Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18General SciencesEVALUATION OF ORGANOLEPTIC PROPERTIES AND GLYCEMIC INDEX OF RECIPES WITH RICE BRAN English0108S. PremakumariEnglish R. BalasasirekhaEnglish K. GomathiEnglish S. SupriyaEnglish K. AlagusundramEnglish R. Jagan MohanEnglishRice bran is a simple item that delivers fantastic health benefits in our daily diet. This study delivers the importance of utilising all parts of the whole grain, including the bran. The objective was to develop the recipes incorporated with rice bran and evaluate their organoleptic properties and estimate their glycemic index. Ten standard Indian subcontinent recipes namely, chapati, mixed vegetable chapati, wheat dosa, wheat rava dosa, kozhukattai, ragi vermicelli, rice vermicelli and pulse based preparations namely adai, rava adai and ragi adai were chosen for incorporating rice bran at three levels, i.e. 25, 30 and 35 per cent replacing the cereals and pulses in the standard recipe. Ten healthy volunteers were selected for the study of glycemic index of each recipe. Comparing the 25 per cent incorporated rice bran with 30 and 35 per cent incorporation, 25 per cent was found to be most acceptable than the rest. The glycemic index of all the standard and the test recipes were compared statistically and the results showed that there is a significant difference in the test recipes when compared to the standard ones (pEnglishRice bran, organoleptic properties, recipes, diabetes, glycemic indexINTRODUCTION International Diabetes Federation (IDF) states that two individuals develop diabetes every 10 seconds worldwide and two individuals die of diabetes related conditions every 10 seconds worldwide (IDF, 2007). The increasing trend of epidemiological transition is taking place in most of the States in India with decline in communicable diseases and increase in chronic non communicable diseases that has resulted in more than 50 per cent of total deaths in India (Thangappan, 2010). In recent years, consumers are dependent upon fast foods, which contain meager amount of dietary fibre. The American Diabetic Association (2007) recommends that individuals with diabetes mellitus increase the amount of dietary fiber in their diets in order to reduce blood glucose and insulin levels following meals. Liener et al., (2008) and Dunaif and Barbara (2008) reported that several dietary fibers can decrease the activity of human pancreatic amylase, lipase and trypsin. Trowell (2006) and Jenkins et al., (2006) and Miranda and Horwitz, (2007) assumed that addition of plant fibers to the diets of subjects with diabetes results in significant reduction in postprandial hyperglycemia.Qureshi et al., (2002) brought into limelight that soluble fiber such as rice bran plays an important role in decreasing cholesterol and controlling of blood glucose. Rice bran is obtained as a byproduct during the rice milling process and the outer layer or parts are removed at the time of polishing of husked rice (David et al., 2006). Stabilized rice bran (SRB), is a powerful source of vitamins, nutrients, proteins and fiber. The soluble and insoluble fibers are necessary for optimum digestion, blood sugar regulation, lowering cholesterol and prevention of diabetes and heart diseases. The stabilized rice bran contains an approximate insoluble versus soluble fiber ratio of 5 to 1. Rice bran exhibits a high digestive tolerance that occurs along the whole digestive tract with no excessive fermentation in the large intestine. SRB contains astounding quality of synbiotics, tocols, oryzanols, polyphenols, sitosterol and phytosterols. Rice bran is packed with full of omega 3 and omega 6 fatty acids ( oogenkamp, 2008). Healthy complex carbohydrates found in stabilized rice bran have “low glycemic index” which means they do not cause spikes in blood glucose (Sayre et al,. 2007). Every year, 63 to 76 million tons of rice bran is produced in the world and more than 90 per cent of rice bran is sold as animal feed for throw away price. Despite its excellent nutritional and nutraceutical properties, it is mainly utilized for animal feed. Earnest efforts are needed to incorporate this healthy ingredient back into our diet. Hence, the present study was undertaken to  develop the recipes incorporated with rice bran and evaluate their organoleptic properties and  estimate their glycemic index. METHODOLOGY Standardization of Rice Bran Incorporated Recipes Ten standard Indian subcontinent recipes were chosen for incorporating rice bran at three levels, i.e. 25, 30 and 35 per cent replacing the cereals and pulses in the standard recipe. These included chapati, mixed vegetable chapati, wheat dosa, wheat rava dosa, kozhukattai, ragi vermicelli, rice vermicelli and pulse based preparations namely adai, rava adai and ragi adai. All the recipes selected were standardized in the laboratory. Chapati is a form of roti made from wheat flour and water. Mixed vegetable chapati is a roti made with wheat flour, water and mixed vegetables. Wheat dosa is a fermented pan cake made from wheat flour. Wheat rava dosa is a pan cake made from wheat rava and water. Rice vermicelli is rice noodles made from rice. Ragi vermicelli is ragi noodles made from ragi. Kozhukattai is dumpings of rice flour using a mixture of grated coconut and jaggery as filling. Adai is a thick pancake prepared from a batter of dhals namely urad, channa and moong dhal. Rava adai is a thick pancake prepared from rava and seasonings. Ragi adai is a thick pancake prepared from ragi flour and seasonings. Conduct of Acceptability Trials Each standard recipe was tried with incorporation of stabilized rice bran at 25, 30 and 35 per cent levels and tested by the 20 panel members in the age group of 20 to 25 years. The 5 point hedonic scale was selected for the evaluation ranging from extremely like to extremely dislike. The results of sensory evaluation indicated that 25 per cent of stabilized rice bran incorporated recipes were highly acceptable (Premakumari et al., 2012) (Table I) and glycemic index of these recipes were determined. Determination of Glycemic Index of the Recipes Glycemic Index is a measurement of how fast 50g of given carbohydrate raises blood glucose levels as it is digested while the glycemic index provides precise information about how 50g of the food will affect blood glucose levels (Anderson, 2007). Ten healthy volunteers (adult men and women) of age 20 – 40 years were selected for the study of glycemic index of each recipe. Three days before the test period, all the subjects were asked to avoid consuming sweet preparations. On the first day of the experiment, fasting blood glucose was determined for all the subjects at 6 a.m. Then all the subjects were given 50 g of glucose in 250 ml of water to drink. The fasting blood glucose level was determined using glucometer using glucose strip which is based on the action of glucose oxidase and the value was recorded. Once in half an hour, blood glucose level was determined for all the subjects’ upto 2 hours. On the second day, all the subjects were fed with one of the 10 standard recipes and the quantities of the dish provided 50 g of carbohydrates which matched the glucose load of 50 g given on the previous day. On the third day, the subjects were made to consume the same recipes containing 50 g of carbohydrate incorporated with 25 per cent level of stabilized rice bran. The subjects were given 10 15 minutes for the consumption of the food. The subjects were not allowed to drink/eat any calorie containing foods. The blood glucose values for each subject were plotted against time in hours on a graph. The area under test recipe, standard recipe and glucose curves were determined. This procedure was repeated for all the ten standardized recipes and their Glycemic Index was determined. Glycemic Index was calculated using the following formula:   The Institutional Human Ethical Clearance number is HEC.2011.21 RESULTS AND DISCUSSION Organoleptic Evaluation The results of the organoleptic evaluation of 10 different rice bran incorporated recipes are given in Table II. Cereals and pulses are mostly used by Indians on daily basis. It is clear from Table II that the mean acceptability score of recipes in standard ranged from 8.35 to 8.8 and in recipes incorporated with 25, 30, 35 per cent of rice bran ranged from 8.05 to 8.45, 4.75 to 6.25 and 2.75 to 4.35 respectively. These scores were lower than the scores obtained by standard recipes. While comparing with the standard 25 per cent incorporation showed less difference than 30 and 35 per cent incorporation in all the recipes. Comparing the 25 per cent incorporated rice bran with 30 and 35 per cent incorporation 25 per cent was found to be most acceptable than the rest. Among the test recipes at 25 per cent level of incorporation of rice bran wheat rava dosa scored high (8.45) followed by rice vermicelli and kozhukattai (8.4), ragi vermicelli (8.2), mixed vegetable chapati (8.1) and chapati and wheat dosa (8.05). These findings showed that the lesser the addition of rice bran greater is the acceptability. According to Gajula et al., (2008) increase in bran level from 0 to 25 per cent significantly reduced the overall acceptability and all other attributes. Among the other preparations, 25 per cent incorporation showed greater acceptability out of all the test recipes when compared to the standard. Twenty five per cent level of incorporation of rice bran showed that ragi adai and rava adai had the acceptability value of 8.2 followed by adai with an acceptability value of 8.0.From the acceptability trials, it was concluded that the rice bran at 25 per cent level of incorporation is most acceptable compared to the other test recipes. Glycemic Index of the Rice Bran Incorporated Recipes Mean Blood Glucose Levels Glycemic index is a numerical system of measuring how much of a rise in circulating blood sugar that the carbohydrate triggers. Higher the number, the greater the blood sugar response. Table III shows the mean blood glucose values of the selected subjects when fed with glucose, standard and experimental recipes with 25 per cent rice bran. When comparison was drawn between the standard and the test recipes, there was a significant difference in blood glucose values when compared at half an hour, one hour, one– and half hour and two hour intervals. Carbohydrates are known to account for the variations in the glycemic response to the meals, but GI also affected by factors such as the nature of starch, cooking and food processing methods and other dietary constituents like dietary fiber, fat and protein. Glycemic index of the recipes The mean glycemic index of the standard and rice bran incorporated recipes is shown in the Table IV. The new glucose revolution refers the glycemic index as “the dietary solution for lifelong health”. The glycemic index of all the standard and the test recipes were compared statistically and the results showed that there is a significant difference in the test recipes when compared to the standard ones (pEnglishhttp://ijcrr.com/abstract.php?article_id=1388http://ijcrr.com/article_html.php?did=13881. International Diabetes Federation, (2007), “World Diabetes Media Kit: every 10 seconds 1 person dies of diabetes”, International Diabetes Federation, Brussels, Belgium. 2. Thangappan, (2010), “High Prevalance of Diabetes And Cardiovascular Risk Factors In India”, Diabetes Care, Vol.31. No3, Pp.1090 101 3. Puupponen pimia, (2002), Olson, BH., Anderson, SM., and Becker, MP., “Psyllium Enriched Cereals Lower Blood Total Cholesterol and LDL Cholesterol But Not HDL Cholesterol in Hypercholesterolemic Adults”, Results of a meta analysis. J Nutr, 127,1973–1980. 4. American Diabetes Association (2007): “Nutrition Recommendations and Interven tions for Diabetes”, Diabetes Care.,Vol. 30 (Suppl. 1):S48–S65. 5. Linear, Allgood, LD., Lawrence, A., (2008), “Cholesterol Lowering Effects of PsylliumIntake Adjunctive to Diet Therapy in Men And Women with Hypercholesterolemia”, American Journal of Clinical Nutrition, 71:472–479. 6. Dunaif and Barbara (2008), “Effects Of Concentrated Bran Fibre Preparation on HDL Cholesterol In Hypercholesterolemic Men”. Hum Nutr Clin Nutr 1984, 38C: 39–45. 7. Trowell, HC., (2006), “Diabetes Mellitus and Dietary Fiber of Starchy Foods”, Am J Clin Nutr, 31: 553–557. 8. Jenkins, DJA., Goff, DV., Leeds, AR., Alberti, KGM., Wlever, TMS., Gassull, MA., and Hockaday,TDR., (2006), “Unabsorbable Carbohydrates and Diabetes, Decreased Postprandial Hyperglycemia”, Lancet 2: Pp.172–174. 9. Miranda, PM., Horwitz, DL., (2007), “High Fiber Diets in the Treatment of Diabetes Mellitus”, Ann Internal Med 88: 482–487. 10. Mani, I., Patel, JJ., Mani, VV., (2008), “Studies on the Effect of Wheat Bran Fiber on Serum and Urinary Amino Acids and Amino Acids in Non insulin dependent Diabetic Patients”, J Clin Bio Chem Nutr 3: 143–148. 11. Qureshi, A., Sami. S. and Khan. F., (2002), “Effect of Stabilized Rice Bran, Its Soluble and Fiber Fractions on Blood Glucose Levels and Serum Lipid Parameters in Humans with Diabetes Mellitus Type I and II”, Journal of Nutritional Biochemistry,Vol.13. No.2, Pp. 145 87. 12. David, A.V., Dendy.D.A.V., Bogdan, J., and Dobraszczyk., (2006), “Cereals and Cereal products Chemistry and Technology”, Edition, I., Springer, Pp.312 313. 13. Bagdon, (2006), “Rice Bran Stabilization By Extrusion Cooking For Extraction Of Edible Oil”, Journal of Food Science, Vol.50, No.2, Pp.361 364. 14. Hoogenkamp, H., (2008), “Rice Bran Isolate: The Alternative For Soy Protein”, Poultry Processing Magazine, 4.2.2008. Pp20 22. 15. Sayre, R.N., Kahlon, T. S., Chow,I F.I., and Chiu.I.M.M., (2007), Diet, Life Style And Risk Of Coronary Heart Diseases, N.Engl.J.Med.,Vol.35, No.5, Pp.1991 2000. 16. Anderson, JW., Midgley, WR., and Wedman,B., (2007), “Fiber and Diabetes”, Diabetes Care 2: Pp369–379. 17. Gajula, H., Alavi, S., Adhikari, K., and Herald, T., (2008) “Pecooked Bran –Enriched Wheat Flour using Extrusion: Dietary Fiber Profile and Sensory Characteristics”, J Food Sci 73(4):5173–5179 18. Pankaj Modi, (2011) “Nutrition and Health, Nutrients, Dietary Supplements and Nutriceuticals”, Part 6, Pp.403 424 19. Premakumari,S., Balasasirekha,R., Gomathi,K., Supriya,S., Jagan Mohan, R., and Alagusundram,K., Development and acceptability of fibre enriched ready mixes, International Journal of Pure and Applied Sciences and Technology, 2012), vol. (2), pp.74 83

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18General SciencesINVESTIGATING THE EFFECTS OF DEMOGRAPHICS ON CUSTOMER ACCEPTANCE OF eBANKING IN DERA ISMIL KHAN, KPK, PAKISTAN: A SURVEY OF SAMPLE CLIENTELE English0916Muhammad SiddiqueEnglish Afia SaadatEnglisheBanking and iBanking are the buzzwords among internet-savvy population of the world. It is happening not only in the advanced countries but also in the developing states like Pakistan. This is because on one hand the Information and Communication Technologies have become accessible both in terms of availability and prices and on the other hand due to the emergence of local Information technology professionals equipped with knowledge and command over the leading-edge technologies. However, research on the implementation of Information technology in the banking sector reports that the process is not automatic rather requires multi-disciplinary treatment with keeping the issues of customer acceptance on top. The customers of every state and city are different not only because of getting different eBanking digital facilities (digital-divide) but also due to the fact that every customer is demographically different from others. This research is about the effects of demographics on Customer Acceptance in Pakistan. The literature from developed states and developing states, including Pakistan has been analyzed to understand the problem and to develop a research model for testing in the native environment. EnglishCustomer acceptance, Demographics, eBanking, iBanking, ICTs, Internet.INTRODUCTION In the last two decades of the 20 th century the information technology revolution led to a proliferation of personal computers (PCs), modems, servers, and other associated electronic data terminal equipment. This rapid growth and expansion of IT and telecommunication networks and interconnectivity encouraged the introduction of electronic services in the banking sector (Banan, 2010). All transactions occur on a secure server of a bank via internet. The bank has all of the required data and software to execute the transactions. Customers go the bank's Web site, log in, and then take advantage of the bank's internet services. Typical bank services are account access and review, bill payment, transfers of funds between accounts, and a variety of new products and services (Ahmad and Al Zu?bi, 2011) In the eBanking context, the attitudes of customers vary in terms of perceptions regarding services offered, product information, delivery terms, form of payment, risks involved, security, privacy, visual appeal, personalization, navigation, entertainment, and enjoyment (Jahangir and Begum, 2008). TAM describes that the attitude is based on the prominent belief which a person has about the consequences of a given behavior and his appraisal of those consequences. Customer attitude is based on characteristic beliefs about the object and perceived value of those characteristics in making the decision to adopt (Adesina and Ayo, 2010). In this study the effects of demographics on customer acceptance have been studied. Compatibility of iBanking with the lifestyle, eliefs, and experiences of current users has added influence on the intention to carry on using eServices. This suggests that users are more meticulous with an innovation that is closer to what they already know and use (Tat et al., 2008). Customer demographics play an important role in shaping their behaviors towards new technologies. Demographics have been identified as the important variables in affecting the customer acceptance of eBanking (Wahab et al., 2009). LITERATURE REVIEW What is eBanking? eBanking is the term which explain the provisions of various services by a bank to its customers through electronic means of communication like computer or television. Thus, eBanking refers to the provision of information about the bank and its products and services through the World Wide Web (Daniel, 1999). The iBanking refers to the viewing of accounts information, transfer of funds, making payments, documentary collections, etc over the Internet (Goldfinger and Perrin, 2001:4; Singh et al., 2002). Banks have used Information and Communication Technologies in the past to drive ATM machines, process checks, and prepare bank statements and the customers rarely noticed the Information System and the use of computers in the banks. But in today?s time, the Web site, email, and the electronic bills payment system are the main gadgets available to the banking customers (Singh et al., 2002). Advanced information technology has a great role in developing easy, convenient, and user friendly banking services. That is why eBanking has captured greater attention of all the stakeholders in the banking and commerce industry (Jahangir and Begum, 2008). Customer Acceptance Adoption can be defined as the acceptance and sustained use of a product or a service (Alam et al., 2009). Most of the customers use online banking for bills paying purpose, and they just do it quiet often with least effort. Besides that, people use iBanking to keep an eye on their money matters, view their account balance and check the received payments from other parties (Yang and Ahmed, 2009). eBanking users? attitudes vary on the basis of product information, services offered, form of payment, delivery terms, and risks involved (Wahab et al., 2009). The understanding of customers? adoption of eBanking can help financial institutions to formulate competitive marketing strategies and strategic IT planning in banking (Al Mudimigh, 2007). In this context, the major factors affecting iBanking adoption are: customer demographics, customer awareness, ease of use, security and privacy, cost of using iBanking, resistance to change, and digital access (Alam et al., 2009). eBanking does not only include the way one shops over the internet, but also the way one performs banking transactions. It allows more independence to customers in the choice on where and when to bank (Yang and Ahmed, 2009). Effects of Demographics: There is a series of research studies on the measurement of demographic implications on the users of computer based information systems including eBanking (see for example, Ramayah et al., 2003; Shih, 2007; Padachi et al., 2007; Yang and Ahmad, 2009; Adesina and Ayo, 2010; Amin and Ramayah, 2010). Demographics have been identified as the intervening and/or moderating variables and have an important role in the case of customer acceptance of eBanking (Tat et al., 2008; Wahab et al., 2009). Similarly the researchers have explored and tested several demographic characteristics however some of these are very frequently used in researches on eBanking. These characteristics nclude: Gender, education, marital status, position (Ramayah et al., 2003); age, education, and income (Padachi et al., (2007); experience with eBanking, experience of using Internet, and frequency of use at least once a week Shih, 2007); gender, marital status, education level, and religion (Amin and Ramayah, 2010). In this research the researcher has used the following demographics for analysis: Respondent Type, Education, Gender, Age, Experience with eBanking, eBank(s) used, and Frequency of Use. The challenge to banks is to realize the diversity of their customers and find the right delivery mix to profitably deliver their products and services to various markets (Comptroller, 1999:4). Thus, user demographics have significant impacts on the customer acceptance of new technologies and this has been established by several researchers over and over that any digital initiative for eBanking cannot be successful unless the issue of customer acceptance is analysed through the filters of their demographic attributes (Suh and Han, 2002; Banan, 2010; Adesina and Ayo, 2010). RESEARCH METHODOLOGY Survey Approach: Given the human and social nature of the research project (Customer Acceptance), the researcher has applied survey approach since urveys are “excellent vehicles for measuring attitudes and orientations in a large population” (Sekaran, 1999:257). Survey approach has been used to measure the user attitudes towards new technologies. For example, researches are available on "Usable Security and eBanking: Ease of Use vis vis Security (Hertzum et al., 2004)”, “What keeps the eBanking customer loyal? Role of consumer characteristics on eLoyalty (Floh and Treiblmaier, 2006)”, “Analyzing the Factors that Influence the Adoption of iBanking in Mauritius (Padachi et al., 2007)”, “SMS banking: Explaining effects of attitude, social norms and perceived security and privacy (Amin and Ramayah, 2010) are a few projects to quote. Population and Sample The population of this study consists on all the literate customers of eBanking in Dera Ismail Khan, KPK, Pakistan. Their number is infinite due to the fact that the eBanking customers are increasing day by day and every bank is trying its level best to shoot up the size of their customer banks. However, the researcher has classified them into five major groups, i.e., bank employees, teachers, students, doctors, and businessmen. The researcher used a pilot study to measure the level of error in responses and then used the same pilot data for determining the size of the required sample. Table 1 details the results of pilot study and the use of statistics for determining the sample for this study is 178. However, 173 questionnaires were received and qualified as usable for analysis therefore the return rate was 97.19%. Table 1. The „Statistics? from Pilot Study and Computation of the Sample Size Data Collection 1. Literature Survey: Initial literature survey provided concepts relating to the topic, their mutual relationships and the theoretical model underlying these relationships. It was continued in the main research to further mature the research design and feed the topic. 2. Questionnaire: Questionnaire is instrumental to the survey research. A structured questionnaire has been prepared strictly according to the extracted variables and guidelines for questionnaire construction (Goode and Hatt, 1952:133; Babbie, 1993:146). A structured questionnaire was extracted from the literature containing seven (7) demographic items and one research variable (customer acceptance). All the research questions were measured on a 5 point Likert scale representing 1 = strongly disagree, 2 = disagree, 3. neutral, 4 = agree and 5 = strongly agree. The same scale has been widely used by the researchers on the customer acceptance of new technologies (Daniel, 1999; Chau and Lai, 2003; Mashadi et al., 2007; Tat et al., 2008; Jahangir and Begum, 2008; Alam et al., 2009; Banan, 2010; Adesina and Ayo, 2010). Data Analysis Data has been analyzed both in descriptive and inferential manners according to the requirements of hypothesis, generated from the literature. Following statistical tools were applied to test the hypothesis: a. ANOVA applications b. Tests c. Regression analysis (step wise) Research Model This research model is developed on the basis of literature review showing the relationships of customer demographics on their behavior towards eBanking acceptance. Hypotheses Following hypotheses were tested in this study: RESEARCH FINDINGS Descriptive Statistics of Respondents for Customer Acceptance: a. Testing the Significance of Mean Differences This section presents the results from the tests of significance applied on testing the mean differences between different groups emerging from the demographic attributes of the respondents. Tests have been applied on the role of RTP (respondent type), EDU (education), GDR (gender), AGE (age), EXP (experience), BKU (banks used) and FOU (frequency of use). 1. ANOVA tests: The above table shows the results of three ANOVA tests for hypotheses testing. Here, we can see that second and third hypothesis have been accepted due to the p value less than 0.05 (i.e., 0.000 and 0.001 respectively), whereas as the first hypothesis has been rejected because of the p value greater than 0.05 (i.e., 0.826). The above table shows the results of four t tests for hypotheses testing. Here, we can see that the third hypothesis has been accepted due to the p value less than 0.05 (i.e. 0.021), whereas as the first, second, and fourth hypothesis have been rejected because of the p value greater than 0.05 (i.e., 0.249, 0.314, and 0.846 respectively). b. Predicting the Customer Acceptance (CA) with Demographics Hypothesis 8. All the demographics predict Customer Acceptance (CA). a Predictors in the Model: (Constant), DBNK b Dependent Variable: CA The table 12 show the summary results of Demographic impact on Customer Acceptance (CA). However, the only Demographic Banks Used (DBNK) shown in table 13 is having significant effect on Customer Acceptance because of the p value less than 0.05 which is the deciding point. Whereas the other demographics (as shown in table 14) DRTP (p value = 0.938), DEDU (p value = 0.812, DGDR (p value = 0.775), DAGE (p value = 0.350), DEXP (p value = 0.447) and DFQU (p value = 0.350) are insignificant in determining Customer Acceptance (CA) due to p values greater than 0.05, which is the required threshold. Hence, the hypothesis is partially supported with one out of seven (1/7) demographics. CONCLUSIONS In this research the researcher has studied the effects of seven demographics, i.e., Respondent Type, Education, Gender, Age, Experience with eBanking, eBank(s) used, and Frequency of Use. However, it has been seen that the demographics play a very little role in predicting the Customer Acceptance of eBanking. For example, the only demographic Banks Used (BKU) has an important role in predicting Customer Acceptance (CA). Similarly taking into account the demographic attributes of the respondents it has be seen that out of seven (7) tests of significance only three (3) were proved significant. Thus, following conclusions have been drawn from the current empirical study: 1. The demographics have indicated no role in the prediction of CA. 2. In Customer Acceptance „The Banks Used? is the only critical factor. 3. The Role of demographics is mixed as a whole (3/7), i.e., 43%. 4. Age, banks used, and experience are the demographics having significant mean differences for customer acceptance. ACKNOWLEDGEMENTS 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. Using this opportunity the authors put their appreciation in black white for the assistance of friends and particularly the respondents who played an important role in data collection. Finally, 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=1389http://ijcrr.com/article_html.php?did=13891. Adesina, A.A. and Ayo, C.K. (2010). An Empirical Investigation of the Level of Users? Acceptance of E Banking in Nigeria. Journal of Internet Banking and Commerce, 15(1). Retrieved June 18, 2011, from http://eprints.covenantuniversity.edu.ng/83 /1/Adesina.pdf. 2. Ahmad, A.M.K. and Al zu?bi, H.A. (2011). 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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18General SciencesINVESTIGATION OF ANTI BACTERIAL AND ANTI FUGAL POTENTIALS OF MACARANGA PELTATA English1724Meenakshi VermaEnglish Narayanan K.English Mitali Thakar B.English Subrahmanyam V.M.English Venkata Rao J.English Dhanaraj S.A.English Vasanth Raj P.EnglishMacaranga peltata belonging to Euphorbiaceae family. Leaves and stem bark were separated, shade dried and extracted separately using methanol. The concentrated methanolic extracts of Macaranga peltata were subjected to antimicrobial studies. The percentage yield of the leaves and stem bark were found to be 47% and 30% respectively. The anti-bacterial activity of Leaf and Stem Bark extracts of Macaranga peltata was determined by Cup-plate method and Zone of Inhibition was measured. Zone of Inhibition was found to be 16mm for Leaf extract and 13mm and 14mm for Stem Bark extract in two different sets against Escherichia coli. Out of two Gram-positive bacteria Bacillus subtilis and Staphylococcus aureus Zone of Inhibition was obtained only for Staphylococcus aureus that was 16mm for Leaf extract and 12mm and 13mm for Stem Bark. Leaf extracts showed better anti-bacterial activity than the Stem Bark extract against both Gram-positive and gram-negative bacteria. Minimum Inhibitory concentration (MIC) for Leaf extract was between 62.5μg/ml to 125μg/ml for Escherichia coli, 125μg/ml to 250μg/ml for Pseudomonas aeruginosa, 62.5μg/ml to 125μg/ml for Bacillus subtilis and 31.25μg/ml to 62.5μg/ml for Staphylococcus aureus. Whereas MIC for Stem Bark extract was between 500μg/ml to 1000μg/ml for Escherichia coli, 250μg/ml to 500μg/ml for Pseudomonas aeruginosa, 62.5μg/ml to 125μg/ml for Bacillus subtilis and 62.5μg/ml to 125μg/ml for Staphylococcus aureus. Ciprofloxacin used as standard antibiotic showed MIC between 1.953 μg/ml to7.813 μg/ml for all four bacterial strains. EnglishMacaranga peltata, Euphorbiaceae, anti-bacterial and Cup-plate methodINTRODUCTION The plant is a biosynthetic laboratory, not only for chemical compounds, but also a multitude of compounds like glycosides, alkaloids etc. These exert physiological and therapeutic effect. The compounds that are responsible for medicinal property of the drug are usually secondary metabolites. A systematic study of a crude drug embraces through consideration of primary and secondary metabolites derived as a result of plant metabolism. The plant material is subjected to phytochemical screening for the detection of various plant constituents [1]. With onset of scientific research in herbals, it is becoming clearer that the medicinal herbs have a potential in today’s synthetic era, as numbers of medicines are becoming resistant. According to one estimate only 20% of the plant flora has been studied and 60%of synthetic medicines owe their origin to plants. Ancient knowledge coupled with scientific principles can come to the forefront and provide us with powerful remedies to eradicate the diseases. According to World Health Organization (WHO) more than 80% of the world's population relies on traditional medicine for their primary healthcare needs. Plants used for traditional medicine contain a wide range of substances that can be used to treat chronic as well as infectious diseases [2]. The 30th World Health Assembly adopted a resolution urging interested governments to utilize their traditional systems of medicine with regulations suited to their national health care systems [3]. Utilization of plants for medicinal purposes has been documented long back in ancient literature. However, organized studies in this direction were initiated in 1956 and off late such studies are gaining recognition and popularity due to loss of traditional knowledge and declining plant population [4]. Macaranga peltata is one of important plants widely found in Western Ghats in India. Macaranga peltata belonging to Euphorbiaceae family is a genus of important pioneer trees widely distributed in south east Asia. Macaranga is a dicot plant with more than 350 species. Genus Macaranga is native to Africa, Australia, Asia and the South Pacific. There are evidences that show that bergenin derivatives and polyphenols have been recorded from Macanga peltata and other flavonoids as well as diterpinoids are suspected to be present. A previous study on Macaranga genus includes study of Macaranga alnifolia for cytotoxic natural products from tropical rainforests in Madagascar through the International Cooperative Biodiversity Group (ICBG) program. Ethanolic extract of the fruit of Macaranga alnifolia Baker (Euphorbiaceae) was obtained for phytochemical investigation. This extract was found to be active in the A2780 ovarian cancer cytotoxicity assay. Bioassayguided fractionation led to the isolation of the five new compounds [5]. Although several traditional plant extracts have historically been known to have antimicrobial activity, to date, there has been relatively little or in some cases, no reports examining the activity against several medically important bacterial and fungal pathogens [6]. Considering the vast of potentiality of plants as sources for antimicrobial drugs with reference to antibacterial and antifungal agents, a systematic investigation was undertaken to screen the local flora for antibacterial and antifungal activity from Macanga peltata. MATERIALS AND METHODS MATERIALS All solvents and reagents purchased form Merck Pvt. Ltd, Mumbai, India. All media components purchased from Himedia (India). All the microorganisms were procured from National Collection of Industrial Microorganisms (NCIM), Pune and subcultured in the laboratory. METHODS Collection and Authentication of Plant The plant Macaranga peltata was collected from the Syndicate circle, Manipal in the month of January 2009. The plant was authenticated by Dr. Chandrakant Bhat, Professor, Muniyal Ayurvedic College, Manipal, Karnataka India. Preparation of Extracts: The collected plant parts (leaves and stem bark) were separated and shade dried. Then the dried parts were chopped and coarsely powdered; the powdered plant materials were extracted separately using methanol by soxhlet extraction. The amount of methanol was taken as methanol : dry powder (100:15) The extracts were then concentrated to dryness under reduced pressure and controlled temperature to yield a deep brown – dark brown semisolids, the percentage yields was calculated.. All the extracts were stored in refrigerator till further use. Phytochemical Studies: Qualitative Phytochemical Analysis: The concentrated methanolic extracts of Macaranga peltata were subjected to chemical test as per the standard methods for the identification of the various constituents. 2-3 mL of the extract solution was taken for all the tests for viz., carbohydrates, Alkaloids, Steroids and Sterols, Glycosides, Saponins, Flavanoids, Tannins, Triterpenoids, Protein and Amino acid:[7] (results not shown). Antimicrobial activity [8]: (a) Growth and Maintenance of Test Microorganism for Antimicrobial Studies: Bacillus subtilis – NCIM 2063 Escherichia coli – NCIM 5011 Pseudomonas aeruginosa – NCIM 7312 Staphylococcus aureus – NCIM 2079 Aspergillus niger – NCIM 545 Candida albicans – NCIM 3100 All the microorganisms were procured from National Collection of Industrial Microorganisms (NCIM), Pune and subcultured in the laboratory. The bacterial cultures were maintained in slants till further use and fungus cultures were maintained on Sabraud’s dextrose agar (SDA). (b) Cup Plate method for determination of Zone of Inhibition: Nutrient agar (20ml) was prepared according to the manufacturers’ recommendation and sterilized. Plates containing 20 ml of sterile nutrient agar each were inoculated with standardized innocula using sterile Pasteur pipette. Six wells each of 5 mm diameter were made on each plate-1 for antibiotic (Ciprofloxacin for antibacterial), 1 for DMSO (Solvent control), 2 for Leaf Extract and 2 for Stem Bark Extract. 50µl of the plant extracts, antibiotic and DMSO were dispensed into subsequent wells. The extracts were allowed to diffuse into the medium for 1hr at room temperature. This was then incubated at for 24 h at 37ºC after which the zones of growth inhibition were measured and recorded in millimeter [9]. (c) Determination of Minimum Inhibitory Concentration by Tube Dilution method: MIC is the lowest concentration of the drug in which turbidity/growth is not observed. A series of test tubes were prepared containing the same volume of medium inoculated with the test organism to obtain about 104 CFU/ml. Two fold serial dilutions were carried out using 1.8 ml of the above inoculum and 0.2 ml test solution. Positive control containing antibiotic, negative control containing uninoculated broth and solvent control containing DMSO were also used. The tubes were incubated at 37º C for 18 hours (Bacteria) or 28º C for 40 hours (Fungi) [10]. The tubes are inspected visually to determine whether the microorganism has grown, as indicated by turbidity. Tubes in which the extract/ antibiotic is present in a concentration sufficient to inhibit bacterial growth remained clear. Yield of plant extract: Percentage yield obtained from leaf was 47% and from stem bark powder was 30% that is very good yield (Table no.1). Antimicrobial activity: Standardization of Colonies: Two Gram-positive and two Gram-negative bacterial colonies were standardized and results were obtained. The numbers of bacterial colonies were represented in terms of Colony Forming Unit (Table no.2). Antimicrobial Activity (Zone of Inhibition): Anti-microbial activity of the plant extracts were determined by Cup-Plate Method and activity was measured by measuring Zone of Inhibition in millimeters. Results were obtained for each bacterial strain tested against Macaranga peltata Leaf and Stem Bark extract. Anti-bacterial activity was obtained only for one Gram-positive and one Gram-negative bacteria out of two gram-positive and two Gram-negative bacterial strains. Leaf extract showed better activity against both Gram-positive and Gramnegative bacteria. DMSO used as solvent control, did not inhibit growth of bacteria. Activity of the extracts was found to be less than the standard antibiotic Ciprofloxacin (Table no.3). RESULTS Minimum Inhibitory concentration (MIC): The results for MIC of Macaranga peltata observed against different bacterial species were recorded. MIC for E.coli: Very low concentration i.e. between 3.906 µg/ml to7.813 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 62.5µg/ml to 125µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 500µg/ml to 1000µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts (Table no.4). MIC for Pseudomonas: Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 125µg/ml to 250µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 250µg/ml to 500µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts (Table no.5). MIC for Bacillus: Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Both Leaf extract and Stem Bark extracts inhibited the bacterial growth between 62.5µg/ml to 125µg/ml concentration (Table no.6). DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was less, still it was comparable with standard. MIC for Staphylococcus: Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard antibiotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 31.25µg/ml to 62.5µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 62.5µg/ml to 125µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts (Table no.7). DISCUSSION Macaranga peltata belonging to Euphorbiaceae family is one of the important plants found in Western ghats specially in Udupi district, which contains potential for active compounds is very less studied. Since different species of Macaranga i.e. Macaranga alnifolia has been already studied for its anti-proliferative activity, Macaranga peltata is studied for its antimicrobial activity. Leaf and Stem Bark samples were collected from Macaranga peltata and shade dried and powdered. Methanolic extracts of these samples were obtained by Soxhlet extraction method. The yield obtained from leaf was 47% and from Stem Bark was 30%. Both plant extracts were subjected to phytochemical analysis. Leaf extract showed the presence of carbohydrates, steroids and sterols, glycisides, flavonoids, tannins, proteins and amino acids while Stem Bark extract showed positive results for carbohydrates, glycosides, saponins, flavonoids, tannins, proteins and amino acids. Biological studies of plant extracts indicate anti-microbial activity. Anti-microbial activity was performed in two steps, one for anti-bacterial and another for antifungal. To screen the plant Macaranga peltata for anti-bacterial activity four bacterial strains were selected; two Gram-positive (Bacillus subtilis and staphylococcus aureus) and two Gram-negative (Escherichia coli and Pseudomonas aeruginosa). These bacterial strains were maintained in slants containing Nutrient Agar and sub-cultured in nutrient broth during use. The standardization of each strain was done and Colony Forming Unit (CFU) for each was determined. The anti-bacterial activity of Leaf and Stem Bark extracts of Macaranga peltata was determined by Cup-plate method and Zone of Inhibition was measured. Zone of Inhibition was found to be 16mm for Leaf extract and 13mm and 14mm for Stem Bark extract in two different sets against Escherichia coli while there was no inhibition observed against another Gram-negative strain Pseudomonas aeruginosa. Out of two Gram-positive bacteria Bacillus subtilis and Staphylococcus aureus Zone of Inhibition was obtained only for Staphylococcus aureus that was 16mm for Leaf extract and 12mm and 13mm for Stem Bark extract in two different sets of the experiment. Leaf extracts showed better anti-bacterial activity than the Stem Bark extract against both Gram-positive and gram-negative bacteria. The extracts that were tested positive were estimated for Minimum inhibitory concentration (MIC). MIC of the extracts was determined against all bacterial strains selected for the experiment. MIC for Leaf extract was between 62.5µg/ml to 125µg/ml for Escherichia coli, 125µg/ml to 250µg/ml for Pseudomonas aeruginosa, 62.5µg/ml to 125µg/ml for Bacillus subtilis and 31.25µg/ml to 62.5µg/ml for Staphylococcus aureus. Whereas MIC for Stem Bark extract was between 500µg/ml to 1000µg/ml for Escherichia coli, 250µg/ml to 500µg/ml for Pseudomonas aeruginosa, 62.5µg/ml to 125µg/ml for Bacillus subtilis and 62.5µg/ml to 125µg/ml for Staphylococcus aureus. Ciprofloxacin used as standard antibiotic showed MIC between 1.953 µg/ml to7.813 µg/ml for all four bacterial strains. For screening of anti-fungal activity of plant Macaranga peltata two fungal strains Aspergillus niger and Candida albicans were selected. There was no antifungal activity observed by the extracts at the concentrations tested. CONCLUSION Macaranga peltata yield obtained from leaf was 47% and from Stem Bark was 30%. Both plant extracts were subjected to phytochemical analysis. Leaf extract showed the presence of carbohydrates, steroids and sterols, glycisides, flavonoids, tannins, proteins and amino acids while Stem Bark extract showed positive results for carbohydrates, glycosides, saponins, flavonoids, tannins, proteins and amino acids. Biological studies of plant extracts indicate antimicrobial activity. Leaf and Stem Bark samples extracts of Macaranga peltata were subjected to anti microbial studies. Both the extracts proved moderate anti bacterial activity among them leaf extracts showed better anti-bacterial activity than the Stem Bark extract against both Gram-positive and gram-negative bacteria. ACKNOWLEDGEMENTS We thank Manipal University for providing the facilities and support to conduct this study. Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript. Inference: Anti-bacterial activity was obtained only for one Gram-positive and one Gramnegative bacteria out of two gram-positive and two Gram-negative bacterial strains. Leaf extract showed better activity against both Gram-positive and Gram-negative bacteria. DMSO used as solvent control, did not inhibit growth of bacteria. Activity of the extracts was found to be less than the standard antibiotic Ciprofloxacin. Inference: Very low concentration i.e. between 3.906 µg/ml to7.813 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 62.5µg/ml to 125µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 500µg/ml to 1000µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts. Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 125µg/ml to 250µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 250µg/ml to 500µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts. Inference: Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Both Leaf extract and Stem Bark extracts inhibited the bacterial growth between 62.5µg/ml to 125µg/ml concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was less, still it was comparable with standard. Inference: Very low concentration i.e. between 1.953 µg/ml to 3.906 µg/ml of ciprofloxacin (used as standard anti-biotic) was able to inhibit the bacterial growth. Leaf extract inhibited the bacterial growth between 31.25µg/ml to 62.5µg/ml concentration while Stem Bark extract inhibited growth of bacteria between 62.5µg/ml to 125µg/ml of concentration. DMSO at its higher concentrations was found to inhibit bacterial growth. Although activity showed by plant extracts was lesser as compared to standard, still Leaf extract showed better activity than Stem Bark extracts. Englishhttp://ijcrr.com/abstract.php?article_id=1390http://ijcrr.com/article_html.php?did=13901. Mahesh B. and. Satish S.; Antimicrobial Activity of Some Important Medicinal Plant against Plant and Human Pathogens; World Journal of Agricultural Sciences; 2008; 4 (S): 839-843. 2. Duraipandiyan V.,Ayyanar M.and Ignacimuthu S.; Antimicrobial activity of some ethnomedicinal plants used by Paliyar tribe from Tamil Nadu, India; BMC Complementary and Alternative Medicine 2006, 6:35 3. Lino A., Deogracious O.; The in-vitro antibacterial activity of Annona senegalensis , Securidacca longipendiculata and Steganotaenia araliacea - Ugandan medicinal plants; African Health Sciences; 2006; 6(1): 31-35 4. Uniyal S.K., Singh K.N., Jamwal P. and Lal B.; Traditional use of medicinal plants among the tribal communities of Chhota Bhangal, Western Himalaya; Journal of Ethnobiology and Ethnomedicine; 2006; 2:14 5. Yoder B. J., Cao S., Norris A., Miller J. S., Ratovoson F., Razafitsalama J., Andriantsiferana R., Rasamison V., and Kingston D; Cytotoxic Prenylated Stilbenes and Flavonoids from Macaranga alnifolia from the Madagascar Rainforest; Journal of Natural Products. 2007 March; 70(3): 342– 346 6. Srinivasan D., Sangeetha N., Suresh T and Perumalswamy PL. Antimicroabial activity of certain Indian medicinal plants used in folkloric medicine. Journal of Ethano Pharmacology. 2001; 74 (3): 217- 220. 7. Khandelwal, K. R. Practical Pharmacognosy, Techniques and Experiments, 8th Ed., Nirali Prakashan. 2001, pp. 45-69. 8. Pao-Chuan H., Jeng-Leun M., Shu-Hui H. Antimicrobial effect of various combinations of plant exracts. Food Microbiology 2001; 18 (1); 35- 43. 9. Laura LZ. Spices and Herbs: Their Antimicrobial activity and its determination. Journal of Food Safety 1988; 9 (2); 97-118. 10. Jennifer MA. Determination of minimum inhibitory concentrations. Journal of antimicrobial Chemotherapy 2001; 48 (suppl 1); 5-16.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18General SciencesA STUDY ON HAMILTONIAN CYCLES English2533N. VedavathiEnglish Dharmaiah GurramEnglishA graph G is Hamiltonian if it has a spanning cycle. The problem of determining if a graph is Hamiltonian is well known to be NP-complete. While there are several necessary conditions for Hamiltonicity, the search continues for sufficient conditions. In their paper, ?On Smallest Non-Hamiltonian Regular Tough Graphs? (Congressus Numerantium 70), Bauer, Broersma, and Veldman stated, without a formal proof, that all 4-regular, 2-connected, 1-tough graphs on fewer than 18 nodes are Hamiltonian. They also demonstrated that this result is best possible. Following a brief survey of some sufficient conditions for Hamiltonicity, Bauer, Broersma, and Veldman?s result is demonstrated to be true for graphs on fewer than 16 nodes. Possible approaches for the proof of the n=16 and n=17 cases also will be discussed. EnglishHamiltonianINTRODUCTION In this paper, we will investigate the conjecture that every 2-connected, 4-regular, 1-tough graph on fewer than 18 nodes is Hamiltonian. First, we investigate the historical development of sufficient conditions for Hamiltonicity as they relate to the notions of regularity, connectivity, and toughness. A graph G consists of a finite nonempty set V = V(G) of n points called nodes, together with a prescribed set X of e unordered pairs of distinct nodes of V. Each pair x = {u,v} of nodes in X is an edge of G, and x is said to join u to v. We write x = uv or x = vu and say that u and v are adjacent nodes, and x is incident on u and v. The order of a graph G is the number of nodes in V(G). In our discussion, we will deal only with simple graphs, i.e., a graph with no loops or multiple edges. The degree of a node v, in a graph G, is denoted deg (v), and is defined to be the number of edges incident with v. Closely related to the concept of degree is that of the neighborhood. The neighborhood of a node u is the set N(u) consisting of all nodes v which are adjacent to u. In simple graphs, deg (u) = ?N(u)??. The minimum degree of a graph G is denoted by ???and the maximum degree is denoted by ?. If ?????????r for any graph G, we say G is a regular graph of degree r, or simply, G is an r-regular graph, i.e. all nodes have degree r. Figure 1.1 contains a 4-regular graph with V(G) = 16 We define a walk to be an alternating sequence of nodes and edges, beginning and ending with nodes, in which each edge is incident on the two nodes immediately preceding and following it. A walk is called a trail if all the edges are distinct, and a path if all the nodes are distinct. A path is called a cycle if it begins and ends with the same node. A spanning cycle is a cycle that contains all the nodes in V(G), and a graph is connected iff every pair of nodes is joined by a path. HAMILTONIAN CYCLES A graph is said to be Hamiltonian if it contains a spanning cycle. The spanning cycle is called a Hamiltonian cycle of G, and G is said to be a Hamiltonian graph (the graph in Figure 1.1 is also a Hamiltonian graph). A Hamiltonian path is a path that contains all the nodes in V(G) but does not return to the node in which it began. No characterization of Hamiltonian graphs exists, yet there are many sufficient conditions. We begin our investigation of sufficient conditions for Hamiltonicity with two early results. The first is due to Dirac, and the second is a result of Ore. Both results consider this intuitive fact: the more edges a graph has, the more likely it is that a Hamiltonian cycle will exist. Many sources on Hamiltonian theory treat Ore‘s Theorem as the main result that began much of the study of Hamiltonian graphs, and Dirac‘s result a corollary of that result. Dirac&#39;s result actually preceded it, however, and in keeping with the historical intent of this paper, we will begin with him. Theorem 1.1 (Dirac, 1952): If G is a graph of order n ??3 such that ? ??n/2, then G is Hamiltonian. As an illustration of Dirac‘s Theorem, consider the wheel on six nodes, W6 (Figure 1.2). In this . Traversing the nodes in numerical order 1-6 and back to 1 yields a Hamiltonian cycle. Theorem 1.2 (Ore, 1960): If G is a graph of order n ??3 such that for all distinct nonadjacent pairs of nodes u and v, deg (u) + deg (v) ? n, then G is Hamiltonian. The wheel, W6, also satisfies Ore‘s Theorem. The sum of the degrees of nonadjacent nodes (i.e., deg(2) + deg (5), or deg(3) + deg (6), etc.) is always 6, which is the order of the graph. Before we discuss the results of Nash-Williams and Chvatal and Erdos, we must first define the notions of connectivity and independence. The connectivity ???????(G) of a graph G is the minimum number of nodes whose removal results in a disconnected graph. For ????k, we say that G is k-connected. We will be concerned with 2-connected graphs, that is to say that the removal of fewer than 2 nodes will not disconnect the graph. For ??= k, we say that G is strictly k-connected. For clarification purposes, consider the following. Let G be any simple graph, ?=3. Then G is 3-connected, 2-connected, and strictly 3-connected. A set of nodes in G is independent if no two of them are adjacent. The largest number of nodes in such a set is called the independence number of G, and is denoted by ?. The following result by Nash-Williams builds upon the two previous results by adding the condition that G be 2- connected and using the notion of independence. Theorem 1.3 (Nash-Williams, 1971): Let G be a 2-connected graph of order n with ?(G) ??max{(n+2)/3, ?}. Then G is Hamiltonian. The graph in Figure 1.3 demonstrates the NashWilliams result. In this 2-connected graph on six  In the same paper, Nash-Williams presents another very useful result. Note that a cycle C is a dominating cycle in G if V(G – C) forms an independent set. Theorem 1.4 (Nash-Williams, 1971): Let G be a 2-connected graph on n vertices with ? ? (n+2)/3. Then every longest cycle is a dominating cycle. Another sufficient condition uses the notion of a forbidden subgraph, i.e., a graph that cannot be a subgraph of any graph under consideration. A subgraph of a graph G is a graph having all of its nodes and edges in G. The following result by Goodman and Hedetniemi introduces the connection between certain subgraphs and the existence of Hamiltonian cycles. A bipartite graph G is a graph whose node set V can be partitioned into two subsets V1 and V2 such that every edge of G joins V1 with V2. If G contains every possible edge joining V1 and V2, then G is a complete bipartite graph. If V1 and V2 have m and n nodes, we write G = Km,n (see Figure 1.4) Goodman and Hedetniemi connected {K1,3, K1,3 + x}-free graphs and Hamiltonicity in 1974. A {K1,3, K1,3 + x}-free graph is a graph that does not contain a K1,3 or a K1,3 + x (see Figure 1.5 ) as an induced subgraph. (i.e., the maximal subgraph of G with a given node set S of V(G).) Theorem 1.5 (Goodman and Hedefniemi, 1974): If G is a 2-connected {K1,3, K1,3 + x}-free graph, then G is Hamiltonian. The wheel, W6, in Figure 1.2, is an example of a graph that is {K1,3, K1,3 + x}-free. The subgraph formed by node 1 and any three consecutive nodes on the cycle is K1,3 plus 2 edges. A year after Nash-Williams‘s result, Chvatal and Erdos proved a sufficient condition linking the ideas of connectivity and independence. Theorem 1.6 (Chvatal and Erdos, 1972): Every graph G with n ??3 and ? ??? has a Hamiltonian cycle. Theorem 1.6 contains, as a special case, the following result: Theorem 1.7 (Haggkvist and Nicoghossian, 1981): Let G be a 2-connected graph of order nwith ? ??(n+??? /3. Then G is Hamiltonian. By requiring that G be 1-tough (which implies 2- connectedness), Bauer and Schmeichel where able to lower the minimum degree condition found in Theorem 1.7. Let ?(G) denote the number of components of a graph G. Then the toughness [20] of G, denoted by ???is defined as follows: We say G is t-tough for t ????G). It is important to note that all Hamiltonian graphs are 1-tough, but the converse is not true. The Petersen Graph (see Figure 1.7) is a 1-tough, non-Hamiltonian graph. Theorem 1.8 (Bauer and Schmeichel, 1991): Let G be a 1-tough graph of order n with ?(G) ??(n+?? - 2)/3. Then G is Hamiltonian By relaxing the minimum degree requirements, we lose Hamiltonicity. Fan later introduced distance as a contributing factor for Hamiltonicity. The distance, d(u,v), between two nodes u and v is the length of the shortest path joining them. Theorem 1.9 builds upon Dirac‘s result by adding a distance condition Theorem 1.9 (Fan, 1984): Let G be a 2- connected graph of order n. If for all nodes u,v with d(u,v) = 2 we have max {deg (u), deg (v)} ? n/2, then G is Hamiltonian. In Figure1.9 above, nodes u and v have distance 2. We can consider Dirac‘s Theorem as a neighborhood condition on one node. By requiring the connectivity to be 2, Fraudee, Gould, Jacobsen, and Schelp were able to consider the neighborhood union of 2 nodes. Theorem 1.10 (Fraudee, Gould, Jacobsen, Schelp, 1989): If G is a 2-connected graph such that for every pair of nonadjacent nodes u and v, Similarly, every pair of nonadjacent nodes satisfies the conditions of Theorem 1.11and G is Hamiltonian. Fraisse further expanded the set of nonadjacent nodes by requiring a higher connectivity. Theorem 1.11 (Fraisse, 1986): Let G be a kconnected graph of order n ??3. If there exists some t ? k such that for every set S of t mutually nonadjacent nodes, Closely related to neighborhood unions are degree sum conditions. These often lead to less strict conditions since the degree sum counts certain nodes twice, unlike the neighborhood conditions. For k ? 2, we define [3] Theorem 1.12 (Jung, 1978): Let G be a 1-tough graph of order n ? 11 with ?2 (G) ??n – 4. Then G is Hamiltonian. A year later Bigalke and Jung proved a result linking independence and minimum degree on 1- tough graphs. HAMILTONICITY IN 4-REGULAR,  1-TOUGH GRAPHS: Statement Bauer, Broersma, and Veldman in [1] consider the problem of finding the minimum order of a non-Hamiltonian, k-regular, 1-tough graph. We will attempt to prove the following conjecture: Conjecture 2.1: Let G be a 1-tough, 2-connected, 4-regular graph of order ? 17. Then G is Hamiltonian. Define an (n, k)-graph to be a non-Hamiltonian, k-regular, 1-tough graph on n nodes. By f(k) we denote the minimum value of n for which there exists an (n, k)-graph. Conjecture 2.1 is best possible for n = 17, since there exists an (18, 4)- graph (see Figure 2.1). Thus, we can restate Conjecture 2.1 as Conjecture 2.1 (Bauer, Broersma, and Veldman, 1990): f(k) = 18. Bauer, Broersma, and Veldman investigated this conjecture in [1]. They convinced themselves, through a lengthy distinction of classes, that the conjecture holds. No formal proof exists, however. In our attempt to prove this conjecture, we shall divide the graphs into subcases based on the number of nodes. Case 1: 5 < n Englishhttp://ijcrr.com/abstract.php?article_id=1391http://ijcrr.com/article_html.php?did=13911. Bauer, D., Broersma, H.J. and Veldman, H.J. On Smallest Non-Hamiltonian Regular Tough Graphs. Proceedings on the Twentieth Southeastern Conference on Combinatorics, Graph Theory, and Computing, Congr. Numer. 70 (1990), 95-98. 2. Bauer, D. and Schmeichel, E. On a theorem of Haggkvist and Nicghossian. Graph Theory, Combinatorics, Algorithms and Applications. (1991) 20-25. 3. Bauer, D., Schmeichel, E. and Veldman, H.J. Some Recent Results on Long Cycles in Tough Graphs. Off Prints from Graph Theory, Combinatorics, and Applications. Ed. Y. Alavi, G. Chartrand, O. R. Ollermann, A. J. Schwenk. John Wiley and Sons, Inc. (1991) 4. Bigalke, A. and Jung, H. A. Uber Hamiltonische Kreise und Unabrhangige Ecken. Graphen Monatsch. Math 88 (1979) 195-210. 5. Bollabas, B. and Hobbs, A. M. Hamiltonian cycles. Advances in Graph Theory. (B. Bollabas ed) North-Holland Publ., Amsterdam, 1978, 43-48. 6. Chartrand, G. and Oellermann, O. R. Applied and Algorithmic Graph Theory. New York: McGraw Hill, 1993. 7. Diestel, R. Graph Theory. New York, Springer, 1997. 8. Erdos, P. and Hobbs, A. M. A class of Hamiltonian regular graphs. J. Combinat. Theory 2 (1978) 129-135. 9. Fan, G. H. New Sufficient Conditions for cycles in graphs. J. Combinat. Theory. B37 (1984) 221-227. 10. Fraisse, P. A New Sufficient Condition for Hamiltonian graphs. J. of Graph Theory. Vol. 10, No. 3 (1986), 405-409.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareCERVICAL TRACTION REDUCES PAIN AND DISABILITY IN PATIENTS WITH UNILATERAL CERVICAL RADICULOPATHY English3441Subhash Chandra RaiEnglish Ajith S.English K.R. BhagavanEnglish Deepak PintoEnglishBackground and purpose: Cervical radiculopathy is a common clinical diagnosis classified as a disorder of nerve root and is a pathologic process consisting of pain. A multitude of physical therapy intervention has been proposed to be effective in the management of cervical radiculopathy, including mechanical cervical traction, manipulation, therapeutic exercises and modalities. The aim of the study is to find out the effectiveness of cervical traction along with conventional therapy in the management of cervical radiculopathy. Study Design: Experimental Materials and Methods: Subjects were assigned randomly to one of two groups, each group consisting of 15 subjects. Group I, received TENS and cervical neck exercise. Group II received TENS, cervical neck exercise and intermittent cervical traction. Pre post assessment is done by Neck disability index (NDI) and Visual analogue scale (VAS) Results: The pre test evaluation showed that, there is no significant difference (P> 0.05) between the two groups for all the variables measured. The post-test evaluation of both groups showed a very high significance (P< 0.05) within the group for all the outcome measurements. A post-test comparison of measured variables, between the groups showed that the Group II demonstrated a statistically significant (P< 0.05) reduction in self rated pain and Neck Disability Index.  Conclusion: The authors concluded that, even though TENS and neck exercise are effective, the addition of intermittent cervical traction with TENS and exercise is even more effective in the management of cervical radiculopathy and that ICT should have a place in the management of cervical radiculopathy. EnglishCervical radiculopathy, intermittent cervical traction, Conventional therapyINTRODUCTION Cervical radiculopathy is a common clinical diagnosis classified as a disorder of nerve root and is a pathologic process which has been defined as pain in the distribution of a specific cervical nerve root caused by nerve root compression from a space occupying lesion such as disc herniation, spondylitic spur, or cervical osteophyte1,2,3 . In a more in depth definition, it encompasses important symptoms other than pain, such as paresthesia, numbness and muscle weakness in dermatomal or myotomal distribution of an affected nerveroot. 4 Cervical radiculopathy is one of the most common health related complaints. 5, 6, 7 . Cervical disk herniation and cervical spondylosis have been described as the main causes of cervical radiculopathy in the literature8,9, and the most frequently involved nerve roots are cervical 6 (C6) and cervical 7 (C7) roots which are typically caused by C5-C6 or C6-C7 disc herniation or spondylosis7,10 . Although patients with cervical radiculopathy may have complaints of neck pain, the most frequent reason for seeking medical assistance is arm pain. 11, 12 . The first choice of management of cervical radiculopathy is non-operative, and various noninvasive interventions have been used with mixed results. The usual treatment of choice is physiotherapy, though in recent years manual therapy is being increasingly used, again with mixed outcomes and probably with an element of risk13. A multitude of physical therapy intervention has been proposed to be effective in the management of cervical radiculopathy, including mechanical cervical traction, manipulation, therapeutic exercises and modalities14, 15 . There are no studies to support or reject the above protocols and also to establish the superiority of one over the other. Further, a combination of TENS, cervical traction and cervical exercise in the management of cervical radiculopathy might give better results than any one of the protocols alone. However there is no comparative study done to find out the effectiveness of conventional therapy versus conventional therapy combined with mechanical intermittent cervical traction on cervical radiculopathy so the aim of our study is to compare the effects between the conventional physiotherapy and intermittent mechanical traction with effects of using conventional Physiotherapy alone on unilateral cervical radiculopathy. MATERIALS AND METHODS This study was approved by the Institutional Ethical Committee. 30 subjects from the outpatient department of a teaching hospital, who were diagnosed by the orthopedic surgeon as having unilateral cervical radiculopathy, were selected for the study. The diagnosis was confirmed by assessment with the special tests for unilateral cervical radiculopathy; the subjects were assigned to one of two groups using random sampling method. Both groups consisted of 15 subjects each of both gender .All the patients selected for the study were in the age group 45 to 65 years. We included the subjects with patients diagnosed of having unilateral cervical radiculopathy, unilateral arm pain lasting more than one month, positive foraminal compression test, positive maximal cervical compression test, positive cervical distraction test, and positive Jackson’s compression test. We excluded the subjects with previous cervical fractures or dislocations, cervical tumors, whiplash injuries, spinal cord injury and disorders, bilateral cervical radiculopathy or unilateral radiculopathy lasting less than one month, patients who had undergone spinal surgeries, structural defects of the vertebral column, infective or inflammatory arthritis of the vertebral column, Pott’s spine, osteoporosis, cervical sprain or strain, vertebro-Basilar insufficiency, brachial plexus lesions, thoracic outlet syndrome, spinal deformities, patients with cardiovascular instability and patients with cognitive problems. Interventions Group I was treated with Transcutaneous Electrical Nerve Stimulation (TENS) and active neck exercises. TENS was applied with the patient in prone position, we selected pulsed current with rectangular, monophasic shape of pulse, pulse duration was 0.1 msec with pulse frequency of 4pps, and we gradually increased the amplitude until a strong muscle contraction was produced. The duration of treatment was 30 minutes with the frequency of five times/ week for two weeks. Active neck exercise for strengthening was given for the superficial neck flexor, deep neck flexor, lower and middle trapezius, serratus anterior and isometric neck exercises.  Group II was treated with traction, active neck exercises and TENS.the protocol for TENS and active exercise was same as for Group I. Traction was given in supine lying, with a towel roll kept under the neck to maintain the neck in 15 degree flexion. A traction force of 1/10 of the body weight in kg was applied. Traction hold time was set at 40 seconds and rest time at 10 seconds. Duration of traction was 15 minutes/day. The frequency of treatment was 5 days/week for two weeks. Outcome measurements All the subjects were evaluated for level of self reported pain and neck disability before the commencement of interventions and at the end of two weeks of interventions. Pain was measured using a 100 mm Visual Analogue Scale(VAS). The subjects were told to mark the intensity of the pain perceived on the scale. Neck disability was measured using the Neck Disability Index (NDI). Statistical Analysis The collected data were analyzed using the statistical tests. The data collected by NDI were analyzed using parametric tests as the data was interval in nature. The intra group pre and posttest data for NDI were analyzed using paired ttest, while the post-test inter group data were analyzed with unrelated t-test. The data collected by visual analog scale were analyzed using non-parametric tests as the data is ordinal in nature. The intra group pre and posttest VAS scores was analyzed using Wilcoxon signed rank test, and post-test inter group VAS scores were analyzed with Mann Whitney U-test. The statistical significance or the P value for all the analyzed data was fixed at 0.05. RESULTS The mean age for Group I was 56.46±6.19 and Group B was 53.66±6.52 as shown in Table1.Group I consisted of 15 subjects (n = 15), with a gender distribution of 8 males (54%) and 7 females (46%). Group II also consisted of 15 subjects (n=15) and a gender distribution of 9 males (60%) and 6 females (40%). These data were presented in Table-2. The mean and the standard deviation (SD) of pre and post-test NDI scores for both, Group I and Group II are presented in Table -3. Compared with the base line, the post-test mean NDI score for Group I was 11.14±4.15 and Group II was 9.06±4.18.The intra group pre and post-test analysis of the NDI score in Group I shows a mean difference of 5.73 (t = 10.62, p= 0.00), which is highly significant statistically (p < 0.05). These results are presented in Table-4.The intra group pre and post-test analysis of the NDI score in Group II shows a mean difference of 7.8 (t = 11.51, p= 0.00), which is highly significant statistically (p < 0.05). These results are presented in Table-5. The results presented in Table -6, and Fig-1 shows the post-test comparison of the NDI scores between Group I and Group II. Group II shows a higher mean difference of 2.07 (t= 2.3, p = 0.03) than Group I which is statistically significant (P>0.05). The mean and the standard deviation (SD) of pre and post-test VAS scores for both, Group I and Group II are presented in Table-7. Compared with the base line, the post-test mean VAS score for Group I was 2.0±1.4 and Group II was 2.13±1.45.The intra group pre-post test comparison of VAS score for group I (z= -3.447, p= 0.001), shows a statistically highly significant reduction (PEnglishhttp://ijcrr.com/abstract.php?article_id=1392http://ijcrr.com/article_html.php?did=13921. Ellenberg MR, Honet JC, Treanor WJ. Cervical radiculopathy. Arch Phys. Med Rehabil. 1994; 75:342-352. 2. Wainner RS, Gill H: Diagnosis and non operative management of cervical Radiculopathy: J Orthop Sports Phys.Ther. 2000 Dec; 30(12):728-44. 3. Farmer JC, Wisneski RJ. Cervical spine nerve root compression. An analysis of neuroforaminal pressures with varying head and arm positions. Spine. 1994;19:149-158. 4. Garvey TA, Eismont FJ. Diagnosis and treatment of cervical radiculopathy and myelopathy. Orthop-Rev. 1991; 10:595-603. 5. Kondo K, Molgaard CA, Kurland LT, Onofrio BM. Protruded intervertebral cervical disc: incidence and affected cervical level in Rochester, Minnesota, 1950 through 1974. Minn Med. 1981; 64:751-53. 6. Radhakrishnan K, Litchy WJ. O Fallon WM, Kurland LT. Epidemiology of Cervical radiculopathy. A population based study from Rochester, Minnesota, 1976 through 1990. Brain 1994; 117(2): 325-335. 7. Hunt WE, Miller CA. Management of Cervical radiculopathy. Clin Neuro-Jur. 1986; 33:485-502. 8. Yu YI, Woo E, Huang CY, Cervical Spondylotic myelopathy and radiculopathy. Acta Neurol Scand. 1987; 75: 367-73. 9. Abdulwahab S. The effect of reading and traction on patients with cervical radiculopathy based on electrodiagnostic testing. J Neuromusculoskeletal Syst. 1999; 7:91-96. 10. Henderson C, Hennessy R. Posterolateral foraminatomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983; 13:504. 11. Daffner SD, Hilibrand AS, Hanscom BS, Brislin BT, Vaccaro AR, Albert TJ. Impact of neck and arm pain on overall health status Spine.2003; 28; 2030-2035. 12. Honet JC, Puri K. Cervical radiculitis: treatment and results in 82 patients. Arch Phys Med Rehabil.1976; 57:12-16. 13. Moffett J, McLean S. The role of physiotherapy in the management of nonspecific back pain and neck pain. Rheumatology. 2006; 45(4): 371-378. 14. Cleland JA, et al: Manual Physical therapy Cervical traction, and strengthening exercise in patients with cervical radiculopathy: a case series: J Orthop Sports Phys. Ther. 2005; 35(12):802-11. 15. Nadler SF. Nonpharmacologic management of pain. JAOA. 2004; 104(11): 6-12. 16. Low J, Reed A. Electrotherapy explained: Principles and Practice. Oxford: ButterworthHeinmann; 2000:113-114. 17. Carrol EN, Badura AS. Focal intense brief transcutaneous electric nerve stimulation for treatment of radicular and postthoracotomy pain. Arch Phys Med Rehabil. 2001; 82:262- 4. 18. Chiu TT, Hui-Chan CW, Chein G. A randomized clinical trail of TENS and exercises for patients with chronic neck pain. Clin Rehabil.2005; 19(8):850-60. 19. Sluka KA, Bailey K, Bogush J, Olson R, Ricketts A. Treatment with either high or low frequency TENS reduces the secondary hyperalgesia observed after injection of kaolin and carrageenan into the knee joint. Pain. 1988; 77(1): 97-102. 20. Nordemer R, Thorner C. Treatment of acute cervical pain – a comparative group study. Pain. 1981; 10(1):93-101 . 21. Joghatataei MT, Arab AM, Khaskar H. The effect of cervical traction combined with conventional therapy on grip strength on patients with cervical radiculopathy. Clin Rehabil. 2004; 18:879-887. 22. Olivera WC, Dulebohn SC. Results of halter cervical traction for the treatment of cervical radiculopathy: retrospective review of 81 patients. Neurosurg Focus. 2002; 12: clinical part 1. 23. Swezey RL, Swezey AM, Warner K. Efficacy of home cervical traction therapy. Am J Phys Med Rehabil. 1999; 78(1): 30-32. 24. Cleland JA, et al: Manual Physical therapy Cervical traction, and strengthening exercise in patients with cervical radiculopathy: a case series: J Orthop Sports Phys Ther. 2005; 35(12):802-11. 25. Graham N, Gross AR, Goldsmith C. Mechanical traction for mechanical neck disorders: A systematic review. J Rehabil Med. 2006; 38(3): 145-152. 26. Nikander R, Malkia E, Parkkari J, Heinonen A, Starck H, Ylinen J. Dose-response relationship of specific training to reduce chronic neck pain and disability. Med Sci Sports Exerc. 2006; 38:2068-2074.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareANATOMICAL VARIATIONS OF LONG TENDONS OF THE THUMB English4246Anjali S. SabnisEnglishThumb has attained a lot of attraction because of its functional significance. In today’s hitechnical era thumb movements have become prime movements which are possible because of the thenar muscles, Extensor pollicis longus (EPL), Extensor pollicis brevis (EPB) and Abductor pollicis longus (APL). Variations in their arrangement, number, origin and insertion are very important in thumb surgery. 50 upper limbs of 25 cadavers of unknown sex were studied to find out any variations in EPL, EPB and APL. In four cadavers we have found variations in EPL, EPB and APL unilaterally. EnglishEPL, EPB, APL, Supernumerary extensor tendons of thumb, Extensors of thumb.INTRODUCTION Thumb being highly evolved structure of the body carries incredible importance. EPL, EPB and APL contribute in skillful and smooth functioning of thumb. EPL arises from lateral part of middle third of posterior surface of the shaft of the ulna and from adjacent interosseous compartment and it is attached to the base of the distal phalanx of the thumb. APL arises from posterior surface of the shaft of the ulna, adjoining interosseous membrane and from the middle third of the posterior surface of the radius and then splits into two slips, one is attached to radial side of the first metacarpal base and other to the trapezium. EPB arises from posterior surface of the radius distal to the abductor and from the adjacent interosseous membrane and inserted on dorsolateral base of the proximal phalanx of the thumb (1). EPL carries out extension of terminal phalanx of the thumb, APL causes extension of thumb at carpometacarpal (CMC) joint, abduction and flexion of wrist joint and EPB causes extension of CMC and metacarpophalageal joint (2). Variations in relation to their structure, number, origin and insertion are not rare. Such variations continue to create interest in hand surgeons, anatomists and physiotherapists. Presence of any supernumerary tendon would be useful for tendon transfer without hampering the functioning of thumb. By keeping aim in the mind to find any variations in the muscles of thumb we carried out a study on 25 cadavers. MATERIAL AND METHODS 25 embalmed cadavers of unknown sex were obtained from department of anatomy. The extensor aspect of forearm and hand was dissected to study muscles of forearm and hand. EPL, APL, EPB were identified according their location, origin and insertion. Vessels and nerves in relation to them were identified. RESULTS In four cases we found variations in EPL, EPB and APL on unilateral sides. All the muscles were supplied by posterior interosseous nerve. On the other side of variation the muscles maintain normal anatomy in relation to origin, insertion and structure. 1. On the left side duplication of EPB originating from lower one third of ulna, one tendon of EPB is inserted on base of proximal phalanx and other is inserted on base of 1st metacarpal bone. EPL was inserted on base of proximal phalanx in addition to normal insertion that is base of distal phalanx. (Fig 1) 2. On the right side EPL was bifurcated at dorsal aspect of 1st metacarpal bone and inserted on base of distal phalanx. EPB maintains normal anatomy. APL was duplicated and its one tendon was inserted on base of proximal phalanx and other was inserted on base of 1st metacarpal bone. (Fig 2) 3. On the left side EPL maintains normal anatomy but EPB was inserted on base of distal phalanx instead of proximal phalanx. APL showed triplication and all the tendons inserted on base of the 1st metacarpal bone.(Fig 3) 4. On the right side EPL maintains normal anatomy but EPB joins tendon of EPL and was inserted on base of distal phalanx. APL trifurcates and inserted on base of 1st metacarpal bone.(Fig 4) DISCUSSION Human thumb plays a crucial role in the smooth functioning of the hand. The muscles like EPL, EPB and APL achieve great importance in the movement of thumb. Wide literature is available regarding the variations in number, origin and insertion of muscles. Usually there are incidental findings during routine cadaver dissection and autopsies (3). Presence of multiple tendons may alter the kinematics around the site of attachment to the phalanx (4). The number, thickness and length of such accessory tendons have a functional significance in the development of de Quervain’s stenosing tenosynovitis (5). de Quervains disease is caused by stenosing tenosynovitis of 1st dorsal compartment of the wrist which includes the tendons of APL and EPB. Patient usually complains of pain at the dorsolateral aspect of wrist radiating towards the thumb or lateral forearm (6). Tenosynovectomy in de Quervain’s disease gives good result (7). EPB commonly has an additional attachment to the base of the distal phalanx, usually through a fasciculus which joins the tendon of EPL (1).We found duplication of EPB originating from lower one third of ulna, one tendon of EPB is inserted on base of proximal phalanx and other is inserted on base of 1st metacarpal bone (Fig1). EPB was inserted on base of distal phalanx instead of proximal phalanx. (Fig 3) and EPB joins tendon of EPL and was inserted on base of distal phalanx (Fig 4). EPB often shows doubling either at the wrist or on the dorsum of the thumb. In 72% of cases EPB is inserted into proximal phalanx, in 6.8% entirely on distal phalanx and in 21.2% it is inserted on both the phalanges (8). EPB was present in all the cases studied and doubling was found in 17 cases (15.4%). It was found to be attached to proximal phalanx in 58.15%, to the distal phalanx in 27.5% and to both the phalanges in 14.6% (9). Variations in EPL are rarely seen. Double extensor pollicis longus tendon found during a dorsal approach to the wrist for rheumatoid arthritis. The accessory tendon was located in an additional separate wrist dorsal compartment, which is an extremely rare arrangement (10).We found that EPL was inserted on base of proximal phalanx in addition to normal insertion that is base of distal phalanx (Fig 1) and EPL was bifurcated at dorsal aspect of 1st metacarpal bone and inserted on base of distal phalanx (Fig 2). EPL originated from lateral part of middle third of posterior surface of the shaft of the ulna and from adjacent interosseous compartment in both the cases. On the other side three muscles showed normal anatomy Ample of variations are commonly seen in number of tendon slips of APL. These tendon slips which have been reported are four (11), seven (12) and nine in number (13). We found that in all the cases APL was present. APL was duplicated and its one tendon was inserted on base of proximal phalanx and other was inserted on base of 1st metacarpal bone. (Fig 2), APL showed triplication and all the tendons inserted on base of the 1st metacarpal bone (Fig 3, 4). Variations are seen in the insertion of tendon as on fascia on abductor pollicis brevis (11) opponens pollicis, thenar fascia and trapezium (13). The anomalies related to the extensor muscles are commonly due to an embryological developmental defect related to the developing extensor sheet of the forearm (14). Surgical and academic significance has created interest in hand surgeons and anatomists. Supernumerary tendons of thumb may create confusion during surgery and invite unwanted complications. Existence of such variations in the human beings may be a result atavism. Hence presence of such varianta also underlines the anthropological importance (13). The anatomical knowledge of the arrangement of extensor tendons and its morphological variations is important for hand surgeons performing tendon transfer and reconstructive surgery. CONCLUSION 1. Incidence of variations of long tendons of thumb is 8% in the present study. (Out of 50 upper limbs, in 4 upper limbs variations in EPL, EPB, and APL are seen unilaterally). 2. Such variations may create confusion and so should not be ignored. 3. Awareness of such variations will be helpful in the reconstructive surgery of hand and supernumerary tendons are useful for tendon transfer. 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=1393http://ijcrr.com/article_html.php?did=13931. Susan Stanrmy, Grays Anatomy, 39th edition, Philadelphia: Churchill Livingstone; 2004, 851-852 2. Chummy Sinnatamby, Lasts Anatomy Regional and applied, 2000, 10th ed, Churchill Livingstone, Edinburgh, 73-74. 3. Srijit Das, The additional tendon of extensor digitorum muscle of hand: an anatomical study with a clinical significance, Bratisl Lek, Listy 2008;108 (12) 584-586 4. Shipra Paul Anomalous Extensor tendons of hand: A case report with clinical importance. Colombia media, 2007,38,2 April June 10 5. Kulthanan T, Variations in abd pollicis longus and ext pollicis brevis tendons in the Quervains a surgical and anatomical study Scand J Plast Res Surg Hand ,2007;41,38-39 6. Nayak SR ,Multiple supernumerary muscles of arm and its clinical significance Bratisl Lek, Listy 2008;109(2) :74-75 7. Melling M supernumerary tendons of abd pollicis, Acta Anat (Basel),1996,155(4),291- 4 8. Hollinshead WH: Anatomy for surgeons,3rd ed, Vol III, Harper and Row Publishers Philadelphia,1982, 423-426 9. Joshi S.S Dorsal Digital Expansion of Thumb Anat Soci of India, 2008, 57 (2) 135-139. 10. N. Sevivas, Double extensor pollicis longus tendon in independent extensor compartments: A case report of an anatomical variation requiring alteration of surgical strategy, Chirugie de la Main, 28(3), 2009, 180–182 11. Martinez R, Bilateral subluxation of the base of the thumb secondary to an unusual abductor pollicis longus insertion: a case report, J Hand surgery(Am), 1985, 10, 396- 399 \ 12. Sarikeioglu L, Bilateral abductor pollicis longus muscle variation, Case report and review of the literature, Morphologie, 2004, 88, 160-163 13. Dil Islam Mansure, Multiple tendons of abductor pollicis longus, International Journal of Anatomic Variations, 2010, 3, 25- 28 14. Abu-Hijdeh MF, Extensor pollicis tertius: an additional extensor muscle to the thumb. Plast. Reconstru Surg 1993:92;340-343

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareNUTRITIONAL PROFILE OF SELECTED DESTITUTE WOMEN IN COIMBATORE DISTRICT English4757Gomathi K.English Yegammai C.EnglishBackground: India women’s health and nutrition is inextricably linked to social, cultural and economic factors 2. The destitute women are more vulnerable to disease and deficiency disorder due to poverty, homelessness, stigmatization and exclusion from many aspects of normal life hence present study aims to assess the nutritional status of destitute women. Methods: Pre tested interview scheduled was administrated in person to the destitute women by the investigator and t test was used to interpreted the results. Results, Majority (30.4 per cent) of the women became destitute due to widowhood, and The diets of all the destitute women irrespective of the age group were found to be deficient in protein Conclusions, The main findings are were destitute women are suffering from many psychological problems. The nutritional status is below the average Indian women. EnglishDestitute women, Interview schedule, Anthropometric, BiochemicalINTRODUCTION A destitute woman is defined as a female suffering from lack of basic necessities for life, extremely poor and without adequate support from family or husband or other relatives 1 . In India the nutrition and health status of women is abysmally low. The National Nutrition Monitoring Bureau survey shows that women’s calorie requirement after the age of 10 years is not adequately met. The poor health status of women in India is mainly due to patriarchy and other socio-cultural constraints leading to poor health. It is a bitter reality that in India women’s health and nutrition is inextricably linked to social, cultural and economic factors 2 . The destitute women are more vulnerable to disease and deficiency disorder due to poverty, homelessness, stigmatization and exclusion from many aspects of normal life 3 Objectives:To  Assess their nutritional status  Estimate their biochemical profile  Assess the nutritional knowledge among destitute women METHODOLOGY Sample A destitute woman is defined who as a result of family tension or discord are made to leave their homes without any mean of subsistence and have no social protection from exploitation and are facing litigation on account of marital disputes (CSWB, 2005). Having this as the criteria, 500 destitute women were chosen. The destitute women were selected from the following homes of Coimbatore, Annai Illam, A Loving Home for Destitute Aged Women, Ondipudur, Aravanaikum Anbu Illam, Home for the Old Age, Thanneer Pandal, Mariyalaya Rehabilitation Home for Young Girls and Women in Distress, Anuparpalayam, Missionaries of Charity, Home for the Dying Destitutes, Ramanathapuram, Neyam Old Age Home, Vadavalli, Ram Aravinder Old Age Home, Vadavalli, St. Joseph Home for Aged Destitute, Podhanur, St. Thoms Old Age Home, Ramanathapuram, Thayakam Home for Women in Difficulties, Singanallore, The Coimbatore District Welfare Association, Senior Citizen Home, Matthipalayam and Tsunami Rehabilitation Centre, Koundampalayam. Scales used 1. An interview schedule is the name usually applied to a set of questions which are asked and filled in a face to face situation with interviewer. The interview method is said to be the easiest and most reliable method of collecting data. Hence an interview schedule was designed to elicit information regarding socio-economic background, food habits, psychological and social problems. Procedure With the help of the Central Social Welfare Board (CSWB) the investigator identified and established rapport with the destitute women in the selected homes based on judgment sampling method. The willingness and consent was obtained from the subjects prior to the survey. Information regarding the socio-economic background, food habits, and psychological, behavioral and social problems were collected from the subjects by direct interview method. Three day weighment method was carried out in all homes and the individuals food intake was also noted and the food and nutrient intake of the individual were calculated. Anthropometric measurements like height, weight, waist and hip circumference were recorded and Body Mass Index (BMI) was calculated and Waist Hip Ratio (WHR) and skin fold thickness were measured. Since anaemia is a common problem among woman, the blood haemoglobin (g/dl) was analysed for all the 500 destitute women using cyanmethaemoglobin method. The prevalence of diabetes is increasing around the world at a rate that appears so dramatic as to have been characterized as an epidemic (Kelley, 2003). So the random blood glucose was analysed for ten pre cent (50) of sub sample by glucose oxidase method (NIN, 2003). Women appear to be at particular risk as the gender advantage for coronary heart disease is counter balanced by an increased incidence of obesity and diabetes (Pradhan et al., 2003). So serum total cholesterol was analysed for ten per cent of (50) subsamples by Zaks method (NIN, 2003). Biochemical parameter like hemoglobin and fasting and post prandial blood glucose levels was analyzed. Clinical assessment was done with a help of a registered medical practioneer a thorough examination of all the destitute women, for the presence or absence of clinical symptoms was noted using ICMR schedule. RESULTS AND DISCUSSION Of the selected destitute women, majority (30.4 per cent) of the women became destitute due to widowhood. Twenty five per cent of the selected women were destitute as they did not have children and they were sent out of their family. It is viewed from the figure that around 18.4 per cent of the destitute women were mentally retarded. Many of their parents and other family members did not want to take care of the mentally retarded patients, hence they were destituted. Majority (29.2 per cent) of the women live as destitute for more than 16 years. This might be due to the reason that they became destitute in their early part of their life (during childhood or adolescence). Goffman (1995) study is in line with the present study, which indicates that out of 161 destitute inmates, who were staying in the Mahila Mandirs of Kerala, 141 were elderly and 20 were adult women whose childhood had been spent in institution. Type of menu followed by the homes High percentage (62.8) of the destitute women reported that their menu was prepared depending on the availability of foods. This shows the low purchasing power of the destitute homes. About 25.8 per cent of selected destitute women mentioned that they had cyclic menu. Only 12.2 per cent of the destitute women said that they had variety in their menu. Most of the destitute homes did not provide adequate amount of fruits, green leafy vegetables, milk and milk products and other vegetables. The only source of fruit in the diet of these destitute women was Tomato. But among the eleven homed surveyed, only two homes rationed the food supply and all the other homes served the required amount of cereal preparations but limited amount of vegetable preparations (poriyal or kootu). Only the left over dhal or sambar of lunch was served with rasam during dinner in many of these homes. It is discouraging to note that the intake of cereal (8-11.3 per cent) was higher than the recommended allowances by adult women and this may result in over weight or obesity. According to American Dietetic Association (2000) older adults experience a decrease in appetite (Anorexia of ageing) and consume less food than younger adult. Similar results were obtained in the study among 100 elderly people by Thirumanidevi and Prapullakumari (2005) in which there was 12 per cent and 27.5 per cent deficit of cereals and pulses respectively. The higher cereal intake is due to the cereal based menu which is provided by the destitute home. NNMB report (1991) showed that the average intake of cereals and millets was 490g, pulses 32g, roots and tubers 40g, green leafy vegetables 11g, other vegetables 49g, milk and milk products 96ml, fats and oils 13g and sugar 29g by the Indian women. When compared with the average Indian women, these selected destitute women consumed lesser amounts. The deficit was highest (76.6-86.6 per cent) with regard to milk and milk products. Hemalatha et al., (2005) stated that expenditure on milk and milk products occupied the least priority among low income group women. Similar trend was also observed in the present study where higher deficit was noted due to inadequate supply in the destitute homes. When compared with the adult women, the elderly women (60 and above) had higher percentage of deficit in the consumption of fruits (88-91 per cent) followed by other vegetables (81.3-89.3 per cent), roots and tubers (80-82 per cent) and milk and milk products (78.3-82 per cent). Consumption of green leafy vegetables was also very less compared to recommended allowances. The deficit ranged from 57 to 80 per cent. The consumption of protective foods like all types of vegetables and fruits were very low due to lack of these foods in the diet of destitute women. A study conducted by Sivard (1995) lines with present study revealing that around 85 per cent deficit of green leafy vegetables in the diet of 366 institutionalized destitute women in Kerala. This slight lower deficit may be due to the fact that few destitute homes had kitchen gardens. The percentage deficit of roots and tubers was 60-75 per cent followed by other vegetables (54-72 per cent), fruits (26-65 per cent), protein (36.6-46.6 per cent), sugar (10-14 per cent) and fats and oils (10-25 per cent) in the diets of the 18-59 year old destitute women. Thus destitute women failed to maintain adequate diet. When compared with 60 to 74 year group women, above 75 years had a greater deficit in all the food groups .This is due to the fact that with ageing process, several physiological and metabolic changes occur. Low appetite as a result of decreased physical activity and dental problems may also lead to overall reduction in the consumption of meat, fruits and all types of vegetables Mean Nutrient Intake Intake of energy was found to be marginally less (2.8-6.4 per cent) than the recommended level in all the age groups except 24 per cent deficit in 55-59 year women. The energy intake of the elderly destitute women was lesser than the RDA. This finding is in accordance with Kauwell et al., (1999) who states that many oldest old (> 80 years) do not consume enough food at meals to meet their energy and nutrient requirements. As the age increases the energy intake decreases. (24.7 and 35.4 per cent by 60-74 and above 75 year aged women). The diets of all the destitute women irrespective of the age group were found to be deficient in protein .Higher (42.5) percentage of deficit of fat intake was observed in the diet of 18-24 year age women. All the other age group women showed a marginal deficit ranging from 3 to 17.5 per cent. According to Sharma (2000), the least adequately supplied nutrients in the diet of Indian elderly are calcium, Iron, vitamin A, and niacin along with energy. The percentage deficit of calcium was 64.5, 71.5, 66.4, 69.9 and 44.6 in the diets of 18- 24, 25-34, 35-44, 45-54, 55-59 year women respectively. Tobias (2004) also found that due to low intake of calcium throughout the life cycle of Indian women, the lumbar spine and femoral neck bone mineral density was lower than Caribbean women. Iron intake was also below the recommended allowances in all the age groups and the deficit ranged from 27.3-57.3 per cent. The other vital haemopoitic nutrient, folic acid was also lesser than the RDA and the deficit was 42.7, 50, 46.2, 47.6 and 51.2 per cent in the age group of 18-24, 25-34, 35-44, 45-54 and 55-59 year women respectively. Thus the cause of prevalence of anaemia is well established. Hoc (1999) suggested that women over 51 year of age and older should consume food fortified with folic acid and vitamin B12. He also reported that 10-30 per cent of older adult women have protein bound vitamin B12 mal absorption. Vitamin B12 intake among the destitute women in the present study was very less compared to normal women and the deficit ranged from 62 to 77 per cent. When compared with other vitamins, the intake of ? carotene was far below the ICMR allowances. This is due to the fact that only negligible amount of protective foods were provided by the destitute homes. It is very clear from the Table that the intake of all the nutrients was lesser than the RDA among elderly women also. Another fact is that as the age increases the deficit is also increases. This is due to the reason that their food intake is very much reduced. It is also found that maximum deficit was found with regard to the vitamin B12 (78 and 81 per cent) followed by calcium (76.1 and 76.4), Thiamine (75.1 and 78.6), ? carotene (73.8 and 74.0), vitamin (55.2 and 58), riboflavin (53.6 and 54.3), folic acid (52.9 and 53.3), iron (33 and 34) and niacin (25.8 and 32.1 per cent) by 60-74 and above 75 year aged women. Taste and smell dysfunction tends to begin around 60 year of age and becomes more severe in persons over 70. Hearing loss, impaired vision and loss of coordination are common in elderly. Income is often inadequate and elderly women may be forced to live under low socio economical status which also affects their food intake. Anthropometric Measurements Mean Height -Table III gives the details of mean height of the selected destitute women. The height of the selected destitute women was lesser than that of NCHS Standard (2002). But the deficit was higher (9.7Cm) in the 18-24 year old women. A study by Haffman et al., (1985) revealed that there is eight cm difference in height when compared to the standard height among the Bangladesh women in the age of 18- 25. The difference was more compared to the normal women in the above study. This might be due to the fact that there was lack of adequate nutrition during growth spurt because of destitution. Mean Weight - Table IV presents mean weight of the selected destitute women. The mean weight of the destitute women was also lesser than the reference standard. But a higher (17.8 kg) difference was observed in the elderly when compared with all the other age groups. The deficit in weight ranged from 7 to 17.3 per cent. Siedell and Visher (2000) also reported similar observations in their study on the elderly, i.e., there was 14 kg difference than standard weight of the elderly, with increasing age and there was a declining trend in both heights and weights of the elderly. Because of destitution there may be a greater deficit in the present study than normal elderly women. Destitute women are more prone to weight loss due to depression. Depression can affect appetite dietary intake, digestion and weight status. Body mass index( BMI) Details of BMI the selected destitute women are presented in Table V. It is saddening to note that only 12 per cent of the adult and middle age and four per cent of the elderly destitute women have the normal BMI and 17.8 per cent of the adult and middle age women were in the grade of low normal. About 11.2 per cent of the destitute women were suffering from I degree chronic energy deficiency. Only a negligible per cent (0.8 and 1.4) were in the grade of obesity I and II. Among the elderly destitute women, majority 24.4 per cent were in the grade of low normal and 18.4 per cent were in the I degree chronic energy deficiency, 5.6 per cent and 0.4 per cent were in II degree and III degree chronic energy deficiency. When compared with middle age, the prevalence of chronic energy deficiency was more in the elderly destitute women. Wadhwa et al., (1997) also reported that elderly become vulnerable to malnutrition owing to inappropriate dietary intake, poor economic status and social deprivation. Statistically a 5 per cent significant relationship was observed in the BMI among the two age groups. Waist Hip Ratio and skin fold thickness Details of Waist Hip Ratio and Skin fold thickness of the selected destitute women are depicted in Table VI. The Waist Hip Ratio was higher in adult and middle age destitute women compared to the standard value, because in this age group 2.2 per cent of them were found to be obese. But the elderly destitute women had lesser Waist Hip Ratio when compared with the reference value. De Groot et al., (1991) observed a consistently lower Waist Hip Ratio in elderly women than in men. The mean skin fold thickness was found to be very less (9.1mm) in elderly destitute women because, the fat depletion occurs with increasing age. Biochemical Estimation Table VII shows the mean haemoglobin, random blood sugar, serum total cholesterol levels of the selected destitute women The mean blood haemoglobin level of the selected destitute women was found to be lower than the reference value. There is significant difference between the adult and elderly women. According to Mahan and Stump (2004) also the iron deficiency anaemia is uncommon in older adults than in younger people especially in women after menopause. NNMB report (1991) showed that 33.8 per cent of women in the age group of 25-44 years had anaemia in Madras. In the present study anaemia was prevalent among 37.7 per cent of adult destitute women. Thus it is clear that prevalence of anaemia is higher among destitute women which might be due to inadequate supply of protective foods in the destitute homes. Random blood sugar level was higher than the reference values for both adult and elderly destitute women. But there was no significant difference between the two age groups. Serum total cholesterol level of the elderly destitute women was beyond the normal range where as in adult and middle age women it was in the normal range. Thus a significant difference was observed between the elderly and adult women. Clinical Examination Details of clinical signs among the selected destitute women are presented in Figure 2. Majority 46.8 per cent of the selected destitute women had bleeding gums which is mainly due to vitamin C deficiency. This is due to the fact that most of these homes did not provide fruits. Poor musculature and deficient subcutaneous fat were common symptoms found among 43 and 16.4 per cent of the destitute women. Twenty five and 10.8 per cent of the selected destitute women had dry or rough skin and hyperkeratosis indicating a deficiency of vitamin A and essential fatty acid. Pale conjunctiva was found among 5.8 per cent of the destitute women. Around 7.6 and 4 per cent of the destitute women had glossitis and angular stomatitis ensuring the deficiency of B complex vitamins. All these symptoms are mainly due to the lack of adequate amount of protective foods. According to Raakhee and Raj (2003) the entry into the institution leads to feeling of neglected, lonely and emotionally deprived and all these may also result in inadequate food intake which leads to nutritional deficiency diseases among women. Nutritional Knowledge D etails of the Nutritional knowledge among the selected destitute women are shown in Table VIII. Majority (97 and 90 per cent) of the middle age and elderly destitute women had the knowledge about energy giving food followed by 79 and 42 per cent of the middle age and elderly destitute women felt that low food intake leads to impaired growth and development. Around 59 and 48 per cent of the middle age and elderly destitute women knew the type of oil needed for good health. When compared with middle age, the knowledge was lesser in the elderly in all nutritional aspects. This might be due to the fact that illiteracy of the elderly destitute women. CONCLUSION Destitute individuals feel neglected, lonely and emotionally deprived. The institutionalized destitute women are mostly forced to live under protection due to adverse circumstances trapped them in the cycle of disease and illness. The environmental and personal hygiene has a great influence on the destitute women’s health status. The poor accesses to health care centre to control infections and prevent diseases also lead to poor health status. Thus the above findings revealed that the nutritional status is below the average Indian women which might be due to two reasons: One the destitute homes provided adequate quantity of foods but it was not adequate in quality and the second reason was that these women did not consume adequate food due to their psychological problems. Hence efforts should be taken by the governmental and voluntary agencies to improve the nutritional status of the destitute women. 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=1394http://ijcrr.com/article_html.php?did=13941. Apte, J.K., Coping strategies of destitute women in Bangladesh, Bangladesh Rural Advancement Committee, Dhaka1997, Pp.110-142. 2. Patel,P., Capoor,I and Joshi,U., Research report on knowledge, awareness,belief and practice on reproductive health in slums of Ahmedabad,2000, P.2. 3. Karkal and Malini. (2000), Dynamics of population and family welfare, Himalaya Publishing House, Bombay, Pp.21-32. 4. Goffman,E., Institutional Neuroses, Psychological Studies, 1995,32(4) Pp.48-50. 5. Padmam,M.S.R., Destitute women in Kerala - psychological resources and psycho-social needs, Behavioural Sciences,2001, 54(4), Pp.5-41. 6. Raamanujam,K.N and Thenmozhi,R (2006), Empowerment of Women, Kisan World, 33(1), P.62. 7. Hemalatha,G., Subapriya,M.S and Chandrasekar,U.,Food expenditure of families belonging to low income group (LIG) and different activity categories, Research Highlights, 2005,15(2), Pp.69-74. 8. Srivard,R., Women - A world survey, World Priorities, Washington, 1995,Pp.109-14. 9. Thirumanidevi,A and Prapullakumari,B. , Nutritional profile and problems of selected elderly living with their family, Research Highlights, 15(3), PP.125-132. 10. American Dietetic Association. , Nutrition ageing and contirum of case, Journal of American Dietetics Association, 2000, 100(2) Pp.580-595. 11. Hoc,L. Practitioner guide to meet the Vitamin B12,Recommonded dietary allowances for people aged 51 years and older, Journal of American Dietetics Association, 1999, 99(.2) Pp.725-727 12. Tobias., A comparison of bone mineral density between Asian and Afro-caribbean women, Clinical Science, 2004 97(5) Pp.587- 91. 13. Kauwell,L., Foote,J,A and Harries R,B. Older adults need guidance to meet nutritional recommendations, Journal of American college of Nutrition, 1999 19, (5), Pp.628- 640. 14. Sharma,S. Dietitian urged to develop dietary guidelines for the elderly, Journal of Nutrition, 2000,30(2) Pp.11,13. 15. Seidell,J.C and Visscher,T.L.S., Body weight and weight change and their health implications for the elderly, European Journal of Clinical Nutrition, 2000, 54(3), Pp.33-39. 16. Huffman,S.L., Wolff,M and Lowell,S., Nutrition and fertility in Bangladesh, Nutritional status of non-pregnant women, American Journal of Clinical Nutrition, 1985,59(2) Pp.725-738. 17. National Centre for Health Statistics. (2002), Third National Health and Nutrition Examination Survey, Center for Disease Control and Prevention, P.39. 18. Wadhwa,A., Sabharwal,N and Sharma,S., Nutritional status of the elderly, Indian Journal of Medical Research, 1997,106, Pp.340-348. 19. De Groot., Sette S. and Zaikar G., Nutritional status and anthropometry, European Journal of Clinical Nutrition, 199145(3), p.31-42. 20. Mahan, L.K and StumpS.E., Krause’s Food, Nutrition and Diet Therapy, 11th Edition, Saunders Publishers, USA, 2004, Pp. 327,344, 1001. 21. Raakhee, A.S and Raj,H.S.S., Alienation of among the institutionalized and noninstitutionalized women, Psychological Studies, 2003,48(2), Pp.65-68.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareUSE OF TOBACO AMONG ADOLESCENCE IN URBAN AREA English5861G.V. KulkarniEnglish M.M. AngadiEnglish V.M. SorganviEnglishTobacco consumption in multiple forms presents an emerging, significant and growing threat to the health of Indian adolescents, especially those from low socio economic communities. The World Health Organization projects that by the year 2030, tobacco use will kill 10 million persons annually, which make tobacco the number one cause of preventable death in the world. Objectives To know the prevalence of tobacco use among urban adults. Material and Methods Study Area Urban Health Training Centre Study Design Cross Sectional Study Sample Size 360 Study Period 1st April to 31st July 2012 Participants Adolescents residing at UHTC area Statistical Analysis Chi-Square Test and Percentage Result: Prevalence of tobacco use was higher among boys than girls. Adolescents reported that using tobacco in multiple forms, chewing tobacco being the most popular. Peer pressure, easy availability and affordability were important reasons associated with tobacco initiation and continued use. Community based intervention can be effective in preventing adolescence from initiating tobacco use in a low resource. EnglishAdolescents use of tobaccoINTRODUCTION Tobacco is a major health problem as it kills more than five million people a year or one person every six seconds, and more than 80% 0f these deaths occur in developing countries1 . Majority of the cardio vascular diseases, cancer and chronic lung diseases are directly attributable to tobacco consumption. Almost 40% of the tuberculosis deaths in the country are associated with smoking. Tobacco kills a third to half of all people who use it; on an average 15 year pre maturely. By 2030, unless urgent action is taken tobacco annual death toll will rise to more than eight millions.2 According to WHO estimates 194 million men and 45 million women use tobacco in smoked or smokeless forms in India 3 India is the second largest consumer of tobacco products and third largest producers of tobacco in the world.4 It is consumed in the forms of beedi , gutka, paan masala ,hukka, cigarettes, chutta,mawa and others. In India tobacco use is estimated to cause 0.8 million deaths annually .5 Nearly 2200 Indian dies each day of tobacco related diseases.6 The most suseptible time for initiating tobacco use in India is adolescence and early adulthood Tobacco use poses a major public health threat particularly for adolescents in India, with the current prevalence of tobacco use being 14% among 13-15 years adolescent’s .7The higher rates of tobacco use reported among adolescents living in urban, low socio economic areas. In India it may be due to increased up take by them or less successful quit attempts .Tobacco use among adolescents is influenced by multiple etiological factors, including individual socio - cultural and environmental factors .Further research is required to describe the complex etiology of tobacco use among the adolescents living in urban areas. Objectives To know the prevalence and Inducing factors for initiating tobacco use among adolescents. MATERIAL AND METHODS A community based cross sectional study was carried in UHTC Field practice area of Community Medicine department, BLDU’S Shri BM.Patil Medical College, Bijapur . The study was carried out from 1’st April to 31’st July 2012. Systematic random sampling techniques were used to identify the households and adolescents in the community. A total of 360 adolescents were interviewed. The study was conducted by house to house visits with a pretested oral questionnaire method. X 2 test and percentage were used for analyzing the data. RESULT Prevalence of tobacco significantly more in late adolescence (65%) compare to early adolescence period (35%). Study also reveals that use of tobacco increases with age of adolescents. In the present study it was found that majority of the adolescents either tobacco user or non user had secondary level education (54%) followed by higher education (31%). Illiteracy has a very little role in the consumption of tobacco in the present study. Consumption of tobacco was found more in boys (84%) compare to girls (16%). Boys were on an average of 5 times more likely to use tobacco than girls. It was noticed that consumption of tobacco is high in low socio-economic class (63%).Study reveals that poorer adolescents tend to use tobacco products more than their wealthier counterparts. Tobacco use is strongly associated with low socio-economic status. The common reasons for initiating the tobacco were influence from the friends (55%), followed by influence of family members. Most of the respondents stated that they had started using tobacco after their friends or family members offered it to them. Initially they started tobacco use irregularly and finally it becomes regular habit of use of tobacco. DISCUSSION Adolescence is a critical time for the health and future development of boys and girls. Experience and behavior during these formative years can influence lifelong health as well as put current health at risk. So present study is an attempt to identify the habit of tobacco addiction among 360 adolescence in UHTC area. This study demonstrates that the prevalence of ever tobacco user was 20.8% in the age group of 10-19 years. In national family health survey (NFHS-3) it was found that 28.6 of the adolescent aged 15-19 years were using any kind of tobacco.8 National wide NFHS-3 as well as other studies documented that the prevalence of tobacco use increases with age9 . Our study also reports a very high tobacco use in late adolescent period (65%) compare to that in early adolescent period (35%) Study reveals that poor and less educated adolescents consume more tobacco. The reason may be that poor and less educated people are less aware of the health hazards of tobacco consumption. The present study high lights the facts that adolescents belongs to low socio economic are more prone to early initiation of tobacco use ,because of several social ,environmental and personal factors. Many adolescents start working at an early age, easy accessibility and affordability of tobacco products encourages their tobacco habit. Friends had a stronger influence on tobacco consumption by adolescence than any other group. The over whelming effect of peer pressure on the initiation of tobacco use among adolescence is a matter of serious concern because it is very difficult to prevent the effect of this factor in an age group which likes the company of their friends. Mohan.S, Sankar Sharma conducted a study in Kerala and stated that friend’s tobacco consumption was found to be significant link between peer pressure and tobacco use.10 Adolescents may initiate use of tobacco to express independence, to “feel” and “act” like adults. Some adolescent smoke to try to control their weight, some smoke to reduce stress. Risk factors for regular tobacco use include having parents, siblings or peers who use tobacco, poor school performance and limited goals, tendency to risk taking behaviors and use of alcohol or other drugs. Despite debate about the roles of media portrayals of tobacco use as normal, natural, and safe and marketing that appears targeted to the young. No nation can stand proud by undermining the health status of every citizen and we cannot claim to be living in a healthy society without giving a massive break in the rising trend of tobacco consumption especially in adolescents .Since tobacco use behavior and pattern in India is mainly determined by cultural and social context, the best way to reduce its incidence is the integrated multi-sectorial initiatives with active community participation. CONCLUSION Consumption of tobacco was found more in boys compare to girls. Prevalence of tobacco significantly more in late adolescence. The poor and uneducated are more likely to be victims of tobacco use. RECOMMENDATION Interventions need to be designed to reduce the use of tobacco among adolescence such interventions should raise awareness on the social, economic and health implications of the uses of tobacco. Equip adolescence to overcome peer influence and provide counseling to quit using tobacco. Community participation and definite government commitment both at state level and national level are the urgent requirement to crush down the current trends of tobacco consumption towards lower level. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Englishhttp://ijcrr.com/abstract.php?article_id=1395http://ijcrr.com/article_html.php?did=13951. Mathes C D, Lancer D. Projection of Global Mortality and burden of diseases from 2002 to2030 PLoS Medicine 2006 3,;1. 2. Peto R (1996) Mortality from smoking world wide .British Medical Bulletin 52 ; 12-21. 3. Sinha, D.N., Gupta, P.C., and Pednekar, M.S. (2003). Tobacco use in a rural area of Bihar, India, Indian J. Commun Med, 28, 167-70. 4. Rani, M., Bonu, S., Jha, P., Nguyen, S.N., and Jamjoum L. (2003). Tobacco use in India. Prevalence and predictors of smoking and chewing in a national cross sectional household survey 2003, 12th ed. Tobacco Control. 5. Country Profile India (1999) Indian Journal of Medical Association 97;377-80. 6. Quarterly News Letter (2009) National Institute of Health and Family Welfare XI,2;Apr-June. 7. Monica Arora, Abha Tiwari etal Communitybased model for preventing tobacco use among disadvantaged adolescents in urban slums of India, 2010. Health Promotion International. Vol 25 No, 25 . 8. National Family Health Survey. 2005-2006. (NFHS-3) International Institute for Population Science Mumbai. 9. Mathes C, Arora.M.(2008) Differences in Prevention of Tobacco use among Indian Urban Youth –Nicotine and Tobacco Research ,10;109-116. 10. Mohan Kumar.P.D., Poorni S.(2006) Tobacco use among school children in Chennai City, Indian Journal of Cancer. 40; 43-59. 11. Poland.B. SparkeR J.(2006) The social contest of smoking ,the next frontier in tobacco control? Tobacco Control 15;59-63. 12. Reddy.K S.Gupta.P.C., Pednekar.M.S.(2003) Tobacco Control in India. New Delhi Minister of Health and Family Welfare. Government of India.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareVIEWS OF MEDICAL STUDENTS ON TORTURE IN AHMEDABAD CITY English6265Jagdeep JadavEnglish Gaurang KothariEnglish RakeshEnglish PadmrajEnglish Harish KhubachandaniEnglish Anand MenatEnglish Kalpesh ShahEnglishTorture is a serious human rights violation which affects the victim both physically and mentally. Training in medical ethics and human rights has been identified internationally as one of the key strategies for the prevention of torture and other human rights. Medical Students studying 5th semester course of 2nd MBBS at B.J Medical College, Ahmedabad, Gujarat, India were asked to fill a self administered, predesigned, multiple choice questionnaire during the year 2012. Multiple-choice questions were asked to assess the views of medical students regarding torture. The survey was consisted of the questions relating to the knowledge and attitude of medical students on torture. Total of 200 students were provided with the proforma of questionnaire. Majority of the students were aware of term torture in broad sense. Though many students are not against custodial violence, they have positive attitude in learning and inclusion of torture medicine in their medical curriculum. Englishattitude, human rights, knowledge, tortureINTRODUCTION Torture of persons held in custody is a global phenomenon. It is a serious violation of human rights which affects the victim both physically and mentally. Persons held in custody by any law enforcing authorities, retain their basic constitutional right except for their right to liberty and a qualified right to privacy. Various international declarations “Declaration of Tokyo”, International Code of Medical Ethics”, the “Declaration of Helsinki”, “Declaration on Protection of All Persons from Torture and other Cruel, Inhuman or Degrading Treatment or Punishment” etc. clearly expressed that Doctor must in no way take part in the practice of Torture or other forms of cruel, inhuman or degrading procedures as his role is to alleviate the distress of his/her fellow persons and, no motive whether personal, collective or political shall prevail against this higher purpose1 .A survey of Amnesty International’s research files from 1997 to mid-2000 found that the organization had received reports of torture by agents of the state in over 150 countries during the period.2 Torture is strongly prohibited by all medical organizations there are evidences that physicians have been implicated in torture in many countries.3,4,5. Medical professionals can play important role in detection and treatment of torture victims and in prevention of torture in community. Forensic medicine is a core discipline in the detection and recording of gross abuse of human rights especially genocide, murder, torture6 . United Nation has recognized the role of experts of Forensic science and related fields to investigate human rights violations effectively, Forensic science is an important tool in detecting evidence of torture and other cruel, inhuman or degrading treatment or punishment 7 .In India, the University Grant Commission has also directed all universities and colleges across the country to incorporate lectures on torture and allied aspects in different undergraduate and postgraduate curriculums8 .In 1984, J. L. Thomsen observed that forensic medicine was being practiced in different ways, and that common guidelines and definitions would facilitate communications.9 Training and exposure in issues related to medical ethics and human rights has been identified internationally as one of the key strategies for the prevention of torture and other human rights 10,11,12,13, . MATERIALS AND METHODS Medical Students studying 5th semester course of 2 nd MBBS at B.J Medical College, Ahmedabad, Gujarat, India were asked to fill a self administered, predesigned, multiple choice questionnaire during the year 2012 .The questionnaire was structured on the basis of a study done by SK Verma and G Biswas14. Nine multiple-choice questions were asked to assess the views of medical students regarding torture. The survey was consisted of the questions relating to the knowledge and attitude of medical students on torture. There was complete anonymity as no names or numbers were mentioned. Participation in the study was voluntary. A total of 200 students were provided with the proforma of questionnaire. They were asked to return the questionnaire after ticking off the response. Obtained results were analysed. RESULTS Total 200 students participated in the study, out of this 73(36.5%) were female and 127(63.5%) were male with means age 20.In response to the question: What do you mean by the term torture?. 191 (95.5per cent) of the students responded correctly, six (3.2 per cent) students gave incorrect response, and three students did not respond. Regarding question: What are the objectives of torture?, 96 (48%) students opined that torture is aimed to destroy the mind without killing a person. 54 (27%) students who were of the opinion that torture is committed to break the personality of an individual. 26 (13%) students were of opinion that torture is done to obtain a confession or information. 24(12%) students responded that it aimed at creating terror in society. In response to the third question (what are the types of torture?), 196(98 per cent) students answered correctly by marking “physical”, “sexual”, and “psychological” as the different types of torture while 4 students were of different opinion. In response to question: what is commonest method used for physical torture?, 142 (71 per cent) students gave the correct answer as blunt trauma (beating and kicking); 20(10 per cent) students marked burns (cigarettes, heated instruments, hot liquids); and 32 (16 per cent) students marked positional forced positioning, suspension by arms, stretching limbs apart. Six (3%) students said that electric shock is the most common method. In response to the question: what is the commonest form of sexual torture?. 95 (47.5 per cent) students correctly said it was rape, and 76 (38 per cent) students said it was forced nakedness. Twenty five students (12.5%) said the insertion of foreign bodies into the private parts was the most common form, and four (2%) said it was sodomy. In regarding to question: which organization deals with allegations of torture or cruelty, inhuman or degrading treatment, or punishment? 165 (82.5 per cent) students responded correctly by marking the National Human Rights Commission. 35(17.5%) ticked off other incorrect choices and eight did not respond to the question at all, In response to question seven: Do you think that beating in police custody to get a confession/ information is proper?, 75 (37.5 per cent) students did not favour this practice, while 120 (60 per cent) students were in favour of beating in police custody. Five students did not respond. In response to question: Do you think doctors should be aware of torture medicine or different techniques involved in torture?, 190 (95per cent) students said yes. Eight students were against such awareness and two students did not answer this question In response to the ninth question: Should the subject of medical treatment for torture victims be included in the undergraduate curriculum?, 169 (84.5 per cent) students were in favour and 22 (11 per cent) students were against. Nine students were undetermined on this issue. DISCUSSION Majority of students were of view that doctors should be aware of torture medicine and majority of students favoured inclusion of torture medicine in medical curriculum. Majority of students were having idea of meaning of torture, type of torture .These are consistent with the study conducted by previous studies by SK Verma and G Biswas 14 and Agnihotri A.K et.al15. 60 per cent students were of opinion that of beating in police custody to get confession or information is proper. These finding is in contrast with study by Agnihotri A.K et al, while studies by Iacopino16 and Sobti17 indicated many of medical practitioners justified the use of coercive techniques and manhandling in dealing with detainees.The study by SK Verma and G Biswas14 indicated that many of students are not against violation of human rights.Majority of students are of views that doctors should know about torture medicine. and majority of students favoured inclusion of torture medicine in medical curricula. CONCLUSION For the promotion of awareness of human rights among doctors, it should be started during their undergraduate medical education. The medicolegal and ethical problems of torture cannot be ignored by the medical profession. The skills of doctors with forensic expertise allow detection of human rights abuses and thereby its potential reduction. There is scope for the reduction torture or ill-treatment, if the professions maintain high standards of medical practice and ethics.18. The medical professionals should be aware of types and methods of infliction of torture and its long term sequelae. It is necessary to make a common forum of forensic and legal fraternities to discuss the role of forensic science in preservation of human rights. ACKNOWLEDGEMENT Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishes 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=1396http://ijcrr.com/article_html.php?did=13961. International instruments, resolutions, declarations and statements on torture. Copenhagen, Denmark: International Rehabilitation Council for Torture Victims, 1999 2. Amnesty International, 2003; Report on Torture, the manual Combating Torture– A Manual For Action pp. 9-10 cited in Appendix 2. 3. Lifton RJ. Doctors and torture. N Engl J Med 2004;351:415-6. 4. Bloche M., Marks J. When doctors go to war. N Engl J Med 2005;352:3-6. 5. Wilks M. A stain on medical ethics. Lancet 2005;366:429-31 6. Professor Stephen M cordner, delivered lecture at The University of Hong Kong on a seminar “Forensic Medicine and Human Rights” on October 11 2001. 7. Human rights and Forensic Science, C.H.R. res. 1998/36, ESCOR Supp. (No. 3) at 130, U.N.Doc. E/CN.4/1998/36 (1998). 8. Hussain M. Rizvi SJ. An encounter with “torture” in the class room --educational aspects. Torture. 1999; 9:87-8. 9. J. L. Thomsen and others, "Amnesty International and the forensic sciences". American Journal for Forensic Pathology. 1984Dec; 5: 4:305-311. 10. Sorensen B, Vesti P. Medical education for the prevention of torture. Medical Education. 1990;24:467-9. 11. Hannibal K. Taking up the challenge: the promotion of human rights. A guide for the scientific community. Science and Human Rights Programme. Washington: American Association for Advancement of Science (AAAS), 1992 . 12. BMA (British Medical Association). Medicine betrayed. The participation of doctors in human rights abuses. London: ZedPublishers, 1992. 13. American College of Physicians. The role of the physician and the medical profession in the prevention of international torture and in the treatment of its survivors. Annals of Internal Medicine 1995;122:607-13. 14. Verma SK, Bisivas G. Knowledge and attitudes on torture by medical students in Delhi. Torture 2005;15:46-50 15. A K Agnihotri, B Purwar, Nilima Jeebun, Smriti Agnihotri. . Awareness of issues related to torture among medical students in Mauritius, Indian Journal of Medical Ethics 2007; 4;3;131-132. 16. Iacopino V, Heisler M, Pishevar S, Kirschner H.Physician. Complicity in misrepresentation and omission of evidence of torture in post detention medical examinations in Turkey. JAMA 1996; 276:396-402. 17. Sobti JC, Chapparwal BC, Holst E. Study of knowledge, attitude and practice concerning aspects of torture. JIMA 2000;98:334-40. 18. Jandoo R. Human rights abuses and the medical profession. Forensic SciInt. 1987 Dec; 35(4): 237-47.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareELIMINATING HEALTH DISCREPANCY AMONG HUMAN IMMUNODEFICIENCY VIRUS INDIVIDUALS: A GUIDE IN SENSITIZING THE ISSUES OF STIGMA AND DISCRIMINATION IN MANIPUR, INDIA English6671Jennifer KipgenEnglish Cecilia Stalsby LundborgEnglishThe human immunodeficiency virus epidemic is a major public health concern and has tremendous worldwide implication. Health sector is one of the main settings where seropositive individuals experience stigma and discrimination. Due to stigma attached to this disease many were faced with difficulties in accessing health services. Eradication of health discrepancy in Manipur will require different facet that comprise of new approaches from a range of lessons in the implementation intervention of public health communities in different parts of the states and countries. The paper attempts to bring out these suggested strategies and propose that Manipur ought to improve the health services by integrating policy makers, health professionals working in Government and Private Sector along with Non Governmental Organization. There is a need to implement a course of action to remove the obstacles and henceforth provide them the health services with a user friendly environment. EnglishHIV, health care services, hospitals setting, stigma, Manipur.INTRODUCTION Stigma and discrimination are two factors that need to be address to produce an effective and sustained response for HIV/AIDS prevention, care and treatment. They prevent an individuals from being tested, limiting them in seeking care and support consequently leading them in not receiving the quality care treatment(1). HIVrelated stigma and discrimination are also recognized as key barriers for not utilizing the health service facilities by the PLHA population. To mention specifically, health setting is the primary meeting place for people with HIV/AIDS. It is the arena where one gets treatment and at the same time, experience stigma and discrimination. The main factors of these discriminatory responses include lack of knowledge, its universal precautions, service provider attitudes, and perceptions that caring for PLHA is ineffective due to its incurable consequences (2). Here comes the urgency to establish a dedicated and strong collaboration which includes government, civil society and NGOs to combat the stigma and discrimination in the society. The aim of this paper is to discuss evidence based interventions applied in some countries which have helped in reducing stigma in health facilities and consider those results if it could be integrated in the context of Manipur, India. The paper begins by defining stigma and how it effects on patients, staff and the health service facility. Though many programmes have been carried out to eliminate the prejudice against PLHA in the state itself, unfortunately combating this crucial barrier still remains a challenging task. METHODS A comprehensive literature search was carried out to identify studies that met the following selection criteria: (1) HIV/AIDS intervention studies conducted in India or abroad (2) empirical studies that report of new interventions on HIV/AIDS studies. These studies were retrieved from the electronic databases like AIDS line, Pub Med, and other online electronic journals. The keywords: HIV, AIDS, intervention programmes, implication, stigma and discrimination, health setting. A total of 22 articles were identified and compare the components with this 22 existing studies, their intervention and how they carried out those intervention strategies. DEFINING STIGMA Stigma is an intricate issue that has unfathomable roots in the complex sphere of gender, race, ethnicity, class, sexuality, and culture (3). For persons living with HIV/AIDS, stigmatization and discrimination may amplify the social isolation and worsen the accessibility of health services. HIV/AIDS-related stigma is often described as a „process of devaluation? of people either living with or associated with HIV/AIDS. Discrimination follows stigma and is the unfair and unjust treatment of an individual (4). People who are stigmatized are marked as being different and are often attached to things which are embarrassing and dangerous (5). HIV stigma is shaped not only by individual views but also by larger societal and economic forces(6). Because of stigma, HIV/AIDS patient often receive inferior care or are denied services from the health service providers(7). Impact of stigma and discrimination in the health setting: In the healthcare setting, HIV stigma and discrimination lead to barriers in access to prevention, care, and treatment services(8). The health care setting is particularly a prominent milieu for people living with HIV/AIDS (PLHA) as they often discover their status, moreover it is where they have the potential to gather information about how to care for themselves and prevent transmission to others (9). A study in Tanzania showed that most health workers showed negative attitudes towards HIV/AIDS patients in the majority of regions(10). Discrimination by health care workers towards PLHA includes: HIV testing without consent, breaches of confidentiality, denial of treatment and care, refusal of admission to hospital, refusal to operate, stopping of ongoing treatment, early discharge, judgmental and moralistic attitudes of hospital workers, physical isolation in the ward, restrictions on movement around the ward or room, restricted access to shared facilities and unnecessary precautions (11, 12). This same discrimination is observed in a study conducted by the first author among the widows living with HIV/AIDS in Manipur, India (13). The table below (Table 1) were kinds of discrimination they received while accessing the health services in different health centres. According to the study the nurses were more discriminative (48%) as compared to the other health professionals (46%) and attendants (6%). Moreover the study also revealed the cases of burning their bedding upon discharge, refusal of the treatment on the basis of their status and using gloves during all interactions, regardless of whether physical contact occurs or not reaffirm the findings of earlier studies(14, 15). The finding showed the lack of awareness among the medical health professionals, which apparently also showed the need to educate in the field of HIV/AIDS. As the doctors and the nurses were the ones who mostly had to deal with the patients, knowledge regarding HIV/AIDS should be imparted to them in an appropriate way. DISCUSSION Combating stigma in health facilities: In order to reduce stigma, focus should be direct on the Health care professionals, Government and also the PLHA. Let us begin by discussing the role of the Health Care Workers. Health Care Professionals: Health service providers expressed relatively high levels of fears and perceived risks for HIV transmission while offering services, care, and support for patients (16). Research conducted in Rwandan health facilities indicate that health providers have negative attitude towards patient with HIV and that they fear becoming HIV infected while dealing with the patients(17). So it could be said that some amount of discrimination is likely to remain while rendering the services as health service providers do not feel safe about themselves. Therefore, interventions need to be developed that focus particularly on reducing providers? fear of infection, in handling the PLHA patients. A part of such intervention should include discussion regarding stigma and HIV risk among providers and ways they could protect themselves against the infection in the workplace. This may help in normalization of HIV and its perceptions to its risk which eventually directs in establishing a work environment that support efforts of health service providers to protect themselves. The Rwandan study also pointed out the need for stigma reduction strategies to be institutionalized in all health service systems in order to deliver quality health services to all PLHA individuals. Health professionals play the most prominent role in health service setting. Therefore need is arise to introduce programmes that provide health workers with comprehensive training in the areas of HIV and the universal precautions that can reduce their qualms regarding the disease. Raising awareness about stigma and allowing for critical reflection on the negative consequences of stigma can be consider an essential step in the stigma reduction programme. Government: The policy makers should try to invest in long term integrated services to promote the well being of the PLHA by integrating services that address their social and emotional needs. Government should form and implement programmes with the aim to reduce the HIV stigmatization among health service providers. There is no strong proper set of rules in the area of health setting to avoid any kind of misconception so far in the state of Manipur. This lack of recognition may lead to fatal confrontation in future. Hence Government could include a strong set of rules in the policy formulation in order to avoid any untoward incidents against the PLHA. For instance a lesson could be learned and shared from some countries where they have attained success to an extent in combating the stigma and discrimination. The first one to be discussed is from China in which they found out the competence in small group behavioural interventions learning through active participation in role-plays, group discussions, games and other interactive activities(2). To make an intervention to be effective, focus must be made on awareness of HIV policies and measures that guarantee access to universal precautions thereby increasing the level of comfort while working with PLHA. Another example is from a study conducted in Andhra Pradesh, India (18). The study reveals that over 70 percent of heath service providers shun themselves in treating people with HIV/AIDS due to its fear of infection. The finding shows the lack of understanding among the service providers in terms of the disease. To battle against stigma „Training of Trainers? was conducted though this study in which the main goal was to sensitize the field staff about HIV/AIDS related stigma and discrimination. The training also focuses on how to improve technical skills among the health service providers. During the session a committee was formed based on anti-stigma or anti-violence at village and block levels. They include all categories of health service providers and all health institutions for creating a linkage between government and private health service providers. In this way they were able to create one common platform for addressing stigma and violence issues hence sensitizing the government health services about stigma and violence by making them more responsive. It is to mention that the workshop had used a participatory, “learning through doing” approach that resulted in health service providers intermingle enthusiastically across their specialized field. Similarly an intervention research study was conducted in four hospitals of Vietnam to address stigma and discrimination issues and also to improve the quality of care in the hospital setting (19). During the study, a training session was conducted which was co –facilitated by people living with HIV/AIDS. The outcome of the study reveals that it is necessary to involve all categories of hospital employees in training and in policy development in order to establish a stigma liberated environment. Apart from the existing essential programme that the state government is initiating to curtail the stigma and discrimination catastrophe, it would be worthwhile if it establishes a similar kind of programme and put into practice to bring down the stigmatizing behaviour among the health professionals. Government with support from NGOs and Lawyers, should engage with professional health care associations and civil society towards strengthening the efforts in giving training to health care professionals on issues of nondiscrimination, informed consent, confidentiality and patient rights. In this way it will ensure that staffs within the health care settings will provide care to all populations in an approach that is fair and protective of their human rights. People Living with HIV/AIDS As PLHA are the one who face the stigmatization, they are the most appropriate who can provide necessary viewpoint when it comes to combating the issues of stigma and discrimination. It is very crucial to strengthen the capability of the right of PLHA by providing the information regarding their rights. They should be empower and encourage by supporting the PLHA organizations and networks. This will enabled them to demand the recognition of their existence, needs, and rights. The PLHA organization has help to form support groups and SHGs (self help groups) and enabled those who are marginalized to challenge discrimination. In fact such kinds of organizations appear as a liberator especially for widows living with HIV/AIDS, who are left with no social support in the state of Manipur. Another lesson which could be learned is from the Brazilian experience. The approach was initiated by a group who identified themselves to be the country?s first self-identified group for people living with HIV. This Group pressurise the politicians to improve treatment and care for people living with HIV/AIDS (20). The result of this group was astonishing as it directs the Government to form a new Constitution in Brazil that focus particularly on human rights. This Constitution became very momentous as it included articles that gave the legal protection against discrimination and safeguarded their right to free healthcare. Apart from the government?s optimistic reaction towards this subject, involvement and participation of civil society groups and PLHA has been the most stupendous feature of Brazil?s response. Even the human rights movement that surface in Brazil during the 80s was vigorous and energetic in fight against HIV/AIDS related discrimination encouraging the government to guard the rights of people living with HIV. The government has since shown assurance and pledge to protect the rights of these marginalized groups. Henceforth Brazil became a rare example of a country that administers to curtail the discrimination crisis. There is an immense need of making PLHA aware concerning their individual rights, which will allow them to exercise and making them free from all social discrimination. CONCLUSION In many countries governments are now developing strategies that can integrate both care and treatment for those infected with HIV. There is an explicable and urgent need for direction in Manipur, a hard hit HIV state which is said to be poorly developed in terms of health systems. Experts and professional?s opinion, political judgement, and views from stakeholders and contingencies are all relevant inputs in the decision making and the formulation of policy. Since evidence from the research on contextual factors is often limited, or sometimes completely lacking. The decision makers most often regard as idiomatic evidence when compiling information on context- dependent factors(21). Therefore while framing any policies, policy makers should also consult successful case studies, for they represent valuable insights in how to execute these interventions. Once the policy is framed, it is suggested to identify how these could be implement to the best. Here it is to note that before any intervention is used, the exact situation of the problems should be diagnosed. Besides there is a need to monitored and evaluate the programme once it is implemented, as often, there is an assumption that the programme is continuing effectively which is not so on the other hand. Moreover a need to identify the tools for evaluating the programs in an effective manner is required. Programmes must have the mechanisms that will enable careful self review, approaches, impact with feedback from the PLHA to see the appropriateness and effectiveness of the intervention offered. If it is carried out in this matter there is a possibility that any unintentionally harm maybe avoided. It is necessary to improve understanding of the health professional in the health service setting by rising awareness at all levels through advocacy and social mobilization. Government must find ways to bring together ministries of NGOs, social welfare, church leaders, social scientist and PLHA and coordinate in an effective way to eradicate the stigma and discrimination issue. It should be a process led by national, regional or local government. The health service sector is both a condition for a successful reform and an obstacle for reform processes given it resistance to change. ACKNOWLEDGEMENT We thank Erasmus Mundus (an exchange project funded by the European Commission) for giving the opportunity to the first author to carry out her research which will benefit the widows living with HIV/AIDS in Manipur. We acknowledge the great help received from the scholars whose articles we cited and included in references of this manuscript. The authors are 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 also 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=1397http://ijcrr.com/article_html.php?did=13971. USAID. Breaking the Cycle: Stigma, Discrimination, Internal Stigma, and HIV. Geneva, Switzerland: USAID, 2000. 2. Wu S, Li L, Wu Z, Liang LJ, Cao H, Yan Z, et al. A brief HIV stigma reduction intervention for service providers in China. AIDS patient care and STDs. 2008;22(6):513-20. Epub 2008/05/09. 3. Valdiserri RO. HIV/AIDS stigma: an impediment to public health. American journal of public health. 2002;92(3):341-2. Epub 2002/02/28. 4. UNAIDS. Stigma and Discrimination Geneva: 2003. 5. NAM. HIV stigma and discrimination. London: 2012. 6. Campbell C, Nair Y, Maimane S, Nicholson J. &#39;Dying twice&#39;: a multi-level model of the roots of AIDS stigma in two South African communities. Journal of health psychology. 2007;12(3):403-16. Epub 2007/04/19. 7. Ogden J NL. Common at Its Core: HIV related stigma Across Contexts. USA: 2005. 8. USAID. Measuring the Degree of HIV-related Stigma and Discrimination in Health Facilities and Providers: Working Report. USA, Washington: 2010. 9. Mahajan AP, Sayles JN, Patel VA, Remien RH, Sawires SR, Ortiz DJ, et al. Stigma in the HIV/AIDS epidemic: a review of the literature and recommendations for the way forward. Aids. 2008;22 Suppl 2:S67-79. Epub 2008/07/25. 10. Kisinza W ME, Mwisongo A, Mubyazi G, Magesa S, Malebo H, Mchro J, Senkoro K. Stigma and Discriminationon HIV/AIDS in Tanzania. . 2002; Tanzania health research Bulletin 4 2:42-6 . 11. Hossain MB, Kippax S. HIV-related discriminatory attitudes of healthcare workers in Bangladesh. Journal of health, population, and nutrition. 2010;28(2):199-207. Epub 2010/04/24. 12. Mahendra V.S. GL, George. B,Samson. L, Mudoi. R, Jadav. S, Gupta. I, Bharat. S, and Daly. C. Reducing AIDS-related Stigma and Discrimination in Indian Hospitals. 2006. Population Council. 13. Jennifer Kipgen. A study on Utilization Pattern of Health Services by widows living with HIV/AIDS in Manipur.(Unpublished PhD Thesis) 2012. 14. Mahendra VS, Gilborn L, Bharat S, Mudoi R, Gupta I, George B, et al. Understanding and measuring AIDS-related stigma in health care settings: a developing country perspective. SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance / SAHARA , Human Sciences Research Council. 2007;4(2):616-25. Epub 2007/12/12. 15. (ACCHO) TAaCCoHAiO. HIV/AIDS Stigma, Denial, Fear and Discrimination: Experiences and Responses of People from African and Caribbean Communities in Toronto. . Toronto, Ontario: 2006. 16. Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? Journal of the International AIDS Society. 2009;12:15. Epub 2009/08/08. 17. USAID. HIV/AIDS-related Stigma, Fear, and Discriminatory Practices among Healthcare Providers in Rwanda. Bethesda,: 2008 18. ICRW. Reducing HIV/AIDS Stigma, Discrimination and Gender-based Violence among Health Care Providers in Andhra Pradesh, India. USA: 2006. 19. Oanh K.TH AK, Pulerwitz J, Ogden J, Nyblade L. Improving hospital-based quality of care in Vietnam by reducing HIV- related stigma and discrimination. USA: 2008. 20. Avert. HIV/AIDS in Brazil. 2010; Available from: http://www.avert.org/aids-brazil.htm . 21. Garrigo M.V GA, John-Arne.R, Busse, R. . Developing Health Technology Assessment to address health care system needs. Health Policy. 2010 94(3):196-202.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareTHE CARRYING ANGLE OF ELBOW- A CORRELATIVE AND COMPARATIVE STUDY English7277Jyothinath KothapalliEnglish Pradeepkumar H. MurudkarEnglish Lalitha Devi SeerlaEnglishBackground and Objectives: The angle formed by the axes of the arm and the axes of forearm when the elbow is fully extended and forearm is supinated that obtuse angle is known as “carrying angle”. Carrying angle evaluation is important to identify deformities of elbow. The present study aimed Measure and correlation of carrying angle with various parameters in young males and females. Materials and methods: The present study includes 220 (110 females and 110 males) healthy students of MBBS from KBNIMS, Gulbarga, belongs to Karnataka were selected and ages groups is 18 to 22 years. Goniometry is used for measurement of carrying angle. Height measured in normal anatomical standing posture and length of forearm measured with measuring tape. Measurements were documented and statistically analyzed. Spearman?s correlation use to get relationship between parameters. Result: In females there was a significant positive correlation (pEnglishCarrying angle, Elbow joint. Sexual dimorphism, Trochlear angleINTRODUCTION The elbow joint is formed between the humerus in the upper arm and the radius and ulna in the forearm and allows the hand to be moved towards and away from the body. When the arm is extended forward, the humerus and forearm are not perfectly aligned a deviation occurs laterally towards the long axis of the arm, which is referred as the "carrying angle" (1). The carrying angle apparently develops in response to pronation of the forearm and keeps the swinging upper extremity away from the side of the pelvis during walking (2). William et al suggested that the angle is formed by the medial edge of trochlea of humerus partly projects nearly 6 mm below the lateral edge and the oblique superior articular surface of the coronoid process which is not set at right angle to the shaft of ulna (3). Some studies showed that the inner lip of trochlea of humerus is a ridge groove deeper in distally anteriorly so ulna is deflected in full extension by this ridge (4, 5). Women on average have smaller shoulders and wider hips than men, which may be one reason for more acute carrying angle. A more recent study based on a sample size of 333 individuals from both sexes concluded that carrying angle is a suitable secondary sexual characteristic. The olecranon- coronoid angle shows high sexual dimorphism and it may be one of the causes of sexual difference observed in carrying angle (6). The evaluation of carrying angle is also essential for handling and monitoring of traumatic lesions that affect the pediatric elbow (7). The increased carrying angle may lead to elbow instability and pain during exercise or in throwing sports and may reduce elbow flexion, dislocation, fracture when fall on outstretched hand and fracture of distal humeral epiphysis (8, 9, 10) and also important anthropologically for sex differentiation in skeletal remains and reduction of fractures complication of supracondylar fracture and may result in cosmetic deformity and for designing total elbow prosthesis (23). Hence, the present study aimed to study the difference in carrying angle between sex (i.e., Male and female) and to find out any correlation of carrying angle with different parameters like age, height, length of the fore arm as this helps orthopedic surgeon for correction of cubitus varus deformity occurring after malunited supracondylar fracture of humerus. MATERIAL AND METHODS After informed consent, 220 (110 female and 110 male) asymptomatic, healthy students of M.B.B.S of Khaja Bandanawaz institute of Medical sciences, Gulbarga belonging to various regions of Andhra Pradesh, Karnataka were recruited for the study. There ages ranged between 18 to 22 years. Medical students of this age group were selected as subject because of easy availability. Demographical data was obtained from each subject including age. The students who had previous elbow injuries as well as congenital anomalies about the elbow were excluded from study. The study was designed to include subjects criteria was those with asymptomatic of any deformity, surgeries or fractures around the elbow joint and right handed individuals. An improvised instrument goniometry was used to measure the carrying angle from both upper limbs of right and left side. The fixed arm placed on the median axis of the upper arm, the movable arm adjusted as to lie on the median axis of forearm and the angle read on the goniometer. Height was measured in standing, erect, anatomical position from vertex to heel with bare foot. Measuring tape was used to measure the length of forearm and technique used for measuring carrying angle is universally accepted. Measurements were documented and statistical analysis was done to get mean, and spearman?s correlation Analysis was done to determine any possible relationship between age, height and length of forearm with carrying angle. RESULTS Table: 1 shows there was a significant difference in carrying angle of the two sides of the upper limbs both in males and females and a significant greater carrying angle was found in females. It was observed that the carrying angle of right limb was greater than left in both sexes. Similarly the right length of the forearm was significant than the left in both males and females. In the present study we have done spearmen?s correlation analysis to observe relationship between various parameters in both sexes. Table: 2 shows there was a significant positive correlation (pEnglishhttp://ijcrr.com/abstract.php?article_id=1398http://ijcrr.com/article_html.php?did=13981. Snell RS. Clinical Anatomy, 7th ed. Philadelphia, PA: Lippincott Williams and Wilkins; 2004:551. 2. Khare GN, Goel SC, Saraf SK, Singh G, Mohanty C. New observations on carrying angle. Indian J Med Sci. 1999; 53:61–67. 3. Williams A, Standring S, Ellis H, Haely J 2005 Gray?s Anatomy. 4. Last RJ 1978 Anatomy – regional and applied 6th edn London. Churchill Livingstone Longman. 5. Decker Gog 1986 Lee Mce Gregor?s synopsis of Surgical Anatomy 12th Edn. Bristol : John Wright and Sons Ltd. 6. Purkait R, Chandra H, An anthropometric investigation into the probable cause of formation of carrying angle: a sex indicator, Journal of Indian Academy of Forensic Medicine, 2004, 26(1):19–23. 7. Balasubramanian P, Madhuri V, Muliyil J. Carrying angle in children: a normative study. J PediatrOrthop B. 2006;15:37- 40.Punia Rs, Sharma R, Usmani Ja, The carrying angle in an Indian population, J Anat Soc India, 1994, 43(2):107–110. 8. Cain EL Jr, Dugas JR, Wolf RS, Andrews JR. Elbow injuries in throwing athletes: a current concepts review. Am J Sports Med.2003;31:621–635. 9. Hutchinson MR, Wynn S. Biomechanics and development of the elbow in the young throwing athlete. Clin Sports Med. 2004; 23:531–544. 10. Van Roy P, Baeyens JP, Fauvart D, Lanssiers R, Clarijs JP. Arthro-kinematics of the elbow: study of the carrying angle. Ergonomics. 2005; 48:1645–1656. 11. ?wirko-Godycki M, Sexing skeletal remains. In: Krogman Wm (Ed), The human skeleton in forensic medicine, 3rd edition, Charles C Thomas, Illinois, 1978, 112–152. 12. Khare Gn, Goel Sc, Saraf Sk, Singh G, Mohanty C, New observations on carrying angle, Indian J Med Sci, 1999, 53(2):61–67. 13. Fick R (1911) Handbuch der Anatomie und Mechanik der Gelenke. Fischer, Jena 14. Hubscher C (1899) Der Ellbogenwinkel. Dtsch Z Chir 53:445 15. Aebi H (1947) Der Ellbogenwinkel, seine Beziehungen zu Geschlecht, Korperbau und Huftbreite. Thesis, University of Basle 16. Paraskevas G, Papadopoulos A, Papaziogas B, Spanidou S, Argiriadou H, Gigis J, Study of the carrying angle of the human elbow joint in full extension: a morphometric analysis, Surg Radiol Anat, 2004, 26(1):19– 23. 17. M.j. Emami, f. Abdinejad, s. Khodabkhshi, m. Amini, Andb. Naseri the normal carrying angle of the elbow. In shiraz mjiri, 1998, 12 (1):37-39. 18. Mehmet Tukenmez, Huseyin Demirel, Sitki Percin, Gunduz Tezeren. Measurement of the carrying angle of the elbow in 2,000 children at ages six and fourteen years. Acta orthop Traumatol Turc 2004, 38 (4): 274-276. 19. Beals RK. The normal carrying angle of the elbow. A radiographic study of 422 patients. Clin Orthop 1976; (119):194-6. 20. Dai L. Radiographic evaluation of Baumann angle in Chinese children and its clinical relevance. J Pediatr Orthop B 1999; 8:197-9. 21. Srushti Ruparelia, Shailesh Patel, Ankur Zalawadia, Shaival Shah, S. V. Patel. Study Of Carrying Angle And Its Correlation With Various Parameters. NJIRM 2010; 1(3):28- 32. 22. Hui JH, Torode IP, Chatterjee A. Medial approach for corrective osteotomy of cubitus varus: a cosmetic incision. J Pediatr Orthop. 2004; 24:477–481. 23. Punia Rs, Sharma R, Usmani Ja, The carrying angle in an Indian population, J Anat Soc India, 1994, 43(2):107–110.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareCUTANEOUS ADVERSE DRUG REACTION MONITORING OF DIFFERENT DRUGS IN DERMATOLOGY OPD OF A TERTIARY CARE TEACHING HOSPITAL English7883Monalisa JenaEnglish Swati MishraEnglish M. PandaEnglish S.S. MishraEnglishBackground: Drugs can cure, suppress or prevent a disease and are usually beneficial to humans. However, they can also produce undesirable/harmful effects, which are known as adverse drug reactions. These are important cause of morbidity, hospitalization, increased health expenditure and even death. Cutaneous adverse drug reactions are among the most frequent adverse drug reactions. Active search is essential for identification of these, as patients may tend to downplay the causal association between drug use and the subsequent cutaneous manifestation. Objective: To observe the types of drug induced cutaneous drug reactions in the patients attending to out patients department of Dermatology in a tertiary care teaching hospital, Bhubaneswar, Odisha and find out the incidence, causal relationship with final outcome ofcutaneous drug reactions. Patients and Methods: A prospective study involving 100 patients attending to the Dermatology Outpatient department was observed during the period of six months to find the patients with CADRs using self-reporting method for selection of cases in the adverse drug reaction monitoring form by CDSCO, India. Causality was assessed using WHO-UMC Causality assessment Scale. Results were analyzed using suitable statistical methods. Results and conclusion: Cutaneous reactions are the most common manifestations of adverse drug reactions. The pattern of adverse drug reactions and the drugs causing them is remarkably different in our population. Knowledge of these drug eruptions, the causative drugs and the prognostic indicators is essential for clinicians for diagnosis and prevention of adverse drug reactions. It is recommended to advise patients to carry a card or an emergency identification of offending drugs in their wallets that list the drug allergies and/or intolerances. EnglishAdverse drug reaction, cutaneous drug eruption, CDSCOINTRODUCTION Drugs are always related with risk of adverse reactions, no matter how safe and efficacious they are. Adverse drug reaction is a response to a drug that is noxious and occurs at doses normally used in man for the prophylaxis, diagnosis or therapy of disease, or for modification of physiological function [1]. It is an unexpected, undesired, and unintended or a toxic consequence of drug administration. Cutaneous drug eruptions are most common types of adverse reaction to drug therapy, with an overall incidence rate of 2%–3% in hospitalized patients [2]. Any medicine can induce skin reactions, and certain drug classes, such as non-steroidal anti-inflammatory drugs, antibiotics and antiepileptics, have drug eruption rates approaching 1%–5% [2]. It was seen that most drug eruptions are serious, some are even severe life threatening. Serious reactions include angio-oedema, erythroderma, Stevens– Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN)[3] .The incidence of the these drug eruptions is directly proportional to the number of drugs prescribed. [4] The historytaking for drug intake is very important, which includes questioning direct, indirect and suggestive. It takes time, but answers are golden in case of cutaneous drug reactions and druginduced dermatitis. [5], [6], [7]Safe use of the drugs is the responsibility of health care professional and a proper knowledge of adverse cutaneous drug reaction related information may be helpful in prevention of it. PATIENTS AND METHODS A prospective study spread over 6 months duration, from May 2012 to October 2012 was carried out in the Dermatology OPD in collaboration with Dept. of Pharmacology, IMS and SUM Hospital, Bhubaneswar, Odisha for recording the Cutaneous adverse drug reactions. 100 patients were enrolled for this study using self-reporting method for selection of cases using ADR reporting form by CDSCO. Following patients were excluded: (i) Patients not willing to take part in the study, (ii) Patients dropping out the study at any stage at their will (iii) Patients lost to follow up. Inclusion criteria’s: (i) Patients of all age groups and either sex (ii) Developing a suspected adverse cutaneous drug reactions following use of any medication were included in the study. Detailed clinical history was taken in a predesigned proforma. History of drug ingestion, self-administration and H/O symptoms, other previous skin and systemic diseases, or any other illness was taken. Thorough clinical examination was carried out. Skin, hair, nail and mucosa (eye, oral and genital) were examined. Diagnosis was confirmed by Dechallenge test (disappearance of signs and symptoms after discontinuation of offending drugs) .Data of suspected cutaneous adverse drug reactions was entered in CDSCO adverse drug reactions reporting form, India. Patients’ consent was obtained to take photos. WHO definition and classifications of adverse drug reactions were followed. The initial history included a recording of all prescriptions and nonprescription drugs taken within the last one month, including dates of administration and dosage and also the history of previous drug exposure and reactions, family history of drug reactions, features and severity of adverse drug reactions etc. Approval from institutional ethics committee was taken before starting the study. Consent from patient was also taken. Causality assessment was done using WHO-Uppsala monitoring center scale, 2002. Cases with a certain, probable or possible were recorded. Relevant laboratory investigations were undertaken to arrive at a clinical diagnosis. Dechallenge was done. Rechallenge was not attempted. The data was compiled and subjected to descriptive statistical analysis. RESULTS 100 patients among which 72 males and 28 females were included in this study (table no 1). The time required to develop cutaneous lesions between 1- 45 days after intake of drug were considered. Sex distribution of drug eruption indicates patients belongs to the 41-50 years age group which is 32% of the study population which is maximum followed by 21-30years(28%) and 31-40 years (20%)of the study population(table no 1). The youngest patient of our study belongs to 1year old and the oldest was 80years old. In pattern of drug eruption and offending drugs: It was seen that cutaneous drug eruption which is commonest in our study was fixed drug eruption which was 61% of study population followed by maculopapular rashes 26%(table no:2). Fixed drug eruption most commonly occurs due to non steroidal anti inflammatory drugs (NSAIDs) around 52% of all fixed drug eruption patients followed by antimicrobials 32%(table no:3). Other drugs like antiepileptics are also responsible for the fixed drug eruption i.e only 13.11%.one case of fixed drug eruption was found due to unknown drug in our study population. The most common NSAIDs to produce fixed drug eruption is Nimisulide (figure no:1) whereas common antimicrobials were Fluoroquinolones, Azithromycine and Cephalosporins. Maculopapular rashes were the 2nd most common cutaneous drug eruption for which the most important and common offending drug was antimicrobials (figure no: 2) followed by analgesics and antipyretics (table no: 4).Some other drugs like antiepileptics, antimalarials, antitubercular drugs were also responsible for development of maculopapular rashes. In our study 3 patients presented with acne form eruptions out of which 2 were due to antitubercular drugs(INH, Rifampicin, Pyrazinamide, Ethambutol) (figure no:3)and one was due to Ampicillin. 2 cases of erythema multiforme were seen because of Ibuprofen (figure no:4). There were 6 cases of Stevens–Johnson syndrome out of which Ibuprofen induced were three in number, two were due to antimicrobials ( Levofloxacin, Cefixime)( Table no :2,figure no:5), one was due to unknown drug. Amongst these two were severe which were managed in intensive care with positive result. There were two cases of toxic epidermal necrolysis, out of which one case was due to Rifampicin( Figure no:6) which was severe but responded well to immediate management. Another one was due to unknown drug which was proved fatal. DISCUSSION Among 100 patients of our study population, 72 were male and 28 were female. So percentage of male patients was more affected by cutaneous drug eruptions than females in our study population. The ratio of male to female patients comes out as 2.57. It is similar as a study done in a North-Indian tertiary care center which reported male preponderance [8] .In some study reports female preponderance also has been found. One possibility to explain the gender difference may be due to their genetic makeup or adherence to the drug more due to variability in the number of the male and female patient attending in different center and so frequently attending patient has higher chances of adverse drug reactions. Next component of the study was to find out whether there is any association between different age groups of the patients and the incidence of cutaneous drug eruptions. In this study among various age group 41-50 years age group had preponderance but in some other Indian studies the young adults had the preponderance [9] . The commonest pattern was fixed drug eruption (61%), followed by maculopapular rashes (26%) and Stevens–Johnson syndrome (6%). According to Pudukadan D et al study, the pattern of cutaneous drug eruption which was commonest was fixed drug eruption (31.1%), followed by maculopapular rash (12.2%) which was similar to our study .[4] Malhotra et al study reported morbilliform rash (29.63%), and urticaria in( 9.26% )as common patterns of reaction. [10] Jhaj et al. reported morbilliform rashas commonest pattern followed by, urticaria (21%).[5]Most important reason for intake of the above drugs are pain, fever and infection. The commonest culprit of fixed drug eruption in our study were NSAIDs, differ from the study by Singh et al where cotrimoxazole was the commonest cause [6] NSAIDs and cotrimoxazole were the common cause of drug eruption in the study by Shrivastav et al. [7],[11] Quinolones were a common cause of maculopapular rash and photosensitivity in our study which indicates increased use of quinolones. [12] Ibuprofen was the commonest cause of erythema multiforme (EM) and Stevens Johnson&#39;s syndrome (SJS) in our study. From the report of Halevi et al Stevens Johnson&#39;s syndrome is due to acetaminophen, [12] while in the study by Devik et al carbamazepine was the commonest offending drug. [13] .The incidence of isoniazide induced acneiform eruptions (0.53%) described in a study by Sharma PP,[14] while we had 3 cases of acne form eruptions due to isoniazide. A high incidence of toxic epidermal necrolysis and Stevens Johnson&#39;s syndrome has also been reported from a North-Indian hospital,[15] while western studies have shown very low incidence[16] Our study had some inherent limitations like: Small sample size, confined to the outpatient department (OPD) of the skin and VD department only and a short period of six months and unable to do the rechallenge. Yet the study clearly provides the baseline data for comparing with other similar studies at the level of state, country and the world. It also provided the information regarding the management of the cutaneous adverse drug reactions and their outcome thus making the drug therapy safer and more rational. This study has been a further step in the direction of strengthening the activity of pharmacovigilance in this part of the country. CONCLUSION It’s the responsibility of clinicians and clinical pharmacists to recognize clinically important ADRs and report them to strengthen the pharmacovigilance activity. This was a prospective and observational study for detection of CADRS and analyzing various facets of the same. The study has revealed many interesting points and has given us insight to carry out further studies of similar type in future so as to derive better information. It is concluded from the above study that by knowing the incidence, morphological patterns and causative agents of various adverse cutaneous drug reactions, many common and serious adverse affects due to drugs can be avoided. Due to lack of interest in ADR monitoring and poor response of the clinician for pharmacovigilance many of them go unreported. It is our contention that the use of high risk drug should be carefully monitored for ADRs and awareness should be created in patients by treating physician so that the morbidity and mortality by the use of the drug should be decreased. 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=1399http://ijcrr.com/article_html.php?did=13991. WHO. International drug monitoring: the role of natTioenchal centres. Rep Ser WHO 1972, no 498 2. Lauraence DR, Bennett PN, Brown MJ. Unwanted effects and adverse drug reactions.Clinical Pharmacology. 8th edn. Churchill Livingstone 1997: 121-137. 3. Dennis L, Kasper MD, Eugene Burunwald MD, Anthony S. Fauci MD, Stephen L Hauser MD, Dan L Longo MD, Larry Jameson J. MD. Ph.D. Harrison’s Principles of internal medicine, 16th edition, Vol – 1, Medical publishing Division 2005: 318-320. 4. Pudukadan D, DM Thappa. Adverse cutaneous drug reactions: Clinical pattern and causative agents in a tertiary care centre in South India. Indian J Dermatol Venereol Leprol 2004; 70:20-4. 5. Jhaj R, Malhotra S, Bhargava VK, Uppal R. Cutaneous adverse reactions in in-patients in a tertiary care hospital. Indian J Dermatol Venereol Leprol ,1999; 65:14-7. 6. Singh KK, Krupashankar DS , Shrinivas CR, Naik RPC. Study of 33 cases of fixed drug eruption, Indian J Dermatol Venereol Leprol ,1990; 56:123. 7. Shrivastava D, Singh SK, Kumar A. Adverse drug reaction monitoring in patients attending skin O.P.D at a teaching hospital. Indian J Pharmacol 2004; 36:S42. 8. Sharma VK, Sethuram G, Kumar B. Cutaneous adverse drug reactions: Clinical pattern and causative agents - A 6 year series from Chandigarh, India. J Postgrad Med 2001; 47:95-99. 9. Barbara S.M, In: Shargel, L., Eds., Comprehensive Pharmacy Review, 4th Edn., Lippincott Williams and Wilkins, London, 2001, 416. 10. Malhotra S, Dogra A, Chopra SC, Gupta C. Cutaneous adverse drug reactions-one year pharmacovigilance study in a tertiary care hospital. Indian J Pharmacol, 2004; 36:S41-2. 11. Prasad PV. A study of Dapsone syndrome at a rural teaching hospital in south India. Indian J Dermatol Venereol Leprol, 2001; 67:69-71. 12. Halevi A, Ben-Amitai D, Garty BZ. Toxic epidermal necrolysis associated with acetaminophen ingestion. Ann Pharmacother 2000; 34:32-4. 13. Devi K, George Sandhya, Criton S, Suja V. Carbamazepine-The commonest cause of toxic epidermal necrolysis and Steven Johnson syndrome: A study of 7 years. Indian J. Dermatol Venereol Leprol 2005; 71:325-8. 14. Sharma RP, Kothari AK, Sharma NK. Antitubercular drugs and acne form eruptions :Indian J Dermatol Venereol Leprol, 1995; 61:26-7. 15. Uppal R, Jhaj R, Malhotra S. Adverse drug reactions among inpatients in a North Indian referral hospital. Natl Med J India 2000; 13:16-18. 16. Naldi L, Conforti A, Troncon MG, Venegoni M ,Caputi A, Ghiotto E, et al.. Cutaneous reactions to drugs. An analysis of spontaneous reports in four Italian regions. Brazilian J Clin Pharmacol 1999;48:839-846.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareDOPING IN SPORTS: CURRENT REVIEW English8487Motilal C. TayadeEnglish Sunil M. BhamareEnglish Prathamesh KambleEnglish Kirankumar JadhavEnglishNowadays doping is critical issue at International level in sport Physiology. This is not only concerned with health matter but also with the moral as well as ethical values of humanity affecting honest team spirit of sports competition. This is directly affecting sports, competitions around the world. Blood doping is the misuse of specific substances to increase one&#39;s red blood cell mass, which allows the body to transport more oxygen to muscles and therefore increase performance and stamina of player or person. There are seen a list numbers of life threatening side effects occurred as a result of blood doping like increases in blood viscosity, myocardial infarction, embolism, stroke, infections, allergic reactions and certain risk of blood born disease like HIV,Hepatitis etc. Anti-doping policies instituted by individual sporting governing bodies may conflict with local laws. There is no such correlation between these authorities and government laws. Nowadays there are a numbers of techniques as well as drugs are using by players, which is really a challenge to detect them by experts and fight the war against doping. However it is our responsibility to fight against them, with update of knowledge and events. EnglishDoping, Erythropoietin, Sport Physiology, Antidoping policiesINTRODUCTION Nowadays doping is critical issue at International level in sport Physiology. This is not only concerned with health matter but also with the moral as well as ethical values of humanity affecting honest team spirit of sports competition. This is directly affecting sports, competitions around the world. Initially term ‘doping’ was restricted only with blood doping. But today the area of doping increases in such a way that the available tests become helpless for doping detection. However avoidance of doping is necessity and duty of experts by updating their knowledge in this field. Any form of practices leading to use of specific drugs with an objective to improve performance or stamina in sport can be referred as Doping. This is considering as unethical by respective organizations where such incidences are repetitively occurring either at National as well as International level. International Olympic committee declares this issue as unlawful and unethical. These committees often charges regular serious actions against such events occurred by time to time. This organization always tries extreme efforts for Doping free sports. 1 Doping is widely used by sportspersons in an attempt to improve their performance without any fear or unawareness related to their consequences or side effects. These practices not only hampers the quality of sports but it may be consider as one part as corruption in sports, thus affecting sport spirit.2 Blood doping is the misuse of specific substances to increase one&#39;s red blood cell mass, which allows the body to transport more oxygen to muscles and therefore increase performance and stamina of player or person. This can be achieving either by direct use of either erythropoietin (EPO), synthetic oxygen carriers or direct blood transfusions. The first documented organized doping controls were carried out in the 1970s. In 1993, the Czech Antidoping Charter was signed and the Antidoping Committee was established. The medical commission of International Olympic Committee decides and declares regularly, which substances and methods are should be prohibited.3 DOPING FORMS 1. Hormone abuse in sports : steroidal and peptide hormones and their modulators, stimulants, glucocorticosteroids, beta2- agonists, diuretics and masking agents, narcotics, and cannabinoids all these, hormones constitute by far the highest number of adverse analytical findings reported by antidoping laboratories.3 2. Blood doping: Blood doping is systemically defined by WADA (World Anti-Doping Agency) as the misuse of techniques and/or substances to increases ones red blood cell count. 4 It is used by either autologus ways or Homologus ways. Most commonly this involves the removal of two units of the athletes blood several weeks prior to competition. The blood is then frozen until 1- 2 days before the competition, when it is thawed and injected back into the athlete. This is known as autologous blood doping. Homologous doping is the injection of fresh blood, removed from a second person, straight into the athlete. 1 3. Use of Artificial Oxygen Carriers: A second method of blood doping involves the use of artificial oxygen carriers. Hemoglobin oxygen carriers (HBOC&#39;s) and Perfluorocarbons (PFC&#39;s) are chemicals or purified proteins which have the ability to carry oxygen. They have been developed for therapeutic use, however are now being misused as performance enhancer&#39;s. Medical Uses of Blood Doping: Artificial Oxygen carriers are the only form of blood doping have important medical use. They were developed for use in emergencies when there is no time for determining and cross-matching a patients blood-type for transfusion, when there is a high risk of infection, or simply when no blood is available. DISCUSION Blood doping is most commonly used by endurance athletes, such as distance runners, skiers and cyclists. By increasing the number of red blood cells within the blood , higher volumes of the protein haemoglobin are present. Haemoglobin binds to and carries Oxygen from the lungs, to the muscles where it can be used for aerobic respiration. Blood doping therefore allows extra Oxygen to be transported to the working muscles, resulting in a higher level of performance, without the use of the anaerobic energy systems. Several Studies have shown that blood doping can improve the performance of endurance athletes.5 Side Effects of Blood Doping : There are seen a list numbers of life threatening side effects occurred as a result of blood doping like increases in blood viscosity, myocardial infarction, embolism, stroke, infections, allergic reactions and certain risk of blood born disease like HIV,Hepatitis etc. Erythropoietin and Blood doping: Erythropoietin (EPO) is a naturally occurring hormone, secreted mainly by the kidneys, which plays an important role in the regulation of production of red blood cells. The use of EPO started in the 1980&#39;s as a quicker, cleaner alternative to blood doping. Testing for EPO only became possible after 2000. Testing may be done by using both blood and urine sample. Erythropoietin is mainly use by endurance athletes such as long distance runners and cyclists.3 Physiology of Erythropoietin: EPO stimulates bone marrow to produce more red blood cells and therefore haemoglobin. For this reason EPO is most commonly used amongst endurance athletes as a higher RBC count means better oxygen transportation and so a higher rate of aerobic respiration. The faster the rate of aerobic respiration, the higher the level at which the athlete can work without utilising the anaerobic systems which produce lactic acid and cause fatigue Side effects of Erythropoietin: There is found major side-effects of using erythropoietin which have proven to be fatal. These are dangerous due to increases in viscosity of blood leads to fever, seizers, nausea, anxiety, lethargy etc. Doping and Law: 1. There are certain laws concerned with punishment in an event occur by sport person. However due to worldwide lack of any uniform policies, doping was leading as Local issue. This is a major drawback in putting applications of strict antidoping laws. 2. Anti-doping policies instituted by individual sporting governing bodies may conflict with local laws. There is no such correlation between these authorities and government laws. 3. Athletes caught in doping may be subject only to penalties from their locality as well from the individual sporting governing body. The body has a only right to bar the player from their association. However these players may continue their carrier through other routes due to lack of uniformity. Doping and India A Zee Research Group analysis released in October 2012 states the fact, doping associated with performance enhancing drugs badly affecting moral, ethical foundations and spirit of competitiveness in modern sports. Sports across the world including India at some or the other point have suffered from doping matter.6 Bangalore based National Anti-Doping Agency (NADA) has introduced blood sampling and testing in India, with the kabaddi World Cup, in 2010.7 In India, the awareness concerned with doping increasing at International as well as National level sports. This is a promising facts noted in Indian doctors, players as well as in officers. 4. The legal status of anabolic steroids varies from country to country. 5. These limitations hamper the strictness concern with such serious issue. Doping – New challenges: Recently German doping specialist Mario Thevis explained more than 100 certain undetectable performance enhancing drugs. According to him these are very difficult to detect due to their structural characteristics.8 It is very difficult to develop tests against these drugs. CONCLUSION Nowadays there are a numbers of techniques as well as drugs are using by players, which is really a challenge to detect them by experts and fight the war against doping. However it is our responsibility to fight against them, with update of knowledge and events. 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=1400http://ijcrr.com/article_html.php?did=14001. Teach PE: http://www.teachpe.com/drugs/epo.php ; Downloaded on 14/12/2012 2. Belson, Ken , N.F.L. Seeks Congressional Help on Drug Policy, The New YorkTimes,(2009-11-04). http://www.nytimes.com/2009/11/04/sports/f ootball/04starcaps.html?_r=1andhpw. Retrieved 2010-05-27. 3. Jeschke J, Nekola J, Chlumský J.Doping in sports. Cas Lek Cesk. 1999 May 10;138(10):291-7. 4. Hartgens F.Medication, athletes and doping regulations. Ned Tijdschr Geneeskd. 2008 Aug 16;152(33):1844-8. 5. Lippi G, Guidi G.Doping and sports. Minerva Med. 1999 Sep;90(9):345-57. 6. Zee Research Group report. The curse of doping in sports. Tuesday, Oct 16, 2012, 21:41 IST Place: New Delhi | Agency: Zee Research Group. http://www.dnaindia.com/india/report_thecurse-of-doping-in-sports_1753162 7. TNN, NADA to crack down on blood doping. Times of India; 17 April 2010. http://articles.timesofindia.indiatimes.com/20 10-04-07/others/28117471_1_blood-dopingnada-samples;downloaded on 03/01/2013. 8. John Mehaffey. Doping-Undetectable new blood boosters available says expert. Olympycs 2012, Reutuers Edition US; http://www.reuters.com/article/2012/03/15/do ping-epo idUSL4E8EF70520120315; Downloaded on 03/01/2013.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareRESPIRATORY HEALTH STATUS OF TRAFFIC POLICEMEN IN PUDUCHERRY, SOUTH INDIA English8892Pajanivel RanganadinEnglish Palanivel ChinnakaliEnglish Kavita VasudevanEnglish Manju RajaramEnglishAim: To assess respiratory health status of traffic policemen using spirometry. Materials and methods: A cross sectional study was conducted among traffic policemen in Puducherry, a town in south India. Information on duration of exposure, respiratory symptoms and usage protective equipment were obtained. Spirometry was done to assess lung function. Observed values of Pulmonary Function Test (PFT) parameters like Forced Vital Capacity (FVC), Forced expiratory volume in one second (FEV1), Peak Expiratory Flow Rate (PEFR) and Mid Maximal Expiratory Flow (MMEF) were compared with predicted values (expected values). Results: A total of 94 traffic policemen were included in the study. Mean duration of working in traffic department was 4.5 years (SD ± 4.2). More than half (52.1%) of policemen reported ‘cough’ in past three months. Rhinitis (common cold) was reported by 40%. All observed PFT parameters (FVC, FEV1, PEFR and MMEF) were less than their respective predicted (expected) values. Conclusion: Respiratory function of traffic policemen showed reduction compared to their expected values emphasizing the need for preventive measures. EnglishPulmonary function test, traffic policemen, respiratory function, respiratory illnessINTRODUCTION Exposure to air pollutants is known to be harmful to health, in general, and to the lungs in particular. In this respect, traffic police personnel, due to the nature of their job, are at a particular risk, since they are continuously exposed to emissions from vehicles. These personnel have to undergo physical strain in an environment polluted by fumes, exhaust of vehicles, use of blowing horns, blow of dust in the air by a speeding vehicle, etc. Prolonged exposure to dust can cause bronchial problems. [1-5] The presence of various particles and gases from vehicular emission like carbon dioxide, carbon monoxide, sulphur, benzene, lead, nitrogen dioxide, nitric oxide and black smoke etc. play a role in the pathogenesis of respiratory diseases. Acute effects include irritation of the eyes and nose, lung function changes, headache, fatigue and nausea. Chronic exposure is associated with cough, sputum production and reduction in lung function. [6,7] In the long run, the pollutants produce diseases like asthma, COPD and malignancy in the exposed individuals apart from significant changes in lung functions. Pulmonary function tests using a computerized spirometer assess respiratory functions and give a fair idea about the respiratory health status of an individual. These changes can be observed even before the disease becomes symptomatic. Hence,  this study aimed at evaluating the respiratory health status of traffic policemen using spirometry and also to document the prevalence of respiratory symptoms among traffic policemen. MATERIALS AND METHODS A cross sectional study was carried out among traffic policemen in Puducherry, a Union territory in southern part of India. This study was carried out as part of annual screening camp organized in the Department of Pulmonary medicine at a tertiary care centre on occasion of World COPD day for traffic policemen. Traffic policemen were screened in three batches. Information on age, gender, years in service, history of smoking and alcohol consumption, usage of protective mask were obtained during the camp. History of respiratory symptoms and family history of allergy and asthma were also recorded. Lung function was assessed by using spirometry, a quite accurate method for assessing the pulmonary function especially the ventilatory functions of the lung. The lung function was assessed using ‘Ferraris KoKo Spirometer’ (Ferraris Respiratory Inc., Louisville, Colorado) using standard protocols. Parameters like FVC, FEV1, PEFR and MMEF were measured and post bronchodilator testing was done as per the need of the case. The actual values (observed values) were compared with predetermined Predicted values of the subjects. The testing was performed in the sitting, relaxed position after adequate motivation and encouragement. Satisfactory demonstrations were carried out about the equipment and the procedure. The subjects were asked to perform the ‘FVC maneuver’ (maximal expiration followed by maximal inspiration) and best of three efforts was taken into account. Chest physicians examined all the study participants to exclude gross pulmonary diseases or anatomical deformity of chest or spine and interpreted the spirometry. The study was reviewed and approved by Institute Ethics Committee. Statistical analysis Data were entered in Microsoft excel spreadsheet and analysis was done in SPSS version 17.0. Observed values of PFT parameters like FVC, FEV1, PEFR and MMEF were compared with predicted values (expected values) standardized for age, height and weight. ‘t’ test was used to compare the difference of means between observed and predicted values. RESULTS A total of 94 traffic policemen were included in the study. The study participants (N=94) constituted about 90% of all traffic policemen working in the study area. All were males and 86% were married (Table 1). Mean duration of working in traffic department was 4.5 years (SD ± 4.2). Forty two percent were working for more than three years. Only 7% of traffic policemen were following some protective measure (mask or handkerchief over face to cover nose and mouth). Twenty percent reported family history of allergy and asthma reported by 12%. More than half (52.1%) of policemen reported ‘cough’ in past three months. Rhinitis (common cold) was reported by 40%. Pulmonary function tests help to evaluate the respiratory status of individuals and helps in diagnosing and managing respiratory problems. Only 81 participants were able to complete the spirometer procedure with good effort. Remaining participants’ spirometry results showed poor effort and were excluded from analysis. Table 2 shows the pulmonary function tests of the traffic policemen. All observed PFT parameters were less than their respective predicted (expected) values. Observed FVC (3.7 L) in traffic policemen were less than expected FVC (4.0 L) and this difference was statistically significant (P Englishhttp://ijcrr.com/abstract.php?article_id=1401http://ijcrr.com/article_html.php?did=14011. Taggart SC. Asthmatic bronchial hyper responsiveness varies with ambient levels of summertime air pollution. Eur Respir 1996; J 9:1146-54. 2. Rusas I. Analysis of relationship between environmental factors and asthma emergency admissions. Allergy 1998; 53: 394-401. 3. Cassino C, Ito K, Bader I, Ciotoli C, Thurston G, Reibman J. Cigarette smoking and ozone-associated emergency department use for asthma by adults. Am J Res Cri Care Med 1999; 159:1773-9. 4. English P, Neutra R, Scalf R, Sullivan M, Waller L, Zhu L. Examining association between childhood asthma and traffic flow using geographic information system. Environ Health Perspect 1999; 107: 761-7. 5. Cotes JE, Malhotra MS. Difference in lung functions between Indians and Europeans. J Physiol 1964; 177: 17-8. 6. Chattopadhyay BP, Alam J, Roychowdhury A. Pulmonary function abnormalities associated with exposure to automobile exhaust in a diesel bus garage and roads. Lung 2003; 181: 291-302. 7. Sydbom A, Blomberg A, Parnia S, Stenfors N, Sandstorm T, Dahlen SE. Health effects of diesel exhaust emissions. Eur Respir J 2001; 17: 733-46. 8. Rastogi SK, Gupta BN, Tanveer H, Srivastava S. Pulmonary function evaluation in traffic policemen exposed to automobile exhaust. Indian J Occup Health 1991; 34: 67- 71. 9. Thippanna G, Lakhtakia S. Spirometric evaluation of traffic police personnel exposed to automobile pollution in twin cities of Hyderabad and Secunderabad. Ind J Tub 1999; 46:129-31. 10. Pal P, John RA, Dutta TK, Pal GK. Pulmonary function test in traffic police personnel in Pondicherry. Indian J Physiol Pharmacol. 2010; 54:329-36. 11. Ingle ST, Pachpande BG, Wagh ND, Patel VS, Attarde SB. Exposure to vehicular pollution and respiratory impairment of traffic policemen in Jalgaon city, India. Ind Health 2005; 43: 656-62. 12. Liwsrisakun C, Tungkanakorn S, Liewhiran A, Yutabootr Y, Praramontol T. Effects of air pollution on lung function: A study in traffic policemen in Chiang Mai. Chiang Mai Med Bull 2002; 41: 89-94. 13. Tamura K, Jinsart W, Yano E, Karita K, Boudoung D. Particulate air pollution and chronic respiratory symptoms among traffic policemen in Bangkok. Arch Environ Health 2003; 58: 201-7. 14. Saenghirunvattana S, Boontes N, Vongvivat K. Abnormal pulmonary function among traffic policemen in Bangkok. J Med Assoc Thai 1995; 78: 686-7. 15. Ogunsola OJ, Oluwole AF, Asubiojo OI, Durosinmi MA, Fatusi AO, Ruck W. Environmental impact of vehicular traffic in Nigeria: health aspects. Sci Total Environ 1994; 146-147: 111-6. 16. Proietti L, Mastruzzo C, Palmero F, Vancheri C, Lisitano N, Crimi N. Prevalence of respiratory symptoms, reduction in lung function and allergic sensitization in a groupof traffic police officers exposed to urban pollution. Med Lav 2005; 96: 24-32. 17. Singh V, Sharma BB, Yadav R, Meena P. Respiratory morbidity attributed to autoexhaust pollution in traffic policemen of Jaipur, India. J Asthma 2009; 46: 118-21.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareMORPHOMETRIC STUDY OF SPUR FORMATION IN DRY ADULT HUMAN CALCANEAE English9397A. PerumalEnglish A. AnandEnglishThe calcaneum is a key tarsal bone in the skeleton of the foot. When a person stands, the calcaneum forms a focal point for transmission of weight. Due to long standing hours and disorders like obesity and diabetes, there is an abnormal growth of bony spur on the inferior surface of the calcaneum either due to calcification or deposition of calcium salts on the fibrous tissue attached to the tubercles. Many studies have highlighted the radiological existence of the spur based on western population. This study is centered around the Morphometric analysis of the calcaneal spur. 218 calcaneae were analyzed. Spur formation in 122 bones was observed. The mean length was more in the right (0.95cm) than left side(0.87cm).The mean breadth was also more in the right (1.73cm) than left (1.71cm). Variations of shape of spur like triangular, circular and oblong shape were categorized. There is a significant difference between radiological appearance and naked eye examination. The findings will serve as a guideline to foot and ankle surgeons who deal with calcaneal spurs. EnglishCalcaneum, calcaneal spur, heel painINTRODUCTION The calcaneum is the key bone and the largest1 in skeleton of the foot which plays the most significant role in transmission of weight, weight bearing, posture and gait. Very rarely the calcaneum may also present itself with a set of accessory bones1 . Such accessory bones of the calcaneum presenting in the inferior or the plantar surface is the os sub calcis and os aponeurosis plantaris. Due in improvement in the quality of life, there is an increase of life expectancy. Increased life expectancy leads to an aging population and presents itself with diseases and conditions associated with it. Out the diseases associated with the formation of a calcaneal spur, obesity plays an important role2 . Although the mechanism of formation of calcaneal spur is not clearly understood it has been suggested that it could either due to longitudinal traction or due to vertical compression and but are yet inconclusive regarding the formation of a spur. Most of the studies on calcaneal spurs have focused mainly on radiological appearance and in some cases the histological architecture and during observation during surgery. This study centers around the calcaneal spurs which are observed by naked eye examination. Whatever be the cause of origin of the calcaneal spur, it results in heel pain for the affected person and leads to an interferes activities of daily living. Persons whose profession involves standing for long hours are the most affected3 . Usually the affected individuals are adults however there are reported cases of calcaneal spur occurring in young individuals also4 . There also exists a higher frequency of calcaneal spur formation in individuals with abductor digiti minimi atrophy5 . MATERIALS AND METHODS 218 Dry Human calcaneae from the Department of Anatomy, Vinayaka Missions Kirupananda Variyar Medical College, Salem were obtained for the study. The calcaneae without spur formation were excluded from the study. Those calcaneae with spurs were measured using a vernier calipers and photographed using digital photographic equipment. A hand lens was used for close examination of the calcaneal spur. The calcaneae with spurs were subjected to the following parameters.  Length of the spur  Breadth of the spur  Thickness of the spur  Any other bony variation RESULTS Out of the 218 calcaneae observed, only 122 calcaneae exhibited spur formation (n=122). The differences in the sides were also categorized (Table-1). The length of the calcaneal spur was measured in which the right sided spurs were longer than the left side (Table-2).There was only a marginal difference in the breadth of the spur of the right and the left sides and the right sided spurs were broader than the left (Table-3). Also the thickness of the spur were more on the right than the left (Table-4). The variations in the shape of the spur were categorized (Table-5). The resultant measurements were statistically analyzed (Table-6). DISCUSSION In the present study it is observed that there was no spur formation from the lateral tubercle of calcaneum and the calcaneal spurs originated from the medial tubercle predominantly and in a miniscule percentage the spur took origin from both the tubercles. This extended presence could be due to the muscles of the first layer of sole and the plantar aponeurosis conjoin to form a single origin at the medial calcaneal tubercle as reported by Simon Smith6 et al. (2007). All the calcaneal spurs were visualized as a hook like projection when viewed from the side whereas in true sense it had a broad margin. The formation of the spurs were due to compression force exerted on the calcaneum during weight bearing. This could be due to an increased load and calcaneal spurs were a resultant feature from obesity7 as reported by Jakob C Thorud et al. The cause for formation of a calcaneal spur is multifactorial but it is evident from the present study that the spur is of various sizes and shapes. There is a preponderance towards a bigger right sided spur than the left which could be due to biomechanical reasons. In all the bones studied the spurs appeared to be an extension from the medial tubercle of the calcaneum rather than a new bone formation and in some of the bones the presence of vascular foramina points out that it had incorporated into and had become an integral part of the medial tubercle of calcaneum. Calcification of the structures attached to the medial tubercle was not observed in any of the bones. The presence of a calcaneal spur affects the normal alignment of structures attached to the medial tubercle of calcaneum thereby causing instability which results in heel pain. The spur is akin to that of an osteophyte or a new bone formation. Repeated traction could result in breakage of the osteophyte resulting in pain and in some instances these micro fractures may not be visible in spite of using sophisticated investigations. CONCLUSION Based on the present study, it can be inferred that spur formation predominantly occurs in the medial tubercle of calcaneum. The differences in the shape and size of the spurs is multifactorial like compression forces and biomechanical reasons. Calcaneal spur formation will result in heel pain and difficulties in posture and walking style of an affected individual. However more elaborate studies have to conducted to exactly pinpoint the cause of formation of a spur in the calcaneum. ACKNOWLEDGEMENTS The authors sincerely wish to thank the management, administrators and the Professor and Head of the department of Anatomy of Vinayaka Missions Kirupananda Variyar Medical College, Salem for their whole hearted support and permissions to utilize their resources and conduct this study. The authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.   Englishhttp://ijcrr.com/abstract.php?article_id=1402http://ijcrr.com/article_html.php?did=14021. Susan Standring, in Gray&#39;s Anatomy, Churchill Livingstone 2008, 40:1437. 2. Hylton B Menz, Gerard V Zammit, Karl B Landorf, Shannon E Munteanu. Plantar calcaneal spurs in older people: longitudinal traction or vertical compression? Journal of Foot and ankle. Research 2008; 1:7. 3. R. Cosentino, P Falsetti, S Manca, R De Stefano, E Frati, B Frediana, F Baldi, E Selvi, R Marcolongo. Efficacy of extracorporeal shock wave treatment in calcaneal enthesophytosis. Ann Rheum Dis 2001; 60: 1064 – 1067. 4. B. Reeves. Development of an os calcaneal spur in a boy between the ages of 10 and 14 years. Ann Rheum Dis 1965; 24: 66. 5. Usha Chundru, Amy Liebeskind, Frank Seidelmann, Joshua Fogel, Peter Franklin, Javier Beltran. Plantar fasciitis and calcaneal spur formation are associated with abductor digiti minimi atrophy on MRI of the foot. Skeletal Radiol 2008: 37:505–510. 6. Simon Smith, Paul Tinley, Mark Gilheany, Brian Grills, Andrew Kingsford. The inferior calcaneal spur—Anatomical and histological considerations. The foot 2007; 17: 25-31. 7. Jakob C. Thorud, Tyler Jolley, Naohiro Shibuya, Daniel C. Jupiter. Association of calcaneal spurs with above average body weight. Texas A & M Health Science Center, College of Medicine, Temple TX.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareRARE DUPLICATION OF URETERS - LEFT SHOWING TWO DIVISIONS AND RIGHT SHOWING FOUR DIVISIONS WITH ANOMALOUS RIGHT KIDNEY English98102Prabhakaran KattimuthuEnglish Manish LamoriaEnglish Ankur Prahalad Bhai PatelEnglish Rupesh KumarEnglishEmbalmed cadavers were dissected as a part of medical undergraduate curriculum; any Unusual or Rare variations/ congenital anomalies were noted and photographed. Rare Duplication of Ureters – Left showing Two Divisions and Right showing Four Divisions with Anomalous Right Kidney were noted. Varieties of congenital Anomalies associated with ureters are of importance to surgeons, Urologist and Gynecologists. Knowing common and rare variations of normal Anatomy helps to avoid undue complications during surgical procedure. Knowledge of Rare variations/congenital anomalies helps to understand the development of the particular structure better including their molecular regulations. EnglishDuplicated ureters, Anomalous KidneyINTRODUCTION Duplication of ureter results from early splitting of the ureteric bud (Sadler1 2006, Moore2 2008, Schoenwolf3 2009).Incidence of duplex ureters, that is two ureters on one side, is 1 in 125 individuals (Standring4 2005) where as incidence of the same bilaterally is 1 in 800 individuals (Standring4 2005).Varieties of congenital Anomalies associated with ureter are of importance to surgeons, Urologist and Gynecologists. Knowing common and rare variations of normal Anatomy helps to avoid undue complications during surgical procedure. Also knowledge of congenital anomalies helps to understand the development of the particular structure better. MATERIALS AND METHODS 20 embalmed cadavers (cadavers were embalmed using standard embalming fluid containing formalin by gravity method and stored in formalin tanks) were dissected as a part of medical undergraduate curriculum in the dissection hall which is well ventilated and well illuminated. Conventional dissection methods using usual dissection instruments (scalpel, forceps, and scissors) were used following instructions of dissection manual (Romanes5 2004) layer by layer under daylight. Any unusual or rare variations/anomalies of the urinary system were noted and studied in detail. Blunt dissection was employed once rare variations/anomalies were detected in order to avoid any damage to the structures. Finally the dissected viscera were photographed using Kodak digital Camera 8.2 Megapixels in both anterior and posterior views. OBSERVATIONS AND RESULTS During cadaveric dissection interesting and rare duplication of ureters on both the right and left side were noted in a male cadaver aged around 60years. (Fig. 3 and 4).The right ureter showed 4 divisions which were partial since all the 4 divisions united soon (Fig. 1and2). Also the right kidney was much smaller in size compared to the left and was only one third -1/3rd the size of a normal kidney (Fig. 3 and 4). The left ureter showed 2 divisions which were once again partial as they united after some distance. Both the right and left ureters opened normally in to urinary bladder. DISCUSSION The ureteric bud develops from the mesonephric duct very close to its entry in to cloaca (Sadler1 2006, Moore2 2008, Schoenwolf3 2009, Standring4 2005). Ureteric bud further develops in to the collecting system and metanephric tissue cap surrounding the ureteric bud develops in to the excretory system. Duplication of ureter results from early splitting of the ureteric bud (Sadler1 2006, Moore2 2008, Schoenwolf3 2009). Incidence of duplex ureters that is two ureters on one side is 1 in 125 individuals (Standring4 2005) where as incidence of the same bilaterally is 1 in 800 individuals (Standring4 2005). Partial duplication of ureters is where the duplicated ureters unite and open as a single structure in to the urinary bladder (Sadler1 2006). Complete duplications are where the duplicated ureters open separately/independently in to the urinary bladder (Sadler1 2006). Many genes are involved in the differentiation of kidney .One of the important Genes Involved in the Differentiation of the kidney –WT1 expressed by the mesenchyme surrounding the ureteric bud that is metanephric tissue caps enables it to respond to induction by the ureteric bud (Sadler1 2006). Due to defect in the WT1 Transcription factor the metanephric tissue cap surrounding the ureteric bud has failed to respond to the induction by the ureteric bud. As a result on the right side the metanephric blastema has not developed completely resulting in anomalous or under developed right kidney. The 4 divisions of the ureter on the right side which unite shortly after some distance from the kidney could be the major and minor calyces, uniting to form the renal pelvis lying outside and at a lower level than the normal location due to underdeveloped or anomalous right kidney. CONCLUSION Rare duplication of ureter – Left showing two divisions and right ureter 4 divisions with anomalous right kidney. Due to defect in the WT1 Transcription factor the metanephric tissue cap surrounding the ureteric bud has failed to respond to the induction by the ureteric bud. As a result on the right side the metanephric blastema has not developed completely resulting in anomalous or under developed right kidney. The 4 divisions of the ureter on the right side which unite shortly after some distance from the kidney could be the major and minor calyces, uniting to form the renal pelvis lying outside and at a lower level than the normal location due to underdeveloped or anomalous right kidney. Different Varieties of congenital Anomalies associated with ureters are of importance to surgeons, Urologist and Gynecologists. Knowing common and rare variations of normal Anatomy helps to avoid undue complications during surgical procedure. Also knowledge of congenital anomalies helps to understand the development of the particular structure better including their molecular regulations. 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. DECLARATION The manuscript represents valid work and that neither this manuscript nor one with substantially similar content under the present authorship has been published or is being considered for publication elsewhere and the authorship of this article will not be contested by anyone whose name (s) is/are not listed here, and that order of authorship as placed in the manuscript is final and accepted by the co-authors. Englishhttp://ijcrr.com/abstract.php?article_id=1403http://ijcrr.com/article_html.php?did=14031. Sadler, T.W., Langman’s Medical Embryology, 10th ed.Lippincott Williams and Wilkins, 2006; P 233-235 2. Moore, K.L., Persaud, T.V.N., The Developing Human Clinically oriented Embryology, 8th ed. Saunders ELSEVIER, 2008; P 255 3. Schoenwolf ,G.C., Bleyl, S.B., Brauer, P.R., Francis, P.H., Larsen’s Human Embryology, 4 th ed. Churchill Livingstone ELSEVIER , 2009; P 497 4. Standring, S., Ellis, H., Healy, J.C., Johnson, D., Williams, A., Gray’s Anatomy the Anatomical basis of clinical practice, 39th ed. Churchill Livingstone ELSEVIER, 2005; P1285 5. Romanes, G.J., Cunningham’s Manual of practical Anatomy, 15th ed.Oxford medical Publications, 2004; Vol. II., P 165.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareSAFETY OF BILATERAL SINGLE STAGE TOTAL KNEE REPLACEMENT UNDER ONE ANAESTHESIA IN TERMS OF PERIOPERATIVE COMPLICATIONS English103111Shekar M.English Chandrasekar C.English Sharan PatilEnglishTotal knee arthroplasty is now the most common joint replacement procedure performed worldwide and many patients require bilateral replacement. Total knee arthroplasty can provide reliable pain relief and correction of limb alignment in patients with moderate or severe arthritis. It follows that when both knees are affected by the end stage arthritis, replacement of one of the two does not fully restore function and the patient remains significantly debilitated. The surgeon and patient are then faced with the decision of whether to proceed with a staged bilateral total knee replacement, done as two unilateral procedures performed on different days, or a single stage procedure on the same day. Our aim was to assess the safety of single stage bilateral total knee arthroplasty under one anesthetic in terms of perioperative morbidity and mortality and the clinical outcome of the procedure.Fifty patients with 100 knees were studied prospectively from the time of admission to final follow up at SPARSH Hospital, Bangalore, between July 2006 to December 2008.The average postoperative knee score at 6 th month follow up was 86.4, which has a statistical significance in terms of functional outcome . Bilateral single stage procedure has definite advantages of reducing the hospital stay and early rehabilitation of the patients suffering from severe bilateral knee arthritis. EnglishBilateral, total knee arthroplasty, complicationsINTRODUCTION Surgical intervention for bilateral gonarthrosis can be performed either with a same day bilateral procedure or with a staged bilateral procedure requiring two separate unilateral procedures performed on different days. Bilateral total knee arthroplasty was primarily being reserved for patients thought to be at high risk for anesthesia which was expanded to include most patients with nearly equal arthritic involvement of both knees by Minter JE et al. 1 The one year mortality rate after bilateral total knee replacement is 2.7%. 2 Therefore patients undergoing bilateral total knee replacement are in general at no more risk of dying than are individuals of similar age dying of natural causes. Additionally, it is estimated that a second arthroplasty would, at a minimum, double the mortality rate associated with unilateral procedures. 2 Patients with concomitant cardiopulmonary conditions may not be good candidates for single stage bilateral procedure, as it increased the risk of cardiopulmonary complications and mortality. 3 The knee lies superficially beneath the skin and the fascial envelope and is covered by only a limited amount of well vascularized muscle as well as by a watershed area of vascular supply to the skin, which lies directly anteriorly in the position of the typical skin incision. Hence, total knee replacement has been associated with greater rate of infection. 4 MATERIALS AND METHOD Fifty patients with 100 knees were studied prospectively from the time of admission to final follow up at SPARSH Hospital, Bangalore.  Period of study: Between July 2006 to December 2008. Inclusion criteria Patients aged between 50 80 years.  Bilateral advanced arthritis.  ASA Grade I and II.  Well motivated patient. Exclusion criteria  Age more than 80 years.  ASA Grade III and IV.  Uncontrolled diabetes and hypertensive with renal functional disturbances, Neuropathy.  Presence of systemic and local infections.  Mentally ill patients.  Patients were admitted one day prior to surgery. Clinical evaluation of all the patients was done by taking complete history and examination of the knees. Standing AP and lateral views of both knees were taken. Preoperative knee scores were calculated by using modified Insall’s knee society scoring system5 which includes both subjective and functional components.  Routine blood investigations as for any major surgery and ECG, 2D ECHO was done. Special investigations like pulmonary function tests, dobutamine stress ECHO was done in relevant cases. Preoperative photographs and videos were recorded. A preoperative checklist was prepared and followed. Proforma was prepared and applied for all the cases. The nature of bilateral total knee replacement including its need, advantages, disadvantages, outcomes and consequences were explained to the patients and their attendants and a valid informed consent was taken. Preanesthetic evaluation and fitness was obtained before the surgery. STATISTICAL METHODS Descriptive statistical analysis has been carried out in the present study. Results on continuous measurements are presented on Mean?SD (Min Max) and results on categorical measurements are presented in Number (%). Significance is assessed at 5% level of significance. Repeated Analysis of variance (RANOVA) has been used to find the significance of study parameters between three or more groups of patients and Student t test (two tailed, dependent) has been used to find the significance of study parameters on continuous scale with in each group. Chi square/ 3x3 Fisher Exact test has been used to find the significance of study parameters on categorical scale between two groups. RESULTS Patient demographics Thirty nine patients were females and 11 patients were males (Table 1).The average age of patients was 61.2 years (43 78 years) (Table 2). Forty two patients were suffering from osteoarthritis (OA) and 8 patients had rheumatoid arthritis [RA] (Table 3). Body mass index (BMI) distribution is as shown in Table 4. Average preoperative knee score was 29.5 (3 63). (Table 5). Average preoperative haemoglobin was 12.4g %( 10.2 15.4g %). Comorbidities Twenty six patients belonged to ASA class I and twenty four patients were ASA class II. Associated comorbidities is as shown in Table 6. Surgical parameters Forty eight patients were operated under epidural anaesthesia and two patients under general anaesthesia. Cruciate retaining (CR) femoral prosthesis was used in 74 knees (37 patients) and cruciate sacrificing (CS) type in 22 knees (11 patients). Cruciate sacrificing rotating platform (RPF) was used in 4 knees (2 patients). Average duration of the surgery was 3 hours 50 minutes. Deep vein thrombosis (DVT) prophylaxis was not used routinely. Deep vein thrombosis prophylaxis was used in only 4 patients . One had past history of varicose veins, two were on regular aspirin and one had difficulty in early mobilization. Duration of follow-up Thirteen patients had a follow up of one year or more and 37 patients were followed up for 6 months. A 70 year old lady with comorbidities such as diabetes, hypertension developed signs of acute renal failure on the same day of surgery. Later her renal parameters came to normal. Though her rehabilitation was delayed, she was able to walk well with good functional range of movements at the time of discharge. Deep seated infection was seen in one patient, who was a 72 year lady without any co morbidities. She was on intravenous antibiotics for 3 weeks, later switched over to oral for another 3 weeks. Following the revision surgery she improved well. Wound healing problem was seen in one patient, who required secondary suturing. Other minor postoperative problems are listed in the table 7. There were no deaths. None of the patients had symptoms suggestive of deep vein thrombosis, pulmonary embolism or myocardial infarction. None of the patients were readmitted within 30 days. The average duration of hospital stay was 11.6 days. The average postoperative knee score at 6 th month follow up was 86.4, which has a statistical significance in terms of functional outcome (Table 8). Immediate postoperative knee scores were low in older age group, but at 6th month follow up it was almost similar in all age groups (Table 9). Males had better functional outcome than females (Table 10). DISCUSSION Adequate data from several sources in the literature have documented that the functional result of a single stage bilateral procedure compares favourably with the result of single procedure. Our study compares well with the already reported literature although there are certain discrepancies (Table 11). Daniel et al 6 and Lombardi et al 7 found that patients who were 80 years or more at the time of surgery, whether they underwent single stage bilateral or unilateral total knee arthroplasty, had higher rates of complications than did their younger counter parts. Pavone et al have concluded that patients belonging to ASA class I and class II had less chance of complications than ASA class III and ASA class IV in their study. These two studies prompted us to exclude patients who are more than 80 years of age and those belonging to ASA grade III and IV from this study. The expected mortality rate for an average 68 year old person is 2.3%. 9 All the procedures in the present study are done in a sequential manner. There were no mortalities in our series. Several authors have found an increased prevalence of cardiovascular complications after bilateral total knee replacement. Lynch et al 10 compared 98 matched patients over the age of 82 years who had either unilateral or single stage total knee replacement and concluded that elderly patients may not have the reserve to manage the fluid shifts that occur after a bilateral procedure. Thus elderly patients undergoing bilateral total knee replacement are at a slightly higher risk for perioperative cardiac complications. None of the patients in the present series had cardiovascular complications. Fat emboli secondary to the release of marrow contents from the intramedullary canals of the femur and the tibia have been described after bilateral total knee replacement. 11,12 One of our patients had significant postoperative confusion which prompted us to think of possible fat embolism phenomenon but it resolved completely on oxygen supplementation. After bilateral total knee replacements patients have a considerable risk of thromboembolic complications. Soudry et al 13 , who evaluated 304 patients and reported a twofold increased relative risk of deep vein thrombosis in the cohort treated with unilateral arthroplasty. Chemoprophylaxis for deep vein thrombosis is not routinely used in our practice. We restrict its use to patients at high risk for deep vein thrombosis. These patients generally would fall into ASA grades III and IV and hence were excluded from this study. However, four patients in this study received chemoprophylaxis. One had calf pain and tenderness in the postoperative period. Doppler studies ruled out measurable deep vein thrombosis for this patient, but chemoprophylaxis was started and continued till the patient was mobilized independently. One had past history of varicose veins and the remaining two were on regular aspirin. Mechanical measures such as early ambulation, compression stockings/bandages were routinely used in all patients. However, calf/foot pump was not used in this series. The routine use of indwelling epidural analgesia may also be one of the contributing factor for reduced incidence of deep vein thrombosis in this study. While successful total joint replacement offers dramatic and lasting improvement in the quality of life, deep infection is the most feared complication of this procedure as it threatens the function of the joint, the preservation of the limb, and occasionally even the life of the patient. 4 Most of the authors also believe that reduced duration of surgery and using separate sterile set of instruments for the other knee may reduce chance of infection. We had one deep infection in our series. Lynch et al 10 have shown the occurrence of renal failure in 3 patients out of 98 following bilateral total knee replacement and 2 patients out of 98 following unilateral total knee replacement. Most of the studies show that the rate of requirement of blood transfusion following bilateral single stage total knee replacement is more when compared to unilateral total knee replacement. The average requirement of number of blood units was 2.65 according to Daniel et al. 2 The average requirement of number of blood units in this study is 1.64. The number of patients requiring more than three units of blood in this series was 4%. There has been marked decline in the hospital stay and rehabilitation time for patients having bilateral knee replacements. The overall hospital stay has decreased from one month in the early studies 13,14 to less than 10 days in the more recent literature. 15,16 SUMMARY AND CONCLUSIONS Bilateral single stage total knee replacements were carried out for 50 patients in this study under a single anesthesia. All the patients were operated by the same surgical team, using standard surgical technique. Postoperative rehabilitation was carried out according to standard protocol. We had four major complications, which includes one deep infection, one acute renal failure, one peptic ulcer disease and one steroid induced myopathy. These were treated accordingly. We also had minor complications such as nausea, vomiting and urinary tract infection in few patients. There was no mortality and no cardiovascular and thromboembolic complications in our series. The average duration of hospital stay was 11.6 days. The mean postoperative knee scores were 86 at th month and 89 at 12 th month follow up, which has statistical significance. Our results are very well comparable with the already reported series. We had few perioperative complications. Major complications in our series including deep infection and acute renal failure were seen in patients who were more than 70 years old. Hence, it may be prudent to think that Indian patients who are more than 70 years age may not be good candidates for single stage procedures. This also correlates with some of the earlier reports. Bilateral single stage procedure has definite advantages of reducing the hospital stay and early rehabilitation of the patients suffering from severe bilateral knee arthritis. It should be emphasized, however, that, as with any surgical procedure, the ultimate result will depend in large part on the expertise of the surgeon and the established pattern of preoperative medical clearance and postoperative management. When the surgeons are experienced in replacement of the knee and have adequate operating room support and assistance, we think that the obvious social and economic advantages of bilateral single stage knee replacement can be offered without compromising the patient’s functional result or increasing the risk of complication or death. Englishhttp://ijcrr.com/abstract.php?article_id=1404http://ijcrr.com/article_html.php?did=14041. Minter JE, Dorr LD. Indications for bilateral total knee replacement. Contemp Orthop 1995; 31: 108 111. 2. Daniel P. Bullock et al. comparision of simultaneous bilateral with unilateral total knee arthroplasty in terms of perioperative complications. J Bone Joint Surg 2003 Oct; 85 A (10): 1981 1986. 3. Camilo Restrepo et al. Safety of simultaneous bilateral total knee arthroplasty A meta analysis. J Bone Joint Surg Am 2007 Jun; 89: 1220 1226. 4. Ayers, David C et al. Common complications of total knee arthroplasty. J Bone Joint Surg Am 1997 Feb; 79 A (2): 278 311. 5. Insall JN, Dorr LD et al. Rationale of the knee society clinical rating system. Clin Orthop 1989; 309: 102 109. 6. Daniel A. Oakes et al. Bilateral total knee replacement using the same anesthetic is not justified by assessment of the risks. Clin Orthop 2004 November; 428: 87 91. 7. Lombardi AV et al. Simultaneous bilateral total knee arthroplasty: Who decides? Clin.Orthop 2001; 392: 319 329. 8. Vito Pavone et al. Perioperative morbidity in bilateral one stage total knee replacements. Clin Orthop 2004 April; 421: 155 161. 9. National Center for Health Statistics. U. S. decennial life tables for 1989 91. Hyattsville: US Department of health and Human services; 1997: 98 1150. 10. Lynch, Nancy M. Trousdale, Robert T. Ilstrup, Duane M. Mayo Clinic Proceedings, 1997 Sept; 72(9): 799 805. 11. George T. Kolettis et al. Safety of 1 stage bilateral total knee arthroplasty. Clin Orthop 1994; 309: 102 109. 12. Dorr LD et al. Fat emboli in bilateral total knee arthroplasty: Predicting factors for neurologic manifestations. Clin Orthop 1989; 248: 112 118. 13. Michael Soudry et al. Succesive bilateral total knee replacement. J Bone Joint Surg 1985 Apr; 67 A (4): 573 576. 14. Ernest L. Gradillas et al. Bilateral total knee replacement under one anesthetic. Clin Orthop 1979May; 140: 153 158. 15. Worland RL et al. Simultaneous bilateral total knee replacement versus unilateral replacement. Am J Orthop 1996; 25: 292 295. 16. Lane et al. Simultaneous bilateral versus unilateral total knee arthroplasty: Outcomes analysis. Clin Orthop 1997; 345: 106 112.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareDONOR CARE AND RECOGNITION IS A STEP TO DEVELOP BLOOD DONATION HABIT AND RETURN BEHAVIOUR English112115Umakanth SiromaniEnglish Thasian T.English Rita IsaacEnglish Dolly DanielEnglish Selvaraj K.G.English Mammen J.J.English Nair S.C.EnglishThere are many determinants deciding the functioning of blood banks efficiently and effectively in order to meet its needs. Donor care and recognition is an important measure for genuine flow of the voluntary blood donors to blood banks to keep their shelves with full of stock all over the year. The determinants like process of donating blood, competent of Staff, time taken for blood donation, tidiness and cleanliness of facilities, post donation care, positive recognition and a word of appreciation would influence blood donors to return. The working hours of blood donation facility should have maximum hours in order to accept blood donors on their convenient time. Time option would be helpful to utilize facility at donors own time. Competent of a staff in venipuncture would be an added advantage. Time taken for blood donation is an important determinant to decide the repetition of blood donation. A pleasant and positive experience promotes safe blood donation and donor return behaviour. EnglishDonor care and recognition, Competent of Staff, Word of appreciation, blood donor return behaviourINTRODUCTION Recruitment and retention of new blood donors is an important task for blood bank personnel to attain self-sufficiency of blood and blood products 1 . Availability of blood and blood products for needy patients has been a social problem for a long time. Converting first-time donors to become regular donors continues to be a challenge for blood banks 2 . Blood banks aim at sourcing safe regular voluntary blood donors, fully aware of transfusion transmissible infections and committed to providing safe blood to recipients. Blood banks urge everyone to respond to the needs of patients so they can increase the stock and able to meet the demand of patients across the country. There are many determinants deciding the efficient and effective functioning of a blood bank to meet its needs. Donor care and recognition is an important measure to increase the flow of voluntary blood donors to blood banks to keep their shelves with full of stock all over the year. Determinants like the process of donating blood, competent staff, time taken for blood donation, tidiness and cleanliness of facilities, post donation care, positive recognition and a word of appreciation would influence blood donors to develop blood donation habit and blood donor return behaviour. The time needed to make a blood donation is an important determinant of repeat donations. Time spared for a noble cause by an individual is valuable and precious. Most of voluntary blood donors may come from their work, studies or important business and they may not be able to wait for a long time. The altruistic behavior of the donor should be recognized and honored by giving the donor priority while collecting blood. Negative impacts on a donor will not promote the concept of blood donation. A pleasant and positive experience improves safety and satisfaction about the donation. Long queuing times might actually prevent donors from donating in the future 3 . The working hours of the blood donation facility should be maximized in order to accept blood donors at the donors’ convenient time. Timing options are helpful to enable donors to use the facility at a time convenient to them. Availability of medical and paramedical staff, donation beds, blood bags and refreshments avoid unnecessary delay in attending to voluntary blood donors. Blood banks that practice both the voluntary and replacement blood donor system should as a priority provide beds exclusively for voluntary blood donors. This enables voluntary blood donors to donate blood immediately without waiting long and eliminates hassles among replacement donors. Competent staff in venipuncture is an added advantage. Reactions and fainting during donation creates an unpleasant experience. The stressful experience of phlebotomy is because of for the higher frequency 4 of reactions among donors. Donor reactions have the most negative impact on the blood donor return rates 5 . Efforts to improve perceptions of the donation experience 6 ensure donor return behavior. A friendly approach from blood bank staff can ease the tension, fear and anxiety of a first time donor. A word of appreciation to donors makes them feel proud about themselves. This ensures a commitment to social responsibility and obligations among donors. Donor recognition differs from blood bank to blood bank recognition of voluntary blood donors need not necessarily be in the form of monetary benefits. It could be a letter of appreciation, a blood group card, a certificate, a badge, a thankyou card, or a seasonal greetings card. Honoring donors at the public functions and donors’ ‘gettogethers’ and inviting the donors’ family to a ‘get-together’ can also create a silent motivation among the relatives. Recognition awards act as an incentive to blood donors and camp organizers and motivate many new potential blood donors to become regular voluntary and repeat blood donors. Recognition and providing donor care for all the blood donors irrespective of their status may develop a good rapport between blood banks and donors. Providing pre and post-donation care is an important determinant of rapport among blood donors. A few donors may feel dizzy and faint due to fear and anxiety. Rest and small refreshment may be helpful to donors after their donation. Providing information on do’s and don’ts, well in advance to blood donors will avoid any untowardness or syncopal reactions. Observing others, fainting produces a reduction in the number of future donations for occasional donors 7 . A word of appreciation would help to enhance a positive attitude among blood donors. This would encourage a volunteer to not only donate blood regularly but also to motivate peer groups and relatives to become volunteers. Some of them could become ambassadors in recruiting new donors even after their retirement due to age or some other health criterion. Retired donors may still be helpful in recruiting new donors or in organizing voluntary blood donation camp in their localities. Organizing and conducting periodic donor meetings is an important measure in recognizing the humane service, social gesture and humanitarian act of donors. Invitations to donors’ families and their friends are compulsory for those meetings. Friendly discussions, feedbacks and close interactions among blood donors develop a friendly network among them. These will influence relatives and friends of donors to convert or become themselves regular blood donors. Practicing universal standards for blood collection and all screening procedure by using disposable syringes and needles ensures the safety of donors from any communicable diseases. Understanding the myths and misconceptions of a first time donor is important. It is to be carefully evaluated so all doubts are cleared. A donor should trust the process and understand that they will not get any infection after the donation. Donors’ trust is equally important in maintaining a donor flow successfully throughout the year. Providing blood group cards and blood-borne viral test results should be compulsory. This will help donors to know their status for any infectious diseases if they have any. However, this would help donors to self-exclude or withdraw from blood donation if they have suspicion about themselves for any untold reasons. Self-exclusion or withdrawal for any suspicious reason would prevent transfusiontransmitted infections (TTIs). Donor selection criteria that include pulse and blood pressure, donor’s weight and total blood volume, minimum hemoglobin and donation interval 8 should be followed uniformly by blood banks. Donors whose services have been used by different blood banks can be put off by lack of uniformity in the process of blood collection and may hesitate to donate even in an emergency. Uniformity in blood collection and a friendly network in transporting blood should be encouraged between blood banks if their stocks are more than their usage. Uniformity of blood collection helps the donors to understand the process easily, and a friendly network in transporting excess blood between blood banks can cater to all patient needs in time and would minimize blood wastage. Steady increase of blood donors is a good sign for healthy development of a blood bank. The blood bank staff should be able to promote their concept and ideas to motivate donors to donate blood regularly. CONCLUSION To conclude that there are many determinants such as, process of donating blood, competent of staff, time taken for blood donation, tidiness and cleanliness of facilities, post donation care, positive recognition and a word of appreciation would influence blood donors to return and decides the functioning of blood banks efficiently and effectively in order to meet its needs" 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=1405http://ijcrr.com/article_html.php?did=14051. Umakanth S, Molly R, Daniel D, Mammen JJ, Nair S C, Ahead to 100% of Voluntary non-remunerated Blood Donation at a tertiary referral hospital blood bank in South India, Asian Journal of Transfusion Science, 2012, 6 (2) 190. 2. Schreiber GB, Sharma UK, Wright DJ, Glynn SA, Ownby HE, Tu Y, et al. and for the Retrovirus Epidemiology Donor Study, First year donation patterns predict long-term commitment for first-time donors, Vox sanguinis 2005:88:114-21. 3. McKeever T, Sweeney MR, Staines A, An investigation of the impact of prolonged waiting times on blood donors in Ireland , Vox sanguinis. 2006; 90(2):113-8 . 4. Zervou EK, Ziciadis K, Karabini F, Xanthi E, Chrisostomou E, Tzolou A, Vasovagal reactions in blood donors during or immediately after blood donation, Transfusion Medicine. 2005; 15(5):389-94. 5. Newman BH, Newman DT, Ahmad R, Roth AJ, The effect of whole-blood donor adverse events on blood donor return rates, Transfusion. 2006; 46(8):1374-9. 6. Thomson RA, Bethel J, Lo AY, Ownby HE, Nass CC, Williams AE, Retention of "safe" blood donors. The Retrovirus Epidemiology Donor Study, Transfusion. 1998; 38(4):359- 67. 7. Ferguson E, Bibby PA, Predicting future blood donor returns: past behaviour, Intentions and observer effects, Health Psychology, 2002; 21(5):513-8. 8. Eder A., Evidence-based selection criteria to protect blood donors, Journal of Clinical Apheresis. 2010; 25(6):331-7.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18HealthcareASSESSMENT OF TYPES OF LEARNING MODES IN MEDICAL STUDENTS English116123Varun MalhotraEnglish Rinku GargEnglish Yogesh TripathiEnglish Usha DharEnglish SanjayEnglish MonishEnglish RanjanaEnglish AbhishekEnglish PronoyEnglishSwadhyaya or deep study, includes Sravana (study) or reading/hearing a concept in physiology, Manana (with attention) pondering over the concept read or heard, Nidididhyasna or forming a definte concept (3). Visual, auditory and kinaesthetic questionnaire was circulated among 75 medical students. Based on the response, they were categorized into visual, auditory and kinaesthetic learners. Percentage incidence and number of visual, auditory and kinaesthetic learners was calculated. This study enabled teachers to modify their methodology of lecture-delivery pictures (power-point), audio CDs and demonstrations. EnglishINTRODUCTION A learning style is a student&#39;s consistent way of responding to and using stimuli in the context of learning. Keefe (1979)6 defines learning styles as the “composite of characteristic cognitive, affective, and physiological factors that serve as relatively stable indicators of how a learner perceives, interacts with, and responds to the learning environment.” Learning styles may also be defined as those “educational conditions under which a student is most likely to learn.” (10). Learning styles are not really concerned with what learners learn, but rather how they prefer to learn. The purpose to identify the learning styles in teaching is a) to design learning activities that students will find interesting b) to ensure that learning is meaningful for every student c) to overcome potential barriers and problems to learning d) to improve 1:1 student-teacher communication d) to demonstrate differences to observers and inspectors.(2) HISTORY The VAK approach (Visual Auditory Kinesthetic) to teaching and learning arose out of the development of magnetic resonance imaging (MRI) in the early 1980s. As doctors used MRI scanning to treat brain-injured patients, they accumulated a mass of data about how the brain processes information. Researchers took the results and aaded them to developing theories in psychology to produce brain-related approaches to learning (2). It is important to think of learning styles as an opportunity to create a meaningful dialogue with your students (2) The Felder Silverman model of learning styles uses an online instrument called the Ïndex of Learning styles and measures students across four dimensions: active/ reflective/sensory/intuitive/visual/verbal/global (2) MATERIAL AND METHODS Seventy five students of first year MBBS 2012- 13 batch of Santosh Medical College, Ghaziabad were given a questionnaire (Appendix 1). Based on their responses, they were categorized as Visual, Auditory and Kinesthetic Learners (Table 1). a choice implied visual, b choice auditory and c were Kinesthetic of the questionnaire. RESULTS 35 students (46.67 %) are visual learners, 27 (36.1%) are auditory learner and 20 students are kinesthetic learners. Predominant students are visual learners. Many students did not have one learning style. Many responses were multiple, implying that students had a flexible repertoire from which to choose, depending on the content of learning. DISCUSSION Other studies data that men have a greater tendency to prefer reading, learning and kinesthetic learning over visual and auditory learning, whereas female tend to have roughly equal preferences for all three modalities. (4) Visual learners (65% of population), respond best when the teacher uses graphs, charts, illustrations or other visual aids, leaves white space in hand outs for note taking, uses gapped handouts for checking retention of knowledge, uses reading materials for in-class and out of class activities, invites questions to help them stay alert in auditory environments, uses flip charts to show what will come and what has been presented, emphasizes key points to cue when to take notes and uses visualization, diagram-labeling and picture drawing activities (5-11) Auditory learners (30% of population), respond best when the teacher, begins new material with a brief explanation of what is coming, concludes with a summary of what has been covered, questions learners to draw as much information from them as possible and then fill in the gaps with expertise, include auditory activities, such as brain storming, buzz groups or jeopardy, leaves plenty of time to debrief activities, this allows learners to make connections of what they learned and how it applies to their situation, uses rhymes, songs, background music or advertising jingles to reinforce main points. (5-11) Kinaesthetic learners (5% of population), respond best when the teacher uses hands on, practical activities that get the learners up and moving, uses conversion exercises that translate text into diagrams, scripts, concept maps, pictures, gives frequent stretch-breaks (brainbreaks), uses props and other items which can be handled and investigated, provides sweets or scents which provides a crosslink of scent (aroma) to the topic at hand (scent can be a powerful recall cue), uses colored matches to emphasize key points on flip charts or wipe boards. (5-11) In our study the students were majority of visual learners, promoting a learning-teaching approach of charts, illustrations and power point. However to let the child learn and nurture his qualities, it is best to use a combination of the three approaches above. CONCLUSION Despite the recent criticisms many educationalists agree that students learn best in the classroom when they are fully aware of their strengths and weakness as learners. It is best to avoid labeling students. Students may prefer one learning style but they respond best to a mix of different activities. So it is best to use a combination of learning styles, as mentioned above, to ensure all student needs are met. (2) 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=1406http://ijcrr.com/article_html.php?did=14061. Learning styles. Why do they matter? Neil D. Fleming, Charles C Bonwell. Lake Washington of Technology. TRiO Student Support Services Projects www.lwtech.edu/trio 2. The FE Toolkit: A Magazine for Grade 1 Teachers: Learning Styles www.newbubbles.com p1-18. 3. Swami Sri Sri Yukteshvarji. The Prophet and His Mission: A Tribute on his 150th Birth Anniversary. How Bhakati Yoga is Attained as per “The Holy Science” 2005, p 18, 19. 4. Coffield, F., Moseley, D., Hall, E., and Ecclestone, K. (2004). Learning styles and pedagogy in post-16 learning: A systematic and critical review. www.LSRC.ac.uk: Learning and Skills Research Centre. Retrieved January 15, 2008: http://www.lsda.org.uk/files/PDF/1543 .pdf 5. Constantinidou, F. and Baker, S. (2002). Stimulus modality and verbal learning performance in normal aging. Brain and Language, 82(3), 296-311. 6. Keefe, J. W. (1979) Learning style: An overview. NASSP&#39;s Student learning styles: Diagnosing and proscribing programs (pp. 1- 17). Reston, VA. National Association of Secondary School Principles. 7. Marzano, R. J. (1998). A theory-based metaanalysis of research on instruction. Midcontinent Regional Educational Laboratory, Aurora, CO. 8. Merrill, D. (2000). Instructional Strategies and Learning Styles: Which takes Precedence? Trends and Issues in Instructional Technology, R. Reiser and J. Dempsey (Eds.). Prentice Hall. 9. Hayman-Abello S.E. and Warriner E. M. (2002). Child clinical/pediatric neuropsychology: some recent advances. Annual Review of Psychology, 53, 309–339. 10. Stewart, K. L., and Felicetti, L. A. (1992). Learning styles of marketing majors. Educational Research Quarterly, 15(2), 15-23. 11. Thompson-Schill, S., Kraemer, D., Rosenberg, L. (2009). Visual Learners Convert Words To Pictures In The Brain And Vice Versa, Says Psychology Study. University of Pennsylvania. News article retrieved July 10, 2011, from http://www.upenn.edu/pennnews/news/ visual-learners-convert-words-pictures-brainand-vice-versa-says-penn-psychology-study Appendix 1: Study Skills - Student Development and Counselling VAK Learning Styles Self-Assessment Questionnaire Circle or tick the answer that most represents how you generally behave. (It?s best to complete the questionnaire before reading the accompanying explanation.) 1. When I operate new equipment I generally: a).Read the instructions first. b).Listen to an explanation from someone who has used it before. c).Go ahead and have a go, I can figure it out as I use it. 2. When I need directions for travelling I usually: a).Look at a map. b).Ask for spoken directions. c). Allow my nose and maybe use a compass. 3. When I cook a new dish, I like to: a).Follow a written recipe. b). Call a friend for an explanation. c).Follow my instincts, testing as I cook. 4. If I am teaching someone something new, I tend to: a).Write instructions down for them. b).Give them a verbal explanation. c).Demonstrate first and then let them have a go. 5. I tend to say: a).Watch how I do it. b).Listen to me explain. c).You have a go. 6. During my free time I most enjoy: a).Going to museums and galleries.

Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524157EnglishN2013April18TechnologyCOMPRESSIVE STRENGTH AND HEATING VALUES EVALUATION OF THE INDIGENEOUS COAL BRIQUETTES OF PAKISTAN (KPK PROVINCE) English124131Unsia HabibEnglish Amad Ullah KhanEnglish Muddasar HabibEnglishPakistan has significant amounts of coal reserves but the country is largely dependent upon the petroleum products and natural gas for their energy needs because of the lack of the large scale technologies to exploit the local coal reserves. The coal Briquetting is one of the small scale technology to use the local coal for various applications. In the current study the coal briquettes were developed by using the coal of the Khyber Pakhtun Khwa province of Pakistan and their strength and thermal properties were evaluated. A small scale experimental unit was made locally for the formation of coal briquettes. Polyvinyl acetate (PVA) binder was chosen for making briquettes because of its good binding characteristics and its organic nature that helped in increasing the mechanical strength and the combustion characteristics of coal briquettes. Different briquettes of the same size and shape were formed by using changing the composition of PVA binder. The mechanical strength of coal briquettes was measured by compressing the Briquetting by applying external load on them until their breaking points. The load required and deflection produced by the briquettes at their yield and break points was found out and a comparison was made among briquettes to identify the high strength briquettes. The thermal properties were measured for all the briquettes by finding out their calorific value. The results show that the thermal properties and strength was the maximum for the briquette no 4 with a composition of 165 ml of PVA binder mixed with 220 ml of water as solvent in 1kg of coal in this work. EnglishCoal briquettes, Binder, strength of coal briquettes,calorific value of coal briquettes, alternative energy sourceINTRODUCTION The development of a nation needs a persistent supply of energy resources. The problem of energy crisis is increasing day by day in the developing countries like Pakistan. The reservoirs of conventional energy resources as petroleum and natural gas have greatly reduced and the country is largely dependent on the import of fuel to meet their energy needs [1]. The use of alternative fuel sources has been proposed from time to time to overcome this issue. Coal is an important energy source and is present in considerable amounts in Pakistan particularly in the province of KhyberPakhtun Khwa (KPK) [2] . Coal reserves of can be used effectively in the form of coal briquettes on a small scale to meet the energy needs of everyday life. Coal Briquetting is a technique to convert raw coal powder into a definite shape. A binder is used to hold or bind the coal particles together in the desired shape. Coal briquettes are better fuel than the raw coal because of their enhanced mechanical and thermal properties. The addition of some binders and other additives not only increases the strength and the heating value of the coal briquettes but also greatly suppresses the emission of poisonous gases in the environment [3]. Coal briquettes have reduced contribution towards the environmental pollution as compared to raw coal and other traditional fuels present in Pakistan like wood, animal dung and charcoal [4]. The coal briquettes can be made indigenously and can serve as a fuel source to meet various domestic and commercial purposes in the developing countries as Pakistan [5]. The performance of coal briquettes is evaluated by its strength and thermal properties. The Mechanical strength is an important parameter in the evaluation of coal briquettes because it affects their storage and the transportation process. The high strength briquettes can be easily transported to the market and their storage and handling process is also easy at the site of usage.The strength of the coal briquettes is dependent upon many factors like type of coal,size of coal used for making briquettes, the type of binder, curing temperature etc. The studies show that reducing the size of raw coal used for briquettes making enhances their strength [6,7,8]. The heat treatment before making briquettes has also found to increase the mechanical and thermal properties of coal briquettes [9]. The type and amount of binder greatly influence the strength and combustion characteristics of the coal briquettes. The use of petroleum products and the coal tar pitch as binder gives high strength briquettes but they are not favorable because they emit poisonous gases on burning and have some adverse effects on the human beings [10]. On the other hand the natural cellulose binders as molasses, saw dust etc. generates less emission but their strength is comparatively lower [10]. In this work Poly vinyl acetate (PVA) was used as a binder in producing briquettes. PVA binder was selected because it is organic in nature so it will not degrade the environment and also because it is locally available at low-price. The compressive strength and the combustion properties of the raw coal and the coal briquettes made were assessed in this work. The strength of the briquettes was measured by applying load on them and their deflection values under the applied load. The values of the load required to break the briquettes and the maximum load that a body can withstand defines its strength, so these values were measured. The thermal properties of the briquettes were determined by measuring the calorific values of the briquettes formed and a comparison was made among the briquettes to recognize the briquette with high strength and high heating value. MATERIAL AND METHODS Raw Materials The indigenous coal samples from KPK (Khyber Pakhtun Khwa ) Province of Pakistan were used in this work. Polyvinyl Acetate was selected as a binder for making coal briquettes . The binder was selected because PVA has good adhesive properties and because it was easily available in the market at low rates. Experimental Setup The Briquetting machine required for producing briquettes was formed locally in the Department of Chemical Engineering UET Peshawar. The design of the Briquetting machine is simple and consists of three main parts i.e Frame, mold and a handle.The frame is used to hold up the other parts of the machine. The mold is the main part of the Briquetting machine in which the coal briquettes are given required shape by putting coal and the binder mixture in it .The cylindrical shape mold with small holes is used in this work.The length of the mold was 200 mm and the inside diameter of the cylindrical mold was 120mm. The small holes present in the mold were 12 in number with a diameter of 10 mm. A long handle is attached to the head of the mold to press the coal mixture inside the mold by applying manual force on the handle. Finally when the coal mixtures acquired the definite cylindrical shape inside the mold, the briquettes were removed from the machine and were kept in the sun for drying. The Briquetting machine used for this work is shown in the Figure 1 The Briquettes made were then tested for their strength in the universal testing machine (UTM). The briquette to be tested was placed in the UTM and the external load was applied on it to compress it. The value of the load was gradually increased and the deflection produced in the briquettes was measured through a computer interface connected with the UTM. . The load and deflection values at the yield and break points of briquettes were identified this way. The maximum load that a material can bear and its corresponding deflection value was also found out. The values obtained were then compared with each other to recognize the composition of high strength briquettes. The comparison of the combustion characteristics was measured by finding the calorific value of the briquettes in the oxygen bomb calorimeter. Briquette Formation The first step in the formation of coal briquettes was the preparation of binder. Five samples of binders were made with different amounts of PVA mixed with the water to make a binder solution. The coal powder was then screened through 200 mm steel mesh to a get a coal sample of uniform size. The amounts of binder, water and coal powder for different briquettes are presented in the table 1. The coal powder was then mixed with the binder solutions manually. The mixture of coal and binder was then poured into the Briquetting press to get the coal briquettes of desired shape. The briquettes formed were then dried in the sun for 2 days. The coal briquettes formation steps are summarized in the figure 2. RESULTS AND DISCUSSIONS The dimensions of cylindrical coal briquettes produced in the study are presented in the table 2. The data in the table III show that there is a slight difference in the L/ D ratios of all the briquettes so all the briquettes have nearly the same size . The relationship of load and deflection produced in all the briquettes as a result of compression force acted upon them are represented in the graphs below. The load and deflection graphs of all the briquettes follow a somewhat parabolic trend. The highest variation from the parabolic trend is displayed in the briquette No 5 because of its zig zag pattern .The Briquettes No 1, 2,and 3 shows deflection without any load in the beginning while briquette no 4 and 5 shows deflection when the load is applied to them. It is also evident from the graphs that less load is required for all the briquettes after the maximum point to produce a further deflection in the briquettes and this value keeps on deceasing until the break point is reached. All the briquettes in this work show a significant decrease in their load values after their maximum point. The purpose of finding the load and deflection relationship is to identify the yield, break point and the maximum point. These values are then plotted for all the briquettes to recognize their strengths and have a comparison of these values. The load graph shows that the briquette No 4 have the highest yield, maximum and the break values which means that more force (in the form of external load ) is required to break the briquette no 4 as compared to other briquettes. Hence briquette No 4 have the maximum strength among all the briquettes. Based on the values of load at yield, break and maximum point the briquettes can be arranged in the following way Briquette no 4 > Briquette no 5> Briquette no 2 > Briquette no 3 > Briquette no 1. Further the deflection values are also compared with each other and are presented in figure 5. The deflection graph shows that the maximum deflection at their yield, maximum and break points is shown by briquette no 5 which means that briquette no 5 is displaced to higher degree under the action of applied load. The lowest amount of deflection is shown by briquette no 4 which means that the briquette no 4 does not dislocate much when load is acted upon it. The high value of deflection shown by briquette no 5 means that it is the most flexible briquette and briquette no 4 is the most rigid or the tough briquette among all the briquettes. All the other briquette shows deflection values in the temperate range. The combustion characteristics of all the briquettes are shown by measuring their gross calorific values. The values obtained are presented in the figure 6. The calorific value data show that the heating value of the briquette no 3 and 4 is greater than the raw coal which means that the PVC binder when added in the ratio as given by the composition of briquette no 3 and 4 results in enhancing the thermal properties of the coal briquettes. The higher heating value is obtained by the briquette no 4 while the lowest value is of briquette no 2. CONCLUSIONS Based on the results provided in this study it can be concluded that, in the absence of any centrally administered coal power generating plant, KPK coal can be effectively used in the form of coal Briquettes. A simple Briquetting press can be developed indigenously for local on site use. Cylindrical shaped briquettes of nearly identical size were made by using PVA as a binder in this work. PVA binder was found to increase the mechanical strength of all prepared briquettes. The combustion characteristics of some briquettes were also enhanced by the addition of PVA binder. The results showed that the thermal properties and strength were maximum for briquette no 4 sample which had a composition of 165 ml of PVA binder mixed with 220 ml of water as solvent and mixed with 1kilogram of raw coal powder for making a cylindrical shaped compressed briquette. 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