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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4General SciencesA REVIEW ON DNA MICROARRAY TECHNOLOGY
English0105Amandeep SinghEnglish Naresh KumarEnglishMicroarray analysis allows scientists to understand the molecular mechanisms underlying normal and dysfunctional biological processes. It has provided scientists with a tool to investigate the structure and activity of genes on a wide scale. Microarray technology could speed up the screening of thousands of DNA and protein samples simultaneously. DNA microarrays have been used for clinical diagnosis and for studying complex phenomena of gene expression patterns. Present review article focus on history, technique and future applications of DNA microarray technology.
EnglishMicroarray, DNA, TechnologyINTRODUCTION
DNA microarray technology emerged in the early 1990s by convergence of two advances. DNA sequencing efforts and focused on the expressed component of the genome, provided DNA sequence information and physical clones for thousands of human genes. Technical advances provided methods to manufacture slides or chips containing thousands of DNA probes arrayed within a small surface area by Dr. Patrick Brown and colleagues at Stanford University1. A DNA microarray is composed of pieces of DNA ranging from 20-5000 base pairs concentrated into specific areas on a solid support such as a glass chip.2 DNA microarrays are used for the investigation of prokaryotic biology because they allow the simultaneous monitoring of the expression of all genes in any bacterium. They offer a more holistic approach to study cellular physiology and therefore complement the traditional “gene-by-gene” approaches.3 The location of a specific probe on the array is termed spot or feature. Whereas the probes are immobilized on a solid support, the targets are applied as a solution onto the array for hybridization after fluorescent labeling.4 Microarray analysis allows scientists to understand the molecular mechanisms underlying normal and dysfunctional biological processes. It has provided scientists with a tool to investigate the structure and activity of genes on a wide scale. Microarray technology could speed up the screening of thousands of DNA and protein samples simultaneously.5
HISTORY
The idea of performing chemical or biological reactions with one reagent spatially immobilized is not new. Southern's 1975 paper described a technique that needs no introduction, and forever altered molecular biology.6 DNA arrays are logical extension of the method described by Gillespie and Spiegelman in 1965, in which DNA immobilized on a membrane can bind a complementary RNA or DNA strand through specific hybridization and the methods described for applying DNA to a treated cellulose surface 7 and DNA blotting hybridization.6 Several publications from the 1980s describe the use of such arrays in DNA mapping and sequencing.8,9 Scientists at the California-based biotech company
Affymax produce the first DNA chips.10 Miniaturized microarrays for gene expression profiling was used in 1995.1 A complete eukaryotic genome (Saccharomyces cerevisiae) on a microarray was published in 1997.11 A DNA microarray which is used to follow changes in gene expression as Deinococcus radiodurans recovers from a sub-lethal dose (3000Gy) of ionizing radiation was constructed in 2002.12
DNA Microarray Technique
In DNA Microarray collection of DNA probes that are arrayed on a solid support and are used to assay, through hybridization in the presence of complementary DNA that is present in a sample.13 DNA Microarray is a chip of size of fingernail having 96 or more tiny wells and each well has thousands of DNA probes or oligonucleotides arranged in a grid pattern on the chip.14, 15 Thousands of different genes are immobilized at fixed locations on chip and it means that a single DNA chip can provide information about thousands of genes simultaneously by base pairing and hybridization. There are two types of DNA microarray: cDNA microarrays and oligonucleotide arrays.16,17, 18 cDNA arrays are produced by printing a double stranded cDNA on a solid support (glass or nylon) using robotic pins.19 Oligonucleotide arrays are made by synthesizing specific oligonucleotides in a specific alignment on a solid surface using photolithography.19 The labeled cDNAs are applied to the microarray and allowed to hybridize under conditions analogous to those established for Southern blotting. After the slide is washed to remove nonspecific hybridization, it is read in a laser scanner that can differentiate between Cy3- and Cy5-signals, collecting fluorescence intensities to produce a separate 16-bit TIFF image for each channel.20, 21 Cy3 and Cy5 fluorescent dyes are used to distinguish cDNA pools which is reverse transcribed from different mRNA samples which have been isolated from cells or tissues.19 Quantification of results is done by measuring the intensity of fluorescence, which corresponds to the amount of gene expressed in the sample.22, 23 The three major steps of a microarray technology are preparation of microarray, preparation of labeled probes and hybridization and finally, scanning, imaging and data analysis.24, 25 Using this technique, a comprehensive understanding of the cell can be achieved.26,27
Applications of DNA Microarray Technology
DNA microarray technology has been used to study many bacterial species which include Escherichia coli 28, 29, Mycobacterium tuberculosis 30,31, Streptococcus pneumonia 32, 33 and Bacillus subtilis34,35, 36 With DNA microarray entire microbial genome can be easily represented in a single array and it is feasible to perform genome-wide analysis 37. Microarray technique is used in medicine development by providing microarray data of a patient which could be used for identifying diseases.38 DNA microarray technology has been used for analyses of natural and anthropogenic factors in yeast and analyzed how the whole genome of yeast is respond to environmental stressors such as temperature, pH, oxidation, and nutrients.39,40,41. Microarray analysis has been applied to identify molecular markers of pathogen infection in salmon.42 DNA microarray has been used for studying gene expression analysis in neurological disorders.43 DNA microarray experiments are carried out to find genes which are differentially expressed between two or more samples of cells. 44,45,46,47 cDNA microarrays provide a powerful tool for studying complex phenomena of gene expression patterns in human cancer.1,48,49 DNA microarrays has been used for clinical diagnosis such as histopathology and molecular pathology e.g. Microarray technique has been identified for analysis of AMACR (α-methylacyl-CoA racemase in prostate cancer compared with normal prostate. 50, 51,52
CONCLUSION
DNA Microarray analysis has provided scientists with a tool to screen thousands of DNA and protein samples. After the completion of Human Genome Project, DNA Microarrays have been used for clinical diagnosis of gene expression patterns. DNA Microarray technology has proved boon to industrial fields serving in clinical diagnosis.
Englishhttp://ijcrr.com/abstract.php?article_id=1018http://ijcrr.com/article_html.php?did=1018
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4General SciencesFISCAL DEFICIT AND ECONOMIC GROWTH IN THE GAMBIA
English626Emmanuel Ating OnwioduokitEnglish Godwin E. BasseyEnglishThe key objective of this paper is to empirically ascertain whether fiscal deficit enhance or retard economic growth in the Gambia between the period 1980 and 2009. The empirical results obtained from the estimation exercise are fairly robust and satisfactory, in that the variables conformed largely to a priori expectation in terms of statistical significance. The empirical results show that fiscal deficit affects the real economic growth positively and significantly with a lag of one year. The sign of the parameter estimate conforms to the presumptive expectation, given that the fiscal deficit in the Gambia was essentially used in financing economic and social infrastructure during the study period. Thus the results support the Keynesian assertion that fiscal deficits have positive impacts on economic growth.
EnglishFiscal Deficit, Economic Growth, The GambiaINTRODUCTION
The impact of fiscal deficits on economic output has been the subject of extensive research over the past eight decades. The debate on the issue is far from settled. However three unique views on the debate can be gleaned from the literature. The Keynesians unequivocally advocate fiscal deficit spending by government believing that it has positive effect on economic growth, while the neoclassical argue that fiscal deficit is detrimental to economic growth. The Ricardian however, view the impact of deficits financing as being neutral to economic growth in the long run.
The conventional wisdom that deficit is bad for growth is based on the neoclassical theory of output and employment, which has two variants. The extreme version assumes the economy to be continuously at the level of output corresponding to full employment. An increase in government spending financed by borrowing leads to a rise in interest rates; higher interest rates lower private investment, thereby lowering output growth. The moderate version of the neoclassical theory (Blinder and Solow 1973) allows that unemployment may exist in the short run so that fiscal policy, specifically budget deficits, may have a positive impact on output. An increase in government expenditure, or a decrease in the tax rate, stimulates spending, output, and employment. However, once full employment has been achieved, the impact of continued government deficit spending becomes inflationary.
From a policy perspective, both variants of neoclassical theory imply that higher investment, output, and employment and lower interest rates and prices over the long run can be obtained only by lowering the budget deficit. The carefully orchestrated fiscal austerity as the principal means to increase long-run economic growth, by the authorities of diverse political persuasions, is rooted in this fundamental theoretical perspective. Yet, empirical reality has not substantiated the neoclassical perspective. Numerous studies including (Taylor 1985) have shown that the effect of budget deficits on growth is ambiguous: deficits can lower or raise output growth.
What is not in dispute however, is the fact that the quality and direction of expenditure that the government applies the deficit substantially determine the outcome of fiscal deficit on economic growth. Government spending can be divided into two categories: consumption spending (expenditure on goods and services) and public investment spending (expenditures on infrastructure, education, public health, research and development, and other expenditure that are conducive to raising business productivity). A number of empirical studies including Onwioduokit (2005) have found that a rise in public investment significantly reduces business costs and improves business profitability, thereby raising the long-run growth rate of the economy. Thus as a rule, where deficits are applied in a growth enhancing sectors including investment in infrastructure, the outcome has been found to be positive, while where deficits are deployed in supporting consumption, the impact on growth has been found to be negative. The other sticking point in the debate is the need to carry out case by case study on the deficit- growth nexus.
Taylor (1985) presented a classical growth cycles (CGC) model to demonstrate that the impact of budget deficits is far more complex than is generally predicted. The CGC model starts with the assumption that growth in output and employment is a persistent feature of the economy, in the short run and the long run. It assumes that investment decisions, rooted in profitability considerations and carried out in an uncertain world, are responsible for growth. This view contrasts with the standard view that growth is a long-run phenomenon resulting from exogenous changes in population and technology. Further, in a fundamentally uncertain world, there is no inherent reason why planned investment spending should match available savings and the mismatch is reflected in the demand for bank credit. Hence, the money supply is not under the total control of the central bank. If banks' profit expectations are the same as those of firms, banks will automatically extend to firms the credit they need, and the money supply will expand endogenously. The model also assumes that unemployment and excess capacity are recurrent features of the economy over the course of business cycles; however, structural unemployment (reflected in the relatively low employment rates of certain strata of the population) persists over the long run when productive capacity is utilized at the normal level. Finally, the model embedded a social accounting matrix with fully articulated stocks and flows.
Barro (1989) contended that the Ricardian results depended on “full employment”, which definitely does not hold in Keynesian models. In a model Keynesian investigation, if every person thinks that a fiscal deficit makes them richer, the resulting increase of aggregate demand increases output and employment and in so doing essentially makes people better off. This outcome is valid if the economy commences in a state of “involuntary unemployment”. There could even be several rational expectations equilibria, where the adjustment in actual wealth equals the change in perceived wealth. This outcome does not necessarily signify that fiscal deficits boost aggregate demand and wealth in Keynesian models. He further opined that if fiscal deficits made people feel poorer, the resulting contractions in output and employment would have made them poorer. Similarly, if we had started with the Ricardian notion that fiscal deficits did not affect wealth, the Keynesian results would have verified that speculation. The peculiar feature of the standard Keynesian model is that anything that makes people feel richer actually makes them better off, notwithstanding that perception and reality might not correspond one on one. This remark raises uncertainties about the formulation of Keynesian models, but says little about the effects of fiscal deficits.
Ball, et al. (1995) in their contribution maintained that in the long run an economy’s output is determined by its productive capacity, which is
fundamentally determined by its stock of capital. When deficits shrink investment the capital stock grows more slowly than it otherwise would. Over a year, or two, this crowding out of investment has a negligible effect on the capital stock. But if deficits persist for a decade or more, they can significantly decrease the economy’s capacity to produce goods and services. Furthermore, fiscal deficits by reducing national saving must reduce either investment or net exports. As a result, they must lead to some combination of a lesser capital stock and greater foreign ownership of domestic assets. If fiscal deficits crowd out capital, national income falls because a smaller fraction is produced; if fiscal deficits lead to trade deficits, just as much is produced, but less of the income from production accrues to domestic residents.
Taking the matter a step further, Devereux and Love (1995) investigated the impact of government deficit spending in a two-sector endogenous growth model developed by King and Rebelo (1990), they extended the model to accommodate an endogenous consumption leisure decision. The authors concluded that there is a positive relationship between lump sum financed government deficit spending and growth rates. They explained that, as in many “endogenous growth” models, the rate of growth are positively related to the rate of return on human and physical capital accumulation. The return on human capital accumulation is higher the greater the fraction of time spent working, in either sector. A higher rate of government deficit spending generates negative wealth effects, leading to a reduction in leisure and a rise in hours worked. Consequently, the rate of growth rises. Although government spending raises the long-run growth rate; it reduces welfare since government deficit spending is a less than perfect substitute for private spending.
Similarly, Yavas (1998) showed that an increase in size of fiscal deficit will increase the steady-state level of output if the economy is at low steady-state (i.e. underdeveloped), and will decrease the steady-state level of output if the economy is at a high steady-state (i.e., developed). He argued that in the underdeveloped countries a significant portion of the deficits is directed to the building of the infrastructure of the economy and this type of expenditure will have a stimulating effect on private sector production. In contrast, the developed countries already have most of their infrastructure built and a major part of their deficit spending is on welfare programmes and various social services. Accordingly, the positive effect of spending on these programmes on private output will not be as great as that of expenditures on infrastructure.
Ahmed and Miller (2000) examined the effects of disaggregated government expenditure on investment using fixed- and random-effect methods. Using the government budget constraint, they investigated the effects of tax- and debt-financed expenditure for the full sample, and for sub-samples of developed and developing countries. The authors reported that, tax-financed government expenditure crowds out more investment than debt financed expenditure. Expenditure on social security and welfare reduces investment in all samples while expenditure on transport and communication induces private investment in developing countries.
Heitger (2001) viewed increases in size of government deficit arising from increased consumption as constraints on growth, while increases in size that arise from government investment should be positive in their effect on growth. His central hypothesis is that government expenditures on core public goods including the rule of law, internal and external security have a positive impact on economic growth, but this positive impact of government tends to decline or even reverse if government further increases expenditures in a way that it also provides private goods. The author stressed that two important reasons for a negative impact of excessive government spending on economic growth are the fact that the necessary taxes reduce the incentives to work, to invest and to innovate, and the fact that
government crowds out more efficient private suppliers.
Empirical findings on the relationship between fiscal deficits and economic growth have been uneven. Guess and Koford (1984) used the Granger causality test to find the causal relationship between fiscal deficits and inflation, gross national product, and private investment using annual data for seventeen OECD countries for the period 1949 to 1981. They concluded that fiscal deficits do not cause changes in these variables. Kormendi and Meguire (1985) conducted a cross-sectional study across forty-seven countries investigating the effects of monetary variance, risk, government spending, inflation and trade openness on growth. Specifically, with respect to government deficit spending, they found that the mean growth rate of the ratio of government deficit spending to output has a positive effect on GDP growth
Grier and Tullock (1989) repeated the work of Kormendi and Meguire (1985) on a larger sample of one hundred and thirteen (133) countries from which they constructed a pooled cross-section/time series data set. They tested for regularities in the data rather than robustness. They found that both the inflation rate and government deficit spending as a proportion of GDP were negatively related to growth. On the larger data set they found, contrary to Kormendi and Meguire, that the mean growth rate of the ratio of government deficit spending to output had a negative and significant impact on GDP growth.
Barro (1991) examined ninety eight (98) countries during the period 1960—1985 and reported a negative relationship between the output growth rate and the share of government consumption expenditures. He noted that growth rates are positively related to measures of political stability and inversely related to a proxy for market distortions. He found measures of political instability inversely related to growth and investment. He further averred that the first source of economic growth, human capital, can be measured in terms of education level and health. He concluded that the growth rate of real per capita GDP is positively related to initial human capital (proxied by 1960 school-enrolment rates). He explained that theories in which the initial values of human capital and per capita GDP matter for subsequent growth rates also suggest relations with physical investment and fertility. The author also suggested that countries with higher human capital also have lower fertility rates and higher ratios of investment to GDP. He noted that in endogenous growth models of Rebelo (1990) and Barro (1990), per capita growth and the investment ratio tend to move together. He stated that growth is inversely related to the share of government consumption in GDP, but insignificantly related to the share of public investment. Finally he submitted that when the share of public investment was considered; he found a positive but statistically insignificant relationship between public investment and the growth rate.
Easterly et al (1992) reported a consistent negative relationship between growth and fiscal deficits. Fischer (1993) supported Easterly et al. (1992) findings when they noted that large fiscal deficits and growth are negatively related. Among other variables such as inflation and distorted foreign exchange markets, he emphasized the importance of a stable and sustainable fiscal policy, to achieve a stable macroeconomic framework.
Easterly and Schmidt-Hebbel (1994) in their contribution to the debate attempted a comprehensive enquiry into the direct and indirect effects of deficits on macroeconomic variables for selected developing countries. An extensive discussion was undertaken on the measurement issues of fiscal deficits. The authors recognised a number of measurements of fiscal deficits which further confirmed the findings of researches on the subject. Series of techniques including correlation, percentages, frequency tables, regression analysis were explored. The graphics used gave deep insight into the trend and composition of deficits.
The authors principally argued that for efficient public investment, particularly in social or physical infrastructure and increased revenue generation through taxes, as this would encourage economic growth. The analysis also demonstrated that fiscal adjustments were important for improved economic performance. They concluded that the relationship between fiscal deficits and macroeconomic variables is complex and differs from country to country. In addition, the means of financing deficits contributed significantly to the impact of the deficits on the domestic economy.
Al-Khedair (1996) studied the relationship between the budget deficit and economic growth in the seven major industrial countries (G-7). The data utilized covered the period 1964 to 1993. The variable included in model were, budget deficit, the money supply, nominal exchange rate, and foreign direct investment. He found that the budget deficit has a significant positive impact on economic growth in France, Germany, and Italy. Overall results concluded that the budget deficit seems to positively and significantly affect economic growth in all the seven major industrial countries.
Kelly (1997) investigated the effects of public expenditure on economic growth among seventy three (73) nations (including developing and developed nations) over the period 1970- 89. This study used OLS to estimate economic growth as a function of various public expenditures including social expenditure, educational expenditure and other expenditures, and certain variables, which have been prominent in the empirical growth literature such as private investment, and the trade openness variable. The study found that public investment, and particularly housing expenditure, registered a uniformly positive and frequently significant relationship with growth. Although the results did not support a robust relationship between public investment and growth, it nevertheless conflicted with the crowding out thesis that dominated the theoretical literature. Social security expenditures were positively related to growth in each specification of the model and significantly so in several versions. The results are important because they suggested that nations may pursue social welfare and growth simultaneously. The results indicated that health expenditures were negatively and sometimes significantly related to growth, while those for education vary in sign and significance.
Jenkins (1997) motivated by the persistent deficits in Zimbabwe, examined public sector deficits and macroeconomic stability in Zimbabwe. The author identified an intense debt problem, drought and terms of trade shocks coupled with the government’s unwillingness to engage in fiscal adjustment as fundamental macroeconomic setbacks in Zimbabwe. Findings of the study showed that uncertainty caused by the growing public-sector debt reduced private investment and further resulted in a decline in growth. The macroeconomic model explored by the researcher showed that the variable with greatest influence on overall growth was agricultural output. However, the budget deficit had an unambiguously negative impact on exports. It also reduced private welfare, worsened income distribution and reduced employment. The author concluded that the growth of government resulted in a drain on the economy, rather than facilitate economic growth and development.
Phillips (1997) critically analyzed the Nigerian fiscal policy between 1960 and 1997 with a view to identifying workable ways for the effective implementation of Vision 2010. He observed that fiscal deficits have been an abiding feature in Nigeria for decades. He noted that with the exception of the period 1971 to 1974, and 1979, there has been an overall deficit in the federal Government budgets each year since 1960. The chronic fiscal deficits and their financing largely by borrowing, he asserted, resulted in excessive money supply, worsened inflationary pressures, and complicated macroeconomic instability, resulting in negative impact on external balance, investment, employment and growth. He
contended however that fiscal policy could be an effective tool for moving Nigeria towards the desired state in 2010 only if it is substantially cured of the chronic budget deficit syndrome it has suffered for decades.
Anyanwu (1998) deviated markedly from past studies that focused more on the effects of deficits and concentrated on the impact of deficits financing. He applied regression analysis to pooled cross-section and time series data for Nigeria, Ghana and the Gambia. The results did not reveal a significant positive association between overall fiscal deficits (and its foreign financing) and domestic nominal deposit interest rates. However, the author reported a significant positive relationship between domestic financing of the fiscal deficits and domestic nominal deposit rates. He concluded that the concern of economists in the Sub-region should shift from the deficits itself to the manner of financing the deficit.
Mugume and Obwona (1998), concerned about the role of fiscal deficits in the reform programme in Uganda, investigated public sector deficits and macroeconomic performance in Uganda. The study set out to provide a more systematic modelling framework to explain the interrelationships between fiscal deficits, current account deficits and real exchange rate depreciation. Another focus of the research was to analyse the behaviour of important aggregate variables such as price level, current account balance, external sector and money stock as influenced directly and indirectly by changes in fiscal deficits. A small macroeconomic model that captured the interactions between exports, import, real exchange rate, government expenditure, price, and money supply was specified. The empirical strategy attempted to build an integrated model linking the public sector with the financial market and then generate implications for the conduct of fiscal policy. A distinct finding of the estimations was the observed interaction of the public sector and monetary sector.
Adenikinju and Olofin (2000) focused on the role of economic policy in the growth performance of the manufacturing sectors in African countries. They utilized panel data for seventeen African countries over the period 1976 to 1993. Their econometric evidence indicated that government policies aimed at encouraging foreign direct investment, enhancing the external competitiveness of the economy, and maintaining macroeconomic balance have significant effects on manufacturing growth performance in Africa.
Prunera (2000) showed a possible mechanism through which deficit may hinder human capital accumulation and therefore economic growth. Taking deficit as an indicator for the presence of disequilibrium and inefficiencies in a country, the author highlighted deficit as a factor that could be reducing the effectiveness of time devoted to education and training. Following a simple growth model and allowing for slight changes in the law of human capital accumulation, the author noted that deficit might sharply reduce human capital accumulation. On the other hand, a deficit reduction carried on for a long time, taking that reduction as a more efficient management of the economy, may prove useful in inducing endogenous growth. He submitted that empirical evidence for a sample of countries seems to support the theoretical assumptions of an inverse relationship between deficit and human capital accumulation as well as the presence of a strongly negative association between the quantity of deficit in the economy and the rate of growth. However, the author averred that there was a certain role for budget deficit in economic growth.
Ahmed and Miller (2000) examined the effects of disaggregated government expenditure on investment using OLS, fixed-effect, and random effect methods. Their empirical results produced several conclusions. First, the openness variable has a significantly positive effect on investment only for developing countries. For developed countries, openness does not significantly affect investment. Second, expenditure on transportation
and communication, crowds in investment for developing countries only. Third, tax financed government expenditure, in general, crowds out investment more frequently that debt-financed government expenditure. That finding may suggest the existence of liquidity constraints within the economy. Finally, expenditure on social security and welfare crowds out investment for both tax and debt-financed increases and in both developing and developed countries. This is the only category of government expenditure that had such a consistent (negative) effect across all specifications.
In recent times as the debate on fiscal deficits and growth progressed, more elegant models and empirical strategies have been explored in the analysis of the subject. Prominent among these include, Adams and Bevan (2002), Korsu (2009) and Keho (2010). Their findings are divergent.
Adams and Bevan (2002) assessed the relationship between fiscal deficits and growth in a panel of forty five (45) developing countries. An overlapping generation’s model in the tradition of Diamond (1965) that incorporated high-powered money in addition to debt and taxes was specified. The estimation strategy involved a standard fixed effect panel data estimation and bi-variate linear regression of growth on the fiscal deficits using pooled data. An important contribution of the empirical analysis was the existence of a statistically significant non-linearity in the impact of budget deficit on growth. However, this non-linearity the authors argued reflected the underlying composition of deficit financing. In effect, Adams and Bevan posited that for a given level of government spending, a shift from a balanced budget to a (small) deficit may temporarily reduce distortions especially if the distortions impact growth rather than output. Based on a consistent treatment of the government budget, the authors found evidence of a threshold effect at a level of the deficit around 1.5 percent of GDP. While there appeared to be a growth payoff to reducing deficits to level, this effect disappeared or reversed itself for further fiscal contraction. The magnitude of this payoff, but not its general character, necessarily depended on how changes in the deficit were financed (through changes in borrowing or seigniorage) and on how the change in the deficit was accommodated elsewhere in the budget. The authors also found evidence of the interactive effects between deficits and debt stock, with high debt stocks exacerbating the adverse consequences of high deficits.
Korsu (2009)’s finding supported the arguments of Jenkins (1997) and Mugume and Obwona (1998) who worked on Zimbabwe and Uganda, respectively. They argued that fiscal deficits were inimical to macroeconomic performance as a whole and advocated for fiscal restraint as a pathway to improving other sectors of the economy and welfare. Korsu (2009)’s work recognised economic growth, low and stable prices and healthy external balance as the macroeconomic policy objectives of the economy of Sierra Leone. These he argued have been hampered by the persistence of fiscal deficits following some background analysis and historical records. To provide empirical support to the background information, aggregate annual data for the period 1971 to 2005 were used in an econometric estimation. Predicated on an open economy model, equations for money supply, price level, real exchange rate and the overall balance of payments were specified. The empirical models were estimated using a 3-stage least square estimation technique. The estimated results showed that fiscal restraint improved the external sector of Sierra Leone by reducing money supply and the price level. The important contribution of Korsu’s paper rested on the simulation experiments which differed from previous studies reviewed. The results pointed to the need for fiscal restraint and improved revenue generation to meet the expenditure requirements of the government.
In his contribution to the debate, Keho (2010) investigated the causal relationship between budget deficit and economic growth in seven
member countries of the West African Economic and Monetary Union (WAEMU). One specific objective was pursued which was to examine if fiscal deficits were really bad for economic growth in all countries of the WAEMU. The study employed the granger causality test developed by Toda and Yamatoto (1995). Annual time series data on real GDP growth, ratio of gross fixed capital formation and public deficit or surplus as a percentage of GDP were used. Unlike most empirical works on granger causality tests, the empirical analysis was undertaken in a multivariate form using gross fixed capital formation as a control variable. This mediating variable related meaningfully to economic growth in traditional growth models and mitigated the possibility of distorting the causality inferences due to omission of relevant variables. A striking feature of the descriptive statistics of the variables was that low levels of economic growth were associated with persistent fiscal deficits. In addition, the correlation coefficients showed that deficit and economic growth were positively related. The empirical results were mixed across countries. In three cases the author found no causality evidence between fiscal deficits and growth. Findings also indicated a two-way causality in three countries, deficits having adverse effects on growth. Overall the author argued that the results gave support to the WAEMU budgetary rule aimed at restricting the size of fiscal deficits as a prerequisite for sustainable growth and real convergence.
It can be concluded from the theoretical and empirical studies presented in this section that there are some similarities and differences between these studies dealing with the impact of public investment on private investment and economic growth. The key objective of this paper is to empirically ascertain whether fiscal deficit enhance or retard economic growth in the Gambia between the period 1980 and 2009. The outcome of this study is expected to contribute to the unfolding literature on the subject while serving as a guide for policy makers in the Gambia.
Stylised Facts on Fiscal Deficits, Inflation and Output in the Gambia
Domestic revenue/GDP ratio averaged 17.9 percent between 2001 and 2003. The ratio improved in the next four consecutive years (2004-2007) above 20.0 percent. The increase in revenue could principally be attributed to the commitment to fiscal transparency and accountability, and the response to the policy measures. However, between 2008 and 2010, the ratio fell marginally to an average of 18.3 percent, on account of a drop in tax revenue. While non tax revenue as a percentage of GDP increased from 1.8 percent in 2008 to 1.9 percent in 2010 this was inadequate to counterbalance the slight decline in tax revenue. Grants as a percent of GDP in 2009 registered a strong growth of 5.1 percent from a paltry 0.9 percent in 2008. This surge in grants (26 percent of total revenue) was principally due to increases in project disbursement and programme grants. Thus, total revenues (including grants) improved from 20.6 percent in 2008 to 24.6 percent in 2010.
With regards to the expenditure, total expenditure and net lending averaged 25.0 percent between 2000 and 2002.The average ratio increased to 26.1 between 2003 and 2006. In 2007 and 2008, respective ratios of 22.8 and 23.0 were registered. However considerable improvement to 27.8 percent was achieved in 2010. The quicker pace of growth stemmed mainly from increased capital spending. Within this total, there had been a shift from recurrent to capital expenditure, with the latter growing by 33.9 percent in 2010 from 24.2 percent in 2008. As can be gleaned from Figure 1, the relationship between the three variables fiscal deficit, real GDP growth and inflation exhibited a mixed trend.
Given the more rapid growth rate of spending relative to revenue, the overall budget balance (excluding grants) worsened from a deficit of 3.3 percent of GDP in 2008 to 8.6 and 8.5 percent in 2009 and 2010, respectively. The deficit was financed from both external and domestic sources. Domestic debt as a ratio of GDP increased significantly by 26.1 percent in 2008 to 34.6 percent in 2010 as a result of Treasury Bills issued. The share of treasury bills to domestic debt widened from 79.7 percent in 2008 to 84.4 percent in 2010.
Inflation which was in double digits in 2002 and 2003 decelerated gradually over the review period to 2.7 percent in 2009 but nudged up to 5.8 percent in 2010. This was completely attributable to good harvest reinforced with a tight monetary policy stance of the Central Bank. A critical analysis of the inflation determinant (food and non-food), indicates that between 2000 and 2009, food inflation had always accounted for higher percentage contribution to CPI basket compared to non-food inflation, indicating that inflation in the Gambia could be dominated by high import content of food in the food basket.
In the last ten years (2001-2010) economic growth in the Gambia has been strong. Beginning from 2001, the real GDP growth rate had been constantly over 5.0 percent but for 2002, when a paltry 1.3 percent growth rate was achieved. The impressive growth experienced by the country was attributable to capital inflows, robust performance in tourism, telecommunication and construction.
Arising from the global economic slowdown which started in late 2007, that resulted in a decline in tourism, and in manufacturing production as well as wholesale and retail trade, the tempo of real GDP growth moderated to 5.6 and 5.0 percent in 2009 and 2010, respectively. The agricultural sector registered a growth rate of 5.5 percent compared to 3.6 percent in 2008, largely as a result of clement weather condition particularly, rains. The share of the service sector in GDP ranged between 54.6 percent in 2000 to 61.5 percent in 2009, fuelled by amplified activity in the construction, transportation and communications. The tourism sector was hard hit as the number of tourists’ arrival in 2009 declined by 17.3 percent relative to 2008. Activities in the industrial sector were equally sluggish in 2010 and the share of industry to GDP whittled down to 3.5 percent from 3.8 percent in 2008.
ANALYTICAL FRAMEWORK AND RESEARCH METHODOLOGY
The analytical framework adopted for this study follows essentially the Keynesian framework. It would be recalled that in a simple Keynesian framework, desired aggregate demand relationship is specified in the goods market as:
Where Y is output; C, consumption; I, investment; G, government spending which is assumed to be exogenous; X, exports; M, imports; Yd, disposable income; T, tax revenue; i, interest rate; e, exchange rate.
In equilibrium (after substituting behavioural equations into the desired aggregate demand equation (1)), output will be given by
From equation (2), increasing taxes will reduce output, while increasing government spending will increase output.
But fiscal deficit (FD) is given by
Fiscal deficit is the excess of government expenditure over its revenue. Assuming that the government derives its total revenue from tax sources (which is quite realistic), G-T gives the deficit position of the government. Since individuals do not spend all their income, the total revenue that could be generated from consumption expenditure is . Thus, subtracting this from government expenditure will give approximate position of the fiscal balance.
Putting (3) into (2) gives
Given that the countries in the WAMZ are essentially small-open economies (without ability to influence international price developments) and for holistic treatment of the economy, the model is extended to incorporate the money sector as well as the external sector. The money market in an open economy can be represented by the following equations:
Equilibrium Condition: (7)
Where is the general price level, international reserves held by the central bank and are coefficients.
From the above money market model, the LM schedule1 can be specified as
LM Schedule:
Given the importance of the external sector in the countries of study, the influence of the sector is incorporated through the balance of payments schedule. The balance of payments schedule is given as
BP Schedule:
Where A2is the aggregate of exogenous components in the net export function and are coefficients. Putting equation (8) into (4) gives
Putting equation (9) into (10) produces
Isolating like terms and re-arranging equation (11) gives
Recasting the second term on the right-hand side of equation (12) in logarithmic generic term gives
where the rate of inflation and .
In equation (12B), equilibrium output is positively related to fiscal deficit.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareSTUDY OF HYPERTENSION AND ITS RISK FACTORS AMONG WOMEN OF REPRODUCTIVE AGE GROUP
English2732Chandrashekhar R.English Shashidhar BasagoudarEnglishObjectives: 1. To find out the proportion of hypertension among women of reproductive age group. 2. To find the association between various socio-demographic factors and hypertension. Material and Methods: A cross-sectional study conducted among ever married women of reproductive age group who have attended the urban health training centre during the study period of six month. Data was collected by direct interview through prestructured questionnaire and examination for measuring blood pressure and anthropometry. Results: Among the 244 women studied 8.6% of the women were hypertensive and 25% of the women were pre-hypertensive. Overweight and obesity (p = 0.02) and family history (p =0.001) were having significant association with presence of hypertension. There was no statistically significant association between type of work and type of diet consumed. Conclusion: Hypertension is a growing problem among the women of reproductive age group. Being overweight or obese and having a family history are the major risk factors for the hypertension among women.
EnglishHypertension, women, reproductive age.INTRODUCTION
Hypertension is defined as a state of chronically elevated arterial blood pressure, as compared to what is normally expected. Hypertension is often referred to as a silent killer. During most of its course, it produces hardly any signs/symptoms by itself; however, it damages the end organs substantially.1 It is the commonest cardiovascular disorder, posing a major public health challenge to population in socio-economic and epidemiological transition.2 In developing countries, high blood pressure is one of the risk factors for cardiovascular diseases, and the estimated 7.1 million deaths especially among middle, and old-age adults is due to high BP.3 India in a process of rapid economic development and modernization with changing lifestyle factors has an increasing trend of hypertension, especially among the urban population.4
Raichur is one of the underdeveloped districts of Karnataka having poor performance in many of the health related indicators. Many of studies previously have clearly highlighted about the higher burden of the communicable diseases. But as the prevalence of non-communicable diseases including hypertension has increased everywhere in the recent period it was essential to have a data regarding this region about hypertension and more so of females as they are often neglected. Hence a study was conducted with the objective of assessing the proportion of women having hypertension among women of reproductive age group and also to know the factors influencing the occurrence of hypertension.
MATERIAL and METHODS:
A cross sectional study was carried out at the Urban Health Training Centre (UHTC), Amtalab, Raichur, which is part of the department of Community medicine, Raichur Institute of medical sciences. Study was conducted among the ever married women in the reproductive age group (15-45 years) who have attended the UHTC during the study period of 6 months (January 2012 to June 2012). Women who were pregnant during study and those women who did not give consent for the study were excluded from the study. Oral consent for participation in the study was obtained from all the participants after informing about the study and its purpose. Data was collected about socio-demographic profile and some risk factors for hypertension through prestructured questionnaire by interview method.
The blood pressure was recorded by sphygmomanometer and taken in sitting posture. The first appearance of sound [phase I] was used to define systolic blood pressure and the disappearance of sound [phase V] was used to define diastolic blood pressure. Reading was repeated after 5 minutes. If the first two readings differ by more than 5 mm of Hg, additional readings were obtained and averaged. Classification of hypertension was done as per the JNC-VII guidelines. Anthropometric measurement like weight and height were also recorded. BMI was calculated using height and weight and it was used for classifying women as normal weight, overweight and obese. Data was analyzed using SPSS 16 software. Data is expressed as proportion or percentage, association between various factors and hypertension was assessed using chi-square test and p value of Englishhttp://ijcrr.com/abstract.php?article_id=1020http://ijcrr.com/article_html.php?did=1020
Bhalwar R, Vaidya R, Tilak R, Gupta R, Kunte R. Textbook of public health and community medicine. 1st ed. Pune: Department of community medicine armed forced medical college; 2009. p.1216-9.
Park K. Textbook of preventive and social medicine. 22nd ed. Jabalpur: Banarsidas Bhanot; 2013. p. 344-8.
World Health Organization, “Reducing risks, Promoting Healthy Life,” type, World Health Report, Geneva, Switzerland, 2002.
Gupta R. Trends in hypertension epidemiology in India. Journal of Human Hypertension 2004; 18(2):73–78.
Yadav S, Boddula S, Genitta G, Bhatia V, Bansal B, Kongara S. Prevalence and risk factors of pre-hypertension and hypertension in an affluent north Indian population. Indian J Med Res 2008 Dec; 128:712-20.
Bharati DR, Nandi P, Yamuna TV, Lokeshmaran A, Agarwal L, Singh JB et al. Prevalence and covariates of undiagnosed hypertension in the adult population of puducherry, south india. Nepal Journal of Epidemiology 2012;2(2): 191-99.
Kannan L, Satyamoorthy TS. An epidemiological study of hypertension in a rural household community. Sri Ramachandra Journal of Medicine 2009 Jun; 2(2): 9-13.
Sidhu S, Kumari K, Prabhjot. Socio-demographic variables of hypertension among adult Punjabi females. J Hum Ecol 2005; 17(3): 211-5.
Rao PSS, Inbaraj SG, Subramaniam VR. Blood pressure measures among women in south India. Journal of Epidemiology and Community Health 1984; 38: 49-53.
Madhukumar S, Gaikwad V, Sudeepa D. An epidemiological study of hypertension and its risk factors in rural population of bangalore rural district. Al Ameen J Med Sci 2012; 5(3):264 -70.
Thawornchaisit P, Looze F, Reid CM, Seubsman S, Sleigh AC. Health risk factors and the incidence of hypertension: 4-year prospective findings from a national cohort of 60569 Thai Open University students. BMJ Open 2013; 1-10.
Raina DJ, Jamwal DS. Prevalance study of overweight/obesity and hypertension among rural adults. Jkscience journal 2009 Jan; 11(1): 20-23.
Janet WH, Li S, Emmy MY, Zheng Y, Wu Z, Jin J et al. Prevalence and risk factors associated with prehypertension: Identification of foci for primary prevention of hypertension. Journal of Cardiovascular Nursing 2010; 25 (6): 461-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareAN EXTREMELY RARE REPORT OF VARIOUS LIGHT MICROSCOPIC IMAGES AND FEATURES OF FEMALE ANCYLOSTOMA DUODENALE FOUND WHILE DOING ENDOSCOPY IN A PATIENT WITH SEVERE ANAEMIA
English3338Govindarajalu GanesanEnglish Latha RagunathanEnglish Kavitha KannaiyanEnglishBefore the introduction of upper gastro intestinal endoscope, the only way to diagnose hookworm infection is by doing stool examination for hookworm ova. But after the introduction of upper gastro intestinal endoscope there has been many reports of finding live adult hookworms in duodenum and rarely in stomach while doing endoscopy. Hence upper gastro intestinal endoscopy is an extremely useful investigation to demonstrate and diagnose the presence of live adult hookworms especially in patients with severe anaemia. One such adult hookworm retrieved out while doing endoscopy in a patient with severe anaemia in our institute was examined under light microscope and was identified as female Ancylostoma duodenale. Various light microscopic images and features of this hookworm and the scientific facts by which the hookworm was identified as female Ancylostoma duodenale are described below in detail as such reports are extremely rare in the literature.
Englishupper gastro intestinal endoscopy, adult hookworms, light microscopic images, severe anaemia.INTRODUCTION
By doing stool examination only hookworm ova and its larvae can be seen after culturing the ova. Hence upper gastro intestinal endoscopy is the only possible investigation to demonstrate and diagnose the presence of live adult hookworms which are commonly seen in the duodenum (1-9) and rarely in stomach (10-11). Moreover while doing upper gastro intestinal endoscopy these adult hookworms can be retrieved out using biopsy forceps and can be studied in detail by examining them under light microscope (2,3, 6-11). Such study of the adult hookworms reveal important scientific facts about these hookworms which are described below in detail.
CASE REPORT
When Upper Gastro-intestinal Endoscopy was done for a 47 year old female patient with severe anaemia in our institute, multiple adult hookworms were found in the first part of duodenum. One of the hookworms was retrieved out using biopsy forceps and immediately sent for microbiological examiniation. After detailed examination of the hookworm under light microscope, the hookworm was identified as female Ancylostoma duodenale. The scientific facts about how to identify a hookworm as Ancylostoma duodenale or Necator americanus and how to identify a hookworm as male or female hookworm by examination under light microscope are described below in detail. Such detailed description of the various light microscopic images and features of an adult hookworm retrieved out while doing endoscopy are extremely rare in the literature.
DISCUSION
There has been many reports of finding live adult hookworms in duodenum while doing endoscopy especially in patients with severe anaemia(6-9). Similarly multiple adult hookworms were found in the first part of duodenum while doing endoscopy in a 47 year old female patient with severe anaemia in our institute. One of the hookworms was retrieved out using biopsy forceps in order to study about the hookworm in detail. Grossly by examination with the naked eye the hookworm was found to be very thin and small measuring only about 10mm in length. The hookworm was also found to be white in colour and was exactly looking like a small cotton thread (12). Hookworm belongs to the Phylum nematoda and nematoda means thread like. But by examination with the naked eye it is impossible to identify whether the hookworm is Ancylostoma duodenale or Necator americanus and whether the hookworm is a male or female hookworm. Hence the hookworm was immediately transferred to the microbiology department in order to study the hookworm in detail under light microscope.
Under light microscope, by looking at the head and the buccal cavity of the hookworm we can identify whether the hookworm is Ancylostoma duodenale or Necator americanus and by looking at the tail of the hookworm we can identify whether the hookworm is a male or female hookworm. Under light microscope we can identify Ancylostoma duodenale by the presence of sharp cutting teeth in its buccal cavity (12-14,16-18) which are absent in Necator americanus (Fig 1,2). In Necator americanus the buccal cavity has semilunar cutting plates (8,9,12-18) instead of the sharp cutting teeth. But the tail of both Ancylostoma duodenale and Necator americanus has almost similar features. In both the species the tail of the male hookworm has a broad, expanded copulatory bursa which gives the characteristic broad and expanded shape to the tail of the male hookworm (9,12,14,16-19). In both the species the tail of the female hookworm does not have the broad, expanded copulatory bursa and hence the tail of the female hookworm is narrow and pointed with tapered end (12,14,16-19) (Fig 3,4).
The hookworm of our patient was identified as Ancylostoma duodenale by the presence of sharp cutting teeth in its buccal cavity (Fig 1,2). The hookworm was also identified as female Ancylostoma duodenale due to its narrow and pointed tail with tapered end because of the absence of the broad, expanded copulatory bursa (Fig 3,4). In the tail of this female hookworm, a distinct notch is seen clearly (9,17) distal to which the tail becomes extremely narrow and pointed/ tail/ with tapered end(Fig 3,4). This notch is nothing but the anus of the female hookworm (17) which is an extremely important microscopic landmark in the tail of the female hookworm.(Fig 3,4).
There is a marked difference in the opening of anus between the male and the female hookworm. In the tail of the male hookworm we can see three important structures, the anus, the male genital opening- both of which open together in the cloaca and the broad copulatory bursa (17-19). But in the tail of the female hookworm we can see only one important structure -the anus alone (17-19)(Fig 3,4). The female genital opening or vulva opens separately away from the anus higher up in the body of the female hookworm(12,16-19). The broad, expanded copulatory bursa which gives the characteristic broad and expanded shape to the tail of the male hookworm is also absent in the tail of the female hookworm. Since the tail of the female hookworm neither has the female genital opening or vulva nor has the broad copulatory bursa and has only the anus, it is narrow and pointed with tapered end(12,14,16-19).(Fig 3,4)
The sharp cutting teeth of Ancylostoma duodenale or the semilunar cutting plates of Necator americanus are used to attach the hookworms to the intestinal mucosa and suck blood by causing injury to the intestinal mucosa (14-17). A single Ancylostoma duodenale sucks upto 300 μl (0.3ml) of blood per day whereas a single Necator americanus sucks upto 40 μl (0.04) ml of blood per day (20-22). Thus the sharp cutting teeth of Ancylostoma duodenale cause more intestinal damage and suck more blood than the semilunar cutting plates of Necator americanus (9,15,20-22). Both the species suck blood by creating negative pressure by contractions of their esophageal muscles(15,23). The muscular oesophagus is present below the buccal cavity.(Fig 1).
The entire hookworm is covered by an extremely tough outer coat called the cuticle(17,19)(Fig 1,3). In the light microscopic images we can clearly see the striations of the cuticle lining the outer aspect of the hookworm(Fig 4). The cuticle protects the hookworm from the attack by the digestive enzymes of the host (human beings). The cuticle also protects the hookworm from the attack by the immune system of the host (human beings). Thus in addition to the sharp cutting teeth the cuticle also plays an extremely important role in contributing to the pathogenicity of the hookworm.
Only few extremely important scientific facts helpful for the identification of the species and the gender of the hookworm along with the two important causes of the pathogenicity of the hookworm namely the sharp cutting teeth and the cuticle are described in this article. But there are also various other light microscopic features of the hookworm which are not described in this article due its extensive nature. However by further detailed study of the various other light microscopic features of the hookworm, we can do extensive scientific research about adult hookworms in the future which can be of great use to the mankind.
CONCLUSION
By doing stool examination only hookworm ova and its larvae (after culturing the ova) can be seen and studied (14). Unlike Ascaris lumbricoides which are passed out in human faeces, adult hookworms are not passed out in human faeces. Hence it is impossible to see and study the adult hookworms by doing stool examination. Hence upper gastro intestinal endoscopy is the only possible investigation to demonstrate and diagnose the presence of live adult hookworms especially in patients with severe anaemia. Moreover while doing upper gastro intestinal endoscopy these adult hookworms can be retrieved out using biopsy forceps and can be studied in detail by examining them under light microscope. In addition to the identification of the species and the gender of the hookworm, by doing such detailed study of the adult hookworms under light microscope, we can do extensive scientific research about adult hookworms in the future which can be of great use to the mankind.
Englishhttp://ijcrr.com/abstract.php?article_id=1021http://ijcrr.com/article_html.php?did=1021
, T. I., Emara, M. H., Darweish, E., Abdul-Fattah, M., Bihery, A. S., Refaey, M. M., and Radwan, M. I. Detection of Parasites During Upper Gastrointestinal Endoscopic Procedures. Afro-Egypt J Infect Endem Dis 2012; 2 (2): 62-68.
LEE, T.-H., YANG, J.-c., LIN, J.-T., LU, S.-C. and WANG, T.-H. Hookworm Infection Diagnosed by Upper Gastrointestinal Endoscopy: —Report of Two Cases with Review of the Literature—. Digestive Endoscopy, 1994 6(1): 66–72 :
Nakagawa Y, Nagai T, Okawara H, Nakashima H, Tasaki T,Soma W, et al. Comparison of magnified endoscopic images of Ancylostoma duodenale (hookworm) and Anisakis simplex.Endoscopy 2009;41(Suppl. 2):E189.
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helminthic infection. Gastrointest Endosc May 2008;67(6) 990-992.
Mahadeva S, Qua C-S, Yusoff W, et al. Repeat endoscopy for recurrent iron deficiency anemia: an (un)expected finding from Southeast Asia. Dig Dis Sci 2007;52:523–525.
Yang-che Kuo, Chen-Wang Chang, Chih-Jen Chen, Tsang-En Wang, Wen-Hsiung Chang, Shou-Chuan Shih. Endoscopic Diagnosis of Hookworm Infection That Caused Anemia in an Elderly Person. International Journal of Gerontology 4 (2010) 199-201
Wu KL, Chuah SK, Hsu CC, Chiu KW, Chiu YC, Changchien CS. Endoscopic Diagnosis of Hookworm Disease of the Duodenum: A Case Report. J Intern Med Taiwan 2002;13:27-30.
Hyun HJ, Kim EM, Park SY, Jung JO, Chai JY, Hong ST . A case of severe anemia by Necator americanus infection in Korea. J Korean Med Sci. 2010 Dec;25(12):1802-4. Epub 2010 Nov 24
Thomas V, Jose T, Harish K, Kumar S. Hookworm infestation of antrum of stomach. Indian J Gastroenterol 2006 May-Jun;25(3):154
Surinder S. Rana,Deepak K. Bhasin,Saroj K. Sinha, Endoscopic diagnosis of chronic severe upper GI bleeding due to helminthic infection,Gastrointest Endosc 2008;68(5):1028
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Ranjan L. Fernando. Tropical Infectious Diseases: Epidemiology, Investigation, Diagnosis and Management 2001:91to93.
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Satish Gupte. The Short Textbook of Medical Microbiology ninth edtion 2006-page 415-416.
Heinz Mehlhorn, Encyclopedic Reference of Parasitology: Biology, Structure, Function, Volume 1 second edition 2001 page 292, 394-414.
Burton J. Bogitsh, Clint E. Carter, Thomas N. Oeltmann . Human Parasitology third edition2005. page 300-312,338-346
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Chen TH, Chen TY, Shyu LY, Lin CK, Lin CC Hookworm infestation diagnosed by capsule endoscopy (with video) Gastrointest Endosc August 2006;64(2): 277-278.
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Vijant Singh Chandail, Vinu Jamwal Hookworm Sucking Human Blood Journal of Digestive Endoscopy 2012; 3(1):22.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareEFFECT OF SHIFT WORK ON RISK FACTORS OF CARDIOVASCULAR DISEASES
English3945Hemamalini R.V.English Arpita PriyadarshiniEnglish Saravanan A.EnglishIntroduction: Due to rapid technological development, shift workers are continuously increasing. Shift workers are subjected to altered circadian rhythm which might make them prone to cardiovascular disorders. Aim: To examine whether longer duration of shift work increases the risk factors for cardiovascular disorders and also to compare it with day workers. Materials & Methods: 50 male industrial workers and security guards at Burla, who did night shift for atleast 1 year and 50 day workers who did not do night shift in the last 2 yrs were involved in the study. The various risk factors such as body mass index, blood pressure, lipid profile, atherogenic indices were estimated at the beginning of the study in both night and dayshift workers. Dietary pattern was not altered during the period of the study. Result: Study revealed that shift work significantly increase the risk of cardiovascular diseases. BMI, BP & atherogenic indices were found to be significantly increased in night shift workers when compared to day workers. Among the night shift workers, at the end of 3 years follow up, risk further increased to higher level. Conclusion: Night shift workers are at higher risk for developing cardiovascular diseases.
EnglishShift workers, body mass index, blood pressure, lipid profile, atherogenic indices, cardiovascular diseaseINTRODUCTION
In this modern environment life style is changing the circadian rhythm of the body by mode of shift work.shift work involves work at times other than normal daylight hours . The number of persons doing shift work appears to be increasing. [1] In normal individuals living on a day-oriented schedule, it is hypothesized that a harmonious relationship between homeostatic and circadian processes serves to promote uninterrupted bouts of 8 h of sleep and 16 h of wakefulness per day. When sleep is displaced, the normal phase relationship between the sleep / wake cycle and the endogenous circadian pacemaker is perturbed.[2]
Shift work is accompanied by a greater incidence of many medical disorders, such as cardiovascular, gastro-intestinal, and neurological disorders [3,4].
Cardiovascular diseases take a huge toll on our society. Atherosclerosis is the leading cause of heart attacks, strokes and peripheral vascular disease.
Atherosclerosis starts when high blood pressure or high cholesterol damage the endothelium. LDL
crosses the damaged endothelium. The cholesterol enters the wall of the artery. Due to focal increase in the content of lipoproteins within the regions of the intima, fatty streak develops which represents the initial lesion of atherosclerosis.[5] Over years, there is formation of plaque in the wall of the artery. Of the various atherogenic indices, TG/HDL ratio is the best predictor of coronary heart disease.
Atherosclerosis usually causes no symptoms until middle or older age. Once narrowings become severe, they cause pain. Blockages can also suddenly rupture, causing blood to clot inside an artery at the site of the rupture.
In Shift workers lipid metabolism is altered. They develop hyperlipidemia [6,7]. This increases the risk for atherosclerosis.
So, this study was primarily undertaken to see whether longer duration of shift work increases the risk factors for cardiovascular diseases such as blood pressure, atherogenic indices ,lipid profile and body mass index or the workers get adapted to this pattern of work in due course of time.
MATERIAL AND METHODS
This cohort study was conducted on an outpatient basis at Department of Physiology, V.S.S Medical college, Burla with the help of Department of Biochemistry.
Industrial workers and security guards undergoing shift duties at Burla were involved in the study. 50 were shift workers who did rotating shifts for atleast 1 year and 50 were day workers who did not undergo shift duties for the past 2 years.
After getting institutional ethical clearance, informed consent was obtained from all volunteers.
At the beginning of our study, Subjects filled out a questionnaire with questions about their working condition ,smoking habit, diet, family history of hypertension, diabetes mellitus, hyperlipidemia, hypothyroidism. Individuals undergoing shift duties were followed for 3 years. Bloodpressure, height, weight, BMI of all subjects were recorded at the beginning & at the end of 3 yrs of follow up.
Blood pressure was measured in the sitting position after 5 minutes rest. Hypertension was defined as having a systolic blood pressure of 140 mmHg or more, or a diastolic blood pressure of 90 mmHg or more. Body weight was measured in light indoor clothing and recorded to the nearest Kg. Height was measured to the nearest centimeter without shoes. Body mass index (BMI) was calculated as weight (Kg) divided by height (m2). Those with a BMI of 30 or more were classified as obese.
EXCLUSION CRITERIA
Subjects suffering from any endocrine, hepatic, renal disease, hypertension, diabetes, cardiopulmonary disease
Those with history of drug intake - beta blockers, lipid lowering drugs, alcohol intake
Those who are chronic smokers and obese were excluded from the study.
SELECTED CASES
Only males within the age group of 25-40 yrs were involved in the study. These individuals were followed up for 3 yrs. During these periods drop outs were 8 in number among shift workers .This is because some got transferred to other place.
BIOCHEMICAL ANALYSIS
Estimation of serum lipid & atherogenic ratios
The serum was analysed for lipid profile. Serum Total cholesterol, Triglycerides, LDL, VLDL and HDL-cholesterol concentration were estimated after 12-hours fasting by using auto analyzer. Risk of dyslipidemia was assessed based on the guidelines followed by American association of clinical endocrinology.
The atherogenic ratios TG/HDL, TC/HDL & LDL/HDL were estimated. The degree of risk was assessed based on Framinghams heart study.
STATISTICAL ANALYSIS
Analysis of data was done with the help of SPSS version 16 soft ware package. Datas were presented as Mean ± Standard Deviation.
UnPaired student’s t test was done to compare the means between two groups. Paired students’t test was done to compare the means between the same group. Pearson correlation analysis was done to correlate between the two variables.p value Englishhttp://ijcrr.com/abstract.php?article_id=1022http://ijcrr.com/article_html.php?did=1022
Masoumeh Ghiasvand,Ramin Heshmat,Reza Golpira:shift work and risk of lipid disorders,American Journal of Epidemiology,2006
Pati AK,Chandrawshi A, Reinberg A. Shift work: consequence and management. Curr Sci. 2002;81:32–4
Williams C: Social factors, work, stress and cardiovascular disease prevention in the European Union Brussels: The European Heart Network;1998
Sjoblom TS, Kalimo R, et al.: Shift work, occupation and coronary disease – over 6 years of fallow up in the Helsinki heart study. Scand J Work Environ Health 1997, 23(4):257
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Rivera-coll A, Funtes-Arderiu L, Diez-Noguera A. Circadian rhythmic variation in serum concentration of clinically important Lipids. Clin Chem. 1994;40:1549–1553
Nakamura K, Shimai S, Kikuchi S, Tominaga K,Takahashi H, Tanaka M, Nakano S, Motohashi Y, Nakadaira H, Yamamoto M (1997) Shift work and risk factors for coronary heart disease in Japanese blue-collar workers: serum lipids and anthropometric characteristics. Occup Med ( Lond) 47, 142.
Koller M. Health risks related to shift work. Int Arch Environ Health.1983;53:59-75.
Angersbach D, Knauth P, Loskant H, Karvonen MJ, Undeutsch K, Rutenfranz J. A retrospective cohort study comparing complaints and diseases in day and shift workers. Int Arch Occup Environ Health. 1980;45:127-140
Taylor PJ, Pocock SJ. Mortality of shift and day workers, 1956-68. Br J Ind Med. 1972;29:201-207.
Knutsson A, Akerstedt T, Jonsson BG, Orth-Gomer K. Increased risk of ischaemic heart disease in shift workers. Lancet. 1986;2:89-92.
Lamon-Fava S, Wilson PW, Schaefer EJ: Impact of body mass index on coronary heart disease risk factors in men and women. The Framingham Offspring Study.Arterioscler Thro Vasc Biol. 1996 Dec;16(12):1509-15.
Short sleep duration andweight gain: a systematic review. Obesity (Silver Spring). 2008; 16:643-536.
Pickering TG (2006) Could hypertension be a consequence of the 24/7 society? The effects of sleep deprivation and shift work. J Clin Hypertens 8: 819–822
Suwazono Y, Dochi M, Sakata K, Okubo Y, Oishi M, et al. (2008) Shift work is a risk factor for increased blood pressure in Japanese men: a 14-year historical cohort study. Hypertension 52: 581–586. Hublin C, Partinen M, Koskenvuo K, Silventoinen K, Koskenvuo M, et al.(2010) Shift-work and cardiovascular disease: a population-based 22-year follow-up study. Eur J Epidemiol 25: 315–323.
Drexel H, Aman FW, Rentschk, et al. Relation of the level of high density Lipoprotein subfraction to the presence and extent of coronary artery disease. Am J Cardiol. 1992;70:436–440.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareSUPRASCAPULAR NOTCH VARIATIONS AND ITS CLINICAL SIGNIFICANCE
English4650Aradhyula HimabinduEnglish B. NarasingaRaoEnglish Nihar SannalaEnglishAim: The suprascapular nerve that lies in the suprascapular notch of scapula requires special attention as it supplies muscles which initiate abduction of the shoulder. From its origin in the upper trunk of the brachial plexus, the suprascapular nerve passes through the suprascapular notch to supply the supraspinatus later it passes through the spinoglenoid notch to supply the infraspinatus. During its course there is a chance of entrapment of the nerve in the suprascapular notch due to its different shapes and dimensions which leads to suprascapular nerve entrapment syndrome. Materials & Methods: The present study was done on 43 dried human scapulae. The suprascapular notch was observed in each bone to find out variations in its shape. Results: This study showed three different types of suprascapular notches. The scapulae showed U, V, & J shaped notches, foramen formed by ossification of the transverse scapular ligament, and coexistence of notch and foramen due to ossification of the anterior coracoscapular ligament. Conclusion: These variations in the suprascapular notches are a great help to clinicians for early diagnosis of suprascapular nerve compression.
Englishscapula, suprascapular nerve, suprascapular notch, transverse scapular ligamentINTRODUCTION
The scapula is a flat bone of shoulder girdle that lies on the posterolateral aspect of the thorax. In the superior border of scapula, there is a suprascapular notch which is bridged by transverse scapular ligament converting into foramen. The suprascapular nerve passes through this foramen and supplies the supraspinatus and infraspinatus which initiate abduction movement. The variations in the shape and dimensions of the suprascapular notch associated with partial or complete ossification of the superior transverse scapular ligament lead to compression of nerve in the notch against the suprascapular ligment during abduction leading to suprascapular nerve entrapment syndrome. Koepell and Thomson were the first to describe the suprascapular nerve entrapment syndrome.(1) Many authors proposed different classifications . Based on the shape Ticker and collegues (2) defined two types of suprascapular notches-U&V and Iqbal (3) defined three types-U, V&J.
A new classification based on parameters such as vertical and transverse diameters of suprascapular notch was proposed by Natsis et al (4). The present study is done on the basis of classification proposed by Iqbal and Natsis et al. These variations will help the clinicians to determine the type of notch and the possibility of suprascapular nerve entrapment.
MATERIALS AND METHODS
The study is conducted on 43 dried scapula of both sides from the department of anatomy, Maharaja’s Institute of Medical Sciences, Nellimarla, Vizianagarum. Variations in the shapes of suprascapular notch were noted. The vertical and transverse dimensions were measured to classify the notch according to Natsis et al. Transverse diameter is the distance between the two edges of the notch and vertical diameter is the distance between the deepest point of the notch to the midpoint of the line joining the two edges of suprascapular notch.
OBSERVATIONS
The present study followed the classifications of Iqbal (3) and Natsis et al (4) to read the suprascapular notch in detail. In this study three different types of notches are observed along with partial or complete ossification of transverse scapular ligament.
The scapulae are grouped depending on the shape of the notch following the Iqbal classification. Of these scapulae, 29 showed U shaped, 5 J shaped and 3 V shaped suprascapular notches (Fig.1)
But in this classification the author did not mention ossification of the transverse scapular ligament, where two bones with U shaped notches showed partial ossification on the medial side of the notch, five bones showed complete ossification and one bone showed a rare feature of coexistence of notch and foramen. In this last bone, an ossified band is seen extending from root of coracoid process to the middle of suprascapular notch forming a foramen below the band and notch above the band.
The present study also followed the Natsis et al classification that was based on the dimensions of the suprascapular notch. This study observed 3 scapulae without a discrete notch (Type I), 26 scapulae showed notches where transverse diameter is more than vertical (Type II), in 8 scapulae vertical diameter is more than transverse diameter (Type III), 5 scapulae had ossification of transverse scapular ligament converting the notch into foramen (Type IV) and only one scapula presented with coexistence of notch and foramen(Type V). (Fig.2)
DISCUSSION
Many authors classified SSN based on certain parameters.
Based on gross examination of its shape, Ticker and collegues (2) described only two types of notches- U& V and Iqbal (3) defined three types-U, V & J.
Depending on the inferior shape of suprascapular notch and the degree of ossification, Rengachary et al(5) classified SSN into six types.
Type I- Wide depression in the superior border of the scapula
Type II- Wide blunted V shape, Type III- Symmetric U shape
Type IV-Very small V shape, often with a shallow groove for the suprascapular nerve
Type V- Partial ossified medial portion of the suprascapular ligament
Type VI- Completely ossified suprascapular ligament
The present study not followed this classification as there is no description of coexistence of notch and foramen.
Natsis et al (4) proposed a simple classification based on the vertical and transverse dimensions of the notch.
Type I- without a discrete notch,
Type II- a notch that was longest in its transverse diameter,
Type III- a notch that was longest in its vertical diameter,
Type IV- a bony foramen
Type V- a notch and a bony foramen
The size of the suprascapular notch plays a role in the impingement of the nerve in the notch. A small notch has higher chances of suprascapular nerve entrapment than a large notch (5). In various cases it was identified that partial or complete ossification of the transverse scapular ligament is the predisposing factor for suprascapular nerve entrapment (2, 6, 7). As the ossified ligament decreases the size of the notch and reduces the space available to the nerve, there is a higher chance of suprascapular nerve entrapment (8). The rare occurrence of the coexistence of suprascapular notch and foramen was first reported by Hrdicka (9) in 1942. Later Natsis et al.(4) reported this feature in his study on 423 dried scapulae. Sinkeet et al.(8) described one case suprascapular notch and foramen in his study on Kenyan population.
The present study predominantly showed Natsis type II suprascapular notches where the transverse diameter is more than the vertical diameter and Iqbal U- shaped notches. In this type of notch there was less chance of suprascapular nerve entrapment syndrome as more space is available for the suprascapular nerve. Along with this the present study also showed a scapula with an ossified transverse suprascapular ligament and that a bone with a rare feature of coexistence of notch &foramen (anomalies). These cases are more prone to suprascapular nerve entrapment due to narrowing of the space for the suprascapular nerve which irritates the nerve during different shoulder movements. (5)
Avery et al (10) first described an additional fibrous band anterior coracoscapular ligament in American population. It is arranged either parallel or obliquely to superior transverse scapular ligament in the suprascapular notch. Later Bayramogluet al(11) found this in Turkish population and recently Piyawinijwong et al (12)in Thai population.
Based on anatomical findings of Avery et al (10), Michal Polgrej.et al.(13) explained the cause for the coexistence of notch and foramen. If ossification occurs only in anterior coracoscapular ligament without affecting superior transverse scapular ligament, it leads to coexistence of notch and foramen reducing the space for the nerve. So the nerve is irritated by the bony margins and increases the risk of suprascapular neuropathy.
CONCLUSION
The suprascapular nerve is closely related to the superior border of the scapula as it passes through the suprascapular notch to innervate muscles. Due to variations in the shape of the notch and ossification of the suprascapular ligament the space available to the nerve decreases leading to suprascapular nerve entrapment syndrome. This causes pain over the shoulder as the nerve supplies the supraspinatus and infraspinatus which initiates abduction of shoulder joint. The present study described different types of suprascapular notches. Of these, U shaped notches have lower chances and ossified transverse scapular ligament have higher chances of impingement of the suprascapular nerve. These anatomical variations can be defined by plain radiographs, so that, the clinicians can easily correlate the nerve entrapment with the type of notch.
Englishhttp://ijcrr.com/abstract.php?article_id=1023http://ijcrr.com/article_html.php?did=1023
Kopell HP, Thompson WA. Pain and the frozen shoulder. Surg Gynecol Obstet 1959;109: 92-96.
Ticker JB, Djurasovic M, Strauch RJ, April EW, Pollock RG, Flatow EL et al. The incidence of ganglion cysts and variations in anatomy along the course of the suprascapular nerve. J. Shoulder Elbow Surg. 1998; 7(5):472-8.
Iqbal K, Iqbal R, Khan SG. Anatomical variations in shape of suprascapular notch of scapula. J. Morphol. Sci. 2010; 27:1-2.
Natsis K, Totlis T, Tsikaras P, Appell HJ, Skandalakis K. Proposal for classification of the suprascapular notch: a study on 423 dried scapulas. Clin. Anat. 2007; 20:135-139.
Rengachary SS, Burr D, Lucas S, Khatab HM, Mohn MP, Matzke H. Suprascapular entrapment. neuropathy: a clinical,anatomical and comparative study, Part 2: anatomical study. Neurosurg. 1979; 5:447-451
Alon M, Weiss S, Fishel B, Dekel S. Bilateral suprascapular nerve entrapment syndrome due to an anomalous transverse scapular ligament. Clin Orthop 1998; 234:31-33.
Cohen SB, Dines DM, Moorman CT. Familial calcification of the superior transverse scapular ligament causing neuropathy. Clin Orthop 1997; 334:131-135.
S.R. Sinkeet, K.O. Awori, P.O. Odula, J.A. Ogeng’o, P.M. Mwachaka The suprascapular notch: its morphologyand distance from the glenoid cavityin a Kenyan population Folia Morphol.Vol. 69, No. 4, pp. 241–245
Hrdicka A (1942) The adult scapula: additional observations and measurements. Am J Phys Antropol 29:363–415
Avery BW,Pilon FM,Barclay JK Anterior coracoscapular ligament and suprascapular nerve entrapment.Clin Anat 2002,15:383-386
Bayramog?lu A, Demiryu¨rek D, Tu¨ccar E, Erbil M, Aldur MM, TetikO, Doral MN (2003) Variations in anatomy at the suprascapularnotch possibly causing suprascapular nerve entrapment: ananatomical study. Knee Surg Sports Traumatol Arthrosc11:393–398
Piyawinijwong S, Tantipoon P (2012) The anterior coracoscapularligament in Thais: possible etiological factor of suprascapularnerve entrapment. Siriraj Med J 64:S12–S14
Michal Polguj.Kazimierz Jedrzejewski.Agata Majos.Miroslaw Topol Coexistance of the suprascapular notch and the suprascapular foramen-a rare anatomical variation and a new hypothesis on its formation based on anatomical and radiological studies Anat Sci Int 2013 88:156-162.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcarePREVALENCE AND RISK FACTORS OF MALARIA PARASITAEMIA IN FEBRILE CHILDREN WITH SICKLE CELL DISEASE IN NORTH CENTRAL NIGERIA
English5157James G. DamenEnglish Obinwa C. UdokaEnglish Dapus DamulakEnglish OkpeEnglish S.E. EnglishBackground: Malaria is endemic in Nigeria and sickle cell disease is very common in Nigeria and it is believed that malaria is the common cause of morbidity and mortality in children with sickle cell disease (SCD) in our environment as a result malaria prophylaxis is always recommended for them. The study was meant to determine the prevalence, risk factors and effect of malaria in sickle cell disease children. Methods: We recruited 200 febrile children with sickle cell disease and another 200 febrile non sickle cell disease children as control into the study. Two miles of their blood were collected and both thin and thick blood films were made on the same slide, stained by Giemsa methods and examined microscopically. Parasite densities were also determined and packed cell volume (PCV) were enumerated. Results: The study showed that the prevalence of malaria in febrile SCD was 49.0% and 61.0% in non SCD. The PCV of ?20% recorded the highest prevalence of 66.7% while the least prevalent of 41.1% malaria was recorded PCV ?40. In the non SCD the highest prevalent of 63.0% and the least prevalent 56.4%. SCD below 5yrs recorded the highest prevalent of 47.7% malaria while the least 20% malaria ?15yrs. In the non SCD ?5years recorded the highest prevalent while the least was 63.9% malaria. There 108 SCD males examined but 56(51.9%) were positive, while of the 112 non SCD males examined, 69(61.6%) were positive. Of the 98 SCD females examined, 42(42.9%) were positive and 88 non SCD female examined, 53(60.2%) were positive. Of the 73 SCD that uses LLINs, 21(28.8%) were positive while 127 do not used LLINs and had 77(60.0%) malaria, non SCD 51 uses LLINs, 23(45.1%) were positive for malaria, 149 without LLINs had 66.4% malaria. There was no malaria in SCD and non SCD that use insect repellants while 198 SCD that do not use repellants had 98(49.5%) malaria. SCD using door screen had 21.3% and without had 71.2% malaria, while non SCD had 32.6% and those without had 86.7%. SCD on malaria prophylaxis had 33.6% malaria, while without had 60.5% positive. Non SCD using prophylaxis had 23.5% malaria and without 64.5%malaria. SCD that take indigenous herbs at home had 56.9% malaria while without herbs had 40.8%malaria, non SCD that take indigenous herbs at home had 22.8% malaria and without had 93.5% malaria. Conclusion: We conclude that non sickle cell disease febrile children are more susceptible to malaria and have higher parasite densities than sickle cell disease febrile children studied. Therefore we recommend that malaria prophylaxis should not be limited to sickle cell disease children but to all children regardless of their genotype.
EnglishFebrile, malaria, children, sickle cell disease.INTRODUCTION
Malaria is a parasitic disease affecting red blood cells and is transmitted to human by infected female anopheles mosquitoes, malaria still rank as the number one killer disease in Africa, children, pregnant women, sickle cell anaemia patients, people in emergency situations and people living with HIV/AIDS are particularly vulnerable to malaria infection.1,2 Malaria is believe to be a major cause of morbidity in sickle cell disease (SCD) patients, it is a precipitating factor for the frequent vaso oclusive crises experienced by these patients3. Globally, some 300,000 children are born with sickle cell disease every year4. More than three quarters of these children are born in sub-Saharan Africa, where in the absence of interventions, their mortality remains high5,6. Although the sickle cell trait (i.e. hemoglobin genotype AS (HbAS) is known to protect against clinical malaria, it is widely believed that malaria is a major risk factor for death among children with SCD who are born in malaria-endemic areas7–9.
MATERIAL AND METHODS
The study was carried out in Emergency pediatric unit, ward 8 and pediatric outpatient department (POPD) of Jos University Teaching hospital north central Nigeria. The study populations were febrile children with sickle cell disease (SCD) while the controls were febrile non SCD febrile children. The children were within the ages of 6 months to 18 years. Ethical clearance was obtained from the Institutional health research ethical committee of Jos University Teaching Hospital before commencement of the study. Informed consent of the parents or guardians were obtained from both the subjects and the controls. A questionnaire was administered to each child of the consented parent or guidance; information required were demographic data, genotype results were obtained from case record note, temperature, history of malaria attack, history of chemoprophylaxis, use of long lasting insecticidal nets LLINs, repellants and door/window screens were obtained and recorded appropriately.
The method of sample collection employed was vene puncture technique.10, 11, 12 Both thick and thin blood films were prepared according to the technique11 from each blood on the same clean grease-free slide using the WHO blood film template, they were allowed to air dried and stained using 3% Giemsa stain solution for 30 minutes as describe by 13 and examined under immersion oil objective of binocular microscope. Speciation of the malaria parasites were done on the thin blood films while the parasite density was carried out on the thick blood films.
RESULTS
The results showed that prevalence of malaria parasitaemia reduces with increase in PCV of both subjects and the controls, this was indicated in the Three of the subjects with PCV of less than 20% had the highest prevalence of 66.7% malaria parasitaemia in the controls while there was no control with this same PCV, this was followed by 48.2% recorded by 144 with PCV of 21 to 30% and 63.0% in the corresponding controls and the least prevalence of malaria was recorded in both the subjects and controls among those that had the PCV of 31-40%, the subjects had 41.1% while the control had 56.4%. The finding of this study showed that malaria parasitaemia prevalence reduces with age in the controls while in the subjects the highest prevalence of 57.0% was recorded by those below the age of 5 years followed by 47.7% by 11 – 15 years then 41.5% by 6-10 years old while the least prevalence of 20% was recorded by those above 15years. The control had 81.7% with those within the age group of ≤ 5 years this was followed by 6-10years 70.4%, 11-15 years 63.9% those above 15 years recorded no infection. In the subjects 108 males were examined, 56(51.9%) were positive, while of the 112 males control examined, 69(61.6%) were positive. Of the 98 females subject examined, 42(42.9%) were positive and 88 female control examined, 53(60.2%) were positive. In this study of the 73 subjects that uses long lasting insecticidal net, 21(28.8%) were positive while 127 do not used LLINs and had 77(60.0%)for malaria, in the control only 51 uses LLINs, 23(45.1%) were positive for malaria, 149 without the use of LLINs had 66.4% prevalence. In the subjects only 2 that uses insect repellants and had no infection, while the 198 that do not use repellants had 98(49.5%) positive. There was only one control that used the repellant and had no infection. Of the 52 subjects that uses door screen, 23(44.2%) were positive, 148 do not used LLINs, 75(50.8%) were positive. In the control 56 uses LLINs 19(33.9%) were positive, 144 do not used LLINs 91(86.7%) were positive. The subjects had 89 that uses 19(21.3%) positive, 111 do not use window screen, 79(71.2%) were positive while of the 95 control that were not using window screen, 31(32.6%) were positive, the 105 that were not using LLINs, 91(86.7%) were positive for malaria. The subjects had 119 who were taken malaria prophylaxis, 40(33.6%) positive, 81 do not used prophylaxis, 49(60.5%) were positive while in the controls, of the 17 that uses prophylaxis, 4(23.5%) were positive and 183 that do not use prophylaxis, 118(64.5%) were positive . In the subjects 102 that always take drugs at home 58(56.9%) were positive, of the 98 that do not take drugs at home, 40 (40.8%) were positive, while 92 of the controls that takes drugs at home, 21 (22.8%) were positive and the 108 that do not take drugs at home, 101(93.5%) were positive.
DISCUSSIONS
The study gave a prevalence of 49% malaria parasitaemia in children with sickle cell disease and 61% in non sickle cell febrile paediatric patients attending Jos University Teaching Hospital. The results showed that children without sickle cell disease are more susceptible to malaria infection and have higher parasite densities than those with sickle cell disease; this finding is similar to previous study in South-South Nigeria14 who recorded 9% malaria parasitaemia in sicklers and 29% in non sicklers, also in South -West Nigeria15 24% and 43% in sicklers and non sicklers respectively. Malaria is widely considered a major cause of illness and death in patients living with SCA in sub-Saharan Africa8,9 but the finding of this study is revealing that patients with SCA have a level of immunity against malaria, this was demonstrated from the low prevalence of malaria infection and parasite densities in febrile sickle cell disease children as compared with the high prevalence of malaria and parasite densities
in febrile non sickle cell disease children. It was earlier known that there is partial protection against malaria by HbS particularly the heterozygous carriers (HbAS).16-18 However from our findings we are opined that the genotype of the homozygous (Hb SS) in which intracellular concentrations of HbS are considerably higher, might be associated with even greater protection. Our finding is also supported by studies that have investigated the mechanisms of malaria protection by HbS.19, 20 It was observed from the finding of this study that the prevalence of malaria parasitaemia decreases with increase in packed cell volume (PCV) of both the subjects and the control. Febrile sicklers patients with PCV of >20% had the highest prevalence of 66.7% malaria, while none of the non sicklers have malaria at this PCV. Sicklers with PCV of 21-30% had 48.2% malaria while their control counterpart had 63.0% malaria and for PCV of 30-40% they had 48.2% malaria while the non sicklers had 43.6% malaria, this finding might be associated with the fact that the pathogenesis of malaria infection is associated with haemolysis of the red blood cell leading to a decrease in the number of circulating red blood cells, which will result in anaemia. This finding is in agreement with 21 who reported that malaria is an important cause of anaemia. The study also showed that malaria was more prevalent on paediatric patient below the age of 5years in both sicklers and non sicklers, our findings are in concordance with those of 22. However febrile sickle cell disease children less than 5years old have a lower prevalent compared with their counterpart non sickle cell disease. This finding corresponds with the results of 23. This might be associated to their low immune status towards infections. We also observed from the results that the prevalence of malaria decreases with increase in age of the children studied for both sicklers and non sicklers, this could probably be base on the understanding that as we grow in life our immunity tends to increase thereby conferring some level of protection against malarial infections. The study showed that males had 51.9% and 61.6% prevalence of malaria for both sicklers and non sicklers respectively. The prevalence of 42.9% and 60.2% malaria were recorded by sicklers and non sicklers female counterpart. This might be associated with the fact that males are more engage in outdoor activities thereby exposing them to frequent contact with the bites of the infected female anopheles mosquitoes this finding corresponds with the previous report.24 The study showed that the prevalence of malaria is higher in children that do not uses long lasting insecticidal nets than those that uses them in both the subjects and the control, this was in agreement reports of.25 also seen in children who uses repellants, door screens, window screens, prophylaxis and those that take herbs at home before going to the health care facility. It was generally concluded that there a reduction in the prevalent of malaria in both the sicklers and non sicklers children who uses some forms of protection against malaria. However, the best method for the control of malaria is by the use of multi dimensional approaches. We therefore make our conclusion that febrile non sicklers children are more susceptible to malaria infection and have higher parasites densities than febrile sicklers children in the study area.
ACKNOWLEDGEMENT
The authors wish to thank the parents and guardians of the children who have given consent on behalf of their children to be part of the studies. We are also grateful to the nurses in the various sites of the study for their cooperation. We are also thankful to the management of Jos University Teaching hospital for the ethical approval given to us for the study, We appreciates the staff of Parasitology laboratory of Jos University Teaching Hospital and Faith medical laboratories for the technical assistance rendered for this study.
Englishhttp://ijcrr.com/abstract.php?article_id=1024http://ijcrr.com/article_html.php?did=1024
National Center for infectious diseases, Division of parasitic Diseases Anopheles mosquitoes. April,23 2004. http://www.cdc.gov/malaria/biology/mosquito/
World Health Organization, 2007.WHO Fact sheet NO. 94. http//www.who.int/mediacentre/factsheets/fs094/en.
Kotila TR, Management of acute painful crises in sickle cell disease. Clin Lab Haem 2005; 27:221-3.
Modell B, Darlison M. Global epidemiology of haemoglobin disorders and derived service indicators. Bull. World Health Organ 2008; 86:480–7.
Fleming, AF, (1979). Abnormal haemoglobins in the Sudan savanna of Nigeria. Prevalence of haemoglobins and relationships between sickle cell trait, malaria and survival. Ann Trop Med Parasitol 1979; 73:161–72.
Molineaux L, Gramiccia G. (1980). The Garki Project: research on the epidemiology and control of malaria in the Sudan Savanna ofWest Africa. Geneva: World Health Organization, 1980.
Serjeant GR. Mortality from sickle cell disease in Africa. BMJ 2005; 330:432–3.
Diallo D, Tchernia G. Sickle cell disease in Africa. Curr Opin Hematol 2002; 9:111–6.19.
Fleming AF. The presentation, management and prevention of crisis in sickle cell disease in Africa. Blood Rev 1989; 3(1):18–28.
Okocha CEC, Ibeh CC, Ele PU, Ibeh NC (2005). Prevalence of malaria parasitaemia in blood donors in a Nigerian Teaching hospital. J. Vector-borne Dis. (142):21-24.
Cheesbrough M (2004) Distric laboratory practice in tropical countries Part 2. Cambridge University Press. Pp 357.
Amali, O.,Agada, BE., Awodi, N.O. and Etem, S. (2009). Malaria parasites among blood donors in Makurdi, Benue state, Nigeria. Nigerian Journal of Parasitology Vol. 30(20) 102-106.
Federal Ministry of Health (2007) A manual for laboratory diagnosis of malaria in Nigeria National Malaria and Vector Control Division Nigeria 47-59.
0kuonghae HO, Nwankwo MU. Offor E. Malarial parasitaemia in febrile children with sickle cell anaemia. J Trop. Paediatric. 1992; 38(2):83-85.
Rachel Kotila, Abiola Okesola and Olufunmilola Makanjuola (2007). Asymptomatic malaria parasitaemia in sickle cell disease patients: how effective is chemoprophylaxis? Journa of Vector Borne Disease 44: 52-55.
Aidoo M, Terlouw DJ, Kolczak M, et al. Protective effects of the sickle cell gene against malaria morbidity and mortality. Lancet. 2002;359(9314):1311-1312.
Williams TN, Mwangi TW, Wambua S, et al. Sickle cell trait and the risk of Plasmodium falciparum malaria and other childhood diseases. J Infect Dis. 2005;192(1):178-186.
May J, Evans JA, Timmann C, et al. Hemoglobin variants and disease manifestations in severe falciparum malaria. JAMA. 2007; 297 (20):2220-2226.
Cholera R, Brittain NJ, Gillie MR, et al. Impaired cytoadherence of Plasmodium falciparum-infected erythrocytes containing sickle hemoglobin. Proc Nat Acad Sci U S A 2008; 105:991–6.
Pasvol G, Weatherall DJ, Wilson RJ. Cellular mechanism for the protective effect of haemoglobin S against P. falciparum malaria. Nature 1978; 274:701–3.
Robert, V., MaCintyre, K., Keating, J., Trape, J-F., Duchemin, J-B., Warren, M and Beier, JC. 2003. Malaria transmission in urban Sub-Saharan Africa. American Journal of Tropical Medicine and Hygiene 68, 169-176.
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Albert N. Komba, Julie Makani, Manish Sadarangani, Tolu Ajala-Agbo, James A. Berkley, Charles R. J. C. Newton, Kevin Marsh and Thomas N. Williams Malaria as a Cause of Morbidity and Mortality in Children with Homozygous Sickle Cell Disease on the Coast of Kenya Clinical Infectious Diseases 2009; 49:216–22
Pam SH, Hawkay PM (1993). Medical parasitology, a practical approach, 2nd edition. 13:421-444.
Jennifer C Davis, Tamara D Clark, Sarah K Kemble, Nalugwa Talemwa, Denise Njama-Meya, Sarah G Staedke1 and Grant Dorse. Longitudinal study of urban malaria in a cohort of Ugandan children: description of study site, census and recruitment Malaria Journal 2006, 5:1.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareEFFECT OF QURS KAFOOR IN THE MANAGEMENT OF USRE TAMS IBTEDAYI (PRIMARY DYSMENORRHOEA) - A CLINICAL OBSERVATION
English5861Firdose K FEnglish Begum W.English Shameem I.English Firdose N F.English Jahan MEnglishIntroduction: Dysmenorrhoea is defined as a severe, painful cramping sensation in the lower abdomen occurring just before or during menstruation. The term primary dysmenorrhoea refers to the pain with no obvious pelvic pathology. It is a common condition, which occurs in 52%, 72% or even 90% of women. It is responsible for the highest degree of absenteeism resulting in loss of work hours and economic loss. The aim of the study is to observe the efficacy of Qurs Kafoor, a compound unani formulation in alleviating Usre Tams ibtedayi (primary dysmenorrhoea) Methodology: Ten patients with regular and painful cycles were observed. USG – pelvis was done to exclude pelvic pathology. Menstrual cramps were rated on a four point scale of dysmenorrhoea, from 0 to 3 depending on the severity. Treatment was given a day prior to the expected date of period until pain persists for 2 consecutive cycles. Reduction in four point scale score is the main outcome measure. Results were considered significant with p < 0.05. Results: Qurs Kafoor showed a significant reduction in four point scale score. In 6 (60%) out of 10 patients four point scale score was reduced to 0, in remaining 4(40%) the four point scale score was reduced to 1. The results were statistically significant. Conclusion: Qurs Kafoor has shown to be effective in the management of primary dysmenorrhoea as assessed by four points scale.
EnglishPrimary dysmenorrhoea, Qurs Kafoor, Four point scale score.INTRODUCTION
Dysmenorrhea is defined as difficult menstrual flow or painful menstruation. The term dysmenorrhea is derived from the Greek words dys, meaning difficult / painful / abnormal, meno, meaning month, and rrhea, meaning flow.1 Primary dysmenorrhea begins at or shortly after menarche and is usually not accompanied by pelvic pathologic conditions.2 It manifests as midline, crampy lower abdominal pain, which begins with the onset of menstruation. The pain can be quite severe and also involve the low back and thighs. The pain gradually resolves over 12 to 72 hours. Pain does not occur at times other than menses. The diagnosis is made largely by the history and physical exam.3 Women with primary dysmenorrhea had a normal pelvic exam. Painful menstruation with a cramping sensation in the lower abdomen often accompanied by other symptoms such as sweating, tachycardia, headaches, nausea, vomiting, diarrhea, and tremulousness.4,5 These all occur just before or during the menses. It not only disturbs the routine but also causes humiliating suffering. This
condition is commonly observed between the ages of 15 and 25 years.
Dysmenorrhoea, especially when it is severe, is associated with a restriction of activity and absence from school or work. Yet despite this substantial effect on their quality of life and general wellbeing, few women with dysmenorrhoea seek treatment as they believe it would not help. 6
The prevalence of dysmenorrhoea (painful menstrual cramps of uterine origin) is difficult to determine because of different definitions of the condition. It occurs in 52%, 72% or even 90% of women.7 However; dysmenorrhoea seems to be the most common gynecological condition in women regardless of age and nationality. Absenteeism from work and school as a result of dysmenorrhoea is common (13% to 51% women have been absent at least once and 5% to 14% are often absent owing to the severity of symptoms). 6
In all, 10-20% of women with primary dysmenorrhoea do not respond to treatment with NSAIDs or oral contraceptives. In addition, some women have contraindications to these treatments. Consequently, researchers have investigated many alternatives to drug treatments.8 Treatment for dysmenorrhoea aims to relieve pain or symptoms either by affecting the physiological mechanisms behind menstrual pain (such as prostaglandin production) or by relieving symptoms. 7
In Unani system of medicine, dysmenorrhoea is known as Usre Tams.The causes attributed by the Unani physicians are many. The important one cause is ascribed as to dominance of Bhalgham or Sauda in the blood. 9, 10 It usually occurs in unmarried, oversensitive girls and those who live lavish life style. Sometimes, chronic diseases, general weakness and stress may be the cause of painful menses. The drugs in the formulation are helpful not only in pain relief, but are also beneficial in relieving the associated symptoms like, nausea, vomiting, diarrhea, tremulousness etc.11,12
The aim of the study is to observe the efficacy of Qurs Kafoor, a compound unani formulation in alleviating Usre Tams Ibtedayi (primary dysmenorrhoea) and associated symptoms.
METHODOLOGY
Ten patients with regular and painful cycles between the ages of menarche and 25 years were observed for a period of two months. After thorough evaluation of the history and clinical examination, baseline investigations like Complete Blood Picture, Complete Urine Examination, RBS, and Serum Calcium were advised; following this USG – pelvis was done to exclude pelvic pathology.
Patients with normal laboratory reports together with normal USG were the selected candidates to be included in this observation. Menstrual cramps were rated on a four point scale of dysmenorrhoea, scoring from 0 to 3 depending on the severity.
Four point scale for dysmenorrhoea rating:
Severity
Score
No pain
0
Minimal*
1
Moderate**
2
Severe***
3
* Can work, somewhat uncomfortable.
** Can work, but quite uncomfortable.
*** Miss work, have to be in bed.
Treatment was given a day prior to the expected date of period until pain persists at a dose of two tablets BD for 2 consecutive cycles.
Test formulation: Qurs Kafoor13
Unani Name
Botanical Name
Dosage
Kafoor
Cinnamomum camphora
1.75gm
Tukhme Kahu
Lactuca sativa
100gm
Tukhme Khurfa
Portutaca olerocea
750gm
Tabasheer
Bambusa Arundinaceae
10gm
Rub us soos
Extract of Glycyrrhiza glabra
10gm
All these are finely grinded and mixed with Arq Gulab (Rose Water) to mould it in tablet form
Dosage: 2 tablet (500gm each) twice daily.
Reduction in four point scale score is the main outcome measure. Results were considered significant with p < 0.05. Statistical analysis was carried out using Chi-Squared test.
RESULTS
In 6 (60%) out of 10 patients four point scale score was reduced to 0, in remaining 4(40%) the four point scale score was reduced to 1. The results were significant at p < 0.001.
Qurs Kafoor showed a significant reduction in four point scale score.
DISCUSSION
The present study observed the efficacy of Qurs Kafoor in alleviating primary dysmenorrhoea. The drugs in the formulation are helpful not only in pain relief, but are also beneficial in relieving the associated symptoms like, nausea, vomiting, diarrhea, tremulousness etc. It effectively reduced the severity of the primary dysmenorrhoea as assessed by the four point score scale. No studies have been conducted to evaluate the efficacy of Qurs Kafoor in the management of primary dysmenorrhoea. The present study is first of its kind in evaluating the effect of Qurs Kafoor in primary dysmenorrhoea.
CONCLUSION
Qurs Kafoor has shown to be effective in the management of primary dysmenorrhoea as assessed by four points score scale. Further trials with larger sample size are required to confirm the efficacy and to elucidate the mode of action.
Table 01: Percentage distribution of frequency of Absenteeism related to severity of dysmenorrhoea
Absence from work or school because of dysmenorrhoea
No. of Patients
%
Every Menstruation
8
80
Alternate Menstruation
2
20
Table 02: Pain severity before and After Treatment
Dysmenorrhoea Severity
No. of patients
Before treatment
After Treatment
No Pain
0
6*
Minimal
0
4*
Moderate
3
0
Severe
7
0
*PEnglishhttp://ijcrr.com/abstract.php?article_id=1025http://ijcrr.com/article_html.php?did=1025
Jamieson DJ, Steege JF. The prevalence of dysmenorrhea, dyspareunia, pelvic pain, and irritable bowel syndrome in primary care practices. Obstet Gynecol. Jan 1996;87(1):55-8. [Medline].
Dawood MY. Nonsteroidal anti-inflammatory drugs and changing attitudes toward dysmenorrhea. Am J Med. May 20 1988;84(5A):23-9
Padubidri V G, Daftari S N. Shaw’s Textbook of Gyaecology 14th ed. India: Elsevier;2009: 265-267.
Katz, Lentz GM, Lobo RA. Katz comprehensive gynaecology. 5th ed, USA: Mosby; 2007. http://www.mdconsult.com/das/book/body/163690968-2/0/1524/251.html cited on 11.09.09.
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Dysmenorrhoea in different settings: are the rural and urban adolescent girls perceiving and managing dysmenorrhoea problem differently. Obs and gynae today XIII(10) 2008. 427-430.
Weissman A W, Hartz A J, Hansen M D, Johnson S R. The natural history of primary dysmenorrhoea: A longitudinal study. BJOG 2004, III; 345-352.
Proctor M, Farquhar C. Diagnosis and management of dysmenorrhoea. BMJ 332 (13) 2006; 1134-1138.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareBILATERAL ADDITIONAL HEAD OF STERNOCLEIDOMASTOID MUSCLE - A CASE REPORT
English6263Seema PrakashEnglish Parveen OjhaEnglish Ghanshyam GuptaEnglishDuring routine dissection of head and neck region in an adult male cadaver additional clavicular head (third head) of sternocleidomastoid muscle was noticed bilaterally. Knowledge of such additional head of sternocleidomastoid is important for anaesthetists, radiologists and surgeons to avoid complications during various procedures like central venous catheterizations and flap transfers performed in this area.
EnglishAdditional head, SternocleidomasroidINTRODUCTION
Sternocleidomastoid descends obliquely across the side of neck and form a prominent surface landmark especially when contracted. Neck is divided into anterior and posterior triangle by this muscle. Muscle is attached inferiorly by two heads. The medial or sternal head arises from upper part of anterior surface of manubrium sterni. While the lateral or clavicular head ascends almost vertically from superior surface of medial third of clavicle. The two heads are separated near their attachment by a triangular interval which corresponds to a surface depression lesser supraclavicular fossa. Sternocleidomastoid insert superiorly by a strong tendon into lateral surface of mastoid process and by a thin aponeurosis into lateral half of superior nuchal line. Clavicular fibres are mainly to mastoid process, the sternal fibres are more oblique and superficial and extend to occiput1. Any variation in origin of sternocleidomastoid muscle can lead to narrowing of lesser supraclavicular fossa and can cause complications during Internal Jugular Vein cannulation. So anaesthetists, radiologists and surgeons must be aware of these variations to avoid hazards during various procedures in these regions.
OBSERVATION
During routine dissection of the neck region in an adult male cadaver, skin and superficial fascia with platysma muscle was reflected. Deep fascia was incised and Sternocleidomastoid muscle on both the sides was exposed. Its sternal head originated from manubrium sternii bilaterally. Clavicular head had two origins on clavicle namely medial and a lateral. This was noticed bilaterally. Lateral origin of the clavicular head (i.e. the third head) was from the superior surface of middle third of clavicle and it ascended as a thin belly and blended with other fibres of sternocleidomastoid near their normal insertion.
Nerve supply of all the three heads was from spinal part of accessory nerve.
DISCUSSION
Variations in origin of both sternal and clavicular heads of stenocleidomastoid muscle have been reported but variations in clavicular head is more commonly seen in the literature than sternal head.
Usually the clavicular origin is narrower than the sternal head .When the clavicular origin is broad it is subdivided into several slips separated by narrow intervals. Additional clavicular heads were reported by Rao et al (2007)2. Unilateral
additional clavicular head is reported by Cherian et al (2008)3 and Fazliogullari et al (2010) 4. Unilateral additional sternal head has been reported by Natsis et al (2008)5 while Nayak et al (2006)6 reported it bilaterally. Kaur et al (2013)7 have reported six heads of origin of sternocleidomastoid muscle.
Knowledge in variations of sternocleidomastoid muscle is important for head and neck surgeons and plastic surgeons during various surgical procedures in this area. Plastic surgeons can make best use of this additional head for muscle graft3. .Anaesthetists, for central venous catheterization prefer internal jugular vein cannulation, as this approach has a lower incidence of pneumothorax. Any variation in origin of sternocleidomastoid muscle can lead to narrowing of lesser supraclavicular fossa, which can complicate internal jugular vein cannulation5.
Knowledge of additional heads of sterrnocleidomastoid muscle in patients with post irradiation induced muscle spasm can help us to understand the need of altered higher dose of Botulinum Toxin injection in treating such patients.8 Awareness of variations in sternocleidomastoid muscle is important for anaesthetists, surgeons and radiologists to avoid complications while treating the patients.
Englishhttp://ijcrr.com/abstract.php?article_id=1026http://ijcrr.com/article_html.php?did=1026
Standring S; Berkovitz, B. K. B.; Hackney,C.N.; Ruskell, I. G. L. Gray’s Anatomy.The Anatomical Basis of Clinical Practice.39 th Churchill and Livingstone, Edinburgh, 2005. P. 536
Ramesh R T, Vishnumaya G, Prakashchandra, S. K and Suresh, R . Int. J.
Morphology 2007; 25(3):621-623
Cherian SB, Nayak S .A rare case of unilateral third head of sternocleidomastoid muscle. Int. J. Morphology 2008; 26 (1):99-101
Fazliogullare Z, Cicekcibasi AE, Dogan NU, Yilmaz Mt, Buyukmumcu M, Ziylan T.The levator claviculae muscle and unilateral third head of sternocleidomastoid muscle : Case report. Int. J. Morphology 2010; 28(3): 929-932, 2010
Natsis K, Asouchidou I, Vasileiou M, Papathanasiou E, Noussios G, Parakevas G. A rare case bilateral supernumerary heads of sternocleidomastoid muscle and its clinical impact. Int. J. Morphology 2007; 25:621-23
Nayak SR, Krishnamurthy A, SJMK , Pai MM, Prabhu LV, Jetti R. A rare case of bilateral sternocleidomastoid muscle variation Morphologie.2006 ;(295):203-4
Kaur D, Jain M, Shukla L.Six heads of origin of sternocleidomastoid muscle: a rare case.Internet Journal Of Medical Update;2013 July;8(2):62-64
Boaro SN, Fragoso Neto RA. Topographic variation of sternocleidomastoid muscle in a just been born children. Int J morphol.2003; 21: 261-264
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareDIAGNOSTIC IMAGING OF INTRACRANIAL NEOPLASMS: HOW FREQUENT ARE INDICATIVE FINDINGS IN CT AND MRI?
English6473Ravinder Kumar English JyotiEnglishObjective: This study aims to compare the ability of computed tomography and magnetic resonance imaging for detection, characterization and localization of intracranial neoplasms. Material and Methods: Total 60 cases with clinical suspicion of intracranial neoplasm of all age groups and either sex were evaluated. All MR images were obtained with a 1.5-T superconducting system (SIEMENS) using a circularly polarized head coil. Pre and post contrast CT was done in all cases on 64 Slice Helical Seimens Somatom CT scanner machine. Results: CT proved to be superior in demonstrating calcifications and a typical tumor density. On the other hand, MRI was better suited for identifying the extraaxial location of tumors, the broad contact of tumors to the meninges, tumor capsules and contrast enhancement adjacent to the tumors. Both methods provided nearly equal results in demonstrating mass effects, hyperostoses, intensive and homogeneous contrast enhancement, and smooth tumor contours after contrast administration. On the whole, neither of the two methods demonstrated a universal superiority for the diagnosis of intracranial neoplasms. Rather, each method displayed distinct advantages. Conclusion: Application of a diagnostic algorithm that integrates advanced imaging features with conventional imaging findings may help the practicing radiologist make a more specific diagnosis for an intracranial tumor.
EnglishComputed tomography, intracranial neoplasm, intratumoral calcification, Magnetic resonance imaging, supratentorial.INTRODUCTION
Intracranial neoplasms can be detected at an early stage with the help of diagnostic modalities. The goals of diagnostic imaging in the patient with suspected intracranial tumour include:
Detection of the presence of a neoplasm.
Localization of the extent of tumour. (Including definition of involvement of key structures and assessment of the presence and severity of secondary changes.)
Characterization of neoplasm.1
In 1970, CT emerged as primary diagnostic screening modality for the detection of intracranial disease. Areas of structural abnormality appeared on CT as regions of altered tissue radiographic density. Accuracy of localization with CT exceeded the accuracy that could be achieved by cerebral angiography or any other invasive diagnostic procedures.2
Since introduction of Magnetic Resonance Imaging (MRI) as clinically practicable diagnostic modality in 1980, it has rapidly earned recognition as the optimal screening technique for the detection of most intracranial neoplasms. Early experience suggested that 3% to 30% more focal intracranial lesions could be identified on MRI than on CT.
Compared with CT, MRI using spin echo, gradient echo and combination of spin and gradient echo pulsing sequences before and after intravenous administration of paramagnetic contrast agents provides inherently greater contrast resolution between structural abnormalities and adjacent brain parenchyma and has fuelled the development of MR from an in vitro laboratory tool to an in vivo diagnostic instrument. Even with current state of the art equipment utilizing very high magnetic fields and rapidly switching gradient coils, MR nevertheless suffers two disadvantages:
MRI requires significantly large image acquisition time.
Abnormalities involving cortical bone, intratumoral calcification and hyperacute haemorrhage are more clearly and accurately assessed with CT.
As both CT and MRI are helpful in the diagnosis of intracranial neoplasms. Hence this study is undertaken to compare the role of computed tomography and magnetic resonance imaging in intracranial neoplasms
MATERIAL and METHODS
Sixty patients with clinical suspicion of intracranial neoplasm attending the various surgical and medicine outpatient departments (OPDs) and wards of our hospital were included in the study.
cOMPUTED TOMOGRAPHY (CT)
Pre and post contrast CT was done in all cases on 64 Slice Helical Seimens Somatom CT scanner machine, time of which is 0.4 seconds.
magnetic RESONANCE IMAGING (MRI)
All the studies were conducted on 1.5 Tesla super conducting magnet, SIEMENS, Head coil was used. Parameters used for analysis were shown in Table 1
RESULTS
Sixty cases comprising of various type of primary and secondary neoplasms were studied. Since, metastases showed fewer incidences in our study because most of the patients with a known primary were subjected to one imaging modality either CT or MRI. So, these patients were excluded from the study as our study was based on comparative evaluation of CT and MRI in intracranial neoplasms. Overall observations were following:
Table II summarizes the general comparison of various features of intracranial neoplasms as follow:
CT failed to demonstrate the lesion in two cases and showed only hydrocephalus whereas MRI showed the lesion in medulla .MRI demonstrated the CSF cleft and pial vessels in 8 out of 10 cases of meningioma and in two cases of dural based metastases and acoustic schwannoma, however these findings were not demonstrated on CT.
Tumor extension into sellar region was noted in 12 cases with MRI while it was observed with 8 cases on CT. There were 18 cases of posterior fossa tumors in our series of 60 cases. MRI displayed the full extent including the inferior extent in 18/18 cases whereas; CT demonstrated the full extent in 10 cases only. In two cases of dural based metastases inferior extent of the base of skull lesion was better demonstrated by MRI.
Extension into internal auditory canal and left orbit in cases of acoustic schwannoma and dural based metastases respectively were better demonstrated on MRI than CT.
MRI showed peritumoral edema in 30 cases while on CT it was observed in 26 cases. Intratumoral hemorrhage was seen in 6 cases with MRI, while on CT it was observed in two cases. CT was able to detect only acute intratumoral hemorrhage while MRI demonstrated both acute and chronic intratumoral haemorrhages.Better demonstration of
acute intratumoral hemorrhage was seen with CT than MRI.
Calcification was noted in 12 cases on CT. MRI failed to depict the calcification in all cases. Bony changes were noted in 8 cases on CT while MRI showed it in6 cases. MRI failed to depict the hyperostosis in a case of meningioma.
MRI showed contrast enhancement in 50 cases while it was observed in 48 cases on CT. CT failed to detect the tumor in two cases in which MRI showed mild enhancement.
Frequency Distribution of Intracranial Neoplasms
Commonest intracranial neoplasms were gliomas (30%), followed by meningioma (16.6%), metastases (10%), medulloblastoma (6.6%) and others.
Age and Sex Distribution of Intracranial Neoplasms
Incidence peaks of gliomas and meningiomas were seen predominantly in 3rd – 4th decade of life. 20% of all intracranial tumour occurred in paediatric age group under 20 years of age. Also we observed one patient presented in Ist decade of life. Men were found to be affected more than women in present study (17:13) except for meningioma with female predominance (1.5:1).
Location Distribution
In present study supratentorial location (40 /60) was found to be more common than infratentorial locations with both CT and MRI. We observed that MRI was more accurate in lesion localisation than CT. In a case of dural based metastases, two out of three metastatic lesions were observed as located infratentorially on CT.Whereas MRI, clearly demonstrated the lesion in supratentorial location on saggital images.
Gliomas
There were eighteen cases of glioma. Most of these were hypodense on NCCT and were hypointense on T1- weighted and hyperintense on T2 – weighted images on MRI. We found that MRI was better in tumour detection, localization, demarcation from normal brain parenchyma, identification of sub acute / chronic intratumoral haemorrhage and degree of enhancement than CT. However, calcification was better seen on CT. (Figure IV and V).
Posterior Fossa Neoplasms
MRI found to be more sensitive than CT.
Meningioma was the most common extra-axial tumour in present study.
MRI provided more information than CT on pituitary morphology and neighbouring structures in sellar, suprasellar, parasellar and juxtasellar neoplasms. MR was superior to CT in assessment of extent of tumour, in demonstration of tumour relationship to vessels, optic chiasma and adjacent structures of brain. (Figure VI). However, CT was superior to MRI in detecting the presence of calcification which is diagnostic in case of craniopharyngioma.
In our two cases of colloid cyst, MR was more sensitive than CT to the presence of tumour and in demonstration of heterogeneity of tumour. (Figure VIII)
In cases of metastases, we made the observation that MR was superior to CT in localisation, assessment of extent of lesion and in degree of enhancement. While, CT demonstrated early intratumoral hemorrhage better than MRI. (Figure VII)
DISCUSSION
Lesion detection:-
McConachie et al4 and Atlas et al1 reported that MR imaging is more sensitive than CT for detection of brain tumors.However, in our study, CT and MRI detected all the cases but in one case of metastasis MRI detected one more lesion.
CSF Cleft / Pial vessels:-
Schubeus et al5 studied fifty cases of meningioma and concluded that MRI appears to be better than CT in demonstrating extraaxial location of the tumour, with the identification of tumour capsule, consisting of CSF margin and displaced vessels and relationship to the meninges.
Similar results were noted in present study as MRI demonstrated the CSF cleft and Pial vessels in eight
out of ten cases of meningioma and in two cases of dural based metastases and acoustic schwannoma, however these findings were not demonstrated on CT. (Figure I, II andIII).
Extent of tumour
Gusnor and Atlas et al 1 reported that MR has the advantage of being able to better define tumour extent than CT because of its greater contrast resolution and multiplanar capability.
Similar results have been found in present study with better demonstration of extent of posterior fossa, base of skull, sellar, parasellar and juxtasella neoplasms on MR than CT.
Peritumoral edema
We observed that FLAIR images showed better demarcation between tumour and edema than conventional MR sequences and CT. In four cases, mild peritumoral edema was seen only on flair images.
Tsuchiya et al also reported the same in their study of 34 patients that FLAIR images showed peritumoral edema more clearly than T2- weighted images when the tumour itself was not hyperintense.
Intratumoral hemorrhage:-
Kieffer and chang described that MRI has greater sensitivity for detection of subacute and chronic haemorrhages whereas early intratumoral or peritumoral haemorrhages are more clearly defined with greater certainty on CT than on MRI.
Similar results were seen in present study, as in two cases where CT failed to detect the intratumoral haemorrhage were found to have subacute / chronic hemmorhage on MRI. In four other cases both CT and MRI showed the early intratumoral haemorrhage but it was more clearly defined with CT than MRI.
Calcification
Lee and Tassel, McConachie et al4 in their studies concluded that CT is highly sensitive in detecting calcification whereas MR cannot reliably demonstrate or exclude its presence. Lovener also found the same that CT is more sensitive than MRI in detecting the presence of calcification. We also observed the same in our study as CT demonstrated calcification in twelve cases whereas MRI was unable to demonstrate it.
Bony changes
Kieffer and Chang, Master and Zimmerman, Yeakley et al reported that CT is superior to MR in demonstration of bone changes like hyperostosis or bone destruction. We also found the same as MRI failed to demonstrate the bony change in a case of meningioma in which CT showed hyperostosis of underlying sphenoid bone. In all other cases, both CT and MRI were equally good in demonstration of bony changes.
Contrast enhancement
Graif et al in their study of seventeen cases of malignant brain tumour compared degree of enhancement with CT and MRI and noted that MRI showed greater degree of enhancement than CT in eight cases. Present study also showed the similar results as MRI showed more enhancement than CT in eight cases, six cases with moderate enhancement and two cases with mild enhancement on CT showed intense enhancement on MRI. In two cases CT was unable to show contrast enhancement while MRI showed mild enhancement.
CONCLUSION
Summarizing, MR has many advantages over CT all without the need of ionizing radiation and iodinated contrast media in imaging of intracranial neoplasms. The multiplanar capability and superior contrast resolution of MRI makes it a better technique than CT in imaging of intracranial neoplasms in terms of tumour detection, localization, assessment of extent of tumour, identification of subacute / chronic intratumoral hemorrhage, degree of enhancement and demonstration of tumour relationship to adjacent structures of brain. MR nevertheless, requires significantly longer image acquisition times than CT. MR is inferior to CT in identification of bony changes, intratumoral calcification and early intratumoral hemorrhage.
Hence, we conclude that MR is the preferable method for evaluation of intracranial neoplasms and CT is useful as a supplementary modality when detailed information about bony anatomy and calcification is required. Also application of a diagnostic algorithm that integrates advanced imaging features with conventional imaging findings may help the practicing radiologist make a more specific diagnosis for an intracranial tumour.
ACKNOWLEDGEMENT
We acknowledge to Geetanjali Medical College and Hospital for their immense support.
Conflict of Interest: None declared
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareBILATERAL HIGH BRANCHING PATTERN OF FEMORAL NERVE - A CLINICO-ANATOMICAL STUDY
English7477Susmita SahaEnglish Rohini PakhiddeyEnglishObjective: The aim of reporting this case is to highlight the abnormal or higher branching pattern of the femoral nerve which is very rarely reported. Materials and Methods: The present anomaly was detected during routine course of cadaveric dissection of a 60 year old male cadaver. Result: The present case reports a very early division of the femoral nerve on both sides of the thigh of a 60 years old male cadaver. The femoral nerve descended through the psoas major muscle and divided into two branches; anterior and posterior, 4.1 cm above the midpoint of the inguinal ligament. Conclusion: Knowledge of this kind of variation in the branching pattern of femoral nerve has much academic and clinical value. Furthermore it will be extremely helpful to the surgeons to prevent iatrogenic injury to femoral nerve and for the anaesthetist to give successful block in the femoral nerve.
Englishfemoral nerve, early division, femoral nerve blockINTRODUCTION
The femoral nerve is the largest branch of the lumbar plexus and it arises from the posterior division of the ventral rami of the second, third and fourth lumber nerves (1.2). The femoral nerve descends on the psoas major muscle and enters the thigh deep to inguinal ligament at the lateral edge of the femoral sheath, which separates it from the femoral artery (2). Conventionally, the femoral nerve is known to divide into anterior and posterior branches below the inguinal ligament (1). This nerve is utilised for nerve block in several surgical procedures and is vulnerable to compression in tight ilio - psoas compartment (3). It may often be injured by sutures or staples, entrapment by tissue scar and local anaesthesia blockade (4, 5). The femoral nerve block is performed on the main trunk of the femoral nerve just below the inguinal ligament (6). The early division of the femoral nerve in the iliac fossa results in incomplete femoral nerve block (3). Prior knowledge of anomalies related to the branching pattern of femoral nerve becomes utmost important for the surgeons while exposing the femoral nerve in the femoral triangle. Hence, it becomes imperative to highlight such an early division of femoral nerve to avoid confusion to surgeons who would usually perform nerve block below the inguinal ligament.
CASE REPORT
During routine dissection of a 60 year old male cadaver in the Department of Anatomy, Maulana Azad Medical College, New Delhi, India, for an undergraduate teaching programme, we detected a higher branching pattern of femoral nerve on both sides of lower limb. The course of the femoral nerve and its relations to other structures were studied carefully and appropriate photography of the variation was done.
The femoral nerve was observed to arise from the posterior division of the ventral rami of the second
to fourth lumber spinal nerves and the nerve was related lateral to the femoral artery. The femoral nerve (‘FN’ in Figure 1) descended along the lateral border of psoas major muscle (‘PM’ in Figure 1) and divided into anterior (‘a’ in Figure 1) and posterior (‘b’ in Figure 1) branches, 4.1 cm above the midpoint of the inguinal ligament (‘IL’ Figure 1). The anterior branches further gave cutaneous branches as well as a branch to the Sartorius (‘s’ in Figure 1) muscle. The posterior branch was located lateral to femoral artery (‘FA’ Figure 1) and was giving saphenous nerve along with branches to the quadriceps muscle. No other abnormalities were noted.
DISCUSSION
The femoral nerve, the psoas major and iliacus muscles are roofed over by the iliacus fascia, which forms a tight fascial compartment. This may account for femoral nerve lesions due to space occupying processes in this area (4). In the cases of femoral nerve paralysis, the existence of some variant muscles or variations in the branching pattern of the femoral nerve may increase the chances of nerve compression (7). The exact knowledge of topographical anatomy of the femoral nerve is required for any successful femoral nerve block. For this procedure, first the inguinal ligament is located, the femoral artery is palpated 2-3 cm below the inguinal ligament and a needle is passed just lateral to the femoral artery (8). Thus, it becomes easy to block the femoral nerve inferior to the inguinal ligament (5, 6). At times, when the femoral nerve has already divided above the inguinal ligament, there are chances that both the branches; the anterior and the posterior branch, may be found deep and inferior to the inguinal ligament (9). Furthermore, any attempt to perform the femoral nerve block may involve incomplete or partial blockage of the divisions of femoral nerve with either of the two branches, i. e. the anterior or the posterior, getting blocked (9). This may be difficult for the orthopaedician and the surgeon who may not be aware of such a fact that the failure of anaesthesia is due to the anomalous early division of the femoral nerve, i. e. branching above the inguinal ligament.
To the best of our knowledge, very few studies have reported such an early division of femoral nerve. Das et al. in 2007 noticed the femoral nerve dividing 3.2 cm above the mid-inguinal point in a male cadaver on both sided of thigh (9). Rajesh et al. have studied the formation and branching pattern of the femoral nerve in sixty four human iliac fossa and observed two lumbar plexuses where femoral nerve was dividing above the inguinal ligament (3). They noticed that in one right lumbar plexus of an adult male cadaver, the nerve divided 4 cm above the inguinal ligament and in another case of a female cadaver; the left femoral nerve divided 3.8cm above the inguinal ligament. In the present case, we observed that the femoral nerve was dividing 4.1 cm above the midpoint of inguinal ligament on both sides of thigh which is at a higher level than previously reported studies. Lack of experience with possible variations could lead to fatal errors in the process of nerve block as well as can cause severe complications during surgical procedures. Variations of such kind could be of assistance to the anaesthetists and surgeons, who go by the conventional knowledge of anatomy regarding the exact site for performing femoral nerve block. To the best of our knowledge, such a very early division of femoral nerve is not documented in previous literature. Awareness of such early division of femoral nerve has much academic and clinical importance.
CONCLUSIONS
Since variations in the branching pattern of femoral nerve are known, it becomes imperative for the anaesthetists and surgeons to be aware of the reported variation in the branching pattern of the femoral nerve while performing femoral nerve block and operating on the lower limbs. Knowledge of this kind of variation will help the
clinicians in preventing iatrogenic complications and for having successful outcome of the surgery.
ACKNOWLEDGEMENT
We would thank our institution for allowing us to dissect cadaver and faculty members without whom this manuscript has been a distant reality.
Figure1. Anterior view of the right lower limb showing: FN – Femoral nerve; a – anterior division of femoral nerve (supplying the Sartorius muscle); b – posterior division of femoral nerve; S – Sartorius muscle; FA- Femoral artery; P – Psoas major muscle; IL – Inguinal ligament. Femoral nerve is dividing into anterior and posterior division above the inguinal ligament. Posterior division (b) of the femoral nerve is lateral to the femoral artery (FA)
Figure legends
FN- femoral nerve
Anterior division of femoral nerve
Posterior division of femoral nerve
S- Sartorius
FA- femoral artery
P-psoas major muscle
IL-inguinal ligament
Englishhttp://ijcrr.com/abstract.php?article_id=1028http://ijcrr.com/article_html.php?did=1028
Sinnatamby CS (2001). Last’s Anatomy. Regional and Applied. London: Churchill Livingstone, 2001: pp 115.
Standring S (2005). Gray’s Anatomy. The Anatomical basisof clinical practice. 38th ed. New York. Elsevier Churchill Livingstone, pp- 1403, 1413 and 1455.
Rajesh BA, Dave UH. Anatomical variations in formation and branching pattern of the femoral nerve in iliac fossa: A study in 64 human lumber plexuses. People’s Journal of Scientific Research 2011; vol. 4 (2): 14- 19.
Gracia- Urena MA, Vega V, Rubio G, Velasco MA. The femoral nerve in the repair of inguinal hernia: well worth remembering. Hernia 2005; 9: 348- 7.
Kim DH, Murovic JA, Tiel RL, Kline DG. Intrapelvic and thigh - level femoral nerve lesions. Management and outcome of 119 surgically treated cases. J Neurosurg 2004; 100:989- 96.
Ellis H, Feldman S, Harrop G W (2004). Anatomy for anaesthetists. Massachusetts, Blackwell Publishing, 2004: pp- 188-19.
Warfel BS, Marini SG, Lachmann EA, Nagler W. Delayed femoral nerve palsy following femoral vessel catheterization. Archives of Physical Medicine and Rehabilitation, 1993; 74 (11): 1211-1215.
Collin VJ. Principles of Anesthesiology.General and regional Anaesthesia. 3rd ed. Pennsylvania: Lea andFebiger, 1993: pp- 1395- 97.
Das S, Vasudeva N. Anomalous higher branching pattern of the femoral nerve: A case report with clinical implications. Acta Medica 2007; 50 (4): 245- 246.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareANALYSIS OF STUDENTS' ATTITUDE TOWARDS ROAD SAFETY
English7881R. Soureche VenguidaragavaneEnglishRoad safety is to be adopted and adored as mandatory life skill by each and every individual in order to adhere to social norms and to build a safe society. Aim: the aim of the study is to instill a positive attitude towards road safety among B. Ed students. Objective: The main objective of the study is to elicit the level of attitude of B. Ed students towards road safety and also to find out the significant difference in their attitude across different demographic variables. Research Methodology: Normative survey method was adopted for the present study. A four point attitude scale with 48 test items related to common traffic rules; signal and symbols was used as the tool for the study. The data were collected from 600 B. Ed students (includes both gender) of eight selected B. Ed colleges in Puducherry region selected using simple random sampling Result: The sample exhibits negative attitude towards road safety. The individual having own vehicles especially two wheeled and those of with urban nativity have high level of attitude than those who use hire- based travel and with rural nativity on road safety. Conclusion: Promotion of road safety awareness through co-curricular activities in teacher education should ensure to develop positive attitude towards road safety and to ensure risks free usage of roads.
EnglishAttitude, Man-made disaster, road safety.INTRODUCTION
Road Traffic Accidents (RTA) as one of the man-made disaster is mainly caused due to urbanization coupled with human negligence. Nowadays there is a drastic increase in RTA in terms of mortality and morbidity rate which is due to the expansion of road network and with high tech-motorization. Between 1970 and 2010, the frequency of this RTA increased by 4.4 times with 9.3 times increase in fatalities and 7.5 times increase in the number of persons injured, while there was an increase of 82 times in the number of registered motor vehicles and more than three times increase in the road network (Nantulya VM, Reich MR., 2002). Road accidents are common in India due to reckless driving by untrained drivers and poor maintenance of roads and vehicles. India accounts for 13-15% of road accident fatalities worldwide and tops in the number of people killed in road accidents.
World Health Organization (WHO) estimated that by 2020 the RTA will be the third highest threat to public health, outranking other serious killer health problems. In South Asia alone, road traffic fatalities are expected to increase to 330,000 in 2020. 85 percent of the world’s road deaths occur in developing countries - South Asia region has one fifth share in these fatalities. The fatalities of mankind and their chattels due to road accidents have emerged as a major public health issues like death, disabilities and hospitalizations, which in turn affect their family members and even the structure of the society in terms of political, social and economic sectors. The United Nations has rightly proclaimed 2011-2020 as the decade of action on road safety Peden M, et al (2004).
NEED FOR THE STUDY
India accounts for around 5 lakh road accidents in 2011 result in the deaths of 1,42,485 people and more than 5.5 lakh persons injured as 1 accident per minute, and 1 road accident death for every 3.7 minutes. The loss to the Indian economy due to fatalities and accident injuries was estimated at 3% of GDP. India stood 9th place in road accidents death in 2004 and likely to be in 5th place by 2030 (Shrinivas PLL 2004).
The mortality rate in road accidents in Pondicherry has slightly increased from 14 dead per 100 accidents in 2007 to 16 deaths in 2010. Around 53.1% of road accident victims were in the age group of 25 to 65 years in 2010. The reason for RTA in Pondicherry could be heterogenic nature of vehicle and human population; lack of proper traffic management systems and poor adherence / enforcement of road safety regulations apart from road network design. Although 4 Es (Education; Enforcement; Engineering (roads as well as vehicles) and Emergency care) are used to mitigate road accidents, educating the public plays a prominent role in reducing the risk of heavy road accidents. Creating sound awareness about road safety among B. Ed students would go a long way in inculcating road safety education among school children at large. The coping trait against road accidents thereby spreads rapidly to all spheres of the society, which helps to develop the accident free zones. Hence as the need of the hour, the investigator chooses to study the attitude of B. Ed students towards road safety in Puducherry for his investigation.
OBJECTIVES OF THE STUDY
To study the attitude of B. Ed students’ towards road safety.
To study the significant difference in the attitude of B. Ed students towards road safety with respect to different demographic variables (gender, nativity, educational background, mode of transport to college and type of vehicle used).
HYPOTHESES OF THE STUDY
The attitude of B. Ed students towards road safety is positive
There is no significant difference in the attitude of B. Ed students towards road safety with respect to the following demographic variables
Gender (Male/Female)
Nativity (Urban/rural)
Educational background (Science/Arts)
Mode of transport to college (Own vehicle /hire)
Type of Motor vehicle used (two wheeler/four wheeler/ other types)
METHODOLOGY
TOOL USED
A four point attitude scale (2 positive and 2 negative points) consists of 48 items was used as the tool for the study. The test items elicit the attitude of the sample about the common traffic rules; signal and symbols related to road traffic safety; preparedness to mitigate the road accidents and situational decision during an accident. The reliability Co-efficient of the tool was computed as 0.87 by split-half method. The response to odd numbered items was scored as 3, 2, 1, 0 and the even numbered items as 0, 1, 2, 3 respectively. The grant score above 50% designated as positive attitude and below 50% represent negative attitude.
SAMPLE
A sample of 600 B. Ed students (includes both gender) from eight selected B. Ed colleges in Puducherry was selected using simple random sampling technique.
RESULTS AND DISCUSSION
The data collected from the sample were analyzed using ‘t’ test and presented in table 1 and 2.
Table – 1: The attitude level of B. Ed students on road safety
Groups
N
Mean
Standard deviation
Total
600
68. 15
40. 29
The mean value for the total Sample is 68. 15 and standard deviation 40.29, which indicates that the mean grant score falls below 50%. Hence it can be concluded that the sample B. Ed students have slightly negative attitude towards road safety. Therefore the stated Hypothesis is rejected.
The result of ‘t’ test reveal that there is a significant difference in the attitudes of B. Ed students on road safety with respect to their mode of transport; nativity and type of vehicle used. Further, it is found that there is no significant difference in the attitudes of B. Ed students of different gender group and different educational background at graduate level.
MAJOR FINDINGS
The overall attitude of the sample toward road safety is slightly negative.
The students having own vehicle have marginally higher level of positive attitude than that of those who use hire- based travel on road safety.
Urban students have high level of positive attitude than that of rural students in road safety
Two wheeler users have marginally higher level of attitude on road safety followed by those using four wheeler and other options like bicycle, auto etc
DISCUSSION
The findings of the study reveal that there is a need to improve the attitude of the students towards road safety. Students having own motor vehicle may give utmost priority to safeguarding their vehicles from any accident rather than learning the road safety skills. Urban students frequently familiarize themselves with different types of new motor vehicles with the help of media and other sources like internet and social network sites etc. Hence they seem to have more positive attitude towards road safety than the rural based students.
SUGGESTIONS
(1) Inculcate the importance of precautionary safety measures during travel; common road safety norms and rules in the core curriculum of teacher education. (2) Celebrate road safety week to emphasize the adverse effects of road traffic accidents through expert talks, film shows and conduct competitions like drama, speech, mime, drawing, painting and essay forms. (3) Impart training on wearing seat belt, helmet, how to handle and use the vehicle properly and efficiently, how to adopt road safety rules in real traffic situations, details about sign boards and symbols by trained officials in social camp activity and physical/health education. (4) Measures should be taken up to liaison with the traffic department to give quality and practical training on road safety.
CONCLUSION
Modernization in transport logistics is an indicator of materialistic development of mankind. Although comfortable travels in modern vehicles have several advantages like sophisticated and comfortable journey, reduced physical tiredness, cut short on travel time and quickened purpose of travel, the foremost need in the fast unavoidable travel is safety while travelling. Safe travel saves vital human lives. Instilling positive attitude regarding road safety helps to create informed and responsive citizenry which is vital for the progress of mankind.
Englishhttp://ijcrr.com/abstract.php?article_id=1029http://ijcrr.com/article_html.php?did=1029
Accidental deaths and suicides in India. National Crime Records Bureau. Ministry of Home Affairs, Government of India. 2009
Castelli DM, Hillman CH, Buck SM and Erwin HE. Physical fitness and academic achievement in third and fifth grade students. Journal of Sport and Exercise Psychology, 2007,Vol. 29, pp 239-252.
Dollman, J, Lewis, N . Active transport to school as part of a broader habit of walking and cycling among South Australian Youth. Pediatric Exercise Science,2007, 19(4): 436-43.
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Nantulya VM, Reich MR. The neglected epidemic: road traffic injuries in developing countries. 2002, BMJ, 324: 1139-1141
Peden M, Scurfield R, Sleet D, Mohan D, Hyder AA, Jarawan E (Eds.) World report on road traffic injury prevention. Geneva: World Health Organization, 2004
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Sirard JR, Riner WF, McIver KL and Pate RR. “Physical Activity and Active Commuting to Elementary School.” Medicine and Science in Sports and Exercise, 2005,37(12): 2062–2069,
Shrinivas PLL. Studies undertaken to identify critical causes of accidents in the highways of Tamil Nadu. Indian Highways, 2004, 31: 11-22.
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Zubrick SR, Wood L, Villanueve K, Wood G, Giles-Corti B and Christian H. Nothing to fear but fear itself: parental fear as a determinant of child physical activity and independent mobility, Victorian Health Promotion Foundation (VicHealth), Melbourne, 2010.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareTHE STUDY OF MATURITY AMONG ADOLESCENT GIRLS OF WESTERN MAHARASHTRA
English8288Varsharani V. KendreEnglish Ghattergi C. H.EnglishIntroduction: Adolescent females are a major needy group. It is critical period of biological, psychological, and social changes, as achievement of optimum growth in girls is considered utmost, improving future health. Purpose: 1) to study physical and physiological changes in adolescent girls, with respect to secondary sexual characters of adolescent girls of Urban Health Center, Govt. Medical College Solapur. 2) To study some sociodemographic characteristics of the same. Methodology: A community based cross-sectional study was done involving 246 adolescent girls (116 nonslum and 130 slum) of Urban Health Center,Solapur.By doing house to house survey, adolescent girls were interviewed with the help of predesigned, pretested questionnaire. Their physical examination was done and secondary sexual characteristics assessed with strict privacy and confidentiality. Menstrual history was also taken. Results: Literacy was more among nonslum adolescent girls. Extended families were more in nonslum area. Family members were more in families of slum girls. There was significant difference between the socioeconomic status of nonslum and slum girls.The mean age of menarche was less in nonslum area than slum area. Also, there was significant difference at I, IV and V stages of SMR between nonslum and slum adolescent girls. Conclusions: There was significant difference in mean age at menarche and sexual maturity between adolescent nonslum and slum girls. Nutritional supplementation should be given to adolescent slum girls to improve their reproductive health.
Englishadolescents, sexual maturity, nonslum, slumINTRODUCTION
The World Health Organization (WHO) defined adolescence as being between ages of 10 to 19 years, encompassing the entire continuum of transition from childhood to adulthood.1 Adolescent represents 23% of population in India.2
The attributes of adolescence are- rapid but uneven physical growth and development, sexual maturity, desire for the experimentation, development of adult mental processes and self-identity, transition from dependence to relative independence.2
During this phase of growth and development, Progression from appearance of secondary sex characteristics (puberty) to sexual and reproductive maturity takes place.3 The phases of adolescence were described as early adolescence 10 to 14 years, mid adolescence as 15-17 years and late adolescence as 18 to 19 years.4 During puberty, ovaries in girls produce enough steroid hormones to cause accelerated growth of genital organs and appearance of secondary sex characters.2
The special health problems encountered in adolescents are both physiological and medical2. Achievement of optimum growth in adolescent girls is considered utmost, improving future health.5 National Health Policy 2000 had identified adolescents as underserved population group.6With reference to these problems of adolescent girls, and present study was aimed at assessing secondary sexual characters and some demographic characteristics of adolescent girls of Urban Health Center, Govt. Medical College Solapur.
MATERIAL AND METHODS
In the present cross-sectional observational study, one nonslum and one slum area with populations of 1395 and 1277 respectively were chosen randomly among all the field practice areas of Urban Health Center, Dr. V. M. Govt. Medical College, Solapur after approval by institutional ethical committee. Verbal consent was also taken.
House to house survey was done and all 246 adolescent girls (aged 10 to 19 years) from above areas were interviewed with the help of pretested proforma.
Out of 120 adolescent girls in nonslum area, 116 responded and Out of 132 adolescent girls in slum area 130 responded to the study. The data collected included identification data, type of family, total number of family members, socioeconomic status and education of girls etc. Nature and purpose of study was also explained to adolescent girls and their parents. Privacy, confidentiality, and anonymity were maintained. Clinical examination was carried out in good daylight. Puberty status was assessed from appearance of secondary sexual characters. The girls were classified according to sexual maturity rating stages as described by Tanner J. M. et al (1962).7
Menstrual history was also taken. Social class grading was done using modified B.G. Prasad’s classification8. Data thus collected was entered and analyzed by using appropriate statistical tool-Chi square test, Z test, t test etc.
RESULTS
Out of 246 adolescent girls, 116 girls were from non-slum area and 130 girls were from slum area. Table 1 depects,out of 116 non slum girls, 23 girls were of 17 years, 14 of 18 years, 11 girls each of 19,16,15,14 years each,10 girls of 13 years, 9 of 12 years and 12 years each, 8 girls of 11 and 10 years each.
Out of 130 slum girls, 25 girls were of 11 years and 24 of 10 years, 13 of 16 and 14 years each, 12 of 15 and 12 years each, 11 of 17 and 13 years each, 6 of 18 years, 3 of 19 years.
In nonslum area, 46 (39.56%) girls were educated up to primary school, 25 (21.5%) upto secondary school, 45 (38.7%) up to higher secondary school and none was illiterate. In slum area, 30 (23.08%) girls were illiterate, 66 (50.82%) educated up to primary school, 27 (20.79%) girls were educated up to secondary school, and 7 (5.39%) up to higher secondary school .
As shown in table-2, among non-slum adolescent girls, 43(37.07%) were from extended families, 37(31.9%) from nuclear families and 36(31.03%) from joint families. Whereas 98 (75.38%) slum adolescent girls were from nuclear families, 28 (21.54%) from joint families and 4(3.08%) from extended families.
In 116 non-slum girls, 35 (30.17%) had 7 members in their family, while 30 (25.86%) had 6 family members.22(18.96%) had more than 7 family members, 20(17.24%) had 4 members, this was followed by 7 (6.03%) having 5 , 2 (1.72%) girls having 3 family members.
In slum area total number of family members In slum area total number of family members were 7 in 44 (33.84%) families, followed by 6 in 37 (28.46%), more than 7 in 30(23.08%) families, 5 in 10 (7.69%) families, 4 in 4(3.08%), 3 in 4(3.08%) and 2 in only 1(0.77%) family .
Table 3 depects, among nonslum girls 80(68.97%) belonged to class I, and 36(31.03%) to class II socioeconomic status whereas 77(59.23%) slum girls belonged to class V, 50(38.46%) slum girls to class IV and 3(2.31%) to class III socioeconomic status.
Table 4 shows, out of total, 43 girls belonged to stage I SMR. In nonslum area, 8(%) girls and in slum area, 35(27.69%) girls belonged to stage I SMR. (All these girls were below 12 years of age).
When stage II SMR was considered total 37 girls , (12(%) non-slum)and 25(%) slum) adolescent girls out of 246 belonged to stage II SMR (Premenarcheal stage).( These girls were of age less than 14 years in nonslum area and less than 15 years in slum area.)
Out of total, 69 girls belonged to SMR III i.e. stage of attainment of menarche, of which 30 (%) were non-slum and 39 (%) were slum. (These girls were between 11-18 years). Seventy three girls belonged to SMR-IV, of which 48 (%) were non-slum and 25 (%) were slum girls.
Twenty four girls belonged to SMR-V, of which 18 (%) were non slum and 6 (%) were slum girls.
When menstrual history was taken, it was found that, among nonslum girls, 88 girls attained menarche. The mean age of menarche in nonslum girls was (13.01±0.71). In the slum girls, 76 had attained menarche. The mean age of menarche in slum girls was (13.33±0.76).
DISCUSSION
In the present study, the number of girls was not uniformly distributed in age groups 10-19 years in both areas.
The literacy of nonslum girls (100%) was more than those of slum girls (87.8%). The number of girls higher educated than secondary school were significantly more in nonslum area (%) than those in slum area (%), (χ2 = , df-, pEnglishhttp://ijcrr.com/abstract.php?article_id=1030http://ijcrr.com/article_html.php?did=1030
S.K. Ganguli and Ratna Majumdar : A study of adolescent girls in Pune; PRESM : Journal of Community Health,2001, Vol.3,No.1,26-33.
Ghai O.P.: Adolescent health, Essential Pediatrics- 7th edition, CBS Publishers, 2009. 42.
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Sachar R.K., Harinder Singh, Soni.R.K.et.al: A cross sectional study of growth parameters of rural adolescent girls of Punjab; Indian Journal of Maternal and Child Health, 1997, 8(1); 21-25.
Sunder Lal: Reaching adolescents for health and development; Indian Journal of Community Medicine, 2001, 26 (4); 167-172.
Tanner J.M.: Growth at adolescence; 2nd edition, 1962, Blackwell Scientific Publication, Oxford, London.
Prasad B.G.: Changes proposed in social classification of Indian Families, Journal of Indian Medical Association, 1970, 55 (16): 198-199.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareORAL CYSTICERCOSIS - A RARE CASE REPORT
English8993Venkatraman J.English Atul JainEnglish Pregnesh ParmarEnglishA 23 year old male presented with a painless solitary nodular swelling near left lateral border of the tongue of 4 years duration. Fine needle aspiration cytology revealed a benign cystic lesion. Excisional biopsy was done for histopathological examination which revealed larvae of the pork tapeworm (cysticercus). Cysticercus normally dwells in the organs of pigs and infection of human tissues is much more unusual. Oral cysticercosis, especially the involvement of tongue is rare in humans.v
EnglishLingual, Cysticercosis, Oral, Tongue, Taenia, Cellulosae.INTRODUCTION
Cysticercosis is caused by the larval stage of Taenia Solium. Taenia solium has a complex 2-host life cycle. It is a hermaphrodite cestode that inhabits the human small intestine of those individuals who have ingested raw or inadequately cooked pork infected with viable larvae (cysticerci). The scolex of the larva evaginates from the cyst inside the small intestine and attaches to the bowel wall. After 3 months, the adult tapeworm develops within its human definitive host, producing a condition known as taeniasis and thereafter begins forming proglottids, which are frequently detached from the distal end of the worm and are excreted in the feces. Each proglottid contains 50,000 to 60,000 fertile eggs, which can remain viable for a longer time in water, soil, and vegetation. Cysticercosis develops when these eggs are ingested by humans and pigs (intermediate host), and oncospheres (embryos) are liberated by the action of gastric acid and intestinal fluids. These embryos actively cross the bowel wall, enter the blood stream and infest in various other tissues and organs where they develop into larval vesicles or cysticerci.
In humans, this potentially fatal parasitic disease mainly occurs as a result of the ingestion of contaminated food or polluted drinking water, but it may also develop by feco-oral contamination in tapeworm carriers.1Although the disease is more common in endemic areas like Latin America, Asia, Africa and Easter Europe, its incidence is also increasing in developed countries as a result of migration of infected persons and frequent travel to and from endemic areas.2 In humans, cysticerci are most commonly located within the central nervous system (CNS), producing a clinical disorder known as neuro-cysticercosis (NCC), but it may also localize primarily in a variety of tissues, including muscle, heart, eyes, and skin. Although oral involvement by cysticercosis is common in swine, this location is very rare in humans.1,3 We hereby present a case of cysticercosis on the tongue of an Indian male.
CASE REPORT
A 23 year old male presented with a swelling on the right lateral border of the tongue. The patient reported that the lesion was present since 4 years
with no associated pain. Intra oral examination revealed that the lesion was spherical in shape, 2x2 cm in size, firm, compressible, smooth surfaced and mobile within the soft tissue of the tongue. A clinical differential diagnosis of mucocele, sialocyst, lymphangioma and minor salivary gland tumour was given. Patient was advised for fine needle aspiration cytology. Aspirate was clear colorless fluid. Microscopic examination of the fine needle aspiration cytology showed a refractile structure on a thin protienaceous background (Figure 1). Report was dispatched as benign cystic lesion. Following which, the lesion was surgically excised under local anaesthesia (figure 2).
Histopathology of the excised tissue revealed a thin capsule of fibrous connective tissue surrounding a cystic cavity, which contained cysticercosis cellulosae (larval form of Taenia solium). The larva composed of a duct like tubal segments that was lined by a homogeneous membrane (Figure 3). Cyst wall and outer fibrous tissue (figure 4) was infiltrated with numerous inflammatory cells, macrophages and few foreign body type giant cells (Figure 5). Based on these findings, a diagnosis of cysticercosis was made. A complete blood and stool examination was performed, results of which were normal.
DISCUSSION
Cysticerci are uncommon in the oral cavity of humans where they appear as cystic nodules that may rupture and heal uneventfully.4 So far 133 cases have been reported globally in English literature.5In swine this location is common. Literature says that a high muscular activity and metabolic rate of oral tissues in humans might act against the lodgment and development of cysticercosis in this location.5According to literature, oral cysticerci usually elicit a clinical diagnosis of mucocele, or a benign tumour of mesenchymal origin, such as lipoma, fibroma, hemangioma, granular cell tumour, or a minor salivary gland tumour.6,7
Routine sections stained with hematoxylin and eosin may be all that is required for diagnosis, although in later stages only an inflammatory response to dead larvae may be seen. Fine needle aspiration cytology (FNAC) can also aid in diagnosis but it is very difficult to confirm the diagnosis.8 Studies have demonstrated that parts of the parasite have been identified in 45% to 100% of the aspirates, particularly when the aspirated material showed a speck of pearly white content that was confirmed to be the larva in acute and chronic inflammatory background by microscopic examination.9,10 In our case ,the aspirate revealed a refractile structure on a thin proteinaceous background suspicious of parasite.
Histopathological examination makes up a diagnosis of cysticercosis by the detection of a cystic space containing the cysticercus cellulosae. The scolex has four suckers and a double crown of rostellar hooklets.11 A duct-like invaginated segment, lined by a homogeneous membrane, composes the caudal end. The eosinophilic membrane that lines the capsule is double-layered, consisting of an outer acellular and an inner sparsely cellular layer. Cysticeri may remain alive for many years; slowly,it elicites a granulomatous reaction that is characterized by macrophages, epithelioid cells and foreign body giant cells, leading to fibrosis of the supporting stroma.Within a period of three to five years, the larva dies and the cyst undergoes calcification. 12
Laboratory findings in patients with cysticercosis reveal eosinophilia, raised immunoglobulin E (IgE), and most importantly, a positive enzyme linked immunosorbent assay (ELISA) test against cysticercus cellulosae. Anti cysticercus cellulosae antibodies are important in the immunodiagnosis of the disease. This procedure may be performed in serum or cerebrospinal fluid, the latter is considered a diagnostic test for neurocysticercosis.13
Drugs as albendazole and praziquantel are potent antihelminthics used in the treatment of cysticercosis14, replacing niclosamide, which was the drug of choice for the treatment of the disease for a long time.
CONCLUSION
In summary, we have showed the clinical and histopathological findings in a man with oral cysticercosis, emphasizing the need to consider cysticercosis along with other causes of cystic lesions, particularly in areas with a high incidence of this condition.
ACKNOWLEDGEMENT
Authors sincerely thank Dr Soumya S, Head, Dept of Pathology, Sri Manakula vinayagar medical college, Puducherry for her constant support. Authors also acknowledge the immense help received from the scholars who 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=1031http://ijcrr.com/article_html.php?did=1031
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Delgado-Azanero WA, Taylor A M, Bregni RC, Delgado RDM, Franco MAD, Vidaurre EC. Oral cysticercosis: a collaborative study of 16 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 103: 528-33.
Romero De Leon E, Aguirre A. Oral cysticercosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 35: 271-3.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareIMPORTANCE OF TUBERCULOSIS IN GLOBAL HEALTH AGENDA-AN EPIDEMIOLOGICAL STUDY OF TUBERCULOSIS AMONG MIGRANT POPULATION FROM SOUTH EAST ASIA, MIDDLE EAST and AFRICAN REGIONS TREATED WITH WHO-DOTS REGIMEN
English9499Vijay Kumar ChattuEnglish Mohammad A.EnglishObjective: To study the epidemiology and clinical characteristics of Tuberculosis among Saudis and migrant population in Saudi Arabia. Methods: Retrospective study was conducted based on the secondary data pertaining to the patients registered at Regional TB center in Buraidah Central Hospital from January 2005 to December 2009. Results: A total of 355 case records were included of which 187 cases are from Saudi Arabia and remaining 168 were from South Asian, African and Middle East countries. All the diagnosed cases were treated as per WHO- DOTS regimen. Cough with expectoration, fever with evening rise, loss of appetite were the chief clinical presentations. Out of the total non Saudi patients, the Indonesian patients contribute to 74 (21%) followed by Indians 39 (11%), Nepalese 12 (3.4%), Philippines and Bangladesh with 9 cases each (2.5%), and Pakistan with 8 cases (2.3%). Among the total cases, there were 341 (96%) new cases, 12 (3.4%) relapse cases and 2 (0.6%) defaulters. Conclusion: Prevalence of TB among migrant is relatively high. Preventive measures for early diagnosis should be performed especially in migrant worker from high-prevalence countries.
EnglishPrevalence, Tuberculosis, Retrospective Study, South AsiaINTRODUCTION
Global health is the health of populations in a global context and transcends the perspectives and concerns of individual nations. In global health, problems that transcend national borders or have a global political and economic impact are often emphasized. Thus, global health is about worldwide improvement of health, reduction of disparities, and protection against global threats that disregard national borders. Tuberculosis (TB) has troubled humankind throughout history. Tuberculosis (TB) is an ancient disease that has affected mankind for more than 4,000 years. It is a chronic disease caused by the bacillus Mycobacterium tuberculosis and spreads from person to person through air. TB usually affects the lungs but it can also affect other parts of the body, such as brain, intestines, kidneys, or the spine. Although a declining trend was observed in most developed countries, this was not evident in many developing countries. Global health is now considered important for national and international security, domestic and global economic well-being. In 2011, there were an estimated 8.7 (range, 8.3–9.0 million) million incident cases (equivalent to 125 cases per 100 000 population) of TB globally [1]. M. tuberculosis is known to be the leading cause of death due to a single infectious agents [2, 3 and 4]. The worldwide annual incidence continues to increase in Africa with 85% new cases because of the human immune deficiency virus HIV epidemic, whereas it is stable or falling in all other regions [5]. Although the majority of infected individuals don’t exhibit overt signs of disease, they represent a large pool of infection that allows for new cases to arise and have a risk of reactivation at a later time in their lives [6]. The risk increases significantly when the immune system of infected individual becomes suppressed, such as individuals infected with HIV [7, 8].
An accurate description of TB is difficult to obtain because of poor diagnostic facilities and reporting systems in many countries where infection is dominant [9]. The best information available on global TB comes from the World Health Organization (WHO) with Southeast Asia holding the highest number of people infected with TB in the world (World Health Organization, 2003).
Cases of pulmonary TB constituted 70.6% while the extra-pulmonary TB cases constituted 29.4% of the total cases in this year [10]. In addition, Saudi Arabia in general with its developmental projects is known to attract a lot of international work force from Asian and African countries where infections might be dominant. Therefore, this study was carried out aiming to determine epidemiological and clinical characteristics of TB cases among general population in Qassim region, Saudi Arabia between January 2005 and December 2009 and to provide valuable insight on pulmonary and extra- pulmonary TB.
MATERIALS AND METHODS
Study population and Data collection
This study was conducted in a regional TB center in Qassim region that lies approximately at the centre of the Arabian Peninsula. It was conducted as a retrospective study based on the secondary data pertaining to the patients registered in hospital from January 2005 to December 2009. Out of 400 cases, the records were scrutinized and completeness of the data available for 355 cases were included and analyzed for the present study. A total of 355 patients registered at the hospital were included in the study. The patients registered at this hospital were coming from all the parts of Al Qassim province which is a representative sample. Patients' case sheets were used as source of data. A detailed questionnaire including the information on socio economic conditions (like income, close contacts, living conditions), personal history (including smoking, alcohol, drug abuse, HIV infection etc) and clinical history was developed and these variables were analyzed in the study to give a clear picture of epidemiology of TB in the region. Findings were cross-checked with TB-Lab register, TB register, and TB cards of patients. Apart from demographic profile of the patients, the presenting symptoms, co-morbid conditions, diagnostic methods used and treatment regimen were also assessed. The cases were diagnosed by the medical officer of the hospital as per the WHO classification using the direct sputum examination and chest X-ray. Montoux test was also done on all the patients.
Ethical consideration and Statistical analysis
The study was approved by the Ethics and Research Committee of Qassim University and the hospital authorities of TB regional center. Data collected through structured questionnaires is entered and analyzed using Epi_info software (CDC Atlanta). Simple proportions and percentage were used as statistical methods.
RESULTS
A total of 355 patients with TB and other co-morbid conditions accessing the TB services at regional TB center at Qassim comprised the study population. Of the 355 patients, Saudi ethnicity observed in 187 (52.7%) patients compared to non Saudi 168 (47.3%) as shown in figure 1. Out of the total non Saudi patients, the Indonesian patients contribute to 74 (21%) followed by Indians 39 (11%), Nepalese 12 (3.4%), Philippines and Bangladesh with 9 cases each (2.5%), and Pakistan 8 (2.3%). There were few patients from other countries like Sudan, Egypt, Jordan,
Srilanka, Syria, Afghanistan and Morocco as shown in figure 2.
Among the total number of patients diagnosed with TB, 150 (42 %) were males and 205 (58 %) were females (Table 1) with the majority of participants 154 (44%) being in the age group of 16-30 years and 101 (28.5%) being in the age group of 31 – 45 years as shown in Table No. 2.
Nearly half of these cases 177 (49.9%) are pulmonary TB, and the other half were divided between 170 (47.9%) were extra-pulmonary cases and 8 (2.2%) cases with both pulmonary and extra-pulmonary involvement as shown in Table 3.
Patients included in this study with both pulmonary and extra pulmonary TB had various clinical presentations but they had complaints similar to the typical TB case presentation. The majority of patients 278 (78.3%) were admitted with fever, 266 (74.9%) had loss of appetite, 264 (74.4%) had loss of weight, 196 (55.2%) complaining of cough with expectoration and 128 (36.2%) were presenting with chest pain as shown in Figure 5. In addition there were co-morbid conditions associated like Diabetes mellitus in 36 cases (10%), and 12 (3.5%) patients were suffering from lung disease and 6 (1.7%) suffering from chronic renal failure as shown in figure 3.
All the cases were treated with Directly Observed Treatment Short course (DOTS) regimen of WHO. Out of total 355 patients on DOTS, 168 (47.3%) patients were put under CAT I, 10 (2.8%) CAT II and 175 cases (49.3%) CAT III. There were 341 (96%) new cases and 12 (3.4%) relapse cases and 2 (0.6%) defaulters among the total patients (table 4).
DISCUSSION
Over the last few decades, considerable effort has been expended in industrialized countries to control the spread of TB. A lot of these processes were effective initially [11]. In the USA, for instance, the incidence of TB decreased by 6% yearly [12]. However, TB remains to be a major health concern throughout the world. It is critical for TB control and surveillance programs to address the burden of TB in certain population. Previous reports have indicated that the incidence of smear-positive TB in Saudi Arabia was estimated to be 20 per 100,000 populations [13]. Neighboring countries such as United Arab Emirates have similar rate of TB incidence.
Our study provides population-based data on the TB cases in Qassim region, Saudi Arabia from 2005 to 2009. As shown approximately, 47.3% of TB cases included in this study are attributed for non Saudi patients indicating the important role that migrants play in TB epidemiology in Saudi Arabia [14]. Majority of migrants were from TB-high burden countries, which is one of the important factors that contribute to resurgence of the disease. Therefore, screening migrants form countries endemic for TB is valuable to significantly reduce the spread of infection according the national guidelines [15]. The high prevalence of extra-pulmonary TB in the study in comparison to overall of Saudi Arabia of 29.4% is probably due to the high number of females immigrating to Saudi Arabia as housemaids from the TB-high burden countries. Nearly half of these cases 177 (49.9%) are pulmonary TB, and the other half were divided between 170 (47.9%) were extra-pulmonary cases. There were other co morbid conditions like Diabetes mellitus in 36 cases (10%), 12 (3.5%) patients were suffering from lung disease and 6 (1.7%) suffering from chronic renal failure
Our data suggested that approximately 73% of subjects participated in this study belong to the age group of 16 – 45 years old proving that TB is a disease of economically productive age group among the low socio-economic strata of the society which goes in agreement with previously published study [16]. TB symptoms and clinical presentation of the present study were typical of TB cases with the majority of patients complained of Fever, loss of appetite, loss of weight, and cough with expectoration.
The positive aspect of this study was that doctors working at the Regional Hospital were following the WHO-DOTS regimen for the diagnosis and treatment of even complicated cases of TB.
CONCLUSION
In conclusion, in the current study, we examined the incidence and the pattern of TB cases registered in Qassim TB center and the findings of this study revealed the high prevalence of TB among migrants mainly those from Southeast Asia. Further studies and continued surveillance of the TB infections are required to formulate plans for the effective management of TB.
ACKNOWLEDGMENT
Authors would like to thank the members of Tuberculosis Regional Center at Buraidah Central Hospital who gave their full cooperation and support for this study. Authors acknowledge the great help received from the scholars whose articles 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. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Conflict of interest: The Authors declare that there is no conflict of interest
Source of Funding: This research work is supported by a grant from the Scientific Research Deanship at Qassim University, Saudi Arabia 2009.
Ethical clearance: The study got ethical clearance from the Ethics and Research Committee of Qassim University
Englishhttp://ijcrr.com/abstract.php?article_id=1032http://ijcrr.com/article_html.php?did=1032
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241522EnglishN2013December4HealthcareKNOWLEDGE AND ITS COMPLICATIONS OF DIABETES AMONGST THE KNOWN DIABETIC PATIENTS - A HOSPITAL BASED STUDY
English100104Vijaya SorganviEnglish S. S. DevarmaniEnglish M. M. AngadiEnglish Rekha UdgiriEnglishIntroduction: At present India is considered as the diabetic capital of the world. There are approximately 3.5 crore diabetics in India. This is expected to increase up to 5.2 crore by 2025. Keeping in view the alarming increase in the incidence and prevalence of diabetes in India, the W.H.O. has declared India as the “Diabetic capital” of the world. Increasing patient knowledge regarding disease and its complications has significant benefits with regard to patient compliance to treatment and to decreasing complications associated with disease. Objective: To asses the level of knowledge regarding diabetes. Study design It is a cross sectional study. Results: The major finding of the study is lack of awareness of diabetes and its complications. Recommendations: An Awareness and Education programme is required to empower diabetic patients and also to increase their quality of life.
EnglishDiabetes, complication, knowledge, awareness.INTRODUCTION
The incidence of diabetes is rising throughout the world. The figures estimated in 1995 were 135 million escalating to 151 million in 2001(1). It is anticipated to be 300 million by 2025 all over the globe (2) of which more than 75% will be in the developing countries (3).
There are approximated 3.5 crore diabetics in India which is expected to increase up to 5.2 crore by 2025. Keeping in view the alarming increase in the incidence and prevalence of diabetes in India, the W.H.O. has declared India as the “Diabetic capital” of the world (4).
Adequate knowledge of diabetes is a key component of diabetic care. Many studies have shown that increasing patient knowledge regarding disease and its complications has significant benefits with regard to patient compliance to treatment and to decreasing complications associated with disease(5). In this study, we tried to evaluate the level of knowledge of diabetes and its complications among the population of diabetes visiting the diabetic clinic in BLDE University’s Sri. B. M. Patil Medical College Hospital and Research Centre.
MATERIALS andMETHODS
We conducted a cross sectional study using pretested questionnaire by interview technique. 249 subjects were collected; and the subjects were diabetic patients attending diabetic clinic in BLDEU’S teaching Hospital. The questionnaire consists of questions that tested the patients knowledge of diabetes and its complications. It was a time bond study, conducted in the month of October to December 2009.
Limitation of the Study
Consecutive cases of Type 2 diabetes aged ≥ 18 years were selected for this study from the out patients attending to our Hospital.
New cases of diabetes were included.
Statistical methods
Data were analyzed using SPSS 15th version. Knowledge score were calculated for correct answers given by the patients. Mann Whitney ‘U’ test was used to find the significant differences and linear regression was applied to find the influence of independent variables on knowledge score.
RESULTS
In this study out the 249 patients interviewed 159(64%) were males and 90(36%) were females, and 233(94%) had type II and 16(60%) had type I diabetes. Total knowledge scores for each patient were calculated for correct answers. The maximum score attained was 35 (out of 40 maximum score). It was surprising that both male and female scored 35 and when compared the median scores of male and female it was statistically not significant (P=0.468). 79(32%) patients did not know the risk factors involved in developing the disease. Multiple linear regression analysis was done, using the scores obtained as the dependent variable and level of education, duration of diabetes, type of diabetes and residence of patients as independent variables. The analysis showed that significant association with educational status and duration of diabetes (P=0.000) and no association was found with type of diabetes and residence of the patients (P= 0.05). (Table 1)
Out of 249 Diabetic patients only 48(19%) were aware that diabetes could be prevented. 51(20%) knew their level of fasting blood sugar and 61(24%) about post prandial blood sugar and only 47(19%) had idea about their Hb level. Out of total study subjects 134(54%) did not know that the kidney function tests should be performed in diabetes. Only 92% (37%) patients had the knowledge that measures can be taken for preventing complications in diabetes, 92(37%) patients knew about symptoms of hypoglycemia and 76 (37%) patients opened that sweet should be consumed when they become hypoglycemic. 113( 45%) patients knew that treatment should be continued throughout the life. (Table 2)
Here 128 (27%) patients had awareness that family history of diabetes was one of the cause and 140(30%) opined that obesity was also risk factor for diabetes. 76 (22%) Patients said that diabetes could affect eyes, 46 (13%) said kidney, 78 (22%) said foot and other complications like heart attacks 103(30%) and lung 45(13%). 92(37%) Patients had the knowledge that if preventive measures are available for preventing complications in diabetes. (Table 3 and 4).
DISCUSSION
The major finding in the study was the lack of awareness of diabetes among the diabetic patients. In this study the knowledge score by men and women were equal but finding was dissimilar to that reported by Michele Gulabani et. al (6). According to Michele Gulabani et al the mean score in men was 2.84 points higher than that in women and the difference was found statistically significant (P=0.016). Vishwanathan et al (7) study revealed that low score was in women (78.5%) than in men (62.5%) and it was found statistically significant.
Only 14% patients knew what preventive measures should be taken to prevent the disease and 140(56%) were aware of the cause of diabetes. 45% patients correctly said that treatment should be continued throughout the life. Overall 13% of them gave correct answer about common cause of death among diabetics. This indicates a significant lack of knowledge of preventive aspects of diabetes in population. The most common cause of death among diabetes is cardio vascular disease (8) but in our study 18% of patients opined that Diabetes affects lungs and kidney.
So most of the patients may not be able to take appropriate preventive measures and may seek medical aid only at very late stages. This is worrying in the context of the fact that India currently leads the World with over 32 million diabetic subjects and these numbers are expected to increase to 79 million by the year 2030.
CONCLUSION and RECOMMENDATION
This study confirms that patient’s knowledge about Diabetes and its complications is limited. This underscores the urgent need to improve the knowledge and awareness about diabetes particularly in developing countries like India.
Thus it is recommended that awareness and Education programs are required to empower diabetic patients and also to increase their quality of life.
ACKNOWLEDGEMENT
Authors acknowledge Mrs Laxmi V. Nitsure, who had encouraged and helped during the entire study.
Englishhttp://ijcrr.com/abstract.php?article_id=1033http://ijcrr.com/article_html.php?did=1033
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