Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareDEVELOPMENT AND ANALYSIS OF OIL FINISH ON COTTON FABRIC
English0103S. Grace AnnapooraniEnglish S. Yamuna DeviEnglishAim: In the present scenario of environmental consciousness the requirement of environment friendly textiles is increased. Plant extracts and oils demonstrating antifungal properties may provide protection for textile application. Methodology: This study was to evaluate the antifungal properties of natural plant extracts, such as essential oils, for se on wood. Three essential oils were evaluated for their ability to inhibit growth of Aspergillus Niger, Trichoderma Reesis. Lemon grass oil, pepper mint oil and pine oil inhibited growth of fungi. Cotton fabric is chosen for the study and the selected oils are applied on to the fabric by dip dry method. Result: The treated fabric is tested with two fungal pathogens(Aspergillus niger, Trichoderma reesis). It shows the better antifungal properties. Also the fabric show better result for physical test. Conclusion: These findings support the application of essential oils for surface treatment or vapour exposure of textile to prevent fungal infection and fungal growth.
EnglishCotton – woven, Natural oils, Antifungal finish, Microbe resistantINTRODUCTION Textile finishing is an important process in the textile industry to obtain good properties of finished fabrics such as wrinkle resistance, flame retardant, water-and-oil repellent finishing, etc. Antimicrobial textiles with improved functionality find a variety of applications such as health and hygiene products, specially the garments worn close to the skin and several medical applications, such as infection control and barrier material. Cotton is a cellulosic fiber and it has a Comfortable Soft hand, Good absorbency, Color retention, Prints well, Good strength. Lemon oil, Pine oil, Peppermint oil having antifungal properties and also having many medicinal properties.
METHODOLOGY SELECTION OF FABRIC Cotton is a cellulosic fiber and it has a Comfortable Soft hand, Good absorbency, Color retention, Prints well, Good strength. Woven cotton fabric is selected for this study.
DESIZING Desizing is the process of removing the size material from the warp yarns in woven fabrics. Sizing agents are selected on the basis of type of fabric, environmental friendliness, ease of removal, cost considerations, effluent treatment, etc.
SELECTION OF LEMON GRASS OIL Lemongrass oil is extracted from the leaves of the plant. It has a thin consistency, and a pale or bright yellow color. It has a strong, fresh, lemony, and earthy scent. Lemongrass (Cymbopogon) is a tall perennial plant from the Poaceae grass family, which thrives in tropical and subtropical regions.
Extraction: Get two lemongrass stalks and remove the leaves. Crush the stalks using a mortar and pestle to release the oil. Fill a jar with your carrier oil of choice and put the crushed stalk in it. Leave the jar for two days in a place where it can get plenty of heat and sunshine. After two days, strain the oil using the cheesecloth and transfer it into another jar. Make sure to press and squeeze the stalks until they’re completely dry. You may need to repeat the process using fresh new stalks to achieve the desired lemongrass fragrance.
SELECTION OF PEPPERMINT OIL Peppermint oil is derived from the leaves of the peppermint plant or Mentha pipertita, a hybrid of the water mint and spearmint plants, and M. arvensis var. piperascensa, a plant from the Labiatae family. The essential oil is often used as a home remedy for stomach problems, muscle pain, and headaches. Aside from being available in its oil form, peppermint oil can be found in supplemental capsule form. Extraction Wash the peppermint leaves, then crush or chop them. This will release their natural oil. Place them in the jar and pour the carrier oil. Make sure the oil covers the leaves completely. Afterward, seal the jar tightly and wait 24 hours. Next, strain the oil and add more chopped peppermint leaves and carrier oil, then reseal. Repeat this process for five days. Remove the peppermint leaves by straining and pour the oil into another container. Store in a cool place.
SELECTION OF PINE OIL Pine oil is extracted from scotch pine (Pinus sylvestris). This high, evergreen tree has a reddish-brown and deeply fissured bark that grows pair of long, stiff needles. Largely produced in the Baltic states, the essential oil from this species is a hypertensive, tonic stimulant.
EXTRACTION Pine oil is extracted by steam distillation of fresh twigs, buds and yield about 0.1 – 0.5%, although another type of oil can also be extracted by steam distilling the needle.
FINISHING ON COTTON FABRIC WITH OIL BY USING EXHAUST METHOD The fabric sample was finished with the prepared herbal extracts microcapsules according to the following recipe with 8% binder. One liter of solution containing 700 grams of capsules is used to finish one meter of fabric. The fabric was immersed in the solution with 8% binder for 30 mins under 50?C in oven. After 30 mins, the fabric was removed from the dub and air dried in shade.
RESULTS AND DISCUSSION
ANTIFUNGAL ASSESSMENT BY AATCC 30 – 2003 TEST METHOD The antifungal activity of the finished fabric (100% cotton woven finished with LG, PM and PI was performed using the fungal strains of Aspergillus niger and Trichodrema reesei. Zone of inhibition was seen on both the plates. The activity was found according to ATCC 30 – 2003 test method.
From the above Table I and Table II indicate that the, Trichoderma reesei (81) zone of inhibition shows a higher range of zone than Aspergillus niger (75) and lemon grass show the better antifungal result than peppermint and pine oil.
CONCLUSION The above study interprets that the natural ailing herbs can be used in the recent trends to cure many skin problems. The recent approaches that are dealing with English medicines are taking a back step leaving the herbal medicines forward. Herbal medicines are the naturally produced products that are used in the treatment of many skin problems with no chemical thus no side effects.
ACKNOWLEDGEMENT Firstly, I would like to express my sincere appreciation and gratitude to Dr.S.Grace Annapoorani for her guidance during my research. Her support and inspiring suggestions have been precious for the development of this article contents. We acknowledge the editor and reviewers for their helpful comments and suggestions.
Englishhttp://ijcrr.com/abstract.php?article_id=315http://ijcrr.com/article_html.php?did=3151. Bajaj P., “ Finishing of Technical Textiles”, in Handbook of Technical Textiles, Horrocks A.R and Anand S.C (ed), Woodhead Publishing, Cambridge, 152- 172 (2000).
2. Duke J A, Handbook of Medicinal Herbs, (CRC Press inc., Boca Raton, Fla), 1985.
3. H Mucha, D Hoter and M Swerve: Antimicrobial Finishes and Modifications, Melliand International, May 2002, Vol 8, PP 148- 151.
4. https://en.wikipedia.org/wiki/Desizing
5. http://www.tradeindia.com/fp2934248/Lemongrass-Oil.html 6. articles.mercola.com/herbal-oils/peppermint-oil.aspx
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareMANAGEMENT OF CANCER WITH MUNZIJ AND MUS' HIL THERAPY: A REGIMEN OF ILAJ BIT TADBEER (REGIMENAL THERAPY) IN UNANI SYSTEM OF MEDICINE
English0409Yasmeen ShamsiEnglish Asim Ali KhanEnglish Tabassum AlamEnglish Azhar JabeenEnglishCancer is one of the most perplexing diseases which have been plaguing worldwide and had been accounted for 8.2 million of all deaths in 2012 as reported by World Health Organization (WHO) in 2014.According to WHO, it is the second leading cause of death in the developing countries after cardiovascular diseases. American Cancer Society defines it as “a large group of diseases, all characterized by uncontrolled growth and spread of abnormal cells”. Its etiology is still not completely understood but certain dietary factors and environmental agents act on the genetic material in cells leading to the chemical changes that may initiate the progression of abnormal cell mass. The Sartan (cancer) is well described in the Unani Classical Medical Literature as “Sartan” or “Warm-e-Sulb-Saudavi”. While going through the literature review of various compendiums written by Unani physicians, it is clear that this system of medicine had vast knowledge about sartan. In spite of the present advanced treatment options there is no effective and satisfactory treatment for cancer. The treatment besides being very expensive, are associated with serious side effects and morbidity due to their toxic effects. The search still continues for a treatment that has minimal side effects and is cost effective. Unani medicine has produced many useful leads in developing medications for chronic systemic diseases as proved by numerous clinical trials. Therefore, a Unani alternative approach is being explored in the light of classical Unani literature for the management of Sartan as a safe and efficacious treatment option. The role of Munzij and Mus’hil therapy, which isan important part of Ilaj bit Tadbeer (Regimenal therapy)in treating such disorders, is well recognized in Unani classical literature.
EnglishCancer, Unani Medicine, Sartan, Ilaj bit tadbeer, Munzij, Mus’hilINTRODUCTION
Cancer is a leading cause of death worldwide despite of its development in prevention, diagnosis and treatment. It is the second leading cause of death after cardiovascular diseases, in the developing countries 1,2,3. World Health Organization (WHO) in 2014 reported that cancer has accounted for 8.2 million deaths i.e. around 13% of all deaths in 20121,2,4. The International Agency for Research on Cancer (IARC) has estimated that there will be 14.1 million new cancer cases each year5.
In developing countries the most common carcinomas are lung, breast and colorectal cancers which cause more burden than the infectious diseases. The most frequently diagnosed cancers worldwide are the breast cancer in females and lung cancer in males. While, the breast cancer comprises almost one third of all malignancies in females with 1.38 million new cases and 458,000 deaths in 2008 6,7,8. The most frequent cancer among malesin developed countries is lung cancer which is preceded by prostate cancer 6,9,10. Dikshit et al reported in 2012 that approximately 5 lakh deaths were due to cancer in 2010 in India 2. The American Cancer Society defines cancer as “a large group of diseases all characterized by uncontrolled growth and spread of abnormal cells” 4 .
Whereas, Hilal Zaid et al in 2010 defines it as a cohort of diseases characterized by uncontrolled cell proliferation and ability to invade other tissues through direct cell migration or through the blood and lymph systems11. Cancer is not a new disease but, a new name for an old malady. The word cancer came from Greek word, karkinos12. Cancer was described as a crablike disease by eminent Greek physician Hippocrates, who observed that it spread all through the body and ultimately bring the life to an end10, 13. The history of Sartan is as old as the history of human being. The earliest evidence of human bone cancer was found in mummies and ancient manuscripts in ancient Egypt about 1600 B.C. Hippocratic School is thought to be the first to document Greek ideas about cancer14.
The world’s oldest recorded case of breast cancer hails from ancient Egypt in 1500 BC there was no treatment for the cancer other than palliative treatment12. According to old scripts the surface tumors were surgically removed in a similar manner as they are removed today. The life in cancer patients can be extended due to early identification and treatment which had been realized and emphasized by well-known Unani physicians (Razi; Abulcasis and Ibn-eSina) that the cure is most likely if the cancer was identified as its earlier stage otherwise it is difficult to treat1415.
Etiology of cancer with the most accepted theory The etiology of Cancer is not completely understood but certain theories suggest that certain dietary factors and environmental agents such as smoking and sunlight act on the genetic material in cells, leading to the chemical changes which may initiate the progression of an abnormal cells mass proliferation6 . The principal environmental agents that cause cancer are ionizing radiation, tumor viruses, carcinogenic chemicals and possibly, xenoestrogens.
Whereas, Population aging and the unsteady growth in population, as well as a sudden increase in adoption of cancer-associated lifestyle alteration including smoking, “westernized’’ diets and physical inactivity is continuously further increasing the burden of cancer9 . Till now, the most prominent and well accepted etiological theory for cancer suggests that somewhere in DNA structure there is a gene, called an oncogene, that produces an abnormal or mutant cell4,10.
Cancer in view of classical Unani literature The description of Sartan (cancer) in the Unani (GrecoArabian) system of medicine is suggested its acquaintance in ancient times (131-200 A.D). It is mostly described under the heading of “Sartan” which means “a crab” whereas some others Unani scholars described Sartan as “Warm-eSulb-Saudavi” a type of Saudavi swelling 14,16. Other terms for tumors, less often used in ancient literature are Scirrhus; Struma; Melicerides; Condyloma; Tuberculoma; Occalescit and Carcinode13,17,18,19. Samarqandi discussed the different types of sartan, as Sartan Bashra (skin cancer), Sartan Akkal (corrosive cancer), Sartan Mukhaati (cancer of mucosa) and Sartan Gudhi (lymph cancer)20,21.
Hippocrates’Humoral theory states that the human body consists of four humors (body fluids) viz. blood, phlegm, yellow bile and black bile. Any imbalance in these body fluids results in a disease condition. “Warm-e-Sulb-Saudavi” (Cancer) has also been attributed to the combustion and imbalance of certain humors in the body that leads to the accumulation of excess of black bile in a particular organ site12,20,21,22. Galen (130-200AD) extended Hippocrates’ definitions of cancer and he further classified tumors into three major types, (i) Onkoi (lumps or masses) (ii) Karkinomas (non-ulcerating cancers) and (iii) Karkinos (malignant ulcers) 14,23.Sartan which is caused by Madda-e-Saudavi-Safrawi is ulcerative type, while sartan which is caused by combustion of Maddae-Balghum-wa-Safrawi is non-ulcerative type.
Though, this concept is not universal, as sometimes the above type may progress to ulcerative. The scholars state that the ulcerative type is incurable and fatal 24. Ancient Unani physicians had very vast knowledge of sartan and they very successfully mentioned the sign and symptoms; etiology; types; pathogenesis; differential diagnosis; principles of treatment; treatment along with Dietary regimen in detail15,37, as evident from various compendiums written by eminent Unani physicians e.g. Hippocrates (460–377 B.C), Dioscorides (40-90 AD), Galen (129-200AD), Tabri (839–923 AD), Razi (854–925AD), Majoosi (930-994AD), Ibn-e-Sina (980-1037AD), Ibn Zuhr (1094–1162AD),Jurjani (1042-1136AD), Samarqandi (13th-centuryAD), Ajmal Khan (1868-1927AD).
The management of cancer hasalso been well elaborated according to pathogenesis and stages of disease. The disease has been classified into five stages and is being treated according to these stages which are mentioned as follows15: 1. Stage of ibtida’-e- marhala (Initial stage) 2. Stage of sartan-e-ghair-mutaqarrah (Non-ulcerative stage) 3. Stage of sartan-e- mutaqarrah (Ulcerative stage) 4. Stage of sartan-e-Khafii (hidden cancer) Unani physicians have discussed many treatment regimens based on their successful experiences in their respective compendium to treat and cure this fatal and incurable condition. Razi (854-925AD), described Sartan as a “Marz-eMuhlik” (fatal disease)in his book Kitab Al-Mansoori23,25.
Moreover, Razi, Ibn-Sina and Majoosi in Kitabul Hawi, Al Qanoon Fit Tib and Kamil-us-Sana respectively discussed the most common sites of Sartan14,24,26. They further stated that breast cancer is the most common sartan in women while Urethra and testes are the commonest sites for cancer in men. As per Unani concept cancer is essentially a disease of the black bile humor. According to Avicenna, cancer is a tumor arising from “burning” of the black bile humor. By ‘burn- ing’ it is meant that the increase of intrinsic heat has become pathological.
The cancerous tumor is usually differentiated from benign tumors by the signs of pain, some degree of throbbing, rapid increase in size and acuteness. Cancer is a multi-factorial disease and Unani philosophy is that cancer is the end stage of the degeneration of the metabolic efficiency of the body, the extinguish of the innate heat, primarily by incorrect diet and other imbalances in various aspects of the patient’s life, usually occurring over a long period of time. Since sartan is a disease of Black Bile Humor (Sauda). It can occur due to imbalance in the black bile humor by excess production of black bile itself or it may take place due to one or more humors (Balgham; Safra) out of balance along with the black bile. Sometimes any abnormal change occurring in the black bile (sauda) may be a leading cause for sartan. There are five types of abnormal changes occur in sauda- excess production of normal sauda, burning of normal sauda in to abnormal sauda, formation of sauda due to combustion of blood, formation of sauda due to combustion of phlegm and formation of sauda due to combustion of safra (bile)20,21,22,27.
It is known fact that the majority of the malignant tumor occurs in incessantly renewing tissues swelling is a manifestation of this black bile substance with the organ. Avicenna notes that cancer occurs mostly in hollow organs. It is also common in the nerves, muscles, tendons, and lymph. In early stage of disease its size is about the size of almond or may be shorter, thereafter as the disease progresses the size of tumor increases and appears as a red and white development along with greenish spreading out prominent veins. While its rootsare obscured in the body like crabs’ tracks and are very strong enough which is an important characteristic of this condition. Cancerous tumors send out crab-like “tracks,” and there is a trend toward blackness, green, and heat. Owing to this character it is named as “Sartan” which means “a crab” (a cancer)21,24.
Management of Cancer Unani medicine, one of the major traditional forms of medical practice in India, has produced many useful leads in developing medications for chronic systemic diseases 3 as proved by numerous clinical trials. Galen explained that cancer is a metabolic disease and it should be treated systemically rather than locally 28. Hence, an alternative approach-“Munzij and Mus’hil therapy: an important part of Ilaj bit Tadbeer (Regimental therapy)” is being explored in light of Unani classical literature for the management of Sartan as a better, safe and efficacious substitute to the existing treatment options. In Unani system of medicine, treatment is carried out in three ways, or there are three principal modes of treatment in Unani system of medicine. These are34: 1.
Ilaj bit Tadbeer wa Taghziya (Regimental and dietotherapy) 2. Ilaj bid Dawa (Pharmacotherapy) 3. Ilaj bil Yad (Surgery) Nuzj and Is’hal is an important part of Ilaj bit Tadbeer (Regimental therapy). In his book entitled “Methods of Treatment”, Galen has hypothesized that cancer is a disease associated with black bile humor which is hardly diagnosed at early stages. In order to treat cancer, Galen has proposed that removal of black bile from the body by means of administering an appropriate purgative, and then the production and accumulation of black bile in vessels should be prevented as far as possible. In case this method is not possible then black bile should be removed from the body at regular time points. Following principles are to be followed while treating the patients of Cancer (Sartan) by Taadil-e-Mizaj (correction of temperament) and Tanqia-e-Mawad (cleansing of morbid material) with reference to Nuzj and Is’hal therapy in our classical literature as:
Taadil-e-Mizaj (correction of temperament) In cancer there is imbalance in Humour called black bile (Sauda) which has cold and dry temperament and therefore, by adopting the measures of Ilaj-bil-zid the drugs and food having hot and wet temperament are given. The diet should be saaleh (healthy), jaiyyadul kaimus (easily digestable) latif (light)having cold and wet temperament butin small quantity. For example: Soups of lean meat,all dry fruits, Kaddu (Cucurbita maxima), Khurfa (Portulaccaoleracea),
Cholaee (Amaranthus polygamus), Bathua (Chenopodiumalbum), Kheera (Cucumis sativus), pomegranate, spinach, Badaam(Prunus amygdalus,)Ma-ul Jubn (whey water), Maus-Shaeer (barley water),Mufarreh Mashroobaat (exhilarant fruit juices) like Sharbat-e-saib (Apple juice)along with arq-e-baid-Mushk-wa-arq-e-Neelofar is very effective as a cardiac tonic. These mentioned foods and drinks reduce the excess production and accumulation of sauda and also refresh the body. Strengthening of the affected organ by the aromatic drugs have been well mentioned in Unani classical literature20, 21,29.
Tanqia-e-Mawad (Cleansing of morbid matter) by Munzij and Mus’hil therapy The concept of Nuzj and Is’hal in the treatment of the diseases is indeed archaic. Jalinoos, RabbanTabri, Razi have given the importance of Munzij and mus’hil therapy in their literature, and they themselves treated patients successfully with this mode of treatment. Kabiruddin30 referring Gilani states that when the morbid materials are extracted from intestine or the nearby structures, then it is called as Talyeen (Laxation) and when the morbid materials are extracted from the vessels and other deeper tissues, then it is known as Is’hal (Purgation). The entire regimen consists of two phases: first Nuzj (Concoction) followed by Is’hal (Purgation). Nuzj (Concoction)is a method by which morbid materials are modified to a form which could be easily evacuated with the help of Mus’hilat (Purgatives).
In this way, viscous humors are diluted enough and vice versa for their easy expulsion out of the body. Nuzj (Concoction) is essential in case of all chronic disorders as well as the diseases having duration of more than 40 days. As per the line of treatment given in Unani classical books, Nuzj (Concoction) is a requisite in chronic diseases, but optional in acute diseases depending upon the severity and acuteness of the condition30,31. In cases of phlegmatic diseases, it is mandatory that purgation should be preceded with Nuzj (Concoction). It is optional in bilious diseases. It is not required in sanguinous diseases. In case of sanguinous diseases, moadillat-e-dam-Advia is given instead of Munzij drugs30.
The duration of Nuzj varies with different humors: • Safra-e-khalis 3days • Safra-e-Ghair-khalis 5days • Balghum Raqeeq 5days • Balghum Ghaleez 12days • Sauda-e-Khalis 15-40days Soon after the signs of Nuzj completion appear, the Mus’hil (Purgative) drugs are added to the Munzij drugs24,30. Mus’hil (Purgative) drugs bring about the Is’hal (Purgation) of the morbid humors (phlegm, sauda and safra) that have been made able to evacuate by the action of Munzijat. It is used to eliminate and evacuate out the morbid materials responsible for the disease. Depending upon the mode of action, the Mus’hilat (Purgatives) is of different types:
According to the severity of actions: Mus’hilat-e-Khafeef(Mild purgatives): these are the drugs which simply increase the peristaltic movements of the intestine, but do not produce spasmodic pain in abdomen and produce semi loose motions. For example:Tubud (Ipomoeae turpethum); Sana-e-Makki (Casia angustifolia). Mus’hilat-e-Shadeed(Strong purgatives): these are the drugs which increase the peristaltic movements of the drugs and bring watery stools without causing the spasmodic pain.
According to the mode of actions: Mus’hil bit-taleen: The drugs which increase the peristaltic movements of the intestine in such a way that they produce laxative effects causing semi soft motions. For example: Turanjbeen; Sher-e-khisht. • Mus’hil bil Izlaq: Aloobukhara; Sapistaan; Tukhm-eKhatmi. • Mus’hil-e-bil-jila: Boora Armani. • Mus’hil-e-bil-quwatl-Mus’hila: Saqmonia. • Mus’hil-e-bil-Aseer: Halailajat; Sharbat-e-ward-mukarar. After the process of purgation has occurred, the drugs for Tabreed are given. Physicians in ancient times used to advise Loab-e-Aspaghol in the evening for people of hot temperament; Tukhm-e-rehaan for moderate temperament and Tukhm-e-tera- tezak for cold temperament, but physicians of present era advise Tabreed daily after purgation.
The commonly used formulation for Tabreed is as follows: Khameera Gaojaban (7gm)with Loab-e-Behdana (3gm), Sheera Unnab(5 piece) in Arq-e- Gaojaban(100 ml) and Sharbat-e-Banafsha (20ml) is given in the morning21. For Khilt-e-sauda commonly used Unani single drugs as Moad’dilat (Alterative); Munzijat (Concoctive) and Mus’hilat (Purgative) 32. Moad’dil (Alterative Sauda drugs)30,36: Ustookhudoos (Levandula Stoechas); baada’ward (Volutarella Divaricate); baaddranjboya (Nepata Puderalis); parshiyaoshah(Adiuntun capillus-veneris); Sapistaan (Cordia dichotoma); Shahatra (Fumaria parviflora); Unnab (Zizyphus vulgaris); Gao-zaban (Borago officinalis); Maweez-e-munaqa (Delphinium staphysagria)etc.
Munzij (Concoctive sauda drugs): Ustookhudoos (Levandula Stoechas)s; baada’ward (Volutarella Divaricate); baaddranjboya (Nepata Puderalis); parshiyaoshah(Adiuntun capillus-veneris); Asl-us-soosmuqashar(Glycyrrhiza glabra); badiyan (Foeniculum vulgare); Barg-e- Shahatra (Fumariaparviflora); Turanjbeen (Alhagi pseudalhagi); Sapistaan (Cordia dichotoma); Unnab (Zizyphus vulgaris); Gao-zaban (Borago officinalis); Gulqand etc.
Mus’hil (Purgative sauda drugs)35: Aamla (Emblica officinalis); Ustookhudoos (Levandula Stoechas); Afteemoon (Cuscuta reflexa); Ayaraj-e-feyqra (Aloe barbadensis); Burg-e- baaddranjboya (Nepata Puderalis); Burg-e-Sana-e-Makki (Cassia angustifolia); Bisfayajh (Polypodium vulgare); Tukhm-e-Baalangoo; Tukhme-Kasoos (Seeds of Vitis carnosa); Hub-ul-Neel; Reywandh Khastaayee; Ga’rayqoon (Agaricus alba); Gul-e-gao-zaban ( Flowers of Borago officinalis); Halela siyah (Terminallia bellerica); Halela qabooli (Terminalia chebula) etc.
Some Important Unani prescriptions on munzij and mus’hil therapy for cancer:
1. Unnab (Zizyphus vulgaris)(5 piece), Gao-zaban (Borago officinalis)(7 gm), Shahatra (Fumaria parviflora)(7mg), Baaddranjboya (Nepata Puderalis) (7gm), Badiyan (Foeniculum vulgare)(7 gm), Asl-ussoos-muqashar (Glycyrrhiza glabra)(5 gm). The above mentioned drugs are soaked in hot water overnight and after sieving it Gulqand (20 gm) or Turanjbeen (Alhagi pseudalhagi) (20 gm) is added to it24.
2. Bisfayajh (Polypodium vulgare); Ustookhudoos (Levandula Stoechas); Maweez-e-munaqa (Delphinium staphysagria); badiyan (Foeniculum vulgare); Gaozaban (Borago officinalis); baaddranjboya (Nepata Puderalis); A’lobukhara; Afteemoon (Cuscuta reflexa) along with Turanjbeen (Alhagi pseudalhagi)21.
3. Maweez-e-munaqa (Delphinium staphysagria)(9 piece); Badiyan (Foeniculum vulgare)(5 gm); Asl-ussoos-muqashar (Glycyrrhiza glabra)(7 gm); Parshiyaoshah (Adiuntun capillus-veneris) (7 gm); Anjeere-zard (Ficus carica) (2 pieces) The decoction of the above mentioned drug incorporated with Gulqand Asli (40gm)24.
4. Unnab (Zizyphus vulgaris)(5 piece); Gul-e-Banafsha (Flowers of Viola odorata) (7 gm); Gul-e-Neelofar (7 gm); Shahatra (Fumaria parviflora)(7 gm); Tukhme-Kasni-Neem-Kofta (Chicorium intybus) (7 gm); Beekh-e-Kasni (root of Chicorium intybus) (7 gm); Gul-e-Surkh(Rosa domescus)24 The drugs are soaked in hot water overnight and after sieving it Sharbat-e-Neelofar (20ml) or Sakbeenajh (20 gm) is added to it.
5. Ayaraj-e-feyqra (Aloe barbadensis); Turbud (Ipomoea Turpethum) (each 3.5 gm); Hub-ul-Neel; Anisoon (Pimpinella anisum) (each 1.75 gm); Saqmonia Biryan; Kateera (Cochlospermum religiosum) (each 6 mg), Tukhm-e-Hanzal (seeds of Citrullus colocynthisschred); Ga’rayqoon (Agaricus alba); Sa’lab misri (each 3 mg)24 Tablets are made from the Powder of the above mentioned drugs with Arq-e-Gulab. Dose: 2-4 tablets
6. Afteemoon (Cuscuta reflexa), Bisfayajh (Polypodium vulgare), Ustookhudoos (Levandula Stoechas), Ga’rayqoon (Agaricus alba), Ayaraj-e-feyqra (Aloe barbadensis), Turbud (Ipomoea Turpethum)22.
7. Ayarjaatlike Ayaraj-e-feyqra (Aloe barbadensis) or Ayaraj-e- Jalinoos or Ayaraj-e-Roofas to eliminate the morbid Sauda and for Taadil-e-Mizaj21.
8. Ayaraj-e-feyqra (Aloe barbadensis) (4.5 gm); Turbud muqashar (Ipomoea Turpethum) (9 gm); Hub ul-Neel(1 gm); Afyun (Papaver somniferum)(1 gm); Ga’rayqoon (Agaricus alba)(1 gm); Shem-e-Hanzal (Citrullus colocynthisschred)(1 gm); Samagh-e-Arabi (Acacia Arabica)(4mg); Kateera (Cochlospermum religiosum)(4gm); Gul-e-Surkh(Rosa domescus) (4 mg); Namak-e-Hindi (4mg); Mastaghi (Pistacia lentiscus)(4mg); Muqil (Commiphora Mukul)(4.5mg); and Rogan Badam (Prunus amygdalus)(1mg). Dose: Half tablet should be administered in the night and remaining half in morning but in empty stomach.
CONCLUSION Cancer is the second leading cause of death in the developing countries after cardiovascular diseases. Its etiology is still not completely understood. The knowledge of Sartan (cancer) in the Unani system of medicine is well described in the Unani Classical Medical Literature as “Sartan” or “Warm-e-Sulb-Saudavi”. Unani System of Medicine has produced many useful leads in developing medications for chronic systemic diseases as proved by numerous clinical trials. The eminent Unani physicians like Hippocrates,Avicenna, Rhazes and Al-Zahrawi had well described the information about the cancer and the principles laid down by them were well recognized in medical science and influenced the medical world for many centuries. Hippocratic School is thought to be the first to document Greek ideas about cancer. According to inscriptions, surface tumors were surgically removed in a similar manner as they are removed today.
Early identification and treatment had been realized and emphasized by eminent Unani physicians (Razi; Abulcasis and Ibn-e-Sina) that the cure is most likely if the cancer was identified as its earlier stage otherwise it is difficult to treat. The present treatments for cancer include surgery, radiation, and chemotherapy with a goal to eradicate as many cancer cells as possible. In spite of all these, there is still no cure and besides being enormously expensive, these medicines are associated with serious side effects and morbidity due to their toxic effects. In such a scenario, the search continues for an ideal treatment that has minimal side effects and is cost effective. Unani Medicine might be a potential safe treatment for cancer. Thus, a Unani alternative approach-“Munzij and Mus’hil therapy: an important part of Ilaj bit Tadbeer (Regimenal therapy)” can be explored for the management of Sartan as a better, safe and efficacious treatment option.
Englishhttp://ijcrr.com/abstract.php?article_id=316http://ijcrr.com/article_html.php?did=3161. Emel Tasci-Duran; Sukran Koc et al: Turkish Social Attitudes towards Cancer Prevention: a Health Belief Model Study. Asian Pac J Cancer Prev. 2014; 15 (18), 7935-7940.
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3. Sunyana Jain; Vikrant Gill et al: Ayurvedic medicines in the treatment of cancer. Journal of Chinese Integrative Medicine, November, 2009, Vol 7(11):1096-1099.
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6. Bernard W Stewart and Paul Kleihues: World health organization (WHO: OMS): International agency for research on cancer: World cancer report. IARC Press, Lyon 2003, pp 182-186.
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9. Ahmedin Jemal; Freddie Bray et al: Global Cancer Statistics. CA CANCER J CLIN 2011; 61:69–90.
10. Gordon Edlin and Eric Golanty: Health and Wellness-9th edition. Jones and Bartlett Publishers Canada; 2007; pp.291-309.
11. Hilal Zaid and Bashar Saad: Cancer treatment in the Arab-Islamic medicine: Integration of tradition with modern experimental trails. 2010: 14: 13-30.
12. Akulapalli Sudhakar: History of Cancer, Ancient and Modern Treatment Methods. J Cancer Sci Ther. 2009 December 1; 1(2): 1–4.
13. Hippocrates, Ancient medicine. Airs, waters and places. Epidemics 1 and 3. The oath. Percepts. Nutriment (Transl. W.H.S. Jones, 1923). London: W. Heinemann. Loeb Classical Library.
14. Yasmeen Shamshi and Rais-ur-Rehman: Concept of cancer in Greco-Roman and Islamic Medicine. International Journal on Biological Sciences (IJBS); 2012; Vol. III (1); pp.63-67.
15. Hkm Asher Qadeer: Tib Unani aur Sartan. Pandrah Rozah-TibbE-Mashriq: Delhi: Cancer Special Issue. New public press, Gali kasim jaan, Delhi-6, December, 2002; pp.76-79.
16. Sadia Nikhat; R. Anjum et al: Perceived risk of cervical cancer among women: A hospital based study. IJUM.2014 January to June 7 (1): 43-48.
17. Celsus, De Medicina (trans. W. G. Spencer, 1938). London: W. Heinemann. Loeb Classical Library. Vol. II and III.
18. Galen, De tumoribus praeter naturam (transl. J. Reedy, 1975). ClioMedica 10 (3):2; 1975; pp.27-238.
19. Soranus’ Gynecology (transl. O. Temkin, 1956). Baltimore and London: The John Hopkins University press. 1956.
20. Allama Najeebuddin Samarqandi: Sharah-e-Asbaab Tarjumah Kabeer: Vol- I (Urdu translation by Hkm Kabiruddin). Ejaj Publishing House, Darya Ganj, New Delhi-110002, 2007, pp.21
21. Allama Najeebuddin Samarqandi: Sharah-e-Asbaab Tarjumah Kabeer: Vol- III and IV (Urdu translation by Hkm Kabiruddin). Ejaj Publishing House, Darya Ganj, New Delhi-110002, 2007, pp.223-226.
22. Ahteshamul-Haq-Quraeishi: Cancer ya Sartan: ek Ta’ruf. Pandhra Rozah-Tibb-E-Mashriq: Delhi: Cancer Special Issue. New public press, Gali kasim jaan, Delhi-6, December, 2002; pp.72
23. Diamandopoulos. G. T: Cancer: an historical perspective. Anticancer Res.1996; 16(4A):1595-1602.
24. Hkm Sayed Kamaluddin Hussain Hamdani: Cancer. Pandhra Rozah-Tibb-E-Mashriq: Delhi: Cancer Special Issue. New public press, Gali kasim jaan, Delhi-6, December, 2002; pp.63-66
25. Weiss. L: Early concepts of cancer. Cancer Metast Rev.2000; 19 (3-4):215-217.
26. Razi Z (2004): Kitabul Hawi fit Tib (Urdu translation by CCRUM); Vol II; Seema Offset press; Delhi.
27. Hkm. Akbar Arzani: Mizan Al-Tib (Urdu translation, by Hkm. Kabiruddin). Published by Idarah Kitab-Us-Shifa New Delhi.2002: 22, 34, 39, and 246.
28. Pervan V; Cohen LH; Jaftha T: Oncology for health care professionals. Cape town: Juta and Co; 1995; pp.5-6.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareA RARE CASE OF BREAST ABSCESS DUE TO SALMONELLA TYPHI
English1012N. MurugesanEnglish R. Alagar samyEnglish M. S. ViswanathanEnglish A. AnbazhaganEnglishBreast abscess is a common clinical condition in the young reproductive age group and is mainly caused by gram positive cocci and anaerobes .The incidence of breast abscess in a patient with typhoid is 0.3%-0.9% in females. Here we report a 60 year old diabetic female patient admitted with history of fever for 10 days followed by pain and lump in the right breast for two days. She gave no history of taking any antibiotics. On admission she was afebrile, a lump of size 7×5 cm in the upper outer quadrant of right breast, firm in consistency without any signs of inflammation. Ultrasonagram of the right breast revealed a breast abscess. Incision and drainage procedure was done and the pus sent for culture and sensitivity test. Salmonella typhi was isolated as the only infective agent from the pus and was sensitive to ampicillin-sulbactum and amikacin. The patient had no evidence of systemic typhoid (negative widal and Blood culture). The patient recovered completely with drainage under antibiotic cover. The case is being presented for its rarity.
EnglishBreast abscess, Salmonella typhi, Widal test, Typhoid feverINTRODUCTION
Enteric fever is endemic in developing countries such as India where healthy sanitary conditions and potable water are not accessible to all. Patients typically present at the end of the first week after the onset of symptoms with fever, influenza-like symptoms with a dull frontal headache, malaise, etc., but with few physical signs. A coated tongue, tender abdomen, hepatomegaly, and splenomegaly are commonly found. A relative bradycardia is also common in typhoid. Blanching erythematous maculopapular lesions commonly called ‘rose spots’ are reported in 5–30% of cases.1 If untreated or where the implicated organism is resistant to the treatment being given, there may be seeding of salmonellae in various organs of the body.2 Such patients usually present with abscess formation and fever. There have been occasional reports on the occurrence of abscesses due to Salmonella spp., such as liver,3 spleen,4 and anterior abdominal wall,5 but unilateral breast abscess is a rare presentation. We present here a rare case of an old non lactating, immunocompetent female who presented with unilateral breast abscesses due to Salmonella typhi. We also review the literature on breast abscesses due to Salmonella typhi.
CASE REPORT A 60-year-old female patient presented with complaints of pain and swelling of right breast for 10 days duration. Two weeks prior to that she had low grade fever without chills and rigor lasting for 3 days which subsided on its own without any antibiotics. There was no history of right nipple discharge or nipple retraction. There was no history of right axillary swelling. The patient was a known diabetic on irregular treatment. General examination of the patient was unremarkable. She was afebrile. She was not anaemic and adequately hydrated.
Local Examination of right breast revealed a firm swelling of size 5x4 cms occupying the upper outer quadrant and the skin over the swelling was erythematous. The right breast swelling was warm and tender which was not fixed to the underlying structures. Right nipple and areola complex appeared normal. There was no regional or generalized lymphadenopathy. Left breast and axilla were normal. Other systems were normal. Investigations:CBCHb-12.6 g/dl, TC-12000 cells/cumm, DC- Neutrophil- 68 %, Lymphocytes-24%, Basophil-2%, Renal function testUrea- 26.6 mg/dl, Creatinine-0.8 mg/dl ,Sodium-134 mEq/ dl, potassium-4.2 Meq/dl, Choloride -101 mEq/dl ,Urine for Albumin, sugar and deposits- nil. Blood sugar-205 mg/ dl.
Chest x ray PA view revealed no abnormality. ECG was within normal limits. Utrasonogram (USG) of right breast revealed an irregular and ill defined hypo echoic lesion of size 1.5x1.3cms in the upper outer quadrant. Under General Anaesthesia and the patient in supine position, diagnostic aspiration revealed pus, hence it was followed by incision and drainage. About 15 ml of pus was drained and necrotic material of the abscess cavity was scraped out. The scrapings from the wall of the abscess cavity were sent for histopathological examination and the pus was sent for culture and sensitivity. A tube drain was kept and wound dressing was done regularly. The right breast wound healed in 10 days.
Histopathological examination of the scrapings from the abscess cavity wall revealed features consistent with a suppurative lesion. The surprise came from the pus culture and sensitivity report which revealed salmonella typhi growth and the organism was sensitive to Amikacin/Ampicilinsulbactam/ Cefepime/Ceftazidime/Pipataz/Imipenam.No other organism was grown in culture.(Figure 1) In hind sight the patient was investigated for systemic typhoid. The reports are as follows: Blood Widal test was negative (o typhi 1 in 40 and H typhi 1 in 80). Blood Culture did not grow any organism. Peripheral smear study was normal. Stool for typhoid bacillus was negative.
DISCUSSION
Salmonella typhi bacteremia is occasionally associated with extraintestinal disease.2 It is capable of forming abscesses in various organs such as liver, subcutaneous tissue, muscles and skin. The pathogenesis of abscess formation is not well established. The possible causes may be infective bile from carriers, hematogenous spread from distant site, and lymphatic spread from gastrointestinal tract. Bilateral breast abscesses due to Salmonella typhi are a rare presentation6 . The present case was associated with a detectable bacteremia in the past.
The incidence of breast abscesses in patients with typhoid has been shown to be around 0.3% by Klose and Sebening (1930) and 0.5% by Pezinski (1937) in a study of 1196 cases of typhoid over a period of 2 years. In females, the incidence was 0.9%.7 Other authors have also reported similar cases of unilateral breast abscess due to Salmonella typhi. 8,9 Other nontyphoidal salmonellae have also been associated with cases of breast abscess. Razeq et al10and Edelstein et al11 had isolated Salmonella Landweisser and Salmonella serogroup B in breast abscess, respectively. In a recently published study from Kuwait, a very rare serotype, Salmonella enterica serotype Poona, was isolated from a case of breast abscess that was associated with erythema nodosum.12Neonatal mastitis due to Salmonella spp. has also been published.13 Kumar14 reported a multidrug-resistant typhoid with breast abscess.
On analyzing the available literature on breast abscesses due to Salmonella spp., we found that most of the patients were immunocompetent females between the ages of 23 and 45 years. They were non lactating. However, no common predisposing factors could be elucidated. The following are associated with the salmonella species.8 a) Typhoid fever and its complications. b) Gastroenteritis. c) Septicemia with abscess in liver, spleen, brain, parotid, etc.. d) Cholecystitis and carrier stage e) Venous thrombosis f) Cystitis, bacilluria, epididymo orchitis g) Osteomyelitis. In Breast abscess the possibility of isolating salmonellae is remote if culture is done by using the following culture media10. 1) Mac Conkey and Deoxycholate citrate media(DCM). 2) Wilson and Blair bismuth sulphite medium 3) Selenite F broth media 4) Tetrathionate broth.
CONCLUSION
Any breast abscess in a nonlactating female with a history of typhoid fever in the recent past and with no other predisposing factors must be evaluated throughly, keeping in mind the possibility of a Salmonella breast abscess. A combination of medical and surgical treatment would help in such a patient for a complete cure, when supported by microbiological culture and sensitivity report.
Footnotes Source of Support: Nil Conflict of Interest: Nil.
ACKNOWLEDGMENT
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=317http://ijcrr.com/article_html.php?did=3171. Parry CM, Hien TT, Dougan G, White NJ, Farrar JJ. Typhoid fever. N Engl J Med. 2002;347:1770-82. [PubMed]
2. Rodriguez M, de Diego I, Mendoza MC. Extraintestinal salmonellosis in a general hospital (1991 to 1996): Relationships between Salmonella genomic groups and clinical presentations. J Clin Microbiol. 1998;36:3291-6.
3. Ciraj AM, Reetika D, Bhat GK, Pai CG, Shivananda PG. Hepatic abscess caused by Salmonella typhi. J Assoc Physicians India. 2001;49:1021-2.
4. Duggal S, Mahajan RK, Biswas NK, Chandel DS, Duggal N, Hans C. Splenic abscess due to Salmonella enterica Serotype Typhi in a young adult. J Commun Dis. 2008;40:219-22.
5. Thakur K, Singh G, Gupta P, Chauhan S, Jaryal SC. Primary anterior parietal wall abscess due to Salmonella typhi. Braz J Infect Dis. 2010;14:328-9.
6. Singh S, Pandya Y, Rathod J, Trivedi S. Bilateral breast abscess: A rare complication of enteric fever. Indian J Med Microbiol. 2009;27:69-70.
7. Barrett GS, MacDermot J. Breast abscess: A rare presentation of typhoid. Br Med J. 1972;2:628-9.
8. Delori M, Abgueguen P, Chennebault JM, Pichard E, Fanello S. Breast abscess with Salmonella typhi and review of the literature. J Gynecol Obstet Biol Reprod (Paris) 2007;36:709-12.
9. Mahajan RK, Duggal S, Chande DS, Duggal N, Hans C, Chaudhry R. Salmonella enterica serotype Typhi from a case of breast abscess. J Commun Dis. 2007;39:201-4.
10. Razeq JH, Glenn A, Thomas G, Sholes A. First human case of Salmonella enterica serotype Landwasser recovered from breast fluid. J Clin Microbiol. 2000;38:4300.
11. Edelstein H. Breast abscess due to Salmonella serogroup B, serotype Reading, in a young nonpuerperal woman. Clin Infect Dis. 1993;17:951-2.
12. Al Benwan K, Al Mulla A, Izumiya H, Albert MJ. Erythema nodosum and bilateral breast abscesses due to Salmonella enterica serotype Poona. J Clin Microbiol. 2010;48:3786-7.
13. Nelson JD. Suppurative mastitis in infants. Am J Dis Child. 1973;125:458-9.
14. Kumar PD. Breast abscess: A rare complication of multiresistant typhoid fever. Trop Doct 1998;28:238-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareACCURACY OF SERUM URIC ACID IN PREDICTING COMPLICATIONS OF PRE-ECLAMPSIA
English1321A. Ramana PriyaEnglish K. JeyapriyaEnglish N. S. KannanEnglishIntroduction: Pre-eclampsia, is a pregnancy-specific syndrome that occurs after mid gestation comprising of gestational hypertension with significant proteinuria. If not treated properly will lead to maternal and foetal complications. Aims: To study the accuracy of serum uric acid in predicting complications of pre-eclampsia and its effect on pregnancy outcome. Methods: Sixty pregnant women at term gestation with diagnosis of pre-eclampsia were included in our study after informed consent. For all patients included in the study all routine investigations including serum uric acid were done and recorded. All the patients were followed up until delivery and all maternal and foetal events were recorded. All complications of pre-eclampsia both maternal and foetal were statistically analysed to prove the predictive value of serum uric acid levels. Results: 18.3% of mothers were between the age group 18-21 years, 26.7% were between 22-25 years, 28.3% were between 26-29 years, and 26.7% were above 30 years. 83.4% of 60 mothers were primi para, 8.3% were para 2, and 8.3% were para 3. The difference in the first minute APGAR in the high risk and no risk category was not statistically significant at p value of 0.1798. The difference in the 5th minute APGAR in the high risk and no risk category was statistically significant at p value of 0.001. 4 out of 42 women (9.52%) with serum uric acid ≥6mg/dl had maternal complications and 7 out of 18 women with serum uric acid EnglishGestational hypertension, Eclampsia, HELLP syndrome, Maternal death, Intrauterine growth restriction, Foetal distress, Perinatal deathINTRODUCTION
Pre-eclampsia, a pregnancy-specific syndrome that occurs after mid gestation, is defined by the de novo appearance of hypertension (systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg), accompanied by new-onset proteinuria, defined as ≥300 mg per 24 hours1 . Previous definitions included oedema, but this sign is nonspecific and is observed in many normotensive pregnant women. Thus, oedema is no longer considered part of the diagnostic criteria for preeclampsia.
The incidence of preeclampsia is 2-10%, depending on the population studied and definitions of Pre-eclampsia2 . It can result in many maternal complications3,4 such as severe hypertension, eclampsia and HELLP syndrome (Haemolysis, Elevated Liver enzymes and Low platelet count), or foetal complications5 such as growth restriction, foetal distress and even perinatal death. Early prediction of these complications might help to decide whether termination of pregnancy might be a better option than expectant monitoring.
AIMS AND OBJECTIVES:
Aims: To study the accuracy of serum uric acid in predicting complications of pre-eclampsia and its effect on pregnancy outcome. Objectives: 1. To estimate the serum uric acid levels in term gestation with pre-eclampsia. 2. To evaluate the relationship between serum uric acid and foetal outcome. 3. To know the association between the level of serum uric acid and severity of hypertension. 4. To correlate serum uric acid levels with maternal morbidity and mortality.
MATERIALS AND METHODS
A prospective study to estimate serum uric acid was carried out in 60 pregnant women at term gestation ( > 37 weeks of gestation) admitted in Raja Muthiah Medical College Hospital during the period October 2011 - September 2013 with diagnosis of pre-eclampsia (pregnancy induced hypertension and proteinuria with or without pathological oedema). These patients were included in the study after due informed consent. The criteria adopted to diagnose pregnancy induced hypertension1 : Systolic blood pressure of ≥140 mm Hg or diastolic blood pressure of ≥90 mm Hg.
The criteria adopted to diagnose significant proteinuria3,17,18: One 24-hour urine collection with a total protein excretion of 300 mg / 24 hours. The criteria adopted with reference to oedema1,2: Previous definitions included oedema, but this sign is nonspecific and is observed in many normotensive pregnant women. Thus, oedema is no longer considered part of the diagnostic criteria for preeclampsia. Pre-eclampsia patients may or may not have pathological oedema. The criteria adopted to diagnose high-risk serum uric acid level19: Values ≥6 mg/dl (360 µmol/l) was cut off level for high risk in our study.
Inclusion criteria: All patients diagnosed as pre-eclampsia as per the above criteria subject to their willingness to participate in the study after informed consent. Exclusion criteria: 1. History of chronic hypertension 2. Family history of hypertension or diabetes mellitus 3. Pre existing medical illness like heart disease, diabetes mellitus, renal diseases or thyroid disorders. 4. Hypertension before 20 weeks of gestation 5. Patients who are not willing to participate in the study. Method of study Out of all cases admitted with the diagnosis of pre-eclampsia, 60 were selected based upon fulfilling inclusion and exclusion criteria.
A detailed history of each patient was taken and complete general and obstetric examination was done. All findings were recorded in pre-designed proforma. Hyperten- sion and Proteinuria were diagnosed as per the criteria already described. For all patients included in the study all routine investigations including serum uric acid were done and recorded. For determination of serum uric acid two methods have been described: 1. Calorimetric method (Caraway’s method) and 2.
Enzymatic method. Calorimetric method is influenced by many factors in the procedure as well as many contaminating substances in the glassware etc. In the enzymatic method, enzyme uricase has been widely used for uric acid determinations because of its improved specificity20-22. Therefore, we used enzymatic method. All the patients were followed up until delivery and all maternal and foetal events were recorded. All complications of pre-eclampsia both maternal and foetal were statistically analysed to prove the predictive value of serum uric acid levels.
RESULTS AND OBSERVATIONS
Distribution according to the age of mothers: 18.3% of mothers were between the age group 18-21 years, 26.7% were between 22-25 years, 28.3% were between 26-29 years, and 26.7% were above 30 years (Table/Fig 2). Distribution according to Gravida: 60.0% of mothers were primi, 28.3% were second gravid, 8.3% were third gravid and 3.3% were fourth gravid (Table/Fig 3). Distribution according to Parity: 83.4% of 60 mothers were primi para, 8.3% were para 2, and 8.3% were para 3 (Table/ Fig 4). Distribution according to period of gestation: 28.3% were 37-38 weeks, 2.0% were 38-39 weeks, 33.3% were 39-40 weeks, 18.3% were 40-41 weeks of gestation (Table/Fig 5).
Mean and Standard Deviation of Blood Pressure, Serum Uric acid and Foetal outcome: The mean systolic was 146.33 and standard deviation 7.12. The mean diastolic was 95.67 and standard deviation 6.21. The mean uric acid was 5.25 and standard deviation 1.64. The mean foetal outcome of APGAR 1 minute was 4.05 and standard deviation 1.84. The mean foetal outcome of APGAR 5 minutes was 6.49 and standard deviation 1.19 (Table/Fig 6). Distribution of Mothers according to Urine Albumin: Urine albumin was 1+ in 26.7% of mothers, 2+ in 43.3% of mothers, 3+ in 26.7 % of mothers and 4+ in 3.3% of mothers (Table/Fig 7).
Distribution of Mothers according to Mode of Delivery: 83.3% of mothers had caesarean section, 6.7% of mothers had abnormal vaginal delivery, another 6.7% had normal vaginal delivery and 3.3% had forceps delivery (Table/Fig 8). Distribution of Mothers according to IUGR (intra uterine growth retardation) and IUD (intra uterine death): 79.4% of 60 mothers were admitted with IUGR, 14.7% of mothers were admitted with IUD and 5.9% of mothers were admitted with both IUGR and IUD (Table/Fig 9). Relationship between 1st min APGAR and Serum Uric Acid: 94.4% of babies under high-risk category had an APGAR of less than 5/10 in the 1st minute of their life, whereas 80.0% of the babies under no risk category had an APGAR of less than 5/10 in the 1st minute of their life. The difference in the first minute APGAR in the high risk and no risk category was not statistically significant at p value of 0.1798 (Table/Fig 10).
Relationship between 5th min APGAR and Serum Uric Acid: 55.6% of babies under high-risk category had an APGAR of less than 5/10 in the 5th minute of their life, whereas 11.9% of the babies under no risk category had an APGAR of less than 5/10 in the 5th minute of their life (Table/Fig 11). The difference in the 5th minute APGAR in the high risk and no risk category was statistically significant at p value of 0.001. From this table infers that the mothers whose serum uric acid was more than 6 mg/dl had 4-5 times increased risk of having APGAR of less than 5/10 at 5th min when compared to mothers with serum uric acid less than 6mg/dl. Maternal complications: 4 out of 42 women (9.52%) with serum uric acid ≥ 6mg/dl had maternal complications and 7 out of 18 women with serum uric acid Englishhttp://ijcrr.com/abstract.php?article_id=318http://ijcrr.com/article_html.php?did=3181. Roberts JM, Pearson G, Cutler J, Lindheimer M. Summary of the NHLBI Working Group on Research on Hypertension During Pregnancy. Hypertension 2003;41:437-45.
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11. Roberts JM, Bodnar LB, Lain KY, Hubel CA, Markovic N, Ness RB, Powers RW. Uric acid is as important as proteinuria in identifying fetal risk in women with gestational hypertension. Hypertension. 2005;46:1263-1269.
12. Parrish M, Griffin M, Morris R, Darby M, Owens MY, Martin JN. Hyperuricemia facilitates the prediction of maternal and perinatal adverse outcome in patients with severe/superimposed preeclampsia. J Matern Fetal Neonatal Med. 2010;23:1541-1545.
13. Laughon SK, Catov J, Powers RW, Roberts JM, Gandley RE. First trimester uric acid and adverse pregnancy outcomes. Am J Hypertens. 2011;24:489-495.
14. Paula LG, da Costa BE, Poli de Figuereido GE, Antonello IC. Does uric acid provide information about maternal condition and fetal outcome in pregnant women with hypertension Hypertens Pregnancy. 2008;27:413-420
15. Yalamati P, Bhongir AV, Betha K, Verma R, Dandge S. Relationship of serum uric acid, serum creatinine and serum cystatin C with maternal and fetal outcomes in rural Indian pregnant women. International journal of reproduction, contraception, obstetrics and gynecology. 2015;4(5):1505-1510. doi:10.18203/2320- 1770.ijrcog20150737.
16. Lind T, Godfrey KA, Otun H, Philips PR. Changes in serum uric acid concentrations during normal pregnancy. Br J Obstet Gynaecol. 1984 Feb;91(2):128-32.
17. Lopez-Espinoza, I, Dhar, H, Humphreys, S, Redman, CWG. Urinary albumin excretion in pregnancy. Br J Obstet Gynaecol. 1986;93:176-181.
18. Sibai, BM, Rodriguez, JJ. Preeclampsia: diagnosis and management. in: Principles and Practice of Medical Therapy in Pregnancy. 2nd ed. Appleton and Lange, Norwalk; 1992:871-879.
19. O’sullivan JB, Francis JO, Kantor N. Comparison of a colorimetric (automated) with an enzymatic (manual) uric acid procedure. Clin Chem. 1965 Mar;11:427-35.
20. www.pointescientific.com/uploads/inserts/OU982-01-2150.pdf
21. Klackar, H.M., J. Biol Chem. 167:429 (1947).
22. Praetorius, E., Poulson, H., Scand. J. Clin. Invest. 5:273 (1953).
23. Macgillivray I, Some observations on the incidence of pre-eclampsia. J Obstet Gynaecol Br Emp. 1958 Aug;65(4):536-9
24. Duckitt K, Harrington D. Risk factors for pre-eclampsia at antenatal booking: systematic review of controlled studies. Bmj. 2005 Mar 10;330(7491):565.
25. Sahijwani D, Desai A, Oza H, Kansara V, Ninama P, Maheshwari K, Soni C, Padhiyar B. Serum Uric Acid as a Prognostic Marker of Pregnancy induced Hypertension. Journal of South Asian Federation of Obstetrics and Gynaecology JSAFOG. 2012 Sep;4(3):130-3.
26. Liedholm H, Montan S, Åberg A. Risk grouping of 113 patients with hypertensive disorders during pregnancy, with respect to serum urate, proteinuria and time of onset of hypertension. Acta Obstet Gynecol Scand 1984;63(S118):43-8.
27. Thangaratinam S, Ismail KM, Sharp S, Coomarasamy A, Khan KS. Accuracy of serum uric acid in predicting complications of pre-eclampsia: a systematic review. Br J Obstet Gynaecol: An International Journal of Obstetrics and Gynaecology. 2006 Apr 1;113(4):369-78.
28. Yassaee F. Hyperuricemia and perinatal outcomes in patients with severe preeclampsia. Iran J Med Sci 2003;28:198-9.
29. Williams KP, Galerneau F. The role of serum uric acid as a prognostic indicator of the severity of maternal and fetal complications in hypertensive pregnancies. J Obstet Gynaecol Can 2002;24:628–32.
30. D’Anna R, Baviera G, Scilipoti A, Leonardi I, Leo R. The clinical utility of serum uric acid measurements in pre-eclampsia and transient hypertension in pregnancy. Panminerva Med 2000;42:101–3.
31. Martin JN Jr, May WL, Magann EF, Terrone DA, Rinehart BK, Blake P-G. Early risk assessment of severe preeclampsia: admission battery of symptoms and laboratory tests to predict likelihood of subsequent significant maternal morbidity. Am J Obstet Gynecol 1999;180:1407-14.
32. Odendaal HJ, Pienaar ME. Are high uric acid levels in patients with early pre-eclampsia an indication for delivery S Afr Med J 1997;87:213-18.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareCLINICOCYTOLOGICAL ANALYSIS OF CYSTOSARCOMA PHYLLOIDES VIS A VIS FIBROADENOMA
English2226Brij Mohan Kumar SinghEnglish Arijit BishnuEnglish Varun Kumar SinghEnglishAim: Phyllodes (PT) tumor is a rare fibro-epithelial neoplasm but requires an accurate preoperative diagnosis on fine needle aspiration cytology and most importantly to be distinguished from fibroadenoma, which allows the surgeon for correct surgical planning and avoidance of reoperation. We have evaluated both these neoplasm and tried to draw a distinction line between these two entities. Methodology: The archival files of department of pathology, Kasturba Medical College, Manipal were searched and cases which were confirmed on histopathology as benign phyllodes were retrieved. For comparison cytologically diagnosed and histopathologically confirmed cases of fibroadenoma were taken. The cytological material in all cases consisted of alcohol fixed Papanicolaou-stained smears. Cytological features of their epithelium and stromal component constituting the background dispersed cell population were evaluated in detail. Results: The number of epithelial fragments including both cluster and syncytial architecture with apocrine metaplasia along with highly cellular and regular borders of stromal fragments and increased numbers of long spindle nuclei to other background nuclei in phylloides tumour were found informative Conclusion: The rate of picking up of these entities on FNA would increase by following these general guidelines and will also add up in good reproducibility.
EnglishCystosarcoma phylloides, Fibroadenoma, Fine needle aspiration cytologyINTRODUCTION Phyllodes tumor (PT) also known as cystosarcoma phylloides are typically large, fast growing masses that originates from the periductal stromal cells of the breast. They are rare fibroepithelial neoplasm and accounts for less than 1% of all breast tumour1 . These tumours are often misdiagnosed by the pathologist leading to partial treatment by the surgeon. Thus, pose a great challenge in the preoperative diagnosis to allow correct surgical intervention and avoid reexploration. During the clinical evaluation, age of the patient may give some clues but should never be overemphasized. These tumours may have identical clinical and radiological features.2 Cytologically, problem gets intensified, as both these tumors, Phylloides and Fibroadenoma(FA) share many features.
Most of the time diagnosis of malignant phylloides is straight forward because of the presence of obvious anaplasia. Problem arises when we have to distinguish between low grade phylloides and fibroadenoma on FNA (Fine needle aspiration cytology). In various studies the cytological features of PT have been described in great details, but the entity in the grey-zone areas i.e. benign variant of PT have not been given enough emphasis in the literature. The study was undertaken to try and evaluate the cytological features of phyllodes tumor with special reference to features that can help in distinguishing it from fibroadenoma.
MATERIALS AND METHOD The archival files of department of pathology, Kasturba Medical College, Manipal were searched from 2007 to August 2015.44 cases of phyllodes tumor diagnosed on FNA were retrieved.Only 24 cases were confirmed on histopathology as benign phyllodes .These 24 cases were considered for the study; FNA slides of the same were reviewed and assessed. The comparison group consisted of 68 cytologically diagnosed and histopathologically confirmed cases of fibroadenoma.The cytological material in all cases consisted of alcohol fixed Papanicolaou-stained smears.
Cytological features of their epithelium and stromal component constituting the background dispersed cell population were evaluated in detail. ? Epithelial cell cluster were studied for the following features ? Number and architecture of the clusters ? Stromal fragments were assessed for ? Number and cellularity of fragments. ? Cellularity was graded as 1+,2+, and 3+ ? Blood vessel crossing the fragments ? The background stromal cells were also studied in details and the cellularity was graded as 1+, 2+ and 3+ ? Characteristics of dispersed cells were studied and the percentage of spindle cells noted. ? Size and shape of the individual dispersed cell were studied and graded as ? Big( when cell size is more than 2 times the small lymphocyte) ? Small (when the size is less than small lymphocyte.)
RESULTS Both the tumour group were characterized by dimorphic pattern. All the cases of both phylloids and fibroadenoma showed many epithelial fragments with 8 cases of fibroadenoma showed only cluster (Table1). There were not many differences in the epithelial features among the two tumour group. More amount of epithelial cells seen in FA as compared to PT. most of the cases of FA showed monolayered sheets of epithelial with staghorn branching pattern and variable number of bare nuclei in the background. Apocrine metaplasia was noted in all the cases of phylloides tumour. The number of stromal fragments was more in number seen in cases of phylloides tumour as compared to fibroadenoma.
The stromal fragments in both the groups were variable in shape, but were cellular and many having myxoid appearance in cases of phylloides tumour. (Table2) The background elements in both the groups showing 3+ and 1+ cellularity in PT and FA respectively. Majority of the phylloides tumour show big cellular architecture with long spindle shaped cells, whereas fibroadenoma showed small sized cells with round architecture. (Table3) Majority of the FA showed foam cells in the background. Considering the background of the smear we saw majority of the phylloides tumour is composed of long spindly nuclei as compared to the fibroadenoma group. (Table 4) Majority of the FA cases shows thin walled blood vessel crossing the epithelial and stromal fragments. (Table5)
DISCUSSION Phyllodes tumour are given as diagnosis on the FNAC when a cytologist see numerous hypercellular stroma and the stromal elements than the epithelial component on the smears. The cells on thesmears were classified by Deen SA et al3 in 1999, and Jayaram G and Sthaneshwar P in 20024 , by comparison with small lymphocytes, in: 1. Short, round/oval cells, two-size smaller than the size of a lymphocyte : considered to be epithelial cells 2. Long, spindle cells, three-size larger than the size of a lymphocyte:considered to be stromal cells.
Phyllodes tumour are further categorized as benign, borderline, or malignant based on certain features such as margins of the tumour, amount of stromal overgrowth, cellularity, necrosis, pleomorphism, and the mitotic figure per high-power field5 generally the treatment protocol for the phyllodes tumour is wide excision because of their inherent property of local recurrence. It has been also suggested in various studies that grades of phyllodes tumour has poor correlation with the local recurrence6,7 but, a well-established relationship has been proved for their metastasis8 therefore there is no room for underdiagnosis by pathologist and overtreatment by the surgeon or vice-versa.
Identification of malignant phyllodes tumors do not pose great challenge as is seen in cases of benign and borderline phyllodes tumors which bear great resemblance to, and are usually mistakenly diagnosed as, fibroadenoma. Such problem are generally seen even with the experienced eye when the stromal component is the dominant component on FNA with marked atypia, pleomorphism and high mitotic activity.9, 10
We, in the present study tried to compare the fibroadenoma and phyllodes tumour on the basis of epithelial and stromal fragment along with the background nuclei in conjunction with Bandyopadhyay, et al11 Most of the studies done on cytological features of the two entities were based on ? Stroma, including the presence of hypercellular stromal fragments, ? Cellularity of the background nuclei, ? Cellular composition and morphology of background nuclei. Many studies have compared the cytomorphology of phyllodes tumor with fibroadenoma and these have yielded conflicting results.12, 13
The presence of hypercellular stromal fragment is the most useful feature in distinguishing phyllodes tumor from fibroadenoma.Hypocellularity of stromal fragments have been noted in both benign phyllodes tumor and Fibroadenoma.14 Similarly, as found by R Bandhyopadhyay et al11, in our study also the stromal fragments found to be hypercellular with more well defined regular borders in phyllodes tumor, compared to Fibroadenoma, with few exceptions.Study done by krisnamurthy et al7 , Suggests that in the event of hypercellular stromal fragments in fibroadenomas, the degree of background cellularity, composition and proportion of long spindly cells may be useful features in differentiation.
Our study has also shown that most of the phyllodestumors have 3+ cellularity of the background nuclei as compared to 1+ in most cases of Fibroadenoma.Size of the background cells also play an important role in cases of phyllodes tumor as most of them have bigger size cells as compared to smaller size in Fibroadenoma.In comparison to study by Nina S. Shabb et al15, Foamy macrophages are not seen in any cases of phyllodes tumor whereas 41% of the Fibroadenoma cases shown this feature.
The importance of spindle cells in the dispersed cell population has been emphasized by some workers16, and we found it to be useful in our study too.While studying these parameters individually may not give encouraging results, taken together, they can be used effectively in distinguishing these two groups of tumor. Based on the stromal fragment an algorithm can be given to guide for differentiating these two dubious entities.
CONCLUSION The preoperative diagnosis and proper management is crucial in Phyllodes tumor. Both Phyllodes tumor and fibroadenoma share many features in common as seen in this study as epithelial characteristic on the FNA smears. The savior in these cases would be to consider the high cellularity, long spindly cell architecture with numerous spindly nuclei in the background with reduced number of blood vessel crossing the epithelial and stromal fragments. FNA has proven to be very reliable and fairly reproducible by choosing the above mentioned feature in differentiating between PT and FA.
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.
Source of Funding Authors will bear all the expenses towards this research work. Conflict of interest: None
Englishhttp://ijcrr.com/abstract.php?article_id=319http://ijcrr.com/article_html.php?did=3191. Jacklin RK et al. optimising preoperative diagnosis in phyllodes tumor of breast. J clin pathol 2006; 59:454-9
2. David D et al. Fine needle aspiration cytology of phyllodes tumor- potential diagnostic pitfalls. 1992;36:215-21
3. Deen SA, McKee GT, Kissin MW. Differential cytologic features of fibroepithelial lesions of the breast.Diagnostic Cytopathol 1999;20:53–6.
4. Jayaram G, Sthaneshwar P. Fine-needle aspiration cytology of phyllodes tumors. Diagn Cytopathol. 2002 Apr;26(4):222-7.
5. Tavassoli FA, Devilee P. Fibroepithelial Tumours. In Tavassoli FA, Devilee D eds. WHO Classification of Tumours: Tumours of the Breast and Female Genital Organs. Lyon: IARC Press; 2003:99-103.
6. Kok KY, Telsinghe PU, Yapp SK. Treatment and outcome of cystosarcoama phyllodes in Brunei: a 13-year experience. J R Coll Surg Edinb. 2001;46:198-201.
7. Kario K, Maeda S, Mizuno Y, Makino Y, Tankawa H, Kitazawa S. Phyllodes tumours of the breast: a clinicopathological study of 34 cases. J Surg Oncol. 1990;45:46-51.
8. Moffat CJ, Pinder SE, Dixon AR, Elston CW, Blamey RW, Ellis IO. Phyllodes tumour of the breast: a clinicopathological review of 32 cases. Histopathology. 1995; 27:205-218.
9. Jayaram G, Sthaneshwar P. Fine needle aspiration cytology of phyllodes tumour. Diagn Cytopath. 2002;26:222-227.
10. Shabb NS. Phyllodes tumour. Fine needle aspiration cytology of 8 cases. Acta Cytol. 1997;41:21-26.
11. R Bandhyopadhyay et al . Distinction of phyllodes tumor from fibroadenoma: cytologists perspective. Journal cytology 2010;27:59-62.
12. Dusenbery D et al. Fine needle aspiration cytology of phyllodes tumor. Potential diagnostic pitfalls. Acta cytol.1992;36:215-21.
13. Shimizu K et al. Cytologic evaluation of phyllodes tumors as compared to Fibroadenoma of the breast. Acta cytol 1994;38:891-7
14. Scolyer RA et al. Can phyllodes tumor of breast be distinguished from fibroadenoma using fine needle aspiration cytology. Diagnostic pathology. 2001;33:437-43.
15. Shabb NS et al. Phyllodes tumor.Fine needle aspiration cytology of eight cases. Acta cytol 1997;41:321-6
16. Rao CR Cystosarcoma phyllodes, diagnosis by fine needle aspiration cytology. Acta cytol. 1992;36:203-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareIMPACT OF CADMIUM ON GERMINATION AND EARLY SEEDLING GROWTH OF CAJANUS CAJAN L.
English2729Swapna B.EnglishCadmium is a highly toxic heavy metal that contaminates soil and adversely affects the plant growth which results in the decrease of crop production. The objective of this study was to find the effect of cadmium on germination and early seedling growth of Cajanus cajan. Seeds placed on sterilized filter papers were exposed to varying concentrations of cadmium solutions (20, 60, 100, 200 and 400 ppm) made using anhydrous Cadmium chloride under laboratory conditions. Increasing concentrations of cadmium chloride significantly reduced the germination percentage, root length, shoot length, fresh weight, dry weight when compared to control.
EnglishCadmium, germination, Cajanus cajan, ProlineINTRODUCTION Heavy metals are the natural components of the earth crust and are present insoil, water and living matter. Elevated levels of heavy metals due to anthropogenic activities such as extended use of superphosphate fertilizers, sewage discharge, industrial effluents and smelters dust spreading cause heavy metal pollution. The uptake and accumulation of heavy metals by plants is hazardous, since plants are part of the food chain. Contamination of food supplies by heavy metals may lead to risk for human and animal health (1). Cadmium, one of the toxic heavy metals has no essential function in plants. It has high mobility in the soil- plant system. Plants exhibit numerous toxic effects as a result of cadmium exposure. The impact of cadmium on various crop plants and their morphological, physiological and molecular responses during stress has been well elucidated by many authors. Genotypic differences in response to cadmium exposure have been reported in various species including wheat (2), cotton (3), pea (4) and rice (5). This is may be due to high mobility of cadmium and its hyperaccumulation leading to leaf chlorosis (6). Such symptoms determine the severity of stress, and therefore may be useful in detecting stress effects and developing appropriate strategies to increase stress tolerance (7, 8). Pigeonpea (Cajanus cajan L.) is an important legume crop (Family-Fabaceae) in the semiarid tropics. It has high commercial and nutritive value. It is an ideal source of protein. The symptoms of cadmium toxicity and seedling survival have close association with each other and determine the final plant stand. Despite scattered information existing (1,9), the present study is carried out to explore the effect of cadmium on germination and early seedling growth of Pigeonpea (cvPushpa).
MATERIAL AND METHODS Seeds of Pigeon pea (Cajanus cajan (L.) Millspaugh) cv. Pushpa obtained from commercial vendors in the local market were surface sterilized using 0.1% HgCl2 and washed repeatedly with sterile distilled water to remove the remnants of adsorbed sterilants. The seeds were then transferred to the germination boxes lined with sterile filter papers for germination and subjected to varying concentrations of cadmium solutions (20, 60, 100, 200 and 400 ppm) made using anhydrous CdCl2 . Distilled water was used in place of cadmium solution to maintain the control. The experiment was conducted with three replications of fifteen seeds each.
For growth analysis, samples were collected on 7th day after sowing and growth parameters like % seed germination, root length, shoot length, fresh and dry weights were measured. Emergence of the radicle was taken as an index for the purpose of identifying seed germination. A cotton thread and cm ruler was used to measure the root length of the seedlings to the nearest mm. Fresh weight of the seedlings was recorded to the nearest mg using an electronic balance. The seedlings were oven dried at 800 C in a hot air oven to a constant dry weight and the data was recorded to the nearest mg using sensitive electronic balance. All the observations are means of three replications.
Seed Germination Percentage (G %): Percentage of seed germination (G %) was calculated by using the formula: G% = 100 × A / N, where A = Number of seeds found germinated N = Total number of seeds used in the germination test.
Proline accumulation during seedling development The accumulation of proline in the leaves was measured (10). Statistical Analysis Data represents mean± standard error. Dunnet’s test was performed to compare control and treatments. Values were considered significant if p< 0.05
RESULTS The percentage of germination decreased in the stress induced plants when compared to control (Fig 1). There was no germination found at 400ppm cadmium concentration. Hence, data on morphological parameters has not been recorded at 400ppm cadmium concentration. Emergence of radicle started on 3rd day after sowing(3DAS).Brown, stunted roots and leaf chlorosis are the visualsymptoms observed in the cadmium treated plants. Elevation in the concentrations of cadmium resulted in significant decrease in root length (Table 1).Shoots did not arise at 200ppm cadmium concentration. Shoot length, fresh weight, dry weight of Cajanus cajan seedlings decreased with increase of cadmium chloride concentrations (Table 1).The osmolyte proline content increased with high concentration of cadmium (Table 2).
DISCUSSION This study showed increasing levels of cadmium exposure is detrimental to Cajanus cajan which is evident from grad ual decrease in germination percentage and early seedling growth. Concentration dependent decrease in germination percentage might be attributed to physiological disturbance in mobilization of the reserve food materials(11). Reduction in root and shoot length may be due to alteration in water relations, nutrient uptake (12). Similar observations of reduction in root length, shoot length, fresh weight and dry weight with Cdcl2 treatment to Cajanus cajan L. (Upas-120) seeds were noticed (9). Reduction in root and shoot length indicated that Cd concentration produced toxic effects within 7 days. Proline is an aminoacid known to accumulate in plants on exposure to abiotic stress. Accumulation of proline may contribute to osmotic adjustment at the cellular level and enzyme protection stabilizes the structure of macromolecules and organelles. Increase in proline content may be either due to de novo synthesis or decreased degradation or both (7). Similar result has been reported in Brassicajuncea, Triticumaestivum and Vignaradiata in response to cadmium toxicity (13).
CONCLUSION Results of this study show that cadmium reduced seed germination and early seedling growth significantly in Cajanus cajan (L.) (Pushpa).
AKNOWLEDGEMENT 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=320http://ijcrr.com/article_html.php?did=3201. Meena Deswal, Laura, J.S. Effect of cadmium on growth, yield and dry matter accumulation in Cajanus cajan L. International Journal of Current Research. 2014, 6(11):10019-10024.
2. Zhang G, Fukami M, Sekimoto H. Influence of cadmium on mineral concentrations and yield components in wheat genotypes differing in Cd tolerance at seedling stage. Field Crops Research2002;77:93-98.
3. Wu F, Wu H, Zhang G, Bachir DML. Differences in growth and yield in response to cadmium toxicity in cotton genotypes. Journal of Plant Nutrition and Soil Science 2004; 167:85-90.
4. Metwally A, Safronova VI, Bellimov AA, Dietz KJ. Genotypic variation of the response to cadmium toxicity in Pisumsativum L. Journal of Experimental Botany 2005; 56:167-178.
5. Wu F, Dong J, Jia G, Zheng S, Zhang G. Genotypic difference in the responses of seedling growth and Cd toxicity in rice (Oryza sativa L.). Agricultural Sciences in China 2006; 5:68-76.
6. Wang ME, Zhou QX. Joint stress of chlorimuron-ethyl and cadmium on wheat Triticumaestivumat biochemical levels. Environmental Pollution, 2006; 144:572-580.
7. Faizan S, Kausar S, Perveen R. Varietal differences for cadmium-induced seedling mortality, foliar toxicity symptoms, plant growth, proline and nitrate reductase activity in chickpea (Cicerarietinum L) Biology and Medicine, 3 (2) Special Issue: 196- 206, 2011
8. Ahmad P, John R. Effect of salt stress on growth and biochemical parameters of Pisumsativum L. Archives of Agronomy and Soil Science 2005; 51:665-672.
9. ArunaPatnaik, B. K. Mohanty. Toxic effect of mercury and cadmium on germination and seedling growth of Cajanus cajan L (Pigeon Pea) Annals of Biological Research 2013, 4 (3):123- 126.
10. Bates, L., R. Waldren, I. Teare. Rapid determination of free proline for water-stress studies. Plant and Soil, 1973; 39: 205–206.
11. De Andrade SAR, da Silveira APD. Mycorrhiza influence on maize development under Cd stressand P supply. Braz. J. Plant Physiol.2008; 20: 39-50.
12. Barcelo J, Poschenrieder C. Plant water relations as affected by heavy metal stress: a review. Journal of Plant Nutrition 1990; 13:1-37.
13. Dhir B, Sharmila P, Saradhi PP. Hydrophytes lack potential to exhibit cadmium stress induced enhancement in lipid peroxidation and accumulation of proline. Aquatic Toxicology 2004; 66:141-147.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareIPSYCHOMETRIC EVALUATION OF KNEEPAIN: ABAB DESIGN A Single Subject Randomized Control Trial
English3032Mahamed AteefEnglishAim: The purpose of this study was to evaluate the efficacy of psychometrictools andphysiotherapeutic interventions on pain perception in knee osteoarthritis patient. Case Study: A 58-year-old male patient with bilateral grade-2 primary knee was referred to a physiotherapist with a complaint of bilateral knee pain. He experienced pain severity of nine on visual analog scale, difficulty climbing stairs and while walking. Pain was also assessed using self-rated psychometric tool such as Knee pain and osteoarthritis outcome score(KOOS). The pain subscale was 12% means severe painprior to the intervention using KOOS questionnaire. The patient was given bilateral multiple angled resisted exercises twice daily for 3 weeks. At the end of 6th week pain was nearly normal twoon visual analog scale andKnee pain and osteoarthritis outcome scorepain subscalewas 90% means substantial pain relief and good improvementin gait. Discussion: Psychometric tools are the most reliable and validated tools in the evaluation pain perception in bilateral knee osteoarthritis as the pain perception differs during various activities of daily life. Conclusion: This case concludes that resisted exercises were effective and these scales are diagnostic as well prognostic in use for longitudinal prospective interventional studies due to their validity and reliability.
EnglishResisted exercises, Knee pain, Visual analog scale, Pain subscale of KOOSINTRODUCTION
Pain is the most excruciating and occurring symptom in people with knee osteoarthritis leading to worsening of the activities of daily living. Many patients with bilateral or unilateral knee pain may appreciate various degree of pain perception during their physical activities of daily living. Among available interventions,resisted exercises were also beneficial in the management of Osteoarthritis knee. Visual analog scale which is most reliable subjective method used to provide pain perception at rest in knee osteoarthritis patients1 and patients may not be able to differentiate pain threshold at various physical activities but the recent development of psychometric tools are most useful tools which assesses the pain levels during activities of daily living2 . Hence, this single subject control trial3 was done to evaluate the effects of resisted exercises and efficacy of psychometric tool as subjective and specific assessment tools.
A SINGLE SUBJECT RANDOMIZED CONTROL TRIAL
Patient history The patient, a 58-year-old male complained of bilateral knee pain for 5 months that had started gradually. There was no history of trauma, congenital or acquired knee deformities, ankylosing spondylitis. The cardinal symptoms were knee pain, with restricted knee painful movements. He had no history of a similar problem in the past. The symptoms worsened as the day progressed and relieved with rest. Physical examination On examination, it was found that the patient had decreased knee movements,inability to flex full range of flexion. Restriction of active extension and flexion were measured using a universal goniometer, where flexion was more restricted than extension , measuring 110° flexion, left and right knee exion was110° each side, He rated his pain threshold level as 9 on a 0-10 linear visual analog scale (VAS). There are 9 psychometric questions of pain domain of KOOS scale2 .
Treatment methods: The patient was informed about the study and his consent was taken. The patient’s pain severity was measured before the intervention as base line value usingvisual analog scale.. Many authors have emphasized the importance of self- rated/subjective scales to evaluate the pain threshold by visual analog scale in musculoskeletal injuries1 .Terweealso reported that physical functioning was very much influenced by knee pain4 . In the present study, active movements were measured by universal goniometer method in knee pain. The patient was then educated about his condition and the possible treatment to be given.
EXERCISE THERAPEUTICS Strengthening Strengthening exercises for extensors and flexors of the knee were administered to maintain the muscle strength. The patient was givenresisted exercise in sitting position twice a day for three alternative weeks along with initial isometrics to overcome muscle soreness and to facilitate resisted exercises. Resisted exercise was carried out using a minimalweights after determining the repetition maximum[1RM]. In the second week, therewas no exercise given . In the third and fifth weeks, the weight was progressed as the patient was more comfortable to the resisted exercise twice a day, like wise on the second,fourth and sixth weeks, he was discontinued from the resisted exercise to see the efficacy of the resisted exercise on pain variable as under ABAB [A-intervention, B-no intervention, A- intervention- no intervention design3 . The first, third and fifth were treatment given weeks, likewise the second, fourth and sixth weeks were control weeks.
clinical outcomes: At the end of the first week of intervention with consolidated weight, the patient was reassessed; his pain had decreased from 9/10 to 7/10, pain subscale of KOOS was 30% from 12% and ROMs of flexion had improved from 110° to 115°. At the end of the second week, without intervention the patient was reassessed; his pain status was the same like at the end of first week, 7/10 on VAS, KOOS was 30% respectively. At the end of the third week of intervention with progressed weight, the patient was reassessed; his pain had decreased from 7/10 to 4/10, KOOS was 60% from 30% and ROMs of flexion had improved from 115° to 120° and respectively. At the end of the fifth week of intervention with progressed weight, the patient was reassessed; his pain had decreased from 4/10 to 2/10, KOOS was 90% from 60% and ROMs of flexion had improved from 120° to 135° and respectively. At the end of the sixth week without intervention, the patient was reassessed, his pain status was same like at the end of the fifth week. This case study with single subject randomized control trial design clearly shows the efficacy of resisted exerciseand psychometric tools in assessing pain and improving the ROM of flexion and extension.
DISCUSSION:
There are many linear psychometric scales available but VAS is more reliable in terms of quantification of pain as a subjective measure of specification of pain intensity and it is unidirectional measure of pain intensity. The sensitivity and reproducibility are very much acceptable5 . But more reliable in literate people than illiterate people5 and also VAS scale has limitation in measuring pain among older adults due to decline in cognitive ability6 and older adults with knee OA may not be able to differentiate the quantity of pain as this OA pain is mostly perceptual during physical activities. The pain subscale of KOOS scale has nine items which is constructed based on the symptoms of rheumatic diseases2 . This scale is highly comprehensive and multidimensional in terms of physical functioning6,7. Due to its comprehensiveness it evaluates the pain threshold during different physical activities6-8 as it helps the clinician to understand and plan the rehabilitation program8,9,10.
CONCLUSION
In this single subject randomized control trial, resisted exercises shown to be effective and pain subscale of KOOS scale has better multidimensional pain evaluation capability than unidirectional VAS scale compared to control weeks.
Clinical implications: Clinicians must select proper questionnaire that is most appropriate for their specificpurpose and betterment of the patient prognosis.
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 Conflict of interest: None Source of funding: None Abbreviations: KOOS - Knee pain and osteoarthritis outcome score, VAS:visual analog scale, ABAB :A-intervention, B-no intervention ,OA: Osteoarthritis, ROM : Range of motion, 1RM : repetition maximum
Englishhttp://ijcrr.com/abstract.php?article_id=321http://ijcrr.com/article_html.php?did=3211. Ferraz MB, Quaresma MR, Aquino LR, Atra E, Tugwell P, Goldsmith CH.Reliability of pain scales in the assessment obliterate and illiterate patients with rheumatoid arthritis. J Rheumatol.1990;17:1022-4.
2. Roos EM, Lohmander LS. Knee injury and Osteoarthritis Outcome Score (KOOS): from joint injury to osteoarthritis. Health Qual Life Outcomes.2003;1:64.
3. Backman CL1, Harris SR.Mar-Apr Case studies, single-subject research, and N of 1 randomized trials: comparisons and contrasts. Am J Phys Med Rehabil.1999;78(2):170-6.
4. Terwee CB, van der Slikke RMA, van Lummel RC, Benink RJ, Meijers WGH, de Vet HCW.Self-reported physical functioning was more influenced by pain than performance-based physical functioning in knee-osteoarthritis patients. Journal of Clinical Epidemiology.2006;59(7):724-731.
5. Grant S, Aitchison T, Henderson E, Christie J, Zare S, McMurray J and Dargie J. A comparison of the reproducibility and the sensitivity to change of visual analogue scales, Borg scales, and Likert scales in normal subjects during submaximal exercise. Chest.1999,116(5):1208-17.
6. Collins NJ, Misra D, Felson DT, Crossley KM., Roos EM.Measures of knee function: International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Knee Injury and Osteoarthritis Outcome Score (KOOS), Knee Injury and Osteoarthritis Outcome Score Physical Function Short Form (KOOS-PS), Knee Outcome Survey Activities of Daily Living Scale (KOS-ADL), Lysholm Knee Scoring Scale, Oxford Knee Score (OKS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Activity Rating Scale (ARS), and Tegner Activity Score (TAS). Arthritis care and research. 2011;63(11):208-28.
7. Nebel MB, Sims EL, Keefe FJ, et al.The relationship of self-reported pain and functional impairment to gait mechanics in overweight and obese persons with knee osteoarthritis. Archives of Physical Medicine and Rehabilitation.2009; 90(11):1874-1879.
8. AteefMd, Shaziya T, Kulandaivelan S. Influence of age on self-reported and actual physical performance measures in primary knee osteoarthritis. Indian Journal of Health and Wellbeing. 2012;3(4):1087-1089.
9. Kulandaivelan S, MahamedAteef, andShaziyaTahseen.Correlation of Self-Reported Questionnaire (KOOS) withSome Objective Measures in Primary OA Knee Patients.ISRN Rheumatology. 2014; Volume 2014 pp:5
10. MahamedAteef.Resisted exercise and outcomes using diseasespecific Urdu version of osteoarthritis outcome score questionnaire in knee osteoarthritis. Saudi Journal of Sports Medicine. 2015; volume 15(1) : 103-5.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareSTRESS DURING PREGNANCY AND LACK OF CALCIUM AND FOLIC ACID INCREASES RISK OF AUTISM SPECTRAL DISORDER IN OFFSPRING
English3336Nandini Vaz FernandesEnglishThe idea that preconception environmental exposures may be involved in Autism Spectrum Disorders (ASD) etiology arose in the 1970s from a retrospective case-control study of ASD that found a statistically significant difference in parental occupational exposure to chemicals during the preconception period 1. ASD are neurodevelopmental disorders characterized by varying deficits in social interactions, communication, and learning, as well as stereotypic behaviors. Over the past years, research into environmental risk factors for autism has grown dramatically, bringing evidence that an array of non-genetic factors acting during the prenatal period may influence neurodevelopment 2. The present study was therefore undertaken to investigate the potential prenatal risk factors for ASD. A total number of 184 individuals were studied. In the present study, factors that have demonstrated significant increases in ASD risk, include advanced maternal age and stress during pregnancy while folic acid and calcium supplement intake was found to be reducing the risk of ASD. Factors that showed insignificant increase in frequency or no association with ASD were intake of medications, fall, respiratory problems and bleeding during pregnancy.
EnglishASD, Maternal stress, Maternal age, Folic acidINTRODUCTION Autism spectrum disorders (ASDs) are complex conditions, with combinations of milder social abnormalities and communication impairment and less rigid interest restrictions. Genetic factors may be the most significant cause for autism spectrum disorders. Others factors may alter this underlying genetic liability such as sex, IQ, and prenatal and perinatal injury1 . From the earlier research works, it is known that ASD is not caused by a single factor. Both genetic and environmental factors have the potential to increase the risk of ASD. The present study was undertaken to investigate potential prenatal and perinatal factors risk factors for ASD.
SUBJECTS AND METHOD To achieve the objective of the study, 184 individuals were surveyed. The individuals surveyed were divided into ASD group and control group. The sample population included ASD group consisting of 92 ASD subjects and control group constituted by 92 subjects of similar age group but with no history of ASD. For achieving the objectives of the study a Proforma was designed to collect information about Prenatal and perinatal factors studied included medications taken, supplements taken during pregnancy, maternal stress, respiratory problems, fall during pregnancy and bleeding during pregnancy. The data collected using the proforma was tabulated and analyzed. For quantitative data, mean and standard deviation were computed. The statistical significance of associations between the various qualitative parameters was evaluated through Fisher’s exact test (two tail).
RESULT ASD subjects studied had a mean age of 9.02 ± 3.26 years. The mean age of detection of the ASD subject’s studied was 2.7 ±1.76 years with a variance of 3.11. The following prenatal factors were studied.
1. Maternal Age: We observed that with advanced maternal age, the risk of having a child with ASD increase. Age of pregnancy in different age intervals of both control and ASD is tabulated (Table 1). The frequency of ASD was higher in maternal age intervals of 31-35 and 36-40 years. The mean maternal age during pregnancy of the ASD subject’s studied was 27.8 ± 5.36 years and a variance of 28.7. The results indicate a significantly higher frequency of 26.09% ASDs in children born to mothers in age interval of 31 – 35 (P = 0.0306) as compared to the control.
2. Intake of medication during pregnancy and ASD: The present study showed an increase in the frequency of ASD in offspring of mothers who consumed medication during the first trimester of pregnancy. The study indicates that higher frequency of 39.13% of history of intake of medication in the mothers of ASD as compared to the control (28.57%). The difference was found to be statistically insignificant (P=0.4312).
3. Stress during pregnancy and ASD: Stress on mothers during pregnancy was another factor studied. Mothers of the subjects were interrogated for physical and mental stress during their pregnancy, in both the control and ASD group. The frequency of stress during pregnancy was found to be higher in mothers of ASD group as compared to those in the control group. The difference is found to be statistically significant (P=0.0257).
4. Respiratory problems during pregnancy and ASD: To evaluate the role of the hypoxic condition of a mother during pregnancy, we analyzed the sample population for respiratory problems during pregnancy. The present study found no correlation between respiratory problems during pregnancy and ASD.
5. Maternal infection during pregnancy and ASD: Infection of the mother may be also a source of impeding the growth of the fetus, which can be a potential risk factor for ASD in offspring. The present study found no correlation between maternal infections during pregnancy and ASD (P = 0.6887).
6. Fall during pregnancy and ASD: This factor was studied to see if the physical impact of fall during pregnancy can be a potential risk factor. The frequency of ASD was higher in 13.04% of the mothers who had a fall during pregnancy as compared to the control. However, the difference was found to be statistically insignificant (P=0.1226).
7. Intake of supplements during pregnancy and ASD: Different types of supplements are necessary for growth and development of the fetus. The vital supplements include vitamins, folic acid, iron, and calcium. The present study tried to evaluate the effect of not consuming folic acid or calcium or both. Most of the mothers of ASD subjects had not consumed folic acid and calcium supplements (52%) as compared to the control (5.5%). The difference was found to be statistically highly significant (P=0.0039).
8. Bleeding during Pregnancy: The present study found no correlation between maternal bleeding during pregnancy and ASD (P = 0.4898).
DISCUSSION The present study evaluated the risk that a child will develop autism increases monotonically with the age of the mother. This study revealed that maternal age during pregnancy is a very crucial factor in determining the neurological development of the fetus. This study indicates a significantly higher frequency of 26.09% of ASDs in children born to mothers in age interval of 31 – 35 (P = 0.0306) as compared to the control. The present study is consistent with the findings of Croen LA et al,3 Kolevzon A et al.,4 and Gardener5 which state that older parents may be statistically more likely to have children with autism. Study of Sandin S et al.,6 reports that children of mothers older than 35 years had 30% increased the risk for autism.
Association of medication during pregnancy with autism risk is indicated in the study of Gardener4 . According to his study, maternal medication use was associated with a 46% increased risk. The present study, however, does not agree with the study of Gardener4 . This study shows a higher frequency of 39.13% of the mothers in ASD group had taken medication during pregnancy as compared to the control (28.57%). However, the difference was found to be statistically insignificant (P=0.4312). Strongest evidence of maternal hypertension and ASD risk is indicated in the studies of Gardener4 .
The important revelation of this study was the association of maternal stress during pregnancy and increased the risk of ASD. The frequency of stress during pregnancy was found to be significantly higher in mothers of ASD group as compared to those in the control group (P=0.0257). Studies of Rai D et al.,7 also revealed that exposure to stressful life events during the prenatal period is associated with an increased risk of offspring ASD.
Whether this association is causal or reflects the risk of autism with severe depression during pregnancy requires further research. The nutritional supplements taken were found to be having a positive influence in decreasing the ASD risk, as per the present study. Most of the mothers of ASD subjects had not consumed all supplements (21.74%) as compared to the control. This study reinforces the findings of Schmidt R. J et al.,8 which indicated that women who consume the recommended daily dosage of folic acid, the synthetic form of folate or vitamin B-9, during the first month of pregnancy may have a reduced risk of having a child with autism. Studies of Lyall K, et al.,2 also support that higher maternal intake of certain nutrients and supplements like folic acid has been associated with a reduction in ASD risk. Vitamin D deficiency – eitherduring pregnancy or early childhood – may be an environmental trigger for ASD in individuals genetically predisposed for the broad phenotype of autism9 .
The factors with the strongest evidence against a role in autism risk included maternal bleeding, intake of medications, respiratory problem and fall during pregnancy. However, meta-analysis of Gardner10 identified fetal distress as potential risk factors for ASD and showed significant 81% elevated risk of ASD in relation to maternal bleeding during pregnancy. The mechanism underlying the suggested association with maternal medication use is also unclear, due to the variety of medications consumed during pregnancy and assessed in these studies.
Heterogeneity in some studies may be on account of methodological limitations that have impaired the precision and validity of results of most studies include small sample size, non-normal control groups, broad disease definition, and retrospective parental recall of exposures which may result in the high possibility of recall bias. Thus, the rising prevalence of ASD, coupled with the severe emotional and financial impact on the families, underscores the need for large, prospective, population-based studies with the goal of elucidating the modifiable risk factors, particularly those during the prenatal period.
CONCLUSION Many factors may have a potential for increasing the risk of ASD. ASD is influenced by both genetic and environmental factors, and the risk increases most likely due to the underlying genetic factors or an interaction of these factors with the environment. In other words, ASD is a complex disorder resulting from the combination of genetic and environmental factors. Those having genetic susceptibility may be more vulnerable to develop ASD when exposed to the environmental risk factors. In the present study, the factors with the strongest evidence for an association with autism risk included advanced maternal age and stress during pregnancy. The study also indicates that folic acid and calcium supplement intake was found to be reducing the risk of ASD. The factors with the strongest evidence against a role in autism risk included were the intake of medications, fall, respiratory problems and bleeding during pregnancy.
ACKNOWLEDGEMENT Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is 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=322http://ijcrr.com/article_html.php?did=3221. Freitag CM. The genetic of autistic disorders and its clinical relevance: a review of the literature. Mol Psychiatry. 2007; 2(1): 222.
2. Lyall K, Schmidt RJ, Hertz-Picciotto I. Maternal lifestyle and environmental risk factors for autism spectrum disorders. Int J Epidemiol. 2014; 43(2):443-64.
3. Croen LA., Najjar DV, Fireman B, Grether JK. Maternal and paternal age and risk of autism spectrum disorders. Arch Pediatr Adolesc Med. 2007; 161(4): 334-40.
4. Kolevzon A, Gross R, Reichenberg A. Prenatal and perinatal risk factors for autism: a review and integration of findings. Arch Pediatr Adolesc Med. 2007; 1(4):326-33.
5. Gardener H., Spiegelman D, Buka SL. Prenatal risk factors for autism: comprehensive meta-analysis. Br J Psychiatry. 2009; 195(1): 7-14.
6. Sandin S, Christina M., Hultman K A, Gross R, MacCabe JH, Reichenberg A. Advancing Maternal Age Is Associated With Increasing Risk for Autism: A Review and Meta-Analysis. J Am Acad Child Adolesc Psychiatry. 2012 May;51(5):477-486.e1. doi: 10.1016/j.jaac.2012.02.018. Epub 2012 Apr 5.
7. Rai D, Golding J, Magnusson C, Steer C, Lewis G, Dalman C. Prenatal and early life exposure to stressful life events and risk of autism spectrum disorders: population-based studies in Sweden and England. PLoS One. 2012;7(6):e38893. doi: 10.1371/ journal.pone.0038893. Epub 2012 Jun 13.
8. Schmidt RJ, Tancredi DJ, Ozonoff S, Hansen RL, Hartiala J, Allayee H, et al. Maternal periconceptional folic acid intake and risk of autism spectrum disorders and developmental delay in the CHARGE (CHildhood Autism Risks from Genetics and Environment) case-control study. Am J Clin Nutr. 2012 Jul;96(1):80-9. doi: 10.3945/ajcn.110.004416. Epub 2012 May 30.
9. Ko?ovská E, Fernell E, Billstedt E, Minnis H, Gillberg C. Vitamin D and autism: Clinical review. Research in Developmental Disabilities. 2012; 33: 5pp 1541–1550.
10. Gardener H., Spiegelman D, Buka SL. Perinatal and neonatal risk factors for autism: a comprehensive meta-analysis. Pediatrics. 2011; 128: 344–355.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524185EnglishN2016March13HealthcareCLASSROOM MANAGEMENT LESSONS FROM FACEBOOK
English3741Jayaprakash JalaEnglish Karthik SistlaEnglish Neethu Mary MathewsEnglishFacebook from its origins in 2004, has had an increasing influence in people’s life. Considering this increase it is important to note that there are features that could be adapted from Facebook which could be of use in a classroom setting. The paper discusses how in a classroom dialogues need to be encouraged while keeping an open mind to ideas from the students, the ability to be more sensitive to the students and their personal life, integration of students irrespective of their differences as a whole unit, about providing a safe environment that nurtures and encourages growth in the students and finally about opening up the classroom beyond the traditional 4 walls and welcoming technology to aid in teaching.
EnglishFacebook, Classroom management, TechnologyINTRODUCTION
Facebook has a staggering 1.49 billion monthly users (as on July 2015) with over 968 million users logging in everyday (as on July 2015). Facebook has influenced the entire fabric of social relationships. Facebook was initially created as a social study tool and then emerged as a platform for connecting people all over the world is a fact unknown to many. The usage of Facebook has become such an integral part of our lives. 850 million people using the feature of groups,450 million people using events,700 million people using messenger each month,40 million small businesses using pages and a mind boggling 1.5 billion searches daily go on to show the profound influence Facebook is having on our day to day life.
For this very reason Facebook is a domain which is being researched extensively. Aaron Smith a senior researcher at the Pew Internet and American Life Project has found that even half of the internet users who do not access Facebook themselves live with someone who does. This shows how far-reaching and widespread the influence of Facebook is. Facebook has been ranked at Number.2 in the Top 500 Global Sites with Google being listed as number one. With such large user interest it makes us wonder what sets Facebook apart from other social networking sites.
Understanding its features and functioning, becomes imperative because it has proved its wide influence on people. Over 29 percent of Facebook users are young adults, so integrating the features that are so engrossing/ engaging on Facebook can only lead to an improvement in the presence of the young minds in the classroom. It has been found that on an average, a person spends about 55 minutes on Facebook.
However previous researchers have found that an individual can have focused attention for about 40 minutes at a time (H.A.Ruff and K.R.Lawson, 1990) and this being the baseline for a class period. That’s a whole 15 minute increase while using Facebook! When teachers in classrooms have had trouble maintaining the 45 minutes of attention, how does Facebook manage to not only capture but also receive an extended attention span a whole another 15 minutes? Has the human mind switched off to their kin all of a sudden or is it that somehow a computer screen is more efficient in capturing the mind? This is a question that has become integral.
Answering this question makes one to ponder over the already existing patterns of classroom interactions. Classroom interactions are an amalgamation of factors like the student, the teacher and classroom in itself. Classroom management is the central element to a productive classroom interaction. The ability to conduct a class with minimal disruption from the students and also make the classes as effective as possible in terms of imparting knowledge constitutes as classroom management. It is independent of methodology and very complex as any situation a teacher is facing is entirely his or her own responsibility (Renart, 2013). Classroom management is closely linked to issues of motivation, discipline and respect. Only by examining the 3 elements of a classroom, the student, the teacher and the classroom itself, can one understand how motivation, discipline and respect be inculcated. The paper tries to draw parallels between Facebook (a social networking site) and the classroom setting in order to help understand what one could do differently. It is important to understand that teaching students the way they prefer to learn, in a setting that is more conducive to them may improve the teaching learning process many fold.
1. What makes Facebook comparable to a classroom
Parallels can be drawn between Facebook and classroom settings. Facebook in general is a forum to share ones personal life events and are extremely personal it works quiet like a classroom in terms of engaging the user, involving the user in enabling him to learn more about the world and sharing the learnt materials with others. While this happens on the virtual side of the world, ideally in a classroom, a teacher is meant to engage and enable the students to take part in the learning process. Personal and professional networking differs only in the content and not in terms of the tool being used. Also due to the advancement of technology usage in the society in the recent years, Expansion of knowledge by asking questions about previously unanswered and unexplored areas has become a crucial part of the learning process. Thus such researches have become an important forte for the academicians. Researchers have recognized the utility of Facebook as a novel tool to observe behavior in a naturalistic setting, to test hypotheses, and recruit participants (Wilson, Gosling, and Graham, 2012).
2. What can we learn from Facebook
The pace at which Facebook has progressed from a simple site to what now exists with complex dimensions to it provides inspiration. In a classroom where only a lecture method was traditionally used, we need to find space for technological advancements and incorporate them along. Teaching aids like video sharing, video conferencing with someone on the other side of the world is important. When our entire world is becoming a single global village, this is hardly a luxury but a requirement. Facebook has been evolving from the time of its launch in 2004, however keeping the basics the same. Even though permanence works in favor of the human mind most of the time, it should be noted that change is the only constant in our rapid growing society. Thus it is vital that the educators of the world understand this. Even though the teaching material might remain the same, the presentation of it should evolve as the years pass by. Years of technological advancement has resulted in various teaching aids being available in the market. Making use of it to improve efficiency in the delivery of teaching should be encouraged.
3. The 3 main elements of a classroom and Facebook
Discussing the elements of a classroom, means examining in detail the characteristics of the students, the teacher and the class room environment. From the vantage point of this paper discussing the initial concept is of less importance than the latter two.
3.1. The Student
Creating or refining one’s self-identity and values have become an important part of college life. College students are encouraged to discover who they are and how they relate to others. Facebook has successfully enabled its users to create a sense of self for themselves by constructing their profiles with pictures, creating photo albums, adding their life’s events and even sharing their likes and dislikes. Allowing the users to create and join groups is another interesting feature of Facebook that can be adopted in the classroom setting. Sets of likeminded people come together in groups where they can freely discuss their ideas, post and share content thereby fostering innovation and spreading knowledge without the fear of judgment from others. Involving people from all walks of life and integrating them into one single unit for the purpose of learning without destroying their sense of self is one of the lessons one needs to take note of. It should be also noted that even though the constants do influence how students react in a classroom setting, their moods and social situation do change constantly and it’s a dynamic that never ceases.
3.2. The Teacher
The teacher influences the students and how they respond to the subject in the classroom. Getting influenced by Facebook, at first may cause a reaction of flinch in every teacher earlier but in the recent years it has become evident that there are a few tips one could learn from it. As one logs on to the said networking site, the first question asked is “What’s on your mind?” Initial reaction to this maybe of indifference but, this addresses the very first rule in any kind of communication, to say aloud what needs to be heard. Humans have not yet reached a stage in evolution where telepathy is possible; therefore to spell out what is on one’s mind is essential. In a classroom setting it is important that the teachers make their thoughts and plans for the class clear.
To be acknowledged by the students is the first step in anyone conducting a class efficiently. Also this process helps prepare the students for the class. An initial briefing about what you have planned for them for the day opens up room for the students to understand and prepare for what lies ahead. The next prominent construct on Facebook is the “news feed”. This is an important feature that helps the user keep updates on all that is happening with his/her friends. Similarly it is always a sign of strength in a teacher to know what is happening with the students he/she is addressing. This results in better rapport with the students and also it has been found that a feeling of being cared for always encourages a better relationship, one that is of mutual respect. The option of commenting upon posts propagates healthy discussion and leads to social constructivism where the students collectively develop an answer instead of relying upon the teacher.
Therefore the teacher supplies the raw materials and dons the role of a guide while the students finish the end product. A similar kind of theory has been highlighted by the noted Russian psychologist Lev Vyogtsky in his Z.P.D (Zone of Proximal Development) theory where he states that “cognitive development stems from social interactions from guided learning within the zone of proximal development as children and their partners co-construct knowledge”. In this study he highlights the need for teachers to use interactive and co-operative methods where the students can take help and learn from their peers. In the modern scenario, this kind of interaction and cooperation happens on Facebook and other social networking sites.
Adopting this kind of methodology can work wonders for both the teacher and the student because social networking interests the learners. Adding on, the chatting feature on Facebook stresses on the need for dialogues instead of monologues. It is essential that the teachers leave rooms for discussions, queries and debates during the class hours. It is a widely accepted fact that the amount of time a teacher spends for the student to interact and ask questions is not much and time is most of the times insufficient. Several times most of the questions are directed by the teacher. Even though this can be difficult due to the time constraints of a class hour, it is vital that there is a balance struck in terms of addressing the class and leaving time for them to give their impressions of the same.
When this equilibrium is not achieved it kills the entire concept of dialogue in the classroom mostly encouraging the philosophy of monologue which kills the fostering and innovation of new ideas in the students’ minds. Knowledge has no bounds and so does the mind of a student, but when ideas don’t come out and start taking shape, they start to stagnate and this ultimately hampers the growth of the individual. Only when one examines and fully comprehends the information provided, is it of value to them. The feature of chatting has become so famous for yet another ingenious characteristic of it being not awkward to approach people directly. The chat acts as a buffer to eliminate any form of perceived judgment and uneasiness of direct contact.
This puts most people at ease and hence a sense of confidence arises. Even though this exact characteristic cannot be adapted to social situations involving face to face contact, it is important to understand that a sense of confidence needs to be built up in the students to approach an educator to discuss issues about classes/ subject matter or even personal issues with a sense of ease. Facebook was one of the first networking sites to come up with a feature like the “like button”. Appreciation for thoughts, photos and ones views on life has encouraged millions to use it as a medium to express, and speak truthfully and sometimes even revolt. It is up to the facilitators to built such an environment which will provide a flow of ideas, innovations and maybe even an answer to the unanswered.
What makes anything in the virtual world exist so successfully is that it can be accessed anytime according to the convenience of the user. This 24/7 availability makes things more convenient and liked. As yet again even though it may not be possible for teachers to be available 24/7, it is a lesson that one should not take lightly. Since the gift of judgment and comprehension has been bestowed upon the human race unlike the virtual world, it is necessary that we use it and keep ourselves open to students accordingly.
3.3. The classroom
A classroom setting is something that should be built for the learning experience and like Facebook which is built on and built for people’s interest, a classroom should be for the learning minds build by the learnt mind. One of the constants of the human mind is that we all like to belong. The sense of belonging drives us. According to Abraham Maslow, a need to belong and feel safe is an important need that motivates all human minds. It is only second to the biological needs of the body. If one could create such an environment that assures this in a classroom, the zest with which a student actually attends the class will definitely be on the rise.
Also when one’s needs of belongingness have been reasonably gratified, their motivating force diminishes, paving way for self esteem needs (Hjelle and Ziegler, 1992). Facebook provides this efficiently. This is something that a professor/ teacher can provide in an educational setting. In a class of 40 or more personal attention to every single person might not be easy or even sometimes possible. However, to make them feel not lost and belong to a class is easy. This kind of reinforcement can come in many forms from the teacher or even other classmates. Adding on to the things to learn off Facebook is the how individuals seem to come together as a unit for various causes despite the fact that they might belong to various different groups. Heterogeneity in classrooms has always interfered with effective classroom management.
Making the heterogeneous groups to be of homogeneous nature at least in a classroom is of importance in terms of classroom management. This fosters group cohesiveness within the students which is vital for a sense of belonging and also helps the teacher attend to the needs of the students more efficiently. This group cohesiveness builds up ones confidence to speak out, be more open to newer concepts which might be complex and also enable healthier relationships within the group. A Meta analytical research conducted showed that there was a positive relationship with the average cohesive group performing 18 percentile points above the average non cohesive group (Evans, 1991).
Facebook has managed to form the homogeneity among people from all walks of life by tem just having the connectivity to the internet. Learning includes complex cognitive processes, memory being an important one. Memory is defined as the capacity to acquire, store and retrieve knowledge effectively. Facebook has shown us how one could make drastic improvements using the virtual world. Using Facebook groups to exchange study materials, exchange ideas on projects and expands ones knowledge on various topics has be encouraged. The virtual media has opened up an entire new world of information exchange. It has been found that Facebooks’ systems process 2.5 billion pieces of content and 500 plus terabytes of data every day. Like on Facebook if mutual friends provide more ground for social networking and expanding ones social circle, do they also provide knowledge sources? This is an important feature to focus upon.
Even though this revolution might have started, it is important to foster it in the right way. Considering that in an education system, one is considered learnt through exhibiting high scores on tests it is by default that one understands the importance of memory. Memory can be defined as the encoding, storage and retrieval in the human mind. Allan Paivio with his theory of dual coding theory stresses on how pictures help with the process. According to the dual coding theory memory exists either (or both) verbally or imaginably. Concrete concepts presented as pictures are encoded into both systems; however abstract concepts are coded only verbally.
Facebook has been seamlessly integrated this into their approach. Profile pictures, cover pictures and creating albums has left a trend that leaves one in confidence that pictures aid in memories in a very effective manner. Reinforcing the importance of imagery Tony Buzan, in his theory on mind mapping stressed on the importance of using images in order to improve retrieval of information. It has been proved to boost productivity, efficiency, creativity, memory and improve ability to learn information.
An article titled “Study shows Facebook Ups Self-Esteem” was published by Cornell Daily Sun based on a study conducted by Prof. Joffrey Hancock and Amy Gonzales in their study, they found a positive relationship between use of Facebook and the self-esteem of the user among college students. "When we’re online, we can selectively self-present," Hancock said. "We can take more time and sound more witty” To adopt this in a classroom setting has loads of positive impact on the way one could impact the students.
4. Learning outside the 4 walls
Sharing materials which may by chance was not successfully finished in the classroom can be uploaded on the networking site. This facilitates learning to continue even outside of the time constraints of a classroom. Also the virtual world has enabled teachers to open up their classrooms beyond where they are physically. They maybe in a small town, but through the internet they can be linked in real time to students elsewhere. The feature of message threads on Facebook is an excellent concept that need be adapted to the leaning process. This feature enables a teacher to set up assignments on Facebook. The students can leave their viewpoints/ comments on a certain subject discussed in class. Also a discussion forum can be set up and subject matters can be looked upon with great details. Facebook thus helps one eliminate time and physical space as a constraint factor in education.
5. New features
Continual additions make Facebook exciting as it facilitates hassle free access to information. One such interesting feature is the hashtag feature which makes it easier for the users to find all the content related to a specific theme. Just one click on a hashtag gives the user all the related information that has been posted under the same hashtag. This way the student can access the required information in a very simple and hassle free manner instead of spending countless hours trying to find the resources required.
6. Possible challenges Even though there are multitudes of advantages to adopting things off the virtual world, the debate comes down to the execution of it. Are the all educators in the teaching fraternity ready to the change? Are all of them equipped to? In these days the students have become the digital natives, the teachers have been left behind as mere digital immigrants who struggle to keep up. Problems of immigrants are often so simple as the inability to cope but sometimes as complex as the rapid progressions and complexities of the immigrant land.
7. Conclusion Increasing the usage of Facebook for academic purposes will result in better dispersion of knowledge in terms of efficiency and the reach. In order to optimize the time spent on socializing for increased learning, teachers can encourage students to give their feedback about the classes, sharing materials, approaching other prominent people in their field of study to work upon extra projects and for enhancement of understanding they already have. This paper sheds light on what one could learn off Facebook that has swept off the new generation lives. By adapting certain features of Facebook to the traditional classroom settings make it more animated and upgraded. Being the digital natives has left the world open to the youth to defy boundaries and expand their knowledge beyond expectations. Facebook offers one of those lessons which show us that boundaries of time and physical presence are not boundaries anymore. It teaches us that existing in virtual time can be molded to the advantages of the education system of this age.
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
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