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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN-0001November30HealthcareANTIBACTERIAL SCREENING AND PHYTOCHEMICAL ANALYSIS OF CLEOME CILIATA (CAPPARIDACEAE) LEAVES
English0611Umerie SC.English Okorie NH .English Ezea SC.English Okpalaononuju A.NEnglishEthanolic extract of leaves of Cleome ciliata were studied for phytochemical constituents and in vitro antibacterial activities by agar diffusion method. The phytochemical analysis of the extract revealed the presence of saponins, alkaloids, flavonoids, tannins, steroids, terpenoids, and glycosides. The extract inhibited the growth of Staphylococcus aureus Salmonella paratyphi and Pseudomonas aeruginosa. The flavonoid fraction of the crude sample was active against Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae, while the tannin fraction was active against Staphylococcus aureus only. The minimum inhibition concentration (MIC) of the ethanolic extract as well as the flavonoid and tannin fractions ranged from 18.14 to 94.02 mg /ml. The results suggest that C. ciliata can be used in the treatment of ailments caused by the test and related organisms.
EnglishCleome ciliata Schmach and Thonn, antibacterial screening, phytochemical analysis.INTRODUCTION
Plants have been one of the important sources of medicines since the dawn of civilization. Recently the use of plants as medicine has been patronized more vigorously, and has therefore resulted in an increase in the amount of herbal products traded within and across countries (Suresh et al, 2008). A number of well-established and important drugs have their source from plants. Plants also serve as source of chemical intermediates needed for the production of some drugs. New medicinal compounds are derived from plant species that have been used as folk, traditional or native remedies for centuries (Okafor, 2005). Information on the use of these medicinal plants has been obtained from herbalists, herb sellers, and indigenous people in Africa over many years (Sofowora, 2002). Many more of such plants are yet to come into limelight because their uses in ethno medicine have not been subjected to any scientific investigation.
Cleome ciliata Schmach and Thonn, belongs to the Capparidaceae family (Dutta, 1995) and is commonly known as ?Spider plant (USDA, 2008). The plant is a green creeping annual or short-lived perennial herb that spreads like a spider. It‘s scrambling habit smoothers and stunts young crop plant. It has a slender leaf stalk with trifoliate leaves; the leaflets are net-veined and elliptical with smooth margin. The fruit is a capsule and dry dehiscent when mature and the seeds are placed centrally axial placentation. Placement of leaves on the plant is spirally alternate and the fruits arise at the axial of the leaves. A related species Cleome rutidosperma is palatable to humans and is sometimes eaten as a cooked vegetable. Records were found of C. rutidosperma to indicate toxicity to people or animals (Jansen, 2004), but not Cleome ciliata. The plant juice in used in ethno medical practice for earache and convulsions (Oliver, 1959), and also for peptic ulcers (ASICUMPON, 2005). The present investigation was conducted to screen for the antibacterial activities and phytochemical properties of Cleome ciliata leaf extracts.
MATERIALS AND METHODS
Collection of plant material: The Cleome ciliata plant was obtained from farmlands and along roadside, in Awka Anambra State, Nigeria, and authenticated at Fame Consultancy Plant Research Centre by Prof. J.C. Okafor (consultant plant taxonomist). The leaves were air-dried and pulverized using an electric grinding machine.
Extract Preparation: The pulverized plant material (300g) was extracted by cold maceration in 1750 ml of distilled water for 24h, filtered and the filtrate concentrated over boiling water bath. A fresh batch of the plant material (600g) was extracted by cold maceration in 3 litres of absolute ethanol for 48h, filtered and the filtrate concentrated at room temperature. The exclusive extractions of flavonoids and tannins from the dried pulverized plant material were carried out by the methods of Underhill et al (1959), and Hagerman and Klucher (1986) respectively.
Phytochemical screening of crude extracts: The phytochemical components of the aqueous and ethanolic extracts of the plant were screened for using the methods of Harborne (1998) and Evans (2002). The components screened for are saponins, alkaloids, glycosides, flavonoids, terpenoids, tannins and steroids.
Preparation of extract solution: The preparation of the extract for antibacterial assay was done by the method of Okore (2005). 1.0g each of the crude ethanolic, flavonoid and tannin extracts were dissolved in separate 5ml volume of Dimethylsulphoxide (DMSO) to give a concentration of 200mg /ml. Further dilutions of the stocks were prepared to obtain desired concentrations.
Sources of micro organisms: The organisms used were clinical isolates and includes Staphylococcus aureus, Peudomonas aeruginosa, Salmonella paratyphii, Escherichia coli and Klebseilla pneumoniae. The organisms were obtained from the Department of Pharmaceutical Microbiology Laboratory, University of Nigeria Nsukka.
Standardization of bacterial suspensions: Sterile and dried nutrient agar plates were prepared and loopful from suspension of the bacteria was aseptically streaked on the surface of solid agar medium in different Petri dishes and the dishes were incubated at 37OC for 24 hours. A colony was aseptically removed from each of the growths and inoculated into preparation double strength nutrient broth in bijou bottle. After incubation, the contents of each bottle were used to flood the surface of the solid nutrient agar slant in roux bottles. They were then incubated for 24 hours. The surface growths on the agar slant were washed with sterile normal saline by centrifugation. The microorganism were bulked in sterile bottles and made up to 10ml with sterile normal saline. Further dilutions with sterile normal saline were made using McFarland standard to obtain the required concentration of approximately 107 Cfu/ml and the organisms were stored in the refrigerator at 4OC until when required for use (Okore, 2005; Anidu, 2002).
Antibacterial screening: The antibacterial activities of the extracts measured as inhibition zone diameter (IZD) was determined using agar diffusion (cup plate) method. The agar plates were incubated at 37OC for 24 hours after which the IZD values were obtained (Okore, 2005). The experiment was replicated and the mean IZD was calculated. The minimum inhibitory concentration (MIC) value was then obtained from the intercept on the natural Iogarithm of extract concentration axis of a graph of natural logarithm of extract concentration against squared IZD (mm2 ). The graph was plotted for each bacterial and their MIC values obtained.
RESULTS
Phytochemical Screening: Phytochemical screening of the ethanolic extract of C. ciliata indicated the presence of alkaloids, flavonoids, glycosides, saponins, tannins, steroids, and terpenoids. However, flavonoids and saponins were not detected in the aqueous extract (Table 1). The yield of the extract was 10.6%
Antibacterial activity of extracts: The results in Table 2 revealed that the ethanolic extract exhibited antibacterial effects on Staph. aureus, Sal. Paratyphis and P. aeruginosa but not on E. coli and K. pneumoniae, The flavonoid extract was active against Staph aureus, E. coil and K. preumoniae only, while the tannin extract was active only against Staph. aureas.
Minimum inhibition concentration (MIC) of the extracts: The MIC of the ethanolic extract for Staph.aureus was 70.10 mg/ml, 94.02 mg/ml for Sal. paratyphii and 43.94 mg/ml for P. aeruginosa. The MIC of the flavonoid extract was 18.67mg/ml against Staph aureus, 38.26mg/ml against E. coil and 40.76 mg/ml against K. pneumoniae while the MIC of tannin extract was 18.14 mg/ml against Staph. aureus. (Table 3).
DISCUSSION
The yield of the ethanolic extract of C. ciliate revealed that their extractive yield is high in polar solvents. This implies that phytochemical components of the plant are polar in nature and substantiates the use of water or ethanol (local gin) as extracting solvents in folkloric medicine. Moreso these classes of components are known to show curative activity against pathogens (Usman and Osuji, 2007).
The crude ethanolic extract was more active in inhibiting Staphylococus aureus, followed by Salmonella paratyphii and Pseudomonas aeruginosa than the tannin and flavonoid fractions. The flavonoid fraction had a wider range of activity than the tannin fraction. The activity of the flavonoid fraction against E. coli and Klebsiella spp. relative to the crude extract suggested that certain phytocomponents could have hindered its activity in the crude sample. This may be associated with the presence of oils, wax, resin, fatty acids or pigments, which has been reported to be capable of blacking the active ingredients in the plant extract, thus preventing the plant extract from accessing the plant cell wall (Doughari and Manzara, 2008).
Flavonoids are hydroxylated phenols and are toxic to microorganisms. Their relative activities increase with increasing level of oxidation (Scalbert, 1991), number of hydroxyl groups and their specific sites (Geissman, 1963) They and the phenols have the ability to complex with nucleophilic amino acids in proteins and bacterial cell walls leading to enzyme inactivation and loss of function (Ogunwenmo et al, 2007).
Water-soluble polyphenols, tannins are toxic to filmentous fungi, yeasts and bacteria (Scalbert, 1991). They owe their antibacterial action to their capacity for protein complexation through hydrogen and covalent bonding and inactivation of microbial adhesions, enzymes and cell envelope transport proteins (Haslam, 1996, Stern et al, 1996). Condensed tannins are known to bind to cell wall of ruminal bacteria preventing growth and protease activity. Hence the consumption of tannins as green teas and wine prevents different illnesses (Ogunwenmo et al, 2007). Consequently consumption of tannins as herbal vegetable like C. ciliata will have the same effect.
Staphylococcus aureus showed highest level of susceptibility than other microorganisms tested and it was sensitive on the three extracts used. This suggested that crude, flavonoid and tannin extracts of C. ciliata could be used in treatment of disease involving this particular bacterium such as in cases of gastrointestinal disorders (Aguwa and Ukwe 1997; Dalziel, 1985). The minimum inhibitory concentration (MIC) values showed that Staph, aureus had the lowest MIC for all the extracts and so very low doses of the extracts would be required to inhibit the growth of the organism Staph. aureus. Very high doses will be required to inhibit the growth of Klebsiella, E.coli Salmonella paralyphi and Pseudomonas aeruginosa.
In conclusion, the extracts of C. ciliata have antibacterial properties. The MIC investigation showed that crude extract flavonoid and tannin fractions were able to inhibit microorganism. The study has therefore justified the use of the plant in ethno medicine.
Englishhttp://ijcrr.com/abstract.php?article_id=2371http://ijcrr.com/article_html.php?did=23711. Aguwa, C.N. and Ukwe, C.V. (1997). Gastrointestinal activities of Sterculla tragacantha leaf extract. Fitoterapia 68 (2): 127-132.
2. Anidu, U.J. (2002). An investigation into the antimicrobial properties of the oil extracts of seeds of Picralima nitida. B. Pharm project, Department of Pharmacognosy, University of Nigeria, Nsukka. pp 1-20.
3. ASICUMPON, (2005). The Association for Scientific Identification, Conservation and Utilization of Medicinal Plants of Nigeria Checklist of Medicinal Plants of Nigeria and their uses. Trinity – Biz Publishers, AbakpaEnugu.
4. Dalziel, J.M. (1985). Useful Plants of West Tropical Africa. Crown Agents for Overseas Government and Administration, London. pp 109-110.
5. Doughari, J.H. and Manzara, S. (2008) In vitro antibacterial activity of crude leaf extracts of Magnifera indica Linn. African Journal of Microbiology Research 2: 67-72.
6. Dutta, A.C. (1995) Bontany Degree Students, 6 th edition. Oxford University Press, Calcutta, India.
7. Evans, W.C. (2002). Trease and Evans Pharmacognosy, 15th edition, W.B. Saunders Company Limited, Edinburgh, UK.
8. Geissman, T.A. (1963). Flavonoid compounds, tannins, lignins and related compounds. In: Florkin, M and Stotz, E.Z. (ed). Pyrrole pigments, isoprenoid compounds and phenolic plant constituents, Vol. 9, Elsevier, New York.
9. Hagerman, A.E. and Klucher, K.M. (1986). Tannin-protein interaction. In: Plant Flavonoids in Biology and Medicine: biochemical, pharmacological, and structure activity relationship, New York,
10. Harborne, J.B. (1998). Phytochemical methods: A guide to modern techniques of plant analysis, 3rd edition. Chapman and Hall, London, UK.
11. Haslam, E (1996). Natural polyphenols (vegetable tannins) as drugs: possible mode of action. J. Nat. Prod. 59: 205-215.
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13. O.A. (2007). Cultivers of Codiaeum variegatum (L) Blume (Euphorbiaceae) show variability in phytochemical and cytological characteristics. African Journal of Biotechnology 6 (20): 2400-2405.
14. Okafor, J.C. (2005). Strategies for conservation of the genetic resources of medicinal plants of Nigeria. In: Checklist of Medicinal Plants of Nigeria and their uses. Trinity-Biz Publishers, Abakpa-Enugu pp 9- 12.
15. Okore, V.C. (2005), Pharmaceutical Microbiology, 1st edition. ELDMAK Publishing Co. Ltd., Enugu, Nigeria
16. Oliver, E.W.H.M. (1959). Medicinal plants of Nigeria, Part II. Technical Memorandum No. 7, Federal Institute of Industrial Research. Published by the Federal Ministry of Commerce and Industry, Lagos, Nigeria.
17. Scalbert, A (1991). Antimicrobial properties of tannins. Phytochemistry 30:3875-3883.
18. Sofowora, A. (2002). Plants in African traditional Medicine-an overview. In: Trease and Evans Pharmacognosy 15th edition, by W.C. Evans. W. Saunder Company Limited, Edinburgh, Uk. pp 488-496.
19. Stern, J.L., Hagerman, A.E., Steinberg, P.D. and Mason, P.K. (1996). Phlorotannin-protein interactions. J. Chem. Ecol. 22:1887-1899. 10 International Journal of Current Research and Review www.ijcrr.com Vol. 04 issue 15 Aug 2012
20. Suresh, K., Deepa, P., Harisaranraji, R. and Vaira Achudhan (2008). Antimicrobial and Phytochemical investigation of the Leaves of Carica papaya L., Cynodon dactylon (L) Pers., Euphorbia hirta L., Melia azedarach L. and Psidium guajava L. Ethnobotanical Leaflets 12: 1184-1191.
21. Underhill E.W., Walkin J.E. and Neish, A.C. (1957) Flavonoids. Canadian J. Biochem. Physiol. 35:219-237.
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23. Usman, H. and Osuji, J.C. (2007). Phytochemical and in vitro antimicrobial assay of the leaf extract of Newbouldia laevis. African Journal of Traditional, Complementary and Alternative Medicine 4 (4):476-480.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN-0001November30General SciencesA SEMI-CIRCLE THEOREM IN RIVLIN-ERICKSEN VISCOELASTIC FLUID IN THE PRESENCE OF MAGNETIC FIELD
English1220Ajaib S. BanyalEnglishA layer of Rivlin-Ericksen viscoelastic fluid heated from below is considered in the presence of uniform vertical magnetic field. Following the linearized stability theory and normal mode analysis, the paper through mathematical analysis of the governing equations of Rivlin-Ericksen viscoelastic fluid convection with a uniform vertical magnetic field, for any combination of perfectly conducting free and rigid boundaries of infinite horizontal extension at the top and bottom of the fluid, established that the complex growth rate ? of oscillatory perturbations, neutral or unstable for all wave numbers, must lie inside a semi-circle
in the right half of a complex r i ? ? -plane, where Q is the Chandrasekhar number and F is the viscoelastic parameter of the Rivlin-Ericksen fluid, which prescribes the upper limits to the complex growth rate of arbitrary oscillatory motions of growing amplitude in the couple-stress fluid heated from below in the presence of uniform vertical magnetic field. The result is important since the result hold for all wave numbers and the exact solutions of the problem investigated in closed form, are not obtainable for any arbitrary combinations of perfectly conducting dynamically free and rigid boundaries.
EnglishThermal convection; Rivlin-Ericksen Fluid; Magnetic field; PES; Rayleigh number; Chandrasekhar number.INTRODUCTION
Stability of a dynamical system is closest to real life, in the sense that realization of a dynamical system depends upon its stability. Right from the conceptualizations of turbulence, instability of fluid flows is being regarded at its root. The thermal instability of a fluid layer with maintained adverse temperature gradient by heating the underside plays an important role in Geophysics, interiors of the Earth, Oceanography and Atmospheric Physics, and has been investigated by several authors (e.g., Bénard ?5? , Rayleigh ?15? , Jeffreys ?11? ) under different conditions. A detailed account of the theoretical and experimental study of the onset of Bénard Convection in Newtonian fluids, under varying assumptions of hydrodynamics and hydromagnetics, has been given by Chandrasekhar ?8? . The use of Boussinesq approximation has been made throughout, which states that the density changes are disregarded in all other terms in the equation of motion except the external force term. Bhatia and Steiner ?6? have considered the effect of uniform rotation on the thermal instability of a viscoelastic (Maxwell) fluid and found that rotation has a destabilizing influence in contrast to the stabilizing effect on Newtonian fluid. The thermal instability of a Maxwell fluid in hydromagnetics has been studied by Bhatia and Steiner ?7? . They have found that the magnetic field stabilizes a viscoelastic (Maxwell) fluid just as the Newtonian fluid. Sharma ?17? has studied the thermal instability of a layer of viscoelastic (Oldroydian) fluid acted upon by a uniform rotation and found that rotation has destabilizing as well as stabilizing effects under certain conditions in contrast to that of a Maxwell fluid where it has a destabilizing effect. In another study Sharma ?18? has studied the stability of a layer of an electrically conducting Oldroyd fluid ?13? in the presence of magnetic field and has found that the magnetic field has a stabilizing influence.
There are many elastic-viscous fluids that cannot be characterized by Maxwell‘s constitutive relations or Oldroyd‘s ?13? constitutive relations. Two such classes of fluids are Rivlin-Ericksen‘s and Walter‘s (model B‘) fluids. RivlinEricksen ?9? have proposed a theoretical model for such one class of elastic-viscous fluids. Sharma and kumar ?19? have studied the effect of rotation on thermal instability in Rivlin-Ericksen elasticoviscous fluid and found that rotation has a stabilizing effect and introduces oscillatory modes in the system. Kumar et al. ?14? considered effect of rotation and magnetic field, with free boundaries only, on Rivlin-Ericksen elasticoviscous fluid and found that rotation has stabilizing effect, where as magnetic field has both stabilizing and destabilizing effects. A layer of such fluid heated from below or under the action of magnetic field or rotation or both may find applications in geophysics, interior of the Earth, Oceanography, and the atmospheric physics.
Pellow and Southwell ?14? proved the validity of PES for the classical Rayleigh-Bénard convection problem. Banerjee et al ?1? gave a new scheme for combining the governing equations of thermohaline convection, which is shown to lead to the bounds for the complex growth rate of the arbitrary oscillatory perturbations, neutral or unstable for all combinations of dynamically rigid or free boundaries and, Banerjee and Banerjee ?2? established a criterion on characterization of nonoscillatory motions in hydrodynamics which was further extended by Gupta et al. ?10? . However no such result existed for non-Newtonian fluid configurations, in general and for Rivlin-Ericksen viscoelastic fluid configurations, in particular. Banyal ?4? have characterized the non-oscillatory motions in couple-stress fluid.
Keeping in mind the importance of nonNewtonian fluids and magnetic field, as stated above, the present paper is an attempt to prescribe the upper limits to the complex growth rate of arbitrary oscillatory motions of growing amplitude, in a layer of incompressible RivlinEricksen fluid heated from below, in the presence of uniform vertical magnetic field, opposite to force field of gravity, when the bounding surfaces are of infinite horizontal extension, at the top and bottom of the fluid and are perfectly conducting with any combination of dynamically free and rigid boundaries. The result is important since the exact solutions of the problem investigated in closed form, are not obtainable, for any arbitrary combination of perfectly conducting dynamically free and rigid boundaries
Where the suffix zero refer to the values at the reference level z = 0. Here g? ?g? ? 0,0, is acceleration due to gravity and ? is the coefficient of thermal expansion. In writing the equation (1), we made use of the Boussinesq approximation, which states that the density variations are ignored in all terms in the equation of motion except the external force term. The magnetic permeability ? e , thermal diffusivity ? , and electrical resistivity ? , are all assumed to be constant. The initial state is one in which the velocity, density, pressure, and temperature at any point in the fluid are, respectively, given by
The essential content of the theorem, from the point of view of linear stability theory is that for the configuration of Rivlin-Ericksen viscoelastic fluid of infinite horizontal extension heated form below, having top and bottom bounding surfaces of infinite horizontal extension, at the top and bottom of the fluid and are perfectly conducting with any arbitrary combination of dynamically free and rigid boundaries, in the presence of uniform vertical magnetic field parallel to the force field of gravity, the complex growth rate of an arbitrary oscillatory motions of growing amplitude, lies inside a semi-circle in the right half of the ? r ? i - plane whose centre is at the origin
the Chandrasekhar number and F is the viscoelasticity parameter of the Rivlin-Ericksen fluid. The result is important since the exact solutions of the problem investigated in closed form, are not obtainable, for any arbitrary combinations of perfectly conducting dynamically free and rigid boundaries
ACKNOWLEDGEMENT
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. The author is highly thankful to the referees for their very constructive, valuable suggestions and useful technical comments, which led to a significant improvement of the paper.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN-0001November30HealthcareDENTAL CARIES - AN INFECTIOUS DISEASE OF CHILDHOOD - A REVIEW
English2129Auxilia Hemamalini TilakEnglish K.RajaEnglish S. Geetha PriyaEnglishDental Caries is a common, chronic disease of childhood. Most studies that have assessed risk factors for dental caries focused on non-modifiable risk factors such as previous caries experience and socioeconomic status. It is also important to investigate modifiable risk factors that can be used in developing guidelines for risk assessment and prevention. This review discusses about dental caries in childhood and it‘s association with Streptococcus mutans, discusses the colonization of Streptoccus mutans, Origin of Streptococcus mutans, factors affecting colonisation of oral cavity in children, and prevention of transmission of Streptoccus mutans from mother to child in detail.
EnglishDental caries, Streptococcus mutans, ChildrenINTRODUCTION
Dental caries is widely recognised as an infectious disease induced by diet. Aetiology of the disease are a) cariogenic bacteria b) fermentable carbohydrates c) susceptible tooth and host d) time.(Seow, 1998).Dental caries remains one of the most common chronic diseases in childhood (Mouradian, 2001). Dental problems in early childhood was not only predictive of future dental problems but it also had an impact on general growth and cognitive development by interfering with sleep, appetite, eating patterns, poor school behavior and negative self-esteem (Ayhan et al, 1996; Acs et al, 1999;Low et al, 1999; Edelstein, 2000; Thomas and Primosch 2002). The principal group of bacteria which causes dental caries are mutans streptococci (van Houte et al, 1982; Milnes and Bowden, 1985). Mutans streptococci had many characteristics that facilitate caries development, including the ability to adhere to tooth surfaces and synthesize certain glucans from sucrose (Freedman et al, 1978). Mutant streptococci ability to synthesize intracellular polysaccharides, that induces continual acid production, results in demineralization of the dental hard tissues (Spatafora et al, 1995). Mutans streptococci participate in the formation of biofilms on tooth surfaces. These biofilms are known as dental plaque(s) (Martin et al. (2006)). Early Childhood Caries or ECC is a particular form of dental caries affecting pre-school aged Children. ECC is defined as ?the presence of one or more decayed, missing(due to caries) or filled tooth surfaces in a infant. In children younger than three years of age, any sign of smooth-surface caries is indicative of severe early childhood caries. From ages three to five, one or more cavitated, missing (due to caries), or filled smooth surfaces in primary maxillary anterior teeth, or decayed, missing, or filled score of equal or more DENTAL CARIES – AN INFECTIOUS DISEASE OF CHILDHOOD – A REVIEW Auxilia Hemamalini Tilak, K.Raja, S. Geetha Priya Department of Microbiology, Asan Memorial Dental College and Hospital, Chengalpet, Tamilnadu E-mail of Corresponding Author: hmtlk2@gmail.com 21 International Journal of Current Research and Review www.ijcrr.com Vol. 04 issue 15 Aug 2012 than 4 (age three), equal or more than 5 (age four), or equal or more than 6 (age five) surfaces, constitutes severe early childhood caries? (American Academy of Pediatric Dentistry, 2003). The aim of this review is to identify dental caries in childhood predominantly associated with Streptococcus mutans and recommend suitable methods for prevention.
Evidence for Streptococcus mutans associated with dental caries in childrens:
ECC causing bacteria grouped as ?Mutans streptococci? of which Streptococcus mutans and Streptococcus sobrinus are the species most commonly isolated in human dental caries (van Houte, 1994). Many evidences shows that Streptococcus mutans are the principal organisms isolated from the carious teeth of children with ECC (van Houte et al, 1982; Berkowitz et al, 1984; Boue, 1987). A high salivary count of streptococcus mutans may be predictive of caries activity (Klock and Krasse, 1979). . (Kohler and Bratthall (1979) developed a method to estimate streptococcus mutans levels in saliva. If the number of colony forming units (CFU) greater than 10μm in diameter was 0-20 it represented a ?low? MS score, 21-100 was a ?moderate? score, and a ?high? MS score was assigned if there were over 100 cFUs. Children with active caries have been shown to have high MS scores (Brown 1985). Children with ?nursing bottle caries? were consistently shown to have very high concentrations of MS in the cultures taken not only from the carious lesions themselves but also from both the white spot margins of these lesions and clinically sound tooth surfaces(van Houte et al (1982)). In another study, MS and lactobacilli were isolated from the dental plaque of children aged between 1and 2.5 years, irrespective of their caries status; however, the mean counts of MS and lactobacilli were 100-fold higher in those with rampant caries than in those who were caries-free (Matee et al, 1992).
Colonisation of streptococccus mutans
Early studies suggested that MS requires a nonshedding surface for colonization and hence it has been hypothesized that they are unable to colonize the mouth of a healthy predentate infant (Carlsson et al, 1970; Berkowitz et al, 1975; Catalanotto et al, 1975). Several studies have failed to demonstrate any MS in predentate infants, but the researchers found MS in the oral cavity once the primary dentition had commenced to erupt (Carlsson et al, 1975; Berkowitz et al, 1980). But in fact MS could persist in the oral cavity by either forming adherent colonies on the mucosal surfaces, or by living and multiplying in saliva. The action of swallowing allows only small percentage of streptococcus mutans to remain in the saliva but bacteria must become attached to an oral surface in order to proliferate. Caufield et., al., 1993 study involves 46 mother and infant pairs from the child‘s birth to between 3 and 6 years of age. 70% of the infants in the study initially acquired MS at the mean age of 26 months, and MS was detected in 25% of these infants by 19 months and in 75 % by 31 months of age. They suggested that the critical time for oral colonization by MS lay within a welldelineated age range of 19 to 31 months of age, a period designated as the ?window of infectivity?. Caries has also been reported in infants under the age of 19 months (Croll, 1988) suggesting that very young children with teeth may also become colonized (Berkowitz et al, 1980;Mohan et al, 1998) In one study 50 % of full-term and 60% of preterm babies were found to colonize MS in the oral cavity by 6 months of age (Wan et al, 2001b).Further longitudinal studies have shown that the younger the child acquires MS, the more caries they experience (van Houte et al, 1981; Alaluusuaand Renkonen, 1983; Burt et al, 1983). In contrast, children with no detectable MS over a study period of seven years did not have any dental caries (Lindquist and Emilson, 2004). So these results and their interpretation should be viewed with some caution, as no account was taken of the possibility of other biological or environmental factors that might be changing at the same time as the primary dentition is erupting, such as dietary preferences, feeding practices and oral hygiene measures, which may influence the ability of MS to colonize the oral cavity of children.
Origin of Streptococcus mutans
Mostof the available evidence points to the mother (as the primary care-giver in most cases), or more rarely another person with intimate physical contact with the infant, as the source of the MS inoculation. This makes evolutionary sense because the transfer of indigenous biota from mother to offspring is a recurring theme in the lower invertebrates for which research data are available (Baumann et al, 1995).There is evidence that mothers with high caries levels have infants with more caries (Alaluusua et al, 1989); Recent studies have confirmed a positive correlation between maternal and infant salivary MS levels (Wan et al, 2001a; Thorild et al, 2002). In the landmark studies carried out by Kohler and coworkers (Kohler et al, 1983; Kohler et al, 1984), the children of selected mothers with high levels of MS in their saliva were monitored for initial acquisition of MS and caries activity over a threeyear period. A strong relationship was demonstrated between the maternal MS levels and those of their infants. Large numbers of MS may be introduced into the infants oral cavity by an infected mother when engaging in practices such as using her own spoon to feed the child. This would be even more significant if the mother had a high saliva MS count. If the mother were feeding the child with sucrose-containing foods this could further support the implantation of MS in the child (Kohler and Bratthall, 1978). Bacteriocins (mutacin) are proteinaceous antibacterial substances that some bacteria produce to interfere with the growth of other bacteria (Gronroos et al, 1998). Their typing has been used as an epidemiological tool for tracing bacterial infections in humans. The bacteriocins produced within four mother-child combo were compared to determine the likelihood of maternal transmission of MS, and between 50 and 100 % of the bacteriocins found in the children matched those of their mothers(Berkowitz and Jordan‘s study (1975),). Homology between maternal MS genotypes and those of their infants has also been demonstrated, which strongly suggests that MS strains are transmitted from mother to infant (Li and Caufield, 1995; Emanuelsson and Wang, 1998). Infection transfer media that have been suggested include feeding spoons, kisses on the mouth, or the mother‘s ?cleaning? the infants pacifier by putting it into her own mouth (Aaltonen and Tenovuo, 1994). Speaking and food tasting may also promote direct salivary contact (Kononen et al, 1992). It has been postulated that the more frequently a mother transmits MS-harbouring saliva to her infants mouth, the earlier the colonization of MS in the baby‘s oral cavity is likely to occur (Kohler and Bratthall, 1978; van Houte et al, 1981). However, no studies have been performed to quantify the effects of mothers and their children sharing food and eating utensils on the subsequent MS colonization in the infants. Evidence that the father is a source of MS infection in an infant has rarely been reported. Emanuelsson et.al., (1998) studied 11 families in which MS was detected in all three family members (mother, father, and child). Six of the children showed MS genotypes identical to those of their mother, five harboured MS genotypes different from those of either parent, and none harbored MS genotypes similar to those of their father. This was in spite of the fact that two-thirds of the fathers had high or very high MS levels. Similar results have been reported elsewhere, and it has been suggested that working father‘s absence from home during the day in the child‘s first three years of life may limit the occasions for close contact (Davey and Rogers, 1984; Li et al, 1995). On the other hand, similar MS strains with identical genotypes have been found among all family members suggesting that any member of a family may be able to acquire MS from other family members (Emanuelsson and Wang, 1998). Taking into account the ability of MS to survive outside the oral cavity for several hours (Kohler and Bratthall, 1978), cultural differences within families such as eating with the same cutlery or from the same plate, using the same toothbrush, and ineffective utensil-washing routines, may increase the likelihood of transmission. While the mother is usually the primary caregiver and consequently may have frequent close salivary contact with her infant, it is also possible that a child can acquire MS from both inside and outside the family (Caufield et al, 1993, Emanuelsson et al, 1998; Emanuelsson and Wang, 1998).
Factors affecting colonization in oral cavity of children:
Maternal MS levels have been shown to be associated with the colonization of infants by MS. As has already been discussed there is a positive correlation between maternal levels of MS and the likelihood of infection being found in the infant (Kohler and Bratthall, 1978; Berkowitz et al, 1980; van Houte et al, 1981; Wan et al, 2000b). It can therefore be postulated that factors resulting in an increase in maternal MS levels will increase the risk of colonization of the infants, oral cavity. Maternal sugar consumption may also influence the colonization of the infant. A diet high in sucrose predisposes an individual to high levels of oral MS (Kristoffersson and Birkhed, 1987), so placing mothers at higher risk of infecting their children (Berkowitz et al, 1981, Kohler et al, 1983).Conversely, children of mothers who consume sucrose less frequently and have low MS levels may themselves exhibit low MS levels (van Houte, 1981). The nature and type of infant feeding practices may influence the establishment of MS. Lactose is present in breast milk (7.4g lactose per 100mL breast milk) and is an essential sugar and energy source in infant nutrition. Neither human nor bovine milk is cariogenic (Weiss and Bibby, 1966; Bowen et al, 1991; Bowen and Pearson, 1993; Jenkins and Ferguson, 1996; Thomson et al, 1996; Erickson and Mazhari, 1999), unless it is taken simultaneously with a cariogenic challenge such as sucrose (Bowen and Pearson, 1993). Evaluation of the cariogenic potential of human milk as opposed to bovine milk and sucrose solution has shown that human milk has a greater acidogenic potential than bovine milk, but is less acidogenic than sucrose solution (Thomson et al, 1996). It is interesting to note however that even though the addition of sucrose to milk renders it cariogenic, milk with a 10% sucrose solution causes less caries than a simple 10% aqueous sucrose solution (Bowen and Pearson, 1993), which supports the notion that milk contains a protective factor. The relationship between various infant formulae or indeed breast milk, and the rate of colonization of the infant oral cavity with MS, has not been explored. The relationship between breast-feeding and caries remains controversial. There are many, usually somewhat anecdotal reports in the historic literature that have promoted the idea that prolonged and excessive breast-feeding is associated with rampant caries in infants (Gardner et al, 1977; Kotlow, 1977; Abbey, 1979). Infants who breast-feed at will during the night can present with higher MS counts in their dental plaque (van Houte et al, 1982; Matee et al, 1992). In one study only 9% of the 96 children who were breast-fed for a prolonged period of time developed caries (Weerheijm et al, 1998), whilst in another study children who either did not breast-feed at all or did so for just a few months actually developed more caries than those who continued breast feeding for many months (Mattos-Graner et al, 1998). It has been suggested that dietary intakes other than breast-feeding could be a confounding factor in these breast-feeding related caries studies (Hackett et al, 1984).
Prevention of streptococci mutans transmission from mother to children: Children whose oral cavities are colonized early by MS show greater caries occurrence than children with later or no MS colonization(Alaluusua and Renkonen, 1983; Kohler et al, 1988). Once MS has been detected in a child, its presence is often persistent. Stable levels are even observed until adulthood (Kohler and Andreen, 1994). Preventing or delaying the transmission of MS from mother to child has the potential to reduce the caries experience in the next generation. Three broad strategies aimed at reducing maternal transmission of MS have been studied: the use of chlorhexidine digluconate, chewing xylitol gum, and oral health education. Expectant mothers with high salivary MS who used one percent chlorhexidine digluconate (CHX) varnish with special applicators, for five minutes once daily for two weeks, not only reduced the levels of MS in their saliva but also delayed the subsequent acquisition of MS in their infants (Kohler et al,1983). A follow-up study confirmed that the reduction of MS level in saliva had a longlasting effect on the MS colonization and caries experience of the children (Kohler and Andreen,1994). In a more recent study (n=16), professional cleaning of the mothers teeth followed by CHX application led to fewer infants exhibiting MS colonization infants at 2 years of age than in a control group of untreated motherchild pairs (n=13), both groups had high initial maternal MS levels (Gripp and Schlagenhauf, 2002). The use of xylitol in a chewing-gum has also been shown to reduce the MS levels in saliva and in plaque (Soderling et al, 1989). This hypothesis was tested in a 2-year study in which mothers regularly chewed xylitol gum for 21 months, starting 3 months after delivery of the baby, the control group receiving either CHX or fluoride varnish treatment at 6, 12, and 18 months after delivery (Soderling et al, 2001). The researchers suggested that the xylitol altered the adhesive properties of the MS and thus inhibited colonization, so allowing MS to be flushed away by saliva (Soderling et al, 1991; Trahan et al, 1992). Over a four-year period, Gomez and Weber (2001) evaluated a free Preventive Dental program (PDP) for 241 mothers in their fourth month of pregnancy and in 180 controls who were not involved in the same programme. The PDP involved oral hygiene and dietary instruction to expectant mothers, with emphasis being placed on teaching them to avoid or minimize infecting their children with their own MS. Ninety-seven percent of the PDP group were caries-free after 4 years compared to 77% in the control group. The targeting of women early in their pregnancies and continuing after the birth of their children may not only be highly effective in preventing and delaying the development of dental caries in the children but may also improve the mothers overall oral health and attitudes to dental care (Weinstein, 1998). Also caries and microbial patterns seen in early childhood will reflect the oral health of individuals as they grow to be teenagers and beyond (Alaluusua et al, 1989), targeting preventive measures as early as possible to play a vital role in overall wellbeing of the child.
CONCLUSION
The earlier MS is detected in the oral cavity, the earlier children develop dental caries. The highest risk being those in whom MS is detected before two years of age. Colonization is more likely when the maternal salivary MS levels are high, when there is frequent salivary contact between mother and child, and when the diet is high in sucrose. From the literature it is clear that mothers are the most common but not the exclusive source of MS infection. However, with the use of new technologies in recent research we can be confident that the MS cultured from infants and children are often the same as those found in their mothers. With this knowledge, oral health professionals can promote measures to improve maternal oral health as a means of preventing or inhibiting MS colonization in children. Advice on personal oral hygiene for expectant mothers as well as proactive treatment of carious lesions and periodontal disease to reduce the bacterial load are a few measures. The use of antibacterial varnishes and xylitol confectioneries may be of value in reducing maternal MS counts and thus delay transmission to their offspring, but further research is required in this area. Oral health professionals should promote oral health awareness in expectant mother and associated healthcare professionals. In this way dental caries can be prevented in younger children
ACKNOWLEDGEMENT
The authors wish to thank Prof. Dr. Jagannathan, principal of Asan dental college, for his constant support and encouragement. We also wish to extend our thanks to Dr. Suresh kumar, and Dr.Rajasekar for their suggestions.
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53. Soderling E, Isokangas P, Pienihakkinen K, Tenovuo J, and Alanen P (2001). Influence of maternal xylitol consumption on acquisition of mutans treptococci by infants. Journal of Dental Research 79: 882-887.
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56. Spatafora G, Rohrer K, Barnard D, and Michalek S (1995). A Streptococcus mutans mutant that synthesizes elevated levels of intracellular polysaccharide is hypercariogenic in vivo. Infection and Immunity 63: 2556- 2563
57. Thomas CW and Primosch RE (2002) Changes in incremental weight and well-being of children with rampant caries following complete dental rehabilitation. Pediatric Dentistry 24: 109-113.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareSELF REPORTED HEARING AID OUTCOME MEASURES USING DISEASE SPECIFIC QUESTIONNAIRE IN HEARING IMPAIRED ADULTS
English3036Ayas MuhammedEnglish KanakaEnglish Rajashekhar BellurEnglishHearing impairment is one of the most frequent sensory deficits in human population, affecting more than 250 million people in the world. It affects the overall well being and cognition which results in depression and reduced quality of life (QOL).Hearing aids are used to rehabilitate these individuals and quantifying the results of a hearing aid fitting is often an overlooked aspect of the patient rehabilitation. Therefore self reported measures play a major role in assessing the outcomes in aural rehabilitation Objective: To assess the self reported hearing aid outcome using disease specific questionnaire, Abbreviated Profile of Hearing Aid Benefit (APHAB) in hearing impaired adults. Method: 15 subjects with age range of 18-60 years
were participated in the study to compare the pre and post (two months) amplification changes with the hearing aid. The outcome of hearing aid fitting was evaluated using APHAB. Results: There were significant changes in hearing aid related aspects and its use. However, it is reported that more benefit with the hearing aid is seen when the device is worn at least for a period of one year. Conclusion: The use of self reported measures in routine clinical settings helps the clinician to select an appropriate amplification device and also provide a scientifically defensible way to measure the real-life success of the hearing aid fitting program and thereby improving their overall quality of life
EnglishHearing impairment, self reported measures QOL, APHAB.INTRODUCTION
Hearing impairment is one of the most frequent sensory deficits in human population, affecting more than 250 million people in the world [1]. According to the World Health Organization (WHO), hearing impairment and deafness are serious disabilities that can impose a heavy social and economic burden on individual‘s families. Hearing loss can occur at any age; it has grave consequences on adults, as most of them are employed and will face problems in working situations. The extent of auditory disability again depends upon the degree, the type of loss and the pattern of auditory configuration. Myklebust [2] suggested that hearing loss between 45 and 65 dBHL clearly affects the social interaction and the background information. Mulrow, Aguilar, Endicott, Tuley, Velez, Charlip, et al. [3] reported that the hearing impairment will affect the overall well being and cognition which results in depression. Dalton, Cruickshanks, Klein, Klein,Wiley and Nondahl [4] stated that the hearing loss is associated with reduced quality of life (QOL), hearing handicap and self-reported communication difficulties in older adults.
To overcome such difficulties, auditory rehabilitation is necessary and it can be achieved through hearing aids. It may be true to a certain degree that hearing aid technology has provided a much better performance but, still are not the same as biological ears. Therefore theses individuals face difficulties with the hearing aid when they use it for first time [5]. Therefore, it is important to know how well an individual is getting benefited with the hearing aid and how it contributes to his / her daily life [6]. Quantifying the results of a hearing aid fitting is often an overlooked aspect of the patient rehabilitation. However, quantification helps the clinicians to precisely assess the subjective benefit, a patient perceives from amplification. Cox [7] reported that the patient based outcomes have become increasingly important in evaluating the overall effectiveness of the treatment. The outcome of audiological rehabilitation involving hearing aid fitting is typically evaluated with the use of self-reported measures using standardized questionnaires such as disease specific questionnaires. These measures may include assessment of satisfaction with hearing aids, benefits from hearing aids and also reduction in client‘s perceived handicap due to the fact that they are wearing hearing aid. In the new era of consumer driven health care, the client‘s point of view is being increasingly accepted as a valid and important indicator in the success of treatment. Therefore in the long run, what the practitioner thinks may not matter very much if the client has a different opinion [8]. However until recently, these were given in informal discussions with non-professionals. Most of the professionals (Audiologists) often did not look at client‘s opinions [9] and they were not regarded as serious scientific data. Therefore, it is important to gather information from the patient‘s perspective regarding the hearing aid use or benefit.
Lack of published studies and research in hearing aid outcome measures in the Indian scenario has led to the present study. Mortensen [10] stated that the use of disease specific questionnaires, gives an overall understanding of QOL and hearing aid related information. Hence, in the present study, Abbreviated Profile of Hearing Aid Benefit (APHAB)[11], a disease specific questionnaire is administered on hearing aid users before and after two months of hearing aid use to assess the hearing aid benefit in order to understand the hearing impaired individuals as a whole.
MATERIALS AND METHODS
The study was carried out in the Department of Speech and Hearing, Manipal University. Fifteen participants were recruited for the study. A disease specific questionnaire-APHAB was administered before and two months after hearing aid fitting. All the subjects were explained about the potential importance and scientific benefit of reporting the data and consensus obtained. Participants were selected based on following criteria. They should have bilateral moderate senosri-neural hearing loss with an age range between 18 years to 60 years. All the participants were fitted with digital hearing aid monaurally and most importantly a first time user. People with congenital hearing loss and with past history of hearing aid usage were excluded from the study. Age, gender and duration of loss are noted in order to avoid its influence on the outcome of the study. APHAB is used to quantify everyday life problems associated with hearing impairment. It is a 24 item self-assessment inventory (table1).APHAB provides scores for 4 subscales. Each item contributes to only one subscale, and there are six items for each subscale, distributed randomly within the inventory. A higher APHAB score indicates more perceived difficulty in a particular situation and also certain items are written with a reversed logic (i.e., ?always‘ means fewer problems). This pattern is followed to maximize the validity and reliability of the data. Once the participants fulfil the selection criteria
Englishhttp://ijcrr.com/abstract.php?article_id=2374http://ijcrr.com/article_html.php?did=2374Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareUTERINE RUPTURE: 5 YEAR STUDY IN A TERTIARY CARE HOSPITAL OF WESTERN RAJASTHAN, INDIA
English3742Savitri SharmaEnglish Ashok SharmaEnglish Annapurna MathurEnglish MadhuSudan SwarnkarEnglish D. S.KhangarotEnglishObjective: To determine the frequency, predisposing, factors, maternal and fetal outcome in Uterine Rupture. Methods: This is a descriptive case series including all cases of uterine rupture who were either admitted with this complication or who developed it in the hospital were included in the study .Patients, who had rupture due to congenital abnormality were excluded from this study .Demographic data ,details of predisposing factors ,types of rupture ,the management ,maternal and fetal outcome were taken into consideration for analysis. Results: The total numbers of deliveries from Jan 2007 to Jan 2012 were28076.There were 22 cases of uterine rupture .Out of them most of the cases (55%) presented between age of 21 to 25 years. Majority of cases (54.54%) of uterine rupture occurred in 1 Para. All the cases were unbooked All cases had complete tear of anterior, lower part of uterus. Common cause (54.54%) of uterine rupture was previous caesarean section, second common because (22.72%) was prolonged obstructed labour .Sub total hysterectomy was performed in45 % cases and only repair was the management in remaining 55% cases. There was no maternal death in this study .live birth rate was 41%. There was still birth in 11(50%) and intra uterine death occurred 2(9%).3 cases had associated bladder injury with uterine rupture. Conclusion: This study showed that main cause of uterine rupture was previous caesarean section, followed by prolonged obstructed labour. Proper antenatal care and update training programme for health care providers is the need of time to prevent the catastrophic but avoidable complications.
EnglishUterine rupture, Caesarean section, Maternal and fetal outcome.INTRODUCTION
Rupture of the gravid uterus is a grave obstetric complication. It is associated with high maternal and prenatal mortality rates. Even where the patient survives, their reproductive function is abruptly terminated, and recovery is often prolonged and turbulent1,2.Uterine rupture related with some instant hitches, such as shock, anaemia and a rupture of urinary bladder, may leave surviving patients with term complications like vesicovaginal fistula and inability to deliver children3 . The prevalence was found significantly high in underdeveloped countries of Asia and Africa in comparison to high income countries 4,5 . The incidence of uterine rupture has dropped significantly in developed countries and is most often encountered while attempting vaginal birth after caesarean section.6 The risk of experiencing uterine rupture during child birth is 50 times higher if the mother already had a caesarean
section.6 Most cases of uterine rupture that occur in developing countries are due to ignorance, quackery, and maladministration or nonavailability of essential medical supplies. Causes of uterine rupture are: grand multiparity, injudicious use of oxytocin particularly when it is not medically indicated and administered, neglected labour, previous caesarean section and myomectomy, uterine instrumentation and manipulation, labour induction, congenital abnormalities of uterus and uterine distension due to polyhydroamnios, multiple pregnancy and foetal macrosomia. The sign and symptoms of uterine rupture largely depend on timing, site and extent of uterine defect, severe haemorrhage, palpable fetal parts, recession of presenting foetal parts, loss of uterine contractility, rarely blood stained urine, appearance of placenta at vulva and prolapsed loops of gut into vagina.7. Hysterectomy is considered the treatment of choice in patients with intractable haemorrhage or when uterine rupture sites are multiple. Repair of ruptured uterus with or without tubal ligation is done in young and stable patient. Repeat caesarean section is done at 36 weeks of gestation in patients with previous uterine repair 8,9 . This study was done with the view that there is paucity of studies related to uterine rupture in Rajasthan even in India.
MATERIAL AND METHOD
This is retrospective hospital based observational study and it was conducted from January 2007 to Jan 2012 at Heera kunwar Ba zanana Hospital Jhalawar which is a tertiary care hospital of Jhalawar Medical College and having 500 bed capacity in General including 150 beds in Zanana hospital. Two units are regularly being run in this institution in Obstetrics and Gynae department. The data collected from the maternity ward and operation theatre registers as well as from the patient‘s case file at the Hospital Medical Record office. 22 cases of uterine rupture were recorded in this period. Various parameters studied were age, parity, distance travelled by patients, maternal and fetal outcome, operative procedure done, blood transfusion and study of immediate complications. History of Previous caesarean section, other uterine surgery, and causes of prolonged labour were recorded. Management was done in the form of sub total hysterectomy, repair of ruptured uterus or bladder with or without tubal ligation. Maternal outcome in the form of recovery, death, also perinatal deaths were recorded and data analyzed. Most cases were referred from periphery and a few suffered uterine rupture in the hospital. Delay in starting definite treatment was found due to long distances travelled by patients from her place to the hospital.
RESULTS
From January 2007 to January 2012, 28076 deliveries conducted and 22 cases of uterine rupture were recorded. The overall incidence rate found 0.0783% or 1 in 1276 deliveries. The age of patients varied between 20 years to 40 years. The highest incidence(55%) of rupture seen in the age group of 21-25 years and 7cases (32%) from 26-30 years, 2 cases(9%) belonged to age group 31-35 years while lowest incidence was observed in 36 - 40 years. In 12(54.45) cases making majority, cause of rupture was previous caesarean section scar ,while second cause noted was obstructed labour 5(9%) ,third important cause came out as manipulation( internal podalic version) in 2 cases. One case refused for caesarean section and was given trial resulted in rupture uterus. Also there were two cases with IUD in which trial was given and uterine rupture occurred. Most of the patients (77%) travelled more then 30 to 45 Kilometers from periphery to hospital and had ruptured uterus at home or with traditional birth attendants or at the level of primary health centre while remaining patients (23%) suffered rupture uterus during management in hospital.
In this study it was observed that highest(59%) cases of rupture occurred in women having one parity, 2 cases (9%) were seen in 2 parity females, 3 cases(14%) of rupture occurred in 3 para ladies while only 3 (14%)cases were seen in 4 or more than 4 para. One case of rupture was seen in nuliparous woman. An analysis regarding fetal outcome revealed that in 41% (9 cases)females delivered live babies, while in 50% (11 cases) there was still birth delivery, 2 cases(9%) suffered from intra uterine death. Regarding maternal mortality no death was seen during management because of rupture uterus. Surgical management was the only choice for saving life of mothers. 10 cases (45%) were managed by subtotal hysterectomy, while a quite good number of cases 12(55%) were treated by repairing uterus for preserving reproductive function. A single case was managed by repair with tubal ligation.
DISCUSSION
Uterine Rupture is one of most dangerous obstetric situation carrying an increased risk of maternal and perinatal morbidity and mortality, which is associated with poorly managed labour10, 11 . The incidence of ruptured uterus (1:1276 deliveries) in this series is lower than 1:167 and 1:110 reported earlier in Nigeria 12 and Ethiopia 13 , respectively, but higher than 1:6331 deliveries reported by chen et al from Singapore 14 . 77% cases were reached this institute either from home directly or from peripheral health institutions. This reflects that these patients try to deliver at home by traditional birth attendants or at remote health centers by health service providers. The majority of patients in this series did receive care neither in antenatal period and/or nor in intrapartum period at primary health care centers. In spite of recognizable risk factors present in almost all of them in the antenatal period, they continued to be dependent either on traditional birth attendants or they remain quite unattended and proceeded to labour. All had prolonged labour and yet this was either not recognized or recognized and managed erroneously by the administration of enormous doses of oxytocin intramuscular which was noticed as a trend adopted by traditional birth attendants and even by trained ANMs (Auxiliary Nurse Midwife) in this area. As 12 cases of uterine rupture had history of previous LSCS cases. If these cases could have been attended at community health centre level equipped with blood bank and if Gynaecologist or Surgeons have attended it there it self providing surgical facility number of still born/IUDs could have been less. In 5 cases (22.72%) prolonged and obstructed labour was the cause for uterine rupture due to injudicious use of oxytocin and delay in transport of patients to tertiary care centre. The injudicious use of oxytocin was found to be a significant predisposing factor in this series unlike reports by Konje et al 12 but similar to reports by chen et al 14, Chen and Hsieh 15 . Majority (54.54%) of patients in this study had a rupture of scarred uterus, similar to a report from Singapore by chen et al 13 in which over two-third of cases occurred in women with scarred uterus.In a retrospective review of 93 cases,P.Veena et al found that maximum number of uterine rupture occurred in younger age group (20-30 years) and 77% cases in her series had previous caesarean section depicting strong association of uterine rupture with previous scarred uterus .These observations match with our study 16 . In our study 2 cases of previous LSCS had uterine rupture during trial for vaginal delivery. In these two case one patient refused for LSCS and in another trial was given under supervision both suffered uterine rupture. In 2 cases internal podalic version for vaginal delivery was the cause for uterine rupture. This calls for caution, especially when some of these patients were subjected to induction or augmentation of labour 14,2. In a trial of labour in patients with scarred uterus, It is important that health workers supervise the labour closely and exercise caution before considering augmentation of the labour 2 . Refusal for LSCS in 1 case with one previous LSCS and other multi gravid with cephalo pelvic disproportion shows that in Indian society still there is big craze for vaginal delivery even when patient was in high risk, constituting cause for uterine rupture. Most patients (45%) had sub total hysterectomy done while 55% had repaired (bilateral tubal ligation in one case). Therefore 45% of patients lost their reproductive and /or menstrual function. The rest could have reproductive and or/ menstrual function maintained. They could only reproduce at risk. Ruptured uterus therefore has grave sociocultural implications, especially in a society where these functions are considered the very essence of womanhood.
In our study there was no maternal mortality, all women with uterine rupture recovered fully and discharged which was due to the fact that they were timely attended and treated as soon as they reached hospital. Also This could happen because of good support from blood bank as in majority of cases 3 or more than 3 units of blood was transfused with no delay. One more reason for better survival in this study appears to be related with the incidence of uterine rupture in younger age group i.e. 21 to30 years (total 87%) who sustained haemorrhagic shock and surgical trauma efficiently. In this study live birth rate was 41% which was higher than that seen in other study (31%) 16 .But a number of still birth 50% is quite worrying in this study which calls for attention.
CONCLUSION
Ruptures uterus is only one of the many preventable obstetric problems with grave consequences. Ruptured uterus remains a problem in our set up, with primary health centers and deliveries by traditional birth attendant being identified as major contributors to this condition. They primarily fail in the reorganization of abnormalities in the antepartum and /or intrapartum periods, with delays in referral and injudicious use of oxytocin. We recommend prohibition of the unsafe prescription of oxytocin. This is presently an over -the -counter drug and has been shown in this study, a dangerous drug in the hands of the unskilled. Health education of women in the reproductive age is also required. We recommend utilizing pyramidal health structure that is primary health centers would be directly responsible to secondary health centers, which in turn would be directly responsible to tertiary health centers. Also there is need that referral health centers at subdivision, tehsil levels need to be well equipped with blood banks and availability of operating surgeon/gynaecologist so patient in such a grave situation may not have to rush for more then 35 Km distance to avail facility at district level/tertiary level centers as happened with them in this series of study, because it puts detrimental effects on maternal as well as foetal outcome in this rural population dominated country.
Englishhttp://ijcrr.com/abstract.php?article_id=2375http://ijcrr.com/article_html.php?did=23751. Elkady AA Bayomy HM. Bekhiet MT. Najib HS. Waliba AK. A review of 126 cases of ruptured gravid uterus.Int Surg 1993:78:231- 5.
2. Prasad RN, Rantan SS. Uterine rupture after induction of labour for intrauterine death using the prostaglandin E2 analogue sulprostone Aus N Z J Obstet Gynaecol 1992:32:282-3.
3. Philpott RH- obstructed labour. Clin obstet Gynaecol 1982; 625-40.
4. Saglamtas M, Vicdan K, Yalcin H,et al.- Rupture of the uterus.Int J Gynaecol Obstet 1995;49:9-15.
5. Lema VM, Ojwang SB, Wanajala SHRupture of the gravid uterus: a review: East Afr Med J 1991;68:430-41
6. Rashmi, Kirshan, Vaid NB – Rupture uterus changing Indian scenario. J Indian Med Assoc 2001; 99:634-7.
7. Khanum Z, Lodhis K-emergency Obstetric Hysterectomy;a lifesaving procedure.Ann King Edvard Medical College 2004; 10:292- 4
8. Bashir A-maternal Mortality in Faisalabad city-A longitudinal study.The Gynaecologist 1993; 3:14-20
9. Lim AC,Kwee A ,Bruinse HW-Pregnancy after uterine rupture:A report of 5 cases and review of theliterature,Obstet Gynaecol Surv 2005;90;16-37
10. Kwast BE, Liff JM-Factors associated with maternal mortality in Addis Ababa, Ethiopia .Int J Epidemiol 1988; 17:115-21
11. Kadowa I- Ruptured uterus in rural Uganda;prevalence,predisposing factors and outcomes.Singapore Med J 2010;51:35-38.
12. Konje JC Odukya OA. Ladipo OA. Ruptured uterus in Ibadan- A twelve-year review Int J Gynecol Obstet 1990:32:207-13.
13. Gessessew A, Melese M. Ruptred uterus – eight year restrospective analysis of causes and management outcome in Adigrat Hospital.Tigray region. Ethiop J Health Dev 2002:16-241-5.
14. Chen LH, Tan KH. Yeo GS. A ten years review of uterine rupture in modern obstetric practice. Anm Acad Med J Singapore 1995:24:830-5.
15. Chen KC, Hsieh TT. Rupture of grand uterus: an eight-year clinical analysis and review of literature .Chang Keng I Hsueh- Chang Keng I Hsueh-Chang Gung Med J 1992; 15:15-22.
16. P.Veena, S Habeebullah, and L.ChaturvedulaA review of 93 cases of ruptured uterus over a period of 2 years in a Tertiary Care Hospital in South India; April 2012: Vol 32- No 3; pages 260-263
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcarePOSTPONEMENT OF ELECTIVE SURGERIES: CAUSES AND PREVENTION
English4348Ashok SharmaEnglish Savitri SharmaEnglish Rajan NandaEnglish Atul TiwariEnglish Usha DariaEnglishAims of study: To identify the factors pertaining to such postponements and to find out a workable solution to prevent postponements caused due to avoidable reasons. Postponement of elective surgery puts financial and psychological pressure on patients. Methods: This study was planned to analyse reasons for postponement of elective surgeries.Duration of study was one year from December 2007 to November 2008 Results: Total number of elective surgeries as recorded were 1245, out of these 177 were postponed. Highest number of postponed cases was due to inadequate preparation of patients 28.8%. Next main cause included multiple Medical reasons 23.7%. Another important reason was shortage of OT time (20.3%) for various reasons. Few other causes were, less number of anesthetists and surgeons15 (08%),
power cut11 (6.2%), interrupted water supply7 (4.00%), sudden declaration of holydays and strikes5 (2.8%) etc were also recorded. Conclusion: Two factors appeared\for postponement of surgeries. First were unexpected medical emergencies that constrained surgeons to postpone surgeries and second included holidays that were declared late or strikes of workers, too accounted for detention of 26.55 % of cases. It can not be controlled by any mean. Postponements due to inadequate preparation and shortage of OT time were more than 50 % (60 %) identifying these two areas to be intervened first, specifying the areas where maximum improvement is required. Still other reasons that occupy small spaces on scale of
percentage, individually, appear big when combined together (27.2 %) suggesting that small efforts are required.
EnglishOT, NPO, postponement, surgical operations, CCUINTRODUCTION
Postponement of surgical cases has been likened to adverse events that require routine monitoring because of its effect on utilization of health system resource,1,2. Furthermore, it is inconvenient and stressful for patients as it results in loss of their working days and disruption of daily life 3, 4 . Every institution strives to be recognized for its efficiency, but a high postponement rate of elective procedures keeps it difficult to accomplish 5 . However operation theatres are underutilized and lie idle many times and many patients who are called for operations from waiting list are not operated upon 6 . Planned operations that are cancelled (on that day) reflect inefficiency in management 7 . It increases theatre costs and decreases the efficiency 8 . It also causes emotional trauma to patient as well as to their families. Jhalawar hospital and medical college is 500 bedded hospital catering services to tribal and low
socioeconomic population reaching here from far flung areas. The study was conducted in order to find out the rate of postponement of the scheduled cases on an operation day in departments of surgery and orthopedics where maximum number of surgeries are performed and, to evaluate the causes of such postponements which in turn would help in figuring out workable solutions to avoid such incidences. The National Health Service (NHS), UK through its ?Modernization Agency Theatre Program? identified ?case postponement? as an incidence that occurs after patient has been notified for operation (9). An efficient surgical service should have a low rate of postponement of operations. If operations are cancelled, the operation theatre is underused, its efficiency jeopardized, waiting list increased and cost is also raised (10). It is well known fact that if resources are not properly utilized, the general population, specially the lower income groups, that depends more on public or government systems for most of their health care needs, suffers a lot. The cost of under utilized facilities and equipments also adds to cost of health care services which ultimately passes on to patients. Avoiding such postponement is an essential step to make health care system cost effective. The National Audit Office in Britain Examined five district health authorities in detail and concluded that Operation Theatres were used only to half of their capacities in spite of huge waiting lists 11. Most of the operations are postponed at 24 hour notice (12). The patients and relatives feel disappointed, frustrated and anxious(5) . Since this institute was upgraded as medical college hospital from District Hospital in 2007 so this was an effort for better functioning of this institute and to provide baseline data for future studies, specially when such study was not conducted in this area, before.
MATERIAL AND METHOD
The study period was 1 year (December 2008 to November 2009). All patients who were scheduled to undergo elective surgeries in two main operation theatres of Jhalawar hospital and medical college were included in this perspective study. Final OT lists were prepared after pre anesthetic checkups by surgeons at 2.00 P.M., a day before the surgery. Any operation that was either already scheduled or was subsequently added to the final list and than was not operated on that day was considered as postponed and was included in the study. Observations regarding causes for postponement were recorded on sheets then transferred to master chart and data analysed.
RESULTS
In duration of 1 year 1245 cases of planned General Surgery and Orthopedic surgery were studied. Out of these 1245 cases, 177 were found postponed on the day of surgery, which is 14.2% of total cases. Maximum cases postponed in this study 28.81% were due to inadequate preparation of patients prior to surgery, inadequate arrangement of medicines and / or, surgical gazettes like suture material, mesh, drains etc. In this category patients who could not arrange blood required for operation or could not follow instructions for keeping NPO were also included, Next highest number of cases 23.7% postponed were due to medical reasons like uncontrolled hypertension, sudden cardiac problems, Acute respiratory diseases and fever. 20.3% cases were postponed due to shortage of available OT time. 08.5% postponement were due unavailability of anesthetists and surgeons on the day of surgery. In contrast to other studies no case was postponed in our institution due to shortage of beds in post operative ward / CCU. One more cause that accounted in other studies i.e. operation not needed was not included in this study. Power failure (6.2%) and interrupted water supply (4%) were among other reasons for postponing surgeries. Rarely some surgeries were postponed for weird reasons like delay in transport of patients to and from OT in between two surgeries (1.7%), uninformed consent, non compliance of patient (1.1%) and/ or no relative with patient, No case was postponed in our study due to failure to administer anesthesia.
DISCUSSION
In our study we found 14.2% operations postponed. The numbers are higher than found in any other study 6,7,13. In UK 8% of scheduled operations were postponed nationally within 24 hours of surgery. (14). The most important cause for postponement in our study was Inadequate preparation of patients 51 cases (28.8%) that was quite high as compared to other studies.
Inadequate availability of medicines, surgical gazettes (mesh, suture material, prosthesis, nails, plates etc.) appeared as clear cut cause for postponing surgeries and was related with poverty in this region. Though, government helps by supplying these materials to enrolled BPL patients but many patients who were not enrolled in BPL category were also found unable to cope up with situation without financial assistance. Lack of such assistance many time resulted in postponing surgeries. We have noted that though voluntary organizations and blood banks support patients by providing stored blood for surgery but since number of thallesemia patients is a more in this south western zone of Rajasthan, requirement of repeated blood transfusions increase the demand. Additionally, requirement of blood is high in Obstetrics & Gynecology department for emergency operations and blood banks could rarely match the demand by supplying stored blood for planned surgeries. This made planned surgeries to depend on blood donation by relatives only. Popular false believe of becoming weak after a blood donation keeps illiterate relatives from donating blood and many times it becomes a reason to postpone a planned surgery. Inadequate management of some other but important medical conditions was second most important cause for postponing surgeries and accounted for 42 (23.7%) cases. Though pre anesthetic check up of all elected cases is a routine but certain medical warnings like sudden ECG changes, angina, uncontrolled blood pressure, uncontrolled and fluctuating diabetes, acute respiratory infections and fever etc forced surgeons to postpone the surgery till the emergent ailment was controlled. Non utilization of emergency operation theatre? for emergency surgeries was also a cause for shortage of operating time in main operation theatre which was avoidable simply by appointing required number of anesthetists, for each operation theatre separately. Shortage of operating time was the third most important factor, accounted for 36 (20.3%) surgeries, postponed. Lots of OT hours were found wasted due to delayed beginning of operations. Time spent in preparing cases, cleaning operation theatres, and transportation of patients to operation theatre also emerged as reasons for the same. Schedule of hospital duty hours also surfaced as one of other causes. Implementing a District hospital schedule of morning (8 am to 12 pm) and evening (5 to 6.30 pm) here, permitted OT to work only for 4 hours in morning, decreasing OT time by 2 hours as compare to other Medical Colleges. Other causes of shortage of OT time included delayed start of operations due to surgeons taking rounds of there wards first then reaching OT late for surgery. Postponement due to shortage of anesthetists, Surgeons, and paramedical assistants in our study was 15 cases (8.5%).11 and 7 cases (6.2% and 4.0%) were documented as postponed due to power failure & interrupted water supply respectively, in this study. No case was postponed due to equipment failure in our study as was seen in other studies. If we consider medical (23.7%) and late announced holidays/strikes (2.8%) as genuine reasons for postponing surgeries even than, remaining 76.16% (121 cases) were postponed for the reasons that could have been managed by administrative will. CONCLUSION The intention of study was to identify factors responsible for postponements of planned surgeries. Two, of all factors appeared as genuine for postponement of surgeries. First were unexpected medical emergencies that constrained surgeons to postpone surgeries and, second included holidays that were declared late or strikes of workers that involved OT staff too. Both of these factors combined to account for detention of 26.55 % of cases. Though, this percentage is a sounding one but it is concluded that nothing could be done to decrease this figure as it can not be controlled by any mean. Out of remaining, just two factors displayed data almost at par with previous two factors and these were, the causes related to preparation of patients for surgery (28.8%) and shortage of actual operation theatre hours for numerable reasons (20.3%). If we add both of these, popped up figure touches almost a halfway mark (49.1 %) specifying the areas where maximum improvement is required. Still other reasons (all, other than above 4) that occupy small spaces on scale of percentage, individually, appear big when combined together (27.2 %) suggesting that small efforts are required everywhere to change the scenario. To evaluate it further when analyzed the cases postponed due to avoidable reasons only, the combined share of postponements due to inadequate preparation and shortage of OT time was more than 50 % (60 %) identifying these two areas to be intervened first, in order to control postponements immediately.
Englishhttp://ijcrr.com/abstract.php?article_id=2376http://ijcrr.com/article_html.php?did=23761. Schofield WN, Rubin GL, Piza M, Lai YY. Cancellation of operation on the day of intended surgery at a major Australian referral hospital. . MJA 2005; 182 (12): 612- 15.
2. Garg R Bhalotra AR, Bhadoria P, Gupta N and Anand R. Reasons for cancellation of cases on the day of surgery- A Prospective study. Indian j Anaesth 2009;53:35-9.
3. Tait AR Voepel- Lewis T, Munro HM, Gutstein HB and Reynolds PI.Cancellion of pediatric out patient surgery ; economic and emotional implications and for patients and their families. J Clin Anaesth 1997; 9:213-9.
4. Chamisa I. Why is surgery cancelled? A retrospective evalution.S Afr J Surg 2008; 46(3):79-81. 5. Ivarsson B, Kimblad PO, Sjoberg T, Larsson S. Pati-ent reactions to cancelled or postponed heart operations. J Nurs Manag. 2002; 10 (2): 75-81.
6. Morrissey S, Alun -Jones T, Leighton S. Why are operations cancelled? BMJ. 1989; 299:778.
7. Vinukondaiah K, Ananthakrishnan N, Ravishankar M. Audit of operation theatre utilization in general surgery. Natl Med J India, 2000; 13(3):118
8. Weinbroum AA, Ekstein P, Ezri T. Efficiency of the operating room suite. Am J Surg, 2003; 185(3):244-50
9. .National Health Services, Modernisation Agency.Theatre Programme.StepGuide to Improving Operating Theatre Performance.London: NHS, 2002. (Assessed on 25th January 2011). Available at http://www.cancerimprovement.nhs.uk.
10. Mangan JL, Walsh C, Kernohan WG, Murphy JS, Mollan RA, McMillen R et al. Total joint replacement: implication of cancelled operations for hospital costs and waiting list management. Qual Health Care, 1992; 1(1):34-7.
11. Dudley H. Empty theatres. BMJ. 1988; 297(6662):1490.
12. Koppada B, Pena M, Joshi A. Cancellation in elective orthopaedic surgery. Health Trends. 1991;23(3):114-5.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareSELF PERCEIVED ORAL HEALTH STATUS, ORAL HEALTH PRACTICES AND UTILISATION OF DENTAL SERVICES AMONG 10-16 YEAR OLD CHILDREN: A CROSS SECTIONAL STUDY
English4957A.M.Deva PriyaEnglish Anupama TadepalliEnglish Dhayanand John VictorEnglishAim: The aim of the study was to assess the oral health practices, behaviours, self perceived oral health status and dental service utilisation among children from a single private school in Chennai. Materials and Methods: 560 students, aged 10-16 yrs participated in a dental camp conducted by SRM Dental College and Hospital, Chennai. Students were asked to complete a structured questionnaire. Statistical significance was determined by chi square test. Results: The results of the study showed that, majority of the boys and girls perceived their oral health as good (36.7%). Only 43% of the children have visited dentist before. All the children used toothbrush and tooth paste for cleaning their teeth. The self perceived oral health status was significantly associated with age and gender (p value < 0.05 respectively). Frequency of brushing showed a significant association with age and self perceived oral health status (p value EnglishChennai, Oral hygiene practices, School children, Self perceived oral health, Utilisation of dental serviceINTRODUCTION
Non communicable diseases like oral and dental diseases are widely prevalent in developing countries like India. India is ranked as the second most populated country in the world 1 with 17.38% of world population. Unfortunately only 4.2% of the Gross Domestic Product (GDP) 2 is spent for health policies, hence there is inadequacy in health care facilities. At present the dentist-to-population ratio in India is 1:13,000 whereas in rural areas it is 1:2,50,0003 . The rural areas hardly have any qualified dentists even though 68.84% of the Indian population live in rural areas 4 . The government provides dental care through primary health centres and through higher referral centres however the capacity of these centres to cater to the needs of the entire population is very limited. Majority of the dental care is provided by private dental hospitals and dental clinics therefore considering the cost of treatment at private establishments, the most effective way of reducing disease burden is by primary level of prevention. Children are more commonly affected by dental diseases and therefore schools serve as the ideal setting for promoting oral health. Children are more receptive and earlier the habits are established, the longer lasting the impact 5 . School dental health education programmes are cost effective ways of improving the dental health of not only the children at an individual level but also the community at large .They play a crucial role by helping children to appreciate the importance of healthy teeth, encouraging good oral hygiene practices and behaviour, educating them to seek regular dental treatment, motivating them to follow good lifestyle etc. Implementation of an effective school oral health programme requires that the target population be evaluated and assessed to set priorities and goals. Utilisation of health care services is an important determinant for health. Age, Gender, Socioeconomic status, Ethnic background, Oral Health related behaviours, and Self Perceived Oral Health Status have all been found to be associated with utilisation of dental services. Self reported assessment of oral health and socioeconomic status have received considerable attention in recent years and have been found to be an important determinant of dental service utilisation6 . Studies 6,7,8 from affluent countries have shown that dental care utilisation is strongly determined by self perception of oral health and parent‘s education Unfortunately data regarding the interactions of these predictors in developing countries like India is lacking. Hence, the aims and objectives of this study were 1. To assess the oral health related behaviours of children in the present study population. 2. To analyse the association between their self perceived oral health status and father‘s education. 3. To assess the influence of self perceived oral health status and father‘s education on utilization of dental services. MATERIALS AND METHODS The study was cross sectional and observational in design. It was carried out as a part of school dental health programme organised by SRM Dental College, Ramapuram, Chennai. Prior permission was obtained from concerned school authorities for conducting the study and the study protocol was approved by the Institutional Ethical review board of SRM University. To fulfil the objectives of this study, the original WHO Oral Health Questionnaire for children by Poul Erik Peterson 2004, was modified and utilised as a screening tool to assess self perceived health status and dental service utilisation .560 students, aged 10- 16 years attending a private school in Chennai participated in the dental camp conducted from September 2010 to January 2011 and completed the questionnaire. The pretested structured questionnaire was completed under the supervision of Investigators who were specifically trained for this purpose and were available at all time for clarifying their doubts. After the completion of questionnaire they were given oral health education, with audiovisual aids and models, later dental examination was carried out and necessary treatment done. As the clinical examination was done by multiple undergraduate students at different period of time, findings could not be recorded for further evaluations due to larger inter examiner errors. All the students responded to all the questions in the questionnaire. The final data was collected from 560 students, 335 boys and 225 girls, aged 10-16 years and Statistical analysis was done using Microsoft SPSS 11.5 package. Chi square test was used to assess the association between the different categorical variables.
RESULTS
The study sample consisted of 335 boys (59.8%) and 225 girls (40%) with the age ranging from 10 – 16 years. Figure 1 shows the distribution of study population with age and gender. The self perceived oral health status of the study population is shown in Table 1. In this study, the majority of the boys and girls perceived their oral health as good. Only 3.2% of the total respondents perceived their oral health as poor. The self perceived oral health status was significantly associated with age (p value < 0.05) and gender (p value < 0.05). Frequency of brushing was significantly associated with the self perception of oral health (p value < 0.001). Father‘s education taken as an indicator of socioeconomic status showed no significant association with self perceived oral health (p value >0.05). Among the total study population 43% had visited the dentist. 51% of boys and 30% of girls have visited dentist at least once (Figure 2). Majority of the boys and girls in all the age group had visited the dentist except girls in the 11 year age group i.e. 56% had never visited dentist. Utilisation of dental services was not associated with Self perception of oral health and father‘s education (p value > 0.05). In the previous 12 months, 36% of boys and 37% of the girls had some trouble in teeth or gums, whereas 53% of boys and 57% of girls did not have trouble. 44.5% of boys and 28% of girls have visited the dentist in the last twelve months. Among those who had trouble in their teeth or gums in the last twelve months, only 13 % of the boys and 9% of girls had been to a dentist for management of symptoms. A further 4% of boys had been to the dentist as a part of follow up for orthodontic treatment,6% had visited the dentist with their parents and 10% had visited the dentist through screening camps held in their residential area in the last twelve months. Some boys could not remember the reason or didn‘t know the reason for their visit .In the last twelve months 4% of girls had visited dentist for follow up for ongoing orthodontic treatment, 5% had visited along with parents and 6% had visited the dentist through screening camps held in their residential area. All the children used toothbrush for cleaning their teeth. Only 0.5% (two boys) had used chew sticks - whenever they visited their native village, for cleaning their teeth. 10% of children used additional aids for cleaning, i.e. 4% used wooden toothpick, 3% used plastic toothpick, 3% of boys and 0.4% (1) of girl used salt for brushing along with toothpaste. The frequency of brushing in the study population is shown in Table 2. Among the boys 45.6% brushed twice daily and 46.2% brushed once daily. From among the girls, 45.3% brushed twice daily and 48% brushed only once. 3.2% of the study population never brushed or brushed two or three times per month. Frequency of brushing showed highly significant association with age (p value < 0.001). Table 2, shows the direction in which the children are brushing their teeth. Majority of children brushed in horizontal direction 26.7%, while 24.4% of them brushed in no specific direction. Among the boys, major percentage i.e. 27.4% brushed in no specific direction while 25.6% brushed in horizontal direction.28% of the girls brushed in horizontal and circular direction respectively. 47% of the girls and 40% of boys brushed for less than five minutes while 46.8% of the boys and 36.4% of girls brushed for more than five minutes. Among the boys, 88.6% of them changed brush within three months while 3.2% changed every 6 – 12 months. 94% of girls changed brush every three months while 0.8% changed brush every 6-12 months (Table 2). 3% of the boys and 0.4% (1) girl were using powered tooth brush.16% of the boys and 6.6% the girls used mouthwash (Table 2). None of the children were aware of fluoride in toothpaste except one girl. Tobacco products were not used by any of the children. Majority of girls and boys in all age group i.e. 32% and 37.6% respectively had sweets, candies at least once a day. Almost similar percentage i.e. 29% of girls and boys respectively took fizzy drinks once a week. Majority i.e. 26.2% of boys had chewing gum with sugar everyday. Majority of the girls and boys never took tea with sugar while significant percentage i.e. 37% of girls and 31% of boys had it everyday.
DISCUSSION
The perception of oral health may influence oral health decisions, health care utilisation patterns and may be associated with clinical, psychosocial and socioeconomic factors. Studies reporting the relationship between dental service utilisation and perception of oral health among school children, in India are lacking, hence in this study we have assessed the oral health awareness of the children and analysed the association between oral health practices, self perceived oral health status, father‘s education and dental service utilisation. Self perceived oral health of majority of the respondents in this study was good and is in accordance to the study by Arun kumar Prasad et al 9 . Eight percentage of children in this study felt their oral health was excellent and 15.2% did not know the status of their oral health, this is similar to study by Navneet Grewal et al 10 among Indian children in Amritsar where 6% of children felt that their oral health was excellent and 16% did not know the status of their oral health. Among 12 year old children in Kerala, 77% perceived their oral health as good 11, which is similar to the current study, where 74% of the 12 year old children felt that their oral health is good. Ostberg and colleagues 12 investigated the association between dental attitudes, behavior and self-perceived oral health in Swedish adolescents, and concluded that girls, more often than boys perceived their oral health as good and that there is a strong association between attitudes towards dental care and self-perceived oral health. Similarly, Corinna Pellizer et al 13 reported in their study that among adolescents in Croatia, girls had a better perception of their oral health. In accordance to the above studies, our analysis showed that girls had better perception of their oral health than boys. Respondents who brushed twice or once daily had better perception of their oral health than those who brushed at lesser frequency. The current study results showed that better self perception of oral health status, increased significantly with age. This could be attributed to the increased frequency of brushing with increasing age, which was shown to be highly significant (p < 0.001). Longitudinal studies that may be conducted to evaluate this hypothesis may be more conclusive. David et al 11 observed no social gradient in correlation with self perceived oral health among Indian school children. Similarly in this study father‘s education, which could be taken as an indicator of socioeconomic status, showed no significant association with self perceived oral health status. In Indian society, father‘s education does not necessarily determine the socioeconomic status as there are multiple factors that decide the economic status of the family. However studies 14, 15 have reported that adolescents, who had parents with high level of education were less likely to be dissatisfied with their oral health compared to those who had parents with low level of education. Pattusi et al 16 among 14-15 year old Brazilian adolescents failed to relate utilisation of dental service with perception of oral health, the results of this study similarly showed no association. It has been shown that children who rated their oral health as poor, with lower parental income and education were strongly associated with lesser utilisation of dental services. Several factors influence the utilisation pattern among children like household income, parents knowledge and awareness of oral health, perceived need for treatment, dental anxiety and fear, hence the results from this study should be interpreted with caution, as only limited variables were assessed and it was a cross sectional study hence causal relationship cannot be determined. Majority of children have never been to a dentist in this study. Among the respondents, more number of boys visited dentist than comparative age group girl. In spite of having trouble in teeth or gums i.e. 37%,only 28% of girls visited the dentist, this could be attributed to good perception of oral health among the girls and ignorance regarding dental visit and disease. Visit to dentist among 12 years old is high (57%) when compared with 12 years old children in Sudan (48%) 17. It is reported that, in developed countries like United States higher percentage of children visit the dentist more frequently i.e. 72% 18 this is attributed to better dental health awareness, good dental care facilities, efficient public dental services, dental insurance etc. whereas, in developing countries like India, visit to dentist is mainly symptomatic. In the current study in spite of having dental problems, only a few children visited the dentist, this shows the poor knowledge regarding preventive and interventional dental care. It was also observed that some children have visited dentist along with their parents and through screening camps conducted by private dental practitioners in their residential area hence, parent‘s need to be educated and motivated to take their children for regular dental visits and dentist should actively take part in creating oral health awareness among the general public. The children in this study population brushed more frequently i.e. twice daily which indicates their health promoting behaviour and motivation. Contrary to the findings by Deepak et al 19, 45.5% of 12 year old children in this study brushed twice daily. Boys in this study brushed more frequently and for more time than girls, this is contrary to as reported by Rise et al 20, Al Sadan et al 21 . Similar to the study by Lian et al 22, Lin et al 23 , toothbrush and toothpaste was the most commonly used oral hygiene aid in this study. Assessment of oral hygiene practice among rural children in Tamil Nadu 24, showed that only 62.96% and 55.5% of children respectively used brush and tooth paste for cleaning their teeth. In this study, maximum use of toothpaste and brush is as expected because the children are living in urban area, studying in a private school, with extensive exposure to mass media and better standards of living. Awareness regarding use of dental floss is very poor among the children in this study as only 2 boys (0.4%) were flossed regularly. Gagandeep kaur et al 25 reported that 25.8% of Indian children were aware of dental floss in his study which is significantly high when compared with this study. Children need to be educated about the benefits and techniques of flossing. Most of the children were aware of powered toothbrush and mouthwash from animated cartoon series and advertisements in television. The parents of the children who were using powered toothbrush were either professionals or working in other countries. The impact of mass media is so enormous that not only does the information reaches even the farthest village instantaneously but also in huge numbers, hence government agencies and Non Govermental Organisations should effectively make use of this media for creating oral health awareness. Frequency of intake of sweets was similar among all age group and no difference between genders is seen which is similar to finding by Al sadan et al 21, since age difference among the groups is small, respondents had similar liking. Intake of fizzy drinks among children in this study is very less i.e. once a week, this is in contrary to findings among secondary school children in Sarwak, Malaysia 17 where 26.3% had it once per day. In Western, European and other countries, fizzy drinks forms a part of their every day diet ,so percentage of intake of those drinks among the children is very high while in Indian food system intake of drinks like milk, tea or coffee is more among the children. Limitations of the study are, students tend to report socially desirable answers and underestimate their negative behaviours when structured questionnaire is administered, only convenient sampling was done, single indicator i.e. education of father was taken for assessment of socio economic status and oral health status could have been compared objectively by clinical examination.
CONCLUSION
Within the limitations of the study, it can be concluded that irrespective of gender all the children had better oral hygiene practices and good perception of oral health. Majority of the children never visited the dentist, this could be attributed to high level of oral hygiene practices, good perception of oral health and lesser incidence of trouble in teeth or gums, hence preventive care seeking behaviour among the study population is lesser and could also be attributed to other factors like socioeconomic status, parent‘s education and motivation etc. Girls had a better perception of their oral health than boys, and children who brushed frequently had a better perception of their oral health. Dental care utilisation showed no association with father‘s education and self perception of oral health. Identifying factors influencing the utilisation of dental services among the children would encourage prevention oriented dental visits as they are more cost effective. In view of the scarce dental resources available in India and high economic burden of the disease, more systematic and efficient oral health education programme should be regularly implemented and reinforced in schools to target children and their parents. Source of funding: Nil Conflict of interest: Nil
ACKNOWLEDGEMENT
Authors like to thank Ms.Aarthi ,Bsc,Msc Biostatistics for helping with the statistics.Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript.The authors are grateful to authors/editors/publishers of all those articles,journals and books from where the literature for the article has been reviewed and discussed.
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8. Chaiana Piovesan, José Leopoldo Ferreira Antunes, Renata Saraiva Guedes, Thiago Machado Ardenghi. Influence of selfperceived oral health and socioeconomic predictors on the utilization of dental care services by school children. Braz Oral Res. 2011; 25:143-149
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10. Grewal N, Kaur M. Status of oral health awareness in Indian children as compared to Western children: A thought provoking situation (a pilot study). J Indian Soc Pedod Prev Dent 2007; 25:15-19
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareEFFECT OF SMOKING ON NERVE CONDUCTION VELOCITY IN YOUNG HEALTHY INDIVIDUALS
English5862Motilal C.TayadeEnglish Nandkumar B. KulkarniEnglishIntroduction: Chemicals in cigarette smoke have been implicated in causing subclinical changes in myelin sheaths of peripheral nerves. This may contribute to nerve dysfunction particularly in the form of decreases in nerve conduction velocity. The degree of this effect has not been clearly established Aim and Objective: To measure nerve conduction velocity in the median nerve in smokers and nonsmokers.
Study Design:
This was a cross-sectional case-control study involving 80 normal healthy subjects (age range, 25-40 years). There were 40 apparently healthy smokers and 40 healthy non-smokers. Conduction velocities were measured in motor and sensory components of the median nerve under similar conditions. Data was analyzed by using appropriate statistical methods. Results: Statistically significant changes (P < 0.05) were found in the sensory nerve conduction velocity (Mean+ SD value in smokers was 55.11+ 2.32 m/s while in nonsmokers it was 57.09+ 4.21 m/s) whereas no such changes were found in Motor nerve conduction velocity (Mean+ SD value in smokers was 54.19 +6.35 m/s while in nonsmokers it was 54.97+ 7.33 m/s) in this study. Conclusion: We conclude that chronic smoking results in reduction of conduction velocities in sensory fibers of the median nerve.
EnglishNerve conduction velocity, smoking, Smoking Index, Median Nerve.INTRODUCTION
More than 4,000 different toxic and carcinogenic chemicals have been found in the cigarette smoke.1 Chemicals in cigarette smoke like nicotine, tar, carbon monoxide etc. are toxic to the peripheral nerves.2 Tobacco smoke has a direct toxic effect on the myelin sheath . Smoking causes subclinical changes in the myelin sheath and the resulting demyelination causes poor electrotonic conduction .3,4 This later results in decrease in the conduction velocity of nerves. With this background in consideration, the present study was planned to assess the effect of smoking on nerve conduction velocity. Study Design: In present study, 80 male volunteer subjects in the age group 25 to 40 years comprising of 40 smokers and 40 nonsmokers as control group were selected. Participant subjects were from staff members, residents and patients from routine OPD. After explaining the procedure and purpose of study, a written informed consent was obtained. Case group included smokers with history of smoking filtered cigarettes for more than 5 years, with no history of major illness like Hypertension, Diabetes Mellitus, Peripheral Neuropathy in past or present.
Smokers were grouped on the basis of smoking index, to assess the severity of smoking both in duration of as well as average numbers of cigarettes smoked per day. 5 Smoking Index is used to determine smoking exposure of the body quantitatively. It is simply calculated by multiplying the average number of cigarettes smoked per day in last seven days and duration of smoking in years. This index is similar to ?Pack years‘ criteria, which is commonly used in developed countries. According to Smoking Index the smokers were classified into: 1. Light smokers: Smoking index < 100 2. Moderate smokers : Smoking index 101-200 3. Heavy smokers: Smoking index >201 (Table no.2) The control group included subjects who have never smoked in life and were not having any other addiction related to tobacco ( like tobacco chewing, gutakha, pan masala, mishri etc. ) and with no history of major illness like Hypertension, Diabetes Mellitus, Peripheral Neuropathy in past and present. Subjects were included from routine OPD, a detailed history was taken regarding their previous illness as well as any drug treatment that may affect the study. The present study was approved by Institutional Ethical Committee. Subjects were called in the morning at 9.00 a.m. after light breakfast. Subjects were asked to abstain from smoking for at least 3 hours prior to tests. All the readings were taken in seating position at 25 0 C. We measured median nerve conduction velocities using a 2-channel EMG equipment (?Octopus‘, Clarity Medical Pvt Ltd, Mohali,India) In the present study, motor and sensory nerve conduction velocity of median nerve was measured. For motor nerve conduction velocity, median nerve was stimulated supramaximally at two points along its course respectively at wrist and antecubital fossa (elbow). The stimulating electrodes were placed with anode 3 centimeters proximal to cathode. Recording and reference electrodes were placed over abductor pollicis brevis along thenar muscle border. Ground electrode was placed over forearm. For sensory nerve conduction velocity, ring electrodes were placed at the proximal and distal interphalangeal joints of index finger. These served as recording electrodes. Stimulating electrodes were placed at the wrist , cathode distal to anode . Ground electrode was placed over the palm. With the help of stimulating electrodes a sub-maximal stimulation was given and antidromic conduction was recorded.
Statistical analysis:
Data was tabulated by using mean + standard deviation for both motor and sensory nerve conduction velocity. (Table no.1) Standard error of difference between two means was taken, Z test was used. (For motor nerve conduction velocity and sensory nerve conduction velocity)
RESULT
Statistically significant changes (P < 0.05) were found in the sensory nerve conduction velocity (Mean+ SD value in smokers was 55.11+ 2.32 m/s while in nonsmokers it was 57.09+ 4.21 m/s) whereas no such changes were found in Motor nerve conduction velocity (Mean+ SD value in smokers was 54.19 +6.35 m/s while in nonsmokers it was 54.97+ 7.33 m/s) in this study. (Table no.1) It was also observed that nerve conduction velocity was reciprocally related to smoking index; greater the smoking index, lesser was conduction velocity. (Table no.2)
DISCUSSION
From the result, it is seen that statistically significant changes were found in conduction velocity of sensory nerves but not in motor nerves. (Table no 1) When smokers were classified according to smoking index criteria changes were observed in the moderate and heavy smokers only; however such changes were not seen in light smokers. (figure no.1) Nerve conduction studies provide a means of demonstrating the presence and extent of a peripheral neuropathy. 6 Conduction velocity is usually reduced in demyelinative neuropathies , including smoking. Nerve conduction velocity tests can precisely measure the degree of damage in large nerve fibres like median nerve, revealing whether symptoms are being caused by degeneration of the myelin sheath.2 In the present study we recorded sensory and motor conduction velocities using surface electrodes which require less precision in placement and are therefore quicker to use. Also using low noise amplifier and signal averaging minute potentials can be recorded from nerve trunks by using these electrodes. Uncertanity of exact site of stimulation, lack of precision of measured conduction distance and uncertainity as to the temperature of the nerve can introduce errors in velocity measurements.7 By using computerised technique, majority of these errors can be eliminated giving more reliable and reproducible results. The conduction velocity values found in this study are seen similar to those observed by Agarwal et.al , who studied subclinical peripheral neuropathy in chronic obstructive pulmonary disease patients.8 Cigarette smoking affects neural function by various mechanisms. Smoking causes vasoconstriction and damages blood vessels by atherosclerosis, plaque formation etc. As a result the blood supply and amount of oxygen delivery to the nerve fibers decreases. (neural ischemia) Smoking also increases cholesterol level in the circulating blood stream which predisposes to the atherosclerosis. 9 The body‘s overall vascular and neural functions are closely related. The initial change which occurs as a result of smoking is constriction of microvasculature. Such microvascular function impairment occurs early in smoking. Hence smoking affects peripheral ends of nerves and then slowly proceeds towards the centre.10 Carbon monoxide released during smoking also damages tunica intima of blood vessels and endothelial cells, which further leads to deposition of fats in the vessel walls.11 Nicotine present in smoke worsens these effects. Myelin, forming a layer around the axon , is essential for the normal functioning of the nervous system. 12 Smoking initially induces subclinical changes in the myelin sheath.13This results in demyelination . This can also cause the blockage of the nerve conduction and decrease in conduction velocity. 14 Also the higher carboxyhemoglobin levels in the circulating blood found in smokers leads to slowing of nerve conduction by its direct action over the myelin sheath.15 Nicotine too has a direct effect on the myelin sheath. In clinical practice, a high frequency of neuropathies of different varieties has been reported in more than 60 percent smokers.16 In our present study, we found no statistically significant changes in motor nerve conduction velocity while significant changes were seen in the sensory nerve conduction velocity. This may be due to the fact that sensory nerves are thinner than the motor nerves and are having shorter internodal distances. As a rule the thinner nerves are early affected than the thicker nerves by any damage. Hence the sensory nerves may be more affected than the motor nerve.17 Further in this study, we also found more severe changes in sensory nerve conduction velocity in smokers whose smoking index is higher. This may be due to greater smoking exposure either in the form of high daily numbers of cigarettes smoking or longer duration of smoking which affects the various neural mechanisms. Both these factors may be responsible for changes which occur at level of nerve fibers. Demyelination process, occurring at the myelin sheath, which covers the nerve fibers is also slowly progressive. As these changes are slow initially, they may not be evident in early smokers or those with less smoking index. Limitations of Present study: An important limitation in present study is that other confounding factors that may influence nerve conduction (like diabetes, nutritional deficiencies, and atherosclerosis) have not been conclusively excluded.
CONCLUSION
From this study we conclude that chronic smoking is associated with reduction in conduction velocity in median nerve sensory fibers.
Englishhttp://ijcrr.com/abstract.php?article_id=2378http://ijcrr.com/article_html.php?did=2378
1. David M. Burns, Nicotine Addiction, Harrison‘s Principles of Internal Medicine: Vol.II, 2008, 17th Edition; Page no. 2736- 2739, McGraw Hill , USA,
2. Stanley Berent, Neurobehavioral Toxicology: Neuropsychological and neurological perspectives : Vol.II, 2005, First Edition; 495, Psychology Press, USA.
3. Richardson JK, Jamieson SC. Cigarette smoking and ulnar mononeuropathy at the elbow: Am J Phys Med Rehabil. 2004 ; Sep;83(9):730-4.
4. Sabyasachi Sircar .Conduction of nerve impulses. (page 90-95) : Principles of Medical Physiology. 2008; First Edition, Thieme, New Delhi.
5. Sanjay P. Zodpey, Suresh N. Ughade . Tobacco smoking and risk of age related cataract in men . Reginal Health Forum ; WHO South –East Asia Region ; September 2006; Vol.3; 336-341.
6. Michael J.Aminoff, Electrodiagnostic Methods for the study of Nerve and Muscle, Pages 1-7 ; Electromyography in clinical Practice : Third Edition ,2008, Churchill Livingstone , New York.
7. Ray cooper, Measurement of nerve conduction, page 61-74: Techniques in Clinical Neurophysiology: Practical manual, First edition, 2003, Elsevier, Edinburgh.
8. Agrawal D, Vohra R, Gupta P, Sood S, Subclinical peripheral neuropathy in stable middle aged patients with chronic obstructive pulmonary disease, Singapore Med. Journal, 2007; 48(10) : 887-894.
9. Effects of diabetes. Diabetes management 101.com , Cited on : 15 May 2011, From: http://www.diabetesmanagement101.com.
10. John R. Polito.whyquit.com, How smoking destroys blood circulation . Cited on : 16 May 2011, From http://whyquit.com/whyquit/LinksJBlood.htm l .
11. Ijzerman RG, Serne EH, van Weissenbruch MM, de Jongh RT, Stehouwer CD. Cigarette smoking is associated with an acute impairment of microvascular function in humans : Clinical Science (2003); 104, 247– 252.
12. Wikipedia contributor , Wikipedia – the free encyclopedia , Myelin, Page Version ID: 438016640, Cited on 15 May 2011, From: http://en.wikipedia.org/wiki/Myelin_sheath
13. Gerhard Scherer. Carboxyhemoglobin and thiocyanate as biomarkers of exposure to carbon monoxide and hydrogen cyanide in tobacco smoke: Experimental and Toxicologic Pathology, Nov.2006; 58, Issues 2-3, 15, Pages 101-124.
14. Nowak D, Brüch M, Arnaud F, Fabel H, Kiessling D, Nolte D et.al . Peripheral neuropathies in patients with chronic obstructive pulmonary disease: a multicenter prevalence study: Lung 1990; 168: 43.51.
15. Faden A, Mendeza E, Flynn F. Subclinical neuropathy associated with chronic obstructive pulmonary disease, possible pathophysiologic role of smoking : Arch Neurol 1981; 38: 639-42.
16. Jennifer Noble, Months Çakan , Ahmet Emin Erbaycu, Sevket Dereli, Ayse Özsöz , Hakan Edipo?lu, Behind Özer. Chronic obstructive pulmonary disease in electromyographic evaluation of peripheral nerves: Turkish respiratory Journal , Aug.2003 ; Vol.4, Issue- 2, Page 51-56.
17. Arthur K. Asbury, Dr. David R. Cornblath . Assessment of current diagnostic criteria for Guillain-Barré syndrome: Annals of Neurology, 1990 ; Volume 27, Issue Supplement 1, pages S21–S24.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareMATRIX PRODUCING MAMMARY CARCINOMA - A RARE BREAST TUMOUR
English6366Zankhana N PrajapatiEnglish Gunvanti B RathodEnglish R.N. GonsaiEnglish T.B. KadamEnglishMatrix producing carcinoma of breast (Metaplastic carcinoma, Carcinosarcoma) is a very rare condition having incidence rate of 0.08 to 0.2% of all malignant breast lesions. In this case, a 50 years old female, admitted in Civil Hospital, Ahmedabad was presented with swelling of right breast. Mammogram and fine needle aspiration cytology suggestive of malignant lesion. Modified radical mastectomy was done and histopathological examination suggestive of matrix producing carcinoma.
EnglishMatrix producing carcinoma of breast, Metaplastic carcinoma, Carcinosarcoma.INTRODUCTION
Matrix producing carcinoma (MPC) of breast was first described by Wargotz and Norris in 1989. Matrix producing carcinoma of breast encompass a histologically diverse spectrum, subtype of metaplastic carcinoma defined as an invasive breast carcinoma with a direct transition of carcinoma to cartilaginous or osseous matrix without an intervening spindle cell component. [1] The identification of this entity is important to pathologist and surgeons both considering prognosis differ from other carcinoma of breast. This report highlights one such case with cytomorphological and histopathological correlation and differential diagnosis. Case History A 50 years old woman presented with a lump in right breast since 1 year, with history of rapid increase in its size since 2-3 months. Swelling was present in upper outer quadrant. Fine needle aspiration cytology was done which was characterised by an abundant chondroid extracellular matrix with variably admixed carcinomatous and chondroid type cells. Ductal cell carcinoma component was also seen in the form of irregular cluster of highly pleomorphic cells with high N/C (nuclei cytoplasm) ratio, hyperchromatic nuclei with prominent nucleoli. Cytodiagnosis of metaplastic carcinoma was made followed by modified radical mastectomy. On gross examination, a 4x4x4 cm3 gray white growth was defined in upper outer quadrant of breast. Base was made up of facia and adipose tissue. Multiple sections were taken. Microscopic examination showed malignant change in both epithelial and stromal component having histology of poorly differentiated invasive ductal carcinoma (figure I) with areas of ductal carcinoma in situ (DCIS) – comedo type (modified Bloom Richardson grade 3). There were also areas of necrosis and numerous abnormal mitotic activities. Stroma showed dense lymphocytic infiltrate. There was a direct transformation of carcinoma into malignant cartilaginous matrix (figure II). There was also pleomorphic undifferentiated malignant stromal component. All surgical margins, base and nipple areola were free from tumour tissue. Total 13 lymph nodes were dissected out of which 2 lymph nodes showed evidence of metastasis. With these features, a diagnosis of matrix producing carcinoma of breast was made. The tumour was ER-PR (estrogen receptor – progesterone receptor) negative. Final report was given as Matrix Producing Carcinoma, BR grade-3, TNM stage - p T2 N1 Mx.
DISCUSSION
Matrix producing carcinoma is a very rare breast neoplasm accounting for less than 0.2% of all breast malignancies. [2] It is a unique subtype of metaplastic carcinoma, characterised by the existence of ductal carcinomatous component with a direct transition to areas showing cartilaginous or osseous differentiation, lacking an interspersed spindle cell component. [1] Wargotz and Norris [1] first described this entity in their study of 26 cases of metaplastic carcinomas. They found that carcinomatous component was moderately to poorly differentiate with a frequent association of intraductal component. The nature of matrix was variable, ranging from bland cartilage to a typical chondroid to osteoid to overt bone formation. The matrix was made up of acid mucopolysaccharides that stained metachromatically with Alcian blue and Aldehyde fuschin and was resistant to hyaluronidase and diastase. It is generally hormone receptor negative and present with larger tumour size, less nodal involvement and higher tumour grade compared with invasive ductal carcinoma. So matrix producing carcinoma is generally treated more aggressively. [3] Ultra-structural analysis of matrix producing carcinoma supports the evidence that the tumour cells are of epithelial & myoepithelial derivation. [1] Myoepithelial cells differentiate along mesenchymal lines and produce a gamut of matricial appearance. After the advent of immunohistochemistry (IHC), it is now accepted that metaplasia of epithelial elements of carcinoma gives these lesions pseudosarcomatous appearance. [4] Giemsa stained smears demonstrate the extracellular metachromatic stromal elements more clearly than papanicolau stained smears. [5] The spectrum of differential diagnosis to be considered which included number of benign and malignant entities like- malignant fibroepithelial lesions with myxochondroid stroma and true sarcoma of breast with cartilaginous metaplasia. [6] Metaplastic carcinoma is a heterogeneous group of tumour that also includes low grade fibromatosis like spindle cell carcinoma, sarcomatoid carcinoma, metaplastic carcinoma with osteoclastic giant cells, adenosquamous carcinoma. The heterologous chondroid component of matrix producing carcinoma can be present in 2 patterns. One displays a typical structure of low grade cartilage and second shows epithelial tumour cells embedded in homogenous eosinophilic extracellular matrix giving appearance of chondroid aura. [7] Cartilaginous metaplasia may be uncommonly seen in other mammary tumors like fibroadenoma, phyllodes tumour and pleomorphic adenoma. The unequivocal presence of carcinoma is helpful distinguishing feature in such cases. In the original description of matrix producing carcinoma by Wargotz and Norris, [1] the authors concluded that the outcome of patients with matrix producing carcinoma is not significantly different from those with invasive ductal carcinomas of similar grade and stage. However one more recent study by Down-Kelly Erinn DO et al. [8] suggests that Matrix producing carcinomas are more aggressive tumours. Study also tells that they examined cases of matrix producing carcinoma diagnosed and evaluated whether the local and distant recurrence rates for matrix producing carcinoma were significantly different from those of invasive ductal carcinomas. They also evaluated that specific histological characteristics of matrix producing carcinoma were associated with tumour recurrence.
CONCLUSION
In summary, diagnosis of matrix producing carcinoma is important though it is a rare variety of metaplastic carcinoma because it is an aggressive variant with increased loco regional and distant tumour recurrence compared with invasive ductal carcinomas.
Englishhttp://ijcrr.com/abstract.php?article_id=2379http://ijcrr.com/article_html.php?did=23791. Wargotz E, Norris H. Metaplastic carcinoma of breast: matrix producing carcinoma. Histopathology 2001; 39:518-83.
2. Feder JM, de paredes ES, Hogge JP, Wilken JJ. Unusual breast lesions radiological and pathological correlation. Radiographics 1999; 19:11-26.
3. Ninomiyo J, Oyama I, Horiguchi J, Koilbuchi Y, Yashida T, Ijima K et al. Two cases of breast cancer with cartilaginous and osseous metaplasia. British Journal of Cancer 2005: 12; 52-6.
4. Saxena S, Bansal A, Mohil RS, Bhatnagar D. Metaplastic carcinoma of breast: A rare breast tumour. Indian Journal of pathology and microbiology, 2004; 47:217-20.
5. Straalhof D, yakimets WW, Mourad WA. FNAC of sarcomatoid carcinoma of breast: A cytological overlooked neoplasm. Diagnostic cytopathology, 1997; 16:242-6.
6. Fulciniti F, Mansueto G, Vetrani A, Accurso A, Fortunato A, Palmbini L. Metaplastic breast carcinoma on FNAC samples: A report of three cases. Diagnostic cytopathology, 2005; 33:205- 9.
7. Kinkor Z, Boudova L, Ryska A, Kajok, Svee A. Matrix producing carcinoma of breast with myoepithelial differentiation. Ceska Gynekol, 2004; 69:229-36.
8. Down-Kelly Erinn DO et al. Matrix producing carcinoma of breast – An aggressive subtype of a Metaplastic carcinoma, The American Journal of Surgical Pathology, April 2009, Volume 33, Issue 4, Page 534 – 541.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2017August15TechnologyANALYSIS OF ELECTROPLATING INDUSTRIAL EFFLUENT WITH REFERENCE TO CHROMIUM COMPOSITION
English6774Seema TharannumEnglish Krishnamurthy V.English Riaz MahmoodEnglishHeavy metal pollution of soil and wastewater is an important environmental issue. The industries like tannery and electroplating are the main source of chromium pollution in India. They are required to comply with the regulations of the Central Pollution Control Boards and concerned State Pollution Control Boards. Thus, our present study contributes towards physicochemical studies and analysis of chromium content using Atomic Absorption Spectrophotometry (AAS) in the effluent released by electroplating industries in 4 different seasons specified by met office of a year to help in the understanding of pollution effects. Study reveals that the effluents from these industries contain Cr (VI) at concentrations ranging from tens to hundreds to thousands of mg/l and unfavorable levels of TSS, TDS, BOD and COD. There are standard values set by Pollution control Board for industrial effluent to be discharged on different types of land. Industrial effluent quality exceeding these specifications is thus harmful. It may cause biochemical effects, such as inhibition of enzymes, metabolic disorders, genetic damage, hypertension and cancer. Microbial load was also studied by enrichment technique which can further be applied for study of potential remediation of chromium.
EnglishAtomic Absorption Spectrophotometry, chromium, Electroplating Industries, Industrial effluent, Pollution.INTRODUCTION
Heavy metal chromium is one among the top metal pollutant. The sources of chromium pollution include effluents from leather tanning, chromium electroplating industries. These industries in India are required to comply with the regulations of the Central Pollution Control Boards and concerned State Pollution Control Boards. Using government subsidies, the industries have built numerous Common Effluent Treatment Plants (CETPs) to treat the toxic wastewater or effluent. Despite this effort, many of the pollution problems are still exist. Several analyses studies have revealed high concentrations of chromium even in so called treated effluents. The majority of chemicals discharged eventually end up in sediments that may act as major source of pollution. Sediments are ecologically important components of the aquatic habitat. The other major issue being, entering into ground water there after contaminating the drinking water. As the world progress with industries, the pollution of the environment with toxic heavy metals is spreading all way through. Petrochemical industries, mining activities, agricultural run off, industrial and domestic effluents are mainly responsible for the increase of the xenobiotic especially metallic species released into the environment. Improper disposal of hazardous and toxic wastes can cause serious damage to both health and environment. Recalcitrant or Xenobiotics are man made compounds that are of major concern. In contrast to toxic organics, that can be degraded, the metallic species released into the environment tend to persist indefinitely, thereby accumulating in living tissues throughout the food chain. Heavy metal pollution of soil and wastewater is a an important environmental issue (Cheng, 2003).Wastewaters from the industries and sewage sludge applications have permanent toxic effects to human aswell the environment (Rehman et al., 2008).The effluent released from electroplating industries contains higher concentration of total dissolved solids, phenols, chlorides, chromium and other heavy metals, etc. Heavy metal chromium is one among the top 5 metal pollutant. Heavy metal chromium is the second most common contaminant of ground water at hazardous waste sites. Major sources of chromium pollution include effluents from leather tanning, chromium electroplating, wood preservation, alloy preparation and nuclear wastes due to its use as a corrosion inhibitor in nuclear power plants (Thacker, U, et.al, 2006). Chromium can exist in multiple valence states, Hexavalent chromium Cr (VI) and trivalent chromium Cr (III) are the most prevalent species of chromium in the natural environment (Cantle, J. E, 1982). Trivalent Cr is ubiquitous in the environment and occurs naturally, while almost all known sources of Cr (VI) are derived from human activities. Trivalent Cr found in the environment is typically found as insoluble crystalline or para crystalline compounds such as Cr (OH) 3, and Cr2O3 .In contrast, Cr (VI) is highly mobile and is considered acutely toxic, although its occurrence is rare in nature. Chromium has been recognized as an essential microelement for animals and humans, potentiating the action of insulin and therefore being effective in carbohydrate and lipid metabolism (Ducros, 1997). On the other hand, recent works point to the severe toxicity of Cr (VI), with respect to human health. Indeed, hexavalent chromium is known to be a skin irritant and to induce allergic contact dermatitis and is considered a class ?A‘ human carcinogen by inhalation (James et al., 1997). The reduced form, Cr (III), is considered to have low acute and chronic toxicity, mostly because of the demonstrated low capacity to penetrate animal cells. Many metals accumulate to high concentration in the surface layer of soils irrigated with sewage sludge of sewage/industrial effluents. World health organization recommended the maximum allowable concentration of 0.05mg/L in drinking water for chromium VI. It is same with Indian Standard Institution. With reference to Central pollution control board, the allowable chromium concentration in effluents is 2.0-5.0 mg/L. With reference to the updated official list of registered factories of 2008 under Karnataka state factories act obtained from the office of dept of boilers and factories, Karmika Bhavana, Bangalore, Industries such as electroplating and tanneries in India are required to comply with the regulations of the Central Pollution Control Boards and concerned State Pollution Control Boards. Using government subsidies, the industries have built numerous Common Effluent Treatment Plants (CETPs) to treat the toxic wastewater or effluent. Despite this initiative, many of the pollution problems are still unresolved. The major components of the electroplating effluents are the toxic trace metal that is chromium. Several analyses reveal high concentrations of chromium even in so called treated effluents. The majority of chemicals discharged through the effluent into aquatic system eventually end up in sediments that may act as major source of pollution. Thus, study of effluent released by industries and the sediment helps in the understanding of pollution effects.
MATERIALS AND METHODS
Sampling location
Sampling area is in Bangalore which is located at a lat. of 12 º 58´ N and longitude of 77 º 35´ E at an altitude of 921 m above mean sea level (Shivashankara, 1999). Sampling area identified is the Peenya industrial complex established in early 1970‘s is the biggest and one of the oldest industrial estates in the whole of Southeast Asia, located at the northern part of the Bangalore city, Karnataka, India (Fig 1). The area spread over 40 sq kms comprising about 4000 small scale industries and few medium scale industries is one of the biggest industrial areas in the country as well as in Southeast Asia. Peenya industrial area hosts maximum industries, majority of them are electroplating industries. 52 registered factories of electroplating industries are considered for study.
Sample collection
Based on the number of employees, they have been categorized into 3 groups 50 and >100. 10% of each category will all together make up to 5 no‘s. Hence 5 factories are selected. With respect to 4 seasons of a year 2010 obtained from met office, Bangalore [Winter season (Jan-Feb), Pre monsoon (Mar-May), Southwest monsoon ( June-Sep ), Northwest monsoon (Oct-Dec)], Sampling was carried out for one year that is in Jan, April, July and Nov 2010, covering all the four seasons. Hence a total of 4 seasonal samples from 5 industries i.e. 20 samples in triplicates were collected and analyzed for chromium concentration using Atomic absorption Spectrophotometry. The effluent samples of around 1000ml volume from outlets of electroplating industries were collected in autoclaved linear polyethylene containers of 1L capacity with polyethylene cap, labeled properly. 100ml of the samples were preserved immediately by acidifying with conc. Nitric acid (1.5ml Conc. /L sample) and stored at 4? C for further analysis.
Sample analysis
Physico-chemical analysis of effluents:
The physiochemical characteristics of effluents like color, odor, pH, Total Suspended Solids, Total Dissolved Solids, BOD and COD values were immediately measured in the laboratory (Standard methods for the examination of water and waste water, APHA, 2005).
Chromium analysis
The other analysis is heavy metal chromium analysis by AAS for which digestion with nitric acid is the preliminary step. Around 50 ml volumes of the effluent samples in evaporating dishes were taken and acidified with conc. Nitric acid. Further 5 ml of conc. Nitric acid was added and evaporated to 10 ml. Then it was transferred to a 125ml conical flask. 5ml of conc. nitric acid and 10ml HClO4 (70%), per chloric acid (70%) were added and heated gently till white dense fumes of HClO4 appear. The digested samples were cooled at room temp, filtered through whatman no.41 or sintered glass crucible and finally the volume was made upto 100ml with distilled water. Then this solution was further boiled to remove oxides of N and Cl. The solution was then used for the analysis of chromium heavy metal using AAS by flame using air acetylene gas (Cantle, J. E., 1982). The next step is Analysis of chromium by Atomic Absorption Spectrophotometry; Atomic absorption spectrophotometer provides accurate quantitative analyses for metals in water, sediments, soils or rocks. Atomic absorption units have 4 basic parts: Interchangeable lamps that emit light with element, specific wavelengths, sample aspirators, aflame or furnace apparatus for volatizing the sample and a photon detector. In order to analyze any metal, a halo cathode lamp is chosen that produces a wavelength of light that is absorbed by the element. Sample solutions are aspirated into the flame. If any ions of the given element are present in the flame, they will absorb light produced by the lamp and then reaches the detector. The amount of light absorbed depends on the concentration of the element or metal present in the sample. Absorbance values for unknown samples are compared to calibration curves prepared by analyzing known samples. The atomic absorption spectrophotometer ( chemito AA201), with glass flow meters with the operating parameters and working range is given in
Table 1.
Bacteriological analysis
Luria Bertani broth and agar supplemented with chromium concentration of 100 ppm using potassium dichromate was used for enrichment of the microbes, samples were inoculated into broth first and incubated at 30 deg C overnight and then spread plated on to LB agar plates which were further incubated at 30 deg C for 48 hours and the colonies were counted .The pure cultures of isolated strains were preserved by refrigerating LB agar slants as well glycerol stocks at 4 deg C and coded as PES 1- PES 10 for further use.
RESULTS AND DISCUSSION
Physico-chemical analysis of effluents In Effluent analysis, the Physico-chemical characterization of effluents was done and is presented in Table 2. Effluent color is white to grades of yellow and odorless. pH is between 3-9, these values are compared to ISI (Indian Standard Institution) standards recommended for disposal of effluent on land and are found not suitable to irrigation purpose. Total suspended solids ranged between 20-200, Total dissolved solids values being 520-5800, BOD (Biological Oxygen Demand) value is between 16-90; COD (Chemical Oxygen Demand) value lies between 91-831. Chromium analysis Heavy metal chromium analysis by AAS was performed. In the present study, chromium concentration was analyzed in the industrial effluent season wise using Atomic absorption Spectrophotometry (Chemito AA201) and is plotted in graph 1. It was found that there is considerably low or BDL (Below detection level) in industry B, while the chromium concentration was high in Industry A, C, E and D with reference to all the 4 seasons. The concentration of chromium was quite high which varied between 239 to 3156 ppm in industry D and C and moderate in Industry A and E which varied between 50.5 to 585.6 ppm. It is interesting to note that the Cr concentration is all time high during winter season and low during southwest monsoon among the five industries. Bacteriological analysis Ten different forms of the colonies were identified based on colony characterization from 20 effluent samples. 7 of them were Gram positive and 3 of them are Gram negative. Gram positive were mostly of the form bacilli and few were cocci, where as all Gram negative were bacilli. The same is recorded in graph 2.
CONCLUSION
Industrialization means more effluent release into the environment. It becomes mandatory on part of the industry to release the effluent treated by Physical, chemical or biological treatment. However, such treatment systems are not effective for removal of color, dissolved solids; trace elements etc. and thus the effluents are directly discharged into drains, public sewers, rivers, etc. Thus effluents containing heavy metals when released into the agricultural land for irrigation purpose, the heavy metal gets accumulated in soil and it in turn is available to plants and gets into plant material and then the food chain follows then to humans and thus become hazardous to human health. Overall findings indicated that industrial effluents of the major industrial areas of Bangalore city have elevated levels of chromium and the data also reveals that most of these industries are discharging heavy metals above specified limit. The result indicates that effluents contain toxic metals in a relatively high composition, thereby polluting nearby soil and groundwater. Hence it is suggested that the industries should give importance to release of effluent with prior treatment with reference to the standards. The microbial load can further be applied for study of potential remediation of chromium.
ACKNOWLEDGEMENT
We thank the management of PESIT, Bangalore, India for encouragement and research facilities and also UGC, New Delhi for financial assistance.
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14. Rehman, A Zahoor, A. Muneer, B. and Hasnain, S. (2008): Chromium tolerance and reduction potential of a Bacillus sp.ev3 isolated from metal contaminated wastewater. Bulletin of Environmental and Contamination Toxicology 81, 25-29.
15. R. Cornelis, J. Caruso, H. Crews and K. Heumann (Eds.), Handbook of Elemental speciation: Techniques and Methodology, John Wiley and Sons Ltd, England (2003).
16. Slavin, M. 1978. Atomic Absorption Spectroscopy. John Wiley and Sons, New York. p.9-14.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareOVERVIEW OF PRACTICE OF PROBLEM BASED LEARNING (PBL)-A REVIEW
English7581Mathada V RavishankarEnglishThe clinical decision making is crucial part of medical service were a medical doctor has to deliver his service in an effective manner, understanding the actual problem which is revolving around many close or distally related facts often put medical man under dilemma where timely decision making becomes a great challenge. One can overcome from such circumstances by effective practice of understanding and solving the existing problem which has conceived a new concept of medical learning called Problem Based Learning (PBL) which certainly can boost the confidence of handling any case of simple to complex nature.Here the medical doctor is thoroughly trained to understand his limitationultimately to render a best possible approach towards the problem.Most of the scholars‘ opinion that education is not just acquiring the knowledge but it is a mere ability to apply the same in practice wherever it is rationally required. PBL is not a just a teaching and learning technique, but it is a strong educational strategy. The present teachers in different fields needs proper updating of their knowledge along with positive attitude of acquiring new skills of teaching, learning and student evaluation to bring out professionally competitive candidates. Based on authors personal experience, for any beginner this article is a lid opener to understand some basic aspects of PBL along with its practice by considering a small illustration.
EnglishCurriculum, Hypothesis, Paradigm, Trigger.INTRODUCTION
The problem solving attitude in human has developed since the time of civilization, which is the base for number of invention and discoveries on the earth which not only made life smooth but also sophisticated by influencingthe change in every aspect of life including advanced professional excellence.There are different ways of learning techniques being practiced by an individual, the learning styles differs in different individuals and personalities.In fact physiologically it is a sensory input and motor output which constitutes learning in an individual. Some patterns of learning styles are including Linguistic, Logical, Spatial, Musical, Bodily, interpersonal, intrapersonal2 .The practice of problem based learning was first started in McMaster University in Hamilton during 1969 in Canada1 .Although there are many modes of learning approaches but the ultimate choice is left with the individual3 .The training in specialized medical branch needs an additional stress on the preferred discipline 4 .Learning is a basis for any professionincluding advanced development in wide range of medical specialties5 ,which is not only a crucial part of development of professional attitudes but it is individuals adoption to different circumstances in every aspect to lead a productive and competitive life. The learning theory without its practical application is a worthless effort, in medical curriculumwhich is least effective without the practice of application ofskills. The target of problem based learning is always revolves around some factswhere it needs properunderstanding in a holistic wayto handle the situation efficiently. The PBL is a change from teaching paradigm to learning paradigm; in the medical profession wherethe student hasto learn how to apply their knowledge of theoryin a realistic manner, probably this has conceived the new conceptswhere ?The Problem Based learning? stands as unique.PBL is not restricted to any particular field but it includes Medical/Alternative medicine, Nursing, Physiotherapy, Pharmacy practice, engineeringetc.,whichaims at critical thinking and understanding a problem. The PBL curriculum is practiced since 30 years mostly in western countries,but it is widely accepted around the word by the different disciplines, it is a learner centered approach which aims at selfdirectedlearning (SDL)6 .The PBL learning stands unique against traditional learning where it focus on one way delivery of contents, teaching is subject oriented, teacher alone will be an active participant, and the students are just audience and are passive learners. Students often take home all the information in spite of lack of clarity on the subject in different aspects; this could be due to the inhabitations exhibited by the learners. In contrast to this the PBL is a two way learning, teaching is objective orientated, here the teacher and students both are active participants. The students are having every opportunity to get the clarity on the topic of discussion; they learn the application along with critical thinking. Some new concepts of learning includes horizontal integration, vertical integration and spiral integration where the pre-clinical, Para-clinical and clinical subjects are blended in a typical manner. The new concepts of learning have invariably formulated new methods of student evaluationin medical profession, whichincludes mainly OSPE (Objective Structured Practical Examination), OSCE (Objective Structured Clinical Examination).PBL has spread across the globe its practice especially from recent past 5 years,it is not limited only to medical course but also in different disciplines of education, including technical higher education 7 .It was found that the group of PBL students with different professional course backgrounds were chosen randomlyand they were assessed, it was found that itsoutcomehas profoundinfluence onthe ideas put fourth by the students of different disciplines8 .The PBL not just deals about a difficulty but also on a threat or a challenge, which can be handled through a strong educational strategy which is mainly based on curriculum designing, conduct of PBL Tutorials including other conventional teaching methods and bed side clinical teaching9 . To start with PBL tutorials the student need to have some information about basic medical subjects, usually here it starts from the 2nd year of medical curriculum. The students get the subject related information of any PBL through trigger, it is a lid opener there may be one or more triggers depends on the case or a single trigger may be split into two, generally they are based on the problems which are linked with each other in a rational manner to create a commonly seen clinical scenario during thepractice of medicine.
PBL Tutorials
The ideal PBL tutorials contain 10 numbers of students out of which one student will be selected as scribe who writes on board and often summarizing the information gathered 10(Photo Legend-1). He also can write or insist others to do drawings, schematic diagrams, flow charts, displaying models etc. The PBL learning usually contains three important components which include key words, learning issues and hypothesis, these three factors depends on the contents of the trigger provided, here we have considered some examples of triggers which is more or less tells about the information consideration for our learning. The time duration of each tutorial is 2 hours. The key words are arranged in a regular order to continue the flow of discussion in a sequential pattern. First the key words are written separately in a respective column which drags the initial attention by understanding their meaning, next the learning issues generate the learning information which needs keen attention to carry out the discussions further, the hypothesis is an assumption made on the basis of existing information in the respective trigger, which is based on the learners knowledge on the subject of basic medical science. Generally the trigger one will be given few days in advance so that the students can come with some home work or it can be given on spot by the facilitator/tutor it is often very effective to initiate a good brain storming. This trigger deals with an the initial hint which states about the main complaints, general signs and symptoms, etiology, age, sex, of the patient along with a brief history. Initially the meaning of new terms should be properly understood by referring medical dictionary which is followed by recapitulating and applying all relevant basic information which they have learnt so far related to the trigger one. The trigger two will be provided usually at the end of first day of PBL to motivate further research on the topic. On second day PBL usually start with a briefing about the previous trigger and it will be continued with the discussion of further case events. Usually the trigger II will enhance the case information like alleviating or suppressing factors, correlation of recent/past history, habits, any treatment provided, physical examination followed by out come of lab investigations followed by tentative diagnosis and its management. The trigger three further considers patient for his response followed by the measures taken or further consideration of any advanced investigations needed, which is guiding the students to go towards the discussion of case with other aspects of differential diagnosis including treatment, complications, prognosis, rehabilitation etc. wherever it is applicable, which direct the learning process in a more specific manner. Out of number of hints provided the more relevant one will be co-related with the existing case scenario and a tentative conclusion will be drawn. At the end of completion of discussion all the triggers are properly summarized, stressed and correlated to establish a link with all our points considered for the existing case scenario, to draw tentative hypotheses to go ahead with the consideration of rational medical or surgical treatment. During the course of discussions the triggers opens many questions out of which some may be left unanswered which is leading some confusion which needs proper directions, as the discussion continues the students may gradually disclosing relevant and irrelevant outcomes, out of which the more relevant and applicable one should be chosen and directed into the main stream of discussion by the facilitator. The sufficient time will be provided to go on spot research by using dictionary, text books, notes, atlas or online information etc. For better case understanding we can make use of pictures, photos, X-rays, animations of patient etc. through proper use of internet which makes the case more interesting.
Type of Triggers
The triggers are nothing but information which progressively discloses the events of case scenario (chart 1). The trigger could be in the form of a statement tells about brief information of any illness or it could be a real patient, simulator, photographs, video clipping, x-rays radiographs, MRI or CT scan reports, Lab reports, a family tree showing an inherited disordered or a pedigree charts etc.10 .
Types of Problem
It may be a medical or surgical case of individual, community, family, occupation related,involving cell,system, organs etc1 .The problems may be of realistic or hypothetical nature one which meets the educational objectives 11 .
The role of facilitator
He should be a medical man who properly trained to conduct PBL Tutorials
Any medical graduate,but need not to be a specialist in the subject.
He has to disclose the ground rules and game plan properly12 .
He should insist for timely use of proper resources to get clarity on the subject.
He is a silent observer; he is the controller and motivator
He himself should not try to solve the problem ?
He has to channelize the discussion in a proper manner by supporting group dynamics
He needs good preparation and should be aware of learning objectives to be covered
He should have good body language and he has to prevent the monopoly and dominance by any one student from the group.
If the student fails to raise the question/learning issues then facilitator has to motivate, often it is done through probing a blank mind.
In case of the arguments between the students, the facilitator has to generate the learning issues and it should be generalized.
He should not offer fast food for the students
Give work to draw, display picture, photo or video clipping and do some action related to the case
He should be impartial and monitors every student‘s participation to give a correct grading.
Evaluation of Students
The evaluation is based on the performance of students regarding his/her presentation/delivery of content, organization, research/home work, and attempt to establish the problem through the proper linking. Generally the students will be graded from zero to four, depends on the overall involvement of every student, by considering all the sessions of PBL.
Advantages:
1. It facilitates brain storming
2. It is an active and self-directed learning 2. The students comes out of inhibitions
3. Understands way of critical thinking and its application7
4. Learn research through different resources
5. makes more competitive 6. Motivates advanced thinking
7. Understanding the problem through holistic approach
8. Learn team work and sharing the information.
9. It creates rappo between teacher and students
10 Boost the self confidence
Disadvantages:
1. It needs more man power
2. Its needs more space and material
3. Opens many unanswered questions
4. Students tend to ignore the basic subject informations
5. Time constrains to complete the objective
6. Often detailed history remains as a mystery and available information in the trigger is limited.
7. The respective block system will guide the possible case scenario and make them more prejudiced about the case
8. Extensive triggers and multiple objectives
9. Students are having limited knowledge
10. Often lead to confusion among students and tutor feels uncertain about on going discussions10 .
ACKNOWLEDGEMENT
The author would like to sincerely acknowledge the guidelines from his teacher Dr Nor Haiyati, University Sains Malaysia (USM) Malaysia, who has conducted the PBL workshops.
CONCLUSION
The practice of PBL may differ in many ways but it supports the strong establishment of connection between methodology of teaching and the complexity of learning in students in analytical manner. The quality of outcome of PBL Learning is solely depends on the quality of trigger which is built with relevant case scenario under the guidelines of expertise so that it can facilitate the student to act independently to construct an algorithm from clinical decision making to practical problem solving. The PBL learning is further continued with advanced practical/clinical case studies of more or less a similar case scenario with the bed side case discussion. The teachers who are following the medical curriculum which is including the traditional method of teaching and learning are often difficult to convince to practice PBL; many times they are reluctant to adopt a new concept of delivery of content unlike conventional teaching. Their strong mind set up and their long professional experience may impend towards new concept of learning, in fact when we compare the outcome between the students who have undergone PBL learning and conventional method of learning both were found with equally competitive attitude towards understanding a problem. In spite of endless arguments regarding the superiority and acceptance of any type of teaching practices one has to abide there mind set up to a small change to bring an effective out come in the field of medical education
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5. FreyerA.Comparison of preferred learning methods between medical students and postgraduatemedicalstaffwww.nottingham.ac. uk/pesl/resources/styles/comparis708/cached. Date of access 4-6-2012.
6. Savery J R. "Overview of Problem-based Learning: Definitions and Distinctions". Inter disciplinary journal of problem based learning. 2006:1(3). Available at:http:/docs.lib.purdue.edu/ijpbl/vil1/iss1/3.D ate of access 4-6-2012
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10. Wood D F.ABC of learning and teaching in medicine.Problem based learning.British medical journal.2003:326,328-330.
11. Erik D G, Kolmos A. Characteristics of Problem based learning. International Journal of Engineering Education. 2003:19(5)657-662.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15General SciencesTAPER QUALITY EVALUATION OF A LASER LATHED STEEL ROD USING MODIFIED FLATBED CO2 LASER CUTTING MACHINE
English8292S.R. SubramonianEnglish A.Z KhalimEnglish R. IzamshahEnglish M. AmranEnglish Hussein N. I. SEnglish M. HadzleyEnglishCO2 flatbed laser cutting machine is one of the advanced machining processes which is capable of machining various materials especially super hard engineered materials. The available CO2 flatbed laser cutting machine is only able to flat worksheets. This paper presents the laser lathing quality, particularly taper of cylindrical steel rod using 2D flatbed CO2 laser cutting machine. A specially designed spinning device mechanism was developed to clamp and spin a steel rod of 10 mm diameter. Three significant cutting parameters were controlled in this experiment, namely; cutting speed, spinning speed and depth of cut. The experiments were carried out based on full factorial DOE matrix design. The results show that, laser lathing is capable of improving almost 80-90 percent as compared to manual lathing within the same range of workpiece properties and dimensional accuracy
English2D flatbed laser cutting, laser turning, laser cutting, CO2 laser machining, Taper qualityINTRODUCTION
Lasers are widely used in industries as cutting tools as they pose ultra-flexibility in cutting technology in obtaining high quality end product besides being quick set-up, non-mechanical contact mechanics, and small region of the heat affected zone. The transformation from 2D flatbed to 3D laser turning has widely provided the lathing possibilities on them. Based on modification of flatbed lasers, some of the common problems handled with traditional mechanical lathe can be solved, especially lathing of micro dimensional parts. Besides that, the machining tolerances of mechanical lathe also affect the quality of end product. A nonmechanical contact of laser has proved its capability in machining of micro parts, where it reduces the unintentional taper for straight turning. The unintentional taper exist when the cutting force tends to deflect the workpiece, particularly products with big diameter to length ratio. Thus, in order to avoid a large taper variation, laser lathing is found to be very suitable for the machining of cylindrical parts as compared to traditional mechanical lathing. Thus, the dimensional accuracies can be maintained while reducing the residue.
REVIEW OF PREVIOUS WORK
A three-dimensional laser machining concept was developed and investigated kinematically in applications of gear making, threading, turning, and milling in completing a die set [1]. A new 'machine tool' for advanced material processing conceptualizing two converging laser beams was introduced to build optical system around a beam splitter that generates two beams from the same laser head [2]. The new concept of laser machining using two intersecting beams was optimized to investigate the phenomena involved in laser 'blind' cutting [3]. Three dimensional laser concepts were focused mainly in laser machining and laser welding by incorporating one or two laser beams simultaneously at industrial level along with their advantages and limitations [4]. A method of removing stock using two laser beams has been investigated where, the first laser beam produced first kerf and second laser beams intersects with the first beam axis to produce second kerf [5]. Threedimensional (3D) laser machining was done using two laser beams to improve the material removal rate and energy efficiency of laser machining [6]. The important issue in three-dimensional laser shaping is improving the dimensional accuracy along the optical axis without decreasing the materials removing rate. The concept of performing threedimensional laser shaping has been performed using Nd-Yag by [7]. CO2 laser machining of three-dimensional autobody panel was investigated to evaluate the cut quality with respect to kerf width, surface roughness, and heat affected zone (HAZ) [8]. Laser machining of 3D micro part based on layer by layer pealing concept carried out by controlling three main parameters namely power, repetition rate and speed of laser process [9]. Threedimensional laser machining allows implementation of turning, milling, and threading, and grooving were investigated where, issues of material removal rate, surface quality, and process control of laser was discussed [10]. A new approach of 3D laser cutting by 2 kW laser mounted directly to the arm of the robot was studied. This set-up enables a simple, off the shelf solution without having to have complicated beam delivery system for applications that require laser power levels of 2 kW [11]. A fully automated 3D laser micromachining based on the main concept of geometrical flexibility integrating two UV laser sources, excimer and diode pumped solid state laser (DPSS) in ns pulse regime with six degrees of freedom to machine complex parts [12]. Three-dimensional laser machining has been carried out on composite materials using two intersecting laser beams to create grooves on a workpiece where, the volume of material is removed when the two grooves converge [13]. The relationship of processes parameters of pulsed Nd:YAG laser-turning operation for production of micro-groove on cylindrical workpiece was investigated by considering air pressure, lamp current, pulse frequency, pulsed width and cutting speed as correspondence controllable parameters [14]. A novel ultra-short pulse laser lathe system for bulk micromachining of axisymmetric features with three-dimensional cylindrical geometry was studied. One hundred twenty femtosecond pulses from 800-nm Ti:sapphire laser were utilized to machine hexanitrostilbene (HNS) rods into diameters of less than 200 micrometres and the results indicate that surface roughness is dependent upon rotation speed and feed rate [15]. Aninnovative technique of CO2 laser machining to create 3D cavities of a mould was conducted. The removal of a single layer is achieved using multiple overlapping straight grooves where the groove profile has been predicted by theoretical models before the work was carried out [16]. The ablation using femtosecond needs more concentration for micromachining as the advantages of efficient ultra-thin layer peeling without undesirable thermal effects for both opaque and transparent materials. The femtosecond laser turning is highly recommended for excellent surface finish requirements. [17]. The integration of interference phenomenon into femtosecond laser micromachining of circular interference pattern was demonstrated by overlapping infrared femtosecond laser pulses [18]. A square micro-groove on cylindrical surface was performed based on five level central composite design techniques by feedforward artificial neural network (ANN) in process modeling of laser turning [19]. The process features of three-dimensional laser machining was presented with industrial robots, specifying the principal reasons for using lasers and describing the system components with respective practical applications [20]. The characteristics of laser beam including cutting obliquity and cutting direction on 3D laser cutting quality was critically investigated. In this experiment, the range of upward 3D cutting was slightly wider than 2D, and the range of downward 3D cutting was sharply narrower than 2D cutting [21]. The effects of processing parameters on laser cutting of aluminum– copper alloys using off-axial supersonic nozzles are present and a quantitative experimental study is used to determine the influence of processing parameters on the cutting speed and quality characteristic [22]. The relationship between cut edge quality and cut edge roughness to the process parameters was studied in order to find out the optimal cutting conditions. Mathematical models were used in determine the relationship between the process parameters and the edge quality parameters [23].
Experimental Set-Up
The intention of this research work is to transform 2D flatbed CO2 laser cutting machine into 3D operational capability. To transform 2D cutting into 3D, a work spinner of single phase motor was embedded with a three jaw chuck to hold the circular workpiece. The motor was mounted on the table where, only the laser head will be maneuvered along the center axis of the part by off-setting the table movement control to adjust the depth of cut value for each pass/cut. The motor and chuck assembly was aligned almost perfect vertically and horizontally to prevent collision between laser head and workpiece during lathing process. Besides setting the alignments to prevent geometrical errors and stock accidents, setting of process parameters also play crucial role in obtaining reasonable output quality. The parameters were clustered into three categories; constant parameters, controllable machine parameters and controllable motor parameters. Motor speeds were varied between 1000 and 1500 rpm throughout the experimentation. Table 1 shows the constant parameters used in this experiment.
EXPERIMENTATION AND RESULT
a) Laser Lathing Experiments were conducted by varying the significant parameters as in table of design matrix. Table 2 shows the controllable parameters and actual coded values used for these entire experiments. Figure 1 clearly shows how a motor is placed on the sacrificial table with the workpiece clamped by a chuck and being lathed by the moving laser head. Thus, the non-contact cutting mechanism is taken advantage to perform lathing. For the first cutting, the rotation of workpiece rod was set to 1000 rpm with 680 mm/min laser speed. The observation shows that the obtained lathed surface was rough and requires fine tuning of interaction between laser speed and work spinning. As to further investigate, the next lathing was carried out at 1500 rpm with the laser head speed of 510 mm/min. Figure 2 shows the cutting phenomenon of the latter set cutting condition. The observed results between first and second set of cutting was totally different where, the surface finish of higher spinning speed with reduced laser cutting speed shows better results as compared to earlier.
b) Conventional lathe
To compare of mechanical lathing with laser lathing, same raw materials were also performed by traditional mechanical lathes. This is to compare the other benefits of traditional lathes (if any) on working with circular stocks. Table 3 shows the machining conditions set on mechanical lathes for rough cut which was obtained from machining handbook [24]. The experimental results of both the manual lathe and laser lathe were obtained successfully. They were compared in terms of percentage for the quality evaluation of roundness. The comparative values of both the lathing techniques are presented in Table 4. Based on the observation, there are large gap of taper between laser lathe and conventional lathe. The overall mean of percentage error between laser lathe and conventional lathe is about 82.9 percent. This error proves that a contact cutting tool (conventional lathe) gives greater impact compared to a non-contact cutting tool (laser lathe). Table 5 shows the matrix of coded values and the lathing results of eight performed experiments. Figure 3 shows the comparative analysis of the manual and laser lathing. It is clear that laser lathing has produced better taper values as compared to manual lathing. Thus, it is confirm that, laser lathing can be performed by flatbed laser cutting machine if the workpiece can be made into rotational towards laser axis.
Taper Quality Evaluation
From the main effects plot of laser lathe in Figure 4, the cutting speed, spinning speed and depth of cut shows a significant effect on taper. As per the main effects are concerned, the optimal conditions for best attained taper value, the laser cutting speed, spinning speed and depth of cut should be set at high level with (680 mm/min), (1500 rpm) and (1.5 mm). Figure 5 show that, all the factors have significant interaction, it's means each of factors have correlation between each other. The effect on taper by machining parameters during laser lathe has been analyzed and can be witnessed that taper is very much not affected by depth of cut. The observation found that, increasing the depth of cut does not affect taper value. This was suspected because laser is a noncontact machining. The taper will be increase when the cutting speed and spinning speed decrease. Figure 6 shows the surface plot for taper over the controllable parameters of laser cutting speed and work spinning speed. The observation found that, the high level of cutting speed and lower level of spinning speed provides better quality of taper. Figure 7 shows the effect of cutting speed and depth of cut on taper value of the lathed part. The surface plot shows that, the taper decrease when the cutting speeds and depth of cut increase. The taper tends to increase when the cutting speed and depth of cut decrease. The surface plot effect between spinning speed and depth of cut in Figure 8 shows that, increasing the spinning speed and the depth of cut results in best quality of taper value. The taper remains increase when the spinning speed and depth of cut decrease.
CONCLUSION
Based on the research work carried out, the two dimensional (2D) flatbed laser cutting machine was able to be transformed to perform laser lathing of a cylindrical part. Not only this, comparative analysis of taper quality between the parts lathed using conventional and modified laser machine shows significant improvement up to 90% adopting the latter. This research proved that, super hard work materials which requires investment in obtaining superior cutting tools can now be seen to have cheaper alternate solution without having to have a real expensive 3D laser cutting machine. Thus, the wider range of metallic steel rods are to be lathed using modified setup to investigate suitability of developed system and their respective parametric setting.
ACKNOWLEDGEMENT
Authors are very thankful to the Ministry of Higher Education for funding this project via Fundamental Research Grant Scheme (FRGS/2010/FKP/TK02/3- F0084). Nevertheless, the authors are indebted to thank top level management of UTeM and Faculty of Manufacturing Engineering (FKP) for their continuous support and encouragement. The authors would also render their sincere thanks to LVD Laser technical support personnel Mr. Vegiayan Ramiah for his expertise and advice provided in transforming 2D machine into 3D laser lathing capability.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15TechnologyDESIGN OF PILOT SCALE HORIZONTAL SUBSURFACE FLOW CONSTRUCTED WETLAND SYSTEM TREATING GREYWATER
English93105RaudeEnglish J. MEnglish MutuaEnglish B.MEnglish Kamau D.N.EnglishWorldwide, diarrhea disease, which causes about 2.6 million deaths annually, mostly among children less than 5 years, is primarily spread through food and water contamination. This is often the result of poor sanitation and hygiene associated mostly with crowded urban and peri-urban settlements. One major area of concern is the disposal of greywater from the unsewered low income, high density population areas of the municipality. Integration of conventional sanitation systems in these areas has been a major challenge due to unplanned settlement structures and the limited available space. The aim of this study was to design and evaluate the treatment performance of horizontal subsurface flow constructed wetland systems (HSF CWs) for treatment of greywater to meet the water quality control standards for safe disposal under the principles of sustainable sanitation. HSFCW system experimental plots treating greywater from domestic households were established. The performance results indicate that this wetland system has excellent removal capability for biochemical oxygen demand ranging from 97.3-99%. Consequently, oxygen demand exerted by micro-organisms to oxidize organics present in greywater during the 48 hours HRT dropped by an average of 97.3%. This study has the aim of informing greywater management decisions for urban and peri-urban areas. This knowledge supports formulation of control measures at the source and designing of an appropriate treatment system for safe reuse or disposal.
Englishconstructed wetlands, greywater treatment, hydraulic, retention timeINTRODUCTION
Greywater discharge often causes water quality deterioration of the receiving water bodies. The discharges contain considerable quantities of organic matter, nitrogen, phosphorous and trace elements and can further degrade the quality of receiving waters (Gjefle, 2011; Sandec, 2006). An appropriate greywater treatment system is essential in sustainable domestic wastewater management. Several methods for removing pollutants from the greywater stream of domestic wastewater exist. The methodology involves solid removal by sedimentation through sand or mechanical filtration (Kumar and Zhao, 2011). Another method is the biological processes which involve use of submerged bioflters (Kadlec and Knight, 1996; Knight et al., 2000). This process involves oxidation of organic matter and nitrification or denitrification. All these physical, chemical and biological processes are combined and act at the same time in a properly designed and constructed wetland system. However, as observed by Ghunmi et al. (2011) in a review of greywater treatment systems technology performance, detailed design criteria and findings of the operational conditions of most of the tested wetland systems were not reported. Wetlands provide suitable environmental conditions for growth and reproduction of microbial organisms. Two important groups of these microbial communities are bacteria and fungi. Bacteria and fungi are typically the first to colonies and begin the sequential decomposition of solids and also have the first access to dissolved constituents in wastewater (Gjefle, 2011; Kumar and Zhao, 2011). Their genetic and functional responses mediate physical, chemical and biological transformation of pollutants, which can be managed in engineered environment. These constructed wetlands which are created under engineered environment help in achieving the desired transformations in wastewater treatment. Knight et al. (2000) observed that microbial metabolism depends, among others things, on environmental conditions such as temperature, dissolved oxygen (DO), pH, and concentration of chemicals substrate undergoing transformation. All these conditions are an important consideration during the design of constructed wetland systems. There are several methods for designing constructed wetland systems (Kadlec and Knight, 1996). The design has evolved from empirical rules of thumb and simple first-order models to detailed modeling of any processes involved in pollution reduction (Sklarz et al., 2010; Kumar and Zhao, 2011). The main designs are based on hydraulic retention time and kinetic (k-C*) models that describes the pollutant removal. Though, the interaction between substrate, vegetation, water and microorganisms are not known (Kadlec and Knight, 1996; Langergraber et al., 2009; Kumar and Zhao, 2011), flow hydraulics and hydrodynamics of the system influence all treatment processes. It is worthwhile to note that the first order degradation kinetic has been used to predict removal process for the majority of pollutants of interest in constructed wetland systems. Such pollutants include organic materials, suspended solids, nitrogen and phosphorous (Kadlec and Knight, 1996; Knight et al., 2000; Sklarz et al., 2010). Although the limitation of the first-order rate equation has been recognized (Kadlec and Knight, 1996), it is still the most appropriate design equation describing pollutant removal. Though constructed wetlands have generally been modeled extensively, the biochemical degradation and transformation process taking place and the associated flow dynamics are rarely explained. However, one detailed wastewater treatment model that attempts to explain treatment process is the CW2D (Constructed Wetland 2-Dimension). This is an extension of Hydrus-2D, variably saturated water flow and solute transport software package (Langergraber and Simunek, 2005; Langergraber et al., 2009). CW2D was developed to model the physical, chemical and biological processes taking place at the same time in a vertical flow constructed wetland system. Constructed wetland systems are considered to be attached-growth biological reactors, and their performance can be estimated with first-order plug flow kinematics for BOD and nitrogen removal (Reed, et al., 1995). The basic relationship used to describe the treatment components is given in Equation 1 as: exp( K t) C C T i e ? ? (1) Where Ce = Effluent polluant concentration, mg/L Ci = Influent polluant concentration, mg/L Kt = Temperature dependant first-order reaction rate constant, d-1 t = Nominal hydraulic residence time, d The nominal hydraulic residence time is calculated from Equation 2 as:
LWy t ? (2) Where L = Length of the wetland cell, m W = Width of the wetland cell, m y = average depth of water in the wetland, m Q = Average flow through the wetland, m3 /d Designs of constructed wetlands The principles of designing a subsurface flow constructed wetland system are based on assumptions of plug-flow movement of water through the wetlands with first-order reaction kinetics primarily by biological degradation (Langergraber et al., 2009, Kumar and Zhao, 2011). It is assumed that the process behaves like an attached biological reactor involving microbes. The basic relationship used to simultaneously describe the two components is given in Equation 3. ? ? Ah Qd Ce Ci KBOD ? ln ? / (3) Where Ah = Bed surface area Qd= Average flow rate (m3 /d) K BOD = BOD rate constant To encourage plug-flow through the bed and avoid flow over the bed surface, bed slope of 1-5% is commonly used. The hydraulic gradient at the outlet is increased by progressively lowering the outlet (Green and Upton 1994). Bed cross sectional area is calculated from Darcy‘s law given as K ? h S ? Q A s d C ? ? ? * / (4) Where Ac = Cross sectional area of bed (m2 ) Ks = Hydraulic conductivity (m/s) dh/ds = Slope of bed (m/m) Modifications on model equation The k-C* model developed by Kadlec and Knight (1996) to reflect treatment wetland performance data is a modification of Equation 3 (Kickuth model). The main difference between the two models is that the Kadlec and Knight model has a non-zero background concentration and is also a reversible first-order reaction equation rather than the irreversible equation. In a study by IWA, 2000), background concentrations of BOD are reported to lie in the range of 1-10mg/L. The K-C* model is given in Equation 5 as: Q KA Q K y A C C C C v i e ? ?? ? ? ? ? ? ? ? ? ? ? * * ln (5) Where Kv = Volumetric rate constant (d-1 ) C* = Non-zero background concentration of BOD5 (mg/L) Values of K and C* are site specific and the variability is caused by temperature, wetland plant (type and density), strength of influent and hydraulic variables (Kadlec and Knight, 1996; Kadlec, 2000; Stein et al., 2007). Kadlec (2000), further proposed an amendment on the K-C* model to include a water balance component across the wetland as shown in Equation 6.
evapotranspiration (m/d) q = Hydraulic loading rate (m/yr) x = Distance from inlet per length of wetland (Fractional distance from the wetland) a = Constant equal to K for subsurface flow constructed wetland with Darcian flow The amendment incorporates the effects of precipitation and evapotranspiration since these two parameters have opposing effects and thus, influence the system hydraulics. While precipitation causes dilution, evapotranspiration causes concentration effect. A further modification by Shepherd (Kumar and Zhao, 2011) due to inadequacies in first-order model, introduced a two parameter time-dependent retardation model for COD removal in a high waste stream. The modification replaces the background concentration by two other parameters Ko and b (Kumar and Zhao, 2011). The model assumes that a high waste stream contains multiple pollutants of variable ease of degradation. As a result, easily degradable substances with faster removal kinematics are gradually replaced with less biodegradable substances with slower removal kinematics. This leaves a solution with less biodegradable constituents. The model seeks to account for the steady decrease in pollutant concentration with increased treatment time rather than a constant residual value (background). The continuous change in solution composition can be represented by a continuous varying volumetric first-order rate constant Kv given by Equation 7. ? 1 ? b? K K o V (7) Where Ko is initial first-order volumetric rate constant, d-1 b is time based retardation coefficient, d-1 ? is retention time (d) According to Kumar and Zhao (2011), the model was considered to be appropriate for constructed wetlands design because it allows a steady decrease in COD (or any other component) with increased treatment time rather than a constant residual COD, C* value. Kadlec (2000) recognizes the limitations of these models in the design of treatment wetlands and further observes that none of the models can correct the degree of treatment influenced by short circuiting. This highlights the importance of wetland hydraulics in improving design models. Designing of constructed wetlands requires a multidisciplinary input of knowledge involving biological and ecological sciences, aquatic chemistry, landscape architecture, hydrological engineering, and flow hydraulics. However, the focus of this study is on low strength domestic wastewater stream (greywater). MATERIALS AND METHODOLOGY Design of greywater treatment system Development of treatment system involved consideration of technically factors in addition to institutional and social issues gathered from the baseline study. These issues influenced controlled decision making during the planning and preliminary design stages. Additionally, a guide to project development after Reeds et al. (1995) that involved characterization of greywater by defining the volume and composition to be treated was used. A conception framework of the procedure followed during design is presented in Figure 1. Figure 1: Conception framework for greywater treatment The hydrodynamic parameters (flow rate, loading rate, porosity and hydraulic residence time) were computed using the baseline data obtained during greywater characterization process. Additional data gathered included influent and effluent pollutant concentrations obtained from National Environmental Management Authority- Kenya, guidelines. Hydraulic loading rate of 0.01- 0.1mg/day obtained from literature was also used as a guide during calculations (Tanner, 2001; Vymazal, 2001). The system size was based on its organic and hydraulic loading rates. To avoid creating another environmental problem in form of malaria mosquito breeding sites, HSFCW system was chosen and water surface maintained at 15 cm below the water level in the system. The wetland bed consisted of an excavation lined with plastic membrane 10mm, 2.0m long, 0.5m wide with an average depth of 0.85 m, in a sand bed planted with vetiver grass. The sand bed comprised graded sand and a drainage system. A compromise of substrate composition was used as recommended by Cooper (1999). The author recognizes the importance of the type of wastewater to be treated and the flow rate required as guiding principles in material selection. The under drains consisted of 50mm diameter PVC pipe containing drain holes overlaid with 0.2m layer of sand. The under drain system supported 0.7m of sand media. Influent flow was greywater from school kitchen and hand wash facility. The greywater was passed through a two compartment pre-treatment chambers of 0.75 and 0.25m3 respectively. The hydraulic application rate was 278 mm/day with a nominal hydraulic residence time of 2 days. Samples of greywater at the inlet and outlet were collected over a period of 12 weeks and analyzed in the laboratory. Pollutant removal efficiency was calculated as percent mass removal given in Equation 8. i i o m m ? m 100 (8) Where mi and mo = mass loading rates at inflow and outflow respectively. The flow rate was controlled using a 120mm diameter gate valve connected to a flow meter. Calibration was conducted at the inlet and outlet, using a beaker and a stopwatch. An overflow pipe was provided for a constant hydraulic grade line, in order to maintain a constant head as the head was maintained at 15cm below the sand surface. Monitoring program began 4 months after planting in order to give sufficient time for the establishment of vegetation and bio-film. To minimize sample deterioration, and thus avoid poor results in the measurement of BOD5, samples were stored in a chilled cool box. Though chilling samples is not necessary if analysis is within 2 hours, samples were chilled (APHA, 1985) and analyzed within 3 hours of collection. The pH, DO, EC, and temperature were measured in-situ. Ammonia nitrogen, nitrate nitrogen and nitrite nitrogen were analyzed in the laboratory, in accordance to procedures in the APHA (1985). Biweekly samples were collected at the inlet and outlet of the treatment system between 09.00- 10.00 hours. Total inorganic nitrogen (TIN) was calculated as the sum of NH4-N, NO2-N and NO3- N in the greywater, the organic fraction of nitrogen was assumed to be relatively low. According to Sklarz et al., 2010, the organic fraction of nitrogen in wastewater accounted for about 12% of total nitrogen (TN) and therefore, this component was assumed to be relatively low and thus neglected in the study. Removal efficiency according to Equation 8 was analyzed. Physical methods Temperature and pH were determined in situ whilst DO was measured immediately after sample collection using a Temperature, DO and pH analyzer/meter (HQ40d dual input multi-parameter digital meter with pHC 101 and LDO 101 probes), portable dissolved oxygen meter. TDS, EC and salinity were measured using VWR EC 300 meter after calibration of the instrument in the laboratory. Biological Oxygen Demand (BOD5) was measured using the procedure of five day Biochemical Oxygen Demand from Standard Methods for Examination of Water and Wastewater (APHA, 1985). RESULTS The design for the system at Crater View was based on both hydraulic and hydrodynamic parameters summarized in Table 1.
Table 1: Greywater Treatment System Hydraulics The treatment performance of Crater View Secondary School wetland was evaluated based on the percentage removal of selected pollutants according to Equation 8. The mean removal efficiency of the wetland was 99.7% (BOD5), 96.5% (TSS), 97.2% (NH+ 4-N), 8.3% (TP) and 17.7% (FC) and is presented in Table 2. Table 2: Influent- effluent laboratory sample analysis It was also observed that, the system was capable of removing nutrients mainly ammonium (97.2%) and total phosphorous (88.3 %). Figure 2 gives a plot of the average influent (TPI) and effluent (TPE) concentrations from the system. Figure 2: Total phosphorous influent and effluent concentrations TSS removal by HSFCW system is high in Figure 3 at 96.5 %. TSS in the greywater is removed by wetlands due to the physical process of filtering action of the bed media. Influent TSS was reduced effectively and the corresponding results are presented in Figure 3. Figure 3: Average concentration of TSS in the influent/effluent The mean influent faecal coliform of 4.97 log.Numbers/100ml in the greywater was reduced to 4.07 logs. Numbers/100ml corresponding to a removal efficiency of 17.7 % as presented in Figure 4. Therefore, poor removal of microorganisms was noted since average removal was 0.9 cfu/100 ml with residual faecal coliforms of 4.07 cfu/100 ml being observed for indicator organisms. Figure 4: Average influent /effluent faecal coliform concentration DISCUSSION Constructed wetlands system design Literature continues to show plug-flow models being used (Crites, 1998; Rousseau et al., 2004). In plug-flow, design considerations are based on expected inlet concentrations and flows, target outlet concentrations and temperature ranges for the treatment sites. However, the use of empirical equations to predict system performance whereby a mathematical relationship from pre-existing data is used, leads to inappropriate designs because these relationship are only based on statistical relationship and provide no information on internal dynamics. This argument is supported by findings reported by Toscano, et al. (2006) in a study of decentralized systems for the protection of public health and environment for the development of long-term strategies in management of water resources. As such, wastewater treatment processes consists of a sequence of complex, physical, chemical and biochemical processes and their dynamics are nonlinear and usually time varying. Depending on the strength of wastewater, a HRT of 0.8 hours to 2.8 days is recommended by Pidou et al. (2007). For this study, a HRT of 2.0 days was adopted which is in agreement with recommendations by Pidou et al. (2007), for low strength wastewater streams such as greywater. Ghunmi et al. (2011) further observed that greywater stored for more than 48 hours at 19- 260C deteriorates in quality. Biological degradation of wastewater produces malodorous compounds, causing esthetic problem, pathogens and mosquito breeding which are health threats if not managed well. Constructed wetland performance evaluation The ability of HSFCWs to remove various selected pollutants from greywater ranged between 17.7% and 99.7%. The average BOD5 concentration in the wetland dropped from 104.0 to 0.33 mg/L (99.7%) with a corresponding average DO concentration drop from 3.01 to 0.08 mg/L (97.3%) as the greywater flowed through the wetland in a nominal residence time of two days. The observed good organic matter removal is supported by earlier findings by Pidou et al. (2007) who reported that biological and extensive CW treatment technologies are effective in organic matter removal. Biological treatment is a natural process achieved by creating an environment suitable for the survival and reproduction of various bacterial cultures and their exposure to organic substances present in wastewater. In subsurface constructed wetland systems, organic matter is removed by aerobic bacteria attached to porous media and plant roots (Vymazal, 1998). The expected role of plants is therefore to create aerobic conditions and support aerobic bacteria in the sand media (Green and Upton 1994). Many treatment wetlands report BOD5 residue of 10 mg/L (APHA, 1995; Toscano, et al., 2006) which is used as a guideline in minimum allowable discharge standard for BOD5. The overall criterion for water and wastewater systems from hygiene point of view is that the risk of infection from environmental sources once the effluent is released to receiving water bodies should never exceed a background level. However, this background levels differs with time and between various regions of the world. The constructed wetland in this study shows good ability to treat greywater. Treated greywater quality was more stable, but still showed some variability as seen in Figure 2 for phosphorous removal process. The good phosphorous removal could be associated with vetiver wetland plants used in the study. Other possibilities are physical processes of phosphorous removal through sedimentation of particulate phosphorous and sorption of soluble phosphorous. In another study by Maina et al. (2010), using vertical flow sand system with vetiver plants, a 47-91% phosphorus removal under different loading rates was reported. These results are consistent with other studies reported in literature for example; similar results are reported by Vymazal (2005) for wastewater treatment. The author observed that removal of nutrients nitrogen (40-55%) and phosphorous (40-60%) was low in constructed wetlands compared to organics and solid removal. Phosphorous is biologically removed by plant uptake. Periphytons and micro-organisms also take up phosphorous but part of it is released again after cell death. The main removal mechanism is adsorption to the filter and/or soil particles, adsorption to the detritus layer and precipitation with certain metals such as iron, aluminum, calcium and magnesium if present (Kadlec and Knight 1996; Vymazal, 2005). It is further reported that removal of nitrogen in most HFCWs is generally low compared to vertical systems (Langergraber et al., 2009). A possible explanation for this achievement could be that in saturated horizontal constructed wetlands, nitrogen is removed by nitrification and denitrification processes. Most treatment systems cannot achieve high removal of total nitrogen or ammonia and nitrate-nitrogen because of their inability to provide simultaneous aerobic and anoxic conditions for denitrification. Compared to unsaturated vertical flow systems that provide conditions for nitrification, horizontal flow systems provide good conditions for denitrification which occurs in the presence of available organic substances. However, even from the design principles, most treatment wetlands are designed primarily to remove organic matter and solids (Vyamazal, 2005) but not the nutrients. Total suspended solids (TSS) Filtration occurs by impaction of particles onto the roots and stems of the macrophytes or onto the sand (soil/gravel) particles in the HSFCW system (Vymazal, 1998; Avsar et al., 2007). HSFCW system in this study reduced TSS by a good margin since the average removal of 96.5% falls within the good performance limits reported in literature. For example, Avsar et al. (2007) reported a 90.4% average removal of TSS for all the three sets of CW systems established. Nitrogen removal The main nitrogen removal process is plant uptake in the form of NH4 + (ammonium) without the need to metabolize. Ammonium was reduced by an average of 97.2% in the treatment system. This was good performance compared to 63.8% average reduction reported by Avsar et al. (2007). However, all the pollutant removal processes studied by the author were having different operating conditions unlike for HSFCW system studied. Pathogens removal The faecal coliform removal was due to sedimentation, filtration and absorption. Similar findings are reported by USEPA, (1988) where surface flow system was studied with respect to the contribution of vegetation to removal of total coliform bacteria in constructed wetlands. With a hydraulic application rate of 5 cm/day and hydraulic residence time of 5.5 days, total coliform removal was 99%. In another study in Listowel Ontario Canada, though under surface flow constructed wetland system, faecal coliform removal efficiency from domestic wastewater was approximately 90 % when operated at a 6-7 day residence time (USEPA, (1988). It therefore follows that the HSFCW system did not succeed in lowering the quantity of pathogenic microorganisms to acceptable levels probably because of a low HRT of 2 days. However, performance efficiencies alone are insufficient to make informed decisions since purification is achieved by a wide variety of physical, chemical and (micro) biological processes. In HSFCWs, these processes are additionally guided by horizontal flow of wastewater through an artificial filter bed consisting of a soil matrix mainly composed of sand or gravel. This matrix is colonized by a layer of attached microorganisms that forms a so-called biofilm (Rousseau et al., 2004). These results are supported by the view presented by Ghunmi et al. (2011) that the internal structure and the operational conditions, namely HRT and SRT, determine the performance of the physical and biological system. CONCLUSION The hydraulic parameters of HSFCW are useful and effective in the design of greywater treatment systems. The system is effective in organic matter reduction, solids and nutrients removal. It has excellent removal capability for biochemical oxygen demand. As the greywater passed through the system, in a period of 48 hours the BOD5 levels dropped by an average of 97.3% and a corresponding residual level of 0.33 mg/l was observed. This was way below the maximum allowable residual level of not more than 10 mg/l for discharge into natural environments. Therefore, HSFCW system was successful in reducing the BOD5 to a level that will have no significant impact on the receiving streams as seen from the oxygen demand exerted by microorganisms.
ACKNOWLEDGEMENT
This work would be incomplete without the generous support of the Resource-Oriented Sanitation concepts for peri-urban areas in Africa (ROSA) project under; Contract No. 037025- GOCE; duration: 1.10.2006 – 31.3.2010), a Specific Target Research Project (STREP) funded within the EU 6th Framework Programme, Subpriority "Global Change and Ecosystems".
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareANALYSIS OF HEALTH RELATED PHYSICAL FITNESS OF PUNJAB STATE KANDI ANDNON-KANDI AREA BOYS
English106112Dalwinder SinghEnglish Kewal SinghEnglishThe present study was conducted to find out the health related physical fitness of Punjab state Kandi and Non-Kandi area boys. In this study, the subjects for data collection were drawn from the different government schools of Kandi and Non-Kandi areas of Punjab state. Random sampling technique was used to select the subjects. The sample consisted of one thousand and fifty (N=1050) boys of Kandi and Non- Kandi areas of Punjab state. To measure maximal functional capacity and endurance of the cardiorespiratory system of the subjects the 9-Minute run test was applied. To evaluate the level of fatness in school age boys, the Skinfold Caliper was used. To assess the abdominal muscular strength and endurance of the subjects, modified sit-ups test was applied. Sit and reach test was used to evaluate the flexibility (extensibility) of the low back and posterior thighs of the subjects. The?t‘ test was applied to find out the
significant differences between Kandi and Non-Kandi area boys. To test the hypothesis, the level of significance was set at 0.05 level. It has been observed that Kandi area boys 14-15 years (class 9th) demonstrated significantly better maximal functional capacity and endurance, body composition, abdominal muscular strength and endurance and flexibility (extensibility) of the low back and posterior thighs than Non-Kandi area boys 14-15 years (class 9th).
EnglishINTRODUCTION
Physical fitness is an inseparable part of sports performance and achievement. The quality of an individual sportsman‘s fitness in terms of its utilitarian values is directly proportional to the level of performance. In the arena of International competition one can hardly differentiate the top notch contenders from one another in terms of levels of fitness. However, deciding factors sometimes remain with fitness in terms of its finer aspects. The longer one remains at high altitude, the better his performance would be, but it never quite reaches the values that are obtained at sea level. It is also mentioned that the training at altitude probably enhances performance at sea level, but only in unconditioned non athlete individuals. For the high trained athletes, the training intensity required for the maintenance of a peak performance cannot achieve at high altitude. Since the dawn of civilization, physical fitness has greatly contributed towards the strength of a nation as history points out that people and communities who cared for their bodies, through vigorous physical activities, remained strong and prosperous, whereas, those who neglected it waned and perished. The great Roman Civilization crumbled because its people took to luxury (Zeilgler, 1979). Fitness is a broad term denoting dynamic qualities that satisfy the needs regarding mental and emotional stability. But the term physical fitness denotes that the organic systems of the body are healthy and function efficiently, so as to enable the fit person to engage in vigorous tasks and leisure activities without much strain (Singing, 1971). Physical fitness refers to the organic capacity of the individual to perform the normal task of daily living without undue tiredness or fatigue having reserve of strength and energy available to meet satisfactorily any emergency demands suddenly placed upon him (Singh et al., 2000). On the other hand, health-related physical fitness is defined as the ability to perform strenuous activity without excessive fatigue, showing evidence of traits that limit the risks of developing diseases and disorders which affect a person‘s functional capacity. Health and physical fitness is important to everyone and should be stressed by physical educators and medical people alike (Tancred, 1987). Health related physical fitness, as such, is a much wider and more significant concept than the idea of mere physical fitness of human body. All the sports programmes and physical fitness programmes designed for school students by the government authorities should, therefore, aim at achieving health related physical fitness for young students as well as for men and women. Regular exercise as well as proper diet, abstention from smoking, proper amount of sleep and relaxation will help us to lead more healthful and hopefully more productive life. To develop and maintain health related fitness, children need exposure to wide variety of sports and fitness activities. Children and youth will hopefully develop interest in the types of physical activities that will promote and maintain physical fitness throughout adult life. Environment is also an important aspect for the mode of doing work which varies from place to place. It is generally seen that people living in hilly areas have to face more physical work as compared to people staying in plains. The daily life work under difficult conditions itself act as a load and demands a physiological change for adaptation in such an environment. The area of investigation under present study was Kandi and Non- Kandi area of Punjab state. The area lying on the North-East of the motelled road running from Chandigarh to Pathankot via SahibzadaAjit Singh Nagar, Roopnagar, Balachaur, Garshankar, Hoshiarpur, Dasuya, Mukerian and Dharkalan block in Gurdaspur District is Sub-Mountain area (Govt. of Punjab, 1973). A large parts of Punjab constituent the plains. It is situated south of mountainous area. It comprises the districts: Amritsar, Barnala, Bathinda, Faridkot, Fatehgarh Sahib, Firozepur, Jalandhar, Kapurthala, Ludhiana, Mansa, Moga, Mukatsar, Patiala, Sangrur and TarnTaran. The parts of five districts such as Sahibzada Ajit Singh Nagar, Roopnagar, Shaheed Bhagat Singh Nagar, Hoshiarpur and Gurdaspur falls under Kandi and Non - Kandi areas. Therefore, the present study was designed to assess the health related physical fitness of Punjab state Kandi and Non-Kandi area boys.
METHOD AND PROCEDURE
Sample
In the present study, the subjects for data collection were drawn from the different government schools of Kandi and Non-Kandi areas of Punjab state. Random sampling technique was used to select the subjects. The sample consisted of one thousand and fifty (N=1050) boys of Kandi and Non- Kandi area of Punjab state.
Selection of variables
To measure maximal functional capacity and endurance of the cardio-respiratory system of the subjects, the 9-Minute run test was applied. To evaluate the level of fatness in school age boys, the Skinfold Caliper was used. To assess the abdominal muscular strength and endurance of the subjects, modified sit-ups test was applied. Sit and reach test was used to evaluate the flexibility (extensibility) of the low back and posterior thighs of the subjects. The?t‘ test was applied to find out the significant differences between Kandi and Non- Kandi area boys. The level of significance was set at 0.05.
Cardio-respiratory function
Table-1 presents the results of variable cardiorespiratory function related to Kandi and NonKandi area boys (14-15 Years Class 9th). The descriptive statistics shows the Mean and SD values of Kandi area as 1873.581 and 258.044 respectively. However, Non-Kandi boys had Mean and SD values as 1791.810 and 221.749 respectively. The Mean Difference and Standard Error Difference of Mean were 81.771 and 14.85 respectively. The?t‘-value 5.507 as shown in the table above was found statistically significant (PEnglishhttp://ijcrr.com/abstract.php?article_id=2384http://ijcrr.com/article_html.php?did=23841. Govt. of Punjab Letter No. 322-SMAC1(1AC) 72/119 dated January 16, 1973).
2. Percival, J., Percival, L., andTaylor, J. (1982). The complete guide to total fitness. A and C Black Publ. Ltd. pp: 224.
3. Mal, B. (1982). Scoring ability in football. SNIPES J. p: 22.
4. Singh, A., Gill, J.S., Brar, R.S., Rathee, N.K., and Bains, J. (2000). Modern Text Book of Physical Education, Health and Sports. Kalyani Publishers.
5. Singing and Karpovish. (1971). Physiology of Muscular Activity. Philadelphia; W.B. Saunder.
6. Tancred, B. (1987). Health Related Fitness, London: Hodder and Stoughton Limited.
7. Zeilgler, E. F. (1979). History of Physical Education and Sports. Englewood Cliff: Prentice Hall Inc.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15General SciencesETHICAL STRATEGY APPROACH TO PROFIT MAXIMIZATION - A STUDY OF TATA TEA"S "JAAGO RE’ (WAKE UP) CAMPAIGN
English113121Nandini ShekharEnglishConflict between economic interests and ethical objectives in business operations has been quite common since Drucker clearly introduced the concept of Corporate Social Responsibility in 1950s. (Drucker, 1993). Also a lack of empirical confirmation of a positive correlation between the two different interests has also been an underlying reason. Lane (1991) has developed an ?ethical strategy? approach which considers importance of converging economic interests and ethical requirements in business based upon both social welfare and profit maximization point of views. This paper focuses on the Tata Tea – Jaago Re advertisement campaign in the light of Lane‘s ethical strategy to emphasize the positive influence of ethical business practices on profit maximization to illustrate the case in point. The paper concludes that an=out of the box‘ approach of Tata Tea as a catalyst for social awakening has resulted in the convergence of economic and ethical goals.
EnglishJaago Re campaign, Lane‘s ethical strategy, Profit maximization, Strategic ethics management, Tata TeaINTRODUCTION Constantly changing competitive environments make it imperative for business organizations to find new methods to meet competition. Differentiation based on product quality, more services associated with marketing or lower prices is no longer effective as most of the products are identical due to technology and better educated customers. This competition puts pressures on company leaders to remain profitable and to show a good return to stakeholders. Often this pressure can result in unethical decisions being made in order to deliver positive results. When this occurs it usually results in a pattern that gets passed down through the organization. Ethics could be seen as a constraint on profitability. This view indicates that ethics and profit are inversely related (Bowie 1998). There are probably times when doing the right thing reduces profits. A more positive view, however, is that there is a positive correlation between an organization‘s ethical behaviors and activities and the organization‘s bottom line results. In fact, a reputation for ethical business activities can be a major source of competitive advantage. High standards of organizational ethics can contribute to profitability by reducing the cost of business transactions, building a foundation of trust with stakeholders, contributing to an internal environment of successful teamwork, and maintaining social capital that is part of an organization‘s market-place image. The link between ethics and profitability has been studied for several years. A study summarized 52 research projects examining the correlation between ethics and profits (Donaldson 1979). The results were encouraging for those supporting a positive linkage between the two variables. Of the 52 studies examined, 33 studies indicated a positive correlation between corporate ethics programs and profitability, 14 studies reported no effect or were inconclusive, and five indicated a negative relationship. Similarly, in a meta-analysis of 82 studies, Allouche and Laroche (2005) found conclusive evidence that corporate social responsibility has a positive impact on corporate financial performance (with effects being strongest in the UK).
Emergence of strategic approach to business ethics and lane's strategy
Under the current environmental changes of global business ethics, strategic approaches to business ethics have emerged which began with Drucker‘s concerns of influences of business decisions on ethical business behaviors in the 1950s (Drucker,1993). Drucker (1993) first connected business decisions to ethical business conducts and corporate social responsibilities. This means that business ethics must be considered the same way project profitability is seriously considered by managers. Second, he implies that business ethics must be continuously considered in the entire operating duration where continuous business decisions are required. Lane (1991) extended these two points made by Drucker as a strategic approach to business ethics. Lane (1991) pointed out a positive correlation between level of business ethics and degree of time horizon for profit. Lane‘s strategic approach (1991) has been defined as ?ethics strategy?. The ethics strategy considers the importance of converging the economic interests and ethical requirement in businesses based upon both social welfare and profit maximization point of views.
METHODOLOGY
This is a conceptual and theoretical paper and it relies on secondary sources for its data. The data has been collected from the official websites of Tata Tea and other sources which have been cited. A number of research papers have also been referred.
Brief history of Tata Tea
Tata Tea is a leading player in the global beverages market with significant presence in over 40 countries. From being a plantation business, it has transformed itself into a key player in the branded tea segment. Tata Teas operations spans the entire value-chain in tea, including research and development, tea cultivation, manufacture of black and instant tea, blending, packaging, branding, marketing, sales and distribution. Tata Tea‘s origins lie in a UK-based company, James Finlay, which played a vital role in the development of the tea industry in India starting in the 1850s. In 1964 Tata and James Finlay entered a joint venture to form Tata Finlay and not long after, in 1976, Tata Finlay took over the production and marketing operations of James Finlay. Tata went on to acquire the entire ownership by 1983 giving birth to Tata Tea. (Chowdary et al, 2009) The challenge that lay ahead was for Tata Tea to brave the fierce competition from the Hindustan Unilever brands, Brooke Bond and Lipton. It devoted its advertising efforts to emphasizing the quality of its tea and how it controlled the entire value chain to ensure that quality. It devoted its investment efforts to expanding its manufacturing facilities in India and Sri Lanka, and establishing subsidiaries in US and UK. Then in 2000 it acquired the British giant Tetley Tea, thus moving to the global level as the second largest tea brand in the world. Along with operational synergies, Tata Tea could now also fall back on Tetley‘s expertise and distribution facilities, worldwide. (Chowdary et al, 2009) Tata Tea continued to communicate various functional properties like freshness and taste. ?Actual freshness? (Asli Taazgi) and ?Say no, regret later? (Na kahoge toh pachtaoge) were some of the slogans that portrayed the tea as an energy booster and refresher. In a bid to target customers from all regions and stratas of society, Tata Tea‘s product/ price portfolio comprised tea for each segment. This entailed innovation and the regular introduction of new flavors and new look products such as flavored tea under the Tetley brand in 2003, sold with the ad line ?A twist in your tea, a twist in your life? (Chai mein twist…. Life mein twist). By the mid nineties, top management felt that there was a need for a combined marketing strategy covering all its national brands- Premium, Gold, Agni and Life, which could promote the mother brand as a whole. They seized upon Cause –Related Marketing (CRM) which had taken off in the US in the 1980s. In CRM a corporation allies itself with a non-profit social organization, typically by donating receipts from sales to the non-profit. In this sort of alliance, the corporation builds brand image while the non-profit increases its funding. (Chowdary et al, 2009).
The Ethical Strategy of Tata
Tea Moving away from positioning tea as just a revitalizing drink and instead stressing social responsibility, Tata Tea wanted to also target the young Indians. In the light of Lane‘s Strategy, Tata Tea can be stated to have positioned itself as a catalyst for social awakening and increasing civic consciousness, exemplifying the alignment of its business with social causes. As a result, in a short span of time, Tata Tea has gone from owning only 3 per cent of market share (1980s) to becoming the number one tea brand in India. To conceptualize the idea Tata Tea hired the advertising agency Lowe Lintas. The agency came up with the Jaago Re! campaign and its theme ?Every morning-don‘t just get up, wake up? (Har subah sirf utho math- Jaago Re!). The slogan raised in a memorable way the idea of social awakening. (Chowdary et al, 2009) A series of 10-second advertisements brought to the forefront several problems- corruption, improper roads, responsibility of political leaders, role of police. The first commercial, for example, featured a young man investigating the credentials of a political leader involved in an election campaign. The idea was to connect with the consumers on emotional issues, to get young people fired up about questioning the system. Given the target group, the ads were promoted using media favored by young people. The Internet was fore grounded- social networking sites and blogs, and a website, www.jaagoindia.org, promoted the campaign. The campaigns were a huge success and helped drive Tata Tea‘s sales from approximately $910 million in 2007 to over $970 million in 2008. Seeing the monetary benefits and increase in brand loyalty, Tata Tea decided to take the campaign further and focus even more on social issues.
The second phase
Thus was born the second phase of the campaign, which focused on the Indian general elections (Jaago Re! One Billion Votes). For the campaign to be powerful, it needed to penetrate down to grass root levels - to achieve this Tata Tea partnered with Janaagraha, a Bangalore based NGO. The aim of the campaign was to alert citizens to their voting rights. Besides bringing out the votes, the campaign also guided the youth through the voting process. A website, www.jaagore.com, was set up to enable registration for voting. Several ads were designed in this phase, which urged the citizens, especially young ones towards a transformation of Indian society through voting. The most popular ad featured the message ?If you are not casting your vote on Election Day, you are sleeping? (Election Ke din agar aap vote nahin Kar rahe ho, to aap so rahe ho). (Chowdary et al, 2009) That ad helped pull over 600,000 people towards the website to register for voting. IT giants with large numbers of young employees such as Infosys and Wipro supported the campaign; most of their employees registered for voting through Jaago Re. The campaign also generated support from Bollywood celebrities. Tata Tea‘s market share increased from 19.4% in 2007 to 20.6% in 2008. The sales, brand loyalty and increase in market share clearly showed that these social marketing campaigns were well received by the customers.
Insights from the Tata Tea Case Study
The analysis of this case throws up some key insights on the positive influence of ethical strategies on profit maximization. These insights though general in nature, can be applied to a wide spectrum of businesses and industries.
Integration of corporate values with the business model
The house of Tata‘s is well known for their CSR initiatives dating back to 1868 when the foundations of this vast business empire were laid. The business model of the organization has always been enmeshed with the vision, mission and values of the Tata group. There has always been top management commitment towards CSR and other philanthropic initiatives ingraining it with a value that has percolated down to the lower echelons of its employees. The pursuit of business excellence has become the norm and there is a focus on innovation. What have not changed are the Group‘s emphasis on ethical business practices and its commitment to the communities in which it operates
1. In-depth understanding of the brand
The intent of the Jaago Re ad campaign was to have a unified message for the four brands under the Tata Tea umbrella -- Tata Tea Premium, Tata Tea Agni, Tata Tea Gold and Tata Tea Life. Tata Tea understood that the advantage it had over the competition was the Tata name and all the positives that it evoked, principally integrity and genuineness. From that flowed the linking of tea drinking, and the feeling of rejuvenation and stimulation that it produced, to social awakening. Tata Tea had discovered the perfect blend to secure a significant slice of advertising attention as well as a means to discharge its civic responsibilities.
2. Long term Strategy
To get a favorable impact, the ethical strategy has to necessarily be a long term strategy with an eye on the future. The Tata Son‘s group has incorporated ethics into its strategy since the inception of the company and has been reaping rich rewards. The brand name itself reveals its commitment to excellence and CSR. In keeping with its values, Tata Tea‘s Jaago Re advertising campaign captures the spirit of these questioning times in a manner that sets the brand apart. .
3. Collaboration with other organizations
In order to achieve effective delivery and showcasing of its philosophy, Tata Tea has capitalized on collaboration with other organizations for maximizing efficiency in propagating its social causes. In the second phase of the campaign, which focused on the Indian general elections, (Jaago Re! One Billion Votes), it partnered with Janaagraha, a Bangalore based NGO, as it needed a powerful campaign which could help it to penetrate down to grass root levels. The website JaagoRe.com was transformed into a community platform where individuals could partner with government approved NGOs by easily volunteering for their services at the click of a button. From a simple website, Jaago Re became a ?social change network‘ where people could pick a cause close to their heart, find likeminded people, form groups, participate in discussions, write articles and most importantly actually ?DO‘ something by volunteering for a live social project. By providing a platform for not for profit organizations to put up social projects, and allowing site members to apply or join these projects, Jaago Re! provides a simple and easy way for collaboration and to take action.
4. Addressing a highly critical and visible social cause
To be effective in its social cause initiatives, a company must address issues that are critical and in urgent need of support. Moreover, the cause must also be sufficiently visible so that people can relate with it. The ad campaign strongly equated the refreshing and rejuvenation obtained by drinking tea to social awakening and being aware of the social issues surrounding us. The objective of this campaign was to transform tea from a medium of mere physical and mental rejuvenation to a medium of social awakening. Jaago Re campaign was recrafted to create widespread awareness on the issue of corruption. ?Aaj Se Khilana Bandh, Pilana Shuru? transcends well beyond just creating awareness and has been presented as a platform where every Indian citizen can be the change he wants to see by taking a pledge not to aid and abet corruption. The idea of the awakening is that in every situation of corruption the greater onus lies on ?Jo Khilata Hai?, the person giving the bribe rather than the one taking it.
5. Effective communication
Communication is vital. Unless people know about a social cause, the effort in enhancing corporate reputation or image and support for the cause may not be fruitful. Messages about corporate ethical and socially responsible initiatives are likely to evoke strong and often positive reactions among stakeholders. Research has even pointed to the potential business benefits of the internal and external communication of corporate social responsibility (CSR) efforts (Maignan et al. 1999). Brown and Dacin (1997) have shown that CSR is generally associated with positive corporate virtues and reflects an organization‘s status and activities with respect to its perceived societal obligations.
6. Impact of CSR initiatives must be measurable
As with other exercises performed in an organization, the impact of the CSR effort should also be measurable. When the Return on Investment (ROI) is clearly highlighted, the company will be able to redirect its efforts to reach the target audience. In the case of Tata Tea, in keeping with the thought of the ?Khilana Bandh, Pilana Shuru‘ campaign, Tata Tea has been urging citizens to take a pledge to stop giving bribes. Within three months of starting this campaign, it has collected over 3.1 lakh pledges through various routes – the Internet, mobile, retail and even schools. In continuation with the campaign objective of awakening citizens to become the change they want to see, it is launching the Tata Tea Jaago Re Vrath Yatra – a 38-day bus journey across the country to connect with the youth and urge them to pledge against corruption. Also, in its next level, the company has launched a Corruption Index, which is a three-city study, including Delhi, Mumbai and Bangalore, which aims to bring out the perceptions of citizens across socio-economic classes about corruption and its impact on the social and economic fabric of the society. The survey, conducted by AC Nielson with a sample size of 1,226, will be conducted on a quarterly basis to track the perception of the citizens. Another parameter of the success of this campaign is the website www.jaagore.com which as of today supports 10 key issues – Corruption, Education, Child Rights, Global Warming, Voting, Human Rights, Women‘s rights, Health, Civic Issues, Differently Abled. Users can create their own profiles (either as individual or as NGO) by associating with one or more issues. The site then offers important features of a social network such as creating profiles, networking, creating groups and events, and contributing content such as articles and documents related to the issue that the user supports. The most important aspect of the website is the ?Social Exchange‘ – a ?listings‘ of social projects put up by the NGOS on the website. On the Social Exchange organizations can put up all kinds of projects where people can volunteer to work from home – such as documentation work for the NGO or work onsite like teaching street children. In order to volunteer, users simply click the ?Volunteer‘ button which triggers an email to the NGO with details of the interested user. Since all NGOs on Jaago Re! are government certified, the whole process of volunteering becomes transparent, simple and effective. Apart from the website, the campaign was powered by social media with communities on Facebook and Twitter supported by a blog. Thousands of citizens have actively participated with the website and volunteers have fuelled over 200 + live projects.
The online movement has received recognition from several counters including a Silver for Best Debut Website at Exchange for Media Digital Awards 2010, was shortlisted at the Goafest Abby‘s 2010 in the Website – Consumer Goods category, Silver in the Best Digital Brand Solution category at Yahoo! Big Idea Chair Awards and another Silver in the Best Website (Activism) category at the W3 Awards in 2010
7. Involving employees at all levels
CSR should be a complete organizational effort and employees play a central role in CSR implementation. While overall CSR success depends first on senior leadership, ultimately, CSR implementation largely rests in the hands of employees and, in some cases, suppliers. In a sense, these parties are often a firm's human face, capable of acting as ambassadors, advocates and sources of new ideas and information on CSR. Rupp et.al (2006) accentuated that CSR plays a role about fostering positive social relationships between organizations and communities. They highlighted that employees will turn to CSR to assess the extent to which their organization values such relationships and so high levels of CSR can meet employees‘ need for belongingness with the organization and the society.
CONCLUSIONS
1. Organizational culture -
The term corporate social responsibility is of recent origin, but the Tata way of conducting its businesses is not. The multitude of social development and environment initiatives Tata has nurtured from its earliest days flows from a wellspring of voluntary, as opposed to obligatory, commitment. The Tata Sons Group have invested organizational resources (both financial and people) in developing cultures of business ethics and integrity. Business ethics, the foundation of the processes by which customers develop feelings of trust in organizations very directly impacts customer‘s perceptions of that organization. The literature on trust, suggests that people (customers) do develop perceptions of trust in organizations (Morgan and Hunt 1994). Hartley (1993) argues that the long-term best interests of businesses are served by seeking a trusting relation with the public. When customers perceive the relationship with an organization to be of value, there are several positive outcomes for the organization.
2. CSR commitment implementation -
The follow up after the JaagoRe ad campaign shows the CSR commitment implementation of the Tata Group. Implementation refers to the dayto-day decisions, processes, practices and activities that ensure the firm meets the spirit and letter of its CSR commitments and thereby carries out its CSR strategy. If CSR commitments can be called ?talking the talk,? then implementation is ?walking the talk.? At one point of time Jaago Re was the sole site where young voters used to visit online for details. It can be said that the awareness was primarily due to the brand backing by Tata Tea, through their ad campaigns. Tata Tea‘s efforts to lend an enabling hand spring from the knowledge that there is more to tea than just the drinking of it.
3. Ethics and Profit -
Unethical behavior is practically encouraged in business due to the very foundation on which business is built. The primary objective of a business is profit. Fundamentally there is nothing wrong with this fact. In order to comply with this, the goal of the executives has been correlated with the profit objective. By focusing on maximizing shareholder wealth with a traditional approach, businesses lose sight of emerging costs and trends that can benefit them. Their eyes are not on the horizon looking to see what is to come. However, good business and good ethics are synonymous. Primeaux and Steiber (1994) concur that ethics is the heart and centre of business and that profits and ethics are intrinsically related.
4. Strategic Planning –
Many consultants emphasize the need for strategic planning of CSR practices. According to Elizabeth A. Wall (2008), ?in order for a firm to make a commitment to a CSR program it must create a committee, discuss the drivers, set goals, formulate policies, source community partners, and implement projects and measure impact?. The Tata Tea ad campaign has incorporated all the above features in delivering and meeting its goal of creating a mother brand for the four Tata Tea brands —Tata Tea Premium, Tata Tea Gold, Tata Tea Agni and Tata Tea Life - into one emotional platform, while successfully overtaking competition, resulting in increased market share while successfully delivering a social message. The result is a measurable connect with the consumers and socially engaging the users in a massive scale. Strategic cause programs also provide companies and nonprofits with valuable leadership and differentiation strategies as well as enhanced brand equity and credibility, greater reach and significant resources and relationships. Now, more than ever, corporations and nonprofits are realizing the power of aligning companies and causes. (Austin,2000) Storper (2008, as cited in London and Morfopoulos 2009) makes the point that modern culture demands that businesses be good stewards of the environment and society. CSR is an organization‘s way of taking action to make a difference in the lives of its customers, employees and the community. If business today is concerned about solving societal problems and creating social change while protecting its markets, it is imperative to have an ethical strategy.
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.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15General SciencesDUAL POLARIZED 3X3 MICROSTRIP ARRAY ANTENNA USING ORTHOGONAL FEEDS
English122126I.GovardhaniEnglish M.Venkata NarayanaEnglish B.Anusha sumanthikaEnglishA microstrip antenna consists of a radiating patch on one side of a dielectric substrate which has a ground plane on the other side. A 3X3 microstrip patch antenna which has width=w‘ and length =l‘ are placed over the surface of the substrate layer. The array of antennas exhibit dual polarization by using two feeds and hence called as orthogonal feeds. When the feed point lies on the diagonal then circular polarization occurs whereas if the feed point lies at any other place elliptical polarization occurs. In this paper we present the major parameters of the antenna as axial ratio, VSWR, radiation pattern, directivity and efficiency which are calculated practically.
Englishmicrostrip antenna, dual polarisation, orthogonal feedsINTRODUCTION
Antenna is piece of conducting material which is form of a wire, rod or any other shape with excitation. In this paper a microstrip array antenna whose return losses and gain had been simulated. A micristrip antenna is also called as patch antenna. whose operating frequency is greater than 1GHZ. The term ?Microstrip‘ came because the thickness of this metallic strip is in micro-meter range.Microstrip patch antennas are popular, because they have some advantages to their conformal and simple planar structure. The features of a microstrip antenna are relatively ease of contruction, light weight, low cost and either confortability to the mounting surface or, at least,an extremely thin protrusion from the surface. These criterian make it popular in the field of satellite and radar communication system. Microstrip antennas are the first choice for the high frequency band such as X-band due to its light weight and low cost and robustness. In this paper we had designed microstrip with 3x3 array which is dual polarized and which has the operating frequency greater than 1GHZ. The following figure shows the geometry of rectangular microstrip patch antenna with dual polarization.
MICROSTIP ANTENNA DESIGN
Microstrip patch antenna consists of very thin metallic strip (patch) which is placed on ground plane where the thickness of the metallic strip is restricted by tEnglishhttp://ijcrr.com/abstract.php?article_id=2386http://ijcrr.com/article_html.php?did=23861. Antenna Theory, analysis and design by Constantine A Balanis.second edition published by john willy and sons.
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6. Eisuke N ISHIYAMA, Kozo EGASHIRA, Masayoshi AIKAWA, ?Array Antenna using Hybrid Multi Layer Feed Circuit?, IEICE technical report. Antennas and propagation 104(561), 7-11, 2005-01-14. (2002) The IEEE website. [Online]. Available: http://www.ieee.org/
7. Kozo EGASHIRA, Eisuke NISHIYAMA, Masayoshi AIKAWA,?Microstrip Array Antenna using Both-Sided MIC Feed Circuits?2002APMC, THOF-72, Nov. 2002.
8. M.Aikawa, H.Ogawa, Double-Sided MIC‘s and Their Applications IEEE Trans. Microwave Theory Tech., vol.37, no.2, pp.406-413, Feb.1989.
9. Kazuya KODAMA, Eisuke Nishiyama, Masayoshi Aikawa, Slot Array Antenna using Both-Sided MIC Technology, 2004 IEEE AP-S, s096p11a, June 2004.
10. Muhammad Mahfuzul Alam, Md. Mustafizur Rahman Sonchoy, andMd. Osman Goni, Design and Performance Analysis of Microstrip Array Antenna, Progress In Electromagnetic Research Symposium Proceedings, Moscow, Russia, August 18-21, 2009.
11. Gi-cho Kang, Hak-young Lee, Jong-kyu Kim, Myun-joo Park, Kuband High Efficiency Antenna with Corporate-SeriesFed Microstrip Array, IEEE Antennas and Propagation Society International Symposium, 2003.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareMALAYSIAN DIETARY GUIDELINES 2010 IN PRACTICE: ACCEPTABILITY AND APPLICABILITY OF NUTRITION DELIVERY TOOLS AMONG UNIVERSITY STUDENTS IN TERENGGANU, MALAYSIA
English127141Pei Lin LuaEnglish Wan Putri Elena Wan DaliEnglish Mohd Razif ShahrilEnglishObjective: To evaluate the acceptability and applicability of nutrition education delivery through three tools; 1) conventional lectures, 2) brochures and 3) text messages via short messaging system (SMS). Methods: A prospective, cross sectional study was conducted among university undergraduates in Terengganu, Malaysia. Included students firstly went through a 1-hour lecture followed by the provision of brochures and contents of text messages. They then completed an evaluation form. Data analysis was carried out using SPSS 16.0 utilising descriptive statistics. 116 undergraduates were enrolled (mean age=19.3). Results: Majority of male (91.9%) and female students (91.1%) rated the slides as comprehensible. Both genders (male=70.3%, female=74.7%) ranked the presentation as ?interesting? while, 64.7% of them ranked the information included as adequate. Brochures were considered to be at
least “good” with regard to its pictorial graphics (85.3%) and languages (81.9%). Most of the students were also generally contented with the information given through the SMS (86.2%). Overall, 94.0% of students believed that nutrition education delivery through a variety of methods can provide and enhance their awareness and knowledge. Conclusion: This provides early evidence that these tools are acceptable and applicable in assisting undergraduates improve their diet and undergo active lifestyle.
EnglishUndergraduates, nutrition education, acceptability, applicabilityINTRODUCTION
The most recent version of the Malaysian Dietary Guidelines (MDG) 2010 was launched on 25th March 2010 with the newly modified edition consisting of 14 key messages compared to the first version in 1999.1 A collection of 55 key recommendations established under these 14 key messages clearly indicate the government‘s efforts to ensure all Malaysians maintain a nutritious diet, healthy weight and adequate exercise in order to reduce the risk for chronic diseases in later life. Although the previous guideline was published 10 years ago, a study conducted by Norimah and comembers has unfortunately shown that about 63% of the respondents from 773 adults in Kuala Lumpur (aged between 18 to 59 years) were not aware of its existence.2 This finding might be one of the crucial factors leading to the increase in nutrition-related diseases such as cardiovascular disease, cancer, hypertension and diabetes.3-5 Hence, efforts to disseminate the information to all age group in Malaysia to enhance awareness of the latest MDG 2010 should be constantly initiated and maintained.
Numerous studies evaluating the incidence of unhealthy eating habits and sedentary lifestyle have demonstrated links to a high prevalence of overweight and obesity.6-7 These two factors were accepted as the major causes of morbidity and mortality.8 As such, health educators should promote education and intervention strategies that encourage improved dietary behaviors.6 One important pathway to dietary improvement is through delivering nutrition education. Nutrition education is defined as any set of learning experiences designed to facilitate voluntary adoption of eating and other nutrition-related behaviour conducive to health and well-being.9 It is recognised as an important component in programs and interventions related to health promotion and disease prevention. Nutrition education can be delivered in a variety of modes such as printed materials (booklets, brochures, leaflets and posters), lectures, via Short Messaging System (SMS) or web-based education.10-12 However, information or contents added in nutrition education tools must be evaluated before delivery to the target population.13 A review by Clayton indicated that there are seven criteria need to be focused in evaluating an education material.14 These criteria includes; 1) content, 2) literacy, 3) graphics, 4) layout and typography, 5) motivating principles, 6) cultural relevance and 7) feasibility. University students are the main targets for delivering nutrition education to improve their dietary habits, in order to reduce excess chronic disease burden and to produce healthy intellectuals in the future. This group is at a crucial stage in their life development as they encounter transition from parental control over lifestyle behaviors to assuming own responsibility for their health choices.15 This highlighted an opportunity to develop nutrition education delivery tools in order to disseminate the information from MDG 2010 in the form of conventional lecture, printed media (brochures) and SMS. In order to elucidate the acceptability and applicability of the nutrition education delivery tools, an evaluation instrument with constructive feedback is necessary so that it can be modified and used as an example of good practice.16 The evaluation is obtained through questionnaires targeting specific information which includes understanding, adequacy of information and visual appeal. As such, the goals of this study were to (i) develop nutrition education delivery tools and (ii) evaluate their acceptability and applicability of nutrition education delivery tools in a sample of university student population.
METHODOLOGY
Study design and sample selection
This investigation was based on a prospective, cross-sectional design which employed convenience sampling method. Participants were undergraduates who were studying in a local public university who met all the inclusion criteria. The inclusion criteria for the respondents were: (1) university students between the age of 18 to 20 years, (2) healthy, without any officiallydiagnosed diseases and (3) able to read, write, speak, and understand Malay or English. On the other hand, the exclusion criteria were: (1) respondents below or above the age range stated, (2) students in health science studies program, (3) students who declared chronic diseases diagnosis and (4) unable to read, speak or understand Malay or English. This study was carried out in twophase; 1) development of nutrition education delivery tools and 2) acceptability and applicability of nutrition education delivery tools.
Phase I – Development of nutrition education delivery tools
Phase I involved rearranging of the latest MDG 2010 to contain only 13 key messages (from the 14 original key messages). These messages were divided into three different modules; 1) Always be healthy (3 messages), 2) Eat moderately (5 messages) and 3) Live the future (5 messages)
(Table 1). Messages which deliberated on the Practise Exclusive Breastfeeding from Birth until Six Months and Continue to Breastfeed until Two Years of Age were excluded due to irrelevance to participants. All included messages were delivered through three modes; 1) conventional lectures, 2) brochures and 3) text messages via short messaging system (SMS). Conventional lectures were carried out in which all key messages in guidelines were compiled into a 64-slide multimedia Microsoft PowerPoint presentation. The slides used were clearly visible for approximately 100 students with appropriate font sizes. Attractive graphics and suitable combination colours were additionally used to stimulate their interest on the topics delivered in a 1-hour session. Brochures were designed to enhance their understanding and memory after the lecture, containing Key Recommendations and How to Achieve the recommendations for each message. Three brochures were developed, each representing the same three modules as presented in conventional lecture. The information was displayed on the coloured art papers in 35.8 cm x 25 cm-sized with four folded as well as doublesided printed. Pictorial graphics which includes food pictures, cartoon pictures and symbols were used to attract the readers. The text language was kept simple with black 12-font sized. Text messages via short messaging system (SMS) can be delivered through all forms of cellular telephone with a limitation of 152 characters for each 13 messages. All thirteen messages were designed to be delivered weekly and received at 10a.m. These text messages were manually delivered through the Mobile Nutritional Education System which was developed by Mobile Content and Services Provider based in Kuala Lumpur, Malaysia. SMSes and abbreviations were avoided to prevent misunderstanding of the information received. Although all information in conventional lecture, brochures and text messages were conveyed in Malay language, the original contents of the guideline were maintained and it had been reviewed by two qualified personnel in the field of nutrition and dietetics.
Phase II – Acceptability and applicability of nutrition education tools
Phase II aimed to evaluate the acceptability and applicability of all three nutrition education delivery tools developed in Phase I. Content validity was evaluated by two qualified researchers experienced in nutrition and dietetics while face validity was gauged by distributing Nutrition Education Tool’s Evaluation Questionnaire (NETEQ) to evaluate the students‘ understanding on the contents, presentation and illustrations showed in the slides, brochures and text messages. Subsequently, the tools were modified based on the inputs and feedbacks obtained from respondents recruited during this phase. Prior to data collection, an information sheet was given to all included participants to enhance their comprehension on the purpose of this study. Those who were willing to participate were requested to complete NETEQ for the purpose of evaluating the acceptability and applicability of these nutrition education delivery tools. A 1-hour lecture and brochures were delivered in original setting while all the intended 13 messages text messages were only shown on a piece of laminated paper (Appendix 1). To ensure the performance and functionality of the Mobile Nutritional Education System, it was tested in a different setting. The process of development, acceptability and applicability of nutrition education tools are summarised in Figure 1. Nutrition Education Tool?s Evaluation Questionnaire This questionnaire was developed based on previous literature to be able to evaluate the acceptability and applicability of nutrition education delivery tools.14, 17-18 Consented students initially completed their demographic profile which comprised of gender, race, living arrangement, study course and financial resources.
The NETEQ consisted of three sections with different questions each evaluating 1) conventional lectures (11 items with multiple choices response), 2) brochures (8 items – ranging from very unsatisfactory to very good) and 3) text messages via SMS (4 items – ranging from very unsatisfactory to very good). The survey on the conventional lectures focused on the level of understanding towards the contents, suitability of illustrations included in the slides and acceptability of the information viewed. Meanwhile, questions on the brochures asked about the contents, languages, frequency of brochure usage and the illustrations utilised. The final section of this questionnaire focused on the four criteria focusing on the contents, languages, time receiving of SMS, frequency of SMS received.
Ethical Approval
Ethical approval was granted by the Institute for Health Behavioral Research (IHBR), Clinical Research Centre (CRC) and Ministry of Health Research and Ethics Committee (MREC), Malaysia. Apart from that, institutional approvals from the selected universities were also sought prior to the data collection process. Permission to use the latest MDG 2010 was approved by National Coordinating Committee on Food and Nutrition (NCCFN), Nutrition Division, Ministry of Health Malaysia.
Statistical analysis
The results of the questionnaire were analysed by using SPSS 16.0 utilising descriptive statistics for all demographic characteristics and responses of acceptability and applicability of nutrition education delivery tools. Findings were presented as mean, standard deviation (SD), frequencies and percentages. A value of pEnglishhttp://ijcrr.com/abstract.php?article_id=2387http://ijcrr.com/article_html.php?did=23871. National Coordinating Committee of Food and Nutrition (NCCFN). Malaysian Dietary Guidelines. Ministry of Health Malaysia, Kuala Lumpur, 2010.
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5. Liu S, Manson JE, Lee IM, Cole SR, Henneken CH, Willett WC, et al. Fruit and vegetable intake and risk of cardiovascular disease: the Women‘s Health Study. Am J Clin Nutr 2000;72:922-928.
6. Chourdakis M, Tzellos T, Papazisis G. Eating habits, health attitudes and obesity indices among medical students in northern Greece. Appetite. 2010;55:722-725.
7. Lollgen H, Bockenhoff A, Knapp G. Physical activity and all-cause mortality. An updated meta-analysis with different intensity categories. Int J Sports Med 2009;30:213- 224.
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10. Ha EJ, Caine-Bish N, Holloman C, LowryGordon K. Evaluation of effectiveness of class-based nutrition intervention on changes in soft drink and milk consumption among young adults. J Nutr 2009;50:1-6.
11. Krishna S, Boren SA. Diabetes selfmanagement care via cell phone: a systematic review. J Diabetes Sci Technol 2008;2:509- 517.
12. Franko DL, Cousineau TM, Trant M, Green TC, Rancourt D, Thompson D, et al. Motivation, self-efficacy, physical activity and nutrition in college students: randomized controlled trial of an internet-based education program. Prev Med 2008;369-377.
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APPENDIX 1
1) Pelbagaikan pilihan makanan dalam setiap hidangan anda untuk memastikan badan anda mendapat semua nutrisi yang diperlukan.
2) Kekalkan berat badan sihat (BMI 18.5 – 24.9) anda dengan mengimbangkan pengambilan makanan and melakukan aktiviti fizikal yang lazim.
3) Mulakan sekarang dengan melakukan aktiviti fizikal yang sederhana seperti bermain badminton, brisk walk, aerobik, sepak takraw, berbasikal dan berenang.
4) JANGAN ABAIKAN SARAPAN PAGI! Pilih bijirin yang tinggi serat seperti oat dan biskut yang rendah lemak dan mengandungi kurang gula dan garam
5) Makan banyak buah-buahan (sebiji oren + sepotong tembikai) and sayur-sayuran (2biji tomato + 1cawan bayam + 1cawan kubis) setiap hari. Pelbagaikan menu.
6) Pengambilan ikan secara kerap amat digalakkan. Daging lembu, ayam, itik atau telur perlulah diambil secara sederhana; makanlah kekacang setiap minggu.
7) Untuk individu yang ingin kurangkan berat badan, susu dan produk tenusu yang rendah lemak adalah pilihan yang sihat berbanding dengan susu penuh krim.
8) Makanlah di tempat yang menyediakan pilihan makanan yang sihat dan minta untuk kurangkan minyak, garam, gula dan lemak apabila memesan makanan.
9) Kurangkan makanan bergaram tinggi; ikan masin, telur masin, sayur jeruk, makanan ringan, sosej, nugget ayam, bebola daging and burger.
10) Kurangkan minuman bergula seperti minuman bergas, kordial, cendol and air batu campur. Pilihlah kuih atau kek yang mengandungi kurang gula.
11) Ingatlah, air yang hilang perlu diganti setiap hari untuk mengekalkan keseimbangan cecair dalam badan. Minum sekurang-kurangnya 8 gelas sehari.
12) Makan makanan and minum minuman yang bersih and selamat untuk mengelak terkena keracunan makanan. Amalkan kebersihan diri ketika menyediakan makanan.
13) Perhatikan maklumat pemakanan pada label makanan/ minuman semasa membuat pilihan seperti maklumat tentang jumlah tenaga dan nutrisi.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15General SciencesEFFECTIVE WAY TO DEVELOP WEB SERVICES
English142149Girish TereEnglish R. R. MudholkarEnglish Bharat JadhavEnglishWe propose a prototype framework, called web service Application Fabric (WSAF) that is used for developing WSDL-centric approach to Java web Services. To encourage good design and make programming easier is to use an application framework. Framework offers a layer of abstraction on top of complex tools. A good SOA framework should encourage use of XML schema libraries and reuse schema across WSDL documents. A web service is a programmatic interface for application-toapplication communication that is invoked by sending and receiving XML. ?WSDL-centric? means creating a web service by building its WSDL and using that WSDL document with references to the Java elements that implement it. Instead of using standard WSDL format we are generating web service interface using our own style. These generated files are easy to process. We found that WSAF performance is better than Apache Axis 2 and JAX-WS. WSAF is an open-source web Services application fabric supporting HTTP protocols such as REST, SOAP, XML, and JSON. From the description written in simple XML, WSAF generates the Client APP (.jar), the Java server code template (.war), the WSDL and the documentation of the description in HTML. We compared performance of WSAF with Axis 2 and JAX-WS frameworks.
EnglishSOA, web services, WSAF, WSDL, XMLINTRODUCTION
A web service is a platform neutral, language neutral and can accessed across the network. A web service has one or more ports. Each port is a binding deployed at a certain network address (endpoint). While most descriptions of web based solutions emphasize their distributed characteristics, their decentralized nature – they have distinct management and control environments and communicate across trust domains – has much more impact on architecture of this framework and the requirements of the underlying protocols. So, we focus our framework first on supporting application-to-application integration between enterprises having disjoint management, infrastructure and trust domains. The focus of this paper and the framework it defines is a model for describing, discovering and exchanging information that is independent of application implementations and the platforms on which applications are developed and deployed. Every web Services platform, like Apache Axis [1], Xfire, JBOSS, JAX-WS [5], Spring or something else, has to provide three core subsystems: ? Invocation ? Serialization ? Deployment WEB SERVICE APPLICATION FABRIC Java is a powerful development platform for service-Oriented Architecture (SOA) [20, 24]. Because robust web Services technology is the foundation for implementing SOA, Java now provides the tools modern enterprises require integrating their Java applications into SOA infrastructures. JWS has weaknesses, particularly when it comes to the development approach known as ?Start from WSDL and Java? [27]. The JWS [5, 10] standards present a Java-centric approach to web Services. This approach is difficult when we need to work with established SOA standards and map Java application to existing XML Schema documents and WSDLs. One way to encourage good design and make programming easier is to use an application framework. For example, the Apache Struts framework encourages web applications development based on the Model View Controller (MVC) framework. Frameworks [6, 7] offer a layer of abstraction on top of complex toolsets. The layer of abstraction encourages you to program in a certain way. By restricting your programming choices to a subset of proven patterns, the framework makes your job easier and less confusing. Application frameworks can also encourage good design. A good SOA framework, therefore, should encourage the use of XML Schema libraries and promote the reuse of schema across WSDL documents. A good SOA framework should separate compiled schemas and WSDL from the rest of the application classes [25]. A common framework identifies specific functions that need to be addressed in order to achieve decentralized interoperability. It does not determine the particular technologies used to fulfill the functions but rather divides the problem space into sub-problems with specified relationships. This functional decomposition allows differing solutions to sub-problems without overlaps, conflicts or omitted functionality. This is not to say that all applications must offer the same facilities, rather that when a feature is offered it should fit into a common framework and preferably have a standard expression. A web application framework is a type of framework, or foundation, specifically designed to help developers build web applications. These frameworks typically provide core functionality common to most web applications, such as user session management, data persistence, and templating systems. By using an appropriate framework, a developer can often save a significant amount of time building a web site. IMPLEMENTATION OF WSAF WSAF is a web service application fabric. WSAF is designed to be able to create web applications based on defined specifications. WSAF is based on a simple way to send requests (using URLs) and handle result (Simple XML format). It generates a set of HTML pages from the specification and some forms to test the application. WSAF generates Java code to invoke the web application and to develop it. It also generates WSDL, unit tests and stubs. WSAF detects if the parameters are conform to the specification. WSAF includes concepts like load balancing, fail over, logging, security, properties and statistics. WSAF accepts protocols: REST, SOAP [4], XMLRPC, JSON [8], JSON-RPC, and Front-end Framework. Designing specification of WSAF is shown in Fig. 1. web services are the most important ingredients in any cloud computing application. A cloud based application can be fabricated using efficient web services. Therefore, there is a need of efficient technique to design and develop good web services to suit the requirements of cloud paradigm.
Runtime descriptions are shown in Fig. 2. All web applications take individual HTTP requests and build appropriate responses. This can be handled in a variety of ways, somewhat dependent on the server platform. The most popular overall design pattern of web application frameworks is Model-ViewController (MVC).
The initial code of the framework [13, 16], or the platform itself, valuates the URL and passes responsibility to the appropriate application controller. The controller then performs any necessary actions with the application's model and then lets the view build the actual response content. DEVELOPING APPLICATION (APP) USING WSAF We demonstrate here the development procedure of Factorial web service. This web service returns the factorial of a given integer. Following steps need to be followed for developing this web service: Write definitions An application (APP) is always part of one project. An APP can contain many functions (operations). Every function is again part of one APP. We created a directory named MyApps as a working directory. This directory contains all files for the project. In this directory, we created a file named wsaf-project.xml
Next we created APP ?factapp? in the application. Since an APP should contain at least one function, user will be requested to provide the name and description of a first function. As a sample, we are presenting herewith contents of a function CalculateFactorial. calculates and return factorial...
The input parameter name is "number" and the output parameter name is "outputInt64". Generation of various codes With this definition our system will generate HTML documentation with test forms; serverside code, with Javadoc documentation; clientside code, with Javadoc documentation; an empty-shell web application in the form of a WAR file. Various screen shots of the generated codes in browser are shown in Fig. 3, 4, 5 for factapp API. Example shows the successful calculation of 5!
In same way we developed Fibonacci web services and String services. Fibonacci web service returns ith element in Fibonacci series (1, 1, 2, 3, 5, 8, 13, ...) String services can be used for performing various operations on string like reverse, changing case, concatenation of two strings. These 3 web services (Factorial, Fibonacci and string) are implemented in WSAF, Axis 2 [1] and JAXWS [10]. EXPERIMENTS PERFORMED Testing We tested and compared performance of our framework, WSAF, with some other frameworks like Axis 2 [1] and JAX-WS [10]. Following software was used: ? WSAF ? Axis 2
? NetBeans 6.8 with Glasfish V2+Java EE+JAX-WS 2 Environment for test: ? Windows XP Professional on both server as well as on client ? JDK 1.6.0 ? Dell Inspiron with Intel Core 2 Duo CPU @ 2.00 GHz and 4 GB RAM (Used for publishing web services) ? One Compaq Laptop Presario C700 with Intel Core 2 Duo CPU @ 2.00 GHz and 2 GB RAM (Used as a client) ? These two computer connected using cross over cable ? Software started: NetBeans 6.8, Ant Commander, WSAF and Google Chrome browser. We used WSDL files generated by 3 frameworks. Results obtained We measured Round Trip Time (RTT) in msec of different web services using following Java code fragment: long start = System.currentTimeMillis(); ...after receiving response from server... System.out.println("Time taken: "+ System.currentTimeMillis() - start)) + "ms"); We run the web services five times and calculated the average value. These values are shown in Table 1 and graphically plotted in Fig.
Every web service can be used by its WSDL (web service definition language). WSDL is a service contract between producer and consumer of the service. The WSDL document is useful for both creating and executing clients against a web service. We have tested the deployed factorial web service in a Google Chrome browser. Automatically generated WSDL document is shown below. http://localhost:8080/factapp/?_function=_W SDL
Analysis of Result We observed that for all developed and tested web services, web services developed with WSAF requires less time as compared with developed by other two frameworks viz. Axis 2 and JAX-WS. Latency time in case of WSAF is decreased by at least 20% - 30%. WSAF is giving better result because we used SAX XML parser and SOAP document-literal encoding was used. CONCLUSIONS To encourage good design and make programming easier one can use an application framework. Framework offers a layer of abstraction on top of complex tools. A good SOA framework should encourage use of XML schema libraries and reuse schema across WSDL documents. We developed a web service Application Framework, WSAF, which is an open-source web Services framework supporting HTTP protocols such as REST, SOAP, XML, JSON, JSON-RPC and more. From the specifications written in simple XML, WSAF generates the Client API (.jar), the Java server code template (.war), the WSDL and the documentation of the specification in HTML. We found that for tested WSDLs performance of our framework is better than Apache CFX and JAX-WS framework. The performance depends more on the hardware, the network, Internet connectivity, the Servlet container where web services are published. ACKNOWLEDGMENT Authors wish to thank staff members of Department of Computer Science, Shivaji University for providing all necessary infrastructure as well as we express our gratitude towards Principal, Thakur College of Science and Commerce, Mumbai for her kind support and her excellent library facility.
Englishhttp://ijcrr.com/abstract.php?article_id=2388http://ijcrr.com/article_html.php?did=23881.Apache Axis 2.x., http://ws.apache.org/axis2 2.Apache CXF, http://cxf.apache.org/ , Accessed on 10th Feb 2012 3.Auletta, V.; Blundo, C.; De Cristofaro, E.; Raimato, G.; , "A Lightweight Framework forWeb Services Invocation over Bluetooth," web Services, 2006. ICWS '06. International Conference on , vol., no., pp.331-338, 18-22 Sept. 2006 4.Ben Shil, A.; Ben Ahmed, M.; Additional Functionalities to SOAP, WSDL and UDDI for a Better web Services' Administration, 2nd International Conference on Information and Communication Technologies, 2006. ICTTA '06. Volume : 1, pp: 572 - 577 5.Bobby Bissett, Building JAX-WS 2.0 Services with NetBeans 5.0 and GlassFish, http://jaxws.java.net/articles/jaxwsnetbeans/glassfish.html, Accessed on 10th Feb 2012 6.Cao Hong-Hua; Ying Shi; Cui Hua; Xiao Yang; , "Towards a Framework for Designing, Deploying and Executing Semantic web service-Based Process," Wireless Communications, Networking and Mobile Computing, 2008. WiCOM '08. 4th International Conference on , vol., no., pp.1- 4, 12-14 Oct. 2008 7.Chaoying Ma; Bacon, L.; Petridis, M.; Windall, G.; , "Towards the Design of a Portal Framework for web Services Integration," Telecommunications, 2006. AICT-ICIW '06. International Conference on Internet and web Applications and Services/Advanced International Conference on , vol., no., pp. 163, 19-25 Feb. 2006 8.Crockford D. ?The application/json Media Type for JavaScript Object Notation (JSON).? The Internet Engineering Task Force (Network Working Group) RFC-4627, July 2006, http://tools.ietf.org/html/rfc4627 9.Davanum Srinivas, Paul Fremantle, Amila Suriarachchi, and Deepal Jayasinghe, web Services are Not Slow, Published on WSO2 Oxygen Tank, 2007, http://wso2.org/print/588, Accessed on 15th Feb 2012
10. Eckstein, and Robert Rajiv Mordani. ?Introducing JAX-WS 2.0 with the Java SE 6 Platform, Part 2,? November 2006.http://java.sun.com/developer/technical Articles/J2SE/jax_ws_2_pt2/Monson-Haefel, Richard. J2EE web Services. AddisonWesley Professional, ISBN 0130655678, October 2003. 11. Gomez-Perez, A.; Gonzalez-Cabero, R.; Lama, M.; , "ODE SWS: a framework for designing and composing semantic web services," Intelligent Systems, IEEE , vol.19, no.4, pp. 24- 31, Jul-Aug 2004 12. Haidar, A. N.; Abdallah, A. E.; Abstractions of web Services, 14th IEEE International Conference on Engineering of Complex Computer Systems, 2009, pp: 182 - 191 13. Jen-Yao Chung; An industry view on serviceoriented architecture and web services, IEEE International Workshop on service-Oriented System Engineering, 2005. SOSE 2005. pp:59 14. Kawahara, Y.; Kawanishi, N.; Ozawa, M.; Morikawa, H.; Asami, T.; , "Designing a Framework for Scalable Coordination of Wireless Sensor Networks, Context Information and web Services," Distributed Computing Systems Workshops, 2007. ICDCSW '07. 27th International Conference on , vol., no., pp.44, 22-29 June 2007 15. Kohsuke Kawaguchi, JAX-WS RI 2.1 benchmark details, http://weblogs.java.net/blog/kohsuke/archive/ 2007/02/jaxws_ri_21_ben.html, Accessed on 10th Feb 2012 16. Kumar, A.; "Distributed system development using web service and Enterprise Java Beans," Services Computing, 2005 IEEE International Conference on , vol.2, no., pp. xiii vol.2, 11-15 July 2005 17. Li Zhang; , "Requirement engineering for web applications," web Site Evolution, 2008. WSE 2008. 10th International Symposium on , vol., no., pp.1, 3-4 Oct. 2008 18. Rama Pulavarthi, Monitoring SOAP Messages Made Easy With JAX-WS RI 2.0.1, http://weblogs.java.net/blog/ramapulavarthi/a rchive/2006/08/monitoring_soap.html, Accessed on 10th Feb 2012 19. Rama Pulavarthi, Useful Goodies for web service Developers in JAX-WS 2.1 RI, http://weblogs.java.net/blog/ramapulavarthi/a rchive/2007/02/useful_goodies.html, Accessed on 10th Feb 2012 20. Sandy Carter, ?The New Language of Business: SOA and web 2.0?, IBM Press, 2007 21. Siblini, R.; Mansour, N.; Testing web services, The 3rd ACS/IEEE International Conference on Computer Systems and Applications, 2005. pp: 135 22. SOAP Version 1.2 Part 0: Primer. W3C Recommendation, June 24 2003, www.w3.org/TR/soap12-part0 23. Tanaka, M.; Ishida, T.; Murakami, Y.; Morimoto, S.; , "service Supervision: Coordinating web Services in Open Environment," web Services, 2009. ICWS 2009. IEEE International Conference on , vol., no., pp.238-245, 6-10 July 2009 24. Thomas Erl, ?service-Oriented Architecture: Concepts, Technology, and Design?, Pearson Education, Inc., 2007. 25. Tsai, W.T.; Paul, R.; Yamin Wang; Chun Fan; Dong Wang; Extending WSDL to facilitate web services testing, Proceedings of 7th IEEE International Symposium on High Assurance Systems Engineering, 2002, pp: 171 - 172 26. Walmsley, Priscilla. Definitive XML Schema. Prentice-Hall PTR, ISBN 0321146182, December 2001. 27. web Services Description Language (WSDL) Version 2.0 Part 1: Core Language. W3C Working Draft, August 3, 2005. www.w3.org/TR/wsdl20/ 28. web Services Description Language (WSDL) Version 2.0 Part 2: Adjuncts. W3C Working Draft, August 3, 2005. www.w3.org/TR/wsdl20-adjuncts
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareANTHROPOMETRIC STUDY OF THE NASAL PARAMETERS OF THE ADULT MEWARIS OF SOUTHERN RAJASTHAN
English150154Pooja GangradeEnglish Kalpana GuptaEnglish Hitesh BabelEnglishThe nasal architecture forms one of the most important aspects while assuming the facial aesthetics. Several authors in the past have considered nasal anthropometry to be one of the best clues to racial origins and also of gender differentiation. The purpose of the present study was to analyze the presence of sexually dimorphic morphometric parameters of the nose in the adult Mewari population of southern Rajasthan. The study involved 1000 adult Mewari volunteers, 500 males and 500 females, with their ages ranging between 18-50 years. A total of ten parameters were recorded by direct anthropometry, of these ten parameters analyzed, significant differences between man and women were found in seven of them. The data thus assimilated by the above study, reinforces the need for such nasal morphometric parameters in our populations, which are useful in various disciplines of medicine and surgery like rhinoplasty, facial reconstructive surgeries and forensic anthropology.
Englishsexual dimorphism, rhinoplasty, nose, anthropometry.INTRODUCTION
Anthropometry is a series of systematically undertaken measuring technique that expresses quantitatively the dimensions of the human body and skeleton. It includes measuring the whole body to individual parts : nose, face, extremities etc. The human face is used for expression, appearance and identity amongst all the rest. On evaluation of the face, one of the things that often calls for the attention are the set of three facial features: the lips, the nose and the chin1 . The extent of the attractiveness of the face and the beauty depends on the reciprocal proportion and aesthetic harmony of the above stated features2 . Nasal anthropometry is considered one of the best clues to racial origin. This evaluation of the nose stems from the neoclassical canons of facial proportions developed by artists and anatomists of the 17th and 18th centuries. Concept of beauty has changed from time to time it is thus apparent that beauty acceptable for one culture may not be the same for the other. Thus notion of a single aesthetic standard is grossly in adequate. The growing demand for cosmetic rhinoplasty3 reflects the importance of a beautiful nose. Thus, a new model of aesthetic standard and beauty unique to a particular ethnic group is required and it becomes surgeon‘s responsibility to maintain core ethnic features while achieving cosmetic enhancements. The above standards are also being used in forensic facial reconstructions4,5. It is a well documented fact that during facial identification the facial approximate is more accurate when tissue thickness tables and external anatomical parameters like nose, lips and ears of the population are known. Researchers have described the importance and applications of nasal forms time and again, not only for technical purposes, but also for aesthetic appreciations that are influences by culture6,7,8 . Hence, the present study was under taken to formulate a baseline standard aesthetic record of the nasal parameters of the people in and around the Mewar region of southern Rajasthan in India.
MATERIALS AND METHOD
The present study was carried out in the local communities of the Udaipur district in Rajasthan. The study was carried out on 1000 adult volunteers, who were selected at random from the local communities, comprising of 500 female and 500 males with their age ranging from 18-50 years. Subjects with deviated nasal septum, trauma and congenital abnormalities of the nose and face were excluded. Measurements were taken with aid of sliding vernier calipers (with least count of 0.001/mm.), scientific calculator and data sheet. Subjects were told to sit upright in a relaxed mood with head in the anatomical position while taking measurements. A single reading by the same investigator was taken to avoid bias All participants declared to have to have at least three generations of Mewar ancestry. To obtain a vision of the nasal base, the volunteer was positioned with the neck in extension, so that pronasion and glabella were in the same plane.
1. Distance between endocanthion (ENL – ENR) : describes the distance between left and right endocanthion points in a patients anatomical position.
2. Bony nasal width (BL – BR): corresponds with the width between the nasal bones of left and right side.
3. Interalar distance (ALL – ALR): it corresponds to the distance between left and right alar points, which corresponds to the nasal wing contour in the most convex area.
4. Bialar base distance (BLL – BLR): corresponds to the distance between both the nasal wings in a patients basal view.
5. Nasal base to pronasal distance { (BLL – BLR ) → PRN)}: it corresponds to the distance from the midpoint of nasal base to pronasion.
6. Nasal wing to pronasion distance (AL – PRN): it corresponds to the distance from the nasal wing in the most convex area to the pronasion.
7. Nasal length (N – PRN): it corresponds to the length of the dorsum of nose from nasion to pronasion
8. Nasal height (EN – N): it corresponds to the distance from the endocanthion to the nasion.
9. Nasal base index :
RESULTS
In all the ten parameters seven parameters were found to be significantly higher in the males than their counterpart female members ( pEnglishhttp://ijcrr.com/abstract.php?article_id=2389http://ijcrr.com/article_html.php?did=23891. Costa JR, Prates JC, De Castilho HT, Santos RA: E studio craniometrico de los huesos nasalesy proceso frontal de maxilla. Int. Journal of Morphology 2005, 23 (1), 9-12.
2. Perez JP, Olson KL: Analysis of African American female nose. Plast. Surg. 2003, 111(2), 620-626.
3. Canut J: Un analisis estetico dentofacial. Rev. Esp. Ortod. 1996, 26,13-30.
4. Rodriguez CJ. La anthropologia forense en li identification humana. Bogota, universidal nacional de Colombia 2004, 185-214.
5. Stephan CN, Henneberg M and Sampson W: predicting nose projection and pronasale position in facial approximation: a test of published methods and proposal of new guidelines. Am J Phys. Anthropology. 2003, 122 (3): 240-50.
6. Bull TR< Rhinoplasty: aesthetics, ethics and airways. J laryng otol. 1983, 97 (10): 901-96.
7. Daniel RK, Farkes LG: Rhinoplasty: image and reality. Clinical plastic surgery.1988 .15 (1): 1-10.
8. Leong SC, White PS: A comparison of aesthetic proportions between Oriental and Caucasian nose. Otolo. All .Sc. 2004 29 (6): 672-6.
9. Bashour M history and current concepts in the analysis of facial attractiveness. Plastic Reconstructive surgery. 2006. Sep11, 8 (3): 741-56.
10. Johnson N, Sandy J. an aesthetic index for evaluation of cleft repair. Eur J orth. 2003, 25(3): 243-9.
11. Heidari z, Khammar T.< Khammar M: anthropometric measurements of the external nose in 18-25 year old sistani and baluch aborigine in southeast of Iran. Folia Morph, 2009, vol 68 (2), 88-92.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15General SciencesENHANCEMENT OF PARAMETERS FOR MULTI LAYER BROADBAND MICROSTRIP PATCH ANTENNA
English160164M. Ajay BabuEnglish I.GovardhaniEnglish Habibulla KhanEnglish M.Venkata narayanaEnglish Ch. Ravi TejaEnglish P. Rajasekhar ReddyEnglish U.B.V.Surya Rao DulamEnglishIn this paper, The proposed model for enhancing gain and return loss, which improves the performance of a conventional microstrip patch antenna. This paper presents a novel wideband probe fed inverted multiple slot microstrip patch antenna. This model adopts contemporary techniques; probe feeding, inverted patch structure and stacked UV-shaped slotted patch. In addition to the easy feeding, the proposed model possesses the advantages of being wide bandwidth, high gain and low return loss. The patch element has the peak gain 13.16 dBi and the return loss is -23.7dB.
EnglishBroadband antenna; microstrip patch antenna; probe fed; Inverted patch.INTRODUCTION
Microstrip antennas are the most rapidly developing field in the last few years. Currently these antennas have a large application in mobile radio systems, integrated antennas, satellite navigation receivers, satellite communications, direct broadcast radio, television, etc. The considerable interest in microstrip antennas is due to their advantages compared to conventional microwave antennas as low profile and light weight, easy to fabricate, conformable to mounting structures, and compatible with integrated circuit technology. However, one of the most serious disadvantages of microstrip antennas is limited bandwidth [1]-[3]. To overcome this inherent limitation of narrow impedance bandwidth, low gain and cross-polarization many techniques have been suggested e.g., for probe fed stacked antenna, microstrip patch antennas on electrically thick substrate, slotted patch antenna and stacked shorted patches have been proposed [4]. Recently, there has been considerable interest in the two layer probe fed patch antenna consisting of a driven patch in the bottom and a parasitic patch [5], [6]. By stacking a parasitic patch on a Microstrip patch antenna, the antenna with high gain or wide bandwidth can be realized [7]. These characteristics of stacked microstrip antenna depend on the distance between a fed patch and a parasitic patch. When the distance about 0.1λ mm(wavelength) the stacked microstrip antenna has a wide bandwidth [7], [8]. Recently, aperture-coupled fed stacked patch antenna[9] have been investigated and bandwidths up to 69% have been reported, however, the major drawbacks are the level of back radiation due to use of a resonant aperture and the surface wave excitation. Other feeding techniques such as the use of L-shaped or F-shaped probes have also been proposed yielding to wide impedance bandwidths [10],[11], at the expense of increased complexity of the design and fabrication, especially of the probe. In [10], an Lprobe fed stacked U-Slot patch antenna was proposed with a bandwidth up to 44.4% being achieved. Vslotted rectangular microstrip antenna with a stacked patch has been shown able to achieve bandwidths as high as 47% [12]. This paper proposes UV-shape slotted multiple stacked patch antenna with wide bandwidth, low return loss and high gain characteristics operating between 16.35-17.1 GHz. This employs contemporary techniques namely, the probe feeding, inverted patch, and stacked patch techniques to meet the design requirement.
ANTENNA MODEL
The geometry of the proposed antenna structure is shown in Fig. 1. The antenna is made-up of two UV-shaped stacked patches, two air layers, two Rogers substrates, and a vertical probe connected to the driven patch. The driven and parasitic patches supported by a low dielectric substrate with dielectric permittivity, ε1 and thickness, h1. The parasitic patch is stacked at the height h2 above the lower substrate with permittivity ε2 and thickness h3. Two air-filled layers are used in between the lower substrate and ground plane with permittivity, ε0 and thickness, h0 and in between lower and upper substrates with permittivity, ε0 and thickness, h2 respectively. The proposed two UV-shaped stacked patches are on two different radiating elements. The use of probe feeding technique, stacked multiple slotted patch with thick air filled substrates provide the gain enhancement. The UV-shaped slots for driven patch and parasitic patch are shown in Fig. 1(a). The driven patch is fed by a direct connected probe along the centreline (x-axis) of the patch as shown in Fig. 1(b). Geometry of the antenna:
RESULTS
The resonant properties of the proposed antenna have been predicted and optimized using a frequency domain three dimensional full wave electromagnetic field solver (Ansoft HFSS).
The above figure shows the return loss graph for the proposed antenna. It can be seen that the minimum value is obtained at 16.35 GHz and the minimum value obtained is -23.7 dB. Hence the antenna works well
Fig 6(b). Radiation pattern of the proposed patch antenna at resonance frequency 16.35 GHz for ? =900
The above figure shows radiation pattern. As shown in fig.6 the designed antenna displays good broadside radiation patterns for both resonance frequencies when ?=00 and ?=900 . It can be seen that 3-dB beam widths of 580 and 600 are at resonance frequencies of 16.35 GHz and 17.1 GHz.
???????CONCLUSION AND DISCUSSION
A UV-shaped slotted patch antenna has been designed for high gain and low return loss. A newly technique for enhancing gain and low return loss of microstrip patch antenna is successfully designed in this research. Simulation results of a wideband microstrip patch antenna covering 16.35 to 17.1 GHz frequency have been presented. Techniques for microstrip broadbanding, gain enhancement and low return loss are applied with significant improvement in the design by employing proposed slotted patch shaped design, inverted patch and probe feeding. The proposed microstrip patch antenna achieves a bandwidth of 16.35 to 17.1 GHz at -23 dB return loss and the maximum achievable gain of the antenna is 13.16 dBi. The design has demonstrated that stacked patch with UV-shape slots and probe fed can be used to form an antenna with very low return loss further more due to its high gain and broad bandwidth more applications can be anticipated.
ACKNOWLEDGMENT
The authors like to express their thanks to the department of ECE and the management of K L University for their support and encouragement.
Englishhttp://ijcrr.com/abstract.php?article_id=2390http://ijcrr.com/article_html.php?did=23901. Y. X. Guo , K. W. Khoo, and L. C. Ongs, ?Wireless circularly polarized patch antenna using broadband baluns?, IEEE Trans. Antennas propag., vol. 56, no. 2, pp. 319-326, Feb.2008.
2. S. J. Lin and J. S. Row, ?Broadband enhancement for dual-freq microstrip antenna with conical radiation?, electron. Lett., vol. 44,no. 1, pp. 515-517, Jan.2008.
3. M. T. Islam, N. Misran, M. S. Islam, M. F. A. Rahim and M. N. Shakib, ?High gain microstrip patch antenna using multiple slot?, in the 4th Int. Colloq on signal processing and its applications (CSPA 2008), Kuala Lumpur, Malaysia, 2008, pp. 421-424.
4. D. Sanchez-Herndez and L. D. Robertson, ? A survey of broadband microstrip patch antennas?, Microwave Journal, pp.60-84, Sep.1996.
5. H. Legay and L. Shafai, ? New stacked microstrip antenna with large bandwidth and high gain?, IEEE proc. Microw. Antennas propag., vol.141,no.3, pp. 199-204, June.1994.
6. W. Y. Tam, A. K. Y. Lai and K. M. Luk, ? Cylindrical rectangular microstrip antennas with coplanar parasitic patches?, IEEE proc. Microw. Antennas propag.,vol. 142, no. 4, pp. 300-306, Aug.1995.
7. S. Egashire and E. Nishiyama, ?Stacked microstrip antenna with wide bandwidth and high gain?, IEEE trans. Antennas propag., vol. 44, pp. 1533-1534,Nov.1996.
8. K. Araki, H. Ueda and M. Takahashi, ? Numerical analysis of circular disk microstrip antenna with parasitic elements?, IEEE trans. Antennas propag., vol. 34, no. 12, pp. 1390- 1394,Dec.1986.
9. S. D. Targonski, R. J. B. Waterhouse, and D. M. Pozar ,?Design of wideband aperture stacked patch microstrip antennas?, IEEE trans. Antennas propag. Vol. 46, no. 9, pp. 1245-1251, Sep.1988.
10. B. L. Ooi and C. L. Lee , ? Broadband air-filled stacked U-slot patch antenna?, electon Lett.,vol. 35, no. 7, pp. 515-517, Apr.1999.
11. B. L. Ooi, C. L. Lee, P. S. Kooi and S. T. Chew, ?A novel F-probe fed broadband patch antenna?, in IEEE Int. Symp. Antennas propag. Soc., vol. 4, pp. 474-477, July.2001
12. G. Z. Rafi and L. Shafai, ? V-slotted rectangular microstrip antenna with a stacked patch?, IEEE Int. Symp. Antennas propag. Soc, vol. 2, pp. 264-267, 2003.
13. K. J. NG, A. A.R. Zainol and M. Tariqul Islam, ? Broadband inverted E-shaped rectangular microstrip patch antenna for 3G applications?, in IEEE National Symp. Microelectronics, NSM 2003, pp.286-289.
14. M.T.Islam,N.Misran,M.N.shakib,B.Yatim,?Low cross-polarization Broadband Microstrip patch antenna?,IEEE Proc. 26-27 Aug 2008.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241415EnglishN2012August15HealthcareHERPES ZOSTER OF TRIGEMINAL NERVE: A CASE REPORT AND REVIEW OF LITERATURE
English165170Sandeepa N. C.English Manoj Kumar A DEnglish Umesh Malavalli DevrajuEnglish Syed ShahbazEnglish Vijay GudubaEnglishHerpes zoster (HZ), commonly called shingles taken from the Latin word cingulum, meaning belt, is an acute skin infection associated with the reactivation of the varicella-zoster virus (the virus that causes primary infection chickenpox). The risk of HZ increases with age; approximately half of all cases occur in persons older than 60 years. One of the most common and debilitating sequelae of HZ is postherpetic neuralgia (PHN), defined as pain persisting more than 3 months after the rash has healed. During chicken pox infection, the virus enters the cutaneous nerves and then travels to the dorsal root ganglia where it lies dormant until something triggers it to become active again. Stress, illness, dental manipulation, emotional upset, immuno-suppressant drugs, fatigue and radiation therapy can trigger the latent virus to travel back down the sensory nerve to infect the surface of the skin. The practising dentist must be familiar with the presenting signs and symptoms of patients experiencing the prodromal manifestations of herpes zoster of the trigeminal nerve. A thorough knowledge of the disease will prevent unnecessary and delayed treatment. Here we report a case of herpes zoster which presented with difficulty in opening mouth and intraoral pustules which was diagnosed at the earliest and was given the proper treatment.
EnglishHerpes zoster (HZ), Shingles, Postherpetic neuralgia (PHN)CLINICAL FEATURES
The clinical feature of HZ can be grouped into 3 phases.1) prodrome, 2) acute, 3) chronic. During initial viral replication, active ganglionitis develops with resultant neuronal necrosis and severe neuralgia. This inflammatory reaction is responsible for the prodromal symptoms of intense pain that preceeds the rash in more than 90%of cases. Prodromal symptoms that herald HZ include pruritus, dysesthesia, and pain along the distribution of the involved dermatome and may be mistaken for myocardial infarction, biliary or renal colic, pleurisy, dental pain, glaucoma, duodenal ulcer, or appendicitis, leading to misdiagnosis and potentially mistreatment. In rare instances, the nerve pain is not accompanied by a skin eruption, a condition known as zoster sine herpete1 . The classic skin findings are grouped vesicles on a red base in a unilateral, dermatomal distribution. However, the lesions of HZ progress through stages, beginning as red macules and papules that, in the course of 7 to 10 days, evolve into vesicles and form pustules and crusts. The exanthema typically resolves in within 2-3 weeks in otherwise healthy individuals Typically, HZ is unilateral, does not cross the midline, and is localized to a single dermatome of a single sensory ganglion (adjacent dermatomes are involved in 20% of cases). The most common sites are the thoracic nerves and the ophthalmic division of the trigeminal nerve. Herpes zoster ophthalmicus, which occurs in 10% to 20% of HZ episodes, can involve the entire eye, causing keratitis, scarring, and vision loss. An early sign of this condition is vesicles on the tip, side, or root of the nose (Hutchinson sign). Herpes zoster of the second and third divisions of the trigeminal nerve may produce symptoms and lesions in the mouth, ears, pharynx, or larynx. Ramsay hunt syndrome, ie, facial paralysis and lesions of the ear (zoster oticus) that are often accompanied by tinnitus, vertigo, and deafness, results from involvement of the facial and auditory nerves. Some cases of Bell palsy may be a form of zoster sine herpete. Disseminated HZ occurs primarily in immunocompromised patients; it usually presents with a dermatomal eruption followed by dissemination. Oral lesions occur with trigeminal nerve involvement andmay be present on the movable or bound mucosa. The lesions often extend to the midline andfrequently are present in conjunction with involvement of the skin overlying the affected quadrant. Individual lesions manifest as 1-4mm white opaque vesicles that rupture to form shallow ulcerations. Differential diagnosis includes herpes simplex virus infection, impetigo, contact dermatitis, insect bites, autoimmune blistering disease, dermatitis herpetiformis, and drug eruptions Several reports have documented significant bone necrosis with loss of teeth in areas involved with HZ because of close anatomical relationship between nerves and blood vessels within neurovascular bundles, inflammatory process within nerves have the potential to extend to adjacent blood vessels2 . The average interval between the appearance of the exanthema and the osteonecrosis is 21 days but has been reported as late as 42 days. The neurologic complications of HZ may include acute or chronic encephalitis, myelitis, aseptic meningitis, retinitis, autonomic dysfunction, motor neuropathies, Guillain-Barré syndrome, hemiparesis, and cranial or peripheral nerve palsies3 . More common complications include bacterial super infection by Staphylococcus aureus or Streptococcus pyogenes, scarring, and hyperpigmentation. Diagnosis Herpes zoster is usually diagnosed clinically by the prodromal pain, characteristic rash, and distinctive distribution but other procedures may be necessary in atypical cases. Although shell vial viral culture remains the criterion standard test, detection of viral DNA by polymerase chain reaction, is the most useful test because it is sensitive and specific and results can be obtained within a few hours. Other tests are direct fluorescent antibody staining, immunoperoxidase staining, histopathology, and Tzanck smear4 . TREATMENT OF ACUTE HZ: The goal of treatment during the acute episode is to control symptoms and prevent complications. Treatment options include antiviral therapy, corticosteroids, and pain medication5 Antivirals Acyclovir, famciclovir, and valacyclovir are nucleoside analogues that inhibit replication of human herpes viruses. These agents reduce the duration of viral shedding, hasten rash healing, reduce the severity and duration of acute pain, and reduce the risk of progression to PHN. These medications are most effective if initiated within 72 hours after the development of the first vesicle. Valacyclovir and famciclovir may be more successful than acyclovir in reducing the prevalence of post herpetic neuralgia. Immunocompromised patients are at greater risk of complications and may require intravenous antiviral therapy. Analgesics Acute pain will be reduced by antiviral drugs, but patients will generally also require analgesics. Nonsteroidal anti-inflammatory drugs are usually ineffective, and opioids may be required. Corticosteroids Review of the data indicated a reduction of pain and disability during the first 2 weeks but no effect on the incidence or severity of post-herpetic neuralgia. In combination with antiviral therapy, they modestly reduce the severity and duration of acute symptoms. Corticosteroids are associated with a considerable number of adverse effects and hence should be used only in patients with severe symptoms at presentation or in whom no major contraindications to corticosteroids exist Postherpetic Neuralgia (PHN) and Management Approximately 15% of affected patients progress to the chronic phase of HZ, which is charecterised by pain (PHN) that persists longer than 3 months after the initial presentation of acute rash. PHN Greater than 25% of patients with HZ will experience PHN over 1 yr. The V-Z virus injures the peripheral nerves by demyelination, wallerian degeneration and sclerosis but change in CNS, including atrophy of dorsal horn cells in the spinal cord, have also been associated with PHN. This combination of central andperipheral injury results in the spontaneous discharge of neurons and an exaggerated response to non painful stimuli. There is also evidence to support the theory that a low grade persistent infection of the ganglion contributes to the PHN pain. Effective therapy often requires multiple drugs. Another general principle is to have patients begin a medication at a very low dose and increase the dose gradually until either analgesia or adverse effects are noticed. It is usually best to begin with a medication that either has the fewest adverse effects or that is perhaps associated with desirable side effects. For example, topical medications are almost always free of systemic adverse effects. Conversely, tricyclic antidepressants (TCAs) often have sedating side effects that may be helpful for patients who suffer from insomnia. Medications that are in use include the following: topical agents, opioids, antidepressants and anticonvulsants5 . Topical Agents Topical lidocaine patches are particularly effective for patients with allodynia. Lidocaine works by decreasing small fiber nociceptive activity, and the patch itself serves as a protective barrier 6 . Capsaicin is another topical agent that has shown efficacy in randomized clinical trials. However, the burning sensation associated with the application of capsaicin often limits its clinical use7 .However, the medication‘s effect often does not occur until 2 weeks or more of therapy. Capsaicin is derived from red peppers andis not recommended for placement on mucosa or open cutaneous lesions. Opioids Their long-term use presents with risks of sedation, mental clouding, and abuse. Because elderly people bear the overwhelming burden of PHN and also have comorbidities that may limit the use of other medications, opioids may have a role in the treatment of these patients. Mixed μ- opioid agonists and norepinephrine reuptake inhibitors such as tramadol may be good choices for patients with PHN, especially for those with risk factors for substance abuse. Other reasonable options include oxycodone with acetaminophen, or morphine. When prescribing opioids, clinicians should recommend prophylactic constipation therapy from the outset in the form of a stool softener and laxative Antidepressants Tricyclic antidepressants are the criterion standard for relieving the pain of PHN. Multiple clinical studies have shown the efficacy of nortriptyline and amitriptyline, the most commonly used members of this class8 . Unfortunately, TCAs are often associated with a variety of anticholinergic adverse effects, sedation, and potential cardiac dysrhythmias. Patients who are unable to tolerate TCAs may do better with selective serotonin and norepinephrine reuptake inhibitors, such as duloxetine or venlafaxine. The selective serotonin reuptake inhibitor antidepressants effectively relieve depression symptoms but they do not specifically relieve neuropathic pain. Anticonvulsants Several anticonvulsants are of use against neuropathic pain. The newer-generation anticonvulsant drugs, such as pregabalin and gabapentin, have fewer adverse effects and require less hematologic monitoring than older anticonvulsants, such as carbamazepine and valproic acid. Pregabalin and gabapentin have both been shown to relieve the pain of PHN9 .Pregabalin has the advantage of a more predictable and linear pharmacokinetic profile. Other therapeutic modalities that have been proposed for PHN include electrical stimulation of the thalamus, anterolateral cordotomy, cryotherapy of the intercostal nerves, and ablation of the dorsal roots using pulsed radiofrequency; however, limited data exist to support these therapies.
PREVENTION
Zostavax is a live, attenuated vaccine that contains the same strain of virus as the varicella vaccines but 14 times more potent than Varivax, the vaccine for chickenpox. In a randomized, placebo-controlled trial involving around 38,000 healthy adults older than 60 years, the vaccine reduced the incidence of HZ by 51%, the burden of illness from HZ by 61%, and the risk of PHN by 66%10.The adverse effects of the vaccine are mild and usually consist of erythema, pain, and pruritus at the injection site. Systemic adverse effects are rare and consist of fever and headache
CASE REPORT:
A 45 yr old male patient reported to us with a chief complaint of pain and swelling in relation to left upper lip and cheek region of duration of 2 days. Patient gave a history of eruptions on left upper lip 2 days back, which got ruptured within a day, followed which he noticed swelling of left upper lip and face and difficulty in opening mouth. Fever and body ache was noted prior to the swelling. Pain was severe, pricking type and was present on the upper lip region on the left side. There was no history of prodromal pain or burning sensation. Patient had itching sensation on the affected area .There was a previous history of chickenpox on general physical examination, there was no abnormality detected. Extra orally gross facial asymmetry on left side was noted .There was diffuse swelling on the left middle third of the face. Crestation was noted on the left middle third of the face. Upper lip along with labial mucosa and buccal mucosa was swollen on left side. Swelling was soft to firm in consistency and severely tender on palpation. There were multiple pustules noted on the left mucosa and lip which was severely tender. All the findings were lead to the tentative diagnosis of Herpes zoster of maxillary division of trigeminal nerve which was confirmed by pathological examination. He was treated with antiviral agents and corticosteroid. There was improvement in his general condition and the lesion. Following 7 days of antiviral therapy patient showed complete resolution of his symptoms. There was no history of pain persisted after the lesion is healed.
CONCLUSION
HZ in the orofacial region can have variable presentation. It is very important to diagnose HZ at the earliest to prevent unnecessary dental treatments and to reduce the risk of PHN.
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