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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30General SciencesPERSISTANCE ANALYSIS OF AEROSOLS AND ITS IMPACT ON RAINFALL QUANTITY AT CHENNAI
English0106K. PadmaEnglish R. Samuel SelvarajEnglish B. Milton BoazEnglishAerosol plays an important role in the radiation budget of Earth’s atmospheric system. They serve as cloud condensation nuclei and have a substantial effect on cloud properties. Large concentrations of human made aerosol have been reported to decrease the rainfall as a result of their radioactive and Cloud condensation Nucleus (CCN) activities. On the other hand, heavily polluted clouds evaporate much of their water before precipitation could occur. This paper concentrates at Chennai (13o 04’ N 80o 17’ E), situated in the north east of Tamil Nadu on the coast of Bay of Bengal. Aerosol generated in urban areas can act to suppress rainfall which inhibits the collision and coalescence process. Moreover, increased, decreased trend of rainfall quantity recorded during the years 1987 - 2009 on this coastal urban area had been analyzed. Correlation Coefficient between aerosol and rainfall quantity were found using Spearman Rank Correlation technique. Hurst exponent had also found to study the behavior of aerosol concentration on the 262 days time series data observed over the year 2010.
EnglishAerosol, rainfall quantityINTRODUCTION
Aerosol is extremely fine liquid droplets or solid particle; those remain suspended in the air. Small aerosol particles affect the natural energy balance of the earth mainly by reflecting (and in some cases absorbing) solar radiation. The radiative and microphysical impacts of aerosols affect the cloud composition, precipitation, hydrological cycle and the atmospheric circulation system. Troposphere aerosols are important in determining cloud properties, but it has been difficult to quantify their effect because they have a relatively short lifetime and vary strongly in space and time (Madhavi Latha et al., 2003). This atmospheric study on the variation of aerosol concentration in relation to metrological parameters, are important to characterize number of phenomena occurring in the lower troposphere (Deepti Saxena et al.2010). Aerosols of both natural and anthropogenic origins play a crucial role in cloud formation and the atmospheric hydrologic cycle. During the past few decades, anthropogenic emission of aerosol precursors has increased considerably because of the increase in industrial activities (Cheng et al. 2005, Gong et al. 2007). The corresponding increase in anthropogenic aerosol would act as a superfluous forcing to alter atmospheric physical process such as radiation, the size spectrum of cloud particles, cloud cover, atmospheric stability, and precipitation (Youg-Sang 2007, Ramanatha et al.2001, Kaufman et al. 2005. Aerosol concentration affects the rainfall in several ways. Direct aerosol effect consists of direct interaction of radiation with atmospheric aerosol, such as absorption or scattering. It produces net radiative forcing and magnitude of the net resultant radiative forcing dependent on the albedo of the underlying surface, as this affects the net amount of radiation absorbed or scattered to space. Due to this effect aerosols on clouds mostly act to suppress precipitation because they decreases the amount of solar radiation that reaches the land surface and therefore causes less heat to be available for evaporating water and energizing convective rain clouds. In addition to that which decreases clouds layers by heating the air and reducing relative humidity where aerosol absorption is strong (Johnson et al. 2003, Penner et al., 2006). Moreover the direct radiative effects of aerosol i.e., the extinction of sunlight by aerosol scattering and absorption can cause changes clouds through changes in temperature structure of atmosphere (termed the semi-direct affect of aerosols on clouds) (Penner et al. 2006). First indirect effect relates to an increase in aerosol particles may increase the initial cloud droplet number concentration if the cloud liquid water content is assumed constant. This effect tends to cool the climate because it increases the cloud optical depth due to change in the cloud droplet number will lead to decrease the size of the cloud droplet ( Penner et al. 2006,Towmey1974). The second indirect effect relates to cloud morphology associated with changes in the precipitation efficiency of the cloud. But the cloud microphysical process that form precipitation depend on the size of the droplet, the cloud life time as well as the liquid water content, the height of the cloud and the cloud cover may increase through the change in droplet number concentration which is sensitive to the meteorological condition. (Ackerman et al.2004). Moreover aerosol incorporated in orographic clouds slow down cloud-drop coalescence and riming on ice precipitation and hence delays conversion of cloud water precipitation. (Amir Givati, et al. 2004). Finally aerosol mixed up into cloud it affects cloud microphysical properties in the anticipated ways increasing cloud droplet number concentration and decreasing droplet effective radius as well as size. The need for broad droplet distribution with a significant population of cloud droplets larger than about 15µm for precipitation to occur efficiently in warm clouds and the polluted clouds having small droplets and narrow droplet size distribution might be less efficient in production of rain. (Ackerman et al.2004). Aerosol particles through their enhancement of clouds may reduce the near surface wind speeds. Slower winds and cooler surface temperature also reduces the moisture advection evaporation. These factors along with the second indirect aerosol effect may reduce precipitation (Mark Z. Jacobson et al. 2006). The winds that blow near the surface of the Earth have two beneficial effects. They provide a renewable source of clean energy and they evaporate water, helping rain clouds to build up. According to Stanford and NASA researches aerosolized particles created from vehicle exhaust and other contaminants can accumulate in the atmosphere and reduce the speed of winds closer to the Earth’s surface which results in less wind speed and also reduced precipitation. Thus increase in aerosol concentrations, via aerosol indirect and semidirect effects, may affect the long-term variations in precipitation in conjunction with other climatic conditions such as global warming. Hence aerosol concentration and precipitation, rainfall are closely related with each other (Mark Z. Jacobson 2006)
DATA AND METHODOLOGY
This study investigates the relationship between aerosol concentration and rainfall quantity at Chennai using daily surface observations of particulate matters (PM10) concentration. Aerosol data has been obtained from Pollution Control Board at Guindy, Chennai. Rainfall data for the corresponding years are obtained from Regional Meteorological Centre, Chennai. Correlation coefficient is found using Spearman Rank Correlation method. The persistence behavior of the aerosol data has been studied by finding Hurst exponent.
The Spearman Rank Correlation (ρ) is a nonparametric measure of statistical dependence between two variables. It is a test for correlation using ranked data. As we use the rank order than the actual values for determining the association between the two set of (aerosol and rainfall) values it is called a “rank correlation.” The actual data are ranked, usually in ascending order i.e., a rank order 1 is allotted to the smallest values of each variable in x and y. The rank order n is given to the largest variable. If two or more values of the variable x and y are tied, they are each assigned the average of the rank positions otherwise they would have been assigned individually if ties had not occurred. For each of the n values of the variables, a set of rank difference is obtained, d = Rx - Ry as the sum of the difference in rank of paired values is zero i.e., ∑d=0, we use ∑d2 . Finally Spearman Rank Correlation (ρ) is ρ = 1- (6 ∑d2 /n3 -n) Where n is the number of data considered and d is the difference between the ranks of each observation on the two variables. The rank correlation coefficient is a relative measure which varies from -1 through 0 to +1. The Hurst exponent is used as a measure of the long term memory of time series, i.e. the autocorrelation of the time series. To calculate the Hurst exponent, estimation of the dependence of the rescaled range on the time span n of observation is very important. A time series of full length N is divided into a number of shorter time series of length n = N, N/2, N/4... (In our study total number of data is 262. It divided into two sets of 131 each (N/2) then it is further divided into four sets of 65 each (N/4) and so on.) The average rescaled range is then calculated for each value of n. Computing (R/S) (t0, w) for time lag w the rescaled range for the time lag w is finally written as the average of those values (Here R, S are calculated for each time series of n). It has been observed that the rescaled range (R/S) over a time window of width w varies as a power law: (R/S) w = k WH, where k is a constant and H is the Hurst exponent. To estimate the value of the Hurst exponent, R/S is plotted against w on log-log axes. The slope of the linear regression gives the value of the Hurst exponent. A value of 0 < H < 0.5 indicates a time series with negative autocorrelation (e.g. a decrease between values will probably be followed by an increase), and a value of 0.5 < H < 1 indicates a time series with positive autocorrelation (e.g. an increase between values will probably be followed by another increase). A value of H=0.5 indicates a true random walk, where it is equally likely that a decrease or an increase will follow from any particular value (e.g. the time series has no memory of previous values). In addition to that the H exponent vary between 0 and 1, with higher values indicating a smoother tend, less volatility and less roughness. The Hurst exponent is related to the fractal dimension D of the time series curve by the formula, D=2-H, D=2-0.6998=1.3002 When the fractal dimension, D for the time series is 1.5, there is no correlation in amplitude change between two successive time intervals and is unpredictable. When dimension decreases to 1 the process becomes more and predictable, when fractal dimension increases from 1.5 to 2 the process exhibit anti persistent. RESULT AND
DISCUSSIONS
The relationship between aerosol concentration and annual rainfall at Chennai has been found using Spearman Rank correlation. The Correlation Coefficient was found to be - 0.199. The aerosol concentration affects the quantity of rainfall to some extend at Chennai. The decreasing trend of the annual rainfall quantity due to the increase in aerosol concentration has been illustrated in fig. 1. The Hurst’s exponent for the concerned aerosol concentration data was found to be 0.699 as shown in fig. 2. The rescaled range (R/S) values are tabulated in table 1. This shows the persistence behavior of it. The Fractal Dimension, D was found to be 1.3002. Aerosol concentration has been increased in Chennai accompanied by a decrease in rainfall events over the last few years. Aerosol concentration has been abruptly increased in the years 1989, 2001, 2003, 2006 and 2009 and decreased in 1991, 1999, 2002 and 2005. On the contrary, the rainfall quantity attained lower heights in the years 1987, 1993, 2000 and 2003 and greater heights in the years 1990, 1996, 2001 and 2005. Insufficient rainfall witnessed in the years 2003. . Further from the graph we can understand aerosol concentration well correlated to rain fall in some years. This result show that increasing aerosol load affects the cloud produces less rain at few individual times some cases were turned when polluted convective clouds produced intensified rainfall via mixed microphysics (Yong-San Choi et.al., 2007). More over since many factor affect precipitation formation and rain fall in urban areas, is difficult to reveal and to quantitatively evaluate effect of aerosol in these areas.
CONCLISION
At the time of our study we were able to collect 23 years (1987-2009) monthly data and 2010 daily data only. From our study we found that the relation between aerosol concentration and rainfall. It shows increasing aerosol concentration affect the cloud development and causes less rainfall in some extend. Furthermore we used 262 days aerosol data and employed R/S method to compute Hurst exponent H and fractal dimension analysis also carried out. It shows the aerosol concentration in time series is predictable. It means that a time series with long – term positive autocorrelation both high value in the series will probably be followed by another high value and that the values a long time on to the future will also tend to be high.
ACKNOWLEDGEMENT
The authors would like to thank Pollution Control Board, Regional Meteorological Centre, Chennai for providing rainfall datat and pollutants data. 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=1465http://ijcrr.com/article_html.php?did=14651. Madhavi Latha. K., Krishna Prasad. V and Badarinath.K.V.S. 2003. Aerosol characteristic and radiative forcing over industrial areas of urban environment – A case study from Hyderabad and its environs. J. Ind. Geophy. Union (2003), Vol.7. No, pp.25-29.
2. Deepti saxena, R.Yadav, Adarsh kumar and Jagdish Rai, 2010. Measurement of atmospheric aerosol during monsoon and winter seasons at Roorkee, India, Indian journal of Radio & space physics, Vol.39.
3. Cheng, y., Lohmann, U, Zhang, J., Liu, Y. and Lesins. G, 2005. Contribution of changes in sea temperature and aerosol loading to the decreasing precipitation trend in southern China, Jr. Climate, 18, 1381-1390.
4. Gong, D.Y.and C.H.Ho, 2007. Shift in the summer rainfall over the Yangtze aaariver valley in the late 1970s, Geophy. Res. Lett. 29, 1436.
5. Yong-Sang Choi and Chang-Hoi Ho, Jinwon Kim, Dao-Yi Gong, Rokjin J.Park 2007. The impact of Aerosols on the summer rainfall frequency in China, Journal of Applied meteorology and climatology, Vol.47, pp. 1802-1813.
6. Ramanathan, Crutyzen V.P.J, Kieh J. Tl., and Rosenfield.D. 2001. Aerosols, climate, and the hydrological cycle, Science, 294, 2119- 2124.
7. Kaufman, Koren Y. J. I, Remer, D. Rosenfeld L. A., and Rudich.Y. 2005. The effect of smoke, dust and pollution aerosol on shallow cloud development over the Atlantic Ocean. Pro. Natl. Acad. Sci. USA, 102, 11207- 11312.
8. Johnson et al. B.T., 2003. The semi–direct effect: Impact of absorbing aerosol on marine stratocumulus, Q. J. R. Meteorol. Soc. 130, 1407 – 1422
9. Penner J.E., QWuaas J., Storelvma T.,Takemura.,T.,.Boucher Kirkevag .K, Kristijansson J.E., and Seland O..2006. Model intercomparison of indirect aerosol ffects.,A tmos.Chem.Phys,Vol.6.3391-3405.
10. Twomey. S., 1974. Pollution and the planetary albedo, Atmos, Environ. 8, 1251- 1256.
11. Ackerman, A. S., Kirkpatrick, M. P., Stevens, D. E., and Toon, O. B, 2004. The impact of humidity above sraitiform clouds on indirect aerosol climate forcing, Nature, 1014-1017.
12. Amir Givati and Daniel Rosenfield, 2004. Quantifying precipitation suppression due to Air Pollution, AMS Journals online, Vol. 43, issue7.
13. Mark Z. Jacobson and Yoram J, Kaufman. November 2006. Wind reduction by aerosol particle. Geo Physical letters, Vol. 33.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30General SciencesPRELIMINARY EXPERIMENTAL ASSESSMENTS OF 12 DIFFERENT ORGANIC MATERIALS FOR SOIL QUALITY AND SOIL FERTILITY MANAGEMENT EXERCISES
English0715S. UsmanEnglish P. J. A. BurtEnglishA preliminary experiment was conducted for 12 different organic materials to examine the physical, physico-chemical and chemical properties for soil quality and soil fertility rehabilitations. The results show that, the animal dung samples: cow, donkey, goat and sheep have common physical properties. Similarly, it appeared that the house-refuse and ani-cro-ber (combination of all materials) have the same physical properties. Leaf samples (Acacia nilotica and Acacia. albida) are types of organic materials, which show some similarities in their textural appearances but differed significantly in term of structure. Millet husk, wood ash and wood husk show unique physical properties. However, it is reported that nitrogen content for all the animal materials is above 2% but show a practical variation in term of phosphorus, potassium, calcium, and magnesium. Ani-cro-ber has the highest nitrogen content of 3.07% while wood-husk has very low content (0.98%). There is high potassium content in Acacia nilotica (2.01%), Acacia albida (1.87%) and ani-cro-ber (1.82%). Generally, with the exception of ani-cro-ber that has phosphorus content of 1.04%, all the remaining organic materials show low phosphorus contain of less than 1%. Calcium is high in ani-cro-ber (17.9%), wood ash (17.6%), and wood husk (16.3%), but very low in sheep dung (0.13%), cow dung (0.16%), millet husk (0.20%), goat dung (0.21%) and donkey dung (0.29%). Also, calcium is high in ani-cro-ber (5.39%), wood husk (4.11%), wood-ash (3.23%), and millet husk (2.88%). This finding suggests that organic materials should be widely used as good sources of essential soil nutrients and soil quality and soil fertility rehabilitations; and this is particularly important under poor soil condition.
EnglishOrganic materials, Properties, soil managementINTRODUCTION
Organic materials (plant and animal sources) have been widely accepted as important source of essential soil nutrients, and play a vital role in sustaining and improving soil structure, soil quality, soil function, soil health, soil fertility and overall crop performance in agricultural production (Usman, 2013). In the past 40 years, farmers in local areas of sub-Saharan Africa (sSA) have been seeing the benefits of incorporating organic matter (decomposed plant and animal materials) in soil. Unfortunately, the development of inorganic fertilizer industries has put a barrier to that. This development of inorganic fertilizers, has led to most of the farmers in s-SA to abundant the use of organic manure (mixture of animals dung and urine), organic matter and organic materials. In recent time, farmers in s-SA have realised the disadvantages of compliant with inorganic fertilizers as major source of soil fertility management in the region. Also, corresponding problem to this is that most of the agricultural dryland soils in the region are infertile due to problems associated with erosion, desertification, and climate change impact (Put et al., 2004; Usman, 2007). Because of these soil problems, farmers complained much about the annual yield reductions of their farm produce in the affected areas. It is one of the key goal of sound soil management creating a healthy soil environment that may retain balance nutrient status by protecting the surface soil cover from unacceptable changes such that its fertility will maintained over time (Omotayo and Chukwuka, 2009). Therefore, understanding the properties and functions of organic materials in soil could profitably be one of the sustainable remedy to sSA farmers in these circumstances; for the reason that, decomposed organic materials in soil, protect soil against runoff, erosion, mass movement of fine soil particles and as such was considered enhance soil water, soil air (pore spaces), and soil productivity (NRCS, 2003; Usman, 2007, Usman, 2013). Organic materials are the storehouse of all essential soil and plant nutrient in soil. They are important components of soil fertility and are associated with a variety of other important soil physical, chemical, and biological characteristics (McDonald, 2010). Organic materials are potential important sources of micro and macro nutrients in agricultural soils environment (Hood, 2001). They affect physical, biological, chemical, and ecological processes in soil. They improve soil structural quality, soil water holding capacity, soil infiltration, soil organism biodiversity, and soil nutrient availability (FAO, 2005). Generally speaking, little information on properties and functions of most used organic materials for soil quality management in many local areas of s-SA can be found. However, most of the studies on soil organic matter (SOM) characterisation, were considered (Evelyn et al., 2004) largely moved away from definitions based solely on chemical extraction procedures, such as laboratory chemical analysis (Mitchell and Everest, 1995), humic and fulvic acids analysis (Reeves, 1997), qualitative spectroscopy [nuclear magnetic resonance (NMR)] and diffuse spectroscopy [reflectance infrared Fourier transform (DRIFT)] (Brian, 2002). The need for characterization based on combine physical and chemical assessments is needed, as physical separation of SOM (Evelyn et al., 2004) relates better to the role that organic matter plays in soil structure and soil function (Lal, 2000; Brady and Weil, 2004). Therefore, to improve the standard balance of the morphological and genetic properties of the deteriorated agricultural soils in the s-SA, it is necessary to be able to address and understand the properties and functions of organic material in single and in combination. This demands understanding of the properties and behaviours of organic materials for soil quality and soil fertility functions. The main objective of this study was introductory report of the properties of 12 different organic materials for soil quality and soil fertility management processes. The study would profitably lead to more sustainable and permanent soil management, soil quality and soil fertility rehabilitations for high crop yield in agriculture.
MATERIALS AND METHODS
The study was conducted under three principal stages as described below: First principal stage: Physical and physicochemical assessment: At the beginning of this exercise, 11 samples of different organic materials were collected using tile spade shovel (animal, wood and house refuse sources) and by hand picking (crop and leaf source). All the samples were stalked separately in a clean experimental plastic rubber (Figure 1). The collection of these samples was partly made from house-hold cattle reared sites (animal source) and partly from cropping and forest-vegetation areas (crop and leaf sources). Experimentally, 500 ml of water was added to each sample after one day of collection and 1.1 kg of each was used to determine the physical and physico-chemical properties. In addition, 0.1 kg from each of the 11 samples were bulked together to have a unique representative sample (ani-cro-ber). The assessment was completed in a 3 week period from 25/12/2010 to 01/01/2011 (1st week), 02/01/2011 to 09/01/2011 (2nd week), and 16/01/2011 to 24/01/2011 (3 rd week). The USDA-NRCS (2002) guidelines were used under this assessment.
Second principal stage: Chemical analyses:
All the 12 organic samples were chemically analysed at Soil Research Institute, Kumasi, Ghana according to the general procedures described by Nelson and Sommers (1982) and that of Bray and Kurtz (1945) for the determination of total organic carbon, organic matter, nitrogen and exchangeable bases.
Third principal stage: statistical analysis of the chemical data:
Cluster analysis was primarily used to classify and group the chemical components of different organic materials as well as different soil strata ‘individually’ treated with the same organic materials. The purpose of using this analysis was to determine the number of groups under the different organic materials as they are closely related to each other for best soil management combination. Addinsoft (2012) version 14.3.1.0 statistical software package was used.
RESULTS
The results of the assessments of 12 different organic materials are presented in Tables 1, 2 and 3. Tables 1 and 2 show the physical and chemical properties while the physic-chemical components are presented in Table 3.
Table 1 shows the physical properties of 12 organic samples under physical assessment. Animal dung samples: cow, donkey, goat and sheep have common physical properties. The colours appearance of these 4 animal samples are black and dark, the structures are blocky and subangular, the textures are cemented and gravely and consistencies are soft and slightly hard. Similarly, the house refuse and ani-cro-ber samples have the same physical properties, characterised by dark and black colour, clotted and hard consistency, decomposed and granular structure as well as cement textural nature. Leaf samples are types of organic materials, which show some similarities in term of texture (fine), consistency (loose) and colour (light green), but differed significantly in term of structure: A. nilotica has massive structure whereas A. albida has single-grain. For millet husk, texture is coarser, structure is granular, consistency is loose and colour is yellowish. However, wood ash and wood husk are two types of organic wood materials but differed significantly. Wood ash is characterised by light-grey colour, loose consistency, massive structure and texture is ashy whereas wood husk is characterised by dark-pink colour, loose consistency and granular and woody structure and texture respectively.
A preliminary chemical analysis of these 12 organic samples is given in Table 2. The nitrogen content for all the animal dung is above 2%, however, a reasonable variation was observed in term of phosphorus, potassium, calcium, and magnesium. Ani-cro-ber has the highest nitrogen content (3.07%) and wood-husk has very low content (0.98%). There is high potassium content in A. nilotica (2.01%), A. albida (1.87%) and anicro-ber (1.82%). With the exception of ani-crober (1.04%), all the organic materials have low phosphorus content (below 1%). Calcium is high in ani-cro-ber (17.9%), wood ash (17.6%), and wood husk (16.3%); but very low in sheep dung (0.13%), cow dung (0.16%), millet husk (0.20%), goat dung (0.21%), and donkey dung (0.29%). Also, calcium is high in ani-cro-ber (5.39%), wood husk (4.11%), wood-ash (3.23%), and millet husk (2.88%). In addition, the result of physico-chemical assessment related to soil quality and soil fertility functions is given in Table 3. Also, a preliminary cluster analysis of all the organic samples given in last column of Table 2 has provided a better understanding of the close relationship of each individual organic material with another in term of their chemical composition.
DISCUSSION
The physical, chemical and physico-chemical properties of different organic materials are reported in Tables 1, 2 and 3. These organic materials were tested for soil quality and soil fertility managements use. Physically, important organic properties: texture, structure, consistency and colour are vital in soil quality development in the soil medium, whereas chemically, significant amount of essential nutrients would provide a wellbeing soil condition under soil fertility function (FAO, 2005, Usman, 2013). This vital role of the properties of different organic materials examined in this study, are believed to have created a healthy and functional soil condition for proper plant growth (Basu et al., 2007; Uzoma et al., 2011). It is also reported that increased addition of organic materials under soil fertility management, has led to increased nutrient concentration and transformation into soil solution (Muriwira et al., 2001; Powlson et al., 2011). This increased nutrient concentration is transferred into the soil as a result of the different concentration of chemical compounds available in the organic materials (Table 2; Powlson et al., 2011). Similarly, the improvement of soil texture, soil structure and soil bulk density as reported in different soil organic matter related studies (e.g. Ascota et al., 1999; Spaccini et al., 2002; Francisco and Lowery, 2003; Maris and Ryan, 2006; Nagaya and Lal, 2008; Wiesmeier et al., 2012) is likely associated with the physical properties of different organic materials reported in Table 1. Also, colour is an important physical property that serves as indication of soil quality and soil health (Foth, 1990; FAO, 2005; Usman, 2013). Most of the organic materials are characterised as black and darker, still some are grey and lightgreen (Table 3). These various colours could reflected the soil and soil properties by transforming the surface soil into more fertile appearance, a condition related to soil ability to attract and accommodate varieties of soil organisms for wide range of soil biodiversity (FAO, 2005). The cluster analysis shown in Figure 2 above, has grouped the available chemical data of twelve different organic materials into three clusters – 1, 2 and 3. This grouping of the organic materials into three cluster-codes was performed according to the order of their chemical content of individual compound tested as presented in Table 2. The cow-dung, sheep-dung, goat-dung, donkydung, rice-husk and house-refuse are grouped under class 1, whereas millet-husk, Acacia albida and Acacia nilotica are grouped under class 2 while wood-ash, wood-husk and ani-cro-ba are grouped under class 3 (Figure 2). This grouping has further suggested that all the organic materials under each respective class have the same chemical characteristics and are likely to have the same function under soil management point of view.
On the other hand, a representative of organic material (e.g. cluster-code 1) from each group can be used in combination with another organic material from other group (e.g. cluster-code 3) as a formulation under best sustainable management practice for high crop yield. It appeared that some of these organic materials have gaseous and sulphurous compounds and some does not have. These gaseous and sulphurous compounds are found presence in all animal samples, ani-cro-ber and house-refuse. However, high reactions in term of these physic-chemical properties were noted strongly in cow dung, donkey dung and ani-cro-ber, but the reaction is very low in sheep and goat dung.
CONCLUSION
Based on the fact that, the present study has shown that organic materials are important source of essential soil physical and chemical components (Tables 1, 2, 3), it is concluded that the transformation and development of soil quality and soil fertility when organic materials is been added to the soil, is likely depend on the availability of chemical physical characteristics of the individual organic material involved (Figure 1). This is because as organic materials slowly decomposed in soil, they colour the surface soil, maintain the soil strength, increase soil resilience (ability of soil to return to its initial state after disturbances), soil aggregation and aggregate stability (Tisdall and Oades, 1982; Wiesmeier et al., 2012), thereby transforming soil texture into stable, suitable and good textural quality classes for wide range of crop production (Hartemink, 2006; Viaud et al., 2011). The finding of this study, suggests that organic materials should be widely use as good sources of essential soil nutrients for soil quality and soil fertility rehabilitations particularly under poor soil condition.
ACKNOWLEDGMENT
This work was funded by the Kebbi State Government of Nigeria for academic and agricultural progress in the State. Therefore, we thank the Kebbi State Government for her effort and in particular, the present Governor Alhaji Saidu Usman Nasamu Dakin-Gari. As part of this salutation, we thank the great aid received from the scholars whose articles cited and included in references of our paper. We also offered thank to publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Personally, we are grateful to IJCRR editorial board members and IJCRR team of reviewers who have facilitated to bring quality to this paper.
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8. Foth, HD. Fundamental of Soil Science. John Wileyas and Sons. New York, USA. 1990, 36-39pp.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareHEPATOPROTECTIVE ACTIVITY OF ETHYL ACETATE EXTRACT OF ADHATODA VASICA IN SWISS ALBINO RATS
English1621Rayese AhmadEnglish Vaseem RajaEnglish Manik SharmaEnglishThe hepatoprotective activity of Ethyl acetate extract of Adhatoda vasica was investigated against CCl4 induced liver damage in Swiss albino rats. At the dose of 1ml/kg, CCl4 induced liver damage in rats as manifested by statistically significant increase in serum Alanine aminotransferase, (ALT), Aspartate aminotransfrase (AST), Alkaline Phosphatase (ALP) and also in serum Bilirubin. Pre-treatment of rats with the ethyl acetate Extract of Adhatoda Vasica (100mg/kg and 200mg/kg) prior to the CCl4 dose at 1ml/kg statistically lowered the three serum level enzymes and also Bilirubin. Histopathlogical observations also coincided with the above results, however 200mg/kg dose was found to be more active. Current results suggest that Ethyl acetate extract of Adhatoda vasica has potent hepatoprotective effect against CCl4 - induced liver damage.
EnglishAdhatoda vasica, CCl4, silymarin and DMSO.INTRODUCTION
Liver is one of the largest organs in the human body and the chief site for intense metabolism and excretion. So it has the surprising role in the maintenance, performance and regulating the homeostasis of body. It is involved in almost all biochemical path ways to growth, to fight against infections, diseases, nutrient supply, energy provision etc. The major functions of liver are carbohydrate, protein and fat metabolism, detoxification, storage of vitamin and formation of bile. Unfortunately, conventional or synthetic drugs used in the treatment of liver diseases are inadequate and some times can have serious side effects. Drug induced liver injury is a major health problem that challenges not only health care professionals but also the pharmaceutical industry and drug regulatory agencies.1 The rate of hepatotoxicity has been reported to be much higher in developing countries like India(8-30%) comp aired to that in advanced countries(2-3%) with a smaller dose schedule2 . The use of medical plants to treat human diseases has been performed for millenniums. Now days it is known that 80% of the world populations have already taken medicinal plants and 30% are prescribed by physicians. To prove the traditional claims, the hepatoprotective activity of Adhatoda vasica was evaluated. Adhatoda vasica (common name- Malabar nut, Family- Acanthacea) is a small ever green plant (1-1.25m) with broad lanceolate leaves. The flowers are white, pink or purple. The plant grows through out the Indian pensula up to an altitude of 1300m3 . The biological work performed so for on this plant showed poultice on rheumatic joints as counter-resistance on inflammatory swelling on fresh wounds, urticaria and in neuralgia4 . The present investigation has been designed to study the hepatoprotective activity of Ethyl acetate extract of the whole plant of Adhatoda vasica in carbon tetrachloride induced hepatic damage in rats.
MATERIAL AND METHODS
Plant material
The plant of Adhatoda vasica was collected from remote areas of Bhopal district, during Dec. 2010. Identification of plant was carried out at department of Botany Bhoj Mahavidhyalya Bhopal. A voucher specimen has been deposited at the Herbarium located at postgraduate department of zoology Bhoj Mahavidhyalya Bhopal. Preparation of plant extract The whole plant of Adhatoda vasica was washed thoroughly with tap water, sun dried and powdered. The powder (100gm) was successively extracted with 90% ethyl acetate in soxhlet apparatus for 48 hours duration. The filtrate was then concentrated and the solvent was evaporated under reduced pressure in a Rotatory evaporator. The yield of the extract was found to be 25.89%. This crude extract was referred to as AV. For administration the crude extract was dissolved in DMSO and used for the experiments. Experimental animals Swiss albino male rats (150-175gms) obtained from the animal house of PBRI. They were housed under the standard laboratory conditions and were feed commercial rat feed (Lipton India Ltd, Mumbai, India) and water, ad libitum. All animal experiments were carried out according to NIH guide lines after getting approval of the institute’ s Animal Ethics Committee (Regd No.1283/c/09 CPCSEA). Carbon tetrachloride induced hepatotoxicity CCl4 was suspended in olive oil and administered p.o, at a dose of 1ml/kg. Healthy rats were divided into five groups (six per group). Group 1, the normal control group received a single dose of DMSO (3ml/kg p.o) for 7 days. Group 2, the CCl4 intoxicated control group received a single dose (1ml/kg bw,p.o). Group 3 received drug silymarin (50mg/kg,bw) for 7 days and a single dose CCl4 (1ml/kg,p.o.) on seventh day. Group 4 and 5 received AV (100and 200mg/kg, bw, p.o) and a single dose of CCl4 (1ml/kg) on the seventh day. The animals were scarified after 24 hours of last treatment. The blood samples from all groups were collected separately by retro orbital puncture and allowed to coagulate for 30 min at 37 oC, the clear serum was separated at 8000 rpm for 10min and subjected to the liver function tests. Liver function tests Biochemical parameters like serum glutamate pyruvate transaminase5 (SGPT), serum gultimate oxaloacetate transaminase5 (SGOT), serum alkaline phosphatase6 (SALP) and serum Bilirubin7 (SB) were assayed according to the standard methods. Histopathological studies After blood draining liver samples were excised from the control and treated groups of animals and washed with normal saline separately. They were suspended in 10% formalin for 24 hours. The formalin-fixed liver samples were stained with haemtoxylin-eosin for photo microscopic observations of the liver histological architecture.
STATISTICAL ANALYSIS
Statistical comparison between control and treated groups was made, Analysis of variance, followed by multiple comparisons 8 .
RESULTS
Administration of the CCl4 (1ml/kg p.o) caused a significant increase in serum enzymes namely SGOT, SGPT, ALP and SB in rats, as compared to normal rats. However pretreatment with plant extract AV, prior to CCl4 administration caused a significant reduction in the values of SGOT, SGPT, SALP and SB, however 200mg/kg dose brought reduction almost comparable to silymarin(50mg/kg) treated groups (table-1) The hepatoprotective of AV was further confirmed by histopathological examinations of the liver samples from respective groups. Histological architecture of CCl4 treated liver sections showed degeneration of hepatic cells with centrilobular necrosis. Sinusoids were observed to be inflamed and flooded with inflammatory cells. However, administration of AV (200mg/kg) almost normalized these defects in the histological architecture of the liver resembling that of silymarin treated groups, showing its potent hepatoprotective effects (Fig 1-5).
DISCUSSION
Herbal based therapeutics for liver disorders has been in use in India for a long time and has been popularized world over by leading pharmaceuticals. Despite the significant popularity of several herbal medicines in general, and for liver diseases in particular, they are still unacceptable modalities for liver disease. The efficacy of any hepatoprotective drug is essentially dependent on its capability to either reduce harmful effects or to maintain the normal hepatic physiological mechanism that have been un balanced by the hepatotoxin9 . The result of the present study reveal that the Ethyl acetate extract of Adhatoda vasica possess significant hepatoprotective activities against CCl4 induced liver damage in Swiss albino rat. It has been observed that the CCl4 is bio-transformed by the cytochrome p-450 system to the trichloronethyl free radical; this free radical may react again with oxygen to form a trichloromethyl per oxygen radical which may attack lipids on the membrane of endoplasmic reticulum10. Trichloromethyl per oxygen free radical leads to lipid per oxidation, the disruption of ca++ homeostasis and finally results in cell death11-12. Therefore the leakage of large quantities of enzymes into the blood stream is often associated with massive necrosis of the liver. Administration of CCl4 results in the rapid increase in the serum GOT, GPT and ALP (table1) .Serum GOT can be found in the liver, cardiac muscles, kidney , brain , lungs, skeletal muscles ,leukocytes and erythrocytes (in decreasing concentrations)13 . Whereas the highest concentration of serum GPT is found in liver tissues, serum GPT occurs in two locations, the cytosol and mitochondria. Serum GPT appears to be more sensitive and specific test for hepatocellular damage than serum GOT. Although the serum enzyme levels are not the direct measure of hepatic injury, they show the status of the liver. The elevated levels of enzymes are indicative of cellular leakage and loss of functional integrity of cell membranes in the liver14. Thus lowering of enzyme content in serum is a definite indication of hepatoprotective action of a drug. Serum ALP and Bilirubin levels are also related to the status and function of hepatic cells. In the present study Ethyl acetate extract of Adhatoda vasica has been found to reduce the serum level enzymes and Bilirubin in the treated groups compared to untreated ones in dose dependent manner (Table-1). The liver sections treated with AV also showed the normal hepatic cell architecture and portal triad coincides with serum levels. The serum and histopathological results confirm the hepatoprotective activity of Adhatoda vasica. Thus may be the best remedy for treatment of liver disease in developed as well as in developing countries. The results coincided with our investigations that200mg/kg b.w showed the best protective effect against the carbon tetrachloride induced liver injuries, therefore the possible hepatoprotective mechanisms of extract of Adhatoda vasica may be due to preventing process of lipid per oxidation, inhabiting the cytochrome p-450 activity, stabilizing the hepatocellular membrane and enhancing the protein synthesis. Preliminary phytochemical studies have indicated the presence of flavonoids in Adhatoda vasica. Flavonoids consumed in large amounts in diet, are known to protect liver15. Hence the anti hepatic toxicity of Adhatoda vasica may due to presence of flavonoids.
CONCLUSION
On the basis of the present investigations it can be concluded that the ethyle acetate extract of Adhatoda vasica seem to poessess hepataprotective activity in rats, it is further demonstrated that 200mg/kg b.w. dose has prominent hepatoprotective activity as is evident from the biochemical and histopathological parameters. Further studies are needed to elaborate whether some compounds present in extract responsible for hepatoprotection I CCl4 induced hepatotoxicity and the molecular basis of their mode of action.
Englishhttp://ijcrr.com/abstract.php?article_id=1467http://ijcrr.com/article_html.php?did=14671. Sobiya R., Vennila, J .J., Aiyavu, C. and Selvam, K.P. (2009). The hepatoprotective effects D of ancholic extract of Annona squamosa leaves on experimentally induced liver injury in Swiss albino mice.international Journal of Integrative Biology, 5 ( 3): 182- 190.
2. Shama, S.K. (2004). Antituberculosis drugs and hepatotoxicity . Infect Genet Evol. 4 : 167-170.
3. Claeson, U.P., Malmfors, T., Wikman, G. and Bruhn, J.G. (2000). Journal of Ethnophamacology, 72, 1-20.
4. Wealth of India, Raw Materials(1985). CSIR New Delhi, 1, 76.
5. Reitman, S. and Frankel, S. (1957). A colorimatric method for the determination of serum gultimate oxaloacetate and glutamic pyruvic acid transaminase. Amr J. Clinic. Pathol, 28: 56-62.
6. Kind, P.R.N. and King, E.J. (1954). Determination of serum alkaline phosphatase. J Clin Pathol, 7: 132-136.
7. Jendrassikl. and Grof, P. (1938). Verenfachte photometrishe method zur bestimmung des blubilirubins. Biochem Z, 297: 81-89
8. Armitage, P. and Berry, G. (1985). Statistical methods in Medical Research, 2ndEdn, Black Well Scientific publications, Edinburgh, UK, 186
9. AL – Howring, T.A., AL – Sohaibani, M.O., AL – Said., M.S., AL – Yahya, M.A., AL – Tahir, K.H. and Rafatullah, S. (2004). Hepatoprotective properties of Commiphora opobalsamum (Balessan), a traditional medicinal plant of Saudi Arabia. Drugs Exptl. Clin. Res, 5 (06): 213-220
10. Manokarn, S., Jaswanth, A., Sengotuvelus., Nandha, K.J., Duraisamy, R., Karthikeyan, D. and Mallegaswari, R. (2008). Hepatoprotective activity of Avera lanata against paracetamol induced liver damage in rats. Research of Pharm and Tech, 1(4): 398- 400.
11. Clawson, G.A. (1989). Mechanism of Carbon tetrachloride hepatotoxicity. Pthol ImmunoPathol Res, 8: 104-115.
12. Reknagel, R.O., Glande, E.A., Dholak, J.A. and Walter, M.A. (1989). Mechanism of carbon tetrachloride toxicity. Pharmacol Ther, 43, 135-140.
13. Rafatullah, S., Moosa, J.S., Ageel, A.M., Alyahya, M.A. and Tariq, M. (1991). Hepatoprotective and Safety evaluation studies on Sarsaparilla. Int J Phamacognosy, 29, 4: 296-301.
14. Susanta, S.K., Goutam, C., Malya, G. and Upal, K.M. (2005). Hepatoprotective activity of Diospyros malabarica Bark in carbon tetrachloride intoxicated rats. Europian Bulletin of Drug Research, 13, (1): 25-30
15. Di Garlo G, Mascolo N, Izzo AA and capasso F(1999). Flavonoids: old and new aspects of a class of natural therapeutic drugs. Life Sci., 65,(4): 337-353
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareAN UNUSUAL CASE OF MAYDL'S HERNIA
English2225B.A. Nikhil NanjappaEnglish K. NatarajanEnglish Alok MohantyEnglish S. Robinson SmileEnglishMAYDL’S HERNIA (hernia-in-W) is one of the rare presentations of strangulated inguinal hernias in adults. Its incidence is reported to be between 0.6-1.92 % of all strangulated hernias [1-3]. Two or more loops of bowel lie in the hernia sac but it is the intervening loop, within the abdomen, that is most severely affected, hence the term hernia-in-W. This case report presents one such case of a Maydl’s hernia. The Intraoperative finding of a strangulated intra-abdominal loop of jejunum with normal jejunum loops in the hernia sac eventually led to the diagnosis of Maydl’s hernia. Jejunum as a content of Maydl’s hernia has not been reported in literature available.
EnglishMaydl’s hernia, strangulated herniaINTRODUCTION
Maydl’s Hernia (hernia-in-W) is one of the rare presentations of strangulated inguinal hernias in adults. Two or more loops of bowel lie in the hernia sac but it is the intervening loop, within the abdomen, that is most severely affected, hence the term hernia-in-W. There are three types of Maydl’s hernia, depending on the content of the hernia sac. Jejunum as a content of Maydl’s hernia has never been reported in literature reviewed.
CASE REPORT
A 60 year old fisherman from Pondicherry, India, a known hypertensive presented to our emergency room with history of irreducibility for 4 hours, of a long standing right inguinal hernia of 10 years. There was mild pain over the swelling but no associated abdominal pain or vomiting. On examination the patient was well oriented, had a pulse rate of 76/minute, blood pressure was 180/100 mm Hg and was well hydrated. Local examination revealed a large (20*10 cm), ovoid shaped, right sided inguinoscrotal swelling which was irreducible, with mild to moderate tenderness, no local rise of temperature, no redness of the skin and absent cough impulse(Figure 1). Bowel sounds were audible over the swelling. The abdomen was soft, non-tender and not distended. Bowel sounds were audible over the abdomen. A diagnosis of irreducible right inguinal hernia was made and the patient was posted for emergency surgery. Under epidural and spinal anesthesia, a 15 cm inguino-scrotal skin incision (hockey-stick shape) was made. As the inguinal canal was opened the large, thick walled hernia sac was visualized. The sac was opened and some serous fluid was suctioned out. At exploration, two loops of normal looking jejunum were present in the sac. After the obstruction was relieved, traction on the loops revealed, a 10 cm long gangrenous loop of jejunum in between the normal loops (Figure 2 and 3). The gangrenous segment was resected and end to end anastomosis was done. The resected segment appeared to be jejunum (Figure 4). A modified Bassini’s hernia repair was done with 1-0 prolene.
The patient had an uneventful post-operative recovery period. The histopathology report confirmed that the resected segment was jejunum.
DISCUSSION
Karel Maydl a Bohemian surgeon in 1895, first described this hernia. Three types of Maydl’s hernia have been described based on their contents as Type 1) only small bowel; Type 2) both small and large bowel and, Type 3) only large bowel [1]. This was a type 1 Maydl’s as it contained only jejunum. The reported incidence of Maydl’s hernia is 0.6 to 1.92% of all strangulated hernias [2-4]. It is extremely rare in Europe and North America. Frankau [2] found only four, in his series of 1487 cases. But Bayley [5] reported five among 26 in Ghana and Cole [3], three out of 157 in Nigeria. Most of the reported cases are from Africa and it could be attributed to high incidence of untreated hernias [6]. Maydl’s hernia occurs more commonly on the right side and in men. It is most likely to contain terminal ileum or caecum [6]. It may occasionally contain transverse colon, hepatic flexure or sigmoid colon (Table 1). Jejunum as content has not been reported in the literature available. The occurrence of Maydl’s hernia depends on a multitude of factors. Long standing hernias may predispose to more bowels being dragged into the sac. Adhesions developing over a period of time may predispose to a ‘W’ configuration preventing one segment to herniate while permitting the more mobile loops to herniate around them [7]. The significance of this type of hernia is the risk of the strangulated middle segment going unnoticed at surgery due to a false judgment made by the presence of two viable loops in the hernia sac. This could be potentially fatal. The clue that may point to the diagnosis of Maydl’s hernia is the presence of blood stained or foul smelling fluid present in the sac disproportionate to the condition of bowel. The possibility of a second Maydl’s loop should be kept in mind and the part of bowel proximal to the neck of the hernia must always be examined [6]. Maydl's hernia should be suspected in patients with large incarcerated hernias and in patients with evidence of intra-abdominal strangulation or peritonitis (7). But In our case the patient did not have any signs of obstruction or strangulation and the irreducibility was for less than 12 hours. There was only mild to moderate tenderness at the root of the scrotum, no signs of peritonitis were present. The strangulated loop was confirmed to be jejunum. Hence the possibility of Maydl’s hernia should always be kept in mind when patients present with large, long standing inguinal hernias with acute onset irreducibility, even when signs of strangulation are absent NC – not commented.
LIST OF ABBREVIATIONS
mm: millimeters.
hg: mercury.
cm: centimeters.
SB: Small bowel.
LB: Large bowel.
Prolene: Polypropylene
ACKNOWLEDGEMENTS The authors would like to thank Dr. Arun T for providing imaging technical assistance.
Englishhttp://ijcrr.com/abstract.php?article_id=1468http://ijcrr.com/article_html.php?did=14681. Ganesaratnam, M: Maydl’s hernia: report of a series of seven cases and review of literature: Brit. J. Surg 1985; 72:737-738.
2. Frankau, C: Strangulated hernia: A review of 1487 cases. Brit. J. Surg 1931; 19:176- 191.
3. Cole, O. J: Strangulated hernia in Ibadan: A survey of 165 patients. Trans. Roy, Soc.Trap. Med. and Hyg 1964; 58: 441-447.
4. Philips, P. J: Afferent limb internal strangulation in obstructed hernia. Brit. J. Surg 1967; 54: 96-99.
5. Bayley, A. C.: The clinical and operative diagnosis of Maydl's hernia; a report of 5 cases. Brit. J. Surg 1970; 57: 687-690.
6. Abdominal wall hernias-principles and management: Robert Bendavid, chapter 82: groin hernias in adults presenting as emergencies-David Watkins.
7. Incarcerated Sliding Colonic Maydl’s Hernia-Dealing with This Rare Emergency : sanoop koshy Zachariah dr: World Journal of Colorectal Surgery, Volume 2, Issue 1,2010 Article 8
8. Paul, M: Maydl's hernia. Brit. J. Surg 1944; 32: 110-101.
9. Moss, C. M., Levine, R., Messenger, N. and Dardick, I: Sliding colonic Maydl's hernia: Report of a case. Dis. Col. andRect 1976; 19: 636-638.
10. Narang RR, Pathania OP, Punjabi PP, Tomar SS. Unusual Maydl's hernia (a case report): J Postgrad Med 1987;33:137
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareMYTHS AND MISCONCEPTIONS REGARDING DIABETES MELLITUS AMONG DIABETIC AND NON-DIABETIC INDIAN POPULATION
English2630Abdullah RehmanEnglish Umrana MirzaEnglish Muneeb JehanEnglish Syed Arif PashaEnglishMyths prevailing about diabetes in the society have become a major hurdle for its proper treatment and control1. Aim: To determine the myths and misconception about diabetes mellitus and its prevention and treatment among diabetic and non-diabetic population. Research Methodology: It was a cross sectional study conducted in a teaching hospital of Hyderabad (Deccan College of Medical Sciences) during April, May and June 2009. A self explained, semi-structured and pretested proforma was used to collect data from purposively selected 300 Diabetic and 300 Non diabetic patients who accompanied them while visiting this institute for their treatment. Information was collected regarding sociodemographic background and their myths and misconceptions regarding diabetes after oral, verbal and written consent. Data was analyzed using SPSS software. Results: Commonest myth among diabetic (40%) and non diabetic patients (71%) was that eating more sweets and sugar causes diabetes. Others were, diabetes is a contagious or inherited disease, diabetes can affect sexual life, insulin causes impotence and it is the only available cure for diabetes. Myths were significantly more common among females, non-diabetics and less educated group. 20 % of the diabetics and 29% of non diabetics were unaware of the complications of diabetes. 21% diabetics 29 % of non-diabetics were unaware of the role of diet in control of diabetes. Conclusion: The prevalence of myths about diabetes is high among both diabetic and non diabetic population which could be associated with poor health seeking behavior and poor compliance with treatment
EnglishDiabetes, Myths, treatmentINTRODUCTION
Diabetes mellitus is the most common metabolic disorder, its prevalence varying widely worldwide and ranging from as low as 50% The World Health Organization (WHO) estimates that more than 180 million people worldwide have diabetes. This number is likely to more than double by 20302 . In Keeping with scenarios of most developing countries, India has long passed the stage of diabetes epidemic. The problem has now reached pandemic proportions. It is a large public health problem growing astronomically every year. Apart from treatment of diabetes we need to pay attention to the prevention and health education of people about the diseases. Myths are defined as stories shared by a group of people which are a part of their cultural identity. They have a strong influence in the life of individuals and their way of living including seeking treatment during illness3 . This false collective beliefs become part of cultural identity and used to justify a social behavior. They have a strong influence in the life of Individuals and their way of living including seeking treatment during Illness. Myths have usually cultural and social backgrounds and usually they stay in a certain society if not challenged by scientific discourse. Lack of education, poverty, lack to health care facilities added with multiple ethnic, linguistic and cultural groups add up to the emergence of many myths. Educational level is protective against myths4 . Therefore, understanding the myths and misconceptions about diabetes mellitus is important in providing better care and health education to both patients and healthy individuals.
OBJECTIVE
To determine the myths and misconception about diabetes mellitus and its prevention and treatment among diabetic and non-diabetic population.
SETTINGS AND DESIGN
It was a cross sectional study conducted in a teaching hospital of Hyderabad (Deccan College of Medical Sciences) during April, May & June 2009. A self explained, semi-structured and pretested proforma was used to collect data from purposively selected 300 Diabetic and 300 Non diabetic patients who accompanied them while visiting this institute for their treatment. Information was collected regarding sociodemographic background and their myths and misconceptions regarding diabetes after oral, verbal and written consent. Data were analyzed using SPSS software. The questionnaire was developed based on international standards concerning the prevailing myths and misconceptions about diabetes mellitus5 . Total of 650 people approached our institute for their diabetes treatment which includes diabetic patients as well as non diabetic relatives or friends accompanying patients during the study period. Out of them 600 people got agree to participate in this research including diabetic patients as well as non diabetics. Ethical approval was obtained by ethical review committee of the study institute.
RESULTS
The current study was conducted in a tertiary care institution focusing on 300 diabetic and 300 non diabetic subjects visiting hospital along with patients and majority of them were males (58%). As shown in the table No.1 below, Majority of study group (39%) comprised of 30 to 50 years of age, while 20 % of the subjects were less than 30 years of age and 41 % of the subjects were of more than 50 years of age. Surprisingly, 31% of the subjects were illiterate and 41 % of them were educated up till 10th grade. High number of study subjects (45 %) were unemployed while out of those subjects, who were suffering from diabetes (300), 20 % were not on any treatment, 50 % were on drugs and 30 % were on insulin.
Table no 2 result shows that almost 35 % of diabetic subjects believe that diabetes is an inherited disease while almost 42 % non diabetics believed it so. 30 % of diabetics and 40 % non diabetics believed that diabetic patient should never take sugar and sweets. Surprisingly 8 % of diabetic and 25 % non diabetics thought that diabetes is a contagious disease. Almost 40 % diabetic and 71 % non diabetics said sugar causes diabetes. 40 % of diabetics believed that a patient can take anything to eat once the treatment has been started. 60 % diabetics believed that insulin is used for the final stage of diabetics and 20 % diabetics said it causes impotence. Almost 79 % of non diabetics believed insulin is a complete cure for diabetes and 57 % of it said once insulin is started, it is for life long. 30 % of diabetics said people with diabetes developed blindness at some point in time and 28 % diabetics believed that diabetes can affect sexual life too.
Above table no 3 shows awareness regarding complication of role of diet and life style in diabetes. Almost 20 % of diabetics and 29 % of non diabetics were not aware of complications of diabetes in our research while almost only 67 % diabetics and 49 % of non diabetics were aware of the role of diet in control of diabetes. Only 67% diabetics and 57 % of non diabetics were aware of the role of health life styles in the control of diabetes.
DISCUSSION
Myths prevail and stay in the societies due to lack of education, cultural beliefs and dogmas. These belief become such deep rooted that they sound true and get inculcated in successive generations. They may become slightly modified but stay in a society for a very long time unless challenged by scientific discourse. To change the behavior of the population we need to educate its masses6,7 . We don’t have many studies of the social aspects of many diseases and very meager literature is available based on the subject. We have however carefully collected almost all the myths and the results are surprising as these myths are common even in people who are educated, though less common than the uneducated lot. Many more such studies must be encouraged to enable us to prevent these myths from creating hurdles for scientific understanding of such common diseases. The most widely believed myth was that eating more sugar causes diabetes. This is not entirely true as it is not directly related to eating sugar, but is very much affected by diet in general. Some people also believe that soaking feet in water helps in decreasing blood sugar levels, a concept which is certainly not true. Some others are of opinion that herbal medicines are very effective in treatment of diabetes. These sections of people often present late to doctors and with complications as they first seek spiritual or herbal treatment. Nasir et al, reported high prevalence of such beliefs in spiritual treatment in Karachi, Pakistan. The prevalence of myths was found to be higher in females. This is almost similar to what was found in the study by Nasir et al in Pakistan8 . Educational status of people seemed to reduce their belief in the myths and they were better informed about the disease. This is similar to what was found by Nasir et al. This study therefore clearly reflects that prevalence of myths and misconceptions about diabetes and its treatment is high in our country and this could be a major hindrance in control and prevention of diabetes which is a disease of national importance. In a hospital based study carried out in India similar results were found. Twenty two percent of respondents believe that consuming sugar causes DM and myths were more common among females9 .
CONCLUSION
Myths and misconceptions about diabetes are prevalent in our society and this can have consequences upon the health seeking behavior of the people. In this study education is shown to be associated with decreased belief in myths. Myths and misconceptions are found to be highly prevalent among both even diabetics as well as non diabetics, though it was little less among diabetics in our research. We need to educate people about this disease and its preventive as well as treatment options. Advocacy of Diabetes program is highly encouraged to deal with the myths and misconceptions in the society.
ACKNOWLEDGEMENT
Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is 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=1469http://ijcrr.com/article_html.php?did=14691. Venkataraman , Kannan AT, Mohan V., Challenges in diabetes management with particular reference to India, Int J Diabetes Dev Ctries 2009 Jul; 29(3):103-9.
2. Global estimates for prevalence of diabetes mellitus and impaired glucose tolerance in adults. WHO Ad Hoc Diabetes Reporting Group. Diabetes care. January 1993;
3. Adler E, Paauw D. Medical myths involving diabetes. Prim Care 2003; 30:607-18.
4. Ben-Abdelaziz A, Drissi L, Tlili H, Gaha K, Soltane I, et al. Epidemiologic and clinical features of patients with type 2 diabetes mellitus in primary care facilities. Tunis Med 2006 84: 415–22
5. Rai M, Kishore J. Myths about diabetes and its treatment in North Indian population. International journal of diabetes in developing countries, Int J Diabetes Dev Ctries. 2009 Jul–Aug; 29(3): 129–132.
6. Funnell MM and Anderson RM. Empowerment and self-management education. Clinical Diabetes 2004; 22: 123–7.
7. Funnell MM, Anderson RM, Arnold MS, Barr PA, Donnelly MB, Johnson PD, et al. Empowerment: An idea whose time has come in diabetes patient education. Diabetes Educ. 1991;17: 37–41.
8. Nisar N, Khan IA, Qadri MH, Sher SA. Myths about Diabetes Mellitus among non diabetic individuals attending primary health care centers of Karachi suburbs. J Coll Physicians Surg Pak 2007; 17: 398-401.
9. Rai M, Kishore J. Myths about diabetes and its treatment in North Indian population. International journal of diabetes in developing countries, Int J Diabetes Dev Ctries. 2009 Jul–Aug; 29(3): 129–132
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareSCLEROSING STROMAL TUMORS OF OVARY - AN UNUSUAL TUMOR IN A YOUNG FEMALE
English3135Acharya A.S.English Bhosle S.S.English Ingle S.B.English Kohale M.G.English Dhobale A.V.EnglishSclerosing stromal tumors are rare benign ovarian neoplasms of the sex cord stromal category.They are frequently seen in second and third decades of life. Herein, we are reporting a unique case of sclerosing stromal tumor of ovary in a 24- year- old female which was clinically suspected as malignancy and diagnosis was confirmed on histopathology. Wherein frozen section played a vital role preventing untoward morbidity of patient due to extensive surgery. Other ovarian stromal tumors includes fibroma and thecoma.They tends to occur in the fifth and sixth decades of life. So in such circumstances clinician should keep in mind the rare possibility of a sclerosing stromal tumor in a young female.
EnglishBenign tumor, ovary, Sex-cord stromal tumor.INTRODUCTION
Sclerosing stromal tumor (SST) is rare benign ovarian neoplasms of the sex cord stromal category which occur predominantly in the second and third decades of life. The tumor is characterized by cellular pseudolobules, prominent interlobular fibrosis, frequently marked vascularity and a dual cell population: collagen producing spindle cells and lipid containing round or ovoid cells [1]. The important differential diagnoses are other sex cord stromal tumors including fibroma, thecoma, and lipoid cell tumors [2].
CASE REPORT
A 24-year-old woman was referred for pelvic pain starting six months earlier with no menstrual complaints. She had noticed abdominal distention three months before presentation. On clinical examination, a hypogastric mass was palpable. Abdominal ultrasonography showed a heterogeneous predominantly solid pelvic mass with some cystic foci measuring 9×6 cm. The patient was hospitalized with the diagnosis of malignant left ovarian tumor. All laboratory tests including tumor markers and serum hormonal assays were normal. The intra operatively (Fig1) mass was solid well encapsulated with glistening external surface. Intra operative frozen section was performed and reported as benign spindle cell tumor of left ovary. In view of this diagnosis patient underwent left salpingoophorectomy. Right ovary showed corpus leuteal cyst .The cyst was removed and right ovary was preserved. Gross examination of left ovary showed a well encapsulated 9×6×5 cm mass weighing 1100 g. The cut surface revealed predominantly solid, with focal cystic and edematous areas (Fig 2). No areas of haemorrhage or necrosis were observed. Capsule was intact. The right ovarian cyst was removed. Microscopic examination of right ovarian mass showed marked sclerosis, prominent vascularity, and amongst it are seen foci of tumor cells with vacuolated cytoplasm and round to oval nuclei (Figures 3 – 4).Immunohistohistochemistry was performed which showed focal positivity for inhibin and CD 34.So the final diagnosis of sclerosing stromal tumor of left ovary was done. On follow up patient doing well. As right ovary was preserved patient conceived and she is now 3 months pregnant.
DISCUSSION
SST of the ovary is a rare tumor derived from the sex cord stroma. This tumor was first described by Chalvaridjian and Scully (1973) and occurs most frequently in the second and third decades of life. The tumor is usually hormonally inactive although some cases with irregular menses and genital bleeding have been reported Peng et al found 114 cases reported until 2003 [3]. The tumor is characterized by cellular pseudolobules, prominent interlobular fibrosis, frequently marked vascularity and a dual cell population: Collagen producing spindle cells and lipidcontaining round or ovoid cells. The heterogeneity due to the variation in cellular size and shape are helpful features in the differential diagnosis of STT, and contrasts with the relative homogeneity of thecoma and fibromas [1, 3]. Also SSTs do not have hyalinized plaques, as do fibromas and thecomas. The finding of a thick rim of compressed residual ovarian tissue at the periphery of the mass suggests a slow growing benign tumor. On the other hand, thecomas and fibromas generally occur in the fifth or sixth decades of life when the ovaries are atrophic, so it is hard to identify residual ovarian tissue at the periphery of the tumor [4]. Our patient presented with pelvic pain with no menstrual irregularities while others reported menstrual irregularity, pelvic pain and nonspecific symptoms related to the ovarian mass [3, 5], anovulatory cycles or masculinizing symptoms [6]. The differential diagnoses of SSTs are other sex cord stromal tumors including fibroma, thecoma, and lipoid cell tumors. Most of the SSTs occur during second and third decades while fibroma and thecoma are rarely encountered in the first three decades of life. Thecoma is typically an estrogenic tumor with peak incidence in the sixth decade and lutein cells are distinct .There clinical manifestations are like infertility and irregular menses because of hormone production. Fibroma is a nonfunctioning tumor, which may have diffuse edema. [5]. SSTs may have a potential for hormone production which is not always manifest or may be of a subclinical nature [7]. Other tumors included in differential diagnosis are vascular tumors due to prominent vascularity of SST, Massive ovarian edema and Krukenberg tumors. Inhibin positivity suggests the diagnosis of SST over vascular tumors. Absence of heterogeneity and preserved ovarian tissue within the edematous stroma favors massive ovarian edema [4]. Krukenberg tumors are the malignant tumors occur in the sixth and seventh decades, are mostly bilateral, and lack the pseudolobulated pattern of sclerosing stromal tumor on cut surfaces. Signet-ring cells of Krukenberg tumors may be confused with vacuolated cells of SST but signet ring cell contain mucin rather than lipid. Mitotic activity and nuclear atypia may be seen in krukenberg tumor.[1] The etiology of SSTs is unknown. Based on the ultrastructural features, SSTs were thought to arise from pluripotent immature stromal cells of the ovarian. In the literature calretinin, inhibin, CD34 and alpha glutathione S-transferase positivity (a-GST) was reported to be useful to differentiate STT from thecoma, fibroma and other sex cord stromal tumors [7, 8]. Similarly our case showed focal positivity for inhibin and CD34. It is difficult to distinguish SSTs consisting of solid and cystic areas from ovarian malignancies on the basis of radiological and macroscopic examination. Radiologically, especially on sonograms the appearance of SSTs may be suspected to be malignant ovarian tumors because they show a mixed pattern, with cystic and solid components [9]. Malignant ovarian tumors usually occur in older women and often show high values of serum tumor markers.
ACKNOWLEDGEMENT
We acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. We are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. We are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
CONCLUSION
The present case suggests that it is necessary to rule out Sclerosing stromal tumor, a rare tumor in young patients and to confirm the diagnosis by expert intraoperative frozen section and careful histopathological examination in such cases.It will help to prevent untoward morbidity of patient due to extensive surgery and selecting the definitive treatment.
CONSENT
Written informed consent of the patient was taken
Englishhttp://ijcrr.com/abstract.php?article_id=1470http://ijcrr.com/article_html.php?did=14701. Chalvardjian A, Scully RE. Sclerosing stromal tumors of the ovary.Cancer 1973; 31: 664-670. 2.
2 Fox H, Wells M. Haines and Taylor Obstetrical and Gynecological Pathology.5th ed. New York: Cherchill Livingstone; 2003: 842 – 843.
3. 3 Peng H, Chang T, Hsueh S. Sclerosing stromal tumor of the ovary. Chang Gung Med J.2003; 26: 444 – 447.
4. Ihara N, Togashi K, Todo G, Nakai A, Kojima N, Ishigaki T, Suginami N, Kinoshita M, Shintaku M. Sclerosing stromal tumor of the ovary: MRI. J Comput Assist Tomogr 1999;23:555–557.
5. S.M. Ismail and S.M. Walker, Bilateral virilizing sclerosing stromal tumor of the ovary in a pregnant woman with Gorlin's syndrome: implications for pathogenesis of ovarian stromal neoplasms. Histopathology 1990; 17: 159¯ 163.
6. Cashell AW, Cohen ML. Masculinizing sclerosing stromal tumor of the ovary during pregnancy. Gynecol Oncol 1991; 43: 281– 285
7. Tiltman AJ, Haffajee Z. Sclerosing stromal tumors, thecomas, and fibromas of the ovary: an immunohistochemical profile. Int J Gynecol Pathol 1999; 18: 254–258.
8. Lam RM, Geittmann P. Sclerosing stromal tumor of the ovary. A light, electron microscopic and enzyme histochemical study. Int J Gynecol Pathol 1988; 7: 280– 290.
9. Lee MS, Cho HC, Lee YH, Hong SR. Ovarian sclerosing stromal tumors: gray scale and color Doppler sonographic findings. J Ultrasound Med 2001; 20(4): 413-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareSUPERNUMARY OF DIGITS AND TOES: A CASE REPORT
English3641Arun Kumar S. BilodiEnglish M.R. GangadharEnglishAim of the study: To report a case of a polydactyly in an elderly persons involving all four limbs. Place and period of study: This case was studied in month of July 2007 in Bangalore who happens to be an owner of the shop on Mysore road, Bangalore. Case Report: A male aged 68 years was found to have a single extra digit (supernumerary of digits) in his all four limbs. He had no other anomalies except skin changes and shown no signs and symptoms. He was father 4 children where second son also had extra limb in his right upper limb. On Examination:He was elderly person tall with well built and well nourished .On clinical examination ,he had a single extra digit (supernumerary of digits) in all limbs i.e.,both upper limbs and lower limbs There was no cyanosis,clubbing jaundice and lymphadenopathy. All his systems were within normal limits. Local Examination: Local examination showed extra digits in all 4 limits So total, he had 12 fingers in his upper limbs (6 in each ) and 12 toes in his lower limbs(6 in each).All the toes and digits were mobile except in extra toe where there was limitation of movements and were almost same calibre of the remaining fingers /toes .No other anomalies were observed. Discussion: Since this is rare anomaly,this case has been review with the available literatures. Later, compared and correlated. Conclusion: This case study gives knowledge of variation the developments Hence it has embryological importance. Surgically it contributes to surgeons about the anatomy of supernumerary of digits so that it can be surgically corrected if required or for cosmetic purposes.Hence it has been studied anatomically and for surgical purposes. Conclusion: This case of polydactyly is of genetic and clinical importance This case has familial tendency and has history of consanguinity.So this case has studied in detail and reported.
EnglishSuper numary of digits, extra digits,pre axial polydactyly,post axial polydactyly, Duplication of thumb.INTRODUCTION
Polydactyly is a very rare anomaly of hand and foot.It may occur single case or may be associated with anomalies. Single isolated cases may occur as Autosomal dominant while when it occurs in syndromes then it is autosomal recessive1 . It is HOX gene mutation which are known to cause anomaly of limbs .During the development of limbs ,there will be lengthening of limb followed by soft tissue development & progression of digits differentiation2A study was done by Finley et al along with data from Jefferson County, Alabama and Uppsala County, Sweden showed the incidences of anomalies of polydactyly was 2.3 /1000in males of white population and 0.6 /1000 females of white populations and 13.5 / 1000 in males of black , and 11.1/ 1000 in females of black populations of all types of polydactyly3 .In various Asian populations,like South China, Hong Kong, and Japan, 90% of cases are Preaxial polydactyly.Duplication of thumb are the common anomalies at the level of metacarpophalangeal joints.[4, 5] . CASE REPORT A 68 year sold male from Kumbalagud, Mysore road, Bangalore was found to have a total of 24 digits in both upper and lower limbs bilaterally. He had no other anomalies with any signs and symptoms. He was father of 4 children where second son had extra limb in his right upper limb who had got married to his own relative but exact relation is not known.
ON EXAMINATION
An elderly person with well built and well nourished body was very tall nearly 6feet and 7 inches. He had no systemic diseases. He was a wrestler in his younger days. There was no cyanosis, clubbing jaundice and lymphadenopathy. All his systems were within normal limits.
LOCAL EXAMINATION
On examination he had supernumerary of the digits both upper limbs and in lower limbs. There were 6 digits in each limb. UPPER LIMB Right Upper Limb: Showed Post axial supernumerary of digits where extra finger was present lateral to little finger, on the Radial side..This finger was short, stout and immobile. Movement was very much restricted. .Other fingers were normal in length and in calibre. Movements were normal, in remaining 5 digits. Nails and skin were normal. Left Upper Limb: Here also Post axial supernumerary of digits was present where extra finger was present lateral to little finger, on the radial side but slightly longer than right upper limb.. This finger was shorter than little finger. and mobile. Movement was not restricted. .Other fingers were normal in length and in calibre. Movements were normal in remaining 5 digits Nails were normal and skin showed trophic changes.
LOWER LIMBS ANOMALIES
Left Lower Limb:-All the 5 toes were present along with extra 6th toe. Both the 6th were toes short and stout within normal movements. Nails were normal and skin showed trophic changes.Nails were normal and skin showed slight trophic changes on the dorsum of the foot. Movements were normal in all digits Right Lower Limb: All the 5 toes were present along with extra 6th toe All the 6TH were toes short and stout with normal movements. Nails were normal and skin showed slight trophic changes on the dorsum of the foot. Movements were normal in all toes except in extra toe where there was limitation of movements.
DISCUSSION
Polydactyly has been classified into into preaxial, central, and postaxial types by Temtamy and McKusick[6] .Preaxial polydactyly involves first digits7 ,central polydactyly involves 2nd 3 rd 4 th digits,while involvement of fifth digit or ray are post axial types. The combination of syndactyly and polydactyly is known as Synpolydactyly.[8, 9]In a study by Castilla et al,[10] polydactyly.are well seen in trisomy 13, Meckel syndrome, and Down syndrome. Polydactyly are well in skeletal dysplasia, which affect the hand for example in hitchhiker thumb in diastrophic dysplasia .A very good prognosis is seen in solitary cases. or polydactyly in short rib polydactyly11& 12hyperkeratosis and acanthosis overlying many nerve bundles in the dermis are seen in Rudimentary polydactyly13 Surgical removal is done in postaxial polydactyly of the foot between 9-12 months of age for the purposes of cosmetics and comfort of shoes14.Emotional stress is seen in a child with anomaly of distal extremity15 A case of Fibular dimelia and mirror polydactylyhas been reported in a girl aged seven months old whose mother took misoprostol in the second month of pregnancy to induce abortion.She had under built stature hypotonia, anteverted nares, long philtrum and carp-like mouth on clinical examination.. There was reduction defect in left hand along with absence of fingers of second, third, and fifth fingers and camptodactyly of the fourth finger, with absence of the extremities of the second, third and fifth fingers and camptodactyly of the fourth finger. There was hypoplastic pelvis. Esophageal atresia with tracheoesophageal fistula and imperforate anus detected during antenatal period Agenesis of the right kidney and duplication of left pyelocaliceal were diagnosed by the ultrasound. X-Ray showed showed iliac and femoral hypoplasia, absence of the tibia with a duplicated fibula and seven metatarsals and toes with no prominent hallux on the foot16 . Polydacyly is characterized by having more than five fingers or digits.It can present alone or as part of any syndrome due to genetic disorders. A Polydactyly can be classified into 5 types –Type-1,Cutaneous ribbon,Type -2 Pedunculated type,type3,Articulating digit with 5th metacarpal bone,Typ4,fully developed digit with sixth metacarpal bone ,Type-5,Polysyndactyly .A case of polydactyly was reported in two brothers of same family.Two sons in a family had polydactyly.The second son and fifth son had post axial polydactyly of both hands and feet Eldeast son was suffering from cardiac disease (Pit Baran Chakraborthy , Bani Marjit, Sikha Datta, Alpana De-2007).17 In chondroectodermal dysplasia, there are bilateral polydactyly associated with hydriotic ectodermal dysplasia involving mainly skin, teeth & nails & congenital anomalies of heart. Such patients should be referred to Dental surgeons, cardiologists, and orthpedic surgeons for early treatment for all anomalies (Eswar.N.J:2001)18 In present study, there was no hydriotic ectodermal dysplasia involving mainly skin, teeth & nails & congenital anomalies of heart. Except polydactyly In Joubert’sSyndrome, there is bilateral post axial polydactyly of hands and feet seen in consanguineous families. It is autosomal recessive disorder. (Aslan H et al2002), 19 Limbr 1 gene is very essential for the development of limb.Any reciprocal changes can result in decrease or increase in number of digits (Clark RM et al ).20 Pallister Hail Syndrome is syndrome charecterized by polydactyly, associated with other anomalies like dysplastic nails, imperforate anus, insertional hexadactyly of left upper limb, and 2 y shaped metacarpal with 6 fingers at right hand (Stroll.C et al)21.In present study, there was no case of dysplastic nails ,imperforate anus,insertional hexadactyly any y shaped metacarpal in both hands.
PRESENT STUDY
Showed bilateral polydactyly in elderly person aged 68 years.All his four limbs(both upper limbs and lower limbs) showed extra digits So totally, he had 24 digits.Out of them one extra digit was having less mobility, short and stout and rest extra digits were mobile.There was no absence of any bones in the forearm nor in the leg All.But there was associated skin changes over the dorsum of the feet.X-Ray of limbs were not taken as he refused to get X-Ray of his limbs.No other anomalies were present .There was no dysplasia of skeletal systems. Another feature of this case is his stature was tall but fingers were short when compared to his height .His toes were normal. He had married to his nearest relative but exact degree of consanguinity is not known. His second son had extra digits in the right upper limb.So this case is of familial and consanguineous. He was not diabetic nor hypertensive. There was neither involvement of nerves nor any other systems except his limbs. In present study, there was no hydriotic ectodermal dysplasia involving mainly skin, teeth, nails & congenital anomalies of heart. Except polydactyly and there was no case of dysplastic nails, imperforate anus, insertional hexadactyly any “y” shaped metacarpal in both hands.
CONCLUSION
This case study gives us the knowledge of variations in the developments of limbs Hence it has embryological importance. Surgically it contributes to surgeons about the anatomy of supernumerary of digits so that it can be surgically corrected if required or for cosmetic purposes.Hence it has been studied anatomically and for surgical purposes. (Anatomists contributing to Surgeons). This knowledge of variations of supernumerary of digits is very important to the surgeons. Hence we are contributing this knowledge to surgical arena.
ACKNOWLEDGEMENTS
Authors acknowledge the great help rcieved from the scholars whose articles cited & included in the references of this manuscript.The authors are also grateful to author / editors / publishers of all these articles, journals, and books from where the literature for this article has been reviewed and discussed .Authors are also grateful to IJCRR team of reviewers who have helped to bring the quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1471http://ijcrr.com/article_html.php?did=14711. Hosalkar HS, Shah H, Gujar P, Kulkarni AD. Crossed polydactyly. J Postgrad Med. Jul-Sep 1999;45(3):90-2.
2. Muragaki Y, Mundlos S, Upton J, Olsen BR. Altered growth and branching patterns in synpolydactyly caused by mutations in HOXD13. Science. Apr 26 1996;272(5261):548-51.
3. Finley WH, Gustavson KH, Hall TM, Hurst DC, Barganier CM, Wiedmeyer JA. Birth defects surveillance: Jefferson County, Alabama, and Uppsala County, Sweden. South Med J. Apr 1994;87(4):440-5.
4. Cohen MS. Thumb duplication. Hand Clin. Feb 1998;14(1):17-27.
5. Hung L, Cheng JC, Bundoc R, Leung P. Thumb duplication at the metacarpophalangeal joint. Management and a new classification. Clin Orthop Relat Res. Feb 1996;31-41.
6. Temtamy SA, McKusick VA. The genetics of hand malformations. Birth Defects Orig Artic Ser. 1978;14(3):i-xviii, 1-619.
7. Belthur MV, Linton JL, Barnes DA. The spectrum of preaxial polydactyly of the foot. J Pediatr Orthop. Jun 2011;31(4):435-47.
8. Malik S, Grzeschik KH. Synpolydactyly: clinical and molecular advances. Clin Genet. Feb 2008;73(2):113-20. [View Abstract]
9. Tian F, Tian LJ, Zhao W, Li XC, Li B, Ji XL. Plastic repair for a case with synpolydactyly. Arch Orthop Trauma Surg. Jun 2011;131(6):869-73.
10. Castilla EE, Lugarinho R, da Graça Dutra M, Salgado LJ. Associated anomalies in individuals with polydactyly. Am J Med Genet. Dec 28 1998;80(5):459-65.
11. Bromley B, Shipp TD, Benacerraf B. Isolated polydactyly: prenatal diagnosis and perinatal outcome. Prenat Diagn. Nov 2000;20(11):905- 8.
12. Zimmer EZ, Bronshtein M. Fetal polydactyly diagnosis during early pregnancy: clinical applications. Am J Obstet Gynecol. Sept 2000;183(3):755-8.
13. Ban M, Kitajima Y. The number and distribution of Merkel cells in rudimentary polydactyly. Dermatology. 2001;202(1):31-4.
14. Morley SE, Smith PJ. Polydactyly of the feet in children: suggestions for surgical management. Br J Plast Surg. Jan 2001;54(1):34-8.
15. Eskandari MM, Oztuna V, Demirkan F. Late psychosocial effects of congenital hand anomaly. Hand Surg. Dec 2004;9(2):257-9.
16. Bernardi P, Graziadio C, Rosa RF, Pfeil JN, Zen PR, Paskulin GA.- Fibular dimelia and mirror polydactyly of the foot in a girl presenting additional features of the VACTERL association: Sao Paulo Med J. 2010;128(2):99-101.
17. Pit Bapran Chakraborthy,Bani Marjit, Sikha Datta, Alpana Dec:2007 Poydactyly; Acase Study:J.AnatSoc.56.(1)35-38,2007.
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20. Clark RM,Marker PC,Roessler E,Dultra A,Schimenti JC,Muenke M,Kingsley DM,Reciprocalmouse and human phenotypes caused by gain and loss of function of mutations affecting Limbr 1.Genetics 2001,oct 159(2)715-26.
21. Stroll C, De Saint Martin A, Donato L, Alembik K,Sauvage P,,Messer.J,Pallister Hall Syndrome with stenosis of cricoids cartilage and microphallus without hypopituitirism. Genet Couns. 2001,:12(3)231-5.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareANTIDEPRESSANT ACTIVITY OF STATINS IN ALBINO MICE AN EXPERIMENTAL STUDY
English4245Chandrashekar K.English Vinayak MetiEnglish Saritha M. K.EnglishObjective: To evaluate the antidepressant activity of statins in mice. Methods: Sixty adult Swiss albino mice weighing 25-30 grams were selected. Thirty were allocated to forced swim test and thirty to tail suspension test models. In each model there were 5 groups. The control group received vehicle (10 ml/kg, p.o), the standard, Imipramine (10 mg/kg, p.o) and the three test groups received atorvastatin, simvastatin and rosuvastatin respectively, 1hour prior to the acute study. In chronic study the drugs were given orally once a day for 10 days and the last dose was given 1hour before the experiment. Duration of immobility was noted in forced swim test and tail suspension test. Statistical analysis was performed using Mean +/- SEM. ANOVA followed by Dunnett’s test. PEnglishForced swim test, Tail suspension test, statins, DepressionINTRODUCTION
Depression is a chronic illness that affects people of all ages. Although there are many effective antidepressants available today, the current armamentarium of therapy is often inadequate, with unsatisfactory results in about one-third of all subjects treated. This provides impetus in the search of newer and more effective antidepressants [1]. Statins are effective and commonly prescribed drugs for hypercholesterolemia. They have received considerable attention in recent times due to their beneficial effects on multiple physiological systems. After realization of pleiotropic effects of statins [2], they are being prescribed to patients suffering from cardiovascular disorders like hypertension and ischemic heart disease, irrespective of the lipid profile. Atorvastatin is the most commonly prescribed statins in the world [3]. Cholesterol reduction using statins improves memory in some cases but not others. Controversy exists over use of statins to alleviate memory problems in Alzheimer's disease (AD) [4]. Correlations of cholesterol and cognitive function are mixed and association studies find that some genetic polymorphisms are related to cognitive function but others are not [5]. Recently, some concerns are raised regarding effects of atorvastatin (and all statins) on memory and psychomotor functions. Hypercholesterolemia is thus suggested to partly mediate age-related brain changes. Possible link between cholesterol and depression has been suggested in both Clinical and preclinical studies. The recently proposed entity of ‘vascular depression’ provides indirect support for hypercholesterolemia as a risk factor in the path physiology of depression. Hence this study was undertaken to find out its role in animal models of depression.
MATERIALS AND METHODS
The experimental protocol was approved by the Institutional Animal Ethics Committee (IAEC) of Chettinad Hospitals and Research Institute, Chettinad University, Chennai, India. Animals Adult male Swiss albino mice weighing 25-35 gm from our breeding stock were used in this study. The animals were housed at 24±2o C with 12:12 h light and dark cycle. They had free access to food and water. The animals were acclimatized for a period of 7 days before the study. The animals were used according to the CPCSEA guidelines for the use and care of experimental animals. Drugs and chemicals The standard antidepressant drug imipramine, statins drugs like atrovastatin, simvastatin and rosuvastatin was obtained from our institutional pharmacy Experimental design On the day of the experiment, the animals were divided randomly into control and experimental groups (n=6). Group 1 received the vehicle, normal saline (10ml/kg) and served as the control group, group 2 received the standard drug imipramine (10mg/kg), groups 3 , 4 and 5 the test drug ( statin drugs like atrovastatin, simvastatin, rosuvastatin .) in doses of 10mg, 30mg 20mg/kg per oral respectively. Drugs/vehicle was administered to the animals 60 minutes prior to the evaluation in acute study, for chronic study, a new set of animals were used. They were grouped as in acute study and were administered the drug/vehicle orally once daily for a period of 10 days. Behavioral evaluation was carried out 60 minutes post drug/vehicle administration on the 10th day [6]. The antidepressant activity of the test drug was evaluated using the experimental models of depression TST and FST: Tail suspension test (TST): The method described by Steru, et. al. was used in our study [7]. The animals were hung by the tail on a plastic string 75 cm above the surface with the help of an adhesive tape. The duration of immobility was observed for a period of 8 minutes, last 6 minutes of the observation were taken for calculation. Mice were considered immobile only when they hung passively and were completely motionless. Forced Swim Test (FST): The method described by Porsolt, et. al. was used in our study [8], Each animal was placed individually in a 5 litre glass beakers, filled with water up to a height of 15 cm and were observed for duration of 6 minutes, last 4 minutes of the observation were taken for calculation The mouse was considered immobile when it floated motionless or made only those moments necessary to keep its head above the water surface. The water was changed after each test.
STATISTICAL ANALYSIS:
The mean±S.E.M. values were calculated for each group. The data were analyzed using oneway ANOVA followed by Dunnet’s multiple comparison test. P< 0.05 was considered to be statistically significant.
RESULTS
Tail suspension test (TST): Results are given in table-1. A significant (PEnglishhttp://ijcrr.com/abstract.php?article_id=1472http://ijcrr.com/article_html.php?did=14721. While A, Keen L. The effects of statins on mood: a review of the literature. Eur J Cardiovasc Nurs. 2012 Mar; 11(1):85-96. PubMed PMID: 20875773
2. Tandon V, Bano G, Khajuria V, Parihar A, Gupta S. Pleotropic effects of Statins. Indian J Pharmacol 2005;37:77-85
3. Berenson A. Lipitor or Generic? BillionDollar Battle Looms. The New York Times, New York City; 2005.
4. Wagstaff LR, Mitton MW, Arvik B, Doraiswamy PM. Statin-associated memory loss: Analysis of 60 case reports and review of the literature. Pharmacotherapy 2003; 23: 871-80.
5. Schreurs BG. The effects of cholesterol on learning and memory. Neurosci Biobehav Rev2010; 34: 1366-79
6. Misra. N, Shastry. R, Gopalakrishna.HN, MRSM. Pai. Preclinical evaluation of antidepressant activity of NR-ANX-C in mice. Indian J Pharmacol. 2003;35(3),192
7. Steru L, Chermat R, Thierry B, Simon P. The tail suspension test: a new method for screening antidepressants in mice. Psychopharmacology (Berl). 1985; 85(3):367-70. PubMed PMID: 3923523.
8. Porsolt RD, Bertin A, Jalfre M. Behavioral despair in mice: a primary screening test for antidepressants. Arch Int Pharmacodyn Ther. 1977 Oct; 229(2):327-36. PubMed PMID: 596982.
9. Heron DS, Shinitzky M, Herschkowitz M, et al (1980) Lipid fluidity markedly modulates the binding of serotonin to mouse brain membranes. Proceedings of The National Academy of Science, USA, 77, 7463-7467.
10. Hawton K and Morgan H G. Suicide prevention by general practitioners. BJP March 1993 162:422; doi:10.1192/bjp.162.3.422.
11. Barradas MA, Mikhailidis DP, Winder AF. Low serum cholesterol and suicide. Lancet. 1992 May 9;339(8802):1168–1168.
12. Delva NJ, Matthews DR, Cowen PJ. Brain serotonin (5-HT) neuroendocrine function in patients taking cholesterol-lowering drugs. Biol Psychiatry. 1996;39:100–106.
13. Papakostas GI, Ongur D, Iosifescu DV, Mischoulon D, Fava M. Cholesterol in mood and anxiety disorders: review of the literature and new hypotheses. Eur Neuropsychopharmacol. 2004b;14:135–142.
14. Ringo DL, Lindley SE, Faull KF, Faustman WO. Cholesterol and serotonin: seeking a possible link between blood cholesterol and CSF 5-HIAA. Biol Psychiatry. 1994;35:957– 959.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareEFFECT OF ANTI-PROGESTROGEN ON THE EPITHELIAL CELL HEIGHT OF RAT ENDOMETRIUM
English4650Khadija QamarEnglish Samina AnjumEnglish Zarmina SagaEnglishObjective: To investigates the effect of mifepristone on height of the epithelial cells of the endometrium. Study Design: Laboratory based randomized controlled trials Place & Duration of the study: Department of Anatomy, Army Medical College Rawalpindi from Jan. 2007-march 2007. Method: Sixty adult female rats were divided randomly into two groups, comprising of 30 animals in each group. In group A one ml of normal saline was given orally daily for three months while in group B mifepristone was given orally in a dose of 1 mg/kg body weight daily for three months. Results: In the experimental group reduction was observed in epithelial cell height. Significantly lower level of progesterone while higher level of estrogen level in experimental group was noted as compared to the control group. Conclusion: Long term mifepristone administration suppresses the endometrial proliferation and epithelium height was decreased. It also lowered the plasma concentration of progesterone. While the plasma concentration of the estrogen was raised
EnglishMifepristone, estrogen, progesterone, epitheliumINTRODUCTION
The progesterone and estrogen hormones induce proliferation and differentiation in the endometrium1 . The inner mucosa, or endometrium, consists of a surface columnar epithelium overlying a thick lamina propria containing numerous blood vessels and endometrial glands2 . Mifepristone acts on the receptors just like the progesterone but may produce different conformational changes. 3With the rising trend of the use of antiprogestin and insufficient knowledge regarding its effects on histomorphology of uterus, this study has been designed to see the long term effects of mifepristone treatment on rat endometrium.
MATERIAL AND METHODS
These laboratory based randomized controlled trials were conducted at the department of Anatomy, Army Medical College Rawalpindi from Jan. 2007-march 2007. Sixty healthy adult female Sprague Dawley rats weighing 200-300 g were procured from the National Institute of Health Sciences Islamabad. The animals were randomly divided into two groups of 30 each.
Group A (Control)
Thirty female rats were given one ml of normal saline orally daily for three months.
Group B (Experimental)
Thirty female rats were given the drug (Mifepristone) orally in a dose of 1 mg/kg body weight daily for three months. All the animals were sacrificed next day after the last oral dose. Two ml blood was taken directly from the heart for measurement of estrogen and progesterone levels. Uterine horns along with a portion of vagina was removed, trimmed and placed into 10% Formalin for 24 hours. About ½ cm piece of tissue was taken from the middle of the right uterine horn. Approx five microns thick sections were cut stained with hematoxylin and eosin for light microscopic study.
MICROSCOPIC OBSERVATIONS
Height of Epithelium
The height of the epithelium was taken from the basement membrane up to the upper limit of the cell facing the lumen under high power field (x40 objective) from three regions and their mean was taken as the reading for that animal.
Statistical analysis
Data had been analyzed using SPSS version 15. Descriptive statistics were used to describe the data. P-value < 0.05 was considered as significant.
RESULT
Total sixty animals were included in the study, 30 in each group. The tubular sections showed three distinct layers (inner, middle and outer). In control group the luminal side of inner layer (Endometrium) was lined by single regular row of cylindrical cells. These closely packed cells having rectangular outlines had round ovoid or elongated nuclei. Their nuclei tended to be aligned at the center of the cells and the cytoplasm was basophilic reflecting the microscopic picture of simple columnar epithelium (Fig. 1b). In experimental group the inner layer was folded giving it an overall ruffled appearance as a result lumen was much reduced as compared to normal group .The epithelium appeared pseudostratified with decrease in height as compared with control group (Fig. 1d). The mean epithelium height in experimental group was 12.8±0.40 μm which was lower than that of the control group. The difference was regarded highly significant statistically (p =0.001) when compared with the control group. Average progesterone level was significantly lower in experimental group as compared to control group (p = 0.001) while average estrogen level was significantly higher in experimental group as compared to control group (p = 0.001). (Table-1)
DISCUSSION
In this study of 3 months we have studied the long term effects of mifepristone treatment on rat endometrium. Uterine epithelium height was decreased in the experimental group after administration of mifepristone compared with control animals. This may be due to effect of drug on the uterus. It has also been reported by others that mifepristone blocks estrogen-induced increase in uterine growth inhibits true uterine growth. 25 hrs, following an injection of progesterone, a significant increase in the height of cells of the luminal epithelium is observed4 . Our data indicated decrease in the height of the cells of the luminal epithelium after mifepristone treatment. Changes caused in the luminal epithelium in response to antiprogesterone are usually attributed to the direct affect of the hormone. 5 Most of the glandular epithelial cells had sub nuclear vacuoles in various studies. Ultra structurally there is noted the presence of large vacuoles, membrane inclusions and myelin like bodies in the endometrial taken from treated animals, features usually suggestive of the disintegration of cytoplasm proteins.6 In treated animals, vacuolization is one of the structural indicators of energy deficit and permeability disorder of membranes in the endometria7 . This hypothesis, that protein synthesis is proceeding at a faster rate in these cells in response to progesterone, is thus consistent with the morphometric data 8 . Endometrial cells require a balance between estrogen and progesterone production. The absence of progesterone removes the progesterone brake leading to persistent estrogenicity and constant endometrial proliferation. The endometrium can become disordered, although the ratio of stroma to glands remains normal, and vascular abnormalities such as dilated capillaries become apparent. It is unlikely to be solely due to the effect of high levels of unopposed estrogen because it occurred in some women, e.g. in Shanghai where there were low estrogen levels with complete suppression of ovarian follicular development9 In a study on ovariectomized rhesus macaques were treated for 5 months with either estradiol (E2) alone, E2 + progesterone (two doses) or E2 + ZK (0.01, 0.05 or 0.25 mg/kg) all doses of ZK blocked endometrial proliferation and induced endometrial atrophy. 10The absence of progesterone removes the ‘progesterone brake’, leading to persistent estrogenicity and constant endometrial proliferation., Though usually there is normal ratio of stroma to glands, vascular abnormalities such as dilated capillaries become apparent and the endometrium can become disordered11 . Rats receiving long-term PR antagonist treatment show endometrial stimulation under the effect of estrogen12. High doses of mifepristone (25 and 50 mg/d) lead to variable effects in women, such as atypical cystic changes, as have been described in eutopic endometrium13. Serum progesterone levels declined in experimental groups after mifepristone administration. Level of estrogen hormone was elevated in the experimental group as compared with the control group. Less congruency has been found in the earlier reports about the effect of mifepristone on progesterone secretion. 14 No statistically significant change in the progesterone levels was observed in the 2-day follow-up using 200 mg of mifepristone 15. With administration of 600 mg mifepristone, there was observed an increase in progesterone levels on day 1 followed by a significant decrease in another study16
CONCLUSION
We concluded that in long term mifepristone affected the endometrial proliferation and induced histomorphological changes in the uteri of the experimental rats. Significant reduction in epithelial height was observed in epithelium height. It also lowered the plasma concentration of progesterone .While the plasma concentration of the estrogen was raised.
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=1473http://ijcrr.com/article_html.php?did=14731. Connelly OM. Female Steroid Hormone Action. Endocrinology 2001; 142(6): 2194- 99.
2. Benakanakere C, Besch-Williford M, Ellersieck R, Hyder SM. Regression of progestin-accelerated7, 12-dimethylbenz[a] anthracene-induced mammary tumors in Sprague-Dawley rats by p53 reactivation and induction of massive apoptosis: a pilot study. Endocr Relat Cancer March 1, 2009; 16(1): 85-98.
3. Antoniou G, Kalogirou D, Karakitsos P.Transdermal estrogen with a levonorgestrel- releasing intrauterine device for climacteric complaints versus estradiolreleasing vaginal ring with a vaginal progesterone suppository. Clinical and endometrial responses. Maturitas. 1997; 26: 103-11.
4. De Vivo I, Hankinson SE, Colditz GA, Hunter DJ. A functional polymorphism in the progesterone receptor gene is associated with an increase in breast cancer risk. Cancer Res 2003; 63: 5236–8.
5. Gopalkrishnan K, Katkam RR, Sachdeva G, KholKute SD, Padwal V, Puri CP. Effects of an Antiprogestin Onapristone on the Endometrium of Bonnet Monkeys: Morphometric and Ultra Structural Studies. Biol Reprod 1959; 68(6): 779-87.
6. Brenner RM, Slayden OD. Estrogen action in the endometrium and oviduct of rhesus monkeys during RU 486 treatment. In: Beier HM, Spitz IM, editors. Progesterone antagonists in reproductive medicine and oncology. Cary, NC: Oxford University Press; 1994; p.82-97.
7. Jeffrey R. Goldberg, MD; Marcus G. Plescia, MD, MPH; Geraldine D. Anastasio. Mifepristone (RU 486) Current Knowledge and Future Prospects. Arch Fam Med. 1998; 7:219-222.
8. Van Look PFA, Ven herizen H. Post ovulatory methods of fertility regulation: the emergence of antiprogestens. In: Van Look PFA, Perez – Polacies G, editors. Contraceptive research and development. New Delhi: Oxford University Press; 1994; P. 151-201.
9. Baird DT, Glasier AF. Science, medicine and the future: contraception. Br Med J 1999; 319: 969-72.
10. Hargrove JT, Maxson WS, Wentz AC, Burnett LS. Menopausal hormone replacement therapy with continuous daily oral micronized estradiol and progesterone. Obstet Gynecol. 1989; 73: 606-12.
11. Maxson WS. The use of progesterone in the treatment of PMS. Clin Obstet Gynecol. 1987; 30: 465-77.
12. Schaison G, George M, Lestrat N, Reinberg A, Baulieu EE. Effects of the antiprogesterone steroids RU 486 during midluteal phase in normal woman. J Clin Endocrinol Metab 1985; 61: 480-9.
13. Murphy AA, Castellano PZ. RU 486: pharmacology and potential use in the treatment of endometriosis and leiomyomata uteri. Curr Opin obstet Gynecol 1994; 6(3): 269-78.
15. O.D. Slayden, M.B. Zelinski, K. Chwalisz, H. Hess-Stumpp, R.M. Brenner Chronic progesterone antagonist–estradiol therapy suppresses breakthrough bleeding and endometrial proliferation in a menopausal macaque model .Hum. Reprod. (2006) 21(12): 3081-3090
16. Chwalisz K, Hsiu JG, Williams RT, Hodgen GD. Evaluation of the antiproliferative actions of the progesterone antagonist’s Mifepristone and onapristone on primate endometruim. Proceeding of the 39th Annual Meeting of the society for Gynecologic Investigation; Texas, USA. Mar 1992; p12-8.
17. S. Schäfer-Somi, O.A. Aksoy, H.B. Beceriklisoy, A. Einspanier, H.O. Hoppen S. Aslan Repeated induction of abortion in bitches and the effect on plasma concentrations of relaxin, progesterone and estradiol-17β. 2007;68: 889-895
18. Ishwad PC, Katkam RR, Hinduja IN, Chwalisz K, Elger W, Puri CP. Treatment with a progesterone antagonist ZR>98.299 delays endometrial development without blocking ovulation in bonnet monkeys. Contraception 1993; 48: 57-70.
19. Sitruk-Ware R. Approval of Mifepristone (RU486) in Europe. Zentraibl Gynakol 2000; 122(5): 241-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareBACTERIOLOGICAL PROFILE AND ANTIMICROBIAL RESISTANCE PATTERN IN EARLY ONSET NEONATAL SEPSIS: CHALLENGE TO THE PHYSICIAN
English5158Kuhu PalEnglish Arnab Kumar SamantaEnglishObjective: Identification of pathogens associated with early onset neonatal sepsis and their resistance pattern so that a guideline for empirical antibiotic regimen can be formulated. Methods: Study was conducted in a teaching hospital in eastern part of Bengal from March 2011 to August 2012. Newborn, age less than 72hours, associated with a clinical diagnosis of sepsis were enrolled in this study. 1 ml of blood was collected maintaining proper asepsis and inoculated in 5 ml of brain heart infusion broth. The broth was incubated aerobically at 370 C and was sub cultured in blood agar, chocolate agar and MacConkey’s agar. Isolates were identified by colonial morphology, Gram staining and standard biochemical tests. Antimicrobial sensitivity test was performed by Kirby Bauer disc diffusion method following CLSI guidelines. Result: Among 192 clinically suspected cases of early onset neonatal sepsis, blood culture was positive in 73(38.0%) cases of which Klebsiella pneumoniae (45.71%) was the predominant organism followed by Staphylococcus aureus (20%), Escherichia coli (11.42%), Enterococcus sp (7.14%), Enterobacter sp (5.71%) etc. Most Gram negative organisms were highly resistant to ampicillin (100%), gentamicin (81.25%) and cephalosporin group of drugs. Imipenem (0%) and ofloxacin (31.25%) were the two most effective drugs against these gram negative bacteria. 50% of Staphylococcus aureus were methicillin resistant. Conclusion: This study reflected alarmingly increasing in vitro resistance of isolated organisms towards commonly used antibiotics specially ampicillin, gentamicin and third generation cephalosporins which were given empirically in neonatal sepsis. Therefore this study recommends introduction of fluoroquinolone along with amikacin in empirical treatment of early onset neonatal sepsis.
Englishearly onset neonatal sepsis, multidrug resistance, fluoroquinoloneINTRODUCTION
Neonatal sepsis is the leading cause of mortality and morbidity in the neonates. The first week of life is a particularly high-risk period when 3/4th of neonatal deaths occur1 . In spite of major improvement in antimicrobial therapy, neonatal life support system and the early notification of risk factors, neonatal sepsis still plays a pivotal role in mortality and morbidity among newborns throughout the world. Symptoms occurring within the age of 72 hrs are considered as early onset sepsis2 . Newborns even though they are born at full term, have relatively immature immune system which is unable to provide a robust defense against virulent pathogens. Therefore neonates are at high risk of developing invasive infections if exposed to pathogenic microorganisms.1
Clinical recognition of neonatal sepsis is not always straight-forward. It is a life threatening emergency and delay in diagnosis and treatment with appropriate antibiotic may have devastating consequences. These neonates therefore usually require aggressive course of parenteral antibiotics. An early etiological diagnosis is essential for appropriate intervention. But microbial etiology of neonatal sepsis is diverse. Several studies on neonatal sepsis have documented the diversity of bacteria and their susceptibility pattern and their temporal variability 3,4,5,6 . In this era of evidence based medicine, today's management may not be acceptable tomorrow. So, the greatest challenge of the day to the pediatrician is the emerging threat of neonatal sepsis coupled with antimicrobial resistance to commonly used drugs. For this reason, active surveillance is needed to identify the pathogens of neonatal sepsis as well as the antibiotic sensitivity pattern for the agents of sepsis in a particular area. This is important in formulating the empirical antibiotic regimen and also to alert clinicians towards emerging pathogens that may pose a threat to the community. So, the study was designed to evaluate the common pathogens associated with early onset neonatal sepsis and their resistance pattern in a newly established teaching institution of rural Bengal and build a treatment policy for early onset neonatal sepsis (EONS).
MATERIAL AND METHODS
Study design: This was a hospital based cross sectional study. Study area: Study was carried out in the Neonatal Care Unit, Department of Pediatrics and Department of Microbiology of a newly established teaching hospital acting as a tertiary care centre for eastern part of Bengal. Study population: Blood culture samples of newborn, age less than 72hours with clinical signs of sepsis, including lethargy, refusal of feed, respiratory distress, abdominal distension, vomiting, hypothermia, hyperthermia etc born inside this hospital as well as referred from different centers were enrolled in this study. Exclusion criteria: Babies who had received antibiotics before collection of blood samples, having surgical problems, chromosomal or congenital anomalies were excluded from the study. Study period: March 2011 to August 2012. Study was carried out after getting permission from Institutional Ethics Committee. Procedure: 1 ml of blood was collected maintaining proper aseptic technique and inoculated in 5 ml of brain heart infusion broth with 0.025 % sodium polyanethol sulfonate. The broth was incubated aerobically at 370 C. A blind subculture was done after overnight incubation. If no growth was obtained then blind subculture was done at 48 hrs, 72 hrs, then on 7th day. Any sign of growth in between was followed by subculture. Media used for subculture were 5% sheep blood agar, chocolate agar and MacConkeys agar (Himedia Laboratories).Isolates were identified by colonial morphology, Gram staining as well as standard biochemical tests. Aerobic spore bearers, wherever grown were regarded as contaminants. The remaining isolates were included in the analysis. Antimicrobial sensitivity test was done by Kirby Bauer disc diffusion method following guidelines provided by Clinical and Laboratory Standards Institute (CLSI) 7 . Gram negative organisms were subjected to testing for extended spectrum β lactamase production (ESBL). All ESBL producers detected in routine screening test were confirmed phenotypically as per CLSI recommendations. Control strain: Escherichia coli -- ATCC 25922; Staphylococcus aureus -- ATCC 25923; Pseudomonas aeruginosa -- ATCC 27853; Enterococcus faecalis – ATCC 29212 and Klebsiella pneumoniae ATCC 700603 (positive control of ESBL) were used for quality control tests. All the antibiotics, media and control strains were purchased from Himedia laboratories, Mumbai (India) except cefotaxime/clavulanic acid (30µg/10µg) disc which was procured from BD diagnostic laboratory. Statistical analysis was done using Microsoft excel.
RESULTS
During this one and half year study period 192 blood samples were obtained from clinically suspected cases of early onset neonatal sepsis. Blood culture was positive in 73(38.0%) cases, of which 3 (1.55%) were non albicans Candida and remaining 70(36.45%) were bacteria. All the culture positive cases were monomicrobial. Infection was found to be more common in male newborn with male and female ratio of 1.7:1. 67.12% of culture positive babies were low birth weight. Gram negative bacteria were the most common organisms isolated in present study accounting 68.57% of total isolated bacteria. Klebsiella sp (45.71%) was the most common organism causing early onset neonatal sepsis followed by Staphylococcus aureus(20%), Escherichia coli(11.42%), Enterococcus sp (7.14%), Enterobacter sp (5.71%), coagulase negative Staphylococcus (CONS) (4.2%), Pseudomonas sp (2.85%) and Acinetobacter sp (2.85%). 84.28% growth occurred within 48 hrs of aerobic incubation. Though the cultures were observed for 7 days but no sign of growth was seen after 96 hrs (Table No. I). In vitro antimicrobial susceptibility testing of blood culture isolates of this study revealed that Klebsiella sp was universally resistant to ampicillin (100%), so were S.aureus, E.coli, Enterococcus sp, Enterobacter sp, Acinetobacter sp and Pseudomonas sp. Klebsiella sp was resistant to almost all cephalosporins ranging from 75% towards cefepime to 93.75% towards cefixime and ceftazidime. Resistance to amikacin was less frequent (40.62%) than resistance to gentamicin (84.34%) in these isolates. E.coli also exhibited high resistance against gentamicin (75%), amoxicillin-clavulanic acid (62.5%), chloramphenicol (62.5%), piperacillin - tazobactam (50%) and cephaolosporins. ESBL production was found in 12(37.5%) Klebsiella sp and 2(25%) E.coli. All the gram negative organisms were sensitive to imipenem. Out of 14 S.aureus isolates, 50% were methicillin resistant Staphylococcus aureus (MRSA). No vancomycin resistant Staphylococcus aureus (VRSA) was found in this study. Enterococcus sp was resistant to almost all antimicrobials except vancomycin and teicoplanin. Resistance pattern of Gram positive and Gram negative bacteria are given in table II and table III respectively and overall resistance pattern of isolates to some recommended combination of antibiotics is given in table IV.
DISCUSSION
Studies in different centres of India have revealed an incidence of culture positive EONS varying from 6.1% to 68.93% 6, 8, 9, 10. In this study it was found to be 38.0 %( 73/192). One of the reasons of this great variation may be due to consideration of EONS up to 72 hrs or 7days and it is possible that some anaerobes might be missed in some studies, including the present one. 67.12% of culture positive babies were low birth weight which was just similar to a study in Gujrat9 where 70% of culture positive newborns were low birth weight. Infection was found to be more common in male newborn with male and female ratio of 1.7: 1.A male dominance was observed in almost all studies5, 8, 10 . As per National Neonatal Perinatal Database11 , the most frequent offender of neonatal sepsis was Klebsiella sp(32.5%),followed by Staphylococcus aureus (13.6%).This was supported by the present study where the most frequent isolate was Klebsiella sp (45.71%) followed by S.aureus (20%), Escherichia coli (11.42%), Enterococcus sp(7.14%), Enterobacter sp (5.71%), coagulase negative Staphylococcus (4.2%) etc. This is in accordance with other Indian studies12, 13, 14. But some other Indian studies reported Pseudomonas sp and S.aureus as most common organism of EONS15, 16. The dissimilarity of microbiological pattern of early onset neonatal sepsis can be explained by the regional variation in the spectrum of organisms and the variation in the use of antibiotics. These findings have also implications for therapy and infection control. Empiric therapy for suspected neonatal sepsis must therefore cover both Gram negative bacilli and Gram positive cocci particularly Klebsiella pneumoniae and Staphylococcus aureus. In this study, antimicrobial susceptibility testing from blood culture isolates revealed that Klebsiella and other Gram negative bacilli were universally resistant to ampicillin (100%).Similar high resistance was also established by others also 13, 17, 18 . Klebsiella was highly resistant to Cephalosporin group of drugs ranges from 75% to 93.7%. Resistance to cefotaxime was found(84.34%) almost similar to the studies by Kumar et al17 (83.5%),R. Viswanathan et al4 (81.3%) and S. Begum et al18(94.2%). Klebsiella was found to be quite sensitive towards ciprofloxacin(R=34.37%) and ofloxacin (R=28.12%) in comparison to other groups of drugs. Similar trend was seen by some other studies in India13, 17 and Bangladesh18 . All S.aureus isolates were resistant to ampicillin, whereas resistant to cefoxitin was 50%, Similar high occurrence of MRSA was also established by different studies in India 10, 14, 17. Resistance to amikacin was found in 42.85% cases which were much higher than the study done by Kairavi. J. Desai 12(15.23%). Linezolid, clindamycin, teicoplanin were the drugs to which S.aureus showed least resistance. No VRSA was isolated in this study. Similar low resistance to vancomycin and linezolid was established by different studies10, 12, 13, 17 but in a study in Sikkim, 60% VRSA were observed14 . Thirty three percent isolates of CONS were resistant to cefoxitin, ciprofloxacin, ofloxacin. No resistance was seen against vancomycin, teicoplanin, linezolid, Almost similar type of result were revealed elsewhere in India10,13,17.Sensitivity pattern of E.coli was almost like Klebsiella sp. Number of isolates of Enterococcus, Enterobacter, Pseudomonas were too small to predict any sensitivity pattern. Combination of cefotaxime and amikacin are used as empirical therapy in suspected neonatal sepsis due to multidrug resistant gram negative bacteria in most of the centers in our country, (AIIMS Protocol 200819) including our centre. But it is a matter of great concern that 81.25% of gram negative organisms and 68.18% of gram positive organisms were resistant to cefotaxime leading to overall resistance of 77.14%. The increasing resistance towards this antibiotic is also supported by the study conducted earlier in this country5, 13, 17. 14(29.16%) Gram negative isolates showed evidence of ESBL production which is higher than that (ESBL= 14%) of an Indian study conducted in Gujrat 10 and this should not be underestimated. On the other hand, fluoroquinolones like ofloxacin and ciprofloxacin showed a superior sensitivity pattern against both Gram positive as well as Gram negative bacteria with overall resistance of 30%(21/70) and 37.14% (26/70)respectively. Moreover, 44.28 %( 31/70) of isolates were found resistant to both amikacin and cefotaxime in vitro. Whereas only 14.28 % (10/70) organisms were resistant to both amikacin and ofloxacin and 17.14% (12/70) were resistant to both amikacin and ciprofloxacin. So, result of our study arises a question towards the rationality of administration of cefotaxime in empirical treatment of neonatal sepsis. Early onset neonatal sepsis with multidrug resistant strains is one of the greatest challenges to the pediatricians. Wise and rational choice of empirical antibiotic is of utmost importance as it takes at least 48 hrs for generation of a proper blood culture sensitivity report. Keeping this in mind, the study strongly recommends introduction of fluoroquinolone in empirical therapy along with amikacin in treatment of EONS in spite of knowing the fact that fluoroquinolones cause arthropathy (arthrosis) and osteochondrosis in juvenile animals of several species. Indications of fluoroquinolone use in pediatric patients have been provided by the American Academy of Pediatrics, which recommends that their use should be limited to the situations where infections have been caused by multidrug-resistant organisms for which there is no effective as well as safe alternative antibiotics are available or as second line therapy in Gram negative neonatal sepsis where first line drugs have failed20. Moreover, in a study including 116 neonates with sepsis, ciprofloxacin were used successfully and no feature suggestive of arthropathy or growth impairment was reported at one year follow up 21 . Though more data from controlled trials to further define the efficacy and safety profile for this class of drugs in pediatric patients especially neonates are desirable, in existing situation of EONS, fluoroquinolones can act as a good alternative to which most of the isolates were susceptible. Moreover, they will also provide some economical relief to the patients over most sensitive carbepenems available in market and we can preserve our last weapon against these notorious pathogens responsible for neonatal sepsis. However, this result was limited to our centre only.
CONCLUSION
This study reveals current data on the pathogens causing sepsis in neonatal care units of this institute but the striking feature is the high rate of in vitro resistance of the isolated organisms to the commonly used antibacterial drugs. This study strongly recommend introduction of fluoroquinolones in the empiric therapy of EONS especially when multidrug resistance gram negative bacteria is suspected to be the causative agent. The present study also emphasizes the importance of periodic surveys of microbial flora encountered in particular neonatal settings to recognize the trend and help in implementation of rational empirical treatment strategy.
ACKNOWLEDGEMENTS
We want to acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript and 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=1474http://ijcrr.com/article_html.php?did=14741. Guha D.K, Saili A. Guha R, Aggarwal A. Common Infections in the Newborn. In: Neonatology – Principles and Practice. Guha D.K; 3rd ed .Jaypee Brothers Medical Publishers (P) Ltd. New Delhi, India; 2005: 654 – 672.
2. Stoll BJ. Infection of the Neonatal Infant. In Nelson’s Text Book of Paediatrics; Behrman RE, Kleigman RM, Jenson HB.18th ed. WB Saunders Co.;2006:794-811
3. Ghanshyam D. Kumhar, V.G. Ramachandran, and Piyush Gupta.Bacteriological Analysis of Blood Culture Isolates from Neonates in a Tertiary Care Hospital in India. J Health Popul Nutr 2002 Dec;20(4):343-347
4. Viswanathan R, Singh AK, Mukherjee S, Mukherjee R, Das P, Basu S.Aetiology and antimicrobial resistance of neonatal sepsis at a tertiary care centre in eastern India: a 3 year study. Indian J Pediatr.2011;78 (4):409-12.
5. Bhat Ramesh Y,Leslie Edwars s Lewis and Vandana KE. Bacterial isolates of early onset neonatal sepsis and their antibiotic susceptibility pattern between 1998 and 2004: an audit from a centre in India. Italian Journal of pediatrics 2011; 37: 32-38
6. Zakariya BP, Bhat V, Harish BN, Arun Babu T, Joseph NM. Neonatal sepsis in a tertiary care hospital in South India: bacteriological profile and antibiotic sensitivity pattern. Indian J Pediatr 2011; 78(4):413-7.
7. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial disk susceptibility tests. Approved standard M2- A10. Wayne, PA: Clinical and Laboratory Standards Institute; 2009
8. Shrestha NJ, Subedi KU, Rai GK. Bacteriological Profile of Neonatal Sepsis: A Hospital Based Study. J Nepal Paedtr Soc 2011;31(1):1-5.
9. Mudey Gargi D, Tankhiwale S. Neelima, Mudey Abhay. Clinical Profile and Haematological Indices of Clinically Diagnosed Early Neonatal Septicaemia: A study Conducted in Teaching Institute Attached to Rural Hospital of Wardha District. International Journal of Current Research and Review 2011;Vol 3(1): 4-8
10. Shah AJ, Mulla SA, Revdiwala SB.Neonatal Sepsis: High Antibiotic Resistance of the Bacterial pathology in a Tertiary Care Hospital.J Clin Neonatol 2012;1:72-75
11. National Neonatology Forum. National Neonatal Perinatal Database. Report for the year 2002 . New Delhi: Dept of Pediatrics.
12. Kairavi. J. Desai, Saklainhaider. S. Malek Neonatal Septicemia: Bacterial Isolates and Their Antibiotics Susceptibility Patterns. NJIRM 2010; Vol. 1(3): 12-15
13. I Roy, A Jain, M Kumar, SK Agarwal et al.Bacteriology of neonatal septicemia in a tertiary care hospital of northern India. Indian J Med Microbiology 2002; 20(3):156-159.
14. Dechen C Tsering, L Chanchal, Ranabir Pal, Sumit Kar.Bacteriological profile of septicemia and the risk factors in neonates and infants in Sikkim.Journal of Global Infectious Diseases 2011;Vol 3(1):42-45
15. Joshi SG, Ghole VS, Niphadkar KB: Neonatal gram-negative bacteremia. Indian J Pediatr 2000; 67:27-32.
16. Karthikeyan G, Premkumar K: Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr 2001; 68:715-717.
17. Kumar S, Rizvi M, Vidhani S, Sharma VK. Changing face of septicaemia and increasing drug resistance in blood isolates. Indian J Pathol Microbiol 2004; 47 (3): 441-446.
18. S Begum, MA Baki, GK Kundu, I Islam, M Kumar, A Haque Bacteriological Profile of Neonatal Sepsis in aTertiary Hospital in Bangladesh. J Bangladesh Coll Phys Surg 2012; 30: 66-70
19. Sankar MJ, Agarwal A, Deorari AK, et al. Sepsis in the newborn. Indian J Pediatr 2008 Mar;75(3):261-266.
20. Committee on Infectious Diseases. The use of systemic fluoroquinolones. Pediatrics 2006;118:1287-1292
21. Drossou-Agakidou Vasiliki, Roilides Emmanuel, Papakyriakidou Koliouska Panagiota et al. Use of ciprofloxacin in neonatal sepsis: lack of adverse effects up to one year. Pediatr Infect Dis J 2004; 23(4): 346-9
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareHOMOCYSTEINE, C-REACTIVE PROTEIN AND TRADITIONAL CARDIOVASCULAR RISK MARKERS IN POLYCYSTIC OVARY SYNDROME
English5968Seerla Lalitha DeviEnglish Syed Abdul JaweedEnglishObjectives: Polycystic ovary syndrome one of the major Endocrine and reproductive abnormality which represent the largest unique young women at high risk for development of premature atherosclerotic heart disease. The Metabolic disturbances associated with PCOS like Insulin resistance, hyperandrogenism, and hypertension may adversely accelerate the cardiovascular risk profile in these young Women. With this background, a case control study was undertaken to evaluate the levels of Traditional and Novel CV risk markers in PCOS women compared to healthy controls. Methods: Fasting blood Glucose, Insulin, Insulin resistance (homeostasis model assessment, HOMA-IR), Testosterone, Lipid levels, Homocysteine, C- reactive protein and Uric acid levels were determined in Fourty diagnosed PCOS women and healthy age matched controls. All biochemical analysis was done using commercial enzymatic kits. Results: Testosterone the main component of PCOS, HOMA-IR were significantly (pEnglishInsulin resistance, Dyslipidemia, Endothelial dysfunction, Cardiovascular riskINTRODUCTION
Women with Polycystic ovary syndrome (PCOS) constitute the largest group at risk for development of cardiovascular diseases (CVD). The characteristic features of PCOS include, oligomenorrhea, hyperandrogenism, hirsutism and irregular menstrual cycle. Clinical androgen excess in women may signal a risk for coronary artery disease 1 . In time the disorder may lead to onset of insulin resistance, early onset of type-2 diabetes mellitus (DM), and CVD. This may be due to probably the result, in part of the metabolic disturbances associated with PCOS. It has been shown that PCOS can cause severe insulin resistance and its secretion disturbances to some extent. Many observations suggest that there is a strong association between menstrual irregularity and insulin resistance among women with PCOS 2 . Although insulin resistance is not a disease, its presence is associated with increased risk of cardiovascular morbidity and mortality and type 2 diabetes 3 Women with PCOS are frequently found to have atherogenic lipid abnormalities that may reflect underlying insulin resistance. Interestingly, it was observed that women with hirsutism and regular cycles do not present dyslipidaemia, whereas those with both hirsutism and oligomenorrhea had lower HDL-C and higher triglycerides, suggesting an association between menstrual irregularity and dyslipidaemia 4 . Women with menstrual irregularities are likely to be those exhibiting more pronounced dyslipidaemia 5 . In recent years, interest has grown in novel biochemical and biophysical markers of cardiovascular risk. C-reactive protein (CRP) has been shown to be a good predictor of vascular events. In addition to being a marker of inflammation, there is evidence that CRP may have a direct role in atherogenesis via adhesion molecule expression, complement activation, and mediation of low density lipoprotein (LDL) uptake by macrophages 6 . Endothelial function and vascular function is also altered in women with PCOS and vascular compliance has been reported to be decreased. Homocysteine is postulated to damage the vascular endothelium directly and also raised homocysteine concentrations have been associated with an increased risk of ischemic heart disease and atherosclerosis7 . Uric acid exerts proinflammatory, prooxidant and proliferative actions at the endothelial cell level that may increase cardiovascular risk. The increase in serum uric acid concentrations is related to cardiovascular events in high-risk subjects, yet this relationship is less established in the general population and the possible roles of uric acid as a causal agent or as a mere marker of cardiovascular risk are debated at present 8 . However all of these are surrogate markers and despite their presence, it remains to be proven (prospectively) that women with PCOS are at increased risk for cardiovascular-related morbidity and mortality. Hence, we aimed to study the levels of both Traditional and Novel CV risk markers in PCOS women and compared with age matched controls inorder to predict the early onset of cardiovascular risk in these patients.
MATERIALS AND METHODS
This was a prospective study done in Department of Biochemistry Bidar Institute of Medical Sciences Bidar (Karnataka), India. After informed consent, Fourty women diagnosed to have PCOS by Rotterdam ESHRE/ASRM PCOS group’s revised 2003 criteria with presence of any two of the three criteria were recruited for the study. These criteria were a) Oligo and/ or anovulation with exclusion of related disorders with similar presentation like hypothyroidism (TSH > 5mIU/ml) b) Clinical and / or biochemical signs of hyperandrogensm, c)Polycystic ovaries with exclusion of congenital adrenal hyperplasia androgen secreting tumors. Other exclusion criteria were patients on oral contraceptives, glucocorticoids, antiandrogens, ovulation inducing agents, antidiabetic drugs or antiobesity drugs or other hormonal drugs during the previous 6 months. The critreria for healthy control group include no menstrual irregularities, hirsuitism, hypertension, Hyperandrogenism and no ultrasound (or) clinical signs of PCOS. None of the subjects were Diabetic, and with acute infections. A family history of Coronary artery disease, smoking, or Concurrent oestrogen, antihypertensive, and lipid lowering medication Subjects were excluded.
Sampling and Storage:
After overnight fasting venous blood samples were collected in a plain bulb, centrifuged at 2000 rpm for 15 minutes and stored immediately at -80 oC until analysis. 1ml of blood was collected in anticoagulated bulb and plasma collected for analysis of glucose.
Biochemical Analysis:
Serum glucose was measured by using glucose oxidase-peroxidase technique. Lipid analysis in fasting serum was performed for all patients. The lipid profile included measurement of the levels of total cholesterol, HDL, LDL and triglyceride. The lipid levels were estimated by commercially available enzymatic assay kits and were expressed as mg/dl. CRP measurements were determined by highly sensitive CRP (hs-CRP) analyzed by immunoturbidometric method using commercial kits. The Homocysteine concentrations were measured by using commercial kit. Analysis of parameters was done on Beckman CX9 auto analyzer using commercial kits. Testosterone levels were analyzed by Chemiluminescence’s method in LIAISON analyzer. Insulin levels were measured by Enzyme linked immunosorbent assay (ELISA) technique and were expressed as µIU/ml. Insulin resistance was determined by the homeostasis model assessment (HOMA- IR)
All subjects had undergone anthropometric measurements including Height (m), weight (kg), measurements were used to calculate the body mass index (BMI = Wt / height in m2 ), evaluation of systolic and diastolic blood pressures. Statistical Analysis: The statistical Package for the Social Sciences (SPSS version 11.5 for Windows) was used for statistical analysis. Results were expressed as mean ± SD. Unpaired t-test (one tailed) was used to compare the means, and a P value less than0.05 was considered to be statistically significant.
Table: 1 Shows the Baseline characteristics of the Study group and control group. By design, there were no significant differences between the two groups in Age, height, weight and BMI. Similarly, there were no significant differences in systolic and diastolic blood pressure in PCOS women when compared to the control group. The main component of PCOS i.e., serum testosterone levels and Insulin resistance (HOMA-IR) levels were significantly elevated in PCOS women when compared to control group (p =0.000), (p=0.014).
Table: 3 shows the novel cardiovascular risk factors i.e., CRP, Homocysteine, and uric acid were found to be significantly elevated in PCOS women (p =0.001) when compared to the control group.
DISCUSSION
This study was attempted to understand whether the traditional and novel CV risk markers were increased in PCOS women in case which may lead to early onset of cardiovascular risk in these population. We noted an abnormal lipid profile, Hyperinsulinemia, Insulin resistance, and increase levels of Homocysteine, CRP, Uric acid levels in PCOS women when compared with age matched controls. It was first reported by Burghen et al 9 in 1980 and subsequently confirmed by Chang et al 10 in 1983 that insulin resistance is present in PCOS women. Insulin resistance is now recognized as a major risk factor for the development of type 2 (non-insulin-dependent) diabetes mellitus (NIDDM). Dunaif et al 11 demonstrated that women with PCOS were insulin resistant, independent of obesity. Many women with PCOS exhibit β-cell dysfunction reducing insulin response to a glucose load insufficient for the degree of insulin resistance. The mechanism responsible includes the markedly diminished insulin-induced receptor autophosphorylation seen in 50% of women with PCOS. This defect is unique to women with PCOS and is attributable to an abnormal protein tyrosine kinase receptor. In the present study the PCOS women showed Hyperinsulinemia (p = 0.011) and insulin resistance. Fasting insulin levels were significantly higher in PCOS group in accordance to previously published studies 12,13, 38. Insulin resistance calculated by HOMA-IR was also found to be elevated in the PCOS group (p = 0.014). Insulin resistance results in hyperandrogenemia due to decrease in sex hormone binding globulin (SHBG). This insulin resistance and the resulting hyperinsulinemia contribute to the reproductive abnormalities of PCOS women 9 . Insulin resistance and androgen excess together collaborate in increasing risk for type 2 DM in PCOS women, a well known risk factor for macrovascular and particularly coronary artery disease. All the PCOS women in the present study had hyperandrogenemia (p=0.001). Polycystic ovary syndrome is an associate with a higher frequency of cardiovascular risk factors. In the present study, PCOS women had increased levels of serum total cholesterol (p=0.002), triglycerides, LDL-C and decreased HDL-C levels (p=0.001) indicating more risk for cardiovascular disease. Our study is in line with Olivier V et al 14, who showed that PCOS women were associated with more pronounced atherogenic lipid profile i.e increased LDL-C and decreased HDL-C levels. In an Indian study done by Anuradha K et al 15, PCOS women also showed increased total cholesterol, triglycerides and LDL-C and decreased HDL-C levels in insulin resistance women compared to insulin sensitive women. Mirjana S et al 16 suggested that PCOS per se without obesity affects insulin secretion and lipid metabolism, mainly triglyceride levels which enhances atherogenic potential in these subjects. In another study, by Haffner SM et al 17 demonstrated that insulin resistance is associated with increased triglycerides and decreased HDL-C levels, which is potent combination that promotes coronary heart disease. Bickerton AST et al 7 did not found any difference in lipid parameters in PCOS women compared with controls their possible explanation is reduced insulin sensitivity. This is supported by the observation that the typical disturbance of lipid parameters seen in PCOS is associated with the presence of insulin resistance 18 . The possible explanation is that Hyperinsulinemia and hyperandrogenemia cause adipocytes to undergo increased catecholamineinduced lipolysis and release of free fatty acids into the circulation. Increased free fatty acids in the liver stimulate secretion of very low-density lipoprotein (VLDL), which ultimately leads to hypertriglyceridemia 19. It has been postulated by Wetterau and coworkers20 that insulin inhibits the expression of the microsomal triglyceride protein, which is responsible for the secretion of apolipoprotein B (apoB) and VLDL. Insulin resistance leads to hepatic overproduction of apoB and VLDL and, ultimately, to hypertriglyceridemia. Atherogenic modifications of LDL cholesterol toward smaller, more dense particles have been demonstrated 21 Androgens, particularly testosterone, may have a role by decreasing lipoprotein lipase activity in abdominal fat cells 22. Hepatic lipase has a role in catabolism of HDL particles, is significantly upregulated in hyperandrogenemia i.e, in PCOS women leading to decreased levels in these women. This is demonstrated by Elbers et al 23 , by supplementation of exogenous androgens in a study of female to male transsexuals. This shows that Traditional CV risk markers are increased in PCOS women which indicate more cardiovascular risk. Plasma homocysteine levels are widely accepted as an independent risk factor for cardiovascular disease. Homocysteine has been reported to promote atherosclerosis by inducing endothelial dysfunction through limited bioavailability of nitric oxide and altered blood vessel elasticity; enhancing the activation of coagulation system and increasing the platelet adhesiveness 24.In the Present study we examined the serum levels of Homocysteine in PCOS women and found elevated levels in PCOS women (P=0.001) when compared to control group. Previous studies had shown that PCOS patients have significantly higher plasma homocysteine concentrations with regardless of BMI i.e., in both lean and obese PCOS patients than control group 25, 26 . Some studies shown that, mean plasma homocysteine levels are significantly higher in Insulin-resistant PCOS patients when compared with non-insulinresistant PCOS patients regardless of BMI which indicates relationship of Homocysteine with IR 27, 28 . Plasma levels of insulin seem to influence homocysteine metabolism through effects on glomerular filtration or by influencing activity of some important enzymes in homocysteine metabolism like methyltetrahydrofolate reductase (MTHFR) and hepatic cystathione β synthase (CBS). Homocysteine levels are seems to be related with risk of cardiovascular disease and complications, by increasing oxidative stress in vascular endothelium, activation of platelets impairment of blood flow stimulation of vascular smooth muscle proliferation and may be one of the signals inducing apoptosis in vascular endothelial cells by activating unfolded protein response 29, 30. Homocysteine levels are influenced by a number of variables, including smoking, renal function, vitamin B12, folate status and enzyme dysfunction states. All of the patients in our study are nonsmokers. Their renal function was normal as evident from the normal serum creatinine levels (0.7?0.052 mg/dl). Methyltetrahydrofolate reductase (MTHFR) enzyme deficiencies and vitamin levels were not screened in this patient group, as in the study by Laivuori et al. 31 and Tsanadis et al. 32 who had studied the enzyme levels and did not found significant levels. Vitamin B12 levels and folic acid levels were examined in the study by Yarali et al 25 and no significant differences were found between PCOS and controls. The vascular endothelial aspect and Hyperinsulinemia might be responsible for the higher homocysteine levels in these patients. Serum markers of inflammation are being increasingly recognized as predictors of atherosclerosis and cardiovascular diseases. Chronic inflammation results in endothelial dysfunction and facilitates the initiation of an atherosclerotic process. Several studies suggest that low grade inflammation, reflected by elevated C-reactive protein (CRP), can contribute to the development of atheriosclerosis 33. CRP is considered not only an inflammatory marker of atherosclerosis but also a mediator of the disease because it contributes to the pathogenesis of lesion formation by interacting with the endothelium and therefore CRP can be seen as a measure of endothelial dysfunction 34. CRP can independently predict type 2 diabetes and has been linked to insulin resistance 35. However, the role of inflammation in the etiology of cardiovascular disease (CVD) and other metabolic diseases is still disputed and is not generally accepted. In our study we find elevated hs-CRP (p=0.001) levels when compared with age matched controls. Our findings are in agreement with other studies who has found a significant difference in CRP levels between PCOS patients and controls, and they suggested a chronic subclinical inflammatory process may be the possible underlying mechanism of atherosclerosis in some PCOS patients 36, 37 . Recent evidence suggests that CRP may have a direct role in the pathogenesis of atherosclerotic lesion formation and appears to affect a number of interrelated pathways in the vascular endothelium, including the induction of expression of adhesion molecules, foam cell formation by inducing LDL opsonisation and which cause monocyte recruitment in the arterial wall. CRP also activates complement and endothelial cell (EC) sensitization which leads to EC damage finally leading to atherosclerotic plaque rupture 38. Theoretically, CRP may differentiate between those PCOS women who are at high risk for developing Type-2 Diabetes and CVD 39 . Uric acid is another newly described coronary risk factor. PCOS women having insulin resistance may lead to hyperuricemia. Recently, an inverse correlation between serum uric acid concentrations and insulin sensitivity has been described in subjects with varying degrees of metabolic syndrome, suggesting that measurement of serum uric acid may provide a simple marker of insulin resistance 40 . In the present study high uric acid levels (p=0.001) were seen in PCOS women compared to control group. This is in contrast to Manuel LuqueRam?´rez1, et al 8 , who found no significant differences in uric acid levels between PCOS women and non-hyperandrogenic control women. Similarly Anttila L et al 40 also found no differences in uric acid concentrations between PCOS women and control group. The findings of the present study are in contrast to the studies described above. Uric acid levels are affected by ethnicity, BMI, renal function. Obesity is the main determinant of serum uric acid levels in PCOS patients 8 . However, obesity cannot be the contributing factor in the present study because the study group and control group were BMI matched to remove the influence of BMI. PCOS women are insulin resistant and exhibit hyperinsulinism. Hyperinsulinism has an inhibitory effect on the renal excretion of uric acid which might explain the higher uric acid levels in PCOS women, though in the reference range compared to the control group. The elevated uric acid levels might be due to Androgens which may increase serum uric acid levels by inducing the hepatic metabolism of Purines 8 . This is supported by the finding that only the antiandrogenic oral contraceptive pill Diane35 Diario, and not the insulin sensitizer metformin, decreased uric acid concentrations significantly in PCOS women. Increases in uric acid concentrations as small as 59 ?mol / strangulated hernias L (0.99mg/dl), increase the frequency of cardiovascular events and ischemic cardiopathy 8 .
CONCLUSION
In conclusion the findings of the present study show significantly elevated levels of both Traditional and Novel Cardiovascular risk markers in PCOS women. The altered glucose metabolism is due to pathogenesis of insulin resistance and abnormal lipid profile results in increased risk for cardiovascular morbidity in PCOS Patients. At the same time, inflammatory risk marker CRP, homocysteine can cause endothelial dysfunction and thus increase the risk of early onset cardiovascular risk in these young women. Hence, correction of these CV risk factors in PCOS women can play an important role in decreasing the cardiovascular mortality in these patients. Hence, routine screening for these parameters helps in early identification of these cardiovascular risk factors can prevent the development of endothelial dysfunction, which is a reversible early event in atherosclerosis and appropriate treatment should be aimed to control these parameter.
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.
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23. Elbers JM, Giltay EJ, Teerlink T, Scheffer PG, Asscheman H, Seidell JC et al. Effects of sex steroids on components of the insulin resistance syndrome in transsexual subjects. Clin Endocrinol (oxf) 2003;58:562-571
24. Hanratty CG, McGrath LT, McAuley DF, Young IS, Johnston GD. The effects of oral methionine and homocysteine on endothelial function. Heart 2001; 85(3):326-30.
25. Yarali H, Yildirir A, Aybar F, Kabakci G, Bukulmez O, Akgul E, Oto A.Diastolic dysfunction and increased serum homocysteine concentrations may contribute to increased cardiovascular risk in patients with polycystic ovary syndrome. Fertil Steril 2001;76(3): 511-6.
26. Loverro G, Lorusso F, Mei L, Depalo R, Cormio G, Selvaggi L. The plasma homocysteine levels are increased in polycystic ovary syndrome. Gynecol Obstet Invest 2002;53(3): 157-62.
27. Morey Schachter, Arieh Raziel, Shevach Friedler, Deborah Strassburger, Orna Bern and Raphael Ron-El, Insulin resistance in patients with polycystic ovary syndrome is associated with elevated plasma homocysteine. Human Reproduction 2003; 18(4):721-727.
28. Ilhan Tarkun, Berrin Cetinarslan Zeynep, Canturk Erdem Turemen. The Plasma Homocysteine Concentrations and Relationship with Insulin Resistance in Young Women with Polycystic Ovary Syndrome Turkish. Journal of Endocrinology and Metabolism 2005; 1: 23-28.
29. Mujumdar, V.S., Tummalapalli, C.M., Aru, G.M. and Tyagi, S.C. Mechanism of constrictive vascular remodeling by homocysteine: role of PPAR. Am. J. Physiol 2002;282:1009-10015.
30. Zhang, C., Yong, C., Adachi, M.T., Oshiro, S., Aso, T., Kaufman, R.J. and Kitajima, S. Homocysteine induces programmed cell death in human vascular endothelial cells through activation of the unfolded protein response. J. Biol. Chem 2001;276:35867- 35874.
31. Laivuori, H., Kaaja, R., Turpeinen, U., Viinikka, L. and Ylikorkala, O. Plasma homocysteine levels elevated and inversely related to insulin sensitivity in preeclampsia. Obstet. Gynecol 1999;93:489-493.
32. Tsanadis, G., Vartholomatos, G., Korkontzelos, I., Avgoustatos, F., Kakosimos, G., Sotiriadis, A., Tatsoni, A., Eleftheriou, A. and Lolis, D. Polycystic ovarian syndrome and thrombophilia. Hum. Reprod 2002; 17: 314-319.
33. Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women.N Engl J Med 2000; 342: 836-843.
34. Verma S, Buchanan MR, Anderson TJ. Endothelial function testing as a biomarker of vascular disease. Circulation 2003; 108: 2054-2059.
35. Freeman DJ, Norrie J, Caslake MJ, et al. West of Scotland Coronary Prevention Study, C-reactive protein is an independent predictor of risk for the development of diabetes in the West of Scotland Coronary Prevention Study. Diabetes 2002; 51: 1596-1600.
36. Boulman N, Levy Y, Leiba R, Shachar S, Linn R, Zinder O, and Blumenfeld Z. Increased C - reactive protein Levels in the Polycystic Ovary Syndrome: A Marker of Cardiovascular Disease. Journal of Clinical Endocrinology and Metabolism 2004; 89(5):2160–2165.
37. Talbott EO, Zborowski JV, Boudreaux MY, Mchugh-pemu KP, Sutton- tyrrell K, Guzick D.S. The Relationship between C - reactive protein and Carotid Intima-Media Wall Thickness in Middle-Aged Women with Polycystic Ovary Syndrome. The Journal of Clinical Endocrinology and Metabolism 2004; 89(12):6061–6067.
38. Alain Tedgui. The role of inflammation in atherothrombosis: implications for clinical practice. Vascular Medicine 2005; 10: 45–53.
39. Ridker PM, Buring JE, Cook NR, Rifai N. Creactive protein, the metabolic syndrome, and risk of incident cardiovascular events: an 8- year follow-up of 14719 initially healthy American women. Circulation 2003; 107:391–397.
40. Anttila L, Rouru J, Penttil T, and. Irjala K. Normal serum uric acid concentrations in women with polycystic ovary syndrome. Human Reproduction 1996; 11: 2405-2407.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareTUBERCULOSIS DIAGNOSIS AND TREATMENT: NEGOTIATING THE SOLUTION AND IMPLEMENTATIONS
English6975Navjot KaurEnglish S.S. BhatiaEnglishTuberculosis (TB) is a pulmonary disease caused by Mycobacterium tuberculosis. Various factors are associated with the transmission of TB including the infectiousness of the patient, duration of exposure and the nature of the environment, where exposure occurs. Tuberculosis diagnosis is the key concern of contemporary health research worldwide. TB control has been achieved in high-income countries but remained a threat for middle and low income countries. Transmission of TB can be reduced by fast diagnosis and complete treatment. Appropriate information of control policies and their adequate implementations are mandatory to achieve the desired results. Lack of awareness, inadequate treatment and fall in appropriate implementation on TB control and prevention programs are prevalent factors which become the barrier to achieve the TB elimination target.
EnglishTuberculosis, Diagnosis, Treatment regime.INTRODUCTION
The emergence and re-emergence of bacterial diseases (such as Cholera, Gonorrhea and Tuberculosis) are the main strain for the third world countries. The emergence and persistence of an infectious disease in population becomes the obstacle for economic as well as social development of a nation. The target of Control and Prevention programs is to protect the community and to promote the quality of life. The death rate from infectious and parasitic diseases is approximately 14 times higher in lowincome countries as compare to high-income countries and almost 3 times higher in middleincome countries (Figure 1)1 . Moreover the core factors, which directly affect the transmission of infections, are lack of awareness, migration, urbanization, increased population densities and unhealthy living conditions in urban slums. And the situation becomes troublesome when transmission of infection is uncontrolled because of mismanagement of available drugs which may lead to the re-emergence of the infection.
Robert Koch, a German physician, in 1882, has first discovered that tuberculosis is a bacterial infection caused by My-cobacterium tuberculosis, which most commonly affects the lungs but it can also affect other parts of the body such as brain, kidneys, or spine. It transmits from person to person via droplets from the throat and lungs of people with the active TB disease. A person become infective when he/she inhale only a small number of bacteria but infected doesn’t necessarily mean to be sick. It could take years for developing tuberculosis; this stage is called latent TB ( stage in which person carries TB bacteria within body but he/she is not infectious) and can develop active TB disease when their immune system becomes weak by some another reason, such as advancing age, infection with HIV, or some other health problem. 24 March is commemorated as World Tuberculosis Day. It is a day which provides opportunity to raise awareness about the global TB burden and to promote prevention and control efforts, but the question about its complete recovery and elimination is still riddled with multiple problems, which needs strong social and political commitments. The greatest challenge, for health experts, researchers and medical practitioners, is how to overcome the spread of tuberculosis. As per WHO data in 2011, 9 million people are infected with TB and 1.4 million died from this disease and more than 95% of TB deaths are associated with low and middleincome countries. Tuberculosis has been declared as notifiable disease in many countries including India. As per WHO report, geographically the burden of TB is highest in Asia and Africa (Figure 2)2 . Two countries, India and China together account for almost 40% of the world’s TB cases [1].
TREATMENT REGIME AND INADEQUACY
Tuberculosis treatment is based on a combination of antibiotics which is recommended to be taken for half a year or more. But the patients often quit therapy prematurely which increases the risk of drug-resistant strains. The initial phase of TB disease treatment continues for two months and continuation phase usually lasts for four to six month of duration. In the initial phase all patients receive an internationally accepted first-line treatment regimen which consists of isoniazid, rifampicin, pyrazinamide and ethambutol, for two months. The preferred continuation phase consists of isoniazid and rifampicin to be given for four months. Isoniazid and rifampicin are the most powerful bacterial drugs which are active against all populations of TB bacilli [10]. Multidrug-resistant TB (MDR-TB) is a result of mismanagement or failure of the first-line drugs. MDR-TB can be treated with second-line drugs and it takes long time for treatment. There was an estimated 310,000 (range, 220,000-400,000) MDR-TB cases among notified TB patients with pulmonary TB in 2011. Almost 60% of these cases were in India, China and the Russian Federation [1]. In 2005, the extensively drugresistant tuberculosis (XDR-TB) was first reported and identified worldwide [16, 17]. XDRTB is associated with mismanagement of treatment and especially among the individuals co-infected with HIV [21, 22]. XDR-TB strains are created when Multidrug resistant TB (MDRTB) is inadequately treated which actually enables amplification of second-line drug resistance [24, 25]. The treatment options are seriously limited for XDR-TB as it is resistant to first- and second-line drugs. In many of the countries, the actual scale of XDR-TB is unknown due to lack of necessary equipment and the incapability to diagnose it properly.
In June 2008, there were 49 countries which confirmed the cases of XDR-TB [18] (Figure 3). On the basis of data WHO estimates that around 40,000 XDR-TB cases emerges per year. At this stage, Drug-susceptibility testing (DST) for firstline and second-line TB drugs is essentially required for developing effective MDR-TB and XDR-TB treatment regimens. The countries with high incidence of TB, requires laboratory facilities for DST but unfortunately these facilities are not available [17].
REASSESS THE IMPLEMENTATIONS OF DIAGONOSIS
Initiatives are being taken for strengthening the health systems and to promote the use of International Standards for TB Control and Care [15, 29]. TB cases are being reduced with the implementation of Directly Observed Treatment Short-course (DOTS), worldwide. This program was conducted by the British Medical Research Council [8] and the US Public Health Service. World Bank identifies DOTS as one of the most cost-effective available health strategies. From 1995 to 2009, nearly 49 million persons were treated with the implementation of DOTS strategy and 41 million were cured from TB [20]. Technical advisory bodies, WHO and the Global Stop TB partnership, endorse the DOTS strategy to promulgate it globally. Widespread implementation for DOTS has been recently recommended by resources from government(s); the Global Fund for AIDS, Tuberculosis, and Malaria; and the Presidents Emergency Plan for AIDS Relief [12, 13]. DOTS strategy is one of the most successful Stop TB strategies which contains five basic components: i) political commitment with adequate and sustained financing; ii) early case detection and diagnosis through quality-assured bacteriology; iii) standardized treatment with supervision and patient support; iv) effective drug supply and management; and v) monitor and evaluate performance and impact. The DOTS strategy is now confronting other obstacles that are: addressing the risk of HIV, diabetes and multidrug-resistant and extensively drug-resistant TB. Other risk factors which accelerate progression of TB disease include malnutrition, alcoholism, smoking, indoor air pollution in poorly ventilated households and outdoor air pollution at workplace [26]. Earlier M. tuberculosis was exclusively detected by culture which takes weeks because the requisite generation time of 18 to 24 hours. But in low resource settings, diagnosis is done on the basis of smear microscopy as culture may not be available there, and ultimately it leads to the failure in detection of nearly half of TB patients [15]. Recently a molecular diagnostic test, Xpert TB/RIF, is made available for the simultaneous detection of TB and rifampicin resistance directly from sputum within two hours hence is quite simple, rapid and accurate [23]. The technology is based on the GeneXpert platform and is developed as a partnership between the Foundation for Innovative New Diagnostics (FIND), Cepheid Inc. and the University of Medicine and Dentistry of New Jersey, along with support from the US National Institutes of Health [28]. Again cost remains an issue for lowincome countries regarding the adoption of TBXpert project. TB is leading infectious disease which results into death among adults. This situation arises because of the unavailability and inaccessibility of diagnostic tests, which are not adequately implemented. Globally, 37% of TB cases remain undetected, and many of the infectives are not receiving optimal treatment regimens. According to an Indian analysis it has been reported that around 72% of TB patients, who have low living standards (e.g., earning US $1-$2; considered to be in international poverty line), initially look for private health providers before starting the treatment with Revised National TB Program [27]. Apart from all the interventions there is a need to make a check over the problems that are associated with gender, expenditure and availability as well as accessibility of drugs. Here accessibility means that the treatment is not approachable for everyone and everywhere. More over awareness programs associated with transmission and cure of TB should be promoted by mass media.
CONCLUSION
There are number of initiatives which must be implemented to achieve the targeted public health responses: First, accurate measures of the incidence, prevalence, and determinants of TB are required. Second, proper management of TB control program are required to figure out accurate number of TB infectives. Finally, the drugs and treatment must be made available to the infectives via expert medical practitioners. Detecting the infectives and their treatment is challenging enough, but the situation becomes panic due to persistence of drug resistant patients. Eradication of TB is possible only when each TB infective will be detected and treated adequately. As mentioned above TB is a notifiable disease that means each TB case will have to be notified to public health authorities to ensure complete assessment and appropriate treatment and identification of secondary cases. Attention to fundamental aspects of TB control (surveillance, prompt culture and DST, DOTS, contact scrutiny and infection control) is needed to control the spread of TB worldwide. In concluding words we can say that TB can be eradicated from the globe through TB infection control measures including early diagnosis and vigilant treatment of the infectious cases.
ACKNOWLEDGEMENT
The first author Navjot Kaur, would like to express her deep gratitude to Dr. Mini Ghosh for her encouragement and useful suggestions. 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=1476http://ijcrr.com/article_html.php?did=14761. World Health Organization. Global Tuberculosis Report 2012. http://who.int/tb/publications/global report/gtbr12 main.pdf
2. Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide. MMWR Morb Mortal Wkly Rep 2006; 55: 301-305.
3. Koch R. Die Aetiologie der Tuberculose: Berliner Klinische Wochenschrift 1882;19:22130. Pinner B, Pinner M, translators. Am Rev Tuberc. 1932; 25:298323.
4. The World Bank. Country and Lending Groups. http://data.worldbank.org/about/countryclassifications/country-and-lending-groups
5. World Health Organization. Global tuberculosis control: a short update to the 2009 report. http://whqlibdoc.who.int/publications/2009/9 789241598866 eng.pdf
6. Fox W. Realistic chemotherapeutic policies for tuberculosis in the developing countries. BMJ. 1964;1:13542.
7. Fendall NR. Auxiliaries and primary medical care. Bull N Y Acad Med. 1972;48:1291300.
8. Fox W. Pillip Ellman Lecture: The modern management and therapy of pulmonary tuberculosis. Proc R Soc Med. 1977; 70:415.
9. Mount FW, Ferebee SH. United States Public Health Service Cooperative investigation of antimicrobial therapy of tuberculosis. V: report on thirty-two week observations on combinations of isoniazid, streptomycin, and para-amino salicylic acid. Am Rev Tuberc. 1954;70:5216.
10. World Health Organization. Treatment of tuberculosis. Guidelines for national programmes. Geneva: World Health Organization, 2003. 11. Rouillon A. The mutual assistance programme of the IUATLD. Development, contribution, and significance. Bull Int Union Tuberc Lung Dis. 1991;66:15972.
12. Raviglione MC, Uplekar M. WHOs new Stop TB strategy. Lancet. 2006; 367:9525.
13. [13] Coggin WL, Ryan CA, Holmes CB. Role of the US Presidents emergency plan for AIDS relief in responding to tuberculosis and HIV coinfection. Clin Infect Dis. 2010;50 (Suppl 3):S2559.
14. Laxminarayan R, Klein EY, Adeyi O. Global investments in TB control: economic benefits. Health A (Millwood). 2009; 28:w73042.
15. World Health Organization. The global plan to stop TB 20112015: transforming The fight Towards The elimination of tuberculosis http://www.stoptb.org/assets/documents/gl obal/plan/TB GlobalPlanToStopTB2011- 2015.pdf
16. Shah N, Wright A, Bai G, Barrera L, Boulahbal F, Martan-Casabona N, Worldwide emergence of extensively drugresistant tuberculosis. Emerg Infect Dis. 2007;13:3807.
17. World Health Organization. Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. Report no. WHO/HTM/TB/2010.3. Geneva: The Organization; 2010
18. World Health Organization (2008). Countries with XDR-TB confirmed cases as of June 2008.
19. Centers for Disease Control and Prevention. Emergence of Mycobacterium tuberculosis with extensive resistance to second-line drugs worldwide. MMWR Morb Mortal Wkly Rep 2006; 55: 301-305.
20. World Health Organization. Global Tuberculosis control 2010. http://whqlibdoc.who.int/publications/2010 /9789241564069 eng.pdf
21. Gandhi NR, Shah NS, Andrews JR, Vella V, Moll AP, Scott M, HIV coinfection in multidrug- and extensively drug-resistant tuberculosis results in high early mortality. Am J Respir Crit Care Med. 2010; 181:806.
22. Gandhi NR, Moll A, Sturm AW, Pawinski R, Govender T, Lalloo U, Extensively drug-resistant tuberculosis as a cause of death in patients co-infected with tuberculosis and HIV in a rural area of South Africa. Lancet. 2006; 368:157580.
23. Boehme CC, Nabeta P, Hillemann D, Nicol MP, Shenai S, Krapp F, Rapid molecular detection of tuberculosis and rifampin resistance. N Engl J Med. 2010; 363:100515.
24. Cox HS, Sibilia K, Feuerriegel S, Kalon S, Polonsky J, Khamraev AK, Emergence of extensive drug resistance during treatment for multidrug-resistant tuberculosis. N Engl J Med. 2008; 359:2398400.
25. Calver AD, Falmer AA, Murray M, Strauss OJ, Streicher EM, Hanekom M, Emer-gence of increased resistance and extensively drug-resistant tuberculosis despite treat-ment adherence, South Africa. Emerg Infect Dis. 2010;16:26471.
26. Lnnroth K, Castro KG, Chakayah JM, Chauhan LS, Floyd K, Glaziou P, Tuberculosis control and elimination 201050: cure, care, and social development. Lancet. 2010;375:181429.
27. Pantoja A, Floyd K, Unnikrishnan KP, Jitendra R, Padma MR, Lal SS, Economic evaluation of publicprivate mix for tuberculosis care and control, India. Part I. Socio-economic pro le and costs among tuberculosis patients. Int J Tuberc Lung Dis. 2009;13:698704.
28. World Health Organization. http://who.int/tb/laboratory/mtbrifrollout/en/.
29. Hopewell PC, Pai M, Maher D, Uplekar M, Raviglione MC. International standards for tuberculosis care. Lancet Infect Dis. 2006; 6:71025.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareMORPHOMETRIC STUDY OF HUMAN FEMUR
English7679Khaleel N.English Hussain Saheb ShaikEnglishThe femur or thigh bone is the longest and strongest bone in human body. It length is associated with striding gait and strength is associated with weight and muscular forces. The study was undertaken in 50 femurs for measuring length, anterioposterior diameter of shaft at upper, middle and lower segments. The results were the mean length of femur was 437.44+31.44mm and mean anteroposterior diameter of shaft at upper segment was 26.56+2.14mm middle segment was 28.50+2.45mm lower segment was 28.50+2.45mm. The knowledge of morphometric values is helpful to anthropological and forensic practice.
EnglishFemur, Anterioposterior diameter, Anthropological practice.INTRODUCTION
Skeleton it plays role in various sciences like medicine, forensic sciences, anthropology. Estimation of sex, age race, stature by skeleton and the presence of disease is discovered by Krogman and Iscan1 . They stated that record of organic evolution is largely written by the hard parts of the body recognizable even after many years after death. Sex is determined after death by skeletal remains of that individual by some forensic anthropologists with the help of pelvis and skull. It is somewhat easier to identify the sex of individual. Here in the present study we are taking the femur either individually or in combination has been subjected to statistical and morphological analysis for the purpose of determination of sex. It is commonly accepted that the examination and statistical analysis of femoral anthropometry among different populations reveals a great amount of variation due to the fact that the femoral anthropometry measurements from different countries are like to be affected by racial variations in diet, heredity, climate and other geographical factors related to life style. Anatomists all over the world were contributing their best and helping to widen the scope for better understanding of the intricate structure of the human body. Strecker et al2 stated that mean values of lengths of right and left femora were found to be similar, although the left femora was generally showed larger values than right, they were not significantly greater, these results are in accordance with those but vertical diameter of right femoral head, which was greater than corresponding left femur. Parsons3 proposed that there was no significant bilateral difference found in bones, he reported that males has bigger neck shaft angles than females through his study and statement in population, in another study of same author studied on sex determination of human femur by using univariate or multivariate discriminate analysis. Parsons and bell4 stated that there was no significant statistical bilateral difference found in bones. Stewart5 studied on maximum femoral length and stated that female was 446mm. Sex determination with maximum anteroposterior diameter of shaft is discussed by Mac Laughlin and Bruce6 . Dittrick and Suchey7 have used either univariate or multivariate discriminate analysis for sex determination and concluded that end of femur bone produced 10% greater accuracy than maximum length or midshaft circumference. William et al8 stated that the axial skeleton weight of male is relatively and absolutely heavier than that of female. Discriminate analysis confirmed that the male femur is usually larger than the female femur9. Distal epiphyseal breadth, maximum length and anteroposterior diameter of midshaft gives 92.3% classification accuracy, distal epiphyseal breadth alone proved 94.9% of accuracy10. Lealavathy et al11 stated that maximum length of femur was found to be the nest parameter in sex determination of the femora. The knowledge of morphometric values is helpful to anthropological and forensic practice.
MATERIALS AND METHODS
The material used for the study contained 50 human femora of unknown sex obtained from different SV medical college, Tirupathi, Andhra Pradesh. The instruments used are metal sliding caliper and osteometric board. The maximum length of femur and anterioposterior diameter of upper, middle and lower shaft of femur was measured.
Maximum Length
It measures the straight distance between the highest point of the head and deepest point on the medical condyle. Femur should be placed with its dorsal side upwards on the osteometric board in such a manner that the epicondyle touches the short vertical wall. The movable cross piece should touch the highest point of head. Osteometric board was used for this purpose.
Anteroposterior diameter of shaft
Upper segment – It measures the anteroposterio diameter of the upper shaft taken at right angle to the transverse diameter of shaft. Middle segment – It measures the distance between the anterior and posterior surfaces of the bone approximately at the middle of the shaft that is the highest elevation of the linea aspera. Lower segment – it measures the distance between the anterior posterior margins of the lower part of the shaft, approximately 4cm above the cartilaginous margin of the condyles taken in the mid sagittal plane. Sliding caliper was used for this purpose.
RESULTS
The results were the mean length of femur was 437.44+31.44mm, right it was 435.11+29.68mm and left was 440.17+33.84mm, maximum length was 514mm and minimum length was 373mm. Mean anteroposterior diameter of shaft at upper segment was 26.56+2.14mm on right it was 26.41+1.92mm and left was 26.74+2.39, the middle segment was 28.50+2.45mm on right it was 26.19+2.02mm and left was 26.60+2.38mm, lower segment was 28.50+2.45mm on right it was 28.15+2.39mm and left was 28.91+2.50mm. No significant difference found between right and left.
DISCUSSION
The femur bone is the longest and strongest bone in human body. Its length is associated with striding gait and strength is associated with weight and muscular forces. Its shaft is almost cylindrical in most of its length and bowed forwards. Proximally the rounded head projects medially on its short neck. Distally it is strong, having two condyles which articulate with tibia. On standing, femora are oblique, shaft converge downwards and medially. Femoral obliquity approximates the feet, bringing them under the line of body weight in standing or walking. It gives the forward movement by increasing speed and smoothness. The femoral obliquity is greater in women due to greater in women due to greater pelvic breadth and shorter femora. The maximum length of the femur varies from a minimum of 373mm to maximum of 514mm with a mean value of 437.44mm. When this is compared to the range of unknown sex, 42 femora out of 50 could be identified as belonging to male and 8 to female. Comparisons were drawn separately for male left and right femora, because individual tend to favor one limb over other. It also has been observed that the female femur is shorter than male and in male the left longer than right and vice versa in female12 . Maximum length of femur was the best parameter for sexing the unknown femora11. Maximum length was measured following the standard techniques recommended by Martin and Seller13 . Discriminate analysis confirmed that the male femur is usually larger than the female femur9 sex differences in long bones is that typically male bones are longer and more massive than typically female bones1 . Anteroposterior diameter of femoral shaft in the present study we had taken measurements of femoral shaft at three different site, Upper – just below the lesser trochanter, Middle – approximately at the middle of shaft that is highest elevation of linea aspera. It measures the distance between anterior and posterior surfaces of the bone. Lower – approximately 4 cm above the cartilaginous margin of condyles taken in mid sagittal plane. Upper anteroposterior diameter of femur ranges from minimum of 22mm to maximum of 32mm with a mean value of 26.56mm. Middle anteropostero diameter of femur varies from minimum of 22mm to maximum of 30mm with a mean value of 26.38mm. Lower anteropostero diameter of femur ranges from minimum of 24mm to maximum of 35mm with a mean value of 28.50mm, when this is compared to the range of known sex 47 out of 50 femora identified as belonging to male and 3 to female by using upper anteroposterior diameter, 45 out of 50 femora could be identified as belonging to male and 5 to female by using middle anteroposterior diameter, 50 out 50 could be identified as belonging to male only by using lower anteroposterior diameter. Anteroposterior diameter of femoral shaft has been reported earlier by Purkait R14, the results of our study are not correlating with this study. Maximum anteroposterior diameter of shaft was measured following the technique given by Mac Laughlin and Bruce6 . Studies by Steyn and Iscan reval that all dimensions of femur were larger in males than in females but determination of sex of an individual from a single femur were a more difficult task15. The shaft of femur is so shaped that it varies at midlevel and at subtrochantric level. Hence several transverse and sagittal diameters are useful1 . According to Martin and Saller13 study femora are categorized in to Hyperplatymeric, Platymeric, Eurymeric and Stenomeric. In the present study 50 femora are categorized into 6 femora belongs Platymeric, 30 are Eurymeric, 14 are Stenomeric and non of femora belongs to Hyperplatymeric. Every parameter independent of others contributes certain percentage of certainty to decide the sex of unknown femur, therefore it is clear that based on no single parameter, sex of femur can be decided. All the parameters have to be considered together for this purpose.
CONCLUSION
The knowledge of morphometric values is helpful to anthropological and forensic practice.
ACKNOWLEDGMENTS
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=1477http://ijcrr.com/article_html.php?did=14771. Krogman, W. M. and Iscan, M. Y. Human Skeleton in Forensic Medicine. 2nd Edition, Charles C. Thomas, Springfield, 1986.
2. Strecker W, Keppler P, Gebhard F, Kinzl L. Length and torsion of the lower limb. J Bone Joint Surg Br. 1997; 79(6):1019-23.
3. Parsons, F.G. The character of the English thigh bone. Journal of Anatomy and physiology 1914; 48: 238-267.
4. Pearson K and Bell J. A study of long bones of the English Skelton Part-I femur, in the influence of race side and sex. Cambridge University Press, London, 1919; 128-130pp.
5. Stewart, T. D., "Identification by the Skeletal Structures," in Gradwohi's Legal Medicine, F. E. camps, Ed.3rd ed. Year Book Medical Publishers, Chicago, 1976;109-135pp.
6. Mac Laughlin SM, Bruce MF. A simple univariate for determining sex from fragmentary femora: its application to a Scottish short cist population. Am J Phys Anthropology 1985;67:413–7.
7. Dittrick J, Suchey JM. Sex determination of prehistoric central California skeletal remains using discriminant analysis of the femur and humerus. Am J Phys Anthropol. 1986; 70(1):3-9.
8. William, P.L., Warwick, R., Dyson, M. and Bannister, L.H.: Gray’s Anatomy. Churchill Livingstone, Edinburgh 1989.
9. Alan M. W. Porter. Analyses of measurements taken from adult femurs of a British population. International Journal of Osteoarchaeology. 1995; 5(4):305-323.
10. Yasar Iscan M, Ding Shihai. Sexual dimorphism in the Chinese femur. Forensic science international. 1995; 74; 79-87.
11. Leelavathy N, Rajangam s, Janakiram S, Thomas JM. Sexing of the femora. Indian journal of anatomical. Society of india.2000; 49(1):17-20.
12. Singh S.P, Singh S. A study of femoral curvature index in Indian subjects; Journal of Anatomical Society of India. 1973; 22(2): 86-89.
13. Martin, R. and Saller, K. Lehrbuch der Anthropologie. Gustav Fisher Verlag, Stuttgart, 1957.
14. Purkait R, Chandra H. Sexual Dimorphism in Femora: An Indian Study. Forensic Science Communications. 2002; 4(3):1-6.
15. Taner Zuylan, Khalil Awadh Murshid. An analysis of Anatolian human femur Anthropometry Turk j med sci. 2002; 32; 231-235.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareSTERNAL FORAMEN - A CASE REPORT
English8086Parvathi S.EnglishThe sternum or Breastbone is one of the flat axial bone forming the anterior part of thoracic skeleton. It resembles a short sword. The upper part is the manubrium, middle part is the body The lowest partappears the point of the sword is xiphoid process or xiphisternum. The length of adult sternum in an averagely build individual is about 17.2cm, which is longer in males that females. The foramen was found in one sternum during routine osteological class taken for 1st MBBS students in academic year-2011-12 in anatomy department. Student by name Krupa.K. JJMMC Davangere Karnataka State come and showed this bone. One oval shaped foramen of size 0.5cmX0.7cm was present on lower 1/3 of body of an adult sternum such a foramen of sternum is not common. This has been not only a focus of attention of anatomists but also at interest of Forensic experts, orthopedicians, paediatricians, cardiothoracic surgeons, physicians because it is very close contact with heart and lungs.
EnglishINTRODUCTION
The sternum or Breast bone is one of the flat axial bone forming the anterior part of thoracic skeleton. It resembles a short sword. The upper part is the manubrium, middle part is the body The lowest part appears the point of the sword is xiphoid process or xiphisternum. The length of adult sternum in an averagely build individual is about 17.2 cm, which is longer in males that females.
AIM:
Sternal along with ribs, vertebral variations described in the literature. The purpose of this study was to review and discuss and to highlight the importance of early recognition of these defects. These lesions are frequently overlooked at the initial evaluation 5 .
NORMAL ANATOMY OF STERNUM: The STERNUM
(from Greek sternon, "chest"; plural "sternums" or "sterna") or breastbone is a long flat bony plate shaped like a capital "T" located anteriorly to the heart in the center of the anterior wall of the thorax (chest). Thus the sternum plays an important role in protecting helps to protect the lungs, heart and major blood vessels from physical trauma. Its average length in the adult is about 17 cm, and is rather longer in the male than in the female. From the front, the sternum is shaped somewhat like a sword\dagger. From the side, the sternum appears as a long, flat bone with a outward curvature. The sternum consists of 3 parts: listed superior to inferior: the manubrium, the body of sternum or gladiolus, and the xiphoid process. The Manubrium (ma-NOO-bree-um) is the broad superior portion of the sternum, connects to the 1st pair of ribs. The superior end supports the clavicles (collarbones), and its margins articulate with the cartilages of the first seven pairs of ribs forming the front of the rib cage. The Body or Corpus Sterni or Gladiolus is the longest part of the sternum connects with the next 6 pairs of ribs. Together, these 7 pairs of ribs are known as the true ribs. The sternal angle is located at the point where the body joins the manubrium. The sternal angle is a useful landmark when counting ribs because the second rib attaches here. In early life its body is divided in four segments, called sternebrœ (singular: sternebra)
The Xiphoid Process or Processus Xiphoidus or Ensiform Appendix or Xiphoid Appendix --Located at the inferior end of the sternum is the pointed is the smallest of the three pieces. It articulates above with the body and on the front of each superior angle presents a facet for part of the cartilage of the 7th, 8th, 9th and 10th ribs. it gives attachment to the linea alba and, on the posterior surface, to the diaphragm9 .
OBSERVATIONS
During the examination of the skeleton an oval defect was found through the Xiphoid Process of the sternum. It was located in the center of the midline of the between the attachments of the 6th and 7th costal cartilages and measured of size 0.5cm X 0.7cm. The edges were smooth, well ossified rounded, and covered by cortical bone.
MATERIALS AND METHODS
The foramen was found in one sternum during routine osteological class taken for 1st MBBS students in academic year-2011-12 in anatomy department. Student by name Krupa. K. JJMMC Davangere Karnataka State come and showed this bone. One oval shaped foramen was present on lower 1/3 of body of an adult sternum such an foramen of sternum is not common. This have been not only a focus of attention of anatomists but also at interest of Forensic experts, orthopedicians, paediatricians, cardiothoracic surgeons, physicians because it is very close contact with heart and lungs.
DISCUSSION
In the fetus the sternum originally consists of two cartilaginous bars, one on either side of the midline, which become connected to the cartilages of the upper 9ribs on each side
These two bars fuse with each other along the middle line to form the cartilaginous sternum which is ossified from six centers in the following order: one for the manubrium and four for the body first piece of the body, during the sixth month; in the second and third pieces of the body, during the seventh month of fetal life; in its fourth piece, during the first year after birth; and one for the xiphoid process, between the fifth and eighteenth years. one for the manubrium, four for the body, and xiphoid process. During the 8th week of gestation these bars migrate, converge toward the midline, and fuse with each other, beginning cephalically. By the 9 week the union of the plates is established in the midline and fusion is almost completed to form the manubrium and body of the sternum. The xyphoid process is formed by a caudal extension of the sternal plate.These ossification centers appear between the articular depressions for the costal cartilages and divide the sternal plate into 6 transverse pieces. The 3rd, 4th, and 5th pieces are often formed from multicentric ossification centers placed laterally. The 3rd and 4 th appear during the 4th and 5th months of fetal life. The 5th usually appears one year after birth. Incomplete fusion of the sternal bars in this area accompanied by eccentric centers of ossification accounts for the relatively rare occurrence of a perforate sternum (sternal foramen), or of a vertical fissure which intersects this part of the bone and which is referred to as fissura sterni. Ossification of the sixth part in the xyphoid process; does not begin until the 5thto 18th year of life and partial cartilaginization may persist well into adult life. Thus, malformations of the xyphoid process due to abnormal fusion and irregular ossification are much more common. Abnormalities of the manubrium and upper portion of the body of the sternum where fusion and ossification occur early in fetal development are much more rare. The position of these defects, in the center of the lower portion of the body of the sterum between the articular surfaces of the costal cartilages, and their characteristic gross appearance are consistent with sternal foramina. Developmental defects of the sternum are usually not readily detected in vivo or in the intact body during postmortem examination, unless they are associated with severe malformations of the rib cage. Perforations or fissures are obscured on routine chest X-rays by the radio-dense structures of the mediastinum and by the superimposed thoracic vertebral column. Abnormalities can be demonstrated at autopsy by holding the removed breastplate between the prosector and a strong light source. If a defect is detected by transillumination, it can be documented by further dissection and by Xraying the breastplate alone. The differentiation between traumatic and congenital defects of the sternum does not present a difficult problem in bodies that are not decomposed. Associated abnormalities, either old or recent, in the surrounding soft tissues and adjacent structures and organs will indicate a lesion caused by injury. To these may be added the occasional existence of two small episternal centers, which make their appearance one on either side of the jugular notch; they are probably vestiges of the episternal bone of the monotremata and lizards. Occasionally some of the segments are formed from more than one center, the number and position of which vary, More rarely still the upper end of the sternum may be divided by a fissure. Union of the various centers of the body begins about puberty, and proceeds from below upward by the age of twenty-five they are all united. The xiphoid process may become joined to the body before the age of thirty, but this occurs more frequently after forty; on the other hand, it sometimes remains un united in old age. In advanced life the manubrium is occasionally joined to the body by bone. When this takes place, however, the bony tissue is generally only superficial, the central portion of the intervening cartilage remaining un ossified 1 . A sternal foramen, has been incidentally detected at CT in nearly 5% of the population Awareness of the presence of a sternal foramen in a patient who is undergoing acupuncture or sterna bone marrow aspiration is particularly important because of the risk of associated complications (eg, hemorrhage and cardiac tamponade.) A sternal foramen is well demonstrated at CT, with a typical bow-tie appearance on axial images of the sternal body .A vertical sclerotic band superior or inferior to the foramen is a common associated finding on coronal CT images. Rarely, a sternal cleft may be seen adjacent to a sternal foramen 3 6 . Minor sternal clefts (e.g., a notch or foramen in the xiphoid process) are common and are of no clinical concern 8 .It is possible that the formation of the sternum and proliferation of midlineangioblastic tissue may be affected by certain mechanisms during the sixth to ninth gestational weeks 10 . Further, in an asymptomatic patient with sternal cleft, careful investigation is needed to identify possible asymptomatic internal vascular anomalies. More frequently seen abnormalities of the lung and bronchial tree are abnormal divisions of the bronchial tree, sometimes resulting in the presence of supernumerary lobules, as in our two cases. Thesevariations in the bronchial tree are of little functional significance, but may cause unexpected difficulties in bronchoscopy 10 . Few doctors, and possibly fewer acupuncturists, are aware of congenital sternal foramina. Some authors conclude that if sternal acupuncture is planned in the corpus sterni region, radiographs should first be done to rule out this anomaly to avoid such fatal complications as cardiac tamponade following sternal puncture during treatment 10 Finally, 1. Severely macerated specimens should confirm the presence of a sternal foramen. The defect will be located in the midline through the lower half of the body of the sternum. The measurements of the defect will be the same on both the outer and inner surfaces of the bone. No beveling will be present on either surface. The edges with a hand lens will reveal it to be smooth and covered by cortical bone. 2. In specimens which have been exposed to insects, fauna, or marine animals, characteristic erosion, teeth, or claw marks may be present around the foramen, but these should not be mistaken for recent antemortem, traumatic injury. 3. The sternal foramen is a relatively rare congenital anomaly but when encountered by the pathologist in a case that has medicolegal implications, the failure to recognize it as a developmental abnormality can be a serious pitfall and hazard. 4. The misinterpretation of this bony defect by the nature of its location can result in ascribing a wrong cause and manner of death and frustrating, unnecessary expenditure of time and effort in the investigation of a suspected homicide or suicide 1 .
MEDICAL LEGAL IMPORTANCE
1. In badly decomposed bodies or skeletonized human remains a sternal defect may present a problem that can lead to misinterpretation and wrong conclusions which have serious consequences.
2. Postmortem artifacts of advanced putrification can obscure and mask the gross and microscopic changes of associated trauma.
3. In skeletons the character of the edges of the defect may be altered by scavenger animals or, when evaluating human skeletons which have been exposed or buried for longer periods of time, demineralization and erosion of the margins of the defect may have occurred.
4. The possibility of an old or recent gunshot wound or a traumatic penetrating lesion caused by an object other than a missile. X-rays of the body or remaining tissue parts and organs are necessary to rule out the presence of a missile. A separate X-ray of the sternum will disclose small metallic fragments about the defect that would be undetectable by gross examination.
5. Imaging of sternal foramen simulating osteolytic lesion 1, 3 . The defect in the body of sternum leaves only the skin separating the pleura and heart from the surface at the affected site, thus any penetrating injury would easily access the heart and cause more severe damage than would normally be. The longer manubrium is unusual and can be both a clinical, radiological and medico-legal challenge when encountered 7 .
APPLIED ASPECTS
Clinicians should be aware of this anatomic variation, because needle insertions in this area may lead to fatal complications Knowledge of the existence of such anatomic variants is important to avoid misdiagnosis as an osteolytic process 3 .
The possibility of a sternal foramen should be mentioned to the clinician because infiltration, biopsy or acupuncture of this area may lead to fatal cardiac complications2 .
Sternal foramina may pose a great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury. They can also be misinterpreted as osteolytic lesions in crosssectional imaging of the sternum.
Variant xiphoid morphology such as bifid, duplicated, or trifurcated may be mistaken for fractures during imaging3. These variations may complicate sternal puncture, and due caution is recommended. The variant xiphisternal morphology may raise alarm for xiphoid fractures and may therefore be considered a differential 2 . Also, important in radiological diagnosis, therapeutic procedures, forensic and medical legal pathological identifications. It is essential to students of medicine, radiology, anatomy and forensic pathology just as each variation could have unique features different from others,
CONCLUSIONS
The findings that are recorded is accordance with literatureThis have been not only a focus of attention of anatomists but also at interest of Genetitians, Embryologists, oncologists, paediatric endocrinologists, surgeons, physicians, psychiatrists, Forensic experts because it makes very verysensivitiv issue on the boy, family and society. Variations in numbers of both vertebrae and ribs do occur which can be subnumerary or supernumerary, and are important in radiological diagnosis, the rapeutic procedures, forensic and medical legal pathological identifications. Knowledge of such variation is essential to students of medicine, radiology, anatomy and forensic pathology just as each variation could have unique features different from others, and could be associated with a number of other congenital anomalies. The discovery of the sternum being different from the usual is important additions to the variations that are expected on the thoracic cage hence need to put this finding in serious consideration during our medical training and practice. Clinicians should be aware of the anatomic variation, because needle insertions in this area may lead to fatal complications 3 .
HIGH SIGNIFICANCE
1. Sternal foramina were significantly in blacks and episternal anomaly in whites. Sternal foramina had no sex predilection.
2. Sternal bone with sternal foramen, fracture and osteoporosis, and that bone marrow aspiration from sternal bones might not be as safe as previously thought.
3. In a retrospective review of the bone scan, patients with breast cancer, found to represent metastatic disease. The sternal lesions may with regional lymphatic tumor spread than hematogenous seeding and so local recurrence common. The incidence and significance of isolated sternal metastases undergoing radionucide bone imaging.
4. Many anatomic variants and congenital anomalies may affect the both sternum and sternoclavicular joints involved in pathologic conditions, including degenerative changes, arthritides, trauma, infection, and primary and secondary tumors.
5.Sternal foramen is a congenital oval fusion defect of the sternum occurring in up to 6.7% of autopsy and prevalence of focal bone thinning, fissures and other abnormalities seen in sternum can be detetected with bone scintigraphy, radiography, and CT imaging.
6. Sternal wound complications may result from median sternotomy procedures following cardiothoracic surgery and can represent a significant management problem like infections and can increase hospital stay, morbidity and mortality, but modern techiniques improves the conditions.
7. MDCT exhibits various sternal variations and anomalies. Sternal foramen is a frequent minor anomaly with sternal sclerotic bands. Early manubriosternal and sternoxiphoidal fusions can be seen in early adulthood with out osteo degeneration. Double-ended xiphoid process and single xiphoidal foramen are frequent sternal variations.
8. A bifid sternum is a rare congenital anomaly diagnosed as asymptomatic at birth may with other congenital anomalies or may be diagnosed only in adult life.
9. A complete congenital sternal cleft (absent sternum) with abnormalities of midline fusion may with pericardial defect and \ or with pectus excavatum of incidence is 0.15% of all chest deformities is very rare. In neonates this and the sternal bars can be easily approximated by simple suture, due to the flexibility of the cartilaginous thorax with little danger of cardiac compression when the repair is performed early in life (1stmonth).
10. The imperfect union is known as midlinesternal foramens, an anomalies mistaken for a gunshot wound or by CT, High resolution computed tomography (HRCT) and visual inspection in the lower part of the sternum, even in the manubrium may be with displacement of the heart or other midline abnormalities.
11.Sternal cleft is a midline defect. May be Incomplete (common) or complete (rare) it leads to mediastinal structures ( the heart and great vessels) can easily be injured by external trauma with no familial, teratogenic or nutritional factors have been identified as a potential cause . Failure of fusion of the lateral sternal bands by an early disturbance affecting the midline mesodermal structures between the 6 th and 9 th IUL. Multiplanar and 3D reconstructed multidetector CT (MDCT) images are useful in the evaluation of the human skeleton - the sternum.
12. Misinterpretation of autopsy findings (artifacts) from forensic pathology are major cause of concern to forensic scientists encountered in the medicolegal autopsy of skeletonized human remains.
13. Sternal foramina may leads great hazard during sternal puncture, due to inadvertent cardiac or great vessel injury . May be mistaken as osteolytic lesions in c\s imaging of the sternum. variant xiphoid morphology such as bifid, duplicated, or trifurcated may be mistaken for fractures.
14. Bony union of the segments of the stenum starts in early childhood but is normally not complete before the 15yrs of life (Ashley, 1954). Early fusion or defective segmentation of the sternum with congenital heart disease seen. Currarino et al. (1958) reported; A large septal defect with a wide ductus arteriosus confirmed by autopsy, noticed one radiological evidence of an aberrant right subclavian artery.
15 Episternal bones were commonly on unilateral [left] than bilateral with out any clinical significance, they are of potential forensic value in individual identification.
ACKNOWLEDGEMENTS
Author acknowledges 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. Special thanks and I am grateful to my brother Anil for his moral support and encouragement during preparation of paper.
Englishhttp://ijcrr.com/abstract.php?article_id=1478http://ijcrr.com/article_html.php?did=14781. J Forensic Sci, Oct. 1974, Vol. 19, No. 4 H. L. Taylor,1 M.D. The Sternal Foramen: The Possible Forensic Misinterpretation of an Anatomic Abnormality.
2. Sternal foramina and variant xiphoid morphology in a Kenyan population) H. ElBusaid, etal.
3. Sternal Foramen Simulating Osteolytic Lesion on Scintigraphy and SPET Imaging. Philip Pevenage1, Michel De Maeseneer2, Kristoff Muylle1, Michel Osteaux21 Department of Nuclear Medicine; 2Department of Radiology Brussels, Belgium.
4. CASE REPORT-- Bifid sternum Year : 2012, Volume : 29, Issue : 1, Page : 73-75Sibes Kumar Das1, Pulak Kumar Jana2, Tapan Das Bairagya3, Bhaswati Ghoshal .
5. Lane F. Donnelly, MD, Donald P. Frush, MD, Joseph N. Foss, MD2,Sara M. O'Hara, MD and George S. Bisset III, MD- Anterior Chest Wall: Frequency of Anatomic Variations in Children.
6. [Henry Gray (1821–1865). Anatomy of the Human Body. 1918. The Sternum.Ossification of sternum.
7. Sternal Anomalies with Supernumerary and Subnumerary Vertebrae and Ribs – Case Reports East and Central African Journal of Surgery, Vol. 12, No. 1, April, 2006, Vol. 12, Num. 1, 2007, pp. 99-104. Ochieng, J. and Ibingira, C.B.R.Department of Anatomy, faculty of medicine, Makerere University Uganda Email: ochiengjoe@yahoo.com.
8. Skeletal System Development. Development of Human Skeletal System Copyright © 2011 by U. Bala)
9. Sternum -Francois Manson, MD ; Philippe Jeanty, MD, PhD.
10. Anatomic and HRCT Demonstration of Midline Sternal Foramina,Tr. J. of Medical Sciences28 (1998) 511-514.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareCOMPARATIVE STUDY OF INTRATHECAL CLONIDINE AND INTRATHECAL BUPRENORPINE FOR POSTOPERATIVE ANALGESIA AFTER LOWER LIMB ORTHOPEDIC SURGERY
English8791Sapkal Pravin S.English Kulkarni Kalyani D.English Rajurkar Sampda S.English Nandedkar Prerna D.EnglishObjective: To evaluate and compare the efficacy, duration of post-operative analgesia and untoward effects of intrathecal Clonidine 60μg and intrathecal Buprenorphine 60μg used as additive adjuvants in spinal anesthesia for lower limb orthopaedic surgeries.
Method: Total 80 patients, aged 20-60 yrs, belonging to ASA grade I and II undergoing elective or emergency lower limb orthopaedic surgery scheduled to last less than 180 minutes and fit to receive spinal analgesia were randomly allocated into two groups. Group C received intrathecal 0.5% heavy Bupivacaine 3.0 ml with Clonidine 60μg and Group B received intrathecal 0.5%. Heavy Bupivacaine 3.0 ml with Buprenorphine 60μg. Duration of subarachnoid block, total analgesia, effective analgesia, number of rescue analgesics and any untoward effects were assessed and compared in both groups.
Results: Both groups were comparable in demographic data. The difference in the duration of subarachnoid block in both groups is statistically significant. The duration of total analgesia in both groups is statistically comparable. Effective analgesia in Clonidine group was statistically longer than Buprenorphine group. The nausea was noted in 17.5% of patients in Buprenorphine group and 7.5% patients in Clonidine group. Vomiting was present in 5% of patients in Buprenorphine group while none of the patient in Clonidine group had vomiting.
Conclusion: This study concludes that intrathecal Clonidine 60μg significantly prolongs the duration of spinal anesthesia and quality of analgesia was acceptable to patients in both groups though VAS assessment was better in Buprenorphine group. Hence we suggest that combination of low dose intrathecal α2 agonist and opioid would give better analgesia & might reduce incidence of untoward effects.
EnglishEffective analgesia, subarachnoid block, ?2 agonist, opoid.INTRODUCTION
Severe acute postoperative pain itself can easily hinder early physiotherapy, which is the most important factor for successful postoperative knee rehabilitation especially following arthroscopic surgeries {1}. Buprenorphine is common & potent opioid which can be safely used intrathecally {2}. But such opioids are not devoid of side effects may be minor like pruritus, somnolence or may be distressing like nausea & vomiting or respiratory depression {3}. Clonidine an α2 agonist is another drug, which when used intrathecally gives good analgesia & is claimed to have no side effects like opioids {4}. But, Clonidine intrathecally may cause bradycardia, somnolence, and hypotension {1}. So we have decided to evaluate effects of intrathecal clonidine and compare it with intrathecal Buprenorphine in elective lower limb orthopedic surgeries.
MATERIALS AND METHODS
This was a prospective study of 80 patients who were randomly enrolled and allocated into either group after written and informed consent.
Inclusion criteria:
American Society of Anesthesiologist (A.S.A.) grade I & II patients, aged 20-60yrs, undergoing lower limb orthopedic surgery emergency or elective scheduled to last less than 180 minutes, and willing to participate in study.
Exclusion criteria:
Patient refusal, patient using α adrenergic receptor antagonist for any reason, patient receiving ACE inhibitors /β blockers, Dysrrhythmias on ECG, morbidly obese patients, contraindication to subarachnoid block, general or epidural anesthesia given in addition to subarachnoid block.
Preoperatively detailed medical, surgical history, allergies were noted. Preoperative detailed general & systemic examination was done and vitals recorded and necessary investigations were done. Demographic data like age, weight (kg), height (cm) obtained for each case. The patients were familiarized with the 10 cm visual analogue scale (V.A.S) for pain during the pre-anesthetic visit. Patients were kept fasting for 6-8hrs prior to anesthesia. After shifting the patients to operation theatre, baseline monitoring of E.C.G, noninvasive blood pressure, oxygen saturation, and respiratory rate were recorded. A 20 Gauge i.v line was established. All patients were preloaded with 10ml/kg of lactated Ringer solution over 15-20 minutes. The patients were randomly assigned to one of the study groups. The study drugs were prepared by an anesthetist not involved in patient assessment. After strict aseptic precautions a midline lumbar puncture was performed with a 26 gauge Quinke needle at the L3-4 interspace with patient in the sitting position. Intrathecal drugs were injected with the needle bevel pointing caudally and over a period of 30 seconds as follows: Group B: 3.0 ml of 0.5% Hyperbaric Bupivacaine + Buprenorphine 60 μg. Group C: 3.0 ml of 0.5% Hyperbaric Bupivacaine + Clonidine 60 μg. The haemodynamic parameters i.e. heart rate, blood pressure, respiratory rate and SpO2 were recorded just before the block and then every 5 minutes after the intrathecal injection until the end of the surgery and then post-operatively every 2hrs until 24 hrs. The level of sensory analgesia, degree of motor blockade and sedation score were recorded every 5 minutes until 30 minutes after the intrathecal injection. The level of sensory analgesia was assessed using 25 gauge short bevel needle and recorded as analgesia to loss of sensation to pin prick. Motor Blockade was determined according to the Modified Bromage Scale {5}. Sedation score was analyzed every 2 hrly during postoperative period for 24hrs.Sedation was analyzed as follows:- Regular intra-operative monitoring was done. Duration of anesthesia was recorded as time interval from intrathecal injection to regression of sensory block below L1. Intraoperative hypotension was defined as a fall of mean arterial pressure (M.A.P.) to less than 20% of baseline and was treated with rapid infusion of 200 ml of Lactated Ringer solution and / or 3 mg aliquots of injection mephenteramine intravenously. Bradycardia i.e.–heart rate less 50 / minute was treated with intravenous atropine sulphate with increments of 0.3 mg. No additional analgesic was given during intraoperative period.
Postoperative Evaluation:
The evaluation started immediately post-operatively. Following data were collected: pulse, NIBP, RR every 2hrly up to 24hrs. Assessment of analgesia by VAS every 1hr up to first dose of rescue analgesia & thereafter every 2 hrly & additionally if patient complained of pain, up to 24hrs. Assessment of data was done as:
1) Duration of subarachnoid block: Time from intrathecal injection up to regression of sensation (pinprick,) at L1 dermatome.
2) Total analgesia i.e. time from subarachnoid injection to first report of pain i.e. VAS≥1.
3) Effective analgesia i.e. time from subarachnoid injection to first parenteral rescue analgesia at VAS ≥4.
4) Presence and time of occurrence of any untoward effects like nausea, vomiting, pruritus, respiratory depression (i.e. RR 0.05 in Unpaired T-test proves that both groups are comparable with respect to total analgesia (min.) The nausea was noted in 17.5% of patients in Buprenorphine group and 7.5% patients in Clonidine group. Vomiting was present in 5% of patients in Buprenorphine group while none of the patient in Clonidine group had vomiting. Other side effects noticed in Clonidine group were hypotension in 2.5% patients, bradycardia in 5% of patients and dryness of mouth in 10% of patients in Clonidine group. Somnolence was noticed slightly higher in Buprenorphine group i.e. 7.5% while, 2.5% in Clonidine group.
DISCUSSION
In the present study it is found that intrathecal Clonidine 60µg significantly prolongs the duration of spinal anaesthesia. Intrathecal Buprenorphine 60µg gives adequate analgesia up to 818.9 ± 135 min to which is significantly longer than that of intrathecal clonidine i.e. 686.5 ± 41.9 min. Similar finding was seen in Forgarthy DJ et.al{7}, Bonnet F et.al {8}, Sites BD et.al {9} and Gordh T {10}. In the present study intrathecal clonidine shown nausea, hypotension, bradycardia and dryness of mouth, While buprenorphine group shown nausea, vomiting and somnolence as side efffect. Eisenach J et.al[{11} found that Clonidine produces its antinociceptive, cardiovascular, and sedative effects by actions at multiple sites. Segal IS et.al {12} found that these effects depend upon site of administration while Filos KS et.al {13} proved that these depend upon dose and concomitant administration of other drugs. Study suggests that combination of two or more drugs from different group (e.g. Opioid and α 2 agonist) can give better analgesia and less chance of side effects.
CONCLUSION
Intrathecal Clonidine 60µg significantly prolongs the duration of spinal anesthesia. Intrathecal Buprenorphine 60µg gives adequate analgesia upto 818.9 ± 135min mins to whichsignificantly longer than that of intrathecal clonidine i.e. 686.5 ± 41.9 min. Quality of analgesia was acceptable to patients in both groups though VAS assessment was better in Buprenorphine group. We further suggest that combination of low dose intrathecal alpha 2 agonist and opioid would give better analgesia & might reduce incidence of untoward effects.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1479http://ijcrr.com/article_html.php?did=14791. Eisenach J, De Kock M, Klimscha W. Alpha2- Adrenergic agonists for regional anesthesia: a Clinical review of clonidine (1984-1995). Anesthesiology 1996; 85:655- 74.
2. Verma RS, Patodiv, et al. Post operative pain relief with intrathecal buprenorphine. Ind Jour of Anaesthesia 1991; 89 : 32-3
3. Boas RA, Villiger JW. Clinical actions of fentanyl and buprenorphine. Br J Anaesth 1985; 57: 192–6.
4. Gradhe RP, Wig J, Yaddanapudi L N: Evaluation of Bupivacaine-Clonidine for unilateral spinal anaesthesia in lower limb orthopedic surgery.J Anas clin pharmacol 2008; 24(2):155-8.
5. Bromage PR.A comparison of the hydrochloride and carbon dioxide salts of lidocaine and prilocaine in epidural analgesia. Acta Anaesthesiol Scand 1965; 16 (Suppl): 55-69
6. IBM SPSS Statistics [computer program].Version 19.0.0. Somers (NY): IBM coporation;2010
7. Forgarthy DJ, Caranine UA, Milligan KR. Comparison of the analgesic effects of intrathecal clonidine and intrathecal morphine after spinal anaesthesia in patients undergoing total hip replacement. Br. J. Anesthesia, 1993;71: 661-4.
8. Bonnet F. Buisson VB, Francois Y, et al . Effects of oral and subarachnoid clonidine on spin Capogna G, Celleno D, Tagariello V, Loffreda-Mancinelli C. Intrathecal buprenorphine for postoperative analgesia in the elderly patient. Anaesthesia 1988; 43: 128
9. Sites BD, Christopher R, Biggs R, Beach ML, Wiley C. Intrathecal clonidine added to a bupivacaine-morphine spinal improves postoperative analgesia following total knee arthroplasty. Indian J Anesth 2002; 96: 918.
10. Gordh T Jr. Epidural clonidine for treatment of postoperative pain after thoracoscopy. A double blind placebo-controlled study. Acta Anesthesiol Scand. 1988;32:702-9.
11. Eisenach J, Detweller D, Hood D. Hemodynamic and analgesic actions of epidurally administered Clonidine. Anesthesiology 1993; 78: 277-87.
12. Segal IS, Jarvis DJ, Duncan SR, White PF, Maze M. Clinical efficacy of oraltransdermal Clonidine combinations during
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareEPIDEMIOLOGY AND AETIOLOGICAL DIAGNOSIS OF KERATOMYCOSIS IN A TERTIARY CARE HOSPITAL IN NORTH KARNATAKA
English9297Sathyanarayan M.S.English Suresh B. SonthEnglish Surekha Y.A.English Mariraj J.English Krishna S.EnglishIntroduction: Keratomycosis is a common cause of corneal blindness and requires prompt diagnosis for early initiation of antifungal treatment. The present study was undertaken to determine the epidemiological features associated with laboratory confirmed cases of keratomycosis, to compare the direct microscopy and culture in the diagnosis of keratomycosis and to determine the pattern of fungal isolates in these cases. Research Methodology: Epidemiological data of 87 suspected keratomycosis cases over a period of one year from July 2009 to June 2010 was noted and the cases were investigated for evidence of fungal pathogens in corneal scrapings by direct microscopy using 10% Potassium Hydroxide (KOH) preparation, Gram stain and fungal culture as per standard protocols.
Results: A majority of the 34 laboratory confirmed cases were noted in the rural population, with a male predominance and mostly in the age group associated with outdoor activity. KOH preparation was found to be most sensitive (82.35%) among the techniques studied. Aspergillus spp. were the commonest isolates (69.56%) encountered.
Conclusion: Rural population, especially males in the active working age group and those involved in agriculture were found to be predisposed to the development of fungal corneal ulcers. Rapid and reliable detection of presence of fungal elements in suspected cases of keratomycosis can be done using direct microscopy with KOH preparations of corneal scrapings. Aspergillus spp. were found to be the commonest isolates, followed by Fusarium spp. and dematiaceous fungi in patients presenting with keratomycosis in Bellary.
EnglishKeratomycosis, KOH preparation, Gram stain, Culture, Aspergillus spp.INTRODUCTION
The term ‘keratomycosis’ refers to invasive infection of corneal stroma caused by a variety of fungal species and is frequently encountered in many tropical countries including India and is a significant cause of infective monocular blindness. The precipitating event for fungal keratitis is often trauma with a vegetable / organic matter, seen mostly in agricultural workers. Implantation of fungus directly in the cornea by trauma leads to slow growth and proliferation to involve the anterior and posterior stromal layers. The fungus can penetrate the descemet's membrane and pass into the anterior chamber. The patients present a few days or weeks later with fungal keratitis. Keratomycosis is reported to be very common, representing 40%-50% of all cases of culture-positive infectious keratitis in India.1,2 Fungi have been reported as the commonest isolates in studies of microbial keratitis from South India.3,4 Bellary is a district in North Karnataka region in southern part of Indian subcontinent with a predominant agriculture based rural population. The study was intended to determine the epidemiological factors and to compare microscopic techniques with culture for the diagnosis of keratomycosis. The present study was undertaken in the department of microbiology to determine the epidemiological features in patients with confirmed keratomycosis, to compare direct microscopy using 10% KOH preparation, Gram stain and Culture on Sabouraud’s Dextrose Agar (SDA) in the diagnosis of keratomycosis and also to study the pattern of isolation of fungal pathogens in cases of keratomycosis among patients attending the tertiary care hospital attached to Vijayanagar Institute of Medical Sciences (VIMS), Bellary, Karnataka.
MATERIALS AND METHODS
This prospective study was carried out over a period of one year from July 2009 to June 2010. Patients presenting with clinically suspected fungal corneal ulcers with signs and symptoms of inflammation with or without hypopyon were included in this study. Patients presenting with suspected or confirmed viral keratitis, bacterial keratitis, interstitial keratitis, sterile neurotropic ulcers and ulcers associated with autoimmune conditions were excluded from the study.5 The clinical history and epidemiological data of the patients included in the study were noted. Corneal scrapings were collected for direct microscopic examination and fungal culture after, performing a detailed ocular examination and clinical diagnosis of keratomycosis as per standard protocol. A total of 86 specimens of corneal scrapings from 48 male and 38 female patients fulfilling the inclusion criteria were collected using standard techniques and processed for direct microscopy using 10% KOH preparation, Gram stain and culture on SDA in the mycology section of the department of microbiology, VIMS, Bellary during the study period. A stained smear or wet mount using 10% KOH preparation was considered positive for fungus if one or more fungal filament was seen on the entire slide and the findings correlated with the clinical condition. The scrapings from the corneal ulcers were inoculated directly onto Sabouraud’s dextrose agar with antibiotics but without cycloheximide as per standard protocols. The material was directly inoculated onto the surface of solid media in a row of c-shaped streaks, incubated at 25°C and 37oC for a period of three weeks; the plates were examined daily during the first week and twice weekly during the next two weeks. The isolate was considered to be significant if it was consistent with the clinical signs, growth occurred on the ‘c’ streak, smear results were consistent with culture and the same organism showed growth on more than one media.2,5,6 The mycelial isolates were identified by their colony characteristics on SDA plates, microscopic morphology on lactophenol cotton blue (LPCB) mount and slide culture as per standard mycological guidelines. The culture was considered as sterile if no growth was observed even after four weeks of incubation.2,5 A definitive case of keratomycosis was considered when fungal elements were detected by microscopic methods or culture on SDA yielded a fungal isolate and the finding was consistent with the clinical condition of the patients.
STATISTICAL METHODS
Diagnostic parameters like Sensitivity, Specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV) of the three diagnostic methods were calculated using standard formulae.
RESULTS
A total of 34 cases (39.08%) were confirmed as keratomycosis in the present study by correlating the laboratory and clinical findings. Males were predominantly affected by keratomycosis as compared to females in the present study- 20 males and 14 females (Male: Female ratio- 1.7:1). Mean age of occurrence of keratomycosis was 46.44 years. Maximum number of keratomycosis cases was encountered in the age groups of 41 – 60 (13/34 cases), followed closely by the age group of 21 – 40 (12/34 cases). No cases were detected in cases in patients below 20 years of age. 18 of the 34 confirmed cases were found to be involved in agricultural occupation (52.94%), 26 of the 34 cases (76.47%) were from a rural area and 19 of them had history of corneal trauma (55.88%). Fungal elements were identified by microscopy by Gram stain in 16 cases, KOH mount in 28 cases and 23 cultures grew fungal isolates on SDA and fulfilled the criteria of being pathogens (Table 1 and 2). All Gram stain positive smears were found to be positive by KOH mount. 11 cases were positive only by KOH preparation and 6 cases were only positive on culture. Thus, Gram stain and KOH mount were found to be sensitive in 69.56% and 73.91% of culture proven keratomycosis cases respectively. Among the techniques studied, the sensitivity of KOH preparation was found to be higher than culture and Gram stain in laboratory confirmed cases of keratomycosis (Table 3). Of the 23 fungal isolates, Aspergillus spp. were the commonest isolates (16/23 isolates- 69.56%), Aspergillus niger being the commonest pathogen isolated in 7 cases, followed by Fusarium spp., and dematiaceous fungi. (Table 4).
DISCUSSION
Fungal infections of the cornea are important causes for monocular blindness, being mainly prevalent in tropical countries and regularly reported from South India.3,4 Fungal infections of the cornea are commoner in persons involved in agricultural occupation. Early diagnosis of cases of keratomycosis is essential to initiate antifungal therapy and to prevent complications including corneal blindness. The incidence of 39.08% of fungal aetiology noted in the present study compares with the findings of other studies.5,7 The mean age of occurrence of keratomycosis in the present study was found to be 46.44 years and the pattern of age distribution of cases encountered showed a majority of the cases being reported in the 21 – 60 years age group reflecting the active working period of life with a higher incidence in those over 40 years of age, exposing them to risk of developing keratomycosis. A majority of the cases noted were from rural areas and in those involved in agriculture. These are comparable to the findings in the studies of J.Chander et al and Parmjeet Kaur Gill et al.5,7 20 of the 34 confirmed cases (58.82%) were in males in the present study which is comparable to the study of Tahereh Shokohi et al.8 Various modalities are available for diagnosis of the condition, but the lack of infrastructure in many laboratories especially in developing countries act as an impediment for the diagnosis. Direct microscopy using a 10% KOH preparation is a technique which can be easily followed even in resource poor settings. The sensitivity of KOH preparations in detecting fungal elements in corneal scrapings have been reported to be high and these preparations have been useful in confirming a diagnosis of fungal keratitis in clinically suspected cases even when the cultures were negative.9 Other microscopic techniques using Calcofluor white (CFW) and its modifications like KOH + CFW preparations have been reported to have higher positive microscopic yield as compared to conventional KOH preparations. However, these methods require the availability of fluorescent microscope. Recent advances include Polymerase Chain Reaction (PCR), Confocal microscopy, Immunofluorescence staining etc.2,10 Gram stain among other stained preparations has been evaluated by various researchers earlier and in the present study lacks sensitivity and hence can result in underreporting of cases of keratomycosis. Isolation is considered as a definitive method of diagnosis of keratomycosis. Culture on SDA was considered as gold standard in many studies.11 However, reports suggest that direct microscopy from the corneal scrapings by KOH preparation can reveal more cases than culture on SDA when microscopic findings are correlated with clinical presentation.12 Agricultural occupation which has been identified as the major risk factor in the present study for keratomycosis has been reported in a number of studies. 5,7 The sensitivity of KOH preparation in confirming the diagnosis of keratomycosis was determined to be 82.35% overall (28/34 cases) and 73.91% among culture positive cases (17/23 cases) in the present study, while that of Gram stain was 47.06% overall and 69.56% among culture positive cases. These findings are comparable to the reports of Jagdish Chander et al and Tahereh Shokohi et al.5,8 The absence of growth on culture in cases where the direct microscopy was positive could be the administration of topical antifungal agents or steroids prior to collection of corneal scrapings. Aspergillus spp. have been reported as the leading cause of keratomycosis in the Indian subcontinent by various authors. 5,6,13,14 The pattern of isolation in the present study is comparable to the report of J. Chander et al. and Samar Basak et al.5,15
CONCLUSIONS
Keratomycosis is commoner in the active working age group, presenting mostly among patients from a rural background with agricultural occupation and exhibits a male predominance. Early diagnosis of the condition is imperative for initiation of antifungal therapy and to prevent blindness. KOH preparation is a simple, rapid and less labour intensive method with reliable sensitivity which can be used for confirming the diagnosis of keratomycosis. Identification of fungal elements in direct microscopy using 10% KOH preparation of corneal scrapings and isolation of fungal pathogens on SDA and correlation with clinical findings are recommended as confirmatory for the diagnosis of keratomycosis. Aspergillus species were the commonest causative fungi, followed by Fusarium spp. and dematiaceous fungi in keratomycosis in the present study.
ACKNOWLEDGEMENTS
The authors express their deep gratitude to the faculty of the departments of ophthalmology and microbiology, VIMS, Bellary for their valuable help in collection and processing of clinical specimens from patients with clinical suspicion of keratomycosis for the study. Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1480http://ijcrr.com/article_html.php?did=14801. Agarwal V, Biswas J, Madhavan HN et al. Current perspectives in infectious keratitis. Indian J Ophthalmol 1994; 42: 171-92.
2. Nayak N. Fungal infections of the eye: laboratory diagnosis and treatment. Nepal Med Coll J. 2008;10:48–63.
3. Thomas PA, Kaliamurthy J, Geraldine P. Epidemiological and microbiological diagnosis of suppurative keratitis in gangetic West Bengal, Eastern India. Indian J Ophthalmol 2005;53:143.
4. Srinivasan M, Gonzales CA, George C, Cevallos V, Mascarenhas JM, Asokan B, et al. Epidemiology and aetiological diagnosis of corneal ulceration in Madurai, south India. Br J Ophthalmol 1997; 8: 965-71.
5. Chander J, Singla N et al. Keratomycosis in and around Chandigarh. A five-year study from North Indian tertiary care hospital. Indian J Path Microbiol 2008; 51 (2): 304-6.
6. Chowdhary A, Singh K. Spectrum of fungal keratitis in North India. Cornea 2005; 24: 8- 15.
7. Parmjeet Kaur Gill, Pushpa Devi. Keratomycosis- A retrosprective study from a North Indian tertiary care institute. JIACM 2011; 12(4): 271-3.
8. T. Shokohi, K. Nowroozpoor-Dailami, T. Moaddel-Haghighi. Fungal keratitis in patients with corneal ulcer in Sari, Northern Iran. Arch Iranian Med 2006; 9 (3):222 – 227.
9. Vajpayee RB, Angra SK, Sandramouli S, Honavar SG, Chhabra VK. Laboratory diagnosis of keratomycosis: Comparative evaluation of direct microscopy and culture results. Ann Ophthalmol 1993; 25: 68-71.
10. Rajeev Sudan, Yog Raj Sharma. Keratomycosis: Clinical diagnosis, Medical and Surgical Treatment. JK Science 2003; 5(1): 3-10.
11. A Laila, Salam MA, B Nurjahan, R Inthekhab, I Sofikul, A Iftikhar. Potassium Hydroxide (KOH) wet preparation for the Laboratory Diagnosis of Suppurative Corneal Ulcer. Bangladesh Journal of Medical Science 2010; 9(1): 27-32.
12. Sharma S, Garg P, Gopinathan U, Athmanathan S, Garg P, Rao GN. Evaluation of corneal scraping smear methods in the diagnosis of bacterial and fungal keratitis: A survey of eight years of laboratory experience. Cornea 2002; 21: 643-647.
13. Venugopal PL. Venugopal TL. Gomathi A, Ramakrishnan S. Ilavarasi S. Mycotic keratitis in Madras. lnd J Pathol Microbiol 1989: 32: 190-97.
14. Chander J, Sharma A. Prevalence of fungal corneal ulcers in Northern India. Infection.1994;22:207-09.
15. Basak SK, Basak S, Mohanta A, Bhowmick A. Epidemiological and microbiological diagnosis of suppurative keratitis in Gangetic West Bengal, eastern India. Indian J Ophthalmol 2005; 53 : 17-22.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareEVALUATION OF FERTILITY EFFICACY OF IONIDIUM SUFFRUTICOSUM EXTRACT ON SENILITY INDUCED STERILITY OF MALE ALBINO RATS
English98103B. Senthil KumarEnglish J. Vijaya KumarEnglish R. SelvarajEnglishBackground: Ageing is associated with the diminished function of various tissues in the body. The gonadal function decreases with the increase in age. Testes undergo atrophy resulting in shrinkage of seminiferous tubules due to reduced testosterone hormone level in elderly male. The process of spermatogenesis decreases in old age when compared to young adults. Today’s lifestyle makes an adult sub fertile even in their earlier age of 30-40 years. To overcome this problem many non-hormonal preparations are in need, so an herbal trial was planned initially on animals which will be followed up to humans in future, if the herb proved to be safe. Objective: To evaluate the fertility efficacy of Ionidium suffruticosum extract on senility induced sterility of male albino rats.
Research Methodology: A total of 16 healthy senile male albino rats weighing 300 to 330 gm were selected. Ionidium suffruticosum extract of 200mg/kg bodyweight were administered orally to the senile experimental albino rats (n=8) and compared to the senile control albino rats (n=8) using various parameters and the drug’s efficacy was proved by the restitution of fertility in senile rats.
Results: The administration of the drug showed significant improvement of all the parameters in experimental rats when compared to control rats. The data’s were analyzed using student’s t test and found to be statistically significant.
Conclusion: The herb was found to be effective on the gonads of senile male albino rats, regaining its fertility to normal, when compared to control rats.
EnglishIonidium suffruticosum, senile rats, Sterility, Seminiferous tubule, Siddha MedicineINTRODUCTION
In our day-to-day life, change in culture and food habits, adulteration, exposure to various radiations, chemical hazards, pollution, smoking, and alcohol, and various diseases like hypertension, diabetes mellitus, obesity, and resultant grave side effects of medication for these conditions, impacts the human species with dangerous and unexpected complications on fertility in life. Even recent studies reveal the fact that, the usage of electronic devices such as mobile phones and its radiations, affect the gonads to a great extent. [1] Ageing is associated with the diminished function of various tissues in the body. This decline in the organism’s capacity for optimal functioning may be attributed to changes arising out of involution and wear and tear of the tissues. With age, there are also changes occurring in the cell membrane and chemicals, particularly in the cellular enzymes. The gonadal function declines with age. In the male, there is progressive atrophy of the spermproducing elements of the testis, resulting in diminished spermatogenesis. [2]
There is a remarkable increase in the use of herbs over the past few years and research interests have focused on various herbs. According to Siddha system of medicine (Indian Medicine) many herbs were used for treating male sexual disorders since ancient times. Several nonhormonal herbal preparations have been used to correct such sexual disorders. Apart from these preparations some individual herbs also have the effect of treating such sexual disorders. The present research was undertaken to study the aphrodisiac effect of individual herb Ionidium suffruticosum (Ging) on fertility of senile male albino rats.
MATERIALS AND METHODS
a) Animal selection
The study was done on 16 healthy senile male albino rats (Rattus norvegicus) of Wister lineage with an average weight of 300 – 330 gm of 16-18 months were housed in the cages and fed with standard pellets and given fresh water ad libitum and acclimatized on a 12 hour light & 12 hour dark schedule. [3] The study was approved by Saveetha University Animal ethical committee approval reference no- ANAT.005/2012. The rats were divided into 2 groups control (n = 8) and experimental (n = 8) by random allocation method. The cages are labeled with group, weight of the animal and dosage of the drug. About one week was given for the acclimatization of rats. The Ionidium suffruticosum (Ging) extract was prepared as per our protocol. [4] About 200 mg / kg bodyweight was diluted with adequate amount of sterile water and administered orally to the experimental group using oral gavage tube and simultaneously sterile water were given orally to control rats (placebo). The drug was administered as single dose, once a day for 30 days regularly to all the experimental animals. Rest period of about 10 days were given to all the animals after drug administration. The sexual behaviour was observed as per our previous study protocol. [5]
b) Sample collection The rats were anaesthetized using Xylazine & ketamine. [6] A vertical incision was given ventrally and jugular vein was traced out, about 2ml of blood was taken followed by midline thoraco-abdominal incision was given and the heart was perfused with normal saline followed by buffered formalin until blenching and twitching occurs in the animal. Scrotum was incised and the testicles were removed. The epididymis was removed from the testes by fine dissection.[7]
I) Measuring dimension of testes The lengths, breadth, height and weight of the testes were measured as per the method used in our previous study. [8] The volume of the testis were calculated using the Lambert’s formula [9] (Volume = Length x Breadth x Height x 0.71 cu.cm). The testes were fixed by gendre’s fluid (Fixative) for 48 hrs. The relative weight of testes gonado-somatic index (GSI) were calculated with the help of following formula (GSI = Weight of testes in grams / Body Weight in grams x 100) where weight of Testes (Absolute weight in gram) and body Weight (weight of rats on the 40th day in gm). [10, 11] The data’s were tabulated.
II) Semen and serum testosterone hormone analysis: The semen samples were collected from the epididymis and sperm count was done as per standard protocol followed in our previous study. [8] Smears were also prepared from the semen samples. The slides were stained by Papanicolaou stain. [12] The morphological characteristic of the sperm cells in all the smears were observed under oil immersion (100 X). The numbers of normal and abnormal sperm cells were tabulated for both control and experimental group, by counting 200 sperm cells per smear and two smears per rat randomly. The data’s were analyzed by ChiSquare test. Serum was separated, from the blood sample. Testosterone hormone level was estimated using ELISA analyzer and the readings were noted down.
III)Histomorphometry of testes The Gendre’s fluid fixed testes were processed in different percentage of alcohol, xylene and embedded in paraffin wax. Eight sections (5 µm thick) were taken at different levels in each half of testis using rotary microtome and stained by haematoxylin and eosin. [12, 13] The stained slides were mounted and carefully observed for histological changes and morphometric analysis was done. Micrometry was used to measure the diameter of the seminiferous tubules. The stained slides were focused under 10x objective, about 50 tubules diameter was measured using Magnus pro image analysis software and calculated using the formula (Diameter of seminiferous tubules = Maximum length + maximum breadth / 2 µm). [14, 15, 16] The mean diameter was taken from the 50 seminiferous tubules per section of testes. The final average diameter of the seminiferous tubules of each animal was tabulated. The mean, standard deviation, Standard error mean were calculated and tabulated. Further all the parameters data’s were analyzed by student’s t test using Graph pad software quick cals online calculator for scientist. [17]
RESULTS
Various parameters such as sexual behaviour, body weight of animals, dimension of testes, hormonal analysis, semen analysis, histological analysis of testes, histomorphometry of seminiferous tubules, and diameter of seminiferous tubules were tabulated (Table 1 & 2) and all the parameters were analyzed using student’s t test except sperm morphology which was analyzed by Chi-square test. The data’s analyzed were found to be statistically significant. The administration of the drug showed significant improvement of all the parameters in experimental rats when compared to control rats and the drug’s efficacy was proved by the restitution of fertility in senile rats.
DISCUSSION
The mounting index has shown variation among the control and experimental rats and it proves that there is some effect of Ionidium on the male sexual activity of senile rats. The total sexual behavior of the rats were observed and the sexual activity was more in experimental rat when compared to the control rats resulting in statistically significant (Table 1). The weight of control rats were more or less equals when compared to the experimental rats. There is no much gain of weight in senile rats when compare to young rats from our previous study and the weight gain is statistically not significant. [8] The results pertaining to the weight and volume of the testes and GSI were analyzed which showed a marked difference between the Control and experimental rats respectively. The testes of control rats showed seminiferous tubules with much shrinkage and loss of their tubular appearance and the lumens appear empty (Fig 1). [18] Whereas the experimental rats have regained more or less normal seminiferous tubules (Fig 2) and these changes resulted the increase in weight, volume of testes and GSI in experimental rats and the data’s were statistically significant (Table 1). Histological analysis of seminiferous tubules showed reduction in number of spermatozoa in control rats than that of experimental rat was observed. [18] Spermatocytes count showed increased severe reduction in number and is significant. In mammals, spermatogenesis is totally dependent upon testosterone. [19,20] The following abnormalities were noticed both in the control and experimental groups as described by Oyeyemi et al headless tail, rudimentary tail, curved mid piece, curved tail, looped tail, bent mid piece, tailless head, and bent tail. [21] The morphological analysis of the spermatozoa of control rats had more number of abnormal spermatozoa than the experimental rats which showed a marked decrease. Further analysis of the spermatozoa count, using Chi-square test was found to be highly significant (p ? 0.001). The control rat testes were compared to that of the experimental group of senile rats. The experimental rat testes showed normal in appearance (Fig 2&4) whereas the control senile rats testes damage was observed in 45 % tubules and some tubules seemed to be completely empty without the spermatozoa (Fig 1&3). The diameter of seminiferous tubule showed marked variation in experimental than control group. The Leydig cells were normal but the stroma was considerably reduced in control rats. [18] Hamada et al had done a study on concentration of testosterone hormone in different age groups stating that the concentration declines with increasing age. [1] The testosterone hormone level of experimental rats showed marked variation than that of control. The Leydig cell which found to be normal in experimental rat seminiferous tubule and that was responsible for secretion of testosterone in experimental rats as well as control rats had few Leydig cells with reduced stroma secreting less testosterone hormone. The hormone levels of both groups were statistically significant (Table 1).
CONCLUSION
Herbs are gaining wide importance in the treatment of various chronic ailments, Nowadays researches turned towards herbal trials because of its need to cure various diseases. A preliminary animal study was carried out in albino rats to evaluate the fertility effect of the herb. The Ionidium suffruticosum extract administration showed significant positive results in improving various parameters involved in maintaining maleness. Various parameters of the study were analyzed which proved to be more effective in senile rats. Furthur the qualitative and quantitative analysis of Ionidium suffruticosum, alkaloid specificity is still under process.
ACKNOWLEDGEMENT
Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Englishhttp://ijcrr.com/abstract.php?article_id=1481http://ijcrr.com/article_html.php?did=14811. Alla J Hamada, Aspinder Singh, Ashok Agarwal. Cell phones and their importance on male fertility, fact or fiction. The Open Reproductive Science Journal 2011; 5: 125- 127.
2. Ganeriwal S K, Tiwari B V, Reddy B V, Kher J R. Effect of geriforte on male reproductive organs in albino rats. Indian Drugs 1998; (19) 3: 102.
3. Ufaw. The Handbook on the management of laboratory animals. Churchillivingstone Edinburgh, London; 1976. pp.46.
4. Senthil Kumar B, Vijaya Kumar J, Selvaraj R. An Acute Oral Toxicity Study of Cycas circinalis and Ionidium suffruticosum in Wister Albino Rats, International journal of Pharmaceutical Sciences Review and Research 2012;17(2): 97-100.
5. Senthil Kumar Babu, Panneer Selvi Gopalsamy, Effect of Ceric Sulphate on Gonads of Male Albino Rats, International Journal of Research in Pharmacy and Science 2012; 2 (3): 60-68.
6. Paul Flecknell. Laboratory animal anesthesia, 3 rd edition. Elsevier publication; 2009. pp.187.
7. Gay IW. Methods of animal experimentation, Academic Press; London; 1966. pp.54.
8. Senthil Kumar B, Vijaya Kumar J, Effect of Ionidium Suffruticosum seeds on Testes of young Albino Rats, International Journal of Pharmacy and Biological Sciences. 2012; 2(3):106-112.
9. Ming Li Hsieh, Shih Tsung Huang, Hsin Chieh Huang, Yu Chen and Yu-Chao Hsu. The reliability of ultrasonographic measurements for testicular volume assessment: comparison of three common formulas with true testicular volume. Asian Journal of Andrology 2009; 11: 261–265.
10. Qamar Hamid, LiagatAliminhas, Sadaf Hamid, Anjuman Gal. Influence of cimetidine and bromocriptine on weight of rats and its relation with fertility. Journal of clinical medicine and research 2010; 2(2): 015-021.
11. RabiaLatif, Ghulam Mustafa Lodhi, Muhammad Aslam. Effects of amlodipine on serum testosterone, testicular weight and Gonado-Somatic Index in adult rats. J Ayubcollabhottabad 2008; 20(4): 8-10.
12. Druby RAB, Wallington EA. Carleton’s Histological technique, 5th edition, Oxford University press, Newyork, 1980. pp. 140- 142, 344-346.
13. Culling CFA. Handbook of Histopathological and Histochemical techniques, 3rd edition, press, 1975, pp.49, 213, 491-92.
14. Tung Yang Wing, Kent Christensen. A Morphometric studies on rat seminiferous tubule. The American Journal of Anatomy 1982; 165: 13-25.
15. Weibel ER, Bolender RP. Stereological techniques for microscopy. A Hayat Ed van Nostrand Reinhold, New York: 237-296.
16. Elias H, Hyde DM. An elementary introduction to stereology (quantitive microscopy). Am J Anat 1980; 159: 411- 446.
17. Graph pad software, website http://www.graphpad.com/quickcalcs/ttest1.c fm
18. Mathur R, ReenaKulshrestha. Restitution of Ceric sulphate- induced sterility in rats by Zinc and speman. J.Scien.Res 1984; 6(I): 11- 13.
19. Pakarainen T F, Zhang S, Makela M. Poutanen I. Huhtaniemi Testosterone replacement therapy induces spermatogenesis and partially restores fertility in luteinizing hormone receptor knockout mice. Endocrinol. 2005; 146: 596-606.
20. Wang R, S Yeh, C Tzeng, C Chang Androgen receptor roles in spermatogenesis and fertility: Lessons from testicular cellspecifi c androgen receptor knockout mice. Endocrinol. Rev.2009 ; 30: 119-132.
21. Oyeyemi MO, oluwatoyin O, AjalaLeigh OO, Adesiji T, Fisayo. The Spermiogram of male Wister rats treated with aqueous leaf extract of veronica amygdalina: Folia Veterinaria 2008; 52(2): 98-101.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareEFFECT OF GENDER, AGE AND DURATION ON DYSLIPIDEMIA IN TYPE 2 DIABETES MELLITUS
English104113Shabana S.English Sasisekhar T.V.D.EnglishIntroduction: The burden of dyslipidemia is high in patients with diabetes. Although there is considerable evidence that abnormalities in serum lipids and lipid metabolism are important risk factors for increased incidence of coronary artery disease in type 2 diabetes, controversy exists regarding the association of dyslipidemia with the gender, age and duration of diabetes.
Objective: To study the prevalence and association of lipid disorders with gender, age, and duration of type 2 diabetes mellitus. Materials and methods: This is a cross-sectional prospective study of 270 diabetic patients at a tertiary care teaching hospital. The subjects were grouped based on the gender, age and duration of diabetes and into subgroups by a five year scale based on the age and duration of diabetes. Fasting venous blood samples were analyzed for serum total cholesterol (TC), triglycerides (TG), low-density lipoprotein LDL-C and high-density lipoprotein cholesterol (HDL-C).
Results: Prevalence of dyslipidemia was more in female than in male diabetics. There was a gender preference of some lipid parameters. By age and by duration of diabetes, certain subgroups showed higher prevalence of dyslipidemia in both sexes. The degree of dyslipidemia by age showed an increasing trend and then reached a plateau, while it increased with increased duration of diabetes in both male and female diabetics. Although the distribution of lipid abnormalities increased with duration of diabetes, by age it showed no particular pattern of predominance in both sexes p>0.05.
Conclusion: The predominance of dyslipidemia at an older age, the increased prevalence and higher lipid abnormalities in the female diabetics indicate that female diabetics are at a higher risk of atherosclerosis and subsequently coronary artery disease compared to male diabetics.
EnglishDyslipidemia, type 2 diabetes mellitus, atherosclerosis, coronary artery diseaseINTRODUCTION
Diabetes is metabolically heterogeneous and dyslipidemia is commonly seen in diabetic patients. Lipid abnormalities in patients with diabetes play an important role in the development of atherogenesis. Together with hypertension and smoking, dyslipidaemia is an established risk factor for coronary artery disease (CAD), both in diabetic and non-diabetic patients. Patients with type 2 diabetes commonly have a number of risk factors for atherosclerosis, among which dyslipidaemia plays a major role in the excess CAD mortality associated with the condition [1]. Mortality from CAD is approximately three times higher in diabetic patients than in the general population [2]. The burden of dyslipidemia is high in patients with diabetes. These lipid disorders include not only quantitative but also qualitative abnormalities of lipoproteins which are potentially atherogenic [3]. Type 2 DM is associated with a cluster of interrelated plasma lipid and lipoprotein (LP) abnormalities that are all recognized as predictors for coronary heart disease [4]. Hypertriglyceridemia combined with a reduced HDL cholesterol is the most common dyslipidemia in patients with noninsulindependent diabetes mellitus, but essentially any pattern of dyslipidemia may be present [5]. Although there is considerable evidence that abnormalities in serum lipids and lipid metabolism are important risk factors for this increased incidence of CAD in type 2 diabetes, controversy exists regarding the association of dyslipidemia with the gender, age and duration of diabetes and reports of prevalence and distribution of dyslipidemia are varied. In view of the predisposition for the development of atherosclerotic vascular disease in the diabetics, attention has been focused on lipid and lipoprotein metabolism in diabetes. We aimed to investigate the prevalence and pattern of lipid disorders among type 2 diabetic patients. In particular, we investigated the prevalence and association of lipid disorders with gender, age, and duration of type 2 diabetes.
MATERIALS AND METHODS
This is a cross-sectional prospective study. A total of 270 patients of both sexes were randomly selected from the outpatient department of medicine, in Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, a tertiary care teaching hospital. The study was approved by the institutions ethical committee and informed consent was obtained from all the subjects enrolled in the study. Subjects of both sexes, in the age group of 35-70 yrs who gave a history of diabetes and were under treatment with either oral antidiabetic drugs or insulin were included in the study. The subjects who gave a history of any cardiovascular, renal or thyroid disorders and whose duration of diabetes was less than 1 year or more than 15 years were excluded from the study. Patients on drugs known to affect lipids i.e., lipid lowering drugs, contraceptive pills, hormone replacement therapy, β-blockers, and thiazide diuretics were excluded from the study. The subjects were grouped based on the gender, age and duration of diabetes and into subgroups by a five year scale based on the age and duration of diabetes. Venous blood samples from all the subjects were collected after at least 8h fasting and analyzed for serum total cholesterol (TC), triglycerides (TG) and high-density lipoprotein cholesterol (HDL-C) on Randox (Daytona) autoanalyzer. Serum total cholesterol and triglycerides assay were done using enzymatic methods and HDL cholesterol by precipitation technique. The level of lowdensity lipoprotein cholesterol (LDL-C) was determined using the Friedwalds formula: LDL= Total Cholesterol – (TG/5 + HDL) when the values of TG were less than 400 mg%. For serum lipid reference level, National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (ATP III) guideline was referred [6]. According to NCEP-ATPIII guideline, hypercholesterolemia is defined as TC >200 mg/dl, high LDL-C when value is >100 mg/dl, hypertriglyceridemia as TG >150 mg/dl and low HDL-C when value is Englishhttp://ijcrr.com/abstract.php?article_id=1482http://ijcrr.com/article_html.php?did=14821. François berthezène. Diabetic dyslipidaemia. Br J Diabetes Vasc Dis 2002;2(suppl 1):S12– S17.
2. Taskinen MR. Strategies for the management of diabetic dyslipidaemia.Drugs 1999; 58(suppl 1):47-51.
3. Sowers JR, Lester MA. Diabetes and cardiovascular disease. Diabetes Care 1999;22(suppl 3):C14-C20.
4. Taskinen MR. Diabetic dyslipidaemia. Atherosclerosis. Supplements, 2002;3 (1): 47–51.
5. Oki JC. Dyslipidemias in patients with diabetes mellitus: classification and risks and benefits of therapy. Pharmacotherapy. 1995;15(3):317-37.
6. Third Report of the Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). http://www.nhlbi.nih.gov/guidelines/choleste rol/atp3full.pdf..
7. Gu K, Cowie C, Harris M. Diabetes and decline in heart disease mortality in US adults. JAMA.1999;281:1291-7.
8. Manson J, Colditz G, Stamfer M et al. A prospective study of maturity onset diabetes and risk of coronary heart disease and stroke in women. Arch Intern Med 1991;151:1141- 7.
9. Mohan V, Deepa R, Rani SS, Premalatha G, Chennai Urban Population Study (CUPS No. 5). Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: the Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol. 2001;38(3):682–7.
10. Arvind K, Pradeepa R, Deepa R, Mohan V. Diabetes and coronary artery disease. Indian J Med Res. 2002;116:163–76.
11. Kannel W, McGee D. Diabetes and cardiovascular disease: the Framingham Study. JAMA 1979;241:2035-8.
12. Fontbonne A, Eschwege E, Cambien F et al. Hypertriglyceridaemia as a risk factor of coronary heart disease mortality in subjects with impaired glucose tolerance or diabetes. Results from the 11-year follow-up of the Paris Prospective Study. Diabetologia 1989;32:300-4.
13. Ogbera AO, Fasanmade OA, Chinenye S, Akinlade A. Characterization of lipid parameters in diabetes mellitus – a Nigerian report. International Archives of Medicine 2009, 2:19.
14. Haseeb AK. Clinical significance of hba1c as a marker of circulating lipids in male and female type 2 diabetic patients Acta Diabetol,Springer-Verlag 2007
15. Nakhjavani M, Esteghamati AR , Esfahanian F and Heshmat AR. Dyslipidemia in type 2 diabetes mellitus: more atherogenic lipid profile in women. Acta Medica Iranica, 2006;44(2): 111-118.
16. U.K. Prospective Diabetes Study 27.Plasma lipids and lipoproteins at diagnosis of NIDDM by age and sex. Diabetes care. 1997;20(11):1683-7.
17. Harris SB, Ekoé J-M, Zdanowicz Y, et al. Glycemic control and morbidity in the Canadian primary care setting (results of the diabetes in Canada evaluation study). Diabetes Res Clin Pract.2005;70:90-97.
18. Otamere HO , Aloamaka CP, Okokhere PO and Adisa WA. Lipid Profile in Diabetes Mellitus; What Impact Has Age and Duration. British Journal of Pharmacology and Toxicology .2011;2(3): 135-137,.
19. Riffat Sultana. Impact of duration of type 2 diabetes mellitus on lipid profile. Gomal Journal of Medical Sciences January-June 2010; 8(1)57-59 20. Wannamethee SG, Shaper AG, Whincup PH, et al. Impact of diabetes on cardiovascular disease risk and all-cause mortality in older men. Arch Intern Med 2011; 171:404-410
21. Walden C, Knopp R, Wahl P, Beach K, Strandness E. Sex differences in the effect of diabetes mellitus on lipoprotein triglyceride and cholesterol concentrations. N Engl J Med 1984;311:953-9.
22. Suhuan Liu and Franck Mauvais-Jarvis. Minireview: Estrogenic Protection of βCell Failure in Metabolic Diseases. Endocrinology. 2010; 151(3):859–864
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareEFFICACY OF FINE NEEDLE ASPIRATION CYTOLOGY IN EVALUATION OF BREAST LUMPS: A ONE YEAR STUDY
English114118Sumit GiriEnglishBackground: Lumps in breast have always commanded a great deal of attention because of fear of their being cancerous. Preoperative diagnosis helps in planning the correct surgical and therapeutic treatment. Aim: This study was aimed to assess the efficacy of Fine Needle Aspiration Cytology (FNAC) in breast lump evaluation with regards to sensitivity, specificity, positive predictive value and negative predictive value. Materials and Methods: This study was carried out on 277 breast lump cases at the Department of pathology, Dr. Hedgewar Arogya Sansthan Hospital from July 2009 to July 2010. FNAC was performed by cytopathologist with a 21 or 22G needle that was attached to a 10cc syringe. Two slides were stained with May Grünwald-Giemsa (MGG) and 2 with Papanicolaou (Pap) stain. FNAC results were compared with final histopathological diagnosis. Taking histopathology as gold standard criteria, sensitivity, specificity, positive predictive value and negative predictive value of FNAC for detection of various lesions were calculated. Results: A total of 277 cases of FNAC of breast Lumps were obtained, out of which histopathological correlation was available in only 31 (11.19%) cases. Out of 12 histopathologically confirmed malignant cases, 8 cases were diagnosed as malignant on FNAC, two cases as suspicious for malignancy, one case as atypical hyperplasia and one as benign mammary lesion. There was not even a single case which was diagnosed as malignant on FNAC and later turned out to be benign on histopathology. Out of 31 cases where histopathology was available, in 28 cases the FNAC diagnoses correlated well with the final histopathological diagnosis. In the remaining 3 cases, one was diagnosed as benign mammary lesion and others as atypical hyperplasia on FNAC. On histopathological examination all 3 showed infiltrating ductal carcinoma. The Sensitivity, Specificity, Positive predictive value and Negative predictive value of FNAC were found to be 90.32%, 100%, 100% and 86.36% respectively.
Conclusion: FNAC is a quick, inexpensive, simple, safe and readily acceptable procedure to patient and can be performed in Out Patient Department. It helps in providing a speedy and accurate diagnosis of not only breast cancers but also the majority of benign lesions mimicking malignancy.
EnglishBreast lump, FNAC, sensitivity, specificity.INTRODUCTION
Breast lumps in women encompasses a spectrum of benign and malignant disorders. Benign proliferative breast disease is an extremely complex and interrelated group of proliferative disorder of the breast parenchyma, most of which are not true neoplasm but are hormonally induced hyperplastic processes. Breast cancer is the most common type of cancer in women, in the age group of 40 – 50 years. It is the second leading cause of cancer deaths i.e about 250,000 women die of this disease every year [1]. Increase in cases of breast cancers are related to late marriage, birth of child in the later age, shorter period of breast feeding and nulliparity or low parity. Though histopathological diagnosis is a universally accepted confirmatory mode of diagnosis & follow up, fine needle aspiration cytology (FNAC) of breast lumps is an important part of triple assessment (clinical examination, imaging, and FNAC) of palpable breast lumps. Fine needle aspiration cytology (FNAC) is a relevant and important diagnostic method in the management of breast cancer. It has high sensitivity and specificity in determining the pathology of breast lumps [2,3,4,5, 6]. This study was aimed to assess the efficacy of FNAC in breast lump evaluation with regards to sensitivity, specificity, positive predictive value and negative predictive value.
MATERIALS AND METHODS
This retrospective study was carried out at the Department of pathology, Dr. Hedgewar Arogya Sansthan Hospital from July 2009 to July 2010. FNAC was performed on 277 cases by cytopathologist with a 21 or 22G needle that was attached to a 10cc syringe. The skin over the lump was completely cleaned with antiseptic solution. The palpable lesion was immobilized and the needle inserted into the lesion. Multidirectional sampling was done by to and fro movement of the needle. Negative pressure was applied during this time and released prior to removing the needle. At least 3 passes were made. The needle was taken out as some fluid /blood appeared in the hub. The sample obtained was pushed onto a glass slide and smeared. At least 4 slides were prepared. 2 slides were airdried and 2 were fixed with 95% alcohol. These air-dried slides were stained with May GrünwaldGiemsa stain, while the alcohol-fixed slides were stained with Papanicolaou stain in the cytopathology laboratory. Unsatisfactory slides were excluded from the study. Except for mild pain reported by some patients, no other complications were recorded. Pre-operative FNAC results were compared with final histopathological diagnosis in 31 patients. Taking histopathology as gold standard criteria, sensitivity, specificity, positive predictive value and negative predictive value of FNAC for detection of various lesions were calculated. The sensitivity of a test is the ability of a test to identify correctly all those who have the disease (True positive/True positive + False negative). The specificity of a test is the ability of the study to identify correctly the candidates who do not have the disease. (True negative /True negative +False positive). The positive predictive value of a test indicates the probability that the patient with a positive test has, in fact, the disease in question (True Positive / True Positive + False Positive). The negative predictive value of a test indicates the probability of a patient with a negative test not having the disease in question (True negative / True negative + False negative ). Formula used for detection of sensitivity, specificity, positive predictive value and negative predictive value was as follows: Sensitivity = (True positive / True positive + False negative) x100 Specificity = (True negative / True negative + False positive) x100 Positive predictive value = (True Positive / True Positive + False Positive) x100 Negative predictive value= (True negative / True negative + False negative) x100
RESULTS
A total of 277 cases of FNAC of breast Lumps were obtained, out of which histopathological correlation was available in only 31 (11.19%) cases. FNAC and histopathology results were grouped into five diagnostic categories (Table 1). Out of 12 histopathologically confirmed malignant cases, 8 cases were diagnosed as malignant on FNAC, two cases as suspicious for malignancy, one case as atypical hyperplasia and one as benign mammary lesion. There was not even a single case which was diagnosed as malignant on FNAC and later turned out to be benign on histopathology. Out of 31 cases where histopathology was available, in 28 cases the FNAC diagnoses correlated well with the final histopathological diagnosis (Table 2). In the remaining 3 cases, one was diagnosed as benign mammary lesion and others as atypical hyperplasia on FNAC. On histopathological examination all 3 showed infiltrating ductal carcinoma (Fig.1). In our study 28 cases were true positive, 3 were false negative and no false positive. Since female without any breast lump was not included in this study, we had no true negatives or female with normal breasts. So we calculated 19 cases (17 benign and 2 inflammatory on histopathology) as true negatives which were also diagnosed as benign and inflammatory lesions on FNAC. The Sensitivity, Specificity, Positive predictive value and Negative predictive value of FNAC is shown in Table 3.
DISCUSSION
Breast lump have always commanded a great deal of attention because of fear of their being cancerous. Most of breast disease takes the form of palpable lump, sometimes painful and most of these conditions have possible confusion clinically with cancer [7]. Women breast lump are in a state of anxiety. Hence a quick diagnosis of lump in the breast is essential. FNAC of breast lump is an accepted and established method to determine the nature of breast lump with high degree of accuracy [8,9,10,11]. This study was aimed to assess the efficacy of FNAC in breast lump evaluation with regards to sensitivity, specificity, positive predictive value and negative predictive value. Our study revealed the sensitivity of 90.32% and specificity of 100% which were in accordance to sensitivity of 77- 99% and specificity of 92-100% reported in various studies[12-18]. In the present study, cases suspicious for malignancy and with atypical hyperplasia were found to be infiltrating ductal carcinoma following biopsy. This emphasizes need for further evaluation of such lesions, which often prove to be malignant [17]. This study also documented the fact that the benign lesions of breast are the most common lesions. This increased case of benign lesions indicates increase in awareness of patients. In such lesions the reassurance is the main line of treatment though close follow up is mandatory.
CONCLUSION
It is concluded that FNAC is an ideal adjunct tool in cancer program and management of patients presenting with breast lump as it helps in early diagnosis. It is a rapid, relatively atraumatic and accurate method for the diagnosis of breast lumps. It is highly accurate and has low false positive and false negative diagnosis. It can be carried out safely as a preoperative diagnostic method in patients with breast lump, mostly in outpatient department. Mastectomies can be prevented by early diagnosis and open biopsies need can be reduced. So it is recommended that FNAC should be used as a routine diagnostic method to maximise availability of health care to patients with breast lesions.
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=1483http://ijcrr.com/article_html.php?did=14831. Fatima S, Faridi N, Gill S. Breast Cancer: Steroid Re-ceptors Prognostic and other Prognostic Indicators. JCPSP 2005; 15 (4): 230 – 233.
2. Furnival CM, Hocking MA, Hughes HE, Reid MM, Blumgart LH (1975). Aspiration cytology in breast cancer. Its relevance to diagnosis. Lancet, 2, 446-9.
3. Nicosia SV, Williams JA, Horowitz SA, et al (1993). Fine needle aspiration biopsy of palpable breast lesions. Review and statistical analysis of 1875 cases. Surg Oncol, 2, 145- 60.
4. Ballo MS, Sneige N (1996). Can core needle biopsy replace fine-needle aspiration cytology in the diagnosis of palpable breast carcinoma. A comparative study of 124 women.Cancer, 78, 773-7.
5. Yeoh GP, Chan KW (1998). Fine needle aspiration of breast masses: an analysis of 1,533 cases in private practice. Hong Kong Med J, 4, 283-8.
6. Chaiwun B, Settakorn J, Ya-In C, et al (2002). Effectiveness of fine-needle aspiration cytology of breast: analysis of 2,375 cases from northern Thailand. Diagn Cytopathol, 26, 201-5.
7. Mushtaque S, Memon N, Karamat KA. Breast cancer in Pakistani women. Pak JPathol 1998; 9 (2); 1-3.
8. Purasiri P, Abdalla M, Heys SD, Ah-See AK, McKean ME, Gilbert FJ, Needham G, Deans HEand Eremin O. A novel diagnostic index for use in the breast clinic. J R Coll Surg Edinb 1996; 41: 30-4.
9. Kaufman Z, Shpitz B, Shapiro M, Rona R, Lew S, Dinbar A. Triple approach in the diagnosis of dominant breast masses: combined physical examination, mammography and fine-needle aspiration. J Surg Oncol 1994; 56: 254-7.
10. Dehn TCB, Clarke J, Dixon JM, Crucioli V, Greenall MJ, Lee ECG. Fine needle aspiration cytology, with immediate reporting in the outpatient diagnosis of breast disease. Ann R Coll Surg Engl 1987; 69: 280-2.
11. Dixon MJ, Anderson TJ, Lamb J, Forest AMP. Fine needle aspiration cytology, in relationships to clinical examination and mammography in the diagnosis of a solid breast mass. Br J Surg 1984; 71: 593-6.
12. Hussain MT. Comparison of fine needle aspiration cytology with excision biopsy of breast lump. J Coll Physicians Surg Pak 2005; 15(4): 211-214.
13. Jayaram G, Alhady SF, Yip CH. Cytological analysis of breast lesions: A review of 780 cases. Malaysian Journal of Pathology 1996; 18: 81-87.
14. Muhamed AZ, Edino ST, Ochicha O, Alhasan Su. The Value of Fine-needle aspiration biopsy in preoperative diagnosis of palpable breast lumps in resource-poor countries: a Nigerian experience. Annals of African Medicine 2005; 4: 19-22.
15. Rubin J, Horiuchi K, Joy N, Haun W, Read R, Ratzer E, Fenoglio M. Use of FNAC for solid breast lesions is accurate and cost effective. Am J Surg 1997; 174: 694-6.
16. Ishikawa T, Hamaguchi Y, Tanabe M, Momiyama N, Chishima J, Nakatini Y, Nozawa A, Sasaki T, Kltamura H, Shimada H. False positive and false negative cases of fine needle aspiration cytology for breast lesions. Breast Carcinoma 2007; 14: 388-92.
17. Argia R, Bloom K, Reddy VB, Klusens L, Francescotti D, Dowlat K, Sizipikou P, Gattuso P. Fine Needle Aspiration of clinically suspicious palpable breast masses with histopathological correlation. Am J Surg 2002; 184: 410-413.
18. Choi YD, Choi YH, Lee JH, Nam JH, Juhng SW, Choi C, Acta Cytol. 2004; 48: 801-806.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30HealthcareROLE OF FATHER IN KEY AREAS OF MATERNAL AND CHILD HEALTH: A CROSS-SECTIONAL STUDY
English119126Swapna S. KadamEnglish Bhagwant S. PayghanEnglishBeing in a male dominant society, Indian women are considered responsible for reproductive and child health. Health education activities regarding reproductive and child health are more women oriented. Responsibility of male partner is considered only in family planning. Role of husbands in maternal and child health is undoubtful as they are decision makers and earning members of the family. Knowledge and awareness about the unknown events during pregnancy can make childbirth an extremely enriching and joyful event. Involvement of men in antenatal care can play a vital role in ensuring safe pregnancy, delivery and moral support to wives. Present study was conducted to assess the knowledge, perceptions and practices of men in key areas of maternal and child health like conception, contraception and Maternal and Child Health care. An observational study was conducted in urban area of Chitradurga .A total of 300 randomly selected men, who had child below two years of age were interviewed by using predesigned, pretested, semi structured questionnaire and after seeking verbal consent. The findings pointed out that respondent’s opinion about age at marriage, age at first conception, son preference, desired family size, acceptance of male contraceptive were adverse and pointed out gaps in knowledge and awareness. Most of the men were aware about the importance of antenatal care and hospital delivery, however their participation in activities related to it was found negligible. Male involvement in child care is seen to be limited to immunization and seeking medical help in illness. The study pointed out gaps in knowledge and misconceptions among men on key areas of MCH issues and stresses the need for male friendly health education. The findings also suggest the need to change perceptions about couple’s role in MCH issues and effective couple communications.
EnglishMale responsibility, RCH, KAP, Antenatal care.INTRODUCTION
Every minute, a woman dies of pregnancy-related causes throughout the world, and for every woman who dies; more than 20 others suffer pregnancy - related illness or infection. (1) Because women bear the greatest burden of pregnancy-related and reproductive ill-health, national health programs are women oriented. Ignoring men in policy decisions fails to take in the full spectrum of influence on issues affecting maternal health. Women are usually not the sole decision makers and often not even the principal decision makers about their own contraceptive use, child bearing and caring. (3) Against this background, male involvement is evolving as an important approach for improving maternal and child health. This is partly because men play important roles in reproductive experiences of females and partly because they are often culturally placed as decision makers .Men regulate the household economics and also force their views or choices on females. However patriarchy, ignorance, lack of knowledge and poverty may make it easy for males to take wrong decision or no decision on matters relating to health of their female partners even when obvious need for urgent and appropriate decision exists. (4) Women cannot utilize even free, basic health services against their husbands wish. To bring about equity in gender relations, male participation or male shared involvement in reproductive health is of utmost importance. However, sense of shared and responsible relationship in all aspects of reproductive and child health among men is lacking and needs to be vigorously promoted. Researches in India have found that male involvement is necessary to enhance both use of contraceptives and antenatal care.(16,17,18) Male participation is not simply a question of who will use the family planning method ,men or women .Rather ,it is a question to what extent men can and will expand their support throughout the reproductive cycle of woman. (2) Present study is an attempt to assess the knowledge of men in key areas of MCH, to study their perceptions about their role in MCH care and to study their practices regarding contraception, conception and child care.
METHODOLOGY
This is a cross sectional study conducted in urban field practice area of Department of Community Medicine,BMCH,Chitradurga.The proportion of married men of aged 19-40 is about 25% , with 95% confidence interval and 5% of absolute precision, the required sample size was 288 .( 10 ) .The urban field practice area is having 15 anganwadi centres.List of children below two years of age was obtained from all anganwadi centers .We randomly selected 20 babies from each anganwadi and fathers of these babies were contacted considering unavailability and refusal of respondents. All the fathers were interviewed by using predesigned and pretested semi structured questionnaire after seeking verbal consent. Along with the socio-demographic characteristics, the perceptions and behaviour of men regarding conception, contraception and maternal and child care was studied. Data was analyzed and percentages were used for comparison.
RESULTS
A total of 300 men interviewed, the average age of study subject was 28.75.The minimum age of subject was 19 years. As shown in table no.1.the average age at marriage for the respondents was 23.15 years and for their spouses it was observed 16.18 years. The average number of children per couple was found to be 2.1. and the average duration of marriage was reported 6.33 years. Out of 300 subjects,8.7% were illiterate and most of them (74 %) were studied up to high school level. 61%were Hindu ,32% were muslims.49.33% were from lower middle class and 33% were from lower class according to modified Kuppuswami’s classification. Majority of the respondents (62%) were unskilled labourer.About 70% have nuclear family. As shown in Table No.2, 58% respondents said that boys should marry after 21 years of age while only 17% think that girls should marry after 18 years of age and 3% men didn’t know the legal age of marriage. About the birth of first child after marriage,47% of respondents said that a couple should have child within one year of marriage.Prefered sex of child was male as reported by 45% of respondents. Only 1% knew that male is responsible for sex of the child. The desired number of children per couple was reported two by 52% of respondents and these respondents also wanted at least one son. Only 27% respondents were currently using contraceptives. 283 (94.3%) respondents said that they would prefer tubectomy as a permanent method of contraception. The reasons quoted were didn’t know about availability y of vasectomy services(10.6%), it’s all woman’s business(39.9%), family or wife would not allow them for vasectomy (36%). Table no.3 shows, responses regarding perceptions and knowledge about MCH care. Only 27% men knew signs of pregnancy,87% knew importance of antenatal visits,75% knew the importance of hospital delivery,95% responded that breastfeeding is essential for babies but only 10% men knew the complete immunization schedule and 38% knew about ideal time for weaning. Among practices(as shown in table no.4) ,52% ensured three ANC checkups for wives during pregnancy but only 13% accompanied wife for ANC check up.52% ensured hospital delivery but only 7.7 % were present at the time of delivery. While 6.3% were not involved in any activity related to care during pregnancy. Very few men are involved regularly in day to day activities of child care. Only 4% helped in feeding the child, 2.67% helped in dressing or bathing child, 9% respondents took child to routine immunization sessions regularly.94.33% respondents sought help for sick child and 85% took child to anganwadi center. (Table no.5) Reproductive health issues discussed with men by health workers is shown in table no. 6. Care of antenatal mothers (15%),Importance of diet and IFA tablets (9.67%), Importance of hospital delivery (35.67 % ) advantages of breastfeeding (19.33%),care of new born baby (22.67%), Ensuring hygiene (21.67%), Immunization (29.33%) were discussed with them. Planning pregnancy after marriage was not discussed with any of the respondent.
DISCUSSION
In the study, the mean age at marriage for men is 23.15 and their wives it is reported 16.18 which was no different than reported in NFHS III survey.(2) Most of the respondents opined that the ideal age of marriage for boys is more than 21 yrs while for girls it is 18yrs. A study conducted in Ethiopia showed that 47% men, who were follower of Ethiopian Orthodox Church, opined that ideal age of marriage for boys as 25-29 years and for girls as 20-24 years. (11) Social customs and traditions do play important role in marriage even in modern era and in urban area, especially in lower and middle income group. Marriage in India marks the point in a woman’s life when childbearing becomes socially acceptable. Age at first marriage has a profound impact on childbearing because women who marry early have on average a longer period of exposure to pregnancy and a greater number of lifetime births.(2) The median age at marriage for women was 16.7 years. (12)In rural India, 40 percent of girls (ages 15 to 19) are married, compared to 8 percent of boys at the same age. Accordingly, childbearing for women in India is also early; among married women in their reproductive years (ages 20to 49), the median age at which they first gave birth is 19.6 years. (12) The study shows that most of the men (47%) opined that a couple should have child within one year of marriage. Similar findings were seen in studies conducted in India. (8, 13) This is mostly because of the social and family pressure. Marriage is not considered successful till the couple has child. This familial or societal pressure forces couples to become parents as early as possible. Apart from the peer pressure lack of inter spousal communication, knowledge regarding family planning and lack of health education on planned parenthood are the main reasons for early childbearing. (9) A strong son preference for sons has been found to be pervasive in Indian society ,affecting both attitude and behaviour with respect to children.(3)The present study has also revealed a strong son preference (45%) among respondents .Similar findings were seen in study conducted in Delhi(3)and in NFHS III survey.(2) Majority of men (52%) knew that having two children is ideal but in practice they had more than two. A study conducted in Khairwar, MP also showed similar findings. (14) A strong want of son is the main reason for opting for more number of children. About 94.3% of men reported tubectomy as method of choice for permanent contraception. 39.9% feel that this is wife’s business while 36% said that wife/family opposed opting vasectomy. A study conducted in Delhi by M.Dutta et al (3) showed that 34.4% reported opposition from wife as reason for non acceptance of contraception. A study conducted by Abhilasha Sharma also showed similar findings. (15) Knowledge and perception about maternal care in general was good. Most of the respondents were aware about importance of antenatal care and hospital delivery however very few (13%) accompanied their wives for ANC or were present at the time of delivery (7.7%).In India, pregnancy is considered special and care during pregnancy is considered as domain of elder female members of the family therefore for ANC check up usually elderly female accompanies pregnant mother. Considering her experience, it is assumed that elderly female member is the ideal person to take care of a pregnant mother. To ensure proper rest, pregnant mothers are sent to mother’s house for first delivery. Husbands are usually ignored in traditional set up as far as care during pregnancy and post-delivery is concerned. Involvement of husbands in antenatal care was not expected and to some extent was seen as unnecessary interference. (9)Delivery and the postdelivery period were found to be exclusively a woman’s affair. In a study conducted by FRSH(9) , men reported that even talking or inquiring about their wife and baby was not deemed necessary and most husbands were unaware as to whether or not their wives had experienced any problems during childbirth. These men did not see any need to learn about such possibilities, and actually saw such inquiries as unwarranted intrusions into female territory. Similar findings are seen in studies conducted in Kathmandu, Nepal (5), in Pakistan (6), in rural Guatemala (7) and in India. (23, 24) The study shows that very few respondents knew about feeding practices and immunization schedule .But these fathers are more particular about seeking medical help during child’s illness and activities like dropping the child to anganwadi centre. Similar findings are seen in studies conducted by Abhilasha Sharma.(15) Traditionally fathers are not involved in child rearing activities; mothers bear the sole responsibility of feeding and caring child. Men are and usually considered as earning member of the family mostly involved in outside activities. As far as health education is concerned, child health seemed to be limited to breastfeeding and immunization and childhood illnesses. Among other maternal care issues only family planning and hospital delivery are focused more.(22) Issues like planning pregnancy support during pregnancy and high risk pregnancy and complications during pregnancy are totally ignored by health workers. Health education has proved to be a cost effective measure .With focused health education men can play important role in maternal and child health care. Maternal morbidity and mortality is more in first three days after delivery due to bleeding or infection .Men can play vital role if they are involved in antenatal care and informed about the complications of pregnancy as they are usually decision makers in the family .They can ensure rest, nutritious diet, hospital delivery and moral support to the wives. (3) Researchers have proved that men are equally important for overall growth and development of the child. (19, 20, 21)
CONCLUSIONS
Role of men in reproductive and child health is totally neglected in traditional socio-cultural set up. Many studies have shown that men can play important role in reducing maternal morbidity, mortality and improving overall development of child. Men should be made aware about their roles and responsibilities in maternal and child health. Strategies, for involving men in RCH, needs to be developed. Appropriate IEC material should be prepared and male friendly approach should be adopted to reach men and address their issues. Efforts should be made to encourage couple communication, acceptance of male contraceptives, Planned Parenthood etc. Women’s education and empowerment are equally important to change their traditional perceptions about gender inequality and the role of husbands in maternal and child health.
LIMITATIONS
Recall bias could have been present even after restricting inclusion to males whose spouses last delivered 24 months prior to the survey. Additionally reporting bias arising from men wanting to provide socially desirable responses especially regarding the care during pregnancy, hospital delivery and child care issues could have been a possible drawback to the study. This could have been overcome by cross confirmation of the men's responses by women interviews. Our study population was largely peri-urban area of tribal district of Karnataka therefore our findings may not be entirely generalizable. However, we gain insights into how similar populations can be targeted to improve male involvement in reproductive and child health. This study design was cross-sectional which limits us from making any causal inferences in relation to the main outcome and independent variables.
ACKNOWLEDGEMENTS
We are thankful to all the interns of 2007 batch, social workers and staff of UHC and Anganwadi workers of Aiyennapethe area, Chitradurga for their help in conducting the survey.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-524156EnglishN2013March30TechnologyENTAIL OF THE INFORMATION AND COMMUNICATION TECHNOLOGY IN EDUCATION
English127132Kamlesh Kumar DhiwarEnglish Ashish RastogiEnglishThe basic objective of this paper is to describe various use / application of ICT (Information and Communication Technology) in education whereby relevant professionals / new comers can efficiently use the ICT / tools according to their suitability and availability. During the preparation of this paper we studied some literatures and also discussed to some educational professionals about the use / role of ICT (Information and Communication Technology) in education area. Finally in this study we get various advantages of ICT in education field. It has also some drawback.
EnglishICT, educational professionalsINTRODUCTION
The student population in higher education is changing. The dynamic state of technological development has made perpetual (or lifelong) learning a necessity. For this reason, more and more adults are returning to school to learn new skills or expand the skills they already have. According to a recent article in The New York Times, the increasing number of adults returning to school is the result of "demands on companies, in an intensely competitive global economy, to keep improving productivity." Everhart believes that this dramatic increase in the student population may force most educational institutions to deliver at least half of all instruction online. Offering traditional on-campus courses to a burgeoning student population would require doubling the number of campuses, classrooms, and professors. This would lead to excessive costs and a critical shortage of instructional personnel. Further Chambers insists that properly designed and implemented online courses "provide faster learning, at lower costs, with more accountability, thereby enabling both companies and schools to keep up with [rapid] changes in the global economy." Both Everhart and Chambers agree that educational institutions cannot ignore the move to online instruction if they hope to attract and keep students in the future. ICT experts and educationist expects that in the future all classrooms will have multimedia delivery access available to allow students and instructors’ access to the Internet. This access will make it possible for the virtual and physical classrooms to mesh to create an alternative course format of "connected learning" that will combine the best of both worlds. The changing modes of instructional delivery will demand that courses be designed to provide for greater student-student and student-teacher interactivity. As more and more courses move from the physical F2F classroom to the "connected" or virtual classroom, students will need to assume more responsibility for their own learning. They will need to become independent learners, able to think and figure things out for themselves
According to research reports half of the students believed that information technology improved the courses that they were taking while most preferred a ‘moderate’ level of IT usage in their courses. There appeared here possibly to be a concern about ‘excessive’ use of information technology, though the study did not explore this area further. The use of information technology by students in their daily lives is increasing and while many instructors are using IT effectively in their courses, it appears that many are not, revealing significant opportunity for improvement.
Categorisation of information technology tools for education: The information technology based tools that can be used for education are expanding daily. The following chart illustrates the technologies available:
ICT: changes the continuing training: Recently the role of higher education institutions in the area of training of employees is limited. The increasing use of ICT could mean a change in this respect. The potential changes because of ICT depend on the extent to which:
ICT (is)/(will be) used as a training tool for training of employees. If the role of ICT is limited, than expected changes in the structure of the market because of this will be limited;
ICT as a training tool can be considered as additional training in the sense that ICT helps to organise training in situations where otherwise no training would have taken place. Points 1 and 2 together determine to what extent the market of training of employees grows as a whole because of the use of ICT as a training tool.
The use of ICT could improve the relative position of higher education institutions in this market. The potential changes for higher education institutions because of ICT will be higher, the more important this training tool turns out to be, the more this will lead to additional training and the more this will change their market position compared to other suppliers.
The importance of ICT as a training tool
In the Netherlands NIDAP organises a yearly survey on continuing training among approximately 800 companies with at least 50 employees. For the survey over 1999, we made use of the possibility to add a number of questions to this survey about their use of ICTbased training. The outcomes of the survey lead to the following estimates for the quantitative use of ICT-based training of the employed.
Benefits/Advantages of ICT in Education:
Here are some of the benefits which ICT brings to education according to recent research findings.
Greater efficiency throughout the school.
Communication channels are increased through email, discussion groups and chat rooms
Regular use of ICT across different curriculum subjects can have a beneficial motivational influence on students’ learning.
ICT facilitates sharing of resources, expertise and advice
Greater flexibility in when and where tasks are carried out
Gains in ICT literacy skills, confidence and enthusiasm.
Easier planning and preparation of lessons and designing materials
Access to up-to-date pupil and school data, anytime and anywhere.
Enhancement of professional image projected to colleagues.
Students are generally more ‘on task’ and express more positive feelings when they use computers than when they are given other tasks to do.
? Computer use during lessons motivated students to continue using learning outside school hours.
Benefits for students
Higher quality lessons through greater collaboration between teachers in planning and preparing resources.
More focused teaching, tailored to students’ strengths and weaknesses, through better analysis of attainment data
Improved pastoral care and behaviour management through better tracking of students
Gains in understanding and analytical skills, including improvements in reading comprehension.
Development of writing skills (including spelling, grammar, punctuation, editing and re-drafting), also fluency, originality and elaboration.
Encouragement of independent and active learning, and self-responsibility for learning.
Flexibility of ‘anytime, anywhere’ access
Development of higher level learning styles.
Students who used educational technology in school felt more successful in school, were more motivated to learn and have increased self-confidence and self-esteem
Students found learning in a technologyenhanced setting more stimulating and student-centred than in a traditional classroom
Broadband technology supports the reliable and uninterrupted downloading of webhosted educational multimedia resources
Opportunities to address their work to an external audience
Opportunities to collaborate on assignments with people outside or inside school Benefits for parents
Easier communication with teachers
Higher quality student reports – more legible, more detailed, better presented
Greater access to more accurate attendance and attainment information
Increased involvement in education for parents and, in some cases, improved selfesteem
Increased knowledge of children’s learning and capabilities, owing to increase in learning activity being situated in the home
Parents are more likely to be engaged in the school community
Disadvantages of ICT
One of the major barriers for the cause of ICT not reaching its full potential in the foundation stage is that schools are facing the cost of the technology. As everyone knows, computers are not cheap and even after purchasing, ICT items will at some point, require maintenance to keep them running, which may again prove costly. Some see it as a potential tool to aid learning whereas others seem to disagree with the use of technology in early year settings. It’s also important that use of this technology is constantly monitored by teaching staff to ensure it is being used correctly. Some people may have the opinion that the teachers who had not experienced ICT throughout their learning tend to have a negative attitude towards it, as they may lack the training in that area of the curriculum. A further disadvantage of ICT in the classroom is the issue of reliability. As those who use technology on a regular basis know, it is not uncommon for something to fail, meaning it is then unable to perform the task you expected it to. It’s important that the teacher addresses this when planning a lesson and have a backup plan if this is the case. It is also hard for teachers to use due to lack of experience using ICT tools.
RECOMMENDATIONS
The teachers should increase the use of ICT for content transaction, preparation of the teaching-learning materials, academic planning, project work and making presentations as these are the components directly related to the teaching-learning process, rather than using it for maintaining records, examination purpose and downloading information. For the fulfillment of this objective, training programmes need to be conducted on a large scale.
The management should encourage and support the schools to develop language laboratory and use it for the teaching of languages.
The management should motivate teachers to use ICT for the teaching-learning process by providing the incentives and framing the policies at the institute.
Govt. and other ICT companies should collaborate with Teacher Education colleges to provide training to in- ervice teachers for using ICT in teaching-learning process.
Number of teachers attending workshops and seminars on “the Use of ICT in the teachinglearning process” should increase. Individual and institutions should utilize such opportunities to the maximum.
Schools should prepare a schedule for a regular access to computers by students for preparing projects and assignments.
Teachers should not restrict their knowledge and expertise of using computers for their own professional growth and development but should plan out activities for contributing to the growth and development of the institution.
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