Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28General SciencesA CURRENT REVIEW ON ASSESSMENT OF GENETIC ANALYSIS SYSTEM FOR MEDICINAL PLANTS WITH MICROSATELLITES
English0111Nitin Kumar VermaEnglish Ashwani KumarEnglish R. K. DeshwalEnglish Vikas TyagiEnglish Priyanka RanaEnglishMicrosatellites or Simple Sequence Repeats (SSR) have been preferred molecular markers ever since their advent in the late eighties. SSR are tandem repeat units of 1 to 6 base pair that are found in many prokaryotic and eukaryotic genomes. Despite growing rivalry from new sequencing and genotyping techniques, the use of these mobile and efficient markers continues to increase, boosted by consecutive technical advances. Random determined expansions look to be elite against for at least part of microsatellite loci, probably because of their effect on organization of chromatin, gene regulation, recombination, replication of DNA, cell-division cycle, mismatch repair system, etc. The illustration methods used previously for finding new microsatellite loci in sand files remain difficult and time consuming; insilico approach, which includes retrieval and investigation of microsatellites from large amounts of sequence data from sequence data based using microsatellite tools can yield many new candidate markers. To make the most of the latest technical developments and outline the need for a well-established strategy including standardized high-throughput bench protocols and specific bioinformatics tools, from primer design to allele calling. In this review also cover the role of microsatellites in identification and isolation of genotypes, characterization and analysis of genetic diversity, and their interactions in SSR variation.
EnglishGenetic Diversity, Molecular Marker, Simple Sequence Repeats, Phylogenetic RelationshipINTRODUCTION
Molecular markers are used in molecular biology and biotechnology experiments where they use to identify a particular sequence of DNA. As the DNA sequences are very highly specific, they can be identified with the help of the known molecular markers which can find out a particular sequence of DNA from a group of unknown (1). Microsatellite based genetic markers, which are distributed across genomes of most of the eukaryotes, fulfill these criteria. Microsatellites also known as Simple Sequence Repeats (SSRs) are short stretches of DNA which consist of an array of simple tandemly repeated mono, di-, tri-, tetra-, penta or hexanucleotide repeats such as (A)n, (CA)n, (GA)n, (GTA)n, (ATT)n, (GATA)n, (ATTTT)n, (ACGTCG)n. They are ubiquitous in prokaryotic and eukaryotic genomes and are randomly distributed, both in protein coding and non-coding regions. A unique oligonucleotide on each side of the repeat region is chosen for the production of a primer pair for each of the microsatellite loci. PCR products of different lengths can be amplified using primers flanking the variable microsatellite region. Allelic variations among individuals are based mostly on differences in the number of tandem repeats in a microsatellite array providing a ready source of polymorphism (2). Thus, the only way in which alleles can be distinguished is by measuring the total length of the microsatellite allele. Cost effectiveness of the assay is achieved by combining two or more loci for simultaneous analysis through multiplex PCR. SSRs are being used extensively in studies involving Forensics, Population Genetic structure analysis, establishment of Kinship, Conservation Genetics, Linkage Mapping, Marker Assisted Breeding etc (6) .
Characterization of Microsatellites
Cephalotaxus oliveri is a scarce medicinal conifer endemic to the south central region of China and Vietnam. In order to study the mating system, population genetics and the genetic effects of habitat fragmentation on Cephalotaxus oliveri, 15 polymorphic and 12 monomorphic microsatellite loci were developed for Cephalotaxus oliveri by using the Fast Isolation by AFLP of Sequences Containing repeats (FIASCO) protocol. The polymorphisms were assessed in 96 individuals from three natural populations (32 individuals per population). The number of alleles per locus ranged from two to 33, the observed and expected heterozygosity per locus ranged from 0.000 to 1.000 and from 0.000 to 0.923, respectively (27). Microsatellite markers were developed for the medicinal plant Isodon rubescens to investigate genetic variability of the species and, in future studies, to assess its relation to the content of pharmacologically active chemicals produced by the plant. Eleven primer pairs were identified and tested in multiple populations of Isodon rubescens and related species (I. henryi, I. enanderianus, I. lophanthoides) from the People's Republic of China. The primers amplified dinucleotide repeats and had between two and 12 alleles per locus in a given population (11) .Microsatellite primers were developed for a Chinese traditional herb, Panax notoginseng, to investigate its genetic diversity and cultivar breeding. Twelve polymorphic microsatellite were assessed in two populations and an assemblage containing individuals from the whole distribution area (24) . Microsatellite markers were developed for the medicinal plant Tripterygium (Celastraceae) to assess its population structure and to facilitate source tracking of plant materials used for medicinal extracts. Ten microsatellite markers were isolated and characterized in Tripterygium wilfordii using an enriched genomic library(28) . We developed a new set of microsatellite markers for studying the genome of the janaguba tree, Himatanthus drasticus (Mart.) Plumel, which is used in folk medicine in northeastern Brazil. Microsatellite loci were isolated from an enriched Himatanthus drasticus genomic library. Nine primer pairs successfully amplified polymorphic microsatellite regions, with an average of 8.5 alleles per locus (2) . Microsatellite primers were developed for a Chinese traditional herb, Panax notoginseng, to investigate its genetic diversity and cultivar breeding. The number of alleles per locus ranged from 3 to 12, with a mean of 5.8; the observed and expected heterozygosity values ranged from 0.0411 to 0.8472 and from 0.0804 to 0.7653, respectively. These new microsatellite markers will be useful for investigating the genetic diversity of this cultivated Panax notoginseng as well as assist in cultivar breeding (23) . Catharanthus roseus is a plant of great medicinal importance, yet inadequate knowledge of its genome structure and the unavailability of genomic resources have been major impediments in the development of improved varieties. For simple sequence repeat (SSR) isolation, a genomic library enriched for (GA)n repeats was constructed from Catharanthus roseus 'Nirmal' (CrN1). A segregating F (2) mapping population consisting of 111 F (2) individuals was generated. For generating the linkage map, a set of 423 codominant markers (378 newly developed and 45 published earlier) were screened for polymorphism between the parental genotypes, of which 134 were identified to be polymorphic (33) . To investigate the profile of gene expression in Salvia miltiorrhiza and elucidate its functional gene, 454 GS FLX platform and Titanium regent were used to produce a substantial expressed sequence tags (ESTs) dataset from the root of Salvia miltiorrhiza (22) . Epimedium sagittatum (Sieb. Et Zucc.) Maxim, a traditional Chinese medicinal plant species, has been used extensively as genuine medicinal materials. The raw reads are cleaned and assembled into a total of 76,459 consensus sequences comprising of 17,231 contigs and 59,228 singlets. Trinucleotide SSR is the dominant repeat type (55.2%) followed by dinucleotide (30.4%), tetranuleotide (7.3%), hexanucleotide (4.9%), and pentanucleotide (2.2%) SSR. The dominant repeat motif is AAG/CTT (23.6%) followed by AG/CT (19.3%), ACC/GGT (11.1%), AT/AT (7.5%), and AAC/GTT (5.9%) (53) . Lychnophora pinaster Mart. (Asteraceae) is a Brazilian medicinal plant, size-selected genomic library comprising 280,000 colonies and representing approximately 18% of the chickpea genome, was screened for (GA)n, (GAA)n and (TAA)n microsatellite-containing clones, of which 389 were sequenced. A total of 174 primer pairs gave interpretable banding patterns, 137 (79%) of which revealed at least two alleles on native polyacrylamide gels.Segregation of 46 markers (39%) deviated significantly (P > or = 0.05) from the expected 1:1 ratio (8). Recombinant DNA libraries were constructed for seven chromosome types isolated from two translocation lines of field bean (Vicia faba L.) with reconstructed karyotypes. The insert size ranged between 50 and 2200 bp and the mean length estimated in individual libraries varied between 310 and 487 bp (20) . Identification and Isolation of Microsatellite Clivia is a genus of great horticultural importance and has been widely cultivated as ornamental plants in all over the world. The number of alleles ranged from two to six, observed heterozygosity ranged from 0.04 to 1.00 and expected heterozygosity ranged from 0.04 to 0.83. These microsatellite marker loci provide tools for future studies of Clivia species and cultivars (5) . Medicinal plant species has a valuable economic importance because of its usage as pharmaceuticals, nutritional, as well as its use in popular medication. SDS-based DNA isolation method was used to extract DNA from 11 species of different aromatic and medicinal plants collected from Saudi Arabia. The extracted genomic DNA was found suitable for restriction digestion and PCR amplification (1). The stems of Dendrobium thyrsiflorum RCHB.F. ex ANDRÉ can be processed into an important class of Traditional Chinese Medicine named "Huangcao Shihu," which has diverse curative effects, such as nourishing yin and clearing away unhealthy heat, benefiting the stomach, and promoting the production of body fluid, 14 Dendrobium thyrsiflorum-specific microsatellite markers were developed in this study (48) . Simple sequence repeat (SSR) was used to investigate the genetic diversity and structure of Dendrobium officinale. A total of 15 primer pairs with stable and repeatable polymorphism were screened out from 60 SSR primer pairs developed by the method of microsatellite enrichment by magnetic beads. Fifteen primer pairs were used in Dendrobium cross-species amplification and totally 13 primer pairs were proved to have the transferability in Dendrobium officinale related species (44). In Salvia miltiorrhiza, 159 simple sequence repeats (SSR) were detected, which amounted to 3.79% of the non-redundant starting sequence population. The results showed that 72 primer pairs were successfully amplified in Salvia miltiorrhiza samples to yield and 279 loci with an average of 3.88 loci per primer pair (4) . Herba Cistanches is a common traditional Chinese medicine, Four Cistanche species were found as Herba Cistanches in China herbal markets, including Cistanches deserticola, Cistanches tubulosa, Cistanches salsa and Cistanches sinensis. Standard chemical fingerprints were generated from each of four Cistanche species, which could be identification markers (31). Flow-sorted plant chromosomes are being increasingly used in plant genome analysis and mapping and report on optimization of procedures for primed in situ DNA labeling (PRINS) and cycling-PRINS (C-PRINS) for fluorescent labeling of repetitive DNA sequences on sorted plant chromosomes suitable for their identification. Chromosomes of barley, wheat, and field bean were sorted onto microscope slides, dried, and subjected to PRINS or CPRINS with primers for GAA microsatellites (barley and wheat) or FokI repeat (field bean) (18) . Analysis of genetic diversity Microsatellite markers of an important medicinal plant, Eurycoma longifolia, were developed for DNA profiling and genetic diversity studies. Eighteen polymorphic microsatellite loci were developed for Eurycoma longifolia. The number of alleles detected per locus ranged from four to 16, while the observed heterozygosity ranged from 0.097 to 0.938. The 18 microsatellite markers of Eurycoma longifolia are highly polymorphic and informative (37) . Microsatellite primers were developed for Gynostemma pentaphyllum, a traditional Chinese medicinal herb, to investigate its population genetic diversity. Using the Microsatellite Sequence Enrichment protocol, 14 polymorphic primers sets were identified in four Chinese Gynostemma pentaphyllum populations. The primers amplified di- and trinucleotide repeats with 1-6 alleles per locus, and the observed heterozygosities ranged from 0.000 to 1.000 per population (21) . The different species of the genus Satureja are known as "Marze Kohi" in Iran, herbal drugs of these plants have long been used in traditional medicine. A total of 515 polymorphic DNA fragments were amplified, with a mean of 103 bands per assay (15) . Salvia miltiorrhiza Bge. is a well-known traditional Chinese herb. The set of ESTs represents a significant proportion of the Salvia miltiorrhiza transcriptome, and gives preliminary insights into the gene complement of Salvia miltiorrhiza (47) . Tribulus terrestris is medicinal importance in curing urino-genital disorders. Six assays each of AFLP and SAMPL markers and 21 each of ISSR and RAPD markers were utilized. AFLP yielded 500 scorable amplified products, of which 82.9% were polymorphic. SAMPL primers amplified 488 bands, 462 being polymorphic (94.7) (32) . Sixty-one clinical and forty-nine environmental isolates of Cryptococcus neoformans var. gattii from Australia and the United States were analyzed by random amplification of polymorphic DNA (RAPD), using 12 to 22-mer primers in pairs, and/or PCR fingerprinting with a single primer derived from the microsatellite core sequence of the wild-type phage M13 (5' GAGGGTGGCGGTTCT 3') (34). To analyze the genetic relationship of 9 Marsdenia species from Yunnan. The range of the GS (genetic similarity) value was 0.6675-0.8210. In 9 Marsdenia species, Marsdenia auricularis is a relative of Marsdenia tenacissima. Marsdenia balansae and Marsdenia officinalis have the closest genetic relationship. It is supported by ISSR that the Marsdenia auricularis which is sib species of Marsdenia tenacissima, and the folk medicine of Marsdenia are worthy deep investigation and study (1) . Paris polyphylla var. chinensis is a perennial herb with medicinal properties and found in China. The observed and expected heterozygosities ranged from 0.000 to 0.467, with a mean of 0.247, and from 0.383 to 0.662 with a mean of 0.537, respectively. Six loci (Pp1, Pp3, Pp6, Pp7, Pp9, and Pp12) were found to significantly deviate from Hardy-Weinberg equilibrium (17) . An effort was made to determine the impact of geographic range on genetic richness and chemical constituents of Valeriana jatamansi Jones, an herb indigenous to the northwestern Himalaya. Overall genetic diversity among the populations was 45 %, with a cumulative range of 35-92 % similarity for most of the high-altitude plants and a comparatively narrow range, 50-88 %, for the population below the altitude of 1,800 m (36) . Microsatellite markers and morphological analyses were used to explore patterns of genetic and morphological diversity in wild populations of Bromelia antiacantha (49). The taxonomic identity of Capsicum species is found to be difficult as it displays variations at morphochemical characters. The six Capsicum species, namely, Capsicum annuum, Capsicum baccatum, Capsicum chinense, Capsicum eximium, Capsicum frutescens, and Capsicum luteum were investigated for phenotypic diversity based on flower color and for genetic differences by molecular makers. Capsicum luteum was found to be rather closer to Capsicum baccatum complex, both phenotypically and genetically (38). Seven polymorphic and transferable nuclear microsatellites were used to investigate the population structure of genetic diversity of Schisandra chinensis and Schisandra sphenanthera for facilitating their conservation and sustainable utilization (45). A genetic linkage map for Bupleurum chinense DC. has not been developed. In this study, with the theory of pseudo-testcross, 96 F1 plants from an intraspecific cross of Bupleurum chinense were used as mapping populations. This map will be provide a basis for studies on gene mapping, map based cloning and marker-assisted selection of important traits in Bupleurum chinense (50). A method was developed based on multiple approaches wherein DNA and chemical analysis was carried out toward differentiation of important species of Sida complex that is being used for commercial preparation. Based on similarity index, S. acuta and Sida rhombifolia found to be most similar (51%). High number of species-specific bands played pivotal role to delineate species at genetic level (39) .
Terminalia trees are being over-exploited because of their medicinal and economical importance leading to loss of valuable genetic resources. The three species are genetically distinct was revealed by all the three marker systems as unique DNA fingerprints were obtained (30). In the identification of Liriope spicata var. prolifera and its affinis species, which are difficult to be differentiated with routine method, based on ISSR molecular marker technology and explore their relationship. In this study screened out 9 effective primers and achieved ISSR electrophoretic spectrum and phylogenetic tree of 15 samples (25) . Njavara is a medicinal rice strain, endemic to Kerala, South India, bestowed with medicinal qualities. Genetic variations and some of the physicochemical properties were studied using standard molecular protocols and compared with those of nonmedicinal rice varieties: Jyothi and IR 64. Genetic similarity coefficient studies showed two well-defined clusters separating Njavara from Jyothi and IR 64. Njavara, Jyothi, and IR 64 have similar amylose equivalent (AE), which was confirmed by microsatellite markers (3) . Paris polyphylla Smith var. yunnanensis (Franch.) Hand.-Mazz. is an important Chinese medicinal herb. Because of overharvesting, the wild populations of this herb have greatly declined and become fragmentized. Although the neighbour-joining cluster analysis seemed to suggest that there was conspicuous genetic differentiation between the natural and cultivated populations, the AMOVA showed that only 4.84% of the total variance existed between groups of natural and cultivated populations, while 67.51% of the variance occurred within populations (10) . RAPD and ISSR markers were used to assess the germplasm genetic diversity among 10 individuals of Rehmannia glutinosa, including 8 cultivars and 2 virus-free lines micropropagated by tip tissue culture.
The 17RAPD primers and 10 ISSR primers generated 177RAPDfragments and 110 fragments, respectively (54). The chemical and genetic methods used in authentication of ginseng, especially the recent advances in microsatellite genotyping. Analysis of well-characterized marker compounds is now the most popular method for identifying the herbal materials and quality control of TCM, eg, ginsenoside profiling for authentication of Panax species (13) . Microsatellites, very short tandemly repeated DNA sequences, are being extensively used in evolutionary genetics and molecular breeding of crop plants, because of their high degree of allelic variability, which is presumably caused by a high rate of mutation that changes microsatellite array length. Compared to animals, higher mutation rates in chickpea are likely to be due to the presence of long (TAA)n microsatellite repeat arrays and the larger number of DNA replications that meristematic initials of the plants undergo before reaching the reproductive phase (40). The analysis of five microsatellite loci in 500 Melaleuca alternifolia individuals produced 98 alleles that were useful for population genetic studies. Considerable levels of observed heterozygosity were recorded (HO = 0.724), with approximately 90% of the variability being detected within populations (12). The genetic variability in agronomically important chickpea accessions (Cicer arietinum L.) as detected by single-locus RFLP probes, RAPD and isoenzyme markers, is rather low. Recently, highly polymorphic microsatellites became the markers of choice for linkage mapping and population studies. Most but not all primers generated distinct fingerprint-like banding patterns after agarose gel electrophoresis and ethidium bromide staining of the amplification products (35) .
CONCLUSIONS
The literature reviewed the fact, that throughput and cost-effectiveness of next-generation sequencing should allow researchers to be more selective in their choice of SSR loci. In particular, sequencing depth should provide sufficient data on sequence variation to focus on conserved regions flanking polymorphic SSR motifs for designing primers, considerably simplifying the whole process of marker testing and considerable progresses have been made in SSR development and genotyping, including in associated bioinformatics. As a consequence, SSR markers are not used to their full power, as shown by our survey of a sample of the recent literature. The use of next generation sequencing techniques instead of cloning and conventional sequencing to obtain sequence data and identify SSRs in such species is just beginning and appears extremely promising. It provides the optimal conditions for subsequent multiplex development by detecting many potential SSRs. The researchers to take a number of precautions and to better evaluate candidate loci, which eventually benefits to the whole genotyping process. The utilization of microsatellites has been demonstrated by a large number of studies applying this marker and by the variety of areas that apply microsatellites for several purposes. Furthermore, new technologies have enabled the development of markers for previously neglected species through the generation of new sequences and a more refined search in databases. With all the difficulties Itemized, we wish to emphasize that for certain phylogenetic problems microsatellites remain the most promising approach and it seems well worth the effort of improving methods for their analysis. The novelty of microsatellite method is that the expected rate of differentiation can be estimated by studying microsatellite mutations. This review showed numerous lines of evidence available, which suggest that SSR genomic distribution; characterization is non-random across coding and noncoding regions, because the evolutionary process leading to length variability at the SSR loci does not follow a simple mutation model, nor does it follow a strict single-stepwise model. Since a significant part of SSR structures are functionally important for gene transcription, translation, chromatin organization, recombination, DNA replication, DNA MMR system, cell cycle, etc.
ACKNOWLEDGEMENT
The authors are thankful to the Executive Director, Shri Ram College, Muzaffarnagar (UP), India for providing the necessary facilities and tools to carry out the project work.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28General SciencesSTUDIES ON THE OCCURRENCE OF DUCT AND SUPERREFRACTION OVER INDIAN REGION
English1220N. Radha Krishna Murthy English S. Vijaya Bhaskara RaoEnglishCosmic GPS data for the years 2007 and 2008 is taken to analyze the occurrence of ducts and super refraction over Indian region corresponding to latitudes -5o to 40o and longitudes from 60o to 100o up to a height of 5Km from sea level. Number of duct regions, high duct strength regions and superrefraction regions are counted over Arabian Sea, Bay of Bengal and land regions. Arabian sea region has more number of duct regions during postmonsoon (September, October, and November), premonsoon (March, April, May) and winter (December, January, February) seasons and less number during summer monsoon (June, July, August,) season. More number of duct regions observed over Bay of Bengal during winter than other seasons. Land region has more number of duct regions during post monsoon season. More number of superrefraction regions occurs over Arabian Sea in pre monsoon season; over Bay of Bengal during winter and Pre monsoon seasons and over land region during post monsoon season. Majority of duct regions are found to occur at heights less than 1.5 Km and majority of superrefraction regions at heights less than 2 Km from sea level.
English INTRODUCTION
The use of GPS satellite signals by means of radio occultation has shown a great potential for the determination of upper troposphere and stratosphere refractivity profiles. Temperature and pressure profiles can be calculated from these refractivity profiles using the hydrostatic equation and ideal gas law [Kursinski et al., 1997]. The Constellation Observing System for Meteorology, Ionosphere, and Climate (COSMIC) will provide high vertical resolution temperature, pressure and water vapor information for a variety of atmospheric process studies and improve the forecast accuracy of numerical weather prediction models. The cosmic data set will allow investigation of the global water vapor distribution and map the atmospheric flow of water vapor that is so critical for understanding and predicting weather and climate. Ducting is caused by a strong gradient in refractivity N with respect to altitude. Refractivity itself is calculated following the formula given by Smith and Weintraub [1953], Valid at GPS frequencies:
pi is atmospheric pressure at level i (with radius ri) in [hPa], Ti is atmospheric temperature at level i in [K], and ei the water vapor partial pressure at level i in [hPa]. The refractivity gradient dN/dh with respect to altitude h is used to characterize the atmospheric conditions. A region with ( dN/dh ) ≥ - 39 Km-1 is called subrefractive. These conditions lead to radio waves being refracted away from the earth’s surface. Regions with ( dN/dh ) < -39 Km-1 and > -79 Km-1 show normal refraction. Regions with dN/dh ≤-79 Km-1 and >-157 Km-1 are called superrefractive [Almond and Clarke, 1973]. Critical refraction occurs when the radius of curvature of the ray is equal to the radius of curvature of atmosphere and the ray will propagate at a fixed height above the surface. Ducts appear when dN/dh leads to rays that curve down into the surface at low altitudes, which is given when: dN/dh ≤ -10-6 / Rc (2) where Rc is radius of curvature of atmosphere in [Km]. This condition is fulfilled when dN/dh ≤-157Km-1 for a mean value of Rc [Kursinski et al.,1997]. dN/dh = N’ = 77.6 (p’/T) -77.6 T’(P/T 2 ) + 3.73X 105 ( e’ /T2 ) - 3.73X 105 T’( e /T3 ) (3) The first term represents the hydrostatic variation of pressure with altitude, it is about - 30 Km-1 . The second term will be more important closer to the surface where higher pressures are found. The third term will generally contribute to ducting at altitudes where strong gradients in e are found. The fourth term is negligible. The nature of the duct is determined by the meteorological conditions that alter temperature and water vapor content in the region. Ducts occur over the earth`s surface as a result of advection, evaporation over the sea, anticyclonic subsidence, subsidence at the frontal surfaces, nocturnal radiative cooling over land, and convective activity during the day ( Turton et al 1988, craig 1996). The surface features from which the weather systems move are crucial in determining the duct characteristics (Gossard 1977). Evaporation and boundary layer ducts are two subgroups of the surface ducts. In addition, more localized effects such as sea breezes, thunder storms, or microburst out flows can cause ducting over land (Turton et al 1988). Ducting has been observed in radiosonde data at altitudes up to around 4km but most ducting events are found below 2 km [Patterson, 1982; Kursinski et al., 1997]. The maximum altitude for ducting was estimated by Kursinski et al. to be around 5Km. . Babin (1996) investigated the height and frequency distributions of surface ducts statistically over Wallops Island, Virginia, by using high-resolution helicopter measurements. He found that the largest surface ducts were observed mostly from April to June and from July to September over Wallops Island. Brooks et al. (1999) studied the surface evaporation and boundary layer duct characteristics over the Persian Gulf. A more recent study on refractive conditions by Bech et al. (1998, 2000, 2002) was done in Barcelona, Spain, to determine the anomalous propagations at their radar site. A comprehensive examination of 2 yr of radiosonde data to determine the surface duct conditions over Istanbul (4°N, 29°E), Turkey, was made by S¸. Sibel Mentes and Zerefsan Kaymaz [2007] . It was found that most of the ducts occur in May and July. The highest occurrence rate of surface ducts was observed in the summer season, and the lowest rate was observed in the winter season. The median duct thickness and duct strength are found to be the highest and the strongest in summer, whereas they are the lowest and the weakest in winter. An interesting study on the effect of ducting has recently been performed based on the European Centre for Medium-Range Weather Forecasts (ECMWF) analysis for a 10 day period in May 2001 [von Engeln et al., 2003] . On the basis of the locations of the simulated occultations in this period, the study examined how often an occultation is affected by ducting as well as the height and thickness distributions of the ducts. It was reported that only 10% of the simulated occultation profiles showed ducts and that no ducts were found above 2.5 km altitude. This study was subsequently expanded with the construction of a ducting climatology using six years of ECMWF analysis data [von Engeln and Teixeira, 2004] , providing extremely valuable information on ducting statistics across the globe.
A comprehensive study on the ducting conditions prevailing over the Indian tropical station of Gadanki (13.5_N, 79.2_E) is made using high-resolution GPS radiosonde observations [ Ghouse Basha et al.,2013 ] . In this study, strong diurnal and seasonal variation in the percentage occurrence of the ducts was found with the highest and lowest occurrences during winter and monsoon seasons, respectively.
DATA AND METHODOLOGY
Cosmic GPS data of years 2007 and 2008 is taken to study occurrences of duct and Superrefraction regions in the region -5 o S to 40oN and 60oE to 100oE. This region is divided into 423 grids each of size 2.0455o x 2 o . Refractivity values over the region from sea level to a height of 5Km are extracted from cosmic data and its seasonal average is calculated for winter, pre monsoon season, summer monsoon and post monsoon seasons. Gradient of refractivity is calculated for every height of 100m from sea level to a height of 5Km and number of duct regions, high duct strength regions [(dN/dh) ≤ 200/Km)] , superrefraction regions are counted over Arabian Sea, Bay of Bengal and Land region during four seasons. Profiles showing variation of number duct regions, High duct strength regions, and super refraction regions over Arabian Sea, Bay of Bengal, and Land region in different seasons during the years 2007 & 2008 at different heights are plotted.
RESULTS AND DISCUSSIONS
Fig 1 represents number of ducts occurred over Indian region during the years 2007& 2008. Arabian sea has more number of ducting regions during pre monsoon , post monsoon, and winter seasons and less number of ducting regions during summer monsoon season. Over Indian land region, large number of ducts occurred during post monsoon season than other seasons. Over Bay of Bengal region more number of ducts occurred during winter season. Fig. 2 represents number of ducts over India at heights ≤ 0.5Km & > 0.5 Km during the years 2007 & 2008. Over Arabian sea, number of duct regions having height less than or equal to 0.5 Km occurred is more during 2007 pre monsoon, post monsoon seasons and less during summer monsoon season. Duct regions having height greater than 0.5 Km occurred more in number during 2007 winter and post monsoon seasons and less in number during summer monsoon season. 2008 year data shows similar variation. Over Bay of Bengal , ducts having heights less than or equal to 0.5 Km occurred more in number during 2007 winter season and less in number during post monsoon and summer monsoon seasons. 2008 year data shows that more number of these ducts occur during post monsoon season and less number of ducts occurred during pre monsoon season. More number of ducts having height greater than 0.5 Km occurred during 2007 pre monsoon and post monsoon seasons and less number of these ducts during summer monsoon season. 2008 year data shows that more number of these ducts occurred during winter season and less number during summer monsoon season. Over land region, number of ducts having height less than 0.5 Km occurred is more during post monsoon season and less during summer monsoon. Similarly 2007 data shows that ducts having height greater than 0.5 Km occurred more in number during post monsoon season and less in number during pre monsoon season. 2008 year data shows that number of these ducts occurred is more during post monsoon season than other seasons. Number of duct regions having gradient less than or equal to -200/ Km over Arabian sea, Bay of Bengal and land region of India during different seasons of the years 2007 & 2008 are represented in figs3. 2007 year data shows that Duct regions having gradient of refractivity less than -200 /Km (high duct strength regions) occurred more in number over Arabian sea during post monsoon and pre monsoon seasons and less in number during summer monsoon season. 2008 year data shows that more number of these duct regions occurred during post monsoon and winter monsoon and pre monsoon seasons and less in number during summer monsoon season. Over Bay of Bengal, number of these high duct strength regions occurred is more during winter season than other seasons. Over land region, number of high duct strength regions occurred is high during post monsoon season than other seasons. Over Arabian sea, [von Engeln, A., 2004 ] number of duct regions is high during pre monsoon, post monsoon and winter seasons. A combination of warm water temperatures during these seasons with dry air from the deserts aloft leads to higher ducting probability [Brooks et al., 1999]. During summer monsoon season, the water temperature decreases. This cooling in summer is produced by the south-west monsoon, which causes southwest winds that generate an upwelling of cold water [Tomczak and Godfrey, 2003]. Increased winds will lead to more mixing, thus reducing the ducting probability. Hence small area over Arabian sea is covered with duct regions during summer monsoon season. Over Bay of Bengal, number of occurrence of duct regions increases during winter monsoon season [Jaswal, A. K., et al.,2012] due to increased difference between sea surface temperature and surface air temperature and clear sky conditions. Over land region, high number of duct regions is occurred during post monsoon season than other seasons. This is due to flow of dry polar north east winds, nocturnal radiative cooling, dew deposition, fog development and clear sky conditions over land regions. Arabian sea, Bay of Bengal region and land region show different ducting behavior due to different local and synoptic weather conditions. Fig. 4 show number of superrefraction regions in different seasons during the years 2007 &2008. During the year 2007, over Arabian sea, more number of superrefraction regions occur in premonsoon season and less number in post monsoon season. 2008 data shows that more number of these regions occur over Arabian sea during premonsoon season and less number in summer monsoon season. Over Bay of Bengal, more number of super refraction regions occur in winter monsoon season and less number in post monsoon season during the year 2007. 2008 year data shows that more number of super refraction regions occur in winter and premonsoon seasons and less number in summer monsoon season. Over land region, more number of super refraction regions occur in post monsoon season than other seasons. Fig.5 shows number of duct regions at different heights over Arabian sea, Bay of Bengal and Land region. Fig.6 shows number of super refraction regions at different heights over Arabian sea, Bay of Bengal and Land regions. . Majority of duct regions are found to occur at heights less than 1.5 Km and majority of superrefraction regions at heights less than 2 Km from sea level.
CONCLUSIONS
Cosmic GPS data of years is 2007 & 2008 is taken to analyze the occurrence of duct regions over India region. Profiles of number of duct regions, high duct strength regions and superrefraction regions from sea level to a height of 5Km are plotted during different monsoon seasons. Except during summer monsoon season, Arabian sea region has high number of duct regions in all seasons. Bay of Bengal region has more number of duct regions during winter season than other seasons. High number of duct regions occurred over land region during post monsoon season than other seasons. More number of high duct strength regions occur over Arabian sea during post monsoon, pre monsoon and winter seasons and less number during summer monsoon season. Bay of Bengal has more number of high duct strength regions during winter monsoon season than other seasons. More number of high duct strength regions occurred over land region during post monsoon season than other seasons. More number of superrefraction regions occur over Arabian sea in pre monsoon season, over Bay of Bengal during winter and Premonsoon seasons, and over land region during post monsoon season.
ACKNOWLEDGEMENTS
We are grateful to M. Venkat Ratnam, National Atmospheric Research Laboratory (NARL), Gadanki, for providing necessary data for the present study. We are also thankful to UGC - SVU CENTRE FOR MST RADAR APPLICATIONS S.V.UNIVERSITY, TIRUPATI , for providing facilities to carry out this work. 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=1277http://ijcrr.com/article_html.php?did=12771. Almond, T., and Clarke, J., 1973, Considerations of the usefulness of the microwave prediction methods on air-toground paths, IEEE Proc., Part F, 130, 649–656.
2. Brooks, I., A. Goroch, and D. Rogers, Observations of strong surface radar ducts over the Persian Gulf, J. Appl. Meteor., 38, 1293–1310, 1999.
3. Babin, S. M., 1996: Surface duct height distributions for Wallops Island,Virginia, 1985–1994. J. Appl. Meteor., 35, 86–93.
4. Brooks, I. M., A. K. Goroch, and D. P. Rogers, 1999: Observations of strong radar ducts over the Persian Gulf. J. Appl.Meteor., 38, 1293–1310.
5. Bech, J., D. H. Bebbington, B. Codiba, A. Sairouini, and J.Lorente, 1998: Evaluation of atmospheric anomalous propagation conditions: An application for weather radars. Remote Sensing for Agriculture, Ecosystems, and Hydrology. E. T.Engman, Ed., International Society for Optical Engineering (SPIE Proceedings Vol. 3499), 111–113.
6. Bech, J., A. Sairouni, B. Codina, J. Lorente, and D. Bebbington,2000: Weather radar anaprop conditions at a Mediterranean coastal site. Phys. Chem. Earth, 25B (10–12), 829–832.
7. Bech, J., B. Codina, J. Lorente, and D. Bebbington, 2002: Monthly and daily variations of radar anomalous propagation conditions: How “normal” is normal propagation? Proc. Second European Conf. of Radar Meteorology, Delft, Netherlands,ERAD Publication Series, Vol. 1, Copernicus GmbH, 35–39.
8. Craig, K. H., 1996: Clear air characteristics of the troposphere.Propagation of Radio Waves, M. P. Hall, L. W. Barclay, and M. T. Hewitt, Eds., The Institution of Electrical Engineers,105–130.
9. Craig, KH., and T. G. Hayton, 1995: Climatic mapping of refractivity parameters from radiosonde data. Proc. Conf. 567 on Propagation Assessment in Coastal Environments, Bremerhaven, Germany, AGARD-NATO, 43-1–43-14.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareUNDESCENDED INFANTILE CAECUM- A CASE REPORT
English2125Akhilandeswari BalasubramanianEnglish Nandhini VenkatachalamEnglishThe Caecum is the commencement of the large intestine. It is the large cul-de-sac which lies in the right iliac fossa and continues with the ascending colon at the level of the ileal opening.[Gray’s Anatomy 2000] Normally caecum lies in on the peritoneal floor of the right iliac fossa and its lower end lies at the pelvic brim [Sinnatamby CS 1999]. The shape of caecum has been classified into four types, ie, conical 2%, quadrate 3%, 90% normal and ampullary 4% by Treves. During routine cadaveric dissection by I MBBS students at BMCRI Bangalore, a variation is seen in a 60 year old female cadaver. The caecum is conical in shape and found in the right lumbar region. Length of the caecum is 5 cm and breadth 5.25 cm. The appendix is retrocaecal and its length 6 cm. This variant shape and position of the caecum can be explained on an embryological basis. The congenital anomaly of undescended caecum gives rise to confusion in diagnosis of appendicitis. The Mc Burneys point used for locating the tenderness of appendicitis totally depends on the normal position of the base of appendix. Despite extraordinary advances in modern radiographic imaging, diagnosis of acute appendicitis remains an enigmatic challenge. A knowledge of variable positions of caecum and appendix will help in diagnosing cases of appendicitis with atypical presentations and in planning proper incisional techniques preoperatively.
EnglishCaecum, undescended caecum, conical caecum, appendix.INTRODUCTION
The Caecum is the commencement of the large intestine. It is the large cul-de-sac which lies in the right iliac fossa and continues with the ascending colon at the level of the ileal opening on the medial side and below this with the vermiform appendix. Its average axial length is 6 cm and breadth about 7.5 cm. Usually the caecum is covered by peritoneum on all sides1 . Normally caecum lies in on the peritoneal floor of the right iliac fossa and its lower end lies at the pelvic brim2 . The shape of caecum has been classified into four types according to Treves 18851 . Anatomical and topographical variations of the caecum are known to occur. Appendicitis is one of the most common clinical conditions that require emergency surgery. Variations in anatomical location of appendix can result in different clinical presentations and the ultimate position of the appendix is influenced by the caecum, which varies in contour and even in position. Surgeons performing abdominal operations in adults and children require a thorough knowledge of normal anatomy and variations of the caecum and appendix. It helps them to make optimal diagnosis of various pathological conditions related to these organs and treat accordingly3 .
MATERIALS AND METHODS
During routine cadaveric dissection by I MBBS students at BMCRI Bangalore, a variation is seen in a 60 year old female cadaver. The anterior abdominal wall doesn’t not show any surgical scar and when opened a variation in the position and shape of the caecum is found. The position of the caecum and its shape is noted down. The length of the caecum is measured from a horizontal line at the level of ileocaecal orifice to its lowest point and width taken at midregion. The length of the mesentery is noted .The position and dimensions of appendix and colon are also noted, measured and photographed.
CASE REPORT
The caecum is conical in shape and found in the right lumbar region. Its peritoneal coverings are normal. Length of the caecum is 5 cm and breadth is 5.25 cm. The appendix is retrocaecal and its length 6 cm .The appendicular orifice is 2.75 cm posteromedial to the ileocaecal junction and the length of the root of mesentry is 10 cms. The arteries supplying caecum and appendix are normal. The ascending colon measures about 12.5 cm in length and 10 cm in width, transverse colon 47.5 cm in length, descending colon 27.5cm in length and the sigmoid 32.5cm. Figure-1
DISCUSSION
Shape of caecum The shape of caecum has been classified into four types according to Treves 1885. First type- Infantile (conical) type 2% Second type- quadrate type 3% Third type- normal 90% Fourth type- ampullary exaggerated type 4% Figure:2 According to Pavlov and Petrov 1968, the third type was called ampullary 78% and infundibular type similar to conical type was 13%, 9% was intermediate1 . Three general types of caeca, (1) the infantile; (2) that prevailing in early childhood; and (3) the adult, may be regarded as a developmental sequence. The factors of intrinsic growth and of gravity (weight-bearing of caecal contents) are considered in the evolution of the caecum from infantile to adult types4 . In a study conducted by Banerjee.et.al, the shape of the caeca were found to be normal/ ampullary in 88%, exaggerated in 8% and 4% conical3 . In the present case the caecum was conical in shape and the appendix arose from its apex. The appendix was retrocaecal in position and normal in length. The ultimate position of the appendix is influenced by the caecum, which varies in contour and even in position, as a result not only of type but also of peristaltic activity, state of filling and other physiologic conditions4 . The present case of conical caecum results in a variant positioning of the base of appendix, whose normal anatomy is usually utilized in diagnosing and treating a case of appendicitis. Position of Caecum Norrnally the caecum lies in the right iliac fossa. In the present case it was found in the right lumbar region. In a study conducted by Delic et al., conical caecum was found in 56% cases and square type of caecum in 44% of cases. It was constant in its position in right iliac fossa in 100% of the investigated cases. The vermiform appendix was attached to the tip of the caecum in 58% of cases, to the medial wall in 32% of cases and to lateral wall in 10% of cases5 . In a study, done on 25 cadavers, 96% of the caeca were found in Right iliac fossa and 4% in subhepatic position. In all cases of subhepatic caecum the right colic artery was absent and middle colic supplied both the caecum and appendix3 . The dimensions of the caecum was an average of length 6cms and breadth 7.5cms according to earlier authors1 . A retrocaecal appendix of 60% incidence is cited by Datta6 .
The shortening of mesentery associated with an undescended caecum can increase the frequency of a volvulus like non rotation than in normal persons7 . In the present case, length of root of mesentery was 10 cms i.e shorter than the usual of 15 cms. This variant shape and position of the caecum can be explained on an embryological basis. Normal Development At the end of second stage of midgut rotation 10th - 12th week, caecum is the last to enter the abdominal cavity and at first lies near the midline high up. It grows then to the right and comes to lie under the liver. With the subsequent growth and elongation of the colon the caecum reaches the right loin. Normally during third stage of midgut rotation between 11 th week and just after birth, the caecum descends into the right iliac fossa and undergoes fixation. After birth the wall of the caecum grows unequally and the appendix comes to lie on its posteromedial aspect8 . Derangement of third stage of rotation Due to faulty rotation of the midgut, caecum may occupy abnormal positions – left iliac fossa, umbilical region, subhepatic region, right lumbar region and in pouch of douglas6 . Rarely the caecum may lie at the level of the right colic flexure, the ascending colon is then absent9 . Too early fixation causes imperfect descent. So the caecum may be subhepatic or right lumbar. Deficient fixation causes pelvic caecum2,8 . Undescended caecum is the most common anomaly of intestinal rotation and more common in males10 . Comparative anatomy The caecum is much longer in herbivorous mammals than carnivores. In anthropoid apes and in man it is smaller in size and its lower end regresses to form vermiform appendix. Its anterolateral wall grows out of proportion to its posteromedial wall11 .
CONCLUSION
The caecum being conical and lumbar in position in the present case may be due to derangement in third stage of rotation and early fixation of midgut. Further the normal unequal growth of the caecal walls after birth did not happen, thus leading to a conical caecum. The congenital anomaly of undescended caecum gives rise to confusion in diagnosis of appendicitis. The Mc Burneys point used for locating the tenderness of appendicitis totally depends on the normal position of the base of appendix. In this case both the shape and position of caecum contribute to a variant location of the appendicular base. The pain of appendicitis for example although initially starting in umbilical region may not shift to right iliac fossa but to right upper quadrant mimicking cholecystitis12. Despite extraordinary advances in modern radiographic imaging, diagnosis of acute appendicitis remains an enigmatic challenge. A knowledge of variable positions of caecum and appendix will help in diagnosing cases of appendicitis with atypical presentations and in planning proper incisional techniques preoperatively. This avoids unnecessary extensions of the conventional grid iron incision.
ACKNOWLEDGEMENTS
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 to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1278http://ijcrr.com/article_html.php?did=12781. Williams P.L. Gray’s Anatomy -The Alimentary system. 38th ed. Newyork: Churchill Livingstone; 2000.p. 1774-1775.
2. Sinnatamby. C.S. Last’s Anatomy- Regional and Applied. 10th ed. London: Churchill Livingstone; 1999.p. 249
3. Banerjee A, Kumar IA, Tapadar A, Pranay. M. Morphological Variations in the Anatomy of Caecum and Appendix - A Cadaveric Study. National Journal Of Clinical Anatomy 2012; vol 1(1): 30-35.
4. Garis.C.F.D. Topography and development of the Cecum-Appendix. Annals of surgery 1941;vol 113(4): 540-548.
5. Delic J, Savkovic A, Isakovic E. Variations in the position and point of origin of the vermiform appendix. Med Arh.2002; 56: 5-8. (Croatian) .
6. Datta A.K. Essentials of Human Anatomy. Part I Thorax Abdomen And Pelvis, 9th ed. Kolkata: Current Books International; 2010.p. 216-219
7. Kuagoolwongse C,Chapalasiri E,Chanthong P. Undescended caecum and right sided sigmoid colon with aberrant right hepatic artery: A Case Report. Siriraj Hosp Gaz. 1992; vol 44(8): 606-609.
8. Decker .G.A.G, Plessis. D.J.D. Lee McGregor’s Synopsis of surgical anatomy. 12th ed. Mumbai: Wright Varghese; 1999.p. 22-30
9. Romanes .G.J, The abdominal cavity. Cunningham’s manual of Practical Anatomy Volume II: Thorax and abdomen, 15th ed. Newyork:Oxford University Press; 2008.p. 141-142.
10. Gardner CEJR. The surgical significance of anomalies of intestinal rotation. Ann.surg 1950;131:879-98.
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12. Snell .R.D. Clinical Anatomy. 7th ed. Philadelphia: Lippincott Williams and Wilkins; 2003.p. 246- 260
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareKNOWLEDGE, ATTITUDE AND PRACTICES ON VOLUNTARY BLOOD DONATION AMONG COLLEGE STUDENTS IN BIJAPUR, KARNATAKA
English2631Arun Pulikkottil JoseEnglish M. M. AngadiEnglish K. A. MasaliEnglish Sowmya BhatEnglish Shashank KJEnglish Prashant WajantriEnglishBackground: Blood is scarce. Even with mankind’s advances in the field of science, there is still no substitute for blood. Voluntary blood donation is the safest and most ideal method to meet the current shortage we face. College students are a good source of easily accessible, quality blood provided that they are sufficiently motivated and sensitized to the need. Objective: To assess the knowledge, attitude and practices on voluntary blood donation among first year medical college (Allopathic and Ayurveda) students. Materials and methods: The study was conducted on a total of 165 first year students of BLDEU’s Shri B. M. Patil Medical College and A. V. S. Ayurveda Mahavidyalaya, Bijapur. A semi-structured questionnaire was used to obtain information regarding knowledge, attitude and practices regarding blood donation. Data was analyzed and presented in the form of percentages and figures. Results: All the students had an incomplete and inadequate knowledge regarding blood donation. Although 87% expressed their desire to donate blood, only 18% had donated before, of which only 14.5% were voluntary blood donations. 18% were not aware of their blood group. 66% felt that donors must be rewarded monetarily. 72% students felt the need of some form of motivation to convince them to donate blood. Conclusion: This study shows that the knowledge, attitude and practices regarding voluntary blood donation is dismal among first year medical students. Measures have to be taken to raise awareness and abolish the myths and fears linked to voluntary blood donation.
EnglishKnowledge, Attitude, Practices, Voluntary Blood DonationINTRODUCTION
Science has advanced in leaps and bounds since the dawn of the 20th century. Blood transfusion has saved millions of lives ever since the discovery of ABO blood groups and advances in the preservation of collected blood. However, we are yet to find a substitute for this so called life giving force that is blood. Hence, blood donation, preferably voluntary donations are still the only hope of life for the countless people that require blood transfusion every day. It is estimated that donation by 1% of the population is sufficient to meet a nation’s most basic requirements for blood.1 Today we are faced with an acute shortage of blood. Developing countries including India are struggling to meet the growing demands of safe blood every year. With a rise in road traffic accidents, advances in surgery and a surge in various other medical conditions that necessitates blood transfusion, there has been a massive increase in demand for good quality, safe blood. In India, like in most other developing countries, we rely heavily on voluntary, unpaid donations to meet our demands. But fears and myths attached to blood donation, misconceptions and superstitions that have been a part of the Indian fabric for centuries have built unseen barriers to the efficient and continuous supply of safe blood. In addition to this there is a lack of awareness and motivation among the educated section of society that would have helped to resolve the crisis we face today. National AIDS Control Organization’s (NACO) statistics show that the annual rate of blood donation in India is about 7.4 million units, against the requirement of 10 million units.2 The youth, especially the student population of India, could prove to be a valuable source of safe blood if they are sufficiently motivated and sensitized to the present day needs. Medical students are a good source of easily accessible safe blood. They are also a valuable and trusted source of information for many who come in contact with them every day, including family members and neighbors. Hence it is essential to motivate and create awareness in them at an early stage itself. This study was conducted among the first year medical students (Allopathy and Ayurveda) to assess their knowledge, attitude and practices regarding blood donation when they enter college.
MATERIALS AND METHODS
Study Design: Observational, Cross Sectional Study Source of Data: The study was conducted on a total of 165 first year students of BLDEU’s Shri B. M. Patil Medical College and A. V. S. Ayurveda Mahavidyalaya, Bijapur. Students below the age of 18 years were excluded from the study as they would be below the eligible age for blood donation. Duration of Study: September -October, 2012 Study Technique: Informed consent was taken from the concerned college authorities. A semistructured questionnaire was used to obtain information regarding knowledge, attitude and practices regarding blood donation. Data was analyzed and presented in the form of percentages and figures.
RESULTS
A total of 165 students were included in the study. 119 (72.12%) were MBBS students and 46 (27.88%) were Ayurveda students. The age of the students ranged from 18 years to 22 years. The mean age of the students was 18.3 years (Table 1). Overall percentage of correct responses for questions pertaining to knowledge was 62.37% (Table 2). The main source of information regarding blood donation was the television (41.2%) followed by newspapers (Table 3). 30 (18.18%) of the students did not know their own blood group. 81.3% of the students had never donated blood before. Out of the 18.7% that have donated previously, 14.5% were voluntary blood donations and 4.2% were replacement donations (Figure 1). 72.12% of the students said that they required some form of motivation to donate blood. The main reason for not donating blood among the non-donors was the fear of blood donation and the procedure (Table 4). The factor cited by most of the students that would motivate them to donate blood was better knowledge regarding the blood donation procedure to allay their fears (25.45%). Most of the students (97.6%) felt that blood donation is beneficial to society. About one third of the students felt that blood donors should be rewarded monetarily.64.24% of the students had a family member or a relative that have donated blood before. While 96.67% of the students assured that they would motivate a family member or friend to donate blood, only 144 (87.27%) said that they were willing to donate blood.
DISCUSSION
The overall percentage of correct responses for the questions pertaining to knowledge regarding blood donation was found to be only 62.37% and no student gave 100% correct responses to all the questions. It is also seen that many questions yielded a poor number of correct responses which throws light on the gaps in knowledge existing among the students. These findings are similar to that of Bharatwaj et al who found that all the participants in their study had a very incomplete knowledge regarding the various aspects of voluntary blood donation and that none of the participants were able to respond to the knowledge part of the questionnaire with 100% accuracy.3 Sabu et al in their study found that their participants had average (43.9%) or poor (13.4%) knowledge regarding blood donation.4 The main source of information regarding blood donation among the students was television followed closely behind by newspapers. The least informative source was apparently the radio. It is also interesting to note that the Doctor and Health worker played a lesser role in providing information than family members and friends. This shows that it is important to create awareness not only among the students but also the people around them. Only 18.7% of the study subjects in our study had donated before. This is still higher compared to previous studies such as the study done by Bharatwaj et al in which only one out of the 104 participants had donated before and another study by Devi et al where 13.9% of the study subjects had donated before.3,5 In the present study, of the 18.7% that have donated blood before, 77.42% were voluntary donations and the remaining were replacement donations done for a family member or relative in need of blood. This is similar to the findings in a study done by Sabu et al where of the 28% of the study subjects that had donated before, 64.1% were voluntary donations, 31.4% were replacement donations and 1.9% was done for money.4 The most common reasons for not donating blood before among the non-donors were the fear of blood donation and the procedure (31.34%) and that no one asked them to donate (26.12%). This is similar to the findings in the studies done before that all quote fear, lack of opportunity, ignorance and lack of family support as the main reasons for not donating blood.3,4,5,6 It is surprising that 18.18% of the study subjects were not aware of their own blood group. This is higher compared to the study done by Sabu et al that found that 4.1% did not know their own blood group.4 However, it is reassuring to know that the attitude towards blood donation was found largely positive with 97.6% considering blood donation to be an honorable act that is beneficial to society. This was similar to the findings made by Bharatwaj et al where 100% of the study subjects felt blood donation was a noble act.3 87.27% of the students were willing to donate blood which is comparable to the studies done before.3,4,5,6 Nevertheless, 72.12% of the study subjects said that they would require some form of motivation for donating blood. Most said that better knowledge regarding the procedure would allay fears that they had, which in turn would help motivate them to donate blood. This is similar to findings made by Salaudeen et al who found that adequate information regarding blood donation and knowledge that a unit of blood would save a life were the most important motivational factors involved.6
CONCLUSION
Medical students are an important source of easily accessible safe blood that is often underutilized and overlooked. This study, just like its previous counterparts, throws light on the inadequate and incomplete knowledge of the medical students as well as the potential of the student population to form a reliable and efficient source of safe blood provided that their doubts and fears related to blood donation are laid to rest. A lack of information results in fears and misconceptions that creep into the minds of students. This can be prevented by incorporating early awareness programmes into the curriculum of medical students. Educating medical students also have the added benefit that they play a key role in spreading awareness among other members in the community especially family members and relatives. Though many students are willing to donate blood, they end up not doing so as they are not sufficiently motivated to put their thought into action. Hence, students that are interested to make this noble sacrifice for society should be encouraged and their efforts should be given the recognition that it deserves, as these students turn into a source of inspiration for the people around them.
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=1279http://ijcrr.com/article_html.php?did=12791. Dhingra N. World blood donor day: new blood for the world. World Health Organization. Availablefrom:http://www.who.int/mediacentr e/news/releases/2010/blood_donor_day_2010 0613/en
2. National AIDS control Organization (NACO), India. Voluntary blood donation programme - An operational Guideline, 2007. Available from: http://www.nacoonline.org/upload/Policies and Guidelines/29, voluntary blood donation.pdf
3. Bharatwaj RS, Vijaya K, Rajaram P. A descriptive study of knowledge, attitude and practice with regard to voluntary blood donation among medical undergraduate students in Pondicherry, Indian Journal of Clinical and Diagnostic Research. 2012 May (Suppl-2), Vol-6(4): 602-604
4. Sabu KM, Remya A, Binu VS, Vivek R. Knowledge, Attitude and Practice on Blood Donation among Health Science Students in a University campus, South India. Online J Health Allied Scs. 2011;10(2):6
5. Devi HS, Laishram J, Shantibala K, Elangbam V. Knowledge, attitude and practice of blood safety and donation. Indian Medical Gazette 2012 Jan: 1-6
6. Salaudeen AG, Odeh E. Knowledge and behaviour towardsvoluntary blood donationamong students of a tertiary institution in Nigeria. Niger J Clin Pract 2011;14:303-7
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareVALUE OF C-REACTIVE PROTEIN IN NEONATAL SEPTICEMIA
English3238Deepandra GargEnglish Shalini BajajEnglish Neha AgrawalEnglish Manish bajajEnglishObjective — To assess the value of c-reactive protein as a diagnostic tool in neonatal septicemia, To find prognostic value of quantitative assay of serial CRP in neonatal septicemia and usefulness of serial CRP for guiding duration of antibiotic therapy in neonatal septicemia. Research Design and Methods
MATERIALS AND METHODS
A total of 35 full-term neonates of birth weight >2.5 kg admitted in Nursery Balchikitsalaya RNT Medical College, Udaipur (Lodger and intramural) were included and undertook relevant routine investigation to assess the neonatal septicemia i.e. blood was taken for blood culture, blood cell count with differential and quantitative CRP and micro ESR. Results— C-reactive protein is having >90% sensitivity in diagnosis of neonatal septicemia as compared with other parameters of sepsis screening. A serial decline in CRP value has a strong positive correlation with duration of antibiotic therapy. (P < 0.001) Conclusions- C-reactive protein is highly sensitive test in diagnosis of neonatal septicemia.CRP estimation should also be done on day-4 i.e. after 72 hours of starting antibiotic therapy in a septic newborn. Persistently high values have prognostic implications and antibiotics should be changed if clinically justified. Serial CRP estimation have greater value as compared to single CRP estimation in judging the course and outcome of neonatal septicemia.
EnglishC–Reactive Protein, Neonatal Septicemia, Blood culture, Blood cell count.INTRODUCTION
Perinatal infection especially neonatal bacterial sepsis is the commonest cause of neonatal mortality and morbidity in India.Current neonatal mortality rate (NMR) of India is about 34/1000 live births.(1) Sepsis accounts for almost half of the deaths that occur during neonatal period. Globally WHO estimates 5 million neonatal deaths a year, infection contributes 30-40% of neonatal deaths globally.(2) Sepsis neonatrum is the completely curable life-threatening disease of the newborn. Prompt institution of specific anti-bacterial therapy can be life saving and can reduce neonatal morbidly and mortality up to a large extent. Newborn is a relatively compromised host who is unable to localize the infection and bacterial sepsis can frequently involve vital organs including meninges. This results in non-specific subtle signs and symptoms, which intrigue even the most astute clinician, the two major problems which concern the neonatal physician are, Is it septicemia? And if confirmed as septicemia, whether the patient is improving? There is no rapid and reliable test for the confirmation of the etiologic diagnosis. The treatment is generally started when early markers of neonatal infection (sepsis screen), support clinical picture.(3) A number of acute-phase proteins serve as useful indicators of infection in the neonates viz. C-reactive protein, alpha-1 acid glycoprotein, heptoglobin, ?-1 antitrypsin, fibrinogen, pre albumin, transferrin etc. These markers are still in a controversial status and none of them has until now established for clinical purpose.(4,5) The best studied amongst them is C-reactive protein. C-reactive protein is synthesized in the liver in response to inflammatory cytokinines. Because of its shorter half-life of 19 hours, its level rises with inflammation and accurately parallel with the activity of the inflammation and quickly fall after efficient eliminations of the microbial stimulus. While a high CRP is of important role in diagnosis, treatment and monitoring of inflammatory disorders. Also serial decline in CRP with therapy is suggestion of adequate response to antibiotics and recovery.(6)
A level of >16 mg/L on day 1 and 2 of life and >10mg/L on subsequent day in the newborn period is considered as abnormal in neonates.(7) A quantitative CRP by immune-turbidimetric test is most accurate, rapid and reliable method which will thus be directly indicating whether the neonate is having septicemia or not.(8) Septicemia of newborn infants can be effectively treated by prompt intravenous antibiotic therapy. Once therapy has been initiated it is important to assess whether the chosen treatment is indeed effective. A successful treatment will be accompanied by a decline in CRP to normal (i.e. 2.5 kg admitted in Nursery Balchikitsalaya RNT Medical College, Udaipur (Lodger and intramural) were included. The study was carried out during the month of March to May of year 2006. Permission was taken from the Institutional Ethics Committee. Inform consent was taken from parents of neonates.
Inclusion criteria were:
Symptoms and signs suggestive of septicemia with positive sepsis screen.(10)
Exclusion Criteria
Neonates with birth asphyxia (APGAR score Englishhttp://ijcrr.com/abstract.php?article_id=1280http://ijcrr.com/article_html.php?did=1280Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareCLINICALLY SIGNIFICANT ANATOMICAL VARIATIONS OF THE LEFT CORONARY ARTERY IN HUMAN CADAVERIC HEARTS
English3944P. DharmendraEnglish Takkallapalli AnithaEnglish Seema MadanEnglish PradeepLondheEnglishThe anatomy of the coronary vessels has been described in detail for atleast 3 centuries. Detailed appreciation of the normal origin, course, branching and myocardial distribution of these vessels is vital so that variations of the normal anatomy can be more easily recognized and applied to clinical practice. Knowledge of normal anatomy and variations in the branching pattern of coronary arteries is very important to identify the cause of coronary artery diseases and to perform therapeutic, radio diagnostic and surgical procedures. Since the left main coronary artery system is the commonly affected vessel and is the first vessel to show blockages, this study was conducted. 93 formalin fixed hearts were collected in the department of anatomy over a period of 2010 to 2012 and dissected. Origin, length, number of terminal divisions and the area of distribution of left main coronary artery was noted. The present study showed that the left coronary artery originated from left posterior aortic sinus except in one heart where it originated from right coronary sinus. The mean length of left coronary artery is 9.2 ±0.31mm, mean outer diameter was 4.64 ± 1.03.In 58.6% cases it bifurcated, in 35.48% cases it trifurcated and in 6.45% hearts it tetrafurcated.
EnglishLeft main coronary artery, variations, tetrafurcation, angiographic anatomy.INTRODUCTION
The incidence of coronary artery diseases has seen an increasing trend in developing countries in the last few decades. The study of variations of coronary arteries especially the left main coronary artery can be of immense help to clinician planning interventional procedures such as stenting, balloon dilatation or graft surgery, particularly when there are secondary changes of calcification, plaque formation and stenosis [1]. In the vast majority of people, there are two main coronary arteries, right and left, which arise from separate ostia in the ascending aorta [2].Most of the area of heart is supplied by the left main coronary artery. The area irrigated by each of coronary arteries using postmortem angiography shows that the left main coronary artery irrigates 68.8% of the cardiac muscle mass, 41.5% by left anterior descending artery and 27.3% by the left circumflex artery[3]. These values may vary depending upon the coronary arterial dominant pattern. The left coronary artery arises from the left sinus of valsalva and courses laterally between the base of pulmonary trunk and left atrium. The left coronary artery usually divides into two major branches, the left anterior descending and left circumflex arteries. A third branch originates between the angle formed by the left anterior descending and the left circumflex arteries and has various names, including “ramus intermediate”, “median artery” , “left diagonal artery” and “straight left ventricular artery [2].
MATERIALS AND METHODS
93 formalin fixed heart specimens were collected from the department of Anatomy, Chalmeda AnandRao Institute of Medical Sciences, Bommakal Karimnagar-Andhra Pradesh, India over a period of 3 years and preserved in 10% formalin. Skin incisions were given and thorax was opened as per instructions of cunningham’s manual of practical anatomy 15th edition [4].The great vessels were ligated and the heart specimens were removed along with them. The coronary arteries were traced from their origin. Length and outer diameter of left main coronary artery were noted using a verniercaliper. Photographs were taken, all the information was meticulously tabulated, statistically analysed and compared with earlier studies. The following criteria have been taken into consideration. i).Origin of left main coronary artery. ii).Length and outer diameter of left main coronary artery. iii).Termination of left main coronary artery.
DISCUSSION
Variations related to the origin and course of coronary arteries may be benign or malignant [5]. The latter predisposes a person to early vascular compromise, ischaemia and fatal infarction. Benign anomalies of origin of left coronary artery include. i). A single coronary artery arises from the right cusp and divides into right coronary artery and left coronary artery, with the left coronary artery coursing anterior to the right ventricular outflow tract [7].
ii). A single coronary artery arises from the left cusp and divides into the right and left main coronaries, with the right coronary artery coursing posterior to the aorta. Malignant anomalies of origin of left coronary artery include. i). Malignant left coronary artery: This occurs when the left coronary artery arises from the right cusp and courses between the aorta and pulmonary artery. In this interarterial segment of the artery is subjected to compression during heavy exercise and can cause sudden death in young persons or athletes. Basso [6] considered that the left coronary artery originating from the right cusp and crossing between the right coronary artery and aorta was more dangerous than right coronary artery taking similar path, as a larger volume of myocardium is put at risk in the former case.[fig: 1] The variations in the origin of coronary arteries may be explained on embryological basis. The first evidence of coronary vessel development is the appearance at the beginning of the fifth week of intrauterine life of a structure like blood islands just under the epicardium in the sulci of developing heart [8,10]. According to the theory of Ogden J; there is a dual origin of coronary arteries, proximal and distal. The distal portion develops first. It is comprised of a retiform vascular network, similar to the capillary network that forms in the other parts of body. This network develops in the interventricular and atrioventricular grooves and forms a complete ring around the developing vessels (peritruncal ring) and communicates with the heart chamber and extra cardiac great vessels. Further development of some vessels and regression of others, the final coronary pattern develops. This theory adequately explains the variations of coronary vasculature [9,10]. In our present study the left coronary artery arose normally from left posterior aortic sinus and in 1.07% of hearts it arose from right coronary sinus. ostium was present below the supra ventricular ridge.[fig:1] [Table no: 1] The length of the left main coronary artery in general varies from 2 to 12 mm but may be upto 30mm. It’s diameter, ranging from 5 to 10 mm is generally inversely related to its length [2].Green G.E. et al [11] studied the length of the left main coronary artery in 50 consecutive autopsy specimens in which 48% of cases, the length of left main coronary artery was 10 mm or less and in remaining 52% cases, the length was up to 25 mm. the short left main coronary artery explains some failures of adequate coronary perfusion. During aortic valve surgery, myocardial perfusion depends on the placement of one or more cannulas in the coronary arteries. In this regard, the length of left main coronary artery prior to its bifurcation is particularly important. A short main trunk makes carrying out coronary angiography difficult because the catheter is inserted into one of the terminal branches, the opacification of the other branch does not occur and an incomplete image of the coronary tree is seen. In the present study, the mean length of left main coronary artery was found to be 9.2 ± 0.31mm which correlates with the above observations. [Table no: 2] Outer diameter of left main coronary artery is important in estimating the extent and severity of dilatation in cases of coronary aneurysm, calcification and stenosis. According to Glagov theory, the outer diameter of coronary artery dilates in the early phases of atherosclerosis, when plaque deposition leads to positive remodeling with preservation of the vessel lumen[16] Reg J et al [12] studied all the characteristics of the main trunk of left coronary artery in 100 autopsy heart specimens. The diameter of the main trunk measured at its midpoint was found to be in between 3 to 7mm with average value of 4.86 ± 0.8 mm. In the present study, the mean outer diameter measured at its mid point was found to be 4.64 ± 1.03 mm which is close to the above observation. [Table no: 2] The termination of left main coronary artery varies from 2 or more branches and accordingly named as bifurcation, trifurcation, tetrafurcation and pentafurcation. Banchi. A [13] described the termination of left main coronary artery varying between two to three branches with the most common pattern of the bifurcation being 64%. Which is close to the observation made in our study i.e. 58.06% hearts. In 35.48% of our present study, the left main coronary artery trifurcated, where as similar observation was also made by cavalcanti JS in 38.18% of heart specimens [14]. Bapista[15] observed that the left main coronary artery tetrafurcated in 6.7% of cases and the similar observation was found in our study i.e. in 6.45% cases. [fig: 2][Table no: 3] The left main trifurcating lesions are generally treated with bypass surgery and left main trifurcation disease is more complex than left main bifurcation disease. Therefore its percutaneous treatment is expected to have a higher rate of adverse events like stent thrombosis. Trifurcation stenting carries a high rate of adverse events and may need to be reserved for patients who are at a high risk of bypass surgery or who refuse surgery [17]. CLINICAL SIGNIFICANCE Anomalous origin of the coronary artery from the opposite sinus of valsalva is particularly important as it has been associated with myocardial ischaemia, ventricular arrhythmias & sudden death, especially when the anomalous artery course is interarterial, intra myocardial or intramural. Surgical repair in the form of uproofing of the vessel seems to be the most promising method for this condition. Isolated coronary hypoplasia, stenosis or atresia are extremely uncommon and the left coronary system is usually hypoplastic and ischaemia is frequent in these conditions. Congenital coronary artery aneurysms are indistinguishable from those acquired conditions secondary to other diseases. Major aneurysms can rupture thrombose or produce infarction due to thromboembolism.
CONCLUSION
Knowledge of coronary circulation is not only important for anatomists but also for radiologists and cardiologists performing angiographies and shunt surgeries, in diagnosis and treatment of congenital, inflammatory, metabolic and degenerative diseases involving the coronary arteries. The advances made in coronary artery bypass surgeries and modern methods of myocardial revascularization led to the present study.
Englishhttp://ijcrr.com/abstract.php?article_id=1281http://ijcrr.com/article_html.php?did=12811. Anand M Rahalkar, Mukund.D.RahalkarPictoral essay : Coronary artery variants and anomalies 2009 February;19(1);49-53.
2. David.M.Fiss, Normal coronary anatomy and anatomic variations, Supplement to Applied Radiology January 2007, 14-26.
3. Kalbfleisch H. Hort W. Quantitative study on the size of coronary artery supplying areas postmortem AM Heart.1977; 94:183- 188.
4. G.J. Romanes, Cunningham’s manual of practical anatomy. 15th Ed; Vol: 2; Thorax and abdomen; Pg: 14-15.
5. Yamanaka O, Hobbs RE. Coronary artery anomalies in 126,595 patients undergoing coronary arteriography. Cathet cardiovasc Diagn. 1990 ; 21: 28-40.
6. Basso C , Thiene G. Congenital coronary artery anomalies at risk of myocardial ischaemia and sudden death: A report Business briefing : European Cardiology. 2005
7. Desmet W , Vanhaecke J, vrolix M , vande werf F, Piessens J, Williams J. Isolated single coronary
8. artery: A review of 50,000 consecutive coronary angiographies Eur.Heart J.1992: 13:1637-40[pub Med].
9. Decker, G.A.G, duplessis, DJ; Lec Mcgregor’s synopsis of surgical anatomy, 12th edition, ch-22 “The heart and the great vessels”,pg-280; K.M.varghese company, Dadar, Bombay 4000014, India, 1986.
10. Ogden J: The origin of the coronary arteries; circulation 1968[38]: Suppl 6:150.
11. Dr.Jyoti kulkarni, Dr.Lopa Mehta,study of angiographic anatomy of right coronary artery IOSR JDMS (sept-oct 2012) Vol 2[1]:pg.39-41.
12. Green GE, Bernsteins,Repper E.H. The length of the left main coronary artery.Surgery Dec 1967;62:1021-1024.
13. Reg J. petit.M. Main trunk of left coronary artery: Anatomic study of the parameters of clinical interst.clinical Anatomy 2004,17;6-13
14. Bnchi A.Mofolgia della arteriae coronariae cordis Arch ital anat.E Embriol 1904;3:87 Cavalcanti JS. Anatomic variation of the coronary arteries, Arq Bras Cardiology 1995,65(6):489:492
15. Bapista CA.Cel Types of division of left coronary artery and the ramus diagonalis of the human heart.Jpn Heart J.1991, 32 (3):323-335.
16. Paolo Angelini MD, Jorge Monge, Newer concepts regarding adults with coronary artery aneurysm. American heart association 2012: 125: 3076-3078.
17. Nicolas W. shammas, MD. Eric J. Dippel MD, Amber Avila Bsc, Lauren gehbauer, Leslie farland, Stefanie Brosius, Michael Jerin, Mathew winter, Penny stoakes, RN. Jeanette Byrd, RN, Lynne majestic, RN, Gail Shammas, RN, Peter Sharis, MD. Jon Robken MD. “ long term outcomes in treating left main trifurcation coronary artery disease with the Paclitayel-Eluting stent. J. invasive cardiol 2007; 19: 77-82.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareNEW TECHNIQUE TO MOUNT SPECIMEN IN THE FORMALIN FILLED JAR FOR ANATOMY MUSEUM WITH ALMOST INVISIBLE SUPPORT
English4550Lalit Kumar JainEnglish Hitesh BabelEnglish Neha VijayEnglishSpecimens in Anatomy museum are mounted by various methods according to anatomical while handling so specimens, organs with their attached vessels and excretory ducts are mounted on glass/acrylic plate/ and used X-Rays plate/ plastic sheets. Organs are stitched parts, organs etc. Specimens lying in the formalin filled glass jar without any support will alter its position with threads. Excessive tight stitches damage the organs specially the brain while heavy organs that are loosely hanging on the X-Ray plate/ plastic sheet will not retain their normal position. Some used paraffin wax blocks but specimen still needed support to maintain the position. Here we supported the mounted specimens with cylindrical pieces of transparent plastic soda bottles without the use of needle and threads. This mounting technique is very easy, less time consuming and does not damage the specimen.
EnglishEasy Mounting method, mounted organs, brain, threads, Transparent Plastic soda Bottle.INTRODUCTION
Anatomy department is also known by its Museum. Human body parts, organs, soft parts and also hard parts are presented in many ways but the most popular method being mounting specimen in glass or acrylic jar filled with 10% formaldehyde solution [1,2] . The lid is tightly sealed with either mixture of white paraffin and bees wax or by cello tape. Many specimens particularly of limbs are mounted by stitching two or more thread on its upper end and the threads are sealed with the jar after tightening them according to position of limb but even then the lower end of the limb is not fixed hence the possibility of change in position is always there as well the thread decreases the beauty of specimen. Many specimens particularly of organs are mounted by stitching them with thread on acrylic/plastic plate. If the stitches are tight they damage the tissue especially fragile tissue like brain. In such method initially tight stitches will produce damage to it and with the passage of time due to the weight of the organ/part the stitches become loose and the organ/part is not in their original position since the organ is not perfectly immobile. The threads reduce the beauty of the specimen. Plaster of Paris can be used to mount brain specimen. Virendra Kumar NIM mounted brain in paraffin wax [3] .In both the specimen with block of plaster of Paris or wax has to be made immovable which will need an extra support. Specimen prepared nicely and properly mounted (i.e. its position should be maintained) increases the beauty of the specimen which will not allow change its position in jar even if the jar is moved. Therefore a specimen should be totally immovable in the glass jar for better inspection by the students and if it is totally immovable then it can be transferred easily from one place to another to teach the students and also labelling on the jar with black OHP pen may be done which give direct information as it is seen in text book and if the support to the organ is almost invisible then it will definitely increase the beauty of the specimen. Srikant Natarajan et al [4] used polyethylene terephthalate (PET, PETE or polyester) in place of centre glass rod and stitched them with specimen to support it. In our method we did not use threads to support the specimen.
MATERIAL AND METHOD
We used transparent plastic soda bottle after removing the pasted label on it. Then the plastic soda bottle was properly washed to make it absolutely clean. Then cylindrical piece of transparent plastic soda bottle was cut of required length with the help of scalpel or scissors to support the specimen of limbs, organs, brain as well as most of the foetuses. Soda bottle is preferred because its plastic is thick. Then cylindrical piece of it was compressed and put between specimen and back wall of jar. It provided enough pressure which will permanently hold the specimen in its position. Whenever the support to the back of the specimen alone was not sufficient extra support with the same material was also provided to the side/sides of the specimen. Another cylindrical piece of transparent plastic soda bottle can be placed below the specimen to provide it support from below. Then the specimen became immobile and the jar was filled with 10% solution of formalin and sealed the lid by wax or cello tape. They became totally immovable in the glass jar filled with 10% solution of formalin. Cylindrical piece of transparent PET bottles (preferably soda bottles) are preferred because its size is suitable to fill the gap between the specimen and the jar in most cases. In this method needle and threads were not used to support the specimen. This is a simple and easy to perform and less time consuming technique to support the mounted the specimen. Here some pictures are shown how different organs or parts were supported with this method. Arrows indicate the supports.
RESULT
We successfully used this technique to support specimen of different size and shape in our museum, still specimen of some foetuses required some support with threads. Most of the specimens of pathology can also be mounted with this method. This method can be used to support mounted specimens of limb, organs (especially brain) and most of the foetuses. Since the support is almost invisible it gives appearance that body part or organ is hanging in formalin filled jar without any support. This method of support to the mounted specimens can be used in place of traditional use of threads and other means.
DISCUSSION
The advantages of using this method over the traditional thread method are that it provides proper support to the specimen without affecting the looks of specimen, second the specimen is not damaged by the use of needle as in this case thread is not used so needle is not passed through the specimen, third this procedure is less time consuming and requires less expertise in comparison to traditional methods and fourth some specimens which are difficult to support with traditional methods (e.g. Kidneys with Urinary Bladder) can be easily supported with this new technique, fifth specimen can be easily transported if required without change in their position, sixth the procedure can be repeated without damage to the specimen if something goes wrong and lastly empty soda bottles which are easily available and cheap provide permanent support to the specimen due to its durability. This certainly increases the beauty of the specimen.
CONCLUSSION
It is concluded that mounted specimen can be supported with small cylindrical pieces of PET (preferably soda) bottles without the use of threads. In future it can be used in place of traditional methods used so far with many advantages. It has a promising future in the field of museum techniques in anatomy.
ACKNOLEDGEMENT
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=1282http://ijcrr.com/article_html.php?did=12821. Pulvertaft RJ. Museum Techniques: A Review. J Clin Pathol 1950; 3:1-23.
2. Proger LW. Perspex Jars for Pathological Museums. J Clin Pathol 1958; 11:92-5.
3. Virendra Kumar NIM, wax mounting of specimen in anatomy museum. J.Anat. Soc. India 61(1)41-43(2012)
4. Srikant Natarajan, Jyoti Ranjan, Karen Boaz, Museum mounting techniques: Revisited econo-mode Year : 2012 | Volume : 55 | Issue : 2 | Page : 260-261
5. Otto FK, Thomas N. On mounting of anatomical specimens in transparent plastics: The anatomical records 1948, 100(2): 201- 23.
6. Von hagens G, Tiedemann K, kriz W. The current potential of plastination: Anat Embryology 1987,775(4): 411-421
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareEVALUATION OF DIABETIC PERIPHERAL NEUROPATHY IN KNOWN CASES OF TYPE 2 DIABETES IN URBAN AND RURAL POPULATION
English5156Lakshmana Kumar N.English Mallikarjuna Rao K.V.N.English Srinivas ChEnglish Kishore K.English Kiran Deedi M. English Lakshmana Rao N.EnglishBackground: Diabetic Peripheral Neuropathy (DPN) is one of the microvascular complications of diabetes, and is responsible for most of the amputations in diabetes. Measurement of Vibration Perception Threshold (VPT) is useful in assessment of peripheral neuropathy. The aim of the study is to study the role and correlation of age, duration of diabetes, fasting plasma glucose, HbA1C, and microalbumin:creatinine ratio with diabetic peripheral neuropathy in known cases of type 2 diabetes mellitus in urban and rural population of Rajahmundry, Andhra Pradesh, India. Methods: Study was done on two groups comprising of 30 cases with normal VPT and 30 cases with abnormal VPT in type 2 diabetes. Age, duration of diabetes, body mass index, fasting plasma glucose, HbA1C, and microalbumin:creatinine ratio were recorded and analyzed. Results: Significant difference in age, duration of diabetes, fasting plasma glucose, HbA1C, and microalbumin:creatinine ratio is observed between groups (P < 0.05). There is significant correlation of age, duration of diabetes, fasting plasma glucose, HbA1C, and microalbumin:creatinine ratio with VPT (P < 0.05) in all cases. Among the correlating parameters multiple regression analysis revealed that age and HbA1C are good predictors of VPT (P < 0.05). Conclusion: Age, duration of diabetes, fasting plasma glucose, HbA1C, and microalbuminuria were associated with DPN in urban and rural population. However age and HbA1C are strong predictors of changes in VPT. There is need to study the prevalence of and other risk factors associated with DPN with a larger sample size in this area.
EnglishDiabetes, Peripheral neuropathy, Vibration perception threshold, Risk factors.INTRODUCTION
Type 2 Diabetes mellitus is one of the most common forms of chronic disease.1 With the change in life style and urbanization, the number of individuals with diabetes are increasing and the age of diagnosis is decreasing.1 Longer periods of exposure to hyperglycaemia have increased the risk of developing complications related to diabetes.1 The real burden of diabetes is due to its micro and macro vascular complications which may present even at the time of diagnosis.2 Diabetic Peripheral Neuropathy (DPN) is one of the microvascular complication of diabetes, and affects approximately 30% of people with diabetes.3 More than 80% of amputations occur after ulceration or injury, which can result from diabetic neuropathy.4 Diabetic patients are 15 times more likely to have an amputation than non diabetic patients.5 Early identification of DPN prevents the morbidity and mortality due to diabetic neuropathy. 5 Assessment of Vibration Perception Threshold (VPT) is one of the recommended standardised quantitative sensory testing methods employed in the diagnosis of DPN.6 Elevated VPT is an effective predictor of neuropathic foot ulceration, one of the most common causes for hospital admission and lower limb amputations among patients with diabetes.7 Along with markers of microangiopathy such as microalbuminuria, VPT may also predict mortality in people with diabetes.8 Most of the available studies in India on DPN were either hospital based or done in metro populations.9,10 There are geographical variations of prevalence and risk factors associated with DPN.10,11,12 Further research is required in small urban and rural population of India to study DPN. The present work was taken up to evaluate the association of age, duration of diabetes, body mass index (BMI), fasting plasma glucose (FPG), glycated haemoglobin (HbA1C), and microalbuminuria in known cases of type 2 diabetes mellitus in urban and rural population of Rajahmundry, Andhra Pradesh, India.
METHODS
This cross-sectional observation study was carried out in Rajahmundry urban and rural population in the month of April 2013. Rajahmundry is a coastal town with a population of 3,43,903 which was divided into 50 municipal wards. The surrounding rural population of five villages (Bommuru, Dowleswaram, Hukumpet, Katheru and Morampudi) under Rajahmundry metro area is 1,34,296. The study group is comprised of 300 known cases of Type-2 Diabetes mellitus. 200 cases were recruited from five wards of Rajahmundry city and 100 cases were recruited from surrounding five villages by systematic random sampling as a part of ongoing Rajahmundry Integrated Diabetes Evaluation and Research (RIDER) study. Study was approved by institutional Ethics committee. Written and informed consent was obtained from all the participants. Known cases of neuropathy due to other causes like chronic inflammatory polyneuropathy, hypothyroidism, B6, B12 deficiency and uraemia were excluded from the present study. Study population was screened using VPT assessment by biothesiometer. VPT below 10 volts was considered as normal and above 10 volts was considered as abnormal with loss of vibratory perception. 30 cases with normal VPT and 30 cases with abnormal VPT (Twenty cases from urban population as four from each ward and ten cases from rural population as two from each village) were selected by systematic random sampling and were recruited for the present study for further anthropometric and biochemical evaluation. VPT was measured using digital biothesiometer (Diabetik foot care India) at six different places (First toe, 1st, 3rd, 5th metatarsal head, instep and heal) on both feet. Average of the twelve readings was taken as final value. Fasting whole blood sample was collected. First morning midstream urine was collected in a sterile urine container. Age, Height and weight were recorded. BMI was calculated from height and weight by the formula Wt. in Kg/Ht. in m2 . HbA1C was measured with whole blood using NGSP (National Glycohemoglobin Standardisation Programme) certified Biorad in2it analyser. Plasma glucose was measured by glucose oxidase and peroxidase method. Microalbumin was measured by immuno turbidimetry and urinary creatinine by Jaffe’s method. Microalbumin: creatinine ratio was calculated.
Statistical Analysis
Data was analyzed using Microsoft excel 2007 and SPSS trial version 16.0. Continuous variables were expressed as mean ± standard deviation. Student ' t ' test was used to compare means of the two groups. Karl Pearson method was used to observe the correlation of variables. Multiple regression analysis was used to study the prediction of dependant variable by correlating variables. Probability (P) value less than 0.05 was regarded as statistically significant.
RESULTS
There is significant difference of mean of all variables except BMI between cases with normal VPT and abnormal VPT (Table -1, 2). Correlation analysis was done in all cases. Age, duration of diabetes, FPG, HbA1C, and microalbumin:creatinine correlates significantly with VPT in type 2 diabetes (Table -3). Microalbuminuria is present in all cases with abnormal VPT. Multiple regression analysis was done to assess the predictability of VPT by correlating variables. Age and HbA1C are good predictors of changes in VPT (Table -4). Discussion In the present study, there is significant difference in age and duration of diabetes between groups, and correlation of age and duration of diabetes with VPT. DPN increases with both age and duration of diabetes, and 50% cases of type 2 diabetes cases aged over 60 years have DPN.13 There is progression of polyneuropathy with advancing age with a decline in sensory and motor action potentials.14 Significant difference in FPG and HbA1C between groups, and correlation of FPG and HbA1C with VPT suggests that impaired glycaemic control plays definite role in development of DPN. Micro vascular complications are caused by prolonged exposure to hyperglycaemia, which damages tissues by polyol pathway, increased advanced glycation end products (AGE), and induction of super oxide production in mitochondria.15 Significant difference in microalbumin;creatinine ratio between groups and correlation of microalbumin:creatinine with VPT supports the concept of coexistence of other microvascular complications like nephropathy and retinopathy in cases of neuropathy.9 All the cases with abnormal VPT have microalbumnuria in the present study. This may be due to the higher prevalence of microalbuminuria in this geographical area.16 The degree of coexistence and prevalence of microvascular complications are associated with differences in individual susceptibility, which is linked with polymorphism of genes like super oxide dismutase (SOD).17 Though some studies have reported negative correlation of BMI with neuropathy, there is no statistically significant difference and correlation of BMI with VPT in the present study. 9 The limitation of the present study is that age wise, gender wise, within the group analysis was not donebecause of small sample size. Evaluation of other parameters like lipid profile, blood pressure, ankle brachial index may help in more detailed evaluation. This study will serve as pilot study for further research in this area. Conclusion This study in urban an rural population shows that age, duration of diabetes, fasting plasma glucose, glycated haemoglobin (HbA1C), microalbumin:creatinine ratio were high in cases with abnormal vibration perception threshold, and correlate with vibration perception threshold in known cases of type2 diabetes mellitus. Body mass index has no association with vibration perception threshold. Age and HbA1C are good predictors of vibration perception threshold in type 2 diabetes. Detailed evaluation with a larger sample size is required to assess the prevalence of and risk factors of diabetic peripheral neuropathy in urban and rural population. Source of funding: Authors have not received any grant for the present study. Conflicts of interest: There are no conflicts of interest in the present study.
ACKNOWLEDGEMENTS
Authors wish to acknowledge Dr.Y.N.Rao, Professor and Head, Department of Biochemistry, GSL Medical College, Rajahmundry for his support and guidance and all the participants of RIDER study for their cooperation. 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=1283http://ijcrr.com/article_html.php?did=12831. Ronald C.W. Ma, Petr C.Y. Tong. Epidemiology of Type 2 Diabetes. In: Richard I.G. Holt, Clive S. Cockram, Allan Flyvbjerg, Barry J. Goldstein, editors. Text book of Diabetes. 4th ed. 20 West Sussex (UK): Wiley –Blackwell; pp.45-46.
2. Shashank R Joshi, AK Das, VJ Vijay, V Mohan. Challenges in Diabetes Care in India: Sheer Numbers, Lack of Awareness and Inadequate Control. J Assoc Physicians India 2008;56: 443-50.
3. Shaw JE, Zimmet PZ, Gries FA, Ziegler D. Epidemiology of diabetic neuropathy. In: Gries FA, Cameron NE, Low PA, Ziegler D, editors. Textbook of Diabetic Neuropathy. Stuttgart/Newyork: Thieme, 2003;64-82.
4. Boulton AJM, Vinik AI, Arezzo JC, Bril V, Feldman EL, Freeman R, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care 2005;28:956-962.
5. Bild DE, Selby JV, Sinnock P, Browner WS, Braveman P, Showstack JA. Lower extremity amputation in people with diabetes: epidemiology and prevention. Diabetes Care 1989;12:24-31.
6. Consensus Development Conference on Standardised Measures in Diabetic Neuropathy. Proceedings of a consensus development conference on standardised measures in diabetic neuropathy. Diabetes Care 1992;15(3):1080-1107.
7. Abbott CA, Vileikyte L, Willimason S, Carrington AL, Boulton AJM. Multicenter study of the incidence of and predictive risk factors for diabetic neuropathic foot ulceration. Diabetes Care 1998;21:1071- 1075.
8. Coppini DV, Bowtell PA, Weng C, Young MJ, Sonksen PH. Showing neuropathy is related to increased mortality in diabetic patients: a survival analysis using an accelerated failu re time model. J Clin Epidemiol 2000.;53:519-523.
9. Hari KVS Kumar, SK Kota, A Basile, KD Modi. Profile of Microvascular Disease in Type 2 Diabetes in a tertiary Health Care Hospital in India. Ann Med Health Sci Res 2012;2(2):103-108.
10. Rani PK, Raman R, Rachapalli SR, Pal SS, Kulothungan V, Sharma T. Prevalence and risk factors for severity of diabetic neuropathy in type 2 diabetes mellitus. Indian J Med Sci 2010;64:51-57.
11. Pradeepa R, Rema M, Vignesh J, Deepa M, Deepa R, Mohan V. Prevalence and risk factors of Diabetic neuropathy in an Urban south Indian population: The Chennai Urban Rural Epidemilogy Study (CURES-55). Diabet Med 2008;25:407-12.
12. Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population based cohort: The Rochestor Diabetic Neuropathy Study. Neurology 1993;43:817-824.
13. Young MJ, Boulton AJM, Macleod AF, Willims DRR, Sonksen PH. A multicentre study of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia 1993;36(2):150-154.
14. Partanen J, Niskanen L, Lehtinen J, Mervaala E, Siitonen O, Uusitupa M. Natural history of peripheral neuropathy in patients with NIDDM. N Engl J Med 1995;333(2):89-94.
15. Ferdinando Giacco, Michael Brownlee. Pathogenesis of Microvascular Complications. In: Richard I.G. Holt, Clive S. Cockram, Allan Flyvbjerg, Barry J. Goldstein, editors. Text book of Diabetes. 4th ed. 20 West Sussex (UK): Wiley –Blackwell; pp.555-574.
16. Lakshmana Kumar N, Mallikarjuna Rao KVN, Kishore K, Priyadarsini DVS, Kiran Deedi M, Laxman Rao N. Awareness of Diabetes and its relation to prevalence of microalbuminuria in known cases of Type 2 Diabetes. Indian Journal of Public Health Research and Development. In press 2013.
17. Al-Kateb H, Boright AP, Mirea L, Xie X, Sutradhar R, Mowjoodi A, et al. Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Research Group. Multiple super oxide dismutase 1/splicing factor serine alanine 15 variants are associated with the development and progression of diabetic nephropathy:the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications Genetics study. Diabetes 2008;57:218-228.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareSTUDY OF MICROBIAL FLORA IN PATIENTS WITH INDWELLING CATHETER
English5760Manish N.English Tankhiwale N. S.EnglishIntroduction: - Catheter associated urinary tract infections are common nosocomial infections, 80% cases of UTI are due to use of catheters. The incidence of becteriuria in catheterized patient is directly related to the duration of catheterization. E.coli, Proteus, Pseudomonas, Klebsiella, Serratia, Staphylococcus, Enterococci and Candida Sp. Are the common micro-organisms causing this infection? Aims and Objective: - The present study is to determine the microbiological profile and the sensitivity pattern which can cause Catheter Associated Urinary Tract Infections. Materials and Method: - The study was conducted in 100 adult patients, whom an indwelling Foley’s catheter was inserted in AVBR Hospital during August 2011 to August 2012, in different medical wards, surgery wards and ICU. The catheterized urine sample was collected after catheterization on 5th day onwards on indwelling catheterization. Approximately 3 ml of urine was taken in sterilized container with the sterile precautions. The urine sample microscopy for pus cells, other abnormalities, gram staining was done and inoculate urine in culture medium. The final reading was done after 18 to 24 hrs. Of incubation of culture plates at 37oC. Antibiogram testing was done by Kirby-Bauer disk diffusion technique. Result and Conclusion :- The most common organism colonizing and causing catheter associated urinary tract infection as per observation were found to be E.Coli (57%) followed by Klebsiella Sp.(20%), Staphylococcus (8%), Enterococcus Sp. (6%), Pseudomonas aeruginosa (5%) and Acinetobacter Sp. (4%). Frequent cleanliness of catheter, area to avoid contamination and colonization of microbial flora, it is recommended to change the catheter every 5th day.
EnglishCatheter associated urinary tract infection, becteriuria, E.ColiINTRODUCTION
Catheter associated urinary tract infections are common nosocomial infections, 80% cases of UTI are due to use of catheters.1 Fifteen to twenty five percent of patient in hospitals, need catheterization.2 Factors that have increased the risk of catheter associated urinary tract infections are prolonged catheterization, severe underlying illness, disconnection of catheter and drainage tube, faulty catheter care and lack of systemic antibiotics therapy.3 About 1% to 48% of hospitalized patient with indwelling catheters still acquire the infection.2 The incidence of becteriuria in catheterized patient is directly related to the duration of catheterization.4 Urethral catheter is a major predisposing factor in the development of nosocomial UTI and catheter- associated bacteremia.5 Most nosocomial UTI can be benign but a systemic complication which is gram-negative septicemia can develop in 30-40% of patients. E.coli, Proteus, Pseudomonas, Klebsiella, Serratia, Staphylococcus, Enterococci and Candida Sp. are the common micro-organisms causing this infection. Many infecting strains display markedly greater antibiotics resistance than organisms that cause community-acquired Urinary tract infection.7 Study of microbial flora in these patients can prevent establishment of UTI and further kidney damage. Antibiotic sensitivity testing will help the clinician to give proper treatment.6
AIMS AND OBJECTIVE
The present study is undertaken to determine the microbiological profile and the sensitivity pattern of the strains which can cause Catheter Associated Urinary Tract Infections.
MATERIAL AND METHOD
The study was conducted in 100 adult patients, whom an indwelling Foley’s catheter was inserted in AVBR Hospital during August 2011 to August 2012. The study was undertaken in patients catheterized and admitted in different medical wards , surgery wards and ICU. The catheterized urine sample was collected after catheterization on 5th day onwards on indwelling catheterization. Sample was collected by 24- gauge needle with all sterile precautions and urine was brought to microbiology lab within 1 hour of collection for further processing. Approximately 3 ml of urine was taken as a sample in sterilized container with the sterile precautions with sterilized syringe. The microorganism growth was seen only after 5th day of catheterization. The urine sample microscopy for pus cells, other abnormalities and gram staining was done. Standard loop was used for inoculating urine in culture medium. The urine was subjected to culture on Blood agar, MacConkey agar, CLED (Cystine Lactose Electrolyte Deficient Medium),TSI and Nutrient agar. The final reading was done after 18 to 24 hrs. of incubation of culture plates at 37oC. The identification of micro-organisms was done by the colony characters, Gram staining, morphology, biochemical reactions as per standard text book (Practical Medical Microbiology, Mackie & McCartney, 14th edition). Colony count >105 cfu/ml was considered as significant. Antibiogram testing was done by Kirby-Bauer disk diffusion technique in MuellerHinton medium.
DISCUSSION
The result of the microbiologic profile in this study is similar to most reported studies. E.Coli still being the most common pathogen (57% of cases) followed by Klebsiella pneumoniae(20%), Staphylococcus(8%), Enterococcus Sp.(6%), Pseudomonas aeruginosa (5%) and Acinetobacter Sp.(4%). In a study conducted by Poudel C.M., Baniya G. Department of Internal Medicine and Department of Microbiology, TUTH, Katmandu the majority of organisms belonged to E.Coli (40.77%),Klebsiella pneumoniae (11.11%), Enterococcus Sp.(11.11%),Pseudomonas (11.11%),Acinetobacter Sp. (3.7%) are all most similar. Present study is comparable to those workers. The most common organism colonizing and causing catheter associated urinary tract infection as per observation were found to be E.Coli (57%) followed by Klebsiella Sp.(20%), Staphylococcus (8%), Enterococcus Sp. (6%), Pseudomonas aeruginosa (5%) and Acinetobacter Sp. (4%). E.Coli are found to be sensitive to Amikacin (87.71%), Nitrofurantoin (82.46%) Ceftazidime (14.03%), least sensitive to Ciprofloxacin (8.77%) and Co-trimaxazole (7.02%) and 100% sensitive to Imipenem. Klebsiella Sp. are found to be sensitive to Amikacin (75%),Ciprofloxacin (30%), least sensitive to Nitrofurantoin (9%) and 100% sensitive to Imipenam and 100% resistance to Co-trimoxazole. Staphylococcus are found to be sensitive to Ciprofloxacin (75%), Co-trimoxazole (62.5%), Erythromycine (62.5%) and 100% sensitive to Nitrofurantoin and Vancomycin and 100% resistance to Penicillin. Enterococcus Sp. are found to be sensitive to Nitrofurantoin (66.66%), Amikacin(33.33%) and 100% sensitive to Vancomycin and Lenezolid and 100% resistance to Penicillin and Ciprofloxacin. Pseudomonas aeruginosa are found to be sensitive to Amikacin (40%), Netillin (40%) and 100% sensitive to Imipenam and Pipracillin and 100% resistance to Ceftazidime, Nitrofurantoin and Ciprofloxacin. Acinetobacter Sp. are found to be sensitive to Amikacin (50%) and 100% sensitive to Imipenam and 100% resistance to Ceftazidime, Nitrofurantoin, Ciprofloxacin and Cotrimoxazole.
CONCLUSION AND RECOMMENDATIONS
Frequent cleanliness of catheter, area to avoid contamination and colonization of microbial flora, it is recommended to change the catheter every 5th day.
Proper aseptic precaution to be taken while collection of samples by syringe.
Microbial flora should be evaluated in catheterized patients through out.
The antibiotic sensitivity report should be referred before giving treatment, if infection is established.
ACKNOWLEDGEMENT
We acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. We 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. We 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=1284http://ijcrr.com/article_html.php?did=12841. Alavaren HF, Lim JA, Antonio-Velmonte M, et al. Urinary Tract Infection in Patients with Indwelling Catheter. Phil J Microbiol Infect Dis 1993; 22(2):65- 74.
2. Billote-Domingo K, Mendoza MT and Torres TT. Catheter-related Urinary Tract Infections: Incidence, Risk Factors and Microbiologic Profile. Phil JMicrobiol Infect Dis 1999; 28(4):133-138.
3. Wenzel R P and Edmond M B. The Impact of Hospital- Acquired Bloodstream Infections. Emerging Infectious Diseases 2001; 7(2):174-177.
4. Saint S, Lipsky BA, and Goold SD. Indwelling Urinary Catheters: A One-Point Restraint? Annals of Internal Medicine 2002; 137(2):125.
5. Mandell, Douglas, Bennet. Principles and Practice of Infectious Diseases. 3rd ed 1990. pp 2205-2215.
6. Platt R, Polk BF, Murdock B, et al. Mortality associated with nosocomial urinary-tract infection NEJM 1982; 307(11):637-642.
7. Walter ES. Urinary tract infections and pyeloneephritis. Harrison’s principles of internal medicine. 16th edition 2004; Volume II; 1715-21.
8. Jain P, Parada JP, David A, et al. Overuse of the indwelling urinary tract catheter in hospitalized medical patients. Arch Intern Med 1995; 155(13): 1425-1429.
9. Dickson G M and Bisno A. Infections Associated with Indwelling Devices: Infections Related to Extravascular Devices antimicrobial agents and chemotherapy. American Society for Microbiology 1989; 33(5): 602-607.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareCOMPARISON OF POSTERIOR SUB-TENON TRIAMCINOLONE WITH INTRAVITREAL BEVACIZUMAB FOR MACULAR EDEMA IN NON-ISCHEMIC RETINAL VEIN OCCLUSIONS
English6171Murali Mohan GurramEnglishPurpose: to compare the efficacy of posterior sub-tenon triamcinolone (PSTT) with intravitreal bevacizumab, when used as the primary treatment for macular edema associated with retinal vein occlusions. The efficacy is studied in improvement of visual acuity and reduction in macular edema. Background: Macular edema is the commonest cause of visual loss in retinal vein occlusions. Many treatments have been advocated including LASER, PSTT etc. with the recent trend being the usage of intravitreal anti VEGF agents and steroids. Methods: In a retrospective comparative case series, the records of patients who received PSTT (group I) and those who received Intravitreal bevacizumab (Group II) for macular edema associated with retinal vein occlusions, between march 2010 and September 2012 were analyzed. Group I had 24 eyes of 24 patients (13 male and 11 female) and group II had 26 eyes of 26 patients (13 male and 13 female). Group I had received Posterior Sub-Tenon injection of Preservative free Triamcinolone Acetonide (40 mg/1 ml) and group II had received intravitreal injection of 1.25 mg/0.05 ml avastin. Changes after four weeks of treatment, in best corrected visual acuity (letters of ETDRS chart) and central macular thickness (time domain OCT measurements) were studied. IOP was also focused on. Results: In group I the BCVA increased from 30.08±10.16 letters to 40.21 ±8.93 letters with an increase of 10.13 ±8.20 letters (P=Englishavastin, bevacizumab, intravitreal injection, posterior subtenon injection, Retinal vein occlusion, triamcinolone AcetonideINTRODUCTION
Retinal vein occlusion (RVO) is second most common retinal vascular disease, only next to diabetic retinopathy.1 In an Indian study, RVOs were detected in 0.8% of adults, with branch retinal vein occlusions (BRVO) being approximately seven times more common than central retinal vein occlusions (CRVO).2 The pathologic site in case of CRVO is behind lamina cribrosa and in BRVO the arteriovenous crossing. Non-ischemic and ischemic are two variants.3The causes for visual loss are macular edema (ME) and ischemia, with Macular edema being the most common cause for visual loss.4 Venous occlusion leads to poor venous drainage, dilatation and tortuosity of the large retinal veins, and increased retinal capillary pressure. These changes lead to secondary inflammation and result ultimately in breakdown of blood retinal barrier with, exudation of blood, fluid, and lipid into the retina, leading to the development of macular edema.5 Role of Vascular Endothelial Growth Factor (VEGF) has been established. The increased backpressure leads to stagnation of blood flow, which leads to hypoxia of retina. This causes release of various chemical agents, of which VEGF is important.6 VEGF is the major vasopermeability factor that disrupts the blood–retina barrier in Retinal vein occlusion (RVO) by inducing fenestrations in capillaries and venules.7 Treatment of ME is very important to improve the vision of the patient. In a study, no case of macular edema with central retinal vein occlusion resolved spontaneously by 1 year, but approximately 30% resolved spontaneously over a long interval, often with neuroretinal or pigment epithelial scarring and atrophy.8 when resolution of ME does occur, it can be long delayed. In one study, the time to resolution of ME in untreated non-ischemic CRVO with ME averaged 23 months compared to 29 months for ischemic CRVO.9 spontaneous resolution of BRVO associated ME is better, but still can lead to macular damage without intervention. 10 Macular grid laser was considered the gold standard treatment. The photocoagulation of the photoreceptors reduces the oxygen consumption of the outer retina and allows oxygen to diffuse from the choroid to the inner retina, where it relieves hypoxia.11 But Central Vein Occlusion Study (CVOS) proved that the macular grid laser is not useful in improving the vision. There was no statistically significant difference between treatment and control visual acuity at any stage of follow-up.12 Branch Vein Occlusion Study (BVOS) Group has advised grid laser for macular edema of more than three months, associated with BRVO. 1 But postponing treatment for more than three months would adversely affect the collaterals, and cause more damage to macula. Therefore early treatment with intravitreal or periocular injections was advised. 13,14 Triamcinolone acetonide is a corticosteroid that, in addition to its anti-inflammatory effects, may cause down-regulation of vascular endothelial growth factor (VEGF).15 Triamcinolone intravitreally was largely used with good results in ME of RVO.16,17 Intravitreal Triamcinolone may be associated with various complications like glaucoma, cataract, endophthalmitis, retinal detachment, scleritis etc.18,19 Since the first report of the efficacy of intravitreal bevacizumab (IVB) in a patient with ME secondary to CRVO in 2005,20 several case series have shown the benefit of this treatment, with an improvement in visual acuity and a decrease of Central Macular Thickness (CMT) in patients with ME with RVO.21 In CRVO, adding triamcinolone to bevacizumab did not have additional benefit when compared to intravitreal bevacizumab alone.22 Need for the operation theatre setup and the cost of anti-VEGF drug may be limiting factors to many patients. As it is an intraocular procedure, it may be associated with severe complications including endophthalmitis, retinal detachment etc. 23,24 Intra-ocular anti-VEGF can be associated even with systemic complications. 25 Posterior subtenon space is adjacent to macular area. The steroid deposited in that area would transfuse through sclera and act on the macular edema. Posterior sub-tenon Triamcinolone has been used for macular edema with good effects. 26, 27 PSTT is a simple outpatient procedure without involvement of huge costs. Most of these patients being poor and unaffordable to costly anti-VEGF injections, can PSTT be tried as an alternative to IVB? This study is aimed to compare the anatomical and visual effects PSTT with intravitreal bevacizumab in macular edema associated with retinal vein occlusions. To the best of our knowledge, this is the first study to compare these two treatment modalities in cases of macular edema associated with non-ischemic vein occlusions.
MATERIALS AND METHODS
This is a Retrospective comparative interventional case series. Setting is a tertiary eye care in Hyderabad, south India. Duration of study was from March 2010 to September 2012. All the records of macular edema associated with retinal vein occlusions, which received PSTT or IVB as first line of treatment, were analyzed. Macular edema with Non-Ischemic RVO as evidenced by clinical and angiographic evaluation, Decreased vision with vision better than PL and CMT ≥ 250 µ were the criteria to include the records in the study. Ischemic RVO, Prior laser treatment, Glaucoma/Ocular Hypertension, Cataract which precludes the evaluation of macula, Vitreous hemorrhage, Macular ischemia, Iris neovascularization, and Prior intravitreal injections formed the exclusion criteria. Total of 50 records were analyzed. Out of these 50, 24 eyes had received PSTT and the other 26 eyes had received IVB. All these patients had undergone basic pre-procedure eye examination including Best corrected visual acuity with 4 meter ETDRS chart (4m ETDRS chart model no. 2121, Akriti Logistics) with 70 letters in 14 lines, thorough slit lamp examination, Goldman Applanation Tonometry, Contact lens biomicroscopy, Indirect ophthalmoscopy, FFA, and OCT (Time domain OCT, Zeiss Stratus OCT). Demographics of the patients are given in table 1.
TECHNIQUE OF PROCEDURE
All procedures were done by a single surgeon, the author. The technique used for Intravitreal bevacizumab: All injections were given in sterile environment of operation theatre. Povidone iodine drops were instilled in the eye prior to painting and draping. After placement of eye speculum, measurement is taken which are 3.5mm for pseudophakics and aphakics and 4 mm for phakic eyes. Inferotemporal quadrant is selected. Conjunctiva is displaced and injection is given in a tunneled incision technique.28 1.25 mg of Avastin in 0.05 ml is used from a multidose vial. (Avastin; Genentech Inc., California, USA). The technique of PSTT was as described by Nozik.29 All injections were given as out-patient procedures. Patient is made to lie down comfortably on the treatment couch. Topical anesthesia drops (Proparacaine 0.5%) were instilled twice with 5 minutes interval. First drop is placed in inferior cul-de-sac and the second drop is placed over the superotemporal quadrant, after asking the patient to look inferonasally. 2 ml syringe is loaded with 1ml (40mg) of preservative free Triamcinolone Acetonide (Aurocort, Aurolabs, India). Needle is replaced with a 26G half inch needle. Surgeon positions himself on the opposite side of the patient. Patient is asked to stare at his/her opposite shoulder (Inferonasal gaze). With left hand, surgeon retracts the upper lid upwards, thus exposing the superotemporal quadrant. Needle was passed through the bulbar conjunctiva and tenon’s capsule, at the posterior most visible area, with bevel facing towards globe. Maintaining the needle as close to the globe as possible, needle is advanced. Side to side movement of the needle is made and limbus is looked for any movement. Any movement of the limbus indicates the presence of needle in sclera. Needle is advanced till the hub is reached over the injection site. Aspiration was done to rule out any blood vessel entry, and then the drug is injected with moderate force. See figure 1. Post procedure instructions for all patients were same with oral acetazolamide and NSAID. Topical medications include Steroid-Antibiotic combination for five days and anti-glaucoma medications, usually timolol 0.5% for one month. Acetazolamide 250 mg is given thrice daily for one day. NSAID is given for 2 days. Data from records was collected so that the results after one month of procedure could be analyzed.
OBSERVATIONS
On 1st post op day, 5 patients in group 1 showed chemosis, 2 showed sub-conjunctival hemorrhages and the rest showed no problems. In group II 5 patients had subconjunctival hemorrhage and 3 had chemosis. None of the patients had severe problems like, endophthalmitis, vitreous hemorrhage or retinal lesions. More than 5 letters improvement in BCVA was noted in 16 eyes (66.7%) in group I and 23 (88.46%) eyes in group II. All of them showed at least some amount of reduction in CMT. None of them had any major complications. The pre-op and post-op measurements are charted below: In group I the pre-op Visual acuity was 30.08±10.16 letters (Mean ± Standard deviation) which improved to 40.21 ±8.93 letters. There was increase in the BCVA by 10.13 ±8.20. Visual acuity in group II increased from 33.81 ± 7.60 to 54.89 ± 8.96 letters by 21.08 ± 11.98. The Central Macular thickness in group I changed from 575.08 ± 131.55 µ to 305.54 ± 157.10 µ with a decrease of 269.54 ± 149.78. Central macular thickness in group II decreased from pro op value of 570.35 ± 115.01 to post op value of 206.58 ± 22.18. The change was 363.77 ± 104.71. Two eyes in group I and one eye in group II had raised IOP which was controlled with additional anti-glaucoma medications. None of the eyes in either group developed any other complications like endophthalmitis, retinal detachment etc. The details of complications are listed in table 2.
STATISTICAL ANALYSIS and RESULTS
Statistical Analysis was made with SPSS software (SPSS for Windows, version 13.0, SPSS Inc., Chicago, Illinois, USA). For the effect on BCVA and CMT in each group, Paired sample statistics was done with 95% confidence interval. Group I BCVA: the mean Pre-Op visual acuity in terms of numbers was 30.08. The standard deviation was 10.164 with standard error of mean 2.075. The Post-Op mean was 40.21 with standard deviation 8.925 and standard error mean 1.822. The pre and Post op were analyzed with paired samples test. The mean change in VA was 10.125 with standard deviation 8.20 and standard error mean 1.674. The 2-tailed significance (P value) was Englishhttp://ijcrr.com/abstract.php?article_id=1285http://ijcrr.com/article_html.php?did=12851. The Branch Vein Occlusion Study Group. Argon laser photocoagulation for macular edema in branch vein occlusion. Am J Ophthalmol. 1984;98:271-282.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareFREQUENCY AND CLINICAL SIGNIFICANCE OF THE CONUS ARTERY AS THIRD CORONARY ARTERY ON 64-SLICE COMPUTED TOMOGRAPHY ANGIOGRAPHY (CTA)
English7276Ritu MehtaEnglish Sanjeev agrawalEnglishBackground of the study: Wide information of the anatomy of coronary arteries is useful for a management decisions of the coronary artery disease or for systemic planning of surgery. The objective of this study is to establish variations of Conus coronary arteries which arise directly from aorta and revealing about their frequency .These findings would be of great significance in the interpretation of coronary arteriography, angiography and surgical myocardium revascularization. Methods: A total number of 111 angiograms were utilized for this study. The coronary angiographic images were evaluated in this study. The study is design to investigate the number by the mean of origin of right conus artery. Results: The results shows the right conus artery originates from right coronary artery in most of the people 77(69.3%). In this study right conus artery originate from same ostium in 15(13.5%) individuals and from Separate ostium (aortic) origin were seen in 18(16.2%). Conclusion: A selective Angiography is recommended for conus artery because the frequency of conus artery as the third coronary artery is 29.7% of screened cases of Cat-scan coronary angiography (CTA).
EnglishRight conus artery (R.Con.A), right coronary artery (RCA), Ostium, pattern of origin,computed tomography Angiography (CTA)INTRODUCTION
Two coronary arteries, the right and the left one are supplying blood to human heart in general population. Prevalence of Congenital coronary variations is are quite low, which is changing from 0.3% of autopsy reports to 1.3% of angiographic studies.(1,2) Sometimes extra coronary arteries are also present. The right conus artery (R.Con.A) considered as the third coronary artery, because it is originates as a separate artery from the anterior aortic sinus. (3) The right conus artery most frequently arises from the proximal part of the right coronary artery (RCA). The conus artery vascularises to the conus, or outflow tract, of the right ventricle and is usually found to be the first branch of the right coronary artery. (4) Several scientists have suggested that it provides a collateral connection between the right and left coronary arteries. The conus artery variation may be an advantage for the person having it. (5) Computed tomography Angiography (CTA) study facilitates the routine diagnostic workup for the management of Cardiac disorders. In Coronary artery diseases patients, it is also needed to carry out conventional angiography of the third coronary artery (6, 7). An intimate knowledge of the occurrence and distribution of conus coronary arteries is important for correct understanding of coronary angiograms, assessment of severity and effect of coronary insufficiency, and appropriate preparation and time being myocardium revascularisation (8).The purpose of this study is to establish variations of Conus coronary arteries which arise directly from aorta and its frequency.
MATERIAL AND METHODS
The patients, who had undergone The CT coronary angiograms for various reasons during 3 years at Geetanjali medical college and hospital, Udaipur, were included in this study. A. Exclusion criteria Patient with high calcium score >500 were excluded. B. CT scan and reconstruction parameters: All examinations were performed with a 64-slice CT scanner (Sensation 64, Siemens, Forcheim, Germany) with the scan protocol described in table no.1. C. Procedure: Pre-procedure precautions The patients were enquired, to rule out the presence of any drug allergy, to avoid the occurrence of any untoward anaphylactic reaction, during the procedure. Patient were advised to avoid tea and coffee a day prior to procedure. Blood urea and creatinine levels were checked before the procedure. The heart rate of patients were stabilised with an oral dose of 40 mg propronalol one hour before the scan ,in whom a heart rate were greater than 75 beats/min. Sublingual nitroglycerine was given to the patient just before the scan. A bolus of 100 ml of high iodinated contrast material (350 mg/ml ULTRAVIST German remedies) was injected into an antecubital vein of the right arm with a flow rate of 5 ml/s, followed by a 40-ml saline chaser. A bolus-tracking method was employed for the synchronization between arterial route of contrast material and MSCT-CA. The patient was now shifted to the CT scanner. Adequate counselling of patients were done to reduce anxiety, to preserve the best possible heart rate of 55-60 beats /min. CT angiograms of 110 patients were studied, to see the pattern of origin of right conus artery.
RESULTS
Variation in origin of Right Conus Artery Out of 111 patients, the right conus artery originates from the right coronary artery in 77(69.3%) patients , common origin from same ostium (right conus artery and right coronary artery ) was seen in 15(13.5%) patients and Separate ostium (aortic) origin of right conus artery were seen in 18(16.2% ) patients as shown in Table no.2.
DISCUSSION
The variations of number of coronary arteries are relatively common in population suggested by many scientists and could be beneficial for person or could create clinical consequences. Some authors described cases of occurrence of only a single coronary artery come up from the left (9) or the right (10) aortic sinus. This single coronary artery may be associated with cardiac complications like congestive heart failure, myocardial infarction and sudden cardiac death in young athletes (11) Hadžiselimovi? (12) points out that even three coronary arteries may arise independently from the right aortic sinus. Four coronary arteries were reported by Almira(2008) in one case, where both supernumerary arteries arose from the right aortic sinus.(13) Usually in most of the cases extra coronary artery begins from the right aortic sinus. Previous studies put forward several terms for classifying this artery: adipose artery, conal artery, arteria of Vieussens, preinfundiblar or supernumerary right coronary artery (12,14,15,16).Usually this coronary artery is a branch of Right coronary artery and called as right conus artery but it has three variations according to its origin. The most appropriate term for this artery when it originate from separate ostium, is the third coronary artery. Information about incidence of the third coronary artery are varying in different population from1.5% as stated by Lo (17) even to 62% as stated by Hadžiselimovi? (12).In our study right conus artery as third coronary artery was found in 29.7 % and this result correlated with Kalpana (2003) 24%, Pinar Kosar et al.(2009) 22% and difference with Susan standring (2006) 34% could be due to geographic variation (18,19,20). The other reason for this deference could be due to inability to selectively canulate conus /third coronary artery on conventional angiography. The common origin of right conus artery with right coronary artery was observed in 13 %.This may be useful while performing conventional coronary arteriography and angiography. Gajbe et al. suggested that a preliminary aortic root injection of dye method was followed to locate the exact number of orifice of the coronary ostia, in order to prevent the fatal outcome (21). An unusual conus artery arising independently from the RCA is mainly at risk for injury from ventriculostomy or other maneuvers carried out during heart surgery (22) According to Udaya Sankari T et al if right conus artery directly arises from the aorta (third coronary artery) than it creates double collateral circulation for intra-ventricular septum and myocardium of the left ventricle. This prevents the right coronary artery ?steal? phenomenon. ?Blessed are the people, those who are born with right conus artery with long branches? (23) In our study, the third coronary artery was found in 29.7% of screened cases what is comparable with the results showed by Yamagishi [30%] (24).In this study, 69.3% of the population had the right conus artery arising from the right coronary artery and in the rest 29.7% of the individual’s right conus artery either arose directly from the aorta or in common with right coronary artery. So the present study suggests that 29.7% of population needs care while performing coronary angiography to prevent fatal outcome. The third coronary artery could be very useful collateral in case of proximal RCA stenosis.
CONCLUSION
A non-invasive imaging of small mobile structures, such as coronary arteries has possible with the new advancement in imaging technology, such as multidetector ECG gated CT. Coronary artery diseases have high morbidity, mortality, and socioeconomic burden on society. A non-invasive detection of Right conus artery stenoses is corner stone in management of coronary artery disease with help of 64-slice computed tomography Angiography (CTA). A selective Angiography is recommended for conus artery because the frequency of conus artery as the third coronary artery is 29.7% of screened cases of CTA. The third coronary artery is appropriate term to categorize extra coronary artery which arises separately from the right aortic sinus. The third coronary artery is an extra artery or god blessing for whom that has it and be very valuable for collateral perfusion.
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22. van GeunsRJ, Cademartiri F. Anatomy of the coronary arteries and vein in CT imaging. In: Schoepf UJ, ed. CT of the heart. Totowa, NJ: Humana, 2005; 219–228.
23. Udaya Sankari T , Vijaya Kumar J, Saraswathi P.The anatomy of right conus artery and its clinical significance. Recent Research in Science and Technology 2011, 3(10): 30-39
24. Yamagishi M., Haze K., Tamai J., Fukami K., Beppu S., Akiyama T., Miyatake K. Visualization of isolated conus artery as a major collateral pathway in patients with total left anterior descending artery occlusion. Cathet. Cardiovasc. Diagn.1988;15(2):95-98
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareBARRIERS TO THE UPTAKE OF CATARACT SURGERY IN A RURAL POPULATION OF SOUTH KARNATAKA, INDIA
English7782Guruprasad S. BettadapuraEnglish Narendra P. DattiEnglish Krishnamurthy DonthiEnglish Ranganath B.G.English Shamanna B. RamaswamyEnglish Sangeetha T.EnglishPurpose: To analyse the barriers to the uptake of cataract surgery in patients aged over 50 years in a rural set up and suggest possible remedial measures. Methods: Sixty one clusters of 50 people aged over 50 years were selected by probability-proportionate to size sampling. All participants were evaluated using standard Rapid Assessment of Avoidable Blindness ( RAAB ) methodology. People with unilateral or bilateral cataract were interviewed about the reasons for not having undergone surgery. Results: Of the 3050 people enumerated, 2907(95.3%) were examined. Among them 1360(47%) were males and 1547(53%) were females. Out of them, 73(2.51%) were bilaterally blind due to cataract(vision < 3/60). The main barriers noted in bilateral cataract blind were "No one to accompany" and "Waiting for maturity"(27.2% each). Conclusion: Augmenting the outreach programmes accompanied by information and motivational campaigns will reduce barriers to uptake of cataract surgery and in turn reduce the cataract blindness.
EnglishBarriers, Cataract surgery, outreach programmes, Rapid assessment, eyecareINTRODUCTION
Cataract continues to be the commonest cause of blindness in India, with three out of every four blind, above 50 years being blind due to cataract. [1] As a result of the National Program of blindness, various government and nongovernemental organisations have increased the scope of the outreach programmes, thus making quality eye care available to the rural poor. Even though there has been tremendous progress in the number of cataract surgeries being performed across the country, some section of the population still have barriers to accepting this service even though they are blind. People's use of health services is influenced by a range of psychological, social, cultural, economic and practical factors.[2] A proper analysis and understanding of these factors is critical to modify the eye care progrmmes and hence increase the uptake of cataract surgical services. The present article discusses the reasons for not undergoing cataract surgery in persons aged over 50 years who were blind due to cataract in Kolar district, Karnataka.
MATERIALS AND METHODS
A Rapid Assessment was carried out by a team consisting of trained personnel from the departments of Ophthalmology and Community Medicine, Sri Devaraj Urs Medical College, Tamaka, Kolar. The survey was carried out between March and June 2011, in accordance with the Helsinki Declaration. Ethical approval was given by the Ethical Committee of Sri Devaraj Urs Medical College. Written informed consent was obtained from all study participants, after explaining the purpose of the study in their local language. Sample size was determined using a prevalence estimate of 4% for blindness ( WHO definition of presenting vision- Englishhttp://ijcrr.com/abstract.php?article_id=1287http://ijcrr.com/article_html.php?did=12871. Neena J, Rachel J, Praveen V, Murthy GV; Rapid Assessment of Avoidable Blindness India study Group. Rapid Assessment of Avoidable Blindness in India. PLoS One 2008;3:e2867.
2. Donoghue M. People Who Don't use eye services: 'Making the invisible visible". Community Eye Health 1999;12:36-8
3. https://www.iceh.org.uk/display/WEB/Rapi d+assessment+of+avoidable+blindness+surv ey+methodology
4. Malhotra R, Uppal Y, Misra A, Taneja DK, Gupta VK, Ingle GK. Increasing access to cataract surgery in a rual area- a support strategy. Indian J Public Health 2005;49:63- 7
5. Venkataswamy PG, Brilliant G. Social and economic barriers to cataract surgery in rural south India: A preliminary report. Vis Impairment Blindness. Dec 1981:405-408
6. Brilliant GE, Lepkowski JM, Zurita B, Thulasiraj RD. Social determinants of cataract surgery utilization in South India: The operations research group. Arch Ophthalmol 1991;109:584-9
7. Gupta SK, Murthy GVS. Where do persons with blindness caused by cataracts in rural areas seek treatment and why? Arch Ophthalmol 1995;113:1337-40
8. Johnson JG, Goode Sen V, Faal H. Barriers to the uptake of cataract surgery. Trop Doct 1998;28:218-20
9. Snellingen T, Shrestha BR, Gharti MP, Shrestha JK, Upadhyay MP,Pokhrel RP. Socio-economic barriers to cataract surgery in Nepal: The South Asian Cataract Management Study. Br J Ophthalmol 1998;82:1424-28
10. Rotchford AP, Rotchford KM, Mthethwa LP, Johnson GJ. Reasons for poor cataract surgery uptake- a qualitative study in rural South Africa. Trop Med Int Health. 2002;7:288-92
11. Dhaliwal U, Gupta SK. Barriers to the uptake of catarct surgery in patients presenting to a hospital. Indian J Ophthal 2007;55:133-6
12. Gyasi M, Amoaku W, Asamany D. Barriers to cataract surgical uptake in the upper eastregion of Ghana. Ghana Med J 2007;41:167-70
13. Vaidyanathan K, Limburg H, Foster A, Pandey RM. Changing trends in barriers to cataract surgery in India. Bull World Health Organ 1999;77:104-9
14. Courtright P. Barriers which keep patients from getting cataract surgery in developing countries. From www.v2020eresource.org
15. Mansour AM, Kassak K, Chaya M, Hourani T, Sibai A, Alameddine MN. National survey of Blindness and low vision in Lebanon. Br J Ophthalmol 1997;81:905-6
16. NPCB at a glance. National Programme for Control of Blindness in India. Ministry of Health and Family Welfare, Government of India. January 2010.
17. Courtright P, Lewallen S, Tungpakorn N, Cho BH, Lim YK, Lee HJ et al. Cataract in leprosy patients: Cataract surgical coverage, barriers to acceptance of cataract surgeryand outcome of surgery in a population based survey in Korea. Br J Ophthalmol 2001;85:643-7
18. Finger RP, Kupitz DG, Holz FG, Chandrasekhar S, Balasubramaniam B, Ramani RV et al. Regular provision of outreach increases acceptance of cataract surgery in South India. Trop Med Int Health 2011;16:1268-75
19. Courtright P, Kanjaloti S, Lewallen S. Barriers to acceptance of cataract surgery among patients presenting to district hospitals in rural Malawi. Trop Geogr Med 1995;47:15-8
20. McCauley AP. Primary eye care: rural Balinese attitudes towards eye care and cataract surgery and suggestions for increasing demand for eye care services. Hellen Keller International, New York, 1986
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareFUNGAL INFECTIONS OF THE ORAL CAVITY
English8388Sayan BhattacharyyaEnglishSatarupa Ghosal Bhattacharyya EnglishFungi, both yeasts and filamentous types, can cause infection of different sites in the oral cavity like buccal mucosa, gingiva and tongue. They are also components of the normal oral microbiota. In specific settings like denture usage, immunodeficiency due to HIV infection and inhalational steroid therapy, fungi, especially yeasts can affect different sites of the oral cavity producing different types of lesions. Studying these infections is important since they might lead to complications if left untreated and usually respond quite favourably to correct and timely antifungal treatment.
EnglishFungi, oral cavity, lesions.INTRODUCTION
Fungi are eukaryotic unicellular or multicellular organisms producing various infections in man(1) . Infections of the different structures in oral cavity can be caused by bacteria, viruses and fungi(2,3) . Different practices like wearing dentures, cigarette smoking and immunosuppressive conditions like HIV infection and inhalational steroid use predispose individuals to oral infection by fungi(4). These infections are produced predominantly by yeasts belonging to Candida spp., although yeasts belonging to other genera as well as filamentous fungi can also cause these infections(5). Hence studying these infections is very important for proper understanding of pathogenesis and treatment. Studies aimed at reviewing the clinical features, pathogenesis and complications of oral infections by fungi are not many in number, notwithstanding the fact that this entity is often encountered in the clinical setting. So we attempted to summarise fungal infections of the oral cavity in a lucid and scientific manner. Scientific literature search was carried out from various indexed journals, national and international in order to collect material for the article and summarise existing knowledge of the oral mycoses.
Normal microbial flora of the oral cavity
The oral cavity abounds in a plethora of different microorganism like bacteria and fungi that colonise or coat the different structures in the oral cavity. Bacteria like oral streptococci and Hemophilus spp. commonly colonise the mouth cavity of healthy subjects(6) . Candida spp. also constitute the microflora of approximately 25- 40% of normal subjects(7). Colonisation by Candida spp. increases significantly in settings like poor oral hygiene, old age, wearing dentures and inhalational steroid use(8,9,10,11 ). These factors increase the risk of developing subsequent oral candidiasis. Risk factors and how they predispose to oral fungal infections Cigarette smoking Smoking is a known predisposing factor for development of oral candidiasis. It has been documented in-vitro by researchers that candidal adhesion and expression of virulence factors like aspartyl protease expression are enhanced in presence of cigarette smoking concentrate(12) . Dry mouth Dry mouth or xerostomia can be found in Sjogren’s syndrome, HIV infection and intake of certain drugs. These factors lead to impaired saliva production and consequent loss of protective lactoferrin, antibodies and Histidinerich protein, leading to increased colonisation and infection with Candida spp(13) . Inhalational steroid and broad-spectrum antimicrobial use It has been shown in several studies that use of inhalational steroids and broad-spectrum antibiotics alter the normal bacterial flora of the mouth cavity and results in overgrowth of Candida spp. by removing competition for growth(14) . Extremes of age In extremes of age, mounting a robust protective local immune response against yeast pathogens becomes very difficult. This results in yeast overgrowth and infection(14) . Wearing of dentures The acrylic in denture material along with its surface irregularities promotes adhesion and colonisation by Candida spp. on oral cavity(15) . Besides, dentures lead to irritation of the oral mucosal lining and loss of epithelium, due to which there is prompt colonisation with Candida spp.(16) . HIV infection Oral candidiasis is very commonly encountered in HIV infection. In fact, in this context it has been found that oral candidiasis is the commonest oral lesion in HIV infected patients. These lesions are significantly associated with a CD4 T cell count of less than 200/µl(17) . Diabetes mellitus Uncontrolled diabetes mellitus can predispose to oral candidiasis. Candidiasis is found more in diabetics due to several factors like poor glycemic control, usage of broad-spectrum antibiotics and reduced flow of saliva(18) . Zygomycosis is also frequently encountered in this group of patients, contributing factors being hyperglycemia and ketoacidosis, the latter culminating in impaired neutrophil function(19) .
Agents causing fungal infections of the oral mucosa
a. Other than Candida spp., which is the principal aetiological agent of oral candidiasis, other fungi like Blastomyces spp., Histoplasma capsulatum and Cryptococcus neoformans can also cause oral disease, as a part of disseminated fungal infection(20) .
b. Histoplasmosis, caused by Histoplasma capsulatum, a dimorphic fungus, can produce verrucous or granulomatous lesions (indurated and painful ulcer) in any area of the mouth, especially tongue, gingiva or palate, usually as a component of systemic infection, although primary affection has also been documented(21) .
c. Aspergillus spp. have been implicated in sinusitis and further extension into the oral cavity can cause involvement of the hard palate, resulting in manifestations like loosening of teeth. Oral aspergillosis has been graded from Grade I to Grade V according to severity(22) .
d. Similarly mucormycosis can extend into the oral cavity from Maxilla and nasal sinuses, manifesting mainly as spreading sinusitis or facial cellulitis with palatal ulcer(23) . Rhizopus spp. is the principal agent associated with this disease entity, and the jaw is almost always involved(24) .
e. Rarely fungi, previously considered as saprophytes, e.g. Rhodotorula spp. can cause infection of the oral mucosa, usually in the immunocompromised host (HIV infected patient)(25)
Agents causing infection of the periodontal tissue
Gingiva can be affected in oral candidiasis, risk factors being the same as enumerated before.Histoplasma capsulatum , a dimorphic fungal pathogen, can also involve the gingiva, initially producing plaque-like lesions that usually ulcerate later. It is usually associated with disseminated infection in about 66% cases(26) . There is one report of Job’s syndrome (primary immunodeficiency along with eczema, recurrent skin and lung infections, elevated serum IgE, and connective tissue and skeletal abnormalities), presenting with gingival infection with Candida albicans(27) . Fungi and progression of dental caries According to recent research, Candida spp. have got a possible role in precipitating dental caries. They can break down dietary carbohydrates to from organic acids which help in the tooth decay. Besides, Candida spp. have the potential of breaking down collagen of teeth by expressing the protein collagenase(28) . Clinical features Oral candidiasis usually manifests as pseudomembranous, white patchy lesions (oral thrush) distributed over buccal mucosa in HIV infected patients. The lesions often show erythematous raw areas when the plaques are removed manually. Other types of lesions described are atrophic in old patients and those using dentures, chronic hyperplastic in HIV infected patients and angular chelitis at angles of mouth(13). There is also a strong association between oral candidiasis and Median rhomboid glossitis, a lesion characterised by central papillary atrophy, found in the midline of dorsum of tongue(29) . Oral aspergillosis often presents with granulomatous affection with late central necrosis of the hard palate, while the typical picture in oral zygomycosis is facial cellulitis with late palatal perforation. In oral zygomycosis, there may be bone destruction, oro-antral fistula and characteristic redness and hyperplasia of the gingiva, called “strawberry tongue” (30,31) . Complications of oral mycoses The chronic hyperplastic variant of oral candidiasis(CHC), typified by parakeratinisation of epithelium and found exclusively in HIVinfected patients, carries a risk of malignant transformation. In studies it has been observed that the risk of developing oral squamous cell carcinoma is about 60-66% when left untreated and minimal when treated early with antifungal agents(32). High-risk groups like patients suffering from End-stage renal disease are at risk of developing invasive fungal infections from Oral fungal infections (OFI)(33) .
PATHOGENESIS
Candida spp. have several virulence factors like adheComplications of oral mycosessins of HWP (Hyphal wall protein) family which are essentially glycoprotein in nature, besides possessing secreted aspartyl proteases(SAPs) that can damage host tissues. This pathogen can show phenotypic switching or conversion to hyphal stage from yeast stage in tissues, and can also form structured multilayered yeast communities called biofilms which make them immune from host defenses and antifungal drugs administered. This type of biofilm formation has most consistently been demonstrated over dentures made up of Polymethylacrylate(34) . On the other hand, zygomycetes like Rhizopus spp., causing mucromycosis ,can bind to collagen of blood vessels and induce self-phagocytosis by endothelial cells. Hence the angioinvasive nature of these pathogens. They can also metabolise heme of Red Blood corpuscles (RBCs)(35)
Laboratory diagnosis of oral mycoses.
a) Direct Microscopy: Direct smear prepared with 10% KOH showing budding yeasts and hyphae along with leucocytes indicates oral infection by fungi. Staining with PAS (Periodic Acid Schiff) and GMS (Gomori’s Methenamine Silver) can show yeasts and hyphae in smear and tissue sections. Fluorescent microscopy after staining witoptical brighteners like Calcofluor white is a faster method since the dye binds with chitin of fungal cell wall(36) .
b) Biopsy: Biopsy is an adjunct to microscopy in diagnosis of oral mycoses and is also useful in investigating correlation of infection with diseases like median rhomboid glossitis and oral dysplasia(37) .
c) Culture: Candida spp. can be commonly recovered by culture from oral mucosal lesions on Saboraud’s Dextrose agar(38) .h
TREATMENT
Treatment can be instituted with polyenes like topical Amphotericin B or Nystatin oral suspension. Among triazoles, Clotrimazole troche can also be administered(39). Only Chlorhexidine mouth wash has also been demonstrated to be very effective. However Nystatin should not be combined with Chlorhexidine gluconate since they mutually inhibit each others’ actions because of the formation of a low- solubility chlorhexidine-nystatin salt(40) . Oral mucormycosis and aspergillosis are best treated with timely surgical debridement along with antifungal medication with Amphotericin B, either conventional (deoxycholate) or liposomal, the latter having a better safety profile(41,42,43) .
DISCUSSION
Oral affection by various fungi tend to produce diverse clinical manifestations and their resultant complications. Therefore more studies are required in this subject to elucidate the etiology and pathogenesis of different oral mycoses as well as newer options for prompt diagnosis and treatment.
CONCLUSION
Oral mycosis is a less reported and discussed entity which is often encountered in clinical and laboratory practice. Further studies are required in this regard to understand its full aetiology, pathogenesis and clinical importance so that patients suffering from oral mycoses are benefited and clinicians are fully abreast with the intricacies of the disease.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles have been 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=1288http://ijcrr.com/article_html.php?did=12881. The Eukaryotes: Fungi, Algae, and Protozoa (Chapter 12) Lecture Materials. For Amy Warenda Czura, Ph.D. Suffolk County Community College.
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4. Torres SR, Peixoto CB, Caldas DM, Silva EB, Magalhaes FAC, Uzeda M, Nucci M. Clinical aspects of Candida species carriage in saliva of xerostomic subjects. Medical Mycology October 2003; 41: 411-415.
5. Epstein JB, Silverman S, Fleischmann J. Oral Fungal Infections. In : Silverman S. Essentials of Oral Medicine. p 170-171. 2001. BC Decker Inc. Hamilton , London.
6. Bik EM, Long CD, Armitage GC, Loomer P, Emerson J, Mongodin EF et al. Bacterial diversity in the oral cavity of ten healthy individuals. ISME J 2010;4(8): 962-74.
7. Nejad BS, Rafiei A, Moosanejad F. Prevalence of Candida species in the oral cavity of patients with periodontitis. African Journal of Biotechnology; 10(15): 2987- 2990.
8. Grimoud AM, Marty N, Bocquet H, Andrieu S, Lodter JP, Chabanon G. Colonization of the oral cavity by Candida species :risk factors in long-term geriatric care. Journal of Oral Science 2003;45(1): 51-55.
9. Malani AN, Psarros G, Malani PN, Kauffman CA. Is age a risk factor for Candida glabrata colonisation? Mycoses 2011;54: 531–537.
10. Godara N, Godara R, Khullar M. Impact of inhalation therapy on oral health. Lung India. 2011 ; 28(4): 272–275.
11. Budtz-Jorgensen E. Ecology of Candidaassociated Denture Stomatitis. Microbial Ecology in Health and Disease 2000; 12: 170–185.
12. Baboni FB, Barp D, Izidoro AC, Samaranayeke LP, Rosa EA. Enhancement of Candida albicans virulence after exposition to cigarette mainstream smoke. Mycopathologia 2009;168(5):227-35.
13. Akpan A, Morgan R. Oral candidiasis. Postgrad Med J 2002;78:455–459.
14. McIntyre GT. Oral Candidosis. Dent Update 2001; 28:132-139.
15. Lotfi-Kamran MH, Jafari AA, Falah-Tafti A, Tavakoli E, Falahzadeh MH. Candida Colonization on the Denture of Diabetic and Non-diabetic Patients. Dental Research Journal 2009; 6(1):23-27.
16. Candida - associated denture stomatitis . Aetiology and management : A review. Part 2. Oral diseases caused by Candida species. Australian Dental Journal 1998;43:(3):160-66.
17. Bodhade AS, Ganvir SM, Hazarey VK.Oral manifestations of HIV infection and their correlation with CD4 count. Journal of Oral Science 2011;53(2):203-211.
18. Al-Maskari AY, Al-Maskari MY, Al-Sudairy S. Oral Manifestations and Complications of Diabetes Mellitus: a review. Sultan Qaboos Univ Med J 2011 11(2): 179–186.
19. Toshniwal OPD, Ravi Prakash SM, Gill N, Verma S. Mucormycosis and myiasis in Uncontrolled diabetes: A double whammy. Journal of Indian Academy of Oral Medicine and Radiology 2011;23(2):132-35.
20. Krishnan PA. Fungal infections of the oral mucosa. Indian Journal of Dental Research 2012;23(5): 650-59.
21. Durso SC. Oral Manifestations of Disease .In: Longo, Fauci, Hauser, Jameson, Loscalzo, editors. Harrison’s Principles of Internal Medicine.18th edition 2012.pp.268. Tata McGraw Hill. New York.
22. Myoken Y, Sugata T, Kyo TJ , Fujihara M. Pathological features of invasive aspergillosis in patients with haematological malignancies. Journal of Oral and Maxillofacial Surgery 1996;54(3):263-70.
23. Doni BR, Peerapur BV, Thotappa LV, Hipparqi SB. Sequence of oral manifestations in rhino-maxillary mucormycosis. Ind J Dent Res 2011;22(2):331-35.
24. Hingad N, Kumar G, Deshmukh R. Oral Mucormycosis Causing Necrotizing Lesion in a Diabetic Patient: A Case Report. International Journal of Oral and Maxillofacial Pathology 2012;3(3):08-12.
25. Kaur R, Wadhwa A, Agarwal SK. Rhodotorula mucilaginosa: an unusual cause of oral ulcers in AIDS patients. AIDS 2007;21(8): 1068-69.
26. Bascones-Martínez A, Criado-Cámara E, Bascones-Ilundáin C, Herrera SA, BasconesIlundáin J. Etiology of Gingivitis. www.intechopen.com. 27. Deepa D, Arun Kumar KV, Joshi CS, Kumar S, Pandey A. Fungal infection of gingiva in a patient with hyperimmunoglobulin-E (Job's) syndrome. 28. Lai G, Li M. The possible role of Candida albicans in progression of dental caries. International Research Journal of Microbiology 2011;2(12): 504-506.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareINTRACRANIAL HUMAN VERTEBRAL ARTERY: A HISTOMORPHOLOGICAL STUDY
English8996Rustagi Shaifaly M.English Bharihoke V.EnglishCerebrovascular disease due to atherosclerotic involvement of the vertebrobasilar system accounts for one of the major causes of stroke. Intracranial vertebral arteries, one of the feeder vessels of the brain are one of the principal sites implicated. Qualitative and Quantitative histological features of the intracranial vertebral arteries were studied in healthy young adults during routine autopsies. Thirty pairs of vessels were processed for paraffin sectioning (young adults: 20-40 years). Seven micron thick transverse sections were stained with Hematoxylin and Eosin, Masson’s Trichrome and Verhoeff’s Stains and observed under the light microscope. The mean luminal diameter was more in left sided vessels whereas tunica intima was thickened more on the right side. Preatherosclerotic ageing changes were observed as early as the third decade of life in apparently healthy young individuals which is an alarming sign for young adults.
EnglishArtery, Intracranial, Histology, Morphology, Vertebral.INTRODUCTION
Cerebrovascular disease due to atherosclerotic involvement of the vertebrobasilar system accounts for one third of the cases of stroke. (1) They can be manifested by a wide range of signs and symptoms, including transitory ischemic attacks, ischemic strokes, and chronic insufficiency of cerebral circulation .Symptomatic occlusions of the vertebral artery are most commonly located in the intracranial portion or the fourth part of the vertebral artery. (2) Our study aims to observe the histological features of the intracranial vertebral artery in apparently healthy adult Indian Population and to study the morphometry of the three tunics and the luminal and histological diameters of the vessels.
MATERIAL AND METHODS
Histological structure of intracranial vertebral arteries was studied in thirty human bodies, 20-40 years of age who had succumbed to road accidents during routine autopsies. Informed consent was obtained from the relatives. The cranial cavity was exposed and following measurements were taken (in situ): The length of the intracranial part of the vertebral arteries from the point of entrance of the artery through the foramen magnum to the basilovertebral junction, with a measuring tape. The intracranial parts were removed and the specimens were preserved in 10% formal saline. 2 mm pieces were taken from the centre of their length and processed for paraffin sectioning. 7µ thick transverse sections were cut on a rotary microtome. Serial sections were stained with Hematoxylin and eosin, Masson’s Trichrome and Verhoeff’s Stains. The stained slides were observed under the light microscope. The following measurements were made with the help of stage and ocular micrometer 4under 3.2x (3): 1) Measurement of the luminal diameter: The measurements were taken along the maximum and minimum diameter of the vessels. The mean of the two readings was taken. The following measurements were made under 40x: 1) The tunica intima, from the endothelium to internal elastic lamina 2) Tunica media, from internal elastic lamina to junction of media and externa 3) Tunica adventitia, from junction of media and adventitia to periphery Measurements of external diameters: The external diameter of the vessels in histological sections was calculated using the formula: [luminal diameter / 2 + (thickness of tunica intima + tunica media + tunica adventitia) x 2]. The external diameter calculated histologically was compared to the gross external diameter and shrinkage factor was calculated. Five measurements were taken at random from every fifth section and their mean calculated. The thickness of the three layers was compared on the right and left side and were statistically evaluated.
RESULTS
The vertebral arteries exhibited three well defined layers, tunica intima, tunica media and tunica adventitia. The subendothelial connective tissue showed thickened areas in most of the cases.(Fig 1) Focal fibroelastic masses(fig 2) in excess of one fifth the thickness of wall were seen in three cases. At these focal areas of intimal thickening, the connective tissue beneath the endothelial cells was more loosely arranged as compared to the deeper part of tunica intima. The deeper part of the tunica intima was rich in longitudinally running smooth muscle cells, interspersed in between elastic fibres. The internal elastic lamina stood out as a prominent waxy layer of elastic fibres. Focal areas of reduplication (fig 3) of the internal elastic lamina were seen in seven cases. (Table 1) The tunica intima varied from very thin to one fifth of thickness of the wall at various sites. Case studies In a 28 year old male who died due to right parietal hematoma, both the exhibited arteries exhibited thickenings in the intima with reduplications at 1 site in all the sections in right vertebral artery and 0-1 site in the left vertebral artery .(fig 3) In a 38-year-old male who died due to fracture of the anterior cranial fossa. A thickened area (Fig 1) is seen in the intima of the left vertebral artery at one site in four sections. The internal elastic lamina is seen as a single prominent layer in these sections. This thickened area is covered by endothelial cells; it is composed of sparse elastic fibres running in the superficial part of this area with empty looking spaces. In the deeper part longitudinally cut muscle cells more compactly arranged are seen. The media is seen to be made up of circularly arranged smooth muscle cells and intervening connective tissue fibers. The right vertebral artery is found to be hypoplastic (Fig 2) with no such areas in the tunica intima.. The remains of the external elastic lamina are found in all the sections in both the vertebral arteries in this individual.
Mean thickness of the three tunics
The mean thickness of tunica intima of the vertebral artery on the right side 19.93 ±8.47µ and on the left side = 17.07± 6.93 µ (p= 0.09) The mean thickness of the tunica media of vertebral artery on the right side 101±24.53 µ and on the left side 108.93±29.05 µ (p= 0.19) The mean thickness of tunica adventitia in vertebral artery on right side is 58.2±11.59 µ and on left side = 62.47±12.24 (p= 0.13) The tunica media comprises of circumferentially arranged smooth muscle cells. In the vertebral arteries exclusive circumferential arrangement is seen .The smooth muscles are arranged in 16-22 lamellae in vertebral artery. In most of the cases, the external elastic lamina cannot be defined, it is seen as fragmented wavy elastic fibres in five cases in the right vertebral artery and three in the left vertebral artery. The mean luminal diameter of the vertebral artery on the right side is 2.175±0.27mm and on the left side is 2.20±0.211mm (p=0.13) The mean histological outer diameter of the vertebral artery on the right side is 2.46±0.42mm and on the left side is 2.54±0.3mm. (p=0.22)
DISCUSSION
It is well documented that in muscular arteries the endothelium rests directly on the internal elastic lamina. (4).In the present study it is seen that variably thickened subendothelial tissue is found in apparently healthy young individuals. Wilkinson studied the extracranial and intracranial structure of twenty vertebral arteries between the ages of 60 and 75 from causes that were neither vascular nor neurological (5). In the intradural segment he found a) adventitial collagen fibres were less marked and the external elastic lamina was either absent completely or represented by sparse single elastic fibrils only. b) The width of the medial coat was noticeably thinner in this part of the artery than extradurally. Fibroelastic masses in the subendothelial tissue were seen in basilar arteries in nine of the thirty six cases .Blumenthal et al (6) and Tuthill (7) documented these in six of the twenty cases he studied. Similar findings in the present study suggest that these fibroelastic masses begin to form in even the younger age groups. Substantial increase in the elastic fiber in the intima found in patients along with the migration of smooth muscle cells are distinct ageing changes in the vessels documented by Simionescu N and Simionescu M (8). Splits in the internal elastic lamina have been observed in seven cases in our study. Similar areas of splitting with fibroelastic masses in between the split fibers in the large cerebral arteries were documented by Blumenthal et al, Tuthill and Hassler (9). However their studies were on children and at branching points of vessels. They considered these to be physiological. In the present study care has been taken to avoid branching points. The presence of split connective tissue fibers and circularly running smooth muscle cells in between these reduplications suggest that they are early ageing changes. Turliuk et al (10) documented arterial intima thickness to be 68.4 +/- 6.3 micron in the third part of vertebral artery. They also observed a moderate increase in the arterial wall thickness on the left (485.15 +/- 35.35 micron) as compared with that of the right VA (416.25 +/- 1l3.42 micron) (P = 0.12), at the expense of the middle tunic and adventitia. However our study is on the fourth part or the intradural part and considerable differences exist between these two parts of the vessel. Jovanikivic et al (11)measured intimomedial thickness (IMT) of the vertebral arteries first part IMT = 0.585 ± 0.134 mm in 50 individuals and second part IMT = 0.782 ± 0.248 mm and hypothesized the IMT to be an atherosclerosis indicator. Keith et al (12) reported histological changes in the tunica intima and tunica media of eighteen dogs using histological staining techniques. Fifteen dogs had abnormalities of tunica intima or tunica media in at least one arterial section examined. Of all arterial sections examined, 40% had histological changes like loss of smooth muscle cells and elastin of the tunica media and replacement by collagen. We have observed abnormalities in the tunica intima of most of the vessels and in 7 of the 30 cases (23.3%) splits of the internal elastic lamella have been found. Moossy (13, 14) also found left sided intracranial vertebral arteries to be more involved in atherosclerotic lesions. In accordance with our study he also observed arteries of patients below 39 years of age to be free of thrombus formation. Johnson et al(15) stained sections from 34 vertebral arteries and reported collagen counts were higher and elastic counts substantially lower within the intracranial segment. They reported degenerative changes were often focal and spared the intracranial segment almost completely. The external elastic lamina cannot be defined, it is seen as fragmented wavy elastic fibres in five cases in the right vertebral artery and three in the left vertebral artery. Blumenthal et al found fine elastic filaments in 16 cases in the place of the external elastic lamina. Ratinov (16) found it in a few cases in the intracranial intracavernous part of carotid artery as an indistinct lamina. Wilkinson observed that it disappeared completely 1cm distal to the point of dural attachment in the vertebral artery. These findings suggest that the external elastic lamina is not a well defined layer in the intracranial vessels. The mean histological outer diameter of the vertebral artery on the right side is 2.46±0.42mm and on the left side is 2.54±0.3mm. . Mitchell and McKay (17) found the microscopic outer diameter of the vertebral artery to measure 2.04?0.55mm on the left side and 2.03?0.52mm on the right side in formalin fixed cadavers. The slightly lower readings in their study are because they did not include the tunica adventitia in calculating the outer diameter. Moreover their study included 45 Blacks and 13 Whites. In the eight white females in their study they recorded the outer diameter 2.13±0.34/mm on the right side and 2.42±0.39mm on the left side which were significantly more in size. They concluded that the females in the white ethnic group may be more at risk as regards vascular accidents after cervical spine manipulation. Based on his conclusion in the present study we can presume that the larger left side vertebral arteries recorded could make the Indian population more at risk of ischemic events. The mean luminal diameter of the vertebral artery on the right side is 2.10 ±0.38 mm and on the left side is 2.16±0.25mm. Mitchell and McKay (17) recorded it to be 1.73 ±0.51mm on the right side and 1.74 ±0.50mm on the left side. The slightly lower readings in their study could be because of the different population they studied.
CONCLUSION
We have observed changes in the tunica intima of 7 of the 30 cases (23.3%).We would like to summarize that the Preatherosclerotic changes observed in the tunica intima of the vertebral arteries is an alarming sign for the young population and indicates towards the lifestyle changes that are imperative for our blood vessels. The mean luminal diameter of the vertebral artery on the right side is 2.10 ±0.38 mm and on the left side is 2.16±0.25mm. The larger left side vertebral arteries recorded could make the Indian population more at risk of ischemic accidents especially after cervical spine manipulation.
ACKNOWLEDGMENTS
We would like to thank the forensic department of U.C.M.S medical College, Delhi, India for their cooperation and support in procuring our samples. 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.
VAHODR= Vertebral artery histological outer diameter right side; VALUR=Vertebral artery luminal diameter right side; VAIR= of carotid artery intima right side; VAMR= Vertebral of carotid artery medial right side; VAAR= Vertebral of carotid artery adventitia right side; VAHODL=Vertebral artery histological outer diameter left side; VALUL=Vertebral of carotid artery intima media left side; VAIL= Vertebral of carotid artery intima left side; VAML= Vertebral of carotid artery media left side; VAAL= Vertebral of carotid artery adventitia left side
Englishhttp://ijcrr.com/abstract.php?article_id=1289http://ijcrr.com/article_html.php?did=12891. Bamford J, Sandercock P, Dennis M, Burn J, Warlow C. Classification and natural history of clinically identifiable subtypes of cerebral infarction. Lancet 1991; 337:152
2. Caplan LR, Gorelick PB, Hier DB. Race, sex and occlusive cerebrovascular disease: a review. Stroke 1986; 17:648–55.
3. Abercrombie M. Estimation of nuclear population from microtome sections. Anat Rec1964; 239-247.
4. Gabella G Cardiovascular system. In: Gray’s Anatomy 38th Churchill Livingstone. New York1995; pp1463.
5. Wilkinson IMS The vertebral artery; Extracranial and intracranial structure. Arch Neurol 1972; 27: 392-396.
6. Blumenthal HT, Handler FP, Blache JO. The histogenesis of Atherosclerosis in large Cereberal arteries, with an Analysis of the importance of mechanical factors. Amer J. Med 1954; 17: 337-347.
7. Tuthill CR. The Elastic Layer in the Cerebral vessels Arch. Neurol Psych 1930; 268-280.
8. Simionescu N and Simionescu M (eds ) (1977) The cardiovascular system. In: Histology, 4th Edition, Greep OR and WeissL. Mc Graw Hill Book Company: New York 1977; 376 –395.
9. Hassler O Physiological Intima Cushions in the large Cerebral arteries of young individuals. Acta Path Microbiol Scand 1962; 55: 19-27.
10. Turliuk DV, Ianushko VA, Ioskevich NN. Topographical and anatomical characteristics of the vertebral artery in the third segment. Angiol Sosud Khir 2009; 15 (3):37-42.
11. Jovaniki? Olivera, Lepi? Toplica, Rai?evi? Ranko, Veljan?i? Dragana, Risti? An?elka . Gligi? Branko. Intimomedial thickness of the vertebral arteries complex: A new useful parameter for the assessment of atherosclerotic process? Vojnosanitetski Pregled 2011; 68 (9):733-38.
12. Keith JC, Rawlings CA, Schaub RG Histological examination of selected areas of canine pulmonary arteries. Am J Vet Res1984; 45(4):751-4.
13. Moossy J Cerebral Infarction and Intracranial Arterial Thrombosis: necropsy studies and clinical implication. Arch Neurol 1966; 14: 119 – 123.
14. Moossy J Cerebral Infarct and the Lesions of Intracranial and Extracranial Atherosclerosis. Arch neurol1966; 14: 124- 128.
15. Johnson CP, Baugh R, Wilson CA, Burns J (2001). Age related changes in the tunica media of the vertebral artery: implications for the assessment of vessels injured by trauma. J. Clin Pathol 2001;54: 139-145.
16. Ratinov G. Extradural Intracranial Portion of Carotid Artery. Arch. Neurol 1964 ;10: 66- 73.
17. Mitchell J and McKay A. Comparison of left and right vertebral artery Intracranial Diameters. Anat. Record 1995; 242:350 – 353.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareA STUDY TO EVALUATE WORKING PROFILE OF ACCREDITED SOCIAL HEALTH ACTIVIST (ASHA) AND TO ASSESS THEIR KNOWLEDGE ABOUT INFANT HEALTH CARE
English97103Shashank K. J. English M.M. Angadi English K. A. MasaliEnglish Prashant WajantriEnglish Sowmya BhatEnglish Arun P. JoseEnglishBackground: One of the main aspects of National rural health mission (NRHM) is to develop a band of Accredited Social Health Activist (ASHA) workers in the rural areas with the purpose of supporting the community to access public health services. She is assigned one thousand populations and given training for 4 months. The discourse on the ASHA’s role centers around three typologies: ASHA as an activist, as a link worker or facilitator, and as a community level health care provider. Objectives: 1) To assess the social and working profile of ASHA workers. 2) To assess the knowledge of ASHA workers on infant health care. Methodology: A cross sectional study was done on 132 ASHA workers selected from 5 random PHCs in Bijapur taluk. Data was collected in a prestructured proforma using interview technique from June to October, 2012. Data was represented in the form of proportions and figures. Results: Average working population of each ASHA was found to be 1078 persons, with 10 household visits/week. 45 (34.1%) ASHA opined that breast feeding should be stopped by one years of age, 34 (25.8%) to discontinue breastfeeding in case of diarrheoa. 58 (43.9%) conveyed that mothers can take Oral Contraceptive Pills during lactation. Conclusion: The effectiveness of ASHA worker largely depends on the training and support from both the health system and the community. Majority of them were not aware about their role in behaviour modification with regards to infant feeding. Reorientation training programmes should be conducted to improve their efficacy.
EnglishNRHM, ASHA, infant, breast feeding.INTRODUCTION
The National Rural Health Mission (NRHM) was launched in the year 2005 to enhance the effectiveness of public health care system especially in rural areas. The main aim of NRHM is to provide accessible, affordable, accountable, effective and reliable primary health care, and bridging the gap in rural health care through creation of a cadre of Accredited Social Health Activist (ASHA). The objective of the NRHM is to strengthen the healthcare delivery system with a focus on the needs of the poor and vulnerable sections among the rural population. The ASHA programme is considered as being vital to achieving the goal of increasing community participation with the health system, and is one of the key components of the NRHM, a flagship programme of the central government of India1 . The general norm will be ‘One ASHA per 1000 population’. ASHA must be primarily a woman resident of the village - ‘Married/Widow/Divorced’ and preferably in the age group of 25 to 45yrs having commitment for social work . ASHA should have effective communication skills, leadership qualities and be able to reach out to the community. She should be a literate woman with formal education up to Eighth Class2 . ASHA will undergo series of training to be completed in 23 days spread over a period of 12 months to acquire efficiency in counseling, identifying health related problems and necessary actions to tackle the situations 2 . This will help in reducing Infant mortality rate (IMR), Maternal mortality rate (MMR) as well as control of specific diseases, and improvement of nutrition status of children and mothers and to achieve health related millennium development goals. ASHA will take steps to create awareness and provide information to the community on determinants of health such as nutrition, basic sanitation & hygienic practices, healthy living and working conditions, information on existing health services and the need for timely utilization of health & family welfare services. The discourse on the ASHA’s role centers around three typologies - ASHA as an activist, as a link worker or facilitator, and as a community level health care provider.3 She will counsel women on birth preparedness, importance of institutional delivery, exclusive breastfeeding and weaning practices , immunization, contraception and prevention of common infections including Reproductive Tract Infection/Sexually Transmitted Infection (RTIs/STIs) and care of infants and young child . ASHA will be the first port of call for any health related demands of deprived sections of the population, especially women and children, who find it difficult to access health services.2 As the performance of ASHA is crucial in achieving the aim and objective set under NRHM, this study was done to access the social and working profile of ASHA and their knowledge regarding infant health care in Bijapur taluk of Karnataka state.
OBJECTIVES
1) To assess the social and working profile of ASHA workers. 2) To assess the knowledge of ASHA workers on infant health care.
MATERIALS AND METHODS
Out of 12 Primary health centre (PHC) in Bijapur taluk , 5 PHC’s were randomly selected for the study. After obtaining prior permission from the District health officer (DHO) , the study was conducted . The ASHA workers were contacted in their respective PHC during their monthly review meetings . After explaining the purpose of the study and obtaining oral consent, the study was conducted using interview technique. Information was collected in a prestructured proforma by the investigator. The study was conducted from June 2012 to October 2012 . Every month one PHC was visited and information was collected from the ASHA. Out of 150 ASHA workers from the 5 PHC ‘s only 132 ASHA workers could be contacted during their monthly meeting. Data was represented in the form of proportions , percentages and figures.
RESULTS
The average age of ASHA workers is 30 years, with majority 71 (53.8%) of them in the age group of 26 to 30 years.129 ( 97.7%) of them are married and 115 (87.1%) were Hindu by religion.80 (60.6%) of ASHA had formal education till 8TH standard as recommended in NRHM. [ TABLE 1] [FIGURE 1]
WORKING PROFILE OF ASHA WORKERS
The average working population of ASHA was 1078 persons/ASHA with an average of 10 household visits/week/ASHA. Each ASHA works for about 3.8 hours / day and 29.3 hrs/week/ASHA on an average.
Only 26 (19.7 %) of ASHA held group discussion with the people on all aspects like health, nutrition, sanitation, family planning. Majority of ASHA 101 (76.5 %) had discussion on nutrition related topics with the community in last three months[Table 2] An average of 31 Antenatal cases was registered by ASHA last year at their respective PHC . 53 (40.2%) of ASHA said that they do 4 ANC visits and another 53 (40.2%) of ASHA did 3 ANC visits for every registered ANC cases with them.[Table 3] Knowledge of ASHA workers about infant health care All the 132 ASHA workers opined that food intake should be increased by the mother during the pregnancy period along with increased iron and vitamin supplementation. 87.1% of ASHA educate about breastfeeding to the mother before the delivery and 100% of them educate the mother and advocated breastfeeding to the new born as soon as possible after delivery. All the 132 ASHA workers gave the correct responses regarding prevention of hypothermia , care of umbilical cord, prelacteal feeds and exclusive breastfeeding practices. Regarding complete cessation of breast feeding 11(8.3%) said at 6 months, 45(34.1%) said by 1 years of age,44(33.3%) said at 2 years of age, 32(24.3%) said at 3 yrs of age. [Figure 2] 45(34.1%) of ASHA still believe that evil spirits affects the child health. Only 58(43.9%) were aware that child suffers from fever after DPT vaccination . 65(49.3%) ASHA opined to postpone the vaccination if child is suffering from high grade fever [Figure 3]. All the 132 ASHA’s agreed that ORS should be the initial treatment for diarrhea in children. 98(74.8%) advised mother to continue breastfeeding even if child is suffering from severe diarrhoea.58(43.9%) of ASHA said that lactating mother can take oral contraceptive pills during the period of lactation.[Table 4]
DISCUSSION
All the 132 ASHA workers who were interviewed were working in their respective villages, which is an important and positive finding of the study. The average age of ASHA is 30 years with majority of them being between the age group of 26-30 years. In the study done by Nirupam Bajpai et al 4 the average age of ASHA was 31 years with majority of them in the same age group as in our study. Similar findings were also seen in the study done by Prof. Deoki Nandan.5 18.2% of ASHA had received education till 8th standard , which is similar to the findings of Prof. Deoki Nandan 5 done in the city of Cuttack . 129(97.7%) of the ASHA were married , which is comparable with the other studies done on ASHA by various authors 4,5,6,8 . Each ASHA worker was supposed to work for a recommended population of 1000 persons /ASHA as per NRHM guidelines 3 . In most of the studies the working population of ASHA varied from as low as 454 persons/ASHA in Chattishargh to 1431 persons /ASHA in the State of Uttar Pradesh 4 . In our study, the average population each ASHA was serving was 1078 persons which is almost equal to the recommendation in NRHM. One of the main working modalities of ASHA workers is conducting of household visits in the community for ANC,PNC, Infant care , immunization and care of the sick. On an average each ASHA was conducting 10 household visits every week in our study which is much lesser than the number of visits by ASHA in the study done by Nirupam Bajpai 4 , where each ASHA conducted 21 house visits every week. Each ASHA on an average registered 31 ANC cases in their respective PHC in the last one year, which is higher than the results found in other studies 4,5. The brighter aspects among the ASHA’s in our study was that 80.4 % of them conducted 3- 4 ANC visits for every registered pregnancy. Nirupam Bajpai et al 4 in their study found that only 56 % of ASHA conducted 3-4 ANC visits. Most of the ASHA had proper knowledge about health education and guidance to be given for mother about breast feeding practices.106(87.1%) of ASHA educated the mother about breastfeeding and its importance before delivery and 100 % of them educate and also insisted on immediate breastfeeding after delivery. Nirupam Bajpai et al 4 in their study done on ASHA in Rajastahan found that 98 % of the ASHAs educate the mother regarding breastfeeding antenatally and 96 % educate the mother postnatally. In our study 34. 1% of ASHA’s still believe that evil spirits have an effect on a child’s health which shows the misconceptions that exists in them even after undergoing training regarding causation of disease. In our study 58(43.9%) of ASHA were aware of the importance of immunization and the adverse events follwing immunization. In the study done by Srivathsha et al 70. 1% of them had good knowledge regarding importance of immunization and its adverse effects. Darshan K. Mahyavanshi Etal 6 observed that 36.92 % of ASHA had good knowledge about immunization. 43.9 % of ASHA’s wrongly advised, OCP as a method of family planning during lactation .
CONCLUSION AND RECOMMENDATION:
In a developing country like India , where more than 70 % of the population reside in the rural areas , the strengthening of the health care facility is one of the top most priority of the government. Among the various national programmes launched by the Government of India, NRHM is one of the major programmes meant for the improvement of the healthcare system in rural areas. The creation of ASHA cadre is one of the major initiatives under the NRHM. All the ASHAs in our study were residents of the community they served in , as a result of which they formed a very effective link between the delivery of health services and the community. The ASHA preferred to do their duties that were associated with financial incentivies such as ANC ,PNC and Immunization services rather than other activities like health education, nutrition, sanitation and family planning. Most of them had good knowledge about ANC, PNC and Infant care but lacked proper knowledge on family planning methods and immunization. ASHA’s also believe that evil spirits have an effect on a child’s health. Hence during the training process we need to concentrate on educating the ASHA on family planning aspects especially for the newly wed couples and contraception during the post natal period and remove belief in effect of bad eye on health. The training programme should also focus on making the ASHA understand the importance of her role in providing immunization services for the community. The Government can also conduct frequent refresher training programmes for the ASHA to strengthen their knowledge and also inform them of recent advances and changes in approach to various public health issues . The most motivating factor for the ASHA is the financial incentives what they get from government and hope of getting absorbed into government jobs in future.
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=1290http://ijcrr.com/article_html.php?did=12901. Park K .Health programmes in Inda. In: Park’s textbook of Preventive and social medicine.21th ed. Jabalpur: M/s Banarsidas Bhanot; 2011.p 405.
2. Government of India, NRHM-ASHA (2005) Module Guidelines,Ministry of Health and Family Welfare, New Delhi.
3. (Internet ref: http://www.mohfw.nic.in/NRHM/RCH/guideli nes/ASHA_guidelines.pdf).
4. Mony P and Raju M . BMC Proceedings 2012: 6 (suppl 5) ; p124) Nirupam Bajpai and Ravindra H. Dholakia, Improving The Performance Of Accredited Social Health Activists In India: South Asia, Columbia University : Working Paper No. 1; May 2011.p 15-19.
5. Prof. Deoki Nandan. A Rapid Appraisal Of Functioning Of Asha Under NRHM In Cuttack, Orrisa: National Institute of Health and Family Welfare, New Delhi; 2007-2008. p 17.
6. Darshan K. Mahyavanshi Etal . A cross sectional study of the knowledge, attitude and practice of ASHA workers regarding child health (under five years of age) in Surendranagar district. Healthline ISSN 2229- 337X : Volume 2 Issue 2 ;July-December 2011.p 50-53.
7. Shrivastava SR , Shrivastava PS . Evaluation of trained Accredited Social Health Acivist (ASHA)workers regarding their knowledge .attitude and practices about child health. Rural and Remote Health 2012:2099
8. S. Haider , S. Vivek Adhish , Sanjay Gupta , Neera Dhar , Utsuk Datta , S. Menon, Deoki Nandan. A rapid appraisal of SAHIYA (ASHA) in Jharkhand. Health and Population: Perspectives and Issues; Vol. 31 (2); 2008. P 80-84.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28HealthcareBOMB BLAST IN HYDERABAD 2013: A MEDICAL ANALYSIS
English104111K. Vishnu PrasadEnglish Vimala ThomasEnglish K. PadmaleelaEnglish Bheemathati Ranga RaoEnglishTerrorist activities have become increasingly and Hyderabad has been often a key witness to such activities. The most recent being on the 21st February 2013, when twin bomb blast rocked the peace fabric in Hyderabad and where 96 victims were injured and 17 killed. Objectives: 1) To detail the action taken post bomb blast 2) Analyse the demographic profile of the victims, 3) Enumerate the pattern of injuries and disability sustained by the victims and 4)Recommend measures for Mass casualty Emergencies. Method: Data collected from the primary site of bomb blast and also data received at the Directorate of Medical Education. Case records of patients taken prospectively as well as retrospectively from the hospitals were used. Results: A total of 113 people were affected, and 17 of them died (12 on the spot and 5 later) giving an overall mortality rate of 15% (17 out of 113) and a ‘critical mortality rate’ of 4.9% (5 out of 101). A higher number of males were dead (16 out of 17) and injured too (80 out of 96). The common injury patterns were Penetrating Wounds (54.5%) followed by fractures (23.9%) and Tympanic membrane Perforation (11.5%). Around 63% of the injured were left with no disability and 2% with severe disability. Rapid action taken by the emergency health team, like in triaging, quick transportation, emergency care services and follows up care, helped in saving numerous lives and also in decreasing the disability among the injured. 7 T’s for management of disaster emergencies have been suggested - Timely intervention; Triage; Transportation; Treatment Protocols; Transfusion and Treatment Supplies; Team Leadership and Spirit; Training. Conclusion: Most of the injuries were due to penetrating metallic sharps contained in the explosives. Males were more affected than females. Timely intervention and good hospital care definitely helps save a number of lives. Still standard guidelines and protocols for managing mass casualty emergencies need to be developed in India.
EnglishBomb Blast, Triage, Injuries, Emergency, Disability.INTRODUCTION
WHO defines disaster as ‘any occurrence that causes damage, economic destruction, loss of human life and deterioration in health and health services on a scale sufficient to warrant an extraordinary response from outside the affected community or area.’ A disaster could be natural or man-made hazard. What we witnessed on the 21st of February 2013, at Hyderabad was a manmade disaster – Bomb blast by terrorists. Terrorism (as developed by Cunningham1 ) is defined as the illegitimate use or threat of violence to further political objectives. It is illegitimate in that it targets civilians. It is designed to affect the audience by creating psychological states of fear in order to influence decision-makers to change policies, practices or systems that are related to the perpetrators’ political objectives.1 Bombs are attractive to terrorists because they are relatively easy to design, assemble, and deliver, and because they are sudden and violent in nature.2 Mass casualties following disasters are characterized by such numbers, severity, and diversity of injuries that can overwhelm the ability of local medical resources to deliver comprehensive and definitive medical care to all victims.3 Large blasts often produce such massive numbers of victims that medical systems can be totally overloaded and incapacitated unless they are prepared to handle the medical consequences of such events. Terrorist bombings around the world during the past 35 years have occurred primarily in urban areas and they frequently generate multiple casualties, but one has to be prepared for this. The most important means of preparing for the large casualty loads caused by bombing disasters is to understand the patterns of injuries and logistical problems that result.4 Andhra Pradesh and in particular Hyderabad has been exposed to terrorist activities for many years. Hyderabad was on the edge after twin blasts which occurred on August 25th 2007 where at least 43 people were killed and more than 70 others were injured as two bombs rocked a crowded outdoor auditorium and a popular eatery (Gokul Chat) in Hyderabad. These blasts occurred at 8:10 pm in the night. Another incident occurred on May 18th 2007, where at least 10 people were killed and more than a dozen injured in blast at 17th century Mecca mosque in Hyderabad. The most recent one was on 21st February 2013 where there was twin bomb blast at Anand Tiffin Centre in Dilsuknagar area in Hyderabad. Till date very few attempts have been made to analyze the medical situations of the victims post bomb blast in India, hence we are attempting to do one. This paper aims to throw light on the action take, the demographic profile of the victims, patterns of injuries sustained by the casualties and the residual disability they are left with and also suggestions for preparedness to tackle such emergencies.
METHOD
On Thursday, 21st February 2013, a terrorist bomb attack was perpetrated in Hyderabad, Andhra Pradesh, which led to a mass injury situation. Twin blasts a few minutes apart shook the entire neighbourhood of Dilsukhnagar area in Hyderabad. The explosions took place between 07:00 and 07:03 PM. This paper is based on the overall information and data collected by the authors and also reported by the Director of Medical education, on the number of victims treated at the different hospitals and primary care facilities at the scene. Data on the patients received at the various hospitals (Both private and Government) treatment taken and their status was taken concurrently and in a few parts obtained retrospectively. Data was analyzed and interpretations made. Out of the 113, casualties, 17 died. Data on the remaining 96 victims forms part of the basis of this report.
RESULTS
Initial emergency treatment and triage was carried out by emergency medical services (108- EMRI) near the scenes of the blasts. Triage of the disaster victims was done at the bomb blast site and the victims were segregated based on their severity and sent to Osmania General Hospital and other nearby private hospitals. Critically injured patients were sent first, followed by patients with intermediate needs, and then by those with minor injuries.
The vast majority of survivors were evacuated by 108 ambulances and many others by private ambulances and vehicles. Most casualties arrived at the hospitals between 7:30 pm and 9:30pm. The average distance of the private hospitals from the bomb blast site was 3 kilometre +/- 0.5 kilometres and Osmania General Hospital was about 6 kilometres away. As suggested by Forensic experts, ammonium nitrate material was used along with sharp metal objects in the bombs. This resulted in multiple injuries, superficial and deep wounds which penetrated the vital internal organs of the body, fractures and head injuries among the victims. These type of injuries cause massive bleeding, shock and collapse and hence some of the victims died on the spot.
The Explosion and the casualties
The explosions resulted in 113 casualties, 12 of who were killed immediately (deaths at the scene). There were 5 subsequent deaths (while resuscitation and in-hospital deaths), which occurred either on the same day or later on, among the 101 victims who were reported to the nearby hospitals, bringing the total death toll to 17 and the overall mortality rate to 15% (17 out of 113) and the ‘critical mortality rate’ to 4.9% (5 out of 101). The 'critical mortality rate' – the death rate among the critically injured survivors – more accurately reflects the magnitude of the disaster and the results of medical management than does the overall mortality rate, and so it should be used when comparing the outcomes from different disasters.5 The number of injured left who took treatment in the hospitals was 96. A number of procedures were performed as part of the initial resuscitation and stabilization of the injured victims upon arrival to the Emergency departments of the hospitals. Some of these procedures included medication (92.7%), fluid administration (68.8%) insertion of nasogastric tube (20.8%), and endo-tracheal intubation (7.3%). Subsequently all other medical measures were taken up. More than 20% of the victims received blood transfusions during their stay at the hospitals, some of them receiving up to 10 units of blood. Study Population Among the injured (n=96), the vast majority were males (n=80, 83.3%). Even among the 17 dead, 16 were males. (Table 1) Age wise distribution is as detailed in Table 2 with the highest percent seen in the age group 21- 30 years (46.9%) followed by 11-20 years (22.9%), the young adults. Injury Characteristics The majority of the victims sustained injury to multiple body regions with different types of injuries. Since the explosive devices contained multiple types of foreign bodies, such as shell fragments, nails, bolts, and metal balls it resulted in a combination of penetrating, blast, blunt and burn injuries. More than 54% had penetrating injuries which were either deep open wounds (28.1%) or superficial wounds (26.1%). The next most common type of injury was fractures (23.9%), the majority being long bones fracture (15.6%). This was followed by tympanic membrane perforation (11.5%). A summary of the type of injuries sustained is detailed in Table 3.
Disability
On analysis of the type of disability sustained by the injured we could conclude that majority (66.7%) have no disability, nearly 21% have minimal disability and about 2% have severe disability. The classification of disability is based on the guidelines issued by the Government of India.6
DISCUSSIONS
Terrorists worldwide have repeatedly shown their willingness and ability to use explosives to inflict significant death, destruction, and fear. Explosive devices are the most common weapons used by terrorists. A sudden and unpredictable bombingrelated Mass Casualty Emergency requires an immediate response; disrupts communication systems; interrupts transportation of casualties, medical personnel, and supplies; and may overwhelm the capacity of responding agencies. Hyderabad has been repeatedly been exposed to bomb blast and with time and experience the preparedness to tackle such mass casualty emergency has improved. Co-incidentally while comparing the number of victims (dead and injured) affected in the last bomb blasts (Gokul Chat) in Hyderabad (on 25th August 2007), to the present, the number were the same 113. The sites selected by the terrorists were crowded areas in both the bomb blast situations. The overall mortality rate for Gokul Chat bomb blasts was 38.1% (dead – 43/113) and for the present one it was 15% (17/113). Some of the factors which could have decreased the mortality rate could have been:
Speed with which the transportation of the victims were done from the scene of the blast along with adequate triaging.
Immediate emergency care at the hospitals including blood transfusions which played a crucial role in saving a number of lives
Role played by the private hospitals as part of their corporate social responsibility and the immediate resuscitation and follow up care given to the victims definitely helped minimize the death toll.
In a study done by J Peral Gutierrez de Ceballos et al,3 where they studied the bomb explosions in Madrid, which resulted in 2062 casualties, the overall 'critical mortality' rate was 17% whereas in another study done by Katz et al,7 they found that after a bomb explosion in a bus the mortality rate was 10.3%. Males were predominantly affected for both injured and the dead. This was also seen in a study done by Kobi Peleg et al,8 where they analyzed the gunshot injuries and explosive injuries and they found that more than 71% affected were males. They however found that patients injured in explosions were children and the elderly which is in variation to our study where we have found that it was the young adults who were affected more. In our study the most frequent injuries found in the bomb blast victims was penetrating injuries, followed by fractures and tympanic membrane perforation. In a study done by J Peral Gutierrez de Ceballos et al3 in Madrid, the most frequent injuries found in the bomb blast victims were tympanic membrane perforations, chest injuries, shrapnel wounds and fractures. In yet another study done by Kobi Peleg et al,8 overall, apart from chest, spine, and abdominal injuries, which are more frequent in Gun Shot Wound victims, all other body regions are injured more frequently in explosion One of the most consistent injury patterns noted among survivors of terrorist bombings is the overwhelming predominance of relatively minor, noncritical injuries that are not lifethreatening.9,10 These are usually caused by secondary and tertiary blast effects, and are typically soft tissue and skeletal injuries that nevertheless tend to be extensive and contaminated, and require multiple procedures. A similar pattern has emerged in our study too. An analysis of the patterns of injury from this event has shown that most of the survivors had no critical injuries or disability as was also seen in other similar studies.5,11,12 The high immediate death rate was probably because of the extreme magnitude of the explosive force as was also reported in a study done by Frykberg et al.5 Most of the fatally injured victims died at the scene of the bomb blast. A similar pattern was seen in other studies too.5,11,12
Recommendations
The following points need to be considered for managing Mass Casualty Emergencies.
7 T’s of Management of Mass Casualty Emergency
1. Timely intervention (golden hour)
2. Triage
3. Transportation
4. Treatment Protocols
5. Transfusion and Treatment Supplies
6. Team Leadership and Spirit
7. Training of the Emergency team
1. Timely intervention
In emergency medicine, the Golden hour is the first 60 minutes after the occurrence of a major multisystem trauma. It is widely believed that the victim’s chances of survival are greatest if he or she receives definitive care within the first hour. The golden hour can be summarized by the 3R rule, “Getting the right patient to the right place at the right time.”13 In a large-scale event, each hospital should have the capability to increase staffing, rapidly assess available bed status, and open occupied beds, especially in the Emergency Department, operating rooms, and intensive care units.
2. The triage system
Triage (French: sorting) means categorization and distribution of casualties, which establishes priorities and proper location of treatment. The triage must be carried out at the disaster site as well as in the hospital. Identification: A simple method of identification, such as a tag banded to a victim, transmits information regarding patient identification. Patients can be classified according to their therapy needs viz. 1) Requiring only outpatient treatment. 2) Requiring indoor admission and expectant treatment, 3) Needing immediate exploration and 4) Capable of tolerating delayed treatment. Sections for each group can be temporarily created. Subsequently, these patients can be managed effectively by different groups of doctors.14 Another immediate priority is to setup a triage area at the entrance into the Emergency Department (ED) treatment area, which allows for unimpeded ambulance flow outside the ED and helps to avoid the immediate need to retriage casualties once inside the ED. Triage can be performed capably by experienced emergency physicians or mid-level surgeons, saving senior trauma surgeons for more effective roles in the ED or operation room.2
3. Transportation
This is of vital importance when coping with such disasters. Well equipped Ambulances with facilities for resuscitation (like endotrachel intubation) and also with ventilatory and monitoring services should be made readily available. Any delay at times result in late initiation of the management of a few patients. Coordinated transportation service is vital.
4. Treatment Protocols
As part of the response to a terrorist bombing, revision to standard of care is required. No universal methodology exists for altering standards of care. Standard Treatment protocols are needed to be developed to cater to the specific injuries post a bomb blast.
5. Transfusion and Treatment Supplies
If a terrorist bombing occurs, large amounts of blood will be required since many victims are seriously injured. The blood banking community should be well prepared to address blood needs in the event of such disasters. Shortages of essential equipment and supplies often occur in the aftermath of a terrorist bombing. Emergency stocks should always be made available. The emergency mass critical care plan should address hemodynamic resuscitation and support using intravenous fluids and vasopressors, administration of antibiotics and other diseasespecific countermeasures, prophylactic interventions to reduce adverse consequences of critical illness, and basic modes of mechanical ventilation.15
6. Team leadership and Team Spirit
Effective preparedness and response demand an established, functional leadership structure with clear organizational responsibilities. There should be a Hospital Emergency Incident Command system. In many instances, particularly at the local operational level, such preparation has not occurred. Consequently, confusion over specific roles and responsibilities during response efforts could occur. The team spirit needs to be kept motivated at all times since seeing the injured and dead in spite of their best efforts, the emergency team may experience feeling of sadness, helpless, and anxiety.
7. Training
Disaster preparedness and response education is not included in most medical or nursing school curricula. Standardized training that addresses clinical care and systems issues should be given to all levels of providers. More physicians and surgeons, require further education on the planning and emergency response process so as to be prepared to tackle any emergency mass casualty situation.
CONCLUSIONS
Most of the injuries were due to penetrating metallic sharps contained in the explosives. Males were more affected than females, with the age group of 21-30 years being most affected. Timely intervention and good hospital care definitely helps save a number of lives. Emergency Preparedness to tackle medical emergencies post a bomb blast needs a lot of planning and team work. Training the emergency team on triaging and providing good transportation facilities and ensuring an adequate supply of blood, drugs and equipment in the hospitals will go a long way in saving numerous lives and also in reducing the morbidity of the injured.
CONFLICT OF INTEREST None ACKNOWLEDGEMENTS
The authors wish to thank the emergency team (EMRI), doctors, and nurses, paramedical staff of the Government and Private hospitals, Aarogyasri Team and the local community. Authors acknowledge the help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to the authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1291http://ijcrr.com/article_html.php?did=12911. Cunningham, W. G. (2003). Terrorism: Definitions and typologies. Terrorism: Concepts, Causes, and Conflict Resolution. Fort Belvoir, VA: Defense Threat Reduction Agency and George Mason University’s Institute for Conflict Analysis and Resolution.
2. M. Kalemoglu. The Medical Management Of Bomb-Blast Scenes In The Emergency Department. The Internet Journal of Rescue and Disaster Medicine. 2007; Volume 6 No 1.
3. Statement on Disaster and Mass Casualty Management: Committee on Trauma, American College of Surgeons
4. J Peral Gutierrez de Ceballos, F TuréganoFuentes, D Perez-Diaz, M Sanz-Sanchez, C Martin- Llorente, and JE Guerrero-Sanz 11 March 2004: The terrorist bomb explosions in Madrid, Spain – An analysis of the logistics, injuries sustained and clinical management of casualties treated at the closest hospital. Crit Care. 2005; 9(1): 104– 111.
5. Frykberg ER, Tepas JJ. Terrorist bombings: lessons learned from Belfast to Beirut. Ann Surg. 1988; 208:569–576.
6. Office of the Chief Commissioner for persons with Disabilities. Government of India. Disability guidelines.
7. Eliezer Katz, Boaz Ofek,, Jacob Adler, Harry B. Abramowitz, Michael M, Krausz. Primary Blast Injury After a Bomb Explosion in a Civilian Bus. Ann. Surg. April 1989; Vol. 209 - No. 5.
8. Kobi Peleg, Limor Aharonson-Daniel, Michael Stein, Moshe Michaelson, Yoram Kluger, Daniel Simon, Israeli Trauma Group (ITG), and Eric K. Noji. Gunshot and Explosion Injuries; Characteristics, Outcomes, and Implications for Care of Terror-Related Injuries in Israel. Ann Surg. 2004 March; 239(3): 311–318.
9. Brismar B, Bergenwald L. The terrorist bomb in Bologna, Italy, 1980: An analysis of the effects and injuries sustained. J Trauma 1982;22:216–220.
10. Biancolini CA, Del Bosco CG, Jorge MA. Argentine Jewish community institution bomb explosion. J Trauma 1999; 47:728– 732.
11. Frykberg ER. Medical management of disasters and mass casualties from terrorist bombings: How can we cope? J Trauma 2002;53:201–212.
12. Teague DC.Mass casualties in the Oklahoma City bombing. Clin Orthop 2004;422:77–81.
13. www.traumafoundation.org/restricted/tinymc e/jscripts/tiny_mce/plugins/filemanager/files/ About%20Trauma%20Care_Golden%20Hou r.pdf. Retrieved on 9-03-2013.
14. AN Supe. Disaster management- are we ready? Journal of Postgraduate Medicine 1993; 39:2-4
15. Centers for Disease Control and Prevention. In A Moment’s Notice: Surge Capacity for Terrorist Bombings. Challenges and Proposed Solutions.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN-0001November30HealthcareMORPHOMETRIC DIMENSIONS OF FETAL LARYNX
English112118Mamatha H.English Vinodhini P.English Suhani S.English Prasanna L.C.EnglishAntony Sylvan D souzaEnglishIntroduction: The laryngeal cavity space extends from the laryngeal inlet down to the lower border of the cricoid cartilage, where it continues as the trachea. The skeletal framework is formed by a series of cartilages interconnected by ligaments and fibrous membranes. The vocal cords are the primary source of phonation. The larynx contributes for indispensable significance from embryologic, anatomic, physiologic and surgical standpoints. Aim: The aim of the present study was to investigate morphometric growth patterns of the cartilaginous components and vocal cords in fetal larynx. Materials and methods: The study was done on 25 spontaneously aborted (13 males and 12 females) fetuses from second to eighth month, in the Department of Anatomy, Kasturba Medical College, Manipal. The fetuses were obtained from the Department of Gynecology, Kasturba Medical Hospital, and Manipal. Results: The dimensions of the larynx and its cartilaginous components were measured and the relationship between the obtained data was statistically assessed. Conclusion: Correlations were found between the cartilaginous components, size of the larynx, and gestational age. Advances in neonatal medicine have resulted in increased care of fetal and neonatal airways, which requires an exhaustive knowledge of fetal airway anatomy and development .This study results are useful in the prenatal analysis, during treatment planning of airway emergencies and while designing supra glottis devices.
EnglishINTRODUCTION
The laryngeal cavity space extends from the laryngeal inlet down to the lower border of the cricoid cartilage, where it continues as the trachea. The skeletal framework is formed by a series of cartilages interconnected by ligaments and fibrous membranes. The vocal cords are the primary source of phonation. The larynx contributes for indispensable significance from embryologic, anatomic, physiologic and surgical standpoints. (1) The laryngeal cartilages and muscles form from the mesenchyme of the fourth and sixth pharyngeal arches. Cartilaginous tissues from the fourth and sixth pharyngeal arches fuse and form the arytenoid, thyroid, cricoid, corniculate and cuneiform cartilages. The laryngeal cartilages, including the epiglottis, originate from the mesenchymal tissue adjacent to both ectoderm and endoderm (1,2) Although thyroid, cricoid and arytenoid cartilages consist of hyaline cartilage, the other cartilages consist of elastic cartilage. Hyaline cartilages tend to ossify after the age of 18 years; this occurs earlier in men than in women. In contrast to hyaline cartilages, ossification does not occur in elastic cartilages. (1,2)
AIM
The aim of the present study was to investigate morphometric growth patterns of the cartilaginous components and vocal cords in fetal larynx.
MATERIALS AND METHODS
The study was done on 25 spontaneously aborted (13 males and 12 females) fetuses from second to eighth month, in the Department of Anatomy, Kasturba Medical College, Manipal. The fetuses were obtained from the Department of Gynecology, Kasturba Medical Hospital, and Manipal.
THYROID CARTILAGE
• Distance between greater and lesser cornua (TY4)
• (right side—left side),
• Height of thyroid notch (TY5),
• Distance between thyroid notch and incisura thyroidea inferior (TY6),
• Height of greater cornua (TC1) (right side— left • side),
• Height of thyroid ala between base of greater
• cornu and base of lesser cornu (TC2) (right
• side—left side)
,• Height of lesser cornua (TC3) (right side—left • side),
• Distance between greater cornua of thyroid
• (TC7),
• Distance between lesser cornua of thyroid (TC8),
CRICOID CARTILAGE (CR)
• Height of cricoid arch (CR1),
• Height of cricoid lamina (CR2),
EPIGLOTTIS CARTILAGE (EP)
• Length of epiglottis (EP1),
• Width of epiglottis (EP2).
RESULTS
The measurements of the human fetal larynx dimensions as seen in PICTURE 1,2,3 were done.
The Diagrammatic representations of the human fetal larynx were depicted in FIGURE 1,2,3
The relationship between the obtained data was statistically assessed.
The tabulations of the mean and the standard deviation are done. and represented in TABLE 1,2,3.
DISCUSSION
When the embryo is approximately 4 weeks old, the primordium of the respiratory system appears as an outgrowth from the ventral wall of the foregut. The internal lining of the larynx is developed from endoderm, but the cartilages and muscles originate from mesenchyme of the fourth and sixth branchial arches.(1,2) Examination in children by means of ultrasonography, which represented a new method for researching normal and pathologic states, particularly functional disorders of the larynx Phonosurgical laryngoplastics is a relatively new branch in surgical laryngology .(3) In the present study, the length and breadth of epiglottis showed a positive correlation with CRL. Cicekcibasi et al in their study on 40 spontaneously aborted fetuses evaluated the measurements of cartilaginous components of larynx with gestational age. In their study, the length and breadth of epiglottis increased from 5.62 mm (§1.13) and 4.06 mm (§0.76), respectively, in second trimester to9.35 mm (§1.52) and 5.63 mm (§0.72), respectively in the third trimester. Our study is similar to Cicekcibasi et al in evaluation of the measurements of the cartilaginous components of the fetal larynx.(4) Different methods have been described to illustrate observations of fetal measurements and to estimate age-specific reference intervals for these measurements. The simplified method proposed by Royston and Wright (2000) appears to be usable to our study, regrouping a limited population. Few studies have been published on the anatomical measurements of the airway in paediatric populations or premature populations Ultrasound measurements in fetuses (Kalache et al.1999) reported a smaller tracheal diameter and higher laryngeal diameter than our results. An experimental study by Kalache et al. (2001) demonstrated that tracheal measurements obtained by ultrasound are smaller than those from anatomical measurements. According to their methods section, the laryngeal diameter measured in this study corresponded to the external cricoid diameter andnot to the endoluminal diameter(5,6) The measurements were slightly smaller when compared with the corrected gestational age of fetuses in the current study, which may be due to the small sample size and methodological divergences in measure (7) Clinical importance of the investigation Laryngotomy in little children is connected to a high risk and followed by many complications. Therefore, findings of anatomical investigations on the larynx size (laryngometry) that are the basis for cannula size determination, as well as the cannulation timing and complications,are of great importance (7,8). Fracture of the laryngeal cartilage has a special forensic- medical importance, as it is associated to the neck trauma (hanging, strangling – infanticide), because it happens most frequently on the cornua superiora of thethyroid cartilage (7, 8, 9) . The data on laryngeal angles, air – lumen and thickness of the laryngeal skeletal parts can significantly help in planning endolaryngeal surgeries, or during transcutaneous insertion of electrodes for laryngeal electromiography. Kaufman (2001) described the problems and complications that occur when performing laryngoplastics, because of the anatomical variations in larynx and unexpected events in surgery connected to this procedure, such as: variable size of the lower thyroid incisure, or its lack, which can cause thyroid cartilage fracture; ossification of thyroid cartilage in the early childhood; tubercules occurring in the region of cricoarytenoid joint which, if large, represents a good orientation in searching this joint; occuring ankylosis and pseudoankylosis.(10,11,12) If a surgeon has not learned about existence of this type of variations, he/she may cause ankylosis of thelarynx joint. The reasons for evaluating the dimensions of the fetal larynx are to provide a reliable data for surgical procedures in premature infants, like transplantation, stenting, intubations, cricothyroidotomy, and endoscopic procedures etc,.(12,3,14) It is suggested that thyroid alar cartilage graft could be used for anterior grafting in laryngotracheoplasty. This study reports the anatomical development of normal laryngotracheal structures during the fetal period. Laryngotracheal structures present a linear growth proportional to the fetal growth. Inequity in the size of endotracheal tube and the airway are the usual consequences to be blamed for the kind of improper instrumental injuries in the larynx. Using suitable endotracheal tubes especially for premature infants is important for effective airway management and for protecting larynx.
CONCLUSION
Correlations were found between the cartilaginous components, size of the larynx, and gestational age. Advances in neonatal medicine have resulted in increased care of fetal and neonatal airways, which requires an exhaustive knowledge of fetal airway anatomy and development .This study results are useful in the prenatal analysis, during treatment planning of airway emergencies and while designing supra glottis devices. 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=1292http://ijcrr.com/article_html.php?did=12921. Standring S, Gray’s Anatomy. 40th Ed., London, Churchill Livingstone. 2008
2. Sadler W.D. Lang man’s Human embryology, 10th edition.
3. Admedina et al, Age Characteristics of the larynx in infants during the first year of life. Periodicum Biologorum UDC 57:61 VOL. 112, No 1, 75–82, 2010
4. Aynur Emine Cicekcibasi The morphometric development of the fetal larynx during the fetal period. 2008) 72, 683—691.
5. Pierre Fayoux ,Prenatal and early postnatal morphogenesis and growth of human laryngotracheal structures. J. Anat.(2008)213, pp86–92.
6. kalache KD, Nishima H, Ojutiku D,ET al.(2001) Visualisation and Measurement of tracheal diameter in the sheep fetus: andultrasound study with stereomicroscopic correlation.Fetal Diagn Ther 16, 342–345.
7. K. Harjeet, Anjali Aggarwal et al. Anatomical dimensions of larynx, epiglottis and cricoid cartilage in fetuses and their relationship with crown rump length. Surg Radiol Anat (2010) 32:675–681.
8. Danuta et al, A morp hometric st udy of prenatal development of the human larynx, 2010, 56, 3, 103–106
9. Michai Szpinda · Marcin Daroszewski et al, Tracheal dimensions in human fetuses: an anatomical, digital and statistical study. Surg Radiol Anat (2012) 34:317–323.DOI 10.1007/s00276-011-0878-7
10. S.M. Meller, Functional anatomy of the larynx, Otolaryngol. Clin. North Am. 17 (1984) 3—12.
11. G.M. Sprinzl et al, Morphometric measurements of the cartilaginous larynx: an anatomic correlate of laryngeal surgery, Head Neck 21(1999) 743—750.
12. Petr Pohunek Development, structure and function of the upper Airwayspaediatric Respiratory Reviews (2004) 5, 2–8 doi:10.1016/j.prrv.2003.09.002.
13. Gawlikowska-Sroka A, Miklaszewska et al, Changes of laryngeal parameters during intrauterine life.
14. T. Lauder Brunton, Theodore CASH,The Valvular Action Of The Larynx. By D.E. Lieberman, Ontogeny of postnatal hyoid and larynx descent in humans.(2001) 117–128
15. TIM Cook ,BEN Howes Supraglottic airway devices: recent advances. Continuing Education in Anaesthesia, Critical Care & Pain j Volume 11 Number 2 2011.56-61.
16. C.K. Koay, Difficult tracheal intubation–— analysis and management in 37 cases, Singapore Med. J. 39 (1998) 112—114.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28TechnologyEFFECT OF SOLID CONTAMINATION IN BALL BEARINGS- A REVIEW
English119124Gagan SingotiaEnglish A.K. JainEnglishThis paper presents the study of literature on solid contamination in ball bearing. Review includes experimental, analytical, and numerical and software based analysis. Effect of contamination on the performance of ball bearing due to solid particle of different material is the main study parameter. Most of the researchers study the dynamic behavior of ball bearing. An exhaustive review shows that the viscosity is also a major factor to effect bearing performance at high speed.
Englishball bearing, solid contamination, materialsINTRODUCTION
The term "bearing" is derived from the verb "to bear”. A bearing being a machine element that allows one part to bear (i.e., to support) another. The simplest bearings are bearing surfaces, cut or formed into a part, with varying degrees of control over the form, size, roughness and location of the surface. Due to the relative motion between the bearings in the moving element a considerable amount of energy is lost to overcome frictional resistance. Other bearings are separate devices installed into a machine or machine part [1]. A bearing is a machine element that constrains relative motion between moving parts to only the desired motion. M.M. Maru (2007) aims to characterize vibration behavior of roller bearings as a function of lubricant viscosity. Experimental tests were performed in NU205 roller bearings, lubricated with mineral oil of three different viscosity grades (ISO 10, 32 and 68). The mechanical vibration was determined through the processing and analysis of bearing radial vibration data, obtained from each of the lubrication conditions, during 2 h of test run for temperature stabilization and under several
bearing shaft speeds. The applied radial load was 10% of the bearing nominal load. Through root mean square (RMS) analysis of the vibration signals, it was possible to identify specific frequency bands modulated by the change in lubricant viscosity, which was related to change in oil film thickness [2]. Changes in lubrication regime of roller bearings due to change in oil viscosity grade could be detected by vibration monitoring. In the tests with ISO 32 and ISO 68 viscosity grades, lubrication regime was of full film type. With the ISO 10 grade, lubrication regime was supposed to be very near to that of mixed type. Variations in oil viscosity in roller bearings, caused by either the use of different oils or temperature variation, only affect the bearing vibration in HF band (600–10 000 Hz).A relationship between RMS vibration values in HF band and l factor was obtained, which was very similar to the standard Steinbeck curve, relating friction coefficient with l factor, found in the literature for system.
BALL BEARING
In these bearing steel balls are interposed between the moving element and fixed element. The purpose of a ball bearing is to reduce rotational friction and support radial and axial loads. It achieves this by using at least two races to contain the balls and transmit the loads through the balls as one of the bearing races rotates it causes the balls to rotate as well. Because the balls are rolling they have a much lower coefficient of friction than if two flat surfaces were sliding against each other [5]. Ball bearings tend to have lower load capacity for their size than other kinds of rolling-element bearings due to the smaller contact area between the balls and races. However, they can tolerate some misalignment of the inner and outer races [5].
a) Simple ball bearing
A ball bearing is a small ball, usually metal that is part of one type of bearing it is used to lessen friction between moving parts of a machine.
b) Deep groove ball bearing
Deep groove ball bearings have deep, uninterrupted raceway grooves. These raceway grooves have a close osculation with the balls, enabling the bearings to accommodate radial and axial loads in both directions. Deep groove ball bearings are the most widely used bearing type. Consequently, they are available from SKF in many designs, variants, series and sizes.
Rolling contact bearings
In rolling contact bearings, steel ball or rollers are interposed between the moving element and fixed element .in this bearings shaft or journal is supported rigidly inner race are which rolls over the rolling element. That balls or rollers these rolling elements in turn are supported by the outer race of the bearing.
Ball bearing materials
There are essentially two choices for the material used in ball bearings - chrome steel or stainless steel. Since the material plays a major part in the performance of a bearing in any given application, it is very important that the correct material is used. Note that the specified material applies to the load bearing components only - the rings and the balls. The retainer and the shields (if used) are usually made from a different material and are subject to separate specification.
a) Chrome steel: -
This is the standard material used for ball bearing applications where load capacity is the main consideration. The mach inability of this steel is excellent, giving smooth, low noise raceway finishes, together with superior life. Chrome steel material is recommended in applications where corrosion is not a factor.
LITERATURE REVIEW
Sujeet K. Sinha (2010) founds that In this paper, we introduce a new class of micro-ball bearing that can be applied between two Si surfaces in relative motion where wear is a problem. Wide channel was created on one Si plate for all the ball bearings to roll within this channel rather than in individual grooves. This type of microbearings can be applied as friction reducers to micro- and nano-machines. The tribometer set-up consisted of a top plate (Si wafer), which was connected to a conventional bearing. Tests on the plate with wide channel consistently exceeded 1 million cycles of rotation without failure of the bearing. The main factors affecting the life-cycle are identified as the presence of a wide channel, ball dispersion, and alignment of the Si plates [8]. Micro-ball bearing has been tested with balls rotating between two 15mmdiameter Si plates, with and without a channel on one of the plates.
In total, The surface bearings exhibit extremely low coefficient of friction due to rolling action. The rolling life-cycles exceeding 1 million is consistently obtained when the balls are rotated between two Si plates with one of the plates having a wide channel. Such a channel helps to keep all the balls within the boundaries giving low coefficient of friction throughout the run Tuncay Karacay (2010) founds Vibration measurements and signal analysis is widely used for condition monitoring of ball bearings as their vibration signature reveals important information about the defect development within them [10]. Time domain analysis of vibration signature such as peak-to-peak amplitude, root mean square, Crest factor and kurtosis indicates defects in ball bearings. However, these measures do not specify the position and/or nature of the defects. Each defect produces characteristic vibrations in ball bearings. Hence, examining the vibration spectrum may deliver information on the type of defects. In this paper a test rig is designed and a pair of brand new commercial ball bearings is installed. The bearings run throughout their lifespan under constant speed and loading conditions. Vibration signatures produced are recorded and statistical measures are calculated during the test. When anomalies are detected in the statistical measures, vibration spectra are obtained and examined to determine where the defect is on the running surfaces. At the end of the test, the ball bearings are disassembled in order to take microscopic photos of the defects [12]. Tiago Cousseau et al (2011) founds that thrust ball bearings lubricated with several different greases were tested on a modified Four-Ball Machine, where the Four-Ball arrangement was replaced by a bearing assembly. The friction torque and operating temperatures in a thrust ball bearing were measured during the tests. At the end of each test a grease sample was analyzed through ferrographic techniques in order to quantify and evaluate bearing wear [9]. The experimental results obtained showed that grease formulation had a very significant influence on friction torque and operating temperature. The friction torque depends on the viscosity of the grease base oil, on its nature (mineral, ester, PAO, etc.), on the coefficient of friction in full film conditions, but also on the interaction between grease thickener and base oil, which affected contact replenishment and contact starvation, and thus influenced the friction torque [13]. A qualitative analysis of the results suggests that the base oil properties and the interaction between base-oil and thickener are the predominant factors in the tribological behaviour of a grease lubricated thrust ball bearing. Chao Jin (2012) founds the operation of a machine tool (MT), the frictions in ball bearings entail sudden and violent heating of the balls which dominants its thermal deformation, and subsequently results in degradation of its accuracy and performance. Modeling of the heat generation in a bearing is a quite difficult job because of the constantly changing characteristics. In this paper, an analytical approach was proposed to calculate the heat generation rate of supporting bearing in a ball– screw system of the MT, with consideration of the operating conditions, such as rotation speed and external loads of the machine tool. The influences of operating conditions to internal load distribution, contact angles and heat generation rate of ball bearings were analyzed. The friction torque due to the applied load and the sliding torque within the contact area were discussed in detail. Experiments were carried out in a highspeed ball–screw system to verify the validity of the presented analytical method. The work described in this paper can be seen as a foundation for the accuracy thermal modeling and thermal dynamic analysis of the ball–screw system in the machine tools [8]. The aim of the paper was to study the heat generation rate of ball bearings with respect to rotational speed and load applied to a feed system. Also, this paper presents an analytical method to calculate heat generation rate of a ball bearing based on careful consideration of load distribution in the internal bearing elements, as well as the changing contact angles of both the inner and outer raceway contacts. Based on an iterative algorithm, it allows one to obtain very quickly the exact angles values to be used in further calculations. Contact forces, pressure, deformation and spin to roll ratios directly do depend on contact angles [6]. Tiago Cousseau et al (2012) found the friction torque and the operating temperatures in a thrust ball bearing were measured for seven different types of greases, including three biodegradable greases having low toxicity. These friction torque tests were performed using a modified Four-Ball machine Rheological evaluations of the lubricating greases were made using a remoter. Bleed oils were extracted from the greases and the dynamic viscosities were measured. In order to compare the performance of the lubricant greases in terms of friction, the grease characteristics were related to experimental results, showing that the interaction between thickener and base oil have strong influences in the bearing friction torque The viscosity of the bleed oil is higher than the viscosity of the base oil in the case of polypropylene thickened greases and the opposite was observed in the case of lithium thickened greases [14]. Carlos M.C.G. Fernandes (2013) Planetary gearboxes used in wind turbines very often have premature bearing and gear failures, some of them related to the lubricants used. Five fully formulated wind turbine gear oils with the same viscosity grade and different formulations were selected and their physical characterization was performed. The lubricant tribological behaviour in a thrust ball bearing was analyzed. A modified Four-Ball Machine was used to assemble the bearings. They were submitted to an axial load and the tests were performed at velocities ranging between 150 and 1500 rpm. Experimental results for the operating temperatures and for the internal friction torque are presented [4]. Above 500 rpm, the total friction torque inside the TBB decreased when the operating speed and temperature increased for the synthetic lubricants (ESTF, ESTR, PAGD and PAOR). The TBBs lubricated with high VI gear oils had an almost constant rolling friction torque for operating speeds equal or above 500 rpm. Above 300 rpm, the rolling torque of the TBB lubricated with mineral oil decreased as the operating speed increased.
CONCLUSION
In rolling bearings, contamination of lubricating oil by solid particles is one of the main reasons for premature bearing failure, So that the effect of lubricant contamination by solid particles on the dynamical behavior of rolling bearings. In order to determine the trends in the amounts of vibration affected by contamination in the oil and by the bearing wear is necessary. The effect of contaminant concentration on vibration was distinct from that of the particle size. The vibration level increased with concentration level, tending to stabilize in a limit. On the other hand, as the particle size increased, the vibration level first increased and then decreased. Particle settling effect was the probable factor for vibration level decrease. In this paper a review of literature has been made to study the effect of contamination on bearing performance.
ACKNOWLEDGMENTS
The authors wish to thanks to the head of the department of mechanical engineering, and also to the principal, Jabalpur Engineering College, Jabalpur [M.P.]. They provided a good laboratory with modern equipments and also created a good research environment in the institute.
Englishhttp://ijcrr.com/abstract.php?article_id=1293http://ijcrr.com/article_html.php?did=12931. Maru MM, Serrato-Castillo RS, Padovese LR., “Influence of oil contamination on vibration and wear in ball and roller bearings”. Ind Lubr Tribol (30): 2007.
2. MM.Maru,R.S.Castiallo,L.R.Padovese, “Study of solid contamination in ball bearing through vibration and wear analyses”, (2006).
3. R. Serrato, M.M. Maru, L.R. Padovese, “Effect of lubricant viscosity grade on mechanical vibration of roller bearings”, Tribology International 40 (2007) 1270– 1275.
4. SKF General Catalogue 6000 EN, November (2005).
5. CousseauT.,Grac-a B.,Campos A., SeabraJ. “Experimental measuring procedure forth friction torque in rolling bearings”. Lubrication Science, press, 2004 doi:10.1002/ls.115.
6. GoldP, SchmidtA, DickeH,LoosJ ,AssmannC. “Viscosity–pressure– temperature behaviour of mineral and synthetic oils”.Journal of Synthetic Lubrication 2001;18(1):51–79.
7. Hamrock BJ,DowsonD. “Ball bearing lubrication, the elastic hydrodynamics of elliptical contacts”.John WileyandSons; 1981.
8. Espejel G. “Using affrication models engineering tool”. Evolution SKF 2006; 06(2):27–30.
9. Qijun L., Shima M., Yamamoto T. and Sato J. “Fretting wear of ball bearing” (Part 4). Tribologists, 1995, 40(4), 1029–1037. 778
10. Maru MM, Serrato-Castillo R, Padovese LR. “Detection of solid contamination in rolling bearing operation through mechanical signature analysis”. Twelfth international congress on sound and vibration, 11–14 July 2005, Lisbon, Portugal.
11. Carver RE. “Procedures in sedimentary petrology”. New York: Wiley; 1971.
12. Serrato-Castillo R, Maru MM, Padovese LR. “Effect of lubricant oil viscosity and contamination on the mechanical signature of roller bearings”. Twelfth international congress on sound and vibration, 11–14 July 2005, Lisbon, Portugal.
13. Hampshire JM, Nash JV, Hollox GE. “Materials evaluation by flat washer testing. In: Hoo JJ, editor, Rolling contact fatigue testing of bearing steels ASTM STP 771”. American Society for Testing and Materials, 1982. p. 46–66.
14. Jonhston GB, Andersson T, Amerogen E, Voskamp A. “Experience of element and full-bearing testing of materials over several years”. In: Hoo JJ, editor, “Rolling contact fatigue testing of bearing steels, ASTM STP 771”. American Society for Testing and Materials, 1982.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28TechnologyEXPERIMENTAL INVESTIGATION OF PERFORMANCE AND EMISSION CHARACTERISTICS OF DIESEL ENGINE FUELED WITH LINSEED BIO DIESEL
English125133B. Madhava VarmaEnglish N. Ravi KumarEnglish G. PrasanthiEnglishIndustrialization, globalization & green revolution in agriculture have increased the demand for the petroleum products. Petroleum fuels release more emissions like CO, NOX, CH4 & CFC which are responsible for global warming & ozone layer depletion. Biodiesel is a less pollutant, biodegradable and renewable alternative fuel that can be used with little modifications. The objective of this study was to investigate the effect of the biodiesel produced from linseed oil on single cylinder diesel engine. Both performance and emission characteristics were studied in the range of one fourth load to full load at fixed compression ratio 16 . In the current research work biodiesel is prepared from linseed oil. The Experimentation was conducted on four stroke single cylinder diesel engine using linseed biodiesel and their performance and emission characteristics were studied. Results of performance & emission using linseed biodiesel were compared with that of diesel fuel.
EnglishINTRODUCTION
Energy is an essential and vital input for economic activity. Building a strong base of energy resources is a pre-requisite for the sustainable economic and social development of a country. Indiscriminate extraction and increased consumption of fossil fuels have led to the reduction in underground-based carbon resources and release harmful emissions which is the main reason for global warming and ozone layer depletion. The depletion of world’s nonrenewable resources provided the incentives to seek alternatives to conventional, petroleumbased fuel. Due to the shortage of petroleum products and its increasing cost, efforts are on to develop alternative fuels especially, to the diesel oil for full or partial replacement. It has been found that the vegetable oils are promising fuels because their properties are similar to that of diesel. It is remembered that vegetable oils could be used as fuel for diesel engines. Studies revealed the usage of straight vegetable oil (SVO) as fuel, causes the choking of injector nozzles, piston ring sticking, crank case oil dilution, lubrication oil contamination, and other problems. The problems could be solved using the chemically treated vegetable oils called as biodiesel. Biodiesel is a biodegradable, non-toxic, sulfur free renewable fuel, it can be produced from vegetable oils and animal fats. Higher viscosity, higher molecular weight and low volatility cause poor atomization leading to incomplete combustion result in several problems. The physical and chemical properties of straight vegetable oil can be improved by transesterification and reduction in viscosity may be achieved. In general, the vegetable oils are in the form of triglycerides which are converted into esters (Biodiesel). Thus the vegetable oils are chemically subjected to a process called transesterification, in which the oil is made to react with methanol or ethanol in the presence of a base catalyst such as sodium hydroxide or potassium hydroxide which yields biodiesel. India is net importer of vegetable oils, so edible oils cannot be used for production of biodiesel. India has the potential to be a leading world producer of biodiesel, as biodiesel can be sourced and produced from non-edible oils like Jatropha, Linseed, Pongamia Pinnata, Mahua, Castor, etc. These oils are not being properly utilized. Wastelands can be used to grow these plants by multiculture which reduces global warming as plants make food by photosynthesis in which they absorb CO2. The temperature of earth is increasing at an alarming rate due to green house gases like CO2, NOx ,CH4 & CFC which are produced by using fossil fuels.
Carbon dioxide’s share in global warming is 63%. The safe limit of CO2 in environment is 270 ppm. It was around 275 ppm before 1950 but after industrialization it is icreasing rapidly and now it is around 370 ppm which led to 1º C rise in earth’s temperature. If it continuous in the same manner, CO2 will be around 550 ppm by 2100 & earth’s temperature will be raised by 4º C which causes the ice at Greenlands & Himalayas to melt and increase the sea levels. This creates major threat for coastal areas and icelands. Linseed oil is a triglyceride. It is converted into ester using transesterification reaction. The reaction requires heat and a strong catalyst (alkalis, acids, or enzymes) to achieve complete conversion of the vegetable oil into the separated esters and glycerin. The reaction is shown in below.
In transesterification reaction the triglyceride molecule of the linseed oil reacts with methanol or ethanol in the presence of a catalyst such as sodium hydroxide (NaOH). The methanol used would react with the triglyceride molecule of the linseed oil and would result in an ester (biodiesel) and glycerin (by product).One molecule of linseed oil would require three molecules of alcohol and would result in an ester and a glycerin molecule. This reaction can also be called as base catalysed transesterification reaction as the reaction would take place in the presence of a base catalyst. Jagannath et al [1] conducted performance and emission analysis on CI engine operated on waste fried oil methyl esters. They found that at higher loads the thermal efficiency of biodiesel is slightly less than that of diesel, as viscosity, volatility, atomization characteristics are lesser for biodiesel. However emissions are reduced compared to diesel. N.R. Banapurmath et al [2] investigated the performance and emission characteristics of DI compression ignition engine using Jatropha oil. They observed that the smoke opacity of the biodiesel will be higher due to their heavier molecular structure, which leads to poor atomization. Also HC emissions would be a little higher due to lesser volatility and lesser atomization. They have observed that NOX emissions were higher for diesel operation compared to biodiesels. Heat release rates of biodiesels were lower during premixed combustion phase, which will lead to lower peak temperatures. Nitrogen oxides formation strongly depends on peak temperature . Mallikappa et al [3] investigated Performance and emission characteristics of double cylinder CI engine operated with cardanol bio fuel blends. They found that brake thermal efficiency increases with increase in load due to the fact that the heat losses got reduced. Ashish Jawalkar et al [4] investigated Performance and Emission Characteristics of Mahua and Linseed Biodiesel Operated at Varying Injection Pressures on CI
Engine. They concluded that at higher loads the emissions reduced as the blend percentage of linseed biodiesel is increased. It is due to the reason that biofuels are oxygenated fuels and undergo complete combustion. A.S. Ramadhas et al [5] conducted Performance and emission evaluation of a diesel engine fueled with methyl esters of rubber seed oil and found that the specific fuel consumption is higher for biodiesel, as the calorific value of biodiesel is lesser than that of diesel. It decreases with increase in load as at higher loads complete combustion takes place and thus lesser fuel is required to produce unit power. V. Dhana raju et al [6] have done experimental investigation of linseed and neem methyl esters as biodiesel on CI engine. They have found that that mechanical efficiency in case of Diesel with LME & NME blends is similar when compared to Diesel but a slight drop of thermal efficiency was found with methyl esters (bio-diesel) when compared with diesel. This drop in thermal efficiency must be attributed to the poor combustion characteristics of methyl esters due to high viscosity. D.Lingaraju et al [7] have conducted an experiment on Diesel engine with diesel, linseed biodiesel and its blends with diesel at different injection pressures. They have found that mechanical efficiency in case of Diesel with blends is similar when compared to Diesel but a slight drop of thermal efficiency was found with methyl esters (bio-diesel) when compared with diesel. This drop in thermal efficiency must be attributed to the poor combustion characteristics of methyl esters due to high viscosity. K.Purushothamana et al [8] investigated Performance, emission and combustion characteristics of a compression ignition engine operating on neat orange oil and observed that orange oil exhibits a longer ignition delay and higher combustion duration compared to diesel. The heat release rate is higher for orange oil than the diesel. The brake thermal efficiency is maximum at full load. HC and CO emissions are reduced for orange oil compared to those of diesel. Smoke emissions are reduced marginally for orange oil than the diesel fuel. NOx emissions are higher for orange oil than the diesel. N.L. Panwar et al [9] evaluated Performance characteristics of diesel engine fuelled with methyl ester of castor seed oil and they found that exhaust temperatures increase with increase of CME in blends and is higher than that with diesel for all blends at all loads. Also a corresponding increase in NOx emission is observed. This may be due to higher combustion chamber temperature, which in turn is indicated by the prevailing exhaust gas temperature. K. Sureshkumar et al [10] investigated Performance and exhaust emission characteristics of a CI engine fuelled with Pongamia pinnata methyl ester (PPME) and its blends with diesel and found that CO2 emission increased with increase in load for all blends. The lower percentage of PPME blends emits less amount of CO2 in comparison with diesel. This is due to the fact that biodiesel in general is a low carbon fuel and has a lower elemental carbon to hydrogen ratio than diesel fuel. At higher loads, higher biodiesel (PPME) content blends emit CO2 at par with fossil diesel, in general biodiesels themselves are considered carbon neutral because, all the CO2 released during combustion had been sequestered from the atmosphere for the growth of the vegetable oil crops. Wagner et al.[11] conducted 200 h engine tests with soybean oil ester fuel on John Deere (4239T Model) engine. It was reported that the engine performance with methyl, ethyl and butyl esters was nearly same as with diesel fuel. There was no difference in thermal efficiency resulting from use of the various fuels to power the engine. The esters showed slight power loss and increased fuel consumption, which was attributed to the lower gross heating values.
PREPARATION OF LINSEED BIODIESEL
Raw vegetable oils requires certain modifications of their properties like viscosity and density before using in IC Engines. Transesterification is a process in which viscosity & density of oil can be reduced. In the transesterification of vegetable oils, a triglyceride reacts with alcohol in the presence of either acid or base catalyst to produce a mixture of fatty acid alkyl ester and glycerol. In this process Linseed oil is made to react with methanol in the presence of base catalyst(NaOH). The biodiesel is obtained from Linseed oil in the following way.
1. A 1000 ml sample of raw linseed oil is taken and is filtered and heated upto 100oC to remove water.
2. When the temperature of the oil reaches to a range of 50 - 60° C, add 120 ml of methanol and heat the oil on a magnetic stirrer for 5 more minutes and then add 3 ml of sulphuric acid (H2SO4).
3. After heating the solution for 1.5 hrs at the temperature range 50-60 °C, heating is stopped and the solution is allowed to separate into glycerin and methylester where the glycerin is settled at the bottom.
4. The settled glycerin is drained out and then oil is again purified using cotton and then base treatment is started.
5. The sample from the acid treatment is again kept for heating on a magnetic stirrer and waits till the temperature reaches to a range of 50 - 60° C. Then
6. Meanwhile methoxide solution is prepared by adding 200 ml of methanol with 5 gm of NaOH. Methoxide is added to the oil sample and heated on magnetic stirrer for 1.5 hrs at constant temperature in the range of 50-60° C.
7. After the sample, containing methoxide is heated for 1.5 hr. The sample is poured into a separating funnel.
8. Settling time of minimum 1.5 hr or more is given for the formation of glycerin left in the sample after the acid treatment and other free fatty acids which settles to the bottom of the separating funnel.
9. Then water wash is carried out in order to remove any excess glycerin or acids added during acid treatment. In this process 600 ml of water and 3 ml of phosphoric acid is added to 1000 ml of oil.
10. The oil is mixed with warter lightly and then allowed to settle in a separating funnel.
11. The water is removed and the process is repeated three times to ensure the glycerin is removed completely.
12. Finally the oil is heated to 100°C to remove any water present in the oil.
EXPERIMENTAL SETUP
The experimental setup consists of 4 stroke, single cylinder, water cooled, direct injection, vertical diesel engine on which the oil was tested. The specifications of the engine are given in table 1. A Schematic of the experimental arrangement is shown in Figure 2. Air flow was determined using air box method by measuring the pressure drop across a sharp edge orifice of the air surge chamber with the help of a manometer. The diesel flow was measured by noting the time taken for 5 cc fuel consumption. The speed of the engine was measured by help of digital tachometer. The loading is applied on the engine using eddy current dynamometer. The exhaust gas constituents HC, CO, CO2, NOx, O2 are measured using AVL DiGas 444 gas analyzer and smoke opacity was measured using AVL 437C smoke meter.
PROPERTIES OF THE BIO-DIESEL
The properties of linseed oil biodiesel were found in the fuels laboratory. The results obtained are shown in Table 2
RESULTS AND DISCUSSION
In this section we investigate the performance and emission characteristics of a high speed diesel engine at various loads from one fourth load to full load fuelled with linseed biodiesel and compared with standard diesel.
Brake Specific Fuel Consumption
Figure 3 shows the variation of specific fuel consumption with load. It is found that as load increases the brake specific fuel consumption decreases for both diesel & linsed biodiesel. This is due to the reason that at higher loads complete combustion tends to take place, thus lesser amount of fuel is required to deliver unit power. Thus bsfc decreases with increase in load. When we compare diesel and biodiesel, the specific fuel consumption is higher for biodiesel, as it has lesser calorific value than that of diesel. At part loads the increase in specific fuel consumption is 22.15% but as the load increases this value decreases and reached to 3.66% at full load.
Mechanical Efficiency
Figure 4 shows the variation of mechanical efficiency with load. It is observed from the figure that mechanical efficiency is increasing with respect to load for both biodiesel & diesel. It is clear that at any load the mechanical efficiency of diesel is higher than that of linseed oil. At part loads the increase in mechanical efficiency 16.3% but as the load increases this value decreases and reached to 8.55% at full load.
Brake thermal Efficiency
Figure 5 shows the variation of brake thermal efficiency with load. It is found that with increase in load the brake thermal efficiency is also increasing for both diesel & linseed biodiesel. It is observed that at any load condition the brake thermal efficiency of diesel is greater than that of linseed biodiesel except at full load. At part load conditions the percentage increase in brake thermal efficiency is 9.5% and it is decresing upto three fouth load and again increasing to 7.8% at full load.
Oxides of Nitrogen
Oxides of nitrogen are the important emission in diesel engines. The oxides of nitrogen in the emissions contain nitric oxide (NO) and nitrogen dioxide (NO2). The formation of NOx is highly dependent on in-cylinder temperature and oxygen concentration. Figure 6 shows the variation of oxides of nitrogen with load. It is observed that at part loads NOx emission is higher for diesel and at three fourth & full load NOx emission is higher for linseed biodiesel. Smoke Smoke is nothing but solid soot particles suspended in exhaust gas. Figure 7 shows the variation of smoke with load. Smoke opacity varies from 85.8 HSU to 79.9 HSU for diesel operation and from 96.1HSU to 94.8 HSU for linseed biodiesel. It is observed that the smoke level for soybean biodiesel is lower than diesel at part load and full loads. The reason for the reduced smoke is the availability of premixed and homogeneous charge inside the engine well before the start of combustion. Higher combustion temperature, extended time of combustion and rapid flame propagation are the other reasons for reduced smoke Carbon Dioxide Figure 8 shows the variation of CO2 with load. It is observed that at any load emission of CO2 is higher for linseed biodiesel when compared to diesel. It is due to more availability of oxygen in case of biodiesel. It is observed that emission of CO2 is increasing initially with respect to load and decreasing gradually and reaches to minimum at full load for both diesel & biodiesel. The minimum values of CO2 at full load for both diesel & bioiesel are 1.2 % vol & 2.4 % vol.
Hydro Carbons
Figure 9 shows the variation of HC with respect to load. The emission of HC’s are increasing initially upto half load and the gradually decreasing when it reaches to full load for both diesel & linseed biodiesel. It is observed that HC emission at full load is almost same for both diesel & biodiesel.
CONCLUSIONS
conclusions are drawn from the experimentation are as follows
Linseed Biodiesel showed high brake specific fuel consumption than that of diesel for same power developed due to its lower calorific value
Brake thermal efficiency of diesel is greater than that of linseed biodiesel except at full load
At any load, mechanical efficiency of diesel is higher than that of linseed oil. At part loads the increase in mechanical efficiency is 16.3% but as the load increases this value decreases and reached to 8.55% at full load.
It is observed that at part loads NOx emission is higher for diesel and at three fourth & full loads NOx emission is higher for linseed biodiesel.
It is observed that the smoke level for linseed biodiesel is lower than that of diesel for all loads.
At any load emission of CO2 is higher for linseed biodiesel when compared to diesel.
The emission of HC’s are increasing initially upto half load and then gradually decreasing when it reaches to full load for both diesel & linseed biodiesel.
Nomenclature
NME neem methyl ester
LME linseed methyl ester
CO2 carbon dioxide
CO carbon monoxide
HC hydro carbon
NOx oxides of nitrogen
CO2 carbon dioxide
HSU Hatridge smoke unit
BTDC before top dead centre
CR compression ratio
CFC chlorofloro carbon
CI compression ignition
ACKNOWLEDGEMENT
The authors are thankful to the All India Council for Technical Education (AICTE), New Delhi for their financial support under RPS scheme vide project grant by 8023/RID/RPS/041/11/12. 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=1294http://ijcrr.com/article_html.php?did=12941. Jagannath Balasaheb Hirkude, Atul S. Padalkar “Performa ce and emission analysis of a compression ignition, P.G. Tewari, R.S. Hosmath “Performance and emission engine operated on waste fried oil methyl esters” Applied Energy Journal 90 (2012) 68–72.
2. N.R. Bannapurmath characteristics of a DI compression ignition engine operated on Honge, Jatropha and sesame oil methyl esters”, Renewable Energy 33 (2008) 1982– 1988.
3. Mallikappa D.N.a, Rana Pratap Reddy, Ch.S.N. Murthy “Performance and emission characteristics of double cylinder CI engine operated with cardanol bio fuel blends” Journal Renewable Energy 38 (2012) 150.
4. Ashish Jawalkar, Kalyan Mahantesh, M Jagadish, Madhusudhan Merawade, M C Navindgi “Performance and Emission Characteristics of Mahua and Linseed Biodiesel Operated at Varying Injection Pressures on CI Engine
5. A.S. Ramadhas”, International Journal of Modern Engineering Research (IJMER) Vol.2, Issue.3, May-June 2012., C. Muraleedharan, S. Jayaraj “Performance and emission evaluation of a diesel engine fueled with methyl esters of rubber seed oil” Renewable Energy 30 (2005) 1789–1800.
6. V.Dhana raju and P.Ravindra kumar “Experimental investigation of linseed and neem methyl esters as biodiesel on CI engine” International Journal of Engineering Science and Technology.
7. D.Lingaraju, S.Chiranjeeva Rao, V.Joshua Jaya Prasad, A.V.Sita Rama Raju.“Fuelling diesel engine with diesel, linseed derived biodiesel and its blends at different injection pressures: performance studies” IJMIE Volume 2, Issue 7
8. K.Purushothamana, G. Nagarajan “Performance, emission and combustion characteristics of a compression ignition engine operating on neat orange oil” Renewable Energy 34 (2009) 242–245.
9. N.L. Panwar, Hemant Y. Shrirame, N.S. Rathore, Sudhakar Jindal, A.K. Kurchania “Performance evaluation of a diesel engine fuelled with methyl ester of castor seed oil” Applied Thermal Engineering 30 (2010) 245–249.
10. K. Sureshkumar, R. Velraj, R. Ganesan “Performance and exhaust emission characteristics of a CI engine fuelled with Pongamia pinnata methyl ester (PPME) and its blends with diesel” enewable Energy 33 (2008) 2294–2302
11. Wagner LE, Clark SJ, Scrock MD. Effects of soybean oil esters on the performance, lubricating oil and wear of diesel engines. Paper No. 841385, SAE; 1984.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28TechnologyFUNCTION PREDICTION USING CLUSTER ANALYSIS OF UNANNOTATED ALIGN SEQUENCES
English134145Anjan Kumar PayraEnglishProteins are responsible for nearly every task of cellular life, including cell shape and inner organization, product manufacture and waste cleanup, and routine maintenance. Proteins also receive signals from outside the cell and mobilize intracellular response. Experimental procedures for protein function prediction are inherently low throughput and are thus unable to annotate a non-trivial fraction of proteins that are becoming available due to rapid advances in genome sequencing technology [15]. This has motivated the development of computational techniques that utilize a variety of high-throughput experimental data for protein function prediction. So, there is need to design algorithm to find similar functional proteomic sequence from large set of sequence database. Here we present a novel unsupervised method, called Function Finder (in short F-Func) for identification function of unannotated proteomic sequence. F-Func uses clustering of sequence information represented by numerical features, performing filtering, assigned score and meet with the criterion produces decision. Using help of producing result estimate success rate of F-Func method. Estimated success rate of F-Func methods, which is almost 70%.
EnglishSequence, Homology, motif, F-Func, Prediction, Cluster.INTRODUCTION
Proteins are macromolecules that serve as building blocks and functional components of a cell, Proteins are responsible for some of the most important functions in an organism. Such categorization of the types of functions a protein can perform has been suggested by Bork [1] et al. [1998]:
Molecular function: The biochemical functions performed by a protein, such as ligand binding, catalysis of biochemical reactions and conformational changes.
Cellular function: Many proteins come together to perform complex physiological functions, such as operation of metabolic pathways and signal transduction.
Phenotypic function: The integration of the physiological subsystems, consisting of various proteins performing their cellular functions, and the interaction qof this integrated system.
In order to predict function we need to study amino acid sequence, where concept of central dogma is crucial. The central dogma [2] of molecular biology is the conversion of a gene to protein via the transcription and translation phases as shown in Fig. 1. The result of this process is a sequence constructed from twenty amino acids, and is known as the protein’s primary structure. This sequence is the most fundamental form of information available about the protein since it determines different characteristics of the protein.
Here using data sequences are closely related with protein phosphorylation, mediated via a group of enzymes (called kinases) that performs addition of phosphate (PO4) group usually to serine (S), threonine (T), tyrosine (Y) residues, is one of the most frequent forms of posttranslational modification mechanism [3]. Function of a gene or protein can predicted using different approaches .Those are given below – ? Homology-based Function Prediction : Homologous genes or proteins are derived from a common ancestral sequence, as given in Fig. 2, where always searching for same constituent. Homologous proteins within or among species are similar in sequence and are likely, but not guaranteed to have a similar function. Comparison of an un-annotated sequence to known homologous sequences is therefore a good starting point for predicting function. Generally, a new sequence could be used to query protein databases using BLAST, to find proteins of known function with high sequence similarity, and their function is transferred to the query sequence.
Several approach have proposed a multi-step strategy for functional annotation based on clustering of protein sequences according to their similarities [Xie et al. 2002; Abascal and Valencia 2003; Sasson et al. 2006]. Figure. 3 show the flowchart of the basic strategy adopted in these two studies. The algorithm starts with the construction of the similarity matrix that stores the BLAST similarity values between the protein sequences in the original training set [15]. This matrix is then used to cluster these sequences, and the annotation of a sequence in these approaches depends not on individual homologous sequences but a cluster composed of many such sequences.
Function Prediction Using Sequence Motifs : Motifs are defined as sub-sequences which are conserved across a set of protein sequences belonging to a family [Bork and Koonin 1996]. Owing to their conservation property, they are candidates for functional sites in proteins, such as sites for ligand binding, DNA binding and interactions with other proteins, and thus are useful as clues for predicting the function of a protein [Bork and Koonin 1996; Huang and Brutlag[2001].
Motif databases such as PROSITE ('database of protein domains, families and functional sites') can be searched using a query sequence as given in Fig. 4. Motifs can, for example, be used to predict sub cellular localization of a protein (where in the cell the protein is sent after synthesis). ? Structure-based Function Prediction: 3D protein structure is generally better conserved than protein sequence, structural similarity is a good indicator of similar function in two or more proteins. Many programs have been developed to screen an unknown protein structure against the Protein Data Bank. The prediction of function from structure, and the ways these perspectives have been formulated in various approaches
Genomic Context-based Function Prediction: The protein function prediction are not based on comparison of sequence or structure as above, but on some type of correlation between novel genes/proteins and those that already have annotations. Also known as phylogenetic profile, these genomic context based methods are based on the observation that two or more proteins with the same pattern of presence or absence in many different genomes most likely have a functional link. Whereas homology-based methods can often be used to identify molecular functions of a protein, context-based approaches can be used to predict cellular function, or the biological process in which a protein acts [15]. For example, proteins involved in the same signal transduction pathway are likely to share a genomic context across all species, as given in Fig. 6.
Protein interaction networks and protein complexes: A protein almost never performs its function in isolation. Rather, it usually interacts with other proteins in order to accomplish a certain function. At the highest level, they can be categorized into genetic and physical interactions. Genetic interactions occur when the mutations in one gene cause modifications in the behavior of another gene, which implies that these interactions are only conceptual and do not occur physically in a genome. Of particular interest in our project are the physical interactions between proteins, since they are more directly related to the process through which a protein accomplishes its functions [15]. The interactions can be structured to form a network, and hence the name protein interaction networks as shown in Fig. 7 and Fig. 8.
Present growth of the protein sequence and structure databases, there remains only a small fraction of proteins whose functions have been experimentally characterized. It is sometimes possible to infer the function of uncharacterized proteins by comparison to the sequences or structures of functionally annotated homolog. Common descent does not necessarily imply functional similarity, however (Hegyi and Gerstein 1999[4] ; Devos and Valencia 2000 [5]; Todd et al. 2001[6]) and functional annotation transferred from one homologous protein to another. Several investigators have considered the problem of functional site prediction using multiple sequence alignments (Casari et al. 1995[7]; Andrade et al. 1997[8]; Hannenhalli and Russell 2000; Li et al. 2003).Casari et al. (1995), applied principal component analysis to a vector representation of protein sequences in a multidimensional ?sequence space,? to derive subfamily-specific residues involved in protein function. Andrade et al. (1997) proposed a rigorous clustering algorithm based on a self-organizing map as a means to identify protein subfamilies and retrieve characteristic sequence patterns. Some methods of functional site prediction use phylogenetic analysis to identify residues associated with functional divergence (Lichtarge et al. 1996[9]; Sjolander 1998[10]; Aloy et al. 001[11]; Madabushi et al. 2002[12]). PRESENT WORK Motivation: Many approaches have been discussed in the previous section over sequence. After studying and going through various papers it can be analyzed that very few assessments had been pursued on clustering this analyzation has encouraged us to work it. I am using homology based similarity to create different clusters to predict functional group of unannotated sequences in F-Func methods. Database and Tools: Data has been collected only serine –phophorylated peptides of length 13 (i.e., 13-mers centered at serine) from the Phospho.ELM database, which are experimentally determined to be substrates of different kinases. Motif –X [13] and F-motif [14] are used for analyzing my algorithms, which are given in next section. Propose Method To predict function of an unannotated sequence using F-Func, we divide three major portions. First phase is to form clusters based on matching criteria. Next two are different approaches to predict. Algorithm: Cluster formation Step1: Consider sequence (Seqi) ={S1,S2,…..Sn}, n≤ 25000. Step 2: Eliminate all repetitions from Seqi and obtained non repeated sequence ( Seqi). Step 3: Consider central (j=6) residue element (……S……) of a sequence of length 13. Extract left pattern (L(Seqij),i≤n, 0≤ j ≤5 ) and right pattern(R(Seqij),i≤n, 7≤ j ≤13 ) for each Seqi. Step 4: Comparing the Seqi with left pattern and generate left cluster (LCP ,p
Step 5: Select random sequence from LCP∩ RCq and consider it as unannotated sequence (Sequn). After cluster formation, our objective is to predict functions of unannotated sequences logically or mathematically, which should be new and well justified. Here, I will discuss two approaches of predicting sequences. 1st approach is given belowAlgorithm: Assigned functional group to unannotated sequence (Sequn) using mean value calculation. Step 1: Consider one of the cluster from collection of clusters (LCP or RCq ) and select sequences from it. Count the number (N0) of sequences for selected cluster. Step 2: Count maximum occurrence (Scount) of a constitutes (eg. S, G, R, P, A etc) present in the sequences of respectively clusters. Step 3: Estimate mean (M) value - . The value of M is assigned as score of the corresponding cluster. Step 4: Repeat the step 1 to 3 till there no cluster is left. LCP € Ø, RCq€ Ø. Step 5: Merge two clusters if selected constitutes (eg. S) and score values are same for both. Step 6: Select a sequence (Si) from Sequn. Estimate occurrence of constitutes in it. Assigned the maximum value to Emax . If Si can’t find suitable clusters to estimate distance for Emax and constitutes, than select next maximum occurrence of constitutes for Si and continue. Step 7: Calculate distance of Si from clustersStep 8: Sequentially Si is more nearer to the cluster with minimum value. Si is more functionally related with the cluster. The sequence Si is placed and function is assigned of the respective cluster. Step 9: Finally, estimate success rate of prediction. Through multiple sequence alignments, patterns of characteristic residues may emerge. Above algorithm is based on basic paradigms Homology. Here basic principal is -
Success rate is always crucial while predicting functional group of a sequence. Here, key in my approach is principal. 2 nd approach is quite similar with 1st approach, it will provide more accurate result as compare previous one. The approach is given belowAlgorithm: Assigned functional group to unannotated sequence (Sequn) using max value calculation of sequence constituents. Step 1: Consider one of the cluster from collection of clusters (LCP or RCq ) and select sequences from it. Count the number (N0) of sequences for selected cluster. Step 2: Count maximum occurrence (Scount) of a constitutes (eg. S, G, R, P, A etc) present in the sequences of respectively clusters. Step 3: Estimate max (CM) constitutes value to assign score of a cluster. [eg. Cluster (N) contains S=8, G=3,R=2.Then CM =8 for S of Cluster(N)] Step 4: Repeat the step 1 to 3 till there no cluster is left. LCP € Ø, RCq€ Ø. Step 5: Merge two clusters if selected constitute (eg. S) and score values are same for both. Step 6: Select a sequence (Si) from Sequn .Estimate occurrence of constitutes in it. Assigned the maximum value to Emax . If Si can’t find suitable clusters to estimate distance for Emax and constitutes, than select next maximum occurrence of constitutes for Si and continue. Step 7: Calculate distance of Si from clusters Step 8: Sequentially Si is more nearer to the cluster with minimum value. Si is more functionally related with the cluster. The sequence Si is placed and function is assigned of the respective cluster.
Step 9: Finally, estimate success rate of prediction. Illustration using example Algorithms of F-Func are applied over prealigned data set of length 13 mers. So, here obtain motif using F-motif [13] and motif-X [14] tools, generate web logo, which is given.
Illustration using example:
Algorithms of F-Func are applied over prealigned data set of length 13 mers. So, here obtain motif using F-motif [13] and motif-X [14] tools, generate web logo, which is given in Fig. 9. Cluster formation, assign scores to the clusters using above
given algorithms are given below. Depending on left and right match sequence form left and right clusters assigned scores using mean and max value calculation. In tabular format, it is given in table 1
After assigned score values to clusters, next select sequence from intersection of left and right cluster randomly and treated it as unannotated sequence. Considering an unannotated sequence to predict functional group, count max occurrence of constituent and assign as a score of the sequence. Estimate distance values (dj ) from all clusters (LCP and RCq ) using above given algorithms. It is given below in Fig. 10. Unannotated sequence will assign by the functional group of the cluster whose distance value is minimum.
Proposed algorithms of F-Func are applied to predict functional groups of unannoated sequences. The results are given in tabular format as table 2. It is concluded to results that, Max approach produces better outcomes as compare Mean approach. It is represented graphically in Fig.12.
CONCLUSION
It is quite clear that, using homology we can predict unannoated sequences successfully. Even success rate can be more than 70% as per my algorithms. Hopefully F-Func algorithms will provide better results for larger dataset. My proposed work adds a dimension to existing methods. Hopefully, performance of the F-Func algorithms will increase if length of left-match and right-match is increased.
ACKNOWLEDGEMENT
It is great help received from the scholars whose articles cited and included in references of this manuscript. I am 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. Hence, I am grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped me to bring quality to this
Englishhttp://ijcrr.com/abstract.php?article_id=1295http://ijcrr.com/article_html.php?did=12951. Bork, P. and Koonin, E.V. 1998. Predicting functions from protein sequences—Where are the bottlenecks? Nat. Genet. 18 313–318.
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3. Cheng, Chung, Aguan, Yang, Wang, N.Paul, PLoS ONE,2011, Dicovery of protein Phosphorylation Motif through Exploratory Data analysis.
4. Anna R. Panchenko, Fyodor Kondrashov, and Stephen Bryant - Prediction of functional sites by analysis of sequence and structure conservation, 2004Devos, D. and Valencia, A. 2000. Practical limits of function prediction. Proteins 41 98–107.
5. Todd, A.E., Orengo, C.A., and Thornton, J.M. 2001. Evolution of function in protein superfamilies, from a structural perspective. J. Mol. Biol. 307 1113–1143.
6. Casari, G., Sander, C., and Valencia, A. 1995. A method to predict functional residues in proteins. Nat. Struct. Biol. 2 171–178.
7. Andrade, M.A., Casari, G., Sander, C., and Valencia, A. 1997. Classification of protein families and detection of the determinant residues with an improved self-organizing map. Biol. Cybern. 76 441–450.
8. Lichtarge, O., Bourne, H.R., and Cohen, F.E. 1996. An evolutionary trace method defines binding surfaces common to protein families. J. Mol. Biol. 257 342–358.
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10. Aloy, P., Querol, E., Aviles, F.X., and Sternberg, M.J. 2001. Automated structure-based prediction of functional sites in proteins: Applications to assessing the validity of inheriting protein function from homology in genome annotation and to protein docking. J. Mol. Biol. 311 395–408.
11. Madabushi, S., Yao, H., Marsh, M., Kristensen, D.M., Philippi, A., Sowa, M.E., and Lichtarge, O. 2002. Structural clusters of evolutionary trace residues are statistically significant and common in proteins. J. Mol. Biol. 316 139–154.
12. http://motif-x.med.harvard.edu/motif-x.htm
13. http://f-motif.classcloud.org 14. “Computational Approaches for Protein Function Prediction: A Survey?- Gaurav Pandey, Vipin Kumar and Michael Steinbach
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241512EnglishN2013June28TechnologyESTIMATION OF NOISE FIGURE USING GFF WITH HYBRID QUAD PUMPING
English146153V.R. PrakashEnglish Himanshu ShekharEnglish Kumara Guru Diderot P.EnglishThis Paper describes the models and simulation of EDFA(Erbium Doped Fiber Amplifier) with optimized Gain and that has been flattened using GFF(Gain flattening Filter) with reduced noise figure using Hybrid Quad Pumping with the wavelengths 980nm and 1480nm oppositely cascaded (Co directional pumping and counter directional pumping) architectures a nd compares the results with EDFA with dual pumping techniques. In DWDM networks EDFA’S are an imperative element and are regarded as a cost effective replacement of classical optoelectronic regenerative repeaters EDFA plays an important role in improvement of performance of optical fiber transmission systems. The proposed model consists of Input source, pumping sources with the wavelengths 980nm, 1480nm connected cascade in opposite sides and Isolator. The Erbium doped fibre amplifier’s gain which appears in the signal to noise ratio expression is computed from the simulation. The resulting models accurately represent EDFA flattened gain dynamics and reduced noise figure. Simulation results EDFA with Hybrid quad pumping model1 with first stage of the wavelengths 980nm twice times and in the second stage 1480nm twice a times show a flattened maximum gain of 5.4DB and noise figure of 7.6 db and EDFA with Hybrid quad pumping model2 with first stage of the wavelengths 980nm and 1480nm and in the second stage 1480nm and 980nm show a flattened maximum gain of 5.3 DB and noise figure of 8.4db. This is applicable in Network reconfiguration and Multi -vendor networks and also addition new services and wavelengths.
EnglishEDFA, Quad Pumping, Isolator, WDM, Gain, Optical communications and Optical fiber Amplifiers, Gain flattening filterINTRODUCTION
Now days, Internet services require large bandwidth, so EDFA’s are used in WDM Technology which increases the optical network capacity without affecting the cost [1]. EDFA finds its applications in optical networks and are used as pre-, line- and power amplifiers giving multi channel amplification with insignificant cross talks. In the ordinary EDFA the optimum Gain efficiency is always accompanied by a compromise in noise figure to a value well above the quantum limit [2]. Hence in our work we are providing EDFA’s with wide and Flat Gain spectrums as well as reducing the Noise figure nearly by half. A wavelength far from the emission peak around 1530nm has to improve the amplification characteristics of the L- band and C-band EDFA. An important issue is the selection of a proper pump wavelength or a suitable pumping configuration. The pump wavelength dependence of the amplification characteristics of the EDFA has been reported mainly in 800-, 980-, and 1480-nm bands and now the 980- and 1480-nm bands, are mostly used for the L- band and C- band EDFA’s. A typical Fixed Gain EDFA contains a length of Erbium Doped Fiber (EDF), followed by a Gain Flattening Filter (GFF). The amplifier is operated such that the EDF provides a fixed amount of Gain, while the GFF is designed to have a spectral attenuation profile that exactly compensates for the spectral gain profile of the EDF. In this way the spectrum at the output of the EDFA is flattened [3]. If the amplifier is operated at another gain, the GFF will not exactly compensate the gain profile of the EDF, and the output of the amplifier will no longer remain flattened. However, for a given length of EDF the gain profile can change drastically as a function of gain, to compensate for such a high gain tilt the GFF would need to attenuate the higher gain wavelengths by a very large amount, thus making the amplifier very inefficient. A relatively high-powered beam of light is mixed with the input signal using a wavelength selective coupler. The input signal and the excitation light must of course be at significantly different wavelengths. The mixed light is guided into a section of fiber with erbium ions included in the core. This high-powered light beam excites the erbium ions to their higher-energy state. When the photons belonging to the signal at a different wavelength from the pump light meet the excited erbium atoms, the erbium atoms give up some of their energy to the signal and return to their lower-energy state. A significant point is that the erbium gives up its energy in the form of additional photons which are exactly in the same phase and direction as the signal being amplified. So the signal is amplified along its direction of travel only. This is not unusual - when an atom “lases” it always gives up its energy in the same direction and phase as the incoming light. That is just the way lasers work. Thus all of the additional signal power is guided in the same fiber mode as the incoming signal. There is usually an isolator placed at the output to prevent reflections returning from the attached fiber. Such reflections disrupt amplifier operation and in the extreme case can cause the amplifier to become a laser. Figure 1. Shows the EDFA with dual pumping using the wavelengths 980-nm in both sides of EDFA as a first model and 1480-nm in both the sides of EDFA as a second model and 980- nm in one side of EDFA and 1480-nm in other side as third model like three models has been computed and simulated and analyzed the performance with the parameters of Gain and Noise figure of Dual Pumping EDFA and also compared with the results of Proposed Hybrid Quad Pumping EDFA models. The block diagram consists of input Source, Isolator, EDFA, WDM, Pumping sources and Isolator allows only forward propagation for that there is no reflected signal. In the Proposed Hybrid Quad pumping technique gives optimized gain has been flattened with reduced noise figure and is compared to Dual Pumping EDFA, the gain has been flattened with the same value of noise figure.
The paper is organized into six sections. In section II Background of this work, while section III presents the methodology and the proposed work Section IV demonstrates the model Simulation details. Section V presents the results and discussions. Finally, the paper is concluded in section VI.
BACKGROUND
In the late 80’s Erbium Doped Fiber Amplifiers (EDFA) have been a target of several improvements. In optical Networks, using EDFA’s it is possible to extend transmission distances and the capacity. The paper [1] proposed a highly reliable approach to EDFA gain and output power control and a power monitoring scheme for fault detection in WDM Networks. These techniques employ a power stabilized control channel, the EDFA gain and output power are controlled by monitoring it. This paper [2] demonstrated and tested a new configuration of EDFA, which enables to efficiently amplify high and low power level signals. The small signal gain is improved by more than 5 dB with the double pass configuration. This paper [3] presents a composite EDFA configuration which incorporates an optical isolator and investigated highly efficient amplifier configurations with high total gain and narrow ASE spectrum. This paper [4] proposed an EDFA pumped in the 660nm and 820nm bands wavelength and increased the signal power and gain. This paper [5] presents amplifier’s gain and power noise which appear in the signal to noise ratio expression, are computed in terms of the internal parameters from simulations and are shown to contribute to its improvement. This paper discusses [6] a new approach for a hybrid gain controlled EDFA based on a complementary actuation of the optical and electronic gain control technique with suppressed transients. The result shows a maximum of 0.6 dB deviation from the set EDFA gain value. This paper [7] without noise figure degradation of L-Band EDFA with 1480 nm discusses power conversion efficiency and improvement without noise figure degradation.
METHODOLOGY
In this work, we proposed the two models of EDFA with Hybrid Quad Pumping using different wavelengths, simulated the models and also compared the results with Dual pumping model and Hybrid quad pumping models using EDFA and WDM blocks and a high performance approach is presented that has not been used in this manner before for such design. Erbium doped fiber amplifiers (EDFA) employed in Wavelength Division Multiplexing (WDM) systems have been shown to incur system impairment due to transient flattened gain with reduced noise.
Applied Methodology
The applied methodology is based on an Opposite Cascade approach. Each block in the architecture was added in t h e model a nd tested a n d l a t e r t h os e b l o c k s w e r e assembled and were added to compose the complete system and then simulated and tabulated the parameter values. Proposed Work Figure 2 shows the General block diagram of Hybrid Quad Pumping. It consists of Input Source, Isolator, Each EDFA of length 10m, WDM (Wavelength division Multiplexer) and Filter. 1 st Proposed model is similar to the General Block diagram except the EDFA using Hybrid Quad Pumping with the wavelengths 980-nm twice a times (in Co directional) and 1480-nm twice a times (in Counter directional). Similar to 1 st model, in the 2 nd Proposed model the EDFA is also using Hybrid Quad Pumping with the wavelengths 980-nm and 1480-nm (in Co directional) and 1480-nm and 980-nm (in Counter directional). A wavelength-division-multiplexing (WDM) technique combined with erbium-doped fiber amplifier (EDFA) is essential for realizing high capacity light wave transmission and flexible optical networks. Compared with Unidirectional transmission, bidirectional transmission over a single fiber has the advantage of reducing not only the number of fiber link, but also the number of passive components such as splitters and WDM multiplexers. Recently, lots of problems in bidirectional EDFAs were investigated, and various structure schemes of the EDFA were reported to overcome the problems, such as back reflections [3] An automatic gain control (AGC) function for bidirectional EDFAs, however, has been rarely reported[4]. This method has the advantage of providing optical fiber with few Erbium clusters because the Er is uniformly doped into silica soot perform in a vapor phase atmosphere. In order to attain highly efficient EDFA’s, the three key factors outlined below must be considered. The first is the Erbium concentration effect on Erbium cluster generation in silica- based glass. It has already been confirmed that an increase in Erbium concentration causes deterioration in amplification efficiency [4]. In the block diagram, we are using an optical source with multiple channels (1520-nm to 1618-nm) whose output is given to the isolator. The isolator allows only the forward propagation restricting the reverse propagation. Further the output of the isolator and the first pumping source (codirectional) has been multiplexed using WDM technique. This multiplexed signal is given to the first EDFA where the signal is amplified to improve the gain characteristics. Again the output is multiplexed with the second pumping source (co-directional), which is then amplified by the second EDFA. The amplified output is given to WDM to combine with third pumping source in counter directional and again given to Third EDFA to increase gain and then given WDM to combine with Last pumping source (Counter directional).
Counter directional pumping gives high gain and Co- directional pumping allows less noise performance especially 980nm pumping gives better noise performance and achieves better population inversion than 1480nm wavelength. The second important factor is to design a fiber structure to maximize the pump/dopant overlap and therefore attain maximum pump efficiency. In previous work, it has been established that Erdoped fibers with a high NA can greatly increase the pumping intensity in a very small core, resulting in a very large gain coefficient. An Er-doped high NA fiber was achieved using a glass system consisting of an ErGe-co- doped silica core and fluorine (F)- doped silica cladding. The fiber has a relative refractive-index difference of 1.88%, which corresponds to a 0.285 numerical aperture.
MODEL SIMULATION
First Hybrid Quad pumping model with the wavelengths 980nm twice times in codirectional 1480-nm twice times in Counter directional has been simulated as shown in Figure 3. And the second Hybrid Quad pumping model with the wavelengths 980-nm, 1480-nm in the co-directional and 1480-nm, 980-nm in the counter directional has been simulated as shown in Figure 8. The parameters Gain and Noise figure has been measured from the simulation models before and after Gain Flattening Filter and that has been plotted as shown in Figure 4, Figure 5 Figure 6 and Figure 7.
Figure 9 and Figure 10 shows Gain characteristics and noise characteristics before GFF of 2nd simulation model. Figure 11 and Figure 12 show the Gain characteristics and Noise Figure Characteristics after GFF of 2nd Simulation model.
RESULTS AND DISCUSSIONS
The Plotted Values of simulation results before re and after GFF are tabulated as shown in Table I. Table I shows the simulation results of 1st and 2nd Hybrid Quad pumping models (Proposed) were compared with Dual Pumping techniques with different wavelengths. The results of Dual pumping models are, Gain has been flattened after GFF but Noise Figure has been maintained. For the Hybrid Quad pumping models, after GFF Gain has been flattened but Noise Figure has been decreased half, means output noise has been decreased half. Table I. shows the tabular representation of the simulation results and comparison of Gain with and without GFF (gain flattening filter) with 980nm, 1480nm, dual and quad hybrid directional pumping. In the first proposed model with hybrid quad pumping (980nm twice in left of EDFA and 1480nm twice in right of EDFA) the gain without GFF is 38.7 and gain with GFF is 5.3 flattened. In the second proposed model with hybrid quad pumping (980nm, 1480nm in left of EDFA and 980nm, 1480nm in right of EDFA) the gain without GFF is 35.9 and the gain with GFF is 5.3 flattened.
Table 2 show results of comparison of Noise Figure with and without Gain Flattening Filter (GFF) with 980nm, 1480nm, Dual and Quad Hybrid Directional Pumping. In the first proposed model with hybrid quad pumping (980nm twice in left of EDFA and 1480nm twice in right of EDFA) the noise figure without GFF is 11.5 and noise figure with GFF is 8.4 flattened. In the second proposed model with hybrid quad pumping (980nm, 1480nm in left of EDFA and 980nm ,1480nm in right of EDFA) the noise figure without GFF is 14.8 and the noise with GFF is 7.6 flattened.
Figure 10. Shows the results of bar chart, comparison of Gain with and without GFF for different pumping models.
CONCLUSION AND FUTURE ASPECTS
The capability of Simulating Models of EDFA with Hybrid Quad pumping with and without GFF is proposed in this work. Based on above discussion it can be concluded that an EDFA with Hybrid Quad pumping has been modeled and simulated successfully with flattened gain and reduced noise figure for DWDM networks to increase transmission quality. Goal is to model Hybrid Quad pumping that would model some real world phenomena using EDFA. Thus, we have shown that the proposed model of an EDFA with Hybrid Quad Pumping was successfully simulated using WDM. In future work, the model can be modified and enhanced further by using different filters will concentrate further optimize the gain
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