Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28General SciencesACCUMULATION OF HEAVY METALS BY PLEUROTUS OSTREATUS FROM SOILS OF METAL SCRAP SITES
English0109G.A. BoamponsemEnglish A.K. ObengEnglish M. Osei-KwatengEnglish A.O. BaduEnglishHeavy metal contamination of our ecosystem is one of the major environmental challenges facing our world today. Fungi have the ability to take out heavy metals from soils. Studies were conducted to determine the effectiveness of using Pleurotus ostreatus for the removal of copper (Cu), zinc (Zn), manganese (Mn) and iron (Fe) from soils of metal scrap sites. P. ostreatus was cultivated on soil samples using sawdust as a substrate. With soils of metal scrap sites, Fe recorded the highest level (10.740 – 68.500 mg/kg) and the least accumulated metal was Cu with a range of Englishenvironmental pollution, mycoremediation, metal scrap site, Pleurotus oystreatus, heavy metalsINTRODUCTION
Contamination of soil environment by heavy metals is becoming prevalent across the globe (Abioye et el., 2010, Nilanjana et al., 2007). There is a steady increase in their concentration in all habitats owing to coal and metal ore mining, chemical manufacturing, petroleum mining and refining, electroplating, paints and dye, as well as battery making industries (Sobha t al., 2007, Gazso, 2001). Metal scrap is used to describe recyclable and other materials that are left over from the utilization of vehicles, building supplies, computers and other electronic gadgets. If heavy metals from such sites are not removed or degraded at once, they get immobilized on soil particles, leach into groundwater, and accumulate in many interlinking food chains because of their persistent nature (Cossich et al., 2002; Klimmek et al., 2001; Adelekan and Abegunde, 2011). Minute quantities of Se, Fe, Zn, Mn and Cu are common in our environment and are essential for the human metabolism by serving as enzyme activators (Yamaca et al. 2007). However, high concentrations of these elements can cause acute or chronic toxicity (Turkekul et al. 2004; Yamaca¸ et al. 2007). Heavy metal toxicity can result in damaged or reduced mental and central nervous function, lower energy levels, and damage to blood composition, lungs, kidneys, liver, and other vital organs (Ruiz-Manriques et al., 1998). Long-term exposure may result in slowly progressing physical, muscular, and neurological degenerative processes that mimic Alzheimer's disease, Parkinson's disease, Wilson’s disease muscular dystrophy, and multiple sclerosis. Repeated long-term contact with some metals or their compounds may even cause cancer (Ruiz-Manriques et al., 1998, International Occupational Safety and Health Information Centre, 1999). Fungus belongs to groups of organisms with very well known heavy metal sorption capacity and excellent metal uptake (Purvis, 1996). Mushrooms can build up large concentrations of some heavy metals, particularly cadmium (Cd), mercury (Hg), lead (Pb) and Cu (Kalac and Svoboda 2004, Kalac 2009). Many studies (Kalac and Svoboda 2005, Kalac et al. 1991) revealed a high ability of mushrooms to accumulate common pollutants present in the biosphere, mainly heavy metals and radionuclides. Various quantities of heavy metals have been observed in mushroom fruiting bodies of different mushrooms collected adjacent to heavy metal smelters, landfills of sewage sludge, emission area (Courtecuisse, 1999; Svoboda et al. 2006; Antonijevic and Maric, 2008; Svoboda and Kalac 2003). Mycoremediation involves the use of fungi to degrade or sequester contaminants in the environment (Stamets, 1999); it relies on microbial enzymatic activities to remove the contaminants from the environment (Philip et al., 2005). Mycoremediation offers an ecofriendly and low-cost bioremediation technique because it is a natural process and does not usually produce toxic by-products. It also provides a permanent solution as a result of complete mineralization of the contaminants in the environment (Perelo, 2010). Arica et al, (2003) reported, the use of turkey tail mushroom and phoenix oyster mushroom mycelia to eliminate 97% mercury ion from water. As observed by Humer et al, (2004), mushroom degraded copper and chromium in treated woods. This research was carried out to determine the effectiveness of using Pleurotus ostreatus in the mycoremediation of heavy metals by evaluating the concentration of heavy metals in Pleurotus ostreatus cultivated in soil samples from the metal scrap sites.
MATERIALS AND METHODS
Soil sampling and experimental design:
Three metal scrap sites (Polyafran-1, Nyonni-2 and Industries-3) in Tamale established in 1999, 2005 and 2007 respectively were randomly selected for investigation. Soil samples were obtained from each site at depths of 0-5 cm (top soil) and 15-20 cm (sub soil) and immediately placed in a fresh tightly sealed sack bag. The soil was spread on a clean rubber sheet placed on a flat surface and air-dried in open under room conditions for 24 hrs. Afterwards, 5 g of sample was taken from the sieved soil (2 mm sieve) and put in polyethylene bags for further analysis. It was an experiment with four replicates and seven (7) treatments. The treatments used were site 1 top soil (S1T),site 1 sub soil (S1S), site 2 top soil (S2S), site 2 sub soil (S2S),site 3 top soil (S3T), site 3 sub soil (S3S), non-metal scrap site (FS). Soil samples from a non-metal scrap site, U.D.S (Nyanpkala), were used as a control.
Cultivation of mushroom:
Sawdust (98%) was mixed with lime (1%) and urea (1%) to decompose. The substrate was decomposed for a month with constant stirring (using the flat bladed shovel) to enhance uniform distribution of oxygen, nutrients and ensure constant temperature. After decomposition, the substrate was combined with the various soil samples in a white perforated polyethylene bag. The bags were filled with 10kg of the substrate both at the base and at the top of the bag. The various soil samples (5kg) were placed it the middle making each bag 25kg. A polyvinyl chloride (pvc) pipe was placed at the neck of the polyethylene bag and was covered with a cotton wool. The bags were steam pasteurized at a temperature of 115 °C to kill potential competitive microorganisms in a sterilizing tank after heating for 1-2 hours. After the substrate has cooled, the spawn of Pleourotus ostreatus (obtained from the Food Research Institute, Ghana) was then broadcast over the surfaces of the bags. This was done under sterile condition in a room without air movement (closed doors and windows). In 30days, the mycelium had grown from the spawn and had permeated into the substrate. The mushroom began to form around the edges of the bag perforations. The bags were maintained under optimal growth conditions of temperature (15 °C) and pH of 7.0. The humidity was maintained at 70-80% by watering the bags regularly to favor fruiting. Afterwards they were then transferred to dark air- conditioned room for the development of the fruiting bodies under mushroom shelves. Following the mycelium growth, the PVC pipe was then plugged out, including the paper and the cotton, to allow primordial formation to occur under suitable environmental conditions. Fruiting bodies stated developing and were harvested one week after transferring to the production room.
Harvesting and analysis of soils and mushroom tissues:
For the analysis of heavy metals, 0.5 g of the soil sample was weighed into a round bottom flask which was connected to a partial condenser and a water cooler. Concentrated H2SO4 (2.5 ml) and HNO3 (2.5 ml) was added to the soil in the round bottom flask. It was then heated for 30 minutes and allowed to cool to room temperature. After cooling, another 10 ml of HNO3 was added and heated for an hour. Distilled water (2 ml) was added after cooling to room temperature. Afterwards, it was heated again for 15 minutes and allowed to cool to room temperature again. The cooled water was then filtered and used for the test. Determination of the heavy metals (Fe, Cu, Mn, and Zn) concentration was done with an atomic absorption spectrophotometer (AAS model 210 VGP). The first and second harvests were made in the first and second weeks. The fruiting bodies were harvested by gently turning them out of the soil and analysed for Mn, Fe, Zn and Cu. The mushroom was dried at a temperature of 70 °C for 15 hours. Dried mushroom samples (0.5 g) from each treatment were digested using concentrated HNO3 (2.5 ml) and H2SO4 (2.5 ml) in a whole glass system which consisted of a round bottom flask, partial condenser and water cooler. Final measurements of heavy metal content of mushroom and soil sample were performed using the Atomic Absorption Spectrophotometer (AAS model 210 VGP)
RESULTS
Heavy metal analysis - soil from metal scrap sites:
Soil analysis (Table 1) showed that Mn, Fe, Cu and Zn levels were higher in the top soils of Polyafran, and Nyonni stes. With the third site (Industries), sub soil concentrations of these metals were higher than the top soil. Heavy metals in top soils ranged from 0.338 mg/kg for Cu - 70.950 mg/kg for Fe with the sub soils ranging between 0.005 (Zn) – 34.46 mg/kg (Fe). Fe recorded the highest concentration in all soil samples followed Mn, Zn and Cu. Mn concentration was highest in site two top soils (S2T) with 7.063 mg/kg and least in site two sub soil (S2S) with 3.360 mg/kg. Fe was highest in site two top soils (S2T) with 70.95 mg/kg and least in site one sub soil (S1S) with 15.387 mg/kg. Cu was high in site one top soil (S1T) with 26.97 mg/kg and least in site three sub soil (S3S) with 0.02 mg/kg and lastly with Zn, it was high in site three top soils (S3T) with 29.43 mg/kg. The least concentrations of Mn, Fe, Cu and Zn were recorded in the control (non-metal scrap site).
Heavy metals concentrations in Pleurotus ostreatus:
In the first harvest, (table 2), Fe content in P. ostreatus was the highest (2.215- 3.445 mg/kg). Mn was the next highly absorbed ranging from 0.455-0.688 mg/kg and it was followed by Zn (0.266-0.547 mg/kg). Cu was the least absorbed with a range of 0.012- 0.038 mg/kg. The highest concentration of Mn recorded was from site 2 subsoil (S2T) and the least recorded in site 1 topsoil (S1T). With Fe, the highest absorption was in site 3 subsoil (S3S) and the least absorbed from site 2 subsoil (S2S). The highest Cu observed was from site 1 subsoil (S1S) and the least observed from site 3 topsoil (S3T). Zn concentration was least in site 3 subsoil (S3S) and highest in site 3 topsoil (S3T).
The highest absorption of the heavy metals by the Pleurotus ostreatus was in Fe, with Mn being the next highly absorbed (table 3). This was followed by Zn and the least was Cu. The lowest Fe concentration was 2.113 mg/kg from site 2 top soil (S2T) but was highly absorbed from site 1 topsoil (S1T) by 4.666 mg/kg. For Mn, the lowest absorption was 0.416 mg/kg from site 2 top soils (S2T) and the highest was 0.746 mg/kg. In Zn, it was least absorbed from site 3 subsoil (S3S) with 0.221 mg/kg and highly absorbed 0.566 mg/kg from site 3 topsoil (S3T). Again, for Cu, the least absorbed was 0.013 mg/kg from site 3 subsoil (S3S) and highly absorbed 0.144 mg/kg from site 1 topsoil (S1T).
It was observed from both harvests that, there was a slight increase in heavy metal concentrations in the second harvest as compared to the first harvest. From tables 2 and 3, non-metal scrap soil (NS), showed the lowest absorption of Mn, Fe, Cu and Zn in Pleurotus osteatus for both harvest. From the first harvest, it was observed that, accumulation of the metals followed in a decreasing order of Fe > Mn > Zn > Cu. The same decreasing trend of Fe > Mn > Zn > Cu was observed in the second harvest Copper concentration in Pleurotus ostreatus: The mushrooms were able to absorb more of the Cu in the second harvest (grand mean- 0.287 mg/kg) than in the first harvest (grand mean0.022 mg/kg). The highest Cu concentration in the first harvest was 0.029 mg/kg from SIS and the least was 0.020 mg/kg in the rest of the treatments. The highest for the second harvest also recorded 0.082 mg/kg from S2S and the least being 0.0165 mg/kg from S2T. However there was no significant difference (P>0.05) between the treatments in both harvest. Manganese concentration in Pleurotus ostreatus: There was no significant difference (p>0.05) in Mn concentration in P. ostreatus between the treatments in both harvests .The second harvest recorded the highest concentration of Mn with a grand mean of 0.587 mg/kg as compared to the first harvest which had a grand mean of 0.520 mg/kg in the fruiting body of the P. ostreatus. In both harvest, the highest absorption of Mn occurred in S1S, with 0.580 mg/kg for the first harvest (table 2) and 0.670 mg/kg for the second harvest (table 3). S3T recorded the least of Mn for the first harvest with 0.486 mg/kg and S1T recorded the least of Mn for the second harvest with 0.499 mg/kg. Non-metal scrap soil (NS) recorded the least as compared to the other treatments (scrap soils) with 0.420 and 0.407 mg/kg for first and second harvest respectively. Zinc concentration in Pleurotus ostreatus: Zinc concentration varied significantly (p0.05) in the Fe concentration between the treatments in the second harvest but the Fe concentration was generally higher as compared to the first harvest (fig.1). However, there was a significant difference (p Zn > Cu. The uptake of Cu was considerably lower in all the treatments and it was the same treatment that recorded the least from the metal scrap soil. Pleurotus ostreatus offered a possibility of amending heavy metal contaminated soils from scrap sites.
Englishhttp://ijcrr.com/abstract.php?article_id=1408http://ijcrr.com/article_html.php?did=14081. Abioye, O. P., Abdul Aziz, A., Agamuthu, P. (2010). Enhanced Biodegradation of Used Engine Oil in Soil Amended with Organic Wastes. Water Air and Soil Pollution. 209: 173 – 179.
2. Adelekan, B. A. and Abegunde, K. D. (2011). Heavy metals contamination of soil and groundwater at automobile mechanic villages in Ibadan, Nigeria International Journal of the Physical Sciences Vol. 6 (5), pp. 1045-1058.
3. Antonijevic, M., Maric, M. (2008). Determination of the content of heavy metals in pyrite contaminated soil and plants. Sensors 8:5857–5865.
4. Arica, M.Y.; Arpa, C.; Kaya, B.; Bektas, S.; Denizilli, A. And Gene, O. (2003).Comparative biosorption of mercuricion from aquatic systems by immobilized live and heatinactivated Trametes versicolor and Pleurotus sajo-caju. Bioresource Technology 89(2):145-154.
5. Barr, D.P. and Aust, S.D. (1994). Mechanisms of white fungi use to degrade pollution. Crit. Rev. Environ. Sci. Technol. 28 (2): 79 – 87.
6. Begume, A., Ramaiah, M., Harikrishna, Khan I., Veena, K. (2009). Analysis of Heavy Metals Concentration in Soil and Litchens from Various Localities of Hosur Road, Bangalore, India. E-J. Chem., 6(1): 13-22. http://www.e-journals.net.
7. Cooper, D.C., Neal, A.L., Kukkadapu, R.K., Brewe, D., Coby A, Picardal F.W. (2005). Effects of Sediment Iron Mineral Composition on Microbially Mediated Changes in Divalent Metal Speciation: Importance of Ferrihydrite. Geochim. Cosmochim. Acta, 69: 1739-1754.
8. Cossich, E S., Tavares, C.R.G., Ravagnani, T.M.K. (2002). Biosorption of chromium (III) by Sargassum sp biomass. August 15 (Cited 26 October, 2005). Available from http//www.ejbiotechnology.info/content/vol 5/issue15/full15/index html. ISSN 0717- 3458. Elec. J. Biotech., 5(2): 133-140.
9. Courtecuisse, R. (1999). Collins guide to the mushrooms of Britain and Europe. Harper Collins Publishers, London.
10. Gazso, L.G. (2001). The Key Microbial Processes in the Removal of Toxic Metals and Radio nuclides from the Environment. A review. Cent. Eur. J. Occup. Environ. Med., 7(3): 178–185.
11. Hamilton-Taylor J., Smith, EJ, Davison, W., Sugiyama, M. (2005). Resolving and Modeling the Effects of Fe and Mn Redox Cycling on Trace Metal Behavior in a Seasonally Anoxic Lake. Geochim. Cosmochim. Acta. 69: 1947-1960.
12. Hamman, S. (2004). Bioremediation capability of white rot fungi. B- 1570, Review article, spring 2004.
13. Hitivani, N. and Mecs, L. (2003). Effects of certain heavy metals, on the growth, dye decolouration and enzyme activity of Lentinula edodes Ectoxicology and Environmental safety 55(2):199-203. http://www.microrestoration-info.com (Assesed 12-11-2012).
14. Humer, M.; Bokan, M; Amartey, S.A.; Sentijure, M. Kalan, P. and Pohleven, F. (2004). Fungal bioremediation of copper, chromium and boron treated wood as studied by electron pragmatic resonance. International Biodeterioration and Biodegradation 53:25-32.
15. International Occupational Safety and Health Information Centre 1999. Metals in Basics of Chemical Safety, Chapter 7, Sep. Geneva: International Labour Organization.
16. Kalac, P. (2009) Chemical composition and nutritional value of European species of wild growing mushrooms: a review. Food Chem 113:9–16.
17. Kalac, P., Burda, J., Staskova, I. (1991) Concentration of lead, cadmium, mercury and copper in mushroom in the vicinity of a lead.
18. Kalac, P., Svoboda, L. (2005) A review of trace element concentrations in edible mushrooms. Food Chem 69:273–281.
19. Kies, C. (1989). Copper bioavailability and metabolism. 1st ed. Plenum Press. New York.
20. Klimmek, S., Stan, H.J., Wilke, A., Bunke, G., Buchholz, R. (2001). Comparative analysis of the biosorption of cadmium, lead, nickel and zinc by Algae. Environ. Sci. Technol., 35: 4283-4288.
21. Malik, A. (2004). Metal bioremediation through growing cells. Envi. Interna. 30: 261-278.
22. Nilanjana, Das; R. Vimala, and P. Karthika, (2006, 2007). School of biotechnology, chemical and biomedical engineering, VIT University, Vellore 632014, India.
23. Oudot, J. (1990). Selective migration of low and medium molecular weight hydrocarbon in petroleum contaminated terrestrial environment. Oil and chemical pollution 6:251-261.
24. Perelo, L. W. (2010) Review: In situ and bioremediation of organic pollutants in aquatic sediments. Journal of Hazardous Materials 177: 81 – 89.
25. Philip, J. C., Atlas, R. M. (2005). Bioremediation of contaminated soil and aquifers. In: Bioremediation: Applied Microbial Solution for Real- World Environmental Clean Up. Atlas, R. M., and Jim, C. P. (ed.) ASM Press, ISBN 1-55581- 239-2, Washington, D.C., pp.139.
26. Ruiz-Manriquez A., Magaña, P. I., Lopez, R., and Guzman, R. (1998). Biosorption of Cu by Thiobacillum ferrooxidans, Bioprocess Engineering 18, pp. 113-118.
27. Samuel, O., Florence, E., Emmanuel, A. and Fredrick, A., (2010). Human risk assessment and epidemiological studies from exposure to toxic chemicals in Tarkwa-Nsuaem municipality, Prestia Huni Valley District and Cape Coast Metropolis Ghana, pp 46-49.
28. Sobha, K., Poornima, A1., Harini, P1., Veeraiah (2007). k2 a study on biochemical changes in the fresh water fish, catla catla (hamilton) exposed to the heavy metal toxicant cadmium chloride kathmandu university journal of science, engineering and technology vol.i, no.iv.
29. Stamets, P. (1999). Undated. "Helping the Ecosystem through Mushroom Cultivation." Adapted from Stamets, P. 1998. "Earth's Natural Internet." Whole Earth Magazine, Fall.
30. Stamets, P. (2005). Mycelium Running. How mushroom can help save the world Ten speed Press, Berkeley/Toronto. 1st Edition. 339 pp.
31. Turkekul, I., Elmastas, M. and Tuzen, M., (2004) Determination of iron, manganese, zinc, lead and cadmium in mushroom samples from Tokat, Turkey, Food chem. 84, 389-392.
32. Veglio, F., Beolchini, F. (1997): Removal of metals by biosorption: a review. Hydrometallurgy 44, 301-316.
33. Volesky, B., Holan, Z.R. (1995): Biosorption of heavy metals. Biotechnology Programme. 11, 235-250
34. Yamaca, M., Yldz, D., Sarku¨rkcu¨, C. C., Elikkollu, M., Halil, Solak M. (2007) Heavy metals in some edible mushrooms from the Central Anatolia, Turkey. Food Chem 103(2):263–267.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28General SciencesSCALED QUANTUM CHEMICAL STUDIES OF THE STRUCTURE AND VIBRATIONAL SPECTRA OF 1, 5- DIMETHYLNAPHTHALENE
English1022N. Jayamani English N. GeethaEnglishThe scaled phase FTIR and FT-Raman spectra of 1,5-dimethylnaphthalene(DMN) has been recorded in the region 4000-400 cm-1 and 4000-50 cm-1, respectively. The fundamental vibrational wavenumbers and intensities of vibrational bands are evaluated with the aid of normal coordinate analysis based on density functional theory (DFT) using the standard B3LYP/6-31G** method and basis set combination with scaled quantum mechanical force field. The Infrared and Raman spectra are also predicted from the calculated intensities. Comparison of simulated spectra with the experimental spectra provides important information about the ability of the computational method to describe the vibrational modes.
EnglishVibrational spectra, 1,5-dimethylnaphthalene, DFT calculations, Vibrational analysisINTRODUCTION
The structure of naphthalene is benzene like, having two six membered rings fused together. Naphthalene resembles benzene in many of its reaction altogether, it is mild aromatic but more reactive than benzene. DMN is a relatively new sprout inhibiter for use a maincrop and seed potatoes. No harm is expected to the public, the environment. DMN is used as an intermediate for synthesis of pharmaceuticals, photochemical, plant growth hormones, insecticides dyes and other organic compounds. It is also used as a surfactant; water reducing and dispersant.1 The department of Health and Human Services [DHS] concluded that naphthalene is reasonably anticipated to be a human carcinogen.2 The vibrational assignments of the compound can be proposed on the basis of wavenumber agreement between the computed harmonics and the observed fundamentals. Quantum chemical computational methods have proven to be an essential tool for interpretations and prediction of vibrational spectra.3,4 A significant advances in this area was made by scaled quantum mechanical (SQM) force field method5-8 . In the SQM approach, the systematic errors of the computed harmonic force field are corrected by a few scale factors which were found to be well transferable between chemically related molecules.4, 9-11 In the present study, we extend a probing with the application of the B3LYP/6-3IG** (basis set) based on the SQM method12 to vibrational analysis and deformational stability of DMN. The geometrical parameters of the most optimized geometry obtained were used for the DFT calculations. The Infrared and Raman intensities were also predicted. Based on these calculations, the simulated FTIR and FTRaman spectra were obtained.
EXPERIMENTAL
The pure crystalline samples of DMN was obtained from Lancaster chemical company, UK, and used without further purification for the spectral measurements. The room temperature Fourier transform infrared spectra of the title compounds were measured in the region 4000-400 cm-1 at a resolution of ±1 cm?¹, using BRUKER IFS 66V Fourier transform spectrometer, equipped with MCT detector, a KBr beam splitter and globar source. The FT-Raman spectra were recorded on the same instrument with FRA-106 Raman accessories in the region 4000-50 cm-1 . The 1064 nm Nd: YAG laser was used as excitation source, and the laser power was set to 200mw.
COMPUTATIONAL DETAILS
The molecular geometry optimization was carried out with the Gaussian 03W program package13 at the B3LYP level, 14,15 supplemented with the standard 6-31G** basis set. The Cartesian representation of the theoretical force constants have been computed at the fully optimized geometry by assuming Cs point group symmetry. Scaling of the force fields were performed by the scaled quantum mechanical procedures with the selective scaling in the local symmetry coordinates representation16 using transferable scale factors available in the literature.12 Transformations of the force field and the subsequent normal coordinates including the refinement of the scaling factors calculation of potential energy distribution (PED), and the prediction of IR and Raman intensities were done on a PC with the MOLVIB program (version V 7.0-G77) written by Sundius. 17, 18, 19 For the plots of simulated IR and Raman spectra, pure Lorenzian band shapes were used with a band width (FWHM) of 10 cm-1 .The vibrational modes were assigned by means of visual inspection using the GAUSSVIEW program.20The symmetry of the molecule was also helpful in making vibrational assignments. The symmetries of the vibrational modes were determined by using standard procedure4, 12 of decomposing the traces of the symmetry operations into the irreducible representations. The analysis for the vibrational modes of DMN is presented in some details in order to better describe the basis for the assignments.
Prediction of Raman intensities:
The Raman activities (Si) calculated with the GAUSSIAN98 program and adjusted during the scaling procedure with MOLVIB were converted to relative Raman intensities (Ii) using the following relationship derived from the basic theory of Raman scattering. 21, 22, 23
Where ?o is the exciting wavenumber (in cm-1 units), ?i the vibrational wavenumber of the ith normal mode; h, c and k are fundamental constants; and ƒ is a suitably chosen scale factor for all peak intensities.
RESULT AND DISCUSSION
Molecular geometry: The optimized molecular structure of DMN having Cs symmetry is shown in fig.1. The global minimum energy obtained by DFT structure optimization for DMN is calculated as 464.5443 Hartrees. The optimized geometrical parameters obtained in this study for DMN is presented in Table 1. Detailed description of vibrational modes can be given by means of normal coordinate analysis (NCA). For this purpose the full set of 89 standard internal coordinates containing 23
redundancies for DMN was defined in Table 2. From this, a nonredundant set of local symmetry coordinates were constructed by suitable linear combinations of internal coordinates following the recommendations of Fogarasi and Pulay7, 16 is summarized in Table 3.
Vibrational spectra
The 66 normal modes of DMN is distributed amongst the symmetry species as Γvib = 45A’ (in-plane) +21A” (out-of-plane) iIn agreement with Cs symmetry. All vibrations are active in both the Raman scattering and Infrared absorption. In Raman spectrum the A’ vibrations give rise to polarized bands while the A” to depolarized bands. The detailed vibrational assignments of fundamental modes of DMN along with observed and calculated wavenumbers, IR and Raman intensities and normal mode dichiptions (characterized by PED) is reported in Table 4. For visual comparison, the observed and simulated FTIR and FT-Raman spectra of the title compound is presented in Figs.2-3 which helps to understand the observed spectral features. They are convenient to discuss the vibrational spectra of DMN in terms of characteristic spectral regions as described below. Methyl Group vibrations: For the assignments of CH3 group wavenumbers, basically nini fundamentals can be associated to each CH3 group namely, CH3 ss – symmetric stretch; CH3 ips – in-plane stretch (i.e. in-plane hydrogen stretching modes); CH3 ipb – inplane bending (i.e. in-plane hydrogen deformation modes); CH3 sb – symmetric bending; CH3 ipr – in-plane rocking; CH3 opr – out-of-plane rocking; tCH3 – twisting hydrogen bending modes. In addition to that, CH3 ops – out-of-plane-stretch and CH3 opb – out-ofplane bending modes of CH3 group would be expected to be depolarized for A’’ symmetry species. The CH3 ss wavenumbers are established at 2897 cm-1 and 2923 cm-1 in IR and CH3 ips are assigned at 2945 cm-1 and 2965 cm-1 in IR for DMN. These assignments are also supported by literature 24 in addition to PED output. The four in-plane methyl hydrogen deformation modes are also well established. We have observed the symmetrical methyl deformation modes CH3 sb at 1447 cm-1 and 1438 cm-1 in IR and in-plane methyl deformation modes CH3 ipb at 1471 cm-1 and 1453 cm-1 in IR. The bands at 2863 cm-1 and 2845 cm-1 in IR and 1401 cm-1 and 1382 cm-1 in IR are attributed to CH3 ops and CH3 ipb respectively in the A’’ species. The methyl deformation modes mainly coupled with inplane bending vibrations. The bands obtained at 1066 cm-1 , 1036 cm-1 and 1016 cm-1 , 977 cm-1 in IR are assigned to CH3 in-plane and out-of-plane rocking modes. The assignment of the bands at 115 cm-1 and 119 cm-1 in Raman are attributed to methyl twisting modes C-H vibrations: Aromatic compounds commonly exhibit multiple week bands in the region 3100-3000 cm-1 due to C-H stretching vibrations. The bands due to C-H in-plane bending vibrations interact some what with CC stretching vibrations, are observed as a number of bands in the region 1500-1100 cm-1 . The C-H out-of-plane bending vibrations occur in the region 1000-700 cm-1 25, 26. Hence, in the present investigation, the FTIR bands identified at 3081 cm-1 , 3069 cm-1 , 3066 cm-1 , 3035 cm-1 , 3026 cm-1 , and 3011 cm-1 are assigned to C-H stretching vibrations of DMN. The FTIR bands at 1423 cm-1 , 1409 cm-1 , 1261 cm-1 , 1202 cm-1 , 1170 cm-1 and FT-Raman band at 1262 cm-1 are assigned to C-H in-plane bending vibrations of DMN. The C-H out-ofplane bending vibrations of the title compound are well identified in the recorded spectra, within their characteristic region.
Ring vibrations: .In the present study, the bands appeared at 864, 863, 803, 586, 564, 528, 512, 440, 410, 380, 332, 270, 219, 208, 195 and 63 cm-1 are assigned to ring in-plane and out-of-plane bending modes, respectively by careful considerations of their quantitative descriptions. Small changes in wave numbers observed for these modes are due to changes in the force constant/reduced mass ratio, resulting mainly due to addition of two methyl groups to DMN and from different extents of mixing between ring and substituent group vibrations.
CONCLUSION
The FTIR and FT-Raman spectra have been recorded and the detailed vibrational assignment is presented for DMN. The equilibrium geometries, harmonic vibrational frequencies, IR and Raman spectra was performed according to the SQM force field method based on DFT calculations at the B3LYP/6-31G** level. The difference between corresponding wavenumbers (observed and calculated) is very small for most of fundamentals. Therefore, the results presented in this work for DMN indicate that the level of theory is reliable for prediction of Infrared and Raman spectra of the title compound (DMN).
ACKNOWLEDGEMENT
The authors are thankful to Sophisticated Analytical Instrumentation Facility (SAIF), IIT Madras, Chennai, and Nehru Memorial College, Puthanampatti, Trichirappalli, India for providing spectral measurements.
Englishhttp://ijcrr.com/abstract.php?article_id=1409http://ijcrr.com/article_html.php?did=14091. Jain MK, Sharma MK, Organic chemistry, Shoban Lal Nagin Chand and Co., Educational Publishers, New Delhi, 2001;
2. Agency for Toxic Substances Disease Registry, Department of Health and Human services, Public Health Services, Atlanta, GA, US, 2005;
3. Hess BA, Schaad Jr, Carsky P, Zaharaduick R, Chem. Rev., 1986; 86: 709.
4. Pulay P, Zhou X, Forgarasi G, in: Fausto R (Ed.), NATO ASI Series, Vol.406 (Ed.:R.Fransto), Kluwer: Dordrecht, 1993; P99.
5. Blom CE, Altona C, Mol. Phys., 1976; 31:1377.
6. Pulay P, Forgarasi G, Pongor G, Boggs JE, Vargha A, J. Am. Chem. Soc., 1983; 105: 7037.
7. Fogaras G, Pulay P, in: Durig JR, (Ed.), Vibrational Spectra and Structure, vol. 14, Elsevier, Amsterdam, 1985;
8. Fogarasi G, Spectrochim. Acta, 1997; 53A:1211.
9. Pongor G, Pulay P, Fogarasi G, Boggs JE, Am J, Chem.Soc., 1984;106:2765.
10. De Mare GR, Panchenko YN, Bock CW, J. Phys. Chem. 1994; 98:1416.
11. Yamakita Y, Tasumi M, J. Phys.Chem.1995; 99: 8524.
12. Rauhut G, Pulay P, J. Phys. Chem.1995; 99: 3099.
13. Frisch MJ, Trucks GW, Schlegal HB, Scuseria GE, Robb MA, Cheesman JR, Zakrzewski VG, Montgomerg JA. Stratmann RE, Jr., Burant JC, Dapprich S, Millam JM, Daniels AD, Kudin KN, Strain MC, Farkas O, Tomasi J, Barone V, Cossi M, Cammi R, Mennucci B, Pomelli C, Adamo C, Clifford S, Ochterski J, Petersson GA, Ayala PY, Cui Q, Morokuma K, Rega N, Salvador P, Dannenberg JJ, Malich DK, Rabuck AD, Raghavachari K, Foresman JB, Cioslowski J, Ortiz JV, Baboul AG, Stetanov BB, Liu G, Liashenko A, Piskorz P, Komaromi I, Gomperts R, Martin RL, Fox DJ, Keith T, AL-Laham MA, Peng CY, Nanayakkara A, Challacombe M, Gill PMW, Johnson B, Chen W, Wong MW, Andres JL, Gonzalez C, Head-Gordon M, Replogle ES, Pople JA, Gaussian 03, Revision A. Vol. 11.4, Gaussian, Inc, Pittsburgh PA, 2002;
14. Becke AD, Phys Rev., 1988; A38:3098.
15. Lee C, Yang W, Parr RG, Phys. Rev.,1998; B37: 785.
16. Fogarasi G, Zhou X, Taylor PW, Pulay P, J.Am.Chem.Soc., 1992; 114: 8191.
17. Sundius T, J. Mol. Spectrosc., 1980, 82: 138.
18. Sundius T, J. Mol. Struct. 218 (1990) 321; MOLVIB: A program for Harmonic Force Field Calculations, QCPE program No. 604: 1991;
19. Sundius T, Vibr.Spectrosc., 2002; 29: 89; MOLVIB (V.7.0): Calculations of Harmonic Force Fields and Vibrational Modes of Molecules, QCPE Program No. 807: 2002;
20. Frisch MJ, Nielson AB, Holder AJ, Gaussview User manual, Gaussian Inc., Pittsburgh. PA, 2000;
21. Polabarapu PL, J.Phys. Chem., 1990; 94: 8106.
22. Kereztury G, Holly S, Varga J, Besenyei G, Wang AY, Durig JR, Spectrochim. Acta 1993; 49A: 2007;
23. Keresztury G, in: Chalmers.JM, Griffiphs PR, (Eds.). Handbook of vibrational spectroscopy. Vol.1, Wiley, 2002;
24. Bunce SJ, Edwards HG, Jhonson AF, Lewis IR, Turner PH , Spectrochim Acta, 1993; 49A: 775.
25. Jag Mohan, Organic spectroscopyPrinciples and Applications, second ed., Narosa Publishing House, New Delhi, 2001.
26. Krishna Kumar V, Balachandran V, Spectrochim Acta. 2006; 63A:464-476.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28General SciencesHANDLING NEGATIVE DEVIANT BEHAVIOUR OF FRONT-LINE EMPLOYEES IN SERVICE ORGANISATIONS
English2330Matthew Apeh AdejohEnglish Loveth Lare AdejohEnglishDeviant behaviours by front – line employees have negative impacts on service organisations which depend on people as most valuable assets. This study was aimed at finding out the nature, incidence and impacts of negative deviant behaviours by front line employees on service organisations and their customers. A population of 150 was sampled from an hotel and a bank, out of which 112 adequately completed and returned questionnaire distributed. The questionnaire which was structured contained options that provided answers to the research questions, based on 5-point Likert scale to assess the level of acceptance or otherwise by the respondents on issues raised. A mean test and standard deviation were performed on the data collected and results show that many front-line employees in service organisations engage in one form of deviant behaviour or the other. The implication is that if nothing is done, the service industry will face colossal irretrievable loss es in view of the fact that they market products that are intangible and highly perishable.. It is recommended that careful staff selection and updated training would go a long way in providing a team of employees that can break barriers and take their organisations to an enviable height.
EnglishDeviant Behaviour, Customer Satisfaction, Service OrganisationsINTRODUCTION
Most service organisations spend millions of naira to advertise to be able to sell their services.. They employ the services of consultants to recruit assumed team of personnel that can deliver. Yet their effort continues to yield little and because of the less attention paid to personnel characteristics that guarantee success through service quality delivery. Quality Service delivery is critical to the customer's assessment of an organization's service quality as observed by [1] and [2a]. Most of the researches on the service delivery have focused on front-line employee behaviours that promote customer satisfaction [3]. The reality is that the encounter between the front-line employee and customer can frequently be a negative and even distressing experience. Therefore, a study that probes into the nature of the service encounter is necessary to understand how and why employees engage in deviant behaviour in the workplace. Front-line employee deviant behaviour is particularly detrimental to service organizations as it will not only influence the customers' satisfaction but also whether or not they will continue to use the services The workplace deviance is about antisocial behaviour, counterproductive behaviour, dysfunctional behaviour and organizational misbehaviour commonly being perpetrated by the employees to intentionally harm or potentially cause harm to individuals within the organization or to the organization itself, violating organizational or social norms [4].
This survey aimed to find out the nature of, causes of and remedies for workplace deviance in hotel and banking organisations. Managers are interested in reducing deviant organizational behavior because it can be a very disruptive and costly problem in terms of both the financial and the emotional tolls [5]
The Nature of Work Deviance
The service encounter is an irreversible, never to be repeated interaction between strangers - a special form of human interaction that is cocreated by employee and customer with each playing defined roles [6]. Front-line employees are paid to smile and create a welcoming and warm atmosphere irrespective of what they are really feeling, be it pressure of the job or the way the customer is treating them. Reference [5] refers to this commercialisation of emotions as emotional labour where employees are required to regulate their emotions to provide a satisfying service experience to customers. Employees are required to express organizationally desired emotions according to an emotional script or set of 'display rules' [7]. This is particularly required for the success of hotel and banking businesses in city centres where competition is very stiff and organisational survival is tied to customer – employee relationship. It is commonplace to find front-line employees who perform emotional labour over a long time and who have to deal with abusive customers or who feel uncomfortable expressing hostile emotions, which could have negative consequences. These could include job dissatisfaction, emotional exhaustion, alienation, and emotive dissonance [8]. Employees can resort to withdrawal behaviours such as slowing down or performing their job in a mediocre way or even more aggressive behaviours such as inflicting physical abuse on a deviant customer. Reference [9] recorded six instances where waiters fought with guests in hotel restaurants, two occasions where counter staff in a bank aggressively assaulted customers who were adjudged as ‘arrogant’. There are two types of workplace deviance as identified by [11]: organizational deviance (OD) which is non personal and is directed at harming the organization; and interpersonal deviance (ID) which is interpersonal and harmful to individuals. Behaviours within each of these types of deviance range from relatively minor acts to more severe and serious acts. The hybrid of these two dimensions, directed at either individual or organization and the severity of the act, whether minor or serious gives rise to four quadrants of deviant behaviour - political deviance, personal aggression, production deviance and property deviance
Production deviance involves employees doing the bare minimum and includes employees calling in sick, being late and letting co-workers carry the work load. Reference [10] describe this form of deviance in terms of employees withholding effort
Property deviance involves employees engaging in acts of sabotage, stealing company property, accepting kickbacks and disclosing confidential company information [10].
Political deviance is defined as acts that reflect 'engagement in social interaction that puts individuals at a personal or political disadvantage' such as gossiping, spreading rumours and management showing favouritism towards specific employees [11]
Personal aggression covers hostile behaviours such as sexual harassment, threats to physically harm co-workers and publicly belittling subordinates. [12].
Causes of Deviant Behaviour in the Workplace
In order to better manage the growing occurrence of deviant behaviour in the service encounter it is important to understand why front-line employees would engage in such acts of deviance. Reference [13] focus on individual or personal factors and organizational and job related factors as well as the role of the customer in influencing front-line employee deviant behaviour.
Personal Factors
A notable range of individual factors such as gender, age, personality traits and employee perceptions of injustice are responsible for the incidence of workplace deviance In the service context, younger employees and males tend to be more inclined to engage in overt acts of deviance [2b] while older employees will overuse display rules by faking and engaging inauthentic behaviour. Employees with high levels of agreeableness do not engage in deviant acts despite negative perceptions of justice and organizational support [14] When employees perceive they are being treated unfairly at work, [15] observe that they are more likely to engage in - stealing - sabotage - lying - revenge or - withdrawal behaviour, aggression, and hostility.
Organisational Factors
Various organizational and job factors have been found to be associated with front-line employee deviant behaviour. Reference [12] and [2] find these factors to include ? Weak organisational service culture. - Front-line employees are more likely to force customers to comply if the service culture is weak. An organization with a weak service culture lacks the passion for service and is not customer focused. It is characterised by unsupportive management and company policies and procedures that make it difficult for customer contact staff to carry out their job. ? Inequity and Unfairness - Employees perceptions of inequity and unfairness in the design and implementation of human resource management (HRM) practices such as selection, performance management and pay systems make it more likely that they will engage in deviant behaviour ? Job conditions- The conditions of the job, such as prolonged contact with customers and a deviant workgroup sub cultures make employees engage in deviant behaviour. ? Perceived autonomy - Perceived autonomy and discretion to make decisions about work has also been linked to employees defying organizational expectations for acceptable conduct and engaging in acts of interpersonal deviance. Reference [16] also subscribe to this view. ? Constraints in the Workplace - Constraints within the workplace such as insufficient job information, lack of assistance from supervisors and co-workers and time pressures can also lead employees to engage in both interpersonal and organizational deviance Customer Behaviour The attitude and behaviour of the customer have also been found to cause the negative behaviour of the employee [17]. The marketing philosophy that customers are kings, makes front-line employees to be faced with the untenable reality of dealing with customers who believe they can behave as badly as they want to [18]. Not willing to take this relegation, employees take revenge on customers. Revenge is a way by which front-line employees attempt to equalise the playing field – i.e. ‘do me, I do you’ Reference [18] identified categories of behaviours that front-line employees engage in to prepare themselves to deal with deviant customers and coping strategies to deal with the deviant customer during and post the incident of deviant customer behaviour. These behaviours include such as consuming drugs before an incident, ignoring, bribing, exploiting sexual attractiveness and manipulating the services during an incident and gaining revenge later. For the fact that there is great implication of work deviance for both organisation and individuals at work, it is essentially necessary to devise means for reducing the adverse impact. There are ways to ensure that employees cope with the negative consequences of emotional labour. These include selecting individuals whose natural emotional and expressive style match the requirements of the 'display rules', and training employees to manage their emotional responses when dealing with the customer [19] Organisational justice and the organizational climate are also critical, since the quality of the work experience can impact employee behaviour in the workplace, be it procedural, distributive or interactional justice [20] RESEARCH METHODOLOGY The research design of this study was a survey. It aimed at investigating the deviant behaviour of the front – line employees in hotel and bank service delivery. A population of 150 was targeted but 112 actually completed and returned questionnaires administered. The respondents were made up of receptionists, waiters, room maids and guests from hotels and receptionists, counter staff, supervisors and customers from a bank. Sixty respondents were from hotel and fifty – two from bank, 79 workers and 33 customers. The worker respondents were made of 7 managers / supervisors and 72 rank and file who had served between 1 and 10 (See Table 1) The instrument used in data collection was a structured questionnaire directed at the research questions on types of negative employee behaviours, their frequency of occurrence and causes and likely remedies for ameliorating them. A 5 – point Likert scale, ranging from Strongly Agree (5) to Strongly Disagree (1); Very serious (5) to Not very serious (1) and Very frequently (5) to Less frequently (1) was adopted for scoring the variables Considering the Likert rating scale of 5, 4, 3, 2, 1, mean and standard deviation were calculated for each variable which made up the answers suggested for each research question FINDINGS AND DISCUSSIONS Data were actually presented and analysed in line with the objectives of this study. Answers to each research question were attempted based on the weight of .data analysed. Apparently, frontline employees in Service Organisations engage in negative behaviour which could have adverse effect on customer patronage. Table 2 reveals that front-line employees in hotels and banks engage in all forms of deviant behaviour, some of which are more rampant such as giving minimal information to customers (3.53 ±1.45) and using confrontational language and physical assaults against the customer {3.64 ± 1.69) . This coincides with [2] who emphasized different interpersonal acts of employees that negate harmonious work relation with customers. On the frequency of occurrence of such behaviours revealed by Table 3, the observation of [8] is hereby substantiated. Receptionists, waiters and chambermaids frequently engage in rudeness, abrupt service and making fun of people’s accents. Table 4 identifies interpersonal, organisational and production causes of deviant acts in the work place which correspond with [13]. Reference [14] suggest that employees with high levels of agreeableness do not engage in deviant acts. This proves the statement of one of the customer interviewees who observed that some of the service staff lacked basics of customer service. The table shows that insufficient organizational support for employees and customers such as ineffective and inflexible operating procedures and policies (3.65 ±1.54), as well as inadequate communication to customers, increasing both the employee's and the customer's frustration (3.93 ± 1.61) are serious causes of frontline employee negative behaviours in workplace In Table 5, the respondents suggested cordial supportive relationship between supervisors and subordinates (4.54 ± 0.66), and instituting an interactive forum for exchange of ideas among organisation members as means of ameliorating deviant practices (4.38 ± 0.77). Their contributions coincide with [19] and [20] who recommend organisational dynamism as an approach for addressing work place deviance. CONCLUSION AND RECOMMENDATIONS Negative work behaviour could be caused by a number of factors which are interpersonal, organisational, political and customer related, manifested in communication skills, leadership style, organisational structuring and employee – customer relationship. Deviant workplace behaviour could have grievous effects on both the organisation and the customer satisfaction. It is linked to enormous costs. Up to 75 percent of employees have engaged in deviant acts such as theft, embezzlement, vandalism, sabotage, or absenteeism. Deviant work behaviour could significantly contribute to low patronage and declining sales volume in hotels, and lend to reasons why many banks were unable to meet deposit requirements and so became distressed. Service organisations actually depend on people as valuable asset more than any other industry do. Therefore, if anything is wrong with the personnel, especially those who are in direct contact with the customer, it will threaten the long term survival of the organisation However, work deviance could be ameliorated by supportive cordial relationship in organisations, improved communication exchange, participative decision making process, and selecting individuals whose natural emotional and expressive style matche the requirements of the ‘display rules’ It is necessary that employees throughout the whole organization adopt specific frame of mind based on the core values and norms. It is imperative that the upper-level management focus on conveying strong ethical values and norms in order for these norms to permeate throughout the whole organization. It is the responsibility of management to understand different subcultures existing in the organisation and provide direction for each of these subcultures towards the actualization of the corporate goals. Moreso, it is imperative in an organization to stop any type of behaviour that would negatively affect it. This can be achieved by conducting frequent background checks when hiring. In addition, violation of established values and norms should be meted with appropriate punishment as a deterrent. In the same vein, sterling behaviours should be recognised and rewarded. Empowering employees is a workable strategy that can yield positive work behaviour. Empowerment is a precursor of pro-social behaviours such as innovation, and innovation is the key to maintaining the competitive edge of a company. This type of a strategy is likely to increase the long-term financial success of the organization, especially when employees have access to information about organizational strategies and goals. Employees are more likely to engage in positive deviant behaviours such as corporate innovation when they have understanding of the corporate environment Finally, regular training is a weapon that helps update the knowledge of the employees about current customer service ideals that facilitate quality service delivery and customer satisfaction.
Englishhttp://ijcrr.com/abstract.php?article_id=1410http://ijcrr.com/article_html.php?did=14101. Parasuraman A, Berry, L.L and Zeithaml A.A. (1991) ‘Understanding customer expectations of service’, Sloan Management Review 32, p. 42.
2. (2a) Harris, L.C. and Ogbonna, E. (2006). “Service Sabotage: A Study of Antecedents and Consequences.” Academy of Marketing Science (2b) Harris, L. C., and Ogbanna, E. (2002). Exploring service sabotage: The antecedents, types and consequences of frontline, deviant, antiservice behaviors. Journal of Service Research, 4, 163−183.
3. Chapman J.A and Lovell G, (2006) "The competency model of hospitality service: why it doesn't deliver", International Journal of Contemporary Hospitality Management, Vol. 18 Iss: 1, pp.78 – 88
4. Muafi, J. (2011). Causes and Consequences of devant workplace behavior. International Journal of Innovation, Management and Technology, 2(2), 123-126.
5. Hochschild, A. (1983) The Managed Heart: Commercialization of Human Feeling. Berkeley: University of California Press.
6. Grandey, A., and Brauburger, A. (2002). The emotion regulation behind the customer service smile. In R. Lord, R. Klimoski, and R. Kanfer (Eds.), Emotions in the workplace: Understanding the structure and role of emotions in organizational behavior. San Francisco: Jossey-Bass
7. Ashforth, B. E., Harrison, S. H., and Corley, K. G. (2008). Identification in organizations: An examination of four fundamental questions. Journal of Management, 34,325−374.
8. Mulki, J. P, Jaramillo F, and Locander, W.B.(2006), “Effects of Ethical Climate and Supervisory Trust on Salesperson’s Job Attitudes and Intention to Quit,” Journal of Personal Selling and Sales Management, 26, 1 (Winter), 19–26.
9. Adejoh, l..l. (2012). A Survey of Workplace Deviant behaviours in Selected Organisations.A Thesis, National Institute for Hospitality and Tourism, Bauchi Campus Nigeria (Unpublished)
10. Bennett, R. J., and Robinson, S. L. (2000). Development of a measure of workplace deviance. Journal of Applied Psychology, 85, 349−360.
11. Robinson, S. L., and Bennett, R. J. (1995). A typology of deviant workplace behaviors: A multidimensional scaling study. Academy of Management Journal, 38, 555−572.
12. Lim, S.G.P. and Cortina, L.M. (2005). Interpersonal mistreatment in the workplace: The interface and impact of general incivility and sexual harassment. Journal of Applied Psychology, 90, 483- 496
13. Kidwell, R. E., and Martin, C. L. (2004). Managing the ambiguity of workplace deviance: Lessons from the study Multidimensional scaling study. Academy of Management Journal, 38(2), 555–572.
14. Colbert, B. A. 2004. ‘The Complex Resource-Based View: Implications for Theory and Practice in Strategic Human Resource Management’. Academy of Management Review, 29(3): 341–58.
15. Bolin, A. and Heatherly, L . ( 2001). Predictors of Employee Deviance: The Relationship between Bad Attitudes and Bad Behaviors.” Journal of Business and Psychology, 15(3), pg 405.
16. Hollinger, R. and Clark, J. (1982).“ Employee Deviance: A response to Perceived Quality of the Work Experience.” Work and Occupations, 9 (1), 97-114.
17. Rupp, D. E. and Spencer, S., 2006, “When customers lash out: The effects of customer interactional injustice on emotional labor and the mediating role of discrete emotions,” Journal of Applied Psychology, Vol. 91, No. 4, pp. 971-978.
18. Reynolds, K.L. and Harris, L.C. (2006), “Deviant customer behavior: an exploration of frontline employee tactics”, Journal of Marketing Theory and Practice, Vol. 14 No. 2, pp. 95-111.
19. Pulich, M. and Tourigny, L. (2004). “Workplace deviance: Strategies for Modifying Employee Behavior.” The Health Care Manager, 23 (4), 290-301.
20. Chiu. S and Peng, J. (2008) “The relationship between psychological contract breach and employee deviance: The moderating role of hostile attributional style.” Journal of Vocational Behavior, 73 (4), 426-433.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28General SciencesINHIBITION OF CANDIDA BIOFILMS BY PYOCYANIN: AN IN-VITRO STUDY
English3136Bhattacharyya S.English Gupta PEnglish Banerjee G.English Jain A.English Singh M.EnglishObjectives: Invasive candidiasis has an attributable mortality of 10-49%. It is associated with biofilm formation over indwelling devices. Biofilm-associated upregulated drug efflux makes treatment expensive and ineffective. Hence low-cost alternatives inhibiting Candidal biofilm formation are needed. Pseudomonas aeruginosa inhibits growth of Candida albicans in vitro. This study aimed to detect whether secreted products of Pseudomonas aeruginosa, especially Pyocyanin, affect biofilm production by Candida albicans and C.tropicalis. Methods: P. aeruginosa strains were incubated overnight at 37°C in Luria broth and centrifuged. Supernatant was filtered by syringe filter (pore size 0.22μm). Yeast isolates were grown overnight in YPD broth (Yeast Extract-Peptone-Dextrose). Turbidity was adjusted to 106 cells/ml in YPD and culture filtrate. Then 100 μl of both suspensions were dispensed in wells of flat-bottomed 96-well microtitre plate with normal saline as negative control. Wells were washed after incubation of 90 minutes at 37°C with Phosphate buffered saline (PBS) and reloaded with 100 μl of respective liquid media. This was repeated after intervals of 24 and 48 hours. Wells were stained with 1% safranine in 95% ethanol, washed with PBS and observed under inverted microscope. Optical density was measured spectrophotometrically. Methods were repeated with filtrate, preheated at 100°C for 20 minutes and Pyocyanin extracted from P. aeruginosa broth culture with the help of Chloroform and acidified water. Results: Biofilm formation of Candida albicans and C. tropicalis was significantly reduced by culture filtrate, both plain and heated, and Pyocyanin. Pyocyanin was found non-toxic to host cells. Conclusions: Pyocyanin can be utilised in vivo to inhibit device-associated biofilm formation by these pathogens.
EnglishBiofilm, Candida spp., Pseudomonas aeruginosa, Pyocyanin.INTRODUCTION
Invasive candidiasis is a major disease concern in developing countries. Candida albicans is the most commonly isolated species [Colombo et al., 2003]. However, in regions like South America, Candida parapsilosis and C. tropicalis are the leading agents of candidemia [Colombo et al., 2003]. This disease entity has an attributable mortality in the order of 40-49% without treatment, which varies from region to region [Ahmad et al, 2012]. It is associated with formation of complex microbial communities known as biofilms over indwelling devices like central venous catheters[Sun et al., 2012].Treatment of invasive candidiasis is difficult owing to biofilm-mediated increased drug efflux[Jabra-Rizk et al., 2004]. Among the antifungal agents available, only Echinocandins and Amphotericin B lipid formulations have shown consistent activity against Candidal biofilms [Kuhn et al, 2002] . However, Amphotericin B can be severely nephrotoxic to the host and Echinocandins are prohibitively costly to be used routinely [Deray, 2002 and Morris and Vilman, 2006]. Hence, there is urgent need of less costly natural products and other alternatives against invasive candidiasis .Some workers have studied the effect of secreted products of Pseudomonas aeruginosa on inhibition of biofilm formation by Candida albicans in vitro [Holcombe et al, 2010]. Keeping these things in mind, our study was aimed at detecting the effect of culture filtrate of P. aeruginosa, both plain and heated, and Pyocyanin, in particular on biofilm formation by Candida albicans and Candida tropicalis in vitro.
MATERIALS AND METHODS
This was a laboratory-based observational study, carried out in the Department of Microbiology, KGMU, Lucknow, Uttar Pradesh, India. The study was conducted from July 2011 to June 2012.
Isolation of microorganisms:-
Routine microbiological culture media like 5% sheep blood agar and MacConkey agar plates were used to culture Pseudomonas aeruginosa from different samples like pus, sputum, urine and others. To isolate Candida spp. from various clinical samples like blood, pus and urine, Saboraud’s Dextrose Agar (SDA) with Emmon’s modification (pH 7.0) was used. Ten (10) each of C. albicans and C. tropicalis and 10 isolates of P. aeruginosa were randomly selected for the study. P. aeruginosa isolates were identified by Non Lactose-fermenting colonies on MacConkey Agar, positive Oxidase reaction and Citrate utilisation tests and blue green diffusible pigment(pyocyanin) production along with fruity (corn-taco) odour of the colonies on solid media[Ferguson et al., 2007, and Gaby and Hadley, 1957]. Candida albicans isolates were identified by positive Germ tube test, growth above 42°C and terminal chlamydospore production on Corn meal agar with Tween 80(Dalmau technique) at 25°C after 48 hours of incubation[Raju and Rajappa, 2011]. Candida tropicalis isolates were identified by wavy pseudohyphae along with budding yeasts on corn meal agar with Tween 80 at 25°C after 48 hours, positive fermentation of Glucose, maltose and sucrose (all in 2% concentration, w/v)but not lactose and negative germ tube test [Fungal descriptions]. Test for Biofilm formation in Candida spp.:- The microtitre plate model, as proposed by Ramage et al, was employed for biofilm formation and its inhibition in vitro [Ramage et al., 2001]. At first, yeast isolates were grown in YPD Broth (1% Yeast Extract, 2% Peptone, 2% Dextrose, w/v) overnight at 37°C. Pseudomonas aeruginosa isolates were incubated overnight in LB or Luria Broth (1 colony suspended in 2 ml LB) and then centrifuged at 3000 rpm for 5 minutes. After that, the culture supernatant was filtered by passing through a membrane filter (syringe filter) of pore size 0.22 µm (Micro-Por Minigen Syringe Filter, Genetix Biotech Asia, New Delhi).This filtrate was divided into 2 parts. One part was left unheated and the other was heated to 100°C for 20 minutes in a water bath and subsequently cooled. Then yeast cell turbidity was adjusted to 106 cells/ml in- a) YPD, b) P. aeruginosa unheated filtrate, and c) P. aeruginosa heated filtrate. About 100 µl of each set of suspension was dispensed in separate wells of a flat-bottomed 96-well microtitre plate (Nunclon A/S, Kampstrupvej, Denmark). Sterile normal saline was added in a well as negative control. After incubating for 90 minutes at 37°C, the wells were washed thrice with Phosphatebuffered saline (PBS, pH 7.2) to remove nonadherent cells and wells were reloaded with respective sterile liquid substrates. Washing and reloading was repeated at intervals of 24 hours and 48 hours. After 48 hours, wells were washed thrice with PBS and stained with 100µl of 1% safranine (w/v) in 95% ethanol for 1 minute. After washing off excess stain with PBS, the wells were observed under inverted microscope under 200X magnification [Ramage et al.,2001]. Subsequently their readings (optical densities) were also measured spectrophotometrically at a wavelength of 450 nm UV light (iMark MicroPlate reader, BioRad, USA). The first round of tests were carried out with Candida albicans ATCC 90028 and C. tropicalis ATCC 750 strains and then with randomly selected clinical isolates. All tests were carried out three times (in triplicate). In a second set of experiment, Pyocyanin was extracted from Pseudomonas aeruginosa isolates by the method described by Vinckx and co-workers [Vinckx et al., 2001]. Briefly, 1 loopful Pseudomonas aeruginosa colony was grown overnight at 37°C in 5 ml Peptone water containing 1% Glucose(w/v), and then centrifuged at 3000 rpm for 5 minutes. To the cell free supernatant, equal volume of chloroform (Ranbaxy SRL, New Delhi, India) was added and it was again incubated at 37°C overnight after thorough shaking. After that the chloroform phase was purified from the bottom and to it, equal volume of acidified distilled water (pH: 4) was added. After another incubation overnight at 37°C , the watery phase was separated out in a sterile test tube and its pH brought to 7.0 (neutral pH) by adding 1 M NaOH to it. The resultant solution was purified extracted pyocyanin and its fluorescence was checked in an Ultraviolet hood. Yeast isolates were suspended in- a) YPD, and b) pyocyanin and turbidity of both was adjusted to 106 cells/ml. Then 100 µl of both suspensions were dispensed in wells of Microtitre plate and incubated similarly at 37°C. Wells were washed with PBS and reloaded with respective liquids. After final washing and staining, wells were observed microscopically and readings were noted spectrophotometrically at 450 nm wavelength. The toxic effects of pyocyanin, if any, were observed by inoculating shell vials coated with Hep-2 (Human laryngeal epithelioma) cell line monolayer, incubating at 37°C and observing vials under inverted microscope every 6 hours.
RESULTS
As observed by both the methods (microscopically and spectrophotometrically), biofilm formation in Candida albicans and C. tropicalis was significantly reduced by crude culture filtrate of P. aeruginosa, both heated and unheated, in vitro. The difference in mean values (O.D. readings) of yeasts in YPD and the culture filtrate were calculated by Z-test of significance [Mahajan, 2010]. The differences were found to be highly statistically significant. Mean O.D. of Candida tropicalis in YPD, unheated and heated filtrates were 3.43, 0.14 and 0.165 respectively (pEnglishhttp://ijcrr.com/abstract.php?article_id=1411http://ijcrr.com/article_html.php?did=14111. Ahmad S, Khan Z. Invasive candidiasis: A review of nonculture-based laboratory diagnostic methods. Ind J Med Microbiol 2012;30:264-69.
2. Bandara HMNH, Lam OLT, Watt RM, Jin LJ, Samaranayeke LP. Bacterial lipopolysaccharides variably modulate in vitro biofilm formation of Candida species. J Med Microbiol 2010;59:1225-34.
3. Bandara HMNH, Yau JYY, Watt RM, Jin LJ, Samaranayake LP. RPseudomonas aeruginosa inhibits in-vitro Candida biofilm development. BMC Microbiology 2010; 10:125-134.
4. Colombo AL, Perfect J, DiNubile M, Bartizal K, Motyl M, Hicks P, Lupinacci R, Sable C, Kartsonis N. Global distribution and outcomes for Candida species causing invasive candidiasis: results from an international randomized double-blind study of caspofungin versus amphotericin B for the treatment of invasive candidiasis. Eur J Clin Microbiol Inf Dis 2003;22: 470-74.
5. Denning GM, Wollenweber LA, Railsback MA, Cox CD, Stoll LL, Britigan BE. Pseudomonas Pyocyanin Increases Interleukin-8 Expression by Human Airway Epithelial Cells. Infect Immun 1998;66(12):5777-5784.
6. Deray, G. Amphotericin B nephrotoxicity. J Antimicrob Chemother 2002; 49 Suppl.S1:37-41.
7. Eggimann P, Bille J, Marchetti O. Diagnosis of invasive candidiasis in the ICU. Ann Int Care 2011;1:37-47.
8. Ferguson D, Cahill OJ, Quilty B. Phenotypic, molecular and antibiotic resistance profiling of nosocomial Pseudomonas eruginosa strains isolated from two Irish Hospitals. J Med Biol Sci 2007;1.
9. Festekjian A, Neely M. Incidence and Predictors of Invasive Candidiasis Associated with Candidemia in Children. Mycoses 2011;54: 146–153.
10. Fungal descriptions. mycologyonline.edu.
11. Gaby WL, Hadley C. Practical Laboratory Test for the identification of Pseudomonas aeruginosa. J Bacteriol 1957; 74:356.
12. Holcombe LJ, McAlester G, Munro CA, Enjalbert B, Brown AJP, Gow NAR, Ding C, Butler G, O’Gara F, Morissey JP. Pseudomonas aeruginosa secreted factors impair biofilm development in Candida albicans. Microbiology 2010; 156: 1476–86.
13. Jabra-Rizk MA, Falkler WA, Meiller TF. Fungal Biofilms and Drug Resistance. Emerg Inf Dis 2004.; 10: 14–19.
14. Klausmeyer P, McCloud TG, Tucker KD, Cardellina JH, Shoemaker RH. Aspirochlorine Class Compounds from Aspergillus flavus Inhibit AzoleResistant Candida albicans. J Nat Prod 2005; 68:1300–1302.
15. Kothari A, Sagar V. Epidemiology of Candida bloodstream infections in a Tertiary Care institute in India. Ind J Med Microbiol 2009;27:171-172.
16. Kothavade RJ, Kura MM, Valand AG, Panthaki MH. Candida tropicalis: its prevalence, pathogenicity and increasing resistance to fluconazole. J Med Microbiol 2010; 59: 873–880.
17. Kuhn DM, George T, Chandra J, Mukherjee PK, Ghannoum MA. Antifungal Susceptibility of Candida Biofilms: Unique Efficacy of Amphotericin B Lipid Formulations and Echinocandins. Antimicrob Agents Chemother 2002;46: 1773–1780.
18. Mahajan BK. Sampling Variability and Significance. In Methods in Biostatistics For Medical Students and Research Workers. 7th Ed 2010. Jaypee Brothers Medical Publishers (P) Ltd. New Delhi. 114 .
19. Martinez LR, Fries BC. Fungal Biofilms: Relevance in the Setting of Human Disease. Curr Fungal Infect Rep 2010;4:266–275.
20. Morris MI, Villman M. Echinocandins in the management of invasive fungal infections, part 2. Am J Health-System Pharm 2006; 63:1813-20.
21. Peters BM, Jabra-Rizk MA, O,May GA, Costerton JW, Shirtliff ME. Polymicrobial Interactions: Impact on Pathogenesis and Human Disease. Clin Microbiol Rev 2012;25: 193-213.
22. Raju SB, Rajappa S. Isolation and Identification of Candida from the Oral Cavity. ISRN Dentistry 2011.
23. Ramage G,Saville SP, Thomas DK, LopezRibot JL. Candida Biofilms: an Update. Eukaryot Cell 2005;4:633–638.
24. Ramage G, Walle KV, Wickes BL, LopezRibot JL. Standardized method for in-vitro antifungal susceptibility testing of Candida albicans biofilms. Antimicrob Agents Chemother 2001; 45:2475-79.
25. Sun Y, Yu S, Sun P, Wu H, Zhu W, Liu W, Zhang J, Fang J, Li R. Inactivation of Candida Biofilms by Non-Thermal Plasma and Its Enhancement for Fungistatic Effect of Antifungal Drugs. PLoS ONE 2012;7: e40629.
26. Vinckx T, Wei Q, Matthijs S, Cornelis P. The Pseudomonas aeruginosa oxidative stress regulator OxyR influences production of pyocyanin and rhamnolipids: protective role of pyocyanin. Microbiology 2010; 156: 678–686.
27. Uppuluri P, Chaturvedi AK, Srinivasan A, Banerjee M, Ramasubramaniam AK, Kohler JR, Kadosh D, Lopez-Ribot JL. Dispersion as an Important Step in the Candida albicans Biofilm Developmental Cycle. PLoS Pathogens 2010 ;6:e1000828.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28General SciencesLAND RESOURCES AND PEOPLE: A STUDY IN KANKSA C.D. BLOCK, BARDDHAMAN DISTRICT, WEST BENGAL
English3749Shyamal DuttaEnglishLand is an essential natural resource, both for the survival and prosperity of humanity, and for the maintenance of all terrestrial ecosystems. Over millennia, people have become progressively more aggressive in exploiting land resources for their own ends. The limits on these resources are finite while human demands on them are not. Increased demand and pressure on land resources enhance the declining crop production, increasing land degradation and competition for land in rural India. So the land utilization for various purposes plays a significant role in controlling the existing economic as well as agro-environmental system. Present study area that is Kanksa C.D. block of Barddhaman district is familiar with agriculture and forest based low level subsistence of economy, so likely land use parameters such as net sown area, forest, culturable waste and its associates such as irrigation facility etc. have been expected as controlling factors in this land use system. In this paper an attempt has been made to identify the dominant factors of agricultural system which have significant impact on development in the 30 years (1971-2001) time span mainly through Principal Component Analysis (PCA) and Geographic Information System (GIS) including the demographic aspect to correlate the land resources with people. The significant spatial mosaic based on Prinsscore shows that the existing agricultural system of this region is directly influenced by a range of variables (irrigated area, culturable waste etc.).
EnglishLand resources, Land use, Agro-environmental System, Principal Component Analysis and GISINTRODUCTION
Land resources refer to a delineable area of the earth's terrestrial surface, encompassing all attributes of the biosphere immediately above or below this surface, including those of the nearsurface climate, the soil and terrain forms, the surface hydrology (including shallow lakes, rivers, marshes and swamps), the near-surface sedimentary layers and associated groundwater and geo-hydrological reserve, the plant and animal populations and outstandingly the human settlement pattern and activities of the past and present human activity (terracing, water storage or drainage structures, roads, buildings, etc.) (FAO/UNEP,1997). Land is not regarded simply in terms of soils and surface topography, but encompasses such features as underlying superficial deposits, climate and water resources, and also the plant and animal communities which have developed as a result of the interactions among these physical conditions. The impact of human activities, reflected by the changes in vegetative cover or by structures, is also regarded as attributes of the land. Changing one of the factors, such as land use, has potential impacts on other factors, such as flora and fauna, soils, surface water distribution and climate. Changes in these factors can readily be explained by ecosystem dynamics and the importance of their relationships in planning and management of land resources has become increasingly evident. Land is the most common denominator of all types of economic activities. It is the place where the social fabrics and agricultural practices flourish. Its use and multiple uses make it controlling factor for whatever is apparent on the surface of the earth (De and Jana, 1997). The man-land relationship can be expressed in three different facets. First, the land and the individual person who uses it; second, the man and his influence on the use of the land as a means of production. In this context institutional infrastructure should be studied for the consideration land use change. The third relationship between land and man can be expressed in terms of man as a social being and the land as an inexhaustible resource. For human existence, within certain biotic, ecological and economic conditions the utilization of land is prime importance. It involves a relationship that exist between the societies on the one hand and cultural advancement, resource planning and carrying capacity on the other (Mandal, 1990). Intensive use of land depends upon population concentration, economic prosperity through better agricultural production, human establishment, industrial location, and communication and transport while extensive use of the land is related to sparse population, dispersed settlements, absence of communication lines and the crude form of transport. However, systematic and planned utilization of land can be able to promote economic and cultural advancement. If there is no utilization of land, one cannot think of any progress. Thus the study of land utilization is of immense importance in tracing out the past use of land and its future trend. Only through the study of the past land utilization, one can able to predict its future use and evolve land use planning of a particular region. The suggestions for better use of land and the improvement of its present capability necessitate mapping and interpretation of land utilization. The changing population as well as the economic, the biological and ecological problems are so alarming that the conversation and the best utilization of land becomes necessity. OBJECTIVES OF THE PRESENT STUDY The objectives of this study can be bifurcated in different directions but the main objective can be articulated as follows: (i) To describe the distribution of present landuse pattern in Kanksa C.D. Block; (ii) To show the temporal changes in different landuse parameters (e.g., net sown area, forest cover, culturable waste etc.) in 30 years (1971-2001); (iii)To identify the controlling factors of land resources when outlook to resource development over space and time and decision making of people are the major consideration; (iv) To show the spatial mosaic of different variables controlling the land use system and (v) To provide a suitable planning for better development. Land resources and geographical background of Kanksa C.D. Block: The study area represents a small tract of westcentral Barddhaman District, comprising the Kanksa C.D. Block. This area is extended from 23°25'N to 23°40'N latitudes and 87°20'E to 87°35’E longitudes. The area is physically bounded by Ajay River in the North and Damodar River in the South. Administratively Kanksa block bounded by Birbhum District in the North, Bankura District in the South , Faridpur-Durgapur Block and Aushgram II Block of Barddhaman District in the west and east respectively (Fig.1). Total area covers of the block is 278.4 sq.km which is 3.96% of the total Barddhaman district. Total population is 151276 (Census, 2001) and population density is 543 per sq.km. In 30 years time span (1971-2001) there is a net 48.7% increase of population increase. The study area is predominantly agricultural with 47.12% of its population (Census, 2001) engaged in agriculture and allied activities and the amount of net sown area 51.2% to the total.
The slope of the area is towards south and southwest with very low gradient. Minimum and maximum ground elevations of the area are 51.57m and 66.74m (GSI, 2005). Close spaces contour pattern throughout area reveals that the topography is highly dissected and undulatory with valleys and ridges having rounded trough and crest repeatedly. Geologically this area is represented by Lalgarh formation, Sijua formation, Chuchura formation and Hooghly formation of Quaternary period. Lalgarh formation comprises laterite and latosol. It shows development of 0.3 to 1m thick with light grey to light brownish grey latosol comprising 71-84% sand, 14-26% silt and 1-3% clay content respectively. The soil cover developed over Sijua formation is yellowish grey in colour impregnated with caliches and belongs to silty loam to sandy loam category with 3-85% sand, 9-89% silt and 2-32% clay (GSI, 2005). Due to poor soil fertility over emphasis is given on irrigation to produce good agricultural crops for the maintenance of livelihood of local region. The main sources are surface water namely ponds, tanks and perennial rivers mainly Damodar, Ajay and Kunur. At the same time groundwater is also used as same place but the importance is relatively low (Fig. 2). Groundwater occurs in the area within a thick saturated granular zone both under unconfined and confined condition. The near surface aquifer from where unconfined groundwater is available consists of clayey silt, sandy silt and laterite. It occurs below groundwater table and tapped by dug wells (GSI, 2005)
The area under study constitutes part of two major river basins, namely Damodar and Ajay. These two drainage basins are separated by a major water divide, which runs almost parallel to G.T. Road and passes through Durgapur and Panagarh. The southern part of the area belongs to Damodar Basin where as the northern part falls in Ajay Basin. Other two important rivers are Tumuni in the north and Kunur in the middle part of the block. Landuse and its temporal change Land Use is characterized by the arrangements, activities and inputs by people to produce change or maintain a certain land cover type. (Di Gregorio and Jansen, 1998). Land use defined in this way establishes a direct link between land cover and the actions of people in their environment. The major land use classes delineated in the area included forest, net sown area, culturable waste, area not available for cultivation including residential area. Forest land cover class exclusively lies in the lateritic Lalgarh surface and constitutes about 22.41% of the study area in 2001 which is slightly decreases from areal coverage of 1971 i.e., 22.74%. The forest land comes under Durgapur P.F., Bilaspur P.F. and Ukhra P.F. It is mainly represented by dense to fairly dense mixed jungle of mainly sal trees. Locally eucalyptus plantation is also made.
Major portion of total land area is occupied by agricultural land since these blocks have the subsistence agricultural economy which is the main occupation of the people in the block. About 49% of total are falls under the net sown area in 2001 which is increased from46.25% in 1971. Changing physico-cultural settings over the years is responsible for significant spatiotemporal variation in net sown area of this study area. The proportion of net sown area in this block increased from 47.7% (13286.36 hec.) in 1971 to 51.2% (13634.2 hec.) in 2001, amounting 3.5% increase of land in this category. Over 30 years of time span there is a net increase of 347.84 hec of net sown area in the study area. From geographical perspective change in net sown area (1971-2001), of this study area may be divided into three broad regions (Table: 3 and Fig. 4 and 5). This change is mainly due to irrigation development in the study area during the period between 1971 to 2001. In this period about 3048.29 hec area under irrigation is increased that is 11.37 % to total area. So within these 30 years irrigation plays an important role in the agricultural expansion and this is also reflected in the wasteland reclamation. About 7% of culturable wasteland has been reclaimed within this period (Fig. 3). Area not available for cultivation is increased about 1 % because urban expansion mainly in Kanksa (CT), Debipur (CT) and Proyagpur (CT) around Panagarh region.
SYSTEM ANALYSIS OF LANDUSE THROUGH PCA:
From the above geo-environmental analysis along with land uses in Kanksa block it is clear that the whole region is based on subsistence level of agricultural economy where inbuilt natural resources and their uses have great influence of prevailing economy. Though some parts of the area is uplifted as urban expansion but main strength of economy is the agricultural production and forest-based production mainly in upper portion of the study area. So, land resources and different land use practices are the controlling factor for livelihood. In this agricultural system rugged topography, laterite soil, climate, groundwater situation exert hindrance in the proliferation of crop production through agricultural production have been expanded at a significant level in between 1971- 2001. So two judge the controlling factors of this agricultural increase during the span of 30 years period (1971-2001) land use based parameters are very much essential to examine. Irrigation facility plays a significant role during this period. In this situation a multivariate analysis to evaluate the whole system controlled by different variables is relevant in this regard. Principal component analysis (Hotelling, 1933) may be the suitable techniques to this evaluation because this technique synthesizes a large number of variables into a smaller number of general components, which retain the maximum amount of descriptive ability (Mahmood and Raza, 2002).
SELECTION OF VARIABLES
To assess the change of agro-economic system in spatio-temporal context, different land uses and social factors are taken as the variables for principal component analysis. In this context some other social parameter could have been included but here we have considered those parameters which are directly related to agrarian land use system. Data of major land use parameters and demographic aspects are collected from District Census Handbook of Barddhaman District in 1971 and 2001.These are as follows: V1= Population density V2= Percentages of S.T. population to total population V3=Percentages of forest cover to total area V4=Percentages of unirrigated area to total area V5= Percentages of culturable waste to total area V6=Percentages of area not available for cultivation to total area V7= Percentages of irrigated area to total area Population density is an important aspect to assess the pressure of population on existing land area. It is also very crucial to examine the level of development in any part of land because all development in earth surface can be judged in terms of human development. Percentages of scheduled tribe population are an indicator of backwardness. In this forest based ecosystem high concentration is seen mainly in the upper and central part of the study area. Forest resources are major sources of their earnings. Four major land use parameters are chosen in this case. Forest cover is predominant in this block. About 22.41% (2001) of total area is covered by mainly under Ukhra, Durgapur and Bilaspur forest ranges. Area under agricultural practices i.e., net sown area have a high level significance in this area. About 48.97% (2001) area falls under this category. Mainly Irrigation development over 30 years (1971-2001) is undoubtedly the controlling factor to such level of agricultural expansion. Irrigation parameters are selected because it enhances the potentiality of agricultural field to uplift it from mono crop production to multi crop production. Naturally high level of unirrigated area put hindrance to such development. Culturable wasteland is also an important indicator of backwardness as it comprises the used and fallow land. Major part in the study area has been fallen under this category due to laterite gully affected areas, rugged topography etc. Area not available for cultivation has been considered mainly as a positive factor for development because it comprises mainly the build up area and urban areas. After calculating Principal Component loadings upto three stages Prinsscore have been calculated based on first principal component of each variable. The following formula has been adopted in this purpose: Prinsscore (Pi) = {(V1×v1) + (V2×v2) + (V3×v3 ) + (V4×v4 ) +..........+(Vn ×vn )}÷Initial Eigen Value. Where, V1, V2, ......Vn= actual values of variables upto ‘n’ number v1, v2, ........vn = loadings from first principal component of each variables(eigen Vectors)
REFLECTION FROM PCA:
First stage analysis of the data based on 1971 has been progressed in two stages considering irrigation as a variable and omitting irrigation as a variable because during this period irrigation facility was low.
a. PCA in 1971 with Irrigation as a variable
In the first stage irrigation facility has been considered as a controlling factor. Now principal component analysis has been done upto three stage. All the variables are very slightly (positive and negative) correlated to each other expect irrigated area. In first principal component analysis only 29.54% variance is explained (Table: 5). In this stage unirrigated area (0.71) and forest cover (-0.83) become the controlling factors positively and negatively respectively. With the 47.59% of explained variations in the second PCA, area not available for cultivation (0.71) becomes the guiding factor of whole system (Table: 5). In the last stage of analysis with an explanation of 62.86%, culturable waste becomes the controlling factor. So there is mixed influence of different variables in the year of 1971.
b. PCA in 1971 without Irrigation Parameter
Within a span the 30years (1971-2001) irrigation facility has developed a lot which has significant role in the agricultural development of the study area. But is there any influence of irrigation in the year of 1971 to control the agricultural system of this area. To get a better response irrigated area has been excluded now for 1971 database. Results are more or less same. Again forest cover, unirrigated area i.e., absence of irrigation and culturable wasteland plays the controlling role in three stages of PCA (Table: 7)
c. PCA in 2001
In 2001 high level expansion of agricultural land and massive change in irrigation facility have occurred with the simultaneous growth of urban landuse due to proximity to Durgapur urban area. Beside this wasteland reclamation has also taken place. As a result this whole system becomes more complex. Degree of correlation increased in this time span (Table: 8). From first PCA with an explained variation of 28.65%, population density (0.63) and forest cover (- 0.87) become the controlling factors (Table: 9). Here it is clear that deforestation and increased demand of population influences on agricultural expansion. Irrigated area (0.61) and unirrigated area (-0.94) also become crucial in the second stage of PCA which clearly shown the positive affect of irrigation on agricultural development to a considerable extent. In third stage of PCA culturable waste (0.95) has high level significance because huge amount of wasteland has been reclaimed through irrigation practices for agricultural development within the time span of 30 years (Table: 9).
SPATIAL DIMENSION
Spatial dimension of agro-economic system can be perceived by prin-score values (Fig. 6 and 7). Mouzas having predominant forest cover (e.g., Bistupur-J.L. No. 44, Brahamangram-J.L. No. 38, Paschimgangarampur- J.L. No. 92, Sadhumara-J.L. No. 73 etc.), concentration of tribal population and lack of irrigation facility response negatively in both stages (analysis with and without considering the irrigation parameter). Mouza having high level of irrigation facility and culturable wasteland with high population pressure (Kanksa, Debipur, Proyagpur, Basuda etc.) have a better positive response in the first stage of analysis.
During 30 years of time span high level increase in irrigated area (Fig. 8), agricultural scenario has also change massively. This affect may reflect in the last part of PCA analysis. Here areas having high amount of irrigated area and low amount of culturable waste or both have high positive response (Fig. 9). But area under predominant forest cover (e.g., Bistupur-J.L. No. 44) responses negatively and indicate very low level of development in agriculture as well as society.
CONCLUSION
Basically different land uses and also some population parameters are the main controller of present agro-environmental system where irrigated area plays a significant role in the agricultural development. Areas having no or minimum irrigation facility and predominant forest cover added with tribal population response negatively which indicates high level backwardness. Greater attention should pay on these regions mainly in the rugged lateritic region of upper part of the study area to uplift this in to mainstream economy. Beside this, over exploitation of groundwater for irrigation purposes, canal irrigation, deforestation are the main negative outcome of this agricultural development though those have trigger agricultural development, but in long those will add environmental problems. So, search for alternative avenues have great importance in present day for future sustainability. Over 30 years of time span the study area has experienced a wide range of change in net sown area. In terms of actual areal coverage only 347.84 hectares under NSA is extended to agricultural land use. But there is enough provision for further extension of cultivation in the study area mainly in terms of wasteland reclamation. Because 54% mouzas have experienced increase in net sown area only upto 30% and at present about 7.82% of total land in the study area belongs to cultivable wasteland. Development of wasteland requires a package of treatment which includes soil erosion control measures, erection of ground water recharge structure and suitable crop production system (Prasad and Ghosh, 2011). Soil erosion control measures are very much essential because huge amount of fertile top soil have been eroded away every year through rill and gully erosion mainly in the forest-endowed upper part of the study area. To decrease sole dependency on ground water as a source of irrigation, use of surface water bodies may be effective. People should be aware about if that extraction of ground water is environmentally hazardous and stagnant surface water has wider scope of small scale irrigation, which may serve wider area if proper reclamation of ponds and wetlands is taken. Rain water harvesting in terms of dug well, tank and ponds are essential tools to mitigate this problem. To promote sustainable agriculture various methods should be applied. These are polycultures in terms of fallow rotation, use of residues, rotation with legumes, bio-manuring, alley cropping, contour planting, etc (Santra, 2010). Social forestry programmes may be effective in this context, because it may increase the green cover in fallow land as well as in culturable wasteland so that already deforested area can be used for agricultural purposes. Besides this social forestry programmes may bring alternative sources of fuel, timber and more specifically income, from different forest products helpful for poor tribals so that pressure on agricultural land decreases and environment may achieve its sustainable level.
ACKNOWLEDGEMENT
The authors expressed his great profound gratitude to Dr. Sanat Kumar Guchhait, Associate Professor of Postgraduate Dept. of Geography, The University of Burdwan (West Bengal), for his encouragement, cooperation and valuable advices, commitment of time throughout the course of this work from checking, examining and compilation of information to the summing up of this article.
Englishhttp://ijcrr.com/abstract.php?article_id=1412http://ijcrr.com/article_html.php?did=14121. Bhattacharya, A.K and N. Dhar, Geological survey of India, (2005) “A Report on GeoEnvironmental Appraisal in DurgapurPanagarh Urban Area and Its Environs for developmental Activities within AsansolDurgapur Development Authority Area, District Barddhaman, W.B.”, Eastern Region, Kolkata
2. De, N.K. and Jana, N.C. (1997): The Land: Multifaceted Appraisal and Management, Sribhumi Publishing Co., Calcutta, pp. 6-7
3. Di Gregorio, A. and Jansen, L.J.M. 1998. A New Concept for A Land Cover Classification System. The Land 2(1): 55- 65.
4. District Census Handbook of Barddhaman District (1971 and 2001), Govt. of India
5. FAO/UNEP. 1997. Negotiating a Sustainable Future for Land. Structural and Institutional Guidelines for Land Resources Management in the 21st Century. FAO/ UNEP, Rome.
6. Hotelling, H. (1933) Analysis of a complex statistical variables into Principal Component, Journal of Educational Psychology, vol.24, pp. 407-441
7. Mahmood, A. and Raza, M. (2002) Statistical Methods in Geographical Studies, Rajesh Publications, New Delhi, p. 159
8. Mandal, R.B., (1990) Land Utilization: Theory and Practice, Concept Publishing Company, New Delhi, pp.4-5
9. Prasad, N. and Ghosh, T. (2011). Spatiotemporal Variation in Net Sown Area in Southwest Birbhum District, West Bengal, Practising Geographer: A Journal of Indian Geographical Foundation, 15 (winter):2, 56- 67
10. Santra, S.C. (2010), Environmental Science. New Central Book Agency (P) Ltd., Delhi.p.526
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareNUTRITIONAL FACTORS ASSOCIATED WITH ANAEMIA AMONG NON-PREGNANT RURAL WOMEN ENGAGED IN AGRICULTURAL SECTOR IN PURBA MEDINIPUR DISTRICT OF WEST BENGAL
English5054Dibyendu BhowmickEnglish Shreyasi SarangiEnglish Chandradipa GhoshEnglishBackground: Anaemia is the biggest female health problem in developing country like India. This problem rises during and after pregnancies due to increased nutritional demands and inadequate iron supply. So, assessment of nutritional anaemia in non-pregnant women has a great importance. Objective: To assess the prevalence of nutritional anaemia and it’s influencial nutritional factors in non-pregnant women engaged in agricultural sector in rural area of West Bengal. Research methodology: This cross-sectional study was conducted in the rural area of Patashpur II block of Purba Medinipur district. Door to door survey was conducted and study subjects (N=255) were divided into four age groups. Anthropometric measurements and haemoglobin estimation were done by the standard methods. Nutritional assessment was done by questionnaire method. Results: The result showed that BMI of all subjects were of below normal value and haemoglobin percentages of all women were below or at the marginal level of the cut off points for diagnosis of anaemia. Protein and carbohydrate intake of all women were sufficient but they intake insufficient amount of fat, Fe (except age groups 25-30), Vitamin-B6, Vitamin-B12 and Folic acid. Conclusion: This study reveals that all non-pregnant women who were engaged in agricultural work had probability to develop severe anaemia. Consumption of green vegetables by promotion of home gardening and awareness may reduce this problem.
EnglishNutritional anaemia, non-pregnant women, ruralINTRODUCTION
Anaemia is considered one of the main nutritional disorders affecting a large fraction of the women population. According to World Health Organization (WHO), anaemia is a major public health problem which is at its peak in developing countries. In India, for example, upto 88% of pregnant and 74% of non-pregnant women are affected1 and anaemia is the 2nd most common cause of maternal deaths accounting for 19% of total maternal deaths 2 . Anaemia affects mainly the women in child bearing age group, young children and adolescent girls3,4 . WHO defines anaemia as a condition in which the Haemoglobin (Hb) content of the blood is lower than the normal as a result of deficiency one or more essential nutrients, regardless the cause of such deficiencies. Anaemia is established if the Hb is below the cut off point recommended by WHO 5 . Anaemia reduces the oxygen carrying capacity of the blood. Iron is an important component of haemoglobin (Hb). Nutritional problem may be caused by deficiency of protein, calorie, iron, calcium, Vit C, etc. Anaemic patients exhibits symptoms such as fatigue, breathlessness, giddiness, pallor of skin, palpitation etc. In recent years, different programs like ICDS, RCH etc, have been introduced to improve the nutritional status of women. National Nutritional Anemia Prophylaxis Program (NNAPP) was initiated in 1970 aiming to bring down prevalence of anemia to 25%6 . The daily dosage of elemental iron for prophylaxis and therapy has been increased to 100 mg and 200 mg respectively under Child Survival and Safe Motherhood Program (CSSM). The present study was planned to investigate the nutritional anaemia of agricultural non-pregnant women in a rural area.
MATERIALS AND METHODS
The present cross-sectional study was conducted in the rural area of Patashpur II block of Purba Medinipur district, West Bengal. House to house survey was conducted in 5 villages. Nonpregnant women, present at home at the time of survey, were included in this study. The criteria of inclusion of this study were symptoms of non-pregnancy and willingness to participate this study. About 323 women of the area were interviewed and excluded some of them due to pregnancy and chronic diseases. Finally the study was conducted among 255 women. Study subjects were divided into 4 age groups. The women were all Hindu by religion and all were moderate workers. Anthropometric measurement, Haemoglobin estimation and Nutritional assessment Height and weight were measured by standard method 7 . Hemoglobin estimation was done by Salhi’s method. Nutritional assessment was done by questionnaire method. Statistical analysis Data was managed on an excel spread sheet. Statistical analyses were done. The mean and standard deviation value of each parameter is calculated.
RESULTS
Table 1 focussed the age wise distribution of the study subjects. Among total 255 women, age group 20-25 were of 23.53 %, age group 25-30 were of 15.69 %, age group 30-35 were of 27.45 % and maximum 33.33 % women were of age group 35-40. Table 2 shows the anthropometric parameters like height, weight and BMI (Body Mass Index). This table shows that all age groups were of below the recommended BMI. Age group 20-25 had minimum 17.67±1.8 (Mean±SD) BMI (kg/m2 ) and age group 25-30 had maximum BMI 20.60±2.8 (Mean±SD) which was also below the recommended level. Table 3 shows blood haemoglobin % and cut off point for diagnosis of anaemia of non-pregnant women8 . These tables show that the haemoglobin % had a marginal value to that cut off point for diagnosis of anaemia of nonpregnant women. Table 4 shows average nutrient intake of the study subjects with recommended values. All study subjects intake recommended amount of protein and carbohydrate and daily energy gain is also high but this shows that they intake insufficient amount of fat, iron, Vit B6, Vit B12 and folic acid mainly they intake folic acid almost half of the recommended value.
DISCUSSION
The situation of anaemia among non-pregnant anaemia in rural India remains precarious. This current study was undertaken to determine the prevalence of anaemia and associated nutritional factors of anaemia among the non-pregnant women who were engaged in agricultural sectors. There was no previous report of this block of the district and this study was done to produce the baseline data for public health interventions and the possible cause of anaemia of this agriculturally dependent region. This study indicates that the blood Hb level of moderate women workers were low i.e. all were anaemic in the rural area of Patashpur II block of District Purba Medinipur. So, it will be severe when these women entered at the stage of pregnancy. This value was substantially higher than that of a study which was done by Maiti et al 9 among the non-pregnant rural women of Paschim Medinipur District (79.55%) which is the neighbouring district. The low BMI indicates that the women were of poor nutritional status. So, poor nutritional status along with low Hb % of the study subjects will make the situation complex for the non-pregnant women at the time of pregnancies. The average protein intake was greater than the recommended; it may be the case of over reporting by the respondents as the women were of poor economic status so they sometimes suppress their actual intake. Average intake of fat of the age groups was less than the recommended, for that reason the subjects had dry and scaly skin with horny papules. As these women were of poor economic status intake of carbohydrate were high than the recommended value. Fe, Vit. B6, Vit.B12 and folic acid consumption were less than recommended value so, these women have possibility to develop iron deficiency anaemia and certain types anaemia related to these nutrients10,11, 12,13 . This area is mainly known for their paddy cultivation for that reason they did not get sufficient amount of green vegetables and fruits. This study had some limitations; the socioeconomic status of these women was not obtained during this study. Further research is needed to find detailed cause of the prevalence of anaemia in this area.
CONCLUSION
The present study findings amply reveal that the agricultural women of Patashpur II block, District Purba Medinipur have probability to develop nutritional anaemia. Promotion of home gardening to increase the common iron rich and vitamin rich foods like green leafy vegetables will help to overcome the problem of availability of green vegetables. Awareness in women must be created. Nutritional counselling may be beneficial. Health and social workers, different voluntary organizations must aware about the consumption of iron rich and vitamin rich foods and detrimental effects of anaemia.
ACKNOWLEDGEMENTS
Authors are thankful to all the subjects who supported us and participated in this study.
Englishhttp://ijcrr.com/abstract.php?article_id=1413http://ijcrr.com/article_html.php?did=14131. World Health Organization, The prevalence of anaemia in women: a tabulation of available information. Geneva.1992
2. Ministry of Health and Family Planning Govt. of India, Annual paper 2001-2002, New Delhi. 2002
3. Luwang NC, Gupta VM, Khanna S Anaemia in pregnancy in a rural community of Varanasi, Ind J Prev Soc Med. 1980: 11: 83-88.
4. Agrawal V, Tejwani S, Prevalence of iron deficiency anaemia in Indian antenatal women especially in rural areas. Ind Med Gaz1999: 300-303.
5. WHOPreventing and controlling iron deficiency anaemia through primary health care, Geneva. 1989.
6. National nutrition policy, Ninth plan (1997- 2002), Planning commission, Govt. of India, New Delhi.2002: 11: p.549.
7. Sodhi HS, In Sports Anthropometry (A Kinanturopometric Approach): Anova Publication, Mohali, Chandigarh, 1991: pp.176-185
8. WHO.Technical report ser.no.405,1968
9. Maiti S, Ali KM, Jana K, Ghosh D, Paul S. Anaemia among non-pregnant women: a community based study in the rural areas of Paschim Medinipur, West Bengal. South Asian J Experimental Boil.2011: 1(4): 198- 201
10. VanderJagt DJ, Spelman K, Ambe J, Datta P, Blackwell W, Crossey M et al () Folate and vitamin B12 status of adolescent girls inorthern Nigeria. J Natl Med Assoc, 2000: 92: pp.334-340.
11. Nutritional anaemia [http://www.sightandlife.org/pdf/NAbook.p df]
12. Allen LH: Pregnancy and iron deficiency: Unresolved issues. Nutrition Reviews, 1997: 55(4):pp.91-101.
13. Van den Broek NR, Anaemia and micronutrient deficiencies. Br Med Bull, 2003: 67:pp.149-60.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareRACIAL VARIATIONS IN SERUM LIPID AND LIPOPROTEIN LEVELS IN BANGALEE AND CHAKMA POPULATIONS OF BANGLADESH
English5560Dwaipayan SikdarEnglish Mohammad Abul HashemEnglish Ramendu ParialEnglishBackground: Racial differences in serum lipid and lipoprotein levels exist and assumed to be important determinants of cardiovascular disease. The purpose of this study is to investigate if there are any differences in serum lipid and lipoprotein level in the population of two different races of Bangladesh. Materials and Methods: Ninty one Chakma subjects (43 male and 48 female) and equal number of Bangalee subjects (39 male and 52 female) were randomly selected. Serum Total Cholesterol (TC), Triglyceride (TG), High Density Lipoprotein Cholesterol (HDL-C) of the study subjects were measured using commercial kits and Low Density Lipoprotein Cholesterol (LDL-C) was calculated. Result: The Bangalee subjects had higher levels of TC, TG, LDL-C and lower level of HDL-C than the Chakma population. The Bangalee males had higher TC, TG and LDL-C than the Chakma male. No significant difference was observed for HDL-C. Bangalee female had higher TC and TG and lower HDL-C than the Chakma female. No significant difference was found for LDL-C. Conclusion: This study clearly showed that racial variations exist in serum lipid and lipoproteins levels between the Bangalee and Chakma population of Bangladesh. Keywords: Racial variation, Lipid, Lipoprotein, Bangalee, Chakma.
EnglishINTRODUCTION
Cardiovascular disease (CVD) is a major cause of death in the world today. The rates of CVD in many developed countries, such as the United States of America and parts of Western Europe, have reached a plateau and, in many instances, have begun to decline. However, in most developed countries, which are experiencing economic growth and rapid urbanization, the rates of CVD are only beginning to rise. The rise of CVD in developing countries is particularly important because the populations of these countries encompass two-thirds of the world’s population. In fact, despite lower rates of CVD, more CVD deaths occur in developing than in developed countries (1). Increased serum lipid and lipoprotein concentrations are recognized risk factors for coronary heart disease and atherosclerosis (2-4). Racial differences have been regarded as an important risk factor of coronary heart disease (CHD). Black adults have been reported to suffer more hypertension and black women appear to more obese than their white counterparts (5-10). There is also evidence of racial differences in lipid and lipoprotein levels, as black subjects have been found to have lower levels of triglycerides and higher levels of highdensity lipoprotein (HDL) cholesterol (11-21). It is important to know the normal level of blood lipid propile of ethnic group to asertain their risk for CHD. In Bangladesh, people of different races e.g. Bangalee, Chakma, Marma, Tripura etc. are living. No significant study has been conducted to examine if there are any differences in lipid and lipoprotein levels of these different races. The aim of this investigation was to determine whether there is any variation in the lipid and lipoprotein levels in the population of two different races namely Bangalee (Proto-Austriod or Veddas in origin and the mainstream population) and Chakma (Tibeto-Mongoloids in origin and tribal population) of Bangladesh.
SUBJECTS AND METHODS
Study subjects The Chakma subjects (43 male and 48 female) were selected from the hilly area of Rangamati, Khagrachari in Bangladesh and ninty one Bangalee people (39 male and 52 female) were selected from the plane land area of Chandanaish, Chittagong. Age and body mass index (BMI) were matched in the two races. Subjects suffering from familial hyperlipidemia and those on hypolipidemic drugs were excluded from the study. Laboratory methods 5 ml venous blood was collected from each subject after an overnight fast of 12-14 hours. Fasting total serum cholesterol, serum triglycerides and HDL-C were determined enzymatically using the kits of Randox Laboratory Ltd. UK. The LDL-C value was calculated using the Friedewald equation (22) when the triglyceride level was less than 400 mg/dl. Statistical analysis Statistical analysis was performed with a SPSS/PC statistical software package. Data were expressed as mean±SD. Unpaired t-test was used for comparison between two groups. Differences with a P value less than 0.05 were considered to be statistically significant.
RESULTS
Characteristics of the study subjects
Age, BMI and WHR showed no significant difference in Bangalee and Chakma subjects. Both systolic and diastolic pressure were significantly higher (p=0.001) in Bangalee than the Chakma subjects (Table 1).
Characteristics of the study subjects depending on sex
Bangalee male subjects showed higher systolic and diastolic pressure compared to the Chakma male subjects. The same pattern was observed in the female subjects of the two races. Age, BMI and WHR showed no significant difference between Bangalee and Chakma subjects of both sex (Table 2).
Lipid and lipoprotein level in Bangalee and Chakma subjects
Serum total cholesterol (TC), TG, LDL-C were significantly higher (p=0.001) and HDL-C was significantly lower (p=0.001) in the Bangalee subjects compared to the Chakma subjects (Table 3).The Bangalee male had significantly higher TC, TG and LDL-C (p=0.001, 0.002, 0.001 respectively) than the Chakma male. No significant difference was observed for HDL-C. Bangalee female had significantly higher TC, TG (p=0.000 and 0.007 respectively) and significantly lower level of HDL-C (p=0.000) than the Chakma female. LDL level was slightly lower in Bangalee female than in Chakma female (Table 4).
DISCUSSION
Our study confirms the racial variations in serum lipid and lipoprotein levels between the Chakma and Bangalee population of Bangladesh and this is the first report with this observation. This study shows the Chakma population had favorable lipid profile than Bangalee population. The Chakma population had significantly lower TC, TG and LDL-C and higher HDL-C than Bangalee population. Both the systolic and diastolic blood pressure were significantly (pEnglishhttp://ijcrr.com/abstract.php?article_id=1414http://ijcrr.com/article_html.php?did=14141. Reddy KS, Yusuf S. Emerging epidemic of cardiovascular disease in developing countries. Circulation 1998; 97 (6): 596-601. 2. Summary of the National Cholesterol Program (NCEP). Adult Treatment Panel II report. JAMA 1993; 269: 3015-3023. 3. Smith GD, Shipley MJ, Marmot MG, Rose G. Plasma Cholesterol concentration and mortality. JAMA 1992; 267. 4. Koukkou E, Watts GF, Mazurkiewicz J, Lowy C. Ethnic differences in lipid and lipoprotein metabolism in pregnant women of African and Caucasian origin. J Clin Pathol 1994; 47: 1105-1107. 5. Kleinbaum DG, Kupper LL, Cassel JC, Kupper LL, Cassel JC, Tyroler HA. Multivariate analysis of risk of coronary heart disease in Evans county, Georgia. Arch Intern Med 1971; 128: 943-948. 6. Tyroler HA, Heyden S, Bartel A, Cassel J, Cornoni JC, Hames CG, et al. Blood pressure and cholesterol as coronary heart disease risk factors. Arch Intern Med 1971; 128: 907-914. 7. Gillum RF. Coronary heart disease in black populations I. Mortality and morbidity. Am Heart J 1982; 104: 852-864. 8. Gillum RF. Pathophysiology of hypertension in Blacks and Whites. Hypertension 1979; 1: 468-475. 9. Five year finding of the Hypertension Detection and Follow-up Program II. Mortality by race, sex and age. JAMA 1979; 242: 2572-2577. 10. United states Department of Health, education, and welfare: US Vital and Health Statistics, Series 11, no 211. Weight and Height of Adults 18-74 Years of Age: United States, 1971-1974. Washington, DC, Publication no. (PHS) 79-1659, 1979 11. Glueck CJ, Gartside P, Laskarzewski PM, Khoury P, Tyroler HA. High density lipoprotein cholesterol in blacks and whites: potential ramifications for coronary heart disease. Am Heart J 1984; 108: 815-26. 12. Hames CG. Evans County cardiovascular and cerebrovascular epidemiologic studyIntroduction. Arch Intern Med 1971; 128: 883-886. 13. Tyroler HA, Hames CG, Krishan I, Heyden S, Cooper G, Cassel JC. Black-white differences in serum lipid and lipoproteins in Evans Country. Prev Med 1975; 4:541-549. 14. Tyroler HA, Heiss G, Schonfeld G, Cooper G, Heyden S, Hames CG. Apolipoprotein AI, A-II and C-II in Black and White residencts of Evan County. Circulation 1980; 62: 249-253. 15. Morrison JA, Degroot I, Kelly KA, Mellies MJ, Glueck CJ. Black-White differences in plasma lipids and lipoproteins in adults: The Cincinnati Lipid Research Clinic Population Study. Prev Med 1979; 8: 34-39. 16. Slack J, Noble N, Meade TW, North WRS. Lipid and lipoprotein concentrations in 1604 men and women in working populations in Northwest London. BMJ 1977; 2: 353-357. 17. Morrison JA, Khoury P, Mellies M, Kelly K, Horvitz R, Glueck. CJ. Lipid and lipoprotein distributions in Black adults: The Cincinnati Lipid Research Clinics Princeton School Study. JAMA 1981; 245: 939-942. 18. Tyroler HA, Glueck CJ, Christensen B, Kwiterovich PO. Plasma High-density lipoprotein cholesterol comparison in Black and White population: The Lipid research Clinics Program Prevalence Study. Circulation 1980; 62: 99-107. 19. Morrison JA, DeGroot I, Kelly KA, Mellies MJ, Khoury P, Lewis D et al: Black and White differences in plasma lipoproteins in Cincinnati school children (one-to-one pair matched by total cholesterol, sex and age). Metabolism 1979; 28: 241-245. 20. Frerichs RR, Srinivasan SR, Webber LS, Berenson GS. Serum cholesterol and triglyceride levels in 3446 children from biracial community: The Bogalusa heart study. Circulation 1976; 54:302-308. 21. Srinivasan SR, Frerichs RR, Webber LS, Berenson GS. Serum lipoprotein profile in children from a biracial community: The Bogalusa heart study. Circulation 1976; 54:309-318. 22. Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low density lipoprotein cholesterol in plasm without use of the preparative ultracentrifuge. Clin Chem 1972; 18: 499- 502. 23. Donahue RP, Jacobs DR, Sidney S, Wagenknecht LE, Albers JJ, Hulley SB. Distribution of lipoproteins and apolipoproteins in young adults: The CARDIA Study. Arteriosclerosis 1989; 9: 656-64. 24. Srinivasan SR, Wattigney W, Webber LS, Berenson GS. Race and gender differences in serum lipoproteins of children, adolescents and young adults-emergence of an adverse lipoprotein pattern in white males: the Bogalusa Heart Study. Prev Med 1991; 20:671-84. 25. Ruixing Y, Qiming F, Dezhai Y, Shuquan L, Weixiong L, Shangling P, et al. Comparison of demography, diet, lifestyle, and serum lipid levels between the Guangxi Bai Ku Yao and Han populations. J lipid Res 2007; 48: 2673- 2681. 26. Tan CE, Tai ES, Tan CS, Chia KS, Lee J, Chew SK, et al. APOE polymorphism and lipid profile in three ethnic groups in the Singapore population. Atherosclerosis 2003; 170 (2): 253-260. 27. Yangchun Z, Bingxian HE, Dayi HU, Xinehun Y, Xinli L, Xinguo Z, et al. Nationality differences in distributions of serum lipids, lipoproteins and apolipoproteins levels in Xinjiang China. Chinese Med J 2001; 114(11): 1128-1131. 28. Hoque MR, Kabir MG, Sikdar D. Racial Variation in serum lipid and lipoprotein levels in type 2 diabetic subjects of Bangladesh. J. bio-sci 17: 113-116, 2009. 29. Russo P, Siani A, Miller MA, Karanam S, Esposito T, Gianfrancesco F, et al. Genetic variants of Y chromosome are associated with a protective lipid profile in Black men. Arterioscler Thromb Vasc Biol 2008; 28: 1569-1574. 30. Singh VP, Ramesh V, Somvanshi S, Tewari S, Khan F, Sinha N, et al. Association of DNA polymorphism at the apolipoprotein B-100 gene locus with plasma lipid concentration and coronary artery disease among North Indians. Am. J Biochem and Biotech 2006; 2 (4): 138-145.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareEFFECT OF SHORT TERM HATH YOGA ON LUNG FUNCTION, AEROBIC CAPACITY AND QUALITY OF LIFE IN HEALTHY YOUNG INDIVIDUALS
English6172Foram DhebarEnglishIntroduction: Yoga is one of the most common methods used as mind body therapy. Hath yoga, one of the many forms or paths of yoga, focuses on overall fitness through pranayama, asana, and meditation. Anxiety and stress are the major problems of the modern world particularly of youth and college going students. There are very few studies on effect of hath yoga on lung function and aerobic capacity of healthy young individuals and there is paucity of data on effect of yoga on quality of life in the same group. Objective: The objectives of the study were to see the effect of short term hath yoga on lung function, aerobic capacity and quality of life in healthy young individuals. Methodology: Study design: experimental study Sample size: 60 volunteers A: experimental group and B: control group. Study setting: students of the college of physiotherapy. Method Hath yoga for 4 weeks,5 days in a week for 60 minutes; including 5 minutes of relaxation-savasana and makarasana, 5 minutes of pranayam, 5-10 minutes warm up, 25-30 minutes asanas (Ardh Paschimotasana, Paschimotasana, Yogamudra, Ardhmatsy endrasana, Uttitakumarasana, Tadasana) 5-10 min savasana, cool down period. Subjects of control group were in waiting list. After 4 weeks control group was taught same hath yoga poses. Peak expiratory flow rate, 12 min walk distance, SF-36 scores were taken as pre and post data. Result: The result shows that there is statistically significant improvement in PEFR, 12 MWD, and component of SF-36 after 4 week of hath yoga practice in healthy young individuals compared to a control group at 5% significance level. Conclusion: The conclusion of the study is that Short term Hath yoga improves lung functions, aerobic capacity and quality of life in healthy young individuals compared to control group.
Englishhath yoga, lung function, aerobic capacity, quality of lifeINTRODUCTION
Complementary and alternative medicine (CAM) is a group of diverse medical and health care systems, therapies and products.1 The American public´s use of complementary and alternative medicine increased substantially during the 1990s.2Complementary and alternative medicine includes techniques such as aromatherapy, massage, yoga, etc. Yoga is one of the most common methods used as mind body therapy. Yoga is a Sanskrit word which means “the unity of body and mind.” Yoga is an ancient Indian practice; first described in Vedic scriptures around 2500 B.C. which utilizes mental and physical exercises to attain “Samadhi”, or “the union of the individual self with the infinite”.3 Yoga is cessation of thought waves in mind.
Hath yoga, one of the many paths of yoga, focuses on overall fitness through breath control exercises (pranayama), yoga poses (asana), and meditation. Practitioners of yoga therapy integrate yoga concepts with western medical and psychological knowledge for example, by using body awareness and breathing activities, physical posture and meditation with an understanding of pathological condition such as back pain or depression4 whereas traditional yoga practice is primarily concerned with personal enlightment of people without understanding of pathology. Yoga since long has been used to reduce the physical symptoms of chronic pain, improves fitness and for meditation. Yoga also may help individuals deal with the emotional aspects of chronic pain, reducing anxiety and depression. Although yoga is historically a spiritual discipline, it has been used clinically for therapeutic intervention. The number of publications on its clinical application has greatly increased over the past 3 decades 5 . In literature there are many articles of use of yoga in variety of condition such as multiple sclerosis, rheumatoid arthritis, breast cancer, low back pain, migraine, epilepsy.6-10 Even though there have been numerous studies on yoga and disease, there have been few on healthy subjects. Several studies have been conducted in the geriatric population to see improvement in balance and fitness, but very few on healthy young subjects.11 Anxiety and stress are the major problems of the modern world particularly of youth and college going students. Stresses have very negative effects on fitness and health. Poor health negative feelings lead to various physical and psychological problems. Stressful life can lead to poor quality of life and fitness. There are studies on yoga and disease related stress, anxiety and effect on well being but very few on healthy young individuals’ fitness aspect. Some studies found improved lung function in condition such as asthma, Bronchiecstasis etc.12- 13 there are very few studies on effect of hath yoga on lung function and aerobic capacity of healthy young individuals and there is paucity of data on effect of yoga on quality of life in the same group. Hence the need of this study to determine whether yoga practice over a short duration of 4 weeks would result in a change in lung function, aerobic capacity and quality of life in healthy young individuals.
MATERIAL AND METHADOLOGY
Study design
A randomized controlled trial Study setting The study was conducted at the College of physiotherapy. Duration of study The total duration of the study was 6 months. Sample size and design 60 healthy volunteers were randomly divided in to 2 groups 1) Experimental group (yoga group)-30 individuals 2) Control group-30 individuals Inclusion criteria Gender- male and female Age-18 to 25 years BMI within normal limits Having full range of motion of all joints Exclusion criteria Those who were doing regular exercises previously Having any history of acute or chronic diseases History of Smoking and drinking Data collection and procedure Material Consent form. Data collection sheet Yoga mats Paper, pencil, pen Apparatus Stop watch Peak flow meter Weighing machine Measure tape Outcome measure Peak expiratory flow rate14 12 min walk distance15 SF-36 questionnaire16 Procedure 68 volunteers, 18-25 years of age were recruited from the undergraduate students of the college of physiotherapy. According to inclusion exclusion criteria 60 volunteers were included in the study. All subjects were explained the study and written consent informed form was taken. Then they are randomly divided in to 2 group’s .group A: experimental group and group B: control group. General characteristics (age, sex, height, and weight and body mass index) were collected. On the first day of study, both groups came to training room and their pre intervention data were collected: 12 min walk distance, peak expiratory flow rate and SF-36 score. Experimental group performed hath yoga for 4 weeks, 5 days in a week. Some important guidelines and precautions for practice of asanas were explained such as Take light snacks 1 hour before yoga class. Evacuate bowel and bladder. Dress should be loose and comfortable. Ladies should not do asana during menstruation. Breathing should be done through nose only. Avoid jerky movements while doing asanas. Exhale during all forward bending movements in which the chest and abdomen are being compressed, and inhale during all movement in which the chest and abdomen is being expanded. Do not force your body to achieve final pose. Each yoga session was taken between 7.30 to 8.30 a.m. for 60 minutes; including 5 minutes of relaxation with savasana and makarasana, 5minutes of pranayam consisting of alternative nostril breathing while maintaining of half lotus pose (ardh padmasana).(Photograph 1) Then 5-10 minutes of warm up focused on slow dynamic muscle movements with dynamic lunges, shoulder/arm circling, and neck rolling. This was followed by 25-30 minutes of asanas consisting of following poses: ArdhPaschimotasana (photograph 2) Paschimotasana (toe touching in long sitting) (photograph 2) Yoga mudra ArdhPaschimotasana (photograph 3) Ardh matsyendrasana (sitting and twisting pose) (photograph 4) Uttita kumarasana (cat and camel pose) (photograph 5) Tadasana (toe standing with arm elevated) (photograph 6) Session was ended with 5 min of relaxation with savasana and cool down period. At the end of 4 weeks post exercises data were collected. Statistical tests were used to compare the data of both groups. Level of significance was kept at 5%. Subjects of control group were in waiting list. After 4 weeks control group was thought same hath yoga poses.
RESULT
The present study comprised of two groups of 30 subjects in each group. Group A was experiental group and Group B was Control group. Group A was given Hath yoga training, while Group B was kept in waiting. All selected subjects completed the study satisfactorily. Subjects were evaluated at end of four weeks. The results of the 60 subjects were analyzed by using Graph pad Prism-5. Graph 1, 2 shows the mean age, body mass index values having no statistical difference. Here paired t test was used for statistical analysis of within group A and B peak expiratory flow rate and 12 MWD
Group A showed statistically significant difference in PEFR (table 1 and 2) and 12 MWD (table 4 and 5) at the end of 4 weeks of Hath yoga practice at 5 % level of significance compared to group B (control group) For comparing the difference in mean PEFR score and 12 MWD Score between Groups A and B, Mann-Whitney U test was performed and found statistically significant (table 3 and 6) In this study subjects were healthy individuals who had no complain of pain and hence pain subscale of physical component was not evaluated. Group A showed statistically significant difference in SF 36 score at the end of 4 weeks of Hath yoga practice p0.05) in physical functioning, general health, rolephysical, vitality, social functioning, roleemotional, and mental health (table 7 – 9)
DISCUSSION
The result shows those 4 weeks of hath yoga practice in healthy individuals can significantly benefit in improving lung function, aerobic capacity and quality of life compared to a control group. This is similar to findings by Yadav RK et al., in a study on 60 healthy young females; where a significant increase was demonstrated in forced vital capacity, forced expiratory volume in 1 second and peak expiratory flow rate.17 Mandanmohan et al. also demonstrated that short-term Yoga practice increased skeletal muscle strength and lung volumes in children.18 Joshi LN et al. found that short term pranayam practice increased respiratory sensation, maximum expiratory pressure and flow rate.19 Respiratory function depends on many factors including nervous system, respiratory muscle strength, and lung dimension. Yoga recognises three methods of breathing: Diaphragmatic, Intercostal, Clavicular 20 According to Chitlow, of these three, diaphragmatic breathing is the most efficient as it uses the least energy and enables the most absorption of oxygen. This is because the surface area of the lungs is greater in the lower lobes resulting in higher quantities of oxygen circulating around the body.21 Yoga stabilizes autonomic equilibrium with a tendency towards parasympathetic dominance rather than stress-induced sympathetic dominance. According to Ernst, Yoga therapy readjusts the autonomic imbalance, controls the rate of breathing and relaxes the voluntary inspiratory and expiratory muscles, which results in decreased sympathetic reactivity.22, 23 Thus; Yoga increases respiratory efficiency, balances activity of opposing muscle groups and slows dynamic and static movements. Pranayama may have psycho physiological benefits by increasing the patient’s sense of control over stress and thus aids in reducing their autonomic arousal factors. Five positions of Hath-Yoga used in this study have been reported to predominantly affect prime mover and accessory respiratory muscle such as external and internal intercostal muscle, pectoral, latisimusdorsi, erector spine, rectus abdominals, serratus anterior and diaphragm.24 Halvorson stated that performing Yoga stretching and balancing movement can lead to improvements of muscle strength and flexibility of all these muscles.25 and thus improve PEFR as seen in present study. The result of this study, showed statistically significant difference in 12 min walk distance at the end of 4 weeks of Hath yoga practice in group A Similarly Balasubramanian and Pansare also reported significant increases in cardiorespiratory endurance after 6 weeks of regular yoga practice. However, the authors had estimated VO2max using the Astrand- Rhyming Step Test.26 In contrast Blumenthal et al. and Raju et al. directly measured VO2max by the analysis of expired gases and reported no significant changes resulting from yoga practice27 .However, the sample population in these two studies consisted of healthy older individuals (ages 60–83) and elite athletes, respectively. Cardiac function in normal young volunteers has been studied in a randomized controlled trial in 24 school children, which was designed to determine whether pranayama had any effect on ventricular performance by measuring systolic time intervals and cardiac autonomic function tests. After 3 months training, parasympathetic activity was seen to be increased and sympathetic activity decreased .28 A study by Bhattacharya on 30 healthy young men also demonstrated improvement in oxidative status and the antioxidant pathological processes following yoga practice leading to an increase in aerobic capacity which could justify the changes seen in present study. 29 The result also suggests improvement in subjective well being and score of SF 36 scale. In this study subjects were healthy individuals who had no complain of pain and hence pain subscale of physical component was not evaluated. As shown in this study, Group A showed statistically significant difference in SF 36 score at the end of 4 weeks of Hath yoga practice. According to Madanmohan, Savasana, the relaxation part of yoga practices, has shown to enhance the ability to withstand stress30 Kamei T et al studied changes in brain waves and blood serum cortisol during yoga exercise and increase in alpha waves and decrease in cortisol level have been reported.31 In vivo evidence has been provided for regulation of conscious states at a synaptic level by yoga nidra 32 . Harinath K et al. studied on the effects after 3 months of hath yoga practice on cardiorespiratory performance, psychological profile and melatonin secretion. They showed improvement in these profiles and increase in plasma melatonin, indicating that yoga could be used as a psycho physiologic stimulus to increase endogenous secretion of melatonin, which in turn might be responsible for improved sense of well-being33 . Prasad concluded the state of the mind and that of the body are intimately related. If the mind is relaxed the muscles in the body will also be relaxed. Stress produces a state of physical and mental tension. Yoga physical postures and breathing exercises improve muscle strength, flexibility, blood circulation and oxygen uptake, as well as hormone function, In addition the relaxation helps to stabilize the autonomic nervous system with a tendency towards parasympathetic dominance. The physiological benefits which follow help the yoga practitioner become more resilient to stressful conditions34 . The limitations of the study were Predominant female individuals were included as participants. Direct estimation of aerobic capacity was not performed. Future Research can be conducted on healthy young individuals to measure relation between quality of life and stress and also can be done in geriatric population to see effect on fitness and quality of life
CONCLUSION
The conclusion of the study is that Short term Hath yoga improves lung functions, aerobic capacity and quality of life in healthy young individuals compared to control group So, clinically it can be implicated to be used to improve physical and psychological fitness in healthy individuals.
ACKNOWLEDGEMENT
I am thankful to Dr. Pankaj Patel, Dean N.H.L. Medical College for giving me an opportunity to do the study. I am grateful to Dr. Neeta Vyas, Principal of S.B.B.College of Physiotherapy, for providing me all facilities for my work, without which it would not have been possible to complete this project. I would like to express my deep sense of gratitude to my respected teacher Dr. Megha Sheth, Lecturer; for her invaluable guidance. I also express my gratitude to all the staff members of S.B.B. College of Physiotherapy for their assistance and help in carrying out this project work I will be failing in my duty if I do not thank my all the subjects, who participated in my study and spent their valuable time. I owe thanks to my family andfriends who shared my anxiety and believed in my abilities specially Amruta Chauhan, Maharshi Trivedi for their support in carrying out this study. I acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. I am also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. I am 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=1415http://ijcrr.com/article_html.php?did=14151. John A. Why patients use alternative medicine: Result of a national study. JAMA. 1998; 279: 1548-1553.
2. Eisenberg DM, Davis RB, Ettner SL, et al. Trends in alternative medicine use in the United States, 1990-1997: Results of a follow-up national survey. JAMA.1998; 280:1569-1575.
3. Lidell L. The Sivananda Companion to Yoga. New York, NY: Simon and Schuster Inc.; 198
4. Worthington V. A History of Yoga. London, UK: Routledge and Kegan Paul; 1982.
5. Khalsa SB. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian journal of physiology and pharmacology, 2004, 48(3):269–85. 5,
6. Oken BS, Kishiyama S, Zajdel D, Bourdette D, Carlsen J, Haas M, Hugos C, Kraemer DF, Lawrence J, Mass M. Randomized controlled trial of yoga and exercise in multiple sclerosis. Neurology 2004; 62: 2058-2064.
7. Dash M, Telles S. Improvement in handgrip strength in normal volunteers and rheumatoid arthritis patients following yoga training. Indian J Physiol Pharmacol. 2001; 45: 355-360.
8. Alyson B. Moadel, Chirag Shah Rosett, Melanie S. Harris, Sapana R. Patel, Charles B. Hall, and, Judith Randomized Controlled Trial of Yoga Among a Multiethnic Sample of Breast Cancer Patients: Effects on Quality of Life. American Society of Clinical Oncology Oncol 2007; 25:4387-4395.
9. P.J. John, PhD; Neha Sharma, MSc; Chandra M. Sharma, MD, DM; Arvind Kankane, MD et al. Effectiveness of Yoga Therapy in the Treatment of Migraine Without Aura: A Randomized Controlled Trial Headache 2007;47:654-661
10. Jayasinghe SR. Yoga in cardiac health (a review). European journal of cardiovascular prevention and rehabilitation, 2004, 11(5):369–75
11. Brown KD, Koziol JA,Lotz M.A. et al. Yoga based exersice programe to reduced the risk of fall in seniors: a pilot study J Alter Complement medi. 2008; 14; 454-7. 11,
12. Nagarathna R, Nagendra HR: Yoga for bronchial asthma: a controlled study. BMJ, 1985; 291: 1077–79 12
13. Visweswaraiah NK, Telles S et al. Randomized trial of yoga as a complementary therapy for pulmonary tuberculosis. Respirology, 2004; 9:96. 13,
14. Scottish Intercollegiate Guidelines Network and The British Thoracic Society (2003) British Guideline on the Management of Asthma - Annex 8: Personal Asthma Action Plan"
15. Cooper, K. H. (1968) A means of assessing maximal oxygen uptake. Journal of the American Medical Association 203:201- 204.
16. McHorney, CA, et al;The 36 item short form health survey (SF-36) test of data quality, scaling assumption, and reliability across diverse patient groups. Med Care 32:40,1994.
17. Yadav RK and Das S. Effect of yogic practice on pulmonary functions in young females. Indian J Physiol Phamacol 45:493- 496, 2001.
18. Mandanmohan, Jatiya L, Udupa K, and Bhavanani AB. Effect of yoga training on handgrip, respiratory pressures and pulmonary function. Indian J Physiol Pharmacol 47: 387-392, 2003.
19. Joshi LN, Joshi VD, and Gokhale LV. Effect of short term “Pranayam” practice on breathing rate and ventilatory functions of lung. Indian J Physiol Phamacol 36:105- 108, 1992
20. Gilbert C. Yoga and breathing. J Bodywork Mov Ther 3:44-54, 1999.
21. Chaitow L and Bradley D. The structure and function of breathing. In: Multidisciplinary Approaches to Breathing Pattern Disorder, edited by Chaitow L, Bradley D and Gilbert C.Edinburgh: Churchill Livingstone, 2002, 1-41.
22. Ernst E. Breathing techniques-adjunctive treatment modalities for asthma? Systematic review. Eur Respir J 2000; 5: 969–972.
23. Ram FSF, Holloway EA, Jones PW. Breathing retraining for asthma. Resp Med 2003; 97:501–507.
24. Levenson C. Breathing Exercise. In: Clinics in Physical Therapy: Pulmonary Management in Physical Therapy, edited by Zadai C. Edinburgh: Churchill Livingstone, 1992, p 135-156.
25. Halvorson C. Stretching to breathe: Can yoga help your asthma? Asthma Mag 7:27- 29, 2002
26. Balasubramanian B, Pansare MS. Effect of yoga on aerobic and anaerobic power of muscles. Indian J Physiol Pharmacol. 1991;35(4):281–282.
27. Raju PS, Madhavi S, Prasad KVV, et al. Comparison of effects of yoga and physical exercise in athletes. Indian J Med Sci. 1994;100:81–87
28. Udupa K et al. Effect of pranayam training on cardiac function in normal young volunteers. Indian journal of physiology and pharmacology, 2003, 47(1):27–33. .
29. Bhattacharya S, Pandey US, Verma NS. Improvement in oxidative status with yogic breathing in young healthy males. Indian journal of physiology and pharmacology, 2002, 46(3):349–54.
30. Madanmohan et al. Modulation of cold pressor-induced stress by shavasan in normal adult volunteers. Indian journal of physiology and pharmacology, 2002, 46(3):307–12.
31. Kamei T et al. Decrease in serum cortisol during yoga exercise is correlated with alpha wave activation. Perceptual and motor skills, 2000, 90(3 Pt 1):1027–32.
32. Kjaer TW et al. Increased dopamine tone during meditation-induced change of consciousness. Brain research. Cognitive brain research, 2002, 13(2):255–9.
33. Harinath K et al. Effects of hath yoga and omkar meditation on cardio-respiratory performance, psychologic profile, and melatonin secretion. Journal of alternative and complementary medicine, 2004, 10(2):261–8.
34. Parshad O et al. Role of yoga in stress management. West Indian medical journal, 2004, 53(3):191–4.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareDO STATINS HAVE POTENTIAL AS ANTI OSTEOPOROTIC DRUGS AND CAN THEY BE USED FOR PREVENTION OR TARGETING OSTEOPOROSIS: A REVIEW
English7381Karmajeet RathEnglish Biswa Bhusan MohantyEnglish Sanjay KumarEnglish Pramila NayakEnglish Jagannath SahooEnglishInhibitors of HMG-CoA reductase enzymes, which are statins, are well known and much prescribed drugs for lowering of cholesterol and used for dyslipidemia. But, they have also been shown across various studies to stimulate bone formation. In bone cells, these inhibitors have been known to increase the gene expression of bone morphogenetic protein-2, thereby helping in osteoblastic differentiation, with some effects also on osteoclastic inhibition. The findings that statins can increase bone formation and thereby mass of bone, can be helpful in preventing bone fractures and improving osteoporosis, which is a condition of marked bone loss. Hence, it is reviewed herein that HMG-CoA reductase inhibitors can be a great way, probably a futuristic drug for osteoporotic treatment and prevention. Keywords: HMG-CoA reductase inhibitors, osteoporosis
EnglishHMG-CoA reductase inhibitors, osteoporosis, osteoblasts, statins, bone metabolism, fractureINTRODUCTION
There has been a remarkable increase in the knowledge about osteoporosis since the past 25 years or so. Osteoporosis is seen to occur more in females than in males, although mortality is higher in men, which are caused by osteoporotic fractures 1, 2, 3. Added to this, post menopausal women have a higher frequency of osteoporotic fractures and osteoporotic incidences 4 . Bone is a metabolically active organ in which mineral and organic components will be important to determine the mechanical function of skeleton5,6 . Bone turnover is under the control of certain defined agents as well as processes, which regulate the formation of bones and also resorption of bone. These are two basic but important processes by which the bone remodelling is occurg. New bone formation is basically a function of the osteoblasts, agents which act by increasing or decreasing the replication of cells in the lineage of osteoblasts, or modifying the differentiated function of the osteoblast. It would therefore be beneficial for stimulating the osteoblastic activity at local sites in bone by an oral anabolic agent, resulting in bone formation, where and when needed. Osteoporosis is defined clinically as reduced bone mass, to such a level where it will result in fracture, with minimal trauma7 . This term will also suggest that there is parallel loss of both bone mineral and matrix that will render the mineralised bones incapable of withstanding minor trauma, without leading to fractures. Osteoporosis is a disease condition which is affecting about 30 million people in United States and about 100 million people worldwide. Unless the bone mass falls below 30% to 50% lower than the normal value, fractures do not occur.
DYNAMICS OF BONE & OSTEOPOROSIS
Bone mass is the net result of a balance between bone formation and resorption. This balance is mostly regulated by genetic as well as environmental factors. Genes regulating bone mass are vitamin D receptor gene, estrogen receptor gene, interleukin-6, transforming growth factor B and gene encoding type 1 collagen 8,9,10,11. Environmental factors include nutritional status, exercise, drugs like glucocorticoids and contraceptive pills, neoplastic diseases such as myeloma, leukemia, lactation, parity, alcohol, smoking, weight loss and long hip axis length. Although the exact pathophysiology of osteoporosis is unknown, an imbalance between bone formation and resorption presumably causes bone mass to decline in adulthood and osteoporosis occurs when the amount of bone removed from the skeleton by bone resorbing osteoclasts exceeds the amount formed by osteoblasts during the coupled process of remodelling. Treatment of osteoporosis is aimed towards restoring this balance.
BONE REMODELLING
Bone remodelling is well established throughout the literature and involves both systemic and non systemic factors. It is well known that in this procedure an important role is played by the system of receptor activator of nuclear factor kappa b ligand – osteoprotegerin 6, some cytokines and bone morphogenic proteins. Mesenchymal stem cells are pluripotent cells with a high mitotic index and are involved in the differentiation of adipocytes under the regulation of genes and transcription factors. Adipose tissue is considered as a separate endocrine gland, responsible for the secretion of adipokines such as leptin, adiponectin and hormones such as vitamin D3, estrogen, etc and in involved in the pathogenesis of some entities. Leptin is considered to exert a control over the RANKL/OPG axis by decreasing the expression of RANKL and increasing OPG to bring out preosteoblasts and mononuclear cells into the circulation. 12,13. There is diversion of adipocyte into an osteoblast, which is a multifactorial process regulated by various factors.
Molecular biology and genetics reveal that both vascular and osteoblast biology have a common pathway of RANK/RANKL/OPG 14. Mundy and colleagues in 1999 reported first that there was an anabolic effect of statins in human bone cells and cultured mouse. Simvastatin and lovastatin enhanced the expression of bone morphogenetic protein- mRNA15 . Statins as potential drugs for osteoblastic activites Several experiments have illustrated the effect of statins in bone metabolism in vitro and vivo. Chan et.al.16 in 2000 demonstrated that there was negative effect of statin on bone repair. But in contrast, there were many other studies which showed beneficial effects. The administration of statins has anabolic effects on the bone by suppressing osteoclasts and promoting osteoblastic activities. Hence, statins can effectively work on bone formation and increase the bone mass density by inhibiting it, thereby helping in prevention of osteoporosis and aiding in fracture healing. Most of these studies have been done in different doses in animal models, apart from showing actions of cholesterol lowering in animals. Some also have shown remarkable increase in required growth factors such as TGFb-1 and VGF or Vascular Growth Factor, possibly showing a path for the statins and bone interaction. There have been more studies in cell cultures, in vitro, which support the findings that statins have a potential mechanism on bone metabolism. There is expression in certain genes like BMP-2, COLLIA1, Osteocalcin, etc while the RANKL gene is depressed are affected by statins, which might be the reason for the bone formation. In 2007, Hughes A et.al. 17 found that the statins of hydrophobic nature and hydrophilic nature have inhibited osteoclastic action in vitro, while some other studies have shown lipophilic agents like simvastatin to have better action 18. It was the pleiotropic effect of statins which led many clinicians to study the use of statins in bone metabolism. A meta analysis by Uzzan et al 19 , found that statins have a positive effect on bone mass density in different bones of the body. It was concluded that there was statistically significant but modest positive effect of statins on BMD. More data is still needed to support the use of statins in prevention of bone fracture. Most of the literatures showed an increase in BMD and also in bone markers. All the available data from various literatures, starting from the experimental studies to the observational studies showed that there is surely some positive effect of statins on BMD. One meta analysis by Bauer et al 20 also showed the beneficial effect of statins on fracture risk. It was demonstrated by Chuengsamarn et al 21 that statins could inhibit bone resorption and stimulate bone formation, with a dual action on bone metabolism. It might be possible for statins to gain a position as a drug used for prevention and management of osteoporosis, so much so that statins is being frequently prescribed by clinicians for other treatments. Possibly in the future, drugs will be up in circulation, which will target the different pathophysiological and biochemical cascades as in statins with alterations of doses and could be used for different bone disorders like osteoporosis.
DISCUSSION
Two recently elucidated pathways may explain how statins can be helpful in building up bone. The first mechanism is through the inhibition of mevalonate production. Many laboratories and researchers noted that cholesterol synthesis and osteoclast activation involved same biochemical cascade. The synthesis of cholesterol is done in plenty of steps. HMG-CoA is converted into mevalonate by enzyme HMG-CoA reductase. This enzyme is inhibited by statins. Then the mevalonate is converted to geranyl phosphate, which is in turn converted to farnesyl pyrophosphate by the enzyme farnesyl pyrophosphate synthese, which is inhibited by bisphosphonate drugs. Then the cholesterol is synthesised22, 23,24. Osteoclasts use the intermediate molecules of farnesyl pyrophosphate and geranyl pyrophosphate from farnesyl pyrophosphate to modify and activate the key intracellular proteins glutamyl transpeptidases and GTP-ase in a process called prenylation25. Bisphosphonates like alendronate and risedronate inhibit farnesyl synthase, preventing the formation of lipid products 26 .
Statins are as efficacious in not allowing osteoclast activation, even in experimental set ups, the action being due to mevalonate production. This will reduce the bone resorption and there is restoration of bone resorption and formation. In many clinical trials, it has been noted that fragility related fractures are reduced27, 28, and 29 . B. Another mechanism which has statins affecting skeleton is that of activation of bone morphogenetic protein-2 promoter. This is a kind of protein which is a growth factor, which leads the osteoblasts into proliferating, maturing and thereby creating a new bone30. In an experiment, when lovastatin was injected into organ cultures of calvarial bones from the neonate mice, thrice a day for 5 days, volume of bone increased by as much as 50%, in comparison to placebo. Histological studies showed enhanced bone formation and osteoid accumulation. 31 .
Although a number of recent drugs have shown to prevent osteoporosis and have been used in the treatment, not one of them has been shown to stimulate bone formation and increase osteoblasts activity. It was suggested that drugs which inhibit HMG CoA reductase, which are statins, many have such effects and reduce the risk of osteoporotic fractures. 30. Many other reports have also suggested such an anabolic bone effect, which might show a new path towards the treatment of osteoporosis. 32. To aid in the proof of such an action, it was stated that statins as a class of unknown bone anabolic agents acted through increased production of one of the important bone growth factors, which is Bone Morphogenetic Protein-2, which directly stimulates the osteoblastic activity and bone formation. Lovastatin was found to be stimulating the BMP-2 promoter, from among 30,000 natural compounds tested. 33. Many other subsequent studies have also demonstrated similar effects through fluvastatin, simvastatin and mevastatin. 34, 35, 36. These studies showed that the drugs inhibiting HMG-CoA reductase commonly utilised nowadays for lowering blood lipid levels, also stimulate bone formation activity by osteoclasts through the increase of BMP-2 expression, which is a proven differentiator of osteoblasts. Chuengsamarn et al also carried out many experiments in form of prospective randomised trials on the impact of simvastatin on osteopenic patients and found that bone formation marker and BMD was significantly higher than in the statin group and the difference of bone resorption market was also significantly lower than in the statin group. 37 .
CONCLUSION
From such studies it can be very well concluded that simvastatin as well as other drugs in this particular group act as double therapeutic weapon by inhibiting the conversion of HMGCoA to mevalonate, which is required for cholesterol synthesis and also inhibits the stimulation of osteoclastic activity. Also, there is increase in the stimulation of osteoblastic activities, providing enough evidence that the simvastatin has a promising role in fighting against osteoporosis. But still more studies are required to find the particular doses and the effect dosage and mode of administration of these statin group of drugs to make it commercially viable. Current therapies of osteoporosis treatment include estrogen replacement therapy, bisphosphonates and selective estrogen receptor modulators and all of them aim at blunting the resorption of bone remodelling. Based on previous findings it was found by Bauer and Cummings that large databases showed association between statin usage and skeletal status, showing relationship between statin use, bone mineral density and subsequent fractures. 38,39. Even a study on post menopausal women has come out which shows an increase in the bone mineral density who are taking statins40. It has been shown to have a protective effect against non pathological fractures among older women. 41,42,43,44 A similar story was involved with the use of Hormone Replacement Therapy or HRT, which was prescribed to ladies around 2000, without much long term studies. Statins are also being pushed nowadays for prevention of fractures. But, with the proper tests and long term studies, it will be coming out clearly, whether the benefits are worth making public.
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. 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=1416http://ijcrr.com/article_html.php?did=14161. Data from the World Health Organization Assessment of osteoporosis at the primary health care level. Summary report of a WHO scientific Group 2007; WHO, Geneva.
2. Cole ZA, Dennison EM, Cooper C, 2008 Osteoporosis epidemiology update. Curr Rheumatol Rep 10: 92-96.
3. Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV, 2007 Residual lifetime risk of fractures in women and men. J Bone Miner Res 22: 781-788.
4. Pinheiro MM, Reis Neto ET, Machado FS, et al, 2010 Risk factors for osteoporotic fractures and low bone density in pre and postmenopausal women. Rev Saude Publica 44: 479-485.
5. Glimcher MJ, Krane SM: The organizational and structure of bone and the mechanism of calcification. In: A treatise on collagen.Biology of collagens. Edited by Ramachandran GN, Goudl BS. New York: Academic Press; 1968:68-91.
6. Glimcher MJ: Comparison, structure and organization of bone and other mineralized tissues and the mechanism of calcification. In: Handbook of physiology, endocrinology, parathyroid gland. Edited by Aubarch GD. Washington: American Physiological Society; 1976:25-48
7. Al-Sebaie H, Al-Hefnawy A. Risk factors for osteoporosis. Egypt Rheum 1997; 24:209-219
8. Morrison N, Qi J, Tikota A, Kelly PJ, Crofts L, Nguyen TV, et al. Prediction of bone density for vitamin D receptor alleles. Nature 1994; 367:384-387.
9. Stuart H, Ralston M. What determines peak bone mass and bone loss. In: Bailliers Clinical Rheumatology, 3rd ed. Philadelphia: Catham Company 1997; 11:479-493.
10. Girasol G, Jjlka R, Passeri G. Estradiol inhibits interleukin-6 production by bone marrow-derived stromal cells. J Clin Invset 1992; 89:883-891.
11. Grant S, Reid D, Blak G, Herd R, Fogelman I, Ralston SH. Reduced bone density and osteoporosis associated with a polymorphic site in the collagen type 1 alpha gene. Nature Genetics 1996; 14:203-205.
12. Vega D, Maalouf NM, Sakhaee K, 2007 Clinical review: the role of receptor activator of nuclear factor kappa B(RANK)/RANK ligand/osteoprotegerin clinical implications. J Clin Endocrinol Metab 92: 4514-45121.
13. Painter SE, Kleerekoper M, Camacho PM, 2006 Secondary osteoporosis: a review of the recent evidence. Endocr Pract 12: 436- 445.
14. Bagger YZ, Rasmussen HB, Alexandersen P, et al, 2007 PERF Study Group. Links between cardiovascular disease and osteoporosis in postmenopausal women: serum lipids or atherosclerosis per se? Osteoporos Int 18: 505-512.
15. Mundy G, Garrett R, Harris S, et al, 1999 Stimulation of bone formation in vitro and in rodents by statins. Science 286: 1946- 1949.
16. Chan KA, Andrade SE, Boles M, Buist DS, Chase GA,Donahue JG, et al. Inhibitors of hydroxymethylglutaryl-CoA reductase and risk of fracture among older women. Lancet 2000;355:2185-8.
17. Hughes A, Rogers MJ, Idris AI, et al, 2007 A Comparison between the Effects of Hydrophobic andHydrophilic Statins on Osteoclast Function In Vitro and Ovariectomy-Induced Bone Loss In Vivo. Calcif Tissue Int 81:403-413.
18. Pagkalos J, Cha JM, Kang Y, et al, 2010 Simvastatin induces osteogenic differentiation of murine embryonic stem cells. J Bone Miner Res, 25: 2470-2478.
19. Uzzan B, Cohen R, Nicolas P, Cucheratc M, Perret G. Effects of statins on bone mineral density: a meta-analysis of clinical studies. Bone 2007; 40:1581-1587.
20. Bauer DC, Mundy GR, Jamal SA, Black DM, Cauley JA, Harris F,Duong T, Cummings SR: Statin use, bone mass and fracture: an analysis of two prospective studies. J Bone Min Res 1999, 14:1188.
21. Chuengsamarn S, Rattanamongkoulgul S, Suwanwalaikorn S, Wattanasirichaigoon S, Kaufman L. Effects of statins vs. non-statin lipid-lowering therapy on bone formation and bone mineral density biomarkers in patients with hyperlipidemia. Bone 2010;46:1011-1015
22. Fisher JE, Rogers Mi, Halasy JM, Luckman SP, Hughes DE, Masarachia† PJ, et al. Alendronate mechanism of action: geranylgeraniol, an intermediate in the mevalonate pathway, prevents inhibition of osteoclast formation, bone resorption, and kinase activation in vitro. Proc Natl Acad Sci USA 1999; 96:133 138.
23. Luckman SP, Hughes DE, Coxon FP, Russell RG, Rogers MJ. Nitrogencontaining bisphosphonates inhibit the mevalonate pathway and prevent posttranslational prenylation of GTP-binding proteins, including Ras. J Bone Miner Res 1996; 13:581-589.
24. Luckman SP, Coxon FR, Ebetino FH, Russell RG, Rogers MJ. Heterocyclecontaining bisphosphonates cause apoptosis and inhibit bone resorption by preventing protein prenylation: evidence from structure-activity relationships in 1774 macrophages. J Bone Miner Res 1998; 13:1668-1678.
25. Zhang FL Casey PJ. Protein prenylation: molecular mechanisms and functional consequences. Annu Rev Biochem 1996; 65:241-269.
26. Van Beek E, Pieterman E, Cohen L, Lowik C, Papapoulos S. Farnesyl pyrophosphate synthase is the molecular target of nitrogencontaining biaphosphonates. Biochem Biophys Res Commun 1999; 264:108-211.
27. McClung MR, Geusens P, Miller PD, Zippel H, Bensen WG, Roux C, et al. Effect of risedronate on the risk of hip fracture in elderly women. Hip Intervention Program Study Group. N Engl J Med 2001; 344:333- 340.
28. Karpf DB, Shapiro DR, Seeman E, Ensrud KE, Johnston CC Jr, Adami S, et al. Prevention of nonvertebral fractures by alendronate: a meta-analysis. Alendronate Osteoporosis Treatment Study Group. JAMA 1997; 277:1159-1164
29. Cummings SR, Black DM, Thompson DE, Applegate WB, Barrett-Connor E, Musliner TA, et al. Effect of alendronate on risk of fracture in women with low bone density but without vertebral fractures: results from the Fracture Intervention Trial. JAMA 1996; 280:2077-2082
30. Mundy C, Garrett R, Harris S, Chan J, Chen D, Rossini G, et al. Stimulation of bone formation in vitro and in rodents by statins. Science 1999; 266:1946-1949.
31. Alberts AW, Chen J, Kuron G, Hunt V, Huff J, Hoffman C, et al. Mevinolin: a highly potent competitive inhibitor of hydroxymethyl-glutaryl - coenzyme A reductase and a cholesterol-lowering agent. Proc Natl Acad Sci USA 1980; 77:3957- 3961
32. Haffner SM, Alexander CM, Cook TJ, Boccuzzi SJ, Musliner TA, Pedersen TR, et al. Reduced coronary events in simvastatin treated patients with coronary heart disease and diabetes or impaired fasting glucose levels, subgroup analyses in the Scandinavian Simvastatin Survival Study. Arch Intern Med 1999; 159:2661-2667
33. Crisby M, Fredriksson-Norden G, Nillsson J. Pravastatin treatment decreases lipid content and cell death in human carotid plaques. Lancet 1998; 30:21-28.
34. Wai-Keilam C, Chan IH, Mundy G. Statins and bone formation. Science 2001; 31:27- 29.
35. Mesako S, Kodama. T, Konishi K. Compactin and simvastatin, but not pravastatin, induce bone morphogenetic protein-2 in human osteosacoma cells. Biochern Biophys Res Commun 2000; 271:688-6
36. Wang PS, Solomon DH, Morgan H, Avorn J. HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patients. JAMA 2000; 283:3211-3216
37. Chuengsamarn S, Rattanamongkoulgul S, Suwanwalaikorn S, Wattanasirichaigoon S, Kaufman L. Effects of statins vs. non-statin lipid-lowering therapy on bone formation and bone mineral density biomarkers in patients with hyperlipidemia. Bone 2010;46:1011-1015
38. Maeda T, Matsunuma A, Kawane T, Horiuchi N: Simvastatin promotes osteoblast differentiation and mineralization in MC3T3-E1 cells. Biochem Biophys Res Commun 2001, 280: 874-877.
39. Bauer DC, Mundy GR, Jamal SA, Black DM, Cauley JA, Harris F, Duong T, Cummings SR: Statin use, bone mass and fracture: an analysis of two prospective studies. J Bone Min Res 1999, 14:1188
40. Edwards CJ, Hart DJ, Spector TD: Oral statins and increased bone-mineral density in postmenopausal women. Lancet 2000, 355:2218-2219.
41. Wang PS, Solomon DH, Mogun H, Avorn J: HMG-CoA reductase inhibitors and the risk of hip fractures in elderly patients. JAMA 2000, 283:3211-3216.24.
42. Meier CR, Schlienger RG, Kraenzlin ME, Schlegel B, Jick H: Statin drugs and the risk of fracture. JAMA 2000, 284:1921-1922,)
43. van Staa TP, Wegman SLJ, de Vries F, Leufkens HGM, Cooper C: Use of statins and risk of fractures [abstract 1067]. J BoneMin Res 2000, 15(suppl):s155.
44. Cauley JA, Jackson R, Pettinger M, Lacroix A, Bauer D, Chen Z, Daugherty S, Hsia J, Lewis CE, McGowan J, McNeeley SG, Passaro M: Statin use and bone mineral density (BMD) in older women: The Women’s Health Initiative Observational Study (WH I-OS) [abstract 1068]. J Bone Min Res 2000,15(suppl):s155.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareUNUSUAL ORIGIN OF UNILATERAL ARTERIAL TRUNK FROM RADIAL ARTERY-CASE REPORT
English8284K. SatheeshNaikEnglish S. LokanadhamEnglishDuring routine dissection we observed an unusual origin of an arterial trunk from radial artery in the right upper limb in a 55 year old male cadaver. The arterial trunk gives rise to common interosseous artery which intend dividing into anterior and posterior interosseous arteries. Bifurcation of brachial artery into radial and ulnar arteries in the cubital fossa found normal but there was no communication between radial and ulnar arteries in the palm. We also observed superficial course of ulnar artery underlying the skin and fascia with absence of branches. The branching patterns of radial and ulnar arteries on the left upper limb are found normal. Anomalies in the origin and course of principal arteries are having practical importance for the radiologists and vascular surgeons.
Englisharterial trunk, radial artery, unusual branchINTRODUCTION
Brachial artery is the major artery to supply the arm and given off radial and ulnar arteries 1cm below the bend of elbow or at the level of upper end of radius [1,2,].Radial artery passes along the lateral side of the forearm up to the wrist. The usual branch of radial artery in the proximal part of the forearm is radial recurrent artery. Distal to the radial tuberosity common interosseous artery a short branch, anterior and posterior ulnar recurrent arteries arise from ulnar artery in the lower part of cubitalfossa before passing deep to pronatorteres.The anterior ulnar recurrent artery originates immediately below the elbow-joint, runs upwards between the brachialis and pronator teres and in front of the medial epicondyle, anastomoses with the superior and inferior ulnar collateral arteries. The posterior ulnar recurrent artery arises somewhat at a lower level than the receding. It passes backwards and medial wards and ascends behind the medial epicondyle of the humerus and anastomoses with the superior and inferior ulnar collaterals and the interosseous recurrent arteries [3,4]. The common interosseous artery about 1 cm in length, originates immediately below the radial tuberosity, and passing backwards to the proximal border of the interosseous membrane and divides into two branches, anterior and posterior interosseous arteries.
MATERIAL AND METHODS
During undergraduate dissection in the department of Anatomy, Basaveshwara Medical College, Chitradurga, a 55 year male cadaver was dissected and exposed the arterial pattern of upper extremities bilaterally from the origin of the brachial artery to its termination into radial and ulnar arteries. In the fore arm we observed an anomalous arterial trunk arising from the radial artery unilaterally on the right side but on the left side all branches are normal. Arterial variations on the right side were recorded and photographed.
CASE STUDY
A 55 year male cadaver was dissected to study the arterial pattern of upper extremities bilaterally. We exposed the brachial artery from origin to its termination. The branches from the brachial artery in the arm were normal and bifurcated in to radial and ulnar arteries to supply the forearm and hand. After bifurcation the ulnar artery is passing superficially in the entire course of fore arm beneath the skin and fascia to enter the palm. The course of radial artery in forearm, we observed an unusual unilateral arterial trunk originating from radial artery (Figure -1). Unusual arterial trunk gives rise to common interosseous artery intend dividing into anterior and posterior interosseous arteries. But on the left side branching pattern of radial and ulnar arteries are normal.
DISCUSSION
Vascular anomalies in the upper limb are unilateral and occasionally bilateral [5,6]. The origin of anterior and posterior interosseous arteries arising from a common trunk or one or both ulnar recurrent branches have been arises from brachial artery reported in the literature [1,4].A.K. Bilodi has been reported that origin of common interosseous artery from radial artery in both right and left upper extremities [7]. Arterial variations in the upper limb are numerous and occur at the level of axillary, brachial, radial and ulnar arteries as well as in palmar arches [8,9]. In our study the unilateral course of unusual arterial trunk from radial artery continues as common interosseous artery and intends dividing into anterior and posterior interosseous arteries. The same case in other literatures stated as common interosseous artery originated from radial artery instead of ulnar artery and ulnar artery was quite superficial instead of passing deep course [10]. We also observed the superficial course of ulnar artery [11,12,13]. Mrudula et al stated radial origin of common interosseous artery as our case [14]. Superficial radial and ulnar arteries where in superficial radial artery gave origin to a common trunk which gave a median artery, muscular branches, artery replacing the anterior recurrent and common interosseous arteries [15]. Brachial artery dividing into radial and ulnar arteries with common interosseous artery arising from radial artery [16].Our case study reveals common interosseous artery was of radial origin as a common arterial trunk and ulnar artery was superficial in its course. It states that unilateral unusual arterial trunk from radial artery is rare but some of the literatures are in agreement with our study.
CONCLUSION
Anomalies in the origin and course of principal arteries are having practical importance for the radiologists and vascular surgeons. In our study arterial trunk originated unilaterally from radial artery is very rare incidence and it is continues in the forearm as common interosseous artery intend terminating in to anterior and posterior interosseous arteries. Accurate knowledge of the normal and variant arterial pattern of the human upper extremities is important for reparative surgery.
ACKNOWLEDGEMENT
Authors are thankful to Dr. G.Mahesh, Principal and Professor of Anatomy and special thanks to Sudha, Anatomy faculty, BMCH, Chitradurga, Karnataka.
Englishhttp://ijcrr.com/abstract.php?article_id=1417http://ijcrr.com/article_html.php?did=14171. Williams PL Bannister LG, Berry MM.Angiology .Gray’s Anatomy. 38th Ed, New York, Churchill L ivingstone.2000; 1544.
2. Datta AK Essentials of Human Anatomy, Superior and Inferior Extremities 2nd Ed, Calcutta, Current Books International.2000; 98 – 100.
3. Bergman, R.A., Thomson S.A. Afifi AK and Saadeh F A, Compendium of Human anatomicvariation, Catalog, Atlas and World Literature,Ba l t imor e ,Urban and Schwa r z enbe rg,1988,pp.75.
4. Schafer E.A., Thane G.D. Quain’s elements ofAnatomy, 10th Edition. vol.2, part II, Longman, Greece and Company, London. 1892, pp. 416.
5. Yucel A.H. Unilateral variation of the arterial pattern of the human upper extremity with amuscle variation of the hand. Acta Med Okayama.1999; 53 (2): 61-65.
6. Icten N, Sullu Y. Tuncer I..Variant high originradial artery: a bilateral case. Surg Radiol Anat1996; 18: 63-66.
7. Bilodi AK, Sanikop MB: 2004 Variations in termination of brachial artery-A case report. Katmandu Medical Journal, 2 (1): 49-51.
8. Rodriguez-Baeza, A. Nebot, J., Ferreira, B.,Reina, F, Perez, J., Sanudo, J.R. and Rolg, M.: An anatomical study and ontogenicexplanation of 23 cases with variations in themain pattern of the human brachio- antebrachial arteries.‘’Journal of Anatomy’’1995; 187: pp.473-479.
9. Coleman S.S. and Anson, B.J. 1961: Arterialpatterns in the hand based upon a study of 650specimens, Surgery Gynecology and Obstetrics.1961; 113 : 409-424.
10. Baral P, VijayabhaskarP et al.Multiple arterial anomalies in upperlimb.Katmandu university medical journal. 2009; vol .7;no.3;293-297.
11. Nakatani T, Tanaka S, Mizubami S et al. Thesuperfi cial ulnar artery originating from theaxillary artery. Anat Anz. 1996; 178: 277-9.
12. Iyer Praveen B. Superfi cial ulnar artery - a casereport. J Anat. Soc. 2005; 54: 48.
13. Weathersby HT. Unusual variation of the ulnarartery. Anat Rec. 1956; 124: 245-8.
14. Mrudula S, Bindu NH. Radial origin of common interosseous artery- a case report. J Anat. Soc, 2005; 54: 50.
15. Shenoy BM, D’Costa S, Narayana K. A case ofvariation of arterial pattern of the upper limb. JAnat. Soc. 2004; 53:41.
16. Udyavar A. Anomalous termination of the brachial artery. J Anat. Soc. 2004; 53:41.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcarePALATO-RADICULAR GROOVE - HIDDEN ROUTE TO DESTRUCTION - CASE REPORT
English8592Maheaswari RajendranEnglish Kiruthika SivasankarEnglishAim: To treat cases of palato-radicular groove associated with localised periodontitis using conservative and/or regenerative approach based on the depth and extent of the groove.
Objective: To utilise various regenerative approaches in the management of palato-radicular groove with associated periodontitis in order to enhance the regeneration of the lost periodontium.
Case description: Three cases of unilateral PRG with localised periodontitis involving the maxillary lateral incisor in 2 cases and central incisor in 1 case has been discussed. The article showcases the result of conservative and /or regenerative approach used in the management of these cases. Bone graft, platelet rich fibrin and guided tissue regeneration using resorbable membrane has been used in the treatment depending on morphology and depth of intrabony defect.
Conclusion: Thorough examination by the clinician helps in early detection of palato-radicular groove and prevents the loss of the periodontium. Palato-radicular groove associated with severe localised periodontitis can be successfully managed using various regenerative approaches.
EnglishPalato-radicular groove, localised periodontitis, guided tissue regeneration, platelet rich fibrin, bone graft.INTRODUCTION
Developmental anomalies of the maxillary incisors include deformations of crown and root, supernumerary teeth, calcifications of the pulp chamber etc. One such anomaly occurring in the maxillary incisors is Palato-radicular groove (PRG). These grooves are also known as palatogingival groove (1), radicular groove (2) etc. Palato-radicular groove is a developmental, anomalous groove usually found on the palatal aspect of maxillary incisors. (3) They are considered as an infolding of the enamel organ and epithelial sheath of Hertwig. (1) These grooves originate in the crown and terminate in different directions and distances along the root.(4) In a recent study by Albaricci et al 2008(5) reported prevalence of PRG as 11.1% in maxillary lateral incisors. Among them 62.8% of the grooves were proximally located; 57.8% originated form lingual fossa. Most of the grooves had an oblique and tortuous course on the root. PRGs serve as plaque retentive areas which lead to clinical attachment loss and pocket formation. Lee et al first reported the association between PRG and localized periodontitis. (1) Radiographically, the groove is seen as a radiolucent line simulating the root canal of the involved teeth hence is referred to as parapulpal line. (6) But this is not a consistent finding. Management of PRG depends on the depth and the extent of the groove, association with the pulp and presence of intrabony defect. Treating cases of PRG with localized periodontitis involves both the management of the groove and the associated pathology. This article presents a series of case reports successfully managed by different procedures involving periodontal and/or restorative approach.
CASE 1
A 21 year old female patient reported to the outpatient department, Department of Periodontics, with a chief complaint of spacing in the upper and lower anteriors. On routine examination an asymptomatic groove was noticed on the mid-palatal aspect of the right maxillary lateral incisor originating in the cingulum and extending apically on the root. On periodontal examination probing depth and clinical attachment level (CAL) of 6mm was present along the groove (Figure 1.1). On testing the vitality, the tooth was found to be vital. Intra-oral periapical radiograph revealed no evidence of parapulpal line or peri-apical pathology. Blood investigation revealed values in normal range. Phase I periodontal therapy consisting of Oral hygiene instructions, Scaling and root planing was performed. During re-evaluation, probing depth was persistent hence periodontal flap surgery was planned. Under LA, envelop flap was elevated on the palatal aspect and PRG was found to be deep in the cingulum and became shallow as it extended till the mid root level (Figure 1.2). After degranulation, the root portion of the groove was managed by saucerisation. Crown portion was restored with Glass Ionomer Cement (GCFuji I, Blackwell supplies, Essex) to normal contour and the flap was approximated and sutured (Figure 1.3). Post surgical instructions were given along with anti-microbial coverage. Patient was reviewed at one month interval for three months to facilitate and encourage oral hygiene maintenance during which no probing was performed. On periodontal examination after 7 months probing depth was reduced to 3mm (Figure 1.4).
CASE 2
A 32 yr old female patient reported to the department of Periodontics with complaint of mobility in relation to right maxillary lateral incisor. On examination, tooth exihibited grade II mobility with probing depth and clinical attachment level of 9mm both labially and palatally (Figure 2.1). A deep palato-radicular groove was present midpalatally extending along the root. Intra-oral periapical radiograph revealed vertical bone loss involving the apical third of the root and periapical pathology (Figure 2.2). The tooth was non-vital. The tooth was temporarily stabilized with braided stainless steel wire and flowable light cure composite for 6-8 weeks and root canal therapy was done. Non- surgical therapy was performed after routine investigations. On reevaluation after 2 months, mobility had reduced to grade I but the probing depth was persistent. Hence periodontal flap surgery was planned. Under LA, full thickness flap was elevated both labially and palatally with vertical releasing incision on the labial aspect. Deep groove was found extending from the cingulum to the apical third of the root. Intra-bony defect was found extending from palatal to labial aspect with dehiscence of the labial cortical plate(Figure 2.3, 2.4). Deep portion of the groove was sealed using GIC (GCFuji I). Demineralised bone matrix xenogeneic graft (Osseograft, Encoll, U. S. A) placed in the defect both labially and palatally (Figure 2.5). Platelet rich fibrin was placed labially covering the dehiscence and flaps were approximated (Figure 2.6). Antibiotics and analgesics were prescribed. Patient was reviewed periodically to examine the oral hygiene maintenance. After nine months the probing depth and CAL was 3mm and 4 mm respectively (Figure 2.7). Mobility was grade I. Post operative radiograph showed evidence of bone fill in the crestal region.
CASE 3
A 23 year old patient referred to the Department of Periodontics, with non vital, rotated and mobile left maxillary central incisor. On examination, mucosal fenestration was present on the labial gingiva with a palato-radicular groove extending along the mesio-palatal aspect of the root with grade II mobility. Probing depth was 10mm mesially and 9mm palatally; CAL was 11mm mesially and 9 mm palatally (Figure 3.1). Midline diastema and extrusion was present. Intra-oral periapical radiograph revealed root canal treated maxillary left central incisor with vertical bone loss on the mesial aspect extending till the apical third of the root (Figure 3.2). Non surgical therapy was performed after routine investigations. Probing depth was 7mm mesio-labially and 6mm palatally on review and surgery was planned. Under LA, muco-periosteal flap was elevated both labially and palatally. Shallow palatoradicular groove extended along the mesiopalatal aspect of the root which terminated in a combined intra-bony defect (Figure 3.3). Radiculoplasty was done with surgical diamond burs. Demineralised bone matrix xenograft was placed in the bony defect and covered with resorbable collagen membrane (Healiguide, Encoll, U. S. A). The membrane was adapted to the tooth using chromic catgut 5-0 suture material (Figure 3.4). Flap was approximated using 3-0 black silk suture material. Periodontal dressing was given with Coe-pack. Patient was reviewed periodically and the healing of the mucosal fenestration on the labial aspect was satisfactory. Nine months post surgery revealed probing depth and CAL of 2mm and 3mm respectively. The tooth was aesthetically corrected by ceramic crown (Figure 3.5). Evidence of bone fill was seen in the defect on the mesial aspect of the tooth radiographically after 9 months (Figure 3.6).
DISCUSSION
Palato-radicular groove (PRG) is a rare developmental anomaly of the maxillary incisor teeth. The association between PRG and localized periodontitis depends on the extent and depth of the groove on the root (1) . PRGs with localized periodontitis usually presents as a perio-endo lesion. These grooves with funnel shaped morphology serve as plaque retentive area and extend along the root. This leads to attachment loss and pulpal necrosis (1) . Channels may be present at the depth of the groove which acts as a passage for the bacterial toxins to gain entry into the pulp canal. (14) Hence most of the cases of PRG with localized periodontitis require endodontic treatment. PRGs may be symptomatic or asymptomatic. Grooves limited to the cingulum usually do not cause damage to the periodontium. Hence these grooves are asymptomatic and intensive treatment is not required. Deep grooves associated with intrabony defect require both periodontal and endodontic management. Parapulpal line observed radiographically is not a pathognomonic feature because these lines are most often obscured by the radiolucent root canal. None of our cases showed these lines radiographically. Recently computerized tomography (CT) has been used in determining the extent of the groove. CT shows the 3D image of the groove and also its proximity with the root canal. (8) Successful management of PRG with localized periodontitis involves two aspects: treating the groove and the resultant pathology (intrabony defects, if present) Prognosis of the tooth with PRG depends on the depth, location and termination on the root. (4) In case 1, the tooth with the groove was asymptomatic. The groove was detected only on routine examination. Crown portion of the groove was deep and was restored with GIC (Fuji I) to normal tooth contour. In case 2, PRG was deep and terminated in an intrabony defect palatally which extended to the labial aspect. Labial cortical plate dehiscence was present. The combination of restorative and surgical approach was done. Different restorative materials have been used in the past which includes amalgam (9), GIC (10, 11) , composite (11) and mineral trioxide aggregate. Glass Ionomer Cement (Fuji I) was used in all the cases due to its property of resistance to water degradation at the tooth – cement interface, sealing ability and good chemical bonding.(10.11) Moreover, studies have reported that during healing epithelial and connective tissue attachment occurs on the cement surface.(12) Various regenerative materials currently used to fill the intra bony defects are bone grafts, platelet rich plasma (13), and enamel matrix derivative (14). In this case, bone defect was filled with demineralised xenograft both labially and palatally. As this bone substitute is osteoconductive, Platelet rich Fibrin (PRF) was placed covering the labial dehiscence. Platelet rich Fibrin belongs to a new generation of platelet concentrate. It is an immune platelet concentrate collecting on a single fibrin membrane all the constituents of a blood sample (cytokines, growth factors etc) for favorable tissue healing. (15) In case 3, as the groove was shallow on the root, radiculoplasty was performed. The defect was a combined intrabony defect with two walled defect on the coronal aspect. Hence bone graft was placed with resorbable membrane covering the osseous defect. Guided tissue regeneration prevents epithelial cell migration and provides connective tissue attachment on the root surface. Hence it improves the clinical attachment gain and reduces the probing depth. (16)
CONCLUSION
Palato-radicular groove may be symptomatic or asymptomatic. Early detection through meticulous examination by the clinician is the pre-requisite in the management of PRG. Successful management and long term prognosis of treating cases of PRG depends on its extent and the associated loss of attachment. Hence, earlier this hidden route is detected; the better is the prognosis of the tooth.
Englishhttp://ijcrr.com/abstract.php?article_id=1418http://ijcrr.com/article_html.php?did=14181. Lee K.W, Lee E.C, Poon K.Y. Palatogingival grooves in maxillary incisors. A possible predisposing factor to localized periodontal disease. Br. Dent J 1968; 124: 14-18.
2. Pecora. J.D, Sousa Neto M.D, Santos T.C., Saquay P.L. In vitro study of the incidence of the radicular groove in maxillary incisors. Braz Dent J 1991; 2: 69-73. 3. Glossary of periodontal terms, edn.
3, Chicago: American Academy of Periodontology, 1992: 22
4. Kogan S.L, The prevalence, location and confirmation of palate-radicular grooves in maxillary incisors. J Periodontal 1986; 57: 231-234
5. Albaricci MF, de Toledo, Zuza EP, Gomes DA, Rossetti EP, Prevalence and features of Palato radicular grooves: An in vitro study . J Int Academy of Periodontology; 2008; 10: 2-5.
6. Everett F.G, and Kramer G.M. The Distolingual groove in the maxillary lateral incisor; a periodontal hazard. J Periodontal 1972; 43: 352-361.
7. Friedman S, Goultschin J. The radicular palatal groove. A therapeutic modality. Endod Dent Traumatol 1988; 4: 282-286.
8. Huumonen S, Kvist T, Grondahl K, Molander A Diagnostic value of computed tomography in re-treatment of root fillings in maxillary molars. Int Endo J 2006; 39: 827-833.
9. J. H, Glick D.H, and Frank A.L, Predictable endodontic and periodontal failures as a result of radicular anomalies. Oral Surg.1971; 31: 823-827.
10. Maldonado A, Swartz ML, Phillips RW. An in vitro study of certain properties of a glass ionomer cement. J Am DentAssoc 1978; 96: 785-791.
11. Vermeersch G, Leloup G, Delmee M, Vreven J Antibacterial activity of glassIonomer cements, compomers and resin composites: relationship between acidity and material setting phase. J Oral Rehabil 2005; 32: 368-374.
12. Dragoo MR. Resin Ionomer and Hybrid ionomer cements: Part II. Human clinical and histologic wound healing responses n specific periodontal lesions. International Journal of Periodontics and Restorative Dentistry 1997; 17: 75-87.
13. Elanchezhian S., Harikaran J, Boris Bhim. Platelet rich plasma in the management of palatogingival groove 2011; 1(2): 125-128.
14. Rethman MP. Treatment of palatogingival groove using enamel matrix derivative. Compend Contin Educ Dent. 2001; 22(9): 792.
15. Joseph Choukroun, Antoine Diss, Steve L. Dohan, Anthony J. J. Dohan, Jaafar Mouhyi et al. Platelet-rich Fibrin (PRF): A Second generation platelet concentrate. Part IV: Clinical effects on tissue healing. Oral Surg, Oral Med, Oral Pathol, Oral Radiol 2006; 101: E56-60.
16. Anderegg CR, Meltzer DG.: Treatment of the palato-gingival groove with guided tissue regeneration. Report of 10 cases. J Periodontol 1993 ; 64: 72-74.
LIST OF FIGURES
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareHETEROTOPIC PREGNANCY FOLLOWING IVF CARRIED TO TERM PREGNANCY: A CASE REPORT
English9396Salah Roshdy AhmedEnglish Hani A. AbdelhafezEnglish Khaled M.IbrahimEnglish Mohamed Alkhatim AlsammaniEnglishNaturally occurring hetetrotpoic pregnancy is exceedingly rare, but the incidence increases with the Introduction of assisted reproduction. Having delivery of a term baby is exceptionally rare. History, clinical examination and ultrasound without high index of clinical suspicion may be misleading. We report a case of a combined intrauterine and intraabdominal pregnancy, diagnosed at Cesarean section at 35 weeks gestations in a 38-year-old multiparous yielded healthy twin at term. Conclusion: Quantitative risks assessment in high risk group may reduce the physician diagnostic errors.
Englishheterotopic, pregnancy, abdominal, fertilization in vitro, pregnancy outcome, last trimesterINTRODUCTION
Since the introduction of assisted reproduction techniques (ARTs) and embryo transfer; heterotopic pregnancy (HTP) is becoming a serious obstetric problem. Recent reports have shown that the in the incidence of heterotopic pregnancy is significantly influenced by the introduction of ARTs. The estimated rate of HTP following spontaneous pregnancy is 1 in 3,800 pregnancies [1]. The rate was even much higher before the year 1948. The rate of heterotopic pregnancy in women with assisted reproduction is closer to 1 in 100 pregnancies [1]. HTP posed diagnostic difficulties even with current diagnostic images. In some cases even when the diagnosis is established, the management is difficult and life threatening. The imperfect obstetrics outcome resulted in increased litigation. In this study, we describe HTP in an asymptomatic patient who was misdiagnosed as intra-uterine twin pregnancy. The diagnosis of HTP was established at Cesarean section at 35 weeks gestation, and both twins were carried to term ended in birth of healthy twin.
CASE REPORT
A 38-year-old lady Gravida 3 Para 2 married for 18 years. Her first pregnancy was spontaneous, ended in unexplained intra-uterine fetal death at 28 weeks; the second was induced pregnancy by IVF after 7 years of secondary infertility ended in a term singleton pregnancy terminated by elective cesarean section at 38 weeks gestation. The index pregnancy followed IVF, after 9 years of secondary infertility done on April 29, 2011. There was no history of pelvic inflammatory disease. The medical history was uneventful. The patient was booked for regular obstetrics evaluation on 27 July 2011. Her initial investigations were as follows: Hb, 12.3g/dl; the total white blood count was within the normal range, and blood group, O positive. The urine analysis was normal. The renal and liver profiles and Blood sugar were normal. Real-time sonography demonstrated intra-uterine viable twin fetuses. Biometric assessment was consistent with a 12-week gestation, and the amniotic fluid volume was normal. A repeat sonogram on September 6, 2011, demonstrated a transverse fetal lie of the first twin and the second twin was presented by breech. The estimated gestational ages were 33 and 30 weeks respectively. The estimated fetuses' weights were 1.578 and 1.253kg respectively. The amniotic fluid volume was normal; the placenta was fundal, and there were no fetuses abnormality detected. The patient did not reveal any complaints. She was admitted on December 24, 2011 at 5 P.M. in labor with a 2-hours history of vaginal discharge. On physical examination, pulse was 90 beats per min, BP was 120/85 mmHg, temperature was 37. C°, respiratory rate was 18 per min, and the body mass index was 27. The obstetric examination revealed a distended abdomen, a fundal height consistent with 38 weeks gestations, multiple fetal parts. The fetuses lie was difficult to determine. On vaginal examination, the cervix was soft, 3 cm dilated, effaced, and the membranes were ruptured. The fetal breech was not engaged, and there was a watery, nonmalodorous vaginal discharge. Emergency Caesarean section was decided on accounted of twin gestation, first beech and a prior cesarean section. At Caesarean section, the uterus was opened through a lower transverse incision. The first twin was delivered by breech extraction. Strikingly, the co-twin was not found in the uterine cavity. Huge, intact, intra-abdominal sac was found, and it was obviously containing the second twin. We incised the sac and a healthy baby was delivered. The first twin was a boy weighing 2.1 kg, cried immediately, with Apgar scores of 8 and 9 in 1 and 5 minutes respectively. The second twin was a female baby weighing 1.8 kg, cried immediately with Apgar scores of 8 and 9 at 1 and 5 minutes respectively. The placenta was morbidly attached to the posterior abdominal and uterine wall and partially to the small bowel (Fig. 1). The cord was ligated with absorbable suture, and the placenta was left in situ (Fig. 2). There was intra-operative oozing from the placental site which necessitated intra-abdominal packing for48 hours. Following this, the patient did well, and she was hemo-dynamically stable. She was transferred to the Intensive care unit, for close observation and follow-up. She had uneventful post-operative recovery. The postoperative treatment included, 4 units of packed RBCs, 2 units of fresh frozen plasma, and intravenous gentamicin (80 mg twice per day), ceftriaxone (1 g twice per day for 5 days), and metronidazole infusion (500mg every 8 hours for 5 days). On the 5th day postoperatively, the patient developed wound dehiscence. Swab culture yielded Acinetobacter baumannii. We continued on antibiotics and daily dressing. On the 8th day post-operatively she was discharged home in good condition. This case was approved by the hospital Ethical Committee.
DISCUSSION
Take home babies in heterotopic without associated fetal or maternal complications is exceedingly rare. In 1983, there were only 13 cases in 589 reports from the world literature where this problem was described 3. Recently, a 30-years review from 1976 to 2006 showed that there were 20 cases out of 58,000 deliveries, for incidence of 0.34 per 1000 deliveries [2]. These reports indicated the scarcity of this condition, resulting in the physician underestimation, and lack of the correct diagnosis at the time of presentation is most reported cases, including the former case. Our case illustrates uneventful a heterotopic pregnancy following an IVF. She had benign obstetric history throughout her pregnancy. In several previous reports, the diagnosis of term abdominal pregnancy was always made late. The majority of cases were diagnosed when the condition of the patient necessitated intervention, e.g. cesarean section or induction of labor. In many cases, the diagnosis of HTP is suspected when the patient presents with abdominal pain following assisted reproduction. Our patient had several risks for extrauterine pregnancy, which include prolonged subfertility, pelvic surgery, IVF and multifetal gestation, but she had no symptoms suggestive of heterotopic pregnancy, especially lower abdominal pain which is the main complaints. Our patient had repeated scan which did not yield any sign suggestive of extrauterine pregnancy. Pre-natal diagnosis of intra-abdominal pregnancy by ultrasound is disappointing; however, it's diagnostic error is as high as 50-90% [3]. Therefore, to diagnose heterotopic pregnancy a high index of clinical awareness is needed. The high rate of diagnostic error reported in many cases, in part due to the fact that almost half of cases of heterotopic pregnancies are asymptomatic; and physicians' usually respond to diseases when symptoms appeared. In such situation, risk assessment will be valuable in reducing our diagnostic errors. The reportedly, high maternal and fetal mortality was related to delayed diagnosis make it becoming necessary to introduce MRI in the evaluation of high risk patients. We recommend that any patients who have had IVF should be offered medical imaging to exclude extrauterine pregnancy especially for those with multifetal gestation. In the current case, the placenta was found to be adherent to the posterior uterine wall and to part of the small bowel, in the majority of the reports the placenta was left in situ. Blood oozing arise from placenta site can be effectively treated with intra-abdominal packing. Our patient developed wound dehiscence and swab culture yielded Acinetobacter baumannii which is an opportunistic infection, but otherwise did well.
CONCLUSION
Heterotopic pregnancy is a rare clinical condition. The diagnosis is difficult especially in asymptomatic patients that constituted almost half of the cases. Quantitative risk assessment may reduce our diagnostic errors. The condition should be suspected in any patient underwent in vitro fertilization with multifetal gestation. We recommend that such patients should be offered an initial medical imaging to exclude heterotopic pregnancy and the radiologist should be notifying for the possibility of HTP. Conflict of interest: We declare no conflicts of interest.
ACKNOWLEDGEMENT
Authors acknowledge the exceptional 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=1419http://ijcrr.com/article_html.php?did=14191. Habana A, Dokras A, Giraldo JL, Jones EE. Cornual heterotopic pregnancy: contemporary management options. Am J Obstet Gynecol. 2000 May; 182(5):1264-70.
2. Reece EA, Petrie RH, Sirmans MF, Finster M, Todd WD. Combined intrauterine and extrauterine gestations: a review. Am J Obstet Gynecol. 1983 Jun 1; 146(3):323-30.
3. Cohen JM, Weinreb JC, Lowe TW, Brown C. MR imaging of a viable full-term abdominal pregnancy. AJR Am J Roentgenol. 1985 Aug; 145(2):407-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareSINONASAL TERATOCARCINOSARCOMA : A RARE NEOPLASM
English97102Nikunj V. MehtaEnglish Sanjay V. DhotreEnglish R.N.GonsaiEnglish Tarang B. KadamEnglish Kalpana K. DaveEnglish Seema K. ModhEnglishBackground: Sino-nasal teratocarcinosarcoma (SNTCS) is rare and unfamiliar entity with grave prognosis. It was first described by Shanmugaratnam et al. in 1983 and was aptly termed as “Teratocarcinosarcoma” by Hefner and Hyams in 1984. As the name suggests, it is composed of benign and malignant epithelial components as well as mesenchymal and neural components Because of its rarity, these lesions are often misdiagnosed as immature teratoma or carcinosarcoma may lead to management difficulties. Objective: The objective is to make pathologists aware with this rare entity and always consider it as differential diagnosis of teratoma and carcinosarcoma which are more common lesions in this location / region. Research Methodology: We report a 30 years old female with SNTCS involving right nasal cavity extending into nasopharynx, maxillary, ethmoid, sphenoid and frontal sinuses. She presented with complains of the nasal blockage, difficulty in breathing and bleeding from right nose since 1 month. Excision biopsy was done. Result: Multiple sections have been taken and final diagnosis of Sino-nasal teratocarcinosarcoma was made.
EnglishSino-nasal teratocarcinosarcoma, Malignant.INTRODUCTION
Sino-nasal teratocarcinosarcoma (SNTCS) is a very rare malignant neoplasm characterized by combined features of immature or malignant teratoma and carcinosarcoma [1,2] . They were previously reported as teratoid carcinoma, malignant teratoma, blastomatous tumours, and blastoma. SNTCS is highly malignant tumour with rapid aggressive growth. Prognosis is poor [1,2]. It was first described by Shanmugaratnam et al. in 1983 and was aptly termed as “Teratocarcinosarcoma” by Hefner and Hyams in 1984. [3,4] . The most common clinical presentation is nasal obstruction and epistaxis.[5,6] It is more common in male with male to female ratio of 7:1[7] . Mean survival time was about 1.7 years after diagnosis with 60% mortality within 3 years[8] . Metastasis is rare and may involve spinal axis, cervical lymph nodes, and respiratory tract [6] .
CASE REPORT
A 30-year-old female presented with nasal obstruction, difficulty in breathing and bleeding from nose since one month. Her hemoglobin level was 13.0 gm/dl at the time of presentation. Other routine hematological and biochemical investigations were normal.
A computed tomography (CT) PNS scan
revealed polypoidal soft tissue mass involving right nasal cavity extending into posterior part of nasal cavity and nasopharynx and into right maxillary sinus with erosion of medial wall of right maxillary sinus ( Fig. I ). A polypoidal mucosal thickening is seen in right maxillary, ethmoid, sphenoid, frontal sinus. Right spheno-ethmoidal recess and fronto-ethmoidal recess appears blocked. Left spheno-ethmoidal recess and fronto-ethmoidal recess appears normal. The mass was in the posterior nasal cavity and nasopharyngeal wall extending into right ethmoidal sinus. The patient was operated with laryngoscopic excision procedure.
HISTOPATHOLOGICAL EXAMINATION
Grossly Single gray–white irregular nodular soft tissue structure measuring 3.5×3×1 cm3 . Cut surface is White with heterogenous consistency
Microscopically:- Sections show tumour tissue consist of cellular, heterogenic tissue elements embedded in proliferative fibrocollagenous stroma. There is presence of primitive looking blastema like hyperchromatic mitotically active densely cellular areas (Fig. IV). There are also definite glandular differentiations with presence of primitive looking glands (Fig. III). Chondromyxoid nodular areas, areas of osseous metaplasia, primitive osteoid tissue lined by pleomorphic tumour cells-tumour osteoid tissue and neuroglial tissue are also seen (Fig. II, V). The stroma between heterologous elements is highly cellular, running in fascicles and mitotically active.
DISCUSSION
Malignant tumours having teratoma and carcinoma were reported previously as teratoid carcinoma, malignant teratoma, or blastematous tumours [9] Heffner and Hyams in 1984 first suggested the tumour to be called as teratocarcinosarcoma in order to describe the complex histological pattern of these neoplasms [4] . The most common clinical presentation for sinonasal teratocarcinoma is nasal obstruction and epistaxis with the average duration of symptoms being reported at 3.5 months[5,6] .Overall, there is a strong male predominance with male to female ratio is 7:1 [7] . Mean survival for this neoplasm has been reported at 1.7 years with a 60% mortality rate within 3 years[8] . Diagnosis of SNTCS can prove to be difficult if only a small incisional biopsy is taken because of the heterogeneity and variegated histological architecture[6] Small sample sizes can underestimate the true histology of this neoplasm and lead to a misdiagnosis such as malignant craniopharyngioma, adenocarcinoma, synovial sarcoma[10] . Histologically, it is different from true carcinosarcoma which consists of a single malignant epithelial and a single malignant mesenchymal component, whereas SNTCS has one or many epithelial and mesenchymal components (both benign and malignant)[11] Variegated architecture and tissue heterogeneity are characteristics of this malignant neoplasm. The malignant epithelial component includes squamous cell carcinoma and adenocarcinoma. “Fetal-type” clear cells, squamous epithelium, and immature neuroepithelium represent important histologic characteristics useful in diagnosis[3,17] . These highly malignant tumours initially present with relatively benign complaints of recurrent epistaxis (53.52% of cases) and nasal obstruction (61.97% of cases). Other manifestations raising suspicions of malignancy, such as odynophagia, dysphagia, expectoration of tissue, epiphora, headache,vision loss, exophthalmos, anosmia and altered mental status arise when the tumour invades surrounding tissues and the severity if related to the degree of tumour extension[12] . The present case had characteristic features of SNTCS including epithelial and mesenchymal elements. Despite several studies, the histogenesis of this tumour remains controversial. Hefner and Hyams postulated that the tumour originates from olfactory membrane due to presence of neural tissue. Some authors believe that SNTCS probably originates from primitive embryonic tissue or immature pleuripotential cells[13] A histogenetic origin from a multipotential adult somatic stem cell with divergent differentiation has been favored over a germ cell origin. This assumption has been based on the lack of germ cell elements and, until recently, the absence of demonstrable amplification of 12p in tumour cells[14] Ultrastructurally, the primitive cells had many neural processes with parallel microtubules. Tumour cells showing squamous cell differentiation were characterized by desmosome-like junction and intracellular tonoflaments. Some of the stromal spindle cells had actin filaments with dense patches and dense core granules[15] In a study by Budrukkar et al., disease recurred in 11 out of 14 patients, with a median time to recurrence of seven months. Multimodality treatment, in the form of a combination of surgery, radiation therapy, and chemotherapy, appears to be the optimal approach [16] A combination of radiotherapy and surgical treatment offers the best five-year survival rate (50%); followed by only surgical treatment (47%). In the recurrent or metastasis lesion, adjuvant chemotherapy may improve the survival rate since the metastatic tissue often contains sarcomata components. Currently no management guidelines are available regarding the disease and most of the literature focus on the histopathological findings. The high rate of recurrence is suggestive of the aggressive biological nature of the disease and although the prognosis does not appear encouraging aggressive surgery followed by chemo-radiation appears to be the mainstay of management for this condition.
Conflict of interest: Authors have declared no conflict of interest.
Englishhttp://ijcrr.com/abstract.php?article_id=1420http://ijcrr.com/article_html.php?did=14201. Chao KK, Eng TY, Barnes J, Dahlia R. Sino nasal teratocarcinosarcoma. Am J Oncol 2004;27:29-32.
2. Ogawa T, Ikeda K, Watanabe M, Satake M, Oshima T, Suzuki N, et al. A case report of sinonasal teratocarcinosarcoma. Tohoku J Exp Med 2000;190:51-9.
3. Shanmugaratnam K, Kunaratnam N, Chia KB, Chiang GS, Sinniah R. Teratoid carcinosarcoma of the paranasal sinuses . Pathology 1983;15:413-9.
4. Heffner DK, Hyams VJ. Teratocarcinosarcoma (malignant teratoma?) of the nasal cavity and paranasal sinuses. A clinicipathological study of 20 cases. Cancer 1984;53:2140-54.
5. Salem F, Rosenblum M K, Jhanwar S C, Kancherla P, Ghossein R A, Carlson D L. Teratocarcinosarcoma of the nasal cavity and paranasal sinuses: report of 3 cases with assessment for chromosome 12p status. Hum Pathol. 2008;39(4):605–609.
6. Wellman M, Kerr P D, Battistuzzi S, Cristante L. Paranasal sinus teratocarcinosarcoma with intradural extension. J Otolaryngol/ 2002, 31(3):173- 176.
7. Wei S, Carroll W, Lazenby A, Bell W, Lopez R, Said-Al-Naief N. Sinonasal teratocarcinosarcoma: report of a case with review of literature and treatment outcome. Ann Diagn Pathol.2008;12(6):415–425.
8. Carrizo F, Pineda-Daboin K, Neto A G, Luna M A. Pharyngeal teratocarcinosarcoma: review of the literature and report of two cases. Ann Diagn Pathol. 2006;10(6):339–342.
9. Patchefsky A, Sundmaker W, Marden PA. Malignant teratoma of the ethmoidal sinus. Cancer 1968;21:714-21.
10. Szudek J, Bullock M, Taylor S M. Sinonasal teratocarcinosarcoma involving the cavernous sinus. J Otolaryngol. 2005; 34(4):286–288.
11. Shindo ML, Stanley RB, Kiyabu MT. Carcinosarcoma of the nasal cavity andparanasal sinuses. Head Neck 1990; 12:516- 9.
12. Smith SL, Hessel AC, Luna MA, Malpica A, Rosenthal DI, El-Naggar AK.Sinonasal teratocarcinosarcoma of the head and neck: a report of 10 patients treated at a single institution and comparison with reported series. Arch Otolaryngol Head Neck Surg 2008; 134: 592-5.
13. Su YY, Friedman M, Huang CC, Wilson M, Lin HC. Sinonasal teratocarconosarcoma. Am J Otolaryngol 2010;31:300-3.
14. Thomas J, Adegboyega P, Iloabachie K, Mooring JW, Lian T. Sinonasal teratocarcinosarcoma with yolk sac elements: a neoplasm of somatic or germ cell origin? Ann Diagn Pathol 2011;15:135- 9
15. Shimazaki H, Aida S, Tamai S, Miyazawa T, Nakanobou M. Sinonasal teratocarcinosarcoma: ultrastructural and immunohistochemical evidence of neuroectodermal origin. Ultrastruct Pathol 2000;24:115-22.
16. Budrukkar A, Agarwal JP, Kane S, Siddha M, Laskar SG, Pai P, et al. Management and clinical outcome of sinonasal teratocarcinosarcoma: single institution experience. J Laryngol Otol 2010;124:739- 43.
17. Wang SY, Zhu L, Li SM, Lin L, Zheng SX, Wu YF, et al. Sinonasal teratocarcinosarcoma : a clinical, radiologic and pathologiac study of 5 cases. Zhonghua Bing Li Xue Za Zhi 2007;36:534-8.
Figure I :- CT Scan of paranasal sinus axial, coronal, bony window and sagittal views showing soft tissue density mass lesion involving right ethmoid sinus extending up to posterior part of nasal cavity and causes erosion of medial wall of right maxillary sinus.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareSEXUAL BEHAVIORS AMONG HIV PATIENTS ATTENDING ART CENTRE, TERTIARY CARE HOSPITAL, KARNATAKA, INDIA
English103113Ramesh K.English Sangeetha GandhiEnglish Vishwas RaoEnglishIntroduction: AIDS is a pandemic now. It has multiple risk factors and of all the risk factors, sexual behaviour acts as a double edged sword. On one hand, the risk of HIV acquisition is known to be closely associated with unprotected sexual intercourse and on the other, diagnosis of AIDS is shown to have a paramount importance on the sexual behaviour of the person. Research shows that there are HIV infected people who do engage in unprotected sex, just as there are HIV negative people or people with unknown serostatus who do so. Sex is an integral part of one’s living. As we extend our vision to the effects of sexual behaviour following diagnosis of AIDS from conventional view of sexual behaviour as a risk factor, other curious questions take wings. How exactly does diagnosis of AIDS have its influence on sexual behaviour of the diseased? Does the diagnosis of HIV positive help in reducing the risky sexual behaviour or do people still opt to continue the same way? In this study we have tried to discover answers to some of these questions. Materials and Methods: A case-series study was conducted among HIV positive patients coming to the ART centre for seeking treatment at ART Centre,Vijayanagara Institute of Medical Sciences Bellary, Karnataka from Novmber 2011 to April 2012. The sample size of the study is 400 and non probability sampling technique was used. Permission from respective authorities and written consent from study participants was obtained. Data was collected using a pre tested semi structured questionnaire. Data was analyzed using SPSS 15.0 and McNemar test was used to compare qualitative variables before and after diagnosis of AIDS. Results: The study subjects included both males (54%) and females (46%). The educational status is less than primary schooling in 88% of study subjects and 90% are married. Among patients, 48% were diagnosed on routine blood investigation and 40% on voluntary. There is no much difference in use of contraceptives before (16%) and after (18%) diagnosis but there is a significant difference in Condom use (before- 20% and after-37%). Sex with multiple partners was found in 34% of patients before diagnosis but it reduced to 13% after the diagnosis. There is no change in alcoholic behaviour. Even after diagnosis, 33% patients continued have unprotected sex with their partners and 25% of patients lost interest in sex after diagnosis. Conclusion: Even after the diagnosis, many sexual risk behaviours remain unchanged among HIV positive patients.
EnglishHiv, ART, Mode of transmissionINTRODUCTION
India has an estimated 2.4 million people living with HIV1 . The HIV epidemic is highly heterogeneous, and the majority of HIV infections occur through heterosexual transmission, with unprotected sex, particularly in the southern states2 . There is little published evidence demonstrating the efficacy of female sex worker (FSW) preventive interventions, either in India3,4 or elsewhere5 .Nowadays, interventions to stem the spread of the Human immunodeficiency virus (HIV) throughout the world are as varied as the contexts in which we find them. HIV epidemic dynamic can be curtailed by not only preventive and treatment options, but also by in depth study of sexual Behavior. This pattern of sexual behavior is widely diverse and influenced by society, culture, custom and tradition. Understanding these factors influencing sexual behavior plays vital role in formulating strategies to combat HIV spread. The predominant mode of HIV infection throughout SouthAfrica is unprotected heterosexual intercourse6 . Prevention programs that target secondary transmission between those known to be HIV positive and their sexual partner have recently gained favor7 but are still underdeveloped in general epidemic setting8,9,10 . Better understanding of patterns of sexual behavior among individuals who know their HIV status remains centered to these efforts11 . Knowledge about unsafe sexual behavior of HIV infected individuals is therefore, crucial for development of specific intervention to reduce sexual transmission12. Progress to promote safer sexual behavior is effective and should be widely disseminated. Here we present the findings of behavior changes of HIV positive patients. This provides insights into the potential prevention benefits in future.
METHODOLOGY
A descriptive case series study was conducted among HIV positive patients coming to the ART centre for seeking treatment at ART Centre, a tertiary care hospital, Bellary, Karnataka from November 2011 to April 2012. Totally 10,000 patients have registered and among them 5000 patients were on treatment at ART centre. Hence the sampling frame included those patients who were on treatment. Totally 400 patients were included for the study. These 400 patients were selected based on non probability purposive sampling technique. Data was collected using a semi structured questionnaire which contained information regarding socio demographic details and behavior. Written informed consent was taken and by interviewing patients, data was collected. After the data collection, health education was given to study subjects on Prevention and treatment of HIV. This study excluded those Patients who were seriously ill and who did not give consent. Data was entered in Microsoft excel and analyzed in SPSS 15. The statistical tests used were Proportion, Mean, Standard deviation, Mcnemar test and Wilcoxon sign rank test.
RESULTS
Out of the 400 subjects in our study 216 were males (54%) and 184 were females (46%). Out of the 216 male subjects, 40% of them were between the age of 30-39 yrs, 29.6% were in the age group of 40 – 49 years, 22.2% were between the age group of 20-29, 5.6% were between age group 50-59 and only 1.9%. Among the female subjects, unlike the male subjects in whom majority were in age group 30-39 years of age, majority were in between the age groups of 20- 29 years. Out of the 184 female subjects, 43.5% were in between the age group of 20-29 yrs. 37% were in the age group of 30-39 years, and 19.6% were in between the age group of 40-49 yrs.
Education
Out the 400 subjects taken for our study, 45% of them were illiterates, 43% had just primary education, 9% subjects had high school education and only 2% of them had completed their education till pre university level (Fig.1).
Occupation
In our study about half of the study subjects were unskilled workers primarily daily wage workers followed by semi skilled and skilled workers who formed 22% and 19% respectively;49 % were unskilled; 7% were professionals (Fig.1).
Marital status
Marital status of the patient was known to generally access the sexual behavior among the subjects. Those who are unmarried are assumed to have Pre marital sex whereas those who are married are assumed to either have sex with either their wives or indulge in extra marital sex. In our study it was found that only 10% of the HIV positive subjects are unmarried (Fig.1).
Income
Poverty is root cause of all the evil in India including the high rates of HIV. Among our study subjects 62% of them earned an income of about 3000-6000Rs per month.17% of them earned an income less than 3000 Rs per month; 21% of them earned an income of more than 6000 Rs per month (Fig.1).
Homosexuality
Homosexuality is the major mode of transmission of HIV in Western countries but in India the major mode of sexual transmission is among heterosexuals. This was also confirmed in our study in which 87% of the study subjects were ignorant to the concept of Homosexuality and did not know what it was. (Fig.2)
Mode of transmission
Poverty and Illiteracy are both very high in India. This has led to ignorance and lack of knowledge among the people in Indian society towards the mode of spread and prevention of HIV, It was seen that about half of our study subjects (50%) got to know about the mode of spread of infection only after their diagnosis and 8% did not know the mode of transmission even after diagnosis. (Fig.2)
Sex with HIV negative spouse
In our study we tried to find out the change in the sexual behavior among subjects whose spouse were not affected with HIV (n=215) and it was found that majority of the people, 56% of study subjects have stopped having sexual intercourse completely whereas 18% of study subjects seek external partner for sex and whereas 26% of the subjects continue to have sex with their spouses. (Fig.2)
Sex with HIV positive spouse
In our study we also tried to find the Sexual behavior among study subjects whose spouse were affected with HIV(n=185) and it was found that half of the study subjects had no change in sexual behavior and continued to have sex with their partners whereas the other half stopped having sex with their infected partner. (Fig.2) Among our study subjects, 99% of the subjects confessed they had indulged in a sexual intercourse at least once. (Fig.3)
Sex before marriage
In our study out of the 396 study subjects who had intercourse at least once, 110(27.7%) of them had sexual intercourse before marriage. And among those who had sex before marriage, 84% of them had intercourse out of their own interest whereas sizeable number of the study subjects (16%) was forced (Fig.3).
Age at first act of sex
Among 396 study subjects who confessed that they had indulged in a sexual intercourse at least once, 82% of the subjects had first act of sexual intercourse between 16 to 25 years age group; 14% had below age of 15 years and 3% had above age of 25 years (Fig.3).
First time sex with
In our study, Out of the 396 study subjects, 62% of the study subjects had their first sexual encounter with their spouse. Sizeable numbers of the study subjects have had their first sexual encounter with a Commercial Sex Worker (19%) and the rest with either friend or relative. (Fig.3) We next asked the participants of our study regarding the various sexual behaviors they might have participated in and if they do so after diagnosis.
Frequency of sex
When asked about frequency of sex of the patient in the 6 months before diagnosis , nearly half (43% of the study population) of the respondents reported a frequency of 3 times a week, 24% of the respondents reported about 1- 3 times a week with none reporting abstinence from sex. In comparison, 43% reported abstinence from coitus and 17% respondents reported having sex 1-3 times a week for the past 6 months after diagnosis. There is a significant decrease in the frequency of sex after diagnosis of HIV. (Table.no.2)
Use of condoms
When we asked the respondents about their condom use in the 6 months before diagnosis an overwhelmingly large number of study subjects (80%) reported not using condom before coitus and only 20% of study subjects reported using condoms. In comparison, 37% reported using condoms in the 6 months after diagnosis and 63% respondents did not use condoms in the 6 months after diagnosis. There is a significant increase in the condom use among the HIV patients in the 6 months after diagnosis according to. (Table.no.2)
Sex with multiple partners and frequency
We then enquired with the study subjects if they engaged in sexual activity with multiple sexual partners (MSP) and if yes, what was the frequency of sexual activity with multiple sexual partners. Of the 396 study subjects 135(34%) subjects told that they did engage in sex with multiple sexual partners in the 6 months before diagnosis of HIV. Out of the 135 subjects who engaged in sex with MSP, 66% had sex with more than 10 partners, 11% with about 6-10 partners in the 6 months before diagnosis. In comparison, after diagnosis of HIV, out of the same 396 study subjects only 13% told that they did engage in sexual activity. (Table.no.2)
Alcohol consumption
We asked our study subjects about their alcohol consumption and regarding the High risk practice of sex under the influence alcohol. Out of the study subjects who consumed alcohol, 42% of the subjects reported having sex under the influence of alcohol. This value reduced after diagnosis, when only 18% of subjects reported having sex under the influence of alcohol. (Table.no.2)
Outlook on sex
The final finding of our report is the gross change in the perception and attitude of the subjects towards sex. Before the diagnosis of HIV, 90% of the subjects approached sex with excitement only 10% reporting approach to sex with fear and guilt. This outlook has drastically changed post diagnosis where only 68% of subjects approached sex with excitement. While 16% associated fear with sex, and the other 12% of subjects associated sex with guilt. (Table.no.2) So change in sexual behavior related to frequency of sex, use of condoms, sex with multiple partners, sex under the influence of alcohol, and outlook on sex were found statistically significant before and after the diagnosis.
DISCUSSION
In our study out of the 400 subjects, 54% were male subjects and 46% were female subjects. On a total, high proportion of subjects fell between age group 30-39 years. Similar findings were observed in a study conducted in India in which 41% were female subjects and 59% were male subjects; majority of them fell between age groups 30-34 years13. In another study as well maximum subjects fell between age group 35-49 years14 . Illiteracy is one of the major reasons for the rampant increase in the number of HIV positive cases. Out of the 400 subjects taken for our study, 45% of them were illiterates. Compared to the similar study done, 30% were illiterate; 24% had a primary education; 36% had a high school education and 10% had a higher education; whereas in our study there were significantly more number of illiterates and less number of subjects with pre-university education13 .
Compared to another similar study done in south India, 25% were illiterate; 50% were educated till high school; 25% were educated up to predegree, but in our study there were significantly more number of illiterates and less number of subjects with high school and pre-university education15. In our study, about half of the study subjects were unskilled workers primarily daily wage workers followed by semi skilled and skilled workers. Compared to a study in INDIA, 19% were unemployed; 81% were employed13 . Compared to another study done in Goa, 66.3% were employed, 15.7% were unemployed and 18% are students16. Whereas in our study, we have a larger unemployed population. Poverty is root cause of all the evil in India including the high rates of HIV. In this study, a maximum number of study subjects earned an income of about 3000-6000 rupees per month (62%). Compared to a similar study, 15% are poorest; 15% were poorer; 3% were middle class; 32% were rich; 15% were richest13; whereas in our study 17% have a very low income and there is no question about rich or richest in our study. Compared to other study, 16% had a low standard of living index; 32% had a medium standard of living indexand 52% had a high standard of living index17 . Marital status of the patient was known to generally access the sexual behavior among the subjects. In our study, it was found that only 10%of the HIV positive subjects are unmarried therefore it can be assumed that the pre marital sex leading to HIV is quite low. Compared to a study done in Chennai 55% are married; 35% were single; 7% were separated; 2% were divorced18. Whereas in our study a significant large number of them are married. In India, the major mode of sexual transmission is among heterosexuals. But when asked about homosexuality, 87% of the study subjects were ignorant to the concept of Homosexuality and did not know what it was. The finding is similar to a study by moni nag19 . It was seen that about half of our study subjects got to know about the mode of spread of infection only after their diagnosis and some did not know the mode of transmission even after diagnosis. Compared to a similar study by Coates TJ et al20, 40% men andwomen knew the exact mode of transmission of HIV, the findings match with our study. Compared to a similar study done in pune21 , Nearly one-third of the men had never heard of AIDS at their screening visit, and less than 25% were able to correctly answer more than nine out of 12 questions on modes of HIV transmission.the findings match with our study. Compared to a study done in uganda22, 9% of male study subjects had unprotected sex with negative partner (forced) and 5% of female study subjects had unprotected sex with negative partner (forced).whereas in our study there were significantly large number who forced their partner. Compared to a similar study23 in India, 89% male subjects were HIV positive andforced their wife for intercourse and 19% female subjects were HIV positive andforced their husband for intercourse. Whereas in our study the number is not that high, the majority stopped sexual intercourse. Among our study subjects, 99% of the study subjects confessed they had indulged in a sexual intercourse at least once. . Late adolescent age group is at threat age group; teenage pregnancies are slowly rising as well. Out of 495 subjects, 14% of the subjects had first act of sexual intercourse before 15 years of age. Compared to a similar study 20, about 12% of study subjects had sexual intercourse before 15 years of age, the findings match with our study. The major Sexual changes are brought about in between the husband and wife depending on the sero status individually. These changes may be attributable to the emotional turmoil in a person infected with HIV or may be due to apprehension of the person towards sex or due to fear of infecting their HIV negative spouse.
These changes have both desirable and undesirable effect. For example, a HIV positive individual may refrain from having sex with his wife due to fear of transmitting infection to her , which is a desirable effect but in turn might visit Commercial sex worker (CSW) and create a nidus for further spread of infection. Hence it is imperative to understand the change in sexual behaviour between husband and wife after diagnosis of HIV. In our study we found that 56% abstained from sex with sero negative spouse which is a healthy finding but 26% approached CSW. This shows the importance of counseling of the sero positive patient regarding his or her moral obligation to his/her spouse and social obligation to the society. These steps to ensure decreased transmission are even more important in the first 6 months of diagnosis of HIV as even temporary reduction in high risk sexual activity has shown to help curtail the spread of HIV within highly active sexual networks, given that per-act probability of transmission of infection is high at this stage of disease. In case of infected individual with sero positive spouse, it is safe practice to have a sexual intercourse. But in our study we found that about half the individuals refrained from sex with sero positive spouse. Almost similar results were found in the study conducted in California24. We also found that the frequency with which the sero positive study subjects had sex also had considerable decrease with increase in the number of individual who abstained frome sex. These changes may be due to apprehension of the person towards sex or due to emotional upheaval caused by diagnosis of HIV. It has been established in other studies that women face more emotional and sexual disturbances25 and men report greater sexual satisfaction and decreased sexual difficulties after diagnosis of HIV26. It has also been reported that HAART has been associated with decrease in libido in men due to increased libido.Government and NGO,s need to address this aspect of a sero positive individual to ensure HIV person leads a happy and healthy life. The biggest risk factor for contracting HIV infection and Spreading HIV infection is sexual contact with multiple sexual partners. This trend is seen in young adults and adults alike. One of the major sexual behaviors causing this trend is Pre marital sex and post marital multiple sex partners (MSP). Unlike even a decade ago, pre marital sex is increasing in India27.This trend may be attributed to increased surveillance and research as a part of HIV prevention as well as more relaxed sexual mores noted recently. These behavior may also be facilitated by communication in unmarried men social network that encourages sexual exploration but places more weight on sexual experience than sexual health. There was a considerable decrease in the number of partners and the frequency of sex with MSP after diagnosis of HIV in our study. But emphasis needs to be laid to reduce the number of partners to lead a healthy life. Condom use has been the highlight of the government efforts to prevent the spread of HIV AIDS. Its various initiatives like providing condoms free of cost, aggressive campaigning in print media and TV has had a considerable effect in reducing the HIV infection across country , especially in cities. The acceptance of condom has generally been low in the villages .Various factors like low availability, decreased privacy at the condom provider, cultural barriers have prevented success of the condom. Also the major factor is the lack knowledge among people regarding the efficacy of the condom to reduce HIV prevention. Our study showed a considerable increase in the usage of condoms after the diagnosis of HIV compared to before diagnosis. This shows the change towards healthy sexual attitude of the subject. But the bottom-line is, the change of sexual behavior is too small to be proud of (20% to 37%).Effective strategies need to be developed to improve the usage and acceptability of condoms.
CONCLUSION
HIV positive patients changed their sexual behaviors related to frequency of sex, use of condoms, sex with multiple partners and their outlook on sex significantly after the diagnosis of HIV
Englishhttp://ijcrr.com/abstract.php?article_id=1421http://ijcrr.com/article_html.php?did=14211. UNAIDS Asia: AIDS epidemic summary: regional summary. http://data.unaids.org/pub/Report/2008/jc15 27_epibriefs_asia_en.pdf, 2009. (Accessed 7 April 20011).
2. Halli SS, Blanchard J, Satihal DG, et al. Migration and HIV transmission in rural South India: an ethnographic study. Cult Health Sex 2007;9:85–94.
3. Gangopadhyay DN, Chanda M, Sarkar K, et al. Evaluation of sexually transmitted diseases/human immunodeficiency virus intervention programs for sex workers in Calcutta, India. Sex Transm Dis 2005;32:680–4.
4. Fung IC, Guinness L, Vickerman P, et al. Modelling the impact and cost-effectiveness of the HIV intervention programme amongst commercial sex workers in Ahmedabad, Gujarat, India. BMC Public Health 2007;7:195.
5. Foss AM, Hossain M, Vickerman PT, et al. A systematic review of published evidence on intervention impact on condom use in sub-Saharan Africa and Asia. Sex Transm Infect 2007;83:510–16.
6. UNAIDS, WHO. AIDS Epidemic Update. Genera,Switzerland:UNAIDS, WHO;2005
7. Centre for Disease Control and Prevention. Incorporating HIV prevention into the medical care of persons living with HIV : recommendation of CDC, the Health Resources and Services Administration, the National Institute of Health, and the HIV Medicine Association of the Infectious Disease Society of America. MMWR Moch Mortal Wkly Rep. 2003;52(RR-12):1-32.
8. Indyk D, Golub S. The shifting locus of riskreduction: the critical role of HIV infected individuals. Soc Work Health Care2006;42:113-132.
9. Janssen R, HoltgraveD, Valdeserre R, etal. The serostatus approach to fighting the HIV epidemic: prevention strategies for infected individuals. Am J Public Health. 2001;91:1019-1024.
10. Sexual Behavior and Reproductive Health among HIV-Infected patients in Urban and Rural South Africa. J. AIDS 2008;47: 484- 493
11. Prevalence of Unsafe Sexual Behavior Among HIV-Infected Individuals: The Swiss HIV Cohort Study JAIDS Journal of Acquired Immune Deficiency Syndromes 33:494–499 © 2003 Lippincott Williams and Wilkins, Inc., Philadelphia 494
12. NIH Consensus Statement. Interventions to prevent HIV risk behaviours. 1997;15(2):1– 41
13. Perkins JM, Khan KT, Subramanian SV (2009) Patterns and Distribution of HIV among Adult Men and Women in India. PLoS ONE 4(5): e5648. doi:10.1371/journal.pone.0005648
14. Journal of Urban Health: Bulletin of New York Academy of Medicine, Vol-83, No.4.2006
15. Chandra PS, Satyanarayana VA, Satishchandra P, Satish KS, Kumar M. Do men and women with HIV differ in their quality of life? A study from South India. AIDS Behav. 2009 Feb;13(1):110-7. Epub 2008 Jul 25.
16. Vaz FS, Ferreira AM, Kulkarni MS, Motghare DD. Sexual risk behaviors and HIV/AIDS awareness among males in a rural community in Goa. J Commun Dis. 2006 Mar;38(1):74-8.
17. An Lwin, Thein Z., "An Examination of the Association between HIV Related Knowledge, Attitudes, and Behaviors and HIV Infection Status in Five High HIV Prevalence States in India." (2011).PublicHealthTheses. Paper168. http://digitalarchive.gsu.edu/iph_theses/168
18. Solomon SS, Celentano DD, Srikrishnan AK, Vasudevan CK, Anand S, Kumar MS, Solomon S, Lucas GM, Mehta SH. Mortality among injection drug users in Chennai, India (2005-2008). AIDS. 2009 May 15;23(8):997-1004.
19. 19.Moni Nag. Sexual behaviour in India with risk of HIV/AIDS transmission. Health Transition Review, Supplement to Volume 5, 1995, 293-305.
20. Coates TJ, Richter L, Caceres C. Behavioural strategies to reduce HIV transmission: how to make them work better. Lancet. 2008 Aug 23;372 (9639):669-84.
21. HIV testing and counseling among men attending sexually transmitted disease clinics in Pune, India: changes in condom use and sexual behavior over AIDS. 1998 oct 1;12(14):1869-77
22. Changes in sexual behavior and risk of HIV transmission after antiretroviral therapy and prevention interventions in rural Uganda AIDS. 2006 jan 2;20(1):85-92
23. HIV transmission in Intimate Partner Relationships in India UNAIDS Nov2009
24. Sexual risk behaviors among heterosexual HIV serodiscordant couples in the era of post-exposure prevention and viral suppressive therapyAIDS. 2000 mar 10;14(4):F47-54.
25. Stall R, Duran L, Wisniewski SR, Friedman MS, Marshal MP, et al. (2009) Running in place: implications of HIV incidence estimates among urban men who have sex with men in the United States and other industrialized countries. AIDS and behavior 13: 615–29. doi:10.1007/s10461-008-9509- 7.
26. Chandra PS, Carey MP, Carey KB, Prasada Rao PS, Jairam KR, Thomas T. HIV risk behaviour among psychiatric inpatients: results from a hospital-wide screening study in southern India. Int J STD AIDS. 2003 Aug;14(8):532-8.
27. Rohit Sharma. More than a quarter of India's youngsters have premarital sex. BMJ 2001(10 March); 322: 575.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareA STUDY OF SERUM CA-125 AND SALIVARY AMYLASE IN OVARIAN NEOPLASM IN A TERTIARY CARE HOSPITAL OF KOLKATA
English114120Sukla NathEnglish Swati BhattacharyyaEnglish Rituparna MajiEnglish H.N. Das English Shikha Das English Ranadip ChowdhuryEnglishIntroduction: Ovarian cancer is the fifth most lethal malignancy in women in the United States and second most common of all genital cancers in developing countries including India .Ovarian cancer is curable in early stages, and seldom curable in advanced stages.
Objective: Study was conducted to determine (1) whether pre operative serum level of CA-125 could differentiate between Benign and Malignant neoplasm (2) to evaluate the significance of serum salivary amylase in ovarian neoplasm.
Material and Methods: This was a cross sectional descriptive observational study conducted in a tertiary care hospital in north Kolkata, West Bengal, India. Detailed information regarding associated diseases and investigation reports were recorded in a case record form.
Results: Serum CA-125 was analysed with pre-operative serum sample in 112 cases of ovarian neoplasm (Benign ???? 73, Malignant ???? 39). Serum level of CA-125 was significantly (p=0.0001) raised in malignant cases compared to benign neoplasm. The sensitivity and specificity of serum CA-125 was 92.3% and 87.6% respectively. In our study 92.3% of malignant tumour cases had raised level of CA-125.Serum salivary amylase was significantly (p=0.0001) more among malignant tumours (refer table-5).
Conclusion: To conclude, in the present study there was significant increase of both serum CA-125 and salivary amylase level in malignant tumour cases than that of benign tumour cases.
EnglishOvarian neoplasm, serum CA-125, salivary amylase, histology gradeINTRODUCTION
Ovarian cancer is the second most common of all genital cancers and accounts for 10-15 % of all gynaecological cancers in India and other developing countries 1 . Up till today there is no regular screening test for diagnosing ovarian cancer and most of the neoplasm patient remain asymptomatic; as a result about 80% of malignant ovarian neoplasm are in stage 3 and stage 4 when diagnosed on histopathological examination of tumour tissues after surgery2 . Ovarian neoplasm may develop from its surface epithelium or from germ cell or from stroma of ovary, including the sex cords which are fore runner of the endocrine apparatus of the postnatal ovary. Malignant transformation of ovarian neoplasm is associated with biochemical changes of some parameters. A number of tumour markers is have been used for investigating ovarian cancer.3 Like serum Cancer antigen-125 (CA-125), a non conventional analyte like salivary amylase can be used to screen the ovarian cancers. .There are different studies showing raised levels of salivary amylase in ovarian malignancy. Luca F et al. shown in their study that after ruling out pancreatic and salivary gland disorders if the serum amylase is raised it is indicative of ovarian tumour and therefore can be used as a marker for ovarian cancer4 . Zakowski J J et al. mentioned in 1984 in the Journal of Clinical Chemistry that human serous-type ovarian tumours contain an acidic isoenzyme of amylase. Purified amylase isoenzyme from a human serous ovarian tumour was characterized and compared with the purified salivary and pancreatic isoenzymes. It was found that, ovarian tumour amylase was similar to the salivary and it differs from the pancreatic enzyme by apparent molecular mass and doublet formation on sodium dodecyl sulfate--polyacrylamide electrophoresis (SDSPAGE), specific activity of pure enzyme, and sensitivity to specific alpha-amylase inhibitors. The tumour amylase is clearly distinct from the pancreatic and differs from the salivary enzyme only in net electrical charge otherwise it is similar to or identical with salivary amylase as an enzyme5 . It also reported that alteration in the values of salivary amylase and CA-125 does not occur in 100% of cancer patients. In that case if these two parameters are used it will be helpful for diagnosis and assessment of grades of tumour as well as prognosis in a very simple and economic way. With this view, aim of our present study was to compare serum CA-125 and Salivary amylase level with benign and malignant tumour groups.
MATERIALS AND METHODS
The cross sectional descriptive observational study was conducted in the department of Biochemistry and Pathology, R.G.Kar Medical College and Hospital, Kolkata ,West Bengal, India. The study was undertaken after approval from institutional ethics committee .All the patients were properly counselled and their written consent was taken in the presence of a witness.
Study Group: 112 cases of USG diagnosed women with ovarian neoplasm in the age bracket 15 to 60 years admitted to Gynaecology ward for operation in one year (august 2011 to July 2012) were the study population.
Exclusion Criteria: One who has received radiotherapy or chemotherapy in ovarian neoplasm was excluded from the study. Also excluded were pregnant women, patient with metastatic neoplasm in ovary, women with any other malignancy, pelvic inflammatory disease, endometriosis, patient having salivary disease and patient with history of pancreatitis.
Specimen Collection and Preparation: For accurate comparison, a fasting venous blood sample was taken as specimen and the usual precaution in collecting of venipuncture samples were observed. Three ml of venous blood was collected in a plain vial .Blood was allowed to clot and centrifuzed to separate the serum from cells. Fresh sera was used to measure salivary amylase, rest of the sera was stored in (-20 0 c) in alliquotes before analysis of CA-125. The tests were performed with available instrumen and reagent in the department of Biochemistry. Estimation of serum CA-125:
Estimation of serum CA-125: Estimation of serum CA-125 level by Enzyme linked immune sorbent assay (ELISA) method 6,7. Instrument used was ELISA reader with automatic washer of Robonik-Read well touch.
Estimation of Serum Salivary Amylase: Salivary amylase was determined by subtracting the serum value of pancreatic amylase from alpha (α) amylase i.e. from total amylase value of each serum sample. Serum alpha (α) amylase and pancreatic amylase was analysed using kinetic method8,9 by Semi auto analyzer of Accurex-112 plus .
Procedure of Histological Slide Preparation: After operation the specimen was sent for histological examination in the dept Pathology and they were differentiated as benign and malignant tumours. After block preparation (tissue processing) tissue section was cut with the help of microtome (LeicaRM2125 RT) into ribbon like section of 5 microns thickness and floated in warm water (≈ 56 degree C) for expansion of curled section. These sections were than collected on albumenized slides and allowed to dry and fix on slides. Staining was done with Harris Haematoxylin and Eosin stain .Slides were mounted in DPX with coverslip and was examined under microscope (Nuclei - blue/black, Cytoplasm - varying shades of pink or clear. Muscle fibers - deep pink/ red, Red blood cellorange/ red, Fibrin – deep pink.) The universal grading system for all types of ovarian carcinomas proposed by Silverberg and colleagues is widely used10. With this system, the grade of carcinoma was determined by the degree of nuclear atypia, the frequency of mitotic figures, and the extent at which the tumour cells form papillae or glands11,12. Universal grading system is given in table (1). Immature teratomas are graded using a system that rates them from grade 0 for a neoplasm composed of entirely of mature tissues to grade 3 for a neoplasm containing abundant immature tissue .Histologic grading of immature teratoma is dependent on amount of immature tissues present in the tumour 13.Grading system of immature teratoma proposed by Norris H J et al. is mentioned in table-2. All data were analyzed on SPSS (statistical package and subjected to Students). Validity statistics and ROC curve were done. Level of significance was assumed at p value < 0.05.
RESULTS
In our study among 112 cases 73 were benign and 39 malignant tumour patients .Mean age of benign neoplasm group and malignant group was 38.55 ±12.36 years and 44.72 ±10.62 years respectively. Out of 39 malignant patients 21 (53.85%) were in post menopause and 29(74.36%) having ascites (refer table - 3). In this study 92.3% of malignant cases had serum level of CA-125 more than 35 U/ml and only 12.3% benign cases had raised level of CA125.CA-125 had sensitivity of 92.3% ,specificity of 87.6% and positive predictive value was 83.7% (refer table-4). According to Youden index (0.4338) cut off level of salivary amylase level was 46 U/L and area under curve was 0.701 (refer to figure-1). With 46U/L cut off sensitivity and specificity were 66.7% and 76.7% respectively. On pre operative serum estimation, 66% of malignant tumour cases had raised level (>46 U/L) of salivary amylase and it showed significant (p=0.0001) difference with benign tumours (refer table-5).
DISCUSSION
There are different case reports showing raised serum level of amylase in malignant ovarian tumour patient mainly due to salivary isoenzyme fraction, but no established reference range is available. In this study pre operative serum level of salivary amylase was estimated to determine its significance in benign and malignant ovarian neoplasm cases. Pre operative serum CA-125 was estimated in study cases to determine its significance in malignant cases, so that only by estimating pre operative serum levels of these two parameters we can predict about status of ovarian tumour patient suffering from and we can plan for early intervention for better prognosis. In the present study 73(65%) were benign and 39 (35%) were malignant cases. Among them 9(12.3 %) patient of benign tumours had elevated level of CA-125 ( >35U/ml to 121 U/ml) whereas 64 ( 87.7 % ) had normal value (46 U/L and 13 (34%) cases had less than 46 U/L (refer table-6). Among 73 benign tumour cases 17 (23.28%) cases had > 46 U/L and 56 (76.72%) cases had < 46U/L of serum salivary amylase .Chi square test shows significant (p=0.0001) difference between benign and malignant cases(refer table-5). From this data analysis we can say that if a patient presenting with ovarian lump has serum salivary amylase >46U/L ,she is more likely suffering from malignancy. But before considering this cut off for screening further study is indicated on a larger population . Each laboratory should establish its own cut off value for serum Salivary amylase. There are case reports showing presence of salivary amylase secreting cells in the tumour tissues. Pose Reino A et al. reported a case of hyperamylasemia produced outside the pancreas. In an ovarian carcinoma patient blood level of amylase was slightly increased16.In another case report an amylase-producing ovarian cancer in 69- year-old woman has been investigated by light and electron microscopy, as well as by amylase isoenzyme analysis. Serum and urinary amylase levels were found to be elevated, especially by an amylase isoenzyme analysis of the tumour homogenate; salivary type amylase was identified in tumour tissue. On amylase isoenzyme electrophoresis they detected the salivary isoenzyme in ascitic fluid17.But in this study the sample size is not large enough to draw such conclusion, future study is indicated on large population to detect the significant relation between malignant tumour and serum salivary amylase.
CONCLUSION
To conclude, in the present study there was significant increase of both serum CA-125 and salivary amylase level in malignant tumour cases than that of benign tumour cases. Moreover due to ease of testing and cost effectiveness, serum salivary amylase can be used alone or as an adjunct to CA-125 in screening and monitoring patients of Ovarian neoplasm especially in remote areas where sophisticated facilities are not available.
ACKNOWLEDGEMENT
We want to acknowledge Prof. (Dr.) Ajit Ranjan Bhattacharyya, HOD, GandO department of R.G Kar Medical College and Dr. Rupam Karmakar, Associate Professor, Department of pathology of R.G Kar Medical College for their co-operation during the whole course of work.
CONFLICT OF INTEREST: None.
Englishhttp://ijcrr.com/abstract.php?article_id=1422http://ijcrr.com/article_html.php?did=14221. Padubidri V G, Daftary SN. Disorders of ovary.In: Shaws Text book of Gynaecology. 13th edn.Lajpat Nagar, New Delhi: Elsevier; 2004, 354-372.
2. Padubidri VG, Daftary SN. Disorders of ovary.In: Shaws Text book of Gynaecology. 13th edn.Lajpat Nagar, New Delhi: Elsevier; 2004,397-400.
3. Joel Larma,Ginger J. Gardner, Ovarian Cancer.in Fortner, Kimberly B.; Szymanski, Linda M.; Fox, Harold E. et al. 3rd Edition .Johns Hopkins Manual of Gynecology and Obstetrics, Baltimore, Maryland: Lippincott Williams and Wilkins,2007:510-525
4. Luca Frulloni, Franca Patrizi, Laura Bernardoni, Giorgio Cavallini. Pancreatic Hyperenzymemia: clinical significance and diagnostic Approach. JOP. J. Pancreas.2005;6(6):536-551.
5. Zakowski J J, Gregory M R and Bruns D E.Amylase from human serous ovarian tumors: purification and characterization. The American Association for Clinical Chemistry, 1984 ; 30: (1), 62-68
6. Hasholzner U,Steiber P, Baumgartner L ,et al.Clinical significance of tumour marker CA125 ? and CA-72-4 in Ovarian carcinoma,Int journal Cancer,1996;69:329-334
7. Sikorska H,Schuster J, Gold P.Clinical application of Cancer antigen 125,Camcer detection preview,1988;12:321-355
8. IFCC Methods for measurement of catalytic concentrations of enzymes,J.Clin.Chemistry.Acta.1999;281:5
9. David H.Hydrolysis by human alpha amylase of p-nitrophenyl oligosaccharides containing four to seven glucose unit.Clinical Chemistry.1982;28:1485-89
10. Silverberg S G. Histopathologic Grading of Ovarian Carcinoma:a review and proposal.International Journal of Gynaecol Pathology,2000;19:7-15.
11. Shimizu Y,Kamoi S,Amada S et al.Toward the development of a universal grading system for ovarian epithelial carcinoma-Testing of a proposed system in a series of 461 patient with uniform treatment and followup.Cancer,1998;82:893-901
12. Shimizu Y,Kamoi S,Amada S et al.Toward the development of a universal grading system for ovarian epithelial carcinoma.I.Prognostic Significance of histologic features-Problems involved in tha architectural grading system.Journal of Gynaecological Oncology.1998;70:2-12
13. Norris H J, Zirkin H J, Benson W L.Immature (Malignant) teratoma of the ovary.A clinical and Pathologic study of 58 cases.Cancer,1976,37:2359-2372
14. Bast RC, Jr, Klug TL, St John E, Jenison E, Niloff JM et al. A radioimmunoassay using a monoclonal antibody to monitor the course of epithelial ovarian cancer. N Engl J Med. 1983;309:883–887
15. Kenemans P, van Kamp GJ, Oehr P, Verstraeten RA. Heterologous doubledeterminant immunoradiometric assay CA 125 II: reliable second-generation immunoassay for determining CA 125 in serum. Clin Chem. 1993;39:2509–2513
16. Tanaka Y, Ueda G, Tanizawa O, Miyake H, Kohno M, Nishiyama S et al.A case of amylase-producing ovarian tumor. Gan No Rinsho. 1986 Jan;32(1):111
17. Kawamurra S, Hiura M, Kaneko H, Yokoyama T, Tanaka M, Chiba T.Amylaseproducing ovarian cancer treated with postoperative QF chemotherapy--a case report. Gan No Rinsho. 1988 Apr;34(4):497-504.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareEFFECT OF DURATION OF EXPOSURE TO SILICA DUST ON LUNG FUNCTION IMPAIRMENT IN STONE CRUSHER WORKERS OF MARATHWADA REGION
English121125Sachin B RathodEnglish Smita R. SorteEnglishSilicosis is one of the oldest occupational disease. It kills thousands of people every year all over the world. It is an irreversible fibrotic process without cure and so best treatment is prevention. Prevalence of silicosis in India differs according to amount of silica in dust and time interval of exposure. Due to lack of data from Marathwada region of Maharashtra, we aimed this study to know effect of duration of exposure to silica dust in stone crusher workers. A cross-sectional type of observational study was conducted. Pulmonary function tests were recorded in 120 male stone crusher workers. Intergroup statistical analysis amongst the workers depending on duration of exposure was carried out by Analysis of Variance (ANNOVA). We found that pulmonary function test bears relationship with duration of exposure, as the duration of exposure increases the pulmonary function tests goes on decreasing.
EnglishPulmonary function test, stone crusher workers, silica, lung function test, silicosis, duration of exposureINTRODUCTION
Today the industrial revolution has brought about the remarkable changes in ecosystem and atmosphere. The stone crushing industry in India has been growing rapidly due to increasing demand from the construction industry and present emphasis on developing the country’s infrastructure. There are more than 12,000 stone crushing units in India (1), these stone crushing units are an unorganized sector of the country. The stone contains approximately 100% free silica and the stone crushing process liberates huge amount of respirable crystalline silica dust in the working environment. (2) Exposure to crystalline silica can result in respiratory and non- respiratory health effects. The first known respiratory ill effect due to inhaled crystalline silica was reported by ancient Greek as silicosis, which is one of the oldest occupational disease and still kills thousands of people every year all over the world. Silicosis is also known as Potter's rot. The full name of illness is pneumonoultramicroscopicsilicovolcanokoniosis. Exposure to large amount of free silica can pass unseen because silica is non-irritant, odorless and does not lead to any immediate evident effect and therefore confused with ordinary dust. The inhaled silica particles are removed from the lung at a very slow rate. Thus, even if exposure is stopped the retained particles may continue to exert their effect on lung. Leigh et al have estimated an annual incidence of occupational diseases between 9, 24,700 and 19, 02,300, leading to over 1, 21,000 deaths in India. (3) Studies carried out by National Institute of Occupational Health observed prevalence of some lung diseases are 54.5% in slate pencil (4), 15.2% in Potteries (5), 38% in Agate Polishing, 21% in Stone Quarries, and 12% in stone crushing.(6) Silicosis is an irreversible fibrotic process without a cure and so treatment rests on preventing insult to the lungs. Being a respiratory ailment, this group of disorder impairs the pulmonary function tests. (7) Very few epidemiological studies on silicosis are conducted in India showing the prevalence of silicosis as 12- 54%. (3) This varying prevalence in various sectors is credited to different silica concentration in the work environment and duration of exposure to Silica dust. Till date no study has been conducted on stone crusher workers of Marathwada region to find the effect of duration on pulmonary function test. Paucity of data provides strong rationale to initiate research on the effect of duration of exposure on lung function tests in stone crusher workers of Marathwada region.
METHOD AND MATERIALS
A cross-sectional type of observational study was conducted at 7 various stone crusher units of Marathwada region of Maharashtra, between the period December 2009 to July 2011. The pulmonary function tests were carried out in 120 male stone crusher workers. Selection criteria were male stone crusher workers aged between 25-55 years, exposed to stone dust for more than 5 years, non smokers and not suffering from any chronic disease. They were divided into three groups according to duration of exposure as 5- 10yrs (51 workers), 11-15yrs (42 workers) and >15yrs (27 workers). Institutional ethics committee approval was taken. Informed consent was taken from all the workers participating in the study. Pulmonary function tests was recorded on computerized ‘MEDSPIROR’ (manufactured by Recorders and Medicare System Pvt. Ltd, Chandigarh) a high performance pneumotachometer that fulfils the criteria for performance and reproducibility laid down by American Thoracic society (ATS). All tests were performed during morning hours. The procedure of lung function tests was explained to all subjects along with demonstration prior to recording. Proper trials were given to ensure that subjects understand and become confident about the whole procedure. The reading was taken in a comfortable upright sitting position in front of the apparatus. Then each subject was asked to perform forced Expiratory manoeuvre and maximum Ventilation volume manoeuvre .(8,9) For forced expiratory manoeuvre workers was asked to take a maximum inspiration then pinch nose and expire forcefully and completely in the mouthpiece of the instrument. For maximum Ventilation volume manoeuvre workers were asked to take a maximum inspiration then pinch his nose and expire as deeply and rapidly as possible for 6 seconds in the mouthpiece. Three readings were taken and best of these was taken for calculation. Parameters considered for study was forced vital capacity (FVC -lit), forced expiratory volume in 1 second (FEV1-lit), peak expiratory flow rate (PEFR -lit/sec), maximum expiratory flow rate (FEF25-75 % - lit/sec), maximum voluntary ventilation (MVV-lit/min). Intergroup statistical analysis amongst the workers depending on duration of exposure was carried out by Analysis of Variance (ANNOVA).
RESULT
Table no. 1 and graph no. 1 shows effect of duration of exposure on pulmonary function test on stone crusher workers. Stone crusher workers were grouped into three categories depending on duration of exposure, 5-10yrs (n=51), 11-15yrs (n=42) and >15yrs (n=27). The values of FVC (PEnglishhttp://ijcrr.com/abstract.php?article_id=1423http://ijcrr.com/article_html.php?did=14231. Gottesfeld P, Nicas M, Kephart JW, Balakrishnana K, Rinehart R. Reduction of respirable silica following the introduction of water spray applications in Indian stone crusher mills. Int J occup Environ Health 2008;14(2):94-103.
2. Tiwari RR, Sathwara NG, Saiyed HN. Serum copper levels among quartz stone crushing workers: A cross sectional study. Indian J Physio Pharmacol 2004;48(3):337-342.
3. Saiyad HN, Tiwari RR. Occupational health research in India. Industrial Health 2004;42:141-148
4. Saiyed HN, Parikh DJ, Ghodasara NB, Sharma YK, Patel GC, Chatterjee SK. Silicosis in slate pencil workers: I. An environmental and medical study. Am J Ind Med.1985;8(2):127–133.
5. Saiyed HN, Ghodasara NB, Sathwara NG, Patel GC, Parikh DJ, Kashyap SK. Dustiness, silicosis and tuberculosis in small scale pottery worker. Indian J Med Res. 1995 Sep;102:138- 42.
6. An Uncommonly Diagnosed Common Occupational Disease. ICMR Bulletin 1999; 29(9). [Internet]. [Cited on 2010 Nov 21]. Available from: http://icmr.nic.in/busep99.htm
7. Tiwari RR, Narain R, Patel BD, Makwana IS, Saiyad HN. Spirometric measurements among quartz stone ex-workers of Gujarat, India. J Occup Health 2003;45:88-93.
8. A.K.Jain. Textbook of Physiology.4 ed. Avichal publishing compony; 2009. Pulmonary function tests; p.488-489.
9. P.S.Shankar. Pulmonary Function Tests in Healthy and Disease. 1st Edition 1998.
10. Kulkarni GK. Prevention and control of silicosis: A national challenge. Indian Journal of Occup Envior Med 2007;11(3):95-96
. 11. Ghotkar VB, Maldhure BR, Zodpey SP. Involvement of lung and lung function tests in Stone quarry workers. Ind. J. Tub. 1995;42:155-160.
12. Liou SH, Shih WY, Chen YP, Lee CC. Pneumoconiosis and pulmonary function defects in silica- exposed fire brick workers. Arch Environ Health 1996;51(3):227-233.
13. Koo JW, Chung CK, Chung YP, Lee SH, Lee KS, Roh YM, Yim HW. The effect of silica dust on ventilatory function of Foundry workers. J Occup Health 2000;42:251-257.
14. Subhashini AS, Satchidhanandam N. Maximal expiratory flow volume curve in quarry workers. Indian J Physiol Pharmacol 2002 Jan;46(1):78-84.
15. Bahrami AR, Mahjub H. Comparative study of lung function in Iranian factory workers exposed to silica dust. Eastern Mediterranean Health Journal 2003;9(3):390-398.
16. Chattopadhyay BP, Gangopadhyay PK, Bandopadhyay TS Alam J. Comparison of pulmonary function test abnormalities between stone crushing dust exposed and non exposed agricultural workers. Environmental Health and Preventive Medicine 2006;11:191- 198.
17. Johncy S, Ajay KT, Dhanyakumar G, Raj PN, Samuel VT. Dust exposure and lung function impairment in construction workers. J Physiol Biomed Sci 2011;24(1):9-13.
18. Hertzberg VS, Rosenman KD, Reilly MJ, Rice CH. Effect of Occupational Silica Exposure on Pulmonary function. Chest 2002;122(2):721- 728.
19. Urom SE, Antai AB, Osim EE. Symptoms and lung function values in nigerian men and women exposed to dust generated from crushing of granite rocks in Calabar, Nigeria. Nigerian Journal of Physiological Sciences 2004;19(1-2):41-47.
20. Jayawardana P, Tennakoon S, V Bandara. Respiratory symptoms and ventilatory function among granite workers working in quarries installed with mechanical crushers in and around Kandy Muncipality limits. Journal of the college of community physician of Sri Lanka 2009;13(2):9-15.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareHISTOPATHOLOGICAL CHANGES IN GALLBLADDER MUCOSA ASSOCIATED WITH CHOLELITHIASIS
English126129Sumit GiriEnglishBackground: Gallstone disease called as cholelithiasis is the most common digestive surgical disorder and account for an important part of health care expenditure. Aim: This work was carried out to study the diverse histopathological changes in the gallbladder mucosa as a result of cholelithiasis.
Materials and Methods: This was a retrospective study carried out in the Department of Pathology, Dr. Hedgewar Arogya Sansthan Hospital during a period of 1 year. The study included 184 cases of cholecystectomy specimens. Results: There was a preponderance of females (M : F ratio 1: 1.5). The age of the patients varied from 23 to 76 years with a mean age of 47 years. On macroscopic examination, the serosal surface of the gallbladder was found normal in 126 specimens (68.48%) and congested in 58 specimens (31.52%). Gallbladder wall thickness was normal (3mm) in 77 specimens (41.85%). Mucosa was normal in 121 (65.76%), hemorrhagic in 23 (12.50%), Strawberry like in 34 (18.48%) and slightly nodular in 6 specimens (3.26%). On microscopic examination, normal epithelium was seen in 34 specimens (18.48%), epithelial hyperplasia was observed in 85 (46.20%), intestinal metaplasia in 47 (25.54%), cholesterolosis in 14 (7.61%) and dysplasia in 4(2.17%) specimens.
Conclusion: Gallstones are accompanied by major changes in the gallbladder epithelium. The morphological spectrum of gallstone disease will certainly contribute to understand its etiopathogenesis and hence prevention.The relation between the observed changes and gallstone formation needs further studies.
EnglishGallstones, cholecystectomy Intestinal Metaplasia, Dysplasia.INTRODUCTION
The gall bladder is a four inch sac with a muscular wall that is located under the liver. Here most of the bile about three to five cups a day is removed, leaving a few tablespoons of concentrated bile. The gallbladder serves as a reservoir until bile is needed in the small intestine for digestion of fat [1]. Gallstone disease is a common health problem worldwide. It is commonly believed that bile stasis is the prime factor for gallstone formation. A major cause for stasis is gallbladder dyskinesia which in turn may be a consequence of gallbladder wall pathology [2]. Epithelium of the gallbladder and biliary tract is exposed to high concentrations of potentially harmful exogenous and endogenous compounds excreted into primary bile [3]. ‘Histological changes in gall bladder due to stone disease’ is very interesting and thought provoking [4]. Cholelithiasis produces diverse histopathological changes in gallbladder mucosa namely, acute inflammation, chronic inflammation, granulomatous inflammation, hyperplasia, cholesterolosis, dysplasia and carcinoma [5]. Cholelithiasis is frequently associated with carcinoma gallbladder in up to 40% 100% patients and is the most common associated factor independent of age or sex [6]. We undertook this study to evaluate the incidence of the histopathological changes in the gallbladder epithelium of patients undergoing cholecystectomy due to cholelithiasis.
MATERIALS AND METHODS
This was a retrospective study carried out in the Department of Pathology, Dr. Hedgewar Arogya Sansthan Hospital during a period of 1 year. The study included 184 cases of cholecystectomy specimens. The history, clinical findings and investigations were retrieved from the records of the hospital. Detailed macroscopic examination of the specimens was done after complete fixation in 10% formalin. Each gallbladder was sectioned serially from the neck to the fundus, processed routinely and embedded in paraffin. Sections were stained with Haematoxylin and Eosin (H and E) stain and histopathological examination was carried out. Data was analyzed using SPSS 17.0 version for windows.
RESULTS
A total of 184 cholecystectomy specimens were received during 1 year period. There was a preponderance of females (M: F ratio 1: 1.5). The age of the patients varied from 23 to 76 years with a mean age of 47 years. On macroscopic examination, the serosal surface of the gallbladder was found normal in 126 specimens (68.48%) and congested in 58 specimens (31.52%). Gallbladder wall thickness was normal (3mm) in 77 specimens (41.85%). Mucosa was normal in 121 (65.76%), hemorrhagic in 23 (12.50%), Strawberry like in 34 (18.48%) and slightly nodular in 6 specimens (3.26%). The gross findings of cholecystectomy specimens are shown in Table1. On microscopic examination, normal epithelium was seen in 34 specimens (18.48%), epithelial hyperplasia was observed in 85 (46.20%), intestinal metaplasia in 47 (25.54%), cholesterolosis in 14 (7.61%) and dysplasia in 4(2.17%) specimens. The microscopic findings of cholecystectomy specimens is shown in Table.2.
DISCUSSION
Gallstone disease (GD) (cholelithiasis) is one of the most prevalent gastrointestinal diseases, with a substantial burden to health care systems [7]. Cholelithiasis is common with the incidence ranging from 10% to 20% of world population, 11% of the general population of USA [8]. The estimated prevalence of gallstone disease in India has been reported as 2% to 9% [9,10]. It is 10 times more frequent in North compared to South India [11]. Dietary differences in the two regions are suspected to be responsible for the difference in the prevalence rate [12]. It is now commonly agreed that gallstones are an important risk factor for facilitating development of gallbladder cancer, despite it being adenocarcinoma [13]. In our study, the mean age of patient was 47 years. In a Brazilian study, the age at presentation was 60.2 years [8]. The average of these patients in India, is a decade younger than those in the west [14]. Epithelial Hyperplasia was the most frequent change and was found in 46.20 percent. Albores S et suggest that a small number of hyperplasia of gall bladder evolves towards atypical hyperplasia and that may progress to in situ carcinoma which finally becomes invasive carcinoma [15]. A single random histological section will detect less than one third of hyperplasias, dysplasias and carcinomas in situ [16]. Thus our study could be missing two thirds of these lesions.Intestinal metaplasia was seen in 25.54% cases which was 16% in other study [4]. It is widely accepted that metaplastic epithelium is more susceptible to malignant transformation than normal [17]. Epithelial dysplasia was found in 2.17% of gall bladder specimens. Others have reported the incidence of dysplasia in 2.2% of cholelithiasis specimens and 42% in the mucosa adjacent to invasive carcinoma [18]. The reasons for the wide discrepancy in the reported incidence of dysplasia could be the number of sections examined and the criteria for histological diagnosis used in various studies. Cholesterolosis was found in 7.61% of cholelithiasis specimens whereas in other study it was found to be 13.4% [19].
CONCLUSION
The mean age group for cholelithiasis was found to be 47 years with a female being more common than males. In all cases of cholecystectomy for gallstone disease, the gallbladder should be opened and examined in detail for macroscopic abnormalities. Overall, the pathological changes of the gallbladder epithelium may play an important role in the process of gallstone formation. Histopathological examination is thus important in every case of cholecystectomy for identifying metaplasia, dysplasia and carcinoma.
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=1424http://ijcrr.com/article_html.php?did=14241. Juan Rosai, Ackerman’s Surgical Pathology, Vol. One, 8 th edition, Hardcourt Brace and co. Asian Pvt Ltd 1996; Chapter 14:943 963.
2. Velanovich VF. Biliary dyskinesia and biliary crystals: a prospective study. Am Surg 1997; 63:69 73.
3. Aust S, Obrist P, Jaeger W, Klimpfinger M, Tucek G, Wrba F, et al. Thalhammer T Subcellular localization of the ABCG2 transporter in normal and malignant human gallbladder epithelium. Lab Invest 2004; 84:1024 1036
4. Khanna R, Chansuria R, Kumar M, Shukla HS. Histological changes in gallbladder due to stone disease. Indian J Surg 2006;68:201 4.
5. Shukla HS, Avasthi K, Naithani YP. A clinicopathological study of the carcinoma of the gallbladder. Indian J Cancer 1981;18:198 201.
6. Hart K, Modan B, Shani M. Cholelithiasis in the aetiology of gallbladder neoplasms. Lancet 1971, 1: 1151 1153.
7. Sun H, Tang H, Jiang S, Zeng L, Chen EQ, Zhou TY, Wang YJ. Gender and metabolic differences of gallstone diseases. World J Gastroenterol 2009; 15: 1886 1891.
8. Coelho JC, Bonilha R, Pitaki SA et al. Prevalence of gallstone in Brazilian population. Int Surg. 1999; 84:25 8.
9. Prakash A. Chronic cholecystitis and cholelithiasis in India. Int Surg 1968;49: 79 85.
10. Khurro MS, Mahajan R, Zargar SA, Javid G. Prevalence of biliary tract disease in India: a sonographic study in adult population in Kashmir. Gut 1989; 30:201 05.
11. Dhir V, Mohandas KM. Epidemiology of digestive tract cancers in India. Indian J Gastroenterol 1999;18:24 8.
12. Malhotra SL. Epidemiological study of cholelithiasis among railroad workers in India with special reference to causation. Gut 1968;9:290 95.
13. Al Hadeedi SY, Moorchead RJ, Leaper DJ, Wong J. Carcinoma of the gallbladder: A diagnostic challenge. J Coll Surg Edin1991;36:174 7.
14. Tandon RK. Pathogenesis of gallstones in India. Trop gastroenterol 1988;9:83 91.
15. Albores Saavedra J, Molberg K, Henson DE. Unusual malignant epithelial tumors of the gallbladder. Semin Diagn Pathol 1996;13:326 38.
16. Durate I, Llanos O, Domke H, Harz C, Valdivieso V. Metaplasia and precursor lesions of gallbladder carcinoma. Frequency, distribution and probability of detection in routine histologic samples. Cancer 1993;72:1878 84.
17. Yamamoto YM, Nakajo S, Tahara E. Carcinoma of the gallbladder: The correlation between histogenesis and prognosis. Virchows Arch Pathol Anat 1989;414:83 90.
18. Martinez Guzman e, de la Rosa Bayan J. Neoplasma and dysplasia of the gallbladder and their relationship with lithiasis. A case control clinic pathological study. Rev Gastroenterol Mex 1998;63:82 8.
19. Meirelles Costa AL, Bresciani CJ, Perez RO, Bresciani BH, Siqueira SA, Cecconello I. Are Histological alterations observed in the gallbladder precancerous lesions? Clinics 2010;65:143 50.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareTEACHING METHODOLOGY OF ANATOMY: A MODERN OUTLOOK
English130135Udaya Kumar P.English Seema MadanEnglishTraditionally sole pedagogy of gross anatomy has been through cadaver dissections and didactic lectures. However increased access to recent technologies, have prompted many universities and colleges to redefine the teaching methods thus effectively impart the knowledge of gross anatomy.
Aim: To compare the traditional teaching method versus modern teaching method and evaluate their effectiveness in learning gross anatomy. To assess the degree of student’s satisfaction of learning with the above said methods.
Material and Methods: A prospective study was carried out among the freshman undergraduate medical students of Gandhi medical college, Andhra Pradesh, India. The students of the Experimental group were taught using power point lectures and computer based dissection visuals, along with the traditional method of teaching. The Control group students were allotted the same number of dissection and lecture hours as the experimental group and followed the same pattern of dissection. The students of this group were taught by using traditional Chalk and Board lectures only. They had no access to power point lectures and computer based dissection visuals. Student’s performance was evaluated using multiple choice questions and a feedback questionnaire,
Results: Experimental group Students performed better than the traditional group. i.e. in 2009, four out of six examinations and in 2010, five out of six examinations, experimental group’s average scores were significantly higher ( p < 0.05 ) than the traditional group. The difference in the averages, between the two groups, was significant, i.e. Z > 1.96.
EnglishCadaver dissections; Chalk & Board; power point lectures.INTRODUCTION
Anatomy has always been a cornerstone in medical education1 . It is an undisputed fact that the comprehensive knowledge of anatomy plays a vital role in proper understanding of any other branch of Medicine. It plays an important role in the process of training medical professionals and thereby ensuring safe medical practices. Traditionally sole pedagogy of gross anatomy has been through cadaver dissections and didactic lectures
1 . However increased access to recent technologies like 3-dimensional audio visuals, digital radiological imaging, and web based study materials etc. have prompted and challenged many universities and colleges to redefine the teaching methods thus effectively impart the knowledge of gross anatomy. The purpose of the present study is 1. To compare the traditional teaching methods versus modern integrated teaching method and evaluate their effectiveness in learning gross anatomy.
2. To assess the degree of student’s satisfaction of learning with the above said methods.
MATERIALS AND METHODOLOGY
Freshman undergraduate medical students joining Gandhi medical college, Andhra Pradesh, during the years of 2009 – 2010 and 2010 – 2011 were considered for the study.
Regular teaching pattern:
In the regular course of teaching, teachers use traditional chalk and board as the main tool of teaching apart from the dissection. Occasionally depending upon the topics dealt and availability of other resources, overhead projectors, specimens, models and power point presentations were also used.
Participants’ selection:
One hundred and fifty (N=150) freshman medical students entering Gandhi medical college, in the order of their merit in the Common Entrance Test, are arranged in alphabetical order of their names and divided into four groups consisting of n1=38, n2=38 ,n3=37 and n4=37 number of students respectively. Each year, out of four, two groups were chosen randomly for the study, one as an Experimental and the other as Control, with a prior informed consent.
EVALUATION
Both the Experimental and Control groups were tested with the same pattern of examinations. Students were given total 6 sets of multiple choice question examinations for both the topics i.e. Upper limb 3 questionnaires and Thorax 3 questionnaires, at regular intervals within the stipulated time period. At the end of study a feedback questionnaire was distributed to both the groups. The purpose of the questionnaire was to assess the efficacy of the recent methods used in the study, the students’ overall satisfaction of learning with the traditional versus modern method of teaching and further suggestions regarding the future improvement and implementation of the newer method. Averages in the test scores, Z – Test values and feedback observations were depicted in tables 1and 2. The results were analyzed statistically.
STATISTICAL ANALYSIS OF THE TEST SCORES:
Test scores of the Control and Experimental group were compared for each topic. The differences in the averages obtained between the two groups, for each test, were assessed for any significance. As the sample size was more than 30 (N > 30) and equal for both the groups, Z-Test was conducted, to assess the significance in average differences between the Control and Experimental groups. The level of significance was set by ‘p’ value i.e. p > 0.05 is non- significant and p < 0.05 is significant. Z-test value greater than 1.96 is considered significantly different between the averages. The average scores and the Z-test and ‘p’ values are depicted in the (Table – 1)
Data analysis:
Upper Extremity and Thorax – 2009;
In initial examination for both the topics, results did not show any significant difference in average marks between Control and Experimental groups. Whereas the latter two examinations showed higher average marks in Experimental group.
Upper Extremity and Thorax – 2010;
The initial examination in upper extremity did not show any significant difference in average marks between Control and Experimental groups. Whereas in all the other examinations results showed higher average marks in Experimental group.
Analysis of the feedback data:
Results of seventy two out of seventy four completed and returned questionnaires show that the computer based dissection visuals and power point lectures were excellent tools to understand and learn gross anatomy. All the students participated in the study felt that the modern integrated method made the subject of anatomy easy and more interesting. Finally students suggested that the use of modern teaching methodology in future would certainly improve the future of anatomy education.
DISCUSSION
Small group learning is considered to be superior method of learning2 , but in India due large numbers of student intake in medical colleges, lecture methods are more preferred and will continue to be put into practice. In order to cater to the needs, the lectures should be made more effective. The review of literature showed that combination of various teaching methods i.e. cadaver dissection, didactic lectures, computer mediated instruction and web based anatomy materials, together yielded better results in learning anatomy. In individual studies by Biasutto SN, et al3 , Boucher, et al4 , Elizondo-Omana, R. E, et al5 , Granger NA, et al6 , Jose A Pereira, et al7 , Dana J. Jamero, PharmD, et al8 , and Forester JP, et al9 M Thomas, et al10, it was observed that, either combination of the newer technological resources with traditional methods yielded better results or newer methods became viable alternative to traditional methods. Nobert A. Jones, et al11, Walsh, R. J. and Bohn, R. C 12, Bukowski EL13, Dobbins C, et al14 and Mc Nulty J A, et al15 in their studies, compared traditional dissection cum didactic lecture method of teaching with the new multimedia and web based methods. Except in the study of Mc Nulty JA, et al15, all the other studies’ results showed that the newer methods are better appreciated by the students than the traditional teaching method. Likewise in the present study also, power point projections and computer based dissection visuals when added to the regular teaching method yielded better results than when used alone. In almost all the studies, by Azer SA, Eizenberg N 16, Patel KM and Moxham BJ17, Vikas Seth, et al18, Walsh, R. J. and Bohn, R.C11, Ganger, et al5 , Jose A Pereira, et al6 , , Dobbins.C, et al13, Dana J. Jamero, PhrmD, et al7 , where the feedback was taken to assess the degree of student satisfaction of learning with the recent advanced methods of teaching, students were of the opinion that either the new media were better than the traditional methods or at least as effective as traditional method in learning human gross anatomy.
Possible reasons for the better results with newer method than the traditional method:
The following observations could be made out for the students’ better performance with the newer method.
1. Incorporation of Audio-Visuals, animations, pictures in the power point lectures, made it more interesting and informative to the students.
2. Most of the anatomy diagrams are difficult to understand in 2-dimensional mode on the chalk and board, but the audio-visual can give a better concept of the subject and long lasting impact on the students.
3. Dissection visuals shown prior to the dissection lab, made the students better prepared for the dissection which eventually helped them in getting good scores in the examinations.
4. As integration of the newer method with the traditional chalk and board, was well managed the students were able to interact with the teacher and also take down notes and the diagrams when needed. 5. The reasons for the continual improvement in the students’ performance in both the groups in consecutive exams, however, might be attributed to the regular examinations conducted as a part of the study and gradual exposure of the subject made the students better prepared. In view of the reduced total teaching time, addition of newer tools to the regular teaching will help the teacher to cover the topics within the stipulated time period with better quality. Eventually, improving the students’ performance, satisfaction of learning and as a whole quality of health education.
LIMITATIONS
As university regulations demand cadaver dissection, comparison to find out whether dissection can be completely replaced with modern methods of teaching, cannot be considered for the present study. This study included smaller groups (n=38) of students. Results of the less sample size may not be applicable for the larger group students in view of the differences in the student’s attention and receptivity in larger group settings. Utility of power point lectures not only depends on the lecture itself but also on the various factors like availability of electricity, students’ personal preferences, teacher’s capabilities (in integrated method) to deal with the technology, subject quality, time management and interaction with students at the same time and trained technical staff to take care of the available resources etc...
CONCLUSION
It is opined that whatever the method of teaching aids used, the impact of the lecture mainly depends on the lecturer. However it is understood from various studies on teaching methodologies that the proper utilization of newer technologies along with the traditional teaching methods will certainly lead to better understanding of gross anatomy and will eventually improve students’ performance. But, until studies prove these possibilities on larger sample sizes, we cannot jump to such conclusions. In view of the poor literature availability in the context of Indian medical education, this study, in its own little way, may add up to it.
Consent:
A prior informed consent was taken from the students that participated in the study.
Competing Interests: The authors declare that we have no competing interests
Ethical committee clearance: As the study did not include any tests of significant importance on the subjects involved in the study, ethical committee clearance was not taken into consideration. Authors will take the responsibility of any further allegations regarding ethical clearance that arise from the study.
ACKNOWLEDGEMENTS
Dr. Ashok Kumar, Dr. Krishna Murthy and my colleagues for their valuable suggestions. All the students who willingly took part in the study and the scholars/authors/editors/publishers whose articles, journals are reviewed, cited and included in the references of this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1425http://ijcrr.com/article_html.php?did=14251. Sugand K, Abrahams P, Khurana A. The anatomy of anatomy: a review for its modernization. Anat Sci Educ. 2010 Mar-Apr; 3(2):83-93.
2. Cannon R. Lecturing, Kensington, NSW; Higher Education Research and Development. Society of Australia; 1988.
3. Biasutto S, Caussa LI, Criado del Rio LE. Teaching anatomy: cadavers vs. computers? Ann Anat. 2006 Mar, 188(2): 187-90.
4. Boucher, Brenda, Hunter, Diana, Henry, Jason. Effectiveness of computer-assisted instruction in teaching biomechanics of the temporomandibular joint. The Journal of Physical Therapy Education. Vol. 13, No. 2
5. Elizondo-Omana, R. E., Morales-Gomez, J. A., Guzaman, S. L., Ibarra, R. P. and Vilchez, F. C., (2004), Traditional teaching supported by computer-assisted learning for macroscopic anatomy. The Anatomical Record Part B: The New Anatomist, 278B: 18-22.
6. Granger NA, Calleson DC, Henson OW, Juiliano E, Wineski L, McDaniel MD, Burgoon JM. Use of Web-based materials to enhance anatomy instruction in the health sciences. Anat Rec B New Anat. 2006 Jul; 289(4): 121-7.
7. Jose A Pereira, Eulogio Pleguezuelos, Alex Meri, Antoni Molina-Ros, M Carmen MolinaTomas, Carlos Masdeu. Effectiveness of using blended learning strategies for teaching and learning human anatomy. J.Med Educ., 41(2): 189-195. Feb 2007.
8. Dana J. Jamero, PhrmD, Amne Borghol, PharmD and Linda Mihm, PharmD. Comparision of Computer-Mediated Learning and Lecture-Mediated Learning for Teaching Pain Management to Pharmacy Students. Am J Pharm Educ. 2009 February 19; 73(1): 05.
9. Forester JP, Thomas PP, McWhorter DL. Effects of four supplemental instruction programs on students' learning of gross anatomy. Clin Anat. 2004 May;17(4):322-7
10. M Thomas, B Appala Raju. Are PowerPoint presentations fulfilling its purpose? South East Asian Journal of Medical Education, Inaugural issue.
11. Nobert A Jones, Ph.D., Raymond P. Olfason, Ph.D. and Jerome Sutin, Ph.D; Evaluation of a Gross Anatomy Program Without Dissection. J.Med.Educ., 53:198-204, 1978.
12. Walsh, R. J. and Bohn, R.C. (1990). Computer-assisted instructions: a role in teaching human gross anatomy. Medical Education, 24: 499-506.
13. Bukowski EL. Assessment outcomes: Computerized instruction in a human gross anatomy course. J Allied Health. 2002 Fall: 31(3): 153-8.
14. Dobbins.C, Kanhere.A, Maddern.GJANZ. Anatomy in the virtual world. J. Surg. 2007; 77 Suppl 1: A77.
15. McNulty JA, Hoyt A, Gruener G, Chandrasekhar A, Espiritu B, Price R Jr, Naheedy R; An analysis of lecture video utilization in undergraduate medical education: association with performance in the courses. BMC Med Educ-01-JAN-2009; 9: 6
16. Azer SA, Eizenberg N. Do we need dissection in an integrated problem-based learning medical course? Perceptions of first- and second-year students. Surg Radiol Anat. 2007 Mar; 29(2): 173-80.Eupub 2007 Feb 21.
17. Patel KM, Moxham BJ, The relationship between learning outcomes and methods of teaching anatomy as perceived by professional anatomists. Clin Anat-01-MAR-2008; 21(2): 182-9.
18. Vikas Seth, Prerna Upadhyaya, Mushtaq Ahmad, Vijay Moghe; Power point or chalk and talk: Perceptions of medical students versus dental students in a medical college in India. Advances in medical education and practice 2010:1 11-16.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28HealthcareSTUDY OF PALMAR DERMATOGLYPHICS IN CARCINOMA OF CERVIX
English136140Balsurkar Smita KashinathappaEnglish Khanzode Lata S.EnglishIn developing countries, most common cancer among women worldwide is carcinoma of cervix. The sample constituted 110 histopathologically confirmed cases of carcinoma of cervix and 110 normal healthy females with no obvious genetic disorder. Different parameters like fingertip patterns, interdigital area patterns, total finger ridge count (TFRC), absolute finger ridge count (AFRC), atd angle, palmar ridge count (a-b, b-c, c-d, t-d) were studied. Statistical analysis of data showed significant increase in frequency of whorls, total finger ridge count (TFRC), absolute finger ridge count (AFRC) & atd angle in both hands of carcinoma cervix patients as compared to controls. There was significant decrease in frequency of ulnar loops & t-d ridge count in both hands of carcinoma In developing countries, most common cancer among women worldwide is carcinoma of cervix. The sample constituted 110 histopathologically confirmed cases of carcinoma of cervix and 110 normal healthy females with no obvious genetic disorder. Different parameters like fingertip patterns, interdigital area patterns, total finger ridge count (TFRC), absolute finger ridge count (AFRC), atd angle, palmar ridge count (a-b, b-c, c-d, t-d) were studied. Statistical analysis of data showed significant increase in frequency of whorls, total finger ridge count (TFRC), absolute finger ridge count (AFRC) & atd angle in both hands of carcinoma cervix patients as compared to controls. There was significant decrease in frequency of ulnar loops & t-d ridge count in both hands of carcinoma cervix patients as compared to controls. While there was no any significant difference in the frequency of radial loops, arches, interdigital area patterns & a-b, b-c, c-d ridge counts between patients & controls.cervix patients as compared to controls. While there was no any significant difference in the frequency of radial loops, arches, interdigital area patterns & a-b, b-c, c-d ridge counts between patients & controls.
EnglishDermatoglyphics, Fingertip patterns, Interdigital area patterns, Finger ridge counts, atd angle, Palmar ridge counts.INTRODUCTION
The skin on the fingertips, palmar surface and plantar surface of man has ridges, which form configurations that are unique to every individual. “Dermatoglyphics” is scientific study of epidermal ridges and their configurations on the volar aspect of palmar and plantar regions (Cummins and Midlo, 1926)3 . The dermatoglyphic patterns make their appearance on volar aspect of palm as early as 6th to 7th week of gestation. They become prominent and subsequently reach their maximum size by 12th week of gestation. Once formed in intrauterine life, these patterns don’t change throughout life (Penrose, 1969)8 . Carcinoma of cervix is the second most common cancer among women worldwide. Primary cause of carcinoma of cervix is not precisely known. Etiological factors for most of the malignancies in general include genetical, environmental or both. Twin studies have shown that heredity plays a role in its etiology. On the other hand the fact that carcinoma of cervix is uncommon in married Jewish women suggest involvement of some racial factors. The present study was undertaken to evaluate dermatoglyphic pattern in females of carcinoma cervix. An attempt was done to draw the conclusion regarding genetic basis of carcinoma cervix.
MATERIAL AND METHODS
The sample constituted 110 patients suffering from carcinoma of cervix, all above 25 years of age group. All patients in this study were histopathologically confirmed cases of carcinoma cervix. While selecting patients of carcinoma cervix, care was taken to rule out any other associated genetic disorder. The control group constituted of 110 females from general population which were normal healthy females with no other obvious genetic disorders, all above 25 years of age group. While selecting control, care was taken to rule out any hereditary disease and carcinoma in the family. Dermatoglyphic prints were taken by ‘INK METHOD’ described by Cummins (1936)2 . The subjects were asked to clean their hands and to dry them but leave some moisture. The requisite amount of ink was placed on the glass slab. It was uniformly spread by the rubber roller. The thin film of ink was applied on the palm by passing the inked rubber roller uniformly over the palm and digits taking care that the hollow of the palm and the flexor creases of the wrist were uniformly inked. The hands of subject were then placed on the sheet of paper from proximal to distal end. The palm was gently pressed between inter–metacarpal grooves at the root of fingers and on the dorsal side corresponding to thenar and hypothenar regions. The palm was then lifted from the paper in the reverse order from distal to proximal end. The fingers were rolled from radial to ulnar side to include all the patterns. The prints were subjected for detail dermatoglyphic analysis with the help of magnifying hand lens. Qualitative parameters (fingertip patterns- arches, radial loops, ulnar loops & whorls, patterns in five interdigital areasthenar/I, II, III, IV & hypothenar areas) & Quantitative parameters ( Total finger ridge countTFRC, Absolute finger ridge count- AFRC, atd angle, palmar ridge count like a-b, b-c, c-d & t-d ridge counts) were studied. For statistical analysis of qualitative data Chisquare test (X2 ) and for quantitative data t- test were applied.
OBSERVATION AND RESULTS
There was significant increase in frequency of whorls, total finger ridge count (TFRC), absolute finger ridge count (AFRC) & ‘atd’ angle in both hands of carcinoma cervix patients as compared to controls (p < 0.001). There was significant decrease in frequency of ulnar loops & t-d ridge count in both hands of carcinoma cervix patients as compared to controls (p< 0.001). While there was no any significant difference in the frequency of radial loops, arches, interdigital area patterns & a-b, b-c, c-d ridge counts between patients & controls (p > 0.05).
DISCUSSION
In developing countries, carcinoma cervix accounts for 80% of cancer & has genetic background (Park, 2000)6 . In malignancy there is increased and uncontrolled growth and since growth is controlled by genes, it indicates that genetic factor is involved in all cancers. However in some cancers primary cause is environmental and some cancers are common in certain races. The etiology of carcinoma of cervix is not clearly defined. Both racial and genetic factors seem to play a part in its causation. Twin study has shown that identical twins have slightly higher concordance of carcinoma of cervix as compared to non identical twins. This suggest genetic basis of carcinoma of cervix. Very little study has been done uptill now on dermatoglyphic features in carcinoma cervix. So the present study is undertaken to find out the variation of palmar dermatoglyphic pattern in carcinoma cervix which is compared and correlated with various workers. Pal G. P. et al (1985)7 observed significant high frequency of arches & low frequency of ulnar loops in both hands of patients of carcinoma of cervix. While Inamdar V.V. et al (2006)4 observed significant high frequency of whorls, low frequency of ulnar loops in both hands, in addition they also observed increased frequency of arches in left hand of carcinoma cervix group as compared to control group. Reddy S.S. et al (1977)9 has observed significant high frequency of whorls only in patients. Present study has revealed significant high frequency (p < 0.001) of whorls (Fig.1) and low frequency (p < 0.001) of ulnar loops in both hands of carcinoma cervix group as compared to control group (Table 1). While frequency of arches and radial loops were found to be non significant (p > 0.05) in both hands of carcinoma cervix group as compared to control group. Pal G. P. et al (1985)7 reported difference for III interdigital area where patients showed significant low frequency for presence of pattern while Inamdar V.V. et al (2006)4 has not observed significant difference for presence of interdigital area pattern between carcinoma cervix and control group. Reddy S.S. et al (1977)9 observed significant difference in frequency of presence of patterns in I, II and IV interdigital areas of patients and controls. In present study no difference (p > 0.05) was observed in the frequency of presence of patterns in palm i.e. I, II, III, IV and hypothenar patterns, in carcinoma of cervix group and control group (Table 2), which matches with the study of Inamdar V.V. et al (2006)4 . No significant difference was observed in a-b ridge count in carcinoma of cervix and control group by Reddy S.S. et al (1977)9 and Pal G.P. et al (1985)7 . Inamdar V.V. et al (2006)4 also has not observed any significant difference in a-b, b-c and c-d ridge count in carcinoma of cervix and control group. In present study, there was no difference (p > 0.05) in a-b, b-c and c-d ridge counts among carcinoma of cervix and control group, in both hands (Table 3). Inamdar V.V. et al (2006)4 & Reddy S.S. et al (1977)9 have reported significant decrease in t-d ridge count in both hands of carcinoma cervix group. Pal G.P. et al (1985)7 has observed decrease in t-d ridge count in both hands of carcinoma cervix group but it was not significant. Present study has observed significant decrease (p < 0.001) in t-d ridge count in both hands of carcinoma cervix group as compared to control group as observed by previous workers (Table 3). Pal G.P. et al (1985)7 reported significant increase in the value of ‘atd’ angle while Inamdar V.V. et al (2006)4 & Reddy S.S. et al (1977)9 have observed significant decrease in the value of ‘atd’ angle in both hands of carcinoma cervix group as compared to control group. In present study the value of ‘atd’ angle was found to be increased significantly (p < 0.001) in both hands of carcinoma cervix group as compared to control group (Table 3) which was also reported by Pal G.P. et al (1985)7 . As there is negative correlation between ‘atd’ angle and t-d ridge count (Berg, 1968)1 , decrease in t-d ridge count will give higher value of ‘atd’ angle. This correlation was not observed by Reddy S.S. et al (1977)9 and Inamdar V.V. et al (2006)4 . Pal G. P. et al (1985)7 reported significant decrease while Inamdar V.V. et al (2006)4 & Reddy S.S. et al (1977)9 have reported significant increase in total finger ridge count in patients as compared to controls. Present study has revealed a significant increase (p < 0.001) in total finger ridge count in patients as compared to controls (Table 4). As present study has revealed high frequency (p < 0.001) of whorls in patients (Fig.1), total finger ridge count is increased in carcinoma cervix group as compared to control group. As there is considerable variation with respect to finger ridgecount asymmetry and diversity from finger to finger (Jantz R.L., 1975)5 , the variation of mean total finger ridge count between the study of previous workers and present study is considerable. Absolute finger ridge count (AFRC) which represents the sum of ridge counts from all the separate triradii on all the ten digits was not studied by previous workers. A significant increase (p < 0.001) in absolute finger ridge count in carcinoma of cervix group as compared to control group was observed in present study (Table 4).
CONCLUSION
The results of our study along with those of other studies showed certain specific association between carcinoma of cervix and ridges indicating that genes which are responsible for disease are also responsible for abnormal ridge formation. This study has indicated that genetic background does exist for the same. A few of the contradictory findings between present study and other study groups can not be explained at this stage. Such variations between populations living in different regions are well known. But dermatoglyphic findings, which have shown association with the carcinoma of cervix, as a diagnostic aid will be of limited use at this stage. More detailed studies in different populations and in big sample size are desirable before arriving at some definitive conclusion.
Englishhttp://ijcrr.com/abstract.php?article_id=1426http://ijcrr.com/article_html.php?did=14261. Berg J.M. (1968): A study of t-d dermal ridge count on the human palm. Human Biology, 40: 375-385.
2. Cummins H. (1936): Dermatoglyphic stigmata in mongolism idiocy. Anatomical record 64: (supplement – 2): 11.
3. Cummins H. and Midlo C. (1926): Palmar and plantar epidermal ridge configurations (Dermatoglyphics) in European Americans. American Journal of physical Anthropology, 9: 471 – 502.
4. Inamdar V. V., Vaidya S. A., Kulkarni P., Devarshi D. B., Kulkarni S., Tungikar S. L. (2006) : Dermatoglyphics in carcinoma of cervix. Journal of Anatomical society of India, 55 (1): 57 – 59.
5. Jantz R. L. (1975): Population variation in asymmetry and diversity from finger to finger for digital ridge - counts. American Journal of physical Anthropology, 42 (2): 215.
6. K park (2000): Textbook of preventive & social medicine, 16th edition by m/s Banarasidas Bhanot publishers 2000, 16: 288.
7. Pal G. P., Routal R. V., Bhagwat S. S. (1985): Dermatoglyphics in the carcinoma of the cervix. Journal of Anatomical society of India, vol. 34, no. 3: 157 – 161.
8. Penrose L. S. (1969): Dermatoglyphics. Journal of Scientific American, 221: 71 – 82.
9. Reddy S. S., Ahuja Y. R., Reddy O. S. (1977): Dermatoglyphic studies in carcinoma of the cervix. Indian Journal of Heredity, 1977, 9: 35 – 40.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524154EnglishN2013February28TechnologyENCRYPTION AND DECRYPTION USING ANGLES
English141147M. YamunaEnglish Kailash Chandra SanwalEnglish Radhe Shyam JangidEnglish Sanyam JainEnglishIn this paper we provide a method of encryption and decryption of messages using properties of angles in a circle. We have devised a method of developing a base chart using concentric circles and hence encrypt and decrypt any message. The base chart and the angle of the circle is used as the encryption decryption key.
EnglishCircle, Angle.INTRODUCTION
Encryption is a process which is applied to text messages or other important data, and alters it to make it humanly unreadable except by someone who knows how to decrypt it. Encryption is a method by which any kind of messages such as email, e-commerce, banking, or any other personal information, become encoded so they are illegible to anyone other the intended person without a special deciphering of the code, with a special key or other code. This form of security is necessary to handle the privacy of almost all personal and private information Encryption Decryption Key that passes through from one computer to another. Information such as data or messages that are sent is regarded as plain text until that information is encrypted and then is labeled as Cipher text. [ 4 ] Encryption becomes vital for a secure and safe environment for the computers and the internet. In cryptography, encryption is the process of encoding messages ( or information ) in such a way that eavesdroppers or hackers cannot read it, but that authorized parties can. In an encryption scheme, the message or information ( referred to as plaintext ) is encrypted using an encryption algorithm, turning it into an unreadable cipher text. Decryption is the reverse process to encryption. Frequently, the same Cipher is used for both encryption and decryption, while encryption creates a Cipher text from a plaintext, decryption creates a plaintext from a Cipher text. [5] In this paper we propose a method of encryption and decryption of any message, using the properties of angles in a circle as the key for encryption and decryption.
MATERIALS AND METHOD
A circle can be defined as the curve traced out by a point that moves so that its distance from a given point is constant. A sector is a region bounded by two radii and an arc lying between the radii. A chord is a line segment whose endpoints lie on the circle. Diameter of a circle is the longest chord, a line segment whose endpoints lie on the circle and which passes through the centre; or the length of such a segment, which is the largest distance between any two points on the circle. Concentric circles are circles with a common center. The region between two concentric circles of different radii is called an annulus. Any two circles can be made concentric by inversion by picking the inversion center as one of the limiting points. [ 2 ] The circle with its center at the origin is a platform for describing all the possible angle measures from 0 to 360 degrees, plus all the negatives of those angles, and plus all the multiples of the positive and negative angles from negative infinity to positive infinity. The positive angles on the unit circle are measured with the initial side on the positive -axis and the terminal side moving counterclockwise around the origin. If we measure angles clockwise instead of counterclockwise, then the angles have negative measures. [ 3 ]
MAIN RESULT
We first determine the number of symbols ( x ) required for encryption of any message. We then construct nine concentric circles to generate eight annulus. Let us label the annulus as A1, A2,…, A8, where A1 is the innermost annulus. We then divide these nine concentric circles into 360 / x parts with respect to the origin by drawing 360 / x diameters that is, all the concentric circles are divided into 360/ x sectors, where the angle of each sector is 360 / x. We fix the upper and lower limits for each angle of the sector. For the first sector we fix the lower limit as 0 and upper limit as 360 / x ( rounded off to nearest integer ). This is expressed as [ 0, 360 / x ]. We design the base chart as follows. We use the annulus for representing the angles and values. All the values in the chart are written in the counter clockwise direction. A1: Label for all the x symbols starting from 1. A2: The x symbols are inscribed in any random order of comfort. A3: The corresponding positive angles of each symbol is listed. A4: The values of the angles rounded off to the nearest integer value is listed. A5: The upper and lower limit values of the corresponding angles is listed. A6: The corresponding negative angles of each symbol is listed. A7: The values of the angles rounded off to the nearest integer value is listed. A8: The upper and lower limit values of the corresponding angles is listed. This base chart can be designed as per the need of the message to be encrypted. This base chart will be the key chart to be used for encryption and decryption that can be designed and decided by the transmitter and receiver depending on their need and use. Once the base chart is decided we decide the encryption key based on the positive or negative angles of the base chart. The message is then encrypted with the first symbol representing the encryption key using the upper lower limit values of the corresponding angles from the base chart.
Model Chart:
For representation of the chart we choose 40 symbols which are necessary for encryption of a normal message. The number of symbols in the chart can be increased on decreased depending on the need of the message to be encrypted. All the forty sectors are represented in the chart where the angle of each sector is 9o . All the values of the eight annulus are listed as explained. The negative angles are listed without the negative sign.
Encryption Decryption Key
Apart from the encryption chart we also decide an encryption key. We provide four possible keys.
1. Key 1 = Positive angles. We shall use p as the encryption key in this case. In an encoded message the first symbol p indicates that the message is encoded using positive angles.
2. Key 2 = Negative angles. We shall use q as the encryption key in this case. In an encoded message the first symbol q indicates that the message is encoded using negative angles.
3. Key 3 = Positive negative angles. We shall use r as the encryption key in this case. In an encoded message the first symbol r indicates that the message is encoded using alternatively positive negative angles.
4. Key 4 = Negative positive angles. We shall use s as the encryption key in this case. In an encoded message the first symbol s indicates that the message is encoded using alternatively negative positive angles.
Encryption Algorithm
Read the message symbol by symbol from left to right.
Decide any one of the four encryption keys and add it as the first symbol of the message that is, the leftmost symbol will represent the decided key.
Replace every symbol by its approximate angle value from the base chart. We assign a three digit value to all the symbols. For symbols with one or two digit angle values prefix the value with zeros.
Replace every approximate angle value by any three digit angle value (one or two digit angle values are prefixed with zeros ) from the corresponding [ lower, upper ] range. ? Encrypted the angle values as the message.
Decryption Algorithm
Get the encrypted message.
From the first three digit values decide the encryption key from the base chart.
Determine the corresponding symbols for the remaining angles using the base chart and encryption key decrypt the message.
Example
Suppose we want to send the message GOOD LUCK. Let us use the positive angle traversal. So the message to be encrypted is PGOOD LUCK. The approximate angle from the base chart is 270 189 261 261 162 9 234 315 153 225. The upper and lower limit angles angle ranges from the base chart is [ 262, 270 ] [ 181, 189 ] [ 253, 261 ] [ 253, 261 ] [ 154, 162 ] [ 0, 9 ] [ 226, 234 ] [ 307, 315 ] [ 145, 153 ] [ 217, 225 ]. Selecting any value from this range one possible way in which the data to be send is ( the data are separated by space ) 182260255159008233313150219 From the limits of the angles we observe that the there are 910 = 3486784401 ways of encoding the message GOOD LUCK. Suppose the received data is 084059170228115137069. Since the first value is 084 from the chart we observe that the decryption key corresponds to negative angle. Also from the chart we can calculate the received values fit in the range [ 55, 63 ] [ 163, 171 ] [ 226, 234 ] [ 109, 117 ] [ 136, 144 ] [ 64, 72 ]. From the chart the received data is decrypted as THANKS This proposed method can be programmed in any comfortable programming language. We have written a program in C++ using the model base chart with 40 symbols. Our output screen for one example is shown below.
Before the message is transmitted we can also swap the three digit values. For example suppose the three digit angle value is 283. Then this can also be encoded as 238, 823, 832, 328, 382. This will avoid anyone from guessing that angles are used for encryption because now the upper limit of the three digit values is no more 360. For each three digit angle value we have 3! Ways of encryption. This infact increases the security of the system. For each of the 9 10 ways of encrypting the message GOOD LUCK we have 3!10 ways of sending the message by this swapping technique. We also have done a program by swapping the data. Our output screen for the same example with swapping is shown below
CONCLUSION
By using combinatory method with additional mathematical techniques (ex: swapping of each angles, some addition or subtraction etc.) it is becoming the most secure cryptographic technique. By doing a complete rotation or two (or more) and adding or subtracting 360 degrees or a multiple of it before settling on the angle’s terminal side, we can get an infinite number of angle measures, both positive and negative, for the same basic angle. We have used a circle to construct the base chart. We can use rectangles, squares, or any kind of polygons and their angles to prepare the base chart. So we conclude that apart from the method provided here to construct the base chart there are many other ways in which one can design the encryption decryption chart. The arrangement of the symbols in the annulus A2 can be done in x! ways. So the three digit angle values assigned to the symbols vary as the arrangement in the annulus A2 changes. Also as the number of symbols under consideration reduce, the number of combinations possible for [upper, lower] limits increases and hence the number of combinations available for encryption of the symbol increases. We can design the base chart with the required number of symbols and hence increase the security of the system. Also in the proposed method we have used only integer values. Use of real numbers for the [upper, lower] limit provides us infinite number of possible ways for encryption of a single symbol. All these advantages of this way of encryption ensure the safety of the encoded message making the proposed system a safe and efficient one.
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=1427http://ijcrr.com/article_html.php?did=14271. Jin Ho Kwak, Sungpyo Hong, Linear Algebra, Second Edition, Springer International Edition.
2. http://en.wikipedia.org/wiki/Circle (accessed on 2012 Nov 05)
3. http://www.dummies.com/howto/content/negative-and-positive-anglescutting-a-circle.html. (accessed on 2012 Nov 05)
4. http://www.essortment.com/encryption29511.html [accessed on 2012 Nov 02].
5. http://en.wikipedia.org/wiki/Encryption. [accessed on 2012 Nov 02]