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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesIMPROVING QUALITIES OF OILS FROM ELAEIS GUINEENSIS SPECIES BY PROCESSING WITH NELSONIA CANESCENS LINN SPRENG (ACANTHECEAE) LEAVES
English0610UmerieEnglish SC.English OkonkwoEnglish JC.English OkorieEnglish NHEnglish Ibekwe BOEnglishNelsonia canescens leaves were used in the processing of palm oils to improve the quality and stability of the oils. Palm oils were obtained from the ripe fruits of Elaeis guineensis var nigrescens and Elaeis guineensis var virescens. Phytochemical analysis of Nelsonia canescens leaves and the oils were arried out. The qualities of the oils were assessed in terms of free fatty acid content, saponification, acid, and iodine values. Results showed the presence of flavonoids, saponins, β-carotenes, tocopherols, alkaloids, tannins and glycosides in the leaves. Oils from both oil palm varieties contained little amounts of arotenoids and flavonoids. The use of Nelsonia canescens leaves removed the saponins present in var virescens oil, lowered the levels of iodine, acid and free fatty acid values, but enhanced the saponification
values in both oil varieties. In lowering iodine value unsaturation property of the oil was reduced.
Consequently rancidity tendencies of the oils were reduced. Evidently, the use of Nelsonia canescens
leaves will enhance the stability and shelf life of palm oils.
EnglishElaeis guineensis varieties; nigrescens and virescens, Nelsonia canescens leaves, palm oil processing and quality.INTRODUCTION
Palm oils are obtained from the flesh (?mesocarp?) of the oil palm, Elaeis guineensis Jacq, fruit. The oil palm varieties Elaeis guineensis var nigrescens and E.guineensis var virescens (the African oil palm) both belong to the family Palmae, Palmaceae or Arecaceae (Mozingo, 1989), subfamily Cocoideae (Okeke, 1981). Each of the varieties has three basic types, the Dura type characterized by thin mesocarp, thick endocarp (shell) with generally large kernels, the Tenera type characterized by thick mesocarp, thin endocarp with reasonably sized kernel, and the Pisifera type characterized by thick mesocarp (with little oil content), no endocarp (shell less) with small kernels (NIFOR, 1985). The unripe fruits of E. guineensis var nigrescens appear blueblack in the bunch and dark red when ripe, while the unripe fruits of the virescens variety appear green but turn orange-red when fully ripe (Hartley, 1988). The oil of the virescens variety foams excessively on heating and this makes it distasteful for oil consumers, hence lowering its market value (Umerie et al, 2004). Palm oil contains a mixture of polyunsaturated, monounsaturated and saturated fatty acids. The relative concentrations are 38.7% oleic acid, 10.5% linoleic acid, 44.3% palmitic acid and 4.6% stearic acid (Anon., 2009). The fatty acid composition of palm oil is similar to that of the adipose tissue in most people on an ordinary diet. The greater acceptance of palm oil over other vegetable oils results from its superior properties as well as its health and nutritional values being a healthy component of human and animal diets (Onwudinjo. 2010). Palm oil and palm oil products are naturally occurring sources of the antioxidant vitamin E constituents, tocopherols and tocotrienols. These natural antioxidants acts as scavengers of damaging oxygen free radicals and one hypothesized to play a protective role in cellular aging, atherosclerosis and cancer. Carotenes and tocopherol contribute to the stability and nutritional importance of palm oil. (Goh, et al 1985). Nelsonia canescens Linn Spreng (N. canescens) belongs to the Acanthus family, Acantheceae, it has blue pussy leaves, grows annually and is native primarily to tropical areas of western central tropical Africa. The plant is a weed and abundant throughout the tropic. It is well known for its antioxidant activity and used in the traditional treatment of cardiovascular and inflammatory diseases (Oweyele et al, 2005). In processing palm oil from the fruits, fresh leaves of N. canescens are included at milling or pounding stage by the natives of some parts of south east of Nigeria to improve the quality and stability of the oil, Umerie at el (2004) have assessed the use of Ficus exasperate leaves to stabilize palm oils. In the same vein, this study therefore, investigates the efficacy of using N. cansescens leaves in processing of palm oils in order to improve and stabilize their qualities.
MATERIAL AND METHODS
Collection of the oil palms fruits and Nelsonia canescens leaves:
The fresh fruits of two palm varieties E. guineensis, var nigrescens and E. guineensis var virescens were obtained from Uke town, Anambra State, Nigeria. Both fruits were of the Tenera type, possessing thick mesocarp, thin endocarp with reasonably sized kernels. The mature leaves of N. canescens leaves were collected from surrounding bush at the Nnamdi Azikiwe University Awka, Anambra State. They were washed and used fresh.
Processing of the oil palm fruits:
Enough quantities of the fruits of the two oil palm varieties E. guineensis var nigreseens E. guineensis var virescens were weighed out separately, washed and boiled with water for 30mins. The fruits were removed from the water and each variety divided into two equal parts. To one part of each of the fruit verities, fresh leaves of N. canescens were added in the ratio 1:2 and manually pounded or digested together in a wooden mortar to separate the mesocarp from the kernel (depulping). The pounding continued until no streak of the coloured outer skin was distinguishable any more. The other remaining parts of the two varieties were similarly digested but without the Neslonia leaves. The oilladen mesocarp pulp of each of the four processed parts was partly hand pressed to obtain some oil, and the residual mass washed out in clean water and oil layer carefully skimmed off. The pressed oil and the skimmed portion were boiled to obtain clarified oils. The oils were collected and stored in four separate bottles until use.
Chemical and Phytochemical properties:
The saponification, iodine and acid values of the oils were estimated by standard procedures described by Plummer (1987), AOCS (1960) and Glasser (2008). The free fatty acid, FFA, was calculated from the relationship given by Norris (1965): 1 unit of Acid = 0.503% FFA (calculated as oleic acid). The methods of Harborne (1998) and Evans (2002) with slight modification were used in the estimation of the phytochemical constituents of the oils and the plant leaf. B-Corotenes and lycopene were determined spectrophotometrically at 445 and 472 nm respectively.
RESULTS AND DISCUSSION
The oils obtained all appeared orange-red but those of E. guineensis var nigrescens had a deeper shade of colouration. Only the oil of E. guineesis var virescens obtained by processing without N. canescens leaves, foamed excessively when heated to effect clarification of the oils. Table 1 gives some chemical and phytochemcal characteristics of the oil samples from the two oil varieties processed with and without N. canescens leaves, while Table 2 gives some phytochemical characteristics of N. canescens leaves. The oils processed with N. canescens leaves had slightly greater saponification values, thereby making the oil better for hair relaxers, body creams, shampoos and soap production. The acid values and consequently FFA values of the oil processed with these leaves were reduced. The presence of FFA is partly attributed to the action of lipolytic enzymes at the base of the fruits which increases rapidly by 60% within an hour after detachment from the bunch (Jacobserg, 1969). The iodine value was also lowered in oils processed with N. canescens leaves due to reduction of unsaturated fatty acids present in the oil. The lower the iodine value the smaller the number of C=C double bond and thus the reduced tendency for rancidity of the oil. Consequently the oil will become more stable and possess an improved shelf life. The observed increase in saponification values (increase in saturated fatty acids) and lowered iodine values (decrease in unsaturated fatty acids) and acid values partly implicates the flavonoid, flavone. Flavonoids are potent antioxidants capable of scavenging hydroxyl radicals, superoxides anions and lipid peroxy radicals, thus keeping oxidative process in check while encouraging reductive processes (Miller, 1996; Ajali, 2004). The use of the Nelsonia leaves effected a deleting action on some of the phytochemical constituents of the oils. The saponins were completely eliminated from the oil of the virescens variety where they occur. Hence eliminating the foaming tendency of the oil as well as the danger of hemolysis of red blood corpuscles due to the presence of saponins (Lewis, 1993; McHenry, 1992). The ability of Nelsonia leaves to modify the property of the oil by eliminating the foaming factor in the virescens oil highlights the presence of anti-foaming agents in the Nelsonia leaves (Shedlovsky, 1966). The leaves have been shown to contain β-carotenes, tocopherols (vitamin E), flavonoids tannins, and glycosides, some of which could have been implicated in the sequestration and precipitation of the saponins from the virescens oil. The plant leaves, rich in carotenoids could partly account for the little increase in the levels of carotenoids in the leaf-processed oils (Table 1). Apart from antioxidant properties, studies suggest that carotenoids enhance immune function by a variety of mechanisms and improve cardiovascular health (Njoku et al, 2010). The leaf tocopherol will also enrich those of the oils thus leaf tocopherol will also add to those of the oils thus increasing the anti-oxidant activities (Ajali, 2004) within the oils.
CONCLUSION
The study has shown that palm oil processed by using N. canescens leaves have relatively improved qualities. The leaves lowered the degree of unsaturation and improved the degree of saturation. The anti-oxidant activities were enhanced while saponins, where present were eliminated. The use of N. canescens leaves have proved effective in improving the qualities of palm oils, thus justifying the use of nelsonia leaves in local palm oil processing to obtain oils of good keeping quality.
Englishhttp://ijcrr.com/abstract.php?article_id=1706http://ijcrr.com/article_html.php?did=17061. Ajali, U. (2004). Chemistry of Bio-compounds 1 st edition Rhyce Kerex Publishers, Enugu, Nigeria.
2. Anon, (2009) Constituents of Palm Kernel. http//www. Google.com (26/08/09).
3. AOCS Official Methods, (1960). Sampling and Analysis of Commercial Fats and Oils. American Oil Chemists Society, Chicago, IL, pp 801-805.
4. Evans, W.C. (2002). Trease and Evans Pharmacognosy, 15th edition. W.B. Saunders Company Limited, Edinburgh, UK.
5. Glasser,A.C. (2008). Analysis of Fixed Oils, Fats and Waxes. In: Pharmaceutical Chemistry, Theory and Applications, Vol 1. Leslie G. Chattern (Editor). CBS Publishers and Distributor, New Delhi, India. PP 405-437.
6. Goh,S.H., Choo, Y.M. and Ong, S.H. (1985). Minor constituents of palm oil. J. Am. Oil Chemical Soc. 62 (2): 237-240.
7. Harborne, J.B. (1998). Phytochemical methods: A guide to modern techniques of plant analysis, 3 rd edition. Chapman and Hall, London, UK.
8. Hartley, C.W.S. (1988). The Oil Palm, 3rd Edition Longman Scientific and Technical Copublishers, New York.
9. Jacobsberg, B (1969). The influence of milling and storage condition on the bleachability and keepability of palm oil. In: ISP Conference on Quality and Marketing of Oil Palm Products, Kuala Lumpur.
10. Lewis, R.J. (1993) Hawley‘s Condensed Chemical Dictionary 12th Edition. Van Nostrand Reinhold Company, New York. pp. 351, 1022.
11. McHenry, R. (1992) Saponins. In: The New Encyclopedia Britannica, Micropaedia, Vol 10. Encyclopaedia Britanica Inc., Chicago. p. 442.
12. Miller, A.L. (1996) Antioxidant Flavonoids: Structure, function and clinical usage. Alternative Medicine Review 1 (2): 103 -111.
13. Mozingo, H.N. (1989) Palm In: Holland N.T. (Ed). The Encyclopaedia Americana, International edition, Vol 21. Grolier Incorporated, Danbury, Connecticut. pp. 319- 321.
14. Nigerian Institute for Oil Palm Research, NIFOR (1985). Oil Palm. In: Highlights of Activities and Achievement. Extension and Research Liaison Services Division, NIFOR, Benin City, Nigeria. pp 1 – 17.
15. Njoku, P.C., Egbukole, M.O. and Enenebeaku, C.K. (2010). Physio-chemical characteristics and dietary metal levels of oil from Elaeis guineensis species. Pakistan Journal of Nutrition 9 (2): 137-140.
16. Norris, F.A. (1995). Fats and Fatty Acids. In: Kirk-Othmer Encyclopaedia of Chemical Technology, Vol. 8 John Wiley, New York, pp. 770-881.
17. Okeke, L.P. (1987) Oil palm, In: Tropical Tree Crops Woye and Sons Ltd., Ilorin, Nigeria. pp. 251-271.
18. Onwudinjo, E.C.U. (2010) Coping with challenges of Nigeria Oil palm industry in the 21st Century. Proceeding of International Conference of Engineering Research and Development 1 (2): 18-25.
19. Oweyele, V.B., Oloriegbe, Y.Y. and Osoladoye, A. (2005) Analgesic and antiinflammatory properties of Nelsonia canescens leaf extract. J. Ethnopharmacology 99:153- 156.
20. Plummer, D.T. (1987) Quantitative analysis of lipids. In: An Introduction to Practical Biochemistry, 3rd edition. McGraw-Hill Book Company (UK) Ltd., England. pp 195-197.
21. Umerie, S.C., Ogbuagu, A.S. and Ogbuagu, J.O. (2004) Stabilization of Palm Oils by using Ficus exasperata leaves in local processing methods, Bioresource Technology 94: 307-310.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesTHE EFFECTS OF DEFICIT IRRIGATION ON THE GROWTH AND YIELD OF ONION
English1118J. D. Owusu-SekyereEnglish Samuel A. ManuEnglishThis study was conducted to determine the effects of deficit irrigation on the growth and yield of onion plants under a rain shelter. The completely randomized design was used with four treatment and three replications. The irrigation treatments imposed were application of 100% crop water requirement (ETc) – T1, 80% ETc -T2, 60% ETc -T3and 40% ETc -T4. Growth parameters determined were bulb size and bulb weight. Uptake of nutrients, NPK, was also considered. The results showed that for both bulb size and weight, growth was in the order T2>T1>T3>T4. No clear pattern was observed in terms of nutrient utilization. It can be concluded from this study that reduction in the daily water requirement by 20% for onion plant will lead to greater yield.
Englishonion, water levels, deficit irrigation, growth, yieldINTRODUCTION
According to Kemp (1996), in Mediterranean countries, ?the world bank argues that the allocation of water to agriculture, which accounts for about 90% of regional water use no longer makes economic sense. In Morocco, for example, it is estimated that the value added by a cubic meter of water in irrigated agriculture is mere 15 cents; used in industry is a striking $25. In Jordan, which uses highly efficient drip irrigation for over half of its irrigated agriculture, the equivalent figures are 30 cents for agriculture and $15 for industry.? Therefore, there is an urgent need to maximize crop yields under conditions of limited water supply. Kang et al (2001) have shown that regulated deficit irrigation at certain periods during maize growth saved water while maintaining yield. Onion (Allium cepa L.) is one of the oldest vegetables known to man and a major vegetable crop in West Africa (Norman,1992). It is originated from the regions covering the Near East and Central Asia. It was introduced to Ghana from Burkina Faso and Northern Nigeria. According to Adomako (2007), the popular cultivar, Bawku Red was introduced into Ghana around 1930 and first grown in Bugri, near Bawku. In 1995, onion and shallot production in the country was 29,000 tonnes covering an area of 1,970 hectares (Vordzeorgbe, 1997). Present world production is about 46.7 million tonnes of bulbs from 2.7 million hectares (FAOSTAT, 2001). One major setback in vegetable production in Ghana, that is, onion and leafy vegetables, is the inability of farmers to determine correct amount of water required by the crop and adoption to the necessary irrigation practices during the growing season so as to maximize profit (Owusu-Sekyere, 2010). This usually results in water stress which directly affects crop growth and yield. Deficit irrigation is a practice of reducing the amount of water supplied to a crop or reducing the frequency of application and this could be one of the best tools to use to ensure optimum yield in times of drought. According to Kirda et al. (2002), deficit irrigation is a strategy that allows a crop to sustain some degree of water deficit in order to reduce costs and potentially increase income. It can lead to increase net income where water costs are high or where water supplies are limited. As a result of this, the study was conducted to determine the effects of applying different levels of water on the growth and yield of onion plants.
MATERIALS AND METHOD
Study Area
The study area was the School of Agriculture Teaching and Research Farm at the University of Cape Coast. Cape Coast Vegetation cover is made up of shrub. The soil type as classified by Asamoah (1973) is a sandy clayey loam of the Benya series, which is a member of the Edina Benya-Udu association. The study area experiences two rainy seasons namely the major season which starts from May and end in July and a minor season that starts around September and ends around mid November to give to the dry Harmattan season that runs through the end of March in the subsequent year. Mean annual temperature range for the day is 30 0 C-34 0 C and that of the night is 22 0 C-24 0 C with relative humidity between 75%-79%.
Experimental design and field layout
The Randomized Complete Block Design was used, with four treatments (T1-T4) and three replications, (R1-R3). Forty-eight (48) poly-bags were filled with sandy loam soil from the experimental site weighed on a scale to a weight of five (5) kilograms each after which they were placed under rain shelter where the research took place and replicated (100%-T1, 80%-T2, 60%-T3, 40%-T4). Six (6) boxes each measuring 1.0m x 0.95m giving a total area of 5.7m 2 divided into three (3) replications with each containing twelve (12) nursery bags were used. Planting Seeds of Red Creole were nursed on 20th October, 2009 and transplanted on 23rd November, 2009. The seedlings were hardened-off a weak before transplanting. Before transplanting, both nursery beds and all forty-eight poly bags were watered to make the seedlings able to withstand field conditions. The transplants were given equal amount of water 200ml each for seven days to ensure uniform recovery of all the transplants. The initial plant height at transplanting time was about 15cm.
Irrigation regime
An irrigation interval of two days was adopted and the amount of water to be applied each two-day interval was derived from the computed loss in weight of each set up over the two days. The equivalent in volume basis was found and applied to the plants as the various treatments demanded. The developmental , mid-season and late season stages lasted for 25days (23rd November – 17th December, 2009), 70days (17th December – 24th February, 2010) and 20days (24th February –16th March, 2010) respectively.
Treatments
The plants were subjected to different amounts of water after determining the crop water requirement per day. There were four (4) treatments (T1-T4) and three replications (R1-R3). There were 12 plants in all for each treatment represented by 4 plants for each replication. A total of 48 plants were considered. The amount of water to be applied for each growth stage was calculated using the following formulae:
Etc = Kc x ETo................................(1)
Where:
ETc = Crop Evapotranspiration
ETo = Reference
crop Evapotranspiration and
Kc = Crop co-efficient
Reference crop Evapotranspiration was also calculated or computed the formula (Allen et al. 1998)
ETo = Ep x Kp........................................ (2)
Where:
Ep = Pan Evaporation, that is depth of water lost from the evaporation pan
Kp = Pan co-efficient which is 0.7 (Allen et al., 1998).
ETc (2days) = Loss in weight of poly bags
ETc for a growth stage = 2 days
ETc x Growth period
Soil analysis
Soil samples were taken from nursery bags and were thoroughly mixed together. The samples were divided into four and two opposite quadrants were taken out. This was repeated and each time, another opposite quadrants was taken off until a substantial amount was obtained. The sample was then dried for four days after which it was grounded and then analyzed for the amount of nitrogen, phosphorous and potassium as well as moisture content and bulk density. This was done for the three growth stages considered. Other data collected a. Plant height: four plants were selected from each treatment replication and the heights were measured using a rule. b. Mean bulb weight: the number of bulbs per treatment was assembled and weighed using the electronic balance. The mean weight of each treatment plot was then computed by dividing the total weight by four. c. Mean bulb size: four bulbs of different sizes from each of the selected plants were assembled and transversely measured using a veneer caliper. The length across each of the selected bulbs was summed up and the mean bulb size was determined.
RESULTS AND DISCUSSION
The onion plants had a remarkable good start at the initial stage at the nursery for the first 35 days. At this stage, the difference in the parameters considered was not evident especially the plant height. However, the difference became evident as the plant entered the developmental, mid-season stage and the late-season stage. The plants had significant differences in the heights especially between control, T1 (100%) and T4 (40%) of the crop water requirement.Plants under T4 showed sign of dryness and wilting eventually leading to death unlike the counterpart T1which showed lavish growth and turgid tissues.
Comparing the mean plant heights at 5% probability level, there were highly significant difference between the various treatments at the developmental stage 25 DAT with T1 and T2 having closer values of 48.6cm and 46.1cm respectively, with T1 having the highest height followed by T2. There exists highly significant difference between T3 and T4 with T4 recording the lowest height among the four treatments at 39cm. At the mid-season stage 70 DAT; there was no significant difference between the plant heightsfor T1 and T2. However, there were significant differences between T1, T3 and T4. T4 recorded the lowest height at 58.1cm which is not significantly different from T3 of plant height 59.7cm. At the late season stage20 DAT; no significant difference existed among the imposed treatments (T1-T4) even though their mean plant height recorded was T1 60.9cm, T2 60.6cm, T3 58.9cm and T4 56.9cm. The highest plant height obtained from the imposed treatment T1 confirms William et al.(1991) studies that plant height increases with increasing amounts of water application. The significant difference in plant heights attained by T1 and T4 for the various growth stages indicates the importance of water to plants.
Also, the significant difference in plant heights among treatments may be due to the increased water use at the latter growth stages of the plants (Allen et al., 1998). The plant grows with increasing water use since leaf area, vegetative biomass, rate of respiration and root development and dispersion increases. Therefore it was very vital to make amends in order not for the plants to reduce or halt its metabolism rates. On the contrary, if this was not done, the rate of growth and development would have drastically be decreased, if the availability of soil moisture becomes a limiting factor then the extent of transpiration is expected to decrease as a physiological mechanism to sustain the plant in times of low moisture and subsequently decrease in growth and development. This however could be the reason for treatment four (T4) showing reduced vegetative growth.
Mean bulb size
Several investigations have reported on the sensitivity of onion growth and yield to water stress ( Shock, 1999, and Goltz, 1971). Results obtained for the mean fruit sizes indicate significant differences among the treatments. However, there were no significant difference between T2 which recorded 51.9mm and T1 which recorded 51.1mm but significantly different from T3 and T4. These results seemed to be in disagreement with those reported by several investigators (Rana and Sharma, 1994) since T2 rather had a higher bulb size than T1. The total yield response to high amounts of total water application could be attributed to the enhancing effects of water to crop‘s biological functions and growth in addition to the improving effects of water on nutrients availability. Mean bulb weight The mean bulb weights obtained for the treatments imposed indicates significant difference among them. T2 had the highest bulb weight of 53.2g which was significantly different from that of T1, T3 and T4 with 50.3g, 48.4g and 36.9g mean bulb weight respectively. According to Shock et al. (1999), increase in total yield, marketable yield and profit of onion are obtained with increasing frequency of irrigation. However, the use of T2 rather resulted in higher bulb weight than T1 treatment imposed.
NPK levels
Soil NPK levels for the developmental, midseason as well as the late season are shown in Figures 1, 2 and 3. The uptake of nutrients such as nitrogen, phosphorus and potassium by plants are influenced by the amount of water available in the soil. Shapiro et al. (1956) indicated that translocation of phosphorus increases when there is improvement in aeration. The results obtained from the study indicates that T3 utilized the most N, where as T2 the most P. With regards to K, utilization was greatest under T3.
CONCLUSION
Results realized from the study have shown that water plays a very important role in the growth and yield of onion plants. Reduced water levels have a relatively detrimental effect on the development, yield and plant survival depending on the extent and magnitude of the water deficit. The study has also shown that reducing the daily water requirement by 20% will rather have remarkable yield even higher than the 100% daily crop water requirements. Thus a deliberate reduction in crop water requirement as a way of saving cost on irrigation should greatly be encouraged.
ACKNOWLEDGEMENT
We are most grateful to the Department of Agricultural Engineering, School of Agriculture, (University of Cape Coast) for their financial support. We also sincerely appreciate Mr. J. Dadzie, Mr. K. Conduah and Mr. Stephen Adu for their assistance during the experiments. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors /publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1707http://ijcrr.com/article_html.php?did=17071. Allen, G. R., Pereira, S. L., Raes, D. & Smith, M. (1998). Crop Evapotranspiration. Guidelines for computing crop water requirement FAO Irrigation and drainage paper 56, Rome.
2. Asamoah, G. K. (1973). Soils of the proposed farm site of the University of Cape Coast. Soil Research Institute (C.S.I.R) Technical Report No.88.
3. Goltz, S.M., Tanner, C.B., Millar, A.A. and Lang, A.R.G. (1971). Water Balance of a Seed Onion Field. .Agron. J. 63, 762-765.
4. Kang S., Zhang L., Hu X., Li Z. and Jerie P. (2001. An improved Water Use Efficiency for Hot Pepper grown under controlled alternate drip irrigation on partial roots. Scientia Horticulture. 89: 257-267.
5. Kemp, P. (1996). New war of words over scarce water. Middle East Economic Digest 49: 2-7.
6. Kirda C., Moutonnet P., Hera C. and Nielsen D.R. (2002). Crop yield response to deficit irrigation. Dordrecht, the Netherlands, Kluwer Academic Publishers.
7. Norman, J. C. (1992). Tropical vegetable crops. Devon: Arthur Stockwell Ltd.
8. Owusu-Sekyere, J. D., Asante, P.and OseiBonsu, P. (2010). Water Requirement, Deficit Irrigation and Crop Coefficient of Hot Pepper (Capsicum Frutescens) using Irrigation Interval of Four (4) Days. ARPN Journal of Agricultural and Biological Science. Vol. 5, No. 5,
9. Rana, D.S. and Sharma, R.P. (1994).Effect of Irrigation Regime and Nitrogen Fertilization on Bulb Yield and Water use of Onion (allium cepa L.). Ind. J. Agr. Sci. 64, No.4, 223-226.
10. Shapiro R. E., Taylor G. S. and Volk G. W. (1956). Soil Oxygen Contents and Ion Uptake by Corn. Soil Sci. Soc. Amer. Proc. 20: 193-197
11. Shock, C.C., Jensen, L.B., Hobson, J.H., Seddigh, M., Shock, B.M., Saunders, L.D. and Stieber, T.D. (1999). Improving Onion Yield Market Grade by Mechanical Straw Application to Irrigation Furrows. Hort Technology, 9, No. 2, 1-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareINMAS (INTEGRATED NEUROMUSCULAR ACUPOINT SYSTEM) AS AN ADJUNCT THERAPY FOR TREATMENT OF TRIGGER FINGER: A CASE REPORT
English1923Darshpreet KaurEnglish Nidhi BilloreEnglish Gunjan KumarEnglishIntroduction: Trigger finger is a common, underdiagnosed finger aliment, thought to be caused by inflammation and subsequent narrowing of the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger in long standing diabetic patients. Till now steroid injections or surgical management has been a main stay for the treatment. Case presentation: We present the case of an otherwise physically-adept 58-year-old Diabetic Indian serviceman, with signs and symptoms consistent with volar flexor middle finger tenosynovitis (Trigger finger) in left hand. Range limitations in all motions of the left metacarpo-phalangeal joints complicated his presentation. Methods and Measures: Physical therapy included conventional intervention with superficial heat, ultrasound, stretching and transverse friction massage directed to the second volar flexor tendon. Conventional joint mobilization techniques addressed the motion limitations of the ii- iv metacarpophalangeal joints, radiocarpal, and midcarpal joints. In addition, INMAS technique was utilised at trigger site to promote pain-free wrist and finger mobility. Patient‘s sugar levels were closely monitored throughout the treatment. Results: The described treatment regime, which involved conventional physical therapy interventions, along with INMAS aided in the early complete resolution of this patient‘s impairments and functional limitations. Conclusion: The combination of conventional physical agents, exercise, and manual therapy, and the less conventional INMAS techniques, proved successful with this patient. INMAS involving needling of SA‘s which developed due to injury or disease. INMAS involving inoculation of minute trauma into the body to restore the mechanisms of self-healing was an effective and efficient adjunct to physical therapy intervention.
EnglishSuperficial dry needling (INMAS), Trigger finger, tenosynovitisINTRODUCTION
Diabetes mellitus has reached epidemic proportions worldwide as we enter the new millennium. The World Health Organization (WHO) has commented there is ?an apparent epidemic of diabetes which is strongly related to lifestyle and economic change‘. Over the next decade the projected number will exceed 200 million. Most will have type-2 diabetes, and all are at risk of the development of complications1 . Diabetes may affect the musculoskeletal system in a variety of ways. The metabolic perturbations in diabetes (including glycosylation of proteins; microvascular abnormalities with damage to blood vessels and nerves; and collagen accumulation in skin and periarticular structures) result in changes in the connective tissue2 . Musculoskeletal complications are most commonly seen in patients with a longstanding history of type 1 diabetes, but they are also seen in patients with type 2 diabetes4 . Some of the complications have a known direct association with diabetes, whereas others have a suggested but unproven association. Diabetic cheiroarthropathy3 , also known as diabetic stiff hand syndrome or limited joint mobility syndrome, is found in 8–50% of all patients with type 1 diabetes and is also seen in type 2 diabetic patients. The prevalence increases with duration of diabetes. Increased glycosylation of collagen in the skin and periarticular tissue, decreased collagen degradation, diabetic microangiopathy, and possibly diabetic neuropathy are thought to be some of the contributing factors. Trigger finger is a common disorder as a result of a disproportion in size between the digital flexor tendons and the A1 pulley. Several authors have noted that, in patients with diabetes mellitus, trigger finger is more common, often occurring in multiple digits. More commonly the nodule is proximal to the A-1 pulley4 , and the patient's digit is more likely to become stuck in the flexed position6 . A mismatch between the flexor tendon and the proximal pulley mechanism occurs in most cases. Several studies have demonstrated a correlation between this condition and activities that require exertion of pressure in the palm while a powerful grip is employed or that involve repetitive, forceful digital flexion (e.g., arc welding, use of heavy shears). Proximal phalangeal flexion in power-grip activities causes high annular loads at the distal edge of the A1 pulley. Hueston and Wilson have suggested that bunching of the interwoven tendon fibres causes the reactive intratendinous nodule.7 Till now corticosteroid and surgical release11 are a main stay of management of Trigger finger. However few studies have proved physiotherapy to be efficacious in prevention of reoccurrences8 .The techniques used conventionally is: superficial heat, ultrasound, stretching and transverse friction massage directed to the second volar flexor tendon. Conventional joint mobilization techniques 8 addressed the motion limitations of the ii- iv metacarpophalangeal joints, radiocarpal, and midcarpal joints and splinting11 . But unfortunately these techniques are sometimes insufficient to relieve patient‘s symptoms. This scenario demands for a deeper look into other available therapeutic options.
CASE REPORT
A 58 years old diabetic (from past 18 years) man was referred to our centre for the management tenosynovitis (Trigger finger) at volar flexor of middle finger in left hand, insidious in onset 1 month back. The patient came to us after receiving 15 sessions of conventional physiotherapy comprising of superficial heat, ultrasound, stretching and transverse friction massage directed to the second volar flexor tendon. He was also wearing a finger splint.
Physical examination revealed:
Finger stiffness, particularly at night and in the morning
A popping or clicking sensation as he moves finger
Tenderness or a bump (nodule) at the base of the middle finger
Finger catching or locking in a bent position, which suddenly pops straight
Pain in stretching fingers outwardly/ making a fist
Radiation of pain towards wrist along the line of middle phalynx
Palpation of the A1 pulley and joint play of the distal interphalangeal joint reproduced/exacerbated the reported pain.
MATERIALS AND METHODS
According to Green's classification of triggering: Grade II (active) - Demonstrable catching, but with the ability to actively extend the digit. After taking approval from BNDC review board and patient‘s written informed consent we added INMAS technique along with conventional therapy at trigger site to promote pain-free wrist and finger mobility. The INMAS techniques involved needling of the symptomatic acupoints (SA‘s) in the affected region. In the first and second session INMAS was given only at the nodule on the base of the middle finger (Fig1). In the third and the fourth session the long flexor muscle of the middle finger was also needled (Fig 2). Patient‘s sugar levels were closely monitored throughout the treatment. Patient was given 5 sittings in 3 weeks‘ time.
RESULTS
After the FIRST treatment involving INMAS, Stretching and Ultrasound, the subject had increased range of motion (ROM) however moderate pain was still present at end range. After SECOND session, there was no clicking with flexion or extension and the extension of the ii MCP was restored to full range. After the THIRD treatment, there was minimal pain upon palpation and the ROM was full without pain. The patient reported to be utilizing his stick shift handle in his car to help self-mobilize. By the FOURTH treatment, there was full pain free ROM and only minimal pain at the capsule with deep palpation, although some weakness/fatigue was becoming evident with repeated flexion. Flexor pollicis longus was rated a 4/5 (patient could hold the position against strong to moderate resistance with full range of motion). At this point the subject reported that he was able to perform all activities of daily living. At the FIFTH treatment, ROM remained full with no recurrence of pain, snapping, or clicking. There was mild weakness (4/5) present as noted in the previous visit but no palpable adhesions were present. The patient had full normal range of motion restored. The subject was given ?theraputty? and released with FINGER exercises (flexion, extension, abduction and adduction) to continue on with strengthening at home. Two months after discharge and 6 months after discharge, he was contacted over telephone and he reported no re-aggravations or further complications. His sugar levels were also under control.
DISCUSSION
Integrated Neuromuscular Acupoint System (INMAS) is a unique treatment protocol developed by Dr. Yun-tao Ma12. Acupuncture needling creates a tiny lesion and bleeding in the contractile muscle and surrounding tissues. As a result, the tight muscle relaxes immediately and blood circulation improves. Thus vicious cycle of energy crises is broken. Once the acupuncture needle becomes coupled to tissue, movements of the needle (rotation or pistoning) may send a signal through connective tissue via deformation of the extracellular matrix13. The needled lesion disturbs the surrounding tissue and generates a small electrical current up to 500 mA/cm. The importance of this effect is that pulling of collagen fibers during needle manipulation may transmit a mechanical signal, through deformation of the extracellular matrix, to cells such as fibroblasts that are abundant in connective tissue. The subsequent signal transduction events may contribute to the therapeutic effect. These observations suggest that the mechanical signal created by acupuncture needle manipulation can induce intracellular cytoskeletal rearrangements in fibroblasts and possibly in other cells present within connective tissue, such as capillary endothelial cells. Cytoskeletal reorganization in response to mechanical load signals has been shown to induce cell contraction, migration, and protein synthesis. Downstream effects of the mechanical signal generated by acupuncture needle manipulation therefore potentially include synthesis and local release of growth factors, cytokines, vasoactive substances, degradative enzymes, and structural matrix elements. Release of these substances may influence the extracellular milieu surrounding connective tissue cells. Changes in matrix composition, in turn, can further modulate signal transduction to and within the cell. In summary, the insertion and manipulation of acupuncture needles may have both local and remote therapeutic effects based on the same underlying mechanism: mechanical coupling of needle to connective tissue, winding of tissue around the needle, generation of a mechanical signal by pulling of collagen fibres during needle manipulation, and mechano-transduction of the signal into cells. Downstream effects of this mechanical signal may include cell secretion, modification of extracellular matrix, amplification and propagation of the signal along connective tissue planes, and modulation of afferent sensory input via changes in the connective tissue milieu.13 A needle induced lesion may last at least 2 days or longer before the body heals it, which means after the needles are removed; the needle-induced lesions keep working for at least 48 hours12. This lesion also triggers the local and systemic immune and anti-inflammatory reaction. Determination of this technique‘s effectiveness with a given patient required some clinical trial and error. The decision to use this technique was guided by substantial ineffectiveness of only conventional physiotherapy treatment and strong support in favour of INMAS. If the involved joints demonstrate an immediate increase in range of motion and pain reduction, then this intervention can be safely used in the patient12 . The purpose of this case report is to introduce INMAS as an adjunct intervention method for the treatment of Trigger Finger.
CONCLUSIONS
This case report serves as an initial step in a research process that would explore INMAS as a useful addition to conventional physical therapy intervention, as there is a paucity of clinical research studies that examine the efficacy of this technique. Thus far, the evidence supporting INMAS is chiefly anecdotal. As with any novel physical therapy intervention, research at all levels is necessary to prove efficacy. In this case study, one interesting conceptual question is raised: Can Superficial Dry Needling / INMAS at acute stage positively influence tendon disorders
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Competing interests The authors declare that they have no competing interests.
Englishhttp://ijcrr.com/abstract.php?article_id=1708http://ijcrr.com/article_html.php?did=17081. Assessment of Burden of Non communicable Disease in India,WHO,2004
2. Rachel Peterson Kim, MD, Steven V. Edelman, MD and Dennis D. Kim, MD. Clinical Diabetes July 2001; 19 ( 3): 132-135
3. The diabetic hand Reumatismo 2004; 56(3):139- 42
4. Schiavon F; Circhetta C; Dani L Hand manifestations of diabetes mellitus. J Hand Surg Am. 2008; 33(5):771-5
5. Ravindran Rajendran S, Bhansali A, Walia R, Dutta P, Bansal V, Shanmugasundar G. Prevalence and pattern of hand soft-tissue changes in type 2 diabetes mellitus. Diabetes Metab. 2011 Sep; 37(4):312-7.
6. Benedetti A, Noacco C, Simonutti M, Taboga C. Diabetic trigger finger. N Engl J Med 1982;306(25):1552 (Letter)
7. Hueston JT, Wilson WF. The aetiology of trigger finger explained on the basis of intratendinous architecture. Hand. Oct 1972;4(3):257-60
8. Salim N, Abdullah S, Sapuan J, Haflah NH.Outcome of corticosteroid injection versus physiotherapy in the treatment of mild trigger fingers. J Hand Surg Eur Vol. 2011 Aug 4. [Epub ahead of print]
9. Watanabe H, Hamada Y, Toshima T, Nagasawa K.Conservative treatment for trigger thumb in children. Arch Orthop Trauma Surg. 2001 Jul; 121(7):388-90.
10. Nemoto K, Nemoto T, Terada N, Amako M, Kawaguchi M. Splint therapy for trigger thumb and finger in children J Hand Surg Br. 1996 Jun; 21(3):416-8.
11. Stahl S, Kanter Y, Karnielli E.J Outcome of trigger finger treatment in diabetes. Diabetes Complications. 1997 Sep-Oct; 11(5):287-90.
12. Biomedical Acupuncture for Pain Management An Integrative Approach By Yun-tao Ma, PhD; Mila Ma, LicAc; and Zang Hee Cho, PhD 2005
13. Helene M. Langevini,David L.Churchill, Marilyn J.Cipolla. Mechanical signaling through connective tissue: a mechanism for the therapeutic effect of acupuncture. The FASEB Journal. 2001;15:2275-2282
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareSTUDY ON THE EFFECT OF UNRIPE PLANTAIN (MUSA PARADISISACA) ON PEFLOXACIN ABSORPTION IN RATS
English2428MBAH C. JEnglish UBOH K. H.EnglishThe present study was carried out to investigate the effect of unripe plantain (Musa paradisisaca) on pefloxacin absorption in rats. Pefloxacin (20mg/kg), was administered orally to three groups of albino rats
fed on standard pellet feeds, 50 % and 100 % unripe plantain respectively. Blood samples were taken at pre-application and at 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0, 10.0, 12.0 and 24.0 h post-application from retro-orbital plexus of the animal using micro-capillary technique. Ultraviolet spectrophotometric method was used to determine pefloxacin concentration in plasma samples. Feeds with 50 % and 100 % unripe plantain respectively, gave significant increase (PEnglishUnripe plantain, pefloxacin, bioavailability.INTRODUCTION
Pefloxacin, 1,4-dihydro-7-(4-methylpiperazinyl)- 4-oxo-3-quinoline carboxylic acid is a second generation fluoroquinoline antibacterial agents. Its mechanism of action like most fluoroquinolones, involves the inhibition of DNA synthesis by promoting cleavage of bacterial DNA in the DNAenzyme complexes of DNA gyrase and type iv topoisomerase, resulting in rapid bacterial death1 . Clinically, the drug is used in the treatment of various disease states such as respiratory and urinary tract infections, skin and soft tissue infections, gastrointestinal tract infections, severe systemic infections. Food can influence absorption of drugs by interfering with tablet disintegration, drug dissolution and its transport through the gastrointestinal tract. A number of studies have reported on the influence of standard meals or food components on drug absorption 2,3,4,5,6,7 . Plantain (Musa paradisisaca), ripe or unripe in various preparations serves as an important source of food to various peoples of the world. In this part of the world, ripe or unripe plantain could be served either as a sauce or eaten as roasted or boiled plantain usually with palm oil. Locally, the unripe plantain serves as: (i) good carbohydrate source for diabetic patients (ii) anti-motility agent for those suffering from gastrointestinal disorders such as diarrhoea or dysentery (iii) readily source of food for workers in offices as well as buyers and sellers in open markets. It is against the background that local patients on pefloxacin could feed on unripe plantain while in offices or markets that the present study investigated the effect of unripe plantain on pefloxacin absorption in rats. Furthermore, literature review has shown little or no study on the effect of plantain on pefloxacin absorption. MATERIALS AND METHODS Pefloxacin mesylate (Fidson Healthcare Ltd, Nigeria), carboxymethyl cellulose (Aldrich-Sigma, USA), unripe plantain (Nsukka, Nigeria) was dried in an oven at 50 o C and pulverized. All other chemicals were of analytical grade. Pharmacokinetic study: In house bred albino rats of either sex weighing between 200-250 g were used for the study. The animals were housed in polypropylene cages and allowed access to food and water. The ethical clearance was obtained from the ethics committee of the Faculty of Veterinary Medicine, University of Nigeria, Nsukka. In one group of rats (n=4) feeding on standard pellet diet (poultry growers feed), pefloxacin (20mg/kg) was administered orally. The second and third groups of rats (n=4) feeding on 50 % (standard pellet diet: unripe plantain, 1:1) and 100 % unripe plantain respectively, also received pefloxacin at the dosage level as the first group of animals. Blood samples (0.5 ml) were collected in tubes containing 1 mg of EDTA sodium through microcapillary technique from retro-orbital plexus8 under light ether anesthesia before treatment with pefloxacin and thereafter at 0.5, 1.0, 1.5, 2.0, 3.0, 4.0, 6.0, 8.0, 10.0, 12.0 and 24.0 h after oral administration of pefloxacin. Plasma samples separated by centrifugation (10 min, 3000 rev/min) were deproteinated with acetonitrile. The plasma and acetonitrile mixture was allowed to stand for 10 min before centrifuging at 5000 rev/min for 10 min. The upper layer was separated and used for the determination of pefloxacin levels. Determination of plasma pefloxacin concentrations: Ultraviolet spectrophotometric method was used to quantify pefloxacin concentrations in plasma samples. Determination of pefloxacin was performed at a maximum wavelength of 280 nm. The standard curve constructed using deproteinized plasma was linear in the range of 1.0 -10 μg/ml. Deproteinized plasma was used as the blank. Accuracy and precision: To determine the intra-day and inter-day accuracy and precision, the concentrations of pefloxacin present in five replicates of deproteinized plasma spiked with 1.0, 2.0 and 3.0 ug/ml respectively was determined within a day or on three consecutive days. Accuracy of 85-100 % and coefficient of variation values < 5 % were considered acceptable. Recovery: Recovery of pefloxacin from plasma was estimated using 1.0-5.0 µg/ml concentrations by comparing absorbance of spiked deproteinized plasma standards with those of corresponding concentration in acetonitrile. Analysis of data: The area under the plasma concentration-time curve (AUC) to the last sampling time was estimated by the linear trapezoidal method. The maximum concentration (Cmax) and maximum time (Tmax) were obtained directly from the generated data. The elimination constants (kel) and terminal half-lives (t1/2) were calculated from the log-linear part of the slope. The differences between the three respective treatment groups were analyzed for significance using student‘s ttest. P values equal to or less than 0.05 were considered significant. RESULTS AND DISCUSSION The calibration graph of pefloxacin was linear in the concentration range of 1.0-10 μg/ml. The regression equation describing the absorbance versus concentration relationship is A = 0.113C + 0.062 (r = 0.9934). The inter-day and intra-day estimation of pefloxacin reveals the reproducibility of the results (Table 1) irrespective of time and day. The recovery analysis (Table 2) shows that the solvent was effective to extract pefloxacin from the spiked plasma. The results indicate that the relative extent of bioavailability of pefloxacin in the presence of 50 % and 100 % unripe plantain respectively, was significantly (pEnglishhttp://ijcrr.com/abstract.php?article_id=1709http://ijcrr.com/article_html.php?did=17091. Hooper DC. Mode of action of fluoroquinolones. Drugs 1999, 58(2): 6-10.
2. Levine R. Factors affecting gastrointestinal absorption of drugs. Am J Digest Dis 1970, 15:171-80.
3. Welling PG. Influence of food and diet on gastrointestinal drug absorption: a review. J Pharm Biopharm 1977, 5:291-34
4. Toothhaker RD, Welling PG. The effect of food on drug bioavailability. Annu Rev Pharmacol Toxicol 1980, 20:173-99.
5. Kirk JT. Significant drug-nutrient interactions. Am. Fam. Physcian 1995, 51 (5): 1175-77.
6. Jefferson JW. Drug and Diet interactions: Avoiding therapeutic paralysis. J Clin. Psychiatry 1998, 59 (16): 3-9
7. Leibovitch ER, Deamer RL, Sanderson LA. Food-Drug interactions; careful drug selection and patient counseling can reduce the risk in older patients. Geriatrics 2004, 59:19-33.
8. Sorg DA, Buckner B. A simple method of obtaining venous blood from small laboratory animals. Proc Soc Exp Biol Med 1964, 115:1131-2.
9. Melander A. Influence of food on the bioavailability of drugs. Clin Pharmacokin 1978, 3:337-51.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesSTUDIES ON FUNGAL DECOLOURIZATION OF SYNTHETIC DYES
English2937D.SudhaEnglish R.BalagurunathanEnglishDecolourization of synthetic dyes like direct greenish blue, direct brilliant violet using Aspergillus niger and Phanerochaete Chrysosporium was carried out at a dye concentration of about 10mg/l. Asthana and Hawker‘s broth was used for decolourization study 10mg/l of two dyes were added and mixed well. After that, the flasks were inoculated with pre-grown fungal mycelial cultures. During the incubation, samples were drawn at 1, 3, 7 and 14 days and analyzed for decolourization, after centrifuging the samples at 8000-9000rpm for 15 minutes. The Supernatent was collected and absorbance was measured using Spectronic 20 at 490nm. The maximum decolourization of direct brilliant violet of about 65%,60% were achieved by Aspergillus niger and Phanerochaete Chrysosporium respectively during 14th day of incubation and the maximum decolourization of direct greenish blue about 76%,70% were achieved by Aspergillus niger and Phanerochaete Chrysosporium respectively during 14th day of incubation. The maximum percentage of degradation of direct brilliant violet was 65% and direct greenish blue was 76% obtained from Aspergillus niger. In order to treat the dyes more effectively, microorganism capable of degrading the toxic compound present in the textile dyes will be used on a large scale and will be introduced into effluent treatment plants for Bioremediation. Keywords: Fungal isolates, Synthetic dyes, Decolourization, Aspergillus niger and Phanerochaete Chrysosporium. ______________
EnglishFungal isolates, Synthetic dyes, Decolourization, Aspergillus niger and Phanerochaete Chrysosporium.INTRODUCTION
Azo dyes are the largest group of dyes used in industry (Ramalho, et al., 2002; Mane, et al., 2008) representing more than half of the annual production (Stolz, 2001). Technological advance has seen an increase in diversity and complexity of synthesized textile dyes with the objective of product improvement through enhancement of dye properties such as resistance to fading, improved delivery of dyes to fabrics and increased variety of shades. This increase in diversity and complexity of dyes is coupled with higher resistance to environmental degradation leading to pollution problems by textile effluent. A larger proportion of these azo dyes which can pass through normal water treatment procedures (Stolz, 2001; Pearce, et al., 2003; Pandey, et al., 2007; Chamunorwa Aloius Togo, 2008) resulting in aesthetically unappealing water. Due to the fungal oxidative mechanisms, it is possible to avoid the formation of hazardous anilines, formed by reductive cleavage of the azo dyes. Compared to other fungal oxidative enzymes, laccases can act oxidatively, non specifically at the aromatic rings and has the potential to degrade a wide range of compounds. Laccases (benzenediol: oxygen oxidoreductase, EC 1.10.3.2) are multicopper containing enzymes that catalyze the oxidation of a variety of phenolic and inorganic compounds, with the concomitant reduction of oxygen to water. Due to their wide substrate specificity, laccases have gained much attention over the last number of years in many industrial and environmental fields (Fernandes et al., 2008; Moldes et al., 2008; Sadhasivam et al., 2009). Enzymatic processes have various advantages over conventional, biological, physical, and chemical treatment processes including selective removal of particular pollutants, application to xenobiotic recalcitrant compounds, high reaction rate and reduction in sludge volume (Sadhasivam, 2007). In recent years, dye decolorization by laccases has received a significant attraction by various researchers (Domi‘nguez et al., 2005; Moldes and Sanroman, 2006). Adequate treatment of textile effluent requires more than one stage as there is need for both colour removal and degradation of aromatic compounds from the decolourization process. Physico-chemical treatment methods are the least desirable owing to their high costs and generation of secondary pollutants. On the other hand, biological treatment methods are attractive due to their cost effectiveness, diverse metabolic pathways and versatility of microorganisms (Singh, et al., 2004; Van de Zee and Villaverde, 2005).
MATERIALS AND METHODS
Dyes and soil sample collection Dyes used in the experiments were purchased from Infra-Tex dye industry, Perunthurai, in Tirupur and were of the highest purity. The soil sample was collected from dye contaminated area nearby textile industry situated in Perunthurai (Erode District), Tamilnadu, India.
Decolourization media
Asthana Hawker‘s broth (Laxminarayana, et al., 2010) was composed of (5 gm glucose, 3.5 g KNO3 1.75 g KH2PO4, 0.75 g MgSO4 7H2O and I L distilled water) was prepared and added with 10mg dye the medium was sterilized at 121°C for 20 minutes and used for the cultivation of mycelia and for decolorization experiments.
Isolation techniques
The soil sample was serially diluted in sterile physiological saline and was transformed to sabouraud‘s dextrose agar. The plates were incubated at room temperature for 3 days. After incubation the plates were noted for the presence of fungal colonies (Cappucino Sherman, 2007).
Identification of fungal isolates- lacto phenol cotton blue staining- tease mount preparation
A drop of lacto phenol cotton blue was placed on a clean glass microscopic slide. With a straight wire slightly bended at the tip, a small portion of the colony was removed and placed it in the drop of LPCB. With the help of another straight wire (or) needle the fungal culture tint was teased into small bits and spread in LPCB. Cover slip was placed and pressure was gently applied over the agar bits to spread evenly. After giving sufficient time for the structure to take up the stain, the slide was examined using microscope under 10x, 45x objectives to examine the fungal morphology. Based on morphological and cultural characteristics, the isolated fungal cultures were identified as Aspergillus niger, Phanerochaete chrysosporium (Cappucino Sherman, 2007).
Decolourization
Asthana and Hawker‘s broth was used for decolourization study 20ml broth was taken in 100ml Erlenmeyer flask and sterilized. Then 10mg/l (Dilek Asma, et al., 2006) of direct brilliant violet and direct greenish blue were added and mixed well. After that, the flasks were inoculated with pre-grown fungal mycelial cultures.
During the incubation, samples were drawn at 1, 3, 7 and 14 days and analyzed for decolourization, after centrifuging the samples at 8000-9000rpm for 15 minutes. The supernatant was collected and absorbance was measured using spectronic 20 at 490nm. The percentage of decolourization was calculated using the formula given below Decolourizing activity was expressed in terms of percent decolourization (Yatome et al., 1993).
Scanning of dyes for its absorbance maximum
The maximum absorbance of the dyes was scanned using spectronic 20 from 490nm. The dyes direct brilliant violet and direct greenish blue, gave a maximum absorbance at 490nm (Soeprijanto et al., 2002) respectively and the samples were analyzed at their respective absorbance throughout the study.
Biomass Estimation
The fungal biomass (pellets) produced was filtered out from the liquid medium by using Whatman filter paper No. 1. It was washed twice with deionized water before application in the experiments. The fungal biomass dried at 110?C for 5 hrs in hot air oven and the dry weight was measured (Ashu – Augustine, et al., 2006). p H of the medium p H of the supernatant was measured using the pH meter during initial stage and 1, 3, 7 and 14 days of incubation in the case of commercial dyes.
RESULTS
The decolourization studies carried out with fungal isolates from the dye effluent Based on morphological and cultural characteristics, the isolated fungal cultures were identified as Aspergillus niger, Phanerochaete chrysosporium (table-1). The results shows that Aspergillus niger performed best when compared to Phanerochaete chrysosporium (tables 2, 3 and figures 1, 2). The synthetic dyes removal was tested using two approaches. The first one was based on the biomass formation the second one was based on p H . Samples were withdrawn at different intervals after dye amendment until 14th day of incubation to determine the dye bio removal and growth media pH changes. The results showed that Aspergillus niger strain gave good efficiency in the removal of direct brilliant violet in 14th day of incubation, where the decolourization reached to 76% (figure). The same fungal strain gave 65% percentage of decolourization in direct greenish blue at 14th day of incubation. Another fungal isolute Phanerochaete chrysosporium gave 70% in direct greenish blue than the direct brilliant violet (60%), on 14th day of incubation. In, the second approach the dye removal in the pH 3.0 – 6.0 showed biomass production of maximmum 0.9g / 20ml by Aspergillus niger at pH 3.0, and 0.8 g / 20 ml by Phanerochaete chrysosporium at pH 5.0. Fungal growth did not occur at pH 2 and 9.
DISCUSSION
Direct greenish blue resulted with maximum decolourization of about 76% in Aspergillus niger 70% in Phaenerochaete chrysosporium. As the decolourization was proceded, the concentration of the dye decreased in terms of its absorbance value at the initial stage, dye decolourization was probably due to the absorption of dye to the mycelium (Cripps, et al., 1990). Likewise, few other studies have also clearly mentioned biosorption/ bioadsorption of certain brown rot Fungi Aspergillus niger, Aspergillus foetidus (Ali, et al., 2007). The primary dyes removal phenomenon coupled with electrostatic pull between the positively charged cell wall and negatively charge dyes (Aksu et al., 1999; Aksu and Tezer, 2000). In this work, the use of Aspergillus niger to remove direct dyes commonly used in textile industry revealed that this fungal culture was capable to remove dyes in short time from the media. This interaction could be based on a biosorption of dyes on the intact fungal biomass; this is in harmony with Juliana and Thuy, 2002. Brilliant green is much more decolorized by Phanerochaete chrysosporium than the structurally similar crystal violet (Paszczynski, A and Crawford, R.L, 1991). Presumably, these differences are duepartly to electron distribution and charge density, although steric factors may also contribute. There appears to have been only one systematic study relating dye structure to degradation by a white rot fungus (Phanerochaete chrysosporium). Pasti-Grigsby, et al (1992) showed that the nature and position of substituents on one of the aromatic rings of azo dyes can markedly influence decolorization, although a simple, clearpattern was not established. In the present study Phanerochaete chrysosporium showed lesser activity when compared Aspergillus niger. Among the two fungal strains tested we found strain, Aspergillus niger which had better potential for the dye decolourization than strain Phanerochaete chrysosporium. White-rot fungi were the fastest decolourizers, but additionally we found very effective decolourizers among brown-rot fungi. The decrease of pH at the end of these experiments may be referred to the excretion of the organic acid by the fungus itself (Abdel – Aal et al., 2001 and Naima et al., 2007). In the present study we also found that the decrease in pH at the end of experiment. Considering the above result we assumed that dye was probably associatd with fungal growth and hyphal uptake mechanism (biosorption / bioadsorption). Textile industries discharge colored dyes and toxic compound in to the environment. Physicochemical methods that are have operation problem and do not provide satisfactory results. But biological treatment methods are cheap and offer the best alternative with proper analysis and environmental control. In order to treat the dyes more effectively, Fungal isolates capable of specifically degrading the toxic compound present in the textile dyes are cultured on a large scale and introduced into effluent treatment plants.
CONCLUSION
The present study reveals that the fungal culture can be used successfully for decolourizing direct brilliant violet and direct greenish blue. 80% of the decolourization of the above dyes were achieved by Aspergillus niger. On the basis of the result of the present study suitable strategy can be developed for the treatment of waste water contaminated with dye. These biological methods can be promoted to degrade the variety of dyes from the textile industries. The treated textile dyes when disposed to the land it has several applications. *improves soil fertility. *very little quantity of bioearth, compost is sufficient for crops and thus input and transport cost could be reduced. *Humus rich, very slow release of nutrient which is essential for growth. *Increases water holding capacity of the soil.
ACKNOWLEDGEMENT
The authors express genuine thanks to the ViceChancellor and the Registrar, Periyar University, Salem, for providing research facilities. Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1710http://ijcrr.com/article_html.php?did=17101. Abdel – Aal S E, Dessouki A M, Gad Y H. Removal of some dyes from industrial effluents by polymeric materials 7 gamma – irradiation. Journal of Radioanalytical and Nuclear Chemistry 2001; 247 (2): 399 – 405.
2. Aksu Z, Calik A, Dursun AY, Demircans Z. Biosorption of iron (III)-cyanide complex anions to Rhizopus arrhizus: application of adsorption isotherms. Process Biochem 1999; 34: 483-491.
3. Aksu Z, Tezer S. Equilibrium and kinetic modelling of biosorption of Remazol Black B by Rhizopus arrhizus in a batch system: effect of temperature. Process Biochem 2000;36: 431-439.
4. Ali N, Hameed A, Ahmed S, Khan AG. Decolorization of structurally different textile dyes by Aspergillus niger SA1. World J.Microbiol. Biotechnol 2007; 24: 1067-1072.
5. Ashu – Augustine, Imelda – Joseph and Paul Raj R. Biomass estimation of Aspergillus niger s14 a mangrove fungal isolate and Aspergillus Oryzae NCIM 1212in solid state fermentation, J. Mar. Biol. Ass. India 2006; 48 (2): 139-146.
6. Cappucino Sherman. Microbiology a Laboratery Manual (Seventh edition) (1st impression), Dorling Kindersley (India) Pvt Ltd 2007; 239 -242.
7. Chamunorwa Aloius Togo, Cecil Clifford Zvandada Mutambanengwe and Christopher George Whiteley. Decolourization and degradation of textile dyes using a sulphate reducing bacteria (SRB) – biodigester microflora co-culture. African Journal of Biotechnology 2008; 7 (2): 114-121.
8. Cripps C, Bumps JA and Aust D. Biodegradation of azo and heterocyclic dyes by Phanerochaete chrysosporium. Appl.Environ.Microbiol 1990; 56: 1114-1118.
9. Dilek Asma, Sibel Kahraman, Seval Cing and Ozfer Yesilada. Adsorptive removal of textile dyes from aqueous solutions of dead fungal biomass. Journal of Basic Microbiol 2006; 46(1): 3-9.
10. Dom?‘nguez A, Rodr?‘guez Couto S, Sanroman MA. Dye decolorization by Trametes hirsuta immobilized into alginate beads. World J Microbiol Biotechnol 2005; 21: 405–409.
11. Fernandes SC, Oliveira IRWZ, Fatibello-Filho O, Spinelli A, Vieira IC. Biosensor based on laccase immobilized on microspheres of chitosan crosslinked with tripolyphosphate. Sens Actuators B Chem 2008; 133: 202–207.
12. Juliana, A.R and Thuy N. Decolourization of textile dyes Trametes versicolor and its effect on dye toxicity. Biotechnology Letters 2002; 24: 1757-1761.
13. Laxminarayana E, Thirumala Chary M, Randheer Kumar M and Singara Charya M. A Decolourization and biodegradation of sulphonated azo dyes by fungi to clean dye contaminated soil environments, Journal of Natural and Environment Sciences 2010; 1(1): 35-42.
14. Mane, U. V., Gurav, P. N., Deshmukh, A. M., Govindwar, S. P.. Degradation of textile dye reactive navy – blue Rx (Reactive blue–59) by an isolated actinomycete Streptomyces krainskii SUK – 5, Malaysian Journal of Microbiology 2008; 4(2): 1-5.
15. Moldes D, D?´az M, Tzanov T, Vidal T. Comparative study of the efficiency of synthetic and natural mediators in laccase assisted bleaching of eucalyptus kraft pulp. Bioresour Technol 2008: 99:7959–7965.
16. Moldes D, Sanroman MA. Amelioration of the ability to decolorize dyes by laccase: relationship between redox mediators and laccase isoenzymes in Trametes versicolor. World J Microbiol Biotechnol 2006; 22:1197– 1204.
17. Naima C, Delia – Laura P, Douglas A M, Arani C, Deiter L, Alexander D R, Karl Werner S and Terrence J C. Fe111 – TAML – catalyzed green oxidative degradation of the azo dye orange II by H2O2 and organic peroxides: products, toxicity, kinetics and mechanism. Green Chem 2007, 9: 49 –57.
18. Pandey A, Singh P, Iyengar L. Bacterial decolourization and degradation of azo dyes. Int. Biodeterior. Biodegrad. 2007; 59: 73-84.
19. Paszczynski, A. and Crawford, R. L. Degradation of azo compounds by ligninase from Phanerochaete chrysosporium: Involvement of veratryl alcohol. Biochem. Biophys. Res. Commun., 1991; 178: 1056- 1063.
20. Pasti-Grigsby, M. B., Paszczynski, A., Goszczynski, S., Crawford,D. L. and Crawford, R. L. Influence of aromatic substitution patterns on azo dye degradability by Streptomyces spp. and Phanerochaete chrysosporium. Appl. Environ. Microbial 1992; 58: 3605-3613.
21. Pearce CI, Lloyd JR, Guthrie JT. The removal of colour from textile waste water using whole bacterial cells: a review. Dyes Pigm. 2003; 58: 179-196.
22. Ramalho, P. A., Scholze, H., Cardoso, M. H. Ramalho, M. T. Oliverira and Campos, A. M. Improved conditions for the aerobic reductive decolourization of azo dyes by Candida zeylamoides, Enzyme and Microbial Technology 2002; 7: 402 – 412.
23. Sadhasivam S. Production, characterization and application of laccase from the ascomycetous fungus Trichoderma harzianum and utilization of biomass produced as biosorbent for colour removal, Ph.D., thesis 2007, Department of Biotechnology, Bharathiar University, Coimbatore, India.
24. Sadhasivam S, Savitha S, Swaminathan K. Redox-mediated decolorization of recalcitrant textile dyes by Trichoderma harzianum WL1 laccase, World J Microbiol Biotechnol 2009; 25:1733–1741.
25. Singh P, Mishra LC, Iyengar L. Biodegradation of 4- aminobenzene sulphonate by newly isolated bacterial strain PNS-1. World J. Microbiol. Biotechnol. 2004; 20: 845-849.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesISOLATION AND IDENTIFICATION OF STAPHYLOCOCCUS SAPROPHYTICUS FROM URINE SAMPLES COLLECTED FROM SEXUALLY ACTIVE YOUNG WOMEN SUFFERING FROM SYMPTOMATIC URINARY TRACT INFECTION
English3844R.Sarath babuEnglish T.V.RamaniEnglish G.IndiraEnglishStaphylococcus saprophyticus may be present on normal human skin and the periurethral area and can
cause urinary tract infection, particularly in sexually active young women. In the present study, an attempt
has been made to isolate, identify and to know the antibiotic sensitivity pattern of Staphylococcus saprophyticus from urine samples collected from the same group. In the present study, a total number of
100 urine samples were collected from sexually active young women 15-40yrs of age attending the Gynaecology outpatients department, MIMS General hospital. Out of 100 samples, 88 were culture positive and 12 samples showed no growth. Out of 88 culture positive cases, 18 (20.45%) samples were
positive for Staphylococcus saprophyticus. All the 18
Staphylococcus saprophyticus strains were identified by their
colony morphology, biochemical tests and were subjected to antibiotic sensitivity testing by modified Kirby-bauer disc diffusion method. All the Staphylococcus saprophyticus strains isolated(n=18) were 100% sensitive to Vancomycin, 55.56% to Oxacillin and Ciprofloxacin, 50% to Gentamicin and 38.89% to Tetracycline. The resistance pattern showed by the above strains isolated was 100% to Penicillin, 61.11% to Tetracycline, 50% to Gentamicin, 44.44% to Oxacillin and Ciprofloxacin respectively. In the present study, Staphylococcus saprophyticus is the second most common organism isolated from sexually active young women suffering from symptomatic urinary tract infection which coincided with several other authors who reported the same in their studies. The present study also reveals the need to report Staphylococcus saprophyticus as a pathogen when isolated from sexually active young female outpatients suffering from symptomatic urinary tract infection.
EnglishINTRODUCTION
Coagulase negative staphylococci constitute a major component of the normal flora of the human body. In the past, coagulase negative staphylococci were generally considered to be contaminants having little significance. Over the past four decades, these organisms have been recognized as important agents of human disease. Staphylococcus saprophyticus may be present on the normal skin and the periurethral area and can cause urinary tract infection, particularly in sexually active young women. Staphylococcus saprophyticus is uniquely associated with uncomplicated urinary tract infection in humans. Staphylococcus saprophyticus is second only to Escherichia coli as the most frequent causative organism of uncomplicated urinary tract infection in women.
The more severe complications include acute pyelonephritis, septicaemia, nephrolithiasis and endocarditis. The vast majority of infections occur in young sexually active women. Common symptoms of inflammation of the lower urinary tract, such as haematuria and pyuria, were seen more often among patients with colonization of Staphylococcus saprophyticus.
Aim of the present study
1. To isolate and identify Staphylococcus saprophyticus from urine samples collected from sexually active young women(15-40yrs of age) suffering from symptomatic urinary tract infection.
2. To know the antibiotic sensitivity pattern of the Staphylococcus saprophyticus strains isolated.
MATERIALS AND METHODS
A total number of 100 urine samples were collected from sexually active young women(15- 40yrs of age) attending the Gynaecology outpatients department , MIMS General hospital, Nellimarla, Vizianagaram.
Inclusion criteria
1.Young women(15-40yrs of age) with symptomatic urinary tract infection, attending the Gynaecology outpatients department.
2.Fever, increased frequency of micturition, dysuria and pain in the lower abdomen were the main symptoms observed in the patients of above age group.
Exclusion criteria
1. Pregnant mothers and hospitalised women of 15-40yrs of age.
All the samples were inoculated on blood agar and macconkey agar and the plates were incubated overnight at 37ºC. Staphylococcus saprophyticus strains were identified by their 1.Colony morphology.
2.Negative Coagulase test.
3.Gram stain.
4.Novobiocin resistance.
5.Negative phosphatase test.
6.Inability to ferment mannitol.
7.Production of urease.
All the S.saprophyticus strains identified were subjected to antibiotic sensitivity testing by modified Kirby-Bauer disc diffusion method.
The following antibiotics were used bearing the concentrations
1.Penicillin G – 10units / disc.
2.Gentamicin – 10mcg.
3.Vancomycin – 30mcg.
4.Ciprofloxacin – 5mcg.
5.Tetracycline – 30mcg.
All the strains(n=18) of S.saprophyticus isolated were screened for
1. Oxacillin sensitivity on Mueller-Hinton agar with 4% Nacl.
2. Novobiocin resistance on blood agar.
DISCUSSION
Among the coagulase negative staphylococci, Staphylococcus saprophyticus is a true urinary pathogen, causing both upper and lower urinary tract infections, primarily in young women. -Present study coincides with studies by several other authors who reported this organism to be the second most common cause of urinary tract infections after Escherichia coli in young female out patients.
-Urinary tract infections due to Staphylococcus epidermidis and other coagulase negative staphylococci were reported to be usually associated with catheterisation and occur in elderly patients with prior instrumentation of urinary tract or surgery like renal transplantation, urolithiasis or other urological abnormalities. -Several potential virulence factors of Staphylococcus saprophyticus have been examined in recent years. -Invitro studies on the adherence of this species to various cell types have been shown that Staphylococcus saprophyticus adheres to uroepithelial, urethral and periurethral cells in greater numbers than other staphylococci, and does not adhere to other cell types, including skin and buccal mucosal cells. -This uroepithelial tissue tropism may explain the high frequency of urinary tract infections caused by this organism. -In the present study, out of ?88? culture positive samples, ?18?(20.45%) were positive for Staphylococcus saprophyticus. -Out of all the Staphylococcus saprophyticus strains isolated, 100% sensitivity was observed to Vancomycin, followed by 10(55.56%) to Oxacillin, 10(55.56%) to Ciprofloxacin, 09(50%) to Gentamicin and 07(38.89%) to Tetracycline. -All the Staphylococcus saprophyticus strains(n=18) isolated were resistant to Penicillin G(100%), followed by 11 ( 61.11% ) to Tetracycline, 09(50%) to Gentamicin, 08(44.44%) to Oxacillin and 08(44.44%) to Ciprofloxacin. CONCLUSION -Present study coincides with several other studies reporting Staphylococcus saprophyticus (20.45%) as the second most common organism in causing symptomatic urinary tract infection in sexually active young female outpatients. -Among the coagulase negative staphylococci, Staphylococcus saprophyticus is a true urinary tract pathogen, causing both upper and lower urinary tract infections, primarily in young women. -Present study reveals a need to report Staphylococcus saprophyticus as a pathogen causing symptomatic urinary tract infection in sexually active young women.
Englishhttp://ijcrr.com/abstract.php?article_id=1711http://ijcrr.com/article_html.php?did=17111. Abu-Taha A.S, Sweileh W.M. Antibiotic resistance of bacterial strains isolated from patients with community acquired UTI‘s: an exploratory study in Palestine? Current clinical Pharmacology journal, 2011 Nov;6(4):304-7.
2. Cernohorska L, Votava M, Antibiotic resistance and biofilm formation in Staphylococcus saprophyticus strains isolated from urine?, Epidemiology, Microbiology and Immunology journal, 2010 April;59(2):88-91.
3. Marzouk M, Ben Abdallah H, Ferjeni A, Hannachi N, Boukadida J Clinical, epidemiological and bacteriological characteristics of urinary tract infections due to Staphylococcus saprophyticus in the central part of Tunisia La Tunisie medicale journal, 2009 March;87(3):184-7.
4. Orden-Martinez B, Martinez-Ruiz R, MillanPerez R et al, What are we learning about Staphylococcus saprophyticus?, Enferm Infecc microbial Clin, 2008 Oct:26(8):495-9.
5. U.Mohan,N.Jindal, P.Agarwal, ?Species distribution and antibiotic sensitivity pattern of coagulase negative staphylococci isolated from various clinical specimens? Indian journal of medical Microbiology,2002 JanMar;20(1):45-6.
6. Mazzulli T, ?Antimicrobial resistance trends in common urinary pathogens?,The Canadian journal of urology,2001 Jun;8 Suppl 1:2-5.
7. Kumari N, Rai A, Jaiswal CP, Xess A, Shahi SK, ?Coagulase negative Staphylococci as causative agents of urinary tract infectionsprevalence and resistance status in IGIMS, Patna?, Indian journal of Pathology and Microbiology,2001 Oct,44(4),415-19.
8. Orrett FA, Shurland SM., ?Significance of Coagulase-negative staphylococci in urinary tract infections in a developing country?, Connecticut medicine journal, 1998, Apr,62(4),199-203.
9. Schneider PF, Riley TV., Staphylococcus saprophyticus urinary tract infections:epidemiological data from Western Australia?, European journal of epidemiology, 1996 Feb;12(1):51-4.
10. Uesugi A, Oguri T, Igari J., ?Studies on coagulase negative Staphylococci isolated from urine, The journal of the Japanese association of infectious diseases,1996 Feb,70(2),180-6.
11. Jellheden B, Norrby RS, Sandberg T et al, Symptomatic urinary tract infection in women in primary health care. Bacteriological, Clinical and diagnostic aspects in relation to host response to infection?, Scandinavian journal of primary health care, 1996 Jun;14(2):122-8.
12. Rupp ME, Soper DE, Archer GL et al, ?Colonisation of the female genital tract with Staphylococcus saprophtyicus?, Journal of Clinical Microbiology,1992 Nov;30(11):2975- 9.
13. Hedman P, Ringertz O, Urinary tract infections caused by Staphylococcus saprophyticus. A matched case control study, The journal of infection,1991 Sep;23(2):145- 53.
14. Galinski J, Namysi E, ?Role of Staphylococcus saprophyticus in urinary infections?, Polskitygodnik lekarski journal,1991,Oct7-21,46(40-42),746-9.
15. Mirovic V, Jokovic B, Tatic M et al, ?The incidence of Staphylococcus saprophyticus in urine and its identification?, Military medical and pharmaceutical review, 1989 MarApr;46(2):108-10.
16. Wathne B, Hovelius B, Mardh PA et al, Causes of frequency and dysuria in women?, Scandinavian journal of infectious diseases, 1987;19(2):223-9.
17. Leighton PM, Little JA, Identification of coagulase-negative Staphylococci isolated from urinary tract infections? American journal of Clinical Pathology, 1986 Jan,859(1):92-5.
18. Hovelius B,Mardh PA et al, Staphylococcus saprophyticus as a common cause of urinary tract infections?, Reviews of infectious diseases journal, 1984 May-Jun; 6(3):328-37.
19. Nicolle LE, Hoban SA, Harding GK., Characterization of coagulase-negative staphylococci from urinary tract specimens?, Journal of clinical Microbiology,1983,feb,17(2)267-71.
20. Robert H.Latham M.D., Kate RunningWHCS, Walter E.Stamm M.D., Urinary tract infections in young adult women caused by Staphylococcus saprophyticus?, The journal of American medical association, 1983;250(22):3063-3066.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareCORRELATION OF HOMOCYSTEINE WITH MALONDIALDEHYDE AND LIPID PARAMETER IN CORONARY ARTERY DISEASE PATIENTS
English4549Sharma AnitaEnglish Sharma AshishEnglish Agrawal ApurvaEnglishAim: To investigate the association of Homocysteine with lipid parameter and oxidative stress Methods: Population based cross sectional study included 60 coronary artery disease patients who visited Himalayan Institute of Medical Sciences during may 2008 to april 2009. Homocysteine and lipid profile was estimated by fully autoanalyzer, MDA level for oxidative stress was estimated by colorimetric technique on RA 50 Semi autoanalyzer. Statistical analysis: Pearson correlation and ?t test? from which p values were obtained. Results: Plasma level of Homocysteine and Malondialdehyde were significantly higher (p=0.000) in cases (CAD patients) than controls. Homocysteine shows significant positive correlation with Total Cholesterol, VLDA, LDL,Triglyceride and Malondialdehyde. Homocysteine shows negative but insignificant correlation with HDL. Conclusion: Levels of Homocysteine and Malondialdehyde obtained were found to be positively correlated with each other and with lipid parameters in this study. This indicates that Homocysteine enhances the oxidative stress by lipid peroxidation, which may be one of the cause for development of coronary artery disease.
EnglishCoronary artery disease CAD), Homocysteine(Hcy), Malondialdehyde(MDA)INTRODUCTION
Coronary artery disease is the commonest cause of heart disease and the most important single cause of death in the affluent countries of the world. Along with the known classical risk factors for the development of coronary artery disease (CAD) like cigarette smoking, hypertension, low HDL, diabetes mellitus, obesity and physical inactivity, few emerging risk factors have also been identified, like lipoprotein ?a‘, homocysteine, prothrombotic factor and pro- inflammatory factor [1]. Homocysteine is naturally occurring sulfur containing intermediate product in normal metabolism of methionine, an essential amino acid. Homocysteine (Hcy) is metabolized by two major pathways which require vitamin B6, B12 and folic acid [2]. Homocysteine increases the damage to the cardiovascular system in different ways, one of them is the formation of reactive oxygen species from the auto oxidation of homocysteine. The auto-oxidation of homocysteine also produces reactive oxygen species including superoxide and hydrogen peroxide and enhances oxidative stress Aldehydes such as thiobarbituric acid reacting substances (TBARS) have been widely accepted as a general marker for free radical production. The most commonly measured TBARS is malondialdehyde (MDA) [3].
The results of more than 75 clinical and epidemiological studies have indicated a positive correlation between total homocysteine levels and CAD, peripheral arterial disease, stroke, and venous thrombosis. However vary few studies have been done to established correlation between homocysteine and oxidative stress in patients of CAD. Therefore this study was undertaken with a view to establish hyperhomocysteinemia and it‘s correlation with oxidative stress as one of the risk factors for coronary artery disease.
MATERIALS AND METHOD
The present study was conducted on 60 patients of coronary artery disease over a period of 12 months (Feb 2008- Jan 2009) in the Department of Biochemistry and Cardiology of Himalayan Institute of Medical Sciences, Swami Rama Nagar, Doiwala, Dehradun. The patients were from the intensive care unit of Cardiology department at HIMS. The patients included in the study satisfied the following criteria: The study also included 30 normal age matched healthy adults (20 males and 10 females), who served as controls. Approval from ethical committee was taken prior to study. Written informed consent was taken from all the participants after explaining detailed methodology to them
Collection of samples
All samples were collected in the morning after 12 hrs of overnight fasting. 2 ml of blood was drawn by venepuncture from the antecubital vein in an EDTA vacutainer for estimation of plasma MDA and homocysteine, and 2 ml of blood was collected in a plain vacutainer for estimation of lipid profile. Estimation of plasma homocysteine, serum total cholesterol, HDL cholesterol and triglycerides were done on SYNCHRON CX5, Automated Chemistry Analyzer of Beckman Coulter Ltd. Serum LDL cholesterol and VLDL cholesterol were calculated by using Friedewald‘s formula. Estimation of plasma malondialdehyde was done by colorimetric technique on RA 50 semi automated chemistry analyzer. Cholesterol was measured by a timed end point method of Allan and Poon (1974). The concentration of triglycerides is measured by a time endpoint method of Bucco and David (1973). The homocysteine levels in the plasma was estimated using the Hcy enzymatic assay as marketed by Diazyme [4]. MDA was measured by method of ceconi,Cargoni,Pasini et al(1992).The result of all the parameters undertaken were tabulated and statistclly analysed by the Pearson correlation and ?t test? from which p value were obtained.
RESULT
Table 1 below represents the mean values obtained for lipid profile, homocysteine and MDA in the case study group as compared with control group. Levels of Triglyceride, Total Cholesterol, LDL-C, VLDL-C were higher in study group than in controls, whereas level of HDL-C was lower in the study group compared to controls. The difference is statistically significant only for TAG, VLDL-C and HDL-C. Plasma level of Hcy and MDA were significantly higher (p=0.000) in cases (CAD patients) than controls. Hcy showed significant positive correlation with Total Cholesterol, LDLC,VLDL-C and triglycerides and insignificant negative correlation with HDL-C.
DISCUSSION
Statistically significant positive correlation between plasma Hcy and MDA obtained in our observations is supported by the study of Moselhy and Denerdash and vishnupriya and surapaneni which shows positive correlation between plasma Hcy and MDA levels with p valueEnglishhttp://ijcrr.com/abstract.php?article_id=1712http://ijcrr.com/article_html.php?did=17121. Hackam D G, Anand S S. Emergency Risk Factors for Atherosclerosis Vascular Disease. J Am Med Assoc. 2003;290:932-40.
2. Kurban S, Mehmetoglu T, Oran B, Kiyici A. Homocysteine levels and total antioxidant capacity in children with acute rheumatic fever. Clinical biochemistry. 2007;41:26-29.
3. Tanriverdi H, Evrengul H, Enli Y, Kuru O, Seleci D, Tanriverdi S et al. Effect of Homocysteine-Induced Oxidative Stress on Endothelial Function in Coronary Slow-Flow. Cardiology 2007;107:313-320.
4. Jones B G, Rose F A, Judball N. Lipid Peroxidation and Homocysteine induced toxicity. Atherosclerosis 1994; 105: 16570.
5. Loscalzo J. The oxidant stress of hyperhomocysteinemia. J Clin. Invest. 1996; 98 : 5-7
6. Harker L A, Slichter S J, Scott C R, Ross R. Homocysteinemia. Vascular injury and arterial thrombosis. N Engl J Med 1974; 291: 537- 43.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31TechnologyEFFECT OF BLAST FURNACE SLAG POWDER ON COMPRESSIVE STRENGTH OF MORTAR
English5055Atul DubeyEnglish R. ChandakEnglish R.K.YadavEnglishThe strength development of mortar containing blast-furnace slag and Portland cement was investigated. Mortar property can be maintained with advanced mineral admixtures such as blast furnace slag powder as partial replacement of cement 5% to 30%. Compressive strength of blast furnace slag mortar with different dosage of slag was studied as a partial replacement of cement. From the experimental investigations, it has been observed that the optimum replacement of GGBFS to cement without changing much the compressive strength is 15%.
EnglishMortar, Blast Furnace Slag Powder, Compressive Strength, Optimum ReplacementINTRODUCTION
Steel slag is a solid waste discharged in large quantities by the iron and steel industry in India. The recycling of these slags will become an important measure for the environmental protection. Iron and steel are basic materials that underpin modern civilization, and due to many years of research, the slag that is generated as a by-product in iron and steel production is now in use as a material in its own right in various sectors. Slag enjoys stable quality and properties that are difficult to obtain from natural materials and in the 21st century is gaining increasing attention as an environmentally friendly material from the perspectives of resource saving, energy conservation and CO2 reduction. The primary constituents of slag are lime (CaO) and silica (SiO2). These constituents are also contained in earth crust in general or in ordinary rocks and minerals, and their chemical composition is similar to that of regular sedimentary rock and Portland cement. CaO the primary constituent of slag is soluble in water and exhibits an alkalinity like that of cement or concrete. And as it is removed at high temperatures of 1,200°C and greater, it contains no organic matter whatsoever. This paper deals with the use of the blast furnace slag powder as a partial replacement of opc and its effect on strength of cement mortar.
Literature Review:
Throughout the long history of the iron and steel industries, ways have been sought to make effective use of these slag, but their traditional use as landfill material has been nearing its limit with the massive expansion of the steel industry since the mid-1970. The steel companies have since taken on as among their important management challenges the development of technology, the maintenance of production facilities and certification for ferrous slag products in the market in order to expand the applications of these slag,and the Japan Iron and Steel Federation (JISF) and Nippon Slag Association (NSA) have promoted the institution and widespread adoption of Japan Industrial Standards (JIS). As a result, 99% of slag is now useful material, employed by such national agencies as the Ministry of Land, Infrastructure and Transport and by local governments and other users, and it has gained both high acclaim and certification. The history of recycling ferrous slag is a long one. Production of Portland blast-furnace slag cement began in 1910, and the Japanese national standard for Portland blast-furnace slag cement (JES 29) was formulated in 1926.some of the study has been done in past which summarized as: Sun, S.S., Zhu, G.L., Zhang concluded that the recycling of steel slag will inevitably become an important measure for the environment protection and therefore will be of great significance .[1] Mineral additives are available in large quantities that can be used to replace Portland cement in concrete.[2] Few studies have been performed to determine, thermal properties, mechanical properties, transport mechanisms and the influence of mineral additions on the durability of blended concrete .[3, 4, 5, 6] Liu, Sun and Zhu found that when compound mineral admixtures with steel slag powder and blast-furnace slag powder are mixed into concrete, the performance of concrete can be improved further due to the synergistic effect and activation each other. [7, 8] Li, Yao ,Wang, Lin The high performance concrete can be produced using mineral admixture with steel slag powder and blast furnace slag so the recycling of steel slag can bring enormous benefits and environmental benefit to whole society.[9] Ground granulated blast furnace slag is commonly used in combination with Portland cement in concrete for many applications. [10,11] The heat of hydration is dependent on the Portland cement used and the activity of the GGBF slag. Roy and Idorn (1982) found a correlation of heat of hydration to strength potential of various blends of GGBF slag and Portland cement. [12] The early age strength development of mixtures containing GGBS is highly dependent on temperature. Under standard curing conditions, GGBS mortars gain strength more slowly than Portland cement mortars .[13]
Research Significance
The research reported in this study, blast furnace slag powder obtained from steel plant Bhilai is used as a cement replacement material in cement mortar paste. Optimal dosage range of this blast furnace slag powder is chosen based on cement paste studies .The ultimate focus of this work is to ascertain the performance of cement mortar containing blast furnace powder and compare it with the plain cement paste. This is expected to provide:- ? To partially replace cement content in concrete & mortar as it directly influences economy in construction. ? Environmental friendly disposal of waste steel slag. ? To boost the use of industrial waste
Material Characteristics
The blast furnace slag powder obtained from Bhilai steel plant used in this study has the chemical composition shown in table 1.
RESEARCH METHODOLOGY
Cement Paste Mortar:
Study of compressive strength of mortar in 3,7,28 days using Blast furnace slag powder in OPC (5%to30%) mortar will be prepared as per the test procedure given in the relevant IS code .For optimal dosage selection of blast furnace slag powder the modified pastes (% ranging from 5 % to30 % Table 2.) cubes are prepared and compared with plain mix cubes. Fig (1) Depicts the compressive strengths of blast furnace slag powder modified cement pastes cured under saturated conditions for 28 days. From fig (1) it can be noticed that, at 28 days the blast furnace modified pastes show compressive strength very close to that of the plain paste, even at 20 % replacement levels. Test for Cement Mortar Strength as per I.S. 4031 Part -7 Cement used: OPC 43 grade Type of Sand used: Standard sand confirming to I.S 650- 1966 W/ c Ratio: To find water requirement added to cement normal consistency is calculated as per I.S Code 4031-1988 [(P/4+3) x total weight of sand and cement /100] where p is normal consistency of cement (27.7/4+3) x24= 238.2 say 238gm Cement: Fine Aggregate proportion used: 1: 3
TEST RESULT
Compressive strength test was conducted to evaluate the strength development of Cement mortar paste containing various % of blast furnace slag powder at the age of 7,14,28 days respectively.
DISCUSSION AND CONCLUSION
The variation of compressive strength of mortar mix with different proportion of BFSP as a partial replacement of cement is shown in fig.1 and fig2 It was observed that 7 days and 14 days and 28 day compressive strength reduces about 25% that is from 31.25 N/mm2 to 21.00N/mm2 , 38.33N/mm2 to 29.20 N/mm2 .and 44.66 N/mm2 to 35.33 N/mm2 respectively as percentage of blast furnace slag powder increases from 0 to 30%. From study it has been found that as the % of BFSP increase, the strength tends to decrease. The main objective of this paper was to provide results of studies conducted on blast furnace slag powder modified cement mortar paste in order to ascertain the influence of blast furnace slag powder on the characteristics strength of mortar. The compressive strength test results conducted in mortar containing OPC and various percentage of BFSP is comparable to that of mortar without slag powder. On replacement of OPC with 15% blast furnace slag powder the depreciation in 28day compressive strength is being near about 5 %.
ACKNOWLEDGEMENTS
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors /editors /publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1713http://ijcrr.com/article_html.php?did=17131. Sun, S.S., Zhu, G.L., Zhang, Y., "ApplicationTechnology of Iron and Steel Slag in China", China Waste Steel, Vol.4, Feb., 2007, pp21-28.
2. Muha mad, I. A. K. and Emmanuel, R., "Effect of Mineral Additives on Some of Durability Parameters of Concrete", Proceeding of International Conference on Advances in Cement Based Materials and Applications in Civil Infrastructure, LahorePakistan, Dec.12-14, 2007, pp289-299.
3. Sobolev, K., "Mechano-chemical Modification of Cement with High Volumes of Blast Furnace Slag", Cement & Concrete Composites, Vol.27, 2005, pp848-853.
4. Malhotra, V. M., "Reducing CO2 EmissionsThe Role of Fly Ash and Other Supplementary Cementitious Materials", Concrete International, Vol.28, Sep., 2006, pp42-45.
5. Park, C.K., Noh, M.H. and Park, T.H., "Rheological Properties of Cementitious Materials Containing Mineral Admixtures", Cement and Concrete Research, Vol.35, 2005, pp842-849.
6. Barnett, S.J., Soutsos, M.N., Millard, S.G., Bungey, J.H., "Strength Development of Mortars Containing Ground Granulated Blast-furnace Slag: Effect of Curing Temperature and Determination of Apparent Activation Energies", Cement and Concrete Research, Vol.36, 2006, pp434-440.
7. Liu, T.C. and Yang, H.M., "Ultrafine Steel Slag and Latest Advance in Blending Materials of High-performance Concrete". Metal Mine, Vol.41, Sep., 2006, pp8-13.
8. Sun, J.Y. and Huang, C.H., "Influence of Slag and Steel Slag Composite on Properties of High Content Slag Concrete", new building materials, vol20 jul.2004,ppl3-15
9. Li, Yao, Wang, Lin effect of steel slag powder on mechanical properties of high performance concrete? 8th international symposium on utilization of high strength and high performance concrete pp628-632
10. Report of ACI committe233,slg cement in concrete and mortar,aci233r-03,American concrete institute, Farmington hills, mich 2003 11. J.Bijen, blast furnace slag cement for durable marine structures,stichingbetonprisma,Netherlands,1 996
12. Roy, D. M., and Idorn, G. M., ?Hydration, Structure, and Properties of Blast Furnace Slag Cements, Mortars, and Concrete,? Proceedings, ACI JOURNAL V. 79, No. 6, Nov.- Dec. 1983, pp. 445-457.
13. S.J. Barnett , M.N. Soutsos, S.G. Millard, J.H. Bungey Strength development of mortars containing ground granulated blast furnace slag :effect of curing temperature and determination of apparent activation energies , Cement and Concrete Research 36 (2006) 434 – 440
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareOSTEOMA OF EXTERNAL AUDITORY CANAL - A CASE REPORT
English5659Gunvanti B. RathodEnglish Pragnesh ParmarEnglish R. N. GonsaiEnglishOsteoma is a rare, benign, bone forming tumour which can arise from various sites in the cranial vault including temporal bone. It is a slow growing tumour. In external auditory canal, normally it is asymptomatic although it may cause cosmetic deformities. Large size osteoma of external auditory canal causes obstruction of external auditory canal along with pressure symptoms such as headache. It must be distinguished from exostosis in external auditory canal, a much common condition in that site, since there is ample clinical and histopathological evidence that these two lesions are separate entities. The purpose of the present study is to present a review of literature about external auditory canal osteoma and to report in details the case of a 10 years old female patient with the lesion and focusing on differentiating features between osteoma of external
auditory canal and exostosis.
EnglishOsteoma, External auditory canalINTRODUCTION
Osteoma of external auditory canal is a benign tumour which is often symptomless, although it may cause cosmetic deformities. Large size osteoma of external auditory canal causes obstruction of external auditory canal along with pressure symptoms such as headache. [1] Incidence of external auditory canal osteoma is 0.05 % of all otologic surgeries. Osteoma is a new bone forming tumour located within bones of cranial vault including temporal bone. In the external auditory canal, it must be distinguished from exostosis, a much more common condition in that site, since there is ample clinical and histopathological evidence that these two lesions are separate entities. [2]
Case report
A 10 years old female patient reported with a swelling in the right external auditory canal since 1 year. It was gradually increasing in size. The patient gave history of right ear discharge since 1 month. There was no history of earache, decrease in hearing, headache, vomiting, giddiness, tinnitus, visual disturbance and neurological deficit. On examination, the swelling was found to arise from the posterior wall of the right external auditory canal. It was about 1x1 cm2 in size, smooth, bony hard, non tender swelling. Right external auditory canal was occluded by the swelling, so otoscopic examination was not possible. X-ray of chest and mastoid both were normal. The patient was undergone procedure for the excision of the tumor under local anesthesia. It was attached to bony external auditory canal and light blows were applied using a mallet on all sides of tumour to separate it and the mass was sent for histopathological examination. On gross examination, received specimen consisted of one whitish, skin covered bony hard nodular tissue, measuring 0.8 x 0.6 cm2 . It was kept for decalcification procedure and after 2 days tissue was processed for routine paraffin embedding. Then Haematoxylin and Eosin (H&E) stained sections were prepared. Microscopic examination revealed mature lamellar bony tissue with presence of intervening fibrovascular connective tissue. Bony tissue was covered by stratified squamous epithelium and overall histology was suggestive of diagnosis of osteoma. (Figure I)
DISCUSSION
Osteoma of external auditory canal is a rare benign lesion which is slowly growing and kept stable for years. [1] Osteoma has often incidental findings at examination but may cause pressure symptom such as headache. [3] It predisposes to wax collection & external otitis and hence causes a conductive hearing loss by direct or indirect meatal occlusion. [4] Important complications of osteoma in external auditory canal are mainly related to treatment and include recurrence, facial nerve affection, sigmoid sinus damage and sensorineural hearing loss, by nerve compression. [5, 6, 7, 8] During removal of anterior lesions the temporo-mandibular joint can be violated resulting in temporomandibular joint prolapse and subcutaneous emphysema secondary to air entry into the joint through a bony defect. Other complications include canal stenosis and tympanic membrane perforation. [9] Microscopically there are four types. 1) Compact: the most frequent one, comprising of dense, compact and lamellar bone, with few vessels and haversian canals. 2) Cartilaginous: It comprising of bone and cartilaginous elements. 3) Spongy: It is a rare type, comprised of spongy bone with marrow and fibrous tissue with tendency to expand the diploe and involving the internal and external lamina of the affected bone. 4) Mixed: It is mixture of spongy and compact types. [6, 10, 11, 12] Graham reported histological findings of osteoma i.e. osteoma is covered by a dense squamous epithelium with an underlying periosteum. The internal structure is characterized by a great abundance of discrete fibrovascular channels surrounded by lamellated bone. The appearance of bone between these channels varies considerably, being primarily dense and oriented in different directions. [2] The histogenesis of osteoma has still not been defined. According to congenital theory, presence of embryonic cartilage results in intensified bone growth after puberty. Friedberg suggested trauma with consequent periostitis as a predisposing factor. [13] According to hormonal theory, there is increase of the periosteal osteoblastic activity, stimulated by endocrine mechanisms which results in increased bone growth. [11] The differential diagnosis should include exostosis, osteoid osteoma, osteoblastic metastasis, eosinophilic granuloma, giant cell tumour, monostotic fibrous dysplasia. [14] Osteoid osteoma is differentiated by central nidus composed of calcified osteoid lined by plump osteoblast and growing within highly vascularized connective tissue. Giant cell tumour can be differentiated from osteoma by presence of stromal cells and osteoclast like giant cells. Monostotic fibrous dysplasia is differentiated by narrow, curved and misshaped bone trabeculae, often having characteristic fish hook configuration. Eosinophilic granuloma is characterized by presence of variable admixture of eosinophils, giant cells, neutrophils, foamy cells and areas of fibrosis. [15] It is important to differentiate osteoma from exostosis as both can produce similar clinical picture and differentiating points are as follows: Osteoma is usually solitary pedunculated lesion attached to the tympanosquamous or tympanomastoid suture lines, where as exostosis is usually multiple, bilateral broad based elevations of bone. Exostosis is thought to be a reactive condition secondary to multiple cold water immersions, or recurrent otitis externa. Ears with exostosis have been called surfer‘s ear or Australian ears as prevalence rate of 73.5% of exostosis is reported in surfing population. [16] Exostosis, in contrast to osteoma, shows parallel concentric layers of subperiosteal bone with numerous osteocytes and absent fibrovascular channels. [2, 17] Treatment for small lesions of osteoma is frequent cleaning of debris from the external auditory canal, while large lesions causing external auditory canal obstruction and hearing impairment require surgical removal.
CONCLUSION
Osteoma of external auditory canal is benign and very rare tumour having incidence rate of 0.05%. If it is small, often not producing any symptoms and purpose of surgical removal is only cosmetic deformities. Large size osteoma of external auditory canal causes obstruction of external auditory canal long with pressure symptoms such as headache. Osteoma of external auditory canal must be differentiated from exostosis. Both have only clinical similarity but incidence, prevalence, etiopathogenesis and microscopic examination all are different.
Englishhttp://ijcrr.com/abstract.php?article_id=1714http://ijcrr.com/article_html.php?did=17141. Friedmann I, Pathological lesions of the external auditory meatus: a review, Journal of the Royal Society of Medicine, 1990, 83: 34-37.
2. Graham M.D, Osteoma and exostosis of the external auditory canal: A clinical, histopathological and scanning electron microscopic study, Annals of Otology, 1979, 88: 566-572.
3. Shenoy P., Paulose K.O., Khalifa S.A., Sharma R., Osteoma of the ear canal presenting with headache, Journal of Laryngology and Otology, 1989, 103: 683-684.
4. Phelps P.O., Scott-Brown‘s Otolaryngology, Vol. 3, Otology, 5th Edition, Butterworths, London, 1987, Page 40.
5. Camacho RR, Vicente J, Cajal SR., Imaging quis case 2, Archives of Otolaryngology, Head and Neck Surgery, 1999; 125 (3): 349, 251-352.
6. Burton DM, Gonzalez C., Mastoid osteoma, Ear Nose Throat Journal, 1991; 70(3): 161 - 162.
7. Denia A, Perez F, Canalis RR, Graham MD, Extracanalicular osteomas of the temporal bone, Archives of Otolaryngology, 1979; 105(12): 706- 709.
8. Tutor EG, Osteoma de mastoids, Anales Otorhinolaryngologicos Ibero Americanos, 1991; 18(4): 325 -330.
9. Sheehy JJ, Diffuse exostoses and osteomata of the external auditory canal: a report of 100 operations, Otolaryngology, Head and Neck Surgery, 1982; 90: 337-342.
10. Fleming JP, Osteoma of the mastoid, Canadian Journal of Surgery, 1966; 9(4): 402-405.
11. Singh I, Sanasam JC, Bhatia PL, Singh LS, Giant osteoma of the mastoid, Ear Nose throat Journal, 1979; 58(6): 243 - 245.
12. Guerin N, Chauveau E, Julien M, Dumont JM, Merignargues G., Osteome de la mastoide, A propos de deux cas, 1996; 11 (2): 127 - 132.
13. Friedberg SA, Osteoma of mastoid process, Archives of Otolaryngology, 1938; 28: 20-26.
14. Probst LE, Shankar L, Fox R., Osteoma of the mastoid bone, Journal of Otolaryngology, 1991; 20(3): 228 - 230.
15. Rosai and Ackerman, Surgical Pathology, 9th edition, Mosby, Edinburgh, 2005, Page 2137-2236.
16. Wong BJ, Cervantis W, Doyle KJ, Karamzadeh AM, Boys P, Brauel G et al., Prevalence of external auditory canal exostoses in surfers, Archives of Otolaryngology, Head and Neck Surgery, 1999; 125: 969 - 972.
17. Kemink, J.L, Graham, M.D., Osteoma and exostosis of the external auditory canal – medical and surgical management, Journal of Otolaryngology, 1982, 11(2): 101-106.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareLAPARASCOPIC PORT SITE INFECTION WITH SALMONELLA - REVIEW OF LITERATURE
English6068Rudresh H. KEnglish Banashankari. G. SEnglish Harsha. A. HuliyappaEnglish Arvind NayakEnglish Prasannakmar KabmleEnglishBackground – salmonella infection of the port site is rare and almost all the cases are secondary to organisms in the bile or the bilestones. Methods – 3 cases of laparoscopic and 1 case of lap converted open cholecystectomy had port and laparotomy site infection with salmonella alone or with bowel contaminants. Results – all cases had evidences of breach in the extraction protocols of gall bladder and would be attributed for same. Conclusion :- adequate antibiotic prophylaxis is just not sufficient for prevention of salmonella infection of the port in chronically infected gall bladder extraction . every gallbladder should be extracted with an endobag especially in developed countries, where the chances of
chronic salmonella infections are common.
Englishport site salmonella infection, gallstone disease, laparascopic cholecystectomy.INTRODUCTION
Laparoscopic cholecystectomy is by far the most commonly performed procedure and is indeed the gold standard in the treatment of symptomatic gall stone disease. The risk and complications of the procedure are more or less directly related to the extent of inflammatory process and comorbid factors preexisting in the patients. Avoiding the spillage of the gallstones or of the infected bile with extraction of an intact gall bladder specimen is a testament to the surgical proficiency of operating surgeon. Several standard operating protocols and methods have evolved over years to prevent the same, though they are not absolute foolproof methods. Overall rate of port site infection/surgical site infection following lap (laparoscopic) cholecystectomy is extremely low 2hrs (2), Acute cholecystitis (3) , empyema gall bladder and bile spillage and bacteribilia (4, 5). Most of the port site infections are caused by gram negative enteric bacteria such as E.coli and Klebsiella. Many cases of unusual infection with Candida, Actinomycosis (6) , Atypical Mycobacterium (7) have also been reported. We present here an unusual series of 4 cases of port site infection with Salmonella with evidence of gall stones at the port site in two cases.
REVIEW METHODOLOGY
Case 1
A 56 year old man with symptomatic cholelithiasis underwent lap cholecystectomy in Jan 2008. Gallbladder was extracted from the umbilical port site. Patient had received ceftriaxone 1 gm as prophylaxis. About 2 months later he presented with fever, malaise, pain and swelling of umbilicus. He was diagnosed to have omphalitis and hence was started on a combination of amoxicillin+clavulinic acid for possible infection by umbilical colonizing bacteria. With no evidence of responsiveness and with an evidence of early abscess on day 4 of antibiotic therapy, incision and drainage was performed during which a small subcentimetric gallstone was seen. It was retrieved and the cavity was thoroughly washed with saline and left for healing. Pus showed gram negative rods and grew Salmonella sp. (species) on culture. It was sensitive to ceftriaxone and the same was started. Wound healed in 3 weeks and no recurrence was noted after 6 months follow up and no evidence of incisional hernia at 2 years follow up.
Case 2
A 39 year old female with symptomatic cholelithiasis (multiple, largest ~ 2 cms), was operated by lap cholecystectomy in Dec 2009. During extraction the gallbladder was brought out partially through the epigastric port site and was opened to extract the stones. With sponge holding forceps, the gallstones were manually picked out under direct vision, followed by uneventful extraction of the gallbladder. Port site was inspected on both sides for any evidence of spillage. Patient was discharged on POD5. Patient returned after 1 month with abscess at port site without systemic symptoms. Pus was sent for culture, which grew Salmonella sp. and with further analysis it was determined to be Salmonella typhi and hence patient was started on ciprofloxacin 500mg bid for 14 days. The wound on exploration showed a 0.5cm partially cut gallstone with exposed core of the stone (Figure 1). The same was sent for analysis, which grew Salmonella typhi on culture. Patient‘s recovery was uneventful.
Case 3
A 58 year male patient with chronic calculus cholecystitis was operated in Nov 2009. Specimen was extracted through epigastric port. However, the port site infection was noted on POD8. Pus sample yielded growth of E.coli and Salmonella species. Patient treated with ciprofloxacin for 14 days. On wound exploration there was no evident stone. Wound was closed primarily. Patient recovered uneventfully.
Case 4
A 44 year old male patient, admitted for empyema gallbladder was operated upon in Dec 2009. In view of dense adhesions in the Calot‘s triangle, the procedure was completed by open cholecystectomy. During dissection, a small quantity of bile leak was noted from the body. Empyema fluid grew E-coli with sensitivity to piperacillin + tazobactum. The general well being of the patient however did not improve with evidence of low grade fever from POD3. The laparotomy site was probed and purulent discharge was evacuated (figure 2). Pus showed polymicrobial infection of E.coli, Klebsiella, and Proteus. With our previous experience of Salmonella infection, pus was also sent for special culture which grew Salmonella sp. Combination of cephalosporins and quinolones was started. Subsequently the infection subsided and the wound healed by 12th day.
RESULTS
In case1, multiple tiny calculi in gall bladder, neck and in the cystic duct were noted on USG. Though there was no gross contamination during the procedure, there might have been contamination of the port site from the exposed cystic duct of the specimen during the extraction. Spilled Gall bladder stones from the cystic duct of the specimen may cause port site infection, if the bile or the stone are infected. In case 2, during the decompression procedure, the delivery of the stones by the forceps might have crushed and cut the stones into pieces, thus exposing the core of the gallstone to the port site in which it was found. The non usage of Endobag in both these cases might have resulted in spillage of stone. In case 3, Salmonella is known to be an uncommon inhabitant of the gallbladder in chronic cholecystitis. Manipulation of the gall bladder during the negotiating of the 10mm epigastric port site would have resulted in dislodgement of the bacteria from the chronically fibrosed gallbladder wall into the bile and hence a minute spillage might have resulted in the infection. In case 4, Empyema gall bladder is known to be polymicrobial usually sensitive to cefuroxime and Cefoperazone. When choosing the antibiotic for biliary infection, the drug and the dosage used should reach MIC (maximum inhibitory concentration) within the blood, biliary tract, bile, peritoneum, GIT, and the surgical site at the time of surgery. It would be prudent if the antibiotics sensitive to Salmonella based on the prevalent culture pattern in the locality, are used, along with coverage for common biliary pathogens in developed countries as the risk of the chronic Salmonella carrier states are more. A study of 100 focal pyogenic abscess by Salmonella showed 15 % to have soft tissue infection including skin, parotid, thyroid, breast and injection site. Salmonella typhi , typhimurium and paratyphii A were isolated in the cultures.
DISCUSSION AND REVIEW OF LITERATURE
Port site infection after an elective video- assisted lap cholecystectomy is reported in about 1 – 9% cases in different series including difficult cholecystectomies.8-11 Most of such post procedure site infection are treated on OPD basis with oral antibiotics which has shown over the years to offer a cure. Several studies report the use of different methods to reduce the incidence of port site infection. Most common mode of such preventive approach is the prophylactic administration of systemic antibiotics. Though many studies recommend and regard it as one of the most essential predictor of wound infection and hence encourage its usage, others have not shown any statistically significant difference in the outcome between the two groups 12-16 . Vincenzo et al17 used topical application of Rifamycin over the port site and showed lower infection rates especially in those with varying degree of immunosupression (Diabetics, patients on steroids/immunosuppresants). Specimen extraction by using endobag, has the least wound infection rates of 1%.18 With surgery duration exceeding > 2 hrs, the risk of Surgical Site Infections is seen to increase proportionately and is well evident in the study by Waqar et al, where 82.3% of SSIs occurs in procedure lasting more than 1 hr.19 Although, the general opinion points towards the role of umbilical flora in the development of port site infection, such association has not yet been proven with significant results. The fact that the port site infections are commoner in the port through which the gall bladder is delivered out, indicates that the nature of the gallbladder infection is more implicated in port site infection. 15,18 Thus, Acute cholecystitis and Empyema gall carry the highest chances of port site infection in view of higher probability of bacterial translocation through an intact bladder wall.20,21 The direct relationship of Bactibilia and bile cultures to the port site infection has been studied extensively. Hamzaoglu I et al 9 rejected both the skin flora and the bile as sources of port site infection. Study by Abassi AA et al on 82 infected gall bladder cases found no significant correlation between infective complications of the procedure and bacteria in the bile or gallbladder wall.21 Positive bile culture and cholelithiasis ranges from 10%-42.5% .12,15 Spillage of bile or the stone which occurs in 11% - 35% of Lap cholecystectomy due to rupture of the gall bladder wall, is the strongest predictor of development of port site infection 22, 23. However many studies have found no correltion between the bile culture, rupture of GB, spillage of gallbladder stones as a significant casual relationship for the port site infection.7, 13, 15 The bacteriology of infected bile is most frequently E.coli, followed by Proteus, Klebsiella, gram positive organisms like Streptococcus viridians, Staphylococcus, anaerobes (Bacteroides sp., Clostridium sp.,) and Candida sp.1,24,25 However there is no study which has isolated Salmonella from the infected bile of calculus cholecystitis/ cholelithiasis. Inhabitation of Salmonella sp. in Gallbladder is frequently seen in the developing countries as a part of chronic typhoid infection due to lack of adequate primary treatment. Salmonella sp. and other bacteria are specifically isolated from the neck of gall bladder (than from the body or fundus), the bile and both the core and the surface of the gall stones. 25The Rokitansky-Aschoff sinuses in the neck host the organisms.27 Development of chronic typhoid carriage is frequently associated with the presence of gallbladder abnormalities, especially gallstones, yet the progression from infection to the carrier state remains undefined.28 The primary constituent of gallbladder stones is cholesterol, whereas calcium bilirubinate predominates in bile duct stones.31 In patients carrying both S. Typhi and cholesterol gallstones in the gallbladder, clinically administered antibiotics are typically ineffective against infection and hence such chronic indolent inflammation has a high risk of developing gall bladder carcinomas. 32, 33 The Widal test is of little help in detection of carriers in endemic areas and is always associated with significant false positivity and negativity 29,30 . Culture is often sterile, especially in endemic zones with inappropriate antibiotic therapy. 34 Sometimes even patients with positive titers are negative on culture. Similarly in our study, no positive bile culture was obtained for Salmonella. Hence, the accuracy of these tests in categorically documenting the presence of Salmonella typhi is debatable. Song et al showed PCR to be helpful in detecting amplification products in blood specimens of suspected blood culture-negative patients with typhoid fever. Since then, several reports have appeared in the literature suggesting PCR be made the gold standard for the diagnosis of typhoid fever. 34 To date, removal of the gallbladder (cholecystectomy) remains the most effective treatment option for chronic typhoid carriers with gallstones. Calculi lost in the peritoneum are known to cause intraperitoneal abscess, empyema thoracis, migration to hernia sac, intraperitoneal granuloma, wound infection, small bowel obstruction and abdominal wall sinus.35-38 As the aphorism of Lord Moynihan states ?Tomb stone erected to the memory of organisms which lie dead within them?, the bacteria inside the gallstones have long been thought to be dead.39 A study conducted by P Hazrah et al, on the frequency of live bacteria in gallstones , have found 81% of stones to harbor enteric and nonenteric organisms(46% and 16%).26 With Klebsiella being the most common organism (17.5%), Salmonella sp. were isolated in 1.5% of cases. Wetter et al. showed culture positive rates in pigment stone to be of 100% whereas no Salmonella was cultured in 100 gallstone cultures in another study.40 A study by Roa et al on 608 patients isolated Salmonella sp. in only 4 cases with chronic cholecystitis.41 Medline search for Salmonella surgical site infection yielded only one report of Postcholecystectomy surgical site infection by chronic Salmonella enterica var. Weltevreden requiring carbepenem for treatment.42 1. Salmonella is a causative organism of port site infection, following biliary surgery, especially cholecystectomy in developing countries and usually are located within the stones and in the fibrosed walls of the gallbladder. 2. Utmost care taken during handling of the specimen while being dissected, grasped, clipped and delivered out would prevent bile spillage. Care must be taken as the cystic duct and the ruptured gallbladder during extraction are the commonest causes of port site infection. 3. Any attempt at extraction of large stone through the same port should always be done with Gall bladder inside an endobag, so that the cuff covering the port site would prevent spillage into the wound. 4. It is more prudent to leave the port site to heal by secondary intention when there is suspicion of abscess, so that a missed stone usually get expelled out during dressing and healing. 5. Antibiotic coverage for both common biliary organisms and also Salmonella sp. would appear essential and needs further studies for validation.
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesNUCLEATION KINETICS, XRD AND SHG STUDIES OF LALANINE SINGLE CRYSTALS GROWN AT DIFFERENT SUPERSATURATION LEVELS
English6978K.K.Hema DurgaEnglish P. SelvarajanEnglish D.ShanthiEnglishL-alanine crystal is a Nonlinear Optical (NLO) active amino acid and it is useful for the future photonic technology. Solubility and nucleation temperature were measured for L-alanine at different saturation temperatures and the sample of this work has positive temperature coefficient of solubility. Metastable zonewidth was obtained from the difference between the saturation and nucleation temperatures and it is
observed to be large at higher temperatures. Induction period measurements for the selected supersaturation levels at different temperatures were carried out for supersaturated aqueous solutions of
L-alanine and it is noticed that induction period decreases with supersaturation ratios. The critical nucleation parameters were evaluated based on the classical theory of homogeneous nucleation. The bulk crystals of L-alanine have been grown from the optimized growth parameters and at different supersaturation levels. Single crystal XRD studies and SHG measurement were carried out for L-alanine
samples grown at different supersaturation levels.
EnglishAmino acid; L-alanine; nucleation kinetics; induction period; supersaturation; Gibbs free energy; growth from solutions; XRD; metastable zonewidth; SHGINTRODUCTION
Amino acids are the repeating building blocks of molecular structure of the important compounds known as proteins and they are a group of organic compounds containing two functional groups such as amino and carboxyl groups. The key elements of an amino acid are carbon, hydrogen, oxygen and nitrogen. Although the neutrally charged structure for an amino acid is commonly written, it is inaccurate because the acidic COOH and basic NH2 groups react with one another to form an internal salt called a zwitterion. It has no net charge because of one positive (NH3 + ) and one negative charge (COO) [1-3] . L-alanine is an organic α-amino acid with the chemical formula CH3CHNH2COOH. It is a white odorless crystal powder and easily dissolves in water, slightly dissolves in alcohol and undissolves in ether. L-alanine is a conditionally essential amino acid and it is an important source of energy for muscle tissue, the brain and central nervous system. L-alanine strengthens the immune system by producing antibodies, helps in the metabolism of organic acids and sugars and is used by protein synthesis and immune system regulation [4,5]. It was first crystallized by Bernal [6] and later by Simpson [7] and Destro et al [8] and it is the simplest acentric crystal with second harmonic generation efficiency of about 0.3 times that of the well known KDP [9-12]. Considering the importance of L-alanine crystal, a research programme is being carried out in our laboratory to study the various physical and chemical properties of L-alanine and its complexes. Considerable interest has been stressed on this material because it is an NLO active material and is a technologically important material. In this work, an attempt has been made to determine the critical nucleation parameters, solubility, induction period, metastbale zonewidth of the recrystallized sample of L-alanine. Growth of bulk single crystals of L-alanine was carried out using the optimized growth parameters obtained from nucleation kinetic studies and grown crystals were subjected to single crystal XRD and SHG studies.
Theory for nucleation process
Nucleation is the precursor and the most important phenomenon for crystal growth. When few atoms, ions or molecules join together in a supersaturated solution, a cluster or nucleus is formed and the overall excess free energy ( G ) between the nucleus and solute in the supersaturated solution is given by G= Gs+ Gv (i) where Gs is the surface excess free energy and Gv is the volume excess free energy. Once the nucleation occurs in the supersaturated solution, the nucleus grows quickly and a bright sparkling particle is seen. The time of observation of the sparkling particle in the undisturbed solution from the time at which the solution reaches experimental temperature is called the induction period ( ). For a given volume of solution, the frequency of formation of nuclei is inversely proportional to the induction period. The expression for the induction period in terms of Gibbs free energy is given by ln = -B+ G/kT (ii) where B is a constant, k is the Boltzmann‘s constant, T is the absolute temperature. Usually nucleus formed in supersaturated solution is assumed to be spherical in shape. According to Gibbs theory in terms of surface thermodynamics, the overall excess free energy between a spherical nucleus and solute can be written as [13] G=4 r 2 +(4/3) r 3 Gv‘ (iii) where Gv‘ is the free energy change per unit volume, r is the radius of the nucleus and is the interfacial tension or surface energy per unit area. This energy will be maximum for certain value of r, which is known as critical radius. Nuclei formed with radius greater than this r are stable and decrease their free energy by growing [14,15]. According to Thomson-Gibbs equation, the volume excess free energy is given by Gv‘ = (kT/v)lnS (iv) where S is the supersaturation ratio and v is volume of a molecule. S is given by S = C/Co where C is the supersaturated concentration and Co is the saturated concentration. The net free energy change ( G) increases with the increase in size of nucleus, attains maximum and decreases with further increase in the size of nucleus. The size corresponding to the maximum free energy change is called critical nucleus . The radius of the critical nucleus can be obtained by setting the differentiation condition
d ( G) / dr = 0
Differentiating equation (iii) we get,
d ( G) / dr = 8 r + 4 r 2 Gv‘ = 0
The size of critical nucleus is obtained by putting r = r* ,
r*= -2 / Gv‘ (v)
Substituting equation. (iv) in the equation (v), we get
r* = -2 v / kT ln S
Since N k = R and taking modulus r*= 2 vN/RTlnS (vi) Where R is the universal gas constant and N is the Avogadro‘s number. Substituting equation (vi) in the equation (iii), we get Gibbs free energy change for the critical nucleus (Here r = r* and G = G* for critical nucleus) G*= (16 3 v 2N 2 )/[3R2T 2 (lnS)2 ] (vii) Therefore, equation (ii) can be written for critical nucleus as ln = -B + (16 3 v 2 N 3 ) /[3R3 T 3 (ln S)2 ] (viii) A plot of 1/ (ln S)2 against ln from equation (viii) is straight line and the slope is m = (16 3 v 2 N 3 )/(3R3 T 3 ) (ix) Therefore, G* = mRT / [N (ln S)2 ] or G* = mkT /(ln S)2 (x) From equation (9) we have, = (RT/ N) [3m / (16 v 2 )]1/3 (xi) The number of molecules in a critical nucleus is found using the following equation n = (4/3) ( /v) r* 3 (xii) The nucleation parameters such as radius of the critical nucleus, Gibbs free energy change, interfacial tension and the number of molecules in the critical nucleus can be determined using the equations (vi), (x) , (xi) and (xii).
RESULTS AND DISCUSSION
Solubility and metastable zonewidth The Analytical Reagent (AR) grade salt of Lalanine was purchased commercially from Merck India and it was further purified by recrystallization. The solubility and metastable zonewidth for the re-crystallized salt of L-alanine were found at different saturation temperatures. Solubility study was carried out using a hot-plate magnetic stirrer and a constant temperature bath. A voltage regulator was attached with hot-plate magnetic stirrer in order to maintain the temperature constant. Initially, the temperature was maintained at 30 oC. The re-crystallized salt of L-alanine was added step by step to 50 ml of de-ionized water in an air-tight container kept on the hot-plate magnetic stirrer and stirring was continued till a small precipitate was formed. This gave confirmation of supersaturated condition of the solution. Then, 25 ml of the solution was pipetted out and taken in a petri dish and it was warmed up at 40 oC till the solvent was evaporated out. By measuring the amount of salt present in the petri dish, the solubility (in g/100 ml) of L-alanine in de-ionized water was determined and this method of measuring solubility is known as gravimetrical method [16]. The same procedure was followed to find solubility of L-alanine samples at various temperatures using a constant temperature bath. Metastable zonewidth is an essential parameter for the growth of good crystals from solution, since it is the direct measure of the stability of the solution in its supersaturated region. The difference between the saturated temperature and the nucleation temperature is taken to be the metastable zone width of a system. In the present work, metastable zonewidth for L-alanine sample saturated at different temperatures was determined by polythermal method [17]. In polythermal method, the equilibrium-saturated solution was cooled from the overheated temperature until the first visible crystal is observed. Since the time taken for the formation of the first visible crystal after the attainment of critical nucleus is very small, the first crystal observed may be taken as the critical nucleus. Using the solubility data, the saturated solution of L-alanine was prepared at 30 oC, and the solution was filtered into a beaker using Whatmann filter paper. This beaker was loaded into a constant temperature bath controlled to an accuracy of ±0.01 oC, provided with a cryostat for cooling below room temperature. The temperature of the solution was raised by 5 oC above the saturated temperature and the solution was continuously stirred for 3 hours using an immersible Teflon coated magnetic stirrer to ensure homogeneous concentration. Now the solution was cooled at the rate of 5 oC/h from this preheated temperature to a temperature at which the first speck of the nucleation appeared. Thus the temperature at which the first speck of nucleus in the saturated solution is noted and it is called the nucleation temperature. The experiment was repeated for solutions saturated at other temperatures like 35 and 40 oC. The plots of solubility curve and nucleation curve for the sample of this work at different saturation temperatures and at different concentrations are presented in figure 1. From the results, it is observed that the solubility increases with temperature and hence the sample of this work has positive temperature coefficient of solubility. The difference between saturation temperature and the nucleation temperature at a particular temperature gives the metastable zonewidth.
Measurement of induction period For the measurement of induction period, isothermal method [18] was used at the selected supersaturation ratios or levels viz. 1.1, 1.15, 1.2 and 1.25 saturated at temperatures such as 30, 35 and 40 oC. Using the solubility diagram, the recrystallized salt of L-alanine was used to prepare supersaturated aqueous solution (by keeping the supersaturation ratio at 1.1 initially ) in a corning glass beaker (nucleation cell), preheated slightly and it was stirred continuously for about 2 hours using a magnetic stirrer to ensure the homogeneous concentration. The nucleation cell was loaded into a constant temperature bath (controlled to an accuracy of 0.01 0C) and illuminated using a powerful lamp to observe the formation of nucleus. The temperature of the constant temperature bath was set at 30 oC and as the temperature reached the experimental temperature (30 oC ), the time was noted. When the first speck of nucleation occurred in the solution, again the time was noted. The time difference between the time of observation of the first speck particle in the nucleation cell and the time at which the solution reached the experimental temperature (30 oC) was the induction period ( ). Similarly, induction period measurements were performed at the other supersaturation ratios (S) and at other temperatures such as 35 and 40 oC. Two or three trials were carried out to ascertain the correctness of the results. From the results (Fig.1), it is noticed that the induction period decreases with the supersaturation ratio (S) and it is reduced when the solution of L-alanine is saturated at higher temperatures.
Determination of critical nucleation parameters
From the measured values of induction period, the critical nucleation parameters were determined. 2 were drawn for different temperatures such as 30, 35 and 40 oC and are presented in the figure 3. In the obtained results, it is noticed that the plots of ln against 1/(ln S)2 are approximately linear (slightly nonlinear) and this explains the classical theory of homogeneous nucleation. This is similar to the results observed by many researchers [19-21]. The effect of heterogeneous nucleation due to dust particles from air and scratchings on the inner walls of nucleation cell was reduced by carrying out the experiment in a relatively dust-free space and by using scratch-free glass beakers. The nonlinearity of plots may be due to heterogeneous nucleation caused by the impurities present in the solution. Using the values of slope, the nucleation parameters such as radius of the critical nucleus, Gibbs free energy change, interfacial tension and the number of molecules in the critical nucleus can be determined based on classical theory of homogeneous nucleation assuming the shape of critical nucleus as spherical. using the equations (vi), (x) , (xi) and (xii) and the obtained values are provided in the table 1.
From the results, it is observed that induction (S) increases for the solutions supersaturated at 30, 35 and 40 oC. Studies on nucleation kinetics of L-alanine s are carried out in order to have the controlled nucleation rate. Nucleation and crystal growth kinetics in connection with the amount of material available for crystal growth determine the number and volume of crystals produced. The number of crystals produced in the supersaturated solution is expressed as nucleation rate i.e. the number of crystals produced per unit volume per unit time. The nucleation rate J were calculated using the equation J = A exp[- G* / (kT)] ( xiii) where A is the pre-exponential factor ( approximately A= 1 x 1030 for solution), G* is the critical free energy of the nucleus, k is the Boltzmann constant and T is the constant temperature of the solution [13] and are given in the table 1. It is noticed from the results that the values of G* , n, r* decrease with increase in supersaturation ratio (S). When G* increases, the nucleation rate decreases according to the above equation (xiii).
Based on the data obtained from the nucleation kinetic studies, the following optimized conditions are useful for the bulk growth of L-alanine single crystals: (i) Formation of multinuclei could be avoided when we use low supersaturation at higher saturation temperatures, (ii) metastable zonewidth is high and hence this leads to high stability of the solution at higher temperatures, (iii) Interfacial tension is low for the aqueous solution of L-alanine and hence water could be used to grow bulk crystals. The studies on induction period, metastable zonewidth, interfacial tension, nucleation rate and other nucleation parameters give ideas for the controlled growth of L-alanine crystals by slow evaporation and slow cooling methods. Growth of crystals at different saturation levels The optimized growth parameters from the studies of nucleation kinetics were used to grow good quality bulk single crystals. It took about 20 to 25 days to harvest the crystals. When the obtained data from nucleation kinetic studies are analyzed, the nucleation rate is low for solution of L-alanine supersaturated at 40 oC and hence spontaneous nucleation will be reduced if the crystals are grown using the solution of L-alanine supersaturated at 40 oC. In this work, L-alanine single crystals were grown by slow evaporation at different supersaturation levels viz. 1.1, 1.15, 1.2 , 1.25 supersaturated at 40 oC . Let these samples be coded as LA1, LA2,LA3, LA4. The grown crystals of this work are displayed in figures 4, 5, 6 and 7. It is observed that the morphology of Lalanine crystals has been changed when the supersaturation levels are altered.
Single crystal XRD studies
The grown crystals of this work (LA1, LA2, LA3 and LA4) were subjected to single crystal XRD studies using an ENRAF NONIUS CAD4 diffractometer with MoKα radiation (λ=0.71073A o ) and the obtained data for all the four samples are found to be same. The unit cell parameters obtained in this work are a = 6.034(2) Å, b = 12.331(4) Å, c o , V = 429.44(2) Å3 . The space group obtained for all the samples of different morphology is P212121 and this is a noncentrosymmetric crystal group which an essential condition for Second Harmonic Generation (SHG) in L-alanine material. The obtained XRD data for L-alanine crystal are found to be in good agreement with the data reported in the literature [22].
Measurement of SHG
The second harmonic generation (SHG) behavior of the powdered form of all the four samples of this work l was tested using the Kurtz and Perry method [23]. A high intensity Nd:YAG laser (λ=1064 nm) with a pulse duration of 6 ns was passed through the powdered sample. The green light was detected by a photomultiplier tube (PMT) and displayed on a Cathode Ray Oscilloscope(CRO). KDP crystal was powdered into identical size as that of the sample and it was used as reference material in the SHG measurement. The SHG was confirmed from the output of the laser beam having the green emission (λ=532 nm). The SHG efficiency of all the grown samples (LA1, LA2, LA3, LA4) are observed to be almost same and it is 0.322 times that of KDP crystal.
CONCLUSIONS
Solubility of L-alanine crystals was measured for various temperatures in the range 30-50 oC and it is observed that it increases with temperature. Metastable zonewidth was measured by finding nucleation temperature for the aqueous solution of L-alanine saturated at different temperatures. Classical theory of nucleation kinetic process was detailed and induction period was measured for Lalanine sample and it decreases with the supersaturation level and this leads to increase in the rate of nucleation of the crystals. Critical nucleation parameters such as interfacial tension, radius of critical nucleus, Gibbs free energy change and number of molecules in the critical nucleus were calculated. Growth of bulk single crystals of L-alanine was performed by solution method and it is observed that there is a change of morphology of crystals when supersaturation level of the solution is altered. Single crystal XRD study reveals the orthorhombic structure of the grown crystals. The measured SHG efficiency of the grown samples was found to be 0.322 times that of KDP crystal.
ACKNOWLEDGEMENT
The authors are grateful to Department of Science and Technology (DST ) and University Grants Commission (UGC) , Government of India for the financial support to carry out this work. Also the authors are thankful to the management of Aditanar College of Arts and Science, Tiruchendur for the encouragement given to us to carry out the research work.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareAWARENESS AND PRACTICES OF BIOMEDICAL WASTE MANAGEMENT AMONG NURSING STAFF OF A HOSPITAL ATTACHED TO A TEACHING INSTITUTE
English7984Mohan M RautEnglish Umesh S JogeEnglish Vilas R MalkarEnglish Sonali G ChoudhariEnglish Harshada M UghadeEnglishTitle: Awareness and Practices of Biomedical Waste Management Among Nursing Staff of A Hospital Attached To A Teaching Institute Objectives -1) To study the awareness and practices about biomedical waste management among nursing staff 2) To assess the use of personal protective measures against biomedical waste. Methodology: A hospital based cross-sectional study conducted among 152 nursing staff. Information regarding awareness and practices of biomedical waste management such as of BMW rules, biohazard symbol, colour coded containers and use of personal protective devices was collected. The actual practice of handling biomedical waste in wards was observed during the morning hours of OPDs. Results: In the present study knowledge about biomedical waste management rules was found in
131(86.18%) study subjects while about 135(88.81%) were aware about bio-hazard symbol printed on bags. About 124(81.57%) nursing staff were aware about risk of transmission of various diseases including HIV/Hepatitis B and injuries due to hospital waste. Knowledge of color code of containers for segregation of biomedical waste in study subjects was good. Most of the study subjects gave a correct answer for Human anatomical waste 137(90.13%), cotton or bandages soiled with blood, pus 122(80.26%). As far as practice of biomedical waste management is concerned it was revealed that 130(85.52%) disposed the biomedical waste in specified colour coded container correctly. Only 66(43.42%) reported injuries due to improperly disposed sharps. With regard to use of personal protective measures 45(29.6%) study subjects used a combination of hand gloves, apron, mask and antiseptic lotion for prevention of disease. Conclusion: Continuous monitoring and evaluation of biomedical waste management is necessary to ensure that policies and procedures are followed. Even a small proportion of badly managed waste can potentially be dangerous.
EnglishBiomedical waste, Nursing staff, Awareness, PracticesINTRODUCTION
According to Biomedical Waste (BMW) Management and Handling rules, 1998 of India ?Biomedical Waste? means any waste which is generated during the diagnosis, treatment or immunization of human being or animal in research activities pertaining thereto or in the production or testing of biological.(1) In the persuasion of the aim of reducing health problems, eliminating potential risks and treating sick people, healthcare services inevitably create waste which itself may be hazardous to health. The waste produced in the course of healthcare activities carries a higher potential for infection and injury than any other type of waste. Inadequate and inappropriate knowledge of handling of healthcare waste may have serious health consequences and a significant impact on the environment as well. (2) Advances in medical facilities with the introduction of sophisticated instruments has increased the waste generation per patient in health care units. The rapid mushrooming of hospitals has increased the quantity of hospital waste production. Appropriate waste management system have been developed and installed globally to handle both hazardous and non-hazardous BMW. The Ministry of Environment and Forests notified the BMW (Management & Handling) law in 1998. (3) Though legal provisions exist to mitigate the impact of hazardous and infectious hospital waste on the community, still these provisions are yet to be fully implemented. The absence of proper waste management, lack of awareness about the health hazards from BMW, insufficient financial and human resources and poor control of waste disposal are the most critical problems connected with healthcare waste.(4) Nursing staff is a first level professional who provides direct patient care during duty shift and assist in management of wards/departments. While attending to the above activities BMW is generated. The role of nurses in BMW management is very important. The head nurse should keep an inventory of materials required and check for an adequate supply. Nursing staff should enquire that waste bags are tightly closed. Senior nursing officer is responsible for training new nurses in BMW handling and management. (5) Hence to explore the various issues in safe management of healthcare waste the present study was undertaken among nursing staff with the objectives to study the awareness and practices about BMW management and to assess the use of personal protective measures against BMW. MATERIAL AND METHODS The present hospital based descriptive cross sectional study was conducted in 500 bedded hospital attached to a teaching institute in district Akola of Maharashtra state during the period 1st October to 31st December 2009. The hospital generates about 250 gm waste per bed per day. The permission from head of institution and clearance from ethics committee was obtained before starting the study. Survey started with the necessary consent of the matron and verbal consent of the respective study participants. Total 152 nursing staff were interviewed by predesigned and pretested questionnaire. Before administering the questionnaire the purpose of the study was explained to all participants. The questionnaire was prepared in local language and had a set of questions based on knowledge and practices regarding BMW management. Initially the introductory information of study subject was filled in and then one to one interview began and it took approximately 15 minutes for each participant. Information regarding awareness and practices of BMW Management such as of BMW rules, biohazard symbol, colour coded containers and use of personal protective devices was collected. The actual practice of handling BMW in wards was observed during the morning hours of OPDs i.e. 9:00 a.m. to 1.00 p. m. and noted in observation checklist. All data forms underwent scrutiny for logical inconsistencies, skip patterns and missing values. The data were coded and double entered into a database. The data entry interface was designed to check for referential integrity, missing values and acceptability constraints. Errors identified at any level were referred back to the field for correction. Analysis was done by using suitable statistical methods Anonymity of the participants was maintained throughout the study RESULTS In the present study knowledge about BMW management rules was found in 131(86.18%) study subjects while about 135(88.81%) were aware about bio-hazard symbol printed on bags. About 124(81.57%) nursing staff were aware about risk of transmission of various diseases including HIV/Hepatitis B and injuries due to hospital waste. Majority 145(95.39%) of subjects were in favour of disinfection of waste before disposal and 137(90.13%) agreed that incinerator is the best method for BMW disposal. (Table 1) Knowledge of color code of containers for segregation of BMW in study subjects was good. Most of the study subjects gave a correct answer for colour code of containers for BMW such as Human anatomical waste 137(90.13%), cotton or bandages soiled with blood, pus 122(80.26%), catheters 141(92.76%), empty saline bottles 129(84.86%). But on the other hand very few 13(8.55%) and 9(5.92%) study subjects knew the color code of expired medicines and ointment tubes respectively. (Table 2) As far as practice is concerned it was revealed that 130(85.52%) study participants disposed the BMW in specified colour coded container correctly and 115(75.65%) disposed sharps in puncture proof containers. Only 66(43.42%) nursing staff reported injuries due to improperly disposed sharps and 105(69.07%) correctly disinfected waste before disposal. (Figure 1) With regard to use of personal protective measures, 45(29.6%) nursing staff used a combination of hand gloves, apron, mask and antiseptic lotion for prevention of diseases while most of the study subjects used one or other device. Surprisingly 9(5.92%) of the study subjects did not use any type of safety measure while handling biomedical waste. (Table 3) Gross observation in wards: Syringe and needle cutter were available in 80% wards while IEC regarding BMW was depicted in about 50% wards. BMW was transported from ward to segregation room in plastic color bags put in trolley and then finally it was sent to final disposal site. The duty of waste collection was entrusted to sanitary staff. Though most of the staff knew the importance of incineration in BMW management but unfortunately the incinerator in hospital is not working since a considerable amount of years. The hospital has a sound record keeping system about amount of hospital waste generation and its disposal. DISCUSSION In present study knowledge about BMW management rules was found in 86.18% study participnats. Similar findings were reported by Mathur V et al(2) (91.7%), Saini S et al(6) (60%) and Mathew S et al(7) (73.7%) while findings by Sharma S(8) (25.1%) contradicts the present finding. About 88.81% of nurses were aware about bio-hazard symbol printed on bags which was consistent with the results of Mathew S et al(7) (86.8%), Naik A et al(9) (90%). Health care waste is hazardous because of its composition and ability to transmit infectious diseases including HIV/AIDS and hepatitis B and C.(10) About 81.57% study participants knew about risk of transmission of HIV/Hepatitis B and C, injuries due to BMW and similar findings (82%), (83.33%), (91%), (92.1%) were reported by(2,7,9,11) respectively. 95.39% participants knew the importance of disinfecting the hospital waste before disposal which is more or less in agreement with Mathur V et al(2) (78.3%). Under BMW law 1998, the heart of the law is segregation at origin. Segregating potentially infectious material from the other waste at the point of generation may reduce both volume and cost. (12) Segregation and color coding of containers is probably the most important pivotal point and crucial for further waste management. Improper colour coding ultimately results in an incorrect method of waste disposal. This may lead to failure of the whole system.(2) It is expected that nursing staff should have 100% knowledge of colour code of containers of BMW. In present study it ranged from 5.92% to 92.76%. Findings of the present study are more or less in accordance with the studies conducted by Saini S et al (5) , Naik A et al (6) while these are in contrast with(2) . Low level of knowledge is mainly attributed to poor training facilities which can be improved by intensive training of health worker at all levels. About 85.52% nursing staff disposed waste in specified colour coded container and 75.65% nurses disposed sharps in puncture proof containers which is in agreement with Mathur V(2) (73.3%) and (71.6%) respectively. The practice of reporting of injuries resulting from improperly disposed biomedical waste was found to be low (43.42%) among the study subjects. Stein et al (12) in their study revealed only 37% nurses reported that they ever suffered needle stick injury while(2,8) got the figure as 30% and 40% respectively. Low reporting of injuries may be attributed to the fact that most of the staff are unaware about a formal system of injury reporting which should be established within all the health facilities. It was noticed that the though the nursing staff knew about the disinfection of waste before disposal, not all were practicing it. Lack of effective supply is the reason stated by majority. In the present study about 29.6% nursing staff used a combination of hand gloves, apron, mask and antiseptic Lotion for prevention. Most of the study subjects used one or other preventive device like gloves by 143(94.08%) which is similar to study by Tuduetso Ramokate and Debashis Basu(11) where out of 150 study participants 122(95%) always used gloves while handling BMW. The current status of employees‘ awareness about safety measures practices for BMW management will help the authorities to create strategy for improving the status in future. The BMW management practices in the hospital were satisfactory, except for a deficiency in supply of needle-cutters in a few wards. This is a typical example of an obstacle coming in the way of a mandatory practice, due to a problem of logistics. It is incumbent upon those responsible for procurement of supplies to ensure timely replacement of such items. Again the IEC material regarding BMW was also lacking in significant number of wards. In such a case it would be better to include all these supplies in the stock items like other disposables and items of regular use, which are stocked in the hospital and provided on demand immediately without loss of time. CONCLUSION Thus continuous monitoring and evaluation of BMW management is necessary to ensure that policies and procedures are followed. Even a small proportion of badly managed waste can potentially be dangerous. Recommendations The WHO acknowledges BMW management as a problem and observes that the human element is as important as technology in waste management. There should be institutional initiatives, sustained dialogues, training and interactions of hospital staff regarding biomedical waste management so that the personal protective measures could be used meticulously and safety management of hospital waste would be possible.
ACKNOWLEDGEMENT
The author would like to thank all the study participants for sharing their time for the interview. Authors also acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1717http://ijcrr.com/article_html.php?did=17171. The Gazette of India; Extraordinary, Ministry of Environment and Forest, Notification, New Delhi, 20th July 1998,http//delhigovt.nic.in/dept/health/bmwco m.pdf or http://envfor.nic.in/legis/hsm/biomed.html.
2. Vanesh Mathur, S Dwivedi, MA Hassan, and RP Misra: Knowledge, Attitude, and Practices about Biomedical Waste Management among Healthcare Personnel:Indian J Community Med. 2011 Apr-Jun; 36(2): 143–145.
3. Bhagya Bhaskar, Hema Nidugala, Ramakrishna Avadhani: Biomedical waste management – knowledge and Practices among healthcare providers in mangalore: Nitte University Journal Of Health Science. Vol 2,No 1,March 2012,ISSN 2249-7110.
4. Plianbangchang PH. W.H.O. Publication; ?A Report on Alternative Treatment and NonBurn Disposal Practices?; Safe Management of Bio-medical Sharps Waste in India.
5. Bio- Medical Waste Management- Self Learning Document for Nurses and paramedical. WHO, India country office , New Delhi
6. Saini S, Nagarajan SS, Sarma RK: Knowledge, Attitude and Practices of Biomedical Waste Management Amongst Staff of a Tertiary Level Hospital in India. Journal of the Academy of Hospital Administration, 2005; 17 (2): 1 – 12.
7. Savan Sara Mathew, A. I. Benjamin, Paramita Sengupta. Assessment of biomedical waste management practices in a tertiary care teaching hospital in Ludhiana. Health line, 2011 Dec; 2(2): 28-30.
8. Shalini Sharma. Awareness about biomedical waste management among healthcare personell of some important medical centers in Agra. International Journal of Environmental science and Development. Vol 1, No 3, August 2010-251-255.
9. Ashish Naik, Bhautik Modi, Bansal R K. Biomedical Waste Handling practices in urban health centre of Surat Municipal Corporation. National Journal of Community Medicine; Vol 3, issue 1 Jan-March 2012.
10. World Health Organization. WHO Fact Sheet no. 281. 2004. Geneva, Switzerland: World Health Organization. http://www.who.int.org.
11. Tuduetso Ramokate, Debashis Basu. Health care waste management at an academic hospital: knowledge and practices of doctors and nurses. Health - South African Medical Journal, June 2009.
12. Stein AD, Makarawo TP, Ahmad MF. A survey of doctors‘ and nurses‘ knowledge, attitudes and compliance with infection control guidelines in Birmingham teaching hospitals. J Hosp Infect. 2003; 54:68–73.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareARCHITECTURAL VARIATIONS ON THE EXTERNAL SURFACES OF LIVER
English8589B. Senthil KumarEnglish A. AnandEnglishBackground: In modern era of surgical advances, liver transplantations play an important role in enhancing the quality of life. Liver transplantations are now performed in many tertiary centers in our country. However in Indian population, very few studies exist regarding variations in the external architecture of liver. Aims and Objectives: To categorize the variations of external architecture of liver Materials and Methods: About 175 formalin fixed liver were utilized for the study. During routine dissection, liver was observed for architectural changes; variations in the size and shape of lobes, accessory lobes, unusual fissures, and unusual nodulated appearances were noted. Result: Varied shapes of both right and left lobes of liver were observed which included hypoplasia of left lobe, bifid caudate process, caudate lobe with papillary process , right lobe showing deep fissures, variations in the shape of Quadrate lobe, and the exit of ligamentum teres, segmented right lobe, hardened impression of ribcage on anterosuperior and lateral surfaces. Conclusion: A thorough knowledge of the architectural variations of the liver will help the surgeons while planning for surgery.
EnglishLiver Lobes, Hypoplasia, FissuresINTRODUCTION
Liver is the most important and largest gland in the human body performing various metabolic functions. It occupies most of the right hypochondrium and epigastrium, and extends into the left hypochondrial quadrants as far as the left midclavicular line. The liver has superior, anterior, right, posterior and inferior surfaces, and has a distinct inferior border. The liver is divided into right and left anatomical lobes by the falciform ligament and the fissure for ligamentum venosum. The right lobe includes quadrate and caudate lobes which are demarcated by fissures for ligamentum venosum and ligamentum teres on right side and groove for inferior vena cava and the fossa for gall bladder on left side. [1] Congenital anomalies of the human liver are usually rare. [2] It could be very high in some populations but the reason why we do not notice them very often is that these cases are usually asymptomatic. [3] There are many kinds of congenital abnormalities of the liver which have been described in literature such as agenesis of its lobes, absence of lobes, lobar atrophy, hypoplastic lobes, transposition of gall bladder and Reidel‘s lobe. [3] The knowledge of anomalies of liver is very much important for surgeons during hepatectomy and oncologists especially when they handle liver tumors and during resection of the primary or metastatic tumors. The major fissures are important for interpretation of lobar anatomy and to help locate the lesions in the liver during hepatic imaging. [4] Any defect during organogenesis of liver by mutation of transcription gene factor leads to hepatic anomalies which are divided into 2 categories like Defective development, and Excessive development. [5] The study was carried out to categorize the variations of external architecture of liver.
MATERIALS AND METHODS
About 175 formalin fixed livers were utilized for the study with digital photographic equipment, dissecting instruments and measuring scale. During routine dissection, the abdomen was exposed, positions of the liver in all cadavers were noted, after which careful dissection was done and the liver was delivered out of the abdominal cavity and examined. Pathological specimens were excluded from the purpose of study. The liver was observed for architectural variations, variations in the size and shape of lobes, the papillary process of the liver was measured, accessory lobes, unusual fissures, unusual nodulated appearances were noted. The deep fissures were measured using a measuring scale and observed carefully for any peritoneal attachments and blood vessels deep inside these fissures. The observations were documented. RESULTS Varied shapes of both right and left lobe of liver were observed in this, hypoplasia of left lobe was 16%, bifid caudate process was 20 %, caudate lobe with papillary process was 12 %, right lobe showing deep fissures 18 %, variations in the shape of Quadrate lobe 8 is %, variation in the exit of ligamentum teres 10 %, segmented right lobe 8%, hardened impression of ribcage on anterior and lateral surface of liver 6 %, Nodules on external surface of liver 2% (Table 1).
DISCUSSION
Very rarely the hepatic lobe is absent in liver which can be noticed only during the cadaveric dissection, autopsy, or on the operating table during surgery. The hepatic lobe anomalies are not always congenital. Congenital agenesis of liver lobes affect left lobe more than the right lobe of liver. [6, 7, 8] In this study the left lobe of the liver shows hypoplasia in about 16% of the dissected specimens (Fig 1) but absence of lobes was not observed during the present study. In about 20% of dissected livers bifid caudate process was observed (Fig 2). The caudate lobe has two separate portions which are intervened by inferior vena cava, one to the left is called as Spiegel‘s lobe and the other to the right extending as caudate process is called as the paracaval portion, both parts are bridged by the caudate isthmus. Kogure et al noted the presence of notch on the inferior border of the liver in many patients undergoing hepatectomy. [9] The existence of external notch between Spiegel‘s lobe and the paracaval portion was taken as an index to separate both the portions of the caudate lobe. Sahni et al found out that the prevalence of a notch appearing decreases with advancing age. [10] The presence of an external notch continuing as vertical fissure on the caudate lobe gives a bifid appearance of the caudate process. Joshi et al reported that 33% of livers showed prominent papillary process. [4] In the present study only 12% of the dissected livers the caudate lobe showed prominent papillary process (Fig 3). The Papillary process was measured which was in a range of 4 to 5 cm. Auh et al reported that on a computed tomography even normal size or small papillary process can be misinterpreted with an enlarged hepatic lymph node whereas an enlarged papillary process mimics a pancreatic body mass when it extends to the left and displaces the body of stomach anteriorly. [11] 18% of dissected livers showed accessory deep fissures which were 3 to 4 in number on the inferior surface of the right lobe (Fig 4). Joshi et al reported that 2 to 5 accessory fissures with veins in the depth of fissure were seen on the inferior surface of the right lobe of liver. [4] In our study no such veins were observed in the depth of the fissures. Some accessory fissures were also seen prominently in the quadrate lobe. The presences of accessory fissures are a potential source of diagnostic errors during imaging. [11] The quadrate lobe showed variations in shape (8%). The various shapes included pear shape, rectangular, triangular, pointing tongue like process as reported by joshi et al. [4] In the present study, the shape varied from being pear shapes to triangular shapes (Fig 5). Some quadrate lobes showed prominent fissures and tongue like processes measuring about 1 - 2 cm which was directed towards the fossa for gall bladder. A narrow or buried or a small quadrate lobe creates confusion during radiological investigation, which can be mistaken as the fissure for ligamentum teres which will be nearer to the left margin of the fossa for gall bladder. [4] The fissure for the ligamentum teres is considered to be an important landmark for measuring the right and the left lobes. The Pons hepatis usually bridges the fissure for the ligamentum teres by joining the quadrate lobe with the left lobe. Joshi et al reported that the Pons hepatis can be seen bridging the upper third of fissure, present in depth of fissure, and completely bridging the fissure. [4] In all our cases the pons hepatis was bridging the upper two thirds of the fissure and gave the appearance as if the ligamentum teres was exiting from a tunnel (10%), and was hanging down freely which was not usually normal (Fig 6). In about 8% of dissected livers it was observed that 2 to 3 segmentations of the right lobe of liver which was due to the presence of accessory fissure on the right lobes (Fig 7) which can give rise to a false interpretation about the lobes of liver during radiological investigations. 6% of dissected livers showed hardened impressions which looked like prominent vertical grooves on the anterosuperior surface. A higher incidence of such grooves was observed by Macchi et al and Auh et al. [12, 13] According to Schafer and Symington and De Burlet (as quoted by Macchi et al), prominent vertical grooves are called as diaphragmatic sulci which results from an uneven growth of hepatic parenchyma due to variable resistance offered by different bundles of diaphragmatic muscle tissue. [12] But radiological and corrosion cast studies have attributed the formation of sulci due to the existence of weak zones of hepatic parenchyma which represent the portal fissures between adjacent portal territories. Thus these weak portions exert lower resistance to external pressure exerted by the diaphragm which can be accentuated by a prominent rib cage. These tend to be a landmark for surface projections of portal fissures and hepatic veins and its tributaries which run through them. [12] Collection of fluid in these fissures can be mistaken for liver cysts, intrahepatic hematomas or as a liver abscess [14] Nodules were also observed on the external surface of liver (2%) which has been hitherto unreported (Table 1).
CONCLUSION
Liver transplantations are being performed from blood relatives only and very rarely the donor is not a relative. The era of cadaveric liver transplantations is not far away. A thorough knowledge of architectural variations of the liver like the present study will serve as an eye opener for endocrine surgeons and surgical gastroenterologists in future.
Englishhttp://ijcrr.com/abstract.php?article_id=1718http://ijcrr.com/article_html.php?did=17181. Standring S, Healy JC, et al. Liver. In: Standring S, ed. Gray‘s Anatomy: The Anatomical Basis of Clinical Practice. 39th ed. London: Elsevier Churchill Livingstone, 2005: 1213-25
2. Abdullahi D Zagga, Azziz A Tadros, Jibrin D Usman, Abubakar Bello. Absence of the left lobe of liver in cadaver: case report 2010; 12: 45-47.
3. Aktan ZA, Savas R, Pinar Y, Arslan O. Lobe and segment anomalies of the liver. J Anat Soc India 2001; 50: 15-16.
4. Joshi SD, Joshi SS, Anthavale SA. Some interesting observations on the surface features of the liver and their clinical implications. Singapore Med J 2009; 202(pt 3): 715-19
5. Chiba S, Suzuki T. A tongue- like projection of the left lobe in human liver, accompanied with lienorenal venous shunt and intrahepatic arterial anastomosis. Okajimas Folia Anatomica Japonica; 68(1): 51-56.
6. Demirici I, Diren HB. Computed tomography in agenesis of the right lobe of liver. Acta Radiologica 1990; 31: 105-6.
7. Kakitsubata Y, Kakitsubata S. Anomalous right lobe of the liver: Ct appearance. Gastrointest. Radiol 1991; 16: 326-28.
8. Radin DR, Colleti YF. Agenesis of the right lobe of the liver. Radiology 1987; 164: 639- 42.
9. Kogure K, Kuwano H, Fujimaki N, Makuuchi M. Relation among portal segmentation, proper hepatic vein and external notch of the caudate lobe in the human liver. Ann Surg 2000; 231: 223-28.
10. Sahni D, Jit I, Sodhi L. Gross anatomy of the caudate lobe of the liver. J Anat Soc India 2000; 49: 123-26.
11. Auh YH, Rosen A Rubenstein WA, et al. CT of the papillary process of caudate lobe of the liver. Am J Roentgenol 1984; 142: 535-38.
12. Macchi V, Feltrin G, Parenti A, De Caro R. Diaphragmatic sulci and portal fissures. J Anat 2003; 202 (pt 3): 303-8.
13. Auh YH, Rubenstein WA, Zinnsky K et al. Accessory fissures of the liver: CT and sonographic appearance. AM J Roentgenol 1984; 142: 562-72.
14. Auh YH, Lim JH, Kmim KW, et al. Loculated fluid collections in hepatic fissures and recesses: CT appearance and potential pitfalls. Radiographics 1994; 14: 529-40.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31TechnologyETHANOL AS ALTERNATIVE FUEL FOR SI ENGINE - A REVIEW
English9095Abhishek Prakash VermaEnglish Alok ChoubeEnglishThe main objective of this review paper is to find effect of Ethanol (ethyl alcohol) as alternative fuel in SI engines. Since Ethanol possesses characteristic, properties that have positive influence on engine performance as well as exhaust emissions. This paper shows how ethanol can be used as fuel for SI Engines, Study is based on technical as well as quantitative data available from different researches. This Review paper is focused on two broad groups namely, effect of compression ratio and effect of ethanol blends on engine performance.
EnglishEthanol, Variable compression ratio, blending Fuel, Alternative fuelINTRODUCTION
As we know the oil crisis led many countries to search for alternative fuels to substitute conventional fuels which is clean, renewable and sustainable. Ethanol is one of the good alternative to it, since it possesses antiknock characteristics, which allow higher compression ratio, and consequently higher engine output power, also characteristics that are relevant to its environmental performance in combustion as a motor fuel[13]. The exhaust gas from SI Engine contain not only normal product of nitrogen, water vapour, and carbon dioxide but also contain carbon monoxide, hydrogen oxygen, unburned gasoline, and other traces of hydrocarbons plus traces of aldehydes, alcohols ketones , etc [20]. Although fossil fuel have became the dominating energy resource for the modern world. alcohol has been used as a fuel through history, the first four aliphatic alcohol (methanol, ethanol propanol, butanol) are the area of interest as they can be synthesized biologically[2] and they have characteristics which allow them to use in now a day's automotive engines. Ethanol is a known ?octane enhancer‘ and ?oxygenate‘. An octane enhancer is a component added to petrol to increase the research octane number (RON) and to reduce engine knock. An oxygenate is a fuel octane component containing hydrogen, carbon and oxygen in its molecular structure.
Bio- Fuel Ethanol
There is no chemical difference between biologically produce alcohol and those obtain from other resources. Due to the high evaporation heat, high octane number and high flammability temperature, ethyl alcohol has positive influence on the engine performance and increases the compression ratio. Variable compression [ 19] Ethanol can be used as an automotive fuel by itself and can be mixed with petrol to form an ethanol/petrol blend. The most common uses are: a) 10% ethanol (known as E10); b) 85% ethanol (known as E85); This blend is used in some states of the US and requires particular vehicle technology known as ?Flexible Fuel Technology‘ (FFT). c) 20 - 24% ethanol (known as E22); d) 100% ethanol (E100); This is also used in Brazil and requires vehicle technology dedicated to the fuel.
Literature Review
Effect of Compression ratio on engine performance : Rodrigo93 [4] presents the effect of compression ratio on engine performance, parameter evaluated were brake mean effective pressure power, specific fuel consumption thermal efficiency exhaust gas temperature volumetric efficiency. In this the effect of compression ratio on the performance of an engine fuelled by hydrous ethanol have been investigate. The result shows that high compression ratio increases cylinder pressure thus increasing the work done on the piston and consequently torque and brake mean effective pressure . Ethanol was used as fuel at high compression ratio to improve performance and to reduce emissions in a small gasoline engine with low efficiency Experiments in variable compression ratio singlecylinder engines fuelled by blends of gasoline and ethanol with different concentrations have been performed by Celik [13], In his study, initially, the engine whose compression ratio was 6/1 was tested with gasoline, E25 (75% gasoline + 25% ethanol), E50, E75 and E100 fuels at a constant load and speed. It was determined from the experimental results that the most suitable fuel in terms of performance and emissions was E50. Then, the compression ratio was raised from 6/1 to 10/1. The engine was tested with E0 fuel at a compression ratio of 6/1 and with E50 fuel at a compression ratio of 10/1 at full load and various speeds without any knock. The experimental results showed that engine power increased by about 29% when running with E50 fuel compared to the running with E0 fuel. Moreover, the specific fuel consumption, and CO, CO2, HC and NOx emissions were reduced by about 3%, 53%, 10%, 12% and 19%, respectively. Yuksel [5]. attempted to determine a suitable ethanol-gasoline blend for spark ignition engine operation, varying compression ratio. Engine output power and HC emissions were optimized with compression ratio 6:1 and 2000 rev/min, using E50 as fuel. With increasing ethanol concentration in the fuel, specific fuel consumption continuously increased, while CO, CO2 and oxides of nitrogen (NOx) emission levels were decreased. The result shows operating the engine with E50 and compression ratio 10:1 simultaneously improved all engine performance and emission parameters in comparison with gasoline and compression ratio 6:1. In the experimental study of Al-Hasan [12], the effects of usage of unleaded gasoline–ethanol blends on spark ignition engine performance and exhaust emission were investigated. The results showed that ethanol addition leads to an increase in brake power, brake thermal efficiency, volumetric efficiency and fuel consumption by about 8.3%, 9%, 7% and 5.7% mean average values, respectively. The best result at the engine performance and exhaust emissions was obtained by usage of 20% ethanol fuel blend. Topgul[7]the effect of compression ratio on engine performance and exhaust emissions was examined at stoichiometric air/fuel ratio, full load and minimum advanced timing for the best torque MBT in a single cylinder, four stroke, with variable compression ratio and spark ignition engine The fuels containing high ratios of ethanol; E40 and E60 had important effects on the reduction exhaust emissions. The maximum decrease was obtained with E40 and E60 fuels at 2000 rpm engine speed. Mustafa [14] shows the effects of unleaded gasoline (E0) and unleaded gasoline–ethanol blends (E50 and E85) on engine performance and pollutant emissions were investigated experimentally in a single cylinder four-stroke spark-ignition engine at two compression ratios (10:1 and 11:1). The engine speed was changed from 1500 to 5000 rpm at wide open throttle (WOT). The results of the engine test showed that ethanol addition to unleaded gasoline increase the engine torque, power and fuel consumption and reduce carbon monoxide (CO), nitrogen oxides (NOx) and hydrocarbon (HC) emissions. Bakhatyar [6 ] It was also found that ethanol–gasoline blends allow increasing compression ratio (CR) without knock occurrence. Owen and Coley [11] pointed out as one of the main advantages over hydrocarbon fuels, allowing for the use of higher compression ratios and, consequently, the production of higher engine output power. Osman et.al. [1] investigated the effect of ethanol–gasoline blends (E10, E20, E30 and E40) on engine performance and emissions at various compression ratios (8, 10, and 12). For each fuel blend, there is an optimum compression ratio that gives maximum indicated power. In this study, optimum compression ratios were found to be 8, 10 and 12 for E10, E20 and E30 fuels, respectively. Celik [13] carried out study to determine the suitable ethanol–gasoline blend rate in terms of performance and emissions for small engines, and to investigate experimentally the improvement of the performance and emissions by testing the engine with suitable ethanol–gasoline blend fuel at high compression ratio without any knock. Ibraham[9 ] The experiments in engine fuelled with four types of fuels blends included the brake power, brake thermal efficiency, exhaust temperature, and brake fuel consumption under various speeds, test runs were made on straight gasoline fuel in order to make comparative assessments The brake power of the engine increases with the engine speed increases for all fuels
Effect of Ethanol on Engine Performance
Zlata [18] pointed out the characterized evaluation of hydrocarbon composition, vapour pressure increases due to formation of azeotropes. The water solubility was increased with higher unsaturated hydrocarbons in petrol also the ethanol content in petrol blend was decreased by water extraction. Ceviz and Yuksel [15] shows that A small amount of cyclic variability (slow burns) can produce undesirable engine vibrations. On the other hand, a larger amount of cyclic variability (incomplete burns) leads to an increase in hydrocarbon consumption and emissions. This paper investigates the effects of using ethanol–unleaded gasoline blends on cyclic variability and emissions in a spark-ignited engine. Results of this study showed that using ethanol–unleaded gasoline blends as a fuel decreased the coefficient of variation in indicated mean effective pressure, and CO and HC emission concentrations, while increased CO2 concentration up to 10vol.% ethanol in fuel blend. On the other hand, after this level of blend a reverse effect was observed on the parameters aforementioned. The 10vol.% ethanol in fuel blend gave the best results. Costa and Sodré [4] compared hydrous ethanol and gasoline ethanol blend (E22) with regard to engine performance and exhaust emissions. The use of hydrous ethanol slightly improved engine torque and output power at high engine speeds, but, due to its lower heating value, it also increased specific fuel consumption in comparison with gasoline. Thermal efficiency was higher when ethanol was used instead of gasoline, as combustion duration was shorter. CO and HC emissions were reduced when ethanol was used, once the presence of oxygen in the ethanol molecule helps to oxidize those components; however, NOx emissions were increased, as higher combustion temperatures were attained. The engine performance and the pollutant emission of a commercial SI engine were investigated by using an ethanol–gasoline blend fuel [5]. Experimental results indicated that using ethanol–gasoline blended fuel, the torque output consumption an increase in the specific fuel consumption and a decrease in the engine torque and power output measurements were observed. Mostly alcohol react with rubber, copper, brass parts which cause a jam in the fuel pipe. Therefore, it is advised to use fluorocarbon rubber as a replacement for rubber[17,21] Owen and Coley[11].The anti-knock characteristic of alcohols was pointed out, also the higher heat of vaporization of alcohols under high temperatures and the faster flame speed permit increased fuel conversion efficiency in comparison with gasoline. Moreover, alcohol combustion generates higher product volume, thus increasing cylinder pressure and the work done on the piston. On the other hand, the smaller low heating value of alcohols results in increased specific fuel consumption in comparison with gasoline, i.e. a higher mass amount of alcohol is required per unit power produced. Cold start is also a problem for alcohol fuels, due to their low vapour pressure Hesis et al. [16] tested fuel with 99.9 pure Ethanol in volumetric ratios 0-30% with gasoline, nearly same torque was obtain with different ratios of ethanol gasoline blends when compared with gasoline E0, better combustion can be achieved and higher torque can be obtain. Topgul et al. [5] examined the effects of ethanol– gasoline blends (E0, E10, E20, E40, E60) and ignition timing on performance and emissions. The result showed that the brake torque slightly increased, and CO and HC emissions decreased with ethanol–gasoline blend was. It was also found that blends with ethanol allowed the compression ratio to increase without any knock. Rong [20] shows the effects of ethanol gasoline blended fuel on cold-start emissions of an SI engine, the engine could be started stably with E5, E10, E20, and E30. The HC and CO emissions decreased significantly with more ethanol than 20% added. However, for E40 the engine idling became unstable because the air-fuel mixture was too lean. C. Ananda[3] examined effects of ethanolblended gasoline with oxygenated additives on a multi – cylinder Spark Ignition (SI) Engine. The experiments were conducted in two stages. The experimental results proved that the blend increased brake thermal efficiency more than a sole fuel, such as gasoline. The emission tests found that the CO slightly decreased, while HC and O2 increased moderately and CO2 and NOx appreciably decreased. Exhaust gas recycle (EGR) is the principal technique used for control of SI engine NO, emissions A fraction of the exhaust gases are recycled through a control valve from the exhaust to the engine intake system. The recycled exhaust gas is usually mixed with the fresh fuel-air mixture just below the throttle valve. EGR acts, at part load, as an additional diluents in the unburned gas mixture, thereby reducing the peak burned gas temperatures and NO formation rates.[10]
CONCLUSION
From the literature review, it is understood that there are slight increases or decreases in Engine performance when the ethanol and ethanol– gasoline blends are used at the original compression ratio in the engines, Emissions like CO, HC, and NOx decrease.. At higher compression ratio, power increases and fuel consumption decreases, and increase in thermal efficiency when hydrous ethanol was used [4]. The compression ratio of air-cooled small engines is low, in air-cooled small engines, exhaust gas temperature are higher [5] the knock tendency is also higher. Thus, the compression ratio is kept lower in these engines to prevent knock. Ethanol addition to gasoline leads to leaner operation and improves combustion ,Engine performance parameters such as effective power and effective efficiency increase with increasing ethanol amount in the blended fuel as a result of improved combustion[6]. Significant improvements can be obtained in power and efficiency if the small engines with low compression ratio can be run at higher compression ratios using fuels resistant to the knock. Ethanol has high octane number, both permits the rising of the compression ratio and gives lower emission. The bio- ethanol is a suitable substitute for fossil fuel whose reserve is limited , since Ethanol is also eco friendly fuel, easily available, cheaper than gasoline.
ACKNOWLEDGEMENT
Author acknowledge the immense help from the scholar whose article are cited and included in reference of this manuscript. The author are also grateful to author/editors/ publisher of all those article, journal, and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1719http://ijcrr.com/article_html.php?did=17191. A.A. Abdel-Rahman, M.M. Osman, Experimental investigation on varying the compression ratio of SI engine working under different ethanol–gasoline fuel blends, International Journal of Energy Research 21 (1997) 31–40
2. Carlos A. Cardona, Oscar J. Sanchez, Fuel ethanol production: Process design trends and integration opportunities
3. C. Ananda Srinivasan and C.G. Saravanan Study of Combustion Characteristics of an SI Engine Fuelled with Ethanol and Oxygenated Fuel Additives Journal of Sustainable Energy & Environment 1 (2010) 85-91
4. Costa RC, José R. Sodré, Compression ratio effects on an ethanol/gasoline fuelled engine performance, Applied Thermal Engineering 31 (2011) 278-283
5. Fikret Yu ksel , Bedri Yuksel, The use of ethanol–gasoline blend as a fuel in an SI engine, Renewable Energy 29 (2004) 1181– 1191
6. Hakan Bayraktar, Experimental and theoretical investigation of using gasoline– ethanol blends in spark-ignition engines Renewable Energy 30 (2005).
7. Hu seyin Serdar Yu cesu , Tolga Topgul, Can Cinar, Melih Okur, Effect of ethanol–gasoline blends on engine performance and exhaust emissions in different compression ratios, Applied Thermal Engineering 26 (2006) 2272–2278
8. H. Serdar Yucesu , Adnan Sozen , Tolga Topgul , Erol Arcaklioglu, Comparative study of mathematical and experimental analysis of spark ignition engine performance used ethanol–gasoline blend fuel
9. Ibrahim Thamer Nazzal Experimental Study of Gasoline –Alcohol Blends on Performance of Internal Combustion Engine European Journal of Scientific Research ISSN 1450- 216X Vol.52 No.1 (2011), pp.16-22
10. J.B. Heywood, Internal Combustion Engine Fundamentals. McGraw-Hill Book Company, Singapore, 1988
11. K. Owen, T. Coley, Automotive Fuels Reference Book, second ed. Society of Automotive Engineers, USA, 1995.
12. M. Al-Hasan, Effect of ethanol–unleaded gasoline blends on engine performance and exhaust emission, Energy Conversion and Management 44 (9) (2003) 1547–1561
13. M. Bahattin Celik, Experimental determination of suitable ethanol–gasoline blend rate at high compression ratio for gasoline engine, applied thermal eng. 28(2008) 396-404.
14. Mustafa Koç a, Yakup Sekmen b, Tolga Topgul c, Hu seyin Serdar Yucesu , The effects of ethanol–unleaded gasoline blends on engine performance and exhaust emissions in a spark-ignition engine, Renewable Energy 34 (2009) 2101–2106
15. M.A. Ceviz, F. Yüksel, Effects of ethanolunleaded gasoline blends on cyclic variability and emissions in a SI engine, Appl. Therm. Eng. 25 (2005) 917e925.
16. W. Hsieh, R. Chen, T. Wu, T. Lin, Engine performance and pollutant emission of an SI engine using ethanol–gasoline blended fuels, Atmospheric Environment 36 (3) (2002) 403– 410
17. Naegeli DW, Lacey PI, Alger MJ, Endicott DL. Surface corrosion in ethanol fuel pumps. SAE paper 971648
18. Zlata Muzikova , Milan Pospisil, Gustav Sebor, Volatility and phase stability of petrol blends with ethanol, Fuel 88 (2009) 1351– 1356
19. Environment Australia 2002, Setting the Ethanol Limit in Petrol, ISBN: 0 642 54804 8
20. Rong-Horng Chen, Li-Bin Chiang , ChungNan Chen , Ta-Hui Lin Cold-start emissions of an SI engine using ethanol gasoline blended fuel
21. V Ganesha internal combustion engine Tata Mc-graw hills 22. Edward F Obert, Internal combustion engines and air pollution , Harper International Edition
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareIMPACT OF INCIDENCE OF FALL AND STUMBLES ON THE LEVEL OF PHYSICAL ACTIVITY IN MIDDLE AGED ADULTS WITH OBESITY
English96102Janakiraman BalamuruganEnglish Rajasekaran Venkat RajEnglishBack ground: The incidence of obesity in middle age as already rose to an alarming number and many variables have been associated with the decline of level of physical activity in obese middle aged adults. However very little is been studied about the impact of falls/stumbles in decreasing the level of physical activity. Objective: The purpose of this study is (1) to examine the relationship between incidences of fall/stumbles and physical activity level in obese middle aged adults (2) to explore potential explanatory factors and preserve the level of Physical activity. Hypothesis: Incidence of falls might significantly influence the level of physical activity in obese middle aged subjects. Study design: Cross sectional, Observation study Outcome measures: Long form of International physical activity questionnaire (IPAQ) a)Categorical variable b) Continuous score-MET-min/day/week. Participants: In total 326 obese middle aged subjects of both genders between age 40-60 years (Mean age: 52.3) with BMI ?30 kg/m2 were enrolled in this study. Intervention: Not applicable Methods: Subjects were retrospectively questioned and categorized as Group A (obese fallers), N=73 and Group B (obese non fallers), N=253 using fall history questionnaire. All subjects were evaluated with base line assessment, International physical activity questionnaire (IPAQ- long term design) continuous score (MET-minutes)and categorical scoring pattern was used in IPAQ for data collection after obtaining consent. Results: Group A mean MET –min/day/week was 472.75 (S.D-288.384), Group B mean MET-min/day/week was 739.81(S.D- 341.165) in continuous score comparison .Mann- Whitney U test analysis revealed that there was a significant difference in the level of physical activity between the groups. Chi-square analysis of categorical data between groups states that the significant difference between expected and observed frequencies is not by chance alone. Conclusion: Incidence of falls/stumble is associated with decline in physical activity levels of major domains among middle aged obese subjects.
EnglishObesity, Physical activity, fall, MET, International physical activity questionnaireINTRODUCTION
Physical inactivity has been identified as the fourth leading risk factor for global mortality, causing an estimated 3.2 million deaths globally and deficiency in physical activity is one among the major reasons for obesity in many countries14 , WHO states physical activity as any bodily movement produced by skeletal muscles that require energy expenditure and an increasing levels of physical inactivity are seen worldwide, in high income countries as well as low- and middleincome countries. Recent statistics of WHO also says that currently at least 60% of world‘s population gets insufficient exercise14.Obesity is now an epidemic medical condition even in the absence of any associated diseases, so for many studies had proved that the only solution for obesity especially in middle aged people is to maintain a good level of physical activity and exercise. Body mass index is a heuristic proxy for human body fat based on height and weight, WHO recommended BMI guidelines for overweight (25.0–29.9 kg/m2 ) and obesity (≥30 kg/m2 ).In the recent past many attempts were made to find out the relationship between basal metabolic rate decline and aging. Age related decline in Basal metabolic rate is due to decrease in lean body mass17 (Lazzer S, Bedogni G 2010) which makes middle aged people gain weight easily. According to Rosenblatt NJ, Grabiner MD Unlike healthy weight fallers, most obese fallers failed to initiate or complete the recovery steps before full-body harness support. So obesity does not appear to increase the overall fall risk but fall rates after laboratory-induced trips were notably higher, potentially due to altered recovery responses. Thus in middle aged obese people a relatively high incidence of falls/stumbles occurs due to diminished static balance21 . Several studies have addressed the importance of physical activity levels and energy expenditure through activities in management of obesity. Inactive people are often not aware of their inactivity. Providing feedback on the actual physical activity level by an activity monitor can increase awareness and may in combination with an individually tailored physical activity advice stimulate a physically active lifestyle. This study aims on determining whether the incidence of fall/stumbles could significantly reduce the level of physical activity among obese middle aged subjects therefore this research would help identifying the risk group and this information would enable health care professional to better estimate the functional consequences of excess body weight thereby preserve or improve the level of physical activity as low levels of physical activity in middle aged obese individual can result in adverse health consequences.
MATERIALS AND METHOD
Subjects In this study a total of 326 obese subjects of age group between 40-60 years of both gender were randomly selected from a population of 639 community dwelling middle aged adults of Chennai. Prior to the selection, participants were subjected to baseline evaluations to check for selection criteria and details of the study were explained to the individual before obtaining consent. As a first step subjects were retrospectively questioned about the incidence of fall and stumbles in the last one year using fall history questionnaire Based on the incidence of fall/stumble the subjects were divided into group A i.e. fallers consisting of 73 subjects and group B non fallers consisting of 253 subjects. Inclusion criteria for the samples are age 40-60 years, both sexes, BMI ≥30. Exclusion criteria‘s for both groups were BMI 60 years, neurological disorders, visual impairments, musculoskeletal disorders and hypotensives.
Physical activity questionnaire
The purpose of utilizing International Physical Activity Questionnaire (IPAQ) as a measuring scale is to obtain comparable estimates of physical activity, the questionnaire is very feasible with excellent reliability for measuring physical activity in large groups or populations and it is used internationally 13 (Craig CL, Marshall AL, Sjostrom SM). The long format of IPAQ asks in detail about walking, moderate-intensity and vigorous intensity physical activity in each of four domains i.e. Work domain, Active transportation domain, Domestic and garden work domain and Leisure-time domain. Based on Continuous scoremetabolic equivalent (MET) of all four domains in minutes per day per week were calculated to get total physical activity MET scores and categorical variable of the questionnaire classifies the subjects into 3 levels, depending on their physical activity in the last seven days as high, moderate and low levels. This categorical scoring method provides different thresholds for measurement of physical activity which is useful mechanism to distinguish variation in population groups18 .
Procedure
The subjects were explained about the International physical activity questionnaire (IPAQ).Four interviewers were trained, supervised and given feedback by first author during data collection and questions were explained in native language when needed.The long version (31 items) was designed to collect detailed information within the domains of household and yard work activities, occupational activity, self-powered transport, and leisure-time physical activity as well as sedentary activity. A probe protocol were implemented by the interviewers to limit any sort of over-reporting of activities in IPAQ, after recording of time (min) of activity in four domains in each day for the last seven days.A metabolic equivalent (MET) score was assigned to each of the activities and the data collected from the long IPAQ questionnaires were summed within each physical activity domain to estimate the total time spent in occupational, transport, household, and leisure related physical activity to obtain total physical activity i.e. Total MET-minutes/week and based on the level of physical activity they were categorized as high, moderate and low. Institutional ethical committee had approved the study and the duration of data collection was a period of 4 months.
STATISTICAL ANALYSIS AND RESULTS
All statistical analysis was performed using the Statistical package for social sciences SPSS, the outcomes of IPAQ are described as mean ± standard deviation. The results were evaluated with Chi-square for categorical variables and Non parametric Mann-Whitney U test was done for MET values of the groups. Table 1 shows in group A only 1.5 % of subjects belong to high level category, when compared with 10.4 % of group B subjects, it is also evident that a total of 55.2% of subjects in group A possess optimal physical activity levels but in group B its only 10.7% .Table 2 shows Pearson chi-square proves that significant difference exist between groups (P.001) and it is not by chance alone. The mean of Group A obese fallers was 472.75 (S.D-288.384), mean of Group B obese fallers was 739.81 (S.D-341.165). NON-PARAMETRIC MANN-WHITNEY U TEST was used to determine the comparison in MET value calculated from IPAQ (P - .000) The significant was set as P < 0.01this significance exist in both categorical variable and continuous score MET value of IPAQ between both the groups (Table 4).
DISCUSSION
WHO estimates that at least 400 `million adults (9.8%) are obese, with higher rates among women than men and rate of obesity also increases with age at least up to 50 or 60 years14 . The positive health benefits of physical activity in people of middle age have been extensively studied and are now commonly accepted, it is immensely essential for the health care eternity to identify factors that could possibly lead to decline of level of physical activity in risk groups11.This study examined the history of fall or ambulatory stumbles in middle aged obese subjects and related decline in the level of physical activity, Statistical data analysis proved that there exists highly significant difference between obese fallers and obese non fallers in level of physical activity in four domains (P < 0.01) which supported the hypothesis of this study. Table 1 clearly exhibits that many fallers had declined their activity levels to much lower intensity in terms of MET, specifically we also found that increased body mass is associated with increased history of falls /stumbles which negatively affects health related physical activity of life. In middle-aged and older adults, obesity was associated with a higher prevalence of falls and stumbling during ambulation stated by (Cecilie Fjeldstad et al 2008)20. According to the study of (Francesco Menegoni et al 2009) excessive amount of body fat modifies the body geometry by adding passive mass to different body regions which influences the biomechanics of activities of daily living16.Adipose tissue accumulation and body mass increases canbe a major factor contributing to the occurrence of falls, which explains why obese persons appear to be at greater risk than normal-weight subjects under daily postural stresses and perturbations. As suggested by this study decline in activity level can adversely affect the quality of life in obese adults. The limitation of this study could be non-usage of objective scale in data collection.
CONCLUSION
This is probably the first study to have studied the physical activity level in middle aged obese adults after history of fall/stumbles. The statistical analysis of data and results of this study concludes the existence of compromise in physical activity in obese adults with more stumbles/falls. So, development of a complete screening tool to identify deficiency of activity will help preserve physical activity and diagnose the early changes.
CLINICAL IMPLICATIONS
If we are to preserve physical activity in obese subjects, attempts should be made to evaluate the factors contributing to fall/stumbles in obese adults and present level of Physical activity
ACKNOWLEDGEMENT
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors/editors/publishers of all those article, journals and books from where the literature for this article has been reviewed and discussed. The authors also thank the staffs and colleagues of Madha medical college and hospital for extending their helping hands.
Englishhttp://ijcrr.com/abstract.php?article_id=1720http://ijcrr.com/article_html.php?did=17201. Lachman ME, Howland J, Tennstedt S, et al. Fear of falling and activity restriction: the Survey of Activities and Fear of Falling in the Elderly (SAFE). J Gerontol B PsycholSci Soc Sci. 1998; 53:P43–P50.
2. Han TS, Tijhuis MA, Lean ME, Seidell JC Quality of life in relation to overweight and body fat distribution. Am J Public Health. 1998; 88:1814–1820.
3. Stenholm S, Rantanen T, Alanen E, et al.Obesity history as a predictor of walking limitation at old age. Obesity (Silver Spring). 2007; 15:929–938.
4. Corbeil P, Simoneau M, Rancourt D, et al. Increased risk for falling associated with obesity: mathematical modeling of postural control. IEEE Trans Neural SystRehabil Eng. 2001; 9:126 –136.
5. Fjeldstad C, Fieldstad AS, Acree LS, et al. The influence of obesity on falls and quality of life. Dyn Med. 2008; 7:4.
6. Blair SN, Cheng Y, Holder JS. Is physical activity or physical fitness more important in defining health benefits? Med Sci Sports Exerc 2001; 33(suppl):S379–99.
7. Petersen L, Schnohr P, Sørensen TI. Longitudinal study of the long-term relation between physical activity and obesity in adults. Int J ObesRelatMetabDisord2004;28:105–12.
8. Mortensen LH, Siegler IC, et al. Prospective associations between sedentary lifestyle and BMI in midlife. Obesity (Silver Spring)2006; 14:1462–71.
9. Metcalf BS, Voss LD, Hosking J, et al. Physical activity at the government recommended level and obesity-related health outcomes: a longitudinal study (Early Bird 37). Arch Dis Child 2008; 93:772–7.
10. Bouchard C, Shephard RJ. Physical activity fitness and health: the model and key concepts. In: Bouchard C, Shephard RJ, Stephens T, editors. Physical activity fitness and health: International proceedings and consensus statement. Champaign (IL): Human Kinetics; 1994. p. 77-88.
11. Blair SN, Brodney S. Effects of physical inactivity and obesity on morbidity and mortality: current evidence and research issues. Med Sci Sports Exerc 1999; 31:S646-62.
12. Nelson, M. E., Rejeski, W. J., Blair, S. N., Duncan, et al. (2007, August). Physical activity and public health in older adults: American College of Sports Medicine and the American Heart Association. Medicine and Science in Sports and Exercise 8, 1435–1445.
13. Cora L. Craig 1, Alison L. Marshall2, et al, International Physical Activity Questionnaire: 12-Country Reliability and Validity Medicine and Science in Sports and Exercise, American college of Sports medicine, 1381- 1395.
14. Puska, P., C. Nishida, and D. Porter, Global Strategy on Diet, Physical Activity and Health. 2003, World Health Organization (WHO).
15. Finkelstein EA, Chen H, Prabhu M, The relationship between obesity and injuries among U.S. adults. Am J Health Promot2007;21:460–468
16. Francesco Menegoni1,2, Manuela Galli1, Elena Tacchini2 et al, Gender-specific Effect of Obesity on Balance. Nature publishing group. Obesity (2009) 17, 1951–1956.
17. Stefano Lazzer1,2, Giorgio Bedogni3, Claudio L., et al, Relationship Between Basal Metabolic Rate, Gender,Age, and Body Composition in 8,780 White Obese Subjects. . Nature publishing group. 2009. Page 71-78.
18. Randy Rzewnicki1,*, Yves Vanden Auweele1 and Ilse De Bourdeaudhuij2 et al Addressing over reporting on the International Physical Activity Questionnaire (IPAQ) telephone survey with a population sample. Public Health Nutrition: 6(3), 299–305
19. Sander M Slootmaker1, Marijke JM Chin A Paw*1, Albertine J Schuit2,3 et al Promoting physical activity using an activity monitor and a tailored web-based advice: design of a randomized controlled trial BMC Public Health 2005, 5:134 1471-2458-5-134
20. Cecilie Fjeldstad1, Anette S Fjeldstad1, Luke S Acree1 et al, The influence of obesity on falls and quality of life. Dynamic Medicine 2008, 7:4 1476-5918-7-4
21. Rosenblatt NJ, Grabiner MD.et al Relationship between obesity and falls by middle-aged and older women. American Congress of Rehabilitation Medicine 2012 368-372
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareA CLINICAL ANALYSIS OF EMERGENCY PERIPARTUM HYSTERECTOMY
English103107G.GanithaEnglishObjectives: To determine the incidence, maternal factors, indications, associated mortality and morbidity and prophylactic measures for peripartum hysterectomy. Methods: A retrospective analysis of 18 cases of peripartum hysterectomy performed over a period of 18 months was done. Results: During the studyperiod, there were 16,385 deliveries which included 1903 cesarean deliveries. 18 cases underwent peripartum hysterectomy giving an incidence of 0.11%. The incidence following vaginal delivery was 0.12% and that of cesarean hysterectomy was 0.9%. 50% of the cases had a scar on the uterus due to previous LSCS or repair of rupture. Indication for surgery was rupture of uterus in 66.6% cases and uncontrolled PPH due to uterine atonicity in33.3% cases. All cases underwent subtotal hysterectomy. The commonest postoperative complications were hypovolemic shock (83%) and febrile morbidity (16%). Perinatal mortality was 72%. Maternal mortality was 22%. In spite of the associated intraoperative and postoperative complications, peripartum hysterectomy is still one of the important life saving procedures.
EnglishObstetric hysterectomy; Cesarean hysterectomy; Rupture uterus; uterine atonicityINTRODUCTION
Peripartum hysterectomy is hysterectomy performed at the time of delivery or during immediate postpartum period. Peripartum hysterectomy is generally performed in the setting of life threatening hemorrhage. It is a double edged sword. Though, it is a life saving procedure, it is associated with loss of reproductive ability, serious morbidity and sometimes mortality. Proper timing and meticulous care are must to reduce complications. . Several studies report incidence rates for peripartum hysterectomy ranging from 0.04% to 0.32%1-9 . The incidence and indications for peripartum hysterectomy varies with the clinical setting, patient characteristics, availability of blood banking facilities and individual practitioner skills. The present study was conducted in a tertiary care, teaching hospital catering mainly to rural population of India.
METHODOLOGY
Among the 16,385 cases admitted for delivery during the study period of 18 months, 18 cases underwent peripartum hysterectomy. These cases were analyzed by a descriptive retrospective study. Data was obtained by reviewing the obstetric admission records, operation records and intensive care unit records.
RESULTS Incidence: During the study period, there were 16,385 deliveries, out of which 1903 were cesarean deliveries. 18 cases underwent peripartum hysterectomy. Accordingly, the incidence of peripartum hysterectomy was 0.11%.The incidence of peripartum hysterectomy following vaginal delivery was 0.12% and following cesarean delivery was 0.94%. Maternal factors: Most women in the study were in the age group of 21-30years (61.1%). 5 were teenaged (27%) and 2 were above 30 years. 55% were of parity 2. There were 3 primigravidas (16%). 30% were of parity ≥3. 44% cases were referred and 50% cases were unbooked. Only one case was booked. In relation to previous pregnancy, 8 cases had undergone LSCS and 1 case had undergone repair for rupture uterus. Out of the 18 cases studied, 9 cases delivered vaginally including 2 VBAC and 2 instrumental deliveries. Labor was accelerated with ARM or oxytocin or both in 3 cases while 6 cases delivered vaginally without acceleration As shown in Table 1, the most common risk factor was scar on the uterus. The indications for surgery are enumerated in Table 2. Rupture uterus (66.6%) was the commonest indication followed by uterine atonicity (33.3%). Rupture uterus was commonest following trial of labor in previous LSCS (6 cases). Nature of surgery: All cases underwent subtotal hysterectomy. 2 cases (11%) required bladder repair. 2 cases (11%) required salpingooopherectomy. In 1 case, breech extraction was attempted and ended in uterine rupture. Decapitation followed by subtotal hysterectomy was done for the same. All patients were given general anaesthesia. No case developed anaesthetic complications or required relaparotomy. Intraperitoneal drain was kept in all cases. The intraoperative findings are summarized in Table 3. Maternal outcome: Hypovolaemic shock was seen in 15 cases. 3 cases (16%) developed febrile morbidity. Table 4 summarizes the post operative complications. At least, 2 units of blood was transfused in all cases. One patient required up to 7 units of blood transfusion. The average duration of stay in hospital was 10-15 days. Maximum duration of stay was 40 days. Maternal and perinatal mortality: There were 4 maternal deaths in the present study. The cause of death was irreversible hypovolaemic (hemorrhagic) shock. The commonest cause for hemorrhage leading to death was atonic PPH (3 cases). Perinatal mortality was 72% (13 cases) DISCUSSION Peripartum hysterectomy still remains a life saving resort in present day obstetrics. The incidence of peripartum hysterectomy in the present study is 0.11% as compared to that of Devi et al1 0.07%, Sahu et al2 0.26%, Gupta et al3 0.26%, Glaze et al4 0.08%, Knight et al5 0.04%, Mathe et al6 0.28%, Kanwar et al7 0.32%, Archana et al8 0.07%, Mukherjee et al 9 0.15%. In the present study 94% of the cases were unbooked or referred from elsewhere. Unbooked and referred cases were found to be at high risk for peripartum hysterectomy in other studies also7-9 . In the present study, 50% of the cases had scar on the uterus. 8 cases had previous LSCS and one case had undergone repair for rupture uterus. Cesarean history is associated with higher incidence of abnormal placentation and uterine rupture in the present pregnancy resulting in increased incidence of peripartum hysterectomy11. The high risk of peripartum hysterectomy associated with prior cesarean delivery has been reported in other studies as well4, 5, 10 .
Rupture uterus was the commonest indication for peripartum hysterectomy in the present study (66.6%) followed by uterine atony (33.3%). Similarly, rupture uterus was reported as the commonest indication by Gupta et al3 70%, Archana et al8 75%, Mukherjee et al9 38.3% and Kanwar et al7 36.6%. However, uterine atony and abnormal placentation was reported as the commonest indication by Devi et al1 46%, Sahu et al2 41%, Glaze et al4 70%, Mathe et al6 40%, Kashani et al10 82%. Post operative shock and febrile morbidity were the commonest post operative complications in the present study and other studies2, 4, 7-10. The maternal and the perinatal mortality in the present study were higher than most studies. Probably, higher rate of mortality and morbidity noted were due to pre existing anemia, malnourishment, handling by untrained dais in peripheries and delayed referral. Table 5 shows the comparison of maternal and perinatal mortality in various studies. CONCLUSIONS In spite of the high incidence of intraoperative and post operative complications, peripartum hysterectomy is still one of the important life saving procedures. Though peripartum hysterectomy should be the last resort in obstetric hemorrhage, timely decision should be taken. All obstetricians should be trained to perform obstetric hysterectomies. Obstetricians should be familiarized with other management options such as the B-Lynch compression sutures and internal iliac artery ligation. Good Antenatal care, timely recognition of antepartum and intrapartum complications, timely referral of high risk cases, judicious selection of cases with prior cesarean delivery for trial of labor, careful intrapartum monitoring, active management of third stage of labor, availability of prostaglandins, good blood banking facilities and increasing familiarity of obstetricians to compression sutures and internal iliac or uterine artery ligation can reduce the incidence, morbidity and mortality of peripartum hysterectomy. ACKNOWLEDGEMENTS The Author acknowledges the immense help received from the scholars whose articles are cited and included in references of this manuscript. The author is also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1721http://ijcrr.com/article_html.php?did=17211. Praneshwari Devi R K, Singh N N, Singh D. Emergency obstetric hysterectomy. J Obstet Gynecol India 2004; 54:127-9.
2. Sahu L, Chakravertty B, Sabral P. Hysterectomy for obstetric emergencies. J Obstet Gynecol India 2004; 54:34-6.
3. Gupta S, Dave A, Bandi G et al. Obstetric hysterectomy in modern day obstetrics: a review of 175 cases over a period of 11 years. J Obstet Gynecol India 2001; 51:91- 3.
4. Sarah Glaze, Pauline Ekwalanga, Gregory Roberts et al, Peripartum Hysterectomy: 1999 to 2006 Obstetrics and Gynecology, 2008; 111: 732-738.
5. Knight M; UKOSS, Peripartum hysterectomy in the UK: management and outcomes of the associated hemorrhage. BJOG. 2007 114:1380- 7.
6. Jeff Kambale Mathe, Ahuka Ona Longombe. Obstetric hysterectomy in rural Democratic Republic of the Congo: an analysis of 40 cases at Katwa Hospital, African journal of reproductive health 2008; 12(1):60-6.
7. Kanwar M, Sood P L, Gupta K B, et al. Emergency hysterectomy in obstetrics. J Obstet Gynecol India 2003; 53 (4):350-2.
8. Kumari Archana, Sahay Priti Bala. A clinical review of emergency obstetric hysterectomy. J Obstet Gynecol India 2009; 59(5): 427-431.
9. Mukherjee P, Mukherjee G, Das C. Obstetric hysterectomy: A review of 107 cases. J Obstet Gynecol India 2002; 52:34-6.
10. Kashani E, Azarhoush R. Peripartum hysterectomy for primary postpartum haemorrhage: 10 years evaluation. European journal of experimental biology 2012;2 (1):32-6.
11. Whiteman M K, Kuklina E, Hillis S D, Jamieson D J, Meikle S F, Posner S F, Marchbanks P A. Incidence and determinants of peripartum hysterectomy. Obstet Gynecol 2006; 108 (6):1486–92.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31TechnologyBANDWIDTH ENHANCEMENT OF WIDE BAND RECTANGULAR MICROSTRIP PATCH ANTENNA USING RECTANGULAR CUT AND L SHAPE CUT ON THE PATCH FOR KU BAND APPLICATIONS
English108113Sarman Kumar AhirwarEnglish Sunil Kumar SinghEnglishThis paper presents bandwidth enhancement of a rectangular microstrip patch antenna which is designed [1][2] for RADAR applications for operating range Ku band. The proposed antenna gives bandwidth of 12.36-16.73GHz for S11EnglishRectangular patch antenna, FR4 Substrate, Input impedance, Return loss, Ansoft High Frequency structure Simulator (HFSS).INTRODUCTION
Ku band primarily used in satellite communications most notably for broadcast services and for specific applications for NASA. Ku band are also used for backhoules and particularily for satellite from remote location back to a television network studio for editing and broadcasting. The wireless communication market has been greatly expanded and the demands of Ku band are increasing. The current fastest and robust microwave towers, mobile service, mobile satellite service, radio location service and radio navigation operate in the Ku band which can provide reliable high-speed connectivity between personal organizers and other wireless digital appliances. The proposed antenna can operate from 12.36- 16.73GHz GHz making it suitable for wideband application. This small printed monopole antenna can be used in the vehicle speed detection. Antennas play a very important role in the field of wireless communications [3] some of them are parabolic reflectors, patch antennas, slot antennas, and folded dipole antennas with each type having their own properties and uses. It is perfect to classify antennas as the backbone and the driving force behind the recent advances in wireless Communication technology [4]. By the early 1980s basic microstrip antenna elements and arrays were fairly well establish in term of design and modeling. In the last decades printed antennas have been largely studied due to their advantages over other radiating systems, which include: light weight, reduced size, low cost, conformability and the ease of integration with active device. A Microstrip Patch antenna consists of a radiating patch on one side of dielectric substrate which has a ground plane on the other side as Shown in Figure 1. The patch is generally made of conducting material such as copper or gold. The radiating patch and the feed lines are usually photo etched on the dielectric substrate .Microstrip patch antennas radiate primarily because of the fringing fields between the patch edge and the ground plane [5]. Therefore, the antenna can be fed by a variety of methods. These methods can be Classified into two categories- contacting and noncontacting. In the contacting method, the RF power is fed directly to the radiating patch using a connecting element such as a microstrip line or probe feed. In the non-contacting scheme, electromagnetic field coupling is done to transfer power between the microstrip line and the radiating patch this includes proximity feeding and aperture feeding. In my design microstrip feeding method is used.
Antenna Design Parameters For a rectangular patch, the length L of the patch is usually 0.333 λ0< L < 0.5 λ0, where λ0 is the free-space wave length [6]. The patch is selected to be very thin such that t Englishhttp://ijcrr.com/abstract.php?article_id=1722http://ijcrr.com/article_html.php?did=17221. Pozar D.M., and Schaubert D.H (1995) Microstrip Antennas, the Analysis and Design of Microstrip Antennas and Arrays, IEEE Press, New York, USA
2. Balanis C.A. (2005) Antenna Theory: Analysis and Design, John Wiley & Sons
3. Piesiewicz, R., J. Jemai, M. Koch, and T.. K urner, ? channel characterization for future wireless gigabit indoor communication systems,? Proc. SPIE, Vol. 5727, 166–176, 2005.
4. Driessen, P. F., ?Gigabit/s indoor wireless systems with directional antennas,? IEEE Trans. Commun., Vol. 44, No. 8, 1034–1043, 1996
5. Ramesh G, Prakash B, Inder B, and Ittipiboon A. (2001) Microstrip antenna design handbook, Artech House.
6. Waterhouse, R. B., S. D. Targonski, and D. M. Kokoto, ?Design and performance of small printed antennas,? IEEE Trans. Ant. Prop., Vol. 46, 1629–1633, 1998.
7. Zeadally, S. and L. Zhang, ?Enabling gigabit network access to end users,? Proc. IEEE, Vol. 92, No. 2, 340–353, 2004.
8. Sharma, A. and G. Singh, ?Design of single pin shorted three dielectric layered substrate rectangular patch microstrip antenna communication systems,? Progress In Electromagnetics Research Lett., Vol. 2, 157– 165, 2008
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareFACTORS PREDICTIVE OF FAILURE OF ARTERIOVENOUS FISTULAS: OUR EXPERIENCE AND REVIEW OF LITERATURE
English114121Chandrashekar A. REnglish Rajendra Prasad B.English Sanjay DesaiEnglish Harsha A. HuliyappaEnglish Bharathi. REnglishObjective: Evaluation of the patency rates of Arteriovenous Fistula with correlation of factors associated with failure of Arteriovenous Fistula. Materials and Methods: 150 successive patients (mean age 57years, range 19–76) on whom 156 primary Arteriovenous Fistulas were created during the period of 1 year between January 2009–December 2009 and who were followed up for 1 year. Results: The primary patency rate was 88% at 3 months. 7 distinct factors were significantly associated with both early and late failure of the fistula. Association of factors such as age>40years, uncontrolled diabetes, hypotension, smoking, pre Arteriovenous Fistula dialysis through central venous catheters, hypercholesterolemia and poor quality of artery and vein resulted in higher failure rates. Conclusion: The major determinants for a successfully created Arteriovenous Fistula were creation of the fistula before the start of dialysis and good quality of both, the artery and the vein. This argues in favour of timely creation of such fistulas in patients with end-stage renal disease, avoidance of hypotension, strict glycemic control and accurate preoperative Doppler examination to establish the quality of the vessels.
EnglishAVF, Patency Rates, Prognostic FactorINTRODUCTION
Chronic kidney disease (CKD) is a worldwide public health problem with a stressful life for the patient and the family. In the year 2000, in the United States (US) alone, about 30 million people were diagnosed with CKD. It was estimated that by 2010, six million people worldwide would need renal replacement therapy (RRT) costing 28 billion dollar (1). Most of the patients with CKD progress to End Stage Renal Disease (ESRD) and are dependent on lifelong RRT until kidney transplantation is possible. Its impact in developing countries like India is well documented as studies based in Delhi revealed a prevalence of CKD (serum creatinine more than 1.8 mg %) at 7852 pmp and studies from Bhopal, revealed an incidence of 151 pmp suffering from ESRD (2). A further increase in the number of patients on dialysis is expected as a result of longevity of population. The number of CKD patients requiring haemodialysis is progressively increasing over the years in other countries also. The most common and the best site for access for haemodialysis is through the creation of a distal autogenous ArterioVenous fistula (AVF) (3) . Originally described by Brescia et al, it allows for easy repeated access to the circulation using the native vessels without the need for prosthetic material once the AVF is created (4). Its advantages are easiness to cannulate with good flow rates and its limited restrictions of AVF arm mobility (5) . Yet, various postoperative complications tend to occur in the lifetime of an AVF. Failure due to thrombosis and local infection being the most common as per many studies (6,7). The major predisposing factor for thrombosis of the fistula is stenosis, which occurs as a result of myointimal hyperplasia at the anastomotic site, accounting for 80% to 85% of thromboses (7). Thrombosis also occurs due to dissection and haematoma during punctures, excessive compression of the fistula after dialysis, hypotension, hypovolaemia and hypercoagulable states. The primary reported failure rate is 12% to 24% and rises upto 50-70% after 6months (8,9,10). Variations in the failure rates by different groups indicate the use of different criteria for selection of patients (11) . This study was undertaken to study the various factors and their contribution in the AVF failure. MATERIAL AND METHODS Patients with Primary arteriovenous fistula created for haemodialysis between January 2009 and December 2009 were followed up for 1 year. Total of 156 such fistulas were created in 150 CKD patients at M.S. Ramaiah Medical College and Hospital, Bangalore, India. There were 108 male and 42 female patients with a mean age of 57years (range 19 to 76). The most frequent co morbid factors included hypertension (n = 128, 85%), diabetes mellitus (n = 110, 73%), smoking (n = 75, 50%), Hypotension (n=21, 14%) obesity (n=56) and dyslipidemia (n = 56) and bronchial asthma (n=26) (Table I). Preoperative procedure: Patients needing haemodialysis were referred from the Department of Nephrology, M. S. Ramaiah Medical College and Hospital, Bangalore, India for AVF creation. Consent was obtained for the procedure and anaesthesia with the advantages, disadvantages, risks involved in the procedure, complications of the procedure including the failure, the need for repeated AVF creation in case of failure or usage of graft in dominant or in nondominant hand, the need for Kidney Transplantations as and when required and the associated morbidity and mortality being explained in patient‘s language. Non-dominant hand was examined mostly to assess the cephalic vein on the radial side of the wrist for its visibility and sufficiency of outflow. The patency of the palmar arch and its contributes were also tested by Allen‘s test (by occlusion of the ulnar and radial arteries). Duplex Scan assessment of the limb vessels was sought for certain cases (n=42) where the size of the vessel on physical examination was doubtful. A patent radial and ulnar artery and a venous diameter of 2.5 mm during proximal venous occlusion were regarded as sufficient. Surgical procedure: Over 99% of the cases were operated under Local anaesthesia with a mixture of 2% Xylocaine and 0.25% Bupivacaine (5:1 ratio) amounting to 5-10ml per AVF. Brachial plexus block or General anaesthesia were used in highly uncooperative patients (n=3). 70 radiocephalic and 86 brachiocephalic AVFs were created, mostly on the nondominant hand (70%, 75%respectively)(Table - II). Through a longitudinal incision on the radial side of the wrist, the cephalic vein and radial artery were dissected and secured. Through a transcubital incision brachial artery and cephalic veins were taken into control for brachiocephalic AVF. The cephalic vein was transected, dilated and patency maintained with intermittent flushing using heparinised saline in all cases. None of the patients experienced spasm of the vein during the procedure. Intraoperative heparin bolus 2000– 5000 IU was used intravenously in all cases. An arteriotomy was made on the radial artery or brachial artery and an end to side AVF anastomosis was created with 6/0 or 7/0 polypropylene running sutures. The mean operating time was 35 minutes.
The patency of anastomosis was assessed perioperatively by palpation, auscultation, and by hand-held Doppler. The fistula was allowed to mature for a period of about 6 weeks, by which time the cephalic vein would be mature enough to be accessed for haemodialysis and sustain an adequate blood flow. Personal outpatient, inpatient, telephonic interviews were performed monthly to know the status of the fistula. All the AVFs were examined at regular interval of 1 month for the following outcomes : complete failure (either early or late failure, including insufficient maturation at 6 weeks), inability to use access site for dialysis due to poor flow, patient‘s death (either with a functioning or a nonfunctioning fistula), AVF complications and normally functioning fistula. Various preoperative, operative, and postoperative variables were analyzed and correlated with the AVF failures (Table - III). Variables included were age, sex, smoking history (non-smoker or smoker), preoperative serum creatinine (mg/dL), serum cholesterol concentration (normocholesterolaemia or hypercholesterolemia), diabetes mellitus (nondiabetic or diabetic), preAVF dialysis (patients who had not been dialysed at the time of creation of the fistula or patients in whom dialysis began before the operation), side of the fistula (left or right), calibre of the artery and vein. RESULTS Most of the failures occurred during the first three months after surgery. One of the 156 primary fistulas occluded within the first 24 hours. 10 fistulas had weak thrill, but only 6 of them failed by 6 weeks. 11 fistulas which were patent at 6 weeks, did not develop sufficiently to be used for access for haemodialysis, and hence were classified as failures. The primary patency rate at 3 months was 88%. In addition to the 156 primary procedures, 14 revisions to the primary repair were made to salvage the fistula and consisted of 12 thrombectomies using Fogarty balloon catheter no. 3 introduced through a venotomy, 1 repair of a pseudoaneurysm and 1 thrombectomy plus vein patch revision. In 11 patients, the salvage procedure took place on the same day as the primary operation (not intraoperative revision of the anastomosis). The other revisions were made at a mean of 7 months after the first operation. 10 revisions were successful. Completely newer anastomosis at a site more proximal than the previous were performed without a vein patch in 24 cases. 11 patients died during the 2-year follow-up, all of them with a functioning fistula at the time of death. The causes of death were cardiac (n = 8), pulmonary (n = 2) or unknown (n = 1). There were no deaths directly related to the surgery. Prognostic factors The following factors were compared between the failure and functioning AVF groups: age, sex, side, poorly controlled diabetic status (HbA1c>8), hypertension and hypotension, smoking, preAVF dialysis, moderate or poor quality of the artery, moderate or poor quality of the vein, S.Creatinine and S.cholesterol levels. The first group includes failures within 3 months (early failure, n = 18) and the second group includes the failures at 3 months or later (late failure, n = 6). (Table - IV) Significant predictors for early failure were: age >40yrs, uncontrolled diabetes, hypotension, smoking, start of dialysis before formation of the fistula, moderate or poor quality of the artery and vein and high S. creatinine. Significant predictors for late failure were: age, smoking, moderate or poor quality of the vein and hypercholesterolemia. DISCUSSION Early AVF failure is known to occur in up to 60% of newly created AVFs. Most of them are due to thrombosis or marked in-flow stenosis, leading to non-maturation of AVF.(12,13) Several studies predict several modifiable variables during initial surgery which have been linked to greater AVF maturation, including use of high-dose intraoperative heparin, utilization of largediameter veins, and a mean arterial pressure of 85mmHg or greater.(14) Apart from clinical examination, Duplex ultrasound of the AVF is a useful armamentarium in the assessment for AVF. A vein diameter ≥4mm or the blood flow rate >500ml/min are highly lucrative with more than 84% of fistulas maturing within four months of AVF creation. According to a study if both the criteria are met, a 95% likelihood of maturation of the fistula for dialysis is observed, whereas if neither criterion is met, only 33% of AVF successfully mature (15) . The venous stenosis and the presence of multiple accessory veins are the other contributors for early failure (16,17). In 78% of non-maturing AVFs, Venous stenosis was mostly adjacent to the anastomotic area. In a documented study, 88% of AVFs matured following the Percutaneous ligation of the accessory veins has been documented (18).The accepted standard for the minimal vein diameter associated with successful AVF is 2– 2.5mm. at vein diameter Englishhttp://ijcrr.com/abstract.php?article_id=1723http://ijcrr.com/article_html.php?did=17231. US Renal data system. USRDS 2000 Annual Data Report: Atlas of End Stage Renal disease in the united states. National institutes of health, national institute of diabetes and digestive and kidney Diseases: Bethesda, MD, 2000.
2. Agarwal SK, Dash SC, Irshad M, Raju S, Singh R, Pandey RM. Prevalence of chronic renal failure in adults in Delhi, India. Nephrol Dial Transplant 2005:20:1638-42.
3. Clinical practice guidelines for vascular access, Am J Kidney Dis, 2006;48(Suppl. 1):S248–73.
4. The Vascular Access Work Group. NKFDOQI clinical practice guidelines for vascular access. National Kidney Foundation—Dialysis Outcomes Quality Initiative. AmJ Kidney Dis 1997; 30 (suppl. 3): S150–191.
5. Leapman SB, Boyle M, Pescovitz MD, Milgrom ML, Jindal RM, Filo RS. The arteriovenous _stula for hemodialysis access: gold standard or archaic relic? Am Surg 1996; 62: 652–657.
6. Fan P-Y, Schwab SJ. Vascular access: concepts for the 1990s. J Am Soc Nephrol 1992; 3: 1–11.
7. Windus DW. Permanent vascular access: a nephrologist‘s view. Am J Kidney Dis 1993; 21: 457–471.
8. Burger H, Kluchert BA, Kootstra G, Kitslaar PJ, Ubbink DT. Survival of arteriovenous _stulas and shunts for haemodialysis. Eur J Surg 1995; 161: 327–334.
9. Connall TP, Wilson SE. Vascular access for hemodialysis. In: Rutherford RB, ed. Vascular surgery. 4th ed. Philadelphia: WB Saunders, 1995: 1233–1244.
10. Palder SB, Kirkman RL, Whittemore AD, Hakim RM, Lazarus JM, Tilney NL. Vascular access for hemodialysis: patency rates and results of revision. Ann Surg 1985; 202: 235–239.
11. Miller PE, Tolwani A, Luscy CP, et al. Predictors of adequacy of arteriovenous _stulas in hemodialysis patients. Kidney Int 1999; 56: 275–280.
12. Dember LM, Beck GJ, Allon M, et al., JAMA, 2008;299(18):2164–71.
13. Dember LM, Dixon BS, Am J Kidney Dis, 2007;50(5):696–9.
14. Feldman HI, Joffe M, Rosas SE, et al., Am J Kidney Dis, 2003;42(5):1000–1012.
15. Robbin ML, Chamberlain NE, Lockhart ME, et al., Radiology, 2002; 225(1):59–64.
16. Beathard GA, Am J Kidney Dis, 1999; 33(5):910–16.
17. Badero OJ, Salifu MO,Wasse H,Work J, Am J Kidney Dis, 2008; 51(1):93–98.
18. Faiyaz R, Abreo K, Zaman F, et al., Am J Kidney Dis, 2002;39(4):824–7.
19. Silva MB Jr, Hobson RW II, Pappas PJ, et al., J Vasc Surg, 1998; 27(2):302–7, discussion 307–8.
20. Mendes RR, Farber MA, Marston WA, et al., J Vasc Surg, 2002;36(3):460–63.
21. Wong V,Ward R, Taylor J, et al., Eur J Vasc Endovasc Surg, 1996;12(2):207–13.
22. Windus DW. Permanent vascular access: a nephrologist‘s view. Am J Kidney Dis 1993; 21: 457–471.
23. Lazarides MK, Iatrou CE, Karanikas ID, et al. Factors affecting the lifespan of autologous and synthetic arteriovenous access routes for haemodialysis. Eur J Surg 1996; 162: 297–301.
24. Leapman SB, Boyle M, Pescovitz MD, Milgrom ML, Jindal RM, Filo RS. The arteriovenous _stula for hemodialysis access: gold standard or archaic relic? Am Surg 1996; 62: 652–657.
25. Colledge J, Smith CJ, Emery J, Farrington K, Thompson HH. Outcome of primary radiocephalic _stula for haemodialysis. Br J Surg 1998; 86: 211–216.
26. Koo Seen Lin LC, Burnapp L. Contemporary vascular access surgery for chronic haemodialysis. J R Coll Surg Edinb 1996; 41: 164–169.
27. Spinowitz BS, Galler M, Golden RA, et al. Subclavian vein stenosis as a complication of subclavian catheterization for hemodialysis. Arch Intern Med 1987; 147: 305–307.
28. Schwab SJ, Quarles LD, Middleton JP, Cohan RH, Saeed M, Dennis VW. Hemodialysis-associated subclavian stenosis. Kidney Int 1988; 33: 1156–1159.
29. Stansby G. Vein quality in vascular surgery. Lancet 1998; 351: 1001–1002.
30. Saran R, Dykstra DM,Wolfe RA, et al., Am J Kidney Dis, 2002;40(6):1255–63.
31. Fiskerstrand CE, Thompson IW, Burnet ME, et al., Artif Organs, 1985;9(1):61–3.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareTHE STUDY OF MORPHOLOGY AND VASCULAR PATTERNOF PLACENTA AND UMBILICAL CORD WITH CLINICAL CORRELATION IN ANDHRA POPULATION
English122130Sirisha BandiEnglish Raju SugavasiEnglish M .SujathaEnglish B .Indira DeviEnglishAbstract: Placenta plays a role exactly similar to that of bridge between the mother and child. Placenta is
responsible for protective, nutritional, respiratory, and an excretory orgon for the growing foetus. Examination of placenta immediately after delivery, gives much idea of prenatal health of baby and the mother. Umbilical cord embedded in the jelly of warton and consists of two Umbilical arteries and one Umbilical vein. Objectives: To compare and contrast the finding of the study with those previous literatures, with a view to analyze the morphology and vascular pattern of placenta and umbilical cord in 100 placentae and to clinically correlate this analysis with the foetal parameters. Materials and Methods: A total of 100 placentae were collected for this study (46 from uncomplicated deliveries and 54
from various factors which complicated pregnancy).The placenta parameters were collected, analyzed and clinically correlated. Results and Conclusion: Out of 100 placentae which were collected, 81 were circular, 15 were oval and 4 were triangular in shape. In the preset study the average diameter of placenta was 15.84 cm, the average thickness was 3.2 cm and the average weight of placenta was in male baby 506.30 gm and female baby 390.27 gm. The average diameter of umbilical cord for male 1.5 cm and female 1.3 cm. The average length of umbilical cord for male baby was 26 cm and female baby was 22 cm. This study shows eccentric insertion of umbilical cord in 70 %, central 7%, battledore 22%, and velamentous was 1%.
EnglishINTRODUCTION
The placenta is a unique orgon in its development and function. The placenta begins to meet the demands of embryo at an early part of intrauterine life. This is the only orgon in the body which is derived from two separate individuals the mother and foetus. Placenta is a flattened discoid mass with circular or oval in shape. It has an average volume of 500 ml, a weight of 470 gm, a diameter of 185 mm, a thickness of 23 mm and a surface area of 30000mm. The umbilical cord is attached near the center of foetal surface [1]. The examination of the placenta in utero and postpartum gives idea about the state of foetal well being [2]. The umbilical cord is about 50 cm long and 1.5 to 2 cm in diameter, embedded in the jelly of warton is two umbilical arteries and one umbilical vein. The placenta is main characteristic feature of mammals which connects between uterus and foetus by the umbilical cord.
MATERIALS AND METHODS
A total of 100 placentae (FIGURE: 01) were collected (90 full term babies and 10 premature babies) for this study from DR. PSIMS and Research Foundation Hospital, Chinoutapalli, Vijayawada, Krishna district, Andhra Pradesh. The placentae were collected both from normal deliveries and caesarean sections. The collected placentae were washed under tap water. The specimens were kept in 10 % of formalin. In all collected placentae, the following parameters were studied
1. Weight – Rerecorded by weighing scale
2. Shape – By observation
3. Thickness – Measured by divider
4. Number of cotyledons - Counted visually
5. Diameter - By measuring tape
Also examined for abnormal placental charecterists
1. Accessory placental lobes
2. Placental calcification
Placentae were collected from
1. Normal un complicated prima gravid and multi gravid
2. Full term and pre maturity
3. Normal and caesarean delivery
4. Pathological factors which complicated pregnancy includes
a. Pregnancy induced hypertension (PIH)
b. Diabetes mellitus
c. Anaemia
d. Intra uterine death (IUD)
e. Abnormal presentation: Breach delivery
The babies whose placenta were obtained were also examined for the following factors
1. Sex of the baby
2. Weight of the baby
3. Any visible anomalies of the baby
In each case a preliminary history was elicited from the mother regarding
1. Age
2. Parity
3. Period of amenorrhea
4. Previous obstetric history
5. History of hypertension, diabetes mellitus, and toxemia of pregnancy
Techniques done in the present study are as follows
1. Study of placental vasculature by eosin and haematoxylin staining (FIGURE: 02)
2. Contrast study of placental vasculature by injecting barium sulphate dye
3. Study of placental vasculature by dissection
Umbilical cords were examined by: Length and Diameter of umbilical cords were measured by measuring tape All the parameters which were studied were tabulated and analyzed in (TABLE – 01)
RESULTS
Shape
In the present study out of 100 cases 81 were circular (FIGURE: 03), 15 were oval in shape and 4 were triangular in shape placentae were seen.
Diameter and thickness of placentae
In the present study the average diameter of placenta was 15.84 cm (Range 10 – 12 cm), and average thickness was 3.2 cm (Range 2.2 – 3.3 cm).
Weight of Placentae
This study shows the placental weight ranged from 225 to 725 gm and average being 469.35 gm
The correlation of weight of placenta with foetal weight of the baby The ratio between the foetal weight and placental weight (Foeto–placental ratio, which is normally 6:1) of Andhra population as shown by the present study is Both sexes considered is – 5.89:1 In Males – 6.20:1, In Females – 5.78:1
Placenta succenturiata (Figure: 04) is seen in one case and a case of omphalocele with short umbilical cord (Figure: 05) also seen in present study. The amniotic membrane was translucent in 98 % of the cases and 2% of cases were opaque membranes. The average number of cotyledons in maternal surface was 18 in number.
The present study shows eccentric insertion of umbilical cord in 70 %, central insertion 7%, battledore insertion 22%, and velamentous insertion was 1% (FIGURE: 06).True knots were observed in 4 cases. The types of insertion of umbilical cord to the placenta in various cases were reported in TABLE: 05.
DISCUSSION
A total number of 100 cases were studied and their morphological observations have been summarized and discussed with special references to the diagnosis. The data obtained in this present study were correlated with the data of previous workers in the field. In the shape of placenta, According to Kurt Benirschke (2000) [3] studies shows 94 placentae were normal circular in shape and 7 were oval in shape. In the weight of placenta Armtiage (1967) [4] reported the average weight of placenta was 508 gm. According to Yousonszai and Haworth (1969) [5] placental weight and size were directly proportional to birth weight of babies. Thomson AM (1969) [6] and Saigal (1970) [7] reported that placental weight and birth weight were below average, but their ratio was slightly increased in case of pregnancy induced hypertension. According to previous studies there are some Factors which complicate the pregnancy, were reported by many authors, Naeye RL and friedman EA (1979) [8] observed that 70 % of foetal deaths in women with hypertension are large due to large placental infarcts. According to Zeek PM and Assali NS (1950) [9] placental infarction as an ischaemic necrosis of a group of villi, due to complete interference wih their blood supply in the deciduas or by the thrombosis of a spiral arteriole. Fox H (1967) [10] and Udainia A (2004) [11] observed placental infarcts in cases of pregnancy induced hypertension. Gernot Desoye (2007) [12] reported that one of the characteristic feature of placenta in maternal diabetes mellitus is its increase in weight. Nordenvall M (1988) [13]
reported paucity of cotyledons seen in cases of PIH, prematurity and low birth weight babies. According to Siegler SL and sacks JJ (1941) [14] placenta succenturiata were associated with ante partum hemorrhage. Pretorius DH (1966) [15] observed 42% of cases of marginal insertion of placenta in pregnancy induced hypertension.
CONCLUSION
The study of morphology and vascular pattern of placenta and umbilical cord with clinical correlation in Andhra population Give a lot of information about the early assessment of the foetal well being. The observations of normal and abnormal placentae and umbilical cord gain greater importance in the specialties of obstetrics and neonatology, where this information are of great significance in the early diagnosis of condition is also useful in the congenital fetal malformations. Accurate study of fetal anomalies is possible with ultrasonography.
AKNOWLEDGEMENTS
I express my deep sense of gratitude to Dr. P. Vithal Kumari, Proff and Hod, Department of Anatomy, Dr PSIMS and RF for her constant support and guidance. My special thanks to Dr. Chudamani, Proff and Hod, Department of Obstetrics and Gynecology. I am thankful to my parents and friends. The authors are also thanks to authors, editors, publishers, journals and books from where the literature for this article has been reviewed and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=1724http://ijcrr.com/article_html.php?did=17241. Standring S. Gray‘s Anatomy. The Anatomical basis of clinical practice. 40th ed. Edinburg. Elsevier Churchill Livingstone. 2008; 77: Pg.1302.
2. Kouvalainen K, Pynnonen AL, Makarainen M, Peltonen T, Weights of placental membranes and umbilical cord. Duodecim. 1971; 87: 1210-1214.
3. Kurt Benirschke, Peter Kaufmman. Pathology of human placenta. Springerverlag, New York Inc. 2000; 4th Ed: pg.31.
4. Armitage P, Boyd JD, Hamilton WJ, Rowe BC. A statistical analysis of a series of birthweights and placental weight. Human Biol. 1967; 39: 430.
5. Yousonszai and Haworth. Placental dimensions and relations in pre term and growth retorted infants. Am J Obst Gynaecol. 1969; 103: 265-271.
6. Thomson AM, Billewicz WZ, Hytten FE. The weight of the placenta in relation to birth weight. Jr Obst and Gynaecol Br commonwealth.1969; 767(10): 865-72.
7. Saigal saroj and Shrivatsav JR. Foeto placental weight relationship in normal pregnancy and pre- eclampsia- eclampsia-A comparative study. Indian Pediatrics. 1970; 7 (2): 68-77.
8. Naeye RL and friedman EA. Causes of prenatal death associated with gestational hypertension and protinuria. Am J Obst and Gynaecol .1979; 133: 8-11.
9. Zeek PM, Assali NS. Vascular changes in the deciduas associated with eclamptogenic toxemia of pregnancy. Am J Clin Pathol. 1950; 20: 1099-1109.
10. Fox H. Abnormities of foetal stem arteries in human placenta. Jr Obst and gynaecol Br commonwealth. 1967; 74: 734-738.
11. Udainia A, Bhagwat SS, Mehata CD. Relation between placental surface area, infarction and foetal distress in pregnancy induced hypertension with its clinical relevance. J. Anat. Soc. India.2004; 53 (1); 27-30.
12. Gernot Desoye and Sylvie Hauguel-de Mouzon. The human placenta in gestational diabetes care. 2007; 30 (2): 120-126.
13. Nordenvall M, sandstedt B,Ulmsten U. Relationship between placenta shape, cord insertion , Lobes and gestational outcome.Acta obstet gynaecol scand. 1988; 67(7):611- 6.
14. Siegler SL and sacks JJ. Placenta succenturiata as a cause of Ante partum haemorrahage. Amer J Obstet Gynae. 1941; 42: 38.
15. Pretorius DH, Chau C, Poeltler DM, Mendoza a, Catanzarite VA, Hollenbach KA. Placental cord insertion, Visualization with prenatal ultrasonography.J ultrasound Med. 1966; 15: 585-593.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31HealthcareA PROSPECTIVE RANDOMIZED STUDY TO COMPARE SEVOFLURANE WITH PROPOFOL FOR LARYNGEAL MASK AIRWAY INSERTION IN PAEDIATRIC PATIENTS
English131147Savita ChoudharyEnglish Seema GandhiEnglish Arvind Kumar YadavEnglishObjective: The present study was done in paediatric patients to compare sevoflurane with propofol inductions for quality and ease of insertion of Laryngeal mask airway (LMA). Methods: The present prospective randomized study was carried out in a tertiary care teaching hospital. Sixty premedicated patients of 3-12 years of age were randomly assigned to two equal groups. In propofol group, injection propofol 3mg/kg intravenous, and in sevoflurane group 6-7% sevoflurane inhalation in 4 lit/min O2 were given. Parameters of comparison were time of induction, time of successful insertion, insertion conditions, number of attempts, ease of insertion, hemodynamic parameter, and postoperative complications. All data were analyzed using paired t-test and chi-square test. P values calculated and PEnglishLaryngeal mask airway (LMA), Sevoflurane, Propofol, InductionINTRODUCTION
The most important role of an anaesthesiologist is to control the airway particularly in paediatric age group who is more vulnerable to life threatening hypoxia. Laryngeal mask airway (LMA) offers some of the advantages of tracheal intubation while avoiding the fundamental disadvantages by eliminating the necessity of visualizing the larynx and penetrating the laryngeal opening.[1, 2] It is safe and preferred in many procedures that are unique to children and require multiple administration of anaesthesia in short interval. Thus LMA serves as effective bridge between facemask and endotracheal tube.[3, 4] Insertion of LMA requires sufficient depth of anaesthesia for suppression of airway reflexes.[5] Among the intravenous induction agents, propofol offers a smooth and rapid induction, potent in depressing the airway reflexes, and emergence is devoid of delirium.[6] Propofol has been proved superior to other intravenous agents in insertion of LMA and has been recommended as induction agent of choice in LMA insertion when used with midazolam and fentanyl.[7, 8] Among inhalation agents, sevoflurane a halogenated volatile agent, has pleasant odour, non-pungency and low blood gas solubility which allows rapid and smooth induction with good recovery characteristics and excellent hemodynamic stability.[5, 9] Its pleasant odour and lack of discomfort coupled with fast induction makes it a highly popular induction agent in paediatric anaesthesia. A high inspired concentration for induction provides good conditions for insertion of LMA.[10-13] LMA have become widely used device in practice of anaesthesia; so it becomes imperative to search an ideal induction agent in LMA insertion. Propofol has been used as induction agent of choice since long time. Growing studies now available comparing sevoflurane ?halogenated volatile agent‘ with propofol. Very few studies were done in paediatric patients in India and no study was done in our institute. So, the present study was done in paediatric patients to compare sevoflurane inhalation induction with propofol intravenous induction for insertion of LMA in a tertiary care teaching hospital. MATERIALS AND METHODS The present study was carried out in a tertiary care teaching hospital. Hospital ethics committee approval was obtained before commencing the study. Informed and written consent was obtained from parents. Sixty patients of 3-12 years of age with ASA grade I or II posted for minor and short duration (anticipated time Englishhttp://ijcrr.com/abstract.php?article_id=1725http://ijcrr.com/article_html.php?did=17251. Cheam EWS, Chui T. Randomized doubleblind comparison of fentanyl, mivacurium or placebo to facilitate laryngeal mask airway insertion. Anesthesia 2000;55(4):323-6.
2. Khan RM, Maroof M. Airway Management – Made Easy. 2nd ed. Hyderabad: Paras Medical Publishers; 2005;113-40.
3. Dorsch JA, Dorsch SE. Understanding anesthesia equipment. 5th ed. Philadelphia: Lippincott William and Wilkins; 2008;461-520.
4. McNicol LR. Insertion of the laryngeal mask airway in children. Anesthesia 1991;46: 330.
5. Sivalingam P, Kandasamy R, Madhavan G, Dhakshinamoorti P. Condition for laryngeal mask insertion in adults. Anaesth Analg.1999;88:908-12.
6. Stoelting RK, Hillier SC. Pharmacology and physiology in anaesthetic practice. 4th ed. Philadelphia: Lippincott William and Wilkins; 2006.
7. Nakazawa K, Hikawa Y, Maeda M, Tanaka N, Ishikawa S, Makita K, et al. Laryngeal mask airway insertion using propofol without using muscle relaxant: a comparative study of pretreatment with midazolam or fentanyl. European Journal of Anesthesiology 1999;16:550-5.
8. Koh KF, Chen FG, Cheong KF, Esuvaranathan V. Laryngeal mask insertion using thiopental and low dose atracurium: A comparison with propofol. Can J Anesth 1999; 46(7):670-4.
9. Swadia VN, Patel MG. Comparison of induction and intubation characteristics of sevoflurane and halothane in pediatric patients. Indian J Anaesth. 2001;45(4): 294-7.
10. Ti LK, Chow MYH, Lee TL. Comparison of sevoflurane with propofol for laryngeal mask airway insertion in adults. Anesth Analg 1999;88:908-12.
11. Gil ML, Brimacombe J, Clar B. Sevoflurane vs propofol for induction and maintenance of anesthesia with the laryngeal mask airway in children. Pediatric Anesthesia 1999;9:485-90.
12. Molloy ME, Buggy DJ, Scanlon P. Propofol or sevoflurane for laryngeal mask airway insertion. Can J Anesth 1999; 46(4):322-6.
13. Priya V, Divatia JV, Dasgupta D. A comparison of propofol vs sevoflurane for laryngeal mask airway insertion. Indian J Anaesth. 2002;46(1):31-4. 14. Girish PJ. Inhalational techniques in ambulatory anesthesia. Anesthesiology Clin N Am 2003;21:263-72.
15. Brimacombe JR. Laryngeal Mask Anesthesia - Principles and Practice. 2nd ed. Philadelphia: Elsevier-Saunders; 2005.
16. Cook TM, Seavell CR, Cox CM. Lignocaine to aid the insertion of laryngeal mask airway with thiopentone. A comparison between topical and intravenous administration. Anesthesia 1996;51(88):787-90.
17. Thwaites A, Edmends S, Smith I. Inhalation induction with sevoflurane: a double blind comparison with propofol. Br J of Anaesth 1997;78:356-364.
18. Gantara SB, Mello JD, Butani M. Condition of insertion of laryngeal mask airway. Comparison between sevoflurane and propofol using fentanyl as a co-induction agent. A pilot study. European Journal of Anesthesiology 2002;19:371-5.
19. Sahar MSS, Marie TA, Samar KT. A Comparison of Sevoflurane-Propofol versus Sevoflurane or Propofol for Laryngeal Mask Airway Insertion in Adults. Anesth Analg 2005;100:1204–9.
20. Koppula RK, Shenoy A. Comparison of sevoflurane with propofol for laryngeal mask airway insertion in adults. J. Anaesth Clin Pharmacol 2005;21(3):271-4.
21. Kati I, Demirel CB, Huseyinoglu UA, Silay E, Yagmur C, Coskuner I. Comparison of propofol and sevoflurane for laryngeal mask airway insertion. Tohoku J Exp Med 2003; 200(3):111-8.
22. Jun L, Ping G, Hong C, Quan LQ. Comparison of LMA insertion conditions with sevoflurane inhalation and propofol TCI anesthesia. Anesthesiology 2008;109 A 777.
23. Guard BC, Sikich N, Lerman J, Levine M. Maintenance and recovery characteristics after sevoflurane or propofol during ambulatory surgery in children with epidural blockade. Can J Anaesth 1998;45(11):1072-8.
24. Joo HS, Perks WJ. Sevoflurane vs Propofol for anesthetic induction. A Meta analysis. Anaesth. Analg 2000;91:213-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241414EnglishN2012July31General SciencesDESIGN OF A ULTRA WIDE-BAND CAPACITIVE FEED MICROSTRIP PATCH ANTENNA FOR Ku-BAND
APPLICATIONS
English148154M. SowmyaEnglish M. Venkata NarayanaEnglish I. GovardhaniEnglish Habibulla KhanEnglishA ultra wideband micro-strip patch antenna with capacitive feed is presented here. In recent years microstrip patch antennas are widely used in communication systems because of their characteristics such as low cost, low profile structure and minimal weight. Due to these characteristics, micro-strip antennas are capable of maintaining high performance over a wide spectrum of frequencies, also the size of the antenna is directly tied to the wavelength at the resonant frequency. One of the important aspects in micro-strip patch antenna is the feed applying to them. Since, the performance of the basic micro-strip patch antenna suffers from number of serious drawbacks; especially its narrow impedance bandwidth associated with probe-fed micro-strip antennas. Here, a capacitive feeding scheme is used which comprises of a radiator patch, air cavity in the substrate and a capacitively-fed in order to overcome the drawbacks associated with probe-fed. Slots are used in the radiating patch at the four sides to attain improved bandwidth. Different parameters like return loss, gain(both 2D & 3D),VSWR, radiation patterns, E & H fields, current distribution are simulated using Ansoft HFSS 13.0. This type of proposed patch can be used for various applications in Ku-band.
EnglishMicro-strip antenna, capacitive feed, air cavity.INTRODUCTION
In high-performance aircraft, spacecraft, satellite and missile applications, we have small size, less weight, low cost, high performance, ease of installation, and aerodynamic profiles are constraints, so we require low profile antennas. Presently there are many other government and commercial applications, such as mobile radio and wireless communications that have similar specifications. To meet these requirements, Microstrip antennas can be used. These micro-strip antennas are low profile, conformable to planar and non planar surface, simple and inexpensive to manufacture using modern printed circuit technology, mechanically robust when mounted on rigid surfaces, and when the particular patch shape and mode are selected; they are very versatile in terms of resonant frequency, polarization, pattern and impedance. In addition by adding the load between patch and ground plane such as pins, adaptive elements with variable resonant frequency, impedance, polarization and pattern canbe designed. In the contacting method, the RF power is fed directly to the radiating patch using a connecting element such as a micro-strip line. In the noncontacting scheme, electromagnetic field coupling is done to transfer power between the micro-strip line and the radiating patch. The Coaxial feed or probe feed (contacting method) is a very common technique for exciting a micro-strip patch antenna. Probe feeding is also referred to as a direct contact excitation mechanism. However, the electrical performance of the basic probe-fed micro-strip antenna suffers from a number of serious drawbacks, especially its narrow impedance bandwidth restricts the performance of antennas in UWB applications [1]. The basic reason for narrow impedance bandwidth is the high quality factor of micro-strip antenna, so decreasing the quality factor is an effective way to increase antenna's impedance bandwidth. One way for decreasing the quality factor is to increase the thickness of the substrate. However, increasing the thickness of the substrate leads to the surface wave excitations i.e., the total power delivered by source goes into surface wave. This surface wave causes the degradation of antenna characteristics. Therefore, antenna technologies about bandwidth enhancement and size reduction are becoming the major design considerations for practical applications. This kind of bandwidth-enhancement technique includes:
the use of a thick air or foam substrate
the loading of a chip resistor or matched network
the changing of antenna shape.
To overcome this problem associated with probefed micro-strip antennas, several useful techniques applied to improve the bandwidth and size reduction. One of the technique is adding a capacitive component to the input impedance of the radiating patch, which compensates for the inductive component of the feed by embedding a cutting slots in it[3]. In this paper, a new ultra-wide bandwidth antenna excited by a capacitively-fed patch with air cavity is proposed. The bigger patch acts as radiator patch, while the smaller patch placed very close to it acts as feed strip. Coaxial feeding is used to excite feed strip has used which is compatible with air gap below the substrate. Very small slots are used at 4 sides of the radiating patch. These slots can be used to increase the total surface current length there by we can improve the radiation. Entire geometry of the antenna is easy to design which makes the structure of the patch symmetrical. Results are simulated using Ansoft HFSS 13.0.
ANTENNA DESIGN MODEL:
In order to improve the antenna's impedance bandwidth and reduce the weight of antenna, an air square cavity is made as part of substrate. Figure 1 shows the basic structure of the proposed antenna with the larger patch served as the radiator and the smaller one worked as a feed strip which couples the energy to the radiator by capacitive means. The antenna substrate is placed above the ground plane and below the radiator patch with a air cavity. The substrate material used for the antenna is Rogers RT/ Duroid 5880 with dielectric constant εr of 2.2 with length of 2.7cm and width of 2.3cm. The main radiator patch element is placed on the air cavity with length 1cm and width 1.4cm.The smaller patch called feed strip is placed very close to the radiator patch with length of 0.1cm and width of 0.4cm.Coaxial probe feed is applied to the radiator patch which increases the gain of the antenna. However, if the probe feed is given to the feed strip element the gain of the antenna decreases. The air cavity is located in the centre of substrate. The length of the air cavity is 1.8cm and width is 1.53cm.The thickness of the air cavity is considered to be same as the thickness of the substrate material. The air cavity is cutted and placed at the center of the substrate.
maximizing the bandwidth. Here, first the gain is measured for the same dimensions of the radiator patch, feed strip elements without air cavity.The gain obtained for this structure without air cavity is around 3dB. But,the gain obtained for the same structure with same dimensions is about 7.714dB. It is certainly understood that, the air cavity locates in the substrate and as the effective substrate height increases or permittivity decreases, the bandwidth of the antenna becomes wider. For maximizing the bandwidth the air gap should be such that[3]: (1) Where is the wavelength corresponding to the frequency of the operating band, h is the height of the substrate and is the relative dielectric constant of the substrate. However, the air cavity in the designed antenna is fully surrounded by substrate,so we need to amend the formula as[3]: (2) Not only the effect of air cavity for the proposed antenna, also the dimensions and location of the feed strip play a major role in obtaining the wide bandwidth. Based on all these simulations are done using Ansoft HFSS 13.0 which is a FEM(Finite Element Method) based, electromagnetic(EM) simulation software.
SIMULATION RESULTS
A. Return Loss: It is related to impedance matching and the maximum transfer of power theory. It is also a measure of the effectiveness of an antenna to deliver of power from source to antenna
TABULAR FORM:
Tabular form represents the different antenna parameters for the proposed antenna designed for 10GHz.
CONCLUSION
A ultra wideband micro-strip patch antenna with small capacitive feed is proposed & designed for the wideband operation in the Ku-band. The effect of air cavity placed at the center of the substrate(Rogers RT/Duroid 5880)plays a critical role in increasing the gain and other parameters of the antenna. And also the slotted sided patch proposed here is mainly to get the constant radiation pattern. The main purpose of using the slots in th patch is for balancing the resistive part & reactive part which affect the impedance matching. In this design, the proposed antenna can operate at 10GHz with return loss (S11) Englishhttp://ijcrr.com/abstract.php?article_id=1726http://ijcrr.com/article_html.php?did=17261. L 1. Bahl and P. Bhartia , Micro-strip Antenna, Norwood, MA: Artech House, 1980.
2. Wong, K. L., Compact Broadband Micro-strip Antenna, John Wiley & Sons, New York, 2002.
3. Liu Ying, Liu Jianping, Li Ping, Designing a Novel Broadband Micro-strip Antenna with Capacitive Feed, IEEE Cross Strait QuadRegional Radio Science and Wireless Technology Conference(CSQRWC),Vol. 1,pp. 156-159,july 2011.
4. P.S.Nakar.,‘Design of a Compact Microstrip Patch Antenna‘,John Wiley & sons,Newyork,2002.
5. Piyush Musale,Sanjay V.Khobragade, Capacitive Feed for Slotted Micro-strip Antenna, IEEE General Assembly & Scientific Symposium,Aug 2011.
6. C. A. Balanis, Antenna Theory Analysis and Design, Second Edition, New York, Wiley, 1997.
7. Veeresh G. Kasabegoudar, Dibyant S. Upadhyyay, and K. J. Vinoy. Design studies of ultra wide band micro-strip antennas with a small capacitive feed. International Journal of Antennas and Propagation, voL 2007, Article ID 67503, 8 pages, 2007. doi:10. 115512007/67503.
8. G. Mayhew-Ridgers, l.W. Odondaal and 1. Joubert, Single-layer capacitive feed for wide band probe-fed microstrip antenna elements, IEEE Trans. Antennas Propagation, voL 5 1, pp. 1405-1407, Nov. 2003
9. J. Constantine, New Multi Band Design for a Microstrip Patch Antenna Masters thesis, American University of Beirut, October 2006.
10. 1. G. Kumar and K. P. Ray, Broadband Microstrip Antennas, Artech House, Norwood, Mass, USA, 2003.
11. Mukesh R. Solanki, Usha Kiran K., and K. J. Vinoy,? Broadband Design of a Triangular Micro-strip Antenna with a Small Capacitive Feed? Journal of Microwaves,Optoelectronics and Electromagnetic Applications, Vol. 7,No.1, June 2008.
12. Lee Chia Ping Chakrabarty, C.K. Khan, R.A. ?design of Ultra Wideband slotted micro-strip patch antenna?, Dept . of Electron. & Communication Eng., Centre for Communication Service Convergence Technol., Kajang, Malaysia Electronics Letters, vol. 40, no. 19, pp. 1166–1167, 2004.
13. N. Herscovici, ?New considerations in the design of microstrip antennas.? IEEE Transactions on Antennas and Propagation, AP- 46, 6, June 1998, pp. 807-812.
14. Sanad, M. ?Microstrip Antennas on Very Small Ground Planes for Portable Communication Systems?. Proceedings of the IEEE Antennas and Propagation Society Symposium, June 1994, pp. 810-813.