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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17General SciencesIN VITRO ANTIBIOTIC SUSCEPTIBILITY OF GRAM POSITIVE ROD ISOLATED FROM SOIL IN THE VICINITY OF A DUMPING SITE
English0111Anirban MullickEnglish Arunima SealEnglish Sreejata BandopadhyayEnglish Durba MukherjeeEnglish Mithun DasEnglish Arup Kumar MitraEnglishAim: Antibiotics resistance of soil borne pathogens is a real problem for medical practitioners of India. In this investigation we have isolated a bacterium from the soil containing various types of dumps and observed its antibiotic susceptibility. Materials and Methods: The isolate found from the serial dilution of soil sample was named as Sample H and was taken for staining, antibiotic susceptibility test and 16S rDNA characterization. Results and Discussion: Gram staining showed it to be Gram positive rods and 16S rDNA characterization showed it to be Bacillus cereus strain KD125. The Phylogenetic analyses showed the Sample H similar to Bacillus anthracis strain APT25 (GenBank Accession Number: KC519402.1). The antibiotic sensitivity test showed that this Sample H is sensitive to Linezolid (LZ) and Ciprofloxacin (RC) and resistant to Cefixime (CF). It was also seen that combinations Linolenic acid (LI) increases the antibacterial activity of LZ. Whereas, Doxycycline (DOC) decreased the zone of inhibitions of Ampicillin (AMP) and Tinidazole (TI) did not show any change in antibacterial activity of RC. It was also seen that antacid Digene (DIG) slightly increased the affectivity of RC but decreased the antibacterial activity of LZ, whereas Pantoprazole (PAN) increased the antibacterial activity of RC and LZ. Thus, it was found that Sample H was maximum sensitive to the combination of LZ+ PAN followed by LZ+ LI and was resistant to all combinations of CF. Conclusion: Thus, sensitive antibiotics, effective combination of antibiotics or antacids obtain from this assay can help to treat this food poisoning causingpathogen Bacillus cereus efficiently.
EnglishAntacids, Antibiotics, Combination, rDNA, Soil.http://ijcrr.com/abstract.php?article_id=1250http://ijcrr.com/article_html.php?did=1250Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17General SciencesGROUND LEVEL OZONE CONCENTRATION PREDICTED BY DECOMPOSITION ANALYSIS
English1218Sachithananthem C.P. English Samuel Selvaraj R. English K.ThamizharasanEnglishAnalysis of the ground level ozone concentration is vital for the purpose of forecasting and in identifying the changes and impacts that are very crucial for an agro-based economy like the capital city of Tamil Nadu. Six months data of Ground level Ozone concentration of south Chennai is used to determine the decomposition method. The objective of this study is to analyse the behaviour of Ground level ozone concentration of metropolitan city of Tamil Nadu using decomposition method. The Decomposition techniques are used to identify salient features of a time series such as trend seasonality and cyclical patterns. The weekly behaviour of ground level ozone concentration in south Chennai is tabulated.
EnglishDecomposition method, Ground level ozone Concentrationhttp://ijcrr.com/abstract.php?article_id=1251http://ijcrr.com/article_html.php?did=1251Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareCORRELATION BETWEEN REFRACTIVE ERROR AND EYE MOVEMENT PATTERNS DURING READING
English1924Noor-Suhailly SaimanEnglish Ai-Hong ChenEnglishPurpose: The purpose of this study was to investigate the correlation between refractive error and eye movement patterns. Methods: Fifty young adults aged between 19 and 27 years were recruited. The refractive errors ranged between +0.50D and -6.0D (mean = -1.77D, standard deviation = ± 1.97). Subjects were required to read the 200-word text at 40 cm on a reading stand while the eye movement was recorded using video oculography (VOG). Results: There was no association between refractive error and total count of saccades during reading (Spearman correlation coefficient, r = -0.2, p > 0.05). There was anegligible correlation between refractive error and total count of fixations during reading (Spearman correlation coefficient, r = -0.3, p = 0.051).However, a moderate negative correlation was found (Spearman correlation coefficient, r = -0.5, pEnglishRefractive error, eye movement patterns, video oculographyINTRODUCTION
Reading involves corresponding visual-motor system which also involves the combination of eye movements with the physiological process of memory, concentration and visual information employment (Garzia et al, 1990). Three common eye movements executed during reading are saccades, fixation and regression. Saccades is a short rapid, abrupt eye movement fixating from one point to another while obtaining fixation on an object which normally took nearly 10% of reading time, with average saccade was about eight to nine character spaces (2-degree visual angle). The peak velocity of 10° amplitude saccades could exceed 300°/s and be accomplished in 40ms (Millodot, 2007; Rowe, 2003; Rayner, 1998; Tinker, 1947). Fixation referred to a number of eye stopped or paused during reading for information processing (Ciuffreda et al, 1995). Regressions were saccades that were directed from right to left, occurred when eyes overshot the target, misapprehend the text and reflexed on comprehension problems for reconfirmation during reading (Rowe, 2003). Reading eye movements were connected to visual–spatial shifts in attention and children with visualperceptual-motor delays were in peril of for reading underachievement especially among hyperopes (Rosner, 1982; 1987). Approximately 90% of reading time was on fixation in which during each fixation foveal information was processed (Solan, 1985). Visual sensitivity was recovered partially at the instigation of fixation and wholly after 70 ms, subsequently at the beginning of fixation (Isheda and Ikeda,1989).Visual information did not derived from fixation but incorporatedspatially and temporally by the movement of saccades in order to form visual perception (Schutz et al, 2011). For the direct connection between the degree of refractive error and fixation during reading, McConkie and Zola (1979) theorized that although rapid decreased visual acuity from the central fovea might affect fixation at the center of wordsbut the influence of refractive error on fixation during reading remained unclear. There was no mention of how was the regression during reading being affected by refractive error as regression represented 14% of saccades among adult and 25% among children (Starrand Rayner, 2001). Understanding the mechanism of the eye movements and the ability to sustain focus while reading is important, therefore the relationship between reading eye movement and refractive error needs to be established. Most common ways ofeye movement assessment in optometric practice includedsubjective observation of the smoothness and precisionof fixation ability, saccadic eye movement and pursuit eye movement. Visagraph III Eye movement recording system (Taylor Associate,NY) and Developmental Eye movement Test (DEM) were used as alternatives of eye movement assessment.The correlation between refractive error and eye movement during reading was investigated using Video-oculography (VOG) techniques in this study, which was introduced as one of the precise techniques to monitor the eye movement (Van der Geest and Frens, 2002). The instrument did not only record eye movement and reading duration precisely, but was also capable of tracking the center of pupil and the location of the eye which enabled the clinician to visualize linear and torsional eye movement while theeye moved (Gans, 2001).
MATERIALS AND METHODS
Fifty young adults (17 male and 33 female) ranged between 19 and 32 years were recruited. Spherical equivalent refractive error of subjects ranged from +0.50 to -6.0 D with astigmatism less than -1.00D. Subjects were fitted with spherical soft contact lenses (O2Optix Contact Lenses, Iotrafilcon B, 33% water content, Ciba Vision, USA) to permit best on-axis distance vision. Exclusion criteria included any ocular disease or binocular anomalies. The study was reviewed and approved by the Universiti Teknologi MARA research ethics committee. Eye movements were recorded using Video oculography or VOG (Sensomotoric Instrument version 5, Berlin, Germany) binocularly through the use of digital video camera which mounted on the goggles for tracking the center of pupil and the location of the eye (Gans, 2001; Van Der Geest and Frens, 2002). For safety and comfortable precaution, the VOG goggle was carefully adjusted. The eye position was adjusted based on iris image and the reference point was identified by capturing the eye image. The head position angle was set up based on habitual head postures. Calibration was made by using 9 reference points at 40cm working distance. Before any measurement was taken, screening as a base line was performed to ensure that all subjects could clearly see at least N6 [2 times smaller than the actual size of the character used (N8)]. Eye movement data was presented in graphic output, similar to the characteristic of eye movement presented by Eye Trac recording (Taylor, 2000). Thetotal numbers of saccades, fixations and regressions were calculated. The text used in the experiment was justified in upper case, black-to-white contrast and using Times Roman font style of N8 character size on A4 white paper (210 x 297 mm) covered 20’ of arc at 40cm. The text selected using the readability Malay language was based on local Malay newspaper consist of 200 words of 16 sentences in single paragraph with each sentence was ranged between 11 to 14 words (Khadijah Rohani, 1989). The subjects were instructed to read silently the text at 40 cm on reading stand while using VOG goggle in a good room illumination reading station which was constantly rechecked in each session.The eye movement recording was from first word until the last word. To avoid non-compliance, subjects were given oral comprehension test after assessment. None have failed during oral comprehension test, thus all data was successfully explored for statistical interpretation.Only data derived from right eyes were used during this experiment. The total number of saccades, fixation and regression during each session were statistically analyzed using SPSS 19.0 (SPSS Inc., Chicago, IL, USA). The overall refractive error was arranged in the manner of highest minus power to the most plus power in diopter (D) according to their spherical equivalent refraction (SER). Non- parametric statistical tests were employed (Shapiro Wilk:p < 0.05). Wilcoxon signed rank test was additionally used to investigate any changes of each reading eye movement among refractive error. Spearman correlation coefficient and linear regression were executed to find any relationship between each reading eye movement and refractive error. The differences in result obtained with p0.05). Linear regression analysis demonstrated insignificant relationship between refractive error and the total count of saccadesduring reading(F1, 48 = 0.479, p>0.05). There was a negligible correlation between refractive error and the total count of fixation (mean = 141.3 ± 35.9)during reading (Spearman correlation coefficient, r = -0.3, p > 0.05). Linearregression analysis showed no significant relationship between total count of fixation and refractive error (F1,48 = 1.16, p > 0.05). However, a moderate negative correlation was found between refractive error and the total count of regressions (mean = 43.4 ± 12.2)during reading(Spearman correlation coefficient, r = - 0.5, pEnglishhttp://ijcrr.com/abstract.php?article_id=1252http://ijcrr.com/article_html.php?did=12521. Alexander C. Schütz, Doris I. Braun and Karl R. Gegenfurtner(2011) Eye movements and perception: A selective review.Journal of Vision, vol. 11 no. 5 article 9 doi: 10.1167/11.5.9
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareROLE OF LIP PRINT IN PERSONAL IDENTIFICATION
English2528Neeraj GuptaEnglish Prerna GuptaEnglish D.I. IngaleEnglish Chandrashekhar BhuyyarEnglish U.C. NuchhiEnglish S. R. HibareEnglishThe lip prints are the normal lines and fissures in the zone of transition of human lip between mucosa and the skin. They are identifiable as early as the sixth week of intrauterine life. They are permanent, unchangeable even after death, and unique to each person except in monozygotic twins. The analysis of fingerprints and bite marks are used to establish identity of an individual in the court of law same way lip print has also been considered to establish the identity of an individual especially in sexual assault cases. The present study is being carried out to identify different types of lip prints, their relation with gender and to see their uniqueness. Lip prints were obtained from 1st year medical students in the age group between 18 – 25 years. The lip prints were taken by applying lipstick and prints taken on bond paper. Prints were studied with the help of a magnifying lens by applying Suzuki’s classification. The result and its implication will be discussed in the presentation.
Englishlip prints, personal identification, Suzuki’s classification.INTRODUCTION
The lip prints are the normal lines and fissures in the zone of transition of human lip between mucosa and the skin.1,2They are permanent, unchangeable even after death, and unique to each person except in monozygotic twins.1-9 The analysis of fingerprints and bite marks are used to establish identity of an individual in the court of law same way lip print has also been considered to establish the identity of an individual especially in sexual assault cases. Objectives of study: To identify different patterns of lip print and their relation with gender.To check the uniqueness of lip print. Source of data: The subjects under study will be 1 st year medical students between age 18-20 yrs of BLDE University’s Shri B.M. Patil Medical College, hospital and research centre, Bijapur. Method of data collection: The study was conducted over a period of 2 months. 1st year medical students of Indian origin, belonging to age group of 18–20 years were taken as subjects.Written informed consent of the subjects were taken.Lipstick was applied on thelips of thesubject with a single stroke.Then with the help of a paper, the centre portion of lips was dabbed first and then left and right corners of lips pressed, applying uniform pressure, taking care to avoid sliding of lips to prevent smudging of the print.After the lip prints were acquired, details such as name, sex, age was documented. Each lip print was assigned a serial number. Each lip print was compared manually with others using a magnifying glass to test the uniqueness of lip prints.2-4 . Patterns of lip print were studied by applying Suzuki’s classification.10-11
INCLUSION CRITERIA
Both males and females between age group 18 - 20 years Subjects free from any ongoing or inert lesions on their lips.
EXCLUSION CRITERIA
Students with known hypersensitivity to lip sticks. Active or passive lip lesions and non-resident Indians. Student who did not give consent. Sample size 1. Male students = 60 2. Females students =68 3. Total sample size = 128 TYPE OF STUDY Prospective study of duration two months and data was analysed by using following statistical methods. Tabulated presentation. Mean +/ - Standard deviation.
Suzuki’s classification
1. Type I: Vertical, complete (end-to-end) longitudinal fissures. 2. Type I’ (one - dash): Incomplete vertical longitudinal fissures. 3. Type II: Branching, Y-shaped pattern. 4. Type III: Criss-cross pattern. 5. Type IV: Reticular, typical chequered pattern,which are fence like
DISCUSSION
It was observed that Type I was the most frequently observed in both the sexes. Other works on Indian subjects have yielded varying results. Vahanwalla and Parekh in their study in Mumbai found that Type I was the most frequent.4 Sivapathasundharam, Prakash and Sivakumar studied the lip prints of Indo-Dravidian population and noted that Type III was predominant. 2 PrateekRastogi in his study among medical students found that the incidence of Type I was the highest among males which is similar to our finding. 12 Cheiloscopy is a relatively new method available to the forensic experts for identification purpose.
UNIQUENESS OF LIP PRINTS
Lip prints are unique to individuals and remain unchanged throughout life. Identifiable lip prints can be reproduced up to one month after being produced. ? Lipstick smears are commonly encountered in forensic science laboratories as an important means of evidence. ? Smears can also be found in other places, such as glasses, cups, spoons or cigarette butts, therefore indicating some kind of relationship between a suspect and the crime scene. 13 ? Cheiloscopy is still an inexact science and more studies need to be done to confirm its validity. Limitations of Cheiloscopy The lip print is produced by a substantially mobile portion of the lip. This fact itself explains the reason for the same individual producing different lip prints, according to the pressureor the method used for taking the print. Amount of lipstick can also affect the print. Smudging of lip prints is one of the major limitations of using lip sticks. Manual register of the overlay is another problem, due to the possibility of some subjectivity Another factor to be considered is the existence of some pathological conditions (lymphangiomas, congenital lip fistula, lip sclerodermi, Merkelson– Rosenthal syndrome, syphilis, lip cheilitis,among others), which can invalidate the cheiloscopic study.14
CONCLUSION
From the results of present study it can be shown that lip print is unique for each individual and it show gender wise predilection. Thus Cheiloscopy can be mean for identification of individual.
ACKNOWLEDGEMENT
Authors acknowledge the great 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. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1253http://ijcrr.com/article_html.php?did=12531. Caldas IM, Magalhaes T, Afonso A. Establishing identity using cheiloscopy and palatoscopy. Forensic Sci Int. 2007;167:1-9.
2. Sivapathasundharam B, Prakash PA, Sivakumar G. Lip Prints (Cheiloscopy). Indian J Dent Res. 2001; 12(4):234-37.
3. Tsuchihashi Y. Studies on Personal Identification by Means of Lip Prints. Forensic Sci. 1974; 3: 233-48
4. Vahanwalla SP, Parekh BK. Study on Lip Prints as an Aid to Forensic Methodology. J Forensic Med and Toxicol. 2000; 17(1): 12- 18.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareA STUDY OF VARIATIONS IN THE SHORT SAPHENOUS VENOUS SYSTEM WITH CLINICAL CORRELATION
English2936Anupama D.English Nagaraj D.N.English B.S. SureshEnglish R. Lakshmi Prabha SubhashEnglishThe common liability of the superficial venous system of the lower extremity to varicoses has naturally attracted the attention of Anatomists and Surgeons. Variations in the superficial veins of the lower limb are very common. The extent of such variations, their connections to either the Long or Short saphenous venous systems are usually described. Generally the clinical assessment, including tourniquet tests and Doppler ultrasound, of primary varicose veins presents no problem. However, in some patients the information so obtained is inadequate for appropriate management and difficulties arise because of abnormal communication between the Long and short saphenous veins. Sometimes the main trunks alone are affected and in others only the tributaries are anomalous. In few cases both are involved. In extensive varicose veins, because of overlap of the long and short saphenous territories, it can be difficult to assess which system is involved or whether both are affected. Detailed knowledge regarding the anatomical variations such as reduplication of the long saphenous vein and unusual termination of the short saphenous vein is a prerequisite in the diagnosis and management of varicose veins. Usually the short saphenous vein terminates in the popliteal fossa a few cms above the knee joint, but in almost one half of patients it terminates at a higher or lower level. In this study short saphenous vein terminated at unusual sites is described. Although attention has been mainly directed to the great saphenous vein for the elucidation of the causation of the varicose condition, the study of the small saphenous vein, which phylogenetically is the more important vein, throws light upon the problem.Interestingly variations seen in this study should be kept in mind due to its clinical and surgical significance.
EnglishShort Saphenous vein, Long saphenous vein, Popliteal vein, Anomalous, Varicoses.INTRODUCTION
The short(small or lesser ) saphenous vein begins posterior to the lateral malleolus as a continuation of lateral marginal vein. In the lower third of the calf, it ascends lateral to the tendo calcaneus, lying on the deep fascia and covered only by superficial fascia and skin. Inclining medially to the midline of the calf, it penetrates into the deep fascia within which it ascends on gastrocnemius, only emerging between it and the deep fascia gradually at about the junction of intermediate and proximal thirds of the calf. Then it ascends between the two heads of gastrocnemius and proceeds to terminate into popliteal vein. Its mode of termination is variable. Mercier's classification describes six types of terminations: 1: The saphenopopliteal junction is situated 2 to 15 cm above the popliteal crease; this situation is observed in half of all cases; 2: The saphenopopliteal junction is also situated 2 to 15 cm above the popliteal crease, but is prolonged by a trunk which anastomoses with the long saphenous vein; 3: The so-called high saphenopopliteal junction terminates on the posterior aspect of the thigh, in the femoral vein, which communicates with the long saphenous vein; 4: The saphenopopliteal junction does not exist and the short saphenous vein terminates exclusively in the long saphenous vein; 5: The high saphenopopliteal junction terminates on the posterior aspect of the thigh,in the femoral vein; 6: The saphenopopliteal junction is complex, with a number of intramuscular anastomoses. It is important for the surgeons operating the varicose veins to be aware of these unusual modes of termination of short saphenous vein, to allow the surgeon for complete flush ligation of the same failing which recurrence is common.
MATERIALS AND METHODS
50 embalmed lower limb specimens were thoroughly cleaned, carefully dissected and studied in detail. Photographs of the same were taken.
OBSERVATIONS AND RESULTS
Sapheno politeal junction (Type1) was the most common type of termination as shown in fig 1. The next common mode of termination was high Sapheno popliteal junction (Type 5) which opened in to femoral vein on the posterior aspect of thigh as shown in fig.2. Sapheno popliteal junction with trunk extending to anastomose with long saphenous vein (Type 2) was the third commonest mode of termination as shown in fig. 3. High long saphenous termination only (Type 4) was seen in one of the limbs as in fig.4. Type 3 termination was seen in one case, where in one branch of the small saphenous vein formed an arch which entered the popliteal vein on an average of 4-5 cm. above the knee-joint, just below the middle of the popliteal space. The terminal part of the arch received the small superficial posterior vein of the thigh (v. cut. fem. post. of Meyer, v. femoro-poplitea of Hyrtl). This vein began in the junction of upper and middle third of the thigh, and ran under the deep fascia on the medial side of the sciatic nerve fig.5. In addition, this vein communicated with the deep posterior muscular veins of the thigh. The other branch of short saphenous vein ran round the medial side of the middle of the thigh towards the great saphenous vein. In one of the limbs, it opened directly into the great saphenous vein, just before its termination. In one limb it terminated in posterior tibial vein below the kneejoint fig6. (Type6) In one case, a small cutaneous veins found running down from the popliteal space to join the long saphenous vein which may be regarded as the usual upward continuation of the main trunk. In another case, it trifurcated in the popliteal fossa, one branch opening in to popliteal vein, second joining the posterior deep femoral vein and the third joining the great saphenous vein just above the knee. In two cases, it terminated by forming a common trunk with gastrocnemius veins which further opened in to popliteal vein fig.7and in another it opened in to posterior tibial vein.(Type6)
DISCUSSION
ONTOGENY:
EmbryologIcally the small saphenous vein represents the post-axial vein of the hind limb bud; it is the first vein to appear and originally opens into the internal iliac through the sciatic and gluteal veins. The subsequent transformation into a short vein opening into the popliteal vein, may be an adaptation to the elongation and relative rigidity of the hind limb. This abbreviation of the post-axial vein of the lower extremity is the main difference in the venous system of the fore and hind limbs. Comparative anatomy seems to indicate that the termination of the small saphenous vein into the popliteal vein is an adaptation peculiar to higher mammals including man. In this the small saphenous vein ends exclusively in the popliteal vein.
CLINICAL IMPLICATIONS
Several anatomical studies have described various types of Short saphenous vein termination among which the study of Giacomini stands out. Varicose veins are one of the commonest disease of veins of the lower limb. It affects more than 5% of the adult population in the western countries. More than ½ of adult men and 2/3 of adult women have physically identifiable varicosities. Varicose veins range in severity from the undesirable appearance of venectasia to protuberant tortuous varicosities with or without associated dermatitis, cutaneous ulceration or severe pigmentation. The cause for varicose veins is said to be multifactorial. It is also linked to FOXC2 gene. As a result of anatomical study of the distribution of varicose veins with the aid of investigations, the treatment is usually decided. The present understanding of the anatomy of the area is to allow the selection of treatment on the basis of the probable cause. The particular anatomical and hemodynamic characteristics of veins of the popliteal fossa responsible for a number of therapeutic difficulties which is related to the confluence of popliteal and saphenous collecting vessels and muscle draining veins. The hemodynamic difficulties are to the fact that the popliteal fossa which is the site of very intense pressure variations. As one of the causes for the varicoses is possible variations in the anatomical course of small saphenous vein and its anastomotic channels, it is very important to alienate the varicosity to either short saphenous or long saphenous venous systems. Usually varicoses in the back of the leg with a palpable dialated small saphenous trunk is suggestive of the incompetence of small saphenous vein. Some varicose veins join both the systems where it becomes confusing to define the mode and extent of surgical management. There is some evidence to say that a more accurate surgical approach reduces the incidence of recurrence of varicose vein which is the most common complication. Unless flush ligation is performed, recurrence is likely. Abnormally distributed varices or a suspiscion of lesser saphenous incompetence requires further assement as the termination of the lesser saphenous vein is very variable.8,9 The principles on which the surgical treatment is based, are to ligate the point of communication, the saphenofemoral and /or saphenopopliteal junctions and to remove the major part of the incompetent trunk to prevent connections to the tributaries. The tributaries are then individually removed by making minor cut downs and avulsions. Preoperative ultrasound localization of the junction should ideally be carried. A transverse skin incision is made in the popliteal fossa just below the termination of the vein. The deep fascia is then split to identify vein till sapheno popliteal junction before it is divided. Tributaries may enter the vein just before its termination. After the vein has been divided, careful stripping of the vein is done from above downwards with dissecting off the sural nerve to ensure that the whole of the small saphenous vein is removed. This obliterates the junction with the midcalf perforator vein which is responsible for many recurrences. Recurrent venous reflux in the popliteal fossa with recurrent varicose veins following short saphenous surgery has been reported frequently. 5,6.7. Incompetence of the short saphenous vein was found to be the main source. Recurrent Short saphenous vein varicosity or persistence may be of 4 types Type 1- Intact Sapheno Popliteal Junction as well as Short saphenous vein. Type 2- Varicosities in the popliteal fossa communicating with Short saphenous vein stump. Type 3- Residual Short saphenous vein communicating with the popliteal vein via a tortuous vein. Type 4-Non communicating residual Short saphenous vein. 10 The relation of the arch of the small saphenous vein to the tibial nerve may be important since it explains the obstinate pain in the leg when the veins become varicose, as it is always intimately connected with it. Motor nerve injury (tibial nerve) should not occur if the affected area is carefully displayed during surgical procedures.3 Damage to the other veins and arteries in the vicinity is also avoidable with detailed anatomical knowledge of the region and also helps to prevent recurrence.11 Compartment syndrome is an infrequent but serious complication which can occur post operatively following short saphenous vein surgery where in raised pressure within a tight compartment results in a combination of sensory andmotor symptoms with vascular compromise.12
Englishhttp://ijcrr.com/abstract.php?article_id=1254http://ijcrr.com/article_html.php?did=12541. Veins of the lower limbs in Cardio vascular system.In: Susan Standring, Gray’s anatomy. 37th ed, Edinburgh:Churchill Livingstone; p15
2. Hollinsheds surgical anatomy, 4th ed, ch 5, Lower limb as a whole, p 345 .
3. Observations on the superficial venous system of the lower extremity by Charles Kosinski.p131-142.
4. F.P. Keeling andM. Lea Thomas.1987, The British Journal of Radiology,60.235-240.
5. Bailey and Love’s Short practice of surgery.25th ed. Venous disorders. Kevin Burnand. ch54, p9 27-932.
6. Farquharson’s text book of operative surgery.R.F.Rintoul.8th ed, 2002. Churchill Livingstone, p57-63.
7. Carol.E.H, Scott Conner in Operative Anatomy.3rd ed Lippincott Williams.p745
8. Wesley .S. Moore, Vascular surgery- a comprehensive review.6th ed. Ch. 42,Chronic venous insufficiency. Niren angle andJohn.T.Bergan, p826-833.
9. Philippe Blanchemaison, Jerome Camponovo, Short Saphenous TerritoryAnatomy of recurrences following SPJunction ligation- Ectatic gastrocnemius veins.p1-3.
10. Tong Y, Royle J. Recurrent varicose veins after short saphenous vein surgery: a duplex ultra sound study.Cardio vascular surg 1996 Jun;4(3):364-7.
11. S-Y Kim, E-A Park, Y-C Shin Preoperative determination of anatomic variations of the small saphenous vein for varicose vein surgery by 3 dimensional tomography venography.Phlebology28.October 2011 at rsmjournals.com
12. Yousef Shahin,Niteen Tapuria andPeter Lee Chong.Compartment syndrome following short saphenous varicose vein surgery:a case report.Cases Journal 2009;2:7118.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN-0001November30HealthcareHAEMATOLOGICAL STATUS AND ANAEMIA PREVALENCE AMONG CHILDREN AGED 5 TO 11 YEARS IN SCHOOL CANTEENS IN ABIDJAN (CÔTE D'IVOIRE)
English3750Baudouin A. KokoreEnglish Mathieu N. BleyereEnglish Dinard KouassiEnglish Paul A. YapoEnglishLeandre K. KouakouEnglishIn Côte d’Ivoire, as in most developing countries, anaemia is a public health problem. The country possesses 5259 canteens in more than 8000 primary schools. Children attending schools with canteens are they concerned with public health problem that is anaemia? Their haematological profile conforms to the standards set by international organizations? To answer these questions, a study was conducted and aimed to determine the prevalence of anaemia in a school population and to study the typology. The work has focused initially on 350 subjects and 310 children (172 girls and 138 boys) aged 5 to 11 years were selected from three municipilities of Abidjan. Blood samples were taken from each child in order to search for the parameters of the blood count and the electrophoretic profile of hemoglobin. The results of study revealed that 82.9 % of children have indicated abnormal haematological status. The prevalence of anaemia (hemoglobin < 11.5 g/dl) was 30.3 % with 33.3 % of males and 29.1 % for girls. Moreover, the mean values parameters of the blood count were compared in accordance with standards established by international organizations. In addition, haemoglobinopathies was found in these children (16.1 %), including sickle cell trait and hemoglobin C traitThe prevalence of anemia among school children selected in Abidjan is more considerable. This could be explained by a deficiency of micronutrients. In view of the results obtained, it is important to extend the work to all school canteens in order to assess the factors of anaemia and to determine normal values parameters of the blood count of children in such environment.
EnglishAnaemia, Typology, Norms of Blood Cells Count, Children, School Canteens/Abidjan (Côte d’Ivoire)INTRODUCTION In Côte d’Ivoire for several years, children benefit from meals at schools like some nations in the world. The number of school canteens to 5259, is for these children a strong opportunity which should guarantee good nutrition in over 8000 primary schools in the country. To this end, school canteens should resolve the concerns of nutritional deficiency and overload. Nutritional deficiencies and overloads represent in school children a real concern for public health (ElHioui et al., 2008a). They may lead to anaemia and obesity (Kuyumcu et al., 2007; Handa et al., 2008; Mohamed, 2008; Ramzan et al., 2009; Mirhosseini et al., 2011). Anaemia is the most common health problem in the world (Maitland et al., 2005; Al-Assaf, 2007). It is the greatest common nutritional disorder worldwide and particularly in Africa, where pregnant women, infants and young children are most affected (Dillon, 2000; Gur et al., 2005; Hazarika et al., 2012; Chhabra et al., 2012). The prevalence of anaemia in the world is 24.8 % (WHO, 2008). The preschool children are most affected with a prevalence of 47.4 %, followed by pregnant women (41.8 %), non pregnant women (30.2 %) and school age children (25.4 %). In each age group and sex studied, the highest prevalence is found in Africa (McLean et al., 2006). Anaemia has multiple consequences which can be extremely severe (Goudarzi et al., 2008; WHO, 2008; Ahmadi et al., 2010). This is the disturbance of physical and mental development often irreversible in infants and children, of least resistance to infections, tiredness and decreased physical and intellectual abilities (Colomer et al., 1990; Scholl and Hediger, 1994; Sakande et al., 2004; Unsal et al., 2007; Hadipour et al., 2010). Despite the multiple consequences of this disease, few investigations are conducted at schools in Côte d'Ivoire. The aim of this study was to determine the prevalence of anaemia and its typology in a population of children aged 5 to 11 years in three municipalities of Abidjan. The study has also conducted the possible changes in the complete blood count of these children in schools. Studies have equally indicated the sex was most exposed to anaemia. In addition, the investigations have proposed standards for parameters blood cell counts among this fringe of school children. Moreover, the investigations have evenly presented hemoglobin profile of these children. MATERIALS AND METHODS Setting and study population In total of 350 school children were selected to achieve a definitive size of 310 pupils including 172 girls and 138 boys (Figure 1). The mean age of the study population was 7.7 ± 0.1 years and ranged from 5 to 11 years (Table 1). The investigation was a cross sectional and descriptive study in school children living in three municipalities in Abidjan. This study occurred at the school group "Libanais Yopougon Ananeraie", primary school "BAD Cocody Belle Côte" and the School Group "Agbékoi Abobo" (Figure 1). This work was carried out during a period from September 2010 to December 2012. The collection of anthropometric data of this study was done from a questionnaire sent to children with free and informed consent of parents, following an explanation of the interest of the study. For the requirements of handling, criteria for inclusion and exclusion have been applied for subject selection. It comes to mainly haematological and gastrointestinal complications and inflammation in the three months preceding the study. All these observations were carried out by a medical team from the National Institute of Public Health (INSP) in Abidjan (Côte d'Ivoire). Blood samples and determination of biological parameters Samples of venous blood from each child are taken into tubes containing an anticoagulant, ethyl diamine tetra acetic acid (EDTA) in the morning. The determination of haematological parameters was performed immediately after homogenization to Coulter, by an automatic analyzer “Sysmex KX 21N”. Moreover, in order to establish the standards parameters of the blood count, all anaemic children were excluded in the second phase of data processing. Criteria defined by the World Health Organization (WHO) were used to estimate different prevalences of the main haematological parameters. In addition, an electrophoretic profile of hemoglobin for each child was conducted from a volume of packed red blood cells at alkaline pH to cellulose acetate by“Helena”. Statistical analysis For statistical analysis, data were entered and analyzed by the STATISTICA software (Windows version 7.1). The mean values of different investigated parameters in school children were compared using the non parametric Mann Whitney U. The comparisons of different proportions of the main obtained biological parameters from the blood count and hemoglobin electrophoresis were performed by the test Loglikelihood ratio (Test "G") with the statistical software "R" version 2.0.1 Windows. p < 0.05 was considered as indicative of significance. RESULT Changes in haematological parameters The values were in accordance with the normal physiological reference values from the literature except for the rate of lymphocytes which is higher overall and by sex. All the parameters did not indicate significant differences between girls and boys (Table 2). In contrast, mean corpuscular volume and mean corpuscular hemoglobin have been statistically different by sex. These two haematological parameters were higher in girls compared to boys. All of 216 non anemic school children showed normal mean values compared with the standards established by international organizations (Table 3). However, the proportion of lymphocytes has been sufficiently high relative to the reference value. Furthermore, no significant differences were observed between girls and boys for all the parameters of the blood count. Conversely, a significant difference was shown at the mean corpuscular hemoglobin between the two sexes. In this context, girls reported a mean value of mean corpuscular hemoglobin more increased compared to boys. Prevalence, typology of anaemia and hemoglobin phenotype The results of the study showed that 82.9 % of school children reported that at least one parameter of the blood count, was abnormal (Table 4). The haematological status was the same for girls (82.6 %) than in boys (83.3 %) with no statistically significant difference between these two groups of children. The prevalence of anaemia was 30.3 % in total population. It was observed in 33.3 % of boys and 28.1 % of girls with no statistically significant difference. Among these anaemias, 57.5 % are hypochromic (18.1 % microcytic hypochromic anaemia and nornocytic hypochromic anaemia 39.4 %), 18.1 % are microcytic (microcytic hypochromic anaemia) and 4.3 % macrocytic (macrocytic normochromic anaemia). In addition, normocytic anaemia was observed in 77.7 % of children and normochromic anaemia in 42.6 %. Microcytic hypochromic anaemia in boys (25 %) was significantly higher compared to girls. Normocytic hypochromic anaemia and macrocytic normochromic anaemia were also more observed in boys than girls with no significant difference. However, normocytic normochromic anaemia was higher among girls than boys with a significant difference. Macrocytosis and microcytosis were indicated respectively in 5.2 % and 10.3 % of subjects with no significant difference between the two sexes. But hypochromia was observed in 35.5 % of children with a significant difference between girls and boys. The proportion of subjects whose hematocrit was below 36 % is 29.4 %. These rates do not change significantly by sex. The results of studies have also shown in Table 5 that 4.2 % and 0.7 % respectively of the children had leukopenia and leukocytosis. Similarly, high neutropenia, lymphocytosis, and thrombocytosis were reported respectively in 44.8 %, 88.7 % and 20 % of study subjects. In contrast, the total population of the investigations has reported normal levels of eosinophils, low proportions of lymphopenia (0.3 %), of monocytopenia (6.5 %) and thrombocytopenia (1.9 %). In the two groups of children, no significant differences were reported for all proportions of leukocyte and thrombocyte parameters. However, girls presented slightly higher proportions of leukocytosis, neutropenia, lymphocytosis and thrombocytosis compared to boys. In contrast, boys reported more or less elevated rates of leukopenia and monocytopenia compared to girls. Screening for hemoglobin disorders in school children revealed that 16.1 % of them are carriers of these anomalies (Figure 2). The most observed abnormalities were the sickle cell trait AS, hemoglobin C trait and sickle cell trait. The observed deficiencies have not significantly different between sex. DISCUSSION This study examined the extent of anaemia and its typology in a population of school children aged 5 to 11 years and attending school canteens in three municipalities of Abidjan. This work also helps to design appropriate monitoring in order to avoid the early onset of anaemia among school children. In this context, different mean values of haematological parameters are similar to physiological values reported in literature by standards of World Health Organization (WHO) except for lymphocytes. These different means are similar to those obtained in Saudi Arabia among children of school age (El-Hazmi and Warsy, 2001). According to these Saudis authors, no significant differences between girls and boys for all parameters of the blood count were observed. Mean value of hemoglobin obtained in this study is similar to that indicated in a rural population of school children of Vietnam (Le et al., 2007). Same results were also reported on a similar population of children with the same age group in Dublin (Ireland) (Taylor et al., 1997). From data available in accordance with the literature, anaemia is very common among school age children and these investigations confirm this. Prevalence of anaemia in this study population was 30.3 %. This rate is relatively lower than that obtained in Côte d’Ivoire in children with same age (46 %) (Asobayire et al., 2001). This decrease could be explained by the fact that study was extended to rural population with different demographic characteristics from those of these subjects. In addition, other studies reported higher prevalences of anaemia in school children (Gomber et al., 1998; Verma et al., 1998; Sudhagandhi et al., 2011). In the same vein, urban African Cameroon recorded a rate of anaemia (42.8 %) among children aged 5-10 years by considering the pathological rate of hemoglobin to 11g/dl (Mbanya et al., 2008). Conversely, the prevalence of anaemia in this study is higher than that specified elsewhere. Such is the case from work which indicated a lower rate of anaemia (12.2 %) in a population of children in Morocco, but no significant difference between girls and boys as in this study (El-Hioui et al., 2008b). This could be explained by the socioeconomic and cultural development of children in each study areas (UNICEF/WHO/UNU/MI, 1998; Singh and Sachan, 2011). Moreover, the presence of canteens in selected schools for needs of our study may reflect low observed prevalence in children. Mean values of MCV and MCH are statistically different by gender. These values are higher for girls than for boys. This result is contrary to that which revealed no significant difference between girls and boys (Rakoto et al., 2000). There is no severe anaemia in this study group. This result is similar to that carried out among school children in India (Sudhagandhi et al., 2011). The hypochromia and microcytosis in this population are higher in boys than in girls. This decrease in MCV and MCH might indicate a deficiency in micronutrients including iron and vitamins in this population (Ugwuja et al., 2007; Ramzan Ali and Salam, 2009). Anaemia has multifactorial causes (Veghari et al., 2007; Porniammongkol et al., 2011). The main reason for the onset of anaemia is of a food (Dillon, 2000). Food in populations of developing countries is deficient in micronutrients (Oguntona and Akinyele, 2002; Yapi et al., 2005a; Mohamed, 2008). The content and composition of meals in canteens could explain reduction in prevalence of anaemia in subjects of this study compared to work above mentioned (Zaidi et al., 1999; El-Hioui et al., 2008a; Mamat et al., 2012). All nutrients (macronutrients and micronutrients) that could include daily diet are the cause of decline in rate of hemoglobin in children of these investigations (Kuyumcu et al., 2007; Amuta and Houmsou, 2009; Kooshki et al., 2010). However, changes in leukocyte and thrombocyte parameters are modified compared to standards. Côte d’Ivoire is situated in an area with high malaria endemicity (Yapi et al., 2005a et b; Mfonkeu et al., 2008; Yapi et al., 2010). Furthermore, influence of malaria on anemia in populations is demonstrated (Umar et al., 2007). Infectious and inflammatory syndromes and haemoglobinopathies degrade haematological status of populations (Ahmed et al., 2006; Shehu et al., 2006; Singotamu et al., 2006; Odebunmi et al., 2007; Inocent et al., 2008; Pourfallah et al., 2011). In this same way, screening for haemoglobinopathies in children revealed that 16.1 % of children are carriers of these anomalies in this study. This is lower than that observed respectively 19 % and 22.5 % in Côte d’Ivoire (Asobayire et al., 2001; Sakande et al., 2004). This could explain alteration of haematological parameters of children in this study. In addition, the proposed standards parameters of the blood count should consider all these factors and represent those obtained in the case of the study. It would be judicious to extend this study to 5259 canteens in over 8000 primary schools in Côte d’Ivoire. CONCLUSION The investigations carried out among school children in Abidjan indicate that the prevalence of anaemia is significant with established standards. However, the rate of anaemia is low compared to previous work by other authors in Côte d'Ivoire. It is also clear from this study that the haematological status of these children is strongly altered. In selected circumstances of the study, the different blood count parameters of children in school canteens should be better than the results reported in other investigations elsewhere in developing countries. The crisis that the country has experienced since 2002 has had to reduce the efforts of officials in charge of school meals supported by international agencies (World Food Programme, World Bank). It is suitable for us to regain the growth dynamics of school meals which should be maintained in any school in the Côte d’Ivoire. Moreover, it must be determined through several work standards parameters of blood count, even if we have given up only those children in three municipalities of Abidjan. We intend to participate in a larger project including all 5259 school canteens for one hand to obtain a true prevalence of anaemia involving the standards of the blood count and also to indicate the micronutrient status (minerals and vitamins), nutritional status and the bioavailability of nutrients in the meals served to children. This advised us to avoid the early onset of nutritional deficiency and overload in children that can impede their physical and intellectual capacity. ACKNOWLEDGEMENTS The authors are grateful to Dr Léonie Clémence KOUONON, all laboratory managers and staff of National Institute of Public Health Abidjan/Côte d’Ivoire (INSP) for their support during our investigations. Our thanks are also due to the children and their parents, also the inspectors, directors and headmasters of schools in which our study has been realized. Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1255http://ijcrr.com/article_html.php?did=12551. Ahmadi A, Enayatizadeh N, Akbarzadeh M, Asadi S, Tabatabaee SHR. Iron Status in Female Athletes Participating in Team BallSports. Pak J Biol Sci 2010; 13 (2): 93-96. 2. Ahmed SG, Umana J, Ibrahim UA. Haematological Parameters of Sickle Cell Disease Patients with Menstruation Induced Vaso-Occlusive Crises. Pak J Biol Sci 2006; 9 (15): 2912-2915. 3. Al-Assaf AH. Anemia and Iron Intake of Adult Saudis in Riyadh City-Saudi Arabia. Pak J Nutr 2007; 6 (4): 355-358. 4. Amuta EU, Houmsou RS. Assessment of Nutritional Status of School Children in Makurdi, Benue State. Pak J Nutr 2009; 8: 691-694. 5. Asobayire SF, Adou P, Davidsson L, Cook JD , Hurrell RF. Prevalence of iron deficiency with and without concurrent anemia in population groups with high prevalences of malaria and other infections: a studiy in Côte d’Ivoire. Am J Clin Nutr 2001; 74: 776–82. 6. Chhabra S, Kaur P, Tickoo C, Zode P. Study of Fetal Blood With Maternal Vaginal Bleeding. Asian J Scient Res 2012; 5 (1): 25-30. 7. Colomer J, Colomer C, Gutierrez D, Jubert A, Nolasco A. Anaemia during pregnancy as a risk factor for infant iron deficiency: Report from the Valencia Infant Anaemia Cohort (VIAC) study. Paediatr Perinat Ep 1990; 4: 196-204. 8. El-Hioui M, Ahami AOT, Aboussaleh Y, Rusinek S, Dik K, Soualem A. Iron Deficiency and Anaemia in Rural School Children in a Coastal Area of Morocco. Pak J Nutr 2008a; 7: 400-403. 9. El-Hioui M, Ahami AO, Aboussaleh Y, Rusinek S, Dik K, Soualem A et al.. Risk Factors of Anaemia Among Rural School Children in Kenitra, Morocco. East Afr Med J 2008b; 5(2): 62-66. 10. El-Hazmi MA, Warsy AS. Normal reference values for hematological parameters, red cell indices, HB A2 and HB F from early childhood through adolescence in Saudis. Ann Saudi Med 2001; 21: 165-169. 11. Dillon JC. Prevention of iron deficiency and iron deficiency anaemia in the tropics. Med Trop 2000; 60: 83-91. 12. Gomber S, Kumar S, Rusia U, Gupta P, Agarwal KN, Sharma S. Prevalence and etiology of nutritional anaemias in early childhood in an urban slum. Indian J Med Res 1998; 107: 269-73. 13. Goudarzi A, Mehrabi MR, Goudarzi K. The Effect of Iron Deficiency Anemia on Intelligence Quotient (IQ) in under 17 Years Old Students. Pak J Biol Sci 2008; 11 (10): 1398-1400. 14. Gur E, Yildiz I, Celkan T, Can G, Akkus S, Arvas A, Güzelöz S, Çifçili S. Prevalence of Anemia and the Risk Factors Among Schoolchildren in Istanbul. J Trop Pediatr 200551(6): 346-350. 15. Hadipour R, Norimah AK, Poh BK, Firoozehchian F, Hadipour R, Akaberi A. Haemoglobin and Serum Ferritin Levels in Newborn Babies Born to Anaemic Iranian Women: a Cross-Sectional Study in an Iranian Hospital. Pak J Nutr 2010; 9 (6): 562-566. 16. Handa R, Ahamad F, Kesari KK, Prasad R. Assessment of Nutritional Status of 7-10 Years School Going Children of Allahabad District: A Review. Middle East J Sci Res 2008; 3 (3): 109-115. 17. Hazarika J, Saikia I, Hazarika PJ. Risk Factors of Undernutrition Among Women in the Reproductive Age Group of India: An Evidence from NFHS-3. Am-Eurasian J Scient Res 2012; 7 (1): 05-11. 18. Inocent G, Marceline DN, Bertrand PMJ, Honore FK. Iron Status of Malaria Patients in Douala - Cameroon. Pak J Nutr 2008; 7:620-624. 19. Kooshki A, Towfighian T, Rahsepar FR, Akaberi A. The Relationship Between the Antioxidants Intake and Blood Indices of the Children with Thalassemia in Sabzevar and Mashhad. Pak J Nutr 2010; 9 (7): 716-719. 20. Kuyumcu A, Karabudak E, Tayfur M, Elmacioglu F, Ozcelik AO, Besler HT. Short-Term Effects of Energy-Reduced Dieting on Weight Loss, Body Composition and Metabolism in Overweight Turkish Men. Pak J Nutr 2007; 6: 582-589. 21. Le HT, Brouwer ID, Verhoef H, Nguyen KC, Kok FJ. Anaemia and intestinal parasite infection in school children in rural Vietnam. Asia Pac J Clin Nutr 2007; 16:716-723 22. Maitland K, Pamba A, Fegan G, Njuguna P, Nadel S, Newton CRJC et al. Perturbations in Electrolyte Levels in Kenyan Children with Severe Malaria Complicated by Acidosis. Clin Infect Dis 2005; 40:9–16. 23. Mamat M, Deraman SK, Noor NMM, Rokhayati Y. Diet Problem and Nutrient Requirement using Fuzzy Linear Programming Approach. Asian J Appl Sci 2012; 5: 52-59. 24. Mbanya D, Tagny CT, Akamba A, Mekongo MO, Tetanye E. Etiology of anaemia in African children from 5 to 10 years. Sante 2008; 18(4):227-230. 25. McLean E, Cogswell M, Egli JE, Wojdyla D, Benoist BD. Report of the World Health Organization Technical Consultation on prevention and control of iron deficiency in infants and young children in malariaendemic areas. Food Nutr Bull 2006; 28(4): S489- S631. 26. Mfonkeu JBP, Gouado I, Kuate HF, Zambou O, Grau G, Combes V et al. Clinical Presentation, Haematological Indices and Management of Children with Severe and Uncomplicated Malaria in Douala, Cameroon. Pak J Biol Sci 2008; 11: 2401-2406. 27. Mirhosseini NZ, Shahar S, Yusoff NAM, Ghayour-Mobarhan MM, Derakhshan AR, Shakery MT. Lower Level of Physical Activity Predisposes Iranian Adolescent Girls to Obesity and its Metabolic Consequences. Pak J Nutr 2011; 10: 728- 734. 28. Mohamed MS. Assessment of the Nutritional Status of Adult Patients with Asthma. Pak J Nutr 2008; 7: 266-272. 29. Odebunmi JF, Adefioye OA, Adeyeba OA. Hookworm Infection among School Children in Vom, Plateau State, Nigeria. Am-Eurasian J Scient Res 2007; 2 (1): 39- 42, 2007. 30. Oguntona RC, Akinyele IO. Food and nutrient intakes by pregnant Nigerian adolescents during the third trimester. Nutr 2002; 18:673-679. 31. Porniammongkol O, Yamborisut U, Intajak T, Sirichakwal PP. Iron Status of Hill Tribe Children and Adolescent Boys: A Cross Sectional Study at a Welfare Center in Chiang Mai, Thailand. Pak J Nutr 2011; 10: 903-909. 32. Pourfallah F, Javadian S, Zamani Z, Saghiri R, Sadeghi S, Zarea B et al. Evaluation of Serum Levels of Essential Trace Elements in Patients with Pulmonary Tuberculosis Before and After Treatment by Age and Gender. Pak J Biol Sci 2011; 14 (10): 590- 594. 33. Rakoto AO, Ratsitorahina M, Pfister P, Laganier R, Dromigny JA. Estimating normal values of the hemogram in Madagascar. Arch Inst Pasteur Madagascar 2000; 66 (1-2):68-71 34. Ramzan M, Ali I, Salam A. Iron Deficiency Anemia in School Children of Dera Ismail Khan, Pakistan. Pakistan J Nutr 2009; 8: 259-263. 35. Sakande J, Sawadogo D, Nacoulma EWC, Tiahou G, Gnagne AC. Iron metabolism and erythrocyte values of ivorian newborn: Relationship with iron status of the mother. Cah étud rech franco/Santé, 2004; 14(1): 17- 20. 36. Scholl TO, Hediger ML. Anernia and iron deficiency anemia: Compilation of data on pregnancy outcome. Am J Clin Nutr 1994; 59: 492s-50 IS. 37. Singh VP, Sachan N. Vitamin B12-A Vital Vitamin for Human Health: A Review. Am J Food Technol 2011; 6: 857-863. 38. Shehu SA, Ibrahim NDG, Esievo KAN, Mohammed G. Neuraminidase (Sialidase) Activity and its Role in Development of Anaemia in Trypanosoma evansi Infection. J Appl Sci 2006; 6:2779-2783. 39. Singotamu L, Hemalatha R, Madhusudhanachary P, Seshacharyulu M. Cytokines and Micronutrients in Plasmodium vivax Infection. J Med Sci 2006; 6: 962-967. 40. Sudhagandhi B, Sivapatham S, William WE, Prema A. Prevalence of anemia in the school children of Kattankulathur, Tamil Nadu, India. Int J Nutr Pharmacol Neurol Dis 2011; 1 (2): 184-188. 41. Taylor MR, Holland CV, Spencer R, Jackson JF, O’Connor GI, O’Donnell JR. Haematological reference ranges for schoolchildren. Clin Lab Haematol 1997; 19: 1–15. 42. Ugwuja EI, Nwosu KO, Ugwu NC, Okonji M. Serum Zinc and Copper Levels in Malnourished Pre-School Age Children in Jos, North Central Nigeria. Pak J Nutr 2007; 6: 349-354. 43. UNICEF/WHO/UNU/MI. Preventing iron deficiency in women and children: Technical consensus on key issues and resources for programme advocacy, planning and implementation. New York: Unicef. 1998. http://www.inffoundation.org/pdf/prevent_ir on_def.pdf. 44. Umar RA, Jiya NM, Ladan MJ, Abubakar MK, Hassan SW, Nataala U. Low Prevalence of Anaemia in a Cohort of PreSchool Children with Acute Uncomplicated Falciparum Malaria in Nigeria. Trends Med Res 2007; 2:95-101. 45. Unsal A, Bor O, Tozun M, Dinleyici EC, Erenturk G. Prevalence of anemia and related risk factors among 4-11 Months Age Infants in Eskisehir. Turk J Med Sci 2007; 7: 1335-1339. 46. Veghari GR, Mansourian AR, Marjani AJ. The Comparison of the Anemia in Pregnant and Non-Pregnant Women in the Villages of the South-East of Caspian Sea-Gorgan-Iran. J Med Sci 2007; 7: 303-306. 47. Verma M, Chhatwa J, Kaur G. Prevalence of anemia among urban school children of Punjab. Indian J Pediatr 1998; 35: 1181- 1186. 48. WHO. Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. WHO, Geneva, Switzerland: 2008; p40. 49. Yapi HF, Ahiboh H, Monnet D, Yapo AE. Intestinal parasites, haematological profile and anthropometric status of school children in the Cote d’Ivoire. Sante 2005a; 15:17–21. 50. Yapi HF, Ahiboh H, Ago K, Ake M, Monnet D. Protein profile and vitamin A in children of school age in Ivory Coast. Ann Biol Clin 2005b 63:291-295. 51. Yapi, H.F., A. Hugues, K. David, Y. Adou, B.K. Brice, M. Dagui et al. Assessment of inflammatory and immunity proteins during falciparum malaria infection in children of Côte d’Ivoire. Am J Scient Ind Res 2010; 1: 233-237. 52. Zaidi SB, Abbas N, Gilani AH, Javed MT, Bukhari S, Habib A. Study on Children with reference to malnutrition and its effect on haematology and serum total Proteins. Pak J Biol Sci 1999; 2: 308-311.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareEVALUATION OF SERUM LEVELS OF REDUCED GLUTATHIONE, GLUTATHIONE-S-TRANSFERASE AND NITRIC OXIDE IN BREAST CANCER PATIENTS UNDERGOING ADJUVANT CHEMOTHERAPY
English5157Charushila Y. KadamEnglish Subodhini A. AbhangEnglishBackground: Alteration in oxidative and nitrosative stress as well as antioxidant status is known to occur in carcinogenesis and during treatment of cancer with chemotherapeutic drugs. Objective: The objective of this study was to evaluate the serum levels of reduced glutathione (GSH) glutathione-s-transferase (GST) and nitric oxide (NO•) in post-operative stage II breast cancer patients undergoing adjuvant chemotherapeutic treatment. Material and Methods: Clinically and histopathologically proven 30 stage II breast cancer patients were selected for the present study. Blood was collected after mastectomy before start of 1st adjuvant chemotherapy cycle and 3 weeks after receiving 1st cycle of chemotherapy. 30 healthy controls were selected for comparison. Serum GSH, GST and NO• levels were estimated by spectrophotometric methods. Results: The serum level of reduced glutathione was significantly lower (PEnglishAntioxidants, Oxidative stress, FEC, S-nitrosoglutathione.INTRODUCTION
Breast cancer is the most common cancer in women and is a leading cause of cancer related deaths in women worldwide 1 . The etiology of breast cancer is multifactorial including age, obesity, oral contraception, diet, family history and prior history of benign breast disease 1, 2 . Though breast cancer can be detected at an early stage, in some patients death occurs due to metastasis and recurrence 3 . The breast cancer treatment mainly comprised of surgical intervention with chemotherapy, radiotherapy and endocrine manipulation, either in the neoadjuvant and/or adjuvant setting 4, 5 . Oxidative stress caused by increased free radical generation and/or decreased antioxidant level in cell has been suggested to play an important role in carcinogenesis and treatment of cancer with chemotherapeutic drugs 6, 7. Free radicals can cause damage to all major classes of biomolecules such as lipids, proteins and nucleic acids and causes changes in their structure and function 2, 6, 7. To combat the deleterious effects of these free radicals, cells have developed different antioxidant mechanisms consisting of enzymatic and non-enzymatic components 1, 2 . Reduced glutathione (GSH) is the most abundant thiol in cells which acts as an important antioxidant. GSH is capable of scavenging hydrogen peroxide and peroxynitrite 8, 9, 10. It may affect the bioactivity of NO• . It is the precursor of s-nitrosoglutathione (GSNO). GSNO can transnitrosate protein thiols, possibly changing protein functions 11. GSH has been shown to be required for maximal activity of inducible nitric oxide synthase (iNOS) in hepatocytes and macrophages 12, 13. Glutathione-s-transferase (GST) is a ubiquitous multifunctional enzyme involved in detoxification. GST catalyze the conjugation of GSH to electrophilic species and plays a central role in the defense against free radicals, lipid hydroperoxides and detoxification of potential alkylating agents including anticancer drugs 13,14. Nitric oxide (NO• ) is an inorganic free radical gas produced by nitric oxide synthase (NOS) using L-arginine 15. Nitric oxide (NO• ) is a polyfunctional molecule that controls the variety of processes such as: vasodilatation, neurotransmission, immunocytotoxicity, carcinogenesis, induction or inhibition of apoptosis, etc 16, 17, 18. Furthermore, it is well known that NOS activity increases in some invasive tumors 19. The role of NO• in tumor biology is still poorly understood 15. Elevated levels of NO• provides primary source of reactive nitrogen species like peroxynitrite 2, 15 . Peroxynitrite which may be cytotoxic by itself is much more reactive and causes diverse chemical reactions in biological systems including nitration of tyrosine residues of proteins, triggering lipid peroxidation, inhibition of mitochondrial electron transport and oxidation of biological thiol compounds 15. Changes in the serum levels of nitric oxide (NO• ), reduced glutathione (GSH) and glutathione-s-transferase (GST) have been reported previously in breast cancer patients 1, 2, 7, 14, 16, 17. However, there is little research regarding the changes in these parameters after chemotherapy. Therefore, the present study was undertaken to evaluate the serum levels of nitric oxide, reduced glutathione and glutathione-stransferase in post-operative stage II breast cancer patients receiving adjuvant chemotherapy treatment.
MATERIAL AND METHODS
30 female breast cancer patients diagnosed with invasive ductal/lobular carcinoma with stage II classified by Tumor-Node-Metastasis (TNM) system and proven by histopathological evidence were involved in this study. The patients were admitted in the Sassoon General Hospital, Pune [Maharashtra, India] and were of 30 - 75 years age (Mean age 52.5±13.42). 30 healthy and age matched female controls were selected for comparison. The study was approved by Institutional Ethical Committee [Ref No. BJMC/IEC/Pharmac/D1210137-39]. After obtaining prior written consent from healthy volunteers and breast cancer patients, 5ml of venous blood was drawn under aseptic precautions after mastectomy before the start of chemotherapy and after three weeks of receiving 1 st adjuvant cycle of 5-Flurouracil, Epirubicin, Cyclophosphamide (FEC) / Adriamycin (Doxorubicin), Cyclophosphamide (AC)/ Paclitaxel chemotherapy. The serum was separated and stored at -80 ?C until analysis. To avoid false positive results, care was taken to exclude subjects suffering from infectious diseases, allergic diseases, hepatic disorders, cardiac disorders, autoimmune diseases, systemic diseases such as diabetes and other malignancies. The required chemicals- Reduced glutathione, 1- chloro-2, 4-dinitrobenzene (CDNB) and 5-5’- Dithiobis, 2-nitrobenzoic acid (DTNB) were purchased from Alfa Aesar, South Korea. Measurement of Reduced glutathione (GSH) GSH content of serum was determined by the method of Moron et al 20. GSH was determined by the use of standard curve and was expressed as mg/dl. Measurement of Glutathione-s-transferase (GST) Serum GST was estimated by CDNB method 21 . GST values were expressed as IU/L. Measurement of Nitric oxide (NO• ) Serum NO• level was determined in terms of nitrate and nitrite by kinetic cadmium reduction spectrophotometric method 22 with detection limits in serum of 2-250 µmol/L and CVs of 9% and 4.7% for nitrate concentrations of 31.4 µmol/L and 80.2 µmol/L respectively. NO• values were expressed as µmol/L. Statistical analysis The data for biochemical analysis was expressed as Mean ± SD. The statistical significance of the results was analyzed by using one-way ANOVA and Student’s t test. Values of PEnglishhttp://ijcrr.com/abstract.php?article_id=1256http://ijcrr.com/article_html.php?did=12561. Rajneesh CP, Manimaran A, Sasikala KR, Adaikappan P. Lipid peroxidation and antioxidant status in patients with breast cancer. Singapore Med J 2008; 49(8):640-3.
2. Gonec A, Erten D, Aslan S, Akinci M, Simsek B, Torun M. Lipid peroxidation and antioxidant status in blood and tissue of malignant breast tumor and benign breast disease. Cell Biol Int 2006; 30:376-80.
3. Prabasheela B, Singh AK, Fathima A, Pragulbh K, Deka NJ, Kumar R. Association between antioxidant enzymes and breast cancer. Recent Res Sci Technol 2011;3(11): 93-5.
4. Simone CB, Simone NL, Simone V, Simone CB. Antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill survival, Part 1. Altern Ther Health Med 2007; 13(1):22-8.
5. Horn SL, Fentiman IS. The role of nonsteroidal anti-inflammatory drugs in the chemoprevention of breast cancer. Pharmaceuticals 2010;3:1550-60.
6. Toyokuni S, Okamato K, Yodoi J, Hiai H. Persistent oxidative stress in cancer. FEBS Letters 1995; 358:1-3.
7. Panis C, Herrere AC, Victorino VJ, Campos FC, Freitas LF, De Rossi T, et al. Oxidative stress and hematological profiles of advanced breast cancer patients subjected to paclitaxel or doxorubicin chemotherapy. Breast Cancer Res Treat 2012;133:89-97.
8. Ewadh MJ, Kadhum NH, Al Hamdani KJ, Alawad AS. Relationship between antioxidants glutathione and total α-L-fucose as tumor markers in breast cancer patients. Medical Journal of Babylon 2009;6(1):164- 75.
9. Sivakumar S, Devaraj N. Enzymatic and nonenzymatic antioxidant status of breast cancer patients in Tamilnadu. IJPBS 2011;2(4):B46- 53.
10. Davis W, Ronai Z, Tew KD. Cellular thiols and reactive oxygen species in drug-induced apoptosis. J Pharmacol Exp Ther 2001;296:1- 6.
11. Wu G, Fang YZ, Yang S, Lupton JR, Turner ND. Glutathione metabolism and its implications for health. J Nutr 2004;134:489- 92. `
12. Harbrecht BG, Silvio MD, Chough V, Kim YM, Simmons RL, Billiar TR. Glutathione regulates nitric oxide synthase in cultured hepatocytes. Ann Surg 1997; 225(1):76-87.
13. Vos TA, Goor HV, Tuyt L, De JagerKrikken, A,Leuvenink R, Kuipers F, et al. Expression of inducible nitric oxide synthase in endotoxemic rat hepatocytes is dependent on the cellular glutathione status. Hepatology 1999;29:421-26.
14. Bakan E, Taysi S, Polat MF, Dalga S, Umudem Z, Bakan N, et al. Nitric oxide levels and lipid peroxidation in plasma of patients with gastric cancer. Jpn J Clin Oncol 2002;32(5):162-6.
15. Mahdy EM, Shousha WG, Ahmed HH, Metwally FM, Ramadan SS. Significance of serum HGF, Bcl-2 and Nitric oxide in primary breast cancer. Nature and Science 2011;9(5):34-41.
16. Coskun U, Gunel N, Sancak B, Onuk E, Bayram M, Cihan A. Effect of tamoxifen on serum IL-18, vascular endothelial growth factor and nitric activities in breast carcinoma patients. Clin Exp Immunol 2004;137:546- 51.
17. Alagol H, Erdem E, Sancak B, Turkmen G, Camlibel M, Bugdayci G. Nitric oxide biosynthesis and malondialdehyde levels in advanced breast cancer. Aust N Z J Surg 1999;69 :647-50.
18. Ewadh MJ, Kadhum NH, Al Hamdani KJ, Alawad AS. The relation between antioxidants Glutathione, Glutathione-stransferase as tumor markers in breast cancer patients. Medical Journal of Babylon 2009;6(1):36-44.
19. Konukoglu D, Turhan MS, Celik V, Turna H. Relation of serum vascular endothelial growth factor as an angiogenesis biomarker with nitric oxide and urokinase-type plasminogen activator in breast cancer patients. Indian J Med Res 2007;125:747-51.
20. Moron MS, Depierre JW, Mannervik B. Levels of glutathione, glutathione reductase and glutathione-s-transferase activities in rat lung and liver. Biochim Biophys Acta 1979;582:67-78.
21. Prabhu K, Bhat GP. Serum total glutathiones-transferase levels in oral cancer. J Can Res Ther 2007;3:167-8.
22. Cortas NK, Wakid NB. Determination of inorganic nitrate in serum and urine by a kinetic cadmium reduction method. Clin Chem 1990;36:1440-3.
23. Peters WHM, Roelofs HMJ, Putten WLJV, Jansen JBMJ. Response to adjuvant chemotherapy in primary breast cancer: no correlation with expression of glutathione-stransferases. Br J Cancer 1993;68:86-92.
24. Conklin KA. Cancer chemotherapy and antioxidants. J Nutr 2004;134(11):3201-4S.
25. Chakraborty P, Ugir HSK, Murmu N, Das JK, Pal S, Bhattacharya S. Modulation of Cyclophosphamide –induced cellular toxicity by diphenylmethyl selenocyanate in vivo, an enzymatic study, J Cancer Molecules 2009;4(6):183-9.
26. Czeczot H, Scibior D, Skrzycki M, Podsiad M, Porembska Z. Glutathione level and activity of GSH dependent enzymes in gastric carcinoma patients-a preliminary report. Gastroenterol Pol 2005;12(2):107-11.
27. Mishra S, Sharma DC, Sharma P. Studies of biochemical parameters in breast cancer with and without metastasis. Indian J Clin Biochem 2004;19(1):71-5.
28. Kasapovic J, Pejic S, Stojiljkovic V, Todorovic A, Radosevic-Jelic L, Saicic ZS, et al. Antioxidant status and lipid peroxidation in the blood of breast cancer patients of different ages after chemotherapy with 5-fluorouracil, doxorubicin and Cyclophosphamide. Clin Biochem 2010;43(16-17):1287-1293.
29. Prabasheela B, Baskaran S, Alteration of glutathione dependent enzymes in pre and post-operative breast carcinoma, JBMAS. 1- 7.
30. Severini G. Glutathione-s-transferase activity in patients with cancer of the digestive tract. J Cancer Res Clin Oncol 1993;120(1-2):112-4.
31. Gunel N, Coskun U, Sancak B, Hasdemir O, et al, Prognostic value of serum IL-18, and nitric oxide activity in breast cancer patients at operable stage. Am J Clin Oncol 2003; 26(4):416-21.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcarePREVALENCE OF DIABETIC FOOT AND THE ASSOCIATED RISK FACTORS AT PRIMARY HEALTH CARE LEVEL IN SOUTHWESTERN SAUDI ARABIA
English5863Hassan M. Al-MusaEnglishIntroduction: An understanding of the causes of diabetic foot enables early recognition of patients at high risk. The objective of the present work was to study frequency and determinants of diabetic foot among diabetics attending the urban primary health care centers (PHCCs) in Abha City, Southwestern Saudi Arabia. Methods: In this cross sectional study researcher included all diabetic patients attending the seven urban PHCCs in Abha city were studied. Data were collected during 15th November, 2011 to 30th March, 2012. Data were obtained from the chronic diseases files, socio demographic variables ¸type and duration of diabetes, diabetic foot and concomitant conditions were investigated and analyzed. Statistical Package for Social Sciences (SPSS ver.18) was used for analysis. Results: The present study included 2308 diabetic patients (1252 males and 1056 females). A minimal prevalence of 1.2% of diabetic foot was found. In multivariate binary logistic regression analysis the following potential risk factors were identified; age more than 60 years, obesity and number of visits for the PHCC of less than four in the previous year. Conclusions: The study emphasizes the importance of regular visits to the PHCCs among diabetic patients. Regular screening for foot complications is recommended in all patients. Treating physicians should be encouraged to exert more attention and care to foot examination, especially for the obese and elderly diabetics.
EnglishDiabetic, Obesity, PHCC, Early, Saudi ArabiaINTRODUCTION
Any foot pathology that results directly from or its long term complications called as diabetic foot.1 Diabetes is recognized as the most common cause of non-traumatic lower limb amputation in the western world, with individuals over 20 times more likely to undergo an amputation compared to the rest of the population. 2According to the World Health organization diabetic Foot can be defined as “The foot of diabetic patients that has the potential risk of pathologic consequences including infection, ulceration and or destruction of deep tissues associated with neurologic abnormalities, various degrees of peripheral vascular disease and / or metabolic complications of diabetes in the lower limb.” Data from the pilot study in Ireland indicate that a sizeable number of people with diabetes attending an urban general practice in the west of Ireland have vascular insufficiency and abnormal measures of neural function in their feet. These findings are of concern given the associations between lowerlimb vascular insufficiency, neuropathy and increased risk of ulceration.3 The term „diabetic foot? (DF) includes any pathology that results directly from diabetes or its long-term complications.4 Globally, foot problems account for more hospital admissions than any of the other long-term complications among patients with diabetes. An understanding of the causes of these problems enables early recognition of patients at high risk. It has been shown that up to 50% of amputations and foot ulcers in diabetes can be prevented by effective identification and education. Foot problems occur in both type 1 and type 2 diabetes and it has been estimated that the lifetime risk of a patient developing a foot ulcer is 25%.5 In Saudi Arabia, DF was prevalent in 13.5% of the diabetic patients referred to the nephrology clinic and 7.7% of the patients undergoing chronic hemodialysis.6 The mortality rate is higher in the patients with DF, and represents approximately twice the number of diabetic patients without DF.7 Identifying diabetic patients who are at high risk of developing DF may constitute a cost effective strategy in controlling progression to end stage complications. The Aseer region is located in the southwest of Saudi Arabia. It extends from the high mountains of Sarawat to the Red Sea, and lies few kilometers from the northern border of the neighboring Yemen. Abha city is the capital of Aseer. The latest Saudi Arabia?s September 2004 population census reported that Abha city has a total population of 220,000.8 This study was approved by the Research Ethics Committee (REC) from the College of Medicine, King Khalid University (KKU), Abha, Kingdom of Saudi Arabia.
MATERIALS AND METHODS
Type of study:
It is a retrospective, cross sectional type of study. Duration of study: 15th November, 2011 to 30th March, 2012 (Proposed) Consent: The data was obtained from the chronic diseases files. After the written consent taken from the administration of the hospital. In this study researcher follows the principles of WMA Declaration of Helsinki - Ethical Principles for Medical Research Involving Human Subjects, principal investigator and all other co- staff members will follow all those ethical principals i.e. protect the life, health, dignity, integrity, right to self-determination, privacy, and confidentiality of personal information of research subjects. Type of sampling: In this study, researcher adopted the convenience type of nonprobability sampling. Inclusion criteria: All the diabetic patients, visited to the primary health care unit in Abha were included in the study. Exclusion criteria: Females who were pregnant or nursing or females of childbearing potential; Life expectancy < 6 months due to concomitant illnesses; Exposure to any investigational drug or procedure within 1 month prior to study entry or enrolled in a concurrent study that may confound results of this study. Active infectious disease and/or known to have tested positive for HBV, HCV, CMV and/or syphilis and History of cancer (other than non-melanoma skin cancer or insitu cervical cancer) in the last two years. Sample Size: As researcher adopted the nonprobability convenience samplings and the sample size is 2308 diabetic patients. List of variables: Socio-demographic variables i.e. age, gender, family history, concomitant conditions, complications and compliances i.e. Hypertension Hyperlipidemia, Smoking, Obesity, type of diabetes, duration of diabetes. Data collection: Researcher collected the data from the chronic diseases files those who visited and fulfilled the inclusion and exclusion criterion, to the primary health care center in Abha. . A well qualified team of doctors and nurses examined the patients and helped the researcher regarding the data availability and data compilation in PHCC Abha, KSA. Data Analysis: Statistical Package for Social Sciences (SPSS) ver. 18 9 was used for entering and analyzing the data. Data were coded for entering purpose List of PHCC in Abha: Al-Manahal Primary Health Care Center, Al-Numais Primary Health Care Center, Al-Mansak Primary Health Care Center, Al-Aziziah Primary Health Care Center, Al –Qabil, Wasat Abha Primary Health Care Center, and Haiyal Moazzifin Primary Health Care Center Statistical Analyses: Descriptive statistics i.e. mean, standard deviation, maxima, minima, range, percentages of Socio- demographic variables were calculated to determine the information about the respondents and risk factors. To check the significance differences among the variables i.e. associated risk factors statistical tests were applied chi-square tests for discrete data i.e. proportion of type I and II diabetes among male and female while t-test for continuous data i.e. comparison of age groups of diabetic males and females. Adjusted odds ratios along with confidence interval were calculated to explore the potential risk factors for diabetic foot. Level of significance: Researcher fixed the level of significance at 95% means any p-value less than 0.05 considered significant.
RESULTS
The present study included 2308 diabetic patients (1252 males and 1056 females). Sociodemographic profile: Table 1 shows the profile of the study sample. The age ranged from 11 to 92 years with an average of 57.65+ 15.06 years and a median of 56 years. Diabetic males were significantly (t= 1.982, P= 0.001) older (58.22 + 15.2 years) than diabetic females (56.9 + 13.2 years). Male diabetics were significantly more educated than females (χ2 =140.3, P=0.001). Types, duration and family history of diabetes: The proportion of type 1 diabetes among male diabetics (15.7%) was significantly (χ2 =8.12, P=0.005) higher than that among female diabetics (11.6%). The duration of diabetes among males (9.24 + 7.44 years) was significantly (t= 3.704, P= 0.001) longer than females (8.17 + 6.26 years). On the other hand the proportion of positive family history of diabetes among females (42%) was significantly higher (χ2 =17.66, P=0.001) compared to males (33.5%). Concomitant conditions: The prevalence of obesity and hyperlipidemia were significantly (P=0.001) higher among females (58.6% and 26.7%, respectively) compared to male diabetics (36.3% and 19.3%, respectively). On the other hand the prevalence of smoking among males (14.4%) was significantly higher (P=0.001) compared to females (1.1%). The prevalence of hypertension was not significantly different (χ2 =0.352, P=0.553) among males (24.1%) and females (25.2%).
Prevalence of Diabetic foot:
The present study included 27 cases diagnosed as diabetic foot giving a minimal prevalence of 1.2%. There was no significant deference (χ2 =0.409, P=0.522) between males (1.1%) and females (1.3%) regarding the prevalence of diabetic foot.
Determinants of diabetic foot:
Multivariate binary logistic regression analysis was used to identify potential risk factors associated with diabetic foot (Table 2). After adjusting for other potential risk factors, the study showed that diabetics aged more than 60 years having more than three times the risk to develop diabetic foot compared to diabetics aged less than 60 years old. Similarly, the following significant risk factors were identified; obesity and number of less than four visits for the PHCC during last year. On the other hand, gender, educational level, nationality, marital status, type and duration of diabetes, family history of diabetes, hypertension, hyperlipidemia, smoking diet, and exercise compliance were found to be of no significant value in developing diabetic foot.
DISCUSSION
The present study reported a minimum prevalence rate of 1.2% of diabetic foot among diabetics at PHC level in Abha. In Saudi Arabia, DF was prevalent in 13.5% of the diabetic patients referred to the nephrology clinic and 7.7% of the patients undergoing chronic hemodialysis.10 In Netherlands an annual incidence rate of DF of 1.2% was reported among diabetics at PHC level.11In Germany, approximately 2–6% of all diabetics developed poor healing and frequently chronic lesions on the feet which were associated with a high risk of minor or major amputation.12 In UK in a cohort of 1192 people with diabetes receiving care in community settings an incidence of DF of 1.9% was found. 13 . This low prevalence in this study indicated that diabetic patients of this study were very cautious about their feet reason being the continuous health education by centre staff enabling then and took all the preventive measures to overcome the foot problems. The present study identified the following potential risk factors; age more than 60 years, obesity and number of less than four visits for the PHCC during last year.A case control study in Riyadh, found that the presence of DF was significantly associated with: male gender, age older than 40 years, illiteracy, type 2 diabetes, longer duration of the disease, earlier age of the onset of diabetes, higher ESR.14 In a crosssectional study in the United Arab Emirates (UAE) investigating the risk factors of DF, the main risk factors for complications of DF were: male gender, poor level of education, UAE nationality, long disease duration, type 2 diabetes mellitus, presence of hypertension, and poor glycemic control.15 Diabetic patients should be given general advice on foot hygiene, nail care and the purchase of footwear. Their risk status should be reviewed annually. Patients with any risk factor should be reviewed more frequently and educated about preventive foot care. These simple steps have been shown to significantly reduce the incidence of foot ulceration. Much of the screening and primary health education of patients with diabetes is undertaken in primary care. A community foot care team might include a general practitioner, and practice nurse. Education for at-risk patients is often provided in this setting. The introduction of multidisciplinary team work in the community has been shown to result insignificant reduction in the number of amputations.16 In conclusion, this study could be considered as a preliminary study of the risk factors of DF in southwestern Saudi Arabia. It emphasizes the importance of regular visits to the PHCCs among diabetic patients. 1.1% of the males and 1.3% of the females? respondent experience the diabetic foot, which reflects the low prevalence but to further reduce this prevalence regular screening for foot complications is recommended in all diabetic patients. To decrease the potential risk factors observed in this study i.e. age over than 60-years, obesity and less than 4 visits to PHCC, Treating physicians should be encouraged to exert more attention and care to foot examination, especially for the obese and elderly diabetics. An important part of preventing diabetic foot is having foot and footwear checks done annually by any healthcare provider who comes in contact with the patient, particularly for those patients with long duration of diabetes who use insulin and those who smoke. Daily foot checks should also be taught to patients and their caregivers 17 Strength and future aspects of the study: This study will help the future researcher to further investigate about the potential risk factors of the DF. In the light of this study, doctors and hospital administration will take the preventive measures to overcome or reduce such risk factors. This study to be followed in the future by a large scale prospective study all over Aseer region, including all the possible risk factors derived from the current study and other studies
Englishhttp://ijcrr.com/abstract.php?article_id=1257http://ijcrr.com/article_html.php?did=12571. Boulton A. The diabetic foot: from art to science. The 18th Camillo Golgi lecture, Diabetologia (2004) 47:1343–1353.
2. J. Rodrigues ,N. Mitta ,Diabetic Foot and Gangrene, Gangrene - Current Concepts and Management Options, Dr. Alexander Vitin. (2011).
3. Nather A, Bee CS, Huak CY et al. Epidemiology of diabetic foot problems and predictive factors for limb loss. J Diabetes Complications (2008) 22: 77-82
4. Boulton A. The diabetic foot.MEDICINE 2010, 38(12): 644-648.
5. Singh N, Armstrong DG, Lipsky BA. Preventing foot ulcers in patients with diabetes. JAMA (2005); 293: 217-28.
6. Qari FA. Profile of Diabetic Patients with End-stage Renal Failure Requiring Dialysis Treatment at the King Abdulaziz University Hospital, Jeddah. Saudi J Kidney Dis Transpl (2002); 13: 199-202.
7. Hunt D. Diabetes: foot ulcers and amputations. ClinEvid 2009; 1: 1-16.
8. Preliminary results of 2004 census. Central Department of Statistics. Riyadh (KSA): Ministry of Economy and Planning; (2005).
9. SPSS Inc. Released 2009. PASW Statistics for Windows, Version 18.0. Chicago: SPSS Inc.
10. Jbour AS, Jarrah NS, et al. Prevalence and predictors of diabetic foot syndrome in type 2 diabetes mellitus in Jordan. Saudi Med J (2003); 24: 761-764.
11. Mulle I, Bartlink M, Grau W, Hoogen H, Gerwen W and Rutten G. Foot ulceration and lower limb ambutation in type 2 diabetic patients in Dutch primary health care. Diabetic Care (2002);25:570-574.
12. Pscherera S, Dippelb F, Lauterbachc S, Kostevd K. Amputation rate and risk factors in type 2 patients with diabetic foot syndrome under real-life conditions in Germany. Primary Care Diabetes 2012; 6: 241–246.
13. Crawford F, McCowan C, Dimitrov BD, Woodburn J, Wylie GH, Booth E, Leese GP, Bekker HL, Kleijnen J, Fahey T. The risk of foot ulceration in people with diabetes screened in community settings: findings from a cohort study.QJM. 2011; 104(5):403- 10.
14. Abolfotouh MA, Alfaifi SA, Al-Gannas AS.Risk factors of diabetic foot in central Saudi Arabia. Saudi Med J. 2011;32(7):708- 13.
15. Al-Maskari F, El-Sadig M. Prevalence of risk factors for diabetic foot complications. BMC FamPract (2007) 10; 8: 59.
16. Krishnan S, Nash F, Baker N, Fowler D, Rayman G. Reduction in diabetic amputations over 11 years in a defined UK population: benefits of multidisciplinary team work and continuous prospective audit. Diabetes Care (2008); 31: 99-101.
17. Larsson J, Apelqvist J. Towards less amputations in diabetic patients: incidence, causes, cost, treatment and prevention-a review. Acta Orthop Scand. 1995; 66(2):181- 192
Table 1: Description of the Study Sample of Diabetics at Primary Health Care Level in Abha City, Southwestern Saudi Arabia
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareASSESSMENT OF BREASTFEEDING PRACTICES IN UDAIPUR CITY AND ADJOINING RURAL AREA
English6468Mittal HemlataEnglish Mishra R. SimmiEnglish Mathur H.N.EnglishBreastfeeding, a component of primary health care has been identified world over as greatest protection of child health. Irrespective of the fact that breastfeeding in India is universal, psychological barrier still exist in early breastfeeding. Hence a study was conducted to assess breastfeeding knowledge, practices and factors influencing them among women in Udaipur city of Rajasthan.Objective:1) To study prevalent breastfeeding practices in mother’s who have nursed in last five years.2) To assess knowledge of respondents on different issues of breastfeeding. Material and methods: The study was conducted in Geetanjali Medical College and Hospital and its urban and rural health centres. 5oo women who had nursed in last 5 years were interviewed using structured proforma. Results: Our study showed that exclusive breastfeeding and total duration of breastfeeding was not as per the WHO/UNICEF recommendation. Significant differences found in Urban/Rural/Semi urban area.62% mothers were unaware of benefits of breastfeeding to mother though 98% were aware of benefits to child. Conclusion: This study emphasises that mother should be educated and motivated for exclusive breastfeeding their babies for 6 months and continue breastfeeding till 2 years. The benefits of breastfeeding for mothers should be explained for this purpose.
EnglishExclusive breastfeeding , duration of breastfeeding, benefits of breastfeeding.INTRODUCTION
Breastfeeding, a component of primary health care has been identified world over as greatest protector of child health. It is fundamental for child’s growth and development and also has great protective potential against major killer diseases of childhood. The World Health Organisation(WHO)/United Nation Children Fund(UNICEF) jointly recommend that women exclusively breastfed their infants for the first 6 months and continue to breastfed into the second year of life or longer. The importance of breastfeeding, especially EBF, is well established for the infant, the mother and the family. In those settings when infant formula is used, they are introduced early and overdiluted. 1 The practice of exclusive breastfeeding depends on various factors related to both mothers and their environment, including the services delivered by health professionals. It is known that support and counselling by health professionals can improve rates, early initiation and total duration of breastfeeding, particularly EBF.1 These scientific facts and knowledge need to be conveyed to nursing as well as potential mothers so that they not only breastfeed the child but correctly breastfeed the child. The attitudes and practices of breastfeeding differ in different segments of society .They depend on traditional cultural practices and taboos prevalent in different groups and knowledge and attitude of women folk. The scientifically correct practices need to be adopted. With this thought an assessment of breastfeeding practices in different segments of society was conducted in Udaipur city and its adjoining rural area.
MATERIALS AND METHODS
This cross sectional study was conducted by Department of Community Medicine Geetanjali Medical College and Hospital,Udaipur. Mothers who had nursed their children in last five years were interviewed using a structured Performa. It included information on socio cultural, economic, educational and vocational aspects of respondents besides questions on different aspects of breastfeeding. Information was collected about nursing practices for youngest child. The subjects of study included
1. Women residing in field practice area of urban and rural health centre.
2. Patients and attendants visiting GMCH(mainly paediatric and OBG dept).
3. Labour class domestic servants.
4. Teachers from secondary schools, STC, and colleges(Government and private schools).
5. Nursing and medical staff doctors executives and other working mother.
6. Traditional birth attendants, VHG and Anganwadi workers.
Permission was sought from concerned authorities for this study explaining them the purpose of exercise and fixing time and place. Clearance was obtained from the Ethical committee of the College for the study
RESULTS
500 mothers were interviewed over a period of 6 months.52% population was from the urban area, 17% were from semi urban and rest from rural.72 percent mothers initiated breast feeding on the first day with 83% feeding their new born colostrum.(Table 1) Exclusive breastfeeding was however not as per WHO guidelines with 52% mothers introducing some complementary feed or starting top feed after 3 months. There was significant difference among mothers from urban, rural and semi urban areas.(Table 2) Similarly the total duration of breastfeeding was also not as per recommended norms with most mothers see (table 3) discontinuing by one year. The total duration of breastfeeding is less than 24 months in among all three sections and there is significant difference in duration. The benefits of breastfeeding to mother are poorly known to mothers themselves as reflected in the table above.42% women know it controls bleeding but just 5% and 10% mothers know it helps prevent cancer and act as a contraceptive respectively. (Table 4). 41% of mothers are aware of nutritive value of breast milk but only 21% know it is protective against illness.(Table 5) The most common galactoguoges across rural, urban and semi urban used were “gond laddos” which are traditionally given in Rajasthan. 80% rural women were unaware of any ayurvedic or allopathic medications that are available to increase lactation, while 89% semiurban and 90% urban women were aware of the preparations that help increase milk secretion.
DISCUSSION
WHO recommends early (i.e. within one hour of giving birth) initiation of breastfeeding. A recent trial has shown that early initiation of breastfeeding could reduce neonatal mortality by 22% which would contribute to the achievement of the Millennium Development Goals. Though the advantages of breastfeeding are significant, the duration and patterns of breastfeeding vary a great deal within India. Studies indicate exclusive breastfeeding until 4-6 months of age to be beneficial to infant survival, but globally exclusive breastfeeding rates are still too low in early infancy.2 Breastfeeding should be initiated within 30 minutes of delivery. The delay in initiation will lead to a delay in the development of oxytocin reflexes, which are very important for the contraction of the uterus and the breast milk reflex. In our study, almost all the mothers initiated breastfeeding within 1 hour of childbirth, which is a good practice. Studies comparing the early onset of breastfeeding on the development of newborns and on their mothers and those studies in which breastfeeding had begun on the 6 th hour after birth show that the earlier breastfeeding begins, the earlier and more effective the consolidation of the process and therefore a better impact on the after-birth period, which helps in the earlier initiation of the secretion of breast milk.3 It protects the child from malnutrition, infections, and helps the overall development of the child. Only 40% of the mothers were doing exclusive breastfeeding, the remaining 60% of the mothers were not. They prematurely start weaning the child, which may lead to the development of infections and may have a long-term effect on the physical growth of the child.3 As a global public health recommendation, exclusive breastfeeding should be practiced for the first 6 months of life, to achieve optimum growth, development and health. In India breastfeeding is almost universal, but the EBF is quite low4 Indian Academy of Pediatrics recommends exclusive breastfeeding for the first 4-6 months followed by sequential addition of semisolid and solid foods to complements breast milk until the child is gradually able to eat the normal family food at around one year of age.5 The median duration is 18.4 months across countries.6 Some studies says that breastfeeding can significantly reduce the risk of cancer death in mothers because longer breastfeeding means fewer menstrual cycles and reduced lifetime exposure to the hormonal factor, especially estrogen, that influence breast cancer risk.7 It is evident that even the most sophisticated and carefully adapted formulae can never replicate human milk, as human milk has anti infective properties, and is a live fluid which cannot be mimicked in an artificial formula. An adequate supply of human breast milk is known to satisfy virtually all the nutritional needs of an infant at least for the first 6 months of life. Breast milk, and especially colostrum, in the long term, prevents atherosclerosis, hypertension, and obesity; it also prevents allergy to non specific proteins and develop immunity. Breastfeeding has a vital child specific effect which is especially important in developing countries where the awareness, acceptability and availability of modern family planning methods are very low.8
CONCLUSION
The most important aspect of breastfeeding is its exclusivity for 6 months and the recommendation of continuing for 2 years to get maximum benefits for child and mother. The study highlights that though women from rural, urban and semi urban are aware of the benefits of breast feeding; ideal breastfeeding is still not achieved. Mothers need to be educated about these aspects as well as that they too benefit immensely through it during antenatal classes, or when they visit health services during pregnancy.
Englishhttp://ijcrr.com/abstract.php?article_id=1258http://ijcrr.com/article_html.php?did=12581. The breastfeeding week celebrated during 1st week of August can serve as an important platform to advocate the same. Abba AM, Koninck MD, Hamelin AM. A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger. International Breastfeeding Journal 2010, 5:8 doi: 10.1186/1746-4358-5- 8 available on www.internationalbreastfeedingjournal.com/c ontent/5/1/8
2. Bandyopadhyay M. Impact of ritual pollution on lactation and breastfeeding practices in rural West Bengal, India. International Breastfeeding Journal[Internet]. 2009,4:2 doi: 10.1187/1746-4358-4-2 available on www.international breastfeeding journal.com/content/4/1/2
3. Madhu K, Chowdary S, Masthi R. Breastfeeding Practices and Newborn Care in Rural Areas: A Descriptive Cross-Sectional Study. Indian Journal of Community Medicine 2009;34:243-6.
4. Oommen A, Vatsa M, Paul VK, Aggarwal R. Breastfeeding Practices of Urban and Rural Mothers. Indian paediatrics 2009;46(10):891- 4.
5. Parekh C, Bavdekar SB, Shaharao V. Study of Infant Feeding Practices: Factors Associated with Faulty Feeding. J Trop Pediatr. 2004;50(5):306-8.
6. Worldbreastfeedingconference.0rg/images/51 -country-report.pdf
7. Greenfield B. Breastfeeding for six Months Can Significantly Cut Risk of Cancer DeathAs Can Less Alcohol and Staying in Shape, Study Finds. By Beth Greenfield, Shine Staff/Healthy Living-Apr 3, 2013 by Shine.yahoo.com/healthy living/Breastfeeding.
8. Reddy S. Breastfeeding- Practices, problems and prospects. Journal of Family Welfare 1995;41:1-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareRHINOLITH ASSOCIATED WITH LONG-TERM TOPIRAMATE THERAPY IN ALCOHOL WITHDRAWAL PATIENTS
English6973Suvendu Narayan MishraEnglish Monalisa JenaEnglish Swati MishraEnglish S.S.G. MohapatraEnglishTopiramate, a commonly used drug in the management of seizures and migraine headache, can increase the risk of calcium phosphate kidney stones. However, specific side effects are nausea, anorexia, parasthesia, memory problems etc. We report a case of 54 year old male patient with alcohol withdrawal syndrome treated with bupropion, disulfiram, topiramate, chlordiazepoxide. After one year of treatment, the patient developed nephrolithiasisand rhinolith on right side which was confirmed by USG and CT scan respectively. As all other drugs except topiramate do not have any tendency to form stones, the most probable drug may be topiramate. ENT specialists should be aware of this possible complication to undertake early interventions.
EnglishTopiramate, Alcohol withdrawal syndrome, Disulfiram, Rhinolith, BupropionINTRODUCTION
Topiramate (Topamax) which is an anticonvulsant (antiepilepsy) drug (first approved by the US FDA, Food and Drug Administration, in 1996).1 It is usually used to control seizures in epileptic patients either as monotherapy or with other antiepileptic medications. It acts through various mechanisms, including blocking sodium channels in neurons (like phenytoin) and modulating chemical receptors in brain.2 Topiramate is used to treat epilepsy seen both in children and adults. It is indicated for the treatment of Lennox-Gastaut syndrome in children, also most frequently prescribed for the prevention of migraines also. Psychiatrists prescribed topiramate to treat bipolar disorders.3 This drug has been investigated for use in treating alcoholism,4,5 methamphetamine addiction6 and obesity,7,8 as it reduces binge eating. 9,10 The main adverse effects of this drug are parasthesia, URTI(upper respiratory tract infection), diarrhea, nausea, anorexia and memory problems. The inhibition of carbonic anhydrase by topiramate is rarely being strong enough to cause metabolic acidosis of clinical importance.11 The U.S. Food and Drug Administration (FDA) has notified prescribers that long term use of topiramate can cause acute myopia and secondary angle closure glaucoma in a small group of people. Researchers found that chronic topiramate therapy (about one year), caused systemic metabolic acidosis (excessive acid in the blood) which make the kidney unable to excrete acid. There is also increased the urine pH and lowered urine citrate with topiramate use which is an important inhibitor of kidney-stone formation. The propensity to form calcium phosphate stones in the kidney is increased due to the above mentioned reason.12 Bupropion is an atypical antidepressant and used as an aid for smoking cessation. 13 Mechanisms behind its pharmacological action is thought to be norepinephrine-dopamine reuptake inhibition. It binds selectively to the dopamine transporter, but its behavioral effects is due to its inhibition of norepinephrine reuptake. 14,15 It is also a nicotinic acetylcholine receptor antagonist. 13,16 Bupropion is used for clinical depression17 , social anxiety disorder. 18 Bupropion reduces the severity of nicotine cravings and withdrawal symptoms, for obesity19 , attention-deficit hyperactivity disorder (ADHD)20 , in methamphetamine dependence.21. Most important side effects which seen with the ingestion of this drug are seizure, hypertension, myocardial infarctions etc. There is no report established for formation of stones with bupropion till date. In the 1920s disulfiram was discovered and as it produces an acute sensitivity to alcohol, used for the treatment of chronic alcoholism. 22 It inhibits the acetaldehyde dehydrogenase and blocks the alcohol metabolism in the body and producing an unpleasant reaction with alcohol. The most commonly seen side effects with disulfiram in the absence of alcohol are drowsiness, headache, and a metallic or garlic taste in the mouth.23 Disulfiram also causes neurotoxicity in the form of extrapyramidal and other symptoms.24
CASE REPORT
We report a case of 54 year old male presented to the outpatient department of psychiatry, IMS and SUM Hospital, Bhubaneswar with chief complaints of tremor in hand, restlessness, increase in sweating, palpitation, and insomnia with irrelevant talk for last 2days. Then the patient was admitted to the psychiatric indoor of our hospital with a diagnosis of alcohol withdrawal syndrome. There was no history of diabetes mellitus, hypertension, epilepsy in the past. The patient was apparently alright 2 days back. To start with he developed the above mentioned symptoms after discontinuation of alcohol which he was taking since last 20 years in a regular basis (> 300ml/day foreign liquor). There was also history of smoking (4-5 cigarettes/day). During the period of admission, all the investigations such as all the blood parameters, CT scan of head, USG(ultrasound) abdomen were done which showed the increased LFT(liver function test) values, fatty liver on USG but CT scan and other parameters were within normal limits. After admission, he got treated with injection lorazepam, injection haloperidol with phenargan, thiamine and multivitamin injection for 4-5 days. After 5 days, the above drugs were changed to its oral formulations along with anticraving drugs such as tab topiramate (100mg/d), tab bupropion (300mg/d), tab chlordiazepoxide (75mg/d), tab disulfiram (250mg/d). Then after 10th day of admission, the patient was discharged from the hospital with the advice of continuing the medicines and to consult after 6months. He was maintaining the abstinence and discontinued the tab chlordiazopoxide gradually. Again he came after one year of the initial visit with a complaint of heaviness around periorbital area. USG abdomen revealed nephrolithiasis and CT scan revealed antrorhinolith in right side with right maxillary sinus collection. The patient was referred to the ENT department of our hospital for further interventions.
DISCUSSION
A rhinolithh is a calculus present in the nasal cavity which can cause nasal obstruction, epistaxis, headache, sinusitis, epiphora.25 In our present case the drugs that are prescribed for a long duration are disulfiram, bupropion and topiramate. The most common side effects of disulfiram are drowsiness, headache and a metallic or garlic taste26 and extrapyramidal side effects.27 Most controversial side effect of bupropion is seizure.28,29,30 Other side effects are hypertension28, myocardial infarction31 , delirium, hallucination32, coma. 30 An association between topiramate and the development of kidney stones has been described previously in several different case reports.33 But all these case reports were of kidney stones and we did not come across any case reports on rhinolith with the use of topiramate. Though our patient was receiving three anticraving drugs, topiramate was thought to be the most likely cause of rhinolith, as there was risk of calcium and phosphate deposition with long term use of topiramate around one year in the kidney. The causality assessment by Naranjo algorithm 34 showed that this adverse drug reaction was “probable” with topiramate.
CONCLUSION
Rhinolith is an uncommon disease. It is the formation of a calculus or stone in the nasal cavity due to calcium, magnesium and phosphate salts deposition in that area. The underlying cause of formation of rhinolith in our present case report was not clear. As more patients receive topiramate now-a-days as anticraving drugs in chronic alcoholism, it is important to alert patients about this kidney stones and rhinolith formation. So precautions to be taken in people with the following conditions like history of kidney stones and liver and kidney diseases. Physicians should also focus on preventing adverse effects and distinguishing serious adverse effects from self limiting adverse effects in order to manage prejudiced and fearful patients with anticraving drugs.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1259http://ijcrr.com/article_html.php?did=12591. Maryanoff, BE; Nortey, SO; Gardocki, JF; Shank, RP; Dodgson, SP (1987). "Anticonvulsant O-alkyl sulfamates. 2,3:4,5- Bis-O-(1-methylethylidene)-beta-Dfructopyranose sulfamate and related compounds". Journal of Medical Chemistry 30 (5): 880–7.
2. Maryanoff, BE; Costanzo, MJ; Nortey, SO; Greco, MN; Shank, RP; Schupsky, JJ; Ortegon, MP; Vaught, JL (1998). "Structure-activity studies on anticonvulsant sugar sulfamates related to topiramate. Enhanced potency with cyclic sulfate derivatives". Journal of Medical Chemistry 41 (8): 1315–43.
3. Arnone, D (2005). "Review of the use of Topiramate for treatment of psychiatric disorders". Annals of general psychiatry 4 (1): 5.
4. Johnson, BA; Ait-Daoud, N; Bowden, CL; Diclemente, CC; Roache, JD; Lawson, K; Javors, MA; Ma, JZ (2003). "Oral topiramate for treatment of alcohol dependence: a randomised controlled trial". Lancet 361 (9370): 1677–85
5. Johnson, BA; Rosenthal, N; Capece, JA; Wiegand, F; Mao, L; Beyers, K; McKay, A; Ait-Daoud, N et al. (2007). "Topiramate for treating alcohol dependence: a randomized controlled trial". JAMA: the Journal of the American Medical Association 298 (14): 1641–51.
6. "Medication can help recovering meth addicts stay sober, study finds". Retrieved 2012-06-13.
7. Van Ameringen, M; Mancini, C; Pipe, B; Campbell, M; Oakman, J (2002). "Topiramate treatment for SSRI-induced weight gain in anxiety disorders". The Journal of clinical psychiatry 63 (11): 981– 4.
8. Wilding, J; Van Gaal, L; Rissanen, A; Vercruysse, F; Fitchet, M; Obes-002 Study, Group (2004). "A randomized double-blind placebo-controlled study of the long-term efficacy and safety of topiramate in the treatment of obese subjects". International journal of obesity and related metabolic disorders: journal of the International Association for the Study of Obesity 28 (11): 1399–410.
9. Shapira, NA; Goldsmith, TD; McElroy, SL (2000). "Treatment of binge-eating disorder with topiramate: a clinical case series". The Journal of clinical psychiatry 61 (5): 368–72
10. McElroy, SL; Arnold, LM; Shapira, NA; Keck Jr, PE; Rosenthal, NR; Karim, MR; Kamin, M; Hudson, JI (2003). "Topiramate in the treatment of binge eating disorder associated with obesity: a randomized, placebo-controlled trial". The American Journal of Psychiatry 160 (2): 255–61.
11. Mirza, Nasir; Marson, Anthony G.; Pirmohamed, Munir (2009). "Effect of topiramate on acid-base balance: extent, mechanism and effects". British Journal of Clinical Pharmacology 68 (5): 655–61
12. Welch, Brian J.. MD; Graybeal, Dion, MD; Moe, Orson W., MD; Maalouf, Naim M., MD; Sakhee, Khashayar, MD. "Biochemical and Stone-Risk ProfilesWith Topiramate Treatment." Am J Kidney Dis 48:555-563.
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14. Terry, P.; Katz, Jonathan L. (1997). "Dopaminergic mediation of the discriminative stimulus effects of bupropion in rats". Psychopharmacology 134 (2): 201– 12.
15. Learned-Coughlin, Susan M; Bergström, Mats; Savitcheva, Irina; Ascher, John; Schmith, Virginia D; Långstrom, Bengt (2003). "In vivo activity of bupropion at the human dopamine transporter as measured by positron emission tomography". Biological Psychiatry 54 (8): 800–5.
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18. Emmanuel, Naresh P.; Brawman-Mintzer, Olga; Morton, W. Alexander; Book, Sarah W.; Johnson, Michael R.; Lorberbaum, Jeffrey P.; Ballenger, James C.; Lydiard, R. Bruce (2000). "Bupropion-SR in treatment of social phobia". Depression and Anxiety 12 (2): 111–3.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcarePOST OPERATIVE WOUND INFECTION: BACTERIOLOGY AND ANTIBIOTIC SENSITIVITY PATTERN
English7479Nitin Goel InsanEnglish Nikhil PayalEnglish Mahesh SinghEnglish Amod YadavEnglish B.L ChaudharyEnglish Ambrish SrivastavaEnglishBackground: Wound infection occurs if the integrity and protective function of the skin is breached. Most Bacteria, certain Viruses (e. g. Herpes virus), Fungi (e.g.Candida albicans) are responsible for wound infection [3]. A study was designed to isolate and identify the aerobic bacterial agents of post operative wound infection as well as to determine their antibiotic sensitivity pattern. Method: Total 102 pus samples were collected from surgical sites and immediately inoculated on Blood agar and MacConkey agar plates. Then the culture plates were incubated at 37oC for 24 hours. After incubation, all isolates were identified by using Gram stain and biochemical methods. Sensitivity tests were performed on Mueller Hinton agar plate by Kirby Bauer’s disc diffusion technique. Result: During the study period (February 2012- January 2013), a total of 102 samples were analyzed. Among 102 samples, 73 (71.5%) showed positive growth. The most frequent isolate was Staphylococcus aureus 24 (32.8%) followed by Escherichia coli 15 (20.5%), Pseudomonas species (16.4%). Antibiotic sensitivity test of the isolates showed that Ampicillin+Sulbactum (87.5%) and Linazolid (85%) were the most effective antibiotics for Gram positive bacteria and Ciprofloxacin (52.5%) was the least effective antibiotic. Gram negative isolates were most sensitive to Lomifloxacin (70.3%) followed by Netilline (61.1%). Cefuroxime (18.5%) was the least sensitive antibiotic for Gram negative bacteria in this study. Conclusion: The most common isolate in wound infection was Staphylococcus aureus followed by E.coli. Ampicillin+Sulbactum was most effective antibiotic for Gram positive bacteria and Lomifloxacin was most effective against Gram negative bacteria.
EnglishWound infection, Staphylococcus aureus, Escherichia coliINTRODUCTION
A wound is a breach in the skin and the exposure of subcutaneous tissue following loss of the skin integrity which provides a moist, warm and nutritive environment that is conductive to microbial colonization and proliferation [1]. Classical signs of inflammation were described by Celsus in the first century as calor, rubor, tumor and dolor (heat, redness, swelling and pain). To these four signs is often added a fifth fluor (discharge) [2]. Wound infections are mainly of two types i.e. open wounds and closed wounds. Open wounds are caused by external damage to intact skin whereas closed wound is infection to tissues below the skin [3]. Post operative wound infection is commonest wound infection and recognized as having a polymicrobial etiology, involving both aerobic and anaerobic microorganisms and intraabdominal infections normally reflect the microflora of the resected organ. Reported wound infection rates following orthopaedic surgery are relatively low (2 to 6.8%) and similar studies, involving a large number of generalized postoperative wound types, have reported overall infection rates of 3.4% in 5,129 operations, 4.7% in 62,939 operations , and 9.4% in 1,770 operations . In the last two studies, the infection rates ranged from 1.5% and 5.9% following clean surgery to 40% and 52.9% following contaminated surgery. Despite the frequency and prevalence of endogenous anaerobes in surgical wound infections, the Center for Disease Control and Prevention guideline for the prevention of surgical site infection has recognized Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp., Escherichia coli, P. aeruginosa, and Enterobacter spp. as the most frequently isolated pathogens. Unfortunately, this view has been based on only two published reports that provided no indication of the inclusion of anaerobic bacteriology in the associated studies, and hence the data may have been biased in favour of aerobic and facultative microorganisms [4]. Surgical site infections (SSI) are important numerically and as a cause of morbidity and prolonged hospital stay. SSI accounts for 12.3% of hospital acquired infections [5]. A study shows surgical site infection rates in India to be between 4 to 30% [6]. The control of post operative infection has become more challenging due to widespread bacterial resistance to antibiotics and the knowledge of the causative agents of post operative infection has therefore proved to be helpful in the selection of empiric antimicrobial therapy and on infection control measures in health institutions.
MATERIALS AND METHODS
This was a retrospective study of pus samples from post operative infections over a period of 1 year from February 2012 to January 2013. Total 102 samples were collected from patients visiting MGM Hospital Kamothe Navi Mumbai. Pus samples were collected with the help of 2 sterile disposable cotton swabs. One swab was used to make smear for detection of pus cells and microorganisms [7]. Other swab was used to inoculate onto Blood agar and MacConkey agar media and incubated at 37oC for 24 hours. After incubation, Identification of bacteria from positive cultures was done with standard microbiological technique which included Gram staining and biochemical reactions [8]. The antibiotic sensitivity test of all isolates was performed (according to CLSI guidelines) by modified Kirby Bauer’s disc diffusion method on Mueller Hinton agar or Blood agar medium using antibiotic discs of Hi media Laboratories Pvt. Limited, India [9].
RESULT
Total 102 patients having wound infection were included in this study, out of which 79 (77.4%) were male patients and 23 (22.6%) were female patients. Out of 102 samples, 73(71.5%) samples showed growth of aerobic bacteria whereas 29 (28.5%) were sterile. Among 73 positive samples, 62 (84.9%) samples were from male patients and 11(15.1%) samples were from female patients.
Out of 102 samples tested, 73 (71.5%) samples showed aerobic bacterial growth and 29 (28.5%) samples were sterile. Out of 73 positive samples 20 (27.3%) showed mixed infection and total 94 bacteria were isolated. Out of 94 bacterial isolates, 40 (42.5%) were Gram positive and 54 (57.4%) were Gram negative. Among Gram positive isolates, Staphylococcus aureus 24 (60%) was the most frequently isolated species and E.coli 15 (27.7%) was the most frequently Gram negative isolate.
ANTIBIOTIC SENSITIVITY PATTERN
The sensitivity pattern showed that the most effective antibiotic for Gram positive bacteria was Ampicillin + Sulbactam (87.5%) followed by Linezolid (85%) and Levofloxacin (85%). The least effective antibiotic for Gram positive was Ciprofloxacin (52.5%). For Gram negative bacteria, Lomifloxacin (70.3%) followed by Netilline (61.1%) and Gentamicin (61.1%) were the most effective antibiotics and Cefuroxime (18.5%) was the least effective antibiotic. For Staphylococcus aureus, the most effective antibiotic was Ampicillin + Sulbactam (87.5%) and Levofloxacinwas also equally effective whereas least effective antibiotic was Ciprofloxacin (54.1%). For Pseudomonas species, Ceftazidime (91.6%) was most effective antibiotic and least effective was Cefuroxime (25%). For E.coli, the most effective antibiotic was Gentamycin (73.3%) followed by amikacin (66.6%) and Netilline(66.6%). whereas the least effective antibiotic was Pefloxacin (6.6%).
DISCUSSION
In this study, total 102 patients, suffering from post operative infections, were included. Out of which 79 (77.4%) were male and 23 (22.6%) were female. The incidence of post operative infection was more common in males than in females. A study carried out in three hospitals (Federal Medical Centre, Owerri, Imo State University Teaching Hospital, Orlu and General Hospital, Okigwe) by Ohalete et al also supported the result who reported that the males (59.3%) were more prone to wound infection than females (40.7%) [10]. Most commonly isolated organism was Staphylococcus aureus 24 (25.5%) followed by E.coli 15 (15.9%) and Pseudomonas species 12 (12.7%). A similar study conducted in Tertiary Hospital in Benin City, Nigeria by Christopher Aye Egbe et al supported the result, as Staphylococcus aureus was the most commonly isolated bacteria [11]. Another similar study carried out in Nigeria by Akinjogunla, O. J. et al showed that most commonly isolated bacteria was Staphylococcus aureus (37.8%) followed by Pseudomonas species (27%) and E.coli (14.9%) [12]. Aizza Zafar et al and Diane M. Citron et al also supported the result [13, 14]. In vitro sensitivity testing of this study showed that Ampicillin + Sulbactam (87.5%) was the most effective antibiotic against Gram positive bacteria followed by Linezolid (85%). For Gram negative bacteria, Lomifloxacin (70.3%) followed by Netilline (61.1%) were the most effective antibiotics. Ciprofloxacin (52.5%) was the least effective antibiotic for Gram positive bacteria whereas Cefuroxime (18.5%) was the least effective antibiotic for Gram negative bacteria. This data was reinforced by study conducted by Arumugam Suresh et al who reported that Linazolid was the most effective drug agains Gram positive bacteria. A similar study conducted in Trivandrum, india by Asha Konipparambil Pappu et al, who also support the data [15]. Sivaraman Umadevi et al reported only 50% sensitivity of Ciprofloxacin [16]. For Staphylococcus aureus, the most effective antibiotics were Ampicillin + Sulbactam and Levofloxacin (87.5%) whereas least effective antibiotic was Ciprofloxacin (54.1%). For E.coli, the most effective antibiotic was Gentamycin (73.3%) followed by Amikacin (66.6%) and Netilline (66.6%) whereas the least effective antibiotic was Pefloxacin (6.6%). Pseudomonas aeruginosa was highly sensitive to Ciprofloxacin and Netilline (83.3%). This result was reinforced by V.Rajalakshmi et al [17].
CONCLUSION
The most common isolate in post operative infection was Staphylococcus aureus followed by, E.coli, Pseudomonas species, Enterococcus species, Klebsiella species, Enterobacter species and others. Ampicillin / Sulbactum (AS) and Linezolid (LZ) were the most effective antibiotics for Gram positive bacteria and Lomifloxacin followed by Netilline and Gentamicin were the most effective antibiotics for Gram negative bacteria.
Englishhttp://ijcrr.com/abstract.php?article_id=1260http://ijcrr.com/article_html.php?did=12601. Shittu A.O., Kolawole d. O., Oyedepo E.A.R, et al. A study of wound infections in two health institutions in ILE-IFE, NIGERIA. Afr. J. Biomed. Res. 2002; 5: 97- 102.
2. Matthew S. Dryden. Complicated skin and soft tissue infection. J Antimicrob Chemother. 2010; 65 Suppl 3: 35-44.
3. Shrestha B, Basnet R.B. Wound infection and antibiotic sensitivity pattern of bacterial isolates. PMJN. 2009 Jan-Jun; 9.
4. Bowler P.G., Duerden B. I., Armstrong D. G. Wound microbiology and associated approaches to wound management. CMR.2001; 14(2):244-269.
5. Mahy B. W, Meulen T, editors. Topley and Wilson’s Microbiology and Microbial Infection. 10th ed. Bacteriology. London: Hodder Arnold; 2007.
6. Suchitra Joyce B, Lakshmidevi N. Surgical site infection. Assessing risk factors, outcomes and antimicrobial sensitivity patterns. African Journal of Microbiology Research. 2009 April; 3(4): 175-179.
7. Cheesbrough M. District Laboratory Practice in Tropical Countries. 2nd ed. New York: Camridge University Press; 2006.
8. Washington C, Allen S. Koneman’s color atlas and textbook of Diagnostic Microbiology. 6th ed. Philadelphia: Lippincott Williams and Wilkins; 2006.
9. Performance Standards for Antimicrobial Disk Susceptibility Tests; Approved Standard-Ninth Edition. CLSI. M2-A9; 26: 1.
10. Ohalete, C.N. Bacteriology of different wound infections and their antimicrobial susceptibility pattern in IMO state Nigeria. World Journal of Pharmacy and Pharmaceutical Sciences. 2012; 1(3): 1155- 1172.
11. Egbe C. A. Microbiology of wound infections and its associated risk fectors among patients of tertiary hospital in Benin City Nigeria. JRHS 2011; 11(2): 109-113.
12. Akinjogunla, O. J. Bacteriology of automobile accident wound infection. International Journal of Medicine and Medical Sciences. 2009; 1 (2): 23-27.
13. Aizza Zafar, Naeem Anwar and Hasan Ejaz. Bacteriology of infected wounds – A study conducted at children’s hospital Lahore. Biomedica. 2008 Jan-Jun; 24: 71-74.
14. Diane M. Citron. Bacteriology of moderate to severe Diabetic foot infections and in vitro activity of antimicrobial agents. J. Clin. Microbiol. 2007; 45(9):2819.
15. Pappu A. K. Microbiological profile of Diabetic Foot Ulcer. Calicut Medical Journal 2011; 9(3):e2.
16. Umadevi S. Microbiological study of diabetic foot infections. Indian Journal of Medical Specialities. 2011; 2(1):12-1
17. Rajalakshmi V. Antibiotic Susceptibility of Bacterial Pathogens Isolated from Diabetic Patients. International Journal of Microbiological Research. 2011; 2(3): 273- 275.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareCOMPLETE OSSIFICATION OF SUPERIOR TRANSVERSE SCAPULAR LIGAMENT: INCIDENCE AND ITS CLINICAL IMPLICATIONS
English8087Parineeta SumanEnglish Raj Kishore MahatoEnglish Sabita SinghEnglish ArunKumar.S.BilodiEnglishIntroduction and Aims- The ossified superior transverse scapular ligament is one of the risk factor for the suprascapular nerve entrapment neuropathy and poses a challenge during suprascapular nerve decompression.This study has been done to understand the various mechanisms of neural injury leading to suprascapular entrapment neuropathy and to compare its incidence in different populations. Materials and Methods-131 dryIndianhuman scapulae (64-right and 67-left) were examined and analysed. Results-6.1%(8 in 131) scapulae presented with completely ossified STSLof which 3 on right side and 5 on left side. Conclusion- The anatomical knowledge of ossified STSLmay be helpful for clinician dealing with suprascapularnerve entrapment neuropathy and the knowledge of underlying mechanism of injury to nerve may be helpful in planning the appropriate treatment strategy.
EnglishScapula, Superior transverse scapular ligament, Suprascapular notch, Suprascapular neuropathy, ossification.INTRODUCTION
The superior transverse scapular (suprascapular) ligament is a thin flat fibro-fasciculus band attached laterally to the base of the coracoid process and medially to the medial (inner) side of the suprascapular notch.1,2The ligament and the notch together form a sharp edged inelasticosteofibrous foramen through which suprascapular nerve travels.3,4Suprascapular artery and vein usually pass over the ligament.1,5The classic description of superior transverse scapular ligament (STSL) is a completely non-ossified single band and should be expected on average, in three-fourth of cases.6 The documented variation of STSL includes calcification, partial or complete ossification and multiple bands.6 The ossification of the STSL was considered anomalous by Harris et al.7The size and shape of suprascapular notch may be a factor in suprascapular nerve entrapmentneuropathybecause narrow notch has been found in patient with this neuropathy.8,9 Suprascapular nerve entrapment neuropathy has also been described in clinical scenario without a visible ossification of STSL.10This is characterised by weakness of abduction and external rotation of the arm due to supraspinatus and infraspinatus muscle denervation and frequently accompanied by ill-defined shoulder pain.11 Variable incidence of complete ossification of STSL has been reported by research workers which vary in different population. In Indian scenario paucity ofdata on complete ossification are available. Hence this study has been reported to compare the incidence of ossified STSL in different population, to explain its various mechanismand to discuss its clinical implications.
MATERIALS AND METHODS
The present study was carried out on 131(Right64, Left-67) dried human scapulae of unknown sex obtained from Department of Anatomy, SVS Medical College,Mahabubnagar, Andhra Pradesh and Raichur Institute of Medical Sciences, Raichur, Karnataka. Each scapula was observed to see the presence of completely ossified STSL. Representative photograph of STSL were taken using digital camera (sony 16 megapixel).Quantative data pertaining to the dimensions of STSL were recorded in milimeters.Dimensions of STSL (Superior maximal length, inferior maximal length, thickness at medial and lateral end) has been measured with divider and meter scale. The scapula with bilaterally damaged superior margin were excluded from the study.
RESULTS
Macroscopic examination revealed that 8 (3- right side, 5- left side) out of 131 (6.1%) scapulae had completely ossified STSL.Dimensions measuredare given in Table-2.
DISCUSSION
Thecompletely ossified STSL is one of the most important factorsof suprascapularnerve entrapment neuropathy andmay pose achallengeat surgical exploration during a suprascapular nerve decompression.6,12Incidence of complete ossification of STSL differs from population to population as shown in table-1. In the present study we observed 6.1% incidence of completely ossified STSL which is close to Polguej12( 6.25%).Silva etal. 13 have reported 30.76% incidencewhich is quite high as compared to our study(6.1%).Gray D J14 found 6.34%(73 in 1151) suprascapular foramen but no foramen in 87 Indian scapulae. In some population complete ossification of STSL was very rare for eg. in Alaskan Eskimos-0.3%, native American- 2.1- 2.9%.15Osuagwuet al. 10 reported a case of complete ossification of STSL in Nigerian male adult. Khan16andDas etal. 17also have reported cases of complete ossification of STSL in Indian population.Cohen18et al described a familial case of calcification of STSL affecting a 58 year old man and his son who had STSL calcification causing entrapment neuropathy of suprascapular nerve and its attendant clinical symptoms of pain, weakness and atrophy of supraspinatus muscle. Usually cases of Suprascapular nerve entrapment neuropathy due to ossified STSL complain of deep and diffuse, poorly localized dullor burning pain in the posterolateralaspectof shoulder, which exaggerate on activity and often can be elicited by palpation over the region of the scapular notch. In some cases the pain radiates to theipsilateral extremity, the side of the neck or the front of the chest. The pain is accompanied by weakness on abduction and external rotation of the shoulder and atrophy of supraspinatus and infraspinatus muscle.19,20Muscle atrophy usually begins before the clinical signs andsymptoms and patient’s complaints.19,20,21Thethorough understanding of anatomy of suprascapular nerve is of paramount importancefor an early diagnosis and proper treatment. Suprascapular nerve, a long mixedsensorimotor peripheral nerve originates from the lateral aspect of superior trunk of the brachial plexus with contribution from the 5th and 6th anterior cervical roots, occasionally from 4th root as well. The nerve then travelsdown to reach the upper border of the scapula and enters the supraspinatus fossa through the suprascapular notchbelowthe STSL(suprascapular vessels usually abovethe STSL). The nerve travel obliquely along the floor of the supraspinatus fossa under supraspinatus muscle,supplies it and take a sharp turn around the lateral margin of the base of the scapular spine with the suprascapular vessels passing below a debated(60.8%)22spinoglenoid ligament to enter the infraspinatus fossa.Here it supplies the infraspinatus muscle.1,4,5,11,19,23 The suprascapular nerveentrapment neuropathy may be of -chronic type (compression, traction, friction leading to repetitivemicrotrauma) or acute type (direct trauma eg. fracture of scapula,dislocation of shoulder,fractureneck of humerus,fracture of the clavicle).11,20,21Suprascapular nerve is commonly susceptible to compression mainly at two major sites, suprascapular notch and spinoglenoid notch.6 Suprascapular nerve injury at suprascapular notch may occur as a result of compression by the overlying superior transverse scapular ligament, specially if it is ossified,12,17 calcified,18 bifid,24 trifid,6 hypertrophied25and/or presence of anterior coracoscapular ligament just below the STSL as reported by Avery 60% (16 in 27)26, Bayramoglu18.8%(6 in 32 )23 , Piyawinijwong 28%(19 in 127)27, Polguej50%(47 in 93)12 and/or presence of space occupying lesion eg. ganglionic cyst reported by Ticker6 , might be due to reduction in available space for the suprascapular nerve passage. The shape of suprascapular notch has been associated with the risk of nerve injury as well. Rangachary9 et al. examined 211 cadaveric scapulae and categorized the notch shape into 6 different types –TypeI-no discrete notch, Type IIwide V-shaped notch, TypeIII- wide U-shaped notch, TypeIV- narrow V-shaped notch with impression of nerve, TypeV- U-shaped notch with partial ossification, TypeVI- bony foramen.Our study is concerned to Type VI. Ticker6 classified the notch into two types ‘U’and ‘V’shaped. Although it has been hypothesized that suprascapular nerve entrapment is more likely to be associated with narrow V-shaped notch, no direct correlation between notch type and suprascapular nerve injury has been demonstrated.28 The suprascapular nerve entrapment neuropathywithout visible ossification of STSLcan be explained by another mechanism of nerve injury ie. traction (mechanical stretching) with or without friction (rubbing) of suprascapular nerve. The nerve courses through several areas of critical nerve fixation (like at the site of emergence and termination of the nerve, at the suprascapular notch and spinoglenoid notch, on the floor of supraspinatus fossa under the hypertrophied supraspinatus muscle) and areas of sharp turns. Due to repetitive overhead activities and forceful rotational movements during sports such as volleyball,29baseball,30the suprascapular nerve is subjected to traction and kinking specially at suprascapular and spinoglenoid notches as the nerve is within a notch and held by a overlying ligament.6,24,25,31Rangachary9 et al. found that nerve become closely opposed to the STSL with depression, retraction and hyperabduction of shoulder and hypothesized that mechanism of nerve injury might involve kinking of the nerve against the STSL(sling effect). The stretching of the nerve may also be exacerbated by scapular protraction which move the scapula(and its base of the spine) laterally. It has been hypothesized that this stretching of nerve can be further exacerbated by simultaneous contraction of infraspinatus muscle in which contracted infraspinatus muscle pulls the nerve medially while it is tethered laterally by the base of the spine of the scapula.29 It has been shown that spinoglenoid ligament inserts into posterior glenohumeral capsule, so during cross body adduction and internal rotation, ligament is tightened and nerve is compressed.22,32Sandowet al. reported that during extreme abduction and full external rotation medial tendinous margin of the supraspinatus and infraspinatus can impinge strongly against the lateral edge of spine, compressing the infraspinatus branch of suprascapular nerve.33Hypertrophied spinoglenoid ligament also causes compression of suprascapular nerve at spinoglenoid notch leading to suprascapular nerve entrapment neuropathy as described by Aeilloet al32. Most paralabral cysts compress the suprascapular nerve only at spinoglenoid notch as it passes within 21 mm from the glenoid rim.34The enlarged spinoglenoid notch vein has been identified as cause of suprascapular nerve compression.35 Another hypothesis of injury is that the intimal damage of axillary or suprascapular artery due to direct trauma or friction can result in microemboli of the vasa nervorum which can result in ischaemic injury to the nerve.31 The best method to prevent permanent muscle atrophy is the early diagnosis and treatment.While dealing a case of shoulder pain and weakness, along with the natural history of suprascapular nerve injury, family history of such complaints and related treatment should be taken into consideration which may help in diagnosis.Most of the authors have agreed that electromyography(EMG) study is essential to confirm suprascapular nerve entrapment neuropathy. The nerve conduction velocity(NCV) is helpful but not essential for the diagnosis.19Radiograph and CT-scan may be useful in assessing the shape of notch, calcified ligament or fracture callus. MRI is particularly helpful in identifying course of nerve, presence of soft tissue lesion(usually cyst) and also in ruling out the other causes of shoulder pain such as rotator cuff tear.20,21 The treatment of suprascapular entrapment neuropathy depends on the duration of the symptoms and the location and cause of entrapment.36If the neuropathy is of acute onset or secondary to a traction injury rather than to a compressive neuropathy, it should respond to non-operative treatment consisting of relative rest and pain control followed by progressive range of motion and controlled strengthening excercises. However, residual atrophy may persist regardless of the type of treatment.21,37If the nerve lesion is proximal and both the supraspinatus and infraspinatus muscles are involved, the entire nerve should be decompressed but most importantly the superior transverse scapular ligament should be released or sectioned from its medial attachment to minimize the risk of injury to the more laterally located suprascapular nerve and vessels.21The ossified STSL is a relative contraindication to the arthroscopic release of STSL.So it should be evaluated preoperatively when considering arthroscopic neurolysis.37 A quarter-inch osteotomy can be used to resectthe ossified STSL.38But if only the infraspinatus muscle is involved or there is a structural lesion at the spinoglenoid notch such as paralabral cyst, the nerve may be simply decompressed at the notch. Some surgeons recommend release or section of both the suprascapular and spinoglenoid ligaments even if lesion is at spinoglenoid notch.20,34Surgical exploration withrelease of compression or traction does not help in regeneration of the nerve or resolution of the atrophy.21 Limitation of the study is that the person with ossified STSL might have suprascapularnerve entrapment neuropathy,but the work was done on dry bone so without clinical history it is hard to say that person had suprascapular nerve entrapment neuropathy.Since the present study was performed with a limited number of dry scapulae,more clinical, radiological and cadaveric studies need to be done.
CONCLUSIONS
The present study revealed that incidence of complete ossification of STSL varied in different populations and it can be one of the risk factors for suprascapular entrapment neuropathy.The anatomical knowledge of understanding of the mechanism of this neuropathy may be helpful in planning the appropriate treatment strategy and thus avoiding the poor treatment outcome or treatment failure.
ACKNOWLEDGEMENT
We sincerely thank the Department of Anatomy, SVS Medical College, Mahabubnagar, Andhra Pradesh and Raichur Institute of Medical Sciences, Raichur, Karnataka for granting permission to carry out the work. Authorsalso acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript.
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5. Yang HJ,GilYC,JinJD,Ahn SV, Lee HY.Topographical anatomy of the suprascapular nerve and vessels at the suprascapular notch.Clin Anat.2012 Apr;25(3):359-65.
6. Ticker, J. B.; Djurasovic, M.; Strauch, R. J.; April, E.W.; Pollock, R. G.; Flatow, E. L. andBigliani, L.U. The incidence of ganglion cysts and variations in anatomy along the course of the suprascapular nerve. J. Shoulder Elbow Surg., 1998;7(5):472-8.
7. Harris, R. I.; Vu, D. H.; Sonnabend, D. H.; Goldberg, J. A. and Walsh, W.R. Anatomic variance of the coracoclavicular ligaments. J. Shoulder Elbow Surg., 2001;10:585-8.
8. Dunkelgrun M, Iesaka K, Park SS,Kummer FJ, and Zuckerman JD. Interobserver reliability and intraobserver reproducibility in suprascapular notch typing. Bull Hosp Joint Dis.2003;61:118-22.
9. Rengachary, S. S.; Burr, D.; Lucas, S.; Hassanein, K.M.; Mohn, M.P. andMatzke, H. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 2. Anatomical study. Neurosurg.,1979;5:447-51.
10. Osuagwu, F. C; Inocemi, I. O. andShokunbi, M. T. Complete ossification of the superior transverse scapular ligament in a Nigerian male adult. Int. J. Morphol., 2005;23(2):121- 2.
11. Holzgraefe M, Kukowski B, Eggert S. Prevalence of latent and manifest suprascapular neuropathy in high level volleyball players. Br J Sports Med. 1994;28:177-179.
12. Michal Polguj, Jedrzejewski K, AgataMajos, Topol M. Variations in bifid superior transverse scapular ligament as a possible factor of suprascapular entrapment: an anatomical study. Int. Ortho. (SICOT). 2012;36:2095-2100.
13. Silva, J. G.; Abidu-Figueiredo, M.; Fernandes, R. M. P.; Aureliano-Rafael, F.; Sgrott, E. A.; Silva, S. F. and Babinski, M. A. High Incidence of Complete Ossification of the Superior Transverse Scapular Ligament in Brazilians and its Clinical Implications Int. J. Morphol., 2007;25(4):855-859.
14. Gray, D. J. Variations in the human scapulae. Am. J. Phys. Anthropol., 1942;29:57-72.
15. Hrdlicka A. The scapula: visual observations. Am J PhysAnthropol. 1942;29:73-94.
16. Khan, M. A. Complete ossification of the superior transverse scapular ligament in an Indian male adult. Int. J. Morphol.,2006;24(2):195-6.
17. Srijit Das, Rajesh Suri,VijayKapur. Ossification of Superior Transverse Scapular Ligament and its Clinical Implications. Sultan Qaboos University Medical Journal. August 2007 ;Vol 7, No. 2, P. 157-160 .
18. Cohen, S. B.; Dnes,D.M.and Moorman, C.T. Familial calcification of the superior transverse scapula ligament causing neuropathy. Clin. Orthop. Rel. Res., 1997;334:131-5.
19. Martin SD, Warren RF, Martin TL, Kennedy K, O’Brien SJ, Wickiewicz TL. Suprascapular neuropathy: results of nonoperative treatment. J Bone Joint SurgAm. 1997;79:1159-1165.
20. Th. Fabre, C. Piton, G. Leclouerec, F. Gervais-Delion, A. Durandeau Entrapment of the suprascapular nerve J Bone Joint Surg Br.,May 1999;Vol. 81-B, No. 3, 414-419.
21. Marc R Safran Nerve Injury About the Shoulder in Athletes, Part 1 Suprascapular Nerve and Axillary Nerve .The American J of Sports Medicine, 2004;Vol. 32, No. 3 , 803-819.
22. Demirhan M, Imhoff AB, Debski RE, Patel PR, Fu FH, Woo SL The spinoglenoid ligament and its relationship to the suprascapular nerve. J Shoulder Elbow Surg. 1998 May-Jun;7(3):238-43.
23. A. Bayramoglu, D. Demiryurek, E. Tuccar, M. Erbil, M.M. Aldur, O. Tetik, M.N.Doral. Variations in anatomy at the suprascapular notch possibly causing suprascapular nerve entrapment: an anatomical study. Knee Surg Sports Traumatol Arthrosc,2003;11:393- 398.
24. Alon M, Weiss S, Fishel B, Dekel S. Bilateral Suprascapular nerve entrapment syndrome due to an anomalous transverse scapular ligament. ClinOrthop. 1988;234:31-33. 25. Garcia G, McQueen D. Bilateral suprascapular nerve entrapment syndrome: case report and review of the literature. J Bone Joint Surg Am. 1981;63:491-492.
26. Avery BW, Pilon FM, Barclay JK. Anterior coracoscapular ligament and suprascapular nerve entrapment. Clin Anat. 2002;15:383- 386.
27. PiyawinijwongSithaPiyawinijwong, PhongpanTantipoon, The Anterior Coracoscapular Ligament in Thais: Possible Etiological Factor of Suprascapular Nerve Entrapment .Siriraj Med J 2012; 64 (Suppl 1): S12-S14.
28. Cummins CA, Anderson K, Bown M, Nuber G, Roth SI. Anatomy and histological characteristics of the spinoglenoid ligament. J Bone Joint Surg Am. 1998;80:1622-1625.
29. Ferretti A, Cerullo G, Russo G. Suprascapular neuropathy in volleyball players. J Bone Joint Surg Am. 1987;69:260-263.
30. Bryan WJ, Wild JJ Jr. Isolated infraspinatus atrophy. A common cause of posterior shoulder pain and weakness in throwing athletes? Am J Sports Med 1989;17:130-1.
31. Ringel SP, Treihaft M, Carry M, Fisher R, Jacobs P. Suprascapular neuropathy in pitchers. Am J Sports Med. 1990;18:80-86.
32. Aiello L, Serra G, Traina GC, Tugnoli HW. Entrapment of the suprascapular nerve at the spinoglenoid notch. Ann Neurol. 1982;12:314- 316.
33. Sandow MJ, Ilic J. Suprascapular nerve rotator cuff compression syndrome in volleyball players. J Shoulder Elbow Surg. 1998;7:516-521.
34. Fehrman DA, Orwin JF, Jennings RM. Suprascapular nerve entrapment by ganglion cysts: a report of six cases with arthroscopic findings and review of the literature. Arthroscopy. 1995;11:727-734.
35. Carroll KW, Helms CA, Otte MT, Moellken SMC, Fritz R. Enlarged spinoglenoid notch veins causing suprascapular nerve compression. Skeletal Radiol.2003;32:72- 77.
36. Sarah yanny, Andoni P. Toms. MR patterns of denervation around the shoulder. Musculoskeletal Imaging Review. AJR:195, August 2010.
37. Peter J. Millett, R. Shane Barton, Iva´n H. Pacheco and Reuben Gobezie. Suprascapular Nerve Entrapment: Technique for Arthroscopic Release Techniques in Shoulder and Elbow Surgery2006;7(2):1-6.
38. Ghodadra Neil Ghodadra, M.D., Shane J. Nho, M.D., M.S., Nikhil N. Verma, M.D., StfanieReiff, B.A.,Dana P. Piasecki, M.D., Matthew T. Provencher, M.D., and Anthony A. Romeo, M.D. Arthroscopic Decompression of the Suprascapular Nerve at the Spinoglenoid Notch and Suprascapular Notch Through the Subacromial Space. Arthroscopy: The Journal of Arthroscopic and Related Surgery,April 2009;Vol.25 No 4, 439-445.
39. Natsis K, Totlis T, Tsikaras P, Appell HJ, Skandalakis P, Koebke J. Proposal for classification of the suprascapular notch: a study on 423 dried scapulas. Clin Anat. 2007;20:135–9.
40. Edelson JG. Bony bridges and other variations of the suprascapular notch. J Bone Joint Surg Br. 1995;77:505–6.
41. Sinkeet SR, Awori KO, Odula PO, Ogeng’o JA, Mwachaka PM. The suprascapular notch: its morphology and distance from the glenoid cavity in a Kenyan population. Folia Morphol (Warsz). 2010;69:241–5.
42. S D Jadhav, R J Patil, P P Roy, M P Ambali, M A Doshi, Rajeev R Desai Supra-scapular foramen in Indian dry scapulae. National Journal of Clinical Anatomy. 2012 Vol.- 1(3), 133-135.
43. KalpanaThounaojam, RenucaKaram, N. Saratchandra Singh. Ossification of transverse scapular ligament. Journal of Evolution of Medical and Dental Sciences. 2013;Vol-2(12):1790-91.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareTHE INCIDENCE OF OSSIFIED SUPERIOR TRANSVERSE SCAPULAR LIGAMENT (STSL) IN TAMIL NADU POPULATION OF INDIA
English8892A. PerumalEnglish Ravichandran D.EnglishBackground: Suprascapular neuropathy is due to suprascapular nerve entrapment in the suprascapular foramen and it is one of the causes for chronic shoulder pain and dysfunction. The suprascapular notch in the superior border of the scapula is usually bridged by the Superior Transverse Scapular Ligament (STSL). Sometimes the ligament gets ossified and compresses the suprascapular nerve passing deep to it producing the characteristic symptoms of compression neuropathy. The incidence of the ossified STSL varies in different ethnic populations. This study attempts to delineate the incidence of ossified STSL in Tamil Nadu population of India. Materials and Methods: Two hundred and thirty seven (237) dry human scapulae were studied. The presence of ossified STSL noted by macroscopic examination with naked eye. Results were tabulated and statistical analysis done. Results: 9.7% of bones show complete ossification of STSL and 10.9% of bones showed partial or incomplete ossification of STSL. Conclusion: The knowledge of incidence of ossified STSL is essential for surgeons performing surgical decompression of the entrapped supra scapular nerve. This paper adds to the morphological data of the Tamil Nadu population, which would be of use to the Orthopedic surgeons working in this area.
EnglishScapula, superior transverse scapular ligament, entrapment, decompression, incidence.INTRODUCTION
The superior border of the scapula in its lateral aspect presents a notch, called the Suprascapular Notch (SN). The notch is converted into a foramen by the Superior Transverse Scapular Ligament (STSL) which bridges the edges of the notch. The Suprascapular Nerve (SSN) passes deep to the ligament whereas the suprascapular vessels pass superior to the ligament. The SSN gives motor innervations to the supraspinatus and infraspinatus muscles and sensory innervations to the rotator cuff muscles and to the shoulder and acromioclavicular joint. Suprascapular nerve neuropathy is a common cause of chronic shoulder pain and dysfunction1 . The suprascapular notch is one of the potential site for compression of the nerve. The condition was first described by Thomas2 in the year 1936. Other etiologies associated with SSN neuropathy include direct trauma, rotator cuff tear, ganglion cysts causing compression, sports injury due to repeated traction, variation of the SN morphology1,3. Apart from these, the ossification of the STSL has also been attributed to be one of the most important cause of SSN compression 4,5,6,7. The knowledge of this clinical condition is essential for the orthopaedic surgeons operating in this area. There is a paucity of information regarding the incidence of ossified STSL in the literature. The present study aims to estimate the incidence of ossified superior transverse scapular ligament in Tamil Nadu population of India. MATERIALS AND METHODS Data for this study are comprised of 237 dry scapulae (Right - 107 and Left - 130) irrespective of sex and age belonging to Tamil Nadu population. The collection was obtained from the bone bank of Anatomy department, VMKV medical college, Salem, India. As criteria of inclusion, none of the scapulae presented fractures, malformations, damage due to conservation or pathologies that could influence the development of the studied region. Each of the scapulae were examined macroscopically for the presence of ossified superior transverse ligament (complete or partial). The results were tabulated and analyzed statistically.
RESULTS
The results are presented in Table 1. Complete ossification of the superior transverse scapular ligament (Fig. 1) was observed in 9.7 % of bones ( 23 bones out of 237). Incomplete or partial ossification of the superior transverse scapular ligament (Fig. 2) was observed in 10.9% of bones (26 bones out of 237).
DISCUSSION
The role of suprascapular nerve entrapment in chronic shoulder pain and dysfunction is well appreciated by Orthopedic surgeons. The morphology of the bony notch altered due to ossification of STSL has been one of the significant causes for entrapment8 . The incidence of ossified STSL has been reported as 1.5% in Finnish population9 , 6.5% in Italian population 10 , 30.76% in Brazilian population 11 and as 10.57% in Indian population 12 . Our study results closely coincide with the results of the other Indian study (Table II). The STSL experiences both compressive and tensile forces. This is indicated by the presence of fibro cartilage entheses13 in the ligament. The incidence of ossification has been noted to increase with age14. This finding indicates that the compressive and tensile forces play a role in the ossification. Research also confirms that the STSL may be calcified partially or ossified completely4,5. Silva 11 has proposed that the pull of muscles and certain habits of life at utilization of the upper limbs are the probable causes of high incidence of calcification in the studied population. Familial cause for calcification has also been described15 . Patients presenting with chronic shoulder pain, dysfunction and wasting of the muscles innervated by suprascapular nerve require surgical decompression of the same. The surgical technique includes direct exploration or arthroscopic release. Arthroscopic release of the STSL is the current trend in the surgical treatment of the suprascapular nerve entrapment neuropathy. The technique of arthroscopic release has been found better when compared to the routine or traditional open release technique16. In arthroscopic release the neurovascular structures and STSL are better visualized and also the procedure is simple and less invasive when compared to direct exploration16. Variation in the STSL as in case of its ossification, the surgical procedure becomes more difficult and risky. Injury to the suprascapular vessels and nerve are the potential risk factors in case of ossified STSL. The choice of instruments (arthroscopic burr VS Kerrison punch) is also to be decided preoperatively in decompressing the suprascapular nerve entrapped due to ossified STSL1,16 . The present study revealed an incidence of 9.7% and 10.9 % of complete and incomplete ossification of STSL respectively. The present study adds to the pre existing data on ossified STSL in Tamil Nadu population and may be useful to the orthopedic surgeons operating in this area.
CONCLUSION
Based on the present study, it can be inferred that the compressive and tensile forces play a role in either partial or complete ossification of STSL. The knowledge of incidence of ossified STSL is essential for surgeons performing surgical decompression of the entrapped suprascapular nerve. The authors recommend cross-sectional studies with large sample size taking into account additional parameters like the age and gender of the bones in future.
ACKNOWLEDGEMENTS
The authors sincerely wish to thank the management, administrators and the Professor and Head of the department of Anatomy of Vinayaka Missions Kirupananda Variyar Medical College, Salem for their whole hearted support and permissions to utilize their resources and conduct this study. The authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1262http://ijcrr.com/article_html.php?did=12621. Vivek Agrawal . Arthroscopy. The Journal of Arthroscopic and Related Surgery 2009; 25 (3): 325-328.
2. Thomas A. La paralysie du muscle sounepineux 1936; 64: 1283-1284.
3. Charalambos P. Economides et al. An unusual case of suprascapular nerve neuropathy: a case report. Journal of Medical Case Reports 2011; 5: 419.
4. Srijit Das, Rajesh Suri, Vijay Kapur. Ossification of Superior Transverse Scapular Ligament and its Clinical Implications. Sultan Qaboos University Medical Journal 2009; 7(2): 157-160.
5. Ticker JB et al. The incidence of ganglion cysts and other variations in anatomy along the course of the suprascapular nerve. J. Shoulder Elbow Surg 1998; 7: 472-478.
6. Lewis OJ. The coracoclavicular joint. J. Anat 1959; 93: 296-303.
7. Harris RI, Vu DH, Sonnabend DH et al. Anatomic variance of the coracoclavicular ligaments. J Shoulder Elbow Surger 2001: 10: 585-588.
8. Rengachary SS, Burr D, Lucas S. Suprascapular entrapment neuropathy: a clinical, anatomical, and comparative study. Part 3: comparative study. Neurosurgery 1979; 5: 452-455.
9. Kajava Y. Uber den Schultergiirtel der Finen. Ann Acad Sci. Fenn. Series A 1924; 21 (5): 1-69.
10. Vallois HV. L’os acromial dans les races humaine. L’Anthropologie, Paris 1925; 35: 977-1022.
11. Silva JG et al. High incidence of complete ossification of the superior transverse scapular ligament in Brazilians and its clinical implications. Int. J.Morphol 2007; 25 (4): 855-859.
12. Jadav SD et al. Supra-scapular foramen in Indian dry scapulae. National Journal of Clinical Anatomy 2012; 1(3): 133-135.
13. Morrigl B. Jax P, Milz S. et al. Fibrocartilage at the entheses of the suprascapular (superior transverse scapular) ligament of man – A ligament spanning two regions of a single bone. J. Anat 2001; 199 (5): 539 – 545.
14. Hrdlicka A. The scapula: Visual observations. Am J Phys Anthropol 1942; 29: 73-94.
15. Cohen SB, Dnes DM, Moorman CT. Familial calcification of the superior transverse scapular ligament causing neuropathy. Clin Orthop Rel Rs 1997; 334: 131-135.
16. Laurent Lafosse, Andrea Tomasi, Gloria Baier et al. Arthroscopic Release of Suprascapular Nerve Entrapment at the Suprascapular Notch: Technique and Preliminary Results. Arthroscopy. The Journal of Arthroscopic and Related Surgery 2007; 23 (1): 34-42.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareUNILATERAL ANATOMICAL VARIATION OF RADIAL ARTERY - CLINICAL IMPLICATION OF SUPERFICIAL RADIAL ARTERY
English9394Prabha UdayakumarEnglish VinodhadeviEnglish Vijayakumar D.A.EnglishThe anatomical variations with respect to the origin of radial artery has been reported extensively in the literature. The incidence of superficial radial artery is 0.5% and associated with high origin of radial artery. Awareness about normal variation and the possibility of unilateral variation of radial artery course could prevent complications during intravenous and arterial cannulation in the upper limb.
EnglishUnilateral Anatomical variation, Superficial Radial Artery, Arterial cannulationINTRODUCTION
A 65yr old male patient belonging to American Society of Anesthesiologists Class 3 was posted for Thoracic Pott’s spine decompression and stabilisation. A wide bore intravenous cannulation and an arterial cannulation was planned for invasive monitoring. An abnormal pulsation of the blood vessel in the origin of cephalic vein region was noted on the right distal forearm as we were about to cannulate the cephalic vein (Fig 1). Normal radial artery pulsation on the right side was absent. Surprisingly, the radial artery course on the distal left forearm was normal and was cannulated. Postoperatively, we confirmed that there was no history of bony or soft tissue injury. The anatomical variations with respect to the origin of radial artery has been reported extensively in the literature by anatomists. The incidence of superficial radial artery is 0.5% and associated with high origin of radial artery.1 Abnormal course of radial artery and its implications during percutaneous coronary intervention and radial artery graft retrieval during coronary artery bypass grafting, has been reported by interventional cardiologist 2 and cardiothoracic surgeons.3 Anaesthetic implication of such variation would be inadvertent arterial cannulation and accidental injection of the drugs intra-arterially. Inadvertent injection of drugs intra-arterially, would lead to arterial spasm, gangrene.4 To conclude, awareness about normal variation and the possibility of unilateral variation of radial artery course could prevent complications during intravenous and arterial cannulation in the upperlimb. All medical personnel should be aware of such variations and to be borne in mind even during simple procedures like intravenous cannulation. Whenever Cephalic vein is prominent or tortuous do look for the pulsatality of the vessel before cannulation.
Englishhttp://ijcrr.com/abstract.php?article_id=1263http://ijcrr.com/article_html.php?did=12631. Rodríguez-Niedenführ M, Vázquez T, Nearn L, Ferreira B, Parkin I, Sañudo JR. Variations of the arterial pattern in the upper limb revisited: a morphological and statistical study, with a review of the literature. J Anat 2001;199:547-566.
2. Jelev L, Surchev L. Radial artery coursing behind the bicepsbrachii tendon: significance for the transradial catheterization and a clinically oriented classification of the radial artery variations. Cardiovasc Intervent Radiol 2008;31:1008-1012.
3. Alameddine AK, Alimov VK, Engelman RM, Rousou JA, Flack JE 3rd, Deaton DW, Engelman DT. Anatomic variations of the radial artery: Significance when harvesting for coronary artery bypass grafting. J Thorac Cardiovasc Surg 2004;127:1825-1827.
4. MacPherson RD, McLeod LJ, Grove AJ. Intra-arterial thiopentone is directly toxic to vascular endothelium. Br J Anaesth 1991;67:546-552
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareAXILLOPALMAR ARTERY- AN ANAMOLOUS EXISTENCE OF AN ARTERY REPLACING SUPERFICIAL PALMAR ARCH WITH REGRESSION OF ULNAR ARTERY- A CASE REPORT
English9598Sharmada K LEnglish Arvind YadavEnglish Sujana M.English Soumya S.EnglishSince human dissection started Vascular variations have always been recorded in origin, course, length, and branching pattern by researchers all across the world which is a subject of controversy and curiosity because of its clinical significance. Interesting vascular variations of upper limb have long received attention of Anatomists, Surgeons and Radiologists. The existence of an anomalous artery in upper limb was encountered during routine dissection for medical undergraduate students. In current case, there was regression of ulnar artery along with absence of superficial palmar arch which was counteracted by a long artery arising from Axillary artery. The occurrence of this interesting variation with reference to origin, course, relations, clinical importance and embryological facts will be discussed during presentation.
EnglishAxillopalmar artery, Ulnar artery, Superficial Palmar arch, Vascular variation.INTRODUCTION
Vascular variations have been recorded regarding origin, course, and length and branching pattern by researchers all across the world which is a subject of controversy and curiosity because of its clinical significance. Interesting vascular variations of upper limb have long received attention of anatomists, Surgeons andRadiologists. Axillary artery is the direct continuation of the subclavian artery at the level of outer border of the first rib. The course of the Axillary artery is anatomically divided into three parts by the pectoralis minor muscle. The first part of the artery gives off superior thoracic artery, second part gives off lateral thoracic and thoracoacromial branch and Sub scapular artery, Anterior and Posterior Circumflex humeral artery arise from the third part. Normally, the ulnar artery begins distal to the bend of the elbow as the larger of the two terminal divisions of the brachial artery. The term Axillopalmar artery is applied to an artery which arises from the axillary artery and courses over the origins of the superficial forearm muscles to join at the mid level of the forearm with the ulnar artery. The Axilloplamar artery has been reported with different terminologies: arteria antebrachialis superficialis ulnaris, high origin of the ulnar artery and superficial ulnar artery with a high origin.
OBSERVATION
During routine anatomy dissection classes for medical undergraduates at MRA Medical College Ambedkarnagar, U.P, we found an anomalous artery arising from second part of axillary artery in axilla of approximately 70 year-old male cadaver. The course, relation of the anamolous artery was studied carefully. The anomalous artery descended along the arm superficial and medial to the median nerve and it gaves muscular branch to the biceps brachii. At the elbow the artery passed superficial to the bicipital aponeurosis and proximal to elbow the artery was subjacent to the median cubital vein. After that, the artery coursed obliquely downwards and medially, superficial to the forearm flexor muscles and in distal part of the forearm it laid between flexor carpi ulnaris and flexor digitorum superficialis muscles. The artery then passed superficial to the flexor retinaculum and lateral to the ulnar nerve, where it divided into two terminal branches to supply the palm and fingers, superficial palmar arch as such was not observed. The brachial artery had a normal course in the arm but it divided into the radial and ulnar arteries at the upper angle of cubital fossa, and the radial artery was of larger caliber instead of ulnar artery. The ulnar artery gave off common interosseous branch and after a short course post.introsseeous artery arose, the main trunk coursed down as ant introsseos artery which after supplying the muscles of flexor compartment underwent regression in the lower part of the forearm. The arterial course and branching pattern was normal on the opposite side.
DISCUSSION
Saeed et al. (2002) reported a bilateral common subscapular-circumflex humeral trunk (3.8%) emerging from the 3rd part of the axillary artery (branching into the circumflex humeral and thoracodorsal arteries). Vijaya Bhaskar et.al (2006) reported a case of bifurcation of axillary artery into Superficial and Deep Brachial arteries. Deep brachial artery gave origin to Anterior and Posterior circumflex humeral, Subscapular and Profunda brachii arteries. Reported incidence of this anomalous branching is 0.12 – 3.2 %. Sharadhkumar et. al.(2012)reported a unusual large branch from the brachial artery was variant of ulnar artery descends on lateral side of arm up to cuboidal fossa and cross the fossa from lateral to medial and superficial to median nerve,then superficial to muscle of flexor compartment of forearm then cross the flexor retinaculum. Thejodhar pulakanta et.al (2009) reported that SUA arising from the 3rd part of rt.axillary artery at the junction of two median nerve roots then SUA crosses over the flexor retinaculam and normal ulnar artery was absent. Mitesh R DAVE et. al. (2012) also reported a variant ulnar artery originated from the second part of axillary artery just above the two roots of median nerve.Alnar artery was a smaller caliber and it coursed superficially over the flexors of the forearm. Venkata Ramana Vollala et. al (2011) reported that The ulnar artery arose from the brachial artery in the middle third of the arm . At the elbow level, the artery ran superficial to the bicipital aponeurosis where it was crossed by the median cubital vein.
CONCLUSION
Accurate knowledge of the normal and variant arterial pattern of the upper limb is important both for reparative surgery and for angiography as upper limb arteries have been used for coronary bypass and flaps in reconstructive surgeryYoshinaga et al. (2006). It is especially relevant in cases of arteriovenous fistulae, aneurysms and abscess drainage in region of axilla, arm and cubital fossa (Taub et al., 1999). Clinical implications of such variations have to be kept in mind during anaesthetic procedures of brachial plexus, shoulder arthroscopy, traumatic injuries involving axillary region. (Ramesh et al., 2008)
Englishhttp://ijcrr.com/abstract.php?article_id=1264http://ijcrr.com/article_html.php?did=12641. Srinivasulu Reddy, Venkata Ramana Vollala, The superficial ulnar artery: development and clinical significance Artéria ulnar superficial: desenvolvimento e relevância clínica, sept.2007.
2. Saeed, M.; Rufai, A. A.; Elsayed, S. E. and Sadiq, M. S.Variations in the subclavianaxillary arterial system.Saudi Med. J., 22(2):206-12, 2002.
3. Yoshinaga, K., Kodama, K., Kameta, K. , Karasawa, N., Kanenaka, N., Kohno, S. and Suganuma, T. A rare variation in the branching pattern of the axillary artery. Indian J.Plast. Surg., 39:222-3, 2006.
4. Taub J, Giannikis G, Shen HY, Ki U. The brachial artery transection following closed elbow dislocation. J Trauma. 1999; 47:176– 178.
5. Standring, S.; Johnson, D.; Ellis, H. and Collins, P. Gray's Anatomy. 39th Ed. Churchill Livingstone, London, 2005.p.856.
6. Hollinshead W.H.: Anatomy for surgeons. The back and limbs. In: Pectoral region, axilla and shoulder - The axilla Vol.3, Paul B.Hoebar, Inc. Med. Book Deptt. of Harper and Brothers, 49 East, 33rd Street, New York 16: pp.290- 300 (1958).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241513EnglishN2013July17HealthcareINCIDENCE OF HIV INFECTION AMONG KNOWN PULMONARY TUBERCULOSIS PATIENTS AND PULMONARY TUBERCULOSIS AMONG KNOWN HIV SEROPOSITIVE INDIVIDUALS; AND A COMPARATIVE STUDY OF ZIEHL-NEELSEN STAINING AND AURAMINE-O STAINING
English99104S. SaraswathiEnglish T.V. RamaniEnglish Supriya PandaEnglishTo know HIV seropositivity among known pulmonary tuberculosis individuals and sputum smear positivity for acid fast bacilli among known HIV seropositive individuals and to do a comparative study of Ziehl-Neelsen staining and Auramine-O staining. Methods: 500 symptomatic patients attending to Designated Microscopic Centre were screened for pulmonary tuberculosis by doing Ziehl-Neelsen staining of sputum samples. Sputum smear positive individuals were screened for HIV antibodies. 500 individuals attending to Integrated Counseling and Testing Centre were screened for HIV antibodies according to National AIDS Control Organization guidelines. HIV seropositive individuals were screened for pulmonary tuberculosis by doing Ziehl-Neelsen stain of sputum smear. Auramine O staining was done for randomly selected sputum samples. Results: Incidence of pulmonary tuberculosis was 15.2 %, and among them 5.3 % were HIV seropositive. Incidence of HIV infection was 16.2 %, out of them two were having pulmonary tuberculosis. Out of 50 sputum smear samples selected randomly, 32 were positive for acid fast bacilli in Ziehl-Nelseen stain, 34 were positive by Auramine O stain. Conclusion: In the present study incidence of HIV infection among pulmonary tuberculosis patients was 5.2% and pulmonary tuberculosis among HIV infected individuals was 2.5%. Auramine O stain for detecting M. tuberculosis was more sensitive than Z-N stain.
EnglishHIV- TB Co-infection, Auramine-O stainingINTRODUCTION
Global annual incidence of Tuberculosis (TB) is 8.5 to 9.2 million in 2010 as per the WHO global TB report 2011with 1.1 million deaths among HIV negative cases of TB and an additional 0.35 million deaths among people who were HIV positive (1). Though India is the second most populous country in the world, India has more new tuberculosis cases annually than any other country. In India annual incidence of TB is 2 million, thus contributing to a fifth of the global burden of TB. It is estimated that about 40% of Indian population is infected with Mycobacterium tuberculosis, but only 10% of them develop disease in life time. Co-infection with HIV increases the risk of developing TB by 5-6 times. Other factors, which increase the risk of TB, are Diabetes mellitus, smoking, malnutrition, silicosis, malignancy, indoor air pollution, poor ventilation, overcrowding, urbanization, migration and poverty. India is third highest HIV burdened country. In India TB is one of the earliest opportunistic diseases to develop among HIV infected individuals, one million people are co infected with TB out of 2.47 million people living with HIV/AIDS (PLHAs) (1). It is the most common opportunistic infection and cause of mortality among PLHAs, difficult to diagnose and treat owing to challenges related to comorbidity, pill burden, co-toxicity and drug interactions. Other way, the incidence of HIV infection in tuberculosis patients varied between states ranging from 0.4 to 20.1 % in India and on average 5% of tuberculosis patients were estimated to be HIV positive (2-12). AIM The present work was taken up to know the incidence of HIV infection in open cases of pulmonary tuberculosis (those who were sputum smear positive) and also to know the incidence of pulmonary tuberculosis by doing Ziehl-Neelsen (Z-N) stain of sputum smear in HIV seropositive individuals. In addition, a comparative study of sputum positivity for M.tuberculosis by two different staining methods, Z-N and fluorescent staining by Auramine O (AO) was taken up.
MATERIALS AND METHODS
Study group: 500 patients suffering from cough and fever for more than 2 weeks attending to Designated Microscopic Centre (DMC) at Maharajah’s Institute of Medical Sciences (MIMS), Nellimerla, Vizianagaram, Andhra Pradesh.500 patients attending Integrated Counseling and Testing centre (ICTC) at MIMS were included in the study after taking written consent from them to undergo the necessary investigations. Study period: For a period of one year from Nov 2009 to Oct 2010. Specimen collection: Two consecutive sputum samples (one spot and one early morning) were collected from each individual attending DMC and HIV seropositive individuals from ICTC.5ml of venous blood was collected from each individual attending ICTC and from those who were acid fast bacilli (AFB) positive in DMC. Both the samples were processed on the same day of collection. Processing: Sputum samples: Smears were prepared from all the specimens collected and stained by ZN stain.50 sputum smears were selected randomly and stained by AO stain. Blood samples: Serum was separated and subjected to HIV antibody testing by using different ELISA kits as per NACO guidelines.
RESULTS
Out of 500 patients attending to DMC at MIMS general Hospital, 76 individuals were sputum smear positive (15.2%) for AFB. Out of 76 sputum smear positive cases, four were HIV seropositive (5.3%). Incidence of pulmonary tuberculosis was more in 46-55 year age and in males. Incidence of HIV infection among pulmonary tuberculosis patients was higher in 36- 45 year age and in males. Out of 500 individuals attending ICTC at MIMS, 81 were found to be positive for HIV antibodies (16.2%). Out of 81 HIV seropositive cases only 2 were found to be sputum smear positive for AFB (2.5%). Incidence of HIV infection was more in 26 -35 year age and in males. Out of 50 sputum samples which were selected randomly, 32 were Ziehl-Nelseen stain positive and 34 were positive by Auramine O stain for M. tuberculosis.
DISCUSSION
A total number of 500 sputum samples over a period of one year from November 2009 to October 2010 were screened for AFB by doing ZN stain. Out of them 76 samples (15.2%) were positive for AFB and maximum incidence was observed in between 46- 55 year age. Percentage incidence of HIV seropositivity in sputum smear positive individuals in the present study was 5.3%, which is higher compare to other studies from India and WHO data. WHO estimated annual rate of tuberculosis among HIV infected is 3.8% (13, 14, 15 ). Out of 500 individuals screened, 81(16.2%) were positive for HIV -1 antibodies and two individuals out of 81 HIV positive were sputum smear positive (2.5%) for AFB in the present study .This is lower than the other studies from India. This low incidence may be due to exclusion of extrapulmonary tuberculosis in the present study (16). In the present study the efficacy of fluorescent staining was found to be more compare to ZN stain and this is as per with the different studies from India (17, 18,19). SUMMARY AND
CONCLUSION
1. Out of 500 sputum smears screened for AFB by ZN staining, 76 individuals (15.2%) were found to be positive for AFB . HIV seropositivity among these sputum smear positive individuals was found to be 5.3%. 2. Out of 500 serum samples screened for HIV antibodies, 81 (16.2%) were found to be HIV seropositive. Sputum smear positivity among these HIV infected individuals was found to be 2.5%. 3. Out of 50 sputum smears selected randomly, thirty two were positive by ZN method and thirty four were positive by Auramine O stain for AFB. So AO staining was found to be more useful for detection and grading than ZN method.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
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