Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25General SciencesBIODEGRADATION OF REACTIVE RED 2 AZO DYE BY BACILLUS LICHENIFORMIS ISOLATED FROM TEXTILE EFFLUENT CONTAMINATED SITE
English0109D. SudhaEnglish R. BalagurunathanEnglishA bacterial isolate Bacillus licheniformis was able to degrade reactive red 2 dye, optimally at pH 9, temperature at 37°C, dye concentration of 50 mg/l at 20% inoculums size. Glucose, NH4NO3 were found to be the best additional carbon and nitrogen sources. The extracellular enzyme from Bacillus licheniformis was studied for dye decolourization potential. Biodegradation was confirmed by analyzing the product using thin layer chromatography (TLC) and gas chromotograpy- mass spectrometry (GC-MS). GC-MS analysis indicated the formation of 2, 4-dichloro-6-[(1H-indazol-5-ylimino)-methyl]-phenol, benzene sulfonamide, 1H indole and urea as final metabolites formed by Bacillus licheniformis. These results indicate the high potential of Bacillus licheniformis to serve as an excellent biomass for the use in reactive red 2 dye removal.
EnglishReactive red 2, Bacillus licheniformis, lignin peroxidase, Biodegradation and Gas chromotograpy- Mass spectrometry.INTRODUCTION
The textile industry plays an important role in the world economy as well as in our daily life, but at the same time, it consumes large quantities of water and generates large amounts of waste water. The chemical reagents used in textile sector are diverse in chemical composition ranging from inorganic to organic molecules (Subhatra et al., 2013). The release of wide range of compounds from industries are creating disturbance to the ecosystem causing climatic changes, reduction of water levels in the ground as well as oceans, melting icecaps, global warming, ozone layer depletion due to photochemical oxidation, etc. (Varsha et al., 2011). Therefore, industrial effluents containing azo dyes must be treated before discharging into the environment to remove the dye toxicity from textile effluent (Rajaguru et al., 2002). Physical and chemical methods (adsorption, chemical transformation, incineration, photo-catalysis, ozonation etc) are not suitable for the removal of recalcitrant dyestuffs, because of high cost, low efficiency and in-applicability to a wide variety of dyes (Dawker et al., 2008).
The microorganisms being highly versatile are expected to develop enzyme systems for the decolourization and mineralization of azo dyes under certain environmental conditions (Pandey et al., 2007). Along with the reductive enzymes, some investigators have demonstrated the oxidative enzymes such as lignin peroxidase, laccase and tyrosinase, in the decolourization and degradation of azo dyes (Bhatia, 2005). Biodegradation using microorganisms are gaining importance as it is cost effective, environmental friendly and produces less sludge (Bella Devassy Tony et al., 2009). In this study, we focused on the isolation and identification of dye-degrading microorganism from textile effluent contaminated site having a decolourizing ability and various intermediates formed have been analyzed during the degradation of reactive red 2 using Gas Chromatography- Mass Spectrometry (GC-MS) techniques.
MATERIALS AND METHODS
Dye
Commercially used textile reactive red 2 was procured from Infra Tex textile industry. The common name of reactive red 2 dye has been used for convenience. Other chemicals used were of analytical grade.
Selection of micro-organism
The effluent sample was collected from Infra Tex textile industry, Perundurai (long 11°13’18.6”N lat 77°39’18.5”E) in Erode district for decolourization studies. The colony was selected on the basis of their ability to form clear zones on this agar plate, containing 50 mg/l of reactive red 2 dye.
16S rRNA sequencing
Amplification of 16S rRNA fragment was performed using16SF (AGAGTTTGATCMTGGCTCAG) and 16SR (TACGGYTACCTTGTTACGACTT). The thermo cycler programme included an initial denaturation of 96°C for 10 seconds and at 94°C for 30 seconds, while it was annealed at 50°C for 5 seconds and extended at 60°C for 4 minutes, these steps cycled a total of 30, while the program was finally extended at 72°C for 10 minutes. The purified products were sequenced by Run 3730, Applied Biosystem 3.0 version (Sudha and Balagurunathan, 2013).
Dye removing efficiency of bacterial culture
For decolourization and degradation study, 250 ml conical flasks containing reactive dyes in mineral salt medium (Moosvi et al., 2007) was inoculated with bacterial isolate. These flasks kept in static incubator at 37°C. After a treatment of 7 days, the decolourized solutions were centrifuged at 10,000 rpm for 4 minutes (Dawker et al., 2008).
Measurement of dye removing capacity
Dye decolourization activity was expressed in terms of decolourization percentage and was determined the absorbance in the supernatent of with drawn samples. Dye removal was calculated according to the equation (Olukanni et al., 2009).
Ao – At
Decolourization (%) = ‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾‾ × 100
Ao
Where:
Ao =Absorbance of the dye solution
At = Absorbance of the treated dyes solution at specific time, t.
Determination of enzyme activities
Bacillus species was grown in 100 ml nutrient broth at 30°C for 24 hours and centrifuged at 6000 rpm for 20 minutes. These cells were suspended in 50 mmol-1 potassium phosphate buffer (pH 7.4), maintaining temperature at 4°C. This extract was used as an enzyme source without centrifugation (Dawker et al., 2008).
Oxidative enzyme during decolourization
Lignin Peroxidase Activity Assay
Lignin peroxidase activity has been performed at 40°C using CaCO3 as a substrate. The assay mixture contains 0.1M citrate/phosphate buffer pH 4.0. The oxidation of CaCO3 led to an absorbance increase at 420 nano meter. One unit of the enzyme activity was defined as the amount of enzyme required to produce 1molar of oxidized product/ minutes under the assay conditions (Dawker et al., 2008). Lignin peroxidase was determined by monitoring the formation of propanaldehyde. The two chemical reagents were used for propanaldehyde estimation such as 2, 4-dinitrophenylhydrazine reagent and Schiff reagent (Bansal Raj, 2009). Cell supernatant and Schiff reagent was added and the colour change was noted after two minutes recommended by schiff test.
2, 4 - Dinitrophenyl Hydrazine Test
Cell supernatant was collected into reaction tube and 20 drops of 2, 4-dinitrophenyl hydrazine was added. Then precipitate formation was noted, if precipitation was not occurred, the next step was carried out. The reaction mixture was rinsed, it indicates the acid removal and recrystallized the product using ethanol (5 ml) and allowed to dry. Then to heat for few minutes and again 2, 4-dinitrophenyl hydrazine was added. Finally colour change was noted.
Biodegradation assay through TLC
After complete decolourization by bacterial isolate at seven days of incubation period, the decolourization medium was centrifuged at 10,000 rpm for 4 minutes and supernatant extracted with ethyl acetate (Dawker et al., 2008). The extract and the aqueous phases were separately evaporated in a rotary evaporator. The concentrated extracts were dissolved in methanol and used for thin layer chromatography (TLC). The mobile phase for the organic extracts was methanol: Hexane (4:1) the bands of aromatic compounds were observed under UV light and spotted then it was scrapped and mixed with methanol; further gas chromatography- mass spectrometry was carried out.
GC –MS analysis
Gas chromatography is one of the most versatile and ubiquitous analytical technique in the laboratory, it is widely used for the identification of organic compounds, when coupled with mass spectrometry as a detection system (Christian, 2009). GC-MS analysis was performed using a Thermo DSQ II Mass spectrometer fitted with GC Trace Ultra Version 5.0 at temperature programming mode with DB 35-MS capillary non polar column. The initial column temperature was held at 50°C then increased linearly to 260°C at 10°C/ minutes. Helium was used as a carrier gas with a flow rate of 1.0 ml/ minutes. Identification of degradation products were made by comparison of retention time and fragmentation pattern with known reference compounds as well as mass spectra in the NIST spectral library.
RESULTS
Isolation, identification of dye decolourizing bacterium
The bacterial strain was selected based on their ability to form a clear zone on nutrient agar plates containing reactive red 2. Among the seven isolated bacterial strains, one strain was selected based on its ability to form high dye decolourization zone on agar plate. The morphological and molecular identifications were performed. This selected strain was identified to be Bacillus licheniformis by 16S rRNA sequencing. The sequence of the 16S rRNA gene of Bacillus licheniformis is available with accession number KC-866382 (Sudha and Balagurunathan, 2013).
Decolourization under different culture conditions
Decolourization of reactive red 2 was studied at different culture conditions. Maximum decolourization was observed at glucose concentration of 10 g/l there was 82%, ammonium nitrate at 3 g/l there was 67% decolourization and dye concentration of 50 mg/l, 85% was achieved at 20% of inoculums. In addition to this, at pH 9 there was 80% colour loss, optimum temperature 37°C there was 79% decolourization after seven days of incubation at static conditions. This indicates that the presence of easily catabolisable C and N sources in the medium enhanced the efficiency of dye degradation. pH 9 and temperature 37°C was found to be most suitable for maximum decolourization.
Enzyme Activity
Estimation of lignin peroxidase enzyme
In order to gain additional insight into the decolourization mechanisms, screening of oxidative enzyme activities were also monitored. The activity of extracellular lip was quantified as 19.8 units per gram substrate in Bacillus licheniformis under the optimized growth condition at 7th day of incubation and qualitatively performed by Schiff Test and 2, 4-Dinitrophenylhydrazine Test.
Schiff Test
Meganta colour was formed in the reaction; it indicates presence of Propanaldehyde (figure 1).
2, 4-Dinitrophenylhydrazine Test
Brown colour precipitate was formed. It indicates presence of Propanaldehyde. So these two methods denote the presence of lignin peroxidase enzyme (figure 2).
Thin layer chromatography
The comparison of TLC chromatogram of the media extracted by the organic phase after decolourization by the Bacillus licheniformis under UV light showed that the decolourized sample had three addition bands, which might originate from the dye metabolites. Aromatic amines are the usual decolourization products of azo dyes that appear in the organic phase extract.
GC-MS analysis
In order to verify degradation products formed during dye decolourization by Bacillus licheniformis, the gas chromotograpy- mass spectrometry analysis was carried out. The untreated textile dye reactive red 2 showed nine peaks in its chromatogram. The compounds analyzed for these peaks were found to be toxic products present in the untreated raw dye sample (figure 3a). Biodegradation analysis showed a major reduction in the entire organic compound and the peaks that were observed was reduced to three to four to significant extent (figure 3b). The pathway is proposed in degradation of reactive red 2, figure 8 showing various steps involved in dye degradation.
According to our proposed pathway, the peroxidase catalyzed initially the asymmetric cleavage, resulted in the intermediate product which was identified as 2, 4-dichloro-6-[(1H-indazol-5-ylimino)-methyl]-phenol with retention time 26.74 minutes and a mass peak of 306 (figure 4), benzene sulfonamide with retention time 22.96 minutes and a mass peak 157.1, (figure 5) supports the oxidative asymmetric cleavage of reactive red 2. The reduction of 2,4-dichloro-6-[(1h-indazol-5-ylimino)-methyl]-phenol giving rise to the intermediate product in this reaction as 1H indole at retention time 26.74 minutes and a mass peak 117 (figure 6). Further ring cleavage reaction might be followed giving rise the intermediate urea at retention time 21.26 minutes and a mass peak 60.6 (figure 7) in this pathway. Thus salient feature of this mechanistic proposed pathway are the release of azo linkage and formation of phenyl radicals, urea as intermediate which indicates that Bacillus licheniformis have potential to degrade the dye reactive red 2.
DISCUSSION
In this study we examined the good decolourization ability exhibited by Bacillus lichenifornmis isolated from textile effluent. Bacillus licheniformis showed decolourization of reactive red 2 at static condition. Optimization of parameters such as carbon source, nitrogen source, carbon + nitrogen source, pH, temperature, inoculums size, dye concentration in reactive azo dye was carried out in this study. The pH plays great influence in decolourization of reactive red 2 dye. The optimum pH was found to be 9 for maximum removal of dye. These present findings are closely similar with El-Sersy (2007). The range of activity on decolourization of reactive red azo dye with 37°C was high with Bacillus licheniformis. present findings were similar to that Ponraj et al., (2011) they reported that the range of activity on decolourization of orange 3 R with 37°C was 78.57%, Bacillus sp. was found to be the most effective decolourizer. Dyes being deficient in carbon sources the biodegradation of dyes without any extra carbon source is very difficult (Senan and Abraham, 2004). Therefore, in this study, glucose was used as carbon source supplemented in the mineral salt medium.
In this present study Oxidative biodegradation takes place upon action of enzyme lignin peroxidase. In previous studies Moharrery et al., (2012) reported that Halomonas strain D2 was able to degrade Toluidine Red due to its enzymatic activity. In this study the addition of lignin peroxidase inducer CaCO3 to the culture medium of microorganism may enhance lip production and facilitate its utilization, in previous study Dawker et al., (2007) reported that the addition of lip and laccase inducers such as CaCO3, indole, veratrole, vanilline and toludine to the culture medium of microorganism may enhance lip and laccase production. Despite the fact that untreated dyeing effluent may cause serious environmental and health hazards, thus it is of concern to analyse the biodegradative product of the untreated and treated effluent sample. According to our proposed pathway, Low molecular weight aromatic compound such as phenol, 1H indole and urea were produced from the degradation of reactive Red 2 by Bacillus licheniformis, our results similar to that Soundararajan et al., (2012). In this study ring cleavage was identified as the final product, this present findings similar to that Jun lin et al., (2010). Hence, this study indicates that the Bacillus licheniformis have a potential to degrade reactive red 2 dye.
CONCLUSION
The results of these findings suggest a great potential for bacteria to be used in decolourization of real dye waste waters. Interestingly, the bacterial species used in carrying out the decolourization in this study are isolated from the dye industry effluents. Thus biological processes that are simple, fast and economical can be adopted by textile and dyeing industries as an effective alternative for treating their wastewater.
ACKNOWLEDGEMENT
The authors express genuine thanks to the Vice-Chancellor and the Registrar, Periyar University, Salem, for providing research facilities. 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=1092http://ijcrr.com/article_html.php?did=1092
Bella Devassy Tony, Dinesh Goyal, Sunil Khanna. Decolourization of textile azo dyes by aerobic bacterial consortium. International Biodeterioration and Biodegradation 2009; 63: 462-469.
Bhatia S C. Text book of biotechnology. Atlantic Publishers and Distributors 2009; 394-397.
Dawker V V, Jadhav U U and Govindwar. Biodegradation of disperse textile dye brown 3REL by newly isolated Bacillus sp.vus. Journal of Applied Microbiology 2008; 105: 14-24.
El-Sersy N A. Bioremediation of methylene blue by Bacillus thuringiensis 4G 1: application of statistical designs and surface plots for optimization. Biotechnology 2007; 6(1): 34-39.
Gary D, Christian. Analytical chemistry. Pashupati Printers Pvt Ltd 2009; 574.
Jun lin, Xingwang zhang, Zhongjian li, Lecheng lei. Biodegradation of reactive blue 13 in a two-stage anaerobic / aerobic fluidized beds systems with a Pseudomonas sp isolate. Bioresource technology 2010; 101: 34-40.
Moharrery M, Otadi A, Safekordi R, Amiri and Ardjmand M. Biodegradation of Toluidine Red, an oil Soluble Azo Dye, With Halomonas Strain D2. World Applied Sciences Journal 2012; 18 (8): 1065-1072.
Moosvi S, Kher X and Madamwar D. Isolation, Characterization and decolourization of textile dyes by a mixed bacterial consortium JW-2. Dyes and pigments 2007; 74: 723-729.
Olukanni O D, Osuntoki and Gbenle G O. Decolourization of azo dyes by a strain of micrococcus isolated from a refuse dump soil. Biotechnology 2009; 8(4): 442-448.
Pandey A, Singh P and Iyengar L. Bacterial decolourization and degradation of azo dyes: a review. International Biodeterioration and Biodegradation 2007; 59: 73-84.
Ponraj M, Gokila K and Vasudeo Zambare. Bacterial Decolourization of Textile Dye – Orange 3R. International Journal of Advanced Biotechnology and Research 2011; 2(1):168-177.
Raj K, Bansal. Laboratory manual of organic chemistry, New Age International Pvt Ltd Publishers 2009; 80.
Rajaguru P, Vidya L, Baskarasethupathi B, Kumar P A, Palanivel M and Kalaiselvi K. Genotoxicity evaluation of polluted ground water and in human peripheral blood lymphocytes using the comet assay. Mutation Research 2002; 517:29-37.
Senan R C and Abraham E T. Bioremediation of textile azo dyes by aerobic bacterial consortium. Biodegradation 2004; 15: 275-280.
Soundararajan N, Gopi V, Akilesh upgade and Nazma Begam. Annals of Biological Research 2012; 3(3): 1773-1778.
Subhathra M, Prabakaran V, Kuberan T and Balamurugan I. Biodegradation of azo dye from textile effluent by Lysinibacillus sphaericus. Sky Journal of Soil Science and Environmental Management 2013; 2(1): 1-11.
Sudha D and Balagurunathan R. Effect of process parameters on anaerobic decolourization of reactive azo dyes using Bacillus licheniformis isolated from textile effluent contaminated site in Perundurai, India. International Research Journal of Environment Sciences 2013; 2(8): 37-43.
Varsha Y M, Naga Deepthi C H and Sameera Chenna. An Emphasis on Xenobiotic Degradation In environmental clean up. Journal of Bioremediation and Biodegradation 2011; S (11).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareORGANOLEPTIC EVALUATION OF SELECTED HIGH FIBRE BREAKFAST MIX
English1014Tharani Devi N.English Amirthaveni M.EnglishIndia is currently passing through an epidemiological transition due to rapid urbanization coupled with economic growth. This could have major implications on the present and future disease patterns in India, with particular reference to an increase in prevalence of non-communicable diseases (NCDs) like obesity, diabetes, and coronary artery disease. Unhealthy, processed food has become much more accessible following India's continued integration in global food markets. The main objective of this study is to formulate a product rich in Dietary Fiber. In the first phase of the study, foods rich in dietary fiber such as oat bran, wheat bran, green gram and whole wheat were selected using various criteria like availability, acceptability and cost. In the second phase, in order to produce an acceptable product with high dietary fiber, recipes such as pongal, roti, kitchadi, adai, chapathi, upma, dosa and porridge were formulated and standardized using numerical scoring method. In the third phase, Total Dietary fibre, toxic compounds, phytates and metals like zinc, tin, arsenic, lead and mercury content of the product was analyzed. Thus from the results obtained, 100g of high fiber mix which contains 16.09 g of dietary fiber along with protein can be recommended for the NCDs. Bran is a boon to NCDs.
EnglishObesity, Non communicable diseases, Dietary fiber, Oat bran, Wheat bran.
INTRODUCTION
Dietary fiber and whole grains contain a unique blend of bioactive components including resistant starches, vitamins, minerals, phytochemicals and antioxidants. As a result, research regarding their potential health benefits has received considerable attention in the last several decades. Epidemiological and clinical studies demonstrate that intake of dietary fiber and whole grain is inversely related to obesity, type II diabetes, cancer and cardiovascular disease (CVD). Defining dietary fiber is a divergent process and is dependent on both nutrition and analytical concepts. Generally speaking, dietary fiber is the edible parts of plants, or similar carbohydrates, that are resistant to digestion and absorption in the small intestine. Recent research has begun to isolate these components and determine if increasing their levels in a diet is beneficial to human health. These fractions include arabinoxylan, inulin, pectin, bran, cellulose, β-glucan and resistant starch (James et al., 2010). The study of these components may give us a better understanding of how and why dietary fiber may decrease the risk for certain diseases.
Oats were first found to have a cholesterol-lowering effect and the active component was identified as beta-glucans (Kerckhoffs et al., 2002). Oats reduced both serum total cholesterol and LDL cholesterol. Soluble fibre from oats lowers cholesterol levels in the blood. Some people are intolerant to gluten. Because oat bran as a cereal does not contain gluten a type of sugar, it is harmless for people suffering from digestion related disorders. Wheat has a natural property of controlling weight amongst all. Dietary intake of beta-glucans is potentially beneficial in the treatment of diabetes and associated cardiovascular risks (Clelenad et al., 2006). Studies have shown that beta-glucans could reduce hyperglycemia, hyperlipidemia, and hypertension. So it was thought that it would be worthwhile considering cereal and pulse in combination with brans to prepare a mix which could help for NCD’s.
MATERIALS AND METHODS
Selection of ingredients
Bran from a wide array of cereal grains have been shown to have an effect on postprandial glucose levels, serum cholesterol, colon cancer, and body mass [Ulmius et al., 2009]. Different foods rich in dietary fibre were selected based on the careful perusal of previous literature. Local availability, ease of procurement and low cost formed the secondary criteria for the choice of the ingredients.
Formulation and standardization of the mix
Supplements were tried out using different ratios ofwhole wheat, green gram, wheat bran and oat bran. The selected ingredients were cleaned, dried, roasted and powdered. This powder was tried in diferrerent ratios for the preparation of various recipes like pongal, roti, kitchadi, adai, chapathi, upma, dosa and porridge. The above mentioned combinations were prepared in the Foods Laboratory of Avinashilingam Institute for Home Science and Higher Education for Women University, Coimabtore, Tamil Nadu.
Organoleptic evaluation of the formulated recipes
Sensory qualities of the recipes were assessed by a numerical scoring for sensory quality attributes; namely, appearance, colour, flavor, texture, taste and overall acceptability. Evaluation was done by semi-trained panel members of Avinashilingam Institute for Home Science and Higher Education for Women University, using score card. The scores obtained in the acceptability trials were statistically analyzed to obtain significant and trustworthy results for the best acceptable and suitable product.
Analysis of the Breakfast mix
Selected breakfast mix was analysed for dietary fiber, active constituents and toxic elements to suit for human consumption.
Total Dietary fiber
Total dietary fiber in foods and food products is estimated by Non-Enzymatic-Gravimetric Method (Lee et al., 1992). The isolated fiber sources are suspended in H2O and incubated 90 min at 37ºC to solubilise sugars and others water-soluble components. Water-soluble fiber components are then precipitated with ethanol. Residue is washed sequentially with 78% ethanol and acetone and then dried at 105ºC. Duplicate was analysed for protein, and other for ash. Total Dietary Fibre (TDF) is calculated as weight of residue, less weight of protein and ash. The crude protein is estimated by Kjeldahl Nitrogen by using % N x 6.25.
Dietary fat
Dietary fat was analysed by was using the procedure outlined in Folch et al., (1957).
Active constituents
Active constituents and the toxic elements such as mercury, zinc, tin, phenol, arsenic, lead, trypsin inhibitor and phytic acid present in the mix were considered and were analyzed using a standard procedure. Essential fatty acids were analysed as prescribed by the AOAC methods (1975). Total sugars were analysed as given by the Dubios et al., (1956).
Anti- nutritional factors
Anti-nutritional factors were analysed for hydrogen cyanide using the standard procedure by Colorimeter estimation.
RESULTS AND DISCUSSION
Standardisation of the high fiber mix
The ingredients selected were cleaned, dried, roasted and powdered separately. For standardization this mix was tried in different combinations for their nutrient content including dietary fiber, cost of the powder and suitability for various recipes. The combinations tried were tabulated below in Table 1.
From the above combinations tried with regard to the fiber content and acceptability, odour and cost, variation A supplied more calories and minimum fiber which was not acceptable. Variations C and D supplied more fiber but these two were unacceptable because of the coarseness and flavor for human consumption. So the investigator thought those combinations may induce various side effects such as constipation and diarrhea. Finally, the investigator decided that variation B would be suitable for the selected obese subjects as that would supply calorie and fiber for an adult individual. Also this was cost effective and suitable combination for the selected recipes
Organoleptic evaluation of the selected recipes
Sensory evaluation is a multidisciplinary science that uses human panelists and their senses of sight, smell, taste, touch and hearing to measure the sensory characteristics and acceptability of food products. Thus the quality of food is judged in terms of appearance, color, taste, texture and flavour (Chandrasekhar, 2002).
For standardization of these recipes, the investigator tried with 100 g of the formulated mix and compared with the standard recipe. This powder was tried in different ratios for various recipes like pongal, roti, kitchadi, adai, chapathi, upma, dosa and porridge. The above mentioned combinations were prepared in the foods laboratory of Avinashilingam Institute for Home Science and Higher Education for Women University, Coimbatore. The average scores obtained was tabulated and discussed below in Table 2.
To evaluate these recipes porridge and pongal was eliminated first because the flavor of bran dominated in these recipes and it was not acceptable with minimum score of 13.2 and 12.7 respectively. Then, the recipes such as kitchadi and uppma had very a maximum score of 16.9 and 17.5 respectively but these two were also eliminated because it required more oil for preparing when compared to other recipes and was not in the acceptability range. Finally, the recipes such as chappathi, adai, dosa and roti with their maximum scores of 26.7, 26.7, 25.5 and 20.2 respectively were nearer to the standard and were selected because they can be cooked with less oil or no oil.
Nutritional factors of high fiber mix
Table 3 gives the nutritive value of the selected mix. The nutritive value of the formulated mix reveals that it provides 235 calories 18.76g of protein, 3-4 g of fat, nearly 70 g of carbohydrate and 17 g of fiber. It is clear that the mix provides one third of the daily requirement for an Indian adult.
Nutritional factors of high fiber mix
The following Table 4 gives the results obtained from quantitative organic and inorganic analysis of the selected mix. As per the above analysis the formulated mix contains 76.73 g of total sugars, 16.9 g of dietary fiber and 4.57 g of dietary fat per 100g. The inorganic components such as Zinc and Lead were also present in minimal amounts of 40 µg/g of zinc and 274 µg/g of lead which is below the acceptable range for humans. The results are under safety limits as suggested by WHO (2005). It is known that certain inorganic mineral elements (potassium zinc, calcium, traces of chromium etc.) play an important role in the maintanance of normal glucose tolerance and in the release of insulin from beta - cells of islets of langerhans (Huntley, 2005).
SUMMARY AND CONCLUSION
With changing dietary fashions, the current emphasis on a fiber rich diet - witness the vast array of ‘light’ and fat-reduced products lining supermarket shelves - has given dietary fibre a front seat. Although people may pay less attention to fibre, its health benefits have not vanished. Fibre remains an essential nutrient and a vital part of healthy eating for everyone, including those with diabetes. In fact, soluble forms of plant fibre may help to mute blood sugar swings.
ACKNOWLEDGMENT
We thank the student who participated actively in the study.
Englishhttp://ijcrr.com/abstract.php?article_id=1093http://ijcrr.com/article_html.php?did=1093
James M. Lattimer and Mark D. Haub * Effects of Dietary Fiber and Its Components on Metabolic Health Nutrients 2010, 2, 1266-1289.
Davidson, M.H., Dugan, L.D., Burns, J.H., Bova, J., Story, K., and Drennan, K.B. The. hypocholesterolemic effects of beta-glucan in oatmeal and oat bran: a dose-controlled study. J.A.M.A. 265:1833-1839. 1991.
Cleland JG, Loh H, Windram J, Goode K, Clark AL, Threats, opportunities, and statins in the modern management of heart failure. Eur. Heart J. 2006 Mar;27(6):641-3. 2006.
Ulmius M, Johansson A, Onning G. The influence of dietary fibre source and gender on the postprandial glucose and lipid response in healthy subjects. . Eur J Nutr. 2009 Oct; 48(7):395-402.
Chandrasekhar, U. “Food Science nd Applications in Indian Cookery” printed at Chaman offset, New Delhi, Pp. 126-140.
WHO. Quality control methods for medicinal plant materials, revised draft. 2005, p.3
Huntley, Diabetic complications. Health Action, 2005, 18 (6), Pp.13-18.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareSTUDY OF LIPID PEROXIDATION PRODUCT, SULPHYDRYL PROTEINS (-SH) AND ANTIOXIDANT STATUS IN SMOKERS
English1521Anita M. RautEnglish A.N. SuryakarEnglish Dilip MhaisekarEnglishLipid peroxide plays an important role in smokers. Increased epithelial permeability produced by cigarette smoke is likely to be mediated through depletion of sulphydryl proteins (-SH) and antioxidant capacity. The oxidant burden in the lungs is enhanced in smokers by the release of ROS from macrophages and neutrophils. Oxidants present in cigarette smoke can stimulate alveolar macrophages to produce ROS some of which attack neutrophils and other inflammatory cells into lungs. 60 smokers with smoking history 20 pkts /year were included in the study.100 healthy non-smokers’ were served as controls. Their base line clinical examination, malondialdehyde (MDA), sulphydryl proteins (-SH), superoxide dismutase (SOD) and total antioxidant capacity (TAC) were measured. The mean malondialdehyde levels in the patients at base line were high (P< 0.001) than Controls. The sulphydryl proteins, superoxide dismutase and total antioxidant capacity were low (PEnglishSulphydryl proteins, Malondialdehyde, Antioxidant status, Superoxide Dismutase, Smokers’, Reactive Oxygen Species (ROS).
INTRODUCTION
The lungs are a pair of sponge like organs in the chest which are primarily responsible for the exchange of oxygen and carbon dioxide between the air we breathe and the blood. (1). It is a unique organ in terms of its direct exposure to high levels of oxygen and reactive compounds (2) .Inhaled ozone induces toxic processes that impair lung function. The oxidant burden in the lungs is enhanced in smokers’ by the release of ROS from macrophages and neutophiles. Oxidants present in cigarette smoke can stimulate alveolar macrophages to produce reactive oxygen species (ROS). Some are weakly attack neutophiles and other inflammatory cells into the lungs (3) .A number of abnormalities and measurement of biomarkers have suggested that increased oxidative stress is occurring and is detrimental in cigarette smokers’. The most convincing way to determine the involvement of oxidative stress in smokers’ is to directly measure oxygen radicals. However direct measurement is difficult. The alternative has been to measure damage by oxygen radicals upon various lung biomolecules usually lipids (4). Lipid peroxidation can be defined as a chain of reaction of oxidative deterioration of polyunsaturated fatty acids, initiated by free radicals(5). Exposure to cigarette smoke has been shown to increase the oxidative metabolism of macrophages and appear to be more prevalent in he lungs of smokers’ and are responsible for the increased O2? production by smokers’ macrophages. Sulphydryl proteins (-SH) and redox states of intracellular and extracellular compartments is critical in the determination of protein structure, regulation of enzyme activity and control of transcription factor activity and binding of-SH / disulfide redox buffer as metal chelators, as radical quencher and as specific reductants of individual protein disulfate’s bonds. Thus the increased level of –SH proteins have been associated with increased tolerance to oxidant stresses in all these systems. Sulphydryl proteins (-SH) groups are essential in the protection against the deleterious effect of reactive species (6) Cigarette smoking increases oxidation of plasma proteins. Exposure to gas phase cigarette smoke caused increased, lipidperoxidation. It is likely that α - ß unsaturated aldehyde, which are abundantly present in cigarette smoke, may react with sulphydryl (-SH) groups leading to the formation of a protein bound aldehyde functional group (7).
To minimize oxidant damage to biologic molecules the human lung is endowed with an integrated antioxidant system of enzymatic and expendable soluble non enzymatic antioxidants. This system includes several antioxidant defense mechanisms that detoxify reactive products and convert them to products that are quenched by other antioxidants. If the oxidant burden is sufficiently great, the reactive species may overwhelm or inactive the antioxidant system. The resulting excess oxygen species can damage major cellular components, including membrane lipids, proteins and DNA etc. The pathophysiological consequences of this injury are inflammation and widespread tissue damage. Thus overall alters the antioxidant status (8).
AIMS AND OBJECTIVES
1-The present work was planned to study -SH proteins as well as oxidant/antioxidant balance in smokers.
Following parameters were studied-
To explore the existence of possible peroxidative damage in smokers by estimating the level of serum malondialdehyde as an index of lipid peroxide.
To evaluate alteration in enzymatic antioxidant such as erythocytic superoxide dismutase (SOD).
To study possible alteration in antioxidant status in smokers by estimating concentration of non enzymatic antioxidant sulphydryl proteins.
To make global assessment of antioxidant defense by measuring total antioxidant capacity in smoker’.
MATERIALS AND METHODS
1. The level of serum total lipid peroxide in terms of Malondiadehyde (MDA) was determined by Kei Satoh method.(9)
2. Serum sulphydryl proteins (-SH) was determined by A.F.S.A.method(10).
3. RBC – Superoxide dismutase activity was estimated by Najwa Cortas and Nabil Wakid method (11)
4. Total antioxidant capacity in plasma (TAC) was assayed by FRAP analysis. (12)
STUDY PROCEDURE
The present study was conducted in the Department of Biochemistry Dr. Vikhe Patil Medical College and Hospital Ahmednagar. Smokers’ with Hypertension, Malignancy, overt cardiac failure, recent surgery, severe endocrine hepatic or renal diseases and use of anticoagulant medicine and the lung disorders were excluded. All smokers’ were active smokers’ without any disease. Smokers’ with smoking history of >20 pkts /year in the age group of 25-60 years of age were included in the study and 100 healthy controls were also included in the study . Informed consent was obtained from each participant in the study.
STUDY DESIGN
Distribution of these subjects was as follows.
Sr. No.
Group
Types
No. of Subjects
1
Controls
Healthy subjects
100
2
Smokers’
Smoking history > 20 pkts/years
60
The control subjects were completely healthy non smokers and showed no abnormality on clinical examinations and were completely symptom less. The study was cleared by institutional ethics committee.
10 ml blood was collected from each patient. 5ml of it was collected in EDTA bulb and 5ml was collected in plain bulb. Plasma and serum were separated from respective bulbs by centrifugation at 3000 rpm for 10 minutes at room temperature. All the samples were analyzed on the same day of collection.
Serum MDA levels were measured reacting than with thiobarbituric acid at high temperature to form pink colored complex which was measured at 530 mn(9). Erythrocyte SOD activity was measured by Kajari Das method (10) which is based on the ability of SOD to inhibit nitrite formation. Plasma -SH protein were measured at 412 nm using A.F.S.A.method (11). And total antioxidant capacity was measured at 593 nm by using FRAP analysis. (12)
The statistical analysis was performed by using student t test and P values < 0.001 were interpreted as statistically significant. The values were expressed as mean ± SD.
RESULTS
Table No. 1 Illustrate the levels of MDA, SOD,-SH, TAC in the healthy controls and smokers
Sr No.
Parameters
Healthy controls n=100
Smokers’ n=60
1.
Sr.MDA
(µmol/L)
1.66±0.28
4.5±2.76 *
2.
Sr. SOD
(U/mg of Hb )
1.38±0.129
0.40±0.1 *
3.
Sr. –SH Proteins
(µmol/L)
19.37±1.7
8.1±1.15 *
4.
Sr.TAC
(umol /L)
1253.12±170.22
411.09±72*
n = number of cases
All values are expressed in mean ± SD
* = Significant when compared with control group DISCUSSION
Table No. 1 display serum total lipid peroxide (MDA) levels in healthy controls and smokers’
Significantly higher levels of serum total lipid peroxide (MDA) (PEnglishhttp://ijcrr.com/abstract.php?article_id=1094http://ijcrr.com/article_html.php?did=1094
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Dominici S, Valentini M, Maellaro E, et. al. Redox modulation of cell surface protein thiols in U937 lymphoma cells the role of gamma – glutamyl turns peptidase- dependent H2O2 production and S. thiolation .Free Radic Biol.Med. 1999, 27, 623 – 635.
I Rahman and I. M. Adcock. Oxidative stress and redox regulation of lung inflammation in COPD. Eur. Respair J. 2006, 28; 219-242.
Dekhuijzen P.N. Aben KK, Dekker I, Aarts L.P. Wielders PL, Van Herwaarden CL, Bast A. Increased exhalation of hydrogen peroxide inpatients with stable and unstable chronic obstructive pulmonary disease. Am J.Respir. Crit. Care Med. 1996 Sept. 154, 813-6.
Chesseman K.H. Slater T.F. An introduction to free radical biochemistry. British Medical Bulletin 1993: 49: 481 – 493.
Di Simplicio P; Franconi F, Frosali S, Giuseppe D. Thiolation and nitrosatin of cysteines in biological fluids and cells. Amino acids 2003, 25, 323-339.
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Suzy A.A. Comhair and Serpel C, Erzurum .Antioxidant responses to oxidant – mediated lung diseases. Am J Physiol lung Cell Mol physiol 2002 283: L246 – L255.
Estimation of lipid peroxide (MDA) by Kei Satoh method .Clinica chemical Acta 1998, 0:37- 43.
Kajari Das, Luna Samanta and GBN chainy A modified spectrophotometric assay of superoxide dismutase using nitrite formation b superoxide radicals. Indian Journal of Biochem and Biophysics Vol 37, June 2000, 201-204.
Habeeb, A F.C.A (1972), Estimation of protein sulphydryl (-SH) groups with Ellman’s reagent. Methods Enzymol: 34:457-464.
Iris F.F. Benzic and J.J. Strain. The Ferric Reducing Ability of plasma (FRAP) as a Measure of “Antioxidant Power”. The FRAP Assay Article No. 0292 analytical Biochem. 239, 1996, 70-76
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38.Paul Kirkham and Irfan Rahman .Oxidative Stress in asthma and COPD: Antioxidants as a therapeutic strategy pharmacology and Therapeutics volume 1: issue 2: August 2006: 476-494.
Irwin Fridovich, Superoxide radical and superoxide dismutase. Ann. Rev. Biochem. 1995: 64-97-112.
Salo DC, Pacifici RE, Lin SW, Giulivi C Davies KJ. Superoxide dismutase undergoes proteolysis and fragmentation following oxidative modification and inactivation. J. Biol Chem. 1990: 265:11919-27.
Fridovich I. Superoxide radical and superoxide dismutase Ann. Rev: Biochem 1995: 64: 97- 112.
R Permanand. P.H.Santosh Kumar and Alladi Mohan. Study of thiobarbituric reactive substances and total reduced glutathione as indices of oxidative stress in chronic smokers with and without chronic obstructive pulmonary disease. Indian J. Chest Dis. Allied Sci. 2007: Jan –Mar: 49( 1 ): 9- 12.
Iris F.F. Benzic and J.J. Strain. The Ferric Reducing Ability of plasma (FRAP) as a Measure of “Antioxidant Power”. The FRAP assay Article No. 0292 Analytical Biochem. 239: 1996: 70-76.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcarePOLYTHELIA OR SUPERNUMERARY NIPPLE - A CASE REPORT
English2225Girish ByadarahallyEnglish Anupama D.English R Lakshmi prabha SubhashEnglish Sameena SultanaEnglish Charishma K.EnglishAn young lady aged about 20 years born of non consanguineous marriage, who was full term pregnant presented with h/o labor pains in the Dept of OBG at SSMC, Tumkur. On general physical examination she had accessory nipples- 3 on the right side and 2 on the left side of which the right middle one was secreting milk. No associated anomaly were found. There was no family history of accessory nipples. Based on clinical features and investigations, a diagnosis of Isolated Polythelia was made. Renal ultrasound was normal. Echocardiogram revealed Situs solitus ( Levocardia). The genetic analysis was done which was normal. The patient was counseled and advised. The presence of supernumerary breast tissue indicates incomplete involution of the milk line, resulting in the formation of accessory mammary tissue from the redundant clusters of ectopic primordial breast cells. Accessory breast tissue has no physiologic significance, but sometimes it can be the site of breast carcinoma. Surgical treatment is performed as a prophylaxis against breast cancer which has a higher prevalence in polythelia or polymastia.
EnglishINTRODUCTION
Congenital breast malformations range in severity from minor to major deformities. These malformations generally fall into 1 of 2 categories, the presence of supernumerary breast tissue and the absence or underdevelopment of breast tissue. Supernumerary nipple (also called third or accessory nipple) is an additional nipple occurring in mammals including humans. [1]This occurs in 2-6% of females and 1-3% of males.[2] They can range in appearance from a small mole-like structure to a full breast, which may lactate, even in men. They are more common in men than in women. [1]
Major deformities may cause significant functional, psychological, and aesthetic concerns. The affected individual may present for consultation at any age, often early in childhood as a result of parental concern.[2] Most of this accessory breast tissue has no physiologic significance, but some may enlarge with the onset of puberty, pregnancy, or lactation, and can be the site of breast carcinoma.[3] Mammary glands are modified and highly specialised type of sweat glands which arise from mammary buds which begin to develop during 6th week as solid downgrowths of thickened epidermis named Mammary crests extending from the axillary to the inguinal regions, into the underlying mesenchyme. Usually the mammary crests persists in the humans only in the pectoral area, where the breasts develop. An extra breast or nipple may occur in 1% of the female population as an inheritable condition.[1,3] Approximately one third of affected individuals have more than one site of supernumerary breast tissue development . 67% of accessory breast tissue occurs in the thoracic or abdominal portions of the milk line, often just below the inframammary crease and more so on the left side. Another 20% occurs in the axilla. The remaining occur anywhere along the milk line or in the buttock, back, face, and neck and foot.[4] In humans the process normally results in two breasts, but the process sometimes may vary. Approximately one third of affected persons may have 2 extra nipples or breasts. Here in we report a case of polythelia of various degrees in an young lady. During embryogenesis, development of all organs and tissues is regularly controlled by different genes. Scaramanga gene said to produce a protein which will determine the breast development.[5] The protein is very similar to proteins found in breast cancer, suggesting a direct link between the two. [6] While proteins carefully control the development of breast cells in the embryo, inappropriate signals to breast cells during adulthood by the same molecules may cause breast cancer. NRG3 activates cells that have a protein very similar to one over-expressed in about 20 per cent of breast.
CASE REPORT
The patient was a 20 years old young woman who had 3 nipples by birth on right and 2 on left side. On the right side, one accessory nipple was located along the milkline 6cms away from the main nipple and it was secreting milk (Polymastia, Class I) and one more in the infra mammary region and another in the region of loin which resembled a mole( Polythelia VI). On the left side one was a rudimentary nipple (Polythelia ,Class VI) located along the milk line in the infra mammary space and another in the region of loin which resembled a mole. Screening of the Breast revealed, breast parenchyma and ducts in the upper accessory nipple on the right side and the ducts communicated with the main breast duct system.There was no evidence of significant focal lesions or ductal dialatation. An abdominal ultrasound showed no urorenal malformations. 2D echocardiography showed Situs solitus (Levocardia). Management of such cases with polythelia or polymastia is discussed in the view of recent literature.
DISCUSSION
The Mammary gland is a complex organ that begins development early in gestation. At birth the rudimentary mammary glands are identical in males and females. The nipple appears as a small pit in the center of a thickened areola containing a few glands of Montgomery. Shortly after birth, the nipples become everted from proliferation of the surrounding mesoderm, and the areola develop a slight increase in pigmentation. [1] In 1915, Kajava published a classification system for supernumerary breast that remains in use till today. [3,7,8] Class I consists of a complete breast with nipple, areola, and glandular tissue. Class II of nipple and glandular tissue but no areola. Class III of areola and glandular tissue but no nipple. Class IV of glandular tissue only, Class V of nipple and areola but no glandular tissue (pseudomamma). Class VI of a nipple only (polythelia). Class VII of an areola only (polythelia areolaris). Class VIII of a patch of hair only (polythelia pilosa). The most common form of supernumerary breast tissue is polythelia, the presence of more than 2 nipples in an individual. Males and females have an overall equal incidence, but differences are observed within ethnic groups. For example, polythelia is present in 5% of Japanese females but only 1.6% of Japanese males. Differences also exist among ethnic groups. Polythelia occurs less frequently in Caucasians (0.6%) than in blacks (3.5%).[7] Most cases are sporadic, but approximately 1% are familial and are believed to represent an autosomal dominant trait with variable penetrance.[3,5] From 43 cases of polythelia studied by Schmidt, males constituted 23(53.5%) of cases. Regarding the anatomical location of polythelia, 2(4.65%) were on the anterior axillary fold, 28(65.1%) on the anterior thoracic wall, 12(27.9%) on the anterior abdominal wall and one (2.3%) was in the inguinal region.[2] Only five cases (11.6%) had family history of previous similar conditions.[3,5] A correlation exists between renal disease and polythelia.[3,8,9] Approximately polythelia is associated with 19% of patients with renal adenocarcinoma and 16.5% of patients with end-stage renal disease. So patients with polythelia, should be aware of the need for regular physical examination and urinalysis any abnormality noted should alert the physician to the need for a renal ultrasound. Polymastia, is the second most common form of supernumerary breast tissue, occurring in 1-2% of the female population exists in various forms , as described by Kajava Classes I through IV, but, most commonly, the nipple and areola are absent or rudimentary. The most common location is in the axillaor inframammary region. [5] In most people, extra nipples are benign and may never be noticed. But if they change, develop a lump, rash or discharge, they should be taken seriously, otherwise polythelia may be surgically removed, just like a mole. Supernumerary nipples serve as a potential important marker for malformations and malignancies.[9,10] Because there have been familial cases of polythelia reported and because accessory nipples have been associated with certain cancers, supernumerary nipples have been proposed as a genodermatosis with malignant potential.
CONCLUSION
Polythelia develops randomly. In this case no associated pathological conditions with polythelia were found and unable to link it to other disease entities,however in general any breast tissue, with normal location or elsewhere is vulnerable to the same diseases that can affect typical breast tissue.
ACKNOWLEDGEMENT
We sincerely thank Dr Meenakshi bhat, Genetic counsellor, Dr Jayarama Kadandale, Clinical Cytogeneticist and Harshal K L, Genetic Research Associate, Division of Cyto Genetics, SSMC, Tumkur for performing genetic analysis in our patient.
Englishhttp://ijcrr.com/abstract.php?article_id=1095http://ijcrr.com/article_html.php?did=1095
The developing Human 8th ed .Keith L Moore TVN Persau Elsiviers ch 19 The Integumentary system p 444-446
Kose R, Ozgoonul A, Bingol I Intra areolar Polythelia : A Rare Anamoly. J Pak Med Assoc.2012 May;62(5):499-500
Emily C Grimshaw BS, Philip R Cohen MD Supernumerary nipple and seminoma: Case report and review of polythelia and genitourinary cancers Dermatology Online Journal 19 (1): 4 January 2013.
Delio Marques Conde Eiji Kashimoto Renado Zocchio Torresan Pseudomamma on the foot : An unusual presentation of Supernumerary breast tissue Dermatology online jounal 12(4): 7
Assimina Galli Tsinopoulou , Carsten Krohn , Heinrich Schmidt. Familial Polythelia over 3 generations with Polymastia in the youngest girl. European journal of Pediatrics. May 2001, Vol 160, Issue 6, pp 375-377.
Mohammad O. Selman MBChB; FIBMS Polythelia: Anatomic and clinical implications IRAQI J MED SCI, 2010; Vol.8 (4):53-56
Justin Brown, MD; Robert A. Schwartz, MD, MPH PEDIATRIC DERMATOLOGY Supernumerary Nipples: An Overview VOLUME 71, MAY 2003 344-46
Schmidt H. Supernumerary nipples: prevalence, size, sex and side predilection –a prospective clinical study Eur J Pediatr. 1998 Oct;157(10):821-3..
James J. Goedert, M.D.; Elisabeth A. Mckeen, M.D.; Nasser Javadpour, M.D.; Robert F. Ozols, M.D.; Linda M. Pottern, M.P.H. and Joseph F. Fraumeni Jr, M.D.Polythelia and Testicular Cancer Ann Intern Med. 1984;101(5):646-647.
CCarlo Enrico UrbaniRoberto BettiA berrant mammary tissue and nephrourinary malignancy: A man with unilateral polythelia and ipsilateral renal adenocarcinoma associated with polycystic kidney disease . Cancer Genetics and Cytogenetics Vol87, Issue 1, March 1996, Pages 88–89
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareCHLORHEXIDINE - A MIRACLE CHEMICAL
English2634Paavai IlangoEnglish M. ArulpariEnglish Mary Medona English T. AbiramiEnglishChlorhexidine is a broad-spectrum antiseptic. It is recognized as Gold standard against which other antiplaque and antigingivitis agents are being compared. We are using it on medical devices and for skin preparation prior to procedures. It is well tolerated by patients and is a true life-saver in terms of prevention of infection and “multi-drug resistant organisms”. Hence it can be called as a “Miracle Chemical”. This article clearly suggests the properties and limitations of this miracle molecule “Chlorhexidine” ensuring the maximum efficacy and the minimum side effects of the agent. Thus, this is one unique chemical which is considered as the past, present and future agent in the ever-growing field of clinical periodontics.
EnglishChlorhexidine, Antimicrobial, Antigingivitis, Antiplaque agent, Mouth wash, Antiseptic.INTRODUCTION
Chlorhexidine is a cationic bisbiguanide that has been used as a broad-spectrum antiseptic in medicine since 1950’s. Its ability to inhibit the formation and development of bacterial plaque was demonstrated in 1970’s. It is the most effective antiplaque, antigingivitis agent. [1]
Structure
It is symmetrical molecule consisting of two 4 chlorophenyl rings, two biguanide groups and a central hexamethylene bridge connecting chlorophenyl and biguanide group. (Fig.1)
After 20 years of use by the dental profession, chlorhexidine is recognized as the Gold standard against which other antiplaque and gingivitis agents are measured. Chlorhexidine's antiplaque effect is a result of the dicationic nature of the chlorhexidine molecule, which affords the agent the property of persistence of antimicrobial effect at the tooth surface, through both bactericidal and bacteriostatic effects.
Mechanism of action
Chlorhexidine is a broad-spectrum biocide effective against Gram positive bacteria, Gram negative bacteria and fungi [16]. Chlorhexidine inactivates microorganisms with a broader spectrum than other antimicrobials (e.g. antibiotics) and has a quicker kill rate than other antimicrobials (e.g. povidone-iodine). Based on its concentration, it has an immediate bactericidal action and a prolonged bacteriostatic action due to adsorption onto the pellicle-coated enamel surface [10]. Chlorhexidine kills by disrupting the cell membrane. [28] (Fig. 2)
Effect on bacteria
Chlorhexidine is a positively charged molecule that binds to the negatively charged sites on the cell wall; it destabilizes the cell wall and interferes with osmosis. [22] The bacterial uptake of the chlorhexidine is very rapid, typically working within 20 seconds. In low concentration, it affects the integrity of the cell wall. Once the cell wall is damaged, it crosses into the cell itself and attacks the cytoplasm membrane. Damage to the cytoplasm's delicate semi permeable membrane allows for leakage of components leading to cell death. In high concentration chlorhexidine solidifies the cytoplasm. (Fig. 3)
Effect on fungi
Fungi uptakes chlorhexidine in a short period of time and the mechanism of action is very similar to bacteria.
Effect on biofilm
Bio films are a complex aggregation of microorganisms growing on a solid substrate. They can occur on organic (e.g. dental plaque) or inorganic surfaces. This matrix protects the cells within it and increases their resistance to antimicrobials. Many antimicrobial agents have a difficult time eliminating organisms in a bio film. Chlorhexidine has shown some ability to help inhibit adherence of microorganisms to a surface thereby preventing growth and development of bio films. [14]
Effects on other microbial organisms
This includes bacterial spores and protozoa. It has also shown activity against enveloped viruses in vitro (e.g., herpes simplex virus, HIV, cytomegalovirus, influenza. But has substantially less activity against nonenveloped viruses (e.g., rotavirus, adenovirus, and enteroviruses). [11]
Effect on skin, mucous membrane
In topical applications, chlorhexidine is shown to have the unique ability to bind to the proteins present in human tissues with limited systemic absorption. Protein bound chlorhexidine releases slowly leading to prolonged activity. This phenomenon is known as substantivity [18] and allows for a longer duration of antimicrobial action against a broad spectrum of bacteria and fungi. In fact, it's antimicrobial activity has been documented to last at least 48 hours on the skin. [7][18] Unlike povidone-iodine, it is not affected by the presence of body fluids such as blood.
Effect on medical equipments
Chlorhexidine has also been applied to medical devices such as dental implants, vascular catheters, needleless connectors and antimicrobial dressings to kill organisms and protect against microbial colonization and subsequently bio film development.
Deactivation
Chlorhexidine is deactivated by anionic compounds, including the anionic surfactants commonly used as detergents in toothpastes and mouthwashes, anionic thickeners such as carbomer. For this reason, chlorhexidine mouth rinses should be used at least 30 minutes after other dental products [4]. For best effectiveness, food, drink, smoking, and mouth rinses should be avoided for at least one hour after use. If it is not deactivated, chlorhexidine lasts longer in the mouth than other mouthwashes and this is partly why it is to be preferred over other treatments for gingivitis.
Safety
Chlorhexidine is harmful in high concentrations, but is used safely in low concentrations in many products, such as mouthwash and contact lens solution. However, numerous scientific papers have reported complications with low level exposure too. In UK, the Medicines and Health Care Products Regulatory Agency (MHRA) has issued a patient safety alert on the risk of anaphylactic reactions from the use of medical devices and medicinal products containing chlorhexidine. Adequate and well-controlled studies in pregnant women have not been done, so this drug should be used during pregnancy only if clearly needed. Caution should be exercised when chlorhexidine is administered to a nursing woman. Ingestion of 3-6ml of chlorhexidine by a small child (~10 kg body weight) might result in gastric distress, including nausea, or signs of alcohol intoxication. Medical attention should be sought if more than 12ml of chlorhexidine is ingested by a small child or if signs of alcohol intoxication develop.
Availability
Chlorhexidine is present in various forms such as oral rinses (0.2% and 0.12% concentration), skin cleansers, Gauze dressings, pre-operative skin preparation, surgical scrub, spray, rubbing agent, gel with and without combination of fluoride, soap, face wash, varnish, local drug delivery, chewing gums and in small quantities it is used as a preservative.(fig.4) As a mouth-rinse, chlorhexidine is sometimes marketed under the brand names Clohex, Foam Safe, Hexicleans, Peridex, and Perichlor. It is also available as a chlorhexidine-chip (PerioChip) in the UK, USA and in Germany. Quinoderm face wash is the brand name for its face wash. Its spray products are mainly marketed under the brand name Corsodyl. It is marketed as ethanol in Italy, Switzerland and other European countries, Chlorhexamed in Germany, Savacol in Australia and New Zealand, clohex in India, Perioxidina in Venezuela, chlorhex in UK. As a skin cleanser, it is marketed under brand names such as Hibiclens, Savinox plus or Dexidin. Surgical hand wash is marketed under the brand name Hexigard. It is also used in some acne skin washes. It is also used as part of a treatment for athlete's foot. In some countries, it is available by prescription only.
Various forms of chlorhexidine
Chlorhexidine mouth wash
Indications
Antiplaque and antigingivitis agent.
It is used to improve bad breath. Morning halitosis is reduced up to 90%.[27]
Improves gingival health for short periods in the absence of any mechanical oral hygiene procedure.[15]
It is used between dental visits as part of a professional program for the treatment of gingivitis [6].
It may also be of some prophylactic value against oral candidial infections.[5]
It decrease the speed and degree to which recurrence of drug-induced gingival enlargement occurs.[24]
During the first postoperative week after a periodontal surgery, patient advised to use twice daily to maintain good oral hygiene.[19]
It may help to reduce the mucositis.[23]
There are oral pathologic conditions like oral cysts, dental traumas etc. in which the maintenance of oral hygiene is required for healing and regeneration of the oral tissues [29] [30].
Side effects
The most common side effects are:
An increase in staining of teeth and other oral surfaces including silicate and resin restorations due to continued use for long periods. [13] This brownish discoloration of teeth and tongue are due to the fact that the disintegration of bacterial membranes leads to the denaturation of bacterial proteins [8]. Other discolorations might be caused by monosaccharide’s such as glucose and fructose that are dissolved in saliva and that react with the amine functions of bacterial proteins.(Maillard reaction)[8].
An increase in calculus formation,
An alteration in taste perception[12]
Minor irritation and superficial desquamation of the oral mucosa.
Parotid gland swelling and inflammation of the salivary glands (sialadenitis).
Frequently reported oral mucosal symptoms are Stomatitis, Gingivitis, Glossitis, Ulcer, Dry mouth, Hypesthesia, Glossal edema, Paresthesia.
Study comparing efficacy of two different concentrations of chlorhexidine mouth-rinse on plaque re growth suggests both are almost equally effective for their plaque inhibiting capacity. [9]
Study evaluating the role of chlorhexidine in caries prevention suggests that it has not been highly effective in preventing caries. [3]
Topical chlorhexidine
Chlorhexidine is used as a topical antiseptic skin scrub in hospital and household settings. It is also used for general skin cleansing, surgical scrub, pre-operative skin preparation and as a rubbing agent prior to the use of hypodermic or intravenous needles in place of iodine. (Fig. 5)
It is contraindicated for use near the meninges, in body cavities, and near the eyes and ears because at 2% concentration, it can cause serious and permanent injury.
Chlorhexidine Spray
It acts as an antiseptic and disinfectant agent. It kills micro-organisms in the areas it is in contact with.
Indications
Aid for preventing build-up of plaque on the teeth and maintaining oral hygiene.
Prevention and treatment of gingivitis.
Promoting gum healing after dental surgery.
Management of apthous ulcers.
Management of candidiasis.
Management of inflammation of the lining of the mouth due to denture irritation.
Side effects
Temporary taste disturbance.
Burning sensation on the tongue.
Brown, non-permanent staining of the teeth avoided by brushing the teeth before using the spray.
Peeling inside the mouth.
Swelling of the salivary glands.
Skin irritation.
Study comparing chlorhexidine spray and mouthwash in the control of dental plaque after periodontal surgery indicates that the efficacy of CHX spray in the post-surgical control of dental plaque is not different from that of CHX mouthwash , but, tooth staining on the contrary was significantly lower in the group using CHX spray[12].
Chlorhexidine gel
It acts as an antiseptic and disinfectant agent. One inch of gel should be used to brush the teeth once or twice a day for about a minute. The brushing aids in both mechanical and chemical plaque control. Indications and side effects are similar to that of spray. It additionally helps in preventing tooth decay in people at high risk, for example people with a dry mouth due to poorly functioning salivary glands (xerostomia).
Chlor-fluro gel
It is used on trays or tooth brush or direct application. It is available in 30 and 250 ml with the composition of 0.2% of chlorhexidine gluconate and 0.003% of sodium fluoride. Chlorhexidine helps control plaque and eases localised gingival and oral infections whereas Fluoride ions present are taken up by tooth structure and help to increase resistance to dental caries [20].
Indications
Used for the control of minor infections and to ease associated discomfort.
Used as an aid to oral hygiene after oral surgical procedures or jaw fixation.
Used to control plaque growth on RPD or orthodontic appliances.
Contraindications
Not recommended for people who cannot expectorate.
Directions to use
Place approximately 1cm on toothbrush, brush thoroughly spit out. No rinsing for approximately 15 minutes once a day.
When using a tray system place a small amount of gel in each tooth segment, gently seat tray into mouth. To achieve full benefit, keep tray seated in the mouth for 1 hour.
Chlorhexidine Soap
It is used to reduce the germs on your skin. It works for a longer time than other soaps and it works when other body fluids such as blood are present. It is found to be more active against Hospital Acquired Infections.
Study evaluating effect of daily chlorhexidine bathing on hospital-acquired infection reveals daily bathing with chlorhexidine-impregnated washcloths significantly reduced the risks of acquisition of MDROs and development of hospital-acquired bloodstream infections [21].
Side effects
Itchiness, redness, and irritation of the skin. But, these side effects often go away quickly.
Chlorhexidine face wash
It has an antibacterial action and prevents spots in the face. Composition includes Chlorhexidine gluconate 0.15% and cetrimide 1.5%. (Fig.6)
Chlorhexidine varnish
The protective varnish containing chlorhexidine and thymol protects exposed root surfaces and controls bacteria.
Indications
Protection of exposed root surface
Treatment of open dentin tubules
Bacterial control in patients e.g. Ortho patients
Inadequate oral hygiene
Gingivitis
Study evaluating the use of chlorhexidine varnishes in preventing and treating periodontal disease indicates that the application of varnishes seems to have beneficial effects in patients with chronic gingivitis, improving their plaque accumulation and bleeding levels and reducing their gingival index. It also suggests that it is possible to maintain beneficial effect for prolonged periods of time, although this requires re-applications of the varnish. Additionally, sub gingival application of high-concentration varnishes following SRP gives greater reductions in pocket depth than those obtained solely by mechanical treatment of the pockets [17].
Local drug delivery of Chlorhexidine
Periochip is a small chip (4.0*5.0*0.35mm) composed of biodegradable hydrolyzed gelatin matrix, cross linked with gluteraldehyde and also containing glycerine and water, into which 2.5mg of chlorhexidine gluconate (36%) has been incorporated. This delivery system releases chlorhexidine and maintains drug concentration in GCF for at least 7 days. [26]
Availability
Periochip 2.5mg is supplied as a small, orange-brown rectangular chip. It is supplied in cartoons of 10 and 20 chips. Each chip is individually packed in a separate compartment of an aluminum blister pack.
Indications
Adjunct to scaling and root planning for reduction of pocket depth.
Used as a part of a periodontal maintenance program.
Dosage and administration
1 periochip is inserted into a periodontal pocket with probing pocket depth 5mm. Up to 8 periochips may be inserted in a single visit.
Chlorhexidine chewing gums
Chewing gum as a delivery system for various topical dental prophylactic and therapeutic agents has been repeatedly studied. A few dental chewing gum products are registered and marketed in various countries. Thus, there are gums containing fluoride, enzymes, mineral salts, metal salts, xylitol, carbamide and CHX diacetate. Chlorhexidine containing chewing gum consists of 5 mg of chlorhexidine diacetate.
Indications
To fight against plaque and gingivitis.
Valid choice for persons with high caries activity in general and especially for oligosialic (hyposalivary) and xerostomic patients.
To fight against halitosis and before and after undergoing periodontal therapy as an adjunct to other oral hygiene measures.
Used by all persons temporarily unable to perform mechanical oral hygiene for whatever reason.
Englishhttp://ijcrr.com/abstract.php?article_id=1096http://ijcrr.com/article_html.php?did=1096
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareCOMPARATIVE STUDY OF OXIDANT AND DIETARY ANTIOXIDANTS IN BENIGN AND MALIGNANT BREAST TUMORS- A PILOT STUDY
English3540Shinde AtulEnglish Abhang Subodhini AEnglish Shelgikar Prachi J.EnglishBackground: The incidence of breast cancer has been increasing in India in the past few years. Oxidative stress is considered to be implicated in the pathophysiology of breast cancers. In normal conditions, a balance between the oxidants and their destruction by the cellular antioxidant system in the human body is maintained. However, any imbalance between the levels of oxidants and antioxidants might cause DNA damage and may lead to tumor development. Though a large number of women are affected with breast tumors, very few studies have been undertaken in India to compare oxidant/ antioxidant status in benign and malignant breast tumors. Therefore the present study was undertaken with following aim. Aim: To compare the oxidative stress and dietary antioxidants in benign and malignant breast tumors. Material and Methods: This study included clinically diagnosed and histopathologically proven 30 each benign and malignant breast tumor patients of stage III and IV as per inclusion criteria. Fresh tumor and fibro adenoma tissues were obtained from patients immediately after surgery. Adjacent normal tissue served as control. The levels of malondialdehyde [MDA]) as a marker of oxidative damage and dietary antioxidants (Vitamin A, E and C) were estimated from the benign, malignant and normal tissues. Results: Significantly increased levels of MDA and decreased levels of dietary antioxidants (Vit E, C, A) were observed in benign and malignant breast tissue as compared to control tissue. A strong negative correlation in MDA Vs all vitamins were found. Conclusion: The results of our study indicate that the imbalance between oxidants and antioxidants leads to oxidative stress which might be playing an important role in tumorogenesis.
EnglishOxidative stress, dietary antioxidants, breast tumorsINTRODUCTION
In India, breast cancer is the most common cancer with an estimated 115,251 new diagnoses and 53,592 breast cancer deaths in 2008 according to breast cancer factsheet.[1] Carcinoma of breast continues to be one of the most frequent cancers in women all over the world. Cancer begins in cells, the building blocks that make up all tissues and organs of the body, including the breast. The buildup of extra cells often forms a mass of tissue called a lump or tumor. Breast tumors can be benign (not cancer) or malignant (cancer).
The etiology of breast tumors is multifactorial. Risk factors are early menarche, late menopause, first pregnancy at late age, obesity, oral contraception, hormone replacement therapy, dietary factors, genetic history, nulliparity etc. [2] Apart from these factors, there are some environmental factors that are behind the process of tumorogenesis. One of the most accepted factors is oxidative stress. Cells in tissues and organs are continuously being subjected to oxidative stress and free radicals on a daily basis. Oxidative stress caused by increased free radical generation and/or decreased antioxidant level in the target cells and tissues have been suggested to play an important role in carcinogenesis. Prime targets of free radicals are polyunsaturated fatty acids in cell membrane and their interaction results in lipid peroxidation. As Breast tissue is loaded with lipids they are more susceptible to oxidative insults. Normally, the free radical is counter acted by the cells’ antioxidant system without damage to the cellular DNA. As a woman ages, cellular protection may become less effective and DNA damage is wrought faster than the free radicals can be controlled and damage repaired. [3]
The levels of free radical molecules are controlled by various cellular defense mechanisms, consisting of enzymatic (catalase, glutathione peroxidase, superoxide dismutase) and non-enzymatic (glutathione and dietary vitamins E and C) antioxidants. Antioxidant vitamins can protect against a number of degenerative diseases including cancer. The main antioxidant vitamins are Vitamin C, E and β-carotene. Dietary antioxidant vitamins and retinol have been proposed to be protective against breast cancer on the basis of their ability to inhibit mutagenesis and cell transformation by reducing oxidative DNA damage. [4, 5, 6]
Thus, it is necessary to determine the role of free radicals and dietary antioxidants in tumorogenesis. We therefore undertook this study to examine the extent of lipid peroxidation in terms of MDA and the status of dietary antioxidant vitamins A, E and C in the tissue of benign and malignant breast tumor patients.
MATERIAL AND METHODS
Thirty each clinically diagnosed and histopathologically confirmed benign and malignant breast tumor cases of stage III and IV were selected. The mean age of patients in the study group was 46 years (range 30-55 years). The patients were not using hormones, oral contraceptives and were nonsmokers. Exclusion criteria includes conditions such as diabetes mellitus, liver disease, rheumatoid arthritis or any other prolonged illness, which could have caused conflict with the results of this study. This study was approved by our Internal review Board.
Fresh tumor and fibro adenoma tissues obtained from patients immediately after surgery were blotted on filter paper, weighed (1gm) and placed in cold 0.9% NaCl solution. Adjacent normal tissue (histopathologically proven) from benign and malignant tumors serves as control. The tissues were homogenized under standardized conditions in saline and 20% tissue homogenate was prepared. The supernatant was kept in an ice cold condition until assayed. Lipid peroxidation was estimated by thiobarbituric acid (TBA) reactivity.[7] Malondialdehyde (MDA) an end product of fatty acid peroxidation reacts with TBA to form a colored complex having maximum absorbance at 532 nm. Vitamin E was measured using the spectrophotometric method of Baker and Frank. [8] Vitamin E from tissue was extracted into n-heptane, which reacts with ferric chloride and reduces ferric to ferrous ions. Ferrous ions then forms a red colored complex with 2, 2 dipyridyl which was read at 520 nm. A correction for ß carotene was made after reading vit E at 520 nm. ß carotene was determined in mg% by multiplying absorbance at 460nm by 856 factor. This is the modified method of Quaife et al. [9] Vitamin C was determined by the method of Ayekyaw. [10] Vitamin C from serum reacts with phosphotungstate to give a blue color that has maximum absorbance at 600 nm.
Statistical analysis
After estimation of sample and control for different assay, the data for the biochemical analysis is expressed as mean ± SD. Statistical comparisons were performed by analysis of variance (ANOVA) followed by Duncan’s multiple range tests.
RESULTS
Malondialdehyde (MDA) is a marker of oxidative stress. The levels of MDA in benign tumor were found to be significantly increased (p < 0.001) than control tissue. When MDA levels of control tissue were compared with malignant tissue the rise was still higher (p< 0.001) than the rise observed in benign tissue [Table1].
Levels of Vitamin E in benign tumor tissue were significantly lower (p < 0.001) than control tissue whereas vitamin E status of control tissue when compared with malignant tissue was further decreased as compared to benign tissue [Table1].
There was significant decline (p < 0.001) in the levels of vitamin C in both benign and malignant tissues as compared to normal tissue [Table1].
Highly significant (p < 0.001) decrease in malignant and benign tissues as compared to control tissue were seen in the levels of vitamin A [Table1].
DISCUSSION
Breast cancer is a leading cause of morbidity and mortality in women’s lives and its incidence is on the rise in metropolitan population. [11] Most of the population is ignorant about breast examination. Screening programme is also not very effective in India. This leads to late detection and poor prognosis. This led us to select the cases of stage III and IV. Though a large number of women are affected with breast cancer, very few studies have been undertaken in India on relation between oxidants and dietary antioxidant status among women with the risk of breast cancer.
We studied the correlation between oxidative stress and dietary antioxidants in both type of tumors by studying MDA levels and Vit E, C, A levels. A strong negative correlation has been observed between oxidant (MDA) and antioxidants (dietary vitamins) in control, benign and malignant tumor tissue [Table 2].
Development of breast tumor is through damage to the breast epithelium by reactive oxygen species which lead to fibroblast proliferation, epithelial hyperplasia, cellular atypia and breast tumor. [12] The reactive oxygen species (ROS) play an important role in tumor initiation and may influence breast cancer by altering gene expression or by promoting oxidative DNA damage. [13, 14] Oxidative stress caused by increased free radical generation and/or decreased antioxidant level in the target cells and tissues have been suggested to play an important role in carcinogenesis.
The evidence for increased action of oxidants in breast cancer is related with the increase in the level of oxidative damage. In our study, it was observed that there was a higher production of oxygen free radicals in benign and malignant tumors as evidenced by high MDA levels. In malignant tissue this rise is more than benign tissue [Table 1].
Similar results were obtained by Tas et al (2005), Sinha RJ et al (2009) in tissues of benign and malignant breast cancer patients. [15, 11] Even Rajneesh CP et al (2008), Seema Khanna (2012) reported same results in serum sample of breast cancer patients.[12, 16] On the contrary Gonenc et al (2006) reported that serum sample of malignant breast disease had lower MDA levels than benign breast disease but both test groups showed prominent rise than controls. [2]
In healthy persons balance between oxidants and antioxidants is always maintained. But this balance is disturbed in diseased conditions. The probable reason for the elevated level of tissue lipid peroxides observed in breast carcinoma may be due to less availability of antioxidants than required, which leads to the accumulation of lipid peroxides in cancer tissue. Recent reports suggest that there is disturbance of the pro-oxidant/antioxidant balance, resulting from increased free radical production, antioxidant enzyme inactivation or excessive antioxidant consumption, is a causative factor in oxidative damage. [2, 11, 16]
Dietary vitamins are involved in direct elimination of reactive oxygen metabolites in association with antioxidant enzymes. They also act as anti-carcinogens and inhibitors at initiation and promotion/transformation stage in carcinogenesis. [5] In this study we estimated the levels of dietary vitamins in breast tumors as less work was carried out about them by researchers.
In our study we found decreased levels of vitamin E, C and A [Table 1] as compared to controls. This decrease may be due to the overutilization of these antioxidant vitamins in order to quench the free radicals. Vitamin E is used up in eliminating lipid peroxide radicals. This utilized vitamin E is regenerated again by vitamin C. This could also be the cause of reduced vitamin levels observed. [17]
Our results are in good correlation with the results obtained by Singh P (2005) about vitamin E and C in serum of breast cancer patients. [18] Ramaswamy (1996) noted fall in serum vitamin A and C levels in benign breast disease than in controls while in cancer patients, there was a significant trend of lower serum vitamin levels with increasing stage of the disease. [19] While Hou MF (1998) found that, the serum vitamin A levels were not decreased in early breast cancer patients but the serum vitamin A levels were significantly decreased in the metastatic breast cancer group. [20]
Thus, it has been hypothesized that the increased production of ROS along with decreased dietary antioxidant vitamin level might be characteristic of tumour cells [Table2].
CONCLUSION
Oxidative stress is in the foreground of both benign and malignant tumor, but its level is more in malignant as compared to benign tumour. The additional oxidative stress produced in case of malignant tumor may contribute to malignancy. Thus, in conclusion oxidative stress plays an important role in tumorogenesis and its intensity decides the nature of tumor i.e. malignant or benign. The results of our study provide strong evidence regarding the definitive role of dietary vitamins in breast tumours. To prove the role of antioxidant vitamins further study is needed with their supplementation in both study groups.
ACKNOWLEDGEMENT
The authors are grateful to all the subjects for actively participating in this study. Our thanks are also to all laboratory managers and staff for their support during our investigations.
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.
Englishhttp://ijcrr.com/abstract.php?article_id=1097http://ijcrr.com/article_html.php?did=1097
Breast Cancer Factsheet By Dhillon PK. South Asia Network for Chronic Disease, Public Health Foundation of India.
Gonenc A, Erten D, Aslan S, Akinci M, Simsek B, Torun M. Lipid peroxidation and antioxidant status in blood and tissue of malignant breast tumor and benign breast disease. Cell Biol Int 2006; 30:376-80.
Heinz G. Breast cancer: the role of free radicals. The Lancet Oncol 2001; 2:196.
Kasapovi? J, Peji? S, Todorovi? A, Stojiljkovi? V, Pajovi? SB. Antioxidant status and lipid peroxidation in the blood of breast cancer patients of different ages. Cell Biochemistry and Function 2008; 26: 723-730.
Borek C. Dietary Antioxidants and Human Cancer. Integrative Cancer Therapies 2004; 3:333-341.
Sivakumar S, Devaraj N. Enzymatic and nonenzymatic antioxidant status of breast cancer patients in Tamilnadu. IJPBS 2011;2(4):B46- 53.
Buege and Aust. Microsomal lipid peroxidation. Methods in Enzymol 1978; 105: 302 - 310.
Baker H, Frank O. Determination of serum ?-tocopherol. In: Gowenlock, McMurry. Varley’s Practical Clinical Biochem; London. 6th ed. 1968: 902-903
Quaife et al. Determination of serum ß carotene. In: Gowenlock, McMurry. Varley’s Practical Clinical Biochem; London. 6th ed. 1968: 903-903.
Ayeqaw. A simple colorimetric method for ascorbic acid determination. Clinica Chem Acta 1978; 86: 153-157.
Sinha RJ, Singh R, Mehrotra S, Singh RK. Implications of free radicals and antioxidant levels in carcinoma of the breast: A never-ending battle for survival. Indian J cancer 2009; 46: 146-50.
Rajneesh C P, Manimaran A, Sasikala K R, Adaikappan P. Lipid peroxidation and antioxidant status in patients with breast cancer. Singapore Med J 2008; 49: 640-643.
Halliwell B, Gutteridge JMC Free Radicals in Biology and Medicine. 2007; 4th edition. Oxford: Oxford University Press,UK.
Feng JF, Lu L, Zeng P, Yang YH, Luo J. Serum total oxidant/antioxidant status and trace element levels in breast cancer patients. Int J Clin Oncol 2011 Oct 5.
Tas F, Hansel H, Belce A, Ilvan S, Argon A. Oxidative Stress in Breast Cancer. Medical Oncology 2005; 22: 11–15.
Khanna S, Pande D, Negi R, Karki K. Oxidative stress induced damage in benign and malignant breast diseases: histopathological and biochemical aspects. Journal of Stress Physiology and Biochemistry 2012; 8: 209-214.
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Singh P, Kapil U, Shukla NK, Deo S, Dwivedi SN. Association between breast cancer and vitamin C, vitamin E and selenium levels: results of a case-control study in India. Asian Pac J Cancer Prev 2005; 6: 177-80.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareA REVIEW ON THE DETECTION OF HEAVY METALS IN WATER BODIES, FISH ORGANS, SEDIMENT RIVER BEDS
English4146Rajeev Kumar1English A. K. GuptaEnglish Amit ChattreeEnglish R. M. TripathiEnglishThe consumption of highly contaminated water and eatables may prove lethal to the human being and may bring genetic disorders. Toxic heavy metals are continuously released to the aquatic bodies in Allahabad as a rapid industrialization. Metals are the problem of magnitude and of ecological significance due to their high toxicity and ability to accumulate in living organisms. Many toxicologists have worked on the analysis and detection of heavy metals in the water bodies, soil, sediments, plankton, fish organs, etc. The main aim of this paper is to provide an in-depth review for the heavy metal concentration in water, fish, sediments, eatables, such as vegetables grown on River beds, etc and to give recommendations to prevent the health hazards against consumption.
EnglishHeavy Metal, Sediments, Industrialization, Hazards.INTRODUCTION
Due to evolution of technology, the rise of industries at or along the bank of water bodies is one of the main causes of pollution which may cause the health hazards for the population consuming the contaminated water and other related eatables. Many publications are available all around the world consisting the heavy metal detection and have been discussed in the paper. Due to the number of references collected from the variety of sources, some lacks or omissions are possible. Authors have tried to cover maximum number of information, some of them are briefly discussed below:-
Widianarko et al (2000) studied the relationship among sediment, water and fish for their metal concentrations in urban streams of Semarang, Indonesia and found a significant declining trend of lead concentrations with increasing organism size, whereas for two other metals, Zn and Cu, the concentrations did not depend on the body weight. However, metal concentration in the sediment was the most important factor governing the toxicity of metal in fish body. The fish living in highly polluted sites have also developed a physiological adaption by accumulating a large quantity of metals.
Tole et al (2003) carried out a study to establish the concentrations of Pb, Cd, As and Se in Lake Victoria waters, sediments and fish in order to assess the current threats to human health from heavy metal pollution, and also compare the current status with previous studies conducted in the Lake, so that current trends in heavy metal pollution in the Lake waters, sediments, and fish can serve as a pointer to future status.
Nnaji et al (2007) used flame Atomic Absorption Spectrometer (AAS). The Oreochromis Niloticus and Synodontis Schall were caught with cast net from twenty sampling points. The fish samples were dissected to separate the fish head/viscera from other parts after weighing. The samples were digested with concentrated acid solution and the digests were analysed. Mean metal contents in the fish head/viscera of O. Niloticus in the upstream and downstream area were calculated. After comparison of these values with FAO limits in fish tissue the study suggested that it is unsafe to consume the fish head/viscera of both fish species from River Galma.
Abdallah (2008) studied the concentrations of Cd, Pb, Cu, Cr and Zn in muscles of some commercially fish species collected from two coastal areas of the Egyptian coast of the Mediterranean Sea west of Alexandria (El-Mex Bay and Eastern Harbour). For all trace element examined, in all fishes zinc was the highest followed by Cr, Cu, Pb and Cd. The levels of Cr surpassed the maximum permissible concentration in most fish tissues, followed by Pb and Cd in some species. Cu and Zn concentrations were found to be below the maximum permissible levels proposed by Food and Agriculture Organization.
In Saudi Arabia V, Cd, Zn, As, Ni, Pb and Hg levels in most common available fish species in Saudi markets were determined by Al-Bader (2008). Results showed that the concentrations of metals were below the maximum allowed limit by the Saudi and international legislations for fish human consumption permissible limit.
Mourtaja (2008) determined concentrations of Zn, Cr, Cd, Pb and Cu in three marine fishes namely, Grey mullet, Barracuda and Sigan species. The average concentrations of these heavy metals in muscles of Grey mullet were for Zn: 4.675; Cr: 0.120; Cd: 0.096; Pb: 2.606 and Cu: 0.3743 (g/g dry wt.). In Barracuda the average concentrations were 6.030, 0.151, 0,092, 2.618 and 0.247( g/g dry wt.), respectively. In Sigan fish the averages were 6.258, 0.141, 0.123, 2.389 and 0.570 (g/g dry wt.), respectively.
Obasohan and Eguavoen (2008) investigated accumulation levels of Cu, Mn, Zn, Cd, Ni and Pb in a freshwater fish (Erpetoichthys Calabaricus) from Ogba River, Nigeria, during dry and rainy seasons. Findings showed that the accumulation levels in fish exceeded the levels of the metals in water and indicated bioaccumulation in fish and no significant differences of metal levels between the dry and rainy season. Findings also showed that both dry and rainy season mean levels of Cu, Mn and Ni in fish exceeded WHO recommended limits in food, suggested that the fishes of the River are not suitable for human consumption. They recommended that a close monitoring of metal pollution of Ogba River is strongly advocated, in view of the possible risks to health of consumers of fish from the River.
Prasath et al (2008) used Atomic Absorption Spectrophotometer for the detection of accumulation of heavy metals (Zn, Cu, Fe, Mn, Co, Pb, Cd and Ni) in water, sediments and fish (Mugil Cephalus) at Poompuhar coast (southeast coast of India) before and after Tsunami. Accumulation of heavy metals was observed in the order of Sediments > Fish > Water. In water, the order was found to be Mn > Fe > Zn > Cu > Ni > Cd > Co > Pb; Mn recorded a maximum of 506.9µ.L-1 and Pb recorded a minimum of 0.006 µ.L-1 In sediments, the order was Mn > Fe > Cu > Zn > Pb ≈ Co ≈ Cd ≈ Ni; Mn recorded a maximum of 851.1µg.g-1 and a minimum of below detectable levels were found in Pb, Co, Cd and Ni. In fish, the order was found to be Fe > Zn > Mn > Cu > Ni > Co ≈ Pb ≈ Cd; Fe recorded a maximum of 529.13 µg.g-1 and a minimum of below detectable levels were found in Pb and Cd.
Saeed and Shaker (2008) presented a report about concentrations of Fe, Zn, Cu, Mn, Cd and Pb in O. Niloticus (Tilapia) fish tissues, water and sediments in northern Delta Lakes. They found that the edible part of O. Niloticus from Lake Edku and Manzala contained the highest levels of Cd while fish from Manzala Lake contained the highest level of Pb. They reported that Nile tilapia caught from these two Lakes may pose health hazards for consumers.
Vinodhini et al. (2008) determined the bioaccumulation of heavy metals in various organs of the fresh water fish exposed to heavy metal contaminated water system using Atomic Absorption Spectrophotometer. The experimental fish was exposed to Cr, Ni, Cd and Pb at sub lethal concentrations for periods of 32 days. The results were given as µg/g dry wt. The accumulation of heavy metal gradually increases in liver during the heavy metal exposure period. All the results were statistically significant at p < 0.001. The order of heavy metal accumulation in the gills and liver was Cd > Pb > Ni > Cr and Pb > Cd > Ni > Cr. Similarly, in case of kidney and flesh tissues, the order was Pb > Cd > Cr > Ni and Pb > Cr > Cd > Ni. In all heavy metals, the bioaccumulation of lead and cadmium proportion was significantly increased in the tissues of Cyprinus carpio (Common carp).
Rauf et al (2009) carried out a study to determine heavy metal (cadmium and chromium) concentrations in gills, kidneys, liver, skin, muscles and scales of three fish species (Catla catla, Labeo rohita and Cirrhina mrigala). The sample collection was carried out from three places viz. Lahore Siphon (Up-stream), Shahdera Bridge and Baloki Headworks (Down stream) in the River Ravi, Pakistan. The results showed that Heavy metal concentrations varied significantly depending upon the type of fish tissues and locations. The concentrations of Cd and Cr differed significantly (pEnglishhttp://ijcrr.com/abstract.php?article_id=1098http://ijcrr.com/article_html.php?did=1098
Widianarko B, VanGestel C A M, Verweij R A and Van Straalen N M (2000).Associations between trace metals in sediment, Water and Aguppy, Poecilia Reticulate (Peters), from urban streams of Semarang, Indonesia. Ecotoxicol. Environ. Saf. 46:101-107.
Mwakio P. Tole and Jenipher Muhalulukhu Shitsama (2003). “Concentrations of Heavy Metals in Water, Fish, and Sediments of the Winam Gulf, Lake Victoria, Kenya”.
Nnaji J C, Uzairu A, Harrison G. F. S. and Balarabe M. L (2007). “Evaluation of Cadmium, Chromium, Copper, Lead and Zinc Concentrations in the Fish Head/Viscera of Oreochromis Niloticus and Synodontis Schall of River Galma, Zaria, Nigeria”.
Abdallah A. M. (2008). Trace element levels in some commercially valuable fish species from coastal waters of Mediterranean Sea, Egypt,. Journal of Marine Systems. 73(1-2): p. 114-122.
Al bader, N. (2008). Heavy metal levels in most common available fish species in Saudi market. Journal of food technology. 6(4): p. 173- 177.
Mourtaja, M. (2008).Evaluation of microble and heavy metals contaminants on fresh fish in Gaza Strip shore, in Food Science and Technology, Al- Azhar: Gaza. p. 100.
E. E.Obasohan and I.O.Eguavoen (2008). Seasonal variations of bioaccumulation of heavy metals in a freshwater fish (Erpetoichthys Calabaricus) from Ogba River, Benin City, Nigeria. African Journal of General Agriculture. 4(3): p. 153156.
P. Martin Deva Prasath and T. Hidayathulla Khan (2008). “Impact of Tsunami on the Heavy Metal Accumulation in Water, Sediments and Fish at Poompuhar Coast, Southeast Coast of India”.
M.S. Saeed and M.I. Shaker (2000). Assessment of heavy metals pollution in water and sediment and their effect on Oreochromis Niloticus in the northern Delta lakes , Egypt in 8th International Symposium on Tilapia in Aquaculture. Egypt. p. 475- 490.
R. Vinodhini and M Narayanan (2008). Bioaccumulation of heavy metals in organs of fresh water fish Cyprinus Carpio (Common carp).
Rauf, Javed M and Ubaidullah M (2009). Heavy metal levels in three major carps (Catla Catla, Labeo Rohita And Cirrhina Mrigala) From The River Ravi, Pakistan.
Lakshmanan R, Kesavan K, Vijayanand P, Rajaram V and Rajagopal S (2009). “Heavy Metals Accumulation in Five Commercially Important Fishes of Parangipettai, Southeast Coast of India”.
Raja P, Veerasingam S, Suresh G, Marichamy G and Venkatachalapathy R (2009). Heavy metals concentration in four commercially valuable marine edible fish species from Parangipettai Coast, South East Coast of India. International Journal of Animal and Veterinary Advances. 1(1): p. 10-14.
Alinnor, J. and Obiji, I.( 2010). Assessment of Trace Metal Composition in Fish Samples from Nworie River. Pakistan Journal of Nutrition. 9(1): p. 81-85.
RA Mandour, YA Azab (2011). “Toxic Levels of Some Heavy Metals in Drinking Groundwater in Dakahlyia Governorate, Egypt in the Year”.
Nada Sabra, Henri-Charles Dubourguier and Tayssir Hamieh (2011). “Sequential Extraction and Particle Size Analysis of Heavy Metals in Sediments Dredged from the Deûle Canal, France.
Simerjit Kaur (2012). “Assessment of Heavy Metals in Summer & Winter Seasons in River Yamuna Segment Flowing through Delhi, India”.
I. S. Shabanda, A. U. Itodo (2012). “Toxins in Gills and Flesh of Synodontissorex and Bagrus filamentosus”.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareCEMENT FACTORIES AND HUMAN HEALTH
English4753Syed Sana MehrajEnglish G.A. BhatEnglish Henah Mehraj BalkhiEnglishCement is currently the most widely used construction material throughout the world. Its production is being recognized to play a hazardous role in the imbalances of the environment and producing air pollutants in the form of various oxides, particulate matter as well as heavy metals which pose a serious threat to living world including humans, plants, animals, livestock etc. Keeping in view the hazards of cement dust it is recommendable that the cement industry management, their workers and health officials should work together to adopt scientific and technical preventive measures. The stack height must be appropriate and air pollution control devices should be installed and regularly checked so that people residing around these industries may not loss their life to fatal diseases.
EnglishCement; hazardous; workers; industries; diseases.INTRODUCTION
Studies on the impact of cement industries dates back to decades but the greatest bulk of research has been conducted within the past few years, not more than twenty years, when health specialists and environmentalists understood its adverse impacts on health and environment. These industries affect air quality, soil, flora and fauna of the region. Several studies have shown that the levels of SPM, NOx and SOx are resulting in higher incidences of respiratory diseases like tuberculosis, cardio-vascular diseases and asthma in the areas (Hart, R.H, 1970; Vestbo et al. 1990; Dockery et al. 1993; Schwartz, J., 2002). As a whole study of impact of cement dust pollution on human health is a relatively interesting field of study that has advanced rapidly during the past few years. There is extensive, diffused and scattered information on the subject in the literature. Due to essential changes caused by the atmospheric pollution are not only restricted to the one component, but also extend to the detrimental effects on human health, vegetation, biodiversity, ecosystem dynamics and human welfare.
The physical properties including particle size and density, shape and penetrability, surface area of cement dust are more important than chemical properties influencing the respiratory tract’s response to the inhaled agent (Morgan, 1984; Sheppard, 1990). People mostly in age group of 65 and older in developed countries and in developing countries 15-44 age group are more prone (Cropper et al., 1860) and above this more effects are seen in children, (Hofmiester et al., 1986) as main route of entry of cement dust particles in the body is respiratory tract or the gastrointestinal tract, (Green et al., 1970) so firstly organs associated with these gets affected (Hart, R.H., 1970) with more hospital visits (Vestbo, et al., 1990). The cancer risk due to cement exhibition showed a positive correlation to the duration of exposition (Maier et al., 1991; Maier et al., 1992) with increased risk of laryngeal cancer and predominantly related to supra glottis cancer, chest pain, cough, and eye problems, (Yhdego, 1992; Yang et al., 1993; Yang et al., 1996).
Cement particles are respirable in size hence Portland cement is important as a potential cause of occupational lung disease. The population living around the cement plant exhibited increased urinary concentration of thallium level in the residents and also exhibited increased hair thallium levels with congenital abnormalities were cleft lip and palate, facial hemangioma, icterus neonatorum, swelling on the back of hands and feet, inguinal hernia, umbilical hernia, lumbar meningomyelocele and ventricular septal defect (Brockhaus et al., 1981; Dolgner et al., 1983) with an increased risk of liver abnormalities, pulmonary disorders, and carcinogenesis were found. Decreased antioxidant capacity and increased plasma lipid peroxidation have also been posed as possible causal mechanisms of disease with cardiovascular, cerebro-vascular mortality (Aydin et al., 2010; Grau, 2009; Peters et al., 2009) and skin irritation, the mucous membrane of the eyes and the respiratory system (Zeleke et al., 2010; Zyede et al., 2010).
Besides local residents surrounding cement industries impacts on cement mill workers appeared to be less prominent initially and became more prominent at later stages, causing varied complications with diffused swelling and proliferation of sinusoidal (hepatic) lining cells, sarcoid type granulomas and perisinusoidal, nephron problems, oral mucosal inflammation, decreased oral health condition, more parodontal disease, pulmonary lesions, diminished lymphatic tissue, decreased DNA, RNA and total protein levels and also causes stomach ache due to presence of chromium in its hexa-valent form and causes laryngeal cancer (Kalacic et al., 1973; Pimental and Menezes, 1978; Schaller 1980; Petersen and Henmar, 1988; Struzak and Bozyk, 1989; Bozyk and Owczarek, 1990; Amandus, 1986; Oleru, 1984; Olsen and Sabroe, 1984; Zhang, 1990; Tuominen, 1991; Vestbo et al., 1991; Dvorianinovich et al., 1993; Jakobsson et al., 1993;Abou-Talebet al., 1995; Abrons et al., 1995; Shortet al., 1996; Yang et al., 1996). Workers which spend more time in cement factories show prominent ill impacts (Alakija et al., 1990; Abuhaise et al., 1997) with high prevalence of asthma in the group with the highest dust exposure. Significant increase in total protein and calcium levels with higher prevalence of respiratory symptoms among cement workers suggested that workers in the construction industry carry an increased risk for head and neck cancer (Fatima et al., 1997; Mengesha et al., 1998; Alvear-Galindo et al., 1999; Maier et al., 1999). Workers at a Portland cement plant had experienced acute eye irritations and higher prevalence of respiratory symptoms and a reduction of FVC, FEV1 and FEV1/FVC ratio among the cement workers with increased daily mortality (Sanderson et al., 1999; Noor et al., 2000; Samet et al., 2000).
Besides respiratory symptoms, rhinitis, conjunctivitis, cardio-pulmonary and dermatitis among the workers it was seen decrease in the mean erythrocytes, lymphocyte and monocyte count. In addition a slight decrease in hemoglobin level and chromosomal aberrations and cancer was also found with pulmonary radiographic abnormalities such as interstitial lung disease, pleural thickening and chronic bronchitis (Mishra, 1991; Dockery et al., 1993; Piotrowski, 1993; Krewski et al., 2000; Al?Neaimi et al., 2001; Fatima et al., 2001; Laraqui et al., 2001; Meo et al., 2002; Calistus Jude et al., 2002; Laraqui Hossini et al., 2002; Schwartz. J., 2002; Meo, 2003; Dietz et al., 2004; Mwaiselage et al., 2004; Schuhmacher et al., 2004; Smailyte et al., 2004; Mwaiselage et al., 2006; Pope and Dockey, 2006). Fugitive dust emissions from cement plants affect health and property of house owners living adjacent to the plant and found that the people of this area are badly affected by respiratory problems, gastrointestinal diseases etc with adverse impact for vegetation, human and animal health and ecosystems with greater risks in winter months (Anglauf et al., 1986; Quiros, 2005; Sabah .A. Abdul Ahab, 2006; Adak et al., 2007; Baby et al., 2008).
DISCUSSION
The aerodynamic diameter of cement particles makes it a potential health hazard as these are respirable in size and reaches in internal organs particularly lungs leading to occupational lung diseases. This size distribution would make the trachea-bronchial respiratory zone, the primary target of cement deposition. The main route of entry of cement dust particles in the body is the respiratory tract and/ or the gastrointestinal tract by inhalation or swallowing respectively (Green, 1970). Both routes, especially the respiratory tract are exposed numerous to potentially harmful substances in the cement mill environment. Besides cement dust various gaseous pollutants are also contributed by cement factories which cause pollution and ultimately affect human health. The various organ systems which get affected because of cement factories include:
Respiratory system: In respiratory system these causes lungs cough and phlegm production, chest tightness, impairment of lung function, obstructive and restrictive lung diseases, Pleural thickening, fibrosis, emphysema, lung nodulation, pneumoconiosis and carcinoma of lung
Gastro intestinal system: Oral cavity, mechanical trauma, mucosal inflammation, loss of tooth surface, periodontal diseases, dental caries, dental abrasion, liver diffuse, swelling and proliferation of sinusoidal (hepatic) lining cells, sarcoid type granulomas, perisinusoidal and portal fibrosis and hepatic lesions is caused in the gastro intestinal system.
Stomach: In stomach it causes stomach ache and cancer.
Central nervous system (brain): Usually causes headache and fatigue.
Lymphatic system: Spleen diminished lymphatic tissue and splenic lesions.
Other affects includes affect in eyes, skin and bones. Irritation in eyes, running eyes and conjunctivitis, skin irritation, itching, skin boil and burn, osteonecrosis, lesion of humerus, thinning of the cortex and reduction of epiphyseal cartilage.
Cement dust is a potential pollutant in the vicinities of cement producing factories creating serious pollution related diseases.
CONCLUSION
From the study it can be concluded that cement dust consists of many toxic constituents. The residents as well as workers who are employed in the cement industries are exposed to cement dust for long periods, thus from the literature it can be concluded that there is significant increase in the various diseases particularly respiratory problems both in workers as well as in the residents and need is to take proper preventive measures so that development may not be at the cost of human lives.
Englishhttp://ijcrr.com/abstract.php?article_id=1099http://ijcrr.com/article_html.php?did=1099
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareEVALUATION OF AGE RELATED MACULAR DEGENERATION AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN A TERTIARY HEALTH CARE CENTRE
English5459Somanath DashEnglish Satish K.English Mishra S. K. English P.Harshavardhan V.EnglishChronic obstructive pulmonary disease (COPD) is one of the leading causes of human morbidity and mortality globally. Its significant extra pulmonary effects have been well evidenced by many studies by different researchers. Age related macular degeneration (ARMD) which is a very common cause of blindness in elderly people is a common occurrence in many COPD cases in our clinical practice. The present study was attempted to find the existence of age related macular degeneration (ARMD) in elderly COPD patients. The study was conducted in a medical college hospital of Andhra Pradesh which is a tertiary care centre. The study was conducted among 107 COPD patients above 50 years of age. All the patients were subjected to examination of the fundus of their eyes. All statistical analyses were performed by MS Excel 2007. In twenty three subjects evidence of age related macular degeneration was found. The ARMD was more in severe and very severe stage of COPD. It was also observed more in the current smokers, especially those who are smoking more number of cigars per day. Among all the smokers 22.6% were having ARMD. Even the ARMD was also found in 24% of former smokers, those who have already stopped smoking earlier. In two non-smoker COPD subjects also ARMD was detected. The present study attempted to establish a causal relationship between these two disease entities and many significant observations were made.
EnglishCOPD, GOLD Staging, ARMD.INTRODUCTION
Chronic Obstructive Pulmonary Disease (COPD) is one of the major causes of chronic morbidity and mortality, worldwide. According to the Global Initiative for chronic obstructive lung diseases (GOLD) guideline updated in 2008, COPD is preventable and treatable disease of the lung with some significant extra pulmonary effect that mostly contributes to the severity of the disease 1. There are many significant extra pulmonary effects of COPD. Cardiovascular, mental and musculoskeletal co-morbidities are few in the list. The disease itself leads to decrease in physical activities of the patient and consequently causes systemic inflammation and left cardiac dysfunctions 2. Local and systemic inflammation, oxidative stress, and derangement in the neurohumoral mechanism are some of the probable reasons for development of these extra-pulmonary complications of COPD 3. Patients with COPD are at increased risk of developing cardiovascular diseases, anaemia, cachexia, osteoporosis, peripheral muscle weakness, cognitive dysfunction and many other systemic conditions. These systemic disorders contribute significantly to the morbidity and mortality in COPD patients. In our regular practice it is observed that many elderly COPD patients complains of defective vision. Along with co-morbidities like cataract we could detect age related macular degeneration (ARMD) in many such individuals.
Age Related Macular Degeneration (ARMD) is one of the leading causes of blindness in elderly people. It is characterized by pigmentary disturbances in the macula of retina. There is progressive degeneration of the retinal pigmentary epithelium (RPE), which is located between the retina and the choroid. International epidemiological age related macular study group defines ARMD as a degenerative disorder of the retina in individuals above 50 years of age 4. The pathogenesis of the disease is not clear. Oxidative stress or antioxidant deficiency may be one of the probable causes of ARMD 5. COPD, the disease itself also leads to increase oxidative stress. The activated leucocytes in COPD usually generate oxygen free radicals by induction of enzymes like NAPDH oxidase, superoxide dismutase, nitric oxide synthase and myeloperoxidase6. Rehman et al in a study found that COPD patients experience more oxidative stress in comparison to the control group 7.
In a study by Nadeem et al it was suggested that there is an imbalance between systemic oxidants and anti-oxidants in the COPD patients 8. There is multi-factorial aetiology for the oxidative burden in COPD. Hypoxemia, poor nutrition, inflammation, infection, and smoking have all been attributed. Smoking is a significant risk factor for the ARMD to develop (POLA Study) 9. Many of the patients in our study group were smokers also.
OBJECTIVE
The present study was conducted to establish causal relationship between these two disease entities, with a hypothesis that COPD may be associated with ARMD in elderly individuals.
MATERIALS AND METHODS
All patients above 50 years diagnosed as COPD attending the department of Pulmonary medicine between February 2010 and January 2012 were sent to the Ophthalmology outpatient department for fundus examination. Fundus photograph was taken for those patients in whom relevant ARMD features were found. Patients having associated co-morbidities like diabetes mellitus and hypertension were excluded from the study. Patients having associated cataract and other maculopathies were also excluded from the study.
Out of the total 349 patients only 107 (86 males and 21 females) were made eligible for the study after exclusion. Ethical clearance from the Institutional Ethical Committee was obtained and Informed consent was also taken from all the participants before the study. The diagnosis of COPD was established in all the participants after a thorough clinical history, examinations, chest X-ray and spirometry. Spirometry was performed by computerized Superspiro spirometer in all the participants. Baseline and post bronchodilator spirometry was conducted. The post bronchodilator FEV1 values were taken into consideration for grading the participants as per the staging suggested by the GOLD guideline. The patients were divided into four stages of severity, according to the post-bronchodilator FEV1 values. Mild: FEV1 >80%; Moderate: FEV1 < 80% and > 50%; Severe: FEV1 < 50% and > 30 %; Very severe: FEV1 < 30 %. They were examined for visual acuity using Snellen’s Chart. All the study participants also underwent thorough dilated slit lamp and fundus examination. Those who were having dense cataract, which obstructed fundus examination were excluded from the study. Evidence of ARMD was confirmed during the fundus examination taking the following findings into account.
Areas of hyperpigmentation
Areas of depigmentation or hypopigmentation
Choroidal neovasculaization
Fibrovascular disciform scarring
Drusens, hyperpigmentation and hypopigmentations are considered as dry ARMD. The size of the drusens was measured with the help of Zeiss fundus camera at 30° and 3X magnification. Findings like Choroidal neovasculaization, Fibrovascular disciform scarring was considered as findings of wet ARMD.
All statistical analyses were performed by Micro Soft Excel 2007. Values were presented as mean ± SD. Variables were expressed as percentages. Chi-square test (fisher’s exact test) was used for examining the qualitative data. For all statistical analyses, p 60 years (61%) and followed by 56-60 years (22%). This also increases with GOLD severity III & IV (Table 3). In our study group we found age related macular degeneration (ARMD) in 23 individuals. There are nine persons with ARMD in each group of severe and very severe stage of COPD patients. Severity status was significantly varied with age among ARMD study participants.
There were 12 ARMD cases among the current smokers group. Even among former smokers we got nine persons having ARMD. Majority among the current smokers (67%) are consuming > 10 cigars /chuttas per day. Smoking status was significantly associated with sex among ARMD study participants.(Table- 4)
Those who were smoking more than 10 cigars per day were more affected with ARMD (Figure- 1). Among the former smokers it was found that the number of ARMD is more in subjects who quitted smoking recently in comparison to those who quitted long back (Figure- 2). Among the non-smoker COPD patients also we found ARMD in two individuals and both of them are females.
DISCUSSION
The effect of COPD on different organ systems has been studied earlier by different authors. Many authors have confirmed the existence of cardiovascular, skeletal, neuromuscular and psychiatric disturbances as co-morbidities in COPD.2, 7, 10 O. KAYACAN et al in a study detected peripheral neuropathy in COPD patients.11According to study conducted by Murat Sezer et al the visual evoke potential (VEP) of patients with COPD, is altered probably due to hypoxemia caused by ventilation perfusion imbalance in COPD.12 In POLA (Pathologies Oculaires Lie´es a` l’Age) study conducted among 2196 participants it was confirmed that tobacco smoking is a causative agent for the ARMD. In our study we found ARMD in 12 out of 53 smokers. The POLA study also says that former smokers are vulnerable for development of the ARMD too9. In our study group out of the 37 former smokers nine persons were having features of ARMD. Among the former smokers those who had stopped smoking for more than 20 years are not having ARMD but there are good numbers of ARMD cases among recent quitters. Daisy Chan in a review article concluded that there is biologically and statistically plausible relationship between cigarette smoking and ARMD13. Hypoxia, microinfarction and degenerative changes are the contributing factors which are attributed to decreased HDL (High density lipoprotein), increased platelet aggregation and thrombosis in smokers. In our study we also found ARMD in two among 17 non-smoking COPD subjects, that to both of them are females. Though it is statistically not significant we can postulate the association of ARMD in non-smoking COPD cases also.
CONCLUSION
We conclude in this study that age related macular degeneration may be an associated systemic manifestation in elderly COPD patients and particularly among those who are continuing smoking. However a larger multicentric study with a bigger sample size may throw some light in establishing the hypothesis that the ARMD is one of the different co-morbidities in patients with COPD. A routine ophthalmological checkup may be suggested in this context for all COPD patients.
ACKNOWLEDGEMENT
We are grateful to Prof. K.V Ramana Rao for his advice and guidance. We are acknowledging the contribution of Mr. N. Lakshman Rao and Mr.Ganapathy Swamy, our statisticians for helping in statistical calculation. The authors are ever thankful to all the study participants who gave their consent for participating in the 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.
Englishhttp://ijcrr.com/abstract.php?article_id=1100http://ijcrr.com/article_html.php?did=1100
KF, Hurd S, Anzueto A, Barnes PJ, Buist SA, Calverley P,Fukuchi Y, Jenkins C, Rodriguez-Roisin R, van Weel C, et al. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: GOLD executive summary. Am J Respir Crit Care Med 2007; 176:532–555.
Henrik Watz, Benjamin Waschki, Corinna Boehme, Martin Claussen, Thorsten Meyer, and Helgo Magnussen. Extrapulmonary Effects of Chronic Obstructive Pulmonary Disease on Physical Activity A Cross-sectional Study American Journal Of Respiratory And Critical Care Medicine Vol 177 2008:743- 751.
Jan Tkac, S. F. Paul Man, Don D. Sin Systemic consequences of COPD Therapeutic Advances in Respiratory Disease (2007) 1(1) 47–59.
Stephen j. Ryan; Retina; 4th edition; Volume-2; Page 1041
Christen WG Jr.; Antioxidants and eye disease Am J Med. 1994 Sep 26;97(3A):14S-17S; discussion 22S-28S.
Ján Tká?c, S. F. Paul Man, Don D. Sin Systemic consequences of COPD Therapeutic Advances in Respiratory Disease (2007) 1(1) 47–59
Irfan Rahman, Douglas Morrison, Kenneth Donaldson, And William MAcNEE; Systemic Oxidative Stress in Asthma, COPD, and Smokers AM J RESPIR CRIT CARE MED 1996;154:1055-60
Nadeem A, Raj HG, Chhabra SK; Increased oxidative stress and altered levels of antioxidants in chronic obstructive pulmonary disease; Inflammation. 2005 Feb;29(1):23-32.
Smoking and Age-related Macular Degeneration The POLA Study Arch Ophthalmol. 1998; 116:1031-1035
Joan B. Soriano et al; Patterns of Co morbidities in Newly Diagnosed COPD and Asthma in Primary Care;CHEST 2005; 128:2099–2107.
O. Kayacan, S. Beder, G. Deda, D. Karnak; Neurophysiological Changes In Copd patients with chronic respiratory insufficiency; Acta neurol. belg., 2001, 101, 160-165
Sezer Et Al ;Visual Evoked Potential Changes In Chronic Obstructive Pulmonary Disease; Eur J Gen Med 2007;4(3):115-118
Daisy Chan OD ; Cigarette smoking and age related macular degeneration; Optometry and vision science, Vol. 75, No:7, July 1998; 476 – 48.
Abbreviations
COPD – Chronic Obstructive Pulmonary Disease
GOLD - Global Initiative for chronic obstructive lung diseases
ARMD - Age related macular degeneration
RPE - Retinal pigmentary epithelium
NAPDH - Nicotinamide adenine dinucleotide phosphate (Reduced Form)
FEV1 - Forced Expiratory Volume in one second
SD - Standard Deviation
VEP - Visual Evoke Potential
POLA - Pathologies Oculaires Lie´es a` l’Age
HDL - High density lipoprotein
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareA STUDY ON THE ASSOCIATION OF HYPERTELORISM AND POSTERIORLY PLACED PINNA IN CHILDREN WITH CONGENITAL ACYANOTIC HEART DISEASES
English6064Sumi GhoraiEnglish Swapan BhattacharyaEnglishObjective: To diagnose undetected cases of asymptomatic congenital acyanotic heart disease by measuring intercanthal distance (ICD) and angle of ear inclination (AEI). Methods: A comparative study was conducted over a period of 2011-2012 in the Department of Paediatric Medicine, Medical College Hospital, Kolkata. 100 patients (Cases: 50 patients with congenital acyanotic heart disease. Control: 50 patients without it) of age group 3 months to 12 years were examined clinically. Echocardiography was done. Intercanthal distance was measured by Vernier’s sliding caliper and angle of ear inclination by photogrametry. Results: Among 50 cases, 7(14%) male and 14(28%) female patients had hypertelorism, 10(20%) male and 16(32%) female patients had posteriorly rotated pinna. Among 50 controls, 4(8%) male, and 6(12%) female patients had hypertelorism and 2(4%) male, and 6(12%) female patients had posteriorly rotated pinna. In both the group female patients had higher incidence. Conclusion: Every child with hypertelorism and obliquely placed pinna should be properly screened for congenital acyanotic heart disease to decrease the morbidity.
EnglishPinna, hypertelorism, Congenital acyanotic heart disease.INTRODUCTION
Craniofacial anthropometry has mostly been used as a descriptive tool and has helped clinicians in the description, diagnosis and surgical treatment of abnormal skeletal and facial patterns. It is especially useful in medical genetics because many of the syndromes present at birth-such as Apert, Down, Turner etc.-involve the head region, so it can assist clinicians to objectively describe what they are seeing”.1 The diagnosis of many dysmorphic syndromes is based not only on advanced cytogenetic and molecular techniques, but also on recognition of subtle morphological anomalies in craniofacial region. Dysmorphic characters are usually reported by clinicians in descriptive terms such as “wide set eyes”,”broad nose”,”large mouth” and “posteriorly placed ear”. However, such description is subjective. Measurements taken from a patient can be compared with the values obtained in normal population and deviations from the normative values can be evaluated.2 The present study was conducted not only to compare the intercanthal distance of the controls without congenital acyanotic heart disease to cases with it but also to acquire knowledge about position of the pinna or angle of ear inclination in cases with congenital acyanotic heart disease and correlate it with the controls. In normal individual the intercanthal distance is about 2 cm to 3.6 cm and angle of ear inclination is approximately 7-120. Deviation from the normal can be indicative of congenital anomalies.
MATERIALS AND METHOD
The study was conducted on 100 patients of age group 3 months to 12 years attending the outpatient department and or, admitted in the department of Paediatric Medicine, Medical College, Kolkata over a period of 2011-2012. Thorough clinical examination of cardiovascular system was done. Echocardiography of the children were performed to confirm the diagnosis. Clinical examinations were done in presence of paediatricians and echocardiographies were done. The intercanthal distance was measured by vernier’s sliding caliper taking into account the error if any, in the instrument (Fig. 1). Profile photograph of the left side of the face of all children was taken including the entire helical rim of left ear, while keeping the head in the Frankfurt Horizontal (FH) plane. The angle of ear inclination (AEI) was directly measured on the photograph fixed on a large white paper sheet. The angle subtended between longitudinal axis(AB) of ear. It was determine as per technique given by Farkas LG3; the line joining highest point on superior aspect of outer rim of helix to the most lowest point on the inferior border of ear lobule and vertical plane(BC) of the head/face represented by a perpendicular drawn on FH plane (FH plane: line extending from the lower border of the left orbit to the upper margin of the external auditory meatus, provided head is held erect and eyes looking straight forward) was considered as angle of ear inclination(AEI)(Fig. 2). The angle was measured with the help of a protractor upto the accuracy of one degree. Each measurement was taken twice by the same examiner. If there is large difference between the initial two measurements a third reading was taken. Among the three measurements the two nearer values were used.
RESULTS
The study was conducted on 100 patients, 50 cases and 50 controls. Out of those 20 were male and 30 were female in both the group. The age range was 3months to 12 years. In this study 7(14%) male and 14(28%) female patients had hypertelorism and 10(20%) male and 16(32%) female patients had posteriorly rotated pinna among the 50 cases with Congenital acyanotic heart disease (Table1). Whereas, 4(8%) male,10(12%) female patients had hypertelorism and 2(4%) male,6(12%) female patients had posteriorly rotated pinna out of 50 patients without Congenital acyanotic heart disease(table 2).
DISCUSSION
The values for AEI reported by Farkas LG4 ranged between 6.3°-35.6° (mean 20°) in normal girls and 9.3°-31.2° (mean 21°) in boys. However, he had not examined the heart and has therefore, not commented on any co-existing cardiac abnormality.
Walia BNS et al5 reported that 18 of the 20 subjects with congenital heart disease having angle of ear inclination more than 12° on photographic measurement, and concluded the mean AEI in heart defects was more than two times as compared to children who had normal ears and normal hearts. In our study 26(52%) of 50 patients with congenital acyanotic heart disease had AEI more than 12°. Of these 26 subjects 10(38.46%) were male,16(61.54%) were female.
Nair S et al6 reported one case of congenital acyanotic heart disease - Ventricular septal defect(VSD), Atrial septal defect(ASD),Patent ductus arteriosus( PDA) with pulmonary hypertension with hypertelorism, low set dysmorphic ears and other facial dysmorphism.
In our study 7(14%) male and 14(28%) female patients with heart disease had hypertelorism.
Noonan’s syndrome is one of the multiple congenital anomaly syndrome which is related with hypertelorism, cardiac defect and many other anomalies as per study of Bertola DR et al7. Our study did show co-relation between heart disease and hypertelorism, as there are 21 subjects who had increased intercanthal distance out of 50 patients with acyanotic heart disease. From the above discussion it can be said that, hypertelorism and obliquely placed pinna is associated with congenital acyanotic heart diseases. During embryologic development, external ear appears in the region around the first pharyngeal groove in the 2nd month and interventricular septum also develops at about the same time. It is possible that the same agent/stimulus acting at this period distorts the development of both the regions simultaneously8.
Neural crest cells are essential for formation of much of the craniofacial region and they also contribute to the conotruncal endocardial cushions, which septate the outflow tract of the heart into pulmonary and aortic channels. So, this might be reason for infants to have cardiac abnormalities with craniofacial defects.9
CONCLUSION
From the above discussion it has been proved that there is certainly a relationship between hypertelorism and congenital acyanotic heart disease. Though, of 50 patients without heart disease 4(8%) male,6(12%) female patients had hypertelorism and 2(4%) male,6(12%) female patients had posteriorly rotated pinna ,that is far less common than in subjects with congenital acyanotic heart disease.
Our data suggest that any child whose pinna appears obliquely placed and eyes look apart on clinical examination should be carefully investigated for coexistence of unrecognized congenital cardiac anomalies.
ACKNOWLEDGEMENT
The authors of this article gratefully acknowledge the inspiration and help received from the scholars whose articles have been cited in the reference section. The authors pay their gratitude to authors/editors/publishers of all those articles/journals/books from where the reviews and literatures for the discussion have been collected.
Englishhttp://ijcrr.com/abstract.php?article_id=1101http://ijcrr.com/article_html.php?did=1101
Identifying fetal alcohol syndrome using computerized craniofacial anthropometry. Medical news today article. Date 27th September 2007. Available form: http://www.medicalnewstoday.com/releases/83589.php. [last cited on 13/08/2013.]
Naglel E, Teibe U, Kapoka D. Craniofacial anthropometry in a group of healthy Latvian residents. Acta Medica Lituanica 2005;12 :47-53.
Farkas LG. Anthropometry of Head and Face. 2nd edition, p-3-56.
Farkas LG. Anthropometry of normal and defective ears. Clin Plast Surg 1990; 17: 213-21.
Walia BNS, Bhalla AK, Dhawan A. Co-Existence Of Oblique Pinnae And Congenital Heart Disease. Indian Pediatrics 1994;31:559-63.
Nair S, Varghese R, Hashim S, Scariah P. Dysmorphic features and congenital heart disease in chromosome 6q deletion. Indian Journal of Human genetics 2012;18:127-29.
Bertola DR, Sugayama SMM, Albano LMJ, Kim CA ,Gonzalez CH. Noonan Syndrome: A Clinical And Genetic Study Of 31 Patients. Rev. Hosp. Clin. Fac. Med. S.Paulo 1999;54:147-50.
Hamilton WJ, Mossman HW. Human Embryology. Cambridge, W. Heffer and Sons Ltd, 1972,186-88 , 289.
Sadler TW. Langman’s Medical Embyology. 9th edition. Baltimore, Maryland, USA: Lippincott Williams and Wilkins; 2004.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241518EnglishN2013September25HealthcareTO STUDY SELF MEDICATION HABITS AMONG PEOPLE IN NAGPUR PART OF CENTRAL INDIA
English6574Manoj B. DagwarEnglish Yogeshkumar ViradiyaEnglish Damayanti MateEnglish Shilpa PiseEnglishBackground: Self medication is defined as the use or intake of any medication by a Patient on his own initiative or on the advice of a Pharmacist or a lay person instead of consulting a medical practitioner. This may generate more economic benefit for patient because of saving in travel, consultation time and direct financial cost of treatment. Objective: To study self medication habits among people in Nagpur part of central India. Research methodology: Samples of 280 patients were selected. Data was collected via face to face structured interview of respondents using the questionnaire. The inclusion criteria for selection of patients were those came to retail pharmacy to buy OTC drugs. Each individual was given explanation about the purpose of study. Results: An inclusion criterion to select the patient was 15 to above 60 year of age. About 89% people had a positive trust in allopathic medicines, 17% people learn self medication from doctors prescriptions provided during their prior illness. 1% were alcoholic, 6% were smokers, 61% people with chronic problems, who were considered in danger findings. Only 27% people were aware about drug interaction. Conclusion: This descriptive study shows, the majority of population had a poor knowledge about appropriate self-medication while the knowledge of the benefits and risks was not adequate. Thus to avoid or minimize the danger of self medication, there is a need to carry out educational campaign to alert population about the use of many OTC medicines available in market. Active participation of health care professionals, specially Physicians and pharmacist, pharmaceutical industry, government regulations and continuous inspection by the competent authorities is important.
EnglishSelf medication, central India, over the counter.INTRODUCTION
According to study conducted internationally, self medication has been reported as being on the rise [1]. Self medication is defined as the use or intake of any medication by a Patient on his own initiative or on the advice of a Pharmacist or a lay person instead of consulting a medical practitioner [1]. Study said that in India 3.5 billion health problems treated annually, 27% were treated with a non prescription drug. Major problems related to self medication is wastage of resources, increased resistance of Pathogens, and serious health hazards such as adverse reaction and prolonged suffering from disease. Antimicrobial resistance is a big problem worldwide particularly in developing countries where antibiotics are often available without a prescription [1]. Self medication with drugs is an economical choice of treatment for common self limiting illnesses [1]. Responsible self medication can help, prevent and treat ailments that do not require medical consultation and reduce the pressure on medical services for the relief of minor ailments. [1]. Self-medication is the treatment of common health problems with medicines especially designed and labelled for use without medical supervision and approved as safe and effective for such use [1] Medicines for self-medication are often called ‘nonprescription’ or ‘Over The Counter’ (OTC) and are available without a doctor’s prescription through pharmacies. In some countries OTC products are also available in supermarkets and other outlets. Medicines that require a doctor’s prescription are called prescription products (Rx products)[3]. Over the counter medicine are drug which can buy without medical supervision advice use for relieve from pain and treat disease. While responsible self medication, which is limited to OTC drug, may generate more economic benefit because of saving in travel, consultation time and direct financial cost of treatment . Some conditions are necessary for these benefits to be realized. The main objective is to ensuring the safety of taking self medicated drugs. They includes drugs used are those indicated for conditions that are self recognizable the user should know how to take or use the drugs; the effects and possible sideeffects of the drug as well as ways of monitoring these side effects. Are well communicated to the user; possible interaction with other drugs is known by the user; duration of the course of the drugs is known by the user and when the user must seek professional intervention. The consequences for incorrect diagnosis and dosage include growing resistance to some drugs. Especially in developing country professional health care is relatively expensive and readily not available therapy is a major problem .self medication is one of the obvious choices of heath care service[1]. The reasons for self medication mentioned in the literature are mild illness, previous experience of treating similar illness, economic considerations and a lack of availability of healthcare personnel. The most common medications used for self medication are analgesics and antimicrobials . Study on self medication shows that it is influenced by many factors such as education, family, society, availability of drugs and exposure to advertisements. Self medication is an area where governments and health authorities need to ensure that it is done in responsible manner, ensuring that safe drugs are made available over the counter and the consumer is given adequate information about the use of drugs and when to consult a doctor. Unlike other aspects of self care, self medication involves the use of drugs, and drugs have the potential to do good as well as cause harm. In this context, the Pharmacist has an important role [1]. Today the internet is emerging as a major source of information on health issues and (with appropriate quality control) offers great promise in helping people with self-care. Now government also strict their rules related to the over the counter drugs.
And this is important because it is related with health matters. It is important to take medicines correctly, and be careful when giving them to children. More medicine does not necessarily mean better. You should never take OTC medicines longer or in higher doses than the label recommends. If symptoms don't go away, it's a clear signal that it's time to see your healthcare provider. We often take pills for common ailments like fever, colds, cough and headache, without bothering to consult a doctor. Self-medication, even for minor ailments, could lead to medical complications. A large number of potent drugs such as pain relievers, cough remedies, antiallergies, laxatives, antibiotics, antacids and vitamins are sold over-the-counter (OTC). Selfmedication with OTC medicines could cause allergy, habituation, and addiction. Misdiagnosing the illness [2] A minor health issue which could be resolved easily with the doctor's advice may become a major problem over time. Symptoms may subside temporarily with self-medication, but it would become difficult for a doctor to correctly diagnose and treat later. Habituation: One could become addicted to prescription drugs such as antacids, cough syrups and pain Relievers. Allergic reactions: Some antibiotics such as penicillin or sulpha drugs can cause severe reactions in the body for some people. Insufficient dosage: Incorrect dosage of medicines will not cure and will prolong recovery. On the other hand, overdosage may damage liver, kidneys and other organs. Indiscriminate use of antibiotics: These could, over a long time, lead to antimicrobial resistance. Consequently, the antibiotic may become ineffective when taken in the future. Risk of stroke: The most commonly misused medicines are painkillers. Analgesics can induce gastritis and can also increase risk of stroke by four times in patients with high BP. Drug interactions: Some herbal drugs and medicines may cause drug-to-drug interactions and adversely affect the body.
RESEARCH METHODOLOGY
Research Design: Descriptive study for the research. Sampling Design: In this project, the convenience sampling is used for the study. Sample Size Calculation: - In this study the sample size was 280, the age group of customers above 15 years for the purpose of the research. Method of sampling:- Best estimate of population size-28 lakhs Rate in the population-12 Maximum acceptance difference-4 %(±) Desired confidence level -96 Required sample size -280
RESULTS AND DISCUSSION
The results were based upon the data captured from 280 sample size selected by convenient sampling method. The prevalence of self medication was reported as percentages. Despite all the explanations provided 124 (44 %) were male and rest were females 159 (56%). The age distribution of respondents is shown in table of 280 patients. Approximately 44 male+41 female =85 (30%) belong to the age group of 15-25, 57male +84female =141(50 %) were in 26 – 40 years, 13male +27female =40 (15 %) were in 41-60.years, 10 male+6 female =16(5%) were in 60 and above years. 55+67=122(43%) people took advice from the drug store pharmacist or salespersons and 20 male +27 female=47 (16 %) from third parties (relative, neighbour, friend). Most used medication were analgesics for aches and pain 72 (26 %) anti pyretic 79(28 %), followed by cough and cold symptom medication 62 (22 %) and antacids 67 (24%).
About 89% people had a positive trust in allopathic medicines,22% people learn self medication from doctors prescriptions provided during their prior illness.3%were alcoholic,12% were smokers,12% people with chronic problems ,who were Considered in danger findings. Only 47% people aware about drug interaction. Most of the self medication was involved with headache and fever, cough and cold, gastrointestinal Infection, mouth ulcer and Throat infection. Respondents were using Schedule H drugs/potent drugs for minor illness.
CONCLUSION
This descriptive study shows, the majority of population had a poor knowledge about appropriate self-medication while the knowledge of the benefits and risks was not adequate. Thus, to avoid or minimize the dangers of self medication, need to carry out educationa companion to alert population about the use of many OTC medicines available in market. Active participation of health care professionals, specially physicians and pharmacist, pharmaceutical industry, government regulations and continuous inspection by the competent authorities is important. The government and health authorities must ensure that only safe drugs should be made available as OTC.
ACKNOWLEDGEMENT
I would like to express my sincere thanks to Dr. Ajay Pise, Director, Institute of Management Sciences and Research Nagpur (IMSR) who had always been there for help with technical advice whenever I encountered problems in the course of my work and guided me all throughout the term and I would like to thank all those who have helped me directly or indirectly for my work and whose names I have unknowingly missed out, in making this project a worthy endeavour
Englishhttp://ijcrr.com/abstract.php?article_id=1102http://ijcrr.com/article_html.php?did=1102
Rohit K Verma, Lalit Mohan, Manisha Pandey, Evaluation of self - medication among professional students in North India , Vol.3 Issue 1, January March 2010
Dangers of self - medication, May 9, 2012, - Times of India, Bangalore Edition.
Self medication with over the counter drugs: A questionnaire based study Mohamed Saleem T.K., C. Sankar, C, Dilip, Azeem. A.K