Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30General SciencesInformation and Communication Technology Enabled and Assistive Devices Used by Differently Abled::
A Detailed Analysis
English0107Garima MishraEnglish U.V. KiranEnglishAim: This study aims to assess the utilization of ICT enabled and assistive devices for differently abled and to assess the purpose of using various ICT and assistive devices by differently abled. Respondents were selected from three categories of the disability (visual impairment, hearing impairment and locomotor impairment) pursuing higher education courses.
Methodology: Multistage random sampling technique has been used for the selection of respondents. Fifty respondents were from visual impairment, forty respondents from hearing impairment and ninety were from the category of locomotor impairment to make a total of 180 respondents. Information was collected with the help of interview method using self made and standardized tool. With the help of developed tool, information was collected regarding uses of ICT and assistive devices and for what purpose they are using these devices. Data was coded, tabulated and analyzed using PAS software. ‘T’ test has been calculated to see the significant differences in the usage of ICT and assistive devices between male and female respondents. Descriptive statistics was calculated to know the number of respondents using particular devices.
Results and Discussion: Findings of this study revealed that highly significant differences in the usage of mobile phones, radio and DAISY books between male and female respondents and significant differences were found in usage of JAWS software, tape recorder and kurzweil reading machine among visually impaired. Results also highlighted that male respondents prefer to use mobile phones than female respondents among locomotor impaired.
Conclusion: In the line of above, the use of Information and Communication Technologies (ICT) allow the removal of many of the remaining obstacle faced by differently abled persons.
EnglishCommunication, Differently abled, disability, ImpairmentINTRODUCTION
The freedom of expression and access to information is a basic human right. The right to information and knowledge is a fundamental right of every person including the differently abled persons. Limited access to information and communication technologies impacts all the people but differently abled persons are affected more adversely.
Over the past few decades, Information and Communication Technology (ICT) has fundamentally changed almost every aspect of our lives. The impact of information and communication technologies has transformed the entire universe into a new dimensional structure and the age-old barriers of distance and time have almost vanished. Now a days ICTs are playing an important role in facilitating the socio-economic, political inclusion, daily lives and mainstreaming of Differently Abled persons as ICTs can enable them to access various services like education, telecommunication facilities, public services, health services, government, information, employment opportunities, communication etc and most importantly, to achieve self reliance inspite of their particular disability.
The term Differently abled was first proposed in the 1980s as an alternative to disabled, handicapped, etc. on the grounds that it gave a more positive message and so avoided discrimination towards people with disabilities (Butterfield, 2013).
With the ingress of information and communications technology (ICT), new prospects are developing for differently abled persons. Despite of enormous challenges, serious efforts are being initiated to implement the use of ICT to overcome barriers faced by differently abled persons. The information society exhibit at once significant opportunities but on the other hand plausible new obstacles are major threat for the social inclusion of differently abled persons.
ICT and Assistive devices used by visually impaired includes mobile phones, screen reader, JAWS software, Braille, computer, laptop, tactile material, radio, tape recorder, abacus, white cane, smart cane, talking books, kurzweil reading books, text to speech software, dictation devices and description etc. The main purpose of providing accessibility mobile phones, computers and laptop to visually impaired persons is to provide the best possible sight enhancement or sight substitution mechanism. At present, mobile phones are important source of communication for everyone but for visually impaired mobile phones with screen reader, JAWS software facility or any speech software provides translated access to text and graphics, which is helpful in creating barrier free environment. Likewise computers and laptop are used for academics and for recreation by visually impaired students. Braille technology is one of the most used ICT devices by visually impaired. Tactile output which purely is text based, produced by Braille display using a special keyboard.
ICT refers to equipment and services related to broadcasting, computing, and telecommunications, all of which process, store and transmit information through computer and communications systems (UNESCO, 2014).
Assistive device is a device that is designed, made, used, or adapted to assist persons with disabilities in performing various tasks such as daily activities, communicating, academic work moving, lifting and enhance overall wellbeing. Well designed assistive devices for differently abled promotes greater independence, improves quality of life by enabling them to perform task more easily by creating barrier free environment.
Information and communication technology enables persons with locomotor disability to compensate for the impairments they experience. The information and communication technology promotes greater independence by reducing physical, social and economic barrier. ICT and Assistive devices used by locomotor impaired include tricycle, crutch, prosthetic device, orthotic device, mobile phones, computers, laptop, radio, television, tape recorder etc. Wheelchair and tricycle is the most preferred assistive device by persons with locomotor disability as the only source of transportation. Tricycles are the preferred mobility aid because it offers long-distance travel capability at a lower price compared to wheelchairs. Thus providing accessibility of wheelchairs which are appropriate for the purpose not only enhances mobility but also begins a process of opening up a new scenario of education, employment and social life.
OBJECTIVES
To assess the utilization of ICT enabled devices for differently abled.
To assess the purpose of using various ICT enabled devices by differently abled.
MATERIALS AND METHODS
Present study is focused on assessment of utilization of ICT enabled devices and purpose of using these devices by differently abled. Differently abled students were selected from the three categories of the disability (Visual Impairment, Hearing Impairment, and Locomotor Impairment) whereas other categories were excluded from the research. Differently abled students were selected from higher educational institutes only whereas students having less educational qualification were excluded from the sample as the students of higher educational institutes are available in clusters and are suitable for the research.
Investigation was carried out purposively from Lucknow district as it is capital city of Uttar Pradesh and one institution offering higher education for special students, is located in Lucknow (Dr. Shakuntala Misra National Rehabilitation University, Lucknow) and hence it was purposively selected for data collection. This institute caters to provide accessible and quality higher education to all challenged students. Exploratory research approach has been adopted to collect information. Data was collected purposively using self structured and standardized questionnaire. The finalized questionnaire consisted of 5 sections as A, B, C, D and E. Section 'A' consists of items to assess usage of various ICT and assistive devices. Respondents have to answer in Yes and No. Section 'B' consists of items to evaluate purpose of using various ICT and assistive devices. Respondents were asked to choose one option as questions in this section were multiple choice questions. Section 'C' consisted of items to assess problems faced by differently abled in the usage of ICT and assistive devices. Section 'D' and 'E' dealt with the open ended questions as to what features they feel to be incorporated in any of the ICT and assistive devices and what other devices they feel to have to improve their quality of life. A total of 180 respondents were surveyed to collect information. Fifty respondents were from the category of visual impairment, forty were from the category of hearing impairment and ninety were from locomotor impairment.
The data was coded, tabulated and analyzed using the PAS software (version 20). Statistical analysis was done using 't' test and frequency percentage method. 'T' test was used for compare the mean value of male and female respondents and to see the significant difference in usage of ICT and assistive devices between male and female respondents. Frequency and percentage method was used to calculate percentage of male and female respondents regarding purpose of using ICT and assistive devices.
RESULTS AND DISCUSSION
Table No: 1. Uses of ICT and Assistive Devices by persons with visual impairment across the gender
S. No.
Mean
Male
Female
't' value
'P' value
Mean
SD
Mean
SD
1.
Use of mobile phones
1.00
0.00
1.21
0.55
1.69**
0.00
2.
Use of JAWS software
1.57
0.67
1.97
0.56
2.23*
0.02
3.
Use of computers/ Laptops
1.67
0.79
1.90
0.82
0.99
0.87
4.
Use of radio
1.19
0.60
1.76
0.95
2.40**
0.00
5.
Use of tape recorders
1.29
0.64
1.79
0.86
2.27*
0.01
6.
Use of talking computer terminal
1.57
0.51
2.21
0.62
3.85
0.97
7.
Use of screen readers
1.57
0.67
1.52
0.83
0.24
0.26
8.
Use of text to speech software
2.00
0.77
2.14
0.74
0.63
0.86
9.
Use of book scanner and software
1.86
0.35
2.03
0.42
1.56
0.63
10.
Use of talking books/ DAISY books
1.10
0.43
1.97
0.91
4.06**
0.00
11.
Use of dictation devices and description
1.52
0.81
1.72
0.84
0.84
0.63
12.
Use of standalone reading machine
2.05
0.74
2.45
0.51
2.27
0.58
13.
Use of kurzweil reading machine
1.90
0.54
2.34
0.67
2.48*
0.01
14.
Use of optacon
2.00
0.32
2.00
0.00
0.00**
0.09
15.
Use of Braille translation software
2.24
0.62
2.41
0.50
1.10
0.73
16.
Use of computer driven Braille printer
2.14
0.65
2.17
0.60
0.16
0.77
17.
Use of tactile devices
1.29
0.64
1.21
0.56
0.46
0.39
18.
Use of smart cane
1.57
0.50
1.83
0.60
1.58
0.69
19.
Use of ABACUS
1.14
0.47
1.31
0.66
0.98
0.05
20.
Use of Braille Slate
1.43
0.74
1.79
0.94
1.47*
0.01
21.
Use of tracing wheel
1.67
0.65
1.97
0.86
1.32
0.15
22.
Use of Braille Kit
1.38
0.80
1.90
0.97
1.98**
0.00
23.
Use of German Slate
1.19
0.51
1.52
0.57
2.07*
0.01
24.
Use of paperless Braille machine
2.10
0.54
2.10
0.55
0.05*
0.82
25.
Use of Braille watch
1.62
0.74
2.45
0.68
4.08
0.65
26
Use of white cane
1.14
0.35
1.34
0.48
1.61**
0.00
.
Total use
43.19
4.93
51.00
8.07
3.92
0.17
Table 1 is concerned with the use of ICT related and assistive technologies used by persons with visual impairment. 'T' statistics has been calculated to test the significant difference between male and female respondents. From the above table, mean and SD values of male and female respondents were compared. Significant differences can also be interpreted from above data. The above table consists of many ICT devices and services such as mobile phones, JAWS software, computer/laptop, radio, television, screen reader, tape recorder, DAISY books, text to speech software, book scanner software, talking computer terminal, kurzweil reading machine, dictation devices and description, standalone reading machine and computer driven Braille printer. Results obtained from table shows highly significant differences between male and female respondents in the usage of mobile phones, radio and DAISY books. From the mean and SD values, it may also be interpreted that female respondents are more interested in using ICT devices than male respondents. Female respondents scored mean value as 1.21, 1.76 and 1.97 which more than male respondents mean and SD value 1.00, 1.19 and 1.10. Results obtained from the above table also show significant differences between male and female respondents as far as usage of JAWS software, tape recorder and kurzweil reading machine are concerned.
On the other hand, some assistive devices like ABACUS, Braille slate, Braille Kit, Jerman Slate and white cane, being used by persons with visual impairment, were also studied. Results indicate significant difference between male and female respondents because these items scored p value between 0.01 to 0.05.Thus from the table it can be interpreted that female respondents are more active in using ICT devices.
Table No: 2. Uses of ICT and Assistive Devices by persons with hearing impairment across the gender
S. No
Items
Male
Female
't' value
'P' value
Mean
SD
Mean
SD
1.
Use computers/ Laptops
1.14
0.52
1
0
0.93
0.35
2.
Use closed captioning, TVs
1.21
0.56
1.17
0.38
0.26
0.79
3.
Use interactive video discs
1.36
0.79
1.50
0.60
0.61
0.54
4.
Use voice carry over (VCO) telephones.
2.14
0.52
2.25
0.45
0.61
0.54
5.
Use loop induction system
1.93
0.60
2.17
0.60
1.15
0.25
6.
Use Hearing Aids
1.29
0.46
1.33
0.49
0.29
0.77
7.
Use speech trainer
1.64
0.73
1.50
0.52
0.61
0.54
8.
Englishhttp://ijcrr.com/abstract.php?article_id=2329http://ijcrr.com/article_html.php?did=2329
Butterfield, J. (2013). Oxford A-Z of English Usage. Second Edition. Oxford University Press. United Kingdom.
http://www.oxforddictionaries.com/definition/english/differently-abled accessed on July 2016.
The American Heritage Dictionary of the English Language, 2013. Fifth edition. Published by Houghton Mifflin Harcourt Publishing Company. Available at http://www.yourdictionary.com/differently-abled accessed on July 2016.
UNESCO, 2014. Model Policy for Inclusive ICTs in Education for Persons with Disabilities. United Nations Educational, Scientific and Cultural Organization. G3ICT. European Agency for Special Needs and Inclusive Education.
Disability. (2016, July 22). In Wikipedia, The Free Encyclopedia. Retrieved 09:02, July 29, 2016, from https://en.wikipedia.org/w/index.php?title=Disabilityandoldid=731035640
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30General SciencesDetermination of Extraction Buffer and Ammonium Sulfate Percentage for Pollen Crude Protein Extracts of Mangifera, Durio and Syzygium Fruit Flowers
English0811Nur Farahiah ZakariaEnglish Seri Intan MokhtarEnglish Mohammed AurifullahEnglish Shamsul MuhammadEnglishFlowering trees are considered the producers of allergenic agent carried by pollen protein. The isolation of protein of interest from intracellular compartment into a solution of well-defined composition especially from never isolated species involves the manipulation of several parameters. The aim of this work is to find the best isolation method for pollen protein of the widely distributed flowering fruit species in Malaysia includes Mangifera indica, Mangifera odorata, Durio graviolens, Durio zibethinus, Syzygium aqueum (red flower), Syzygium aqueum (white flower), to give the maximum yield extract of crude protein. The most efficient buffer to be used specifically for each species were as followed; Mangifera indica (Tris HCl 0.5M pH 6.8 with 1.3 mg/ml); Mangifera odorata (Tris HCl 0.5M pH 6.8 with 1.8 mg/ml); Durio graviolens (PBS 0.02M pH 7.4 with 1.6 mg/ml); Durio zibethinus (PBS 0.02M pH 7.4 with 2.2 mg/ml); Syzygium aqueum -red flower (Tris HCl 0.5M pH 6.8 with 1.0 mg/ml); Syzygium aqueum-white flower (PBS 0.02M pH 6.8 with 1.7 mg/ml). Pectinase activity reveals the best ammonium sulfate percentage for Mangifera indica, Mangifera odorata, Durio graviolens, Durio zibethinus, Syzygium aqueum -red flower, Syzygium aqueum-white flower is either 80% or 85%. Different types of buffer definitely have different ability on the protein solubilization, while the 80% of salt precipitation was the most ideal percentage for salting out the protein in every sampled species.
EnglishFlower, Pollen, Protein, Buffer, Precipitation
INTRODUCTION
Plant pollen is one of the most common causes of seasonal allergic disease worldwide. Between 10%- 40% of the present world population is allergic to pollen [1]. Pollen allergy is caused by proteins, glycoprotein or even a single peptide which are present in the pollen wall and cytoplasm [2]. According to Allergy Centre Malaysia in 2014, pollen is the third contribution to allergic rhinitis. Although, studies on the allergenic properties of pollen from various species have been carried out by several workers [3,4,5,6], information on allergy to pollen in Malaysia is completely lacking, even though there are numerous tropical fruits trees flowering in all season of the year. Nevertheless, there was no such type of research work carried out in Malaysia for investigating the reason of pollen allergy except by [7] where he perform a survey of skin prick tests (SPT) using pollen extracts on 200 patients with clinical symptoms of asthma. The plantation with thousands acres of fruit orchards could release unlimited pollen just waiting to be inhale by people which could create asthma, bronchitis, rhinitis and lung cancer also in the severe stage [8]. In view of the extensive distribution of local plant trees in Malaysia and the prevalence of its pollen in the atmosphere, three genera and six species of fruit flowers have been chosen for this study. They are Mangifera indica, Mangifera odorata, Durio graveolens, Durio zibethinus, Syzygium aqueum -red flower, Syzygium aqueum-white flower. These local fruits are among the most planted in fruit orchards in Malaysia.
Since the target protein was undefined until it has been characterize, protein extract from the species must be at its optimal yield as possible. Protein extraction procedures have been reported in the literature as the first step in proteomics studies and the most important initial steps for further purification and characterization of allergenic protein [9, 10, 11]. The type, concentration and pH of buffer used may differ regarding the species.
The development of a reliable extraction method will ensure highest extraction efficiency before further purification and allergenic test could be conducted. In this study, an efficient method of cell disruption has been developed involving the manipulation of extraction buffer which release the protein in soluble form from intracellular compartment into a solution of a well-defined composition. In addition, a series of percentage of ammonium sulphate precipitation has been tested to ensure that solubility of the pollen crude protein.
Methodology
Collection and screening of flower pollen
Fruit flowers were collected from various fruit orchards in Kelantan and sun dried. To obtain pollen grains powder, the dried flowers were sieved through different grades of sieves (100, 200, and 300 mesh/cm2) and analyzed under the microscope to ensure purity varying from 85% to 90%. Pollen grain powder was further dried in an oven at and stored at 40C in airtight containers for further use.
Pollen Protein Buffer Extraction
Proteins from dried pollen grain powder were extracted in two types of buffer with different concentration and pH (Tris HCl 0.2M pH 6.8, Tris HCl l 0.2M pH 7.4, Tris HCl 0.5M pH 6.8, Tris HCl 0.5M pH 7.4, Phosphate buffer saline (PBS) 0.02 pH 6.8, Phosphate buffer saline (PBS) 0.02M pH 7.4, Phosphate buffer saline (PBS) 0.05M pH 6.8 and Phosphate buffer saline (PBS) 0.05M pH 7) by continuous stirring at 40C for 24 hrs. Then, the pollen was macerated by mortar and pastel to form a pollen paste. The pollen paste extract was clarified by centrifugation at 15,000 x g for 20 min at 40C. The supernatant was separated and tested for protein concentration with Bradford method [12]. The highest crude protein concentration supernatant from a particular buffer extraction was selected for ammonium sulphate precipitation.
Ammonium sulphate precipitation
The selected supernatant with high crude protein concentration was gently stirring in 50% and 90% concentration at interval of 5% and 10% for fractional precipitation with ammonium suphate to screen for the best percentage that could dissolved the salts completely. The dissolved solution was kept overnight in a chiller and was centrifuged at 10,000g for 15 minutes [13]. The precipitate was re-suspended in specific buffer and desalted by dialyzing against distilled water for 48 hrs at 40C by frequent changes of the distilled water using dialysis sacs (MW cut off 9 kDa) [5]. The protein crude extracts were subjected to pectinase enzyme assay to determine its activity.
Pectinase enzyme assay of protein crude extracts
Pectinase assays were carried out by using modified DNS method [14]. 1 ml of the reaction mixture containing equal amount of substrate (0.5%) prepared in suitable diluted enzyme was incubated at 50oC for 30 min in a water bath. After incubation, 3.0 ml DNS solution was added to stop the reaction and the tube was kept in boiling water for another 10 min. Once cooled, the developed colour was read at 575 nm using UV-visible spectrophotometer. The amount of released sugar was quantified using D-galacturonic acid as standard. The enzyme activity was calculated as the amount of the enzyme required to release one micromole equivalent of D-galacturonic acid per min under assay condition. Finally, the supernatant that was proven to have enzyme activity was passed through a Millipore filter membrane lyophilized in small aliquots, and stored at -200C until further purification steps before it allergenic properties could be ascertained. The crude pectinase without addition of ammonium sulphate (0%) was used as control.
RESULTS
Figure 1 shows the crude protein supernatant concentration of the three genera of common fruit flowers. Generally, genus Mangifera showed high protein concentration yield by both PBS and Tris HCl buffers. Protein concentration for Durio genus could only be detected for PBS buffer. The two varieties from Syzygium aqueum show contrasting result; the red flower gave better yield in Tris-HCl buffer and low yield in PBS buffer, and the result was vice versa for white flower. Extracts for Mangifera indica and Mangifera odorata contained 1.3 mg/ml and 1.8 mg/ml protein concentration respectively. While for Durio, PBS 0.02M pH 7.4 gave 1.6 mg/ml protein concentration for Durio graveolens and 2.2 mg/ml in Durio Zibethinus, which was the highest compared to the other extraction buffer. The highest protein concentration obtained for Syzygium aqueum (red flower) was 1.0 mg/ml in Tris HCl 0.5M pH 6.8 while Syzygium aqueum (white flower) was 1.7 mg/ml showed by PBS 0.02, pH 6.8.
bars indicate the standard deviation values. This experiment was carried out in triplicates and there are significant different between means (Duncan, pEnglishhttp://ijcrr.com/abstract.php?article_id=2330http://ijcrr.com/article_html.php?did=2330[1] D'Amato, G., Cecchi, L. and Bonini, S. 2007. Allergenic pollen and pollen allergy in Europe. Allergy. 62:976-90.
[2] Chanda, S. 1996. Pollen Grains as Aeroallergens: Morphological, Biological and Chemical Approach. In: Agashe SN (Ed): Recent Trends in Aerobiology, Allergy and Immunology, Oxford and IBH publ Co. Pvt. Itd, New Delhi. 85-92.
[3] Singer, B.D., Ziska, L.H., Frenz, D.A., Gebhard, D.E., Straka, J.G. 2005. Increasing Amb a1 content in common ragweed (Ambrosia artemisiifolia) pollen as a function of rising atmospheric CO2 concentration. Functional Plant Biology. 32(7):667-670.
[4] Talukdar, G., Hossain, I., Nitai, R.C., Roy, N.K., Sana, S.R., Kabir, K.K., Biswas, N.R. and Shaha, RK. 2012. Allergen Protein from Mango (Mangifera indica) Flowers Pollen. Asia pacific. J. Mol. Biol. and Biotech. AsPac J. Mol.Biol. Biotechnol. Vol. 20 (1) : 11-18.
[5] Shaha, R.K., Nitai, R. and Talukdar, G. 2012. Reduction of allergenicity of litchi chinensis flowers pollen protein. Journal of Advanced Laboratory Research in Biology. 3 (2):110-119. ISSN 0976-7614.
[6] Saito, A., Shaha, R.K., Aoki, R and Kato, A. 2008. Strategy for development of oral tolerogen to cedar pollen allergy. China Allergy Journal. 4: 45-48.
[7] Sam, C.K., Kesavan-Padmaja, Liam, C.K., Soon, S.C., Lim, A.L. and Ong, E.K. 1998. A study of pollen prevalence in relation to pollen allergy in Malaysian asthmatics. Asian Pac J Allergy Immunol. Mar:16 (1):1-4.
[8] Nielsen, G.D., Hansen, J.S., Lund, R.M., Bergqvist, M., Larsen, S.T. and Clausen, S.K. 2002. IgE-mediated asthma
and rhinitis I: a role of allergen exposure? Pharmacology and Toxicology. 90(5):231-242.
[9] Tanaka, H., Degawa, M., Kawata, E., Hayashi, J and Shoyamaa, Y. 1998. Identification of Cannabis pollens using an allergic patient's immunoglobulin E and purification and characterization of allergens in Cannabis pollens. Forensic Science International. 97 139-153.
[10] Ribeiro, N., Cruz, A., Ferreira, A., Machado, H., Reis, A., and Abreu, I. 2009. Pollen allergenic potential nature of some trees species: A multidisciplinary approach using aerobiological, immunochemical and hospital admissions data. Environmental Research. 109: 328-333.
[11] Cadot, P., Díaz, J.F., Proost, P., Van Damme, J., Engelborghs, Y., Stevens, E.A.M. and Ceuppens, J.L. 2000. Purification and characterization of an 18-kd allergen of birch (Betula verrucosa) pollen: identification as a cyclophilin. J. Allergy Clin Immunol, Feb:105(2 Pt 1):286-91.
[12] Bradford, M.M. 1976. A rapid and sensitive method of the quantification of microgram quantities of protein utilizing the principle of protein-dye binding. Anal. Biochem. 72:248-254.
[13] Buga, M.L., S. Ibrahim and A.J. Nok, 2010. Partially purified polygalacturonase from Aspergillus niger (SA6). Afr. J. Biotechnol. 9: 8944-8954.
[14] Miller, G. L. 1959. Use of dinitrosalicylic acid reagent for determination of reducing sugar. Analytical Chemmistry. 31: 426-428.
[15] Singh, A.B. and Singh, A. 1994. Pollen allergy- a global scenario. In Agashe S.N., editor. Recent trends in aerobiology and immunology. Oxford: IBH, 143-173.
[16] Vrtala, S., Grote, M., Duche^ne, M., vanRee, R., Kraft, D., Scheiner, O. 1993. Properties of tree and grass pollen allergens; reinvestigation of the linkage between solubility and allergenicity. Int Arch Allergy Immunol 102:160-9.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcareAmoebic Peritonitis Associated with Cirrhosis of Liver: A Case Report
English1213Kavita Ashish BhilkarEnglish Chhaya ChandeEnglish Amandeep SinghEnglish Abhiroop VermaEnglish Abhay ChowdharyEnglishIntroduction: Amoebic peritonitis is due to the rupture of amoebic liver abscess or perforation of amoebic colitis. Amoebic peritonitis is associated with very high mortality. Methodology: A case of amoebic peritonitis is reported in a young adult female with live cirrhosis. The diagnosis of amoebic peritonitis was established by the demonstration of trophozoites in the ascitic fluid and significant titres in indirect haemagglutination test.
Result: Cytopathological examination of peritoneal fluid showed presence of large number of trophozoites of E. histolytica. Anti E. histolytica serum antibodies by indirect haemagglutination(IHA) were present in titres 1:320.
Conclusion: A high index of suspicion in any case of colitis along with serological testing is indicated for the early diagnosis and timely management.
EnglishAmoebic perironitis, Perforative peritonitis, E. Histolytica.Introduction
Amoebiasis is a parasitic infection caused by protozoan Enatamoeba histolytica. Infection by E histolytica is endemic in Indian subcontinent with as high as 67% prevalence rate.[1] Invasive amoebiasis is associated with significant morbidity and mortality in areas endemic for E. histoltytica. [2] Colonic perforation, liver abscess, pleural and pericardial effusion, enteric fistulae and amoeboma formation are some of the complications of invasive amoebiasis. [3] Amoebic peritonitis is most often due to the rupture of amoebic liver abscess. Nearly 22% cases of Amoebic liver abscess can rupture to give peritonitis.[4,5] The colonic perforation cases are extremely rare.[6] Here we report a fatal case of amoebic peritonitis affecting young adult female patient.
Case Report
A 38 year old female was admitted with history of distension of abdomen since two months and pedal oedema since 10 days. She had diarrhoea and abdominal pain since three months. There was no history of fever, haetemesis, malena or convulsions. No history suggestive of tuberculosis, Diabetes mellitus, hypertension and receiving blood transfusion in past. On physical examination she had icterus and abdominal distension with tenderness. There was no lymphadenopathy. On examination, RS, CVS and CNS were normal. Laboratory investigations showed that the total leucocytes count was 13300 with polymorphs 70%, Lymphocytes 25%, Eosinophils and monocytes 3% and 2% respectively. Liver function tests showed significant rise in total bilirubin and raised SGOT (78IU/mL) and SGPT (148 IU/mL). Serum creatinine was 3mg/dl and blood urea was 68mg%. HIV, HBsAg, HCV and HAV serology was negative. The alpha fetoproteins were raised (87.75IU/mL) where as beta chorionic gonadotrophins were within normal range. USG abdomen revealed splenomegaly, nodular liver with irregular surface and liver parenchymal disease consistent with cirrhosis of liver and gross ascites. CT scan of abdomen was suggestive of cirrhosis of liver with changes of portal hypertension. The aspirated ascitic fluid was dark yellow with alkaline pH and sugar 102%. Cytopathological examination of peritoneal fluid showed presence of RBCs, WBCs and large number of trophozoites of E. histolytica. Anti E. histolytica serum antibodies by indirect haemagglutination(IHA) were present in titres 1:320.
The patient was treated with parenteral Metronidazole and a third generation cephalosporin, Ceftriaxone. However, the patient did not show any response to the treatment, developed acute renal failure and died on the 6th day of admission. An autopsy was performed which confirmed the diagnosis of cirrhosis liver; however colonic invasion was not substantiated on autopsy.
Discussion
Amoebic peritonitis could be either due to rupture of amoebic liver abscess into peritoneum or due to perforation of invasive amoebic colitis.[5] Ruptured Amoebic liver abscess is the most common cause of amoebic peritonitis accounting for 22 to 32% cases.[4,5]
Perforation with peritonitis is uncommon and reported in 3 to 5 % autopsies on patients dying of amoebisis.[6] Incidence of perforation in amoebic colitis is around 2% with a high mortality rate regardless of the treatment.[7] Amoebiasis is the most common cause of colonic perforation besides TB and malignancy.[8]
The present case was diagnosed as Amoebic peritonitis on the basis of presence of trophozoite forms of E. histolytica in ascitic fluid and positive IHA test. However, there was no clinical evidence of amoebic liver abscess or bowel perforation in though the patient had symptoms suggestive of amoebic colitis. Fever, chronic diarrhoea and abdominal pain are the main presenting symptoms in invasive amoebiasis. As Ultrasonography revealed presence of findings consistent with cirrhosis, the ascites was attributed to the cirrhotic changes in liver parenchyma and altered liver function. In the absence of any indication of liver abscess and presence of trophozoites in the ascetic fluid along with positive IHA test, the diagnosis of amoebic peritonitis secondary to bowel leak was entertained. The amoebic peritonitis may be caused by either frank perforation or through a slow leak through diseased bowel.[9,2,3] There are three forms of perforation, an extraperitoneal sealed perforation, a perforation of amoebic ulcer or amoeboma and a perforation in the presence of acute dysentery. Extra-intestinal disease via haematogenous spread to the liver, lung, brain and rarely other organs is reported in invasive amoebisis.
High mortality is reported in amoebic peritonitis secondary to bowel perforation as compared to rupture of amoebic liver abscess.
In the present case, the diagnosis of amoebic peritonitis was established by the demonstration of trophozoites in the ascitic fluid and significant titres in indirect haemagglutination test. Serologic testing for amoebisis is highly specific, the IHA is considered as the most specific test.[10]
Conclusion
Considering the high endemicity of the disease and high fatality rate of amoebic colitis[2], a high index of suspicion in any case of colitis along with serological testing is indicated for the early diagnosis and timely management.
Englishhttp://ijcrr.com/abstract.php?article_id=2331http://ijcrr.com/article_html.php?did=2331
Mahajan RC, Sehgal R,Ganguly NK. Recent developments in amoebiasis research. Ind Rev Life Sci. 1991;11:139-167.
Jain BK, Garg PK, Kumar A, Mishra K, Mohanty D, Agrawal V. Colonic perforation with peritonitis in amoebiasis: A tropical disease with high mortality. Trop Gastroenterol. 2013;34(2):83-86.
Adams EB and Macleod IN. Invasive amoebiasis I. Amoebic dysentery and its complications. Medicine (Baltimore) 1977; 56:315-323.
Mukhopadhyay M, Saha AK, Sarkar A, Mukherjee S. Amoebic liver abcess: presentation and complications. Indian J Surg 2010;72: 37-41.
Monga NK, Sood S, Kaushik SP, Sachdeva HS, Sood KC, Datta DV. Amoebic peritonitis. Am J Gastroenterol. 1976;66(4):366-373.
Archampong EQ and Clark CG. Surgical problems in Amoebiasis. Ann. Roy. Coll. Surg. Engl. 1973;52:36-48.
Eggleston FC, Verghese M, Handa AK. Intraperitoneal rupture of amoebic liver abcess. Br J Surg. 1989;76:202-203.
Singla K, Mahajan G, Agarwal S, Sharma S. Role of histopathological examination in nontraumatic perforation of colon. Trop Gastroenterol. 2012;33(4):265-269.
Essenhigh DM and Carter RL. Massive necrosis of the colon due to amoebiasis. Gut 1966;7: 444-447.
Hung CC, Chen PJ, Hsiegh SM, Wong JM, Fang CT, Chang SC et al. Invasive amoebiasis: an emerging parasitic disease in patients infected with HIV in an area endemic for amoebic infection. AIDS 1999; 13 (17):2421-2428.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcarePrevalence of Inducible Clindamycin Resistance of Staphylococcus aureus in Hospitalized Patients in Tertiary Care Hospital
English1417Smita S. DamkeEnglish Shahin VishaniEnglish Ramesh P. FuleEnglishBackground: Methicillin resistant Staphylococcus aureus (MRSA) has emerged as one of the most common pathogen isolated from patients with very few drugs available for their treatment. Clindamycin is a good alternative optional drug for the treatment of these infections. In vitro routine testing may fail to detect such resistance. Thus it is important to detect such resistance by simple D test.
Material and Methods: 300 staphylococcal isolates where isolated from clinical samples by conventional microbiological methods. Of these 208(69.33%) were identified as Staphylococcus aureus. Methicillin resistance and inducible clindamycin resistance was detected by cefoxitin disk diffusion method and D test as per CLSI guidelines respectively.
Results: 135 (64.9%) were MRSA and 73 (35.09%) were Methicillin sensitive Staphylococcus aureus (MSSA), 45(21.63%) isolates showed inducible clindamycin resistance, 19(9.1%) showed constitutive clindamycin resistance, 112(53.84%) showed MS phenotype whereas 32(15.38%) were erythromycin sensitive. Inducible clindamycin resistance and constitutive clindamycin resistance was higher in MRSA than in MSSA (25.92%, 11.11% and 13.69%, 5.47% respectively).
Conclusion: D test should be done as routine test in all Microbiology laboratory for detection of true resistance of clindamycin among staphylococcal isolates.
EnglishMRSA, Inducible clindamycin resistance, D testIntroduction
Staphylococcus aureus infections are a major cause of morbidity and mortality worldwide. The increasing prevalence of Methicillin resistant Staphylococcus aureus (MRSA) infections especially with the spread of resistant strain in the community (1,2) pose a challenge to physician in terms of the use of alternative antibiotic agents. Although clindamycin has been considered an acceptable option for patients with community acquired MRSA infections, reports on high rates of clindamycin resistant community-acquired MRSA strains are limiting its use(2).
Antimicrobial resistance in S. aureus has become an ever increasing problem among hospitalized patients, persons in long term care facilities and ambulatory outpatients. This has led to the renewed interest in the use of macrolide-licosamide streptogramin B (MLSB) to treat S. aureus infection with clindamycin being preferred agent due to its excellent pharmacokinetic properties (3). Clindamycin is frequently used to treat skin and bone infection because of its tolerability, cost, oral forms and excellent tissue penetration and the fact that it accumulates in abscesses and no renal dosing adjustment are needed(4). Good oral absorption makes it an important option in outpatient therapy as follow-up after intravenous therapy. Clindamycin is good alternative for the treatment of both methicillin resistant and susceptible staphylococcal infections (5).
However wide spread use of MLSB antibiotics has led to an increase in number of Staphylococcal strain acquiring resistance to MLSB antibiotics (6). The most common mechanism of such resistance is target site modification mediated by erm genes which can be expressed either constitutively (constitutive MLSB phenotype) or inducibly (inducible MLSBphenotype). Strains with inducible resistance to clindamycin are difficult to detect in routine laboratory as they appear erythromycin resistance and clindamycin sensitive in vitro when not placed adjacent to each other. In such cases, in vivo therapy with clindamycin may select constitutive erm mutants leading to clinical therapeutic failure.
In vitro, staphylococcus aureus isolates with constitutive resistance are resistant to both erythromycin and clindamycin whereas those with inducible resistance are resistant to erythromycin but appears to be sensitive to clindamycin (iMLSB). These isolates, when used along with clindamycin, erm mutants for constitutive resistance emerge, which leads to failure in treatment(7). This resistance goes undetected by Kirby Bauer method however, it is detected by simple D test. The result is observed as a flattening zone in the area between erythromycin and clindamycin disc, in a shape of 'D' which indicates inducible clindamycin resistance.
Thus the present study was carried out to find the prevalence of inducible clindamycin resistance of S. aureus by very simple method of detecting inducible clindamycin resistance in hospitalized patients by performing D test.
Material and methods
This study was a prospective study over a period of six months from July 2014 to December 2014 in the department of Microbiology attached to the tertiary care hospital in central India. After obtaining ethical clearance a total of 300 isolate of staphylococcus from various clinical specimen like pus, wound swabs, sputum, throat swabs, suction tips, aspirates, blood and urine were tested. Isolates were identified upto species level by conventional methods such as Gram stain, growth on mannitol salt agar, slide and tube coagulase test, DNAse test and by biochemical tests (8).
The isolates were subjected to susceptibility testing by Kirby bauer disc diffusion method on Mullier Hinton agar plate using erythromycin (15ug), clindamycin (2ug), linozolide (30ug), rifampicin (5ug), cotrimaxazole (30ug), ciprofloxacin (5ug), gentamycin (30ug), tetracycline (30ug), penicillin (10ug), nitrofurantoin (10ug) and norfloxacin (300ug)(for urinary isolates only). The results were interpreted as per CLSI guidelines. Methicillin resistance was detected by cefoxitin disc diffusion method.
To detect inducible clindamycin resistant, 15 ug erythromycin and 2ug clindamycin discs were placed on Mullier Hinton plate that had been inoculated with staphylococcal isolates. The disc were placed at a distance of 15 -20 mm edge to edge from each other. Plates were incubated overnight at 37o C. A positive D test was taken as flattening of the zone of inhibition around clindamycin disc proximal to erythromycin disc (D shaped zone of inhibition) and was defined as inducible MLSB resistance (Figure 1). Strains that were resistant to both erythromycin and clindamycin were defined as exhibiting constitutive MSLB resistant and those that were resistant to erythromycin and sensitive to clindamycin were MS phenotype.
Results
In the present prospective study, a total of 300 isolates of Staphylococcus were studied. Among these 208 (69.33%) were found to be coagulase positive Staphylococcus aureus and 92 (30.66%) were coagulase negative staphylococcus. Of 208 staphylococcus aureus isolates, 135(64.9%) were methicillin resistance staphylococcus aureus (MRSA) while 73 (35.09%) were methicillin sensitive staphylococcus aureus (MSSA).
In the present study, inducible clindamycin resistance i.e. positive D test in MRSA was found to be in 35(25.92%) isolates and 10 (13.69%) isolate showed D test positive in MSSA. Strains showing resistance to both clindamycin and erythromycin i.e. exhibiting constitutive MSLB (cMLSB) resistance were found to be 15 (11.11%) in MRSA isolates and 4 (5.47%) in MSSA. Isolates showing resistance to erythromycin and sensitivity to clindamycin, termed as MS phenotypes was found to be 70 (51.85%) in MRSA and 42 (57.83%) in MSSA(Table 1) (Figure1).Thus in the present study, higher incidence of resistance was found to be in methicillin resistance staphylococcus aureus whereas higher incidence of sensitivity was found in methicillin sensitive staphylococcus aureus.
Discussion
There is a growing concern about the rapid rise in resistance of S. aureus to antimicrobial agents (9). In India, the importance of MRSA as a problem has been recognized relatively late (10). The prevalence of MRSA varies in different parts of India and is not uniform. This variation in prevalence may be because of several factors like study design, population and geographical distribution, differential clonal expression, drug pressure in community, health care facilities available in the hospital, implementation and monitoring of infection control committee, rationale antibiotic usage which varies from hospital to hospital. MRSA is a major cause of nosocomial infection worldwide. Serious endemic and epidemic MRSA infections occur globally as infected and colonised patients in the health care settings are the reservoirs.
Emergence of MRSA has left us with very little therapeutic options to treat staphylococcal infections. In the present study, a total of 300 staphylococcal isolate, the prevalence of S. aureus was found to be 208 (69.33%) isolates were coagulase positive and out of this 135(64.9%) were MRSA and 73(35.09%) were MSSA. Similar results were found by Borge et al (11) and Dar et al(12) having the prevalence rate of MRSA as 65% and 54.85% respectively.
The determination of antimicrobial susceptibility of a clinical isolate is often crucial for optimal antimicrobial therapy of infected patients. This is particularly important considering the increase of resistance and the emergence of multidrug resistant organisms. There are only few options available for treatment of MSSA and MRSA infections, with clindamycin being one of the good alternatives(5). However, clindamycin resistance can develop in staphylococcal isolates with inducible phenotype, and from such isolates, spontaneous constitutively resistant mutants have arisen both in vitro testing and in vivo during clindamycin therapy(13).
In the present study, of the total coagulase positive staphylococcal isolates inducible clindamycin resistance was found to be 45 (21.63%), of this 35 (25.92%) were from MRSA and 10(13.69%) from MSSA. The study report by Dardichandran Kaur(14), Gadepalliet(6), Pal et al(15) and Lt. Col. Mahima Lall(16) showed prevalence of inducible clindamycin resistance as 21.12%, 21%, 24.63% and 20.3% respectively. The study by Deotale et al(3)reported 27.6% iMLSB in MRSA, whereas Yilmaz et al(13) found inducible resistance of 24.4%in MRSA and 14.8% in MSSA; Gadepalli et al(6) showed it to be 30% in MRSA and 10% in MSSA, while Mohamed Rahabar et al(17) reported 22.6% in MRSA and 4% in MSSA. In another study Schreckenberger et al(18) and Levin et al(19) showed higher percentage of inducible resistance in MSSA as compared to MRSA, 7-12% in MRSA and 19-20% in MSSA; 12.5% MRSA and 68% MSSA respectively.
In our study, constitutive resistance was observed to be 19(9.1%) isolates, in which 15 (11.11%) from MRSA and 4 (5.47%) from MSSA. Other studies reporting constitutive MLSB differ in their prevalence as Sireesha et al(20) reported 10% and Deotale et al (3) reported 3.6%. Results near about similar to our study were observed in the studies by Gurdale Yilmaz et al(13) showed 14.8%; Ciraj et al (21)15.3% and Sireeshaet al (20) 18%.
Prabhu K et al (22) observed that percentage of inducible resistance and constitutive resistance were higher in MRSA as compared to MSSA which is in concordance with our present study.
Conclusion
The true sensitivity to clindamycin can only be judge after performing the D test on erythromycin resistant isolates. The use of D test in routine laboratory will help us in advising the clinicians regarding the use of clindamycin in superficial skin and soft tissue infections, as clindamycin should not be used for clindamycin induced resistant staphylococcus i.e. D test positive while it can be the drug of choice in case of D test negative isolates. Thus microbiological laboratories should report Saureus isolates exhibiting inducible MLSB as clindamycin resistant.
Acknowledgment: 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 / Support: Nil
Conflict of Interest: Nil
Table 1: Distribution of resistance pattern of S. aureus
iMLSB
cMLSB
MS phenotype
Erythromycin sensitive
MRSA (n=135)
35(25.92%)
15 (11.11%)
70 (51.85%)
15(11.11%)
MSSA(n= 73)
10 (13.69%)
4 (5.47%)
42 (57.83%)
17(23.28%)
Total (n=208)
45(21.63%)
19(9.1%)
112(53.84%)
32(15.38%)
(MRSA-methicillin resistant staphylococcus aureus; MSSA- methicillin sensitive staphylococcus aureus; iMLSB- inducible macrolide-licosamide streptogramin B; cMLSB - constitutive macrolide-licosamide streptogramin B)
Englishhttp://ijcrr.com/abstract.php?article_id=2332http://ijcrr.com/article_html.php?did=2332
Gorak EJ, Yamada SM, Brown JD. Community-acquired methicillin-resistant Staphylococcus aureus in hospitalized adults and children without known risk factors. Clin Infect Dis 1999; 29: 797-800.
Daum RS. Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus. N Engl J Med 2007; 357: 380-90.
Deotale V, Mendiratta DK, Raut U, Narang P (2010) Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. Indian J Med Microbiol 28:124-126
Kasten MJ (1999) Clindamycin, metronidazole, and chloramphenicol. Mayo Clin Proc 74:825-833
Fiebelkorn KR, Crawford SA, McElmeel ML, Jorgensen JH. Practical disc diffusion method for detection of inducible clindamycin resistance in Staphylococcus aureus and coagulase negative Staphylococci. J Clin Microbiol 2003;41:4740-4.
Gadepalli R, Dhawan B, Mohanty S, Kapil A, Das BK,Chaudhry R. Inducible clindamycin resistance in clinical isolates of Staphylococcus aureus. Indian J Med Res 2006;123:571-3.
Mukesh Patel, Ken B. Waites, Stephen A. Moser, Gretchen A. Cloud and Craig J. Hoesley, 2006. Prevalence of Inducible Clindamycin Resistance among Community- and Hospital- Associated Staphylococcus aureus isolates: J Clin Microbiol.44( 7), 2481-2484.
Kloos WE, Banerman TL. Staphylococcus and Micrococcus, Chapter 22. In: Manual of clinical microbiology. 7th ed. Murray PR, Baron EJ, Pfaller MA, Tenover FC, Yolken RH, editors. Washington DC: ASM Press; 1999. p. 264-82.
Mulla S, Patel M, Shah L, Vaghela G. Study of antibiotic sensitivity pattern of methicillin-resistant Staphylococcus aureus. Indian J Critical Care Medicine. 2007;11(2):99-101.
Rajaduraipandi K, Mani KR, Panneerselvam K, M, Bhaskar M, Manikandan P. Prevalence and antimicrobial susceptibility pattern of methicillin resistant Staphylococcus aureus: a multicentre study. Indian J Med Microbiol 2006;24:34-8.
Borg M, Scicluna E, De Kraker M, Van de Sande-Bruinsma N, Tiemersma E, Gur D et al (2006) Antibiotic resistance in the southeastern Mediterrenean-preliminary results from the AR medical project. European surveillance 11(7):639
Dar JA, Thoker MA, Khan JA, Ali A, Khan MA, Rizwan M et al (2006) Molecular epidemiology of clinical and carrier strains of methicillin resistant Staphylococcus aureus in the hospital settings of north India. Ann Clin Microbiol Antimicrobial 5(1):22
Yilmaz G, Aydin K, Iskender S, Caylan R, Koksal I. Detection and prevalence of inducible clindamycin resistance in staphylococci. J Med Microbiol 2007;56:342-5.
Dardi CK, Khare AS. Inducible clindamycin resistance in staphylococcus aureus in a tertiary care rural hospital. I Jou
Pal N, Sharma B, Sharma R, Vyas L. Detection of inducible clindamycin resistance among Staphylococcal isolates from different clinical specimens in western India. J Postgrad Med 2010;56:182-5.
Lt Col Mahima L, Brig Sahni AK. Prevalence of inducible clindamycin resistance in staphylococcus aureus isolated from clinical samples. Med J Armed forces India 2014;70:43
Rahabar M, Hajia M. Inducible clindamycin resistance in Staphylococcus aureus: A cross sectional report. Pak J Biol Sci 2007;10:189-92.
Schreckenberger PC, Ilendo E, Ristow KL. Incidence of constitutive and inducible clindamycin resistance in Staphylococcus aureus and coagulase-negative staphylococci in a community and a tertiary care hospital. J Clin Microbiol 2004;42:2777-9.
Levin TP, Suh B, Axelrod P, Truant AL, Fekete T. Potential clindamycin Resistance in clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus: Report of a clinical failure. Antimicrob Agents Chemother 2005;49:1222-4.
Sireesha P, Setty CR. Detection of various types of resistance patterns and their correlation with minimal inhibitory concentrations against clindamycin among methicillin-resistant Staphylococcus aureus isolates. Indian J Med Microbiol 2012;30:165-9.
Ciraj AM, Vinod P, Sreejith G, Rajani K. Inducible clindamycin resistance among clinical isolates of staphylococci. Indian J Pathol Microbiol 2009;52:49-5.
Prabhu K, Rao S, Rao V. Inducible clindamycin resistance in Staphylococcus aureus isolated from clinical samples. J Lab Physicians 2011;3:25-7.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcareMotivational and Satisfaction Level Among Medical Teachers in India: A Questionnaire Based Survey
English1825S. Zafar AbbasEnglish Shilpa KhullarEnglish Ankur SachdevaEnglishIntroduction: Job satisfaction is one of the most widely discussed issues in the organisational behaviour, personnel and human resource management. This study was conducted to determine the level of job satisfaction among medical teaching faculty of a teaching institution. An attempt was made to determine the factors that influence the job satisfaction of the faculty members.
Materials and Methods: 64 faculty members agreed to be a part of the study. It was conducted as an opinion survey based on a pre-structured questionnaire divided into two sections: section 1– socio-demographic features of the subjects and section 2 – divided into 6 sub sections with total 19 statements (S1to S19) exploring different factors. The mean score was calculated for each of the statements.
Results: 68.75% of the faculty were young (EnglishFaculty members, Teaching institution, Job satisfactionIntroduction
Job satisfaction is a complex and multifaceted concept which can mean different things to different people.1It is usually linked with motivation, but the nature of this relationship is not clear.It is considered more of an attitude, an internal state which could be associated with a personal feeling of achievement either qualitative or quantitative.2
The terms job satisfaction and motivation are often but wrongly used interchangeably in verbal (and often in written) communication, however there is a clear distinction between the two. Job satisfaction is a person's emotional response to his or her job conditions, whereas motivation is the driving force to pursue and satisfy needs. However, job satisfaction and motivation work together to increase job performance and healthcare organizations can do many things to increase job satisfaction, primarily by focusing on the motivating interests of existing and future staff.3
Job satisfaction is one of the most widely discussed issues of today in terms of organisational behaviour, personnel and human resource management as well as organisational management.4 Simply stated it is the extent to which one feels good about one's job.4
There are three important features of job satisfaction. First, organizations should be
guided by human values. Such organizations will be oriented towards treating workers fairly and with respect.In such cases the assessment of job satisfaction may serve as a good indicator of employee effectiveness.5High levels of job satisfaction may be a sign of good emotional and mental state of employees. Second, the behaviour of workers depending on their level of job satisfaction will affect the functioning and activities of the organization's business. From this it can be concluded that job satisfaction will result in positive behaviour and vice versa, dissatisfaction from the work will result in negative behaviour of employees.5Third, job satisfaction may serve as an indicator of organizational activities.6
In the health care field, attaining health objectives in a population depends to a large extent on the provision of effective, efficient, accessible, viable and high-quality services. The health workforce, present in sufficient numbers and appropriately allocated across different occupations and geographical regions is arguably the most important input in a unique production process that has a strong impact on overall health system performance.7The lack of explicit policies for human resource management has produced, in most countries, imbalances that threaten the capacity of health care systems to attain their objectives.8
The workforce in the health sector has specific features that cannot be ignored and motivation can play an integral role in many of the compelling challenges facing health care today.9In this area, the task of motivation is exacerbated by:
1. The nature of the economic relationship between those using the system and the system itself (physicians, patients and hospitals).
2. The heterogeneity of the workforce to be managed.
In a teaching hospital, where doctors are playing dual role of teaching and patient care, this may have wider ramifications. The discontent of faculties may get translated into their academic output and may influence the morale and attitudes of medical students to the profession. At the same time, poor job satisfaction of these physicians will adversely affect patient care.10
The medical faculty is critical to the infrastructure of any teaching institution. Attention to job satisfaction of medical faculty has gained national attention in part due to the current economic climate in which recruitment of faculty to replace those who leave is costly. Recent national survey data from the American Association of Medical Colleges (AAMC) reported a staggering 38-40% attrition rate of academic medical faculty over a ten-year period. Since faculty retention and job satisfaction are intimately linked, understanding what drives and satisfies academic medical faculty is invaluable for providing continuous and quality patient care, teaching the next generation of physicians, and minimizing the high cost of recruiting new faculty.11
Based on the proposed report of MCI undergraduate education working group 2010, the most significant challenge for regulatory bodies has been to balance the need for more medical colleges with the maintenance of quality standards .12
In this regard, the job satisfaction of medical teachers is perhaps not getting its due attention. It is a very important but very less studied issue. More work needs to be done to link the perception of individual faculty with the organizational context in which they work and with the wider political, economic, and social context of medical education reforms. This study was undertaken to construct the 'job satisfaction profile' of teaching faculty of a multispecialty teaching institution in India to evaluate their level of satisfaction and to describe variables related to their job satisfaction.
The aims and objectives of the study were:
To ascertain the level of job satisfaction among faculty members of a tertiary care teaching institution of India.
To determine the factors that influence 'job satisfaction' of faculty members.
To determine factors leading to dissatisfaction among faculty members.
Materials and Methods
This study was conducted at a medical teaching institution amongst its faculty members over a period of two months.
Study population
The study comprised of all the 64 faculty members of this college. The purpose of the study was explained to all the participants and written informed consent was taken from them before beginning of the project (copy of consent form enclosed). They subjects were informed that their participation is voluntary and they could withdraw from the study anytime they wished to do so.
Institutional Ethics Committee (IEC) approval was taken prior to the start of the study. The convenient sampling technique was used.
Data collection tool -questionnaire design
The study was conducted as an opinion survey among the faculty members based on a pre-structured questionnaire which was divided into two sections.
The questionnaire was designed to be simple, comprehensive and easily understandable by the faculty members.
The details of the questionnaire used were as follows:
Section 1 -socio-demographic features: age, sex, job title, duration of service with this organisation and type of employment.
Section 2 -factors influencing job satisfaction: this section had six sets of questions exploring the various factors influencing an employees’ satisfaction and his motivation level. There were total 19 statements numbered as S1 to S19
Factor 1 -professional practice environment (S1-S6)
Factor 2 -organisational factors of social support (S7-S8)
Factor 3- job competency (S9-S10)
Factor 4 -welfare measures offered by the organisation (S11-S14)
Factor 5 –job reward (S15-S17)
Factor 6 -motivation and work experience (S18-S19)
In addition, each faculty member was asked to give minimum two suggestions for improvement in their job satisfaction and motivation.
Data collection method
Initially the questionnaire was mailed at the official e-mail addresses of all the faculty members. They were informed verbally as well as through text messages that they had been mailed a questionnaire for this study. They were expected to download the questionnaire, give their responses and mail it back within a week's time, which would aid in maintaining the confidentiality and anonymity of the responses given by the subjects. However, after several reminders only 22 faculty members responded via mail which could be due to lack of internet facility in the college. A printout of the questionnaire was eventually given to the remaining faculty members who did not respond via E- mail.
Technique used
In terms of scaling, a five-point Likert scale was used (5- highly satisfied, 4-satisfied, 3- neither satisfied nor dissatisfied, 2- dissatisfied and 1- highly dissatisfied).
An excel sheet was prepared to enter the data collected from the subjects. The mean score was calculated for each of the 19 statements along with the average mean score for all the statements combined. Based on the responses and suggestions given by the faculty members major satisfiers and dissatisfiers were identified.
Results
The study was conducted on 64 faculty members of a medical teaching institution of different designations (Professor, Associate professor and Assistant professor). The socio-demographic features of the study population can be seen in Table 1. Most of the subjects comprised of females (56.25%) and Assistant Professors (53.12%). Around 50% of the subjects had been working in the organisation for 2-3 years and 2/3rd had been recruited on a regular basis.
Table 1: Socio-demographic characteristics of the respondents
Variable
No. of subjects
N=64
%
Age
(years)
20-30
2
3
30-35
30
46.8
36-40
12
18.75
41-50
16
25
>50
4
6.3
Sex
Male
28
43.75
Female
36
56.25
Job title
Professor/Head
8
1.25
Associate professor
22
34.37
Assistant professor
34
53.12
Duration of service
(years)
Englishhttp://ijcrr.com/abstract.php?article_id=2333http://ijcrr.com/article_html.php?did=23331.Usop AM, Kadtong ML, Amir D, Usop SO. The significant relationship between work performance and job satisfaction in Philippines. International Journal of Human Resource Management and Research 2013;3(2):9-16.
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16. Rainey HG, Steinbauer P. Galloping elephants: developing elements of a theory of effective governance organisations. Journal of Public Administration Research and Theory1999;9(1):1-32.
17. Mahmoud Al-Hussami RN. A study of nurses' job satisfaction: the relationship to organisational commitment, perceived organisational support, transactional leadership, transformational leadership and level of education. European Journal of Scientific Research2008;22(2) :286-295.
18. Buciuniene I, Blazeviciene A, Bliudziute E. Health care reforms and job satisfaction of primary health care physicians in Lithuania. BMC Family Practice2005; 6:10
19. Wright BE, Davis BS. Job satisfaction in the public sector: the role of the work environment. American Review of Public Administration2003; 33(1):70-90.
20. Allen NJ, Meyer JP. The measurement and antecedents of affective, continuance and normative commitment to the organisation. Journal of Occupational and Organisational Psychology 1990; 63:1-18.
21. Harrison DA, Newman DA, Roth PL. How important are job attitudes? meta- Analytic comparisons of integrative behavioural outcomes and time sequences. Academy of Management Journal2006;49(2):305-325.
22. Jain M, Mathur A, Joshi S, Goklani P, Kothari B, Prabhu D, et al. Job satisfaction assessment among dentists and dental auxiliaries in India. Internet Journal of Dental Sciences2009; 7(2).
23. Byrne M. The implications of Herzberg's "motivation-hygiene" theory for management in the Irish health sector. Health Care Manag2006; 25(1):4-11.
24. Shigli K, Hebbal M Nair KC. Teaching, research and job satisfaction of Prosthodontic faculty members in Indian Academic Dental Institutions. Journal of Dental Education 2012;76(6):783-791.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcareClinical Outcome and Complications of Therapeutic Nasolacrimal Duct Probing in Adult Cases of Chronic Dacryocystitis
English2628Garima AgrawalEnglishIntroduction: Chronic dacryocystitis is a common presentation in our outpatient department. We explored the possibility of an effective and minimally invasive procedure for the treatment of this disease. The underlying pathophysiology of chronic dacryocystitis is nasolacrimal duct obstruction. We designed a study to evaluate the clinical outcome and complications of nasolacrimal duct probing as a therapeutic procedure for the treatment of chronic dacryocystitis in adults. Nasolacrimal duct probing is effective in the treatment of congenital nasolacrimal duct obstruction. We report the results of nasolacrimal duct probing in adults.
Aim: Clinical outcome and complications of nasolacrimal duct probing in adult cases of chronic dacryocystitis seen at a regional Institute of Ophthalmology.
Methodology: 100 consecutive cases of chronic dacryocystitis fitting into the study criteria were enrolled. The patients were subjected to a thorough preoperative examination and subsequent nasolacrimal duct probing under standard conditions. The patients were subjected to a strict postoperative regime and were followed up for three months.
Result: Nasolacrimal duct probing was successful (both subjectively and objectively) in 98 out of 100 patients with chronic dacryocystitis.
Discussion: We report successful treatment of adult cases of chronic dacryocystitis by nasolacrimal duct probing.
Conclusion: We conclude that adults with chronic dacryocystitis can be managed successfully with nasolacrimal duct probing.
EnglishTherapeutic nasolacrimal duct probing, Chronic dacryocystitis in adults
Introduction
Chronic dacryocystitis and acquired nasolacrimal duct obstruction are a very common presentation in our Out Patient Department in the adult age group. The standard treatment of chronic dacryocystitis in ages above 18 years is a dacryocystorhinostomy either external or endoscopic 1. The procedure is a major operation with a post operative facial scar. The success rates are encouraging though recurrences are not uncommon. The repeat procedure is difficult with varying results. The pathophysiology of chronic dacryocystitis is an obstruction of the nasolacrimal duct. Probing of the nasolacrimal duct with a lacrimal probe restores patency of the nasolacrimal duct. This study was designed to observe the clinical outcome and complications of nasolacrimal duct probing in adult cases of chronic dacryocystitis.
Aim
Clinical outcome and complications of nasolacrimal duct probing in adult cases of chronic dacryocystitis seen at a regional Institute of Ophthalmology.
Methodology
The study was carried out at our Regional Institute of Ophthalmology from November 2016 to April 2017. All patients of chronic dacryocystitis above 18 years of age were enrolled. Patients with acute dacryocystitis and or abscess were excluded from the study. Patients with active infection as evidenced by purulent regurgitation on pressure over the lacrimal sac or syringing were started on topical antibiotics (moxifloxacin 0.5% four times a day after sac emptying). Once the regurgitant from the sac on pressure over the lacrimal sac or syringing was non-purulent, mucoid or watery then only the patient was included in the study. The diagnostic criteria for chronic dacryocystitis without active infection included a history of constant watering from the eye, regurgitation of nonpurulent, mucoid or watery fluid on pressure over the lacrimal sac, absence of tenderness, a hard stop on probing and a non-patent nasolacrimal duct on lacrimal syringing. The patients were subjected to a thorough clinical work up including blood pressure measurement. Blood and urine investigations including random blood sugar, bleeding time and clotting time were carried out. Uncontrolled diabetes and hypertension were controlled by medication before enrolment. A plain X ray of paranasal sinuses and a thorough nasal examination in collaboration with ENT consultant were done to rule out nasal causes of obstruction at the meatal opening of the nasolacrimal duct.
Written consent of the procedure was taken from all patients. The standard preoperative workup was done as for all surgeries. A course of oral Amoxycillin and Cloxacillin as per dose and topical moxifloxacin eye drops four times a day after sac emptying were prescribed for one week prior to the procedure. In the operation theatre painting and draping of the eye were done. The lacrimal sac was then emptied completely by pressing against the bony lacrimal fossa. After cleaning the lower punctum was dilated with a punctum dilator. A lacrimal probe was passed first vertically into the lower punctum, the lower lid was then pulled laterally and the probe was subsequently made horizontal. Once a hard stop was felt the probe was made vertical and directed into the nasolacrimal duct. The direction of the probe as documented is downwards , backwards and laterally. Gentle force is used to break any fibrous bands/ adhesions/ membranes at any point in the nasolacrimal duct including its lower end. The probe is allowed to remain in the nasolacrimal duct for one minute and then it is removed. The whole procedure is repeated three times from the lower puctum and once from the upper punctum.
Lacrimal syringing is done to confirm patency. The patient is asked to report feeling of water in nose or throat. Alternatively we also watched for deglutition at the time of lacrimal syringing. Nasal bleeding occurred in many patients at the time of the procedure or afterwards which was controlled by asking the patients to pinch their nose for two minutes post procedure.
The patients were followed on day one,one week, six weeks and three months. Postoperatively the patients were advised emptying of the lacrimal sac by pressing it against the bony lacrimal fossa. Thereafter the eye was to be cleaned with sterile wet cotton swab. One drop of moxifloxacin eye drop to be subsequently instilled in the lower conjunctival de sac. This post-operative regime was to be followed four times per day for six weeks religiously.
The clinical outcome was determined by symptomatic relief of watering, no regurgitation on pressure over the lacrimal sac, patent syringing 6 weeks post procedure.
Result
95 out of the 100 patients were observed to have a patent nasolacrimal duct six weeks post procedure. The five patients who did not have a patent nasolacrimal duct, three were observed to be noncompliant of the postoperative regime. Once compliance was ensured there was a return of patency in four weeks. Two patients had pseudomonas isolated from the conjunctival de sac which responded to the sensitive antibiotic after culture sensitivity with return of patency in subsequent four weeks. The only complication observed included nasal bleeding which could be effectively controlled by pinching the nose two minutes post procedure.
Discussion
We report successful treatment of adult chronic dacryocystitis due to nasolacrimal duct obstruction by nasolacrimal duct probing.
LiH, HeZ have reported an article on treatment for chronic dacryocystitis by probing through nasolacrimal duct under endoscopy. They report successful treatment of 28 out of 30 eyes with chronic dacryocystitis by nasolacrimal duct probing under endoscopic/rhinoscope control. Two eyes were successful after a second surgery.2
Tsai C et al reported good long term results (overall patency rate of 94%) for probing with adjunctive topical Mitomycin C for cases of adult epiphora caused by obstruction of the nasolacrimal duct followed by repeat procedure if necessary. 3
Perry J et al reported balloon dacryocystoplasty as a satisfactory primary treatment for adults with acquired nasolacrimal duct obstruction who exhibit no clinical signs of chronic infection. 4
Lee JS et al reported successful (93..2% success rates) of polyurethrane stenting without fluoroscopic guidance for primary management of nasolacrimal duct obstruction.5
Conclusion
We conclude that adults with chronic dacryocystitis can be managed successfully with nasolacrimal duct probing. This is a simple and atraumatic procedure. We recommend an initial trial of nasolacrimal duct probing in all cases of chronic dacryocystitis without active infection as evidenced by a nonpurulent regurgitant from the lacrimal sac. The current standard of treatment of chronic dacryocystitis is a dacryocystorhinostomy either external or endoscopic. Balloon dacryocystoplasty or stenting of the nasolacrimal duct are newer procedures for the treatment of acquired nasolacrimal duct obstruction in adults. Few studies have reported the efficacy of probing for the treatment of chronic dacryocystitis with nasolacrimal duct obstruction in adults. More long term and multicentre studies are needed to document the efficacy of nasolacrimal duct probing as a definitive procedure for the treatment of chronic dacryocystitis.
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.
Ethical Clearance: Taken
Informed Consent: Taken
Source of funding: None
Conflict of Interest: None
Englishhttp://ijcrr.com/abstract.php?article_id=2334http://ijcrr.com/article_html.php?did=23341. Hurwitz JJ. The lacrimal drainage system. In: Yanoff M, Duker JS, editors. Ophthalmology.4th Ed. China: Elsevier Saunders;2009. p 1346-1351.
2. LiH, HeZ. Treatment for chronic dacryocystitis by probing through a naso-lacrimal duct under endoscopy. Lin Chuang Er Bi Yan Hou Ki Za Zhi 1999;13(5):200-201.
3. Tsai C, Kau H, Kao S, Hsu W, Liu J et al.Efficacy of probing the nasolacrimal duct with adjunctive Mitomycin C for epiphora in adults. Ophthalmology. 2002 ; 109(1): 172-174.
4. Perry JD, Maus M, Nowinski TS, Penne RB. Balloon catheter dilation for treatment of adults with partial nasolacrimal duct obstruction: A preliminary report. Am J Ophthalmol 1998; 126(6) : 811-816.
5. Lee JS, Jung G, Oum BS, Lee SH, Roh HJ. Clinical efficacy of the polyurethane stent without fluoroscopic guidance in the treatment of nasolacrimal duct obstruction. Ophthalmology. 200; 107(9): 1666-1667.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcarePostpartum Weight Retention in Congolese Pregnant in Kinshasa
English2935Kahindo P. MuyayaloEnglish Njiri A. OliviaEnglish Mbungu M.R.EnglishObjectives: This study’s objectives were to determine proportion of Congolese women with post-partum weight retention and its average level; to identify its risk factors; to determine the proportion of obese women 6 weeks after delivery.
Materials and Methods: A prospective study was conducted from 1st October 2012 to 30th June 2013. We followed up a cohort of 199 women, with a singleton pregnancy, recruited during antenatal care (which began at least at 20 weeks of gestation) in 2 maternity hospitals of Kinshasa. These women were also examined in the labor room and 6weeks after delivery. Our variables of interest were pre-gestational BMI, gestational weight gain and postpartum lifestyle. All data was analyzed using the SPSS 18.0 software.
Results: The mean post-partum weight retention was 3.14 kg with a median of 3kg and extremes ranging from -5 to 17 kg; 75.4% of women were affected by this weight retention. High economic status (p = 0.04) and GWG (p = 0.000) are the main factors associated with weight retention 6 weeks after childbirth. The proportion of obese women increased by 8%.
Conclusion: Our study found that majority of women had weight retention 6 weeks after delivery. They retained an average of 3.14 kg. Care providers should monitor the nutritional status (BMI) of postpartum women through lifestyle counseling.
EnglishGestational weight gain, Post-partum weight retention, ObesityIntroduction
Pregnancy is a period characterized by significant changes in the maternal organism (1). In addition to the effects produced by hormones of placental origin, there is a tissue neoformation mainly on the uterus, breasts and the extracellular fluid (1, 2). These modifications, associated with development of fetus, result in a gestational weight gain (GWG). After delivery the physiological return to non-pregnant state, of organs that have undergone changes during pregnancy, usually occurs around the 6th week of postpartum (3, 4). However, many women retain their GWG several months after childbirth (5-7). The difference between that weight retained and pre-gestational weight defines postpartum weight-retention (PPWR) (8, 9). This PPWR exposes affected women to an increased risk of obesity (6), chronic cardiovascular diseases (10) as well as certain very frequent pathologies during pregnancy, such as pre-eclampsia and gestational diabetes (5-7).
Obesity is spreading at an alarming rate, not only in industrialized countries, but also in developing countries (11). World Health Organization (WHO) estimates that one in 10 (1/10) people are obese worldwide and, according to its predictions, more than half of the adult population in the world will become obese or overweight by 2030 (11). At that time, 80% of obese people will live in developing countries (12).
Democratic Republic of Congo (DRC) is not spared of this world "pandemic". According to the survey of risk factors for non-communicable diseases in Kinshasa (DRC), the prevalence of obesity was 5.7% (2.6% for men and 7.7% for women) (13).
Women are the most affected by obesity worldwide (14) and a lot of studies (5-7) have highlighted pregnancy as a trigger for obesity.
So, to prevent obesity in women involves not only identification of people at risk and risk periods, but also detection and suppression of risk factors including PPWR.
This study's objectives will be to determine the frequency and the average of weight retention 6 weeks after delivery; to identify risk factors and behaviors associated with PPWR and determine the proportion of obese women 6 weeks after delivery in the study population.
Material and Methods
A cohort of 199 pregnant women with a single pregnancy, who started their prenatal care at least the 20th week of gestation, were followed from 1st October 2012 to 30th June 2013 in 2 maternities of Kinshasa (University Hospital of Kinshasa and Saint Joseph Hospital). These pregnant women were recruited during prenatal care, re-examined at the labor room and also at the 6th week post partum's appointment.
Pre-gestational weight was the one taken before the 20th week of pregnancy in accordance with a previous study which demonstrated the absence of significant weight change until the 20th week (26).
Maternal information collected were age, economic status, marital status, education level, pre-gestational weight, height, pre-gestational body mass index (BMI), gestational weight gain (GWG), parity, weight at term (at the end of pregnancy), mode of delivery. Maternal weight and type of breastfeeding was collected at the postpartum week six. The newborn information collected was birth weight.
The economic status was defined according to the ownership index of some household properties from which the mother was raised (tap water, electricity, personal toilet, radio set, television set, refrigerator and vehicle). This index distinguishes 4 categories, namely:
High level : tap water, electricity, internal toilet, and each of four consumption materials (radio, television, refrigerator and vehicle);
- Moderately high level : any source of drinking other than surface water; internal toilet or not; electricity or not; at least two consumption materials;
- Moderate level : any combination of water source, toilet, electricity, consumption materials which is bigger than those defined by low level but smaller than those defined moderately high level;
- Low level : surface water is used neither as drinking and undrinkable water, no toilet, no electricity, nor any consumption materials.
Parity was the number of pregnancies which was at least 28 weeks irrespective of the outcome. According to the number of these pregnancies, the primiparas was the one that had one pregnancy while the multiparous had at least two.
Signed consent was also obtained from each participant and the information published anonymously.
Statistical Methods
The data was analyzed using SPSS 18.0 software. Proportions and confidence intervals was calculated for all categorical variables and the mean with standard deviation, as well as the median and extremes for quantitative variables.
Comparison of proportions was calculated using Pearson's chi-square test and comparison of mean was calculated using Student t-test and analysis of variance (One-way ANOVA); α =0.05 level, with a 95 % confidence interval.
RESULT
Maternal and neonatal anthropometric parameters
GWG varied between -4 and 27 kg with a mean of 8.8 3.9 kg; majority of pregnant women (58.8%) had a lower GWG than the IOM recommendations (Table I).
Frequency and average of weight retention at the 6th week postpartum
The proportion of women who retained weight 6 weeks after delivery was 75% (Fig. 1) with an average of 14 3.597 kg and a median of 3kg (extremes from -5 to 17 kg) (Table I).
Factors and behaviors associated with weight retention at the 6th week postpartum
Sociodemographic characteristics
Only the economic status is significantly associated with weight retention 6 weeks after childbirth. Women with high economic status have a greater weight retention than those with lower status with a statistically significant difference between the high economic level and the middle one (α= 0.000) (Table II).
Obstetric Parameters
Six weeks after delivery, multiparous women had a higher weight retention than primiparas; Similarly, women who gave birth by caesarean section retained more weight than women who gave birth by vaginal mode; but the difference between these groups was not statistically significant (P value 0.67 for parity and 0.83 for delivery mode) (Table III).
Anthropometric parameters
We noted a statistically significant association (p = 0.000) between PPWR 6 weeks after delivery and GWG (Table IV).
Postpartum behaviors (lifestyle)
None of these factors were significantly associated with weight retention 6 weeks after delivery (Table V).
Evolution in BMI categories from pre-gestational period to the 6th week postpartum
The proportion of obese women (BMI ? 30 kg / m 2) increased by 8%; from 21 (10, 6%) before pregnancy to 37 (18.6%) 6weeks after childbirth with a statistically significant difference (p = 0.03) (Table VI).
Discussion
In this study, 75% of women had weight retention 6 weeks after delivery. This observation is close to those reported by Schauberger et al. (78%) (17) and Olsen et al. (72%) (18) in USA.
Six weeks seems to be a short period to allow the restoration of pre-gestational weight after childbirth not only in the Congolese women but also in USA (1, 18) and in Asia (19). This high frequency of PPWR at the 6th week postpartum can be explained by the weight loss model in the early postpartum period (20) which suggests that a woman with normal pre-gestational weight and optimal GWG (13.75 kg) can maintain about 4.75 kg during the first 2 weeks of postpartum after expulsion of the fetus (5 kg), loss of the first fluid and regression of non-fat tissue volume such as uterus (4kg) (17, 21, 22). The remaining weight is largely fat deposition (23). According to Lawrence et al. (21) loss of fat deposits in the first weeks of postpartum occurs at a rate of 0.25 kg per week. Therefore, it will take about 19 weeks to lose the 4.75 kg retained after delivery.
The mean of weight retention at the 6th week postpartum in our study population was 3.14 kg. In a meta-analysis conducted in Western countries (Europe and America) from 1986 to 2004, the mean of weight retention in the 6th postpartum week varied between 3-7 kg (24). A similar study conducted in Asia from 1990 to 2010 reported a mean of PPWR at the 6th week between 2.5 and 8.6 Kg (25). PPWR at week 6 among Congolese women is in the same range with those countries, in which obesity is currently a public health problem (23, 24% of women are obese in Western countries and 29% in Asia) (14). Congolese care providers should take preventive measures against PPWR and, in that way, be able to control in part the emerging problem of obesity (26).
In our study, gestational weight gain and economic status were significantly associated with the PPWR. Regarding GWG, it is the most important predictor of postpartum weight retention in the literature (24, 25).
The economic status is significantly associated to PPWR at the 6th week of post-partum (p Englishhttp://ijcrr.com/abstract.php?article_id=2335http://ijcrr.com/article_html.php?did=23351. Lederman SA, Paxton A, Heymsfield SB, Wang. J, Thoronton J, Pierson RN. Maternal body fat and water during pregnancy: do they raise infant birth weight? Am J Obstet Gynecol, 1999 ; 180 : 235-240.
2. Trebatica L, Ketola T, Klemme I, Eccard JA, Ylonen H. Is reproduction really costly? Ecoscience 2007; 14 (3): 306-3013.
3. Cunningham FG., Gant NF., Leveno K.J, Gilstrap LC, Hauth, JC, Wenstrom, CD. William's obstetrics. 21st ed. New York: McGraw-Hill; 2001. p. 465-78.
4. Walker L O, Sterling BS, Timmerman GM. Retention of pregnancy-related weight in the early postpartum period: implications for women's health services. J Obstet Gynecol Neonatal Nurs 2005; 34: 418-27.
5. Keppel KG, Taffel SM. Pregnancy-related weight gain and retention: implications of the 1990 Institute of Medicine guidelines. Am J Public Health 1993; 83: 1100-1103.
6. Ohlin A, Rossner S. Maternal body weight development after pregnancy. Int J Obes Relat Metab Disord 1990; 14: 159-173.
7. Smith D, Lewis C, Cavery J, Perkins L, Burke G, Bid D. Longitudinal changes in adiposiy associated with pregnancy. The CARDIA Study (Coronary Artery Risk Development in Young Adults Study) JAMA 1994; 271:1747-51.
8. Postpartum behaviour as predictor of weight change from before pregnancy to one year postpartum. BioMed Central Public Health 2011, 11:165 http://www.biomedcentral.com/1471-2458/11/165, accessed march13 at 10 P.M, 2013.
9. Monvit T, Tripop L. Postpartum Weight Retention in Thai Singleton Pregnant Women with Normal Pre-Pregnancy Body Mass Index. Thai Journal of Obstetrics and Gynaecology, 2008; 16: 221-226.
10. Obésité et surpoids, Aide-mémoire . www.who.int , accessed august 1th at 11 P.M, 2013.
11. Kelly T, Yang W, Chen CS, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond) 2008; 32: 1431-1437
12. L'obésité, une nouvelle épidémie mondiale. http://www.tv5.org , accessed august 23 at 8 P.M., 2012.
13. Longo M, Beya E, Ekwanzala, M'buyamba K, Bieleli I et coll. : Enquête sur les facteurs de risque des maladies non transmissibles à Kinshasa, selon l'approche STEPS de l'OMS, Rapport d'Analyse. RDC, Ministère de la Santé, Direction de la lutte contre la maladie, Kinshasa, Novembre 2006.
14. Organisation mondiale de la Santé, Statistiques sanitaires mondiales 2012. www.who.int, accessed july 22th, 2102.
16. Mbungu M R, Tandu-Umba N F B, Muls E. Évolution de la composition corporelle et du métabolisme basal au cours de la grossesse chez la noire congolaise de Kinshasa, République démocratique du Congo (RDC). Journal de Gynécologie Obstétrique et Biologie de la Reproduction 2007 ; 36 : 699-704.
17. Schauberger CW, Rooney BL, Brimer LM. Factors that influence weight loss in the puerperium. Obstet Gynecol 1992; 79: 424- 429.
18. Olsen LC, Mundt M. H. (1986). Postpartum weight loss in a nurse-midwifery practice. Journal of Nurse-Midwifery, 31(4), 177-181.
19. Cheng H-R., Walker L. O., Tseng Y-F. and Lin P-C. Post-partum weight retention in women in Asia: a systematic review. obesity reviews 2011; 12: 770-780.
20. Walker L O, Timmerman G M, Sterling B S, Kim M, Dickson P. (2004). Do low income women attain their prepregnant weight by the 6th week of postpartum? Ethnicity and Disease, 2004; 14: 119-126.
21. Hytten, F. E. (1991). Weight gain in pregnancy. In F. Hytten and G. Chamberlain (Eds.), Clinical Physiology in Obstetrics (2nd ed.) (pp. 173-203). Oxford, England: Blackwell Scientific.
22. Lawrence M, McKillop FM, Durnin JGVA, et al. Women who gain more fat during pregnancy may not have bigger babies: implications for recommended weight gain during pregnancy. Br J Obstet Gynecol 1991; 98:254-9.
23. Sohlstrom A, Forsum E. Changes in adipose tissue volume and distribution during reproduction in Swedish women as assessed by magnetic resonance imaging. Am J Clin Nutr 1995, 61:287-95.
24. Walker L O, Sterling BS, Timmerman GM. Retention of pregnancy-related weight in the early postpartum period: implications for women's health services. J Obstet Gynecol Neonatal Nurs 2005; 34:418-27.
25. Cheng H-R., Walker L. O., Tseng Y-F. and Lin P-C. Post-partum weight retention in women in Asia: a systematic review. obesity reviews 2011; 12:770-780.
26. L'obésité croissante en Afrique est mauvaise pour la Production du travailleur, Octobre 2010 http://www.ipsnews.net/africa/ , accessed september 10, 2012.
27. Quesnel-V. A., Renahy E.,Pregnancy: A risk factor for social inequalities in overweight and obesity? Page web paa2011.princeton.edu/papers/111496?, accessd august 13,2013.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-5241918EnglishN-0001November30HealthcarePharmacobiological Treatments in Autism Spectrum Disorders
English3639Anusha JayaramanEnglish Nandini MundkurEnglishAutism spectrum disorders (ASD) refer to a group of neuro-developmental disorders affecting young children and adults. Currently, the treatment options for ASD are mostly restricted to treating its symptoms. Among the various approaches for treating ASD, pharmacobiology-based treatments are numerous. Our objective is to review the up-to-date information on different types of medications and briefly discuss the evidence-based potential of these treatments in ASD therapy. PubMed searches for reports and reviews on clinical data from the last 15 years, between 2002-2017, using search terms of each category of treatment along with the terms “autism”, “mechanism”, and/or “side effects” were conducted. Several pharmacobiological interventions have been prescribed for ASD, including antipsychotics, stimulants, antidepressants, supplements, and special diets. However, none of these methods is an effective ASD treatment, and only few show much promise. We provide a brief overview of the current pharmacobiological treatments for ASD, their mechanisms of action, and clinical research-based evidence on their effectiveness. Based on our review, we recommend that caution should be exercised when choosing a pharmacobiological treatment method for ASD as majority of existing evidence is not from large-scale long-term high quality studies.Future research should focus on rigorous investigative design, long-term implementation, and meaningful uniform outcome measurements.
EnglishAntidepressants, Antipsychotics, Special diet, VitaminsIntroduction
Autism spectrum disorders (ASD) in young children and adults are characterized by impaired socialization, communication, emotion processing, and stereotyped/repetitive behaviors, along with sensory processing dysfunction, speech and language impediments, seizures, gastrointestinal issues, irritability, aggression, hyperactivity, and sleep disorders [1, 2]. According to recent statistics by Centers of Disease Control and Prevention (CDC), 1 in every 68 children in the US is affected by ASD [3]. This could be due to true increase in prevalence or increased awareness and diagnosis. ASD also shows higher prevalence in boys[3], familial patterns and sibling learning issues [4, 5], and high monozygotic twin concordance [6]. Numerous underlying causes for ASD have been indicated such as genetic mutations, neurotoxicity and inflammation, impaired immune response, dysbiosis, nutrient imbalance, and oxidative stress [2].
Several treatment strategies have been undertaken in patients with ASD including behavioral and physiological interventions. Here, we review some of the physiology- and pharmacology-based interventions for ASD along with recent-advances in ASD treatment and their effectiveness in treating ASD. These include selective serotonin receptor-uptake inhibitors (SSRIs), antidepressants, antipsychotic drugs, stimulants, dietary supplements, and special diets[7, 8]. Very limited data are currently available regarding the long-term effectiveness and side-effects of these treatments for ASD. So far, no medication has shown a consistent positive effect on patients with ASD.
Apart from the above mentioned treatments, therapeutic approaches such as stem cell therapy, hyperbaric oxygen therapy, transcranial magnetic stimulation, and early intervention therapies involving speech and language therapy, music therapy, and sensory therapy are also undertaken for patients with ASD[9, 10].Among all the different approaches for ASD treatment, the early intervention method has been shown to be most effective till date [11, 12]. However, a review of these targeted approaches are beyond the objective of this review.
Selective serotonin-uptake inhibitors (SSRIs) and Tricyclic antidepressants
Serotonin (5-hydroxytryptamine) is a neurotransmitter derived from tryptophan, and mainly sourced from the raphe nuclei in the brain. The serotonergic system plays an important role in attention, arousal, and feeding [13]. Studies have shown that children with autism have elevated levels of blood serotonin [14].
SSRIs used in the treatment of ASD in various randomized controlled trials (RCTs) include fluoxetine, fluvoxamine, fenfluramine, and citalopram. SSRIs block the re-uptake of serotonin at the synapse, thus increasing the availability of serotonin and the activation of serotonin receptors [15]. In children and adults, SSRIs have shown limited positive outcome, although all the studies have been with small sample sizes, with potential risk of bias [16, 17]. In addition, SSRIs such as olanzapine, and fluvoxamine, have been shown to have undesirable side effects including irritability and weight gain [16, 18]. A large multi-center, double-blinded, randomized controlled trial has been recently started known as Fluoxetine for Autistic Behaviors (FAB trial) to determine the efficacy of low-dose fluoxetine for treating ASD symptoms in children and adolescents [19].
On the other hand, prenatal exposure to SSRIs have been linked to ASD risk in epidemiological studies [20, 21]. However, two very recent studies have concluded that there is no significant relationship between prenatal exposure to SSRIs and ASD risk and suggest that the previously observed association may be due to other factors [22, 23].
Tricyclic antidepressants (TCAs) have the same effect as SSRIs in increasing the serotonin levels [24]. A short-term treatment of tianeptine showed a modest effect on irritability in 12 children with ASD [25]. Low-dose amitriptyline has also shown promise in youth with ASD for hyperactivity and impulsivity [26]. However, no large randomized clinical trials have been conducted till date with TCAs for treatment of ASD.
Antipsychotics
Old antipsychotics or neuroleptics are D2 dopamine receptor antagonists, although they are also effective against acetylcholine receptors, serotonin receptors, and adrenergic receptors. The old antipsychotics are less preferable due to their tight, long-lasting binding with the receptors. On the other hand, the second generation or atypical antipsychotics such as risperidone and aripiprazole, dissociate more rapidly from the receptors due to hit-and-run binding properties. Risperidone and aripiprazole have shown positive effects in several different clinical trials especially for ASD-related irritability[27, 28]. However, the major drawback of atypical antipsychotics are side effects such as weight gain, metabolic changes, sleep disturbances, higher risk of sedation and tremor, drooling, increased appetite, fatigue, dizziness, and withdrawal dyskinesias [29, 30]. Another atypical antipsychotic drug, clozapine, has been shown to be effective against hyperactivity and aggression in children with ASD [31].Therefore, based on limited evidence with small sample sizes and short follow-ups, atypical antipsychotics may be more effective as short-term interventions for certain behavioral symptoms in patients with ASD.
Stimulants and Non-stimulants
Stimulants such as methylphenidate are shown to improve the hyperactivity-impulsive symptoms in children with ASD that are regulated by multiple monoaminergic gene variants and has been shown to be well-tolerated and efficacious in several studies [32, 33]. However, some studies have shown severe adverse effects with methylphenidate including social withdrawal, irritability, insomnia, and anorexia in children with ASD [34].
Among non-stimulants, atomoxetine has been commonly used for treating the hyperactivity-attention deficit symptoms of ASD. In a recent double-blind placebo-controlled trial in children with ASD, the atomoxetine group showed an improvement in hyperactivity symptoms, with side effects of only fatigue and reduced appetite [35].
Supplements
Based on the Pauling theory that suggests that deficiencies of vitamins and minerals may lead to mental disorders, many doctors have recommended the use of supplements in children with ASD, including omega-3-fatty acids, various vitamins, magnesium, iron, zinc and copper. An insufficiency in omega-3-fatty acids has been linked to abnormal development of the nervous system and to various psychiatric disorders [36]. In ASD studies, although omega-3-fatty acid supplementation had no significant beneficial effects in adult patients [37], another study on children have shown significant improvements in social and communication responses[38]. Among vitamins, vitamin B6 and magnesium [39], and vitamin D [40], have shown beneficial effects in few studies, while others such as vitamin A, and vitamin B12 and folic acid have been proposed as potential treatment options for ASD. Minerals such as magnesium [39], iron[41], and zinc [42], have also been recommended for nutritional therapies in ASD. However, large-scale high-quality randomized-controlled studies are required to conclusively determine if nutritional supplements are an effective therapeutic approach for ASD.
Special diets
Although special diets such as gluten-free casein-free (GFCF) diet have been reported to have beneficial outcomes in children with ASD, most of these reports are anecdotal and do not have sufficient clinical evidence. The hypothesis behind the proposal of GFCF diet for ASD treatment is that the overload of high peptides such as gluten and casein may produce an opioid-like effect that could manifest as common behavioral symptoms of ASD. In addition, inflammation of the gastro-intestinal tract as well as unbalanced gut microbial, both of which are implicated in ASD, could get aggravated with casein and gluten, causing discomfort and pain in children with ASD leading to behavioral issues. However, intervention studies with GFCF diet show mixed results. Two of the most recent reviews on this topic suggest that there is very little evidence to suggest any beneficial outcome with GFCF diet on ASD symptoms [43, 44]. GFCF diet may be beneficial for ASD individuals with specific gut-related issues, or as a short-term relief.
The ketogenic diet, which is usually used for treating children with refractive epilepsy, is a high-fat, low-protein, low-carbohydrate diet. One study that investigated the effect of ketogenic diet on 30 children with ASD showed significant improvements in social and communication functions [45].
A low-oxalate diet has been recommended for children with ASD (40-50 mg per day) based on one study in patients with ASD showing higher plasma oxalate and urine oxalate levels [46].
Conclusion
Apart from the various treatments reviewed here, other approaches such as acupuncture, music therapy, various early behavior interventions, and social skill groups have been implemented for treatment of ASD with varying results. The review of recent literature from the last 15 years shows no large-scale, high-quality studies for any ASD treatments that have investigated their long-term effectiveness and/or side effects. Moreover, the evidence is contradictory between studies for several treatments. For treatments that show promise, for example, atypical antipsychotic drugs, the side effects are significant. Hence, well-designed long-term RCTs with sufficient sample size are required to conclusively link the potential efficacy and/or the side effects of these treatments with ASD. Based on the existing quality of evidence, we recommend caution before choosing these modes of treatment for ASD. Currently, early intervention-based approaches that integrates both developmental and behavioral models seem to be the most effective treatment paradigm for ASD.
Acknowledgements
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are also grateful to authors / editors / publishers of all those articles, journals and books from where the literature for this article has been reviewed and discussed.
Funding Source
None
Conflict of Interest
The authors have no conflict of interest to declare
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