49(4), 483-487.
  • Belza, B. L., Henke, C. J., Yelin, E. H., Epstein, W. V., & Gilliss, C. L. (1993). Correlates of fatigue in older adults with rheumatoid arthritis. Nursing research.
  • Bodur, H., Ataman, Ş., Rezvani, A., Buğdaycı, D. S., Çevik, R., Birtane, M., et al. (2011). Quality of life and related variables in patients with ankylosing spondylitis. Quality of Life Research, 20(4), 543-549.
  • Bostan, E. E., Borman, P., Bodur, H., & Barca, N. (2003). Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatology international, 23(3), 121-126
  • Braun, J., & Sieper, J. (2007). Ankylosing spondylitis. The Lancet, 369(9570), 1379-1390.
  • Calin, A., Garrett, S., Whitelock, H., Kennedy, L., O’hea, J., Mallorie, P., & Jenkinson, T. (1994). A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. The Journal of rheumatology, 21(12), 2281-2285.
  • Dagfinrud, H., Vollestad, N. K., Loge, J. H., Kvien, T. K., & Mengshoel, A. M. (2005). Fatigue in patients with ankylosing spondylitis: a comparison with the general population and associations with clinical and selfreported measures. Arthritis care & research, 53(1), 5-11.
  • Dalyan, M., Güner, A., Tuncer, S., Bilgiç, A., & Arasıl, T. (1999). Disability in ankylosing spondylitis. Disability and rehabilitation, 21(2), 74-79.
  • Doward, L., Spoorenberg, A., Cook, S., Whalley, D., Helliwell, P., Kay, L., et al. (2003). Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Annals of the rheumatic diseases, 62(1), 20-26.
  • Duruöz, M., Doward, L., Turan, Y., Cerrahoglu, L., Yurtkuran, M., Calis, M., et al. (2013). Translation and validation of the Turkish version of the ankylosing spondylitis quality of life (ASQoL) Questionnaire. Rheumatology international, 33(11), 2717-2722.
  • Feldtkeller, E., Khan, M., Van Der Heijde, D., Van Der Linden, S., & Braun, J. (2003). Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatology international, 23(2), 61-66.
  • Garrett, S., Jenkinson, T., Kennedy, L. G., Whitelock, H., Gaisford, P., & Calin, A. (1994). A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. The Journal of rheumatology, 21(12), 2286-2291.
  • Günaydin, R., Karatepe, A. G., Çeşmeli, N., & Kaya, T. (2009). Fatigue in patients with ankylosing spondylitis: relationships with diseasespecific variables, depression, and sleep disturbance. Clinical rheumatology, 28(9), 1045-1051.
  • Hayran, M. (2011). Sağlık araştırmaları için temel istatistik: Omega Araştırma.
  • Kotsis, K., Voulgari, P. V., Drosos, A. A., Carvalho, A. F., & Hyphantis, T. (2014). Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert review of pharmacoeconomics & outcomes research, 14(6), 857-872.
  • Landewé, R., Dougados, M., Mielants, H., van der Tempel, v. d. H., & van der Heijde, D. (2009). Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Annals of the rheumatic diseases, 68(6), 863-867.
  • Missaoui, B., & Revel, M. (2006). Fatigue in ankylosing spondylitis. Paper presented at the Annales de réadaptation et de médecine physique.
  • Ozer, H. T., Sarpel, T., Gulek, B., Alparslan, Z. N., & Erken, E. (2005). The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity. Clinical rheumatology, 24 (2), 123-128.
  • Schneeberger, E. E., Marengo, M. F., Dal Pra, F., Cocco, J. A. M., & Citera, G. (2015). Fatigue assessment and its impact in the quality of life of patients with ankylosing spondylitis. Clinical rheumatology, 34(3), 497-501.
  • Sieper, J., Braun, J., Rudwaleit, M., Boonen, A., & Zink, A. (2002). Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61(suppl3), iii8-iii18.
  • Stebbings, S. M., Treharne, G. J., Jenks, K., & Highton, J. (2014). Fatigue in patients with spondyloarthritis associates with disease activity, quality of life and inflammatory bowel symptoms. Clinical rheumatology, 33(10), 1467-1474.
  • Turan, Y., Duruöz, M. T., Bal, S., Guvenc, A., Cerrahoglu, L., & Gurgan, A. (2007). Assessment of fatigue in patients with ankylosing spondylitis. Rheumatology international, 27(9), 847-852.
  • Van Tubergen, A., Coenen, J., Landewé, R., Spoorenberg, A., Chorus, A., Boonen, A., et al. (2002). Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis care & research, 47(1), 8-16.
  • Wanders, A., Landewe, R., Dougados, M., Mielants, H., Van der Linden, S., & Van Der Heijde, D. (2005). Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation? Annals of the rheumatic diseases, 64(7), 988-994.
  • Ward, M. M. (1999). Health related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis care & research, 12(4), 247-255.
  • Yang, X., Fan, D., Xia, Q., Wang, M., Zhang, X., Li, X., et al. (2016). The healthrelated quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Quality of Life Research, 25(11), 2711-2723.
  • Zhao, L., Liao, Z., Li, C., Li, T., Wu, J., Lin, Q., et al. (2007). Evaluation of quality of life using ASQoL questionnaire in patients with ankylosing spondylitis in a Chinese population. Rheumatology international, 27(7), 605-611.
  • Zochling, J. (2011). Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS‐G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies HAQ‐S). Arthritis care & research, 63(S11).
  • Zochling, J., Braun, J., & van der Heijde, D. (2006). Assessments in ankylosing spondylitis. Best Practice & Research Clinical Rheumatology, 20(3), 521- 537.
Yıl 2019, Cilt: 4 Sayı: 1, 19 - 23, 20.01.2019

Öz

Kaynakça

  • Akkoc, Y., Karatepe, A. G., Akar, S., Kirazli, Y., & Akkoc, N. (2005). A Turkish version of the bath ankylosing spondylitis disease activity index: reliability and validity. Rheumatology international, 25(4), 280-284.
  • Alkan, B. M., Fidan, F., Erten, Ş., Aksekili, H., Alemdar, A., Eroğlu, E., et al. (2013). Fatigue and correlation with disease-specific variables, spinal mobility measures, and health-related quality of life in ankylosing spondylitis. Modern rheumatology, 23(6), 1101-1107.
  • Almodóvar, R., Zarco, P., Collantes, E., González, C., Mulero, J., FernándezSueiro, J., et al. (2009). Relationship between spinal mobility and disease activity, function, quality of life and radiology. A cross-sectional Spanish registry of spondyloarthropathies (REGISPONSER). Clinical & Experimental Rheumatology, 27(3), 439.
  • Ariza-Ariza, R., Hernández-Cruz, B., & Navarro-Sarabia, F. (2003). Physical function and health- related quality of life of Spanish patients with ankylosing spondylitis. Arthritis care & research, 49(4), 483-487.
  • Belza, B. L., Henke, C. J., Yelin, E. H., Epstein, W. V., & Gilliss, C. L. (1993). Correlates of fatigue in older adults with rheumatoid arthritis. Nursing research.
  • Bodur, H., Ataman, Ş., Rezvani, A., Buğdaycı, D. S., Çevik, R., Birtane, M., et al. (2011). Quality of life and related variables in patients with ankylosing spondylitis. Quality of Life Research, 20(4), 543-549.
  • Bostan, E. E., Borman, P., Bodur, H., & Barca, N. (2003). Functional disability and quality of life in patients with ankylosing spondylitis. Rheumatology international, 23(3), 121-126
  • Braun, J., & Sieper, J. (2007). Ankylosing spondylitis. The Lancet, 369(9570), 1379-1390.
  • Calin, A., Garrett, S., Whitelock, H., Kennedy, L., O’hea, J., Mallorie, P., & Jenkinson, T. (1994). A new approach to defining functional ability in ankylosing spondylitis: the development of the Bath Ankylosing Spondylitis Functional Index. The Journal of rheumatology, 21(12), 2281-2285.
  • Dagfinrud, H., Vollestad, N. K., Loge, J. H., Kvien, T. K., & Mengshoel, A. M. (2005). Fatigue in patients with ankylosing spondylitis: a comparison with the general population and associations with clinical and selfreported measures. Arthritis care & research, 53(1), 5-11.
  • Dalyan, M., Güner, A., Tuncer, S., Bilgiç, A., & Arasıl, T. (1999). Disability in ankylosing spondylitis. Disability and rehabilitation, 21(2), 74-79.
  • Doward, L., Spoorenberg, A., Cook, S., Whalley, D., Helliwell, P., Kay, L., et al. (2003). Development of the ASQoL: a quality of life instrument specific to ankylosing spondylitis. Annals of the rheumatic diseases, 62(1), 20-26.
  • Duruöz, M., Doward, L., Turan, Y., Cerrahoglu, L., Yurtkuran, M., Calis, M., et al. (2013). Translation and validation of the Turkish version of the ankylosing spondylitis quality of life (ASQoL) Questionnaire. Rheumatology international, 33(11), 2717-2722.
  • Feldtkeller, E., Khan, M., Van Der Heijde, D., Van Der Linden, S., & Braun, J. (2003). Age at disease onset and diagnosis delay in HLA-B27 negative vs. positive patients with ankylosing spondylitis. Rheumatology international, 23(2), 61-66.
  • Garrett, S., Jenkinson, T., Kennedy, L. G., Whitelock, H., Gaisford, P., & Calin, A. (1994). A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. The Journal of rheumatology, 21(12), 2286-2291.
  • Günaydin, R., Karatepe, A. G., Çeşmeli, N., & Kaya, T. (2009). Fatigue in patients with ankylosing spondylitis: relationships with diseasespecific variables, depression, and sleep disturbance. Clinical rheumatology, 28(9), 1045-1051.
  • Hayran, M. (2011). Sağlık araştırmaları için temel istatistik: Omega Araştırma.
  • Kotsis, K., Voulgari, P. V., Drosos, A. A., Carvalho, A. F., & Hyphantis, T. (2014). Health-related quality of life in patients with ankylosing spondylitis: a comprehensive review. Expert review of pharmacoeconomics & outcomes research, 14(6), 857-872.
  • Landewé, R., Dougados, M., Mielants, H., van der Tempel, v. d. H., & van der Heijde, D. (2009). Physical function in ankylosing spondylitis is independently determined by both disease activity and radiographic damage of the spine. Annals of the rheumatic diseases, 68(6), 863-867.
  • Missaoui, B., & Revel, M. (2006). Fatigue in ankylosing spondylitis. Paper presented at the Annales de réadaptation et de médecine physique.
  • Ozer, H. T., Sarpel, T., Gulek, B., Alparslan, Z. N., & Erken, E. (2005). The Turkish version of the Bath Ankylosing Spondylitis Functional Index: reliability and validity. Clinical rheumatology, 24 (2), 123-128.
  • Schneeberger, E. E., Marengo, M. F., Dal Pra, F., Cocco, J. A. M., & Citera, G. (2015). Fatigue assessment and its impact in the quality of life of patients with ankylosing spondylitis. Clinical rheumatology, 34(3), 497-501.
  • Sieper, J., Braun, J., Rudwaleit, M., Boonen, A., & Zink, A. (2002). Ankylosing spondylitis: an overview. Annals of the rheumatic diseases, 61(suppl3), iii8-iii18.
  • Stebbings, S. M., Treharne, G. J., Jenks, K., & Highton, J. (2014). Fatigue in patients with spondyloarthritis associates with disease activity, quality of life and inflammatory bowel symptoms. Clinical rheumatology, 33(10), 1467-1474.
  • Turan, Y., Duruöz, M. T., Bal, S., Guvenc, A., Cerrahoglu, L., & Gurgan, A. (2007). Assessment of fatigue in patients with ankylosing spondylitis. Rheumatology international, 27(9), 847-852.
  • Van Tubergen, A., Coenen, J., Landewé, R., Spoorenberg, A., Chorus, A., Boonen, A., et al. (2002). Assessment of fatigue in patients with ankylosing spondylitis: a psychometric analysis. Arthritis care & research, 47(1), 8-16.
  • Wanders, A., Landewe, R., Dougados, M., Mielants, H., Van der Linden, S., & Van Der Heijde, D. (2005). Association between radiographic damage of the spine and spinal mobility for individual patients with ankylosing spondylitis: can assessment of spinal mobility be a proxy for radiographic evaluation? Annals of the rheumatic diseases, 64(7), 988-994.
  • Ward, M. M. (1999). Health related quality of life in ankylosing spondylitis: a survey of 175 patients. Arthritis care & research, 12(4), 247-255.
  • Yang, X., Fan, D., Xia, Q., Wang, M., Zhang, X., Li, X., et al. (2016). The healthrelated quality of life of ankylosing spondylitis patients assessed by SF-36: a systematic review and meta-analysis. Quality of Life Research, 25(11), 2711-2723.
  • Zhao, L., Liao, Z., Li, C., Li, T., Wu, J., Lin, Q., et al. (2007). Evaluation of quality of life using ASQoL questionnaire in patients with ankylosing spondylitis in a Chinese population. Rheumatology international, 27(7), 605-611.
  • Zochling, J. (2011). Measures of symptoms and disease status in ankylosing spondylitis: Ankylosing Spondylitis Disease Activity Score (ASDAS), Ankylosing Spondylitis Quality of Life Scale (ASQoL), Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), Bath Ankylosing Spondylitis Functional Index (BASFI), Bath Ankylosing Spondylitis Global Score (BAS‐G), Bath Ankylosing Spondylitis Metrology Index (BASMI), Dougados Functional Index (DFI), and Health Assessment Questionnaire for the Spondylarthropathies HAQ‐S). Arthritis care & research, 63(S11).
  • Zochling, J., Braun, J., & van der Heijde, D. (2006). Assessments in ankylosing spondylitis. Best Practice & Research Clinical Rheumatology, 20(3), 521- 537.
Toplam 32 adet kaynakça vardır.

Ayrıntılar

Birincil Dil Türkçe
Bölüm Araştırma Makaleleri
Yazarlar

Yasemin Acar

Gerçek Can Bu kişi benim

Nursen İlçin Bu kişi benim

Yayımlanma Tarihi 20 Ocak 2019
Gönderilme Tarihi 3 Aralık 2018
Yayımlandığı Sayı Yıl 2019 Cilt: 4 Sayı: 1

Kaynak Göster

APA Acar, Y., Can, G., & İlçin, N. (2019). Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, 4(1), 19-23.
AMA Acar Y, Can G, İlçin N. Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi. İKÇÜSBFD. Ocak 2019;4(1):19-23.
Chicago Acar, Yasemin, Gerçek Can, ve Nursen İlçin. “Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk Ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 4, sy. 1 (Ocak 2019): 19-23.
EndNote Acar Y, Can G, İlçin N (01 Ocak 2019) Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 4 1 19–23.
IEEE Y. Acar, G. Can, ve N. İlçin, “Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi”, İKÇÜSBFD, c. 4, sy. 1, ss. 19–23, 2019.
ISNAD Acar, Yasemin vd. “Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk Ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi 4/1 (Ocak 2019), 19-23.
JAMA Acar Y, Can G, İlçin N. Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi. İKÇÜSBFD. 2019;4:19–23.
MLA Acar, Yasemin vd. “Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk Ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi”. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi, c. 4, sy. 1, 2019, ss. 19-23.
Vancouver Acar Y, Can G, İlçin N. Ankilozan Spondilit Hastalarında Hastalığa Özgü İndeksler, Yorgunluk ve Yaşam Kalitesi Arasındaki İlişkinin İncelenmesi. İKÇÜSBFD. 2019;4(1):19-23.