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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20General SciencesSYNTHESIS, CHARACTERIZATION AND EVALUATION OF ANTIBACTERIAL ACTIVITY OF COPPER(II) CHELATES OF 3-NITRO-1,5-DIARYLFORMAZANS English0107Manavjot Kaur1English Nitika2English Rajeev Sharma2EnglishCopper(II) chelates of 3-nitro-1,5-diarylformazans have been synthesized by reacting aqueous solution of copper(II) acetate tetrahydrate with methanolic solution of the ligand. The so synthesized copper(II) chelates of 3-nitro-1,5-diarylformazans were purified, crystallized and characterized on the basis of elemental analysis, IR, Electronic and EPR spectral studies, and magnetic susceptibility measurements. The studies reveal that these copper(II) chelates of 3-nitro-1,5-diarylformazans characterized as bis-chelates having 1:2 stoichiometry, are paramagnetic in character and most probably have a symmetrical six membered chelate ring structure. The anti-bacterial activity of these bis(3-nitro-1,5-diarylformazanato)copper(II) chelates has been evaluated against Escherichia coli and Bacillus subtilisby disc diffusion method and compared with standard Amoxycillin and they are found to possess potent anti-bacterial activity against selected bacterial strains. English3-nitro-1,5-diarylformazan, Copper(II), Chelates, Anti-microbial activityINTRODUCTION 3-nitro-1,5-diarylformazan ligands react with copper(II) acetate tetrahydrate in 2:1 molar ratio in methanol to yield bis(3-nitro-1,5-diarylformazan) copper(II)chelates. These compounds have been characterised by elemental analysis, IR, EPR, electronic spectral data and magnetic measurements. The studies suggest that the copper(II) chelates are paramagnetic in character and probably contain planar symmetric six membered chelate rings. The copper(II) chelates of formazans are generally prepared by reacting copper(II) acetate[1-8] or copper(II) chloride[9] with hot alcoholic solution of formazan[2-9]. There are reports in literature that certain 3-acetyl-1,5-diarylformazans[10], 3-benzyl-1,5-diarylformazans[11] and 3-ethoxycarbonyl-1,5-diarylformazans[10] react with copper(II) acetate in ethanol to give copper(II) formazan complex having 1:1 stoicheiometry. The copper(I) complex of 1,3,5-triphenylformazan has structure I, and thus the first stage in this reaction is the oxidation of formazan to tetrazolium salt by cupric ion. Subsequently, 1,3,5-triphenylformazan reacts with cuprous ion to give a copper(I) complex I, having 2:1stoicheiometry with a constitution comprising one molecule of1,3,5-triphenylformazan and one molecule of deprotonated 1,3,5-triphenylformazan, i.e. a formazylanion and one copper(I)ion. The behavior of 1,5-diarylformazans having acetyl-, benzyl- or an ethoxycarbonyl group in the3-position, with cupric ions contrasts with that of a1,3,5-triphenylformazans that the former are reported to give copper(II) complex II, having a 2:1 stoicheiometry under comparable conditions. It is a well known fact that very often the reaction between copper(I) ions and 3-arylformazan results in the formation of a mixture of copper(II) and copper(I) formazan chelates, it was thought worthwhile to investigate whether 3-nitro-l,5-diarylformazans also behave in a similar manner or not. It was also aimed to identify the products of the reaction of copper(II) with 3-nitro-1,5-diarylformazans on the basis of elemental analysis, IR, EPR, electronic spectral data and magnetic measurements. Gilroy (2008)[12] prepared complexes of (Fe3+, Co3+, Ni2+ and Pd2+) metals and used 3-substituted diphenyl formazans (3-cyano and 3-nitro formazan) as ligands. Nitika et al [13] prepared 3-nitroformazans by reacting diazotized aromatic amine with nitromethane in cold in an alkaline medium and reported them to be intra-molecularly hydrogen bonded having strongly chelated and a symmetrical structure (III). Balt et al[14] reported kinetic study of complex formation between copper(II) and 1-(2-hydroxyphenyl)-3,5-diphenylformazan in an ammoniacal ethanol-water mixture has brought evidence for a stepwise coordination of the tridentate ligand to the metal ion. Search for new metallic species with enhanced biological applications is ongoing. Among the metal ions, copper, nickel, cobalt and zinc complexes have proved to be excellent candidates. Copper complexes have shown remarkable efficiency in antioxidant[15], DNA-binding and anti-cancer studies[16-17]. In the present work an attempt has been made to synthesize copper(II) chelates of 3-nitro-1,5-diarylformazans. The so obtained chelates were characterized on the basis of elemental analysis, IR, electronic and EPR spectral studies and magnetic measurement studies. The anti-microbial activities of these copper(II) chelates have been evaluated by studying the zone of inhibition against test organisms E. coli and B. subtilis by Agar Well Diffusion method and compared with standard Amoxycillin.   MATERIAL AND METHODS Synthesis of copper(II) complexes of 3-nitro-1,5-diarylformazans: The method of preparation of one of the representative copper(II) complex of 3-nitro-1,5-diarylformazansis given below: Copper(II)acetate tetrahydrate (200 mg) was dissolved in minimum quantity of distilled water. Solution of the ligand, 3-nitro-1,5-di-p-bromo-phenylformazan(700 mg in 50 ml of methanol) was added to this. The mixture was kept undisturbed for 3-4 hours and then refluxed on water bath for 2 hours. After that the solution was concentrated and cooled by adding a few ml of distilled water. The reddish brown precipitates formed were filtered, washed with distilled water and dried. The crude complex was then column chromatographed using benzene as eluent. The brown fraction which eluted out first was collected, concentrated and re-crystallized from chloroform-hexane. The gummy impurities remained adhered to the column and could not be moved by using methanol as eluent. It was found difficult to crystallize these gummy products but these showed a negative test for copper. Nitrogen in these copper(II)chelates was estimated by Kjeldahl's method[18] and copper was estimated iodometrically[19].The results are given in Table 1. The IR spectra of these copper(II) chelates were recorded and the results are as given in Table2. EPR spectra of powdered samples of the complexes were recorded on JES-FE 3XG EPR spectrometer operating at X-band frequency (9.44 GHz), at room temperature. The magnetic susceptibility measurements for the bis(3-nitro-1,5-diarylformazanato)copper(II) complexes were made on finely powdered samples using magnetic susceptibility equipment based on Evans method and manufactured by Johnson Matthey Catalytic systems division standard procedure. µeff values calculated are reported in Table 2. EVALUATION OF ANTI-MICROBIAL ACTIVITY OF COPPER(II)CHELATES             Anti-microbial activity was studied by disc diffusion method against Escherichia coli and Bacillus subtilis, and was compared with the standard Amoxycillin. RESULTSAND DISCUSSION Elemental Analysis and Spectral Studies The elemental analysis of copper(II) chelatesof 3-nitroformazans shows that they have 1:2 stoichiometry. The lack of NH absorption band (2900-3200 cm-1) in their IR spectra as compared to those of ligands reveal that these complexes are formed by the replacement of imine hydrogen atom of formazan ring by copper(II). The bis(3-nitro-1,5-diarylformazan)copper(II) complexes are neutral and aresoluble in organic solvents. Therefore, they are not Copper(I) chelates of 3-nitro-1,5-diarylformazans. Thus, it appears that in case of 3-nitro-1,5-diarylformazans only copper(II) chelates and not a mixture of copper(II) and copper(I) chelates are formed. Having established the composition of reaction between copper(II) and 3-nitro-1,5-diarylformazans, effort was made to establish the structure of these chelates. TheνNO2(asym) and νNO2(sym) appear approximately in the samerange in the IR of these copper(II) chelates as compared to νNO2(asym) and νNO2(sym) of the corresponding ligands. Had the-NO2 group been involved in coordination with copper(II), it would lead to the linkage of the type, III or IV. In which event, the νNO2(asym) and νNO2(sym) which appear in the IR of the ligands in the range 1570-1520 cm-1 and1290-1250 cm-1 respectively would disappear and two new absorption bands in the range 1390-1360 cm-1 and 1110-1050cm-1characteristic of metal-nitrito type of linkage would have appeared, as very strong bands. No such change is observed in the IR of bis(3-nitro-1,5-diarylformazanato)copper(II) chelates. There is only a slight decrease in νN=N(sym),νN=N-C-N(sym) and νN-N=Ar of the free ligands as compared to the complexes as expected because the coordination of copper(II) with formazyl group is bound to decrease these frequencies slightly. On the basis of above IR data, the following two structures V and VI are likely.                 It is obvious from above structures VII and VIII that the stabilisation through π-electron delocalisation will be more predominant in a planar symmetric six membered ring structure, VII as compared to unsymmetric five membered ring structure VIII. This extensive π-electron delocalization in a symmetric six membered structure VII tends to favour aplanar configuration as in case of bis(1,3,5-triphenylformazan)Copper(II), bis(1,3-diphenyl-5-p-tolylformazan)Copper(II),bis(1,3-diphenyl-5-p-chlorophenylformazan)Copper(II) and bis-(1,3-diphenyl-5-o-carboxyphenylformazan)Copper(II)[28]. Also, the ring strain in five membered structure VIII, is more than in the six membered structure VII. This fact also favours a six membered structure VII in these bis(3-nitro-1,5-diarylformazan)Copper(II).             Consideration of both of these factors as mentioned above led Ermakova et al[29] to believe that bis(formazan)Copper(II) complexes have a planar symmetric sixmembered structure II,(where Ar'=p-tolyl, R=Ar=C6H5; Ar'=p-chlorophenyl, R=Ar=C6H5; Ar'=o-carboxyphenyl, R=Ar-C6H5).This was later on confirmed by X-ray studies[30].             Similar very extensive π-electron delocalisation exists in case of bis(3-nitro-1, 5-diarylformazan)Copper(II). The µeff. in case of bis(3-nitro-1,5-diarylformazan)Copper(II) complexes also fall in the range 1.8-2.23 BMas in case of bis(3-arylformazan)Copper(II) complexes (TABLE 3). Hathaway[28] has reported that in practice moments of magnetically dilute compounds of Copper(II) are in the range1.8-2.23 BM with compounds whose geometry approaches octahedral having moment at the lower end and those with geometries approaching tetrahedral having moments at the higher end, but their measurements cannot be used diagnostically with safety unless supported by other evidences. The ‘gavvalues calculated for bis(3-nitro-1,5-diarylformazanato)Copper(II) complexes reported in Table 2 are consistent with the planar structure of these Copper(II) complexes. Therefore, a planar six membered symmetric ring structure V is indicated to be the structure of bis(3-nitro-1,5-diarylformazanato)copper(II) complexes. However, this is merely a conjecture, unless X-ray studies are carried out. Results of study of antimicrobial activity of copper(II) chelates of 3-nitro-1,5-diarylformazans Different compounds were studied for zone of inhibition against the test organism E.coli and Bacillus subtilisusing Well diffusion method. The maximum activity was observed at 100% concentration of different compounds and standard Amoxycillin. The zone of inhibition of compounds is Table 4.             The study reveals that bis(3-nitro-1,5-diarylformazan)copper(II) chelates possess promising anti-microbial activity against E. coli and B. subtilis.   CONCLUSIONS From the above results it is concluded that An attempt has been made to synthesize bis(3-nitro-1,5-diarylformazanato)copper(II) complexes by reacting methanolic solution of 3-nitro-1,5-diarylformazan with aqueous solution of copper(II)acetate tetrahydrate. These chelates were found to have stoichiometry 1:2 and paramagnetic in character. These bis(3-nitro-1,5-diarylformazanato)copper(II) chelates have µeff. between 1.8-2.23 BM. All the bis(3-nitro-1,5-diarylformazanato)copper(II) complexes reported here probably have a planar six membered symmetric ring structure, as supported by their µeff.and 'gav' values. The antimicrobial activity of these copper chelates was evaluated against E. coli and Bacillus subtilis by Agar well diffusion method. The observations show that the zones of inhibition for bis-(3-nitro-1,5-di-p-chlorophenylformazanato)copper(II) against E. coli and Bacillus subtilis are good and are quite comparable to standard Amoxycillin. Englishhttp://ijcrr.com/abstract.php?article_id=105http://ijcrr.com/article_html.php?did=105 Hunter, L.; Roberts, C.B.; J.Am.Chem.Soc., 823(1941). Wizinger R.; Bird V.;Helv. Chim. Acta, 32, 901(1949). Seyhan, M.; Rev. Fac. Sci. Univ. Istanbul, 17A, 182 (1952). Ibid. 299 (1952). Wizinger R.; Herzog, H.; Helv. Chim. Acta, 36, 531(1953). Seyhan M.; Fernlius, W.C.; Chem. Bet., 89, 2482(1956). Hirsch, B.; Ann., 637, 137(1960). Petrovanu, M.; Borcea, A.; AnaleleStiint Univ.A. I. Cuza" Jasi, Sect I[N.S], 4, 157(1958); C.A. 55,452i. Lipunova, G.N.; Krylov E.I.; Bednyagina, N.P.; Sharov, V.A.;Zh. Obsch. Khim,39(6), 1293(1964). Hirsch, B.; Ann., 637, 137(1960). Hirsch,B.; Jauer, E.A.; Ann., 682, 99(1965). Gilroy JP; The design, synthesis and Chemistry of stable verdazyl radicals and their precursors; Thesis for Ph. D, University of Victoria; 2008 Nitika, Kumar S and Sharma R; Chem Sci Trans; 2014; 3(2); 670-675 Balt S; Meuldijk J; and Renkema WE; Inorg Chim Acta. 1977; 22:161-168 Ho, Y.P.; Au-Yeung, S.C.; Med Res Rev. 23,633–655(2003). Marzano, C.; Pellei, M.; Tisato, F.; Santini, C.; Agents Med. Chem., 9,185 211(2014). Ruiz-Azuara, L.; Bravo-Gomez, M.E.; Curr. Med. Chem. 17, 3606–3615(2010). Steyermark,A.I.;Quantitative Organic Micro Analysis, Academic Press, New York and London, Edition 11, p.209(1961). Jeffery, G.H.; Bassett, J.; Mendham J.; Denney, R.C.;Vogel's Text Book of Quantitative Chemical Analysis,5th Edition,p.393(1989). Koyama, H.; Saito Y.; Kuroya, H.; J. Inst. Polytechn. Osaka City Univ., 4, 43(1953). Bevan, J.A.;Graddon,D.P.; McConnell, J.F. Nature, 199, 373(1963). Figgis, B.N.; Harris, C.M.;J. Chem. Soc., 85(1959). Adams, S.G.;Tyson, G.N.;J. Am. Chem. Soc., 62L 1228(1940). Harris, C.M.;Kokot, E.; Lenzer, S.L.; Nature, 196, A71(1962). Gill, N.S.; Nyholm, R.S.; J.Chem. Soc., 3977(1959). Lyons, F.; Martin,K.V.;J.Am. Chem.Soc., 79, 1273(1959). Ermakova, M.I.; Krylov,E.E.; Postovskii, I.Ya. Zh;Obshchei.Khim, 30, 849(1960). Hathaway, B.J.;Stereochemistry and Electronic Propertiesof the Copper(II) Ion, Essays in Chem., 2, Press London, p.61-92(1971). Ibid. 299 (1952). Budesinsky, B.W.; Svec.J.; Inorg. Chem., 2, 10(1971).

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20General SciencesInvestigations on the growth, Structural, Optical, Mechanical and Cytotoxicity Properties of a Semiorganic Single Crystal: Cytosinium Nitrate English0814P. JaikumarEnglish T. BalakrishnanEnglish M. S. Mohamed JaabirEnglish S. SakthivelEnglishAim: To synthesize and grow pyrimidine based cytosinium nitrate single crystals and characterize the grown crystals for structural, optical, mechanical, dielectric and proliferation assay. Methodology Cytosinium nitrate, a semi organic material was synthesized and single crystals were grown from aqueous solution employing the technique of controlled slow evaporation. Results and Discussion: The lattice parameter of the grown crystal was determined using single crystal X – ray diffractometer. Fourier transform infrared spectral analysis is carried out to identify the functional group of the grown crystal. The grown crystals were characterized using UV – Vis – NIR and dielectric analysis. Mechanical strength was estimated using Vickers microhardness test. The crystal exhibits reverse indentation size effect and belongs to soft material category. A sharp emission peak was observed in photoluminescence spectrum at 378 nm. The anti – proliferative property of grown crystal was tested on human lung cancer cell line A549. Conclusion: All these investigations were used to reveal the properties like structural, dielectric parameters, optical, mechanical, surface morphology and biological activity. EnglishCrystal growth, Optical materials, Mechanical properties, Dielectric measurements, PhotoluminescenceIntroduction In the past few decades, there has been extensive investigation made in the design and characterization study of inorganic, organic and semiorganic nonlinear optical(NLO) materials [1]. Nonlinear optical materials are very significant because of its wide applications in the field of laser technology, laser communication, optoelectronic and photonic applications [2]. In particular organic materials possessing a large third – order non linearity have attracted many researchers owing to their potential application in optical switching and sensor protection [3]. Synthesis and characterization of novel materials for third order nonlinear optical application has gained much attention by the researchers [4]. Cytosine is one of the five main nucleic acids used in storing and transporting genetic information within a cell [5]. The single crystal structure of anhydrous cytosine [6] and cytosine monohydrate [7] was reported. Several researchers reported the single crystal structure of cytosine derivatives [8-11]. Most of these complexes are dealt with application of crystal engineering to active pharmaceutical and biological applications. The epigenetic mechanism such as methylation of cytosine in DNA was discussed by Plitta et al [12]. The molecular recognition of cytosine based on proton–transfer reaction elucidated by Portalone et al [13]. Kistenmacher et al [14] made systematic study on enzyme – metal – nucleic acid ternary complexes with cytosine. It is identified that cytosine may be an interesting material to optimize them for nonlinear optical limiting applications. Because the protonation of cytosine base pair carries important structural implications in crystal engineering. In particular the base pair ability known to self – assemble in acidic media. Though, the structure of cytosinium nitrate has been reported earlier [15], there are no earlier reports on the bulk crystal growth of cytosimium nitrate. In our present investigation we report the single crystal XRD, powder XRD, FTIR, UV – Vis - NIR optical analysis, photoluminescence, dielectric, Vickers microhardness, etching studies and proliferation Assay on cytosinium nitrate single crystal. Materials and Methods Crystal Growth Cytosine (C4H5N3O) and nitric acid (HNO3) was dissolved in deionised Millipore water at room temperature. The resultant solution was stirred well to obtain clear homogeneous solution. The prepared solution was filtered using Whatman filter paper and taken in a beaker. Beaker containing the solution was closed with perforated polythene paper and kept in an undisturbed dust free condition. Slow evaporation at room temperature yielded transparent single crystals of cytosinium nitrate (CN) of 7 mm × 2 mm × 1 mm size were harvested in a growth period of 15 days. The as grown single crystals of CN are shown in Fig. 1. Results and Discussion X – ray Diffraction Analysis Single crystal X – ray diffraction data of the grown CN crystal were collected on a BRUKER NONIUS X – ray diffractometer using monochromated Cu Kα radiation (λ = 1.5408? ) at 293K. From the single crystal X – ray diffraction analysis it is confirmed that grown CN belongs to triclinic system. The obtained cell parameters are in good agreement with the corresponding reported values of Cherouana et al. [15] as is evident from Table. 1 Powder X – ray diffraction The powder X – ray diffraction pattern of the grown single crystal of CN was recorded on a REICH SIEFERT X – ray diffractometer instrument using Cu Kα (1.540 Å) radiation employing the reflection mode for scanning. The finely crushed sample was scanned in the 2θ values ranging from 10 – 80° at a rate of 1°/min. All the observed reflection lines were indexed with the help of computer program AUTOX 93 (Fig. 2). Fourier Transform Infrared (FTIR) spectrum In order to identify the functional groups, the FTIR spectral analysis of CN was carried out in the middle infrared region extending from 400 – 4000 cm-1 using a Perkin Elmer FTIR spectrometer by KBr pellet technique. The recorded FTIR spectrum is shown in Fig. 3. In the higher energy region, the NH2 asymmetric and symmetric stretching vibrational frequencies are observed at 3342 and 3214 cm-1 respectively. The peak at 2932 cm-1 is attributed to the symmetric stretching vibration of NH.  The strong band at 1728 cm-1 is due to the C=O stretching vibration. The NH2 deformation and wagging vibrations are observed at 1665 cm-1. The intense peak at 1546 cm-1 arises due to C – NH stretching vibration. The strong band appears at 1381 cm-1 in the spectrum is assigned to C=C stretching vibration C–N stretching vibration observed at 1201 cm-1. The peak at 792 cm-1 is due to the C = O bending vibration. The peaks due to NO2 deformation are observed at 632 and 576 cm-1.   The prominent vibrational frequencies of FT-IR spectra with tentative assignments of CN crystal are listed in Table.2. Linear optical analysis The UV – Vis – NIR spectrum gives more information about the band structure and optical quality of material. The absorption or emission of radiation and cut – off wavelength of grown crystals are prime factor for optical applications [16]. The UV – visible optical transmission spectrum of CN crystal was recorded between 190 – 1100 nm using Perkin – Elmer Lambda 35 spectrophotometer. The recorded transmittance spectrum of CN single crystal is shown in Fig.4. The crystal has wide transparency in the entire UV and visible region. The CN crystal is optically transparent in the entire visible region with 97% transmittance with lower cut-off wavelength of 291 nm. The optical absorption coefficient (α) was calculated using the following relation. Where, T is the transmittance and t is the thickness of the crystal. The dependence of the optical absorption coefficient on the photon energy helps us to study the band structure and the types of transition of electrons [17]. The band gap energy of the material is calculated using the following relation Where, A is a constant, Eg is optical band gap of the crystal, h is Planck’s constant and υ is the frequency of the incident photon. The Eg could be estimated from the Tauc’s plot of variation of (αhυ)2 versus hυ and shown in Fig. 5. Eg is obtained from the extrapolation and interception of the linear part of the graph with X – axis [18]. The band gap energy was found to be 4.1eV. The extinction coefficient is an essential parameter to examine amount of absorption when electromagnetic waves propagates through a medium. The absorption coefficient (α) is related to the extinction coefficient K by K = λα / 4π Where, K is the extinction coefficient, λ is the wavelength and α is the absorption coefficient.  Fig. 6 shows that variation of extinction coefficient (K) as a function of wavelength. Fig. 6 Dependence of extinction coefficient with wavelength of CN crystal Dielectric studies The different polarization effects, relaxation phenomena and optical properties of solids can be explained by analyzing dielectric behaviour [19]. By employing the HIOKI 3536 LCR instrument the dielectric measurement were carried out on CN single crystal in the frequency region from 1 KHz to 5 MHz. Silver coated CN sample of 2mm thickness was used as the parallel plate capacitor to form dielectric medium. The capacitance of the sample was recorded by varying the frequency at different temperatures (Room temp, 50 °C, 70 °C and 90 °C). The dielectric constant of the material was calculated using equation ε´ = Cd / (Aε0). Where C is the capacitance of the sample, d is the thickness of the crystal, ε0 is the permittivity of free space (ε0 ≈ 8.854 X 10-12 F / m) and A is the area of the sample. The variation of dielectric constant with frequency of CN crystal is shown in Fig. 7. From Fig. 7 it is observed that, the dielectric constant decreases with increasing frequency and reaches a constant value. The high value of  dielectric constant at lower frequencies may be due to the contribution of all the four polarizations namely space charge, orientation, electronic and ionic polarizations and its low value at higher frequencies may be due to the loss of significance of these polarizations gradually [20]. The dielectric loss was calculated using the equation ε´´ = ε´ tan δ and the variation of dielectric loss with varying frequency is depicted in Fig. 8. From the plot one can understand that the dielectric loss decreases with increase of frequency at different temperatures. The low dielectric loss value in high frequency for the sample suggests that the crystal has good optical quality and lesser defects. Photoluminescence study Optical properties of the as grown CN single crystal were analyzed by photoluminescence spectroscopy. The near – band – edge photoluminescence of solids gives important information about the quality and composition of materials by probing the electron [21]. Photoluminescence is the absorption of photon energy promotes a valence electron from its ground state to an excited state. The excited energy is released as short wavelength light [22]. Photoluminescence of CN crystal is recorded with a Cary Eclipse fluorescence spectrometer (Type – Savitzky Golay) with auto excitation filter mode in the range 340 – 600 nm. The sample was excited at 320 nm. Photoluminescence spectrum of CN crystal is shown in Fig. 9. Spectrum shows a broad emission peaked at 378 nm which may be due to the vibrations in crystal lattice by changing incident power and sample temperature[23]. Intensity is slowly decreases in higher wavelength region. The result indicates that the emission of crystal is in violet region. The energy band gap of CN crystal has been calculated to be 3.2 eV using the formula Eg = 1240/ λ (eV) Vickers  microhardness analysis For the commercial usage and device fabrication microhardness indentation analysis play a major role for conforming the mechanical stability. Microhardness studies were carried out on flat surface of the grown crystal of CN by using Shimadzu HMV-2000 hardness tester. Several trials of indentation were carried out for different loads (5g, 10g, 25g, 50g and 100g) at room temperature. Vickers hardness number (Hv) was calculated using the relation Hv = 1.8544 P /d2 (kg/mm2), where P is the applied load in kg and d is the average diagonal length of indentation in mm. For loads above 100 g cracks started developing around the indentation impression. The variation of Vickers hardness values (Hv) with applied is shown in Fig. 10. Hardness (Hv) value increases with the increasing load. This type of variation of hardness is termed as reverse indentation size effect (RISE). In order to analyse the reverse indentation size effect (ISE), Meyers law was used by fitting the experimental data from the relation P = Adn , where P is the applied load, A is a constant, d is the average diagonal length of the indenter and n is the work hardening coefficient. By plotting log P versus log d (Fig.11), the value of work hardening coefficient (n) is calculated as 2.3. According to Onitsch [24], n lies between 1 and 1.6 for hard materials and for soft materials it is above 1.6. This implies that cytosinium nitrate belongs to soft material category Chemical etching analysis. The microstructural analysis of the grown crystal by etching the surface gives more information about dislocations, imperfections and surface morphology. Optical behaviour of the NLO material in particular nonlinear efficiency mainly depends on the quality of the crystal. So it is very essential to study the surface morphology by etching of the as-grown crystal [25]. The etching of CN crystal was carried out by using double distilled water as an etchant. The cytosinium nitrate single crystal was immersed in water for few seconds and dried with tissue paper to remove the water molecules. The etch patterns in the crystal was examined using normal incident light type microscope. The photographs of etch patterns were captured by Motic camera fitted with optical microscope. The microphotograph of CN crystal for etching time 5 s is shown in Fig. 12 (a). The figure shows predominant parallel ridges on crystal. Some of them extended over the surface while others are partly extended. Further the etching period was increased to 10 s and the etch pattern is shown in Fig. 12 (b). After etching for 10 s, the ridges were elongated in large number and forms different etch pattern. From the etching study there is such a periodicity seen in distribution of etch pattern. Proliferation Assay The synthesized cytosinium nitrate was evaluated for its anti-proliferative activity. For this, the cytosinium nitrate was tested for its anti-cancer properties on human lung cancer cell line A549. This assay was performed for determining the IC50. The cells were maintained in Dulbecco’s modified Eagle’s medium (DMEM) (Sigma-Aldrich Chemie Gmbh), supplemented with 10% fetal bovine serum (HyClone), 100IU/ml penicillin, 100mg/mL Streptomycin, and 2mmol/L L-glutamine (Sigma). Cells were seeded into 96-well plates at 5000 cells per well and incubated overnight. The medium was replaced with a fresh one containing the desired concentrations of CN dissolved in DMEM, ranging from 25µM, 50µM, 75µM, 100µM, 250µM and 500µM. Cells with cytosinium nitrate were incubated further for 24h and 48h. After treatment period, medium with cytosinium nitrate was removed and washed with 1XPBS (Phosphate buffered saline). Thereafter 100µl of MTT (3, 4, 5-dimethylthiazol-2yl)-2, 5-diphenyltetrazolium bromide)dye dissolved in serum free medium at the concentration of 5mg/mL, was added to the cells and incubated for 3h in CO2 incubator. After 3h, the medium was removed and the formazan crystals were dissolved in 100µl of acidified isopropanol. The purple color of the formazan product was read in Robonik ELISA plate reader at 570nm. The percentage of cell viability was calculated with respect to control cells cultured at conditions similar to treated cells. Triplicate was maintained for all concentrations, including control cells.  Results indicate that cytosinium nitrate in the concentrations from 25µM to 250µM did not show any anti-cancer activity. Both control and treated cells have similar optical density upto 250µM. At 500µM concentration, a drastic decrease was observed in cell viability. At 24h, the viability was about 28%, which further decreased to 23% at 48h (Fig.13). This significant decrease may be due to the change in pH of the medium. At high concentrations such as above 250 µM, the nitric acid, component of cytosine nitric acid, induce change in pH towards acidicity. Change in color of the medium from pink to colorless even before the addition of MTT reagent for the MTT assay was probably the reason of cell death and cannot be considered due to toxicity of the compound per se. Study on the pharmacological effects of bioactive compounds on cancer treatments and prevention has increased dramatically over the past few decades. Many novel compounds, complexes of metals and heterocyclic combinations have been demonstrated to be cytotoxic and to possess anti-cancer activities in various cancer cells without exhibiting significant damage to normal cells [26 – 27]. In the present investigation, there was no significant toxicity demonstrated by the cytosine derivative at lower concentrations upto 250 µM, however, toxicity at 500 µM either did not seem to be evident due to its toxic nature, but due to high acidic nature of the compound itself. Cytosine being a significant bioactive molecule in its physiological perspective, it is believed by the authors that its modification further to make it toxic may provide a potential anti-cancer related bioactive molecule. Conclusion Cytosinium nitrate single crystals of size 7 mm × 2 mm × 1 mm were grown from aqueous solution by slow evaporation technique at room temperature. The grown crystal belongs to the triclinic system with centrosymmetric space group P1. Various functional groups were present in the grown crystal was confirmed by FT IR analysis. It is evident from UV – Vis – NIR optical transmittance, the CN crystal has a wide transparency range in the entire UV visible and near infra red region. The low value of dielectric constant and dielectric loss of CN at higher frequencies revealed from dielectric measurements. The Vickers microhardness value increases with increase of load and shows reverse indentation size effect. The value of Meyer’s index n turned out to be higher than 1.6 for CN and the material belongs to soft materials category. The variation of dielectric constant and dielectric loss were studied with varying frequency at different temperatures. Etching analysis shows the presence surface dislocations in the sample. The violet emission was identified by photoluminescence spectrum. Anticancer property was tested on human lung cancer cell line A549. No significant toxicity was demonstrated even by increasing concentrations. Acknowledgement Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Financial support The author Dr. T. Balakrishnan thanks the Council of Scientific and Industrial Research (CSIR), New Delhi, India for financial support [CSIR MRP.NO.3 (1314)/14/EMR-II, Dated 16.4.14]. Conflict of interest: Nil Ethical approval: Not required Englishhttp://ijcrr.com/abstract.php?article_id=106http://ijcrr.com/article_html.php?did=106 J.Zyss, Molecular Nonlinear Optics: Materials, Physics and Devices, Academic Press, Boston, MA, 1994. P.K. Hedge, A.V. Adhikari, M.C. Manjunath, C.S. Suchand Sandeep and R. Philip, Syn. Metals. 160 (2010) 1712–1717. A. Philominal, S. Dhanuskodi and  R. Philip, Curr. Appl. Phys. 12 (2012) 401 – 404. S. Suresh, A. Ramanand, D. Jayaraman and P. Mani. Rev. Adv. Mater. Sci. 30 (2012) 175-183. L. Liu, J. Ouyang and W.R.G. Baeyens, J. Chromotogr. A. 1193 (2008) 104-108. D. L. Barker, and R. E.Marsh, Acta Cryst. 17 (1964) 1581-1587. G. A. Jeffery, and Y. Kinoshita, Acta. Cryst. 16 (1963) 20-38. B. Das, and J. B. Baruah, J. Mol. Struct. 1001 (2011) 134-138. T. Lee, and P. Y. Wang, Cryst. Growth Des.10, (20 10) 1419 – 1434. P.T. Muthiah, J.J. Robert, S.B. Raj, G. Bocelli and  R. Olla, Acta. Crystallogr. Sect.E, 5 7 (2001) m558 – m560. D.T. Qui and M. Bagieu, Acta. Crystallogr., Sect.C, 46 (1990) 1645 – 1647. B. Plitta, E. Adamska, M. Giel – Pietraszuk, A. Fedoruk – Wyszomirska, M. Naskret – Barciszewska, W. T. Markiewicz and J. Barciszewski. Eur. J. Med. Chem. 55 (2012) 243 – 254. G. Portalone and M. Colapietro, J. Chem. Crystallogr. 39(2009) 193 – 200. T.J. Kistenmacher, D.J. Szalda and L.G. Marzilli, Acta Cryst. B31 (1975) 2416-2422. A.Cherouana, K.Bouchouit, L.Bendjeddou and N.Benali-Cherif, Acta. Crystallogr., Sect.E, 59 (2003) o983 – o985. B.K. Periyasamy, R.S.Jebas, N. Gopalakrishnan and T. Balasubramanian, Mater. Lett, 61 (2007) 4246 – 4249. D. Kalaiselvi and R. Jayavel, Appl. Phys. A. 107 (2012) 93 – 100. J. Tauc, Amorphous and liquid semiconductors, J. Tauc (Ed), Plenum, New York, 1974. A.K. Chawla, D. Kaur and R. Chandra, Opt. Mater. 29 (2007) 995 – 998. S. Suresh and D. Arivuoli, J. Miner. Mater. Char. Eng. 10 (2011) 517 – 526. S.M. Dharmaprakash and P. Mohan Rao, J. Mater. Sci. Lett 8 (1989) 1167 – 1168. A. Aravindan and P. Srinivasan, Cryst. Res. Technol. 11 (2007) 1097 – 1103. G. Senthil Murugan and P. Ramasamy, Phys. B Condens. Matter, 406 (2011) 1169 – 1172. E. M. Onitsch, Mikroskopie. 95,(1950) 12-14. R. Ittyachan, P.C. Thomas, D.P. Anand, M. Palanichamy and  P. Sagayaraj, Mater. Chem. Phys. 93 (2005) 272 – 276. R.S. Katiyar, N.R. Kushwaha, R.V. Ramji Lal and N. Suryanarayana, Int. J. Agric. Cul. Sci. 4 (2009) 229 – 232. S.K. Mantena, S.D.Sharma and S.K. Jatiyar. Mol. Canc. Therp. 5 (2006) 296 – 308.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20General SciencesStresses in an Orthotropic Elastic Layer Lying Over an Irregular Isotropic Elastic Half-Space English1520Dinesh Kumar Madan1English Poonam Arya2English N.R. Garg2English Kuldip Singh3EnglishObjective: The objective is to obtain the stresses due to strip loading in orthotropic plate lying over an irregular isotropic elastic medium. Methods: Anti-plane strain problem with perfect bonding boundary conditions following by Fourier Transformation on the equilibrium equation are used to obtain the solution. The deformation field due to shear line load at any point of the medium consisting of an orthotropic elastic layer lying over an irregular isotropic elastic medium is obtained. The anti-plane strain problem with the presence of rectangular irregularity is considered. In order to study the effect of irregularity present in the medium and of anisotropy of the layer, we computed shearing stresses in both the media graphically. EnglishOrthotropic, Shear load, Anti-plane strain, Rectangular irregularityIntroduction It is well known that the upper part of the Earth is recognized as having orthorhombic symmetry. Orthorhombic Symmetry is also expected to occur in sedimentary basins as a result of combination of vertical cracks with a horizontal axis of symmetry and periodic thin layer anisotropic with a vertical symmetry axis. When one of the planes of symmetry in an orthorhombic symmetry is horizontal, the symmetry is termed as orthotropic symmetry and most symmetry systems in the Earth crust also have orthotropic orientations (Crampin1). The problem of deformation of a horizontally layered elastic material due to surface loads is of great interest in geosciences and engineering. In material science engineering, the applications related to laminate composite material are increasing. Many works related to Earth, such as fills or pavements consist of layered elastic medium. When the source surface is very long, then a two-dimensional approximation simplifies the algebra and one can easily obtain a closed form analytical solution. The deformation field around mining tremors and drilling into the crust of the Earth can be analyzed by the deformation at any point of the media due to strip-loading. It also contributes for theoretical consideration of volcanic and seismic sources as it account for the deformation fields in the entire medium surrounding the source region. It may also find application in various engineering problems regarding the deformation of layered isotropic and anisotropic elastic medium (Garg et al2, Singh et al3). The study of static deformation with irregularity present in the elastic medium due to continental margin, mountain roots etc is very important to study. Chattopadhyay4, Kar et al5, De Noyer6, Mal7, Acharya and Roy8 discussed the problems with irregular thickness. Love9 provided the solution of static deformation due to line source in an isotropic elastic medium. Salim10 studied the effect of rectangular irregularity on the static deformation of initially stressed and unstressed isotropic elastic medium respectively. The distribution of the stresses due to strip-loading in a regular monoclinic elastic medium had been studied by Madan et al11. The effect of rigidity and irregularity present in fluid-saturated porous anisotropic single layered and multilayered elastic media on the propagation of Love waves had been analyzed by Madan et al12 and Kumar et al13 respectively. Recently, Madan and Gabba14 studied two-dimensional deformation of an irregular orthotropic elastic medium due to normal line load.   In this paper, we have obtained the closed-form expressions for the displacement and shearing stresses in a horizontal orthotropic elastic plate of an infinite lateral extent lying over an irregular isotropic base due to strip-loading. Numerically, at different sizes of irregularity, we have studied the variations of shearing stresses with horizontal distance and it has been observed that the shearing stresses show significant variation with horizontal distance at the different depth levels. PROBLEM FORMULATION Consider a horizontal orthotropic elastic plate of thickness H lying over an infinite isotropic elastic medium with x1- axis vertically downwards. The origin of the Cartesian coordinate system x1, x2,x3  is taken at the upper boundary of the plate. The orthotropic elastic plate occupies the region 0≤ x1≤H  and is described as Medium I whereas the region x1>H  is the isotropic elastic half space over which the plate is lying and is described as Medium II. (Fig. 1) Suppose a shear load P  per unit area is acting over the strip |x2|≤h   of the surface x1=0  in the positive x3-  direction. The boundary condition at the surface x1=0  is   Numerical Results and Discussion In this section, we intend to examine the effect of irregularity on the stresses due to shear line load acting at any point of the orthotropic elastic layer lying over an irregular isotropic half space. For numerical computation, we use the values of elastic constants of Topaz (Orthotropic) for Medium I and the values of elastic constants of Glass (Isotropic) for Medium II given by Love9. Figures (2)-(4) and Figures (5)-(7) show the variation of shearing stresses τI31 and τI32  respectively, with horizontal distance x2  for different values of a=1, 1.2, 1.4, 1.6   and for different depth levels x1=0.5, 1, 1.5 . Figures (5)-(7) clearly show that for different values of a , the difference between shearing stresses in magnitude significantly decreases as the depth increases. Figures (8)-(10) and Figures (11)-(13) show the variation of shearing stresses τII31 and τII32 respectively with horizontal distance x2  for different values of a=1, 1.2, 1.4, 1.6 . It has been found from the Figures (8)-(10) that for different values of a, the difference between shearing stresses τII31 in magnitude significantly increases as the depth increases. Conclusions The explicit expressions for the shearing stresses in an elastic medium consisting of orthotropic elastic layer lying over an irregular isotropic half space due to shear loading has been obtained. The results obtained are useful to study the static deformation around mining tremors and drilling into the crust of the Earth. The results are also useful to study the effect of irregularity present between the layer and the half-space. Graphically, it has been observed that the difference between the shearing stresses in magnitude in orthotropic elastic layer decreases as depth increases due to irregularity present. Further, it has also been observed that in isotropic semi-infinite half-space, the difference between the stresses in magnitude increases with the increase of depth. Thus, it has been concluded that the stress distribution in a layer with irregularity present at the interface is affected by not only the presence of irregularity but also by anisotropy of the elastic medium as a result of shear load acting over the strip of an orthotropic elastic medium. Acknowledgement Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of the manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. The authors are also extremely thankful to the reviewers and editors for helping in the improvement of the paper. Englishhttp://ijcrr.com/abstract.php?article_id=107http://ijcrr.com/article_html.php?did=107 Crampin S. Geophysical Prospecting 1989; 37: 753-770. Garg NR, Madan DK, Sharma RK. Two-Dimensional Deformation of an Orthotropic Elastic Medium due to Seismic Sources. Phys. Earth Planet. Inter., 1996; 94: 43-62. Singh K, Madan DK, Goel A, Garg NR. Two-Dimensional Static Deformation of Anisotropic Medium. Sadhana(India) 2005; 30: 565-583. Chattopadhyay A, Chakraborty M, Pal AK. Effect of irregularity on the propagation of guided SH-waves. J. Mechan. Theor. Applied 1983; 2: 215-225. Kar BK, Pal AK, Kalyani VK. Propagation of love waves in an isotropic dry sandy layer. Acta Geophysics 1986; 157:157-170. Noyer JD. The effect of variations in layer thickness of Love waves. Bull. Seism. Soc. Am. 1961; 51: 227-235. Mal AK. On the frequency equation of love waves due to abrupt thickening of crustal layer. Geofis. Pure Applied 1962; 52: 59-68. Acharya DP, Roy I. Effect of surface stress and irregularity of the interface on the propagation of SH-waves in the magneto-elastic crustal layer based on a solid semi space. Sadhana 2009; 34: 309-330. Love AEH. A Treatise on the Mathematical Theory of Elasticity. Dover Publication, New York 1944. Selim MM. Effect of Irregularity on Static deformation of Elastic Half Space. International Journal of Modern Physics 2008; 22:2241-2253. Madan DK, Chugh S, Singh K. Stresses in an anisotropic Elastic Plate due to Strip-Loading. International Journal of Mechanics 2011; 5: 57-62. Madan DK, Kumar R, Sikka JS. Love wave propagation in an irregular fluid saturated porous anisotropic layer with rigid boundaries. Journal of Applied Science and Research 2014; 10: 281-287. Kumar R, Madan DK, Sikka JS. Shear wave propagation in multilayered medium including an irregular fluid saturated porous stratum with rigid boundary. Advances in Mathematical Physics 2014; 10: 1-9. Madan DK, Gabba A. 2-Dimensional Deformation of an Irregular Orthotropic Elastic Medium. IOSR Journal of Mathematics 2016; 12: 101-113.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareHemorrhagic risks associated with dental procedure in a rare case of Type II Sturge weber syndrome English2125Ashwini Nerkar1English Rajeev Gadgil2English Ajay Bhoosreddy3English Karan Shah4EnglishAim: Sturge weber syndrome (SWS) is a sporadic congenital neurocutaneous disorder. It belongs to phakomatoses group of disorders. It is basically combinations of manifestations such as port-wine stains (PWS) of the face, ipsilateral leptomeningeal angioma (cerebral malformations and tumours), glaucoma, seizures and mental retardation. Sturge weber syndrome type II have no evidence of brain involvement though it shows a vascular malformation on the face and the possibility of glaucoma. We hereby delineate a case of a female, reported with PWS and diagnosed as Type II Sturge weber syndrome. Case Report: We reported a case of a 35-year-old female who had a diffused swelling on the right maxillary region corresponding to the distribution of the cutaneous port-wine stain and glaucoma of the right eye. Positive manifestations with respect to skin, eyes and oral cavity along with negative radiographic findings, we arrived to the diagnosis of Type II Sturge weber syndrome. Discussion: Differential diagnosis of SWS includes Rendu Osler Weber syndrome, Von Hippel Lindau Disease and Maffucci Syndrome. Diagnosis is made only on the basis of clinical and imaging features. Conclusion: Dental procedures are associated with increased possibility of hemorrhage in sturge weber syndrome. Thus, doing treatment in such patients is a difficult task for oral health care practitioners. Therefore the intent of the presented case is to keep in background a clinical scenario of similar pattern, if observed, will need to be diagnosed with utmost caution prior to any dental procedure. EnglishEncephalotrigeminal angiomatosis, Ocular manifestations, Oral manifestations, Sturge weber syndrome, Vascular lesions INTRODUCTION Sturge   weber  syndrome  (SWS), also known as,  meningofacial  angiomatosis[1], encephalotrigeminal  angiomatosis [2] and encephalotrigeminal angiomyomatosis [3]   is congenital and  non-familial in its origin [4]. It belongs to syndromes of phakomatoses disorders  (mother-spot diseases) [4].It is one of the Systemic syndromes of  Phakomatoses  pigmentovascularis  (PPV) [5] and is also categorized  into neurocutaneous disorders[6].In 1860 Schirmer and in 1879 Sturge associated dermatological and ophthalmic manifestations to this neurologic condition ,which was later on accompanied by radiological alterations given by Weber.[7] The increase in the formulation of mutant Gaq  protein  is due to a somatic activating  mutation  in guanine nucleotide-binding protein alpha-q (GNAQ).This process is found to be affiliated with SWS [8].It is typically a static lesion but few cases with progressing  lesions have been  reported [9]. Estimated frequency is of 1 per 50,000 live births [10]. SWS  is characterized  by the presence  of   leptomeningeal  angiomas , PWS (sharply demarcated vascular lesions that occur unilaterally along the dermatomes  supplied by first two divisions of  trigeminal nerve), along with ocular disorders, CNS involvement and oral involvement[11].Manifestation  of  the syndrome  is due to endurant dysfunction  of  embryonal  vascular system [12] which develops during the 6th week of embryonic life[13]. Presence of only two of the positive findings i.e. presence of facial angiomas , ocular involvement such as glaucoma, which may or may not  be present, suggests diagnosis of Type II SWS. Complete absence of CNS involvement is a peculiar finding of type II SWS[14]. Manifestations such as ipsilateral  angiomatosis of lips (causing  macrochelia ) can be seen. Intraorally, gingival lesion which can be present as vascular hyperplasia or massive hemangiomatous proliferation . Also, pyogenic granulomas may be seen. Unilateral angiomatosis of  buccal  mucosa, palate, and floor of the mouth is seen on the affected side. Ipsilateral hypertrophy of alveolus, premature eruption, or delayed eruption and malocclusion are the other abnormalities reported till date[15]. Owing to its occasional  incidence and a wide  spectrum of exemplifications  in its manifestations (skin +brain +eyes +oral cavity) we report a case of a female, showing idiosyncratic illustrations of this syndrome. CASE-REPORT A 35 year old female reported with a chief complaint of pain and swelling on right mid-face region and presented with   pigmentation in the same region, which was static in size since birth. However, with increase in the age, apparent increase in the intensity of colour, from light pink to deep purplish  red was reported. Past medical history was negative with respect  to any systemic problem, seizure episodes, any drug intake, trauma or abnormality during pregnancy and delivery. No relevant family history was reported. On   extraoral examination a maculo-papular  area of deep purplish –red pigmentation  was  noticed  over right middle third of face which was unilateral and not crossing the midline.The  rash  was extending over the supraorbital region, infra-orbital region including  bridge of the nose, malar  region of cheek and the supralabial  region along with a gross enlargement of right half of the upper lip suggestive of macrochelia [Fig 1]. Patient didn’t report any bleeding, burning sensation, numbness or parasthesia in the pigmented or surrounding areas. Examination of the right eye revealed a visual acuity of no light perception, conjunctival chemosis, episcleral haemangioma with raised intraocular pressure suggestive of glaucoma.[Fig 2] On palpation, absence of  bruit or pulsation was  noticed .An  intraoral examination  revealed  erythematous, swollen and edematous gingiva involving the right maxillary arch, which was tender on palpation and soft in consistency and restricted within the midline.[Fig 3]. Similar macular purplish red patch was seen involving the right side of the buccal mucosa [Fig 4] and on hard palate extending to the midline.[Fig 6]. Patient’s oral hygiene was poor and showed chronic generalized periodontitis, spacing with maxillary anteriors and prognathic maxilla.[Fig 3]. A Lateral skull and PA  radiograph was advised to find  out presence of any tram track gyral calcifications but did not reveal any such changes.[Fig 6 a&b ]. The haemogram  of  the  patient was well within normal limits. Based upon history and clinical appearance a final diagnosis of type II SWS was given. Patient along with her family was educated and made aware about the condition and the possible complications that could arise during the necessary dental procedures. She was prescribed with antibiotics and analgesics course of 5days and advised for oral prophylaxis and extraction with all grossly carious teeth[Fig 7] followed by replacement with  fixed prosthesis. DISCUSSION According to National Institute of Neurological Disorders and Stroke, SWS is a neurological disorder. It is characterized  by a congenital facial birthmark, known as a capillary malformation and other neurological abnormalities. The other symptoms include eye and internal organ irregularities which vary in degree [15]. It has no racial or sex predilection [16]. The most apparent sign of SWS is a birthmark or PWS on the face. The PWS is due to an overabundance of capillaries just beneath the surface of the involved areas. When the port wine stain covers the eye and forehead region of the face, SWS should be considered. In rare instances, SWS is present even in the absence of the PWS [17]. SWS can be cited  as  comprehensive only when both CNS and  facial angiomas are present and is considered to be fragmentary when only one area is affected without the other .It can be classified as complete and incomplete depending on presence of facial and leptomeningeal angioma [18]. Roach developed a scale for classification which is as follows [19]. Type I - Both facial and leptomeningeal angiomas; may have glaucoma Type II - Facial angioma alone (no CNS involvement); may have glaucoma  Type III - Isolated leptomeningeal angioma; usually no glaucoma. The oral manifestations include ipsilateral PWS of oral mucosa along with the hypervascular changes. Angiomatous   lesions of gingiva which can vary from slight vascular hyperplasia to hemangiomatous proliferation. It is characterized by increase in the vascular component and gingival hemorrhage at minimal trauma [6,19,20].Gingival hyperplasia can also be attributed  to anticonvulsant medication and secondary to poor oral hygiene in mentally retarded patients. Macroglossia and maxillary bone hypertrophy have also been reported in a few cases [21]. The ocular complications manifests as glaucoma, vascular malformations conjunctiva, episclera, choroid and retina. This may produce a localized or diffuse pinkish discoloration of the bulbar conjunctiva especially in the limbus zone. [7]. Tram track calcification  caused  by in opposing  gyri, ipsilateral  calvarial thickening  and enlargement of the paranasal  sinuses and  mastoid  may be visible in skull films. Higher imaging modalities like CT for calcification and MRI for brain assessment can also be used. MRI is the current gold standard for diagnosis of this disease especially in infants [23] . Differential diagnosis of SWS includes Rendu Osler Weber syndrome, Von Hippel Lindau Disease and Maffucci Syndrome. Diagnosis is made only on the basis of clinical and imaging features [24]. Hereditary hemorrhagic telangiectasia (HHT) or Rendu Osler Weber Syndrome along with positive family history is characterized by the presence Nosebleeds (epistaxis), mucocutaneous telangiectases  and visceral arteriovenous malformation (AVM). AVM’s may be pulmonary, cerebral, hepatic, spinal, gastrointestinal and pancreatic.  The clinical diagnosis of HHT is considered definite, possible or suspected and unlikely, which depends on the number of findings present[25]. Von Hippel–Lindau disease (VHL) is an autosomal dominantly inherited disorder predispose to the development of a variety of tumours (most commonly retinal and central nervous system haemangioblastomas, clear cell renal carcinoma and phaeochromocytomas). Visceral cysts (renal, pancreatic and epididymal) are common  but rarely compromise organ function. Less frequent tumours include adrenal and extra-adrenal  pheochromocytomas , non-functioning pancreatic endocrine cancers, endolymphatic sac tumours and occasionally, head  and  neck paragangliomas [26]. Maffucci syndrome is characterized by benign enlargements of cartilage (enchondromas); bone deformities; and dark, irregularly shaped hemangiomas. There is a tendency for malignant transformation of enchondromas into chondrosarcomas or of hemangiomas into vascular sarcomas. Patients with Maffucci syndrome also are susceptible to the development of other malignant lesions such as glioma [27]. Table no 1. Demonstrates classical clinical manifestations of  SWS and of those present in our case. Our patient exhibited characteristic clinical manifestations of Type II SWS including  PWS and oral manifestations. Table 1   POSITIVE   MANIFESTATIONS  IN THE PRESENT CASE OF SWS Sr.No Manifestations seen in SWS Present case findings 1 EPILEPSY - 2 PORT WINE STAIN + 3 ABNORMAL RADIOGRAHIC FINDINGS - 4 MENTAL RETARDATION - 5 ORAL MANIFESTATIONS + 6 HEMIPARESIS - 7 OCCULAR MANIFESTATIONS +   Treatment and prognosis of SWS depends on the extent of involvement. PWS can cause severe psychological trauma to the patients and hamper their personality development. PWS can be improved by dermabrasion, tattooing and flash lamp pulse dyed lasers. Various treatment modalities like sclerotherapy, cryotherapy, laser and surgical excision have been tried with varying degrees of success to surmount intraoral lesions [28]. Dental management should be mostly stressed on preventive measures. Patients should be educated, motivated and complied to follow a strict oral hygiene regimen to prevent dental caries and secondary gingival inflammatory enlargement. These patients can undergo endodontic procedure but over instrumentation should be avoided. Gingival hyperplasia has been reported to be successfully managed with CO2 laser surgery with minimal hemorrhage[29]. It is a challenging task to carry out dental procedures in a SWS patient due to risk of severe intra- and postoperative haemorrhage. Special precautions to keep in mind in order to prevent and treat complications may include hospitalization, application of local anaesthetics with vasoconstrictors, dressings, splints[28] CONCLUSION Stupendous scope of clinical manifestations of SWS makes diagnosis a critical task. Patients affected with SWS may or may not exhibit intraoral manifestations. It is crucial for oral health care practitioners’ to have keen and deep rooted knowledge of this rare congenital disorder and exhibit surplus surveillance during routine dental procedures in order to prevent from life’s threatening   complication. Acknowledgement    Special thanks to Dr.Priyanka Vedpathak, Dr. Gaurav Verma, Dr.Manjiri Choudhary, Dr.Apurva Patil, Dr. Akansha Bhandhari, Dr. Kalyani Vaijwade and  Dr. Mala Jaisinghani for their valuable contribution. Disclosure The authors claim to have no financial interest in any company or any of the products listed in this article. Conflict of interest : All authors have none to declare   Englishhttp://ijcrr.com/abstract.php?article_id=108http://ijcrr.com/article_html.php?did=1081. Gorlin RJ, Pindborg JJ.1964. Syndromes  of  head  and  neck. New York: McGraw-Hill, pp. 406–9. 2. Welty LD.(2006) Sturge-Weber Syndrome: A Case Study, Neonatal Network:® The Journal of Neonatal Nursing 25(2):89-98 3. Suman Bhagat, Garima Gupta, Sohan Singh.(2015) Unusual presentation of sturge weber syndrome, Journal of case reports 5(1):111-11 4.Ravala Siddeswari, Siddula Manohar, Thatikala Abhilash.(2014) Sturge-Weber syndrome, Journal of Medical & Allied Sciences 4( 2 ): 88-90. 5. Sumit Sen, Sanchaita Bala, Chinmay Halder, Rahul Ahar, Anusree Gangopadhyay. (2015) Pigmentovascularis Presenting with Sturge?Weber Syndrome and Klippel Trenaunay Syndrome, Indian Journal of Dermatology 60(1) 6.Neville BW, Damm DD, Allen CM, Bouquot JE .2009. Oral and Maxillofacial Pathology, 3rd ed, St. Louis: Elsevier. 7. Neto FXP, Junior MAV, Ximenes LS, de Souza Jacob CC, Junior AGR, Palheta ACP.(2008) Clinical Features of Sturge-Weber Syndrome, Intl Arch Otorhinolaryngol  12(4):565-70. 8. Anne-Sophie Dutkiewicz, Khaled Ezzedine, Juliette Mazereeuw-Hautier, Jean-Philippe Lacour, S_Ebastien Barbarot, Pierre Vabres, Juliette Miquel, Xavier Balguerie, Ludovic Martin,  Franck Boralevi, Pierre Bessou, Jean-Franc¸ Ois Chateil, And Christine L_Eaut_E-Labr_Eze.(2015) A prospective study of risk for sturge-weber syndrome in children with upper facial port-wine stain, J am Acad Dermatol. 9.  Asdullah, Arti S. Sachdev, K.Srinivas, P. Ratnakar.(2015) Sturge-weber syndrome : A case report, University J Dent Scie,1(2) 10. Haslam R.1996 Neurocutaneous syndromes. In: Nelson WE,BehrmanRE, Kliegman RM, Arvin AM, eds. Nelson textbook of pediatrics,15th ed. Philadelphia: W. B. Saunders,1707-9. 11.  Natarajan Mannivanan, Subramanium Gokhulathan, Ramakrishna Ahathya, Gubernath, Rajkumar Daniel, Shanmungasundaram.(2012)Sturge –weber syndrome, J Pharm Bioallied Sci 4(Suppl 2): S349–S352. 12. Nathan N, Thaller SR.(2006) Sturge-Weber syndrome and associated congenital vascular disorders: A review, J Craniofac Surg 17:724-8. 13. Comi AM.(2007) Update on Sturge-Weber syndrome: Diagnosis, treatment, quantitative measures, and controversies, Lymphat Res Biol 5:257-64. 14.Bhansali RS, Yeltiwar RK, Agrawal AA.(2008) Periodontal management of gingival enlargement associated with Sturge-Weber syndrome, J Periodontol 79:549-55 15.Chaundhary SC, Sonkar SK, KumarV, Golchha S.(2011)Sturge Weber Syndrome, J Associ Physicians India 59:327-9 16.Khan AN, Turnbull I, Macdonald S, et al. Sturge Weber Syndrome. Available from: http:// emedicine.com 17.The Sturge Weber Foundation: http://www.sturge-weber.org 18.  Ankita Pandey, Prasad Yeshwant Deshmukh, Balaji Jadhav, Y. S. Nandanwar.(2015)   A rare case of pregnancy with Sturge-Weber syndrome ,Int J Reprod Contracept Obstet Gynecol 4(3):866-868 19. Mustapha adekunle fatai, Adebanjo Oluyemi mary and Aadebimpe Oluwafisayo adenike.(2015) Case Report  Sturge-Weber Syndrome: A Case Report in a 39 Yr- Old Man with Delayed Diagnosis , Austin J Clin Neurol 2(6): id1049 20. Paller AS.(1987)The Sturge Weber Syndrome. Pediatric Dermatology 4(4):300-4. 21.Khambete N, Risbud M, Kshar A.(2011) Sturge-Weber Syndrome: A Case Report,International Journal of Dental Clinics 3(1):79-81. 22. Solmaz Abdolrahimzadeh, Vittorio Scavella, Lorenzo Felli, Filippo Cruciani,Maria Teresa Contestabile, and Santi Maria Recupero.(2015) Review Article Ophthalmic Alterations in the Sturge-Weber Syndrome, Klippel-Trenaunay Syndrome, and the Phakomatosis Pigmentovascularis: An Independent Group of Conditions?,Hindawi Publishing Corporation BioMed Research International Volume 23. Wahab Arif, Wahab Shagufta, Khan Rizwan Ahmad, Goyal Ruchi, Dabas Nisha(2008) Sturge Weber Syndrome: A Review Bombay Hospital Journal 50(1):55-58. 24. Godge P, Sharma S, Yadav M, Patil P, Kulkarni S.(2011) Sturge Weber syndrome: A case report, Rev Odonto Cienc 26(4):366-369. 25. Sadick H, Sadick M, Gotte K, Naim R, Riedel F, Bran G, et al.(2006) Hereditary hemorrhagic telangiectasia: an update on clinical manifestations and diagnostic measures ,Wien Klin Wochenschr 118:72–80. 26.Maher ER, Yates JRW, Harries R, et al.(1990) Clinical-Features and Natural-History of von Hippel-Lindau Disease, Quart J Med 77:1151–1163. 27. Elston JB, Payne WG.(2014) Maffucci syndrome. Eplasty 14(ic1):1. 28. D. E. C. Perez, J. S. Pereira Neto, E. Graner, M. A. Lopes.(2005) Sturge–Weber syndrome in a 6-year-old girl, International Journal of Paediatric Dentistry 15:131-135. 29. Darbar UR, Hopper C, Spoight PM.(1982) Combined treatment approach to gingival over growth due to drug therapy, J Clin Periodontol  23: 940

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareStudy of Serum magnesium levels in Type -2 Diabetes Mellitus English2628Siddanagouda Biradar1English Shivraj Patil1English Deepak Kadeli1EnglishBackground The global burden of diabetes and its related complications is growing at an unprecedented level. India has the highest no of diabetics in the world. Various modalities of treatment are being explored to retard the progression of the disease apart from the traditional hypoglycemic agents. Newer theories have tried to link elements like magnesium and Vitamin D to the glucose metabolism. This study tries to associate deficiency of magnesium levels with the risk of diabetes mellitus. Objectives To compare the levels of serum magnesium in patients with type 2 diabetes mellitus and normal healthy individuals and a correlation of these values with the glycemic control. Materials and Methods It is an observational study done comparing the magnesium levels in 50 patients with diabetes with 50 matched healthy individuals. Results The mean FBS levels among cases and controls were 230. ±17.8 mg/dl and 99.42±25.4 mg/dl respectively. The mean serum magnesium levels among diabetic group and control group were 1.67±0.37 mg/dl and 2.03±0.25 respectively, the difference being statistically significant (pEnglishHypomagnesemia, Diabetes mellitus, Glycemic controlIntroduction There has been increased interest about the role of magnesium ion in the pathogenesis of diabetes mellitus particularly the progression of the disease. Studies have associated hypomagnesaemia occurring at an increased frequency among patients with diabetes Mellitus compared with their counterparts without diabetes. Although diabetes is known to induce hypomagnesaemia, magnesium deficiency has also been proposed as a risk factor for diabetes mellitus type 2. Lower than normal levels of magnesium occurs at an incidence of 13.5 to 47.7% among diabetes patients. Hypothesis explaining this deficiency include  decreased dietary intake, altered insulin metabolism, glomerular hyperfiltration, osmotic diuresis, autonomic dysfunction, recurrent metabolic acidosis, hypophosphatemia, and hypokalemia. In diabetics  hypomagnesaemia is more commonly linked to those subset who have poor control of sugars, atherosclerotic arteries specifically coronary arteries, hypertension, micro and macro vascular complications like diabetic retinopathy, nephropathy, neuropathy, and foot ulcerations. It has been postulated that the increased incidence of hypomagnesaemia among diabetics is multifactorial.1 many studies have suggested that magnesium supplementation has a beneficial effect on insulin action and glucose metabolism in diabetics.2 Low serum magnesium levels have been reported in type 1 and type 2 diabetes mellitus regardless of the type of therapy.3  To compare the levels of serum magnesium in patients with type 2 diabetes mellitus and normal healthy individuals and a correlation of these values with the glycemic control. Materials and Methods  The study was conducted in medical college hospital and research and research center in Vijayapur.A total of 50 cases of type-2 diabetes mellitus were included in the study after satisfying the inclusion and exclusion criteria. 50 non diabetic patients were included as controls.  The inclusion criteria included patients diagnosed as diabetes mellitus as per WHO  criteria.Patients excluded from this study were those diabetics who had associated hypertension, gastrointestinal disorders, impaired renal function, alcoholism, pancreatitis, other endocrinal disorders, those on diuretic therapy  and aminoglycosides. Fasting blood samples were collected for glucose levels. Serum magnesium and creatinine levels were also done in both groups of patients. Serum magnesium was measured by Calmagite endpoint method.4, 5 The Data was analyzed using z test and chi square test. Results The mean age of the patients in diabetic group was 55.42±12.65 years whereas in controls it was 55.58±12.84 years. Both among the cases and controls the sex distribution was same i.e. 62% males and 38% females. The maximum numbers of patients were in the age group of 41-50 years (42%). The mean FBS levels among cases and controls were 230. ±17.8 mg/dl and 99.42±25.4 mg/dl respectively. The mean serum magnesium levels among diabetic group and control group were 1.67±0.37 and 2.03±0.25 mg/dl respectively (Table 1), the difference being statistically significant (pEnglishhttp://ijcrr.com/abstract.php?article_id=109http://ijcrr.com/article_html.php?did=109 Pham PC1, Pham PM, Pham SV, Miller JM, Pham PT.Hypomagnesemia in patients with type 2 diabetes.Clin J Am Soc Nephrol. 2007 Mar;2(2):366-73. Epub 2007 Jan 3. Nadler JL, Malayan S, Luong H, Shaw S, Natrajan RD, Rude RK. Intracellular free magnesium deficiency plays a key role in increased platelet reactivity in type 2 diabetes mellitus. Diabetes Care 1992; 15: 835-41. Riduara RL, Stamfer MJ, Willet WC, et al. Magnesium intake and risk of type 2 diabetes mellitus in men and women. Diabetes Care 2004; 27:134-140. Glindler EM, Hetti DA. Colorimetric determination with bound ‘calmagite’ of magnesium is human blood serum. Clin Chem 1971;17:662. Tietz NW. Textbook of Clinical Chemistry. 3rd edition, Burtis CA, Ashwood ER (Eds.), WB Saunders 1999:p. 1034-36, et. 1408-10. Huerta MG, Holmes V F, Roemenich J N, et al. Magnesium deficiency is associated with insulin resistance in obese children. Diabetes Care 2005; 28: 1175-1181. Jain AP, Gupta NN, Kumar A. Some metabolic facets of magnesium in diabetes mellitus. J Asso phys Ind 1976; 24:827-830. Riduara RL, Stamfer MJ, Willet WC, et al. Magnesium intake and risk of type 2 diabetes mellitus in men and women. Diabetes Care 2004; 27:134-140. Nagase N. Hypertension and serum magnesium in the patients with diabetes and coronary heart disease. Hypertens Res1996 ;19:65-68. Lennon EJ, Lemann J Jr, Piering WF, Larson LS. The effect of glucose on urinary cation excretion during chronic extracellular volume expansion in normal man. J Clin Invest 1974;53(5):1424-33. Rodriguez-Moran M, Guerrero-Romero F. Oral magnesium supplementation improves insulin sensitivity and metabolic control in type 2 diabetic subject: a randomized double-blind controlled trial. Diabetes Care 2003;(4):1147-52. Linderman RD, Adler S, Yeingst MJ, Beard ES. Influence of various nutrients on urinary divalent cation excretion. J Lab Clin Med 1967;70(2):236-45.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareMeasurement of Renal Length and Width in Healthy Adults and Their Association with Various Parameters English2932Subodh Kumar Yadav1English Renu Yadav2English Sunil Chakradhar3English Abhishek Karn4EnglishObjective: To find out the renal length and width in the studied Nepali healthy individuals; to see whether they have any association with the age, gender, height, weight and BMI (Body Mass Index). Methods: Ultrasonographic measurement of renal length and width were taken in 110 healthy persons (57 males and 53 females) who were screened for presence of any renal anomaly. Height and weight of these individuals were measured and BMI was calculated. The significance of linear association between variables was tested using Pearson’s correlation coefficient where p < 0.05 was considered significant and regression equation derived. Results: The mean renal length for the right and left kidneys were 9.77 ± 0.98 cm and 9.94 ± 0.86 cm. respectively. The mean renal width for the right and left kidneys were 4.08 ± 0.63 cm 4.18 ± 0.86 cm respectively. The renal length had statistically significant association with the weight (p < 0.01) and BMI (p < 0.01) but not with the age, sex and height of the individuals. Conclusions: The renal length and width in this population was lesser than the reference values in international literature and the renal length had significant association with the weight and BMI of the individual. Also, in forensic practice if a dismembered body with intact kidneys is found, estimation of the weight of the individual can be done in this population.. EnglishKidney, Ultrasonographic, Weight, Age, GenderIntroduction The renal size is a vital diagnostic concern in urological and nephrologic practice when assessing patients likely to have renal disease. The standard anatomy text-books regards the adult kidney to be 12 cm long and 6 cm wide, 1 research articles however suggests the renal length and width to differ between ethnic groups and according to body size, age, gender and body mass indexes.2-7 Therefore, discerning the normal population specific reference values of normal kidney is imperative to assess any alterations that might happen in that population. Patients with renal problems typically go through ultrasonography of their kidneys which being simple, cost-effective, and harmless; having very petite interobserver changeability endows the doctor with crucial anatomical facets of the kidneys.8-11 Renal length and width are significant clinical factors in the assessment of patients having various renal diseases, 12 still there are very few studies essentially devised to evaluate renal dimension in healthy adults without any renal disease.13, 14 Nevertheless, few researchers have given the ultrasonographic reference values for renal length in healthy individuals15-17 but such studies are lacking in Nepal. Though population based large studies are needed to ascertain the normal reference values for Nepalese individuals, in this study we determined the ultrasonographic renal length and width in a group of healthy individuals with no known renal disease and assessed the effect of age, gender, height, weight and BMI which will be valuable radiologically while investigating renal disease in this population and forensically in cases where dismembered body parts are found and identification of the individual is to be made. Materials and Methods The ultrasonographic measurement of renal length and width were taken in 110 healthy persons aged 15-80 years from 1st October 2015 to 31st October 2016 who were screened for presence of any renal anomaly in the department of Radiology at Nobel Medical College and Teaching Hospital, Nepal. Ethical clearance was obtained from the Institutional Review Committee of Nobel Medical College. Only asymptomatic patients having normal serum creatinine level and normal calculated creatinine clearance using the Cockroft-Gault formula to establish the estimated glomerular filtration rate18 were chosen and individuals having any disease that could affect renal length and width were excluded. A general physical examination of these individuals was performed and vital parameters like respiratory rate, pulse rate, systolic and diastolic blood pressure recorded. The weight of the individuals was taken on a digital scale whilst dressed in an examination gown over undergarment, and height was measured using a wall-mounted measuring scale with the patient standing barefoot. Body Mass Index (BMI) was determined with the height and weight of the individuals. Digital renal ultrasound was performed with a “SIEMENS ACUSON X 300 Ultrasound System” (Simens Healthineers). Highest frequency curved linear array probe possible was used and scanning was initiated with 7MHz and worked down upto 2 for hefty individuals. The depth of penetration required was evaluated and adapted. The renal dimensions measured include length (distance pole to pole) and width (transversal axis) in centimeters. All ultrasonographic assessments were carried out by one experienced radiologist to eliminate inter-observer disparity. Statistical Method: The obtained data were statistically analyzed using the SPSS® for Windows, Version 17.0.  Continuous variables means were evaluated using the Student t test. Regression equations and coefficients of correlation were obtained for each pair of variables. In order to find the association of renal length and width of the individual with age, gender, height, weight and BMI, the significance of linear association between variables was tested using Pearson’s correlation coefficient where p < 0.05 was considered significant. Results Out of the entire 110 individuals, 57 were males and 53 females. The mean age was 35.58 ± 15.45 years; 37.66 ± 17.44 years for males and 33.33 ± 12.76 years for females. The mean right kidney length was 9.77 ± 0.98 cm and that for left was 9.94 ± 0.86 cm. The mean right kidney width was 4.08 ± 0.63 cm and that for left was 4.18±0.86 cm. When the observed parameters were compared between males and females (Table 1), it was found that the only parameters to show significant differences were weight and height. Though not significantly, but the length of female kidneys were lesser than the male kidneys. Table 1 Statistical significant difference in kidney length and width between right and left side was not found. The right and left renal length had a significant correlation with weight (for right kidney R score = 0.32, p < 0.01; for left kidney R score = 0.81, p < 0.01) but not with height (R score = 0.18, p = 0.059) and age (R score = 0.02, p = 0.86). Fig.1 and Fig. 2 shows scatter diagrams of mean right and left renal length with body weight respectively. The left renal length had more significant correlation with weight as compared to left renal length’s correlation with weight. The BMI being dependent on body weight, showed a correlation with renal length (p < 0.05). Linear regression equations for predicting variable (renal length) from independent variable (body weight) were obtained as follows: Right Renal Length = 0.025 × Body weight + 7.887; and Left Renal Length = 0.058 × Body weight + 5.703. Figure 1 Figure 2 Discussion Our study faction of 110 individuals showed a mean kidney length of 9.85 ± 0.92 cm and width of 4.13 ± 0.74 cm. This shows that this group had mean renal length and width smaller than reference values presented in international literature, probably an expression of the comparatively smaller body size. The significant correlation of renal length with body weight that has been found in our study has also been observed in previous studies.19-21 A likely rationalization is based on Brenner&#39;s principle of right renal dosing which states that bigger body mass requires a bigger nephron dose to meet its metabolic demands21-24 and hence a bigger kidney. In clinical practice, the body weight can be easily recorded and right and left renal length can be easily calculated by our regression equation to compare the actual renal length with the renal norm in this population, even in rural areas where ultrasonographic facilities are not available. In forensic practice, at times, dismembered body parts may be brought for identification of that individual. If right and/or left renal length is known, then the body weight of that individual can be estimated by our regression equation in this population which will be of immense help to the forensic experts in identification of that individual. The finding that there is no significant difference in renal length between males and females is consistent with other studies.21, 25 Though, some studies reveal renal length to be greater in males19, 20 but statistically significant difference will not be found if males and females of comparable body weights are analyzed. A preliminary study done in Nepalese population found the length and width of the right kidney to be 85.25 ± 10.7mm. and 50.65 ± 5.8mm. and that of the left 91.65 ± 9.2mm. and 53.65 ± 5.2mm. respectively.26 Our finding is not in accordance with this study because this study was done in normal-appearing formalin-preserved adult kidneys using a sliding caliper for measuring the length and width. In our study, the height of the person had no correlation with renal length. The limitation of our study was that it did not reflect on parameters like race, culture, ethnicity and socioeconomic status, and owing to the small sample size, our study does not represent the whole Nepalese population. Population-based larger studies are required to ascertain the normal values for Nepalese. Conclusion This study has given measurements of normal renal length and width in the studied Nepali population. We state that the mean renal length and width in this population was lesser than the reference values presented in international literature and the renal length increased significantly with the weight and BMI of the individual. Renal length can be estimated quickly by measuring the body weight and applying our regression equation even in the absence of ultrasonographic facilities in rural areas. Also, in forensic practice if a dismembered body with intact kidneys is found, we can estimate the weight of the individual in this population which will help in the identification of that individual. A large population based study is required to ascertain reference ranges of renal dimension in Nepal. Acknowledgement Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Ethical Clearance Ethical clearance was obtained from the Institutional Review Committee of Nobel Medical College and Teaching Hospital, Biratnagar-5, Morang. Source of Funding None declared. Conflict of interest None declared. Englishhttp://ijcrr.com/abstract.php?article_id=110http://ijcrr.com/article_html.php?did=110 Williams PL. Grays Anatomy. 38th ed, U.K. Churchill Livingstone, 1995. Shcherbak Al. Angriographic criteria in the determination of indications for organ preserving surgery in renal artery occlusion. Klin. Khir., 1989;2:5 Guzman RP, Zierler RE, Isaacson JA, el al: Renal atrophy and arterial stenosis. A prospective study with duplex ultrasound. Hypertension. 1994:23:346-347. Emamian Sa, Nielsen MB. Pedersen iF, et al. Kidney dimensions at sonography. Correlation with age, sex and habitus in 665 adults volunteers. Am. J. Rocntgenol., 1993:160:83-84. Odita JC. Ugbodaga Cl. Roentgenologic estimation of kidney size in adult Nigerians. Trop. Geogr. Med., 1982:34:177-179. Sainpaio EJ. Mandarun de Lacerda Ca, Morphometry of the kidney. Applied study in urology and imaging. J. Urol. Paris. 1989:95:77-78. Wang F, Cheok SP. Kuan BB. Renal size in healthy Malaysian adults by ultrasonography. Med. J. Malaysia, 1989:44:45-46. Noble VE, Brown DF: Renal ultrasound. Emerg Med Clin North Am 2004;22:641-659. Rosenberg ER: Ultrasonographic evaluation of the kidney. Crit Rev Diagn Imaging 1982;17:239-276. Emamian SA, Nielsen MB, Pedersen JF: Intraobserver and interobserver variations in sonographic measurements of kidney size in adult volunteers. A comparison of linear measurements and volumetric estimates. Acta Radiol 1995;36:399-401. Hergesell O, Felten H, Andrassy K, et al: Safety of ultrasound-guided percutaneous renal biopsy-retrospective analysis of 1,090 consecutive cases. Nephrol Dial Transplant 1998;13:975-977. Binkert CA, Debatin JF, Schneider E, Hodler, et al: Can MR measurement of renal artery flow and renal volume predict the outcome of percutaneous transluminal renal angioplasty? Cardiovasc Intervent Radiol 2001;24:233–239. Sienz M, Ignee A, Dietrich CF: Sonography today: reference values in abdominal ultrasound: aorta, inferior vena cava, kidneys. Z Gastroenterol 2012;50:293-315. Barton EN, West WM, Sargeant LA, et al: A sonographic study of kidney dimensions in a sample of healthy Jamaicans. West Indian Med J 2000;49:154-162. Brandt TD, Neiman HL, Dragowski MJ, et al: Ultrasound assessment of normal renal dimensions. J Ultrasound Med 1982;1:49–52. Thakur V, Watkins T, McCarthy K, et al: Is kidney length a good predictor of kidney volume? Am J Med Sci 1997;313:85–89 Allan P: The normal kidney. In: Clinical Ultrasound: A Comprehensive Text, 2nd Ed., edited by Meire H, Cosgrove D, Dewbury K, Farrant P, New York, Churchill Livingstone, 2001, pp 513–528 O&#39;Neill WC: Sonographic evaluation of renal failure. Am J Kidney Dis 2000;35:1021-1038. Buchholz NP, Abbas F, Biyabani SR, et al: Ultrasonographic renal size in individuals without known renal disease. J Pak Med Assoc 2000;50:12-16.  Wang F, Cheok SP, Kuan BB: Renal size in healthy Malaysian adults by ultrasonography. Med J Malaysia 1989;44:45-51. El-Reshaid W,  Abdul-Fattah H. Sonographic Assessment of Renal Size in Healthy Adults. Med Princ Pract 2014;23:432–436. Otiv A, Mehta K, Ali U, et al: Sonographic measurement of renal size in normal Indian children. Indian Pediatr 2012;49:533-536. Brenner BM, Lawler EV, Mackenzie HS: The hyperfiltration theory: a paradigm shift in nephrology. Kidney Int 1996;49:1774-1777. Luyckx VA, Brenner BM: Low birth weight, nephron number, and kidney disease. Kidney Int Suppl 2005;97:S68-S77. Luyckx VA, Brenner BM: The clinical importance of nephron mass. J Am Soc Nephrol 2010;21:898-910. Ray B, Gupta N, Ghosh S. Renal dimensions in Nepalese population: a preliminary study. Nepal Med Coll J. 2004 Dec;6(2):119-122.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareCurrent concepts of SEAS (Scientific Exercise Approach to Scoliosis): Adolescent Idiopathic scoliosis (AIS) English3337Mudasir Rashid Baba1English Ravindra Mohan Shenoy2English Ajith Soman3EnglishAdolescent Idiopathic scoliosis (AIS) is a habitual curvature of spine with unknown aetiology with an approximately of 5% of incidence rate. Prevalence ratio in females is well known. Literature reports have tried to explain the Prevalence in selected populations, possible ways of legacy, related to nutritional deficiency, environmental stress and over physical stress which may be a character for the evolution to the irregularity of the spine. SEAS “Scientific Exercise Approach to Scoliosis”, is a potent modern neurophysiologic approach designed to stimulate the reflex and to improve the functioning of spinal musculature. It is employed in idiopathic scoliosis with low-medium degree curves below 200 during growth attempting to minimize the progression of Cobb angle. The mean of this paper is to review and update concepts of determined self-correction approach carried out without external aid in group settings with the assistance of trained family members and teachers. EnglishScoliosis, Risk factors, Screening, SEASINTRODUCTION: Idiopathic scoliosis is a pathological entity of unknown aetiology. It was first described by Hippocrates, the term “idiopathic scoliosis” was probably presented in the mid of the nineteenth century by Bauer; the term was used by Nathan in 1909, Whitman defined it in 1922, Cobb put the term in his classification, and promoted by the Scoliosis Research Society1. Idiopathic scoliosis is classified into three types: infantile, juvenile and adolescent idiopathic scoliosis. The age at which the scoliosis manifest determines the variability between the three types. The infantile type occurs from birth till 3 years, the juvenile type from 4 to 9 years of age, and the adolescent type from 10 to 16 years of age.   The other types of scoliosis are composed of neuromuscular scoliosis and congenital scoliosis. Neuromuscular scoliosis which can occur with neuropathic or myopathic conditions, like cerebral palsy, poliomyelitis and Duchene Muscular disease. Congenital scoliosis on the hand develops due to the vertebral anomalies that occur during pregnancy. Vertebrae usually have minimum of three growth zones2. The presence of neural stem is associated with the growth of posterior arch and is different than the growth of vertebral body which is similar to growth of long bones. Vertebral bodies start to ossify in the third month of intrauterine life. All vertebrae other than C1, C2 and sacrum ossify from three primary ossification centres. Ossification begins in the lower thoracic and upper lumbar spine and passes on to both the cranial and caudal direction3 .Once the primary centres appear in the vertebral arches, the primary ossification centres of the vertebral bodies appear successively within the cervical spine. The ossification of vertebral body starts in the lower cervical spine (C6 and C7). The human skeleton consists of two rapid growth periods, the first one ranging from birth to 5 years and the second one during the onset of puberty2. The standing height at birth is about 30% to that of final height of an individual. The spine makes up to 60% of the sitting height, whereas the head represents 20% and pelvis the remaining 20%. The average sitting height varies from 34cm at birth, 62cm at the age of 5 years, whereas the height reaches 88cm for women and 92 cm for men at maturity4. The spine length triples from the time of birth until adulthood. The length of vertebral column (C1 to sacrum) is around 24 cm at birth. The length of average adult spine averages 70cm in men and 65cm in women at maturity. The vertebral column comprises of 12cm of cervical spine, 28cm of thoracic spine, 18cm of lumbar spine and 12cm of sacrum. FORMATION OF SCOLIOSIS: Idiopathic scoliosis has been identified to be related with hypokyphosis; which is thought to be the result of a disproportional growth of anterior and posterior structures. This theory states that the growth of anterior structures overpower the growth of posterior structures, and as a result forward bending causes the bodies of vertebrae at the apex to have a tendency to move out of the way by turning to the side5 There was no considerable difference in the length of thoracolumbar spine on radiographs of patients with idiopathic scoliosis as compared to those of controls, but the girls with scoliosis, at the time of puberty showed a faster spinal growth, the growth starting one year ahead to those of controls6 The girls with idiopathic scoliosis have been proved to have a propensity to be taller and leaner than their peers. The children with scoliosis have been identified to have more slender and longer spine than those with no scoliosis. The pattern of spine has been implicated towards column-buckling. Early adolescence stage has been seen to have a tendency towards fast growth, just when chances of scoliosis are high, it is suggested that the buckling of spine during growth results in failure of posterior ligaments to grow in response to the anterior growth and results in spinal lordosis. The vertebrae belonging to the segment of lordosis translate to the side and result in scoliosis during forward bending7 BIOMECHANICAL CONSIDERATIONS: Over the past few decades various studies have proposed the role of the paraspinal muscles in the mechanism of Adolescent Idiopathic Scoliosis (AIS). Controversies among authors prevails regarding the onset of AIS is a result of the faulty musculature or the actual changes in the muscles are due the structural changes that predispose the muscle pathology8. Several studies included about the muscle related to other segments particularly those in pelvic and shoulder girdle region. Very few evidences are there sighting such consequences of AIS on the structures. The action of scapular muscles using surface electromyography, revealed that there was a delay in activation of superior and inferior trapezium, the serratus and anterior deltoid muscles in individuals with AIS9 The involvement of hip musculature by evaluating flexor and extensor group in patients with AIS. The study concluded that there was alteration of flexors and extensors hip muscles like rectus femoris, ilipsoas and gluteus maximus. With left lumbar curvature, flexors of right hip and extensors of left hip were found to be increased in strength. With right lumbar curvature flexors of left hip and extensors of right hip were found to be increased in strength8 In a morphologic and morphometric study involving 15 cases of AIS, myopathic changes and a marked reduction in type II fibers was found only on the concave side suggesting AIS to be a diffuse disease process and may be considered basically as a muscle at fault10 A comparative study was carried out to find the functional changes in muscles of patients of AIS and healthy individuals during functional tasks by electromyography. They found that quadratuslumborum, gluteus medius, gluteus maximus and abdominals has decreased strength in both group. In the AIS group there was increased activity of erector spinae and quadratuslumborum with no marked differences between concave and convex side. Thus it was suggested that some compensatory mechanism plays a major role to maintain the stability among muscles due to the structural changes suffered in scoliosis11 RISK FACTORS: Environmental: There are two critical stages in the development of body posture during the school years. These are the age when a child goes to school and the attainment of puberty. They pose some risks to the quality of the body posture, occurring during the puberty stage, in the period of 6-7 and 12-16 years old. During this the child is most vulnerable to the impact of various external factors and the development of the muscular system is does not follow the rapid growth of the bones. Role of the external environment in which a child resides have a significant impact on the child’s posture. It depends on the knowledge and activity of the organizers of the environment that is parents and teachers. This determines the foundation of the entire educational and social activities in the corrective process12 The ill effects of heavy back packs in school children found to carry a high incidence of postural deformities like kyphosis (56.6%), lordosis (16.6%) and scoliosis (26.67%).However, these deformities were unnoticed by parents13 The serum levels of tartrate-resistant acid phosphatase serum band, 5(TRAP5b) was correlated between bone metabolism and bone density. It was found that lower bone density in AIS patients showed higher rates of bone resorption14 A cross-sectional study on pre and post menarcheal girls with AIS was identified with lower serum levels of 25 Hydoxyvitamin D (25-OH-D3) and calcitonin in subjects with AIS. Calcitonin levels were found to be two times less in AIS group as compared to age matched healthy subjects. The study concluded that the deficiency of vitamin D can have a role in AIS15 EPIDEMIOLOGICAL CONSIDERATIONS: The incidence of scoliosis was screened among school going children of Lower Assam in the age group of 5 to 16 years. Scoliosis was reported in 0.2% of population with girls having predilection over boys by a ratio of 2.2:1. The study also concluded that idiopathic variety was the most common aetiological curve and the thoracic segment is commonly involved16 The prevalence of scoliosis among children in three Thai schools revealed a higher incidence of scoliosis in girls as compared to boys with a ratio of 1.7:117 AIS with a prevalence of 0.47-5.2% is a common disease having a female to male ratio of 1.5:1 to 3:1 and this ratio has been seen to increase with age. Also the occurrence of increased Cobb angle is considerably higher in girls than in boys18 Screening of scoliosis at Singapore Schools in the age group of 9 to 13 years of both gender, using the scoliometer to find out the angle of trunk rotation. The study reported that there was a significant increase in prevalence rates in the age group 10-11 years and 12-13 years. They recommended that screening for females should be done annually from 10 years till 13 years of age19 COMMON EVALUATION METHODS: Three non-invasive techniques namely scoliometer, back contour device and moiré topographic imaging were used to measure scoliosis and it was found that all the three techniques are sensitive in certain segments and cannot be used interchangeably in clinical records20   Persons with scoliosis show alteration in postures while standing with prominence of deformity of the rib cage. Various methods evolved for evaluating the relation between the extents of rib cage deformity observed external and internal spinal changes. Identification of scoliotic curves usually done in the form of screening program started at schools. These programs are directed towards early identification and intervention before they become worse21 To quantify scoliosis several clinical measures have been introduced and still evolving as the need of a more precise measure is still there. The advantages of such methods are that they can provide a quantitative value that can be used to track the progression or regression of the curves22 The scoliometer is a reliable and simple instrument which detects the rotational deformity of the spine which is very often associated with scoliosis. The measurement by the scoliometer had good reproducibility though its correlation with lateral curvature of the spine was low. Thus the scoliometer cannot alone be used as a diagnostic measure23 A study using Walter reed visual assessment scale (WRVAS) to correlate curve pattern and radiographic findings in scoliosis concluded that WRVAS is not sensitive for measuring the segmental changes24 Advanced technology in the form of iphones have been used for Cobb measurements and results have shown that the new generation smart phones are as efficient as certain conventional Cobb measurement tools like manual protector. Also the use of iphones as Cobb measurement tool has been seen to be 15% less time consuming when compared to its traditional counterpart. Mobile phones with inclinometer application with storage facility of measurements in updated versions of the software for measurement of angle may make these modern tools useful for clinical measurement applications.25 The validity, reliability and evaluation of the scoligauge iPhone app, shows outstanding intra and inter observer dependability and validity comparable to that of scoliometer. They also suggested that this application is an effective means for evaluating clinical measurements even without a special adapter26 SCIENTIFIC EXERCISE APPROACH TO SCOLIOSIS (SEAS): SEAS is the acronym for "Scientific Exercise Approach to Scoliosis,” denoting all by itself the basis of the methodology28. The changes to the approach do not result from random decisions of the authors but are instead based on the measured introduction of new facts gleaned from scientific literature27 The SEAS began from continuing efforts dating back to 1960s, when a scoliosis centre was established in Italy by Vigevano, Antonio Negrini and Nevia Verzini which later became to be known as “Centro Scoliosi Negrini” (CSN). They devised a treatment which employed exercises directed towards therapeutic goals. Due to their continuing efforts the authors founded “Italian study Group of Scoliosis” and had a vital role in finding best scientific papers related to conservative treatment of scoliosis during their systemic work from 1978. Although Lyon school first showed through their study the efficiency of exercises for AIS when they included results of more than 100 patients of CSN, the evidence of physiotherapeutic treatment had not yet been produced28 Progress of the spine stability in active self-correction is the key objective of SEAS.  Exclusively, the exercise implemented through SEAS is intended to train neuromotor function leading to self-correction of posture during the activities of daily living28. As a result, active self-correction according to the SEAS must be skilled without external aid. The experienced therapist conducts 3 to 4 sessions in a year, with one session lasting for about 1.5 hour. The patient continues his exercise programme at home with a daily session of 15 minutes or a minimum of 2 or 3 sessions of 45 minutes each per week.27 Exercise plays a key role to minimize the development of curve below 200 in AIS. The study reported that to improve the quality of life (QOL) in AIS, supervised exercise programme was superior when compared to controls in diminishing the spinal deformities29. A randomised controlled trail on the effect of the exercise on progression of AIS, recommended exercises can be advocated according to level-1b evidence with the aim of reducing scoliosis progression. However no data exists regarding exercises or when braces can be used.28 DISCUSSION: Progress of the spine stability in active self-correction is the key objective of SEAS, which improve the quality of life (QOL) in AIS28. Instrumented posterior correction, regarded as major spinal surgery has been in use for several years but has caused a loss of large blood volumes often necessitating replacement of blood.30 This critical blood loss following spine fusion for AIS is now being acknowledged in large national databases. The complication rate linked with spine fusion for correcting deformities in AIS has been considered to be in the range of 5 to 23%.31 The various complications that may arise after spine fusion for AIS are gastrointestinal complications, site infection and implant-related complications, venous thromboembolism. The 30 day readmission rate for AIS was 2.66% and the most common causes were found to be either site infection or disturbances of gastrointestinal system (GI) 30 The scoliosis research society (SRS) has shown a complication rate of 5.7% following spinal fusion surgeries that was recorded between 2001 and 2003 among 6334 AIS patients, with disproportionate values of 5.2%, 5.1% and 10.2% for anterior, posterior and combined respectively. The SRS has recently updated an overall complication rate for AIS to 6.3%.31 The outcome of spine fusion surgery has been seen to affect both clinically and as increased healthcare expenditure in the form of duration of hospital stay, added diagnosis, societal expenditure, treatments, loss of productivity, out of pocket charges and outpatient visits.32 The operation related complications for AIS has remained comparatively stable despite a huge 193% increase in surgical procedures amounting to 5228 surgeries in 2012 compare to 1783 cases in 1997.31 CONCLUSION: Individuals with AIS most commonly fall in the age group of 9 to 10 years. These children are mostly found to be unaware of the fact. Various high risk factors predispose the pre pubertal females for AIS. Developing practice guidelines in the form of a simple group activity may improve the quality of life of AIS children which can be followed in school setting. CONFLICT OF INTERESTS: The authors declared that there is no conflict of interests regarding the publication of this paper. HUMAN AND ANIMAL RIGHTS AND INFORMED CONSENT:  This article does not include any studies with human or animal subjects performed by any of the authors. ACKNOWLEDGMENT: The authors thank Dr. Vinitha Ramanath Pai, Professor & Deputy Director, MPhil & PhD Program, Yenepoya University for spending her valuable time and support during our work.   Englishhttp://ijcrr.com/abstract.php?article_id=111http://ijcrr.com/article_html.php?did=1111. Lowe TG, Edgar M, Margulies JY, Miller NH. Etiology of idiopathic scoliosis: current trends in research. J Bone Joint Surg Am. 2000 Aug; 82-A (8):1157-68 2. Dimeglio A. Growth in pediatricorthopedics. In: Morrissy, R.T., Weinstein, S.L. (eds.)   Lovell and Winter’s Pediatric Orthopaedics, 6th edn, pp. 35–65. Lippincott Williams & Wilkins, Philadelphia (2006)         3.Ganey T, M Ogden, J A. Development and maturation of the axial skeleton. In:Weinstein, S.L.(ed.) The Paediatric spine. Principles and practice,2nd edn,pp. 3-54. Lippincott Williams & Wilkins, Philadelphia (2001) 4. Dimeglio  A: Growth of the spine before the age 5 years. J. Pediatr. Orthop. B 1, 102–107 (1992) 5. Dickson RA. Scoliosis in the community. Br Med J (Clin Res Ed). 1983 Feb 19; 286(6365): 615-8 6. Miller NH. Genetics of familial idiopathic scoliosis. ClinOrthopRelat Res. 2007 Sep; 462 (462):6-10 7. Willner S, Johnson B. Thoracic kyphosis and lumbar lordosis during the growth period in children. Acta Paediatr Scand. 1983 Nov; 72(6):873-8.   8. Pingot M, Czernicki J, Kubacki J. Assessment of muscle strength of hip joints in children with idiopathic scoliosis. Ortop Traumatol Rehabil. 2007; 9(6):636-43.    9. Lin JJ, Chen WH, Chen PQ, Tsauo JY. Alteration in shoulder kinematics and associated muscle activity in people with idiopathic scoliosis. Spine (Phila Pa 1976). 2010; 35(11): 1151-7. 10. Sahgal V, Shah A, Flanagan N, Schaffer M, Kane W, Subramani V, et al. Morphologic and morphometric studies of muscle in idiopathic scoliosis. ActaOrthop Scand. 1983; 54(2):242-51. 11. Mahaudens P, Thonnard JL, Detrembleur C. Influence of structural pelvic disorders during standing and walking in adolescents with idiopathic scoliosis. Spine J. 2005; 5(4):427-33. 12. Lizak D, Czarny W, Niewczas M. The problem of postural defects in children and adolescents and the role of school teachers and counsellors in their prevention. Scientific Review of Physical Culture.2016 (4): 4 13. Mrinal Das, Bakul Let, Dr. SantanuPatar , Rathindranath Datta.  Postural defect of school going children due to heavyweight bag”, International Journal of Current Research.2015 May ;( 7):16278-79 14. Ko Ishida1, Yoichi Aota, Naoto Mitsugi1, Motonori Kono, Takayuki Higashi, Takuya Kawai, et al., Scoliosis: Relationship between bone density and bone metabolism in adolescent idiopathic scoliosis (2015) 10:9 DOI 10.1186/s13013-015-0033-z 15. Go?dJa?kiewicz J, Knapik-Czajka M, Dr?g J, Gawlik M, Cie?la M,.zialska A,  et al. Association of Calcium and Phosphate Balance, Vitamin D, PTH, and Calcitonin in Patients with Adolescent Idiopathic Scoliosis. SPINE 2016 Volume 41, Number 8, pp 693–697 16. Saikia K C, Duggal A, Bhattacharya P K, Borgohain M. Scoliosis: an epidemiological study of school children in lower Assam. Indian J Orthop 2002; 36:243-5. 17. Sakullertphasuk W, Suwanasri  C, Saetang L , Siri N , Junsiri P, Yotsungnoen S , et al. Prevalence of Scoliosis among High School Students. J Med Assoc Thai 2015; 98 (Suppl. 5): S18-S22   18. Konieczny MR, Senyurt H, Krause R. Epidemiology of adolescent idiopathic scoliosis.J Child Orthop. 2013 Feb; 7(1):3-9 19. Flordeliza Yong, Hee-Kit Wong, Khuan-Yew Chow. Scoliosis Among Female Students in Singapore. Ann Acad Med Singapore. 2009; 38:1056-63 20. Pearsall DJ, Reid JG, Hedden DM. Comparison of three non-invasive methods for measuring scoliosis. Phys Ther. 1992 Sep; 72(9):648-57 21. Vrtoven T, Pernus F, Likar B. a review of methods for quantitative evaluation of spinal curvature. Eur spine J.2009; 18:593-607 22. Mehta SS, Modi HN, Srinivasalu S, Chen T, Suh SW, Yang JH, Song HR .Inter observer and intra observer reliability of Cobb angle measurement: endplate versus pedicle as bony landmarks for measurement: a statistical analysis. J Pediatr Orthop 2009, 29(7):749-754 23 .Sanders JO, Polly DW, Cats-Baril W, Jones JA, Lenke LG, O&#39;Brien MF, et al. Analysis of patient and parent assessment of deformity in idiopathic scoliosis using the  Walter Reed Visual Assessment Scale. Spine 2003, 28:2158-2163 24. Pineda S, Bago J, Climent JM, Gilperez C: Validity of the Walter Reed Visual Assessment Scale to measure subjective perception of spine deformity in patients with idiopathic scoliosis. Scoliosis 2006, 1:18 25. Shaw M1, Adam CJ, Izatt MT, Licina P, Askin GN.  Use of the iPhone for Cobb angle measurement in scoliosis. Eur Spine J. 2012 Jun; 21(6):1062-8 26. Balg F, Juteau M, Theoret C, Svotelis A, Grenier G. Validity and reliability of the iPhone to measure rib hump in scoliosis. J Pediatr Orthop. 2014 Dec; 34(8):774-9 27. Romano M, Negrini A, Parzini S, Tavernaro M, Zaina F, Donzelli S, et al . SEAS (Scientific Exercises Approach to Scoliosis): a modern and effective evidence based approach to physiotherapic specific scoliosis exercises. Scoliosis. 2015; 10: 3 28.   Negrini S,  Grivas T B, Kotwicki T, Maruyama T, Rigo M,  Weiss H R. Why do we treat adolescent idiopathic scoliosis? What we want to obtain and to avoid for our patients. SOSORT 2005 Consensus paper. Scoliosis. 2006; 1:4 29. Shahnawaz Anwer, Ahmad Alghadir, Md. Abu Shaphe,  Dilshad Anwar. Effects of Exercise on Spinal Deformities and Quality of Life in Patients with Adolescent Idiopathic Scoliosis BioMed Research International. 30. Miao Y, Ma H, Guo W, Wu J, Liu Y, Shi W et al. The Efficacy and Cost-Effectiveness of Cell Saver Use in Instrumented Posterior Correction and Fusion Surgery for Scoliosis in School-Aged Children and Adolescents. PLoS ONE. 2014;9(4):e92997. 31. Murphy RMooney J. Complications following spine fusion for adolescent idiopathic scoliosis. Curr Rev Musculoskeletal Med. 2016;9(4):462-469. 32. Yeramaneni S, Robinson C, Hostin R. Impact of spine surgery complications on costs associated with management of adult spinal deformity. Current Reviews in Musculoskeletal Medicine. 2016;9(3):327-332.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareComparison of Physical Parameters and Somatotyping Components of the Throwers and Jumpers English3840Karanjit SinghEnglishAim: The purpose of the present study was to evaluate and compare the physical parameters and somatotyping components of throwers and jumpers. Methodology: 80 (40 throwers and 40 jumpers) male university level athletes were assessed during the All India Inter University Athletic Meet. The age of athletes was between 18 to 25 years. All subjects were assessed for height, weight, breadths and circumferences. Results: The independent samples t-test revealed that the throwers were significantly taller (pEnglishSomatotyping, Body Mass Index, Throwers, Jumpers, Endomorphy, MesomorphyINTRODUCTION The physical trainers and coaches have understood the importance of various factors such as training, skill, personality, motivation in the sports performance but most important of them all is physical parameters and somatotyping characteristics because these factors are definite predictions of the degree of efficiency and level of success of sportsperson. The sports performance of athletes is greatly influenced by such factors as age, height, weight and body structure. It is also observed that persons of the same age group vary in body size and shape, the individuals of the same height differ greatly in body weight, the persons may weigh the same, but the relative proportion of muscle, fat, and bone will be varied (Johnson and Nelson 1982). The human physique differs in many ways and variation in physical characteristics is an interesting aspect. This variety of human physique plays an important role to attain better performance in particular sports. Every game requires a specific type of body where as unsuitable body types in relation to the sports may build great stumbling block in the progress of the sports performance. According to Heath and Carter (1967) somototype is a description of the present morphological conformation. It is expressed in a numeral rating consisting of three sequential numerals always recorded in the same manner. Each numeral represents the evaluation of the three primary components of physique which describe individual variations in human morphology and composition. Physique refers to the shape, the size and type of an individual. All three factors are closely interrelated with each other and are manifestations of the internal structure and tissue components which are affected by the environmental and genetic factors (Sodhi and Sidhu, 1984)              One of the useful indirect techniques of evaluating physique characteristics is somatotyping. It is an established fact that the ideal body types of athletes varies according to the requirements of sport or event.  The combined rating of each component describes an individual’s somatotype. If one component is dominant then the somatotyping describes that component (Carter & Heath, 1990; Duquet et al., 1996). Specific athletic events require different body types and weights for maximal performance (American Dietics Association, 1987).             Somatotype analysis can provide a synthetic descriptive picture of the kinanthropometric characteristics of high level athlete. In this sense, the somatotyping method is believed to yield better results than simple linear anthropometric measurements (Rienzi et al., 1999), since it combines adiposity, musculo-skeletal robustness and linearity. The technique of somatotyping as a means of assessing body shape and composition independent of size has been applied to the description of groups of outstanding athletes. The present study aims to evaluate and compare the physical parameters and somatyping components of the university level throwers and jumpers. METHODOLOGY The present was conducted on 80 university level jumpers and throwers which were purposively selected from All India Inter University Athletic Meet held at Manonmaniam Sundaranar University Tirunelveli (Tamilnadu). The study was conducted jumpers and throwers of age between 18 to 25 years. The study was conducted only on male jumpers and throwers. The high jumpers, long jumpers, triple jumpers and pole vaulters were selected as subjects. The throwers viz. discus throwers, javelin throwers, hammer throwers and shot putters were selected as subjects for the study. Data Collection Body weight was measured with portable weighing machine to the nearest 0.5 kg. Height was measured by using the standard anthropometric rod (HG-72, Nexgen ergonomics, Canada) to the nearest 0.5 cm. Widths and diameters of body parts were measured by using sliding caliper. Circumferences of the body parts of the throwers were measured with the help of steel tape to the nearest 0.5 cm. Body mass index (BMI) was calculated by the following formulae: BMI (Kg/m2) = (Body mass in kg)/ (Stature in m2)                                    (Meltzer et al., 1988) Somatotyping Somatotype components (endomorphy, mesomorphy, ectomorphy) were estimated according to protocol of Carter and Heath (1990) using the next equations Endomorphy  = - 0.7182 + 0.1451 (X) - 0.00068 (X2) + 0.0000014 (X3) where X = (sum of triceps, subscapular and supra-iliac skinfolds) multiplied by (170.18/height in cm). Mesomorphy = 0.858 ´ humerus breadth + 0.601 ´ femur breadth + 0.188 ´ corrected arm girth + 0.161 ´ corrected calf girth – height 0.131 + 4.5. Where    corrected arm girth =flexed arm girth - triceps skinfold/10                corrected calf girth = maximal calf girth - calf skinfold/10. Ectomorphy = 0.732 HWR - 28.58 Where HWR = height / cube root of weight If HWR is less than 40.75 but greater than 38.25 then Ectomorphy = 0.463 HWR - 17.63 If HWR is equal to or less than 38.25 then Ectomorphy = 0.1 Statistical analysis Values were presented as descriptive statistics viz. mean values and SD. Independent samples t tests was used to compare the throwers and jumpers.  Data was analyzed using SPSS Version 16.0 (Statistical Package for the Social Sciences, version 16.0, SSPS Inc, Chicago, IL, USA). Significance levels were set at pEnglishhttp://ijcrr.com/abstract.php?article_id=112http://ijcrr.com/article_html.php?did=112 American Dietetics Association (1987) Position of the American Dietetics Association Nutrition for the physical fitness and athletic performance for adults. J. Am. Diet Assoc., 76:437-443. Carter, J.E.L. and Heath, H.B. (1990) Somatotyping—Development and Application. Cambridge University Press. De, A.K., Ray, A.S., and Debnath, P.K. (1991) Simple anthropometry and peak expiratory flow rate in elite South Asian athletes. Journal of Sports Medicine and Physical Fitness, 31:598. Duquet, W. and Carter, J.E.L. Eston, R. and Reilly, T. (eds) (1996) Somatotyping. Kinanthropometry and exercise physiology laboratory manual pp. 41-43. E & FN Spon , London. Heath, B.H. and Carter, J.E.L. (1967) A modified somatotype method. American Journal of Physical Anthropology, 27:57-74.   Johnson, B.L. and Nelson, J.K. (1982) Practical Measurements for Evaluation in Physical Education. Burgess Publishing U.S.A (in India, Surjit Publicaiton, Delhi). Kruger, Ankebe (2004) Kinantropometriese en asimmetriese profile van internasionale manlike elite-spiesgooiers. M.Sc. thesis, north-west university, Potchefstroom Campus. Malhotra, M.S., Joseph, N.T., Mathur, D.N. and Gupta, J. (1973)   physiological assessment of Indian hockey players, Sports Medicine, 2:5. Meltzer, A., Mueller, W., Annegers, J., Grimes, B. and Albright, D. (1988). Weight history and hypertension. J. Clin. Epidemiol., 41:867–874. Mokha, R. and Sidhu, L.S. (1988)  Fat and fat patterning of Indian female athletes at different levels of competition, Annalei dell isef VII : 49 – 50. Rienzi, E., Reilly, T., Malkin, C. (1999) Investigation of anthropometric and work-rate profiles of Rugby Sevens players. J. Sports Medicine and Physical Fitness. 39: (2), 160-164. Sodhi, H.S. and Sidhu, L.S. (1984) Physique and Selection of Sportsmen. Punjab Publishing House, Patiala. Tanner, J.M. (1964). The Physique of the Olympic Athletes (Allen & Unwin London), 1964. Thorland, W.G., Johanson, G.O., Fargot, T.G., Tharp, G.D. and Hammer R.W. (1981) Body composition and somatotype characteristics of junior Olympic athletes. Medicine and Science in Sports and Exercise, 13 (5): 332-338.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareEffect of Gestational Diabetes Mellitus on Macrosomia Infants English4145Mutangala Muloye Guy1English2*English Isango Idi Yves2English Kaya Mulumbati Charles3English Munganga Ngoy Didier4English Yowa Muya Sandra5English Kasangye Ka NgoyAurelie3English6English Mwembo Tambwe Albert2English3English Wei Zeng Tao1EnglishAim: This study aims to explore fetal and maternal complications of macrosomia; and also to compare fetal characteristics of macrosomia infants of GDM and Non- GDM mothers. Methodology: This is a retrospective study, on women who delivered macrosomia infants over a two-year period (2014-2015), at the University of Lubumbashi hospital and Don Bosco Clinic in Lubumbashi/ Democratic Republic of Congo. Obstetrical parameters were taken from the labor register and all data were analyzed using SPSS 17.00 statistical software; independent and paired sample t- test, Chi-square tests were performed (α=0.05 level, 95 % confidence interval). Results: A total of 87 women, with a mean age of 32.73 51 (± 5.16) were enrolled into the study. From these women 54 % had Gestational Diabetes Mellitus (GDM).Mean birth weight of babies from GDM mothers (4182.25 ± 177) was higher than those with Non-GDM mothers (4156±165.662) with a p value EnglishMacrosomia, Gestational Diabetes, Democratic Republic of CongoINTRODUCTION Fetal macrosomia is defined as birth weight >4000 g [1]. Numbers of studies have related birth weight to several maternal characteristics, including racial origin, age, body mass index, parity, cigarette smoking, and medical conditions, such as pre-pregnancy diabetes mellitus [2]. In all these risk factors diabetes has a strongest association with macrosomia (macrosomia was detected in 70% to80% of pregnancies that were complicated by diabetes mellitus) [3]. There are three types of Diabetes Mellitus: Type I, Type II and Gestational Diabetes, this study will focus more on Gestational diabetes Mellitus (GDM), which occurs when a woman without diabetes develops high blood sugar levels during pregnancy. GDM has an important link with the incidence of overweight in the newborn [4]. Genetic as well as epigenetic factors play a great role in the GDM pathogenesis, which is shown by the fact that this complication also affects women with normal BMI. Infants of women with GDM are at an increased risk of becoming overweight or obese at a young age (during adolescence) and are more likely to develop type II diabetes later in life. In addition, findings of several studies that epigenetic alterations of different genes of the fetus of a GDM mother in utero could result in the transgenerational transmission of GDM and type II diabetes are of concern [5]. Fetal macrosomia is also associated with a range of maternal and fetal complications such as shoulder dystocia, birth asphyxia, nerve injuries, clavicular and humerus fractures in neonates, admission to the intensive-care nursery, and increased perinatal mortality for the newborn, vaginal and perineal trauma, uterine rupture, postpartum infection and hemorrhage to the mother [6]. It can also be linked to Cephalohematoma, which is defined as a hemorrhage of blood between the skull and the periosteum of a newborn baby secondary to rupture of blood vessels crossing the periosteum [7]. This study will aim to explore fetal and maternal complications of macrosomia; and also to compare fetal characteristics of macrosomia infants of GDM and Non- GDM mothers. DESIGN/METHODS This is a retrospective study of macrosomia infants (baby weighing 4kg or more), born at the University of Lubumbashi hospital and Don Bosco Clinic in Lubumbashi/ Democratic Republic of Congo over a two-year period (2014-2015). Data collection Obstetrics data were obtained from the labor register. Maternal information collected were age, parity, macrosomia antecedents and GDM. Labor event considered was mode of delivery (caesarean sectional emergency or vaginal deliveries). The neonatal information collected were weight of the baby, sex of the baby, Head circumference, Apgar score at 1, at 5 and at 10 minutes. Maternal complications taken into consideration were perineal trauma, postpartum hemorrhage, infection and uterine rupture, Neonatal complication such as hypoglycemia, cephalomatoma, nerve injuries (Brachial plexus palsy) and whether the fetus was alive or dead(perinatal mortality) were also taken into consideration. Women with diabetes antecedents, meaning women who knew themselves as being diabetics before pregnancy, were excluded from the study. Glycaemia control during pregnancy Glycaemia control was done once for each of the three trimesters of the pregnancy. A non-challenge blood glucose test was used. It involved measuring glucose levels in blood samples without challenging the subject with glucose solutions [8]. Criteria for diagnosis of gestational diabetes was defined when the level of glucose intolerance was>95 mg/dl, and a woman was diagnosed with gestational diabetes when glucose intolerance continues beyond 24–28 weeks of gestation. Neonatal Hypoglycemia Neonatal hypoglycemia is defined as a plasma glucose level of less than 40 mg/dl, in the first 24 hours of life and less than 50 mg/dl thereafter [9]. Statistical analysis All data were analyzed using SPSS 17.00 statistical software; measurement data are analyzed by independent and paired sample t- test for comparison. Categorical data were analyzed by chi-square test, α=0.05 level, with a 95 % confidence interval. RESULTS Mothers information and post-partum complication A total of 87 women, with an age between 21 to 42 years (Mean age: 32.7351 ± 5.16) delivered macrocosmic babies at the University Hospital and Don Bosco Clinic of Lubumbashi during the study period. It was observed that 72macrocosmic neonates (82.7%) were delivered from multiparty mothers and 50mothers (57.5%) had macrocosmic babies before (antecedent of macrosomia), and 47 mothers (54 %) had GDM. The percentage of women who delivered vaginally was 70.1 % (61women) while 29.9% (26 women) delivered by cesarean section. Macrosomia usually causes some complications among women. This study revealed that only one woman (1.1%) had infection after delivery, 11 women (12.6 %) suffer from post-partum hemorrhage, and one woman (1.1 %) had uterine rupture. Among women who deliver vaginally 19 (21.9%) had perineal trauma, (X2= 7.675 and p value = 0.000), showing a strong association between perineal trauma and vaginal delivered. Infants information There were 46 (52.8 %) male babies and 41 (47.1 %) female babies; the mean birth weight of the macrocosmic babies was 4168.51 ± 170.72and the mean head circumference (in cm) was 36.041 ± 1.064.Comparing the mean birth weight of male to female babies, this study shows that the mean weight was higher in males(4194.22 ± 164.945) than in females (4139.51± 176.365)with a p value < 0.05.They were no brachial plexus palsy, but 14(16.1 %) had hypoglycemia, 6(6.8 %) babies had cephalohematoma and 2 (2.3 %) babies died during labor (perinatal mortality). This figure shows that the mean Apgar score of the babies was increased from minute 1 to 5 and from minute 5 to 10. P =0.000 for both Apgar 1 vs 5, and Apgar 5 vs 10. There was statistically difference in the birth weight of babies in the two groups of the mothers (p0.05. Figure 2 shows that the mean Apgar score at 1, 5 and 10 minute was higher in Non-GDM infants than GDM infants but this difference was not statistically different because the p values were > 0.05.    DISCUSSION In our study the percentage of caesarean delivery was  low (29.9%) compared to studies done by other authors. The prevalence of caesarean section in a study among Pakistani women was 40.5% and the rate of cesarean section among women delivering macrosomia babies was 47.6% in Saudi Arabia [10][11]. Other works, however, failed to find a substantial decrease in fetal morbidity and mortality in macrosomia babies delivered by caesarean section to justify the high prevalence of caesarean section, and therefore advocate earlier induction at term in mothers of macrocosmic babies [12][13]. However, with a high percentage of vaginal delivery in our study, there was a very low perinatal mortality. Fetal sex influences macrosomia potential, male infants weigh more than female infants[14], and our study has confirmed this assertion. The most feared complication of macrosomia is shoulder dystocia .Up to one fourth of the infants with shoulder dystocia had described to suffer from brachial plexus or facial nerve injuries or fractures of the humerus or clavicle [15]. But in this study, no brachial plexus palsy was reported. Comparing the mean birth weight of the babies, it was observed that infants from GDM mothers have a mean birth weight higher than those with Non-GDM mothers. This can be explaining by the fact that all of the nutrients the fetus receives come directly from the mother&#39;s blood. If the maternal blood has too much glucose, the pancreas of the fetus senses the high glucose levels and produces more insulin in an attempt to use this glucose. The fetus converts the extra glucose to fat. Even when the mother has gestational diabetes, the fetus is able to produce all the insulin it needs. The combination of high blood glucose levels from the mother and high insulin levels in the fetus results in large deposits of fat which causes the fetus to grow excessively large [16]. However the mean head circumference was high in babies from GDM mothers than in non- GDM mothers but not statistically significant; this result corroborate with a study done by Joan. L et al which affirm that usually, head circumferences are not typically increased in Infants from diabetic mothers [17]. The study has shown that there were 6(6.8%) babies with cephalohematoma in this population of macrosomia infants. But there was no statistical correlation between cephalohematoma and GDM. Cephalohematoma occurs in Macrosomia infants if the baby is atypically large, resulting in complication of vaginal birth. There is a risk of prolonged labor in which the fetus might be stuck in the birth canal. Instrumental delivery (with forceps or vacuum) may be needed, and even unplanned or emergency cesarean section may be necessary [5]. Low Apgar score has been related to many factors such as umbilical cord problems, uterine rupture, trauma, macrosomia, severe preeclampsia and Amniotic fluid embolism [18]. In this study, the Apgar score at 1, 5 and 10 minute was good (>7), indicating it was always normal. However comparing Apgar means at1, 5 and 10 minute of the two groups of babies, the mean Apgar score was quiet high in infants from Non- GDM mothers has compared to those from GDM mothers. This could be related to the fact that infant from GDM are at risk of hypoglycemia and have a high birth weight than those from Non-GDM mothers. This study revealed also that GDM induce hypoglycemia in newborn. This result corroborate with a study done by Ogunyemi. D et al , that suggested that diabetes was protective of neonatal hypoglycemia, which may be explained by optimum maternal glucose management; nevertheless macrosomia was independently predictive of neonatal hypoglycemia [19]. Another study done in Austria has shown that infants of diabetic mothers are at risk for hypoglycemia [20].Hypoglycemia refers to low blood glucose in the baby immediately after delivery. This problem occurs if the mother&#39;s blood glucose levels have been consistently high, causing the fetus to have a high level of insulin in its circulation. After delivery, the baby continues to have a high insulin level, but it no longer has the high level of glucose from its mother, resulting in the newborn&#39;s blood glucose level becoming very low. The baby&#39;s blood glucose level is checked after birth, and if the level is too low, it may be necessary to give the baby glucose intravenously [16]. It is worth nothing that there are a number of outcomes that may be due to GDM that our study did not explore; further research is recommended with a larger sample size. CONCLUSION There are various fetal outcome associated with fetal macrosomia such as hypoglycemia, brachial plexus palsy and perinatal mortality. This study revealed that a number of these outcomes can be different when it occurs in infants from GDM mothers or non-GDM mothers. Hypoglycemia in infants was found to have a strong association with GDM; while perinatal mortality, brachial plexus palsy or cephalohematoma didn’t t have a statistical association with GDM. From this result, it can be recommend that: Glucose control during pregnancy should be increased in order to reduce the risk of hypoglycemia in newborn. Cooperation of gynecologists, pediatricians and dieticians should be enhanced in order to minimize adverse maternal and fetal outcomes. Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=113http://ijcrr.com/article_html.php?did=1131.   Rouse DJ, Owen J, Goldenberg RL, Cliver SP (November 1996). "The effectiveness and costs of elective cesarean delivery for fetal macrosomia diagnosed by ultrasound".JAMA. 276 (18): 1480–6. doi:10.1001/jama.1996.03540180036030. PMID 8903259. 2.   - Leona C. Y. Poon, George Karagiannis, Ismini Staboulidou, Akram Shafiei, Kypros H. Nicolaides. Reference range of birth weight with gestation and first-trimester prediction of small-for gestation neonates. Prenatal Diagnosis Explore this journal , Volume 31, Issue 1,January 2011 ,Pages 58–65 3.   Suneet P, Chauhan, MD, William A. Grobman, MD, Robert A. Gherman, MD, Vidya B. Chauhan, BS, Gene Chang, MD, Everett F. Suspicion and treatment of the macrosomic fetus: A review American Journal of Obstetrics and Gynecology 2005; 193: 332–46 4.   Wendland EM, Torloni MR, Falavigna M, Trujillo J, Dode MA, Campos MA, et al. Gestational diabetes and pregnancy outcomes–a systematic review of the World Health Organization (WHO) and the International Association of Diabetes in Pregnancy Study Groups (IADPSG) diagnostic criteria. BMC Pregnancy Childbirth 2012;12:23. Cross Ref External Web Site Icon PubMed External Web Site Icon 5.   Kamana Kc, Sumisti Shakya, Hua Zhang, Gestational diabetes mellitus and macrosomia: a literature review, Annals of Nutrition & Metabolism 2015, 66 Suppl 2: 14-20 6.   Stotland NE, Caughey AB, Breed EM, Escobar GJ. Risk factors and obstetric complications associated with macrosomia. Int J GynaecolObstet 2004; 87: 220–22. 7.  . Memidex, cephalohematoma,http://www.memidex.com/cephalohematoma, December23,2016 8. Gestationaldiabetes, https://en.wikipedia.org/wiki/Gestational_diabetes ,December 23, 2016 9. Tugashipoglikemia, https://www.scribd.com/document/242957905/Tugas-Hipoglikemia, January 26, 2016. 10. RaziaIftikhar. Intrapartum complications of Macrosomic fetus. JLUMHS 2007; May - August: 52-55. 11. Alsammani MA, Ahmed SR. Fetal and maternal outcomes in pregnancies complicated with fetal macrosomia. North American Journal of Medical Sciences  2012; 4(6):283–286. 12. Langer O. Prevention of macrosomia. Bailliere&#39;s ClinObstetGynaecol 1991; 5: 333–347. 13. Spellacy WN, Miller S, Winger. A macrosomia maternal characteristics and infant complications. J ObstetGynaecol 1985; 16(2):158161. 14. HabibaSharafAli ,ShahinaIshtiaque, Fetal macrosomia:Its maternal and neonatal complications The Professional Med J 2014;21(3): 421-426 15. Gherman RB, Ouzounian JG, Goodwin TM. Obstetric maneuvers for shoulder dystocia and associated fetal morbidity. Am J Obstet Gynecol. 1998;178:1126–30. 16. http://www.stanfordchildrens.org/en/topic/default?id=gestational-diabetes-mellitus-gdm-85-P00337 17. Joan L. Nold, and Michael K. Georgieff, Infants of diabetic mothers, Pediatr Clin N Am 51 (2004) 619–637 18. https://www.abclawcenters.com/practice-areas/diagnostic-tests/apgar-score-for-assessment-of-the-newborn/ 19. D. Ogunyemi, P. Friedman, K. Betcher, A. Whitten, N. Sugiyama, L. Qu, Amitai Kohn &Holtrop Paul , Obstetrical correlates and perinatal consequences of neonatal hypoglycemia in term infants Journal,The Journal of Maternal-Fetal & Neonatal Medicine (2016) Pages 1-6 20. Landon MB, Catalano PM, Gabbe SG. Diabetes mellitus complicating pregnancy. In: Gabbe SG, Niebyl JR, Simpson JL, et al, eds. Obstetrics: Normal and Problem Pregnancies. 6th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 39.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524194EnglishN2017February20HealthcareDeterminants of quality of life among the caregivers of persons suffering from dementia English4650Maithreyi P.1English Siva Ilango T.2English Priya S.3English Nambi S.4EnglishAim: Dementia is a chronic and progressive neurodegenerative disorder resulting in impairment of cognition and behaviour. Caring for person with dementia results in significant stress and this study aims to assess the quality of life of caregivers of patients suffering from dementia and the factors associated with it in the semi urban South Indian population Methodology: This study was conducted in the outpatient of the department of Psychiatry at a tertiary care hospital in south India. Persons over the age of sixty years meeting the diagnosis of dementia according to ICD 10 criteria along with the carers who were staying with them for at least a year were included in the study. Quality of life of the care givers which is the primary outcome measure of this study was assessed using the WHOQOL BREF version. Results: Half of the caregivers included in the study had poor quality of life. Some of the factors that predict poor quality of life among the caregivers are being unmarried or widowed, having comorbid physical illness, presence of behavioural and psychological symptoms in patients with dementia. Discussion: The results emphasize the importance of caring the caregivers and the management should be considered as a unit and treatment should not only focus on the patients but also on their caregivers. Conclusion: The findings of our study suggest that the caregivers of the persons suffering from dementia have poor quality of life. Female caregivers, elderly caregivers and with history of comorbid illness, the caregivers of dementia patients with behavioural and psychological symptoms have poor quality of life. EnglishDementia, Caregiver, Quality of life, WHOQOL- BREFIntroduction: Dementia is a syndrome due to disease of brain, usually of a chronic or progressive nature in which there is disturbance of multiple cortical functions, including memory, thinking, orientation, comprehension, calculation, learning capacity, language and judgement. Consciousness is not clouded. Impairments of cognitive function are commonly accompanied and occasionally preceded by deterioration in emotional control, social behaviour or motivation.1 This growth in the number of elderly is inevitably accompanied by an increase in the number of people with age related diseases especially Dementia.2It is critically important to recognize that dementia strikes a family unit and is not limited to the effects on the individual manifesting the cognitive impairment. Dementia progresses from a mild syndrome to increasingly severe impairment where the individual needs help with every activities of daily living.3Most studies have found that depressive and anxiety symptoms in caregivers of people with dementia are strongly associated with care recipients behavioural and psychological symptoms particularly depression.4 Caregivers are often faced with the loss of friends, privacy and leisure opportunities. The combination of these factors increases the risk that caregivers become isolated in their situations which in turn can lead to increased depression, social deprivation and poorer quality of the caregiving. As dementia progresses caregivers give up most of their activities to provide more time for care giving leading to enormous stress and related problems.5, 6 There are many factors found to worsen caregiver quality of life including strained finances, poor family functioning, difficulty patient behaviour, financial burden and the amount of time caregivers spend caring for dementia patient.7, 8There are lot of studies for the western world about caregiving aspects, factors that increase the carer burden and affecting their quality of life. We know that there are significant differences in our culture compared to the western world.  In our society most of the care giving is done by family members also called informal carers in contrast to the developed countries where formal care arrangements are readily available. In this study, we try to assess the quality of life of caregivers of patients suffering from dementia and the factors associated with it in the semi urban South Indian population. Methodology This study was conducted in the outpatient of the department of Psychiatry at a tertiary care hospital in south India. The multi-speciality teaching hospital provides care to patients with a wide variety of disorders. The study subjects include 41 elderly persons suffering from Dementia along with their caregivers. Persons over the age of sixty years meeting the diagnosis of dementia according to ICD 10 criteria along with the carers who were staying with them for at least a year were included in the study. Persons having comorbid severe mental illness, substance abuse except tobacco and other degenerative disorders were excluded from the study. Informed consent was obtained from the study subjects and their carers. Ethical approval was obtained from the institutional ethics committee. Demographic details of the patient and the caregivers were obtained using a semi structured proforma specifically designed to capture the relevant factors that will impact on the quality of life of the caregivers as known from the previous studies. Study subjects were screened for cognitive impairment using the Mini Mental State Examination (MMSE).9 Quality of life of the care givers which is the primary outcome measure of this study was assessed using the WHOQOL BREF instrument which is a shorter version of the original instrument. It covers 4 domains 1) Physical health (item no 3, 4, 10, 15-18), 2) Psychological health (item no 5-7, 11, 19, 26), 3) Social relationships (item no: 20-22) and 4) Environment (item no 8, 9, 12-14, 23-25). In addition two items on general wellbeing (item no 1 and 2).10Each item is scored between 1 and 5 except for item 3, 4 and 26 which are scored in a reverse manner. Domains were derived via a polytomous scoring algorithm which is adjusted for relative order of the items and converted onto a 0-100 scale.11The psychometric property of the brief version is comparable to the full version WHOQOL group 1998. A high correlation of domain score(0.89) between the four domains of the two scales has been established. The scale has established discriminate validity, content validity, test and retest reliability and internal consistency.Final scoring and calculation for analysis is done by using formula as per SPSS syntax editor. Results The age of the persons suffering from dementia ranged from 63 to 83 and the mean was 69.88(sd 5.08). Of the total sample 68.3% were women and 31.7% were men. 65.9% came directly to the psychiatry while 34.1% were referred from other departments.  Hindus constituted 65.9%, of the sample, Christians and Muslims were 17.1% each, 39%belong to nuclear family type and 59% joint family type. Of the total sample 58% were married and 39% were widowed. 75.6% had completed high school and 24.4% did not complete high school. 9.8% depend on pensions for their source of income,36% from Savings, 22% income from other sources, 24% depend on children and 7.3% Dependence on others. (Table 1) The age of the caregivers ranged from 42 to 76. The mean age of the caregiver is 59.12 (sd 10.35). Of the caregiver sample, 46.3% were women and 53.7% were men. 48.8%   of the caregivers were spouses,while 19.5% were daughters, 22%   were sons and 9.8% are daughters in law. The mean age of spouse is 69.22 (sd 5.3). Of the caregivers 2.4% were illiterate,9.8% hadcompleted primary education, 17.1%   had completed middle school education, 24.4% had completed high school, 19.5% had completed intermediate or post high school diploma, 17.1% had graduated and 9.8% are postgraduates. 58.5% of the caregiver study sample has time for religious activities. (Table 1)   Mean duration of illness of dementia is 2.21 years (sd 1.33).The mean duration of treatment for dementia is 1.70 years (sd 1.11). Of the subtypes of dementia in study sample, 63.4% had Alzheimer s dementia, 22% vascular Dementia, 12.2% Parkinson disease dementia and 2.4% others (post head injury Dementia).  63.4% have history of behavioural and psychological symptoms of Dementia. On screening with Mini Mental Status Examination, scores ranged from 5 to 24 with meanof 15.9(sd 4.9). In patients suffering from dementia, 37.5% have comorbid diabetes Mellitus, 34.1% hypertension, 40% have osteoarthritis, 4% have respiratory Distress,10% sustained fractures in the past, 7% history of cerebrovascular accident in the past. 17% of the total sample has family history of depression. 20% of the caregivers have a past history of depression. On studying history of comorbid physical illness among the caregivers 43.9% have comorbid diabetes mellitus,26% have hypertension and 24.3% have osteoarthritis. (Table 2)   The quality of life of the caregiver was assessed by WHO Quality of life scale BREF which has 26 items with 4 domains. The first domain denotes the physical health, the scores ranged from 13 to 81, the mean being 48.8(sd 20.25). The second domain denotes the psychological health, the scores ranged from 13 to 88, the mean of 57.66(sd 19.56). The third domain denotes the social relationships and the scores ranged from 19 to 75, the mean being 50.02(sd 22.65). The fourth domain denotes the environmental, with scores ranging from 13 to 69 with mean of 37.76(sd 18.6).   In this study, a score of 50 was taken as overall mean score of quality of life across all domains and scores above the mean was taken as having good quality of life. Correlation statistics was obtained to find any demographic or clinical factors among the patient or their caregiver would affect the perceived quality of life in the carer. Percentage of people who scored less than 50 in each domain suggesting poor quality of life indicating positive correlation is given below (Table 3 – 5). From table 3 – 5, it is evident the caregivers who are either unmarried or widowed, who have comorbid physical illness, presence of behavioural and psychological symptoms in patients with dementia are found to have poor quality of life across all domains. According to thisstudy there is no correlation between the duration of the illness and duration of stay of the caregiver with the patient. Discussion There has not been many studies conducted in developing world where there is major demographic shift is ongoing with lot of aging population and associated health care problems. This study helps us to understand the impact of a degenerative illness among the caregiver. As evident from previous studies patients suffering from dementia with associated behavioural and psychological symptoms have significant stress and poor quality of life. The results from this study confirm the findings from earlier studies that significant percent of carers have poor quality of life. The higher the age of the patient, poorer quality of life of the caregiver as the cognition worsens with age and patients becoming more dependent on the carer.11-13 Caregivers who are single or widowed have poor quality of life as they themselves are in need emotional and social support. Caregivers who are spouses and daughters have poor quality of life as they have close relationship with the patient prior to the onset of the illness compared to others seeing the gradual decline in functioning. There is a positive correlation between quality of life of the caregiver and the comorbid physical illness as it limits their ability to provide the required level of care and some carers develop sense of guilt feelings leading to poor quality of life.15, 16 The positive correlationbetween quality of life of the caregiver of persons suffering from dementia with behavioural and psychological problems has been noted in several studies and it includes agitation, aggressive behaviour, wandering behaviour, perception abnormalities, thought content mood or behaviour, hoarding and disinhibited behaviour. These symptoms have a significant impact on the quality of life of the caregiver.17-20 The poor quality oflife of the caregivers would affect the care given by them to the persons suffering from dementia. This will further increase the cognitive as well as behavioural problems of the patient thus becoming a vicious cycle. Hence persons suffering from dementia along with their relatives have to be considered as aunit and treatment should not only focus on the patients but also on their caregivers. The limitations of the study are its low sample size, being a hospital based sample, the results are not truly representative of the community and a comparative group would have strengthened the findings of this study. Conclusion The findings of our study suggest that the caregivers of the persons suffering from dementia have poor quality of life. Female caregivers, elderly caregivers and with history of comorbid illness, the caregivers of dementia patients with behavioural and psychological symptoms have poor quality of life. The need for good psychosocial support to the caregivers of the dementia persons is needed. Application of recent advances in medical therapies and treatment of behavioural problems along with support to the caregivers would go a long way in reducing the stress.   Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in the references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of Funding: Nil Conflict of Interest: None. Englishhttp://ijcrr.com/abstract.php?article_id=114http://ijcrr.com/article_html.php?did=114 International classification of diseases  (ICD 10), 1992 World Health Organization. World atlas of ageing. Kobe, Japan: World Health Organization centre for health development, 1998. Alzheimer’s Association Caregiver stress [coping] July 2003. 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