Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28General SciencesA METHOD FOR EFFICIENT EXTRACTION OF CELL WALL PROTEINS FROM CANDIDA ALBICANS
English0107Pavithra Amrath JainEnglish R. D. KulkarniEnglish B.M. SwamyEnglish Gopala MugerayaEnglish Srinikethan G.English Sharanbasu K.A.EnglishCandida cell wall proteomics is a challenging area of research. Extraction of cell wall proteins needs to be done carefully to obtain reproducible results. We used two different methods for extraction of candida cell wall proteins and documented the modifications required. In the course of extraction, we also evaluated efficacy of cell wall disruption by mechanical procedure of homogenization with glass beads to increase the protein yield and purity. For extraction of candida cell wall proteins, we utilized detergents like Sodium dodecyl sulphate (SDS), dithiothreitol (DTT), tris base and chitinase. This method was further optimized using homogenization of candida cells with glass beads over different time intervals. Amount of cell disruption at each time interval of bead beating using two varieties of beads was evaluated by gram stain, culture, protein estimation and SDS PAGE subsequently. We observed that method using detergents and Chitinase yielded better quality proteins, less contaminated with salts. For homogenization, bead beating with glass beads of 0.5 mm diameter over 18 minutes was found to be superior. Our initial experiments revealed limits of both the methods in candida cell wall protein extraction. Mechanical disruption of the cells could be further optimized using routinely available vortex mixer to increase final protein yield and gave consistent and reproducible results.
EnglishCandida albicans, Cell wall proteins, glass bead homogenization, SDS PAGE.INTRODUCTION
Candida albicans is a polymorphic fungus, causing opportunistic infection in immunocompromised hosts. Generally, this yeast occurs as a commensal in the oral cavity, urogenital tract etc. of human beings(1). The role of commensal flora leading to opportunistic infections needs careful investigations to understand their role of cell wall proteins in pathogenesis. The cell wall proteins of candida and their receptors on mucosa play vital role in pathogenesis (2) . C. albicans cell wall proteins are being extensively studied to evaluate their role in variety of processes; adhesion to host cells, for antigenic studies, anti-mannan antibody preparation etc. (3,4). As said in Pitarch et al (2002), Cell wall protein studies have been done using intact cells or after cell wall protein extraction using detergents or chaotropic agents, or by using, secretary products of developing cells from the culture filtrates (5,10). In few studies along with detergents; enzymes like glucanases were used to extract cell wall proteins of candida (6). In the present study we used one of the commonly used extraction method proposed by Pitarch et al, 2002(6) to obtain cell wall proteins with few modifications. The present study evaluate the method of extraction of cell wall proteins of C.
albicans described by Pitarch et al (2002) and the improvements made to the original procedure.
OBJECTIVES
The following objectives were pursued in the study:
1. To evaluate two different methods of candida cell wall protein extraction.
2. To standardize the glass bead homogenization technique.
MATERIALS AND METHODS
C. albicans growth conditions: The study was conducted at SDM College of Medical Sciences and Hospital, Dharwad and Department of Chemical Engineering, National Institute of Technology Karnataka, Suratkal from August 2011 to November 2011. C. albicans was grown in yeast nitrogen broth for 30 hrs at 35 oC in shaking incubator (Rotek, BOD Cooling Incubator Shaker ROSI-1) at 150 rpm, to limit the growth to stationary phase. The culture was centrifuged and candida cells were washed 3 times with distilled water in a cold centrifuge (Eppendorf India Centrifuge 5415 R) at 14,000 rpm at 4 oC. The washed cells were processed for cell wall protein extraction method by Pitarch et al. 2002 (6) .
Cell Wall Protein Extraction Method by Pitarch et al. (2002) (6):
Cells were washed initially with lysis buffer (10 mM Tris HCl, pH 7.4, containing 1 mM PMSF) 5 times and homogenized with glass beads for 10 minutes. The lysate was washed again with distilled water and centrifuged. The pellet was successively washed in 5%, 2% and 1% NaCl and then with cold distilled water 5 times each and then boiled in extraction buffer (50 mM Tris HCl, pH 8.0, 0.1 M EDTA, 2% SDS, 10 mM DTT) and cooled. Boiling step was again repeated similarly for one time. Tubes were cooled to room temperature (RT) and pellet was washed again with 0.1 mM sodium acetate buffer. Resulting pellet was suspended in extraction buffer and treated with chitinase (Sigma, Aldrich) (2 units, 0.2 ml) overnight (18 hrs) at 37 oC. The suspension was pelleted down by centrifugation and the pellet was washed in cold distilled water five times followed by 0.1 M sodium acetate buffer, pH 5.5 ten times. Finally, resulting proteins in the pellets were precipitated by tri-chloro acetic acid (6%).
Optimization of Pitarch et al (2002) (6) method, by standardization of Glass beads homogenization step:
The protein concentration of the extracts in method by Pitarch et al. (2002) was estimated by Folin Lowry’s method using bovine serum albumin (BSA) as a standard. [11] The proteins were then subjected to gradient SDS PAGE (10- 17%). Method by Pitarch et al. (2002) though gave better band quality; there were vertical streaks in the bands observed (6). The protein extracted after gram staining showed the presence of intact cells remaining. Due to unavailability of bead beating instrument in our laboratory, we had used simple vortexer in initial extraction procedures. Therefore, method by Pitarch et al. (2002) (6) was further optimized using careful evaluation of glass bead beating homogenization procedure to aid the lysis of the tough candida cell walls. For standardization of homogenization with glass beads, one ml of washed pellet was again suspended in lysis buffer and adjusted to suggested turbidity for yeasts (12) . Ten ml screw capped sterile plastic tubes, were prefilled with beads up to roughly 10 mm height. To this 1 ml of the pellet adjusted to the required turbidity were added and tubes were cooled at -20 ºC for 30 minutes before being subjected to disruption. Two types of beads were used, a 0.5 mm glass beads (HiMedia), and 3-5 mm diameter glass beads (HiMedia), separately. Proper head space was left for the beads and pellet to move freely during vortexing. The tubes were labelled as 0 min, 3 min, 6 min, 9 min, 12 min, 15 min and 18 min, accordingly bead beating was done for 3, 6, 9, 12, 15 and 18 minutes for respective tubes. The experiments were carried out separately for both 3-5 mm and 0.5 mm glass beads. The first tube labelled as 0 minutes, was not subjected to glass bead homogenization. Second tube onwards, the tubes were vortexed continually for 3 minutes then kept in the ice box to cool for 2 minutes before next vortexing. This was to minimize warming up of the suspension during homogenization, so as to avoid thermal disruption of proteins in the suspension. A 100 μl of extracted sample from each tube of bead homogenization experiment were diluted 1:10 times using sterile normal saline. A 10 μl quantity of the diluted sample was plated on to SDA by semi quantitative streak culture method. The plates were incubated at 37 oC for 48 hrs. After incubation, number of colonies was carefully counted and candida colony count was estimated for 1 ml of direct sample. The results of both the techniques of bead beating were compared. Pellets from all the different tubes were processed further with the next steps of extraction mentioned in Method by Pitarch et al. (2002) (6) . Analysis of protein extraction procedures Representative samples from Method by Pitarch et al. (2002) (6), homogenized with glass beads for various time intervals were analyzed for protein estimation by Folin Lowry method and the quality of extracted proteins was assessed by SDS-PAGE (10-17%), (MONOKIN, Techno Source, Mumbai) and microscopy. All the tests were conducted in duplicate. SDS Gel electrophoresis Proteins were separated on SDS gel, according to the method explained previously with a few modifications (13). Samples were suspended and vortexed for 1 minute in a SDS sample buffer containing Tris-HCl pH 6.8, Glyceine, β- Mercaptoethanol, bromophenol blue, kept in a water bath at 95 oC for 5 minutes and cooled to RT. Proteins were then separated in 10-17% polyacrylamide gel using the discontinuous constant voltage of 120V for stacking gel and 150V for resolving gel. Resulting gel was stained with silver stain method and bands were compared with molecular weight marker run in the gel. Microscopic observation: Extracted samples from each set of experiments were smeared, stained by gram stain and observed under 100 X objective. Disrupted yeast appeared as dark "ghost" cells while intact yeasts were refractile. The percentage of disruption of cells was calculated by counting ratio of disrupted cells to total no. of cells in 25 oil immersion fields.
RESULTS
Table 1 shows effect of vortexing by two sizes of glass beads evaluated on two different strains of Candida albicans viz. RL-112 and CN-192. The parameters we used to evaluate the quality of cell disruption were percentage of disrupted cells protein concentration of the lysate, determination of viability of the cells and number of clear bands given by SDS-PAGE. The samples were initially homogenized by vortexing with glass beads. The resulting lysate was evaluated by gram stain and semi-quantitative culture on SDA and further subjected to extraction. The final yield was tested by protein estimation and SDS-PAGE electrophoresis. The methods were intended to disrupt the cells maximally by increase in vortexing time. The percentage of disrupted cells increased proportionate to vortexing time. At 15 and 18 minutes the disruption was around 90% using 0.5 mm beads. Vortexing for all time periods showed that use of 0.5 mm beads was always better than 3- 5 mm beads in lysing the cells. The lysates were pelleted and protein concentration was estimated. It is evident from table 1 that the protein yield also increased with vortexing time. The protein yield was highest at 18 min of vortexing. With 3-5 mm beads percentage of cells disrupted was 76.9% (RL-112) and 78.8% (CN-192) at 18 minutes of homogenization. At 18 minutes of homogenization with 0.5 mm beads, 99.4% of cells in CN-192 and 92.0% in RL-112 showed disruption and the band quality was better. Better lysis and better recovery of cell wall proteins at 18 min of disruption is reflected by scanty or no growth from the lysate on SDA and more number of bands on SDS-PAGE. The strain CN -192 gave no growth after 18 min of vortexing indicating complete lysis. The same was reflected on SDS-PAGE as the number of bands was 34, the maximum recorded in the present study.
DISCUSSION
Cell wall proteins act as major cell surface antigens that are recognized for adhesion by mucosal receptors to begin the infection process. Serotype A and B of C. albicans differ in cell wall mannoprotein structure (14). Candida cell walls possess an electron dense outer layer having mannoproteins and the electron transparent inner layer formed of β 1-3 glucan and chitin. Mannoprotens give porocity to the cell wall. Specific manoproteins are synthesized during the hypheal mophogenesis. Chitin is glycosidecally linked to non-reducing ends of β-1-3 glucan and β- 1-6 glucan (14, 15). Hyphal forms carry significantly higher chitins as the organization of the cell wall is under the influence of morphogenetic codes (2) . Candida cell wall proteins have been extracted using different methods by different workers. The starting material and the method used for cell wall protein extraction influences final outcome or quality of extracted proteins. Studies have been carried out on various source materials like intact cells, cell wall extracted by cell disruption and proteins secreted into medium when protoplasts are synthesizing their cell walls (5-9). The method used in the present study was based on breakage of cells to isolate cell wall protein. In the method by Pitarch et al. (2002) (6) detergents were used to disrupt the cell wall. We observed excessive retention of intact candida cells in the lysate on storage which was indicating incomplete lysis of the cells by this method. The intact cells can act as artifact in SDS PAGE gels (16).The lysis of intact cells can release cytosolic proteins affecting the purity of the cell wall protein extract. Therefore, complete breakage of all intact cells is crucial in the cell wall protein extraction. Pitarch et al. (2002)(6) also have explained the need for complete mechanical disruption of the cells, not to leave behind intact cells, since subsequent enzymatic extraction in the later step can cause lysis of these intact cells and contaminate cell wall lysate with intracellular materials (6). We, therefore, tried standardisation of bead beating step using 0.5 mm and 3-5 mm glass beads. We ran the beating over different time intervals and found that 0.5 mm glass beads used over 18 minutes in a simple vortexer gives best results. After homogenization the lysate was extensively washed with decreasing concentration of NaCl, to remove extracellular or cytosolic proteins attached through electrostatic forces (6). The lysis of the candida cells was found to be >90% at 18 minutes of vortexing by 0.5 mm glass beads. The band quality and number on SDS-PAGE by the 0.5 mm bead beating was superior to using 3-5 mm beads over the same time period. Mechanical methods are commonly used to disrupt fungal cell walls, with the combination of other methods. Klimerck et al. (2011) worked upon chemical, mechanical and osmotic shock in disrupting fungal cell wall and suggested that bead milling lead to better results in obtaining cell free extracts containing high concentration of soluble proteins, however for particular species further adjustments are required(17) . However, Okunghowa et al. (2007) suggested that the mechanical methods like sonication, French pressure cell press give good protein yield but glass beads provides a lesser quantity of protein and lead loss of protein activity (18) . Standardization of glass bead homogenization has to be done carefully with maintaining correct quantity of cells subjected to homogenization. Ratio of cells Vs glass beads, size of the glass beads and time for vortexing needs to be carefully standardized. Kessler et al (1959) had obtained clean cell wall by beating the cells with glass beads in a blender for 90 minutes aided by treatment with 0.25 M sucrose solution (19). In the original method of Pitarch et al. (2002) mechanical disruption of candida cells by bead beating, for 10 minutes with 30 S pulse in a bead beater was used (6). We used simple vortex mixer, due to the unavailability of bead beater and sequentially increased homogenization time to test the efficacy of cell disruption. Pitarch et al. (2002) have suggested overnight NaOH extraction for the release of enriched fractions of proteins directly linked to 1-3 glucan through their o-glycoside chains or other alkali sensitive linkages (6). They also have suggested simultaneous the enzymatic treatment using quantazyme and exochitinase (7). Since it was also shown by Kessler et al. (1959) that treatment with alkali can cause degradation of proteins linked with carbohydrates and lectin like proteins, we omitted the alkali extraction step (19). The enzymes can release glycolytic enzymes tightly trapped within glucan-chitin complex (6) . In contrast to this, Klis et al. (2007) suggested use of high concentration of detergents to perturb plasma membrane and release cytosolic proteins. According to them, use of low concentrations of detergents, sodium phosphate buffer at pH 8 and extraction at low temperature avoids contamination of cell wall protein extraction with cytosolic proteins (20). Feiz et al. (2006) did not use enzymes and detergents for the extraction but used instead, NaCl, low ionic strength buffer during extraction to prevent early release of cell wall proteins (8). They showed that 78% proteins released by method by Pitarch et al. (2002), were intracellular proteins. However, Pitarch et al. (2002) demonstrated that, the proteins released by their method were from cell wall by showing failure to detect Sec 14p antigens, through immunoblotting procedure. Sec 14p is a marker of cytosolic contamination (6). Casonova et al. (1992) biotinylated cell wall proteins during their growth stages, and performed extraction of cell wall proteins using β-mercaptoethanol and β-glucanses and confirmed extracted proteins to be of cell wall origin by doing extravidin alkaline peroxidase reaction in western blotting (5) . There are lot of researches conducted in the view of isolating cell wall proteins with avoiding cytosolic contamination. We intend to continue the studies with inclusion of a set of agents for detecting cytosolic proteins in our cell wall protein preparations and thus maximize the yield by continuous optimization of experiments.
CONCLUSIONS
With the above findings we conclude that one can use method by Pitarch et al. (2002)(6) for extraction of candida cell wall proteins with proper homogenization and lysis of the cells using glass beads. Since we used simple vortexer for homogenization this method can be easily adopted by laboratories not having sophisticated bead beaters or blenders or sonicators.
Englishhttp://ijcrr.com/abstract.php?article_id=1121http://ijcrr.com/article_html.php?did=11211. Scully C, El-Kabir M, Samaranayake LP. Candida and oral candidosis: a review. Crit Rev Oral Biol Med 1994; 5: 125-57.
2. Chaffin WL, López-Ribot JL, Casanova M, Gozalbo D, Martínez JP. Cell wall and secreted proteins of Candida albicans; identification, function, and expression. Microbiol Mol Biol Rev. 1998; 62(1): 130-80.
3. de Groot PW, de Boer AD, Cunningham J, Dekker HL, de Jong L, Hellingwerf KJ, de Koster C, Klis FM. Proteomic analysis of Candida albicans cell walls reveals covalently bound carbohydrate-active enzymes and adhesins. Eukaryotic Cell. 2004; 3(4): 955-65.
4. Marcilla A, Valentín E, Sentandreu R. The cell wall structure; developments in diagnosis and treatment of candidiasis. Int Microbiol. 1998; 1(2): 107-16.
5. Casanova M, Lopez-Ribot JL, Martinez JP, Sentandreu R.. Characterization of cell wall proteins from yeast and mycelial cells of Candida albicans by labelling with biotin; comparison with other techniques. Infect Immun. 1992; 60(11): 4898-906.
6. Pitarch A, Sánchez M, Nombela C, Gil C. Sequential fractionation and two-dimensional gel analysis unravels the complexity of the dimorphic fungus Candida albicans cell wall proteome. Mol Cell Proteomics. 2002; 1(12): 967-82.
7. Feiz L, Irshad M, Pont-Lezica RF, Canut H, Jamet E. Evaluation of cell wall preparations for proteomics; a new procedure for purifying cell walls from Arabidopsis hypocotyls. Plant Methods. 2006; 27: 2-10.
8. Kapteyn JC., Dijkgraaf GJ., Montijin RC., and Klis FM. Glucosylation of cell wall proteins in regenerating spheroplasts of Candida albicans. FEMS Microbiol Lett. 1995; 128: 271-7.
9. Elorza MV., Rico H., Gozalbo D., and Sentandreu R. Cell wall composition and protoplast regeneration in Candida albicans. Antonie Leeuwenhoek 1983; 49: 457-69.
10. Lowry OH, Rosebrough NJ, Farr AL, Randall RJ. Protein measurement with the Folin phenol reagent. J Biol Chem. 1951; 193(1): 265-75.
11. Casanova M, Chaffin WL. Cell wall glycoproteins of Candida albicans as released by different methods. J Gen Microbiol. 1991; 137(5): 1045-51.
12. Mackie and McCartney, Practical Medical Microbiology. 14th edition. 2006 Edited by J.G.Collee, A.G.Fraser, B.P.Marmion, A.Simmons.”Centrifuges, colorimeters and bacterial counts “ by R.Brown, I.R.Poxton. P 845-52. Churchhill Livingstone Elsevier
13. Laemmli UK. Cleavage of structural proteins during the assembly of the head of bacteriophage T4. Nature. 1970; 227(5259): 680-5.
14. Martínez JP, Gil ML, López-Ribot JL, Chaffin WL,. Serologic response to cell wall mannoproteins and proteins of Candida albicans. Clin Microbiol Rev. 1998; 11(1): 121-41.
15. Ruiz-Herrera J, Mormeneo S, Vanaclocha P, Font-de-Mora J, Iranzo M, Puertes I, Sentandreu R. Structural organization of the components of the cell wall from Candida albicans. Microbiology. 1994; 140: 1513-23.
16. Protein gel electrophoresis tips and troubleshooting guide, aldrin.tripod.com/index-3.html.
17. Klimek-Ochab M, Brzezi?ska-Rodak M, Zyma?czyk-Duda E, Lejczak B, Kafarski P. Comparative study of fungal cell disruption-- scope and limitations of the methods. Folia Microbiol (Praha). 2011; 56(5): 469-75.
18. F.I. Okungbowa, A.K. Ghosh, R. Chowdhury, P. Chaudhuri, A. Basu and K. Pa. Mechanical Lysis of Candida Cells for Crude Protein and Enzymatic Activity Estimation; Comparison of Three Methods. World Journal of Medical Sciences. 2007; 2 (2): 101-104.
19. Kessler G, Nickerson WJ. Glucomannanprotein complexes from cell walls of yeasts. J Biol Chem. 1959; 234: 2281-5.
20. Klis FM, de Jong M, Brul S, de Groot PW. Extraction of cell surface-associated proteins from living yeast cells. Yeast. 2007; 24(4): 253.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareA STUDY TO FIND THE EFFECT OF MYOFASCIAL RELEASE ON CHEST EXPANSION IN CEREBRAL PALSY CHILDREN
English0814Albin JeromeEnglish Nishta PassiEnglish Snehal KoliEnglishBackground: Cerebral palsy is defined as a non-progressive insult to a developing or immature central nervous system (CNS), particularly to those areas that affect motor function. People with spastic cerebral palsy, the stabilization of the rib cage is not proper so with each respiration there occurs flaring of the lower ribs, which should otherwise be fixated by abdominals so as to provide diaphragm with a stable base to contract upon. A disturbance in this synergy causes the whole process to become inefficient. Purpose of the study: The aim of this study is to find out an effective method to improve chest expansion in spastic Cerebral palsy children. Method: 50 Spastic cerebral palsy children of both genders with age 5-12 years satisfying inclusion criteria were included for the study. The children were taken in supine position on the mat/plinth and were made to relax. Then command was given to exhale as much as possible and hold the position to take the chest circumference at the maximal voluntary expiration (Cexp).This was followed by deep breath as much as possible and was held for chest circumference at the maximal voluntary inspiration (Cinsp). The children were made to practice this process and then the mean of the highest value of Cinsp and the lowest value of Cexp difference in best three attempts were recorded for all the children. The chest measurements were taken at three levels at axilla, nipple level and tip of xyphoid process. These readings were documented as Pre Test Score. Myofascial release was given to the Pectorals (major and minor) bilaterally, Rib cage (Intercostals), anterior chest wall and the Diaphragm, with the subject in supine position.Post treatment data was taken and statistical analysis was performed. Results: The difference of the pre and post readings of the expansion at the axilla level shows a mean difference of 0.42 which is significant statistically, p value being EnglishCereberal Palsy, Chest Expansion, Myofascial release.INTRODUCTION
Cerebral palsy (CP) is a non-progressive disorder of movements and posture resulting from an insult to the growing brain usually in first 2 years of life. It is a group of disorders affecting the development of movement and posture, causing activity limitation; those are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain.1 It is defined as an “umbrella, term covering a group of non progressive, but often changing, motor impairments syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development.” 2 Research has shown that the lesion that causes cerebral palsy most often causes damage to more then one system, resulting in impairment that influence movement control. The impairment could be: - Primary impairments - Secondary impairments Primary impairments are those that are immediate and the direct result of the lesion, while secondary impairments develop in system or organs over time because of the effects of one or more primary impairment.3 Thus understanding the development of these impairments is extremely important. The physiotherapist may have a strong influence on the course of development of these secondary impairments than primary impairments.3 Therefore an understanding of how secondary impairments develop offers the opportunity to intervene as much as possible before they begin.3 Respiratory system muscles which support the posture and movements are usually compromised in a child with Spastic cerebral palsy and they suffer from a high incidence of respiratory dysfunction such as recurrent pneumonia, atelectasis, bronchiectasis, sleep apnea, chronic obstructive lung disease, and restrictive lung disease. A number of these conditions are secondary and develop over time or due to failure of development of more mature respiratory pattern from the infant belly breathers. Respiratory dysfunction is known to be a leading cause of death among individuals with CP.4 As CP does not have articular involvement, the limited chest mobility may be attributed to impaired neuromotor control and incoordination, weakness, spasticity and secondary changes in the respiratory muscles. The inability of the respiratory muscles to adequately increase and decrease the volume of the thoracic cavity may result in stiffening of the costovertebral joints, which may also decrease chest expansion. While Cerebral palsy itself does not directly cause airway or parenchymal lung dysfunction, consequences of neuromuscular impairment may lead to lung damage and reduced lung function. Poor nutritional status, drooling, aspiration, gastroesophageal reflux, impairment of airway clearance by muscular weakness or incoordination and poor pulmonary reserve (due to chest wall or spine deformity and spasticity) increases the risk of significant morbidity and mortality from respiratory infections.5 However, respiratory dysfunction in children with severe CP has not been well studied, possibly due to the difficulty of testing these uncooperative young children. Chest expansion reduces in these children because of many reasons, as the secondary complications develop. The rib cage is either barrel shaped with excessive sustained superficial muscle activity or is flattened with distal rib flaring. The shape of rib cage changes due to over activity of the trunk muscles, including intercoastals, diaphragm and rectus abdominis. This results in shallow respiration with an immobile rib cage during inhalation and exhalation.3 As in the patients of Spastic cerebral palsy, the stabilization of the rib cage is not proper so with each respiration there occurs flaring of the lower ribs, which should otherwise be fixated by abdominals so as to provide diaphragm with a stable base to contract upon. A disturbance in this synergy causes the whole process to become inefficient. Along with this there occurs adaptive soft tissue tightness or shortening at the chest wall in response to the altered position of the chest (e.g. barrel shaped chest). Added to the inefficient expansion mechanism of the chest, this tightness of the muscles, fascia and the skin overlying the chest reduces the overall excursion of the chest thus all the more reduced expansion of the chest.
It has been documented that reduced chest expansion will lead to compromised cardiopulmonary functions. The physiotherapist working with Cerebral palsy children should identify these secondary problems and treat it in order to help the children achieve functions that are not likely to develop if left untreated. The fascia which surrounds every muscle, bone, nerve, blood vessel and organs of the body, all the way down to the cellular level is a tough connective tissue which spreads throughout the body in a three dimensional web without interruption. Because the fibres in fascia run in all directions, fascia is distensible in all directions to accommodate changes in muscle bulk and to permit stretching. Fascia (also called connective tissue) is a tissue system of the body to which relatively little attention has been given in the past. Fascia is composed of two types of fibers: ? Collagenous fibers which are very tough and have little stretch ability. ? Elastic fibers which are stretchable. From the functional point of view, the body fascia may be regarded as a continuous laminated sheet of connective tissue that extends without interruption from the top of the head to the tip of the toes. It surrounds and invades every other tissue and organ of the body, including nerves, vessels, muscle and bone. Fascia is denser in some areas than others. Myofascial system is made up of muscles and fascia. Each time when there is a trauma, or an inflammatory process or poor postures over time, the fascial system becomes restricted. These restrictions act like the concentric layers of an onion. These adaptive layers slowly tighten and lead to lose of physiologic adaptive capacity and begin to pull out of three-dimensional orientation with gravity. 6 This is fascial sweater concept which states that fascial restriction in one area will strain areas away from the restriction and cause abnormal movement patterns. 7 Thus the tight myofascia should be stretched to its normal length. Myofascial release is a system of manual therapy involving massage and stretching techniques that are advocated to cause changes or "releases" in restricted or pathological fascial structures. A "release" is defined by Upledger and Vredevoogd and Manheim and Lavett as a "softening" or "letting go" when resistance melts and the tissue is felt to relax and elongate. According to Manheim and Lavett the elongation helps alleviate impediments to normal movement. Myofascial release techniques can involve direct superficial or deep pressure at the point of restriction or lowload prolonged gentle distraction of restricted tissues.8 The goal of Myofascial Release is to help return the individual's physiological adaptive capacity by increasing space and mobility and restoring threedimensional balance and returning the structure to as close as potentially possible to its vertical orientation with gravity. This equilibrium allows the individual's self-correcting mechanisms to come into play and alleviate symptoms and restore proper function.
METHODOLOGY
50 Spastic cerebral palsy children of both genders with age 5-12 years satisfying inclusion criteria were included for the study. The children were taken in supine position on the mat/plinth and were made to relax. Then command was given to exhale as much as possible and hold the position to take the chest circumference at the maximal voluntary expiration (Cexp).This was followed by deep breath as much as possible and was held for chest circumference at the maximal voluntary inspiration (Cinsp). The children were made to practice this process and then the mean of the highest value of Cinsp and the lowest value of Cexp difference in best three attempts were recorded for all the children. The chest measurements were taken at three levels at axilla, nipple level and tip of xyphoid process. These readings were documented as Pre Test Score. Myofascial release was given to the Pectorals (major and minor) bilaterally, Rib cage (Intercostals), anterior chest wall and the Diaphragm, with the subject in supine position .Post treatment data was taken and statistical analysis was performed.
DATA ANALYSIS AND RESULTS
The difference of the pre and post readings of the expansion at the axilla level shows a mean difference of 0.42 which is significant, p value being Englishhttp://ijcrr.com/abstract.php?article_id=1122http://ijcrr.com/article_html.php?did=11221. Bax M, Goldstein M, Rosenbaum P, et al; “Proposed definition and classification of Cerebral palsy [review]”; Dev Med Child Neurol 2005; vol: 47:571–6.
2. Sankar Chitra, Mundkur Nandani ; “Cerebral Palsy – Definition, Classification, Etiology and Early Diagnosis” ; Indian Journal of Pediatrics ; Oct 2005 ; vol 72
3. Stamer M. Posture and movement of the child with cerebral palsy. Congenital hemiplegia, 1st Edition, Therapy Skill Builder, 2000; 9-16
4. Eun Sook Park, Jung Hyun Park, Dong-Wook Rha, Chang Il Park, and Chan Woo Park; Comparison of the Ratio of Upper to Lower Chest Wall in Children with Spastic Quadriplegic Cerebral Palsy and Normally Developed Children; Yonsei Med J Vol. 47, No. 2, 2006, pp 237 – 242.
5. Ersoz M, Selçuk B, Gündüz R, Kurtaran A, Akyüz M; Decreased chest mobility in children with spastic cerebral palsy; Turk J Pediatr 2006; 48; No 4; 344-350.
6. Manhein CJ; The myofascial release Manual; 3rd Ed; Slack Publications; 2001; 1-36, 123- 131, 180-185.
7. Cantu RI, Grodin AJ; Myofascial manipulation: theory and clinical application; 2nd Ed; Aspen publication, Maryland; 2001; 15-90.
8. William P. Hanten, Sandra D. Chandler; Effects of Myofascial Release Leg Pull and Sagittal Plane Isometric Contract-Relax Techniques on Passive Straight-Leg Raise Angle; JOSPT, 20, No. 3 Sep 1994; 138-144.
9. Karen J D, Nichols F T, Kerr Graham. A randomized controlled trial of strtength training in young people with cerebral palsy. Developmental medicine and child neurology, 2003; 45: 652-657.
10. Suman Kuhar, Khatri Subhash, Jeba Chitra; Effectiveness of myofascial release in treatment of plantar fasciitis: a rct; Indian Journal of Physiotherapy and Occupational Therapy. July-Sept., 2007, Vol. 1, No. 3.
11. Michael Stanborough; Direct Release Myofascial Technique; 3rd Ed, Elsevier Publishers, 2001, 3-23.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareTO STUDY DETERMINATION OF HEIGHT BY FOOT LENGTH IN FEMALES
English1519Deepak SuntnooreSaranabasavappa KaraddiEnglish Prakash BabladiEnglish Anand Mugadlimath English Santosh S Garampalli English Basavaraj S PatilEnglishThe present study was carried out in Mahadevappa Rampure Medical College, Gulbarga. Total of 100 female students from 1st semester to 5th semester are included in the study. Individual student’s foot length and stature are taken separately. The length of foot is measured from outer most margin of heel to the tip of extension of longest toe in both the feet with the help of a verniers caliper and it is recorded in centimeters. In the present study a significant correlation of stature with right and left foot length has been observed (P0.05). Either right or left foot length may be used to predict the stature by regression formula. Regression equations are derived separately for individual foot length. Estimation of stature from foot length is easy, economical and convenient. No specialized equipment or training is required.
EnglishFoot length, P value, stature, verniers caliperINTRODUCTION
Though there are several parameters which help in identifying a person, stature of an individual is one of the important parameter, as it is an inherent characteristic. There is an established relationship between stature and dimensions of various parts of the body allowing the Forensic expert to estimate the stature from available data. Many studies have been carried out to estimate the stature from different body parts like arm length, fore arm length, hand and finger length, length of long bones, foot and shoe lengths etc. Linear regression models are widely used to predict height of an individual on the basis of their body parts1 . Examination of footprint provides important evidence in a crime scene investigation as it helps in the estimation of stature of a criminal. Significant and positive correlation coefficient has been shown to exist between stature and measurements of foot prints. Ossification of bones of foot occurs earlier than that of long bones of lower extremities. Even during adolescent age, the height can be predicted more accurately from foot measurements than long bones of lower limb. Taken together, evidences suggest that relationship between foot length and stature is of practical use in medico legal cases, anthropology and archeological studies; when such evidence is provided to the investigator, it helps to establish the individual’s physical description. Footprints are also used for identifying newborn babies in hospitals. Analysis of bare footprints is often carried out in the developing countries where the footprints are frequently recovered at the crime scene. In most of the countries, a footprint record is maintained for all the air-force flying personnel since feet often resist destruction (often shoe clad) by aircraft accidents, fires etc2 . Foot prints and shoe prints are different forms of physical evidence which have tremendous values in tropical country like India. Footprints have been accepted as evidence of identification in courts of many countries.
AIMS AND OBJECTIVES OF THE STUDY
1. To study the relation between human foot length and stature in females.
2. To compare between the stature estimation by right foot length and stature estimation from the left foot length females.
METHODOLOGY
The present study was carried out in Mahadevappa Rampure Medical College, Gulbarga. Total of 100 female students from 1st semester to 5th semester are included in the study. The aim and objective of the intended study were properly explained to all the students and consent is taken on the proforma. Individual student’s foot length and stature are taken separately. The length of foot is measured from outer most margin of heel to the tip of extension of longest toe in both the feet with the help of a verniers caliper and it is recorded in centimeters. Each student is asked to stand bare feet in anatomical position on the floor with her heel and occiput touching to the wall where markings for measuring the height are already made. Student is instructed not to move the head while measuring the height. A thin cardboard is kept horizontally at the vertex of the head. The height is measured from heel to the horizontal cardboard in centimeters. With this foot length, height of the individual is calculated with the help of regression formula. The calculated height is compared with the actual height of the individual and the results are encouraging. Any student with abnormality of foot/lower limb or any spinal deformities are not included in the study.
OBSERVATIONS AND RESULTS
RFL – Right foot length, Min Ht – Minimum height, Max Ht – Maximum height, Avg Ht – Average height, SD – Standard Deviation The average height of 100 female students with corresponding various levels of right foot length is presented in table-1. A linear correlation and regression analysis was done on data obtained from 100 girls for assessing the relationship between right foot length with stature and estimation of height for different levels of right foot lengths. In our study the maximum number of female students had right foot length of 22-23cms in which there were 34 individuals and average height in these girls was 163.6cms with Standard Deviation of 6.14 as shown in this table. In 100 girls we studied, right foot length varied from 20-25cms. The average height in girls with right foot length of 20-21cms was 152.87cms, which increased to 170.77cms with maximum right foot length of 24-25cms showing a positive correlation between the right foot length and stature. Table-2 shows left footprint length and actual height of 100 female students. Linear correlation and regression analysis were done for assessing the relationship between left foot length with height in 100 female students and for estimation of stature for different levels of left foot length. In this study the maximum number of 33 girls had left foot length of 22-23cms, and their mean height is 163.54cms. with Standard Deviation of 6.77cms. Average height of female students with corresponding various levels of left foot length is represented. Left foot length among these girls ranged from 20- 25cms. It can be seen that height of the girls increases as the left foot length increases, showing positive correlation between the two parameters.
Average height was 153.55cms for left foot length of 20-21cms which increased to 172.57cms with maximum left foot length 24-25cms. Table-3 shows correlation between right foot length, left foot length, and height in 100 female students. From the analysis it was revealed that there was a significant positive correlation between right foot length and left foot length (r = +0.88 for both RFL and LFL) with stature. The difference in correlation coefficient is statistically significant (P 0.05). Correlation and regression analysis were applied to know the relationship between right foot length with stature and left foot length with stature. An attempt is made to predict the stature from a known right or left foot length. Following points can be observed from the present study: ? There is no statistically significant difference in right and left foot length. ? Stature can be determined by right or left foot length separately in females. ? There is no statistically significant difference in stature estimated by right foot length and left foot length. The present study is statistically significant (PEnglishhttp://ijcrr.com/abstract.php?article_id=1123http://ijcrr.com/article_html.php?did=11231. Peter Vanezis and Anthony Busuttil, Suspicious death scene investigation. Bare Foot and Shoe Print. 1996 March; 55-58.
2. Parikh CK, Personal Identification. Parikh’s text book of Medical Jurisprudence, Forensic Medicine and Toxicology. 6th ed, reprint 2008, New Delhi: CBS Publishers and distributors: p. 2.16
3. Theodoros B G, Mihas. Correlation of foot length with height in school age children. J Forensic and Legal Medicine. 2008 Feb; 15(2): 89-95.
4. Abraham Philip. Formulae for estimating stature from foot size by regression method. J IndAcadFor Med, 1990; 12 (2): 57-62.
5. Devesh V O, Kuruvilla A, Saralaya KM. Estimation of stature and sex from foot print length using regression formulae and standard foot print length formulae respectively. J Punjab Acad Forensic Med and Toxicol. 2006; Vol 6: p. 5-8
6. DeopaDeepa. Estimation of stature from foot length in Uttarakhand region. Indian Journal of Forensic Medicine and Toxiclogy 2010; 4(1).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareEFFICACY AND SAFETY OF ORAL TRIPLE DRUG COMBINATION (VOGLIBOSE, GLIMEPIRIDE AND METFORMIN) IN THE MANAGEMENT OF TYPE 2 DIABETES MELLITUS
English2026C. RaoEnglish A. A. FaruquiEnglishThe prevalence of type 2 diabetes across the world has been described as a global pandemic. Despite the introduction of new agents, efforts for better management of diabetes are disappointing and the control of blood glucose level remains unsatisfactory. When antidiabetic therapy is initiated, it is now recommended that the selection of agents should be directed towards both fasting as well as postprandial hyperglycaemia. Material and method: This study was a post marketing surveillance (PMS) non-randomized, open, non-comparative, mono centric study. The drug administered was a fixed dose combination of Voglibose 0.2mg, Glimepiride 1/2mg and Metformin 500mg SR, 20 type 2 diabetic patients were given fixed dose combination twice daily with major meals for 3 months. Observation: Baseline value was recorded for glycated haemoglobin (HbA1c), fasting blood glucose and post prandial blood glucose level. There was significant decrease in glycated haemoglobin value (8.86 ± 0.7111 gm/dl vs. 8.0 ± 0.66 gm/dl), fasting (137±17.64 mg/dl vs. 116.8 ± 6.129 mg/dl, P < 0.0001) and post prandial blood glucose level ((237.8 ± 59.22 mg/dl vs.173.4 ± 27.6 P < 0.0004) after 3 months of treatment. The combination was found to be effective in controlling both fasting and post prandial glucose level and was well tolerated. Investigator commented that the use of triple drug combination is a good option in the management of type 2 diabetes which controls both fasting as well as post prandial blood glucose. Conclusion: The triple drug fixed dose combination of Voglibose, Glimepiride and Metformin significantly decreased the HbA1c value, fasting plasma glucose level and post prandial glucose level at the end of the treatment.
EnglishHbA1c, Fasting Plasma Glucose, Post Prandial Blood Glucose, PMSINTRODUCTION
The prevalence of type 2 diabetes across the world has been described as a global pandemic despite the introduction of new agents to the armamentarium of hypoglycaemic agents; efforts for better management of diabetes are disappointing and the control of blood glucose levels remains unsatisfactory1 . Optimal management of type 2 diabetes requires a consideration on the relationship between glycosylated haemoglobin (HbA1c), fasting plasma glucose and postprandial glucose (the glucose triad). Early and sustained control of glycaemia remains important in the management of type 2 diabetes. The contribution of postprandial glucose levels to overall glycaemic control and the role of postprandial glucose targets in disease management are currently debated2 . However, many patients do not reach HbA1C targets set according to published guidelines.
Guidelines for good glycaemic control have been agreed upon and a patient is generally considered to have achieved successful disease control when their HbA1C is < 7% 3, 4, 5 . It is now more and more clear that physicians are likely to have to consider plasma glucose levels both after the overnight fast and after meals as well as the variability of glucose levels, in order to achieve optimal glycaemic control for each patient. When antidiabetic therapy is initiated, physicians may need to consider selection of agents that target both fasting and postprandial hyperglycaemia. Controlling the Glucose triad (HbA1c, fasting plasma glucose and postprandial glucose): Regardless of the HbA1C goal that is agreed upon, it is doubtful to be reached unless both fasting and postprandial glucose levels are adequately controlled, ideally through a combination of lifestyle modification and appropriate drug therapy2 . Routine measurement of postprandial glucose levels is not currently recommended or even practical for all patients with type II diabetes. However, improved understanding of the relative influence of fasting and postprandial glucose levels throughout the course of the disease might influence the class of drug that is prescribed. Recent research has suggested that intensification of glucose control with insulin therapy may not be advisable for all patients with type 2 diabetes and oral antidiabetic drugs should be used for as long as possible6 . International Diabetes Federation (IDF) guidelines for the management of post meal (postprandial) glucose state that the goal of diabetes therapy should be to achieve glycaemic status as near to normal as safely possible in all three measures of glycaemic control, namely HbA1C, fasting premeal glucose and post meal glucose7 . Treatment of both fasting and postprandial hyperglycaemia should be initiated simultaneously at all levels of HbA1C above agreed levels. Traditional treatments such as metformin and thiazolidinediones primarily lower fasting plasma glucose. As sulphonylureas are generally taken in the morning, they do lower postprandial glucose levels during the day and subsequently have an effect on overnight fasting levels. Therapeutic agents are available that preferentially lower postprandial glucose, including alphaglucosidase inhibitors, glinides, incretin mimetics, dipeptidyl peptidase (DPP)-4 inhibitors and rapid acting insulin. Current recommendations of the American Diabetes Association include a trial of diet and exercise as first line therapy for the treatment of patients with type 2 diabetes8 . If glycemic control is not achieved with diet and exercise within a three-month period, pharmacologic intervention is required. Moreover if adequate control is not obtained with the use of a single agent, combination therapy is an option. Several of the available oral agents have been studied in combination and have been shown to further improve glycemic control when compared to monotherapy.9 Some physicians now advocating the therapy combining three oral agents (sulfonylurea, metformin, alpha-glucosidase inhibitor or sulfonylurea, metformin, thiazolidinedione) in the management of type 2 diabetes 10 . This study was conducted to evaluate the safety of triple drug combination (i.e. Voglibose, Metformin and Glimepiride) and its impact on Glucose Triad.
MATERIALS AND METHOD
A total of 20 type 2 diabetic patients were enrolled and completed the treatment. At the time of entry into the study, base-line data were recorded. Patients were observed on 1st month of treatment, than subsequent 2nd and 3rd month of the treatment. The patients were asked for the determination of FPG and PPG regularly at the interval of each month. The HbA1C level was examined only before the treatment and after 3 months of treatment. The glycosylated haemoglobin determination was carried out by using BIORAD Micromat II HbA1C instrument, while FPG and PPG were determined in the laboratory.
INCLUSION CRITERIA
Known cases of type 2 diabetes patients with age more than 35 yrs, of either sex & glycosylated haemoglobin > 7% were included in the study. Clinical criteria for the evaluation included fasting blood glucose level, post prandial blood glucose level and glycated haemoglobin (HbA1c) value. Patients were prescribed to receive fixed dose combination of Voglibose 0.2mg, Glimepiride 1/2mg and Metformin 500mg SR, one tablet twice daily with major meals for three months.
EXCLUSION CRITERIA
Patients with current insulin therapy or received insulin for more than six weeks in last 3 months, who had known hypersensitivity to Biguanides and sulphonylurea, who are on chronic medication known to affect glucose metabolism were excluded from the study. Also the patients with renal disease or renal dysfunction, with congestive heart failure, hepatic insufficiency, alcoholic person and pregnant and lactating women were excluded from the study.
EFFICACY AND SAFETY EVALUATIONS
The primary efficacy variable was the change in HbA1C, FPG & PPG from baseline to 3 month. Safety outcomes included adverse events, particularly hypoglycaemic symptoms. The patients were interviewed and asked for any type of adverse events throughout the study. The patients were specially asked for the hypoglycaemic symptoms. The daytime hypoglycaemic episodes are usually recognized by sweating, nervousness, tremor, and hunger while night time hypoglycemia may be without symptoms or manifest as night sweats, unpleasant dreams, or early morning headache.
STATISTICAL ANALYSIS
The analysis of Glycosylated haemoglobin and fasting and post prandial glucose was carried out by using graph pad prism 6. Comparison between the baseline values with the value on the 1st, 2nd and 3rd month of treatment were made, as well as comparison in between these months was done by applying one way analysis of variance & the Turkeys multiple comparison test. Value of PEnglishhttp://ijcrr.com/abstract.php?article_id=1124http://ijcrr.com/article_html.php?did=11241. Nathan DM, Kitrick C, Larkin M, Schaffran R, Singer DE. Glycemic control in diabetes mellitus: have changes in therapy made a difference? Am J Med 1996;100:157-63.
2. A. Ceriello. The glucose triad and its role in comprehensive glycaemic control: current status, future management: Int J Clin Pract, November 2010; 64(12): 1705–1711.
3. American Diabetes Association. Standards of medical care in diabetes. Diabetes Care 2008; 31(Suppl. 1): S12–54.
4. Canadian Diabetes Association. Canadian Diabetes Association 2008 clinical practice guidelines for the prevention and management of diabetes in Canada. Can J Diabetes 2008; 32(Suppl. 1): S1–201.
5. Ryden L, Standl E, Bartnik M et al. Guidelines on diabetes, prediabetes, and cardiovascular diseases: executive summary. The Task Force on Diabetes and Cardiovascular Diseases of the European Society of Cardiology (ESC) and of the European Association for the Study of Diabetes (EASD). Eur Heart J 2007; 28: 88–136
6. Currie CJ, Peters JR, Tynan A et al. Survival as a function of HbA1c in people with type 2 diabetes: a retrospective cohort study. Lancet 2010; 375: 481–9
7. Ceriello A, Colagiuri S, Gerich J, Tuomilehto J. Guideline for Management of Postmeal Glucose. Brussels: International Diabetes Federation, 2007.
8. American Diabetes Association. The pharmacological treatment of hyperglycemia in NIDDM. Diabetes Care 1995;18:1510-8.
9. Riddle M. Combining sulfonylureas and other oral agents. Am J Med 2000;108 (suppl 6a):15S-22S.
10. Ovalle F, Bell DSH. Triple oral antidiabetic therapy in type 2 diabetes mellitus. Endocr Pract 1998;4:146-7
11. Glucose tolerance and mortality: comparison of WHO and American Diabetes Association diagnostic criteria. The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in EuropeLancet 1999; 354: 617–621.
12. Glucose tolerance and cardiovascular mortality: comparison of fasting and 2-hour diagnostic criteria, Arch. Intern. Med. 2001; 161 397–405.
13. F. Cavalot, A. Petrelli, M. Traversa, K. Bonomo, E. Fiora, M. Conti, et al., Postprandial blood glucose is a stronger predictor of cardiovascular events than fasting blood glucose in type 2 diabetes mellitus, particularly in women: lessons from the San Luigi Gonzaga Diabetes Study, J. Clin. Endocrinol. Metab. 91 (2006) 813–819.
14. Kuo-Liong Chien a,b, Bai-Chin Lee b, HungJu Lin b, Hsiu-Ching Hsu b, Ming-Fong Chen; Association of fasting and post-prandial hyperglycemia on the risk of cardiovascular and all-cause death among non-diabetic Chinese: Diabetes research and clinical practice 2009; 83:e4 7– e50
15. S. Yamagishi, K. Nakamura, M. Takeuchi, Inhibition of postprandial hyperglycaemia by acarbose is a promising therapeutic strategy for the treatment of patients with the metabolic syndrome, Med. Hypotheses 65 (2005) 152– 154.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareDUPLEX APPENDIX: A MORPHOLOGICAL, EMBRYOLOGICAL AND APPLIED ASPECT
English2730Vandana DaveEnglish Hitendra Kumar LohEnglish Avinash ThakurEnglish Rajesh Kumar SuriEnglishThe vermiform appendix has been noted as a vestigial structure that has lost most of its original functions through the process of evolution. Duplication of appendix is extremely rare congenital entity which can be related with other anomalies of gastrointestinal tract. Double appendix represents a challenging clinical scenario in cases of right lower quadrant pain. In the present study we report a peculier case of double appendix. Understanding of appendiceal duplication is essential for clinicians to prevent acute and serious intestinal, genitourinary conditions; for surgeons performing surgeries and for medico legal connotations.
Englishvermiform appendix, vestigeal, appendicitis, double appendix.INTRODUCTION
The vermiform appendix is positioned at the commencement of the large gut and has the same basic structure. It is an elongated tubular cul-desac connected to the caecum situated in the right iliac fossa of the abdomen. Though proposed as vestigeal in humans after losing its original functions during evolution, it still serves as a significant lymphoid organ. Large masses of confluent lymphatic nodules in the walls of appendix contain germinal centers for local defense against infection and make up a part of Gut Associated Lymphoid Tissue (GALT). It is presumed that these are homolog of the avian bursa of fabricus related to the acquisition of immunological competence by certain lymphocytes. In lower mammals particularly herbivores, the caecum and appendix are large and significant sites of digestion of cellulose by symbiotic bacteria1 . Though the length and position of the appendix exhibit normal anatomical variations, its duplication is a rare occurrence reported with an incidence of 0.004% 2 . The first case of appendix duplex was reported in a female patient who had associated anomalies of duplication of entire large bowel, two uteri with two vaginae, ectopia vesicae and exomphalos3 . Most anomalies of appendix have been observed in adults and most were noticed incidentally during surgery not primarily involving the appendix 4 . The complications that might arise from an unidentified duplicate appendix may have serious, life-threatening consequences for the patient.
Embryological Aspect:
Initially the appendix is a tiny diverticulum of the caecum. It increases rapidly in length. At birth it is relatively a long tube arising from the distal caecal end. After birth the right wall of the caecum grows excessively and pushes the appendix medially5 . The appendix is subject to considerable, positional variations. It may pass posterior to the caecum (retrocaecal appendix) or colon (retrocolic appendix) or it may descend on the pelvic brim (pelvic appendix). Although In majority of people (64%), it is retrocaecal in position5 .
CASE REPORT
During routine dissection hall teaching curriculum of medical undergraduates, two appendices, normal and accessory were identified in a 56 years old male Indian cadaver. The normal appendix was subcaecal in position situated 2 cms below the ileocaecal junction and had a patent lumen. This appendix measured 3.1 cms in length from its base to the tip. The maximum outer diameter using vernier calipers was 0.9 cms. The accessory appendix was positioned at iliocaecal junction along the taenia line. It was smaller than the normal appendix and measured 2.6 cms in length from its base to the tip. The maximum outer diameter measured 0.4 cms. It was found in promonteric position. The lumen of this accessory appendix was obliterated. Both the appendices had mesoappendix containing appendicular artery at their free margin. The respective appendicular arteries were branches of iliocolic artery. Histologically, both appendices revealed normal mucosa, submucosa, muscularis externa and serosa.
DISCUSSION
Double appendix is usually asymptomatic. Accessory appendices are mostly diagnosed during abdominal surgeries, postmortem examination or on barium enema studies6 . Appendiceal duplication was first classified by Cave in 19367 . Wallbridge and Waugh in 1963 worked on the appendiceal duplication and divided these duplications into three groups as Type A, Type B and Type C8 . Type A consists of various degrees of partial duplication on a normally localized appendix with a single caecum. Type B consists of a single caecum with two completely separated appendices. Type B is divided further into two subgroups. B1 group includes two appendices localized symmetrically on either side of the ileo-cecal valve; this resembles the normal phylogenetical arrangement in birds, so this group was called the ‘bird-like or avian’ type. In B2 group (taenia-coli type) there is a normally localized appendix arising from the caecum at the usual site and a second, separate, rudimentary appendix localized along the taenia line. In type C there are two caeca, each bearing its own appendix8 . Some cases are difficult to categorize into a suitable type so the authors started to add additional types. Type D includes a horse-shoe appendix with two opening at the common caecum9 . The present case can be compared with type ‘B2’ variety, as one appendix arose from the normal site while the other accessory appendix which was smaller in size rather rudimentary, arose from the ileo-caecal junction. Most of the cases of double appendix studied by Wallbridge were of the ‘B’ type; out of the 50 reported cases, 30 were of this variety8 . Phylogenetically, the appendix is absent in several species like Felis (tiger, leopard, lion) and Canis (dog, wolf, fox) 10. Morphologically there is no reason why the human being might not have two appendices. Duplication is said to be possible in any part of gastrointestinal tract11. Aetiology of the double appendix has been explained by many workers. Environmental factors such as trauma or hypoxia during early fetal development have also been suggested to play a role11. Despite normal embryogenesis, the pathogenesis of appendiceal duplication is yet unclear. There are four theories to explain the embryology of gastrointestinal duplication namely the split notochord theory, the median septum formation, failure of the normal regression of embryonic diverticula and partially twinning procedure12. Embryogenesis of appendiceal duplication can be explained to some extent by the theory of ‘failure of the normal regression of embryonic diverticula’. Cave explained the embryological basis of its occurrence by referring to the work of Kelly and Hurden, Gladstone and Wakeley and emphasized that a transient appendix develops from the tip of the caecum at the beginning of the 5th week, atrophies at the 7th week and disappears soon after7 . The normal vermiform appendix differentiates later. The transient appendix may be substantiation of ancestral caecal duplicity in mammalia7 .
APPLIED ASPECT
The anomalies of appendix detected during childhood are always associated with severe intestinal, genitourinary or bony malformations, seen most often in conjunction with Type B1 and Type C duplication13. Carcinoma of the intestinal tract with coexistent duplication has also been reported. This condition is very rare and appears limited to a few number of cases14, 15 . In case of double appendix, the symptoms are usually the result of obstruction and inflammation of the bowel. In patients with appendiceal duplication, it has been reported that acute appendicitis occurs in one16 or both11 appendices and reoccurs six years after the first appendectomy17. In patient with appendicular duplication both appendices are removed whenever one is found inflamed. This is done to avoid diagnostic confusion that may arise on removal of a single appendix 11. The clinical presentation can vary according to the location of the appendices. Anomalies of the appendix such as duplication and malposition are of great practical importance and a surgeon must acknowledge this fact during operations.
CONCLUSION
A double appendix is rather rarest which accounts for surgical complications or may be associated with a carcinoma of gastrointestinal tract. Embryologically this duplication occurs due to the failure of normal regression of embryonic diverticula. Acknowledging such appendiceal duplications can circumvent diagnostic perplexity and help clinicians foresee acute or chronic intestinal or genitourinary conditions.
Englishhttp://ijcrr.com/abstract.php?article_id=1125http://ijcrr.com/article_html.php?did=11251. Williums PL, Bannister LH. The anatomical basis of medicine and surgery. ELBS with Chrchil Livingstone Grays Anatomy.1995; 38th ed. pp 1775-76.
2. Kjossev KT, Losanoff JE. Duplicated vermiform appendix. Br J Surg. 1996; 83; pp 1259.
3. Picoli G. (Quoted by Gupta and Kak, 1964) Progresso Medico (Napoli). 1892; 6; pp 32.
4. Eroglu E, Erdogan E, Gundogdu G, Dervisoglu S, Yeker D. Duplication of appendix vermiformis : a case in a child. Tech Coloproctol. 2002; 6; pp 55-57.
5. K. L. Moore, T.V.N. Persaud. The developing human, clinically oriented embryology. 2009; 8 th ed. pp 227-229.
6. Mitchell IC, Nicholls JC. Duplication of the vermiform appendix. Report of a case: Review of classification and medico legal aspects. Medicine, Science, Law. 1990; 30(2); pp 124- 26.
7. Cave AJE. Appendix vermiformis duplex. J Anat. 1936; 70; pp 283-292.
8. Wallbridge PH. Double appendix. Br J Surg. 1963; 50(221); pp 346- 347.
9. Drino E, Radnic D, Kotjelnikov B, Aksamija G. Rare anomalies in the development of the appendix. Acta Chir Iugosl. 1991;38; pp 103- 11.
10. Chew DK, Borromeo JR, Gabriel YA, Holgersen LO. Duplication of the vermiform appendix. J Pediatr Surg. 2000; 35; pp 617- 618.
11. Bishop HC, Koop CE. Surgical management of duplications of the alimentary tract. Am J Surg. 1964; 107; pp 434-442.
12. Jimenez SG, Oliver MR, Stokes KB, Morreau PN, Chow CW. Case report: Colonic duplication: a rare cause of obstruction. J Gastroenterol Hepatol. 1999; 14; pp 889–892.
13. Tinckler LF. Triple appendix vermiformis: a unique case. Br J Surg. 1968;55; pp 79-8.
14. Holcomb GW 3rd, Gheissari A, O'neill JA Jr, Shorter NA, Bishop HC. Surgical management of alimentary tract duplications. Ann Surg. 1989; 209; pp 167-174
15. Chen CC, Yeh DC, Wu CC, Li MC, Kwan PC. Huge cystic duplication of the ascending colon in adult. Zhonghua Yixue Zazhi (Taipei). 2001; 64; pp 174-178
16. Griffiths EA, Jagadeesana J, Fasihe T, MercerJonesa M. Bifid vermiform appendix: a case report. Curr Surg. 2006; 63; pp 176-178.
17. Travis JR, Weppner JL, Paugh JC. Duplex vermiform appendix: case report of a ruptured second appendix. J Pediatr Surg. 2008; 43; pp 1726–1728.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareVASCULAR VARIATIONS IN AXILLARY ARTERY - A CADAVERIC STUDY
English3134M. GurushanthaiahEnglish Satheesh Naik KEnglish S. LokanadhamEnglishAn Unilateral variation in the branching pattern of third part of axillary artery was observed on the left upper extremity of a 52 years old embalmed cadaver, during routine dissection for medical undergraduate students. In the present study we observed high origin of brachial artery and a common arterial trunk from the third part of axillary artery. The common arterial trunk gave rise to subscapular, profunda brachii, and common circumflex humeral arteries. The subscapular artery divided into thoracodarsal and circumflex scapular arteries. The common circumflex humeral artery gave rise to anterior circumflex humeral and posterior circumflex humeral arteries. On the right upper extremity branching pattern of third part of axillary artery was normal. Arterial anomalies in upper limb are important for surgeons and anaesthesiologists for reparative surgery and angiography.
EnglishINTRODUCTION
The axillary artery is the direct continuation of the subclavian artery, begins at the outer border of the first rib, and ends normally at the inferior border of teres major muscle where onwards it continues as the brachial artery. Pectoralis minor muscle crosses it and so divides it into three parts which are proximal, posterior and distal to the muscle. Conventionally, the proximal part (first part) gives superior thoracic artery, the posterior part (second part) gives thoraco-acromial and lateral thoracic arteries and distal part (third part) gives subscapular artery, anterior and posterior circumflex humeral arteries (1).Many Authors have described the variations in the branching pattern of the axillary artery [2, 3, 4–10]. During routine dissection of the upper limb, we came across a unilateral variation in the branching pattern of third part of Axillary artery. The variation observed is not only rare but seems to be relevant and significant for understanding the formation of the arteries of the arm. There is an extensive collateral circulation associated with the branches of subclavian and Axillary arteries, particularly around the scapula. This clearly becomes of clinical significance during injury of the axillary artery.
MATERIALS AND METHODS
A 52 years male cadaver, bilateral upper extremity was dissected for medical under graduate students in the department of anatomy, Basaveshwara medical college, Chitradurga. We came across a unilateral variation in the branching pattern of third part of Axillary artery in the left upper extremity. Variations were studied and photographed. On the right side the branching pattern of third part of axillary artery was normal. Case Study A 52 years male cadaver was dissected to study the bilateral arterial pattern of upper extremity. We exposed the axillary artery from outer border of first rib to lower border of teres major muscle. From the third part we observed high origin of brachial artery and an unusual arterial trunk gives rise to subscapular artery, profunda brachii artery and common circumflex humeral artery (Figure – 1). The Subscapular artery divided into thoracodarsal, and circumflex scapular arteries, common circumflex humeral divided into anterior and posterior circumflex arteries. The course and distribution of the first, second part arteries and profunda brachii were normal. DISCUSSION Vascular anomalies in the upper limb are unilateral and occasionally bilateral (11, 12). Magden et a, has been reported that "abnormal" branching pattern of the axillary artery The lateral thoracic and thoracodorsal arteries arose together from the third part of the axillary artery as "a lateral thoracicthoracodorsal" common trunk. The superior thoracic artery was out of the position and the subscapular artery was not present. In our observation subscapular artery gives rise to thoracodarsal and circumflex scapular arteries. Johnson and Ellis studies show that in up to 30 - 40% of cases, the subscapular artery can arise from a common trunk with the posterior circumflex humeral artery. The posterior circumflex humeral artery may arise from the profunda brachii artery and pass back below the teres major instead of passing through the quadrangular space (13). In this study common arterial trunk gives rise to subscapular, profunda brachii and common circumflex humeral arteries. In another report by Samuel et al. (2006) the third part of the axillary artery gave a common arterial trunk, which further gives rise to anterior and posterior circumflex humeral, subscapular, radial collateral, and middle collateral and superior ulnar collateral arteries with absence of profunda brachii artery (14). Our cadaveric study reveals subscapular, profunda brachii and common circumflex humeral arteries was of axillary origin as a common arterial trunk. Anatomic variations in the major arteries of the upper limb have been reported. These include absence of the radial artery and the presence of a superficial brachial artery as well as a superficial ulnar artery (15). Our present report differs from this earlier report in branching pattern as well as course of these branches. Such anomalous branching pattern may represent persisting branches of the capillary plexus of the developing limb buds and their unusual course may be a cause for concern to the vascular radiologists and surgeons and may lead to complications in surgeries involving the axilla and the pectoral regions. The seventh cervical segmental artery gives rise to axillary artery and any abnormality during development results in the unusual branching pattern (16).
CONCLUSION
Anomalies in the branching pattern of axillary artery having practical importance for the radiologists and vascular surgeons. In our study high origin of brachial artery and a common arterial trunk arises from third part of axillary artery is uncommon and which gives rise to subscapular, common circumflex humeral and profunda brachii arteries, further supplies the axilla and fore arm. Variation in the principal artery branches are used for coronary bypass and important for vascular radiologist and surgeons of various clinical disciplines.
ACKNOWLEDGEMENT
Authors are thankful to Dr. G.M. Mahesh, Principal and Professor of Anatomy. Special thanks to Miss. Sudharani, Assistant professors and PG Students in Department of Anatomy, BMCH, Chitradurga, Karnataka.
Englishhttp://ijcrr.com/abstract.php?article_id=1126http://ijcrr.com/article_html.php?did=11261. Standring, S.; Johnson, D.; Ellis, H. and Collins, P. Gray's Anatomy. 39th Ed. Churchill Livingstone, London, 2005. p.856.
2. Saeed M, Rufai AA, Elsayed SE, Sadiq MS. Variations in subclavian-axillary arterial system. Saudi Med J. 2002; 23: 206–212.
3. Yang HJ, Gil YC, Jung WS, Lee HY. Variations of the superficial brachial artery in Korean cadavers. J Korean Med Sci. 2008; 23: 884–887.
4. Susan Standring ed. Gray’s Anatomy. 40th Ed., London, Churchill Livingstone. 2008; 815–817.
5. Patnaik VVG, Kalsey G, Singla RK. Branching pattern of axillary artery – a morphological study. J Anat Soc India. 2000; 49: 127–132.
6. Rodriguez-Baeza A, Nebot J, Ferreira B, Reina F, Perez J, Sanudo JR, Roig M. An anatomical study and ontogenetic explanation of 23 cases with variations in the main pattern of the human brachio-antebrachial arteries. J. Anat. 1995; 187: 473–479.
7. Patnaik VVG, Kalse G, Singla RK. Bifurcation of axillary artery in its 3rd part – a case report. J Anat Soc India. 2001; 50: 166– 169.
8. Bhat KM, Gowda S, Potu BK, Rao MS. A unique branching pattern of the axillary artery in a South Indian male cadaver. Bratisl Lek Listy. 2008; 109: 587–589.
9. Tan CB, Tan CK. An unusual course and relations of the human axillary artery. Singapore Med J. 1994; 35: 263–264.
10. Saralaya V, Joy T, Madhyastha S, Vadgaonkar R, Saralaya S. Abnormal branching of the axillary artery: subscapular common trunk. A case report. Int J Morphol. 2008; 26: 963–966.
11. Yucel A.H. Unilateral variation of the arterial pattern of human upper extremity with a muscle variation of the hand. Acta Med Okayama.1999;53(2): 61 – 65.
12. Icten N, Sullu Y. Tuncer I.. Variant high origin radial artery: a bilateral case. Surg Radiol Anat 1996;18:63 – 66.
13. Johnson, D. and Ellis, H. Pectoral girdle and upper limb. In: Standring, S. Ed. Gray's Anatomy. 39th ed. Edinburgh, Elsevier, 2005. p. 845.
14. Samuel, V. P.; Vollala, V. R.; Nayak, S.; Rao, M.; Bolla, S. R. and Pammidi, N. A rare variation in the branching pattern of the axillary artery. Indian J. Plast. Surg., 39:222- 3, 2006.
15. Venieratos, D. and Lolis, E. D. Abnormal ramification of the axillary artery: subscapular common trunk. Morphologie., 85(270):23-4, 2001.
16. Wollard, H. H. The development of the principal arterial stems in the forelimb of the pig. Contrib. Embryo.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareA COMPLICATED BANG’S DISEASE - CASE REPORT
English3537Sunny D.A.N.English Amirtha B.G.English Tevethia H.V.English Kadavanu T.English Panchbhaya R.English Siva P.K.English Somasundsaram S.EnglishAn uncommon organism or IE at an uncommon site is sufficient to create a diagnostic concondrum. Since its signs and symptoms are nonspecific, getting an absolute etiological diagnosis becomes a herculean task. A 45 year old man presented with fever, drenching sweats, right shoulder pain, low back ache and weight loss for 9 months. He gives history of travel to the middle east and was a gardener by occupation. H/O Ingestion of Unpasteurized milk was present. H/O rearing farm animals in middle east was present. Blood cultures were negative, 2D echo and Trans esophageal echo confirmed the presence of vegetations, So with the specific history IgM antibody for Brucella melitensis was done and showed positive. The titres showed 1:320. A Lumbosacral and Hip X-ray showed Sacroilitis. He was started on streptomycin and doxycycline. After 1 week he developed acute onset of breathlessness subsequently went to cardiogenic shock and was diagnosed to have rupture of sinus of valsalva and acute aortic regurgitation. He was immediately taken up for surgery for valve replacement. He is doing well on subsequent post operative follow ups. The purpose of presenting this case report is that, brucellosis is very rare and is an even rarer cause of endocarditis in our country. It also signifies the importance of detailed history taking in terms of travel and occupational history. Brucella accounts for 2% of all IE cases. We here present a case diagnosed as brucella endocarditis, who had later landed up in complications.
EnglishBrucellosis, EndocarditisINTRODUCTION
Brucellosis has been present for over a millennia1 . Brucella accounts for less than 2% of all infective endocarditis (IE) cases2 . We here present a case diagnosed as brucellosis who later presented with complications.
CASE REPORT
A 45 year old man presented with fever, drenching sweats, right shoulder pain, low back ache and weight loss for 9 months. He travelled to the middle east and was a gardener (who used to rear farm animals) by occupation. He had Ingested Unpasteurized milk. On Examination his was pulse96/min, Blood pressure-120/70 mmHg, On auscultation a grade 2/6 Ejection Systolic murmur with soft Early Diastolic Murmur was present in the Aortic area, other systems were within normal limits. Investigations showed High Serum Transaminases levels with all other routine investigations being normal. Blood cultures were negative, 2D echo and Trans esophageal echo confirmed the presence of vegetations with normal left ventricular function, IgM antibody for Brucella melitensis was positive in which titres showed 1:320. A Lumbosacral and Hip X-ray showed Sacroilitis, Right Shoulder X-ray showed peri arthritis. Tuberculin test was negative. He was started on streptomycin and doxycycline. He was discharged at request due to his personal reasons. He presented to the ER after 1 week with acute onset of breathlessness with cardiogenic shock and was diagnosed as rupture of sinus of valsalva and severe aortic regurgitation with moderate left ventricular dysfunction. He was immediately taken up for surgery for valve replacement. He was doing well on subsequent post operative follow ups.
DISCUSSION
Brucellosis is common over a wide regionof middle-east.3 . About half a million cases of brucellosis have been reported worldwide, though detection rate varies around 30-40% of actual incidence10 . Although Brucellaendocarditis is a rare entity, it is associated with high mortality rates in animals in the Middle East, Brucella melitensis (serovar 2 or 3) predominates; in humans, serovar 3 is the cause of most cases3 . Brucellosis often involves the spine4 . Peripheral arthritis is the most common and is nonerosive5 . A second form, characterized by sacroiliitis6 . This patient had both fever and osteoarticular disease. In Suspicion of endocarditis, a transesophageal echocardiogram may help with the diagnosis2 . Culture, though considered as gold standard, is not being always positive, isolation rates varying from 20 to 50% and may take up to one month and molecular techniques like PCR, though sensitive and specific,9 are not available at all places due to limitation of resources. Endocarditis remains the principal cause of mortality in the course of brucellosis,It usually involves the aortic valve and typically requires immediate surgical valve replacement. Early recognition, adequate antibiotic treatment, and the absence of signs of heart failure can guide the practitioner toward prolonged, conservative treatment7 . Vegetations were revealed on transthoracic echocardiography. The treatment was given as per guidelines. The streptomycincontaining regimen is slightly more efficacious in preventing relapse8 . In this patient the guideline treatment was initiated at the earliest and after surgery which lead to drastic improvement.
CONCLUSION
The purpose of presenting this case report is that, brucellosis is very rare and is an even rarer cause of endocarditis in our country. It also signifies the importance of detailed history taking in terms of travel and occupational history. Optimization of medical therapy for cardiac failure which has normalized ventricular function in this patient during his follow ups. We hereby stress the role of optimal medical therapy in addition to surgery.
Englishhttp://ijcrr.com/abstract.php?article_id=1127http://ijcrr.com/article_html.php?did=11271. Capasso L. Bacteria in two-millennia-old cheese, and related epizoonoses in Roman populations. J Infect 2002;45:122-127
2. Mylonakis E, Calderwood SB. Infective endocarditis in adults. N Engl J Med2001;345:1318-1330
3. Refai M. Incidence and control of brucellosis in the Near East region. Vet Microbiol 2002;90:81-110
4. Bouaziz MC, Ladeb MF, Chakroun M, Chaabane S. Spinal brucellosis: a review. Skeletal Radiol2008;37:785-790
5. Bosilkovski M, Krteva L, Caparoska S, Dimzova M. Hip arthritis in brucellosis: a study of 33 cases in the Republic of Macedonia (FYROM). Int J Clin Pract 2004;58:1023-1027
6. Ariza J, Pujol M, Valverde J, et al. Brucellar sacroiliitis: findings in 63 episodes and current relevance. Clin Infect Dis 1993;16:761-765
7. Reguera JM, Alarcon A, Miralles F, Pachon J, Juarez C, Colmenero JD. Brucella endocarditis: clinical, diagnostic, and therapeutic approach. Eur J Clin Microbiol Infect Dis 2003;22:647-650
8. Solera J, Martinez-Alfaro E, Saez L. Metaanalysis of the efficacy of rifampicin and doxycycline in the treatment of human brucellosis.Med Clin (Barc) 1994;102:731-738
9. Probert WS, Schrader KN, Khuong NY, Bystrom SL, Graves MH. Real-time multiplex PCR assay for detection of Brucella spp, B. abortu s and B. melitensis. J Clin Microbiol 2004; 42 :1290-3.
10. World Health organization; Fact sheet N173. World Health Organization: Geneva; 1997.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareNUTRITIONAL STATUS OF THE ELDERLY FEMALE IN A MUNICIPAL TOWN OF WEST BENGAL
English3842Bigitendriya DebsharmaEnglishThe present research based study was undertaken to determine the prevalence of undernutrition using two different variables, body mass index (BMI) and mid-upper arm circumference (MUAC) among elderly females (> 60 years) of Chakdah municipal town of Nadia District, West Bengal, India. A total of 250 were measured using standard techniques. Internationally recommended cut-off values of MUAC (EnglishBody mass index, Mid-upper arm circumference, chronic energy deficiency, Elderly female.INTRODUCTION
Low socioeconomic status, limited functional ability and social isolation are often major driving factors for undernutrition in the community. Financial constraints will affect access to basic necessities such as nutritious food. Living or eating alone often results in lower food intake for older people and increases their risk of undernutrition [1] . World Health Organization (1995) has recommended that anthropometry could be used to assess the nutritional and health status of adults. Low Body Mass Index (BMI) and high levels of undernutrition (based on BMI) are major public health problem especially among rural underprivileged adults of developing countries (WHO, 1995) [2]. Although adult nutritional status can be evaluated in many ways, the BMI is most widely used because its use is simple, inexpensive, safe and suitable for large scale surveys (Lohman et al., 1988; Ferro-Luzzi et al., 1992; James et al., 1994; Lee and Nieman, 2003) [3]. Thus, BMI is the most established anthropometric indicator used for assessment of adult nutritional status (Lee and Nieman, 2003) [4]. Ferro-Luzzi and James [5] have proposed MUAC cut-off points for use in screening acute adult undernutrition. Nutritional problem mainly under-nutrition in older people is sadly far too common, even in developed countries. Protein energy malnutrition in older people comes at a significant cost to the individual, families, communities and the healthcare system. Failure to address this syndrome is not only unethical and unhealthy, but also costly. Vigilance and community awareness is important in ensuring that this important syndrome is detected and managed appropriately. Advances in medical technology, better nutrition and healthcare have extended the human life span in 20th century. The 21st century must therefore live with the consequences of that far-reaching achievement. One million people cross the 60 year mark every month, and of them 80 percent are in the developing world. The age of 60 or 65, roughly equivalent to retirement ages in most developed countries is said to be the beginning of old age. The United Nations generally uses 60+ years to refer to the older population. According to 2001 census total population of India is 102, 86, 10,328 of which 60+ population is 7, 66, 22,321(7.44% of the total population). In case of West Bengal, the total population is 8, 01, 76,197 of which the number of 60+ population is 57, 00,099 (7.11% of the total population of West Bengal). Among the total elderly persons of West Bengal 33.21% is urban and 66.79 % is rural. The objective of the present study is to evaluate the nutritional status, based on MUAC and BMI of elderly females of Chakdah Municipal Town of Nadia District, West Bengal, India. Another one is to find out the Socio-economic Problem of the elderly peoples of the proposed study area.
MATERIAL AND METHODS
Study Sample: The present cross sectional study was conducted among 250 elderly females age 60 years and above were measured from 22 wards of the Chakdah Municipal town of Nadia District. Random sampling method was used to sampling the population. Data on socioeconomic background of the individual respondent, food habits, last two years disease, their living condition and day-to-day activities have been collected with the help of household census survey, interview technique aided by structured question schedule.
Study Area:
The Chakdah Municipal Town is selected as study area which consisted with 22 wards, near the Chakdah Railway Station; approximately 95 KMs far from Kolkata, the provincial capital of West Bengal, India. Chakdah today is totally service sector oriented economy along with business as an unorganized informal sector. Total population of Chakdah Municipality is 86965 according to 2001 census. People of this region, work in neighbouring areas and in Kolkata. Industries are almost nonexistent except a few small-scale industries mainly plastic factories. There are just seven small scale industries in the municipal region.
CALCULATION
BMI was calculated with applying the formula BMI = Weight (kg) / height (m2 ). Nutritional status was evaluated using internationally accepted BMI guidelines. Anthropometric variables height, weight and mid upper arm circumferences were included. The following cut-off points were usedCED BMI Englishhttp://ijcrr.com/abstract.php?article_id=1128http://ijcrr.com/article_html.php?did=11281. Sampson G. Weight loss and malnutrition in the elderly – the shared role of GPs and ADPs. Aust Fam Physican 2009; 38:507– 10.
2. World Health Organization (1995) Physical status: the use and interpretation of anthropometry. Technical Report Series no. 854. World Health Organization, Geneva.
3. Ferro-Luzzi, A., W. P. James, Lee and Nieman, 2003, British Journal of Nutrition, 75 (1996) 3.- Lee, R.D. andNieman, D.C. (2003). Nutritional Assessment. New York: McGraw Hill.
4. James WPT, Mascie-Taylor CGN, Norgan NG, Bristrian BR, Shetty P, Ferro-Luzzi A (1994) The value of arm circumference measurements in assessing chronic energy deficiency in Third World adults. European Journal Clinical Nutrition. 48:883–894.
5. World Health Organization (1995) Physical status: the use and interpretation of anthropometry.
6. Technical Report Series no. 854. World Health Organization, Geneva.
7. van Veenrooij LMW, de Vos R, BorgmeijerHoelen AMMJ, Kruizenga HM, JonkersSchuitema CF, de Mol BAMJ. Quick-andeasy nutritional screening tools to detect disease-related undernutrition in hospital inand outpatient settings: a systematic review of sensitivity and specificity. Clin Nutr 2007;2:21–37.
8. Janssen I, Mark AE. Elevated body mass index and mortality risk in the elderly. Obes Rev 2007;8:41–59.
9. Paddon-Jones D, Short KR, Campbell WW, Volpi E, Wolfe RR. Role of dietary protein in the sarcopenia of aging. Am J Clin Nutr 2008;87:1562S–6.
10. Olukoya, A. A. Internet Journal of Gynecology and Obstetrics, 31 (1990) 231.-
11. Harries, A.D., A. J. Laura., R. V. Heatley., R. G. Newcombe., J. Rhodes, Clinical Nutrition, 2, (1984) 193.
12. Zunzunegui MV, Sanchez MT, Garcia A, Casado JM, Otero A. Body mass index and long-term mortality in an elderly Mediterranean population. J Aging Health 2012; 24:29–47.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareCOCCYGEAL FRACTURES IN ADULTS AS A RESULT OF FALL ON FROZEN SNOW DURING WINTER IN KASHMIR
English4346Bashir Ahmed MirEnglish Muzamil Ahmad BabaEnglish M.A. HalwaiEnglish Adil Bashir ShikariEnglish Maajid ShabeerEnglish Naila NazirEnglishBackground There is not much literature available on coccygeal fractures, only a few case reports. We present a first series of 15 cases of coccygeal fractures in adults as a result of similar mode of trauma due to fall on frozen snow during the winter months in the valley of Kashmir. Material and Methods: The study included patients with coccygeal fractures that occurred as a result of direct fall due to slip on ice during the winter months, December to February in the valley of Kashmir. Study was done over a period of 5 years (2007 to 2012) and included a total of 15 patients. Results: 15 cases of coccygeal fractures with an age group of 48 to 72 (average 65 years), 12 females and 3 males is presented. All patients were managed conservatively with uneventful recovery. Conclusion: Our study revealed coccygeal fractures mostly occur in elderly age group with underlying osteoporosis. Although most cases can be managed conservatively with uneventful recovery, measures should be taken to avoid fall related trauma in winters especially in older age group.
EnglishCoccyx, Conservative management, snow fall, Kashmir.INTRODUCTION
The coccyx is usually formed of four rudimentary vertebras; the number may vary from three to five, with its contour normally the continuation of the lower sacrum.6 Fractures of the coccyx are uncommon injuries, but trauma accounts for about one third of all cases of coccygodynia.4 Dislocations and displacements are of equal importance as compared to the fractures. Lewin has stressed dislocation as important cause of the clinical disturbances.10 We over a period of 5 years (2007 to 2012) collected data. Our study added a total of 15 cases to the sparse literature available regarding coccygeal fractures.
MATERIAL AND METHODS
The present study was carried out over a period of 5 years from 2007 to 2012 at the Postgraduate department of orthopaedics, Government Medical College Srinagar. After obtaining the institutional review board approval and informed consent from the patients, all cases with coccygeal fractures were included in the study. Patients with previous pathology in the area, chronic history of coccygeal pain and those with doubtful diagnosis of a fracture were excluded from the study. To our surprise all cases occurred during the months of winter in our valley as a result of snowfall. Initial radiographs of pelvis with both hips were taken to rule out other associated fractures. Lateral views of the coccyx with hips flexed were taken to reveal the fracture.
RESULTS
In our series 15 patients with coccygeal fractures, the average age of the patients was 58.67 years (range of 44-72 years). 12 (80%) patients were females and 3 (20%) males (Table 1). There were other associated fractures in two cases, a right sided colle’s fracture in one female aged 67 years (managed with close reduction and cast) and an undisplaced scaphoid fracture in a male aged 49 years (managed in a scaphoid cast for 8 weeks). Both had an uneventful recovery (Table 1). The cause of trauma was similar in all our cases due to fall on ice during the months of December to February, the peak months of winter in the valley with temperature touching -200 centigrade. Patients with more than 2 weeks of trauma, previous history of coccygeal pain and in cases where fracture was not identified on X-rays were excluded from the study. Of the falls causing the fracture 11 occurred in the early morning hours due to frozen condition outside and 4 cases occurred in the evening. All patients were managed conservatively with activity restriction for a few days and continuous use of an inflatable rubber ring for all sitting purposes. Analgesics (NSAIDS) were prescribed for the first couple of days of trauma. The use of the rubber ring was continued until patient was symptom free which was two to three months in most of the cases. None of the patients developed any complications during the treatment. One case of a female, aged 70 years continued with pain after the trauma for 11 months. A wait and watch policy with continuous use of inflatable ring during sitting finally led to her complete recovery. All patients were managed on outpatient basis and none required admission.
DISCUSSION
Coccyx fractures commonly occur as isolated injuries due to direct fall on the buttocks and rarely have associated injuries. Our series revealed two cases with associated fractures a colle's fracture in one patient and an undisplaced scaphoid fracture in other case. To injury from locally directed external forces little protection is offered by the overlying soft parts.7 From internal forces injury is inevitable under certain conditions of malposition or fixed deformity, either to coccyx or to the adjacent structures entering into the production of such forces.7 Clinically, patients describe immediate, severe pain in the area of coccyx. Pain on defecation may be present as well as pain on rectal examination. Radiographic identification may be difficult at times, although lateral x-rays of the coccyx with the hips flexed maximally may reveal the fracture (Fig.1). The coccyx may appear to be acutely angulated which is a normal anatomical variant and should not be confused with a fracture. CT and MRI scanning may be helpful in differentiating between physeal plates and fracture lines.1 When in doubt a rectal examination may reveal tenderness and abnormal mobility of the coccygeal fragment. Injury by external forces usually occur as a result of considerable violence such as sitting forcibly on hard objects; kicks or blows received upon the tip of the spine; falls upon the buttocks, in the latter instance due to fall upon the buttocks, males are probably less susceptible to such trauma because of closer approximation of tuberosities of the ischia.4 This is in concordance with our study with 90% of our cases being females and all of our cases occurred due to direct fall on the buttocks. Among other causes in various reports injury by internal forces, pressure against the coccyx from within may be the cause of damage and even case of descending head during labour may result in fracture or dislocation.5 Treatment is conservative in majority of the cases consisting of activity restriction and use of an inflated doughnut cushion with return to full activities in 4 to 6 weeks.2,7, 11 In our cases we used an inflated rubber ring, for all sitting activities. Patients were advised to inflate the ring sufficiently so that the weight was borne entirely by the structures resting on the perimeter of the ring. The use of the ring was continued till disappearance of symptoms in our study. All patients had uneventful recovery in our study except one case that developed chronic coccygeal pain but with a wait and watch policy patient was pain free at 11 months after trauma. Following a coccyx fracture, surgery is not usually required and often yields disappointing results; however, if the pain continues even after the fracture has healed, and is severe enough to cause disability, a coccygectomy may be required. 8,12 All our cases were managed conservatively and none required any form of surgical intervention.
CONCLUSION
Although rare injuries coccygeal fractures are more frequently seen in elderly patients with other risk factors. Conservative management yields excellent results and should be tried in all cases. As all our patients were a result of fall related trauma during winters, measures should be taken to avoid such fractures as well as other fall related injuries.
ACKNOWLEDGEMENTS
We thank Dr. Shakir, Dr. Manan and Dr. Omar for helping us in compiling the data. We also thank Mr. Hameed for his technical assistance.
Englishhttp://ijcrr.com/abstract.php?article_id=1129http://ijcrr.com/article_html.php?did=11291. Broome DR, Hayman LA, Herrick RC, et al. Postnatal maturation of the sacrum and coccyx: MR imaging, helical CT, and conventional radiography. AJR Am J Roentgenol 1998;170(4):1061-1066.
2. Caldwell, G. A.: Minor injuries of the lumbar spine and coccyx. S. Clin. North America, October 1951, p. 1345.
3. Dean LM, Syed MI, Jan SA, Patel NA, Shaikh A, Morar K, Shah O. Coccygeoplasty: treatment for fractures of the coccyx. Journal of vascular and interventional radiology. 2006 May; 17(5): 909-12.
4. George H. Thiele. Coccygodynia: causes and treatment. Diseases of the colon and rectum. November-December, 1963, volume 6, issue 6, pp 422-436.
5. Grant Cooper MD, Mike S. Lee MD and Gregory E. Lutz MD. Fracture of coccyx during childbirth: a case report of an unusual cause of coccygodynia. Archives of Physical Medicine and Rehabilitation Volume 84, Issue 9 , September 2003, Page E15
6. GRAY. Anatomy of the Human Body. Ed. 21. Phila., Lea and Febiger, 1924.
7. John C. McCauley Jr. Fractures of coccyx and coccygodynia. The American Journal of Surgery1937, Volume 36, Issue 1, April, Pages 303-307.
8. Key, J. A.: Operative treatment of coccygodynia. J. Bone and Joint Surg. n.s.19: 759, 1937.
9. Kim WY, Han CW, Kim YH. Joystick reduction and percutaneous pinning for an acutely anteriorly dislocated coccyx: a case report Journal of Orthopaedic Trauma 2004 Jul; 18 (6): 388-9.
10. LEWIN, P. Coccyx, its derangements and their treatment. Surg. Cynec. and Obst., 45: 705 (Nov.) 1927.
11. Rockwood and Wilkins Fractures in Children. Fractures of the pelvis. 7th edition, Chapter 20/Page 759-760.
12. Spence, K. F., Jr.: Coccygectomy. Am. J. Surg.102: 850, 1961.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareVALUE OF RAPID ANTIGEN ASSAY IN DIAGNOSIS OF PYOGENIC AND PARTIALLY TREATED MENINGITIS
English4753Shalini BajajEnglish Deepandra GargEnglish Manish bajajEnglish Neha AgrawalEnglish S.L. MandowaraEnglishObjective: To assess the usefulness of rapid antigen assay in diagnosis of pyogenic meningitis and to compare CSF culture with Rapid antigen Assay in pyogenic meningitis in terms of percentage recovery of the pathogen. Research Design and Methods: The prospective observational study was conducted on all suspected cases of meningitis, admitted in Bal Chikitsalaya, Department of Paediatrics, RNT Medical College, Udaipur over a period of 6 months. A total of 20 children with pyogenic meningitis were enrolled in our study. Their haematological and CSF cytochemical findings, management, clinical course during illness and outcome were also recorded and analyzed. Rapid Antigen detection by Latex Agglutination Test was compared with CSF culture. Results: In our study, the overall positivity on Rapid Antigen assay was 85% of cases with a sensitivity and specificity of 85% and 100% respectively. This in sharp contrast to CSF gram’s stain and culture where the results were positive in 55% and 40% cases respectively.Streptococcus pneumoniae was the commonest organism isolated on Rapid antigen assay in 47.06% followed by Neisseria meningtidis in 35.29% and Hemophilus Influenzae in 11.76% .Case fatality rate was 15% in our study. Conclusions: We concluded that Rapid antigen asssay has high sensitivity and specificity .So, it can be advised as an additional laboratory investigation to found etiology of bacterial meningitis mainly in pretreated cases and also differentiate partially treated cases from that of tubercular meningitis as it is a common dilemma encountered by the clinicians.
EnglishC–Reactive Protein, Neonatal SepticemiaINTRODUCTION
Acute bacterial meningitis, also referred to as pyogenic meningitis, is one of the most serious illnesses leading to high morbidity and mortality all over the world, especially in developing countries such as in India.(1)In the pre antibiotic era of the previous century the epidemics and endemic potentials of this disease with a predominate fatal outcome, were recognized particularly in children.(2)With the availability of antibiotics and chemotherapeutic agents, mortality has substantially reduced, but still remains the major cause of death in paediatric age group. Mortality rate due to acute bacterial Meningitis remains significantly high in India and other developing countries ranging from 16-32 %. (3) The mortality in untreated cases of pyogenic meningitis is nearly 100%. There are significant complications in as many as 50% of patients of pyogenic meningitis in spite of treatment (4) Prompt diagnosis is the corner stone for effective management. Lumbar puncture and CSF examination remains most important early diagnostic test. (5) The conventional methods of diagnosis like Gram staining and bacterial culture do not always yield positive results. The CSF become sterile on culture because frequent administrations of antibiotics before a specific diagnosis. (6) Gram staining of the CSF smear is a very helpful and cheap method and can be rapidly and accurately performed. CSF protein > 100 mg /dl and CSF sugar < 40mg /dl are suggestive of bacterial meningitis, but can also be seen in other causes of meningitis. The only reliable method is bacterial culture of CSF .However; positivity by this method varies from only 30-60% cases to 70-80% (7,8) The CSF culture is time consuming and can give false negative results if the specimen has been transported and stored under unsatisfactory conditions or if an antibiotic therapy has been initiated before the specimen was taken.(9)Therefore, there is an urgent need for finding an alternate method of diagnosis. Detection of microbial antigens in cerebrospinal fluid may be the single most important test in partially treated meningitis since Gram’s stain and culture may be negative and it is a valuable aid when choosing antimicrobial therapy.(9) Not many studies have been performed in India to assess the role of rapid antigen assay .The present study is ,therefore, being planned to find out the usefulness of rapid antigen assay in diagnosis of pyogenic meningitis as well as its role in detection of partially treated meningitis and differentiating it from tubercular meningitis.
MATERIAL and METHODS
The Study of was carried out on all suspected cases of meningitis, admitted in Bal Chikitsalaya, Department of Paediatrics, RNT Medical College, Udaipur over a period of 6 months. Each patient evaluated on the bases of detailed history, clinical examination and Relevant laboratory investigations including-Complete blood counts, ESR, Lumbar puncture- complete CSF analysis, CSF culture for pyogenic organism, Rapid Antigen detection by Latex Agglutination Test ,Blood Sugar, Ultrsonography (USG) Skull, cranial CT scan, MRI whenever required,
SELECTION OF CASES
Inclusion Criteria
All suspected cases of meningitis will be included in the study Group I – Cases.-This group will include: (A) All definite cases of pyogenic meningitis (10) as suggested by history, clinical examination, Radiological investigations and CSF analysis. (B)"partially treated pyogenic meningitis", where the meningitis symptoms, signs and CSF findings are modified after receiving antibiotics. When this happens, CSF findings may resemble those of viral meningitis or early tubercular meningitis. A total of 20 cases will be included in this group. Group II- Control group-This group will include: ? Definitive cases of tubercular meningitis (meningoencephalitis) (11)based on history, clinical examination, Radiological investigations and CSF analysis ? Viral encephalitis/meningoencephalitis ? Cerebral Malaria etc. 10 patients will be included in this group.
Exclusion Criteria:
Traumatic lumbar puncture. The CSF was collected with aseptic technique by lumbar puncture in 3 sterile containers and transported to the laboratory as soon as possible. In case of delay in transportation CSF was kept in an incubator at 35-37OC. In all the patients Rapid Antigen Assay of Cerebrospinal Fluid by Latex Agglutination test will be performed. Latex agglutination test will be used using Pastorex kit for CSF samples only. (12)
RESULTS
20 cases and 10 controls were enrolled and were studied for clinico-microbiological profile as per the inclusion and exclusion criteria mentioned above. Majority of the patients 11 (55%) were in the age group >5 Years. Males were 11 (55%) as compared to Females 9 (45%) in the present study. (p >0.3) Male to Female ratio was 1.22:1.. (x2 = 2.86, p >0.3) In the present study fever was the commonest symptom in 19 (95%) followed by convulsion in 15 (75%).When various clinical sign at admission were analysed in the present study, Signs of meningeal irritation were present in 11 (55%) cases, bulging fontanallae were seen in 5(25%) cases. Leucocytosis was higher in untreated patients as compared to partially treated ones, with a coefficient of linear regression value of 0.91. A higher CSF protein and lower glucose level was also found in untreated as compared to partially treated patients. (r 0.91) It was observed positivity of CSF culture among untreated patients 6 (42 %) was higher in comparison to partially treated patients 02 (33.33%).Positivity of Rapid antigen test among untreated patients {12(85.71%)} was slightly higher than among partially treated patients {5(83.33%)}.Overall, Rapid antigen assay led to more isolation of organisms {(in 17 cases (85%)} as compared to culture {in 8 cases (40%)} [Table No.1]. This difference was statistically significant (p5 Years. Males were 11 (55%) as compared to Females 9 (45%) in the present study.However, the difference was statistically insignificant (P value >0.3). The male to female ratio in the current study was 1.22:1. Similar to our study and Rao et al (1998) from Libya reported male to female ratio of 1.2:1. (13) It was observed that there is a higher admission rate of males as compared to that of females. Moreover, because of social and cultural bias in favour of males, they are provided with earlier and better medical and social care. In the present study, Fever was the commonest symptom (95%) followed by convulsion (75%), Vomiting (55%) Similarly Gupta and Dhande (2002) also observed fever (98.28%) as the commonest symptom followed by convulsion (67.24%) and vomiting (31.03%). (14) In the present study, a sign of meningeal irritation (in 55% cases) was the commonest observed sign. Comparable to our study, Gupta and Dhande (2002) also observed the same. (14)In contrast to our study, Chinchankar et al (2002) reported meningeal irritation signs in 26% cases only. (15) The variation observed in incidence of clinical features in patients with pyogenic meningitis depends upon age of patients, duration of onset, host resistance and infectivity of organism. In the present study (30%) patients received preadmission antibiotics. The TLC in untreated patients was found to be more as compared to patients who had received prior antibiotic therapy but the difference was statistically insignificant (P >0.8). In current study, >60% polymorphs were seen in 83.33% of partially treated cases and 78.57% of untreated cases of pyogenic meningitis respectively. Similar observation was found by Gupta and Dhande (2002). (14) On cytochemical examination of CSF, it was observed that CSF cell count was higher in untreated cases. A linear regression analysis revealed a significantly higher cell count in untreated patients(r 0.91).This is expected as partial treatment with antibiotics is likely to alter the CSF picture. However, in the study conducted by Gupta and Dhande (2002), such a difference was not found.(14) The CSF protein was also high in untreated patients compared to partially treated.CSF glucose was also lower in untreated as compared to partially treated group (r 0.91). (Table .2) The culture was positive for organism in 33.33% of partially treated as compared to 42.85% of untreated patients. However, the difference between these two groups was statistically insignificant (P>0.1). Similarly Gupta and Dhande (2002) also observed culture positivity in partially treated (21.42%) as compared to 46.66% in untreated cases.(14) Yang et al (1993) from China observed that only 2.5% of partially treated patients had culture positivity.(17) (Table no.3) In our study Streptococcus pneumoniae was the commonest organism cultured (37.5%) followed by Staphylococcus aureus and Niesseria meningtidis (25% each).Gupta and Dhande (2002) isolated Staphylococcus aureus and Khaliq and Salam (2002) recovered Klebsiella (33.33%), as the predominant organism respectively.(14,18) In contrast to above mentioned studies many authors reported that the most common causative organism in pyogenic meningitis grown on CSF culture was H. influenzae (Rao et al, Choo et al).(Table no.3) . (13, 19) This could be a difference in the geographic distribution of H. Influenzae. In current study it was observed that commonly isolated organisms on Rapid Antigen Assay were Streptococcus pneumoniae(47.06%), Nisseria meningtidis(35.29%), and Hemophilus influenza (11.76%).[Table no.3 ] Chavez-Bueno et al(2005) observed that, in infants and children worldwide, S.pneumoniae, N.meningtides, H.influenzae were the common organisms causing bacterial meningitis(20) Similar to our study, Das et al(2003) observed that common etiological organisms were S. pneumoniae, H. influenzae type b and N. meningitidis.(21) In contrast a study by Drow et al(1983) using coagglutination revealed H. influenzae, 97%; group B Streptococcus, 75%; S. pneumoniae, 71%; and N. meningitidis,58% as most common organisms.(22) Rapid Antigen Assay showed a sensitivity of 85% and specificity of 100% in diagnosis of bacterial meningitis in our study. In contrast Gram’s stain and culture were positive in 55% and 40% cases respectively. Similarly, in a study by Das et al (2003), an etiological diagnosis could be made by LPA in 83% cases of bacterial meningitis as compared to 6% by culture and 36% by gram's stain respectively. The sensitivity and specificity of LPA test were 83% and 100%, respectively, very similar to our study. (21) In our study 70% patients were discharged on recovery while 15% of cases expired. Higher mortality has been observed by many workers (Kumar et al and Bhat et al,). (7, 16) Earlier detection of the organism by Rapid Antigen assay and prompt institution of the appropriate antibiotics could have contributed to our lower case fatality rate.
CONCLUSION
From above mentioned facts observed in the present study, we concluded that pyogenic meningitis is certainly contributing to pediatric mortality and morbidity, especially because of changing causative microbiological pattern. Streptococcus pneumoniae infection is the most significant cause of pyogenic meningitis in all pediatric ages. Rapid antigen assay has high sensitivity and specificity and is rapid enough to guide the clinician for instituting proper antibiotics. So, it can be advised as an additional laboratory investigation to found etiology of bacterial meningitis mainly in pretreated cases and also differentiate partially treated cases from that of tubercular meningitis as it is a common dilemma encountered by the clinicians. We hope that the present study will go a long way in improving the quality of survival of patients with pyogenic meningitis.
Englishhttp://ijcrr.com/abstract.php?article_id=1130http://ijcrr.com/article_html.php?did=11301. Srivastava JR. Srivastava VK, Mehrotra SN and Samuel KC. Clinical and bacteriological study of pyogenic meningitis in children. Indian J Pediatric 1968: 35:423-28.
2. Vancent J, Quagliarello and Scheld WM, New perspective on bacterial meningitis Clin Infect Dis. 1993; 7: 603-608.
3. Mani R, Pradhan S, Nagarathna S, Wasiulla R, Chandramukhi A. Bacterio,logical profile of community acquired acute bacterial meningitis a 10 year retrospective study in a tertiary neurocare centre in South India. Indian J Med. Microbiology 2007; 25: 108-14
4. Sinha KK.Acute pyogenic meningitis. Some important aspect. Hospital Today 1999;4:209- 216
5. Dean A. Seehusen, M.D., Mark M. Reeves, M.D., And Demitri A. Fomin, M.D. Cerebrospinal Fluid Analysis. American Family Physician 2003;68(6):1003-1008
6. Pandit L, Kumar S, Karunasagar I, Karunasagar I. Diagnosis of partially treated culture-negative bacterial meningitis using 16S rRNA universal primers and restriction endonuclease digestion. J Med Microbiol 2005; 54: 539-542.
7. Kumar L. Chitlangia S, Ayyagari A.The current status of pyogenic meningitis in children. Ind.Paediatrics. 1980; 17:438-444
8. Converse GM, Gwaltney JM, Strassburg DA, Handley JO.Alteration of cerebrospinal fluid findings by partial treatment of bacterial meningitis.J Pediatrics. 1973; 83(2): 220-225
9. Surinder K, Bineeta K, Megha M. Latex particle agglutination test as an adjunct to the diagnosis of bacterial meningitis. Indian J Med Microbiol 2007;25:395-7. 10. Prober CG. Central Nervous system infections .Nelson Textbook of Pediatrics, 2004;(17 ): 2038 -2044
11. Munqj FM, Starke JR. Tuberculosis. Nelson textbook of Pediatrics, 2004; (17):958-972 12. Forbes, B.A., D.F. Sahm, A.S. Weissfeld, eds. 2002. Meningitis and other infections of the central nervous system .Bailey and Scott’s Diagnostic Microbiology, 11th ed. p. 907-916
13. Rao BN, Kashbur IM, Sembesh NM, Bargathy SM. Etiology and occurrence of acute bacterial meningitis in children in Benghazi, Libyan Arab Jamahiriya 1998; 4 : 50-57. 14. Gupta BD, Dhande NR, An epidemiologic and clinical study of Pyogenic meningitis in children submitted to University of Rajasthan for MD (Ped.) 2002. 15. Chinchankar N, Mane M, Bhave S, Diagnosis and outcome of acute bacterial meningitis in early childhood. Indian Pediatrics 2002; 39: 914-921.
16. Bhat BV, Verma IC, Puri RK, Sinivasan S and Naini P. Prognostic indicator in pyogenic meningitis. Indian Pediatr. 1987; 24: 977-983. 17. Yang Y.H, Fu S.G. Penh H et al. Abuse of antibiotics in China and its potential interference in determining the etiology of pediatric bacterial disease. Pediatr. Infect Dis J 1993; 12:986-988. 18. Abdul Khaliq A Sallam. Etiology and presentation of acute bacterial meningitis in children at Al-Thawrah Hospital, Sana`a, Yemen J Ayub Med Coll Abottabad Oct - Dec 2004;16(4):40-3. 19. Choo K.E, Ariffin W.A, Ahmed T, Linn W.L, Gururaj A.K. Pyogenic meningitis in hospitalized children in Kelantan, Malaysia. Ann Trop Pediatr. 1990; 10(1) : 89-98. 20. Susana Chávez-Bueno, George H. McCracken Jr, Bacterial Meningitis in Children. Pediatric Clinics of North America 2005;52(3):795-810 21. B.K. Das, Rajesh Lal Gurubacharya, T.M. Mohapatra and O.P. Mishra. Bacterial Antigen Detection Test in Meningitis. Ind J Pediatrics 2003; 70 (10) : 799-801. 22. Doris L. Drow,David F. Welch, Diane Hensel,Kathy Eisenach,Earl Long And M. Slifkin Evaluation of the Phadebact CSF Test for Detection of the Four Most Common Causes of Bacterial Meningitis. Journal of Clinical Microbiology, Dec. 1983, p. 1358- 1361.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28HealthcareAN EPIDEMIOLOGICAL STUDY OF LOW BIRTH WEIGHT IN A TERTIARY CARE HOSPITAL, TIRUPATI, ANDHRA PRADESH
English5462N. SwarnalathaEnglish P. BhuvaneswariEnglishObjective: To know the prevalence of low birth weight and its association with socio demographic and maternal factors in Tertiary care Hospital, Tirupati. Settings: Government Maternity Hospital attached to S.V. Medical College, Tirupati Study design: Hospital based cross sectional study Participants: 1200 postnatal women who delivered single live baby in the Government Maternity Hospital, Tirupati. Methodology: Systemic random sampling Study Period: January 2011 to December 2011 Statistical analysis used: Chi-square test and binary logistic regression analysis Results: Prevalence of Low birth weight was 26.8%. The prevalence of low birth weight was high and significant in less than 20 years of age group (42.0%), illiterate mothers (37.4%), occupation as labor (27.4%), low income (28.5%), consanguinity history (38.7%), primigravida (29.8%), women of birth order 3 and above (33.3%), narrow birth interval (34.8%), gestational age less than 37 weeks (72.7%), weight gain less than 6 kgs (57.7%), height less than 145cms (51.0%), weight less than 45kgs (55.2%), low hemoglobin level, less than 3 ante-natal checkups (87.5%), IFA tablets not consumed or less than 50 tablets during pregnancy (48.0%), hard physical labor during pregnancy (56.4%), tobacco chewing (44.7%), female babies (30.6%) and obstetric complications during pregnancy (50.4%). sHowever residence of mother showed any significant effect on low birth weight. Conclusion: To emphasize on need of improving ante natal coverage as well as quality of services.
EnglishLow birth weight, antenatal check up, IFA tablets, birth intervalINTRODUCTION
Children’s health is tomorrow’s wealth is one of the World Health Organization’s slogans of recent years. However, children’s health is to a great extent determined by factors that operate in utero, well before they are born. At birth fetal weight is accepted as the single parameter that is directly related to the health and nutrition of the mother, and on the other hand is an important determinant of the chances of the newborn to survive and experience healthy growth and development.[1] A multifactorial inter-relationship exists between the environment in which pregnant mothers live and the growth of the fetus.[2] This relationship has prompted public health personnel to suggest that birth weight distribution and the low birth weight babies to be considered as indicators of socioeconomic development. Low birth weight (LBW) (0.039) has no significant association with low birth weight. Table 2 summarizes low birth weight according to maternal anthropometry and Hb% level. There was statistical significant association of low birth weight with maternal height less than 145cms (χ2 = 15.82; pEnglishhttp://ijcrr.com/abstract.php?article_id=1131http://ijcrr.com/article_html.php?did=11311. Wicox AJ, Skaeven R. Birth weight and perinatal mortality. The effect of gestational age. Am J Public Health 1992; 82:378-83.
2. Makhija K, Murthy GVS, Kapoor SK, Lobo J. Socio-biological determinants of birth weight. Ind J Paed 1989; 56:639-43.
3. Harfouche JK. WHO bulletin 1979:3; 387- 403.
4. UNICEF. Childinfo, Monitoring the situation of children and women, cited April 25, 2012 available at http://www.unicef.org/infobycountry/India_sta tistics.html.
5. Trivedi CR, Mavalankar DV. Epidemiology of low birth weight in Ahmedabad. Ind J Paed 1986; 53:795-800.
6. Lt.Col Singh G, Capt. Chouhan R and Major Sidhu K. Maternal factors for low birth weight babies. Medical journal Armed Forces India, 2009; 65(1):10-12.
7. Kramer MS. Determinants of low birth weight. Methodological assessment and metaanalysis. Bull of World Health Organization 1987; 65(5): 663-737.
8. Velankar DH. Maternal factors contributing to Low birth weight babies in an urban slum community of Greater Mumbai. Bombay Hospital Journal. 2009; 51(1):26-35.
9. Sachdev HP. Low birth weight in South Asia. Int J Diab Dev Ctries 2001; 21:13-33.
10. Pachauri S, Marvah SM. Socioeconomic factors in relation to birth weight. Indian Pediatr 1970; 7:462-8.
11. International Institute of Population Sciences, National Family Health Survey, India; 2005- 06 (NFHS-3, vol1) 2007; 223.
12. Sachin S Mumbare, Girish Maindarkar, Rajesh Darade, Surekha Yenges, Madhav kumar and Kiran Patole. Maternal Risk Factors Associated with Term Low Birth Weight Neonates: A Matched-Pair-Case Control Study. Indian Pediatrics. 2011; May 30.
13. Sharma MK., Kumar D, Huria A and Gupta P: Maternal risk factors of Low birth weight in Chandigarh India. The internet Journal of Health. 2009; 9(1):DOI:10.5580/10f1
14. Negi KS, Kandapal SD, Kukreti M. Epidemiological factors affecting low birth weight. J K Science, Journal of Medical Education and Research 2006; 8(1):31-34.
15. Kamaladoss T, Abel R, Sampathkumar V. Epidemiological correlates of low birth weight in rural Tamil Nadu. Ind J Pediatr 1992; 59(3):299-304.
16. Anand K, Garg BS. A study of factors affecting Low birth weight. Indian J Com Med 2000; 25(2): 57-62.
17. Rizvi SA, Hatcher J, Jehan I and Qureshi R. Maternal risk factors associated low birth weight in Karachi: A case control study. Eastern Mediterranean Health Journal 2007; 13(6): 1343-52.
18. Roudhari M, Yaghmaer M and Soheili M. Prevalence and risk factors of low birth weight infants in Zahedan, Islamic Republic of Iran. Eastern Mediteranean Health Journal 2007; 13(4); 838-45.
19. Mavalankar DV, Gray RH, Trivedi CR. Risk factors for preterm and term low birth weight in Ahmedabad. Indian Journal of Epidemiology 1992; 21(2):263-72.
20. Kiran A, Garg BS. A study of factors affecting LBW. Indian Journal of community medicine 2000;25:57-62
21. Acharya D, Nagraj K, Nair NS, Bhat HV. Determinants of Intrauterine Growth Retardation: A Case Control Study in Udupi District, Karnataka. Indian Journal of Community Medicine.2004; 29(4):181-82.
22. Joshi HS, Subba SH, Dabral SB, Dwivedi S, Kumar D, Singh S. Risk factors associated with Low birth weight in newborns. Indian Journal of Community Medicine. 2005; 30(4): 142-3.
23. Idris MZ, Gupta A, Mohan U, Srivastava AK, Das V. Maternal health and LBW among institutional deliveries. Indian J Community Med 2000; 25(4):156-60.
24. Phaneendra Rao RS, Prakash KP, Sreekumaran Nair N. Influence of PrePregnancy Weight, Maternal Height and Weight Gain During Pregnancy on Birth Weight. Bahrain Medical bulletin 2001; 23(1):1-8.
25. Mehta A, Shukla S. Tobacco and pregnancy. J Obstet Gynaecol India 1990; 40:1556-60.
26. Felke Y, Enquoseassie F. Maternal age, parity and gestational age on the size of newborn in Addis Abab. East Africa Medical journal 1999; 76(8):468-71.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28TechnologyPREDICTIVE ANALYSIS OF SULPHUR REMOVAL BASED ON ITS AS-BENEFICIATED CONTENT AND INPUT CONCENTRATION OF ACETIC ACID DURING LEACHING
English6370T. O. ChimeEnglishAn attempt has been made to investigate the predictive analysis of desulphurization of as received iron ore using acetic acid. The investigation is based on as beneficiated iron ore content and input concentration of acetic acid. A solution of acetic acid was used for leaching the iron oxide ore and the reaction vessel containing the solution and ore was maintained at a temperature of 300C for 10 minutes. A model was derived and used as a tool for the analysis. The validity of the two-factorial model: γ = 0.6235 β3 – 1.1661 β2 + 0.5327β + θ2 – 0.081θ + 0.0005 Was rooted on the expression γ + 0.081θ - 0.0005 = 0.6235 β3 – 1.1661 β2 + 0.5327β + θ2 where both sides of the expression are correspondingly approximately equal. Statistical analysis of the results of removed sulphur from derived model and experiment for each value of the input concentration of acetic acid shows standard errors of 0.034 and 0.04% respectively. Removed sulphur per unit input concentration of acetic acid as obtained from derived model-predicted and experimental results are 0.0079 and 0.0085 %/M. The maximum deviation of the model-predicted concentration of removed sulphur iron is less than 24%, implying an operational confidence level above 76%. It is inferred that desulphurization of the iron ore is feasible under the prevailing conditions of the experiment and model analysis.
EnglishModel, Sulphur Removal, Acetic Acid Solution, Iron Ore Leaching.INTRODUCTION
Failure of steel structures in hot service conditions has awakened a lot of concern and the need to intensify research and development aimed at producing high quality defect free steel materials with admissible sulphur content. The failure of steel serving in very hot enclosure or environment resulting from the presence of a membrane of high concentration of sulphur as iron sulphide in the steel crystal has been studied (Chapman, 1972). Under this condition, the material becomes embrittled and abruptly fails due to hot shortness. Desulphurization mainly takes place at the metal-slag interface but the behavior of sulphur in the bulk of metal is also of greater importance (Nwoye,2007). In the presence of oxygen, sulphur can form oxysulphides, which have low melting point. The intergranular sulphurrich layers of the metal has been found to be soften on heating the ingots before rolling or forging, hence the bonds between the grains are destroyed and cracks can form during plastic working resulting in red shortness (Ednernal,1979). If manganese is present in steel, oxysulphide solidifies with the formation of manganese sulphide and complex sulphides preventing red shortness of the metal in hot working but impairs mechanical properties, since brittle manganous sulphides are located at the grain boundaries (Nwoye,2007). Wide applicability has been given to desulphurization of pig iron outside of or during the blast furnace operation by way of filling a ladle with the pig iron and adding to it as a single charge or in a series of smaller incremental charges, soda in granulated or powder form (Kosmider and Danckert, 1973). Application of lime in various desulphurization methods has been as a mix (lime/magnesium mix) or a lone addition. The researchers observed that usage of "fluidized" lime and magnesium not only decreases explosion risks associated with usage of calcium carbide but reduces the cost of the treatment compared to the process of using calcium carbide. This technique also has less environmental impact. The researchers also explored the potentiality of using another technique for desulphurizing pig iron which involves blow by pneumatic means lime or calcium carbide powder into the inactive pig iron in the ladle by means of an immersion lance. This complements a discontinuous method; where the pig iron to be desulphurized must first be collected in the ladle in order to desulphurize the total ladle content. Such large quantities of pig iron can be desulphurized in most metallurgical plants, however, this method is obviously relatively expensive. Kosmider and Danckert (1973) observed that the degree of desulphurization is dependent: (1) upon the quantity of the desulphurizer (kg per ton of pig iron) (2) upon the initial sulphuric content (3) upon the desired final content of sulphur in the pig iron (4) upon the grain size of the desulphurizer, (5) upon the holding time of the pig iron in the reactor and (4) upon the immersion depth of the blowing lance. Nwoye (2009) carried out gaseous desulphurization process on Agbaja iron ore using powdered potassium trioxochlorate (v) KCLO3 as oxidant. He observed that the oxygen used for the desulphurization process was gotten from the decomposition of KCLO3 . The process suggests that the mechanism of the desulphurization process involves gaseous state interaction between oxygen and sulphur through molecular combination. The results of his work reveal that simultaneous increase in both the percentage of the oxidant added and treatment temperature used are the ideal conditions for the best degree of desulphurization. The present work is to derive a model for predictive analysis of sulphur removal based on as-beneficiated sulphur content and input concentration of acetic acid during leaching of Agbaja (Nigeria) iron ore.
MATERIALS AND METHODS
The iron ore was crushed for the purpose of liberation size. Tyler standard was employed to produce particle size of 250µm. The raw Agbaja iron ore was then sent for chemical analysis using X-ray fluorescence diffraction spectrometer and atomic absorption spectrophotometer.
Scrubbing processing
Scrubbing was carried to remove argillaceous materials from the raw iron ore. The iron ore was poured into a head pan and water was poured to a reasonable level. The ore was washed and the water decanted. This was repeated for five times until clear water was observed. At this point 5g of sodium silicate and 25drops of oleic acid were sprinkled and distributed uniformly throughout the ore.20litres of distilled water was also introduced into the pan and the content mixed thoroughly. After mixing, the argillaceous materials were removed leaving behind the iron ore. The residue was washed thoroughly and was sun dried for 24hours.Some quantities were sent for chemical analysis.
Chemical leaching process
The dried scrubbed iron ore was further pulverized and sieved to obtain a particle size of 10µm. Analar grade of acetic acid solutions of different moles of 0.25M, 0.50M, 0.75M, 1.00M and1.25M were prepared. 50g of constant particle size of 10microns of scrubbed iron ore was poured into the crucible (reactor). 25ml of 0.25M of acetic acid was poured into the crucible containing the iron ore. The mixture was thoroughly mixed to ensure homogeneity. The content was allowed to leach for 10, 20, 30, 40, 50, and 60minutes at 30ºC. At the end of each period the solution was cooled and filtered. The residue was collected, washed to neutrality with distilled water, air dried and oven dried at 150ºC for 24hours. The experiment was repeated for different concentrations and temperatures of 40, 50 and 60ºC. The samples were analyzed using atomic absorption spectrophotometer and X-ray fluorescence diffraction spectrometer.
Model Formulation
Computational analysis of experimental data in Table 1 resulted to Table 3 which indicates that;
Boundary and Initial Condition
Consider iron ore (in a reactor) placed with in acetic acid solution (oxidant).The reactor atmosphere is not contaminated i.e (free of unwanted gases and dusts). Initially, atmospheric levels of oxygen are assumed (due to air in the reactor). Mass of iron oxide ore: (50g), leaching time considered: 10 mins., range of concentration of acetic acid: 0.25-1.25M, constant treatment temperature: 30oC, constant ore grain size; 10µm, were also used. The boundary conditions are: reactor oxygen atmosphere since the reactor was air-tight closed at the bottom and top of the ore particles interacting with the gas phase. At the bottom of the particles, a zero gradient for the gas scalar are assumed and also for the gas phase at the top of the particles. The reduced iron is stationary. The sides of the particles are taken to be symmetries.
RESULTS AND DISCUSSIONS
The result of the chemical analysis carried out on the beneficiated iron ore concentrate is presented in Table 1. The table shows that the percentage of total iron (FeT) in the as-beneficiated ore is 52.67%.
Furthermore, the derived model was validated by comparing removed sulphur concentrations predicted by the model and that obtained from the experiment. This was done using various evaluative techniques such as computational, statistical, graphical and deviational analysis.
Computational Analysis
Computational analysis of the experimental and model-predicted removed sulphur concentration was carried out to ascertain the degree of validity of the derived model. This was done by comparing removed sulphur concentration per unit input concentration of acetic acid evaluated from model-predicted results with those from actual experimental results Removed sulphur concentration per unit input concentration of acetic acid γR (%/ M) was calculated from the equation;
A plot of the removed sulphur concentration against input concentration of acetic acid (as in Fig. 2) using derived model-predicted results gives a slope: - 0.0079 %/ M on substituting the points (0.25, 0.0704) and (1.25, 0.0625) for (β1, γ1) and (β2, γ2) respectively into equation (6). This is the modelpredicted removed sulphur concentration per unit input concentration of acetic acid. It is important to state that the evaluated removed sulphur concentrations per unit input concentration of acetic acid obtained as slopes (from derived model-predicted and experimental results) are just the magnitude of the slopes i.e 0.0079 and 0.0085 respectively. The negative sign preceding the slopes indicates that sulphur removal decreased with increase in the input concentration of acetic acid from 0.25 to 0.75M and then increased at 1.25M. However, the removed sulphur concentration at 1.25M is lower than that obtained at 0.25M. Based on the foregoing, removed sulphur concentrations per unit input concentration of acetic acid as obtained from derived model and experiments are 0.0079 and 0.0085 %/ M respectively.
A comparison of this set of values for removed sulphur concentration (per unit input concentration of acetic acid) also shows proximate agreement and a high degree of validity of the derived model. Statistical Analysis Standard errors (STEYX)
The standard errors (STEYX) in predicting the removed sulphur concentration (using results from derived model and experiment) for each value of the input concentration of acetic acid are 0.034 and 0.04% respectively. The standard error was evaluated using Microsoft Excel version 2003.
Correlation R = √R2 ----------------------- (7)
The correlations between removed sulphur concentration and input concentration of acetic acid as obtained from derived model and experiment was calculated using equation (7) considering the coefficient of determination R2 from Figs. 1 and 2. The evaluated correlations are 0.8904 and 0.8146 respectively. The proximity in these correlations indicates significant reliability and hence validity of the model.
Graphical Analysis
Comparative graphical analysis of Fig. 3 shows very close alignment of the curves from modelpredicted removed sulphur concentration (MoD) and that of the experiment (ExD). The degree of alignment of these curves is indicative of the proximate agreement between both experimental and model-predicted removed sulphur concentration.
Deviational Analysis
Critical analysis of removed sulphur concentration from the experiment and derived model revealed deviations on the part of the model-predicted values relative to values obtained from the experiment. This is attributed to the fact that the surface properties of the iron ore and the physiochemical interactions between the ore and the acetic acid solution which were found to have played vital roles during the process were not considered during the model formulation. This necessitated the introduction of correction factor, to bring the model-predicted removed sulphur concentration to those of the corresponding experimental values.
Fig. 4 shows that the maximum deviation of the model-predicted removed sulphur concentration from the corresponding experimental value is less than 24%. The figure show that the least and highest magnitudes of deviation of the modelpredicted removed sulphur concentration (from the corresponding experimental values) are -2.78 and – 23.89 % which corresponds to removed sulphur concentrations: 0.007 and 0.0532 % and input concentrations of acetic acid: 0.75 and 0.5M respectively. Comparative analysis of Figs. 4 and 5 indicates that the orientation of the curve in Figs. 5 is opposite that of the deviation of model-predicted removed sulphur concentration (Fig.4). This is because correction factor is the negative of the deviation as shown in equations (9) and (10).
factor
It is believed that the correction factor takes care of the effects of surface properties of the iron ore and the physiochemical interactions between the ore and the acetic acid solution which have played vital roles during the process, but were not considered during the model formulation. Fig. 5
indicates that the least and highest magnitudes of correction factor to the model-predicted removed sulphur concentration are +2.78 and + 23.89%. These correction factors correspond to removed sulphur concentrations: 0.007 and 0.0532% and input concentrations of acetic acid: 0.75 and 0.5M respectively. It is important to state that the deviation of model predicted results from that of the experiment is just the magnitude of the value. The associated sign preceding the value signifies that the deviation is a deficit (negative sign) or surplus (positive sign). CONCLUSION Predictive analysis of sulphur removal during iron ore leaching was carried out based on asbeneficiated sulphur content and input concentration of acetic acid. A model was derived and used as a tool for the analysis. The validity of the two-factorial model was rooted on the expression γ + 0.081θ - 0.0005 = 0.6235 β 3 – 1.1661 β 2 + 0.5327β + θ2 where both sides of the expression are correspondingly approximately equal. Statistical analysis of the results of removed sulphur from derived model and experiment for each value of the input concentration of acetic acid shows standard errors of 0.034 and 0.04% respectively. Removed sulphur per unit input concentration of acetic acid as obtained from derived model-predicted and experimental results are 0.0079 and 0.0085 %/M. The maximum deviation of the model-predicted concentration of removed sulphur is less than 24%, implying an operational confidence level above 76%.
Englishhttp://ijcrr.com/abstract.php?article_id=1132http://ijcrr.com/article_html.php?did=11321. Chapman, W. A. P. (1972). Workshop Technology, part 1, 5th edition, Edward Arnold, London, pp. 31-51.
2. Edneral, F. P. (1979). Electrometallurgy of steel and Ferroalloys. MIR publishers, Moscow, 1, pp. 99.
3. Kosmider, H., Danckert, D. (1973). Methods for Desulphurizing Pig Iron. U. S. Patent 3715202, Application No. 05/115296.
4. Nwoye, C. I. (2008). C-NIKBRAN; Data Analytical Memory.
5. Nwoye, C. I. (2009). Process Analysis and Mechanism of Desulphurization of Agbaja Iron Oxide Ore. Journal of Metallurgical and Materials Engineering, 8:27-32.
6. Nwoye, C. I. (2007). Gaseous state Desulphurization of Agbaja Iron Ore Concentrate. Journal of Engineering and Applied Sciences,3:72-75.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241516EnglishN2013August28TechnologyA LITERATURE REVIEW ON MALWARE AND ITS ANALYSIS
English7182Aparna VermaEnglish M.S.RaoEnglish A.K.GuptaEnglish W. JebersonEnglish Vrijendra SinghEnglishMalwares are nasty software‘s .It is designed to damage computer systems without the knowledge of the owner using the system and technique advancements are posing big challenges for researchers in both academia and the industry. The purpose of this study is to examine the available literatures on malware analysis and to determine how research has evolved and advanced in terms of quantity, content and publication outlets. Most malware programs are large and complex and one can‘t possibly understand every detail. Educating the internet users about malware attack, as well as the implementation and proper application of anti-malware tools, are critical steps in protecting the identities of online consumers against malware attacks.
EnglishMalware, Internet, malware attack, forensic analysis, anti-malware toolshttp://ijcrr.com/abstract.php?article_id=1133http://ijcrr.com/article_html.php?did=1133