Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27General SciencesLand Use/Cover Mapping of Konkan Region, Maharashtra
English0106Arjun B. DokeEnglishThe land is used for different activity, such as agriculture, forests, mining, transport, settlement, entertaining and manufacturing. The unused lands are unproductive waste and i.e. barren and fallow (temporary and permanent) land. Green canopy plays an important role in maintain surface temperature and humidity. The present study land use and land cover was identified through exploratory analysis, done on the bases of multitemporal Landsat TM data. The final classification map provided the land use and land cover information. The ground truthing was used to assess the accuracy of the land use and land cover analysis. Three specific bands were used with reasonable success to correlate soil, wetness and vegetation. The present study the cropland covers the highest area 10814 square kilometer in percent 35.17. Dense forest cover second large area 5653 square kilometer in percent 18.39. The settlement covers the lowest area, which is 678 square kilometer in percent 2.18. Combinations of supervised and unsupervised classifications were conducted to define land cover and land use types for the study area. The resulting products of the exploratory analyses and classification were then used to assess spatial patterns of land cover and land use in the study area.
EnglishLand use, Land cover, Remote sensing, Image classification, Konkan RegionIntroduction:
The land is necessary for human survival because it’s available for
a human with living space (Bhagawat, 2011). The idea of depicting the use of land in a map was first conceived by Saucer in 1919. Stamp in Britain is given a contribution regarding land use mapping study. The concept of land use has been defined by Stamp in 1962. The land should fulfill all the necessary and legitimate needs of the nation (Stamp, 1930). According to Nanavati conservation of land is also connected with land use (Nanavati, 1951). This needs strong scientific, rational and economic preparation to use the available resource of land, on another side we have to maintain ecological and socio-economic balance (Mohammad, 1980). The land use and land cover are indispensable for human development (Doke, 2017).
The development in the remote sensing and Geographical Information System environment present day support to the change detection as well as monitoring of earth surface resources (Aher and Dalvi, 2012). The land use is the result of a combination of both natural genesis and human influences which have been brought to bear on it in the past and of those which are still active in the present (Vink, 1975). Satellite remote sensing imagery and it’s coupled in GIS environment for land use/land cover analysis is a key to many diverse applications such as environment, forestry, hydrology and agriculture (Parlhad and Deore, 2010). Any areas natural resource management watershed management (Deshmukh et al., 2012) planning and monitoring depend on accurate information about the land cover in a region. The accurate representation of terrestrial vegetation is a key requirement for global change research (Jung et al. 2006; Lambin et al. 2001).The vegetation map is an essential base map for managing natural resources as vegetation provides a base for all living beings and plays an essential role in affecting global climate change, such as influencing terrestrial CO2 (Xiao et al. 2004). In order to initiate vegetation protection and restoration programs, it is necessary to obtain the current status of vegetation cover (Egbert et al. 2002; He et al. 2005). The traditional methods such as field surveys, literature reviews, map interpretation and collateral and ancillary data analysis, are not effective to acquire land use and land cover because they are time consuming, date lagged and often too expensive. In recent decade remote sensing techniques are being widely used for land use and land cover mapping and change dictation (Boyd et al., 2003; Ingram, 2005; Lu et al., 2004; Maynard et al., 2007; Dadhwal et al., 2009) which measures the spectral reflectance of the land cover (Zianis et al., 2005).
The remotely sensed spectral signatures are used for understanding the nature of vegetation characteristics however, it is affected by various factors like vegetation composition, soil characteristics, atmospheric conditions, topography and moisture content (Chen and Wang, 2008). Remote sensing has been the only feasible way of acquiring vegetation information over vast areas at a reasonable cost and acceptable accuracy due to repetitive data collection at a feasible effort (Lu, 2006). The developments in sensor technology have allowed the acquisition of remotely sensed data at a various range of scales ranging from coarse spatial resolution of 500 m (e.g., NOAA AVHRR, MODIS) to medium spatial resolution of 20_30 m (e.g., Landsat TM, Landsat ETM+, SPOT HRVIR) as well as high spatial resolution of less than 5 m (e.g., Ikonos, Quick Bird, LIDAR, and others). The coarse spatial resolution optical sensors such as NOAA AVHRR (Dong et al., 2003) and MODIS (Baccini et al., 2004) have been useful for mapping vegetation at the global, continental, national and regional scale, because of spatial resolution, image coverage and high frequency in data acquisition (Lu, 2006).
The medium resolution satellite imagery such as Landsat TM is used at regional and at a local scale for vegetation mapping. The Landsat Thematic Mapper (TM) use in Land use and Land cover mapping (Hall et al., 2006; Heiskanen, 2006; Ingram, 2005; Lu, 2006; Lu et al., 2004). The thematic mapper (TM) is an advanced, multispectral scanning, earth resources sensor designed to achieve higher image resolution, sharper spectral interval, improved geometric fidelity, and greater radiometric accuracy and resolution than that of the MSS sensor.
Study Area:
Konkan Region is one of six administrative divisions of Maharashtra State in India. Konkan is the west division in the state, with an administrative headquarters in the city of Mumbai and it is also state capital as well as finical capital of India. Amravati and Nagpur divisions makeup the region of Vidarbha. The seven districts i.e. Mumbai City, Mumbai Suburban, Raigad(Alibag), Ratnagiri, Sindhudurg, Thane and Palghar (1stAugust 2014)is included in the Konkan Region shown in Figure 1. Total area is 36,740 square km, total population 28,739,397and literacy 98.88 percent.
The ‘Konkan’ is the narrow strip of the coastal land situated between Arabian Sea and Western Ghats escarpment. The famous Western Ghats is lying in the ‘Konkan’. ‘Damanganga’ River separating Maharashtra and Gujrat States forms the northern limit of ‘Konkan’. In the south it extends up to ‘Terekhol’ Creek. The ‘Konkan’ strip is extended for about 720 km in north-south direction and is a distinct physiographic region of the State. The ‘Konkan’ region forms dissected topography and its average East-West extension is 40-50 km which varies considerably within the coastal lowland and decreased from north to south (Karlekar, 2002). Width of the region decreases as one proceeds toward south. The widest stretch is about 110 km in Ulhas river basin in north Thane District (Jog et al., 2002). Elevation of most of the ‘Konkan’ lies below 200 m ASL. The area of ‘Konkan’ varies in lithology, geomorphic configuration, nature of hinterland and climate. ‘Konkan’ region of Maharashtra can be conveniently divided into North ‘Konkan’, Middle ‘Konkan’ and South ‘Konkan’. These division is based on Physico- climatic characteristics of the region suggested by Dikshit (1986).
Objective:
To classification of Land Use and Land Cover using Remote Sensing Data in Konkan Region.
Materials and Methods:
Landsat TM FCC (bands 4, 3 and 2, scale 1: 50,000, December, 2016) were used for this study. Using Erdas Imagine software 14, downloaded Landsat images were mosaiced together and Project to UTMWGS 84 coordinate system. The study area was extracted by subsetting from the whole image. The flowchart of the research methodology can be divided into five stages: (i)preparation of reference maps for gathering the existing and relevant information in the spatial form, (ii) pre-field classification of the satellite data, (iii) ground truthing, (iv)post-field correction and (v) field verification of the final map. The spectral variation of each vegetation type was extracted from digital data by interpreting satellite images based on the interpretation elements such as the image color, texture, tone, pattern and association information etc. The standard "falsecolor" composite. Vegetation looks in shades of red. Coniferous trees will seem darker red than hardwoods. For land cover and land use study, this is a very standard band combination. Typically dark red color indicates healthy vegetation covers including wide leaf and light red color indicates sparsely vegetated land cover which includes grass land areas. Diverse methods have been developed to do this. Those methods can be broadly grouped into unsupervised classification or supervised classification depending on whether or not true ground data are inputted as references (table 1). The flow chart of the research methodology is shown in Figure 2.
Result and Discussion:
The entire area of the study is almost flat only north western part is hilly. Figure 3 represent the physical division of the study area. The vegetation map inferred from image classification is considered accurate if it provides a true representation of the region it portrays (Foody 2002; Weber 2006). The rectified Landsat TM scenes covering districts were analyzed to generate the vegetation map. All the major forest classes (viz. dense forest, open forest, scrubs) were classified. Along with forest, other land use/cover classes (viz. cropland, fallow land, wetland, settlement and water bodies) found in the Konkan Region. Table 1 gives the statistics of the study area generated from the classified output of the Landsat TM data. Table 2 shows the spatial extent of land cover in square kilometer and in percentages.
The total forest area is 43.72 (13440 square km) percent of the total geographical area of the Konkan Region. The moist dense forest constitutes the bulk of the total forest area and was found in around the west side of Western Ghat (fig.4). Open forest covers 2732 square km (8.89 Percent) and Scrubs cover 5055 square km (16.44 Percent). Agriculture covers the larger area of Konkan region 10814 square km (35.17 Percent).
Wetland cover the small area around 879 square km (2.86 Percent). The water bodies cover 2.43 percent (746 square km) area. Open land and scrub land covers an area of 16.44 per cent. The table 2, gives the land use/cover statistics of Konkan Region generated from the classified output of the Landsat TM data. The main tree species of this forest are Ain (Terminalia tomentosa), Jambha (Xylia dolabriformis), Kinjal (Terminalia paniculata), Sagwan (Tectona grandis), Surangi (Mammeasuriga), Kokam (Garcinia indica), Kumbha (Careya arbprea), Karmal (Dillenia pentagyna), Amba (Mangifera Indica), Bibba (Semecarpus anacardium), Asana (Bridelia
retusa), Anjani (Memocylon umbellatum ), Shisham (Dalbergia latifolia), and Khair (Acacia catechu . At several locations, the forests were found in the varying stages of degradation. The output classified map is shown in Figure 4. The accuracy assessment in the first stage is done by visual inspection of derived maps; however, the method is highly subjective and often not
accurate. The second stage is more objective methods in which comparisons of the area extents of the classes in the derived thematic maps (e.g. the percentage of a specific vegetation group in the area) are made with the corresponding extents on ground or in other reference datasets. Accuracy assessment for the forest mapping was done with randomly selected sample distribution points on the ground and tallied with represented data. The classification was validated with 180 randomly selected sample points. The total accuracy of the forest cover mapping, therefore, comes to be 82.12%. The discrepancy in the forest area may be due to time on which the satellite data for the present study was acquired.
Conclusion:
The present study demonstrated the effective role of the spatial technologies in land use and cover types. The results of land use and cover mapping from remote sensing imagery represent well with the actual land cover community composition. The optimal use of satellite imagery in land use and cover mapping is effective when it is complemented with fieldwork. When selecting a right vegetation classification system for better classification accuracy, the following points should be taken into consideration (i) refining class definitions to decrease ambiguity, (ii) adding sufficient number of new classes to describe the complexity of local vegetation patterns and (iii) using a higher level of classification (Rapp et al. 2005). To map vegetation under such circumstances various difficulties are often encountered hence it is better to adopt more advanced image classification method such as sub-pixel analysis (Lee and Lathrop 2005). Another solution is to choose higher resolutions of imagery so as to increase the distinguishable possibility in image classification (Cingolani et al. 2004), however higher resolutions of imagery will most likely increase the cost. Though there are some standard methods for image preprocessing, however, there are no super image classifiers that can be uniformly applicable to all applications, hence it is hot research topic, to apply effective classifiers or to develop new powerful classifiers suitable for specific applications. The present study can be used as baseline information for policy and decision makers to develop sound management strategies for effective natural resource management as well as regional planning for the study area (Konkan Region).
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27General SciencesChange in Urban Landuse and its Effect on Natural Drainage System: A Geographical Micro Leveled Study of Bhosari Stream (PCMC)
English0710Ramakant KaspateEnglish Avinash KadamEnglishHorizontal and vertical expansion of urban areas has been increasing the rate of exploitation of natural resources, systems and their processes. Now a day, urban landuse has also been changing drastically and primarily affecting the natural set up at very micro level and then spreading it for large areas also. The present investigation is trying to highlight the micro leveled changes by such anthropogenetic activities, basically on physical parameters. For this, the paper mainly focusing on issues of natural drainage system created by change in landuse. By selecting Bhosari stream from Pimpri Chinchwad Municipal Corporation (PCMC) area, the changes in landuse have been identified and studied with the help remote sensing (RS) tools and techniques. The Google Earth Images for 2005 and 2016 have been analyzed, compared and presented by using GIS technique. For this, information from SOI toposheet has also been taken as a base of the study. The selected basin area, a study area has mainly undertaken by PCMC and by the Defense Authority. The changes in land use have also considerable difference in both these areas. But the effects of such changes have observed differently. In short, specifically in PCMC area, the drastic changes in morphometric systems have been noticed like vanishing the upper order streams, displacement of channel, change in pattern of slope and deposition etc. Because of unnatural changes in drainage, most of the urban places have facing natural calamities. It is therefore necessary to maintain the natural processes and systems particularly in the urban area
EnglishUrbanization, Drainage, Land use, GIS and RS techniques, Morphometric changes, Micro Leveled studyIntroduction
At global level, cities are growing with their population and infrastructural, unpredicted and unplanned nature (Bingqing and Qihao, 2011). UNO 2011 has rightly predicted that the world’s urban population shared about 52 per cent to the total population. Urbanization have worldwide phenomenon where all mega cities are rapidly developing due to various factors including population increases, industrialization and rural-urban migration (Kadam, 1999 and Das et al, 2012). As per 2011 census, in Maharashtra urban population is 15.99 per cent and Pune District urban population 60.9 per cent. Now a day, urban growth has also changed land use and land cover (Bhagawat, 2011; Adil and Rafiq, 2014). Pimpri Chinchwad city has also growing very fast. Growth of urban areas has increasing the rate of exploitation of natural process, system and resources (Kadam, 2002). This urban change has triggered number of geo-environmental problem at many scales such as loss of natural drainage system, natural drainage flow, loss of upper stream order, decline in water quality etc. The increase in urban population density and built up areas directly or indirectly affects on river and small stream i.e. locally known as an Odha (Noorazuan et al, 2003; Kadam et al, 2013). The land use maps have used to provide information on the type, location, spatial, distribution and extend of land use and land cover. These changes are very useful for policy makers, particularly for town planners (Jieying et al, 2005; Golam et al, 2008). The present investigation has mainly trying to identify and explain the cause-effect relationship of such changes at the following study area.
The Study Area
The study area is a part of PCMC in the Pune district state of Maharashtra (India). PCMC lies between 18°33' to 18°43' North latitude and 73°42' to 73°56’ East longitude. The Bhosari stream (Odha), the prime study area is a small part of the PCMC. The extents of this study area are from 18°35'04" to 18°38'52" North latitude and 73°49'33" to 73°51’38" East longitude. The study area divided in two parts that is under PCMC boundary and under central defence authority as shown in the figure 1.
Methodology
It is necessary to compare the changes in land use – land cover (LULC), at least for recent years. It is therefore LULC classification for the PCMC has been worked, based primarily on Google Earth Image dated 20 January 2005 and 17 January 2016. These images has been digitized with the help of simple computer based tools and techniques. The studies of landscape patterns and spatial statistics have also been carried out by using suitable GIS software. In this study, the urban built-up area has classified in residency, commercial, industry, slum, school, temporary huts, and water bodies.
Results
As mentioned in the methodology, the images have been analysed for the years 2005 and 2016. It is clearly showing the change in LULC. The actual change in areas under major classes of LULC has also been measured and tabulated in the table 1 and 2 with their per cent change. As the area is under two authorities, the drastic change has been observed in PCMC area than that of the area under defense. In both the areas, the open area has occupied by the other purposes. Decrease in the LULC has observed only in case of open land. Actually, the open land was covered by some sort of moderately dense forest and scrubs on or before 2005. Then after the tree cover and even scrubs has also been ruined with fast rate. Now a day, the remaining open land has very rare scrubs and small trees. It means that at both end, the reduction in area and change in vegetation cover has also been noticeable with negative remarks in the environmental contests.
The PCMC area occupying about 7.3616 sq.km area of this selected catchment area of the stream. Table 1 devoted to show the actual general land use and per cent change in it with micro LULC classes of study area. As discussed above, excluding open land, all the classes has increased their land under use. There are three main purposes i.e. residential, industrial and commercial use, which has encroached mainly on open land and other natural land uses. It has also observed at very micro level that the denseness of such purposes has reached up to an optimum to over pressured level. In case of slums, the change in area has just 0.12 per cent but the rowdiness and open areas within and between the slums even for internal paths has also observed to be as at the vanishing stage. Likewise all other purposes e.g. residential, commercial, industrial, etc have been creating high level pressure and extending with drastic movements. It results to damage natural things with decreasing open land.
The defense authority is occupying about 6.0040 sq.km area from the study area. Here also open land has reduced with 3.16 per cent but it converted mainly in to water bodies. The built up area has also occupied the open land, but not as like as crowning nature.
Discussion
Urban built up area has increased and at some places, manmade activity has been affecting the natural drainage systems. Such as village Bhosari Goan Lake stream at middle part are replaced at built up and other purposes. Near Bhairavanath School first order stream flow change by built up area. In middle part of study area near Landewadi slum area industrial built up replace stream. Goan lake stream raw material dump in stream basin and change flow direction of stream. At defense area newly constructed water pool stream flow doing narrow below water pool. In this study area there is 22 first order streams, 2 second order stream and one third order stream.
Conclusion
The present study has revealed that GIS techniques have significant prospective for mapping and monitoring of land use. There is major decrease of open area and increase in residential, commercial, industrial area from year 2005 to year 2016. The rapid urban growth has transformed most of the open land into residential area. In short, specifically in PCMC area, the drastic changes in vanishing the upper order streams, displacement of channel, change in pattern of slope and deposition.
Acknowledgement
Authors are very thankful to research scholars whose article and references are reviewed for this research paper and thankful to, editors and publishers of that articles.
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Cheng-fan LI and Jing-yuan Yin (2011). Research Overview on Urban Land Use Change Based on Remote Sensing Images. International Journal of Environmental Science and Development, 2(1), pp. 45-48.
Das, S.; Mali, S. and Misra, A. (2012). Urban Land use/Land-Cover Change Detection Analysis of Aurangabad City Using Geoinformatics Techniques. International Journal of Scientific and Research Publications, 2(9), pp. 1-5.
Golam, R.; Deanna, A. and Sirajul, I. (2008). City Growth with urban Sprawl and Problems of Management. 44th ISOCARP Congress, pp. 1-11.
Jieying, X.; Yanjun, S. and Jingfeng, G. (2005). Evaluating urban expansion and land use change in Shijiazhuang, China, by using GIS and remote sensing. Landscape and Urban Planning, pp. 69-80.
Kadam, A.; Bhosle, A. and Avhad, B. (2013). Drainage Characteristics and its Relation to Soil pH and EC of Kurunda River Basin of Maharashtra. 3(6), pp. 35-37.
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Noorazuan, M. Ruslan, R. and Hafizan, J. (2003). GIS Application in Evaluating Land Use-Land Cover change and its Impact on Hydrological Regime in Langat River Basin, Malaysia. Map Asia Conference, pp 1-11.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27General SciencesPossibility for Improving Carcass Composition and Meat Quality Traits by Selective Breeding
English1118Trygve GjedremEnglishAn advantage of aquaculture farming compared with fisheries is that it is possible to genetically improve economically important traits through selective breeding. This is possible because many traits have underlying heritable genetic components and individuals carrying those desirable traits can be selected as the parents of the next generation. A difficulty however, is how to measure the quality traits on the potential breeders. Traditionally, measuring the traits on relatives like full- and half-sibs have been applied. However, with new technologies such as near-infrared reflectance spectroscopy, X-ray tomography (CT) and Fotofish, it is now possible to measure fat% and filet color with high precision. Furthermore, new technological advances have opened new doors to potentially estimate fat% and filet color on live animals. Improving fat% by selective breeding is possible, as the heritability of the trait is relatively high (h2 = 0.25) and a genetic gain of 4 % per generation has been reported for rainbow trout. On the other hand, the heritability for flesh color shows high variation, but it is particularly high when measured using CT (h2 = 0.47). Finally, fillet yield has a rather low heritability (h2 = 0.16) and reported genetic gain per generation is close to zero.
EnglishAquaculture, Genetic gain, Heritability, Meat quality, Selective breedingIntroduction
Quality traits and carcass composition in fish and shellfish are important characters for both consumers and farmers. In general, from marketing perspective there product can be a complicated process, as different markets may have different quality preferences. For farmers, the size and variation as well as dressing%, fillet yield, shape and color decide the price. Important factors in the market are processors and for salmon smoking operations to improve the product quality. For consumers, the size of the fillet, fat%, texture and color are important quality traits. For Furthermore, in some fish species such as carp and silver barbnumber of intramuscular bones usually have a better market acceptance. This trait seems to be highly variable within species. For instance, it has been reported that the number of intramuscular bones in different ploidies of crucian carp (Carussiusauratus) can vary from 77 to 86[1]. In Blunt snote bream (Megalobramaamblycephala) the number of intermuscular bones is estimated to vary from 108 to 129 [2]For consumers these small bones can be a concern, as they are usually difficult to remove, making them unpopular.
However, one of the main problems of including quality traits in breeding goals is that these traits can not only vary extensively between species, but their preferences can also greatly differ across markets. From a breeding point of view, it is therefore often difficult to decide which traits should be included in the breeding goal and how to rank those traits according to their economic values. With this in mind, the purpose of this short review paper is to discuss possibilities on how to improve quality traits in fish and shellfish through selective breeding. One of the main difficulties of improving carcass and quality traits is how to record the traits on the live animal with high repeatability. However, there are some new promising technologies on the horizon, considering that currently we are mainly relying on recording the traits on the relatives (full- and half-sibs) of potential breeders. Subject scoring has been widely used, which in general has low repeatability and chemical analysis are laborious and expensive. For the purpose of this review, I will not discuss hybridization and monosex culture.
Methods to measure quality traits
In recent years, much work has taken place to investigate different technologies to measure quality traits both on live animals as well as on carcasses. For instance, using ultrasound imaging, Bosworth et al.[3] explained 48-56% and 31-38% of the variation in meat yield traits in female and male catfish, respectively. Sang et al. [4] studied methods to measure quality traits of river catfish by taking measurement of the live fish. The correlation between the predicted and the observed values for fillet weight, fillet yield and fillet fat were 0.93 (5 measurements), 0.86 (4 measurements) and 0.85 (4 measurements). Texture is another example of important quality trait in fresh as well as in processed products. Mørkøre[5] used mechanical pressure to measure texture. It was found that sensory hardness is correlated with a Warner-Blatzler blade of 12.5 mm in diameter in raw salmon (r = 0.70). Gjerde and Martens [7] studied near-infrared reflectance spectroscopy (NIR) to measure water, fat % and protein % in the fillet of rainbow trout. They found very high correlations between chemical analysis and NIR measurements for water, fat % and protein %, ranging from r = 0.97-0.99. Folkestad et al. [6] applied near infrared (VIS/NIR) spectroscopy to estimate fat % in live Atlantic salmon and reported a correlation of 0.94 with chemical estimates. NIR is also an efficient tool for estimating fat % in the gutted and fillet weight. Further, VIS showed to be efficient in estimation of pigments in the fillet. Wold et al. [8] showed that Raman spectroscopy was a suitable method for none destructive estimation of pigments (r = 0.95) and fat % (r = 0.97) in the ground salmon meat.
Computer assisted X-ray tomography (CT) was first used to measure body and carcass composition in live pigs [9]. In rainbow trout, Gjerde [10] estimated correlation between the observed and predicted CT values of 0.88 for water %, 0.89 for fat % and 0.68 for protein %. In a dataset of 174 Atlantic salmon, Rye [11] obtained a correlation of 0.92 between the observed and predicted values for fat and water content. For protein, no significant prediction was recorded. Quillet et al. [12] used Distell Fish Fatmeter in selection for muscle lipid content in rainbow trout. Fillet color is another example of important quality trait particularly in salmonid species. In 2003, researchers (Erland Austreng and Kjell Arne Rørvik) at AKVAFORSK (now Nofima) took the initiative to develop an instrument named Fotofish, which was revised later. In addition to color, Fotofish can also be used to measure the % pigment in the fat. Rørvik et al. [13] report correlations between Fotofish predictions and the following quality traits: pigment (mg/kg), r = 0.94 for salmon and r = 0.97 for rainbow trout, fat %, r = 0.95 for salmon and 0.85 for trout, and color score r = 0.95 for both species. At present, there are several efficient methods for obtaining estimations of the most important quality traits with high precision on both live fish as well as on the carcasses. These are potentially important tools and approaches for further improvements of economically important traits in aquatic species.
Heritability and genetic variation in quality traits
A literature survey for heritability estimates of quality traits and their averages have been presented in Tables 1 and 2, respectively. For most traits, the heritability estimates seem to vary considerably. Such variations might be due to low repeatability of measurements, variations among populations, species and differences in environmental conditions that the animals were exposed to. On average, the reported heritability estimates for protein % is close to zero (h2 = 0.03), the heritability for carcass and quality score are rather low (h2 = 0.10 - 0.15) and this is further followed by h2 = 0.16 for dressing % and fillet texture. For fillet yield there are at least 10 different h2 estimates, with the average across all estimates to be approximately 0.16. The fat % and carotenoids both seem to have a moderate heritability (h2 = 0.25). On the other hand, the heritability for flesh color, measured by tomography, is very high (h2 = 0.47). In general, we can see that most economic traits of interest show genetic variation [14, 15]. For many of these traits extensive work is now underway to better understand their underlying molecular architecture. For example Wan et al. [16] showed that abundant microRNA were functionally involved in regulating the development and differentiation of intermuscular bones and connective tissues in the blunt snout bream. Bai et al. [17]investigated quality traits in triangle pearl mussel. The authors found four QTL explaining 26%-28% of the trait variation, which will provide valuable information for marker-assisted selection of the freshwater pearl mussel. Kuang et al. [18] investigated the genetic variation in fat % in common carp. A genome-wide significant QTL was detected, explaining 36.2% of the phenotypic variance. Further, they identified three QTL with significant effects explaining 14.3%-19.5% of fat content in the common carp. These findings suggest that the observed phenotypic variations of many quality traits might mainly be explained by a few major genes and QTL.
Phenotypic and genetic correlations between quality traits
While the phenotypic correlations (rP) between body weight and fat % are positive, varying from 0.05%-0.72%, the genetic correlations (rG) have been reported to range from -0.21 to 0.80 (Table 3). On the other hand, both phenotypic and estimated genetic correlations between body weight and flesh color are low with one exception (rG = -0.21). The genetic correlations between fat % and flesh color are also all low and negative while the phenotypic correlations vary from low negative to high positive. Both phenotypic and genetic correlations between dressing % and quality traits are low with a couple of exceptions (rG = -0.03 with body weight and rP= -0.22 with flesh color). Quality traits are in general measured on carcasses of animals, all with the same age but usually of varying sizes. Using a different approach, Kristiansson [24] estimated correlations between quality traits and body weight on animals of the same age (sa) and similar weights (sw). Both phenotypic and genetic correlations between body weight (sa) and fat % were high and significant. On the other hand, the genetic and phenotypic correlations between weight (sw) and fat % was low. Haffray et al. [33] estimated high negative genetic correlations between body weight and body tissue development as head yield or the head and vertebral column yield (-0.48 to -0.57).
Genetic gain
Table 3 shows estimates of genetic gain for some important traits. For fat % in rainbow trout a genetic gain of 4% per generation has been reported [12] . This means that it is possible to improve this important quality trait in farmed fish only over a few generations. For filet yield, the pattern is different. For Nile tilapia, the genetic gain is close to zero as it was estimated for the meat yield in mussel.
Conclusion
Fish and shellfish both from fisheries and aquaculture are healthy food for people, considering their protein and fat contents and important micronutrients such as omega 3 fatty acids. In aquaculture, it is possible to change feed composition and in addition, it is possible to change and improve product quality and carcass composition through selective breeding. For some traits, at least, the possibilities for genetic improvement is highly promising, with perhaps one of the best examples being the fillet fat % which shows moderate heritability (h2 = 0.25) and a genetic gain of 4 % per generation in rainbow trout. Of course, while in some species it might be of interest to increase fat %, in some other species it might be more desirable to reduce it. By using new technological, it is possible to measure various traits like flesh color and carotenoids on the live animal opens numerous possibilities and opportunities for genetic improvements of these economically important traits, particularly in salmonids. For protein % the heritability is close to zero (h2 = 0.03) indicating low genetic variation and no response to selection. For fillet yield the heritability is rather low (h2 = 0.16) and the two estimates of genetic gain in tilapia and one in mussel are close to zero. Gjerde et al. [42] discussed the low genetic gain in tilapia, and concluded: “The close to unity genetic correlation between round body weight and fillet weight indicates that genetic improvement of one of the traits without achieving a proportional genetic change in other is difficult or even impossible. This implies that improvement of fillet yield through direct selection is difficult to achieve”.
Acknowledgment
Author acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.. Are cited and included in references of this manuscript. The author are also grateful to authors/ editors/ publishers of all those articles, journals and books from where the literature for this revive has been reviewed and discussed. I am grateful to Nofima who funded this work. I would also like to thank Dr. Hooman Moghadam for his review and comments on the manuscript,
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27General SciencesEpidemiology of Animal Bites with Special Reference to Post-exposure Prophylaxis of Rabies in and Around Malda, West Bengal: A Hospital-based Study
English1922Arindam KarmakarEnglish Aishwarya BhattacharyaEnglishBackground: Bites from stray dogs are the reason of rabies infection in India most of the time, whereas bite of several other animals such as cats, monkeys, jackals and wolves may cause rabies. People of poor socio-economic class are the majority of victims. Lack of knowledge regarding primary wound management and requirement of post-exposure prophylaxis prevails in a large part of our country.
Objectives:
1. To assess the epidemiological profile of animal bite victims.
2. To assess the adherence to the present post – exposure prophylaxis protocol.
3. To assess the present practice and knowledge regarding treatment of animal bites.
Materials and Methods: Total 100 animal bite victims attending the Rabies vaccination clinic at Malda Medical College and Hospital, Malda, West Bengal were interviewed using a pre-tested questionnaire format.
Results: Majority of the victims were from lower income group (58%). 62% were male. The biting animal was mostly dog (82%). 69% patients were bitten on lower extremities; 61% having grade III exposure, the rest being grade II exposures.
Only 21% of the victims took proper care of the wound; whereas, a considerable number (20%) took no care of the wound at all.
All the patients were administered anti-rabies vaccine but only one patient with grade III exposure was administered rabies immunoglobulin. The victims showed inadequate knowledge regarding primary wound management.
Conclusion: Lack of awareness and motivation were significant reasons for poor wound-care and failure to adhere to the post-exposure prophylaxis schedule apart from great distance from the vaccination clinic and unavailability of rabies immunoglobulin
EnglishAnimal bite, Malda, Post-exposure prophylaxis, RabiesINTRODUCTION
Rabies has been endemic in India since time immemorial and about 20,000 persons die of rabies each year.1 Most of these victims (97%) are attributed to bites by dogs which is the major reservoir of this disease. Bites by several other animal species like cats, monkeys, jackals and wolves may cause rabies. A WHO-sponsored multi-centric study conducted all over India in 2003 revealed that people of poor socio-economic class both in rural and urban populations were the majority of animal bite cases. Dogs, mainly stray dogs were the major culprits. A considerable proportion of the persons did not take initial care of the wound; many of them did not opt for Anti-Rabies vaccine and too few persons were administered Rabies- Immunoglobulin.2 But in a country as diverse as ours, the importance of local data regarding the profile of animal bite victims, status of post-exposure prophylaxis of rabies and the status of knowledge and practice of common people cannot be overemphasized. This study was designed to assess the epidemiological profile of the animal bite cases coming to the Emergency and Outpatient department of Malda Medical College & Hospital, Malda. Information was gathered to assess the knowledge and practice of animal bite victims regarding immediate management and post-exposure prophylaxis of rabies.
OBJECTIVES
To assess the epidemiological profile of animal bite victims.
To assess the adherence to the present post – exposure prophylaxis protocol.
To assess the present practice and knowledge regarding treatment of animal bites.
METHODOLOGY
The cross-sectional study was done at the Rabies vaccination clinic of Malda Medical College & Hospital, Malda. Animal bite victims were enquired using a pre-tested questionnaire format (annexure 1) after receiving informed consent from the patients. Convenient sampling during the month of May, 2014 was done.
RESULTS
Total 100 patients were interviewed. After the analysis of the collected data it was found that 37 persons were from rural areas whereas 63 patients were from urban areas. Males (62%) were more affected than females (38%). (Table 1)
Majority of the patients (58%) were from poor and lower income groups, both among urban and rural patients. (Table 3)
The site of bite was lower extremities in most of the cases (69%) followed by upper extremity (21%), head and neck (6%), buttocks (2%) and abdomen and groin (2%). Interestingly all the persons bitten in the head & neck were female including one girl child. (Table 4)
Majority of the patients suffered from grade III exposure (61%). Rest had grade II exposure. As it was a vaccination clinic based study, no persons having grade I exposure turned up as there is no need of vaccination in grade I exposure. (Table 5)
The biting animal was in most of the cases dogs (82%) followed by cats (10%) and monkey (6%). Single cases of rat bite and jackal bite were also present. Most of the dogs were stray whereas most of the cats were pets. (Table 6)
Out of the 82 dog bite cases, 40 dogs were alive, 01 died during the observation period of 10 days and 10 dogs were killed by people. The status of the rest 31 dogs was unknown. It is evident from the Table 7 that dogs were killed mostly in the rural areas. Most cats were alive.
Regarding the wound care (Table 8), 21 patients washed the wound with soap-water and applied antiseptic on the wound, 31 patients washed with soap-water only and 08 persons applied antiseptic only. Rest of the patients resorted to washing with water (17), being treated by quack doctors (02), application of neem leaves (01) and taking no care of the wound at all (20).
All the persons coming to the clinic received anti rabies vaccines. However, only one person received anti-rabies immunoglobulin. On examination of the time taken to reach the vaccination centre after the exposure in terms of rural and urban population as well as relation with the distance from the vaccination centre (Table 9A and Table 9B) it is apparent that
A considerable proportion of the patients failed to turn up at the clinic within 24 hours
Even a delay of more than 7 days was quite common (14%)
Both the rural as well as urban populations show similar trends.
The number of people coming very late to the clinic (more than 72 hours) increased with increasing distance from the clinic but a considerable number of patients living within 10 kms (11% patients) came very late.
A significant proportion of patients living more than 10 kms far from the vaccination center turned up within 24 hours.
Average distance from vaccination clinic was 10.5 kms
While the patients were enquired regarding the adherence to the vaccination schedule only 5% of the patients (5 patients) were found to have missed the prescribed date for vaccination. On a closer look at the persons with poor compliance it was found that 2 of them lived at a distance of more than 50 kms from the clinic. The other 3 patients were from urban population and lived at a distance of 10 kms or less from the clinic and all of them class II exposure. (Table 10)
Upon questioning regarding the knowledge of the patients regarding wound care, importance of anti-rabies vaccination and the importance of observation of the biting animal, it was discovered that 68% of the victims had the knowledge of primary wound care; 95% had the knowledge of the importance of anti-rabies vaccination and 51% had the knowledge of importance of observing the biting animal for 10 days. (Table11)
DISCUSSION
This was a vaccination-clinic based study with the hospital situated at Malda town, the district headquarter of Malda district. So evidently the most of the bite victims (63%) were from urban Population. Majority were from lower income group in both urban and rural groups. Males (62% including male children) and children (23%) were frequently affected probably due to outdoor activities of males and the mischievousness and carelessness of the children. This finding is similar to other studies held across India 2, 3, 4, 5 as well as around the world 6, 7. In agreement with other studies, the biting animal was dog in most of the cases (82%) followed by cats (10%) and other animals. Most of the dogs were stray. 2, 3, 5 Like in other studies, extremities were the most frequent site of bite. 1, 3, 7
The primary management of the wound at the bite site was not satisfactory similar to other studies in India. 2, 3, 8
As this was a vaccination clinic based study all the patients had been receiving vaccination contrary to the community based studies performed elsewhere in India.
However, only one patient out of the 61 category III bites received Rabies immunoglobulin which reflects the tendency in other parts of the country. 1, 3, 9 Unavailability of rabies immunoglobulin was the reason of the failure to administer RIG in this study. Only one patient could be convinced to purchase the expensive immunoglobulin from market.
Just as the study conducted by Ichhpujani RL et al 8, knowledge on wound care after animal bite was inadequate amongst the victims.
CONCLUSION
This vaccination-clinic based study at Malda points out the fact that the cause of delay, failure or poor adherence of the animal bite victims to medical care is on many occasions, a lack of knowledge and motivation, apart from distance from the clinic and loss of working hours. It emphasizes the importance of information, education and communication activities regarding animal bites to motivate the victims to seek appropriate medical attention in time. Widespread availability of treatment of animal bite cases with constant supply of vaccine and immunoglobulin is also essential if elimination of rabies has to be achieved in near future.
Conflict of interest: nil
Source of funding: nil
Acknowledgement: Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1189http://ijcrr.com/article_html.php?did=11891. Sudarshan M, Madhusudana S, Mahendra B, Rao N, Ashwath Narayana D, Abdul Rahman S, et al. Assessing Burden of Rabies in India. Report of a WHO Sponsored National Multi-Centric Rabies Survey. International Journal of Infectious Diseases 2007;11:29-35.
2. Sudarshan M, Mahendra B, Madhusudana S, Ashwath Narayana D, Rahman A, Rao S, et al. An Epidemiological Study of Animal Bites in India: Results of a WHO Sponsored National Multi-Centric Rabies Survey. J. Commun. Dis. 2006;38(1):32-39.
3. Ichhpujani R, Mala C, Veena M, Singh J, Bhardwaj M, Bhattacharya D, et al. Epidemiology of animal bites and rabies cases in India. A multicentric study. The Journal of Communicable Diseases 2008 March;40(1):27-36.
4. Agarwal N, Reddajah V. Epidemiology of dog bites: a community-based study in India. Tropical Doctor 2004;34(2):76-78.
5. Shetty R, Chaturvedi S, Singh Z. Profile of animal bite cases in Pune. The Journal of Communicable Diseases 2005 March;37(1):66-72.
6. Eng T, Fishbein D, Talamante H, Hall D, Chavez G, Dobbins Jea. Urban epizootic of rabies in Mexico:epidemiology and impact of animal bite injuries. Bulletin of the World Health Organization 1993;71(5):615-24.
7. Cleaveland S, Fe`vre EM, Kaare M, Coleman PG. Estimating human rabies mortality in the United Republic of Tanzania from dog bite injuries. Bulletin of the World Health Organization 2002;80(4):304-10.
8. Ichhpujani R, Chhabra M, Mittal V, Bhattacharya D, Singh J, Lal S. Knowledge, attitude and practices about animal bites and rabies in general community--a multi-centric study. The Journal of Communicable Diseases 2006 December;38(4):355-61.
9. Mondal T, Ray Karmakar P. Care of animal bite victim in Community and in health care facility in a rural area of West Bengal. IOSR Journal of Dental and Medical Sciences 2016 Jan;15(1, version IV):01-04.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareHealth Problems and Coping after Laparoscopic Sterilization: A Descriptive Correlational Study
English2327Diana MonteiroEnglishJuliana Linnette D SaEnglishFemale sterilization is one of the most commonly used contraception. Women often experience health problems after sterilization and use several coping strategies to overcome their problems.
Objective: This study is aimed atidentifying health problems experienced by women after laparoscopic sterilization and coping strategies used by them and finding the relationship between health problem and coping.
Methods: The descriptive correlation study was conducted in an urban area of Mangalore city in a southern state of India. Using snowball sampling 135 women were selected and interviewed at their residences. Data were collected with a background information questionnaire, Health Problem Rating Scale and the Jalowiec Coping Scale.
Results: Women experienced psychosocial problems more frequently than physical problems;sexual problems were least reported. They effectively used confrontive, self-reliant, and optimistic coping styles. Health problems and coping styles had a significant positive correlation. A strong positive correlation was also found between use of coping style and coping effectiveness.
Conclusion: This study advances current literature by linking health problems and coping of women who have undergone laparoscopic sterilization. However, future research and in-depth study is necessary for analyzing the interaction between health problems and strategies to cope with them.
EnglishLaparoscopic sterilization, Health problems, Coping styles, Coping strategiesIntroduction
With an estimated population of 1.3 billion, India represents 18 percent of the world’s population. India will overtake China to be the world’s most populated country in 2022(1). Use of contraceptives contributes towards controlling the population growth. Globally, contraceptive prevalence among married or in-union women of reproductive age has increased from 55% in 1990 to 63% in 2011. With 19% relying on female sterilization and 14% using IUDs, these two methods were most commonly used worldwide, in 2015(2). The United States reports a decline in the use of female sterilization(3). However, In India, it accounts for two third of total contraceptive use and 77% of the modern contraceptive use.(4). Although a convenient method, its popularity is decreasing. Recent statistics from the first phase of the National Family Health Survey(NFHS) found married women less likely to use modern family planning methods in eight of the Indian states surveyed. Karnataka, a southern Indian state has a decline in the rate of female sterilization from 57.4% in 2005-2006 to 42.8% in 2015-2016(5). In spite of the declining use, it continues to remain the popular choice of modern contraceptives.
Female sterilization involves occlusion of the fallopian tubes by either an abdominal or trans-cervical route. Laparoscopic sterilization, performed through the abdominal approachis often chosen because of its irreversibility, specifically among women who do not wish to retain future fertility. A United Kingdom study reported that women chose sterilization for one of the three reasons: to avoid the possible side-effects of hormones, to avoid continually having to make decisions regarding child- bearing or because of lack of information regarding reversible methods(6).
The period following sterilization is however not without complications or health problems. Several physical, psychosocial and sexual problems are prevalent. The risk for menstrual disturbances were reported. Although rare, failed sterilization may result in ectopic pregnancy. An association between tubal occlusion and subsequent hysterectomy was reported(7). Regret after sterilization is most often experienced by couples who had substantial conflict prior to undergoing sterilization(8). Young age and gender of a child, are among the many factors associated with regret, with 5% of sterilized women aged 15–49 reporting regret in India(9).
Knowledge about health problemsas a consequence of contraceptives has an influence on the choice and the ability of women to cope with their problems. The goal of nursing care is to promote the healthy behavior of people and to help them to use appropriate coping strategies. Therefore, it is of paramount importance that women are educated about the health problems associated with tubal sterilization which they may perceive as burdensome.
To manage taxing demands that exceed their personal resources and eliminate distress, individuals use cognitive and behavioral efforts. Health problems are taxing to most individuals and they are compelled to use various coping efforts or styles that are unique to them. Coping is both, situational and person-base(10). Women have a choice of using predominately problem-oriented or affective-oriented coping strategies. When the event is modifiable, they use problem -oriented coping strategies. In contrast,they prefer affective-oriented coping strategies when the stressful situation can at best, be attenuated(11). Some styles may be perceived more effective than the others. In managing emotionally stressful events certain coping strategies are effective in the short-term but can be harmful in the long-term. Identifying health problems and encouraging women to use appropriate coping strategies will provide a basis for promoting their health and assist them in coping effectively.
To date, empirical research has not fully examined the health problems of women following laparoscopic sterilization, and how coping styles are related to the health problems. Therefore, this aimed at identifying the health problems experienced by women after laparoscopic sterilization and the coping strategies used by them, and finding the relationship between health problems and coping.
Methods and Material:
A descriptive correlational study on health problems and coping strategies of women after laparoscopic sterilization was conducted on 135 women. After identifying the first participant from the medical record of the Postpartum Centre, using snowball sampling, women between 25 and 45 years of age and willing to participate, were recruited. The setting was an urban area adopted by a governmental postpartum center in a southern Indian city.
After seeking administrative permission and taking informed consent, women were interviewed at their residences using a background information questionnaire (demographic items and a modified Srivastava Socioeconomic Status Scale: urban), Health Problems Rating Scale (HPRS) and Jalowiec Coping Scale (JCS)(12). The 28- item HPRS: physical (18 items), sexual (3 items) and psycho-social (7 items) problems, was developed, drawing on several published materials. Respondents were required to check the item in the ‘yes’ column if they experienced the problem and rate it on a three - point scale: ‘always’, ‘most of the time’ or ‘sometimes’. The absence of the problem would draw a ‘no’ response to the ‘no' column. The item-wise scores ranged from 0-3, with a maximum possible score was 54. The content validity of the HPRS was established on the basis of percentage of agreement among seven experts. The Cronbach’s alpha was 0.96, affirming the reliability. After seeking permission from the author to adapt the 60-item JCS to the Indian context, seven items were simplified. For example, an item which read “got mad and let off steam” was simplified to read as “got irritated and started screaming”. Validation was done by seven experts. The JCS had two scales: ‘use' refers to the frequency at which the coping method was used and ‘effectiveness' refers to how effective the responses were in dealing with the resolution of health problems. The eight sub-scales of coping were: confrontive, evasive, optimistic, fatalistic, emotive, palliative, supportant and self-reliant. The score for each item ranged from 0 – 3. The JCS used for this study was reliable; Cronbach’s alpha for ‘use’ scale was 0.93 and for 'effectiveness' scale was 0.94. The tools were translated to Kannada language, and back- translated to establish language validity before pretesting.
Results
Sample Characteristics:The majority of participants (52.6%) were between 30-35 years of age, 40% were between 25-30 years of age and 7.4% were 35 - 45 years old. The majority (72.6%) were the second para;22.3% were third para; 2.2% were above three, and the parity of 3.0 % were primigravidas. Most (51.1%) belonged to middle socioeconomic status;45.9% were from high socio-economic status. The duration since the laparoscopic surgery was less than one year in two-third of the participants (33%).
Health Problems: Higher mean percentage score (23.9%) was reported for the psychosocial health problems score; followed by physical (18.7%) and sexual health problems (10.6%). Top -ranked psychosocial problems were worry over small problems (rank 1; 78.5%), feel terrible (rank 3; 74.8 %), experiencing non- acceptance by family members (rank 5: 62.96%) and feel sad (rank 6; 61.4%). Pain and menstrual problems were among the top-ranked physical problems. Pain while flexing feet (rank 2; 78.5%) back pain while bending to pick up objects (rank7; 58.0 %) and pelvic pain (rank10; 55.5 %) were frequently reported. Majority reported menstrual problems; excessive menstrual bleeding (rank 4; 68.8%), increased duration of menstruation (rank 8; 57.0%) and dysmenorrhea (rank 9; 56.2%). (Table 1).
Coping: The use and effectiveness scores for coping styles were computed.The adjusted use score was calculated by dividing the raw use score for a given coping style by the number of coping styles used for that given coping style. The highest score was for confrontive (0.48), followed by self-reliant (0.45), emotive (0.34) and optimistic coping (0.30). Evasive (0.28), palliative (0.24%), supportant (0.20), and fatalistic coping (0.15) were less frequently used.
The adjusted effectiveness score was obtained by dividing the raw effectiveness score for a given coping style, by the number of coping methods used for that given coping style. It was maximum for confrontive (0.46) self-reliant (0.40) and optimistic coping (0.31). The less effective coping styles were evasive(0.29), emotive(0.28), supportant (0.27), palliative (0.20) and fatalistic coping( 0.15)
The relationship between health problems and coping strategies: Pearson correlation demonstrates a positive relationship between health problems and coping. Health problems were positively correlated with the adjusted mean use scores of coping although weak (r = 0.245, pEnglishhttp://ijcrr.com/abstract.php?article_id=1190http://ijcrr.com/article_html.php?did=11901. United Nations, Department of Economic and Social Affairs, Population Division (2015). World Population Prospects: The 2015 Revision, Key Findings and Advance Tables. Working Paper No. ESA/P/WP.241.
2. United Nations, Department of Economic and Social Affairs, Population Division. Trends in Contraceptive Use Worldwide2015(ST/ESA/SER.A/349)
3. Daniels K, Daugherty J, Jones J. NCHS Data Brief, Number 173, December 2014. 2011;
4. International Institute for Population Sciences (IIPS) and Macro International. 2007. National Family Health Survey (NFHS-3), 2005–06: India: Volume I. Mumbai: IIPS.
5. International Institute for Population Sciences. National Family Health Survey-4. State Fact Sheet Karnataka 2015-16. 2015;2. Available from: http://rchiips.org/nfhs/factsheet_NFHS-4.shtml
6. Kane R, Irving G, Brown S, Parkes N, Walling M, Killick S. Long-acting, reversible and permanent methods of contraception’ insight into women’s choice of method. Qual Prim Care. 2009;17(2):107–14.
7. Melville C, Bigrigg A. Male and female sterilization. ObstetGynaecolReprod Med 2008;18(12):330–4. ?
8. Jamieson DJ, Kaufman SC, Costello C, Hillis SD, Marchbanks PA, Peterson HB. A com- parison of women’s regret after vasectomy versus tubal sterilization. ObstetGynecol 2002;99(6):1073–9.
9. Singh A, Ogollah R, Ram F, Pallikadavath S. Sterilization regret among married women in India: Implications for the Indian national family planning program. IntPerspect Sex Reprod Health. 2012; 38(4):187–195.
10. Costa PT, Somerfield MRJ, McCrae RR. Personality and coping: A reconceptualization. In: Zeidner M, Endler NS, editors. Handbook of coping: Theory, research, applications.Canada: Wiley; 1996. P. 44-61.
11. Lazarus RS, Folkman S. Stress Appraisal and Coping. New York: Springer Publishing Co., 1984.
12. Jalowiec A, Murphy SP, and Powers MJ (1984). Psychometric Assessment of Jaloweic Coping Scale, Nursing Research, 33,157-161.
13. Basgül A, Uzuner A, Kavak ZN, Bozkurt N, Onaran H, Ertürk MS. Impact of tubal sterilization on women’s health. ClinExpObstet Gynecol. 2007; 34(1):39–41
14. Oddens BJ. Women’s satisfaction with birth control: a population survey of physical and psychological effects of oral contraceptives, intrauterine devices, condoms, natural family planning, and sterilization among 1466 women. Contraception. 1999;59(5):277-86.
15.Lutala PM, Hugo JF, Luhiriri LN. Psychosocial implications of tubal ligation in a rural health district: A phenomenological study. Reprod Health. 2011 8(1):38.
16. Peterson HB, Jeng G, Folger SG, Hillis SA, Marchbanks PA, Wilcox LS. The Risk of Menstrual Abnormalities after Tubal Sterilization. N Engl J Med. 2000 343(23):1681–7.
17. Costello C, Hillis SD, Marchbanks PA, Jamieson DJ, Peterson HB, US Collaborative Review of Sterilization Working Group. The effect of interval tubal sterilization on sexual interest and pleasure. Obstet Gynecol. 2002;100(3):511–7.
18. Gulum M, Yeni E, Sahin MA, Savas M, Ciftci H. Sexual functions and quality of life in women with tubal sterilization. Int J Impot Res 2010; 22(4):267–71.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareThe Incidence of Heparin Induced Thrombocytopenia in Orthopedic Surgery Patients in Khartoum, Sudan
English2831Amar Ibrahim Omer YahiaEnglish Maria Mohamed Hamad SattiEnglishAim: The aim of this study was to determine the incidence of low molecular weight heparin (LMWH) induced thrombocytopenia in patients undergoing orthopedic surgery in Khartoum Teaching Hospital. Heparin induced thrombocytopenia (HIT) is a complication of heparin therapy in which the platelet count falls by 50% or more of the baseline value, or falls to below 150×109/L.
Methodology: This is a prospective cross sectional study carried out in Khartoum Teaching Hospital, Department of Orthopedic Surgery in the period between April-July 2013.
Results: Seventy three patients were included, forty nine (67.1%) were males and 24 (32.9%) were females. Most of the patients were between 40-59 years of age (50.7%). Sixty nine (94.52%) of the patients were not exposed to heparin before. All patients received LMWH as prophylaxis except 2 patients who received it for treatment. Fifty patients (68.49%) received LMWH in a dose of 3500 (IU) per day while 23 patients (31.51%) received it in a dose of 4500 IU. Fifty six of the patients received LMWH for 2 weeks, 15 patients for less than 2 weeks while 2 patients for more than 2 weeks. All patients had a baseline platelet count equal or more than 150×109/L. On day 14, none of the patients had 50% reduction or more in the platelet count from the baseline or a platelet count of less than 150×109/L.
Conclusion: The study found that no patient treated with LMWH had significant HIT.
EnglishLow molecular weight heparin, Khartoum teaching hospital, Baseline platelet countIntroduction
Heparin induced thrombocytopenia (HIT) is a complication of heparin therapy in which the platelet count falls by 50% or more from the patients baseline platelet count, or falls to below 150×109/L, and it may associated with increased incidence of arterial and/or venous thromboembolic complications [1]. Most often thrombocytopenia with or without thrombosis is seen. The presence platelet factor 4 /heparin-dependent immunoglobulin G antibodies can be implicated, so HIT is considered as a clinicopathologic syndrome since both clinical and laboratory features are important [2, 3]. HIT is around 10 fold less common with low molecular weight heparin preparations (LMWH) than with unfractionated heparin (UFH) [4]. Heparin is a drug widely used for thromboprophylaxis or treatment in many clinical conditions, including cardiovascular surgery and invasive procedures, acute coronary syndromes, venous thromboembolism, atrial fibrillation, peripheral occlusive disease, dialysis and during extracorporeal circulation [5, 6]. Unfortunately, it can cause serious adverse effects, such as HIT which is a common, serious and potentially life-threatening condition [2, 7-9]. The majority of patients have type I HIT which appears to result from non immunologic activation of platelets [10] resulting in platelet aggregation due to heparin itself [11]. Type I HIT is relatively mild (platelet count >100×109/L), and has no adverse clinical consequences, even if the heparin is continued and usually resolves spontaneously [10]. Type II HIT occurs in 3 to 5% of patients receiving UFH, it is less common in patients receiving LMWH (< 1%). It is caused by an immunoglobulin G (IgG) antibody that reacts with a complex of heparin bound to platelet factor 4 (PF4), results in platelet activation and endothelial cells injury. Type II HIT usually occurs after 5 to 14 days of heparin exposure. The platelet count is typically 50 to70×109/L, with a 50% (or more) drop in the platelet count from the baseline value [10]. Thrombotic events in type II HIT can include deep venous thrombosis and pulmonary embolism, arterial or venous gangrene of limbs, myocardial infarcts and strokes, and skin necrosis [10]. The apparent range in frequency of HIT was ranges from common (1%) in postoperative orthopedic and cardiac surgery patients receiving heparin for 1–2 week, to infrequent (0.1–1%) in medical patients receiving UFH or surgical patients receiving LMWH to rare (Englishhttp://ijcrr.com/abstract.php?article_id=1191http://ijcrr.com/article_html.php?did=11911. Kaushansky K, Lichtman MA, Beutler E, et al. Williams Hematology. 8th ed. China: The McGraw-Hill Companies; 2010. P. 2685.
2. Warkentin TE. Heparin-induced thrombocytopenia: pathogenesis and management. Br J Haematol 2003; 121:535–555.
3. Warkentin TE. Platelet count monitoring and laboratory testing for heparin-induced thrombocytopenia: recommendations of the College of American Pathologists. Arch Pathol Lab Med 2002; 126:1415–1423.
4. Hoffbrand AV, Catovsky D, Tuddenham EGD, et al. Acquired Venous Thrombosis. In: Hunt BJ, Greaves M. Post graduate Haematology. 6th ed. Chichester: Wiley-Blackwell; 2011. P. 891.
5. Chong BH: Heparin-induced thrombocytopenia. J Thromb Haemost 2003; 1:1471-1478.
6. Jang I-K, Hursting HJ: When heparins promote thrombosis. Review of heparin-induced thrombocytopenia. Circulation 2005; 111:2671-2683.
7. Warkentin TE: Heparin-induced thrombocytopenia. Diagnosis and management. Circulation 2004; 110:e454-458.
8. Cines DB, Bussel JB, McMillan RB, et al: Congenital and acquired thrombocytopenia. Hematology (Am Soc Hematol Educ Program) 2004; 390-406.
9. Warkentin TE, Greinacher A: Heparin-induced thrombocytopenia: recognition, treatment, and prevention: the Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy. Chest 2004; 126(3 Suppl): 311S-337S.
10. Kern W. PDQ HEMATOLOGY. 1st ed. US: 1-55009-176-x; 2002. P.197-210.
11. Beck N, Diagnostic Hematology. 1st ed. London: Springer; 2009. P.275.
12. Lee DH, Warkentin TE. Frequency of heparin-induced thrombocytopenia. In:Warkentin TE, Greinacher A, eds. In: Heparin-induced Thrombocytopenia, 3rd ed. New York: Marcel Dekker, Inc., 2004:107–148.
13. Warkentin TE, Levine MN, Hirsh J, et al: Heparin-induced thrombocytopenia in patients treated with low-molecular-weight heparin or unfractionated heparin. N Engl J Med 1995; 332:1330.
14. Greinacher A, Eichler P, Lubenow N, et al: Heparin-induced thrombocytopenia with thromboembolic complications: Meta-analysis of 2 prospective trials to assess the value of parenteral treatment with lepirudin and its therapeutic aPTT range. Blood 2000; 96:846.
15. Wallis DE, Workman DL, Lewis BE, et al: Failure of early heparin cessation as treatment for heparin-induced thrombocytopenia. Am J Med1999; 106:629.
16. Colwell CW Jr, Spiro TE, Trowbridge AA, et al. Use of enoxaparin, a lowmolecular-weight heparin, and unfractionated heparin for the prevention of Deep venous thrombosis after elective hip replacement: a clinical trial comparing efficacy and safety. J Bone Joint Surg Am 1994;76:3-14.
17. Leyvraz PF, Bachmann F, Hoek J, et al. Prevention of deep vein thrombosis after hip replacement: randomised comparison between unfractionated heparin and low molecular weight heparin. BMJ 1991;303:543-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareContralateral Perinephric Urinoma Complicated Retrocaval Ureter Repair: A Surgical Trap of Pyelic Fusion Anomaly
English3234Rabea Ahmed GadelkareemEnglishAim: To present a case of pyelic fusion anomaly with orthotopic kidneys which is extremely rare. For maximum and only, it was reported twice in the literature. Its diagnosis may be unpredictable and it may predispose to major surgical complications.
Case Report: An 8-year-old child was diagnosed to have a retrocaval ureter which was repaired through a flank incision. A striking finding of a cut and retracted tubular structure was noted during ureteral dissection. Postoperative contralateral perinephricurinoma developed and drained percutaneously. Then, two surgical explorations were done on the left kidney without detection of a cause for urinary extravasation. The left ureter was atretic during explorations. Kidney autotransplantation and ileal reconstructions seemed difficult solutions and nephrectomy was the final step.
Discussion: Pyelic fusion anomaly was reported, mainly, in association to renal fusion anomalies like horseshoe and crossed ectopic kidneys. However, it is the first time to report a case of retrocaval ureter in association to pyelic fusion and normally-located and positioned kidneys. Contralateral urinoma after repair of a retrocaval ureter was a striking complication referred to an underlying crossing left-to-right anomalous pathway. This case represented a surgical trap, because it is an extremely rare and unpredictable association of renal anomalies.
Conclusion: Pyelic fusion with orthotopic well-positioned kidneys is an extremely rare renal anomaly. Its association to retrocaval ureter makes it extremely unpredictable, especially, when it is undiagnosed preoperatively.
EnglishPyelic fusion, Retrocaval ureter, Surgical trap, Urinoma
Introduction:
Although fusion anomalies of the kidney are rare, theyare well-known urological lesions, especially the horseshoe kidney. It may associate to the extremely rare anomalies of pyelicand ureteral fusion[1, 2]. The latters may occur, also, with crossed ectopic kidneys[3] or other extremely rare fusion anomalies[4]. However, pyelic fusion anomaly in non-fused orthotopic kidneys is exceedingly rare and hardly detectable in the literature[5, 6]. Previously unreported anatomical anomalies may predispose to major surgical complications like what happened in the following case. So, it is practically attractive and configures a lesson that may deserve to be exposed for learning purposes.
Case report:
An 8-year-old boy presented by mild abdominal pain of many months duration. Abdominal ultrasound revealed moderately obstructed right kidney and normal left side. Plain Kidney-Ureter-Bladder film showed no stones or other abnormalities. Urine analysis parameters were normal and serum creatinine was 0.6 mg/dl. Intravenous urography revealed moderate right hydronephrosis and the upper ureter was dilated with S-shape course consistent with a retrocaval ureter. Both kidneys were well-rotated and the left one was not obstructed, slightly larger in size, but without definite duplication of the pelvicalyceal system. Preoperative routine work up was unremarkable.
The child was admitted to our department for surgical repair and explored through the right extraperitoneal flank incision. During ureteral dissection at the retrocaval part, the assistant surgeon declared that a small tubular structure was seen cut and retracted within the retroperitoneal tissues. Accordingly, the main surgeon examined the part of upper ureter and renal pelvis and found nothing abnormal. So, he proceeded and completed the steps of the ureteral repair on a JJ stent. The wound was closed on a tubal drain. After 3 days the patient had fever and left side abdominal pain. Abdominal ultrasound revealed a large left perinephricurinoma which was drained percutaneously. Right side drain was draining nothing, so it was removed on the fifth day.
On the 10th day, a new intravenous urography study was requested and revealed fine right kidney with only residual dilatation on JJ stent. The left kidney was normal in shape and not obstructed, but with perinephric extravasation of the dye. Surgical exploration of the left side was done, but surgeons could not define the source of urinary leakage. The left ureter was incised and found atretic at multiple levels with intra-renal small renal pelvis. Formal nephrostomy tube was inserted and the wound was closed for further evaluation. However, urinary leakage continued. So, second exploration by more senior urologists was done after further 3 weeks. However, they found nothing more and, as a reflex, decided nephrectomy. Strikingly, leakage stopped by removal of the left kidney and the patient discharged and the JJ stent was removed eight weeks from the primary surgery.
Discussion:
An extremely rare urological anomaly may represent a surgical trap for the urologist when it is unnoticed preoperatively[7]. In the current case, the surgical trap happened and resulted in a contralateral perinephricurinoma as an unpredictable complication for repair of retrocaval ureter. Visualized cut tubular structure during dissection of the right upper ureter and left ureteral atresia on exploration of the left side were definite findings reported by the surgeons. Proposed right side causes for urinoma like an injured duplicated ureter or upper calyceal infundibulum are not accepted, because the urinoma is, simply, on the left side and the right side was free, postoperatively. Also, suggestion of spontaneous rupture of the left kidney is not valid, because the latter was not obstructed at any stage before or after interventions. The only explanation is a congenital left-to-right connection between the pelviureteral segments. Although it is extremely rare, pyelic fusion anomaly with normally-ascended kidneys should be considered. This case represented a surgical hallmark and surprise in our records for many years. However, the suggestion of an underlying pyelic fusion is plausible after reporting of two similar cases in the literature by Enganti et al. [5] and Bhat et al. [6]which encouraged me to report this unique case which occurred many years ago. The similarity to these cases was in regard to the position and location of the kidneys. The differences, however, were presence of solitary ureter and multiple anomalies in Enganti et al. case and the incidental discovery in Bhat et al. case. Moreover, in the current case and to the first time, retrocaval ureter was a major component. In contrast to the current case, retrocaval ureter usually manifests in adulthood age of 30 – 40 years [8].
Novel imaging techniques might facilitate the diagnoses of the reported cases. However, at the time of presentation of this child, the available employed tools were abdominal ultrasonography and intravenous urography as the best for retrocaval ureter anomaly [8]. They could not diagnose the associated anomaly, preoperatively.
Urinoma is an encapsulated urinary collection which is contained within a thick membrane formed by extensive fibrous reaction of the tissues to the extravasated urine[9]. In the current case, it could be one of the factors hindered the detection of the transected fusing segment during the repeated surgery. Uniquely, the urinoma was contralateral to the primarily diagnosed pathology and the primary surgical intervention.
The decision of nephrectomy could be questionable, but it was a situational reflex. Moreover, the surgeons were reluctant to more complicate this difficult situation by alternatives (autotransplantation or ileal ureteral replacement) which seemed relatively difficult.
To the best of my knowledge, the current case is the first in the literature to report a contralateral urinoma formation associated to retrocaval ureter repair due to an underlyingpyelic fusion with well-rotated orthotopic kidneys. At the time where the surgeries for this case were done, it was definitely previously unreported and unpredictable anomaly. Now, however, it is the third reported case of pyelic fusion anomaly with orthoptopic well-rotated kidneys.
Conclusion:
Pyelic fusion with orthotopic well-rotated kidneys is an extremely rare reported urological anomaly. Moreover, its association to retrocaval ureter makes the condition very hardly detectable. It is a surgical trap that deserves declaration to the urologists to help prevent undue major complications in the similar situations.
Acknowledgement:
I acknowledge the immense help received from the scholars whose articles are cited and included in reference of this article. I’m grateful to authors / editors / publishers of all those articles and journals from where the literature for this article has been reviewed and discussed.
Ethical approval:
This case study was approved by the ethical committee of the Faculty of Medicine in Assiut University. Informed consent was taken from the patient’s father.
Conflict of interest: None.
Funding: None.
Englishhttp://ijcrr.com/abstract.php?article_id=1192http://ijcrr.com/article_html.php?did=11921. Ram, A.D., Thomas, R.E., Malone, P. A new operative technique for a rare case of pyelic fusion. J Pediatr Urol, 2011 Oct. 7(5): p. 574-5.
2. Yesilli, C., Erdem, O., Akduman, B., et al., Horseshoe kidney with pyelic fusion and crossed single ureter. J Urol, 2003 Jul. 170(1): p. 175-6.
3. Aragona, F., Serretta, V., Fiorentini, L.,et al., Combined renal and pyelic fusion with crossed ectopia of single ureter. Urology, 1986 Oct. 28(4): p. 339-41.
4. Brueziere, J., Fretin, J. A new case of pyelic fusion. Eur Urol, 1980 6(4): p. 249-50.
5. Enganti, B., Chitekela, N., Nallabothula, A. K., et al., Renal pyelic fusion with crossed solitary ureter: case report and review of literature. Int J Urol, 2013 Oct. 20(10): p. 1043-5.
6. Bhat, S., Paul, F., Doddamani, S.C. Renal pyelic fusion anomaly. Indian J Urol, 2015 Apr-Jun. 31(2): p. 148-9.
7. Cybulka, B., Podgorny, M., Rapela, J., Wach, A. Surgical trap of a routine procedure. scrotal hernia with concomitant sliding of the urinary bladder: Case report. Pol Przegl Chir, 2015 Nov. 87(11): p. 587-91.
8. Hassan, R., Aziz, A.A., Mohamed, S.K. Retrocaval ureter: the importance of intravenous urography. Malays J Med Sci, 2011 Oct-Dec. 18(4): p. 84-7.
9. McInerney, D., Jones, A., Roylance, J. Urinoma. Clin Radiol, 1977 May. 28(3): p. 345-51.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareUterine Arteriovenous Malformation is Rare, but Life-Threatening Disease:
A Report of 2 Cases
English3539Bakisololo Miyuna JacquelineEnglish Wang HualiEnglish Mbungu Mwimba RogerEnglish Guan LinlinEnglishAim: Though uterine arteriovenous malformation (UAVM) is a rare event, it remains a life-threatening among reproductive women. Since its original description done by Dubreuil and Loubatin 1926; approximately 100 cases have been listed in the literature.
The aim of the present report is to state the effectiveness of uterine embolization in the management of UAVM.
Case Report: In this report, we present two patients with uterine arteriovenous malformation who were admitted for recurrent vaginal hemorrhage and treated twice to thrice, prior to confirm the diagnosis. These patients had a history of either cesarean or curettage. In addition, one of the cases (case number 2) had a previous conization for cervical intraepithelial neoplasia III (CINIII) one month earlier, which is an unusual case. The diagnosis has been made by color Doppler and Spectral flow imaging (CDFI) and Digital Subtraction Angiography (DSA). One of the patients was treated with embolotherapy, while another underwent a hysterectomy. The postoperative period was favorable.
Discussion: Although the uterine embolization being effective, the treatment of UAVM is not standardized. However, it depends on the clinical condition of the patient, desire of fertility and age.
Conclusion: The uterine arteriovenous malformation is a dangerous morbidity, which requires prompt diagnosis. Doppler ultrasound and MRI are non-invasive tools for the diagnosis. Furthermore, the uterine artery angiography remains the gold procedure of the diagnosis, concomitantly leads the procedure of the embolotherapy. The embolization of the UAVM has the advantage to preserve fertility. However, hysterectomy should be considered as the last option to save the patient’s life.
EnglishArteriovenous malformation, Cesarean, Curettage, Vaginal bleeding Introduction
The arteriovenous malformation is a sporadic disease. Since its original description done by Dubreuil and Loubatin 1926[2, 12]; approximately 100 cases have been listed in the literature [1]. The UAVM accounts 1-2 % of gynecologic hemorrhage [4, 5]. In 1982, Glowacki and Milliken divided the arteriovenous malformation into two categories, congenital and acquired [8, 9].
The frequent symptom is recurrent vaginal bleeding “ex utero” [2]. Previously the diagnosis of UAVM was made by histopathology of uterine specimen after performing hysterectomy[3,7,15]. Currently, color and Spectral flow Doppler Ultrasound is the most used as well as Magnetic resonance imaging (MRI) [3, 12,14] which helps to assess the extent of the lesion [8]. The angiography is diagnostic and therapeutic procedure which guides embolization, when fertility is required. Others therapeutic procedures such as the resection of the fistula or the hysterectomy can be performed. [14].
These cases report highlights our experience with two patients having this rare morbidity and treated differently. The embolization of UAVM reveals effective for the management of this kind of vascular malformation.
Case reports
Case 1
A 30- year-old patient gravida 1 para 1 complained of slight vaginal bleeding and fever, 15 days following a cesarean section delivery of a baby weighing 3900g. She has no history of coagulation disorder. She had normal vital signs, fever 38.4oC, the uterus was slightly tonic, the pelvic ultrasound was normal. Accordingly, she was treated by anti-inflammatory, antibiotics and oxytocin. She was discharged after 3days with complete resolution of symptoms. On postpartum day 31, she was readmitted in the emergency ward for heavy vaginal bleeding (the hemoglobin level 87g/l,CRP: 28.73mg). She was transfused with 1 unit of red blood cells and treated with oxytocin and antibiotics for Escherichia coli vaginitis. The pelvic color Doppler ultrasound shown a tortuous mass in the myometrium with no significant blood flow signal (figures 1, 2). She had intermittent bleeding on the second day of hospitalization (the hemoglobin level 74g/l). Consequently; she was transfused with 2 units of red blood cell. The subsequent color and spectral Doppler ultrasound revealed a sign of blood flow with low impedance and high velocity in the myometrium of the uterus body (Figure 3). The diagnosis of an arteriovenous malformation was considered; in order to confirm and assess the extent of the lesion, further MRI was done. She was referred to the interventional radiology where a DSA was done; displaying a right uterine arteriovenous malformation (Figure 4. A). Then, the right uterine artery embolization was performed (Figure 4. B). The patient was discharged home without any symptoms. The menstrual cycle became normal, and she did not have any recurrence within 3 years of follow up.
Case 2
A 44 -year-old patient gravida 2, para 1, Abortion 1 was admitted for vaginal bleeding. She had a history of curettage for termination of a pregnancy and a history of cervical conization (for a CINIII with HPV 16 positive) one week earlier. She was clinically instable, Hemoglobin concentration: 79g / L, she was transfused with 2 units of red blood cells; therefore, the CDFI revealed a heterogeneous tubular hypoechoic structure, hypervascularized with a peak systolic and diastolic velocity, on the posterior wall of the cervix (Figures 5 and 6). On day 13, she presented a heavy vaginal bleeding, on the subsequent ultrasound, the findings were similar to the previous examination, and consequently she obtained the diagnosis of a uterine arteriovenous malformation. A Transvaginal bilateral uterine artery ligation has been done. The post operatory period was uneventful and she was discharged home. 1 week later, she presented with another bleeding; after counseling, she underwent a transabdominal total hysterectomy and bilateral salpingectomy. In vitro specimen from the cervix reported an arteriovenous fistula at the right posterior wall of the cervical canal. She had no further hemorrhage during a follow up of 6 months.
Discussion
The UAVM is an abnormal connection between an artery and a vein circumventing the capillary system [8,10,12,14]. There are two categories. The congenital subset is due to a disturbance during embryogenesis, concerning vessel differentiation, and induces many vascular connections[3,5, 7].While, the acquired one represents a sole joining between an artery and a vein [ 5, 10]. The acquired subtype, also known as “fistulae” [5, 8] is a consequence of mechanical trauma, such as normal delivery, cesarean [5,6, 11,], inflammation, neoplasm, intrauterine surgical procedures like the dilatation–curettage [6, 10, 12, 15] and the hysteroscopy. Others risk factors include hysterectomy, gestational trophoblastic disease and maternal exposure to diethylstilbestrol [4, 15].
The UAVM can lead to a torrential and recurrent gynecological bleeding [2, 10]; previously, the diagnosis was made by the histopathology of a uterine specimen. Currently, the ultrasonography and MRI are the non-invasive tools used. The grayscale ultrasound shows an anechoic, tubular or sinusoidal structure in the myometrium [5]. In addition, the color Doppler ultrasound visualizes the tortuous blood flow, while the Spectral Doppler further displays the peak speed of blood wave [5]. Thus, expresses low impedance by resistance index calculation [7, 13, 16]. Therefore, the spectral Doppler differentiates the UAVM to others hypoechoic images seen in grayscale US such as retained product of conception. MRI, CT and CT Angiography are used for large UAVM [7,12].
The Angiography is the cornerstone of the diagnosis [7]. The embolotherathy is widely used with success and fertility is therefore preserved [7,12]. However, hysterectomy is the definitive treatment, frequently when the conservative treatment fails.
A systematic review of Panagiotis Peitsidis et al., assessed 103 patients; all of them underwent Doppler US and Angiography for diagnosis. 62 out of 103 patients underwent embolization with a failure rate of 12, 6% [7].
Among the included patients, we reported a case of arteriovenous fistula following a cervical conization (case 2). This case is of interest; since a fistula following a conization is unusual, with many risk factors such as CINIII and previous curettage. A hysterectomy was done after a transvaginal bilateral uterine artery ligation has failed. Another patient (case 1) had a fever after cesarean that may precipitate the formation of the fistula, she has been treated with embolization
using gelatin sponge (Gelfoam) with good outcome. Others embolization agents have been reported in the literature, Tris-Acryl-gelatin and Polyvinyl alcohol particles being examples [7]. In fact, our 2 patients were at high risk because of the combination of risk factors, according to the pathophysiology reported in a systematic review of Daniel et al [11].
The treatment of UAVM is not standardized; However, depends on the clinical condition of the patient, desire of fertility and age [13]. Before performing curettage for unknown vaginal bleeding, a better assessment of the cause is required to prevent profuse hemorrhage [16]. Because of ionization side effects[10], Because of ionizing effects, angiography diagnosis should only be completed to guide embolization [14].
Our limitation is based on the fact that the diagnosis was not made promptly, while our strength is the length of follow up.
Conclusion: Uterine arteriovenous malformation is a rare and life-threatening condition. Clinicians should always consider a UAVM in a case of periodical bleeding after a uterine trauma, such as a curettage [5]. The Spectral flow and Doppler ultrasonography helps the diagnosis, but requires adequate skills [7]. The embolotherapy is affective; however, the hysterectomy remains the last management for difficult and dangerous UAVM.
List of abbreviations
UAVM: Uterine arteriovenous malformation
CDFI: Color Dopplerflowwith spectral imaging
DSA: Digital subtraction imaging
CT: Computed tomography
MRI: Magnetic resonance imaging
CIN: Cervical intraepithelial neoplasia
CRP: C- reactive protein
HPV: Human papilloma virus
Acknowledgements
The authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors /
publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
The authors are also thankful to the ultrasound department of Dalian Gynecology and Obstetrics (Maternal and child health care) Hospital affiliated to Dalian Medical University and to the Interventional radiology department of Dalian central hospital for their collaboration.
Englishhttp://ijcrr.com/abstract.php?article_id=1193http://ijcrr.com/article_html.php?did=11931. Farias M, Santi C, Lima A, Teixeira S, De Biase T. Radiological findings of uterine arteriovenous malformation: a case report of an unusual and life-threatening cause of abnormal vaginal bleeding. Radiol Bras. 2014 Mar/Abr;47(2):122–124.
2. Kylie Hae-Jin Chang., et al., Uterine arteriovenous malformation caused by intrauterine instrumentation for laparoscopic surgery due to left tubal pregnancy. ObstetGynecol Sci. 2014; 57(5):419-423.
3. Jacques L, Lund M and Baruah D. Uterine Arteriovenous Malformations: A Rare Cause of Vaginal Hemorrhage after Hysterectomy. 2016; Vol.2 No.2:29.
4. Taehwan K, Ji H, JinooK, Hyun-Ki Y,Gi-Young K, Dong-Il G,et al. Management of Bleeding Uterine Arteriovenous Malformation with Bilateral Uterine Artery Embolization, Yonsei Med. 2014; 55: 2.
5. Natali A, Tiffanee A, Brook J, Deirdre J.. Postpartum Uterine Arteriovenous Fistula, Obstet Gynecol. 2004;103:1076–8.
6.Yasmine A, Jon D, Nami A. Ultrasound-guided Transcutaneous Embolization of Uterine Arteriovenous Fistula Performed for Treatment of Symptomatic, Heavy Vaginal Bleeding: Case Report with Brief Review of Literature, Journal of Medical Ultrasound. 2015; 23: 146-149.
7. Panagiotis P, Emmanouil M, Vasiliki T, Rolf K ,Lukas S. Uterine arteriovenous malformations induced after diagnosticcurettage: a systematic review, Arch Gynecol Obstet. 2011; 284:1137–1151.
8. Lisa H, Tracy C. Marchant, D, Douglas C. and Amanda J. Scherbel, BS. Vascular Malformations: Classification and Terminology the Radiologist Needs to Know, Semin Roentgenol 2012;47(2):106–117.
.9. Mulliken JB, Glowacki J: Hemangiomas and vascular malformations in infants and children: A classification based on endothelial characteristics. Plast Reconstr Surg. 1982; 69:412-422.
10.Ravi Srinivasa,et al., Transcatheter Percutaneous Embolotherapy of Uterine Arteriovenous Malformations: A Report of 2 Cases, J Women’s Health Care 2015; 4:4.
11. Daniel J, Megan J, Jamal A, Catalin B, Joshua D.A Systematic Review of Acquired Uterine Arteriovenous Malformations: Pathophysiology, Diagnosis, and Transcatheter Treatment, Am J Perinatol Rep. 2016;6:6–14.
12. Geetha Visvalingam, et al., An Unusual Case of Acquired Uterine Arteriovenous Malformation with Persistent Scar Ectopic Pregnancy Successfully Managed with Uterine Artery Embolization, JJ Med Cases. 2016;7(4):143-147.
13. Hilwati H, Ouzreiah N. Uterine Arteriovenous Malformation, Malays J Med Sci. 2013; 20(2): 76-80.
14. Andrew M, Montu P, Navid E , Mandy W, Cynthia H, Harold N. Diagnosis and Treatment of an Acquired Uterine Arteriovenous Malformation in a 26-Year-Old Woman presenting with Vaginal Bleeding.2015, 167: 198-22115.
15.Tom M, Victor H, , and Eric G. Uterine Arteriovenous Malformation - A Rare Cause of Uterine Haemorrhage, Aust NZ J ObstetGynaecol1994; 34 2 197.
16.D. Timmerman, J. Wauters, S. Van, D. Van , G. Maleux, T. Van et al. Color Doppler imaging is a valuable tool for the diagnosis and management of uterine vascular malformations, Ultrasound Obstet Gynecol. 2003; 21:570 – 577.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareMorphometric Evaluation of the Jugular Foramen at Base of the Skull in North Indian Population
English4043RajkumarEnglish Prabhakaran KattimuthuEnglish Punita ManikEnglish Kumud DharwalEnglishVikram SinghEnglishAim and Objective: The present study is the morphometric evaluation of the dimensions of jugular foramen in regard to the variability in shape and size of jugular foramen and the relationship between antero-posterior diameter (APD) and mediolateral diameter (ML) of jugular foramen on each side (right & left) . The dimensions of the jugular foramen are clinically important because intracranial and extracranial lesions may affect the jugular foramen. The intrinsic abnormalities and pathological processes affecting the jugular foramen are intracranial meningiomas, paragangliomas, schwannomas, metastatic lesions and infiltrative inflammatory processes from surrounding structures such as the middle ear. Other diseases associated with jugular foramen include Vernet’s syndrome and Villaret’s syndrome.
Methodology: 297dry adult human crania of unknown sex were analyzed from the department of Anatomy, GSVM medical college, Kanpur And KGMU, Lucknow (U.P).
Anteroposterior diameter (APD) of jugular foramen: The maximum anteroposterior diameter of jugular foramen on both right and left sides were measured.
Mediolateral (ML) diameter of jugular foramen: This diameter was taken between medial most and lateral most points of jugular foramen on both right and left sides. Metric measurements were taken by using digital vernier calipers.
Results: The mean anteroposterior diameter of the jugular foramen on the right and left were 15.55±2.00mm and 14.48±1.93mm. The mediolatral diameter were 9.33±1.45 mm and 7.74±1.63mm on the right and left respectively. The mean area on the right was 114.06±22.54 mm and on the left 88.90±25.23 mm.
Conclusion: These findings may be helpful for anatomists and neurosurgeons to approach the cranial base with maximum safety and minimum mortality and morbidity or clinicians in finding the appropriate diagnosis..
EnglishJugular foramen, Anteroposterior, Mediolateral, Human Dry SkullINTRODUCTION
The jugular foramen is a very complicate structure to understand and access surgically; It is difficult to conceptualize because it varies in size and shape in different crania and also on two sides in the same cranium. Another point of difficulty is its formation by two bones, and the numerous nerves and venous channels that pass through it1.
The jugular foramen lie between the occipital bone and the petrous part of the temporal bone, and can present as much elongated and irregularly shaped foramen2. It is the chief route for the venous outflow from the skull. The glossopharyngeal, vagus and cranial part of the spinal accessory nerve passes through this and exit the cranial cavity3.The neural and vascular compartments are generally separated by a bony projection called the intrajugular process4,5,6.
Recent studies report that the foramen can have many variations in its shape and size. The so-called anomalies of the jugular bulb and glomic tumors are related to the jugular foramen, as they come in direct contact with structures that cross it, like the internal jugular vein, the internal carotid artery, and the cranial nerves. Moreover schwannomas metastatic lesions and infiltrating inflammatory processes can also modify the jugular foramen.2
A knowledge of jugular foramen is necessary in surgical conditions for microsurgical procedures, such as the lateral suboccipital access for the removal of these lesions, which were formerly thought to be very difficult to undergo an operation.7,8
The tumors involving jugular foramen and nearby structure require microsurgical approach to enter into this region. In most of the cases, we have to drill the nearby bones around the jugular foramen for proper exposure, but the tumor tends to alter the normal anatomy of the foramen by eroding and invading it. Therefore, it is not possible to have correct anatomic visualization of the foramen in the presence of such pathologies. Hence, a detailed knowledge of the jugular foramen is needed to all the neurosurgeons while doing surgery in this region9.
The fundamental knowledge of jugular foramen as well as symptoms of these lesions such as loss of hearing, tinnitus, otorrhoea, pain, and paralysis of the facial, glossopharyngeal, vagus, and accessory nerves, is necessary. Dysfunction of these nerves is called syndrome of the jugular fossa (Vernet’s syndrome) which is characterized by: loss of taste sensation in the posterior third of the tongue, paralysis of the vocal cords and soft palate, and weakness of the Trapezius and sternocleidomastoid muscles. If tumors of the jugular foramen region extend medial1y to the hypoglossal canal and cause hypoglossal nerve paralysis, the clinical presentation is known as Collet-Sicard syndrome 10,11,12 .
Latest information provides a detailed anatomy of the jugular foramen. Surgical resection is the treatment of choice in the majority of these cases. Advances in microsurgical techniques have made possible the removal of advanced jugular foramen lesions, which were once assumed to be inoperable 13.
Knowledge of Intracranial and extracranial lesions may affect the jugular foramen in addition to intrinsic abnormalities. The pathological conditions affecting JF include intracranial meningiomas, paragangliomas, glomusjugulare (jugular ganglion of the vagus nerve), schwannomas, metastatic lesions and infiltrative inflammatory processes from adjoining structures like the middle ear 14,15,16.
Recent studies report that ligation of the internal jugular is sometimes performed during radical neck dissection with the risk of venous infarction, which some adduce to be due to ligation of the dominant internal jugular vein. The 9th, 10th and 11th cranial nerves exit the cranial cavity through the JF. In the syndrome of the JF (Vernet’s syndrome), there is paralysis of the 9th, 10th and 11th cranial nerves. These, along with paralysis of the 12th cranial nerve (Villaret’s syndrome),occur with a retropharyngeal lesion invading the posterior fossa. In some instances, involvement of two or more of these nerves in other combinations is encountered (as in Jackson’s vagoaccessory hypoglossal paralysis, Schmidt’s vagoaccessory syndrome and Tapia’s vagohypoglossal palsy)17.
MATERIALS AND METHODS:-
The present study was undertaken in adult north Indian skulls different region of north India, from different medical colleges. The total number of 297 dry adult human crania of unknown sex was analyzed from the Department of Anatomy, GSVM Medical College, Kanpur and King George Medical University, Lucknow (U.P).
The anteroposterior, and mediolateral diameters or area of the jugular foramina was determined. Metric measurements were taken by using digital vernier calipers. The mean, standard deviation and range of each dimension and derived index were compared. Right and left side differences were analyzed. Above all parameters were measured both side (right & left) of the jugular foramen.
Anteroposterior diameter (APD) of jugular foramen:- maximum anteroposterior diameter of jugular foramen was measured showing no.1.
Mediolateral (ML) diameter of jugular foramen:- This diameter was taken between medial most and lateral most points of jugular foramen showing no.2.
Area of the foramen (A): The area of the foramen was calculated using the formula A=π×{A {{D×ML/4}, The areas of both sides the foramina were compared.
Only fully ossified adult skulls were included in the present study. Skulls showing wear and tear, any fracture or pathology were excluded.
Statistical Methods
The statistical analysis used for the study is SPSS (Statistical Package for Social Sciences, IBM).Version 21.
RESULTS
In the present study, the mean anteroposterior diameter (APD) of the jugular foramen on right and left were 15.55±2.00mm and 14.48±1.93mm, and mediolatral (ML) 9.33±1.45 mm and 7.74±1.63mm on the right and left sides respectively. The mean area on the right was 114.06±22.54 mm and on the left 88.90±25.23 mm
DISCUSSION:-
In the present study, the mean anteroposterior diameter of the jugular foramen on right and left were 15.55±2.00mm and 14.48±1.93mm, and mediolatral 9.33±1.45 mm and 7.74±1.63mm on the right and left sides respectively. The mean area on the right was 114.06±22.54 mm and on the left 88.90±25.23 mm (Table no.1).
The comparison of the anteroposterior and mediolaterally diameter of the present study with the study done by other authors is shown in table no.2. The right foramen is larger than the left. These findings are similar to the findings of Hussain Saheb, Vijisa P, Maharshi Abhilasha, Roma Patel, Shruthi B.N, Anjali Singla, Avanish Kumar, Osunwoke E.A,O.E. Idowu shown in table no.2. Some funding is larger than the present study and some finding are smaller than present study.
CONCLUSION
This study provides detailed morphological and morphometric anatomy of the jugular foramen. Knowledge of it is very helpful for neurosurgeons dealing with a space occupying lesion in jugular foramen. These findings may be helpful for anatomists and neurosurgeons to approach the cranial base with maximum safety and minimum mortality and morbidity or clinicians in reaching the appropriate diagnosis.
Englishhttp://ijcrr.com/abstract.php?article_id=1194http://ijcrr.com/article_html.php?did=1194
Hussain Saheb S et al A .Morphometric study of the jugular foramen in human adult skulls of south India. J Biomed Sci and Res., Vol 2 (4), 2010,240-243
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Vijisha P, Bilodi AK, Lokeshmaran Morphometric study of jugular foramen in Tamil Nadu region. Natl J Clin Anat. 2013;2:71–4.
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Williams P, Warwick R, Dyson M, Bannister L. Gray Anatomia. 37th ed. Vol. 2. Rio de Janeiro: Guanabara Koogan; 1995. pp. 329–31.
Guido H, Zorzetto N. Observaçõesanatômicassobre o forame jugular. Rev Bras de Otorrinolaringol. 1997;63:541–7.
Idowu OE. The jugular foramen - A morphometric study. Folia Morphol (Warsz) 2004;63:419–22. [PubMed]
Singla A, Sahni D, Aggrawal A, Gupta T, Kaur H. Morphometric study of the jugular foramen in North West Indian population. J Postgrad Med Educ Res. 2012;46:165–71.
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Kumar A., Akhtar J., Kumar A.: Variations in jugular foramen of human skull. Asian Journal of Medical Sciences. 2015; 6 (2): 95–98.
Friedman C.D., Costantino P.D., Teitelbaum B.S.: Primary extracranial meningiomas of the head and neek. Laryngoscop. 1990; 100: 41–48.
Erongun U., Uyar Y., Çakir B., Uygyn A., Kocaogullar Y.: Infratemporal approach for jugular foramen meningioma. Turkish Neurosurgery. 1993; 3: 128–133.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcareDetection of Carbapenem-Resistant Klebsiella Pneumoniae Isolates from Clinical Specimens in Nnamdi Azikiwe University Teaching Hospital, Nnewi
English4448Onukwube Cyril ChineduEnglish Agbakoba Nneka ReginaEnglish Egwuatu Chukwudi CharlesEnglish Aghanya Iloduba NnaemekaEnglishBackground: Carbapenem-resistant Klebsiella pneumoniae is emerging rapidly worldwide. The accurate and prompt identification of Klebsiella pneumoniae carbapenemase (KPC) is a key to limiting the spread of these bacteria. Increasingly, Klebsiella bacteria have developed antibiotic resistance most recently to the class of antibiotics known as carbapenems.
Aim: The study was done to detect carbapenem-resistant Klebsiella pneumonia isolates from clinical specimens in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria.
Methodology: K. pneumoniae clinical isolates were collected and processed at Nnamdi Azikiwe University Teaching Hospital Medical Microbiology and Parasitology laboratory from August 2012 to February 2013. Fifty-two Klebsiella pneumoniae recovered from different specimens namely; wound swabs (14), urine (26), sputum (7), and endocervical swab/high vaginal swab (5) were analyzed. Antimicrobial susceptibility testing (AST) was determined by agar disc diffusion method using Mueller-Hinton agar according to Clinical and Laboratory Standards Institute recommendations. Modified Hodge test (MHT) was carried out on clinical isolates that showed reduced disc sizes to carbapenem and resistant to the third generation cephalosporin. Polymerase chain reaction (PCR) was carried out to detect the presence of blaKPC gene. Results: Antibiotics susceptibility results revealed that meropenem and Imipenem showed the highest sensitivity (100%) against the isolates tested. Ertapenem showed 94.2% sensitivity. K. pneumoniae was isolated more from female patients 30(57.7%) than from male patients 22(42.3%). The result of the single PCR also revealed the absence of blaKPC gene. The PCR and MHT results showed strong consistency when compared.
Conclusion: Care must be taken in the prescription and administration of carbapenem as it is the last resort for many bacterial infection. Infection control policies should be strictly adhered to.
EnglishK. Pneumonia, Antimicrobial susceptibility testing (AST), Parasitology, CarbapenemINTRODUCTION
Klebsiella pneumoniae is a Gram-negative, non-motile, encapsulated, lactose fermenting, facultative anaerobic, rod shaped bacterium found in the normal flora of the mouth, skin, and intestines (Ryan and Ray, 2004).
K. pneumoniae is an important cause of human infections or diseases which are usually nosocomial or hospital-acquired. Diseases caused by K. pneumoniae include; urinary tract infections, pneumonia, septicemia, and soft tissue infections (Podschun and Ullmann, 1998). The diseases caused by K. pneumoniae can result in death for patients who are immunodeficient. Capsular polysaccharide and lipopolysaccharide O side chain are two of the most important virulence factors of K. pneumoniae (Cortés et al., 2002).
Increasingly, Klebsiella bacteria have developed antibiotic resistance most recently to the class of antibiotics known as carbapenems (LA County Department of Public Health, 2010). Detection of carbapenemase-producing isolates in the microbiology laboratory is difficult (Tenover et al., 2006). Acquisition of a blaKPC gene alone does not always confer resistance to carbapenems, as defined by current breakpoints of the Clinical and Laboratory Standards Institute (CLSI). Some KPC isolates show low-level resistance to carbapenems; with elevated minimal inhibitory concentrations (MICs) (2 to 4 µg/mL) or with reduced disk zone diameters but within the susceptible range.
Emergence of carbapenem resistance in health care settings is increasingly attributed to the production of β-lactamases capable of hydrolysing carbapenems (Bilavsky et al., 2010). Carbapenemases are sub-class of β-lactamase enzymes that are classified by their specific resistant mechanisms, (such as AmpC and others), this research will concentrate on Klebsiella pneumoniae carbapenemase (KPC). The KPC enzyme confers resistance to all β-lactam agents including penicillins, cephalosporins, monobactams, and carbapenems (Smith et al., 2003; Alba et al., 2005).
KPC represents an emerging bacterial resistance mechanism and is currently more prevalent in the north-eastern part of the U.S. (New York, New Jersey and Maryland), although it has been seen with more frequency in other parts of the country (Martin et al., 2010). KPC-producing bacteria have also caused outbreaks in Israel and recently have become an emerging public health concerns in several regions worldwide, such as China, Latin America and Greece (Nordmann et al., 2009). Though there have been increasingly, reported cases of carbapenem-resistant Klebsiella pneumoniae worldwide, there is limited data in Africa. We decided to carry out this research due to the high incidence of medical tourism by Nigerians in places where KPC has been reported. Therefore, this work was centred on detection of Klebsiella pneumoniae carbapenemase as it is the prevalent and most documented mechanism of resistance by carbapenem-resistant Klebsiella pneumoniae.
Given the limited therapeutic options available, the accurate detection of KPC-possessing Klebsiella pneumoniae is crucial in controlling its spread. The current guidelines for the phenotypic detection of KPC-producing organisms in US hospitals are based on reduced susceptibility to carbapenems, which has to be confirmed by the Modified Hodge Test (MHT) (CLSI, 2009).
MATERIALS AND METHODS
Isolates Collection and Identification
Out of 702 bacterial isolates examined from Nnamdi Azikiwe University Teaching Hospital Medical Microbiology and Parasitology laboratory Nnewi, 52 were isolated as presumptive K. pneumoniae. Isolates were collected from urine, sputum, wound swab, high vaginal swab and endocervical swab samples. The collected isolates were processed using standard routine Microbiological methods. Isolation was done by sub-culturing the presumptive K. pneumoniae on MacConkey and EMB (Eosin Methylene Blue) agars. The plates were incubated at 37oC for 24hours. Confirmation of K. pneumoniae was based on morphology, gram staining and standard biochemical tests.
Antibiotics susceptibility testing
Antibiotics susceptibility testing was determined using the Kirby-Bauer disk diffusion method on Mueller-Hinton agar plates as recommended by Clinical and Laboratory Standard Institute (CLSI, 2009).
The standard commercial disks used and their concentrations are as follows: Ciprofloxacin (5µg), Imipenem (10µg), Ceftazidime (30µg), Cefotaxime (30µg), (Abtek biological, UK), Ertapenem (10µg), Aztreonam (30µg), Piperacillin/Tazobactam (10µg), Gentamicin (10µg), and Cefepime (30µg), (Oxoid, UK), Meropenem (10µg) (Mast Diagnostics ltd, UK).
Three to five discrete colonies of K. pneumoniae isolates selected from an 18-24hour agar plate were touched with a sterile wire loop and suspended in 5ml of sterile saline in a bijou bottle. The suspension was mixed thoroughly to obtain a homogenous mixture. The turbidity of the suspension was then adjusted to match the 0.5 McFarland turbidity standard.
Each of the isolates was uniformly and aseptically inoculated into a well dried Mueller-Hinton agar, in plates by spread plate method, as follows; a sterile swab stick was dipped in the suspension, squeezed by the side of the bottle before streaking over the sensitivity plates. The appropriate antibiotic discs were placed aseptically on the agar using sterile forceps. Inoculated plates were incubated at 37°C for 18-24hours after which the diameters of the inhibition zones were measured and recorded (as susceptible, intermediate or resistant). All susceptibility tests were carried out in duplicates. Klebsiella pneumoniae ATCC 13883 was used as control strain.
Modified Hodge Test
This is a phenotypic test which could be used to determine if reduced susceptibility to carbapenems is mediated by a carbapenemase. It’s the most easily performed confirmatory test for KPCs.
Modified Hodge test (MHT) was performed first by streaking a susceptible Escherichia coli isolate on a Mueller-Hinton plate, after which a carbapenem disk (Meropenem) was placed on the centre. Isolates suspected of carbapenemase production then were streaked from the disk to the outer margin of the plate. This test was also repeated in duplicates. Quality control was performed using Escherichia coli ATCC 25922, Klebsiella pneumoniae ATCC BAA 1705.
Molecular Analysis
DNA Amplification
Polymerase Chain Reaction (using the PCR machine; PTC-200 BY MJ Research) was carried out to detect the presence of blaKPC gene. The primers used are as follows; blaKPC-F1: TCGCTAAACTCGAACAGG and blaKPC-R1: TTACTGCCCGTTGACGCCCAATCC. The PCR reaction system contained 0.1-1.0µM for each primer. Cycling parameters were; initial denaturation at 93oC for 3 minutes, followed by 35 cycles of 1 minute at 93oC, 30 seconds at 56oC, and 1 minute 30 seconds at 72oC. The PCR amplification was ended by a final extension at 72oC for 10 minutes.
RESULTS
Of the 702 bacterial isolates analyzed for the presence of K. pneumoniae, 52 were identified as K. pneumoniae. Sources of the isolated K. pneumoniae were; wound swab 14(26.9%), urine 26(50.0%), sputum 7(13.5%), and ECS/HVS 5(9.6%), as shown in Table 4.1. The prevalence of K. pneumoniae clinical isolates was found to be 7.4%.
Table 4.1 shows the percentage distribution of K. pneumoniae in clinical samples from NAUTH.
Table 4.2 outlined the percentage distribution of K. pneumoniae amongst male and female patients.
Fig. 4.1 shows the age distribution of K. pneumoniae amongst male and female patients in NAUTH. Among the male patients, age interval of 40-49 was the modal class, while the mean was 39.95. The modal class for the female patients was 50-59 while the mean was 45.83.
The Antimicrobial susceptibility pattern of the 52 Klebsiella pneumoniae clinical isolates was evaluated. Table 4.3 shows the results of the test.
10(19.2%) clinical isolates of K. pneumoniae that showed reduced susceptibility and resistance to third generation cephalosporin were subjected to polymerase chain reaction (PCR) to detect if blaKPC gene was present. Plate 1: shows the result. BlaKPC gene was not detected from the K. pneumoniae isolates tested.
DISCUSSION
With the increased dependence on carbapenem antibiotics, KPCs are a major public health concern. Bacterial isolates producing KPCs are able to hydrolyze a broad spectrum of β-lactams including the penicillins, cephalosporins, carbapenems and monobactams. They have the potentials to spread rapidly in hospital environments to cause nosocomial infections with high mortality rates (Hirsch and Tam, 2010). Carbapenems are a class of β-lactam antibiotics with a broad spectrum of antibacterial activity. They are one of the antibiotics of last resort for many bacterial infections, such as Escherichia coli (E. coli) and Klebsiella pneumoniae (Smith, 2010).
In this study, a total of 52 clinical isolates of Klebsiella pneumoniae were isolated from 702 clinical bacterial isolates. Sources of K. pneumoniae clinical isolates were as follows; wound swab, urine, sputum, and ECS/HVS. K. pneumoniae was predominantly isolated from urine samples 26(50%) followed by wound swab 14(26.9%), then sputum and ECS/HVS 7(13.5%) and 5(9.6%) respectively. This result conforms to the research done by Jombo et al., (2011) who reported urine specimen to have the highest number of Klebsiella isolates followed by wound swab or pus, sputum and then ECS/HVS. Iroha et al., (2011), reported that out of 390 samples collected, K. pneumoniae was isolated from 150 samples (urine 72, HVS 12, wound swab 16, and sputum 50). In their research, urine specimen constituted the largest number of K. pneumoniae isolates. Sarathbabu et al., (2012), also isolated K. pneumoniae predominantly from urine samples in hospitalised patients in India. K. pneumoniae is an opportunistic bacterium which affects the elderly and the immunocompromised. Therefore, the isolation of K. pneumoniae more frequently from urine specimen could be due to the presence of indwelling devices such as catheter in patients associated with the diseases. Presence of these devices in the body leads to the adherence of Gram-negative organisms such as Klebsiella on the surfaces of these devices which eventually promotes the establishment and development of the disease. Unlike the mucous membrane which serves as the first line of defence against bacteria and other pathogens, these invasive devices do not have such protective properties rather, it predisposes one to infections.
Antimicrobial susceptibility testing revealed that all K. pneumoniae isolates were susceptible to meropenem and Imipenem (100% sensitivity each). Fifty (94.2%) K. pneumoniae isolates showed susceptibility to ertapenem. High antimicrobial drug susceptibility pattern was also observed among other antimicrobial drugs used; Cefepime 51(98.1%), Piperacillin/tazobactam 46(88.5%), Aztreonam 39(75%), Gentamycin 43(82.75), Ceftazidime 49(94.2%), Cefotaxime 50(96.2%), and Ciprofloxacin 45(86.2%). This result is similar to that reported by Iroha et al., (2011), who in their research reported resistance to the commonly used antimicrobial agents such as chloramphenicol and ampicillin while carbapenems, aminoglycosides, cephalosporins, fluoroquinolones and monobactam showed greater sensitivity. This result is an indication that the antimicrobial drugs used in this study have not been grossly misused in this environment.
Varying degree of resistance (1-3 of the antimicrobial drugs used) was observed among the K. pneumoniae clinical isolates. Aztreonam showed highest resistance (19.2%) while lowest antimicrobial drug resistance was observed in cefepime (1.9%) and ertapenem (1.9%). It is worthy of note here that ertapenem non-susceptibility is not specific for carbapenemase production especially in areas where carbapenemase production is uncommon (Woodford et al., 2007). Among the carbapenems, K. pneumoniae showed no resistance to meropenem and imipenem. However, (1.9%) resistance and moderate susceptibility (1.9%) was observed in ertapenem. Meropenem and ertapenem is a more sensitive indicator than imipenem for the detection of KPC (CLSI) using disc diffusion.
Results from this research showed that K. pneumoniae infection was observed more in female patients (57.7%) than in their male counterpart (42.3%). The age distribution amongst the male patients showed that the age interval of 40-49 occurred more frequently (27.3%) and therefore, is the modal class while the mean was calculated to be 39.95. Amongst the female patients, the modal class was observed to be 50-59 while the calculated mean was 45.83. Age distribution pattern of subjects infected with K. pneumoniae ranged from 7months to 87years. There was no statistical significant difference between the distribution of K. pneumoniae isolates amongst male and female patients.
The outcome of the single PCR amplification showed that Klebsiella pneumoniae carbapenemase was not detected among Klebsiella pneumoniae isolates in NAUTH. Comparing the Modified Hodge Test (MHT) result and that of PCR, one can observe that both results showed 100% sensitivity for the detection of KPC activity. This finding is consistent with those of Lijun et al., (2012). Here Lijun and associates investigated the presence of K. pneumoniae carbapenemase genes from 159 clinical Gram-negative isolates resistant to several classes of β-lactam antibiotics. The sensitivity and specificity of MHT by this result have shown to exceed 90%; however, several reports have noted the occurrence of false positive results when the MHT was used to detect carbapenemase in ESBL-producing isolates (Carvalhaes et al., 2010; Wang et al., 2011). The absence of carbapenem-resistant Klebsiella pneumoniae (CRKP) in NAUTH Medical Microbiology and Parasitology Laboratory as of the time of this research could be as a result of the exorbitant prices of carbapenems which makes them not to be readily availability, and therefore not easily misused.
CONCLUSION
Based on the outcome of this study, Klebsiella pneumoniae demonstrated a high resistance to Aztreonam and Gentamycin compared to other antimicrobial drugs used. Therefore, care must be taken in the prescription and administration of these antimicrobial agents. Strict infection control policies (such as hand washing hygiene, use of gowns, contact precautions etc) should be put in place to control the growing incidence of antibiotics resistance. Antimicrobial drugs should be bought only from certified local manufacturers and importers. This will help to reduce the high level of counterfeit drugs in the country. Proper education of the public through jingles and adverts should also be considered to discourage self-medication. With the outcome of the antimicrobial susceptibility testing (AST), one can conclude that if these antimicrobial agents are used judiciously, it will go a long way in providing the desired treatment efficiencies and at the same time minimising resistance.
AKNOWLEDGEMENT
We sincerely acknowledge the technical assistance of the laboratory scientists and resident doctors in the Department of Medical Microbiology and Parasitology, Nnamdi Azikiwe University Teaching Hospital, Nnewi Campus, Nigeria. We also acknowledge all the scholars whose articles are cited and included in the references of this manuscript. We are equally grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Source of funding: None
Conflict of interest: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=1195http://ijcrr.com/article_html.php?did=1195Alba, J., Ishii, Y., Thomson, K., Moland, E.S., and Yamaguchi, K. (2005). Kinetics study of KPC-3, a plasmid-encoded class A carbapenem-hydrolyzing β-lactamase. Antimicrobial Agents and Chemotherapy; 49: 4760-4762.
Bilavsky, E., Schwaber, M.J., and Carmeli, Y. (2010). How to stem the tide of carbapenemase-producing Enterobacteriaceae?: proactive versus reactive strategies. Current Opinion in Infectious Diseases; 23: 327-331.
Carvalhaes, C.G., Picao, R.C., Nicoletti, A.G., Xavier, D.E., and Gales, A.C. (2010). Cloverleaf test (modified Hodge test) for detecting carbapenemase production in Klebsiella pneumoniae: be aware of false positive results. Journal of Antimicrobial Chemotherapy; 65: 249-251
Clinical and Laboratory Standards Institute (2009). Performance standards for antimicrobial susceptibility testing; Nineteenth Informational Supplement. CLSI Document M100- S19. Wayne, PA: Clinical and Laboratory Standards Institute.
Cortés, G., Borrell, N., De-astorza, B., Gómez, C., Sauleda, J., and Albertí, S. (2002). "Molecular Analysis of the Contribution of the Capsular Polysaccharide and the Lipopolysaccharide O Side Chain to the Virulence of Klebsiella pneumoniae in a Murine Model of Pneumonia". Infection and Immunity; 70(5): 2583-2590.
Hirsch, B., and Tam, V.H. (2010). Detection and treatment options for Klebsiella pneumoniae carbapenemases (KPCs): an emerging cause of multidrug infection. Journal of antimicrobial chemotherapy; 65: 1119-1125.
Iroha, I.R., Oji, A.E., and Ayogu, T.E. (2011). Analysis of Antibiotic susceptibility of Klebsiella pneumoniae strains isolated from different clinical specimens in Enugu state. International Journal of Current Research; 2(1): 8-14.
Jumbo, G.T.A., Emanghe, U.E., Akpan, S., and Bolarin, D.M. (2011). Klebsiella infections and Antimicrobial susceptibility patterns in the 21st century: A Paradigm shift. Asian journal of Pharmaceutical and Health Sciences; 1(4): 204-208.
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Lijun, W., Haitong, G., and Xinxin, L. (2012). A Rapid Low-cost Real-time PCR for the Detection of Klebsiella pneumoniae Carbapenemase Genes. Annals of Clinical Microbiology and Antimicrobials; 11(9): 1-6.
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Nordmann, P., Cuzon, G., and Naas, T. (2009). The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infection Disease; 9: 228–236.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27HealthcarePrevalence of Asymptomatic Peripheral Vascular Disease Among Type 2 Diabetes Mellitus Patients
English4952Surendra KumarEnglish Akhil GuptaEnglish Vinod AswalEnglish Prabhu Dayal BaralaEnglishBackground: Peripheral vascular disease (PVD) is one of the significant Macrovascular complications of type 2 diabetes mellitus presenting commonly with symptoms of intermittent claudication, it is the leading cause for limb gangrene and hence amputation in diabetic patients, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease, The routine PVD assessment in type 2 DM patients showing importance in the light of a long duration of asymptomatic period in the natural course of the disease
Aim: This study was done with the aim to determine the prevalence of asymptomatic PVD among Type 2 diabetes patients, so that by early recognition of PVD, related complications can be limited
Material and Method: Our study was conducted in the Department of Medicine, S.P. Medical College and Associated group of hospitals, Bikaner. A total of 108 type-2 DM cases who visited medical outdoor and those admitted in PBM hospital were selected for study after obtaining proper informed consent
Result and Conclusion: Prevalence of asymptomatic PVD (ABI < 0.9) is about 12% in our study. Thus a significant proportion of type 2 diabetic subjects are affected by PVD, and hence due importance to be given for active screening annually specially by ABI and prevention and management of complication among type 2 diabetes patients.
EnglishPeripheral Vascular Disease, Ankle Brachial Index, Type 2 Diabetes MellitusINTRODUCTION
Peripheral vascular disease (PVD) is one of the significant Macrovascular complications of type 2 diabetes mellitus. The most common symptom of PVD is intermittent claudication, defined as pain, cramping, or aching in the calves, thighs, or buttocks that appears reproducibly with walking exercise and is relieved by rest. More extreme presentations of PVD include rest pain, tissue loss, or gangrene; these limb-threatening manifestations of PVD are collectively termed critical limb ischemia (CLI). and while it is a major risk factor for lower-extremity amputation, it is also accompanied by a high likelihood for symptomatic cardiovascular and cerebrovascular disease15. The routine PVD assessment in type 2 DM patients showing importance in the light of a long duration of asymptomatic period in the natural course of the disease and hence the importance of active screening for PVD with special emphasis on ankle – Brachial index gains importance for saving the limbs of Diabetic patients1. Although Diabetic Peripheral Neuropathy and Peripheral Vascular Disease (PVD) both contribute to the development of diabetic foot, the risk of amputation raises steeply only if there is associated PVD2. Diabetes predominately leads to PVD in the infrageniculate arteries of calf and the risk factors associated with development of PVD in diabetes are found to be advancing age, uncontrolled hyperglycemia, hypertension, dyslipidaemia and smoking3,9.
Several population studies have shown that diabetes is a strong risk factor for PVD4 and PVD was found in approximately 20% of the diabetic patients5 but this probably greatly underestimates the prevalence, given that many more people with PVD are asymptomatic rather than symptomatic. In the United Kingdom prospective diabetes study (UKPDS) PVD was found in 11% of patients after a follow up period of 6 years from the time of diagnosis of type 2 diabetes6. It can be safely concluded based on these population studies that PVD is a highly prevalent disorder, in particular in the elderly diabetic patient. Unfortunately, the awareness of the physicians that these patients have PVD is low, resulting in inadequate preventive measures for reducing lower extremity amputation and to reduce the grossly elevated general cardiovascular risk7,8.
AIMS AND OBJECTIVES
To determine the prevalence of asymptomatic PVD among Type 2 diabetes patients, so that early recognition of PVD by active screening in diabetic subjects can be done, before devastating complications of peripheral limb ischemia develops and timely management can be done.
MATERIAL AND METHODS
Our study was conducted in the Department of Medicine, S.P. Medical College and Associated group of hospitals, Bikaner. A total of 108 type-2 DM cases who visited medical outdoor and those admitted in PBM hospital were selected for study after obtaining proper informed consent.
The exclusion criteria used were
Clinical evidence of thromboangitisobliterans.
Suspected arteritis subjects.
Patients suffering from hypercoagulable states including heamotologic diseases.
Hypothyroidism
Collagen vascular disorders
Valvular heart disease
A patient without clinical evidence of coronary, cerebrovascular, and peripheral artery disease (PAD).
Present study was conducted on patients of type 2 diabetes mellitus and was interviewed with special attention on elicitation of history regarding symptoms of PVD, in the form of intermittent claudication, Ischemic rest pain, history of foot ulcers in the past and present. Smoking was recorded in pack-years of cigarettes smoked. Duration of diabetes since diagnosis was recorded and they were grouped accordingly.
The anthropometric measurements were recorded and the body-mass index was calculated. Waist-hip ratio was also recorded. The blood pressure was recorded in both the upper limbs and both the lower legs using the standard B.P cuff. An comprehensive physical examination was done and findings recorded. Special importance was given to foot examination. Peripheral neuropathy assessment was done using simmel-weiss monofilament testing and timed vibration sense perception recordings. Symptoms of peripheral neuropathy were also noted.
For detection of peripheral vascular disease recordings of ankle-brachial index (ABI) was recorded using the hand held Doppler probe (5-8 MHz) is positioned over the posterior tibial artery after applying the sphygmomanometer cuff over lower calf just above the ankle. The two consecutive readings were taken. Patients with ABI of 1.15 were screened with duplex color Doppler-imaging for screening for PVD.
Results
Out of total 108 patients studied 63 were males and 45 were females. Total 13 (12%) patients had PVD(peripheral vascular disease) positive, stating 12% prevalence ,which is quite significant (Table I), with women having a slightly higher prevalence (6 out of 45; 13.33%), as compared to men (7 out of 63; 11.11%).(Table II). None of the patient was symptomatic at the time of diagnosis of PVD. Mean age in PVD positive cases were 61.85±12.22 while mean age in PVD negative cases was 52.33±10.70 and the difference was found statistically significant (p0.5).
In our study prevalence of asymptomatic peripheral vascular disease (ABI Englishhttp://ijcrr.com/abstract.php?article_id=1196http://ijcrr.com/article_html.php?did=1196
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Macgregor A5 et al Role of Systolic – Blood Pressure and Plasma triglycerides in Diabetic peripheral arterial disease. The Edinburgh artery study. Diabetes care 1999; 22; 453-8.
Adler AI, et al – UKPDS 59; Hyperglycaemia and other potentially modifiable risk factors for peripheral vascular disease in type 2 Diabetes melitus; Diabetes care 2002; 25; 894-9.
Hirsch AT et al, Peripheral arterial disease detection, awareness and treatment in primary care. JAMA 2001; 286; 1317-24.
A pelquist J et.al., what is the most effective way to reduce incidence of amputation in the diabetic foot? Diabetes metob res rev 2000; 16 (supl 1); s75-83.
Price JF et al. Relationship between smoking and cardiovascular risk factors in the development of peripheral arterial disease and coronary artery disease; Edinburgh artery study. Eur. Heart- J 1999; 20 : 344-53.
Beks PJ etal peripheral arterial disease in relation to glycaemic level in an elderly Caucasian population: the hoorn study. Diabetologia 1995; 38: 86-96.
Seki J, Ohashi M, Sato T, Yamamoto M, Fujii S, Wada M. Peripheral vascular disease in Japanese diabetics: screening by the Doppler ultrasonic technique. Tohoku J Exp Med. 1983; 141 Suppl:499-506.
Agarwal AK, Singh M, Arya V, Garg U, Singh VP, Jain V. Prevalence of peripheral arterial disease in type 2 diabetes mellitus and its correlation with coronary artery disease and its risk factors. J Assoc Physicians India. 2012; 60:28-32.
Mohan V, Premalatha G, Sastry NG. Peripheral vascular disease in non-insulin-dependent diabetes mellitus in south India. Diabetes Res Clin Pract. 1995; 27(3):235-40.
Meijer WT et al, peripheral arterial disease in the elderly: the Rotterdam study. Arterio sclera thromb vasc biol. 1998; 18; 185-192.
Violi F, Atherosclerosis. 1996 Feb;120(1-2):25-35
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241Vol 09 issue 10 current issue EnglishN2017May27TechnologyEnergy Efficient Greedy Algorithm for Wireless Mesh Networks
English5357Veenu MorEnglish Harish KumarEnglishAim: Wireless Mesh Networks (WMN’s) are gaining recognition among users. But WMN resources are not always utilized up to their full capacity. Redundant links and nodes can be turned in low power state for energy savings. WMN’s build on IEEE 802.11s, supports link based power saving mode (PSM). But IEEE 802.11s standard does not specify switching among PSM. This research work provides a greedy approximation algorithm to allow redundant nodes and links in low power state to achieve minimum energy consumption.
Methodology: Proposed algorithm is based on traffic consolidation over few nodes, subject to available link slots due to wireless interference. This will permit redundant nodes in deep sleep mode.
Results: Analysis reveals that choosing power saving mode carefully of peer links can achieve great energy efficiency.
Conclusion: Results signifies that energy saving comes with cost of delay. So traffic consolidation based approaches are more suitable for delay tolerant networks.
EnglishEnergy Efficient, Wireless Mesh Network, Power Saving Mode, Greedy Approach, Traffic ConsolidationINTRODUCTION
With increasing usage to digital devices and need of access toInternet from anywhere, Wireless Mesh Networks (WMN’s) are gaining popularity among community. WMN can be designed based on various wireless standards like IEEE 802.11a/b/g/s IEEE 802.16, IEEE 802.15 etc. IEEE 802.11s is specially designed to support features of WMN. Unlike previous standard of IEEE 802.11, IEEE 802.11s supports link based power saving mode (PSM) namely light sleep mode, deep sleep mode, and active mode. PSM of link of a node can be chosen independent of PSM value of other links. But standard itself does not specify PSM switch criteria. In order to save network energy a feasible approach is desired so that redundant resources can be switched in low power state. To identify and allow redundant nodes in low power state, by solving mathematical problem as mixed linear programming problem [1-2] can be computationally expensive and practically not feasible. A greedy algorithm as an approximation to optimized solution can be a valuable approach. The energy aware greedy routing algorithm based on resource consolidation, subject to available link slots due to wireless interference has been proposed. Traffic consolidation is an approach where traffic of several underutilized nodes is consolidated to few active nodes. Algorithm will allow many nodes i in doze state so that system capacity could be utilized efficiently. The performance of the proposed algorithm has been evaluated and analyzed. The remaining of text is structured as follows. Section II presents related area of work, Section III presents greedy algorithm to achieve PSM for links to let maximum nodes in deep sleep mode. Section IV gives results and Section V provides the discussion. Finally, concluding remarks are presented in section VI.
Related Works
Energy Efficient WMN is active area of studies, number of research work exist in literature. Ashraf [3] has proposed a heuristic based greedy algorithm for placement of gateway in WMN in energy efficient way. The known traffic demands are satisfied while minimizing the overall energy usage of the network. Yu et al. [4] have given energy-aware design of the network selection, sub channel, and power assignment in cellular and Wi-Fi networks. Researchers in [3-4] have focused on energy minimization by network designing. While authors in [5] reduces energy consumption by accessing information of medium access layer via control packet. In [6] authors have enhanced the network life time by shutting down the unnecessary nodes. The nodes to be shutdowns are identified based on threshold distance. A node can decide to shutdown itself if its distance to neighbor node is within threshold distance. Performance of network highly depends on selected value for threshold distance. Ismail et al. [7] have given cooperation based approach so that networks with overlapping coverage may cooperate to let others switch off. But traffic consolidation subject to link availability has not been given due considerations. Keeping in view of growing interest in energy efficient WMN this research work focuses at providing greedy algorithm to consolidate the determined traffic over few nodes in energy efficient way subject to link slot availability
Research Methodology
A greedy algorithm has been proposed for network having nodes with sufficient power supply. Here objective is to reduce energy consumption of overall network
Energy_Aware_Resource_Consolidation (Algorithm 1) consolidates the traffic over minimum number of nodes in energy efficient way, to allow maximum number of links and nodes in energy saving mode. Load is redistributed by cooperation among neighbor nodes to let maximum link and nodes in low power state. Under law of wireless interference, algorithm firstly computes shortest path in term of energy towards gateway nodes using Minimum_Energy_Route (Algorithm 2). Active degree of any nodes is computed based on incoming {1i, j } /outgoing links {1j, i}, which in turn is given by number of 1 in corresponding column on ALs*1. Redundant nodes identified using step 2 and 3 are set in doze state and their associated links in deep sleep mode. A list of nodes in increasing order of load is computed. For traffic consolidation, least loaded node is picked for adjustment of their traffic over existing active nodes. Based on greedy assumption that re-adjustment of lower loaded nodes will be more feasible and beneficial in terms of energy. If load can’t be adjusted then traffic of next least loaded node in list is readjusted and so on till we reach at end of list. If all traffic of such node can be rerouted successfully then least loaded node is set to doze state and their associated links in deep sleep mode. Then updated list of nodes is sorted in increasing order of load. Minimum_Energy_Route (Algorithm 2) finds best available route with minimum energy consumption based on available slots as per law of wireless interface under single channel. Algorithms 3 address feasibility of traffic on a link to be routed.
RESULTS
Algorithm has been implemented in C++. Multiple runs reveal that algorithm is energy efficient. 30 slots per frame have been assumed for simulation. Let energy used in transmitting a packet is 3.1 mJ, energy used in receiving a packet is 0.2 mJ, and energy consumption of an MR is 15W. Considering network topology given in figure 1 and 2. Let network have single channel to operate. As per law of wireless interference network will be highly congested if traffic at all MAP’s exceed 10 packets. Results for random and grid topology are given in Table 1 and Table 2.
DISCUSSION
By reducing redundant peer links energy saving can be enhanced in 802.11s. Analysis reveals that choosing PSM carefully of peer links can achieve great energy efficiency. As solving the optimization problem can be computationally expensive. So, greedy based approach can be very effective. During low traffic period more resources are underutilized, so algorithm can let more links and nodes in deep sleep mode. But when traffic is close to peek level, resources are utilized up to their maximum capacity and percentage of energy saving reduces.
CONCLUSION
This work represents importance of wireless mesh network in today network. PSM of IEEE 802.11s can achieve great energy saving. According to IEEE 802.11s standard a mesh node may choose to enter in doze state (in doze state a mesh node may switch off the transceivers) for power saving only if the mesh STA operates in light sleep mode or deep sleep mode for all of its mesh peering. A greedy algorithm has been proposed to minimize energy consumption. Results reveal that algorithm is effective in reducing energy consumption of network, but comes with cost of increase in traffic delay. So traffic consolidation approaches are more suitable for delay tolerant network.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Source of Funding: Nil Conflict of Interest: Nil
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