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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30General SciencesHEXACHLOROBENZENE - SOURCES, REMEDIATION AND FUTURE PROSPECTS
English0112D.J. Mukesh KumarEnglish S. Dinesh KumarEnglish D. KubendranEnglish P.T. KalaichelvanEnglishHexachlorobenzene (HCB) is one of the highly toxic and persistent compounds that are released unintentionally through various man-made chemicals. It is considered as a member of POPs (persistent organic pollutants) because it is persistent for long period of time in the environment and found to be hazardous for all living organisms. The present review focuses on the various sources of hexachlorobenzene present in the environment. Few Remediation technologies currently available for destruction of HCB from the environmental compartment such as soils, sediment and air were described in detail. Further, the transfer of HCB in to environment, their mode of action, toxicity, exposure and its health effects were also discussed.
EnglishHexachlorobenzene (HCB), Persistent Organic Pollutants (POPs), Remediation technologiesINTRODUCTION
Hexachlorobenzene (HCB) is a persistent nondegradable chlorinated hydrocarbon which was first introduced as fungicide in year 1945 for seed treatment. It is also found as an unintentional byproduct in the manufacture of chlorinated solvents such as carbon tetrachloride, perchlorethylene, trichloroethylene and pentachlorbenzene (Ritter et al., 1995). HCB is a white crystalline solid having 6 chlorine atoms and has low solubility in water (5 μg/l) at 25°C (Ramamoorthy and Ramamoorthy, 1997) but soluble in benzene, chloroform, ether, carbon disulfide, and boiling alcohol. It is quite volatile and can be expected to partition into the atmosphere as a result. It is found to be strongly resistant to breakdown and has a high partition coefficient (KOW=3.03-6.42), and is known to bioaccumulate in the fat of living organisms (Ritter et al., 1995).
The first reports on the toxicity of HCB was reported in 1950, describing liver damage, irritation of the respiratory system, and eye damage with the warning that the allowable concentration was 50 ppm, but that itself should be considered as dangerous (John Jarrell et al., 2000). However, hexachlorobenzene had come to public attention during 1954 -1959 when people of eastern turkey developed porphyria diseases, due to ingestion of HCB treated seed grains.
Although HCB is no longer used directly as a pesticide, it is currently formed as an unintentional by-product of several industrial sectors where both chlorine and carbon are present (Royal Haskoning, 2003). HCB is toxic, persistent, and liable to bioaccumulate and so is recognized as a POPs (Persistent Organic Pollutants). The HCB has a half-life from 2.7 to 6 years in water and in the atmosphere, and may have a half life of more than 6 years in soil (Mackay et al., 1992). According to the Environmental Protection Agency’s Toxic Chemical Release Inventory, in 1997 about 18 tonnes of hexachlorobenzene were reported to be accumulated per year as waste product (WHO 1997).
MODE OF TRANSFER TO THE ENVIRONMENT Due to its high persistivity and long range transport property, HCB is distributed throughout the environment. Hexachlorobenzene may enter the environment through air emissions, pesticide impurities, combustion products, municipal incinerators, volatilization and leaching from landfills, and emissions from combustion processes.
The total HCB emissions in atmosphere from 15 OSPARCOM countries in 1990 were 2851 kg/year (Berdowski et al., 1997). The world-wide emissions of HCB in the mid 1995 are estimated to be in the range of 12,000 to 92,000 kg/year (Bailey, 2001).
Soil is the major environmental media that has high impact over HCB exposure. Although the global volume of soil is considerably less than the volume of air, soil will contain a much greater mass of HCB than air. It is estimated that soil consists of higher HCB concentration than air and water. It has 88% of total HCB concentration (Fig.1). Thus transfer of HCB to the soil must seriously be taken into account (Tissier et al., 2005). The relationship between soil and air concentrations under equilibrium conditions is described by the soil/air partition coefficient (KSA). Reported log KSA values for HCB range from 7.27 (Meijer et al., 2003b) to 4.98 (Hippelein and McLachlan, 1998). Hexachlorobenzene is emitted onto soils by pesticides use and through waste disposal. Even though production of hexachlorobenzene as pesticide was discontinued in many countries, it is unintentionally released as a by-product in the manufacture of chlorinated solvents, chlorinated aromatics and chlorinated pesticides. Approximately 4130 tons/year of hexachlorobenzene were generated as a waste product in 1986 in USA and that nearly 77% of this was produced from the manufacture of three chlorinated solvents: carbon tetrachloride, trichloroethylene and tetrachloroethylene (WHO, 1997).
In case of air which has huge global volume, the partition coefficient of hexachlorobenzene will be high. But its concentration will be low in the air when compared to soil, because the release of HCB in this compartment is very low. Around the globe air comprises of 9% of total HCB concentrations ( Fig. 1). Industrial production of inorganic chemicals plays vital role in releasing HCB into the air. About 958 pounds were estimated to be present in the air during 1996, which comprises about 48% of total HCB concentration in the air. The production of silicone-based products, which includes antifoams, emulsions, hard coats, elastomers, adhesives, release coatings, and sealants, is reported as the source of HCB emissions from this source category. Production of pentachlorophenol emits Hexachlorobenzene in workplace air (Melnikova et al., 1975).
Next to air, the water and sediments consists of 1% and 2% of total HCB concentration in atmosphere ( Fig. 1). These low concentrations are due to low water solubility of HCB (5µg/liters). Thus HCB does not directly discharge into water. HCB releases to water include direct point source discharges to water bodies as well as contamination via agricultural runoff from the use of pesticides containing HCB. According to toxic release inventory (TRI) data pesticide and chloralkali production facilities periodically discharge HCB to local water bodies. In 1997, 250 lbs of HCB were released into water by the alkalies and chlorine sector and 26 lbs by the agricultural chemicals sector, where only 4 lbs of HCB is released directly into the water.
MODE OF ACTION
Although HCB is persistent, it does degrade at a slower rate in all environmental compartments. This degradation depends on half-life of HCB in various compartments. If it is released to the soil, it has a half-life of 3-6 years. This means that half of the total amount will disappear after 3-6 years, half of the remaining amount will disappear in another 3-6 years, and this process will continue each 3-6 years thereafter. If it is released to surface waters such as lakes, rivers, and streams, the halflife is 2.7-5.7 years, and if it is released to groundwater, the half-life is 5.3-11.4 years. Its half-life in air ranges from 0.63 to 6.28 years.
Once HCB enters the environment, it breaks down very slowly, making it extremely persistent. One reason for its slow degradation is that it does not dissolve in water, mostly sticks strongly to soil particles as well as to sediment on the bottom of lakes and rivers. It can also build up in wheat, grasses, some vegetables, and other plants when it is present in soil (NRDC, 2001).The major route of human exposure is through food.
Hexachlorobenzene can enter our body when we eat food contaminated with it. After it enters the body, it rapidly spreads through the blood to many tissues in the body, especially to fat. This probably happens within a few hours. It will remain in the body, especially in fat, for years. During pregnancy, this substance can transfer to the fetus through the mother's blood, or after birth large amount of HCB can also be transferred through breast milk. Most of the HCB is eliminated from body through feces and urine (ATSDR, 1996).
TOXICITY
The first toxicity on HCB exposure was reported during 1954-1959 when people of Anatolia, Eastern Turkey developed porphyria turcica, a disorder of heme biosynthesis and porphyria cutanea tarda. 500 people were fatally poisoned and more than 4,000 people felt ill by eating bread made with HCB-treated flour that was intended for agriculture use. Most of the people were affected with porphyria cutanea tarda, which disturbs the metabolism of hemoglobin and results in skin lesions. Mortality was recorded up to 14%. Mothers, who had eaten tainted bread, transfer the HCB to their children by placental transfer and through breast milk. Children born to these women developed "pembe yara" or pink sore and died within 2 years (Peters, 1976).
The women who survived the Turkish HCB episode were identified as an appropriate group to evaluate for human reproductive outcomes (John Jarrell et al., 1998). A study on the toxic profile of HCB was conducted with 42 subjects affected with Porphyria Cutanea Tarda. Meanwhile, another 42 subjects were selected from the same region of Diyarbakir in southeastern Turkey who had not exposed to HCB (control group). In addition, 42 subjects were obtained from the capital, Ankara (control group). After 40 years of studying John Jarrell et al., 1998 noticed that the control subjects did not differ from the exposed group in the mean serum concentrations of HCB. From this he concluded that HCB had been effectively eliminated from the exposed population, or the HCB is transferred over a long distance and exposed to control groups. Follow-up studies conducted by Jensen et al., 1991 concludes that average HCB levels in breast milk were still more than seven times the average for unexposed women.
EXPOSURE AND HEALTH EFFECTS
People were exposed to these contaminants primarily through the foods contaminated with HCB as a result of the accumulation of this substance in the high-fat foods, such as, dairy products, eggs, animal fats, and some fish. HCB is highly found to be accumulated in fat rich tissues, so marine mammals such as blue whales and seals will be highly exposed to HCB emissions (Espelend et al., 1997). In addition, HCB is poor water soluble, thus it concentrated on sea water and exposed to marine organisms through food chain. By eating fishes that were exposed to HCB, humans were also subjected to exposure. The infants receive large dose of HCB from their mother either through breast feed or via lipid rich eggs. Nakashima et al (1997) showed that rats transfer HCB to their offspring’s through breast feed.
About 90% of HCB has been intake by adults in the general population through diet. Based on levels of HCB in air, water and food, the total intake of HCB by adults is estimated to be between 0.0004 and 0.003 ng/g body weight per day (ATSDR, 2002). In Germany, the women who ate a healthy diet (with low meat consumption and high fruit and vegetable intake) had much lower levels of HCB in their milk compared to women who ate a lot of meat (Schade and Heinzow, 1998). HCB exposure occurs by industrial emissions also. Quinsey et al (1995) showed that areas with less industrialization have significantly lower levels of HCB in the general population, whereas people living in industrial areas have high concentration of HCB exposure.
Exposure to HCB may cause eye, skin, and respiratory tract irritation. Long-term oral exposure has been reported to cause liver disease with associated skin lesions such as porphyria cutanea tarda in humans (U.S.EPA, 2000). Porphyria is the most consistently identified outcome following exposure of humans with HCB. It was discovered that HCB induces Porphyria after outbreak of porphyria cutanea tarda (PCT) in Turkey between 1955 and 1959 (John Jarrell et al., 1998). The symptoms reported for this disease are neuritis, photosensitivity, fragile and scarred skin and increased excretion of porphyrins (Peters et al, 1982). Studies in animals and humans have provided inconclusive evidence of carcinogenicity for hexachlorobenzene. Animal studies have reported cancer of the liver, thyroid, and kidney from oral exposure to hexachlorobenzene. The International Agency for Research on Cancer (IARC) has determined that hexachlorobenzene is possibly carcinogenic to humans. They placed HCB in Group 2B (IARC, 1987). The U.S.EPA has concluded that hexachlorobenzene is a probable human carcinogen. They placed HCB in Group B2 (ATSDR, 2002).
SOURCES OF HCB HCB
dominated its emissions during the 1950s and 1960s due to its direct use as fungicide. During this period thousands of tonnes of HCB were used each year. This period is referred to as peak period of HCB emission. Details of the global production of HCB are not known for this peak period. Today, however, HCB is no longer used in agriculture. Its use as a fungicide was banned in most countries in the 1970s and 1980s. This period is referred to as peak decline period. During this period the largest single primary source of HCB in the environment was removed, and therefore emissions of HCB fell sharply in the 1980s. The graphical data showing significant decreases in HCB emissions in Europe from 1970- 1995 was shown in Fig. 3.
Currently, the principal sources of HCB in the environment are estimated to be the manufacturing of chlorinated solvents, the manufacture and application of HCB-contaminated pesticides, and inadequate incineration of chlorine-containing wastes (Bailey, 2001).
Industrial sources
The common route for industrial HCB production is the direct chlorination of benzene at 150-200°C over a ferric chloride catalyst or from the distillation of residues from the production of perchloroethylene (Brooks and Hunt, 1984). However this direct synthesis of HCB was banned in 1970, it is produced inadvertently by following industries.
i. The Metals Industry
The metallurgical processes such as high temperature steel production, electrolytic production of aluminium, the smelting and refining of copper are found to be typical sources of HCB. HCB is emitted to the atmosphere in form of flue gases generated by metallurgical industries (Bailey, 2001). Westberg et al. (1997) has reported that smelting of hexachloroethane (HCE) can produce HCB with an emission factor of 5.2mg of HCB/ton of aluminium. The smelting of magnesium is also believed to produce HCB in high rates. Surface coating of metal cans also will release significant amount of HCB. About 420 lbs i.e., 21% of total HCB emissions were found to be released from surface coating of metal cans (U.S.EPA, 2000).
ii. Pulp and Paper Mills
The manufacture of pulp and paper has resulted in HCB release into environment. Unlike poly chlorinated biphenyls (PCBs) pulp and paper mills do not favour production of HCB. But report from the Ontario Ministry of Energy and Environment, based on Municipal/Industrial Strategy for Abatement (MISA) states that pulp and paper mills take part in emitting HCB in limited amount (Jonathan Barber et al., 2005).
iii. Inorganic chemical industry
Silicon-based products such as antifoams, emulsions, hard coats, elastomers, adhesives, release coatings, and sealants, are reported as inorganic chemicals that releases HCB in large amount. These industries generate HCB by reducing silica (sand) to elemental silicon by reaction with methyl chloride at 300ºC in the presence of a copper catalyst. About 958 lbs i.e., 48% of total HCB emissions were found to be released from industrial inorganic chemicals (USEPA, 2000).
Combustion Sources
i. Cement Production
It is a controlled combustion process. Burning of hazardous waste as fuels for cement kilns has caused release of HCB into atmosphere. About 16% of the cement kilns burn hazardous waste as an auxiliary fuel. Data from a survey conducted by the Canadian Portland Cement Association states that during cement production about 0.17 mg of HCB is released per ton of cement (Bailey, 2001).
ii. Fires and open burning
It is an uncontrolled combustion process. Open burning of house hold waste plays a significant role in release of HCB. The amount of HCB emitted from residential open burning is estimated at 22-48 mg /ton of waste burned (Lemieux et al., 1999).
iii. Petroleum Refining The sources of HCB at petroleum refineries are not known accurately. A very limited literature is available for the emission of hexachlorobenzene from petroleum refineries. Catalytic reforming process is best example for Refining process. Here Regeneration of spent catalyst requires oxidative removal of contaminants at temperatures of 400- 455ºC and then reactivation of the catalyst through the use of chlorinated compounds (e.g., methylene chloride, 1,1,1-trichloroethane, and ethylene dichloride) at 400-500ºC. Due to heating of chlorine containing compounds at high temperature, it releases HCB and PCBs. About 32 lbs/year i.e., 1.6% of total HCB emissions were found to be released from this process (USEPA, 2000).
Incineration Sources
Incineration is an important source of HCB in the environment. HCB can be emitted from incineration as a result of incomplete thermal decomposition of HCB-contaminated industrial wastes, chlorinated organic compounds such as Kepone, mirex, chlorobenzenes, PCBs, PCP, PVC and mixtures of chlorinated solvents (Jonathan Barber et al., 2005). Municipal waste, medical waste and sewage sludge incinerators are major source of incineration process reported to emit hexachlorobenzene in large amount (Benazon, 1999). Total HCB releases from municipal incinerators in the US were estimated to be 977 kg/year in the early 1980s (Brooks and Hunt, 1984). HCB has been detected in emissions from the incineration process such as combustion of coal and hazardous wastes. HCB emissions from incineration facilities vary widely depending on the type of furnace, collection method and incineration temperature. There are many emission routes are possible from incineration. Among that most important emission route was concluded to be flue gas accounting about 62-97.9% followed by fly-ash and incinerator ash accounting about 1.9-38% and 0-2% respectively.
By-Product Sources
i. Pesticide Production:
Historically, HCB has been formed as a byproduct during the production of several chlorinated pesticides such as pentachlorophenol, dicloran, pentachloronitrobenzene (PCNB), chlorothalonil (TPN), trimethyl 2,3,5,6-terephthalate (TCTP), picloram and dacthal. These pesticides contribute bulk emission of HCB. Usually they found as an impurity in these pesticides (Ritter et al., 1995). But current applications of such pesticides are eliminated due to bans and restriction against HCB usage. When pesticides containing HCB are applied to crops, lawns, or gardens, HCB is released into the environment. The amount of contamination of HCB in various pesticides was estimated by Bailey (2001).
At present, all these pesticides except DCPA, picloram, and chlorothalonil have been banned in Europe. These pesticides contained HCB as an impurity in the final product. The impurity occurs when the appropriate procedures for synthesis and purifications were not followed. As a result, the level of HCB could be much higher (for example, PCNB was reported to contain 1.8-11% HCB (Tobin, 1986)). Almost every country including India has banned usage of these HCB contaminated pesticides, In Japan, HCB was never registered as an agricultural chemical, but during the period from 1952-1972, 70,000 tonnes of HCB was produced as a raw material for PCP, and this was probably the major source of HCB in that country.
ii. Chlorinated Solvent Production
Hexachlorobenzene is released as an unintentional by-product during manufacture of chlorinated solvents. Substantial quantities of HCBs are contained in the wastes generated by chlorinated solvent production. Perchloroethylene (PCE), Trichloroethylene (TCE), Carbon tetrachloride and pentachlorbenzene were major chlorinated solvents found to be emitting HCB in large quantities (Ritter et al., 1995). Even though, the HCB is removed by distillation of the solvents, the traces may still remain. The HCB can be separated by distillation process and settled in the distillation bottom fractions. The concentration of HCB in distillation bottoms in the 1980s was estimated to be 25% for perchloroethylene, 15% for carbon tetrachloride, and 5% for trichloroethylene (Jacoff et al, 1986). Manufacture of vinyl chloride monomer and volatile hydrocarbons is also known to produce HCB as a by-product. About 142 lbs/year i.e., 7% of total HCB emissions were found to be released from chlorinated solvent production (USEPA, 2000).
REMEDIATION AND REDUCTION OF HCB
Remediation involves removal of HCB from different compartments like soil sediments, air and water. Since, HCB was highly detected in soils and sediments (Fig.1). The majority of remediation technique adapted involves destruction of HCB from soils. HCB was settled down in soils for many years due to its long half life (more than 6 years) and affect the soil stability. There are several techniques to destroy the traces of HCB from soils and sediments. These treatment equally reduces the concentration of chemical congeners that are been produced by the HCB.
Base-Catalyzed Decomposition (BCD)
High grade impacted soils and wastes can be treated with this technology and contaminant load can be reduced by repeated treatment (Chen et al., 1997). BCD technology treats contaminated media by mixing it with an alkali (sodium bicarbonate) and heating them in a thermal desorption reactor to between 315 –500°C, which evaporates the halogenated compounds. The vapour stream is then condensed and sends to a BCD liquid tank reactor (LTR), where sodium hydroxide (catalyst) and carrier oils are added. The suspension in the reactor heated above 326°C for 3 - 6hrs, in which the contaminants are broken down. The technology can treat modest amounts of a wide range of soil sediments and mixed wastes, highly impacted with HCB to achieve very stringent clean-up targets if required by repeated application of the process to the same contaminated mass.
High-Temperature Dehalogenation (HTD)
This technology is used to treat high grade waste contaminated with pesticides and stockpiled material, by using the byproducts of calcium salt, elemental carbon and hydrogen, all of which are non-hazardous reaction products. It is effective only on HCB contaminated medium. In HTD process, the contaminated soils are mixed with calcium hydride or Ca2+ and placed in a reaction chamber containing a tungsten element, which is pressurized under pure argon gas and then electricity is pulsed through the tungsten coil to initiate the reaction. Once initiated, the temperature will reach to 3727°C. At such high temperature the POPs were break down into calcium chloride, carbon and H2. This technology has been proven at bench scale to destroy all POPs (mainly trialed on HCB).
GeoMelt techniques
GeoMelt can be used to treat very high concentration media and stockpiles, either in ex - situ or in -situ (Balmer et al., 2000; Goncalves et al., 2006). This technology uses intense heat to destroy HCB and permanently immobilize high grade wastes residues. The GeoMelt process uses a series of graphite electrodes and graphite frit within the soil matrix, placed in the ground. When matrix is heated between 1400 to 2000°C, the HCB break down typically to CO2, H2O and some HCl and volatilizes. The end product would be crystallized form of HCB and thus the media is completely free from HCB contamination. This technique is not suitable to treat soils below the water table or those having high water content.
High Temperature Incineration
The technology can treat small quantities of high grade to low grade soils, sediments and waters contaminated with HCB and PCBs. The process involves the heating of the contaminated media at 450-1100°C in a continuous indirect feed horizontal rotary kiln, under vacuum pressure below 50 kPa in the absence of air. The contaminants will vaporize and can be eliminated. This technique is used to remove HCB, PCBs, and dioxins. By this process contaminant samples of 0.1 ton/hr can be removed (Health and Safety Executive, 1993).
Gas Phase Chemical Reduction (GPCR)
The technology is used to clean-up impacted media with all forms of high grade POPs, at full scale to very low residual levels, in a sealed system. High grade POPs impacted soils, sediments and leachate/extracted waters can be treated by GPCR. The process uses 2 stages to achieve removal of HCB. In the first stage materials are heated to 600°C without oxygen in a batch process. This desorbs the POPs that volatilize and the treated soil is allowed to cool. In the second phase the gas vapours from the initial reaction pass to the GPCR reactor, where they react with H2 gas at 850–900°C. At this stage organic compound is converted to methane and water, chlorinated compounds are converted into HCL. Thus along with chlorinated compounds the HCB is eliminated. GPCR has been selected by UNIDO for pilot scale demonstration to treat 1,000 tons of HCB contaminated soil in Slovakia.
The major advantage in this process is that, it converts contaminants partly to CH4 which is then used as fuels.
Bioremediation process
Biological treatment includes usage microorganisms in the process that involves biodegradation. This biological treatment is a costly technique when compared to the incineration technique (Leagau, 1990). Biodegradation is a treatment process which uses microorganisms such as fungi and bacteria to degrade hazardous substances into nontoxic substances like water, CO2 (Ballerstedt et al., 1997; Mori and Kondo, 2002). After the HCB was degraded, the microbial population is reduced because they have completely utilized HCB as their food source. The extent of biodegradation is dependent on type of microorganism selected. Bioremediation can take place under aerobic and anaerobic conditions. In absence of oxygen, microorganism’s will breakdown HCB in the soils and sediments. In aerobic conditions, with sufficient oxygen, microorganisms will convert chlorinated compounds to carbon dioxide and water.
Solvent extraction process
Solvent extraction is a physico-chemical process adopted for separating organic contaminants from soil and sediment. By this process a considerable amount of chlorinated contaminant such as HCB that are present in soil and sediments are destroyed. In this process contaminated samples are fed into the extraction system along with solvent. Typically, more than 99% of the organics are extracted from the feed. In the extraction systems the solvent and organics are separated from the treated feed. After the separation the solvent and organic mixture passes to the solvent recovery system. In the solvent recovery system, the solvent is vaporized and recycled as fresh solvent. The organics are either reused or disposed off. Treated feed is discharged from the extraction system as slurry. The overall extraction efficiency of this process was found to be dependent upon the number of extraction cycles performed (Meckes et al., 1997).
CONCLUSION
With the knowledge of the various sources of the HCBs, action must be taken to reduce the exposure of such man-made chemicals. HCBs are considered as toxic by all routes of administration. Hematotoxicity and immunotoxicity have been consistently reported to be the most sensitive indicators of these chemical compounds. Therefore, more data are needed to establish the equivalency factors between their effects and their toxicity so as to allow normalization of measurements between different studies.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30General SciencesCORRELATION OF ELECTRON SPIN RESONANCE, NUCLEAR QUADRUPOLE RESONANCE, REFLECTANCE AND MAGNETIC PARAMETERS OF Ti (II, III), V (II, III &IV) AND Cr (III) COMPLEXES: A DFT STUDY
English1331Harminder SinghEnglish A. K. BhardwajEnglish M. L. SehgalEnglish Susheel K. MittalEnglishDFT implemented by ADF2010.02 was applied to calculate and correlate 14 ESR, NQR, reflectance and magnetic parameters of the first transition metal ion complexes. Commands like Single Point, LDA, Default, Spin Orbit, Unrestricted, None and Collinear were applied to the software using DZ or TPZ Basis sets.36 complexes such as [TiX4]- (X=F, Cl, Br, I), [TiX4]2- (X=F, Cl, I), [TiX6]3-,4- (X=F, Cl, Br I),[Ti(OH2)4]2+,3+, [VF4]0,1- (X=F, Cl, Br I), [VX6]4- (X = F, Cl, Br I), [V(H2O)6]+2, [CrX6]3- (X= F, Cl, Br, I, CN) and [Cr (NH3)]3+ having both the regular (Td, Oh) and the distorted stereochemistries (C1, D4h , D6h , D12 and S4) were selected to carry out all the computations in the gas phase. In [TiX6]4- (X= Br, I), LDA was replaced by GGABP. Spin Polarization was kept equal to the number of unpaired electrons present in the metal ions respectively. All the complexes possessed a Nysom symmetry and definite Pre-optimization .The software gave ESR (g11, g22, g33, giso, a11, a22, a33, Aten ), NQR [?, q11, q22, q33, NQCC] and optimization parameters [bonding energy, total energy having contributions from LDA and GGA components]. Two more ESR parameters [H^, ΔEhf] were calculated from these parameters. Also, two Reflectance parameters [? complex, % covalent character] were obtained from the giso parameter. Again, five magnetic parameters [?soc, ?t, ?net, t2g electron delocalization and its constant k] were derived from ESR and Reflectance parameters. Lastly, the Laplace equation was verified from the NQR parameters (q11, q22, q33,).The values of the ESR parameter like t2g electron delocalization constant (k) agreed well with the Reflectance parameter namely Nephelauxetic ratio (?35) because both determine the % covalent character in the complexes. The values of all the parameters calculated by the selective use of 18 relations would change with the change in oxidation states of the metal ions but were always in agreement with their reported values.
EnglishDFT, Nephelauxetic ratio, Pre-optimization.INTRODUCTION
Effective Spin Hamiltonian (H^) is a mathematical expression that determines the energy of an ESR transition in a paramagnetic complex. It depends upon the ESR [anisotropic and isotropic splitting factors (g11, g 22, g 33, g iso), hyperfine coupling constants (a11,a22, a33, A ten)] and NQR [electric field gradient or efg (q11,q22, q33), Nuclear Quadrupole Constant (Q)]* parameters, (S), (?e), (?n), (I), ( g n) and nature of the surrounding nuclei possessing quadrupole moments (I?1).
The following points necessitated the present study to be taken up with the help of software: There had hardly been any attempt made to theoretically calculate and correlate ESR, NQR, Reflectance and Magnetic parameters of transition metal ion complexes.
I. Theoretical calculation of (H^) of the complexes was never reported before as a class. II. With ESR transitions falling in low energy microwave region (X band: 9000-10000 MHz), the experiments required cumbersome cryoscopy conditions.
With certain commands, the ADF 2010.02 software gave the five ESR and NQR parameters. They were together used to calculate two other ESR parameters [effective spin Hamiltonian (H^) and hyperfine coupling energy (?E hf).The giso parameter was further correlated to two Reflectance parameters [spin orbit coupling constant (?complex), % covalent character]. Again, ESR and Reflectance parameters were together used to calculate and correlate five magnetic parameters [magnetic moments like total (?t), net (?net) and that containing contributions from spin and orbital (?soc or ?ADF), t2g electron delocalization and its constant (k)].
This communication is an extension of our previous work (1). Here, we have calculated and correlated parameters of 36 Ti(II,III),V(II,III,IV) and Cr(III) complexes such as [TiX4] 1- (X=F, Cl, Br, I), [TiX4] 2- (X=F, Cl, I), [TiX6] 3-,4- (X=F, Cl, Br I), [Ti(OH2)4] 2+,3+, [VF4] 0, 1- (X=F, Cl, Br I), [VX6] 4- (X=F, Cl, Br I), [V(H2O)6] 2+ ,[CrX6] 3- (X= F, Cl, Br, I, CN) and [Cr(NH3)]3+ having both regular (Td ,Oh) and distorted stereochemistries (C1,D4h, D6h , D12 , S4).We applied DFT(2-3) implemented in ADF 2010.02 software to obtain 5 parameters (g, a, q, NQCC, ?) which were further used to calculate 9 more parameters [H^,?E hf, ? complex, % covalent character, ?t , ?net, ?soc, t2g electron delocalization and its constant (k)].
(1) Calculation of ESR Parameters(4-12) Effective Spin Hamiltonian (H^) and Hyperfine Coupling Energy (?E h f)
Four contributing factors to H^ are: g, a, Q and interaction of nuclear magnetic moment with external magnetic field (I).Relations [1-3] having contributions from these four factors were used to calculate H^. The Hyperfine Coupling Energy (?E h f) was calculated by relations [4]. Relation [1] was used for systems with different values of g and a. [2] Was applied to axially symmetric systems. [3] Was applied if the systems had the same values of both a and g or g only. The first and the last terms in these relations were in ergs and the other two were in MHz (6.627 ? 10-21 erg = one MHz; ?e=1.3994 MHz/Gauss; ?n =?e /1836. g n has a specific value for each metal). ?Eh f and Q are in MHz).
(2) Calculation of NQR parameters (13-14) Asymmetry Coefficient (?) and Laplace Equation are calculated by relations [5-6]. Relations [1-6] are given under Table: 1. 5 A.
Relations used for calculating Reflectance and Magnetic parameters (15-20)
Parameters like ?soc, ?t , ?net, t2g electron delocalization (all in B.M), its constant k and ?complex (both in cm-1 ) were calculated by relations [7-18] given below the Table: 1. 6 B. ? soc was the magnetic moment from the spin orbit coupling and (?t) represented the total magnetic moment. ?tip and ?tip were the Zeeman Second Order molar magnetic susceptibility and Zeeman Second Order magnetic moment. ?Mol .s. o , always represents the molar magnetic susceptibility from ? s. o (1250.0Χ10-6 , 3333.3Χ10-6 and 6250.0Χ10- 6 c g s /mol with 1, 2 and 3 unpaired electrons respectively).?t was the total molar magnetic susceptibility and k was t2g electron delocalization constant. n =8 or 4 for A or E ground terms respectively. ?Metal ion and ?complex were the spin-orbit coupling constant of metal ions in different oxidation states when free and when they form complexes [?Ti (II,III) = 61.5, 155.0 ; ?V(II,III,IV) = 56.7, 105.0, 250.0 and ?Cr(III) = 92.0 ]. ?complex and ?Metal ion possessed different values. The g t and g eff were the total and effective values of g respectively. The former made use of the results obtained from the software while the latter used the reflectance parameters from the literature. The constant A=1.5 for Ti (II, III) in the relation [18].
METHODOLOGY
After optimization of the complexes on ADF 2010.02, the software was run with Single Point, LDA*, Default, Spin Orbit, Unrestricted, None and Collinear commands by using DZ* or TPZ* Basis sets for all the Ti (II, III), V (II, III, IV) and Cr (III) complexes except [TiX6] 4- (X= Br, I) where LDA was replaced by GGABP*. All the complexes had Nysom* symmetry.
[I]- Complexes of Ti (II andIII) Ti (II) is a non –Kramer ion. The degeneracy of its m j states is always completely removed even by the crystal field to give only singlet m j levels. [a] (i) With no spin –orbit coupling in tetrahedral Ti (II) complexes having 3A2 ground term, we would expect longer relaxation times to observe their ESR spectra easily. Of course, the electron cloud of 3A2 ground term of Ti (II) would intermix with its higher 3 T2 term of the same multiplicity to make 3A2 to acquire some T character. A weak spin –orbit coupling would operate but with hardly any affect on the relaxation times.
(ii) Only a few examples of ESR spectra of octahedral complexes of Ti (II) having 3T1g ground state were reported due to the presence of extensive spin -orbit coupling.
b] (i) Although, tetrahedral Ti (III) complexes with 2E ground term did not possess any spinorbit coupling, yet the electron cloud of the 2E term would intermix with electron cloud of its higher 2T2 term to make 2E term to acquire some T character. A weak spin –orbit coupling would operate but without affecting the relaxation times. So their ESR spectra were easy to observe.
(ii)Ti (III) octahedral complexes (21) with ground term 2 T2 g, always experience a considerable spin orbit coupling which shortens their spin relaxation times.ESR experiments in such cases were observed only at the liquid helium temperatures.
No doubt, some work had been reported on Reflectance and Magnetic data of Ti (II, III) complexes (22-23) , yet more study is needed to correlate their ESR, NQR, Reflectance and Magnetic parameters.
RESULTS
Each Output file of a complex gave values of two ESR (g11, g22 , g33 and g iso, product of g n and a11,a22,a33,Aten) and three NQR(?,q11,q22,q33, NQCC) parameters along with its optimization parameters[point group, dipole moment, bonding energy and total energy (X c)]. X c was made up of LDA and GGA components, each one further contained Exchange and Correlation parts]. The bonding energy was computed as an energy difference between molecule and fragments. With the fragments being single atoms, they were usually computed as Spherically Symmetric and Spin-Restricted. So this might not represent the true atomic ground state (24-25).
Tables: 1.1 and 1.1A contained values of the optimization parameters of the Ti (II, III) complexes. Tables: 1.2 -1.5 gave values of all the five ESR and NQR parameters and verification of Laplace equation for four and six coordinate Ti (II, III) complexes respectively. Table: 1.2A -1.5 A gave giso, Aten and Q values along with contributions from their respective factors and also contribution from the fourth factor called interaction of nuclear magnetic moment with external magnetic field factor (I) into H^. They also contained their ?Eh f (≈ 0.5 A ten) values. The magnetic parameters of 10 out of the 17 complexes were given in Tables: 1.6, 1.6 A and 1.6 B.
DISCUSSION
The discussion regarding Ti (II, III) complexes was divided into two parts:
[A] Calculation of ESR and NQR parameters: (a) Effective Spin Hamiltonian (H^):
Depending upon the symmetries and the values of parameters, the complexes were categorized as:
i) [Ti X4] 1- (X=F, Cl, Br, I) possessed characteristics of D4h axial symmetry with (a) Two of three g called g? were of same value and third of higher value called g?? . (b) Two of three a called a? parameters were of same value and third of higher value called a11. (c) Two of the three q parameters had same value. (d) ?=0. Relation [2] was applied to calculate their H^.
ii) [Ti (OH2)4] 3+ possessed C1 symmetry and different g and a values. Relation [1] was applied to calculate its H^.
iii) [Ti I4] 2- had characteristics of axial symmetry. Relation [2] was used to calculate its H^.
iv) [TiX4] 2- (X=F, Cl) and [Ti (OH2)4] 2+ were of Td and S4 symmetries respectively with same g and a values. Relation [3] was applied to calculate their H^.
v) [TiX6] 3- (X= F, Cl, Br) possessed D6h, Oh, D6h symmetriesrespectively but showed characteristics of D4h axial symmetry. Relation [2] was applied to calculate their H^.
vi) [TiI6] 3- possessed Oh symmetry with same g and a values. So its H^ was calculated by [3].
vii) [TiX6] 4- (X= F, Cl, I) possessed Oh symmetry but showed characteristics of D4h axial symmetry. Relation [2] was applied to calculate their H^.
viii) [TiBr6] 4- had distorted Oh symmetry with different values of g and a. Relation [1] was applied to calculate its H^. (Put S_x=S_y=S_z=1/2 for Ti3+ and 1 for Ti2+; I_x=I_y=I_z=2.5 and g n = - 0.315392). Values written in small brackets in horizontal rows at end of each complex (Tables: 1.2A-1.5A) gave contributions from four factors (?), i.e. g, a, Q and (I) into H^
(b) Verification of Laplace equation and parameters such as ? (Tables: 1.2-1.5) and ?E hf (Tables: 1.2 A-1.5 A) were calculated by relations 6, 5 and 4 respectively.
[B] Calculation of Reflectance and Magnetic parameters from ESR parameters:
It included calculation of ?ADF, ?tip, ?tip, ?t , ?net, gt , t2g electron delocalization,its constant (k), ?complex and % covalent character(26) . It may be noted that:
(i) No authentic 10 D q data of [TiI4] 1- , [TiI4] 2- , - 3- , [TiI6] 2- , 3- , [TiX4] 2- (X=F, Cl) were found in literature. So calculations of magnetic parameters of these 7 complexes were omitted.
(ii) [Ti X6] 3- (X= F, Cl, Br) with one unpaired electron possessed small magnetic moments and negligible t2g electron delocalization. So, their ?complex ? free ?Ti (III) = 155.0 cm-1 .
(iii) [Ti X6] 4- (X= F, Cl, Br) also should have very small t2g electron delocalization due to small ?Ti (II) [61.2 cm-1 ].So their ?complex and % covalent character were not calculated.
(iv) ?ADF of these complexes was somewhat less than the spin only values of Ti (II, III). (a) Table: 1.6 contained [Ti X4] 1- (X=F, Cl, Br) and [Ti (H2O) 4] 3+ with 2E ground term for Ti (III). All the magnetic parameters were calculated by applying already given relations. (b) Table: 1. 6 A contained [TiX6] 3- (X= F, Cl, Br) with 2T2g ground term for Ti (III).All the parameters except t2g electron delocalization and % covalent character were calculated. (c) Table: 1.6 B contained [TiX6] 4- (X= F, Cl, Br) with 3T1g ground term Ti (II). All the parameters except t2g electron delocalization and % covalent character were calculated.
[II] Complexes of V (II, III, IV) and Cr (III)
Some work has already been reported on Reflectance and Magnetic properties (28-29) of V (II, III, IV) complexes. But, quite a large number of papers are reported on Cr3+ complexes (31-38) Still a detailed study was needed to know as to how parameters of a metal change with change in its oxidation states. V (IV), V (II) and Cr (III) are Kramer ions and V (III) is a non –Kramer ion.
(a) Both V (II) and Cr (III) [Oh] have 4A2g ground state. Therefore, they should show Zero Field Splitting (D) and Jahn -Teller effect. But in [VX6] 4- (X=F, Cl, Br, I), [V (OH2)6] 2+, [CrX6] 3- (X= F, Cl, Br, I, CN), [Cr (NH3)] 3+, the ligands were so chosen that either octahedral or nearly octahedral symmetry was enforced. So Jahn - Teller effect was neglected. The software was so designed that did not account for Zero Field Splitting.
(b) Because of the presence of extensive spin orbit coupling in 3T2g ground term, only a few examples of ESR spectra of V (III) [Oh] complexes had been reported.
In V (III) [Td] complexes with 3A2 ground term and no spin –orbit coupling, longer relaxation times were expected. Hence their ESR spectra were easy to observe. Of course, an intermixing of electron cloud of its ground 3A2 term with higher 3T2 term of the same multiplicity should cause 3A2 term to acquire some T character to allow week spin orbit coupling. But this weak coupling would hardly affect the relaxation times.
(c) In V (IV) [Oh] complexes, the ground term 2T2g should experience a considerable spin orbit coupling to make their ESR spectra difficult to observe.V (IV) [Td] complexes having 2E ground term did not possess any spin-orbit coupling.
But an intermixing of its 2E ground term with higher 2T2 would make it to acquire T character. As it did not affect relaxation times, their ESR spectra were easy to observe.
RESULTS
(A) Tables: 2.1, 2.1 A and 3.1, 3.1 A contained some optimization parameters of vanadium, chromium metals as well as of the V (II, III, IV) and Cr (III) complexes.
(B) Tables: 2. 2 -2.4 and 3.2 give values of all the five ESR and NQR parameters for V (II, III, IV) and Cr (III) complexes respectively.
(C) Tables: 2. 2 A -2.4A and 3.2 A give g iso, A ten and Q values and contributions from their respective factors along with contribution from the fourth factor (I) into H^ and ?Eh f (≈ 0.5 A ten) for V (II,III,IV) and Cr (III) complexes respectively
(D) Tables: 2.5-2.5B and 3.3 contain magnetic parameters of 7 out of the 13 V (II, III, IV) and 5 of the 6 Cr (III) complexes as calculated from their ESR and Reflectance parameters.
DISCUSSION
Calculation of ESR and NQR parameters [A]Effective Spin Hamiltonian (H^)
(a) The V (II, III, I V) complexes showed a variety of geometries .They were categorized as:
(i) [VX4] (X=F, Cl, Br, I) had D4h symmetry with (a) Two of the three g called g? had the same value and the third of higher value called g??. (b) Two of three a called a? parameters were of same value and third of higher value called a11. (c) Two of the three q values were same. (d) ?=0. Relation [2] was applied to calculate their H^.
(ii) [VX4] 1- (X=F, Cl, Br) were of regular Td symmetry with same values for g and a. Relation [3] was applied to calculate their H^.
(iii)[VI4] 1- had D4 h symmetry. Relation [2] was applied to calculate its H^.
(iv) [VX6] 4- (X= Cl, Br, I) and [VF 6] 4- were of Oh and D12 symmetries respectively with same g and a values. Relation [3] was applied to calculate their H^.
(v) [V (H2O) 6] 2+ had, no doubt, C1 symmetry but its g values were nearly the same. So relation [3] was applied to calculate its H^.
(b) The Six Cr (III) complexes showed either Oh or nearly Oh geometries and were categorized as:
(i) [CrX6] 3- (X= F, Cl, Br, I, CN) were of Oh symmetry with same g and a parameters. Relation [3] was applied to all to calculate their H^.
(ii) [Cr (NH3)6] 3+ had axial symmetry with (a) Two of the three g values called g? were same and the third of higher value called g?? . (b) Two of three a called a? parameters were of same value and third of higher value called a11. (c) Two of the three q values were of same value. (d) ? ? 0.Relation [2] wasapplied to calculate H^. (Put S_x=S_y=S_z=1/2, 1 and 3/2 for V(IV,III,II) ; I_x=I_y=I_z=3.5 ; g n= 1.4710588 and S_x=S_y=S_z=3/2; I_x=I_y=I_z=1.5 for Cr(III) ; gn= -0.3163600 ).
The contributions from four factors towards the total value of H^ for all the thirteen V (II, III, IV) and six Cr(III) complexes are given in small brackets of horizontal rows shown at the bottom of each complex (?) in Tables:2.2A- 2.4A and 3.2A respectively.
(c) Parameters such as (?), verification of Laplace equation (Tables: 2.1-2.3 and 3.2) and
(?E h f) (Tables: 2.1A- 2.3A and 3.2A) were calculated by relations 5, 6 and 4 respectively.
[B]Calculation of Reflectance and Magnetic parameters from ESR parameters (1) calculation of ?ADF , ?tip, ?tip , ?t , ?net , gt , t2g electron delocalization and its constant (k), ? complex and % covalent character(26) of V (II,III,IV) complexes.
(a) As the authentic 10Dq values of [VX4] (X=F, Br, I), [VX4] 1- (X=Cl, I) and [VI6] 4- were not reported in literature, calculation of their magnetic parameters was omitted.
(b) Table: 2. 5 contained only one complex [VCl4] with V (IV) having 2E ground term. All the above named parameters were calculated by putting ?V (IV) = 250.0 cm-1 .
(c) Table: 2 .5 A contained complexes [VX4] 1- (X=F, Br) with ground term 3A2 for V (III). All the above named parameters were calculated by putting ?V (III) =105.0 cm-1 .
(d) Table: 2.5 B had complexes such as [VX6] 4- (X=F, Cl, Br) and [V (OH2)6] 2+ with ground term 4A2g for V (II). ?V (II) being small (56.7 cm-1 ), they would possess negligibly small values of t2g electron delocalization. The parameter (k) was found to be reasonably in agreement with Nephelauxetic Ratio (?35) for these complexes (27, 31-32)
(2) Calculation of ?ADF, ?tip, ?tip, ?t, t2g electron delocalization, ?net for Cr(III) complexes (Table:3.3)
The constant (k) and ? Complex could not be calculated as 10 D q values of octahedral Cr (III) complexes were very high while ? Cr(III) [92.0 cm- 1 ] was small. So ?tip and t2g electron delocalization would be very small [ ? 2-4 % and ? 1-2 % of ?ADF respectively]. Lastly, in V (III), Cr (III) and V (IV) complexes, ?net values are expected to be somewhat less than their respective spin only (?so) values both in Td and Oh geometries. But very minor differences occur because as the charge increases (+3, +4), covalence increases (Fazans' rule) and crystal field approximations become poorer. Therefore, calculated parameters differ slightly from the experimental values. Also, assuming t2g electron delocalization to be equal to the average negative of difference of g t and g iso may not be an ideal assumption.
CONCLUSIONS With certain commands, the ADF software gave five ESR and NQR parameters. These parameters were used to calculate nine other ESR, NQR, Reflectance and Magnetic parameters by the selective use of 18 relations. So these 14 parameters of the four techniques were correlated in 36 Ti (II, III), V (II, III, IV) and Cr (III) complexes. Theoretically calculated values of these parameters were found to be fairly in agreement with their experimental values reported in the literature. The authors had already proved this fact in 20 Co (II) and Ni (II) complexes(1) in the previous communication and hope to prove the same in forty five more complexes of 2nd and 3rd transition series metal ions in the forthcoming communication.
ACKNOWLEDGEMENTS 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. Authors are grateful to Mr. S.R. Heer, Chief Engineer (Retd.), North Zone, Doordarshan, New Delhi (India), for his invaluable cooperation in the installation and smooth working of the ADF software.
Englishhttp://ijcrr.com/abstract.php?article_id=1448http://ijcrr.com/article_html.php?did=14481. Harminder Singh, Bhardwaj, A.K.,Sehgal, M.L.and Susheel K.Mittal, IJCRR., 4[22](2012)12-28.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareDONOR PROFILE AND BLOOD SAFETY: COMPARISON BETWEEN FIXED (INSTITUTE) AND MOBILE SITE (CAMP) BLOOD COLLECTIONS
English3235B.AbhishekhEnglish K.C.UshaEnglishBackground: The importance of blood safety in public health was recognized long ago and data are essential to plan strategies to improve its status. Ability to ensure an adequate blood supply depends on knowing and understanding donor demographics and characteristics and their impact on collections. Objectives: To explore and compare the demographic profile and seropositivity among donors donating whole blood at fixed and mobile donation sites. Methods: The information of all the donors registered and donated blood was collected from the donor registration forms. Serological results of the donors were obtained from the Transfusion Transmitted Disease Screening division of the department. Data were entered into Microsoft excel sheet and results analyzed on SPSS software version 10. Results: In fixed site female donors contributed for about 1% of donations while at the mobile site their participation attributed to 18% of donations. Seropositivity was slightly higher among donors at fixed site (HBV-2.5%, HIV-1.1%) when compared to donors at the mobile site (HBV-1.8%, HIV-0.6%). The vasovagal reactions among donors were around 4% in fixed site and around 3% at mobile sites.
Englishfixed site, mobile site, donor profileINTRODUCTION
Fixed site is a widely used term for a permanent or freestanding blood collection center. The fixed site may be located in a hospital based donor room or in a community blood center building. In mobile blood drives the donor room is essentially transported to the donor. The mobile blood collection team generally arranges mobile blood drives with a sponsoring organization often a business, school, hospital, public service organization, trusts, NGO’s, religious group, or military installation etc. It is generally easier and more cost effective to run a fixed site1, 2. The convenience of a mobile drive brings in new and voluntary donors into donor pool. Mobile blood drives should be set up along the same basic principles as fixed sites, although a certain amount of flexibility is often in order in terms of cleanliness, ventilation, space, temperature, privacy to discuss the many personal questions on the donor-screening questionnaire etc3, 4 . Ability to ensure an adequate blood supply depends on knowing and understanding donor demographics and characteristics and their impact on collections5 . Aim: This study was aimed to explore and compare the demographic profile and seropositivity among donors donating whole blood at fixed and mobile donation sites.
RESEARCH METHODOLOGY This was a cross sectional study with the study setting being the department of transfusion medicine of Trivandrum Medical College which is a major referral and tertiary care centre of south Kerala. Camps are conducted regularly every week in and around Trivandrum in both urban and rural areas within 60 km from the college collecting on average 30-50 whole blood donations. The information like age, sex, education status, occupation, donation status(first time/repeat) of all the donors registered and donated blood at various camps conducted during the year 2009 were collected from the donor registration forms. All the donors who registered and donated blood at the department on the same day of the camps were included as comparison group. At the department the whole blood collection ranges 80-120. The donors from the camps wherein the venue was college premises were excluded to avoid homogeneity among the study population. Serological results of the donors were obtained from the TTD Screening division of the department. The tests used were antibody detection ELISA for HIV (double sandwich 3rd generation anti HIV 1 / 2) and HCV (3rd generation anti Hep C virus), HBsAg detecting solid phase micro plate direct sandwich ELISA for HBV, single step rapid immunochromatographic test for detection of P. Falciparum, P.Vivax antigens for malaria and non Treponemal macro agglutinin rapid slide method for Syphilis reagin antibodies in serum. Data were entered into Microsoft excel sheet and results analyzed on SPSS software version 10.
DEFINITIONS6 Voluntary Blood Donor: A voluntary blood donor donates blood out of his/her free will without expecting anything of monetary value from the blood bank or patients” relatives or any other source at the time of donation or in future.
Replacement Blood Donor: Replacement blood donor is a member of the family (familial) or a friend of the patient who donates blood in replacement of blood needed for the particular patient without involvement of any monetary or other benefits from any source. Directed Donation: When blood is donated by a relative (donor) for a particular patient.
RESULTS In fixed site female donors contributed for about 1% of donations while at the mobile site their participation attributed to 18% of donations (pEnglishhttp://ijcrr.com/abstract.php?article_id=1449http://ijcrr.com/article_html.php?did=14491. Graeme Woodfield; Road blocks in achieving 100% voluntary blood donation rate in the south Asian region; AJTS 2007 vol 1 issue 1 pg 33-38
2. Hillyer; Blood collection sites: Fixed and Mobile; Blood banking and Transfusion Medicine basic principles and Practice 2nd edn page 157-79
3. Patricia M. Carey, Patrick M. High Et al Donation return time at fixed and mobile donation sites. Transfusion 2012; 52:127-33.
4. C. T. Tagny, S. Owusu-Ofori, D. Mbanya and V. Deneys.The blood donor in sub-Saharan Africa: a review. Transfusion Medicine, 2010, 20, 1–10
5. Code of Federal Regulations. 21 CFR 606.40. Washington, D.C., U.S. Government Printing Office, April 1, 2005.
6. National Guidebook on Blood Donor Motivation. Ministry of Health and Family Welfare. 2nd ed. Government of India: 2003.
7. Kuppuswamy B. Manual of socioeconomic status (Urban), Manasayan, Delhi, 1981.
8. Ownby HE, Kong F, Watanabe K, Tu Y, Nass CC. Analysis of donor return behavior. Transfusion 1999; 39:1128-35.
9. Nguyen DD, Devita DA, Hirschler NV, Murphy EL. Blood donor satisfaction and intention of future donation. Transfusion 2008; 48:742-8.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareSELF-MEDICATION PATTERN AND ITS COMPARISON AMONGST MEDICAL AND NON-MEDICAL COLLEGE STUDENTS OF UDAIPUR, INDIA
English3643Meena AtrayEnglish Rupin KumarEnglishPurpose of Study: This study envisages highlighting the main ailments for which college students use self-medication and to compare and contrast significant differences in the pattern of drug use between two study groups- Undergraduate Medical and Non-Medical students of the city of Udaipur, India Methods: Self-administered, pretested, close-ended, semi-structured questionnaire was used to collect data, and to analyze the pattern from 320 Medical and 320 Non-Medical students. Results: More Non-Medical (30%) students used media as their source of information (pEnglishSelf medication, Medical students, Non-medical studentsINTRODUCTION
Self medication implies the use of medicine with therapeutic intent but without professional advice.1-2 The concept of self medication which encourages individuals to look after minor ailments with simple and effective remedies has been adopted worldwide.3-6 Evidently, there has been an increasing interest to gauge the self medication trends in a developing country like India7-8 owing to the availability of a wide variety of over 7000 drugs at local chemist shops and a skewed doctor-population ratio of 0.6/1000 coupled with a lack of awareness and literacy on proper medicine use. In a bid to save time, and due to limited availability of financial resources, the concept of self-medication is quite rampant among adolescents and college-going students9,10 with drug use and abuse being promoted among peer groups.10,11,12 The study aims to fill in the lacunae in knowledge of self-medication practices by college-going students of the city of Udaipur. Study of such a pattern among this highly vulnerable group is of great significance as many students in this age bracket are unaware of potentially harmful effects of drugs viz. drug habituation, drug addiction, allergies and other adverse reactions, which might develop as a result of injudicious drug use.
13 Irrational drug combinations and indiscriminate use of drugs like antibiotics have led to the evolution of Multi-Drug resistant bacterial strains in India, a prime example of the recent New Delhi Beta Lactamase strain being cited in this case.14 There is also a tendency to propagate the wrong type of treatment based on peer advises and personal experience; that in turn leads to a wrong choice of drug and development of adverse reactions in genetically prone individuals.15 Students suffering from ailments that carry an underlying sexual etiology, in order to maintain anonymity from family and friends, may resort to selfmedication with drugs that have potential harmful effects.16,17 The fraternity of Medical students was chosen for comparison as they are expected to have more knowledge on drug use and abuse in contrast to an average non-medical student.
Previous studies highlight the adverse effects and various other implications, including drug dependence and addiction, masking of malignant and potentially fatal diseases18, hazard of misdiagnosis19, the global emergence of Multi-Drug Resistant pathogens, problems relating to over and under dosaging20, drug interactions and tragedies relating to the side effect profile of specific drugs , especially those relating to developing countries.21,22 Most studies agreed to the fact that the prevalence of self-medication is quite high in most countries, irrespective of socio-economic levels and promotion of the concept of self medication would lead to decreased burden on medial professionals22, 23, 24, 26
MATERIAL AND METHODS The city of Udaipur is located in west India and there are two Medical and two Dental Colleges. The study group was divided into two categories- Medical and Non-Medical students. All four medical colleges and four non medical colleges (two technical and two non technical) were selected. The students were selected by simple randomization (equal from each college) Medical students were those pursuing either M.B.B.S. or B.D.S. in any of the medical and dental colleges located within the city. Only allopathic students were included. Homoeotherapy, Ayurveda and Unani students were excluded. Students who had knowledge of Pharmacology, final year students for M.B.B.S and third and fourth year students for B.D.S were included in the study.
Non-Medical students were defined as those pursuing undergraduate studies in all fields except Medical Science. Students of final year were included in the study. The study excluded Post-Graduate students in both groups. There was no age criterion. The minimum sample size to compare the trend in two groups was estimated to be 320 for both groups. MaCorr Inc. Sample size calculator was used for estimating the sample size. The alpha error was set at 0.05 and power at 0.9. Result was statistically analyzed by using Chi square test. The data was collected using a pretested, closeended, semi-structured, self-administered questionnaire which was filled in by the participants under the supervision of the researcher.
RESULTS Popularity of self-medication 1% of Medical and 9% of Non Medical students had always used self medication. 88% of Medical and 65% of Non Medical students replied that they sometimes use self- medication. 11% of Medical and 26% of Non Medical students had never used self medication. Source of knowledge about the drugs Most Medical students (69%) and Non-Medical students (65%) obtained information about the drug used from Friends and Family members, 30% of Non-Medical students, while only 8% of Medical students used media as source of information (pEnglishhttp://ijcrr.com/abstract.php?article_id=1450http://ijcrr.com/article_html.php?did=14501. Covington TR. Non prescription drug medications and self-care. Non prescription Drug Therapy: Issues and Opportunities. Am J Pharm Educ. 2006; 70:137.
2. Lefterova A, Getov I. Study on consumers' preferences and habits for over-the-counter analgesics use. Cent Eur J Public Health 2004; 12:43-5.
3. Awad A, Eltaved I, Matowe L, et al. Selfmedication with antibiotics and antimalarials in the community of Khartoum State. Sudan. J Pharm Sci. 2005;8:326-331.
4. Major C, Vincze Z, Mesko A, et al. medicating outside the consulting room. Orv Hetil. 2007;148:291-298.
5. Segall A. A Community Survey of selfmedication activities. Med Care. 1990; 28:307-310.
6. Kamat VR, Nichter M. Pharmacies, selfmedication and pharmaceutical marketing in Bombay, India. Soc Sci Med 1998; 47:779- 794.
7. Dinesh Kumar B, Raghuram TC, Radhaiah G, Krishnaswamy K.: Profile of drug use in urban and rural India. Pharmcoeconomics 1995 Apr;7(4):332-46.
8. Sharma R, Verma U, Sharma CL, Kapoor B. Self-medication among urban population of Jammu city. Indian J Pharmacol 2005;37:40- 3.
9. Greenhalgh T. Drug prescription and selfmedication in India: an explorative survey. Soc Sci Med 1987; 25:307-318.
10. C.T. Chambers, G.J. Reid, P.J. McGrath, and G.A. Finley. Self-administration of Over-the-counter Medication for Pain among adolescents. Arch Pediatr Adolesc Med 1997;151:449 - 455.
11. G.S. Lau, K.K. Lee, and M.C. Luk. Self medication among university students in Hong Kong. Asia Pac J Public Health 1995 Jul 1;8(3):153-157.
12. Tse MH, Chung JT, Mungo JG. SelfMedication among secondary school pupils in Hong Kong: A descriptive study. Fam Pract. 1989;6:303-306.
13. Olatude A. Self medication: Benefits, Precautions and Dangers. 1st ed. Macmillan Press Ltd.;1979.
14. Kumarasamy K.K., Toleman M.A., A.Walsh, et al. Emergence of a new antibiotic resistance mechanism in India, Pakistan, and the UK: a molecular, biological, and epidemiological study. Lancet Infect Dis. 2010 Sep;10(9):597-602.
15. Deak K. Lay care in illness. Soc Sci Med. 1986; 22:125-130.
16. Gordon S.M., Mosure D.J., Lewis J, et al. Prevalence of self-medication with antibiotics among patients attending a clinic for treatment of sexually transmitted diseases. Clin Infect Dis. 1993;17:462-465.
17. Yelland N.J., Vietch P.C.. How do patients identify their drugs? Aust Fam Physician. 1989;18:1441-1445.
18. Shankar PR, Partha P, Shenoy N. Selfmedication and non-doctor prescription practices in Pokhara valley, Western Nepal: a questionnaire-based study. BMC Fam Pract 2002;3:17.
19. Burak L.J., Damico A. College students' use of widely advertised medications. J Am Coll Health 2000;49:118-21.
20. Bauchner H, Wise P. Antibiotics without prescription: "bacterial or medical resistance"? Lancet 2000; 355:1480-84.
21. James H, Handu S.S., Khalid A.J., Khaja A, Otoom S, Sequeira R.P.. Evaluation of the knowledge, attitude and practice of selfmedication among first-year medical students. Med Princ Pract 2006;15: 270-5.
22. Tomson G, Sterky G. Self-prescribing by way of pharmacies in three Asian developing countries. Lancet 1986; 2: 620-2.
23. Hsiao FY, Alee J, Huang W-F, Chen S-M, Cheny H-Y. Survey of medication knowledge and behaviors among college students in Taiwan. Am J Pharm Educ 2006; 70: 30
24. Vucic VA, Trkulja V, Lackovic Z. Content of home pharmacies and self-medication practices in households of pharmacy and medical students in Zagreb, Croatia: findings in 2001 with a reference to 1977. Croat Med J 2005; 46: 74-80.
25. O.A.Afolabi.Factors influencing the pattern of self-medication in an adult Nigerian population. Annals of African Medicine 2008:120-127.
26. Sarah Saleem, Self-medication amongst University Students of Karachi: Prevalence, Knowledge and Attitudes. Journal of Pakistan Med Ass 2003:198-202.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareINDUCIBLE CLINDAMYCIN RESISTANCE AMONG CLINICAL ISOLATES OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS
English4448Nilima R. PatilEnglish Ulhas S. MaliEnglish Sunanda A. KulkarniEnglish M. V. GhorpadeEnglish Poorva P. Bhave (Sule)EnglishThe resistance to antimicrobial agents among Methicillin resistant Staphylococcus aureus (MRSA) is an increasing problem. Clindamycin is commonly used for the treatment of serious soft tissue infections produced by Staphylococcus aureus and treatment failures are reported during therapy. Routine antibiotic sensitivity test for Clindamycin susceptibility may fail to identify iMLSB (inducible MLSB) strains of Staphylococcus aureus due to erm gene. Present study was carried out to find out the percentage of inducible Clindamycin resistance in MRSA in our hospital using D-test. 250 isolates of Staphylococcus aureus from various clinical samples were confirmed by standard protocol and included in this study. MRSA were detected by using Oxacillin (1ug) and Cephoxitin (30ug) disc diffusion method. Results were interpreted according to CLSI criteria. Antibiotic sensitivity to routine antimicrobial agents was carried out using Kirby Bauers disc diffusion method. D-test was performed on all Erythromycin resistant Staphylococcus aureus to detect inducible Clindamycin resistance and constitutive Clindamycin resistance. Out of 250 isolates of Staphylococcus aureus, 90(36%) were found to be MRSA. Among these, 46(51.11%) were Erythromycin resistant. 17(36.95%) isolates showed inducible Clindamycin resistance, 4(8.69%) showed constitutive Clindamycin resistance and 25(54.34%) showed MS phenotype in MRSA. Conclusion – We therefore conclude that it is necessary to perform D- test for detection of inducible Clindamycin resistance among Staphylococcus aureus in routine antibiotic sensitivity test. Therapeutic failures may thus be avoided.
EnglishStaphylococcus aureus, inducible MLSB, constitutive Clindamycin resistance, D-test, MRSA.INTRODUCTION
Staphylococcus aureus is one of the most common human pathogens which cause wide range of infections. The emergence of resistance to antimicrobial agents among Staphylococci is an increasing problem. Emergence of methicillin resistance in Staphylococcus aureus has resulted in therapeutic alternatives to treat Staphylococcal infections. The Macrolides (Erythromycin, Clarithromycin) and lincosamides (Clindamycin, Lincomycin) serve as one such alternative. Macrolides, Lincosamides and Streptogramin B are structurally unrelated but microbiologically having same mode of action (1). Clindamycin is commonly used for the treatment of serious Staphylococcal infection due to its excellent pharmacokinetic properties but sometimes treatment failures were reported during therapy (2, 3). However widespread use of Macrolideslincosamides-streptogramin B (MLSB) antibiotics has led to an increased resistance to these antibiotics by Staphylococcal strains (4). The well established mechanism for such resistance is target site modification mediated by erm gene which can be expressed either constitutively or inducibely. Erythromycin & Clindamycin discs are commonly used while doing antibiotic sensitivity test for Staphylococcus aureus strains. Inducible resistance to Clindamycin is difficult to detect in routine antibiotic sensitivity test as organisms are resistant to Erythromycin and sensitive to Clindamycin in vitro when not placed adjacent to each other. In such cases, in vivo therapy with Clindamycin may select constitutive erm mutants leading to clinical therapeutic failure. Another mechanism of resistance to Macrolides by MRSA is efflux of antibiotic. Staphylococcal isolates appear Erythromycin resistant and Clindamycin sensitive in both in vivo and in vitro and the strain does not typically become Clindamycin resistant during therapy (5). The present study was carried out to find out inducible Clindamycin resistance in MRSA & interpretation of susceptibility test to guide therapy.
MATERIAL AND METHODS The present study was conducted from November-2010 to November -2011. A total 250 isolates of Staphylococcus aureus were isolated from various clinical specimens like pus, wound swabs, blood and various aspirations received in the department of Microbiology, B.V.D.U.M.C & H. Sangli. All the Staphylococcus species were identified by conventional microbiological methods including colony morphology, gram stain, slide coagulation test, tube coagulation test and mannitol fermentation test, and then subjected to susceptibility testing by Kirby – Bauers disc diffusion method on Muller Hinton agar plate using routine antibiotic discs as per CLSI guidelines. Methicillin resistance was detected by using Oxacillin (1-ug) and Cephoxitin (30-ug) on Muller-Hington agar supplemented with 2% NaCl followed by incubation at 35oC. (6) The isolates which were found to be Erythromycin resistant were examined for inducible Clindamycin resistance [iMLSB] by using double disc approximation test (D test) as per CLSI guidelines. Erythromycin (15-ug) disc was placed at a distance of 15 mm (edge to edge) from Clindamycin (2-ug) disc on MullerHington agar plate. After overnight incubation at 37oC, flattening of zone (D shaped) around Clindamycin in the area between the two discs indicated inducible Clindamycin resistance. Strains that do not form inhibition zone around Clindamycin and Erythromycin discs are accepted as constitutive to MLSB phenotype (cMLSB). (6, 7) Figure No. 1, 2, and 3 show iMLSB, cMLSB and MS phenotype.
RESULT Specimen wise distribution of 250 samples is shown in table No.1. Out of the 250 Staphylococcus aureus isolates, 90 were found to be MRSA. Among these, 46 (51.11%) were Erythromycin resistant. D-test was performed for these isolates, 17 (36.95%) isolates showed inducible MLSB phenotype (D-test positive), 4 (8.69%) showed constitutive MLSB phenotype and 25 (54. 34%) showed D- test negative suggesting MS phenotype. (Table No. 2)
DISCUSSION MRSA strains which cause serious infections may give serious problems in treatment. Prevalence of MRSA has been reported to vary between 9 and 54.6% in hospital based infections (8, 9, 10). Characteristically, reports from different regions have shown different patterns of resistance. Some reports show high prevalence while others show low prevalence. Prevalence of MRSA in our study was 36%. A study from south Maharashtra had reported that more than 90% isolates are resistant to Penicillin, Ampicillin, Erythromycin and Gentamycin where as only 39.1% were resistant to Methicillin (14). Kandle et al showed 32.8% MRSA (15) and study from Nepal had shown 31.60% MRSA (16). Our results correlate with all of them.
The determination of antimicrobial susceptibility of a clinical isolate is often crucial for optimal antimicrobial therapy of infected patients. Resistance to macrolide, lincosamides, and streptogramin B [MLSB] antibiotics most only results from acquisition of Erythromycin resistant methylase gene (erm gene) which encodes enzymes that methylate the 23S rRNA. In our study iMLSB was found in 36.95% MRSA which is less than P. Sreenivasulu Reddy et al who observed it in 46.2% cases in MRSA (11) but is more than Yilmaz et al who found it in 24.4% and Gadepalli et al who found in 30% of MRSA cases (12) (4).
Constitutive resistance in our study is seen in 8.69% of MRSA isolates which is in accordance with V. Deotale-2010 study (7.3%) (17). 54.34% of our isolates of MRSA were sensitive to Clindamycin, against which it would be safe & appropriate to use Clindamycin or other Macrolides. It correlates with previous studies who have reported 57% of susceptibility towards Clindamycin among MRSA stains (13). Above studies showed that prevalence of inducible resistant isolates may differ from place to place.
CONCLUSION Our observations suggest that, D-test should be mandatory for all microbiological laboratories before reporting Clindamycin susceptibility as Clindamycin is not a suitable drug for D- test positive isolates while it can definitely prove to be a drug of choice in case of D - test negative isolates. Therefore, regular surveillance of antimicrobial susceptibility pattern of MRSA, determination of phenotypic pattern of inducible Clindamycin resistance and formulation of a definite antibiotic policy may be helpful in reducing the burden of MRSA infections and failures in Clindamycin treatment in the hospital.
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=1451http://ijcrr.com/article_html.php?did=14511. Fiebelkorn KR, Crawford SA, McElmeel ML, et al. Practical disc diffusion method for detection of inducible Clindamycin resistance in Staphylococcus aureus and coagulase negative Staphylococcus. J Clin Micro-biol 2003; 41: 4740-4744.
2. George K siberry GK, Tekle T, Carroll K, Dick Failure of Clindamycin treatment of methicillin resistant Staphylococcus aureus expressing inducible Clindamycin resistance in vitro. Clin Infect Dis 2003; 37:1257–60.
3. Lewis JS 2nd, Jorgensen JH. Inducible Clindamycin resistance in Staphylococci: should clinicians and microbiologists be concerned? Clin Infect Dis 2005; 40: 280-5.
4. Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK, Choudhary R. inducible Clindamycin resistance in clinical isolates of Staphylococcus aureus. Indian J med Res 2006; 123: 571-3.
5. Steward CD, Raney PM, Morell AK, et al. Testing for induction of Clindamycin resistance in erythromycin resistant isolates of Staphylococcus aureus. J Clin Micro-biol 2005; 43: 1716-17121.
6. Clinical and laboratory standards institute. Performance standards for antimicrobial susceptibility testing; seventeenth informational supplement. Clinical Laboratory Standards Institute. 2007;Vol.27 (No.1)
7. Laclercq R. Mechanisms of resistance to Macrolides and lincosamides: Nature of resistance elements and their clinical implications. Clin Infect Dis. 2002; 34:482– 492.
8. Manian FA, Meyer PL, Setzer J, Senkel D. Surgical site infections associated with methicillin-resistant Staphylococcus aureus: do postoperative factors play a role? Clin. Infect. Dis., 2003, 37: 863-868.
9. Karadenizli A. Hastanelerde metisilin dirençli Staphylococcus aureus (MRSA) kontrol politikalar? ve MRSA. Hastane ?nfeksiyonlar? Dergisi, 2002, 6: 12-18.
10. Orret FA, Land M. Methicillin Resistant Staphylococcus aureus Prevalence: Current susceptibility pattern in Trinidad. BMC. Infect. Dis. 2006, 5;6:83-85.
11. P. Sreenivasulu Reddy, R. Suresh, Phenotypic detection of Clindamycin resistance among the clinical isolates of Staphylococcus aureus by using lower limit of inter disk Space.J. Microbiol. Biotech. Res., 2012, 2 (2): 258-64.
12. Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. J Med Microbiol. 2007; 56:342–5.
13. Delialioglu N, Aslan G, Ozturk C, Baki V, Sen S, Emekdas G. Inducible Clindamycin resistance in staphylococci isolated from clinical samples. Jpn J Infect Dis. 2005;58:104–6.
14. Mehta et al control of methicillin resistant Staphylococcus aureus in the tertiary care center. A five year study. J. Med. Microbiolol 1998; 16:31-4
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16. Pal N, Sharma B, Sharma R, Vyas L (2010). Detection of inducible Clindamycin resistance among Staphylococcal isolates from different clinical specimens in western India. J. Postgrad. Med., 56(3):182-185.
17. Deotale V, Mendiratta DK, Raut U, Narang P. Inducible Clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Indian J Med Microbiol. 2010;28( 2):124–126.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareHEART RATE VARIABILITY DURING DEEP BREATHING AS AN INDEX OF AUTONOMIC DYSFUNCTION IN OBESE MEDICAL STUDENTS- A CROSS SECTIONAL STUDY
English4953Rohini H.N.English Padmashri S. KudachiEnglish Shivaprasad S. GoudarEnglishBackground: Students getting admitted in private medical colleges belong to rich affluent family background. They tend to consume relatively high calories compared to physical output, leading to significant weight gain overtime. Objective:-Study objective was to find the association between heart rate variability and obesity in obese medical students. Materials and Methods:-A cross sectional study of one forty eight medical and dental students was conducted. They were screened for body mass index. The students were divided into three groups according to WHO technical series 854 recommended cut off values. An ECG is recorded continuously throughout the period of deep breathing. The result is then expressed as the mean of the difference between maximum and minimum heart rates for the six measured cycles in beats per minute. A difference of ? 15 beats/min (normal), 11 -14 beats/min (borderline), and values of ?10 beats/min (abnormal). Results:-Among students with BMI cut off value 85th percentile, 31(96.9%) and 1(3.1%) had normal and mild values respectively. Majority of male students [96.2 %( n= 50)] and female [91.2 %(n=73) ]showed normal HRV values. Conclusion:- In this study, there was no association between obesity and heart rate variability. The gender did not appear to be related to heart rate variability during deep breathing.
EnglishHeart rate variability, Deep breathing High calories, Medical students, Obesity.INTRODUCTION
Overweight and obesity are major public health problems and the most common nutritional disorder. The prevalence of obesity is expected to rise with urbanization and as lifestyle shift towards reduced physical activity [1] Assessing the risk for the presence of major CVS risk factors in young adults is of particular importance, since it would allow us to promptly identify the persons at high risk of development of clinical cardiovascular disease later in life and the need to implement health promotion programs and perform large scale epidemiological studies within the young adults. The BMI is the simplest and most widely accepted measure of obesity. HRV db is a reliable and sensitive and is one of the most promising clinical test for early detection of cardiovagal dysfunction in a wide range of autonomic disorders. [2,3,4] The study objective was to assess heart rate variability during deep breathing (HRVdb) in obese medical students.
MATERIALS AND METHODS The present study was conducted among the medical and dental students enrolled in the academic year 2010-2011. Study design- A cross sectional study. Selection of participants- The total number of 150 medical and 100 dental students within the age group of 18-20 years, including males and females were recruited as study participants. All these students were belonged to Asian continent. Ethical clearance- The study protocol was submitted to the ‘Institutional Ethics Committee for Human Subjects Research’ for approval. The study was undertaken after the ethical clearance was obtained by the institutional ethical committee.
Selection criteria- A proforma containing a set of questions about name, age, sex, nativity, demographic, food habits, family history of obesity, hypertension and diabetes or both, medication was given to the participants. Baseline clinical examination including heart rate and blood pressure was done. Based on this data healthy students were taken for the study. The participants who were on long term drug therapy (steroids), taking anticholinergics (including antidepressants,antihistamines),Sympathomimeti cs (α and β agonist), Parasympathomimetics and with history of endocrinal disorders were excluded from the study. Method of data collection- The total number of 250 students were screened for height and weight. Body weight was measured by the Digital scale (seca) with an accuracy of + 100gm. Subjects were made to stand on the scale platform and weighed without shoes in light clothings. Standing height was measured without shoes by using commercial stadiometer. The heels of the feet were placed together and touching the base of the vertical board. BMI was calculated using an formula Weight in Kg/ Height in m2 . Based on BMI these students were classified based on WHO Technical series 584 recommended cut off values for the adolescents [5] .
1) 85th percentile- At risk of Overweight Out of total 250 students, 52 male students and 80 female students’ total of 148 students were recruited in the study. 16 students who did not consent to participate in the study were excluded. Finally 132 underwent the test procedure. Written informed consent was taken from each subject The group II category with the BMI 50th - 85th percentile was taken as normal control group. The subjects were informed to avoid food preceding two hours of the testing and to avoid coffee, nicotine or alcohol 24 hrs and have a sound sleep prior to the test. All the subjects arrived to the laboratory in the early morning between 8.30-9.30AM. The students were 15 minutes prior to the commencement of testing procedure. The participant was explained in detail about the procedure.
The subject was made to lie down in supine position comfortably in couch. Electrocardiogram was recorded by using a instrument BPL Cardiart 108T- DIGI. Lead II was placed by applying gel and was asked to inspire for the first 5 seconds from the count of 1 to 5 and expire the next 5 seconds from the count of 5 to 1. ECG was recorded in lead II. The subjects were instructed not to talk, move hands, legs and body, sleep and cough. Short term HRV analysis was done by recording 5 minutes ECG in lead II during deep breathing. An electro-cardiogram was recorded continuously throughout the period of deep breathing and the onset of each inspiration and expiration were marked. The maximum and minimum R-R intervals during each breathing cycle were measured and converted to beats per minute. The result was then expressed as the mean of the difference between maximum and minimum heart rates for the six measured cycles in beats per minute. A difference of 15 beats or more was considered to be normal, mean values between 11 to 14 beats per minute as borderline, and values of 10 beats or less per minute as abnormal. [6]
Statistical analysis The obesity and heart rate variability scores were analyzed by chi square test, gender differences and anxiety scores were compared with X2 With Yates Correction. p< 0.05 was considered as significant.
RESULTS There was no significant heart rate variability changes as 93.2% had normal HRV values. (Table 1). Spearman’s correlation coefficient value between BMI and HRV was zero and p values was 0.996, between BMI and HRV in males p value was 0.800 and in females p value was 0.679. Hence there was no gender differences.
DISCUSSION Heart rate variability (HRV) is beat to beat variation in heart rate (i.e. in R-R intervals) under resting conditions. These beat to beat variations occur due to continuous changes in the sympathetic and parasympathetic outflow to the heart. HRV has been shown to be a good tool to quantify the tone of autonomic nervous system to the myocardium. It has been associated with high predictive value in many diseases. Heart rate variability (HRV) and respiration over the past 150 years has led to the insight that HRV with deep breathing (HRVdb) is a highly sensitive measure of cardiovagal or parasympathetic cardiac function. This sensitivity makes HRVdb an important part of the battery of cardiovascular autonomic function tests. The present study was intended to measure the obesity in young medical and dental students by standard parameters and also intended to detect the subclinical autonomic dysfunction by HRV test. In our study no change in HRV was observed. The possible reason for this findings may be for not including the tests that detect sympathetic predominance like hand grip test and cold pressor test, for not recording 24 hours long term recording. Another possibility could be the study participants being in younger age group with no morbid obesity changes. Further research including morbid obesity group may show autonomic dysfunction. The findings of the current study indicated that there were no predictable changes in cardiovascular autonomic activity as measured by HRV.
The significance of our study was early screening of autonomic dysfunction in young obese individuals and warns for specific therapeutic strategies that may reduce the risk of developing various metabolic syndromes and cardiovascular diseases involving autonomic disturbances. In our study there was no gender differences in autonomic function in the obese population. Our study included 80 female and 52 male students. Clearly more work is need to be done with the battery of autonomic function tests when they reach the adulthood. Heart rate variability measures the effect of autonomic function on heart alone so it the most useful method to investigate the effect of obesity on cardiovascular disease and it is important to emphasize the effect of obesity on heart rate variability. Decrease in heart rate variability significantly increase cardiovascular mortality [7] Higher measures of both overall and central adiposity confer greater risk of subsequent CVD in both men and women [8,9] . A previous studies concluded that there was decreased sympathetic activation and no change in parasympathetic nervous system functioning in obese children as compared to controls[10-12] An increase in sympathetic tone shows reduction in vagal tone. This allows to hypothesize that autonomic nervous system changes depend on the time course of obesity development.[13] . In Cardiac autonomic neuropathy, the disruption of the parasympathetic nervous system is usually detected earlier than that of the sympathetic nervous system Decrease in heart rate variability (HRV) is noticed as first indicator of cardiac autonomic neuropathy and decrease in E/I ratio is considered to be a sign of parasympathetic dysfunction. [14] Another study observed that the parameters reflecting parasympathetic tone (HF band, root mean square successive differences, proportion of successive normal to normal intervals and scatter plot width) were significantly and persistently decreased in obese groups with lean controls. In this study power spectral analysis was done to assess heart rate variability. [15] A study conducted by Nargai provided evidence of autonomic depression in obese children which was associated with duration of obesity [16] . In a study boys had higher LF/ HF ratio reflecting increased sympathetic modulation but counterpart females had less sympathetic modulation explaining the cardio protective effect. In this study sample size was 1,724 adolescents where our study sample size was very less which is one of the limitation of our study [17] .
CONCLUSION In this study, there was no association between obesity and hear rate variability. The gender did not appear to be related to heart rate variability during deep breathing.
ACKNOWLEDGEMENT We extend our sincere gratitude towards Department of Psychiatry, JNMC, Belgaum and thank the statistician Mr. M.D.Mallapur for analyzing the data. We are thankful to technical staff, Department of Physiology, Mr. Prem kumar Yadav and all the Ist year medical students/
Englishhttp://ijcrr.com/abstract.php?article_id=1452http://ijcrr.com/article_html.php?did=14521. Yanowski,S.Z., Yanowski,J.A . obesity.N Eng J MED 2005; 346: 591-602.
2. ROBERT W. SHIELDS, JR, MD. Cleveland Clinic Journal of Medicine. April 2009;2:37- 40.
3. Schwartz P.J., Priori S.G. Sympathetic nervous system and cardiac arrhythmias. In: Zipes D.P., Jalife J., eds. Cardiac Electrophysiology. From Cell to Bedside. Philadelphia: W.B.Saunders.1990;330-343
4. Wheeler T, Watkins PJ. Cardiac denervation in diabetes. Br Med J1973; 4:584–586.
5. WHO technical report series 854. Physical status: The use and interpretation of Anthropometry. World health organization Geneva ; 1995: p271
6. Ewing, D. J., Clarke, B. F. Diagnosis and management of diabetic autonomic neuropathy. Br. Med. J. 1982; 285: 916-20.
7. Min HK. NIDDM in Korea. Diabet Med 1996;13:S13-5.
8. Sheldon.E.Litwin,MD,FACC. Which Measures Of Obesity Predict Cardiovascular risk?. J Am coll Cardiol 2008; 52:616-619.
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10. Mona Bedi, Shilpa Khullar and V.P. Varshney. Vascular Disease Prevention 2009; 6: 139-141
11. Piccirillo G, Vetta F, Viola E, et al. To asses autonomic modulation of cardiovascular activity in massively obese subjects. Int J Obes Relat Metab Disord 1998; 22(8): 741- 50.
12. Hofmann KL, Mussgsy L, Ruddel H. Autonomic cardiovascular regulation in obesity. J Endocrinol 2000; 164: 59-66.
13. Rabbia et al. Autonomic Modulation in Adolescent Obesity.Obesity research April 2003(4);11: 541
14. Vinik AI, Maser RE, Mitchell BD & Freeman R. Diabetic autonomic neuropathy. Diabetes Care 2003; 26: 1553–1579.
15. Riva P, et al. Obesity and autonomic function in adolescence.Clin EXP Hypertens 2001 Jan-Feb;23(1-2):57-67.
16. Nagai N. Autonomic nervous system activity and the state and development of obesity in Japanese school children. Obes Res 2003; 11: 25-32.
17. Chen-Chung Fu. Heart Rate Variability in Taiwanese Obese Children.Tzu Chi Med J 2006;18:199-204.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareUTILITY OF ULTRASOUND GUIDED FINE NEEDLE ASPIRATION CYTOLOGY IN ASSESSING AXILLARY LYMPH NODE STATUS IN CARCINOMA BREAST
English5457Sandhyalakshmi B.N.English Poornima Naregal English Rajeev GotheEnglish M.H. KulkarniEnglishAssessment of lymphnode status in carcinoma breast is an important factor in staging. Lymphnode status can be evaluated by different methods such as physical examination and sentinel node biopsy. Ultra sonography features such as round, hypo echoic, with loss of central hilum, eccentric cortical hypertrophy of lymphnode indicate the malignant involvement of lymph nodes. This study was conducted to evaluate the ultra sonography features of metastatically involved axillary lymphnodes. Ultrasound guided fine needle aspiration of involved axillary lymph nodes was done to confirm the findings. Ultrasonography of axillary lymphnodes will detect the small lymphnodes which can be missed on physical examination. Ultrasound guided fine needle aspiration will help in removal of metastatically involved lymphnodes in axillary clearance in a single surgery.
EnglishUltrasound, FNAC, Axillary lymphnode, Carcinoma breast.INTRODUCTION
Axillary lymph node status is the most important prognostic factor in breast cancer. The presence of nodal metastases decreases 5-year survival by approximately 40% compared to node-negative patients. Noninvasive imaging techniques have been used to predict the preoperative axillary lymph node status. Ultra Sonography has higher diagnostic accuracy than mammography, computed tomography, magnetic resonance imaging, and positron emission tomography for diagnosing axillary node metastasis1,3.However axillary sonography has been shown to be moderately sensitive (48.8%–87.1%). UltraSonography is reported to be more sensitive in the detection of metastatic axillary lymph nodes than palpation or mammography2, 6 . Fine needle aspiration cytology (FNAC) of radiologically abnormal axillary lymph nodes in patients with breast cancer can identify patients suitable for primary axillary clearance rather than sentinel node biopsy, enabling surgical axillary staging by a single operation 4 .
MATERIALS AND METHODS This study was carried out in Karnataka institute of medical sciences, Hubli, Karnataka a tertiary care centre for one year (2006-2007). Thirty cases of carcinoma breast diagnosed on fine needle aspiration cytology were selected for detection of axillary lymphnode status. Axillary lymphnodes were palpated to know the presence in these 30 cases. Verbal consent was taken by the patients after explaining the procedure. They were subjected to conventional fine needle aspiration cytology first and US guided fine needle aspiration cytology later.
Philips HDI Ultrasonography machine along with hand held probe was used to determine the status of axillary lymphnodes. Ultrasonographically axillary nodes that are round, hypo echoic, with loss of central hilum, eccentric cortical hypertrophy were considered malignant and others were reactive. Lymphnodes either positive or negative on sonography basis were selected for fine needle aspiration cytology. Fine needle aspiration cytology was done using 5ml syringe with 20-22 gauge needle. Smears stained with H&E stain and Wright’s stain were examined. They were categorised as no material, reactive changes and metastatic deposits as depicted in Table 1 and Fig.1.
RESULTS In the present study, 2 cases did not have any axillary lymphnodes while on physical examination 6 were negative. Ultrasonography assesment of lymphnodes whether they were reactive or metastatically involved were complimented by FNAC. None of the cases on US guided FNAC showed no material while 8 cases yielded no material on conventional FNAC. Reactive features were seen in 10 cases on US guided FNAC and 3 cases on conventional FNAC. Metastatic deposits was seen in 18 cases on US guided FNAC and 13 on conventional FNAC. Physical examination did yield positive results only when the lymphnodes were of sufficient size (>2cms) but not for the lymphnodes which were smaller. Ultrasonography showed the lymphnodes immaterial of the size (smaller being 0.5cms) along with additional information of metastatic deposits as depicted in Table 2 and Figure 2.
DISCUSSION Breast cancer is the second most common malignancy in India after carcinoma of cervix 7 . The incidence of breast carcinoma is increasing among the young females. Early diagnosis of carcinoma will have better prognosis and has varied modalities of treatment. Initial assesment of a lump in a breast can be done with mammography, ultrasonography, fine needle aspiration cytology, core biopsy and excision biopsy. Once the lump has been diagnosed as carcinoma staging becomes the important prognostic factor. Assesment of axillary lymphnode status is an important factor in staging of breast cancer. Many of the times axillary lymphnodes are missed on physical examination of axilla owing to smaller size or deeper location and it will affect the staging. Traditional use of axillary sentinel node biopsy raised issue of false negative results 8 . These false negative cases may be because of massive metastasis in a single lymphnode in the draining area3 .The use of ultrasonography in detecting axillary lymphnode status has limited application because of low sensitivity (48.8%– 87.1%) 2 .
However use of sonography to detect metastically involved lymphnodes will reduce the sentinel lymphnode biopsies. It will also help in diagnosing metastatically involved lymphnodes which might have been missed on physical examination. Ultrasonography is much more cost effective , can be used in centres where the facility for CT and MRI are not available. US guided FNAC will compliment the diagnostic findings of sonography. With precise assesment of lymphnode status staging can be more accurate. Axillary clearence incase of involved nodes can be done with primary removal of breast tumor in a single operation. Hence it will reduce the two stage surgery or surgery at a later date.
CONCLUSION Ultra sonography of axillary lymphnodes will help in identifying the enlarged axillary lymphnodes which can be missed by physical examination. The charachteristic features of metastatically involved lymphnodes will help in proper staging of carcinoma breast. Ultra sonography guided fine needle aspiration cytology will compliment the findings and help in removal of metastatically involved lymphnodes in a single surgery.
ACKNOWLEDGEMENTS: To all the patients who were part of this study for their co-operation. To the editorial committee for accepting and publishing this artcle.
Englishhttp://ijcrr.com/abstract.php?article_id=1453http://ijcrr.com/article_html.php?did=14531. Jae Jeong Choi, Bong Joo Kang, Sung Hun Kim, Ji Hye Lee, Seung Hee Jeong, Hyun Woo Yim et al. Role of Sonographic Elastography in the Differential Diagnosis of Axillary Lymph Nodes in Breast Cancer. J Ultrasound Med 2011; 30:429–436.
2. Isil Gunhan-Bilgen, Esin Emin Ustun, Aysenur Memis. Inflammatory Breast Carcinoma: Mammographic, Ultrasonographic, Clinical and Pathologic Findings in 142 cases. Radiology 2002; 223:829–838.
3. Soledad Alvarez, Enrique Añorbe, Pilar Alcorta, Fernando López, Ignacio Alonso, Julia Cortés. Role of Sonography in the Diagnosis of Axillary Lymph Node Metastases in Breast Cancer: A Systematic Review. AJR 2006; 186:1342–1348.
4. Brian D Hayes, Linda Feeley, Cecily M Quinn, M M Kennedy, Ann O'Doherty, Fidelma Flanagan et al. Axillary fine needle aspiration cytology for pre-operative staging of patients with screen-detected invasive breast carcinoma. J Clin Pathol 2011;64: 338-342.
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8. Fraile M, Rull M, Julian FJ, et al. Sentinel node biopsy as a practical alternative to axillary lymphnode dissection in breast cancer patients: an approach to its validity. Ann Oncol 2000; 11:701–705.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareCARTILAGE METABOLIC MARKERS AND ANTIOXIDANTS: ITS CORRELATION IN OSTEOARTHRITIC PATIENTS OF SIKKIM
English5863Sonam Choden BhutiaEnglish T. A. SinghEnglish Mingma Lhamu SherpaEnglishBackground: Oxidative stress has been implicated as a mediator of cartilage damage in patient with Osteoarthritis (OA). Aim: To assess the antioxidant markers like superoxide dismutase (SOD) , glutathione peroxidase (GPx) and uric acid (UA) in the blood and cartilage metabolic markers like hyaluronic acid (HA) and keratan sulphate (KS) in the synovial fluid of osteoarthritic patients and to find the correlation between these parameters in the blood and synovial fluid. Methods: This was an observational study conducted in the department of Biochemistry, Sikkim Manipal Institute of Medical Sciences (SMIMS), Gangtok. 75 osteoarthritic patients and healthy volunteers were taken for the study. Blood levels of antioxidants (SOD, GPx and UA) were assayed in both osteoarthritic and healthy volunteers. Cartilage metabolic markers like HA and KS were assayed in the synovial fluid. Result: Osteoarthritic patients showed statistically significant increase in KS and decrease in HA level indicating cartilage damage. Decrease in SOD and GPx activities indicates increase in oxidative stress. The difference in UA levels in the two groups was not statistically significant. This study did not establish any significant positive/negative correlation between the antioxidants in the blood and cartilage metabolic markers in the synovial fluid of osteoarthritic patients.
EnglishOsteoarthritis, cartilage metabolic markers, Antioxidants, GPx, SODINTRODUCTION
Osteoarthritis (OA) is the leading cause of chronic disability worldwide between the fourth and fifth decade of life with a prevalence of 17% to 60.6% in India (1, 2). Knee is possibly the most commonly affected joint in most of the communities (3). Articular cartilage destruction in OA is believed to be a result of excessive loading, age-related changes, and metabolic imbalance in the tissues (4, 5, 6). The body fluid levels for direct and indirect biochemical markers of structural or metabolic changes in joint tissues has begun to provide clinically useful information. Cartilage derived molecules present in the synovial fluid may be markers of biosynthetic changes or of degradative changes (7). Keratan sulphate (KS) estimation has been proposed to be a potential marker of cartilage destruction in arthritis (8). Hyaluronic acid (HA) plays an important role in the protection of articular cartilage and soft tissue surfaces of the joint(9). Serum HA has been suggested as a useful indicator in assessing knee osteoarthritic activity (10). In knee OA the mechanism of cartilage matrix degradation is not clearly understood, but it is thought that Reactive Oxygen Species maybe one of the causes. Free radicals are formed in both physiological and pathological conditions in mammalian tissues (11).
Alteration of the Redox status is known to occur in rheumatic diseases (12,13) .To prevent ROS toxicity, our body possesses well co-ordinated antioxidant systems like superoxide dismutase (SOD), glutathione peroxidase (GPx) and non enzymic antioxidant like Uric acid (UA) among others. Antioxidants are compounds that dispose, scavenge and suppress the formation of free radicals or oppose their actions. It is reported that HA also acts as an antioxidant as it is an anti-inflammatory substance (14). To date various biomarkers of OA have been studied to potentially aid in the diagnosis and to assess minor changes in bone and cartilage of knee OA. Very few correlation studies between blood antioxidants and a cartilage metabolic marker have been published. The study aims to evaluate the activities of antioxidant enzyme SOD, GPx and non enzymic antioxidant level UA in the blood and cartilage metabolism markers like HA and KS in the synovial fluid of osteoarthritic patients and to determine the correlations between the parameters measured in blood and synovial fluid.
MATERIALS AND METHODS This study is an observational study and was conducted in the Department of Biochemistry, Sikkim Manipal Institute of Medical Sciences, Gangtok, Sikkim with due approval from the Institutional Ethics Committee. Participation in the study by all was solely voluntary, with prior detailed information and consent.
Subjects: 75 clinically diagnosed patients with primary knee osteoarthritis of age group (40-80 years) were selected from patients attending Sir Thutop Namgyal Memorial Hospital (STNM) and Central Referral hospital (CRH), Gangtok. 75 healthy volunteers were taken for the statistical comparison for the parameters analyzed in the blood. No comparison could be made in healthy volunteer’s synovial fluid due to ethical concerns. Classification of the cases: Osteoarthritis was classified according to the classification criteria described by American College of Rheumatology (15). Exclusion criteria: Smokers, alcoholics, diabetics, hypertensive and patients suffering from any other systemic disease including patients with post traumatic osteoarthritis were excluded from the study. Sample collection and processing: Heparinised venous blood samples were collected and part of it was centrifuged and plasma was used for the estimation of UA (Uricase Method, RFCL, India) (16). The other part of the venous whole blood was hemolysed and used to estimate the activity of SOD by Ransod kit, and activity of GPx by Ransel kit (Both from Randox laboratory ltd, UK) (17,18). Synovial fluid was aspirated and centrifuged to remove the debris and the supernatant was used for the estimation of HA and KS by sandwich ELISA (Blue Gene Biotech Co ltd, Shanghai) (19). Since we did not have any healthy synovial fluid for comparison we have used the reference range obtained from Bluegene (19).
Statistical analysis SPSS (version 16) was used for our statistical analysis. The results were analyzed by using Independent‘t’ test for comparing the means between osteoarthritic patients and healthy controls. Pearson’s correlation was used to study the relation between the antioxidants and cartilage metabolic markers in osteoarthritic patients. P0.05) (table 2).
DISCUSSION Different studies worldwide have shown alteration in redox status and the shift towards oxidative stress leading to decrease in antioxidant levels as they are oxidized by the free radical and this is the protective response of the body to any oxidative damage. Synovial cavity damage has been associated with oxidative stress by some studies (20). In our study significant decrease in antioxidant enzymes SOD and GPx is in consort with few other studies (21, 22). UA, though being an antioxidant, no significant difference was observed in our study and this could be due to the complex, selective antioxidant capacity of uric acid (23). Our study findings are consistent with the findings of insignificant changes in UA and no association of serum uric acid in OA (24, 25).
The decreased levels of HA in OA in our study is similar to previous studies (26, 27). The decrease may be due to dilutional effects, reduced hyaluronan synthesis and free radical degradation (28). Different studies have projected that KS levels increases in OA (29, 30) and stated that it is a promising marker of early cartilage breakdown (31, 32). This study showed no significant correlation between the antioxidants in the blood and the cartilage metabolic markers in the synovial fluid. This may be due to the fact that the assays for antioxidants were done in the blood and the cartilage markers in the synovial fluid and blood antioxidants may not truly reflect local redox status.
CONCLUSION Our results suggest that even though the antioxidants are significantly lowered in blood, it did not show any significant positive/ negative correlation with the synovial fluid cartilage metabolic markers in study. This may be due to the limitations of our study where the antioxidant assay and cartilage metabolic markers were studied in different body fluids and the total antioxidant status (TAS) assay was not done. This limitation was due to the fact that we could not get healthy volunteers for synovial fluid analysis due to ethical reasons. Further studies would be required to compare the total antioxidants in blood and synovial fluid and correlating the findings both in serum and synovial fluid to get a true picture of the role of redox status in osteoarthritis. The significant decrease in antioxidant enzymes and hyaluronic acid and increase in keratan sulphate level supports the plausible role of oxidative stress in osteoarthritis and may pave way for developing different preventive and therapeutic strategies.
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.
Englishhttp://ijcrr.com/abstract.php?article_id=1454http://ijcrr.com/article_html.php?did=14541. Lutzner J, Kasten P, Gunther KP, Kirschner S.Surgical options for patients with Osteoarthritis of the knee. Nat Rev Rheumatol 2009; 5:309-16.
2. Sharma MK, Swami HM, Bhatia V, Verma A, Bhatia SP, Kaur G. An Epidemiological study of correlates of Osteoarthritis in Geriatric population of UTChandigarh. Indian J.Community Med.2007; 32:77-8
3. Syed A.HAQ, Fereydoun Davatchi. Osteoarthritis of the knees in the COPCORD world International Journal of Rheumatic Disease.2011; 14(2): 122-129.
4. T.Aigner, J.Haag, J.Martin, J.Buckwalter. Osteoarthritis: aging of matrix and cellsgoing for a remedy. Current Drug Targets 2007; 8(2): 325-331.
5. T.Aigner, N Gerwin. Growth plate cartilage as developmental model in osteoarthritis research potentials and limitations. Current Drug Targets 2007;8 (2):377-385
6. P. M. Van der Kraan, E. N. Blaney Davidson, W. B. van den Berg. A role for age-related changes in TGF beta signaling in aberrant chondrocyte differentiation and osteoarthritis. Arthritis Research and Therapy 2010; 12(1):201-214.
7. Thonar EJ-MA, Manicourt D-H. Noninvasive markers in Osteoarthritis. In Osteoarthritis: Diagnosis and Medical/ Surgical Management, 3 ed. Edited by Markowitz R, Goldberg V, Vowell DS, Altman RD, Buckwalter J. Philadelphia, and PA: WB Saunders; 2001:293-313.
8. Budsberg SC, Lenz ME, Thonar E. Serum and synovial fluid concentrations of keratan sulfate and hyaluronan in dogs with induced stifle joint osteoarthritis following cranial ligament transaction. Am J Vet Res 2006; 67: 429-32.
9. Van den Bekerom MP, Lamme B, Sermon A, Mulier M. What is the evidence for Viscosupplementation in the treatment of patients with hip osteoarthritis? Systematic review of the literature.Arch Orthop Trauma Surg 2008; 128(8):815-823.
10. Turan Y, Bal S, Gurgan A, Topac H, Koseoglu M. Serum hyaluronan level in patients with knee Osteoarthritis .Clin Rheumatol 2007; 26:1293-8.
11. TAS F,Hansel H,Belce A,Ilvan S, Argon A, Camlica H , et al. Oxidative stress in ovarian cancer. Med Oncol.2005; 22(1):11- 15.
12. Mezes M, Bartosiewicz G. Investigations on vitamin E and lipid peroxide status in rheumatic diseases .Clin Rheumatol 1983; 2:259-63.
13. Ostalwska A,BirknerE,Wiecha M, Kasperczyk S,Kaspercyzk A,Kapolka D et al. Lipid peroxidation and antioxidant enzyme in synovial fluid of patients with primary and secondary Osteoarthritis of the knee joint. Osteoarthritis Cartilage 2006; 14:139-45.
14. Campo GM, Avenoso A, Nastasi G, Micali A, Prestipino V, Vaccaro M, et al. Hyaluronan reduces inflammation in experimental arthritis by modulating TLR-2 and TLR-4 cartilage expression. Biochem Biophys Acta 2011 Sep; 1812 (9):1170-81.
15. Altman R, Asch E,Bloch D,Bole G, Borenstein D, Brandt k et al. Development of criteria for the classification and reporting of Osteoarthritis: Classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29:1039-1049.
16. Trinder P. Ann.Clin.Biochem 1969; 6:24- 27.
17. Woolliams JA, Wiener G, Anderson PH, Mc Murray CH. Research in Veterinary Science 1983; 34:253-256.
18. Paglia, D.E and Valentine, W.N., J.Lab. Clin. Med 1967; 70:158.
19. Shanghai Bluegene Biotech CO., Ltd. Human Hyaluronic acid Elisa kit and Human keratan sulphate Elisa kit. Cat number- E01H0004, E0590HU. lot #20110815.
20. Hooiveld, M.J.J., Roosendaal G, Vanden Berg, H.M, Lafeber et al. J.W.J Poster 47th Annual meeting. Orthopaedic Research Society, San Francisco, California. 2001: P- 455.
21. M Maneesh, Jayalekshmi, T Suma, S Chatterjee, A Chakrabarti, T.A.Singh. Evidence of oxidative stress in Osteoarthritis; Indian Journal of clinical Biochemistry 2005; 20(1):129-3.
22. Kalaci A, Yilmaz HR, Aslan B, Sogut S, Yanat AN, Uz E .Effects of hyaluronan on nitric oxide levels and superoxide dismutase activities in synovial fluid in knee osteoarthritis. Clinical Rheumatol 2007 Aug; 26(8):1306-11.
23. Sautin, Yuri; Johnson, Richard. "Uric Acid: The Oxidant-Antioxidant Paradox". Nucleosides, Nucleotides and Nucleic Acids 2008; 27 (6): 608–19.
24. G.M.Rao, Sreelaxmi, A.Naser, Vandana. Reduced blood glutathione in erythrocyte stability in osteoarthritis. Biomedical Research 2005; 16(3):201-203.
25. Y Sun, H Brenner, S Sauerland, K.P.Gunther, W.Puhl, T.Sturmer. Serum uric acid and patterns of radiographic osteoarthritis – the Ulm Osteoarthritis Study. Scandinavian Journal of Rheumatology 2000; 29 (6):380-386
26. Dahl B, Dahl LM, Engstrom-Laurent A, Granath K. Concentration and molecular weight of sodium hyaluronate in synovial fluid form patient with Rheumatoid Arthritis and other arthropies .Ann Rheum Dis1985;44:817-22
27. Balazs, EA. The physical properties of synovial fluid and the specific role of Hyaluronic acid. In: Helfet AJ, edition.In. In Disorders of the knee.Philadelphia: JB Lippincott; 1982.pp.61-74.
28. Van den Bekerom MP, Mylle G, Rys B, Mulier M. Viscosupplementation in symptomatic severe hip osteoarthritis: a review of the literature and report on 60 patients. Acta Orthop Belg 2006; 72 (5):560-568.
29. Mehrabaan F, Finnegan CK, Markowitz RW.Serum keratan sulfate quantitative and qualitative comparison in inflammatory versus no inflammatory arthritides. Arthritis Rheum 1991; 34:383-92.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareFAMILY PLANNING PRACTICES AMONG RURAL HEALTH TRAINING CENTER BENEFICIARIES
English6468Veena S. AlgurEnglish S.A. KaziEnglish M.C. YadavannavarEnglishFamily planning is the method by which a couple can plan when to have and not have children. It allows individuals and couples to anticipate and attain their desired number of children and the spacing and timing of their births. It is achieved through use of contraceptive methods and the treatment of involuntary infertility. A woman’s ability to space and limit her pregnancies has a direct impact on her health and well-being as well as on the outcome of each pregnancy. Family planning services are defined as "educational, comprehensive medical or social activities which enable individuals, including minors, to determine freely the number and spacing of their children and to select the means by which this may be achieved." The present study has been carried out with the 369 patients who attended during the period between 1st June and 15th July 2009 at a Rural Health and Training Centre, Shivanagi (village) adopted by Shri B.M.Patil Medical College, Bijapur. The aim of the study was to find out the gender equality prevailing in rural area in respect of family planning. Out of 369 respondents 159 were males and 210 were females. However 61 (38.36%) of male respondents were in favor of use of contraceptives and 84 (40%) of females could favor for such method of birth control. None of the respondent was in favor of sterilization.
EnglishFamily Planning, Contraception, Sterilization infertility, Pregnancy.INTRODUCTION Family Planning is an integral part of population policy which aims at quality of life .It refers to the practices that help individuals and couples to plan to bring about wanted births, avoid unwanted births and even to space between the births which results in a happy and healthy family. Family planning is defined by WHO expert committee 1971 as ‘a way of thinking & living that is adopted voluntarily upon the basis of knowledge, attitude and responsible decisions by individuals and couples, in order to promote the health and welfare of the family groups and thus contribute effectively to the social development of a country’.1 Onokerhoraye defined family planning as the provision of birth prevention information services and appliances .it also involves teaching men and women about their babies and teaching them how to prevent births usually with contraceptives but sometimes also with abortion or sterilization. 2 The contraceptive methods are broadly categorized in to barrier, chemical, natural and surgical types .Surgical method is a permanent method which includes vasectomy and tubectomy. Effective family planning is based on knowledge attitude and practice of family planning We the Indians are known for our own unique feature of family life like, its durability & depth of its binding, to maintain such unique family the members of family contribute maximum to protect the interest of the family. Females play a key role in managing all most all the dimensions of family affairs, sometimes she is involved more and over burdened, there is gender bias in even sharing family planning responsibilities.
Statement of Problem: It is well-known fact that from the time immortal gender bias is followed and practiced in sharing all most all the responsibilities of life. Due to various physical, biological, social & psychological factors females bare most of the day to day burden without any second thought, though the present era of changing socio economic status has lead females to empower to some extent but her burden continues. In the present study an attempt has been made to find out among the eligible subjects is there any gender equality in the percentage of family planning adopters in rural area if so, which gender has adopted family planning methods?
And why? And what are the different methods adopted.
Objectives
1. Is there any gender bias in family planning practice among eligible subjects?
2. To analyze what are the different family planning methods adopted in rural area.
MATERIALS AND METHODS Study Area: RHTC Shivanagi rural field practice area of Shri B M Patil Medical College, Bijapur. Study Design: Cross Sectional study Participants: Ever married adult patients attending RHTC OPD clinic Study Period: 1 st June to 15th July.2009 Method: A total of 369 respondents were interviewed using pre tested & predesigned pro forma. Analysis: Analysis was done using percentage, Chi square test.
RESULTS AND DISCUSSIONS In this study majority of the respondents were in the age group of 31 to 50 years, 247(67.4%)
Table No.1: Out of 369 respondents no single person had gone for sterilization of family planning. However, 145 (39.30%) respondents did use contraception to prevent unwanted pregnancies. The table No. 1 reveals that though all the persons who visited the Centre were interviewed irrespective of their age to find out whether they had practiced any method to prevent unwanted pregnancies. Though it is less than 40% but among them a majority was from the age ranging between 21 and 59. This age structure and family planning use was found to be statistically significant, p=0.02.
Table No. 2: This table reveals that out of 369 respondents 159(43.08%) were males. None of them had adopted any permanent family planning method but responded frankly that their spouses 61 (38.36%) have accepted contraception. Out of 210 female respondents only 84(40%) have accepted contraception .This observation was found to be statistically significant, p=0.000.
Table No. 3: Most of the respondents were either illiterate or educated up to primary level 290 (78.59%).Level of education of the respondents was not an influencing factor for acceptance of contraception , However this finding was found to be statistically significant ,p=0.05,Similar findings were observed in a study by Padma Mohan et al3
Table No. 4: Table no 4 shows that majority of the respondents were belonging to socio economic class 3 and below. In the present study socio economic status and contraceptive use was not significant p=0.10, probably for the reason to have more number of children.
Table No. 5: Family planning based on number of living children, it was found 108(74.4% ) respondents have accepted Tubectomy with three or more children whereas 37(25.5% ) have accepted with than two children, this difference was found statistically significant p=0.0000 as reported in Bijapur at a glance 2007- 2008 by District Statistical Office Bijapur4 only 9 vasectomy and 12899 tubectomy were reported .
Table Nos. 6 and 7: Out of 224 non acceptors family planning methods against 145 acceptors more number of Muslims and good number of Hindus had denied the adoption of contraceptive use due to family restrictions and for want of more children.
CONCLUSION AND RECOMMENDATION There is a need to shift from only women centric approach to couple centric approach for family planning. There is need of strong political interest commitment and social responsibility of the public .Adoption of tubectomy after Second child , participation of males in family planning to share equal responsibility and eradication of illiteracy which contributes to improvement in socio economic status and rational out look at religious binding needs to be given prime concern .Creating awareness in rural community by focused group discussions and health education using IEC (information ,education and communication ) material ,BCC( behavior change communication) among general public.
ACKNOWLEDGEMENT We the authors acknowledge the encouragement and support of Prof. Dr. P.B.Jagirdar and Viraj B. Yaragol. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references in this paper. 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=1455http://ijcrr.com/article_html.php?did=14551. WHO Technical Report Series no 482, 1990.
2. Onokerhoraye, AG .Health and Family Planning services in Nigeria.ASpatial perspective, The Benin Social Science Services for Africa University of Benin 1997;p1-153.
3. Padma Mohan et al, Fertility pattern and Family planning practices in rural area in Dakshina kannada IJCM vol xxv111 no 1 Jan –Mar 2003.
4. Bijapur at a Glance 2007-8 published by District statistical office Bijapur.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareCOMPARATIVE STUDY ON DISTRIBUTION OF LOAD AND STRESS ON NATURAL TOOTH AND PERIODONTIUM IN RELATION TO DIFFERENT TYPES OF RESTORATIVE CROWN MATERIALS - A PHOTOELASTIC STUDY
English6981K. VinayagavelEnglish C. ThulasingamEnglish C SabarigirinathanEnglish D. MythireyiEnglishBackground: The selection of restorative materials for fabrication of crown and bridge which delivers less amount of stress to the periodontium is a challenging job for successful dentist. The resiliency of crown material plays a pivotal role in delivering stress to the periodontium and supporting structures. Aim: To evaluate the amount of stress transmitted to tooth and periodontium with different restorative crown materials with different magnitude and direction of load. Materials and method: Stress distribution is studied on seven different types of restorative crown materials on the natural tooth mounted on the photoelastic model. Results: In photoelastic study the stress distribution is assessed by fringe order and fringe value. The highest stress inducing crown materials have highest fringe value. The study result shows metal ceramic restoration exhibits highest stress distribution followed by nickel chromium, silver palladium, gold, IPS empress 2, targis vectris. The least stress transferred to the periodontium was by acrylic resin. Conclusion: The heat cure acrylic resin and the modified resin targis vectris have found to be the material of choice for complete coverage as far as stress concentration on the supporting structures is concerned.
EnglishFringe Order, Load Transfer, Photoelastic Study, Stress Distribution.INTRODUCTION
The restoration of tooth irrespective of its vitality is found to be an attractive treatment in the modern era of dentistry. Attention should be focused on conserving the health of supporting structures in this kind of restorative management. The metallic and non metallic restorative material used in full coverage restoration exhibit their minimum, moderate and maximum influence on the supporting structure of the teeth. The stress developed during masticatory function is transmitted on the supporting structures through roots 1,4,7 . The amount of stress induced has a close relationship with factors such as magnitude of occlusal load, direction of load and type of restorative material employed and the resiliency of reastoration31. Periodontal health is one of the important determinants in the longevity of restoration. Factors that hamper the health of periodontium include torque forces, restorative materials with high modulus of elasticity and by the occlusal forces which go beyond the adaptive capacity of periodontium 16,5,10,12 . It is of vital importance to use restorative material which possess all the basic requirements and physical properties without compromising the periodontium. Experimental biochemical models such as photoelastic models have been employed to determine the bone response to external load on restorative materials. The photoelastic method is a recognized engineering method of stress analysis and was first applied in dentistry in 1949 by Noonan 9 . In this study the application of photoelastic method to analyse the stress distribution to the periodontium with different restorative materials have been proposed in the models on various load transfer.
AIM AND OBJECTIVES
1. To evaluate the amount of stress transmitted to the supporting structures by loading the natural teeth restored with different restorative materials
2. To evaluate the stress distribution with different magnitude of load transfer
3. To evaluate the stress distribution with different direction of load transfer-vertical loading, oblique loading
4. To evaluate the resiliency of various restorative materials
5. To compare the resiliency exhibited by different types of materials selected in this study
MATERIALS AND METHODS This study was conducted to analyse the stress distribution on the supporting structure of the natural tooth with complete veneer crowns of different restorative material existing in current clinical practice1 . The crowned natural teeth with different restorative materials were fixed in a photoelastic study model to perform a two dimensional study to obtain fringes 9,14. These crowned teeth were subjected to different magnitude of loading and in different direction of loading to simulate the masticatory load transmitted during function8,15 . Restorative materials used in the fabrication of crown were
1. Non precious alloy nickel chromium alloy
2. Palladium silver alloy
3. Precious alloy Type III gold
4. IPS Empress 2
5. Targis Vectris
6. Feldspathic porcelain – (ultra low fusing )
7. Tooth colored heat cure acrylic resin
Materials used to prepare the photoelastic study models 1. Dentulous typhodont models 2. Two natural teeth ) lower molar ) 3. Flowable silicone 4. Irreversible hydrocolloid impression material 5. Modeling wax 6. Epoxy resin with hardener Armamentarium: 1. Hand piece 2. Torpedo chamfer 3. Flat end tapered diamond 4. Long needle diamond 5. Fine grit round tipped tapered 6. Inlay casting wax 7. PKT instrument
Seven different restorative materials were selected for this study and for each restorative material five test samples (crowns) were prepared. Totally 35 test samples were prepared.
Preparation of photoelastic study model A photoelastic model was fabricated with natural tooth by following techniques Preparation of wax models: A study model of a lower dentulous typhodont was duplicated in wax using irreversible hydrocolloid impression material. The modeling wax was melted to liquid state and poured into alginate impression. Right half of wax model was cut at premolar level, to create a single segment wax model. Preparation of site for molar tooth: Using a hot spatula wax was removed from the first molar tooth to a depth so as to accommodate a molar tooth. Fixation of molar tooth in wax model: The mandibular first molar natural tooth was placed in the prepared site of the wax model. The interface between the tooth and the wax is smoothened with hot instrument. Impression procedure: Impression of the wax model with the tooth was made with flowable silicone and allowed to set. The wax was eliminated by boiling out technique leaving behind the mould with the natural molar tooth. Preparation of Photo elastic material: An epoxy resin and hardener ( Araldite, Cy230, HY 951, CIBAGEIGY) in the ratio of 10:1 were mixed in an aluminium container for 15 min. The material was then poured into a mould along its sides again to ensure that no air bubble was incorporated, the material was allowed to set for 48 hrs at room temperature curing to obtain photoelastic models with natural tooth in position.
Preparation of natural tooth to receive complete veneer crown in the photoelastic model: Two identical photoelastic models were fabricated with natural teeth in position. Tooth preparation was carried out based on the bio mechanical principles on both the natural tooth embedded in photoelastic model. Chamfer and shoulder finish lines were given to them respectively. Preparation of wax pattern: The wax pattern is the precursor of the finished cast restoration that will be placed on the prepared tooth. For all metal restoration, the wax pattern thickness was 1.5mm. For all ceramic and resin restoration, the overall wax pattern thickness was 2.0mm. The wax pattern was invested, casted, finished and polished by the conventional casting technique. Two dimensional photo elastic technique: The photo elastic study is an well recognized engineering method of stress analysis. The technique involves construction of a model of the structure to be investigated from a photoelastic material9,14. The temporary double refraction under stress of photo elastic materials is utilized for photo elastic analysis. The ray of light is resolved into two rays which travel at different velocities along the principle plane of the material and emerge retarded with each other. The amount of retardation is directly proportional to the difference between the principle stress and is measured using a polariscope. The coloured fringes obtained are used to determine the stress distribution,
The models were loaded with 30.60 and 90 pounds and the resultant stress were calculated from the amount of fringes which have been photographed. Loading photoelastic model: The single molar crown was cemented on the prepared molar tooth of the photo elastic model and the model was placed in the photoelastic straining frame. Vertical and oblique forces of 30 lbs, 60 lbs, and 90 lbs were applied on the occclusal surface of the various crown within the straining frame. The resultant stresses transmitted to the bone were photographed for each load application and the fringe pattern was recorded. All photographs were evaluated visually for stress induced fringes. This procedure was repeated for all the five samples of seven restorative materials taken up for this study.
RESULTS Interpretation of results for vertical loading : Under 30, 60, 90 pounds Group V exhibited minimum stress distribution, and Group IV exhibited maximum stress distribution. The stress distribution in descending order is as follows Group IV > II > I > III > VI >VII > V Interpretation of results for oblique laoding : Under 30, 60, 90 pounds Group V exhibited minimum stress distribution, and Group IV exhibited maximum stress distribution. The stress distribution in descending order is as follows Group IV > II > III > I >VII > VI > V Under 30 pounds Group I and Group VII exhibited equal stress distribution. Under 60 pounds Group II and Group IV exhibited equal stress distribution. Color patterns of the internal stress in the photoelastic materials indicate the relative magnitude and distribution of stress that result from the force applied. The total numbers of isochromatic fringes observed were directly proportional to the magnitude of the force and areas of high stress concentration are represented by how close the fringes are to each other. Fringe order is based on the fringe color position in the color sequence namely as the colors become brighter {fringe order Black, Gray, white, yellow, orange red, blue, green}. Higher stress are indicated as said by Dally in his experimental stress analysis 1985.
DISCUSSION Restorative materials of metallic, non metallic and combination of both are commonly used in clinical practice to fabricate restorations. These restorative materials are selected based on several factors to fulfill the requirements of the clinician and the demands of the patient. Biomechanical factors such as heavy biting forces and grinding forces deliver vertical, oblique and horizontal load. These forces are of different magnitude and act in different direction on the periodontium causing damage to the supporting tissues along with the local factors already present in the oral cavity. Under these situations, the rigidity of the restoration could act as a potential factor to increase the magnitude of force resulting in excess stress concentration on the supporting structures beyond the physiological tolerance3,13. Hence this study was conducted to find out the quantum of stress concentration on the supporting structures on the tooth restored with commercially available restorative materials in current clinical practice.
The load applied on the prepared restoration is 30 pounds, 60 pounds and 90 pounds to simulate the masticatory load exerted by various types of restorations such as complete denture against natural tooth, removable partial denture against natural tooth and fixed partial denture against natural tooth respectively7,15. Loads were applied in two different directions, the axial direction simulating maximum biting force and the oblique loading simulating the grinding force. The oblique load was applied at an angle of 65 to the long axis of the tooth. In this study 7 different restorative materials were selected which are the common materials used in the fabrication of restoration like complete veneer crown.
The metal ceramic crown exhibited maximum stress concentration followed by nickel chromium, palladium silver, gold, IPS Empress 2 and Targis vectris crowns. The least stress distribution was exhibited by acrylic resin. Metal ceramic restoration is not a stress absorbing material due to its high rigidity. Although esthetically pleasing, it is highly detrimental to the periodontium especially during masticatory function. The oblique force was found to be more damaging when compared to the vertical force5,10,12 . Following metal ceramic restoration the nickel chromium, silver palladium and gold restorations transmit more stress respectively11. All these alloys exhibit less or no resilience to minimize the stress distribution due to high Young’s modulus value as far as these alloys are concerned. The gold alloys exhibit minimum stress concentration than niti is because of its low elastic modulus along with its ductility and malleability. Hence gold alloy may be suitable choice to restore the posterior teeth where esthetic demand is negligible. Among the non metallic restorative materials, the all ceramic restoration Empress 2 exert more force and resulting in higher stress concentration over the supporting structure.
Now all ceramic material have gained the highest popularity among the tooth colored restorative material of choice for complete coverage although illusion effect, color stability, longevity of material is found to be extremely good to fulfill the estheticand functional demands of the individual. But its rigidity is high according to Young s modulus. Although wear resistence of ceramic is very high it tends to wear off the opposing tooth. Targs vectris modified resin and heat cure acrylic resin exhibit low stress concentration particularly the heat cure acrylic resin is the least one2,3,6. The acrylic resin has shock absorbing property due to their resiliency so it will dampen the impact forces that are exerted on the tooth through the restoration. So the stress distribution to the bone by the acrylic restorations is less when compared to all the other materials evaluated in this study.
CONCLUSION The metal ceramic restoration exhibited maximum stress distribution and The acrylic resin restoration exhibited lower stress to the bone under 30,60 and 90 pounds on vertical and oblique loading. Among the metallic restorative material the gold alloy exhibits less stress concentration. Among the non metallic restorative material the heat cure acrylic resin exhibit the least stress concentration and all ceramic restotation exhibited maximum stress concentration. Comparing all the restorative materials under two types of directions and three types of loading, the decreasing order of stress concentration is as follows: metal ceramic > nickel chromium crown>palladium silver crown>gold crown>empress 2>targis vectris> acrylic resin.
The decreasing order of resiliency of the seven restorative materials is as follows: acrylic resin > targis vectris>empress 2> gold crown > palladium silver>nickel chromium> metal ceramic From the above study it can be concluded that the heat cure acrylic resin and the modified resin targis vectris have found to be the material of choice for complete coverage as far as stress concentration on the supporting structures is concerned. When comparing and evaluating other physical properties they are very low and could not compete with metal ceramic and all ceramic materials. Hence an elaborate research and study have to be conducted to improve the physical properties of resin based restorative materials without compromising their resiliency.
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=1456http://ijcrr.com/article_html.php?did=14561. Akpinar I et al ( 2000) evaluated natural tooth stress distribution in occlusion with a dental implant J O Rehab 2000 June 27 ( 6) 538 – 45
2. Ciftci Y et al the effect of veneering materials on stress distribution in implant supported FPD IJOMI 2000 Jul – Aug 15 (4) 57
3. Gracis SE et al Shock absorbing behaviours of 5 restorative materials used on implants IJP 1991 May Jun 4(3) 282 -91
4. Hood JA et al Modification of stress in alveolar bone induced by a tilted molar jpd 1975 Oct 34 (4) 415 -21
5. Hojjatie B et al Three dimensional finite element analysis of glass ceramic dental crowns J Biomech 1990 23 (11) 1157 -66
6. Inan O et al Effect of functional stress on alveolar bone created by restorative materials – A photoelastic study Imp Dent 1999 8 (#) 311- 6
7. Ishigaki S et al Effect of stress distribution in supporting bone around an implant and a natural tooth under chewing function Clin Oral Imp Res 2003 Feb (!)97 -102
8. Nakamura T et al stress analysis of metal free polymer crowns using FEA IJP 2001 Sept – Oct 14(5) 401- 5
9. Noonan M A the use of photoelasticity in the study of cavity preparation J Dent 1949 16 24 -28
10. Papavasiliou G et al Three dimensional FEA of effect of veneering materials and load direction on stress distribution JPD 1996 Dec 76 (6) 633 -40
11. Proos KA et al FEA studies of a metal ceramic crown on a first premolar tooth IJP 2002 Nov Dec 15 (6) 521-7
12. Pospiech P et al All ceramic resin bounded bridges FEA E J Oral Sci 1996 Aug 104 390 -5
13. Suzuki H et al FEA of ceramic crown on premolar relation between ceramic materials and abutment materials Nippon Hotetsu Shiku 1989 Apr 33 (2) 283 -93
14. Tanner AN Factor affecting the design of photoelastic models for two dimensional analysisJPD 1972 27 48 -62
15. White SN et al effect of cantilever length on stress transfer by implant supported prosthesis JPD 1994 May 71(5) 493 -9
16. Watanabe F et al Effect of stress distribution by varying degree of inclination of the implant and varying load position and direction odontology 2003 Sept 19 91 (3) 31- 6
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareCONDITION OF OBSERVING THE PRINCIPLES OF RADIATION PROTECTION IN RADIOLOGY CENTERS IN SISTAN AND BALUCHESTAN PROVINCE OF IRAN
English8285Mohammad Javad Keikhai FarzanehEnglish Ali Akbar Mehmandoost-Khajeh-Dad English Baharan NamayeshiEnglish Zahra Noori VarmalEnglish Mohsen MesgaraniEnglishObjective: One of the most important complications of imaging with X-rays is genetic effects and carcinogenic nature of these radiations. For this reason, various guidelines in the field of ionizing radiation protection have been done from national and international organizations in the recent decades. This study aims to investigate the amount of observing the principles of radiation protection in Sistan and Balouchstan radiological centers. Materials and Methods: in this descriptive study, a checklist was provided based on the recommendations done by the institute for the principles of radiation protection of Iran Atomic Energy Organization and then 10 diagnostic imaging centers was evaluated to determine the value of observing the principles of radiation protection according to this checklist. Findings: considering the centers under study, 10% of them did not have protection shield in reproductive glands; all the centers were benefitted from leaden hood, but these leaden hoods were used only in 60% of the centers for the protection of one accompanier; no outdated films were used in the centers and film badge was used in all centers for the radiation monitoring of the personnel. Of the centers under study, 20% of them were involved in their activity without using air conditioning device. 10% of the centers were devoid of entrance warning signs, but the sign of radiation zone was installed in all centers. In 10% of the concerned centers, the entrance door of the radiography room was not completely closed, but more leaden partition was used for more protection against radiation in the time of portable radiography. There was no leaden glass in 50% of the regarded centers, but no leaden glass was also used in the imaging process of the centers that have leaden glasses. Results and Discussion: although observing the radiation protection in the concerned centers is satisfactory, these protection principles were not completely observed in all centers, which the observation of protective principles can be promoted through the orderly observation and controlled by the relevant authorities and holding the classes of protection against radiation.
Englishradiation protection; X-rays; radiology.INTRODUCTION
Radiation is one of the factors about which most studies have been done regarding its morbidity effects, though there are many points regarding how the radiation affects living organisms which must be clarified, but the mechanisms by which radiation damages living organism's cells and molecules have been studied and recognized more than other damaging agents. The observed effects of radiation are generally divided into two random and non-random categories in which the biological effects of the radiations are often fall into the non-random effects category. To turn up the non-random effects into the living organisms, the rate of radiation on the living organisms should be exceeded from a special minimum; otherwise, the above effects will not be revealed. The other category of the effects of radiations is the genetic effects which are created in the individual's sexual cells due to the change in the DNA structure and these effects cannot be seen in the person being radiated at, but it will be visible in the next generations and the children of those persons.
To review these effects on people, "Genetically Significant Dose" will be used. GSD depends on the radiation caused by received dose by gonads and the person's age. Accordingly, when a person ages over 50 years is placed under radiation who has naturally a little chance for a childbirth has a little role in GSD population, and conversely, giving radiation to children's genitalia is mostly contributed in GSD population. In the annual report delivered in 1972, Bier estimated that GSD caused by Rontgen rays in America can be reduced up to 50% by applying coatings and shields for the sexual glands (1).For this reason, for the protection of reproductive glands against radiations, leaden shield are used which is led to the reduction of exposure of reproductive glands and the reduction of the probability of genetic effects occurrence, and of course, using contact shields has more effects on reducing sexual glands spectrometry(2).
Finally, the most important complication regarded in the diagnostic radiology centers is the radiation's random complications, especially genetic effects and carcinogenic effects of the radiation, for these complications are resulted from direct effects of radiation on the genetic cells which are subsequently created after being received low radiation dose and there is no radiation dose that can be called safe dose (3).That's why, to prevent from individual's unwilling exposure, observing the radiation protection principles in radiology sectors are seems necessary.
MATERIALS AND METHOD In this sectional and descriptive study, first; a suitable checklist based on all the radiation protection principles designed and then the checklist was completed by interview and observation with referring to the regarded centers.
FINDING Of the concerned centers of radiology under study, all of them had suitable leaden hood to be used, but these hoods were used only in 60% of centers for patient protection. On the other hand, 80% of the centers under study were benefitted from reproductive glands shields, but only 30% of these shields were used for patient protection. All the regarded centers used film badges for controlling personnel dose. They also use warning sign of exposure zone, but none of the radiology centers have specific mechanical devices to make the patient standstill in its due time. Finally, all the centers under study used leaden partition for the protection against X-rays while using portable radiography device.
RESULTS AND DISCUSSION One of the most important protection points is to use special shields for the protection against reproductive glands, especially regarding in toddlers and children, because despite the fact that 80% of the centers are benefitted from reproductive glands shield, only 30% of the centers under study unfortunately use the shields for the patient's protection against reproductive glands, and given that the probable changes made in the DNA of the reproductive cells in the person being exposed to will be manifested in their children and the upcoming generations, considering this protection point is highly important. On the other hand, if the personnel does not use film badge, their received dose cannot be monitored and if the protective tips do not observe, their dose will be reached higher than determined Dose Limit (4). Fortunately, film badges are used in all the radiological centers under study to monitor the individual personnel dose. Regarding the fact that leaden hood is used for the accompaniers in the needed time, despite the fact that all the centers under study have leaden hood, only 60% of these leaden hoods are used for the protection of those accompanying patients that worth being thought about. Entrance warning sign equipped with a lamp above the entrance of radiography room should be installed to be lightened in the time of patient's exposure and hence prevent from entering the patients and personnel in the time of doing radiography.
Fortunately, this sign has been used in 90% of this center. On the other hand, the special sign of the danger of ionizing radiations exposure must be installed above the radiography room entrance, for the patients or the accompaniers are gathered besides radiography room without being noticed at, and this cause they are exposed to; moreover, this problem can be exacerbated and the received dose can be increased if the radiography room entrance door is opened (5). Fortunately, exposure zone warning sign has been used in 100% of the concerned centers and the radiography room entrance door was completely closed up in 90% centers which are hereby led to reducing referent's exposure. On the other hand, having been done quality control test, it has been found that optical filed and X-ray field are not completely adopted to each other in 60% of the centers, which this causes the zones that are not seemingly faced with X-rays with regard to optical field are not involved in radiation filed in the time of exposure and doing radiography in practice and even sometimes sensitive organs of the patient are unwillingly exposed. Finally, observing the radiation protection principles in the regarded centers are evaluated satisfactorily; however, to observe more the protection principles, orientation classes can be hold for the radiation protection principles and an optimal use of protection devices and facilities in the radiology centers can be recommended.
Englishhttp://ijcrr.com/abstract.php?article_id=1457http://ijcrr.com/article_html.php?did=14571. Hering E.R., Van T.J., Wanwkotze T.J. etal. An estimation of the genetically Physics. 1998; 47:419-28.
2. Barchman N, Egan I, Dowd SB. gonadal protection methods in neonatal chest radiography.Radiotechnol, 1997; 69: 157-61.
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4. Thomas SC, James ED, Robert M. Christensensphysica of diagnostic radiology. 4thed.London: LeaxFebiger, 1990;93-98.
5. BushongSC.Radiation Scientific for Technologist. Fifth ed. Mosby Year Book 1993;217-33.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareSTUDY OF THE VARIANT SOLEUS MUSCLE
English8689Sharadkumar Pralhad SawantEnglish Shaguphta T. ShaikhEnglish S. D. LeleEnglish Shaheen RizviEnglish S.R.MenonEnglish R. UmaEnglishAim: To study the variant soleus muscle. Materials and Methods: 50 lower limbs of 25 donated embalmed cadavers (15 males and 10 females) of age group ranging from 70 to 80 years were studied in the department of Anatomy at K. J. Somaiya Medical College, Sion, Mumbai, INDIA. The right lower limb of one male cadaver showed the three separate heads of soleus muscle. All the lower limbs were thoroughly and meticulously dissected to note the variation of the soleus muscle. The arterial pattern in the leg was also observed. The photographs of the variation of the soleus muscle were taken for proper documentation. Observations: Out of 100 specimens the variations in the soleus muscle was found in one specimen. The right lower limb of a female cadaver showed three separate heads of soleus muscle. The tibial head from soleal line present on the posterior surface of the tibia, the fibular head from the back of the head of the fibula and the intermediate head from the tendinous arch placed between the tibial and the fibular origins of the muscle. The three heads of soleus muscle along with the medial and the lateral heads of gastrocnemius formed the tendo calcaneus which got inserted into the middle part of the posterior surface of the calcaneus bone. There was no associated arterial variation seen in the specimen. The variation was unilateral and the left lower limb of the same cadaver was normal. Conclusion: The existence of such variation of the soleus muscle should be kept in mind by the surgeons, the orthopaedicians, the radiologists and also by the physiotherapists. The three heads of soleus may prove significant and lead to confusion during surgical procedures. A lack of awareness such variations might complicate surgical repair.
EnglishSoleus Muscle, Three Heads, Surgeons, Orthopaedicians, Radiologists, Physiotherapists.INTRODUCTION
The soleus is a broad flat muscle situated immediately in front of the gastrocnemius. It arises by tendinous fibers from the back of the head of the fibula, and from the upper third of the posterior surface of the body of the bone; from the popliteal line, and the middle third of the medial border of the tibia; some fibers also arise from a tendinous arch placed between the tibial and fibular origins of the muscle, in front of which the popliteal vessels and tibial nerve run. The fibers end in an aponeurosis which covers the posterior surface of the muscle, and, gradually becoming thicker and narrower, joins with the tendon of the gastrocnemius, and forms with it the tendo calcaneus (1). Accessory head to its lower and inner part usually ending in the tendocalcaneus, or the calcaneus, or the laciniate ligament (2). The gastrocnemius and soleus together form a muscular mass which is occasionally described as the Triceps surae; its tendon of insertion is the tendo calcaneus (Tendo Achillis), the common tendon of the gastrocnemius and soleus, is the thickest and strongest in the body. It is about 15 cm. long, and begins near the middle of the leg, but receives fleshy fibers on its anterior surface, almost to its lower end. Gradually becoming contracted below, it is inserted into the middle part of the posterior surface of the calcaneus, a bursa being interposed between the tendon and the upper part of this surface. The tendon spreads out somewhat at its lower end, so that its narrowest part is about 4 cm. above its insertion. It is covered by the fascia and the integument, and is separated from the deep muscles and vessels by a considerable interval filled up with areolar and adipose tissue. Along its lateral side, but superficial to it, is the small saphenous vein (4).
MATERIALS AND METHODS 50 lower limbs of 25 donated embalmed cadavers (15 males and 10 females) of age group ranging from 70 to 80 years were studied in the department of Anatomy at K. J. Somaiya Medical College, Sion, Mumbai, INDIA. The right lower limb of one male cadaver showed the three separate heads of soleus muscle. All the lower limbs were thoroughly and meticulously dissected to note the variation of the soleus muscle. The arterial pattern in the leg was also observed. The photographs of the variation of the soleus muscle were taken for proper documentation.
OBSERVATIONS Out of 100 specimens the variations in the soleus muscle was found in one specimen. The right lower limb of a female cadaver showed three separate heads of soleus muscle. The tibial head from soleal line present on the posterior surface of the tibia, the fibular head from the back of the head of the fibula and the intermediate head from the tendinous arch placed between the tibial and the fibular origins of the muscle. The three heads of soleus muscle along with the medial and the lateral heads of gastrocnemius formed the tendo calcaneus which got inserted into the middle part of the posterior surface of the calcaneus bone. There was no associated arterial variation seen in the specimen. The variation was unilateral and the left lower limb of the same cadaver was normal.
Figure showing the photographic presentation of the right lower limb of a male cadaver showed three separate heads of soleus muscle. All the three heads of soleus are supplied by the tibial nerve.
DISCUSSION The accessory soleus muscle was first described in literature by Fue Cruvelhier in 1834. The variant soleus muscle is present in 0.7 to 5.5% of the population (5). It is a rare anatomical variation that can present as a soft tissue tumor in this region. A congenital muscle anomaly is more frequent in the upper limbs and is rarely seen in the lower limbs. During embryogenesis the soleous muscle separates into two parts, and this supernumerary muscle has its own blood supply and innervations (6, 7). This supernumerary muscle is located under the gastrocnemius muscle, in the posterior upper third of the fibula, in the oblique soleus line, between the fibular head and the posterior part of the tibia. From its origin, the accessory soleus muscle runs anteriorly and medially until it reaches the Achilles tendon.
Five accessory soleus muscle types were described based on their insertion characteristics, including the Achilles tendon, the muscle insertion in the upper calcaneus region, the tendon insertion in the upper calcaneus, the muscle insertion in the medial calcaneus region, and finally the tendon insertion in the medial part of the calcaneus (5). The accessory soleus muscle is usually observed during the second or third decade of life and more often in males at 2:1 ratio (8, 9, 10). This is a rare condition and its general prevalence has not been established yet (11). Statistical analysis shows that accessory soleus muscle is more frequently a unilateral finding (12). In the present case the variation in the soleus muscle was unilateral and the right lower limb of the same cadaver was normal. The reports in the literature stated a 0.7 to 5.5% presence of accessory soleus muscle in human beings (13, 14, 15, 16). Some investigators reported a prevalence ranging from 1 to 6% in human beings (17). Sometimes it is very difficult to identify the origin and insertion of the accessory soleus muscle on the MRI study (18, 19, 20). The variations in the soleus muscle were common in males (21). In the present case the variation was observed in male specimen. Thus our finding coincides with the literature.
CLINICAL SIGNIFICANCE The knowledge of any variation in the soleus muscle is clinically important because the soleus muscle is called as peripheral heart. The presence of variant soleus muscle may appear as a soft tissue tumor on MRI study in this region.
CONCLUSION The existence of such variation of the soleus muscle should be kept in mind by the surgeons, the orthopaedicians, the radiologists and also by the physiotherapists. The three heads of soleus may prove significant and lead to confusion during surgical procedures. A lack of awareness such variations might complicate surgical repair.
COMPETING INTERESTS The authors declare that they have no competing interests.
AUTHORS' CONTRIBUTIONS SPS wrote the case report, performed the literature review and obtained the photograph for the study. SDL, UR performed the literature search, SR assisted with writing the paper. STS conceived the study and SRM helped to draft the manuscript. All authors have read and approved the final version manuscript.
ACKNOWLEDGEMENT All the authors are thankful to Dr. Arif A. Faruqui for his support. We are also thankful to Mr. M. Murugan for his help. Authors also 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=1458http://ijcrr.com/article_html.php?did=14581. Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, et al. The Nervous system. In: Gray’s Anatomy, 39th edn, Churchill Livingstone, New York; 2005; 879 - 880.
2. Hamilton WJ. Textbook of the Human Anatomy, 2nd edn, Macmillan Press Ltd., London 1976; 651.
3. Last RJ. Anatomy: Regional and Applied, 7th edn, Churchill Livingstone, Edinburgh 1984; 89.
4. Snell RS. Clinical Anatomy for Medical Students, 5th edn, Little Brown and Company, USA; 1995; 434.
5. Sookur PA, Naraghi AM, Bleakney RR, Jalan R, Chan O, White LM. Accessory muscles: anatomy, symptoms and radiology evaluation. Radiographics. 2008; 28 (2) : 481 - 99.
6. Moore KL, Dalley AF. Clinically Oriented Anatomy. 4th ed. Philadelphia: Lippincott Williams and Wilkins, 1999: 347-560.
7. Boyd, J.D.; Clark, W.E.; Hamilton, W.J.; Yoffey, J.M.; Zuckerman, S; Appleton, A.B.: Textbook of Human Anatomy In: Cardiovascular system. Blood Vessels. Mcmillan and Co. Ltd. New York. : 341-346 (1956).
8. Romanus B, Lindahl S, Sterner B. Accessory soleus muscle. A clinical and radiographic presentation of eleven cases. J Bone Joint Surg Am. 1986; 68 (5) :731-4.
9. Leswick DA, Chow V, Stoneham GW. Resident’s corner. Can Assoc Radiol J. 2003; 54 (5) : 313 - 5.
10. Kouvalchouk J.F, Lecocq J, Parier J, Fischer M. The accessory soleus muscle: a report of 21 cases and a review of the literature. Rev Chir Orthop Reparatrice Appar Mot. 2006; 91 (3) : 232 - 8. French.
11. Kurtoglu Z, Uluutku H. Bilateral accessory soleus muscle. Turk J Med Sci. 2000; 30: 393 - 5.
12. Christodoulou A, Terzidis I, Natsis K, Gigis I, Pournaras J. Soleus accessorius, an anomalous muscle in a young athlete: case report and analysis of the literature. Br J Sport Med. 2004; 38 (6) : e 38.
13. Toit MN, de Villiers RV, Derman EW. Persistent pain following ankle sprain: bilateral accessory soleus muscle. S Afr Med J. 2009; 99 (11) : 791 - 2.
14. Mir NA, Kangoo KA. Accessory soleus muscle: a case report and review of the literature. JK Sci. 2002; 4 (1): 41 - 2.
15. Reis FP, Aragão JA, Fernandes AC, Feitosa VL, Fakhouri R, Nunes MA. The accessory soleus muscle: case report and a review of the literature. Int J Morphol. 2007; 25 (4) : 881 - 4.
16. Singh S, Suri RK Mehta V, Loh H, Arora J, Rath G. Bilateral additional bellies of the soleus muscle: anatomical and clinical insight. Int J Anat Var. 2009; 2 : 20 - 2.
17. Luck MD, Gordon AG, Beblea JS, Dalinka MK. High association between accessory soleus muscle and Achilles tendonopathy. Skeletal Radiol. 2008; 37 (12) : 1129 - 33.
18. Featherstone T. MRI diagnosis of accessory soleus muscle strain. Br J Sports Med. 1995; 29 (4) : 277 - 8.
19. Doda N, Peh WC, Chawla A. Symptomatic accessory soleus muscle: diagnosis and follow-up on magnetic resonance imaging. Br J Radiol. 2006; 79 (946) :e129 - 32.
20. Caroll JF. Accessory muscles of the ankle. MRI Web Clinic [Internet]. 2008 Nov [cited 2012 Jan 31]. Available from: http://www.radsource.us/clinic/0811.
21. Meherzi MH, Bouaziz M, Hamida FB, Ghannouchi M, Quertatani M, Nouri H, et al. The accessory soleus muscle: a report of the two cases with review of the literature. Méd Chir Pied. 2009; 25 (1) : 17 - 20.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30General SciencesTHE SIGNIFICANCE OF HEART AND CONSCIENCE HEALTH
English9094Mohammad ZareiEnglish Rahmatollah Joghataei SabzevariEnglish Zahra Noori VarmalEnglishOne of the greatest blessings of God is health and according to religious teachings, the highest extent of health is human’s spirit and heart health. Islam introduced the true meaning of health for humans and because human’s life and living does not limit to worldly life, health considers in a broad context which humans reached to health and well-being in all facets of life by performing the religious sects and the need to acquire to this significant issue and the key for world’s happiness is to recognize spirit and self. This study aims to explore the significance of human’s spiritual and intellectual aspects, define heart and considers the health and disease according to the narratives and verses and finally indicate the effectiveness of heart’s health on human body and introducing the spiritual dimensions.
EnglishHealth, Heart, Disease, Medic.INTRODUCTION
Health is one of the great blessings of God which has two dimensions: the first dimension is physical health which plays a main role in human’s greatness and intellectual ability and its maintenance is very important. However, the second dimension, which is more important than physical health, is heart and spiritual health. In Islamic school, as physical health has been emphasized on and no, one is entitled to damage his/her health and is led to disease and killed by doing damaging works such as drinking poison and damaging to the body and lack of physical hygiene, it is not appropriate to harm spiritual health and doing inappropriate things. By referring to the Islamic teachings, these two types of health and the necessity of thanksgiving are very important. Imam Ali (Peace be upon Him) said in a narration there are three types of blessings for humans: Firstly, lack of need to people, that is having enough livelihood to manage affairs of life. Second, which is more better than the first one, is physical health and the third one which is more virtuous than the first one is piety and spiritual health.
Given the importance of human’s spiritual health, this article aims to study this issue which has an effective role in physical health. One of our main tasks in the world is to recognize the spirit and becoming aware of health standards and its diseases and also the types of heart diseases and finding the ways to treat them, because human’s physical dimension is not all his/her reality as the unbelievers and denials of God and the Hereafter think about. “…Worldly life is nothing but dying and living, what causes our death is time and nature…and unfortunately many Muslims are affected to this materialistic type of thinking, for we know no dangerous disease but physical disease such as gastrointestinal and cancer to making our mind to treat and cure them".
Heart: The Companion of Ethical Issues ‘Heart’ literally means the pure of everything, as human heart which is the most purest of his existential being. The term heart, which is used as changing the objects, has other applications and attributions. One of the contributions of this term is self. Although the term heart is the same pineal part of human body in medical and physiological sciences.
Heart in Qur’an More than one hundred and thirty times heart mentioned in Qur’an, and it is so clear that by Heart in Qur’an, it does not mean the fleshy heart. By studying the various verses in which heart used and some traits, cognitive states and features related to human’s self and soil attribute to heart, such as understanding, thinking, decision-making, making friendship and enemies, ascending and descending, etc. It is resulted the term heart in Qur’an is the same as human’s spirit and self and is attributed to all his/her realities, which the illness and health is originated from the thoughts, beliefs and good and bad deeds.
Heart Diseases in terms of Qur’an Allame Tabatabiae mentioned in Almizan interpretation that: The sentence “…there are diseases in their heart” is summarily indicate that human’s heart is under the danger of some disease and when some disease percieved for something has also a physical state, because health and disease are oppositions to each other not to each of them is supposed on. There is no supposition on the other hand such as blindness and eyesight which a person cannot be called as a blind one due to the fact that he is not able to see it, because there is no talent to see it and also it cannot be attributed to something else.
Because the person has no talent for becoming health and in any place in which God Almighty mentioned the disease for the hearts, its states also mentioned and the outcomes mentioned and some issues has been mentioned which indicated that the hearts lost their innate strengths and deviated from the path of moderation. Let note the following verses: “… there is the time when the hypocrites and those whose hearts are sick said: God and His Messenger had promised us nothing but lie and deceive” (Ahzab: 12) and the verse: “…when the hypocrites and those who are diseased in heart said that these people’s religion deceived them” (Anfal: 49). “… in order to God make the temptations of Satan as sedition and experiment in diseased people’s hearts (Haj: 53) and also other verses".
In interpreting disease and heart’s health, Allame Tabatabaie said: “Heart's disease is that someone affects a kind of anxiety and doubt and make his belief to God and the assurance to his verses turbid and unclear and the belief in his hearts is mixed with unbelief, and therefore it can be observed that the person is affected by a state of temperament proper to disbelief and therefore the deeds he/she performs is appropriate to disbelief in God and his revelations".
On the other hand, heart’s health is something that heart is placed in somewhere that created there or on the other hand heart does not lose the path of mediation and returning this state to heart’s purity is in God’s monotheism and trusting to Him and dismembering from anything else which is drawn by the whims. Therefore, if the one who affects to heart’s disease is going to cure him/herself and remove his disease must repent to God and it is having faith to Him and mentioning to good thoughts and decent deeds. Sin is a Disease Every human is created healthy and pure in every circumstances as innate structure and inside dignity. Greed, envy, avarice, hypocrisy, immorality and other sins are inherent to humans, but they are the complications that are affected to human due to a series of family and social factors. The Prophet said that: “Every child born on the context of monotheism, Islam and prophecy. This is the parents who bring them up as believers or disbelievers. “ O people, surely the lord give unto you advices and sermons and it is a healing of what (religious and moral beliefs) is in your hearts and is all guidance and mercy for believers” (Younes, 57). According to Qur’an, this disease can be forgiven. “save those who repented and reformed afterwards and compensate for the past sins which their repentance will be accepted , because God is allforgiving, all-merciful”.(Al-emran,8).
The Surrendered Heart, the Only Wealth to be Saved It can be seen among Abraham’s rhetoric in describing the resurrection that: “there will be no much effect in that Day except a surrendered heart”. “ Salim”, which is derived from health, has a clear cut idea, i.e. a heart which is away from any disease and moral and religious deviations”. In some hadith, the concept of a surrendered heart is well indicated
1. In a hadith narrated by Imam Sadegh (PBUH) below the verse in question that: The heart which is no affected by polytheism and doubt will be elapsed and is worthless”.
2. On the other hand, it is known that intense material and worldly devotion interest is brought human to And therefore a surrendered heart is the one in which is devoid of “ love of the world”, as Imam Sadegh mentioned in an another hadith below this verse that: “ this is the heart that is healthy of worldly love”. According to the verse 197 of Sura Baghare, it becomes clear that a surrendered heart is the one in which is the source of divine piety by being healthy.every guilt and deviations, because love of this world is the source of every sin.
healthy. 3. Finally, a surrendered heart is the one there is nothing within but God, as Imam Sadegh said regarding a question about this verse that: “ a surrendered one is the one which meets God while there is nothing within but God”.
It is completely clear that by heart in these cases, it means human’s soul and spirit. Ibn Jouzi mentioned six perspectives regarding heart’s health in his interpretation: 1. Being healthy from infidelity. 2. A safe heart which is the heart of believers, because those of pagans is diseased.
4. Being intact from the damages of children’s properties and 6. Being safe from innovations and being sure of traditions.
As the health of apparent heart is the cause of physical health and its disease is the one with all body members, why are body cells are fed by the kind of blood which is transferred to all parts of body by the help of heart, as the health and corruption of human’s life programs is a reflection of health and corruption in belief and morality.
The effect of spiritual diseases on human’s body Health cannot consider only from the perspective of body, because experience has proved that not only internal disturbances, diseases and emotions disrupt thinking’s disturbances and anxiety, it has also bad effects on the body and is the source of various diseases, for example, two mental illness mentioned:
Jealousy One of the mental illness is jealousy. Although a jealous one is care of all aspects of health, the severity of jealousy, being intensified in his heart, makes him angered and destroy his health. Imam Ali (PBUH) said: “…well-being is the result of a little envy” (14), which he mentioned a significant issue of medicine and health and indicated that jealousy is the source of many diseases. It has been scientifically proven that ulcer disease and a series of human’s inner diseases are resulted from psychological diseases and concerns which is based on jealousy. One of the scientists wrote: it is not possible that a jealous man have a happy life.
Imam Ali often emphasized on this issue, including in Speech 225 that he said: “Surprisingly, jealous people are healthy. In an another place he said: “ jealously is a fatal disease that will not be disappeared unless the destruction or death of someone which is envied”. He states in another case that: “there are three things that brings its owner to disturbance: hatred, envy and immorality”, and also said that “the worst people in terms of comfort is a jealous one”. (15).
Hopelessness Being hopeless of the future and disappointment from God’s mercy is considered as greatest sin and is led humans to blasphemy and it is resulted in grief. It is one of the human’s mental states that brings mankind nothings but sickness and disease. Imam Ali said: “sadness and sorrow will destroy the body”.
When the one who has sorrow is happy in life? Let not have grief in life to have a happy life Soul and body are interconnected and unified to such an extent that the good and bad states of one of them will affect on the other. And this issue has been accepted by all past and present scientists. Human body is affected by mental states and the psyche is also affected by body states. Imam Ali said: “sorrow is half of the aging”. Scientists have proved in scientific research that a considerable part of the disease in different parts of the body is resulted from spiritual emotions and mental concerns.
To basically treat these diseases, it is required that the attention be paid on the root of the disease and the concerns and anxieties are dealt with before medical and drug treatment and remove them from the patients. Seventy percents of the patients who referred to medics can personally treat if they free himself from the constraints of fear and anxiety, including: nervous indigestion, some stomach ulcers, heart diseases, sleeping sickness, some types of headaches and some types of paralysis. Dr Joseph Montako, the author of the book regarding stomach disorders also mentioned the same opinion that what is eaten does not cause ulcers, but what eats you ( concern) is the cause of appearing this wound. Dr Elvariz, working in Mayoukar clinic said that there is sometimes direct relationship between the severity and weakness of stomach ulcers and the severity and weakness of the rate of internal emotions.
This finding relies on the experiments and research in 15000 patients who referred to the clinic for the ulcer disorders and four-fifth of them did not believe that the basis and cause of their disease is due to their ulcer. Fear, worry, envy, high egotism, non-merit in compromise with the environment are main causes of ulcer diseases and its wounds. Ulcer stomach is the cause of death, and according to the contents of “Life” magazine, it is the tenth grade among the most dangerous diseases. Brothers Mauo, which their clinic is well-known, announced that more than half of the hospital’s beds are occupied by those who are affected to nervous disturbances and their disease is not due to fact that their nerve is corrupted or disturbed, but rather from the internal emotions, withdrawal, anxiety, worry, fear, failure and hopelessness.
The outstanding chapters of Dr. Edward Podlsok entitled “ prevent from the concerns to be occurred and have a healthy and comfortable life” is indicated: what effect has concern with the heart? Blood pressure is resulted from concern, rheumatism may be due to concern, how the stomach will be weakened by concern? Worry, sweat glands and diabetes is caused by worry. Dr. William McGonikel said in American Association of Dentists that: concern causes damage and decay to teeth and so continued his speech: “ the emotions and feelings which is created by worry and fear causes the disturbance the disturb of calcium and will decay teeth.
Psychotherapy by Faith Some tendencies have recently been created among the psychologists that favors more attention to religion for mental health and mental illnesses. They believe that faith in God is an extraordinary force that gives human a kind of spiritual power. it makes help humans in tolerating the life difficulties and takes them away from the concerns and anxieties that many people are affected to.
The tendency to material things and the competition to own it causes spiritual pressure and confusion on modern humans and put them under the attacks of anxieties and various mental diseases. One the first one who raised this issue was William James, the American philosopher and psychologist. He says: “ without doubt, faith is the most effective treatment for anxiety. Faith is a force that should be existed in humans life to be benefitted from. Lack of faith is a warning that causes human’s inability against the life difficulties. He said in another elsewhere that: there is an unbroken relationship between God and us. If we put ourselves under the dignity of God and be surrendered, all our dreams and desires will be fulfilled”.
The psychoanalyst, Karl Jung , said: During the last thirty years ago, many people from various nationalities consulted to me and I cured hundreds of patients, however the patients who are living in the second half of their life ( that is thirty years onwards), I have not even seen one patient who does not need to one particular religious orientation in life. It can assuredly be said that all of them were the victim of mental diseases for this reason which were bereft of what is given to the followers of religious sects, and only when all of them returned to religion and religious views are fully treated.
Another psychoanalyst, A.A . Brill puts it that: Never will a religious man be affected to mental illness. The American psychologist, Henry Link mentioned in the book “returning to faith” that: as a result of my long experiences in carrying out the psychological tests on workers, I figured out the religious people and those who goes to monarchies have much more strong and better personality than those who never goes to worship God.
The therapeutic Physicians As the body’s disease can be treated with referring to the physician and taking prescriptions and eating medicines, spiritual diseases can also be treated by the physicians which this kind of disease can be eradicated from their spirits and hearts by becoming aware to its instructions and practicing them, though it is too heavy and chronic. The physician of these kinds of diseases is God the compassionate, prophets, imams and clergies. The way God introduced for curing the sins is Qur’an and the way prophets and imams and clergies introduced is the wise speech, compassionate advices and kindly preaches.
CONCLUSION Mental health is the highest form of health which is interpreted as morality. It is incumbent upon everyone to make his heart pure of the Satanic temptations and moral vices and it is making pure heart with remembering God and the strong faith in God that humans are reached to a stable composure and this health has a direct relationship on human’s physical health. It is required, for those who want to purify his heart, to make use of the ways introduced by Allah.
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11. The interpretation of Safi, below this verse.
12. Kafi, quoted from Safi, below the verse in question.
13. Ibn- JouziAbolfarajAbdolrahmanibn Ali, ZadAlmasir fi elmeAltafsir, Dar-AlketabAlarabi, Beirut, 1422 AH.
14. NahjAlbalaghe, Hekmat, 256.
15. Translation and interpretation of Nahj-Albalaghe, Vol. 3, PP. 549-550.
16. GhorarAlhekam, P. 321.
17. HorAmeli, VasayelAshiite, Al-Albeyt institution, Qom, VasayelAlshiite, Vol. 9, P. 402.
18. Shirazi, Ahmad Amin, “ Islam, the ultimate true direction. http//ketab.iec-md.org
19. Rosh Magazine of school’s consultation, winter 2006, No. 2, PP. 3-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareCAFFEY'S DISEASE - A DIAGNOSTIC DILEMMA
English9599Soundarya MahalingamEnglish Kamalakshi BhatEnglish GopakumarEnglish Basavaprabhu AchappaEnglishFever in infancy can imply a wide spectrum of illnesses that range from an innocuous upper respiratory infection to life threatening systemic infection. Hence fever without a focus in an infant has been, is and will be a diagnostic dilemma for the paediatrician. Here we present a case who presented similarly with fever without focus, however the cause finally elucidated was the rare Caffey’s disease. Caffey’s disease is a rare disorder whose etiology is yet to be clearly elucidated. It is characterised by cortical hyperostosis with inflammation of adjacent fascia and at times the overlying muscle is also involved. It most often presents in infancy with sudden irritability, soft tissue swelling visible over the involved bones having a woody induration with no suppuration, fever and anorexia. The disease is also known to have an unpredictable course with remissions and relapses. A high index of suspicion with a good radiology and laboratory backup is thus necessary to make a diagnosis and plan treatment.
EnglishCaffey’s disease; Fever; Infantile Cortical HyperostosisCASE REPORT
A 56 day old male baby, born to nonconsanguineous parents was referred with low grade continuous fever of ten days duration, and minimal upper respiratory infection with nasal block since the last two days. He was treated elsewhere with oral and parenteral antibiotics for eight days and referred to us for persistence of fever. He was immunised to date and was on breast feeds and top feeds. On examination, he was irritable, had significant pallor, short neck, with diffuse swelling in mandibular and sub mandibular regions bilaterally and no obvious facial dysmorphism. He was febrile (102 degree F), tachycardic ( 158 / min) and tachypnoeic (62/ min).
His anthropometric measurements were appropriate for age. On auscultation, a short systolic murmur was heard at the apex. Liver was enlarged 3cm below Rt. costal margin. Initial blood investigations revealed anemia (Hb – 8.1g %), neutrophilic leucocytosis (TLC 34, 480 cells/cu. mm with 72 % neutrophils, 5% band forms) and thrombocytosis (12, 07,000 cells/cu. mm). CRP was elevated (84 mg/L). Liver function tests, renal function tests and serum electrolytes were normal. Malarial test was negative. Urine and stool routine was normal and urine and Blood culture and sensitivity also yielded no growth. Our initial diagnosis was sepsis with anemia in congestive cardiac failure, hence he was started on intravenous piperacillin / tazobactam and packed RBCs were transfused.
After 48 hrs of admission, the fever was still present, CRP was further elevated (236 mg / L), hence ECHO was done to rule out infective endocarditis, which was normal. During these two days he was noticed to have severe nasal block and assumed a hyperextended neck posture hence CT scan head-neck and lumbar puncture were done, which were normal except for few enlarged cervical lymph nodes. Nasal secretion from suction catheter was sent for culture and sensitivity which grew Staphyloccus aureus and Escherichia coli, hence antibiotics were changed appropriately. On the 7th day of admission, he continued to have fever and developed paucity of movement of left arm with swelling and tenderness over the left clavicular region. X ray and USG of local area over clavicle showed cortical irregularity and adjacent periosteal thickening and osteomyelitis could not be ruled out, hence anti-inflammatory drugs were started and antibiotics continued.
There was gradual symptomatic improvement and the baby became less irritable and started moving the limb. Repeat investigations showed total count (26,850 cells/cu. mm), platelet count (7,73, 000 cells/cu.mm),elevated ALP (843IU/L) and ESR (65mm/ hr). Over the next few days in hospital, a similar swelling over the right clavicular region and fever persisted. CT scan of bilateral clavicular region was done that showed B/L clavicular periosteitis with adjacent soft tissue inflammation. In search for the etiology the following tests were ordered - VDRL (Negative), serum ferritin (698ng/ml), IgM CMV (negative), HIV (negative), Central line culture (sterile), all of which were normal. Immunoglobulin profile showed elevated IgE – 475 IU/mL and IgM 1.05 IU/mL with normal IgA and IgG levels. In view of persisting fever with increasing clavicular inflammation despite appropriate antibiotic treatment, bone biopsy was done by orthopaedic surgeon which revealed periosteal inflammation composed of neutrophils, eosinophils, occasional focal lymphoplasmacytic infiltrates with fibrosis and hyperostosis.
On review of literature, these clinical findings along with anemia, thrombocytosis, elevated inflammatory markers, the typical imaging studies and biopsy were found to be consistent with the diagnosis of Caffey’s Disease. In the following days of hospital stay, on antiinflammatory measures, baby became symptomatically better with no fever, less irritability, weight gain, hand movements improved, though the swelling over the clavicles remained. At discharge, investigations showed Hb – 10.7 gm%, total count – 14,500 cells / cu mm, DC - N34 L55 E2 M9, platelet count – 1, 70,000 cells / cu mm.
On follow up visits, baby has normal development with good weight gain and there was no evident clavicular or mandibular swelling. Hematological parameters had improved with normal haemoglobin, platelet count and decreasing ESR. He is one year old now and has not had recurrence of symptoms.
DISCUSSION Fever in infancy has always been a diagnostic dilemma, more so when there are no localising signs at the outset. Caffey’s disease is one such situation wherein the search for the diagnosis can mislead without a good clinical suspicion and multidisciplinary approach to the diagnosis. It was first reported as a disease entity by Caffey and Silverman in 1945 and is also known as Infantile Cortical Hyperostosis. It is a self limiting disorder characterized by a triad of systemic symptoms like irritability, fever, soft tissue swelling and underlying cortical bone thickening. The exact aetiology of this condition is still unknown [1].
Most cases are sporadic, but a few familial cases with autosomal dominant and recessive patterns have been described [2]. The existence of two forms of Caffey disease has been suggested, a classical mild infantile form delineated by Caffey and Silverman and a severe form with prenatal onset [1,3,4,5]. The classic form has an onset within the first 6 months of life, usually with symptoms of irritability, swelling of the overlying soft tissue that precedes the cortical thickening of the underlying bones, fever and anorexia. The swelling is painful with induration but with no redness or warmth, thus suppuration is absent. Mandible is the most commonly involved site followed by scapula, clavicle, ribs and long bones. There are usually no other signs and symptoms.
Isolated cases of facial nerve palsy and Erb’s palsy following nerve entrapment have been reported in the literature [6, 7]. The pain can be severe and can also result in pseudo paralysis. Laboratory findings include elevated ESR, and in some patients high alkaline phosphatase, thrombocytosis, anaemia and raised immunoglobulin levels [8]. Radiography is the most valuable diagnostic study in ICH. Cortical new bone formation (Cortical Hyperostosis) beneath the regions of soft tissue swelling is the characteristic feature. While no laboratory tests are specific, the important differential diagnosis that are to be excluded are osteomyelitis, chronic hypervitaminosis A, bone tumour, scurvy, child abuse and prolonged PGE1 infusion [9,10].
Complications have been seen with usually the severe prenatal disease, include pseudoparalysis, torticollis, pleural effusions, mandibular asymmetry and bony fusions when adjacent flat bones are involved. Caffey disease is mostly self-limiting and resolves within six months to one year and may not need any treatment [4]. However, Indomethacin or Naproxen could be used in really symptomatic cases. Steroids (prednisolone) can be administered if there is poor response to Indomethacin, and in cases without thrombocytosis [9].
CONCLUSION Caffey’s disease, though a rare and self limiting condition, may mimic common childhood illnesses. The disease may present, as in our case, with only fever and evolve over the following days with the typical features of fever, soft tissue swelling and irritability. Awareness of this condition, a good history, clinical examination, basic laboratory studies and plain radiographs are sufficient for diagnosis in most cases. Counselling the parents is important as this disease is known to relapse and remit throughout childhood and complications can occur if the disease stays untreated.
ACKNOWLEDGEMENTS 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=1460http://ijcrr.com/article_html.php?did=14601. Restrepo S, Sánchez AM, Palacios E. Infantile cortical hyperostosis of the mandible. Ear Nose Throat J 2004 Jul; 83(7):454-455.
2. Bernstein RM, Zaleska DJ. Familial Aspects of Caffey Disease. Am J Orthop 1996; 24:777-778.
3. Susan S, Rabih C, Comelia T, Katharina L, Stephan M, Sigrid T. Antenatal onset of cortical hyperostosis. Am J Med Genet 2003; 120:547-552.
4. Mohammed ALF. Caffey Silverman Disease: Case Report and Literature Review. Kuwait Medical journal 2006; 38(1):49-52.
5. Harris VJ, Ramilo J. Caffey’s disease: a case originating in the first metatarsal and review of a 12 year experience. Am J Roentgenol 1978 Feb;130(2):335-337
6. Challapalli M, Cunningham DG, Varnado SC. Infantile cortical hyperostosis and facial nerve palsy. Int J Pediatr Otorhinolaryngol 1998 Mar; 43(2):175-178.
7. Holtzman D. Infantile cortical hyperostosis of the scapula presenting as an ipsilateral Erb’s palsy. J Pediatr 1972 Oct; 81(4):785-788.
8. Kumar TS, Scott JX, Mathew LG. Caffey disease with raised immunoglobulin levels and thrombocytosis. Indian J Pediatr 2008 Feb; 75(2):181-182.
9. Varma R, Johny VF. Infantile cortical hyperostosis. Indian Pediatr 2002 Nov; 39(11):1057.
10. Almada Rodriguez Hugo D. Non accidental injuries in Children-common pit falls Online ISSN: 0972-8074, published on 2005 July 1, accessed on 4th April 2009.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareAN ERGONOMIC RISK ASSESSMENT FOR CATERING WORKERS
English100105M. JagannathEnglish Minal V. ShelatEnglish D. TamilselviEnglishModern technological society is evolving with highly sophisticated equipments that persist in employing manual worker like Caterers. Catering workers are under increasing pressure to provide their services efficiently to the customers. This stressful situation can be made worse by their physical discomfort caused due to the increased exposure of repeated tasks and nature of the job. The objective of this study is to assess the physical discomforts of catering workers using Psychophysiological study. Twenty six participants involved in this study. The study was based on subjective measure by means of questionnaire using Rehabilitation Bioengineering Group Pain Scale (RBGPS). Results showed that there is a significant difference (p < 0.05) in pain scores of catering workers between the upper and lower body regions. Both men and women workers have significant discomfort in the lower back regions as compared to the upper back. Findings also showed that women workers have high physical discomforts in the regions such as neck, shoulder, upper back and lower extremities when compared to men. The outcome of this study helps the management and ergonomists to improve the workplace design, consequently enhance the quality of life of catering workers.
EnglishManual labour, Discomfort, Musculoskeletal disorders, Psychophysiological test.INTRODUCTION
Modern technological society is evolving with automation and highly sophisticated equipments that persist in employing manual labour for majority of their activities in many industries and organizations [1]. Several explanations may be attributed to this approach being abundant manpower availability, cheap labour, flexibility in adjusting to demand requirements, etc. This necessitates the continuous assessment of the jobs involving manual work contents for ergonomic risk [2]. Hence, ergonomic assessment contributes an essential part in ergonomic interventions and in turn targeting on quality improvements of worker’s life. Ergonomic evaluation of manual operations among workers has been in vogue for more than a century. The discomfort or pain perceived on various regions of the human body by several types of manual work has been well-researched and documented [3, 4].
The cumulative trauma caused by the repetitive nature of work has attracted the attention of biomedical and ergonomics researchers all around the world [5]. When workers get overloaded due to physical or environmental causes, the efficiency of repeated jobs decreases and thus the quality of the services decreases likewise [6, 7]. Thus, ergonomic considerations require interventions to support manual labour in their working environment. Discomfort on workers lead to various types of disorders such as musculoskeletal disorders (MSDs), cumulative trauma disorders, etc. Literature suggests the existence of several risk assessment tools [8, 9].
In this paper, we used Rehabilitation Bioengineering Group Pain Scale (RBGPS) for evaluating catering workers discomfort and pain. RBGPS is a simple, low-cost tool based on existing methods and can aid organizations towards focusing on, and simultaneously improving the quality of working life.
METHODS AND MATERIALS Participants The study group consisted of 7 male and 19 female catering workers of our organization with a mean age of 34.8(±2.6) years and 42.1(±3.4) years respectively. Participants have minimum of five years of experience in the catering field. All participants were made fully aware of the experimental details, before their active involvement in this study. They signed the informed consent that conformed to the ethical guidelines of our organization.
Experimental Design Figure 1 shows the typical catering workers at work. Self administered questionnaire was given to each participant to grade their perceived discomfort or pain that occurs during their activities of job. Participants graded their discomfort at different body regions such as neck, shoulders, upper back, elbows, hands/wrists, lower back, hip/thighs, buttocks, knees, legs, ankles/foot, etc. The different body regions are shown in Figure 2. The pain score was categorized using RBGPS ranging from "No discomfort (0)" to "Severe pain (5)". The criterion for pain scale is depicted in Table 1.
Table 1. RBG pain scale criteria adapted from [8] that was used for evaluating perceived discomfort and pain of catering workers.
Statistical Analysis Skewness test performed on the discomfort/pain scores showed that they were not normally distributed. Hence a nonparametric test, MannWhitney U test was used to determine the significant difference in pain scores between the men and the women catering workers. Friedman test was performed for pain scores within participant, to determine the differences in discomfort among the different body regions. All statistical testing was carried out using commercially available statistical software (SPSSTM v10.0.1) at a significance level of p < 0.05.
RESULTS AND DISCUSSION Statistical tests were able to significantly differentiate (p < 0.05) the perceived discomforts in different body regions between men and women catering workers. The purpose of this study was to understand better the physical aspect of discomfort/pain among catering workers due to prolonged standing and nature of their jobs. The perception of discomfort/pain is a qualitative measure and is entirely subjective in nature. Psychophysiological tests involving questionnaire studies are well established methodologies for evaluating musculoskeletal related disorders.
The present study group consisted of men and women catering workers. Results from the questionnaire studies showed that the workers perceived pain in the upper extremities of the body in regions of shoulders, upper back, elbows and wrists. There is a significant (p < 0.05) perceived discomfort between men and women in the body regions of upper extremities, knees, legs, ankles. The women workers have significantly high discomfort as compared to men (Figure 3 and Figure 4).
A study by Pehkonen et al. [10] investigated a participatory ergonomic intervention process applied in 59 municipal kitchens. In groups of three to five kitchens, the workers participated in eight workshops, and evaluated solutions to optimize musculoskeletal load in their work. By the end, 402 changes were implemented as a result of minimizing the musculoskeletal load. Evaluative data were collected using research diaries, questionnaires, and inter personal interviews. The intervention model has shown the feasible and the participatory approach were mostly experienced as motivating factor. The changes in ergonomics were perceived to decrease physical load and improve musculoskeletal health [10]. In this study, we have attempted to understand the physical factors due to wide range of tasks performed by the catering workers.
The present study uses questionnaire in a potential analysis of work related musculoskeletal disorders. Heavy lifting, forceful and repeated actions are the causes of pain in back, neck, shoulders and joints. This study showed the clear evidence of discomfort and pain caused to the catering workers as a consequence of dynamic work situations. In the present study, the results showed that the perceived pain in the lower back region has significantly high when compared to the upper back regions. Both men and women catering workers have graded significantly (p < 0.05) high pain score in the lower back region. The reason may be due to their posture that they adopt during the course of food preparation. The buttocks region has the least significant pain score in both men and women catering workers. Stationary standing is a kind of posture adopted by the catering workers, in which they intermittently walk while they are on the job [9]. Several literatures had reported that stationary standing decreases the flow of blood to the muscles, accelerates the onset of discomfort or pain in the leg, back and neck muscles [11]. The present study corroborates with the findings of the literature.
Moreover, excessive standing may also cause the joints in the spine, hip, knees and feet to become temporarily immobilized or locked. This immobility can subsequently lead to rheumatic diseases due to degenerative damage to the tendons and ligaments [12]. To minimize the physical load of the catering workers, a flexible workplace design and ergonomic training should be given to the workers [13]. In addition, the catering workers expressed a wish for more support from the management and ergonomists to improve their quality of life.
CONCLUSION This study helps us to understand the consequences of work load in catering jobs. From the results, it is evident that there is a higher discomfort in the lower back region of catering workers when compared to the upper back region. There is a possibility that this high discomfort might aggravate their symptoms. Findings showed that there is a higher incidence of reported discomfort or pain in women workers who were employed in catering where there is a high level of exposure to physical loading as compared to men caterer. These inferences should be used while designing workplace and allocation of jobs based on the capability of the catering workers.
ACKNOWLEDGMENT: Authors would like to thank all the participants for their time and effort to make this study possible. 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=1461http://ijcrr.com/article_html.php?did=14611. Diyar A, Ali MA, Kurt A. NEFCLASS based extraction of fuzzy rules and classification of risks of low back disorders. Expert Systems with Applications 2008; 35(4):2107-2112.
2. Changxu W, Yili L. Development and evaluation of an ergonomic software package for predicting multiple-task human performance and mental workload in humanmachine interface design and evaluation. Computers and Industrial Engineering 2009; 56(1):323-333.
3. Andersson GBJ. Epidemiologic aspects on low-back pain in industry. Spine 1981; 6(1):53–60.
4. Chaffin DB, Andersson BJG, Martin BJ. Occupational Biomechanics, 3rd Edition, New York: Wiley Interscience, 1999.
5. Wells R, Norman R, Neumann P, Andrews D, Frank J, Shannon H, Kerr M. Assessment of physical work load in epidemiologic studies: common measurement metrics for exposure assessment. Ergonomics 1997; 40(1):51–61.
6. Winkel J, Mathiassen SE. Assessment of physical workload in epidemiologic studies: concepts, issues and operational considerations. Ergonomics 1994; 37(6):979-988.
7. Choi G. A goal programming mixed-model line balancing for processing time and physical workload. Computers and Industrial Engineering 2009; 57(1):395-400.
8. Balasubramanian V, Swami Prasad G, Varadhan SKM. Quantitative evaluation of low back pain in bar benders. NICMAR Journal of Construction Management 2005; 20(4):31–36.
9. Balasubramanian V, Adalarasu K, Regulapati R. Comparing stationary standing with an intermittent walking posture during assembly operations. Human Factors and Ergonomics in Manufacturing 2008, 18(6): 666-677.
10. Pehkonen I, Takala EP, Ketola R, ViikariJuntura E, Leino-Arjas P, Hopsu L, Virtanen T, Haukka E, Holtari-Leino M, Nykyri E, Riihimäki H. Evaluation of a participatory ergonomic intervention process in kitchen work. Applied Ergonomics 2009; 40(1):115- 123.
11. Quiros L. BNL Ergonomics Bulletin, Brookhaven National Laboratory, New York, 2001, 4.
12. Bernard BP. Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Department of Health and Human Services, Cincinnati, 1997.
13. Robertson MM, Huang YH, O’Neill MJ, Schleifer LM. Flexible workspace design and ergonomics training: Impacts on the psychosocial work environment, musculoskeletal health, and work effectiveness among knowledge workers. Applied Ergonomics 2008; 39(4):482-494.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareIN VITRO EVALUATION OF ANTIMICROBIAL EFFECT OF FRESH GARLIC EXTRACT AND ITS INTERACTION WITH CONVENTIONAL ANTIMICROBIALS AGAINST ESCHERICHIA COLI ISOLATES
English106114Vishal GaekwadEnglish N.A. TrivediEnglishEscherichia coli (E. coli) is the most common etiological agent, for causation of uncomplicated urinary tract infection. At the same time it is one of the bacterial strains account for wide range of antimicrobial resistance. Garlic (allium sativum) possesses antimicrobial activity against wide variety of organisms. In the present study antimicrobial activity of fresh garlic extract (FGE) was assessed by well diffusion as well as tube dilution method and effects of combination of ampicillin and ciprofloxacin with FGE were studied by well diffusion method against the clinical isolates of E Coli spp. FGE per se produced dose dependent increase in zone of inhibition. In the combination study, addition of FGE with various concentrations of ampicillin (2.5-20mcg/ml) resulted in marked further increase in zone of inhibition than that produced by ampicillin per se at the respective concentration. While combining different concentrations of ciprofloxacin with FGE, ciprofloxacin 1.25mcg/ml with 20mg/ml and 40mg/ml of FGE produced synergistic effect. This study suggests possibility of concurrent use of antimicrobial drugs and FGE in treating infections caused E. coli spp. Further detailed pharmacokinetic and in vivo studies of garlic are required.
EnglishGarlic; Ampicillin; Ciprofloxacin; Antimicrobial activity; E ColiINTRODUCTION
Antimicrobial resistance is the ability of a microorganism to survive when exposed to antimicrobial drugs against which it was previously sensitive1 . Infections caused by resistant micro-organisms often fail to respond to the standard first line treatment, resulting in more expensive therapies, prolonged illness, prolonged treatment, prolonged hospital stay and greater risk of death. Overall increases health-care costs and the financial burden to families and societies. E. coli is the gram –ve bacterial organism most commonly recovered in the clinical laboratories and has been incriminated in infectious diseases involving virtually every human tissue and organ system. However, this organism which was once susceptible to all major class of antimicrobials, is now becoming a therapeutic challenge due to release of Extended Spectrum Beta-Lactamase (ESBL).2, 3 Most strains of E. coli were highly susceptible to ampicillin when it was first introduced in early 1960’s but now percentage of E. coli resistance to ampicillin reaches up to 40-50 %2 .
Ciprofloxacin is the fluorinated 4-Quinolone having broad spectrum of antimicrobial activity. It is a potent bactericidal agent used widely for E. coli infections2 . However resistance to E. coli is increasing may be up to 30-50% according to community based surveillance by WHO in India4 . As emergence of resistance is a natural process of evaluation for the microorganisms, the only answer mankind has against this is, rapid and faster discovery of more and more potent antimicrobials. Over the past 20 years, there has been much interest in the investigation of natural products as sources of new antibacterial agents. Garlic (Allium sativum) is coming up as one of such promising source of antimicrobial agent. Garlic is a perennial bulb-forming plant belonging to family Liliaceae.
Various ancient literatures have suggested use of garlic for variety of treatment for preventing common cold, malaria, cough and tuberculosis and sexually transmitted diseases, wound infection etc5 . Various modern literatures also suggest antimicrobial activity of garlic against variety of gram +ve, gram -ve organisms as well as against fungi and viruses5-11. This broad spectrum of activity has been attributed to the phytotherapeutic sulphur compounds (eg. Allicin and Thiosulfinates) present in varying concentrations in garlic5, 9 .So, this study was aimed to evaluate antimicrobial action of Fresh Garlic Extract (FGE) and assessing its in vitro interaction with ampicillin and ciprofloxacin against E. coli spp.
MATERIALS AND METHODS Preparation of Garlic Extract Garlic was purchased from the local market; garlic bulbs were peeled, weighed 100gm and cleaned. Cleaned cloves were surface-sterilized by immersing them into 70% (v/v) ethanol for 60 seconds. After letting the residual ethanol on surface evaporate, garlic bulbs were homogenized aseptically in sterile mortar and pestle, allowed to stand for ten minutes and filtered through Whatman filter paper No. 1. This Fresh Garlic Extract (FGE) was then collected in the sterile bottle and stored in refrigerator. This extract was considered as the 100% concentration of the extract. The concentrated extract was further diluted with sterile distilled water12. FGE once prepared was used for 4 days.
The concentration of FGE was calculated as the total weight of garlic per milliliter. 100 grams of raw garlic yielded an average of ~ 7ml of juice. This extract was considered as the 100% concentration12. Every time 100% FGE was inoculated on MacConkey’s agar for 24hrs to check for its sterility.
Sample Collection Escherichia coli species isolated in the Microbiology laboratory of Medical College, Baroda from the samples of urine collected from the different clinical wards of the S.S.G. Hospital, Baroda during the period of November 2010 to October 2011 were used.
Isolation of Pure Culture A flame sterilized nichrome inoculating loop was used to inoculate the infective material on MacConkey’s agar. The inoculum was spread into four quadrants of the plate by turning the plate at 90 degree angles. The loop was sterilized between each successive quadrant streak. The purpose of this technique was to dilute the inoculum sufficiently on the surface of agar medium so that well defined colonies of bacteria known as colony forming units can be obtained13 . The pure colonies thus obtained were confirmed by standard biochemical tests.
Preparation of Standard Inoculum Pure colonies were picked up with the help of flame sterilized inoculating straight wire from MacConkey’s medium and emulsified in a test tube containing peptone water and kept for 20-30 minutes. The turbidity was matched with 0.5 McFarland standards (containing 1×107 CFU/ml) approximately against a sheet of white paper. The turbidity was adjusted to the proper density as the McFarland by adding sterile saline or more bacterial inoculum.
(I) Antimicrobial susceptibility testing of FGE
(I a) By Well Diffusion Method 8, 14-16
Mueller Hinton Agar (MHA) was prepared according to the manufacturer’s instructions (Himedia); then media was poured in media plates of 9-10 cm diameter and depth of agar was kept about 3-4 mm. With a sterile cotton swab the standard inoculum was spread evenly over the plate successively in three directions and over the rim, to obtain even inoculum. The plate was allowed to dry for 3-5 minutes. 4-5 wells of 6mm were cut on the surface of the agar. 100μl of 5%, 10%, 15%, 20%, 25%, 35%, 50%, 75% and 100% solutions v/v of fresh garlic extract was added to different wells. Different dilutions of fresh garlic extract were prepared by adding 30µl of sterile distilled water. One well was filled with sterile distilled water which served as a control. The plates were incubated at 37?C for 18-24 hours. The zone of inhibition was measured by a scale to the nearest mm including well diameter.
(I b) By Macro broth dilution technique 8, 14-15 Experiments were performed by using macro broth dilution method where in 100µl of different dilutions (5%, 10%, 15%, 20%, 25%, 35%, 50%, 75% and 100%) of fresh garlic extract was added in 2ml of Mueller Hinton Broth. 1 ml of standard inoculums of the microorganism was added to each tube. A tube of the growth medium without garlic extract served as a growth control and uninoculated tube of medium was incubated to serve as a negative growth control. After 18-24 hours of incubation at 37?C, tubes were examined for turbidity, indicating growth of the microorganism. From these samples, we calculated Minimum Inhibitory Concentration (MIC). The MIC was defined as the lowest concentration of garlic extract that completely inhibited the visible growth of the organism6, 8, 11
(II) Determination of the combined activity of Fresh Garlic Extract (FGE) and conventional antimicrobial agents using Well-diffusion method
Ampicillin and ciprofloxacin were purchased from Hi-Media Laboratory Ltd., Mumbai (India). Antimicrobial effect of serial dilutions of, ampicillin (2.5-20µg/ml) and ciprofloxacin (1.25- 20µg/ml) were assessed per se as well as in combination with different concentrations of FGE (5-160mg/ml) on E. coli spp. using well diffusion method. Agar plates of Mueller Hinton agar medium were swabbed using cotton swab with standard inoculum culture of the E. coli spp.
The plates were allowed to dry for 3-5 minutes. Five wells of 6mm in diameter were punched in the agar. The wells were filled up with different concentrations of FGE and conventional AMAs alone or in combination keeping the total volume in each well to 30µl11, 12, 16, and 17. Serial dilutions of ampicillin (2.5, 5, 10, 15, 20mcg/ml) and ciprofloxacin (1.25, 2.5, 5, 10, 20mcg/ml) were prepared by using sterile distilled water as diluents. The plates were incubated at 37 °C for 18-24 hour. The antibacterial activity was assessed by measuring the zone of inhibition (mm).
CLSI guidelines were used to label E. coli ‘sensitive’, ‘intermediate sensitive’, or ‘resistant’ to ampicillin and ciprofloxacin18 . Synergism effect is defined when combined zone of inhibition is increased by 5mm compared to the individual drug11, 16. Antagonism effect is defined when combined zone of inhibition is less than that produced by individual drug19 .
RESULT In the present study we evaluated antimicrobial activity of FGE alone and in combination with conventional antimicrobial agents, ampicillin and ciprofloxacin on Escherichia coli spp. Total 45 samples of E. coli spp. were isolated from microbiology laboratory of the Medical College; Baroda from the samples of urine from the different clinical wards of the S.S.G. Hospital, Baroda, during the period of November 2010 to October 2011.
Evaluation of antimicrobial effect of FGE Different concentrations of FGE produced statistically significant dose dependent increase in zone of inhibition compared to control. (Table 1) 10% and higher concentrations of FGE produced mean zone of inhibition more than 15mm while 100% FGE produced mean zone of inhibition 32.8± 3.2mm. Minimum Inhibitory Concentration (MIC) was determined using macro broth dilution method using 15 isolates of E. coli spp. Mean MIC of FGE was 134.53mg/dl. Figure 1 shows the correlation analysis between mean zone of inhibition and different concentrations of FGE. Increase in zone of inhibition positively correlates with increase in concentration of FGE. (R2= 0.92) (P< 0.001) From this correlation mean MIC value of FGE 134.53mg/ml is correlated with 17.12mm zone of inhibition.
Effect of combination of ampicillin and FGE on E coli spp using well diffusion method:
Table 2 shows zone of inhibition produced by combination of FGE with different concentrations of ampicillin (2.5-20mcg/ml). As shown in the table, the addition of different concentrations of ampicillin to FGE produced minimum further increase of 1-2mm in mean zone of inhibition than that produced by the same concentration of FGE per se. However, addition of FGE to different concentrations of ampicillin (2.5-20mcg/ml) produced marked further increase in mean zone of inhibition (9-10mm) than that produced by ampicillin per se at the respective concentration. Addition of 80mg and higher concentrations of FGE to ampicillin 2.5mcg/ml and higher makes the E. coli spp. intermediate to sensitive the combination.
Effect of combination of ciprofloxacin and FGE on E. Coli spp. using well diffusion method:
Table 3 shows effect produced by addition of ciprofloxacin (1.25-20mcg/ml) to different concentrations of FGE (5-320mg/ml). As shown in table, addition of ciprofloxacin to different concentrations of FGE produced marked further increase in mean zone of inhibition than that produced by FGE alone at the said concentration.
The rise in mean zone of inhibition (8-9mm) by combination was maximally observed at FGE concentration 40mg/ml and lesser concentration, while at 80mg/ml and higher concentration of FGE plateau is observed. Further addition of varying concentrations of ciprofloxacin produced lesser increase in mean zone of inhibition (3- 4mm). Varying concentrations of FGE alone per se produced dose dependent statistically significant increase in mean zone of inhibition. E. coli spp. were intermediately sensitive to FGE 80mg/ml and higher concentrations. However, addition of ciprofloxacin 2.5- 5mcg/ml made the combination sensitive to FGE. As shown in the table ciprofloxacin per se at different concentrations produced mean zone of inhibition of 12 to 16mm, making E. coli spp. intermediate sensitive to ciprofloxacin.
However, addition of FGE to varying concentrations of ciprofloxacin further increased the zone of inhibition than that produced by ciprofloxacin alone at the said concentration making it sensitive to E. coli even at lower concentrations. Combination of ciprofloxacin in concentration as low as 1.25 and 2.5mcg/ml with FGE 160 and higher concentrations produced zone of inhibition of 21.2mm and higher making it sensitive to E. coli. E. coli was intermediate sensitive to ciprofloxacin 5mcg/ml concentration per se. However addition of 80mg/ml and higher concentrations of FGE made E. coli sensitive to the combination.
DISCUSSION The continuous spread of multidrug-resistant pathogens has become a serious threat to public health and a major concern for infection control practitioners worldwide. In addition to increasing the cost of drug regimens, this scenario has paved way for the re-emergence of previously controlled diseases and has contributed substantially to the high frequency of opportunistic and chronic infection cases in developing countries. The slow pace of newer antibiotic development and emergence of resistance developed the need to explore nature, in search of phytotherapeutic agents with novel targets and mode of actions.
Garlic has had an important dietary and medicinal role for centuries. Most of its prophylactic and therapeutic effects are ascribed to specific oil and water-soluble organosulfur compounds (allicin and thiosulfinates). There are extensive literatures on the antibacterial effects of various garlic preparations6-8, 10-12,20 . Deresse Daka et al (2009)7 assessed antibacterial effect of crude preparation of garlic on diarrhea causing bacteria (E. coli, salmonella and shigella strains). The study found that, at the concentration of 30- 37.5 mg/ml garlic has a bacteriostatic effect and at concentration higher than 37.5mg/ml garlic has bactericidal effect, which was comparable with cotrimoxazole, ciprofloxacin and chloramphenicol.
Also, in a study done by B.A. Iwalokun AO et al6 , antibacterial activity of aqueous garlic extract by well diffusion and macro broth dilution method was characterized by inhibition zone of 20.2-22.7 mm and minimum inhibitory concentrations ranged from 15.6-48.3 mg/ml for gram positive organisms. In the present study antibacterial effect of FGE alone and in combination with conventional drugs ampicillin and ciprofloxacin against E. coli was studied. Antimicrobial susceptibility when assessed using well diffusion method, showed dose dependent increase in zone of inhibition ranging from 13mm to 32mm which is comparable to studies done by Iwalokun 6 and durairaj 8 . FGE concentration of 10% and higher have significant antimicrobial activity with mean zone of inhibition ≥ 16mm. All 15 E. coli spp. were sensitive to FGE showing maximum zone of inhibition up to 32mm zone of inhibition with 100% FGE.
In present study mean MIC value of FGE found was 134mg/ml which is higher than that stated in above studies. Variations in composition of garlic and genetic disparity among bacteria or different species may be responsible for such inconsistency. In routine microbiology practice, zone of inhibition in mm is used to define the antimicrobial sensitivity as it is cumbersome and time consuming to study MIC every time. Therefore a correlation analysis was done between different concentrations of FGE with the zone of inhibition obtained, which showed a strongly positive correlation (R2 =0.92) between zone of inhibition obtained and concentration of FGE used.
From this correlation analysis we observed that mean MIC of 134mg/dl correlated with 17.12 mm zone of inhibition. Few studies have been conducted to determine antibacterial effect of garlic in combination with conventional antimicrobials. Plaksha et al 12 studied the antibacterial effect of garlic extract on streptomycin resistant Staphylococccus aureus and E. coli strains solely and in combination with streptomycin. Finding shows garlic extract had significant antibacterial activity and combination with streptomycin produced increase in sensitivity to both Staphylococccus aureus and E. coli strains.
Mei-Chin Yin et al 10 had assessed the inhibitory effects of aqueous garlic extract, garlic oil and four diallyl sulphides against four enteric pathogens and their interactions with conventional antimicrobials. Most interactions of four antibiotics (meropenem, ceftazidime, imipenem and gentamicin) with diallyl polysulphide, determined as FIC index, showed synergistic or additive effects. In the present study, addition of FGE with ampicillin resulted in additive effect by well diffusion method. Out of 15 E. coli spp. used, 13 were resistant to ampicillin. According to CLSI guidelines ampicillin sensitive strains of E. coli should produce ≥17mm zone of inhibition at 10mcg/ml concentration18. In present study even with 20mcg/ml concentration this zone of inhibition cannot be achieved which is even not a tolerable dose in vivo.
Different concentrations of FGE (5-160mg/ml) produced dose dependent increase in zone of inhibition and with 160mg/ml produced zone of inhibition >16 mm. Combinations of FGE and ampicillin produced additive effect. Zone of inhibition produced by combination was 9-10mm more than that produced by ampicillin per se. However, it was only 2-3mm more than that produced by FGE per se. Addition of FGE 80-160mg/ml to ampicillin concentration as low as 2.5mcg/ml makes it intermediate sensitive to E. coli. However, at higher concentrations of FGE (80-160mg/ml) there is masking of effect of ampicillin. When different concentrations of ciprofloxacin was combined with FGE, combination makes E. coli spp. completely sensitive to ciprofloxacin even at the concentration as low as 1.25 and 2.5mcg/ml which is lower than MIC of ciprofloxacin (5mcg/ml). Combination of ciprofloxacin 1.25mcg/ml with 20mg/ml and 40mg/ml FGE produced synergistic effect producing additional rise of >5mm than produced by any of drug alone.
Thus combinations of FGE with these antibiotics not only help to regain the sensitivity of the older less toxic and comparatively cheaper drugs, but also reduce the dosage required for the therapy. FGE may probably retard the development of resistance to these important antimicrobial agents. In evaluation of antibacterial activity of garlic reported by various studies the mean zone of inhibition remains identical in various studies 6-8 , however there is marked variation in MIC value obtained by different studies. MIC value reported from garlic extract ranged from 35-320mg/ml by various studies. The probable reason for such variation is, variations in composition of garlic and genetic disparity among bacteria or different species. Standardization of garlic extract used by isolation and purification of the active component is necessary.
So, this study suggests the possibility of use of antimicrobial drugs and garlic extracts in combination for treatment of infections caused by E. coli strains. However, it is hard to predict synergistic effects in vivo on the basis of the presented in vitro evidence alone because data from the in vitro study may not be extrapolated in in vivo drug efficacy as in vitro can not reflect the pharmacodynamic and pharmacokinetic features of antimicrobial agents after it has been ingested.
CONCLUSION In conclusion, FGE as a sole agent is having significant antimicrobial effect against E. coli spp. in in vitro studies. Moreover, there is a possibility of concurrent use of antimicrobial drugs and Fresh garlic extract in treating infections caused E. coli spp. This may help to not only regain the sensitivity of older less toxic agents but also reduce the dosage required for the therapy. Further detailed pharmacokinetic and in vivo studies of garlic are needed.
ACKNOWLEDGEMENT The authors are thankful to Department of Microbiology, Medical College Baroda for their support and valuable guidance for carrying out this work. Authors acknowledge the great help received from the scholars whose articles cited and included in reference of this manuscript. The authors are also grateful to authors/ editors / publishers of all those articles, journals and book 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=1462http://ijcrr.com/article_html.php?did=14621. WHO. Antimicrobial Resistance. February 2011; Available from: ttp://www.who.int/mediacentre/factsheets/fs 194/en/.
2. Bruton L, Chabner B, Knollmann B. Goodman and Gilman's The pharmacological basis of therapeutics2011.
3. Fauci As, Kasper DL, Longo DL, Braunwald E, Hauser s, Jameson L, et al. Harrison's Principles of internal medicine. seventeenth edition ed2008.
4. WHO. Community-Based Surveillance of Antimicrobial Use and Resistance in Resource-Constrained Settings Report on five pilot projects2009.
5. Organization WH. WHO monographs on selected medicinal plants 1999.
6. B.A. Iwalokun AO, 2 D.O. Ogbolu,3 S.B. Bamiro,4 and J. Jimi-Omojola2. In Vitro Antimicrobial Properties of Aqueous Garlic Extract Against Multidrug-Resistant Bacteria and Candida Species from Nigeria. Journal of medicinal food. 2004;7(3).
7. Daka D, Awole M. Assessment of the Antibacterial Effect of Crude Preparation of Garlic (Allium Sativum) on Diarrhea Causing Bacteria: An In Vitro, study. asian Journal of Medical Sciences. 2009;1(1):12-4.
8. Durairaj S, Srinivasan S, Lakshmanaperumalsamy P. In vitro Antibacterial Activity and Stability of Garlic Extract at Different pH and Temperature. Electronic Journal of Biology. 2009;5(1):5- 10.
9. Goncagul G, Ayaz E. Antimicrobial Effect of Garlic (Allium sativum) and Traditional Medicine. Journal of animal and Veterinary Advances. 2010;9(1).
10. Yin M-C, Chang H-C, Tsao S-M. Inhibitory Effects of Aqueous Garlic Extract, Garlic Oil and Four Diallyl Sulphides against Four Enteric Pathogens. Journal of Food and Drug Analysis. 2002;10(2):120-6.
11. Ahmad I, Aqil F. In vitro efficacy of bioactive extracts of 15 medicinal plants against ESbL-producing multidrug-resistant enteric bacteria. Microbiological Research. 2007;162 264-75.
12. Palaksha M, N., Ahmed M, Das S. Antibacterial activity of garlic extract on streptomycin-resistant Staphylococcus aureus and Escherichia coli solely and in synergism witj streptomycin. Journal of Natural Science, Biology and Medicine. july 2010;1(1).
13. Dini C, Fabbri A, Geraci A. The potential role of garlic (Allium sativum) against the multi-drug resistant tuberculosis pandemic: a review. Ann Ist Super Sanità. 2011;47(4):465-73.
14. Mackie, Cartney M. Mackie and Mc Cartney Practical Medical Microbiology. 14th ed. Collee JG, Marmion B, P., Fraser A, G., Simmons A, editors: Churchil livingstone; 2007.
15. Scott B. Bailey and Scott's Diagnostic Microbiology. 12th ed. Forbes B, A., Daniel FS, weissfeld A, s., editors: Mosby elsevier; 2007.
16. Adwan G, Mhanna M. Synergistic Effects of Plant Extracts and Antibiotics on Staphylococcus aureus Strains Isolated from Clinical Specimens. Middle-East Journal of Scientific Research. 2008;3(3):134-9.
17. Ahmed Z, Khan SS, Khan M, Tanveer A, Ahmad Lone Z. Synergistic Effect of Salvadora persica Extracts, Tetracycline and Penicillin Against Staphylococcus aureus. African Journal of Basic and Applied Sciences. 2010;2(1-2):25-9.
18. Performance Standards for Antimicrobial Disc Susceptibility Tests, NCCLS. january 2002;22(1).
19. Eja ME, Arikpo GE, Enyi-Idoh KH, Ikpeme EM. An evaluation of the antimicrobial synergy of Garlic (Allium sativum) and Utazi (Gongronema latifolium) on Escherichia coli and Staphylococcus aureus. Malaysian Journal of Microbiology. 2011; Vol 7(1):49- 53.
20. Egbobor ME, Asikong BE, Abriba C, Arikpo GE, Anwan EE, Enyi-Idoh kh. a comparative assessment of the antimicrobial effects of garlic (allium sativum) and antibiotics on diarrheagenic organisms. southeast asian j trop med public health. 2007;vol 38 s( No. 2).
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareSTUDY OF ERUPTION OF TEMPORARY TEETH FOR THE DETERMINATION OF AGE
English115119Pragnesh ParmarEnglish Gunvanti B. RathodEnglishIdentification means determination of individuality of a person. Teeth are very important indicators in medico-legal cases as they help in identification and age estimation in the living as well as in the dead because they resist putrefaction, heat, chemicals etc. and are constant in their appearance. Eruption of teeth depends upon climate, race and sex, nutritional and geographical variations. India is a very big country, with different climates. Hence it is not correct to apply same data to whole of the country. In our study, 101 children up to the age of 36 months were studied for the time of eruption of their temporary teeth at our place where such type of study has not been performed recently. It was studied in correlation with age, sex, right and left side of both upper and lower jaw. From the findings, it was concluded that there was a delayed pattern of eruption in case of upper central incisor, upper lateral incisor, first molar and canine. Teeth appeared earlier in the male except upper canine, lower canine and lower first molar and teeth appeared earlier in the upper jaw except in case of lower central incisor.
EnglishEruption, Temporary teeth, Mean age.INTRODUCTION
Teeth are helpful in estimation of age from eruption, as teeth are very durable; resist heat, chemicals, putrefaction etc. From eruption of temporary teeth, one can estimate the age of a child from 6 months to 36 months. Eruption of teeth is affected by climate, race, sex, nutritional and geographical factors. [1] India is a very big country, with different climates, race, nutritional and geographical variability. Hence it is not correct to apply same data to whole of the country. However no recent study on age estimation from eruption of temporary teeth has been performed in our region. Because of this, present work was undertaken.
MATERIAL AND METHOD In this study, a total of 101 subjects were examined for eruption of temporary teeth. The cases were taken from outdoor and indoor patient departments of Dentistry and Paediatrics. Their teeth were examined for eruption and charting of teeth was done on Palmer’s notation chart. This system uses numbers 1 to 5 starting from centre to periphery for each half of jaw. Only healthy children who did not show any diseased tooth or chronic illness in the form of endocrinal disorder or nutritional disorder or musculoskeletal disorder, with good and moderate nutrition after doing their general physical examination along with height and weight were considered. The visual examination was done in good light using probe, spatula and mirror. The teeth were examined either in good day light or by using a torch having a fine focusing of light. A tooth is considered erupted, if it has pierced through gums and not erupted if not present in oral cavity. Only those cases were considered whose records were available for date of birth from school records, ration cards, horoscope, birth certificates, identity cards, driving licence and immunisation card. After examination of teeth, statistical tables were prepared for mean age, range and Standard Deviation (S.D.) for eruption of each tooth in the upper and lower jaw and also for right and left sides of the same jaw. The statistical tables were also prepared for both sexes separately and were analysed statistically.
OBSERVATION
After doing the statistical analyses, it was found the mean age of eruption of central incisors of upper jaw was 9.48 + 1.02 months and of lower jaw was 7.55 + 0.76 months. In case of lateral incisors, the mean age of eruption was 9.71 + 0.96 months for upper and 11.87 + 0.99 months for lower jaws. The first molars of lower jaw erupted at a mean age of 14.65 + 1.09 months and of upper jaw at 14.54 + 0.70 months of age. For canines, mean age of eruption was 18.29 + 0.81 months and 18.79 + 0.91 months in upper and lower jaws respectively. Second molars of upper and lower jaw erupted at the mean age of 26.15 + 3.47 months and 26.34 + 3.22 months respectively (Table - 1). Comparison of mean age of eruption of teeth according to the sex of the individuals was done (Table - 2).
DISCUSSION Kuldeep Singh et al. (2004) described in their study that eruption of lower central incisor, upper central incisor, lateral incisor, lower first molar, upper first molar, upper canine, lower canine and second molar occurred at 8.28 + 0.84 months, 9.48 + 0.96 months, 10.20 + 1.08 months, 15.56 + 0.72 months, 15.84 + 0.72 months, 19.20 + 1.44 months, 19.32 + 1.56 months and 27.72 + 3.36 months respectively. [2] Findings of our study were correlating with above mentioned study.
Gorden, Turner and Price (1953) described that during infancy and childhood, a fairly accurate estimate of age can be made from the study of teeth. The temporary teeth appear usually with the lower central incisor at 6 months, then the other incisors. The first temporary molars appear at about 12 months, the canine at about 18 months, and second temporary molars at about 2 years. Between 2 to 6 years, the temporary dentition is complete. [3] In our study, eruption of lower central incisor, first molar and second molar was delayed in compare to above study. Gonzales et al (1954) described the teeth may give, reliable information as to the age in childhood and youth. Beyond adult life, the changes are too uncertain to be of value. The temporary dentition appears at 6 to 8 months and is completed by 22 to 24 months, and is 20 in number. [4]
Polson (1955) described that when a tooth of the first dentition has erupted, the infant is probably 6 to 8 months old (in our study 7.55 + 0.76 months). An infant, who has completed first dentition, has reached about 2 years of age (in our study 26.34 + 3.22 months). [5] Smith (1955) described the earlier eruption of teeth in the lower jaw than in the upper jaw. Temporary dentition begins at 6-8 months of age by eruption of lower central incisors (in our study 7.55 + 0.76 months) and is completed at 24 months by eruption of second molars (in our study 26.15 + 3.47 months and 26.34 + 3.22 months in upper and lower jaw respectively). [6] Kerr (1957) described in his text book of Forensic Medicine, eruption of central incisors lateral incisors, canine, first molars and second Molars at 5-8 months, 7-9 months, 16-20 months, 12-16 months, 20-24 months respectively. [7] In our study, eruption of central upper incisor, lateral lower incisor and second molar was delayed compared to above study.
Edgar and Hamilton (1973) described eruption of lower central incisor earlier (6-8 months) than upper central incisors (7-9 months).The eruption of lateral incisor is at 9-10 months, first molar at 12 months, canine at 18 months and second molar at 2 years. The temporary teeth begin to shed at 5 to 7 year. [8] In our study, eruption of upper central incisor, lower lateral incisor, first molar, canine and second molar was delayed compared to above study.
Grewal (1973) described eruption of temporary teeth in children at 6 months for lower central Incisors, 7 months for upper central incisors, 7 to 9 months for upper lateral incisors, 10 to 12 months for lower lateral incisors, 1 year for first molar, 18 months for canine and 24 months for second molar. [9] In our study, eruptions of all teeth were delayed compared to above study. Tedechi, Eckert and Tedechi (1977) described that from birth to 6 months of life, accurate age estimation can be based on the mineralization of the deciduous crowns and from then up to 13 months of age, estimation may be determined by the state of eruption. There is no significant influence of external factors on eruption of deciduous teeth. [10] Ghai (1987) has described the earlier eruption of teeth in the upper jaw than in the lower jaw except lower central incisors. The lower central incisors appear usually between ages of 5 and 8 months, upper a month later and lateral incisors in next 3 months, first molar at 12 to 15 months, canine teeth at 18 to 21 months and second molar at 21-24 months. [11] In our study, eruption of second molar was delayed compared to above mentioned study.
Reddy KSN (2010) described that temporary teeth are 20 in number and in weak children and in rickets dentition may be delayed, while in syphilis, teeth may be premature or even present at birth. In both deciduous and permanent teeth, dentition occurs earlier in lower jaw except for the lateral incisors which erupts earlier in upper jaw. Tooth eruption in females may be one year earlier than that of males. The eruption occurs in case of lower central incisor at 6-8 months, Upper central and lateral incisor at 7-9 months, lower lateral incisor at 10-12 months, first molar at 12- 14 months, canine at 17-18 months and second molar at 20-30 months. [12] In our study, eruption occurred earlier in upper jaw except in case of lower central incisor and eruption of upper central incisor, upper lateral incisor, first molar and canine was delayed compared to above study.
Swami et al (1992) conducted study on 1250 (625 males and 625 females) from Himachal Pradesh for eruption of temporary teeth for age estimation. Only healthy residents of Himachal Pradesh between age group of 6 months to 30 months were studied. They found no difference of mean ages of eruption between right and left halves of same jaw. All the teeth appeared earlier in males except second molar tooth. Lower central incisors appeared earlier in both sexes in case of females. [13] In our study, eruption of upper canine, lower canine and lower first molar occurred earlier in female compared to male.
CONCLUSION Following conclusions are drawn from our study:
1. Average age and range for eruption of temporary teeth in general is given in Table No. 1.
2. Average age for eruption of temporary teeth in male and female is given in Table No. 2.
3. No significant difference of means ages in the eruption of temporary teeth for right and left halves of the same jaw was found.
4. No significant difference was observed in the eruption of teeth in upper and lower jaw for canine, first molar and second molar.
5. For all teeth, eruption occurred earlier in upper jaw except in case of lower central incisor.
6. Order of eruption of temporary teeth was started from lower central incisor followed by upper central incisor followed by upper lateral incisor followed by lower lateral incisor followed by first molar followed by canine followed by second molar.
7. Eruption of lower central incisor, upper central incisor, upper lateral incisor, lower lateral incisor, upper first molar, upper second molar and lower second molar occurred earlier in male compared to female.
8. Eruption of upper canine, lower canine and lower first molar occurred earlier in female compared to male.
9. Eruption of upper central incisor, upper lateral incisor, first molar and canine was delayed compared to Reddy KSN (2010).
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=1463http://ijcrr.com/article_html.php?did=14631. J.B. Mukherjee’s Forensic Medicine and Toxicology, 4th edition, Academic publishers, 2011, p. 121-131.
2. Kuldeep Singh, R.K. Gorea, Vipin Bharti, Age estimation from eruption of temporary teeth, Journal of Indian Academy of Forensic Medicine, 2004, 26(3): 107-109.
3. Gordon I, Turner R, Price TW., Medical jurisprudence, 3rd edition, Livingstone Ltd, Edinburgh and London, 1953, p. 343-72.
4. Gonzales TA, Vance M, Helpern M, Umberger CJ., Legal medicine pathology and toxicology, 2nd edition, Appleton Century Crofts, Inc; NY, USA, 1954, p. 46.
5. Polson CJ., The essential of forensic medicine, English Universities Press Limited, London, 1955, p. 51.
6. Smith SS, Fiddes FS, Forensic medicine: A text book for students and practitioners, 10th edition, J. and A. Churchill Ltd, London, 1955, p. 88-89.
7. Kerr DJA, Forensic medicine: A text book for students and a guide for the practitioners. 6th edition, Adam and Charles Black; London, 1957, p. 42-43.
8. Edgar R, Hamilton S. Glaister’s medical Jurisprudence and toxicology, 13th edition, Churchil Livingstone; Edinburgh and London, 1973, p. 77-78.
9. Grewal RS, Medical jurisprudence and toxicology, 1st edition, Scientific Book Agency; Calcutta, India, 1973, p. 40-41.
10. Tedeschi CG, Eckert WG, Tedeschi LG, Age determination - Forensic medicine, a study in trauma and environmental hazards, Vol 2, W. B. Saunders Company; Philadelphia, London, Toronto, 1977, p. 1124-1134.
11. Ghai OP, The essential paediatrics, 6th edition, Interprint; New Delhi, India, 1987, p. 5.
12. Reddy KSN, The Essentials of Forensic Medicine and Toxicology, 29th edition, K. Suguna Devi, Om Sai Laser Graphics, Hyderabad, India, 2010, p. 61-64.
13. Swami D, Mishra VK, Bahal L and Rao CM, Age estimation from eruption of temporary teeth in Himachal Pradesh, Journal of Forensic Medicine and Toxicology, 1992; 9: 3-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524151EnglishN-0001November30HealthcareCUTANEOUS ANGIOSARCOMA OF FACE - A CASE REPORT
English120126Gunvanti B. RathodEnglish Atul JainEnglish Pragnesh ParmarEnglishCutaneous angiosarcoma of the face and scalp is a rare but aggressive vascular tumour of endothelial cell origin, having poor prognosis. Clinically it presents with an asymptomatic erythematous to bruise like macular lesion in face or scalp. Local spread, recurrence and metastasis to regional lymph nodes and lungs are common. Early diagnosis and treatment are essential for local control of this aggressive tumour, but recognition can be delayed because of its rarity or because of difficulty in making a pathological diagnosis. Early detection and multidisciplinary approach may improve survival. Cutaneous angiosarcoma (CA) accounts for 60% of cases of angiosarcoma. We report here a case of 65 years old man who presented with 4 months history of indurated swelling over the left infraorbital area extending the forehead, scalp and the other side of face with marked induration of the skin. Histsopathological examination of the biopsy from the nodule confirmed the diagnosis of cutaneous angisarcoma.
EnglishCutaneous angiosarcoma, Vascular tumour, Poor prognosis.INTRODUCTION
Angiosarcoma is a rare, aggressive soft tissue sarcoma of endothelial cell origin. Cutaneous angiosarcoma (CA) accounts for 60% of cases of angiosarcoma. These include primary CA and secondary CA, caused by previous irradiation, chronic lymphoedema and pre-existing vascular malformation. About 50% of cutaneous angiosarcoma affects the head and neck region in elderly men, in particularly the scalp area. [1] Overall, sarcomas occur uncommonly in the head and neck, constituting less than 1% of all head and neck malignancies. [2] The prognosis for patients with angiosarcoma of the head and neck remains dismal, with a reported 5 years survival rate of nearly 10%. [3, 4, 5, 6]
CASE REPORT A 65 years old, male, presented to outdoor patient department of dermatology with 4 months history of indurated swelling over the left infra-orbital area. On examination, it was extending over the forehead, mid scalp and the other side of face. The scalp lesions began as small nodule which enlarged and increased in numbers gradually. There was no preceding trauma though the nodules bleed easily. The nodules ranged from 0.5 cm to 1 cm in diameter. Multiple nodules are ulcerated and bluish discoloration of skin was also present. No lymph node was palpable. The routine haematological investigations, renal function tests, liver function tests and creatine kinase were normal. X-ray sinus showed no evidence of sinusitis. Skin biopsy (punch by 5 mm) from temporal region was taken and sent for histo-pathological examination.
Microscopically, the tumour was located in the dermis. The tumour consisted of proliferation of malignant spindle cells without apparent differentiation. The tumour cells were seen to invade into the surrounding dermis and subcutaneous tissue (Photo - 1 and 2). Many mitotic figures were scattered (Photo - 3), and there were few areas of necrosis. Intracytoplasmic vesicles were recognized in several areas (Photo - 4 and 5). A few abortive vasoformative channels are also recognized. The presence of red blood cells in the vasoformative channels suggested the tumour was not a lymphatic tumour but a vascular tumour (Photo - 6). Hence, the diagnosis of cutaneous angiosarcoma was established.
DISCUSSION Cutaneous angiosarcoma (CA) was first described in 1945 by Caro and Stubenrauch. [7] In 1948, Stewart and Treves described association between angiosarcoma and postmastectomy lymphedema, the Stewart-Treves syndrome. [8] Wilson-Jones described cutaneous angiosarcoma primarily affects scalp and face of elderly in 1964. [9] CA is a rare neoplasm, accounting for 5 cm, (2) depth of invasion >3 mm, (3) mitotic figures >3/HPF, (4) positive surgical margin, (5) tumour recurrence and metastasis. [12] Management is by multidisciplinary approach. Combination of wide local excision, radiotherapy and chemotherapy had been adopted in various institutions.
CONCLUSION The rarity of primary angiosarcoma, unusual presentation of our case and possible diagnostic pitfalls associated with poor prognosis emphasizes the need for systemic presentation of these tumours in order to help pathologists and clinicians for early and accurate diagnosis with proper management. The aggressive nature of this disease demands careful follow-up of the patient and due to rarity of the condition, the appropriate strategies of treatment remain to be determined.
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=1464http://ijcrr.com/article_html.php?did=14641. Morgan MB, Swann M, Somach S, et al., Cutaneous angiosarcoma: a case series with prognostic correlation, Journal of American Academy of Dermatology, 2004; 50: 867- 874.
2. Figueiredo MT, Marques LA, Campos-Filho N., Soft tissue sarcomas of the head and neck in adults and children: Experience at a single institution and a review of the literature, International Journal of Cancer, 1988; 41: 198–200.
3. Holden CA, Spittle MF, Jones EW, Angiosarcoma of the face and scalp, prognosis and treatment, Cancer, 1987; 59: 1046–1057.
4. Liu AC, Kapp DS, Egbert B, et al., Angiosarcoma of the face and scalp, Annals of Plastic Surgery, 1990; 24: 68 –74.
5. Hodgkinson DJ, Soule EH, Woods JE, Cutaneous angiosarcoma of the head and neck, Cancer, 1979; 44: 1106–1113.
6. Maddox JC, Evans HL, Angiosarcoma of skin and soft tissue: a study of 44 cases, Cancer, 1981; 48: 1907–1921.
7. Caro M, Stubenrauch C., Hemangioendothelioma of the skin, Archieves of Dermatology and Syphilis, 1945; 51: 295-301.
8. Stewart FW, Treves N., Lymphangiosarcoma in postmastectomy lymphedema, Cancer, 1948; 1: 64-81.
9. Wilson-Jones E., Malignant angioendothelioma of the skin, British Journal of Dermatology, 1964; 76: 21-39.
10. Young RJ, Brown NJ, Reed MW, et al., Angiosarcoma, The Lancet Oncology, 2010; 11: 983-991.
11. North PE, Kincannon J., Vascular neoplasms and neoplastic like proliferations, Bolognia JL, Jorizzo JL, Rapini RP’s Dermatology, 2nd edition, Elsevier; United States, 2008, p.1788-1790.
12. Morgan MB, Swann M, Somach S, et al., Cutaneous angiosarcoma: A case series with prognostic correlation, Journal of American Academy of Dermatology, 2004; 50: 867- 874.
13. Holden CA, Spittle MF, Jones EW., Angiosarcoma of the face and scalp, prognosis and treatment, Cancer, 1987; 59: 1046-1057.
14. North PE, Kincannon J., Vascular neoplasms and neoplastic like proliferations, Bolognia JL, Jorizzo JL, Rapini RP’s Dermatology, 2nd edition, Elsevier, United States; 2008, p.1788-1790.
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