Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30General SciencesOPTIMUM DIETARY INCLUSION LEVEL OF BACILLUS COAGULANS FOR GROWTH AND DIGESTIBILITY IMPROVEMENT FOR CATLA CATLA (HAMILTON)
English0110Anita BhatnagarEnglish Shashi RapariaEnglishPurpose: The present studies were conducted to evaluate the optimum inclusion levels of probiotic Bacillus coagulans, isolated from the intestine of Catla catla for improved growth performance and nutrient retention. Methods: Catla fingerlings (avg. wt. 0.2±0.02 g) were fed on isocaloric and isonitrogenous diets supplemented with 2×104 (D1), 2×105(D2) and 2×106(D3) Bacillus coagulans cells 100g-1 of feed for 90 days @ 4 % body weight per day in two equal installments in three replicates. The control treatment (DC) was not supplemented with Bacillus coagulans. Growth and digestibility parameters and intestinal enzyme activities were monitored. Results: The growth of fish in terms of live weight gain (g), growth per day in percentage body weight and specific growth rate were significantly (PEnglishBacillus coagulans, Catla catla, Dietary probiotic, Growth performance, Intestinal enzymesINTRODUCTION
Development of commercial scale intensive aqua farming with high stocking densities, high food inputs and high organic load accompanies problems of aquatic pollution and disease outbreaks, affecting fish growth, survival and production(1). To combat these problems large amount of chemotherapeutics / antibiotics are often used; the abuse of these drugs has led to the development of multiple drug resistant bacteria (2, 3). Increased concern about these resistant microorganisms has led to several alternatives including the use of beneficial non-pathogenic micro-organisms as probiotics (4). The use of commercial probiotics in fish is relatively ineffective as most commercial preparations are based on strains isolated from non fish sources that are unable to survive or remain viable at high cell density in the intestinal environment of fish during the active growth phase of fish (5). Hence, there is elegant logic in isolating the putative probiotics from the host in which the probiotics is intended to use. The criteria for selection therefore, demands that the bacteria should be of same species origin,produces antimicrobial metabolites and should adhere to intestinal mucosa (6). Bacillus have been widely used as potential probiotics (7), since they secrete a variety of antimicrobial compounds and exoenzymes (5, 8). Ringpipat et al. (9) reported that use of Bacillus spp. (strain S11) provides pathogenical protection by activating both cellular and immune defenses. Zhou et al. (10) studied the effect of Bacillus sublitis, Bacillus coagulans and Rhodopseudomonas sp. on growth performance of Tilapia, but they used these probiotic bacterial cultures as water additives. Studies were undertaken in our laboratory to isolate gut adherent potential probiotic bacterium to improve fish growth and digestibility in Catla catla (11), however, the inclusion level of probiotic in feed of specific fish species need to be searched. Therefore, this study is attempted to investigate the effect of dietary supplementation of different inclusion level of probiotic bacterium Bacilllus coagulans, on growth performance, digestibility and nutrition retention in C. catla.
MATERIALS AND METHODS
The present study was conducted at Aquaculture Research Unit, Department of Zoology, Kurukshetra University, Kurukshetra (29°58’N latitude and 76°51’E longitude), Haryana, India. Fingerlings of C. catla of average weight 0.2±0.02 g were obtained from local fish farm. Fingerlings were released into aquariums (50L capacity) after acclimatizing for 10 days to prevailing laboratory condition of water temperature (25±1°C), pH (7.2- 7.8) and oxygen range between 5-6 mg/L. Studies were conducted at room temperature for 90 days. Each aquarium was filled with de-chlorinated tap water and then stocked with 20 fish (fingerlings with average BW 0.2±0.02 grams and length 1.7±0.09 cm respectively).Aquarium water was renewed daily with water adjusted to laboratory temperature ( 25° C). The probiotic bacterium isolated from the intestine of Catla catla was identified from IMMTECH Chandigarh, India as Bacillus coagulans and mass cultured for 48 hours, at 30oC in shaken bottles with nutrient Agar media (Hi-Media, India). The cultures were centrifuged at 5000 rpm for 15 minutes at 40C, washed thrice with sterile 1 % NaCl solution and the pellets were re-suspended in sterile saline water. The processed soybean (40 %) based experimental diets were prepared by absorbing suspension of probiotic bacterium and a mechanical pelletizer to produce 0.5 mm pellets. To eliminate / inactivate antinutrient factors (ANFs), soybeans were hydrothermically treated at 15 psi and 121?C for 15 min; 1% chromic oxide (Cr2O3) was added as an external indigestible marker for digestibility estimations. Four dietary treatments (DC, D1, D2 and D3) were performed with three replicates of each treatment. In treatment 1 (DC), fishes were fed on artificial diet without probiotic bacteria (i.e. control diet). In treatment 2, 3 and 4, fishes were fed on artificial diet containing mass cultured Bacillus coagulansCC1 in proportions 2x104 , 2x105 and 2x106 cells 100g-1 of feed (Table 1). All these diets were isocaloric and isoproteic with approximately 40% proteins. After spraying the feed was air dried at room temperature. The bacterial concentration was calculated as 1.69 x 104 , 1.89 x 105 and 1.73 x 106 CFU 100 g-1 of feed D1, D2 and D3 respectively ( see table- 1 for proximate composition). Finally, the feeds were stored in vacuumed plastic container at 40C. All groups of fish were fed daily at 4% BW in 2 installments at 8:00 and 16:30 hours for 90 days. Average weight of all fish in each tank was measured, and the amount of feed was adjusted accordingly every 15 days. Each group of fish was exposed to their respective diet for four hours; thereafter, the uneaten feed was siphoned out, stored, and dried separately for calculating feed consumption per day. The fecal matter voided by the fish was collected every morning by siphoning. Fecal samples were dried in a hot air oven at 60?C and subsequently analyzed for digestibility estimations. At the end of the feeding trials, water samples from each aquarium were collected at two-hour intervals over a period of 24 h for the estimation of excretory levels of total ammonia (N-NH4+ ) and reactive orthophosphate following the American Public Health Association (12),and calculated following Sumagaysay-Chavoso (13). At the termination of experiment, the fish from all the treatments were individually weighed to the nearest gram and measured to the nearest millimeter and processed for subsequent analyses. From each treatment, eight fish were randomly sampled and kept on ice to remove the intestines which were processed for the determination of enzyme activity of protease (14), amylase (15), and cellulose (16). Proximate analysis (Dry matter, ash, crude protein, crude fat, NFE and phosphorus) of experimental diets and fish carcass (initial and final) was done following (17). Chromic oxide levels in the diets as well as in the fecal samples were estimated spectrophotometrically (18). Growth and nutrient retention parameters were calculated following Steffens (19). Apparent protein digestibility (APD) of the diets was calculated according to of Cho et al. (20).Live weight gain (g), percent weight gain, specific growth rate, feed consumption per day in percentage of body weight, feed conversion ratio (FCR), gross conversion efficiency (GCE), and protein efficiency ratio (GER) were calculated using standard method (19).Gross energy content of the diet and fish carcasses was calculated using the average caloric conversion factor of 0.3954, 0.1715, and 0.2364 Kj g−1 for lipid, carbohydrate, and protein, respectively (21), whereas metabolizable energy in diets and feeds was calculated using caloric conversion factors: 0.335, 0.138, and 0.188 Kj g−1 for lipid, carbohydrate, and protein, respectively (22). Statistical Analysis ANOVA followed by Duncan’s multiple range test (23) was applied to find out significant differences among dietary treatments
RESULTS
Survival rate (%) was high in all dietary treatments and slight mortality occurred only during the initial days of experiment. The growth of fish in terms of live weight gain (g), growth/day in percentage body weight and specific growth rate (SGR) were significantly (PEnglishhttp://ijcrr.com/abstract.php?article_id=909http://ijcrr.com/article_html.php?did=909REFERENCES
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30General SciencesANTIOXIDANT AND ANTIFUNGAL ACTIVITIES OF METHANOLIC EXTRACT OF CHAETOMORPHA LINUM FROM INDIAN SOUTHEAST COAST
English1116Durga Devi V.English Minhajdeen A.English Pavithra V.English Brindha S.English Sree Jaya S.English Saranya R. S.English Varun S.English Senthilkumar P.English Sudha S.EnglishAim: Sea weeds are vital part of complementary and unconventional medicine suitable for the ability to generate secondary metabolites that are used to re-establish health and to treat many diseases. The present study aims at determinining the antioxidant and antifungal activities of the green seaweed Chaetomorpha linum. Methodology: Chaetomorpha linum, collected from the Gulf of Mannar, regions of Mandapam coastal area, Southeast coast of India were reported foremost for the antioxidant and antifungal activities based on the free radical-scavenging activity of the 1, 1-diphenyl-2-picrylhydrazyl radical (DPPH), ferrous reducing antioxidant property (FRAP), and total phenolic content in the methanolic extract. The antifungal properties of the methanolic extract of C. linum were tested against pathogenic fungal strains like Fusarium dimerum and Trichoderma ressei. Results: The DPPH scavenging activity was equivalent to an IC50 value of 8.8 μg/mL ascorbic acid. The total phenolic content was 668.2 mg/g gallic acid equivalent, and the IC 50 value by FRAP assay was 8.6 μg/mL. On further examination, when compared with standard antibiotics, C. linum extract be a sign of considerable activity against Fusarium dimerum and Trichoderma ressei. Conclusion: Our findings represents C. linum is a natural antioxidant and a potential natural source of antifungal agents against selected fungal pathogens.
EnglishSea weeds, antifungal activity, DPPH activity, antioxidantsINTRODUCTION
Natural antioxidants are paid much consideration in the field of biomedicine with their association on health benefits (1). Many reports suggest that seaweed as a potential source of natural antioxidants as of their biological activities (2, 3). Among prospective features of marine algae and its components, quite a lot of extracts have been screened with regard to antioxidant and radical scavenging activity using stable free radicals (4-7). Seaweeds are used in the treatment of various infectious diseases traditionally. For many years, a mixture of synthetic chemicals used as antifungal agents inhibits the growth of plant pathogenic fungi. However, there are serious problems on the effective use of these chemicals (8, 9). Many studies proved that there are a large number marine species showing antifungal activities which in future throws more light on the use of marine algae by the pharmaceutical technologies for the extraction of useful drugs (10, 11). Furthermore, several groups of green, red, and brown seaweed have investigated for various properties (12, 13). Majority of seaweeds from the Gulf of Mannar has not been examined for their bioactive substances. Despite of the abundance and diversity of algae in coastal waters, Chaetomorpha linum (Class: Ulvophyaceae; Order: Cladoporales; Family: Cladoporaceae) is widespread in the Mandapam coastal region of the Gulf of Mannar on southeast coast of India which is mainly used as food, animal feed, and agriculture and until now, no screening of antioxidant activities has been performed. In this investigation, we evaluated the antioxidant and antifungal activity of a methanolic extract of C. linum, obtained from the Gulf of Mannar, a southeastern coastal region of India.
MATERIALS AND METHODS
Sample collection and preparationKutzing green seaweed C. linum collected from the Mandapam coastal region (78 ?8’E, 9?17’N), in the Gulf of Mannar, Tamilnadu, South India, on low tide in December 2012 was brought immediately to the laboratory in polythene bags which was washed several times with seawater to remove sand, mud, and attached fauna. The algae were cleaned using a brush to remove epiphytes with distilled water. After cleaning, it was dried in the shade at room temperature for 1 week. The dried algal materials were homogenized to a fine powder and subjected to extraction. Preparation of extracts Five hundred grams of powdered C. linum seaweed sample was taken and extracted successively with methanol (90%) using a soxhlet apparatus. The crude extracts were later concentrated under reduced pressure to obtain their corresponding residues. The methanolic extracts were further subjected to antioxidant and antifungal assays in triplicate. Radical scavenging assay The radical-scavenging activity of methanolic C. linum extracts against DPPH radicals was determined by the method of Blois et al (14). DPPH (0.1 mM in methanol) was prepared, and 1.0 mL of this solution was added to 3.0 mL of extract in methanol at various concentrations (1-16 μg/ mL). Thirty minutes later, the absorbance was measured at 517 nm. A blank was prepared ithout extract. Ascorbic acid at various concentrations (1 to 16 μg/mL) was used as the standard. A lower absorbance of the reaction mixture indicates greater free radical-scavenging activity. The ability to scavenge DPPH radical was calculated using the following equation: DPPH Scavenged (%) = A control– A test / A control X100 where A control is the absorbance of the control reaction and A test is the absorbance in the presence of the extracts. The antioxidant activity of the C. linum extract was expressed as IC50 and compared with the standard. The IC50 value was defined as the concentration (in μg/mL) of extract that inhibited the formation of DPPH radicals by reducing power assay. The reducing power of methanolic extracts of C. linum was determined (15). Various concentrations of the extracts (1-16 μg/mL) in 1.0 mL of deionized water were mixed with phosphate buffer (2.5 mL) and potassium ferricyanide (2.5 mL). The mixture was incubated at 50°C for 20 min, and aliquots of trichloroacetic acid (2.5 mL) were added to the mixture, which was then centrifuged at 3000 rpm for 10 min. The upper layer of the solution (2.5 mL) was mixed with distilled water (2.5 mL) and freshly prepared ferric chloride solution (0.5 mL). The absorbance was measured at 700 nm. A blank was prepared without extract. Ascorbic acid at various concentrations (1 to16 μg/mL) was used as the standard. Increased absorbance of the mixture indicates an increase in reducing power. % Increase in Reducing Power = A test / A blank - 1 x 100 where A test is the absorbance of the test solution and A blank is the absorbance of the blank. The antioxidant activity of the seaweed extract was expressed as IC50 and compared with the standard.
Determination of total phenolic content
Total phenolic content of the C. linum extracts was determined using the Folin-ciocalteu reagent (16). One milliliter of extract in Gallic acid (20, 40, 60, 80, and 100 mg/L) was added to a 25 mL volumetric flask, containing distilled deionized water. The blank reagent was set with distilled deionized water. One milliliter of Folin-ciocalteu phenol reagent was added to the mixture and mixed by shaking. After 5 min, 10 mL of 7 % Na2CO3 solution was added to the mixture. The solution was diluted to 25 mL with deionized distilled water and mixed. After incubation for 90 min at room temperature, the absorbance against the prepared blank reagent was measured at 750 nm on a spectrophotometer. Total phenolic content of the seaweed was expressed as mg Gallic acid equivalents (GAEs) or 100 g fresh weight. All samples were analyzed in triplicate.
Antifungal activity
The following strains of fungi were used: Fusarium dimerum (MTCC 6583), and Trichoderma ressei (MTCC-3929) was obtained from the Institute of Microbial Technology, Chandigarh, India. Cultures were maintained on potato dextrose agar (Hi Media, India) slants at 4°C for further use. The extracts were tested for their efficiency against the fungal pathogens by using an agar dilution technique (18). Different concentrations of the extracts; 20%, 10%, and 5% were obtained by amending PDA. The amended medium was dispensed into sterile petri plates and allowed to solidify with streptomycin (100 µg/ml). Each plate was inoculated with F. dimerum and T. ressei. A 4-mm diameter mycelia disc of each of the test organisms was inoculated on each amended agar plate. Inoculated plates were incubated at 25 ± 2 oC and growth measured along the perpendicular lines. Daily radial growth of each test organism in any of the test extracts was recorded for 7 days. Each treatment was replicated thrice with appropriate untreated controls. In here three replications were prepared for each treatment. Then all the culture plates were incubated at 25 ± 2 oC in dark condition. The mycelia growth of fungus was measured after 96 hours. Percentageinhibition was calculated against the mycelia growth over control (19).
RESULTS
DPPH, a stable free radical, will decolorize in the presence of antioxidants on DPPH antioxidant assay. The comparison of the antioxidant activity of the extracts (at 1, 2, 4, 8, and 16 μg/mL) and reference standard is shown in Table 1. The methanolic extract of C. linum exhibited a significant dose-dependent inhibition of DPPH activity, with an IC 50 value 8.8 µg/mL. The IC 50 value of the extract was comparable with that of the reference standard, ascorbic acid (IC 50 = 8.7 µg/mL), indicating the antioxidant activity of C. linum (Figure 1). The IC 50 value in the reducing power assay was 8.2 µg/mL and 3.4 µg/mL, respectively, for the methanolic extract of C. linum and ascorbic acid (Figure 2). By Folin-Ciocalteu method, the highest total phenolic content of C. linum was 668.2 mg/GAE/100 g/extract. The methanolic extract of C. linum was tested for its antifungal activity. The results of the antifungal studies with regard to percentage of radial growth inhibition in PDA plat are shown in Table 2. All the extracts exhibited different degrees of antifungal activity against F. dimerum and T. ressei. The growth of T. ressei was highly inhibited by all the tested concentrations (5-20%) of methanol extracts of sea weeds compared with control, the corresponding inhibition ranging from 81% - 72%. The extract showed comparatively very low activity against F. dimerum ranging from 86% - 76%.
DISCUSSION
The detection of antioxidants from sea weeds is a fast-growing and many antioxidants have been investigated by several methods. The rapid, reliable, and economical method to evaluate the antioxidative potential of various natural compounds is through DPPH assay (18). Methanolic extracts of C. linum show signs of potent antioxidant activity in a dose-dependent manner, by DPPH radical scavenging assay. In the present study, the methanolic extract of C. linum contains a high amount of phenolic compounds which exhibited the greatest antioxidant activity. Reducing power is associated with antioxidant activity and the reduction of ferrous ion to ferric ion was calculated in the methanolic extract of C. linum. All concentrations of methanolic extract showed significant activity when compared with the standard, ascorbic acid. There was a concentration-dependent increase in the reducing power of methanolic extract of C. linum. Many earlier studies have proved for the antifungal effects of marine sea weeds (19, 20). The methanolic extract of C. linum showed strong antifungal activity against selected human pathogens. The largest zone of inhibition was observed against Fusarium dimerum and Trichoderma ressei. These results are notable, because they were obtained with methanolic extracts, which are not pure products but with superior effect. Considering the total phenolic content, reducing power, and DPPH radical scavenging activity, our findings reveal it as a prospective source of natural antioxidants, indicating that C. linum is capable of treating diseases that are related to free radical reactions. Our results prompt further studies to isolate and identify the active compounds that evaluate a possible synergism between components with regard to their antioxidant and antifungal activity. This work provides insight into the molecular basis of the therapeutic properties of C. linum in pharmaceutical industry. The antifungal study revealed that the methanolic extract of C. linum contains certain constituents with important antifungal properties. The overall results of the study revealed that the crude extract of marine sea weed can act as a potential for the studies on the isolation and characterization of the plant extract necessary to realize new biological antioxidants and antibiotics.
CONCLUSION
Results from this study exposed the antifungal property of the crude extract of seaweeds that contain certain constituents be a better alternative to the hazardous pathogens. In addition, it forms a basis for selection of this as in additional pharmacological investigation. C. linum is undergoing research with the aim of isolating biologically active molecules along with novel antifungal agents.
ACKNOWLEDGMENTS
The authors are grateful to the authorities of Karpagam University, Coimbatore, Tamil Nadu, India for providing facilities and for their encouragement. Authors also thank Dr. M. Ganesan, Scientist, CSMCRI- Marine Algal Research station, Mandapam camp, Tamilnadu, India for the species identification. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=910http://ijcrr.com/article_html.php?did=910REFERENCES
1. Kalim MD, Bhattacharyya D, Banerjee A, Chattopadhyay S. Oxidative DNA damage preventive activity and antioxidant potential of plants used in Unani system of medicine. BMC Complement Altern Med. 2010; 10: 77.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareFINE NEEDLE ASPIRATION CYTOLOGY (FNAC) - AS A DIAGNOSTIC TOOL IN SALIVARY GLAND LESIONS
English1725Abhishek RavalEnglish Hansa GoswamiEnglish Urvi ParikhEnglish Prabhat SharmaEnglish Venu GhodasaraEnglish Safal PatelEnglishIntroduction: Fine Needle Aspiration Cytology (FNAC) is well accepted as a safe, reliable, minimal invasive and cost effective method for preoperative diagnosis of salivary gland lesions. Aims and Objectives: The aim of this study is to evaluate diagnostic accuracy, sensitivity and specificity of FNAC in various salivary gland lesions in correlation with their histopathology, which helps in the appropriate therapeutic management. Materials and Methods: A total of 88 FNACs were done on salivary gland lesions from January 2013 to November 2013 in the Pathology Department of one of the largest government tertiary care teaching hospital, Ahmedabad (Gujarat, India). Formalin fixed (10%), surgically resected specimens were received, they were processed and slides were prepared for histopathological diagnosis. The stained cytological and histopathological slides were studied, analyzed and correlated. Results: Our study included 88 patients who underwent preoperative FNAC for salivary gland lesions with subsequent surgical excision. Out of 88, 52 (59.1%) were males and 36 (40.9%) were females. Male to female ratio was 1.4: 1. The median age was 42 years. Parotid gland was involved in 60 (68.2%) cases, submandibular in 26 (29.55%) cases and other minor salivary glands in 2 (2.27%) cases. Out of 88, 79 cases (89.8%) were cytologically diagnosed as benign lesions and 9 (10.2%) were malignant. The most common benign cytological diagnosis was pleomorphic adenoma; 41 out of 79 cases (51.9%). Cytological diagnoses were compared with histopathological ones and were true-negative in 77 (97.5%), true-positive in 8 (88.9%), false-negative in 2 (11.1%) and false-positive in 1 (2.5%) cases regarding detection of malignant tumors. The overall cytological diagnosis achieved a sensitivity of 80%; a specificity of 98.7%, Positive Predictive Value of 88.9%, Negative Predictive Value of 97.5% and diagnostic accuracy of 96.6%. Conclusion: This study indicated that FNAC of salivary gland is a reliable and highly accurate diagnostic method for diagnosis of salivary gland lesions. It not only provides preoperative diagnosis for therapeutic management but also can prevent unnecessary surgery.
EnglishDiagnostic Accuracy, Fine Needle Aspiration Cytology (FNAC), Salivary Gland Lesions, Sensitivity, SpecificityINTRODUCTION
Fine Needle Aspiration Cytology (FNAC) is a safe, simple, cost-effective, accurate and minimal invasive for evaluation salivary gland lesions [1-4] . It plays an important role in the evaluation of salivary gland lesions. It has been used to differentiate non neoplastic lesions from neoplasms, and benign from malignant neoplasms [1, 5, 6] . Although salivary gland tumors are rare, they account for 2-6.5% of all the head and neck tumors and 21% to 46% are malignant [7], their superficial location, easy accessibility and high diagnostic accuracy makes FNAC, a popular method for evaluating them [8-10]. Salivary gland tumors are uncommon, the world wide annual incidence of salivary gland tumors ranges from 0.4 to 13.5 cases per 1,00,000 population [11]. Among the primary epithelial tumors, 64-80% occurs in the parotid glands, 7-11% occurs in the submandibular, less than 1% occurs in the sublingual and 9-23% occurs in the minor salivary glands [12- 14] . FNAC is not only useful in planning definitive preoperative diagnosis but also can prevent unnecessary surgery procedures [13, 15, 16, 17] . However, the management of patients with salivary gland lesions should not be based on cytology alone. It’s superior to the combination of physical examination and radiological findings [18- 20] . FNAC of salivary gland lesions has been performed at various institutions. A review of the recent reported series found that the diagnostic sensitivity of FNAC varied from 81-100%, the specificity varied from 94-100% and the diagnostic accuracy varied from 61-80% [19, 21] . Hence, the appropriate therapeutic management could be planned earlier, whether it was local excision for benign neoplasms, conservative management for non-neoplastic lesions, radical surgery for malignant tumors and chemotherapy or radiotherapy for metastasis and lymphoproliferative disorders [10] . Hence, the present study was done to know the diagnostic accuracy, which helps in an early diagnosis and appropriate therapeutic management.
MATERIAL AND METHODS
The present study was undertaken from January 2013 to November 2013 at Pathology Department of one of the largest government tertiary are teaching hospital, Ahmedabad (Gujarat, India). It comprised of 88 cases of salivary gland tumours which were diagnosed by FNAC. After taking the informed consent, the aspiration was done following a thorough clinical examination. The cytological findings were correlated with the histopathological findings. The nodule of interest was palpated and fixed with the thumb and the index finger of one hand. Under aseptic precautions, a 10 cc syringe with a 22-25 gauge needle was introduced into the nodule. The material was aspirated and smeared onto clean glass slides. The air dried and ethanol fixed smears were stained with Haematoxylin & Eosin (H&E), MGG (May Grunwald’s Giemsa) and Pap (Papanicolau) respectively. In cases of fluid aspiration, slides were prepared from the centrifuged sediment. Formalin fixed (10%); surgically resected specimens were received in the Department of Pathology, processed and stained with haematoxylin and eosin for histopathological examination. The stained cytological and histopathological slides were studied, analyzed and correlated. The definitive histopathological report was the gold standard diagnosis against which FNAC was compared. The discrepant diagnoses were categorized as sampling or interpretive errors. Data analysis was based on Galen and Gambino method to calculate Sensitivity and Specificity which was described below. Sensitivity for the presence of malignancy (true positive/true positive + false negative), specificity for absence of malignancy (true negative/ true negative + false positive), positive predictive value (PPV) (true positive/true positive + false positive), negative predictive value (NPV) (true negative/true negative + false negative) and accuracy of FNAC (true positive + true negative/total) were calculated and compared with other studies.
RESULTS AND OBSERVATIONS
Among the 88 cases included in the present study, there were 52 (59.1%) males and 36 (40.9%) females, with male to female ratio of 1.4:1. The age range was 16-82 years with a median age of 42 years. Parotid gland was involved in 60 (68.2%) cases, submandibular gland in 26 (29.55%) cases and other minor salivary glands in 2 (2.27%) cases. Out of 88 cases, 78 (88.64%) were benign and 10 (11.36%) were malignant. Out of total 78 benign lesions, 28 lesions were benign non neoplastic and 50 were benign neoplasms. In present study, the most common Non Neoplastic lesion was Chronic Sialadenitis in 22 (25%) cases followed by benign Cystic lesion in 6 (6.82%) cases and most common benign Neoplastic salivary gland tumor is Pleomorphic Adenoma in 42 (47.73%) cases followed by Warthin’s Tumor in 7 (7.95%) cases. [Table 1] In Histologically diagnosed 78 benign salivary gland Lesions, 1 case was misdiagnosed as a malignant by Fine Needle Aspiration Cytology. Amongst the malignancies, Mucoepidermoid Carcinoma and Adenoid Cystic Carcinoma were more common malignant tumor than other tumors like Acinic Cell Carcinoma, Polymorphous low grade Adenocarcinoma and infiltrating salivary duct carcinoma. [Table 2] In Histologically diagnosed 10 malignant salivary gland Lesions, 2 cases were misdiagnosed as a benign by Fine Needle Aspiration Cytology. Among total 88 cases, Fine Needle Aspiration Cytological diagnosis showed benign lesions in 79 (89.8%) and malignancy in 9 (10.23%) cases. The final histopathological diagnosis showed 78 (88.68%) benign lesions and 10 (11.36%) malignant neoplasms. The Comparison results are shown in Table 3. For entire group, the overall diagnostic accuracy is 96.6%, Sensitivity is 80%, Specificity is 98.7%, Positive Predictive Value is 88.9% and Negative Predictive Value is 97.5%. These results are summarized in Table 4.
DISCUSSION
Tumors of the salivary glands comprise 2-6.5% of all head and neck tumors in adults [7]. FNAC is a safe, relatively non-traumatic and accepted diagnostic procedure that can quickly provides important preoperative information [22] . It is a very useful procedure in assisting clinicians in deciding whether a particular patient should be managed surgically [16, 23]. The main goal of FNAC is to determine if a mass is inflammatory and/or reactive, benign or malignant neoplasm and if possible, to render a specific diagnosis [24] . FNAC in salivary gland legions is one of the most difficult topics in cytopathology due to overlapping morphologic patterns in many benign and malignant neoplasms and the various differences in histological pattern that may be detected within the same tumor [25] . Cytomorphological features of most salivary gland lesions have been described; they are so characteristic and highly reproducible. If those criteria are present and strictly observed, the great majorities of the common variants of non neoplastic and both benign and malignant neoplasms can be diagnosed with high level of accuracy. However, there remain a proportion of problematic cases (perhaps 10-15%) for which cytological criteria have not yet been established [26, 27]. In such cases the diagnosis must be left opened with a few suggested differential diagnoses, rather than issuing a misleading report that will lead to inappropriate surgery [25] . In this study, benign and malignant tumor accounted for 88.64% and 11.36% of the salivary gland tumors, respectively, the majority of benign tumor was pleomorphic adenoma (47.73%). Among the malignant tumors mucoepidermoid carcinoma and adenoid cystic carcinoma were the most common. These frequencies were similar to those previously reported where salivary gland tumors are commonly benign and pleomorphic adenomas accounted for near half of benign tumors [28] . In this study, sensitivity and specificity of preoperative FNAC were 80.0% and 98.7%, respectively. Our results were within the range of that reported in the literature, where FNAC achieved a sensitivity of 62% to 98% and the specificity was usually higher ranging from 85 to 100% [29]. In a similar manner, the diagnostic accuracy achieved in our study was 96.6%, which compares well with other studies where the diagnostic accuracy ranged from 86% to 98% [30] . The accuracy is related to the experience of the cytologist, the type and quality of sample material. Heterogeneous structure of many salivary gland tumors and the overlap of some cytomorphological features, limit the accuracy of FNAC due to small size and selective sampling [31] . False positive and false negative diagnoses were pointer towards problems and pitfalls in cytological interpretation. The guiding principle of any cytologist should always be to reduce the rate of false diagnoses to the absolute minimum, so that the confidence of the referring specialist, in FNAC, is boosted and more important, no patient with malignancy is falsely assured or patient with benign lesion underwent an unnecessary surgical procedure [32] . In Histologically diagnosed 10 malignant salivary gland Lesions, 2 cases were misdiagnosed as a benign by Fine Needle Aspiration Cytology. The first case was diagnosed cytologically as chronic sialadenitis and proved to be acinic cell carcinoma. A review of the smear revealed that the acinic cells were larger than normal with slight degree of nuclear irregularities together with less evenly distributed chromatin pattern and slightly higher Nucleo / Cytoplasmic ratio than normal [Figure (1)]. Acinic cell carcinoma is a relatively rare malignant salivary gland neoplasm. Classically, the aspirates are highly cellular, composed of fragments and associated cells that are larger than benign ones, a characteristic feature is the presence of numerous dissociated naked tumor cell nuclei. When the classic features of acinic cell carcinoma are present, its diagnosis may not be difficult [Figure (2)]. However, problems arise when overlapping features are present [3]. The nuclear features of normal (non-neoplastic) acinar cells are quite similar to those observed in acinic cell carcinoma, the only subtle differences is the smaller size of the non-neoplastic acinar cell nuclei as compared with neoplastic acinar one and the basally oriented nuclei in normal cells, whereas in acinic cell carcinoma they are often centrally located. The most helpful diagnostic feature in the differential diagnosis is the low power arrangement of non-neoplastic salivary gland in a lobulated, rosette-like and acinar pattern, features which are readily can be observed in tissue sections rather than cytologic smears. Also, cells of acinic cell carcinoma, instead, are arranged in large, flat, monotonous, cellular sheets. In addition, a honeycomb appearance due to well defined cytoplasmic borders and syncytial fragments may be seen. At low power, one can also see the admixture of sheets of ductal epithelium and interstitial adipose tissue with lobulated nests of acinar cells in nonneoplastic salivary gland, while in acinic cell carcinoma, this pattern is characteristically absent [33] . The second case was a histologically proved adenoid cystic carcinoma diagnosed as pleomorphic adenoma on FNAC. The smear showed syncytial fragments composed of monotonous small tumor cells with high N/C ratio and hyperchromatic nuclei. Hyaline globules were absent, but focal areas of chondromyxoid background were seen. The distinction between pleomorphic adenoma and adenoid cystic carcinoma is clinically important. The stromal component does not always help. Hyaline stromal globule may be seen in pleomorphic adenoma and a fibrillar stroma can be seen in adenoid cystic carcinoma. Thus the differential diagnosis between these tumors can therefore not be based solely on the stromal component. Cytologic details must be closely studied. A well defined cytoplasm, no or few stripped nuclei, a bland finely granular nuclear chromatin and fragments of chondromyxoid matrix incorporating spindle cells favor pleomorphic adenoma while scanty cytoplasm, a high N/C ratio, naked nuclei, nuclear molding and nuclear hyperchromasia and coarseness favor adenoid cystic carcinoma [34] . [Figure (3)] In Histologically diagnosed 78 benign salivary gland Lesions, 1 case was misdiagnosed as a malignant by Fine Needle Aspiration Cytology. This case was histopathologically proved pleomorphic adenoma showed high cellular yield, stromal fragments resembled epithelial mucin, occasional mucin secreting cells and atypical squamous cells dominating the smear [Figure (4)]. The case was falsely diagnosed cytologically as mucoepidermoid carcinoma. Most pleomorphic adenomas are easily identified both histologically and cytologically because of their characteristic biphasic pattern, comprised of epithelialmyoepithelial cells and fibrochondromyxoid stroma in varying proportions [Figure (5)]. The cytological diagnosis of pleomorphic adenoma is obvious in typical cases, the focally striking variation in the histological pattern is rarely a problem in surgical pathology when the whole tumor can be examined, but can sometime cause difficulties in FNAC due to the limited sampling by needle biopsy, thus, one particular feature may dominate the smear to the extent that true nature of the tumor is not recognized [34]. Mucoepidermoid carcinoma and pleomorphic adenoma need to be differentiated as it is a recognized pitfall, chondromyxoid and fibrillary stroma is absent in mucoepidermoid carcinoma, squamous differentiation in pleomorphic adenoma may show keratinization, a feature much less evident in mucoepidermoid, goblet cells occur only infrequently in pleomorphic adenoma and plasmacytoid cells, since they have not been described in mucoepidermoid carcinoma are a good marker for pleomorphic adenoma [35] .
CONCLUSION
In summary, our study shows the high accuracy, sensitivity and specificity and confirms that Fine Needle Aspiration Cytology (FNAC) in salivary gland lesions is a valuable diagnostic tool in the workup of patients with salivary gland lesions. Many patients are saved the necessity of surgery. It is simple, accurate and cost effective method so it is suitable for developing countries with low financial resources. For these reasons, FNAC should be part of the initial evaluation of patients with major salivary gland lesions. However, we should realize that false positive and false negative results will always occur. We agree with the recommendation that use of FNAC in combine with clinical examination and radiological findings (the triple test) approach similar to that used in FNAC of breast lesion would protect false negative and false positive diagnoses and provide valuable and accurate diagnosis in the investigation of salivary gland lesions
ACKNOWLEDGEMENT
We would like to express our gratitude towards the Department of Pathology, B.J. Medical College, Ahmedabad. We also acknowledge the immense help received from the scholars whose articles cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. We are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=911http://ijcrr.com/article_html.php?did=911REFERENCES
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12. Fernandes GC, Pandit AA. Diagnosis of salivary gland tumours by FNAC. Bombay Hospital Journal 2000;42:108-111.
3. Qizilbash AH, Sianos J, Young JE, Archibald SD. Fine needle aspiration biopsy cytology of the major salivary glands. Acta Cytol 1985;29:503-512.
14. Spiro RH. Salivary neoplasms- An overview of 35 years of experience with 2807 patients. Head Neck Surg 1986;8:177-184.
15. Layfield LJ, Tan P, Glasgow BJ (1987). Fine needle aspiration of salivary gland lesions. Arch Pathol lab Med, 111, 346-353.
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17. Zhang S, Bao R, Bagby J, Abreo F (2009). Fine needle aspiration of salivary glands: 5- year experience from a single academic center. Acta Cytol, 53, 375-82.
18. Owen EERTC, Banerjee AK, Prichard AJN, Hudson EA, Kark AE (1989). Role of fineneedle aspiration cytology and computed tomography in the diagnosis of parotid swellings. Br J Surg, 76, 1273-4.
19. Stewart CJR, MacKenzie K, McGarry GW, Mowat A (2000). Fine needle aspiration cytology of salivary gland: a review of 341 cases. Diagn Cytopathol, 22, 139-46.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareDELAYED DIAGNOSIS OF THE ACTUAL CAUSE FOR WHEEZE IN A LABELLED BRONCHIAL ASTHMATIC - ROLE OF ANAESTHESIOLOGIST AS A PERIOPERATIVE PHYSICIAN
English2630Dhanabagyam GovindarajuluEnglish Vinodhadevi VijayakumarEnglish D.M. MohanEnglishAim: Approach to a patient like a primary physician with meticulousness in eliciting history and evaluation, makes an anaesthesiolgist a perioperative physician. Case Report: Our patient was diagnosed to have bronchial asthma for 3 years duration and admitted with a renal malignancy. During pre operative evaluation he was found to have mediastinal widening. On further evaluation with computerized tomography, diagnosed to have retrosternal goitre compressing the trachea. Combined procedure of right nephrectomy and right hemithyroidectomy was done necessitating sternotomy. On post-operative follow up patient had no wheeze after the thyroidectomy. Discussion: The natural history of retrosternal goitre is of a slow increase in size, often presenting as an incidental finding on a chest x-ray. Patients with retrosternal/substernal goiter may not have an obvious swelling in the neck. They may present with wheeze and wrongly labelled as an asthmatic like in our patient. Late onset wheeze, persistent wheeze inspite of treatment, exertional dyspnoea, widening of superior mediastinum in chest x-ray made us to think about possible airway obstruction other than bronchial asthma for wheeze. Confirmed it to be a paratracheal, retrosternal colloid goitre. Conclusion: The late onset wheezer to be evaluated for anatomical airway obstructions. Approach to a patient like a primary physician with meticulousness in eliciting history and evaluation, makes an anaesthesiolgist a perioperative physician.
EnglishRetro sternal goitre, Bronchial asthma, Wheeze, Mediastinal mass.INTRODUCTION
The natural history of retrosternal goitre is of a slow relentless increase in size, often presenting as an incidental finding on a chest x-ray. Patients may have retrosternal/substernal goiter without obvious swelling in the neck. The majority of patients with retrosternal goiter presents with shortness of breath or asthma like symptoms.
CASE REPORT
A 64 year old male, known diabetic and bronchial asthmatic was diagnosed to have right renal cell carcinoma and posted for open right nephrectomy. He is a diabetic on oral hypoglycemic agents for 6 years, on regular follow up and good glycemic control. Bronchial asthmatic for the past 3 years on fluticasone and salbutamol inhalers. During pre-anaesthetic evaluation, physical examination was normal other than the bilateral occasional wheeze on auscultation. Airway examination revealed short neck and all other parameters were normal. Blood investigations and ECG were within normal limits. Computerized Tomography (CT) of abdomen revealed a large heterogeneously enhancing mass lesion arising from the lower half of right kidney suggestive of
DISCUSSION
In our patient he was diagnosed to have bronchial asthma for 3 years duration and treated with bronchodilators. As he came with haematuria, dysuria and urgency, on evaluation he was suspected to have a renal malignancy by ultrasound and CT scan of the abdomen. During pre operative evaluation for anaesthesia and to rule out secondaries chest x ray was done, which showed a mediastinal widening and led us to do a CT scan of thorax. CT Thorax showed a retrosternal goitre compressing the trachea which gave us a clue for the possible etiology of his wheeze. Combined procedure of right hemithyroidectomy and right nephrectomy was done. Intraoperatively, the thyroid gland was plunging inside the thorax in the shape of dumbbell, necessitating sternotomy. Postoperative follow up revealed that the patient had no wheeze after the thyroidectomy.
Terms such as retrosternal, substernal, intrathoracic or mediastinal have been used to describe a goitre that extends beyond the thoracic inlet. However, there is a lack of consensus regarding the exact definition of a retrosternal goitre (RSG).1 The natural history of retrosternal goitre is of a slow relentless increase in size, often presenting as an incidental finding on a chest x-ray in the fifth or sixth decade of life.2 The majority of patients with retrosternal goiter presents with shortness of breath or asthma like symptoms. Other symptoms and signs include neck mass, hoarseness of voice, dysphagia or superior vena caval obstruction. Airway obstruction due to thyroid gland has been reported up to 31%3 and difficulty in intubation has been reported in 11%4. The reported incidence of substernal thyroid gland in the general population varies from 0.02 to 0.5% based on chest x-ray screening reports.5 The CT scan is the most useful tool showing the nature and extent of the lesion.6 The thyroid is usually removed through a conventional thyroid incision in the neck, but occasionally division of the upper part of the sternum is necessary. Unrecognized mediastinal goitre can produce asthma-like symptoms, which may lead to late diagnosis or misdiagnosis and deficient treatment. 7 The cause for wheeze need not be always bronchial asthma. Late onset wheeze, persistent wheeze inspite of treatment, exertional dyspnoea, widening of superior mediastinum in chest x-ray made us to think about possible airway obstruction other than bronchial asthma for wheeze. Confirmed it to be a paratracheal, retrosternal colloid goitre. Anaesthesiologist’s careful history taking, examination and evaluation have been useful to identify a curable cause for wheeze. Due to the active multidisciplinary approach, both the surgeries were done simultaneously and safely after thorough evaluation. If we would have missed it could have resulted in unanticipated difficult airway, post extubation airway issues, persistent wheeze with poor response to bronchodilators life long.
CONCLUSION
Patients with retrosternal/substernal goiter without obvious swelling in the neck can present with airway obstruction. The late onset wheezer to be evaluated for anatomical airway obstructions. Approach to a patient like a primary physician with meticulousness in eliciting history and evaluation, makes an anaesthesiolgist a perioperative physician.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=912http://ijcrr.com/article_html.php?did=912REFERENCES
1. Hunis CT, Gerogalas C, Mehrzad H, Tolley NS. A new classification system for retrosternal goiter based on a systemic review of its complications and management. Int J Surg. 2008;6:71-6.
2. Mack E. Management of patients with substernal goiters. Surg Clin North Am. 1995;75:377-94.
3. Hedayati N, McHenry CR. The clinical presentation and operative management of nodular and diffuse substernal thyroid disease. Am Surg. 2002;68:245-51.
4. Amathieu R, Smail N, Catineau J. Difficult intubation in thyroid surgery: myth or reality. Anesth Analg. 2006;103:965-8.
5. Reeve TS, Rubenstein C, Rundle FF. Intrathoracic goiter: Its prevalence in Sydney metropolitan mass x-ray survey. Med J Aust. 1957;2:149-51.
6. Grainger J, Saravanappa N, D’Souza A, Wilcock D, Wilson PS. The surgical approach to retrosternal goiters: the role of computerized tomography. Otolaryngol Head Neck Surg. 2005;132(6):849-51.
7. Vadasz P, Kotsis L. Surgical aspects of 175 mediastinal goiters. Eur J Cardiothorac Surg. 1998;14:393-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareFORAMINA TRANSVERSARIA 'BIPARTITA': A STUDY OF CERVICAL VERTEBRAE
English3134Gyata MehtaEnglish Swapnali ShamkuwarEnglish Varsha MokhasiEnglishObjectives: The Foramen Transversarium (FT) transmits the vertebral artery (except in C7 vertebra), vertebral veins and the sympathetic plexus that accompanies the vessels. The deformation and variation of this foramen may affect the anatomical course of vital vascular and neural structures and consequently cause pathological conditions. With the advent of newer surgical techniques for treatment of unstable cervical spine, awareness about morphological variations of cervical vertebrae and surrounding structures has become essential. Aim: Aim of the study was to find the incidence and distribution of accessory foramina transversaria in cervical vertebrae with emphasis on their embryological basis and surgical importance. Methods: Five hundred cervical vertebrae (typical and atypical) were collected from the Department of Anatomy. Each cervical vertebra was examined for the presence of accessory FT. They were also observed for the absence of FT. Results: It was observed that accessory FT was found in 66 (13.2 %) vertebrae. Amongst these 17(25.75%) showed accessory FT bilaterally and 49 (74.24%) showed accessory FT on one side only. There was no significant difference in the presence of accessory FT on the two sides. Absence of FT was not seen. Conclusions: Recognition of double FT has significant clinical importance as the course of vertebral artery may be distorted in such situations. It is of great relevance to neurophysicians, neurosurgeons and radiologists.
Englishcervical vertebrae, accessory Foramina Transversaria, vertebral artery.INTRODUCTION
The cervical vertebrae are characterized by the presence of Foramen Transversarium (FT) in the transverse process. This foramen usually contains vertebral artery (except in C7 vertebra), veins and sympathetic plexus. The deformities and variations of this foramen may affect the anatomical course of vascular and neural structures and consequently cause pathological conditions. It may cause vertebrobasilar insufficiency as a result of neck movements. Compression of vertebral artery may result in headache, migraine and fainting attacks1 . Since vertebral and basilar arteries contribute to the blood supply of the inner ear, hence spasm of the same artery due to irritation of the sympathetic plexus, may be manifested not only by neurological symptoms but also by labyrinthine or hearing disturbances2 . Accessory FT is considered when the FT is anatomically divided by a fibrous or bony ridge and the smaller posterior part is called the accessory FT3 . Ambiguity persists about the content of this accessory FT, whether it is occupied by the vertebral vein or vertebral nerves or by a duplicate vertebral artery or both. The relations of these structures are of surgical importance in the posterior approach of the cervical spine.
MATERIAL AND METHODS
Five hundred cervical vertebrae were collected from the Department of Anatomy. Out of these, 177 were typical cervical vertebrae and 323 were atypical cervical vertebrae. Amongst the atypical cervical vertebrae, 106 were C1, 137 were C2 and 80 were C7. Each cervical vertebra was examined for the presence of accessory FT. They were also observed for the absence of FT. Photographs were taken and archived.
RESULTS
Out of the total 500 cervical vertebrae, Accessory FT was observed in 66 (13.2%) vertebrae. Amongst these 17 (25.75%) showed accessory FT bilaterally and 49 (74.24%) showed accessory FT on one side only. There was no significant difference in the presence of accessory FT on the two sides. It was observed that accessory FT was found more in C7 vertebrae and typical vertebrae and less frequently in C1 and C2 vertebrae.
DISCUSSION
The FT is the result of special formation of the cervical transverse process. It is formed by a vestigial costal element fused to the body and the originally true transverse process of the vertebra. The vertebral plexus and nervous plexus are caught between the bony parts4 . Many factors are involved in causing morphological variations of FT including developmental factors, mechanical stress, size and number of anatomical structures passing through5 . Since the vertebral vessels are a factor in the formation of the FT, it can be assumed that variation in the presence and course of the vessels will be manifested in changes in the FT. Conversely, variations of the FT can be useful for estimating change or variations of the vessels and accompanying nerve structures. The embryogenesis of the vertebral arteries occurs between day 32 and 40 of gestation. The paired vertebral arteries arises from longitudinal branches that link together to form a longitudinal vessel and secondarily lose their intersegmental connections to the aorta6 . It has been speculated that persistence of a portion of the primitive dorsal aorta with two intersegmental arteries may give rise to vertebral artery duplication. Failure on the regression of the inter segmental arteries can also result in vertebral artery fenestration7 . This fenestration may contribute to the development of double FT. Hence accessory FT is likely to be associated with anatomical variants of vertebral artery such as duplication and fenestration. Duplicated vertebral arteries have two origins and fusion points in the neck outside the spinal canal. Fenestrated vessels have single origin and divide into two parallel trunks within or outside the vertebral canal. Studies on accessory FT have been undertaken earlier. The occurrence rate ranged from 1.5%8 to 22.7%1 . Taitz et al reported double FT in 7% of vertebrae and triple FT (unilateral) in 0.2%2 . A study of typical cervical vertebrae showed the presence of double FT in 8% of vertebrae, more common in C6 vertebra3 . Another study showed total incidence of 1.6% with unilateral presence more than bilateral and more common in lower cervical vertebrae (C6 & C7)9 . The findings of the present study were consistent with the previous studies. Double FT were seen in 13.2% of vertebrae with higher prevalence of unilateral double FT(74.24%) as compared to bilateral double FT(25.75%).There was not much significant difference on the two sides. Absence of FT was not found, when compared to other studies showing bilateral absence of FT10 .
CONCLUSION
Knowledge of accessory FT is clinically significant as it may affect the course of vertebral vascular bundle and nerves causing symptoms to patients. Recognition of such variations is important particularly in posterior cervical surgery. It is of great relevance to neurophysicians, neurosurgeons and radiologists.
Englishhttp://ijcrr.com/abstract.php?article_id=913http://ijcrr.com/article_html.php?did=913REFERENCES
1. Kaya S et al. Double Foramen Transversarium Variation in Ancient Byzantine Cervical Vertebrae: Preliminary Report of an Anthropological Study. Turkish Neurosurgery 2011;21,534-538
2. Taitz C, Nathan H , Arensburg B .Anatomical observations of the foramina Transversaria. Journal of Neurology, Neurosurgery and Psychiatry;1978,41,170-176
3. Sharma A, Singh K, Gupta G, Srivastava S. Double foramen transversarium in cervical vertebrae an osteological study. J Anat.Soc.India 2010;59,229-231
4. Gray H. Development of vertebral column. Gray’s Anatomy. The Anatomical Basis of Clinical Practice, 40 th ed. Susan Standring, Elsevier Churchill Livingstone, London; 2008, p792-796
5. Jaffar AA, Mobarak HJ, Najm SA. Morphology of the Foramen Transversarium A Correlation with Causative Factors. AlKindy Col Med J 2004;2,61-64
6. William J Larsen. Development of vasculature. Human Embryology. 3 rd ed. Churchill Livingstone, London; p179-181
7. Sim E, Vaccaro AR, Berzlanovich A, Thaler H, Ullrich CG. Fenestration of the extracranial vertebral artery: Review of the literature. Spine 2001;26,139-142
8. Das Srijit, Suri R, Kapur V. Double Foramen Transversaria: an osteological study with clinical implications. Int Med J 2005;12,311- 313
9. Murlimanju BV et al. Accessory Transverse Foramina in the Cervical Spine: Incidence, Embryological Basis, Morphology and Surgical Importance. Turkish Neurosurgery 2011;21,384-387
10. Nayak S. Bilateral absence of foramen transversarium in atlas vertebra: a case report. Neuroanatomy 2007;6,28-29
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareEVALUATION AND COMPARISON OF LUNG FUNCTION PARAMETERS DURING PREGNANCY
English3538Ganesh PradhanEnglish B.C. VastradEnglish Nishitha MendoncaEnglish Vishnu Vardhan G.EnglishAim: The study was aimed to evaluate and compare the pulmonary function in pregnant South Indian women at 36weeks and at full term of pregnancy. Methodology: A total 60 pregnant women were assigned to two groups: study group I: 36weeks (30 nos) and study group II: full term pregnancy (30 nos) antenatal cases recruited from women who visited the OBG Dept. of PESIMSR hospital, during the period 2008-2009. Inclusion criteria were: healthy pregnant women with age group of 20-40 yrs and Exclusion criteria included, smokers, pre-eclampsia, hypertension, diabetes. Baseline pulmonary functions were recorded with a computerized spirometer “Winspiro”. The pulmonary function parameters evaluated were FEV1, FVC, FEV1/FVC, FEV25-75%, PEFR AND MVV. Statistical analysis was done by “t” test method with SPSS software. Results: All the pulmonary function parameters were increased except PEFR in group II as compared to group I but this was not statistically significant. The PEFR was increased in group II as compared to group I and this was statistically significant. Conclusion: The PEFR was increased significantly in 36 weeks pregnancies, and should be interpreted carefully in pregnant women.
EnglishPregnant women, pulmonary function, spirometryINTRODUCTION
Pregnancy manifests as one of the most remarkable states of physiological adaptations. The changes of cardiovascular, hematological, hormonal, metabolic and excretory function during pregnancy have been studied in detail1 . Changes in respiration are sparsely reported2 . The conclusion of earlier studies on pulmonary functions test (PFT) during pregnancy showed conflicting results. Studies have reported that increased in vital capacity of the lung during pregnancy but on the other hand few authors? have observed there is decrease3 or remains unchanged4 . Studies have also observed changes of pulmonary function on different women5 and each trimester during pregnancy6 . Many studies have been reported changes of lung function during pregnancy in western population as well as Indian population, however to be appear less consistent7 . The present study was aimed to evaluate and compare the pulmonary function test values at 36 weeks pregnancy and full term pregnancy.
MATERIAL AND METHODS
A total of 60 healthy pregnant women with age (20-40) who visited the OBG department of PESIMSR Hospital, Kuppam, during the period 2008-2009 were enrolled after approval from institutional ethics committee and written consent was obtained. The subjects grouped under: GroupI: 30 subjects at 36 weeks pregnancy. Group-II: 30 subjects at full term pregnancy. Care was taken to exclude those suffering from pre-eclampsia, smoking, hypertension, diabetes, any disease of chest or with recent history of illness. Details of family history regarding presence of pulmonary disease like bronchial asthma, tuberculosis were asked and such individuals were also excluded. Anthropometry was done in each subject age, height in cm, weight in kg. Pulmonary function tests were performed by using Win Spiro, which is a Pc based spirometer with flow transducer. Parameters studied included, forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, peak expiratory flow rate (PEFR), forced expiratory flow (FEF25%-75%) and maximum voluntary volume (MVV). Discrete explanation and demonstration of each test was given to the each subjects. All tests were carried out with the subjects in sitting position and. Three trials were performed on the subjects; the best value was taken for analysis and reported and each subject was asked to relax 5 minutes before performing the procedure of PFT. Statistical analysis The data was compared and analyzed by using„t? test with software SPSS 20 version. P value Englishhttp://ijcrr.com/abstract.php?article_id=914http://ijcrr.com/article_html.php?did=914REFERENCES
1. Surekha DE, R.P.Bhargava, S.Benawri, Longitudinal ventilatory function (static and dynamic) studies during defferent trimesters in pregnant women.Journal of Obstetrics and Gynaecology of India. 1984; 36: 812-816.
2. Spiropoulos K, Prodromaki E, Tsapanos V. Effect of body position on PaO2 and PaCO2 during pregnancy. Gynecol Obstet Invest, 2004: 58: 22-25.
3. Rubin, Russo, Goucher. The effect of pregnancy upon pulmonary function in normal women.Am J Obstet gyencol 1956;72:963 – 969.
4. Cugell DW, Frank NR, Gaensler EA, Badger TL. Pulmonary function in pregnancy. Serial observations in normal women. Am Rev Tuberc Pulm Dis 1953; 67: 568-597.
5. Saxena SC, Rao VSC, Mudgal SA. Study of Pulmonary function tests during pregnancy.J obstet Gynaecol of India 1979;29:993-995.
6. Puranik BM, Kurhade GA. PEFR in preganancy: A longitudinal study. Indian Journal of Physiol Pharmacol,1995;39:135 – 139.
7. Sing KC, Sircar SS, Sharma KN. Airway functions in pregnant Indian women. Indian J Physol Phamacol.1995 Apr;39(2):160-2.
8. Gilory RJ, Mangura BT, Lavietes MH. Rib cage and abdominal volume displacements during breathing in pregnancy. Rev Resp Dis, 1988; 129: 669-672.
9. Weinberger SE, Weiss ST, Cohen WR, Weiss JW, Johnson TS. Pregnancy and Lung. Am Rev Resp Dis 1980; 121:559-557.
10. Grindheim G, Toska K, Estensen ME. Changes in pulmonary function during pregnancy: A longitudinal cohort study. BJOG, 2012; 119: 94-101.
11. Neeraj, Candy Sodhi, John Promod, Joydeep Singh,Vaneet Kaur et al. Effect of advanced uncomplicated pregnancy on pulmonary function parameters of north Indian subjects. Indian J Physol Phamacol, 2010; 54:69-72.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareHYPERTENSION - PREVALENCE AND RISK FACTORS AMONG URBAN POPULATION IN NORTH KARNATAKA
English3945Madhumitha M.1 English Naraintran S. Manohar C. English Revathi S. English Mallikarjun K. BiradarEnglish R.S. PatilEnglishBackground: Hypertension, a major public health problem, is directly responsible for 57% of all stroke deaths and 24% of coronary heart disease related deaths in India. The prevalence of hypertension is increasing rapidly in developing countries more in urban areas due to changing life style and increasing longevity. Objectives: 1.To estimate the prevalence of hypertension and associated risk factors among urban population (18 years and above) of Raichur district of North Karnataka Materials and Methods: Prevalence of hypertension among adults from the previous studies was found to be 35%. Sample size of 713 was calculated using the formula 4pq/L2 with 10% allowable error. Systematic random sampling was used and after taking informed consent, participants were interviewed using a pre tested questionnaire based on WHO STEPS approach for chronic disease risk factor surveillance and examined. Diagnostic criteria were based on JNC VII guidelines, SBP ?140mmHg and/or DBP ?90mmHg. Data was analysed using Epi-info and SPSS version 17. proportions and chi square test were used. Results: Prevalence of hypertension was found to be 37.6%; significantly associated with smoking, fruits and vegetables intake, salt intake, junk foods, family history of hypertension and obesity. There is no significant association with type of diet (vegetarian or non vegetarian) alcohol and physical activity. Conclusion: prevalence of hypertension among urban population is high. Life style factors are significantly associated with hypertension. So there is an urgent need for life style modification among urban especially among those with positive family history
EnglishHypertension, Prevalence, risk factors, family history, urbanINTRODUCTION
Hypertension is the commonest cardiovascular disorder affecting at least 20% of adult population in several countries. It is one of the important risk factors for cardio-vascular mortality accounting for 20-30% of all deaths1 . It became evident in the early 1970s itself that only about half of the hypertensive subjects in the general population of most developed countries were aware of the condition, only about half of those aware of the problem were being treated. If this is the situation with highly developed medical services, the proportion treated in developing countries would naturally be far less1. It is an interesting as well as a dangerous disease entity. It remains silent without any symptoms but causes continuous damage to person’s cardio vascular system. For the same reason WHO has given the name “SILENT KILLER” as the disease does not cause any harm by itself but predisposes to other cardiovascular diseases like stroke, myocardial infarction etc. It is a major risk factor for cardiovascular disease, chronic renal disease and stroke2 Every year, 17th May is dedicated to World Hypertension Day (WHD). This is an initiative of the World Hypertension League, an affiliated section of the International society of Hypertension(ISH). The WHD was first inaugurated in May 2005 and has become an annual event ever since. The purpose of the WHD is to promote public awareness of hypertension and to encourage citizens of all countries to prevent and control this silent killer, the modern epidemic3 . Hypertension is an iceberg disease. The CUPS study revealed that the RULE OF HALVES is still valid in the south Indian population4 . So it is important to detect hypertension and treat promptly to avoid further life threatening complications. Since no other study has been conducted so far in this area, this study aims to estimate the prevalence of hypertension and its associated risk factors.
AIMS AND OBJECTIVES:
1. To estimate the prevalence of hypertension among subjects aged 18 and above. 2. To study the association between the hypertension and its risk factors.
MATERIALS AND METHODS
Study Design: Community based cross sectional study. Duration of study: August 2010 – September 2012. Study Population: people aged 18 years and above residing in the urban field practice area of Navodaya Medical College and Hospital, Raichur Diagnostic criteria: Based on JNC VII criteria, a person was considered hypertensive if- 1. SBP ≥140 and/or DBP ≥90 mmHg 2. Persons with history of hypertension and on anti-hypertensives. Sample Size calculation Prevalence of hypertension among adults from the previous studies was found to be 35% Sample size of 713 was calculated using the formula 4pq/L2 w i t h 1 0 % a l l o w a b l e e r r o r Sampling method: Systematic random sampling. House was taken as the sampling unit. Step -1: sampling interval, m= total number of houses/sample size=3625/713 = 3.73≈ 4 Step 2: k, random number should be less than or equal to sampling interval i.e., m Random number was selected as 3 by using lottery method and so 3rd house was taken as the first house and from then on every 4 th house was be visited to find the eligible person. If there were more than one eligible person at the time of visit, the subject to be interviewed was selected by lottery method. If the inhabitants were not at home at the time of visit, the next house was visited. Step-3: 3, 3+4, 7+4, 11+4...... After taking informed consent, the participants were interviewed and examined. Collection of data: Data was collected by interviewing the study subjects using a pre-tested Madhumitha M. et. al. HYPERTENSION – PREVALENCE AND RISK FACTORS AMONG URBAN POPU questionnaire based on WHO STEPS approach for chronic disease risk factor surveillance. Measurement of blood pressure: The study participants were made to sit comfortably for 5 minutes before BP was measured. Blood pressure was measured using the auscultatory method with a standardized calibrated mercury column type sphygmomanometer and an appropriate sized cuff encircling at least 80% of the arm in the seated posture, with feet on the floor and arm supported at heart level. The first blood pressure measurement was recorded after obtaining sociodemographic information from the study subject, while the second was recorded after a brief clinical examination. The reading at which korotkoff sound is first heard will be considered as systolic blood pressure and at which the korotkoff sound disappears will be taken as diastolic blood pressure. We used the average of two readings of SBP and DBP to describe the blood pressure of the participant. In cases where the two readings differed by over 10 mm of Hg, a third reading was taken and average of the three measurements was taken.
STATISTICAL ANALYSIS:
STATISTICAL ANALYSIS: Data was analysed using Epi info and SPSS version-17.0. Proportions, was used to find out the Prevalence and Chi–square test was used to find the association between categorical variables.
RESULTS
Prevalence The prevalence of hypertension was found to be 37.6%; 30.2% were in stage I HTN 7.4% of the subjects were in stage II hypertension. Among them 53.7% of hypertensives were already diagnosed to have HTN while 46.3% were newly detected hypertensives; this proves that hypertension is an iceberg disease. 40.4% were found to be pre hypertensives. This shows that more than 3/4th of the population is suffering from high BP. Association with Risk factors This study revealed that hypertension was significantly associated with body mass index, maximum in obese patients when compared to normal and underweight;(p 6 grams/day and family history of hypertension were found to be significantly associated with hypertension. (p=0.009; p=0.003 respectively). \
DISCUSSION
Prevalence of hypertension was found to be 37.6%. 30.2% were in stage I and 7.4% in stage 11 HTN (SBP 140-159 mmHg and/or DBP 90-99 mm Hg and SBP >160 mmHg and/or DBP > 100 mm Hg) respectively; 50.7% of hypertensives were already diagnosed to have HTN while 49.3% were newly detected hypertensives. This shows the submerged portion of the iceberg. Findings of our study are similar to Gupta, R in Jaipur, in urban adults in 2002 which showed prevalence of hypertension as 36% in men and 37% in women5 and a study conducted by Avadaiammal6 et.al in Trivandrum city, Kerala, south India in 2006 which showed the prevalence as 47% In our study 40.4% were having pre hypertension. This was high when compared to a Study carried out by M.M.H,V.K Desai7 et al,2011 in urban area of south Gujarat region which showed the overall prevalence of prehypertensives as 34.5%But a study conducted by Chaudhry K et al in 2012 in Wardha, in young females 18-25 years showed that 58% were prehypertensives8 Our study revealed a positive correlation with family history of hypertension similar to studies conducted by Patnaik N9 et al in Orissa S.S.Reddy1 in Tirupati in 2005, Haresh Chandwani10 in Gujarat in 2010. Significant association of hypertension was found with smoking. studies done by PatnaikN9 ,S.S.Reddy1 et al in Tirupati(2005), S.Yadav11 et al(2008) ,HareshChandwani10 et al in Gujarat in 2010 also showed similar results. A recent case-control study from Bangalore also showed that smoking was an independent risk factor for hypertension12 (odds ratio 2.25, p=0.014). Our study showed a significant association between HTN and alcohol consumption (p=0.013).A study done by NC Hazarika13 et al in Assam in 2003 in elderly population found that Alcohol consumption increased the risk of hypertension in the study population. S.S.Reddy1 in Tirupati in 2005, Patnaik N9 in Orissa in 2005, Haresh Chandwani10 et al in Gujarat in 2005 also revealed higher prevalence of hypertension among those who consume alcohol. Study conducted by M.M.H, V.K.Desai7 et al in Surat found that prevalence of hypertension was higher (40.1%) among alcohol consumer than non- drinker (27.2%). Study by Saunders 14et al. found a significant positive association between hypertension and alcohol consumption. In their study, in most cases the BP level fell to normal levels after abstinence and remained so in those who continued to abstain but returned to the hypertensive state in those who resumed consumption of alcohol, thus indicating that alcohol is an important risk factor for hypertension. The Chennai urban population study in 2003 showed BMI was more in hypertensives compared to non hypertensive individuals15. A multi-centric study conducted by Hypertension study group in 2001 among the elderly in Bangladesh and India found that High body mass index was an important correlate of hypertension16. Studies done by Zachariah17 et al, S.S.Reddy in Tirupati 1 et al (2005), Patnaik N9 in Orissa (2005), S.Yadav11 et al (2008) and Haresh Chandwani10 et al in Gujarat also revealed the similar findings. There is significant association with increased waist hip ratio similar to Chennai Urban Population Study (CUPS) 15 in 2003.Studies by Mehan M B18.in urban Indian population showed similar findings. This study also found a positive correlation with salt intake, fruits and vegetable intake similar to studies done by Haresh Chandwani10 in Gujarat and Avadaiammal Vimala6 in urban population of Kerala. Our study can be compared to study by Mehan M Bet al which revealed that hypertension was found in all subjects who consume < 500 gm of vegetables and fruits per day.18. The INTERHEART STUDY in 2003 by Salim Yusuf 19 et al found that low consumption of fruits, vegetables constitute a major risk for myocardial infarction worldwide in both sexes and at all ages in all regions In our study, there is no significant association between Hypertension and physical activity. (p=0.586).Our study can be compared to a study done by L. Patnaik etal9 in Orissa in 2005 where there is no statistical significance between HTN and physical activity. (p>0.05 ).But studies conducted by S.S.Reddy in Tirupati1 and Shantirani15 et al. in Chennai (Chennai Urban Population Study) found significant association with hypertension and physical activity in contrast to our study. Our results can be compared with a study done by Avadaiammal Vimala6 which showed that the prevalence of hypertension among subjects on vegetarian diet vs. mixed diet was 41% vs. 49%, respectively but the difference was not statistically significant. (p= 0.09). A study done by Gilberts E C 20 et al in a south Indian population also did not find significant association between diet and hypertension.
CONCLUSION
Prevalence of hypertension was found to be 37.6%. pre hypertension is also high with 40.4%.There is significant association of hypertension with smoking , alcohol, fruits and vegetable consumption , junk foods, salt intake and positive family history. Body mass index and waist hip ratio also showed significant association. How ever, there is no association with physical activity and type of diet. So, life style factors certainly influence the occurrence of hypertension especially among urban population. Almost half the hypertensives were newly detected during the course of the study. So screening of the population for BP is the only effective method for to diagnose this silent killer and treat adequately for prevention of further complications like stroke, coronary artery disease and renal failure. IEC activities has to be undertaken at the community level which should focus on weight reduction, cessation of smoking and alcohol, increased physical activity and restriction of dietary salt intake. Schools must provide opportunities for promotion of healthy life style in children and the youth. Mental relaxation techniques like yoga and meditation has to be promoted. Public education has to be the cornerstone for successful national campaign to detect, evaluate and treat high BP.
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=915http://ijcrr.com/article_html.php?did=915REFERENCES
1. Reddy SS, Prabhu GR. 2005 “ Prevalence of hypertension and its risk factors among adults aged 20-60 years residing in an urban slum area of Channa Reddy Colony (Urban slum area) in Tirupati town” Indian Journal of community Medicine Vol: 30(3);84-86.
2. International Society of Hypertension. World hypertension day 17th may, 2005. Available at http://www.ishworld.com/default.aspx?World Hypertension Day accessed on 10.06.2012.
3. World Health Organization, Heart Beat: The rhythm of health report on World Health Day. 7 th April 1991.geneva: WHO 1992.
4. Deepa R, Shanthirani CS, Pradeepa R, Mohan V. “Is the Rule of Halves” in Hypertension still valid? Evidence from Chennai Urban Population study. J Association physicians India.2003; 51:153-7
5. R Gupta, Trends in hypertension epidemiology in India Journal of Human Hypertension (2004) 18, 73–78.
6. Avadaiammal Vimala, Suja Ann Ranji, Mattummal Thodi Jyosna et al,2009” prevalence, risk factors and awareness of hypertension in urban population” Saudi journal of renal disease and transplantation. Vol 2094):685-689
7. M.M. H, V.K. Desai, A. Kavishwar: A Study On Effect Of Life Style Risk Factors On Prevalence Of Hypertension Among White Collar Job People Of Surat. The Internet Journal of Occupational Health. 2011 Vol 1; Number 1
8. Chaudhry K, Diwan SK, Mahajan SN Prehypertension in young females, where do they stand? Indian heart J 2012 MayJun;64(3):280-3
9. L. Patnaik, N. C. Sahani, T.Sahu et al 2005. A Study on Hypertension in Urban Slum of Brahmapur, Orissa,journal of community medicine, Indian association of preventive and social medicine Orissa chapter 10.
10. Chandwani H, Pandor J, Jivarajani P, Jivarajani H. 2010 “Prevalence and correlates of hypertension among adults in the urban area of Jamnagar, Gujarat” Electronic Physician; Vol 2: 52-59.
11. Yadav S, Boddula R, Genitta G, Bhatia V, Bansal B, Kongara S, et al 2008. “Prevalence and risk factors of pre-hypertension and hypertension in an affluent north Indian population” Indian Journal of Medical Research: 712-720.
12. WHO. Integrated Management of Cardiovascular Risk. Report of a WHO Meeting. Geneva; July 2002
13. NC Hazarika, D Biswas, J Mahanta Hypertension in the Elderly Population of Assam JAPI • VOL. 51 • JUNE 2003
14. Saunders J.B, Beevers D.G and Paten A. Alcohol induced hypertension. Lancet1961; 2: 653-656.
15. CS Shanthirani et al. Prevalence and Risk Factors of Hypertension in a Selected South Indian Population - The Chennai Urban Population Study (J. Assoc Physicians India 2003; 51:20-27).
16. Iftekhar Quasem, Mrunal S.Shetye, Shiney C. Alex, et al Hypertension study group. 10. Prevalence, awareness, treatment and control of hypertension among the elderly in Bangladesh and India: a multicentric study, Bulletin of the World Health Organization 2001,79:490-500
17. Zachariah M G, Thankappan K R, Alex S C. Prevalence, correlates, awareness, treatment, and control of hypertension in a middle-aged urban population in Kerala. Indian Heart J. 2003 May-Jun; 55(3):245-51
18. Mehan MB, Srivastava N, Pandya H. Profile of non communicable disease risk factor in an industrial setting. J Post grad Med September 2006 Vol 52(3) 167-73.
19. Salim Yusuf, Steven Howken, Stephanie Ounpuu et al. “Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries” THE INTER HEART STUDY: case-control study The Lancet, Volume 364, Issue 9438, Pages 937 - 952, 11 September 2004
20. Ericus C A M Gilberts, Marinus J C W J Arnold, Diederick E Grobbee. Hypertension and determinants of blood pressure with special reference to socio economic status in a rural south Indian community. Journal of epidemiology
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareTHE EFFECT OF EXERTIONAL HEAT STRESS INDUCED HYPOHYDRATION ON COGNITIVE PERFORMANCE IN HUMAN
English4651Medha KapoorEnglish Laxmi Prabha SinghEnglish Shuchi BhagiEnglish Shashi Bala SinghEnglishAim: Investigations on the effect of hypohydration on cognitive function present with ambiguous and contradictory results. The purpose of this study was to evaluate the effect of exertional heat stress induced hypohydration (Graded hypohydration: 2% and 4%) on cognitive function in Human. Methodology: Six healthy military personnel (age: 25±4 years, height: 172±4cm, weight : 66±3 Kg) performed sub-maximal exercise at 45 ?C and 30% Relative Humidity (RH) in Human Climatic Chamber (HCC) till the desired levels of hypohydration were achieved (2% or 4%). Cognition was assessed using stroop color and word test and PGI battery. Result and Conclusion: Cognitive performance was found to be unaltered upon 2% or 4% hypohydration. The cognitive function was retained under hypohydration demonstrating cognitive resilience in response to moderate body fluid deficits (up to 4%).
EnglishExertional heat stress, hypohydration, stroop color and word test, PGI battery test, cognitionINTRODUCTION
Hypohydration, commonly known as dehydration refers to a fall in body water level below normal. Certain occupational workers such as soldiers and athletes are prone to hypohydration, as they have to undergo extensive physical activity at high temperatures [1]. More that 1% of body weight loss due to fluid loss is referred to as mild hypohydration. 4% of hypohydration is somewhat moderate and severe dehydration corresponds to fluids deficit of 5% percent or more. Investigations on the effect of hypohydration on cognitive function present with ambiguous and contradictory results. Significant alterations in cognition have been reported in response to hypohydration as low as 1-2 % [2, 3]. Hypohydration above 2% body mass has been shown to impair endurance exercise performance in hot environments [4, 5]. Moderate hypohydration has been found to be associated with cognitive performance decline at elevated temperature. However, there are many contradictory reports suggesting that hypohydration doesn't affect cognition. This ambiguity can be attributed to difference in methodology to induce hypohydration and cognitive function tests employed [2, 3]. We have attempted to evaluate the effect of exertional heat stress induced hypohydration on cognitive function in Human. Six healthy military personnel performed sub-maximal exercise at 45 ?C and 30% RH in the HCC till the desired levels of hypohydration were achieved (2% or 4%). It is acknowledged that the hypohydration in Military and sports settings can at certain occasion be much more severe than 4%, but due to the concerns of subject safety, hypohydration above 4% was not included in the experimental design. The cognitive function was assessed both before and after exercise in the HCC using stroop color and word test and PGI battery. Cognitive performance was found to be unaltered upon 2% or 4% hypohydration demonstrating cognitive resilience in response to moderate body fluid deficits (up to 4%).
MATERIALS AND METHODS
Participants: Six healthy male [age 31.33 ± 2.5 years, height 170.4 ± 7.5 cm, body mass 76.85 ± 5.1 kg, body surface area 1.87± 0.1m2 ] participated in the study. Inclusion criteria consisted of a medical history free of musculoskeletal, cardiac, endocrine, and heatrelated illnesses. Prior to the study, the experimental procedure including the risks involved was explained to each participant. Written consent was then obtained. Institutional ethical committee for humans approved all protocols and procedures. Preliminary Procedures: One week of familiarization and preliminary testing were carried out one month before the experimental trials. During preliminary testing, volunteers performed cognitive function test of similar pattern to acquaint them to the nature of test which will be provided in experimental condition inside the Human Climatic Chamber (HCC) in order to reduce training and learning effects. Each familiarization session took place in a 25 C 30 % RH. Experimental design: To assess the effects of exertional heat stress induced hypohydration on human cognition, the participants were made to perform sub-maximal exercise [6] in Human Climatic Chamber (HCC) simulated at 45 ?C and 30% RH. The exercise was performed at two separate occasions to attain two different hydration states: 2% body weight reduction or 2% hypohydration and 4% body weight reduction or 4% hypohydration. The two exercise sets were separated by at least two weeks to ensure the reestablishment of normal physiological status by nullification of the effect of previous exposure. All the participants were instructed not to engage in any vigorous physical activity for at least 24 hours prior to each exercise session and consume normal balanced diet throughout and also, to refrain from alcohol and smoking. All the sessions were conducted approximately at the same time of the day for each participant. 4% hypohydration represents a state of significant body water loss and the value was chosen to facilitate a comprehensive assessment of potential implications of severe hypohydration on human body. We couldn’t evaluate the effect of a more severe hypohydration due to the volunteers’ safety considerations. To evaluate the effect of graded hypohydration on brain dysfunction, cognition, and psychopathology, the stroop color and word conflict test [7] was undertaken by volunteers at two time points: before and after the desired level oh hypohydration was attained. Stroop color and word conflict test is a mental stress test involving sensory rejection and has been used as a model of the defense reaction in humans. The test consists of three pages. The first is a word page with color names printed in black ink. The second is the color page with ‘Xs’ printed in different colors and the last page is the conflict page displaying words from the first page printed in colors from the second page yielding three scores based on the number of items completed on each of the sheets described above as the respondent reads words or names in the ink colors as quickly as possible within a time limit. The values obtained are a reflection of the cognitive flexibility, creativity, and reaction to cognitive pressures. The Stroop color and word conflict test is a quick, easy and highly reliable test for neuropsychological assessment applicable to individuals with age ranging from 15 to 90. It provides valuable diagnostic information on brain and assesses cognitive processing with accuracy. Along with this, PGI memory test was also administered. PGI memory scale [8, 9], which is standardized on Indian population, is used mostly in India. It is an Indian adaptation of the Wechsler Memory Scale. It includes 10 subtests including forward and backward digit spans, one minute delayed recall of a word list, immediate recall of sentences, retention of similar word pairs, retention of dissimilar pairs, visual retention, visual recognition, recent memory, remote memory and mental balance test. This test provides a reliable and easy means to assess memory dysfunction. Administration of the scale is simple and takes approximately 20–30 min. Standardized norms are available according to age and education. Separate norms are available for three education levels: 0–5 years of schooling, 6– 9 years of schooling and ≥10 years of schooling. Experimental procedure: The subjects were instructed to ingest 5 ml of water per kilogram body weight 2 h before reporting to the laboratory to attain a euhydrated state [10]. After reporting to the laboratory the subjects were made to rest for 60 minutes. troop color and word conflict test and battery test were carried out in Human Climatic Chamber (HCC) maintained at 25 C and 30% RH. After completion of the test which was taken as control, the oral temperature was recorded outside the chamber using YSI electrodes from which the core body temperature was deduced. Skin mean temperature was calculated using Ramanathan equation [11]. Initial nude body weight was measure using digital human weighing machine model PFPF 100K and make PERFECT. The participant then entered the HCC maintained at 45°C and 30% RH and performed sub-maximal exercise (standardized step test, 15 steps/min) [6] until targeted hypohydration level was attained. After the attainment of desired level of hypohydration, Stroop color and word conflict test and PGI battery test were carried out in chamber itself. The post exposure core body and skin mean temperature was obtained as soon as the participant came out of the chamber.
Statistical
analysis: All variables were analyzed using student t-test. At least a 95% confidence level (pEnglishhttp://ijcrr.com/abstract.php?article_id=916http://ijcrr.com/article_html.php?did=916REFERENCES
1. Singh LP, Kapoor M, Singh SB. Heat: not black, not white. It's gray!!! J Basic Clin Physiol Pharmacol. 2013;24(4):209-24.
2. Lieberman HR. Hydration and cognition: a critical review and recommendations for future research. J Am Coll Nutr. 2007 Oct;26(5 Suppl):555S-561S.
3. Ganio MS, Armstrong LE, Casa DJ, McDermott BP, Lee EC, Yamamoto LM, Marzano S, Lopez RM, Jimenez L, Le Bellego L, Chevillotte E, Lieberman HR. Mild dehydration impairs cognitive performance and mood of men. Br J Nutr. 2011 Nov;106(10):1535-43.
4. Cheuvront SN, Carter R 3rd, Sawka MN. Fluid balance and endurance exercise performance. Curr Sports Med Rep. 2003 Aug;2(4):202-8.
5. Sawka MN. Physiological consequences of hypohydration: exercise performance and thermoregulation. Med Sci Sports Exerc. 1992 Jun;24(6):657-70.
6. Evaluation of physical performance on the basis of test. In: Åstrand PO, Rodahl K., editors. Textbook of Work Physiology: Physiological basis of exercise. 4 th ed. USA: McGraw-Hill; 2003. p. 280-290.
7. Golden, C. J. (1976), Identification of brain disorders by the stroop color and word test. J. Clin. Psychol.,32: 654– 658.doi: 10.1002/1097- 4679(197607)32:33.0.CO;2-Z
8. Pershad D, Verma SK. Handbook of PGI Battery of Brain Dysfunction (PGIBBD) Agra: National Psychological Corporation; 1990.
9. Pershad D, Wig NN. The Construction and Standardization of a Clinical Test of Memory in Simple Hindi. National Psychological Corporation, Agra, 1977.
10. Montain SJ, Coyle EF. Influence of graded dehydration on hyperthermia and cardiovascular drift during exercise. J Appl Physiol (1985). 1992 Oct;73(4):1340-50.
11. Ramanathan NL. A new weighting system for mean surface temperature of the human body. J Appl Physiol. 1964 May;19:531-3.
12. Adam GE, Carter R 3rd, Cheuvront SN, Merullo DJ, Castellani JW, Lieberman HR et al. Hydration effects on cognitive performance during military tasks in temperate and cold environments. Physiol Behav. 2008 Mar 18;93(4-5):748-56.
13. Patel AV, Mihalik JP, Notebaert AJ, Guskiewicz KM, Prentice WE. Neuropsychological performance, postural stability, and symptoms after dehydration. J Athl Train. 2007 Jan-Mar;42(1):66-75.
14. Szinnai G, Schachinger H, Arnaud MJ, Linder L, Keller U. Effect of water deprivation on cognitive-motor performance in healthy men and women. Am J Physiol Regul Integr Comp Physiol. 2005 Jul;289(1):R275-80.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareA STUDY ON EVALUATION OF SURFACE ROUGHNESS AND ANTI-STANING PROPENSITY OF NANO - COMPOSITE DENTURE TEETH
English5257Jyoti Kundu English Ravinder Kumar English Shivam SeshanEnglishBackground and Objective: The introduction of nano-filled resin systems has resulted in considerable controversy. Lack of evidence-based scientific information and unavoidable time lag in establishing the precise relationship between their physicomechanical properties and clinical performance sought us to substantiate & qualify relative surface roughness & anti-staining characteristics of three commercially available type of artificial teeth. Materials and Methods: Three brands of three types of artificial teeth were examined .The staining behavior of the artificial teeth after immersion in tea solution for one hour was evaluated by spectrophotometeric analysis. Qualitative SEM analysis was used to assess the surface appearance after treatment with 2% citric acid for four hours. Results: The difference in mean optical density values for unstained and stained specimen suggested least staining with nanocomposite among the combinations used. Examined teeth when subjected to citric acid retreatment showed no qualitative surface changes in nano and micro filled composite but significant surface alterations were observed in dual cross-linked acrylic teeth. Conclusion: Within the limitations of this study, Nano composite showed significantly improved surface smoothness and stain resistance when compared to microfilled composite and dual cross-linked teeth tested.
EnglishNanocomposite denture teeth, surface finish, stain resistance, scanning electron microscope, spectrophotometry.INTRODUCTION
Artificial teeth are often necessary for prosthodontic rehabilitation when natural teeth are lost. Acrylic resins and porcelains have been used for the fabrication of artificial teeth; however, neither type completely accomplishes the requirements for an ideal prosthetic tooth.1 It is well known that some dietary factors, such as tea lead to extrinsic tooth discoloration. 19Also citric acid , an organic acid found in high percentages in many dietary supplements, cause dental erosion and produces surface roughness of denture teeth. 20 Its been observed that during wear of resin composite teeth, inorganic fillers debond from the resin matrix and leave a void, increasing the surface roughness and forming a surface susceptible to exterior stain3 . The amount of filler content, the geometry and size of the filler particles,and the properties of the polymer matrix have been reported to influence the properties of polymer materials.2,4-12 A new type of denture tooth, fabricated of nano-composite resin, has recently been developed as a highly polishable, stain and impact resistant material.14 Few laboratory tests have been able to substantiate and quantify the surface roughness and anti staining property of polymeric denture teeth. Also, evidence-based scientific information regarding these new types of artificial teeth with respect to composition and physicomechanical properties is lacking. Therefore, studies critically discussing latest peer- reviewed reports and evaluating properties of commercial artificial teeth become necessary.
MATERIALS AND METHODS
Three groups of teeth (dual cross- linked acrylic resin, microfilled composite resin & nanofilled composite resin) were analysed for study.
SURFACE ROUGHNESS ANALY
SIS Preparation of samples and methodology for surface roughness evaluation
Fourteen specimens of maxillary central incisors from each type were used for SEM analysis using the sophisticated Scanning Electron Microscope (SEM). (JEOL, JFC - 1100E, Hitachi, HighTechnologies Corp, Tokyo, Japan). After vaporcoating with gold by ion sputtering device, the untreated incisal surfaces were examined in the SEM with the back-scattered electron images under high magnification of 1000x operating at 20Kv . Subsequently, these specimens were soaked in l0ml of 2% citric acid solution for 4 hours (assuming that average exposure is 40 sec. per day, thus simulating 1 year of exposure)20 . This was followed by qualitative SEM analysis to assess the surface appearance of the resultant acid treated specimens
STAIN RESISTANCE EVALUATION
Specimen preparation Fourteen specimens of maxillary 2nd molar from each type were used for stain resistance evaluation. Perspex strips of dimension 5x1 cm were prepared and maxillary 2nd molar was mounted at a height of 2.5 cm at an angulation of 45 degrees such that occlusal surface facing outward direction. This was the standardized guideline followed for specimen preparation such that focus of UV- Light of spectrophotometer is identical in position and location for all the specimens to be evaluated. Tea Solution Preparation 100ml of double distilled water was taken in a beaker & allowed to boil . After that 1gm of green tea leaves (Elixir, rohini estate, Darjeeling), measured in electronic balance, were brewed for 5 min. As temperature affects staining reaction ( Addy et al, 1985) so, experiment was planned to be conducted at room temperature 27 . The tea solution was cooled to room temperature and filtered with Whitman filter paper no.6. Wavelength Selection Absorbance decreases gradually from 360nm to 600nm wavelength. At 360nm absorbance of unstained specimen at constant stable position, optical density was 0.513 and at 600 nm, it was 0.153. Since 360-370 nm wavelength is the transition zone, so we opted for 395nm wavelength as the dominant wavelength showing peak absorbance of 0.418. Method of Data Collection Optical density of each of the unstained forty two specimen at selected wavelength of 395nm was noted. Then, all the forty two specimens were immersed in freshly prepared tea solution for 60 minutes & later on washed with distilled water for 30sec & bench dried27. Stained dried specimens were then subjected to spectrophotometer UVlight at same constant stable position and wavelength. Optical density of dried, stained specimens was noted and difference in the optical density of the specimens, before and after staining, was taken as a criteria to measure stain resistance. Lesser the difference, more the stain resistance. Statistical technique used ANOVA One way analyses of variance were used to test the difference between groups. To find out which of the two groups means is significantly difference scheffe’F’ test is used.\
RESULTS
Surface Roughness Analysis Qualitative Assessment as shown in figure 1, 2, 3 ? The SEM image of untreated nanocomposite tooth surface shows the small angular splintered nano-filler complexes of various sizes distributed in the matrix. While on other hand, SEM image of 2% citric acid treated nanosurface looks like the mirror image of untreated one, depicting the excellent surface smoothness even after one hour of citric acid treatment. ? In case of microfilled composite, untreated tooth surface analysis shows angular and spherical prepolymerised microfiller complexes incorporated in organic matrix.Whereas for the treated surface, SEM image shows no topographic changes suggestive of no significant alterations in the surface smoothness. ? Untreated Dual cross-linked acrylic SEM images shows macrofillers of various sizes of identical or different composition admixed in organic matrix of Urethane Dimethacryl (UDMA). But here in this case, noticeable difference was seen on surface treatment with citric acid and prominent surface irregularities were seen, indicative of certain qualitative changes in the surface topography debarring the surface smoothness.
Stain Resistance Evaluation
Table 1 shows the calculated mean and standard deviation of optical density of unstained and stained specimens among three groups. With tea, least staining was seen with nanocomposite while minimum stain resistance was shown by Dual Cross linked Acrylic (DCL) specimen teeth, although data may vary depending upon evaluation designs. The difference in mean absorbance value (optical density) of three groups exist on account of material composition & homogenity.
DISCUSSION
New materials, even if they are proved excellent, often have one or the other limitation, because they may be associated with a re - evaluation of the established systems of use and may not readily be amenable for use. Furthermore, there is an unavoidable time lag in establishing the precise relationship between their properties and clinical performance. Thus, the introduction of nanofilled resin systems has led to considerable controversy, both from the standpoint of the dentist and within the scientific community. However, it is possible to evaluate newer composite resins systems on the basis of their microstructure. Earlier researchers and manufacturers have reported that nano-composites were made up of homogenous urethane organic matrix reinforced by heterogeneous, pre-polymerized silica fillers13,14,22. While the micro-filled composite denture teeth (Endura) are heterogeneous, microfilled composite resins with agglomerated microfillers are similar to traditional macro-filled ones in size and chemistry, but not in structure. Further, they allow a substantial increase in the micro-filler content when admixed to an organic matrix. Such a resin composite has been known to demonstrate excellent finishing and perfect surface qualities. However, not much is known about the in vivo performance of composites with nano fillers. Consequently, available property data on these composite materials is rather limited. The absence of such vital data was the basis for taking up the study reported here. Results of this study clearly indicate that the hybrid (especially the nano-filled) resin composites are markedly superior to the traditional composites and acrylic resins in terms of surface smoothness and anti-staining tendency. Further, as the filler particle size is reduced, the polishability, permanence of surface smoothness, and esthetics of the nano-filled composites improve.
CONCLUSION
Judging by these results, it can be authentically concluded that nano-composite denture teeth may be one of the most promising and appropriate materials for denture teeth in near future. However, further investigation of other characteristics such as wear, impact resistance, and bonding to reparative autopolymerizing resins should be performed.
ACKNOWLEDGEMENT
We acknowledge to Geetanjali Medical College and Hospital, Udaipur and Indian Institute of Sciences, Bangalore for their immense support.
Conflict of Interest
None declared
Englishhttp://ijcrr.com/abstract.php?article_id=917http://ijcrr.com/article_html.php?did=917REFERENCES
1. Zarb GA, Bolender CL. Eckert SE, Jacob RF,Fenton AH, Merickske-stern RM. Prosthodontic treatment for edentulous patients:Complete denture and Implantsupported prosthesis. 12th ed. St. Louis: Mosby; 2004. p. 195-8.
2. Zeng J, Sato Y, Ohkubo C, Hosoi T. In vitro wear resistance of three types of composite resin denture teeth. J Prosthet Dent 2005; 94: 453–457.
3. Huan lu,:leslie b. roeder,: Effect of Surface Roughness on Stain Resistance of Dental Resin Composites J Esthet Restor Dent 17:102–109, 2005.
4. Kim KH, Ong Okuno O. The effect of filler loading and morphology on the mechanical properties of composites.J Prosthet Dent 2002;87:642-9.
5. Condon JR, Ferracane JL. In vitro wear of composite with varied cure, filler level, andfiller treatment. J Dent Res 1997;76:1405- 11.
6. Li Y, Swartz ML, Philips RW, Moore BK,Roberts TA. Effect of filler content and size on properties of composites. J Dent Res1985;64:1396-401.
7. Jaarda MJ, Wang RF, Lang BR. A regression analysis of filler particle content to predict composite wear. J Prosthet Dent 1997;77:57- 67.
8. Hashinger DT, Fairhurst CW. Thermal expansion and filler content of composite resins. J Prosthet Dent 1984;52:506-10.
9. Soderholm KJ. Influence of silane treatment and filler fraction on thermal expansion of composite resins. J Dent Res 1984;63:1321-6.
10. Schwartz JI, Soderholm KJ. Effect of filler size, water, and alcohol on hardness and wear of dental composites. Acta Odontol Scand 2004;62:102-6.
11. Turssi CP, Ferracane JL, Vogel K. Filler features and their effects on wear and degree of conversion of particulate dental composites.Biomaterials 2005;26:4932-7.
12. Miyasaka T. Effect of shape and size of silanated fillers on mechanical properties of experimental photo cure composite resins.Dent Mater J 1996;15:98-110.
13. Lutz F, Philips RW. A classification and evaluation of composite resin sytems. J Prosthet Dent 1983;50:480-8.
14. Suzuki S. In vitro wear of nano-composite denture teeth.J Prosthodont 2004; 13: 238– 243.
15. Fumiaki Kawano, Takafumi Ohguri, Tetsuo IchikawaIwate Mizuno, Akira Hasegawa. Shock absorbability and hardness of commercially available denture teeth. Int J Prosthodont 2002;15: 243-247.
16. Mandikos MN, McGivney, Davis E,Bush PJ, Carter JM. A comparison of the wear resistance and hardness of indirect composite resins. J Prosthet Dent 2001;85:386-95.
17. Kawano F, Ohguri T, Ichikawa T, Mizuno I, Hasegawa A. Shock absorbability and hardness of commercially available dentureteeth. Int J Prosthodont 2002;15:243-7.
18. Okada K, Tosaki S, Hirota K, Hume WR.Surface hardness change of restorative filling materials stored in saliva. Dent Mater 2001;17:34-9.
19. Leard A. Addy:The propensity of different brands of tea and coffee to cause staining associated with chlorhexidine.JClin Periodontol 1997:24:115-118.
20. Asher C, Read MJF: Early enamel erosion in children associated with the excessive consumption of citric acid.Br. HP.HI J 19X7; 162:384-387.
21. Mui S. Soh, Adrian U. J. Yap , Alan Sellinger (2007): Physicomechanical evaluation of lowshrinkage dental nanocomposites based on silsesquioxane cores . European Journal of Oral SciencesVolume 115, Issue 3, Pages 230- 238
22. Paola G. Loyaga-Rendon, Hidekazu Takahashi,Iwao Hayakawa, c and Naohiko Iwasaki (2007) : Compositional characteristics and hardness of acrylic and composite resin artificial teeth. (J Prosthet Dent 2007; 98: 141-149.)
23. Muhamad Ghazal and Matthias Kern (2009): The influence of antagonistic surface roughness on the wear of human enamel and nanofilled composite resin artificial teeth .J Prosthet Dent 2009;101:342-349.
24. M. Addy and W. R. Roberts ( 1981): Comparison of the bisbiguanide antiseptics alexidine and chlorhexidine. II. Clinical and in vitro staining properties. . Journal of Clinical Periodontology 1981: 8: 220-230.
25. T. Stober , H. Gilde, P. Lenz (2001): Color stability of highly filled composite resin materials for facings. Dental Materials 17 (2001) 87±94.
26. JM Brady and RD Wood (1977) : Scanning microscopy of cervical erosion .J Am Dent Assoc, Vol 94, No 4, 726-729.1977.
27. A.Leard and M.Addy (1997) : The propensity of different bunds of tea and coffee to cause staining associated with chlorhexidine. J Clin Periodontol 1997; 24: 115-118
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareVARIATIONS IN THE PRESENCE AND PROMINENCE OF THE FEATURES IN THE LONG BONES OF LIMBS
English5864Sayee RajangamEnglish Vidhya REnglish Siva CharanEnglish Safeer KhanEnglish Flossie JayakaranEnglishObjectives: The present study was undertaken, to report the subjectively observed variations in the presence and / or prominence of features in the long bones of limbs. Material and Method: The observed features multiplied with the total number of bones were: humerus 576(16x36); radius 240(8x30); ulna 270(9x30); femur 1008(16x63); tibia 380(10x38), fibula 152(4x38). The features were graded for their presence or prominence and analyzed for their combined/ individual total; total between and within the right and left sides. Results: The combined total of the presence and prominence of the features were greater for the right femur (576/1008, 57.1%). The individual total showed that the presence of features was greater in tibia (259/380, 68.2%) and prominence of features in ulna (164/270, 60.8%). Between sides, the prominence of the features was greater for right femur (355/603, 59%). Within the sides, the prominence of the features was high for ulna (82/126, 65%). X2 value indicated that the prominence of the features for femur could be of value in side determination. The observations on the prominence of individual features in long bones of the limbs showed a high percentage value for the nutrient foramen in femur (56/63, 88.9%). Conclusion: From the present study, it is seen, that features could have become prominent due to genetic and/or environmental factors such as nutrition and biomechanics during the process of the formation of the features.
Englishfeatures, humerus, radius, ulna, femur, tibia, fibulaINTRODUCTION
The long bones of the upper limb are the humerus, radius and ulna and that of the lower limb are the femur, tibia and fibula. Being long bones, they possess a shaft, body, upper or proximal and lower or distal ends. The two ends have articular areas and bony projections. The articular areas are considered under the category of ‘pressure epiphysis’ and the bony projections (tubercles, trochanters) are included under the category of ‘traction epiphyses’. The projections, lines and facets of long bones are molded by the attachments of muscles, tendons, ligaments and the axis and planes of movements. From standard text books in Anatomy, it is seen that the side to which the bone belongs could be determined by the presence of well-defined features on the bones.1,2 In spite of the presence of individual and racial variations in shape and prominence, earlier studies have shown that these well-defined structures in long bones, contribute either subjectively or objectively to sex determination.3 During the teaching of osteology in Anatomy, the well-defined features of long bones are described and explained as the general and specific features. At that time, the teaching faculty have observed and felt the prominence or lack of it in some of those features. Hence, the present study was undertaken, to subjectively report the observed variations in the features of the long bones of the upper and lower limbs, both for their presence and / or prominence.
MATERIALS AND METHODS
Long limb bones that are used for teaching and learning Osteology at the International Medical School, Bangalore, were sorted according to their side. The total numbers of the selected bony features were multiplied with the total number of bones and it was: humerus 576 (16x36); radius 240 (8x30); ulna 270 (9x30); femur 1008 (16x63); tibia 380 (10x38), and fibula 152 (4x38). The features were graded as single + for their presence and double ++ for their prominence. The features are listed in Appendix 1. The statistical analysis applied to the obtained values was percentage occurrence and the X2 test.
RESULTS
The obtained values from the bones were analyzed under 6 categories for the ‘presence and prominence’ of the features:1) the combined total of the presence and prominence; 2) the individual total of the presence and prominence; 3 and 4) the total of the presence or prominence for the right and left sides; 5 and 6) the total of the presence and or prominence within the right and left sides.
DISCUSSION
Early reports in literature studied and reported sex differences in the skeleton and its various components based on the morphological features and morphometry.2 The general and specific features of the long bones of the limbs could become prominent especially if they belong to the category of traction or pressure epiphysis. Of course, it depends on the attachments, tension and the pull of the muscles / tendons / ligaments of the joints and its movements; weight transmission as well the genetic and / or environmental factors affecting the process of ossification. In the present study, features were selected randomly for their presence and / or prominence. Present study: Interpretations i) Among the bones, the combined total features have occurred more on the left side ii) Between presence and prominence of features, the total value of prominent features were greater for ulna and femur iii) When considered separately between the sides, prominent features were greater on the right femur iv) Within the same side, the value of the prominent features was greater in the right ulna v) From the study on the prominence of the individual features, a high percentage was seen for the nutrient foramen in femur and this indeed is a surprising finding. vi) In their presence and/or prominence, the features seemed to contribute to the determination of side in any given fragment of these bones. vii) The prominence of the features in the right femur may indicate that weight transmission is preferentially more on the right side in the standing and sitting positions of the body; while in the right as well as in the left ulna, the movements may be more bilateral (pronation and supination). The observations of the present study could not be discussed further in view of the absence of any published literature relevant to this article / research.
CONCLUSION
It may be concluded that the present study has reported the subjectively observed variations in the features of long bones of the limbs, both for their presence and / or prominence. It was thought, that in spite of the features’ presence and / or prominence and also being subjective, still they could become a study of academic interest. The variations in features could be because of the biomechanics and the phenomenon of the ossification process at the primary (diaphysis) and secondary (epiphysis) centres.
Englishhttp://ijcrr.com/abstract.php?article_id=918http://ijcrr.com/article_html.php?did=918REFERENCES
1. Standring S. Gray’s Anatomy. The Anatomical Basis of Clinical Practice. 40th edition. London; Churchill Livingstone Elsevier: 2008.
2. Krogman WM. The Human Skeleton in Forensic Medicine. Illinois; Charles C Thomas Pub Ltd: 1969.
3. Kadasne DK. Kadasne’s Text book of Anatomy (Clinically Oriented). Volume1. Upper and Lower Extremities. Delhi; JAYPEE Brothers Medical Publishers (P) Ltd: 2009.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareASSESSMENT OF OXIDATIVE STRESS AND ANTIOXIDANT STATUS AMONG NEWBORNS IN RELATION TO MODE OF DELIVERY
English6573Soumika BiswasEnglish Swati BhattacharyyaEnglish Chinmoy GhoshEnglish Sayari BanerjeeEnglish Kasturi MukherjeeEnglish Arghya BasuEnglishOxidative stress results from an imbalance between reducing agents and enzymes involved in the removal of free radicals (FR) and/or reactive oxygen species (ROS). Objective of the study was to compare oxidative stress between newborns delivered by normal vaginal delivery and elective caesarean section by estimation of cord blood ischemia modified albumin (IMA) and to compare antioxidant status between them by measuring activity of super oxide dismutase and tocopherol in their cord blood. Cord blood was collected from 50 newborns delivered by uncomplicated normal vaginal delivery and 50 newborns delivered by elective caesarean section. Mean serum ischemia modified albumin level in cord blood of newborns born by normal vaginal delivery (35.34+-3.4U/ml, mean+-2SD) was higher than serum IMA values in cord blood of newborns born by caesarean section(24.89+-2.86U/ml, mean+-2SD)( by albumin cobalt binding assay method). Mean serum tocopherol in cord blood of newborns born by normal vaginal delivery was found to be lower (1.99+-0.62mg/lit, mean+-2SD), than that of cord blood of newborns born by caesarean section (4.21+-1.04mg/lit, mean+-2SD) in this study( by Baker and Frank method). Mean cord blood plasma super oxide dismutase values were found to be lower in cord blood of normal delivery born babies (3.54+-0.60U/ml, mean+-1SD), than that of caesarean section born babies (5.82+-0.45U/ml, mean+-1SD) (by Kakkar’s method). So, there is increased antioxidant status in cord blood of caesarean section born babies and increased oxidative stress (which is indicated by raised ischemia modified albumin) in cord blood of normal delivery born newborns. Antioxidant supplementation to mothers and newborns may be considered.
EnglishOxidative stress, Normal vaginal delivery, Elective caesarean section, AntioxidantsINTRODUCTION
Oxidative stress results from an imbalance between reducing agents and enzymes involved in the removal of free radicals (FR) and/or reactive oxygen species (ROS)[1]. Pregnancy, mostly because of the mitochondria rich placenta ,is a condition that favours oxidative stress .Transition metals ,especially iron, which is particularly abundant in the placenta, are important in the production of free radicals, The lungs of the newborns are especially prone to oxidative damage induced by both reactive oxygen species and reactive nitrogen species[2]. Yet these infants are often -exposed to high oxygen conc., have infection or inflammation, have reduced antioxidant defence and high free iron levels which enhance toxic radical generation, this is ‘oxygen radical diseases of neonatology’, Oxidative stress increases when more resuscitation with pure oxygen and nasopharyngeal tubing is done[3].So,at birth the newborn encounters an environment much richer in oxygen(PO2 100 TORR) than the intrauterine environment(20-25 TORR), this 4-5 fold increase exposes the newborn to a flood of free radicals[1]. The consequence of oxidative stress on foetal structure involves the activation of a complex array of genes involved in inflammation, coagulation, fibrinolysis, cell cycle and signal transduction [4]. In moderate quantities and in presence of a good antioxidant capacity, free radicals are continuously generated in the organism and are essential for cell aerobic metabolism and foetal growth, but they are toxic when overproduced, resulting in an attack on all classes of biological macromolecules, polysaccharides, nucleic acid ,lipids and proteins[5]. Hypoxia, hyperoxia, inflammation, fenton chemistry, endothelial damage, arachidonic acid cascade are other mechanisms that form highly reactive products. Free radical reactions lead to DNA damage (fragmentation, apoptosis, base modifications and strand breaks)[6]. Therefore, estimation of the antioxidant status of the newborn will help us to predict the defence mechanism of them against oxidative injury. In this study, cord blood plasma level of super oxide dismutase and cord blood serum level of alphatocopherol was measured in normal vaginal delivery group and elective caesarean section group and comparison was done to predict which group has higher antioxidant status. In this study, serum ischemia modified albumin in cord blood was measured in the above two groups and oxidative stress was compared between those two groups. Estimation of antioxidant status of the newborn in both modes of delivery leads to prediction of which mode has higher oxidative stress. In modern era, there has been a rise of caesarean section rate all over the world, this study will help to decide whether caesarean section is truly beneficial from the point of view of oxidative stress.
REVIEW
OF LITERATURE Antioxidant is any substance that when present at low concentrations compared with those of an oxidizable substrate significantly delays or prevents oxidation of that substrate. The main antioxidant defence comprises of Superoxide dismutase, Catalase, Glutathione Peroxidase (they catalytically remove free radicals and other reactive species).Super oxide dismutase converts superoxide to hydrogen peroxide and oxygen. Alpha tocopherol, retinol, Ascorbic acid, Bilirubin,Uric acid, these agents scavenge the reactive oxygen species with help of their large molecular size and presence of double bonds [7]. Ischemia/reperfusion induced oxidative stress changes the structure of the amino terminus of albumin in such a way that causes the loss of its Co2+ binding capacity leading to the formation of an ‘ischemia-modified albumin'. HPLC, LC-MS and NMR analysis have shown that the N terminal region of human serum albumin Asp-Ala-His-Lys binds the transition metals cobalt and nickel, modification of this region by way of N acetylation or the deletion of one or more amino acid resulted in no binding of cobalt, an assay that detects this reduced binding could be useful in the diagnosis of ischaemia [8]. Super oxide dismutase activity per gram haemoglobin in cord blood erythrocytes from normal term infants is significantly lower than that of red blood cells from adults. When the activity was expressed per erythrocyte no difference was found, the normocromic macrocytic red blood cells of the neonate most likely explain this discrepancy [9]. In Indian population mean cord blood SOD values is lower in preterm deliveries than full term deliveries. Increase in red cell super oxide dismutase activity in response to hypoxic stress may prevent toxic effects of O2 - radicals and oxygen toxicity to the lung [10]. Serum maternal ischemia modified albumin significantly increased during pregnancy in comparison to non pregnant controls, this may be due to physiologic oxidative stress state of pregnancy[11]. Abnormal Doppler examinations are associated with elevated ischemia modified albumin levels in complicated pregnancies where oxidative stress was more. This is higher in newborns with perinatal asphyxia as compared to healthy controls [12]. Reduced blood flow, such as that resulting from vascular compressions in complicated labor or placental ischemia, may increase IMA.IMA level in cord blood can serve as an indicator of foetal hypoxia and foetal tissue ischaemia.IMA levels in neonates from non complicated deliveries are also significantly higher than those of an adult control population, suggesting that IMA may increase as a consequence of labor,. This transient increase in IMA reflects in part transient localized tissue ischemia due to external forces exerted on foetus during the mechanism of labor during normal vaginal delivery.IMA levels in cord blood from complicated delivery neonates are 50% higher than that in neonates from uneventful deliveries, while their albumin values were not significantly different [13]. In comparison to healthy adults, newborn infants have lower levels of serum tocopherol. Tocopherol is present in significantly higher concentration in maternal plasma than in cord plasma [3]. In two separate studies done in 2000and 2005, it has been shown that route of delivery has an effect on oxidative stress in newborns exposed to oxidative stress during delivery and super oxide dismutase levels were significantly higher in the elective caesarean group than the normal vaginal delivery group [14, 15]. In 2009 a study investigated the effect of two modes of labor (vaginal delivery and elective caesarean section)on thiobarbituric reactive substances (TBARS) as markers of lipid per oxidation and oxidative stress, total antioxidant power (TAP, ferric reducing ability),and total thiol molecules (TTM) in blood of mothers and their newborns. The results indicated that mothers in vaginal delivery and their newborns are in more oxidative stress than those who underwent elective caesarean section for delivery [16]. In 2011 a study on Asian population found that malondialdehyde levels in the umbilical cord blood (which is a sensitive indicator of lipid per oxidation and thus of oxidative stress), was statistically and significantly higher in normal vaginal delivery group than those in the elective caesarean section group [17]. In 2007 a study proved that 15-f(2t)-isoprostane levels, an index of oxidative stress levels, were statistically and significantly higher in infants born after vaginal delivery compared to those delivered by elective caesarean section[18]. In 2002 a study showed the effect of delivery on umbilical cord blood gases and lipid per oxidation and observed that C.S. with epidural anesthesia is safer than NVD when lipid per oxidation were concerned[19]. In 2005, researchers investigated arterial and venous umbilical cord levels of glutathione in neonates born by vaginal delivery or cesarean section . Glutathione levels in venous and arterial umbilical samples were higher after vaginal delivery as compared to cesarean section, (P < 0.03) and (P < 0.02), respectively. These results suggest that vaginal delivery is associated with more oxidative stress than delivery by cesarean section[20]. In 2013 a study determined maternal and fetal oxidative stress levels by measuring concentrations of derivatives of reactive oxygen metabolites (d-ROMs) in umbilical artery at delivery. They also measured the pH, partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and base excess (BE) in umbilical artery blood collected at delivery. They found that the concentrations of d-ROMs in umbilical artery were significantly higher in the VD group than the CD group. Compared to the CD group, umbilical artery pH tended to be lower (pEnglishhttp://ijcrr.com/abstract.php?article_id=919http://ijcrr.com/article_html.php?did=919REFERENCES
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2. Casanova E, Viteri FE.Iron and oxidative stress in pregnancy. J Nutr 2003 May; 133(5 suppl 2):1700S-1708S,
3. Gitto E, Pellegrino S, D’Arrigo S, Barberi I, Reiter RJ.Oxidative stress in resuscitation and in ventilation of newborns. Eur Respir J 2009Dec; 34(6):1461-9.
4. Wagenaar GT, Horst SA, Van Gastelen MA,Leijser LM,Maunad T,Van der Velden PA et al .Gene expression profile and histopathology of experimental bronchopulmonary dysplasia induced by prolonged oxidative stress. Free Radical Biol Med 2004;36:782-801.
5. Halliwell B, Free radicals, antioxidants and human disease:curiosity,cause or consequence? Lancet 1994; 344:721-24.
6. Saugstad OD.Mechanisms of tissue injury by oxygen radicals: implications for neonatal disease.Acta Paediatr1996;85:1-4.
7. Halliwell B,Gutteridge JMC,1999.Free radicals in biology and medicine,3rd ed. Oxford university press Inc.New York.
8. Bar-Or D, Curtis G, Rao N. Characterization of the Co2+ and Ni2+ binding amino-acid residues of the N terminus of human albumin: an insight into the mechanism of a new assay for myocardial ischemia. Eur J Biochem.2001;268:42-47.
9. Haga P,Kran S. Ceruloplasmin levels and RBC SOD activity in small preterm infants during the early anaemia of prematurity. Acta Peadiatrica(1981);70:861-64.
10. Soumitra Chakravarty,Alka N. Sontakke.A correlation of antioxidants and lipid peroxidation between maternal and cord blood in full term and preterm deliveries.Curr Pediatr Res 2012 ;16(2):167-174.
11. Guven S,Alver A,Mentese A,Ilhan F.C.,Calapoglu,M, Unsal A.The novel ischaemia marker Ischaemia modified albumin is increased in normal pregnancies. Acta Obstet Gynaecol Scand 2009;88(4):479- 82.
12. Kumral A,Okyay E,Guclu S,Gencpinar P, Islekel GH,SS oguz,Kant M,Demirel G,Duman N,Ozkan Het al. Cord blood IMA:Is it associated with abnormal Doppler findings in complicated pregnancies and predictive of perinatal asphyxia?. Journal of obstetrics and gynaecology research 2012(Dec.):1-4.
13. Gugliucci A,Hermo R,Monroy C,Numaguchi M,Kimura S. Ischaemia modified albumin levels in cord blood: a case control study in uncomplicated and complicated deliveries. Clinica chimica acta international journal of clinical chemistry(2005);362:155-160.
14. Sazzad Y,Leonard M,Doyle M.Antioxidant levels in the cord blood of term fetus.Journal of obstetrics and gynaecology.2000;(20)No.5:468-471.
15. Inanc F,Kilinc M,Kiran G,Guven A,Kurutas EB,Cikim IG,Akyol O.Relationship between oxidative stress in cord blood and route of delivery. Fetal Diagn Ther.2005 SepOct;20(5):450-3.
16. Vakilian K,Ranjbar A,Zarganjfard A,Mortazavi M,Vosough-Ghanbari S,Mashaiee S,Abdollahi M.On the relation of oxidative stress in delivery mode in pregnant women;a toxicological concern. Toxicol Mech Methods 2009 Feb;19(2):94-9.
17. Gulbayzar S, Arica V,Hatipoglu S,Kaya A,Arica S,Karatekin G. Malondialdehyde level in cord blood of newborn infants. Iran J Paediatr 2011 September;21(3):313-319.
18. Greco A,Minghetti L,Puopolo M,Pietrobon B,Franzoi M,Chiandetti L,Suppiej A.Plasma levels of 15-F(2t)-isoprostane in newborn infants are affected by mode of delivery. Clin Biochem 2007 Dec;40(18):p.1420-22.
19. Pence S,Kocoglu H,Balat O,Balat A.The effect of delivery on umbilical arterial cord blood gases and lipid peroxides :comparison of vaginal delivery and caesarean section. Clin exp obstet gynaecol 2002;29(3):p.212-4.
20. M. T. M. Raijmakers , E. M. Roes , E. A. P. Steegers , B. van der Wildt , W. H. M. Peters.Umbilical glutathione levels are higher after vaginal birth than after cesarean section. Journal of Perinatal Medicine; Volume 31, Issue 6: Pages 520–522.
21. Watanabe K , Iwasaki A , Mori T, Kimura C, Matsushita H, Shinohara K, Wakatsuki A. Differences in levels of oxidative stress in mothers and neonate: the impact of mode of delivery. J Matern Fetal Neonatal Med. 2013 Jun 20. [Epub ahead of print]
22. Üdris Mehmetoúlu (Akkuþ),Ali Kart,Osman .Aúlayan,Metin.Apar,Recep G.K.E. Oxidative Stress in Mothers and Their Newborns in Different Types of Labour. Turk J Med Sci (2002);32: 427-429.
23. Z.Hracsko,Z.Safar,H.Orvos,Z.Novak,A.Pal,I S Varga.Evaluation of oxidative stress markers after vaginal delivery or caesarean section. in vivo 2007; 21 :703-706.
24. Saphire O,Schneid-Kofman N,Silberstein E,Silberstein T. Does mode of delivery affect neonate oxidative stress in parturition?.Arch gynaecol obstet 2013 Mar;287(3):403-6.
25. Gitto E,Pellegrino S,Gitto P,Barberi I,Reiter RJ .Oxidative stress of the newborn in the pre and postnatal period and the clinical utility of melatonin.J Pineal Res 2009 Mar;46(2):128- 39.
26. Kakkar P,Das B, Vishwanathan PN. A modified spectrophotometric assay of super oxide dismutase.Ind J Biochem Biophys1984;21:130-132.
27. Gowenlock AH,Mc Murray JR,Mc Lauchlan DM. Determination of serum tocopherol ,Baker and Frank,1968.Varley’s Clinical Biochemistry 1988:902.
28. Robert H. Christenson, Show Hong Duh. Characteristics of an Albumin Cobalt Binding Test for Assessment of Acute Coronary Syndrome Patients: A Multicenter study. Clinical Chemistry 2001;47:464-470.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcareTRANSITIONAL CELL CARCINOMA OF THE OVARY: A RARE CASE REPORT
English7478Madhavan ManoharanEnglish Sridevi ManianEnglish Deepa GaneshEnglishIntroduction: Transitional cell carcinoma of the ovary is a rare, recently recognized, subtype of ovarian surface epithelial carcinoma. Transitional cell carcinoma is sufficiently different from malignant Brenner tumour (MBT) in that it is reasonable to suppose that ovarian TCC arises directly from pluripotential surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative Brenner tumor precursor. Case presentation: We present a case of TCC of the ovary, managed by total abdominal hysterectomy and bilateral salpingo-oophorectomy with omentectomy. Conclusion: Primary TCC of the ovary is a rare subtype of epithelial ovarian tumours and their response to chemotherapy is better than that for other types of ovarian cancers.
EnglishTransitional cell carcinoma, malignant Brenner tumour, pluripotential surface epithelium, total abdominal hysterectomy, bilateral salpingo-oophorectomy with omentectomy.NTRODUCTION
Transitional cell carcinoma (TCC) of the ovary is a rare subtype of ovarian surface epithelial tumours. Incidence of occurrence is less than 1% of Primary ovarian carcinomas1 . Admixture of other types of surface epithelial tumours, including serous, endometrioid and undifferentiated carcinoma are common, but transitional cell carcinoma pattern must predominant (>50%)of the tumour to make the diagnosis2,3 .
CASE PRESENTATION
A 40-year-old woman presented with history of lower abdominal pain and dysuria on and off. On per abdominal examination, there was a pelvic mass on the right side. Ultra sonogram of the abdomen showed a pelvic mass measuring 31 × 35 mm with homogeneous echogenicity. Abdominal computed tomography also showed a right adnexal mass measuring 4×3 x2 cm separate from ovary. A possibility of fibroid in the right broad ligament was considered. There was no lymphadenopathy present. The liver and kidneys were unremarkable. Routine laboratory results were all within normal ranges. Initial investigation of tumour marker showed increased serum CA-125 (70.3 U/mL; normal, 0-35 U/mL). She underwent surgery under the impression of malignant ovarian tumour. A solid mass, arising from the right ovary was found. The other ovary, uterus, both tubes and broad ligaments were within normal limits. Therefore, a staging laparotomy including total abdominal hysterectomy, bilateral salpingooophorectomy and omentectomy was performed. No lymph nodes were present. Intraoperative, a small amount (about 100 ml) of fluid was found in the pelvic cavity and the same was sent for cytological examination.
PATHOLOGICAL EXAMINATION
Uterus with cervix measured 7.5x4.5x3 cm. Cervix appeared hypertrophied. Cut section showed a thinned out endometrium and an intramural fibroid measuring 1.5cm in diameter. Each fallopian tube measured 5cm in length. The right ovarian mass measuring 6.5x3x2 cm was sent detached. The external surface was nodular. Cut surface was solid and yellowish (Figure 1). The left ovary measured 3.5x1.5x1cm. Cut section appeared within normal limits. Microscopic examination of the right ovarian mass showed a malignant tumour. The tumour was composed of oval to round cells with moderate amount of cytoplasm, vesicular to hyper chromatic nuclei and prominent nucleoli. The tumour cells were arranged in nesting pattern, broad papillae, glandular pattern and focal area shows cystic change lined by tumour cell (Figure. 2, Figure. 3). The tumour cells were separated by fibrous stroma and many punched out micro spaces were present (figure. 4). Mitosis was focally high, 5/10 HPF. There was no benign, metaplastic or proliferating Brenner component found in the tumour. The left ovary showed metastatic deposit of the tumour (Figure. 5). The tumour cells are strongly positive for CK 7 (Fig. 6). Sections of omentum showed lobules of adipose tissue with a focus of dystrophic calcification. No evidence of metastasis was present. The cytological examination of the fluid showed no malignant cells. The final diagnosis was transitional cell carcinoma of right ovary with metastasis to left ovary.
DISCUSSION
TCC of the ovary is a recently recognised subtype of ovarian surface epithelial carcinoma4 . It was first defined by Austin and Norris5 and added to the histologic classification of ovarian tumours by the World Health Organisation/International Society of Gynaecologic Pathologists 5 . Transitional cell tumour of ovary is a category of ovarian tumours that have epithelial cells resembling those of transitional cell neoplasms of urinary tract. They consist of Brenner tumour (benign, proliferating and malignant) and transitional cell carcinoma. World Health Organization classification defines ovarian transitional cell tumours as those “containing epithelial cells resembling urothelial transitional cells” and TCC as an invasive tumour that lacks a component of benign Brenner tumour and is characterized by “the presence of papillae lined by malignant cells of transitional cell type or nests of such cells in a fibrous or fibromatous stroma.” Ovarian TCC was thought to arise directly from the pluripotential surface epithelium of the ovary and from cells with urothelial potential, rather than from a benign or proliferative Brenner tumour precursor. Incidence of TCC is less than 1% of ovarian tumours. 10 to 15% of advanced stage ovarian carcinoma contains a TC component2 . They predominantly occur in post-menopausal age group, and the mean age is 56 years1 . The mean size of the tumour is 10 cm. In most of the patients, they are solid and cystic. But it can also present as purely solid or purely cystic with soft, fleshy or papillary areas often with haemorrhage and necrosis6 . They are unilateral or bilateral.Bilateralism is seen in 15 to 20% of cases (1). In our patient, the tumour was grossly seen only in the right ovary. The contralateral ovary appeared normal in size. However, it showed tumour deposit microscopically and hence considered as metastasis. The most important microscopic feature is the „punched out? micro spaces (87%). Other common features are large cystic spaces (73%) and large blunt papillae (63%). The less commonly occurring microscopic features are slit-like fenestrations (49%), bizarre giant cells (35%), small filiform papillae (18%), gland-like tubules (17%), and squamous differentiation (13%), and psammoma bodies (4%). The lining cells are crowded, highly stratified, polygonal to spindled cells with scant eosinophilic or clear cytoplasm and mild to severe nuclear atypia. Necrosis is common. In addition to not having a benign Brenner tumour component, TCC lacks the prominent stromal calcification which is mainly seen in malignant Brenner tumour7 . The micro spaces present in TCC may be mistaken for an endometrioid or a serous carcinoma. The former will show squamous differentiation associated with endometriosis whereas the latter will show complex papillae lacking transitional like cells and often contain Psammoma bodies1 . The ovarian TCC can be differentiated from an urothelial tumour metastatic to the ovary with the help of clinical findings and immunohistochemistry. Though both tumours can express cytokeratin 7, the ovarian TCCs are negative for cytokeratin 20 which is usually detected in bladder TCCs. Unlike bladder TCCs, ovarian TCCs are positive for Wilms tumour antigen (WT1)1, 2, 6 . It is well known that primary ovarian TCC has a better prognosis than all other types of ovarian carcinomas following standardized chemotherapy8 . Hence it becomes essential that the ovarian TCC has to be diagnosed correctly.
CONCLUSION
This case report will bring awareness of the rare and recently introduced entity, so that a tumour with urothelial features will be diagnosed properly and appropriately managed.
Englishhttp://ijcrr.com/abstract.php?article_id=920http://ijcrr.com/article_html.php?did=920REFERENCES
1. Christopher P. Crum. Transitional cell tumours. In DiagnosticGynaecologic and Obstetric Pathology, 2nd Edition. Marisa R. Nucci, and Kenneth R. Lee, 2011, 882-887.
2. AncelBlaustein. Transitional cell tumours. In Blaustein'sPathology of the Female Genital Tract, 5th Edition .Robert J. Kurman, 2002, 881-884
3. Christopher D. M. Fletcher. Transitional cell tumours. In Diagnostic Histopathology of Tumors , 4th Edition, William R. Schmitt , Kathryn DeFrancesco, 2013, 685-686, Volume 1.
4. Satoshi Ichigo, Hiroshi Takagi, KazutoshiMatsunami, Takayuki Murase, Tsuneko Ikeda, Atsushi Imai. Transitional cell carcinoma of the ovary (Review). Oncology Letters. 2011:3-6.doi: 10.3892/o1.2011.453
5. Austin RM, Norris HJ. Malignant Brenner tumor and transitional cell carcinoma of the ovary: a comparison. Int J GynecolPathol. 1987;6:29–39. doi: 10.1097/00004347- 198703000-00004
6. Scully RE. Histological Typing of Ovarian Tumours, 2nd ed. Berlin: Springer-Verlag, 1999.
7. Juan Rosai.Transitional cell tumours. In Rosai and Ackerman's Surgical Pathology, 10th Edition. Michael Houston, Joanne Scott, 2011, 574- 1576, Volume 2.
8. Eichhorn JH, Young RH. Transitional cell carcinoma of the ovary: a morphologic study of 100 cases with emphasis on differential diagnosis. Am J SurgPathol. 2004;28:453–63. doi: 10.1097/00000478-200404000-00004
9. Kommoss F, Kommoss S, Schmidt D, Trunk MJ, Pfisterer J, du Bois A. ArbeitsgemeinschaftGynaekologischeOnkolog ieStudiengruppeOvarialkarzinom. Survival benefit for patients with advanced-stage transitional cell carcinomas vs. other subtypes of ovarian carcinoma after chemotherapy with platinum and paclitaxel. GynecolOncol. 2005;97:195–9. doi: 10.1016/j.ygyno.2004.12.047
10. Satoshi Ichigo, Hiroshi Takagi, KazutoshiMatsunami, Takayuki Murase, Tsuneko Ikeda, Atsushi Imai. Transitional cell carcinoma of the ovary (Review). Oncology Letters. 2011:3-6.doi: 10.3892/o1.2011.453
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30HealthcarePREVALENCE OF DEPRESSION AND ANXIETY SYMPTOMS IN FIRST ATTACK MYOCARDIAL INFARCTION PATIENTS OF MEWAR REGION: A CROSS SECTIONAL STUDY
English7985Jitendra JeengerEnglish Swati WadhwaEnglish Devendra Mohan MathurEnglishBackground: According to various studies psychiatric morbidities in post Myocardial Infarction (MI) patients increases the morbidity and mortality. Prevalence of psychiatric morbidities is important for to early intervention and to improve the quality of life. There is a paucity of research on Indian subjects and specially those of this area of south Rajasthan. Aim: To find out the prevalence of Depression and Anxiety following first attack of acute Myocardial Infarction. Method: 60 cases with an established diagnosis of first episode of acute MI were assessed in cardiac OPD by a cardiologist during follow up, after 2-3 months of attack and they were compared with 60 healthy controls. Results: 40% myocardial infarction patients were found to be suffering from depressive episode, 35% from anxiety symptoms and 16.6% from mixed anxiety and depressive symptoms. Severity of Depression and Anxiety also measured and findings were significantly associated with MI patients as compared to healthy controls. Conclusion: The high proportion of patients with MI found to be suffering from symptoms of depression and/ or anxiety two to three months after MI highlights the essential need to assess these symptoms in all such patients during the post - MI period as they merit appropriate treatment along with that of MI.
EnglishINTRODUCTION
Coronary heart disease (CHD) is one of the most common and life threatening illness. With urbanization, the prevalence of risk factors for CHD is increasing rapidly in the developing countries as well. Cardiovascular diseases have almost reached to epidemic proportions in India.1 The reason for high risk of coronary artery disease among Indians is still unclear but could be attributed to genetic predisposition and unhealthy lifestyles.1,2 Depression, anxiety, suppressed anger and type A personality have been shown to be risk factors for developing coronary artery disease. Depression and Cardiovascular diseases (CVD) are both highly prevalent disorders and both of them cause a significant decrease in quality of life of the patient. Depressed individuals are more likely to develop angina, or fatal or non-fatal MI than their non-depressed counterparts.3,4 Prevalence of depression in patients of MI ranges from 16 to 45 % in studies using a standardized interview for the diagnosis of depression. Further more, studies using a validated questionnaire or rating scale have reported similar prevalence of depressive symptoms in 10 % to 45 % of patients of MI.5 These prevalence rates of depression in MI population are higher than the possibly conservative rates of major depression in the general population of 5% as reported by theNational Co- Morbidity study, 5-10% in primary care, or in 6 to14% in other inpatient medical settings.6,7 The interaction of heart and psyche works both ways. Emotions and stressful experiences affect the heart directly through the autonomic nervous system, as well as indirectly via neuroendocrine pathways. Conversely, pathologic cardiac activity and function trigger distress and contribute to psychopathology, such as depressive syndromes following M.I or strokes.8 Patients with an acute Myocardial Infarction and symptoms of depression and anxiety not only experience higher rates of long-term morbidity and mortality but also report a worse quality of life than patients without symptoms of these psychiatric disorders. 9,10,11 The present study was planned to assess the prevalence and severity of depression, anxiety and mixed anxiety and depression in patients with first episode of post myocardial infarction and compared with healthy controls. There is scarcity of data on this topic in Indian population hence the study was planned.
AIMS AND OBJECTIVES
To find out the prevalence and assessment of severity of Depression and Anxiety in post myocardial Infarction patients.
MATERIALS AND METHOD
The study was conducted at the departments of Cardiology and Psychiatry of Geetanjali Hospital, attached to the Geetanjali Medical College, Udaipur. Before starting the study, approval of the study protocol was taken from ethics committee of Geetanjali Medical College and Hospital. 60 cases of acute myocardial infarction diagnosed by cardiologist on the basis of ST elevation, in state of stable enough to complete the assessment following two to three months of acute myocardial infarction constituted the sample of study. Similarly, 60 subjects preferably relatives and friends of the patients matched on parameters of age and sex, who gave informed consent and who were not having any past or present history of MI, formed the control group. Illiterate patients, patients having other major medical or surgical illnesses, patients having history of MI in past and patients of more than 70 years of age were excluded. The selected patients (group A) and control (group B) were interviewed in detail by using following tools: (A) A specially designed Proforma prepared for the purpose of this study. The Proforma included identification data, sociodemographic profile and past history of illness in the subjects. (B) Goldberg’s Health Questionnaire (GHQ-12): (Gautam et al 1987)12 It is Hindi version, self-administered 12-item questionnaire. It is a short version of original G.H.Q.-60. The respondent is asked to compare his recent state with his usual state. Interpretation of the answers is based on a four point response scale scoring using a bimodal method (symptom present: 'not at all' = 0, 'same as usual' = 0, 'more than usual' = 1 and 'much more than usual' = 1. Maximum score is 12 and cut off score is 2 or more. (C) Beck’s Depression Inventory (BDI): (13) The BDI developed by Aaron Beck is a rating scale to measure the severity of depression. BDI is a self-rated scale in which individual rate their own symptoms of depression. In the present study, Hindi adaptation of BDI was used. Individuals were require to rate themselves on a 0 to 3 spectrum with a total score range of 0 to 63. Scores from 0 to 9 represent no depressive symptoms, scores of 10 to 18 indicate mild depression, scores of 19 to 29 indicate moderate depression, and scores above 29 indicate severe depression. (D) Hamilton Anxiety rating scale (HAM-A): (Hamilton M, 1959)14 The HAM-A developed by Max Hamilton is the most widely utilized assessment scale for anxiety symptoms. It consists of 14 items and it is heavily focused on somatic symptoms, with a great reliance on the patient’s subjective report. Each item is rated on 0-4 scale (0-not present, to 4-severe) with a final item, which rates behavior at interview.
OBSERVATION
Information so gathered and data so collected were subjected to suitable statistical analysis using appropriate statistical tools and conclusions were drawn and tabulated.
Tables 1 and 2 compare the profile of patient and control groups with regards to sociodemographic, history of tobacco use and family characteristics. There was no difference between the two groups except tobacco use (58.3%) and family history of cardiac illness (31.6%) were significantly more in MI patients compared to controls (16.6%). Table 3 shows distribution of subjects according to GHQ 12 scores, It was observed that 76.6% of myocardial infarction patients scored positively on GHQ 12, while only 46.6% controls scored more than 2 and it was statistically rated significant. Table 4 depicts the severity of depression, 16.6%, 16.6% and 6.6% of myocardial infarction patients and 8.3%, 5% and 1.6% of controls suffered respectively from mild, moderate and severe depression. Severity of depression was significantly higher in myocardial infarction patients than controls. Table 5 shows distribution of severity of anxiety on HAM-A scale. Total 35% of MI pts were suffering from Generalized Anxiety disorder, 6.6% pts having severe Anxiety, 11.6% suffering from Moderate anxiety symptoms, 16.6% subjects were having Mild Anxiety symptoms. MI patients had in statistically significant number of Anxiety symptoms.
DISCUSSION
This study was aimed at finding out the Psychiatric Morbidity in MI pts following the first acute attack. It was observed that 76.6% of myocardial infarction patients scored significantly positive on GHQ 12, while only 46.6% controls scored positive significantly. Various studies15,16,17 support on higher prevalence of psychiatric morbidity in post myocardial infarction patients. Frasure-Smith N, Lesperance F. (2008),18 also found elevated BDI II score in 27.4% and elevated HADS-A scores in 41.4% of acute myocardial infarction patients. Where in our study 40% myocardial infarction patients were suffering from depressive episode, 35% from anxiety disorder and 16.6% from mixed anxiety and depressive episode. In India Akhtar MS et al. (2004),19 found, symptoms of depression in 14%, anxiety symptoms in 18% and mixed anxiety and depressive symptoms in 18% of myocardial infarction patients. Co morbidity of depression and anxiety in MI patients as regards to severity of Psychiatric symptoms, as an independent denominator may be characteristic of severity of symptoms experienced of acute MI experienced, plan of management and personality characteristics of the subjects. Severity of the depression has been measured on BDI, in present study 16.6% MI pts were suffering from mild depression, 16.6% from moderate depression and 6.6% had severe depression. Martens EJ et al. (2008),20 identified four groups and classified as non-depressed 40%, mildly depressed 42%, moderately depressed 14% or severely depressed 4% in post myocardial infarction pts. Rafanelli C et al. (2005),21 who reported that 30% of myocardial infarction patients were identified as suffering from a major depressive disorder, 9% patients were suffering from minor depression. Meneses R et.al (2007),22 found moderate depression in 36% of the subjects and severe depression in 14% of myocardial infarction patients. Significant number of MI pts 35% were having Anxiety symptoms, 6.6% pts having severe Anxiety, 11.6% pts suffering from Moderate to severe anxiety symptoms, 16.6% pts having Mild to moderate Anxiety according to scores on HAM-A.
CONCLUSION
Due to the increasing awareness about the clinical and public health significance of depression and anxiety in MI patients, recognizing burden and severity of these psychiatric disorders will not only help in improving diagnostic practices but will also help to plan the management aimed to improve quality of life and other clinical outcomes in these high risk patients.
Limitations and future implication
The size of the sample was small and it included cases from a private hospital located in Mewarregion of state of Rajasthan. A multicentric study including greater number of population from different cultures prevailing in different parts of state would prove most appropriate. Therefore, these findings cannot be generalized. Many patients were excluded from the study because they were not literate up to minimum educational standard middle class level and were not able to understand and complete the proforma. Therefore such tools should be used which can evaluate even illiterate patients. Long term prognosis of various psychiatric disorders thus identified in MI patients may be evaluated in a prospective study.
ACKNOWLEDGMENT
We acknowledge the immense help received from the scholars whose articles are cited and included in reference of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals, and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=921http://ijcrr.com/article_html.php?did=921REFERENCES
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524167EnglishN-0001November30TechnologyDESIGN AND EVALUATION OF HEXABAND MICROSTRIP ANTENNA
English8690Ambresh P. A.English Sujata A. A.English P. V. HunagundEnglishThis paper demonstrate simple, low cost Hexaband microstrip antenna with suitable feeding technique and dielectric substrate for applications in GHz frequency range. The optimum design parameters of the antenna are selected to achieve the improved bandwidth, high gain as well as best possible characteristics such as better radiation pattern, low SWR etc. Designed antenna achieved a bandwidth of 46 % resonating at six different bands between L to Ku band frequency ranges. Effect of slot on the patch is studied experimentally for enhancing the bandwidth. Designed antennas are suitable for L to Ku-band applications of wireless systems. Details of antenna design and results are discussed.
EnglishMicrostrip antenna, Quad band, Rhombus, VNA, Bandwidth.INTRODUCTION
Modern wireless communication system requires low profile, light weight, high gain and simple structure antennas to assure reliability, mobility and high efficiency characteristics. Hence microstrip antennas (MSAs) are most widely used due to their attractive features such as light weight, low volume, ease in fabrication and low cost [1]. The demerits of the MSA are its narrow bandwidth and low gain and high SWR [1-2] which restricts their many useful applications. Different design configurations of microstrip antenna can give high gain, wide bandwidth and improved efficiency. With suitable feeding network which accumulates all of the induced voltages to feed into one point [3]. The proper impedance matching throughout the corporate and series feeding array configurations provides high efficiency microstrip antenna [4]. Power distribution among antenna elements can be modified by feed network. The feed network can also steer beam by introducing phase change [5]. The desirable design parameters (dielectric material, height and frequency etc) are important because antenna performance depends on these parameters. Radiation performance can be improved by using proper design structures [6]. The use of high permittivity substrates can also miniaturize microstrip antenna size [7]. Thick substrates with lower range of dielectric offer better efficiency and wide bandwidth but it requires larger element size [8]. Microstrip antenna with superconducting patch on uniaxial substrate gives high radiation efficiency and high gain in millimeter wave lengths [9]. The width discontinuities in a microstrip patch reduces the length of resonating microstrip antenna and radiation efficiency [10].
Antenna Geometry
Microstrip patch antennas consist of very thin metallic strip (patch) placed on ground plane where the thickness of the metallic strip is restricted by tEnglishhttp://ijcrr.com/abstract.php?article_id=922http://ijcrr.com/article_html.php?did=922REFERENCES
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