Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30General SciencesKINETICS AND EQUILIBRIUM STUDIES OF THE ADSORPTION OF PHENOL AND METHYLENE BLUE ONTO COLA NUT SHELL BASED ACTIVATED CARBON
English0109Lekene Ngouateu R. B.English Kouoh Sone P M. A.English Ndi Nsami J.English Kouotou D.English Belibi Belibi P. D.English Ketcha Mbadcam J.EnglishThe aim of this work was to study the removal of methylene blue (MB) and phenol from aqueous solution using powder activated carbon prepared from cola nut shells chemically activated with KOH solution. The effect of contact time, adsorbent dose, pH and initial concentration has been studied using batch adsorption method. Given the base line for the results, the percentage removal of MB and phenol were 98.19 % and 61.81 % respectively. The maximum adsorption of MB and phenol occur at pH 8 and 6. Also the quantity adsorbed decreases with the adsorbent dose for both adsorbates. The quantity adsorbed of MB
increases with increased in initial concentration whereas reverse result was observed with phenol. The adsorption equilibrium data were confronted to Langmuir, Freundlich, Tempkin and Dubinin-Kaganer-Radushkevich isotherms models. The Langmuir model describes better the adsorption with maximum monolayer adsorption capacities of 65.79 mg.g-1 and 6.22 mg.g-1 for MB and phenol respectively. The kinetics of methylene blue and phenol adsorption were also discussed using pseudo-first-order, pseudo-second-order, Elovich, mass transfer and intra-particle diffusion models. The adsorption process follows the pseudosecond- order and mass transfer kinetic models respectively for methylene blue and phenol owing to their high correlation coefficient. This study shows that the prepared activated carbon can be used as low cost alternative adsorbent for removal of both phenol and MB.
EnglishAdsorption, Activated carbon, Equilibrium, Kinetics, Methylene blue and PhenolINTRODUCTION
Many industries discharge wastewaters containing many hazardous substances such as phenols, heavy metals and dyes. The contamination of water by industrial activities is the source of problems to human health and environment (Hameed et al, 2007a). MB in industries has wide variety of application such as colouring of papers, dyeing textiles and cosmetics. Consequently, their effluents contain notable amounts of this dye stuff (Shen et al, 2009; Reddy et al, 2012). On the other hand, phenol found mostly in pesticides, pharmaceuticals, petro-chemicals, steel manufacturing, etc. (Alam et al, 2006; Varghese et al, 2004; Isichei and Okieimen, 2012) causes several problems. In addition, phenol and the MB are very harmful to humans and other aquatic organisms (Hameed et al, 2007b; Ekpete et al, 2012). The presence of MB in water inhibits sun light diffusion into the water, which reduces the photosynthetic process of aquatic plants (Idris et al, 2012a; Ndi et al, 2013). The ingestion of methylene blue and phenol causes many problems like vomiting, mental confusion, diarrhea, dark urine, cyanosis, tissue necrosis and increased heart bit rate (Hameed et al, 2007a; Karabacako?lu et al, 2008). Thus, it is important to treat wastewaters before their rejection into the nature. And for this purpose, many methods of removing these pollutants have been used such as chemical precipitation, filtration, ion exchange, reverse osmosis, ultra-filtration, biological degradation, membrane separation, solvent extraction and adsorption. These methods differ in their efficiency to remove dyes and phenol and are very expensive (Moraitopoules et al, 2009). However, adsorption remains the outmost process because of its simplicity, high efficiency and easy recovery (Ndi Nsami et al, 2013). In the scientific literature, many adsorbents have been used such as zeolite, clay, silica gel, resins, activated alumina and activated carbon (Ketcha et al., 2007; Ketcha Mbadcam et al, 2012a). Activated carbon is the most widely used adsorbents owing to its well-developed pore structure, large active surface area, good mechanical properties and multiple functional groups at their surface (Wu et al, 2005, Kouotou et al, 2013). There are many precursors from which it can be prepared and some of these precursors include corn cobs (Tsai et al, 2001; Ketcha Mbadcam et al, 2012a), apricot stone (Kobya et al, 2005), sugar bagasse, coconut shells (Jaguaribe et al, 2005), peanut hull (Guler et al, 2007), rattan sawdust (Hameed et al, 2007a), bamboo (Hameed et al 2007b), hazelnut bagasse (Karabacako?lu et al, 2008), cotton stalk fibre (Kunquan et al, 2009), rice husk (Yahaya et al, 2011), oil palm shell (Kouotou et al., 2012), cola nut shell (Ndi et al, 2013); olive stone (Hanen and Abdelmottaleb, 2013) The aim of the present study was to examine the adsorption capacities of MB and phenol from aqueous solution onto activated carbon prepared from cola nut shells activated with KOH using batch system. The effects of factors such as contact time, adsorbent dose, pH and initial concentration were investigated. The kinetics and equilibrium data were confronted to several models.
MATERIALS AND METHODS
Preparation of adsorbent
The cola nut shells were initially washed with tap water followed by distilled water, sun dried and mechanically ground using a grinding machine (Retch) then sieved through a sieve (Retch) to get geometrical size less than 1.5 mm. The prior sieved cola nut shells was kept in an oven at 110 °C for a period of 24 hours, then allowed to cooled to room temperature, in a desiccator containing CaCl2 (drying agent) for 30 min. It was removed from the desiccator and a mass reagent ratio 1:1 was applied, mixed, and dried for 24 hours at 110 °C in an oven (Ndi et al, 2013). The carbonization and activation were accomplished in a one-single step by carrying out thermal transformation of cola nut shells impregnated with KOH as activating agent in the absence of air in a Carbolite furnace (OSI) at 500 °C for 1 hour as resident time. After activation, the furnace was allowed to cool to room temperature. The pyrolysed carbons were leached with 1 % HCl (v/v) for 2-3 hours and washed several times with distilled water until a neutral pH was achieved. The activated carbon obtained was later dried in an oven at 110 °C for at least 24 hours and kept for further application (Ndi Nsami et al, 2013).
Characterization of adsorbent
The surface functional groups of the prepared activated carbon were estimated using Fourier Transform Infrared (FTIR) spectroscopy (Alpha - Bruker). The FTIR spectra of our sample were recorded within 400-4000 cm-1. The BET specific surface area, the total pore volume and the pore size of activated carbon were determined by standard multipoint techniques of nitrogen adsorption using Micromeritrics ASAP 2020 equipment. The iodine number which is a measure of micropore content of the activated carbon is determined by the American Standard for Testing of Materials (ASTM D2866-94).
Preparation of solutions
All the reagents used in this study were of analytical grade. Two stocks solutions of MB and phenol of concentration 50 mg.L-1 and 1000 mg.L-1 respectively were prepared by dissolving 0.050 g of MB and 1.000 g of phenol separately in 1000 mL volumetric flask. These solutions were stirred until total dispersion and the volume completed with distilled water up to mark. These solutions were stirred on a magnetic agitator for 6 hours to homogeneity. All the experimental solutions were prepared by diluting the stock solution to the required concentration.
Batch adsorption study
The batch adsorption was carried out at room temperature. The effects of contact time, adsorbent dose, pH of solution and the initial concentration of these adsorbates were studied. In each experiment, 20 mL of MB or phenol solution of known concentration were mixed with a known mass of activated carbon. The pH of the mixture was adjusted either with 0.1 N HCl or 0.1 N NaOH solutions. The suspension was stirred for a given interval of time, using a magnetic agitator and stirrer at a controllable speed. After agitation, the suspensions were filtered using Whatman No°1 filter paper. The concentration of phenol after adsorption was determined using a back titration method as described by Jeffery et al and that of MB was determined using a UV-visible spectrophotometer (CORNING, 256) at the maximum absorption wavelength of 668 nm.
RESULTS AND DISCUSSION
Results
Characterisation of prepared activated carbon The FTIR spectrum of activated carbon is shown in (Fig. 1) with the following significant absorption bands: 3321 cm-1; 873, 802, 752 cm-1; 1574 cm-1; 1163 cm-1; 1089.9 cm-1
The effect of contact time of both adsorbates was determined by agitating 20 mL solution of phenol of initial concentration of 200 mg.L-1 with 0.05 g of activated carbon and 20 mL of MB solution with initial concentration of 18 mg.L-1 and 0.005 g of AC. The experimental The effect of contact time of both adsorbates was determined by agitating 20 mL solution of phenol of initial concentration of 200 mg.L-1 with 0.05 g of activated carbon and 20 mL of MB solution with initial concentration of 18 mg.L-1 and 0.005 g of AC. The experimental results obtained are shown in Fig. 2. The adsorption rate of phenol was slow within the first 10 minutes, and then increased rapidly and reaches equilibrium at 25 minutes.
Adsorbent dose
To study the effect of adsorbent dose on the adsorption of phenol and MB, a series of adsorption experiments were carried out with different adsorbent mass varying from 0.005 to 0.025 g at initial concentration of 18 mg.L- 1 for MB and from 0.05 to 0.2 g at initial concentration of 200 mg.L-1 for phenol. Results (Fig. 3) showed that with an increase in activated carbon dose, the adsorption capacity decreases.
Effect of pH
The pH is an important parameter that influences adsorption of pollutants from aqueous solutions, because it affects both the surface of adsorbent and adsorbate (Jadhav and Vaujara, 2004; Tagne et al, 2013). In this work, the pH was varied between 2 and 10 using 200 mg.L-1 of initial phenol concentration and 0.05 g of activated carbon, 18 mg.L-1 initial MB concentration and 0.005 g of activated carbon
The effect of initial concentration of adsorbents on adsorption of phenol and MB was carried out on different concentrations ranging from 100, to 500 mg.L-1 for phenol and 9 to 18 mg.L-1 for MB.
Adsorption isotherm models
An adsorption isotherm is the relationship between the adsorbate in the liquid phase and the adsorbate adsorbed on the surface of the adsorbent at equilibrium at constant temperature. In order to successfully represent the dynamic adsorptive behaviour of any substance from the fluid to the solid phase, it is important to have a satisfactory description of the equilibrium state between the two phases composing the adsorption system (Ndi Nsami et al, 2013). Classical adsorption models are used to describe the equilibrium established between adsorbed component on the adsorbent and unadsorbed component in solution (represented by adsorption isotherms). Langmuir, Freundlich, Dubini-Radushkevich (D-R) and Tempkin adsorption models were used to analyse the equilibrium data of adsorption of both phenol and methylene blue onto the activated carbon.
Langmuir adsorption isotherm: The Langmuir adsorption equation is one of the most common isotherm equations for modelling equilibrium data in solid-liquid systems. This equation is based on three assumptions: (i) - Adsorption cannot proceed beyond monolayer coverage. (ii) - All the surface sites are equivalent and can accommodate at most one adsorbed atom. (iii) - The ability of a molecule to be adsorbed at a given site is independent of the occupation of neighbouring sites (Ketcha Mbadcam et al, 2011). The general form of the Langmuir equation is:
Freundlich adsorption isotherm: The Freundlich equation is an equation based on adsorption on a heterogeneous surface. Its general form equation is given by equation (6) (Anagho Gabche et al, 2013):
Dubinin-Radushkevich (D-R): This model envisages the heterogeneity of the surface energies and can be written in the following linear form (8) (Ketcha Mbadcam et al, 2012b).
Tempkin adsorption isotherm: Tempkin isotherm assumes that the heat of adsorption decreases linearly with the coverage due to adsorbent - adsorbate interaction (Tagne et al, 2013). The Tempkin isotherm has generally been applied in the following linear form:
The data obtained from these studies have been tested with the Langmuir, Freundlich, Dubinin-Radushkevich and Tempkin linearized equations. The results are summarized in Table 2.
Kinetics adsorption models In the present work, the kinetics of adsorption of both phenol and MB onto activated carbon was studied using five kinetic models:
Mass transfer kinetic model: the general equation of mass transfer kinetic model is as follows (Ketcha Mbadcam et al, 2011):
Intraparticle diffusion kinetic model: the transportation of adsorbate from solution phase to the surface of the adsorbent particles may be controlled either by one or more steps such as: (i) film or external diffusion, (ii) pore diffusion, (iii) surface diffusion and (iv) adsorption on the pore surface, or a combination of more than one step (Kunquan et al, 2009). The general equation of intraparticle diffusion model is given by (Weber and Morris, 1963. Srivastava et al., 1989; Hameed and Daud, 2008; Idris et al, 2012b):
where, is the amount of pollutant adsorbed at time t, (mg.g-1.min-1) is the intraparticle rate constant and C the intercept. In order to obtain parameters related to each kinetic model, experimental data have been tested with linear forms of these models. The straight-line plots are presented on Fig. 6 to 10, while the parametric constants for these models are given in Table 2. It can be noted that the adsorption of MB and phenol onto prepared activated carbon adequately follows respectively pseudo-second-order and mass transfer kinetics models from their correlation coefficient (R2 = 1 and 0.9418)
DISCUSSION
Characterisation of prepared activated carbon The broad adsorption band at 3321 cm-1 is the characteristic stretching vibration of O-H for phenols, alcohols or carbonyls. The bands at 873, 802, and 752 cm-1 are due to plane deformation mode of C-H for different substituted benzene ring (Benadjemia et al, 2011). The band at 1574 cm-1 can be attributed to the stretching of carbonyl group (C=O), and the broad band at 1163 cm-1 represents the haloalkyl group (C-H) (Kunquan et al, 2009). The band at 1089.9 cm-1 is due to internal vibration of Si-O-Si (Maghri et al, 2012; Ravichandra et al, 2012). The prepared activated carbon exhibit a low specific surface area of 2.0448 m2 .g-1. This might be due to the activating reagent (KOH) because same precursor was used with same operating conditions, but at this time with ZnCl2 as activation reagent which present a significant surface area of about 648 m2 /g (Ndi Nsami et al, 2013). The values of pore size and iodine number indicate that the prepared activated carbon consist of micropores and mesopores which are favourable for respective adsorption of MB and phenol.
Contact time
According to Fig.2, the first step might be due to the intraparticle transport of phenol from bulk solution to the external surface of the porous adsorbent and the second step the diffusion into the interior pore (Ranjan et al, 2009; Ndi Nsami et al, 2013). For MB, the amount adsorbed increases rapidly and reaches equilibrium after 5 minutes. This result showed that within this time, the adsorption sites were exhausted and the remaining vacant sites were difficult to be occupied by other molecules due to the repulsive forces between adsorbate present on solid and bulk phase (Tagne et al, 2013).
Adsorbent dose
The decrease in the quantity adsorbed can be due to the agglomeration/aggregation of adsorbent particles at higher masses, which limit the surface area available for the adsorbates and also the increase in the diffusional path length (Kunquan et al, 2009; Essomba et al, 2014)
pH
For the phenol adsorption (Fig. 4), at low pH value, the surface of activated carbon as well as phenol molecules gets protonated and with formation of positive charges on both adsorbate and adsorbent. This result leads to the reduction of phenol adsorption due to repulsive forces. With the increase of pH to 6, molecular form of phenol persist in the medium and surface protonation is minimum, leading to the enhancement of phenol adsorption and finally reaches its maximum (Jadhav and Vaujara, 2004). Significant decline in removal efficiency was for further increase in pH, which may be attributed to formation of phenolate anions and at the same time the presence of hydroxyl ions on the activated carbon prevents the uptake of phenolate ions (Ekpete et al, 2010). For the MB (Fig. 4), the amount adsorbed increases with an increase in pH value. This is probably due to the presence of delocalized -electrons within the graphene layers which are described as Lewis basic site (electron donor) and which reacts with MB molecule which are positively charged (cationic dye) (Benadjemia et al, 2011).
Concentration
The adsorption capacity (Qe ) increased as initial MB concentration increased (Fig.5); showing that the initial concentration provides a powerful driving force to overcome the mass transfer resistance between the aqueous and solid phases (Tsai et al, 2006). For adsorption of phenol (Fig. 5), within 100 and 200 mg.g-1 the amount adsorbed increases and beyond this interval, the amount adsorbed decreases with increase in concentration. The high sorption at the initial concentration may be due to an increased number of vacant sites on the activated carbon available at the initial stage. As the initial concentration increases there is a decrease in amount of phenol adsorbed due to the accumulation of phenol particles on the surface (Ekpete et al, 2010).
Isotherm
The results in table 2 show clearly that adsorption isotherms are in agreement with the Langmuir adsorption isotherm for both MB and phenol adsorption with higher values of correlation coefficient R2 of 0.9875 and 0.8956 respectively. In addition, the mean sorption energy (E) which is given by the D-R adsorption isotherm is less than 8 kJ.mol-1 (0.05 kJ.mol-1) for phenol adsorption, indicating a physical adsorption. On the other hand, E = 12.9 kJ.mol-1 for MB adsorption indicates the chemical process of adsorption (Ranjan et al, 2009). The values of are 0.23 and 0.0003 for phenol and MB respectively, which indicates that the adsorption is favourable onto prepared activated carbon.
Kinetics
The high value of correlation coefficient implies that MB adsorption on activated carbon may occur through a chemical process involving the valence forces of shared or exchanged electrons (Ho, 2006). The kinetic of adsorption of phenol better fit the mass transfer kinetic model with high correlation coefficient, R2 = 0.9418. In addition, the high value of the intraparticle rate constant (kid =10.899 mg.g-1.min-1) indicates that the particle diffusion mechanism predominates in adsorption of phenol. Similar results have been reported by Idris et al 2012b, Idris et al, 2012.
CONCLUSION
The activated carbon prepared from cola nut shells was successfully employed as an adsorbent for the removal of MB and phenol in aqueous solution. The equilibrium data fitted well the Langmuir adsorption isotherms for both adsorbates. The values of RL were found to be 0.23 and 0.0003 respectively for phenol and MB and confirmed that the prepared activated carbon is favorable for adsorption of both phenol and MB. The kinetics data of adsorption of phenol and MB follow respectively mass transfer and pseudo-second order model. These results indicated that the activated carbon prepared from cola nut shells could be used as low cost alternative adsorbents to commercial activated carbon in the removal of organic compounds such as phenol and MB from wastewater.
ACKNOWLEDGEMENT
The authors are grateful to Dr. Isaac Nongwe Beas, for recording the IR analysis; the Research Unit- Adsorption and Surface of the Applied Physical and Analytical Chemistry Laboratory of the University of Yaoundé I. The authors are also grateful to the scholars whose articles are cited and included in references of this manuscript, and grateful to authors, editors, and publishers of all the articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=553http://ijcrr.com/article_html.php?did=5531. Alam Z. M., Muyibi A. S., Mansor F. M., Wahid R. 2006. Activated carbons derived from oil palm empty-fruit bunches: Application to environmental problems. Journal of Environmental Sciences. 19, 103-108.
2. Anagho Gabche s., Tchuifon Tchuifon D. R., Ndifor-Angwafor N.G., Ndi Nsami J., Ketcha Mbadcam J., Nchare M. 2013. Nickel adsorption from aqueous solution onto kaolinite and metakaolinite: kinetic and equilibrium studies. International Journal of chemistry. 04, 1-14.
3. Benadjemia M., Millière L., Reinert L., Benderdouche N., Duclaux L. 2011. Preparation, characterization and Methylene Blue adsorption of phosphoric acid activated carbons from globe artichoke leaves. Fuel Processing Technology. 92, 1203-1212.
activated carbon for phenol removal in aqueous systems. Journal of Engineering and Applied Science. (5)9: 39-47.
5. Ekpete O. A., Spiff A. I., M. Horsfoll Jnr, Adowei P. 2012. Adsorption of phenol and chlorophenol in aqueous solution on a commercial activated in batch sorption systems. Innovation in Science and Engineering. 2, 72-78.
6. Essomba J. S., Ndi Nsami J., Belibi Belibi P. D., Tagne G. M., Ketcha Mbadcam J. 2014. Adsorption of cadmium(II) ions from aqueous solution onto kaolinite and metakaolinite. Pure and Applied Chemical Sciences. 2(11): 11- 30.
7. Guler C., Copur Y., Cihat T. 2007. The manufacture of particleboards using mixture of peanut hull (Arachis hypoqaeaL) and European Black pine (Pinus nigra Arnold) wood chips. Bioresource Technology. 99, 2893-2897.
8. Hameed B. H., Ahmed A. L., latiff K. N. A. 2007a. Adsorption of basic dye (methylene blue) onto activated carbon prepared from rattan sawdust. Dyes and Pigment. 75, 143- 149.
9. Hameed B. H., Din A. T. M., Ahmed A. L. 2007b. Adsorption of methylene blue onto bamboo-bossed activated carbon: kinetics and equilibrium studies. Journal of Hazardous Materials. 141, 819 – 825.
10. Hameed B.H., Daud F.B.M. 2008. Adsorption studies of basic dye on activated carbon derived from agricultural waste: Hevea brasiliensis seed coat. Chemical Engineering Journal. 139, 48-55.
11. Hanen N. and Abdelmottaleb O. 2013. Modeling of the Dynamics Adsorption of Phenol from an Aqueous Solution on Activated Carbon Produced from Olive Stones. Chemical Engineering and Process Technology. 4:3, 1-7.
12. Ho Yuh-Shan. 2006. Review of second-order models for adsorption systems. Journal of Hazardous Materials. 136, 681-689.
13. Idris S., Iyaka Y.A., Dauda B.E.N., Ndamitso M.M. and Umar M.T. 2012b. Kinetic study of utilizing groundnut shell as an adsorbent in removing chromium and nikel from dye effluent. American Chemical Science Journal. 2(1): 12-24.
14. Idris S., Ndamitso M. M., Iyaka Y. A., Muhammad E. B. 2012a. Sawdust as adsorbent for the removal of MB from aqueous solution adsorption and Equilibrium Studies. Journal of Chemical Engineering. 1(1): 12-24.
15. Isichei T. O. and Okieimen F. E. 2012. Adsorption of phenol onto water hyacinth activated carbon-kinetics and equilibrium studies. Journal of Environmental Chemistry and Ecotoxicology. 4(13): 234-241.
16. Jadhav A. N ., Vaujara A. k. 2004. Removal of phenol from waster using sawdust, polymerized sawdust and sawdust carbon. Indian Journal of Chemical technology, 11, 35-41.
17. Jaguaribe E. F., Medeiros L. L., Barreto M. C. S. and Araujo L. P. 2005. The performance of activated carbons from sugarcane bagasse, babassu, and coconut shells in removing residual chlorine. Brazilian Journal of Chemical Engineering. 22(1): 41-47.
18. Jeffery G. H., Bassett J., Mendham J., Denney R. C. (fifth editon), 1989. Vogel’s textbook of quantitative chemical analysis. John Wiley and sons Inc., 605 Third Avenue, New York N Y 10158, 408 - 409.
19. Karabacako?lu B., Tümsek F., Demiral H., Demiral I. 2008. Liquid Phase Adsorption of Phenol by Activated Carbon Derived From Hazelnut Bagasse. J. Int. Environmental Application and Science. 3(5): 373-380.
20. Ketcha Mbadcam J., Dina Joh D. D., H.M. Ngomo and Ndi N.J. 2012a. Preparation and Characterization of Activated Carbons Obtained from Maize Cobs by Zinc Chloride Activation. American Chemical Science Journal. 2(4): 136-160.
21. Ketcha Mbadcam J., Dongmo S. and Dinka’a Ndaghu D. 2012b. Kinetic and thermodynamic Studies of the Adsorption of Ni(II) ions from Aqueous solutions by Smectite Clay from Sagba-Cameroun. International Journal of Current Research. 4(5): 162-167.
22. Ketcha Mbadcam. J., Anagho Gabche S., Ndi Nsami. J., kammegne A.M. 2011. Kinetic and equilibrium studies of the adsorption of lead (II) ions from aqueous solution onto Cameroon clays: kaolinote and smectite. Journal of Environmental Chemistry and Ecotoxicology. 3(11): 290-297.
23. Kobya M., Demirbas E., Senturk E., Ince M. 2005. Adsorption of heavy metal ions from aqueous solutions by activated carbon prepared from apricot stone. Bioresource Technology. 96, 1518-1521.
24. Kunquan L., Zheng Z., Xingfa H., Guohua Z., Jingwei F., Jibiao Z. 2009. Equilibrium, kinetic and thermodynamic studies on the adsorption of 2-nitroaniline onto activated carbon prepared from cotton stalk fiber. Journal of Hazardous Materials. 166, 213-220.
25. Maghri I., Kenz A., Elkouali M., Tanane O., Talbi M. 2012. Textile Dyes removal from Industrial Waste Water by Mytilus Edulis Shells. Journal of Materials Environmental Science. 3(1): 121-136.
26. Moraitopoules I., Ioannou Z., Simitzis J. 2009. Adsorption of phenol, 3 – nitrophenol and Dyes from aqueous solution onto and activated carbon column under semi – Batch and Continuous operation. World Academy of science, Engineering and technology. 34, 218–222.
27. Ndi Nsami J., Ketcha Mbadcam J., Anagho Ngabche S., Ghogomu Numboniu J., Belibi Belibi P. D. 2014. Physical and chemical characteristics of activated carbon prepared by pyrolysis of chemically treated Cola nut (cola acuminata) Shells wastes and its ability to adsorb organics. International Journal of Advanced Chemical Technologie. 3(1): 1 – 13.
28. Ndi Nsami J., Ketcha Mbadcam. J. 2013. “The adsorption efficiency of chemically prepared activated carbon from cola nut shells by ZnCl2 on methylene blue”. Hindawi Publishing Corporation Journal of Chemistry, 1-7.
29. Ranjan D., Talat M., Hasan S.H. 2009. Biosorption of arsenic from aqueous solution using agricultural residue ‘rice polish’. Journal of Hazardous Materials, 166, 1050-1059.
30. Ranjan D., Talat M., Hasan S.H. 2009. Biosorption of arsenic from aqueous solution using agricultural residue rice polish. Journal of hazardous materials. 166, 1050-1059.
31. Ravichandra P., Farzana H. M., and Meenakshi S. 2012. Sorption equilibrium and kinetic studies of Direct Yellow 12 using carbon prepared from bagasse, rice husk and tex-tile waste cloth. Indian Journal of Chemical Technology, 19, 103-110.
32. Reddy S. B., Krishna V., and Ravindhranath K. 2012. Removal of methylene blue dye from waste waters using new bio-sorbents derived from Annona squamosa and Azadiracta indica plants. Journal of Chemical and Pharmaceutical Research. 4(11): 4682-4694
33. Shen J., Xie Y., Zhou Y. 2009. Adsorption of methylene blue from aqueous solution on pyrophyllite. Applied Clay Science. 46, 422-424.
34. Tagne G. M., Ndi Nsami J., Ketcha Mbadcam J., 2013. Adsorption of copper ions from aqueous solution onto synthetic geothite and two natural aviable red soils from Yaoundé-Cameroon. British Biotechnology Journal. 3(3): 221 – 235
35. Tsai W. T., Lai C. W., Su T. Y. 2006. Adsorption of bisphenolA from aqueous solution onto minerals and carbon adsorbents. Journal of Hazardous Materials. 134, 169-175
. 36. Tsai W.T., Chang C.Y., Wang S.Y., Chang C.F., Chien S.F., Sun H.F. 2001. Cleaner production of carbon adsorbents by utilizing agricultural waste corn cob, Resources, Conservation and Recycling, 32, 43-53.
37. Varghese S., Vinod V. P., Anirudhan T. S. 2004. Activated carbons derived from oil palm empty-fruit bunches: Application to environmental problems. Indian Journal of Chemical Technology. 11, 825-833.
38. Wu F.C., Tseng R.L., Juang R.S. 2005. Preparation of highly micro porous carbons from fir wood by KOH activation for adsorption of dyes and phenol from water. Separation and Purification Technology. 47, 10-19.
39. Yahaya E. M. K. N., Latiff M. P. F. M., Abustan I., Bello S. O., Ahmad M. A. 2011. Adsorptive Removal of Cu (II) Using Activated Carbon Prepared From Rice Husk by ZnCl2 Activation and Subsequent Gasification with CO2. International Journal of Engineering and Technology. 11(2): 164-168.
40. Kouotou D., Ngomo Manga H., Baçaoui A., Yaacoubi A. and Ketcha Mbadcam J. 2013. Physicochemical Activation of Oil Palm Shells using Response surface Methodology: Optimization of Activated Carbons Preparation’’. International Journal of Current Research, 5(3), 431-438.
41. Kouotou D., Horace Ngomo Manga, Abdelaziz Baçaoui, Abdelrani Yaacoubi and Ketcha Mbadcam J. 2013. Optimization of Activated Carbons prepared by H3 PO4 and Steam Activation of Oil Palm Shells, Journal of Chemistry, article ID 654343,10.
42. Ketcha Mbadcam J., Ngomo Manga H., Kouotou D., Ngamou Tchoua P. H.., “Kinetic and Equilibrium Studies of the Adsorption of Nitrate Ions in Aqueous Solutions by Activated Carbons and Zeolite”. Research Journal of Chemical Environment, 11(3), 47, 2007.
43. Largregren S. About the Theory of so called Adsorption of Soluble Substances, Ksver verterskapsakard Handl 24, 1-6, 1898.
44. Ho Y.S., Mckay G. D., Wase A.J. and Foster C.F. 2000. Study of the Divalent Metal Ions on to Peat. Adsorption Science and Technology, 18, 635-650.
45. Chien S. H. and Clayton W. R. 1980. Application of Elovich Equation to the Kinetics of Phosphate Release and Sorption on Soils, Soil Science Society of American Journal, 44, 265- 268.
46. Weber W. J. and Morris J. C. 1963. Kinetics of Adsorption on Carbon from Solution, J. Sanit. Eng. Div. American Society of Civil Engineering, 89, 31-60.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30General SciencesDIVERSITY AND DISTRIBUTION OF AQUATIC INSECTS IN SOTHUPARAI RESERVOIR, AT PERIYAKULAM, THENI DISTRICT, TAMILNADU, INDIA
English1015Medona Mary R.English Nirmala T.English M. R. Delphine RoseEnglishThe present study deals with the diversity and distribution of aquatic insects from Sothuparai Reservoir. It is located at the foothills of the Western Ghats. The aquatic entamofauna were sampled systematically and randomly using standard protocols. The aquatic insects act as an indicator species to monitor the environmental pollution. Ephemeropteran were most diverse and its presence indicative of good water quality. The abundance of organic pollution tolerant Baetis were found in downstream, nearer to human settlements. The physico chemical variations of water taken into account for the study were found to be influencing
the distribution of aquatic insects. It is suggested that routine bio monitoring of the reservoir using aquatic insect indicators will facilitate better conservation and management.
EnglishAquatic insects, Diversity, Water quality, May flies, Sothuparai reservoir and Bio indicatorINTRODUCTION
India is one of the mega diverse countries, with a notable diversity of aquatic habitats of about 3,166,414 Km2 with significant variations in rainfall, altitude topography and latitude. The Western Ghats are, also called as Sahyadri hills, one of the tropical biodiversity hotspot in India. The diverse climatic conditions, physical and geographical nature of the Ghats renders shelter for rich fauna and flora. The Western Ghats is bestowed with a number of perennial and intermittent, small and large streams and rivers, the region shows high species diversity. The Ghats not only supports terrestrial but also aquatic diversity of flora and vertebrate fauna and least is the importance to invertebrate fauna ( Ramachandran et al., 2010). The linear morphology of streams and river is unique. The water current is one of the salient stream features but it varies seasonally, with depth and throughout the longitudinal profile of the water course. Freshwater habitats including both lentic and lotic habitats serve as a home to greater entamofauna. Among the 56% of insects, only 3-5% is aquatic and they are minor fraction of all insects. Nearly 3% of all the insects initiate their life cycle as aquatic larvae before emergence as winged terrestrial forms (Daly, 1996). The habitats for insect communities in streams show a great variation of aquatic invertebrate diversity. Cascade, riffles and pools are the most common stream habitat. Cascades are the habitats where the water flows turbulently through boulders and cobbles. Woody debris and litter get collected in the cascades because of its physical structure. The water flows with little turbulence over gravel and sand is the riffle. Pools are habitats with minimum water flow and least turbulence (Subramanian, 2003). Studies of invertebrate fauna of lentic ecosystems were correlated to species – habitat relationship with regard to the environmental variables (Compin and Cerghino, 2003; Azrina et al., 2005). Over 95% of the total individual in fresh water particularly streams comprise of these immature life stages of aquatic insects. They play an important role in food chain of stream ecosystem. Some freshwater insects have specific requirements regarding their nutrients, water quality, substrate and vegetation. The impact of human on freshwater were assessed by the use of indicator species (Carter and Resh, 2001; Nagendran, N., 2007). Indicator species are those taxa known to be par ticularly sensitive to specific environmental factors. Any changes in their incidence and abundance may directly reflect an environmental change (New, 1984). The aquatic insects, that have one of more life stages adapted for living in the aquatic environment, which may takes a few weeks to several years. Three aquatic orders, Ephemeroptera, Plecoptera and Odonata have a hemimetabolous life cycle. The other aquatic orders, Trichoptera and Megaloptera are holometabolous life cycle. Heteroptera has a paurometabolous life cycle. Among these orders Ephemeroptera, Plecoptera, Trichoptera, Coleoptera and Diptera are found in abundance in many streams (Subramanian, K.A., 2007 and Sivaramkrishnan, 2005). Most of the stream ecosystems are becoming increasingly polluted by domestic sewage, agricultural runoff, urban waste and industrial effluents (Trivedy and Goel, 1985; Trivedy, 1988, 1990; Kumar, 2001). Anthropogenic impacts on the structure and the organisms of freshwater ecosystems are diverse, unpredictable and unaccountable. It leads to structural and functional disturbance in freshwater ecosystem and finally reduces the biodiversity at different levels of biological organization. The use of living organisms to assess water quality is a century old approach to water quality evaluation. Physical and chemical data reflect a condition that exists during sampling. But biological monitoring gives an indication of past conditions also. The use of aquatic insects as bio indicators provides data to estimate the degree of environmental impact and its potential effects on other living organisms (Wahizatul, et al., 2011). In general, aquatic insects are largely ignored in the contemporary estimation on Indian biodiversity and hence the present study documents the diversity of aquatic entamofauna in Sothuparai reservoir, Theni District, Tamilnadu, India
MATERIAL AND METHODS
Description of Study site Sothuparai is located at 9 km from periyakulam and situated between the longitude 770 28’ 4’’ and latitude 100 7’ 45’’. Sothuparai dam supplies water to periyakulam throughout the year. Irrigation under sothuparai system 2,865 acre. Water spread area of maximum water level is 48.64 square meter. Maximum flood discharged allowed, 807.48. Full reservoir level is 405.5cm. Length of dam is 345 meter. Height of the dam is 1035.00 feet. Maximum water level is 100.22 feet. This stream is across the Varaha River.The wide expanse of stored water is an impressive sight.
Sample Collection
The water samples for the present study were collected once a month from the upstream and downstream of the reservoir between 10 am to 11 am. Sterlized sampling bottles were used to collect the water samples. After collection, the samples were kept in ice cold box before transporting to the laboratory
Analysis of water quality parameters
On the sampling spot, water quality parameters viz temperature, humidity, water current, depth and width of the stream and pH were measured. Width and depth of the streams were measured using a marked pole and measuring tape at each stream. Total Alkalinity, Total Hardness were analyzed by volumetric means. The chemical parameters such as Calcium, Iron, Magnesium, Nitrate, Nitrite, sulphate, Phosphate, DO, and BOD were analyzed in the laboratory following the standard methods as prescribed by APHA, (2005).
Sampling of Aquatic Insects
The study was conducted during the early hours of the day from June, 2013 to May, 2014. Two sites were selected for the study i.e. upperstream and downstream. A length of 100m reach was considered as a unit and the aquatic entamofauna were sampled using D- frame dip net as also kick net both of which are of 500µm mesh size. The Kick net was placed in the upperstream and downstream. One meter above stream bottom substrates was kicked to dislodge invertebrates clinging to debris and stones into the kick net. The contents were emptied into the tray and invertebrates were collected. The D frame net was employed to trap specimens clinging to vegetation, root mats etc., along the boundary (Merit and Cummins, 1988). Riffles and pools were sampled separately to account for sub habitat variations (Subramanian and Sivaramakrishnan, 2007). The collected specimens were preserved in jars containing 70% ethanol. They were identified using a LABOMED stereo zoom microscope with the help of standard keys (Merit and Cummins, 1988; Dudgeon, 1999 and Subramanian and Sivaramakrishnan, 2007).
Data Analysis
Species diversity indices such as Shanon -Weiner, Eveness were computed to understand the biotic community of each study site. Shanon –Weiner diversity (Shannon and Wiener, 1949) index helps in species relative abundance, evenness index is used for the degree to which the abundances are equal among the species present in a sample.
RESULTS
Samples Collected
A total of 7243 individuals of entamofauna representing 43 genera categorized under 332 families and 9 orders were collected from the upstream and downstream of the Sothuparai Reservoir. The aquatic entamofauna of upper stream constituted 43 genera, 32 families and 9 orders, while in downstream it was recorded as 35 genera, 27 families and 9 orders. The abundance of entamofauna at Sothuparai Reservoir was recorded maximum in upper stream and minimum (2518) in downstream (Figure 2)
Composition of insect taxa in sothuparai Reservoir
Figure 3 depicts the species diversity and percentage composition of various insect orders collected from the Sothuparai Reservoir. The highest numbers of taxa were in the order Ephemeroptera, while the Hemipterans had the highest number. Hemiptera showed the highest numerical abundance (36.73%) of the total insect fauna. It was represented by 8 families Viz., Hydrometridae, Belastomidae, Gerridae, Ranatridae, Notonectidae, Nepidae, Naucoridae and Corixidae. The diversity of the Aquatic entamofauna in upper stream is higher than in downstream. The evenness was high in upperstream whereas it was lower in down stream. In both the upper and downstream the evenness was so high during the month of July whereas it was low in December.
Out of the eight families Gerridae was the dominant family both in the upper stream and downstream of the Reservoir. This was followed by Hydrometridae, Notonectidae, Nepidae, Ranatridae, Belastomidae, Corixidae and Naucoridae.
DISCUSSION
Ephemeroptera
The Ephemeroptera is one of the intolerant group of insects which are consider as an indicator of water quality because of its presence in both the polluted and unpolluted reaches of the aquatic body.Thalerosphyrus belonging to the Heptagindae family was found to be abundant in upstream and absent in downstream. However, it appears to be intolerant to pollution (Abhijna et al., 2012). Tim, 1997; Menetrey et al., 2008 and Abhijna et al., 2012 reported that the genera Baetis species were tolerant top organic pollution. Arimoros and Muller (2010) stated that the overall composition and density of Ephemeroptera depends on the physico chemical and biological factors of the environment. The present study documents the Ephemeroptera taxa richness and diversity remain at a relatively high in the upper stream but reduced drastically in downstream of the reservoir.
Plecoptera Fore et al., (1996) stated that the order Plecoptera is highly sensitive to environmental degradation. In our present study the presences of stone flies were high in upper stream and very low in downstream. It was represented by only one genus Perlidae.
Trichoptera They were contributed by 6 genera Hydropsychidae, Lepidostomatidae, Helicopsychidae, Calamoceratidae,
Pilopotamidae and Psychomyidae. The numerical abundance of caddis flies was equal in both the streams of the reservoir. Sivaramakrishnan, et al (2000) concluded that Trichoptera as the most popular order of aquatic insects in the streams of Western Ghats in terms of the total abundance but it was contrary to our present findings of Sothuparai Reservoir in the Southern foot hills of Western Ghats.
Odonata
Odonata contributes 19 % of the total fauna. Libelluidae, Gomphidae and Euphaeidae were the families belonging to Odonata. The nymphs of this family remain attached to macrophytes. Crocothemis was the species of the Libelluidae, the naid of which is mud dwelling. 16 genera in Western Ghats have been collected by Subramanian and Sivaramakrishnan, (2005).
Diptera
The composition of dipterans in the Sothupari Reservoir was 4.76 % of the insect fauna. Tipulidae and simulidae are the families which belong to the order Diptera. Courtney, (2009) studied that dipteran species can be considered aquatic and they require a moist to wet environment within the tissues of living plants, decaying organic materials as parasites or in association with bodies of water.
Orthoptera , Megaoptera and Coleoptera
Orthoptera and Megaloptera were least in number of the total insect fauna recorded in Sothuparai Reservoir. Coleopterans were 5. 27 % of the insect communities in the Reservoir. It was represented by 6 genera categorized under 4 families. Dineutus was high in number abundance in upper stream, where as in downstream Gyrinus species was high and both of them belongs to Gyrinidae family. The major family of aquatic Coleoptera was Gyrinidae, Hydrophyllidae, Psephenidae and Noteridae. Khan and Gosh, 2001 observed that the Hydrophylidae family was water scavenger beetles and they were present in shallower regions of wetland. The emergent ones of Hydrophylide feed mainly on detritus, Algae and decaying vegetative matter. Nagendran, (2004) reported 7 families in selected streams in the three states of Southern Western Ghats.
Diversity and Evenness
Diversity of aquatic entamofauna was high during June and it was low in May whereas, in downstream the diversity was high in June and low in November (Figure 4). This is in par with Dinakaran and Anbalagan (2007) and Kalayarsi (2008).
The present study reveals that the evenness value was recorded high in downstream (0.96) and in upperstream it was slightly low (0.94) indicating relatively more or less even distribution of species in the reservoir (Figure 5).
Water Quality Parameters The water quality parameters of the Reservoir were within the Permissible Limit as described APHA, (2005) (Table 1) (Sumitha and Rupali, 2013).
EPT Taxa Richness
The percentage of EPT index indicates the richness in upper stream and 25.80 % in downstream and this is in par with the results observed by Abijna et al., (2012) and Wahizatul et al., (2013). Thus the results indicated a better water quality was recorded in upper streams compared with the downstream of the Reservoir.
Anthropogenic activities might change the normal development of these fragile ecosystems especially at downstream of the Reservoir. This may be because of the several human activities such as recreation; agricultural activities and this in turn affect the diversity of aquatic insect communities. The present study clearly documents that the composition of the aquatic insect communities is moulded by their different levels of sensitivity to pollution in accordance with the abiotic factors in the stream ecosystem.
CONCLUSION
The physico chemical parameters and the aquatic insect communities together indicated the natural and manmade influences. Thus the study states that the biomonitoring of the Reservoir using benthic macro invertebrates in running water is the effective tool for the better management of the Sothuparai Reservoir.
ACKNOWLEDGEMENT
Authors express their deep sense of gratitude to University Grants Commission and Jayaraj Annapackiam College for Women (Autonomous), Periyakulam for providing the fund and the laboratory facilities. 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=554http://ijcrr.com/article_html.php?did=5541. Abhijna, U G, Ratheesh, R, Bijukumar A, 2013. Distribution and Diversity of aquatic insects of Vellayani Lake in Kerala. Journal of Environmental Biology, 34: 605-611.
2. Arimoro, F O, W J, Muller., 2010: May Fly (Insecta: Ephemeroptera) Community structure as an indicator of the ecological status of a stream in the Niger Delta area of Nigeria. Environmental Monitoring assess, 166: 581-594.
3. APHA: Standard Methods of Examination of Water and Waste water.21st Edn. APHA, AWWA And WPCF publications, Washington Dc, USA.
4. Arienzo, M, Adamo, P, Bianco, M, Violanta, P, 2001. Impact of land use and urban runoff on the contamination of the Sarno river Baasin in Southern Italy. Water, Air, Soil Pollution. 131- 349, 366.
5. Armiatge, P D, Moss, D, Wright, J F, Fruse, M T, 1983. The performance of a new biological water quality score system based on macroinvertebrattes over a wide range of unpolluted running water sites. Water Research, 17: 333-347.
6. Azrina, M Z, Yap, C K, Rahim Ismail, A, Ismail, A , Tan, S G, 2005. Anthropogenic impacts on the distribution and biodiversity of benthic macroinvertebrates and water quality of the Langat River, Peninsular Malaysia, Ecotoxicology and Environmental Safety, 16: 184-210.
7. Balchandran, C, Chandan, M D S, Ramachandran, T V, 2011. Distribution and Biology of the Western Ghats, Sahyadri eNews, 35.
8. Carter, J L, Resh V H, 2001: After site selection and before data analysis sampling, sorting and laboratory procedures used in stream using benthic macroinvertebrates monitoring programme by USA. J.N. Am. Benthol. Soc., 20: 658 -682.
9. Compin, A, Cereghino, R, 2003. Sensitivity of aquatic insect species Richness to disturbance in the Adour – Garonne stream system (France). Ecological Indicators. 2: 345- 360.
10. Courtney, G W, Pape, T J, SkeVington, H, Sindair, B J, 2009. Biodiversity of Diptera. In: Insect Biodiversity: Science and Society. (Edn: R. Footit and P. Adler) I1t Edn: Blackwell Publishing LTd, Oxford, UK. 185- 222.
11. Daly, H V, 1996. General classified key to the orders of aquatic and semi aquatic insects In: An introduction to the aquatic insects of North America (Eds. Merrit R.W.and Cummins, K.W) Kendall Hunt, Iowa, USA. 101-112.
12. Dudgeon, D, 1999. In tropical Asian streams – Zoorenthos, Ecology and Consolation, Hong Kong University Press, Hong Kong. 828.
13. Fore, L S, Karr, J R, Wisseman, RW, 1996. Assessing invertebrate response to human activities: evaluating alternative approaches. Journal of North America Benthol. Soc., 15: 212-231.
14. Kumar, A, 2001. (Ed.), Ecology of Polluteed waters, Vol.I and II. Ashish Publishing House, New Delhi. 1233.
15. Menetrey, N, Oertli, B, Sartori, M, Wagner, A, Lacha, J.B, 2008.Vanne: Eutrophication: Are May flies (Ephemeropteera) good bioindicators for ponds. Hydrobiolgia, 579:123-135.
16. Merrit, R W, and Cummins, K W, 1988. An Introduction to the aquatic insects of North America (2nd Edn.) Kendall. Hunt Publication Company, Dubuque, Iowa: 722.
17. Nagendran, N A, 2007. Stream Characteristics and biomonitoring of Perumal Patha Odai, Karanthamalai, TamilNadu. Ecol. Env and Cons.13 (1): 57—62.
18. New, T R, 1984. Insect Conservation Dr. W. Junk Publishers, Dordrecht, Netherlands.188-198.
19. Ramachandra, T V, Chandran , M D S, Bhat, H R, Dudani, S, Rao, G R, Boominathan, M, Mukri, V, Bharath S, 2010. Biodiversity, Ecology and socio economic aspects of Gundia river basin in the context of proposed mega hydroelectric power project, CES Technical Report -122, Centre for Ecological Sciences, Indian Institute of Science, Bangalore
. 20. Shannon, C E, Weiner, W, 1949. The Mathematical theory of communication. University of Illinosis press, Urbana: 117.
21. Subramanian, K A, 2003. Stream insect communities of Western Ghats and their bioindicators potentials (Thesis submitted to Madurai Kamarj University, Tamil Nadu)
22. Subramanian, K A, Sivaramakrishnan, K G, 2007. Aquatic insects of India: A field guide.
23. Ashoka Trust for Research in Ecology and Environment (AITREE), Bangalore.
24. Susmita Gupta, Rupail Narzary, 2013. Aquatic Insect community of lake, Phulbari Anua in Cachar, Assam. Journal of Environmental Biology, 34: 591-597.
25. Timm, H, 1997: Ephemeroptera and Plecoptera larvae as environmental indicators in running waters of Estonia.
26. Trivedy, R K and Goel, P K, 1985.(Eds). Current Pollution Researches in India. Environmedia. Karad, M.P: 344.
27. Wahizatul, A A , Luna, S H, Ahamed, A, 2011. Composition and distribution of aquatic insect communities in relation to water quality in two freshwater streams of Hulu Terengganu, Terengganu. Journal of Sustainability Science and Management, 6, (1).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30General SciencesCAFFEINE EXTRACTION AND CHARACTERIZATION
English1619Pradeep S.English G. N. RameshaiahEnglish Hadagali AshokaEnglishCaffeineextracted and characterised from tea (black) leaves and coffee beans. Isolation was done by liquid-liquid extraction using di-chloromethane as an extracting agent. This extraction was done in four steps: steeping, evaporation, liquid-liquid extraction and recrystallization. The recrystallization was done using anhydrous sodium sulphate.The technique used for purity analysis and characterisation were: High performance liquid chromatography, Differential scanning calorimeter, Fourier transform infrared spectroscopyand Melting point. First, the analysis was done using melting point analysis. The melting point of caffeine
extracted from coffee beans and tea leaves was found to be 238°C. The absorption bands were compared with that available in literature and were found to be similar. Further, the purity check was done using High performance liquid chromatography method.Effective characterization of caffeine was achieved by determining Infrared spectrum, and employing a melting point apparatus and differential scanning calorimeter. The purity showed that the results that the extracted coffee was 90% pure. Further improvements in extraction efficiency will increase the yield and minimize wastage.
EnglishCaffeine, Methyl xanthine, Theophylline, Differential scanning calorimeter, Fourier transform infrared spectroscopy, High performance liquid chromatographyINTRODUCTION
Caffeine is a psychoactive CNS stimulant drug discovered by German chemist Friedrich Ferdinand Runge in 1819. He coined the term ‘Kaffein’ which became Caffeine5 .Caffeine is a methyl xanthine along with theophylline and theobromine.It is a natural pesticide.Caffeine does not counteract the effects of alcohol. Caffeine is a xanthine alkaloid compound that acts as a stimulant in humans. It is a central nervous stimulant, having the effect of temporarily warding off drowsiness and restoring alertness.2 Every time we drink tea, coffee, cocoa, chocolate or cola we are giving our body a “hit” of caffeine. Along with nicotine and alcohol, caffeine is one of the three most widely used mood – affecting drugs in the world5 .
OBJECTIVES
To extract caffeine from tea leaves and coffee beans by liquid-liquid extraction method.
To characterize the obtained caffeine by melting point, Infrared spectroscopy and Differential scanning calorimetermethod.
To develop an easily adaptable method for the qualitative or purity analysis of caffeine
PHYSICAL AND CHEMICAL PROPERTIES
Caffeine is sparingly soluble in most polar solvents but is highly soluble in less polar solvents. The melting point is 234°C-239°C and the chemical formula is C8 H10N4 O2 .It is an intensely bitter, white powder in its pure state. Caffeine is an alkaloid of the methylxanthine family, which also includes the similar compounds theophylline and theobromine2 .The structure of caffeine is
ADMET OF CAFFEINE
Absorption and Distribution
Caffeine is absorbed orally with a max blood peak after 120 mins spreading quickly in all tissues.Caffeine is classified as a stimulant because it increases the activity of cardiovascular, digestive and sympathetic nervous system, and produces the sense of alertness in the brain. It can have a lethal effect ( acute intoxication) when ingested at amounts of 1-5 g, with plasma concentrations higher than 80mg/ml and the first intoxication signs appear at about 250mg4 .
Metabolism and Elimination
Hepatic metabolism becomes longer and more difficult in presence of alcohol and medical drugs while cigarette smoke accelerates its hepatic metabolism.Only 10% is eliminated through the kidney as unmodified caffeine4 .
Caffeine intoxication
The symptoms include restlessness, nervousness, and excitement, insomnia, flushing of the face, increased urination, gastro-intestinal disturbance, muscle twitching, and psychomotor agitation.The treatment is based on serum levels of caffeine which may be followed by peritoneal dialysis, hemodialysis, or hemo filtration. Caffeine stimulates acid production in the stomach so it is better not to drink coffee in case of gastric ulcer4
EXTRACTION OF CAFFEINE
Steeping procedure is used.The solvent used is dichloromethane.Purification methods like distillation and recrystallization are also followed.The success of extraction involving a natural product is often expressed as percentage recovery
The percentage recovery is called the purified percent recoveryor crude percent recovery. The extraction with the highest percent recovery is considered the most successful extraction5 .
MATERIALS REQUIRED
5g of tea leaves, 10g coffee beans, 4g of calcium carbonate, 2g sodium carbonate, 25ml methylene chloride, anhydrous sodium sulphate, Whatmann no.1 filter paper,15ml of dichloromethane,50ml and 500ml of Erlenmeyer flask, separating funnels, MilliQwater,etc.
CHARACTERIZATION OF CAFFEINE
Based on various physical methods.
1. Determination of melting point
2. Infrared spectroscopy
3. Degradation by Differential scanning calorimeter
4. Purity check by High performance liquid chromatography
RESULTS
Extraction of caffeine from tea and coffee was achieved by using chloroform as an extracting solvent
DISCUSSION
It was observed that the extraction efficiency of caffeine from various sources by using chloroform was much higher than other solvents. Table 2 shows the extraction efficiency of crude caffeine from tea and coffee leaves. The amount of caffeine obtained from L- L extraction after further recrystallization was found to be 3.37% from tea and 5.04% from coffee.We observed that coffee contained a high percentage of crude caffeine as compared to tea. To purify the crude caffeine, similar procedures were utilized. However, the caffeine content of various sources varies with soil conditions and climate. Table 3-6 shows the characteristics of caffeine in various parameters for both sample and standard respectively. Also 2-5 shows the result of caffeine samples being measured respectively. The pure white crystalline caffeine isolated from sources was found to melt at 238o C. The Infrared-spectrum of isolated caffeine showed similar absorption bands similar to that given in literature. The Infrared-spectrum indicates the absolute purity of the purified caffeine.
We have developed a High performance liquid chromatography method for the determination of caffeine, which was carried by High Performance Liquid Chromatography instead of using UV- Visible spectrophotometer. We chose High performance liquid chromatography method for the determination of caffeine, because High performance liquid chromatography is the most widely used qualitative and quantitative determination and separation method. This method is popular because it is non-destructive and unlike gas chromatography may be applied to thermally liable compounds. Moreover it is also a very sensitive technique as it incorporates a wide range of detection methods. With the use of post column derivatization methods to improve selectivity and detection limits, High performance liquid chromatography can easily be extended to trace determination of compounds that do not usually provide adequate detector response. The wide applicability of High performance liquid chromatography as a separation method makes it a valuable separation tool in many scientific fields. By using this method, we determined the retention time and the relative peak area of extracted purified caffeine. The retention time of the purified caffeine and that of the standard caffeine were almost similar, which confirmed the identity of caffeine. The amount of extracted purified caffeine for different samples was determined by studying the relative peak area on the calibration curve.
CONCLUSION
A method has been developed for the extraction, purification of caffeine from tea and coffee. Caffeine from tea and coffee was extracted by liquid- liquid extraction followed by recrystallization. The purified caffeine was then analysed by High performance liquid chromatography. Effective characterization of caffeine was achieved by determining IR spectrum, and employing a melting point apparatus and differential scanning calorimeter. The serious concern about potential use of caffeine for pathogenic effects has made it one of the most broadly studied drugs. It provides clinicians with the information they require in order to understand, diagnose and treat the effects of caffeine consumption in their patients.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. Authors are also grateful to authors, editors and 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=555http://ijcrr.com/article_html.php?did=5551. Barone, J.J., Roberts, H.R. (1996) Caffeine Consumption , Food Chemistry and Toxicology, McGraw-Hill, Newyork,34, 119
2. Arnaud, M. J. (1987) The Pharmacology of Caffeine, Prog Drug, 31, 273.
3. S. Mathkar, S. Kumar, , A. Bystol, K. Olawoore, D. Min, R. Markovich, A. Rustum: The use of differential scanning calorimetry for the purity verification of pharmaceutical reference standards,Journal of Pharmaceutical and Biomedical Analysis, Volume 49, Issue 3, 5 April 2009, Pages 627–631.
4. H. T. Debas, M. M. Cohen, I. B. Holubitsky, and R. C.Harrison. Caffeine-Stimulated Acid and Pepsin Secretion: Dose-Response Studies, Scandinavian Journal of Gastroenterology, August 1971, Vol. 6, No.
5 , Pages 453-457. 5. Md. Abdul Mumin, Kazi Farida Akhter, Md. Zainal Abedin, Md. Zakir Hossain: Determination and Characterization of Caffeine in Tea, Coffee and Soft Drinks by Solid Phase Extraction and High Performance LiquidChromatography, Malaysian Journal of Chemistry, 2006, Vol. 8, No. 1, 045 – 051.
6. Islam, M. S, Rahman, M. M., Abedin, M.Z. (2002) Isolation of caffeine from commercially available available tea and tea waste, Jahangirnagar Uni. J. Sci.,25,9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareTHREE DIMENSIONAL EVALUATION OF CONDYLAR HEAD INCLINATION WITH RESPECT TO RAMUS AMONG POST PUBERTAL CLASS II PATTERNS
English2027Abhilasha GoyalEnglish R. H. KambleEnglish Sunita ShrivastavEnglish Narendra SharmaEnglishObjective: To assess the condylar head inclination with respect to ramus in Angle’s Class II division 1 and division 2 skeletal patterns using Digital Volume Tomography.
Material and method: The sample consisted of 45 post pubertal patients who were divided on the basis of clinical and cephalometric analysis into three groups - skeletal Class I, Class II division 1 and Class II division 2. The selected cases underwent Digital Volume Tomography and the images obtained were used to assess condylar head inclination, mediolateral and anteroposterior thickness of the condylar head on right and left sides for all the three groups. ANOVA, Least significance difference and Paired student’s t test were done.
Results: The Class II division 2 group showed significantly more anteriorly angulated condyles as compared to those of Class II division 1 and Class I groups on both right and left sides. Class II division 1 group showed significantly smaller mediolateral dimension as compared to Class I and Class II division 2 groups. The anteroposterior dimension was not significantly different in all three groups studied.
Conclusion: There exists a variation in the condylar morphology in the various skeletal malocclusions examined. The individuals with Class II division 2 malocclusion had a tendency towards having more anteriorly angulated condyles. Also the mediolateral dimension of condylar head of individuals with Class II division 1 malocclusion is smaller than Class II division 2 and Class I malocclusions.
EnglishCondyle, Class II malocclusion, DVTINTRODUCTION
In dentofacial orthopaedics, thorough knowledge of the skeletal and dental components that contribute to a particular malocclusion is essential as these may influence the approach to treatment. Form and function are considered to be closely linked, also it follows that the morphology of the temporomandibular joint (TMJ) might be related to functional forces. The role of mandibular growth has specially intrigued practitioners due to its variability and relative unpredictability. There are several factors that could affect the TMJ morphology and position, such as age, sex, facial growth pattern, pathological or functional alterations, decreased or increased muscular activity, and dental occlusion changes.1-4 As a result of these changes, there is a remodelling and reconfiguration of the TMJ surfaces as an adaptation response.5 However, the amount of this remodelling will depend on the mechanical and functional conditions to which adjacent structures are faced.4, 5 Studies evaluating maxillary and mandibular skeletal and dental positions and vertical components of Class II patients have reported conflicting results. Most of the studies selected Class II patients on a dental basis, but patients with a dental Class II malocclusion may have a Class I or a Class II skeletal pattern.6 Few studies evaluated patients with both skeletal and dental Class II malocclusion.7-9 The only exceptions are the studies by Gianelly et al10, who studied the position of condyle in the fossae in Class II patients with deep-bite and no overjet, and the study by Ricketts, 11-12 in which the Class II group were studied. He stated that those with skeletal Class II division 2 malocclusions, when compared with normal Class I or Class II division 1 subjects have larger masticatory muscles that are oriented in a more anterior direction. It shows that TMJ loading in patients with skeletal Class II division 2 patterns differs from those having other dentofacial morphologies. It has been claimed that Class II division 2 malocclusions do not exhibit a distinct skeletofacial pattern, and, with the exception of the maxillary central incisor position, there is no other difference in morphology when compared with Class II division 1 subjects. This view, however, has been challenged by others who claim that Class II division 2 malocclusion is a distinct dentoskeletal entity.13 As the mandible and the TMJ can be loaded differently in persons with varied dentofacial morphologies, one could hypothesize that the condyle might differ between people with various malocclusions. There is no doubt that scarce information exists on the morphologic assessment of the dentofacial complex and the factors that may or may not contribute to its growth. Three-dimensional high resolution imaging allows the quantification of facial bone tissues in approximately real dimensions (1:1 ratio) without significant magnification, distortion or superimposition providing clear visualization of the areas of interest and opening new perspectives for analyzing these joints with any difficulty. The purpose of this study was to determine the relationship between condylar characteristics measured using preorthodontic three dimensional reconstructions of post pubertal Class II patients and their skeletal malocclusions.
MATERIALS AND METHOD
Sample selection
Forty five patients, ranging in age from 18 to 40 years, were selected from the outdoor patients Department of Orthodontics, Sharad Pawar Dental College and students of Datta Meghe Institute of Medical Sciences (DU), Sawangi (M), and Wardha. The selected patients were divided into three groups based on clinical and cephalometric examination as Group 1- Skeletal Class I, Group 2- Skeletal Class II division 1 and Group 3- Skeletal Class II division 2 comprising of 15 patients each. The cephalometric criteria used for dividing the sample into Skeletal Class I and Skeletal Class II are described in Table 1.
Radiographic analysis
The lateral cephalograms were taken by a Planmeca proline cc (Finland) machine. Tracings were digitized and analyzed using Vistadent software. The selected cases, after cephalometric evaluation, were subjected to Digital Volumetric Tomography. The samples were scanned using Phillips Allura Xper FD20 3D RA, Digital Subtraction Angiography unit (Netherlands) with exposure parameters of 80 kVp, 10 Ma and 4-5 sec with Field of View- 12” 270? rotation. The images were obtained with the patients in maximum dental intercuspation and the head positioned so that the Frankfort horizontal plane was perpendicular to the floor. Three dimensional (3D) images, as well as, multiplanar reconstruction (MPR) images were obtained using 3D RA software at computer work station, which were then evaluated using Intruis Suite R2 software.
For each sample a total of 3 measurements (for right and left side each) were calculated:
1. Condylar head inclination with respect to ramus This measurement was completed according to the format described by Sug-Joon Ahn et al 14 (F ig.1)
2. Mediolateral thickness of condylar head Measured as the largest mediolateral dimension. (Fig.2a)
3. Anteroposterior thickness of condylar head Measured as the largest anteroposterior dimension. (Fig.2b)
Statistical analysis
Descriptive statistics for all variables were studied. Group differences were tested with one-way ANOVA and Multiple Comparison Least Significant Difference test. Paired Student t-test was used for each measurement to evaluate the average of differences between the sides for each element of the sample of all the groups.
RESULTS
Statistical description of the condylar head inclination and dimensions of condyle according to skeletal pattern are given in Table 2 and 3. With respect to the condylar head inclination (for both right and left sides) One Way Anova test revealed statistically significant values (p value=0.001*) between the groups and within the groups. Significant findings were obtained when Group 1 was compared to Group 2 and Group 3 (p value=0.001). Also, when Group 2 was compared to Group 3 the values were statistically significant with (p value=0.001).
For the thickness of condyle mediolaterally, for both right and left sides, it was observed that there is statistically significant difference when comparing Group 1 to Group 2(p value=0.01) and Group 2 to Group 3(p value=0.01). No statistically significant difference was found when comparing Group 1 to Group 3(p value=0.09). A statistically non significant difference was identified regarding the anteroposterior thickness of the condyle when the three groups were compared. A paired Student’s t test showed no statistical difference between right and left sides for all the variables. (Table 4)
DISCUSSION
Understanding the TMJ morphology in the Class I and Class II groups remains a challenge for orthodontists. In literature it has been stated that the condyle and the fossa might differ in shape and their interrelations among people with various malocclusions while the mandible and the temporomandibular joint can be loaded differently in persons with diverse dentofacial morphologies. The difficult visualization of the TMJ (due to its complex anatomy and the superimposition of adjacent structures) might be a factor responsible for the discrepancies in the results of different studies concerning this joint. Nowadays other methods are used for evaluating 3-dimensional morphology of the skeletal structures of TMJ such as cone beam computed tomography (CBCT), multi slice computed tomography (MSCT) and Digital Volume Tomography (DVT). All of these provides an optimal imaging of the osseous components of the TMJ and gives a full size truly volumetric 3D description in real anatomical (1:1) size. The evidence of its accuracy was evaluated by Anuraag B. Choudhary et al15 who assessed the diagnostic quality of images generated using the then newly developed digital volume tomography (DVT) system and comparing them with conventional images obtained from patients with maxillofacial trauma. The results and statistical analysis clearly indicated that the diagnosis of maxillofacial traumatic injuries involving the midface and mandibular condylar region (condylar head) is significantly enhanced using Digital Volume Tomography compared with conventional radiographs. Condylar head inclination with respect to ramus in all three groups on right and left sides, were evaluated. The Class II division 2 group showed significantly more anteriorly angulated condyles as compared to those of Class II division 1 and Class I groups on both right and left sides (Fig 3). This shows altered glenoid fossa relationship in the experimental group. The Class II division 1 group had increased anterior condylar angulation as compared to Class I group but less as compared to Class II division 2 groups. Findings of this study can be explained by the research done by Gail Burke et al1 who evaluated the correlation between the skeletal growth pattern and condyle glenoid fossa relation using preorthodontic lateral cephalograms and tomograms of 136 preadolescent Class II patients. He stated that patients with vertical facial morphologic characteristics displayed posteriorly angled condyles whereas anteriorly angled condyles were significantly correlated to the patients with a horizontal facial morphology. Similar findings were obtained by Elias G. Katsavrias16 who studied the shapes of the condyle and the glenoid fossa in patients with Class II division 1, Class II division 2, and Class III malocclusions. Axially corrected tomograms of 189 patients were used (109 Class II division 1, 47 Class II division 2, and 33 Class III). The Class III group had a more elongated and anteriorly inclined condylar head with a wider and shallow fossa. In the present study the Class II division 2 group consisted of predominantly horizontal growers while the Class II division 1 group consisted of a mixed sample of vertical and horizontal growers. This explains the increased angulation in the Class II division 1 group than the Class I group. Also the methodology used in the previous studies was different from the one used in this study. Although no significant difference was found between the right and left sides for condylar head inclination, the mean value obtained for the right side in all three groups were greater than that of the left side. This asymmetry may be attributed to side preferences during mastication. To the best of our knowledge to date, no study has been conducted to study the condylar head inclination with respect to ramus in skeletal Class II division 1 and Class II division 2 cases. The previous studies only concentrated on the association of growth pattern in Class II cases with the condylar head inclination. The correlation obtained between condylar head inclination and facial morphology is consistent with results previously reported in early literature. Posterior inclination of the condyles has been shown to dominate the individuals with the Classic long face syndrome, and anterior inclination of the condylar head can be associated with counter-clockwise mandibular rotators.17 It has also been reported in the literature that reduced condylar growth represents clockwise rotation of the mandible in relation to the cranial base.18 Proliferation of condylar cartilage and endochondral ossification of the condyle occurs via a complex of biomechanical interactions. The magnitude, direction and duration of the resultant condylar growth may be influenced by genetic determinants as well as intrinsic and extrinsic control factors.
Animal studies have shown that mandibular protrusive appliances can result in increased chondrocytic proliferation and subsequent osseous development of the condyle in a posterior and posterosuperior direction.19-22 the magnitude of the temporomandibular joint’s adaptability and subsequent alteration will also be dependent upon maturational age, adaptive potential and neuromuscular function.1 The dimension of the condyle showed statistically significant results for mediolateral dimension of the condyle. On comparison of Class II division 1 showed significant values when compared with Class I and Class II division 2 whereas the values were not significant when Class I and Class II division 2 were compared. Overall, the mean for Class II division 2 was greater than that on Class I and Class II division 1 respectively for both mediolateral and anteroposterior dimensions of the condyle (Fig 4). Krisjane et al23 studied the TMJ parameters in Class II and Class III patients using volumetric three dimensional imaging and they concluded that there were no statistically significant differences in the anteroposterior width of the condyle in both the groups. These findings are in favour of the present study. We found a statistically significant difference in the mediolateral dimension of the condyle; the values being least for Class II division 1and greatest for Class II division 2 samples. This variation may be attributed to the mixed sample present in the Class II division 1 group (horizontal and vertical growers). However no significant difference was found when Class I and Class II division 2 group were compared. The axial view is most appropriate to assess the symmetry between the condyles in the anteroposterior and mediolateral aspects because it shows both condyles in the same image. This also permits measuring the real dimensions of the condyles. The dimensions of the condyle showed no statistically significant differences between the right and left sides. These findings of symmetry are supported by various studies present in the literature. Cohlmia et al24 assessed the temporomandibular joint in Class I, Class II division 1, Class II division 2 and Class III patients and found that the anteroposterior thickness of the condylar head was not significantly different between the right and left sides in the sample studied. Vitral et al25 and Rodrigues et al26 using the same methodology, found similar results in a Class II division 1 subdivision and Class I sample , respectively. Also the results of study by Rodrigues et al26 on a sample of Class II division 1 and Class II malocclusion support the findings of the present study. These results seem to confirm the statement of Ben-Bassat et al27 that the occlusal features might be associated with TMJ structure remodelling to create symmetrical relationships. Contrasting results were shown in the study done by Vitral et al28 on subjects with normal occlusion. He found statistically significant difference in the linear measurement of the mediolateral diameter of the condylar process between the right and left sides.
CONCLUSIONS
The individuals with Class II division 2 malocclusion had a tendency towards having more anteriorly angulated condyles as compared to individuals with Class II division 1 and Class I malocclusions. Individuals with Class II division 1 malocclusion showed significantly smaller mediolateral dimension as compared to Class I and Class II division 2 individuals. The anteroposterior dimension was not significantly different in the three groups examined.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. Authors are also grateful to the authors / editors / publishers of all those articles, journals and books from where the literature has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=556http://ijcrr.com/article_html.php?did=5561. Gail Burke, Paul Major, Kenneth Glover and Narasimha Prasad. Correlations between condylar characteristics and facial morphology in Class II adolescent patients. Am J Ortho Dentofac Orthop. 1998; 114 (3): 328-336.
2. Ishibashi H, Takenoshita Y, Ishibashi K, Oka M. Age-related changes in the Human mandibular condyle: a morphologic, radiologic and histologic Study. J Oral Maxillofac Surg. 1995; 53(9):1016–23.
3. Yale SH, Allison BD, Hauptfuehrer JD. An epidemiological assessment of mandibular condyle morphology. Oral Surg Oral Med Oral Pathol. 1966; 21(2): 169–77. 4. Kurusu A, Horiuchi M, Soma K. Relationship between occlusal force and mandibular condyle morphology. Angle Orthod. 2009; 79(6):1063–9.
5. Arnett GW, Milam SB, Gottesman L. Progressive mandibular retrusion idiopathic condylar resorption-Part II .Am J Orthod Dentofacial Orthop. 1996; 110(2):117– 27.
6. M. Ozgar Say?n, Hakan Turkkahramana. Cephalometric Evaluation of Nongrowing Females with Skeletal and Dental Class II, division 1 Malocclusion. Angle Orthod. 2005; 75:656–660
.7. Hunter WS. The vertical dimensions of the face and skeletodental retrognathism. Am J Orthod. 1967; 53:586–595.
8. Bacon W, Eiller V, Hildwein M, Dubois G. The cranial base in subjects with dental and skeletal Class II. Eur J Orthod. 1992; 14:224–228.
9. Ishii N, Deguchi T, Hunt NP. Craniofacial morphology of Japanese girls with Class II division 1 malocclusion. J Orthod. 2001; 28:211–215.
10. Gianelly AA, Petras JC, Boffa J. Condylar position and Class II deep-bite, no-overjet malocclusions. Am J Orthod Dentofacial Orthop. 1989; 96:428-32.
11. Ricketts RM. Variations of the temporomandibular joint as revealed by cephalometric laminagraphy. Am J Orthod. 1950; 36: 877-98.
12. Ricketts RM. Tomographic research studies of the temporomandibular joint and occlusion. In: Provocations and perceptions in craniofacial orthopaedics. Dental science and facial art. Denver: Rocky Mountain Orthodontics; 1989. p. 901-46.
13. Elias G. Katsavrias. Morphology of the temporomandibular joint in subjects with Class II division 2 malocclusions. Am J Orthod Dentofac Orthop. 2006; 129:470-8.
14. Sug-Joon Ahn,Tae-Woo Kim, Dong-Yul Lee, and Dong-Seok Nahm. Evaluation of internal derangement of temporomandibular joint by panoramic radiographs compared with panoramic resonance imaging. Am J Orthod Dentofacial Orthop.2006; 129:479-85
15. Anuraag B. Choudhary , Mukta B. Motwani , Shirish S. Degwekar , Rahul R. Bhowate , Panjaj J. Banode , Abhilasha O. Yadav and Aarti Panchbhai. Utility of Digital Volume Tomography in Maxillofacial trauma. Journal of Oral and Maxillofacial Surgery. 2011 June; 69 (6):135-140.
16. Elias G. Katsavrias, Demetrios J. Halazonetis. Condyle and fossa shape in Class II and Class III skeletal patterns: A morphometric tomographic study. Am J Ortho Dentofac Orthop. 2005; 128:337-46.
17. Bjork A, Skieller V. Facial development and tooth eruption: An implant study at the age of puberty. Am J Orthod. 1972; 62:339-83.
18. Bjork A, Skieller V. Normal and abnormal growth of the mandible: A synthesis of longitudinal cephalometric implant studies over a period of 25 years. Eur J Orthod. 1983;5: 1-46,
19. Stockli PW, Willert HG. Tissue reactions in the temporomandibular joint resulting from anterior displacement of the mandible in the monkey. Am J Orthod .1971; 60:142- 55.
20. McNamara JA Jr. Neuromuscular and skeletal adaptations to altered function in the orofacial region. Am J Orthod .1973; 64:578-606?
21. McNamara JA Jr, Hinton RJ, Hoffman DL. Histologic analysis of temporomandibular joint adaptation to protrusive function in young adult rhesus monkeys (Macaca mulatta). Am J Orthod. 1982; 82:288-98.
22. McNamara JA Jr, Bryan FA. Long-term mandibular adaptations to protrusive function: an experimental study in Macaca mulatta. Am J Orthod. 1987; 92:98-108.
23. Zane Krisjane, Ilga Urtane, Gaida Krumina, Katrina Zepa. Three-dimensional evaluation of TMJ parameters in Class II and Class III patients. Stomatologija, Baltic Dental and Maxillofacial Journal. 2009, Vol. 11, No. 1.
24. Jeff Cohimia, Joydeep Ghosh, Pramod K. Sinha, Ram S. Nanda and G. Frans Currier. Tomographic assessment of temporomandibular joint in patient with malocclusion. Angle Orthod. 1996; 66(1): 27-36.
25. Robert Willer Farinazzo Vitral, Carlos de Souzza Telles. Computed tomographic evaluation of TMJ alteration in patients with Class II division 1 subdivision malocclusion: condylar symmetry. Am J Ortho Dentofac Orthop. 2002 April; 121: 396-375.
26. Andreia Fialho Rodrigues, Marcelo Reis Fraga and Robert Willer Farinazzo Vitral. Computed tomography evaluation of the temporomandibular joint in Class I malocclusion patients: Condylar symmetry and condyle-fossa relationship. Am J Orthod Dentofacial Orthop. 2009;136:192-8
27. Ben-Bassat Y, Yaffe A, Brin I, Freeman J, Ehrlich Y. Functional and morphological-occlusal aspects in children treated for unilateral posterior cross-bite. Eur J Orthod 1993; 15: 57-63.
28. Robert Willer Farinazzo Vitral, Marcio Jose da Silva Campos, Andreia Fialho Rodrigues and Marcelo Reis Fragac. Temporomandibular joint and normal occlusion: Is there anything singular about it? A computed tomographic evaluation. Am J Orthod Dentofacial Orthop. 2011; 140:18-24.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareSTUDY OF SACRUM AND ITS IMPORTANCE IN EPIDURAL BLOCK
English2832P. SasikalaEnglish Arunkumar S. BilodiEnglishAim of study: The objective of study is on sacrum for sacral hiatus due to its importance in epidural anesthesia.Place of study: This study was done in the department of anatomy at Velammal medical college hospital and research institute,Madurai, India.Period of study: This study was done during the month of February 2015.Materials and methods: 30 dry unknown human sacra from department of anatomy constituted the materials for the present study. Their dimensions were measured and sacral index were calculated for each sacrum. Shape, composition of sacrum, shape of sacral hiatus, level of sacral hiatus and curvature of the sacrum were noted down.
Conclusion: Anatomical knowledge of sacral hiatus will be of great help in administering caudal analgesia through sacral hiatus.
EnglishSacral hiatus, Epidural block, Equilateral triangleINTRODUCTION
Sacrum is a triangular bone having fusion of 5 sacral vertebrae. Normally, there is inverted U shaped gap in the posterior wall sacral canal called sacral hiatus. This sacral hiatus is due to failure of fusion of 5th sacral laminae that meet in median plane [1]. Vinod Kumar and Pandey S.N studies showed maximum sacral composition of 5 segments amounting to 69.8%. The sacral hiatus shows discrepancies in sizes and shapes [2]. Therefore Anatomy of sacral hiatus has said to increase the reliability and success of caudal epidural block [3]. Hiatus is covered by the skin, subcutaneous fatty layer and saccrococygeal membrane [4]. It has been reported that failure of caudal epidural block is due to absence of hiatus seen in 7.7% [5].
MATERIALS AND METHODS
In the present study thirty human dry unknown sacrum of unknown sex were studied. Their length, breadth were measured and sacral index were calculated. Observations were made on sacral hiatus on their shapes and length. Observation was done on dorsal aspect of sacrum. Any irregularities of bones, shapes of hiatus, level of the apex and base of the sacral hiatus were analyzed. Depth of hiatus was also noted. Length of sacral hiatus was measured. Angulation of maximum curvature measured.
Observation and results
Table 7: Location of base of sacral hiatus
Other observations are
From the above table it is observed that the incidence of base of sacral hiatus at the level of S5 is 82.76% and at the level of coccyx is 10.34%.
Other observations are
1. In 3 sacra, length and breadth are equal
. 2. In 4 Sacra, breadth is longer than the length.
3. 5 Sacra are more curved and long - probably female sacra.
4. 1 sacrum shows lumbosacralization.
5. 1 sacrum shows complete ossification of right sacroiliac joint.
6. 1 sacrum is longest with 12cm distance from base to apex.
DiscussionCaudal epidural block is a procedure used in surgeries of anorectal and perineal in labour and also in lower limbs regions. So it is important to know the anatomy around sacral hiatus so as to carry out procedures without any hindrance [6]. Anupriya et al studies have shown maximum incidences of sacral hiatus of inverted V and U shaped 35.85 % and 26.42% [3]. It is very important to know the apex of sacral hiatus for the safety of the dura. In the studies of Anupriya et al, apex is found most commonly at the level of S4 (68.67%), 21.57% at the level of S5, S3 in 39.8 % [3]. From the present study, it is observed that location of apex of sacral hiatus is present at the level of S4 in 72.41% and least percentage is seen in 6.90% at S3 level. The position of base of sacral hiatus is also important. Position has varied from S4 to coccyx. In Anupriya et al studies it is S5 seen in 62.26%. It was lowest location of coccyx in their studies 24.53%, while in Nagar studies it was 72.6% [7], in Anjali studies it was 61.40% [8]. Present studies has shown base of sacral index in 82.76% at S5 level while in at level of coccyx it is found in 10.34%. Regarding maximum curvatures, Anupriya et al studies showed maximum curvatures of 53 dry sacrum. 40 sacrum showed maximum curvatures at the level of S3 in 75.47%, 12 bones at S4 foramen level in 22.64%, only one bone showed S5 level in 1.9% [3]. While in Anjali et al level of S3 in 80% of cases [8]. In the present study maximum curvatures were seen in 5 sacra (16.67%) at S3 and two sacra showed moderate curvatures (6.67%). Caudal Epidural Injections have proved more success, effective with less dose of local anesthesia and less vascular puncture by the practitioners [9, 10]. To manage low back pain, injections of corticostertoids by epidural route have been accepted as non surgical way of treatment [11]. Yoon JS et al have reported abnormality of the sacral hiatus makes canulation difficult and sometimes impossible in 5-10% of cases [12]. It is by guidance of ultra sound, anatomical details of the sacral hiatus, bilateral sacral cornua, apex of the sacral hiatus, anterior and posterior walls of the sacral canal and sacrococcygeal ligament can be detected clearly [13, 14, 15]. Since sacrum is a component of axial bone and pelvic girdle it is the most important bone for the identification of sex. It is sacral index that helps in determining the sex of sacra [16]. In the present study mean sacral index is 102.5 and the mean width of sacrum is 9.7. There are different shapes and sizes of sacral hiatus. There may be absence of sacral hiatus due to fusion of laminae in the midline or failure of fusion causing incomplete bony dorsal wall of sacral canal [17]. The various shapes of sacral hiatus in India were studied by Kumar et al. (1992).They were Inverted V, inverted U, dumbbell, irregular, bifid, absent, and other shapes. It was inverted V shape which was very commonly found [18]. In the present study sacral hiatus are U shaped 53.34%, V shaped 36.6%, Irregular 3.34%, cornua fused 6.67%. X-Rays of lumbosacral spine will be of useful in identifying the absence of sacral hiatus, shapes of sacral hiatus and level of SH apex and base [19]. Importance of sacral hiatus Sacral Hiatus is very important part of sacrum which has anatomical variations. Less than 3 mm depth of sacral hiatus causes difficulty in the insertion of the needle. Its different shapes, surrounding bony irregularities and defects in dorsal sacral canal should be studied in order to avoid failure of epidural block. Hence detailed knowledge of sacral hiatus is essential. (Agarwal et al) [20]. It is the genetic and racial factors that cause incidences of variations [21]. X Rays of lumbosacral spine will be of useful in identifying the absence of sacral hiatus, various shapes of sacral hiatus and levels of base and apex of sacral hiatus [19]. In the surgeries done by orthopedic surgeons caudal epidural block is used both as diagnostic and therapeutic tool. Failure rate is 35% is mainly due to variations of sacral hiatus and surrounding structures [22]. The incidence of variations may be due to genetic and racial factors. Exact location of sacral hiatus in caudal epidural block determines its success rate. The variabilities provided in this study should be kept in mind before giving Caudal Epidural Block. Further clinical trials are required to compare the existing techniques and our anatomical description to provide more data to support the results of this study.
CONCLUSION
The study on sacral hiatus gives us information of sacral hiatus regarding its patency and suitable for epidural block. If it is blocked, then epidural block cannot be carried out. So this study gives knowledge of sacral hiatus about its shape, extent etc especially for anesthetists, surgeons and gynecologists (spinal analgesia).
Carry home message
Anatomical knowledge of sacral hiatus has brought accomplishment of caudal epidural block.
ACKNOWLEDGEMENT
Authors thank colleagues from Department of Anatomy for their invaluable guidance and contribution of outstanding ideas. Authors would also thank authors of reference articles which are quoted in this article.
Englishhttp://ijcrr.com/abstract.php?article_id=557http://ijcrr.com/article_html.php?did=5571. Gray, Henry, 1825-1861; Williams, Peter L (Peter Llewellyn); Bannister, Lawrence H. 38th ed. / chairman of the editorial board, Peter L. Williams; editorial board, Lawrence H. Bannister ... [et al.]. New York : Churchill Livingstone, 1995. NLM ID: 9503696 [Book]
2. Kumar V, Pandey SN, Bajpai RN, Jain PN, Longia GS. Morphometric study of sacral hiatus. J Anat Soc India. 1992;41:7–13.
3. Anupriya A, Sophia MM. Anatomical study of sacral hiatus in south Indian population and its clinical significance in caudal epidural anesthesia. NJCA. 2014; 3(3): 128-136.
4. Sekiguchi M, Yabuki S, Satoh K, Kikuchi S. An anatomic study of the sacral hiatus: a basis for successful caudal epidural block. Clin J Pain. 2004 Jan-Feb;20(1):51-4. PubMed PMID: 14668657.
5. BLACK MG. Anatomic reasons for caudal anesthesia failure. Curr Res Anesth Analg. 1949 Jan-Feb;28(1):33-9. PubMed PMID: 18105828.
6. Brown DL. Atlas of Regional Anesthesia: Elsevier Health Sciences; 2010.
7. Nagar SK. Shah Medical College, Jamnagar, Gujarat: A study of sacral hiatus in dry human sacra. J Anat Soc India. 2004;53:18–21
. 8. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2009 Dec;31(10):793-800. doi: 10.1007/s00276-009-0529-4. Epub 2009 Jul 4. PubMed PMID: 19578805.
9. Marhofer P, Schrögendorfer K, Koinig H, Kapral S, Weinstabl C, Mayer N. Ultrasonographic guidance improves sensory block and onset time of three-in-one blocks. Anesth Analg. 1997 Oct;85(4):854-7. PubMed PMID: 9322469.
10. Marhofer P, Schrögendorfer K, Wallner T, Koinig H, Mayer N, Kapral S. Ultrasonographic guidance reduces the amount of local anesthetic for 3-in-1 blocks. Reg Anesth Pain Med. 1998 Nov-Dec;23(6):584-8. PubMed PMID: 9840855.
11. Abdi S, Datta S, Trescot AM, Schultz DM, Adlaka R, Atluri SL, Smith HS, Manchikanti L. Epidural steroids in the management of chronic spinal pain: a systematic review. Pain Physician. 2007 Jan;10(1):185-212. Review. PubMed PMID: 17256030.
12. Yoon JS, Sim KH, Kim SJ, Kim WS, Koh SB, Kim BJ. The feasibility of color Doppler ultrasonography for caudal epidural steroid injection. Pain. 2005 Nov;118(1-2):210-4. Epub 2005 Oct 4. PubMed PMID: 16213088.
13. Blanchais A, Le Goff B, Guillot P, Berthelot JM, Glemarec J, Maugars Y. Feasibility and safety of ultrasound-guided caudal epidural glucocorticoid injections. Joint Bone Spine. 2010 Oct;77(5):440-4. doi: 10.1016/j.jbspin.2010.04.016. Epub 2010 Sep 24. PubMed PMID: 20869897.
14. Chen CP, Wong AM, Hsu CC, Tsai WC, Chang CN, Lin SC, Huang YC, Chang CH, Tang SF. Ultrasound as a screening tool for proceeding with caudal epidural injections. Arch Phys Med Rehabil. 2010 Mar;91(3):358-63. doi: 10.1016/j. apmr.2009.11.019. PubMed PMID: 20298824.
15. Najman IE, Frederico TN, Segurado AV, Kimachi PP. Caudal epidural anesthesia: an anesthetic technique exclusive for pediatric use? Is it possible to use it in adults? What is the role of the ultrasound in this context? Rev Bras Anestesiol. 2011 Jan-Feb;61(1):95-109. doi: 10.1016/S0034- 7094(11)70011-3. Review. PubMed PMID: 21334512.
16. Hardlika A. Practical anthropometry. Philadelphia: Winster Institute; 1939. Quoted by Krogman 1962
. 17. Letterman GS, Trotter M. Variations of the male sacrum: Their significance in caudal analgesia. Surg Gynecol Obstet. 1944;78:551–5.
18. El-Monem AH, Neven MG. A morphological study of the sacral hiatus. Zagazig University Medical Journal (ZUMJ) 2006;12:2877–86.
19. Mustafa MS, Mahmoud OM, El Raouf HH, Atef HM. Morphometric study of sacral hiatus in adult human Egyptian sacra: Their significance in caudal epidural anesthesia. Saudi J Anaesth. 2012 Oct-Dec;6(4):350-7. doi: 10.4103/1658-354X.105862. PubMed PMID: 23493625; PubMed Central PMCID: PMC3591553.
20. Aggarwal A, Aggarwal A, Harjeet, Sahni D. Morphometry of sacral hiatus and its clinical relevance in caudal epidural block. Surg Radiol Anat. 2009 Dec;31(10):793-800. doi: 10.1007/s00276-009-0529-4. Epub 2009 Jul 4. PubMed PMID: 19578805.
21. Chhabra N. An Anatomical Study of Size and Position of Sacral Hiatus; Its Importance in Caudal Epidural Block.. IJHSR. 2014; 4(12): 189-196. 22. Mayuri J, Vijay G, Vasudha N, Anita G, Asha P. Anatomical Study Of Sacral Hiatus In Dry Isolated Sacra. J Res Med Den Sci. 2014; 2(2): 43-46. doi:10.5455/jrmds.20142210
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareSPINAL ANAESTHESIA IN DOWN'S SYNDROME- A CASE REPORT
English3335V. BhavaniEnglish Deepak PauloseEnglishPatients with Down's syndrome presents with unique set of problems while taking up for surgeries. Anaesthesiologists should have a clear knowledge of pathophysiology and potential problems that can happen intraoperatively and should be equipped to tackle these problems.
EnglishChromosomal abnormality, Spinal anaesthesia, Syndrome involves, BreathlessnessINTRODUCTION
Down's syndrome is the commonest chromosomal abnormality with the incidence of 1/800live births. (1). As this syndrome involves all the major systems it poses great challenges to Anaesthesiologist when anaesthetising such patients.
CASE REPORT
35year old female with Down’s syndrome presented with strangulated epigastric hernia for emergency laparotomy. On examination she had a swelling in the epigastric region associated with pain and vomiting. Her last oral intake was four hours back. She had mild mental retardation but was cooperative. Her weight was 55 kg height 145 cms ( BMI-26). History of snoring was present. There was no history of neck pain, breathlessness, recurrent respiratory infection or cyanotic spells. On inspection she was short statured, obese with a short neck. There was mild midfacial hypoplasia and macroglossia with laxity of fingers and elbow joints. Her Mallampatti grade was 2 with normal interincisor and thyromental distances. There was no pallor. On auscultation heart sounds and lung fields were normal. Her blood investigations and ECG were within normal limits. Echocardiography revealed good systolic function. Ultrasound examination of abdomen showed omentum inside the hernia sac. In view of the full stomach, short neck, obese macroglossia and laxity of joints it was decided to do the surgery under spinal anaesthesia. She was taken up under American society of Anaesthesiologists class IIE. Approval was obtained from the caregiver after explaining the anaesthetic technique. She was preloaded with warm Ringer lactate 750 ml and premedicated with ranitidine 50 mg i.v, metaclopromide 10 mg i.v and glycopyrrolate 0.2 mg i.v. Her ECG, pulse oximetry, and blood pressure were monitored. She was cooperative but was unable to comprehend that she had to lie still for administering spinal anaesthetic. So midazolam 1.5 mg i.v was given to keep her calm. Spinal anaesthesia was administered in right lateral position using 25G Quincke’s needle with 2ml 0.5% hyperbaric bupivacaine and fentanyl 25 micrograms(2) as additive. After administering spinal anaesthesia she was placed in supine position. A sensory level of T4 was achieved.(3) Oxygen was supplemented using facemask at 5l/min. Intraoperatively she had two episodes of hypotension which were treated with Inj. Mephentermine 5mg iv. Omentectomy and anatomical closure of epigastric hernia repair was done. Procedure lasted for one hour and she tolerated the surgery well. Patient was shifted to postoperative ward where she was continuously monitored. Her postoperative period was uneventful. She was given Injection Tramadol 50 mg intramuscular 8th hourly for her postoperative pain.
DISCUSSION
Skillful Anaesthetic management is mandatory in patients with Down’s syndrome for better postoperative results. In our case we decided to proceed with spinal anaesthesia because of , full stomach, short neck, obese macroglossia and laxity of joints and she was hemodynamically stable. .Although our patient did not exhibit signs of Atlanto occipital instability such as brisk deep tendon reflexes or ankle clonus presence of laxity of upper limb joints might be a predisposing factor for Atlanto occipital Instability. (1) The risk of general versus regional was considered in our patient and finally regional was decided because of the above said reasons. Meticulous dose titration was done and dose was calculated based on height of the patient 0.06 mg/cm height(2)(3) . Our patient height being145 cm, the dose of bupivacaine calculated was 8.7mg and it was approximated to 10mg(2ml).The total volume used was 2.5ml (2ml bupivacaine with 25 micrograms of fentany
CONCLUSION
Although not many cases are reported in literature spinal anaesthesia can still be considered as a option in selected cases of Down’s syndrome because of the multisystem involvement. As these patient exhibit an array of problems, we should deliver a safe anesthetic technique. Meticulous planning in preparing the patient, and selecting the patient, discussion of risks and technical problems extra watchfulness during intraoperative and postoperative care should be undertaken. In future many such cases will pose great challenges to anaesthesiologists as the maternal age of conception is increasing.
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
Englishhttp://ijcrr.com/abstract.php?article_id=558http://ijcrr.com/article_html.php?did=5581. Bhattarai, B., Kulkarni, A. H., Rao, S. T., and Mairpadi, A. (2008). Anesthetic consideration in downs syndrome-a review, 10(3), 199–203.
2. Lee, Y., Balki, M., Parkes, R.,and Carvalho, J. C. A. (n.d.). Dose Requirement of Intrathecal Bupivacaine for Cesarean Delivery Is Similar in Obese and Normal Weight Women, 679–683.
3. Tanvir Samra and Sujata Sharma Estimation of the dose of hyperbaric bupivacaine for spinal anaesthesia for emergency caesarean section in an achondroplaIndian J Anaesth. 2010 Sep-Oct; 54(5): 481–482.
4. Hubert J. Schmitt MD Erlangen, Germany Spinal anesthesia in a patient with Down’s syndrome C J A 638-639
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareAWARENESS AND ASSSESSMENT OF ORAL HYGEINE AND PERIODONTAL STATUS AMONG THE CONSTRUCTION WORKERS IN A J HOSPITAL CAMPUS, MANGALORE
English3643Bipina P.English Manjushree KadamEnglish Nasila MohammedEnglish Anjali JainEnglishBackground: The health of construction workers goes ignored because of their stressful working conditions, busy schedules and poor economic conditions. The need for dental care should be emphasized among these workers. Limited literature on their attitude towards oral health, their awareness, habits and behavior among these construction workers incited us to assess the preventive oral health care awareness and oral hygiene practices among the construction workers in A.J hospital, campus, Mangalore.
Materials and methods: Total of 136 systemically healthy construction workers were selected for the study. A questionnaire was administered by examiner. The study proforma consisted of demographic data and data related to oral hygiene habits and practices. Oral Hygiene Index-Simplified and Community Periodontal Index and Treatment Needs indices were used to record oral hygiene status and periodontal status respectively. Chi-square test was used to determine the association between the variables. P value < 0.05 were selected to denote statistical significance.
Results: Majority of the workers brushed once daily and had adverse habits, poor oral hygiene status and periodontitis associated with bleeding gums and halitosis. Most of the workers had a dental visit only in problem.
Conclusion: The community should be provided with dental health education by giving more importance in oral hygiene maintenance, habit counseling and regular dental visits.
EnglishDental awareness, Oral hygiene status, Periodontal status, Construction workersINTRODUCTION
It is a truism to say that what man is and to what disease he may fall victim depends on a combination of two sets of factors-his genetic factors and the environmental factors to which he is exposed.1 Oral health is an integral part of general health and plays an important role in improving the quality of life. The oral cavity is the port of entry for many diseases and presents several unique features that make it especially prone to occupational diseases. Ramazzini, “the father of industrial hygiene”, was the first to advocate the inclusion of the patient’s occupation in medical history and to point out a number of oral symptoms.2 Industrial workers constitute well-defined population groups, although building and construction industry is recognized as the unorganized sector with vast labor intensity and economic activity after agriculture in India. In some surveys, it was observed that some risk factors for oral diseases in workers are age, educational level, smoking habits and general health status.3 According to World Health report 2003, the prevalence of periodontitis is 86% in India. Periodontal diseases are the major dental problems which affect people worldwide as well as the Indians.4 Periodontium is widely affected by dental plaque; a diverse microbial community which is found on the tooth surface, which is embedded in a matrix of polymers of bacterial and salivary origin.5 If not removed by mechanical methods, the plaque gets mineralized to form calculus, which in turn, initiates the inflammatory process of the periodontium. This results in tooth loss and mobility. The role of the personal risk factors such as a poor life style and negative psychosocial conditions, have been said to play an important role in the etiology of adult periodontitis.6 It is also generally considered to result from an imbalance between the potentially pathogenic microbes and the nature and the efficacy of the local and systemic host responses.7 The extent and the severity of periodontal disease was shown to be different in different age groups.8 The workers are also involved in smoking, chewing tobacco and drinking habits, which predispose to oral diseases, particularly those which are related to the gums.9 Oral health behavior and seeking oral health care depends upon a number of factors. Patients comply better with oral health care regimens when informed and positively reinforced. The motives prompting workers to seek preventive dental care include the beliefs that one is susceptible to dental disease that dental problems are serious, and that dental treatment is beneficial.10Owing to the paucity of literature among this vulnerable populationthe propositions of this study were to assess the dental awareness, oral hygiene and periodontal status among the construction workers in A.J Hospital Campus.
MATERIALS AND METHODS
A cross sectional study was conducted among 136 construction workers, working at A.J Hospital Campus to evaluate the awareness of oral hygiene and to assess their oral hygiene status and periodontal status.Concerned approval was obtained from Institution Ethical Committee. Subjects who gave informed consent were included for study.Mouth mirror, WHO probe and illuminated light source were used for examination. Clinical Examination was conducted by a calibrated examiner.
Inclusion criteria
Systemically healthy individuals
Presence of more than 15 teeth.
Exclusion criteria
Patients with a history of systemic diseases
Pregnancy and lactation
Undergone oral prophylaxis in last 6 months.
A questionnaire was administered by the examiner. The study proforma consisted of demographic data and data related to oral hygiene habits and practices. Oral Hygiene Index-Simplified and Community Periodontal Index and Treatment Needs indices was used to record oral hygiene status and periodontal status respectively. The data was compiled, tabulated and subjected to statistical analysis using the SPSS package (version 17). Chi-square test was used to determine the association between the variables. P value < 0.05 were selected to denote statistical significance.
RESULTS
Out of 136 subjects (91 males and 45 females) with mean age 34.28 all the subjects cleaned their teeth using tooth brush and paste. The sociodemographic characteristics are shown in table 1. 47.07% workers used smokeless form of tobacco. On evaluating the dental awareness it was revealed that 72.05% people brushed once daily and their oral hygiene status was found to be poor. This was found to be statistically significant (Graph 1, Graph 2). 38.23% people were using medium bristle brush and 43.38% workers used tooth brush more than 6 months period. Frequency of changing brush and oral hygiene status and periodontal status was statistically significant (Graph 3, Graph 4). None of the workers used any other interdental oral hygiene aids. 61% workers cleaned there tongue and this relation was found to be statistically significant (Graph 5, 6). 72% workers noticed bleeding from gums and 80.8% were aware that that have halitosis, this was found to be statistically significant when compared to oral hygiene and periodontal status (Graph 7,8 and 9).55.8% workers visited dentist only in problem. Assessment of periodontal status revealed 70.58% workers had periodontitis. Comparison of different parameters with Oral Hygiene Index-Simplified and Community Periodontal Index and Treatment Needsis given in table 2 and 3 respectively.
DISCUSSION
Periodontaldiseases are triggered by a disruption of a balance between the host resistance and the factors which provoke the disease.In the study it was found than males workers constituted more than females and majority of workers were between the age group of 30- 35years. Smokeless tobacco (47.07%) constituted the highest among the habits observed among construction workers. The tobacco consumption in the study was lesser than those which were reported by Knutsson11 and Nilsson12 and Ansari13 et al. but it was greater than that which was reported by Mou et al. The present study demonstrated that the prevalence of tobacco usage increased subsequently in the old age group as compared to that in younger age group.64.7% of the workers with adverse habits showed periodontitis. Cross-sectional studies have consistently shown the higher prevalence, extent, and severity of various periodontal disease outcomes in smokers than in non-smokers14,15. It has been further noted that the prevention of smoking should thus be a very important goal in any health education program, if one desires to maintain optimum oral health.
A lack of knowledge on good oral hygiene practices, lack of motivation and lack of regular health checkup, poor lifestyle may be the reasons for poor oral hygiene status. In this study 79.41% workers had poor oral hygiene. It was found that people who brushed once daily had poor oral hygieneand had periodontitis. Similar results were observed in other studies by Skaleric, Kovac –KavicMandGulie EE, Albander JM. The role of the dental plaque, as the principal etiological factor in the development of periodontal diseases, has been shown by Loe and coworkers 16,17 in the 1960s and as the level of the oral hygiene is directly related to the amount of plaque build-up on the teeth, it is reasonable to predict that the level of oral hygiene in a population is positively correlated with the prevalence and severity of the periodontal disease. 42% of the study subjects required periodontal therapy which included scaling root planning and surgical procedures. Periodontal treatment needs increased with age in the study which is as similar to that reported by study in Finland. 64.7% of the workers with adverse habits showed periodontitis. Dental visit is still not considered a positive dental behavior at present, it depends only on treatment needs. So these group people fail to make prophylactic visits to dentist thus giving them poor dental health behavior
CONCLUSION
The findings of this study provide an insight of oral health and periodontal status of construction workers. A comprehensive understanding of the extent of the public health problem would enable an effective planning of intervention measures. A health promotion program is highly desirable in this study population which addresses the need of importance of maintaining oral hygiene, habit counselingand regular visits to a dentist.
ACKNOWLEDGEMENTS
Authors acknowledge immense help received from the scholars whose articles are cited and included in references of this manuscript. 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=559http://ijcrr.com/article_html.php?did=5591. Park K. Park’s textbook of preventive and social medicine. 20th ed, (2009)BanarsidasBhanot, Jabalpur,12-48,708-723.
2. Schour I, Sarnat BG. Oral manifestations ofoccupational origin. J Am Med Assoc1942;120: 1197-1207.
3. Dini EL, Guimar es LO. Periodontal conditions and treatment needs(CPITN) in a worker population in Araraquara, SP, Brasil. Int Dent J 1994;44(4):309-11.
4. Shah N. Oral and dental diseases: Causes, Prevention and treatment strategies. NCMH Background papers-Burden of Disease in India. 2007;275-98
5. Marsh PD. Microbial Ecology of Dental Plaque and its Significance in Health and Disease. Adv Dent Res. 1994;8:263- 71.
6. Dharmashree S, Chandu GN, Pusphanjali K, Jayashree SH, Shafiulla MD. Periodontal status of industrial workers in Davangere City, Karnataka – a descriptive cross sectional study. J Indian Assoc Public Health Dent. 2006;7:20-24.
7. Sood M. A Study of Epidemiological Factors Influencing Periodontal Diseases in selected Areas of District Ludhiana, Punjab. Indian J Community Med. 2005;30:70-71.
8. Agarwal V, Khatri M, Singh G, Gupta G, Marya CM, Kumar V. Prevalence of periodontal diseases in India. J Oral Health Comm Dent 2010;4:7-16.
9. Yoshida Y, Ogawa Y, Imaki M, Nakamura T, Tanada S. Lifestyles and Periodontal Disease of Japanese Factory Workers. Environ Health Prev Med 1997;1:188-92.
10. Rajala M. Occurrence of tooth loss, dental caries and need of operative dental treatment in an industrial population. Kuopio: Publications of the University of Koupio. Community Health. Series Original Reports 2/1977.103.
11. Knutsson A, Nilsson T. Tobacco use and exposure to environmental tobacco smoke in relation to certain work characteristics. Scand J Soc Med 1998;26(3):183-89.
12. Ansari ZA, Bano SN, Zulkifle M. Prevalence of tobacco use among power loom workers - a cross-sectional study. Indian J Community Med 2010;35(1):34-39.
13. Mou J, Fellmeth G, Griffiths S, Dawes M, Cheng J. Tobacco Smoking Among Migrant Factory Workers in Shenzhen, China. Nicotine TobRes2012 Apr 6. [Epub ahead of print].
14. Axelsson P, Paulander J, Lindhe J. Relationship between smoking and dental status in 35-, 50-, 65-, and 75-year old individuals. J ClinPeriodontol. 1998;25:297-305.
15. Bergstr.m J, Eliasson S, Dock J. Exposure to tobacco smoking and periodontal Loe H, Theilade E, Jensen SB. Experimental gingivitis in man. J ClinPeriodontol. 1965;36:177- 87.
16. Silness J, Loe H. Periodontal disease in pregnancy. Correlation between oral hygiene and periodontal condition. ActaOdontolScand1964;22:121-35
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareEVALUATION AND COMPARISON OF VARIOUS PRESCRIPTION SPECIFICATIONS AND SLOT DISTORTION OF PRE-ADJUSTED EDGEWISE BRACKETS MANUFACTURED BY DIFFERENT COMPANIES AVAILABLE IN INDIA
English4451Eshan AwasthiEnglish Narendra SharmaEnglish Sunita ShrivastavEnglish R.H. KambleEnglishObjective: To assess and evaluate the tip, torque, slot size and slot distortion of maxillary central incisor, maxillary lateral incisor and maxillary canine brackets from commercially available bracket systems (Agile Mini Brackets- 3M series, Mini series- American Orthodontics, Mini Gem series- Dento Smile, Fine Series Brackets - Galaxy Orthodontics, Centrino Mini brackets- Libral trader, Orthox Organizers) in the 0.022-inch dimension.
Material and method: The sample consisted of three brackets each (maxillary central incisor, lateral incisor and canine) of all the companies the tip, torque and slot dimension of which were measured in the 0.022-inch dimension. Images were obtained using stereomicroscope and measurements were taken after operator calibration using AU|TOCAD software 2012, and a digital readout was produced.
Results: Results indicated that none of the companies showed exact values of tip and torque however 3M Agile Mini series showed values nearest to normal whereas Orthox Organizers showed most inaccurate values. For slot dimension American Orthodontics Mini series showed most accurate values whereas Orthox Organizers showed most inaccurate values. All the companies showed oversized slot except Dento Smile Mini Gem series which showed undersized slot. Slot distortion was found maximum in Orthox Organizer and least in American Orthodontics Mini series.
Conclusion: Inaccuracy in slot dimension, inbuilt tip and torque of the pre-adjusted brackets can affect the final position of teeth in the arch with an added need of wire bending to achieve desired results.
EnglishTip, Torque, Slot size, Slot distortionEnglishhttp://ijcrr.com/abstract.php?article_id=560http://ijcrr.com/article_html.php?did=5601. Thickett E, Taylor NG, Hodge T. Choosing a pre-adjusted orthodontic appliance prescription for anterior teeth. J Orthod 2007; 34:95-100.
2. Andrews LF. Straight Wire, the Concept and Appliance. San Diego: L. A. Wells; 1989.
3. Peck S. Orthodontic slot size: it’s time to retool. Angle Orthod. 2001; 71:329–330.
4. Rubin R. A plea for agreement. Angle Orthod. 2001; 71:156.
5. M. E. Hixson, W. A. Brantley, J. J. Pincsak, and J. P. Conover, “Changes in bracket slot tolerance following recycling of direct-bond metallic orthodontic appliances,” The American Journal of Orthodontics, vol. 81, no. 6, pp. 447–454, 1982.
6. Raghuraj. M.B. et al. Evaluation of efficacy of the MBT appliance in expressing inbuilt tip and torque values: using torque angulation device. J. Orthod Research; 2013:135- 141.
7. Meiling. T.R. et al. The effect of second order couple on the application of torque. Am J Orthod Dentofac Orthop 1998; 113:256-62.
8. Aditya. G. et al. Slot .022” MBT bracket torque accuracy (Evaluation of scanning electron microscopy- Research Article). Cited – 2013.
9. Kusy.R.P. Assessement of second-order clearances between orthodontic archwires and brackets slots via the critical contact angle for binding. Angle Orthod 1999; 69(1):71-80.
10. A.C Cash et al An Evaluation of Slot Size in Orthodontic Brackets—Are Standards as Expected? Angle Orthod 2004;74:450–453
11. Flores. D.A. et al. Deformation of metal brackets: a comparative study. Angle Orthod 1994; 64(4):283-290.
12. Kapur. et al. Comparision of load transmission and bracket deformation between titanium and stainless steel brackets. Am J Orthod Dentofac Orthop1999; 116:275-8
13. Lacoursiere. R.A. et al. Measurement of orthodontic bracket tie wing elastic and plastic deformation by arch wire torque expression utilizing an optical image correlation technique. J Dent Biomech 2010:1-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareFINE NEEDLE ASPIRATION CYTOLOGY VERSES CORE NEEDLE BIOPSY IN BREAST LESIONS - A COMPARATIVE STUDY
English5260Siddavatam SupriyaEnglish C. NirmalaEnglish Lakshmi S. A. R. RaghupathiEnglishBackground and Objectives: Fine needle aspiration cytology (FNAC) is a part of triple assessment in evaluation of breast lesions in our country. In the western countries, core needle biopsy (CNB) is fast replacing FNAC as part of screening programmes and early detection of cancer. This study was undertaken to know the advantages, limitations of each procedure and their diagnostic utility in patients in and around Bangalore.
Methodology: 50 female patients presenting with breast lesion were subjected to both FNAC and CNB. Grades were assigned as C1-C5 for FNAC and B1-B5 for CNB. Statistical analysis was done using kappa correlation score and the concordance rate between the two procedures was determined.
Results: The most common age group was between 21-40 years and left sided lesions were more common. Out of 50 cases, there was concordance between FNAC and CNB in 38 cases and 12 cases were discordant. Kappa score of agreement was 0.559 indicating a moderate degree of concordance between the two tests.
Conclusion: Both FNAC and CNB are equally good in assessment of breast lesions. However, FNAC is more suitable in the developing counties, for palpable lesions due to better turnaround time and it is cost effective. Whenever there is discrepancy between clinical findings, imaging studies and FNAC, CNB can be used as the next step in assessment before definitive treatment. Also, it can be used in cases of low grade malignancies, where it is difficult to give a diagnosis of malignancy on FNAC alone.
EnglishFine needle aspiration cytology (FNAC), Core needle biopsy(CNB), Breast lesionsINTRODUCTION
The breast is one of the common sites of cancer, mostly in women. It is also a common site for different types of benign lesions, like benign tumors, and inflammatory processes. FNAC has been used since a long time for this purpose, along with clinical examination and mammography. It is popular because of its accuracy, cost effectiveness, and ease of use1 . However, it has certain limitations like inability to differentiate between invasive and in situ carcinomas, insufficient samples and false negative results2 . Core Needle Biopsy has recently gained popularity, especially in the evaluation of non-palpable breast lesions3 . It has the advantages of lower inadequacy rates, allowing of ancillary methods, grading and typing of cancer2 . However, it is more time-consuming and expensive2 . The present study was taken up to compare and analyze the advantages and limitations of FNAC and CNB in patients in preoperative assessment and in diagnosing breast lesions.
MATERIALS AND METHODS
A prospective study was done, patients presenting with a breast lesion to Department of Pathology, Victoria and Bowring and Lady Curzon Hospitals during the period of November 2013 to October 2014.All the patients were subjected to both FNAC and CNB.
Procedure of FNAC
The breast lump is palpated and fixed between 2 fingers. After observing aseptic conditions, a 22-24 gauge disposable sterile needle with 10ml disposable syringe was used to enter the swelling and multiple passes were given. Smears were made, air dried and wet fixed, stained with Giemsa stain and Haematoxylin and Eosin stains. The samples were categorized from C1 to C5. [Table 1]
Procedure of core needle biopsy
Following xylocaine test dose the area to be biopsied was cleaned and depending on the case, 2 to 4 ml of 2% xylocaine was injected into the swelling and the overlying skin for local anaesthesia. After 5-8 minutes, the sterile automated 18 gauge core biopsy gun with a 20mm throw is introduced into the breast and keeping the direction of the gun away from the chest wall, it was released so that a core of tissue of breast nodule is taken into the gun. The device is removed and the core transferred to a container having 10% formalin solution. For each patient, 2 to 3 cores are taken. The biopsies are fixed in 10% formalin 8-12hrs and processed routine histopathology. Sections taken at 3 to 4 micron thickness, and stained with Hematoxylin and Eosin stains. The biopsy slides were categorized from B1 to B5. Statistical analysis was performed using med-calc and open epi software and results were tabulated. [Table 2]
RESULT
In our study, 10% cases were in C1 category,(fig 1) (inadequate/unsatisfactory aspirate) on CNB showed 3 cases in B1 category (fig 2) (normal tissue) and 2 cases in B2(benign) category. C2 category (fig 3) (benign) composed of maximum number of cases, that correlated well with B2 category (fig 4)with few cases in B1, B3,(fig 6) and 1 malignant lesion on biopsy was also diagnosed as C2 on cytology. This was a case of DCIS on biopsy cohesiveness of tumor cells and minimal pleomorphism was seen, it was misplaced in C2 category. [Table 3] 3 cases of inflammatory breast lesions were diagnosed on FNAC as well as CNB, these were Breast Abscess, Fat necrosis and Granulomatous mastitis. One case in our study belonged to C3 category(fig 5) (atypia probably benign) due to cellularity and nuclear pleomorphism which was categorized as B2 on CNB. 2 cases were categorized as C4 (fig 7)(suspicious of malignancy) due to discohesive cells and minimal pleomorphism was diagnosed as malignant lobular carcinomas on CNB. 14 cases were diagnosed in C5 category(fig 8) (malignant), out of which 10 cases were diagnosed malignant on CNB. 4 cases were in B1, B2 and B3 category, misdiagnosed due to absence of malignant tissue in the core biopsy which can be attributed to the sampling error. As all our cases underwent biopsy without guidance the malignancy was missed on CNB this error could be reduced by radiological guidance. Cytology showed more sensitivity in the diagnosis of malignancy than CNB in our study. In a study by Chuo et al, the 68 cases diagnosed as C5 category all proved to be malignant on CNB and were classified under B5 category4 (fig 9 and 10).This could be attributed to usage of guided biopsy wherever necessary.
DISCUSSION
Both FNAC and CNB are useful in the preoperative assessment of breast lesions, in both palpable and nonpalpable lesions, with or without radiological guidance. Both procedures have their own advantages and limitations, when judiciously used can complement each other and increase the pre-operative diagnostic accuracy considerably. While there is widespread preference for CNB in most developed countries, FNA is still valuable initial procedure for evaluating palpable breast lesions5 . FNAC is a well accepted procedure in developing countries due to its low cost, safe and affordable with rapid results5 , pain is minimal and no further care is needed6 . FNAC requires an excellent aspirator to obtain satisfactory material and breast cytopathologic expertise in interpreting breast aspirates. The narrow gauge needle used in FNAC can be directed into different areas of the lesion and the tissue is sampled in more than one plane. It is said that FNAC sees 10 times more tissue than CNB, due to the multiple passes, also because all the aspirated material can be studied at once and hence incidence of missing the diagnosis due to sampling error is less compared to CNB. FNAC selectively samples tumor cells in sclerotic tumors. FNAC is an excellent method of obtaining cells for microarray transcriptional profiling studies. Core biopsy was introduced in the late 1990s in the assessment process of screen-detected abnormalities of breast, and later was followed in symptomatic breast clinics as well7 . The various devices available include 14 to 18 gauge core biopsy guns which can be done with or without image guidance by either ultrasound or mammography8 . The gauge of needle used for CNB is also important, 14 gauge needle offers more tissue and hence better sensitivity and specificity9 .
Core biopsies are done under local anesthesia with or without a skin incision. The biopsy gun has a spring mechanism. The trocar is present inside, which is thrust forward approximately 2cm, depending on the gun and at almost same time, the cutting cannula present outside is thrust over the inner trocar filling the inside notch with the breast tissue specimen8 . The CNB procedure is expensive due to the higher cost of the biopsy gun. The biopsy guns are available as disposable guns and guns with disposable needles. The biopsy procedure is more time consuming and traumatic due to use of larger bore needles. CNB can be associated with complications like vasovagal reaction, infection, pneumothorax, infarction, epithelial displacement and needle tract malignant seeding are rarely seen and described in literature5 . However no such complications were encountered during our study. Difficulties are encountered while doing CNB in lesions close to the skin, chest wall, in axilla, with calcification and in small lesions due to less control over the needle in automated guns used for CNB whereas these lesions can be satisfactorily sampled on FNAC. Care needs to be taken while doing the CNB procedure near vital organs, chest wall, large blood vessels with automatic CNB guns .The needle has a fixed throw, the direction and depth of penetration of the needle should be calculated before doing the procedure to avoid damage to vital organs. FNAC is at less risk of penetrating the vital organs as the needle is more under the control of the operator. The depth and direction can be changed by the feel of the tissue while doing the procedure. FNAC is suitable in aspiration of benign cystic lesions where as it is not possible to obtain tissue sample on CNB. Fine-needle aspiration (FNA) can be used for the diagnosis of inflammatory swellings of breasts such as abscess, granulomatous diseases including tuberculosis, where the aspirates can be used for culture of organisms and special stains like Ziehl-Neelsen, Gram’s stain can be used to identify bacilli10. FNA is preferred in sampling multifocal lesions. It can be reliably used for pathologic confirmation of an inoperable advanced stage breast cancer before systemic therapy. It is also preferred during post surgery followup of breast cancer patients, to sample chest wall lesions and to determine whether they are due to recurrence or reactive in nature. Preoperative evaluation of axillary, supraclavicular nodes is preferably conducted with FNA, which also eliminates the need for sentinel node biopsy. FNAC can be used to diagnose metastatic tumors to breast5 . In a study by Willems et al, FNAC is more suitable for patients on anticoagulants and for lesions close to the skin, chest wall, vessels and implants or very small lesions. However, popularity of FNAC is decreasing due to paucity of well trained cytopathologists at individual centers, leading to more diagnostic errors. It may yield low cellular aspirates in cases which have abundant fibrotic or desmoplastic stroma. CNB may be used as a second line diagnostic tool in lesions which FNA yields insufficient cells and equivocal diagnosis. Since there is lack of histologic architecture, sometimes, even a cellular smear cannot yield an accurate diagnosis18 .But it has not achieved surgical decision making and management process for both the surgeon and oncologist at the expected level11. Also, Surgeons find it difficult to accept FNAC reports for making a definitive diagnosis as they lack important information about features like histopathological type, grade, intrinsic behavior of tumor etc12.
CORE NEEDLE BIOPSY
CNB is more accurate than FNAC13 and in screen detected lesions, it is reasonable to undertake CNB14. It may be used as a second line diagnostic tool for lesions in which FNAC yields an equivocal diagnosis or insufficient cells. It is also preferred when determination of in-situ versus invasive carcinoma/tumor sub typing is required5 . CNB is more invasive and time consuming than FNAC but less invasive and time-consuming than excisional biopsy. It has similar limitations like FNAC such as sampling errors. It requires local anesthesia and on-site immediate assessment of material is not available. With CNB it is not possible to aspirate fluid collections. CNB can be associated with subsequent histologic changes such as hemosiderin deposits, fibrosis, foreign body reaction and infarction of lesion like papilloma. Post VACB, there can be ultrasound appearance mimicking malignancy5 . The pathologist should correlate the histopathological findings with radiological abnormality. For routine breast cancer patients, the types of carcinoma and lymphovascular invasion are assessed. Receptor analysis is done. Prognostic factors derived from core biopsies correlate well with surgically excised specimens but the grade may be underestimated because of low mitotic rate estimated on a smaller sample. Pure Ductal Carcinoma In Situ is usually detected as microcalcifications on mammography and less commonly as mass lesion15.
LIMITATIONS OF FNAC ASPIRATES
A definite diagnosis is not possible sometimes by FNAC either due to inherent limitations of cytological examination or by inability to obtain adequate material for diagnosis16. By FNAC it may be difficult to distinguish between fibroadenoma and phyllodes tumor, fibroadenoma and fibrocystic change, fibroadenoma and papillary lesions.
Occasionally, it may be difficult to distinguish between myxoid change in fibroadenoma and mucinous carcinoma, and benign sclerosing lesions from low-grade carcinoma. It may be difficult to give a definitive diagnosis on FNAC alone in cases of low grade or borderline lesions such as Atypical Ductal Hyperplasia, Atypical Lobular Hyperplasia, papillary lesions, tubular carcinoma and invasive lobular carcinoma5 . Apocrine cells in smears may appear rather pleomorphic and may dissociate. Recognition of the dusty blue cytoplasm, with or without cytoplasmic granules with Giemsa stains or pink cytoplasm on Papanicolaou or Haematoxylin and Eosin stains coupled with a prominent central nucleolus is the key to identifying cells as apocrine17. Aspirates from lobular carcinoma are sometimes difficult to interpret. In the present study all cases diagnosed as lobular carcinoma on CNB were interpreted as suspicious of malignancy (C4). The cellularity of these specimens is usually less than that seen in ‘Ductal’ carcinoma and can appear small benign-looking uniform to atypical. The presence of small three-dimensional collections of cells with only slightly enlarged nuclei is a helpful clue. A large number of cells with intracytoplasmic lumina in association with the above features is an indication of lobular carcinoma, although not specific17. Also, Ductal Carcinoma In Situ and Invasive ‘Ductal’ carcinoma cannot be distinguished accurately by cytology alone18. While some of the cases of Ductal carcinoma in situ are overtly malignant, the small cell type may present a diagnostic dilemma. The cellularity of these samples are moderate, they are never as cellular as frank carcinomas. One should be guided by the increased nuclear/cytoplasmic ratio in the presence of normal size cells. The abnormal nuclear chromatin pattern is a clue to the real nature of the lesion. The presence of some necrotic debris in the background should alert the interpreter to the possible malignant nature of the lesion. A clue in some cases can be obtained from the architectural pattern within the rather rigid and monomorphic clumps. In some cases a report of intraductal proliferation (atypical or suspicious) may be all that can be given, and in such cases biopsy may be the only way to resolve the problem17.
LIMITATIONS OF CORE NEEDLE BIOPSIES
Interpretational errors are seen with CNB such as distinguishing between Fibroadenoma and Phyllodes tumor, benign and atypical or malignant papillary lesions, between Atypical Ductal hyperplasia and low-grade Ductal Carcinoma In Situ and between complex sclerosing lesion / radial scar and tubular carcinoma5 . Certain lesions diagnosed on core biopsies can be associated with pitfalls and may require excision. These lesions include fibroepithelial lesions such as pseudoangiomatous hyperplasia, atypia including flat epithelial atypia, papillary lesions, mucinous lesions, radial scar, complex sclerosing lesion, malignant processes that mimic benign lesions15. Also, in cases diagnosed as Atypical Ductal Hyperplasia on CNB, excision is recommended19. Mild atypia of epithelium within lobular units is one of the commonest problems encountered in core biopsy samples. These should not be overdiagnosed, as epithelial hyperplasia, apocrine change or reactive changes. Conversely, more severe degrees of atypia must be looked for, as these may reflect cancerization of lobules by high grade DCIS. The degree of atypia should be helpful in distinguishing the process, and the nuclear chromatin and presence of mitoses (although rarely seen) may aid in the diagnosis17. Proliferations of stroma may cause difficulties in diagnosis in core biopsy samples. Sometimes, a second biopsy sample taken from a patient may show fibroblastic proliferation; this may represent the target lesion but could also reflect tissue reaction and repair at the previous biopsy site. If the lesion is from the core site, an associated histiocyte reaction or fat necrosis may be present and hemosiderin-laden macrophages may be seen. A stromal proliferation may also be seen in phyllodes tumor and evidence for an epithelial component should be looked for, for example by taking deeper sections17. Immunohistochemistry(IHC) may not prove helpful and the multidisciplinary approach must be applied to the clinical, radiological and histopathological features. When a definitive histological diagnosis cannot be made, the abnormality should be reported as a spindle cell lesion of uncertain histogenesis or nature and classified as B317. A phyllodes tumor may rarely be difficult to distinguish from other stromal lesions. Usually, the differential diagnosis lies between a cellular fibroadenoma and a phyllodes tumor. Features including stromal atypia, if present, can be helpful, but the degree of cellularity of the stroma is the most valuable feature to assess. In rare cases, it is not possible to distinguish between these two lesions and the sample should be reported as a ‘fibroepithelial lesion’ and classified under B317. Small foci of invasive lobular carcinoma can be missed in histological sections and be dismissed as chronic inflammation of stromal cells. The targetoid infiltrative pattern of classical lobular carcinoma may be helpful, but a reactive process containing lymphocytes can also have a periductal or perilobular distribution. IHC with cytokeratin, to demonstrate the neoplastic cells is of value in difficult cases17.
CONCLUSION
Both FNAC and CNB are useful in the preoperative assessment of breast lesions, in both palpable and nonpalpable lesions with or without radiological guidance. Both procedures have their own advantages and limitations, they can complement each other. While there is widespread preference for CNB in most developed countries, FNA is still valuable initial procedure for evaluating palpable breast lesions5 , in view of its ease, simplicity, affordability, safety, and rapidity, low-cost and high degree of accuracy In cystic lesions, CNB procedure is not possible whereas, FNAC gives sufficient material to diagnose these cases. Malignancy can also be made out accurately by FNAC. However, it cannot distinguish between in-situ and invasive components with ease. FNAC requires an excellent aspirator to obtain satisfactory material and breast cytopathologic expertise in interpreting breast aspirates and in countries with limited resources like India, FNAC may be used as the sole sampling technique or first line of diagnostic tool for pathologic evaluation. Unsatisfactory samples are obtained on FNAC when the lesions contain abundant fibrotic or desmoplastic stroma leading to sampling error even in the hands of experienced pathologists. CNB proves to be very useful in such cases in obtaining the sample5 . CNB can further classify benign lesions in subtypes which is difficult to classify on cytology. The cases in C3 (atypia probably benign) and C4 (suspicious, probably malignant) category, indecisive on cytology could be given a definitive diagnosis on CNB. Hence CNB can be used as a confirmation test in such cases where definite opinion cannot be given on cytology. Tissue obtained by CNB can be used for IHC and genetic studies. With image guidance, the sensitivity rate increases and sampling error can be reduced. It should be determined by patient’s economic status, preference of managing surgeon, need for biomarker studies, availability of equipment and expertise, clinical and radiological indications5 . Both FNAC and CNB are complimentary to each other and are useful in diagnosis of breast lesions. Both procedures have specific advantages and limitations. CNB cannot replace FNAC, it is not needed to diagnose all breast lesions. It can be used as an adjunct in cases indecisive on cytology and those cases requiring biomarker studies.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=561http://ijcrr.com/article_html.php?did=5611. Rikabi A, Hussain S. Diagnostic Usefulness of Tru-Cut Biopsy in the Diagnosis of Breast Lesions. Oman Med J. 2013; 28:125-27
2. Ghaemian N, Siadati S, Nikbakhsh N, Mirzapour M, Askari H, Asgari S. Concordance rate between Fine Needle Aspiration Biopsy and Core Needle Biopsy In Breast lesions. Iranian Journal of Pathology 2013; 8: 241-246
3. Ballo MS, Sneige N. Can Core Needle Biopsy Replace Fine Needle Aspiration Cytology in the Diagnosis of Palpable Breast Carcinoma. American Cancer Society 1996; 773-77.
4. Chuo CB and Corder AP. Core biopsy vs fine needle aspiration cytology in a symptomatic breast clinic. EJSO. 2003; 29: 374-78
5. GongY. Breast Cancer: Pathology, Cytology, and Core Needle Biopsy. Methods for Diagnosis Breast and Gynecological Cancers: An Integrated Approach for Screening and Early Diagnosis in Developing Countries. 2013; 19-37
6. Outpatient Cytopathology Center(US). FNA or Core Needle Biopsy? Johnson City; 2004.
7. Pilgrim S, Ravichandran D. Fine needle aspiration cytology as an adjunct to core biopsy in the assessment of symptomatic breast carcinoma. Breast. 2005; 14: 411–14
8. Kass RB, Lind DS, Souba WW, Breast Procedures- 1[Internet]. North Carolina: WebMD;2007. Available from http://www.med.unc.edu/surgery/education/files/articles/ACS%20surgery%20breast%20procedures.pdf
9. Luechakiettisak P, Rungkaew P. Breast Biopsy: Accuracy of Core Needle Biopsy Compared with Excisional or Incisional Biopsy: A Prospective Study. The THAI J SURGERY. 2008; 29:6-10
10. Bukhari MH, Arshad M, Jamal S, et al., Use of Fine-Needle Aspiration in the Evaluation of Breast Lumps.Pathology Research International 2011; Article ID 689521, 10 pages, 2011. doi:10.4061/2011/689521
11. Hassan TMM, Rao AM. S Does Final-Needle Aspiration Cytology Of The Breast Is Still An Accurate Diagnostic Technique for Breast Lumps? IOSR JDMS. 2014; 13: 37-44
12. Bdour M, Hourani S, Mefleh W, Shabatat A, Karadsheh S, Nawaiseh O et al. Comparision Between Fine Needle Aspiration Cytology And Tru-Cut Biops In The Diagnosis Of Breast Cancer .Journal of Surgery Pakistan 2008; 13: 19-21
13. Homesh NA, Issa MA, El-Sofiani HA. The diagnostic accuracy of fine needle aspiration cytology versus core needle biopsy for palpable breast lumps. Saudi Med J. 2005; 26: 42-46
14. Lieske B, Ravichandran D, Wright D. Role of fine-needle aspiration cytology and core biopsy in the pre-operative di-agnosis of screen-detected breast carcinoma. Br J Cancer. 2006; 95(1): 62-66.
15. Joshi M, Reddy SJ, Nanavidekar M, Russo JP. Russo AV, Pathak R. Core biopsies of the breast: Diagnostic pitfalls. IJPM. 2011; 54: 671-682
16. Bajwa R, Zulfiqar T. Association of Fine Needle Aspiration Cytology with tumor size in palpable breast lesions. Biomedica 2010; 26: 124-129
17. Non operative diagnosis subgroup of the National Coordinating Committee for Breast Screening Pathology. Guidelines for non-operative diagnostic procedures and reporting in breast cancer screening. NHSBSP publication number 50. Sheffield, NHS Breast Screening Programme Publications, 2001.
18. Radhakrishna S, Gayathri A, Chegu D. Needle core biopsy for breast lesions: An audit of 467 needle core biopsies. Indian J Med Paediatr Oncol. 2013; 34: 252–56.
19. Koo JS, Kim MJ, Kim E, Jung W. Factors in the Breast Core Needle Biopsies of Atypical Ductal Hyperplasia that can predict Carcinoma in the Subsequent Surgical Excision Specimens. J Breast Cancer 2010; 13: 132-137
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcarePREVALENCE OF MALARIA AND HEPATITIS B VIRUS INFECTION IN FEBRILE PATIENTS IN KANO NORTHWEST NIGERIA
English6165Sharif A. AEnglish Dabo N. T.English Getso M. I.EnglishBackground and Objectives: Malaria and Hepatitis B Virus (HBV) infections are co-endemic throughout much of the tropical and Sub-Saharan Africa and both present major threat to public health. Nigeria is endemic for both Malaria and Hepatitis B virus infections. Presence of both infections concurrently in an individual might have significant clinical and public health implications. Hence the present study was undertaken to detect the prevalence of Hepatitis B-Malaria co-infections in a tertiary health center in Northwestern Nigeria.
Methodology: The study was carried out on 200 patients presenting with fever to the General Outpatient Department (GOPD) of the Murtala Muhammed Specialist Hospital (MMSH) Kano using Gold Standard microscopy and rapid diagnostic test (RDT).
Results: Fifty one (25.5%) out of the total subjects studied were malaria positive. Females presented with higher rate of malaria infection with 18% prevalence than males with 7.5%. Age group 15-24 had the highest malaria prevalence (11%), followed by age group 25-34 with 6.5%. Thirteen (6.5%) subjects were HBsAg positive. Males had higher rate of infection with 4.5% prevalence than females with 2.0%. Nine individuals representing 4.5% of the total population had co-infection with higher prevalence observed among the males with 3.0%. Age groups 25-34 were observed to have high co-infection rate of 1.5% and the least prevalence was observed among the age group 15-24 with 0.5% prevalence for both males and females.
Conclusion: These findings ware discussed in the light of the prevalence of co-infection with the two ailments and showed a decreasing trend of the infections.
EnglishMalaria, Hepatitis B, co-infection, MMSH, KanoINTRODUCTION
Fever is a non specific symptom that manifests due to many conditions of infectious origin such as malaria and hepatitis. It is a common presentation and accounts for most consultations in general outpatient units of major hospitals in tropical and sub-tropical regions (Igharo 2012). Both Malaria and HBV infections can present with febrile illness associated with generalized body ache, weakness, headache and yellowish sclera as their first symptoms. Malaria still remains a burden globally particularly in Sub-Saharan Africa. The World health organization (WHO) reported an estimated 219 million cases of malaria in 2010 with an estimated 660,000 death mostly affecting the African population where 90% of malaria infection occurs and also reported that 99 countries worldwide have an ongoing malaria transmission in 2012. Nigeria was first among the six most endemic countries for malaria which altogether account for 103 million cases. Southeast Asia is the second most affected region in the world with India taking the highest cases among the countries (WHO 2012). As a result of efforts mounted towards control and prevention there was decline in transmission, limited to 97 countries only with an estimated 207 million cases and 627,000 deaths. Pathetically however, 90% of these cases occur in Sub Saharan Africa and children less than five being worst affected (WHO 2013). HBV infection though a vaccine preventable disease remains a global health problem. An estimated 2 billion people have been infected with HBV (WHO 2012) and more than 300 million people worldwide suffer from persistent infection. It is estimated that about 600, 000 people die every year due to the acute or chronic consequences of the disease (Lee 1997, Ekanem 2013, WHO 2013,). Again the prevalence rate of the infection is highest in the Sub-Saharan Africa and Eastern parts of Asia. The infection is largely acquired during childhood with 5-10% of the adults developing a chronic disease. Malaria and HBV infection co-endemic throughout much of the tropical and Sub-Saharan Africa and they both present major threat to public health (Mazie 2002, Paulyn 2010, Jeya 2010, WHO 2011). Co-infection of Malaria with HBV may occur in areas where both infections are endemic and because of their geographical coincidence (Freimanis 2012, Andrade 2011). These two infections live some of their developmental stages within the liver and hepatocyte damage in HBV infection may cause poor liver handling of malaria parasites (Thurz 1995, Paulyn 2010) thus culminating in increased morbidity. In line with this, co-infection with Plasmodium parasite and HBV virus in individual may possibly influence progression of both agents and associated severity.
MATERIAL AND METHODS
Before commencement of the study, ethical clearance was obtained from the Ethical committee of the Kano State Hospital Management Board (KSHMB). The study was conducted between July and December 2013, in General Outpatient Department (GOPD) of the MMSH in Kano. The study was carried out among patients presented with febrile illnesses. Two hundred informed and consented subjects aged between 15- 64 were recruited for the study. Exclusion criteria were patients with an established clinical condition other than malaria and/ or HBV infection such as obstructive jaundice, cirrhosis, renal diseases, hypertension, diabetes mellitus, sickle cell disease, pregnancy, cancer and patients already on course of chemotherapy or who had it in the last two weeks for treatment of an earlier diagnosed illnesses were also excluded.
Sample Collection
From each individual subjects, 5 ml of blood sample was obtained via venopuncture from the subjects using vacoutainer needle (Cheesbrough 2005). Two milliliters of the blood was placed in ethylenediethyltetra acetic acid (EDTA) bottles for parasitological analysis. The remaining 3 ml placed in universal bottle and centrifuged at 3000rpm for 5 minutes to obtain the serum for serological detection of the HBsAg.
Parasitological examination
Incidence of malaria parasites in the blood samples was established using the gold standard microscopic procedure using Giemsa staining technique on thin and thick film smears were made from the 2ml collected above for specie determination and the level of parasiteamia respectively. Level of parasiteamia was expressed as number of parasite/µl of blood. (Alperex 1932, WHO 1991, Cheesbrough 2005)
Hepatitis B serology
Hepatitis B infection was diagnosed using serology. The 3ml portion of the blood sample was used for the detection of HBsAg. The blood was centrifuged and the serum obtained from which HBsAg was detected using Micropoint ELISA commercial Kits technique following the manufacturer’s instructions.
Statistical Analysis
Results obtained were analyzed using SPSS software (version 20) for both the descriptive and inferential analysis. Results were expressed as means and standard deviation. One way analysis of variance (ANOVA) was used to determine the level of significance between the parameters.
RESULTS
The distribution of the subjects based on gender and age is presented in Table 1 below. Of the 200 studied, 90 (45.0%) were males and 110 (55.0%) were females. Subjects aged 15-34 constitute 66% of the population studied.
Malaria Assessment
Fifty one (25.5%) of the subjects studied were positive for malaria (Table 2). This comprises of 15 (7.5%) males and 36 (18.0%) females, thus the females had greater burden than the male, however, statistical analysis showed no significant difference (P>0.05) in infection rates between male and female. Males aged 15-34 had the highest 13(6.5%) malaria infection than the other groups. A similar observation was also made among the females aged 15-34 constituting 24(12%) of the total infected. Fifty one (25.5%) of the subjects studied were positive for malaria (Table 2). This comprises of 15 (7.5%) males and 36 (18.0%) females, thus the females had greater burden than the male, however, statistical analysis showed no significant difference (P>0.05) in infection rates between male and female. Males aged 15-34 had the highest 13(6.5%) malaria infection than the other groups. A similar observation was also made among the females aged 15-34 constituting 24(12%) of the total infected.
HBsAg Serology
Thirteen persons (6.5%) out of the 200 subjects studied were positive for HBsAg (Table 3). Higher infection was observed among the males with 9 (4.5%) infection rate than the females with 4(2.0%). Higher infection rate was observed within 25-34 and 35-44 age groups each with 3(1.5%) among the male population. This was followed by 2 (1.0%) observed within 15-24 age group for both male and female population. Least infection rate 1(0.5%) was seen within the age group 55-64 among male population and within 25-34 and 35-44 age groups among female population.
Malaria/HBV Co-infection
Nine individuals (4.5%) were observed to have co-infection of malaria and HBV infection. Again, the males had higher co-infection rate 6 (3.0%) than their female counterparts 3 (1.5%). Male patients within the age group 25-34 were observed to have higher co-infection rate 3(1.5%). This is followed by 2(1.0%) each for both female and male patients within the age groups 35-44 and 25-34 respectively. The least co-infection rate was observed among age group 15-24 1(0.5%) for both male and female population.
DISCUSSION
Malaria and HBV infection are both endemic and life threatening diseases in this part of the world. This study presents 25.5% prevalence rate of malaria infection among the study population which is less than 30.59% reported by (Gobir 2014) from kano metropolis and 77.6% reported by (Igwe 2014) from Enugu, South-East Nigeria. The reduction in trend as observed in this study may be due to adequate measures taken in malaria prevention and prompt diagnostic measures (WHO 2012, 2013). Female population in this study is more affected with 18.0% prevalence. This may point to high vulnerability of women especially when they are pregnant. This finding is not consistent with the findings by (Gobir 2014) who reported a prevalence rate of 61% in female than their male counterparts with a 38%. These results showed continuous decline in malaria prevalence as stated by WHO (2013). Age group affected in both females and males were within 15-24 and 25-34. This study presents a 6.5% prevalence of HBsAg which differs from the results obtained from other studies within the same state and from other geopolitical zones of Nigeria. Recent report on the prevalence of Hepatitis B infection on adolescent in Kano puts the rate at 12.5% (Yunusa, 2014). The figure is also lower than 11% (Sule 2010) reported from studies in Anyingba, kogi state, 11.5% (David, 2012) from Ekiti State and 10.6% (Esumeh, 2003) from South-South region is also lower than 12.3%, (Hamza, 2013) and 18.2% (Luka, 2008) obtained among HIV infected population in Aminu Kano Teaching Hospital and among pregnant women in Zaria, respectively. It is also lower than 47.2% and 20% re-ported from Benue State among blood donors and Borno State among primary school pupils respectively. (Nneka, 2007) also reported a 17.1% from Nasarawa State among commercial sex workers. Several studies also reported values similar or less than this. (Dawaki and Kawo, 2006) reported 7.3% prevalence among pregnant women in Kano, 6.8% (Ndako, 2011) among secondary school students in north central Nigeria. 4.2% (Mukhtar, 2005) in Zaria, 4.1 % (Ugwuja, Okonko, 2010). Age specific prevalence rate was found to be 1.5% which is higher among 25-34 and 35-44 age groups followed by 1.0% each among 15-24 age groups. Least infection rate was observed among 55-64 age groups at 0.5%. These findings agree with that reported by (Gambo, 2012, okonko 2010) indicating the high rate of hepatitis B infection among these age groups 25-34 and 35-44. They constitute the sexually active population among the study group and they are at high risk of engaging in several ways through which one can contract the infection. The study figured out no significant difference (p=0.94) in Hepatitis B infection among the two sex groups with male patients having 4.5% while females recorded 2.0% prevalence rate. Higher rate of HBV infection and coinfection (3.0%) among males, though lower than the previously reported findings of 12.1% and 32% prevalence of HBsAg among male population reported from Kano, North west and North east by respectively (Nwokedi,2010 ,Gambo 2012) can probably be explained by unequal exposure to risk factors of contracting the infection. Male population in this part of the country are more engaged in one form of risk behavior or the other while the female population are always under close monitoring by parents. In this area the ratio of men to women that are engaged in business occupation, civil service, schools and other outdoor activities is significant going by their tradition, culture and religion.
CONCLUSION
The low rate of co-infection presented by this study proves that, there is decrease in the trend of malaria and HBV infections as reported by the World Health Organization. It also shows that the effort at containment of these two infections is reaching the target as the study shows reduction in prevalence of the twin infection. However, the prevalence of HBV infection has shown a fluctuating trend in the area.
ACKNOWLEDGEMENT
The authors are grateful to the Bayero University, Kano for providing assistance and enabling atmosphere to do the study and to the management of the MMSH, Kano for permission to use their facility and for the ethical clearance to carry out the investigation. The authors also acknowledge the help received from scholars whose articles are sited and included in the references of this manuscript. They are also grateful to authors, editors and 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=562http://ijcrr.com/article_html.php?did=5621. Andrade BB, Santos CJN, Camargo LM, Souza-Neto SM., Reis-Fiho A: Hepatitis B infection is associated with asymptomatic malaria in the Brazilian Amazon. PLoS ONE, 2011, 6(5): e19841
2. Cheesbrough, M: District laboratory practice in tropical countries, part 1. Cambridge University Press. Cambridge, 2005, Pp 239-245
3. David OM, Oluduro AO, Ariyo AB, Ayeni DI, and Famurewa OI: Sero-epidemiological survey of hepatitis B surface antigenemia in children and adolescents in Ekiti State, Nigeria. J of pub health and Epid, 2012, 5(1): 11-14
4. Dawaki SS and Kawo AH: Seroprevalence of HBsAg in pregnant women attending urban maternity hospital in Kano: Nig J of microb, 2006, 20:705-709
5. Esumeh FI, Ugbomoiko D, and Isibor JO: Seroprevalence of HIV and Hepatitis B surface antigen (HBsAg) among blood donors in central hospital Benin City, Nigeria. J of med lab sci,2003, 12(2): 52-55
6. Earle, WS, Perex M: Enumeration of parasites in the blood of malaria patients: J of lab and clinical med, 1932, 1(7): 1124
7. Friemanis GL, Owuso-Ofori S, Allain JP: Hepatitis B virus Infection does not significantly influence plasmodium parasite density in asymptomatic infections in Ghanian transfusion recipients. PLoS ONE, 2012, 7(11):e49967
8. Gambo IM, Rabiu AM Muhammad MB, Shugaba AI: Seroprevalence of HBsAg among Fulani Nomads in Toro North Eastern Nigeria. Global adv research J of Medicine and Med Sciences, 2012, 1(8): 214-217
9. Gobir Z, Tukur Z: Prevalence of Malaria parasitemia using rapid diagnostic test among apparently healthy children in Kano, Nigeria. Journal of Medical Trop, 2014, 1(6):1-4
10. Hamza M, Samaila AA, Yakasai AM, Babashani M, Borodo MM, Habib AG: Prevalence of Hepatitis B and C virus infections among HIV-infected patients in a tertiary hospital in North western Nigeria. Nig J of Basic Clin Sci, 2013, 10: 76-81
11. Igwe NM, Joannes UO, Chukwuma OB, Chukwudi OR, Oliaemeka EP, Maryrose AU, Joseph, A: Prevalence and parasite density of asymptomatic malaria parasiteamia among unbooked paturients at Abakaliki, Nigeria. J of Basic Clin and Repro Sci ,2014, (3):44-8
12. Jeya, DB., Botelho de suza, RA., Batista da Silva, E: Cohuman infection by plasmodium and hepatitis B: Clinical aspect, Immunological and Serological: Tropical medicine foundation of amazon, 2010.
13. Mazie JB, Barcus TT, Nicholas JW, Kantilaras JF, Schwartz, IK, Andrew C, Baird JK, :Hepatitis B infection and severeplasmodium falciparum malaria in Vietnamese adults: Amer J of tropical medicine and hygiene, 2002, 66(2), 140- 142
14. Mukhtar HM, Sulaiman AM, Jones M: Safety of blood transfusion: Prevalence of HBsAg In donor in Zaria: Nig J of Surgical research, 2005, 7(4): 290-292
15 Ndako JA, Nwankiti OO, Echeonwu GON, Junaid SA, .Anaele O, Anthony TJ: Studies on prevalence and risk factors for hepatitis B surface antigen Among secondary school Students In North central Nigeria. Serria leone journal of Biomedical research, 2011, 3(3): 163-68
16. Nneka O: Seroprevalence of Hepatitis B virus infection among commercial sex workers in Keffi, Nigeria. Nassarawa State University, 2007, 1-18 [Dessertation]
17. Nwokedi EO, Odimayo MS, Emokpae AM, Yahaya IA, Sadiq MN, Okwori EE: Seroprevalence of HBsAg among patients attending Aminu Kano Teaching Hospital, Kano. Nigerian journal of medicine, 2010, 19(4):423-6
18. Okonkwo, Soleye FA, Alli JA, Ojezele MO, Udeze AO, Nwanze JC, Adewale OG, Iheanyi,O: Seroprevalence of HBsAg Antigenemia among patients in Abeokuta, South Western Nigeria.Global journal of medical research,2010, 10(2): 140-149
19. Paulyn TA, Terdzungwe TS: Prevalence of plasmodia and HBV co-infection in blood donors at Bishop Murray Murray Medical Centre, Markurdi, Benue State, Nigeria: Asian pacific Journal of tropical medicine, 2010, pp 22- 226
20 Sule WF, Okonko IO, Ebute AJ, Donbraye E, Fadeyi A, Udeze AO, Alli JA : Farming and non farming individuals attending grimard catholic Hospital Anyingba Kogi State Nigeria, were Comparable in Hepatitis B surface antigen Seroprevalence. Current reaserch journal of Biological sciences, 2010, 2(4): 278-282
21. Thurz, MR Kwiatkowski D, Torok ME. Allsopp CE, Greenwood BM: Association of hepatitis B surface antigen carriage with severe malaria in Gambian children: Natural Medicine, 1995, (1), pp 374-375.
22. Ugwuja E, Ugwu N: Seroprevalence of HBsAg and liver function test among adolescents in abakaliki, south eastern Nigeria. The internet journal of tropical medicine, 2010, 6(2)
23. World health organization (2010): A global strategy for Malaria control, Geneva. www.who.int/malaria/publication/ world-malaria-report-2010/en/ (accessed on 13/10/2013)
24. World health organization (2012): world malaria report fact sheet www.who.int/malaria/media/world-malaria-report-2012/en/ (accessed on 12/09/2013)
25. World health organization (2013): world malaria report fact sheet www.who.int/malaria/publication/world-malariareport-2013/en/ (accessed on 15/02/2014)
26 Yunusa I, Minjibir AI, Ahmad IM, Madobi AL, Abdulkadir RS, Huzaifa U, Kabir N, Ezeanyika LU: Low body Mass index does not correlate with HBsAg infection in Female adolescents: British journal of Applied Science and technology, 2014, 4(8):1230-1237.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareNANOTECHNOLOGY - ADVANCING THE FIELD OF BIOMEDICAL ENGINEERING
English6670Prajakta Kishore KalangutkarEnglishBiomedical Engineering is one of the most important fields in engineering as it deals with interfacing the human body with electronic devices. Thus the performances of these Biomedical devices need to meet the requirements. However the traditional devices lack in certain aspects due to the accessibility of complex structures. With the recent advances in Nanotechnology, a wide range of Biomedical devices are gaining a boom in development by overcoming the drawbacks of the traditional devices. The application of Nanotechnology in Biomedical engineering has given rise to a drug delivery system that directly targets the affected cell, a nano capsule with camera that can be swallowed by patient for diagnosing ailments and many more such applications that make the diagnosing and treatment much simpler and the complex structures accessible. This paper reviews the advancement of Biomedical applications due to the integration of Nanotechnology field
EnglishNanoparticles, Nanomanufacturing, Microbots, BiomarkersINTRODUCTION
Nanotechnology is one of the most important emerging fields in medical sciences. In a broader sense, it is a field where the diverse fields of physics, chemistry, biology, materials science, and engineering converge at a scale ranging from 1 to 100 nanometers, essentially known as the nanoscale [3]. Nanotechnology is a science of understanding and controlling of atoms and molecules at nanoscale using a procedure called nanomanufacturing. The art of nanomanufacturing has brought about a revolution in the field of biomedical engineering where, the nano -materials and –devices are designed to interact with the body at sub-cellular level [1]. A wide range of biomedical applications have been benefited from nanotechnology, such as biosensors, drug and gene delivery, artificial cells, nanorobots for surgery, and many more. Most significant property of nanoparticles is the carbon strength, which is so tough that recently with a carbon nanotube a bullet proof T-shirt/vests was manufactured [2].
NANOTECHNOLOGY
Although nanotechnology seems to have gained a widespread interest in the recent years, the concepts behind nanoscience and nanotechnology are dated back to 1959 when physicist Richard Feynman delivered a talk entitled ?There‘s Plenty of Room at the Bottom at an American Physical Society meeting at the California Institute of Technology (CalTech). However, the term ‘nanotechnology‘ was coined over a decade later, by Professor Norio Taniguchi, in his explorations of ultraprecision machining [3]. In his talk, Richard Feynman also mentioned about a suggestion made by his friend, Albert R. Hibbs regarding micromachines. Hibbs quoted that, “… it would be interesting in surgery if you could swallow the surgeon. You put the mechanical surgeon inside the blood vessel and it goes into the heart and “looks’’ around … It finds out which valve is the faulty one and takes a little knife and slices it out. Other small machines might be permanently incorporated in the body to assist some inadequately- functioning organ.” - Richard Feynman [4]. The possibility that was considered by Richard and Hibbs, almost 55 years ago is becoming a reality now. In 1981 as the scanning tunneling microscope developed, the evolution of nanotechnology began to turn out today as a revolution in the fields of engineering and technology, imaging, measuring, modeling, and manipulating matter nanoscale [3].
NANOMATERIALS
Today researchers worldwide are manufacturing nanomaterials to make new products and applications, ranging from medical devices and drugs, to strong and lightweight materials that reduce fuel costs for cars and planes. Based on the shapes and dimensions, different types of nanomaterials are named, such as particles, tubes, wires, films, flakes, or shells that have one or more nanometer-sized dimension. Producing nanomaterials for use in biomedicine is a challenging task. However the recent advances in Nanotechnology-based drug carriers and materials have yielded more medical benefits especially the field of cancer therapy by improve the solubility of poorly soluble drugs, circulate in blood stream for longer time without being recognized by macrophages, as well as controlled release of drugs at an expected rate in the desired area. Nanocarrier systems can be designed to interact with target cells and tissues or respond to stimuli in well-controlled ways to induce desired physiological responses [3]. Figure 1 shows the different types of nanomaterials used in nanotechnology [5]
NANOTECHNOLOGY IN BIOMEDICAL ENGINEERING
The Biomedical applications of Nanotechnology are basically a convergence between the two rapidly growing fields of Nanotechnology and Biotechnology. Nanotechnology deals with manufacturing, investigation and utilization of systems at nanoscale and Biotechnology deals with metabolic process with microorganisms. These interdisciplinary disciplines are also used to make atomic-scale machines by imitating or incorporating biological systems at the molecular level, or building tiny tools to study or change natural structure properties atom by atom. Thus these fields have helped in innovation and creation of many powerful tools that are now used in Biomedical applications. The application of Nanotechnology in Biomedical mainly involves the production of the nano -materials and –devices are designed to interact with the body at sub-cellular level [1].
NANOTECHNOLOGY IN MEDICINE:
The medical application of nanotechnology is widely termed as nanomedicine. It ranges from medical applications of nanomaterials to nanoelectronics biosensors. The research and development of nanomedicine is broadly divided into three factors. The first impact of nanoscience on medicine is evolutionary. A second development is explicit and revolutionary, emphasizing great advances to be gained by radical new nanotechnology approaches. A third source of nanotechnology on medicine is indirect through the development and application of ever-improving nanotools and devices based on smaller and more precise technologies. These technologies impact research, diagnostics and therapeutics [3]. Most of the nanotechnology applications in medicine are widespread. It starts with the identification and validation and is extended up to the treatment. Figure 2 shows the various applications of Nanotechnology in Biomedical applications:
REVIEWING NANOTECHNOLOGY IN BIOMEDICAL APPLICATIONS
Many medical nanotechnology applications are still in their infancy. However, an increasing number of products is currently under clinical investigation and some products are already commercially available, such as surgical blades and suture needles, contrast-enhancing agents for magnetic resonance imaging, bone replacement materials, wound dressings, anti- microbial textiles, chips for in vitro molecular diagnostics, microcantilevers, and microneedles [6], as depicted in Figure 3 [9].
PillCam:
With the introduction of PillCam by “ GIVEN IMAGING” in 2001, the first step towards application of nanotechnology in medicine was taken [10]. The PillCam is a capsule, ideally the size of a normal pill, contains a light and camera which is to be swallowed by the patient. Images beamed wirelessly from the capsule can be analyzed and used for diagnostic purposes, thus replacing procedures like the traditional endoscopy, in which a flexible tube containing a flashlight and camera is inserted into the digestive tract. The PillCam, is ideal for use in the passageways of the gastrointestinal system since it can be swallowed.
Drug Delivery:
Since 1960, researchers have been developing drug delivery systems that can directly target the affected regions. Due to the small size of nanoparticles, they are proving out to be suitable for such drug delivery systems. Based on the type of particle, the active substance of nanoparticle can be encapsulated or attached to the surface. This means that even if they dissolve poorly in water, they can be transported in an aqueous solution, such as blood, and are better protected against degradation by enzymes, for example. A suitable coating on the nanoparticle can prevent identification and removal by the immune system [12]. The nanoparticles Dendrimers are commonly used for drug delivery system due to their well defined size, shape, molecular weight and monodispersity [13]. Although they are complicated to synthesize, the advantage of dendrimers is that their synthesis results in a single molecular weight rather than distribution of sizes [14].
Figure 5: Dendrimers
(Image courtesy: http://www.lv-em.com/)
Biomarkers
Nanoparticles can be used for both quantitative and qualitative in vitro detection of tumour cells. They enhance the detection process by concentrating and protecting a marker from degradation, in order to render the analysis more sensitive. The research results have shown that the fluorescent nanospheres provided a sensitivity of 25 times more than that of the conjugate streptavidin-fluorescein [1]. Many kinds of nanomaterials will be used to help researchers develop prototype nanotechnology-based sensors for measurement of biomarkers. Materials like metal nanoparticles (gold, silver), semiconductor nanoparticles, and enzyme-loaded carbon nanotubes (CNTs) may be used to amplify biomarker signals.
Figure 6: Gold nanoparticles used for biomarkers (Image Courtesy: http://web.ornl.gov/info/news/pulse/pulse_ v246_07.htm)
Microbots:
Microbots are extremely small devices that can work inside the human body to help fight diseases. One of the microbot being developed resembles the flagella – a spiral shaped tail that helps bacterium to swim. These artificial bacterial flagella (ABFs) are about half the diameter of a human hair and are made using computer chip technology. Robots this small are called Nanobots, much smaller than bacteria. A magnetic head is attached to the ABF, so that, through a magnetic field, can be made to rotate, and move forward and forward. Once it is directed to a precise location, the robot could deliver medicine that destroys tumors [16]. In addition to cancer treatment, microbots are also being considered potentially useful for other medical purposes. Diabetes patients have to test their blood multiple times daily to ensure that their glucose levels are stable. Using nanobots would enable doctors to receive data from many different locations simultaneously throughout the body and allow for a more continuous monitoring of blood sugar levels without the pain and inconvenience of selftesting [17].
Cancer Detection and Treatment:
The NCI Alliance for Nanotechnology in Cancer states that, In the fight against cancer, half the battle is won based on early detection. Nanotechnology research is contributing to improved cancer survival rates through advances in screening, diagnosis, monitoring, and treatment. In the traditional methods of chemotherapy, it was found that 99% of the times the drug would not reach the target cell. Nanotechnology has proved its efficiency in early detection of the cancerous cells as well as treatment of cancer. Nanoparticles also carry the potential for targeted and time-release drugs. A potent dose of drugs could be delivered to a specific area but engineered to release over a planned period to ensure maximum effectiveness and the patient’s safety. These treatments aim to take advantage of the power of nanotechnology and the voracious tendencies of cancer cells, which feast on everything in sight, including drug-laden nanoparticles. One experiment of this type used modified bacteria cells that were 20 percent the size of normal cells. These cells were equipped with antibodies that latched onto cancer cells before releasing the anticancer drugs they contained. Another used nanoparticles as a companion to other treatments. These particles were sucked up by cancer cells and the cells were then heated with a magnetic field to weaken them. The weakened cancer cells were then much more susceptible to chemotherapy [19]. Figure 8 illustrates the use of nanoparticles for cancer therapy.
DISCUSSION
In the field of Biomedical, nanotechnology is a boon since extremely small devices such as the nanobots or the PillCam can be created to help cure people faster and without the side effects that other traditional drugs have. The traditional drugs have a drawback that they dissolve poorly in water; however the drugs developed with the help of nanotechnology have the ability to transport easily in an aqueous solution, such as blood. You will also find that the research of nanotechnology in medicine is now focusing on areas like tissue regeneration, bone repair, immunity and even cures for such ailments like cancer, diabetes, and other life threatening diseases. Although today Nanotechnology is a fast growing field, there are some challenges associated with using Nanotechnology in Biomedical engineering which need to be taken care of. Since these particles are very small, problems can actually arise from the inhalation of these minute particles, much like the problems a person gets from inhaling minute asbestos particles [20]. If we change the structure of material on the nano level without understanding the potential impact on the nanoscale, we risk creating a whole world of materials that have atoms that actually do not fit together cohesively [21]. Presently, nanotechnology is very expensive and developing it can cost a lot of money. It is also pretty difficult to manufacture, which is probably why products made with nanotechnology are more expensive [20].
CONCLUSION
Although the advances of Nanotechnology in Biomedical field are advancing at a comparatively slower rate, however the revolution in Nanotechnology has made it possible to overcome the drawbacks of the traditional devices. Thus this manuscript reviews the advancement of Biomedical applications due to the integration of Nanotechnology field.
ACKNOWLEDGEMENT
Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. Author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature of this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=563http://ijcrr.com/article_html.php?did=5631. Herbert Ernest and Rahul Shetty, “Impact of Nanotechnology on Biomedical Sciences: Review of Current Concepts on Convergence of Nanotechnology With Biology”, Submitted: March 26th, 2005.
2. Shalini Singh, “Nanostructures: Enhancing Potential Applications in Biomedicals”, Journal of Biomaterials and Nanobiotechnology, 2013, Vol.4, No.1, Article ID: 26835.
3. Kalangutkar, Prajakta Kishore. “The Evolution of Nanomedicine with the Re-Evolution of Nanotechnology.”
4. There’s Plenty of Room at the Bottom- http://www.zyvex. com/nanotech/feynman.html.
5. Weili Qiao, BochuWang, YazhouWang, Lichun Yang, Yiqiong Zhang, and Pengyu Shao “Cancer Therapy Based on Nanomaterials and Nanocarrier Systems”, Journal of Nanomaterials, Volume 2010, Article ID 796303.
6. B.Roszek, W.H. de Jong and R.E. Geertsma, “Nanotechnology in medical applications: state-of the-art in materials and devices”, RIVM report 265001001/2005
7. Rajshri M.Navalakhe and Tarala D.Nandedkar, “Application of Nanotechnology in Biomedicine”, Indian Journal of Experimental Biology, Feb 2007,Vol.54, pp. 160-165.
8. Biomedical Application of Nanotechnology: http://www. ece.gatech.edu/
9. Siddhartha Shrivastava and Debabrata Dash , “Applying Nanotechnology to Human Health Revolution in Biomedical Sciences”, Journal of Nanotechnology,Vol.2009, Article ID 284702.
10. YaleScientific: http://www.yalescientific.org/2013/02/ microbots-using-nanotechnology-in- medicine/
11. Given Imaging: http://www.givenimaging.com/, visited on 30/12/2014.
12. Nanotechnology medical applications – Research at the University of Maryland.
13. Anirudha Malik, Sudhir Chaudhary, Garima Garg and Avnika Tomar, “Dendrimers: A Tool for Drug Delivery”, Advances in Biomedical Research,2012, Vol. 6, issue 4, pp. 165-169.
14. Low Voltage Electron Microscope - http://www.lv-em. com/news-and-events/lvem5-desktop- tem-used-to-imagedendrimers
15. Oak Ridge National Laboratory: http://web.ornl.gov/info/ news/pulse/pulse_v246_07.htm, visited on 26/12/2014.
16. Medical Discovery News: http://www.medicaldiscoverynews.com/shows/255-microbots.html, visited on 22/12/2014.
17. Yale Scientific: http://www.yalescientific.org/2013/02/ microbots-using-nanotechnology-in- medicine/, visited on 22/12/2014.
18. Scoop.It! http://www.scoop.it/t/nanoscience-resourcesfor-secondary-schools, visited on 2/1/2015.
19. http://health.howstuffworks.com/medicine/modern-technology/gold-nanotech1.htm, visited on 29/12/2014.
20. Introduction to Nanotechnology: http://nanogloss. com/nanotechnology/advantages-and - disadvantages-of-nanotechnology/#ixzz3OUXqd79a, visited on 29/12/2014.
21. Introduction to Nanotechnology: http://nanogloss. com/nanotechnology/the-potential- disadvantages-of-nanotechnology/#ixzz3OUbIWuwF, visited on 29/12/2014.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareATTITUDE OF PHYSIOTHERAPY STUDENTS TOWARDS DISABLED PERSONS
English7177James GhagareEnglish Akshay OswalEnglish Rachana DabadghavEnglish Nilima BedekarEnglish Ashok ShyamEnglishAbstract Body: This study examined the attitudes of physiotherapy students towards persons with disabilities in Maharashtra. The Scale of Attitudes toward Disabled Persons (SADP) was sent to 1000 physiotherapy students all over Maharashtra and with a response rate of 40.8%, 408 students including 300 female and 108 male students completed the survey. Given that physiotherapists play a vital role in providing information, support and rehabilitation to persons with disabilities, a greater understanding of their attitudes toward this segment of the population will support efforts to implement appropriate interventions.
Results and Conclusion: It was concluded after this study that physiotherapy students hold a moderately positive attitude towards disabled persons and perceived disabled persons as quite similar to non-disabled persons.
EnglishAttitude, Disabled persons, Physiotherapy studentsINTRODUCTION
The ATDP was developed by Yuker et al.1 The ATDP-Form O, used in this study, has been shown to be internally consistent, stable, and reliable, with split–half reliability coefficients ranging from.75 to.85, and test-retest reliability values of.66 to.89.2This scale takes about 5 minutes to administer and consists of 20 items pertaining to persons with disabilities. The scale was sent to physiotherapy students from second year at bachelors’ level as well as post graduate students with an age group of 19-24 with a standard deviation of 1.45. According to the World Health Organization (WHO), 7 to 10% of the populations in developing countries live with some form of disability3 . The state of Maharashtra offers an undergraduate and post graduate physiotherapy programme. The programme aims at training competent physiotherapists who can address the needs of people with disabilities. Therefore it is important to ensure that the perceptions of physiotherapy students towards disability are appropriate. The quality of medical and rehabilitation services is influenced by the attitudes of health care professionals toward persons with disabilities. If physiotherapists have misconceptions about disability or have limited experience and knowledge about managing disability, this could negatively impact on the quality of services provided to persons with disabilities. Physiotherapists play an influential role in determining the priorities and direction of rehabilitation services. The quality of rehabilitation services is influenced by the attitudes of physiotherapists toward persons with disabilities. The reason why this study was conducted was to find out what the attitudes of physiotherapy students towards disabled persons is. There has been some study on the extent to which personal attributes influence attitudes towards persons with disabilities. Most studies observed that women hold more positive attitudes than men. Several studies have compared the attitudes of health professional students across professions. Tervo et al4 and Garven and Stachura5 , whilst comparing nursing, physiotherapy and occupational therapy students, found that nursing students held the least positive attitudes, whereas occupational therapy students showed the most positive attitudes toward persons with disabilities. A bet ter understanding of the multidimensional and intricate relationship between knowledge, attitudes, and behaviour would permit policy-makers and health professionals to design intervention strategies to change attitudes towards persons with disabilities and improve medical and rehabilitation services.
MATERIALS AND METHODOLOGY
The SADP was sent to 1000 physiotherapy students all over Maharashtra by email. The SADP is a questionnaire containing 20 questions. All students at second year bachelors’ level till post graduate level were included in the study. The first year students at bachelors’ level were excluded from the study since they have no exposure to patients at this stage. A written consent was taken from all the participants and the study was approved by the Institutional Review Board. The data was then analyzed using Microsoft Excel.
RESULTS
A total of physiotherapy students completed the questionnaire, providing an overall response rate of 40.8%. The mean age was 20.9years. Just over three fourth of the respondents were female 75%. Given that the majority of the students were females, the attitudes of females in this study may simply be a reflection of the attitudes of female physiotherapy students The respondents perceived the disabled persons as similar to non disabled ones. The attitude of the respondents can be said to be moderately positive, since the average score of the attitudes of the respondents was 23.04 out of a maximum achievable score of 40.
DISCUSSION
Physiotherapy students had significantly a positive attitude toward persons with disabilities on total SADP. Although most studies conducted in Europe and North America observed that older people showed more positive attitudes than younger ones; according to Bakheit Am Shanmugalingam6 , older people in south India expressed less positive attitudes than younger people toward persons with disabilities. It may be that a factor related to Asian culture has some negative influence on the attitudes of older people.
Q1- Parents of children with disabilities should be less strict than other parents 366 of the students gave a positive response as most of them feel that parents of children with disabilities should be less strict than other parents.
Q2- Persons with physical disabilities are just as intelligent as nondisabled ones 327 students gave a positive response since they felt that persons with physical disabilities are just as intelligent as nondisabled ones.
Q3- Persons with disabilities are usually easier to get along with than other people 249 students gave a positive response since they felt that persons with disabilities are usually easier to get along with than other people. But on the other hand the remaining 159 students felt that persons with disabilities are not usually easier to get along than other people.
Q4- Most people with disabilities feel sorry for themselves 327 students gave a negative response since they felt that people with disabilities feel sorry for themselves whereas 81 of the students gave a positive response since they felt that people with disabilities do not feel sorry for themselves.
Q5- People with disabilities are often the same as anyone else 384 of the students gave a positive response since they feel that people with disabilities are often the same as anyone else.
Q6- There should not be special schools for children with disabilities 234 students feel that there should not be special schools for children with disabilities since they perceived people with disabilities as similar to those without disabilities. But the remaining 174 students did feel that there should be special schools for children with disabilities. Hence, we can say that there was a mixed picture of attitudes for this question.
Q7- It would be best for persons with disabilities to live and work in special communities Just more than half of the respondents i.e. 205 students felt that it would be best for persons with disabilities to live and work in special communities whereas the remaining half i.e. 203 students felt the other way. Hence, the overall response for question is a mixed picture.
Q8- It is up to the government to take care of persons with disabilities Majority of the students i.e. 311 students gave a positive response since they feel that disabled persons are capable enough to take care of themselves. Only 97 of the respondents felt that it is up to the government to take care of persons with disabilities.
Q9- Most people with disabilities worry a great deal Most of the respondents i.e. 310 of them felt that gave a negative response since they felt that people with disabilities worry a great deal. Only 98 respondents gave a positive response since they did feel that people with disabilities do not worry a great deal.
Q10- People with disabilities should not be expected to meet the same standards as people without disabilities Just over half the respondents i.e. 218 of them feel that people with disabilities should not be expected to meet the same standards as people without disabilities whereas the other half i.e. 190 gave a positive response since they felt the other way.
Q11. People with disabilities are as happy as people without disabilities More than 2/3 rd of the respondents i.e. 281 of them feel that people with disabilities are as happy as people without disabilities but about 1/3 rd of them i.e. 130 of the respondents feel that people with disabilities are not as happy as people without disabilities.
Q12- People with severe disabilities are no harder to get along with than those with minor disabilities More than half of the respondents i.e. 206 of them feel that people with severe disabilities are no harder to get along with than those with minor disabilities whereas the other half 202 felt the other way. Hence a mixed picture of attitudes is seen for this question.
Q13- It is almost impossible for a person with a disability to lead a normal life Only 60 respondents feel that it is almost impossible for a person with a disability to lead a normal life. But the remaining 348 feel that it is possible for a person with a disability to lead a normal life. Hence, a positive response can be seen for this question.
Q14- You should not expect too much from people with disabilities 164 people responded in a negative way since they felt that you should not expect too much from people with disabilities but the remaining 244 gave a positive response since they felt the other way.
Q15- People with disabilities tend to keep to themselves much of the time 281 of the students felt that people with disabilities tend to keep to themselves much of the time. The remaining students i.e. 127 of them felt the other way since they perceived people with disabilities as similar to those without disabilities.
Q16- People with disabilities are more easily upset than people without disabilities 205 students gave a negative response since they felt that people with disabilities are more easily upset than people without disabilities and the other half i.e. 203 students feel that people with disabilities are not more easily upset than people without disabilities.
Q17- People with disabilities cannot have a normal social life Only 60 students feel that people with disabilities cannot have a normal social life but the remaining students i.e. 348 students feel that people with disabilities can have a normal social life.
Q18- Most people with disabilities feel that they are not as good as other people 275 students feel that most people with disabilities feel that they are not as good as other people but the remain-ing students i.e. 133 feel that most people with disabilities feel that they are as good as other people.
Q19- You have to be careful what you say when you are with people with disabilities Almost all students i.e. 390 students feel that you have to be careful what you say when you are with people with disabilities. Only 18 students feel the other way.
Q20- People with disabilities are often grouchy
Most of the students i.e. 240 students feel that people with disabilities are not often grouchy and 168 students feel the other way. Hence, we see an overall positive response for this question. It is often difficult for people who have disabled friends or relatives, to provide adequate care and support due to the commitments required of their work. This may lead to feelings of frustration and excess burden in relation to persons with disabilities. This study is limited, in that it used a convenience rather than a random sample. The SADP appeared to be the most relevant measure and psychometrically sound scale available; it was developed in the United States. Due to the essential role that physiotherapists play in providing information and rehabilitation services to persons with disabilities and their families, it is essential that they possess positive attitudes, sound knowledge and skill with regard to managing disability.
CONCLUSIONS
The attitudes of the respondents towards disabled persons can be said to be moderately positive as they perceived disabled persons as being similar to non disabled persons.
ACKNOWLEGEMENTS
Authors take immense pleasure to express our sincere and deep sense of gratitude towards Dr. Parag Sancheti for his constant support and guidance. Authors would like to thank all the participants who participated in the study. 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=564http://ijcrr.com/article_html.php?did=5641. Yuker, HE, Block, JR, and Campbell, WJ. A scale to measure attitudes toward disabled persons. Human Resources Ctr, Albertson (NY); 1960 (Study No. 5)
2. Antonak, RF and Livneh, H. The measurement of attitudes toward people with disabilities: methods, psychometrics and scales. CC Thomas, Springfield (IL); 1988
3. World Health Organisation. Training in the Community for People with Disabilities. Geneva:1989
4. Tervo RC, Palmer G. Health Professional Student Attitudes Towards Persons with Disability. Clinic Rehabilitation, 2004;18,908-915.
5. Garven F, Stachura K. Comparison of Occupational Therapy and Physiotherapy Students’ Attitudes Towards People with Disabilities. Physiotherapy, 2003;89,653-664.
6. Bakheit A, Shanmugalingam V. A Study of the Attitudes of a Rural Indian Community Towards People with Disability. Clinical Rehabilitation, 1997;11(4),329-34.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareHISTOMORPHOLOGICAL ANALYSIS OF GRANULOMATOUS LESIONS IN A TEACHING HOSPITAL, PUDUCHERRY
English7884Sandhya Panjeta GuliaEnglish M. LavanyaEnglish Archana V.English S. P. Arun KumarEnglish Kalaivani SelviEnglishAims: The present study is done to study the frequency, morphology and to find out the etiology of granulomatous lesions by clinicopathologic correlation wherever possible.
Materials and methods: A retrospective analysis of 75 biopsy sections was done from August 2010 – July 2014. Diagnosis was confirmed by haematoxylin and eosine stained slides alongwith the special stains wherever required.
Results: A total of 75 cases of granulomatous lesions were identified of which 42(56.0%) were malesand 33(44.0%) were females. Granulomas due to tuberculosis accounted for the majority of the types of granulomas,i.e,46 cases(61.33%), followed
by 7 (9.33%)cases of foreign body granulomas, 5 (6.67%) fungal granulomas, 4 (5.33%) actinomycosis, granulomas of unknown etiology were - 4(5.33%) cases of granulomatous synovitis, 1(1.33%) cases of granulomatous cystitis and 5 (6.67%) cases of non infectious skin granulomas. The granulomatous skin lesions reported were mostly infectious –3(4.0%) leprosy, 2 (2.67%) lupus vulgaris, 3(4.0%)cases of actinomycosis, 1(1.33%) scrofuloderma, and fungal granulomas – 2(2.67%) subcutaneous phaeohyphomycosis 1(1.33%) maduramycosis, 1(1.33%) chromoblastomycosis, 1(1.33%)zygomycosis; 5(6.67%)non
infectious skin granulomas reported as granuloma annulare, erythema nodosum and acne agmeneta. Granulomatous lesions of the genitourinary tract constituted 8(10.67%) cases – 3 (4.0%) tuberculosis of cervix and fallopian tube, 4 (5.33%) tuberculousepididymoorchitis and scrotal abscess; 1 (1.33%) granulomatous cystitis. Tuberculous lesions affecting the gastrointestinal tract were – 3(4.0%)cases of fistula in ano, 1(1.33%) appendicular tuberculosis and 1(1.33%) case rectum.1(1.33%) case each of tuberculosis of spine and actinomycosis of tonsil was reported. AFB stain was positive in 14 (30.43%) cases of tuberculosis.
Conclusion: Tuberculosis was the commonest cause of granulomatous lesion and lymph nodes were the most common site affected. Epithelioid type of granuloma was the most common morphology.
EnglishEpithelioid, Granuloma, Lymph nodes, TuberculosisINTRODUCTION
Granulomas are a characterstic microscopic finding of chronic inflammation. Granulomatous inflammation is considered as a response to pathogens and persistent irritants of exogenous and endogenous origin[1]. Granulomas are discrete collections of histiocytes with admixture of multinucleated giant cells and inflammatory cells[2]. The granulomas are formed as a result of series of events that involves the interplay of antigen (persistent endogenous / exogenous) resulting in activation of cell mediated type IV hypersensitivity reaction, activation of macrophages, T and B cell responses with release of chemical mediators of inflammation mainly cytokines. Classification of granulomas based on etiology could be: bacterial, fungal, viral/chlamydial, helminthic, foreign body type and unknown cause[3]. According to the morphology granulomas can be classified as: epithelioid, histiocytic, foreign body, necrobiotic/palisading and mixed inflammatory[3]. It is imperative to find out the correct etiology of the granulomatous lesions to start the appropriate treatment so correlating the clinical history with the histopathological findings proves to be valuable in establishing the correct diagnosis in majority of the cases. The present study was undertaken to find out the frequency, morphology and etiology where ever possible, of granulomatous lesions in the teaching hospital, and to compare with the similar studies.
MATERIALS AND METHODS
A retrospective study conducted in the department of Pathology, Sri Venkateshwaraa Medical College Hospital and Research Centre, Puducherry on the biopsies recieved from August 2010- July 2014 to analyse the frequency of granulomatous lesion. Alongwith routine haematoxylin and eosine stained sections, special stains like acid fast stain, fitefaraco and PAS stain was done wherever required.
RESULTS
A total of 75 cases of granulomatous lesions were identified out of which 42(56.0%) were male patients and 33(44.0%) were females with M:F ratio of being 1.27:1. The maximum number of cases, 28 (37.33%), were reported in the age group of 21-30 years; only one case was less than 10 years and 5 (6.67%) cases were more than 60 years age(Table 1).
Granulomas due to tuberculosis (Fig. 1) accounted for the majority,i.e,46 cases(61.33%), followed by foreign body granulomas 7 (9.33%), fungal granulomas 5 (6.67%), actinomycosis4 (5.33%). Among the seven cases of foreign body granulomas, the most common etiologic agent was ruptured epidermal cyst with keratin and cholesterol granuloma in 4(5.33%) cases and xanthoma in 3(4.0%)cases. Granulomas of unknown etiology were – 4(5.33%) cases of granulomatous synovitis, 1(1.33%) case of granulomatous cystitis and 5 (6.67%) cases of non infectious skin granulomas.
According to the site of distribution (Table 2)the majority of cases of tuberculosis, 18(24%),were reported in the lymph nodes with 8 (44.44%) cases positive for acid fast stain. Bones and soft tissues accounted for total of 17(22.67%) cases of granulomatous lesions reported as tuberculousosteomyelitis, soft tissue tuberculosis, foreign body granulomas and granulomatous synovitis with no case showing acid fast positivity
The granulomatous skin lesions reported were mostly infectious –3(4.0%) leprosy, 2 (2.67%)lupus vulgaris which showed acid fast positivity in both cases, 3(4.0%) cases of actinomycosis, 1(1.33%) case ofscrofuloderma, and 5 (6.67 %) cases of fungal granulomas, 2(2.67%) subcutaneous phaeohyphomycosis, 1(1.33%)case of maduramycosis,1(1.33%) case of chromoblastomycosis, 1(1.33%)case of zygomycosis; 5(6.67%)cases of non infectious skin granulomas reported as granuloma annulare, erythema nodosum and acne agmeneta. Granulomatous lesions of the genitourinary tract constituted 8(10.67%) cases – 3 (4.0%) tuberculosis of cervix and fallopian tube, 4 (5.33%) tuberculousepididymoorchitis and scrotal abscess; 1 (1.33%) granulomatous cystitis. Tuberculous lesions affecting the gastrointestinal tract were – 3(4.0%)cases of fistula in ano, 1(1.33%) appendix and 1(1.33%) case in rectum. 1(1.33%) case each of tuberculosis of spine and actinomycosis of tonsil were reported.
DISCUSSION
Majority of granulomatous lesions in our study were seen among the males 42 (56%) as compared to the females 33 (44%) with maximum number of cases in the age group of 21-30 years. These results were similar to the studies done by Adhikari RC et al [4], Permi HS et al [5] and Pawale JS [3] and Patel et al [6]. The present study showed that the etiology of the majority of granulomatous lesions was infectious in 57 (76%) cases which is in accordance to the study done by Bal et al [7]. In the present study the majority of the granulomas, 18(24%) cases, were reported in lymph nodes similar to the findings of Adhikari[4] who also reported lymph nodes (41.1%) as the commonest site of granulomas followed by skin and subcutaneous tissue (22.0%), bones and joints (11.5%), respiratory system (7.7%) and gastrointestinal tract (5.5%). Whereas Permi HS et al [5] in his study reported majority of the granulomas in skin and subcutaneous tissue with 68(24.72%) cases followed by lymph nodes in 59(21.46%)cases. In the study done by Permi HS [5] in 2012, lymph node tuberculosis was reported in 53(40.76%) cases, tuberculosis of bones and synovium in 35(26.92%)cases, cutaneous tuberculosis in 4(3.08%),intestinal tuberculosis in 14(10.76%),sinus tract in 4(3.08%) cases, fallopian tube in 2 (1.54%), bladder in 3 (2.30%) and kidney, lung, breast, epididymis in 1 (0.76%) case each. Patel et al [6] in 2013 reported 55% granulomas in lymph nodes, 5% respiratory tract, 8% skin, 5% GIT, 9% bones and joints, 10% head and neck, 6% reproductive system and 4% others. Whereas in the present study lymph node tuberculosis was reported in 18(24.0%)cases, skin and soft tissue tuberculosis in 9 (12.0%) cases, tuberculous osteomyelitis in 7(9.33%) cases, tuberculosis of rectum in 1(1.33%) case, appendicular tuberculosis in 1(1.33%), tuberculosis in female genital tract in 3(4.0%) cases, and tuberculosisin male genital tract in 4(5.33%) cases. Adults seem to develop tuberculousepididymoorchitis by direct spread from the urinary tract [8]. The usual presentation is painful inflamed scrotal swelling that is difficult to differentiate from acute epididymo – orchitis[9]. The diagnosis requires comprehensive evaluations – histology,cytology and microbiological investigations and further clinical follow up to avoid complications[10]. The most common cause of granuloma in our study was found to be tuberculosis in 61.33% cases which is similar to the findings of the studies done by Adhikari RC [4] et al in 61.7%, Permi HS [5] reported in 47.26%, Pawale JS in 49.41% [3] and Patel et al in 106 (81%) cases [6] who also reported tuberculosis as the commonest cause of granuloma. In the study conducted by Pawale et al [3],ZN stain was positive in 19(22.62%) out of 84 casesof tubercular granuloma. Whereas it was positive in 91(71%) out of 128 cases in the study of Krishnaswamy et al[11]. The study done by Permi HS [5] demonstrated tubercle bacilli in 27(20.74%) out of 130 cases. Whereas the findings of the present study are in contrast to the other studies where out of the total 46 cases of tubercular granulomas, acid fast stain was positive in 14(30.43%) and negative in 32 (69.57%)cases. The liquefaction of necrotic focus is considered to be associated with increased proliferation of AFB and infiltration of neutrophils with a high degree of hypersensitivity reaction [12]. In the study done by Chakrabarti et al [13] it was found out that culture positivity was found only in 13% cases of tuberculosis because of dead and altered organisms in the tissues.
The most common type of granuloma reported in the present study is necrotizing epithelioid type in 46 (61.33%) cases (Fig. 2) with the other types being epithelioid with suppuration (usually seen in fungal granulomas) 5 (6.67%), foreign body granulomas 7 (9.33%), necrobiotic granuloma 2 (2.67%) cases and also mixed inflammatory type (where the differential diagnosis of fungal infections and tuberculosis should be considered ) and histiocytic granulomas. In tuberculosis different types of granulomas can be encountered on histopathology like – epithelioid granuloma without necrosis, chronic nonspecific granuloma, chronic non-specific inflammation, epithelioid granuloma with necrosis and abscess [13]. Adhikari RC [4] also reported epithelioid granuloma as the commonest type in his study. Pawale JS [3] described tuberculoid granuloma 98 (57.65%), histiocytic granulomas in 29 (17.06%), foreign body granulomas in 17 (10.00%), ill defined granulomas in 13 (7.65%), mixed inflammatory granulomas in 11 (6.47%) and necrobiotic granulomas in 2 (1.18%). The commonest morphological pattern found in the study done by Permi HS et al [5] was epithelioid 165 (60% ), foreign body 35 (12.72%), ill defined 29 (10.54%), histiocytic 23 (8.36%), mixed inflammatory 19 (6.9%) and necrobiotic granulomas in 4 (1.45%) cases. Apart from tuberculosis, epithelioid granulomas are also seen in sarcoidosis, leprosy, fungal infections, crohns disease and tumor associated; epithelioid granulomas with suppuration can be seen in fungal infection, tuberculosis, cat-scratch disease and leishmaniasis; histiocytic granulomas found in parasitic infestation and fungal infections; foreign body granulomas seen as a reaction to foreign body; mixed inflammatory granulomas seen in parasiticinfestation, tuberculosis, leishmaniasis and chalazion[4].
In the skin granulomas of unknown etiology, 2 (2.67%) cases each of granuloma annulare and erythema nodosum and 1 (1.33%) case of acne agminata were reported. A case of perforating granuloma annulare was reported in 38 years male with multiple punched out ulcers over the trunk and proximal extremities covered by black eschar for which clinical differential diagnosis of ecthymagangrenosum and papulonecrotictuberculid was suggested. The biopsy picture showed degenerated collagen and mucin material surrounded by histiocytes. The mucin nature was suggested by PAS stain (Fig. 3) which showed a strong positivity. These findings were similar to those described by Pawale et al in their study [3]. These findings were similar to the observation made by Gautam et al[14],Billet A et al[15]and Joana Alexandra[16] reported 4(3.7%) cases of granuloma annulare.
Acne agminata is idiopathic in etiology, though the histopathology shows tuberculoid granulomas, all other relevant investigations for tuberculosis were negative in the case similar to the case reported by Sule[17]. Out of the 30 cases of leprosy the fitefaraco stain was positive in 17(56.66%) and negative in 13(43.33%) cases in the study done by Pawale[3] whereas in the study done by Nayak et al it was positive in 25(44.64%) and negative in 31(55.35%) cases[18]. It was positive in only 9(25.72%) cases and negative in 31(55.36%) cases in the study done by Permi HS et al [5].Whereas in our study, the stain was positive in one case of borderline tuberculoid leprosy (Fig. 4) and (Fig. 5).
The commonest fungal lesion found in the study done by Pawale et al were 3(30%) cases of madura mycosis followed by 2 cases(20%) rhinosporiodosis, 2 (20%) cases of P.boydii and one case each of histoplasmosis and mucormycosis[3] whereas in the study done by Chavan SS et al rhinosporiodosis formed the majority, 34 (68%), of cases of fungal granulomas followed by madura mycosis in 8(16%)cases[19]. In the study done by Permi HS et al [5] fungal infections were aspergillus in 6(25%),rhinosporiodosis 4(16.6%), chromoblastomycosis in 3(12.5%), pseudolleshcheriaboydii in 2(8.33%), subcutaneous entomphothormycosis in 1(4.16%),mucormycosis in 2(8.33%),cryptococci in 2(8.33%), madura mycosis in 1(4.16%) and candida in 1 (4.16%) case. In the study by Gautam K et al, cutaneous chromoblastomycosis comprised 2.8% cases[14]. Whereas our study showed 2 (2.67%) cases of subcutaneous phaeohyphomycosis, 1 (1.33%) madura mycosis (Fig. 6), 1 (1.33%) zygomycosis, and 1(1.33%) chromoblastomycosis. The H and E stained sections of zygomycosis showed presence of broad septate hyphae with focal bulbous dilatations which was more evidently depicted in PAS stain. It was found that the patient was having diabetes mellitus due to which he developed secondary fungal lesion of cutaneous zygomycosis / mucormycosis. The microscopic picture of chromoblastomycosis sections revealed microabscessesand granulomatous infiltrate in the dermis with multiple brown coloured copper penny bodies.
All 4(5.33%)cases of actinomycosis showed suppurative granulomas with central actinomycotic colonies seen on Haematoxylin and Eosine(Fig. 7) stained slides were confirmed by gram staining which showed gram positive filaments. These findings are comparable to the findings ofPawale JS [3], Permi HS et al[5], Mirza M et al[20] which was similar in our study. It is always advisable to search for the organisms in the centre of necrotic granulomas rather than peripheral viable and inflammatory tissue.
In the study conducted by Permi HS [5], foreign body granulomas were encountered in 23 cases – epidermal cyst with keratin and cholesterol granulomas in 13(56.52%) cases, xanthomas 4(17.4%) cases, sinus tract in 2(8.7%) cases, bile induced granulomas in 2(8.7%) cases and gouty arthritis in 2(8.7%) cases. In our study 7 cases of foreign body granulomas were reported and the probable etiologies identified were foreign body reaction to keratin and cholesterol, xanthogranuloma, suture granuloma and granuloma in the sinus tract. In the study of Permi HS et al[5],22(8.0%) cases of granulomas were of unknown etiology, PawaleJS et al[3] reported 11(6.47%) cases of granulomas of unknown etiology, i.e, granulomatous mastitis, granuloma annulare, sarcoidosis, granulomatous orchitis, granuloma in the pleura and mastoid antrum. The granulomas where etiology could not be found out in our study were 5(6.67%)cases - 4 (5.33%) cases of granulomatous synovitis, 2 (2.67%) cases of granuloma annulare, 1 (1.33%) case of acne agminata and 1 (1.33%) case of granulomatous cystitis. The etiology could not be established by doing stains like ZN and PAS hence they were grouped as granulomatous lesions[3,5] The definitive diagnosis to find out the exact etiology of granuloma formation could be made in 70 (93.33 %) cases out of total of 75 cases in the present study after doing special stains. After relevant special stains the etiological diagnosis could be confirmed in 95% cases in the study done by Patel et al [6]. Even after doing the special stains, in some cases, it is not possible to find out the etiology of the granulomatous lesion. hence ancillary studies of culture, serology, PCR may be required for confirmation.
CONCLUSION
The most common cause of granulomatous lesion in our study was tuberculosis with lymph node being the most common site. Majority of the granulomas had infectious etiology. According to the morphology epithelioid type was the predominant granuloma followed by foreign body type.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references in this manuscript. The authors are also grateful to the authors/publishers/editors of all those articles,journals and books from where the literature for this has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=565http://ijcrr.com/article_html.php?did=5651. Mariano M. Does macrophage deactivating factor play a role in the maintainence and fate of infectious granulomata? Mem. Inst. Oswaldo Cruz, 86:485-487,1991.
2. Weedon D. The granulomatous reaction pattern. In: Weedon D(ed). Skin Pathology, 2nded. Philadelphia: Churchill Livingstone;2002.pp193-220.
3. Jayashree Pawale, Rekha Purani, MH Kulkarni. A Histo- Jayashree Pawale, Rekha Purani, MH Kulkarni. A Histopathological study of Granulomatous Inflammations with an attempt to find the Aetiology. JCDR 2011;5(2):301-306.
4. Adhikari RC, Shrestha KB, Savami G. Granulomatous in- Adhikari RC, Shrestha KB, Savami G. Granulomatous inflammation: A histopathological study. Journal of Pathology of Nepal 2013;3:464-468.
5. Harish S. Permi, Jayaprakash Shetty K, Shetty K Padma, Teerthanath S, Michelle Mathias, Sunil Kumar Y, Kishan Prasad HL,Chandrika. A Histopathological Study of Granulomatous Inflammation. NUJHS 2012;2(1):15-19.
6. Vaidehi Patel, Jasmin Jasani, RajolI. Desai. The histo- Vaidehi Patel, Jasmin Jasani, RajolI. Desai. The histopathological study of granulomatous diseases in various organs to find the exact etiology of granulomas. IJBAR 2013;4(7):478-483.
7. BalA, Mohan H, Dhami GP. Infectious granulomatous dermatitis: aclinocopathologic study. Indian J Dermatol 2006;51:217-20.
8. Madeb R, Marshall J, Nativ O, Erturk E. Epididymal tuber- Madeb R, Marshall J, Nativ O, Erturk E. Epididymal tuberculosis: case report and review of the literature. Urology 2005;65(4):798.
9. Keyur N. Surati, Kaushal D. Suthar, Jainam K Shah. Isolat- Keyur N. Surati, Kaushal D. Suthar, Jainam K Shah. Isolated Tuberculous Epididymo-Orchitis: A Rare and Instructive Case Report. SEAJCRR 2012;1(3):46-50.
10. Vishnu Prasad Shenoy, Shashidhar Viswanath, Annet D Souza, Indira Bairy, Joseph Thomas. Isolated tuberculousepididymo-orchitis: an unusual presentation of tuberculosis. J Infect DevCtries 2012;6(1):92-94.
11. Krishnaswamy H, Job CK. The role of Ziehl Neelson and Flourescent stains in tissue sections in the diagnosis of tuberculosis. Indian Journal of Tuberculosis, 1974;21(10):18- 21.
12. Kunh, IIIC and Askin, F.B. Andersons Pathology, edited by J.M. Kissane, 8th Ed., Mosby Co, St. Louis, 1985, 852.
13. Ashish Kumar Chakrabarti, Krishna Kumar Halder, Shikha Das, Subrata Chakrabarti. Morphological Classification of Tuberuclous Lesions: Preliminary Observations. Ind. JTub 1994;41(139):139-142.
14. Gautam K, Pai RR, Bhat S. Granulomatous lesions of the skin. Journal of Pathology of Nepal 2011;1:81-86.
15. Billet A,Viseux V,Chaby G,Dascotte-Barbeau E,Gontier MF, Deneoux JP, Lok C. Perforating granuloma annulare with transfollicular perforation. Ann DermatolVenereol 2005;132(8-9):678-81.
16. Joana Alexandra Devesa Parente, Jose Alberto Machado Dores, Joao Manuel Pires Arhana. Generalized Perforating Granuloma Annulare: Case Report. Annal Dermatovenerol Croat 2012;20(4):260-262.
17. Sule RR, Athavale NV, Gharpuray MB. Lupus miliar- Sule RR, Athavale NV, Gharpuray MB. Lupus miliaris disseminates faciei. Ind J Dermatol Venereol Leprol 1992;58:102-4.
18. Nayak SV, Shivrudrappa AS, Mukamil AS. Role of fluorescent microscopy in detecting Mycobacterium leprae in tissue sections. Annals of diagnostic pathology 2003;7(2):78-81.
19. Chavan SS. A clinicopathlogical study of fungal lesions encountered in tissue sections (dissertation unpublished), Hubli, Karnataka university, 1998.
20. Mirza M, Sarwar M. Recurrent cutaneous actinomycosis. Pakistan Journal of Medical Sciences 2003;19:230-31.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareA COMPARATIVE STUDY ON EFFECTIVENESS OF ABDOMINAL BINDER ON BLOOD PRESSURE IN LYING TO STANDING POSITION AMONG YOUNG SELF REPORTED HEALTHY COLLEGE STUDENTS
English8590Dhivakar MuruganEnglish Moushami PurkayasthaEnglish Raja Senthil KandasamyEnglish Thangavelu L. Perichi GounderEnglish Sankar Sahayaraj MuthukaruppanEnglishAim: The Cardiovascular changes may take place during upright standing position. Several types of compression bandage areused to treat the orthostatic hypotension, mainly abdominal compression bandages are recommended for the reduction of gravity induced blood pressure drop. The aim of the study was to determine the effect of abdominal binder on blood pressure in lying and standing position among self-reported college students.
Methodolgoy: The blood pressure was measured in both the groups from lying to standing position by the use of sphygmomanometer.Subjects in group B wear abdominal binder in lying and standing position while measuring blood pressure. The values in both the positions were recorded.
Results: The result showed there were significant changes within group analysis of systolic blood pressure in lying and standing position (pEnglishBlood pressure, Abdominal binder, Orthostatic hypotension, Positional variationINTRODUCTION
The autonomic nervous system plays major role in regulation of blood pressure and heart rate1 .Generally, the term blood pressure refers to arterial blood pressure. Arterial blood pressure is defined as the lateral pressure exerted by the contained column of blood on the wall of arteries. The pressure is exerted when the blood flows through the arteries2 . In standing position the blood goes down from chest to the distensible venous capacitance system below the diaphragm. The abdominal contents are unsupported in anterior and inferior surface because of the gravity. It results in drop in blood pressure, cardiac output, venous return and ventricular filling this is due to the fluid shift, approximately 500 to 1,000 ml of pooling of blood into the lower extremities is takes place within ten seconds and the total transfer occurs within 3 to 5 minutes. It will stimulate the sympathetic outflow, which results increases peripheral vascular resistance; it will limit the reduction in blood pressure3 . Any pathological variations may cause alteration in the blood pressure2 . Reflex mechanisms and hemodynamics prevent drop in blood pressure and bring the cardiovascular changes during upright standing position. Failure of one of the subsystems can leads to gravitation-induced shifts in blood volume. It results in a clinical symptoms termed orthostatic hypotension4 . In orthostatic hypotension, this complex system does not allow the circulatory system to compensate the gravity induced drop in the blood pressure3 . Wearing an abdominal binder helps to support the abdominal contents and decreases the drop in blood pressure. The function of abdominal binder is to improving the respiratory mechanism. Several types of compression bandage are used to treat the orthostatic hypotension mainly abdominal compression bandages are recommended for the reduction of gravity induced blood pressure drop3 . The abdominal binder increases the intra-abdominal pressure. This negative pressure help prevent redistribution of blood into the abdomen and lower extremities when in standing position5 .The elastic abdominal binder that exerted 15 to 20 mmHg of blood pressure during standing position. The effect of compression therapy and beneficial effect of this treatment in orthostatic hypotension is unclear. In India there are only few studies to investigate the effect of abdominal compression stocking to control the drop in blood pressure. Orthostatic hypotension commonly found in upper spinal card injury. In India a study conducted at 2014 presented about 2716 cases of spinal cord injury patients, on that 1400 were cervical and 1316 were thoraco-lumbar, with male to female ratio of 4.2:1 and 71% in the age group of 20 to 49 years6 . Studies are required to examine the effectiveness of the abdominal binder in orthostatic hypotension for spinal cord injuries. Unnoticed orthostatic hypotension during the home programs may leads immediate medical attentions. Studies in healthy subjects will provide a clear picture about the blood fall changes with binder. The present study aimed to determine the effect of abdominal binder on blood pressure in lying and standing position among young healthy self-reported college student.
MATERIAL AND METHOD
The study design was a comparative study design. After getting the approval from the institutional ethical committee, willing subjects were communicated through appropriate channels. The selection criteria includes both gender students with the age group of between 18 to 25 years within normal blood pressure (systolic blood pressure 110 to 140 and diastolic blood pressure 60 to 80) were included for screening in the present study. Subjects with the history of hypertension or hypotension, cardiovascular, respiratory, and neurological problems, underwent recent abdominal surgeries, period of menstrual cycle in females, chronic abdominal pain, obese subjects, recent blood donors and other problems such as gastritis; spinal disc lesion, kidney stone, stomach cancer, urinary incontinence and spinal deformity were the exclusion criteria. 87 students enrolled their names to involve in the study. In which 63 students were selected based on the selection criteria. They were randomly allocated into two groups by using closed envelop method. After the commencement of the study, three students were withdrawn from the study. Group A consisted of 30 members (control group) and Group B consisted of 30 members (experimental group). Both the groups received explanation in details about the present study. The subjects were instructed not to wear tight cloths or bands and lie down in table for blood pressure settlement and general relaxation for 5 min. Then subjects were instructed to be in supine lying position on manual tilting table and were made to wear the safety straps. The blood pressure was measured in lying position by using sphygmomanometer and stethoscope. After the measurement the table was tilted to 90 degree to achieve upright standing position and then the blood pressure was measured in this position immediately (Figure-1). The group ‘A’ subject’s blood pressure was measured without the abdominal binder application and the group ‘B’ subject’s blood pressure was measured with the application of abdominal binder in both the lying and standing position. The values of blood pressure in lying and standing position were recorded.
DATA ANALYSIS AND RESULTS
The values of systolic and diastolic blood pressure with and without abdominal binder was analyzed by ‘t’ test.
WITHIN GROUP ANALYSIS
Results of systolic blood pressure of group A and Bin which p values (pEnglishhttp://ijcrr.com/abstract.php?article_id=566http://ijcrr.com/article_html.php?did=5661. A. A. Smit et al., Pathophysiological basis of orthostatic hypotension in autonomic failure. J Physiol, 519, pp. 1-10, (1999).
2. K. Sembulingam Ph.D., school of health science, Health campus university sains Malaysia. Essentials of medical Physiology (third edition)
3. Hollister AS. Orthostatic hypotension – causes, evaluation and management, West J Med. 1992; 157: 652-7.
4. H. E. Smeenk et al., Compression therapy in patients with orthostatic hypotension: a systematic review. Vol: 72, no: 2 February: 2014.
5. Kerk JK et al., Effect of an abdominal binder during wheelchair exercise. Med Science Sports Exercise; 27: 913-919, 1995.
6. N Mathur et al., Spinal Cord Injury: Scenario in an Indian State. Spinal Cord, doi:10.1038/sc.2014.153.,16 September 2014.
7. Choe, MA et al., The effect of changing position from supine to standing upright on the circulation of young men and women.
8. Tanaka H et al., Cardiac output and blood pressure during active and passive standing.
9. A. A. Smit et al., Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clin Auton Res, pp. 167-175, 2004.
10. Goldman JM et al., Effect of abdominal binders on breathing in tetraplegic patients. Thorax, 41:940-945, 1989.
11. Boaventura CD et al., Effect of an abdominal binder on the efficacy of respiratory muscles in seated and supine tetraplegic patients. Physiotherapy; 89: 290 -295, 2003.
12. Estenne M et al., Effects of abdominal strapping on forced expiration in tetraplegic patients. Am J Respiratory Care Med; 157:95-98, 1998.
13. Hart N et al., Respiratory effects of combined truncal and abdominal support in patients with spinal cord injury. Arch Physical Med Rehabilitation; 86: 144-145, 2005.
14. Maloney FP et al., Pulmonary function in quadriplegia: effects of a corset. Arch Phys Med Rehabilitation; 60: 261- 265, 1979.
15. Mc Cool FD et al., changes in lung volume and rib cage configuration with abdominal binding in quadriplegia. J Applied Physiology; 60: 1198-1202, 1986.
16. Huang CT et al., Cardiopulmonary response in spinal cord injury patients: effect of pneumatic compressive devices. Arch Physical Medicine and Rehabilitation; 64: 101=106, 1983.
17. De Troyer A et al., Rib cage motion and muscle use in high tetraplegics. Am Rev Respiratory Disorder; 133: 1115- 1119, 1986.
18. BM Wadsworth et al., Abdominal binder use in people with spinal cord injuries: a systematic review and meta-analysis. Spinal cord 47, 274-285, 2009.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareINTENSIVE AUDIT DRIVE OF HEALTH-CARE WASTE AT A REFERRAL HOSPITAL IN DELHI
English9194Renu GurEnglish Sharon Rainy RongpharpiEnglish Shalini Dewan DuggalEnglish Avinash KumarEnglish Ritu NayarEnglish Priyanka ChaskarEnglish Sudesh SagarEnglish Manju RaniEnglish Devendra DhayalEnglish Chander Mohan KhanijoEnglishIntroduction: The quantum of biomedical waste generated during diagnosis, treatment, interventions and management of patientscan be minimised and effectively managed if there are continuous surveillance mechanisms and regular audits. One such intensive biomedical waste audit drive was undertaken at our hospital, a 500 bedded hospital in Northwest Delhi.
Methodology: A prospective study involving daily audits was carried out by the biomedical waste team including doctors from the department of Microbiology. At the end of every month audit report was discussed in the biomedical waste committee and sent to the Medical Superintendent for necessary action.
Results: A total of 280 rounds were taken of different areas in the hospital during a period of 9 months (January –September 2013). The most common problem was improper segregation (19.28%); followed by overfilled sharp containers (3.57%), nonfunctional needle destroyer (3.57%) and non-availability of bags (1.43%). Documentation of biomedical waste generation, segregation and transport was improper in 19.64% areas.
Discussion and conclusion: Daily discussions of observations and prompt rectification helped to maintain a constant sense
of awareness of the biomedical waste rules and regulations. Proactive measures concerning biomedical waste management, timely interventions and involvement of all the hospital staff go a long way in effective management of health-care waste.
EnglishHealth-care waste, Audit, Rounds, Segregation, FrainingINTRODUCTION
Health-care waste (biomedical waste) management is an integral part of any health care facility. It may be considered a by-product generated during diagnosis, treatment, interventions and management of patients. After implementation of the Health-care Waste Management and Handling Rules in 1998,[1]it is expected of every health care personnel to have proper knowledge, practices, and capacity to guide others for waste collection and management, and proper handling techniques. Hospital waste is a potential health hazard to the health care workers, general public, flora and fauna of the area. Problems related to waste disposal in hospitals and other health-care institutions have become issues of increasing concern. [2] World Health Organization states that only 15% of hospital wastes are actually hazardous among which 10% are infectious and 5% are non- infectious. [3] This hazardous waste is also the most expensive component of the total hospital waste comprising on average two-thirds of total waste costs.[4]The quantum of biomedical waste can be minimised and effectively managed if there are continuous surveillance mechanisms on the segregation practices and regular audits. Waste audits can serve as essential waste management tools to enable healthcare providers to understand performance of their waste management systems and practices across their generation sites.[4]One such intensive biomedical waste audit drive was undertaken at Dr. Baba Saheb Ambedkar Hospital, a 500 bedded hospital in Northwest Delhi. The objective was to understand how efficiently our biomedical waste management rules and the standard procedures were being followed.
METHODOLOGY
This was a prospective study involving daily audits by the biomedical waste management team including doctors from the department of Microbiology and biomedical waste management nurses. Each day, designated areas were visited according to the roster. A form was designed (Annexure1) to record the observations on daily basis from the identified generation sites. After discussion among the biomedical waste team, problem areas were identified and corrective action was planned. At the end of every month audit report was discussed in the biomedical waste management committee and sent to the Medical Superintendent for necessary action.
RESULTS
A total of 280 rounds were taken at different areas in the hospital during a period of 9 months (January –September 2013). The most common problem wasimproper segregation (19.28%); non-functional needle destroyer (3.57%) and non-availability of bags (1.43%). These have been show as bargraphs in figures 1, 2, 3. Few sharp containers were found overfilled(3.57%). Documentation of biomedical waste generation, segregation and transport was improper in 19.64% areas (Figure 4). In our hospital, both digital as well as mercury based thermometers and blood pressure monitoring devices were being used. A record of the mercury based equipments was collected from various patient care areas and deposited in the hospital store for authorized disposal. Since July 2013, the hospital is not using any mercury based devices.
DISCUSSION
Mixing of non-infectious waste with infectious waste renders the whole waste hazardous and interferes with treatment and recycling processes. Therefore it is of utmost importance that waste is segregated properly at source. The cause of improper segregation was maximally seen during April and May which could be attributed to increased workload during these months, change of the duty staff, or recruitment of new resident doctors. Regular training programmes were conducted among all the categories of health care workers to improve segregation and the effect was evident in subsequent months. However, awareness among patients and visitors is also essential for proper disposal of waste. Different posters instructing waste disposal have been displayed in all patient care areas. At our hospital, we have zero tolerance for the infectious sharp waste disposal and anybody found responsible for non- compliance is dealt with very strictly. All the unit In-charges are responsible forthe availability of waste bags and sharp containers and functionality of needle destroyers. During our daily rounds these parameters were checked and sister in charges were instructed to change the non-functional needle destroyer and have alternative back up arrangements. They were instructed to indent them immediately and maintain stock position of the bags and sharp disposal containers in their respective wards. Also, it was ensured that there was adequate supply of these items in the stores. Waste disposal bags were in limited supply during the month of January. Waste was sent on daily basis except on Sundays. So the sharp containers were usually overfilled on Mondays. Instructions were then given to send all biomedical waste every 24hours irrespective of the quantum of waste as per the rules. The daily onsite record register is maintained in various wards. Improper documentation was seen in various wards due to initial reluctance and lack of knowledge of its importance which gradually improved after regular training. The involvement of doctors conducting the audits and their direct interaction with hospital staff and onsite training helped to enforce the biomedical waste management rules more stringently. Daily audits like this have not been done (Annexure 1) though audits relating to quantum of health-care waste generated have been reported. [5, 6]
CONCLUSION
Daily discussions of observations and prompt rectification helped to maintain a constant sense of awareness of the health-care waste rules and regulations. Proactive measures concerning waste management, timely interventions and involvement of all the hospital staff go a long way in effective management of health-care waste
. ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=567http://ijcrr.com/article_html.php?did=5671. Government of India. Health-care Waste (Management and Handling) Rules. 1998. Extraordinary, Part II, Section3, Subsection (ii). The gazette of India, No. 460,27 Jul 1998.
2. Hem Chandra. Hospital Waste an Environmental Hazard and Its Management,(1999).
3. Chartier Y, Emmanuel J, Pieper U, Pruss A, Rushbrook P, Stringer R, et al. Safe management of wastes from health-care activities. 2 nd Edition. World Health Organization 2013, Geneva, SwitzerlandVol I: p. 77-85.
4. Department of Health, State Government of Victoria. Waste management auditing: Example waste audit specification. Available at: http://docs.health.vic.gov.au/docs/doc/B2 8E7910B30DA408CA2579FE007FB7D2/$FILE/examplewaste-audit-specification.pdf. Accessed: 27/01/2015.
5. Chitnis V, Vaidya K, Chitnis DS. Health-care waste in laboratory medicine: audit and management. Indian J Med Microbiol. 2005 Jan;23(1):6-13.
6. Srivastav S, Kariwal P, Singh AK, Shrotriya VP. Evaluation of Biomedical waste management practices in multi-speciality tertiary hospital. Indian Journal of Community Health 2010; S(1): 46-50.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcareMORPHOLOGIC AND MORPHOMETRIC STUDY OF SUPRA TROCHLEAR FORAMEN OF DRIED HUMAN HUMERI OF TELANGANA REGION
English9598Udaya Kumar P.English Sukumar C. D.English Sirisha V.English Rajesh V.English Murali Krishna S.English Kalpana T.EnglishIntroduction: Olecranon fossa and coronoid fossa of lower end of humerus are separated by a thin plate of bone called supratrochlear septum. In some cases this septum is perforated, named as supratrochlear foramen.
Materials and Methods: The present study is carried out with 270 (119 left sided + 151 right sided) dried humeri of unknown sex and age. Bones were examined for the presence of supratrochlear foramen, their shape and measured vertical and horizontal diameters. Translucency of septum was identified by keeping the bone against a light source.
Results: Observation of 270 humeri showed the presence of Supra trochlear foramen in 57(26%) bones. 26% left sided bones and 17.21% of right sided bones were found to have STF. Oval shaped foramen dominated the other shapes. The mean transverse diameter of foramen was observed to be 6.36 ± 2.88 mm on left side and 5.76 ± 2.22 mm on right side, where as the vertical diameter was found to be 4.76 ± 2.64 mm mm on left side and 4.64 ± 2.45 mm on right side. Out of 213 bones, transluscency
of septum was observed in 130 (61.03%) humeri.
Conclusion: The present study suggests left preponderance with majority of oval shape of supra trochlear foramen in similaritywith most other studies done in India. The knowledge of STF is important to Orthopedicians, radiologists and Anthropologists
EnglishSupra trochlear septum, Supra trochlear foramen, Humerus, Translucency of septumINTRODUCTION
Olecranon fossa and coronoid fossa of lower end of humerus are separated by a thin plate of bone called supratrochlear septum. It is lined by synovial membrane in life1 . In some cases this septum is perforated, called supratrochlear foramen. Supra trochlear foramen was also called as epitrochlear foramen, intercondylar foramen or septal aperture in various anthropometric studies. It was first described by Merckel in 18252 . Supratrochlear foramen has been described in dogs, rats and cattle by various animal studies3, 4. Paraskevas et al.5 reported that the medullary canal is shorter in bones with supratrochlear foramen. With the increase in intramedullary nailing as a means of supracondylar fracture repair of humerus, it is of clinical significance to orthopedicians, as is also of great interest to anthropologists in establishing evolutionary relationship between lower animals and humans.
MATERIALS AND METHODS
Aim of the study is to analyze the morphology and morphometry of supratrochlear foramen and to calculate its incidence in Telangana region of South India. The present study is carried out in with 270 (119+151) dried humeri of unknown sex and age. Bones were obtained from the department of Anatomy, Mamata Medical College. One hundred and nineteen left sided and One hundred and fifty one right sided bones, free from pathological changes, were examined for the presence of supratrochlear foramen and their shape. Vertical and horizontal diameters were measured using vernier caliper. Translucency of septum was identified by light source from behind.
RESULTS
Two hundred and seventy dry humeri were observed for the presence of supra trochlear foramen. Out of 119 left sided bones, 31 bones (26%) and out of 151 bones, 26 (17.21%) bones were found to have supra trochlear foramen. Twenty six (21.9 %) left sided bones and nineteen (12.6%) bones on the right showed oval shaped foramen. rounded foramen was observed in five bones both on right side (3.3%) as well as on the left side (4.2%). A Triangular shaped foramen and a semi lunar foramen were observed in two individual right sided bones (Figure No.1). The mean transverse diameter of foramen was observed to be 6.36 mm on left side and 5.76 mm on right side with a standard deviation of 2.88 mm and 2.22 mm respectively, where as the vertical diameter was found to be 4.76 mm on left side and 4.64 mm on right side with a standard deviation of 2.64 mm and 2.45 mm respectively. Out of 213 bones, transluscency of septum was observed in 130 (61.03%) humeri with 63.07% (82) on left side and 36.92% (48) on right side. Comparative data on incidence of various shapes, mean and standard deviation of vertical and horizontal diameters of supra trochlear foramina are shown in tabular form (Table No: I and II).
DISCUSSSION
Various mechanisms have been postulated, explaining the reasons for existence of supratrochlear foramen. Tyllianakis, et al.6 considered this foramen as atavistic, in contradiction to the popular theory of mechanical pressure causing this foramen in the distal end of humerus during hyper extension or due to larger olecranon process. Brauer, et al.7 suggested that the Joint hyper mobility on left side and in females is the reason for high prevalence of the same. Hirsh et al.8 proposed that the pressure of olecrenon process reduces the blood flow to the septum, leading to the formation of foramen. Benfer9 and Sahajpal et al. 10 attributed this formation of foramen to disturbance of calcium metabolism and excessive bone resorption during child growth respectively. According to Blakely et al. 11, supra trochlear foramen is a phylogenetic character found in primates, which is expressed in weaker limbs and suppressed in the stronger limbs. Statistics show that the incidence of STF in Indian population ranges from 19.17% (Veerappan et al. 12) to 40.78% (Jadhav Maryuri et al. 13). Incidence of STF in various studies in India are tabulated (Table no. III). 26% of bones showed the presence of supra trochlear foramen in the present study. The frequency of supra trochlear foramen is higher on left side than on the right, in almost all the studies as was observed in the present study also. In contrast Nayak et al.14 and Kumarasamy S A15, observed the frequency of supra trochlear foramen to be higher on right ( 44.5% and 36.6% respectively) side than on left (26.8% and 22.8% respectively) side. Singhal S.16 found that the frequency was similar on both sides. In seperate studies by Bhanu PS et al. 17 and Krishna Murthy et al. 18, anupama et al.19 and Manjappa20, translucency of septum was found in 82.14% and 66.6%, 62% and 48.4% of humeri respectively. vasantha bhai21 and veerappan12 reported an incidence of 66.6%, 545.8% respectively, chiefly on right side in contrast to the above said studies. In the present study the translucency was found to be in 61.03% with 63.07% (82) on left side and 36.92% (48) on right side. As De Wilde V et al. 22 pointed out, Radiological misinterpretation of STF can avoided with the knowledge of STF, as it may be mistaken with osteolytic or cystic lesion of distal end of humerus. In the present study the average transverse diameter was found to be 6.36 ± 2.88 mm on left side and 5.76 ± 2.22mm on right side, and vertical diameter was found to be 4.76±2.64 on left side and 4.64 ± 2.45 on right side, which was observed to be in close proximity to all the other studies. The knowledge of STF is a necessity to orthopedicians as the presence of STF poses difficulty in fixation of supra condylar fracture by intra medullary nailing. Akpinar et al23, observed that the humeri with septal aperture have very narrow medullary canal. Paraskevas5 advised that the antegrade route is better for intramedullary nailing, than retrograde method, in people with STF.
CONCLUSION
The present study suggests left preponderance with majority of oval shape of supra trochlear foramen in similarity with most other studies done in India. But in view of smaller sample size in many studies, the statistics need to be carefully considered before radiological diagnosis or undertaking surgical interventions.
ETHICAL COMMITTEE CLEARANCE:
As the study included only dry human bones from the bone bank of department of Anatomy, ethical committee clearance was not taken into consideration. Authors will take the responsibility of any further allegations regarding ethical clearance that arise from the study.
ACKNOWLEDGEMENTS
Authors would like to thank Dr Suseelamma D., Professor and Head of the Depatment of Anatomy and their colleagues for their precious suggestions and support during the study. Authors would like to extend their gratitude to all the scholars / authors / editors / publishers whose articles; journals are reviewed, cited and included in the references of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=568http://ijcrr.com/article_html.php?did=5681. Kate BR, Dubey PN. A note on the septal apertures in the humerus of Central Indians. Eastern Anthropologists. 1970; 33:105-10, as cited in Manjappa T, Premchand SA; Incidence and morphometric study of septal aperture in south Indian population of Karnataka region, Int J Pharm Bio Sci 2014 Oct; 5(4): (B) 788–792.
2. Meckel JH, Kate, BR, Dubey, PN. A note on the septal apertures in the humerus of Central Indians. Eastern Anthropologist. 1970; 33:270–284.
3. Haziroglu RM, Ozer M. A supratrochlear foramen in the humerus of cattle. Anat Histol Embryol. 1990; 19:106–108.
4. Riesenfild A, Somon M. Septal apertures in humerus of normal and experimental rats. Am J Phys Anthropal 1975 Jan; 42(1):57-61.
5. Paraskevas GK, Papaziogas B, Tzaveas A, Giaglis G, Kitsoulis P, Natsis K. The supratrochlear foramen of the humerus and its relation to the medullary canal: a potential surgical application. Med. Sci.Monit. 2010; 16(4):119-23
6. Tyllianakis M, Tsoumpos P, Anagnostou K et al: Intramedullary nailing of humeral diaphyseal fractures. Is distal locking really necessary? Int. J. Shoulder Surg, 2013; 7(2): 65–68.
7. Brauer CA, Lee BM, Bae DS et al: A systematic review of medial and lateral entry pinning versus lateral entry pinning for supracondylar fractures of the humerus. J Pediatr Orthop, 2007; 27: 181–86.
8. Hirsh IS: The supratrochlear foramen: clinical and anthropological considerations. Am J Surg, 127; 2: 500–5, as Cited in Morton SH and Crysler WE. Osteochondritis dissecans of the supratrochlear septum. J Bone Joint Surg. 1945; 27-A: 12–24.
9. Benfer RA, McKern TW: The correlation of bone robusticity with the perforation of the coronoid-olecranon septum in the humerus of man. Am J Phys Anthropol, 1966; 24(2): 247–52.
10. Sahajpal DT, Pichora D: Septal aperture: an anatomic variant predisposing to bilateral low-energy fractures of the distal humerus. Can J Surg, 2006; 49(5): 363–64.
11. Blakely RL, Marmouze RJ, Wynne DD: The Incidence of the Perforation of the Coronoid-olecran Septum in the Middle Mississippian Population of Dickson Mounds, Fulton County, Illinois. In Proceedings of the Indiana Academy of Science, 2013; 78: 73–82.
12. Veerappan V, Ananthi S, Kannan NG et al: Anatomical and radiological study of supratrochlear foramen of humerus. World J Pharm Pharm Sci, 2013; 2(1): 313–20.
13. Jadhav M, Tawte A, Pawar P, Mane S. Anatomical study of Supratrochlear foramen of Humerus. J Res Med Den Sci 2013;1(2):33-35.
14. Nayak SR, Das S, Krishnamurthy A et al: Supratrochlear foramen of the humerus: An anatomico-radiological study with clinical implications. Ups J Med Sci, 2009; 114(2): 90–94.
15. Suba Ananthi Kumarasamy, Manickam Subramanian, Vaithiananthan Gnanasundaram, Aruna Subramanian, Ramalingam. Study of intercondylar foramen of humerus. Rev Arg de AnatClin, 3 (1): 32-36, (2011).
16. Singhal S, Rao V. Supratrochlear foramen of the humerus. Anat Sci Int, 82: 105-107, (2007).
17. Bhanu PS, Sankar KD: Anatomical note of supratrochlear foramen of humerus in south costal population of Andhra Pradesh. Narayana Medical Journal, 2012; 1(2): 28–34
18. Krishnamurthy A, Yelicharla AR, Takkalapalli A: Supratrochlear foramen of humerus – a morphometric study. Int J Biol Med Res, 2011; 2(3); 829–31.
19. Anupama mahajan A, Batra APS, Seema, Khurana BS. Supratrochlear foramen; study of humerus in North Indians. Professional Med J. 2011;18(1):128-132.
20. Manjappa T, Premchand SA; Incidence and morphometric study of septal aperture in south Indian population of Karnataka region, Int J Pharm Bio Sci 2014 Oct; 5(4): (B) 788 – 792. 21. Vasantbhai PS: Morphometric Study of Supratrochlear Foramen of Humerus. International Journal of Biomedical and Advance Research, 2013; 4(2): 89–92.
22. De Wilde, V., De Maeseneer, M., Lenchik, L., Van Roy, P., Beeckman, P., and Osteaux, M. (2004). Normal osseous variants presenting as cystic or lucent areas on radiography and CT imaging: a pictorial overview.European Journal of Radiology 51, 77–84.
23. Akpinar F, Aydinlioglu A, Tosun N, Dogan A, Tuncay I, Unal O. A morphometric study on the humerus for intramedullary fixation. Tohoku J Exp Med 2003;199:35-42
24. Himabindu A, Narasinga Rao B, supratroclear foramen – a phylogenic remanent, International Journal of Basic and applied medical sciences.2013; 3 (2): 130-132.
25. Sejal V Patel, Lajja K Sutaria, Tushar V Nayak, Daxa. P. Kanjia, B M Patel, S H Aterkar, Morphometric study of supra trochlear foramen of humerus, Int J Bio Med Adv Res 04 (02): 89-92, 2013.
26. Rakesh KD, Archana R, Anita R, Jyoti C, Srivastava AK et al. Incidence of supratrochlear foramen of humerus in North Indian population. Biomedical Research, 24 (1): 142-145, (2013).
27. Varalakshmi K.L, Sweekritha Shetty, Qudsia Sulthana, Study of Supratrochlear Foramen of Humerus and Its Clinical Importance. J Dent and Med Sci; 2014; 13 (7): 68-70
28. Jaswinder kaur ,Zorasingh, Supratrochlear Foramen of Humerus – A Morphometric Study; Indian Journal of Basic and Applied Medical Research; June 2013: 7(2), 651-654.
29. Naqshi BF, Shah AB, Gupta S et. al. Supratrochlear foramen: an anatomic and clinico-radiological assessment. Int J Health Sci Res. 2015;5(1):146-150.
30. Raghavendra K, Anil Kumar Reddy Y, Shirol VS, Daksha Dixith, Desai SP. Morphometric analysis of septal aperture of humerus. Int J Med Res Health Sci, 3 (2): 269-272, (2014).
31. Singh S, Singh SP. A study of the supratrochlear foramen in the humerus of North Indians. J Anat Soc India, 21: 52- 56,(1972). As cited in Manjappa T, Premchand SA; Incidence and morphometric study of septal aperture in south Indian population of Karnataka region, Int J Pharm Bio Sci 2014 Oct; 5(4): (B) 788 – 792.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524179EnglishN-0001November30HealthcarePROLIFERATING BRENNER TUMOUR OF OVARY - A RARE ENTITY
English99101Mourouguessine VimalEnglish Tukkaram ChitraEnglish Arun B. HarkeEnglishAim: We report a case of proliferating Brenner tumour of the ovary, whichis a rare clinical entity.
Case Report: A postmenopausal lady came with complaints of abdominal pain and distension for past 1 month. On examination, she had a uterine mass of 32 weeks size. Ultrasonography of the abdomen showed a cystic mass with multiple loculi havingirregular septations. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was done. On gross examination, cut
surface of the left ovarian mass revealed partly cystic and solid areas with yellowish white discolouration and papillary projections.On microscopic examination, multiple sections from the left ovarian mass showed well demarcated nests of epithelial cells resembling transitional epithelium, surrounded by stromal component of fibroblastic nature, with papillary formations at some places and coffee bean nuclei.The characteristic clinical and histopathological findings helped in clinching the diagnosis of proliferating Brenner tumour of the ovary.
Discussion: Proliferating Brenner tumours are a type of surface epithelial stromal tumours of the ovary and they have to bedistinguished from their benign and malignant counterparts. Presence of papillary projections in the cystic areas of the tumour on gross examination as well as in microscopy,hintthe diagnosis of proliferating Brenner tumour. Malignant Brenner tumours
have cellular atypia and stromal invasion.
Conclusion: Prompt and correct diagnosis of the Brenner tumour of ovary and its sub-classification forms the basis for its correct management. This can be achieved with the knowledge of its characteristic histopathological findings discussed in this case report.
EnglishOvarian neoplasm, Surface epithelial tumours of ovary, Transitional cell, Ovarian carcinoma, Ovarian cancerINTRODUCTION
Ovarian cancers are one of the deadliest malignancies with 44% of five year survival rate. (1) Ovarian cancers are of various types. According to the World Health Organisation(WHO) histological classification of the ovarian tumours, Brenner tumours are a type of surface epithelial stromal tumours and they are further classified into benign, borderline or proliferating, and malignant. (2) Proliferating Brenner tumour is a rare entity and very few case reports are available in literature. We report another case of proliferating Brenner tumour of the left ovary.
CASE REPORT
A 65 years old postmenopausal woman was admitted in our institute for complaints of dragging abdominal pain and abdominal distension for past 1 month. She was a multipara with last child birth 35 years back. She underwent tubectomy and was menopausal for past 25 years. On examination, she had an abdominal mass arising from uterus of 32 weeks size. Ultrasonography of the abdomen showed a large multilocular thin walled cystic mass measuring 25x19x23 cm. The cyst had multiple irregular septations. Both the ovaries could not be seen separately. The patient was posted for staging laparotomy. Intraoperative findings revealed a large mass arising from the left ovary and extending up to the xiphisternum. The mass appeared vascular and contained 5 litres of mucinous material which was aspirated. It was sent for histopathological examination. The right ovary was normal. Total abdominal hysterectomy with bilateral salpingooophorectomy was done. Postoperative period was uneventful.
Gross:
The uterus with right adnexa was unremarkable. The left ovarian mass measured 22x18x12cm. Externally it showed congested blood vessels (Figure 1). On cut section, it revealed partly cystic and solid areas with yellowish white discolouration. There were multiple elevated solid prominences with papillary formations at some places (Figure 2).
Microscopy:
Sections from the cervix, endometrium, both tubes and right ovary appeared unremarkable.Multiple sections from the left ovarian mass showed nests of epithelial cells resembling transitional epithelium surrounded by stromal component of fibroblastic nature (Figure 3). At places, the tumour cells were arranged in papillary formations (Figure 4). The epithelial cell nests showed sharply defined outlines. The nuclei of the tumour cells were oval, some of which showed longitudinal grooves – coffee bean nuclei. There was no nuclear atypia. The cytoplasm of the individual tumour cell was clear. Foci of cystic change and tumour necrosis were also observed. Histopathologically, all the above findings are consistent with the diagnosis of proliferative Brenner tumour of the left ovary.
DISCUSSION
According to the World Health Organization(WHO) histological classification (2), transitional cell tumours of the ovary are a type of surface epithelial stromal tumours. They are further classified into the following 4 types:
• Benign Brenner tumour
• Proliferating or borderline Brenner tumour
• Malignant Brenner tumour
• Transitional cell carcinoma (non-Brenner type)
Brenner tumours are rare clinical entities and they constitute around 1 to 2% of all the ovarian tumours. Proliferating Brenner tumours are still rarer, accounting for 8% of the Brenner tumours.(3) Roth and Sternberg, in 1970 described proliferating Brenner tumour to be a distinct clinical entity having features inbetween their benign and malignant counterparts.(4) Previous literatures (5,6) on benign Brenner tumour suggests their diagnosis on identification of the following gross and microscopic features. On gross examination, the tumour appears multilobulated, nodular with a glistening surface. The cut section may show whitish nodules which are well circumscribed and surrounded by fibromatous tissue. On histopathological examination, well demarcated nests of transitional epithelial cells with longitudinal nuclear grooves resembling coffee bean are seen. These nests of urothelial cells are surrounded by abundant fibromatousstroma. A case report (7) on proliferating Brenner tumours suggests their distinguishing features from benign Brenner tumours. On gross examination, the presence of cystic areas with papillary projections in addition to some solid areas favour proliferating Brenner tumour. On microscopic examination, they have papillary projections that are lined by transitional epithelium in addition to the transitional cell nests and surrounding abundant stromaseen in benign Brenner tumour. These cells do not show cellular atypia and stromal invasion, which if present, they will be classified as malignant Brenner tumour. Our case had typical gross and histopathological features of proliferating Brenner tumour. Proliferating Brenner tumours are usually asymptomatic and discovered incidentally. They are mostly unilateral tumours occurring in age group of 60 – 70 years.They are treated by surgical resection due to their well circumscribed nature and their recurrence rate is very low.(8) Some Brenner tumours can be functional, especially estrogen secreting and hence can lead to proliferative hyperplasia of endometrium, fibromyoma and adenomyosis of the uterus.(9)
CONCLUSION
The characteristic histopathological features help us in differentiating between the benign, proliferating and malignant Brenner tumours of the ovary. Benign Brenner tumours have well demarcated nests of epithelial cells resembling transitional epithelium surrounded by fibroblastic stroma and coffee bean nuclei.In addition to these features, if papillary projections are present, it indicates the diagnosis of proliferating Brenner tumour. Presence of nuclear atypia and stromal invasion suggest malignant Brenner tumour. We report this case of proliferating Brenner tumour of the ovary because of its clinical rarity and to emphasise the significance of its correct diagnosis and sub-classification which forms the basis for its correct management.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=569http://ijcrr.com/article_html.php?did=5691. Kmietowicz Z. Death rate from ovarian cancer in England has fallen by a fifth since 2001. BMJ. 2012;345:e7861.
2. Kaku T, Ogawa S, Kawano Y, Ohishi Y, Kobayashi H, Hirakawa T, et al. Histological classification of ovarian cancer. Med Electron Microscopy. 2003 Mar;36(1):9–17.
3. Takeuchi M, Matsuzaki K, Sano N, Furumoto H, Nishitani H. Malignant Brenner tumor with transition from benign to malignant components: computed tomographic and magnetic resonance imaging findings with pathological correlation. J Comput Assist Tomogr. 2008 Aug;32(4):553–4.
4. Roth LM, Sternberg WH. Proliferating Brenner tumors. Cancer. 1971 Mar;27(3):687–93.
5. Borah T, Mahanta RK, Bora BD, Saikia S. Brenner tumor of ovary: An incidental finding. J Midlife Health. 2011 Jan;2(1):40–1
. 6. Heye S, Bielen D, Vanbeckevoort D. Left ovarian Brenner tumor. J BR-BTR. 2005 Oct;88(5):245–6.
7. Ziadi S, Trimeche M, Hammedi F, Hidar S, Sriha B, Mestiri S, et al. Bilateral proliferating Brenner tumor of the ovary associated with recurrent urothelial carcinoma of the urinary bladder. N Am J Med Sci. 2010 Jan;2(1):39–41.
8. Chen VW, Ruiz B, Killeen JL, Coté TR, Wu XC, Correa CN.Pathology and classification of ovarian tumors.Cancer. 2003 May 15;97(10 Suppl):2631–42.
9. Shaaban AH, Abdine FH, Youssef AF. Functioning Brenner tumour of the ovary. J ObstetGynaecol Br Emp. 1960 Feb;67:138–41.