Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Notice: Undefined index: issue_status in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 142
Notice: Undefined index: affilation in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 195
Notice: Undefined index: doiurl in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 198
Warning: Cannot modify header information - headers already sent by (output started at /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php:195) in /home/u845032518/domains/ijcrr.com/public_html/downloadarchiveissuexml.php on line 234
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30General SciencesAtom Bond Connectivity Indices of Kragujevac Trees (Kgd,k)
English0107Keerthi G. MirajkarEnglish Bhagyashri R. DoddamaniEnglish Priyanka Y.B.EnglishAim: The aim of this article is to determine first four types of atom bond connectivity indices of Kragujevac trees with isomorphic branches and increased ordered branches.
Methodology: The method applied to obtain the goal of this article is analytic.
Results: The results we constructed here are for first four types of atom bond connectivity indices of Kragujevac tree with all branches of tree are mutually isomorphic to each other and increasing ordered branches.
Conclusion: The first four types of atom bond connectivity indices on kragujevac trees with isomorphic branches and increasing ordered branches are determined. Also, atom bond connectivity indices can be computed for other class of graphs.
EnglishAtom bond connectivity indices, Kragujevac tree
Introduction:
Mathematical chemistry is a branch of theoretical chemistry using mathematical methods to discuss and predict molecular properties without necessarily referring to quantum mechanics [1,15,22]. Chemical graph theory is a branch of mathematical chemistry which applies graph theory in mathematical modeling of chemical phenomena [8]. This theory has an important effect on the development of the chemical sciences.
A graph G = (V, E) is a collection of points and lines connecting them. The points and lines of a graph are also called vertices and edges respectively. If e is an edge of G, connecting to the vertices u and v, then we write e = uv. A connected graph is a graph such that there exists a path between all pairs of vertices. The distance d(u, v) = dG(u, v) between two vertices u and v is the length of the shortest path between u and v in G.
Amolecular graph is a simple graph such that its vertices correspond to the atoms and edges corresponds to the bonds. According to the IUPAC terminology, a topological index is a numerical value associated with chemical constitution, which can be then used for correlation of chemical structure with various physical and chemical properties, chemical reactivity and biological activity [9,10,12,17,19,20,21,24].
In mathematical chemistry, numbers encoding certain structural features of organic molecules and derived from the corresponding molecular graph, are called graph invariants or more commonly called as topological indices.
Among topological descriptors, connectivity indices are very important and they have a prominent role in chemistry. In other words, if G be the connected graph, then we can introduce many connectivity topological indices for it, by distinct and different definition.
One of the best known and widely used is the connectivity index, introduced in 2009, Furtule[4] proposed the first atom bond connectivity index of a graph G as:
Where du denotes degree of vertex u and dv denotes degree of vertex v in G.The second atom bond connectivity index is introduced by A. Graovac[7]. It is defined as follows:
Where nu denotes the number of vertices of G whose distance to the vertex u is smaller than distance to the vertex v.Farahani[3] proposed a third atom bond connectivity index of G as follows:
where mu is the number of edges of G lying closer to u than to v and mv is the number of edges of G lying closer to v than to u
Ghorbani [6] defines a new version of atom bond connectivity index. It is named as fourth atom bond connectivity index and defined as:
where su denotes the sum of degrees of all neighbor of vertex u in G. Reader can find the history and results on this family of indices in [23,25-27].
All graphs considered here are connected, finite without multiple edges and loops. For undefined terminologies, we refer to [16].
Motivated by [3,4,6,7], In this article we study and compute the above mentioned four types of Atom Bond Connectivity Indices on the special class of graph called the Kragujevac tree with isomorphic branches and increasing ordered branches.
Definition 2.1. [11] Let P3 be the 3 vertex tree rooted at one of its terminal vertices, see Figure 1. For k = 2, 3,… construct the rooted tree Bk by identifying the roots of k copies of P3 .The vertex obtained by identifying the roots of P3 trees is the root of Bk .
Examples illustrating the structure of the rooted tree Bk are depicted in Figure.1.
A Kragujevac tree of degree d = 5, in which β1, β2, β3≅B2, β4≅B3,β5≅B5. The branches Bk has 2k + 1 vertices and 2k edges. A typical Kragujevac tree is denoted by Kgd,k where d ≥ 2 is the degree of central vertex and k ≥ 2.
Methadology:
In this article, we determine the first four types of atom bond connectivity indices on a special class of graph called as Kragujevac tree. To find these four types of atom bond connectivity indices on Kragujevac tree we have applied analytic method and hence established the following results.
Results:
Theorem 3.1. Let Kgd,k be the Kragujevac tree of degree d ≥ 2 with all branches Bk of tree are mutually isomorphic to each other. Then the first atom bond connectivity of Kgd,k is
Proof. By the definition of kragujevac tree Kgd,k of degree d ≥ 2, with all isomorphic branches Bk ,∀k ≥ 2. Further each branch Bk of Kgd,k contains k pendent vertices. Then the kragujevac tree contains [k (2k + 1) + 1] vertices and (2k + d) edges.
We consider the following cases to compute the proof, which are depending upon the degree of the vertices in Kgd,k.
Case i. Each branch Bk has 2k edges, where k edges are incident with pendent vertices and the vertices of degree 2. Remaining k edges are incident with vertices of degree 2 and vertex of degree (k + 1). Since there are d number of branches present in Kgd,k, then
From equation (1),
The ABC1 for d number of Bk branches of Kgd,k is
Case ii. Now consider the d edges incident with central vertex of degree d and the vertices of degree (k + 1).
From equation (1),
The ABC1 for d edges of Kgd,k is
From equation (5) and (6),
Corollary 3.2. The first atom bond connectivity of Kragujevac tree Kgd,k , when d = k is
Proof. The proof follows from the theorem 3.1 and replacing d by k
Theorem 3.3. Let Kgd,k be the Kragujevac tree of degree d ≥2 with all branches Bk of tree are mutually isomorphic to each other, then the second atom bond connectivity of Kgd,k is
Proof. Here we consider the Kragujevac tree Kgd,k of degree d ≥2, with all isomorphic branches Bk ,∀k ≥2. We compute the ABC2 by considering the following
cases depending upon the distance between of the vertices in Kgd,k.
Case i. Each branch Bk has 2k edges, where k edges are incident with pendent vertices and the vertices of degree 2. Here one vertex of degree 2 is closer to the pendent vertices and [d (2k + 1)] vertices are closer to the vertices of degree 2. The remaining k edges are incident with vertices of degree 2 and vertex of degree (k + 1). Hence 2 vertices are closer to vertices of degree 2 and [d (2k + 1) - 1] edges are closer to the vertex of degree (k + 1). Since there are d number of branches present in Kgd,k, then
From equation (2),
The ABC2 for d number of Bk branches of Kgd,k is
Case ii. Now consider the d edges incident with central vertex of degree d and the vertices of degree (k + 1). Here the (2k + 1) vertices are closer to the vertices of degree (k + 1) and [d (2k + 1) – 2k] vertices are closer to the vertex of degree d.
From equation (2), The ABC2 for d edges of Kgd,k is
Corollary 3.4. The second atom bond connectivity of Kragujevac tree Kgd,k , when d = k is
Proof. The proof follows from the theorem 3.3 and replacing d by k.
Theorem 3.5. Let Kgd,k be the Kragujevac tree of degree d ≥ 2 with all branches Bk of tree are mutually isomorphic to each other. Then the third atom bond connectivity of Kgd,k is
Proof. Here we consider the Kragujevac tree of degree d ≥2, with all isomorphic branches Bk, ∀k ≥ 2. We consider the following cases to compute the proof, which are depending upon the distance between of the edges and vertices in Kgd,k.
Case i. Each branch Bk has 2k edges, where k edges are incident with pendent vertices and the vertices of degree 2. Here one edge is closer to the pendent vertices and [d (2k + 1)] edges are closer to the vertices of degree 2. The remaining k edges are incident with vertices of degree 2 and vertex of degree (k + 1). Hence 2 edges are closer to vertices of degree 2 and [d (2k + 1) - 1] edges are closer to the vertex of degree (k + 1). Since there are d number of branches present in Kgd,k, then
From equation (3),
The ABC3 for d number of Bk branches of Kgd,k is
Case ii. Now consider the d edges incident with central vertex of degree d and the vertices of degree (k + 1). Here (2k + 1) edges are closer to the vertices of degree (k + 1) and [d (2k + 1) – 2k] edges are closer to the vertex of degree d.
From equation (3),
The ABC3 for d edges of Kgd,k is
Corollary 3.6. The third atom bond connectivity of Kragujevac tree Kgd,k , when d = k is
Proof. The proof follows from the theorem 3.5 and replacing d by k.
Theorem 3.7. Let Kgd,k be the Kragujevac tree of degree d ≥ 2, with all branches Bk f tree are mutually isomorphic to each other, then the fourth atom bond connectivity of Kgd,k is
Proof. Let Kgd,k be the Kragujevac tree of degree d ≥ 2, with all isomorphic branches Bk,∀k ≥ 2. We consider the following cases to compute the proof, which are depending upon the degree of neighbor vertices of Kgd,k..
Case i. Each branch Bk has 2k edges, where k edges are incident with pendent vertices and the vertices of degree 2. For the pendent vertices the neighbor vertices are of degree 2 and for the vertices of degree 2 the neighbor vertices are of degree (k + 2). The remaining k edges are incident with vertices of degree 2 and vertex of degree (k + 1). For the vertices of degree 2 the neighbor vertices are of degree (k + 2) and for the vertices of degree (k + 1) the neighbor vertices are of degree (2k + d). Since there are d number of branches present in Kgd,k, then
Case ii. Now consider the d edges of Kgd,k which are incident with central vertex of degree d and the vertices of degree (k + 1). For the vertex of degree d the neighbor vertices are of degree [d (k + 1)] and for the vertices of degree (k + 1) the neighbor vertices are of degree (2k + d).
From equation (4),
The ABC4 for d edges of Kgd,k is
Corollary 3.8. The fourth atom bond connectivity of Kragujevac tree Kgd,k
, when d = k is
DISCUSSION
The original atom bond connectivity index was introduced in 1990’s and is defined in [2]. Atom bond connectivity Indices of Kragujevac trees emerged in several studies addressed to solve the problem of characterizing the tree with minimal atom bond connectivity index [5,13,14]. Let G be a simple graph on n vertices. By uv we denote the edge connecting the vertices u and v. A vertex of degree one is referred to as a pendent vertex. An edge whose one end vertex is pendent is referred to as a pendent edge. The formal definition of a Kragujevac tree was introduced in [18]. Hence by using degree of vertices, distances between the vertices and edges of Kragujevac tree, we established our results for atom bond connectivity indices of Kragujevac trees.
CONCLUSION
In this article, we studied the first four types of atom bond connectivity indices and have calculated the first four types of atom bond connectivity indices for Kragujevac trees with isomorphic branches and increased ordered branches. Also in this article we observe the second and third atom bond connectivity indices are same for Kragujevac trees for both isomorphic and increasing ordered branches. Nevertheless, there are still many other class of graphs that are not covered here. For further research, the atom bond connectivity indices for other class of graphs can be computed.
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. Conflict of Interest: Nil Source of Funding: Nil
Englishhttp://ijcrr.com/abstract.php?article_id=2253http://ijcrr.com/article_html.php?did=22531. S. J, Cyvin and I. Gutman, Kekulé Structures in Benzenoid Hydrocarbons, Lecture Notes in Chemistry, Springer Verlag, Berlin, 46, (1988).
2. E. Estrada, L. Torres, L. Rodr?guez, I. Gutman, An atom–bond connectivity index: modelling the enthalpy of formation of alkanes, Indian J. Chem., 37A, (1998), 849–855.
3. M. R. Farahani, Computing a New version of Atom bond connectivity Index of circumcoronene Series of Benzenoid Hk by using Cut Method, J. Math. Nano Science, 2, (2012) (In press).
4. B. Furtula, A. Graovac and D. Vuki?evi?, Atom-bond connectivity index of trees, Disc. Appl. Math. 157, (2009), 2828 - 2835.
5. B. Furtula, I. Gutman, M. Ivanovi? and D. Vuki?evi?, Computer search for trees with minimal ABC index, Appl. Math. Comput., 219, (2012), 767 - 772.
6. M. Ghorbani, M. A. Hosseinzadeh. Computing ABC4 index of nanostar dendrimers, optoelectron. Adv. Mater. - Rapid commun. 4(9), (2010), 1419 - 1422.
7. Graovac and M. Ghorbani, A New version of Atom-Bond Connectivity Index. Acta chim. Slov., 57, (2010), 609 - 612.
8. A. Graovac, I. Gutman and N. Trinajsti?, Topological Approach to the Chemistry of Conjugated Molecules, Springer Verlag, Berlin, (1977).
9. A. Graovac, I. Gutman and D. Vuki?evi?, Eds., Mathematical Methods and Modelling for Students of Chemistry and Biology, Hum naklada, Zagreb, (2003).
10. I. Gutman, Graph Theory Notes New York, 27, (1994), 9 - 15.
11. I. Gutman, Kragujevac trees and their energy, SER. A: Appl. Math. Inform. and Mech. 6(2), (2014), 71 - 79.
12. I. Gutman and A. R. Ashrafi, The edge version of the Szeged Index, Croat. Chem. Acta, 81, (2008), 263 - 266.
13. I. Gutman and B. Furtula, Trees with smallest atom-bond connectivity index, MATCH Commun. Math. Comput. Chem., 68, (2012), 131 - 136.
14. I. Gutman,, B. Furtula and M. Ivanovi?, Notes on trees with minimal atom-bond connectivity index, MATCH Commun. Math. Comput. Chem., 67, (2012), 467 - 482.
15. I. Gutman and O. E. Polansky. Mathematical concepts in organic chemistry, springer Verlag, Berlin, (1986).
16. F. Harary, Graph Theory, Addison - Wesely, Reading, (1969).
17. H. Hosoya, On Some Counting Polynomials in Chemistry Disc. Appl. Math., 19, (1988), 239 - 257.
18. S. A. Hosseini, M. B. Ahmadi and I. Gutman, Kragujevac Trees with minimal Atom-bond Connectivity Index, MATCH Commun. Math. Comput. Chem., 71, (2014), 5 - 20.
19. P. V. Khadikar, S. Karmarkar and V. K. Agrawal, A novel PI index and its applications to QSPR/QSAR studies. J. chem. Inf. Comput. Sci., 41, (2001), 934 - 949.
20. N. Raos and A. Mili?evi?, Topological indices in estimating coordination compound stability constants, Arh. Hig. Rada Toksikol., 60, (2009), 123 - 128.
21. N. Trinajasti?, Chemical Graph Theory, CRC Press, Boca Raton, FL, (1992).
22. N. Trinajsti? and I. Gutman, Mathematical Chemistry, Croat. Chem. Acta, 75, (2002), 329 - 356.
23. T. S. Vassilev, L. J. Huntington, On the minimum ABC index of chemical trees, J. Appl. Math. 2, (2012), 8 - 16.
24. H. Wiener, Structural determination of paraffin boiling points, J. Am. Chem. Soc., 69, (1947), 17 - 20.
25. R. Xing, B. Zhou, Extremal trees with fixed degree sequence for atom-bond connectivity index, Filomat, 26, (2012), 683 - 688.
26. R. Xing, B. Zhou, Z. Du, Further results on atom-bond connectivity index of trees, Discr. Appl. Math. 158, (2011), 1536 - 1545.
27. J. Yang, F. Xia, H. Cheng, The atom-bond connectivity index of Benzenoid systems and phenylenes, Int. Math. Forum, 6, (2011), 2001 - 2005.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30General SciencesPromoting Rural Entrepreneurship Through Skill Development for Decent Livelihood: A Review
English2125Priyanka TripathiEnglish Neetu SinghEnglishUnemployment, especially among rural people is a biggest challenge for India. As a result rural people are moving towards urban areas to obtain better employment opportunities and amenities of life. Agriculture is the principal economic activity but due to post harvest losses like food weight loss, loss of food quality, loss of food values, loss of economic values, make food less acceptable by consumers that results poor earning or less profit to farmers, a solid factor of rural poverty. Rural youth are educated but not skilled unlike urban youth. Lack of new, challenging and better job opportunities in agriculture sector limits the job opportunities for educated rural youth. So there is a need to generate agripreneurship and new agricultural job opportunities to reduce migration of rural people and to promote rural upliftment. Thus the entrepreneurship in food processing and value addition of food can create boom in employment for rural areas. It is a better way to combat poverty and for rural development. Government has started so many vocational courses, training programs, schemes and programs for skill development of youth to promote rural entrepreneurship.
EnglishEntrepreneurship, Skill development, AgripreneurshipIntroduction: In India major population is still living below poverty line especially rural population. They have to struggle to meet even their primary need. Their living status is very low. A large number of people are being shifting from rural areas to urban areas in search of better amenities of life and employment opportunities. Urban population is increasing and rural population is decreasing day by day. According to Census report of 2011 the urban population is growing from 10.8% to 31.2%. There are many leading factors, responsible for migration of rural population towards urban area. Unemployment is one of those influencing factors. In India majority of population (68.8%) is living in rural area are dependent on agricultural activities for their bread and butter. Agriculture provides limited job opportunities so there is need to promote rural entrepreneurship.Successful farmers differ from others in terms of three personality traits. They have more belief in their ability to control events, problem-solving abilities and social initiative (Schiebel, 2002). Entrepreneurs are the people who exhibit common traits such as single-mindedness, drive, ambition, creative, problem solving, practical, and goal-oriented. An entrepreneur is an individual who recognizes an opportunity or unmet need and takes the risk to pursue it. He needs to develop these abilities, managing productivity and seeking out new markets (Singh A.P., 2013). A major long-term challenge in India is that many youth, because of lack of awareness and improper training on agripreneurship are migrating from rural to urban areas. They cannot afford to remain unemployed for long and, hence, pick up activities which lead to underemployment (Narendran K. and Ranganathan T.T, 2015). The most important quality of entrepreneur is the capacity to bear risk related to his enterprise establishment and nourishment and its management by simple and creative solutions as farmers invest more human and non-human resources, getting poor or less profit in agricultural activity. Therefore farmers can be proved better entrepreneur if proper training is given. Similarly a farmer owning and cultivating land in same will be ideal person to start a micro or medium enterprise. Rural people are not well skilled as urban people are well educated in skill courses like engineering, medical and so on because of their financial problems. Rural areas are rich in raw material for industries. However the income level of rural people is lower than urban people because of centralization of processing centers in urban areas. Centralization of employment opportunities in urban areas not only results unbalanced development but aggregation of urban slums. Prosperity of rural areas will not come unless employment will be created at the rural areas itself. Establishment of micro or household industries in rural areas can break the cycle of poverty and ensure food safety and way to decent livelihood by providing employment to rural youth, women, farmers and landless people. The energy of womenfolk can be used for productive purpose with establishment of small and micro enterprises in rural areas. Thus creation of new opportunities of employment in rural areas is seen the best way to stop distress migration from village.
Need to promote rural entrepreneurship: Entrepreneurship development is the driving force of socio-economic growth of any nation. Sah (2009) stated that developing entrepreneurs in agriculture will solve the entire problem like dependency on agriculture, rural unemployment and migration from rural to urban areas, Personal qualities of an agri-entrepreneur, significantly affect the agribusiness (Brockhaus and Horwitz, 1986; Nandram and Samson, 2000). Agriculture and allied sectors are considered to be mainstay of the Indian economy because these are important sources of raw materials for industries and they demand for many industrial products particularly fertilizers, pesticides, agriculture implements and a variety of consumer goods (Bairwa et al., 2014). The development of entrepreneurship in village will create utilities and generation of employment at rural area. It starts from the innovation of the idea to establishing, nourishing the enterprise at rural sector. Jobs in agriculture sector are limited. Migrants coming from villages in search of employment to obtain decent livelihood are forced to do lower job in urban areas to sustain themselves and their condition becomes poor to poorer. So it becomes need of the day to promote agripreneurship and establishment of enterprises related to agriculture raw material at rural areas. The trend of establishment of rural industries will reverse the migration to urban areas. People prefer more to buy cost effective products. The total cost of the product will be reduced to start enterprise based on local available resources. Rural entrepreneurship will not only bring prosperity in villages but will also save energy, consume in the transportation of bulky amount of raw materials and human-resources to the nearby urban areas for employment.
Food processing as a solution: Agriculture is the principal means of livelihood for Indian population. In India most of the people are engaged in farming and allied activities. Farmers face huge loss every year due to post harvest losses like food weight loss, loss of food quality, loss of food values, and loss of economic values that make food less acceptable by consumers, results poor earning or less profit to the farmers, a solid factor of rural poverty. Food processing industry employs 13 million people directly and 35 million people indirectly (Government of India, 2011-12). Even after a strong agricultural production base, food processing industry of India is still under developed. The highest share of the processed food is in the dairy sectors whereas 35% of total produce is processed, and only 15% is processed by the organized sector. The processing level is around 2.2% in fruits and vegetables, 21% in meat and poultry products. Of the 2.2% processing in fruits and vegetable only 48% is in organized sector remaining in unorganized sector (Mohammad Rais et al, 2013). Increasing urbanization, consciousness on health and nutrition and changing life style are changing the consumption habits of India. The number of working women, single students/professionals and nuclear families are creating demand for processed, ready–to–eat foods (Mohammad Rais et al, 2013).Food processing sector can create boom in employment sector by generating new and diversified job opportunities for rural people. In India Post-harvest losses are higher in fruits and vegetables. Most of the people consume raw fruit and vegetable. Very less amount of fruit and vegetable is being used in food processing. Though processed and value added food are very popular among people and the demand of processed food is increasing. Food processing enhances the shelf life of food. In this way entrepreneurship in food processing and value addition is emerging as a solution of rural migration, rural unemployment, rural poverty and food insecurity among rural population. In present time processed and value added food products are very popular among people. Food processing is labor intensive and can provide numerous diversified job opportunities to the farmers, youth and women. In this sector micro and cottage industries can be started at their own place by local people. Availability of raw material and human resources for establishment of enterprise reduces the total cost of production.Skill development in food processing sector is central to improve employment and livelihood opportunities, reduce poverty, enhancing productivity and food safety.
Need of skill development for entrepreneurship: Education certainly opens the doors to lead a life of liberty but skills makes that liberty meaningful by allowing one to achieve prosperity. Education and skills increase the ability to innovate and adopt new technologies in agriculture and enhance farmers’ performance (Hartl M., 2009). There is a wide gap between skills needed and available. If India is to make its presence in the world market, then there is a need to bridge this gap as soon as possible. There is a huge gap in demand and supply market. According to a survey done by NSDC, there is a huge demand for skilled workers at all the stages in food processing industry, especially for person with short term course training, having education level below 10th/ 12th standard (Mohammad Rais et al, 2013). India currently faces a severe shortage of well-trained, skilled workers. It is estimated that only 2.3 % of the workforce in India has undergone formal skill training as compared to 68% in the UK, 75% in Germany, 52% in USA, 80% in Japan and 96% in South Korea (www.firstpost.com, 2017). There is wide gap between skill needed and skill available. Lack of skilled and trained manpowerin food processing industry is also a big issue. Around 58% of the employers are dissatisfied with technical skills and knowledge needed for the industry (https://issue.com/advanceinfomedia/docs/ oil food journal august 2014/40). There are emerging skill shortages due to mismatch between the demand for specific skills and available supply. In fact, of late shortage of skilled, semi-skilled and unskilled workers has emerged as a critical factor impacting the competitiveness of Indian food industries. Around 58% of the employers are dissatisfied with technical skills and knowledge needed for the job (FICCI survey, 2009). Also 72% showed discontent with employees’ ability to use appropriate and modern tools, equipment, and technologies, specific to their job (FICCI survey, 2010). A study carried out by Sanjeeb Hazarika (2016) on 40 entrepreneurs (included men and women both) of Assam who have started their enterprise after receiving training from State Institute of Rural Development (SIRD) indicated that 67% of the entrepreneur’s living status was improved. Skill and knowledge about enterprise to be started are the prerequisite for an entrepreneur. Lack of education and lack of skill is a pestilence that we need to overcome in over current system and the faster we do this, the better for all concerned. The shape of enterprises and jobs are being change with the development of new technology. Alarge section of the educated workforce has little or no job skill, making them largely unemployable. Skilling of rural population will improve economy and growth in GDP (Gross domestic Product) and has a cascading effect on employment opportunities for creating rural entrepreneurship. Rural entrepreneurship is the way to improve living standard of rural people. It is necessary to train rural people for reducing rural migration rate, poverty alleviation and unemployment eradication.
Promoting youth entrepreneurship through training: The majority of the world’s youth live and work in rural areas, rural labour markets in most developing countries do not provide sufficient decent work (FAO, 2013). In 2012, the global youth unemployment rate was 12.4%, almost three times higher than the corresponding rate for adults (ILO, 2013). A study conducted by Sanjeeb Hazarika to know motivational role of training and its effect on starting an enterprise in rural area showed that overall employment in the units had increased at the rate of 23%, 63% of the entrepreneurs have developed their leadership skills through various training, 59% respondents have upgraded themselves technically with the support of technically skilled trainers, 52% of respondents could efficiently allocate available resources. It is important to discuss that 71% women established their small enterprises and earn their livelihood after getting training. The study also revealed that only 13% of respondents were aware to a few of the schemes and again only 13% respondents had come to know about programs through print media and rest of them came to know from friends and relatives (Sanjeeb Hazarika, 2016). A multi-prolonged approach to employment promotion- including a favorable macro-economic environment, skills and labour market policies that facilitate the school-to-work transition, rights at work, youth entrepreneurship and social protection of young workers- is essential. Shaping effective policies for decent work for young people- at home and in the context of migration – requires the engagement of governments, employers’ organizations and trade unions in social dialogue. Promoting and incentivizing youth participation in the agricultural sector will provide much-needed employment opportunities for rural youth, and help fortify food security at the household and national levels (FAO, 2013). Majority of youth population live in rural area. In India, deficit of decent work and poverty is higher among youth and women. For rural development it is necessary to bring youth in main stream of development by developing their skill. Very small efforts and basic training regarding establishment and nourishment of enterprises can motivate rural people for making them as an entrepreneur. Rural youth are not well educated if educated they are not skilled like urban youth. In this situation it becomes necessary to develop skill among youth generation to achieve decent livelihood. So it has become a need of the time to focus overall skill development in order to become a great power and utilize our demographic dividend i.e. strength of youth.
Need to promote women entrepreneurship: There is a strong and genuine need to free the women from under-productive tasks and augment the productivity of their work as a means of accelerating the development process One of the options is to promote micro and small-scale enterprises for women to increase their productivity and family income. One such option is Post Harvest Technology based enterprise for women. It would not only augment their income but also help in achieving household food and nutritional security at an affordable cost (Nawab Ali, Post-harvest technology for employment generation in rural sector of India).The female population accounts almost half portion of the entire population in India, and have adequate potential to give pace to country’s economy only if their participation in the workforce will be increased. Entrepreneurship in food processing provides job opportunities for women near their home place. Women can get viable income, decent work by developing their skill and thus can turn out to be major role in contributing equally to the economic growth of the nation. Furthermore, there is a need to replace the conventional vocational courses with the emerging technological ones for promoting youth’s and women’s participation in nontraditional occupations.
Government Initiatives for skill development and promoting entrepreneurship: The Ministry of Skill Development and Entrepreneurship was set up in November 2014 to drive the ‘Skill India’ agenda in a ‘Mission Mode’ (Ministry of skill development and entrepreneurship). Indian government has established separate ministry ‘Ministry of Skill Development and Entrepreneurship’ for promoting entrepreneurship and skill development. Various Government and non-government programs and schemes are being run for generating better amenities and decent livelihood for rural and poor people. Recognizing the importance of rural entrepreneurship and skill development number of initiatives “Start-up India” and “Stand-up India”, Pradhan Mantri Kaushal Vikas Yojna and Aajeevika is recently launched.Government of India is implementing various programs and schemes with objectives to promote entrepreneurship and building capacity by skill up-gradation and self-employment oriented training programs on skill development for youth, entrepreneurs, farmers and women. Support to Training and Employment Program (STEP) aims to provide skills that give employability to women and to provide competencies and skill that enable women to become self- employed or entrepreneurs (Ministry of Women and Child Development). Priyadarshini scheme empowers poor women and adolescent girls through Self Help Group formation. Rural Self Employment and Training Institutes are non-profit institutions established with the support of State and Central Governments to mitigate the unemployment and underemployment problems among rural youth through capacity building and by facilitating in settlement in vocations. National Urban livelihoods mission aims employment through skill training and placement of urban poor (Yojana, October, 2015). Some other programs and schemes like Training of Rural Youth for Self Employment (TRYSEM), Integrated Rural Development Programme (IRDP), NABARD, Mahila Uddyami Scheme, Women Enterprise Development (WED), Swarojgar credit card, Pradhanmantri Mudra Yojna, Micro Credit Scheme (MCS), Development of Women and Children in Rural Areas (DWCRA) are running to train youth and women and promoting rural entrepreneurship to get decent livelihood.
Discussion: It is noticed that rural people are migrating day by day for searching new employment to get better livelihood. Rural areas are rich in human and non- human resources. Farmers face huge post-harvest losses every year due to poor storage of food product thus the entrepreneurship in food processing may become a perfect solution for rural unemployment. There is gap between skill needed and available. Rural youth and women participation in rural entrepreneurship should be promoted through training to reduce rural poverty. So many Government schemes are being run by the Government to promote rural youth and women participation in rural entrepreneurship establishment.
Conclusion: Rural entrepreneurship is the solution to reduce rural migration. Skill development of rural population is recognized as an urgent need of the day to reduce rural migration and achieve decent livelihood. Government has launched many strategic measures to get decent livelihood through entrepreneurship development at rural sector but in spite of programs, schemes and vocational courses India is considered as industrially underdeveloped country. People are not aware of these government initiatives. So it is necessary to raise awareness among rural people regarding government schemes and programs being run for the promotion of rural entrepreneurship. Mass media play an important role to disseminate new information among the people. Electronic media has a vital impact on audience. But the electronic media like T.V, radio, Internet, Mobile are not much involved to disseminate information regarding government schemes and programs to promote rural entrepreneurship. Therefore the use of effective media for the motivation and promotion of rural entrepreneurship should be increased. With the development of technology, the demand of technically skilled labors is increased. Rural people are not technically skilled. So it becomes an urgent need to develop technical skill of rural people to fill this skill gap. Women and youth are deficit in decent livelihood. Youth and women should be motivated to participate in economic development of nation through establishing enterprises at local area. Conventional vocational courses should be replaced by new vocational courses based on technology for rural development.
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.
Source of funding: There is no source of funding for this work.
Conflict of interest: There is no such conflict of interest.
Englishhttp://ijcrr.com/abstract.php?article_id=2255http://ijcrr.com/article_html.php?did=2255
Bairwa, S. L., Kushwaha, S., Meena, L. K., Lakra, K. and Kumar P., 2014, Agribusiness Potential of North Eastern States: A SWOT Analysis. In Edited by Singh et al., 2014 "Agribusiness Potentials in India: experience from hill states". EBH Publishers (India) Guwahati -New Delhi. PP 544 - 556.
Brockhaus, R. H. and Horwitz, P. S., 1986,The psychology of the entrepreneur (in D.L. Sexton and R.W.Smilor (eds.), The art and science of entrepreneurship. Ballinger publishing company, Cambridge, pp. 25-48.
FICCI, 2010, Survey on challenges in food processing sector, Mumbai, India.
Gray, C. 2002, Entrepreneurship, Resistance to change and Growth in Small Firms, Journal of Small Business and Enterprise Development, 9 (1), 61-72
Hartl M., 2009, Technical and Vocational Education and Training (TVET) and Skills Development for Poverty Reduction - Do Rural Women Benefit Paper submitted to FAO-IFAD-ILO Workshop on "Gaps, Trends and Current Research in Gender Dimensions of Agricultural and Rural Employment: Differentiated Pathways out of Poverty”(Rome: 2009)
Mohammad Rais, Shatroopa Acharya and Neeraj Sharma, 2013, Food Processing Industry in India: S and T Capability, Skill and Employment Opportunities, Journal of Food Processing and Technology. 2157-7110.
Narendran K. and Ranganathan T.T., 2015, International Journal in Management and Social Science, 3(8)
Nawab Ali, Post-harvest technology for employment generation in rural sector of India.
Sah, Pooja, Sujan, D. K. and Kashyap, S. K., 2009 Role of Agripreneurship in the Development of Rural Area, Paper presentation in ICARD at Banaras Hindu University, Varanasi.
Sanjeeb Hazarika, 2016, A Study on State Institute of Rural Development for Rural Enterpreneurship: A Study on State Institute of Rural Development (SIRD), Assam, International Journal of Research and Analytical Reviews. Vol.3[issue3]
Schiebel W, 2002, Entrepreneurial Personality Traits in Managing Rural Tourism and Sustainable Business, AgramarketingAltuell 2002/2003, pp 85-99.
Singh, A. P., 2013, Strategies for Developing Agripreneurship among Farming Community in Uttar Pradesh, India, Academicia: An International Multidisciplinary Research Journal, 3(11) 1- 12.
Yojana, 2015,A Journal on Skill development: Scaling New Heights, Special issue, ISSN-0971-8400.
Advance info media/docs, 2014, available at https://issue.com/ oil food journal retrieved on 20/12/2016.
FAO, 2013, promoting decent employment opportunities for rural youth, available at http://www.fao.org/docrep/018/i2976e/i2976e.pdf retrieved on 10/12/2016.
FICCI, 2009, Rising Skill Demand-A Major Challenge for Indian food Industry, Federation of Indian chamber of Commerce & Industry, New Delhi, available at http://ficci.in/SPdocument/20067/Food Industry Skill Demand Study.pd retrieved on 8/12/2016.
Firstpost, 2017, PM Modi launches skill development mission hopes to make India hub of skilled manpower, available athttp://www.firstpost.com/economy/pm-modi-launches-skill-development-mission-hopes-to-make-india-hub-of-skilled-manpower-2344090.html, retrieved on 30.06.2017.
Food-Processing-Bottlenecks-study.pdf, 2007, available athttp://ficci.in/SEDocument/20073 retrieved on 21/12/2016
Government of India, 2012, Ministry of food processing Industries (2011-12) Annual report. New Delhi, India. Available athttp://mofpi.nic.in/contentpage.aspx?CategoryId=1109, retrieved on 10.12.2016.
ILO. 2013. ILO Global employment trends for youth, 2013. Geneva, ILO, available at www.ilo.org/wcmsp5/groups/public/@dgreports/@dcomm/.../wcms_212423.pdf, retrieved on 11.12.2016.
Ministry-of-women--child-development., available athttp://www.indiagovernance.com/ retrieved on 18/12/2016.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30HealthcareStapled Hemorrhoidopexy Versus Classical Hemorrhoidectomy - A Prospective Comparative Study with
3 Years Follow-up
English2631Kasibhatla Lakshmi Narasimha RaoEnglish Samir Ranjan NayakEnglish Satveer SinghEnglish Dillip Kumar SorenEnglish Ganni Bhaskara RaoEnglishHemorrhoids are the common benign anal problems in rural India and usually the patients present to the surgical outpatient department at late stage. This prospective randomized clinical trial is aimed to compare the results of classical versus stapled hemorrhoidopexy for treatment of third and fourth degree hemorrhoids.
Objective: We report our experience on surgical treatment focusing on postoperative pain, complications and days to return normal activities after the procedure
Methods: 106 patients admitted for surgical treatment with class III/IV hemorrhoids from June 2011 to May 2013 were randomly assigned to classical (n=53) or stapled hemorrhoidopexy (n=53).The outcomes included in form of post operative pain, procedure time, number of days taken to return to work, post-operative bleeding, acute urinary retention, need of dressings, and anal stricture were compared. The patients were followed up to 3 years for recurrence of symptoms.
Results: Stapled procedure group had less postoperative pain, earlier return to normal activity and less recurrence after 3 years of the study. There is no need of Seitz bath after stapled procedure
Conclusion: Stapled hemorrhoidopexy is an effective alternative treatment for third and fourth degree hemorrhoids with significant advantages for patients compared with traditional open hemorrhoidectomy.
EnglishClassical Milligan- Morgan hemorrhoidectomy (CH), Third and fourth degree hemorrhoids, Stapled hemorrhoidopexy(SH)INTRODUCTION
Hemorrhoids – bleeding piles are the commonest benign anorectal problem attending to the surgical OPD.In the modern laparoscopic era there are major advances in the treatment of colorectal diseases but only few modifications are available in the management of hemorrhoid disease. Surgical hemorrhoidectomy has been reserved for third and fourth-grade hemorrhoids and the most frequent traditional surgical procedures performed are Milligan-Morgan open hemorrhoidectomy and Ferguson closed hemorrhoidectomy[1,2]. Stapled hemorrhoidepexy, as designed by Dr Antonio Longo made the surgeon to think for an alternative method of conventional excisional hemorrhoidectomy.
In contrast to the traditional approach of removing hemorrhoid tissue, SH involves excising a circumferential ring of mucosa three to four centimeters above the dentate line using a circular stapler which interrupts the superior hemorrhoidal vessels and restores the hemorrhoid tissues back to their anatomic position [3].
We present a prospective randomized clinical trial to compare the results of using stapled hemorrhoidopexy versus classical hemorrhoid surgery for treatment of third and fourth degree hemorrhoids at department of surgery, GSL medical college with follow-up of 3 years
PATIENTS AND METHODS
The present study was prospective randomized clinical study comparing the use of stapled hemorrhoidopexy with traditional hemorrhoidectomy in department of surgery, GSL medical college and General Hospital from June 2011 to may 2013 by surgeons from two units.
The study protocol was approved by the ethical committee and written informed consent was obtained from all participants prior to entry into the trial.
The outcome of the study was to compare
1. Duration of surgery 2. Postoperative pain 3.post surgery complications (bleeding, urinary retention, infection) 5.Duration of hospital stay.6.Days return to work 7.Cost between the procedures and 8.Follow up anal stenosis /recurrence
The study population included 106 patients with symptomatic third degree hemorrhoids (prolapsed upon defecation or straining, but must be manually reduced) and fourth degree hemorrhoids (prolapsed and cannot be manually reduced) internal hemorrhoids, who are fit for anesthesia. Randomization was performed prior to commencement of the study as follows:
Patient admitted on Monday are planned for classical hemorrhoidectomy, and admitted on Thursday for stapled hemorrhoidopexy. First group (53 patients) was randomized to Milligan-Morgan traditional hemorrhoidectomy and second group (53 patients) was randomized to stapled hemorrhoidopexy procedure.
Exclusion criteria in the study group
1. First and second degree hemorrhoids or thrombosed hemorrhoids
2. Concomitant perianal fistula, fissures, abscess
3. Previous anal surgery
4. Patients with known history of bleeding disorder
5. Having psychiatric illness
6. Patient not giving consent
The surgery was performed by two unit surgeons experienced in hemorrhoid surgery, both open and stapler hemorrhoidopexy.
Preoperative evaluations: Preoperative evaluations included a detailed medical history, physical examination, proctoscopy/ sigmoidscopy, and routine laboratory tests in all patients. Patients over 40 years underwent cardiologic evaluation preoperatively. As the study was conducted in a medical college patient was evaluated only after admission.
Anesthesia was standardized for all cases under spinal anesthesia .Laxative 2 packets in 200ml water given at bed time before the day of surgery .The procedures were performed in the lithotomy position for all patients. After anal dilation anoscope was kept for evaluation. Operative technique for the Milligan-Morgan group consists of retraction of the pile mass with a forceps and diathermy dissection and excision. The vascular pedicle was ligated with vicryl 1-0. The stapled procedure was done according to the technique described by Longo and colleagues. The hemorrhoid stapler PPH 03 33mm Johnson and Johnson was used for all the case of stapler hemorrhoidepexy.Post procedure in both the group diclofenac suppository and then anal pack covered with paraffin gauze dressing was kept .
Procedure time was recorded from starting of anesthesia till the anal pack placement.
Postoperative management consisted of standard nursing care and analgesia. All patients kept nil orally only for 6 hrs.The anal packs was removed after 1 hrs of surgery. Local external examination was done day 1and on day of discharge.
Each patient was given a discharge prescription for lactulose 20 ml each day. An outpatient appointment was arranged for 7 days after surgery and patients were given an advice sheet and telephone number in case of emergency.
Outcome measures
The primary and most important endpoints of the study were measurement of postoperative pain after 24hours of surgery and every day till discharge. The pain scores were measured using Visual analog scale where score of 0 represents no pain and score 10 represents the worst unbearable pain. Analgesic was administered to keep pain below 3 or4.
The secondary outcome measures were procedural time, incidence of postoperative bleed, duration of hospital stay, need of dressings, patients satisfaction and time until return to normal activity. Operative time duration was measured from anesthesia up to final wound dressing. The total cost of the procedures also documented. The total analgesic consumption during the first 7 days of postoperative period was recorded. Patients were asked to record the first bowel movements.
Hemorrhoidal symptoms were assessed postoperatively and at 1 and 3 months on follow up outpatient visits. On 2nd year and 3rd year patient was contacted on phone for the wellbeing and any recurrence of symptoms. Patients were asked to rate their satisfaction into four categories: unsatisfactory; satisfactory; good; excellent.
All data observed means by Student's t test in order to show a difference of one SD in average pain scores between groups. We used the student t test to compare operative time, duration of hospital stay and time to return to normal activities. Chi square or Fisher's exact tests were used for categorical data.
RESULTS
The study conducted on 106 patients divided into two equal groups, 60males and 46 females. There was a predominance of males in both groups, but without any significant difference. The majority of the cases were in the fourth decade of life.
The majority of the patients had third grade hemorrhoids (71/106 -- 66.9%). The main complaint of the patients was anal bleeding. No patients in both groups complained of fecal incontinence preoperatively. .
Age
The mean age of the patients was 45.11 versus 42.94 years in classical and stapled groups respectively.
P value and statistical significance:
The two-tailed P value equals 0.0001 by conventional criteria, this difference is considered to be extremely statistically significant.
Confidence interval:
The mean of Group One minus Group Two equals -5.16000
95% confidence interval of this difference: From -7.69113 to -2.62887
Intermediate values used in calculations:
t = 4.0427
df = 104
standard error of difference = 1.276
Pain scoring post hemorrhoidectomy
Post surgery diclofenac suppository kept in all patients. The pain score was significantly higher in classical surgery group.
Post surgery immediate complications
Bleeding was seen in 11.2% of patients with stapled hemorrhoidopexy as compare to 26.41% in classical group(table -4). Supportive stitches required for 3 patients in stapled group and 7 cases in open group. Rests of cases were managed with anal pack. In one case after removal of pack patient had major bleed, shifted to OR and local site suturing done
Urinary retention was the common postoperative findings as seen in other pelvic surgery. In the study group urinary retention was seen in 15.09 % in stapled group as compare to 20.75% in classical group. These patients were managed with temporary urinary bladder drainage
Residual prolapse seen in 28.3% in classical group as compare to 7.4 % in stapled group. All the cases were in follow up with medication of Calcium Dobesilate, and Troxerutin as active ingredients for 1 month. 2 cases in stapled group required the excision of prolapsed external hemorrhoids. The residual prolapsed seen in grade IV hemorrhoids.
Seitz bath was advised for all classical groups for relief of pain and dressing. It was the major concern for treatment in classical hemorrhoidectomy
DURATION OF HOSPITAL STAY
Hospitalization time ranged between 5 and 7 days. As this study was conducted in the general hospital attached to medical college, the investigations were done after admission .On second day medical/ cardiology evaluation and pre anesthesia checkup was done. The surgery was conducted on the 3rd day of hospital admission.
56.6 % of Stapled hemorrhoidopexy cases were discharged on 2nd postoperative day as compare to 37.7 % in classical group. As there is no need of major wound examination and dressing the stapled group were discharged on 2nd or 3rd post operative day after the bowel movements. Duration of hospital stay is significantly low in stapled group
Return to the regular activities
In the study group stapled patient returned to their regular activities within the 10 days of surgery where as the classical group attend the activities at the end of second week. The mean days to return to the regular activities is 6 days in stapled group and 12 days in the classical group.
Patient satisfaction score
Patient with stapled group were having maximum level of satisfaction as compare to classical hemorrhoidectomy
Follow-up status
From the study group we called the patient for the follow-up as per their availalbility. We noticed 5 cases from stapled group and seven cases from classical group were having residual prolapsed managd surgically.2 cases in open group developed anal stenosis for which anal dilation was done. There was no incontinence in any group.
Cost effectiveness
The study was conducted in medical college and general hospital. Surgery and bed charges and investigations were done with free of cost. The patients were advised to bring the medication
DISCUSSION:
This was hospital based study conducted in the department of general surgery, GSL medical college and General Hospital, Rajahmundry, Andhrapradesh for duration of 2 years with follow-up for 3 years. It was a prospective study comparing stapled hemorrhoidopexy and classical Milligan Morgan procedure for the management of grade 3 and grade 4 hemorrhoids.106 patients were included in the study protocol, 53 patients underwent stapled and 53 patients underwent Millgan -Morgan technique
The mean age of the patients was 45.11 versus 42.94 years in classical and stapled groups respectively. In a similar study by Sachin ID et al the mean age is 40.05 and 39.50 respectively [2, 10, 16].
There was a predominance of males in both groups; the majority of the cases were in the fourth decade of life. The majority of the patients had third grade hemorrhoids (71 - 66.9%). The main complaint of the patients was anal bleeding [11].
The procedure time longer in the traditional group (mean = 40.05 minutes) than the stapled group ( mean of 34.9 minutes).we calculated the procedure time from the starting of spinal anesthesia till anal pack. The P value equals 0.0001. By conventional criteria, this difference is considered to be extremely statistically significant. A series of studies shows duration of surgery is significantly low in stapled group [4, 5, 6].
Intraop/immediate postoperative minor bleed and urinary retention is more common in classical hemorhoidectomy group compare to stapled, in more than 95% of cases complete circumferential donut of the stapler line achieved at the end of procedure [8,9,11].
Residual hemorrhidal prolapse seen in 28.3% in classical group as compare to 7.4 % in stapled group. 2 cases in stapled group required the excision of prolapsed external hemorrhoids. Jayram S et al noted that stapler hemorrhoidopexy is associated with higher risk of prolpase[10]. Laughlan k et al reported that stapled hemorrhoidopexy is associated with reduced pain but an increased rate of recurrent prolapse.In our study even after 3 years no significant prolapsed was seen in stapler group. The residual prolapse noticed in grade IV hemorrhoids only[14,15].
The postoperative pain was assessed by VAS score and the aim was to keep score less than 3 with adequate analgesia. The pain score was high in classical hemorrhoidectomy group at 12 hrs, day one and day 2. Tjandra JJ et al, Laughlan K et al, reported similar findings[12,3,14]. We adopted sitz bath procedure for classical hemorrhoidectomy cases to keep pain score less but the sitz bath was more discomfort for the patient. In comparison Stapler hemorrhoidectomy group experienced less postoperative pain where as cheetham et al reported persistent pain and fecal urgency after stapled hemorrhoidectomy, the explanation may be related to stapled line may be more close to dentate line [4].
In our study stapled group were discharged on 2nd/3rd postoperative day while the classical hemorrhoidecomy patient discharge on 5th/6th POD. Duration of hospital stay was significantly low in the stapled group. This findings supports the report by Tjandra JJ et al, Laughlan K et al.[12,14]
Stapled group returned to their daily activities much faster than classical hemorrhoidectomy patients. Ganio E et al have opined similar finding in their publication [5].
The post procedure satisfaction was significantly higher in the stapled group as compared to classical Milligan -Morgan procedure [15,16].
The procedural cost is higher in stapled group as compare to classical group. For common rural people it is difficult to convince to undergo stapled procedure even if the outcomes are satisfactory.
CONCLUSION
Our experience confirms the validity of both Classical hemorrhoidectomy and Stapled hemorrhoidopexy. Classical hemorrhoidectomy procedure is more invasive and slightly more painful in immediate postoperative period than SH surgery, which is slightly more expensive ones. The costly procedure stapled hemorrhoidopexy is associated with shorter procedural time, less postoperative pain and early recovery with high patient satisfaction as compare to Milligan-Morgan procedure.Compliaction is less if surgical technique is perfect with constant practice. To the safe side SH is the gold standard for III grade hemorrhoids while CH is suggested in IV hemorrhoids to avoid relook surgery for residual prolpase.SH is a novel technique and in the laparoscopic era with advance of insurance policy system in INDIA SH may emerged as alternative to classical hemorrhoidectomy.
ACKNOWLEDGEMENT Authors acknowledge the great help received from the scholars whose articles cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed. Authors are grateful to IJCRR editorial board members and IJCRR team of reviewers who have helped to bring quality to this manuscript.
Ethical Clearnace: obtained in written format
Source of Funding : NIL
Conflict of Interest : NIL
Englishhttp://ijcrr.com/abstract.php?article_id=2256http://ijcrr.com/article_html.php?did=22561. Milligan ETC, Morgan CN, Jones LE, Officer R. surgical anatomy of the nal canal and the operative treatment of hemorrhoids.Lancet.1937;2:119-24
2.Shalaby R, Desoky A. Randomised clinical trial of stapled versus Milligan-Morgan hemorrhoidectomy. Br J Surg2001;88(8):1049-53
3.Rowsell M,Bello M, Hemingway DM. Circumferential mucosectomy (stapled hemorrhoidectomy) versus conventional hemorrhoidectomy: randomized control trial. Lancet .2000;355(9206)779-81
4.Cheetham MJ, Mortensen NJM, Nystom PO, Kamm MA, Phillips RKS. Persistent pain and fecal urgency after stapled hemorrhoidectomy. Lancet 2000;356:730-3
5.Ganio E, Altomare DF, Gabrielli F, Milito G, Canuti S. prospective randomized multicentre trial comparing stapled with open hemorrhoidectomy Br J Surg .2001;88(5)669-74.
6.Rovelo JM. Tellez O, Obregon L. stapled rectal mucosecomy vs closed hemorrhoidectomy a randomized clinical trial. Dis colon Rectum.2002;45:1367-75
7.Palimento D, Picchio M, attanasio U, Lombardi A, Bambini C, Renda A, stapled and open hemorrhoidectomy: randomized controlled trail. Lancet 200;355:782-5
8.Hetzer FH, Demantrines N, Handschin AE. stapled Vs excisional hemorrhoidectomy: long term results of a prospective randomized trial. Arch Surg.2002;137:337-4. experience of 3711 stapled hemorrhoidectomy operation.Br J surg.2006;93:226-30
9.Bikhchandani J, Agarwal PN, Kant R. Randomized control trial to compare the early and mid term results of stapled versus open hemorrhoidectomy. Am J Surg.2005;189(1):56-60
10.Jayaraman S, Colquhoun PH, Malthaner RA, Stapled versus conventional surgery for hemorrhoids. Cochrane Database Syst Rev.2006;4:CD005393
11.Ng KH, HoKS, Ooi BS. experience of 3711 stapled hemorrhoidectomy operation. Br J surg.2006;93:226-30
12.Tjandra JJ, Chan MK.Systemic review on the procedure for prolpase hemorrhoids and stapled hemorrhoidopexy Dis colon Rectum.2007;50(6);878-92
13.Stolfi VM, Sileri P, Micossi C, Carbonaro I, Venza M, Gentileschi P et al .Treatment of hemorrhoids in day surgery: stapled hemorrhoidopexy vs Milligan-Morgan hemorrhoidectomy. Journal of gastrointestinal surg.2008;12(5)795-801
14.Laughan K, Jayne DG, Jackson D, Rupprecht F, Ribaric G. Stapled haemorrjoidopexy compared to Milligan Morgan and Ferguson hemorrhoidectomy: a systemic review. Int J colorectal Dis.2009;24(3):335-44
15. A prospective comparative study between stapled and conventional haemorrhoidectomy. Anil Kumar, Arun K Gupta, Nikhil Gupta, Umesh Krishnegowda, C.K. Durga. Hellenic Journal of Surgery (2015) 87:6, 468-472
16.Stapled hemorrhoidopexy versus open hemorrhoidectomy:a comparative study of short term resuls. Sachin ID et al , Int surger J.2017;4(2)472-78
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30HealthcareEffect of Cryogenic Treatment on Fracture Resistance of Nickel Titanium Rotary Instruments a Systematic Review
English3236Kumar UjjwalEnglish Anamika C. BorkarEnglish Piyush OswalEnglish Karan BhargavaEnglishIntroduction: Endodontic instruments upon rotation are subjected to both tensile and compressive stresses in curved canals. This stress is localized at the point of curvature. It has been demonstrated that the continuous cycle of tensile and compressive forces in the area of curvature of the canal to which (Nickel Titanium) NiTi rotary instruments are subjected produce a very destructive form of loading, causing cyclic fatigue and eventually fracture of the instrument.2 The aim of this study is to conduct a systematic review on the effect of cryogenic treatment on fracture resistance of nickel titanium rotary instruments.
Methods: Two Internet sources of evidence were used in the search of appropriate papers satisfying the study purpose: the National Library of Medicine (MEDLINE PubMed) and Google Scholar, Google and manual search using DPU college library resources. All cross reference lists of the selected studies were screened for additional papers that could meet the eligibilitycriteria of the study.
Results: Preliminary screening consisted total of 54 articles out of which 24 articles were selected. The papers were screened independently by two reviewers. At first the papers were screened by title and abstract. As a second step, full text papers were obtained when they fulfilled the criteria of the study aim. Any disagreement between the two reviewers was resolved after additional discussion. Finally 3 articles were included in this study.
Conclusions: Within the limitations of this study we can conclude that the cryogenic treatment increases the fracture resistance of nickel titanium rotary instruments.
EnglishTreatment, Fracture Resistance, Nickel-Titanium Rotary InstrumentsINTRODUCTION
Nickel-titanium alloy exhibits the unique properties of shape memory (SM) and pseudoelasticity.1 It is well known that instrument separation occurs either by brittle fracture (cyclic fatigue) or by ductile fracture (torsional fatigue). Endodontic instruments upon rotation are subjected to both tensile and compressive stresses in curved canals2. This stress is localized at the point of curvature. It has been demonstrated that the continuous cycle of tensile and compressive forces in the area of curvature of the canal to which NiTi rotary instruments are subjected produce a very destructive form of loading, causing cyclic fatigue and eventually fracture of the instrument2. Despite the extreme flexibility,4 these thermomechanically processed NiTi instruments undergo permanent plastic deformation, especially while reusing the smaller size instruments5,6 due to inadequate martensite content. Cryogenic treatment is a supplementary procedure of subjecting stainless steel7,8 and superelastic NiTi3 to subzero temperatures that affects the entire bulk of the material rather than the accessible surface alone. One of the mechanisms proposed behind the improvement in properties following cryogenic treatment is the complete martensitic transformation from the austenite phase.9 It has been proved that deep cryogenic treatment (DCT) at a soaking temperature of up to −185°C increases the martensite content of SM NiTi alloys by a similar mechanism.10 Previous studies have been done evaluating the effect of cryogenic treatment on the fracture resistance of nickel titanium rotary instruments. However, no systematic review comparing the effect of cryogenic treatment on fracture resistance of nickel titanium rotary instruments have been conducted. The aim of this study is to conduct a systematic review on the effect of cryogenic treatment on fracture resistance of nickel titanium rotary instruments.
METHODS
Inclusion criteria:
Articles in English or those having detailed summary in English.
In vitro Studies published between 1st January 1985 and 31st June 2016.
New packet of Nickel-Titanium rotary files.
Cryogenic treatment modality.
Exclusion criteria:
Used nickel-titanium rotary file.
In vivo studies, reviews, case reports were excluded.
PICO:
P – Product: Nickel-titanium rotary files.
I - Exposure: treatment modalities.
C -Comparison: between cryogenically treated and non treated nickel titanium rotary instruments.
O - Outcome: increase in the fracture resistance of treated nickel-titanium rotary files.
Two Internet sources of evidence were used in the search of appropriate papers satisfying the study purpose: the National Library of Medicine (MEDLINE PubMed) and Google Scholar, Google and manual search using DPU college library resources. All cross reference lists of the selected studies were screened for additional papers that could meet the eligibility criteria of the study. The databases were searched up to and including 31st June 2016 using the search strategy.
RESULTS
Preliminary screening consisted total of 54 articles out of which 24 articles were selected. The papers were screened independently by two reviewers. At first the papers were screened by title and abstract. As a second step, full text papers were obtained when they fulfilled the criteria of the study aim. Any disagreement between the two reviewers was resolved after additional discussion. Finally 3 articles were included in this study. (Fig no.1)
DISCUSSION
Biomechanical preparation has been considered the most important step in root canal therapy.15 Advent of rotary NiTi instruments has aided endodontists in cleaning and shaping of root canals. Civjan et al in 1975 suggested the use of NiTi alloy for fabrication of hand and rotary endodontic instruments.15 The extraordinary characteristics of super elasticity and shape memory of the NiTi alloy have made it possible to manufacture rotary instruments.1
Endodontic instruments upon rotation are subjected to both tensile and compressive stresses in curved canals.2 This stress is localized at the point of curvature. It has been demonstrated that the continuous cycle of tensile and compressive forces in the area of curvature of the canal to which NiTi rotary instruments are subjected produce a very destructive form of loading, causing cyclic fatigue and eventually fracture of the instrument.2 It has been suggested that cyclic fatigue has accounted for 50–90% of mechanical failures.2
Cryogenic methods have been used to increase the wear, abrasion, corrosion resistance, and to improve the strength of metals. Cryogenically treated NiTi instruments have shown increased microhardness. Deep cryogenic treatment involves suspending the metal over a super-cooled bath containing liquid nitrogen at −196°C or −320°F and then allowing the metal to slowly warm to room temperature.16
Methods like boron ion implantation,17thermal nitridation,18 physical vapor deposition of titanium nitride19 and electropolishing20 have been used for increasing the cutting efficiency of rotary NiTi instruments. Anderson et al in 2007 showed that electropolished instruments performed significantly better than non-electropolished instruments in both the cyclic fatigue testing and static torsional loading, which is likely to be caused by a reduction in surface irregularities that serve as points of stress concentration and crack initiation in nickel titanium.21
Methods like boron ion implantation17 thermal nitridation18 physical vapor deposition of titanium nitride19 and electropolishing20 have been used for increasing the cutting efficiency of rotary NiTi instruments. Anderson et al in 2007 showed that electropolished instruments performed significantly better than non-electropolished instruments in both the cyclic fatigue testing and static torsional loading, which is likely to be caused by a reduction in surface irregularities that serve as points of stress concentration and crack initiation in nickel titanium.21
Kim et al 200522 studied the effect of cryogenic treatment on nickel-titanium endodontic instruments.30 size 25 nickel-titanium K-files (NTO2525; Dentsply-Tulsa Dental) were embedded in epoxy resin (811-563-103 and 811-563-104; Leco, St Joseph, MI, USA) mixed according to the manufacturer’s instructions. 15 control instruments and 15 cryogenically treated instruments were used. Each instrument was cut at the handle and then placed within a mounting ring (20-8161-010; Buehler, Lake Bluff, IL, USA). The mounting rings were brushed with releasing agent (20-8185-032; Buehler) and placed upon a flat surface. The resin and hardener were then mixed until clear in appearance and was then poured into each mounting ring. The epoxy resin was left to cure for 8 h. The resin blocks were then removed from the mounting rings and ground to reveal a cross-section of the instruments and polished flat using a grinder/polisher (Phoenix Beta; Buehler). Silicon carbide polishing papers (240, 320, 400, 600 and 1200) were used in succession followed by Al2O3 powder/H2O suspensions (1.0, 0.3 and 0.05μm particle sizes) for final polishing. A Vicker’s indenter was used to make two indentations adjacent to the edge of the instrument cross-section (FM-7; Future Tech, Tokyo, Japan). A 9.8 N indentation load was applied for a 15 s dwell time. Both indentation diagonals were measured, and the Vicker’s microhardness (VHN), was calculated from the size of the indentation. According to the equation
VHN = 0.1891F/ d 2
Where, F is the indentation load having unit (N) and d is the average diagonal length of indentation having unit (mm).
It was concluded that there was an increase in the microhardness following cryogenic treatment. Non treated instruments had a mean VHN of 339.3 ± 23.0, and treated instruments had VHN of 346.7 ± 20.6 (Fig. 2). A Student’s t-test showed this to be a statistically significant difference (P < 0.001; β > 0.999).
Mahalaxmi Sekar et al 201116 studied the effect of deep dry cryotreatment on the cutting efficiency of three rotary nickel titanium instruments. 20 NiTi instruments of RaCe (FKG Dentaire, Switzerland), K3 (Sybron Endo, CA, USA) and Hero Shaper (Micro Mega, France) of size 25, 21mm length and of 0.06 taper, were used for this study. The files were randomly divided into two groups for evaluating the cyclic fatigue as follows:
Group A: untreated NiTi rotary files and Group B: cryotreated NiTi rotary files. These were further divided as the follows.
Group A1: 10 untreated RaCe rotary files : Group A2: 10 untreated K3 rotary files:Group A3: 10 untreated Hero Shaper rotary files.
Group B1: 10 cryotreated RaCe rotary files: Group B2: 10 cryotreated K3 rotary files: Group B3: 10 cryotreated Hero Shaper rotary files.
Mean number of cycles required to fracture in Group B1 (405 ± 3) was significantly higher than that of Group A1 (352 ± 2) (P < 0.0001). Mean number of cycles to fracture in Group B2 (708 ± 4) was significantly higher than that in Group A2 (452 ± 3) (P < 0.0001). Mean number of cycles to fracture in Group B3 (359 ± 10) was significantly higher than that in Group A3 (268 ± 7) (P < 0.0001). Groups B1, B2, and B3 showed significantly higher number of cycles to fracture than Groups A1, A2 and A3 (P < 0.0001).
The results of this study showed an increase in the fracture resistance of NiTi files which were treated as compared to untreated files. This could be attributed to the fact that the complete transformation of the austenitic phase of the alloy to martensitic phase, which could have occurred at −195°C, would have decreased the internal stress within the alloy due to plastic deformation. Amini et al [15] have explained in their study that the presence of residual austenite phase in an alloy decreases hardness and also reduces the wear resistance of the tool. Thus, increasing resistance to wear, reduction of internal stresses can be regarded as the most important benefits of using cryogenic treatment. It was observed that by decreasing the temperature of cryogenic environment, better properties were obtained. The deep dry cryogenic treatment (DCT) has been seen to affect the entire cross section of the instrument rather than just the surface, with no change in the elemental crystalline composition of the alloy.
T.S.Vinothkumar et al 201614 studied mechanical behavior of deep cryogenically treated martensitic shape memory nickel–titanium rotary endodontic instruments. The martensitic SM NiTi instruments made from controlled memory wire (HyFlex® CM; ColteneWhaledent Inc., Cuyahoga Falls, OH, USA) of size 25, 0.06 taper were selected for this study. A total of 75 instruments were randomly divided into three groups of 25 each as follows: DCT 24: Soaking temperature −185°C, soaking time 24 h, DCT 6: Soaking temperature −185°C, soaking time of 6 h, number of cycles to failure (NCF) for each instrument. The NCF is directly proportional to the cyclic fatigue resistance of the instrument. They concluded that the maximum NCF of each HyFlex® CM rotary endodontic instrument following rotation in artificial root canals with 30° angle of curvature was observed in DCT 24 group followed by DCT 6 and control.
Despite the extreme flexibility of HyFlex® CM SM NiTi instrument, supplementary cryogenic treatment would further increase the volume of martensite resulting in superadded benefits, especially for smaller size instruments. Cryogenic treatment can be classified based on the soaking temperature as deep (−185°C) and shallow (−80°C).[9,19,20] Deep soaking temperatures are effective in increasing the martensite content of SM NiTi alloys than the conventional shallow cold treatments. Consequently, DCT significantly reduces the hardness and increases the wear resistance of the SM NiTi alloy. Therefore, the objective of this study was only to evaluate the role of DCT soaking time with respect to the constant cooling and warming rate. The advantage of the dry DCT facility used in this study is to gradually increase or decrease the temperature in order to avoid thermal shock to the instrument that would make it brittle.
CONCLUSION
This systematic review summarizes that the cryogenic treatment of NITI Rotary endodontic instruments increases the fracture resistance of the instruments. It could be attributed to the complete transformation of the austenitic phase to martensitic phase.
LIMITATIONS
Search strategy may not be complete due to limited accessibility.
IMPLICATIONS FOR FUTURE RESEARCH
Cryogenic treatment appears to be a promising supplementary method in the manufacturing of nickel titanium endodontic instruments. Cryogenic treatment significantly increases the fracture resistance of nickel titanium alloy. Further investigations are required to evaluate the impact of cryogenic treatment on fracture resistance of nickel titanium rotary instruments.
ACKNOWLEDGEMENTS
The completion of this systematic review would not have been possible without the people who fill my life with positivity.
It has been a privilege to work under my advisor, my mentor and guide Dr. Anamika C. Borkar. I thank her for her timely advice and constant encouragement.
I would like to acknowledge all the authors and researchers for their contribution to the subject.
Abbreviations:
NITI – Nickel Titanium
SM - Shape Memory
DCT – Deep Cryogenic Treatment
VHN – Vicker’s Hardness Number
NCF – Number of Cycles to Failures
Englishhttp://ijcrr.com/abstract.php?article_id=2257http://ijcrr.com/article_html.php?did=2257
Walia H, Brantley WA, Gerstein H. An initial investigation of thee bending and torsional properties of Nitinol root canal files. J Endod 1988;21:346-51.
Pruet JP, Clmenat DJ, Carnes DL. Cyclic fatigue testing of NiTi endodontic instruments. J Endod 1997;23:77-85.
Vinothkumar TS, Miglani R, Lakshminarayananan L. Influence of deep dry cryogenic treatment on cutting efficiency and wear resistance of nickel-titanium rotary endodontic instruments. J Endod 2007;33:1355-8.
Testarelli L, Plotino G, Al-Sudani D, Vincenzi V, Giansiracusa A, Grande NM, et al. Bending properties of a new nickel-titanium alloy with a lower percent by weight of nickel. J Endod 2011;37:1293-5.
Haapasalo M, Shen Y. Evolution of nickel-titanium instruments: From past to future. Endod Topics 2013;29:3-17.
Peters OA, Gluskin AK, Weiss RA, Han JT. An in vitro assessment of the physical properties of novel Hyflex nickel-titanium rotary instruments. Int Endod J 2012;45:1027-34.
Lal DM, Renganarayanan S, Kalanidhi A. Cryogenic treatment to augment wear resistance of tool and die steels. Cryogenics 2001;41:149-55.
Bensely A, Senthilkumar D, Lal DM, Nagarajan G, Rajadurai A. Effect of cryogenic treatment on tensile behavior of case carburized steel-815M17. Mater Charact 2007;58:485-91.
Barron RF. Cryogenic treatment of metals to improve wear resistance. Cryogenics 1982;22:409-13.
Vinothkumar TS, Kandaswamy D, Prabhakaran G, Rajadurai A. Microstructure of cryogenically treated martensitic shape memory nickel-titanium alloy. J Conserv Dent 2015;18:292-6.
Fayyad DM, ElhakimElgendy AA. Cutting efficiency of twisted versus machined nickel-titanium endodontic files. J Endod 2011;37:1143-6.
Parashos P, Messer HH. Rotary NiTi instrument fracture and its consequences. J Endod 2006;32:1031-43.
Plotino G, Grande NM, Cordaro M, Testarelli L, Gambarini G. A review of cyclic fatigue testing of nickel-titanium rotary instruments. J Endod 2009;35:1469-76.
Vinothkumar TS, Kandaswamy D, Prabhakaran G, Rajadurai A. Mechanical behavior of deep cryogenically treated martensitic shape memory nickel–titanium rotary endodontic instruments. Eur J Dent 2016;10:183-7.
Civjan S, Huget EF, DeSimon LB. Potential applications of certain nickel titanium alloys. J Dent Res 1975;54:89-96.
George GK, Sanjeev K, Sekar M. An in vitro evaluation of the effect of deep dry cryotreatment on the cutting efficiency of three rotary nickel titanium instruments. J Conserv Dent. 2011 Apr;14(2):169-72.
Lee DH, Park B, Saxeba A, Serene TP. Enhanced surface hardness by boron implantation in Nitinol alloy. J Endod 1996;22:543-6.
Rapisarda E, Bonaccorso A, Tripi TR, Fragalk I, Condorelli GG. The effect of surface treatments of nickel-titanium files on wear and cutting efficiency. Oral Surg Oral Med Oral Pathol Oral RadiolEndod 2000;89:363-8.
Schäfer E. Effect of physical vapour deposition on cutting efficiency of nickel titanium files. J Endod 2002;28:800-2.
Baumann MA. Reamer with alternating cutting edges–concept and clinical application. Endod Top 2005;10:176-8.
Anderson EM, Price JW, Parashos P. Fracture resistance of electropolished rotary nickel-titanium endodontic instruments. J Endod 2007;33:1212-6.
Kim J. W., Griggs J. A., Regan J. D., Ellis R. A. andCai Z. Effect of cryogenic treatment on nickel-titanium endodontic instrument. IntEndod J. 2005 June ; 38(6): 364–371.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30HealthcareHistory of Breast Cancer - A Quick Review
English3744M. Vidya BhargaviEnglish Venkateswara Rao MudunuruEnglish Sampath KalluriEnglishBreast cancer is an atrocious disease that haunts us as much now as it did in the past hundreds of years. The disastrous physical and mental conditions of cancer in general have been mentioned in medical records throughout the centuries. The women of these ancient eras suffered from not only noticeable bumps on their breasts, but also oppression from the people of their society. Unlike other cancers that typically have internalized tumors, breast cancer presents itself with external lumps that are extremely noticeable. The object of this article is to explore the history of this cancer and the developments in treating it in the present century.
EnglishBreast Cancer, History, Lymph gland, Autopsies, Mammography, Chemotherapy
INTRODUCTION
When the month of October arrives, the first topic that usually comes to mind is the celebration of Halloween. In actuality, October not only entails Halloween, but also Breast Cancer Awareness Month. Homage is paid to those men and women who have survived or passed due to the malignant disease. Around 40, 000 women in the United States were expected to die in 2014 from breast cancer, although death rates have been decreasing since 1989. These decreases are thought to have been the result of treatment advances, such as earlier detection through screening and increased awareness. Although breast cancer is known for being a genetic disease, it has been found that about 85% of breast cancers occur in women with no family history of the disease. These instances occur due to genetic mutations that happen as a result of the aging process and life occurrences in general, rather than being inherited. Breast Cancer is a genetic disease and can be found in both men and women. The epidemic of breast cancer dates all the way back to the Greek and Roman Period of 460 BC.
Before the modern era, the concept of cancer was not easily understood and the attempted remedies for sick individuals typically included some type of ceremony constructed by entertainers, witch doctors, and “healers”. In old Babylon (2100–689 BC) it was normal practice to place the sick out in public and allow strangers to judge their stage of disease. The Code of Hammurabi described how healers were paid for their successful surgical endeavors and punished for surgeries that resulted in death.
The consequence of a surgical death included the severing hands of the medical practitioners (Donegan). After 3000 BC, medical practitioners had finally realized the uselessness of treating tumors of the breast. Among the eight surviving Egyptian therapeutic papyri, Edwin Smith Surgical Papyrus was credited to hold the first reference to breast malignancy.
This surgical content, written in hieratic script, is a fragmented duplicate of a unique archive that related to the pyramid period of Egypt (3000–2500 BC) and was potentially composed by Imhotep, the medical practitioner draftsman who perfected the step pyramid in Egypt in the 30th century BC (Lakhtakia 2014). The article published the most factual information on the suturing of wounds and cauterization with blaze drills. More importantly, the manuscript discusses the findings and medical advances of eight instances of illness of the chest, significant to the bones and delicate tissues of the foremost chest region. Most of which were in men because of the apparent wounds. One of the five cases identifying with delicate tissues (Case 45) depicts "protruding tumors" in the chest. The writer describes that if the tumors have spread over the breast, are cool to the touch, and are protruding, there is no cure and the prognosis is lethal.
THE GREEK AND ROMAN PERIOD
(460 BC - 475 AD)
The ancient Greek civilizations were full of rich mythology, dependent upon faith in close cooperation between the living and divine beings. History experts believed that Aesculapius, the God of Medicine, may have had his origins in medicine around the time of the attack on Troy (≈1300 BC). In the Iliad, Homer said Aesculapius had two children who were respected physicians that joined the siege (Winchester and Winchester 2006, Lakhtakia 2014). The ancient Aesculapius is featured on the seal of the American College of Surgeons, where he is depicted by holding his staff weaved with a serpent, representing the image of life and insight.
During this time in ancient Greece, the Greeks looked for cures by immersing themselves in the baton at the sanctuaries of Aesculapius and appreciating the cohort showers and diversions, which are examples of present day health spas. Offerings for vows of fulfillment, such as breasts, offer proof that some came searching for cure of the unknown chest illness. Greek medicine was the most advanced during this time, successfully curing many diseases.
While on his conquests, Alexander the Great of Macedonia (356–323 BC) established the city of Alexandria on the Nile delta in 332 BC, where an internationally celebrated therapeutic school, that was founded around 300 BC, is still functioning. The library at Alexandria was the largest of its time, housing more than 700,000 books. Numerous notable Greek and Roman medical practitioners studied, taught, and flourished in Alexandria. The researchers of life systems were dependent upon dismemberment of human forms.
Physicians of the Hellenistic period give vivid records of breast tumors. The Greek term "karkinoma" was utilized to depict the chest lump developments and "scirrhus" to portray physically rigid tumors. “Cacoethes" was a term that alluded to an early onset of some type of sickness. A "concealed" growth was one not apparent on the skin. Herodotus (484–425 BC), a history specialist on the wars between Greece and Persia, wrote that Democedes, a Persian medical practitioner living in Greece, cured the wife of Persian King Darius of a breast tumor that had ulcerated and metastasized.
Hippocrates (460–375 BC), the most notable Greek doctor, wrote a medical book on his findings, titled the Corpus Hippocratic. He supported that each disease was dissimilar and emerged from characteristic reasons, not from divine beings or spirits (Lakhtakia and Chinoy, 2014). He put fact into the force of nature to mend the beginning of infections. He believed that a mixture of the four natural liquids: blood, phlegm, yellow bile, and dark bile were fundamental for exceptional health. Hippocrates, on the other hand, depicted instances of breast disease in portion. Hippocrates proposed that breast cancer, among other abnormal growths, was a 'systemic disease' caused by an excess of black bile. One of his cases was of a lady of Abdera who had a malignant growth within her breast that was seeping bloody drainage from her nipples. Hippocrates confirmed through his research that when the bloody discharge ceases, the woman would die. In addition, he found that when a women’s monthly menstruation cycle ceased, it typically meant that she was suffering from breast cancer, thus in younger females he would try to restore their periods to combat the disease. Hippocrates findings still hold true today, in saying that the breast tumors usually metastasize by growing firmer, without the addition of pus, and metastasize to other areas of the body. When this happens the victim suffers from shooting pains from the breast into the shoulders, loss of appetite and thirst, and eventually becomes undernourished.
THE MIDDLE AGES (467-1500 AD)
The middle Ages started with the breakdown of the Roman Empire in 476 and finished with the Renaissance and finding of the New World in 1492. During the Middle Ages came feudalism, bubonic sickness, campaigns, and the period of confidence. The impact of the Church spread as the Holy Roman Empire and human dismemberment was disallowed by the Papal announcement; restriction to church principle constituted abuse to those who were discovered. To recover his soul, the space expert Copernicus (1473–1543 AD) was constrained to repeal his philosophy that the earth surrounded the sun, and the doctor Michael Servetus (1511–1553), who identified the air flow circulation of the lungs. Monks divided cures, and the chances of surgery were close to none. Removal of the breast was depicted as a type of torture in the story of St. Agatha, the holy saint of bosom malady (Lakhtakia and Chinoy, 2014). Some of the remarkable healing were attributed to saints and faith healing which included laying hands over the affected parts. Traditional folk style medicine was sometimes used and included freshly sliced dogs or cats.
After the death of the prophet Muhammad (570–632 AD), the ascent of Islam brought about the Arab victory of the southern shores of the Mediterranean from Persia to Spain, ultimately ending the therapeutic focus in Alexandria. Medicinal records that survived were made Arabic for study and protected; interpreted later from Arabic to Latin, thus re-entering the European landmass. Some of the most powerful doctors of this period were Avicenna (980–1037 AD), the Jewish doctor Maimonides (1135–1204 AD) and Albucasis (936–1013).6 Avicenna's notoriety equaled that of Galen, however he had no new knowledge about chest malignancy. Lbucasis in Moorish Spain supported the harsh provisions for medicine of chest malignancy, however, conceded that he himself had never cured an instance of breast growth and knew of no one else who had. Scathing glue (a mixture of zinc chloride, stibnite, and Sanguinaria Canadensis) was utilized as a treatment for breast cancer until the 1950s in the United States. The glue was used to connect the tissue, necrosis, which was then removed or permitted to mend by granulation, or through the forming of new connective tissue and blood vessels over a wound. After gluing, the utilization of charms, supplications to God, medicaments, and caustics in conjunction with surgery and cutting edge routines were how modern breast cancer treatments were performed.
After many years, a connection had been made between hormones and breast cancer. In the 14th century, breast cancer was known as the nun’s disease because of its high frequency amongst nuns. The act of never having borne a child put nuns at a higher-than-average risk.However, most women at that time had borne children at a young age and therefore had a relatively low risk.
In the late middle Ages, Henri de Mandeville (1260–1320 AD), surgeon to the lord of France, refined Galen's dark bile hypothesis with a connection between dark bile from the liver. The dark bile from the liver made a hard tumor in the chest (a sclerosis), which eventually metastasized. He described breast cancer accurately, as being ulcerated with thick edges and baring a sour scent. The prescribed medication was to slim down and cleanse and de Mandeville liked that inadequate evacuation of the medication regularly brought about non-healing (Lakhtakia and Chinoy, 2014).
RENAISSANCE PERIOD
Renaissance can be termed as the “rebirth of era” leading to the evolution of a new creative force in art and science. It can also be termed as the bridge between the middle Ages and the modern period. It was during the beginning of twelfth century, with the establishment of universities in the Western Europe there is been a remarkable awakening in the history of literary culture. A wide variety of practitioners were involved: university trained physicians, literate and illiterate 'empirics', religious figures, surgeons, barbers, apothecaries, midwives, relatives of the patient and specialist healers. University trained physicians tossed the term ‘empiric’ to refer to those practitioners who are illiterate and non-university trained but gained their skills by practical training. The scientific study of medicine and medical practice by the physicians was simulated during the Renaissance period.
16th CENTURY
In 1518, King Henry VIII founded the Royal College of Physicians of London. This medical college in England is the oldest known medical college in the history. Thomas Linacre, the first president of the College of Physicians, London, found an academic body of physicians rather than an organized guild (Royal College of Physicians, 2017). Physicians were treated as the educated elite of the medical world. The publication of the London Pharmacopoeia in 1618 created the first standard list of medications and their ingredients and purposes were published in England.
Breast cancer has been described for centuries. Recognition of “bulging tumors of the breast” is recorded in the valuable Edwin Smith Papyrus of 1600 BC found at Thebes, Egypt in 1862 and has been translated since then.
Anatomy and physiology brought a critical reexamination to scientific surgery. Andreas Vesalius (1514-1564) the author of “De Humani Corpis Fabrica” (The Fabric of the Human Body), was a revolutionary Renaissance study of the human body that greatly contributed to the advancement of surgery. It also greatly opposed Galen's doctrines (Lakhtakia and Chinoy, 2014).
The theory that cancer is caused by excess of black bile continued to prevail through the 16th century. At this time cancer was still considered incurable, however, a variety of temporary measures were available including creams and pastes, surprisingly containing arsenic.
Bartoleny Gabrol (1590) in Montpellier advocated an extreme mastectomy, which was brought to life by Halsted, 300 years later. However, the lack of anesthesia and the problem of wound infections (due to the lack of the aseptic techniques) generated significant problems for the surgeons of that time. Surgery was often 'heroic' but primitive and even inhumane by current standards (Lakhtakia and Chinoy, 2014). Therapeutic rejection of religious principles was the common attitude regarding breast cancer, at least among the vast majority of surgeons.
17th CENTURY
Autopsies, performed by Harvey (1578-1657) in the 17 century, gave insight into the circulation system (Lakhtakia and Chinoy, 2014). By about the same period, Gaspare Aselli (1581-1626) discovered the lymphatic system, which led to the termination of a century old theory that excessive black bile caused cancer. A French physician, Claude Gendron, suggested that cancer arises locally as a hard, growing mass, is untreatable with drugs, and must be removed along with all of its filaments. The discovery of the microscope and further experiments by Anthony van Leevenhoek (1632-1723) added momentum to the quest for the cause and cure of cancer.
The opinion of Nicholas Tulip (1593-1674) of Amsterdam, who saw the need for early surgery said that, “The sole remedy is a timely operation,” (Lakhtakia and Chinoy, 2014). The procedure varied from impalement of the breast with needles and ropes followed by amputation instrumental techniques, performed entirely without the use of anesthetics.
18th CENTURY
Sir Astley P. Cooper (1768-1841), an English surgeon who performed a number of successful surgeries and made contributions in several different branches of medicine and surgery, published On the Anatomy of the Breast just before his death. The book depicted Cooper's medical mastery through outstanding illustrations. It "includes one of the earliest descriptions of hyperplasic cystic disease of the breast, which Cooper referred to as 'hydatid disease'” (Lakhtakia and Chinoy, 2014).
John Hunter (1728-1793) amassed more than 2,000 pathological preparations of his own that eventually found their way into the Hunter Museum. The accumulated data presented numerous cases of cancer, indicating Hunter’s early contributions to oncology. His collection included different examples of tumors; early instances in which cancer of the breast and rectum had spread to regional lymph nodes, initial cases of pathological atheroma, and evidence of malignancies from carcinoma.
Observing the rapid growth of ulcerating breast cancers, Claude Nicholas le Cat (1700-1768) in Rouen postulated that exposure to air was a stimulant to cancers. Multiple affected family members supported the suspicion that breast cancer was infectious long before the hereditary aspect of the disease became known (Lakhtakia and Chinoy, 2014).
In 1749-1806, Scottish surgeon Benjamin Bell (1749-1806) and French surgeon Jean Louis Petit (1674-1750) were the first to remove affected breast tissue and underlying chest muscle to treat breast cancer. The European doctors linked the tumors in the breast to the lymph glands in the armpit, brought on by the belief that removing the breast and enlarged lymph glands would prevent the cancer from spreading further (Fillmore).
In 1779, Dutch anatomist and surgeon Petrus Camper explained that breast cancer may drain to lymph nodes along the internal mammary artery. In 1952, Margottini introduced the extended radical mastectomy to remove these lymph nodes. Removal of portions of the first three ribs and the sternum was an integral part of this extensive operation. No evidence suggests that this approach improved the survival rate.
19th CENTURY
Major advances were made in human pathology and in the safety of surgery during this time. Hungarian physician Ignac Semmelweis (1818-1865) and Professor of Anatomy Oliver Wendell Holmes (1809-1894) both promoted hand washing and the need for a sterile environment while operating. Antiseptics techniques, surgical masks, and sterile gloves were introduced as means to further decrease the risk of contamination during surgery. From 1838 to 1840, Holmes worked in Dartmouth College as a Professor of Anatomy and later after this he returned to his Boston practice. Holmes only contribution of high distinction was published in the year 1843. The title of his work was "Contagiousness of Puerperal Fever” (Scientific Papers, 1910) .
The microscope proved to be an essential piece of equipment in the advancements of pathology. Matthias Schleiden (1804-1881) and Theodor Schwann (1810-1882) recognized that animals and plants were made up of living cells, with the nucleus being the most important feature (Hudis, Norton, Winchester, Winchester, 2006). The English naturalist Robert Hooke (1635 - 1703) coined the term "cell" after viewing slices of cork through a microscope. The term came from the Latin word cella which means "storeroom" or "small container". He documented his work in the Micrographia, which was written in 1665.
Johannes Müller (1801-1859) made contributions in numerous domains of physiology, in the specific areas involving the voice, speech and hearing; as well as the chemical and physical properties of lymph, bile, and blood. His first important works, Zurvergleichenden Physiologie des Gesichtsinns (“On the comparative physiology of sight,” Leipzig, 1826) and Über die phantastischen Gesichtserscheinungen (“On visual hallucination,” Coblenz, 1826), are of a subjective philosophical tendency. Müller was the first to report that cancers are also composed of living cells. He noted the similarity of cells in a “scirrhus” of the breast and its metastases in the ribs and noted that cancer cells had lost the proportions of normal cells (Schneider, Zimmerman, Depprich, Kubler, Engers, Naujok, and Handschel, 2009).
Rudolph Carl Virchow,“the father of modern pathology," worked at the University of Berlin, and later became Robert Froriep's successor. Unlike his German peers, Virchow had great faith that clinical observation, animal experimentation (to determine causes of diseases and the effects of drugs) and pathological anatomy, particularly at the microscopic level, were the basic principles of investigation in medical sciences. Virchow also developed a standard method of autopsy procedure, named after him. Many of his techniques are still used today. He is also credited with inventing the liver probe, a device used to take the temperature of a dead body.
Paget had an invaluable scientific gift of being able to pinpoint a key question – “What is it that allows tumor cells to spread around the body?” – a question that still remains unanswered. In the early years of the 19th century, a French doctor by the name of René-Théophile-Hyacinth Laennec explained how skin cancer could spread to the lungs before he went on to invent the stethoscope in 1816. The mother of this invention was a young lady whom he described as having a ‘great degree of fatness,’ which made her heartbeat difficult to hear by the then conventional method of placing ear to chest. Using a piece of paper rolled into a tube as a bridge, Laennec was somewhat taken aback that the beat was more distinct than he had ever heard before.
It was another French surgeon, Joseph Recamier, who subsequently coined the term metastasis, (to be precise ‘métastases’’) to describe the formation of secondary growths derived from a primary tumor (Lakhtakia and Chinoy, 2014). Tumor cells that find a way to spread to other areas of the body are termed ‘secondary tumors.’ However, these tumors generally remain dormant for months or years until some trigger finally sets them off. The same group has now modeled this ‘pre-metastatic niche’ for human breast cancer cells, showing that the switch between dormancy and take-off is controlled by proteins released by nearby blood vessels. The critical protein that locks tumor cells into hibernation appears to be TSP-1 (thrombospondin-1). As long as TSP-1 is made by the blood vessel cells metastatic growth is suppressed. This effect is overridden by stimuli that turn on new vessel growth and in so doing switch secretion from TSP-1 to TGFB (transforming growth factor beta). Now proliferation of the disseminated tumor cells is activated and the micro-metastasis becomes fully malignant. It should be said that this is a model system and may possibly bear little relation to what goes on in real tumors. However, the fact that specific proteins that are, moreover, highly plausible candidates, can control such a switch strongly suggests its relevance and also highlights potential targets for therapeutic manipulation.
Marie Velpeau (1795-1867) deducted, after studying 400 malignant and 100 benign tumors under the microscope that, “the so-called cancer cell is merely secondary product rather than the essential element in the disease. Beneath it, there must exist some more intimate element which science would need in order to define the nature of cancer.” Paget disease of the breast (also known as Paget disease of the nipple and mammary Paget disease) is a rare type of cancer involving the skin of the nipple and, usually, the darker circle of skin around it, which is called the areola. Most people with Paget disease of the breast also have one or more tumors inside the same breast. These breast tumors are either ductal carcinoma in situ or invasive breast cancer. Paget disease of the breast is named after the 19th century British doctor Sir James Paget, who, in 1874, noted a relationship between changes in the nipple and breast cancer. Paget stated, “…certain chronic affections of the skin of the nipple and areola are very often succeeded by the formation of sirrhous cancer in the mammary gland…” These changes of the nipple generally preceded breast cancer (Hudis, Norton, Winchester, Winchester, 2006). (Several other diseases are named after Sir James Paget, including Paget disease of bone and extra mammary Paget disease, which includes Paget disease of the vulva and Paget disease of the penis. These other diseases are not related to Paget disease of the breast. This fact sheet discusses only Paget disease of the breast.)
During the late 1860’s in Liverpool, Charles Moore (1821-1870) recommended intact removal of the breast and, if clinically involved, the lymph nodes. In 1887 William Banks removed the breast and lymph nodes (Lakhtakia and Chinoy, 2014). The Halsted theory explained that cancer spread in an orderly fashion from breast to the lymph nodes and later to other organs in the body. The predominance of the Halsted radical mastectomy as the method of choice for the surgical extirpation of breast cancer remained dominant for nearly 80 years. The operation paid the price with high morbidity of large open wounds left to heal by granulation, near universal lymph edema, and overall disability. Ernst G. F. Küster (1839-1922) in Berlin was performing routine axillary clearance and reported that it virtually eliminated recurrences in the axilla. In 1875 Richard von Volkmann (1830-1889) was routinely removing the pectorals major fascia, and Kuster’s assistant Lothar Heindenhain (1860-1940) held the muscle itself suspect. The mastectomy samples revealed the cancer in deep pectoral fascia, as well as the muscle in some cases. The work of these surgeons, as well as Joseph Lister and Samuel D. Gross, who were strong proponents of detailed axillary dissection, had a significant influence on William Stewart Halsted (Lakhtakia and Chinoy, 2014).
The origin of the word mastectomy traces back to the Greek term “mastos,” meaning the breast. The advancement of mastectomy over the past century has evolved considerably from the description from Halsted and Meyer in the mid-1890s. Near the turn of the century, William Stewart Halsted published the Johns Hopkins Hospital experience and the standard of care became the radical mastectomy. Halsted is well known for his role in the history of mastectomy, and in this as in other areas of his career he can illuminate these themes for students. Halsted’s radical mastectomy included the removal of the breast along with its skin, the auxiliary lymph nodes, part of the pectoralis major muscle, and areas of the supraclavicular region. The history of radical mastectomy has particular power for many because the tensions that the measure introduced into the lives of sufferers continue to be recognizable in our own. Although the radical mastectomy was associated with significant postoperative deformity and diminished upper extremity function and the operative procedure itself resulted in significant intraoperative blood loss, it had a dramatic impact on loco regional control and was quickly adopted (Lakhtakia and Chinoy, 2014).
In the 1930 DH Patey of London popularized the modified radical mastectomy, which spared the pectoral muscle while removing the breast, axillary contents and a large ellipse of skin. The safety of modified radical mastectomy was demonstrated when long term follow up failed to demonstrate any breast cancer recurrences in the preserved pectoral muscles, and presented no difference in survival compared with radical mastectomy.
The end of Halsted radical mastectomy arrived when it became apparent that although dramatically affecting local recurrence rates, the procedure had no significant impact on overall survival.
Cushman D. Haagensen was both a staunch supporter and a critic of radical mastectomy (Lakhtakia and Chinoy, 2014). His book Diseases of the Breast published in 1956 is a classic. In opposing breast reconstruction, Dr. Haagensen said he believed that cancer could be spread by another operation, that the cosmetic results he had seen were not esthetically successful and that if there was enough skin left to do an implant, the surgery had not been radical enough and the patient had less chance of survival. By the end of the nineteenth century two events became famous for critical treatment to be applied for breast cancer. The first was the discovery of X-rays by Wilhelm Conrad Röntgen in 1895, which provided the basis for radiotherapy and mammography. These rays were capable of penetrating through tissue and killing cancers. The second was the breakthrough that breast cancer occurrence was hormone dependent. A year following Röntgen’s discovery of X-rays, a scientific lab was established. Three cases of breast cancer were treated with the help of X-rays by Hermann Goethe in Hamburg and Emile Grubbe in Chicago (Lakhtakiaand Chinoy, 2014). All the three cases involved advanced stages and inoperable tumors. Likely equipment for X-ray production was developed and continued to be used in almost all medicinal fields. The invention of radioactivity by Marie and Pierre Curie in 1898 added to the treatment of breast cancer by exposing the tissue or tumor to radium.
Hormonal treatment began with oophorectomy. Oophorectomy is a surgical procedure that involves the removal of one or both ovaries. Prophylactic oophorectomy is usually reserved for women with a significantly increased risk of breast cancer and ovarian cancer due to an inherited mutation in the BRCA1 or BRCA2 gene — two genes linked to breast cancer, ovarian cancer and other cancers. High-risk women age 35 and older who have completed childbearing are the best candidates for this surgery. Prophylactic oophorectomy may also be recommended if the patient has a strong family history of breast cancer and ovarian cancer but no known genetic alteration. It might also be recommended if there is a strong likelihood of carrying the gene mutation based on family history but choose not to proceed with genetic testing (Cline, 1963).
20th CENTURY
The twentieth century produced new techniques to treat breast cancer by the introduction of mammography and chemotherapy. Breast cancer was recognized as the major health problem in the Western world, stimulating a concerted effort against it. Research confirmed a hereditary component of breast cancer. Clinical investigators controlled trials with sophisticated statistical analysis of data. Radical mastectomy was the pillar of medication for the starting four decades of the twentieth century. In spite of the fact that radical mastectomy helped extend a woman’s survival, particularly if performed early, numerous ladies chose to opt out of the surgery because it left them deformed. Moreover, there were issues like a twisted midsection divider, lymph edema or swelling in the arm because of lymph hub evacuation and torment.
Mammography, a useful development in the detection of breast cancer, was developed along with surgical techniques. Mammography allowed clinical testing and observation of ductal carcinoma, which was regularly curable. Film-screen mammography is one such technique in which a blast of X-rays is incident on the targeted breast tissue to activate a rare earth screen that glowed in response. This screen is visually exposed on photosensitive screen, developed, and then stored in cassettes that provided an image source of the disease. Though X-rays were first used on breasts in 1913, mammography did not grab the attention of the medical field because it was not yet a reliable tool. There were no precise images or techniques for technicians to replicate, and many thought it would never prove useful. With the hope that tumors will alter the beam of bright lights, doctors developed like trans-illumination techniques instead of radiology. The technique involved doctors pressing the affected breasts of patients with bright light beams in a dark black closet. This technique was a failure andcaused skin problems (Rebecca, 2001).
Screening with mammography and physical examination determined that 30% of cancers could be detected by mammography alone, and deaths from cancers among screened woman were reduced by 30% compared with unscreened. Later mammography was followed by a number of innovative means for imaging the breast like magnetic resonance imaging (MRI). As the twentieth century advanced, radical surgery was opposed greatly by Kaae and Johansen of Denmark by protesting that selective uses of radical mastectomy did not offer an overall increase in cures. Bernard Fisher, Professor of Surgery at the University of Pittsburgh and a researcher in the biology of metastasis, critically evaluated the treatment of breast cancer. Referring to the Halsted’s rationale for radical mastectomy (1979), Fisher wrote in 1970 that “…either the original surgical principles have become anachronistic or, if they are still valid, they were conceived originally for the wrong reasons” (Fisher B, 1970).
Chemotherapy developed in parallel with changes in local treatment. Its beginnings can be traced to the use of mustard gas in World War I. Exposure caused lymphoid tissue followed by death from pneumonia. In 1942, Goodman and Philips used mustard gas on human lymphoma at Yale University. The results were suppressed throughout the war until 1946. Systemic “chemotherapy”, a word coined by the researcher Paul Ehrlich, often produced temporary regression and occasionally complete disappearance of advanced breast cancers (Hawley, Fagerlin, Janz, and Katz, 2008).
A similar approach involved combining the drugs cyclophosphamide, fluorouracil and methotrexate improved survival effectively. In humans, exposure to ionization radiation increased the risk as demonstrated through the survivors of Japan after the atomic bombings in Hiroshima and Nagasaki. This chemotherapy introduction to treatment of breast cancer coordinated the specialists in bringing to bear a medley of surgery, radiation therapy, and systemic hormonal chemotherapy on the components of diseases. The discovery of predisposing mutations in BRCA1 and BRCA2 genes of families prone to breast cancer confirmed genetic transmission and provided a means to identify individuals at great risk.
CONCLUSION
Breast cancer still remains a challenging issue to deal in the field of science and medicine. For practicing physician’s radiotherapy, medical oncology, surgical oncology, and even breast surgery had become specialties. According to the recent cancer statistics by American Cancer Society, in 2015 there will be a total of 1.6 million new cancer cases expected to be diagnosed and close to 600,000 deaths due to cancer in America. With screening and modern therapy, the death rate had begun to decline and overall relative survival 5 years after diagnosis, cured and uncured, was 86.6%.
ACKNOWLEDGEMENTAuthors 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.
CONFLICT OF INTEREST
None of the authors of this paper has any competing interests and declare no conflict of interest with other people or organizations.
Englishhttp://ijcrr.com/abstract.php?article_id=2258http://ijcrr.com/article_html.php?did=2258
Donegan, William L., and W. L. Donegan. "Introduction to the history of breast cancer." Cancer of the Breast (1995): 1-15.
Fillmore, Randolph. "Surgery in the 1700’s." (2009)
Motwani SB , Strom EA: “Radiation therapy in early and advanced breast cancer”. In: Breast Cancer, 2nd Edition. Winchester DJ, Winchester DP, Hudis C, Norton L (editors), BC Decker, Hamilton, Ontario, 2006.
Lakhtakia, Ritu, and Roshan F. Chinoy. "A Brief History of Breast Cancer: Part II-Evolution of surgical pathology." Sultan Qaboos University medical journal14.3 (2014): e319.
Schneider, Michael, et al. "Desmoplastic fibroma of the mandible-review of the literature and presentation of a rare case." Head Face Med 5.25 (2009): 1-5.
Cline, John W. "Cancer of the Breast." California medicine 99.6 (1963): 393.
A Report on “Treatment of Primary Breast Cancer”. N Engl J Med 1979; 301:340
Hawley, Sarah T., et al. "Racial/ethnic disparities in knowledge about risks and benefits of breast cancer treatment: does it matter where you go?." Health services research 43.4 (2008): 1366-1387.
Fisher, Bernard. "The changing role of surgery in the treatment of cancer."Radiotherapy, Surgery, and Immunotherapy. Springer US, 1977. 401-421.
Lakhtakia, Ritu. "A brief history of breast cancer: Part I: Surgical domination reinvented." Sultan Qaboos University medical journal 14.2 (2014): e166.
Winchester, D. J., and D. P. Winchester. "Atlas of Clinical Oncology–Breast Cancer. BC Decker Inc., Londyn 2000. 7. Jatoi I, Kaufmann M, Petit J. Atlas of Breast Surgery." (2006).
"Our history." RCP London. N.p., 21 June 2017. Web. 10 July 2017.
Scientific papers; physiology, medicine, surgery, geology, with introductions, notes and illustrations. New York, P. F. Collier and son [c1910] The Harvard classics v. 38.
Skloot, Rebecca. "How A Pitt Alum Refused to Let Mammography Be Ignored." N.p., n.d. Web, 2001.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30HealthcareA Review on Quality of Life in Cancer Patients: An Indian Scenario
English4548Reena KumariEnglish Jaspreet KaurEnglish Monika KajalEnglishCancer is a major public health concern among million of people worldwide and claims thousands of life. The main aim of this review article was to assess the Quality of life (QOL) in Indian cancer patients. QOL is a vital health outcome measure that can only be described in individual terms. It integrates several aspects of life and takes into account impact of illness and treatment. According to the available articles and literature reviews it is found that most of the patients were leading unsatisfactory QOL. Various domains such as physical, psychological, social dimensions etc are affected which in turn influenced the QOL of the patient. Factors such as pain, reduced working capability, and disturbed sleep pattern were significantly found to be affecting the QOL of cancer patients.
EnglishIndia, carcinogens, QOL (Quality of life)Introduction
Cancer is major cause of morbidity and mortality 1,2 and second most common cause of death after heart attack worldwide 3. It is a group of diseases that occurs due to uncontrolled growth and proliferation of abnormal cells which can even lead to death if not controlled 2, 4. It also leads to physical inadequacies and psychological problems with periods of remission and exacerbations 5. Current dogma states that cancer is a multi-gene, multi-step disease which originates from a single abnormal cell (clonal origin) with an altered DNA sequence also known as mutation 2.
Epidemiology
Cancer mortality is higher among men (207.9 per 100,000) than women (145.4 per 100,000). Globally most common cancers in men are cancers of lung, prostate, colorectum, stomach and liver amounting to a total of 4.3 million cancer cases. In women, most common cancers are cancers of breast followed by colorectum, lung, and cervix, and corpus uteri with a total of 3.7 million cases 1. It is highest in African American men and lowest in Asian/ Pacific Islander women 6. Approx 16% of cancer worldwide is caused by infection. Figure 1 shows the world region of cancer caused by infection 7 . The global burden is expected to increase to 21.4 million new cancer cases and 13.2 million cancer deaths by 2030 due to increase in size of population, adoption of western lifestyles such as smoking, poor diet, physical inactivity, and reproductive factor 4.
According to World Health Organization (WHO), 14.1 million cases were diagnosed and 8.2 million cancer-related deaths were estimated in 2012 1, whereas according to the 2016 estimates by National cancer institute new cases are 1,685,210 and 595,690 are cancer-related death in the united states 6 and is expected to increase till 25 million a year in over the next 20 years 3, 8. Cancer is leading cause of death accounting for 27% of all deaths in Americans, Native Hawaiians and Pacific islanders (AANHPTs) and 12% of deaths worldwide which only differ by 4% in Africa to 23% in Northern America. Worldwide cancer deaths are projected to increase by 60% from 2012 to 2030 (SEER cancer statistics review 1975-2013).
Cancer is a major public health concern in India with 1.01 million new cancer cases per year, indicating India as a single country contributing to 7.8% of the global cancer burden 1,5. Incidence of cancer in India varies from 44-122 per 100,000 populations in males and 52-128 per 100,000 populations in females 5 and according to The International Agency for Research on Cancer GLOBOCAN project, it will nearly double in the next 20 years 2. The number of cancer incidence in five cities of India is shown in FIGURE 2 9.
The most common cancer in Indian men are tobacco related whereas for Indian women, cervical cancer (122,844 diagnosed and 67,477 death) 10 is the second most incident cancer, breast cancer being the first 2.
Types
More than 100 types of cancer are present worlwide and are named according the the organs, tissue(histological types) or sites involved. On the basis of histological types they are grouped into six major categories: carcinoma, sarcoma, leukemia, lymphoma, myeloma and mixed types. Carcinomas result from altered epithelial cells, which cover the surface of our skin and internal organs and accounts for 80-90% of all cases. Sarcomas result from changes in muscle, bone, fat, or connective tissue and resemble the tissue in which they grow. Example: Osteosarcoma, Kaposi sarcoma, malignant fibrous histiocytoma, liposarcoma, dermatofibrosarcoma protuberans etc. Leukemia results from overproduction of malignant white blood cells. It is 4 types, acute or chronic based on how quickly the disease gets worse and lymphoblastic or myeloid based on types of blood cells involved. Lymphoma is a cancer of the lymphatic system cells in which abnormal lymphocytes proliferate in lymph nodes and lymph vessels, as well as in other organs of the body. They may also occur in brain, stomach and breast. Myelomas also known as plasma cell myeloma and kahler disease are cancers of specialized white blood cells that make antibodies. The abnormal Plasma cells build up in the bone marrow and form tumors in all bones of the body. When two or more components of cancer are involved they come under mixed types. Carcinosarcoma, teratocarcinoma etc are categorized into Mixed types11,12,13,14.
Aetiology
There are multiple causes of cancers which involves both environmental and Genetic/Hereditary factors 12. Cancer is a genetic disease that is caused by mutation in genes and can be inherited from our parents. The genetic changes that causes cancer tend to affect, proto-oncogenes, tumor suppressor genes, and DNA repair genes .These changes are sometimes called “drivers” of cancer 8. Different types of genes associated with risk of most important and common cancer are shown in Table 1 3.
Environmental factor include X-rays(radon), UV light, viruses (human papillomavirus, hepatitis B, Epstein-Barr virus, human T-cell leukemia virus and herpes virus) 8,12 , tobacco products, pollutants, chemicals (benzene, arsenic and organic solvents) 12, alcohol consumption 15. Cancer deaths in the U.S., including cancers of the lung, esophagus, bladder and pancreas are caused by tobacco smoking which contributes to half of cancer deaths in U.S. UV light is associated with most skin cancers, including the deadliest form, melanoma. These factors probably act directly or indirectly on the genes that are already known to be involved in cancer 12. Many causes of cancer are still unknown16.
Risk factors
Tobacco use, Alcohol use, Dietary factors, including insufficient fruit and vegetable intake, Age (older people are at greater risk), Overweight and obesity, Physical inactivity, Chronic infections from helicobacter pylori, hepatitis B virus (HBV), hepatitis C virus (HCV) and some types of human papilloma virus (HPV), exposure to chemicals 5,19,21 are considered among the main risk factors of cancer.
Discussion
According to WHO, Quality of life (QOL) is defined as ‘individuals’ perception of life, values, objectives, standards, and interests in the framework of culture 1,19 of the social environment in which they live and in relation to their goals, expectations, standards and concerns 5. It is a multidimensional construct that includes several aspects of life such as physical health status, psychological wellbeing including people’s emotion, social and cognitive functioning and take into account impact of disease and treatment based on patient’s life experiences6, 11, 12. When the hopes of an individual are fulfilled by experience in accordance to their goals, expectations, standards and concerns, he is said to be having a good quality of ife19 and it is usually expressed in terms of satisfaction, contentment, happiness and fulfilment and the ability to cope impact of illness and treatment20. Quality of life should be taken into account so that it can help in selecting more suitable treatment alternatives5.
Various studies there are several therapeutic modalities for cancer treatment such as surgery (curative, palliative) chemotherapy, and radiation therapy, which may be used alone or in combination and may have impact on the quality of life of those being treated 1,6,8,10,12,21,26.has been done to assess the QOL of patient in India and worldwide and
Kannan et al (2011) conducted a study on “Assessment of quality of life of cancer patients in a tertiary care hospital of South India” in which the aim of the study was to assess the QOL of cancer patients by using a validated questionnaire. Eleven types of cancer were identified. Study concluded that among the total samples, 80% of them has average and below average QOL, suggesting that an increasing importance should be given to the incorporation of Quality of Life as an outcome, in addition to other clinical endpoints12.
Sunderam et al (2016) conducted a study
to assess the quality of life among cancer patients in relation to type of treatment (chemotherapy vs. radiotherapy) and to determine the quality of life in relation to number of chemotherapy cycle.113 cancer patients (64 undergoing chemotherapy and 49 undergoing radiotherapy) were selected and interviewed by a validated questionnaire. Study concluded that cancer patients undergoing treatment had poor quality of life and among them patients undergoing chemotherapy had lower quality of life compared to patients undergoing radiotherapy 1. Treatment modalities due to their long term side effects has impacts on QOL in patients 10,22.
Dehkordi et al (2009) 23 conducted a study on “Quality of Life in Cancer Patients undergoing Chemotherapy” in which the aim of the study was to assess the quality of life in cancer patients with solid tumours and at different chemotherapy (CT) cycle. He concluded that cancer patients should be encouraged to complete a CT course as it plays an important role in the treatment outcome and the QoL in cancer patients undergoing CT. The result was similar to the study done by the same author in 201119. In a study done by Elsaie et al (2012) most function dimensions of QOL for colorectal cancer patient significantly decreased post the first chemotherapeutic session and all symptom dimensions except fatigue and overall symptoms have been increased post the first chemotherapeutic session21. There is a strong correlation between QOL and number of treatment cycles and the various cancer related factors can affect the QOL 19.
The most frequently seen cancer among women are breast cancers and are ranked third among all cancer deaths. A study was done by Akca et al (2014) to evaluate the changes in quality of life of the female patients who had undergone surgical treatment for breast cancer. Female patients with breast-preserving surgery (BPS), modified radical mastectomy (MRM), simple mastectomy (SM) aged between 28-55 years were included in the study. Validated Turkish versions of EORTC QLQ-C30, and EORTC–BR23 questionnaires were used for all patients. The study concluded that MRM group was found to be more adversely affected than the BPS group 5. In a similar study performed by Dubashi et al (2010), overall QOL in younger patients with breast cancer appeared to be overall good. The QOL and sexual function were marginally worse in the breast conservation group when compared to mastectomy group24.
Cervical cancer is the most common cancer and Hemavathy et al (2016) conducted a study to explore the quality of life among women with cervical cancer in which 280 samples were included. According to her, QOL among cervical cancer patients is very important aspects in developing country like India and there is a need to assess the QOL and implement the relevant measures to cervical cancer survivors 10.leading cause of death for Indian women which affects the QOL of women.
Jyothi D. Souza et al 2013 conducted a study to assess the QOL and performance status of Head and Neck Cancer patients to find relation between domains of QOL and to find association between QOL and demographic and disease variables in which Karnofsky Performance Status (KPS) scale was used to assess performance status. Subjects with all stages of HNC and primarily diagnosed with HNC and undergoing disease specific treatment. Study concluded that physical, psychological, social, spiritual, functional domains are affected in patients with HNC. The impact on one domain area of well being, significantly affects the other domain of QOL and there is relationship between the performance status and QOL 25.
According to our knowledge scarce studies are available on the quality of life in different types of cancer in India. Most of the studies are done on breast cancer. Cancer can lead to different types of changes in the life of cancer patient which can be the general well being or physical, psychological and social status of the patient. Various studies shows that there is no correlation between the QOL and age, sex, marital status, educational status, duration of disease, economic condition, and occupational functions of the cancer patient 1, 19. Problem in the case of long term survivors in the areas of support i.e social or emotional, spiritual and philosophical views of life and health status was also prominently seen. The gap between expectation and reality should be reduced, and the patient should be satisfied with what he\ she have to improve their QOL20.
Conclusion
The present review concluded that cancer is an important health issue which influences QOL in cancer patient. It is necessary to narrow the gap between hopes, aspiration, dreams and reality to improve their QOL. Further studies need to be done as there is need to understand the causes and impact of cancer related factors on QOL and also the impact of cancer treatment and implement strategies accordingly.
Acknowledgements
I would like to acknowledge my co-authors for their immense support and guidance and helping me find my literature for this review article. 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.
Source of funding: none
Conflict of interest: There is no conflict of interest
Englishhttp://ijcrr.com/abstract.php?article_id=2259http://ijcrr.com/article_html.php?did=2259
Sunderam S, Jeseena KJ, Kashyap V, Singh SB, Kumar M. Study on Quality Of Life of Cancer Patients In Relation To Treatment Modality in a Tertiary Health Institute of Jharkhand. IOSR Journal of Dental and Medical Sciences 2016; 15(5):16-20
Mallath M.K, Taylor DG, Badwe RA, Rath GA, ShantaV , C S Pramesh CS et al. The growing burden of cancer in India: epidemiology and social context. SERIES 2014; 1-8
Anand P, Kunnumakara AB, Sundaram C, Harikumar KB, Tharakan ST, Lai OS, Sung B, and Aggarwal BB. Cancer is a Preventable Disease that Requires Major Lifestyle Changes. Pharmaceutical Research 2008; 25(9): 2097-2116
American Cancer Society. Global Cancer Facts and Figures 2nd Edition.2011
Akca M, Ata A, Nay?r E, Erdo?du S, Ar?can A. Impact of Surgery Type on Quality of Life in Breast Cancer Patients. J Breast Health. 2014; 10: 222-8.
Manandhar S, Shrestha DS, Taechaboonsermsk P, Siri S, Suparp J. Quality of Life among Breast Cancer Patients Undergoing Treatment in National Cancer Centres in Nepal. Asian Pac J Cancer Prev 2014;15(22): 9753-9757
American cancer society. Global facts and figures. 3rd edition. 2015
Bukhtoyarov OV, Samarin DM. Pathogenesis of Cancer: Cancer Reparative Trap. Journal of Cancer Therapy 2015; 6: 399-412.
Marimuthu P. projection of cancer incidence in five cities and cancer mortality in India. Indian journal of cancer 2008; 45(1): 4-7
Hemavathy V, Julius A. A study to assess the quality of life among women with cervical cancer in selected hospitals at Chennai. Int J Pharm Bio Sci 2016; 7(4): 722–724
Subathra V. A Study on Quality of Life of Patients Receiving Palliative Care Services. Paripex- Indian journal of research 2012; 1(10): 26-27
Kannan G, Rani V, Ananthanarayanan RM1 Palani T, I Nigam N, Janardhan V, Reddy UM . Assessment of quality of life of cancer patients in a tertiary care hospital of South. India. Journal of Cancer Research and Therapeutics 2011; 7(3):275-279
SEER Training modules, U.S. National institutes of health, national cancer institute. 6, May.2017
Mandal A. Cancer classification. Medical news. 2012
Connor J. Alcohol consumption as a cause of cancer. Society for the Study of Addiction. 2016; 112: 222–228
Clapp R, Howe G, Lefevre MJ. Environmental and Occupational Causes of cancer. Lowell Center for Sustainable Production. 2005: 1-50.
Chemicals, Cancer, and You. American Cancer Society Fact Sheet “Occupation and Cancer”; International Agency for Research on Cancer. 2009
World Health Organization. NMH Fact sheet January 2010
Haydarnejad MS, Hassanpur Dehkordi A, Solati Dehkordi K. Factors affecting quality of life in cancer patients undergoing chemotherapy. African Health Sciences 2011;11(2):266-270
Calman KC. Quality of life in cancer patients – an hypothesis. Journal of medical ethics. 1984; 10: 124-127
Elsaie OA, Elazazy HM, Abdelhaie SA. The Effect of Chemotherapy on Quality Of Life of Colorectal Cancer Patients before and 21 Days after the First Chemotherapeutic Sessions. Life Science Journal 2012; 9(4): 3504-3514.
Nemati M, Alhani F, Zandshahdi R. Quality of life in cancerous adolescences undergoing chemotherapy. 1st congress in quality of life. Tehran, Iran: Book of Abstracts 2003;25
Dehkordi A, Heydarnejad MS, Fatehi D. Quality of Life in Cancer Patients undergoing Chemotherapy. Oman Medical Journal. 2009; 24(3)
Dubashi B, Vidhubala E, Cyriac S, Sagar TG. Quality of life among younger women with breast cancer: study from a tertiary cancer institute in south India. Indian J Cancer 2010; 47: 142-147.
Prima Jenevive Jyothi D.Souza, Chakrabarty J, Sulochana B, Gonsalves J. Quality of Life of Head and Neck Cancer Patients Receiving Cancer Specific Treatments. Journal of Krishna Institute of Medical Sciences University. 2013; 2(1): 51-57.
Damodar G, Gopinath.S, Kumar SV, Rao AV. Reasons for Low Quality of Life in South Indian Cancer Patient Population: A Prospective Observational. Indian Journal of Pharmaceutical Sciences. 2014; 76(1): 2-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30HealthcareCorrelation of Birth Weight with other Anthropometric Parameters of Newborns in Himachal Pradesh
English4954Soni PankajEnglish Kapoor KanchanEnglishIntroduction: Birth weight is an important indicator of child survival. Anthropometric measurements of infant body help us to predict their health and future growth. All the health personal working in child health care should be familiar with normal patterns of growth, so that they can recognize any deviations from the normal range and try to deal with the underlying disorders which could be nutritional, socioeconomic or infectious diseases.
Methods: The present study included 409 normal newborns (216 male, 193 female) delivered in labor ward of civil hospitals in Himachal Pradesh, measurements of the parameters were taken in 12-24 hours after birth, measured by using digital vernier caliper. The study was undertaken to document birth weight, crown heel length, head circumference, chest circumference and abdominal circumference of full term newborns in Himachal Pradesh.
Results: The mean and standard deviation (Mean±SD) for all the anthropometric parameters between male and females were obtained and high significant was found in birth weight (p=0.013) and head circumference (p=0.000) in Himachal Pradesh.
Conclusion: Chest circumference showed high correlation with abdominal circumference (r=0.785) in Himachal Pradesh, (r=0.752) in outer Himalayas and (r=0.848) in middle Himalayas. There is minimal but positive correlation of birth weight to all the anthropometric parameters in Himachal Pradesh.
EnglishHimachal, Anthropometry, Newborn, Birth weight, Crown heel length, Head, Chest, Abdomen, CircumferenceINTRODUCTION
Anthropometry is a series of systematized measuring techniques that expresses quantitatively the dimensions of the human body and skeleton. Newborn anthropometry is the most important as there is no such measurement for universal use because it is dependent on racial, ethnic, environmental, age factors, biological, ecological and geographic factors1.
All health personnel having responsibility for the care of children should be sufficiently familiar with the normal patterns of growth and milestones so that they can recognize overt deviations from the normal range as early as possible, in order for underlying disorders to be identified and given appropriate attention. Growth principally implies changes in size of body as a whole or of its separate parts.
Birth weight is the most sensitive and reliable indicator of the health in a community. It is universally acknowledged that size at birth is an important indicator of foetal and neonatal health in the context of both individual and population. Birth weight in particular is strongly associated with foetal, neonatal and post-neonatal mortality and with infant and child morbidity. It is the most important determinant of children’s chance of survival, healthy growth and development in future2.
The birth size is the result of fetal growth. The fetal growth which commences shortly after conception is largely determined genetically with the modification of this genetic process by the environment3.
Approximately four million global neonatal deaths that occur annually, 98% occur in developing countries, where most newborns die at home while they are being cared by mothers, relatives, and traditional birth attendants (dais) 4.
Species of Homo-sapiens lived an isolated life for centuries; they exhibited variations from the nearby population with respect to their social, cultural, linguistic and morphological behavior. These variations between the human groups are the result of complex mixture of biological, geographical and cultural determinants. Since time immemorial, there has been the uniqueness of genetics that humans evolved which got dissolved or diluted because many isolates of these races lost their reproductive barrier5.
In ancient times, anthropometry was used in criminology where criminals were identified by measuring parts of their body. During the early 20th century, one of its primary uses was to find out racial differences6.
Anthropometric studies are mostly conducted with the aim to obtain the characteristics of ethnic/racial groups inhabiting a particular geographical region. These studies assist in understanding the frequency distribution of human morphologies among different races.
The geographical location, racial and environmental factors are responsible for the differences in growth and body composition in individuals. In view of this, we selected to undertake an anthropometric study of normal newborns in hills of Himachal Pradesh, which is known for its unique and uncanny socio-political and cultural tradition. Its unique composition, location, and character all makes it the bounder land7.
The aim of the present study is to measure birth weight, crown heel length, head circumference, chest circumference and abdominal circumference of full term newborns of different zones of Himachal Pradesh and to calculate mean value, standard deviation of each zone and compare the present findings with the available literature on the same.
AIM AND OBJECTIVE
To measure anthropometrically significant parameters of full term newborn of all three zones of Himachal Pradesh. To calculate and compare mean value and standard deviation of anthropometric measurements of all three zones of Himachal Pradesh. Determine the correlation between different anthropometric parameters and compare the present findings with the available literature on the anthropometry of newborn of hilly region.
MATERIALS AND METHODS
The study was undertaken on 409 normal full term newborns comprising of 216 males (52.81%) and 193 females (47.19%) delivered in the labor ward of civil hospitals of Himachal Pradesh. All the parameters were measured in 12-24 hours after birth by using digital vernier caliper.
Ethical clearance was taken from Geetanjali University, Udaipur, Rajasthan (India). Informed consent of mother /father /guardians and permission from Director of Health Services, Shimla, Himachal Pradesh government was taken before the study.
The exclusion criteria included neonates of high risk or complicated pregnancies having medical illness such as hypertension, diabetes mellitus, infection, autoimmune disease, heart disease etc. Neonate who had caput succedaneum and cephalheamatoma and who were delivered by caesarean section showing any craniofacial deformity were also not included in the study.
Baby weight was recorded from the hospital record in the labor ward.
The crown heel length was measured in supine position with full extension of knee and distance between top of head and heel when press against a vertical surface and role on a stabilizing board.
Head circumference of neonates was calculated by placing measuring tape around the head to pass above the ears and eyebrows. It measures the occipito-frontal circumference.
The chest circumference was measured by placing flexible non- stretchable measuring tape along the point of nipples. Abdominal circumference was measured at the level of the umbilicus with a flexible non- stretchable measuring tape. The measurement was made at the end of a normal expiration (Fig1)
The data for each newborn was recorded in a form and analyzed. For comparison of the means of the anthropometric measurements unpaired t- test was used.
OBSERVATION AND RESULTS
The present study was conducted to obtain a baseline standard criterion (Mean ±SD) of normal full term newborn’s parameters and their correlation of birth weight with other anthropometric parameters. Birth weight (p=0.013) and head circumference (p=0.000) in Himachal Pradesh showed statistically significant sex difference (pEnglishhttp://ijcrr.com/abstract.php?article_id=2260http://ijcrr.com/article_html.php?did=2260
Shastry CKR and Bhat BPR. Anthropometric measurements of newborns. Int J Contemp Pediatr. 2015; 2(2): 85-89.
Kaur M, Singh Z, Kaur G and Goyal LD. Correlation of birth weight with other anthropometric measurements of newborns. Indian Journal of Basic and Applied Medical Research. 2013; 8(2): 870-79.
Alshemeri KDH. Some Anthropometric Measurements of Normal Full Term Neoborns at Birth. The Iraqi postgraduate medical journal. 2008; 7(1): 6-11.
The World Health Organization report. The newborn health that went unnoticed, prenatal mortality. A listing of available information. World Health Organization, Geneva, 1996.
Spielman RS. Do the natives all look alike? Size and shape component of anthropometric differences among Yanomama Indian villages. The American Naturalist. 1973; 107 (957): 694-708.
Franciscus RG and Long JC. Variation in Human Nasal height and Breadth. Am J Phys Anthropol. 1991 Aug; 85(4): 419-27.
Balokhara JM. The Wonderland Himachal Pradesh. 1st Ed. India. H.G publication. 2011.
Kataria SK and Gaur S. An Anthropometric Study of Normal Full Term Newborns at Birth in Western Rajasthan. International Journal of Advanced Research. 2014; 2(10): 671-75.
Taksande AM, Lakhkar B and Gadekar A. Anthropometric measurements of term neonates in tertiary care hospital of Wardha district. Al Ameen J Med Sci. 2015; 8(2): 140-43.
Anupama MP and Dakshayani KR. The Study of Anthropometric Measurements of Newborn Babies in Relation to Maternal Illness. Anatomica Karnataka. 2013; 7(1): 67-71.
Pachauri S and Marwah SM. An anthropometric study of the newborn in a New Delhi urban community. Indian J Pediat. 1971 July; 38(7): 291-97.
Suneetha B and Kavitha VK. A study of relationship between birth weight and various anthropometric parameters in neonates. IOSR Journal of dental and medical sciences. 2016 Feb; 15(2): 50-57.
Sajjadian N, Shajari H, Rahimi F, Jahadi R and Barakat MG. Anthropometric measurements at birth as predictor of low birth weight. Health. 2011; 3(12): 752-56.
Jaya DS, Kumar NS and Bai LS. Anthropometric indices, cord length and placental weight in newborns. Indian Pediatr. 1995 Nov; 32(11): 1183-88.
Safak SK and Turgut HB. Weight, length, head and face measurements in Turkish newborns of central Anatolia. Gazi Medical Journal.1998; 9(3): 116-20.
Kramer JK, Farnworth ER, Johnston KM, Wolynetz MS, Modler HW and Sauer FD. Myocardial changes in newborn piglets fed sow milk or milk replacer diets containing different levels of erucic acid. Lipids.1990 Nov; 25(11): 729-37.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30General SciencesToxicity Effect of Copper on Aquatic Macrophyte (Pistia Stratiotes L.)
English1420Rolli N.M.English Hujaratti R.B.English Giddanavar H.S.English Mulagund G.S.English Taranath TCEnglishIndustrial development coupled with population growth had resulted in the over exploitation of natural resources. Life support systems viz, water, air and soil are thus getting exposed to an array of pollutants, especially heavy metals released by anthropogenic activities. But tolerant species of aquatic plants are able to survive and withstand the pollution stress and serves as a pollution indicators and as tools for p1hytoremediation of heavy metals from the aquatic ecosystems. Phytoremediation is an biogeotechnological application based on “Green liver concept” and operates on biogeochemical cycling. The present study focuses on copper toxicity on morphology, biochemical parameters and bioaccumulation potential of Pistia. The laboratory experiments were conducted for the assay of morphological index parameter (MIP), biochemical parameters and accumulation profile of copper in the test plants at various concentrations viz, 2, 5,10, 15 and 20 ppm, at 4 days regular intervals for 12 days exposure. The test plants show visible symptoms like withering of roots, chlorosis, necrosis and lower leaves gets decayed at higher concentrations (severe at 20 ppm), however, the test plant showed normal growth at lower concentration viz, 2 and 5 ppm. The estimation of biochemical parameters viz, total chlorophyll, protein and carbohydrates of test plants showed significant increase at lower concentrations (2 and 5 ppm) of Cu. The biochemical constituents decreased with increase in exposure concentrations (10, 15 and 20 ppm) and duration. The toxic effect of sewage was directly proportional to its concentrations and exposure duration. The accumulation profile of Cu by Pistia was maximum at 4 days exposure and gradually decreases at subsequent exposure duration.
EnglishCopper, Accumulation, Toxicity symptoms, Biochemical parametersINTRODUCTION
Industrialization and urbanization coupled with alarming rate of population growth have resulted in the large scale pollution of aquatic ecosystems by industrial and domestic waste water discharge. Natural erosion and anthropogenic activities are greatly responsible for water pollution particularly heavy metals like Zinc (Zn), Lead (Pb), Cadmium (Cd), Copper (Cu) etc. There is likelihood of phytotoxicity both micro and macrophytes and environmental risks (de-Fillipes and Pallghy, 1994; Wei, et al., 2003). Heavy metals persisting in sediments may be slowly released into the water and become available to the organisms. Some heavy metals viz, Zn, Cu, Iron (Fe), Manganese (Mn) etc. are represented as micronutrients (Reeves and Baker, 2000) and are only toxic when taken in excess quantities (Blaylock and Huang, 2000; Campenela, 2001), but nonessential ions like Pb, Cd and Ni can inhibit various metabolic activities even in small quantities (Cerventes, et al., 2001; Dinkar, et al., 2001; Choudhary and Sharma, 2009).
The waste water emitting from source metals which could be toxic to flora and fauna. Biological treatment of waste water through aquatic macrophytes plants has great potential for its purification, which effectively accumulates the heavy metals (Brix and Schirup, 1989). Aquatic macrophytes accumulate considerable amount of toxic metals and make the environment free from the pollutants. Thus they play significant role in cleaning up of environment and make the environment free from toxic pollutants. So many aquatic plants have been successfully utilized for removing toxic metals from the aquatic environments (Satyakala and Kaiser Jamil 1992). The metal tolerance of plants may be attributed to different enzymes, stress proteins and Phytochelatins (Van-Asche and Clijsters 1990). Accumulation of metals at higher concentration causes retardation of growth biochemical activities and also generation of –SH group containing enzymes (Weckx and Clijsters 1996).
In the present investigation Pistia stratiotes, a common aquatic macrophyte is used to study the effect of different concentrations of copper on morphology, biochemical constituents and accumulation profile of Cu from the experimental pond under laboratory conditions
MATERIALS AND METHODS
Pistia stratiotes, a free floating aquatic plant from unpolluted water bodies is maintained in cement pots (1 m diameter ) under natural conditions at a temperature 28-300C. About 20 g of young healthy Pistia is acclimatized for two weeks in Arnon and Hoagland nutrient solution maintaining pH between 7.1-7.4. The concentrations of Cu in the polluted water are in the range of 02, 05, 10, 15 and 20 mg/l and tap water as a control. Morphological Index parameters (MIP) viz, root length, leaf length and breadth were observed for 12 days at interval of 4 days. Photographs of Pistia treated with different concentrations of copper were taken by using Canon’s Power Shot G2 digital camera. For the further study the plants were harvested at the end of 4, 8 and 12 days exposure and are thoroughly washed with distilled water and used for the estimation of total chlorophyll, protein and carbohydrate and also for morphological observations. Plants harvested after 48 hrs were dried at 800C for 2 days for metal extraction.
The fresh plant sample of 1g is macerated in 100 ml of 80% (v/v) chilled acetone by using pestle and mortar. The centrifuged and supernatant was used for the estimation of total chlorophyll by standard method (Arnon, 1949) using 652 nm against the solvent (80% acetone as a blank). The protein was estimated by Lowry’s method (Lowry et al., 1951) using Bovine Serum Albumin (BSA) as a standard, using 660 nm and carbohydrates by phenol sulphuric acid method (Dubois et al., 1956) using glucose as standard at 490 nm. Morphological characters were identified with the help of photographs, using Canon’s Power Shot G2-digital camera.
The estimation of metal Cu in the test plant was carried out by using standard method (Allen et al., 1974). The dried and powdered 1 g plant material was digested by using mixed acid digestion method in Gerhardt digestion unit. The digested samples were diluted with double distilled water and filtered through Whatman filter paper No-44. The estimation of Cu was done by AAS (GBC 932 Plus Austrelia) with air acetylene oxidizing flame and metal hollow cathode lamp at 217.00 nm wavelength. Working standards (SISCOP-Chem-Bombay Lab) were used for the calibration of instrument.
Statistical analysis: Data are presented as mean values ± SE from two independent experiments with three replicates each. Data were subjected to Two - way ANOVA to know significance between concentrations and between exposure duration for the accumulation of heavy metal (Cu). Further, Dunet’s test is also applied for multiple comparisons between control and other concentrations. Two – way ANOVA test is also extended to know the significance between concentration and duration for biochemical parameters.
RESULTS
The experiments were conducted with the following parameters:
Effect of Copper toxicity on morphology:
The test plant showed luxuriant growth and slight increase in the laminal length and breadth at 5 ppm concentration. The 5 ppm Cu found to promote length by 6.900cm (± 0.047) in comparison to control, 5.33cm (± 0.027) and laminal length 2.63 cm (± 0.047) and breadth, 2.33 cm (± 0.027) when compared to control (laminal length, 1.766 cm ± 0.027 and breadth 1.56cm ± 0.027) respectively during 12 days exposure. However, at 20 ppm Cu, severely inhibit the root length by 1.63 cm (± 0.034) in comparison to control 5.33 cm (± 0.027) and laminal length, 0.80 cm (± 0.047) and breadth, 0.63 cm (± 0.108), when compared to control (laminal length, 1.76 cm ± 0.027 and breadth 1.566 cm ± 0.027) respectively during 12 days exposure (Table 1). MCA test also represented maximum deviation at higher concentration compared to control.
Effect of Copper toxicity on biochemical parameters:
The chlorophyll content was very sensitive to copper toxicity. The results found that Cu at 5 ppm found to augment chlorophyll synthesis and was directly proportional to concentration and exposure duration. The chlorophyll content increased by 3.81% ( 0.381 mg/gm), 4.10% (0.406mg/gm) and 4.79% (0.415mg/gm) respectively at 4, 8 and 12 days exposure compared to control pond. However, the higher concentration of copper found to inhibit the chlorophyll synthesis. The inhibition at 20 ppm Cu by 13.35% (0.318mg/gm), 27.7% (0.284mg/gm) and 46.71% (0.211mg/gm) (significant at p > 0.95) at 4, 8 and 12 days exposure respectively compared to control. Two-way ANOVA represents biochemical toxicity to the test plant, concentrations were significant at p > 0.01 level but duration is not significant (Fig. 1).
The increase in the carbohydrate content of Pistia at 5 ppm Cu by 23.06% (32.0 mg/g), 35.71% (38.0 mg/g) and 36.66% (41.0 mg/g) respectively during 4, 8 and 12 days exposure duration. The severity of inhibition of carbohydrate synthesis was noticed at 20.0 ppm by 46.15% (14.0 mg/g), 57.14% (12.0 mg/g) and 68.75% (10.0 mg/g) respectively at 4, 8 and 12 days exposure in comparison to control (fig.).
The protein synthesis at 5 ppm Cu was promotive irrespective exposure duration. However, the protein content decreased at subsequent higher concentration and inhibition was directly proportional to the duration of exposure. The 5 ppm Cu promoted protein synthesis by 8.06% (6.7 mg/g), 18.75% (7.6 mg/g) and 19.11 (8.1 mg/g) respectively at 4, 8 and 12 days exposure duration. The reduction in protein content was observed with progressive increase in Cu concentration. The inhibition of protein content increase viz, 11.36% (3.9 mg/g), 32.60% and (3.1 mg/g) and 43.75% (2.7 mg/g) was respectively at 4, 8 and 12 days exposure in comparison to respective control (Fig. 1)
Application of two-way ANOVA, it is found that the biochemical responses of test plant species with respect to concentrations were significant at p < 0.01 level. However, exposure duration was not statistically significant (Table 2).
Profile of Metal Accumulation
The accumulation data (Fig 2) revealed that ‘Cu’ accumulation in Pistia was directly proportional to its concentration and exposure duration. The Pistia grown in experimental pond containing 5 ppm accumulate 2812.04 µg/g, 3062.0 µg/g and 3208 µg/g and accumulation at higher concentration (20 ppm) was 8425.0µg/g, 8750.0 µg/g and 8770.0 µg/g during 4, 8 and 12 days exposure respectively. Two-way ANOVA showed that both concentration and exposure duration were significant at p < 0.01 level in test plants and further Dunet’s test was applied for the multiple comparison between control and different concentration treatments of test plant. From the statistical analysis it is clear that concentration treatments are significantly differ with control (Table 3).
DISCUSSION
Effect of Copper toxicity on morphology Morphometric assay, is one of the quantitative tool for the assessment of toxicants, was measured by using Morphological Index Parameters (MIP). The rate of inhibition of growth in the root and leaf was directly proportional to the concentrations of copper. The test plant show luxurieant growth and slight increase in the laminal length and breadth at 5 ppm concentration. However, at higher concentration (20 ppm) severely inhibit the root length, laminal length and breadth. Similar observations were made by Garg et al.(1994) in Limnathemum cristastum at 1 ppm concentration of Pb, Zn and Cr. Our results of toxicity symptoms of copper at higher concentrations observed were similar to Dagon and Saygideger (2011) and Kopitte et al., (2007) and also of Yongpisamshap et al., (2005) in Salvinia natanas. Two – way ANOVA states that the concentrations were significantly toxic at 5% level but duration was not significant. MCA test also represented maximum deviation at higher concentration compared to control (Table. 1).
Effect of Copper toxicity on biochemical parameters: Copper is essential trace element required by all plants. The accumulation of copper in plants lead to biochemical changes. Total chlorophyll content, a parameter, was a sensitive to heavy metal toxicity (Gupta and Chandra, 1996). Similar observations had been reported by Dhir and Srivastava (2013) in Salvinia natanas at 10 ppm of Cu, Fe, Zn, Co and Cr. The stimulation of chlorophyll synthesis may be due to phytochelatins (PCs) which plays role in detoxification (Rolli, et al ., 2010) however, the higher concentration of Cu found to inhibit the chlorophyll synthesis. The inhibition at 20 ppm Cu by 13.35% (0.318mg/gm), 27.7% (0.284mg/gm) and 46.71% (0.211mg/gm) (significant at p > 0.95) at 4, 8 and 12 days exposure respectively compared to control. Similar observations was made by Singh et al 2011 in Hydrilla verticillata at higher concentration of Pb at 20 ppm and Cd at 0.05 ppm. This is due to decline in chlorophyll content in plants exposed to Cu due to: 1) inhibition of important enzymes associated with chlorophyll synthesis, 2) peroxidation of chloroplast membranes resulting from heavy metals induced oxidative stress, 3) formation of metal substituted chlorophyll (Patsikka, et al., 2002). Two-way ANOVA represents biochemical toxicity to the test plant, concentrations were significant at p > 0.01 level but duration is not significant. Two way ANOVA represents toxicity was at p > 0.01 level significant towards but duration was not significant.
Our investigation revealed that lower concentration of copper (5 ppm) promotes the carbohydrate synthesis. The carbohydrate content was increased at lower concentration of Cu, was due to detoxification free radicals by quenching / utilization by enzymatic superoxide dismutase (SOD), peroxidase (POD), catalases or glutathione reductase (Wang et al. 1997). Similarly Choudhary and Ramachandra (2005) observed stimulatory effect of carbohydrate in Nostoc muscorum at lower concentration (1.5 ppm) of Cu like other heavy metals. But the severity of inhibition of carbohydrate was noticed (Fig. 1). The heavy metals damaged the photosynthetic apparatus, in particular light harvesting complex II (Krupa, 1988) and photosynthesis I and II (Siedlecka and Krupa, 1996) and Hasan et al., (2009).
The proteins play an important role in energy metabolism. In the test plant, the lower concentration of copper enhances the protein synthesis and is directly proportion to exposure duration. However, the protein content was decreased at subsequent higher concentration and inhibition was directly proportional to the exposure duration. Many studies show that protein content of many aquatic macrophyte was increased by accumulation of Pb at lower toxicity concentration. The stimulation of protein synthesis at lower concentration of Cu (5 ppm) may be attributed to the synthesis of stress proteins. The phytochelatins (PC) and phytochelatin synthetase bind and regulate the Cu and sequesters the toxicity in the plants and thus showed metal tolerance Mohan and Hosetti, 1997; Steffens, 1997). The reduction in protein content was observed with progressive increase in Cu concentration. The inhibition of protein content increase viz, 11.36% (3.9 mg/g), 32.60% and (3.1 mg/g) and 43.75% (2.7 mg/g) was respectively at 4, 8 and 12 days exposure in comparison to respective control (fig. 1)
The proteins played an important role in energy metabolism. A decrease in protein content could be due to inactivation of protein synthesizing enzymes in the cell. The Cu induced oxidative stress by generating reactive oxygen species (ROS). These disrupted cellular homeostasis, thus, enhanced the production of ROS. These ROS reactions with proteins, lipids, nucleic acids causing membrane damage and enzyme content of macrophyte may be due to above reasons (Garg et al., 1994; Romero et al., 2007). (fig. 1)
Application of two-way ANOVA, it is found that the biochemical responses of test plant species with respect to concentrations were significant at p < 0.01 level. However, exposure duration was not statistically significant (Table 2).
Profile of Metal Accumulation
Heavy metal pollution of a water is a major environmental concern, is increasing at (Dushenkar et al. 1995) alarming rate due to anthropogenic activities and is drawing attention and gaining paramanual importance due to its obvious impact on health through the food chain (Prasad 1997). The aquatic plants are able to accumulate heavy metals from sediment water. In the present investigation aquatic macrophyte viz, Pistia stratiotes is used in accumulation. The accumulation data (Fig 2) revealed that ‘Cu’ accumulation in Pistia was directly proportional to its concentration and exposure duration.
It was observed that the rate of accumulation is maximum at 4 days exposure irrespective of concentrations and exposure duration, however, at remaining durations it is marginal. Similar observations were made by Bendra et al., (1990) in Cladophora glomerata at the concentration of 0.1M solution of Cd. Initial increase in the accumulation might be due to the availability of increased number of binding sites for the complexation of heavy meals ions leading to the increased complexation of heavy metal ions, leading to the increased absorption, however, slow accumulation may be attributed to binding ions to the plants and establishment of equilibrium status between adsorbate and adsorbent (Rai and Kumar, 1999; Sibihi, et al., 2012).
Two-way ANOVA showed that both concentration and exposure duration were significant at p < 0.01 level in test plants and further Dunet’s test was applied for the multiple comparison between control and different concentration treatments of test plant. From the statistical analysis it is clear that concentration treatments are significantly differ with control (Table 3)
CONCLUSION
It is concluded from the findings of the present investigation, it is concluded that morphological, biochemical responses and profile of Cu accumulation by Pistia stratiotes are directly proportional to concentration of the media and exposure duration. Regular harvest of the plants at the interval of 4 days help to cleanup aquatic environment.
ACKNOWLEDGEMENT
The authors are thankful to the Principal, BLDEA’s Degree College, Jamkhandi (India), Research and Development centre, Bharthiar University, Coimbatore. Dept. of Botany, Karnatak University Dharwad for providing necessary facilities to carry out research work. Further, 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 greatful to authors / editors, publishers of all those articles, journals and books from where the literature for this article has been received and discussed.
Englishhttp://ijcrr.com/abstract.php?article_id=2261http://ijcrr.com/article_html.php?did=2261Allen, S.E., Grimshaw, H.M., Parkinson, J.A.and Quarmby, C. 1974. Chemical analysis of ecological materials. Blackwell Scientific Publications, Oxford.
Arnon, D.I. 1949. Copper enzymes in isolated chloroplast Polyphenol Oxidase in Beta vulgaris. Plant Physiol, 24: 1-15.
Bendra, M., Mc Hardy, Jennifer, J. and George. 1990. Bioaccumulation and toxicity of zinc in the Green alga, Clodophora glomerata. Environmental Pollution. 66: 55-66.
Blaylock, M.J., Haung, J.W. 2000. Phytoremediation of toxic metals using plants to clean up the environment (Eds : 1 Raskin and B D Ensley) John wiley and sons Inc 53-70.
Brar, M.S., Mahli, S.S., Singh, A.P., Arora, C.L.and Gill, K.S. 2000. Sewer water irrigation effects on some potentially toxic trace elements in soil and potato plants in Northwestern India. Can. J. Soil. Sci. 80: 465-471.
Cervanates, C., Campos-Garcia, J., Devars, S., Gutierrez-Corona, F., Loza-Tavera, H., Torres-Guzman, J.C. and Moreno-Sanchez, R. 2001. Interactions of Cr with microorganisms and plants. FEMS. Microbial. Rev. 25: 335-347.
Chaudhary, S., Yogesh Kumar, S. 2009. Interactive studies of potassium and copper with cadmium on seed germination and early seeding growth in maize (Zea mays L.). J. Environ. Biol. 30: 427-432.
Choudhary, M.P. and Ramachandra. 2005. Toxicity assessments of heavy metals with Nostoc muscorum L. Journal of Environmental Biology. 26(1):129-134.
de Filippis, L.F, Pallaghy, C.K. 1994. Heavy metals: Sources and biological effects. In: Rai, L.C., Gaur, J. P. and Soedar, C. J. (eds) Algae and water pollution. E. Schweizerbart’she Verlagsbuchhandlung. Stuttgart, 31-77.
Dhir, B. and Srivastava, S. 2013. Heavy metal tolerance in metal hyperaccumulator plant, Salvinia natans. Bull Environ Contam Toxicol 90: 720-724.
Dinakar, N., Nagajyothi, P.C., Suresh, S., Dhamodharam, T. and Suresh, C. 2009. Cadmium induced changes on proline, antioxidant enzymes, nitrate and nitrite reductases in Arachis hypogaea L. J. Environ. Biol. 30: 289-294.
Dogan, M., Saygideger, S.D. and Colak, U. 2009. Effect of lead toxicity on aquatic macrophyte Elodea Canadensis Michx. Bull Environ Contam Toxicol 83: 249-254.
Dubois, M., Gilles, K.A., Hamilton, J.K., Rebers, P.A. and Smith, F. 1956. Colorimetric method for determination of sugars and related substances. Annul. Chem. 28: 350-356.
Dushenkov, V., Kumar, P.B.A.N., Motto, H. and Raskin, I. 1995. Rhizofiltration the use of plant to remove heavy metals from aqueous streams. Environ. Sci. Tech. 29:1239-1245.
Garg, P., Chandra, P. and Devi, S. 1994. Cr (VI) induced morphological changes in Limnanthemum cristatum Griseb: A possible biondicator. Phytomorphology. 44(3 and 4): 201-206.
Gupta, M., and Chandra, P. 1996. Response of Cd to Ceratophyllum demersum L. A rootless submerged plant. Waste management. 16:335-337.
Hasan, S.A., Fariduddin, Q., Ali, B., Hayat, S. and Ahmad, A. 2009. Cd: Toxicity and tolerance in plants. J. Environ. Biol. 30(2): 165-174.
Koppitte, P.M., Asher, C.J., Koppitte, R.A. and Menzies, N.W. 2007. Toxic effects of Pb2+ on growth of cowpea (Vigna unguiculata). Environ Pollut 150: 280-287.
Krupa, Z. 1988. Cadmium induced changes in the composition and structure of the light-harvesting complex Ii in radish cotyledons. Physiol. Plant. 73: 518-524.
Lowry, O.H., Rosebrough, N.J., Randall, R.J. and Farr, A. 1951. Protein determination by the folin phenol reagent. J. Biol. Chem. 193: 265-275.
Mohan, B.S. and Hosatti, B.B. 1997. Potential phytotoxicity of Pb and Cd to Lemna minor grown in sewage stabilization ponds. Environmental pollution. 98:233-238.
Patsikka, E., Kairavuo, M., Seren, F., Aro, E.M. and Tyystjavi. 2002. Excess copper predisposes photosystem II to Photoinhibition in vivo by outcompeting iron and causing decrease in leaf chlorophyll. Plant Physiol 129: 1359-1367.
Prasad, M.N.V. 1997. Trace metal In: Plant ecophyscology (Ed. Prasad, M.N.V.) John Wiley and Son. New York. 207-249.
Rai, A.K. and Kumar, S. 1999. Removal of Cr (VI) by low cost dust adsorbants. Applied Microbiol. Biotechno. 39:661-667.
Reeves, R.D. and Baker, A.J.M. 2000. Metal accumulating plants, In: Phytoremediation of toxic metals: Using plant to clean up the environment. (Ed. I. Raskin and B.D. Ensely). John Wiley and sons, Inc, Torento, Canada. 193-229.
Rolli, N.M., Suvarnakhandi, S.S., Mulagund, G.S., Ratageri, R.H. and Taranath, T.C. 2010. Biochemical responses and accumulation of cadmium in Spirodela polyrhiza. J. Environ Biol 31: 529-532.
Romero-Puertas, M.C., Corpas, F.J., Rodriguez-Seranno, M., Gornez, M., and Dei Rio, L.A. 2007. Differential expression regulation of antioxidative enzymes by cadmium in pea plants. J Plant Physiol 164: 1346-1357.
Satyakala, G. and Jamil, K. 1992. Cr-induced biochemical changes in Eichhornea crassipes (Mart) Solms and Pistia stratiotes L. Bull. Environ. Contam. Toxicol. 48: 921-928.
Sibihi, K., Cherifi, O., Agarwal, A., Oudra, B. and Aziz, F. 2012. Accumulation of toxicological effects of cadmium, copper and zinc on the growth and photosynthesis of the fresh water diatom Planothidium lanceolatum (Brebison) Lange-Bertalot; A laboratory study. J Mater Environ Sci 3: 497-506.
Siedlecka, A.and Krupa, Z. 1996. Interaction between cadmium and iron and effects on photosynthetic capacity of primary leaves of Phaseolus vulgaris. Plant. Physiol. Biochem. 34: 833-841.
Singh, A., Kumar, C.S. and Agarwal, A. 2011. Phytotoxicity of Cadmium and Lead in Hydrilla verticillata (L.F) Royle. Journal of Physiology 3: 01-04.
Steffens, J.C. 1997. The heavy metal binding peptides of plants, Ann. Rev. Plant Physiol. Plant mol. Biol. 41: 553-575.
Van Assche, F. and Clijsters, H. 1990. Effects of metals on enzyme activity in plants, Plant. Cell Environ. 13: 195-206.
Wang, W. and Lewis, M.A. 1997. Metal accumulation by aquatic macrophytes In: Plants for environmental studies (Eds: W. Wang, J.W. Gorsuch and J.S. Hugkes). CRC Press, New York. 367-416.
Weckx, J. and Clijsters, H. 1996. Oxidative damage and deference mechanisms in primary leaves of Phaseolus vulgaris. Physiol. Plant. 96: 506-512.
Wei, L., Donat, J.R., Fones, G. and Ahner, B.A. 2003. Interactions between Cd, Cu, and Zn influence particulate phytochelatin concentrations in marine phytoplankton: laboratory results and preliminary field data. Environ. Sci. Technol. 37: 3609-3618.
Yongpisanphop, J., Chue, M.K. and Porethitiyook, P. 2005. Toxicity and accumulation of Lead and Chromium in Hydrocotyle umbellate, Journal of Environmental Biology. 26(1):79-89.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241915EnglishN-0001November30ResearchA Study on Infrastructural Facilities for Differently Abled in Banks
English0813Archana SinghEnglish U.V. KiranEnglishIntroduction: Differently abled is a term applied to all persons with disabilities including those having long term physical, intellectual impairment, mental impairments etc. Person with disability often struggle with the complexity of built environment. There are many areas where person with disability face many difficulties of which, bank is one of the main places. This research paper focuses on infrastructural facilities available for differently abled in banks and problems faced by them in bank. Objective: The present study was taken up to explore the availability of infrastructural facilities for the differently abled and problems faced by them in banks. Material and Methods: This study adopted a check list method, collected information through observation and questionnaire method from the visitors of the bank. A total of ninety respondents were selected from the Lucknow city irrespective of gender. Result: The results of this study showed that many banks and ATMs are not physically accessible. There is a general lack of infrastructure and awareness that permits persons with disability to use banking services. ATMs are not equipped to be used by person with disability. Accessible feature and technologies in banks are very low. There are problems for the persons with disability like- lack of ramp and elevators, uncomfortable height of ATMs, etc. Conclusion: Accessibility for persons with disabilities in banks is very important. Bank should focus on easily available information, bold text explanations etc. which may also include building usable and user friendly voice systems etc.
EnglishAccessibility, Bank, Differently abled, InfrastructureIntroduction-
Disability is a part of human condition. Persons with disability face many problems in their daily life. Disability is a complex, dynamic, multidimensional and contested. It is a condition of impairment physical or mental, having an objective aspect that can be usually described by physician (Uromi 2014).
There are many types of disability like- Physical, visual, hearing, speech, and mental disability (Gobalakrishanan 2013). The differently abled face many obstacles in public places, and banks are one such institutions. Where many of the transactions require personal presence and if proper infrastructural facilities for differently are not provided then, it may lead to many hindrance in then day to day life. There is lack of understanding of their needs. Persons with disability face many obstacles when it comes to living a normal life (Mishra and Kiran, 2016). It becomes very difficult for differently abled to use public facilities due to lack of accessibility. Lack of ramp which makes impossible for a wheelchair user to use a bank. Uncomfortable height of ATMs which make unwieldy for a wheelchair user to access it are some of the known barriers which generally differently abled face. Barrier free environment makes the differently abled independent and enhance the accessibility to the facilities and services as for a normal person. Hence the present study was taken up to explore the availability of infrastructural facilities for the differently abled and problems faced by them in banks.
Rationale of the study
India has one of the largest disabled populations in the World. It was estimated that approximately 2.21 percent of India's total population or 2.69 crore are disabled as per census 2011. There are many types of disability like- Physical, visual, hearing, speech, and mental disability. Persons with disabilities face many problems even in doing daily tasks like- walking, hearing, seeing, bending, travelling and moving independently etc.
Special infrastructure is required at public places for making them independent. Bank is one of them, so that they can move easily; enhance their work capacity and their goals. The main purpose of the study is an attempt to explore the facilities provided by our government to provide barrier free environment for persons with disabilities in banks.
Background
Hasanzada M. Taqi (2012), in his study monitored and observed 1725 public buildings including schools, University, government organizations, hospitals, non government buildings in 24 provinces across Afganistan. The result shows that physical accessibility of public places is very difficult.
Banking Services Survey Report (2013). In this survey “Access to Banking Services” found that many disabled face barriers when they use banking services. Disabled person do not get proper access to branches, ATMs etc. But very few disabled people get barrier free facilities in banks.
Basha Rozafa (2015), in her study “Disability and Public Space” focuses to identify the major problems arising from bad planning, design and management of the city. Lack of physical accessibility of public buildings is a main problem. If the public building have ramp before entrance very often their slope is incorrectly designed.
Masood Hajra and Shahla Shabeeh Shaheen (2014) in their study on “Barrier free environment: An analysis of Aligarh city, India”, found that barriers make the environment unsafe and cause a high level of difficulty to the user. But more importantly, barriers cause space to be out of reach, denying people the opportunity of participation in various spheres of life.
Materials and methods-
The present study focused on infrastructural facilities available for differently abled in banks and problems faced by them in bank.
In this study, different banks in Lucknow city were selected. Ninety differently abled respondents were selected from Lucknow city, irrespective of gender. In this study a self structured check list was used for exploring the bank facilities as well as the problems faced by people visiting the bank. Simple random sampling and exploratory research design were adopted in the present study.
Statistical methods:-
The data was coded, tabulated and analyzed using the PAS software (version 20). The problems faced by differently abled across various categories of disability were analyzed using ANOVA.
Results:-
Problems faced by persons with disabilities in banks
The problems faced by the differently abled in banks are presented in table 1. The result revealed that majority of the wheelchair users in orthopedically handicapped has problem, as the space inside the bank was very limited and there were lot of restrictions to reach the counter. Access space was very limited and which was the major barrier for OH to be independent.
Availability and utilization of emergency alarms in bank was very essential to avoid accident/ injuries. The placement of alarm should be in such a place that the normal, as well as differently abled can utilize that service. From the data, it was evident that the hearing impaired had a problem as their audibility was very high and hence could not immediately react to the bells, unless light were fired.
Most of the banks are not provided with proper fire protection controls and it was very important to take note, as it may lead to fire accidents. Almost eighty percent of all categories of differently abled felt that banks were equipped with anti skid flooring.
Almost all the respondents felt that space at entry gate was sufficient and do not create any barrier for entry. Lighting in the banks reported to be sufficient, even the low vision people reported enough lighting in the banks. More percent of the respondents reported that proper seating is available in the banks and available in convenient places.
It may also be noted that more than 95 percent of VI, 90 percent of OH and 87 percent of HI reported that non availability of the ramp facility at the entrance, creates obstacles and entry into the bank was very problematic specially for the lower limb amputees or wheel chair users.
.It was also reported by the respondents that placement of steps was a common feative among the banks and usually they do not have ramps. Even the banks exiting in the upper floors, were no provided with the ramps but only stair case was available, which creates barriers especially for the differently abled. (Table 1)
General facilities available for persons with disabilities in banks
General facilities available for persons with disabilities in banks are elaborated in table 2. The facilities studied include door width, threshold, entrance landing adjacent to ramp, entrance and exit etc. The dimensions are compared using the standard given by Guidelines and space standards for built environment for disabled and elderly person (Central public works department ministry of urban affairs and employment India 1998) accordingly, the standard width of the entrance door should be 900mm. all the three banks have door width more than the standards and hence movement through for the differently abled is convenient (bank A- 1524mm, bank B-1828mm, bank C-1371mm.).
The Entrance landing adjacent to ramp is required, so that the differently abled can reach the entrance easily, but none of the banks has entrance landing. The standard ramp width, maximum length of ramp, height of double handrail, guiding block away from starting and ending of ramp should be 1800 mm, 9 mm, 800 mm * 900 mm, and 300 mm respectively according to the standard. Without ramp and guiding blocks in the banks differently abled specially wheelchair users and visually impaired people cannot reach the bank easily. Wheelchair users cannot enter in the bank without ramp.
The width of the stairs is also one of the prominent factor and in selected banks, it was found that the bank B had appropriate width of stairs, and bank A and C were bigger than the standard width. Where the standard stair width should be 1350mm. The standard height of riser should be 150 mm and surveyed in surveyed banks, it was found that in bank A (152 mm), in bank B (203 mm) the height of the riser is more than the standard height. Hence differently abled face problem in climb the stairs. The standard width of the tread should be 300 mm. and in bank A, tread width is lesser than the standard, so differently abled cannot put their feet properly. Where as in bank B, it was according to the standard and hence comfortable. Bank C, it is 762 mm, bigger than the standard. The standard extension of handrail should be 300 mm, but was found to be missing in all the surveyed banks and without extension of handrail climbing the stairs is very difficult for differently abled and is quiet accident prone.
The standard height of handrail should be 800 mm and 900 mm, in bank B it is 1219mm, bank C it is found to be 914 mm. The height of handrail is more in bank B and C than standard and it poses problem for the differently abled in climbing the staircase. One of the banks do not have handrail at all and is quiet accident prone.
The standard Counter height in banks should be 700mm. In all the banks, the counter height was not found according to standards (bank-A 1524 mm, bank-B 1066mm, bank-C 2133mm.) The counter height was not convenient for differently abled because of the excessive height of the counter. The standard depth under the counter should be 350 mm. In bank A, it was found that the depth of counter is 254 mm, and it was not according to the standard, and hence differently abled cannot use the counter properly. In bank B, it was 381 mm; it was found to be convenient for differently abled and bank C the counter depth was found to be 177.8 mm. It was less than the standard depth and hence differently abled cannot use it conveniently.
The height of placement of switches from the finished floor should be 900-1200mm., but no banks has followed the standards and the switches are placed at a height, where the wheelchair users cannot use them at all. The opening controls of windows and doors were also not found to be as per standard (1400mm from the finished floor), and hence the wheelchair users cannot comfortably control the openings. (bank- A 2133mm, bank C- 1828mm.). (Table 2)
Discussion-
This research paper highlights many problems faced by differently abled when they use banking. Physical accessibility is found to be the major problem in banks, if the bank building is not provided with enough ramp and clear entrance. Visually impaired often face lot of problems while using ATMs, because the keys are not in Braille. ATMs are not at proper height and hence standing up wheelchair users cannot see the ATM screen. These barriers create difficulties for differently abled. Accessible features and technologies in banks are very low. Wheelchair users cannot access the bank easily. They cannot open the door and access the counter, because counters very high. So the banks should improve their physical accessibility for differently abled. Though the banks are mandated to ensure there is accessibility in banks, but there is still a lot that needs to be done. There are several measures that can be taken up by banks, which will not be costly and which will be especially rewarding for differently abled. For the mobility they have to profoundly rely on the other people. Offices be made more accessible and prepared with assistive aids such as wheelchairs, handrails and facilities such as ramps, stairs with double handrail, sufficient space at entry gate, separate counter for differently abled etc. Special measures should be adopted for providing specific provisions for wheelchair users, such as a selected queue and teller, so that they do not have to wait in queue for a long period of time.
Conclusion-
This study has clearly demonstrated that there are many problems for persons with disabilities in banks. Persons with disabilities cannot use banking services properly. The respondents reported many problems in banks like- no sufficient space for wheelchair users, no separate counter for persons with disability. No availability of ramp and emergency alarms etc. On the other hand, result indicates that lack of infrastructural facilities of bank as per the standard is found to be the major problem for persons with disabilities. Physical access in banks faces major problem for the users and hence the availability of ramp, wider lift, guiding blocks, ATMs at proper height, handrails etc. in banks should be concentrated to enhance the accessibility of differently abled users.
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.
Source of Funding-
I have been receiving University fellowship for this program.
Abbreviations-
OH
Orthopedically handicapped
VI
Visually impaired
HI
Hearing impaired
ATM
Automated Teller Machine
PAS
Power Analysis Software
Figure 1: Prospective view of the bank where there is no ramp facility.
Englishhttp://ijcrr.com/abstract.php?article_id=2262http://ijcrr.com/article_html.php?did=2262Access to Banking Services Survey Report( 2013) .available at http://www.dpa.org.sg/wp-content/uploads/2013/04/Survey-Report.pdf. /Accessed on February 2017.
Banking and Accessibility in India: A Study on Banking Accessibility in India (2013). Available at http://cis-india.org/accessibility/blog/banking-accessibility.pdf Accessed on February 2017.
Basha Rozafa (2015), “Disability and Public Space –Case Studies of Prishtina and Prizren”, International Journal of Contemporary Architecture, 2015, vol.2 no. 3,54-66.
Gobalakrishanan, C. (2013). “Problem faced by physically challenged persons and their awareness towards welfare measures”, International journal of innovative research and development, 2013, vol.2 no4,487-493.
Guidelines and space standards for built environment for disabled and elderly person ( Central public works department ministry of urban affairs and employment India 1998) http://cpwd.gov.in Accessed on February 2017.
Hasanzada, M. Taqi (2012), “Physical accessibility of persons with disabilities to public places”. In Afghanistan independent human rights commission. http://www.aihrc.org.af/ Accessed on March 2017.
Mishra Garima and Kiran, U.V. (2016), “Barrier in using ICT devices among visually impaired students” International journal of research in social sciences, 2016,vol. 6, issue 9, 569-587.
Masood Hajra and Shahla Shabeeh Shaheen. (2014). “Barrier free environment: An analysis of Aligarh City, India.in International journal of interdisciplinary and studies, 2014, Vol.1, no 9, 8-15.
Uromi M.Sabbath and Mazagwa Iboku (2014). “Challenges facing people with disabilities and possible solutions in Tanzania”, Journal of education policy and entrepreneurial research (2014), Vol 1, no.2, 158-165.